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Sample records for management insights study

  1. Asthma Insights and Management in India: Lessons Learnt from the Asia Pacific - Asthma Insights and Management (AP-AIM) Study.

    PubMed

    Salvi, Sundeep S; Apte, Komalkirti K; Dhar, Raja; Shetty, Pradeep; Faruqi, Rab A; Thompson, Philip J; Guleria, Randeep

    2015-09-01

    Despite a better understanding of the pathophysiology of asthma, presence of reliable diagnostic tools, availability of a wide array of effective and affordable inhaled drugs and simplified national and international asthma management guidelines, asthma remains poorly managed in India. The Asia-Pacific Asthma Insight and Management (AP-AIM) study was aimed at understanding the characteristics of asthma, current management, level of asthma control and its impact on quality of life across Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand. This paper describes the results of asthma management issues in India in detail and provides a unique insight into asthma in India. The AP-AIM India study was conducted in eight urban cities in India, viz: Ajmer, Delhi, Kolkata, Rourkela, Chennai, Mangalore, Mumbai and Rajkot from February to July 2011. Face-to-face interviews were conducted in adult asthmatics and parents of asthmatic children between the ages of 12 and 17 years with a confirmed diagnosis or a treatment history of 1 year for asthma. Four hundred asthmatics (M:F::1:1.273), with a mean age of 50 ± 17.8 years, from across India were studied. 91% of the asthmatics in India perceived their asthma to be under control, however, none of the asthmatics had controlled asthma by objective measures. Asthmatics in India believed that their asthma was under control if they have up to 2 emergency doctor visits a year. The quality of life of these patients was significantly affected with 93% school/work absenteeism and a loss of 50% productivity. Seventy-five percent of the asthmatics have never had a lung function test. The common triggers for asthmatics in India were dust (49%) and air pollution (49%), while only 5% reported of pollen as triggers. Eighty-nine percent of Indian asthmatics reported an average use of oral steroids 10.5 times a year. Only 36% and 50% of Indian asthmatics used controller and rescue inhalers with a majority

  2. Survey of asthma management in Thailand - the asthma insight and management study.

    PubMed

    Boonsawat, Watchara; Thompson, Philip J; Zaeoui, Uraiwan; Samosorn, Chanee; Acar, Gurbet; Faruqi, Rab; Poonnoi, Piriya

    2015-03-01

    Previous Thai surveys of asthma care have shown suboptimal management and poor control. Since then several editions of the Thailand National Asthma Guidelines have been distributed to help improve asthma control. A new survey was undertaken to see if any improvement in care had occurred. It examined patients' insights, attitudes and perceptions about their asthma and its treatment. Asthma patients (>12 years) were randomly selected and participated in face-to-face interviews. Patients answered 53 questions exploring general health, diagnosis, symptoms, exacerbations, patient burden, disease management, treatment and attitudes. The Global Initiative for Asthma guidelines were used to assess asthma control. Data were obtained from 400 asthma patients from 8,177 screened households. This showed that 36% had had exacerbations in the previous year, 17% had been hospitalized and 35% had had an unscheduled emergency visit to hospital or a doctor's office or clinic. Work or school was missed by 44% due to asthma while a similar number had had an asthma episode that made them feel their life was in danger. Only 8% had good asthma control. Patients had low expectations with respect to asthma treatment and their understanding of how to use therapies was poor. Forty-four percent of participants reported day-time symptoms and about one-third (34%) of adults and adolescents in the survey reported night-time symptoms at least once a week in the previous 4 weeks. Asthma patients in Thailand rated their average productivity when asthma was at its worst at 48%, on a scale of 0 to 100%, which equates to a 36% decline in productivity. Rescue medication during the previous four weeks had been used by 44% of asthma patients while 54% had used a controller medication. Pill controller medication is the most used form among those reporting controller medication use (67%), whereas 57% reported taking an inhaler. Oral steroids had been used in the previous 12 months by 40% of patients with

  3. An evaluation framework and a pilot study of a mobile platform for diabetes self-management: insights from pediatric users.

    PubMed

    Padman, Rema; Jaladi, Sravani; Kim, Sean; Kumar, Saumitra; Orbeta, Philip; Rudolph, Kate; Tran, Tony

    2013-01-01

    According to WHO, pediatric diabetes is a rising global public health problem, with increasing impact on developing nations. This study summarizes a multidimensional, scalable pilot evaluation of a diabetes self-management platform combining mobile technology with social networking to capture four key metrics of Type 1 diabetes self-management, associated social interactions, and gaming features providing targeted feedback to 8 pediatric users. Based on their 2-month interaction with the application, we analyze click-stream data from social interactions, key health metrics, text comments, and usability and satisfaction surveys to evaluate engagement with the platform and effectiveness in controlling blood glucose using a product-process-program framework. Our preliminary results indicate that this framework was successful in demonstrating the potential of the mobile health platform to effectively leverage the growing use of mobile applications and social media to present a unique benefit that engaged pediatric users and provided useful insights for self-health management.

  4. An evidence-based referral management system: insights from a pilot study.

    PubMed

    Wright, Ellen; Hagmayer, York; Grayson, Irene

    2015-07-01

    Improving the informational quality of referrals from primary to secondary care and appropriately re-directing referrals is an important goal of clinical commissioning groups in England. Based on the available empirical evidence, a referral management and booking service that combined referral guidelines, online referral templates and administrative and clinical triage, was developed by a primary care trust in southeast London. A pilot study of 13 out of 46 practices in the trust was conducted using a mixed methods approach. Referral numbers were investigated by analysing changes in practices' rates of first outpatient attendances in secondary care. Informational referral quality was assessed by analysing triage outcomes. Semi-structured interviews were used to inquire about practices' evaluation of the new system. Structured telephone interviews were conducted to assess patients' satisfaction. Overall rates of first outpatient attendances declined more strongly for pilot practices than controls. The number of referrals challenged for being incomplete or having insufficient clinical information decreased. The rate of referrals challenged by clinical triage for not conforming to referral guidelines was well below the rate of inappropriate referrals published in the literature. Interviews with practices revealed a number of themes and a broad range of attitudes. Patients were highly satisfied. Findings provided favourable evidence for the effectiveness of the new referral management system. They were, however, preliminary. If referrals into secondary care continued to be reduced on a long-term basis, the system would be cost effective despite the time and effort required for clinical triage.

  5. Recent advances in the management of autoimmune myocarditis: insights from animal studies.

    PubMed

    Tajiri, Kazuko; Yasutomi, Yasuhiro; Aonuma, Kazutaka

    2016-01-01

    A growing body of evidence has been accumulating to demonstrate that human myocarditis and dilated cardiomyopathy involve a complex interaction with autoimmunity triggered by cardiotropic microbial infections. Animal experiments have provided direct evidence that infections with a particular microbe can incite autoimmune myocarditis, and this autoimmune response can be mimicked by immunization with the cardiac autoantigen, α- myosin. Animal models greatly advanced our understanding of the molecular mechanisms of myocarditis, and various novel therapeutic strategies have been reported during the last two decades. In this review we present animal models of autoimmune myocarditis and describe the outlook of possible drug targets by showing the latest findings from animal studies.

  6. The participant's perspective: learning from an aggression management training course for nurses. Insights from a qualitative interview study.

    PubMed

    Heckemann, Birgit; Breimaier, Helga Elisabeth; Halfens, Ruud J G; Schols, Jos M G A; Hahn, Sabine

    2016-09-01

    Aggression management training for nurses is an important part of a comprehensive strategy to reduce patient and visitor aggression in healthcare. Although training is commonplace, few scientific studies examine its benefits. To explore and describe, from a nurse's perspective, the learning gained from attending aggression management training. This was a descriptive qualitative interview study. We conducted semi-structured individual interviews with seven nurses before (September/October 2012) and after they attended aggression management training (January/February 2013). Interview transcripts were content-analysed qualitatively. The study plan was reviewed by the responsible ethics committees. Participants gave written informed consent. Aggression management training did not change nurses' attitude. Coping emotionally with the management of patient and visitor aggression remained a challenge. Nurses' theoretical knowledge increased, but they did not necessarily acquire new strategies for managing patient/visitor aggression. Instead, the course refreshed or activated existing knowledge of prevention, intervention and de-escalation strategies. The training increased nurses' environmental and situational awareness for early signs of patient and visitor. They also acquired some strategies for emotional self-management. Nurses became more confident in dealing with (potentially) aggressive situations. While the training influenced nurses' individual clinical practice, learning was rarely shared within teams. Aggression management training increases skills, knowledge and confidence in dealing with patient or visitor aggression, but the emotional management remains a challenge. Future research should investigate how aggression management training courses can strengthen nurses' ability to emotionally cope with patient and visitor aggression. More knowledge is needed on how the theoretical and practical knowledge gained from the training may be disseminated more effectively

  7. Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions.

    PubMed

    Moosa, Shabir; Derese, Anselme; Peersman, Wim

    2017-01-21

    Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal. This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method. There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team. Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by

  8. Insights into water managers' perception and handling of uncertainties - a study of the role of uncertainty in practitioners' planning and decision-making

    NASA Astrophysics Data System (ADS)

    Höllermann, Britta; Evers, Mariele

    2017-04-01

    Planning and decision-making under uncertainty is common in water management due to climate variability, simplified models, societal developments, planning restrictions just to name a few. Dealing with uncertainty can be approached from two sites, hereby affecting the process and form of communication: Either improve the knowledge base by reducing uncertainties or apply risk-based approaches to acknowledge uncertainties throughout the management process. Current understanding is that science more strongly focusses on the former approach, while policy and practice are more actively applying a risk-based approach to handle incomplete and/or ambiguous information. The focus of this study is on how water managers perceive and handle uncertainties at the knowledge/decision interface in their daily planning and decision-making routines. How they evaluate the role of uncertainties for their decisions and how they integrate this information into the decision-making process. Expert interviews and questionnaires among practitioners and scientists provided an insight into their perspectives on uncertainty handling allowing a comparison of diverse strategies between science and practice as well as between different types of practitioners. Our results confirmed the practitioners' bottom up approach from potential measures upwards instead of impact assessment downwards common in science-based approaches. This science-practice gap may hinder effective uncertainty integration and acknowledgement in final decisions. Additionally, the implementation of an adaptive and flexible management approach acknowledging uncertainties is often stalled by rigid regulations favouring a predict-and-control attitude. However, the study showed that practitioners' level of uncertainty recognition varies with respect to his or her affiliation to type of employer and business unit, hence, affecting the degree of the science-practice-gap with respect to uncertainty recognition. The level of working

  9. Managing Organizational Commitment: Insights from Longitudinal Research

    ERIC Educational Resources Information Center

    Morrow, Paula C.

    2011-01-01

    This article summarizes what is known about the "active" management of affective organizational commitment (AOC) through a review of 58 studies employing longitudinal research designs. The review yields six broad categories of antecedents that have empirically demonstrated effects on AOC: socialization practices, organizational changes, human…

  10. Management of ErbB2-positive Breast Cancer: Insights from Preclinical and Clinical Studies with Lapatinib

    PubMed Central

    Vogel, Charles; Chan, Arlene; Gril, Brunilde; Kim, Sung-Bae; Kurebayashi, Junichi; Liu, Li; Lu, Yen-Shen; Moon, Hanlim

    2010-01-01

    The management of human epidermal growth factor receptor 2-positive (ErbB2+) breast cancer is challenging; patients with ErbB2+ breast tumors have more aggressive disease and a poor prognosis. The increasing incidence of breast cancer in Asia and the limitations of existing treatments pose additional challenges. In this review, we summarize the preclinical and clinical evidence that indicates how lapatinib, a novel inhibitor that targets the human epidermal growth factor receptor (ErbB1) and ErbB2 may help clinicians address four particularly challenging issues in the management of ErbB2+ breast cancer. These issues are: (i) trastuzumab therapy failure, (ii) development of central nervous system metastases, (iii) minimizing toxicity and (iv) selecting the most appropriate partners (chemotherapy and non-chemotherapy) for combination therapy with lapatinib. Lapatinib, in combination with chemotherapeutic agents, such as capecitabine, provides clinical benefits to patients with ErbB2+ breast cancer, including patients who develop progressive disease on trastuzumab. Lapatinib, in combination with non-chemotherapeutic agents, such as letrozole, may also provide a chemotherapy-free treatment option for postmenopausal patients with estrogen receptor-positive/ErbB2+ metastatic breast cancer. Encouraging results have also emerged regarding the synergistic effects of lapatinib in combination with other agents for the treatment of ErbB2+ breast cancer. Promising findings have also been reported for the use of lapatinib to prevent and treat central nervous system metastases. Collectively, these results indicate that the judicious use of lapatinib, an effective oral therapy with a manageable toxicity profile, can enhance the management of patients with ErbB2+ breast cancer. PMID:20542996

  11. Insights and participatory actions driven by a socio-hydrogeological approach for groundwater management: the Grombalia Basin case study (Tunisia)

    NASA Astrophysics Data System (ADS)

    Tringali, C.; Re, V.; Siciliano, G.; Chkir, N.; Tuci, C.; Zouari, K.

    2017-02-01

    Sustainable groundwater management strategies in water-scarce countries need to guide future decision-making processes pragmatically, by simultaneously considering local needs, environmental problems and economic development. The socio-hydrogeological approach named `Bir Al-Nas' has been tested in the Grombalia region (Cap Bon Peninsula, Tunisia), to evaluate the effectiveness of complementing hydrogeochemical and hydrogeological investigations with the social dimension of the issue at stake (which, in this case, is the identification of groundwater pollution sources). Within this approach, the social appraisal, performed through social network analysis and public engagement of water end-users, allowed hydrogeologists to get acquainted with the institutional dimension of local groundwater management, identifying issues, potential gaps (such as weak knowledge transfer among concerned stakeholders), and the key actors likely to support the implementation of the new science-based management practices resulting from the ongoing hydrogeological investigation. Results, hence, go beyond the specific relevance for the Grombaila basin, showing the effectiveness of the proposed approach and the importance of including social assessment in any given hydrogeological research aimed at supporting local development through groundwater protection measures.

  12. Insights and participatory actions driven by a socio-hydrogeological approach for groundwater management: the Grombalia Basin case study (Tunisia)

    NASA Astrophysics Data System (ADS)

    Tringali, C.; Re, V.; Siciliano, G.; Chkir, N.; Tuci, C.; Zouari, K.

    2017-08-01

    Sustainable groundwater management strategies in water-scarce countries need to guide future decision-making processes pragmatically, by simultaneously considering local needs, environmental problems and economic development. The socio-hydrogeological approach named `Bir Al-Nas' has been tested in the Grombalia region (Cap Bon Peninsula, Tunisia), to evaluate the effectiveness of complementing hydrogeochemical and hydrogeological investigations with the social dimension of the issue at stake (which, in this case, is the identification of groundwater pollution sources). Within this approach, the social appraisal, performed through social network analysis and public engagement of water end-users, allowed hydrogeologists to get acquainted with the institutional dimension of local groundwater management, identifying issues, potential gaps (such as weak knowledge transfer among concerned stakeholders), and the key actors likely to support the implementation of the new science-based management practices resulting from the ongoing hydrogeological investigation. Results, hence, go beyond the specific relevance for the Grombaila basin, showing the effectiveness of the proposed approach and the importance of including social assessment in any given hydrogeological research aimed at supporting local development through groundwater protection measures.

  13. Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study.

    PubMed

    Gupta, Milan; Szmitko, Paul; Singh, Narendra; Tsigoulis, Michelle; Kajil, Mahesh; Stone, James

    2015-05-01

    Although clinical practice guidelines for the management of hypertension exist in Canada, the rate of contemporary blood pressure (BP) control remains unclear. In the Primary Care Audit of Global Risk Management (PARADIGM) study, 3015 healthy, middle-aged Canadians, free of cardiovascular disease (CVD) or diabetes were evaluated. In this analysis, we characterized the CVD risk factors, treatment patterns, and BP control rates in subjects with uncomplicated hypertension. A total of 917 subjects (30.4%) had a diagnosis of hypertension. The median age was 59 ± 8 years. The mean treated systolic/diastolic BP were 134 ± 14 mm Hg/82 ± 9 mm Hg, respectively. CVD risk factors included past/current smoking (35.9%), abdominal obesity (62.5%), and dyslipidemia (59.4%). Using the Framingham Risk Score, 20.4%, 41.0%, and 38.5% of the subjects were at low, intermediate, and high risk, respectively. Of the 88% with treated hypertension, 46.9%, 38.7%, and 14.3% received 1, 2, or ≥3 drugs, respectively. The rate of BP control was 57.4% (systolic BP < 140 and diastolic BP < 90 mm Hg). The rate of BP control was lower in patients prescribed diuretic monotherapy (53.2%) vs those who received angiotensin converting enzyme inhibitor/angiotensin receptor blocker monotherapy (66.5%; P < 0.01). Importantly, BP control deteriorated with increasing Framingham Risk Score, and was lower in patients with metabolic syndrome vs those without (P < 0.00001 for both). PARADIGM demonstrated that CVD risk factors are prevalent in Canadians with uncomplicated hypertension. BP control was modest (57.4%) and was lowest in patients prescribed diuretic monotherapy and in those at highest CVD risk. Despite the success of national hypertension strategies, enhanced efforts are warranted to improve BP control in Canada. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Psychosomatic pain: new insights and management strategies.

    PubMed

    Rubin, Jay J

    2005-11-01

    At least 40 to 60 percent of women and at least 20 percent of men with chronic pain disorders report a history of being abused during childhood and/or adulthood. This incidence of abuse is two to four times higher than in the general population. Patients with more severe or frequent abuse, usually during childhood and worse if sexual in nature. often develop specific syndromes or combinations of syndromes. These syndromes include posttraumatic stress disorder, fibromyalgia, and other conditions characterized by repression, somatization, and increased utilization of medical care. Psychosomatic symptoms and dysfunctional behaviors may emerge as these patients seek attention and validation of their suffering, while paradoxically repressing painful memories of trauma. Behavioral observations and key features of the physical examination may greatly help the clinician identify both the presence and severity of psychosomatic disease. In addition, it is very interesting that various studies document physiologic changes in the brains of patients with a history of abuse and in patients with a diagnosis of fibromyalgia. These studies suggest that abuse may physiologically and developmentally increase a person's susceptibility to pain and that some organic changes may be associated with psychogenic disease. Diagnosis and treatment of even the most challenging patients with chronic pain is much more effective if it includes (a) careful inquiry about any history of past or present abuse or other severe trauma, (b) empathy and constructive validation of disease and suffering, (c) recognition of dysfunctional pain behaviors and personality traits, (d) documentation of nonanatomic as well as anatomic features on examination, (e) multidisciplinary treatments including psychotherapy whenever indicated, and (f) noninvasive procedures and alternatives to potentially habit-forming medications whenever possible and appropriate. Furthermore, it has been shown that helping patients gain

  15. Insight: An ontology-based integrated database and analysis platform for epilepsy self-management research.

    PubMed

    Sahoo, Satya S; Ramesh, Priya; Welter, Elisabeth; Bukach, Ashley; Valdez, Joshua; Tatsuoka, Curtis; Bamps, Yvan; Stoll, Shelley; Jobst, Barbara C; Sajatovic, Martha

    2016-10-01

    We present Insight as an integrated database and analysis platform for epilepsy self-management research as part of the national Managing Epilepsy Well Network. Insight is the only available informatics platform for accessing and analyzing integrated data from multiple epilepsy self-management research studies with several new data management features and user-friendly functionalities. The features of Insight include, (1) use of Common Data Elements defined by members of the research community and an epilepsy domain ontology for data integration and querying, (2) visualization tools to support real time exploration of data distribution across research studies, and (3) an interactive visual query interface for provenance-enabled research cohort identification. The Insight platform contains data from five completed epilepsy self-management research studies covering various categories of data, including depression, quality of life, seizure frequency, and socioeconomic information. The data represents over 400 participants with 7552 data points. The Insight data exploration and cohort identification query interface has been developed using Ruby on Rails Web technology and open source Web Ontology Language Application Programming Interface to support ontology-based reasoning. We have developed an efficient ontology management module that automatically updates the ontology mappings each time a new version of the Epilepsy and Seizure Ontology is released. The Insight platform features a Role-based Access Control module to authenticate and effectively manage user access to different research studies. User access to Insight is managed by the Managing Epilepsy Well Network database steering committee consisting of representatives of all current collaborating centers of the Managing Epilepsy Well Network. New research studies are being continuously added to the Insight database and the size as well as the unique coverage of the dataset allows investigators to conduct

  16. Clinical assessment and management of toddlers with suspected autism spectrum disorder: insights from studies of high-risk infants.

    PubMed

    Zwaigenbaum, Lonnie; Bryson, Susan; Lord, Catherine; Rogers, Sally; Carter, Alice; Carver, Leslie; Chawarska, Kasia; Constantino, John; Dawson, Geraldine; Dobkins, Karen; Fein, Deborah; Iverson, Jana; Klin, Ami; Landa, Rebecca; Messinger, Daniel; Ozonoff, Sally; Sigman, Marian; Stone, Wendy; Tager-Flusberg, Helen; Yirmiya, Nurit

    2009-05-01

    With increased public awareness of the early signs and recent American Academy of Pediatrics recommendations that all 18- and 24-month-olds be screened for autism spectrum disorders, there is an increasing need for diagnostic assessment of very young children. However, unique challenges exist in applying current diagnostic guidelines for autism spectrum disorders to children under the age of 2 years. In this article, we address challenges related to early detection, diagnosis, and treatment of autism spectrum disorders in this age group. We provide a comprehensive review of findings from recent studies on the early development of children with autism spectrum disorders, summarizing current knowledge on early signs of autism spectrum disorders, the screening properties of early detection tools, and current best practice for diagnostic assessment of autism spectrum disorders before 2 years of age. We also outline principles of effective intervention for children under the age of 2 with suspected/confirmed autism spectrum disorders. It is hoped that ongoing studies will provide an even stronger foundation for evidence-based diagnostic and intervention approaches for this critically important age group.

  17. Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High-Risk Infants

    PubMed Central

    Zwaigenbaum, Lonnie; Bryson, Susan; Lord, Catherine; Rogers, Sally; Carter, Alice; Carver, Leslie; Chawarska, Kasia; Constantino, John; Dawson, Geraldine; Dobkins, Karen; Fein, Deborah; Iverson, Jana; Klin, Ami; Landa, Rebecca; Messinger, Daniel; Ozonoff, Sally; Sigman, Marian; Stone, Wendy; Tager-Flusberg, Helen; Yirmiya, Nurit

    2010-01-01

    With increased public awareness of the early signs and recent American Academy of Pediatrics recommendations that all 18- and 24-month-olds be screened for autism spectrum disorders, there is an increasing need for diagnostic assessment of very young children. However, unique challenges exist in applying current diagnostic guidelines for autism spectrum disorders to children under the age of 2 years. In this article, we address challenges related to early detection, diagnosis, and treatment of autism spectrum disorders in this age group. We provide a comprehensive review of findings from recent studies on the early development of children with autism spectrum disorders, summarizing current knowledge on early signs of autism spectrum disorders, the screening properties of early detection tools, and current best practice for diagnostic assessment of autism spectrum disorders before 2 years of age. We also outline principles of effective intervention for children under the age of 2 with suspected/confirmed autism spectrum disorders. It is hoped that ongoing studies will provide an even stronger foundation for evidence-based diagnostic and intervention approaches for this critically important age group. PMID:19403506

  18. Clinical insights for office practice management.

    PubMed

    Lamothe, H L

    1998-01-01

    This manual is intended to be an easily used reference tool for office nurses who are involved with orthopaedic practice management. The manual can be enhanced with personal annotation, creating a working desk reference. While it is beyond the scope of this publication to be a textbook of ambulatory nursing, concepts will be introduced, ideas shared, and resources listed without pretense of attempting to instruct nurses in the science of ambulatory nursing. Some sections are in question and answer format. This will guide the reader through situations commonly encountered and provide possible solutions applicable to individual settings. Because office/clinic nursing is diversified in setting and clinical focus, it is beyond the scope of this manual to provide answers applicable for all situations. Sections have been included regarding office setup, equipment issues, space requirements, regulations, certification, and accreditation. Contributing authors have provided expert information on managed care issues, CPT/ICD9 coding, risk management, and OSHA regulations. By outlining common areas of concern and pitfalls to avoid, nurses can develop a workbook specific to their own setting.

  19. Endometriosis: translation of molecular insights to management.

    PubMed

    Langan, K L; Farrell, M E; Keyser, E A; Salyer, B A; Burney, R O

    2014-09-01

    Endometriosis is a debilitating gynecologic disorder causing pelvic pain and infertility and characterized by the implantation of endometrial tissue to extrauterine locations. Though aspects of the condition remain enigmatic, the molecular pathophysiology of endometriosis appears to be clarifying. Estrogen dependence of the disease is a sentinel endocrine feature and reduction of estrogen bioavailability is the therapeutic principle upon which traditional treatment and prevention approaches have been based. Endometriosis is a chronic inflammatory condition associated with lesional neoangiogenesis and attenuated progesterone action at the level of the endometrium. The elucidation of the molecular pathways mediating these observations has revealed new targets for directed medical and surgical treatment. This paper will review current approaches to the management of endometriosis in the context of the molecular pathophysiology.

  20. Scientific Insights for Managing Droughts in California

    NASA Astrophysics Data System (ADS)

    Lund, J. R.; Medellin-Azuara, J.; Howitt, R. E.; MacEwan, D.; Sumner, D. A.

    2015-12-01

    Droughts stress water systems and provide important opportunities to learn about vulnerabilities and motivate improvements in water systems. Current and past droughts in California show that this highly-engineered system is highly robust and resilient to droughts, as agriculture and urban water needs are mostly fulfilled and recover quickly following drought. However, environmental systems remain highly vulnerable and have shown less resilience to drought, with each drought bringing additional native species closer to extinction, often with little recovery following the drought. This paper reviews the impacts of California's ongoing 4-year drought and its importance for better understanding its ecological and water supply systems, as well as motivating improvements in water management and scientific work.

  1. Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.

    PubMed

    Jaarsma, Tiny; Lesman-Leegte, Ivonne; Hillege, Hans L; Veeger, Nic J; Sanderman, Robbert; van Veldhuisen, Dirk J

    2010-04-27

    Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients. Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs. From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program. Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98). Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639). Copyright (c) 2010 American College of Cardiology Foundation

  2. Humanistic Insights into Managing Diversity: The Humanities/Management Partnership.

    ERIC Educational Resources Information Center

    Yahr, Michael A.

    Global managers of the l990s and beyond must have definitive impacts on their work environments. Among the skills they need to possess are the abilities to adapt to new and fast-changing situations and to interact with people who view the business world from varied perspectives. A humanities/management partnership offers a viable and effective…

  3. A microgenetic study of insightful problem solving.

    PubMed

    Luwel, Koen; Siegler, Robert S; Verschaffel, Lieven

    2008-03-01

    An eight-session microgenetic study of acquisition of an insightful problem-solving strategy was conducted. A total of 35 second graders who did not use this insightful strategy initially were assigned to two groups that differed in the frequency of problems likely to facilitate discovery and generalization of the strategy. Children in the facilitative problems group discovered the insightful strategy earlier, used it more often subsequently, and transferred it more often to novel problems than did those in the nonfacilitative problems group. Children generally discovered the insightful strategy on the most facilitative items and extended it progressively to items on which its advantages were smaller but still substantial. The results indicate that experience outside the experimental situation, as well as experience inside the experimental situation, influences use of new strategies.

  4. Perioperative leadership: managing change with insights, priorities, and tools.

    PubMed

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors.

  5. Insights into Population Health Management Through Disease Diagnoses Networks

    PubMed Central

    Feldman, Keith; Stiglic, Gregor; Dasgupta, Dipanwita; Kricheff, Mark; Obradovic, Zoran; Chawla, Nitesh V.

    2016-01-01

    The increasing availability of electronic health care records has provided remarkable progress in the field of population health. In particular the identification of disease risk factors has flourished under the surge of available data. Researchers can now access patient data across a broad range of demographics and geographic locations. Utilizing this Big healthcare data researchers have been able to empirically identify specific high-risk conditions found within differing populations. However to date the majority of studies approached the issue from the top down, focusing on the prevalence of specific diseases within a population. Through our work we demonstrate the power of addressing this issue bottom-up by identifying specifically which diseases are higher-risk for a specific population. In this work we demonstrate that network-based analysis can present a foundation to identify pairs of diagnoses that differentiate across population segments. We provide a case study highlighting differences between high and low income individuals in the United States. This work is particularly valuable when addressing population health management within resource-constrained environments such as community health programs where it can be used to provide insight and resource planning into targeted care for the population served. PMID:27461860

  6. Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes: Insights from EPICOR, an international study of current practice patterns.

    PubMed

    Bueno, Héctor; Sinnaeve, Peter; Annemans, Lieven; Danchin, Nicolas; Licour, Muriel; Medina, Jesús; Pocock, Stuart; Sánchez-Covisa, Joaquín; Storey, Robert F; Jukema, J Wouter; Zeymer, Uwe; Van de Werf, Frans

    2016-02-01

    To describe international patterns and opportunities for improvement of pre- and in-hospital care of patients hospitalized for acute coronary syndromes (ACS), with special focus on anti-thrombotic therapy. EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients), an international, cohort study, which enrolled 10,568 consecutive ACS survivors from 555 hospitals in 20 countries across Europe and Latin America (September 2010 to March 2011), prospectively registered detailed information on pre- and in-hospital management. Globally, 4738 (44.8%) were attended before hospitalization, 4241 (40.1%) had an ECG, 2119 (20%) received anti-platelet therapy and 101 STEMI patients (2%) fibrinolysis. In-hospital, 7944 patients (75.2%) received dual anti-platelet therapy, most often with clopidogrel (69.7%), and less with prasugrel (5.4%); 1705 (16.1%) had triple anti-platelet therapy, and 849 (8%) single anti-platelet therapy. STEMI patients more often received pre-hospital anti-thrombotics, and prasugrel, GP IIb/IIIa inhibitors and UFH in-hospital (all p < 0.001). More NSTE-ACS patients received clopidogrel, single anti-platelet therapy, and fondaparinux (all p < 0.001). As many as 33% of ACS patients were medically managed. A significant decreasing gradient was found between Northern, Southern and Eastern Europe and Latin America in use of more potent patterns of anti-platelet therapy, reperfusion therapy and invasive strategy. This large international study shows room for improvement in use of anti-thrombotic drugs and other strategies for optimal management of ACS, including pre-hospital ECG and anti-thrombotic therapy. Regional practice differences not based on evidence or conditioned by economic constraints should be reduced. © The European Society of Cardiology 2015.

  7. Women versus men with chronic atrial fibrillation: insights from the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY).

    PubMed

    Ball, Jocasta; Carrington, Melinda J; Wood, Kathryn A; Stewart, Simon

    2013-01-01

    Gender-based clinical differences are increasingly being identified as having significant influence on the outcomes of patients with cardiovascular disease (CVD), including atrial fibrillation (AF). To perform detailed clinical phenotyping on a cohort of hospitalised patients with chronic forms of AF to understand if gender-based differences exist in the clinical presentation, thrombo-embolic risk and therapeutic management of high risk patients hospitalised with chronic AF. We are undertaking the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY) - a multi-centre, randomised controlled trial of an AF-specific management intervention versus usual care. Extensive baseline profiling of recruited patients was undertaken to identify gender-specific differences for risk delineation. We screened 2,438 patients with AF and recruited 335 into SAFETY. Of these, 48.1% were women who were, on average, 5 years older than their male counterparts. Women and men displayed divergent antecedent profiles, with women having a higher thrombo-embolic risk but being prescribed similar treatment regimens. More women than men presented to hospital with co-morbid thyroid dysfunction, depression, renal impairment and obesity. In contrast, more men presented with coronary artery disease (CAD) and/or chronic obstructive pulmonary disease (COPD). Even when data was age-adjusted, women were more likely to live alone (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.47 to 3.69), have non-tertiary education (OR 2.69; 95% CI 1.61 to 4.48) and be symptomatic (OR 1.93; 95% CI 1.06 to 3.52). Health care providers should be cognisant of gender-specific differences in an attempt to individualise and, hence, optimise the management of patients with chronic AF and reduce potential morbidity and mortality.

  8. Managing Water Resources for Drought: Insights from California

    NASA Astrophysics Data System (ADS)

    Medellin-Azuara, Josue; Lund, Jay

    2016-04-01

    Droughts bring great opportunities to better understand and improve water systems. California's economic powerhouse relies on highly engineered water systems to fulfill large and growing urban and agricultural water demands. Current and past droughts show these systems are highly robust and resilient to droughts, as they recover promptly. However, environmental systems remain highly vulnerable and have shown less resilience to drought, with each drought bringing additional native species closer to extinction, often with little recovery following the drought. This paper provides an overview of the economic and ecosystem impacts of the recent multi-year drought in California in the context of a global economy. We explore the potential of water markets, groundwater management and use of remote sensing technology to improve understanding of adaptation to drought. Insights for future management of water resources and scientific work are discussed.

  9. [Physicians see both pros and cons of health care financial management. Questionnaire study provides more insights--with starting point in controversial DN-article series].

    PubMed

    Björk, Joar; Petersson, Christer

    2015-05-12

    In the spring of 2013, the Swedish journalist Maciej Zaremba wrote a series of articles criticizing the impact of NPM (New Public Management) on Swedish health care. The present study examines the views of experienced Swedish physicians (general practitioners and internal medicine speclialists) on the problems focused in Mr Zaremba's article series. The respondents (51 general practitioners and 61 internal medicine specialists) mention advantages as well as disadvantages with NPM in Swedish health care. The majority agrees that with NPM, physicians loose influence over health care governance to other professional groups. The majority disagree with the charge made by Mr Zaremba that NPM has had the effect of manipulating Swedish physicians away from the standards of good medical care.

  10. How to Maximally Support Local and Regional Biodiversity in Applied Conservation? Insights from Pond Management

    PubMed Central

    Lemmens, Pieter; Mergeay, Joachim; De Bie, Tom; Van Wichelen, Jeroen; De Meester, Luc; Declerck, Steven A. J.

    2013-01-01

    Biodiversity and nature values in anthropogenic landscapes often depend on land use practices and management. Evaluations of the association between management and biodiversity remain, however, comparatively scarce, especially in aquatic systems. Furthermore, studies also tend to focus on a limited set of organism groups at the local scale, whereas a multi-group approach at the landscape scale is to be preferred. This study aims to investigate the effect of pond management on the diversity of multiple aquatic organism groups (e.g. phytoplankton, zooplankton, several groups of macro-invertebrates, submerged and emergent macrophytes) at local and regional spatial scales. For this purpose, we performed a field study of 39 shallow man-made ponds representing five different management types. Our results indicate that fish stock management and periodic pond drainage are crucial drivers of pond biodiversity. Furthermore, this study provides insight in how the management of eutrophied ponds can contribute to aquatic biodiversity. A combination of regular draining of ponds with efforts to keep ponds free of fish seems to be highly beneficial for the biodiversity of many groups of aquatic organisms at local and regional scales. Regular draining combined with a stocking of fish at low biomass is also preferable to infrequent draining and lack of fish stock control. These insights are essential for the development of conservation programs that aim long-term maintenance of regional biodiversity in pond areas across Europe. PMID:23951328

  11. How to maximally support local and regional biodiversity in applied conservation? Insights from pond management.

    PubMed

    Lemmens, Pieter; Mergeay, Joachim; De Bie, Tom; Van Wichelen, Jeroen; De Meester, Luc; Declerck, Steven A J

    2013-01-01

    Biodiversity and nature values in anthropogenic landscapes often depend on land use practices and management. Evaluations of the association between management and biodiversity remain, however, comparatively scarce, especially in aquatic systems. Furthermore, studies also tend to focus on a limited set of organism groups at the local scale, whereas a multi-group approach at the landscape scale is to be preferred. This study aims to investigate the effect of pond management on the diversity of multiple aquatic organism groups (e.g. phytoplankton, zooplankton, several groups of macro-invertebrates, submerged and emergent macrophytes) at local and regional spatial scales. For this purpose, we performed a field study of 39 shallow man-made ponds representing five different management types. Our results indicate that fish stock management and periodic pond drainage are crucial drivers of pond biodiversity. Furthermore, this study provides insight in how the management of eutrophied ponds can contribute to aquatic biodiversity. A combination of regular draining of ponds with efforts to keep ponds free of fish seems to be highly beneficial for the biodiversity of many groups of aquatic organisms at local and regional scales. Regular draining combined with a stocking of fish at low biomass is also preferable to infrequent draining and lack of fish stock control. These insights are essential for the development of conservation programs that aim long-term maintenance of regional biodiversity in pond areas across Europe.

  12. Insights into enzymatic halogenation from computational studies

    PubMed Central

    Senn, Hans M.

    2014-01-01

    The halogenases are a group of enzymes that have only come to the fore over the last 10 years thanks to the discovery and characterization of several novel representatives. They have revealed the fascinating variety of distinct chemical mechanisms that nature utilizes to activate halogens and introduce them into organic substrates. Computational studies using a range of approaches have already elucidated many details of the mechanisms of these enzymes, often in synergistic combination with experiment. This Review summarizes the main insights gained from these studies. It also seeks to identify open questions that are amenable to computational investigations. The studies discussed herein serve to illustrate some of the limitations of the current computational approaches and the challenges encountered in computational mechanistic enzymology. PMID:25426489

  13. Supply Chain Development: Insights from Strategic Niche Management

    ERIC Educational Resources Information Center

    Caniels, Marjolein C. J.; Romijn, Henny A.

    2008-01-01

    Purpose: The purpose of this paper is to contribute to the study of supply chain design from the perspective of complex dynamic systems. Unlike extant studies that use formal simulation modelling and associated methodologies rooted in the physical sciences, it adopts a framework rooted in the social sciences, strategic niche management, which…

  14. Supply Chain Development: Insights from Strategic Niche Management

    ERIC Educational Resources Information Center

    Caniels, Marjolein C. J.; Romijn, Henny A.

    2008-01-01

    Purpose: The purpose of this paper is to contribute to the study of supply chain design from the perspective of complex dynamic systems. Unlike extant studies that use formal simulation modelling and associated methodologies rooted in the physical sciences, it adopts a framework rooted in the social sciences, strategic niche management, which…

  15. Towards risk-based management of critical infrastructures : enabling insights and analysis methodologies from a focused study of the bulk power grid.

    SciTech Connect

    Richardson, Bryan T.; LaViolette, Randall A.; Cook, Benjamin Koger

    2008-02-01

    This report summarizes research on a holistic analysis framework to assess and manage risks in complex infrastructures, with a specific focus on the bulk electric power grid (grid). A comprehensive model of the grid is described that can approximate the coupled dynamics of its physical, control, and market components. New realism is achieved in a power simulator extended to include relevant control features such as relays. The simulator was applied to understand failure mechanisms in the grid. Results suggest that the implementation of simple controls might significantly alter the distribution of cascade failures in power systems. The absence of cascade failures in our results raises questions about the underlying failure mechanisms responsible for widespread outages, and specifically whether these outages are due to a system effect or large-scale component degradation. Finally, a new agent-based market model for bilateral trades in the short-term bulk power market is presented and compared against industry observations.

  16. Insights to integrated river management from a geomorphological viewpoint

    NASA Astrophysics Data System (ADS)

    Valyrakis, Manousos; Liu, Da

    2016-04-01

    In the context of increasing magnitude and frequency of extreme hydrologic events, eco-hydraulic engineers have a dual role of providing novel designs that both help stabilise river systems, as well as help effectively route floodwater safely downstream, though the catchment. One of such soft and green measures commonly used in engineering to protect channel banks and floodplains, is riverbank vegetation. Riverbank vegetation can be of high importance both in preserving the form (morphology) and function (ecology) of our natural as well as engineered river systems. Here the results of an experimental flume study, investigating riverbank hydrodynamics are presented. The effect of different riverbank vegetation densities on flow hydrodynamics across the channel are reported and discussed. Flow diagnostics including mean and turbulent intensity flow profiles along the streamwise and lateral directions, are being assessed via acoustic Doppler velocimetry (ADV) both at the main channel and within the riverbank. The configuration of vegetation elements follows a linear or staggered arrangement as vegetation density is progressively increased. Implications for sediment transport are discussed by considering the change in near-bed shear stresses at the main channel (increasing) and riverbank (decreasing) as the riverbank density increases. As such processes have the potential to affect both the form and function of the river system, the insights from this study are of significant importance to geomorphologists and hydraulic engineers, as well as ecologists.

  17. Wildland fire management futures: insights from a foresight panel

    Treesearch

    Robert L. Olson; David N. Bengston; Leif A. DeVaney; Trevor A.C. Thompson

    2015-01-01

    Wildland fire management faces unprecedented challenges in the 21st century: the increasingly apparent effects of climate change, more people and structures in the wildland-urban interface, growing costs associated with wildfire management, and the rise of high-impact fires, to name a few. Given these significant and growing challenges, conventional fire management...

  18. Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

    PubMed Central

    Devanarayana, Niranga Manjuri

    2011-01-01

    Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. Since most of the management strategies of childhood constipation are not evidence-based, high-quality randomized controlled trials are required to assess the efficacy of currently available or newly emerging therapeutic options. Contrary to the common belief that children outgrow constipation as they grow up, a sizable percentage continue to have symptoms beyond puberty. PMID:21369490

  19. The Singapore Field Epidemiology Service: Insights Into Outbreak Management

    PubMed Central

    Seetoh, Theresa; Cutter, Jeffery

    2012-01-01

    Field epidemiology involves the implementation of quick and targeted public health interventions with the aid of epidemiological methods. In this article, we share our practical experiences in outbreak management and in safeguarding the population against novel diseases. Given that cities represent the financial nexuses of the global economy, global health security necessitates the safeguard of cities against epidemic diseases. Singapore's public health landscape has undergone a systemic and irreversible shift with global connectivity, rapid urbanization, ecological change, increased affluence, as well as shifting demographic patterns over the past two decades. Concomitantly, the threat of epidemics, ranging from severe acute respiratory syndrome and influenza A (H1N1) to the resurgence of vector-borne diseases as well as the rise of modern lifestyle-related outbreaks, have worsened difficulties in safeguarding public health amidst much elusiveness and unpredictability. One critical factor that has helped the country overcome these innate and man-made public health vulnerabilities is the development of a resilient field epidemiology service, which includes our enhancement of surveillance and response capacities for outbreak management, and investment in public health leadership. We offer herein the Singapore story as a case study in meeting the challenges of disease control in our modern built environment. PMID:23091652

  20. Overutilization and underutilization of operating rooms - insights from behavioral health care operations management.

    PubMed

    Fügener, Andreas; Schiffels, Sebastian; Kolisch, Rainer

    2017-03-01

    The planning of surgery durations is crucial for efficient usage of operating theaters. Both planning too long and too short durations for surgeries lead to undesirable consequences, e.g. idle time, overtime, or rescheduling of surgeries. We define these consequences as operating room inefficiency. The overall objective of planning surgery durations is to minimize expected operating room inefficiency, since surgery durations are stochastic. While most health care studies assume economically rational behavior of decision makers, experimental studies have shown that decision makers often do not act according to economic incentives. Based on insights from health care operations management, medical decision making, behavioral operations management, as well as empirical observations, we derive hypotheses that surgeons' behavior deviates from economically rational behavior. To investigate this, we undertake an experimental study where experienced surgeons are asked to plan surgeries with uncertain durations. We discover systematic deviations from optimal decision making and offer behavioral explanations for the observed biases. Our research provides new insights to tackle a major problem in hospitals, i.e. low operating room utilization going along with staff overtime.

  1. Mining the Management Literature for Insights into Implementing Evidence-Based Change in Healthcare

    PubMed Central

    Harlos, Karen; Tetroe, Jacqueline; Graham, Ian D.; Bird, Madeleine; Robinson, Nicole

    2012-01-01

    Objective: We synthesized the management and health literatures for insights into implementing evidence-based change in healthcare drawn from industry-specific data. Because change principles based on evidence often fail to be translated into organizational practice or policy, we sought studies at the nexus of organizational change and knowledge translation. Methods: We reviewed five top management journals to identify an initial pool of 3,091 studies, which yielded a final sample of 100 studies. Data were abstracted, verified by the original authors and revised before entry into a database. We employed a systematic narrative synthesis approach using words and text to distill data and explain relationships. We categorized studies by varying levels of relevance for knowledge translation as (1) primary, direct; (2) intermediate; and (3) secondary, indirect. We also identified recurring categories of change-related organizational factors. The current analysis examines these factors in studies of primary relevance to knowledge translation, which we also coded for intervention readiness to reflect how readily change can be implemented. Preliminary Results and Conclusions: Results centred on five change-related categories: Tailoring the Intervention Message; Institutional Links/Social Networks; Training; Quality of Work Relationships; and Fit to Organization. In particular, networks across institutional and individual levels appeared as prominent pathways for changing healthcare organizations. Power dynamics, positive social relations and team structures also played key roles in implementing change and translating it into practice. We analyzed journals in which first authors of these studies typically publish, and found evidence that management and health sciences remain divided. Bridging these disciplines through research syntheses promises a wealth of evidence and insights, well worth mining in the search for change that works in healthcare transformation. PMID

  2. Culturally Relevant Management Education: Insights from Experience in Nunavut

    ERIC Educational Resources Information Center

    Wihak, Christine

    2005-01-01

    The author's experience with a Nunavut business management education program illustrates how to develop culturally relevant organizational behavior curriculum. The process initially involved interviews with Inuit Elders about culturally appropriate responses to scenarios of cultural conflicts in the workplace identified by Inuit managers. The…

  3. Insights into sleep's role for insight: Studies with the number reduction task.

    PubMed

    Verleger, Rolf; Rose, Michael; Wagner, Ullrich; Yordanova, Juliana; Kolev, Vasil

    2013-01-01

    In recent years, vibrant research has developed on "consolidation" during sleep: To what extent are newly experienced impressions reprocessed or even restructured during sleep? We used the number reduction task (NRT) to study if and how sleep does not only reiterate new experiences but may even lead to new insights. In the NRT, covert regularities may speed responses. This implicit acquisition of regularities may become explicitly conscious at some point, leading to a qualitative change in behavior which reflects this insight. By applying the NRT at two consecutive sessions separated by an interval, we investigated the role of sleep in this interval for attaining insight at the second session. In the first study, a night of sleep was shown to triple the number of participants attaining insight above the base rate of about 20%. In the second study, this hard core of 20% discoverers differed from other participants in their task-related EEG potentials from the very beginning already. In the third study, the additional role of sleep was specified as an effect of the deep-sleep phase of slow-wave sleep on participants who had implicitly acquired the covert regularity before sleep. It was in these participants that a specific increase of EEG during slow-wave sleep in the 10-12 Hz band was obtained. These results support the view that neuronal memory reprocessing during slow-wave sleep restructures task-related representations in the brain, and that such restructuring promotes the gain of explicit knowledge.

  4. Intestinal Lymphangiectasia: Insights on Management and Literature Review

    PubMed Central

    Alshikho, Mohamad J.; Talas, Joud M.; Noureldine, Salem I.; Zazou, Saf; Addas, Aladdin; Kurabi, Haitham; Nasser, Mahmoud

    2016-01-01

    investigations showed that the patient had IL. Suitable diet modification plans were applied as a long-term management plan. Conclusions: IL is a rare disease of challenging nature due to its systematic effects and lack of comprehensive studies that can evaluate the effectiveness of specific treatments in a large cohort of patients. Medium-chain triglyceride (MCT) oils and diet modification strategies are effective in reducing the loss of body proteins and in maintaining near-normal blood levels of immunoglobulins. However, octreotide and MCT oils had no proven role in reducing lymphedema in our patient. PMID:27440277

  5. Intestinal Lymphangiectasia: Insights on Management and Literature Review.

    PubMed

    Alshikho, Mohamad J; Talas, Joud M; Noureldine, Salem I; Zazou, Saf; Addas, Aladdin; Kurabi, Haitham; Nasser, Mahmoud

    2016-07-21

    BACKGROUND Intestinal lymphangiectasia (IL) is a rare disease characterized by a dilatation of the intestinal lymphatics and loss of lymph fluid into the gastrointestinal tract leading to hypoproteinemia, edema, lymphocytopenia, hypogammaglobinemia, and immunological abnormalities. Iron, calcium, and other serum components (e.g., lipids, fat soluble vitamins) may also be depleted. A literature search revealed more than 200 reported cases of IL. Herein, we report our observations of a patient diagnosed with IL; we also present our conclusion for our review of the published literature. CASE REPORT A 24-year-old male was admitted to Aleppo University Hospital with the complaints of abdominal pain, headache, arthralgia, fever, and rigors. His past medical history was remarkable for frequent episodes of diarrhea, recurrent infections, and swelling in the lower limbs. In addition, he had been hospitalized several times in non-academic hospitals due to edema in his legs, cellulitis, and recurrent infections. In the emergency department, a physical examination revealed a patient in distress. He was weak, dehydrated, pale, and had a high-grade fever. His lower extremities were edematous, swollen, and extremely tender to touch. The overlying skin was erythematous and warm. Moreover, the patient was tachycardic, tacypneic, and moderately hypotensive. The patient was resuscitated with IV fluids, and Tylenol was administered to bring the temperature down. Blood tests showed anemia and high levels of inflammatory markers. The patient's white blood cell count was elevated with an obvious left shift. However, subsequent investigations showed that the patient had IL. Suitable diet modification plans were applied as a long-term management plan. CONCLUSIONS IL is a rare disease of challenging nature due to its systematic effects and lack of comprehensive studies that can evaluate the effectiveness of specific treatments in a large cohort of patients. MCT (medium-chain triglyceride

  6. Integrated pest management: theoretical insights from a threshold policy.

    PubMed

    Costa, Michel I da Silveira; Faria, Lucas Del B

    2010-01-01

    An Integrated Pest Management is formulated as a threshold policy. It is shown that when this strategy is applied to a food web consisting of generalist, specialist predators and endemic and pest prey, the dynamics can be stable and useful from the pest control point of view, despite the dynamical complexities inherent to the application of biocontrol only. In addition, pesticide toxicity depends rather on the species intrinsic parameters than on the chemical agent concentration.

  7. Contemporary HIV/AIDS research: Insights from knowledge management theory.

    PubMed

    Callaghan, Chris William

    2017-12-01

    Knowledge management as a field is concerned with the management of knowledge, including the management of knowledge in research processes. Knowledge management theory has the potential to support research into problems such as HIV, antibiotic resistance and others, particularly in terms of aspects of scientific research related to the contribution of social science. To date, however, these challenges remain with us, and theoretical contributions that can complement natural science efforts to eradicate these problems are needed. This paper seeks to offer a theoretical contribution grounded in Kuhn's paradigm theory of innovation, and in the argument by Lakatos that scientific research can be fundamentally non-innovative, which suggests that social science aspects of knowledge creation may hold the key to more effective biomedical innovation. Given the consequences of ongoing and emerging global crises, and the failure of knowledge systems of scientific research to solve such problems outright, this paper provides a review of theory and literature arguing for a new paradigm in scientific research, based on the development of global systems to maximise research collaborations. A global systems approach effectively includes social science theory development as an important complement to the natural sciences research process. Arguably, information technology and social media technology have developed to the point at which solutions to knowledge aggregation challenges can enable solutions to knowledge problems on a scale hitherto unimaginable. Expert and non-expert crowdsourced inputs can enable problem-solving through exponentially increasing problem-solving inputs, using the 'crowd,' thereby increasing collaborations dramatically. It is argued that these developments herald a new era of participatory research, or a democratisation of research, which offers new hope for solving global social problems. This paper seeks to contribute to this end, and to the recognition

  8. Contemporary insights into the management of type A aortic dissection.

    PubMed

    Tolis, George; Sundt, Thoralf M

    2016-10-01

    Acute Type A Dissection remains a surgical emergency with a relatively high operative mortality despite advances in cardiac surgical techniques and medical management over the past thirty years. In this presentation we will discuss the issues surrounding diagnosis, triage, surgical treatment and perioperative medical management as well as long term surveillance of patients suffering from Acute Type A Dissection and present the literature that supports our management strategies. Expert commentary: The ultimate goal of surgical intervention for patients with Type A Acute Aortic Dissection is an alive patient. A more complicated operation which addresses the root and arch and potentially reduces late complications should be approached with caution since it may increase the operative mortality of the procedure itself. With the recent evolution in endovascular techniques, there is hope that later complications can be reduced without increasing the risk of the primary operation. It remains to be seen whether the improved distal aortic remodeling afforded by a combined open/endovascular approach to Acute Type A Dissection will lead to decreased need for aortic reinterventions and overall long term complications of a residual descending thoracic chronic dissection.

  9. Insights from Small-"N" Studies

    ERIC Educational Resources Information Center

    Gouvea, Julia

    2017-01-01

    Small-"N" studies have been relatively uncommon in biology education research and are likely less familiar to instructors and administrators than large-"N" studies. Nevertheless, many scholars in the social sciences have argued for the value of small-"N" studies in informing research and practice (e.g., Flyvbjerg…

  10. Insights into sleep's role for insight: Studies with the number reduction task

    PubMed Central

    Verleger, Rolf; Rose, Michael; Wagner, Ullrich; Yordanova, Juliana; Kolev, Vasil

    2013-01-01

    In recent years, vibrant research has developed on “consolidation” during sleep: To what extent are newly experienced impressions reprocessed or even restructured during sleep? We used the number reduction task (NRT) to study if and how sleep does not only reiterate new experiences but may even lead to new insights. In the NRT, covert regularities may speed responses. This implicit acquisition of regularities may become explicitly conscious at some point, leading to a qualitative change in behavior which reflects this insight. By applying the NRT at two consecutive sessions separated by an interval, we investigated the role of sleep in this interval for attaining insight at the second session. In the first study, a night of sleep was shown to triple the number of participants attaining insight above the base rate of about 20%. In the second study, this hard core of 20% discoverers differed from other participants in their task-related EEG potentials from the very beginning already. In the third study, the additional role of sleep was specified as an effect of the deep-sleep phase of slow-wave sleep on participants who had implicitly acquired the covert regularity before sleep. It was in these participants that a specific increase of EEG during slow-wave sleep in the 10-12 Hz band was obtained. These results support the view that neuronal memory reprocessing during slow-wave sleep restructures task-related representations in the brain, and that such restructuring promotes the gain of explicit knowledge. PMID:24605175

  11. Multiple sclerosis: basic knowledge and new insights in perioperative management.

    PubMed

    Makris, Alexandros; Piperopoulos, Alexandros; Karmaniolou, Iosifina

    2014-04-01

    Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system affecting young adults that may lead to significant disability. The clinical course varies among the types of the disease as well as among individuals. Herein we provide a brief review of the recent data concerning the clinical presentation, diagnosis, causes, and pathogenesis of MS as well as medication used, followed by the anesthetic considerations of patients diagnosed with the disease. To accomplish this, we conducted a systematic PubMed literature search for articles, using the terms multiple sclerosis, anesthesia, general, regional, perioperative, and preoperative, and we then manually reviewed the references from each pertinent article. Because randomized controlled trials on the field are rare, most information is derived by case reports and case series. We concluded that the disease itself as well as the treatment modalities may have several implications in the conduct of anesthesia and perioperative management of MS patients. General and regional anesthetic techniques have been successfully used. With thorough preoperative evaluation and in depth knowledge of the disease and its complications, the MS patients can be managed safely.

  12. Bureau of Land Management density management study.

    Treesearch

    John Cissel; Paul Anderson; Shanti Berryman; Sam Chan; Deanna Olson; Klaus. Puettman

    2004-01-01

    The Bureau of Land Management (BLM), Pacific Northwest Research Station (PNW), U.S. Geological Survey (USGS), and Oregon State University (OSU) established the Density Management Study (DMS) in 1994 to develop and test options for young stand management to meet Northwest Forest Plan objectives in western Oregon. The DMS demonstrates and evaluates alternative approaches...

  13. Mechanistic Insight and Management of Diabetic Nephropathy: Recent Progress and Future Perspective

    PubMed Central

    Xue, Rui; Gui, Dingkun; Zheng, Liyang; Zhai, Ruonan

    2017-01-01

    Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes and the largest single cause of end-stage renal disease (ESRD) in many developed countries. DN is also associated with an increased cardiovascular mortality. It occurs as a result of interaction between both genetic and environmental factors. Hyperglycemia, hypertension, and genetic predisposition are the major risk factors. However, the exact mechanisms of DN are unclear. Despite the benefits derived from strict control of glucose and blood pressure, as well as inhibition of renin-angiotensin-aldosterone system, many patients continue to enter into ESRD. Thus, there is urgent need for improving mechanistic understanding of DN and then developing new and effective therapeutic approaches to delay the progression of DN. This review focuses on recent progress and future perspective about mechanistic insight and management of DN. Some preclinical relevant studies are highlighted and new perspectives of traditional Chinese medicine (TCM) for delaying DN progression are discussed in detail. These findings strengthen the therapeutic rationale for TCM in the treatment of DN and also provide new insights into the development of novel drugs for the prevention of DN. However, feasibility and safety of these therapeutic approaches and the clinical applicability of TCM in human DN need to be further investigated. PMID:28386567

  14. Overcoming resistance against managed care - insights from a bargaining model.

    PubMed

    Ehlert, Andree; Wein, Thomas; Zweifel, Peter

    2017-12-01

    Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed. In a "three-player/three-cake" game the coalitions {SHI, MCO}, {MCO, RI}, and {SHI, RI} can form. Players' possibility to switch between coalitions creates new outside options, causing the conventional bilateral Nash bargaining solution to be replaced by the so-called von Neumann-Morgenstern triple. These triples are compared to the status quo (where the RI has no threat potential) and related to institutional conditions characterizing Germany, the Netherlands, and Switzerland.

  15. Age to age: insight into managing a multigenerational staff.

    PubMed

    Stanley, Kay B

    2007-01-01

    Diversity in age and culture-medical practices and healthcare entities mirror the business world in the diversity of culture and age groups among their employees and patients. Differences create challenges, but with understanding and skillful communication, distinctions become opportunities for growth and excellence. The concept we are exploring is that as a generation we are who we are because of what was going on in our world during our formative years. We find that just naming ourselves aspart ofa group is a good starting point. The objective of this article is to identify characteristics of various age groups and to present ways to promote harmony and to maximize performance through practical management techniques. The goal is to better understand ourselves and each other so that our work is more productive and rewarding.

  16. Neurosteroidogenesis: Insights from Studies of Songbirds

    PubMed Central

    Schlinger, Barney A.; Remage-Healey, Luke

    2011-01-01

    The long-held dogma that the brain is a target of steroids produced by peripheral organs has delayed widespread acceptance of the functional importance of neurosteroidogenesis. Comparative studies have been vital for establishing the key actions of gonadal and adrenal hormones on brain and behavior. No doubt, studies across diverse phyla will continue to be crucial for revealing the true significance of neurosteroidogenesis to proper function of the vertebrate brain. Here we review work out of our lab and others highlighting advances to our understanding of brain steroid synthesis and action using songbirds as animal models. These studies show that steroidogenic transporters and enzymes are present in the songbird brain and their expression and/or activities are subject to developmental, seasonal or short-term regulation. Our work in a songbird points to synaptic synthesis of neuroactive steroids and fast, peri-synaptic membrane actions. Combined with evidence for rapid steroidal control of behavior, these studies firmly establish a neuromodulatory role for avian neurosteroids. We hope this work will join with that of other species to embolden acceptance of neurosteroidal signaling as a core property of vertebrate neurobiology. PMID:21535249

  17. Domain Visualization Using VxInsight[R] for Science and Technology Management.

    ERIC Educational Resources Information Center

    Boyack, Kevin W.; Wylie, Brian N.; Davidson, George S.

    2002-01-01

    Presents the application of a knowledge visualization tool, VxInsight[R], to enable domain analysis for science and technology management. Uses data mining from sources of bibliographic information to define subsets of relevant information and discusses citation mapping, text mapping, and journal mapping. (Author/LRW)

  18. Domain Visualization Using VxInsight[R] for Science and Technology Management.

    ERIC Educational Resources Information Center

    Boyack, Kevin W.; Wylie, Brian N.; Davidson, George S.

    2002-01-01

    Presents the application of a knowledge visualization tool, VxInsight[R], to enable domain analysis for science and technology management. Uses data mining from sources of bibliographic information to define subsets of relevant information and discusses citation mapping, text mapping, and journal mapping. (Author/LRW)

  19. Acquiring synaesthesia: insights from training studies

    PubMed Central

    Rothen, Nicolas; Meier, Beat

    2014-01-01

    Synaesthesia denotes a condition of remarkable individual differences in experience characterized by specific additional experiences in response to normal sensory input. Synaesthesia seems to (i) run in families which suggests a genetic component, (ii) is associated with marked structural and functional neural differences, and (iii) is usually reported to exist from early childhood. Hence, synaesthesia is generally regarded as a congenital phenomenon. However, most synaesthetic experiences are triggered by cultural artifacts (e.g., letters, musical sounds). Evidence exists to suggest that synaesthetic experiences are triggered by the conceptual representation of their inducer stimuli. Cases were identified for which the specific synaesthetic associations are related to prior experiences and large scale studies show that grapheme-color associations in synaesthesia are not completely random. Hence, a learning component is inherently involved in the development of specific synaesthetic associations. Researchers have hypothesized that associative learning is the critical mechanism. Recently, it has become of scientific and public interest if synaesthetic experiences may be acquired by means of associative training procedures and whether the gains of these trainings are associated with similar cognitive benefits as genuine synaesthetic experiences. In order to shed light on these issues and inform synaesthesia researchers and the general interested public alike, we provide a comprehensive literature review on developmental aspects of synaesthesia and specific training procedures in non-synaesthetes. Under the light of a clear working definition of synaesthesia, we come to the conclusion that synaesthesia can potentially be learned by the appropriate training. PMID:24624072

  20. Improving management of student clinical placements: insights from activity theory.

    PubMed

    O'Keefe, Maree; Wade, Victoria; McAllister, Sue; Stupans, Ieva; Burgess, Teresa

    2016-08-24

    An approach to improve management of student clinical placements, the Building Teams for Quality Learning project, was trialed in three different health services. In a previous paper the authors explored in some detail the factors associated with considerable success of this approach at one of these services. In this paper, the authors extend this work with further analysis to determine if the more limited outcomes observed with participants at the other two services could be explained by application of activity theory and in particular the expansive learning cycle. Staff at three health services participated in the Building Teams for Quality Learning project: a dental clinic, a community aged care facility and a rural hospital. At each site a team of seven multi-disciplinary staff completed the project over 9 to 12 months (total 21 participants). Evaluation data were collected through interviews, focus groups and direct observation of staff and students. Following initial thematic analysis, further analysis was conducted to compare the processes and outcomes at each participating health service drawing on activity theory and the expansive learning cycle. Fifty-one interview transcripts, 33 h of workplace observation and 31 sets of workshop field notes (from 36 h of workshops) were generated. All participants were individually supportive of, and committed to, high quality student learning experiences. As was observed with staff at the dental clinic, a number of potentially effective strategies were discussed at the aged care facility and the rural hospital workshops. However, participants in these two health services could not develop a successful implementation plan. The expansive learning cycle element of modeling and testing new solutions was not achieved and participants were unable, collectively to reassess and reinterpret the object of their activities. The application of activity theory and the expansive learning cycle assisted a deeper understanding of

  1. Educators' insights in using chronicle diabetes: a data management system for diabetes education.

    PubMed

    Wang, Jing; Siminerio, Linda M

    2013-01-01

    Diabetes educators lack data systems to monitor diabetes self-management education processes and programs. The purpose of the study is to explore diabetes educator's insights in using a diabetes education data management program: the Chronicle Diabetes system. We conducted 1 focus group with 8 diabetes educators who use the Chronicle system in western Pennsylvania. The focus group was audiotaped and transcribed verbatim. Themes were categorized according to system facilitators and barriers in using Chronicle. Educators report 4 system facilitators and 4 barrier features. System facilitators include (1) ability to extract data from Chronicle for education program recognition, (2) central location for collecting and documenting all patient and education data, (3) capability to monitor behavioral goal setting and clinical outcomes, and (4) use of a patient snapshot report that automatically summarizes behavioral goal setting and an education plan. Barriers reported are (1) initially time-consuming for data entry, (2) Health Insurance Portability and Accountability Act privacy concerns for e-mailing or downloading report, (3) need for special features (e.g., ability to attach a food diary), and (4) need to enhance existing features to standardize goal-setting process and incorporate psychosocial content. Educators favor capabilities for documenting program requirements, goal setting, and patient summaries. Barriers that need to be overcome are the amount of time needed for data entry, privacy, and special features. Diabetes educators conclude that a data management system such as Chronicle facilitates the education process and affords ease in documentation of meeting diabetes self-management education standards and recognition requirements.

  2. Managing Dog Waste: Campaign Insights from the Health Belief Model

    ERIC Educational Resources Information Center

    Typhina, Eli; Yan, Changmin

    2014-01-01

    Aiming to help municipalities develop effective education and outreach campaigns to reduce stormwater pollutants, such as pet waste, this study applied the Health Belief Model (HBM) to identify perceptions of dog waste and corresponding collection behaviors from dog owners living in a small U.S. city. Results of 455 online survey responses…

  3. Managing Dog Waste: Campaign Insights from the Health Belief Model

    ERIC Educational Resources Information Center

    Typhina, Eli; Yan, Changmin

    2014-01-01

    Aiming to help municipalities develop effective education and outreach campaigns to reduce stormwater pollutants, such as pet waste, this study applied the Health Belief Model (HBM) to identify perceptions of dog waste and corresponding collection behaviors from dog owners living in a small U.S. city. Results of 455 online survey responses…

  4. Novel insights on nutrient management of sarcopenia in elderly.

    PubMed

    Rondanelli, Mariangela; Faliva, Milena; Monteferrario, Francesca; Peroni, Gabriella; Repaci, Erica; Allieri, Francesca; Perna, Simone

    2015-01-01

    Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of muscle mass and strength. The more rationale approach to delay the progression of sarcopenia is based on the combination of proper nutrition, possibly associated with the use of dietary supplements and a regular exercise program. We performed a narrative literature review to evaluate the till-now evidence regarding (1) the metabolic and nutritional correlates of sarcopenia; (2) the optimum diet therapy for the treatment of these abnormalities. This review included 67 eligible studies. In addition to the well recognized link between adequate intake of proteins/amino acids and sarcopenia, the recent literature underlines that in sarcopenic elderly subjects there is an unbalance in vitamin D synthesis and in omega-6/omega-3 PUFA ratio. Given the detrimental effect of these metabolic abnormalities, a change in the lifestyle must be the cornerstone in the treatment of sarcopenia. The optimum diet therapy for the sarcopenia treatment must aim at achieving specific metabolic goals, which must be reached through accession of the elderly to specific personalized dietary program aimed at achieving and/or maintaining muscle mass; increasing their intake of fish (4 times/week) or taking omega-3 PUFA supplements; taking vitamin D supplementation, if there are low serum levels.

  5. Novel Insights on Nutrient Management of Sarcopenia in Elderly

    PubMed Central

    Rondanelli, Mariangela; Faliva, Milena; Monteferrario, Francesca; Peroni, Gabriella; Repaci, Erica

    2015-01-01

    Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of muscle mass and strength. The more rationale approach to delay the progression of sarcopenia is based on the combination of proper nutrition, possibly associated with the use of dietary supplements and a regular exercise program. We performed a narrative literature review to evaluate the till-now evidence regarding (1) the metabolic and nutritional correlates of sarcopenia; (2) the optimum diet therapy for the treatment of these abnormalities. This review included 67 eligible studies. In addition to the well recognized link between adequate intake of proteins/amino acids and sarcopenia, the recent literature underlines that in sarcopenic elderly subjects there is an unbalance in vitamin D synthesis and in omega-6/omega-3 PUFA ratio. Given the detrimental effect of these metabolic abnormalities, a change in the lifestyle must be the cornerstone in the treatment of sarcopenia. The optimum diet therapy for the sarcopenia treatment must aim at achieving specific metabolic goals, which must be reached through accession of the elderly to specific personalized dietary program aimed at achieving and/or maintaining muscle mass; increasing their intake of fish (4 times/week) or taking omega-3 PUFA supplements; taking vitamin D supplementation, if there are low serum levels. PMID:25705670

  6. Abnormal Bleeding During Menopause Hormone Therapy: Insights for Clinical Management

    PubMed Central

    de Medeiros, Sebastião Freitas; Yamamoto, Márcia Marly Winck; Barbosa, Jacklyne Silva

    2013-01-01

    Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman’s characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT), it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies. PMID:24665210

  7. Management of carbon across sectors and scales: Insights from land use decision making

    NASA Astrophysics Data System (ADS)

    Dilling, L.; Failey, E. L.

    2008-12-01

    Carbon management is increasingly becoming a topic of interest among policy circles and business entrepreneurs alike. In the United States, while no binding regulatory framework exists, carbon management is nonetheless being pursued both by voluntary actions at a variety of levels, from the individual to the national level, and through mandatory policies at state and local levels. Controlling the amount of carbon dioxide in the atmosphere for climate purposes will ultimately require a form of governance that will ensure that the actions taken and being rewarded financially are indeed effective with respect to the global atmosphere on long time scales. Moreover, this new system of governance will need to interface with existing governance structures and decision criteria that have been established to arbitrate among various societal values and priorities. These existing institutions and expressed values will need to be examined against those proposed for effective carbon governance, such as the permanence of carbon storage, the additionality of credited activities, and the prevention of leakage, or displacement of prohibited activities to another region outside the governance boundary. The latter issue suggests that interactions among scales of decision making and governance will be extremely important in determining the ultimate success of any future system of carbon governance. The goal of our study is to understand the current context of land use decision making in different sectors and examine the potential for future carbon policy to be effective given this context. This study examined land use decision making in the U.S. state of Colorado from a variety of ownership perspectives, including US Federal land managers, individual private owners, and policy makers involved in land use at a number of different scales. This paper will report on the results of interviews with land managers and provide insight into the policy context for carbon management through land

  8. Improving participant selection in disease management programmes: insights gained from propensity score stratification.

    PubMed

    Linden, Ariel; Adams, John L

    2008-10-01

    While the randomized controlled trial (RCT) remains the gold-standard study design for evaluating treatment effect, outcomes researchers turn to powerful quasi-experimental designs when only observational studies can be conducted. Within these designs, propensity score matching is one of the most popular to evaluate disease management (DM) programme effectiveness. Given that DM programmes generally have a much smaller number of participants than non-participants in the population, propensity score matching will typically result in all or nearly all participants finding successful matches, while most of the non-participants in the population remain unmatched and thereby excluded from the analysis. By excluding data from the unmatched population, the effect of non-treatment in the remaining population with the disease is not captured. In the present study, we examine changes in hospitalization rates stratified by propensity score quintiles across the entire population allowing us to gain insight as to how well the programme chose its participants, or if the programme could have been effective on those individuals not explicitly targeted for the intervention. These data indicate the presence of regression to the mean, and suggest that the DM programme may be overly limited to only the highest strata when there is evidence of a potential benefit for those in all the lower strata as well.

  9. Managing aging in nuclear power plants: Insights from NRC's Maintenance Team Inspection reports

    SciTech Connect

    Fresco, A.; Subudhi, M.

    1992-01-01

    A plant's maintenance program is the principal vehicle through which age-related degradation is managed. From 1988 to 1991, the NRC evaluated the maintenance program of every nuclear power plant in the United States. Forty-four out of a total of sixty-seven of the reports issued on these in-depth team inspections have been reviewed for insights into the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear plant structures, systems, and components (SSCs). Relevant information has been extracted from these inspection reports sorted into several categories; including Specific Aging Insights, Preventive Maintenance, Predictive Maintenance and Condition Monitoring, Post Maintenance Testing, Failure Trending, Root Cause Analysis and Usage of Probabilistic Risk Assessment in the Maintenance Process. Specific examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging have been identified.

  10. Managing aging in nuclear power plants: Insights from NRC`s Maintenance Team Inspection reports

    SciTech Connect

    Fresco, A.; Subudhi, M.

    1992-12-31

    A plant`s maintenance program is the principal vehicle through which age-related degradation is managed. From 1988 to 1991, the NRC evaluated the maintenance program of every nuclear power plant in the United States. Forty-four out of a total of sixty-seven of the reports issued on these in-depth team inspections have been reviewed for insights into the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear plant structures, systems, and components (SSCs). Relevant information has been extracted from these inspection reports sorted into several categories; including Specific Aging Insights, Preventive Maintenance, Predictive Maintenance and Condition Monitoring, Post Maintenance Testing, Failure Trending, Root Cause Analysis and Usage of Probabilistic Risk Assessment in the Maintenance Process. Specific examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging have been identified.

  11. Pilot study of INSIGHT therapy in African American women.

    PubMed

    Mynatt, Sarah; Wicks, Mona; Bolden, Lois

    2008-12-01

    The purpose of this pilot study was to determine if treatment with INSIGHT therapy, designed specifically for women, could reduce depressive and anxiety symptoms, hopelessness, and loneliness in African American women. Prevalence of mental illness differs in African Americans and Caucasians. The nonexperimental one-group pretest posttest design study examined the effectiveness of a 12-week INSIGHT group intervention. Due to the stigma of mental illness, groups met at an African American church. Reliability and validity of instruments were effectively demonstrated. Statistically significant difference was found in the level of depression but the study was underpowered to detect statistically significant differences in anxiety, hopelessness, and loneliness. Clinically significant improvement occurred for some participants in anxiety, hopelessness, and loneliness.

  12. Development and consideration of global policies for managing the future risks of poliovirus outbreaks: insights and lessons learned through modeling.

    PubMed

    Thompson, Kimberly M; Duintjer Tebbens, Radboud J; Pallansch, Mark A; Kew, Olen M; Sutter, Roland W; Aylward, R Bruce; Watkins, Margaret; Gary, Howard; Alexander, James P; Venczel, Linda; Johnson, Denise; Cáceres, Victor M; Sangrujee, Nalinee; Jafari, Hamid; Cochi, Stephen L

    2006-12-01

    The success of the Global Polio Eradication Initiative promises to bring large benefits, including sustained improvements in quality of life (i.e., cases of paralytic disease and deaths avoided) and costs saved from cessation of vaccination. Obtaining and maintaining these benefits requires that policymakers manage the transition from the current massive use of oral poliovirus vaccine (OPV) to a world without OPV and free of the risks of potential future reintroductions of live polioviruses. This article describes the analytical journey that began in 2001 with a retrospective case study on polio risk management and led to development of dynamic integrated risk, economic, and decision analysis tools to inform global policies for managing the risks of polio. This analytical journey has provided several key insights and lessons learned that will be useful to future analysts involved in similar complex decision-making processes.

  13. Managing aging in nuclear power plants: Insights from NRC maintenance team inspection reports

    SciTech Connect

    Fresco, A.; Subudhi, M.; Gunther, W.; Grove, E.; Taylor, J.

    1993-12-01

    A plant`s maintenance program is the principal vehicle through which age-related degradation is managed. From 1988 to 1991, the NRC evaluated the maintenance program of every nuclear power plant in the United States. Forty-four out of a total of 67 of the reports issued on these in-depth team inspections were reviewed for insights into the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear plant systems, structures, and components. Relevant information was extracted from these inspection reports and sorted into several categories, including Specific Aging Insights, Preventive Maintenance, Predictive Maintenance and Condition Monitoring, Post Maintenance Testing, Failure Trending, Root Cause Analysis and Usage of Probabilistic Risk Assessment in the Maintenance Process. Specific examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging have been identified. The information also was sorted according to systems and components, including: Auxiliary Feedwater, Main Feedwater, High Pressure Injection for both BWRs and PWRs, Service Water, Instrument Air, and Emergency Diesel Generator Air Start Systems, and Emergency Diesel Generators Air Start Systems, emergency diesel generators, electrical components such as switchgear, breakers, relays, and motor control centers, motor operated valves and check valves. This information was compared to insights gained from the Nuclear Plant Aging Research (NPAR) Program. Attributes of plant maintenance programs where the NRC inspectors felt that improvement was needed to properly address the aging issue also are discussed.

  14. Using economic instruments to develop effective management of invasive species: insights from a bioeconomic model.

    PubMed

    McDermott, Shana M; Irwin, Rebecca E; Taylor, Brad W

    2013-07-01

    critical. To accomplish the management and enforcement of these economic policies, we discuss modification of existing agencies and infrastructure. Finally, a sensitivity analysis revealed that lowering the economic cost of invader removal would strongly increase the probability of invader eradication. Taken together, our results provide quantitative insight into management decisions and economic policy instruments that can encourage invasive species removal across a social landscape.

  15. The Science Manager's Guide to Case Studies

    SciTech Connect

    Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.; Vallario, Robert W.

    2001-09-24

    This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.

  16. Data base management study

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Data base management techniques and applicable equipment are described. Recommendations which will assist potential NASA data users in selecting and using appropriate data base management tools and techniques are presented. Classes of currently available data processing equipment ranging from basic terminals to large minicomputer systems were surveyed as they apply to the needs of potential SEASAT data users. Cost and capabilities projections for this equipment through 1985 were presented. A test of a typical data base management system was described, as well as the results of this test and recommendations to assist potential users in determining when such a system is appropriate for their needs. The representative system tested was UNIVAC's DMS 1100.

  17. Is creative insight task-specific? A coordinate-based meta-analysis of neuroimaging studies on insightful problem solving.

    PubMed

    Shen, Wangbing; Yuan, Yuan; Liu, Chang; Zhang, Xiaojiang; Luo, Jing; Gong, Zhe

    2016-12-01

    The question of whether creative insight varies across problem types has recently come to the forefront of studies of creative cognition. In the present study, to address the nature of creative insight, the coordinate-based activation likelihood estimation (ALE) technique was utilized to individually conduct three quantitative meta-analyses of neuroimaging experiments that used the compound remote associate (CRA) task, the prototype heuristic (PH) task and the Chinese character chunk decomposition (CCD) task. These tasks were chosen because they are frequently used to uncover the neurocognitive correlates of insight. Our results demonstrated that creative insight reliably activates largely non-overlapping brain regions across task types, with the exception of some shared regions: the CRA task mainly relied on the right parahippocampal gyrus, the superior frontal gyrus and the inferior frontal gyrus; the PH task primarily depended on the right middle occipital gyrus (MOG), the bilateral superior parietal lobule/precuneus, the left inferior parietal lobule, the left lingual gyrus and the left middle frontal gyrus; and the CCD task activated a broad cerebral network consisting of most dorsolateral and medial prefrontal regions, frontoparietal regions and the right MOG. These results provide the first neural evidence of the task dependence of creative insight. The implications of these findings for resolving conflict surrounding the different theories of creative cognition and for defining insight as a set of heterogeneous processes are discussed.

  18. Battling Carpal Tunnel Syndrome through Ergonomics: A Case Study of Texas A&M's Library Provides Insights and Answers.

    ERIC Educational Resources Information Center

    Thornton, Joyce K.

    1995-01-01

    Current library automation practices and new technologies have forced library managers to seek some means of reducing carpal tunnel syndrome, and a case study of Texas A&M's library provides insights. Highlights include identifying and assessing the injuries, adjusting work surfaces, testing and selecting new keyboards, and developing…

  19. Battling Carpal Tunnel Syndrome through Ergonomics: A Case Study of Texas A&M's Library Provides Insights and Answers.

    ERIC Educational Resources Information Center

    Thornton, Joyce K.

    1995-01-01

    Current library automation practices and new technologies have forced library managers to seek some means of reducing carpal tunnel syndrome, and a case study of Texas A&M's library provides insights. Highlights include identifying and assessing the injuries, adjusting work surfaces, testing and selecting new keyboards, and developing…

  20. Insights from human studies into the host defense against candidiasis.

    PubMed

    Filler, Scott G

    2012-04-01

    Candida spp. are the most common cause of mucosal and disseminated fungal infections in humans. Studies using mutant strains of mice have provided initial information about the roles of dectin-1, CARD9, and Th17 cytokines in the host defense against candidiasis. Recent technological advances have resulted in the identification of mutations in specific genes that predispose humans to develop candidal infection. The analysis of individuals with these mutations demonstrates that dectin-1 is critical for the host defense against vulvovaginal candidiasis and candidal colonization of the gastrointestinal tract. They also indicate that CARD9 is important for preventing both mucosal and disseminated candidiasis, whereas the Th17 response is necessary for the defense against mucocutaneous candidiasis. This article reviews the recent studies of genetic defects in humans that result in an increased susceptibility to candidiasis and discusses how these studies provide new insight into the host defense against different types of candidal infections.

  1. Orbital debris hazard insights from spacecraft anomalies studies

    NASA Astrophysics Data System (ADS)

    McKnight, Darren S.

    2016-09-01

    Since the dawning of the space age space operators have been tallying spacecraft anomalies and failures then using these insights to improve the space systems and operations. As space systems improved and their lifetimes increased, the anomaly and failure modes have multiplied. Primary triggers for space anomalies and failures include design issues, space environmental effects, and satellite operations. Attempts to correlate anomalies to the orbital debris environment have started as early as the mid-1990's. Early attempts showed tens of anomalies correlated well to altitudes where the cataloged debris population was the highest. However, due to the complexity of tracing debris impacts to mission anomalies, these analyses were found to be insufficient to prove causation. After the fragmentation of the Chinese Feng-Yun satellite in 2007, it was hypothesized that the nontrackable fragments causing anomalies in LEO would have increased significantly from this event. As a result, debris-induced anomalies should have gone up measurably in the vicinity of this breakup. Again, the analysis provided some subtle evidence of debris-induced anomalies but it was not convincing. The continued difficulty in linking debris flux to satellite anomalies and failures prompted the creation of a series of spacecraft anomalies and failure workshops to investigate the identified shortfalls. These gatherings have produced insights into why this process is not straightforward. Summaries of these studies and workshops are presented and observations made about how to create solutions for anomaly attribution, especially as it relates to debris-induced spacecraft anomalies and failures.

  2. Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study.

    PubMed

    Goodman, Shaun G; Nicolau, Jose C; Requena, Gema; Maguire, Andrew; Blankenberg, Stefan; Chen, Ji Yan; Granger, Christopher B; Grieve, Richard; Pocock, Stuart J; Simon, Tabassome; Yasuda, Satoshi; Vega, Ana Maria; Brieger, David

    2017-06-01

    To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions. Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904). 9225 patients were enrolled (median 1.8years) post-MI: 52% with prior ST-elevation MI, median age 67years, 24% women, 67% Caucasian, 55% had ≥2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥140/90mmHg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6years); continued DAPT >1year was highest (39%) in Asia-Pacific and lowest (12%) in Europe. Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  3. Right Hemispheric Dominance of Creative Insight: An Event-Related Potential Study

    ERIC Educational Resources Information Center

    Shen, Wangbing; Liu, Chang; Zhang, Xiaojiang; Zhao, Xiaojun; Zhang, Jing; Yuan, Yuan; Chen, Yalin

    2013-01-01

    The purpose of this study was to investigate the hemispheric effect of creative insight. This study used high-density ERPs to record participants' brain activity while they performed an insight task. Results showed that both insight solutions and incomprehension solutions elicited a more negative ERP deflection (N320~550) than noninsight solutions…

  4. Right Hemispheric Dominance of Creative Insight: An Event-Related Potential Study

    ERIC Educational Resources Information Center

    Shen, Wangbing; Liu, Chang; Zhang, Xiaojiang; Zhao, Xiaojun; Zhang, Jing; Yuan, Yuan; Chen, Yalin

    2013-01-01

    The purpose of this study was to investigate the hemispheric effect of creative insight. This study used high-density ERPs to record participants' brain activity while they performed an insight task. Results showed that both insight solutions and incomprehension solutions elicited a more negative ERP deflection (N320~550) than noninsight solutions…

  5. Disease impact and patient insight--a study on a local population of asthmatics.

    PubMed

    Ahmad, N S; Chan, M Y; Hiew, F L; Sharif, S A; Vijayasingham, P; Thayaparan, T; Loh, L C

    2003-10-01

    The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.

  6. Management systems research study

    NASA Technical Reports Server (NTRS)

    Bruno, A. V.

    1975-01-01

    The development of a Monte Carlo simulation of procurement activities at the NASA Ames Research Center is described. Data cover: simulation of the procurement cycle, construction of a performance evaluation model, examination of employee development, procedures and review of evaluation criteria for divisional and individual performance evaluation. Determination of the influences and apparent impact of contract type and structure and development of a management control system for planning and controlling manpower requirements.

  7. Unifying niche shift studies: insights from biological invasions.

    PubMed

    Guisan, Antoine; Petitpierre, Blaise; Broennimann, Olivier; Daehler, Curtis; Kueffer, Christoph

    2014-05-01

    Assessing whether the climatic niche of a species may change between different geographic areas or time periods has become increasingly important in the context of ongoing global change. However, approaches and findings have remained largely controversial so far, calling for a unification of methods. Here, we build on a review of empirical studies of invasion to formalize a unifying framework that decomposes niche change into unfilling, stability, and expansion situations, taking both a pooled range and range-specific perspective on the niche, while accounting for climatic availability and climatic analogy. This framework provides new insights into the nature of climate niche shifts and our ability to anticipate invasions, and may help in guiding the design of experiments for assessing causes of niche changes.

  8. Managing 'difficult emotions' and family life: exploring insights and social support within online self-management training.

    PubMed

    Sanders, C; Rogers, A; Gardner, C; Kennedy, A

    2011-06-01

    Previous research has demonstrated how the Internet can foster emotional support and provide a 'private' space for discussing sensitive issues. Whilst the family has been located as a primary source of support, empirical research on the dynamics of close personal relationships in chronic illness experience remains a challenge. To explore the role of family relationships in supporting self-care and the nature of social support exchanged within an online self-management training course. Qualitative thematic and narrative analysis of online discussion boards. Postings for 218 participants, divided between 11 groups were included for a course section that focused on 'difficult emotions'. Participants exchanged a high degree of emotional support and revealed much about their 'real life' relationships. The latter highlighted the complexities of managing illness within family contexts alongside additional pressures of daily life such as caring commitments and work roles. The private interactive space created within the course allowed insights into the dynamics of family life associated with illness management that are challenging to research. Simultaneously, collective support was developed amongst this group of predominantly working women. The article points to the implications for such interventions and associated evaluative research beyond this selective group.

  9. USDA Climate Hubs - delivering usable information and tools to farmers, ranchers and forest land managers - Communication insights from the Regions

    NASA Astrophysics Data System (ADS)

    Johnson, R.; Steele, R.

    2016-12-01

    The USDA Climate Hubs were established in 2014 to develop and deliver science-based, region-specific information and technologies, with USDA agencies and partners, to agricultural and natural resource managers to enable climate-informed decision-making. In the two and half years of existence, our regional leads have gained insights into communicating with the agricultural and forestry communities throughout the different regions of the country. Perspectives differ somewhat among regions and sectors. This talk will share those various insights.

  10. Insight and Action Analytics: Three Case Studies to Consider

    ERIC Educational Resources Information Center

    Milliron, Mark David; Malcolm, Laura; Kil, David

    2014-01-01

    Civitas Learning was conceived as a community of practice, bringing together forward-thinking leaders from diverse higher education institutions to leverage insight and action analytics in their ongoing efforts to help students learn well and finish strong. We define insight and action analytics as drawing, federating, and analyzing data from…

  11. Program management model study

    NASA Technical Reports Server (NTRS)

    Connelly, J. J.; Russell, J. E.; Seline, J. R.; Sumner, N. R., Jr.

    1972-01-01

    Two models, a system performance model and a program assessment model, have been developed to assist NASA management in the evaluation of development alternatives for the Earth Observations Program. Two computer models were developed and demonstrated on the Goddard Space Flight Center Computer Facility. Procedures have been outlined to guide the user of the models through specific evaluation processes, and the preparation of inputs describing earth observation needs and earth observation technology. These models are intended to assist NASA in increasing the effectiveness of the overall Earth Observation Program by providing a broader view of system and program development alternatives.

  12. A qualitative insight into self-management experience among Chinese breast cancer survivors.

    PubMed

    Cheng, Huilin; Sit, Janet W H; Cheng, Karis K F

    2017-07-01

    With increasing awareness in the chronic nature of cancer, promoting the engagement of breast cancer survivors in self-management has become a priority of cancer care reform initiatives. This study aimed to reveal Chinese breast cancer survivors' views and experiences of self-management in extended survivorship. Archived interview transcripts from 19 breast cancer survivors (<5 years since diagnosis) were subjected to a secondary analysis. Each transcript was re-examined through qualitative content analysis. Three categories were established to represent the perceptions of the participants on their self-management tasks related to health and well-being, emotions, and roles and relationships. Managing health and well-being covers modifying lifestyle, taking traditional Chinese medicine, attending regular follow-ups, managing symptoms, and adhering to hormonal therapy. Managing emotions involves maintaining a positive attitude and utilizing supportive resources. Managing roles and relationships comprises adjusting to life as cancer survivors, maintaining marital relationships, and performing familial and other social roles. Most participants actively participated in various self-management tasks and behaviors that can help improve their health and prevent cancer recurrence. They may exhibit optimal self-management in their emotions and most health aspects but may exert limited efforts in managing their different roles during survivorship. Copyright © 2016 John Wiley & Sons, Ltd.

  13. Optimising qualitative longitudinal analysis: Insights from a study of traumatic brain injury recovery and adaptation.

    PubMed

    Fadyl, Joanna K; Channon, Alexis; Theadom, Alice; McPherson, Kathryn M

    2017-04-01

    Knowledge about aspects that influence recovery and adaptation in the postacute phase of disabling health events is key to understanding how best to provide appropriate rehabilitation and health services. Qualitative longitudinal research makes it possible to look for patterns, key time points and critical moments that could be vital for interventions and supports. However, strategies that support robust data management and analysis for longitudinal qualitative research in health-care are not well documented in the literature. This article reviews three challenges encountered in a large longitudinal qualitative descriptive study about experiences of recovery and adaptation after traumatic brain injury in New Zealand, and the strategies and technologies used to address them. These were (i) tracking coding and analysis decisions during an extended analysis period; (ii) navigating interpretations over time and in response to new data; and (iii) exploiting data volume and complexity. Concept mapping during coding review, a considered combination of information technologies, employing both cross-sectional and narrative analysis, and an expectation that subanalyses would be required for key topics helped us manage the study in a way that facilitated useful and novel insights. These strategies could be applied in other qualitative longitudinal studies in healthcare inquiry to optimise data analysis and stimulate important insights. © 2016 John Wiley & Sons Ltd.

  14. Sustainable management for rangelands in a variable climate: evidence and insights from northern Australia.

    PubMed

    O'Reagain, P J; Scanlan, J C

    2013-03-01

    Inter-annual rainfall variability is a major challenge to sustainable and productive grazing management on rangelands. In Australia, rainfall variability is particularly pronounced and failure to manage appropriately leads to major economic loss and environmental degradation. Recommended strategies to manage sustainably include stocking at long-term carrying capacity (LTCC) or varying stock numbers with forage availability. These strategies are conceptually simple but difficult to implement, given the scale and spatial heterogeneity of grazing properties and the uncertainty of the climate. This paper presents learnings and insights from northern Australia gained from research and modelling on managing for rainfall variability. A method to objectively estimate LTCC in large, heterogeneous paddocks is discussed, and guidelines and tools to tactically adjust stocking rates are presented. The possible use of seasonal climate forecasts (SCF) in management is also considered. Results from a 13-year grazing trial in Queensland show that constant stocking at LTCC was far more profitable and largely maintained land condition compared with heavy stocking (HSR). Variable stocking (VAR) with or without the use of SCF was marginally more profitable, but income variability was greater and land condition poorer than constant stocking at LTCC. Two commercial scale trials in the Northern Territory with breeder cows highlighted the practical difficulties of variable stocking and provided evidence that heavier pasture utilisation rates depress reproductive performance. Simulation modelling across a range of regions in northern Australia also showed a decline in resource condition and profitability under heavy stocking rates. Modelling further suggested that the relative value of variable v. constant stocking depends on stocking rate and land condition. Importantly, variable stocking may possibly allow slightly higher stocking rates without pasture degradation. Enterprise

  15. An Insight into Communication Barriers between Bank Managers and their Customers.

    ERIC Educational Resources Information Center

    Golen, Steven

    1987-01-01

    The study attempted to identify specific industry-related communication problems of bank managers. A questionnaire was completed by 193 managers identifying perceived communication barriers and relative importance of each. Resistance to change and tendency not to listen were considered serious barriers. (CH)

  16. Cognitive insight in schizophrenia patients and their biological parents: a pilot study.

    PubMed

    Raffard, Stéphane; Bortolon, Catherine; Macgregor, Alexandra; Norton, Joanna; Boulenger, Jean-Philippe; El Haj, Mohamad; Capdevielle, Delphine

    2014-11-01

    Clinical insight in schizophrenia patients is partly associated with familial environment but has been poorly studied to date. We aimed to explore (1) the relationship between parents' cognitive insight and their offspring's; (2) the relationship between parents' cognitive insight and their clinical insight into the disease of their offspring; and (3) the clinical and cognitive determinants of cognitive insight in parents. Cognitive insight was assessed in 37 patient-biological parent pairs/dyads with the Beck Cognitive Insight Scale (BCIS). Other measures included the Scale to assess Unawareness of Mental Disorder and cognitive assessments. We found no significant association between parents' cognitive insight and their offspring's. Conversely, a positive association between parents' cognitive insight and parents' insight into their offspring's symptoms was found. Better awareness of their offspring's specific symptoms was associated with lower levels of overconfidence in one's beliefs and with BCIS total score. BCIS Self-Certainty and BCIS total score were associated with better executive functioning and verbal comprehension. Better insight into their offspring's symptoms is associated with cognitive insight in biological parents of schizophrenia patients. Our results support the integration of cognitive intervention targeting parents' cognitive flexibility in family psychoeducational programs and provide an important first step towards developing a more refined understanding of the factors involved in insight into symptoms of illness in parents of schizophrenia patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. New Insights into the Surgical Management of Tetralogy of Fallot: Physiological Fundamentals and Clinical Relevance.

    PubMed

    Bove, Thierry; François, Katrien; De Wolf, Daniel

    2015-01-01

    The surgical treatment of tetralogy of Fallot can be considered as a success story in the history of congenital heart diseases. Since the early outcome is no longer the main issue, the focus moved to the late sequelae of TOF repair, i.e. the pulmonary insufficiency and the secondary adaptation of the right ventricle. This review provides recent insights into the pathophysiological alterations of the right ventricle in relation to the reconstruction of the right ventricular outflow tract after repair of tetralogy of Fallot. Its clinical relevance is documented by addressing the policy changes regarding the optimal management at the time of surgical repair as well as properly defining criteria and timing for late pulmonary valve implantation.

  18. Obesity and cancer: mechanistic insights from transdisciplinary studies

    PubMed Central

    Allott, Emma H.; Hursting, Stephen D.

    2015-01-01

    Obesity is associated with a range of health outcomes that are of clinical and public health significance, including cancer. Herein, we summarize epidemiologic and preclinical evidence for an association between obesity and increased risk of breast and prostate cancer incidence and mortality. Moreover, we describe data from observational studies of weight change in humans and from calorie restriction studies in mouse models which support a potential role for weight loss in counteracting tumor-promoting properties of obesity in breast and prostate cancers. Given that weight loss is challenging to achieve and maintain, we also consider evidence linking treatments for obesity-associated co-morbidities, including metformin, statins and non-steroidal anti-inflammatory drugs, with reduced breast and prostate cancer incidence and mortality. Finally, we highlight several challenges that should be considered when conducting epidemiologic and preclinical research in the area of obesity and cancer, including the measurement of obesity in population-based studies, the timing of obesity and weight change in relation to tumor latency and cancer diagnosis, and the heterogeneous nature of obesity and its associated co-morbidities. Given that obesity is a complex trait, comprised of behavioral, epidemiologic and molecular/metabolic factors, we argue that a transdisciplinary approach is the key to understanding the mechanisms linking obesity and cancer. As such, this review highlights the critical need to integrate evidence from both epidemiologic and preclinical studies to gain insight into both biologic and non-biologic mechanisms contributing to the obesity-cancer link. PMID:26373570

  19. Management of Federally Sponsored Libraries: Case Studies and Analysis.

    ERIC Educational Resources Information Center

    Missar, Charles D., Ed.

    This book provides insight into how managers of federally sponsored libraries view their roles and carry out their duties. Seven federally supported libraries were selected to serve as case studies. These libraries represent a cross-section of various types, and the nine chapters are written by librarians from these facilities. The discussion…

  20. Management of Federally Sponsored Libraries: Case Studies and Analysis.

    ERIC Educational Resources Information Center

    Missar, Charles D., Ed.

    This book provides insight into how managers of federally sponsored libraries view their roles and carry out their duties. Seven federally supported libraries were selected to serve as case studies. These libraries represent a cross-section of various types, and the nine chapters are written by librarians from these facilities. The discussion…

  1. A study of poor insight in social anxiety disorder.

    PubMed

    Vigne, Paula; de Menezes, Gabriela B; Harrison, Ben J; Fontenelle, Leonardo F

    2014-11-30

    We investigated levels of insight among patients with Social Anxiety Disorder (SAD) as compared to patients with Obsessive-Compulsive Disorder (OCD) and evaluated whether levels of insight in SAD were related to specific sociodemographic and/or clinical features. Thirty-seven SAD patients and 51 OCD patients attending a tertiary obsessive-compulsive and anxiety disorders clinic were assessed with a sociodemographic and clinical questionnaire, a structured diagnostic interview, the Brown Assessment of Beliefs Scale (BABS), the Social Phobia Inventory (SPIN), the Beck Depression Inventory (BDI), the Sheehan Disability Scale (SDS), and the Treatment Adherence Survey-patient version (TAS-P). According to the BABS, SAD patients exhibited insight levels that were as low as those exhibited by OCD patients, with up to 29.7% of them being described as "poor insight" SAD. Although poor insight SAD patients were more frequently married, less depressed and displayed a statistical trend towards greater rates of early drop-out from cognitive-behavioral therapy, their insight levels were not associated with other variables of interest, including sex, age, employment, age at onset, duration of illness, associated psychiatric disorders, SPIN and SDS scores. Patients with poor insight SAD might perceive their symptoms as being less distressful and thus report fewer depressive symptoms and high rates of treatment non-adherence. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Records management modernization study

    SciTech Connect

    Kadec, S.; Hill, L.G.; Riemer, C.A.

    1989-12-01

    The Department of Veterans Affairs (VA) has a single purpose or mission: to provide benefits to the veterans of the nation. Most of these benefits are provided through its medical and health facilities located around the country: the hospitals, nursing homes, and clinics that give medical examinations and provide long-term care or hospitalization. A second sizeable program managed by the Veterans Benefit Administration (VBA) gives pensions, benefits for disability and education, insurance, and home loans to those veterans eligible under law and specific service conditions. In support of the benefits programs, VA staff in the regional offices (ROs) receive and create a large amount of documentation. This documentation supports the award or disallowance of benefits by providing the information necessary to determine eligibility and the amount of the award. This paperwork, which is necessary to document actions and support the appeals process, creates a huge record-keeping problem for the ROs. 6 tabs.

  3. The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study.

    PubMed

    Kureshi, Faraz; Shafiq, Ali; Arnold, Suzanne V; Gosch, Kensey; Breeding, Tracie; Kumar, Ashwath S; Jones, Philip G; Spertus, John A

    2017-01-01

    Although eliminating angina is a primary goal in treating patients with chronic coronary artery disease (CAD), few contemporary data quantify prevalence and severity of angina across US cardiology practices. The authors hypothesized that angina among outpatients with CAD managed by US cardiologists is low and its prevalence varies by site. Among 25 US outpatient cardiology clinics enrolled in the American College of Cardiology Practice Innovation and Clinical Excellence (PINNACLE) registry, we prospectively recruited a consecutive sample of patients with chronic CAD over a 1- to 2-week period at each site between April 2013 and July 2015, irrespective of the reason for their appointment. Eligible patients had documented history of CAD (prior acute coronary syndrome, prior coronary revascularization procedure, or diagnosis of stable angina) and ≥1 prior office visit at the practice site. Angina was assessed directly from patients using the Seattle Angina Questionnaire Angina Frequency score. Among 1257 patients from 25 sites, 7.6% (n = 96) reported daily/weekly, 25.1% (n = 315) monthly, and 67.3% (n = 846) no angina. The proportion of patients with daily/weekly angina at each site ranged from 2.0% to 24.0%, but just over half (56.3%) were on ≥2 antianginal medications, with wide variability across sites (0%-100%). One-third of outpatients with chronic CAD managed by cardiologists report having angina in the prior month, and 7.6% have frequent symptoms. Among those with frequent angina, just over half were on ≥2 antianginal medications, with wide variability across sites. These findings suggest an opportunity to improve symptom control. © 2016 Wiley Periodicals, Inc.

  4. New insights into the molecular diagnosis and management of heritable thoracic aortic aneurysms and dissections.

    PubMed

    Campens, Laurence; Renard, Marjolijn; Callewaert, Bert; Coucke, Paul; De Backer, Julie; De Paepe, Anne

    2013-01-01

    Since the identification of the fibrillin‑1 gene as the causal gene for Marfan syndrome, our knowledge of molecular genetics and the applicability of genetic testing for heritable thoracic aneurysms and dissections (H-TAD) in clinical practice have increased substantially. Several new syndromes related to H-TAD have been described and the list of mutated genes in syndromal and nonsyndromal H-TAD is rapidly expanding. This knowledge has led to a significant improvement of our insight into the underlying pathophysiology of H-TAD resulting in new opportunities for targeted treatment, as well as in improved risk stratification. Clinicians involved in the care for H-TAD patients require a basic knowledge of the disease entities and need to be correctly informed on the applicability of genetic testing in their patients and families. Gene‑tailored treatment and management should now be considered as part of good clinical practice. We provide a systematic overview of genetic H-TAD entities and practical recommendations for genetic testing and patient management.

  5. Ecosystem Services Insights into Water Resources Management in China: A Case of Xi’an City

    PubMed Central

    Liu, Jingya; Li, Jing; Gao, Ziyi; Yang, Min; Qin, Keyu; Yang, Xiaonan

    2016-01-01

    Global climate and environmental changes are endangering global water resources; and several approaches have been tested to manage and reduce the pressure on these decreasing resources. This study uses the case study of Xi’an City in China to test reasonable and effective methods to address water resource shortages. The study generated a framework combining ecosystem services and water resource management. Seven ecosystem indicators were classified as supply services, regulating services, or cultural services. Index values for each indicator were calculated, and based on questionnaire results, each index’s weight was calculated. Using the Likert method, we calculated ecosystem service supplies in every region of the city. We found that the ecosystem’s service capability is closely related to water resources, providing a method for managing water resources. Using Xi’an City as an example, we apply the ecosystem services concept to water resources management, providing a method for decision makers. PMID:27886137

  6. Ecosystem Services Insights into Water Resources Management in China: A Case of Xi'an City.

    PubMed

    Liu, Jingya; Li, Jing; Gao, Ziyi; Yang, Min; Qin, Keyu; Yang, Xiaonan

    2016-11-24

    Global climate and environmental changes are endangering global water resources; and several approaches have been tested to manage and reduce the pressure on these decreasing resources. This study uses the case study of Xi'an City in China to test reasonable and effective methods to address water resource shortages. The study generated a framework combining ecosystem services and water resource management. Seven ecosystem indicators were classified as supply services, regulating services, or cultural services. Index values for each indicator were calculated, and based on questionnaire results, each index's weight was calculated. Using the Likert method, we calculated ecosystem service supplies in every region of the city. We found that the ecosystem's service capability is closely related to water resources, providing a method for managing water resources. Using Xi'an City as an example, we apply the ecosystem services concept to water resources management, providing a method for decision makers.

  7. Obesity and cancer: mechanistic insights from transdisciplinary studies.

    PubMed

    Allott, Emma H; Hursting, Stephen D

    2015-12-01

    Obesity is associated with a range of health outcomes that are of clinical and public health significance, including cancer. Herein, we summarize epidemiologic and preclinical evidence for an association between obesity and increased risk of breast and prostate cancer incidence and mortality. Moreover, we describe data from observational studies of weight change in humans and from calorie-restriction studies in mouse models that support a potential role for weight loss in counteracting tumor-promoting properties of obesity in breast and prostate cancers. Given that weight loss is challenging to achieve and maintain, we also consider evidence linking treatments for obesity-associated co-morbidities, including metformin, statins and non-steroidal anti-inflammatory drugs, with reduced breast and prostate cancer incidence and mortality. Finally, we highlight several challenges that should be considered when conducting epidemiologic and preclinical research in the area of obesity and cancer, including the measurement of obesity in population-based studies, the timing of obesity and weight change in relation to tumor latency and cancer diagnosis, and the heterogeneous nature of obesity and its associated co-morbidities. Given that obesity is a complex trait, comprised of behavioral, epidemiologic and molecular/metabolic factors, we argue that a transdisciplinary approach is the key to understanding the mechanisms linking obesity and cancer. As such, this review highlights the critical need to integrate evidence from both epidemiologic and preclinical studies to gain insight into both biologic and non-biologic mechanisms contributing to the obesity-cancer link. © 2015 Society for Endocrinology.

  8. Hydraulic fracturing: insights from field, lab, and numerical studies

    NASA Astrophysics Data System (ADS)

    Walsh, S. D.; Johnson, S.; Fu, P.; Settgast, R. R.

    2011-12-01

    Hydraulic fracturing has become an increasingly important technique in stimulating reservoirs for gas, oil, and geothermal energy production. In use commercially since the 1950's, the technique has been widely lauded, when combined with other techniques, for enabling the development of shale gas resources in the United States, providing a valuable and extensive source of domestic energy. However, the technique has also drawn a degree of notoriety from high-profile incidents involving contamination of drinking water associated with gas extraction operations in the Marcellus shale region. This work highlights some of the insights on the behavior of subsurface hydraulic fracturing operations that have been derived from field and laboratory observations as well as from numerical simulations. The sensitivity of fracture extent and orientation to parameters such as matrix material heterogeneity, presence and distribution of discontinuities, and stress orientation is of particular interest, and we discuss this in the context of knowledge derived from both observation and simulation. The limitations of these studies will also be addressed in terms of resolution, uncertainty, and assumptions as well as the balance of fidelity to cost, both in computation time (for numerical studies) and equipment / operation cost (for observational studies). We also identify a number of current knowledge gaps and propose alternatives for addressing those gaps. We especially focus on the role of numerical studies for elucidating key concepts and system sensitivities. The problem is inherently multi-scale in both space and time as well as highly coupled hydromechanically, and, in several applications, thermally as well. We will summarize the developments to date in analyzing these systems and present an approach for advancing the capabilities of our models in the short- to long-term and how these advances can help provide solutions to reduce risk and improve efficiency of hydraulic fracturing

  9. Regression of Atherosclerosis: Insights from Animal and Clinical Studies

    PubMed Central

    Feig, Jonathan E.

    2014-01-01

    Based on studies that extend back to the 1920s, regression and stabilization of atherosclerosis in humans has gone from just a dream to one that is achievable. Review of the literature indicates that the successful attempts at regression generally applied robust measures to improve plasma lipoprotein profiles. Examples include extensive lowering of plasma concentrations of atherogenic apolipoprotein B and enhancement of reverse cholesterol transport from atheromata to the liver. Possible mechanisms responsible for lesion shrinkage include decreased retention of atherogenic apolipoprotein B within the arterial wall, efflux of cholesterol and other toxic lipids from plaques, emigration of lesional foam cells out of the arterial wall, and influx of healthy phagocytes that remove necrotic debris as well as other components of the plaque. However, currently available clinical agents cause less dramatic changes in plasma lipoprotein levels, and thereby fail to stop most cardiovascular events. There is, therefore, a clear need for preclinical and clinical testing of new agents expected to facilitate atherosclerosis regression with the hope that additional mechanistic insights will allow further progress. PMID:24751561

  10. Insights from protein-protein interaction studies on bacterial pathogenesis.

    PubMed

    Gagarinova, Alla; Phanse, Sadhna; Cygler, Miroslaw; Babu, Mohan

    2017-09-01

    The threat bacterial pathogens pose to human health is increasing with the number and distribution of antibiotic-resistant bacteria, while the rate of discovery of new antimicrobials dwindles. Proteomics is playing key roles in understanding the molecular mechanisms of bacterial pathogenesis, and in identifying disease outcome determinants. The physical associations identified by proteomics can provide the means to develop pathogen-specific treatment methods that reduce the spread of antibiotic resistance and alleviate the negative effects of broad-spectrum antibiotics on beneficial bacteria. Areas covered: This review discusses recent trends in proteomics and introduces new and developing approaches that can be applied to the study of protein-protein interactions (PPIs) underlying bacterial pathogenesis. The approaches examined encompass options for mapping proteomes as well as stable and transient interactions in vivo and in vitro. We also explored the coverage of bacterial and human-bacterial PPIs, knowledge gaps in this area, and how they can be filled. Expert commentary: Identifying potential antimicrobial candidates is confounded by the complex molecular biology of bacterial pathogenesis and the lack of knowledge about PPIs underlying this process. Proteomics approaches can offer new perspectives for mechanistic insights and identify essential targets for guiding the discovery of next generation antimicrobials.

  11. Laboratory Studies of Vibrational Relaxation: Important Insights for Mesospheric OH

    NASA Astrophysics Data System (ADS)

    Kalogerakis, K. S.; Matsiev, D.

    2016-12-01

    The hydroxyl radical has a key role in the chemistry and energetics of the Earth's middle atmosphere. A detailed knowledge of the rate constants and relevant pathways for OH(high v) vibrational relaxation by atomic and molecular oxygen and their temperature dependence is absolutely critical for understanding mesospheric OH and extracting reliable chemical heating rates from atmospheric observations. We have developed laser-based experimental approaches to study the complex collisional energy transfer processes involving the OH radical and other relevant atmospheric species. Previous work in our laboratory indicated that the total removal rate constant for OH(v = 9) + O at room temperature is more than one order of magnitude larger than that for removal by O2. Thus, O atoms are expected to significantly influence the intensity and vibrational distribution extracted from the Meinel OH(v) emissions. We will report our most recent laboratory experiments that corroborate the aforementioned result for fast OH(v = 9) + O and provide important new insights on the mechanistic pathways involved. We will also highlight relevant atmospheric implications, including warranted revisions of current mesospheric OH models. Research supported by SRI International Internal R&D and NSF Aeronomy grant AGS-1441896. Previously supported by NASA Geospace Science grant NNX12AD09G.

  12. Laboratory Studies of Vibrational Relaxation: Important Insights for Mesospheric OH

    NASA Astrophysics Data System (ADS)

    Kalogerakis, Konstantinos S.; Matsiev, Daniel

    2016-04-01

    The hydroxyl radical has a key role in the chemistry and energetics of the Earth's middle atmosphere. A detailed knowledge of the rate constants and relevant pathways for OH(high v) vibrational relaxation by atomic and molecular oxygen and their temperature dependence is absolutely critical for understanding mesospheric OH and extracting reliable chemical heating rates from atmospheric observations. We have developed laser-based experimental approaches to study the complex collisional energy transfer processes involving the OH radical and other relevant atmospheric species. Previous work in our laboratory indicated that the total removal rate constant for OH(v = 9) + O at room temperature is more than one order of magnitude larger than that for removal by O2. Thus, O atoms are expected to significantly influence the intensity and vibrational distribution extracted from the Meinel OH(v) emissions. We will report our most recent laboratory experiments that corroborate the aforementioned result for OH(v = 9) + O and provide important new insights on the mechanistic pathways involved. We will also highlight relevant atmospheric implications, including warranted revisions of current mesospheric OH models. Research supported by SRI International Internal R&D and NSF Aeronomy grant AGS-1441896. Previously supported by NASA Geospace Science grant NNX12AD09G.

  13. Testing the Efficacy of INSIGHTS on Student Disruptive Behavior, Classroom Management, and Student Competence in Inner City Primary Grades.

    PubMed

    McClowry, Sandra Graham; Snow, David L; Tamis-Lemonda, Catherine S; Rodriguez, Eileen T

    2010-03-01

    A prevention trial tested the efficacy of INSIGHTS into Children's Temperament as compared to a Read Aloud attention control condition in reducing student disruptive behavior and enhancing student competence and teacher classroom management. Participants included 116 first and second grade students, their parents, and their 42 teachers in six inner city schools. Teachers completed the Sutter-Eyberg Student Behavior Inventory (SESBI) and the Teacher's Rating Scale of Child's Actual Competence and Social Acceptance (TRS) at baseline and again upon completion of the intervention. Boys participating in INSIGHTS, compared with those in the Read Aloud program, showed a significant decline in attentional difficulties and overt aggression toward others. Teachers in INSIGHTS, compared to those in the attention control condition, reported significantly fewer problems managing the emotional-oppositional behavior, attentional difficulties, and covert disruptive behavior of their male students. They also perceived the boys as significantly more cognitively and physically competent.

  14. Insight into dementia care management using social-behavioral theory and mixed methods.

    PubMed

    Connor, Karen; McNeese-Smith, Donna; van Servellen, Gwen; Chang, Betty; Lee, Martin; Cheng, Eric; Hajar, Abdulrahman; Vickrey, Barbara G

    2009-01-01

    For health organizations (private and public) to advance their care-management programs, to use resources effectively and efficiently, and to improve patient outcomes, it is germane to isolate and quantify care-management activities and to identify overarching domains. The aims of this study were to identify and report on an application of mixed methods of qualitative statistical techniques, based on a theoretical framework, and to construct variables for factor analysis and exploratory factor analytic steps for identifying domains of dementia care management. Care-management activity data were extracted from the care plans of 181 pairs of individuals (with dementia and their informal caregivers) who had participated in the intervention arm of a randomized controlled trial of a dementia care-management program. Activities were organized into types, using card-sorting methods, influenced by published theoretical constructs on self-efficacy and general strain theory. These activity types were mapped in the initial data set to construct variables for exploratory factor analysis. Principal components extraction with varimax and promax rotations was used to estimate the number of factors. Cronbach's alpha was calculated for the items in each factor to assess internal consistency reliability. The two-phase card-sorting technique yielded 45 activity types out of 450 unique activities. Exploratory factor analysis produced four care-management domains (factors): behavior management, clinical strategies and caregiver support, community agency, and safety. Internal consistency reliability (Cronbach's alpha) of items for each factor ranged from.63 for the factor "safety" to.89 for the factor "behavior management" (Factor 1). Applying a systematic method to a large set of care-management activities can identify a parsimonious number of higher order categories of variables and factors to guide the understanding of dementia care-management processes. Further application of this

  15. Pathobiology and management of prostate cancer-induced bone pain: recent insights and future treatments.

    PubMed

    Muralidharan, Arjun; Smith, Maree T

    2013-10-01

    Prostate cancer (PCa) has a high propensity for metastasis to bone. Despite the availability of multiple treatment options for relief of PCa-induced bone pain (PCIBP), satisfactory relief of intractable pain in patients with advanced bony metastases is challenging for the clinicians because currently available analgesic drugs are often limited by poor efficacy and/or dose-limiting side effects. Rodent models developed in the past decade show that the pathobiology of PCIBP comprises elements of inflammatory, neuropathic and ischemic pain arising from ectopic sprouting and sensitization of sensory nerve fibres within PCa-invaded bones. In addition, at the cellular level, PCIBP is underpinned by dynamic cross talk between metastatic PCa cells, cellular components of the bone matrix, factors associated with the bone microenvironment as well as peripheral components of the somatosensory system. These insights are aligned with the clinical management of PCIBP involving use of a multimodal treatment approach comprising analgesic agents (opioids, NSAIDs), radiotherapy, radioisotopes, cancer chemotherapy agents and bisphosphonates. However, a major drawback of most rodent models of PCIBP is their short-term applicability due to ethical concerns. Thus, it has been difficult to gain insight into the mal(adaptive) neuroplastic changes occurring at multiple levels of the somatosensory system that likely contribute to intractable pain at the advanced stages of metastatic disease. Specifically, the functional responsiveness of noxious circuitry as well as the neurochemical signature of a broad array of pro-hyperalgesic mediators in the dorsal root ganglia and spinal cord of rodent models of PCIBP is relatively poorly characterized. Hence, recent work from our laboratory to develop a protocol for an optimized rat model of PCIBP will enable these knowledge gaps to be addressed as well as identification of novel targets for drug discovery programs aimed at producing new analgesics

  16. Testing the Efficacy of "INSIGHTS" on Student Disruptive Behavior, Classroom Management, and Student Competence in Inner City Primary Grades

    ERIC Educational Resources Information Center

    McClowry, Sandra Graham; Snow, David L.; Tamis-LeMonda, Catherine S.; Rodriguez, Eileen T.

    2010-01-01

    A prevention trial tested the efficacy of "INSIGHTS into Children's Temperament" as compared to a Read Aloud attention control condition in reducing student disruptive behavior and enhancing student competence and teacher classroom management. Participants included 116 first and second grade students, their parents, and their 42 teachers…

  17. Caffeine Awareness in Children: Insights from a Pilot Study

    PubMed Central

    Thakre, Tushar P.; Deoras, Ketan; Griffin, Catherine; Vemana, Aarthi; Podmore, Petra; Krishna, Jyoti

    2015-01-01

    consistently able to identify caffeine content or lack thereof in some common beverages. The results of this pilot study show that caffeine literacy in adolescents warrants further investigation and educational intervention. Citation: Thakre TP, Deoras K, Griffin C, Vemana A, Podmore P, Krishna J. Caffeine awareness in children: insights from a pilot study. J Clin Sleep Med 2015;11(7):741–746. PMID:25845895

  18. An Integrated Approach Is Needed for Ecosystem Based Fisheries Management: Insights from Ecosystem-Level Management Strategy Evaluation

    PubMed Central

    Fulton, Elizabeth A.; Smith, Anthony D. M.; Smith, David C.; Johnson, Penelope

    2014-01-01

    An ecosystem approach is widely seen as a desirable goal for fisheries management but there is little consensus on what strategies or measures are needed to achieve it. Management strategy evaluation (MSE) is a tool that has been widely used to develop and test single species fisheries management strategies and is now being extended to support ecosystem based fisheries management (EBFM). We describe the application of MSE to investigate alternative strategies for achieving EBFM goals for a complex multispecies fishery in southeastern Australia. The study was undertaken as part of a stakeholder driven process to review and improve the ecological, economic and social performance of the fishery. An integrated management strategy, involving combinations of measures including quotas, gear controls and spatial management, performed best against a wide range of objectives and this strategy was subsequently adopted in the fishery, leading to marked improvements in performance. Although particular to one fishery, the conclusion that an integrated package of measures outperforms single focus measures we argue is likely to apply widely in fisheries that aim to achieve EBFM goals. PMID:24454722

  19. An integrated approach is needed for ecosystem based fisheries management: insights from ecosystem-level management strategy evaluation.

    PubMed

    Fulton, Elizabeth A; Smith, Anthony D M; Smith, David C; Johnson, Penelope

    2014-01-01

    An ecosystem approach is widely seen as a desirable goal for fisheries management but there is little consensus on what strategies or measures are needed to achieve it. Management strategy evaluation (MSE) is a tool that has been widely used to develop and test single species fisheries management strategies and is now being extended to support ecosystem based fisheries management (EBFM). We describe the application of MSE to investigate alternative strategies for achieving EBFM goals for a complex multispecies fishery in southeastern Australia. The study was undertaken as part of a stakeholder driven process to review and improve the ecological, economic and social performance of the fishery. An integrated management strategy, involving combinations of measures including quotas, gear controls and spatial management, performed best against a wide range of objectives and this strategy was subsequently adopted in the fishery, leading to marked improvements in performance. Although particular to one fishery, the conclusion that an integrated package of measures outperforms single focus measures we argue is likely to apply widely in fisheries that aim to achieve EBFM goals.

  20. How does vineyard management intensity affect ecosystem services and disservices - insights from a meta-analysis

    NASA Astrophysics Data System (ADS)

    Winter, Silvia; Zaller, Johann G.; Kratschmer, Sophie; Pachinger, Bärbel; Strauss, Peter; Bauer, Thomas; Paredes, Daniel; Gómez, José A.; Guzmán, Gema; Landa, Blanca; Nicolai, Annegret; Burel, Francoise; Cluzeau, Daniel; Popescu, Daniela; Bunea, Claudiu-Ioan; Potthoff, Martin; Guernion, Muriel; Batáry, Péter

    2016-04-01

    Viticultural agro-ecosystems provide a range of different ecosystem services which are affected by management decisions of winegrowers. At the global scale, vineyards are often high intensity agricultural systems with bare soil or inter-row vegetation consisting of only a few plant species. These systems primarily aim at optimizing wine production by reducing competition for water and nutrients between grapevines and weeds and by preventing the outbreak of pests and diseases. At the same time, this kind of management is often associated with ecosystem disservices such as high rates of soil erosion, degradation of soil structure and fertility, contamination of groundwater and decline of biodiversity. Recently, several initiatives across the world tried to overcome detrimental effects of that management style by creating biodiversity friendly vineyards. The consequences of establishing divers cover crop mixes or tolerating spontaneous vegetation in vineyards for ecosystem services (including yield) overstretching local case studies has not been investigated yet. This meta-analysis will provide an overview of all published studies comparing the effects of different vineyard management practices on a range of different ecosystem services like biodiversity, pest control, pollination, soil conservation and carbon sequestration. The aggregated effect size will point out which management measures can provide the best overall net sum of ecosystem services. This meta-analysis is part of the transdisciplinary BiodivERsA project VineDivers and will ultimately lead into management and policy recommendations for various stakeholder groups engaged in viticulture.

  1. A management study template for learning about postwildfire management.

    Treesearch

    B.T. Bormann; J.A. Laurence; K. Shimamoto; J. Thrailkill; J. Lehmkuhl; G. Reeves; A. Markus; D.W. Peterson; E. Forsman

    2008-01-01

    The concept of management studies--implemented by managers as normal business to meet priority learning needs--is applied to a priority regional question: how to manage after a large wildfire to better meet preexisting or new societal needs. Because of a lack of knowledge and studies, deciding how to manage after wildfire is fraught with uncertainty. We have developed...

  2. Behavior Management in Preschool Classrooms: Insights Revealed through Systematic Observation and Interview

    ERIC Educational Resources Information Center

    Ritz, Mariah; Noltemeyer, Amity; Davis, Darrel; Green, Jennifer

    2014-01-01

    This mixed methods study examined behavior management strategies used by preschool teachers to address student noncompliance in the classroom. Specifically, the study aimed to (1) examine the methods that preschool teachers are currently using to respond to noncompliant behavior in their classrooms, (2) measure the frequency with which each…

  3. Behavior Management in Preschool Classrooms: Insights Revealed through Systematic Observation and Interview

    ERIC Educational Resources Information Center

    Ritz, Mariah; Noltemeyer, Amity; Davis, Darrel; Green, Jennifer

    2014-01-01

    This mixed methods study examined behavior management strategies used by preschool teachers to address student noncompliance in the classroom. Specifically, the study aimed to (1) examine the methods that preschool teachers are currently using to respond to noncompliant behavior in their classrooms, (2) measure the frequency with which each…

  4. Insights into the deep continental lithosphere from xenolith studies

    NASA Astrophysics Data System (ADS)

    Lee, C. A.; Rudnick, R. L.

    2006-12-01

    Studies of xenoliths provide a depth dimension to surface geology studies, and, in favorable circumstances, also provide the fourth dimension of time. In particular, geochemical studies of xenoliths provide insights into the processes that formed and modified the deep lithosphere (e.g., melting, metamorphism, fluid infiltration, basaltic underplating) and when they occurred. While xenoliths can provide a glimpse of the types of lithologies present at depth and how they formed, they cannot be assumed to be representative of the deep lithosphere, and inferences regarding the dominant lithologies present in the lower crust or upper mantle must be tempered by geophysical constraints on bulk physical properties of these regions. Mantle. Xenoliths from the lithospheric mantle are generally composed of peridotite, with lesser amounts of pyroxenite and/or eclogite. Equilibration T for these lithologies can generally be determined on the basis of two-pyroxene thermometery; precise depths of equilibration are much harder to estimate unless the samples contain garnet. The crystallization ages of mantle xenoliths are also usually difficult to constrain, as zircon is a rare phase in most upper mantle lithologies and most xenoliths have resided above the blocking temperature of other radiogenic isotope systems (Rb-Sr, Sm-Nd, Lu-Hf) for a significant fraction of their histories. The Re- Os isotope system provides arguably the best means of determining the crystallization age of mantle xenoliths, but, like most model age approaches, carries significant uncertainty. Crust. Xenoliths from the lower continental crust can be extremely heterogeneous in composition, but mafic compositions dominate in a number of regions. Equilibration T and P may determined from coexisting phases and, in some cases, thermal histories deduced from presence of frozen metamorphic reactions (e.g., coronas). The presence of zircon and other U-bearing accessory phases provides the opportunity to determine the

  5. Fostering acceptance of computerized physician order entry: insights from an implementation study.

    PubMed

    Muslin, Ivan S; Vardaman, James M; Cornell, Paul T

    2014-01-01

    Computerized physician order entry (CPOE) allows physicians to enter orders in a computer rather than handwriting them. Computerized physician order entry is touted as a major improvement in patient safety, and although the literature suggests that such systems have the potential to improve patient outcomes, studies also suggest that CPOE may have significant drawbacks that accompany those benefits. Physicians have often been resistant to accept its implementation. This study investigates the implementation of CPOE at a 217-bed rural hospital in the southeastern United States. Drawing on a mixed-method approach, we identify correlates of change acceptance and propose a set of recommendations for health care managers to foster acceptance of CPOE. Findings from physician surveys (n = 19) indicate that older physicians are less accepting of CPOE, but high-quality change communication may overcome resistance even among older physicians. With insights derived from the organizational change literature, findings bring to the fore a set of practices that managers can use to foster acceptance of CPOE. The thrust of these practices is that managers should make physicians active participants in fine-tuning CPOE within the unique needs and constraints of the local hospital setting.

  6. Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.

    PubMed

    Gomez-de-León, Andrés; Gómez-Almaguer, David; Ruiz-Delgado, Guillermo J; Ruiz-Arguelles, Guillermo J

    2017-09-01

    The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.

  7. Assessing surface water flood risk and management strategies under future climate change: Insights from an Agent-Based Model.

    PubMed

    Jenkins, K; Surminski, S; Hall, J; Crick, F

    2017-04-03

    Climate change and increasing urbanization are projected to result in an increase in surface water flooding and consequential damages in the future. In this paper, we present insights from a novel Agent Based Model (ABM), applied to a London case study of surface water flood risk, designed to assess the interplay between different adaptation options; how risk reduction could be achieved by homeowners and government; and the role of flood insurance and the new flood insurance pool, Flood Re, in the context of climate change. The analysis highlights that while combined investment in property-level flood protection and sustainable urban drainage systems reduce surface water flood risk, the benefits can be outweighed by continued development in high risk areas and the effects of climate change. In our simulations, Flood Re is beneficial in its function to provide affordable insurance, even under climate change. However, the scheme does face increasing financial pressure due to rising surface water flood damages. If the intended transition to risk-based pricing is to take place then a determined and coordinated strategy will be needed to manage flood risk, which utilises insurance incentives, limits new development, and supports resilience measures. Our modelling approach and findings are highly relevant for the ongoing regulatory and political approval process for Flood Re as well as for wider discussions on the potential of insurance schemes to incentivise flood risk management and climate adaptation in the UK and internationally.

  8. Management studies in medical education.

    PubMed

    Noor Ghani, S; Saimy, I

    2005-08-01

    In 1977, the World Health Assembly (WHA) set the social target--the "Health For All" goal and in 1995, urged member states to "re-orientate medical education and medical practice for "Health For All" (resolution WHA 48.8). This led to World Health Organisation to enunciate the "5-star doctor" needing skills in healthcare management, quality assurance and health economics. The Faculty of Medicine, University of Malaya introduced the New Integrated Curriculum (NIC) in 1995. The objective was aimed at producing a competent doctor with a holistic approach to the practice of medicine. This was to be achieved by having 3 strands of studies i.e. The Scientific Basis of Medicine (SBM), the Doctor, Patient, Health and Society (DPHS), and Personal and Professional Development (PPD) over the 5-year programme, split into 3 phases. Elements of the "5-star doctor" were introduced in strand 2--DPHS and strand 3--PPD. Management studies were introduced in the Personal and Professional Development (PPD) strand. This led to an instructional module--"Principles of Management in Health Care Services (PMGT)" comprising of the Management of Self, Resources and People and incorporating a three week field programme. Evaluation is undertaken at the end of the phase IIIA of the studies. This NIC approach will be able to produce a "5-star doctor", a team player, leader, communicator and an effective manager.

  9. Fostering sustainable operations in a natural resource management agency: insights from the field

    Treesearch

    Patricia L. Winter; Shawn M. Burn

    2010-01-01

    Sustainable operations (SO; operating in an environmentally, economically, and socially sustainable manner) is consistent with the environmental stewardship mission of natural resource management organizations. This study sought to examine SO practices in the daily work lives of US Forest Service employees, including those primarily stationed in the office and in the...

  10. The Field of Educational Management: Some Intellectual Insights from the 2007 BELMAS National Conference

    ERIC Educational Resources Information Center

    Oplatka, Izhar

    2008-01-01

    Historical accounts of the field of educational management (EM) have seen the last quarter of the nineteenth century as the beginning of EM as a profession and later on as a field of study in American universities. The search for efficiency in education in those days encouraged many American educators to participate in administrator preparation…

  11. Adolescent Girls' Assessment and Management of Sexual Risks: Insights from Focus Group Research

    ERIC Educational Resources Information Center

    Bay-Cheng, Laina Y.; Livingston, Jennifer A.; Fava, Nicole M.

    2011-01-01

    We conducted focus groups with girls ages 14 to 17 (N = 43) to study how the dominant discourse of sexual risk shapes young women's understanding of the sexual domain and their management of these presumably pervasive threats. Through inductive analysis, we developed a coding scheme focused on three themes: (a) "types of sexual risk,"…

  12. Asthma Management in Minority Children: Practical Insights for Clinicians, Researchers, and Public Health Planners.

    ERIC Educational Resources Information Center

    National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

    This monograph summarizes asthma management conclusions developed by five studies funded under a 5-year federal program titled "Interventions for the Control of Asthma among Black and Hispanic Children." The research goals were to develop model, replicable programs to reduce asthma morbidity; decrease inappropriate use of health care…

  13. Soil erosion-runoff relationships: insights from laboratory studies

    NASA Astrophysics Data System (ADS)

    Mamedov, Amrakh; Warrington, David; Levy, Guy

    2016-04-01

    Understanding the processes and mechanisms affecting runoff generation and subsequent soil erosion in semi-arid regions is essential for the development of improved soil and water conservation management practices. Using a drip type laboratory rain simulator, we studied runoff and soil erosion, and the relationships between them, in 60 semi-arid region soils varying in their intrinsic properties (e.g., texture, organic matter) under differing extrinsic conditions (e.g., rain properties, and conditions prevailing in the field soil). Both runoff and soil erosion were significantly affected by the intrinsic soil and rain properties, and soil conditions within agricultural fields or watersheds. The relationship between soil erosion and runoff was stronger when the rain kinetic energy was higher rather than lower, and could be expressed either as a linear or exponential function. Linear functions applied to certain limited cases associated with conditions that enhanced soil structure stability, (e.g., slow wetting, amending with soil stabilizers, minimum tillage in clay soils, and short duration exposure to rain). Exponential functions applied to most of the cases under conditions that tended to harm soil stability (e.g., fast wetting of soils, a wide range of antecedent soil water contents and rain kinetic energies, conventional tillage, following biosolid applications, irrigation with water of poor quality, consecutive rain simulations). The established relationships between runoff and soil erosion contributed to a better understanding of the mechanisms governing overland flow and soil loss, and could assist in (i) further development of soil erosion models and research techniques, and (ii) the design of more suitable management practices for soil and water conservation.

  14. Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers.

    PubMed

    Drennan, Vari M; Halter, Mary; Gale, Julia; Harris, Ruth

    2016-11-01

    To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area. Against a global shortage, retaining nurses is a management imperative for the quality of hospital services. Semi-structured interviews, thematically analysed. Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment. In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies. Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment. © 2016 The Authors Journal of Nursing Management Published by John Wiley & Sons Ltd.

  15. Gliding Motility in Bacteria: Insights from Studies of Myxococcus xanthus

    PubMed Central

    Spormann, Alfred M.

    1999-01-01

    motor in M. xanthus controls cell movement in groups (S-motility system). It is dependent on functional type IV pili and is operative only when cells are in close proximity to each other. Type IV pili are known to be involved in another mode of bacterial surface translocation, called twitching motility. S-motility may well represent a variation of twitching motility in M. xanthus. However, twitching differs from gliding since it involves cell movements that are jerky and abrupt and that lack the organization and smoothness observed in gliding. Components of this motor are encoded by genes of the S-system, which appear to be homologs of genes involved in the biosynthesis, assembly, and function of type IV pili in Pseudomonas aeruginosa and Neisseria gonorrhoeae. How type IV pili generate force in S-motility is currently unknown, but it is to be expected that ongoing physiological, genetic, and biochemical studies in M. xanthus, in conjunction with studies on twitching in P. aeruginosa and N. gonorrhoeae, will provide important insights into this microbial motor. The two motility systems of M. xanthus are affected to different degrees by the MglA protein, which shows similarity to a small GTPase. Bacterial chemotaxis-like sensory transduction systems control gliding motility in M. xanthus. The frz genes appear to regulate gliding movement of individual cells and movement by the S-motility system, suggesting that the two motors found in this bacterium can be regulated to result in coordinated multicellular movements. In contrast, the dif genes affect only S-system-dependent swarming. PMID:10477310

  16. Gliding motility in bacteria: insights from studies of Myxococcus xanthus.

    PubMed

    Spormann, A M

    1999-09-01

    motor in M. xanthus controls cell movement in groups (S-motility system). It is dependent on functional type IV pili and is operative only when cells are in close proximity to each other. Type IV pili are known to be involved in another mode of bacterial surface translocation, called twitching motility. S-motility may well represent a variation of twitching motility in M. xanthus. However, twitching differs from gliding since it involves cell movements that are jerky and abrupt and that lack the organization and smoothness observed in gliding. Components of this motor are encoded by genes of the S-system, which appear to be homologs of genes involved in the biosynthesis, assembly, and function of type IV pili in Pseudomonas aeruginosa and Neisseria gonorrhoeae. How type IV pili generate force in S-motility is currently unknown, but it is to be expected that ongoing physiological, genetic, and biochemical studies in M. xanthus, in conjunction with studies on twitching in P. aeruginosa and N. gonorrhoeae, will provide important insights into this microbial motor. The two motility systems of M. xanthus are affected to different degrees by the MglA protein, which shows similarity to a small GTPase. Bacterial chemotaxis-like sensory transduction systems control gliding motility in M. xanthus. The frz genes appear to regulate gliding movement of individual cells and movement by the S-motility system, suggesting that the two motors found in this bacterium can be regulated to result in coordinated multicellular movements. In contrast, the dif genes affect only S-system-dependent swarming.

  17. Case Studies in Broadcast Management.

    ERIC Educational Resources Information Center

    Coleman, Howard W.

    This collection of case studies, based on factual situations which have challenged broadcast managers in recent years, is designed to stimulate thinking about and solving of "real world" problems in commercial radio and television operations. Topics of a serious, long-run nature include enlarging the radio audience; station revenue and economy;…

  18. Insights Into Nephrolithiasis From the Nurses’ Health Studies

    PubMed Central

    Prochaska, Megan L.; Taylor, Eric N.

    2016-01-01

    Objectives. To review the contributions of the Nurses’ Health Study (NHS) I and NHS II to understanding the role of dietary factors, beverages, body size, and urinary factors in the development of kidney stones. Methods. We conducted a review of kidney stone–related publications of NHS I and NHS II between 1976 and 2016. Results. Studies using NHS I and NHS II data have demonstrated the importance of many factors in kidney stone formation and were the first to report that higher dietary calcium was associated with a lower risk of incident kidney stones in women. Data from these cohorts were instrumental in emphasizing that nephrolithiasis is a systemic disease and suggesting that a kidney stone or shared risk factors may lead to hypertension, diabetes, and cardiovascular disease. Conclusions. Findings from the NHSs have changed the scientific understanding and the clinical practice of stone prevention and have been incorporated into widely consulted textbooks and the American Urological Association Medical Management of Kidney Stones guidelines. PMID:27459448

  19. Initial insights on the performances and management of dairy cattle herds combining two breeds with contrasting features.

    PubMed

    Magne, M A; Thénard, V; Mihout, S

    2016-05-01

    Finding ways of increasing animal production with low external inputs and without compromising reproductive performances is a key issue of livestock systems sustainability. One way is to take advantage of the diversity and interactions among components within livestock systems. Among studies that investigate the influence of differences in animals' individual abilities in a herd, few focus on combinations of cow breeds with contrasting features in dairy cattle herds. This study aimed to analyse the performances and management of such multi-breed dairy cattle herds. These herds were composed of two types of dairy breeds: 'specialist' (Holstein) and 'generalist' (e.g. Montbeliarde, Simmental, etc.). Based on recorded milk data in southern French region, we performed (i) to compare the performances of dairy herds according to breed-type composition: multi-breed, single specialist breed or single generalist breed and (ii) to test the difference of milk performances of specialist and generalist breed cows (n = 10 682) per multi-breed dairy herd within a sample of 22 farms. The sampled farmers were also interviewed to characterise herd management through multivariate analysis. Multi-breed dairy herds had a better trade-off among milk yield, milk fat and protein contents, herd reproduction and concentrate-conversion efficiency than single-breed herds. Conversely, they did not offer advantages in terms of milk prices and udder health. Compared to specialist dairy herds, they produce less milk with the same concentrate-conversion efficiency but have better reproductive performances. Compared to generalist dairy herds, they produce more milk with better concentrate-conversion efficiency but have worse reproductive performances. Within herds, specialist and generalist breed cows significantly differed in milk performances, showing their complementarity. The former produced more milk for a longer lactation length while the latter produced milk with higher protein and fat

  20. On the "Demystification" of Insight: A Critique of Neuroimaging Studies of Insight

    ERIC Educational Resources Information Center

    Weisberg, Robert W.

    2013-01-01

    Psychologists studying problem solving have, for over 100 years, been interested in the question of whether there are two different modes of solving problems. One mode--problem solving based on analysis--depends on application of past experience to the problem at hand and proceeds incrementally toward solution. The second mode--problem solving…

  1. On the "Demystification" of Insight: A Critique of Neuroimaging Studies of Insight

    ERIC Educational Resources Information Center

    Weisberg, Robert W.

    2013-01-01

    Psychologists studying problem solving have, for over 100 years, been interested in the question of whether there are two different modes of solving problems. One mode--problem solving based on analysis--depends on application of past experience to the problem at hand and proceeds incrementally toward solution. The second mode--problem solving…

  2. Insight Into Quality of Prescription Writing - An Instituitional Study

    PubMed Central

    Dyasanoor, Sujatha

    2016-01-01

    Introduction Prescription writing is an important task performed by a doctor during patient management. Prescription refers to written instructions given to a patient regarding medications. Lack of attention during prescription writing can lead to prescription errors which in turn can adversely affect patients’ well-being. Thus, prescriptions are an important target area for improvement. Aim The purpose of the present study was to analyze the quality of prescriptions dispensed by the students of The Oxford Dental College and Hospital, Bangalore and to compare the prescription writing patterns amongst undergraduates, interns and postgraduates of this institution. Materials and Methods A cross-sectional study was conducted on 500 randomly selected prescriptions dispensed by the students of The Oxford Dental College and Hospital, Bangalore, India. All the prescriptions were analyzed for the presence of (a) Patient’s information: Out-Patient file number, name, age, gender, address and contact number (b) Doctors information: Full name, department name, qualification, contact details, date of prescription, superscription, and signature (c) Drug information: Name, strength, dosage form, dosage instructions, duration and total quantity. Each prescription was further categorized into groups A, B, C or D, depending on the scores obtained. Prescription quality was then compared between the undergraduates, interns and postgraduates. Results Analysis of prescriptions performed using Chi-square test showed that groups A, B, C and D had 12 (2%), 155 (31%), 333 (67%) and 0 (0%) students respectively. Association between the groups and qualifications showed statistically significant results (p<0.05). Undergraduate prescriptions were better written in comparison to interns and postgraduates. Conclusion Findings of the current study demonstrate the need for further improvement in the quality of prescription writing by students of The Oxford Dental College and Hospital, Bangalore

  3. Patient and physician asthma deterioration terminology: results from the 2009 Asthma Insight and Management survey.

    PubMed

    Blaiss, Michael S; Nathan, Robert A; Stoloff, Stuart W; Meltzer, Eli O; Murphy, Kevin R; Doherty, Dennis E

    2012-01-01

    Long-term achievement of asthma control is dependent in part on the use of mutually understandable asthma terminology in all verbal and written patient-physician communications. Using data from the Asthma Insight and Management (AIM) survey, the objective of this analysis is to provide a contemporary depiction of asthma deterioration terminology as used by current asthma patients and physicians in the United States. As part of the 2009 AIM survey, current asthma patients (≥12 years of age; weighted n = 2499) and physicians (n = 309) were queried about their recognition, understanding, and/or use of the terms "asthma attack," "asthma flare-up," and "asthma exacerbation" in telephone interviews. Nearly all patients had heard the term "asthma attack" (97%), but relatively few had heard the term "asthma exacerbation" (24%); 71% had heard "asthma flare-up." In contrast, physicians reported using the term "asthma attack" least (65%) and the term "asthma exacerbation" most (77%) when discussing asthma with their patients; 70% reported using "asthma flare-up." Among patients familiar with "asthma flare-up" and "asthma exacerbation" (n = 502), only 38% said that the terms mean the same thing; nearly all physicians (94%) said that the terms mean the same thing. Collectively, data from the AIM survey suggest that patients and physicians use different asthma deterioration terminology and, more importantly, that they do not necessarily understand each other's terms. Standardizing asthma deterioration terminology may help optimize asthma patient-physician communication to improve patient understanding of written asthma action plans and therefore, enhance patient outcomes.

  4. Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes: PRIME-FFR (Insights From the POST-IT [Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease] and R3F [French FFR Registry] Integrated Multicenter Registries - Implementation of FFR [Fractional Flow Reserve] in Routine Practice).

    PubMed

    Van Belle, Eric; Baptista, Sergio-Bravo; Raposo, Luís; Henderson, John; Rioufol, Gilles; Santos, Lino; Pouillot, Christophe; Ramos, Ruben; Cuisset, Thomas; Calé, Rita; Teiger, Emmanuel; Jorge, Elisabete; Belle, Loic; Machado, Carina; Barreau, Didier; Costa, Marco; Hanssen, Michel; Oliveira, Eduardo; Besnard, Cyril; Costa, João; Dallongeville, Jean; Pipa, João; Sideris, Georgios; Fonseca, Nuno; Bretelle, Christophe; Guardado, Jorge; Lhoest, Nicolas; Silva, Bruno; Barnay, Pierre; Sousa, Maria-João; Leborgne, Laurent; Silva, João Carlos; Vincent, Flavien; Rodrigues, Alberto; Seca, Luís; Fernandes, Renato; Dupouy, Patrick

    2017-06-01

    Fractional flow reserve (FFR) is not firmly established as a guide to treatment in patients with acute coronary syndromes (ACS). Primary goals were to evaluate the impact of integrating FFR on management decisions and on clinical outcome of patients with ACS undergoing coronary angiography, as compared with patients with stable coronary artery disease. R3F (French FFR Registry) and POST-IT (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease), sharing a common design, were pooled as PRIME-FFR (Insights From the POST-IT and R3F Integrated Multicenter Registries - Implementation of FFR in Routine Practice). Investigators prospectively defined management strategy based on angiography before performing FFR. Final decision after FFR and 1-year clinical outcome were recorded. From 1983 patients, in whom FFR was prospectively used to guide treatment, 533 sustained ACS (excluding acute ST-segment-elevation myocardial infarction). In ACS, FFR was performed in 1.4 lesions per patient, mostly in left anterior descending (58%), with a mean percent stenosis of 58±12% and a mean FFR of 0.82±0.09. In patients with ACS, reclassification by FFR was high and similar to those with non-ACS (38% versus 39%; P=NS). The pattern of reclassification was different, however, with less patients with ACS reclassified from revascularization to medical treatment compared with those with non-ACS (P=0.01). In ACS, 1-year outcome of patients reclassified based on FFR (FFR against angiography) was as good as that of nonreclassified patients (FFR concordant with angiography), with no difference in major cardiovascular event (8.0% versus 11.6%; P=0.20) or symptoms (92.3% versus 94.8% angina free; P=0.25). Moreover, FFR-based deferral to medical treatment was as safe in patients with ACS as in patients with non-ACS (major cardiovascular event, 8.0% versus 8.5%; P=0.83; revascularization, 3.8% versus 5.9%; P=0.24; and freedom from angina, 93.6% versus 90.2%; P=0.35). These

  5. Local people's knowledge with regard to land use activities in southwest Madagascar - Conceptual insights for sustainable land management.

    PubMed

    Fritz-Vietta, Nadine V M; Tahirindraza, H Stone; Stoll-Kleemann, Susanne

    2017-09-01

    Environmental conditions in the Mahafaly Plateau region in southwest Madagascar are harsh, with a long dry season and a short rainy season. The local people's land use capabilities and skills are adapted to these conditions. Nevertheless, they are currently confronted by drastic climatic changes, including longer dry seasons, which have resulted in food and water scarcities. It is therefore essential to ensure sustainable land management in the region. At present, the main land use activities are agriculture, livestock farming, natural resource collection including timber and non-timber forest products, and the practice of local customs. Land use activities have always resulted in land conversion, yet over time this ecological transformation also leads to the accumulation of knowledge. The aim of the present article is therefore twofold. First, it aims to examine local people's knowledge with regard to land use activities and the transmission of this knowledge from one generation to the next; second, it considers the extent to which local people's knowledge may contribute to the development of sustainable land management. Our research is based on more than 80 qualitative interviews with local inhabitants of the Mahafaly Plateau region. Our analysis of local people's knowledge identifies four categories: ecological knowledge, knowledge related to natural resource usage, knowledge of names, and the interconnection between knowledge and belief. Furthermore, these knowledge categories provide conceptual insights for sustainable land management. Along with the long-term persistence of natural resources and their functions and the satisfaction of basic needs through resource usage, both the recognition of mental images as a regulating mechanism and the maintenance of the relation between the natural and the supernatural world have a role to play in sustainable land management in the study area. Local knowledge transmission processes serve to foster ongoing learning and

  6. Unanticipated Insights into Biomedicine from the Study of Acupuncture.

    PubMed

    MacPherson, Hugh; Hammerschlag, Richard; Coeytaux, Remy R; Davis, Robert T; Harris, Richard E; Kong, Jiang-Ti; Langevin, Helene M; Lao, Lixing; Milley, Ryan J; Napadow, Vitaly; Schnyer, Rosa N; Stener-Victorin, Elisabet; Witt, Claudia M; Wayne, Peter M

    2016-02-01

    Research into acupuncture has had ripple effects beyond the field of acupuncture. This paper identifies five exemplars to illustrate that there is tangible evidence of the way insights gleaned from acupuncture research have informed biomedical research, practice, or policy. The first exemplar documents how early research into acupuncture analgesia has expanded into neuroimaging research, broadening physiologic understanding and treatment of chronic pain. The second describes how the acupuncture needle has become a tool to enhance biomedical knowledge of connective tissue. The third exemplar, which illustrates use of a modified acupuncture needle as a sham device, focuses on emergent understanding of placebo effects and, in turn, on insights into therapeutic encounters in treatments unrelated to acupuncture. The fourth exemplar documents that two medical devices now in widespread use were inspired by acupuncture: transcutaneous electrical nerve stimulators for pain control and antinausea wrist bands. The final exemplar describes how pragmatic clinical trial designs applied in acupuncture research have informed current general interest in comparative effectiveness research. In conclusion, these exemplars of unanticipated outcomes of acupuncture research comprise an additional rationale for continued support of basic and clinical research evaluating acupuncture and other under-researched therapies.

  7. Unanticipated Insights into Biomedicine from the Study of Acupuncture

    PubMed Central

    Hammerschlag, Richard; Coeytaux, Remy R.; Davis, Robert T.; Harris, Richard E.; Kong, Jiang-Ti; Langevin, Helene M.; Lao, Lixing; Milley, Ryan J.; Napadow, Vitaly; Schnyer, Rosa N.; Stener-Victorin, Elisabet; Witt, Claudia M.; Wayne, Peter M.

    2016-01-01

    Abstract Research into acupuncture has had ripple effects beyond the field of acupuncture. This paper identifies five exemplars to illustrate that there is tangible evidence of the way insights gleaned from acupuncture research have informed biomedical research, practice, or policy. The first exemplar documents how early research into acupuncture analgesia has expanded into neuroimaging research, broadening physiologic understanding and treatment of chronic pain. The second describes how the acupuncture needle has become a tool to enhance biomedical knowledge of connective tissue. The third exemplar, which illustrates use of a modified acupuncture needle as a sham device, focuses on emergent understanding of placebo effects and, in turn, on insights into therapeutic encounters in treatments unrelated to acupuncture. The fourth exemplar documents that two medical devices now in widespread use were inspired by acupuncture: transcutaneous electrical nerve stimulators for pain control and antinausea wrist bands. The final exemplar describes how pragmatic clinical trial designs applied in acupuncture research have informed current general interest in comparative effectiveness research. In conclusion, these exemplars of unanticipated outcomes of acupuncture research comprise an additional rationale for continued support of basic and clinical research evaluating acupuncture and other under-researched therapies. PMID:26745452

  8. A Case Study of Classroom Management Practices and the Influence on Classroom Disruptions

    ERIC Educational Resources Information Center

    Rusk, Robert Brian

    2016-01-01

    This qualitative case study explored how the classroom management practices of sampled teachers in a private school in central Oregon influenced classroom disruptions. Through the study, the researcher was able to provide insight on the differences in specific classroom management processes between teachers who had a high number of Positive…

  9. A Case Study of Classroom Management Practices and the Influence on Classroom Disruptions

    ERIC Educational Resources Information Center

    Rusk, Robert Brian

    2016-01-01

    This qualitative case study explored how the classroom management practices of sampled teachers in a private school in central Oregon influenced classroom disruptions. Through the study, the researcher was able to provide insight on the differences in specific classroom management processes between teachers who had a high number of Positive…

  10. Heat Management Strategy Trade Study

    SciTech Connect

    Nick Soelberg; Steve Priebe; Dirk Gombert; Ted Bauer

    2009-09-01

    This Heat Management Trade Study was performed in 2008-2009 to expand on prior studies in continued efforts to analyze and evaluate options for cost-effectively managing SNF reprocessing wastes. The primary objective was to develop a simplified cost/benefit evaluation for spent nuclear fuel (SNF) reprocessing that combines the characteristics of the waste generated through reprocessing with the impacts of the waste on heating the repository. Under consideration were age of the SNF prior to reprocessing, plutonium and minor actinide (MA) separation from the spent fuel for recycle, fuel value of the recycled Pu and MA, age of the remaining spent fuel waste prior to emplacement in the repository, length of time that active ventilation is employed in the repository, and elemental concentration and heat limits for acceptable glass waste form durability. A secondary objective was to identify and qualitatively analyze remaining issues such as (a) impacts of aging SNF prior to reprocessing on the fuel value of the recovered fissile materials, and (b) impact of reprocessing on the dose risk as developed in the Yucca Mountain Total System Performance Assessment (TSPA). Results of this study can be used to evaluate different options for managing decay heat in waste streams from spent nuclear fuel.

  11. Pathogenesis of depression: Insights from human and rodent studies.

    PubMed

    Ménard, C; Hodes, G E; Russo, S J

    2016-05-03

    Major depressive disorder (MDD) will affect one out of every five people in their lifetime and is the leading cause of disability worldwide. Nevertheless, mechanisms associated with the pathogenesis of MDD have yet to be completely understood and current treatments remain ineffective in a large subset of patients. In this review, we summarize the most recent discoveries and insights for which parallel findings have been obtained in human depressed subjects and rodent models of mood disorders in order to examine the potential etiology of depression. These mechanisms range from synaptic plasticity mechanisms to epigenetics and the immune system where there is strong evidence to support a functional role in the development of specific depression symptomology. Ultimately we conclude by discussing how novel therapeutic strategies targeting central and peripheral processes might ultimately aid in the development of effective new treatments for MDD and related stress disorders.

  12. Pathogenesis of depression: insights from human and rodent studies

    PubMed Central

    MÉNARD, Caroline; HODES, Georgia E.; RUSSO, Scott J.

    2015-01-01

    Major depressive disorder (MDD) will affect one out of every five people in their lifetime and is the leading cause of disability worldwide. Nevertheless, mechanisms associated with the pathogenesis of MDD have yet to be completely understood and current treatments remain ineffective in a large subset of patients. In this review, we summarize the most recent discoveries and insights for which parallel findings have been obtained in human depressed subjects and rodent models of mood disorders in order to examine the potential etiology of depression. These mechanisms range from synaptic plasticity mechanisms to epigenetics and the immune system where there is strong evidence to support a functional role in the development of specific depression symptomology. Ultimately we conclude by discussing how novel therapeutic strategies targeting central and peripheral processes might ultimately aid in the development of effective new treatments for MDD and related stress disorders. PMID:26037806

  13. Adolescent Girls’ Assessment and Management of Sexual Risks: Insights from Focus Group Research

    PubMed Central

    Bay-Cheng, Laina Y.; Livingston, Jennifer A.; Fava, Nicole M.

    2010-01-01

    We conducted focus groups with girls ages 14 to 17 (N = 43) in order to study how the dominant discourse of sexual risk shapes young women’s understanding of the sexual domain and their management of these presumably pervasive threats. Through inductive analysis, we developed a coding scheme focused on three themes: (a) types of sexual risk; (b) factors that moderate sexual risk; and (c) strategies for managing sexual risk. Collectively, participants identified many risks but distanced themselves from these by claiming that girls’ susceptibility is largely a function of personal factors and therefore avoidable given the right traits, values, and skills. We consider this reliance on other-blaming and self-exemption, as well as instances in which individual participants diverged from this group discourse, in the context of neoliberalism. PMID:21860537

  14. Is health care a special challenge to quality management? Insights from the Danderyd Hospital case.

    PubMed

    Striem, Jörgen; Øvretveit, John; Brommels, Mats

    2003-01-01

    A 10-year quality journey of a Swedish university hospital is described in this case study based on a variety of data sources. A series of quality initiatives were implemented according to total quality management (TQM) "best practice." Many projects were successful, but still a majority of those did not meet the staff's requirement of practical relevance, and they provoked scepticism toward instruments introduced and resistance to service-related quality definitions. The hospital's incentive structures did not reward an engagement in improvement activities. The findings are interpreted as demonstrating that the programs were viewed upon as part of a "management" rather than "professional" agenda, despite the underlying philosophy of TQM. It is suggested that applying professional practice development approaches to improvement initiatives might help to overcome the barrier thus created.

  15. Insight into the prevalence and distribution of microbial contamination to evaluate water management in the fresh produce processing industry.

    PubMed

    Holvoet, Kevin; Jacxsens, Liesbeth; Sampers, Imca; Uyttendaele, Mieke

    2012-04-01

    This study provided insight into the degree of microbial contamination in the processing chain of prepacked (bagged) lettuce in two Belgian fresh-cut produce processing companies. The pathogens Salmonella and Listeria monocytogenes were not detected. Total psychrotrophic aerobic bacterial counts (TPACs) in water samples, fresh produce, and environmental samples suggested that the TPAC is not a good indicator of overall quality and best manufacturing practices during production and processing. Because of the high TPACs in the harvested lettuce crops, the process water becomes quickly contaminated, and subsequent TPACs do not change much throughout the production process of a batch. The hygiene indicator Escherichia coli was used to assess the water management practices in these two companies in relation to food safety. Practices such as insufficient cleaning and disinfection of washing baths, irregular refilling of the produce wash baths with water of good microbial quality, and the use of high product/water ratios resulted in a rapid increase in E. coli in the processing water, with potential transfer to the end product (fresh-cut lettuce). The washing step in the production of fresh-cut lettuce was identified as a potential pathway for dispersion of microorganisms and introduction of E. coli to the end product via cross-contamination. An intervention step to reduce microbial contamination is needed, particularly when no sanitizers are used as is the case in some European Union countries. Thus, from a food safety point of view proper water management (and its validation) is a critical point in the fresh-cut produce processing industry.

  16. Managing U.S. climate risk through mitigation: Insights from the American Climate Prospectus

    NASA Astrophysics Data System (ADS)

    Kopp, R. E., III; Hsiang, S. M.; Houser, T.; Larsen, K.; Rasmussen, D. M., Jr.; Jina, A.; Rising, J.; Delgado, M.; Mohan, S.; Muir-Wood, R.; Wilson, P. S.

    2014-12-01

    The American Climate Prospectus (ACP), the technical analysis underlying the Risky Business project, quantitatively assessed the economic risks posed to the United States by six categories of climate change impacts: crop yield, energy demand, coastal storm damage, criminal activity, labor productivity, and mortality [1]. At a national level, measured by impact on gross domestic product, increased mortality and decreased labor productivity pose the large risks, followed by increased energy demand and coastal damages. Changes in crop yield and crime have smaller impacts. The ACP was not intended to conduct a benefit-cost analysis of climate change mitigation. It assessed the economic consequences of future impacts on an economy with a structure equivalent to that of the current economy, not accounting for socio-economic development and adaptation, and did not assess the cost of mitigation. One of its primary goals was to inform adaptation decisions that are conventionally considered 'endogenous' in economic analyses of climate change. Nonetheless, its results provide insight into the potential of mitigation to manage climate risk. Differences between RCP 8.5 (moderately-high business-as-usual emissions), RCP 4.5 (moderate mitigation) and RCP 2.6 (extremely strong mitigation) are not apparent until mid-century and become significant only late in the century. For all impacts except coastal damages, mitigation significantly reduces uncertainty in late-century impact estimates. Nationally, mitigation significantly and monotonically reduces median projected labor productivity losses and violent crime. Switching from RCP 8.5 to RCP 4.5 also significantly reduces median projections of mortality and energy demand, but the domestic value to the U.S. of further mitigation to RCP 2.6 is less clear. The marginal benefits decline in part because some regions of the country (especially the Northwest) may experience increased crop yields, reduced mortality, and reduced energy

  17. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches.

    PubMed

    Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  18. Management of myocardial infarction in the elderly. Insights from Spanish Minimum Basic Data Set.

    PubMed

    Ariza-Solé, Albert; Alegre, Oriol; Elola, Francisco J; Fernández, Cristina; Formiga, Francesc; Martínez-Sellés, Manuel; Bernal, José L; Segura, José V; Iñíguez, Andrés; Bertomeu, Vicente; Salazar-Mendiguchía, Joel; Sánchez Salado, José C; Lorente, Victòria; Cequier, Angel

    2017-07-01

    We aimed to assess the impact of implementation of reperfusion networks, the type of hospital and specialty of the treating physician on the management and outcomes of ST segment elevation myocardial infarction in patients aged ⩾75 years. We analysed data from the Minimum Basic Data Set of the Spanish public health system, assessing hospital discharges between 2004 and 2013. Discharges were distributed in three groups depending on the clinical management: percutaneous coronary intervention, thrombolysis or no reperfusion. Primary outcome measure was all cause in-hospital mortality. For risk adjustment, patient comorbidities were identified for each index hospitalization. We identified 299,929 discharges, of whom 107,890 (36%) were in-patients aged ⩾75 years. Older patients had higher prevalence of comorbidities, were less often treated in high complexity hospitals and were less frequently managed by cardiologists ( p<0.001). Both percutaneous coronary intervention and fibrinolysis were less often performed in elderly patients ( p<0.001). A progressive increase in the rate of percutaneous coronary intervention was observed in the elderly across the study period (from 17% in 2004 to 45% in 2013, p<0.001), with a progressive reduction of crude mortality (from 23% in 2004 to 19% in 2013, p<0.001). Adjusted analysis showed an association between being treated in high complexity hospitals, being treated by cardiologists and lower in-hospital mortality ( p <0.001). Elderly patients with ST segment elevation myocardial infarction are less often managed in high complexity hospitals and less often treated by cardiologists. Both factors are associated with higher in-hospital mortality.

  19. Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

    PubMed Central

    Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

    2002-01-01

    BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

  20. Insights into fisheries management practices: using the theory of planned behavior to explain fish stocking among a sample of Swiss anglers.

    PubMed

    von Lindern, Eike; Mosler, Hans-Joachim

    2014-01-01

    Using inadequate management tools often threatens the natural environment. This study focuses on the example of Swiss recreational fishermen (hereafter called "anglers") as recreational fisheries management stakeholders. In recreational fisheries, fish stocking conducted by anglers has been identified as one important factor associated with declining fish catches. We therefore aimed to a) gain insights into why anglers want to maintain fish stocking and b) identify entry points for interventions to promote more pro-ecological management practices. Results (N = 349) showed that the majority of anglers think very uncritically about stocking and that they frequently engage in it. We conclude that outcome expectancies and beliefs about risks, in combination with a lack of stocking success controls are the main reasons that anglers retain stocking measures. We suggest that providing anglers with direct experience and feedback about stocking success is suitable to change their intentions regarding stocking and their actual stocking behavior, and thus, to promote more pro-ecological management methods. From a more general perspective, the results of this study are likely to help improve pro-ecological ecosystem management in other domains where problems similar to those in recreational fisheries management might exist.

  1. Insights into Fisheries Management Practices: Using the Theory of Planned Behavior to Explain Fish Stocking among a Sample of Swiss Anglers

    PubMed Central

    von Lindern, Eike; Mosler, Hans-Joachim

    2014-01-01

    Using inadequate management tools often threatens the natural environment. This study focuses on the example of Swiss recreational fishermen (hereafter called “anglers”) as recreational fisheries management stakeholders. In recreational fisheries, fish stocking conducted by anglers has been identified as one important factor associated with declining fish catches. We therefore aimed to a) gain insights into why anglers want to maintain fish stocking and b) identify entry points for interventions to promote more pro-ecological management practices. Results (N = 349) showed that the majority of anglers think very uncritically about stocking and that they frequently engage in it. We conclude that outcome expectancies and beliefs about risks, in combination with a lack of stocking success controls are the main reasons that anglers retain stocking measures. We suggest that providing anglers with direct experience and feedback about stocking success is suitable to change their intentions regarding stocking and their actual stocking behavior, and thus, to promote more pro-ecological management methods. From a more general perspective, the results of this study are likely to help improve pro-ecological ecosystem management in other domains where problems similar to those in recreational fisheries management might exist. PMID:25514798

  2. Families as Case Managers: A Longitudinal Study.

    ERIC Educational Resources Information Center

    Seltzer, Marsha Mailick; And Others

    1989-01-01

    Performed follow-up study measuring effects of case management training on management activities of families of elderly persons. Interviewed 78 subjects from original study and found case management to be normative activity for families of elderly. Noted differences reported between male and female case managers and in types of obstacles…

  3. Insight into the diagnosis and management of subclinical genital tuberculosis in women with infertility

    PubMed Central

    Mahajan, Nalini; Naidu, Padmaja; Kaur, Simran Deep

    2016-01-01

    Genital tuberculosis (GTB) is an important cause of infertility in India. Lack of an accurate diagnostic test has led to an indiscriminate use of antitubercular treatment in infertile women. Apart from concerns of drug toxicity, this may be a contributing factor in the increasing incidence of multidrug-resistant TB reported in India. We conducted a study to analyze whether a combination of tests could help improve diagnostic accuracy. An algorithm for the management of GTB in infertile women based on the use of multiple tests is presented. PMID:27803580

  4. The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight.

    PubMed

    Aziato, Lydia; Adejumo, Oluyinka

    2014-03-01

    Nurses form an indispensable part of the clinical team that manages postoperative pain (POP). Within a particular clinical context, nurses perceive and respond to pain based on specific factors. This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients' POP. It also identified the factors that influenced nurses' pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients' pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses' response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.

  5. Cardiovascular findings and management in Turner syndrome: insights from a French cohort.

    PubMed

    Donadille, Bruno; Rousseau, Alexandra; Zenaty, Delphine; Cabrol, Sylvie; Courtillot, Carine; Samara-Boustani, Dinane; Salenave, Sylvie; Monnier-Cholley, Laurence; Meuleman, Catherine; Jondeau, Guillaume; Iserin, Laurence; Duranteau, Lise; Cabanes, Laure; Bourcigaux, Nathalie; Bonnet, Damien; Bouchard, Philippe; Chanson, Philippe; Polak, Michel; Touraine, Philippe; Lebouc, Yves; Carel, Jean-Claude; Léger, Juliane; Christin-Maitre, Sophie

    2012-10-01

    Congenital cardiovascular malformations and aortic dilatation are frequent in patients with Turner syndrome (TS). The objective of this study was to investigate the cardiovascular findings and management in a large cohort of patients, including children and adults. We recruited 336 patients with TS from a network of tertiary centers. We reviewed their files, checking for cardiovascular events, cardiac valve abnormalities, and aortic diameters indexed to body surface area (BSA) from magnetic resonance imaging (n=110) or echocardiography (n=300). Informative cardiovascular data were available for only 233 patients. Vascular surgery was reported in 7.4% of the cohort. The first cause of surgery was aortic coarctation, detected in 6.9% at a median age of 9.5 (range: 0-60) years. Bicuspid aortic valve (BAV) was detected in 21% at a median age of 20 years (25th-75th percentiles: 15-30). At least one aortic diameter exceeded 32 mm in 12% of the cohort. This was detected at a median age of 19 (7-30) years. When indexed to BSA, at least one aortic diameter exceeded 20 mm/m(2) in 39% of the cohort. Our study shows that cardiovascular monitoring for TS patients is currently insufficient in France. BAV is present at birth, but often remains undiagnosed until later in life. Therefore, improved management in cardiovascular monitoring is required and a more systematic approach should be taken.

  6. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

    PubMed

    Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

    2013-01-01

    With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

  7. Usual Populations, Unusual Individuals: Insights into the Behavior and Management of Asian Elephants in Fragmented Landscapes

    PubMed Central

    Srinivasaiah, Nishant M.; Vaidyanathan, Srinivas; Sinha, Anindya

    2012-01-01

    Background A dearth in understanding the behavior of Asian elephants (Elephas maximus) at the scale of populations and individuals has left important management issues, particularly related to human-elephant conflict (HEC), unresolved. Evaluation of differences in behavior and decision-making among individual elephants across groups in response to changing local ecological settings is essential to fill this gap in knowledge and to improve our approaches towards the management and conservation of elephants. Methodology/Principal Findings We hypothesized certain behavioral decisions that would be made by Asian elephants as reflected in their residence time and movement rates, time-activity budgets, social interactions and group dynamics in response to resource availability and human disturbance in their habitat. This study is based on 200 h of behavioral observations on 60 individually identified elephants and a 184-km2 grid-based survey of their natural and anthropogenic habitats within and outside the Bannerghatta National Park, southern India during the dry season. At a general population level, the behavioral decisions appeared to be guided by the gender, age and group-type of the elephants. At the individual level, the observed variation could be explained only by the idiosyncratic behaviors of individuals and that of their associating conspecific individuals. Recursive partitioning classification trees for residence time of individual elephants indicated that the primary decisions were taken by individuals, independently of their above-mentioned biological and ecological attributes. Conclusions/Significance Decision-making by Asian elephants thus appears to be determined at two levels, that of the population and, more importantly, the individual. Models based on decision-making by individual elephants have the potential to predict conflict in fragmented landscapes that, in turn, could aid in mitigating HEC. Thus, we must target individuals, in addition to

  8. Better Insight Into Water Resources Management With Integrated Hydrodynamic And Water Quality Models

    NASA Astrophysics Data System (ADS)

    Debele, B.; Srinivasan, R.; Parlange, J.

    2004-12-01

    Models have long been used in water resources management to guide decision making and improve understanding of the system. Numerous models of different scales -spatial and temporal - are available. Yet, very few models manage to bridge simulations of hydrological and water quality parameters from both upland watershed and riverine system. Most water quality models, such as QUAL2E and EPD-RIV1 concentrate on the riverine system while CE-QUAL-W2 and WASP models focus on larger waterbodies, such as lakes and reservoirs. On the other hand, the original SWAT model, HSPF and other upland watershed hydrological models simulate agricultural (diffuse) pollution sources with limited number of processes incorporated to handle point source pollutions that emanate from industrial sectors. Such limitations, which are common in most hydrodynamic and water quality models undermine better understanding that otherwise could be uncovered by employing integrated hydrological and water quality models for both upland watershed and riverine system. The SWAT model is a well documented and verified hydrological and water quality model that has been developed to simulate the effects of various management scenarios on the health of the environment in terms of water quantity and quality. Recently, the SWAT model has been extended to include the simulation of hydrodynamic and water quality parameters in the river system. The extended SWAT model (ESWAT) has been further extended to run using diurnally varying (hourly) weather data and produce outputs at hourly timescales. This and other improvements in the ESWAT model have been documented in the current work. Besides, the results from two case studies in Texas will be reported.

  9. Balancing opioid-induced gastrointestinal side effects with pain management: Insights from the online community.

    PubMed

    Whitman, Cynthia B; Reid, Mark W; Arnold, Corey; Patel, Haridarshan; Ursos, Lyann; Sa'adon, Roee; Pourmorady, Jonathan; Spiegel, Brennan M R

    2015-01-01

    Opioids cause gastrointestinal (GI) symptoms such as nausea, vomiting, pain, and (in 40 percent) constipation that diminish patients' quality of life. Outside traditional surveys, little is known about the opioid-induced constipation (OIC) patient experience and its impact on pain management. The purpose of this study was to use data from social media platforms to qualitatively examine patient beliefs about OIC and other prominent GI side effects, their impact on effective pain management and doctor-patient interaction. The authors collected Tweets from March 25 to July 31, 2014, and e-forum posts from health-related social networking sites regardless of timestamp. The authors identified specific keywords related to opioids and GI side effects to locate relevant content in the dataset, which was then manually coded using ATLAS.ti software. The authors examined 2,519,868 Tweets and more than 1.8 billion e-forum posts, of which, 88,586 Tweets and 9,767 posts satisfied the search criteria. Three thousand three individuals experienced opioidinduced GI side effects, mostly related to phenanthrenes (n = 1,589), and 1,274 (42.4 percent) individuals described constipation. Over-the-counter medications and nonevidence-based natural approaches were most commonly used to alleviate constipation. Many individuals questioned, rotated, reduced, or stopped their opioid treatments as a result of their GI side effects. Investigation of social media reveals a struggle to balance pain management with opioid-induced GI side effects, especially constipation. Individuals are often unprepared to treat OIC, to modify opioid regiments without medical advice, and to resort to using natural remedies and treatments lacking scientific evidence of effectiveness. These results identify opportunities to improve physician-patient communication and explore effective treatment alternatives.

  10. Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

    PubMed

    Kwan, Bethany M; Jortberg, Bonnie; Warman, Meredith K; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas; Martinez, Vincent; Nease, Donald E

    2017-06-01

    Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR.

  11. Usual populations, unusual individuals: insights into the behavior and management of Asian elephants in fragmented landscapes.

    PubMed

    Srinivasaiah, Nishant M; Anand, Vijay D; Vaidyanathan, Srinivas; Sinha, Anindya

    2012-01-01

    A dearth in understanding the behavior of Asian elephants (Elephas maximus) at the scale of populations and individuals has left important management issues, particularly related to human-elephant conflict (HEC), unresolved. Evaluation of differences in behavior and decision-making among individual elephants across groups in response to changing local ecological settings is essential to fill this gap in knowledge and to improve our approaches towards the management and conservation of elephants. We hypothesized certain behavioral decisions that would be made by Asian elephants as reflected in their residence time and movement rates, time-activity budgets, social interactions and group dynamics in response to resource availability and human disturbance in their habitat. This study is based on 200 h of behavioral observations on 60 individually identified elephants and a 184-km(2) grid-based survey of their natural and anthropogenic habitats within and outside the Bannerghatta National Park, southern India during the dry season. At a general population level, the behavioral decisions appeared to be guided by the gender, age and group-type of the elephants. At the individual level, the observed variation could be explained only by the idiosyncratic behaviors of individuals and that of their associating conspecific individuals. Recursive partitioning classification trees for residence time of individual elephants indicated that the primary decisions were taken by individuals, independently of their above-mentioned biological and ecological attributes. Decision-making by Asian elephants thus appears to be determined at two levels, that of the population and, more importantly, the individual. Models based on decision-making by individual elephants have the potential to predict conflict in fragmented landscapes that, in turn, could aid in mitigating HEC. Thus, we must target individuals, in addition to populations, in our efforts to manage and conserve this threatened

  12. The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation

    PubMed Central

    McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Huerta, Timothy R

    2015-01-01

    Objective To improve understanding of facilitators of EHR system implementation, paying particular attention to opportunities to maximize physician adoption and effective deployment. Data Sources/Study Setting Primary data collected from 47 physician and 35 administrative key informants from six U.S. health care organizations identified because of purported success with EHR implementation. Study Design We conducted interviews and focus groups in an extensive qualitative study. Data Collection/Extraction Methods Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method. Principal Findings Conceptualizing EHR adoption as loss through the lens of Kübler-Ross's five stages of grief model may help individuals and organizations more effectively orient to the challenge of change. Coupled with Kotter's eight-step change management framework, we offer a structure to facilitate organizations' movement through the EHR implementation journey. Combining insights from these frameworks, we identify 10 EHR strategies that can help address EHR implementation barriers. Conclusions Loss is one part of change often overlooked. Addressing it directly and compassionately can potentially facilitate the EHR implementation journey. We offer a summarized list of deployment strategies that are sensitive to these issues to support physician transition to new technologies that will bring value to clinical practice. PMID:25219627

  13. Regional solid waste management study

    SciTech Connect

    Not Available

    1992-09-01

    In 1990, the Lower Savannah Council of Governments (LSCOG) began dialogue with the United States Department of Energy (DOE) regarding possibilities for cooperation and coordination of solid waste management practices among the local governments and the Savannah River Site. The Department of Energy eventually awarded a grant to the Lower Savannah Council of Governments for the development of a study, which was initiated on March 5, 1992. After careful analysis of the region`s solid waste needs, this study indicates a network approach to solid waste management to be the most viable. The network involves the following major components: (1) Rural Collection Centers, designed to provide convenience to rural citizens, while allowing some degree of participation in recycling; (2) Rural Drop-Off Centers, designed to give a greater level of education and recycling activity; (3) Inert landfills and composting centers, designed to reduce volumes going into municipal (Subtitle D) landfills and produce useable products from yard waste; (4) Transfer Stations, ultimate landfill disposal; (5) Materials Recovery Facilities, designed to separate recyclables into useable and sellable units, and (6) Subtitle D landfill for burial of all solid waste not treated through previous means.

  14. Forest management for mitigation and adaptation: insights from long-term silvicultural experiments

    Treesearch

    Anthony W. D' Amato; John B. Bradford; Shawn Fraver; Brian J. Palik

    2011-01-01

    Developing management strategies for addressing global climate change has become an increasingly important issue influencing forest management around the globe. Currently, management approaches are being proposed that intend to (1) mitigate climate change by enhancing forest carbon stores and (2) foster adaptation by maintaining compositionally and structurally complex...

  15. Knowledge Management Analysis: A Case Study

    ERIC Educational Resources Information Center

    Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

    2009-01-01

    It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

  16. Knowledge Management Analysis: A Case Study

    ERIC Educational Resources Information Center

    Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

    2009-01-01

    It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

  17. Best Practices in Information Technology (IT) Management: Insights from K-12 Schools' Technology Audits.

    ERIC Educational Resources Information Center

    Michael, Steve O.

    1998-01-01

    Analysis of over 100 technology audits conducted by graduate students in Ohio K-12 school organizations yielded insights into best practices that school leaders may find useful, including attention to user access rate, leadership promise, technology planning, staff development, technical support, strategic hardware and software procurement,…

  18. How can we improve the management of vascular risk in type 2 diabetes: insights from FIELD.

    PubMed

    Steiner, George

    2009-10-01

    Intensive multifactorial risk factor intervention, targeting blood glucose, blood pressure and low-density lipoprotein cholesterol, is central to therapeutic management of type 2 diabetes. This strategy reduces, but does not eliminate the risk for cardiovascular complications, and microvascular complications such as diabetic retinopathy and nephropathy still continue to develop or progress. Fibrates have been shown to be effective in managing mixed dyslipidemia characterized by elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C), typically associated with type 2 diabetes. Data were reviewed from the largest fibrate study to date, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study which evaluated the effect of fenofibrate treatment in 9,795 patients with type 2 diabetes (about 80% without prior cardiovascular disease or microvascular complications). Although FIELD did not show a significant benefit with fenofibrate for major coronary events (the primary outcome), there was significant reduction in total cardiovascular events (relative risk reduction [RRR] 11%, p = 0.035 vs. placebo). The clinical benefits of fenofibrate treatment were greater in patients with marked mixed dyslipidemia (elevated triglycerides >or=200 mg/dL and low plasma levels of HDL-C), features of the metabolic syndrome commonly observed in patients with type 2 diabetes, with a RRR of 27%, p = 0.005. These data are consistent with evidence from other fibrate trials showing increased treatment benefits in patients with metabolic syndrome or type 2 diabetes and mixed dyslipidemia. The FIELD study also provided promising data for microvascular benefits with fenofibrate, specifically on the need for laser treatment for diabetic retinopathy, progression of albuminuria, and prevention of diabetes-related lower-limb amputation. Adding fenofibrate to primary statin therapy might be a useful strategy to address residual macrovascular and microvascular risk in

  19. Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

    PubMed

    Longo, Maria Cristina

    2015-01-01

    The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

  20. Multiproject interdependencies in health systems management: a longitudinal qualitative study.

    PubMed

    Spaulding, Aaron; Gamm, Larry; Kim, Jungyeon; Menser, Terri

    2014-01-01

    A health care organization often engages in the simultaneous implementation of multiple organization change initiatives. However, the degree to which these initiatives are implemented and can be enhanced based on their interdependencies is an open question. How organizations and the change initiatives they pursue might benefit from more careful examination of potential interdependencies among projects was explored in this article. The aim of this study was to introduce a multiproject management conceptualization that stresses project interdependencies and suggests synergies can be found to enhance overall project and organizational performance. It examines this conceptualization in the context of a health system pursuing several major initiatives to capture insights into the nature of such interdependencies. Longitudinal qualitative analysis of interviews conducted with hospital leaders attempting to manage multiple initiatives being implemented by the system's leadership team was used in this study. The implementation of an electronic medical record (EMR) is empirically identified as the most central among multiple projects based on other projects dependencies on the EMR. Furthermore, concerns for data are identified most frequently as success factors across all projects. This reinforces the depiction of the EMR as a central organizational focus. A unique perspective on multiproject management in hospitals and on EMR projects is presented. In addition, the interdependency conceptualization and its application and results provide insights into multiproject management that can help ensure that benefits of individual projects are more fully optimized or exploited in leveraging the effectiveness of other project initiatives.

  1. A Review of Solution Chemistry Studies: Insights into Students' Conceptions

    ERIC Educational Resources Information Center

    Calyk, Muammer; Ayas, Alipa; Ebenezer, Jazlin V.

    2005-01-01

    This study has reviewed the last two decades of student conception research in solution chemistry pertaining to aims, methods of exploring students' conception, general knowledge claims, students' conceptions and difficulties, and conceptual change studies. The aims of solution chemistry studies have been to assess students' understanding level of…

  2. A Review of Solution Chemistry Studies: Insights into Students' Conceptions

    ERIC Educational Resources Information Center

    Calyk, Muammer; Ayas, Alipa; Ebenezer, Jazlin V.

    2005-01-01

    This study has reviewed the last two decades of student conception research in solution chemistry pertaining to aims, methods of exploring students' conception, general knowledge claims, students' conceptions and difficulties, and conceptual change studies. The aims of solution chemistry studies have been to assess students' understanding level of…

  3. Managing Residual Contaminants – Reuse and Isolation Case Studies

    SciTech Connect

    Kevin M. Kostelnik, Ph.D.; James H. Clarke, Ph. D.

    2008-03-01

    Contaminants remaining on sites after regulatory-approved environmental remediation operations are complete represent continued risk to human health and the environment. Many sites require continued management efforts to: (1) protect the integrity of the engineered remedy/control, (2) limit the exposure of individuals to residual contamination by limiting reuse activities, (3) maintain ready access to accurate records/information, and (4) protect against vulnerabilities from intentional threats/actions. This paper presents performance information from selected case studies to provide insight into various management approaches employed for addressing the risks associated with residual contaminants. The case studies involve sites remediated within the U.S. CERCLA framework, and illustrate two prevailing management approaches for addressing the risks. Sacrifice Zones are sites that are purposefully isolated to prevent human access onto the property. Reuse Sites provide limited access for specific use.

  4. The SEIS Experiment for the Insight Mission: Development and management plan

    NASA Astrophysics Data System (ADS)

    Laudet, P.

    2015-10-01

    SEIS is a Mars seismometer, provided by CNES to JPL to be the threshold instrument of the next Mars mission, InSight, to be launched by NASA in March 2016. Discovery missions leads to a very strict frame of development, where schedule is driving development and qualification plans. We will explain how this constraint has been taken into account during development phases, until delivery of flight model, with a context of international cooperation without exchange of founds between partners.

  5. Insights into Coupled Folding and Binding Mechanisms from Kinetic Studies*

    PubMed Central

    Crabtree, Michael D.; Dahal, Liza; Wicky, Basile I. M.; Clarke, Jane

    2016-01-01

    Intrinsically disordered proteins (IDPs) are characterized by a lack of persistent structure. Since their identification more than a decade ago, many questions regarding their functional relevance and interaction mechanisms remain unanswered. Although most experiments have taken equilibrium and structural perspectives, fewer studies have investigated the kinetics of their interactions. Here we review and highlight the type of information that can be gained from kinetic studies. In particular, we show how kinetic studies of coupled folding and binding reactions, an important class of signaling event, are needed to determine mechanisms. PMID:26851275

  6. The journey through grief: insights from a qualitative study of electronic health record implementation.

    PubMed

    McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Huerta, Timothy R

    2015-04-01

    To improve understanding of facilitators of EHR system implementation, paying particular attention to opportunities to maximize physician adoption and effective deployment. Primary data collected from 47 physician and 35 administrative key informants from six U.S. health care organizations identified because of purported success with EHR implementation. We conducted interviews and focus groups in an extensive qualitative study. Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method. Conceptualizing EHR adoption as loss through the lens of Kübler-Ross's five stages of grief model may help individuals and organizations more effectively orient to the challenge of change. Coupled with Kotter's eight-step change management framework, we offer a structure to facilitate organizations' movement through the EHR implementation journey. Combining insights from these frameworks, we identify 10 EHR strategies that can help address EHR implementation barriers. Loss is one part of change often overlooked. Addressing it directly and compassionately can potentially facilitate the EHR implementation journey. We offer a summarized list of deployment strategies that are sensitive to these issues to support physician transition to new technologies that will bring value to clinical practice. © Health Research and Educational Trust.

  7. A Review of Solution Chemistry Studies: Insights into Students? Conceptions

    NASA Astrophysics Data System (ADS)

    Çalýk, Muammer; Ayas, Alipaşa; Ebenezer, Jazlin V.

    2005-03-01

    This study has reviewed the last two decades of student conception research in solution chemistry pertaining to aims, methods of exploring students' conception, general knowledge claims, students' conceptions and difficulties, and conceptual change studies. The aims of solution chemistry studies have been to assess students' understanding level of solution chemistry and in some studies compare understanding based on age and year at school or college. The methods of exploring students' conceptions consisted of interviews, paper and pencil surveys (open-ended questions and multiple-choice questions), free writing and drawings and the validity of these methods have been highlighted. The general knowledge claims synthesized in this study are students' (a) attending to mechanical events, (b) preference for everyday language usage over chemical language, (c) confusing solution chemistry with non-related concepts, (d) lack of sub-microscopic explanation for macroscopic observation, (e) difficulty with visualizing and representing sub-microscopic ideas, (f) difficulty with symbolic representations, (g) inconsistent explanations, (h) development of student understanding with age, and (i) development of conservation reasoning with age. To incorporate students' conceptions, conceptual change studies have used strategies such as worksheet, analogy, collaboratively working with a teacher, hypermedia, and group exploration. The results of conceptual change studies generally have had a positive impact enabling students to consider their ideas and develop plausible models of solution chemistry. For improvement of student learning in chemistry, this review of solution chemistry studies sheds light on teacher thinking and capacity building with respect to explicitly incorporating students' conceptions into chemistry curriculum; practicing research-based strategies; forging links among types of chemical knowledge; collaborating for experimental teaching; and conducting further

  8. Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study

    PubMed Central

    Engh, John A; Friis, Svein; Birkenaes, Astrid B; Jónsdóttir, Halldóra; Ringen, Petter A; Ruud, Torleif; Sundet, Kjetil S; Opjordsmoen, Stein; Andreassen, Ole A

    2007-01-01

    Background Beck Cognitive Insight Scale (BCIS) has been designed for assessment of self-reflection on patients' anomalous experiences and interpretations of own beliefs. The scale has been developed and validated for patients with schizophrenia. We wanted to study the utility of the scale for patients with bipolar disorder. The relationship between the BCIS as a measure of cognitive insight and established methods for assessment of insight of illness was explored in both diagnostic groups. Methods The BCIS self-report inventory was administered to patients with schizophrenia (n = 143), bipolar disorder (n = 92) and controls (n = 64). The 15 items of the inventory form two subscales, self-reflectiveness and self-certainty. Results The internal consistency of the subscales was good for the patient groups and the controls. The mean subscale scores were not significantly different for the three groups. Four items in subscale self-reflectiveness referring to psychotic experiences gave, however, different results in the control subjects. Self-certainty and scores on insight item PANSS correlated significantly in the schizophrenia, but not in the bipolar group. Conclusion BCIS with its two subscales seems applicable for patients with bipolar disorder as well as for patients with schizophrenia. The self-report inventory can also be applied to control subjects if the items referring to psychotic experiences are omitted. In schizophrenia high scores on self-certainty is possibly associated with poor insight of illness. For the bipolar group the subscales are largely independent of traditional insight measures. PMID:18072961

  9. Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study.

    PubMed

    Owen, G S; David, A S; Richardson, G; Szmukler, G; Hayward, P; Hotopf, M

    2009-08-01

    Mental capacity is now a core part of UK mental health law and clinicians will increasingly be expected to assess it. Because it is a legal concept there is a need to clarify associations with variables that clinicians are more familiar with, especially insight. In this cross-sectional study we recruited consecutive psychiatric admissions to the Maudsley Hospital, London. We carried out structured assessments of decision making using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), resulting in a clinical judgement about capacity status. We analysed associations with a range of sociodemographic and clinical variables, including insight score on the Expanded Schedule for the Assessment of Insight (SAI-E). The same variables were compared in an analysis stratified according to diagnostic group: psychotic disorders/bipolar affective disorder (BPAD)/non-psychotic disorders. Psychotic disorders and manic episodes of BPAD are most strongly associated with incapacity. In such patients, insight is the best discriminator of capacity status. In patients with non-psychotic disorders, insight is less strongly associated with capacity; in this group depressed mood discriminates capacity status whereas it does not in psychotic disorders. Cognitive performance does not discriminate capacity status in patients with psychotic disorders. Mental capacity has complex relationships with psychopathological variables, and these relationships are different according to diagnostic group. Insight is the best discriminator of capacity status in psychotic disorders and BPAD but not in non-psychotic disorders.

  10. Use and Users of the Cranberry Backcountry in West Virginia: insights for eastern backcountry management

    Treesearch

    Herbert E. Echelberger; George H. Moeller

    1977-01-01

    Management of backcountry recreation areas in the eastern United States should be based in part on information about the identity of backcountry users and what they seek in their backcountry experiences. Because little of this kind of information is now available, managers may be adopting some strategies with inadequate knowledge of the consequences of their decisions...

  11. An Interpersonal Approach to Classroom Management: Strategies for Improving Student Engagement. Classroom Insights from Educational Psychology

    ERIC Educational Resources Information Center

    Davis, Heather A.; Summers, Jessica J.; Miller, Lauren M.

    2012-01-01

    Like having a hidden camera in other teachers' classrooms, An Interpersonal Approach to Classroom Management engages you from the start by contrasting how two teachers respond differently to common situations. The authors expertly bridge the gap between educational psychology and peer and student-teacher management from the perspectives of student…

  12. An Interpersonal Approach to Classroom Management: Strategies for Improving Student Engagement. Classroom Insights from Educational Psychology

    ERIC Educational Resources Information Center

    Davis, Heather A.; Summers, Jessica J.; Miller, Lauren M.

    2012-01-01

    Like having a hidden camera in other teachers' classrooms, An Interpersonal Approach to Classroom Management engages you from the start by contrasting how two teachers respond differently to common situations. The authors expertly bridge the gap between educational psychology and peer and student-teacher management from the perspectives of student…

  13. New Insights on the Use of Dietary Polyphenols or Probiotics for the Management of Arterial Hypertension

    PubMed Central

    de Brito Alves, José L.; de Sousa, Vanessa P.; Cavalcanti Neto, Marinaldo P.; Magnani, Marciane; Braga, Valdir de Andrade; da Costa-Silva, João H.; Leandro, Carol G.; Vidal, Hubert; Pirola, Luciano

    2016-01-01

    Arterial hypertension (AH) is one of the most prevalent risk factors for cardiovascular diseases (CD) and is the main cause of deaths worldwide. Current research establish that dietary polyphenols may help to lower blood pressure (BP), thus contributing to the reduction of cardiovascular complications. In addition, the health benefits of probiotics on BP have also attracted increased attention, as probiotics administration modulates the microbiota, which, by interacting with ingested polyphenols, controls their bioavalability. The aim of the present mini-review is to summarize and clarify the effects of dietary polyphenols and probiotics administration on BP using combined evidence from clinical and experimental studies, as well as to discuss the current debate in the literature about the usefulness of this nutritional approach to manage BP. Clinical trials and experimental studies have demonstrated that consuming dietary polyphenols or probiotics in adequate amounts may improve BP, ranging from modest to greater effects. However, the mechanisms linking probiotic intake and reduced BP levels need to be further elucidated as a definitive consensus on the link between intake of polyphenols or probiotics and improvement of AH has not been reached yet. PMID:27766081

  14. The Sea Level Conundrum: Insights From Paleo Studies

    NASA Astrophysics Data System (ADS)

    Siddall, Mark; Clark, Peter; Thompson, Bill; Waelbroeck, Claire; Gregory, Jonathan; Stocker, Thomas

    2009-03-01

    Empirical Constraints on Future Sea Level Rise; Bern, Switzerland, 25-29 August 2008; Eustatic sea level (ESL) rise during the 21st century is perhaps the greatest threat from climate change, but its magnitude is contested. Geological records identify examples of nonlinear ice sheet response to climate forcing, suggesting a strategy for refining estimates of 21st-century sea level change. In August 2008, Past Global Changes (PAGES), International Marine Past Global Change Study (IMAGES), and the University of Bern cosponsored a workshop to address this possibility. The workshop highlighted several ways that paleoceanography studies can place limits on future sea level rise, and these are enlarged upon here.

  15. Insights into Departure Intention: A Qualitative Case Study

    ERIC Educational Resources Information Center

    Natoli, Riccardo; Jackling, Beverley; Siddique, Salina

    2015-01-01

    Efforts to address attrition rates at universities have been driven by Tinto's (1975) model of student engagement with its focus on student: (a) pre entry attributes; (b) academic engagement; and (c) social engagement. Using an ethnographic approach, the study involves interviews with business students to explore the links between these aspects…

  16. Insights from studying prejudice in the context of American atheists.

    PubMed

    Charles, Eric P; Rowland, Nicholas J; Long, Brooke; Yarrison, Fritz

    2012-12-01

    Our research on non-religion supports the proposed shift toward more interactive models of prejudice. Being nonreligious is easily hideable and, increasingly, of low salience, leading to experiences not easily understood via traditional or contemporary frameworks for studying prejudice and prejudice reduction. This context affords new opportunity to observe reverse forms of interactive prejudice, which can interfere with prejudice reduction.

  17. The Young Person's Job Search: Insights from a Study.

    ERIC Educational Resources Information Center

    Dayton, Charles W.

    1981-01-01

    Studies the success of job search methods used by young adults. Demographic factors account for less than half the variance in employment and less in job satisfaction. Results show ambition, education, persistence, and careful job search techniques, such as an effective resume, improve chances of finding employment. (JAC)

  18. Childhood-Onset Schizophrenia: Insights from Neuroimaging Studies

    ERIC Educational Resources Information Center

    Gogtay, Nitin; Rapoport, Judith L.

    2008-01-01

    The use of longitudinal neuroimaging to study the developmental perspectives of brain pathology in children with childhood-onset schizophrenia (COS) is described. Structural neuroimaging is capable of providing evidence of neurobiological specificity of COS to distinguish it from other brain abnormalities seen in neuropsychiatric illnesses like…

  19. Childhood-Onset Schizophrenia: Insights from Neuroimaging Studies

    ERIC Educational Resources Information Center

    Gogtay, Nitin; Rapoport, Judith L.

    2008-01-01

    The use of longitudinal neuroimaging to study the developmental perspectives of brain pathology in children with childhood-onset schizophrenia (COS) is described. Structural neuroimaging is capable of providing evidence of neurobiological specificity of COS to distinguish it from other brain abnormalities seen in neuropsychiatric illnesses like…

  20. Insights from Systems Biology in Physiological Studies: Learning from Context.

    PubMed

    Imenez Silva, Pedro Henrique; Melo, Diogo; de Mendonça, Pedro Omori Ribeiro

    2017-06-26

    Systems biology presents an integrated view of biological systems, focusing on the relations between elements, whether functional or evolutionary, and providing a rich framework for the comprehension of life. At the same time, many low-throughput experimental studies are performed without influence from this integrated view, whilst high-throughput experiments use low-throughput results in their validation and interpretation. We propose an inversion in this logic, and ask which benefits could be obtained from a holistic view coming from high-throughput studies-and systems biology in particular-in interpreting and designing low-throughput experiments. By exploring some key examples from the renal and adrenal physiology, we try to show that network and modularity theory, along with observed patterns of association between elements in a biological system, can have profound effects on our ability to draw meaningful conclusions from experiments. © 2017 The Author(s). Published by S. Karger AG, Basel.

  1. Insight into the primordial MHC from studies in ectothermic vertebrates.

    PubMed

    Flajnik, M F; Ohta, Y; Namikawa-Yamada, C; Nonaka, M

    1999-02-01

    MHC classical class I and class II genes have been identified in representative species from all major jawed vertebrate taxa, the oldest group being the cartilaginous fish, whereas no class I/II genes of any type have been detected in animals from older taxa. Among ectothermic vertebrate classes, studies of MHC architecture have been done in cartilaginous fish (sharks), bony fish (several teleost species), and amphibians (the frog Xenopus). The Xenopus MHC contains class I, class II, and class III genes, demonstrating that all of these genes were linked in the ancestor of the tetrapods, but the gene order is not the same as that in mouse/man. Studies of polyploid Xenopus suggest that MHC genes can be differentially silenced when multiple copies are present; i.e. MHC 'subregions' can be silenced. Surprisingly, in all teleosts examined to date class I and class II genes are not linked. Likewise, class III genes like the complement genes factor B (Bf) and C4 are scattered throughout the genome of teleosts. However, the presumed classical class I genes are closely linked to the 'immune' proteasome genes, LMP2 and LMP7, and to the peptide-transporter genes (TAP), implying that a true 'class I region' exists in this group. A similar type of linkage group is found in chickens and perhaps Xenopus, and thus it may reveal the ancestral organization of class I-associated genes. In cartilaginous fish, classical and non-classical class I genes have been isolated from three shark species, and class II A and B chain genes from nurse sharks. Studies of MHC linkage in sharks are being carried out to provide further understanding of the putative primordial organization of MHC Segregation studies in one shark family point to linkage of classical class I and class II genes, suggesting that the non-linkage of these genes in teleosts is a derived characteristic.

  2. Cutting down: insights from qualitative studies of smoking in pregnancy.

    PubMed

    Graham, Hilary; Flemming, Kate; Fox, David; Heirs, Morag; Sowden, Amanda

    2014-05-01

    The adverse effects of smoking in pregnancy are minimised if the mother quits completely in early pregnancy. Smokers are therefore advised to quit abruptly; cutting down is not recommended either as a method of, or alternative to, quitting. However, most pregnant smokers do not quit and cutting down is widely reported. Evidence comes primarily from quantitative studies; qualitative research has contributed little to understandings of cigarette consumption in pregnancy. In consequence, little is known about the place and meaning of cutting down for pregnant smokers. The paper investigates this important dimension of maternal smoking. It explores perceptions and experiences of cutting down among pregnant smokers by examining data from a systematic review of qualitative studies of smoking in pregnancy. The studies were located in high-income countries and published between 1970 and 2012. Twenty-six studies, reported in 29 papers, were included, representing over 640 women. Meta-ethnography guided the analysis and synthesis. Data (participants' accounts and authors' interpretations) were extracted and coded; codes were progressively combined to identify overarching themes ('lines of argument'). Running through the lines of argument was evidence on cutting down; the paper presents and analyses this evidence. The analysis indicates that cutting down figured centrally as both a method of quitting and, for persistent smokers, a method of harm reduction. While pregnant women were aware that official advice was to quit abruptly, cutting down was seen as a positive behaviour change in often-difficult domestic circumstances, and one that health professionals condoned. Our findings suggest that cutting down in pregnancy, as an aid and an alternative to quitting, requires greater recognition if healthcare and tobacco control policies are to be sensitive to the perspectives and circumstances of pregnant smokers.

  3. The Central Eurasia collision zone: insights from a neotectonic study

    NASA Astrophysics Data System (ADS)

    Tunini, Lavinia; Jiménez-Munt, Ivone; Fernandez, Manel; Vergés, Jaume

    2017-04-01

    In this study, we explore the neotectonic deformation in the whole Central Eurasia, including both the India-Eurasia and the Arabia-Eurasia collision zones, by using the thin-sheet approach in which the lithosphere strength is calculated from the lithosphere structure and thermal regime. We investigate the relative contributions of the lithospheric structure, rheology, boundary conditions, and friction coefficient on faults on the predicted velocity and stress fields. The resulting models have been evaluated by comparing the predictions with available data on seismic deformation, stress directions and GPS velocities. A first order approximation of the velocity and stress directions is obtained, reproducing the counter-clockwise rotation of Arabia and Iran, the westward escape of Anatolia, and the eastward extrusion of the northern Tibetan Plateau. To simulate the observed extensional faults within Tibet a weaker lithosphere is required, provided by a change in the rheological parameters or a reduction of the lithosphere thickness in NE-Tibet. The temperature increase generated by the lithospheric thinning below the Tibetan Plateau would also allow reconciling the model with the high heat flow and low mantle seismic velocities observed in the area. Besides the large scale, this study offers a coherent result in regions with little or no data coverage, as in the case of the Arabia-India inter-collision zone, over large areas of Pakistan and entire Afghanistan. The study is supported by MITE (CGL2014-59516-P) and WE-ME (PIE-CSIC-201330E111) projects.

  4. Software for Managing Parametric Studies

    NASA Technical Reports Server (NTRS)

    Yarrow, Maurice; McCann, Karen M.; DeVivo, Adrian

    2003-01-01

    The Information Power Grid Virtual Laboratory (ILab) is a Practical Extraction and Reporting Language (PERL) graphical-user-interface computer program that generates shell scripts to facilitate parametric studies performed on the Grid. (The Grid denotes a worldwide network of supercomputers used for scientific and engineering computations involving data sets too large to fit on desktop computers.) Heretofore, parametric studies on the Grid have been impeded by the need to create control language scripts and edit input data files painstaking tasks that are necessary for managing multiple jobs on multiple computers. ILab reflects an object-oriented approach to automation of these tasks: All data and operations are organized into packages in order to accelerate development and debugging. A container or document object in ILab, called an experiment, contains all the information (data and file paths) necessary to define a complex series of repeated, sequenced, and/or branching processes. For convenience and to enable reuse, this object is serialized to and from disk storage. At run time, the current ILab experiment is used to generate required input files and shell scripts, create directories, copy data files, and then both initiate and monitor the execution of all computational processes.

  5. Cancer Pain Management Insights and Reality in Southeast Asia: Expert Perspectives From Six Countries

    PubMed Central

    Irawan, Cosphiadi; Mansor, Marzida Binti; Sriraj, Wimonrat; Tan, Kian Hian; Thinh, Dang Huy Quoc

    2016-01-01

    This expert opinion report examines the current realities of the cancer pain management landscape and the various factors that hinder optimal pain control in six countries in Southeast Asia, describes ongoing efforts to advance patient care, and discusses approaches for improving cancer pain management. Information was gathered from leading experts in the field of cancer pain management in each country through an initial meeting and subsequent e-mail discussions. Overall, there are vast disparities in cancer pain management practices and access to opioids in the Southeast Asian countries. The experts considered cancer pain as being generally undermanaged. Access to opioids is inadequate in most countries, and opioid use for analgesia remains inadequate in the region. Several system-, physician-, and patient-related barriers to adequate pain relief were identified, including widespread over-regulation of opioid use, shortage of trained health care workers, inadequacies in pain assessment and knowledge about managing pain, and widespread resistance among patients and physicians toward opioid treatment. According to the experts, many of the ongoing initiatives in the Southeast Asian countries are related to educating patients and physicians on cancer pain management and opioid use. Efforts to improve opioid availability and reduce regulatory barriers in the region are limited, and much work is still needed to improve the status of cancer pain management in the region. Enacting necessary change will require recognition of the unique needs and resources of each country and collaboration across interdisciplinary professional teams to improve cancer pain care in this region. PMID:28717706

  6. Cancer Pain Management Insights and Reality in Southeast Asia: Expert Perspectives From Six Countries.

    PubMed

    Javier, Francis O; Irawan, Cosphiadi; Mansor, Marzida Binti; Sriraj, Wimonrat; Tan, Kian Hian; Thinh, Dang Huy Quoc

    2016-08-01

    This expert opinion report examines the current realities of the cancer pain management landscape and the various factors that hinder optimal pain control in six countries in Southeast Asia, describes ongoing efforts to advance patient care, and discusses approaches for improving cancer pain management. Information was gathered from leading experts in the field of cancer pain management in each country through an initial meeting and subsequent e-mail discussions. Overall, there are vast disparities in cancer pain management practices and access to opioids in the Southeast Asian countries. The experts considered cancer pain as being generally undermanaged. Access to opioids is inadequate in most countries, and opioid use for analgesia remains inadequate in the region. Several system-, physician-, and patient-related barriers to adequate pain relief were identified, including widespread over-regulation of opioid use, shortage of trained health care workers, inadequacies in pain assessment and knowledge about managing pain, and widespread resistance among patients and physicians toward opioid treatment. According to the experts, many of the ongoing initiatives in the Southeast Asian countries are related to educating patients and physicians on cancer pain management and opioid use. Efforts to improve opioid availability and reduce regulatory barriers in the region are limited, and much work is still needed to improve the status of cancer pain management in the region. Enacting necessary change will require recognition of the unique needs and resources of each country and collaboration across interdisciplinary professional teams to improve cancer pain care in this region.

  7. Insights into human evolution from ancient and contemporary microbiome studies

    PubMed Central

    Schnorr, Stephanie L; Sankaranarayanan, Krithivasan; Lewis, Cecil M; Warinner, Christina

    2017-01-01

    Over the past decade, human microbiome research has energized the study of human evolution through a complete shift in our understanding of what it means to be human. The microbiome plays a pivotal role in human biology, performing key functions in digestion, mood and behavior, development and immunity, and a range of acute and chronic diseases. It is therefore critical to understand its evolution and changing ecology through time. Here we review recent findings on the microbiota of diverse human populations, non-human primates, and past human populations and discuss the implications of this research in formulating a deeper evolutionary understanding of the human holobiont. PMID:27507098

  8. Caffeine Awareness in Children: Insights from a Pilot Study.

    PubMed

    Thakre, Tushar P; Deoras, Ketan; Griffin, Catherine; Vemana, Aarthi; Podmore, Petra; Krishna, Jyoti

    2015-07-15

    Caffeine, a commonly consumed psychoactive substance, can have significant effects on sleep. Caffeine intake among children is increasing, mainly in the form of sodas. However, adolescent caffeine consumers may lack knowledge about the caffeine content in common beverages. If true, this very fact may hamper the assessment of the effects of caffeine consumption on sleep in children if such assessments are a priori dependent on responders being able to reliably distinguish between caffeinated and noncaffeinated beverages. This preliminary study investigated adolescents' caffeine knowledge and intake at a Cleveland-area public middle school. Seventh- and eighth-grade students were surveyed using: (1) the Caffeine Literacy and Sleep Study (CLASS), a 15-question pilot instrument designed to assess caffeine knowledge and intake by type, quantity and timing, as well as sleep habits; and (2) the Cleveland Adolescent Sleepiness Questionnaire (CASQ), a validated survey measuring excessive daytime sleepiness in adolescents. These questionnaires were distributed and collected during a specified class period. Of the 635 seventh- and eighth-grade students who attended school on the day of the study, 555 (87%) participated. Lack of knowledge about caffeine content of particular drinks was noted in seventh and eighth graders of both sexes with nearly 29% unaware that their favorite drinks contain caffeine and more than 50% unable to correctly identify the drinks with the most caffeine. A low percentage of students correctly identified light-colored sodas lacking caffeine: 7-Up (24.1%), Sierra Mist (38.9%), ginger ale (39.8%), Sprite (39.8%), and Fresca (53.7%). The percentages of students correctly identifying caffeinated light-colored beverages were: Arizona Green Tea (43.5%), Mello Yellow (50.9%), and A&W cream soda (67.6%). However, Mountain Dew was correctly identified by most (93.5%) as caffeinated. Students were not consistently able to identify caffeine content or lack

  9. Functional Insights into Chromatin Remodelling from Studies on CHARGE Syndrome

    PubMed Central

    Basson, M. Albert; van Ravenswaaij-Arts, Conny

    2015-01-01

    CHARGE syndrome is a rare genetic syndrome characterised by a unique combination of multiple organ anomalies. Dominant loss-of-function mutations in the gene encoding chromodomain helicase DNA binding protein 7 (CHD7), which is an ATP-dependent chromatin remodeller, have been identified as the cause of CHARGE syndrome. Here, we review recent work aimed at understanding the mechanism of CHD7 function in normal and pathological states, highlighting results from biochemical and in vivo studies. The emerging picture from this work suggests that the mechanisms by which CHD7 fine-tunes gene expression are context specific, consistent with the pleiotropic nature of CHARGE syndrome. PMID:26411921

  10. Genomic imprinting--insights from studies in mice.

    PubMed

    Ferguson-Smith, Anne; Lin, Shau-Ping; Tsai, Chen-En; Youngson, Neil; Tevendale, Maxine

    2003-02-01

    A subset of mammalian genes is controlled by genomic imprinting. This process causes a gene to be expressed from only one chromosome homologue depending on whether it originally came from the egg or the sperm. Parental origin-specific gene regulation is controlled by epigenetic modifications to DNA and chromatin. Genomic imprinting is therefore a useful model system to study the epigenetic control of genome function. Here we consider the value of the mouse as an experimental organism to address questions about the role of imprinted genes, about the regulation of mono-allelic gene expression and about the evolution of the imprinting function and mechanism.

  11. [New insight of genome-wide association study (GWAS)].

    PubMed

    Hotta, Kikuko

    2013-02-01

    The number of obese patients is increasing in Japan, due to the westernization of lifestyle. Obesity, especially visceral fat obesity, is important for the development of metabolic syndrome. Genetic factors are important for the development of obesity as well as environmental factors. Importance of genetic factors of fat distribution is also reported. Recent genome-wide association studies (GWASs) have revealed the obesity and fat distribution-related polymorphisms. GWAS will highlight a better understanding of the underlying molecular mechanisms in the regulation of obesity and distribution of body fat.

  12. Nurse consultants 10 years on: an insight to the role for nurse managers.

    PubMed

    Mullen, Chris; Gavin-Daley, Ann; Kilgannon, Helen; Swift, Juliette

    2011-09-01

    To evaluate the Non-Medical Consultant role in the North West of England. The objective was to identify the current number of Non-Medical Consultants, what they do and the impact of the role in practice. The Non-Medical Consultant role for nursing and midwifery was introduced in the UK in 2000 to provide better outcomes for patients by improving service and quality; strengthening clinical leadership; and providing a new career opportunity to help retain experienced and expert professionals in practice. A combined qualitative and quantitative design was adopted. This included desktop review of previous studies, a survey questionnaire to current consultants, focus group meetings with Non-Medical Consultants, sponsors and champions. The role is effective, flexible, responsive and outward facing both internal to the organization and externally on a local, regional and national basis. A key challenge for the Non-Medical Consultants was organizational understanding of the role. The small size of the Non-Medical Consultant workforce can limit individual organizations experience of establishing and supporting the role. Effective Non-Medical Consultants lead, drive and support quality improvement, increased productivity and service effectiveness. Other impacts include sharing and promoting best practice with colleagues, income generation and financial savings through service redesign and/or staff skill mix changes. Managerial issues identified may assist Nurse Managers seeking to introduce new consultant roles and/or support, and retain existing consultants to reach their full potential. 2011 Blackwell Publishing Ltd.

  13. Dawning of the age of genomics for platelet granule disorders: improving insight, diagnosis and management.

    PubMed

    Bariana, Tadbir K; Ouwehand, Willem H; Guerrero, Jose A; Gomez, Keith

    2017-03-01

    Inherited disorders of platelet granules are clinically heterogeneous and their prevalence is underestimated because most patients do not undergo a complete diagnostic work-up. The lack of a genetic diagnosis limits the ability to tailor management, screen family members, aid with family planning, predict clinical progression and detect serious consequences, such as myelofibrosis, lung fibrosis and malignancy, in a timely manner. This is set to change with the introduction of high throughput sequencing (HTS) as a routine clinical diagnostic test. HTS diagnostic tests are now available, affordable and allow parallel screening of DNA samples for variants in all of the 80 known bleeding, thrombotic and platelet genes. Increased genetic diagnosis and curation of variants is, in turn, improving our understanding of the pathobiology and clinical course of inherited platelet disorders. Our understanding of the genetic causes of platelet granule disorders and the regulation of granule biogenesis is a work in progress and has been significantly enhanced by recent genomic discoveries from high-powered genome-wide association studies and genome sequencing projects. In the era of whole genome and epigenome sequencing, new strategies are required to integrate multiple sources of big data in the search for elusive, novel genes underlying granule disorders.

  14. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry.

    PubMed

    Behr, Jürgen; Kreuter, Michael; Hoeper, Marius M; Wirtz, Hubert; Klotsche, Jens; Koschel, Dirk; Andreas, Stefan; Claussen, Martin; Grohé, Christian; Wilkens, Henrike; Randerath, Winfried; Skowasch, Dirk; Meyer, F Joachim; Kirschner, Joachim; Gläser, Sven; Herth, Felix J F; Welte, Tobias; Huber, Rudolf Maria; Neurohr, Claus; Schwaiblmair, Martin; Kohlhäufl, Martin; Höffken, Gert; Held, Matthias; Koch, Andrea; Bahmer, Thomas; Pittrow, David

    2015-07-01

    After introduction of the new international guidelines on idiopathic pulmonary fibrosis (IPF) in 2011, we investigated clinical management practices for patients with IPF according to physicians' diagnoses. A prospective, multicenter, noninterventional study with comprehensive quality measures including on-site source data verification was performed in Germany. 502 consecutive patients (171 newly diagnosed, 331 prevalent; mean±SD age 68.7±9.4 years, 77.9% males) with a mean disease duration of 2.3±3.5 years were enrolled. IPF diagnosis was based on clinical assessments and high-resolution computed tomography (HRCT) in 90.2%, and on surgical lung biopsy combined with histology in 34.1% (lavage in 61.8%). The median 6-min walk distance was 320 m (mean 268±200 m). The mean forced vital capacity was 72±20% pred and diffusing capacity of the lung for carbon monoxide was 35±15% pred. No drugs were administered in 17.9%, oral steroids in 23.7%, N-acetylcysteine in 33.7%, pirfenidone in 44.2% and other drugs in 4.6% of patients. Only 2.8% of the cohort was listed for lung transplantation. IPF patients were diagnosed in line with the new guidelines. They had more severe disease than those enrolled in recent randomised controlled trials. In addition to HRCT, the frequency of lung biopsies was surprisingly high. Treatment patterns varied substantially.

  15. Multisensory object representation: insights from studies of vision and touch.

    PubMed

    Lacey, Simon; Sathian, K

    2011-01-01

    Behavioral studies show that the unisensory representations underlying within-modal visual and haptic object recognition are strikingly similar in terms of view- and size-sensitivity, and integration of structural and surface properties. However, the basis for these attributes differs in each modality, indicating that while these representations are functionally similar, they are not identical. Imaging studies reveal bisensory, visuo-haptic object selectivity, notably in the lateral occipital complex and the intraparietal sulcus, that suggests a shared representation of objects. Such a multisensory representation could underlie visuo-haptic cross-modal object recognition. In this chapter, we compare visual and haptic within-modal object recognition and trace a progression from functionally similar but separate unisensory representations to a shared multisensory representation underlying cross-modal object recognition as well as view-independence, regardless of modality. We outline, and provide evidence for, a model of multisensory object recognition in which representations are flexibly accessible via top-down or bottom-up processing, the choice of route being influenced by object familiarity and individual preference along the object-spatial continuum of mental imagery. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Reproductive costs in terrestrial male vertebrates: insights from bird studies

    PubMed Central

    Gamelon, Marlène; Sæther, Bernt-Erik

    2016-01-01

    Reproduction requires resources that cannot be allocated to other functions resulting in direct reproductive costs (i.e. trade-offs between current reproduction and subsequent survival/reproduction). In wild vertebrates, direct reproductive costs have been widely described in females, but their occurrence in males remains to be explored. To fill this gap, we gathered 53 studies on 48 species testing direct reproductive costs in male vertebrates. We found a trade-off between current reproduction and subsequent performances in 29% of the species and in every clade. As 73% of the studied species are birds, we focused on that clade to investigate whether such trade-offs are associated with (i) levels of paternal care, (ii) polygyny or (iii) pace of life. More precisely for this third question, it is expected that fast species (i.e. short lifespan, early maturity, high fecundity) pay a cost in terms of survival, whereas slow species (with opposite characteristics) do so in terms of fecundity. Our findings tend to support this hypothesis. Finally, we pointed out the potential confounding effects that should be accounted for when investigating reproductive costs in males and strongly encourage the investigation of such costs in more clades to understand to what extent our results are relevant for other vertebrates. PMID:26791619

  17. Unmarried parenthood: new insights from the Millennium Cohort Study.

    PubMed

    Kiernan, Kathleen; Smith, Kate

    2003-01-01

    This study uses information from the Millennium Cohort Study to examine the characteristics of families where children are born within a marriage, within a cohabiting union or outside of a co-residential partnership. For this latter group, for the first time in a national data set, an assessment can be made of the 'strength' of the parent's relationship at the time of the birth. We show that the context of childbearing varies with respect to geography, ethnicity, age, parity and educational status of the mother, and that the socioeconomic wellbeing of families varies according to the partnership status of their parents. A closer look at the non-partnered parents shows that the extent to which the fathers were involved with the mother of the child around the time the baby was born was related to the presence of the father at the birth of the child and whether his name was recorded on the child's birth certificate; as well as to subsequent behaviour, such as, whether they moved in with the mother, saw their children on a regular basis or contributed money to the child's maintenance.

  18. Molecular mechanisms in atopic eczema: insights gained from genetic studies.

    PubMed

    Brown, Sara J

    2017-01-01

    Atopic eczema (synonymous with atopic dermatitis) is a common heterogeneous phenotype with a wide spectrum of severity, from mild transient disease to a severe chronic disorder with atopic and non-atopic comorbidities. Eczema is a complex trait, resulting from the interaction of multiple genetic and environmental factors. The skin, as an organ that can be biopsied easily, provides opportunities for detailed molecular genetic analysis. Strategies applied to the investigation of atopic eczema include candidate gene and genome-wide studies, extreme phenotypes, and comparative analysis of inflammatory skin diseases. Genetic studies have identified a central role for skin barrier impairment in eczema predisposition and perpetuation; this has brought about a paradigm shift in understanding atopic disease, but specific molecular targets to improve skin barrier function remain elusive. The role of Th2-mediated immune dysfunction is also central to atopic inflammation, and has proved to be a powerful target for biological therapy in atopic eczema. Advances in understanding eczema pathogenesis have provided opportunities for patient stratification, primary prevention, and therapy development, but there remain considerable challenges in the application of this knowledge to optimize benefit for patients with atopic eczema in the era of personalized medicine. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

  19. Olfactory function in psychotic disorders: Insights from neuroimaging studies

    PubMed Central

    Good, Kimberley P; Sullivan, Randii Lynn

    2015-01-01

    Olfactory deficits on measures of identification, familiarity, and memory are consistently noted in patients with psychotic disorders relative to age-matched controls. Olfactory intensity ratings, however, appear to remain intact while the data on hedonics and detection threshold are inconsistent. Despite the behavioral abnormalities noted, no specific regional brain hypoactivity has been identified in psychosis patients, for any of the olfactory domains. However, an intriguing finding emerged from this review in that the amygdala and pirifom cortices were not noted to be abnormal in hedonic processing (nor was the amygdala identified abnormal in any study) in psychotic disorders. This finding is in contrast to the literature in healthy individuals, in that this brain region is strongly implicated in olfactory processing (particularly for unpleasant odorants). Secondary olfactory cortex (orbitofrontal cortices, thalamus, and insula) was abnormally activated in the studies examined, particularly for hedonic processing. Further research, using consistent methodology, is required for better understanding the neurobiology of olfactory deficits. The authors suggest taking age and sex differences into consideration and further contrasting olfactory subgroups (impaired vs intact) to better our understanding of the heterogeneity of psychotic disorders. PMID:26110122

  20. Protein-bound uremic toxins: new insight from clinical studies.

    PubMed

    Liabeuf, Sophie; Drüeke, Tilman B; Massy, Ziad A

    2011-07-01

    The uremic syndrome is attributed to the progressive retention of a large number of compounds which, under normal conditions, are excreted by healthy kidneys. The compounds are called uremic toxins when they interact negatively with biological functions. The present review focuses on a specific class of molecules, namely the family of protein-bound uremic toxins. Recent experimental studies have shown that protein-bound toxins are involved not only in the progression of chronic kidney disease (CKD), but also in the generation and aggravation of cardiovascular disease. Two protein-bound uremic retention solutes, namely indoxyl sulfate and p-cresyl sulfate, have been shown to play a prominent role. However, although these two molecules belong to the same class of molecules, exert toxic effects on the cardiovascular system in experimental animals, and accumulate in the serum of patients with CKD they may have different clinical impacts in terms of cardiovascular disease and other complications. The principal aim of this review is to evaluate the effect of p-cresyl sulfate and indoxyl sulfate retention on CKD patient outcomes, based on recent clinical studies.

  1. Targeting neutrophils in ischemic stroke: translational insights from experimental studies

    PubMed Central

    Jickling, Glen C; Liu, DaZhi; Ander, Bradley P; Stamova, Boryana; Zhan, Xinhua; Sharp, Frank R

    2015-01-01

    Neutrophils have key roles in ischemic brain injury, thrombosis, and atherosclerosis. As such, neutrophils are of great interest as targets to treat and prevent ischemic stroke. After stroke, neutrophils respond rapidly promoting blood–brain barrier disruption, cerebral edema, and brain injury. A surge of neutrophil-derived reactive oxygen species, proteases, and cytokines are released as neutrophils interact with cerebral endothelium. Neutrophils also are linked to the major processes that cause ischemic stroke, thrombosis, and atherosclerosis. Thrombosis is promoted through interactions with platelets, clotting factors, and release of prothrombotic molecules. In atherosclerosis, neutrophils promote plaque formation and rupture by generating oxidized-low density lipoprotein, enhancing monocyte infiltration, and degrading the fibrous cap. In experimental studies targeting neutrophils can improve stroke. However, early human studies have been met with challenges, and suggest that selective targeting of neutrophils may be required. Several properties of neutrophil are beneficial and thus may important to preserve in patients with stroke including antimicrobial, antiinflammatory, and neuroprotective functions. PMID:25806703

  2. Insightful monitoring of natural flood risk management features using a low-cost and participatory approach

    NASA Astrophysics Data System (ADS)

    Starkey, Eleanor; Barnes, Mhari; Quinn, Paul; Large, Andy

    2016-04-01

    Pressures associated with flooding and climate change have significantly increased over recent years. Natural Flood Risk Management (NFRM) is now seen as being a more appropriate and favourable approach in some locations. At the same time, catchment managers are also encouraged to adopt a more integrated, evidence-based and bottom-up approach. This includes engaging with local communities. Although NFRM features are being more readily installed, there is still limited evidence associated with their ability to reduce flood risk and offer multiple benefits. In particular, local communities and land owners are still uncertain about what the features entail and how they will perform, which is a huge barrier affecting widespread uptake. Traditional hydrometric monitoring techniques are well established but they still struggle to successfully monitor and capture NFRM performance spatially and temporally in a visual and more meaningful way for those directly affected on the ground. Two UK-based case studies are presented here where unique NFRM features have been carefully designed and installed in rural headwater catchments. This includes a 1km2 sub-catchment of the Haltwhistle Burn (northern England) and a 2km2 sub-catchment of Eddleston Water (southern Scotland). Both of these pilot sites are subject to prolonged flooding in winter and flash flooding in summer. This exacerbates sediment, debris and water quality issues downstream. Examples of NFRM features include ponds, woody debris and a log feature inspired by the children's game 'Kerplunk'. They have been tested and monitored over the 2015-2016 winter storms using low-cost techniques by both researchers and members of the community ('citizen scientists'). Results show that monitoring techniques such as regular consumer specification time-lapse cameras, photographs, videos and 'kite-cams' are suitable for long-term and low-cost monitoring of a variety of NFRM features. These techniques have been compared against

  3. Fetal developmental programing: insights from human studies and experimental models.

    PubMed

    Lopes, Gisele Aparecida Dionísio; Ribeiro, Vinícius Luís Bertotti; Barbisan, Luís Fernando; Marchesan Rodrigues, Maria Aparecida

    2017-03-01

    Environmental factors, particularly nutrition during pregnancy and early life can influence the risk of chronic diseases in later life. The underlying mechanism, termed "programing", postulates that an environmental stimulus during a critical window of time, early in life, has a permanent effect on subsequent structure and function of the organism. In this study we review the concept of fetal programing on chronic diseases and the proposed hypotheses for the association between early development and later disease, including epigenetic variation. We concentrate on specific aspects of maternal nutrition, particularly under-nutrition and over-nutrition, in humans and animal models. An adequate maternal nutrition during pregnancy is crucial for the health outcome of the offspring at adulthood.

  4. Insight On Colorectal Carcinoma Infiltration by Studying Perilesional Extracellular Matrix.

    PubMed

    Nebuloni, Manuela; Albarello, Luca; Andolfo, Annapaola; Magagnotti, Cinzia; Genovese, Luca; Locatelli, Irene; Tonon, Giovanni; Longhi, Erika; Zerbi, Pietro; Allevi, Raffaele; Podestà, Alessandro; Puricelli, Luca; Milani, Paolo; Soldarini, Armando; Salonia, Andrea; Alfano, Massimo

    2016-03-04

    The extracellular matrix (ECM) from perilesional and colorectal carcinoma (CRC), but not healthy colon, sustains proliferation and invasion of tumor cells. We investigated the biochemical and physical diversity of ECM in pair-wised comparisons of healthy, perilesional and CRC specimens. Progressive linearization and degree of organization of fibrils was observed from healthy to perilesional and CRC ECM, and was associated with a steady increase of stiffness and collagen crosslinking. In the perilesional ECM these modifications coincided with increased vascularization, whereas in the neoplastic ECM they were associated with altered modulation of matrisome proteins, increased content of hydroxylated lysine and lysyl oxidase. This study identifies the increased stiffness and crosslinking of the perilesional ECM predisposing an environment suitable for CRC invasion as a phenomenon associated with vascularization. The increased stiffness of colon areas may represent a new predictive marker of desmoplastic region predisposing to invasion, thus offering new potential application for monitoring adenoma with invasive potential.

  5. Insight On Colorectal Carcinoma Infiltration by Studying Perilesional Extracellular Matrix

    PubMed Central

    Nebuloni, Manuela; Albarello, Luca; Andolfo, Annapaola; Magagnotti, Cinzia; Genovese, Luca; Locatelli, Irene; Tonon, Giovanni; Longhi, Erika; Zerbi, Pietro; Allevi, Raffaele; Podestà, Alessandro; Puricelli, Luca; Milani, Paolo; Soldarini, Armando; Salonia, Andrea; Alfano, Massimo

    2016-01-01

    The extracellular matrix (ECM) from perilesional and colorectal carcinoma (CRC), but not healthy colon, sustains proliferation and invasion of tumor cells. We investigated the biochemical and physical diversity of ECM in pair-wised comparisons of healthy, perilesional and CRC specimens. Progressive linearization and degree of organization of fibrils was observed from healthy to perilesional and CRC ECM, and was associated with a steady increase of stiffness and collagen crosslinking. In the perilesional ECM these modifications coincided with increased vascularization, whereas in the neoplastic ECM they were associated with altered modulation of matrisome proteins, increased content of hydroxylated lysine and lysyl oxidase. This study identifies the increased stiffness and crosslinking of the perilesional ECM predisposing an environment suitable for CRC invasion as a phenomenon associated with vascularization. The increased stiffness of colon areas may represent a new predictive marker of desmoplastic region predisposing to invasion, thus offering new potential application for monitoring adenoma with invasive potential. PMID:26940881

  6. New insights into handling missing values in environmental epidemiological studies.

    PubMed

    Roda, Célina; Nicolis, Ioannis; Momas, Isabelle; Guihenneuc, Chantal

    2014-01-01

    Missing data are unavoidable in environmental epidemiologic surveys. The aim of this study was to compare methods for handling large amounts of missing values: omission of missing values, single and multiple imputations (through linear regression or partial least squares regression), and a fully Bayesian approach. These methods were applied to the PARIS birth cohort, where indoor domestic pollutant measurements were performed in a random sample of babies' dwellings. A simulation study was conducted to assess performances of different approaches with a high proportion of missing values (from 50% to 95%). Different simulation scenarios were carried out, controlling the true value of the association (odds ratio of 1.0, 1.2, and 1.4), and varying the health outcome prevalence. When a large amount of data is missing, omitting these missing data reduced statistical power and inflated standard errors, which affected the significance of the association. Single imputation underestimated the variability, and considerably increased risk of type I error. All approaches were conservative, except the Bayesian joint model. In the case of a common health outcome, the fully Bayesian approach is the most efficient approach (low root mean square error, reasonable type I error, and high statistical power). Nevertheless for a less prevalent event, the type I error is increased and the statistical power is reduced. The estimated posterior distribution of the OR is useful to refine the conclusion. Among the methods handling missing values, no approach is absolutely the best but when usual approaches (e.g. single imputation) are not sufficient, joint modelling approach of missing process and health association is more efficient when large amounts of data are missing.

  7. New Insights into Handling Missing Values in Environmental Epidemiological Studies

    PubMed Central

    Roda, Célina; Nicolis, Ioannis; Momas, Isabelle; Guihenneuc, Chantal

    2014-01-01

    Missing data are unavoidable in environmental epidemiologic surveys. The aim of this study was to compare methods for handling large amounts of missing values: omission of missing values, single and multiple imputations (through linear regression or partial least squares regression), and a fully Bayesian approach. These methods were applied to the PARIS birth cohort, where indoor domestic pollutant measurements were performed in a random sample of babies' dwellings. A simulation study was conducted to assess performances of different approaches with a high proportion of missing values (from 50% to 95%). Different simulation scenarios were carried out, controlling the true value of the association (odds ratio of 1.0, 1.2, and 1.4), and varying the health outcome prevalence. When a large amount of data is missing, omitting these missing data reduced statistical power and inflated standard errors, which affected the significance of the association. Single imputation underestimated the variability, and considerably increased risk of type I error. All approaches were conservative, except the Bayesian joint model. In the case of a common health outcome, the fully Bayesian approach is the most efficient approach (low root mean square error, reasonable type I error, and high statistical power). Nevertheless for a less prevalent event, the type I error is increased and the statistical power is reduced. The estimated posterior distribution of the OR is useful to refine the conclusion. Among the methods handling missing values, no approach is absolutely the best but when usual approaches (e.g. single imputation) are not sufficient, joint modelling approach of missing process and health association is more efficient when large amounts of data are missing. PMID:25226278

  8. Insights into the Angoff method: results from a simulation study.

    PubMed

    Shulruf, Boaz; Wilkinson, Tim; Weller, Jennifer; Jones, Philip; Poole, Phillippa

    2016-05-04

    In standard setting techniques involving panels of judges, the attributes of judges may affect the cut-scores. This simulation study modelled the effect of the number of judges and test items, as well as the impact of judges' attributes such as accuracy, stringency and influence on others on the precision of the cut-scores. Forty nine combinations of Angoff panels (N = 5, 10, 15, 20, 30, 50, and 80) and test items (n = 5, 10, 15, 20, 30, 50, and 80) were simulated. Each combination was simulated 100 times (in total 4,900 simulations). The simulation was of judges attributes: stringency, accuracy and leadership. Impact of judges attributes, number of judges, number of test items and Angoff's second (compared to the first) round on the precision of a panel's cut-score was measured by the deviation of the panel's cut-score from the cut-score's true value. Findings from 4900 simulated panels supported Angoff being both reliable and valid. Unless the number of test items is small, panels of around 15 judges with mixed levels of expertise provide the most precise estimates. Furthermore, if test data were not presented, a second round of decision-making, as used in the modified Angoff, adds little to precision. A panel which has only experts or only non-experts yields a cut-score which is less precise than a cut-score yielded by a mixed-expertise panel, suggesting that optimal composition of an Angoff panel should include a range of judges with diverse expertise and stringency. Simulations aim to improve our understanding of the models assessed but they do not describe natural phenomena as they do not use observed data. While the simulations undertaken in this study help clarify how to set cut-scores defensibly, it is essential to confirm these theories in practice.

  9. Translational Science Project Team Managers: Qualitative Insights and Implications from Current and Previous Postdoctoral Experiences

    PubMed Central

    Wooten, Kevin C.; Dann, Sara M.; Finnerty, Celeste C.; Kotarba, Joseph A.

    2015-01-01

    The development of leadership and project management skills is increasingly important to the evolution of translational science and team-based endeavors. Team science is dependent upon individuals at various stages in their careers, inclusive of postdocs. Data from case histories, as well as from interviews with current and former postdocs, and those supervising postdocs, indicate six essential tasks required of project managers in multidisciplinary translational teams, along with eight skill-related themes critical to their success. To optimize the opportunities available and to ensure sequential development of team project management skills, a life cycle model for the development of translational team skills is proposed, ranging from graduate trainees, postdocs, assistant professors, and finally to mature scientists. Specific goals, challenges and project management roles and tasks are recommended for each stage for the life cycle. PMID:25621288

  10. Translational Science Project Team Managers: Qualitative Insights and Implications from Current and Previous Postdoctoral Experiences.

    PubMed

    Wooten, Kevin C; Dann, Sara M; Finnerty, Celeste C; Kotarba, Joseph A

    2014-07-01

    The development of leadership and project management skills is increasingly important to the evolution of translational science and team-based endeavors. Team science is dependent upon individuals at various stages in their careers, inclusive of postdocs. Data from case histories, as well as from interviews with current and former postdocs, and those supervising postdocs, indicate six essential tasks required of project managers in multidisciplinary translational teams, along with eight skill-related themes critical to their success. To optimize the opportunities available and to ensure sequential development of team project management skills, a life cycle model for the development of translational team skills is proposed, ranging from graduate trainees, postdocs, assistant professors, and finally to mature scientists. Specific goals, challenges and project management roles and tasks are recommended for each stage for the life cycle.

  11. Advances in plant virus evolution: Translating evolutionary insights into better disease management

    USDA-ARS?s Scientific Manuscript database

    Revolutionary theoretical concepts derived from experimental evolution have reached the realm of plant viruses, and their empirical demonstration is opening new avenues for disease management. From a populational standpoint, plant viruses and viroids constitute dynamic spectra of variants. The frequ...

  12. Depression in medical students: insights from a longitudinal study.

    PubMed

    Silva, Vanessa; Costa, Patrício; Pereira, Inês; Faria, Ricardo; Salgueira, Ana P; Costa, Manuel J; Sousa, Nuno; Cerqueira, João J; Morgado, Pedro

    2017-10-10

    Factors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time. A prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009-2010 to 2012-2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression. The response rate was 84, 92, 88 and 81% for academic years 2009-2010, 2010-2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems

  13. Insights from the study of high-temperature interface superconductivity.

    PubMed

    Pereiro, J; Bollinger, A T; Logvenov, G; Gozar, A; Panagopoulos, C; Bozović, I

    2012-10-28

    A brief overview is given of the studies of high-temperature interface superconductivity based on atomic-layer-by-layer molecular beam epitaxy (ALL-MBE). A number of difficult materials science and physics questions have been tackled, frequently at the expense of some technical tour de force, and sometimes even by introducing new techniques. ALL-MBE is especially suitable to address questions related to surface and interface physics. Using this technique, it has been demonstrated that high-temperature superconductivity can occur in a single copper oxide layer-the thinnest superconductor known. It has been shown that interface superconductivity in cuprates is a genuine electronic effect-it arises from charge transfer (electron depletion and accumulation) across the interface driven by the difference in chemical potentials rather than from cation diffusion and mixing. We have also understood the nature of the superconductor-insulator phase transition as a function of doping. However, a few important questions, such as the mechanism of interfacial enhancement of the critical temperature, are still outstanding.

  14. Cerebral cavernous malformations: clinical insights from genetic studies.

    PubMed

    Mindea, Stefan A; Yang, Benson P; Shenkar, Robert; Bendok, Bernard; Batjer, H Hunt; Awad, Issam A

    2006-07-15

    Familial disease is responsible for one third to one half of cerebral cavernous malformation (CCM) cases presenting to clinical attention. Much has been learned in the past decade about the genetics of these cases, which are all inherited in an autosomal dominant pattern, at three known chromosome loci. Unique features of inherited CCMs in Hispanic-Americans of Mexican descent have been described. The respective genes for each locus have been identified and preliminary observations on disease pathways and mechanisms are coming to light, including possible explanations for selectivity of neural milieu and relationships to endothelial layer abnormalities. Mechanisms of lesion genesis in cases of genetic predisposition are being investigated, with evidence to support a two-hit model emerging from somatic mutation screening of the lesions themselves and from lesion formation in transgenic murine models of the disease. Other information on potential inflammatory factors has emerged from differential gene expression studies. Unique phenotypic features of solitary versus familial cases have emerged: different associations with venous developmental anomaly and the exceptionally high penetrance rates that are found in inherited cases when high-sensitivity screening is performed with gradient echo magnetic resonance imaging. This information has changed the landscape of screening and counseling for patients and their families, and promises to lead to the development of new tools for predicting, explaining, and modifying disease behavior.

  15. Iodine Incorporation in Calcite: Insights from Computational and Experimental Study

    NASA Astrophysics Data System (ADS)

    Feng, X.; Redfern, S. A. T.

    2016-12-01

    The incorporation of iodine into calcite is important both in the context of radioactive waste disposal (carbonates seem to be the principal host for iodine at the Hnaford site) as well as in paleoproxy methods applied in paleo-oceanography, where iodine content has been proposed as a proxy for fO2. Here, we report on studies of iodine incorporation into calcite carried out by a combination of earlier X-Ray absorption spectroscopy, Raman spectroscopy, X-Ray diffraction and new ab initio DFT calculations (using VASP). Our results show that iodine is principally incorporated into the calcite lattice as IO3, replacing carbon in the carbonate group. The much larger size of iodine, and different outer shell electronic configuration, leads to a distortion of the calcite structure locally. Our DFT results show that the adjacent layers of CO3 groups are significantly distorted, over a length scale of around 0.5 nm, and that this distortion leads to a slight increase in enthalpy associated with the iodine point defect. The relationship to the distorted structure of calcite II is considered, and the role of iodine as an agent of "internal pressure" will be discussed.

  16. Benefits of the Mediterranean Diet: Insights From the PREDIMED Study.

    PubMed

    Martínez-González, Miguel A; Salas-Salvadó, Jordi; Estruch, Ramón; Corella, Dolores; Fitó, Montse; Ros, Emilio

    2015-01-01

    The PREDIMED (PREvención con DIeta MEDiterránea) multicenter, randomized, primary prevention trial assessed the long-term effects of the Mediterranean diet (MeDiet) on clinical events of cardiovascular disease (CVD). We randomized 7447 men and women at high CVD risk into three diets: MeDiet supplemented with extra-virgin olive oil (EVOO), MeDiet supplemented with nuts, and control diet (advice on a low-fat diet). No energy restriction and no special intervention on physical activity were applied. We observed 288 CVD events (a composite of myocardial infarction, stroke or CVD death) during a median time of 4.8years; hazard ratios were 0.70 (95% CI, 0.53-0.91) for the MeDiet+EVOO and 0.70 (CI, 0.53-0.94) for the MeDiet+nuts compared to the control group. Respective hazard ratios for incident diabetes (273 cases) among 3541 non-diabetic participants were 0.60 (0.43-0.85) and 0.82 (0.61-1.10) for MeDiet+EVOO and MeDiet+nuts, respectively versus control. Significant improvements in classical and emerging CVD risk factors also supported a favorable effect of both MeDiets on blood pressure, insulin sensitivity, lipid profiles, lipoprotein particles, inflammation, oxidative stress, and carotid atherosclerosis. In nutrigenomic studies beneficial effects of the intervention with MedDiets showed interactions with several genetic variants (TCF7L2, APOA2, MLXIPL, LPL, FTO, M4CR, COX-2, GCKR and SERPINE1) with respect to intermediate and final phenotypes. Thus, the PREDIMED trial provided strong evidence that a vegetable-based MeDiet rich in unsaturated fat and polyphenols can be a sustainable and ideal model for CVD prevention.

  17. The othering of old age: Insights from Postcolonial Studies.

    PubMed

    van Dyk, Silke

    2016-12-01

    When it comes to old age, we are witnessing almost revolutionary changes at the present time. After decades of ignorance and lack of public interest, old age has fundamentally been re-negotiated. A diverse range of authors have diagnosed the growing bifurcation of old age into a rather independent and capable Third Age and a deep old Fourth Age that is characterized by sickness, frailty and dependency. Against this backdrop, many gerontologists claim that the so-called young-old are praised and valued for their (ongoing) "sameness" in terms of midlife-norms and capabilities, whereas the oldest old are increasingly excluded from humanity by radical "othering". Taking up this diagnosis, the article elaborates on this growing polarization within later life: Based on empirical research on the re-negotiation of old age in Germany, this contribution argues that the juxtaposition of "sameness" and "otherness" obscures the true character of the polarization, particularly with regard to the social role of the Third Age. Instead of sameness and otherness, we rather witness different processes of othering, with the young-old being valued as the other and the oldest old being disdained as the other. Despite the existence of profound critical analyses of the abjection associated with the Fourth Age as well as a considerable amount of literature on old age activation and the new role of the young-old, the specific point of this article's concern-the othering of the Third Age-has been completely neglected. The article discusses the reasons for this gap in more detail and will indicate to what extent concepts from Postcolonial Studies may help us to understand the dual process of othering-glorification and abjection.

  18. Mass aggregation of diatom blooms: Insights from a mesocosm study

    NASA Astrophysics Data System (ADS)

    Alldredge, Alice L.; Gotschalk, Chris; Passow, Uta; Riebesell, Ulf

    While the aggregation and mass settlement of diatoms at the termination of blooms results in significant export of carbon from the surface ocean, the mechanisms of bloom aggregation have been poorly understood. The aggregation of a multispecies diatom bloom was investigated under controlled conditions in a 1200 liter, nutrient-enriched, laboratory mesocosm in order to elucidate the parameters sufficient to accurately predict bloom aggregation. A diverse bloom of diatoms dominated by several species of Chaetoceros and Thalassiosira progressed through a classic pattern of exponential, stationary, and senescent phases in the mesocosm. Aggregates larger than 0.5 mm became detectable on the eighth day after inoculation, and aggregates >1 mm increased exponentially from Day 10 onward producing the appearance of a mass aggregation event late on Day 10. The bloom aggregated sequentially with Thalassiosira dominating early aggregates and Chaetoceros dominating later ones. Chaetoceros resting spores formed only in aggregates. Aggregation was not linked to nutrient depletion or to the physiological state of the cells since the onset of aggregation and the mass aggregation event occurred 1 to 3 days prior to nutrient depletion and while carbon:nitrogen ratios of cells were still very low and growth rates high. Moreover, visible aggregates did not form in the mesocosm until cell abundances were considerably higher than abundances observed to aggregate in nature, suggesting that aggregation was not strongly linked to phytoplankton cell concentration. Complementary studies in this volume clarify the role of non-phytoplankton particles in aggregation of the mesocosm bloom. The mesocosm approach proved highly effective in producing an aggregating diatom bloom under controlled conditions.

  19. A STUDY ON CRISIS MANAGEMENT,

    DTIC Science & Technology

    THREAT EVALUATION, DECISION MAKING), (*STRATEGIC WARFARE, THREAT EVALUATION), (*FOREIGN POLICY, DECISION MAKING), OPERATIONS RESEARCH, MANAGEMENT ...PLANNING AND CONTROL, AERIAL WARFARE, USSR, PERCEPTION, GAME THEORY, WEAPON SYSTEMS , WARFARE, EGYPT, ISRAEL, JORDAN, LEBANON, CUBA, CYPRUS, THEORY, COMMUNISTS, CHINA, SOUTH KOREA, NORTH KOREA.

  20. Army Ecosystem Management Policy Study

    DTIC Science & Technology

    1997-03-01

    principles to manage biological and physical systems in a manner that safeguards the long-term ecological sustainability, natural diversity, and...focus on ecosystem management (e.g., biodiversity conservation; restoration of native ecological systems). In all fairness, such a judgment would be...decisions. Regardless of which view one adheres to, a region can be defined along multiple dimensions—biological, physical , socio -cultural and economic. The

  1. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry

    PubMed Central

    Kreuter, Michael; Hoeper, Marius M.; Wirtz, Hubert; Klotsche, Jens; Koschel, Dirk; Andreas, Stefan; Claussen, Martin; Grohé, Christian; Wilkens, Henrike; Randerath, Winfried; Skowasch, Dirk; Meyer, F. Joachim; Kirschner, Joachim; Gläser, Sven; Herth, Felix J.F.; Welte, Tobias; Huber, Rudolf Maria; Neurohr, Claus; Schwaiblmair, Martin; Kohlhäufl, Martin; Höffken, Gert; Held, Matthias; Koch, Andrea; Bahmer, Thomas; Pittrow, David

    2015-01-01

    After introduction of the new international guidelines on idiopathic pulmonary fibrosis (IPF) in 2011, we investigated clinical management practices for patients with IPF according to physicians' diagnoses. A prospective, multicenter, noninterventional study with comprehensive quality measures including on-site source data verification was performed in Germany. 502 consecutive patients (171 newly diagnosed, 331 prevalent; mean±sd age 68.7±9.4 years, 77.9% males) with a mean disease duration of 2.3±3.5 years were enrolled. IPF diagnosis was based on clinical assessments and high-resolution computed tomography (HRCT) in 90.2%, and on surgical lung biopsy combined with histology in 34.1% (lavage in 61.8%). The median 6-min walk distance was 320 m (mean 268±200 m). The mean forced vital capacity was 72±20% pred and diffusing capacity of the lung for carbon monoxide was 35±15% pred. No drugs were administered in 17.9%, oral steroids in 23.7%, N-acetylcysteine in 33.7%, pirfenidone in 44.2% and other drugs in 4.6% of patients. Only 2.8% of the cohort was listed for lung transplantation. IPF patients were diagnosed in line with the new guidelines. They had more severe disease than those enrolled in recent randomised controlled trials. In addition to HRCT, the frequency of lung biopsies was surprisingly high. Treatment patterns varied substantially. PMID:25837040

  2. Inspiring change: humanities and social science insights into the experience and management of breathlessness

    PubMed Central

    Oxley, Rebecca; Macnaughton, Jane

    2016-01-01

    Purpose of review Breathlessness can be debilitating for those with chronic conditions, requiring continual management. Yet, the meaning of breathlessness for those who live with it is poorly understood in respect of its subjective, cultural, and experiential significance. This article discusses a number of current issues in understanding the experience of breathlessness. Recent findings Effective communication concerning the experience of breathlessness is crucial for diagnosis, to identify appropriate treatment, and to provide patients with the capacity to self-manage their condition. However, there is an evident disconnect between the way breathlessness is understood between clinical and lay perspectives, in terms of awareness of breathlessness, the way symptoms are expressed, and acknowledgement of how it affects the daily lives of patients. Summary The review highlights the need for integrated multidisciplinary work on breathlessness, and suggests that effective understanding and management of breathlessness considers its wider subjective and social significance. PMID:27490147

  3. Risk management and precaution: insights on the cautious use of evidence.

    PubMed Central

    Hrudey, Steve E; Leiss, William

    2003-01-01

    Risk management, done well, should be inherently precautionary. Adopting an appropriate degree of precaution with respect to feared health and environmental hazards is fundamental to risk management. The real problem is in deciding how precautionary to be in the face of inevitable uncertainties, demanding that we understand the equally inevitable false positives and false negatives from screening evidence. We consider a framework for detection and judgment of evidence of well-characterized hazards, using the concepts of sensitivity, specificity, positive predictive value, and negative predictive value that are well established for medical diagnosis. Our confidence in predicting the likelihood of a true danger inevitably will be poor for rare hazards because of the predominance of false positives; failing to detect a true danger is less likely because false negatives must be rarer than the danger itself. Because most controversial environmental hazards arise infrequently, this truth poses a dilemma for risk management. PMID:14527835

  4. Predator harvesting in stage dependent predation models: insights from a threshold management policy.

    PubMed

    Costa, Michel Iskin da Silveira

    2008-11-01

    Stage dependent predation may give rise to the hydra effect--the increase of predator density at equilibrium as its mortality rate is raised. Management strategies that adjust predator harvest rates or quotas based on responses of populations to past changes in capture rates may eventually lead to a catastrophic collapse of predator species. A proposed threshold management policy avoids the hydra effect and its subsequent danger of predator extinction. Suggestions to extend the application of threshold policies in areas such as intermediate disturbance hypothesis, density-trait mediated interactions and non-optimal anti-predatory behavior are put forward.

  5. Phosphorus dynamics in lake sediments: Insights from field study and reactive-transport modeling

    NASA Astrophysics Data System (ADS)

    Dittrich, Maria; Markovic, Stefan; Cadena, Sandra; Doan, Phuong T. K.; Watson, Sue; Mugalingam, Shan

    2016-04-01

    Phosphorus is an indispensable nutrient for organisms in aquatic systems and its availability often controls primary productivity. At the sediment-water interface, intensive microbiological, geochemical and physical processes determine the fraction of organic matter, nutrients and pollutants released into the overlying water. Therefore, detailed understanding of the processes occurring in the top centimeters of the sediment is essential for the assessment of water quality and the management of surface waters. In cases where measurements are impossible or expensive, diagenetic modelling is required to investigate the interplay among the processes, verify concepts and predict potential system behavior. The main aims of this study are to identify and predict the dynamics of phosphorus (P) in sediments and gain insight into the mechanism of P release from sediments under varying environmental conditions. We measured redox, O2 and pH profiles with micro-sensors at the sediment-water interface; analyzed phosphate and metals (Fe, Mn, Al, Ca) content in pore waters collected using in situ samplers, so called "peepers"; determined P binding forms using sequential extraction and analyzed metals associated with each fraction. Following the sediment analysis, P binding forms were divided in five groups: inert, carbonate-bound, organic, redox-sensitive, and labile P. Using the flux of organic and inorganic matter as dynamic boundary conditions, the diagenetic model simulates P internal loading and predicts P retention. This presentation will discuss the results of two years studies on P dynamics at the sediment-water interface in three different lakes ranging from heavy-polluted Hamilton Harbor and Bay of Quinte to pristine Georgian Bay in Ontario, Canada.

  6. A geochemical study of the River Lagan, Northern Ireland: Insights into the hydrochemical catchment response

    NASA Astrophysics Data System (ADS)

    Russell, Alexander; Hindshaw, Ruth

    2015-04-01

    The management of water resources is rapidly becoming one of the most important issues affecting many societies worldwide. The chemical components of a river are often not directly related to discharge, instead the water chemistry and transit time of a catchment are a function of several parameters including the flow pathways, water sources and the storage of water within a catchment. There is a need to constrain the parameters controlling hydrochemistry if water resources are to be managed efficiently and be protected from anthropogenic influences. This study will present experimental analysis of a small catchment, focusing on the relationship between discharge and hydrochemistry; tracing water sources through the investigation of the hydrochemistry, δ18O and 87Sr/86Sr composition of rain water, groundwater, and stream water. This study focuses on the River Lagan catchment in Northern Ireland. The lower catchment of the river surrounds the city of Belfast, where it drains into the sea. However, the upper catchment (84.6 km2) is noted to be a natural regime, unaffected by damming and, as such, should provide an ideal opportunity to gain insight into the natural hydrochemistry and hydrologic pathways of the catchment. The bedrock of the area is dominated by the Southern Uplands-Down-Longford Terrane, consisting of greywacke sandstone and mudstone successions. Geochemical data obtained from the Geological Survey of Northern Ireland (GSNI), focusing on stream sediment and soils, suggests there is minimal geochemical variation throughout the upper catchment. The response of the catchment to rainfall was investigated through a time series, recorded during July and August 2014. This time series included a more intensive hourly series, taken over a period of 24 hours, during a forecast rain event. Potential end-members were also sampled: shallow groundwater samples were taken from a well and regular rain samples were collected. Spatial variability within the catchment

  7. Disability and Study: Layers of Management

    ERIC Educational Resources Information Center

    Werth, Shalene; Hammer, Sara; d'Abadie, Danielle

    2014-01-01

    The findings of this paper are based on a 3-year study of students registered with disability services at an Australian, regional university between 2008 and 2010. The concept of self-management, in its various dimensions, was a key theme emerging from the study. We argue that participants in our study employ "layers of self-management"…

  8. Creativity Development in Adolescence: Insight from Behavior, Brain, and Training Studies

    ERIC Educational Resources Information Center

    Kleibeuker, Sietske W.; De Dreu, Carsten K. W.; Crone, Eveline A.

    2016-01-01

    Creativity is a multifaceted construct that recruits different cognitive processes. Here, we summarize studies that show that creativity develops considerably during adolescence with different developmental trajectories for insight, verbal divergent thinking, and visuospatial divergent thinking. Next, these developmental time courses are mapped to…

  9. Early Language and Literacy Development among Young English Language Learners: Preliminary Insights from a Longitudinal Study

    ERIC Educational Resources Information Center

    Roessingh, Hetty; Elgie, Susan

    2009-01-01

    This article reports on the preliminary findings of a two-staged empirical study aimed at gaining insights into the variables salient in the early language and literacy development of young English language learners (ELL). Increasingly, young ELL, whether foreign-born or Canadian-born, arrive at school with little developed English-language…

  10. Insights into the Intrinsic and Extrinsic Challenges for Implementing Technology Education: Case Studies of Queensland Teachers

    ERIC Educational Resources Information Center

    Finger, Glenn; Houguet, Belinda

    2009-01-01

    This study, embedded within the "Researching School Change in Technology Education" (RSCTE) project in Queensland, Australia, aimed to gain insights into the intrinsic and extrinsic challenges experienced by teachers during the implementation of technology education within primary school settings. The official publication and launch of…

  11. The Importance of Emotional Insight in Cognitive Behaviour Therapy for Anorexia Nervosa: An Adolescent Case Study

    ERIC Educational Resources Information Center

    Rupa, Megha; Girimaji, Satish; Muthuswamy, Selvi; Jacob, Preeti; Ravi, Malavika

    2013-01-01

    Anorexia nervosa is a rare but sever psychiatric disorder in adolescence, with chronicity and death being the most feared consequence. Emotional Insight into one's problem is considered a key determinant of success in therapy. The following case study of a 14-year-old client, describes the process of therapy as it unfolded across 45 sessions. An…

  12. Best Practices Case Study: Insight Homes - Seaford, DE, Deep Creek, DE

    SciTech Connect

    2011-09-01

    Case Study of Insight Homes who built 36 identical houses, three at a time, with increasing energy-efficiency measures in each generation until they arrived at the most cost-effective mix. Advanced framing and high-efficiency HVAC located in a sealed, insulated crawlspace helped them achieve a HERS scores of 49 to 56 and average utility bills of $93 per year.

  13. Creativity Development in Adolescence: Insight from Behavior, Brain, and Training Studies

    ERIC Educational Resources Information Center

    Kleibeuker, Sietske W.; De Dreu, Carsten K. W.; Crone, Eveline A.

    2016-01-01

    Creativity is a multifaceted construct that recruits different cognitive processes. Here, we summarize studies that show that creativity develops considerably during adolescence with different developmental trajectories for insight, verbal divergent thinking, and visuospatial divergent thinking. Next, these developmental time courses are mapped to…

  14. Enrollment Management Study: Five Scenarios.

    ERIC Educational Resources Information Center

    Albers, James R.; Burns, James A.

    The effect of enrollment level changes on the long-range future of Western Washington University are investigated. Due to the high rate of Washington state in-migration, declining enrollments are not projected for Western Washington University. The impact of managed enrollment goals was examined to help the university determine the most…

  15. Stress management and erectile dysfunction: a pilot comparative study.

    PubMed

    Kalaitzidou, I; Venetikou, M S; Konstadinidis, K; Artemiadis, A K; Chrousos, G; Darviri, C

    2014-08-01

    Erectile dysfunction (ED) is a complex disorder with various biopsychosocial implications leading the individual into a state of chronic stress that further worsens ED symptoms. The aim of this study is to investigate the effects of a 8-week stress management programme on erectile dysfunction (ED). A convenience sample of 31 newly diagnosed men with ED, aged between 20 and 55 years, was recruited during a period of 5 months to receive either tadalafil (12 patients) or tadalafil and the 8-week stress management programme. Both groups showed statistical significant improvement of both perceived stress and erectile function scores. Men practising stress management showed a statistical significant reduction in perceived stress score compared with men receiving tadalafil alone. No other statistical significant differences were noted between the two groups, although the stress management group showed a lower daily exposure to cortisol compared with the control group after 8 weeks. Finally, perceived stress and cortisol showed some interesting correlations with sexual function measurements. These findings provide important insight into the role of stress management, as part of the recommended biopsychosocial approach, in ED. Future studies should focus on randomised, controlled trials with larger samples and longer follow-up time.

  16. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management.

    PubMed

    Erez, Offer; Mastrolia, Salvatore Andrea; Thachil, Jecko

    2015-10-01

    Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanisms of disease leading to this complication in essential for a favorable outcome. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC.

  17. Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey

    PubMed Central

    Chiang, Chern-En; Naditch-Brûlé, Lisa; Brette, Sandrine; Silva-Cardoso, José; Gamra, Habib; Murin, Jan; Zharinov, Oleg J.; Steg, Philippe Gabriel

    2016-01-01

    Background Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients’ clinical characteristics, AF control, and symptom burden. Methods RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit. Results Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p<0.001). Multivariate logistic regression analysis revealed that age <75 years or the paroxysmal or persistent form of AF favored the choice of a rhythm-control strategy. A change in strategy was infrequent, even in patients with European Heart Rhythm Association (EHRA) Class > = II. Conclusions In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved. PMID:26800084

  18. The institutionalization of River Basin Management as politics of scale - Insights from Mongolia

    NASA Astrophysics Data System (ADS)

    Houdret, Annabelle; Dombrowsky, Ines; Horlemann, Lena

    2014-11-01

    River Basin Management (RBM) as an approach to sustainable water use has become the dominant model of water governance. Its introduction, however, entails a fundamental realignment and rescaling of water-sector institutions along hydrological boundaries. Creating such a new governance scale is inherently political, and is being described as politics of scale. This paper analyzes how the politics of scale play out in the institutionalization of RBM in Mongolia. It furthermore scrutinizes the role of the broader political decentralization process in the introduction of RBM, an issue that has so far received little attention. Finally, it assesses whether the river basin is an adequate water management scale in Mongolia. This article finds that institutionalizing RBM in Mongolia is indeed a highly political negotiation process that does not only concern the choice of the governance scale, but also its detailed institutional design. It furthermore reveals that Mongolia's incomplete political decentralization process has for a long time negatively impacted the decentralization of water-related tasks and the implementation of RBM. However, the 2011 Budget Law and the 2012 Water Law provide for a fiscal strengthening of local governments and clearer sharing of responsibilities among the various different institutions involved in water management. Nevertheless, only if the 2012 Water Law is complemented by adequate by-laws - and if the newly created river basin institutions are adequately equipped - can RBM be effectively put into practice. This article confirms the usefulness of a politics-of-scale approach to understand scalar practices and changes in water management. However, the article also argues for a broadening of the analytical perspective to take the interdependencies between changes in water governance and other political processes, such as decentralization, into account.

  19. Insights for aging management of light water reactor components: Metal containments. Volume 5

    SciTech Connect

    Shah, V.N.; Sinha, U.P.; Smith, S.K.

    1994-03-01

    This report evaluates the available technical information and field experience related to management of aging damage to light water reactor metal containments. A generic aging management approach is suggested for the effective and comprehensive aging management of metal containments to ensure their safe operation. The major concern is corrosion of the embedded portion of the containment vessel and detection of this damage. The electromagnetic acoustic transducer and half-cell potential measurement are potential techniques to detect corrosion damage in the embedded portion of the containment vessel. Other corrosion-related concerns include inspection of corrosion damage on the inaccessible side of BWR Mark I and Mark II containment vessels and corrosion of the BWR Mark I torus and emergency core cooling system piping that penetrates the torus, and transgranular stress corrosion cracking of the penetration bellows. Fatigue-related concerns include reduction in the fatigue life (a) of a vessel caused by roughness of the corroded vessel surface and (b) of bellows because of any physical damage. Maintenance of surface coatings and sealant at the metal-concrete interface is the best protection against corrosion of the vessel.

  20. Therapy of endocrine disease: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe.

    PubMed

    Grossman, Ashley; Johannsson, Gudmundur; Quinkler, Marcus; Zelissen, Pierre

    2013-12-01

    Conventional glucocorticoid (GC) replacement for patients with adrenal insufficiency (AI) is inadequate. Patients with AI continue to have increased mortality and morbidity and compromised quality of life despite treatment and monitoring. i) To review current management of AI and the unmet medical need based on literature and treatment experience and ii) to offer practical advice for managing AI in specific clinical situations. The review considers the most urgent questions endocrinologists face in managing AI and presents generalised patient cases with suggested strategies for treatment. Optimisation and individualisation of GC replacement remain a challenge because available therapies do not mimic physiological cortisol patterns. While increased mortality and morbidity appear related to inadequate GC replacement, there are no objective measures to guide dose selection and optimisation. Physicians must rely on experience to recognise the clinical signs, which are not unique to AI, of inadequate treatment. The increased demand for corticosteroids during periods of stress can result in a life-threatening adrenal crisis (AC) in a patient with AI. Education is paramount for patients and their caregivers to anticipate, recognise and provide proper early treatment to prevent or reduce the occurrence of ACs. This review highlights and offers suggestions to address the challenges endocrinologists encounter in treating patients with AI. New preparations are being developed to better mimic normal physiological cortisol levels with convenient, once-daily dosing which may improve treatment outcomes.

  1. Spinocerebellar Ataxia Type 2: Clinicogenetic Aspects, Mechanistic Insights, and Management Approaches

    PubMed Central

    Velázquez-Pérez, Luis C.; Rodríguez-Labrada, Roberto; Fernandez-Ruiz, Juan

    2017-01-01

    Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant cerebellar ataxia that occurs as a consequence of abnormal CAG expansions in the ATXN2 gene. Progressive clinical features result from the neurodegeneration of cerebellum and extra-cerebellar structures including the pons, the basal ganglia, and the cerebral cortex. Clinical, electrophysiological, and imaging approaches have been used to characterize the natural history of the disease, allowing its classification into four distinct stages, with special emphasis on the prodromal stage, which is characterized by a plethora of motor and non-motor features. Neuropathological investigations of brain tissue from SCA2 patients reveal a widespread involvement of multiple brain systems, mainly cerebellar and brainstem systems. Recent findings linking ataxin-2 intermediate expansions to other neurodegenerative diseases such as amyotrophic lateral sclerosis have provided insights into the ataxin-2-related toxicity mechanism in neurodegenerative diseases and have raised new ethical challenges to molecular predictive diagnosis of SCA2. No effective neuroprotective therapies are currently available for SCA2 patients, but some therapeutic options such as neurorehabilitation and some emerging neuroprotective drugs have shown palliative benefits. PMID:28955296

  2. Data management system evolution study

    NASA Technical Reports Server (NTRS)

    Douglas, Katherine

    1990-01-01

    Hardware and software products and technologies that are available for implementation in the early space station data management system (DMS) design are expected to have limited capabilities in such areas as system performance, capacity, and throughput. With the anticipated growth in operations and payload user requirements during the space station's operational phase, a knowledge base of technological advancements and their possible incorporation into the DMS design will be maintained. System growth and technologies insertion issues for DMS design and development are addressed.

  3. Lake Erie Wastewater Management Study.

    DTIC Science & Technology

    1982-09-01

    uptake (Ref 6). A detailed discussion of the methods used to calculate nutrient loadings to Lake Erie is contained in a separate technical report of...successfully adopting these practices. Besides changing tillage practices, several practices (e.g. the method of fertilizer application, pesticide usage...Management Alternatives for Erosion Control and Phosphorus Reduction. Emphaais has been placed on conservation tillage as a cost effective method of

  4. Data management system evolution study

    NASA Technical Reports Server (NTRS)

    Douglas, Katherine

    1990-01-01

    Hardware and software products and technologies that are available for implementation in the early space station data management system (DMS) design are expected to have limited capabilities in such areas as system performance, capacity, and throughput. With the anticipated growth in operations and payload user requirements during the space station's operational phase, a knowledge base of technological advancements and their possible incorporation into the DMS design will be maintained. System growth and technologies insertion issues for DMS design and development are addressed.

  5. Insights from the past: incorporating long-term landscape evolution in studies of land degradation

    NASA Astrophysics Data System (ADS)

    Ferro-Vazquez, Cruz; Lang, Carol; Kabora, Tabitha; Thornton-Barnett, Senna; Richer, Suzi; Gallello, Gianni; Stump, Daryl

    2017-04-01

    Modern approaches for assessing land degradation encompass multidisciplinary studies that have allowed a more realistic understanding of the causes and consequences of land degradation. This incipient perspective includes an increasingly important role of the studies of the past, including human history, to understand modern ecosystems and landscapes. Indeed, the current promotion of indigenous resource-use strategies as models of sustainable development was initially prompted by historical studies. However, systematic studies on whether or not indigenous management practices led to land degradation, and therefore their benefits or constraints for sustained use of natural resources, are not truly known. We argue that a joint approach combining the characterization of current soil properties with the archaeological study of traditional agricultural systems can provide insights on their sustainability. Archaeological excavation enables discerning the order in which sediments are deposited and the sequence in which structures are built. This provides data on coincident cultural and ecological change, and a long-term perspective on how agro-ecological systems operated in pre-modern states and the ways in which they resemble or differ from modern contexts. Simultaneously, these changes would have left a physical, chemical and isotopic imprint in soils that can be detected and interpreted to contribute to the production of a "usable past" (Stump, 2013). The premise is: since ancient agricultural sites may provide information on agronomic conditions after centuries to millennia of use, they can help in understanding the ways in which agroecosystems have survived, failed or adapted in the past. This will contribute to a better holistic understanding of social-ecological systems evolution by including a temporal perspective, and to a more nuanced assessment of land degradation and sustainable use. To illustrate this we present the outcome of our research at two traditional

  6. Work domain analysis for enhancing collaborations: a study of the management of microsystems design.

    PubMed

    Durugbo, Christopher

    2012-01-01

    Collaboration is an important process that enables organisations to achieve goals or solve problems and, in design processes, is an important factor for accomplishing interdisciplinary and multidisciplinary tasks. An understanding of the functional configuration of organisations could therefore offer a useful insight into collaborations of designers. This study makes use of work domain analysis (WDA) to analyse the management of design by organisations within the microsystems technology (MST) domain. The WDA considers the functional configuration of MST companies in terms of management constraints and boundaries. This study also makes use of the WDA to suggest ways of establishing collaborative design and enhancing collaboration between organisations. Practitioner Summary: The results of this methodical analysis offer useful insights for managing design functions. This study also presents recommendations for enhancing collaboration in organisations. The ability to manage and collaborate in design functions is valuable for improving the productivity, cost-effectiveness and time-to-market systems.

  7. Case Studies in Middle Management Supervision

    ERIC Educational Resources Information Center

    White, Lori S.

    2011-01-01

    This chapter presents a series of supervision-related case studies of situations that midlevel managers might face. Individuals enrolled in a midlevel management professional development course recommended the topics selected for this chapter. Drawing upon her experience teaching the course, the author selected four case studies that individuals…

  8. Insights from venous oxygen profiles: oxygen utilization and management in diving California sea lions.

    PubMed

    McDonald, Birgitte I; Ponganis, Paul J

    2013-09-01

    The management and depletion of O2 stores underlie the aerobic dive capacities of marine mammals. The California sea lion (Zalophus californianus) presumably optimizes O2 store management during all dives, but approaches its physiological limits during deep dives to greater than 300 m depth. Blood O2 comprises the largest component of total body O2 stores in adult sea lions. Therefore, we investigated venous blood O2 depletion during dives of California sea lions during maternal foraging trips to sea by: (1) recording venous partial pressure of O2 (P(O2)) profiles during dives, (2) characterizing the O2-hemoglobin (Hb) dissociation curve of sea lion Hb and (3) converting the P(O2) profiles into percent Hb saturation (S(O2)) profiles using the dissociation curve. The O2-Hb dissociation curve was typical of other pinnipeds (P50=28±2 mmHg at pH 7.4). In 43% of dives, initial venous S(O2) values were greater than 78% (estimated resting venous S(O2)), indicative of arterialization of venous blood. Blood O2 was far from depleted during routine shallow dives, with minimum venous S(O2) values routinely greater than 50%. However, in deep dives greater than 4 min in duration, venous S(O2) reached minimum values below 5% prior to the end of the dive, but then increased during the last 30-60 s of ascent. These deep dive profiles were consistent with transient venous blood O2 depletion followed by partial restoration of venous O2 through pulmonary gas exchange and peripheral blood flow during ascent. These differences in venous O2 profiles between shallow and deep dives of sea lions reflect distinct strategies of O2 store management and suggest that underlying cardiovascular responses will also differ.

  9. New insights into phosphorus management in agriculture--A crop rotation approach.

    PubMed

    Łukowiak, Remigiusz; Grzebisz, Witold; Sassenrath, Gretchen F

    2016-01-15

    This manuscript presents research results examining phosphorus (P) management in a soil–plant system for three variables: i) internal resources of soil available phosphorus, ii) cropping sequence, and iii) external input of phosphorus (manure, fertilizers). The research was conducted in long-term cropping sequences with oilseed rape (10 rotations) and maize (six rotations) over three consecutive growing seasons (2004/2005, 2005/2006, and 2006/2007) in a production farm on soils originated from Albic Luvisols in Poland. The soil available phosphorus pool, measured as calcium chloride extractable P (CCE-P), constituted 28% to 67% of the total phosphorus input (PTI) to the soil–plant system in the spring. Oilseed rape and maize dominant cropping sequences showed a significant potential to utilize the CCE-P pool within the soil profile. Cropping sequences containing oilseed rape significantly affected the CCE-P pool, and in turn contributed to the P(TI). The P(TI) uptake use efficiency was 50% on average. Therefore, the CCE-P pool should be taken into account as an important component of a sound and reliable phosphorus balance. The instability of the yield prediction, based on the P(TI), was mainly due to an imbalanced management of both farmyard manure and phosphorus fertilizer. Oilseed rape plants provide a significant positive impact on the CCE-P pool after harvest, improving the productive stability of the entire cropping sequence. This phenomenon was documented by the P(TI) increase during wheat cultivation following oilseed rape. The Unit Phosphorus Uptake index also showed a higher stability in oilseed rape cropping systems compared to rotations based on maize. Cropping sequences are a primary factor impacting phosphorus management. Judicious implementation of crop rotations can improve soil P resources, efficiency of crop P use, and crop yield and yield stability. Use of cropping sequences can reduce the need for external P sources such as farmyard manure

  10. Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians

    PubMed Central

    Dufour, Carlo

    2015-01-01

    Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3–4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management. PMID:25642312

  11. Performance assessments insights on the use of cements in waste management

    NASA Astrophysics Data System (ADS)

    Esh, D.; Philip, J.; Snyder, K.

    2011-04-01

    The use of cementitious materials has been proposed in a variety of waste management systems because these materials can have a variety of desirable performance characteristics: hydraulic isolation, chemical isolation, structural stability. Cementitious barriers are commonly engineered with a goal of achieving the highest quality material possible (e.g. minimizing hydraulic conductivity, porosity, tortuosity, diffusivity). However, a single performance goal may not be optimum when practical considerations of designs and performance characteristics are considered simultaneously. In addition, laboratory-scale optimized designs may have field-scale characteristics that are less than ideal.

  12. New Insights into Potential Prevention and Management Options for Chemotherapy-Induced Peripheral Neuropathy

    PubMed Central

    Schloss, Janet; Colosimo, Maree; Vitetta, Luis

    2016-01-01

    Objective: Neurological complications such as chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain are frequent side effects of neurotoxic chemotherapy agents. An increasing survival rate and frequent administration of adjuvant chemotherapy treatments involving neurotoxic agents makes it imperative that accurate diagnosis, prevention, and treatment of these neurological complications be implemented. Methods: A consideration was undertaken of the current options regarding protective and treatment interventions for patients undergoing chemotherapy with neurotoxic chemotherapy agent or experience with CIPN. Current knowledge on the mechanism of action has also been identified. The following databases PubMed, the Cochrane Library, Science Direct, Scopus, EMBASE, MEDLINE, CINAHL, CNKI, and Google Scholar were searched for relevant article retrieval. Results: A range of pharmaceutical, nutraceutical, and herbal medicine treatments were identified that either showed efficacy or had some evidence of efficacy. Duloxetine was the most effective pharmaceutical agent for the treatment of CIPN. Vitamin E demonstrated potential for the prevention of cisplatin-IPN. Intravenous glutathione for oxaliplatin, Vitamin B6 for both oxaliplatin and cisplatin, and omega 3 fatty acids for paclitaxel have shown protection for CIPN. Acetyl-L-carnitine may provide some relief as a treatment option. Acupuncture may be of benefit for some patients and Gosha-jinki-gan may be of benefit for protection from adverse effects of oxaliplatin induced peripheral neuropathy. Conclusions: Clinicians and researchers acknowledge that there are numerous challenges involved in understanding, preventing, and treating peripheral neuropathy caused by chemotherapeutic agents. New insights into mechanisms of action from chemotherapy agents may facilitate the development of novel preventative and treatment options, thereby enabling medical staff to better support patients by reducing this

  13. Indigenous Studies Speaks to Environmental Management

    NASA Astrophysics Data System (ADS)

    Richmond, Laurie; Middleton, Beth Rose; Gilmer, Robert; Grossman, Zoltán; Janis, Terry; Lucero, Stephanie; Morgan, Tukoroirangi; Watson, Annette

    2013-11-01

    This article describes the increasing connections between the fields of Indigenous studies and environmental management and examines some of the ways that an Indigenous studies perspective can guide thinking about environmental management. Indigenous groups have been involved in the management of environmental and natural resources on their lands since time immemorial. Indigenous groups have also become increasingly involved in Western practices of environmental management with the advent of co-management institutions, subsistence boards, traditional ecological knowledge forums, and environmental issues affecting Indigenous resources. Thus, it is an important time for scholarship that explores how Indigenous groups are both shaping and being affected by processes of environmental management. This article summarizes key findings and themes from eight papers situated at the intersection of these two fields of study and identify means by which environmental managers can better accommodate Indigenous rights and perspectives. It is the authors’ hope that increased dialog between Indigenous studies and environmental management can contribute to the building of sustainable and socially just environmental management practices.

  14. Linking current river pollution to historical pesticide use: Insights for territorial management?

    PubMed

    Della Rossa, Pauline; Jannoyer, Magalie; Mottes, Charles; Plet, Joanne; Bazizi, Abderazak; Arnaud, Luc; Jestin, Alexandra; Woignier, Thierry; Gaude, Jean-Marie; Cattan, Philippe

    2017-01-01

    Persistent organic pollutants like organochlorine pesticides continue to contaminate large areas worldwide raising questions concerning their management. We designed and tested a method to link soil and water pollution in the watershed of the Galion River in Martinique. We first estimated the risk of soil contamination by chlordecone by referring to past use of land for banana cultivation and took 27 soil samples. We then sampled surface waters at 39 points and groundwater at 16 points. We tested three hypotheses linked to the source of chlordecone pollution at the watershed scale: (i) soils close to the river, (ii) soils close to the sampling point, (iii) throughout the sub-watershed generated at the sampling point. Graphical and statistical analysis showed that contamination of the river increased when it passed through an area with contaminated plots and decreased when it passed through area not contaminated by chlordecone. Modeling showed that the entire surface area of the watershed contributed to river pollution, suggesting that the river was mainly being contaminated by the aquifers and groundwater flows. Our method proved to be a reliable way to identify areas polluted by chlordecone at the watershed scale and should help stakeholders focus their management actions on both hot spots and the whole watershed.

  15. Novel insights in the management of sickle cell disease in childhood

    PubMed Central

    Iughetti, Lorenzo; Bigi, Elena; Venturelli, Donatella

    2016-01-01

    Sickle cell disease (SCD) is a life-threatening genetic disorder characterized by chronic hemolytic anemia, vascular injury and multiorgan dysfunctions. Over the last few decades, there have been significant improvements in SCD management in Western countries, especially in pediatric population. An early onset of prophylaxis with Penicillin and a proper treatment of the infections have increased the overall survival in childhood. Nevertheless, management of painful episodes and prevention of organ damage are still challenging and more efforts are needed to better understand the mechanisms behind the development of chronic organ damages. Hydroxyurea (Hydroxycarbamide, HU), the only medication approved as a disease-modifying agent by the United States Food and Drug Administration and the European Medicines Agency, is usually under-used, especially in developing countries. Currently, hematopoietic stem-cell transplantation is considered the only curative option, although its use is limited by lack of donors and transplant-related toxicity. SCD symptoms are similar in children and adults, but complications and systemic organ damages increase with age, leading to early mortality worldwide. Experts in comprehensive care of young patients with SCD, especially those approaching the transition age to adulthood, are missing, leading people to rely on urgent care, increasing health care utilization costs and inappropriate treatments. It would be important to establish programs of comprehensive healthcare for patients with SCD from birth to adulthood, to improve their quality and expectancy of life. PMID:26862499

  16. Large-scale genetic survey provides insights into the captive management and reintroduction of giant pandas.

    PubMed

    Shan, Lei; Hu, Yibo; Zhu, Lifeng; Yan, Li; Wang, Chengdong; Li, Desheng; Jin, Xuelin; Zhang, Chenglin; Wei, Fuwen

    2014-10-01

    The captive genetic management of threatened species strives to preserve genetic diversity and avoid inbreeding to ensure populations remain available, healthy, and viable for future reintroduction. Determining and responding to the genetic status of captive populations is therefore paramount to these programs. Here, we genotyped 19 microsatellite loci for 240 captive giant pandas (Ailuropoda melanoleuca) (∼64% of the captive population) from four breeding centers, Wolong (WL), Chengdu (CD), Louguantai (LGT), and Beijing (BJ), and analyzed 655 bp of mitochondrial DNA control region sequence for 220 of these animals. High levels of genetic diversity and low levels of inbreeding were estimated in the breeding centers, indicating that the captive population is genetically healthy and deliberate further genetic input from wild animals is unnecessary. However, the LGT population faces a higher risk of inbreeding, and significant genetic structure was detected among breeding centers, with LGT-CD and WL-BJ clustering separately. Based on these findings, we highlight that: 1) the LGT population should be managed as an independent captive population to resemble the genetic distinctness of their Qinling Mountain origins; 2) exchange between CD and WL should be encouraged because of similar wild founder sources; 3) the selection of captive individuals for reintroduction should consider their geographic origin, genetic background, and genetic contribution to wild populations; and 4) combining our molecular genetic data with existing pedigree data will better guide giant panda breeding and further reduce inbreeding into the future.

  17. Endocrine-related adverse events associated with immune checkpoint blockade and expert insights on their management.

    PubMed

    Sznol, Mario; Postow, Michael A; Davies, Marianne J; Pavlick, Anna C; Plimack, Elizabeth R; Shaheen, Montaser; Veloski, Colleen; Robert, Caroline

    2017-07-01

    Agents that modulate immune checkpoint proteins, such as cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed death receptor-1 (PD-1), have become a mainstay in cancer treatment. The clinical benefit afforded by immune checkpoint inhibitors can be accompanied by immune-related adverse events (irAE) that affect the skin, gastrointestinal tract, liver, and endocrine system. The types of irAEs associated with immune checkpoint inhibitors are generally consistent across tumor types. Immune-related endocrine events can affect the pituitary, thyroid, and adrenal glands, as well as other downstream target organs. These events are unique when compared with other irAEs because the manifestations are often irreversible. Immune-related endocrine events are typically grade 1/2 in severity and often present with non-specific symptoms, making them difficult to diagnose. The mechanisms underlying immune-related target organ damage in select individuals remain mostly undefined. Management includes close patient monitoring, appropriate laboratory testing for endocrine function, replacement of hormones, and consultation with an endocrinologist when appropriate. An awareness of the symptoms and management of immune-related endocrine events may aid in the safe and appropriate use of immune checkpoint inhibitors in clinical practice. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  18. Category III chronic prostatitis/chronic pelvic pain syndrome: insights from the National Institutes of Health Chronic Prostatitis Collaborative Research Network studies.

    PubMed

    Nickel, J Curtis; Alexander, Richard B; Anderson, Rodney; Berger, Richard; Comiter, Craig V; Datta, Nand S; Fowler, Jackson E; Krieger, John N; Landis, J Richard; Litwin, Mark S; McNaughton-Collins, Mary; O'Leary, Michael P; Pontari, Michel A; Schaeffer, Anthony J; Shoskes, Daniel A; White, Paige; Kusek, John; Nyberg, Leroy

    2008-07-01

    Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.

  19. Adding insight: A qualitative cross-site study of physician order entry

    PubMed Central

    Ash, Joan S.; Sittig, Dean F.; Seshadri, Veena; Dykstra, Richard H.; Carpenter, James D.; Stavri, P. Zoe

    2006-01-01

    Summary The research questions, strategies, and results of a 7-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative nature of qualitative inquiry stimulates a consecutive stream of research foci, which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question “what are the success factors for implementing CPOE?” Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process. PMID:15964780

  20. Self-esteem and insight as predictors of symptom change in schizophrenia: a longitudinal study.

    PubMed

    Erickson, Molly A; Lysaker, Paul H

    2012-07-01

    Though it is known that symptom profiles in schizophrenia change throughout the course of the illness, it is not yet clear which psychological antecedents predict these changes. The purpose of the present study was to explore "level of insight into mental illness" and "self-esteem" as predictors of positive symptom change in schizophrenia patients. Fifty-seven schizophrenia patients completed assessments of self-esteem, insight into mental illness, positive symptoms and paranoia once every four weeks for a total of eight individual testing sessions. Hierarchical linear regression analysis revealed that changes in self-esteem predicted future changes in paranoia as well as positive symptoms more broadly; decreases in self-esteem at any given time point were associated with an increase in persecutory beliefs and other positive symptoms at the following assessment. On the other hand, decreases in insight were not significantly associated with paranoia or positive symptoms, either as a stable trait of the mental illness or as a predictor of change over time. Taken together, these results suggest that change in self-esteem, but not insight, has a significant and unique association with positive symptoms of schizophrenia, and may be a valuable target for future treatment.

  1. Insights into Surface Structure and Performance of Fluorinated Silicates from Cohesive Energy Studies

    DTIC Science & Technology

    2016-03-17

    fluorinated silicates from cohesive energy studies 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Andrew J...Insights into surface structure and performance of fluorinated silicates from cohesive energy studies 17 March 2016 Andrew J. Guenthner,1 Timothy...distribution is unlimited. PA Clearance Number 16153 Comparison of Surface Energy Parameters for Fluorosilicates 5 • Typical Surface Energies : -CF3 = 6

  2. Management of change for nurses: lessons from the discipline of organizational studies.

    PubMed

    Shanley, Chris

    2007-07-01

    This paper explores the literature on change management from the discipline of organizational studies to provide insights that nurse managers can use in their professional practice. The paper will benefit nurse managers by extending the nursing discourse on change management to include wider theoretical and academic perspectives. Important aspects of change management explored are the roles of power and political behaviour, how much change can be planned and controlled, how to combine top-down and bottom-up approaches to change, the role of emotions in the change management process, a comparison of prescriptive and analytical approaches to understanding change, and the connection between theory and practice in managing change. While nurses can draw much useful information from within the nursing discipline, they can also benefit by exploring other disciplinary areas. In the case of change management, there are many useful lessons nurses can carry over into their professional practice.

  3. Where Health and Death Intersect: Insights from a Terror Management Health Model.

    PubMed

    Arndt, Jamie; Goldenberg, Jamie L

    2017-01-01

    This paper offers an integrative understanding of the intersection between "health" and "death" from the perspective of the terror management health model. After highlighting the potential for health-related situations to elicit concerns about mortality, we turn to the question, how do thoughts of death influence health decision-making? Across varied health domains, the answer depends on whether these cognitions are in conscious awareness or not. When mortality concerns are conscious, people engage in healthy intentions and behavior if efficacy and coping resources are present. In contrast, when contending with accessible but non-conscious thoughts of death, health relevant decisions are guided more by esteem implications of the behavior. Lastly, we present research suggesting how these processes can be leveraged to facilitate health promotion and reduce health risk.

  4. Insights into the contemporary management of heart failure in specialized multidisciplinary ambulatory clinics.

    PubMed

    Abrahamyan, Lusine; Trubiani, Gina; Witteman, William; Mitsakakis, Nicholas; Krahn, Murray; Wijeysundera, Harindra C

    2013-09-01

    Heart failure (HF) clinics are associated with improved outcomes in randomized trials, however, there is substantial heterogeneity in the service models of HF clinics in practice. Our objective was to evaluate the effect of this clinic level heterogeneity on HF patient management in Ontario, Canada. Charts were abstracted from 9 HF clinics, chosen at random from the 34 HF clinics in operation in Ontario in 2011. From each clinic, approximately 100 patient charts were randomly selected for detailed abstraction on patient demographic characteristics, comorbidities, diagnostic tests, medication use, and referrals, over a 1-year period from the first clinic visit. Significant heterogeneity was observed in patient baseline profiles, pharmacological therapies, diagnostic testing, clinic personnel, and referrals across 9 clinics. The mean age of patients was 66.1 ± 15.7 years and was significantly different between the clinics. Most patients were male (65%), and mean left ventricular ejection fraction was 33%. There was significant variation in the utilization of echocardiography (42%-94%) and coronary angiography (19%-62%). Overall, approximately 88% of patients were prescribed angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, and 85% were prescribe β-blockers. The rates of referral to cardiac rehabilitation programs were overall low at 10.4% of patients, with substantial variation (1%-28%). Specialized HF clinics have wide variation in the health personnel involved and the care provided; in addition, patients treated at these HF clinics have important differences in clinical characteristics. Strategies should be considered at the appropriate level (eg, province-wide in Ontario) to standardize HF management and provide best evidence-based care to patients. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  5. A Study of Personal Information Management Strategies for Online Faculty

    ERIC Educational Resources Information Center

    Kearns, Lorna R.; Frey, Barbara A.; Tomer, Christinger; Alman, Susan

    2014-01-01

    The literature suggests that personal information management is a serious challenge for many computer users. Online faculty are especially challenged because of the large number of electronic files necessitated by teaching online. Those who have experience in this environment may offer valuable insights regarding information management challenges…

  6. Legacy phosphorus accumulation and management in the global context: insights from long-term analysis of major river basins

    NASA Astrophysics Data System (ADS)

    Powers, S. M.; Burt, T. P.; Chan, N. I.; Elser, J. J.; Haygarth, P. M.; Howden, N. J. K.; Jarvie, H. P.; Peterson, H. M.; Shen, J.; Worrall, F.; Sharpley, A. N.

    2014-12-01

    Phosphorus (P) is closely linked to major societal concerns including food security and water quality, and human activities strongly control the modern global P cycle. Current knowledge of the P cycle includes many insights about relatively short-term processes, but a long-term and landscape-level view may be needed to understand P status and optimize P management towards P sustainability. We reconstructed long-term (>40 years) P mass balances and rates of P accumulation in three major river basins where excess P pollution is demanding improvements in P management at local, national, and international levels. We focus on: Maumee River Basin, a major source of agricultural P to Lake Erie, the southernmost and shallowest of the Laurentian Great Lakes; Thames River Basin, where fluxes of effluent P from the London, England metropolitan area have declined following improvements in wastewater treatment; Yangtze (Changjiang) River Basin, the largest in China, which is undergoing rapid economic development. The Maumee and Thames are intensively monitored, and show long-term declines in basin P inputs that represent a step towards P sustainability. However, river P outputs have been slower to decline, consistent with the hypothesis that legacy P is mobilizing from soils or from within the river network. Published data on the Yangtze indicate the P flux from land to water has clearly increased with industrialization and population growth. Historical trajectories of P accumulation and depletion in major river basins are providing new understanding about the long-term impacts of P management, including watershed P legacies and response times, that may inform future policy towards local, national, and global P sustainability.

  7. Competition between Public Supervision and Professional Management: An Ethnographic Study of School Governance Reforms in Switzerland

    ERIC Educational Resources Information Center

    Hangartner, Judith; Svaton, Carla Jana

    2014-01-01

    This article discusses insights from an ethnographic study of local governance practices in the Canton of Bern, Switzerland, under changing policy conditions. Recent reforms introduced and strengthened the position of head teachers, enhanced the responsibility of the municipalities and introduced new quality management procedures in local…

  8. Competition between Public Supervision and Professional Management: An Ethnographic Study of School Governance Reforms in Switzerland

    ERIC Educational Resources Information Center

    Hangartner, Judith; Svaton, Carla Jana

    2014-01-01

    This article discusses insights from an ethnographic study of local governance practices in the Canton of Bern, Switzerland, under changing policy conditions. Recent reforms introduced and strengthened the position of head teachers, enhanced the responsibility of the municipalities and introduced new quality management procedures in local…

  9. Top Management Education, An Evaluation Study.

    ERIC Educational Resources Information Center

    Jerkedal, Ake

    A study of top management education was carried out in a practical training situation to determine attitude change and relationships between training objectives and training evaluation, initial standing and change, and initial standing and background factors. Subjects were 140 people completing one of five management courses. A questionnaire and…

  10. Natural Resources Management: Course of Study.

    ERIC Educational Resources Information Center

    Ingvalson, Brian

    The document presents a course outline for the study of natural resources management by junior and senior year high school students. Basic information and practical experiences are offered to the student in the classroom and through several field trips in order to acquire more knowledge in various areas of natural resources and their management.…

  11. Case Studies for Management Development in Bangladesh.

    ERIC Educational Resources Information Center

    McLean, Gary N.

    Eight case studies appropriate for use in a course in management development were prepared and are provided in this document. The typical case describes a real business situation in which a real manager had to reach a decision. The case gives quantitative and qualitative information that is, or may be, relevant to that decision. Questions for…

  12. Study on Case Teaching of Financial Management

    ERIC Educational Resources Information Center

    Che, Zhenghong; Che, Zhengmei

    2011-01-01

    Case teaching is an efficient teaching method of management. It plays an important role to enhance the students' ability to practice the theory. However, case teaching of financial management has not achieved the expected results. The paper aims to study the importance, characteristics and corresponding methods of case teaching method of financial…

  13. Self-Managed Studying in College Courses.

    ERIC Educational Resources Information Center

    Edwards, K. Anthony

    In an introductory psychology course, students were taught some principles of "adjustment" using self-management techniques and were required to conduct a self-management project. The four student projects reported herein were specifically designed to improve study skills through use of Premack's principle and stimulus control. Course…

  14. Overcoming gaps in the management of asthma in older patients: new insights.

    PubMed

    Barua, Pranoy; O'Mahony, M Sinead

    2005-01-01

    Asthma is under-recognised and undertreated in older populations. This is not surprising, given that one-third of older people experience significant breathlessness. The differential diagnosis commonly includes asthma, chronic obstructive pulmonary disease (COPD), heart failure, malignancy, aspiration and infections. Because symptoms and signs of several cardiorespiratory diseases are nonspecific in older people and diseases commonly co-exist, investigations are important. A simple strategy for the investigation of breathlessness in older people should include a full blood count, chest radiograph, ECG, peak flow diary and/or spirometry with reversibility as a minimum. If there are major abnormalities on the ECG, an echocardiogram should also be performed. Diurnal variability in peak flow readings >or=20% or >or=15% reversibility in forced expiratory volume in 1 second, spontaneously or with treatment, support a diagnosis of asthma. Distinguishing asthma from COPD is important to allow appropriate management of disease based on aetiology, accurate prediction of treatment response, correct prognosis and appropriate management of the chest condition and co-morbidities. The two conditions are usually readily differentiated by clinical features, particularly age at onset, variability of symptoms and nocturnal symptoms in asthma, supported by the results of reversibility testing. Full lung function tests may not necessarily help in differentiating the two entities, although gas transfer factor is characteristically reduced in COPD and usually normal or high in asthma. Methacholine challenge tests previously mainly used in research are now also used widely and safely to confirm asthma in clinical settings. Interest in exhaled nitric oxide as a biomarker of airways inflammation is increasing as a noninvasive tool in the diagnosis and monitoring of asthma. Regular inhaled corticosteroids (ICS) are the mainstay of treatment of asthma. Even in mild disease in older adults

  15. From quantifying historical LULCC impacts to optimizing land management for climate mitigation: Insights from climate modelling

    NASA Astrophysics Data System (ADS)

    Davin, E.; Lejeune, Q.; Seneviratne, S. I.

    2015-12-01

    Human activities have profoundly transformed the land surface through land use/land cover change (LULCC). The consequence of this transformation is twofold: First, the conversion from natural to anthropogenic systems exert a direct forcing on climate (through both biogeochemical and biogeophysical processes); Second the transformed ecosystems may modify land-atmosphere feedback mechanisms thus modulating the response to climate change or to specific weather events. The first point will be illustrated by reviewing recent modelling results, including LUCID and CMIP5 model intercomparisons, to shed some light on the relative importance of LULCC versus other climate forcings. Given the importance of LULCC impacts at the regional scale, some recent efforts to improve the representation of land processes in regional climate models [1] as well as a regional assessment of the impact of amazonian deforestation [2] will be presented. The second point will be discussed through two examples. First, the fact that LULCC may modulate certain modes of variability will be illustrated based on model experiments highlighting the regional interplay between ENSO variability and amazonian deforestation. Second, we will show that peak temperatures during heat waves can be strongly influenced locally by the type of land cover or land management practices. In particular no-till farming, by increasing surface albedo, can lead to a substantial attenuation of hot temperatures during heat waves, in part due to a more efficient radiative cooling effect during cloud-free conditions [3]. References:[1] Davin, E.L. and S.I. Seneviratne (2012), Role of land surface processes and diffuse/direct radiation partitioning in simulating the European climate, Biogeosciences, 9, 1695-1707, doi:10.5194/bg-9-1695-2012.[2] Lejeune, Q., E.L. Davin, B. Guillod and S.I. Seneviratne (2015), Influence of Amazonian deforestation on the future evolution of regional surface fluxes, circulation, surface temperature and

  16. New insights in the management of patients with hairy cell leukemia.

    PubMed

    Cornet, Edouard; Damaj, Gandhi; Troussard, Xavier

    2015-09-01

    Although hairy cell leukemia (HCL) was identified in 1958 by Bouroncle and colleagues, HCL remains in 2015 a mysterious disease. Accurate diagnosis of HCL relies on the recognition of hairy cells by morphology and flow cytometry in blood and/or bone marrow. However, there are cases difficult to diagnose, particularly in variants of HCL. Furthermore, some diseases such as splenic diffuse red pulp small B-cell lymphoma are very close to HCL and may be misdiagnosed. Major advances in the management of patients who have HCL have been made following the use of purine nucleoside analogs. However, new treatment options can be available in relapsed/refractory HCL: monoclonal antibody therapy, BRAF inhibitors, or immunotoxins. The presence of the BRAFV600E mutation was recently identified in most cases of HCL and its absence in variants of HCL and in other B-cell chronic lymphoproliferative disorders. The precise cellular origin of HCL remains elusive but BRAF mutations were detected in hematopoietic stem cells of patients with HCL. Assessment for minimal residual disease is important in clinical trials. Minimal residual disease detection can clearly predict inferior long-term outcomes or early relapses in patients with HCL. Recent reports have shown that inhibition of BRAF kinase by drugs such as vemurafenib is effective in relapsed/refractory HCL. Immunotoxins offer new opportunities even in patients without BRAF mutations. All these findings have major implications for diagnosis, monitoring, and treatment of HCL and variant forms of HCL.

  17. Berberine: New Insights from Pharmacological Aspects to Clinical Evidences in the Management of Metabolic Disorders.

    PubMed

    Caliceti, Cristiana; Franco, Placido; Spinozzi, Silvia; Roda, Aldo; Cicero, Arrigo F G

    2016-01-01

    Berberine is a quaternary ammonium salt from the protoberberine group of isoquinoline alkaloids found in such plants as gender Berberis. Berberine is recognised to improve glucose and lipid metabolism disorders and preliminary clinical evidences suggest the ability of berberine to reduce endothelial inflammation improving vascular health, even in patients already affected by cardiovascular diseases, suggesting a possible interesting role of berberine and its metabolites in clinical practice. However, its physicochemical properties, pharmacokinetic, and metabolism are not fully elucidated and contradictory data have been reported. This review provides a summary regarding the pharmacological and biological features of berberine, with a focus on berberine as well as their pharmacologically active metabolites and the different mechanisms underlying their activities in order to clarify the correct use of berberine supplementation, alone or in association with other nutraceuticals, for the management of metabolic disorders associated to increased cardiovascular disease risk. A particular attention has also been given to the available clinical trials assessing its short- and middle- term use tolerability, safety and efficacy in various conditions, such as dyslipidaemia, impaired fasting glucose, metabolic syndrome and type 2 diabetes.

  18. Segmentation studies provide insights to better understanding attitudes towards science and technology.

    PubMed

    Cormick, Craig; Romanach, Lygia Malzoni

    2014-03-01

    Values-based studies of people's attitudes towards science and technology not only provide great insights into what drives different attitudes to issues like climate change and genetically modified foods, but allow for segmenting the general public by homogeneous values. Such segmentations both provide better predictions of people's attitudes to new technologies or contentious science issues than age, sex, or other standard demographics, and allow a better matching of different messages with different community values.

  19. Acute and chronic cardiovascular effects of hyperkalemia: new insights into prevention and clinical management.

    PubMed

    McCullough, Peter A; Beaver, Thomas M; Bennett-Guerrero, Elliott; Emmett, Michael; Fonarow, Gregg C; Goyal, Abhinav; Herzog, Charles A; Kosiborod, Mikhail; Palmer, Biff F

    2014-01-01

    The plasma pool of potassium is a partial reflection of the overall body, transient cellular shifts, and potassium elimination regulated by the kidneys. Potassium concentrations elevating above the upper limit of normal (> 5.0 mEq/L) have become more common in cardiovascular practice due to the growing population of patients with chronic kidney disease and the broad applications of drugs that modulate potassium excretion by either reducing production of angiotensin II (angiotensin-converting enzyme inhibitors, direct renin inhibitors, beta-adrenergic receptor antagonists), blocking angiotensin II receptors (angiotensin receptor blockers), or antagonizing the action of aldosterone on mineralocorticoid receptors (mineralocorticoid receptor antagonists). In addition, acute kidney injury, critical illness, crush injuries, and massive red blood cell transfusions can result in hyperkalemia. Progressively more severe elevations in potassium are responsible for abnormalities in cardiac depolarization and repolarization and contractility. Untreated severe hyperkalemia results in sudden cardiac death. Traditional management steps have included reducing dietary potassium and discontinuing potassium supplements; withdrawal of exacerbating drugs; acute treatment with intravenous calcium gluconate, insulin, and glucose; nebulized albuterol; correction of acidosis with sodium bicarbonate for short-term shifts out of the plasma pool; and, finally, gastrointestinal ion exchange with oral sodium polystyrene sulfonate in sorbitol, which is mainly used in the hospital and is poorly tolerated due to gastrointestinal adverse effects. This review explores hyperkalemia as a complication in cardiovascular patients and highlights new acute, chronic, and preventative oral therapies (patiromer calcium, cross-linked polyelectrolyte, ZS-9) that could potentially create a greater margin of safety for vulnerable patients with combined heart and kidney disease.

  20. Reciprocal insights into adaptation from agricultural and evolutionary studies in tomato

    PubMed Central

    Moyle, Leonie C; Muir, Christopher D

    2010-01-01

    Although traditionally separated by different aims and methodologies, research on agricultural and evolutionary problems shares a common goal of understanding the mechanisms underlying functionally important traits. As such, research in both fields offers potential complementary and reciprocal insights. Here, we discuss adaptive stress responses (specifically to water stress) as an example of potentially fruitful research reciprocity, where agricultural research has clearly produced advances that could benefit evolutionary studies, while evolutionary studies offer approaches and insights underexplored in crop studies. We focus on research on Solanum species that include the domesticated tomato and its wild relatives. Integrated approaches to understanding ecological adaptation are particularly attractive in tomato and its wild relatives: many presumptively adaptive phenotypic differences characterize wild species, and the physiological and mechanistic basis of many relevant traits and environmental responses has already been examined in the context of cultivated tomato and some wild species. We highlight four specific instances where these reciprocal insights can be combined to better address questions that are fundamental both to agriculture and evolution. PMID:25567935

  1. Power module Data Management System (DMS) study

    NASA Technical Reports Server (NTRS)

    1978-01-01

    Computer trades and analyses of selected Power Module Data Management Subsystem issues to support concurrent inhouse MSFC Power Study are provided. The charts which summarize and describe the results are presented. Software requirements and definitions are included.

  2. Interval Management Display Design Study

    NASA Technical Reports Server (NTRS)

    Baxley, Brian T.; Beyer, Timothy M.; Cooke, Stuart D.; Grant, Karlus A.

    2014-01-01

    In 2012, the Federal Aviation Administration (FAA) estimated that U.S. commercial air carriers moved 736.7 million passengers over 822.3 billion revenue-passenger miles. The FAA also forecasts, in that same report, an average annual increase in passenger traffic of 2.2 percent per year for the next 20 years, which approximates to one-and-a-half times the number of today's aircraft operations and passengers by the year 2033. If airspace capacity and throughput remain unchanged, then flight delays will increase, particularly at those airports already operating near or at capacity. Therefore it is critical to create new and improved technologies, communications, and procedures to be used by air traffic controllers and pilots. National Aeronautics and Space Administration (NASA), the FAA, and the aviation industry are working together to improve the efficiency of the National Airspace System and the cost to operate in it in several ways, one of which is through the creation of the Next Generation Air Transportation System (NextGen). NextGen is intended to provide airspace users with more precise information about traffic, routing, and weather, as well as improve the control mechanisms within the air traffic system. NASA's Air Traffic Management Technology Demonstration-1 (ATD-1) Project is designed to contribute to the goals of NextGen, and accomplishes this by integrating three NASA technologies to enable fuel-efficient arrival operations into high-density airports. The three NASA technologies and procedures combined in the ATD-1 concept are advanced arrival scheduling, controller decision support tools, and aircraft avionics to enable multiple time deconflicted and fuel efficient arrival streams in high-density terminal airspace.

  3. Burn patients' experience of pain management: a qualitative study.

    PubMed

    Yuxiang, Li; Lingjun, Zhou; Lu, Tang; Mengjie, Liu; Xing, Ming; Fengping, Shen; Jing, Cui; Xianli, Meng; Jijun, Zhao

    2012-03-01

    Pain is a major problem after burns and researchers continue to report that pain from burns remains undertreated. The inadequate pain control results in adverse sequalae physically and psychologically in the burn victims. A better understanding of a burn patient's experience is important in identifying the factors responsible for undertreated pain and establishing effective pain management guidelines or recommendation in the practice of pain relief for burn injuries. This study sought to explore and describe the experience that patients have about pain related to burn-injury during hospitalization. Semi-structured interviews were conducted on eight patients with moderate to severe pain from burn injuries recruited from a Burn Centre in Northwest China. Data was collected by in-depth interviews and qualitative description after full transcription of each interview. Analysis involved the identification of themes and the development of a taxonomy of patients' experience of burn pain and its management. Three themes were indentified: (1) patients' experience of pain control, (2) patients' perception on burn pain management, and (3) patients' expectation of burn pain management. Findings from this study suggested that patients experience uncontrolled pain both physically and psychologically which may serve as an alert for awareness of health professionals to recognize and establish a multidisciplinary pain management team for burn victims, including surgeons, critical care specialists, anesthesiologists, nurses, psychologists, and social workers to accomplish safe and effective strategies for pain control to reach an optimal level of pain management in burn patients. It also provides insights and suggestions for future research directions to address this significant clinical problem.

  4. Insights into the management of emerging infections: regulating variant Creutzfeldt-Jakob disease transfusion risk in the UK and the US.

    PubMed

    Ponte, Maya L

    2006-10-01

    vCJD contamination in the UK, contributed to a greater sense of urgency and a speedier implementation of regulations in that country. Third, while the results of scientific studies played a prominent role in the construction of regulations in both nations, this role was shaped by existing social and professional networks. In the UK, early focus on a European study implicating B-lymphocytes as the carrier of prion infectivity in blood led to the introduction of a policy that requires universal leukoreduction of blood components. In the US, early focus on an American study highlighting the ability of plasma to serve as a reservoir of prion infectivity led the FDA and its advisory panel to eschew similar measures. The results of this study yield three important theoretical insights that pertain to the global management of emerging infectious diseases. First, because the perception and management of disease may be shaped by previous experience with disease, especially catastrophic experience, there is always the possibility for over-management of some possible routes of transmission and relative neglect of others. Second, local specificities within a given nation may influence the temporality of decision making, which in turn may influence the choice of disease management policies. Third, a preference for science-based risk management among nations will not necessarily lead to homogeneous policies. This is because the exposure to and interpretation of scientific results depends on the existing social and professional networks within a given nation. Together, these theoretical insights provide a framework for analyzing and anticipating potential conflicts in the international management of emerging infectious diseases. In addition, this study illustrates the utility of qualitative methods in investigating research questions that are difficult to assess through quantitative means.

  5. Insights into the Management of Emerging Infections: Regulating Variant Creutzfeldt-Jakob Disease Transfusion Risk in the UK and the US

    PubMed Central

    Ponte, Maya L

    2006-01-01

    of blood products for possible vCJD contamination in the UK, contributed to a greater sense of urgency and a speedier implementation of regulations in that country. Third, while the results of scientific studies played a prominent role in the construction of regulations in both nations, this role was shaped by existing social and professional networks. In the UK, early focus on a European study implicating B-lymphocytes as the carrier of prion infectivity in blood led to the introduction of a policy that requires universal leukoreduction of blood components. In the US, early focus on an American study highlighting the ability of plasma to serve as a reservoir of prion infectivity led the FDA and its advisory panel to eschew similar measures. Conclusions The results of this study yield three important theoretical insights that pertain to the global management of emerging infectious diseases. First, because the perception and management of disease may be shaped by previous experience with disease, especially catastrophic experience, there is always the possibility for over-management of some possible routes of transmission and relative neglect of others. Second, local specificities within a given nation may influence the temporality of decision making, which in turn may influence the choice of disease management policies. Third, a preference for science-based risk management among nations will not necessarily lead to homogeneous policies. This is because the exposure to and interpretation of scientific results depends on the existing social and professional networks within a given nation. Together, these theoretical insights provide a framework for analyzing and anticipating potential conflicts in the international management of emerging infectious diseases. In addition, this study illustrates the utility of qualitative methods in investigating research questions that are difficult to assess through quantitative means. PMID:17076547

  6. New insight on the water management in Ica Valley-Peru

    NASA Astrophysics Data System (ADS)

    Guttman, Joseph; Berger, Diego

    2014-05-01

    The Andes divide Peru into three natural drainage basins: Pacific basin, Atlantic basin and Lake Titicaca basin. According to the National Water Authority (ANA), the Pacific basin is the driest basin. The bulk of water that feed the local aquifers in the coastal Pacific region is coming from rivers that flow west from the Andes. One of them is the Ica River- source of the Ica Aquifer and the Pampas de Villacuri Aquifer. The Ica River flows in a graben that was created by a series of faults. The graben is filled with sand and gravel with interbeded and lenses of clay. The aquifer thickness varies between 25 meters to more than 200 meters. The Ica Valley has an extension of 7700 km2 and belongs to the Province of Ica, the second larger economic center in Peru. The Valley is located in the hyperarid region of the Southern Coastal area of Peru with a few millimeters of precipitation per year. The direct recharge is almost zero. The recharge into the Ica Valley aquifer is comes indirectly by infiltration of storm water through the riverbed generates in the Andes, through irrigation canals and by irrigation return flow. In this hyperarid region, local aquifers like the Ica Valley are extremely valuable resources to local populations and are the key sources of groundwater for agriculture and population needs. Therefore, these aquifers play a crucial role in providing people with water and intense attention should be given to manage the water sector properly and to keep the aquifer sustainable for future generations. The total pumping (from rough estimations) is much greater than the direct and indirect recharge. The deficit in the water balance is reflected in large water level decline, out of operation of shallow wells and the ascending of saline water from deeper layers. The change from flood irrigation that contributes about 35-40% of the water to the aquifer, to drip irrigation dramatically reduces the amount of water that infiltrates into the sub-surface from the

  7. A prospective study of the trajectories of clinical insight, affective symptoms, and cognitive ability in bipolar disorder.

    PubMed

    Depp, Colin A; Harmell, Alexandrea L; Savla, Gauri N; Mausbach, Brent T; Jeste, Dilip V; Palmer, Barton W

    2014-01-01

    Clinical insight in bipolar disorder is associated with treatment adherence and psychosocial outcome. The short-term dynamics of clinical insight in relationship to symptoms and cognitive abilities are unknown. In a prospective observational study, a total of 106 outpatients with bipolar disorder I or II were assessed at baseline, 6 weeks, 12 weeks, and 26 weeks. Participants were administered a comprehensive neuropsychological battery, clinical ratings of manic and depressive symptom severity, and self-reported clinical insight. Lagged correlations and linear mixed-effects models were used to determine the temporal associations between symptoms and insight, as well as the moderating influence of global cognitive abilities. At baseline, insight was modestly correlated with severity of manic symptoms, but not with depressive symptoms or cognitive abilities. Insight and depressive symptoms fluctuated to approximately the same extent over time. Both lagged correlations and mixed effects models with lagged effects indicated that the severity of manic symptoms predicted worse insight at later assessments, whereas the converse was not significant. There were no direct or moderating influences of global cognitive abilities. Our sample size was modest, and included relatively psychiatrically stable outpatients, followed for a six month period. Our results may not generalize to acutely symptomatic patients followed over a longer period. Clinical insight varies substantially over time within patients with bipolar disorder. Impaired insight in bipolar disorder is more likely to follow than to precede manic symptoms. © 2013 Published by Elsevier B.V.

  8. Why hospital pharmacists have failed to manage antimalarial drugs stock-outs in pakistan? A qualitative insight.

    PubMed

    Malik, Madeeha; Hassali, Mohamed Azmi Ahmad; Shafie, Asrul Akmal; Hussain, Azhar

    2013-01-01

    Purpose. This study aimed to explore the perceptions of hospital pharmacists towards drug management and reasons underlying stock-outs of antimalarial drugs in Pakistan. Methods. A qualitative study was designed to explore the perceptions of hospital pharmacists regarding drug management and irrational use of antimalarial drugs in two major cities of Pakistan, namely, Islamabad (national capital) and Rawalpindi (twin city). Semistructured interviews were conducted with 16 hospital pharmacists using indepth interview guides at a place and time convenient for the respondents. Interviews, which were audiotaped and transcribed verbatim, were evaluated by thematic content analysis and by other authors' analysis. Results. Most of the respondents were of the view that financial constraints, inappropriate drug management, and inadequate funding were the factors contributing toward the problem of antimalarial drug stock-outs in healthcare facilities of Pakistan. The pharmacists anticipated that prescribing by nonproprietary names, training of health professionals, accepted role of hospital pharmacist in drug management, implementation of essential drug list and standard treatment guidelines for malaria in the healthcare system can minimize the problem of drug stock outs in healthcare system of Pakistan. Conclusion. The current study showed that all the respondents in the two cities agreed that hospital pharmacist has failed to play an effective role in efficient management of anti-malarial drugs stock-outs.

  9. Why Hospital Pharmacists Have Failed to Manage Antimalarial Drugs Stock-Outs in Pakistan? A Qualitative Insight

    PubMed Central

    Hassali, Mohamed Azmi Ahmad; Shafie, Asrul Akmal; Hussain, Azhar

    2013-01-01

    Purpose. This study aimed to explore the perceptions of hospital pharmacists towards drug management and reasons underlying stock-outs of antimalarial drugs in Pakistan. Methods. A qualitative study was designed to explore the perceptions of hospital pharmacists regarding drug management and irrational use of antimalarial drugs in two major cities of Pakistan, namely, Islamabad (national capital) and Rawalpindi (twin city). Semistructured interviews were conducted with 16 hospital pharmacists using indepth interview guides at a place and time convenient for the respondents. Interviews, which were audiotaped and transcribed verbatim, were evaluated by thematic content analysis and by other authors' analysis. Results. Most of the respondents were of the view that financial constraints, inappropriate drug management, and inadequate funding were the factors contributing toward the problem of antimalarial drug stock-outs in healthcare facilities of Pakistan. The pharmacists anticipated that prescribing by nonproprietary names, training of health professionals, accepted role of hospital pharmacist in drug management, implementation of essential drug list and standard treatment guidelines for malaria in the healthcare system can minimize the problem of drug stock outs in healthcare system of Pakistan. Conclusion. The current study showed that all the respondents in the two cities agreed that hospital pharmacist has failed to play an effective role in efficient management of anti-malarial drugs stock-outs. PMID:24223321

  10. Thyroid disease in pregnancy: new insights in diagnosis and clinical management.

    PubMed

    Korevaar, Tim I M; Medici, Marco; Visser, Theo J; Peeters, Robin P

    2017-10-01

    Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.

  11. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study.

    PubMed

    Paul, Ian M; Williams, Jennifer S; Anzman-Frasca, Stephanie; Beiler, Jessica S; Makova, Kateryna D; Marini, Michele E; Hess, Lindsey B; Rzucidlo, Susan E; Verdiglione, Nicole; Mindell, Jodi A; Birch, Leann L

    2014-07-18

    Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This "parenting" intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT's central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent-child responsibility for feeding, reducing subsequent risk for overeating and overweight. 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the "parenting" or "safety" groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3-4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second

  12. New insights into managing the risk of hypoglycaemia associated with intermittent high-intensity exercise in individuals with type 1 diabetes mellitus: implications for existing guidelines.

    PubMed

    Guelfi, Kym J; Jones, Timothy W; Fournier, Paul A

    2007-01-01

    -to-recovery ratios observed in team and field sports have been conducted. The findings of these studies do not support the existing recommendations for managing blood glucose levels during IHE. Hence, the purpose of this article is to discuss the results of these recent studies, which provide new insight into the management of blood glucose levels during and after IHE and have implications for current guidelines aimed at minimising the risk of hypoglycaemia. These findings, along with future investigations, should provide valuable information for health professionals and individuals with type 1 diabetes on the management of blood glucose levels during and after exercise to allow for safe participation in intermittent activities along with their peers.

  13. New Insights into Managing the Risk of Hypoglycaemia Associated with Intermittent High-Intensity Exercise in Individuals with Type 1 Diabetes Mellitus : Implications for Existing Guidelines.

    PubMed

    Guelfi, Kym J; Jones, Timothy W; Fournier, Paul A

    2007-11-01

    -to-recovery ratios observed in team and field sports have been conducted. The findings of these studies do not support the existing recommendations for managing blood glucose levels during IHE. Hence, the purpose of this article is to discuss the results of these recent studies, which provide new insight into the management of blood glucose levels during and after IHE and have implications for current guidelines aimed at minimising the risk of hypoglycaemia. These findings, along with future investigations, should provide valuable information for health professionals and individuals with type 1 diabetes on the management of blood glucose levels during and after exercise to allow for safe participation in intermittent activities along with their peers.

  14. Advances in plant virus evolution: translating evolutionary insights into better disease management.

    PubMed

    Acosta-Leal, R; Duffy, S; Xiong, Z; Hammond, R W; Elena, S F

    2011-10-01

    Recent studies in plant virus evolution are revealing that genetic structure and behavior of virus and viroid populations can explain important pathogenic properties of these agents, such as host resistance breakdown, disease severity, and host shifting, among others. Genetic variation is essential for the survival of organisms. The exploration of how these subcellular parasites generate and maintain a certain frequency of mutations at the intra- and inter-host levels is revealing novel molecular virus-plant interactions. They emphasize the role of host environment in the dynamic genetic composition of virus populations. Functional genomics has identified host factors that are transcriptionally altered after virus infections. The analyses of these data by means of systems biology approaches are uncovering critical plant genes specifically targeted by viruses during host adaptation. Also, a next-generation resequencing approach of a whole virus genome is opening new avenues to study virus recombination and the relationships between intra-host virus composition and pathogenesis. Altogether, the analyzed data indicate that systematic disruption of some specific parameters of evolving virus populations could lead to more efficient ways of disease prevention, eradication, or tolerable virus-plant coexistence.

  15. New Insights in Nutritional Management and Amino Acid Supplementation in Urea Cycle Disorders

    PubMed Central

    Scaglia, Fernando

    2016-01-01

    Sodium phenylbutyrate is used in the pharmacological treatment of urea cycle disorders to create alternative pathways for nitrogen excretion. The primary metabolite, phenylacetate, conjugates glutamine in the liver and kidney to form phenylacetylglutamine that is readily excreted in the urine. Patients with urea cycle disorders taking sodium phenylbutyrate have a selective reduction in the plasma concentrations of branched chain amino acids despite adequate dietary protein intake. Moreover, this depletion is usually the harbinger of a metabolic crisis. Plasma branched chain amino acids and other essential amino acids were measured in control subjects, untreated ornithine transcarbamylase deficiency females, and treated patients with urea cycle disorders (ornithine transcarbamylase deficiency and argininosuccinate synthetase deficiency) in the absorptive state during the course of stable isotope studies. Branched chain amino acid levels were significantly lower in treated patients with urea cycle disorders when compared to untreated ornithine transcarbamylase deficiency females or control subjects. These results were replicated in control subjects who had low steady-state branched chain amino acid levels when treated with sodium phenylbutyrate. These studies suggested that alternative pathway therapy with sodium phenylbutyrate causes a substantial impact on the metabolism of branched chain amino acids in patients with urea cycle disorders, implying that better titration of protein restriction can be achieved with branched chain amino acid supplementation in these patients who are on alternative pathway therapy. PMID:20299258

  16. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management.

    PubMed

    Apostolakis, Stavros; Konstantinides, Stavros

    2012-01-01

    Until recently, the right ventricle (RV) received little attention in adult patients with congenital heart disease and even less attention in the setting of acquired heart failure. However, in the last two decades, our perspective towards the right side of the heart has begun to change. Advances in imaging modalities have permitted the accurate study of RV physiology and made it apparent that RV function is an important determinant of prognosis in heart failure irrespective of the underlying etiology. This article summarizes the existing data on the unique anatomical and physiological features of the RV. The hemodynamic conditions and cellular and biochemical pathways that lead to right heart failure are presented. Moreover, the imaging modalities that aid in the assessment of RV structure and function are described and the importance of the diagnostic and prognostic information they provide is discussed.

  17. Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management

    PubMed Central

    Olin, Jeffrey W.; Sealove, Brett A.

    2010-01-01

    Peripheral artery disease (PAD), which comprises atherosclerosis of the abdominal aorta, iliac, and lower-extremity arteries, is underdiagnosed, undertreated, and poorly understood by the medical community. Patients with PAD may experience a multitude of problems, such as claudication, ischemic rest pain, ischemic ulcerations, repeated hospitalizations, revascularizations, and limb loss. This may lead to a poor quality of life and a high rate of depression. From the standpoint of the limb, the prognosis of patients with PAD is favorable in that the claudication remains stable in 70% to 80% of patients over a 10-year period. However, the rate of myocardial infarction, stroke, and cardiovascular death in patients with both symptomatic and asymptomatic PAD is markedly increased. The ankle brachial index is an excellent screening test for the presence of PAD. Imaging studies (duplex ultrasonography, computed tomographic angiography, magnetic resonance angiography, catheter-based angiography) may provide additional anatomic information if revascularization is planned. The goals of therapy are to improve symptoms and thus quality of life and to decrease the cardiovascular event rate (myocardial infarction, stroke, cardiovascular death). The former is accomplished by establishing a supervised exercise program and administering cilostazol or performing a revascularization procedure if medical therapy is ineffective. A comprehensive program of cardiovascular risk modification (discontinuation of tobacco use and control of lipids, blood pressure, and diabetes) will help to prevent the latter. PMID:20592174

  18. Using insights from behavioral economics and social psychology to help patients manage chronic diseases.

    PubMed

    Mogler, Braden K; Shu, Suzanne B; Fox, Craig R; Goldstein, Noah J; Victor, Ronald G; Escarce, José J; Shapiro, Martin F

    2013-05-01

    Despite a revolution in therapeutics, the ability to control chronic diseases remains elusive. We present here a conceptual model of the potential role of behavioral tools in chronic disease control. Clinicians implicitly accept the assumption that patients will act rationally to maximize their self-interest. However, patients may not always be the rational actors that we imagine. Major behavioral barriers to optimal health behavior include patients' fear of threats to health, unwillingness to think about problems when risks are known or data are ambiguous, the discounting of risks that are far in the future, failure to act due to lack of motivation, insufficient confidence in the ability to overcome a health problem, and inattention due to pressures of everyday life. Financial incentives can stimulate initiation of health-promoting behaviors by reducing or eliminating financial barriers, but may not produce long-term behavior change without additional interventions. Strategies have been developed by behavioral economists and social psychologists to address each of these barriers to better decision-making. These include: labeling positive behaviors in ways consistent with patient life goals and priorities; greater focus on more immediate risks of chronic diseases; intermediate subgoals as steps to a large health goal; and implementation of specific plans as to when, where, and how an action will be taken. Such strategies hold promise for improving health behaviors and disease control, but most have not been studied in medical settings. The effectiveness of these approaches should be evaluated for their potential as tools for the clinician.

  19. Insights into the impact and use of research results in a residential long-term care facility: a case study

    PubMed Central

    2012-01-01

    Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. Methods We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. Results We observed the importance of understanding organizational routines and the impact of key events in the facility’s environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides)—what they did and said mattered, and TREC provided a means of having one’s voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. Conclusions Four themes emerged regarding staff engagement with the research process

  20. Insights into the impact and use of research results in a residential long-term care facility: a case study.

    PubMed

    Cranley, Lisa A; Birdsell, Judy M; Norton, Peter G; Morgan, Debra G; Estabrooks, Carole A

    2012-09-13

    Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at 'Restwood' (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. We observed the importance of understanding organizational routines and the impact of key events in the facility's environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides)-what they did and said mattered, and TREC provided a means of having one's voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. Four themes emerged regarding staff engagement with the research process: sharing feedback reports from the TREC study; the

  1. Dynamic Neural Network of Insight: A Functional Magnetic Resonance Imaging Study on Solving Chinese ‘Chengyu’ Riddles

    PubMed Central

    Zhao, Qingbai; Zhou, Zhijin; Xu, Haibo; Chen, Shi; Xu, Fang; Fan, Wenliang; Han, Lei

    2013-01-01

    The key components of insight include breaking mental sets and forming the novel, task-related associations. The majority of researchers have agreed that the anterior cingulate cortex may mediate processes of breaking one’s mental set, while the exact neural correlates of forming novel associations are still debatable. In the present study, we used a paradigm of answer selection to explore brain activations of insight by using event-related functional magnetic resonance imaging during solving Chinese ‘chengyu’ (in Chinese pinyin) riddles. Based on the participant’s choice, the trials were classified into the insight and non-insight conditions. Both stimulus-locked and response-locked analyses are conducted to detect the neural activity corresponding to the early and late periods of insight solution, respectively. Our data indicate that the early period of insight solution shows more activation in the middle temporal gyrus, the middle frontal gyrus and the anterior cingulate cortex. These activities might be associated to the extensive semantic processing, as well as detecting and resolving cognitive conflicts. In contrast, the late period of insight solution produced increased activities in the hippocampus and the amygdala, possibly reflecting the forming of novel association and the concomitant “Aha” feeling. Our study supports the key role of hippocampus in forming novel associations, and indicates a dynamic neural network during insight solution. PMID:23555020

  2. Process of Change in Pain-Related Fear: Clinical Insights From a Single Case Report of Persistent Back Pain Managed With Cognitive Functional Therapy.

    PubMed

    Caneiro, J P; Smith, Anne; Rabey, Martin; Moseley, G Lorimer; O'Sullivan, Peter

    2017-09-01

    Study Design Single case report with repeated measures over 18 months. Background Management of persistent low back pain (PLBP) associated with high pain-related fear is complex. This case report aims to provide clinicians with insight into the process of change in a person with PLBP and high bending-related fear, who was managed with an individualized behavioral approach of cognitive functional therapy. Case Description A retired manual worker with PLBP believed that his spine was degenerating, that bending would hurt him, and that avoidance was the only form of pain control. At baseline, he presented high levels of pain-related fear on the Tampa Scale of Kinesiophobia (score, 47/68) and a high-risk profile on the Örebro Musculoskeletal Pain Questionnaire (score, 61/100). Unhelpful beliefs and behaviors led to a vicious cycle of fear and disengagement from valued life activities. Guided behavioral experiments were used to challenge his thoughts and protective responses, indicating that his behavior was modifiable and the pain controllable. Using a multidimensional clinical-reasoning framework, cognitive functional therapy management was tailored to target key drivers of PLBP and delivered over 6 sessions in a 3-month period. Outcomes Over an 18-month clinical journey, he demonstrated improvements in bending-related fear, pain expectancy, and pain experience, and substantial changes in pain-related fear (Tampa Scale of Kinesiophobia: 33/68; change, -14 points) and risk profile (Örebro Musculoskeletal Pain Questionnaire: 36/100; change, -25 points). Clinical interviews at 6 and 18 months revealed positive changes in mindset, understanding of pain, perceived pain control, and behavioral responses to pain. Discussion This case report provides clinicians with an insight to using a multidimensional clinical-reasoning framework to identify and target the key drivers of the disorder, and to using cognitive functional therapy to address unhelpful psychological and

  3. Best practice in the management of clinical coding services: Insights from a project in the Republic of Ireland, Part 2.

    PubMed

    Reid, Beth A; Ridoutt, Lee; O'Connor, Paul; Murphy, Deirdre

    2017-09-01

    This is the second of two articles about best practice in the management of coding services. The best practice project was part of a year-long project conducted in the Republic of Ireland to review the quality of the Hospital Inpatient Enquiry data for its use in activity-based funding. The four methods used to address the best practice aspect of the project were described in detail in Part 1. The results included in this article are those relating to the coding manager's background, preparation and style, clinical coder (CC) workforce adequacy, the CC workforce structure and career pathway, and the physical and psychological work environment for the clinical coding service. Examples of best practice were found in the study hospitals but there were also areas for improvement. Coding managers would benefit from greater support in the form of increased opportunities for management training and a better method for calculating CC workforce numbers. A career pathway is needed for CCs to progress from entry to expert CC, mentor, manager and quality controller. Most hospitals could benefit from investment in infrastructure that places CCs in a physical environment that tells them they are an important part of the hospital and their work is valued.

  4. Accuracy of Seattle Heart Failure Model and HeartMate II Risk Score in Non-Inotrope-Dependent Advanced Heart Failure Patients: Insights From the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients).

    PubMed

    Lanfear, David E; Levy, Wayne C; Stehlik, Josef; Estep, Jerry D; Rogers, Joseph G; Shah, Keyur B; Boyle, Andrew J; Chuang, Joyce; Farrar, David J; Starling, Randall C

    2017-05-01

    Timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients not on inotropes is unclear. Relevant prediction models exist (SHFM [Seattle Heart Failure Model] and HMRS [HeartMate II Risk Score]), but use in this group is not established. ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) is a prospective, multicenter, nonrandomized study of 200 advanced heart failure patients not on inotropes who met indications for LVAD implantation, comparing the effectiveness of HeartMate II support versus optimal medical management. We compared SHFM-predicted versus observed survival (overall survival and LVAD-free survival) in the optimal medical management arm (n=103) and HMRS-predicted versus observed survival in all LVAD patients (n=111) using Cox modeling, receiver-operator characteristic (ROC) curves, and calibration plots. In the optimal medical management cohort, the SHFM was a significant predictor of survival (hazard ratio=2.98; P<0.001; ROC area under the curve=0.71; P<0.001) but not LVAD-free survival (hazard ratio=1.41; P=0.097; ROC area under the curve=0.56; P=0.314). SHFM showed adequate calibration for survival but overestimated LVAD-free survival. In the LVAD cohort, the HMRS had marginal discrimination at 3 (Cox P=0.23; ROC area under the curve=0.71; P=0.026) and 12 months (Cox P=0.036; ROC area under the curve=0.62; P=0.122), but calibration was poor, underestimating survival across time and risk subgroups. In non-inotrope-dependent advanced heart failure patients receiving optimal medical management, the SHFM was predictive of overall survival but underestimated the risk of clinical worsening and LVAD implantation. Among LVAD patients, the HMRS had marginal discrimination and underestimated survival post-LVAD implantation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01452802. © 2017 American Heart Association

  5. Creativity Development in Adolescence: Insight from Behavior, Brain, and Training Studies.

    PubMed

    Kleibeuker, Sietske W; De Dreu, Carsten K W; Crone, Eveline A

    2016-01-01

    Creativity is a multifaceted construct that recruits different cognitive processes. Here, we summarize studies that show that creativity develops considerably during adolescence with different developmental trajectories for insight, verbal divergent thinking, and visuospatial divergent thinking. Next, these developmental time courses are mapped to changes in brain activity when individuals perform divergent thinking tasks. The findings point to an important role of the prefrontal cortex for generating novelty and complexity. Finally, the potentials and limitations of training creativity in adolescence are described. The findings are interpreted vis-à-vis the dynamic changes that occur during adolescence in brain development and behavioral control processes.

  6. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study

    PubMed Central

    2014-01-01

    Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic

  7. New Insights about Enzyme Evolution from Large Scale Studies of Sequence and Structure Relationships*

    PubMed Central

    Brown, Shoshana D.; Babbitt, Patricia C.

    2014-01-01

    Understanding how enzymes have evolved offers clues about their structure-function relationships and mechanisms. Here, we describe evolution of functionally diverse enzyme superfamilies, each representing a large set of sequences that evolved from a common ancestor and that retain conserved features of their structures and active sites. Using several examples, we describe the different structural strategies nature has used to evolve new reaction and substrate specificities in each unique superfamily. The results provide insight about enzyme evolution that is not easily obtained from studies of one or only a few enzymes. PMID:25210038

  8. New insights about enzyme evolution from large scale studies of sequence and structure relationships.

    PubMed

    Brown, Shoshana D; Babbitt, Patricia C

    2014-10-31

    Understanding how enzymes have evolved offers clues about their structure-function relationships and mechanisms. Here, we describe evolution of functionally diverse enzyme superfamilies, each representing a large set of sequences that evolved from a common ancestor and that retain conserved features of their structures and active sites. Using several examples, we describe the different structural strategies nature has used to evolve new reaction and substrate specificities in each unique superfamily. The results provide insight about enzyme evolution that is not easily obtained from studies of one or only a few enzymes.

  9. Pain management in trauma: A review study

    PubMed Central

    Ahmadi, Alireza; Bazargan-Hejazi, Shahrzad; Heidari Zadie, Zahra; Euasobhon, Pramote; Ketumarn, Penkae; Karbasfrushan, Ali; Amini-Saman, Javad; Mohammadi, Reza

    2016-01-01

    Abstract: Background: Pain in trauma has a role similar to the double-edged sword. On the one hand, pain is a good indicator to determine the severity and type of injury. On the other hand, pain can induce sever complications and it may lead to further deterioration of the patient. Therefore, knowing how to manage pain in trauma patients is an important part of systemic approach in trauma. The aim of this manuscript is to provide information about pain management in trauma in the Emergency Room settings. Methods: In this review we searched among electronic and manual documents covering a 15-yr period between 2000 and 2016. Our electronic search included Pub Med, Google scholar, Web of Science, and Cochrane databases. We looked for articles in English and in peer-reviewed journals using the following keywords: acute pain management, trauma, emergency room and injury. Results: More than 3200 documents were identified. After screening based on the study inclusion criteria, 560 studies that had direct linkage to the study aim were considered for evaluation based World Health Organization (WHO) pain ladder chart. Conclusions: To provide adequate pain management in trauma patients require: adequate assessment of age-specific pharmacologic pain management; identification of adequate analgesic to relieve moderate to severe pain; cognizance of serious adverse effects of pain medications and weighting medications against their benefits, and regularly reassessing patients and reevaluating their pain management regimen. Patient-centered trauma care will also require having knowledge of barriers to pain management and discussing them with the patient and his/her family to identify solutions. PMID:27414816

  10. Tool Version Management Technology: A Case Study.

    DTIC Science & Technology

    1990-11-01

    Technical Report AD-A235 639 CMU/SEI-90-TR-25 Tool Version Management Technology: A Case Study Peter H. Feiler Grace F. Downey November 1990 x 91...00304 90 7 Technical Report CMU/SEI-90-TR-25 ESD-90-TR-226 November 1990 Tool Version Management Technology: A Case Study Peter H. Feiler Grace F. Downey...trademark holder. Table of Contents 1. lntroducton 1 2. The Problem 3 2.1. Tool Version Organization and Selection 3 2.2. Stability of Selected Tool

  11. Rock weathering on the eastern mountains of southern Africa: Review and insights from case studies

    NASA Astrophysics Data System (ADS)

    Sumner, P. D.; Hall, K. J.; van Rooy, J. L.; Meiklejohn, K. I.

    2009-12-01

    The mountains in the eastern region of southern Africa are of significant regional importance, providing for a diverse range of land use including conservation, tourism and subsistence agriculture. The higher regions are comprised of flood basalts and are immediately underlain by predominantly aeolian-origin sandstones. Our understanding of the weathering of these basalts and sandstones is reviewed here, with particular focus on the insights gained from the Lesotho Highlands Water Project and an ongoing study into the deterioration of rock art. While the chemical weathering attributes of the basalts have been substantially investigated, it is evident that the environmental surface conditions of rock moisture and temperature, as affecting weathering processes, remain largely unknown. Within the sandstones, studies pertaining to rock art deterioration present insights into the potential surface weathering processes and highlight the need for detailed field monitoring. Outside of these site-specific studies, however, little is understood of how weathering impacts on landscape development; notably absent, are detail on weathering rates, and potential effects of biological weathering. Some palaeoenvironmental inferences have also been made from weathering products, both within the basalts and the sandstones, but aspects of these remain controversial and further detailed research can still be undertaken.

  12. Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices.

    PubMed

    Utz, Bettina; Delamou, Alexandre; Belaid, Loubna; De Brouwere, Vincent

    2016-01-01

    Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.

  13. Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices

    PubMed Central

    Delamou, Alexandre; Belaid, Loubna; De Brouwere, Vincent

    2016-01-01

    Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation. PMID:27803934

  14. Teaching Goal-Setting for Weight-Gain Prevention in a College Population: Insights from the CHOICES Study.

    PubMed

    Gardner, Jolynn; Kjolhaug, Jerri; Linde, Jennifer A; Sevcik, Sarah; Lytle, Leslie A

    2013-01-01

    This article describes the effectiveness of goal setting instruction in the CHOICES (Choosing Healthy Options in College Environments and Settings) study, an intervention evaluating the effectiveness of weight gain prevention strategies for 2-year college students. Four hundred and forty-one participants from three community colleges were recruited. Participants randomized into the intervention (n=224) enrolled in a course that taught strategies to help maintain or achieve a healthy weight. Participants were instructed in SMART (Specific, Measurable, Attainable, Realistic, Time-based) and behavioral goal-setting practices. Throughout the course, participants set goals related to improving their sleep, stress-management, exercise, and nutrition." Intervention participants set four hundred eighteen goals. Each goal was carefully evaluated. The efforts to teach behavioral goal-setting strategies were largely successful; however efforts to convey the intricacies of SMART goal-setting were not as successful. Implications for effective teaching of skills in setting SMART behavioral goals were realized in this study. The insights gained from the goal-setting activities of this study could be used to guide educators who utilize goals to achieve health behavior change. Based on the results of this study, it is recommended that very clear and directed instruction be provided in addition to multiple opportunities for goal-setting practice. Implications for future interventions involving education about goal-setting activities are discussed.

  15. Bringing explicit insight into cognitive psychology features during clinical reasoning seminars: a prospective, controlled study.

    PubMed

    Nendaz, Mathieu R; Gut, Anne M; Louis-Simonet, Martine; Perrier, Arnaud; Vu, Nu V

    2011-04-01

    Facets of reasoning competence influenced by an explicit insight into cognitive psychology features during clinical reasoning seminars have not been specifically explored. This prospective, controlled study, conducted at the University of Geneva Faculty of Medicine, Switzerland, assessed the impact on sixth-year medical students' patient work-up of case-based reasoning seminars, bringing them explicit insight into cognitive aspects of their reasoning. Volunteer students registered for our three-month Internal Medicine elective were assigned to one of two training conditions: standard (control) or modified (intervention) case-based reasoning seminars. These seminars start with the patient's presenting complaint and the students must ask the tutor for additional clinical information to progress through case resolution. For this intervention, the tutors made each step explicit to students and encouraged self-reflection on their reasoning processes. At the end of their elective, students' performances were assessed through encounters with two standardized patients and chart write-ups. Twenty-nine students participated, providing a total of 58 encounters. The overall differences in accuracy of the final diagnosis given to the patient at the end of the encounter (control 63% vs intervention 74%, p = 0.53) and of the final diagnosis mentioned in the patient chart (61% vs 70%, p = 0.58) were not statistically significant. The students in the intervention group significantly more often listed the correct diagnosis among the differential diagnoses in their charts (75% vs 97%, p = 0.02). This case-based clinical reasoning seminar intervention, designed to bring students insight into cognitive features of their reasoning, improved aspects of diagnostic competence.

  16. Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study.

    PubMed

    Moise, Imelda K; Mulhall, Peter F

    2016-01-01

    Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded

  17. Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study

    PubMed Central

    Moise, Imelda K.; Mulhall, Peter F.

    2016-01-01

    Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded

  18. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research

    PubMed Central

    Cooper, Christine; Burden, Sorrel T; Cheng, Huilin; Molassiotis, Alex

    2015-01-01

    The aim of this study was to summarize the existing qualitative literature in order to develop the evidence base for understanding and managing weight loss and anorexia, in order to make recommendations for clinical practice. A systematic search was performed to retrieve English language studies using electronic search and manual checks of selected reference lists. Keywords included qualitative, cancer cachexia, weight loss, anorexia, appetite, malnutrition, food, eating, and drinking. The selection and appraisal of papers were undertaken by two reviewers. Twenty-one qualitative articles were included in the review. There were three major findings emerging from the previous qualitative studies including ‘the multidimensionality of weight loss and anorexia experience’, ‘patients and caregivers' responses to coping with weight loss and anorexia’, and ‘clinical assessment and management of weight loss and anorexia’. The literature review revealed the multidimensional nature of cachexia and weight loss experience by patients and caregivers, which was not recognized and adequately managed by healthcare professionals. Future research in this area would be helpful in enabling a deeper understanding of the complexity of cachexia and weight loss experience in order to move forward to develop an optimal model of supportive care for patients and caregivers. PMID:26136417

  19. Gene regulation in amphioxus: An insight from transgenic studies in amphioxus and vertebrates.

    PubMed

    Kozmikova, Iryna; Kozmik, Zbynek

    2015-12-01

    Cephalochordates, commonly known as amphioxus or lancelets, are the most basal subphylum of chordates. Cephalochordates are thus key to understanding the origin of vertebrates and molecular mechanisms underlying vertebrate evolution. The evolution of developmental control mechanisms during invertebrate-to-vertebrate transition involved not only gene duplication events, but also specific changes in spatial and temporal expression of many genes. To get insight into the spatiotemporal regulation of gene expression during invertebrate-to-vertebrate transition, functional studies of amphioxus gene regulatory elements are highly warranted. Here, we review transgenic studies performed in amphioxus and vertebrates using promoters and enhancers derived from the genome of Branchiostoma floridae. We describe the current methods of transgenesis in amphioxus, provide evidence of Tol2 transposon-generated transgenic embryos of Branchiostoma lanceolatum and discuss possible future directions. We envision that comparative transgenic analysis of gene regulatory sequences in the context of amphioxus and vertebrate embryos will likely provide an important mechanistic insight into the evolution of vertebrate body plan. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Parasitic worms and allergies in childhood: insights from population studies 2008-2013.

    PubMed

    Amoah, Abena S; Boakye, Daniel A; van Ree, Ronald; Yazdanbakhsh, Maria

    2014-05-01

    The last few decades have seen a marked increase in the global prevalence of allergic diseases particularly among children. Among the factors attributed to this rise has been reduced exposure to pathogens during childhood leading to insufficient maturation of the regulatory arm of developing immune systems. Over the years, a number of epidemiological studies have observed an inverse relationship between parasitic worm (helminth) infections and allergies. The purpose of this review is to highlight insights from population studies conducted among children published between 2008 and 2013 that explore the complex dynamics between helminth infections and allergies. These insights include the effect of anthelmintic treatment on allergic responses, an elucidation of immune mechanisms and an examination of helminth-induced immunoglobulin E cross-reactivity. A better understanding of the relationship between helminths and allergies is imperative as research directions move toward harnessing the therapeutic potential of helminths and their products in the treatment of allergic disorders. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Insights into Hydrocarbon-rich Environments from Studies of Protein Dynamics, Thermodynamics, and Spectroscopy

    NASA Astrophysics Data System (ADS)

    Magyar, J. S.; Asous, N. K.; Barth, S. J.; Benzik, E.; Chou, J.; Dalchand, N.; Gallagher, G. E.; Montero, K. S.; Lone, S. K.; Salerno, G. J.

    2015-12-01

    Extraordinary amounts of information are now available from genomic and metagenomic analyses of a wide variety of environments of geological and biological interest. Using such genomic information as a starting point, we are interested in looking at microbial systems at the molecular level, using the tools and approaches of inorganic chemistry, physical chemistry, and molecular biology. From these studies, spanning the molecular to the global, we gain insights into relationships between microbial life and the geochemical environment in which it lives. In our work to date, we have focused on hydrocarbon-rich environments, including the La Brea Tar Pits and the Gulf of Mexico. Starting from genomic information, we have identified proteins of interest, cloned synthetic genes into E. coli, overexpressed and purified the proteins, and characterized them by UV-visible absorption, circular dichroism, and NMR spectroscopies; X-ray crystallography; and electrochemistry. Using as examples our recent studies of a metal-uptake protein from a methanogenic archaeon native to the La Brea Tar Pits, and of electron-transfer and hydrocarbon-degrading proteins from cold marine ecosystems, we describe how new combinations of genomics, molecular biology, and bioinorganic chemistry can provide novel insights into geobiological processes.

  2. Long-term data from silvicultural studies: interpreting and assessing old records for economic insights

    Treesearch

    Paul E. Sendak; Robert M. Frank; William B. Leak

    2006-01-01

    Long-term silvicultural studies on the Penobscot Experimental Forest in Maine and Bartlett Experimental Forest in New Hampshire offer opportunities for the patient financial analyst. The economist working with carefully collected growth and yield data can increase the value of these studies to other researchers and ultimately to forest managers. Issues related to data...

  3. Management System for EMR Work Study Program.

    ERIC Educational Resources Information Center

    Columbia County Board of Public Instruction, Lake City, FL. Exceptional Child Education Dept.

    A computerized information management system involving the specification of objectives, the coding of teacher evaluations of students, and a variety of possible outputs has been used in a work study program for educable mentally retarded adolescents. Instructional objectives are specified and coded by number and category. Evaluation is by means of…

  4. Japanese-Style Management: A Bibliometric Study.

    ERIC Educational Resources Information Center

    Noguchi, Sachie

    1988-01-01

    Reports results of a bibliometric study of the literature on Japanese-style management published in western languages from 1971-84 in order to: (1) determine Japanese contributions to the literature; (2) determine whether there are nuclear journals for the subject; and (3) investigate how the flow of information from Japan to overseas countries…

  5. Structure, dynamics, and function of the monooxygenase P450 BM-3: insights from computer simulations studies

    NASA Astrophysics Data System (ADS)

    Roccatano, Danilo

    2015-07-01

    The monooxygenase P450 BM-3 is a NADPH-dependent fatty acid hydroxylase enzyme isolated from soil bacterium Bacillus megaterium. As a pivotal member of cytochrome P450 superfamily, it has been intensely studied for the comprehension of structure-dynamics-function relationships in this class of enzymes. In addition, due to its peculiar properties, it is also a promising enzyme for biochemical and biomedical applications. However, despite the efforts, the full understanding of the enzyme structure and dynamics is not yet achieved. Computational studies, particularly molecular dynamics (MD) simulations, have importantly contributed to this endeavor by providing new insights at an atomic level regarding the correlations between structure, dynamics, and function of the protein. This topical review summarizes computational studies based on MD simulations of the cytochrome P450 BM-3 and gives an outlook on future directions.

  6. Spacelab data management subsystem phase B study

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The Spacelab data management system is described. The data management subsystem (DMS) integrates the avionics equipment into an operational system by providing the computations, logic, signal flow, and interfaces needed to effectively command, control, monitor, and check out the experiment and subsystem hardware. Also, the DMS collects/retrieves experiment data and other information by recording and by command of the data relay link to ground. The major elements of the DMS are the computer subsystem, data acquisition and distribution subsystem, controls and display subsystem, onboard checkout subsystem, and software. The results of the DMS portion of the Spacelab Phase B Concept Definition Study are analyzed.

  7. Managing Complex Change in Clinical Study Metadata

    PubMed Central

    Brandt, Cynthia A.; Gadagkar, Rohit; Rodriguez, Cesar; Nadkarni, Prakash M.

    2004-01-01

    In highly functional metadata-driven software, the interrelationships within the metadata become complex, and maintenance becomes challenging. We describe an approach to metadata management that uses a knowledge-base subschema to store centralized information about metadata dependencies and use cases involving specific types of metadata modification. Our system borrows ideas from production-rule systems in that some of this information is a high-level specification that is interpreted and executed dynamically by a middleware engine. Our approach is implemented in TrialDB, a generic clinical study data management system. We review approaches that have been used for metadata management in other contexts and describe the features, capabilities, and limitations of our system. PMID:15187070

  8. Transmembrane signaling of chemotaxis receptor tar: insights from molecular dynamics simulation studies.

    PubMed

    Park, Hahnbeom; Im, Wonpil; Seok, Chaok

    2011-06-22

    Transmembrane signaling of chemotaxis receptors has long been studied, but how the conformational change induced by ligand binding is transmitted across the bilayer membrane is still elusive at the molecular level. To tackle this problem, we carried out a total of 600-ns comparative molecular dynamics simulations (including model-building simulations) of the chemotaxis aspartate receptor Tar (a part of the periplasmic domain/transmembrane domain/HAMP domain) in explicit lipid bilayers. These simulations reveal valuable insights into the mechanistic picture of Tar transmembrane signaling. The piston-like movement of a transmembrane helix induced by ligand binding on the periplasmic side is transformed into a combination of both longitudinal and transversal movements of the helix on the cytoplasmic side as a result of different protein-lipid interactions in the ligand-off and ligand-on states of the receptor. This conformational change alters the dynamics and conformation of the HAMP domain, which is presumably a mechanism to deliver the signal from the transmembrane domain to the cytoplasmic domain. The current results are consistent with the previously suggested dynamic bundle model in which the HAMP dynamics change is a key to the signaling. The simulations provide further insights into the conformational changes relevant to the HAMP dynamics changes in atomic detail. Copyright © 2011 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  9. How do CARs work?: Early insights from recent clinical studies targeting CD19.

    PubMed

    Davila, Marco L; Brentjens, Renier; Wang, Xiuyan; Rivière, Isabelle; Sadelain, Michel

    2012-12-01

    Second-generation chimeric antigen receptors (CARs) are powerful tools to redirect antigen-specific T cells independently of HLA-restriction. Recent clinical studies evaluating CD19-targeted T cells in patients with B-cell malignancies demonstrate the potency of CAR-engineered T cells. With results from 28 subjects enrolled by five centers conducting studies in patients with chronic lymphocytic leukemia (CLL) or lymphoma, some insights into the parameters that determine T-cell function and clinical outcome of CAR-based approaches are emerging. These parameters involve CAR design, T-cell production methods, conditioning chemotherapy as well as patient selection. Here, we discuss the potential relevance of these findings and in particular the interplay between the adoptive transfer of T cells and pre-transfer patient conditioning.

  10. Category III Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Insights from The National Institutes of Health Chronic Prostatitis Collaborative Research Network Studies

    PubMed Central

    Nickel, J. Curtis; Alexander, Richard B.; Anderson, Rodney; Berger, Richard; Comiter, Craig V.; Datta, Nand S.; Fowler, Jackson E.; Krieger, John N.; Landis, J. Richard; Litwin, Mark S.; McNaughton-Collins, Mary; O'Leary, Michael P.; Pontari, Michel A.; Schaeffer, Anthony J.; Shoskes, Daniel A.; White, Paige; Kusek, John; Nyberg, Leroy

    2010-01-01

    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains an enigmatic medical condition. Creation of the (NIH) Chronic Prostatitis Collaborative Research Network (CPCRN) funded by the National Institutes of Health has stimulated a renewed interest in the research and clinical aspects of CP/CPPS. Landmark publications of the NIH-CPCRN over the last 10 years document a decade of progress. Insights from these CPCRN studies have improved our management of patients diagnosed with CP/CPPS and offer hope for continued progress. PMID:18765132

  11. The biology and evolution of polyspermy: insights from cellular and functional studies of sperm and centrosomal behavior in the fertilized egg.

    PubMed

    Snook, Rhonda R; Hosken, David J; Karr, Timothy L

    2011-12-01

    Recent studies of centrosome biogenesis, microtubule dynamics, and their management point to their role in mediating conditions such as aging and cancer. Centrosome dysfunction is also a hallmark of pathological polyspermy. Polyspermy occurs when the oocyte is penetrated by more than one sperm and can be pathological because an excess of centrosomes compromises development. However, in some taxa, multiple sperm enter the egg with no apparent adverse effect on zygote viability. Thus, some taxa can manage excess centrosomes and represent cases of non-pathological polyspermy. While these two forms of polyspermy have long been known, we argue that there is limited understanding of the proximate and ultimate processes that underlie this taxonomic variation in the outcome of polyspermy and that studying this variation could help uncover the control and role(s) of centrosomes during fertilization in particular, but also mitosis in general. To encourage such studies we: 1) describe taxonomic differences in the outcome of polyspermy, 2) discuss mechanistic aspects of reproductive biology that may contribute to the different consequences of polyspermy, and 3) outline the potential selective events that could lead to the evolution of variation in polyspermy outcomes. We suggest that novel insights into centrosome biology may occur by cooperative studies between reproductive and evolutionary biologists focusing on the mechanisms generating variation in the fitness consequences of polyspermy, and in the taxonomic distribution of all these events. The consequent discoveries of these studies may lead to informative insights into cancer and aging along with other centrosome-related diseases and syndromes.

  12. Market Orientation within University Schools of Business: Can a Dynamical Systems Viewpoint Applied to a Non-Temporal Data Set Yield Valuable Insights for University Managers?

    ERIC Educational Resources Information Center

    Cox, John C.; Webster, Robert L.; Hammond, Kevin L.

    2009-01-01

    This study investigates the use of using complexity theory--the study of nonlinear dynamical systems of which chaos and catastrophe theory are subsets--in the analysis of a non temporal data set to derive valuable insights into the functioning of university schools of business. The approach is unusual in that studies of nonlinearity in complex…

  13. Antiprotozoal Nitazoxanide Derivatives: Synthesis, Bioassays and QSAR Study Combined with Docking for Mechanistic Insight

    PubMed Central

    Scior, Thomas; Lozano-Aponte, Jorge; Ajmani, Subhash; Hernández-Montero, Eduardo; Chávez-Silva, Fabiola; Hernández-Núñez, Emanuel; Moo-Puc, Rosa; Fraguela-Collar, Andres; Navarrete-Vázquez, Gabriel

    2015-01-01

    In view of the serious health problems concerning infectious diseases in heavily populated areas, we followed the strategy of lead compound diversification to evaluate the near-by chemical space for new organic compounds. To this end, twenty derivatives of nitazoxanide (NTZ) were synthesized and tested for activity against Entamoeba histolytica parasites. To ensure drug-likeliness and activity relatedness of the new compounds, the synthetic work was assisted by a quantitative structure-activity relationships study (QSAR). Many of the inherent downsides – well-known to QSAR practitioners – we circumvented thanks to workarounds which we proposed in prior QSAR publication. To gain further mechanistic insight on a molecular level, ligand-enzyme docking simulations were carried out since NTZ is known to inhibit the protozoal pyruvate ferredoxin oxidoreductase (PFOR) enzyme as its biomolecular target. PMID:25872791

  14. Understanding dissociation and insight in the treatment of shortness of breath with hypnosis: a case study.

    PubMed

    Anbar, Ran D; Linden, Julie H

    2010-04-01

    Training in hypnosis is particularly valuable for the physician seeking to better appreciate the interplay between mind and body. Through such experiences the physician can learn that presentation of symptoms often is affected by patients' psychological states, and that symptoms sometimes serve as solutions for patients' psychological dilemmas. The presented case study demonstrates how an 11-year-old's complaint of shortness of breath becomes an opportunity for an appropriately trained physician to provide treatment by helping the patient to engage his inner resources. The case illustrates the strength of hypnosis for accessing resources outside of conscious awareness and use of dissociative language to both support and alter the patient's defenses. We discuss the role of hypnosis when working psychodynamically with a patient, and whether and when insight is important or necessary for change of behavior.

  15. The Honeywell Studies: How Managers Learn to Manage.

    ERIC Educational Resources Information Center

    Zemke, Ron

    1985-01-01

    Describes how a group of Honeywell Corporation human resources specialists determined how the organization's management development process could be improved to support the needs of the business. Discusses corporate management development strategy, curriculum, conference center, on-the-job experiences, and how experience, relationships, and…

  16. Insights into Facebook Pages: an early adolescent health research study page targeted at parents.

    PubMed

    Amon, Krestina L; Paxton, Karen; Klineberg, Emily; Riley, Lisa; Hawke, Catherine; Steinbeck, Katharine

    2016-02-01

    Facebook has been used in health research, but there is a lack of literature regarding how Facebook may be used to recruit younger adolescents. A Facebook Page was created for an adolescent cohort study on the effects of puberty hormones on well-being and behaviour in early adolescence. Used as a communication tool with existing participants, it also aimed to alert potential participants to the study. The purpose of this paper is to provide a detailed description of the development of the study Facebook Page and present the fan response to the types of posts made on the Page using the Facebook-generated Insights data. Two types of posts were made on the study Facebook Page. The first type was study-related update posts and events. The second was relevant adolescent and family research and current news posts. Observations on the use of and response to the Page were made over 1 year across three phases (phase 1, very low Facebook use; phase 2, high Facebook use; phase 3, low Facebook use). Most Page fans were female (88.6%), with the largest group of fans aged between 35 and 44 years. Study-related update posts with photographs were the most popular. This paper provides a model on which other researchers could base Facebook communication and potential recruitment in the absence of established guidelines.

  17. Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients.

    PubMed

    Pousa, Esther; Duñó, Rosó; Blas Navarro, J; Ruiz, Ada I; Obiols, Jordi E; David, Anthony S

    2008-05-01

    Poor insight and impairment in Theory of Mind (ToM) reasoning are common in schizophrenia, predicting poorer clinical and functional outcomes. The present study aimed to explore the relationship between these phenomena. 61 individuals with a DSM-IV diagnosis of schizophrenia during a stable phase were included. ToM was assessed using a picture sequencing task developed by Langdon and Coltheart (1999), and insight with the Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al., 1993). Multivariate linear regression analysis was carried out to estimate the predictive value of insight on ToM, taking into account several possible confounders and interaction variables. No direct significant associations were found between any of the insight dimensions and ToM using bivariate analysis. However, a significant linear regression model which explained 48% of the variance in ToM was revealed in the multivariate analysis. This included the 5 insight dimensions and 3 interaction variables. Misattribution of symptoms--in aware patients with age at onset >20 years--and unawareness of need for medication--in patients with GAF >60--were significantly predictive of better ToM. Insight and ToM are two complex and distinct phenomena in schizophrenia. Relationships between them are mediated by psychosocial, clinical, and neurocognitive variables. Intact ToM may be a prerequisite for aware patients to attribute their symptoms to causes other than mental illness, which could in turn be associated with denial of need for medication.

  18. Insights into Alzheimer disease pathogenesis from studies in transgenic animal models.

    PubMed

    Schaeffer, Evelin L; Figueiro, Micheli; Gattaz, Wagner F

    2011-01-01

    Alzheimer disease is the most common cause of dementia among the elderly, accounting for ~60-70% of all cases of dementia. The neuropathological hallmarks of Alzheimer disease are senile plaques (mainly containing p-amyloid peptide derived from amyloid precursor protein) and neurofibrillary tangles (containing hyperphosphorylated Tau protein), along with neuronal loss. At present there is no effective treatment for Alzheimer disease. Given the prevalence and poor prognosis of the disease, the development of animal models has been a research priority to understand pathogenic mechanisms and to test therapeutic strategies. Most cases of Alzheimer disease occur sporadically in people over 65 years old, and are not genetically inherited. Roughly 5% of patients with Alzheimer disease have familial Alzheimer disease--that is, related to a genetic predisposition, including mutations in the amyloid precursor protein, presenilin 1, and presenilin 2 genes. The discovery of genes for familial Alzheimer disease has allowed transgenic models to be generated through the overexpression of the amyloid precursor protein and/or presenilins harboring one or several mutations found in familial Alzheimer disease. Although none of these models fully replicates the human disease, they have provided valuable insights into disease mechanisms as well as opportunities to test therapeutic approaches. This review describes the main transgenic mouse models of Alzheimer disease which have been adopted in Alzheimer disease research, and discusses the insights into Alzheimer disease pathogenesis from studies in such models. In summary, the Alzheimer disease mouse models have been the key to understanding the roles of soluble b-amyloid oligomers in disease pathogenesis, as well as of the relationship between p-amyloid and Tau pathologies.

  19. Automation impact study of Army Training Management

    SciTech Connect

    Sanquist, T.F.; Schuller, C.R.; McCallum, M.C.; Underwood, J.A.; Bettin, P.J.; King, J.L.; Melber, B.D.; Hostick, C.J.; Seaver, D.A.

    1988-01-01

    The main objectives of this impact study were to identify the potential cost savings associated with automated Army Training Management (TM), and to perform a cost-benefit analysis for an Army-wide automated TM system. A subsidiary goal was to establish baseline data for an independent evaluation of a prototype Integrated Training Management System (ITMS), to be tested in the fall of 1988. A structured analysis of TM doctrine was performed for comparison with empirical data gathered in a job analysis survey of selected units of the 9ID (MTZ) at Ft. Lewis, Washington. These observations will be extended to other units in subsequent surveys. The survey data concerning staffing levels and amount of labor expended on eight distinct TM tasks were analyzed in a cost effectiveness model. The main results of the surveys and cost effectiveness modelling are summarized. 18 figs., 47 tabs.

  20. Insights from internet-based remote intrathoracic impedance monitoring as part of a heart failure disease management program.

    PubMed

    Mullens, Wilfried; Oliveira, Leonardo P J; Verga, Tanya; Wilkoff, Bruce L; Tang, Wai Hong Wilson

    2010-01-01

    Changes in intrathoracic impedance (Z) leading to crossing of a derived fluid index (FI) threshold has been associated with heart failure (HF) hospitalization. The authors developed a remote monitoring program as part of HF disease management and prospectively examined the feasibility and resource utilization of monitoring individuals with an implanted device capable of measuring Z. An HF nurse analyzed all transmitted data daily, as they were routinely uploaded as part of quarterly remote device monitoring, and called the patient if the FI crossed the threshold (arbitrarily defined at 60 Omega) to identify clinically relevant events (CREs) that occurred during this period (eg, worsening dyspnea or increase in edema or weight). A total of 400 uploads were completed during the 4-month study period. During this period, 34 patients (18%) had an FI threshold crossing, averaging 0.52 FI threshold crossings per patient-year. Thirty-two of 34 patients contacted by telephone (94%) with FI threshold crossing had evidence of CREs during this period. However, only 6 (18%) had HF hospitalizations, 19 (56%) had reported changes in HF therapy, and 13 (38%) reported drug and/or dietary plan nonadherence. The average data analysis time required was 30 min daily when focusing on those with FI threshold crossing, averaging 8 uploads for review per working day and 5 telephone follow-ups per week. Our pilot observations suggested that Internet-based remote monitoring of Z trends from existing device interrogation uploads is feasible as part of a daily routine of HF disease management.

  1. Valuing stormwater, rainwater and wastewater in the soft path for water management: Australian case studies.

    PubMed

    Chanan, A; Vigneswaran, S; Kandasamy, J

    2010-01-01

    A Water Sensitive City is now commonly acknowledged best practice for designing the cities of the future. In Australia, the National Water Initiative has allocated high priority towards offering insight into successful water sensitive urban development projects, to facilitate capacity building within the industry. This paper shares innovative water sensitive projects implemented at Kogarah City Council, in Sydney. Four key projects are discussed, demonstrating how stormwater, rainwater and wastewater can be incorporated into decentralised water systems to offer sustainable water management of the future. The case studies included in the paper highlight Kogarah's journey towards the Soft Path for Water Management.

  2. Six decades of vitiligo genetics: genome-wide studies provide insights into autoimmune pathogenesis.

    PubMed

    Spritz, Richard A

    2012-02-01

    Generalized vitiligo (GV) is a complex disease in which patchy depigmentation results from autoimmune loss of melanocytes from affected regions. Genetic analyses of GV span six decades, with the goal of understanding biological mechanisms and elucidating pathways that underlie the disease. The earliest studies attempted to describe the mode of inheritance and genetic epidemiology. Early genetic association studies of biological candidate genes resulted in some successes, principally HLA and PTPN22, but in hindsight many such reports now seem to be false-positives. Later, genome-wide linkage studies of multiplex GV families identified NLRP1 and XBP1, which appear to be valid GV susceptibility genes that control key aspects of immune regulation. Recently, the application of genome-wide association studies to analysis of GV has produced a rich yield of validated GV susceptibility genes that encode components of biological pathways reaching from immune cells to the melanocyte. These genes and pathways provide insights into underlying pathogenetic mechanisms and possible triggers of GV, establish relationships to other autoimmune diseases, and may provide clues to potential new approaches to GV treatment and perhaps even prevention. These results thus validate the hopes and efforts of the early investigators who first attempted to comprehend the genetic basis of vitiligo.

  3. Chromobacterium violaceum: important insights for virulence and biotechnological potential by exoproteomic studies.

    PubMed

    Ciprandi, Alessandra; da Silva, Wanderson Marques; Santos, Agenor Valadares; de Castro Pimenta, Adriano Monteiro; Carepo, Marta Sofia Peixe; Schneider, Maria Paula Cruz; Azevedo, Vasco; Silva, Artur

    2013-07-01

    Chromobacterium violaceum is a beta-proteobacterium with high biotechnological potential, found in tropical environments. This bacterium causes opportunistic infections in both humans and animals, that can spread throughout several tissues, quickly leading to the death of the host. Genomic studies identified potential mechanisms of pathogenicity but no further studies were done to confirm the expression of these systems. In this study 36 unique protein entries were identified in databank from a two-dimensional profile of C. violaceum secreted proteins. Chromobacterium violaceum exoproteomic preliminary studies confirmed the production of proteins identified as virulence factors (such as a collagenase, flagellum proteins, metallopeptidases, and toxins), allowing us to better understand its pathogenicity mechanisms. Biotechnologically interesting proteins (such as chitinase and chitosanase) were also identified among the secreted proteins, as well as proteins involved in the transport and capture of amino acids, carbohydrates, and oxidative stress protection. Overall, the secreted proteins identified provide us important insights on pathogenicity mechanisms, biotechnological potential, and environment adaptation of C. violaceum.

  4. Genetic Assignment Methods for Gaining Insight into the Management of Infectious Disease by Understanding Pathogen, Vector, and Host Movement

    PubMed Central

    Remais, Justin V.; Xiao, Ning; Akullian, Adam; Qiu, Dongchuan; Blair, David

    2011-01-01

    For many pathogens with environmental stages, or those carried by vectors or intermediate hosts, disease transmission is strongly influenced by pathogen, host, and vector movements across complex landscapes, and thus quantitative measures of movement rate and direction can reveal new opportunities for disease management and intervention. Genetic assignment methods are a set of powerful statistical approaches useful for establishing population membership of individuals. Recent theoretical improvements allow these techniques to be used to cost-effectively estimate the magnitude and direction of key movements in infectious disease systems, revealing important ecological and environmental features that facilitate or limit transmission. Here, we review the theory, statistical framework, and molecular markers that underlie assignment methods, and we critically examine recent applications of assignment tests in infectious disease epidemiology. Research directions that capitalize on use of the techniques are discussed, focusing on key parameters needing study for improved understanding of patterns of disease. PMID:21552326

  5. Exosomes in the Diseased Brain: First Insights from In vivo Studies

    PubMed Central

    Levy, Efrat

    2017-01-01

    Extracellular vesicles (EVs) are nanoscale size vesicles secreted by cells and are important mediators of intercellular communication and genetic exchange. Exosomes, EVs generated in endosomal multivesicular bodies, have been the focus of numerous publications as they have emerged as clinically valuable markers of disease states. Exosomes have been mostly studied from conditioned culture media and body fluids, with the difficulty of isolating exosomes from tissues having delayed their study in vivo. The implementation of a method designed to isolate exosomes from tissues, however, has yielded the first insights into characteristics of exosomes in the brain. It has been observed that brain exosomes from murine models of neurodegenerative diseases and human postmortem brains tend to mirror the protein content of the cells of origin, and interestingly, they are enriched with toxic proteins. Whether this enrichment with neurotoxic proteins is beneficial by relieving neurons of accumulated toxic material or detrimental to the brain by propagating pathogenicity throughout the brain remains to be answered. Here is summarized the first group of studies describing exosomes isolated from brain, results that demonstrate that exosomes in vivo reflect complex multicellular pathogenic processes in neurodegenerative disorders and the brain's response to injury and damage. PMID:28386213

  6. Consequences of early adverse rearing experience (EARE) on development: insights from non-human primate studies

    PubMed Central

    Zhang, Bo

    2017-01-01

    Early rearing experiences are important in one's whole life, whereas early adverse rearing experience (EARE) is usually related to various physical and mental disorders in later life. Although there were many studies on human and animals, regarding the effect of EARE on brain development, neuroendocrine systems, as well as the consequential mental disorders and behavioral abnormalities, the underlying mechanisms remain unclear. Due to the close genetic relationship and similarity in social organizations with humans, non-human primate (NHP) studies were performed for over 60 years. Various EARE models were developed to disrupt the early normal interactions between infants and mothers or peers. Those studies provided important insights of EARE induced effects on the physiological and behavioral systems of NHPs across life span, such as social behaviors (including disturbance behavior, social deficiency, sexual behavior, etc), learning and memory ability, brain structural and functional developments (including influences on neurons and glia cells, neuroendocrine systems, e.g., hypothalamic-pituitary-adrenal (HPA) axis, etc). In this review, the effects of EARE and the underlying epigenetic mechanisms were comprehensively summarized and the possibility of rehabilitation was discussed. PMID:28271667

  7. Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies.

    PubMed

    Kaye, Walter H; Frank, Guido K; Bailer, Ursula F; Henry, Shannan E; Meltzer, Carolyn C; Price, Julie C; Mathis, Chester A; Wagner, Angela

    2005-05-19

    Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders with relatively homogenous presentations such as age of onset and gender distribution. In addition, they share symptoms, such as extremes of food consumption, body image distortion, anxiety and obsessions, and ego-syntonic neglect, raises the possibility that these symptoms reflect disturbed brain function that contributes to the pathophysiology of this illness. Recent brain imaging studies have identified altered activity in frontal, cingulate, temporal, and parietal cortical regions in AN and BN. Importantly, such disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Emerging data point to a dysregulation of serotonin pathways in cortical and limbic structures that may be related to anxiety, behavioral inhibition, and body image distortions. In specific, recent studies using PET with serotonin specific radioligands implicate alterations of 5-HT1A and 5-HT2A receptors and the 5-HT transporter. Alterations of these circuits may affect mood and impulse control as well as the motivating and hedonic aspects of feeding behavior. Such imaging studies may offer insights into new pharmacology and psychotherapy approaches.

  8. Developmental origins of the adipocyte lineage: new insights from genetics and genomics studies.

    PubMed

    Billon, Nathalie; Dani, Christian

    2012-03-01

    The current epidemic of obesity and overweight has caused a surge of interest in the study of adipose tissue formation. Much progress has been made in defining the transcriptional networks controlling the terminal differentiation of adipocyte progenitors into mature adipocytes. However, the early steps of adipocyte development and the embryonic origin of this lineage have been largely disregarded until recently. In mammals, two functionally different types of adipose tissues coexist, which are both involved in energy balance but assume opposite functions. White adipose tissue (WAT) stores energy, while brown adipose tissue (BAT) is specialized in energy expenditure. WAT and BAT can be found as several depots located in various sites of the body. Individual fat depots exhibit different timing of appearance during development, as well as distinct functional properties, suggesting possible differences in their developmental origin. This hypothesis has recently been revisited through large-scale genomics studies and in vivo lineage tracing approaches, which are reviewed in this report. These studies have provided novel fundamental insights into adipocyte biology, pointing out distinct developmental origins for WAT and BAT, as well as for individual WAT depots. They suggest that the adipose tissue is composed of distinct mini-organs, exhibiting developmental and functional differences, as well as variable contribution to obesity-related metabolic diseases.

  9. Insights into Tropospheric Ozone from the INTEX Ozonesonde Network Study (IONS)

    NASA Technical Reports Server (NTRS)

    Thompson, Anne M.; Witte, J. C.; Kucsera, T. L.; Merrill, J. T.; Morris, G.; Newchurch, M. J.; Oltmans, S. J.; Schmidlin, F. J.; Tarasick, D. J.

    2004-01-01

    Ozone profile data from soundings integrate models, aircraft and other ground-based measurements for better interpretation of atmospheric chemistry and dynamics. A well-designed network of ozonesonde stations, with consistent sampling, can answer questions not possible with short campaigns or current satellite technology. The SHADOZ (Southern Hemisphere Additional Ozonesondes) project, for example, has led to these findings about tropical ozone: definition of the zonal tropospheric wave-one pattern in equatorial ozone, characterization of the "Atlantic ozone paradox" and establishment of a link between tropical Atlantic and Indian Ocean pollution. Building on the SHADOZ concept, a short-term ozone network was formed in July-August 2004 to coordinate ozonesonde launches during the ICARTT/INTEX/NEAQS (International Consortium on Atmospheric Research on Transport and Transformation)/Intercontinental Transport Experiment/New England Air Quality Study. In IONS (INTEX Ozonesonde Network Study), more than 250 soundings, with daily frequency at half the sites, were launched from eleven North American stations and an oceanographic ship in the Gulf of Maine. Although the goal was to examine pollution influences under stable high-pressure systems and transport associated with "warm conveyor belt" flows, the INTEX study region was dominated by a series of weak frontal system that mixed aged pollution with stratospheric ozone in the middle troposphere. Deconvoluting ozone sources provides new insights into ozone in the transition between mid-latitude and polar air.

  10. Insights into Tropospheric Ozone from the INTEX Ozonesonde Network Study (IONS)

    NASA Technical Reports Server (NTRS)

    Thompson, Anne M.; Witte, J. C.; Kucsera, T. L.; Merrill, J. T.; Morris, G.; Newchurch, M. J.; Oltmans, S. J.; Schmidlin, F. J.; Tarasick, D. J.

    2004-01-01

    Ozone profile data from soundings integrate models, aircraft and other ground-based measurements for better interpretation of atmospheric chemistry and dynamics. A well-designed network of ozonesonde stations, with consistent sampling, can answer questions not possible with short campaigns or current satellite technology. The SHADOZ (Southern Hemisphere Additional Ozonesondes) project, for example, has led to these findings about tropical ozone: definition of the zonal tropospheric wave-one pattern in equatorial ozone, characterization of the "Atlantic ozone paradox" and establishment of a link between tropical Atlantic and Indian Ocean pollution. Building on the SHADOZ concept, a short-term ozone network was formed in July-August 2004 to coordinate ozonesonde launches during the ICARTT/INTEX/NEAQS (International Consortium on Atmospheric Research on Transport and Transformation)/Intercontinental Transport Experiment/New England Air Quality Study. In IONS (INTEX Ozonesonde Network Study), more than 250 soundings, with daily frequency at half the sites, were launched from eleven North American stations and an oceanographic ship in the Gulf of Maine. Although the goal was to examine pollution influences under stable high-pressure systems and transport associated with "warm conveyor belt" flows, the INTEX study region was dominated by a series of weak frontal system that mixed aged pollution with stratospheric ozone in the middle troposphere. Deconvoluting ozone sources provides new insights into ozone in the transition between mid-latitude and polar air.

  11. Identifying Patients with Undiagnosed COPD in Primary Care Settings: Insight from Screening Tools and Epidemiologic Studies

    PubMed Central

    Han, MeiLan K.; Steenrod, Anna W.; Bacci, Elizabeth D.; Leidy, Nancy K.; Mannino, David M.; Thomashow, Byron M.; Barr, R.G.; Make, Barry J.; Bowler, Russ P.; Rennard, Stephen I.; Houfek, Julia F.; Yawn, Barbara P.; Meldrum, Catherine A.; Walsh, John W.; Martinez, Fernando J.

    2015-01-01

    Objective: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, yet research suggests this disease is greatly underdiagnosed. This literature review sought to summarize the most common and significant variables associated with case-finding or missed cases of COPD to inform more effective and efficient detection of high-risk COPD patients in primary care. Methods: PubMed and EMBASE were searched for articles describing case-finding and epidemiologic research to detect or characterize new cases of COPD. International studies in primary and non-primary care settings, published in English from 2002–2014, were eligible for inclusion. Studies related to risk factors for development of COPD were excluded. Results: Of the 33 studies identified and reviewed, 21 were case-finding or screening and 12 were epidemiological, including cross-sectional, longitudinal, and retrospective designs. A range of variables were identified within and across studies. Variables common to both screening and epidemiological studies included age, smoking status, and respiratory symptoms. Seven significant predictors from epidemiologic studies did not appear in screening tools. No studies targeted discovery of higher risk patients such as those with reduced lung function or risks for exacerbations. Conclusion: Variables used to identify new cases of COPD or differentiate COPD cases and non-cases are wide-ranging, (from sociodemographic to self-reported health or health history variables), providing insight into important factors for case identification. Further research is underway to develop and test the best, smallest variable set that can be used as a screening tool to identify people with undiagnosed, high-risk COPD in primary care. PMID:26236776

  12. Second Language Acquisition: Possible Insights from Studies on How Birds Acquire Song.

    ERIC Educational Resources Information Center

    Neapolitan, Denise M.; And Others

    1988-01-01

    Reviews research that demonstrates parallels between general linguistic and cognitive processes in human language acquisition and avian acquisition of song and discusses how such research may provide new insights into the processes of second-language acquisition. (Author/CB)

  13. Forest fire management to avoid unintended consequences: a case study of Portugal using system dynamics.

    PubMed

    Collins, Ross D; de Neufville, Richard; Claro, João; Oliveira, Tiago; Pacheco, Abílio P

    2013-11-30

    Forest fires are a serious management challenge in many regions, complicating the appropriate allocation to suppression and prevention efforts. Using a System Dynamics (SD) model, this paper explores how interactions between physical and political systems in forest fire management impact the effectiveness of different allocations. A core issue is that apparently sound management can have unintended consequences. An instinctive management response to periods of worsening fire severity is to increase fire suppression capacity, an approach with immediate appeal as it directly treats the symptom of devastating fires and appeases the public. However, the SD analysis indicates that a policy emphasizing suppression can degrade the long-run effectiveness of forest fire management. By crowding out efforts to preventative fuel removal, it exacerbates fuel loads and leads to greater fires, which further balloon suppression budgets. The business management literature refers to this problem as the firefighting trap, wherein focus on fixing problems diverts attention from preventing them, and thus leads to inferior outcomes. The paper illustrates these phenomena through a case study of Portugal, showing that a balanced approach to suppression and prevention efforts can mitigate the self-reinforcing consequences of this trap, and better manage long-term fire damages. These insights can help policymakers and fire managers better appreciate the interconnected systems in which their authorities reside and the dynamics that may undermine seemingly rational management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Transgenic mouse models in the study of reproduction: insights into GATA protein function.

    PubMed

    Tevosian, Sergei G

    2014-07-01

    For the past 2 decades, transgenic technology in mice has allowed for an unprecedented insight into the transcriptional control of reproductive development and function. The key factor among the mouse genetic tools that made this rapid advance possible is a conditional transgenic approach, a particularly versatile method of creating gene deletions and substitutions in the mouse genome. A centerpiece of this strategy is an enzyme, Cre recombinase, which is expressed from defined DNA regulatory elements that are active in the tissue of choice. The regulatory DNA element (either genetically engineered or natural) assures Cre expression only in predetermined cell types, leading to the guided deletion of genetically modified (flanked by loxP or 'floxed' by loxP) gene loci. This review summarizes and compares the studies in which genes encoding GATA family transcription factors were targeted either globally or by Cre recombinases active in the somatic cells of ovaries and testes. The conditional gene loss experiments require detailed knowledge of the spatial and temporal expression of Cre activity, and the challenges in interpreting the outcomes are highlighted. These studies also expose the complexity of GATA-dependent regulation of gonadal gene expression and suggest that gene function is highly context dependent.

  15. Mineral carbonation: energy costs of pretreatment options and insights gained from flow loop reaction studies

    SciTech Connect

    Penner, Larry R.; O'Connor, William K.; Dahlin, David C.; Gerdemann, Stephen J.; Rush, Gilbert E.

    2004-01-01

    Sequestration of carbon as a stable mineral carbonate has been proposed to mitigate environmental concerns that carbon dioxide may with time escape from its sequestered matrix using alternative sequestration technologies. A method has been developed to prepare stable carbonate products by reacting CO2 with magnesium silicate minerals in aqueous bicarbonate/chloride media at high temperature and pressure. Because this approach is inherently expensive due to slow reaction rates and high capital costs, studies were conducted to improve the reaction rates through mineral pretreatment steps and to cut expenses through improved reactor technology. An overview is given for the estimated cost of the process including sensitivity to grinding and heating as pretreatment options for several mineral feedstocks. The energy costs are evaluated for each pretreatment in terms of net carbon avoided. New studies with a high-temperature, high-pressure flow-loop reactor have yielded information on overcoming kinetic barriers experienced with processing in stirred autoclave reactors. Repeated tests with the flow-loop reactor have yielded insights on wear and failure of system components, on challenges to maintain and measure flow, and for better understanding of the reaction mechanism.

  16. Structural insight into the glucokinase-ligands interactions. Molecular docking study.

    PubMed

    Ermakova, Elena

    2016-10-01

    Glucokinase (GK) plays a key role in the regulation of hepatic glucose metabolism. Inactivation of GK is associated with diabetes, and an increase of its activity is linked to hypoglycemia. Possibility to regulate the GK activity using small chemical compounds as allosteric activators induces the scientific interest to the study of the activation mechanism and to the development of new allosteric glucokinase activators. Interaction of glucokinase with ligands is the first step of the complicated mechanism of regulation of the GK functioning. In this paper, we study the interaction of GK with native (glucose) and synthetic (allosteric activators) ligands using molecular docking method. Calculations demonstrate the ability of molecular docking programs to accurately reproduce crystallized ligand poses and conformations and to calculate a free energy of binding with satisfactory accuracy. Correlation between the free energy of binding and the bioactivity of activators is discussed. These results provide a new insight into protein-ligand interactions and can be used for the engineering of new activators.

  17. Insight in modulation of inflammation in response to diclofenac intervention: a human intervention study

    PubMed Central

    2010-01-01

    Background Chronic systemic low-grade inflammation in obese subjects is associated with health complications including cardiovascular diseases, insulin resistance and diabetes. Reducing inflammatory responses may reduce these risks. However, available markers of inflammatory status inadequately describe the complexity of metabolic responses to mild anti-inflammatory therapy. Methods To address this limitation, we used an integrative omics approach to characterize modulation of inflammation in overweight men during an intervention with the non-steroidal anti-inflammatory drug diclofenac. Measured parameters included 80 plasma proteins, >300 plasma metabolites (lipids, free fatty acids, oxylipids and polar compounds) and an array of peripheral blood mononuclear cells (PBMC) gene expression products. These measures were submitted to multivariate and correlation analysis and were used for construction of biological response networks. Results A panel of genes, proteins and metabolites, including PGE2 and TNF-alpha, were identified that describe a diclofenac-response network (68 genes in PBMC, 1 plasma protein and 4 plasma metabolites). Novel candidate markers of inflammatory modulation included PBMC expression of annexin A1 and caspase 8, and the arachidonic acid metabolite 5,6-DHET. Conclusion In this study the integrated analysis of a wide range of parameters allowed the development of a network of markers responding to inflammatory modulation, thereby providing insight into the complex process of inflammation and ways to assess changes in inflammatory status associated with obesity. Trial registration The study is registered as NCT00221052 in clinicaltrials.gov database. PMID:20178593

  18. Insights from the Global Longitudinal Study of Osteoporosis in Women (GLOW).

    PubMed

    Watts, Nelson B

    2014-07-01

    GLOW is an observational, longitudinal, practice-based cohort study of osteoporosis in 60,393 women aged ≥55 years in 10 countries on three continents. In this Review, we present insights from the first 3 years of the study. Despite cost analyses being frequently based on spine and hip fractures, we found that nonvertebral, nonhip fractures were around five times more common and doubled the use of health-care resources compared with hip and spine fractures combined. Fractures not at the four so-called major sites in FRAX(®) (upper arm, forearm, hip and clinical vertebral fractures) account for >40% of all fractures. The risk of fracture is increased by various comorbidities, such as Parkinson disease, multiple sclerosis and lung and heart disease. Obesity, although thought to be protective against all fractures, substantially increased the risk of fractures in the ankle or lower leg. Simple assessment by age plus fracture history has good predictive value for all fractures, but risk profiles differ for first and subsequent fractures. Fractures diminish quality of life as much or more than diabetes mellitus, arthritis and lung disease, yet women substantially underestimate their own fracture risk. Treatment rates in patients at high risk of fracture are below those recommended but might be too frequent in women at low risk. Comorbidities and the limits of current therapeutic regimens jeopardize the efficacy of drugs; new regimens should be explored for severe cases.

  19. Communication and the primate brain: insights from neuroimaging studies in humans, chimpanzees and macaques.

    PubMed

    Wilson, Benjamin; Petkov, Christopher I

    2011-04-01

    Considerable knowledge is available on the neural substrates for speech and language from brain-imaging studies in humans, but until recently there was a lack of data for comparison from other animal species on the evolutionarily conserved brain regions that process species-specific communication signals. To obtain new insights into the relationship of the substrates for communication in primates, we compared the results from several neuroimaging studies in humans with those that have recently been obtained from macaque monkeys and chimpanzees. The recent work in humans challenges the longstanding notion of highly localized speech areas. As a result, the brain regions that have been identified in humans for speech and nonlinguistic voice processing show a striking general correspondence to how the brains of other primates analyze species-specific vocalizations or information in the voice, such as voice identity. The comparative neuroimaging work has begun to clarify evolutionary relationships in brain function, supporting the notion that the brain regions that process communication signals in the human brain arose from a precursor network of regions that is present in nonhuman primates and is used for processing species-specific vocalizations. We conclude by considering how the stage now seems to be set for comparative neurobiology to characterize the ancestral state of the network that evolved in humans to support language.

  20. Comparative Study of Lectin Domains in Model Species: New Insights into Evolutionary Dynamics

    PubMed Central

    Van Holle, Sofie; De Schutter, Kristof; Eggermont, Lore; Tsaneva, Mariya; Dang, Liuyi; Van Damme, Els J. M.

    2017-01-01

    Lectins are present throughout the plant kingdom and are reported to be involved in diverse biological processes. In this study, we provide a comparative analysis of the lectin families from model species in a phylogenetic framework. The analysis focuses on the different plant lectin domains identified in five representative core angiosperm genomes (Arabidopsis thaliana, Glycine max, Cucumis sativus, Oryza sativa ssp. japonica and Oryza sativa ssp. indica). The genomes were screened for genes encoding lectin domains using a combination of Basic Local Alignment Search Tool (BLAST), hidden Markov models, and InterProScan analysis. Additionally, phylogenetic relationships were investigated by constructing maximum likelihood phylogenetic trees. The results demonstrate that the majority of the lectin families are present in each of the species under study. Domain organization analysis showed that most identified proteins are multi-domain proteins, owing to the modular rearrangement of protein domains during evolution. Most of these multi-domain proteins are widespread, while others display a lineage-specific distribution. Furthermore, the phylogenetic analyses reveal that some lectin families evolved to be similar to the phylogeny of the plant species, while others share a closer evolutionary history based on the corresponding protein domain architecture. Our results yield insights into the evolutionary relationships and functional divergence of plant lectins. PMID:28587095

  1. Using Learning Teams for Reflective Adaptation (ULTRA): insights from a team-based change management strategy in primary care.

    PubMed

    Balasubramanian, Bijal A; Chase, Sabrina M; Nutting, Paul A; Cohen, Deborah J; Strickland, Pamela A Ohman; Crosson, Jesse C; Miller, William L; Crabtree, Benjamin F

    2010-01-01

    The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practice-wide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.

  2. Further Insights in Trichothiodistrophy: A Clinical, Microscopic, and Ultrastructural Study of 20 Cases and Literature Review

    PubMed Central

    Ferrando, Juan; Mir-Bonafé, José M.; Cepeda-Valdés, Rodrigo; Domínguez, Anna; Ocampo-Candiani, Jorge; García-Veigas, Javier; Gómez-Flores, Minerva; Salas-Alanis, Julio C.

    2012-01-01

    Background: Trichothiodistrophy (TTD) is a rare autosomal recessive condition that is characterized by a specific congenital hair shaft dysplasia caused by deficiency of sulfur associated with a wide spectrum of multisystem abnormalities. In this article, we study clinical, microscopic, and ultrastructural findings of 20 patients with TTD with the aim to add further insights regarding to this rare condition. Additionally, analyses of our results are compared with those extracted from the literature in order to enhance its comprehensibility. Materials and Methods: Twenty cases of TTD were included: 7 from Mexico and 14 from Spain. Clinical, microscopic, scanning electron microscopy (SEM) studies and X-ray microanalysis (XrMa) were carried out in all of them. Genetic studies were performed in all seven Mexican cases. Patients with xeroderma pigmentosum and xeroderma pigmentosum/TTD-complex were excluded. Results: Cuticular changes and longitudinal crests of the hair shaft were demonstrated. These crests were irregular, disorganized, following the hair longest axis. Hair shaft sulfur deficiency was disposed discontinuously and intermittently rather than uniformly. This severe decrease of sulfur contents was located close to the trichoschisis areas. Only five patients did not show related disturbances. Micro-dolichocephaly was observed in five cases and represented the most frequent facial dysmorphism found. It is also remarkable that all patients with urologic malformations also combined diverse neurologic disorders. Moreover, three Mexican sisters demonstrated the coexistence of scarce pubic vellus hair, developmental delay, onychodystrophy, and maxillar/mandibullar hypoplasia. Conclusions: TTD phenotype has greatly varied from very subtle forms to severe alterations such as neurologic abnormalities, blindness, lamellar ichthyosis and gonadal malformations. Herein, a multisystem study should be performed mandatorily in patients diagnosed with TTD. PMID:23180925

  3. Insight into growth of Au-Pt bimetallic nanoparticles: an in situ XAS study.

    PubMed

    Nayak, Chandrani; Bhattacharyya, D; Bhattacharyya, K; Tripathi, A K; Bapat, R D; Jha, S N; Sahoo, N K

    2017-07-01

    Au-Pt bimetallic nanoparticles have been synthesized through a one-pot synthesis route from their respective chloride precursors using block copolymer as a stabilizer. Growth of the nanoparticles has been studied by simultaneous in situ measurement of X-ray absorption spectroscopy (XAS) and UV-Vis spectroscopy at the energy-dispersive EXAFS beamline (BL-08) at Indus-2 SRS at RRCAT, Indore, India. In situ XAS spectra, comprising both X-ray near-edge structure (XANES) and extended X-ray absorption fine-structure (EXAFS) parts, have been measured simultaneously at the Au and Pt L3-edges. While the XANES spectra of the precursors provide real-time information on the reduction process, the EXAFS spectra reveal the structure of the clusters formed in the intermediate stages of growth. This insight into the formation process throws light on how the difference in the reduction potential of the two precursors could be used to obtain the core-shell-type configuration of a bimetallic alloy in a one-pot synthesis method. The core-shell-type structure of the nanoparticles has also been confirmed by ex situ energy-dispersive spectroscopy line-scan and X-ray photoelectron spectroscopy measurements with in situ ion etching on fully formed nanoparticles.

  4. Testing of the Patients' Insights and Views of Teamwork (PIVOT) Survey: a validity study.

    PubMed

    Henry, Beverly W; Rooney, Deborah M; Eller, Susan; Vozenilek, John A; McCarthy, Danielle M

    2014-09-01

    To explore patient observations of teamwork-related behaviors such as inter-team communication through a newly designed survey. In this cross-sectional study, 101 patients (N=86) and caregivers (N=15) recruited from the emergency department (ED) of an urban, academic medical center (>85,000 visits/year) completed the 16-item Patients' Insights and Views Observing Teams (PIVOT) Survey. We evaluated validity evidence through descriptive statistics and analysis including a Many-facet Rasch model to determine associations between questionnaire items and sociodemographic characteristics. Participant responses provided evidence survey items performed well and reflected patients' awareness of team behaviors such as inter-team communication, coordination, and keeping teammates informed. Also, participants responded about the consistency of information from team members and knowing what people's jobs were on the team. Rasch analysis largely supported that the PIVOT items reflected the intended content area and adequacy of ratings scales supporting evidence of response processes. High internal consistency (Cronbach alpha, r=.87) supported evidence of internal structure. As expected, response patterns differed by ED visit acuity level and length of stay. The PIVOT survey offered a means to collect patient and caregiver observations of health care teams. PIVOT survey responses may contribute to evaluation of teamwork behaviors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Field methods in the study of toxic cyanobacterial blooms: results and insights from Lake Erie research.

    PubMed

    Wilhelm, Steven W

    2008-01-01

    Sound field methodologies are an essential prerequisite in the development of a basic understanding of toxic cyanobacteria blooms. Sample collection, on-site processing, storage and transportation, and subsequent analysis and documentation are all critically dependent on a sound field program that allows the researcher to construct, with minimal uncertainty, linkages between bloom events and cyanotoxin production with the ecology of the studied system. Since 1999, we have collected samples in Lake Erie as part of the MELEE (Microbial Ecology of the Lake Erie Ecosystem) and MERHAB-LGL (Monitoring Event Responses for Harmful Algal Blooms in the Lower Great Lakes) research programs to develop appropriate tools and refine methods necessary to characterize the ecology of the reoccurring cyanobacterial blooms in the systems. Satellite imagery, large ship expeditions, classical and novel molecular tools have been combined to provide insight into both the cyanobacteria responsible for these events as well as into some of the environmental cues that may facilitate the formation of toxic blooms. This information, as well new directions in cyano-specific monitoring will be presented to highlight needs for field program monitoring and/or researching toxic freshwater cyanobacteria.

  6. Adduct Formation and Context Factors in Drug Hypersensitivity: Insight from Proteomic Studies.

    PubMed

    Gonzalez-Morena, Juan M; Montanez, Maria I; Aldini, Giancarlo; Sanchez-Gomez, Francisco J; Perez-Sala, Dolores

    2016-01-01

    Drug hypersensitivity reactions result from the activation of the immune system by drugs or their metabolites. The clinical presentations of drug hypersensitivity can range from relatively mild local manifestations to severe systemic syndromes that can be lifethreatening. As in other allergic reactions, the causes are multifactorial as genetic, metabolic and concomitant factors may influence the occurrence of drug hypersensitivity. Formation of drug protein adducts is considered a key step in drug adverse reactions, and in particular in the immunological recognition in drug hypersensitivity reactions. Nevertheless, noncovalent interactions of drugs with receptors in immune cells or with MHC clefts and/or exposed peptides can also play an important role. In recent years, development of proteomic approaches has allowed the identification and characterization of the protein targets for modification by drugs in vivo and in vitro, the nature of peptides exposed on MHC molecules, the changes in protein levels induced by drug treatment, and the concomitant modifications induced by danger signals, thus providing insight into context factors. Nevertheless, given the complexity and multifactorial nature of drug hypersensitivity reactions, understanding the underlying mechanisms also requires the integration of knowledge from genomic, metabolomic and clinical studies. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  7. Novel insights into thyroid hormones from the study of common genetic variation.

    PubMed

    Dayan, Colin M; Panicker, Vijay

    2009-04-01

    Effects of thyroid hormones in individual tissues are determined by many factors beyond their serum levels, including local deiodination and expression and activity of thyroid hormone transporters. These effects are difficult to examine by traditional techniques, but a novel approach that exploits the existence of common genetic variants has yielded new and surprising insights. Convincing evidence indicates a role of type 1 iodothyronine deiodinase (D1) in determining the serum T(4):T(3) ratio and a role of phosphodiesterase 8B in determining TSH levels. In addition, studies of type 2 iodothyronine deiodinase (D2) variants have shown that thyroid hormones contribute to osteoarthritis and these variants influence Intelligence quotient alterations associated with iodine deficiency. Preliminary evidence suggests associations between TSH-receptor variants and fasting glucose level, D1 variants and insulin-like growth factor I production, and D2 variants and hypertension, psychological well-being and response to T(3) or T(4) treatment. Intriguingly, most of these associations are independent of serum thyroid hormone levels, which highlights the importance of local regulation of thyroid hormones in tissues. Future research might reveal novel roles for thyroid hormones in obesity, cardiovascular disease, osteoporosis and depression and could have implications for interpretation of thyroid function tests and individualization of thyroid hormone replacement therapy.

  8. Carbon allocation in plants and ecosystems - insights from stable isotope studies

    NASA Astrophysics Data System (ADS)

    Gessler, Arthur

    2014-05-01

    Trees are large global stores of carbon (C) that will be impacted by increased carbon dioxide levels and climate change. However, at present we cannot properly predict the carbon balance of forests in future as we lack knowledge on how plant physiological processes, the transfer of carbon within the plant, carbon storage, and remobilization in the plant tissues as well as the release of carbon from the roots to the soil interact with environmental drivers and ecosystem-scale processes. This paper will summarise how stable isotope techniques can give new insights in the fate of newly assimilated C in plants and ecosystems on time scales from hours to seasons and it will include studies either characterizing temporal and spatial variation in the natural abundance of carbon and oxygen isotopes or applying isotopically enriched tracers. It comprises the assessment of the mechanisms of C partitioning among specific metabolic pathways, between plant organs and into various ecosystem C pools with different residence times. Moreover stable isotopes are highly suitable tools to characterise the role of the phloem, which is the central long-distance conveyer distributing C from source to sinks and thus plays a central role in linking sites and structures of storage, growth and other metabolic activities. A deeper understanding of these processes and their interaction with environmental drivers is critical for predicting how trees and ecosystems will respond to coming global environmental changes, including increased temperature, altered precipitation, and elevated carbon dioxide concentrations.

  9. Molecular neuropathology of frontotemporal dementia: insights into disease mechanisms from postmortem studies.

    PubMed

    Mackenzie, Ian R A; Neumann, Manuela

    2016-08-01

    Frontotemporal dementia (FTD) is a clinical syndrome with a heterogeneous molecular basis. The past decade has seen the discovery of several new FTD-causing genetic mutations and the identification of many of the relevant pathological proteins. The current neuropathological classification is based on the predominant protein abnormality and allows most cases of FTD to be placed into one of three broad molecular subgroups; frontotemporal lobar degeneration with tau, TDP-43 or FET protein accumulation. This review will describe our current understanding of the molecular basis of FTD, focusing on insights gained from the study of human postmortem tissue, as well as some of the current controversies. Most cases of FTD can be subclassified into one of three broad molecular subgroups based on the predominant protein that accumulates as pathological cellular inclusions. Understanding the associated pathogenic mechanisms and recognizing these FTD molecular subtypes in vivo will likely be crucial for the development and use of targeted therapies. This article is part of the Frontotemporal Dementia special issue.

  10. State Practitioner Insights Into Local Public Health Challenges and Opportunities in Obesity Prevention: a Qualitative Study

    PubMed Central

    Lewis, Moira; Khoong, Elaine C.; LaSee, Claire

    2014-01-01

    Introduction The extent of obesity prevention activities conducted by local health departments (LHDs) varies widely. The purpose of this qualitative study was to characterize how state obesity prevention program directors perceived the role of LHDs in obesity prevention and factors that impact LHDs’ success in obesity prevention. Methods From June 2011 through August 2011, we conducted 28 semistructured interviews with directors of federally funded obesity prevention programs at 22 state and regional health departments. Interviews were transcribed verbatim, coded, and analyzed to identify recurring themes and key quotations. Results Main themes focused on the roles of LHDs in local policy and environmental change and on the barriers and facilitators to LHD success. The role LHDs play in obesity prevention varied across states but generally reflected governance structure (decentralized vs centralized). Barriers to local prevention efforts included competing priorities, lack of local capacity, siloed public health structures, and a lack of local engagement in policy and environmental change. Structures and processes that facilitated prevention were having state support (eg, resources, technical assistance), dedicated staff, strong communication networks, and a robust community health assessment and planning process. Conclusions These findings provide insight into successful strategies state and local practitioners are using to implement innovative (and evidence-informed) community-based interventions. The change in the nature of obesity prevention requires a rethinking of the state–local relationship, especially in centralized states. PMID:24625363

  11. An Insight into the Pharmacophores of Phosphodiesterase-5 Inhibitors from Synthetic and Crystal Structural Studies

    SciTech Connect

    Chen,G.; Wang, H.; Robinson, H.; Cai, J.; Wan, Y.; Ke, H.

    2008-01-01

    Selective inhibitors of cyclic nucleotide phosphodiesterase-5 (PDE5) have been used as drugs for treatment of male erectile dysfunction and pulmonary hypertension. An insight into the pharmacophores of PDE5 inhibitors is essential for development of second generation of PDE5 inhibitors, but has not been completely illustrated. Here we report the synthesis of a new class of the sildenafil derivatives and a crystal structure of the PDE5 catalytic domain in complex with 5-(2-ethoxy-5-(sulfamoyl)-3-thienyl)-1-methyl-3-propyl-1, 6-dihydro-7H-pyrazolo[4, 3-d]pyrimidin-7-one (12). Inhibitor 12 induces conformational change of the H-loop (residues 660-683), which is different from any of the known PDE5 structures. The pyrazolopyrimidinone groups of 12 and sildenafil are well superimposed, but their sulfonamide groups show a positional difference of as much as 1.5 Angstroms . The structure-activity analysis suggests that a small hydrophobic pocket and the H-loop of PDE5 are important for the inhibitor affinity, in addition to two common elements for binding of almost all the PDE inhibitors: the stack against the phenylalanine and the hydrogen bond with the invariant glutamine. However, the PDE5-12 structure does not provide a full explanation to affinity changes of the inhibitors. Thus alternatives such as conformational change of the M-loop are open and further structural study is required.

  12. Insights on Cytochrome P450 Enzymes and Inhibitors Obtained Through QSAR Studies

    PubMed Central

    Sridhar, Jayalakshmi; Liu, Jiawang; Foroozesh, Maryam; Stevens, Cheryl L. Klein

    2013-01-01

    The cytochrome P450 (CYP) superfamily of heme enzymes play an important role in the metabolism of a large number of endogenous and exogenous compounds, including most of the drugs currently on the market. Inhibitors of CYP enzymes have important roles in the treatment of several disease conditions such as numerous cancers and fungal infections in addition to their critical role in drug-drug interactions. Structure activity relationships (SAR), and three-dimensional quantitative structure activity relationships (3D-QSAR) represent important tools in understanding the interactions of the inhibitors with the active sites of the CYP enzymes. A comprehensive account of the QSAR studies on the major human CYPs 1A1, 1A2, 1B1, 2A6, 2B6, 2C9, 2C19, 2D6, 2E1, 3A4 and a few other CYPs are detailed in this review which will provide us with an insight into the individual/common characteristics of the active sites of these enzymes and the enzyme-inhibitor interactions. PMID:22864238

  13. Biophysical studies suggest a new structural arrangement of crotoxin and provide insights into its toxic mechanism

    PubMed Central

    Fernandes, Carlos A. H.; Pazin, Wallance M.; Dreyer, Thiago R.; Bicev, Renata N.; Cavalcante, Walter L. G.; Fortes-Dias, Consuelo L.; Ito, Amando S.; Oliveira, Cristiano L. P.; Fernandez, Roberto Morato; Fontes, Marcos R. M.

    2017-01-01

    Crotoxin (CTX) is the main neurotoxin found in Crotalus durissus rattlesnake venoms being composed by a nontoxic and non-enzymatic component (CA) and a toxic phospholipase A2 (CB). Previous crystallographic structures of CTX and CB provided relevant insights: (i) CTX structure showed a 1:1 molecular ratio between CA and CB, presenting three tryptophan residues in the CA/CB interface and one exposed to solvent; (ii) CB structure displayed a tetrameric conformation. This study aims to provide further information on the CTX mechanism of action by several biophysical methods. Our data show that isolated CB can in fact form tetramers in solution; however, these tetramers can be dissociated by CA titration. Furthermore, CTX exhibits a strong reduction in fluorescence intensity and lifetime compared with isolated CA and CB, suggesting that all tryptophan residues in CTX may be hidden by the CA/CB interface. By companying spectroscopy fluorescence and SAXS data, we obtained a new structural model for the CTX heterodimer in which all tryptophans are located in the interface, and the N-terminal region of CB is largely exposed to the solvent. Based on this model, we propose a toxic mechanism of action for CTX, involving the interaction of N-terminal region of CB with the target before CA dissociation. PMID:28256632

  14. Biophysical studies suggest a new structural arrangement of crotoxin and provide insights into its toxic mechanism.

    PubMed

    Fernandes, Carlos A H; Pazin, Wallance M; Dreyer, Thiago R; Bicev, Renata N; Cavalcante, Walter L G; Fortes-Dias, Consuelo L; Ito, Amando S; Oliveira, Cristiano L P; Fernandez, Roberto Morato; Fontes, Marcos R M

    2017-03-03

    Crotoxin (CTX) is the main neurotoxin found in Crotalus durissus rattlesnake venoms being composed by a nontoxic and non-enzymatic component (CA) and a toxic phospholipase A2 (CB). Previous crystallographic structures of CTX and CB provided relevant insights: (i) CTX structure showed a 1:1 molecular ratio between CA and CB, presenting three tryptophan residues in the CA/CB interface and one exposed to solvent; (ii) CB structure displayed a tetrameric conformation. This study aims to provide further information on the CTX mechanism of action by several biophysical methods. Our data show that isolated CB can in fact form tetramers in solution; however, these tetramers can be dissociated by CA titration. Furthermore, CTX exhibits a strong reduction in fluorescence intensity and lifetime compared with isolated CA and CB, suggesting that all tryptophan residues in CTX may be hidden by the CA/CB interface. By companying spectroscopy fluorescence and SAXS data, we obtained a new structural model for the CTX heterodimer in which all tryptophans are located in the interface, and the N-terminal region of CB is largely exposed to the solvent. Based on this model, we propose a toxic mechanism of action for CTX, involving the interaction of N-terminal region of CB with the target before CA dissociation.

  15. H2S biosynthesis and catabolism: new insights from molecular studies.

    PubMed

    Rose, Peter; Moore, Philip K; Zhu, Yi Zhun

    2016-11-14

    Hydrogen sulfide (H2S) has profound biological effects within living organisms and is now increasingly being considered alongside other gaseous signalling molecules, such as nitric oxide (NO) and carbon monoxide (CO). Conventional use of pharmacological and molecular approaches has spawned a rapidly growing research field that has identified H2S as playing a functional role in cell-signalling and post-translational modifications. Recently, a number of laboratories have reported the use of siRNA methodologies and genetic mouse models to mimic the loss of function of genes involved in the biosynthesis and degradation of H2S within tissues. Studies utilising these systems are revealing new insights into the biology of H2S within the cardiovascular system, inflammatory disease, and in cell signalling. In light of this work, the current review will describe recent advances in H2S research made possible by the use of molecular approaches and genetic mouse models with perturbed capacities to generate or detoxify physiological levels of H2S gas within tissues.

  16. Insights into pharmaceutical nanocrystal dissolution: a molecular dynamics simulation study on aspirin.

    PubMed

    Greiner, Maximilian; Elts, Ekaterina; Briesen, Heiko

    2014-09-02

    The presented molecular dynamics simulations are the first simulations to reveal dynamic dissolution of a pharmaceutical crystal in its experimentally determined shape. Continuous dissolution at constant undersaturation of the surrounding medium is ensured by introducing a plane of sticky dummy atoms into the water slab. These atoms have a strong interaction potential with dissolved aspirin molecules, but interactions with water are excluded from the calculations. Thus, the number of aspirin molecules diffusing freely in solution is kept at a low value and continuous dissolution of the aspirin crystal is monitored. Further insight into face-specific dissolution is drawn. The dissolution mechanism of receding edges is found for the (001) plane. These findings are in good agreement with experimental results. While the proposed dissolution mechanism for the (100) plane is terrace sinking on a rough surface, no pronounced dissolution of the perfectly flat face is seen in the present work. Molecular simulations of pharmaceuticals in their experimentally obtained structure therefore have shown to be especially suited for the investigation of dissolving faces, where the edges have a pronounced effect. In contrast to previous studies a propagation of the dissolution front into the crystal face is reported, and the crystal bulk is stable over the whole simulation time of 150 ns.

  17. How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure

    PubMed Central

    Digne-Malcolm, Holly; Frise, Matthew C.; Dorrington, Keith L.

    2016-01-01

    Though antihypertensive drugs have been in use for many decades, the mechanisms by which they act chronically to reduce blood pressure remain unclear. Over long periods, mean arterial blood pressure must match the perfusion pressure necessary for the kidney to achieve its role in eliminating the daily intake of salt and water. It follows that the kidney is the most likely target for the action of most effective antihypertensive agents used chronically in clinical practice today. Here we review the long-term renal actions of antihypertensive agents in human studies and find three different mechanisms of action for the drugs investigated. (i) Selective vasodilatation of the renal afferent arteriole (prazosin, indoramin, clonidine, moxonidine, α-methyldopa, some Ca++-channel blockers, angiotensin-receptor blockers, atenolol, metoprolol, bisoprolol, labetolol, hydrochlorothiazide, and furosemide). (ii) Inhibition of tubular solute reabsorption (propranolol, nadolol, oxprenolol, and indapamide). (iii) A combination of these first two mechanisms (amlodipine, nifedipine and ACE-inhibitors). These findings provide insights into the actions of antihypertensive drugs, and challenge misconceptions about the mechanisms underlying the therapeutic efficacy of many of the agents. PMID:27524972

  18. Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan.

    PubMed

    Pradhan, Nousheen Akber; Rizvi, Narjis; Sami, Neelofar; Gul, Xaher

    2013-07-05

    Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition - the main targets of the strategy. The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities' survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies

  19. Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan

    PubMed Central

    Akber Pradhan, Nousheen; Rizvi, Narjis; Sami, Neelofar; Gul, Xaher

    2013-01-01

    Background Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition – the main targets of the strategy. Objective The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities’ survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed

  20. DHEA effects on brain and behavior: insights from comparative studies of aggression.

    PubMed

    Soma, Kiran K; Rendon, Nikki M; Boonstra, Rudy; Albers, H Elliott; Demas, Gregory E

    2015-01-01

    Historically, research on the neuroendocrinology of aggression has been dominated by the paradigm that the brain receives sex steroid hormones, such as testosterone (T), from the gonads, and then these gonadal hormones modulate behaviorally relevant neural circuits. While this paradigm has been extremely useful for advancing the field, recent studies reveal important alternatives. For example, most vertebrate species are seasonal breeders, and many species show aggression outside of the breeding season, when the gonads are regressed and circulating levels of gonadal steroids are relatively low. Studies in diverse avian and mammalian species suggest that adrenal dehydroepiandrosterone (DHEA), an androgen precursor and prohormone, is important for the expression of aggression when gonadal T synthesis is low. Circulating DHEA can be converted into active sex steroids within the brain. In addition, the brain can synthesize sex steroids de novo from cholesterol, thereby uncoupling brain steroid levels from circulating steroid levels. These alternative mechanisms to provide sex steroids to specific neural circuits may have evolved to avoid the costs of high circulating T levels during the non-breeding season. Physiological indicators of season (e.g., melatonin) may allow animals to switch from one neuroendocrine mechanism to another across the year. DHEA and neurosteroids are likely to be important for the control of multiple behaviors in many species, including humans. These studies yield fundamental insights into the regulation of DHEA secretion, the mechanisms by which DHEA affects behavior, and the brain regions and neural processes that are modulated by DHEA. It is clear that the brain is an important site of DHEA synthesis and action. This article is part of a Special Issue entitled 'Essential role of DHEA'. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Muslim Women in Graduate Studies: Some Insights into the Accessibility of Higher Education for Minority Women Students

    ERIC Educational Resources Information Center

    Oplatka, Izhar; Lapidot, Orit

    2012-01-01

    Based on semi-structured interviews with 11 Muslim women graduate students in Israel, the current study provides insight into the determinants enabling this group of women in the Arab sector to apply for a second degree and succeed. Among these determinants are the family, the high school, the individual's personal drive for learning, the…

  2. Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care

    PubMed Central

    Balasubramanian, Bijal A.; Chase, Sabrina M.; Nutting, Paul A.; Cohen, Deborah J.; Strickland, Pamela A. Ohman; Crosson, Jesse C.; Miller, William L.; Crabtree, Benjamin F.

    2010-01-01

    PURPOSE The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. METHODS We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. RESULTS Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practice-wide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. CONCLUSION Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence. PMID:20843884

  3. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study

    PubMed Central

    Korpershoek, YJG; Vervoort, SCJM; Nijssen, LIT; Trappenburg, JCA; Schuurmans, MJ

    2016-01-01

    Background In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. Methods A qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59–88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015. Results Several patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions. Conclusion This study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account. PMID:27932877

  4. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study.

    PubMed

    Korpershoek, Yjg; Vervoort, Scjm; Nijssen, Lit; Trappenburg, Jca; Schuurmans, M J

    2016-01-01

    In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. A qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59-88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015. Several patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions. This study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account.

  5. Physical comorbidity, insight, quality of life and global functioning in first episode schizophrenia: a 24-month, longitudinal outcome study.

    PubMed

    Sim, Kang; Chan, Yiong Huak; Chua, Thiam Hee; Mahendran, Rathi; Chong, Siow Ann; McGorry, Patrick

    2006-12-01

    This prospective study sought to determine the clinical impact of physical comorbidity on patients with first episode schizophrenia (FES) and we tested the hypothesis that patients with physical comorbidity were associated with poorer clinical and functional outcomes. The severity of psychopathology, insight, social/occupational functioning and quality of life were evaluated using Positive And Negative Syndrome Scale (PANSS), Scale to assess Unawareness of Mental Disorder, Global Assessment of Functioning Scale (GAF), and World Health Organisation Quality of Life-Bref Scale (WHOQOL-Bref) respectively at baseline and at 6, 12, 18 and 24 months. Out of 142 patients, physical comorbidity was present in 21.8% (n=31) of the patients, and they were mainly related to the cardiovascular, respiratory and endocrine systems. Compared to baseline measurements, patients with physical comorbidity had greater awareness into the consequences of their psychiatric illness at 12 months, the need for treatment at 12 and 18 months, and better improvement of PANSS total and general psychopathology subscale scores at 24 months. FES patients with physical comorbidity also had less reduction in their WHOQOL-Bref scores in the physical health domain at 12 and 18 months and greater increase in the GAF scores at 18 and 24 months, indicating better subjective rating of quality of life and objective measure of their global functioning prospectively. Clinicians need to be aware of the substantial rates of physical comorbidity in FES patients which may not be necessarily associated with worse longitudinal outcomes and the findings should encourage even greater efforts at early identification and management of these physical conditions.

  6. Nitric oxide and cardiovascular effects: new insights in the role of nitric oxide for the management of osteoarthritis

    PubMed Central

    Mackenzie, Isla S; Rutherford, Daniel; MacDonald, Thomas M

    2008-01-01

    Nitric oxide (NO) is an important mediator in both health and disease. In addition to its effects on vascular tone and platelet function, it plays roles in inflammation and pain perception that may be of relevance in osteoarthritis. Many patients with osteoarthritis take nonsteroidal anti-inflammatory drugs (NSAIDs) long term for pain control. Over recent years concern has been raised about the possible cardiovascular side effects of NSAIDs. The reasons for this possible increased cardiovascular risk with NSAIDs are not yet entirely clear, although changes in blood pressure, renal salt handling and platelet function may contribute. Recently, drugs that chemically link a NSAID with a NO donating moiety (cyclo-oxygenase-inhibiting NO-donating drugs [CINODs]) were developed. NO is an important mediator of endothelial function, acting as a vasodilator and an inhibitor of platelet aggregation, and having anti-inflammatory properties. The potential benefits of CINODs include the combination of effective analgesic and anti-inflammatory actions with NO release, which might counterbalance any adverse cardiovascular effects of NSAIDs. Effects of CINODs in animal studies include inhibition of vasopressor responses, blood pressure reduction in hypertensive rats and inhibition of platelet aggregation. CINODs may also reduce ischemic damage to compromised myocardial tissue. In addition, endothelial dysfunction is a recognized feature of inflammatory arthritides, and therefore a drug that might provide slow release of NO to the vasculature while treating pain is an attractive prospect in these conditions. Further studies of the effects of CINODs in humans are required, but these agents represent a potential exciting advance in the management of osteoarthritis. PMID:19007428

  7. Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management.

    PubMed

    Van Mierlo, Lisa D; Meiland, Franka J M; Van Hout, Hein P J; Dröes, Rose-Marie

    2014-07-08

    The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create future guidelines for successful implementation of case management in other regions. A qualitative case study design was used; semi-structured interviews were conducted with 22 stakeholders on the execution and continuation phases of the implementation process. The stakeholders represented a broad range of perspectives (i.e. project leaders, case managers, health insurers, municipalities). The independence of the case management organization in the intensive model facilitated the implementation, whereas the presence of multiple competing case management providers in the linkage model impeded the implementation. Most impeding factors were found in the linkage model and were related to the organizational structure of the dementia care network and how partners collaborate with each other in this network. The results of this process evaluation show that the intensive case management model is easier to implement as case managers in this model tend to be more able to provide quality of care, are less impeded by competitiveness of other care organizations and are more closely connected to the expert team than case managers in the linkage model.

  8. Managing Intentionally Created Communities of Practice for Knowledge Sourcing across Organisational Boundaries: Insights on the Role of the CoP Manager

    ERIC Educational Resources Information Center

    Garavan, Thomas N.; Carbery, Ronan; Murphy, Eamonn

    2007-01-01

    Purpose: The purpose of this article is to explore strategies used by communities of practice (CoPs) managers when managing intentionally created CoPs. Design/methodology/approach: Four intentionally created CoPs in Ireland are explored, using a qualitative research design with data from observation, interviews and analysis of documents. Findings:…

  9. Managing Intentionally Created Communities of Practice for Knowledge Sourcing across Organisational Boundaries: Insights on the Role of the CoP Manager

    ERIC Educational Resources Information Center

    Garavan, Thomas N.; Carbery, Ronan; Murphy, Eamonn

    2007-01-01

    Purpose: The purpose of this article is to explore strategies used by communities of practice (CoPs) managers when managing intentionally created CoPs. Design/methodology/approach: Four intentionally created CoPs in Ireland are explored, using a qualitative research design with data from observation, interviews and analysis of documents. Findings:…

  10. Information management system study results. Volume 1: IMS study results

    NASA Technical Reports Server (NTRS)

    1971-01-01

    The information management system (IMS) special emphasis task was performed as an adjunct to the modular space station study, with the objective of providing extended depth of analysis and design in selected key areas of the information management system. Specific objectives included: (1) in-depth studies of IMS requirements and design approaches; (2) design and fabricate breadboard hardware for demonstration and verification of design concepts; (3) provide a technological base to identify potential design problems and influence long range planning (4) develop hardware and techniques to permit long duration, low cost, manned space operations; (5) support SR&T areas where techniques or equipment are considered inadequate; and (6) permit an overall understanding of the IMS as an integrated component of the space station.

  11. Social networks of health care providers and patients in cardiovascular risk management: a study protocol

    PubMed Central

    2014-01-01

    Background In recent years, preventive and clinical interventions for cardiovascular risk management have been implemented widely in primary care in the Netherlands. Although this has enhanced quality and outcomes of cardiovascular risk management, further improvement remains possible. In the planned observational study, we aim to examine the role of social networks of healthcare providers and patients in quality and outcomes of cardiovascular risk management. Methods/Design In a longitudinal observational study, data on social networks of approximately 300 primary care providers from 30 general practices and 900 cardiovascular patients will be collected twice, with a six month interval, using a mix of measures. Social networks are documented with specifically designed questionnaires for patients, relatives, and healthcare professionals. For each included patient, we will extract from medical records to gather data on clinical processes and cardiovascular risk predictors. Data on self-management and psychosocial outcomes of patients will be collected using questionnaires for patients. The analysis focuses on identifying network characteristics, which are associated with (changes in) cardiovascular risk management or self-management. Discussion This research will provide insight into the role of social networks of patients and providers in cardiovascular risk management in primary practice. Trial registration Nederlands Trial Register NTR4069. PMID:24942555

  12. Assessing the effects of management on forest growth across France: insights from a new functional–structural model

    PubMed Central

    Guillemot, Joannès; Delpierre, Nicolas; Vallet, Patrick; François, Christophe; Martin-StPaul, Nicolas K.; Soudani, Kamel; Nicolas, Manuel; Badeau, Vincent; Dufrêne, Eric

    2014-01-01

    Background and Aims The structure of a forest stand, i.e. the distribution of tree size features, has strong effects on its functioning. The management of the structure is therefore an important tool in mitigating the impact of predicted changes in climate on forests, especially with respect to drought. Here, a new functional–structural model is presented and is used to assess the effects of management on forest functioning at a national scale. Methods The stand process-based model (PBM) Castanea was coupled to a stand structure module (SSM) based on empirical tree-to-tree competition rules. The calibration of the SSM was based on a thorough analysis of intersite and interannual variability of competition asymmetry. The coupled Castanea–SSM model was evaluated across France using forest inventory data, and used to compare the effect of contrasted silvicultural practices on simulated stand carbon fluxes and growth. Key Results The asymmetry of competition varied consistently with stand productivity at both spatial and temporal scales. The modelling of the competition rules enabled efficient prediction of changes in stand structure within the Castanea PBM. The coupled model predicted an increase in net primary productivity (NPP) with management intensity, resulting in higher growth. This positive effect of management was found to vary at a national scale across France: the highest increases in NPP were attained in forests facing moderate to high water stress; however, the absolute effect of management on simulated stand growth remained moderate to low because stand thinning involved changes in carbon allocation at the tree scale. Conclusions This modelling approach helps to identify the areas where management efforts should be concentrated in order to mitigate near-future drought impact on national forest productivity. Around a quarter of the French temperate oak and beech forests are currently in zones of high vulnerability, where management could thus mitigate

  13. Insight Into the Relationship Between Impulsivity and Substance Abuse From Studies Using Animal Models

    PubMed Central

    Winstanley, Catharine A.; Olausson, Peter; Taylor, Jane R.; Jentsch, J. David

    2010-01-01

    Drug use disorders are often accompanied by deficits in the capacity to efficiently process reward-related information and to monitor, suppress, or override reward-controlled behavior when goals are in conflict with aversive or immediate outcomes. This emerging deficit in behavioral flexibility and impulse control may be a central component of the progression to addiction, as behavior becomes increasingly driven by drugs and drug-associated cues at the expense of more advantageous activities. Understanding how neural mechanisms implicated in impulse control are affected by addictive drugs may therefore prove a useful strategy in the search for new treatment options. Animal models of impulsivity and addiction could make a significant contribution to this endeavor. Here, some of the more common behavioral paradigms used to measure different aspects of impulsivity across species are outlined, and the importance of the response to reward-paired cues in such paradigms is discussed. Naturally occurring differences in forms of impulsivity have been found to be predictive of future drug self-administration, but drug exposure can also increase impulsive responding. Such data are in keeping with the suggestion that impulsivity may contribute to multiple stages within the spiral of addiction. From a neurobiological perspective, converging evidence from rat, monkey, and human studies suggest that compromised functioning within the orbitofrontal cortex may critically contribute to the cognitive sequelae of drug abuse. Changes in gene transcription and protein expression within this region may provide insight into the mechanism underlying drug-induced cortical hypofunction, reflecting new molecular targets for the treatment of uncontrolled drug-seeking and drug-taking behavior. PMID:20491734

  14. Insight into the relationship between impulsivity and substance abuse from studies using animal models.

    PubMed

    Winstanley, Catharine A; Olausson, Peter; Taylor, Jane R; Jentsch, J David

    2010-08-01

    Drug use disorders are often accompanied by deficits in the capacity to efficiently process reward-related information and to monitor, suppress, or override reward-controlled behavior when goals are in conflict with aversive or immediate outcomes. This emerging deficit in behavioral flexibility and impulse control may be a central component of the progression to addiction, as behavior becomes increasingly driven by drugs and drug-associated cues at the expense of more advantageous activities. Understanding how neural mechanisms implicated in impulse control are affected by addictive drugs may therefore prove a useful strategy in the search for new treatment options. Animal models of impulsivity and addiction could make a significant contribution to this endeavor. Here, some of the more common behavioral paradigms used to measure different aspects of impulsivity across species are outlined, and the importance of the response to reward-paired cues in such paradigms is discussed. Naturally occurring differences in forms of impulsivity have been found to be predictive of future drug self-administration, but drug exposure can also increase impulsive responding. Such data are in keeping with the suggestion that impulsivity may contribute to multiple stages within the spiral of addiction. From a neurobiological perspective, converging evidence from rat, monkey, and human studies suggest that compromised functioning within the orbitofrontal cortex may critically contribute to the cognitive sequelae of drug abuse. Changes in gene transcription and protein expression within this region may provide insight into the mechanism underlying drug-induced cortical hypofunction, reflecting new molecular targets for the treatment of uncontrolled drug-seeking and drug-taking behavior.

  15. Molecular insights into the historic demography of bowhead whales: understanding the evolutionary basis of contemporary management practices

    PubMed Central

    Phillips, C D; Hoffman, J I; George, J C; Suydam, R S; Huebinger, R M; Patton, J C; Bickham, J W

    2013-01-01

    Patterns of genetic variation observed within species reflect evolutionary histories that include signatures of past demography. Understanding the demographic component of species' history is fundamental to informed management because changes in effective population size affect response to environmental change and evolvability, the strength of genetic drift, and maintenance of genetic variability. Species experiencing anthropogenic population reductions provide valuable case studies for understanding the genetic response to demographic change because historic changes in the census size are often well documented. A classic example is the bowhead whale, Balaena mysticetus, which experienced dramatic population depletion due to commercial whaling in the late 19th and early 20th centuries. Consequently, we analyzed a large multi-marker dataset of bowhead whales using a variety of analytical methods, including extended Bayesian skyline analysis and approximate Bayesian computation, to characterize genetic signatures of both ancient and contemporary demographic histories. No genetic signature of recent population depletion was recovered through any analysis incorporating realistic mutation assumptions, probably due to the combined influences of long generation time, short bottleneck duration, and the magnitude of population depletion. In contrast, a robust signal of population expansion was detected around 70,000 years ago, followed by a population decline around 15,000 years ago. The timing of these events coincides to a historic glacial period and the onset of warming at the end of the last glacial maximum, respectively. By implication, climate driven long-term variation in Arctic Ocean productivity, rather than recent anthropogenic disturbance, appears to have been the primary driver of historic bowhead whale demography. PMID:23403722

  16. Molecular insights into the historic demography of bowhead whales: understanding the evolutionary basis of contemporary management practices.

    PubMed

    Phillips, C D; Hoffman, J I; George, J C; Suydam, R S; Huebinger, R M; Patton, J C; Bickham, J W

    2012-01-01

    Patterns of genetic variation observed within species reflect evolutionary histories that include signatures of past demography. Understanding the demographic component of species' history is fundamental to informed management because changes in effective population size affect response to environmental change and evolvability, the strength of genetic drift, and maintenance of genetic variability. Species experiencing anthropogenic population reductions provide valuable case studies for understanding the genetic response to demographic change because historic changes in the census size are often well documented. A classic example is the bowhead whale, Balaena mysticetus, which experienced dramatic population depletion due to commercial whaling in the late 19th and early 20th centuries. Consequently, we analyzed a large multi-marker dataset of bowhead whales using a variety of analytical methods, including extended Bayesian skyline analysis and approximate Bayesian computation, to characterize genetic signatures of both ancient and contemporary demographic histories. No genetic signature of recent population depletion was recovered through any analysis incorporating realistic mutation assumptions, probably due to the combined influences of long generation time, short bottleneck duration, and the magnitude of population depletion. In contrast, a robust signal of population expansion was detected around 70,000 years ago, followed by a population decline around 15,000 years ago. The timing of these events coincides to a historic glacial period and the onset of warming at the end of the last glacial maximum, respectively. By implication, climate driven long-term variation in Arctic Ocean productivity, rather than recent anthropogenic disturbance, appears to have been the primary driver of historic bowhead whale demography.

  17. Diabetes mellitus: novel insights, analysis and interpretation of pathophysiology and complications management with imidazole-containing peptidomimetic antioxidants.

    PubMed

    Babizhayev, Mark A; Lankin, Vadim Z; Savel'Yeva, Ekaterina L; Deyev, Anatoliy I; Yegorov, Yegor E

    2013-12-01

    peroxidase type of activity and protection of antioxidant enzymes from inactivation (such as in a case of superoxide dismutase). Carnosine biological mimetics react with methylglyoxal and they are described in this study as a glyoxalase mimetics. The imidazole-containing carnosine biological mimetics can react with a number of deleterious aldehydic products of lipid peroxidation and thereby suppress their toxicity. Carnosine and carcinine can also react with glycated proteins and inhibit advanced glycation end product formation. These studies indicate a therapeutic role for imidazole-containing antioxidants (non-hydrolized carnosine, carcinine, D-carnosine, ophthalmic prodrug N-acetylcarnosine, leucyl-histidylhidrazide and patented formulations thereof) in therapeutic management strategies for Type 2 Diabetes.

  18. Master of Business Administration (MBA) Student Outcomes in Vietnam: Graduate Student Insights from a Qualitative Study

    ERIC Educational Resources Information Center

    Ly, Chau Thi Minh; Vickers, Margaret H.; Fernandez, Santha

    2015-01-01

    Purpose: Exploratory insights into the graduate student experiences of offshore MBA programmes in Vietnam are presented. Students are considered key stakeholders in the higher education (HE) debate, and their views were sought in light of recent shifts in HE worldwide, associated business education changes, nagging questions around the quality of…

  19. A Multidimensional Reappraisal of Language in Autism: Insights from a Discourse Analytic Study

    ERIC Educational Resources Information Center

    Sterponi, Laura; de Kirby, Kenton

    2016-01-01

    In this article, we leverage theoretical insights and methodological guidelines of discourse analytic scholarship to re-examine language phenomena typically associated with autism. Through empirical analysis of the verbal behavior of three children with autism, we engage the question of how prototypical features of autistic language--notably…

  20. A Multidimensional Reappraisal of Language in Autism: Insights from a Discourse Analytic Study

    ERIC Educational Resources Information Center

    Sterponi, Laura; de Kirby, Kenton

    2016-01-01

    In this article, we leverage theoretical insights and methodological guidelines of discourse analytic scholarship to re-examine language phenomena typically associated with autism. Through empirical analysis of the verbal behavior of three children with autism, we engage the question of how prototypical features of autistic language--notably…

  1. Master of Business Administration (MBA) Student Outcomes in Vietnam: Graduate Student Insights from a Qualitative Study

    ERIC Educational Resources Information Center

    Ly, Chau Thi Minh; Vickers, Margaret H.; Fernandez, Santha

    2015-01-01

    Purpose: Exploratory insights into the graduate student experiences of offshore MBA programmes in Vietnam are presented. Students are considered key stakeholders in the higher education (HE) debate, and their views were sought in light of recent shifts in HE worldwide, associated business education changes, nagging questions around the quality of…

  2. Field Studies Provide Insight into Tritium Migration in an Arid Environment

    NASA Astrophysics Data System (ADS)

    Andraski, B. J.; Garcia, C.; Michel, R. L.; Stonestrom, D. A.; Mayers, C.; Johnson, M.

    2009-12-01

    Questions concerning radionuclide migration include the spatial extent of contamination and the rate at which contamination spreads. Previous work at the Amargosa Desert Research Site, Nevada used a plant-based method to map large-scale, tritium plumes in a 72-ha area adjacent to a closed, commercial low-level radioactive waste facility. The objectives of this study were to (i) determine if the plant-mapped contaminant distribution has changed with time and (ii) use soil water-vapor samples to gain insight into subsurface transport. Mapping of plant-water tritium concentrations was repeated 5 yr after the initial mapping. During this 5-yr period, annual soil water-vapor samples from the root zone (~0 to 1-m depth) and sub-root-zone gravelly sand (~1 to 2-m depth) were collected along transects that passed through two tritium hot spots. Mapped plant-water tritium concentrations within the main body of both hot spots decreased ~30-40% over 5 yr. In contrast, the plant data along the periphery of the south hot spot showed little change with time, while those along the west hot spot increased and indicated continued lateral advancement of the western plume. The peak sub-root-zone water-vapor concentration within the south hot spot (2,150 Bq/L) was measured 100 m from the facility and that for the west hot spot (11,970 Bq/L) was immediately adjacent to the facility. Soil water-vapor transect data supported the plant-mapping results. For example, over 5 yr, sub-root-zone concentrations at south-transect locations within 200 m of the facility and west-transect locations within 25 m of the facility decreased by ~40%. In addition, the west-transect 200-m location showed a relatively steady increase in annual sub-root-zone water-vapor concentrations that confirmed lateral advancement of the western plume. Data collected in the south hot spot show that long-distance lateral migration of the shallow vapor-phase tritium plume occurs preferentially through the gravelly layer

  3. S Plant Aggregate Area management study report

    SciTech Connect

    Not Available

    1992-11-01

    The US Department of Energy (DOE) Hanford Site in Washington State is organized into numerically designated operational areas including the 100, 200, 300, 400, 600, and 1100 Areas. The US Environmental Protection Agency (EPA), in November 1989, included the 200 Areas of the Hanford Site on the National Priorities List (NPL) under the Comprehensive Environmental Response, Compensation and Liability Act 1980. Inclusion on the NPL initiates the Remedial investigation (RI) and (FS) process for characterizing the nature and extent of condition to human health and the environment, and selection of remedial actions. This report presents the results of an aggregate area management study (AAMS) for the S plant Aggregate Area located in the 200 Areas. The study provides the basis for initiating RI/FS under CERCLA or under the Resource Conservation and Recovery Act (RCRA) Facility Investigations (RFI) and Corrective Measures Studies (CMS). This report also integrates RCRA treatment, storage, or disposal (TSD) closure activities with CERCLA and RCRA past-Practice investigations.

  4. Top management and management science: An exploratory study in 15 Federal civilian agencies

    NASA Technical Reports Server (NTRS)

    White, M. J.

    1971-01-01

    A study of the relation between top managers in Federal agencies and the operations research and management science (OR/MS) group is reported. Sixteen managers were questioned about the following characteristics: closeness of top managers to OR/MS groups; top managers' attitudes toward the OR/MS activities; relation between closeness and these attitudes; and top managers' use of OR/MS groups. It is concluded that OR/MS is relevant to many top managers and that OR/MS has begun to play a role in decisions. Top management attitudes and actions are not related in obvious ways. The consequences to top management's use of and closeness to an OR/MS group need not be the success of the group as a professional, innovative, research-oriented unit.

  5. The management of pain in arthritis and the use of cyclooxygenase-2 inhibitors: new paradigms and insights.

    PubMed

    Ross, Edgar

    2004-12-01

    Chronic pain from arthritis has been one of the biggest causes of disability and loss of function in the United States. This is still the case despite many new insights into the pathophysiology of pain, effective treatment approaches, and new safer medications that can be used for long-term use. There are many different types of arthritic problems. New disease- modifying agents that are available for some of these types of arthritic diseases such as rheumatoid arthritis have the potential to have a substantial impact on improvement in the long-term prognosis. Despite this optimistic outlook, pain often is a significant problem and should be treated whenever it becomes a barrier to function.

  6. Significance of atrial fibrillation during acute myocardial infarction, and its current management: insights from the GUSTO-3 trial.

    PubMed

    Wong, Cheuk-Kit; White, Harvey D; Wilcox, Robert G; Criger, Douglas A; Califf, Robert M; Topol, Eric J; Ohman, E Magnus

    2003-09-01

    The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO)-3 atrial fibrillation (AF) substudy assessed the prognostic significance of AF during acute myocardial infarction (AMI), the use of antiarrhythmic therapies, and whether different antiarrhythmic therapies were associated with different outcomes. The timing of the onset of AF relative to other post-AMI complications was recorded in the study. Of the 13,858 patients who were in sinus rhythm at the time of enrolment into GUSTO-3, 906 (6.5%) developed AF and 12,952 did not. Worsening heart failure, hypotension, third-degree heart block, and ventricular fibrillation were independent predictors of new-onset AF. The risks of 30-day and 1-year mortality were increased among patients with AF versus patients without AF before (odds ratio [OR] 2.74, 95% confidence interval [CI] 2.56-3.34; and OR 2.93, 95% CI 2.48-3.46, respectively) and after adjustment for baseline factors and pre-AF complications (OR 1.49, 95% CI 1.17-1.89; and OR 1.64, 95% CI 1.35-2.01, respectively). A total of 1,138 patients had data available on the management of their AF, including 117 with a history of paroxysmal AF and 138 with chronic AF prior to AMI. Of these 1,138 patients, 317 (28%) received antiarrhythmic therapies: class I antiarrhythmic drugs in 12%, sotalol in 5% and amiodarone in 15%. Electrical cardioversion was attempted in 116 patients (10%). Sinus rhythm was restored in 72% of patients given class I drugs, 67% of those given sotalol, 79% of those given amiodarone, and 64% of those who underwent electrical cardioversion. After adjustment for baseline characteristics and pre-AF complications, none of the specific antiarrhythmic therapies was associated with a higher chance of having sinus rhythm at discharge or before deterioration to in-hospital death. However, the use of class I antiarrhythmic drugs or sotalol was associated with lower unadjusted 30-day and 1-year mortality rates. After adjustment for baseline

  7. Enhancing evidence use in public health nutrition policymaking: theoretical insights from a New Zealand case study.

    PubMed

    Field, P; Gauld, R; Lawrence, M

    2016-11-25

    Enhancing the use of evidence in policymaking is critical to addressing the global burden of nutrition-related disease. Whilst the public health nutrition community has embraced evidence-informed policymaking, their approach of defining relevant evidence and evaluating policy has not brought about major shifts in policymaking. This article uses a public health nutrition case study to refine a novel theory-informed framework for enhancing the use of evidence in government public health nutrition policymaking. Our aim is to contribute insights from evidence-informed policy to the emerging paradigm in public health nutrition policymaking. An enquiry framework informed by three groups of theories underpinning evidence-informed policy was used to explore the role of socially mediated processes on the use of evidence. A public health nutrition case study on food marketing to New Zealand children was conducted to refine the framework. Interview data collected from 54 individuals representing four key policy stakeholder groups, policymakers, academics, and food industry and non-government organisations were analysed using deductive and inductive thematic analysis. To enhance theoretical robustness, an alternative hypothesis of political explanations for evidence use was explored alongside the enquiry framework. We found the prevailing political climate influenced the impact of advocacy for evidence inclusive processes at the meta-policy and policymaking process levels and in policy community relationships. Low levels of awareness of the impact of these processes on evidence use and uncoordinated advocacy resulted in the perpetuation of ad hoc policymaking. These findings informed refinements to the enquiry framework. Our study highlights the role advocates can play in shifting government public health nutrition policymaking systems towards enhanced use of evidence. Our Advocacy for Evidence Use framework argues for a three-channel approach to advocacy for using evidence in

  8. Improving the production of applied health research findings: insights from a qualitative study of operational research.

    PubMed

    Crowe, Sonya; Turner, Simon; Utley, Martin; Fulop, Naomi J

    2017-09-08

    Knowledge produced through applied health research is often of a form not readily accessible to or actionable by policymakers and practitioners, which hinders its implementation. Our aim was to identify research activities that can support the production of knowledge tailored to inform policy and practice. To do this, we studied an operational research approach to improving the production of applied health research findings. A 2-year qualitative study was conducted of the operational research contribution to a multidisciplinary applied health research project that was successful in rapidly informing national policy. Semi-structured interviews (n = 20) were conducted with all members of the project's research team and advisory group (patient and health professional representatives and academics). These were augmented by participant (> 150 h) and non-participant (> 15 h) observations focusing on the process and experience of attempting to support knowledge production. Data were analysed thematically using QSR NVivo software. Operational research performed a knowledge mediation role shaped by a problem-focused approach and an intent to perform those tasks necessary to producing readily implementable knowledge but outwith the remit of other disciplinary strands of the project. Three characteristics of the role were found to support this: engaging and incorporating different perspectives to improve services by capturing a range of health professional and patient views alongside quantitative and qualitative research evidence; rendering data meaningful by creating and presenting evidence in forms that are accessible to and engage different audiences, enabling them to make sense of it for practical use; and maintaining perceived objectivity and rigour by establishing credibility, perceived neutrality and confidence in the robustness of the research in order to unite diverse professionals in thinking creatively about system-wide service improvement. Our study

  9. Measuring illness insight in patients with alcohol-related cognitive dysfunction using the Q8 questionnaire: a validation study

    PubMed Central

    Walvoort, Serge JW; van der Heijden, Paul T; Kessels, Roy PC; Egger, Jos IM

    2016-01-01

    Aim Impaired illness insight may hamper treatment outcome in patients with alcohol-related cognitive deficits. In this study, a short questionnaire for the assessment of illness insight (eg, the Q8) was investigated in patients with Korsakoff’s syndrome (KS) and in alcohol use disorder (AUD) patients with mild neurocognitive deficits. Methods First, reliability coefficients were computed and internal structure was investigated. Then, comparisons were made between patients with KS and patients with AUD. Furthermore, correlations with the Dysexecutive Questionnaire (DEX) were investigated. Finally, Q8 total scores were correlated with neuropsychological tests for processing speed, memory, and executive function. Results Internal consistency of the Q8 was acceptable (ie, Cronbach’s α =0.73). The Q8 items represent one factor, and scores differ significantly between AUD and KS patients. The Q8 total score, related to the DEX discrepancy score and scores on neuropsychological tests as was hypothesized, indicates that a higher degree of illness insight is associated with a higher level of cognitive functioning. Conclusion The Q8 is a short, valid, and easy-to-administer questionnaire to reliably assess illness insight in patients with moderate-to-severe alcohol-related cognitive dysfunction. PMID:27445476

  10. Origins, Consequences, and Management of Countertransference: A Case Study

    ERIC Educational Resources Information Center

    Rosenberger, Eric W.; Hayes, Jeffrey A.

    2002-01-01

    Insight into the construct of countertransference may be gained by studying the relationships among its constituents. Toward that end, a single therapy dyad was analyzed for 13 sessions. Client verbalizations predicted to trigger countertransference reactions were studied in relation to their possible consequences, and the potential mitigating…

  11. Managing Emerging Technology: Case Studies in Document Imaging Systems

    DTIC Science & Technology

    1990-01-01

    1990 Thesis/Dissertation 00 S Managing Emerging Technology : Case Studies in Document ( Imaging Systems Richard Kevin Brown AFIT Student at...older report. blank, the abstract is assumed to be unlimited. Standard Form 298 Back (Rev. 2-89) MANAGING EMERGING TECHNOLOGY : CASE STUDIES IN...Brancheau Carroll Fren el Iz e 71 &ur s Date . Brown, Richard Kevin (M.S., Management Science/ Information Systems) Managing Emerging Technology : Case

  12. Managers' and Teachers' Perspectives of Dyslexic Teachers in the English and Finnish Further Education Workforce: New Insights from Organisational Routines

    ERIC Educational Resources Information Center

    Thorpe, Anthony; Burns, Eila

    2016-01-01

    This article explores the topic of diversity in the teaching workforce though the enactment of policy concentrating on teachers with dyslexia within the Further/Vocational Education and Training sectors of England and Finland. Two research projects from Finland and England focusing, respectively, on individual teachers' perspectives and managers'…

  13. Managers' and Teachers' Perspectives of Dyslexic Teachers in the English and Finnish Further Education Workforce: New Insights from Organisational Routines

    ERIC Educational Resources Information Center

    Thorpe, Anthony; Burns, Eila

    2016-01-01

    This article explores the topic of diversity in the teaching workforce though the enactment of policy concentrating on teachers with dyslexia within the Further/Vocational Education and Training sectors of England and Finland. Two research projects from Finland and England focusing, respectively, on individual teachers' perspectives and managers'…

  14. Interdependency Management in Universities: A Case Study

    ERIC Educational Resources Information Center

    Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana

    2015-01-01

    There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…

  15. Interdependency Management in Universities: A Case Study

    ERIC Educational Resources Information Center

    Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana

    2015-01-01

    There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…

  16. Public Management of Science Case Studies.

    ERIC Educational Resources Information Center

    American Univ., Washington, DC. Coll. of Public Affairs.

    Presented are six papers pertaining to the management of science, research, and development by federal agencies. The papers were prepared by students in a management of science course offered at the American University, Washington, D.C. Federal agencies reviewed include: National Aeronautics and Space Administration (NASA); Department of…

  17. Role of Academic Managers in Workload and Performance Management of Academic Staff: A Case Study

    ERIC Educational Resources Information Center

    Graham, Andrew T.

    2016-01-01

    This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…

  18. Role of Academic Managers in Workload and Performance Management of Academic Staff: A Case Study

    ERIC Educational Resources Information Center

    Graham, Andrew T.

    2016-01-01

    This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…

  19. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study.

    PubMed

    Bellani, Giacomo; Laffey, John G; Pham, Tài; Madotto, Fabiana; Fan, Eddy; Brochard, Laurent; Esteban, Andres; Gattinoni, Luciano; Bumbasirevic, Vesna; Piquilloud, Lise; van Haren, Frank; Larsson, Anders; McAuley, Daniel F; Bauer, Philippe R; Arabi, Yaseen M; Ranieri, Marco; Antonelli, Massimo; Rubenfeld, Gordon D; Thompson, B Taylor; Wrigge, Hermann; Slutsky, Arthur S; Pesenti, Antonio

    2017-01-01

    Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse. To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful. The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome. Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159-1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mm Hg. NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).

  20. How Energy Metabolism Supports Cerebral Function: Insights from 13C Magnetic Resonance Studies In vivo

    PubMed Central

    Sonnay, Sarah; Gruetter, Rolf; Duarte, João M. N.

    2017-01-01

    Cerebral function is associated with exceptionally high metabolic activity, and requires continuous supply of oxygen and nutrients from the blood stream. Since the mid-twentieth century the idea that brain energy metabolism is coupled to neuronal activity has emerged, and a number of studies supported this hypothesis. Moreover, brain energy metabolism was demonstrated to be compartmentalized in neurons and astrocytes, and astrocytic glycolysis was proposed to serve the energetic demands of glutamatergic activity. Shedding light on the role of astrocytes in brain metabolism, the earlier picture of astrocytes being restricted to a scaffold-associated function in the brain is now out of date. With the development and optimization of non-invasive techniques, such as nuclear magnetic resonance spectroscopy (MRS), several groups have worked on assessing cerebral metabolism in vivo. In this context, 1H MRS has allowed the measurements of energy metabolism-related compounds, whose concentrations can vary under different brain activation states. 1H-[13C] MRS, i.e., indirect detection of signals from 13C-coupled 1H, together with infusion of 13C-enriched glucose has provided insights into the coupling between neurotransmission and glucose oxidation. Although these techniques tackle the coupling between neuronal activity and metabolism, they lack chemical specificity and fail in providing information on neuronal and glial metabolic pathways underlying those processes. Currently, the improvement of detection modalities (i.e., direct detection of 13C isotopomers), the progress in building adequate mathematical models along with the increase in magnetic field strength now available render possible detailed compartmentalized metabolic flux characterization. In particular, direct 13C MRS offers more detailed dataset acquisitions and provides information on metabolic interactions between neurons and astrocytes, and their role in supporting neurotransmission. Here, we review state

  1. How Energy Metabolism Supports Cerebral Function: Insights from (13)C Magnetic Resonance Studies In vivo.

    PubMed

    Sonnay, Sarah; Gruetter, Rolf; Duarte, João M N

    2017-01-01

    Cerebral function is associated with exceptionally high metabolic activity, and requires continuous supply of oxygen and nutrients from the blood stream. Since the mid-twentieth century the idea that brain energy metabolism is coupled to neuronal activity has emerged, and a number of studies supported this hypothesis. Moreover, brain energy metabolism was demonstrated to be compartmentalized in neurons and astrocytes, and astrocytic glycolysis was proposed to serve the energetic demands of glutamatergic activity. Shedding light on the role of astrocytes in brain metabolism, the earlier picture of astrocytes being restricted to a scaffold-associated function in the brain is now out of date. With the development and optimization of non-invasive techniques, such as nuclear magnetic resonance spectroscopy (MRS), several groups have worked on assessing cerebral metabolism in vivo. In this context, (1)H MRS has allowed the measurements of energy metabolism-related compounds, whose concentrations can vary under different brain activation states. (1)H-[(13)C] MRS, i.e., indirect detection of signals from (13)C-coupled (1)H, together with infusion of (13)C-enriched glucose has provided insights into the coupling between neurotransmission and glucose oxidation. Although these techniques tackle the coupling between neuronal activity and metabolism, they lack chemical specificity and fail in providing information on neuronal and glial metabolic pathways underlying those processes. Currently, the improvement of detection modalities (i.e., direct detection of (13)C isotopomers), the progress in building adequate mathematical models along with the increase in magnetic field strength now available render possible detailed compartmentalized metabolic flux characterization. In particular, direct (13)C MRS offers more detailed dataset acquisitions and provides information on metabolic interactions between neurons and astrocytes, and their role in supporting neurotransmission. Here

  2. Offering architects insights into experiences of living with dementia: A case study on orientation in space, time, and identity.

    PubMed

    Van Steenwinkel, Iris; Van Audenhove, Chantal; Heylighen, Ann

    2017-01-01

    Due to memory loss, people with dementia are increasingly disorientated in space, time, and identity, which causes profound experiences of insecurity, anxiety, and homesickness. In the case study presented in this article, we explored how architecture can support people in coping with this challenge. We took a novel approach to offer architects insights into experiences of living with dementia. Starting from a critical realist and constructionist approach, we combined ethnographic techniques with an architectural analysis. This case study offers insights into the experiences and activities of a woman living with dementia within the architectural context of her home. We describe how the physical and social environment provided her guidance through sequences of day-to-day activities. This study highlights how architecture can support people with dementia in orientating by accommodating places for (1) everyday activities and (2) privacy and togetherness.

  3. Trait and State Attributes of Insight in First Episodes of Early-Onset Schizophrenia and Other Psychoses: A 2-Year Longitudinal Study

    PubMed Central

    Parellada, Mara; Boada, Leticia; Fraguas, David; Reig, Santiago; Castro-Fornieles, Josefina; Moreno, Dolores; Gonzalez-Pinto, Ana; Otero, Soraya; Rapado-Castro, Marta; Graell, Montserrat; Baeza, Inmaculada; Arango, Celso

    2011-01-01

    Background: Increasing evidence supports the important role of illness state and individual characteristics in insight. Methods: Insight, as measured with the Scale to Assess Unawareness of Mental Disorder, over the first 2 years of early-onset first-episode psychosis and its correlations with clinical, socio-demographic, cognitive, and structural brain variables are studied. Results: (1) insight at 2 years is poorer in schizophrenia spectrum disorders (SSDs) than in subjects with other psychoses; (2) the more severe the psychosis, the worse the insight. In SSD, depressive symptoms, poorer baseline executive functioning, lower IQ, longer duration of untreated psychosis (DUP), and poorer premorbid infancy adjustment are associated with poorer insight; frontal and parietal gray matter (GM) reductions at baseline correlate with worse insight into having psychotic symptoms at 2 years; (3) insight into having a mental disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1) at 1 year, DUP, and baseline IQ are the most consistent variables explaining different aspects of insight at 2 years in SSD patients. IQ and SUMD1 at 1 year, together with left frontal and parietal GM volumes, explain 80% of the variance of insight into having specific psychotic symptoms in SSD patients (adjusted R2 = 0.795, F = 15.576, P < .001). Conclusion: Insight is a complex phenomenon that depends both on severity of psychopathology and also on disease and subject characteristics, such as past adjustment, IQ, DUP, cognitive functioning, frontal and parietal GM volumes, and age, gender, and ethnicity. PMID:20884756

  4. Parents' experiences of managing their child's postoperative pain at home: an exploratory qualitative study.

    PubMed

    Longard, Julie; Twycross, Alison; Williams, Anna M; Hong, Paul; Chorney, Jill

    2016-09-01

    To understand parents' experiences of managing their child's postoperative pain at home. Recent changes in children's health care services often shift the responsibility of managing children's postoperative pain to parents. Although pain management is important for good postoperative outcomes, it can be a challenging task for families, and children's pain is often under-managed. This qualitative study used semi-structured interviews to explore parents' experiences of managing their child's postoperative pain at home. Participants were parents of 10 typically developing 5- and 6-year olds, who underwent (adeno)tonsillectomy, and experienced no complications leading to hospitalisation in the postoperative period. One-on-one interviews were conducted with parents within three months of their child's surgery. Interviews were transcribed verbatim and content analysis was used to identify themes in parents' experiences. All children experienced some postoperative pain. Parents' experiences of managing their child's pain were impacted by balancing the pros and cons of administering analgesic medications, managing the emotional and psychological effects of their child's pain, as well as parents' information needs. Most parents' information needs were met yet they still struggled to manage their child's pain. These findings provide insight into some of the barriers that make this process challenging for many families, and what health care centres can do to help support parents manage their child's postoperative pain at home. The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences. © 2016 John Wiley & Sons Ltd.

  5. Groundwater-dependent ecosystems: recent insights from satellite and field-based studies

    NASA Astrophysics Data System (ADS)

    Eamus, D.; Zolfaghar, S.; Villalobos-Vega, R.; Cleverly, J.; Huete, A.

    2015-10-01

    Groundwater-dependent ecosystems (GDEs) are at risk globally due to unsustainable levels of groundwater extraction, especially in arid and semi-arid regions. In this review, we examine recent developments in the ecohydrology of GDEs with a focus on three knowledge gaps: (1) how do we locate GDEs, (2) how much water is transpired from shallow aquifers by GDEs and (3) what are the responses of GDEs to excessive groundwater extraction? The answers to these questions will determine water allocations that are required to sustain functioning of GDEs and to guide regulations on groundwater extraction to avoid negative impacts on GDEs. We discuss three methods for identifying GDEs: (1) techniques relying on remotely sensed information; (2) fluctuations in depth-to-groundwater that are associated with diurnal variations in transpiration; and (3) stable isotope analysis of water sources in the transpiration stream. We then discuss several methods for estimating rates of GW use, including direct measurement using sapflux or eddy covariance technologies, estimation of a climate wetness index within a Budyko framework, spatial distribution of evapotranspiration (ET) using remote sensing, groundwater modelling and stable isotopes. Remote sensing methods often rely on direct measurements to calibrate the relationship between vegetation indices and ET. ET from GDEs is also determined using hydrologic models of varying complexity, from the White method to fully coupled, variable saturation models. Combinations of methods are typically employed to obtain clearer insight into the components of groundwater discharge in GDEs, such as the proportional importance of transpiration versus evaporation (e.g. using stable isotopes) or from groundwater versus rainwater sources. Groundwater extraction can have severe consequences for the structure and function of GDEs. In the most extreme cases, phreatophytes experience crown dieback and death following groundwater drawdown. We provide a brief

  6. Hierarchical mechanics of connective tissues: integrating insights from nano to macroscopic studies.

    PubMed

    Gohl, Kheng Lim; Listrat, Anne; Béchet, Daniel

    2014-10-01

    As the key component of the musculoskeletal system, the extracellular matrix of soft connective tissues such as ligaments and tendons is a biological example of fibre-reinforced composite but with a complex hierarchical architecture. To establish a comprehensive structure-function relationship at the respective levels (i.e., from molecule to tissue) of the hierarchical architecture is challenging and requires a multidisciplinary approach, involving the integration of findings from the fields of molecular biology, biochemistry, structural biology, materials science and biophysics. Accordingly, in recent years, some of these fields, namely structural biology, materials science and biophysics, have made significant progress in the microscale and nanoscale studies of extracellular matrix using new tools, such as microelectromechanical systems, optical tweezers and atomic force microscopy, complemented by new techniques in simultaneous imaging and mechanical testing and computer modelling. The intent of this paper is to review the key findings on the mechanical response of extracellular matrix at the respective levels of the hierarchical architecture. The main focus is on the structure and function--the findings are compared across the different levels to provide insights that support the goal of establishing a comprehensive structure-function relationship of extracellular matrix. For this purpose, the review is divided into two parts. The first part explores the features of key structural units of extracellular matrix, namely tropocollagen molecule (the lowest level), microfibril, collagen fibril, collagen fibre and fascicle. The second part examines the mechanics of the structural units at the respective levels. Finally a framework for extracellular matrix mechanics is proposed to support the goal to establish a comprehensive structure-function relationship. The framework describes the integration of the mechanisms of reinforcement by the structural units at the

  7. Collisional Histories of Comets and Trojan Asteroids: Insights from Forsterite and Enstatite Impact Studies

    NASA Technical Reports Server (NTRS)

    Lederer. S. M.; Jensen, E. A.; Wooden, D. H.; Lindsay, S. S.; Smith, D. C.; Cintala, M. J.; Nakamura-Messenger, K.; Keller, L. P.

    2012-01-01

    Impacts into forsterite and orthoenstatite at speeds typically encountered by comets demonstrate that shock imparted by collisions is detectable in the infrared signatures of their dust. The spectral signatures can be traced to physical alterations in their crystalline structures, as observed in TEM imaging and modeled using a dipole approximation. These results yield tantalizing insights into the collisional history of our solar system, as well as the history of individual comets and Trojan asteroids.

  8. Cryogenic Propellant Management Device: Conceptual Design Study

    NASA Technical Reports Server (NTRS)

    Wollen, Mark; Merino, Fred; Schuster, John; Newton, Christopher

    2010-01-01

    Concepts of Propellant Management Devices (PMDs) were designed for lunar descent stage reaction control system (RCS) and lunar ascent stage (main and RCS propulsion) missions using liquid oxygen (LO2) and liquid methane (LCH4). Study ground rules set a maximum of 19 days from launch to lunar touchdown, and an additional 210 days on the lunar surface before liftoff. Two PMDs were conceptually designed for each of the descent stage RCS propellant tanks, and two designs for each of the ascent stage main propellant tanks. One of the two PMD types is a traditional partial four-screen channel device. The other type is a novel, expanding volume device which uses a stretched, flexing screen. It was found that several unique design features simplified the PMD designs. These features are (1) high propellant tank operating pressures, (2) aluminum tanks for propellant storage, and (3) stringent insulation requirements. Consequently, it was possible to treat LO2 and LCH4 as if they were equivalent to Earth-storable propellants because they would remain substantially subcooled during the lunar mission. In fact, prelaunch procedures are simplified with cryogens, because any trapped vapor will condense once the propellant tanks are pressurized in space.

  9. [Evaluation by case managers dementia : An explorative practice based study on types and content].

    PubMed

    Ketelaar, Nicole A B M; Jukema, Jan S; van Bemmel, Marlies; Adriaansen, Marian J M; Smits, Carolien H M

    2017-06-01

    This practice based explorative study aims to provide insight into the ways in which case managers shape and fill up the evaluation phase of their support of the informal care network of persons with dementia. A combination of quantitative and qualitative research methods were used. A group of 57 case managers of persons with dementia in three different organisational networks took part in this study. Results from the quantitative and qualitative data are organized into four themes: (1) attitude towards evaluation, (2) forms of evaluation, (3) implementation of evaluation and (4) content of evaluation. There are different ways in shaping evaluation and the content of it. The importance of interim and final evaluation is recognized, but is difficult to realize in a methodical way. Barriers experienced by the case managers include various factors associated both with clients as professionals. Case managers evaluate continuously and in an informal way to assess whether the extent of their assistance is meeting the needs of the client and informal network. Case managers do not use systematic evaluation to measure the quality of care they offer to persons with dementia and their caregivers. The findings demand a discussion on the level of clients, as well as on the professional and societal level about the way case managers should evaluate their support.

  10. Verification of a Quality Management Theory: Using a Delphi Study

    PubMed Central

    Mosadeghrad, Ali Mohammad

    2013-01-01

    Background: A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model. Methods: The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement. Results: The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation. Conclusion: A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence. PMID:24596883

  11. A Study of MX Environmental Management Information System (MXEMIS) Needs.

    DTIC Science & Technology

    1983-12-01

    ENVIRONMENTAL MANAGEMENT INFORMATION SYSTEM (MXEMIS) NEEDS by Ronald Webster Ralph Mitchell Valorie Young -J : 2 34 LA--. Approved for public release...System (SAIFS) The MX Management Information System (MX MIS) The Mobilization Early Warning System (MEWS) The Computer-Aided Environmental Baseline...26 REFERENCES DISTRIBUTION I5 S’ t A STUDY OF MX ENVIRONMENTAL 2 EXISTING SYSTEMS CLASSIFICATION MANAGEMENT INFORMATION SYSTEM (MXEMIS

  12. Energy management study for lunar oxygen production

    NASA Technical Reports Server (NTRS)

    Fazzolare, R. A.; Wong-Swanson, B. G.

    1989-01-01

    Energy management opportunities in the process of hydrogen reduction of ilmenite for lunar oxygen production are being investigated. An optimal energy system to supply the power requirements for the process will be determined.

  13. Effect of reflective practice education on self-reflection, insight, and reflective thinking among experienced nurses: a pilot study.

    PubMed

    Asselin, Marilyn E; Fain, James A

    2013-01-01

    A mixed-method study was conducted to determine whether nurses' participation in a reflective practice continuing education program using a structured reflection model makes a difference in nurses' self-reflection, insight, and reflective thinking about clinical practice situations. Findings suggested that use of structured reflection using question cues, written narratives, and peer-facilitated reflection increased nurses' engagement in self-reflection and enhanced reflective thinking in practice. Including reflective practice education in novice orientation and preceptor training may be beneficial.

  14. Metagenomics: Tools and Insights for Analyzing Next-Generation Sequencing Data Derived from Biodiversity Studies

    PubMed Central

    Oulas, Anastasis; Pavloudi, Christina; Polymenakou, Paraskevi; Pavlopoulos, Georgios A; Papanikolaou, Nikolas; Kotoulas, Georgios; Arvanitidis, Christos; Iliopoulos, Ioannis

    2015-01-01

    Advances in next-generation sequencing (NGS) have allowed significant breakthroughs in microbial ecology studies. This has led to the rapid expansion of research in the field and the establishment of “metagenomics”, often defined as the analysis of DNA from microbial communities in environmental samples without prior need for culturing. Many metagenomics statistical/computational tools and databases have been developed in order to allow the exploitation of the huge influx of data. In this review article, we provide an overview of the sequencing technologies and how they are uniquely suited to various types of metagenomic studies. We focus on the currently available bioinformatics techniques, tools, and methodologies for performing each individual step of a typical metagenomic dataset analysis. We also provide future trends in the field with respect to tools and technologies currently under development. Moreover, we discuss data management, distribution, and integration tools that are capable of performing comparative metagenomic analyses of multiple datasets using well-established databases, as well as commonly used annotation standards. PMID:25983555

  15. Insight into the Dzyaloshinskii-Moriya interaction through first-principles study of chiral magnetic structures

    NASA Astrophysics Data System (ADS)

    Sandratskii, L. M.

    2017-07-01

    The purpose of the paper is to gain deeper insight into microscopic formation of the Dzyaloshinskii-Moriya interaction (DMI). The paper aims at the development of the physical picture able to address apparently contradicting conclusions of recent studies concerning the location of the DMI energy in the real and reciprocal spaces as well as the relation between values of the atomic moments and the DMI strength. The main tools of our study are the first-principles calculations of the energies of the spiral magnetic states with opposite chiralities. We suggest a method of the calculation of the spiral structures with account for the spin-orbit coupling (SOC). It is based on the application of the generalized Bloch theorem and generalized Bloch functions and allows to reduce the consideration of arbitrary incommensurate spiral to small chemical unit cell. The method neglects the anisotropy in the plane orthogonal to the rotation axis of the spirals that does not influence importantly the DMI energy. For comparison, the supercell calculation with full account for the SOC is performed. The concrete calculations are performed for the Co/Pt bilayer. We consider the distribution of the DMI energy in both real and reciprocal spaces and the dependence of the DMI on the number of electrons. The results of the calculations reveal a number of energy compensations in the formation of the DMI. Thus, the partial atomic contributions as functions of the spiral wave vector q are nonmonotonic and have strongly varying slopes. However, in the total DMI energy these atom-related features compensate each other, resulting in a smooth q dependence. The reason for the peculiar form of the partial DMI contributions is a q -dependent difference in the charge distribution between q and -q spirals. The strongly q -dependent relation between atomic contributions shows that the real-space distribution of the DMI energy obtained for a selected q value cannot be considered as a general

  16. Ecological speciation in the tropics: insights from comparative genetic studies in Amazonia

    PubMed Central

    Beheregaray, Luciano B.; Cooke, Georgina M.; Chao, Ning L.; Landguth, Erin L.

    2015-01-01

    Evolution creates and sustains biodiversity via adaptive changes in ecologically relevant traits. Ecologically mediated selection contributes to genetic divergence both in the presence or absence of geographic isolation between populations, and is considered an important driver of speciation. Indeed, the genetics of ecological speciation is becoming increasingly studied across a variety of taxa and environments. In this paper we review the literature of ecological speciation in the tropics. We report on low research productivity in tropical ecosystems and discuss reasons accounting for the rarity of studies. We argue for research programs that simultaneously address biogeographical and taxonomic questions in the tropics, while effectively assessing relationships between reproductive isolation and ecological divergence. To contribute toward this goal, we propose a new framework for ecological speciation that integrates information from phylogenetics, phylogeography, population genomics, and simulations in evolutionary landscape genetics (ELG). We introduce components of the framework, describe ELG simulations (a largely unexplored approach in ecological speciation), and discuss design and experimental feasibility within the context of tropical research. We then use published genetic datasets from populations of five codistributed Amazonian fish species to assess the performance of the framework in studies of tropical speciation. We suggest that these approaches can assist in distinguishing the relative contribution of natural selection from biogeographic history in the origin of biodiversity, even in complex ecosystems such as Amazonia. We also discuss on how to assess ecological speciation using ELG simulations that include selection. These integrative frameworks have considerable potential to enhance conservation management in biodiversity rich ecosystems and to complement historical biogeographic and evolutionary studies of tropical biotas. PMID:25653668

  17. Ecological speciation in the tropics: insights from comparative genetic studies in Amazonia.

    PubMed

    Beheregaray, Luciano B; Cooke, Georgina M; Chao, Ning L; Landguth, Erin L

    2014-01-01

    Evolution creates and sustains biodiversity via adaptive changes in ecologically relevant traits. Ecologically mediated selection contributes to genetic divergence both in the presence or absence of geographic isolation between populations, and is considered an important driver of speciation. Indeed, the genetics of ecological speciation is becoming increasingly studied across a variety of taxa and environments. In this paper we review the literature of ecological speciation in the tropics. We report on low research productivity in tropical ecosystems and discuss reasons accounting for the rarity of studies. We argue for research programs that simultaneously address biogeographical and taxonomic questions in the tropics, while effectively assessing relationships between reproductive isolation and ecological divergence. To contribute toward this goal, we propose a new framework for ecological speciation that integrates information from phylogenetics, phylogeography, population genomics, and simulations in evolutionary landscape genetics (ELG). We introduce components of the framework, describe ELG simulations (a largely unexplored approach in ecological speciation), and discuss design and experimental feasibility within the context of tropical research. We then use published genetic datasets from populations of five codistributed Amazonian fish species to assess the performance of the framework in studies of tropical speciation. We suggest that these approaches can assist in distinguishing the relative contribution of natural selection from biogeographic history in the origin of biodiversity, even in complex ecosystems such as Amazonia. We also discuss on how to assess ecological speciation using ELG simulations that include selection. These integrative frameworks have considerable potential to enhance conservation management in biodiversity rich ecosystems and to complement historical biogeographic and evolutionary studies of tropical biotas.

  18. The Asthma Insights and Reality in the Maghreb (AIRMAG) study: perspectives and lessons.

    PubMed

    Bourdin, Arnaud; Doble, Adam; Godard, Philippe

    2009-12-01

    Asthma is the most frequently encountered allergic respiratory disease, and one that has a potentially serious impact on patients' functioning and well-being. From a public health perspective, it is important to collect data on the prevalence, burden and management of asthma in order to improve understanding of the pathogenesis of asthma and to ensure that national healthcare policies are adapted and appropriate. In this respect, the different AIR surveys, which have collected standardised data on asthma in the general population of a large number of countries around the world, have made an important contribution. The latest of these surveys is the AIRMAG survey, performed in the three Maghreb countries of Algeria, Morocco and Tunisia. In these countries, the prevalence of asthma (3.4% to 3.9%) is in the low to moderate range. This is consistent with rates observed elsewhere in the Mediterranean basin. Nonetheless, the prevalence of asthma in the Maghreb may be expected to rise in the future as populations become more urbanized and adopt a more 'Westernized' lifestyle. Indeed the prevalence of asthma is already higher in the urban coastal regions of these countries than in the more rural mountainous and desert regions. Asthma control in the Maghreb is relatively poor compared to other regions evaluated in previous AIR studies, with control being unacceptable in around three-quarters of respondents. Although part of the explanation may reside in limited access to care, treatment rates for inhaled corticosteroids (26.1% of adults and 29.1% of children) were no worse than those reported in previous AIR studies. On the other hand, asthma monitoring through regular follow-up visits, home flow-meter use and preparation of individualised asthma management plans was in general unsatisfactory. In addition, awareness of asthma in the general population of the Maghreb countries was low. Education measures directed at the patient, together with programmes directed at the

  19. Integrated dementia care in The Netherlands: a multiple case study of case management programmes.

    PubMed

    Minkman, Mirella M N; Ligthart, Suzanne A; Huijsman, Robbert

    2009-09-01

    The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy

  20. Quantum chemistry behind bioimaging: insights from ab initio studies of fluorescent proteins and their chromophores.

    PubMed

    Bravaya, Ksenia B; Grigorenko, Bella L; Nemukhin, Alexander V; Krylov, Anna I

    2012-02-21

    The unique properties of green fluorescent protein (GFP) have been harnessed in a variety of bioimaging techniques, revolutionizing many areas of the life sciences. Molecular-level understanding of the underlying photophysics provides an advantage in the design of new fluorescent proteins (FPs) with improved properties; however, because of its complexity, many aspects of the GFP photocycle remain unknown. In this Account, we discuss computational studies of FPs and their chromophores that provide qualitative insights into mechanistic details of their photocycle and the structural basis for their optical properties. In a reductionist framework, studies of well-defined model systems (such as isolated chromophores) help to understand their intrinsic properties, while calculations including protein matrix and/or solvent demonstrate, on the atomic level, how these properties are modulated by the environment. An interesting feature of several anionic FP chromophores in the gas phase is their low electron detachment energy. For example, the bright excited ππ* state of the model GFP chromophore (2.6 eV) lies above the electron detachment continuum (2.5 eV). Thus, the excited state is metastable with respect to electron detachment. This autoionizing character needs to be taken into account in interpreting gas-phase measurements and is very difficult to describe computationally. Solvation (and even microsolvation by a single water molecule) stabilizes the anionic states enough such that the resonance excited state becomes bound. However, even in stabilizing environments (such as protein or solution), the anionic chromophores have relatively low oxidation potentials and can act as light-induced electron donors. Protein appears to affect excitation energies very little (<0.1 eV), but alters ionization or electron detachment energies by several electron volts. Solvents (especially polar ones) have a pronounced effect on the chromophore's electronic states; for example, the

  1. Insights from early experience of a Rare Disease Genomic Medicine Multidisciplinary Team: a qualitative study.

    PubMed

    Ormondroyd, Elizabeth; Mackley, Michael P; Blair, Edward; Craft, Jude; Knight, Julian C; Taylor, John; Taylor, Jenny C; Wilkie, Andrew Om; Watkins, Hugh

    2017-06-01

    Whole-exome/whole-genome sequencing (WES/WGS) has the potential to enhance genetic diagnosis of rare disease, and is increasingly becoming part of routine clinical care in mainstream medicine. Effective translation will require ongoing efforts in a number of areas including: selection of appropriate patients, provision of effective consent, pre- and post-test genetic counselling, improving variant interpretation algorithms and practices, and management of secondary findings including those found incidentally and those actively sought. Allied to this is the need for an effective education programme for all members of clinical teams involved in care of patients with rare disease, as well as to maintain public confidence in the use of these technologies. We established a Genomic Medicine Multidisciplinary Team (GM-MDT) in 2014 to build on the experiences of earlier successful research-based WES/WGS studies, to address these needs and to review results including pertinent and secondary findings. Here we report on a qualitative study of decision-making in the GM-MDT combined with analysis of semi-structured interviews with GM-MDT members. Study findings show that members appreciate the clinical and scientific diversity of the GM-MDT and value it for education and oversight. To date, discussions have focussed on case selection including the extent and interpretation of clinical and family history information required to establish likely monogenic aetiology and inheritance model. Achieving a balance between effective use of WES/WGS - prioritising cases in a diverse and highly complex patient population where WES/WGS will be tractable - and meeting the recruitment targets of a large project is considered challenging.

  2. Physical activity patterns in urban neighbourhood parks: insights from a multiple case study.

    PubMed

    McCormack, Gavin R; Rock, Melanie; Swanson, Kenda; Burton, Lindsay; Massolo, Alessandro

    2014-09-17

    Many characteristics of urban parks and neighbourhoods have been linked to patterns of physical activity, yet untangling these relationships to promote increased levels of physical activity presents methodological challenges. Based on qualitative and quantitative data, this article describes patterns of activity within urban parks and the socio-demographic characteristics of park visitors. It also accounts for these patterns in relation to the attributes of parks and their surrounding neighbourhoods. A multiple case study was undertaken that incorporated quantitative and qualitative data derived from first-hand observation in a purposive sample of four urban parks. Quantitative data, based on direct observation of visitors' patterns of use and socio-demographic characteristics, were collected using a structured instrument. Differences in frequencies of observed activities and socio-demographic characteristics of visitors were compared between the four parks. Qualitative data, based on direct observation of park characteristics and patterns of use, were generated through digital photography and analyzed through captioning. Quantitative data on patterns in activity and socio-demographic characteristics were synthesized with the qualitative data on park and usage characteristics. A comprehensive portrait of each park in the study was generated. Activity types (sedentary, walking, dog-related, cycling, and play), patterns of park use (time of day, day of week), and socio-demographic characteristics (age group, social group) differed between the four parks. Patterns in park use and activity appeared to be associated with socio-demographic characteristics of the surrounding neighbourhoods as well as the physical and social environmental characteristics specific to each park. Both park and neighbourhood characteristics influence patterns of use and physical activity within parks. The study findings suggest that socio-demographic characteristics of neighbourhoods

  3. Trace organic chemical attenuation during managed aquifer recharge: Insights from a variably saturated 2D tank experiment

    NASA Astrophysics Data System (ADS)

    Regnery, Julia; Lee, Jonghyun; Drumheller, Zachary W.; Drewes, Jörg E.; Illangasekare, Tissa H.; Kitanidis, Peter K.; McCray, John E.; Smits, Kathleen M.

    2017-05-01

    Meaningful model-based predictions of water quality and quantity are imperative for the designed footprint of managed aquifer recharge installations. A two-dimensional (2D) synthetic MAR system equipped with automated sensors (temperature, water pressure, conductivity, soil moisture, oxidation-reduction potential) and embedded water sampling ports was used to test and model fundamental subsurface processes during surface spreading managed aquifer recharge operations under controlled flow and redox conditions at the meso-scale. The fate and transport of contaminants in the variably saturated synthetic aquifer were simulated using the finite element analysis model, FEFLOW. In general, the model concurred with travel times derived from contaminant breakthrough curves at individual sensor locations throughout the 2D tank. However, discrepancies between measured and simulated trace organic chemical concentrations (i.e., carbamazepine, sulfamethoxazole, tris (2-chloroethyl) phosphate, trimethoprim) were observed. While the FEFLOW simulation of breakthrough curves captured overall shapes of trace organic chemical concentrations well, the model struggled with matching individual data points, although compound-specific attenuation parameters were used. Interestingly, despite steady-state operation, oxidation-reduction potential measurements indicated temporal disturbances in hydraulic properties in the saturated zone of the 2D tank that affected water quality.

  4. Electrophysiological Mechanisms of Brugada Syndrome: Insights from Pre-clinical and Clinical Studies

    PubMed Central

    Tse, Gary; Liu, Tong; Li, Ka H. C.; Laxton, Victoria; Chan, Yin W. F.; Keung, Wendy; Li, Ronald A.; Yan, Bryan P.

    2016-01-01

    Brugada syndrome (BrS), is a primary electrical disorder predisposing affected individuals to sudden cardiac death via the development of ventricular tachycardia and fibrillation (VT/VF). Originally, BrS was linked to mutations in the SCN5A, which encodes for the cardiac Na+ channel. To date, variants in 19 genes have been implicated in this condition, with 11, 5, 3, and 1 genes affecting the Na+, K+, Ca2+, and funny currents, respectively. Diagnosis of BrS is based on ECG criteria of coved- or saddle-shaped ST segment elevation and/or T-wave inversion with or without drug challenge. Three hypotheses based on abnormal depolarization, abnormal repolarization, and current-load-mismatch have been put forward to explain the electrophysiological mechanisms responsible for BrS. Evidence from computational modeling, pre-clinical, and clinical studies illustrates that molecular abnormalities found in BrS lead to alterations in excitation wavelength (λ), which ultimately elevates arrhythmic risk. A major challenge for clinicians in managing this condition is the difficulty in predicting the subset of patients who will suffer from life-threatening VT/VF. Several repolarization risk markers have been used thus far, but these neglect the contributions of conduction abnormalities in the form of slowing and dispersion. Indices incorporating both repolarization and conduction and based on the concept of λ have recently been proposed. These may have better predictive values than the existing markers. PMID:27803673

  5. Electrophysiological Mechanisms of Bayés Syndrome: Insights from Clinical and Mouse Studies

    PubMed Central

    Tse, Gary; Lai, Eric Tsz Him; Yeo, Jie Ming; Yan, Bryan P.

    2016-01-01

    Bayés syndrome is an under-recognized clinical condition characterized by inter-atrial block (IAB). This is defined electrocardiographically as P-wave duration > 120 ms and can be categorized into first, second and third degree IAB. It can be caused by inflammatory conditions such as systemic sclerosis and rheumatoid arthritis, abnormal protein deposition in cardiac amyloidosis, or neoplastic processes invading the inter-atrial conduction system, such as primary cardiac lymphoma. It may arise transiently during volume overload, autonomic dysfunction or electrolyte disturbances from vomiting. In other patients without an obvious cause, the predisposing factors are diabetes mellitus, hypertensive heart disease, and hypercholesterolemia. IAB has a strong association with atrial arrhythmogenesis, left atrial enlargement (LAE), and electro-mechanical discordance, increasing the risk of cerebrovascular accidents as well as myocardial and mesenteric ischemia. The aim of this review article is to synthesize experimental evidence on the pathogenesis of IAB and its underlying molecular mechanisms. Current medical therapies include anti-fibrotic, anti-arrhythmic and anti-coagulation agents, whereas interventional options include atrial resynchronization therapy by single or multisite pacing. Future studies will be needed to elucidate the significance of the link between IAB and atrial tachyarrhythmias in patients with different underlying etiologies and optimize the management options in these populations. PMID:27303306

  6. What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies

    PubMed Central

    Tse, Gary; Yeo, Jie M.; Chan, Yin Wah; Lai, Eric T. H. Lai; Yan, Bryan P.

    2016-01-01

    Sudden cardiac death (SCD) remains an unsolved problem in the twenty-first century. It is often due to rapid onset, ventricular arrhythmias caused by a number of different clinical conditions. A proportion of SCD patients have identifiable diseases such as cardiomyopathies, but for others, the causes are unknown. Viral myocarditis is becoming increasingly recognized as a contributor to unexplained mortality, and is thought to be a major cause of SCD in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological, and structural remodeling may play important roles in generating life-threatening arrhythmias. The aim of this review article is to examine the electrophysiology of action potential conduction and repolarization and the mechanisms by which their derangements lead to triggered and reentrant arrhythmogenesis. By synthesizing experimental evidence from pre-clinical and clinical studies, a framework of how host (inflammation), and viral (altered cellular signaling) factors can induce ion electrophysiological and structural remodeling is illustrated. Current pharmacological options are mainly supportive, which may be accompanied by mechanical circulatory support. Heart transplantation is the only curative option in the worst case scenario. Future strategies for the management of viral myocarditis are discussed. PMID:27493633

  7. Parents' beliefs and knowledge about the management of acute otitis media: a qualitative study.

    PubMed

    Hansen, Malene Plejdrup; Howlett, Janine; Del Mar, Chris; Hoffmann, Tammy C

    2015-07-07

    Acute otitis media is a common reason for antibiotic prescribing, despite strong evidence that antibiotics provide minimal benefit. Studies have demonstrated that patients' (or parents') expectations of antibiotics often influence general practitioners' (GPs) decision to prescribe antibiotics, but few have explored parents' expectations of the management of infections in children, or which factors influence the development of these expectations. This study aimed to explore parents' knowledge and beliefs about the management of acute otitis media in children. Individual semi-structured interviews were conducted with 15 parents of children who had recently presented to their GP with acute otitis media. Parents were recruited at childcare centres or playgroups in Brisbane, Australia. Many parents did not have an accurate understanding of what causes acute otitis media. GPs were primarily consulted for the management of symptoms such as pain and fever. Others specifically wanted reassurance or were concerned about hearing loss. Most parents assumed that antibiotics were the best treatment option. Parents' perceptions about the best treatment were mainly based on their previous experience and the advice of the GP. Pain relief medications, such as paracetamol and non-steroidal anti-inflammatory drugs, were not considered by parents to be sufficient treatment on their own. There is discrepancy between parents' beliefs and expectations of management of acute otitis media and the evidence-based recommendations. This study provides insights into parents' expectations of management of acute otitis media, which may help inform clinicians about perceptions and misperceptions that may be valuable to elicit and discuss.

  8. Insights into RNA structure and function from genome-wide studies.

    PubMed

    Mortimer, Stefanie A; Kidwell, Mary Anne; Doudna, Jennifer A

    2014-07-01

    A comprehensive understanding of RNA structure will provide fundamental insights into the cellular function of both coding and non-coding RNAs. Although many RNA structures have been analysed by traditional biophysical and biochemical methods, the low-throughput nature of these approaches has prevented investigation of the vast majority of cellular transcripts. Triggered by advances in sequencing technology, genome-wide approaches for probing the transcriptome are beginning to reveal how RNA structure affects each step of protein expression and RNA stability. In this Review, we discuss the emerging relationships between RNA structure and the regulation of gene expression.

  9. New Insights into Fluvial Carbon Responses to Future Forest Management and Climate Change Obtained from Multi-Scale Modelling of Biogeochemical Processes

    NASA Astrophysics Data System (ADS)

    Oni, S. K.; Tiwari, T.; Futter, M. N.; Agren, A.; Teutschbein, C.; Ledesma, J.; Schelker, J.; Laudon, H.

    2014-12-01

    The boreal ecozone covers 2x107 km2 of the northern circumpolar region and includes 29% of the world's forests. The boreal consists of mosaic of forest/wetland landscape elements and stores about 500 Gt3 carbon (C) with a delicate sink-source C balance. Dissolved organic carbon (DOC) is the main form of C exported from boreal landscapes and is fundamental to global C cycling. This northern ecosystem is vulnerable to global climate change, and increasing demands for forest products threaten its surface water resources. So far, there have been no attempts to assess the combined impacts of climate change and forest management on the future DOC fluxes from boreal surface waters. While differences in model assumptions may have negligible effects on present day simulations, these differences could be amplified when projecting the future climate and land use change conditions. Here we use an ensemble of regional climate models and multi-scale models of biogeochemical processes to gain insights into uncertainties associated with climate change and forest management on C and runoff dynamics in boreal landscape. While there are significant uncertainties associated with model projections, our results show that climate change will be the main driver of long term DOC dynamics in meso- to large boreal catchments in the future. However, forestry intensifies hydrological processes and can lead to large DOC fluxes at the headwater scales.

  10. Management case study: Tampa Bay, Florida

    USGS Publications Warehouse

    Morrison, Gerold; Greening, Holly; Yates, Kimberly K.; Wolanski, Eric; McLusky, Donald S.

    2011-01-01

    Tampa Bay, Florida, USA, is a shallow, subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of seagrasses and other selected habitat types, to support estuarine-dependent faunal guilds. Over the past three decades, nitrogen controls involving sources such as wastewater treatment plants, stormwater conveyance systems, fertilizer manufacturing and shipping operations, and power plants have been undertaken to meet these and other management objectives. Cumulatively, these controls have resulted in a 60% reduction in annual total nitrogen (TN) loads relative to earlier worse-case (latter 1970s) conditions. As a result, annual water-clarity and chlorophyll a targets are currently met in most years, and seagrass cover measured in 2008 was the highest recorded since 1950. Factors that have contributed to the observed improvements in Tampa Bay over the past several decades include the following: (1) Development of numeric, science-based water-quality targets to meet a long-term goal of restoring seagrass acreage to 1950s levels. Empirical and mechanistic models found that annual average chlorophyll a concentrations were a primary manageable factor affecting light attenuation. The models also quantified relationships between TN loads, chlorophyll a concentrations, light attenuation, and fluctuations in seagrass cover. The availability of long-term monitoring data, and a systematic process for using the data to evaluate the effectiveness of management actions, has allowed managers to track progress and

  11. Concepts of health and well-being in managers: An organizational study.

    PubMed

    Mayer, Claude-Hélène; Boness, Christian

    2011-01-01

    Global changes and new managerial challenges require new concepts of health and well-being in organizational contexts. In the South African context, health and well-being of managers have gained relevance in organizations and in management sciences. International organizations, in particular, attempt to address the increasing demand for health care and the delivery of health services to their managers. Careful and appropriate health management requires research to evaluate context-specific health concepts and strategies. The purpose and aim of this article is to assess managerial concepts on health and well-being that could be used by the organization to contribute to managerial well-being by implementing health promotion according to managerial needs. At the same time, this article contributes to salutogenetic health research that is very rare with regard to the South African organizational management research.This study is a multi-method research study conducted in a selected international organization in South Africa. However, in this article, selected qualitative findings will only be presented.This organizational study presents selected research findings on health concepts and strategies employed by managers. Findings demonstrate that the managerial concepts of health and strategies mainly refer to not only physical but also to mental and spiritual aspects, with a priority on physical health and well-being.The findings presented are based on qualitative research methods and their research criteria.This assessment serves as a foundation for new approaches to health management within the international work context in South Africa. It also contributes to a paradigm shift from pathogenetic to salutogenetic concepts of health and well-being within the South African organizational work context.The article produces new insights into the qualitative health concepts of South African managers and expatriates and contributes to promoting salutogenesis in organization

  12. Concepts of health and well-being in managers: An organizational study

    PubMed Central

    Boness, Christian

    2011-01-01

    Global changes and new managerial challenges require new concepts of health and well-being in organizational contexts. In the South African context, health and well-being of managers have gained relevance in organizations and in management sciences. International organizations, in particular, attempt to address the increasing demand for health care and the delivery of health services to their managers. Careful and appropriate health management requires research to evaluate context-specific health concepts and strategies. The purpose and aim of this article is to assess managerial concepts on health and well-being that could be used by the organization to contribute to managerial well-being by implementing health promotion according to managerial needs. At the same time, this article contributes to salutogenetic health research that is very rare with regard to the South African organizational management research. This study is a multi-method research study conducted in a selected international organization in South Africa. However, in this article, selected qualitative findings will only be presented. This organizational study presents selected research findings on health concepts and strategies employed by managers. Findings demonstrate that the managerial concepts of health and strategies mainly refer to not only physical but also to mental and spiritual aspects, with a priority on physical health and well-being. The findings presented are based on qualitative research methods and their research criteria. This assessment serves as a foundation for new approaches to health management within the international work context in South Africa. It also contributes to a paradigm shift from pathogenetic to salutogenetic concepts of health and well-being within the South African organizational work context. The article produces new insights into the qualitative health concepts of South African managers and expatriates and contributes to promoting salutogenesis in

  13. Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study.

    PubMed

    Lebeaux, David; Freund, Romain; van Delden, Christian; Guillot, Hélène; Marbus, Sierk D; Matignon, Marie; Van Wijngaerden, Eric; Douvry, Benoit; De Greef, Julien; Vuotto, Fanny; Tricot, Leïla; Fernández-Ruiz, Mario; Dantal, Jacques; Hirzel, Cédric; Jais, Jean-Philippe; Rodriguez-Nava, Veronica; Jacobs, Frédérique; Lortholary, Olivier; Coussement, Julien

    2017-05-15

    Solid organ transplant (SOT) recipients are at risk of nocardiosis, a rare opportunistic bacterial infection, but prognosis and outcome of these patients are poorly defined. Our objectives were to identify factors associated with 1-year mortality after nocardiosis and describe the outcome of patients receiving short-course antibiotics (≤120 days). We analyzed data from a multicenter European case-control study that included 117 SOT recipients with nocardiosis diagnosed between 2000 and 2014. Factors associated with 1-year all-cause mortality were identified using multivariable conditional logistic regression. One-year mortality was 10-fold higher in patients with nocardiosis (16.2%, 19/117) than in control transplant recipients (1.3%, 3/233, P < .001). A history of tumor (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8), invasive fungal infection (OR, 1.3; 95% CI, 1.1-1.5), and donor age (OR, 1.0046; 95% CI, 1.0007-1.0083) were independently associated with 1-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR, 0.85; 95% CI, 0.73-0.98). Seventeen patients received short-course antibiotics (median duration 56 [24-120] days) with a 1-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 [6-136] months). One-year mortality was 10-fold higher in SOT patients with nocardiosis than in those without. Four factors, largely reflecting general medical condition rather than severity and/or management of nocardiosis, were independently associated with 1-year mortality. Patients who received short-course antibiotic treatment had good outcomes, suggesting that this may be a strategy for further study.

  14. Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies.

    PubMed

    Clavier, Carole; Gendron, Sylvie; Lamontagne, Lise; Potvin, Louise

    2012-07-01

    This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme-context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004-2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent-child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of

  15. Managing boundaries between professional and lay nursing following the influenza pandemic, 1918-1919: insights for professional resilience today?

    PubMed

    Wood, Pamela J

    2017-03-01

    To examine lay-professional nursing boundaries, using challenges to the New Zealand nursing profession following the 1918-1919 influenza pandemic as the example. The influenza pandemic of 1918-1919 had an overwhelming international impact on communities and the nursing profession. After the pandemic, the expectation for communities to be able to nurse the sick reflects today's increasing reliance on families to care for people at home. It similarly raised questions about the profession's role and professional boundaries in relation to volunteer or lay nursing. In New Zealand, the postpandemic challenge to build community lay nursing capacity tested these boundaries. Historical research. Analysis of historical primary sources of official reports, newspaper accounts, articles in New Zealand's professional nursing journal Kai Tiaki and the memoir of Hester Maclean, the country's chief nurse. Interpretation of findings in relation to secondary sources examining similar historical tensions between professional and lay nursing, and to the more recent notion of professional resilience. Maclean guarded nursing's professional boundaries by maintaining considerable control over community instruction in nursing and by strenuously resisting the suggestion that this should be done in hospitals where professional nurses trained. This historical example shows how the nursing profession faced the perceived threat to its professional boundaries. It also shows how competing goals of building community lay nursing capacity and protecting professional boundaries can be effectively managed. In the context of a global nursing shortage, limited healthcare budgets and a consequently increasing reliance on households to provide care for family members, this historical research shows nurses today that similar issues have been faced and effectively managed in the past. © 2016 John Wiley & Sons Ltd.

  16. Space station human productivity study. Volume 5: Management plans

    NASA Technical Reports Server (NTRS)

    1985-01-01

    The 67 Management Plans represent recommended study approaches for resolving 108 of the 305 Issues which were identified. Each study Management Plan is prepared in three formats: Management Plan Overview (lists the subsumed Issues, study background, and related overview information); Study Plan (details the study approach by tasks, lists special needs, and describes expected study products); Schedule-Task Flow (provides a time-lined schedule for the study tasks and resource requirements). The Management Relationships Matrix, included in this volume, shows the data input-output relationships among all recommended studies. A listing is also included which cross-references the unresolved requirements to Issues to management plans. A glossary of all abbreviations utilized is provided.

  17. Wildlife disease ecology from the individual to the population: Insights from a long-term study of a naturally infected European badger population.

    PubMed

    McDonald, Jenni L; Robertson, Andrew; Silk, Matthew J

    2017-08-16

    Long-term individual-based datasets on host-pathogen systems are a rare and valuable resource for understanding the infectious disease dynamics in wildlife. A study of European badgers (Meles meles) naturally infected with bovine tuberculosis (bTB) at Woodchester Park in Gloucestershire (UK) has produced a unique dataset, facilitating investigation of a diverse range of epidemiological and ecological questions with implications for disease management. Since the 1970s, this badger population has been monitored with a systematic mark-recapture regime yielding a dataset of >15,000 captures of >3,000 individuals, providing detailed individual life-history, morphometric, genetic, reproductive and disease data. The annual prevalence of bTB in the Woodchester Park badger population exhibits no straightforward relationship with population density, and both the incidence and prevalence of Mycobacterium bovis show marked variation in space. The study has revealed phenotypic traits that are critical for understanding the social structure of badger populations along with mechanisms vital for understanding disease spread at different spatial resolutions. Woodchester-based studies have provided key insights into how host ecology can influence infection at different spatial and temporal scales. Specifically, it has revealed heterogeneity in epidemiological parameters; intrinsic and extrinsic factors affecting population dynamics; provided insights into senescence and individual life histories; and revealed consistent individual variation in foraging patterns, refuge use and social interactions. An improved understanding of ecological and epidemiological processes is imperative for effective disease management. Woodchester Park research has provided information of direct relevance to bTB management, and a better appreciation of the role of individual heterogeneity in disease transmission can contribute further in this regard. The Woodchester Park study system now offers a rare

  18. Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies

    PubMed Central

    Sgaier, Sema K; Baer, James; Rutz, Daniel C; Njeuhmeli, Emmanuel; Seifert-Ahanda, Kim; Basinga, Paulin; Parkyn, Rosie; Laube, Catharine

    2015-01-01

    By the end of 2014, an estimated 8.5 million men had undergone voluntary medical male circumcision (VMMC) for HIV prevention in 14 priority countries in eastern and southern Africa, representing more than 40% of the global target. However, demand, especially among men most at risk for HIV infection, remains a barrier to realizing the program's full scale and potential impact. We analyzed current demand generation interventions for VMMC by reviewing the available literature and reporting on field visits to programs in 7 priority countries. We present our findings and recommendations using a framework with 4 components: insight development; intervention design; implementation and coordination to achieve scale; and measurement, learning, and evaluation. Most program strategies lacked comprehensive insight development; formative research usually comprised general acceptability studies. Demand generation interventions varied across the countries, from advocacy with community leaders and community mobilization to use of interpersonal communication, mid- and mass media, and new technologies. Some shortcomings in intervention design included using general instead of tailored messaging, focusing solely on the HIV preventive benefits of VMMC, and rolling out individual interventions to address specific barriers rather than a holistic package. Interventions have often been scaled-up without first being evaluated for effectiveness and cost-effectiveness. We recommend national programs create coordinated demand generation interventions, based on insights from multiple disciplines, tailored to the needs and aspirations of defined subsets of the target population, rather than focused exclusively on HIV prevention goals. Programs should implement a comprehensive intervention package with multiple messages and channels, strengthened through continuous monitoring. These insights may be broadly applicable to other programs where voluntary behavior change is essential to achieving

  19. Exploring competencies: a qualitative study of Chinese nurse managers.

    PubMed

    Luo, Wen-Yi; Shen, Nan-Ping; Lou, Jian-Hua; He, Ping-Ping; Sun, Ji-Wen

    2016-01-01

    To identify core competencies needed in the transition of nurse managers on the way to excellence. There is growing recognition of the importance of nurse managers in hospitals. Most managers still learn through their failures and few studies have described the perceptions of nurse managers in China. It is vital to understand what competencies Chinese nurse managers should have in order to establish suitable training programmes and improve their management skills. A phenomenological approach that included in-depth interviews with 12 nurse managers in six Chinese hospitals was conducted. The transition to management included four phases: the adaptive phase, the running-in and stable phase, the stagnation phase and the maturation phase. In order to fulfil their clinical responsibilities, nurse managers need to develop multifaceted competencies, specifically in communication and stress management. Ideally, nurse managers should progress through the four phases mentioned above to achieve excellence. There is a requirement for utilising various methods for nurse managers in adapting new roles, improving communication and relieving stress. © 2015 John Wiley & Sons Ltd.

  20. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    PubMed Central

    2012-01-01

    Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary

  1. Everyday Functioning in Huntington's Disease: A Laboratory-Based Study of Financial Management Capacity.

    PubMed

    Sheppard, David P; Pirogovsky-Turk, Eva; Woods, Steven Paul; Holden, Heather M; Nicoll, Diane R; Filoteo, J Vincent; Corey-Bloom, Jody; Gilbert, Paul E

    2017-01-01

    One important limitation of prior studies examining functional decline in Huntington's disease (HD) has been the reliance on self-reported measures of ability. Since report-based methods can be biased by lack of insight, depression, and cognitive impairment, contrasting self-reported ability with measures that assess capacity may lead to a more comprehensive estimation of real-world functioning. The present study examined self-reported ability to perform instrumental activities of daily living (iADLs) and performance-based financial management capacity in 20 patients diagnosed with mild-moderate Huntington's disease (HD) and 20 demographically similar healthy adults. HD patients reported significantly greater declines in their ability to manage finances. On the capacity measure of financial management, HD patients performed significantly below healthy adults. Additionally, in the HD group there were no significant correlations between self-reported ability and capacity measures of financial management. HD patients endorsed declines in global iADL ability and exhibited deficits in functional capacity when performing a financial management task. Capacity measures may aid in assessing the extent to which HD patients accurately estimate real-world iADL performance, and the present findings suggest that such measures of capacity may be related to the cognitive, but not motor or affective, symptoms of HD.

  2. Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army

    DTIC Science & Technology

    2009-09-21

    Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 21 September...Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 5a. CONTRACT NUMBER 5b...Service Supply Chain , Services Acquisition, Service Lifecycle, Contract Management, Project Management, Program Management = = ^Åèìáëáíáçå=oÉëÉ~êÅÜ

  3. A General Procedure to Assess the Internal Structure of a Noncognitive Measure--The Student360 Insight Program (S360) Time Management Scale. Research Report. ETS RR-11-42

    ERIC Educational Resources Information Center

    Ling, Guangming; Rijmen, Frank

    2011-01-01

    The factorial structure of the Time Management (TM) scale of the Student 360: Insight Program (S360) was evaluated based on a national sample. A general procedure with a variety of methods was introduced and implemented, including the computation of descriptive statistics, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).…

  4. Clinical Characteristics, Management, and Control of Permanent vs. Nonpermanent Atrial Fibrillation: Insights from the RealiseAF Survey

    PubMed Central

    Murin, Jan; Naditch-Brûlé, Lisa; Brette, Sandrine; Chiang, Chern-En; O’Neill, James; Steg, P. Gabriel

    2014-01-01

    Background Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample. Methods and Results Data from RealiseAF, an international, observational, cross-sectional survey of 10,491 patients with atrial fibrillation, were used to characterize permanent atrial fibrillation (N = 4869) and nonpermanent atrial fibrillation (N = 5622) patients. Permanent atrial fibrillation patients were older, had a longer time since atrial fibrillation diagnosis, a higher symptom burden, and were more likely to be physically inactive. They also had a higher mean (SD) CHADS2 score (2.2 [1.3] vs. 1.7 [1.3], p<0.001), and a higher frequency of CHADS2 score ≥2 (67.3% vs. 53.0%, p<0.001) and comorbidities, most notably heart failure. Physicians indicated using a rate-control strategy in 84.2% of permanent atrial fibrillation patients (vs. 27.5% in nonpermanent atrial fibrillation). Only 50.2% (N = 2262/4508) of permanent atrial fibrillation patients were controlled. These patients had a longer time since atrial fibrillation diagnosis, a lower symptom burden, less obesity and physical inactivity, less severe heart failure, and fewer hospitalizations for acute heart failure than uncontrolled permanent atrial fibrillation patients, but with more arrhythmic events. The most frequent causes of hospitalization in the last 12 months were acute heart failure and stroke. Conclusion Permanent atrial fibrillation is a high-risk subset of atrial fibrillation, representing half of all atrial fibrillation patients, yet rate control is only achieved in around half. Since control is associated with lower symptom burden and heart

  5. Experience of acute noninvasive ventilation-insights from 'Behind the Mask': a qualitative study.

    PubMed

    Smith, Tracy A; Agar, Meera; Jenkins, Christine R; Ingham, Jane M; Davidson, Patricia M

    2016-08-26

    Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure. Qualitative face-to-face interviews analysed using thematic analysis. Australian tertiary teaching hospital. Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded. 13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease. Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Activin and NADPH-oxidase in preeclampsia: insights from in vitro and murine studies.

    PubMed

    Lim, Rebecca; Acharya, Rutu; Delpachitra, Pavitra; Hobson, Sebastian; Sobey, Christopher G; Drummond, Grant R; Wallace, Euan M

    2015-01-01

    Clinical management of preeclampsia has remained unchanged for almost 5 decades. We now understand that maternal endothelial dysfunction likely arises because of placenta-derived vasoactive factors. Activin A is one such antiangiogenic factor that is released by the placenta and that is elevated in maternal serum in women with preeclampsia. Whether activin has a role in the pathogenesis of preeclampsia is not known. To assess the effects of activin on endothelial cell function, we cultured human umbilical vein endothelial cells in the presence of activin or serum from normal pregnant women or pregnant women with preeclampsia, with or without follistatin, a functional activin antagonist or apocynin, a NADPH oxidase (Nox2) inhibitor. We also administered activin to pregnant C57Bl6 mice, with or without apocynin, and studied maternal and fetal outcomes. Last, we assessed endothelial cell Nox2 and nitric oxide synthase expression in normal pregnant women and pregnant women with preeclampsia. Activin and preeclamptic serum induced endothelial cell oxidative stress by Nox2 up-regulation and endothelial cell dysfunction, which are effects that are mitigated by either follistatin or apocynin. The administration of activin to pregnant mice induced endothelial oxidative stress, hypertension, proteinuria, fetal growth restriction, and preterm littering. Apocynin prevented all of these effects. Compared with normal pregnant women, women with preeclampsia had increased endothelial Nox2 expression. An activin-Nox2 pathway is a likely link between an injured placenta, endothelial dysfunction, and preeclampsia. This offers opportunities that are not novel therapeutic approaches to preeclampsia. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Youth Studies and Timescapes: Insights from an Ethnographic Study of "Young Night Drifters" in Hong Kong's Public Housing Estates

    ERIC Educational Resources Information Center

    Groves, Julian M.; Ho, Wai-Yip; Siu, Kaxton

    2012-01-01

    This article draws on insights from the sociology of time to examine how scheduling influences social interaction and identity among young people and those who work with them. Drawing on an ethnographic analysis of "Young Night Drifters" and youth outreach social workers in Hong Kong's public housing estates, we create a framework to…

  8. Insights into the Management of Large Carnivores for Profitable Wildlife-Based Land Uses in African Savannas

    PubMed Central

    Funston, Paul J.; Groom, Rosemary J.; Lindsey, Peter A.

    2013-01-01

    Large African predators, especially lions (Panthera leo) and leopards (Panthera pardus), are financially valuable for ecotourism and trophy hunting operations on land also utilized for the production of other wildlife species for the same purpose. Predation of ungulates used for trophy hunting can create conflict with landholders and trade off thus exists between the value of lions and leopards and their impact on ungulate populations. Therefore productionist and conservation trade-offs are complexly graded and difficult to resolve. We investigated this with a risk-benefit analysis on a large private wildlife production area in Zimbabwe. Our model showed that lions result in substantial financial costs through predation on wild ungulates that may not be offset by profits from hunting them, whereas the returns from trophy hunting of leopards are projected to exceed the costs due to leopard predation. In the absence of additional income derived from photo-tourism the number of lions may need to be managed to minimize their impact. Lions drive important ecological processes, but there is a need to balance ecological and financial imperatives on wildlife ranches, community wildlife lands and other categories of multiple use land used for wildlife production. This will ensure the competitiveness of wildlife based land uses relative to alternatives. Our findings may thus be limited to conservancies, community land-use areas and commercial game ranches, which are expansive in Africa, and should not necessarily applied to areas where biodiversity conservation is the primary objective, even if hunting is allowed there. PMID:23527083

  9. Insights into the management of large carnivores for profitable wildlife-based land uses in African savannas.

    PubMed

    Funston, Paul J; Groom, Rosemary J; Lindsey, Peter A

    2013-01-01

    Large African predators, especially lions (Panthera leo) and leopards (Panthera pardus), are financially valuable for ecotourism and trophy hunting operations on land also utilized for the production of other wildlife species for the same purpose. Predation of ungulates used for trophy hunting can create conflict with landholders and trade off thus exists between the value of lions and leopards and their impact on ungulate populations. Therefore productionist and conservation trade-offs are complexly graded and difficult to resolve. We investigated this with a risk-benefit analysis on a large private wildlife production area in Zimbabwe. Our model showed that lions result in substantial financial costs through predation on wild ungulates that may not be offset by profits from hunting them, whereas the returns from trophy hunting of leopards are projected to exceed the costs due to leopard predation. In the absence of additional income derived from photo-tourism the number of lions may need to be managed to minimize their impact. Lions drive important ecological processes, but there is a need to balance ecological and financial imperatives on wildlife ranches, community wildlife lands and other categories of multiple use land used for wildlife production. This will ensure the competitiveness of wildlife based land uses relative to alternatives. Our findings may thus be limited to conservancies, community land-use areas and commercial game ranches, which are expansi