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Sample records for minimal important change

  1. Minimal Pairs: Minimal Importance?

    ERIC Educational Resources Information Center

    Brown, Adam

    1995-01-01

    This article argues that minimal pairs do not merit as much attention as they receive in pronunciation instruction. There are other aspects of pronunciation that are of greater importance, and there are other ways of teaching vowel and consonant pronunciation. (13 references) (VWL)

  2. Establishing the Minimal Clinical Important Difference and Minimal Detectable Change for the Cumberland Ankle Instability Tool.

    PubMed

    Wright, Cynthia J; Linens, Shelley W; Cain, M Spencer

    2017-09-01

    To establish the minimal detectable change (MDC) and minimal clinically important difference (MCID) for the Cumberland Ankle Instability Tool (CAIT) in a population with chronic ankle instability (CAI). Experimental cohort. Laboratory. A convenience sample of individuals with CAI (N=50; 12 men; 38 women; episodes of giving way, 5.84±12.54mo). CAI inclusion criteria included a history of an ankle sprain, recurrent episodes of giving way, and a CAIT score ≤25. Participants completed demographic information, an injury history questionnaire, and the CAIT. Participants then either participated in 4 weeks of wobble board balance training, resistance tubing strength training, or no intervention. After 4 weeks, participants recompleted the CAIT and recorded their global rating of change (GRC). Dependent variables were pre- and postintervention scores on the CAIT and postintervention GRC. The MDC with 95% confidence interval was calculated. A receiver operating characteristic (ROC) curve identified the optimal CAIT cut point (MCID) between improved and unimproved individuals on the basis of their GRC. The area under the curve was used to identify a significant ROC curve (α=.05). The average CAIT score preintervention was 16.8±5.6, and postintervention, it was 20.0±5.2. Thirty-one participants (62%) rated themselves as improved on the GRC scale, whereas 19 (38%) were not improved. The ROC curve was significant (area under the curve, .797; P=.001), indicating that the CAIT change score significantly predicted clinical status. The MDC was 3.08, and the MCID was ≥3 points. The CAIT has an MDC and MCID of ≥3 points. When CAIT scores are used to assess patient change over time, these scores should be used as a minimum threshold to indicate detectable and clinically meaningful improvement. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy.

    PubMed

    Chen, Chia-ling; Shen, I-hsuan; Chen, Chung-yao; Wu, Ching-yi; Liu, Wen-yu; Chung, Chia-ying

    2013-03-01

    This study examined criterion-related validity and clinimetric properties of the pediatric balance scale (PBS) in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine criterion-related validity by analyzing the correlation between the PBS, including PBS-static, PBS-dynamic, and PBS-total, and criterion measures, including the Gross Motor Function Measure-66 items (GMFM-66) and Functional Independence Measures for Children (WeeFIM). Responsiveness was examined by paired t test and by standardized response mean (SRM). The minimal detectable change (MDC) was analyzed at the 90% confidence level, and the minimal clinically important differences (MCID) was estimated by anchor-based and distribution-based approaches. The PBS with GMFM-66 and WeeFIM showed fair-to-excellent concurrent validity at pretreatment and follow up and predictive validity. The SRM values of all PBS scales were 0.75. For the PBS-static, PBS-dynamic, and PBS-total, the MDC(90) values were 0.79, 0.96, and 1.59, and the MCID ranges were 1.47-2.92, 2.23-2.92, and 3.66-5.83, respectively. Improvement of at least MDC values on the PBS can be considered a true change, not measurement error. A mean change must exceed the MCID range on PBS to be considered clinically important change. Therefore, all PBS scales were moderately responsive to change. Clinicians and researchers can use these clinimetric data for PBS to determine if a change score represents a true or clinically meaningful effect at posttreatment and follow up.

  4. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain

    PubMed Central

    Kovacs, Francisco M; Abraira, Víctor; Royuela, Ana; Corcoll, Josep; Alegre, Luis; Tomás, Miquel; Mir, María Antonia; Cano, Alejandra; Muriel, Alfonso; Zamora, Javier; del Real, María Teresa Gil; Gestoso, Mario; Mufraggi, Nicole

    2008-01-01

    Background The minimal detectable change (MDC) and the minimal clinically important changes (MCIC) have been explored for nonspecific low back pain patients and are similar across different cultural settings. No data on MDC and MCIC for pain severity are available for neck pain patients. The objectives of this study were to estimate MDC and MCIC for pain severity in subacute and chronic neck pain (NP) patients, to assess if MDC and MCIC values are influenced by baseline values and to explore if they are different in the subset of patients reporting referred pain, and in subacute versus chronic patients. Methods Subacute and chronic patients treated in routine clinical practice of the Spanish National Health Service for neck pain, with or without pain referred to the arm, and a pain severity ≥ 3 points on a pain intensity number rating scale (PI-NRS), were included in this study. Patients' own "global perceived effect" over a 3 month period was used as the external criterion. The minimal detectable change (MDC) was estimated by means of the standard error of measurement in patients who self-assess as unchanged. MCIC were estimated by the mean value of change score in patients who self-assess as improved (mean change score, MCS), and by the optimal cutoff point in receiver operating characteristics curves (ROC). The effect on MDC and MCIC of initial scores, duration of pain, and existence of referred pain were assessed. Results 658 patients were included, 487 of them with referred pain. MDC was 4.0 PI-NRS points for neck pain in the entire sample, 4.2 for neck pain in patients who also had referred pain, and 6.2 for referred pain. MCS was 4.1 and ROC was 1.5 for referred and for neck pain, both in the entire sample and in patients who also complained of referred pain. ROC was lower (0.5 PI-NRS points) for subacute than for chronic patients (1.5 points). MCS was higher for patients with more intense baseline pain, ranging from 2.4 to 4.9 PI-NRS for neck pain and

  5. Validity, responsiveness, minimal detectable change, and minimal clinically important change of the Pediatric Motor Activity Log in children with cerebral palsy.

    PubMed

    Lin, Keh-chung; Chen, Hui-fang; Chen, Chia-ling; Wang, Tien-ni; Wu, Ching-yi; Hsieh, Yu-wei; Wu, Li-ling

    2012-01-01

    This study examined criterion-related validity and clinimetric properties of the Pediatric Motor Activity Log (PMAL) in children with cerebral palsy. Study participants were 41 children (age range: 28-113 months) and their parents. Criterion-related validity was evaluated by the associations between the PMAL and criterion measures at baseline and posttreatment, including the self-care, mobility, and cognition subscale, the total performance of the Functional Independence Measure in children (WeeFIM), and the grasping and visual-motor integration of the Peabody Developmental Motor Scales. Pearson correlation coefficients were calculated. Responsiveness was examined using the paired t test and the standardized response mean, the minimal detectable change was captured at the 90% confidence level, and the minimal clinically important change was estimated using anchor-based and distribution-based approaches. The PMAL-QOM showed fair concurrent validity at pretreatment and posttreatment and predictive validity, whereas the PMAL-AOU had fair concurrent validity at posttreatment only. The PMAL-AOU and PMAL-QOM were both markedly responsive to change after treatment. Improvement of at least 0.67 points on the PMAL-AOU and 0.66 points on the PMAL-QOM can be considered as a true change, not measurement error. A mean change has to exceed the range of 0.39-0.94 on the PMAL-AOU and the range of 0.38-0.74 on the PMAL-QOM to be regarded as clinically important change.

  6. Responsiveness to Change and Minimally Important Differences of the Patient-Reported Outcomes Measurement Information System Gastrointestinal Symptoms Scales.

    PubMed

    Khanna, Dinesh; Hays, Ron D; Shreiner, Andrew B; Melmed, Gil Y; Chang, Lin; Khanna, Puja P; Bolus, Roger; Whitman, Cynthia; Paz, Sylvia H; Hays, Tonya; Reise, Steven P; Spiegel, Brennan

    2017-05-01

    The NIH-sponsored Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal (GI) Symptoms scales were developed to assess patients' GI symptoms in clinical settings. To assess responsiveness to change and provide minimally important difference (MID) estimates for the PROMIS GI Symptoms scales. A sample of 256 GI outpatients self-administered the eight PROMIS GI Symptoms scales (gastroesophageal reflux, disrupted swallowing, diarrhea, bowel incontinence/soilage, nausea and vomiting, constipation, belly pain, and gas/bloating/flatulence) at two visits. Patient self-reported and physician-reported assessments of the subjects' overall GI condition were employed as change anchors. In addition, we prospectively assessed change at both visits using a GI-symptom anchor, the Gastrointestinal Symptom Rating Scale (GSRS). Responsiveness to change was assessed using F-statistics. The minimally changed group was those somewhat better or somewhat worse on the retrospective anchors and changing by one category on the modified GSRS (e.g., from slight to mild discomfort to moderate to moderately severe discomfort). Responsiveness to change was statistically significant for 6 of 8 PROMIS scales using the self-report GI anchor, 3 of 8 scales using the physician-reported anchor, and 5 of 5 scales using the corresponding GSRS scales as anchors. The MID estimates for scales for improvement and worsening were about 0.5-0.6 SD using the GSRS anchor and generally larger in magnitude than the change for the "about the same" group. The responsiveness and MID estimates provided here for the PROMIS GI Symptoms scales can aid in scale score interpretation in clinical trials and observational studies.

  7. Sensitivity to Change and Minimal Important Differences of the LupusQoL in Patients With Systemic Lupus Erythematosus

    PubMed Central

    McElhone, Kathleen; Abbott, Janice; Sutton, Chris; Mullen, Montana; Lanyon, Peter; Rahman, Anisur; Yee, Chee‐Seng; Akil, Mohammed; Bruce, Ian N.; Ahmad, Yasmeen; Gordon, Caroline

    2016-01-01

    Objective As a health‐related quality of life (HRQOL) measure, the LupusQoL is a reliable and valid measure for adults with systemic lupus erythematosus (SLE). This study evaluates the responsiveness and minimal important differences (MIDs) for the 8 LupusQoL domains. Methods Patients experiencing a flare were recruited from 9 UK centers. At each of the 10 monthly visits, HRQOL (LupusQoL, Short Form 36 health survey [SF‐36]), global rating of change (GRC), and disease activity using the British Isles Lupus Assessment Group 2004 index were assessed. The responsiveness of the LupusQoL and the SF‐36 was evaluated primarily when patients reported an improvement or deterioration on the GRC scale and additionally with changes in physician‐reported disease activity. MIDs were estimated as mean changes when minimal change was reported on the GRC scale. Results A total of 101 patients were recruited. For all LupusQoL domains, mean HRQOL worsened when patients reported deterioration and improved when patients reported an improvement in GRC; SF‐36 domains showed comparable responsiveness. Improvement in some domains of the LupusQoL/SF‐36 was observed with a decrease in disease activity, but when disease activity worsened, there was no significant change. LupusQoL MID estimates for deterioration ranged from −2.4 to −8.7, and for improvement from 3.5 to 7.3; for the SF‐36, the same MID estimates were −2.0 to −11.1 and 2.8 to 10.9, respectively. Conclusion All LupusQoL domains are sensitive to change with patient‐reported deterioration or improvement in health status. For disease activity, some LupusQoL domains showed responsiveness when there was improvement but none for deterioration. LupusQoL items were derived from SLE patients and provide the advantage of disease‐specific domains, important to the patients, not captured by the SF‐36. PMID:26816223

  8. Sensitivity to Change and Minimal Important Differences of the LupusQoL in Patients With Systemic Lupus Erythematosus.

    PubMed

    McElhone, Kathleen; Abbott, Janice; Sutton, Chris; Mullen, Montana; Lanyon, Peter; Rahman, Anisur; Yee, Chee-Seng; Akil, Mohammed; Bruce, Ian N; Ahmad, Yasmeen; Gordon, Caroline; Teh, Lee-Suan

    2016-10-01

    As a health-related quality of life (HRQOL) measure, the LupusQoL is a reliable and valid measure for adults with systemic lupus erythematosus (SLE). This study evaluates the responsiveness and minimal important differences (MIDs) for the 8 LupusQoL domains. Patients experiencing a flare were recruited from 9 UK centers. At each of the 10 monthly visits, HRQOL (LupusQoL, Short Form 36 health survey [SF-36]), global rating of change (GRC), and disease activity using the British Isles Lupus Assessment Group 2004 index were assessed. The responsiveness of the LupusQoL and the SF-36 was evaluated primarily when patients reported an improvement or deterioration on the GRC scale and additionally with changes in physician-reported disease activity. MIDs were estimated as mean changes when minimal change was reported on the GRC scale. A total of 101 patients were recruited. For all LupusQoL domains, mean HRQOL worsened when patients reported deterioration and improved when patients reported an improvement in GRC; SF-36 domains showed comparable responsiveness. Improvement in some domains of the LupusQoL/SF-36 was observed with a decrease in disease activity, but when disease activity worsened, there was no significant change. LupusQoL MID estimates for deterioration ranged from -2.4 to -8.7, and for improvement from 3.5 to 7.3; for the SF-36, the same MID estimates were -2.0 to -11.1 and 2.8 to 10.9, respectively. All LupusQoL domains are sensitive to change with patient-reported deterioration or improvement in health status. For disease activity, some LupusQoL domains showed responsiveness when there was improvement but none for deterioration. LupusQoL items were derived from SLE patients and provide the advantage of disease-specific domains, important to the patients, not captured by the SF-36. © 2016, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

  9. Evaluation of the Dutch version of the Foot and Ankle Outcome Score (FAOS): Responsiveness and Minimally Important Change.

    PubMed

    Sierevelt, I N; van Eekeren, I C M; Haverkamp, D; Reilingh, M L; Terwee, C B; Kerkhoffs, G M M J

    2016-04-01

    The aim of this study was to evaluate the responsiveness of the Foot and Ankle Outcome Score (FAOS) and provide data on the Minimally Important Change (MIC) in patients 1 year after hindfoot and ankle surgery. Prospective pre-operative and 1 year post-operative FAOS scores were collected from 145 patients. A patient's global assessment and a longitudinal derived Function Change Score were used as external anchors. To assess responsiveness, effect sizes (ES) and Standardized Response Means (SRM) were calculated and hypotheses on their magnitudes were formulated. Additional ROC curve analysis was performed, and the Area Under the Curve (AUC) was calculated as a measure of responsiveness. MIC values were estimated using two different methods: (1) the mean change method and (2) the optimal cut-off point of the ROC curve. Responsiveness was supported by confirmation of 84% of the hypothesized ES and SRM and almost all AUCs exceeding 0.70. MIC values ranged from 7 (symptoms) to 38 (sport) points. They varied between calculation methods and were negatively associated with baseline values. A considerable amount of MIC values did not exceed the smallest detectable change limit, indicating that the FAOS is more suitable at group level than for longitudinally following individual patients. The FAOS demonstrated good responsiveness in patients 1 year after hindfoot and ankle surgery. Due to their wide variation, MIC estimates derived in this study should be interpreted with caution. However, these estimates can be of value to facilitate sample size calculation in future studies. Diagnostic study, Level I.

  10. Minimal important change (MIC) based on a predictive modeling approach was more precise than MIC based on ROC analysis.

    PubMed

    Terluin, Berend; Eekhout, Iris; Terwee, Caroline B; de Vet, Henrica C W

    2015-12-01

    To present a new method to estimate a "minimal important change" (MIC) of health-related quality of life (HRQOL) scales, based on predictive modeling, and to compare its performance with the MIC based on receiver operating characteristic (ROC) analysis. To illustrate how the new method deals with variables that modify the MIC across subgroups. The new method uses logistic regression analysis and identifies the change score associated with a likelihood ratio of 1 as the MIC. Simulation studies were conducted to investigate under which distributional circumstances both methods produce concordant or discordant results and whether the methods differ in accuracy and precision. The "predictive MIC" and the ROC-based MIC were identical when the variances of the change scores in the improved and not-improved groups were equal and the distributions were normal or oppositely skewed. The predictive MIC turned out to be more precise than the ROC-based MIC. The predictive MIC allowed for the testing and estimation of modifying factors such as baseline severity. In many situations, the newly described MIC based on predictive modeling yields the same value as the ROC-based MIC but with significantly greater precision. This advantage translates to increased statistical power in MIC studies. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Minimal important difference to infer changes in health-related quality of life-a systematic review.

    PubMed

    Jayadevappa, Ravishankar; Cook, Ratna; Chhatre, Sumedha

    2017-07-01

    The objective of the study was to assess the usability of minimal important difference (MID) and minimal clinically important difference (MCID) for measuring meaningful changes in disease-specific and generic health-related quality-of-life (HRQoL) outcomes in patient-centered care. We adopted a two-step literature review process. First, we used PubMed and Google scholar to identify a broad range of search terms. Next, we searched OVID Medline, JSTOR, and PubMed for terms "MID," and "MCID." We excluded non-English language studies, articles older than 1995, those not related to generic- and disease-specific HRQoL measures, and protocols of future studies. Studies were grouped according to generic- and disease-specific measures. We assessed MID or MCID calculation methods, effect sizes, estimated values, and significance. Eighty articles satisfied the inclusion criteria. Our synthesis provides a comprehensive assessment of MID or MCID for 10 generic-specific and 80 disease-specific instruments. We observed a lack of consistency in the application of methods for computing MID or MCID for generic and disease-specific HRQoL measures. Only 43 (54%) studies used both anchor and distribution methods to elicit MID or MCID. Thirty-four articles estimated MID values only, whereas 47 articles estimated MCID. The anchor-based method yields conservative estimates of MID or MCID, compared to the distribution-based method. The distribution method does not take into account patient perspectives and should be accompanied by anchor method while computing MID. The MID should be interpreted with caution, and available estimates for a particular instrument must be used. This will help in integrating the MID estimates into the overall research or clinical plan for a specific context. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Minimal Change Disease.

    PubMed

    Vivarelli, Marina; Massella, Laura; Ruggiero, Barbara; Emma, Francesco

    2017-02-07

    Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS), characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it accounts for approximately 15% of patients with idiopathic NS, reaching a much higher percentage at younger ages, up to 70%-90% in children >1 year of age. In the pediatric setting, a renal biopsy is usually not performed if presentation is typical and the patient responds to therapy with oral prednisone at conventional doses. Therefore, in this setting steroid-sensitive NS can be considered synonymous with MCD. The pathologic hallmark of disease is absence of visible alterations by light microscopy and effacement of foot processes by electron microscopy. Although the cause is unknown and it is likely that different subgroups of disease recognize a different pathogenesis, immunologic dysregulation and modifications of the podocyte are thought to synergize in altering the integrity of the glomerular basement membrane and therefore determining proteinuria. The mainstay of therapy is prednisone, but steroid-sensitive forms frequently relapse and this leads to a percentage of patients requiring second-line steroid-sparing immunosuppression. The outcome is variable, but forms of MCD that respond to steroids usually do not lead to chronic renal damage, whereas forms that are unresponsive to steroids may subsequently reveal themselves as FSGS. However, in a substantial number of patients the disease is recurrent and requires long-term immunosuppression, with significant morbidity because of side effects. Recent therapeutic advances, such as the use of anti-CD20 antibodies, have provided long-term remission off-therapy and suggest new hypotheses for disease pathogenesis. Copyright © 2017 by the American Society of Nephrology.

  13. Minimally Important Differences and Change Across Time in Patients Treated Surgically and Non-Surgically for Full-Thickness Rotator Cuff Tears

    PubMed Central

    Miller, Bruce S.; Robbins, Christopher; Gagnier, Joel Joseph

    2016-01-01

    Objectives: The minimally important difference (MID) is the smallest change in an outcome measure that is perceived by patients as beneficial. The MIDs for the ASES and WORC scores have not been established in a homogenous population of patients with rotator cuff tears. The objective of the present study was to establish the MIDs for patients with known cuff tears who were treated both surgically and non-surgically, and to compare the MIDs over time. Methods: We included 209 subjects with known full-thickness rotator cuff tears who were followed prospectively for two years. The WORC and ASES scores were collected at baseline, 4, 8, 16, 32, and 48 weeks, 1 year and 2 years. At the final follow-up point patients filled out an end-of-study form which included questions regarding change in their condition after treatment. Results: For those that indicated being minimally better, the change from baseline for the ASES score was -20.57 (-2.94 to -38.20) and for the WORC was 418.60 (70.39 to 766.81); both indicated improvement in outcomes. When converted to the percentage change score the WORC change represented 19.93%. The plots of these new MID values for the ASES and WORC indicate that not only does the operative group improve more than the non-operative group but it does so to an extent that is greater than the MID. The non-operative group also improved across time, but the magnitude did not exceed the MID for either the WORC or the ASES. Conclusion: We found that the ASES and the WORC MIDs in patients with rotator cuff tears is different from that previously reported, and that the operative group change was greater than the non-operative group change. This information will directly improve our ability to: (1) Determine when patients with RCTs are changing in a meaningful manner; (2) Accurately power clinical studies using these outcome measures; (3) Make more informed choices of treatments in these patients. This is the first study to report MIDs for the ASES and WORC

  14. Responsiveness and Minimal Important Changes of the Western Ontario and McMaster Universities Osteoarthritis Index in Subjects Undergoing Rehabilitation Following Hip Fracture.

    PubMed

    Monticone, Marco; Ambrosini, Emilia; Secci, Claudio; Rocca, Barbara; Ferrante, Simona; Capone, Antonio

    2017-05-01

    To evaluate the responsiveness and minimal important changes (MICs) for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and its subscales in subjects with hip fractures. At the beginning and end of a 2-month rehabilitation program, 106 patients completed the WOMAC. After the program, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the WOMAC and its subscales were calculated by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic curves; correlations between change scores of the WOMAC and its subscales and GPE). Receiver operating characteristic curves were also used in order to compute the best cutoff levels between improved and stable subjects (MICs). The effect size ranged from 0.64 to 11.10 and the standardized response mean from 0.79 to 2.65. The receiver operating characteristic analyses revealed an MIC value (area under the curve, sensitivity, specificity) for the WOMAC of 29 (0.817, 92, 78); values of 35 (0.820, 77, 76) 44 (0.625, 25, 95), and 24 (0.707, 100, 76) were found for pain, stiffness, and physical function subscales, respectively. Correlations between change scores of the WOMAC and its subscales and GPE were low (0.240, for stiffness subscale) to moderate (0.438-0.570 for the other subscales and the WOMAC). The WOMAC and its subscales (all but stiffness) were sensitive in detecting clinical changes in subjects with hip fracture undergoing rehabilitation. We recommend taking the MICs provided into account when assessing patients' improvement or planning studies in this clinical context.

  15. Responsiveness and minimal important changes for the Neck Disability Index and the Neck Pain Disability Scale in Italian subjects with chronic neck pain.

    PubMed

    Monticone, Marco; Ambrosini, Emilia; Vernon, Howard; Brunati, Roberto; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

    2015-12-01

    To evaluate the responsiveness and minimal important changes (MICs) for the Italian Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) as well as which questionnaire was the most responsive in subjects with chronic neck pain (NP). At the beginning and end of an 8-week rehabilitation programme, 200 patients completed the NDI and NPDS. After the programme, the global perceived effect (GPE) was also evaluated and collapsed to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods (ROC curves; correlations between change scores of NPDS and NDI, and GPE). ROC curves were also used to compute the best cutoff levels between improved and stable subjects (MICs). The ES was 0.66 and 0.73, and the SRM was 1.09-1.26 for the NDI and NPDS, respectively. The ROC analyses revealed AUCs of 0.96 and 0.91 for the NDI and NPDS, respectively; the MICs were 7-percentage points for the NDI (sensitivity: 98%; specificity: 81%) and 10 for NPDS (93; 83%), showing equivalent responsiveness properties. Baseline NPDS scores did not affect MIC estimate for the NPDS, while, for the NDI, higher MICs were found for patients with worst disability levels. Correlations between change scores of the NDI and NPDS and GPE were, respectively, high (0.71) and moderate (0.59). The Italian NDI and NPDS were equally sensitive in detecting clinical changes in subjects with chronic NP undergoing rehabilitation. We recommend taking the MICs into account when assessing patient improvement or planning studies in this clinical context.

  16. Biological variation, reference change value (RCV) and minimal important difference (MID) of inspiratory muscle strength (PImax) in patients with stable chronic heart failure.

    PubMed

    Täger, Tobias; Schell, Miriam; Cebola, Rita; Fröhlich, Hanna; Dösch, Andreas; Franke, Jennifer; Katus, Hugo A; Wians, Frank H; Frankenstein, Lutz

    2015-10-01

    Despite the widespread application of measurements of respiratory muscle force (PImax) in clinical trials there is no data on biological variation, reference change value (RCV), or the minimal important difference (MID) for PImax irrespective of the target cohort. We addressed this issue for patients with chronic stable heart failure. From the outpatients' clinic of the University of Heidelberg we retrospectively selected three groups of patients with stable systolic chronic heart failure (CHF). Each group had two measurements of PImax: 90 days apart in Group A (n = 25), 180 days apart in Group B (n = 93), and 365 days apart in Group C (n = 184). Stability was defined as (a) no change in NYHA class between visits and (b) absence of cardiac decompensation 3 months prior, during, and 3 months after measurements. For each group, we determined within-subject (CVI), between-subject (CVG), and total (CVT) coefficient of variation (CV), the index of individuality (II), RCV, reliability coefficient, and MID of PImax. CVT was 8.7, 7.5, and 6.9 % for groups A, B, and C, respectively. The II and RCV were 0.21, 0.20, 0.16 and 13.6, 11.6, 10.8 %, respectively. The reliability coefficient and MID were 0.83, 0.87, 0.88 and 1.44, 1.06, 1.12 kPa, respectively. Results were similar between age, gender, and aetiology subgroups. In patients with stable CHF, measurements of PImax are highly stable for intervals up to 1 year. The low values for II suggest that evaluation of change in PImax should be performed on an individual (per patient) basis. Individually significant change can be assumed beyond 14 % (RCV) or 1.12 kPa (MID).

  17. Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication

    SciTech Connect

    Conijn, Anne P.; Jonkers, Wilma; Rouwet, Ellen V.; Vahl, Anco C.; Reekers, Jim A.; Koelemay, Mark J. W.

    2015-10-15

    PurposeThe minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC).MethodsIn this multicenter study, we recruited 294 patients with IC between July and October 2012. Patients completed the VascuQol, with scores ranging from 1 to 7 (worst to best), and the WIQ, with scores ranging from 0 to 1 (worst to best) at first visit and after 4 months follow-up. In addition, patients answered an anchor-question rating their health status compared to baseline, as being improved, unchanged, or deteriorated. The MID for improvement and deterioration was calculated by an anchor-based approach, and determined with the upper and lower limits of the 95 % confidence interval of the mean change of the group who had not changed according to the anchor-question.ResultsFor the MID analyses of the VascuQol and WIQ, 163 and 134 patients were included, respectively. The MID values for the VascuQol (mean baseline score 4.25) were 0.87 for improvement and 0.23 for deterioration. For the WIQ (mean baseline score 0.39), we found MID values of 0.11 and −0.03 for improvement and deterioration, respectively.ConclusionIn this study, we calculated the MID for the VascuQol and the WIQ. Applying these MID facilitates better interpretation of treatment outcomes and can help to set treatment goals for individual care.

  18. Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication.

    PubMed

    Conijn, Anne P; Jonkers, Wilma; Rouwet, Ellen V; Vahl, Anco C; Reekers, Jim A; Koelemay, Mark J W

    2015-10-01

    The minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC). In this multicenter study, we recruited 294 patients with IC between July and October 2012. Patients completed the VascuQol, with scores ranging from 1 to 7 (worst to best), and the WIQ, with scores ranging from 0 to 1 (worst to best) at first visit and after 4 months follow-up. In addition, patients answered an anchor-question rating their health status compared to baseline, as being improved, unchanged, or deteriorated. The MID for improvement and deterioration was calculated by an anchor-based approach, and determined with the upper and lower limits of the 95 % confidence interval of the mean change of the group who had not changed according to the anchor-question. For the MID analyses of the VascuQol and WIQ, 163 and 134 patients were included, respectively. The MID values for the VascuQol (mean baseline score 4.25) were 0.87 for improvement and 0.23 for deterioration. For the WIQ (mean baseline score 0.39), we found MID values of 0.11 and -0.03 for improvement and deterioration, respectively. In this study, we calculated the MID for the VascuQol and the WIQ. Applying these MID facilitates better interpretation of treatment outcomes and can help to set treatment goals for individual care.

  19. Responsiveness and Minimal Important Changes of the Scoliosis Research Society-22 Patient Questionnaire in Subjects With Mild Adolescent and Moderate Adult Idiopathic Scoliosis Undergoing Multidisciplinary Rehabilitation.

    PubMed

    Monticone, Marco; Ambrosini, Emilia; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

    2017-06-01

    Single-center, prospective study. Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS). Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes. At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle <25°) and 140 subjects with moderate AS (Cobb angle <35°) completed the SRS-22. Upon completing the programs, subjects also performed the global perceived effect (GPE) scales test, which was divided to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated for all SRS-22 domains but satisfaction with management by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic [ROC] curves; correlations between change scores of the SRS-22 and GPE). ROC curves were also used to compute the MICs. The effect size ranged from 1.23 to 1.50 in AIS and from 1.02 to 1.37 in AS. The standardized response mean ranged from 0.95 to 1.27 in AIS and from 0.66 to 0.90 in AS. The ROC analyses revealed the following MIC values (area under the curve; sensitivity; specificity): function, 0.70 (0.739;66;70) for AIS and 0.60 (0.842;84;76) for AS; pain, 0.70 (0.731;71;70) for AIS and 0.40 (0.817;81;70) for AS; mental health, 0.50 (0.708;83;58) for AIS and 0.55 (0.750;69;78) for AS; self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from -0.347 to -0.667. The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when

  20. Post Hoc Analysis of Data from Two Clinical Trials Evaluating the Minimal Clinically Important Change in International Restless Legs Syndrome Sum Score in Patients with Restless Legs Syndrome (Willis-Ekbom Disease).

    PubMed

    Ondo, William G; Grieger, Frank; Moran, Kimberly; Kohnen, Ralf; Roth, Thomas

    2016-01-01

    Determine the minimal clinically important change (MCIC), a measure determining the minimum change in scale score perceived as clinically beneficial, for the international restless legs syndrome (IRLS) and restless legs syndrome 6-item questionnaire (RLS-6) in patients with moderate to severe restless legs syndrome (RLS/Willis-Ekbom disease) treated with the rotigotine transdermal system. This post hoc analysis analyzed data from two 6-mo randomized, double-blind, placebo-controlled studies (SP790 [NCT00136045]; SP792 [NCT00135993]) individually and as a pooled analysis in rotigotine-treated patients, with baseline and end of maintenance IRLS and Clinical Global Impressions of change (CGI Item 2) scores available for analysis. An anchor-based approach and receiver operating characteristic (ROC) curves were used to determine the MCIC for the IRLS and RLS-6. We specifically compared "much improved vs minimally improved," "much improved/very much improved vs minimally improved or worse," and "minimally improved or better vs no change or worse" on the CGI-2 using the full analysis set (data as observed). The MCIC IRLS cut-off scores for SP790 and SP792 were similar. Using the pooled SP790+SP792 analysis, the MCIC total IRLS cut-off score (sensitivity, specificity) for "much improved vs minimally improved" was -9 (0.69, 0.66), for "much improved/very much improved vs minimally improved or worse" was -11 (0.81, 0.84), and for "minimally improved or better vs no change or worse" was -9 (0.79, 0.88). MCIC ROC cut-offs were also calculated for each RLS-6 item. In patients with RLS, the MCIC values derived in the current analysis provide a basis for defining meaningful clinical improvement based on changes in the IRLS and RLS-6 following treatment with rotigotine. © 2016 American Academy of Sleep Medicine.

  1. Post Hoc Analysis of Data from Two Clinical Trials Evaluating the Minimal Clinically Important Change in International Restless Legs Syndrome Sum Score in Patients with Restless Legs Syndrome (Willis-Ekbom Disease)

    PubMed Central

    Ondo, William G.; Grieger, Frank; Moran, Kimberly; Kohnen, Ralf; Roth, Thomas

    2016-01-01

    Study Objectives: Determine the minimal clinically important change (MCIC), a measure determining the minimum change in scale score perceived as clinically beneficial, for the international restless legs syndrome (IRLS) and restless legs syndrome 6-item questionnaire (RLS-6) in patients with moderate to severe restless legs syndrome (RLS/Willis-Ekbom disease) treated with the rotigotine transdermal system. Methods: This post hoc analysis analyzed data from two 6-mo randomized, double-blind, placebo-controlled studies (SP790 [NCT00136045]; SP792 [NCT00135993]) individually and as a pooled analysis in rotigotine-treated patients, with baseline and end of maintenance IRLS and Clinical Global Impressions of change (CGI Item 2) scores available for analysis. An anchor-based approach and receiver operating characteristic (ROC) curves were used to determine the MCIC for the IRLS and RLS-6. We specifically compared “much improved vs minimally improved,” “much improved/very much improved vs minimally improved or worse,” and “minimally improved or better vs no change or worse” on the CGI-2 using the full analysis set (data as observed). Results: The MCIC IRLS cut-off scores for SP790 and SP792 were similar. Using the pooled SP790+SP792 analysis, the MCIC total IRLS cut-off score (sensitivity, specificity) for “much improved vs minimally improved” was −9 (0.69, 0.66), for “much improved/very much improved vs minimally improved or worse” was −11 (0.81, 0.84), and for “minimally improved or better vs no change or worse” was −9 (0.79, 0.88). MCIC ROC cut-offs were also calculated for each RLS-6 item. Conclusions: In patients with RLS, the MCIC values derived in the current analysis provide a basis for defining meaningful clinical improvement based on changes in the IRLS and RLS-6 following treatment with rotigotine. Citation: Ondo WG, Grieger F, Moran K, Kohnen R, Roth T. Post hoc analysis of data from two clinical trials evaluating the minimal

  2. Cultural change and support of waste minimization

    SciTech Connect

    Boylan, M.S.

    1991-12-31

    The process of bringing a subject like pollution prevention to top of mind awareness, where designed to prevent waste becomes part of business as usual, is called cultural change. With Department of Energy orders and management waste minimization commitment statements on file, the REAL work is just beginning at the Idaho National Engineering Laboratory (INEL); shaping the attitudes of 11,000+ employees. The difficulties of such a task are daunting. The 890 square mile INEL site and in-town support offices mean a huge diversity of employee jobs and waste streams; from cafeteria and auto maintenance wastes to high-level nuclear waste casks. INEL is pursuing a three component cultural change strategy: training, publicity, and public outreach. To meet the intent of DOE orders, all INEL employees are slated to receive pollution prevention orientation training. More technical training is given to targeted groups like purchasing and design engineering. To keep newly learned pollution prevention concepts top-of-mind, extensive site-wide publicity is being developed and conducted, culminating in the April Pollution Prevention Awareness Week coinciding with Earth Day 1992. Finally, news of INEL pollution prevention successes is shared with the public to increase their overall environmental awareness and their knowledge of INEL activities. An important added benefit is the sense of pride the program instills in INEL employees to have their successes displayed so publicly.

  3. Minimally important difference estimates and methods: a protocol

    PubMed Central

    Johnston, Bradley C; Ebrahim, Shanil; Carrasco-Labra, Alonso; Furukawa, Toshi A; Patrick, Donald L; Crawford, Mark W; Hemmelgarn, Brenda R; Schunemann, Holger J; Guyatt, Gordon H; Nesrallah, Gihad

    2015-01-01

    Introduction Patient-reported outcomes (PROs) are often the outcomes of greatest importance to patients. The minimally important difference (MID) provides a measure of the smallest change in the PRO that patients perceive as important. An anchor-based approach is the most appropriate method for MID determination. No study or database currently exists that provides all anchor-based MIDs associated with PRO instruments; nor are there any accepted standards for appraising the credibility of MID estimates. Our objectives are to complete a systematic survey of the literature to collect and characterise published anchor-based MIDs associated with PRO instruments used in evaluating the effects of interventions on chronic medical and psychiatric conditions and to assess their credibility. Methods and analysis We will search MEDLINE, EMBASE and PsycINFO (1989 to present) to identify studies addressing methods to estimate anchor-based MIDs of target PRO instruments or reporting empirical ascertainment of anchor-based MIDs. Teams of two reviewers will screen titles and abstracts, review full texts of citations, and extract relevant data. On the basis of findings from studies addressing methods to estimate anchor-based MIDs, we will summarise the available methods and develop an instrument addressing the credibility of empirically ascertained MIDs. We will evaluate the credibility of all studies reporting on the empirical ascertainment of anchor-based MIDs using the credibility instrument, and assess the instrument's inter-rater reliability. We will separately present reports for adult and paediatric populations. Ethics and dissemination No research ethics approval was required as we will be using aggregate data from published studies. Our work will summarise anchor-based methods available to establish MIDs, provide an instrument to assess the credibility of available MIDs, determine the reliability of that instrument, and provide a comprehensive compendium of published anchor

  4. Minimally important difference estimates and methods: a protocol.

    PubMed

    Johnston, Bradley C; Ebrahim, Shanil; Carrasco-Labra, Alonso; Furukawa, Toshi A; Patrick, Donald L; Crawford, Mark W; Hemmelgarn, Brenda R; Schunemann, Holger J; Guyatt, Gordon H; Nesrallah, Gihad

    2015-10-01

    Patient-reported outcomes (PROs) are often the outcomes of greatest importance to patients. The minimally important difference (MID) provides a measure of the smallest change in the PRO that patients perceive as important. An anchor-based approach is the most appropriate method for MID determination. No study or database currently exists that provides all anchor-based MIDs associated with PRO instruments; nor are there any accepted standards for appraising the credibility of MID estimates. Our objectives are to complete a systematic survey of the literature to collect and characterise published anchor-based MIDs associated with PRO instruments used in evaluating the effects of interventions on chronic medical and psychiatric conditions and to assess their credibility. We will search MEDLINE, EMBASE and PsycINFO (1989 to present) to identify studies addressing methods to estimate anchor-based MIDs of target PRO instruments or reporting empirical ascertainment of anchor-based MIDs. Teams of two reviewers will screen titles and abstracts, review full texts of citations, and extract relevant data. On the basis of findings from studies addressing methods to estimate anchor-based MIDs, we will summarise the available methods and develop an instrument addressing the credibility of empirically ascertained MIDs. We will evaluate the credibility of all studies reporting on the empirical ascertainment of anchor-based MIDs using the credibility instrument, and assess the instrument's inter-rater reliability. We will separately present reports for adult and paediatric populations. No research ethics approval was required as we will be using aggregate data from published studies. Our work will summarise anchor-based methods available to establish MIDs, provide an instrument to assess the credibility of available MIDs, determine the reliability of that instrument, and provide a comprehensive compendium of published anchor-based MIDs associated with PRO instruments which will help

  5. [Clinical importance and diagnostic methods of minimal hepatic encephalopathy].

    PubMed

    Stawicka, Agnieszka; Zbrzeźniak, Justyna; Świderska, Aleksandra; Kilisińska, Natalia; Świderska, Magdalena; Jaroszewicz, Jerzy; Flisiak, Robert

    2016-02-01

    Minimal hepatic encephalopathy (MHE) encompasses a number of neuropsychological and neurophysiological disorders in patients suffering from liver cirrhosis, who do not display abnormalities during a medical interview or physical examination. A negative influence of MHE on the quality of life of patients suffering from liver cirrhosis was confirmed, which include retardation of ability of operating motor vehicles and disruption of multiple health-related areas, as well as functioning in the society. The data on frequency of traffic offences and accidents amongst patients diagnosed with MHE in comparison to patients diagnosed with liver cirrhosis without MHE, as well as healthy persons is alarming. Those patients are unaware of their disorder and retardation of their ability to operate vehicles, therefore it is of utmost importance to define this group. The term minimal hepatic encephalopathy (formerly "subclinical" encephalopathy) erroneously suggested the unnecessity of diagnostic and therapeutic procedures in patients with liver cirrhosis. Diagnosing MHE is an important predictive factor for occurrence of overt encephalopathy - more than 50% of patients with this diagnosis develop overt encephalopathy during a period of 30 months after. Early diagnosing MHE gives a chance to implement proper treatment which can be a prevention of overt encephalopathy. Due to continuing lack of clinical research there exist no commonly agreed-upon standards for definition, diagnostics, classification and treatment of hepatic encephalopathy. This article introduces the newest findings regarding the importance of MHE, scientific recommendations and provides detailed descriptions of the most valuable diagnostic methods.

  6. Minimal clinically important difference--exacerbations of COPD.

    PubMed

    Calverley, Peter M A

    2005-03-01

    Exacerbations of COPD are now recognised as being important events in the natural history of the condition and become more frequent as the disease worsens. Defining a minimum clinically important difference in exacerbation rate is fraught with difficulty. There is substantial between and within subject differences in the occurrence of these events that makes an individual evaluation of their importance problematic. At present, the most widely used definition of an exacerbation identifies an episode where the patient seeks medical help rather than a predefined change in one or more symptoms. Despite these problems, intervention studies with bronchodilator drugs, inhaled corticosteroids, and pulmonary rehabilitation appear to reduce the frequency of exacerbation events. In patients with an FEV1 below 50% predicted there is reasonable consistency about the magnitude of change and a 4-unit improvement in the St George's Respiratory Questionnaire is commonly associated with a 20-25% reduction in the reported number of exacerbations. Individual studies vary depending upon the recruitment protocol. Patients who experience symptomatic benefit may be those in whom a clinically important change in exacerbations occurs but this concept requires testing prospectively. Existing methodologies for estimating clinically important differences are hard to apply with a binary outcome like this, and more work will be needed to develop a robust approach for dealing with this important clinical variable.

  7. Item response theory analysis to evaluate reliability and minimal clinically important change of the Roland-Morris Disability Questionnaire in patients with severe disability due to back pain from vertebral compression fractures.

    PubMed

    Lee, Minji K; Yost, Kathleen J; McDonald, Jennifer S; Dougherty, Ryne W; Vine, Roanna L; Kallmes, David F

    2017-06-01

    The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability. To evaluate the psychometric quality of the RMDQ in patients with severe disability. Observational clinical study. The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty. The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up. With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID). Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods. Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

    PubMed

    Altenburg, Wytske A; Duiverman, Marieke L; Ten Hacken, Nick H T; Kerstjens, Huib A M; de Greef, Mathieu H G; Wijkstra, Peter J; Wempe, Johan B

    2015-02-19

    Although the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR. Data were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen's effect size was used as distribution based method. The estimated MID of the ESWT with the different anchors ranged from 186-199 s, 76-82% and 154-164 m. Using the distribution based method the MID was 144 s, 61% and 137 m. Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186-199 s, 76-82% or 154-164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions. ClinicalTrials.Gov (ID NCT00135538).

  9. The minimal important difference of exercise tests in severe COPD.

    PubMed

    Puhan, M A; Chandra, D; Mosenifar, Z; Ries, A; Make, B; Hansel, N N; Wise, R A; Sciurba, F

    2011-04-01

    Our aim was to determine the minimal important difference (MID) for 6-min walk distance (6MWD) and maximal cycle exercise capacity (MCEC) in patients with severe chronic obstructive pulmonary disease (COPD). 1,218 patients enrolled in the National Emphysema Treatment Trial completed exercise tests before and after 4-6 weeks of pre-trial rehabilitation, and 6 months after randomisation to surgery or medical care. The St George's Respiratory Questionnaire (domain and total scores) and University of California San Diego Shortness of Breath Questionnaire (total score) served as anchors for anchor-based MID estimates. In order to calculate distribution-based estimates, we used the standard error of measurement, Cohen's effect size and the empirical rule effect size. Anchor-based estimates for the 6MWD were 18.9 m (95% CI 18.1-20.1 m), 24.2 m (95% CI 23.4-25.4 m), 24.6 m (95% CI 23.4-25.7 m) and 26.4 m (95% CI 25.4-27.4 m), which were similar to distribution-based MID estimates of 25.7, 26.8 and 30.6 m. For MCEC, anchor-based estimates for the MID were 2.2 W (95% CI 2.0-2.4 W), 3.2 W (95% CI 3.0-3.4 W), 3.2 W (95% CI 3.0-3.4 W) and 3.3 W (95% CI 3.0-3.5 W), while distribution-based estimates were 5.3 and 5.5 W. We suggest a MID of 26 ± 2 m for 6MWD and 4 ± 1 W for MCEC for patients with severe COPD.

  10. Minimal Clinically Important Differences of Three Patient-Rated Outcomes Instruments

    PubMed Central

    Sorensen, Amelia; Howard, Daniel; Hui Tan, Wen; Ketchersid, Jeffrey; Calfee, Ryan P.

    2013-01-01

    Purpose Patient-rated instruments are increasingly used to measure orthopaedic outcomes. However, the clinical relevance of modest score changes on such instruments is often unclear. This study was designed to define the minimal clinically important differences (MCID) of the Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH, and Patient Rated Wrist Evaluation (PRWE) for atraumatic conditions of the hand, wrist, and forearm. Methods One hundred two patients undergoing nonoperative treatment for isolated tendonitis, arthritis, or nerve compression syndromes from the forearm to the hand were analyzed prospectively. Patients completed the DASH, Quick DASH (subset of DASH), and PRWE at enrollment, 2 weeks (n=78 used in analysis), and 4 weeks (n=24 used in analysis) after initiating treatment by telephone. Patients reporting clinical improvement each contributed a single data point categorized as no change (n=41), minimal improvement (n=30), or marked improvement (n=31) via a validated anchor-based approach. The minimal clinically important difference was calculated as the mean change score for each outcome measure in the minimal improvement group. Results The MCID (95%CI) for the DASH was 10 (5-15). The MCID for the Quick DASH was 14 (9-20). The MCID was 14 (8-20) for the PRWE. MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement. MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores. Discussion Longitudinal changes on the DASH of 10 points, the Quick DASH of 14 points, and the PRWE of 14 points represent minimal clinically important changes. We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients. These MCID values may provide a basis for sample size calculations for future

  11. A point of minimal important difference (MID): a critique of terminology and methods.

    PubMed

    King, Madeleine T

    2011-04-01

    The minimal important difference (MID) is a phrase with instant appeal in a field struggling to interpret health-related quality of life and other patient-reported outcomes. The terminology can be confusing, with several terms differing only slightly in definition (e.g., minimal clinically important difference, clinically important difference, minimally detectable difference, the subjectively significant difference), and others that seem similar despite having quite different meanings (minimally detectable difference versus minimum detectable change). Often, nuances of definition are of little consequence in the way that these quantities are estimated and used. Four methods are commonly employed to estimate MIDs: patient rating of change (global transition items); clinical anchors; standard error of measurement; and effect size. These are described and critiqued in this article. There is no universal MID, despite the appeal of the notion. Indeed, for a particular patient-reported outcome instrument or scale, the MID is not an immutable characteristic, but may vary by population and context. At both the group and individual level, the MID may depend on the clinical context and decision at hand, the baseline from which the patient starts, and whether they are improving or deteriorating. Specific estimates of MIDs should therefore not be overinterpreted. For a given health-related quality-of-life scale, all available MID estimates (and their confidence intervals) should be considered, amalgamated into general guidelines and applied judiciously to any particular clinical or research context.

  12. Minimal Clinically Important Difference on Parkinson's Disease Sleep Scale 2nd Version

    PubMed Central

    Horváth, Krisztina; Aschermann, Zsuzsanna; Ács, Péter; Deli, Gabriella; Janszky, József; Komoly, Sámuel; Karádi, Kázmér; Kovács, Márton; Makkos, Attila; Faludi, Béla; Kovács, Norbert

    2015-01-01

    Background and Aims. The aim of the present study was to determine the estimates of minimal clinically important difference for Parkinson's Disease Sleep Scale 2nd version (PDSS-2) total score and dimensions. Methods. The subject population consisted of 413 PD patients. At baseline, MDS-UPDRS, Hoehn-Yahr Scale, Mattis Dementia Rating Scale, and PDSS-2 were assessed. Nine months later the PDSS-2 was reevaluated with the Patient-Reported Global Impression Improvement Scale. Both anchor-based techniques (within patients' score change method and sensitivity- and specificity-based method by receiver operating characteristic analysis) and distribution-based approaches (effect size calculations) were utilized to determine the magnitude of minimal clinically important difference. Results. According to our results, any improvements larger than −3.44 points or worsening larger than 2.07 points can represent clinically important changes for the patients. These thresholds have the effect size of 0.21 and −0.21, respectively. Conclusions. Minimal clinically important differences are the smallest change of scores that are subjectively meaningful to patients. Studies using the PDSS-2 as outcome measure should utilize the threshold of −3.44 points for detecting improvement or the threshold of 2.07 points for observing worsening. PMID:26539303

  13. Important changes for 2013 Important changes for 2013

    NASA Astrophysics Data System (ADS)

    Quin, Sarah

    2013-02-01

    Journal of Geophysics and Engineering has moved from sequential page numbering to an article numbering system, offering important advantages and flexibility by speeding up the publication process. Papers in different issues or sections can be published online as soon as they are ready, without having to wait for a whole issue or section to be allocated page numbers. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance, from this issue: M Gorjian et al 2013 J. Geophys. Eng. 10 015001 Articles will continue to be published online in advance of the print edition.

  14. Minimal important difference in field walking tests in non-cystic fibrosis bronchiectasis following exercise training.

    PubMed

    Lee, A L; Hill, C J; Cecins, N; Jenkins, S; McDonald, C F; Burge, A T; Rautela, L; Stirling, R G; Thompson, P J; Holland, A E

    2014-09-01

    The 6-min walk distance (6MWD) and incremental shuttle walk distance (ISWD) are clinically meaningful measures of exercise capacity in people with non-cystic fibrosis (CF) bronchiectasis, but the change in walking distance which constitutes clinical benefit is undefined. This study aimed to determine the minimal important difference for the 6MWD and ISWD in non-CF bronchiectasis. Thirty-seven participants with mean FEV1 70% predicted completed both field walking tests before and after an 8-week exercise program. The minimal important difference was calculated using a distribution-based and anchor-based method, with the global rating of change scale used. The mean change in 6MWD in participants who reported themselves to be unchanged was 10 m, compared to 36 m (small change) and 45 m (substantial change) (p = 0.01). For the ISWD, the mean change in participants who reported themselves to be unchanged was 33 m, compared to 54 m (small change) and 73 m (substantial change) (p = 0.04). The anchor-based method defined the minimal important difference for 6MWD as 24.5 m (AUC 0.76, 95% CI 0.61-0.91) and for ISWD as 35 m (AUC 0.88, 95% CI 0.73-0.99), based on participant's global rating of change. The distribution-based method indicated a value of 22.3 m for the 6MWD and 37 m for the ISWD. There was excellent agreement between the two methods for the 6MWD (kappa = 0.91) and the ISWD (kappa = 0.92). Small changes in 6MWD and ISWD may represent clinically important benefits in people with non-CF bronchiectasis. These data are likely to assist in the interpretation of change in exercise capacity following intervention. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Minimal Clinically Important Worsening on the Progressive Supranuclear Palsy Rating Scale

    PubMed Central

    Hewer, Sarah; Varley, Sue; Boxer, Adam L.; Paul, Eldho; Williams, David R

    2016-01-01

    Structured Abstract Introduction Despite the widespread use of the PSP rating scale it is not known what change in this scale is meaningful for patients. Methods We analyzed data from a large clinical trial in PSP-Richardson’s syndrome (AL-108-231) to calculate minimal clinically important worsening. This was defined as the difference in mean change of PSP rating scale in subjects rated ‘a little worse’ and those rated ‘unchanged’ on the Clinicians’ Global Impression of Change Scale. A multivariate analysis using logistic regression assessed the relationship between clinical worsening, PSP rating scale, depression and activities of daily living. Results The minimal clinically important worsening on the PSP rating scale was 5.7 points, corresponding to the mean decline over six months in the trial. Changes in activities of daily living and PSP rating scale were significantly associated with clinical worsening. Conclusion Clinically meaningful change is measurable on the PSP rating scale over six months. PMID:27324431

  16. PUBLISHER'S ANNOUNCEMENT: Important changes for 2008 Important changes for 2008

    NASA Astrophysics Data System (ADS)

    Quin, Sarah

    2008-01-01

    As a result of reviewing several aspects of IOP journal content, both in print and online, we have made some changes for 2008, some of which benefit Journal of Physics D: Applied Physics. Article numbering In common with many other IOP journals, Journal of Physics D: Applied Physics has moved from sequential page numbering to an article numbering system which offers greater flexibility for faster publication of articles. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance: Surname X and Surname Y 2008 J. Phys. D: Appl. Phys. 41 015203 Faster online publication Articles will continue to be published on the web in advance of the print edition but the introduction of article numbering makes it possible to achieve more frequent online publication while retaining the established grouping of articles into subject sections, which was not possible with the former page numbering system. We now expect to publish a new batch of articles each week, instead of every two weeks as previously, with a consequent reduction in our already rapid publication time. A new look and feel Journal of Physics D: Applied Physics has changed from European A4 format to a slightly smaller size which is closer to US Letter format, and we have taken the opportunity to refresh the cover in order to modernize the typography and create a consistent look and feel across our range of publications. If you have any questions or comments about any of these changes, please contact us at jphysd@iop.org

  17. EDITORIAL: Important changes for 2008

    NASA Astrophysics Data System (ADS)

    SAME ADDRESS--> Isabelle Auffret-Babak,

  1. Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method.

    PubMed

    Thissen, David; Liu, Yang; Magnus, Brooke; Quinn, Hally; Gipson, Debbie S; Dampier, Carlton; Huang, I-Chan; Hinds, Pamela S; Selewski, David T; Reeve, Bryce B; Gross, Heather E; DeWalt, Darren A

    2016-01-01

    To assess minimally important differences (MIDs) for several pediatric self-report item banks from the National Institutes of Health Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). We presented vignettes comprising sets of two completed PROMIS questionnaires and asked judges to declare whether the individual completing those questionnaires had an important change or not. We enrolled judges (including adolescents, parents, and clinicians) who responded to 24 vignettes (six for each domain of depression, pain interference, fatigue, and mobility). We used item response theory to model responses to the vignettes across different judges and estimated MID as the point at which 50 % of the judges would declare an important change. We enrolled 246 judges (78 adolescents, 85 parents, and 83 clinicians). The MID estimated with clinician data was about 2 points on the PROMIS T-score scale, and the MID estimated with adolescent and parent data was about 3 points on that same scale. The MIDs enhance the value of PROMIS pediatric measures in clinical research studies to identify meaningful changes in health status over time.

  2. Estimating Minimally Important Difference (MID) in PROMIS Pediatric Measures using the Scale-Judgment Method

    PubMed Central

    Thissen, David; Liu, Yang; Magnus, Brooke; Quinn, Hally; Gipson, Debbie S.; Dampier, Carlton; Huang, I-Chan; Hinds, Pamela S.; Selewski, David T.; Reeve, Bryce B.; Gross, Heather E.; DeWalt, Darren A.

    2015-01-01

    Objective To assess minimally important differences (MID) for several pediatric self-report item banks from the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System® (PROMIS®). Methods We presented vignettes comprising sets of two completed PROMIS questionnaires and asked judges to declare whether the individual completing those questionnaires had an important change or not. We enrolled judges (including adolescents, parents, and clinicians) who responded to 24 vignettes (six for each domain of depression, pain interference, fatigue, and mobility). We used item response theory (IRT) to model responses to the vignettes across different judges and estimated MID as the point at which 50% of the judges would declare an important change. Results We enrolled 246 judges (78 adolescents, 85 parents, and 83 clinicians). The MID estimated with clinician data was about 2 points on the PROMIS T-score scale, and the MID estimated with adolescent and parent data was about 3 points on that same scale. Conclusions The MIDs enhance the value of PROMIS Pediatric measures in clinical research studies to identify meaningful changes in health status over time. PMID:26118768

  3. Changes occurring to minimally disturbed soil and to plant covers

    USDA-ARS?s Scientific Manuscript database

    During the transition to organic production certain materials and practices, as described under US law, can not be used. During the transition period growers may, or may not, disturb the soil. There is little known about changes that occur if the soil is minimally disturbed during the transition t...

  4. Minimal pathologic changes of the lung and asbestos exposure

    SciTech Connect

    Bellis, D.; Andrion, A.; Delsedime, L.; Mollo, F.

    1989-02-01

    A group of 199 autopsy subjects was investigated for minimal pathologic pulmonary changes possibly resulting from asbestos exposure. According to the standards proposed by the Pneumoconiosis Committee of the College of American Pathologists, features consistent with asbestosis grade 1 (AG1) include findings of bilateral pleural plaques, high concentrations of asbestos bodies (ABs) in digested lung tissue, and a history of occupational risk. Similar changes without evidence of ABs on histologic section and referred to as small airway lesions (SALs) present a less well-correlated association. In this study, SALs showed significant differences when compared with the features observed in subjects without possible asbestos-related pulmonary fibrotic changes. Minimal bronchioloalveolar fibrotic changes with concomitant presence of ABs can be considered a mild pneumoconiotic lesion (AG1), and SALs may be regarded as an additional indicator of asbestos exposure.

  5. The Minimal Important Difference in Borg Dyspnea Score in Pulmonary Arterial Hypertension.

    PubMed

    Khair, Rubina M; Nwaneri, Chisom; Damico, Rachel L; Kolb, Todd; Hassoun, Paul M; Mathai, Stephen C

    2016-06-01

    Despite therapeutic advances, pulmonary arterial hypertension remains a disease without a cure. Focusing on symptoms, such as dyspnea, is an important part of assessing response to therapy. To determine the minimal important differences for the Borg dyspnea score and the Borg fatigue score in adult patients undergoing initial therapy for pulmonary arterial hypertension. We studied 129 patients enrolled between 2003 and 2013 in the Pulmonary Arterial Hypertension Program registry at Johns Hopkins University Hospital in Baltimore, Maryland. We analyzed baseline demographics, clinical characteristics, 6-minute-walk test distance, and Borg dyspnea and fatigue scores at baseline and at follow up 3 months after initiation of pulmonary arterial hypertension therapy. The minimal important differences for the Borg dyspnea and fatigue scores were determined using distributional and anchor-based methods, using 6-minute-walk test distance as the anchor. Most subjects were in New York Heart Association functional class II or III and had moderate to severe pulmonary arterial hypertension. The baseline Borg dyspnea score was 3.4 ± 1.9 units; the baseline Borg fatigue score was 2.8 ± 2.2 units. After therapy, the average change in the dyspnea score was -0.16 ± 1.9 units and the average change in the fatigue score was -0.21 ± 2.4 units. Using distributional methods, the minimum important difference for Borg dyspnea score ranged from 0.7 to 1.24 units and for Borg fatigue score ranged from 0.73 to 1.39 units. Using anchor-based methods, the minimum important difference for the Borg dyspnea scales was 0.36; this could not be calculated for the Borg fatigue score. Using distributional and anchor-based methods, we estimate the minimum important difference for Borg dyspnea scale in pulmonary arterial hypertension is approximately 0.9 units. Using distributional methods only, we estimate the minimum important difference for the Borg fatigue scale is around 1 unit

  6. Minimal clinically important differences in the Edmonton symptom assessment system in patients with advanced cancer.

    PubMed

    Bedard, Gillian; Zeng, Liang; Zhang, Liying; Lauzon, Natalie; Holden, Lori; Tsao, May; Danjoux, Cyril; Barnes, Elizabeth; Sahgal, Arjun; Poon, Michael; Chow, Edward

    2013-08-01

    Longitudinal symptom monitoring is important in the setting of patients with advanced cancer. Scores over time may naturally fluctuate, although a patient may feel the same. The purpose of this study was to determine the minimal levels of change required to be clinically relevant (minimal clinically important difference [MCID]) using the Edmonton Symptom Assessment System (ESAS). Between 1999 and 2009, patients completed the ESAS before palliative radiotherapy and at follow-up. MCIDs were calculated using both the anchor- and distribution-based methods for improvement and deterioration; 95% confidence intervals for the differences in mean change scores between adjacent categories also were calculated. A total of 276 patients completed the ESAS at baseline and during at least one follow-up visit. At the four-week follow-up, decrease of 1.2 and 1.1 units in pain and depression scales, respectively, constituted clinically relevant improvement, whereas increase of at least 1.4, 1.8, 1.1, 1.1, and 1.4 units, respectively, in pain, tiredness, depression, anxiety, and appetite loss items were required for deterioration. At the subsequent follow-ups, these values were similar. Overall, the MCID for improvement tended to be smaller than that for deterioration. The distribution-based method estimates tended to be larger than the 0.3 SD estimates, but closer to the 0.5 SD estimates. MCIDs allow health care professionals to determine the success of treatment in improving the patient's quality of life. MCIDs may prompt health care professionals to intervene with new treatment. Future studies should confirm our findings with a variety of anchors. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  7. Minimal clinically important difference in Parkinson's disease as assessed in pivotal trials of pramipexole extended release.

    PubMed

    Hauser, Robert A; Gordon, Mark Forrest; Mizuno, Yoshikuni; Poewe, Werner; Barone, Paolo; Schapira, Anthony H; Rascol, Olivier; Debieuvre, Catherine; Fräßdorf, Mandy

    2014-01-01

    Background. The minimal clinically important difference (MCID) is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson's Disease Rating Scale (UPDRS) scores in early Parkinson's disease (EPD) and for UPDRS scores and "OFF" time in advanced Parkinson's disease (APD). Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR) as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves "a little better" on patient global impression of improvement (PGI-I) minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR) for UPDRS II were -1.8 and -2.0, for UPDRS III -6.2 and -6.1, and for UPDRS II + III -8.0 and -8.1. MCIDs in APD for UPDRS II were -1.8 and -2.3, for UPDRS III -5.2 and -6.5, and for UPDRS II + III -7.1 and -8.8. MCID for "OFF" time (pramipexole ER, pramipexole IR) was -1.0 and -1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  8. Evaluating minimal important differences for the FACT-Melanoma quality of life questionnaire.

    PubMed

    Askew, Robert L; Xing, Yan; Palmer, J Lynn; Cella, David; Moye, Lemuel A; Cormier, Janice N

    2009-01-01

    Minimal Important Differences (MIDs) establish benchmarks for interpreting mean differences in clinical trials involving quality of life outcomes and inform discussions of clinically meaningful change in patient status. The purpose of this study was to assess MIDs for the Functional Assessment of Cancer Therapy-Melanoma (FACT-M). A prospective validation study of the FACT-M was performed with 273 patients with stages I through IV melanoma. FACT-M, Karnofsky Performance Scales, and Eastern Cooperative Oncology Group Performance Status scores were obtained at baseline and 3 months following enrollment. Anchor- and distribution-based methods for assessing MIDs were compared, and pattern-mixture modeling was employed to derive multivariate adjusted estimates. This study indicates that an approximate range for MIDs of the FACT-M subscales is between 5 to 9 points for the Trial Outcome Index, 4 to 6 points for the Melanoma Combined Subscale, 2 to 4 points for the Melanoma Subscale, and 1 to 2 points for the Melanoma Surgery Subscale. Each method produced similar but not identical ranges of MIDs. The properties of the anchor instrument employed to derive MIDs directly affect resulting MID ranges and point values. When MIDs are offered as supportive evidence of a clinically meaningful change, the anchor instrument used to derive clinically meaningful thresholds of change should be clearly stated along with information supporting the choice of anchor instrument as the most appropriate for the domain of interest.

  9. Estimating a minimally important difference in pulmonary arterial hypertension following treatment with sildenafil.

    PubMed

    Gilbert, Claire; Brown, Martin C J; Cappelleri, Joseph C; Carlsson, Martin; McKenna, Stephen P

    2009-01-01

    No guidelines exist to help physicians determine whether functional and health-related quality of life (HRQoL) changes observed following treatment of patients with pulmonary arterial hypertension (PAH) represent important benefits. These analyses were undertaken to help define a minimally important difference (MID) in exercise capacity, measured by the 6-min walk distance (6MWD), and HRQoL, measured by the Short Form-36 (SF-36) questionnaire in patients with PAH. Data from a 12-week sildenafil study in patients with PAH were used to calculate MIDs for 6MWD and the SF-36 physical functioning, role-physical, social functioning, and vitality scales using effect size, SEM, and SE of the difference approaches. Data from all patients enrolled into the treatment groups in the study were included. A range of plausible MID estimates, including a score change for SF-36 scales and a change in distance walked in meters for 6MWD, were generated for each end point. Mean values were calculated for each outcome and recommended as MIDs for each parameter. Based on these computations, the mean MIDs for the SF-36 physical functioning, role-physical, social functioning, and vitality scales and for 6MWD were 13, 25, 21, and 15 points, and 41 m, respectively. This is the first clinical investigation to estimate MIDs for key SF-36 domains and 6MWD in patients with PAH and provides a much needed metric for interpreting the level of change in patients with PAH against which other treatments and trials can be measured.

  10. Minimal Important Difference (MID) of two commonly used outcome measures for foot problems.

    PubMed

    Landorf, Karl B; Radford, Joel A; Hudson, Susie

    2010-05-14

    The Visual Analogue Scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are two commonly used outcome measures for evaluating foot health. This study aimed to calculate the Minimal Important Difference (MID) of the VAS and the FHSQ. 184 participants with plantar heel pain were recruited from the general public to take part in two randomised trials (92 participants in each trial) that studied the effectiveness of two conservative interventions for plantar heel pain. Data from these participants were used to calculate the MIDs of the VAS and the FHSQ. An anchor-based method was used to calculate the MIDs. Two distinct types of pain were investigated for the VAS: average pain and first-step pain. All four domains of the FHSQ were investigated: foot pain, foot function, footwear and general foot health. The MID for the VAS using the anchor-based approach was -8 mm (95% CI: -12 to -4) for average pain and -19 mm (95% CI: -25 to -13) for first-step pain on the 100 mm VAS. The MID for the FHSQ was 13 points (95% CI: 6 to 19) for pain and 7 points (95% CI: 1 to 13) for function. The MID for the footwear domain of the FHSQ was -2 points (95% CI: -8 to 4) and 0 points (95% CI: -7 to 6) for the general foot health domain of the FHSQ. The results of this study provide additional evidence for MID values of the VAS and the FHSQ for plantar heel pain. This is important for clinicians and researchers as it provides a greater understanding of how much improvement is required by a patient before a minimal, worthwhile change is experienced. The calculated MIDs will also assist researchers with prospective sample size calculations.

  11. Minimal Important Difference (MID) of two commonly used outcome measures for foot problems

    PubMed Central

    2010-01-01

    Background The Visual Analogue Scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are two commonly used outcome measures for evaluating foot health. This study aimed to calculate the Minimal Important Difference (MID) of the VAS and the FHSQ. Methods 184 participants with plantar heel pain were recruited from the general public to take part in two randomised trials (92 participants in each trial) that studied the effectiveness of two conservative interventions for plantar heel pain. Data from these participants were used to calculate the MIDs of the VAS and the FHSQ. An anchor-based method was used to calculate the MIDs. Two distinct types of pain were investigated for the VAS: average pain and first-step pain. All four domains of the FHSQ were investigated: foot pain, foot function, footwear and general foot health. Results The MID for the VAS using the anchor-based approach was -8 mm (95% CI: -12 to -4) for average pain and -19 mm (95% CI: -25 to -13) for first-step pain on the 100 mm VAS. The MID for the FHSQ was 13 points (95% CI: 6 to 19) for pain and 7 points (95% CI: 1 to 13) for function. The MID for the footwear domain of the FHSQ was -2 points (95% CI: -8 to 4) and 0 points (95% CI: -7 to 6) for the general foot health domain of the FHSQ. Conclusion The results of this study provide additional evidence for MID values of the VAS and the FHSQ for plantar heel pain. This is important for clinicians and researchers as it provides a greater understanding of how much improvement is required by a patient before a minimal, worthwhile change is experienced. The calculated MIDs will also assist researchers with prospective sample size calculations. PMID:20465855

  12. Minimally important difference for the Expanded Prostate Cancer Index Composite Short Form.

    PubMed

    Skolarus, Ted A; Dunn, Rodney L; Sanda, Martin G; Chang, Peter; Greenfield, Thomas K; Litwin, Mark S; Wei, John T

    2015-01-01

    To establish a score threshold that constitutes a clinically relevant change for each domain of the Expanded Prostate Cancer Index Composite (EPIC) Short Form (EPIC-26). Although its use in clinical practice and clinical trials has increased worldwide, the clinical interpretation of this 26-item disease-specific patient-reported quality of life questionnaire for men with localized prostate cancer would be facilitated by characterization of score thresholds for clinically relevant change (the minimally important differences [MIDs]). We used distribution- and anchor-based approaches to establish the MID range for each EPIC-26 domain (urinary, sexual, bowel, and vitality/hormonal) based on a prospective multi-institutional cohort of 1201 men treated for prostate cancer between 2003 and 2006 and followed up for 3 years after treatment. For the anchor-based approach, we compared within-subject and between-subject score changes for each domain to an external "anchor" measure of overall cancer treatment satisfaction. We found the bowel and vitality/hormonal domains to have the lowest MID range (a 4-6 point change should be considered clinically relevant), whereas the sexual domain had the greatest MID values (10-12). Urinary incontinence appeared to have a greater MID range (6-9) than the urinary irritation/obstruction domain (5-7). Using 2 independent approaches, we established the MIDs for each EPIC-26 domain. A definition of these MID values is essential for the researcher or clinician to understand when changes in symptom burden among prostate cancer survivors are clinically relevant. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2017-02-01

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

  14. Asthma Symptom Utility Index: Reliability, validity, responsiveness and the minimal important difference in adult asthma patients

    PubMed Central

    Bime, Christian; Wei, Christine Y.; Holbrook, Janet T.; Sockrider, Marianna M.; Revicki, Dennis A.; Wise, Robert A.

    2012-01-01

    Background The evaluation of asthma symptoms is a core outcome measure in asthma clinical research. The Asthma Symptom Utility Index (ASUI) was developed to assess frequency and severity of asthma symptoms. The psychometric properties of the ASUI are not well characterized and a minimal important difference (MID) is not established. Objectives We assessed the reliability, validity, and responsiveness to change of the ASUI in a population of adult asthma patients. We also sought to determine the MID for the ASUI. Methods Adult asthma patients (n = 1648) from two previously completed multicenter randomized trials were included. Demographic information, spirometry, ASUI scores, and other asthma questionnaire scores were obtained at baseline and during follow-up visits. Participants also kept a daily asthma diary. Results Internal consistency reliability of the ASUI was 0.74 (Cronbach’s alpha). Test-retest reliability was 0.76 (intra-class correlation). Construct validity was demonstrated by significant correlations between ASUI scores and Asthma Control Questionnaire (ACQ) scores (Spearman correlation r = −0.79, 95% CI [−0.85, −0.75], P<0.001) and Mini Asthma Quality of Life Questionnaire (Mini AQLQ) scores (r = 0.59, 95% CI [0.51, 0.61], P<0.001). Responsiveness to change was demonstrated, with significant differences between mean changes in ASUI score across groups of participants differing by 10% in the percent predicted FEV1 (P<0.001), and by 0.5 points in ACQ score (P < 0.001). Anchor-based methods and statistical methods support an MID for the ASUI of 0.09 points. Conclusions The ASUI is reliable, valid, and responsive to changes in asthma control over time. The MID of the ASUI (range of scores 0–1) is 0.09. PMID:23026499

  15. Minimally Important Difference of the Absolute and Functional Claudication Distance in Patients with Intermittent Claudication.

    PubMed

    van den Houten, M M L; Gommans, L N M; van der Wees, P J; Teijink, J A W

    2016-03-01

    Disease severity and treatment outcomes in patients with intermittent claudication (IC) are commonly assessed using walking distance measured with a standardized treadmill test. It is unclear what improvement or deterioration in walking distance constitutes a meaningful, clinically relevant, change from the patients' perspective. The purpose of the present study was to estimate the minimally important difference (MID) for the absolute claudication distance (ACD) and functional claudication distance (FCD) in patients with IC. The MIDs were estimated using an anchor based approach with a previously defined clinical anchor derived from scores of the walking impairment questionnaire (WIQ) in a similar IC population. Baseline and 3 month follow up data on WIQ scores and walking distances (ACD and FCD) were used from 202 patients receiving supervised exercise therapy from the 2010 EXITPAD randomized controlled trial. The external WIQ anchor was used to form three distinct categories: patients with "clinically relevant improvement," "clinically relevant deterioration," and "no clinically relevant change." The MIDs for improvement and deterioration were defined by the upper and lower limits of the 95% confidence interval of the mean change in ACD and FCD, for the group of IC patients that remained unchanged according to the WIQ anchor. For the estimation of the MID of the ACD and FCD, 102 and 101 patients were included, respectively. The MID for the ACD was 305 m for improvement, and 147 m for deterioration. The MID for the FCD was 250 m for improvement, and 120 m for deterioration. The MIDs for the treadmill measured ACD and FCD can be used to interpret the clinical relevance of changes in walking distances after supervised exercise therapy and may be used in both research and individual care. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference

    PubMed Central

    Sullivan, Katherine J.; Cen, Steven Y.; Rose, Dorian K.; Koradia, Cherisha H.; Azen, Stanley P.; Duncan, Pamela W.

    2010-01-01

    Background When people with stroke recover gait speed, they report improved function and reduced disability. However, the minimal amount of change in gait speed that is clinically meaningful and associated with an important difference in function for people poststroke has not been determined. Objective The purpose of this study was to determine the minimal clinically important difference (MCID) for comfortable gait speed (CGS) associated with an improvement in the modified Rankin Scale (mRS) score for people between 20 to 60 days poststroke. Design This was a prospective, longitudinal, cohort study. Methods The participants in this study were 283 people with first-time stroke prospectively enrolled in the ongoing Locomotor Experience Applied Post Stroke (LEAPS) multi-site randomized clinical trial. Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke. Improvement of ≥1 on the mRS was used to detect meaningful change in disability level. Results Mean (SD) CGS was 0.18 (0.16) m/s at 20 days and 0.39 (0.22) m/s at 60 days poststroke. Among all participants, 47.3% experienced an improvement in disability level ≥1. The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS. Limitations Because the mRS is not a gait-specific measure of disability, the estimated MCID for CGS was only 73.9% sensitive and 57.0% specific for detecting improvement in mRS scores. Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s. Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not. Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke. PMID:20022995

  17. Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients

    PubMed Central

    Lauridsen, Henrik H; Hartvigsen, Jan; Manniche, Claus; Korsholm, Lars; Grunnet-Nilsson, Niels

    2006-01-01

    Background The choice of an evaluative instrument has been hampered by the lack of head-to-head comparisons of responsiveness and the minimal clinically important difference (MCID) in subpopulations of low back pain (LBP). The objective of this study was to concurrently compare responsiveness and MCID for commonly used pain scales and functional instruments in four subpopulations of LBP patients. Methods The Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0–10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP. Results RMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM = 0.5–1.4; ROC = 0.75–0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4–0.9; ROC = 0.76–0.89; RMQ: SRM = 0.3–0.9; ROC = 0.72–0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM = 1.3–1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM = 1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score

  18. Minimally important differences of the gout impact scale in a randomized controlled trial

    PubMed Central

    Sarkin, Andrew J.; Khanna, Puja P.; Shieh, Marian M.; Kavanaugh, Arthur F.; Terkeltaub, Robert A.; Lee, Susan J.; Singh, Jasvinder A.; Hirsch, Jan D.

    2011-01-01

    Objective. The Gout Impact Scale (GIS) is a gout-specific quality of life instrument that assesses impact of gout during an attack and impact of overall gout. The GIS has five scales and each is scored from 0 to 100 (worse health). Our objective was to assess minimally important differences (MIDs) for the GIS administered in a randomized controlled trial (RCT) assessing rilonacept vs placebo for prevention of gout flares during initiation of allopurinol therapy. Methods. Trial subjects ( n = 83) included those with two or more gout flares (self-reported) in the past year. Of these, 73 had data for Weeks 8 vs 4 and formed the MID analysis group and were analysed irrespective of the treatment assignment. Subjects completed the GIS and seven patient-reported anchors. Subjects with a one-step change (e.g. from very poor to poor) were considered as the MID group for each anchor. The mean change in GIS scores and effect size (ES) was calculated for each anchor’s MID group. The average of these created the overall summary MID statistics for each GIS. An ES of 0.2–0.5 was considered to represent MID estimates. Results. Trial subjects (n = 73) were males (96.0%), White (90.4%), with mean age of 50.5 years and serum uric acid of 9.0 mg/dl. The mean change score for the MID improvement group for scales ranged from −5.24 to −7.61 (0–100 scale). The ES for the MID improvement group for the four scales ranged from 0.22 to 0.38. Conclusion. The MID estimates for GIS scales are between 5 and 8 points (0–100 scale). This information can aid in interpreting the GIS results in future gout RCTs. Trial Registration. Clinicaltrials.gov, www.clinicaltrials.gov, NCT00610363. PMID:21372003

  19. Don’t middle your MIDs: regression to the mean shrinks estimates of minimally important differences

    PubMed Central

    Fayers, Peter M.; Hays, Ron D.

    2014-01-01

    Minimal important differences (MIDs) for patient-reported outcomes (PROs) are often estimated by selecting a clinical variable to serve as an anchor. Then, differences in the clinical anchor regarded as clinically meaningful or important can be used to estimate the corresponding value of the PRO. Although these MID values are sometimes estimated by regression techniques, we show that this is a biased procedure and should not be used; alternative methods are proposed. PMID:23722635

  20. Don't middle your MIDs: regression to the mean shrinks estimates of minimally important differences.

    PubMed

    Fayers, Peter M; Hays, Ron D

    2014-02-01

    Minimal important differences (MIDs) for patient-reported outcomes (PROs) are often estimated by selecting a clinical variable to serve as an anchor. Then, differences in the clinical anchor regarded as clinically meaningful or important can be used to estimate the corresponding value of the PRO. Although these MID values are sometimes estimated by regression techniques, we show that this is a biased procedure and should not be used; alternative methods are proposed.

  1. Limited responsiveness related to the minimal important difference of patient-reported outcomes in rare diseases.

    PubMed

    Johnston, Bradley C; Miller, Patricia A; Agarwal, Arnav; Mulla, Sohail; Khokhar, Rabia; De Oliveira, Kyle; Hitchcock, Christine L; Sadeghirad, Behnam; Mohiuddin, Mukarram; Sekercioglu, Nigar; Seweryn, Michal; Koperny, Magdalena; Bala, Malgorzata M; Adams-Webber, Thomasin; Granados, Alicia; Hamed, Alaa; Crawford, Mark W; van der Ploeg, Ans T; Guyatt, Gordon H

    2016-11-01

    To explore the responsiveness of patient-reported outcomes (PROs) in interventional studies involving patients with rare lysosomal storage diseases (LSDs). We searched eight databases for experimental and nonexperimental studies. Pairs of trained reviewers independently screened articles and subsequently extracted data from the eligible studies. Among studies with 10 or more patients using a valid PRO, we assessed the responsiveness of PROs based on a reanalysis of the data using minimal important difference estimates. Our analyses focused on statistically significant within-group differences in PROs for observational studies or the statistically significant between-group differences in PRO scores for controlled studies. Of 2,679 unique records, 62 interventional studies addressing patients with Fabry (55%), Gaucher (19%), Pompe (16%), and mucopolysaccharidoses (11%) proved eligible. The most frequently used PROs were the Short-Form-36 (25 studies), Brief Pain Inventory (20 studies), EuroQoL-5D (9 studies), and the Fatigue Severity Scale (6 studies). Observational studies suggest that PROs sometimes detect significant within-group changes when present. Randomized trials raise questions regarding the responsiveness of PROs to small differences between groups. Most studies have relied on generic PROs to evaluate quality of life and symptoms in patients with rare LSDs. PROs appear more responsive in observational studies than randomized trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Estimating Minimally Important Differences for Two Vision-Specific Quality of Life Measures

    PubMed Central

    Gillespie, Brenda W.; Musch, David C.; Niziol, Leslie M.; Janz, Nancy K.

    2014-01-01

    Purpose. To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ). Methods. A total of 607 subjects with newly-diagnosed open-angle glaucoma (OAG) was enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) and randomized to initial treatment with medications or surgery. Subjects underwent an ophthalmic examination and telephone-administered quality of life (QOL) interview before randomization and every six months thereafter. The VAQ and NEI-VFQ were used to assess participants' perceptions of their visual function. Clinical measures included the mean deviation (MD) from Humphrey 24-2 full threshold visual field (VF) testing, and best-corrected visual acuity (VA) measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Anchor-based (using MD and VA) and distribution-based methods were used to estimate MIDs. Results. Anchor-based cross-sectional analyses at 66 months follow-up found a 10-letter increment in better eye VA corresponded to MIDs of 5.2 units for VAQ and 3.8 units for NEI-VFQ total scores. A 3-dB increment in the better eye MD yielded MIDs of 2.6 and 2.3 units for the same two questionnaires. In longitudinal analyses, MIDs for the VAQ were 3.2 units for a 10-letter change of VA and 3.4 units for a 3-dB change in the MD. Distribution-based MIDs were larger. Conclusions. A range of MIDs for the VAQ (2.6–6.5 units) and NEI-VFQ (2.3–3.8 units) was found. Although similar in magnitude, MIDs were sensitive to the MID estimation method, the anchor chosen, and differences between questionnaires. (ClinicalTrials.gov number, NCT00000149.) PMID:24906863

  3. Estimating minimally important differences for two vision-specific quality of life measures.

    PubMed

    Gillespie, Brenda W; Musch, David C; Niziol, Leslie M; Janz, Nancy K

    2014-06-06

    To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ). A total of 607 subjects with newly-diagnosed open-angle glaucoma (OAG) was enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) and randomized to initial treatment with medications or surgery. Subjects underwent an ophthalmic examination and telephone-administered quality of life (QOL) interview before randomization and every six months thereafter. The VAQ and NEI-VFQ were used to assess participants' perceptions of their visual function. Clinical measures included the mean deviation (MD) from Humphrey 24-2 full threshold visual field (VF) testing, and best-corrected visual acuity (VA) measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Anchor-based (using MD and VA) and distribution-based methods were used to estimate MIDs. Anchor-based cross-sectional analyses at 66 months follow-up found a 10-letter increment in better eye VA corresponded to MIDs of 5.2 units for VAQ and 3.8 units for NEI-VFQ total scores. A 3-dB increment in the better eye MD yielded MIDs of 2.6 and 2.3 units for the same two questionnaires. In longitudinal analyses, MIDs for the VAQ were 3.2 units for a 10-letter change of VA and 3.4 units for a 3-dB change in the MD. Distribution-based MIDs were larger. A range of MIDs for the VAQ (2.6-6.5 units) and NEI-VFQ (2.3-3.8 units) was found. Although similar in magnitude, MIDs were sensitive to the MID estimation method, the anchor chosen, and differences between questionnaires. (ClinicalTrials.gov number, NCT00000149.). Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  4. Minimal important difference for 6-minute walk test distances among patients with chronic heart failure.

    PubMed

    Täger, Tobias; Hanholz, Wiebke; Cebola, Rita; Fröhlich, Hanna; Franke, Jennifer; Doesch, Andreas; Katus, Hugo A; Wians, Frank H; Frankenstein, Lutz

    2014-09-01

    The 6-minute walk test (6 WT) is an established tool in the assessment of endurance and prognosis in patients with chronic heart failure (CHF). For these patients there is very limited data on biological variation of 6 WT distances. We determined the minimal important difference (MID) for the 6 WT in patients with stable systolic CHF. Two cohorts of patients with stable systolic CHF were included from the outpatients' clinic of the University of Heidelberg. In these cohorts, two 6 WT measurements were performed - in cohort 1 (n=461) 180 days and in cohort 2 (n=512) 365 days apart. Stability was defined as the absence of clinical events (3 months before the first test, between both tests, and 6 months after the second test) and stability of symptoms (NYHA) between tests. Using a standard error of measurement (SEM)-based approach, we determined the MID for both cohorts. The intraclass correlation coefficient was 0.89 at 180 days and 0.88 at 365 days. The results were consistent for groups stratified for age, gender, etiology of CHF, and individual NYHA class. The MID for the 6 WT in stable CHF patients was 35 m and 37 m between presentation and 180 and 365 days, respectively. Submaximal exercise capacity as represented by the 6 WT varies little in stable CHF patients for up to 1-year intervals. The MID for changes in 6 WT values in patients with stable CHF over a period of 6 to 12 months is ~ 36 m. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Minimal Clinically Important Difference of Carpal Tunnel Release in Diabetic and Non-Diabetic Patients

    PubMed Central

    Ozer, Kagan; Malay, Sunitha; Toker, Serdar; Chung, Kevin C.

    2016-01-01

    Background Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is essential in outcomes research to evaluate patients’ perspective of treatment effectiveness. We aim to determine (MCID) after carpal tunnel release in diabetic and non-diabetic patients using the Boston Carpal Tunnel Questionnaire (BCTQ). Methods We prospectively evaluated 114 patients (87 non-diabetic, 27 diabetic) undergoing carpal tunnel release. In addition to standard history and physical examination, we obtained preoperative electrodiagnostic studies to confirm Carpal Tunnel Syndrome (CTS). The BCTQ was administered before and after the surgery at 3 and 6 months. Patients were asked about their level of satisfaction at the final follow-up period. We applied the receiver operating characteristic (ROC) curve approach to determine the MCID of symptom and function severity scales of the questionnaire. We used patient satisfaction as the reference standard to compare against the standardized change in scores after surgery for the 2 groups. Results For both diabetic and non-diabetic patients, symptom and function severity scales showed large effect size of >0.8 at 3 and 6 months after the surgery. At 6 months after surgery to be satisfied, diabetic patients required an MCID of 1.55 and 2.05 points for symptom and function scales, whereas non-diabetic patients required 1.45 and 1.6 points, respectively. Conclusion Diabetic patients needed a greater improvement in BCTQ score to be satisfied on functional and symptom severity scales than non-diabetic patients. Overall diabetic patients had less improvement in BCTQ final scores compared to non-diabetics. PMID:23416439

  6. Minimal important differences for fatigue patient reported outcome measures-a systematic review.

    PubMed

    Nordin, Åsa; Taft, Charles; Lundgren-Nilsson, Åsa; Dencker, Anna

    2016-05-26

    Fatigue is the most frequent symptom reported by patients with chronic illnesses. As a subjective experience, fatigue is commonly assessed with patient-reported outcome measures (PROMs). Currently, there are more than 40 generic and disease-specific PROMs for assessing fatigue in use today. The interpretation of changes in PROM scores may be enhanced by estimates of the so-called minimal important difference (MID). MIDs are not fixed attributes of PROMs but rather vary in relation to estimation method, clinical and demographic characteristics of the study group, etc. The purpose of this paper is to compile published MIDs for fatigue PROMs, spanning diagnostic/patient groups and estimation methods, and to provide information relevant for appraising their appropriateness for use in specific clinical trials and in monitoring fatigue in defined patient groups in routine clinical practice. A systematic search of three databases (Scopus, CINAHL and Cochrane) for studies published between January 2000 to April 2015 using fatigue and variations of the term MID, e.g. MCID, MIC, etc. Two authors screened search hits and extracted data independently. Data regarding MIDs, anchors used and study designs were compiled in tables. Included studies (n = 41) reported 60 studies or substudies estimating MID for 28 fatigue scales, subscales or single item measures in a variety of diagnostic groups and study designs. All studies used anchor-based methods, 21/60 measures also included distribution-based methods and 17/60 used triangulation of methods. Both similarities and dissimilarities were seen within the MIDs. Magnitudes of published MIDs for fatigue PROMs vary considerably. Information about the derivation of fatigue MIDs is needed to evaluate their applicability and suitability for use in clinical practice and research.

  7. Determining minimally important score differences in scales of the Copenhagen Psychosocial Questionnaire.

    PubMed

    Pejtersen, Jan Hyld; Bjorner, Jakob Bue; Hasle, Peter

    2010-02-01

    To determine minimally important differences (MIDs) for scales in the first version of the Copenhagen Psychosocial Questionnaire (COPSOQ). Data were taken from two separate studies: a national population survey (N = 1062), and an intervention study at 14 workplaces (N = 1505). On the basis of the population survey, the MID for each COPSOQ scale was calculated as one-half of a standard deviation (0.5 SD). For the core COPSOQ scales on ''Quantitative demands'', ''Influence at work'', ''Predictability'', ''Social support (from colleagues and supervisors, respectively)'', and ''Job satisfaction'', the MIDs were evaluated in the intervention study, where score differences for the scales were linked to the respondents' global self-evaluation of the impact of the interventions. The scales were scored from 0 to 100 in both studies. The MIDs calculated as 0.5 SD were, on average, 9.2 (range 6.8-14.9) for the long version scales, and 10.8 (range 7.6-14.9) for the medium-length version scales. The analysis of the self-evaluated changes on the scale scores for the core COPSOQ scales showed that the anchor-based estimates of MID were generally lower than 0.5 SD. We recommend the following MID values for the COPSOQ scales: ''Quantitative demands'', 0.3 SD; ''Influence'', 0.2 SD; ''Predictability'', 0.3 SD; ''Social support from colleagues'', 0.3 SD; ''Social support from supervisor'', 0.7 SD; and ''Job satisfaction'', 0.4 SD. For all other COPSOQ scales, where we do not have anchor-based results, we recommend the conventional MID value of 0.5 SD.

  8. Reliability and minimal detectable change in scapulothoracic neuromuscular activity.

    PubMed

    Seitz, Amee L; Uhl, Timothy L

    2012-12-01

    Alterations in scapular muscle activity, including excess activation of the upper trapezius (UT) and onset latencies of the lower trapezius (LT) and serratus anterior (SA) muscles, are associated with abnormal scapular motion and shoulder impingement. Limited information exists on the reliability of neuromuscular activity to demonstrate the efficacy of interventions. The purpose of this study was to characterize the reproducibility of scapular muscle activity (mean activity, relative onset timing) over time and establish the minimal detectable change (MDC). Surface electromyography (sEMG) of the UT, LT, SA and anterior deltoid (AD) muscles in 16 adults were captured during an overhead lifting task in two sessions, one-week apart. sEMG data were also normalized to maximum isometric contraction and the relative onset and mean muscle activity during concentric and eccentric phases of the scapular muscles were calculated. Additionally, reliability of the absolute sEMG data during the lifting task and MVIC was evaluated. Both intrasession and intersession reliability of normalized and absolute mean scapular muscle activity, assessed with intraclass correlation coefficients (ICC), ranged from 0.62 to 0.99; MDC values were between 1.3% and 11.7% MVIC and 24 to 135 mV absolute sEMG. Reliability of sEMG during MVIC was ICC = 0.82-0.99, with the exception of intersession upper trapezius reliability (ICC = 0.36). Within session reliability of muscle onset times was ICC = 0.88-0.97, but between session reliability was lower with ICC = 0.43-0.73; MDC were between 39 and 237 ms. Small changes in scapular neuromuscular mean activity (>11.7% MVIC) can be interpreted as meaningful change, while change in muscle onset timing in light of specific processing parameters used in this study is more variable. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Combining distribution- and anchor-based approaches to determine minimally important differences: the FACIT experience.

    PubMed

    Yost, Kathleen J; Eton, David T

    2005-06-01

    Health-related quality of life (HRQOL) is an important endpoint in cancer clinical trials and in cancer treatment in general; however, the meaningfulness of HRQOL scores may not be apparent to clinicians or researchers. Minimally important differences (MIDs) can enhance the interpretability of HRQOL scores by identifying differences likely to be meaningful to patients and clinicians. This article's objective is to describe and provide examples of approaches we have used to identify MIDs for instruments in the Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. Distribution- and anchor-based approaches are described and illustrated. We also discuss the importance of assessing the appropriateness of anchors, and we provide suggestions for combining results into a single range of plausible MIDs. MIDs for FACIT instruments established to date are summarized, and general guidelines that can be used to estimate MIDs for other FACIT instruments are provided. Applications of MIDs in research are illustrated.

  10. Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference

    PubMed Central

    Alma, Harma; de Jong, Corina; Jelusic, Danijel; Wittmann, Michael; Schuler, Michael; Blok, Bertine Flokstra-de; Kocks, Janwillem; Schultz, Konrad; Molen, Thys van der

    2016-01-01

    The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28–0.61 (CCQ), 1.46–3.08 (CAT) and 6.86–9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD. PMID:27597571

  11. Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference.

    PubMed

    Alma, Harma; de Jong, Corina; Jelusic, Danijel; Wittmann, Michael; Schuler, Michael; Flokstra-de Blok, Bertine; Kocks, Janwillem; Schultz, Konrad; van der Molen, Thys

    2016-09-01

    The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George's Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28-0.61 (CCQ), 1.46-3.08 (CAT) and 6.86-9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD.

  12. Climate change: the importance of place.

    PubMed

    Hess, Jeremy J; Malilay, Josephine N; Parkinson, Alan J

    2008-11-01

    Climate change-related risks are place-specific and path-dependent. Accordingly, location is an important determinant of hazardous exposure, and certain places will bear more risk than others. This article reviews the major environmental exposures associated with risky places in the U.S., including coastal regions, islands, the desert Southwest, vectorborne and zoonotic disease border regions, cities, and the U.S. Arctic (Alaska), with emphasis on exposures and vulnerable populations of concern. In addition to these hotspots, this study considers the ways in which the concept of place--the sense of human relationship with particular environments--will play a key role in motivating, developing, and deploying an effective public health response. In considering the importance of place, we highlight the concepts of community resilience and risk management, key aspects of a robust response to climate change in public health and other sectors.

  13. Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer.

    PubMed

    Pickard, A Simon; Neary, Maureen P; Cella, David

    2007-12-21

    Understanding what constitutes an important difference on a HRQL measure is critical to its interpretation. The aim of this study was to provide a range of estimates of minimally important differences (MIDs) in EQ-5D scores in cancer and to determine if estimates are comparable in lung cancer. A retrospective analysis was conducted on cross-sectional data collected from 534 cancer patients, 50 of whom were lung cancer patients. A range of minimally important differences (MIDs) in EQ-5D index-based utility (UK and US) scores and VAS scores were estimated using both anchor-based and distribution-based (1/2 standard deviation and standard error of the measure) approaches. Groups were anchored using Eastern Cooperative Oncology Group performance status (PS) ratings and FACT-G total score-based quintiles. For UK-utility scores, MID estimates based on PS ranged from 0.10 to 0.12 both for all cancers and for lung cancer subgroup. Using FACT-G quintiles, MIDs were 0.09 to 0.10 for all cancers, and 0.07 to 0.08 for lung cancer. For US-utility scores, MIDs ranged from 0.07 to 0.09 grouped by PS for all cancers and for lung cancer; when based on FACT-G quintiles, MIDs were 0.06 to 0.07 in all cancers and 0.05 to 0.06 in lung cancer. MIDs for VAS scores were similar for lung and all cancers, ranging from 8 to 12 (PS) and 7 to 10 (FACT-G quintiles). Important differences in EQ-5D utility and VAS scores were similar for all cancers and lung cancer, with the lower end of the range of estimates closer to the MID, i.e. 0.08 for UK-index scores, 0.06 for US-index scores, and 7 [corrected] for VAS scores.

  14. Minimal clinically important difference of the L Test for individuals with lower limb amputation: A pilot study.

    PubMed

    Rushton, Paula W; Miller, William C; Deathe, A Barry

    2015-12-01

    The L Test is a reliable/valid clinical evaluation of mobility that measures walking speed in seconds. It can be used with individuals with lower limb amputation. Responsiveness of the L Test is not yet determined. The purpose of this pilot study was to determine how well the L Test identified individuals with a lower limb amputation who have/have not undergone a minimal clinically important difference. Prospective follow-up study. In total, 33 individuals with lower limb amputation, deemed to require a major intervention, were recruited consecutively from a follow-up clinic. Participants completed the L Test at baseline and follow-up. A Global Rating Change scale was also completed at follow-up. The participants had a mean age ± standard deviation of 60 ± 13.0 years, and 81.8% had a transtibial amputation. The mean ± standard deviation for the L Test change scores was 6.0 ± 13.9. The area under the curve was 0.67, and the minimal clinically important difference was 4.5 s. The L Test identified individuals as having an important clinical change. Results must be interpreted with caution, as the accuracy, based on the Global Rating Change scale, is low. Further inquiry into the L Test is encouraged. The L Test can guide the clinical management of individuals with lower limb amputation. Results from this pilot study indicate that individuals with a lower limb amputation who improve by at least 4.5 s on the L Test after an intervention have likely undergone an important change. This result must be interpreted with caution given that the ability of the L Test to correctly identify individuals, who have and have not undergone an important change, using the Global Rating Change scale as the gold standard, is limited because this is a pilot study. It is plausible that the precision of the cut-point threshold could increase or decrease given a larger sample or when using a different method of identifying important clinical change. © The International Society for

  15. PUBLISHER'S ANNOUNCEMENT: Important changes for 2008

    NASA Astrophysics Data System (ADS)

    2008-02-01

    As a result of reviewing several aspects of our content, both in print and online, we have made some changes for 2008. These changes are described below. Article numbering Inverse Problems has moved from sequential page numbering to an article numbering system, offering important advantages and flexibility by speeding up the publication process. Articles in different issues or sections can be published online as soon as they are ready, without having to wait for a whole issue or section to be allocated page numbers. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance: Surname X and Surname Y 2008 Inverse Problems 24 015001 Articles will continue to be published on the web in advance of the print edition. A new look and feel We have taken the opportunity to refresh the design of Inverse Problems' cover in order to modernise the typography and create a consistent look and feel across IOP Publishing's range of publications. We hope you like the new cover. If you have any questions or comments about any of these changes, please contact us at ip@iop.org Kate Watt Publisher, Inverse Problems

  16. The estimation of the thyroid volume before surgery--an important prerequisite for minimally invasive thyroidectomy.

    PubMed

    Ruggieri, M; Fumarola, A; Straniero, A; Maiuolo, A; Coletta, I; Veltri, A; Di Fiore, A; Trimboli, P; Gargiulo, P; Genderini, M; D'Armiento, M

    2008-09-01

    Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two

  17. The Minimal Clinically Important Difference for the Rasch Neuropsychiatric Inventory Irritability and Aggression Scale for Traumatic Brain Injury.

    PubMed

    Malec, James F; Hammond, Flora M

    2017-09-13

    To determine the Minimal Clinically Important Difference (MCID) for a Rasch measure derived from the Irritability/Lability and Agitation/Aggression subscales of the Neuropsychiatric Inventory (NPI-TBI-IA). Distribution-based statistical methods were applied to retrospective data to determine candidates for the MCID. These candidates were evaluated by anchoring the NPI-TBI-IA to Global Impression of Change (GIC) ratings by participants, significant others, and a supervising physician. NPI-TBI-IA. Postacute rehabilitation outpatient clinic. 274 cases with observer ratings; 232 cases with self-ratings by participants with moderate-severe TBI at least 6 months post-injury. For observer ratings on the NPI-TBI-IA, anchored comparisons found an improvement of ½ SD was associated with at least minimal general improvement on GIC by a significant majority (69-80%); ½ SD improvement on participant NPI-TBI-IA self-ratings was also associated with at least minimal improvement on the GIC by a substantial majority (77-83%). The percent indicating significant global improvement did not increase markedly on most ratings at higher levels of improvement on the NPI-TBI-IA. A ½ SD improvement on the NPI-TBI-IA indicates the MCID for both observer and participant ratings on this measure. Copyright © 2017. Published by Elsevier Inc.

  18. Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer

    PubMed Central

    Pickard, A Simon; Neary, Maureen P; Cella, David

    2007-01-01

    Background Understanding what constitutes an important difference on a HRQL measure is critical to its interpretation. The aim of this study was to provide a range of estimates of minimally important differences (MIDs) in EQ-5D scores in cancer and to determine if estimates are comparable in lung cancer. Methods A retrospective analysis was conducted on cross-sectional data collected from 534 cancer patients, 50 of whom were lung cancer patients. A range of minimally important differences (MIDs) in EQ-5D index-based utility (UK and US) scores and VAS scores were estimated using both anchor-based and distribution-based (1/2 standard deviation and standard error of the measure) approaches. Groups were anchored using Eastern Cooperative Oncology Group performance status (PS) ratings and FACT-G total score-based quintiles. Results For UK-utility scores, MID estimates based on PS ranged from 0.10 to 0.12 both for all cancers and for lung cancer subgroup. Using FACT-G quintiles, MIDs were 0.09 to 0.10 for all cancers, and 0.07 to 0.08 for lung cancer. For US-utility scores, MIDs ranged from 0.07 to 0.09 grouped by PS for all cancers and for lung cancer; when based on FACT-G quintiles, MIDs were 0.06 to 0.07 in all cancers and 0.05 to 0.06 in lung cancer. MIDs for VAS scores were similar for lung and all cancers, ranging from 8 to 12 (PS) and 7 to 10 (FACT-G quintiles). Discussion Important differences in EQ-5D utility and VAS scores were similar for all cancers and lung cancer, with the lower end of the range of estimates closer to the MID, i.e. 0.08 for UK-index scores, 0.06 for US-index scores, and 0.07 for VAS scores. PMID:18154669

  19. Minimal-change disease as a paraneoplastic syndrome in a patient with ovarian carcinoma.

    PubMed

    González-Fontal, Guido R; Restrepo, Juan G; Henao-Martínez, Andrés F

    2011-12-01

    Minimal-change disease (MCD) is an exceptional paraneoplastic presentation. We are describing the case of an ovarian paraneoplastic nephrotic syndrome. The kidney biopsy was consistent with MCD. Steroids and immunosuppressive therapy were given with no change in the nephrotic-range proteinuria. A complete resolution of the nephrotic syndrome was soon observed with improvement of her clinical condition after five cycles of chemotherapy with paclitaxel and carboplatin and tumor-debulking surgery. Ovarian carcinoma paraneoplastic nephrotic syndrome secondary to MCD is an extremely rare event, which is important to recognize since it is responsive to the standard chemotherapy.

  20. Moving beyond resistance to restraint minimization: a case study of change management in aged care.

    PubMed

    Johnson, Susan; Ostaszkiewicz, Joan; O'Connell, Beverly

    2009-01-01

    This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility. The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted. Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

  1. 9 CFR 94.19 - Restrictions on importation from BSE minimal-risk regions of meat and edible products from...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... minimal-risk regions of meat and edible products from ruminants. 94.19 Section 94.19 Animals and Animal... on importation from BSE minimal-risk regions of meat and edible products from ruminants. Except as..., and goats—is derived from bovines that have been subject to a ruminant feed ban equivalent to...

  2. The minimal important difference for measures of urticaria disease activity: Updated findings.

    PubMed

    Mathias, Susan D; Crosby, Ross D; Rosén, Karin E; Zazzali, James L

    2015-01-01

    The Urticaria Patient Daily Diary (UPDD) is a validated patient-reported outcome that captures key measures of urticaria disease activity. To update estimates of the minimal important difference (MID) for urticaria disease activity measures in the UPDD, including the weekly itch severity score, weekly number of hives score, weekly average size of largest hive score, and the composite measure of itch severity and number of hives over 7 days, or urticaria activity score 7 (UAS7). A total of 975 subjects with chronic idiopathic urticaria from three randomized, double-blind, placebo-controlled studies completed the UPDD and other patient-reported outcome assessments (the Dermatology Life Quality Index, Medical Outcomes Study Sleep Scale, the Chronic Urticaria Quality-of-Life Questionnaire, the EuroQoL-5 Dimension Questionnaire) multiple times. MIDs were estimated through a combination of distribution- and anchor-based methods. MID estimates ranged from 4.5 to 5.0 for the weekly itch severity score, 5.0 to 5.5 for weekly hives count score, 9.5 to 10.5 for the UAS7, and 4.0 to 4.5 for the weekly size of the largest hive score. This analysis provided confirmation of the previous MID estimates for the urticaria disease activity measures in the UPDD.

  3. Minimizing Glycemic Fluctuations in Patients with Type 2 Diabetes: Approaches and Importance.

    PubMed

    Dandona, Paresh

    2017-08-03

    Glycemic fluctuations, characterized by short-term oscillations in plasma glucose, are important when managing type 2 diabetes (T2D) and may be considered a target of glucose-lowering therapies. Continuous glucose monitoring (CGM) has been used to evaluate the effects of different treatments on glycemic fluctuations. This review examines approaches to and the importance of minimizing glycemic fluctuations among patients with T2D. Measures of HbA1c, fructosamine, and glycated albumin reflect a long-term average of plasma glucose, and are therefore unable to provide an accurate measure of short-term glycemic oscillations. CGM provides accurate monitoring of real-time glucose fluctuations and has been used to investigate the effects of lifestyle and treatment on daily glycemic control. Dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists have demonstrated significant improvements in measures such as the mean amplitude of glucose excursions and standard deviation of CGM. Case studies of two patients with T2D utilizing CGM are also included in this review, which demonstrated that CGM was a useful tool for diagnosing unrecognized hypoglycemia and hyperglycemia in situations in which it was impractical to check fingerstick concentrations. Altogether, the evidence suggests that glycemic fluctuations are a potential target to consider when managing T2D. CGM allows for the real-time evaluation of glycemic fluctuations and may assist in the development of an individualized treatment plan to adequately control short-term oscillations in blood glucose levels.

  4. Minimal important difference after hand surgery: a prospective assessment for DASH, MHQ, and SF-12

    PubMed Central

    Maia, Maurício Vieira de Pádua; de Moraes, Vinícius Ynoe; dos Santos, João Baptista Gomes; Faloppa, Flávio; Belloti, João Carlos

    2016-01-01

    Introduction: Minimal important difference (MID) score is an important measure for surgical clinical research and impacts on treatment decisions. Our approach considered patient satisfaction as the relevant anchor criteria. The aims of this study were: determine after surgery MID for three relevant questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Questionnaire (MHQ), and Short Form 12 (SF-12); and assess the correlation between these scores and patient reported satisfaction. Methods: Adult patients where surgery was indicated for any hand/wrist conditions. Study was conducted in a teaching hospital, São Paulo, Brazil. Participants responded to DASH, SF-12, MHQ, and a Likert satisfaction scale before and three months after a procedure. Satisfaction was considered as the anchor for determining MID after a procedure. The correlation between satisfaction and the instruments were measured. Two statistical approaches were utilized for determining MIDs and were used for consistency and generalizability purposes. For MID determination, receiver operating curves were utilized and MID cut-offs were followed by sensitivity and specificity measures. Results: Fifty patients were included with no follow-up losses. MID for DASH was 18.8 and 15.4. MID for MHQ was 14.7 for both approaches. Data from SF-12 was not reliable after statistical analyses and demonstrated poor correlation with patient satisfaction. MID for DASH and MHQ were found and demonstrated larger standards than literature-reported patients when surgery was not the main intervention. DASH and MHQ had moderate correlation with patient reported satisfaction. SF-12 MID was not reliable and had poor correlation to patient satisfaction. These data suggests that ambulatory hand surgery patients may have greater expectations regarding improvement than other patients. PMID:27716460

  5. USE OF THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE (MCID) FOR EVALUATING TREATMENT OUTCOMES WITH TMJMD PATIENTS: A PRELIMINARY STUDY1

    PubMed Central

    Ingram, Megan; Choi, Yun Hee; Chiu, Chung-Yi; Haggard, Rob; Dougall, Angela Liegey; Buschang, Peter; Gatchel, Robert J.

    2012-01-01

    Temporomandibular joint and muscle disorder (TMJMD) is one of the most prevalent types of musculoskeletal disorders. The major goal of the study was to more objectively quantify clinically meaningful relief for TMJMD treatment outcomes by using the new metric of minimal clinically important difference (MCID). Pre- to post-treatment changes on a number of self-report measures were evaluated in a cohort of 101 acute TMJMD patients. An anchor-based MCID approach was employed, with an objective chewing performance measure serving as the clinical outcome of interest. Using a Receiver Operating Curve analysis, it was found that the Physical Component Scale (PCS) of the SF-36 was the most robust self-report measure to use as the MCID in a TMJMD patient population. PMID:22919263

  6. Determining the Minimally Important Difference in the Clinical Disease Activity Index For Improvement and Worsening in Early Rheumatoid Arthritis

    PubMed Central

    Curtis, JR; Yang, S; Chen, L; Pope, JE; Keystone, EC; Haraoui, B; Boire, G; Thorne, JC; Tin, D; Hitchon, CA; Bingham, CO; Bykerk, VP

    2015-01-01

    Background Simplified measures to quantify rheumatoid arthritis (RA) disease activity are increasingly used. The minimally clinically important differences (MCID) for some measures, such as the clinical disease activity index (CDAI), have not been well-defined in real-world clinic settings, especially for early RA patients with low/moderate disease activity. Methods Data from Canadian Early Arthritis Cohort patients were used to examine absolute change in CDAI in the first year after enrollment, stratified by disease activity. MCID cutpoints were derived to optimize the sum of sensitivity and specificity versus the gold standard of patient self-reported improvement or worsening. Specificity, positive predictive value and negative predictive values were calculated against patient self-reported improvement (gold standard) and for change in pain, HAQ and DAS28 improvement. Discrimination was examined using area under receiver operator curves (ROC). Similar methods were used to evaluate MCIDs for worsening for patients who achieved low disease activity. Results A total of 578 patients (mean (SD) age 54.1 (15.3) years; 75% women, median (IQR) disease duration 5.3 (3.3, 8.0) months) contributed 1169 visit pairs to the improvement analysis. The MCID cutpoints for improvement were 12 (patients starting in high disease activity, CDAI>22), 6 (moderate, CDAI 10–22), and 1 (low disease activity, CDAI <10). Performance characteristics were acceptable using these cutpoints for pain, HAQ, and DAS28. The MCID for CDAI worsening among patients who achieved low disease activity was 2 units. Conclusions These minimally important absolute differences in CDAI can be used to evaluate improvement and worsening and increase the utility of CDAI in clinical practice. PMID:25988705

  7. Minimally clinically important difference for the UCSD Shortness of Breath Questionnaire, Borg Scale, and Visual Analog Scale.

    PubMed

    Ries, Andrew L

    2005-03-01

    Dyspnea is a primary symptom of chronic lung disease and an important outcome measure for clinical trials. Several standardized measures have been developed to evaluate this important symptom and are being used increasingly in clinical trials. The minimally clinically important difference (MCID) is not well defined for these measures but is important in interpreting the clinical meaning of results of studies in this area. The purpose of this paper is to evaluate the MCID for three commonly used measures to assess dyspnea in chronic lung disease: UCSD Shortness of Breath Questionnaire (SOBQ), Borg Scale (Borg), and Visual Analog Scale (VAS). The analysis is based on a retrospective review of published trials evaluating the response to a pulmonary rehabilitation or exercise intervention that is known to produce modest, but clinically meaningful changes for such patients. Using a distribution-based approach based primarily on effect size, the recommended MCID for these measures are: 5-units for the SOBQ, 1-unit for the Borg scale, and approximately 10 to 20 units for the VAS.

  8. Role Playing, Issue Importance, and Attitude Change.

    ERIC Educational Resources Information Center

    Sarup, Gian

    1981-01-01

    Contrasted three major theories on attitude change: cognitive dissonance, incentive, and social judgment. Results from student questionnaires provided little support for cognitive dissonance. Also provided credible, though overlapping, evidence for incentive and social judgment theories. Improvised role playing produced more change than did…

  9. Minimally important differences for Patient Reported Outcomes Measurement Information System pain interference for individuals with back pain

    PubMed Central

    Amtmann, Dagmar; Kim, Jiseon; Chung, Hyewon; Askew, Robert L; Park, Ryoungsun; Cook, Karon F

    2016-01-01

    Background The minimally important difference (MID) refers to the smallest change that is sufficiently meaningful to carry implications for patients’ care. MIDs are necessary to guide the interpretation of scores. This study estimated MID for the Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI). Methods Study instruments were administered to 414 people who participated in two studies that included treatment with low back pain (LBP; n=218) or depression (n=196). Participants with LBP received epidural steroid injections and participants with depression received antidepressants, psychotherapy, or both. MIDs were estimated for the changes in LBP. MIDs were included only if a priori criteria were met (ie, sample size ≥10, Spearman correlation ≥0.3 between anchor measures and PROMIS-PI scores, and effect size range =0.2–0.8). The interquartile range (IQR) of MID estimates was calculated. Results The IQR ranged from 3.5 to 5.5 points. The lower bound estimate of the IQR (3.5) was greater than mean of standard error of measurement (SEM) both at time 1 (SEM =2.3) and at time 2 (SEM =2.5), indicating that the estimate of MID exceeded measurement error. Conclusion Based on our results, researchers and clinicians using PROMIS-PI can assume that change of 3.5 to 5.5 points in comparisons of mean PROMIS-PI scores of people with LBP can be considered meaningful. PMID:27175093

  10. Minimally important differences for Patient Reported Outcomes Measurement Information System pain interference for individuals with back pain.

    PubMed

    Amtmann, Dagmar; Kim, Jiseon; Chung, Hyewon; Askew, Robert L; Park, Ryoungsun; Cook, Karon F

    2016-01-01

    The minimally important difference (MID) refers to the smallest change that is sufficiently meaningful to carry implications for patients' care. MIDs are necessary to guide the interpretation of scores. This study estimated MID for the Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI). Study instruments were administered to 414 people who participated in two studies that included treatment with low back pain (LBP; n=218) or depression (n=196). Participants with LBP received epidural steroid injections and participants with depression received antidepressants, psychotherapy, or both. MIDs were estimated for the changes in LBP. MIDs were included only if a priori criteria were met (ie, sample size ≥10, Spearman correlation ≥0.3 between anchor measures and PROMIS-PI scores, and effect size range =0.2-0.8). The interquartile range (IQR) of MID estimates was calculated. The IQR ranged from 3.5 to 5.5 points. The lower bound estimate of the IQR (3.5) was greater than mean of standard error of measurement (SEM) both at time 1 (SEM =2.3) and at time 2 (SEM =2.5), indicating that the estimate of MID exceeded measurement error. Based on our results, researchers and clinicians using PROMIS-PI can assume that change of 3.5 to 5.5 points in comparisons of mean PROMIS-PI scores of people with LBP can be considered meaningful.

  11. Minimally invasive cardiopulmonary bypass: does it really change the outcome?

    PubMed Central

    Ranucci, Marco; Isgrò, Giuseppe

    2007-01-01

    Introduction Many innovative cardiopulmonary bypass (CPB) systems have recently been proposed by the industry. With few differences, they all share a philosophy based on priming volume reduction, closed circuit with separation of the surgical field suction, centrifugal pump, and biocompatible circuit and oxygenator. These minimally invasive CPB (MICPB) systems are intended to limit the deleterious effects of a conventional CPB. However, no evidence exists with respect to their effectiveness in improving the postoperative outcome in a large population of patients. This study aimed to verify the clinical impact of an MICPB in a large population of patients undergoing coronary artery revascularization. Methods We conducted a retrospective analysis of 1,663 patients treated with an MICPB. The control group (conventional CPB) was extracted from a series of 2,877 patients according to a propensity score analysis. Results Patients receiving an MICPB had a shorter intensive care unit (ICU) stay, had lower peak postoperative serum creatinine and bilirubin levels, and suffered less postoperative blood loss. Within a multivariable model, MICPB is independently associated with lower rates of atrial fibrillation (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69 to 0.99) and ventricular arrhythmias (OR 0.45, 95% CI 0.28 to 0.73) and with higher rates of early discharge from the ICU (OR 1.31, 95% CI 1.06 to 1.6) and from the hospital (OR 1.46, 95% CI 1.18 to 1.8). Hospital mortality did not differ between groups. Conclusion MICPBs are associated with reduced morbidity. However, these results will need to be confirmed in a large, prospective, randomized, controlled trial. PMID:17433112

  12. Minimally important difference of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q)

    PubMed Central

    2011-01-01

    Background A previous study has documented the reliability and validity of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) in exploring patient satisfaction with medicines for chronic health conditions in routine medical practice, but the minimally important difference (MID) of this tool is as yet unknown. The objective of this research was to estimate the MID for the SATMED-Q total score and six constituent domains. Methods The sample of patients (456 subjects, mean age 59 years, 53% male) used for testing psychometric properties was also used to assess MID. Item #14 of the Treatment Satisfaction Questionnaire for Medication (TSQM) was used as an anchor reference since it directly explores satisfaction with medicine on a 7-point ordinal scale (from extremely satisfied to extremely dissatisfied, with a neutral category). Patients were classified into four categories according to responses to this item (extremely satisfied/dissatisfied, very satisfied/dissatisfied, satisfied/dissatisfied, neither satisfied nor dissatisfied (neutral), and calculations were made for the total score and each domain of the SATMED-Q using standardised scores. The mean absolute differences in total score (and domains) between the neutral category and the satisfied/dissatisfied category were considered to be the MID. Effect sizes (ES) were also computed. Results The MID for the total score was 13.4 (ES = 0.91), while the domain values ranged from 10.3 (medical care domain, ES = 0.43) to 20.6 (impact on daily living, ES = 0.85). Mean differences in satisfaction (as measured by the total SATMED-Q score and domain scores) using the levels of satisfaction established by item #14 were significantly different, with F values ranging from 12.2 to 88.8 (p < 0.001 in all cases). Conclusion The SATMED-Q was demonstrated to be responsive to different levels of patient satisfaction with therapy in chronically ill subjects. The MID obtained was 13.4 points for the overall normalised

  13. PUBLISHER'S ANNOUNCEMENT: Important changes for 2008

    NASA Astrophysics Data System (ADS)

    Bedrock, Claire

    2008-01-01

    Having reviewed several aspects of IOP journal content, both in print and online, we have made some changes for 2008, some of which affect Semiconductor Science and Technology. Article numbering In common with many other IOP journals, Semiconductor Science and Technology has moved from sequential page numbering to an article numbering system. Articles will continue to be published on the web in advance of the print edition. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance: Surname X and Surname Y 2008 Semicond. Sci. Technol. 18 015003 A new look and feel Semiconductor Science and Technology has changed from European A4 format to a slightly smaller size, closer to US Letter format, and we have taken the opportunity to refresh the cover, in order to modernise the typography, and create a consistent look and feel across our range of publications. If you have any questions or comments about any of these changes, please contact us at sst@iop.org

  14. Curriculum change: the importance of team role.

    PubMed

    Broomfield, D; Bligh, J

    1997-03-01

    This paper describes a study examining aspects of team role in the management of curriculum change. The Belbin Team Role Self-Perception Inventory was completed by 25 members (83%) of a faculty curriculum development team. Overall the group showed a preference for the implementer and shaper roles, whilst the completer-finisher role was relatively weakly represented, ranking fifth out of eight possible roles. Older and more senior team members favoured the co-ordinator role, whilst younger and more junior members favoured the team-worker and completer-finisher roles. Some implications of these findings are discussed in the light of the current trend for widespread change in undergraduate medical curricula and the challenges faced by medical schools in a resource constrained environment.

  15. Segmentation of Arteries in Minimally Invasive Surgery Using Change Detection

    NASA Astrophysics Data System (ADS)

    Akbari, Hamed; Kosugi, Yukio; Kojima, Kazuyuki

    In laparoscopic surgery, the lack of tactile sensation and 3D visual feedback make it difficult to identify the position of a blood vessel intraoperatively. An unintentional partial tear or complete rupture of a blood vessel may result in a serious complication; moreover, if the surgeon cannot manage this situation, open surgery will be necessary. Differentiation of arteries from veins and other structures and the ability to independently detect them has a variety of applications in surgical procedures involving the head, neck, lung, heart, abdomen, and extremities. We have used the artery's pulsatile movement to detect and differentiate arteries from veins. The algorithm for change detection in this study uses edge detection for unsupervised image registration. Changed regions are identified by subtracting the systolic and diastolic images. As a post-processing step, region properties, including color average, area, major and minor axis lengths, perimeter, and solidity, are used as inputs of the LVQ (Learning Vector Quantization) network. The output results in two object classes: arteries and non-artery regions. After post-processing, arteries can be detected in the laparoscopic field. The registration method used here is evaluated in comparison with other linear and nonlinear elastic methods. The performance of this method is evaluated for the detection of arteries in several laparoscopic surgeries on an animal model and on eleven human patients. The performance evaluation criteria are based on false negative and false positive rates. This algorithm is able to detect artery regions, even in cases where the arteries are obscured by other tissues.

  16. Validity, Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Change of "Pediatric Balance Scale" in Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Chen, Chia-ling; Shen, I-hsuan; Chen, Chung-yao; Wu, Ching-yi; Liu, Wen-Yu; Chung, Chia-ying

    2013-01-01

    This study examined criterion-related validity and clinimetric properties of the pediatric balance scale ("PBS") in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine…

  17. Validity, Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Change of "Pediatric Balance Scale" in Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Chen, Chia-ling; Shen, I-hsuan; Chen, Chung-yao; Wu, Ching-yi; Liu, Wen-Yu; Chung, Chia-ying

    2013-01-01

    This study examined criterion-related validity and clinimetric properties of the pediatric balance scale ("PBS") in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine…

  18. Importance of minimal residual disease in hairy cell leukemia: monoclonal antibodies as a therapeutic strategy

    PubMed Central

    THOMAS, DEBORAH A.; RAVANDI, FARHAD; KEATING, MICHAEL; KANTARJIAN, HAGOP M.

    2014-01-01

    With the use of nucleoside analogs as frontline therapy, the prognosis of hairy cell leukemia (HCL) has improved dramatically. Unfortunately, disease recurrence remains problematic. Eradication of minimal residual disease (MRD) persisting after therapy may further improve outcome. The evolution of available techniques used to assess MRD, and the potential incorporation of novel agents such as monoclonal antibodies (MoAbs) into the treatment armamentarium for HCL mandate that MRD analyses be performed concurrently with routine assessments of disease status. Herein, the available data regarding the prevalence and clinical relevance of MRD after therapy for HCL is reviewed. PMID:19814695

  19. 50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 1 2010-10-01 2010-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION, SALE...

  20. 50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 1 2012-10-01 2012-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION,...

  1. 50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 1 2013-10-01 2013-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION,...

  2. 50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 1 2014-10-01 2014-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION,...

  3. 50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 1 2011-10-01 2011-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION,...

  4. [Kimura's disease: an unrecognized cause of adult-onset nephrotic syndrome with minimal change disease].

    PubMed

    Shehwaro, N; Langlois, A-L; Gueutin, V; Debchi, L; Charlotte, F; Rouvier, P; Rottembourg, J; Izzedine, H

    2014-02-01

    Kimura's disease (KD) is an angiolymphoid proliferative disorder of soft tissue with eosinophilia, with a predilection for head and neck regions in young Oriental men. Kidney disease is thought to be rare in KD. About a case of adult-onset nephrotic syndrome with minimal change disease, we comment Kimura's disease and its associated kidney damage. Kimura disease should be suspected and included in the diagnosis of adult-onset nephrotic syndrome with minimal change disease.

  5. Importance of shield design in minimizing radioactive-material inventory in tokamaks

    SciTech Connect

    Jung, J.; Abdou, M.

    1980-01-01

    An optimization study is carried out for the outboard bulk shielding of the STARFIRE reactor. The optimization criteria used include: (1) reactor accessibility shortly after shutdown; (2) minimization of high-level long-term induced activation; and (3) radiation protection of reactor components. It is shown that with a 1.1 m-thick shield, the biological dose inside the reactor room decreases to approx. 1.5 mrem/h within 24 h after shutdown. It is also shown that more than 90% of the total mass of the radioactive material inventory in STARFIRE has a high potential for recycling within 30 to 50 yr after component replacement or reactor decommissioning.

  6. Communication growth in minimally verbal children with ASD: The importance of interaction.

    PubMed

    DiStefano, Charlotte; Shih, Wendy; Kaiser, Ann; Landa, Rebecca; Kasari, Connie

    2016-10-01

    Little is known about language development in children with Autism Spectrum Disorders (ASD) who remain minimally verbal past age 5. While there is evidence that children can develop language after age 5, we lack detailed information. Studies of this population generally focus on discrete language skills without addressing broader social-communication abilities. As communication and social deficits are both inherent to ASD, an examination of not only what language skills are acquired, but how those skills are used in interactions is relevant. Research in typical development has examined how communication interchanges (unbroken back-and-forth exchanges around a unified purpose) develop, which can be used as a framework for studying minimally verbal children. This study examined the interchange use by 55 children with ASD over the course of a 6-month play and engagement-based communication intervention. Half of the children received intervention sessions that also incorporated a speech-generating device (SGD). Interchanges were coded by: frequency, length, function, and initiator (child or adult). Results indicated that children initiated a large proportion of interchanges and this proportion increased over time. The average length and number of interchanges increased over time, with children in the SGD group showing even greater growth. Finally, children's total number of interchanges at baseline was positively associated with their spoken language gains over the course of intervention. This study supports the crucial relationship between social engagement and expressive language development, and highlights the need to include sustained communication interchanges as a target for intervention with this population. Autism Res 2016, 9: 1093-1102. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

  7. A stopping theoretic approach to minimal time detection of system parameter change

    NASA Technical Reports Server (NTRS)

    Mazumdar, Ravi R.

    1986-01-01

    The problem of minimal time detection of abrupt parameter changes in linear stochastic systems considered. The problem is posed as an optimal stopping problem for the detection in change of the induced probability measure. Under the assumption of a prior distribution for the time of change (or disruption) a stopping rule is given which minimizes the average detection delay when there is knowledge of the new measure after the change. When the new induced measure is unknown, a stopping rule is given, based only on the noisy observations and is shown to be better than the a priori knowlege of the disruption time.

  8. Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation.

    PubMed

    Chen, Poyu; Lin, Keh-Chung; Liing, Rong-Jiuan; Wu, Ching-Yi; Chen, Chia-Ling; Chang, Ku-Chou

    2016-06-01

    To examine the criterion validity, responsiveness, and minimal clinically important difference (MCID) of the EuroQoL 5-Dimensions Questionnaire (EQ-5D-5L) and visual analog scale (EQ-VAS) in people receiving rehabilitation after stroke. The EQ-5D-5L, along with four criterion measures-the Medical Research Council scales for muscle strength, the Fugl-Meyer assessment, the functional independence measure, and the Stroke Impact Scale-was administered to 65 patients with stroke before and after 3- to 4-week therapy. Criterion validity was estimated using the Spearman correlation coefficient. Responsiveness was analyzed by the effect size, standardized response mean (SRM), and criterion responsiveness. The MCID was determined by anchor-based and distribution-based approaches. The percentage of patients exceeding the MCID was also reported. Concurrent validity of the EQ-Index was better compared with the EQ-VAS. The EQ-Index has better power for predicting the rehabilitation outcome in the activities of daily living than other motor-related outcome measures. The EQ-Index was moderately responsive to change (SRM = 0.63), whereas the EQ-VAS was only mildly responsive to change. The MCID estimation of the EQ-Index (the percentage of patients exceeding the MCID) was 0.10 (33.8 %) and 0.10 (33.8 %) based on the anchor-based and distribution-based approaches, respectively, and the estimation of EQ-VAS was 8.61 (41.5 %) and 10.82 (32.3 %). The EQ-Index has shown reasonable concurrent validity, limited predictive validity, and acceptable responsiveness for detecting the health-related quality of life in stroke patients undergoing rehabilitation, but not for EQ-VAS. Future research considering different recovery stages after stroke is warranted to validate these estimations.

  9. Minimal Clinically Important Difference in the Physical, Emotional, and Total Symptom Distress Scores of the Edmonton Symptom Assessment System.

    PubMed

    Hui, David; Shamieh, Omar; Paiva, Carlos Eduardo; Khamash, Odai; Perez-Cruz, Pedro Emilio; Kwon, Jung Hye; Muckaden, Mary Ann; Park, Minjeong; Arthur, Joseph; Bruera, Eduardo

    2016-02-01

    The Edmonton Symptom Assessment System (ESAS) is one of the most commonly used symptom batteries in clinical practice and research. We used the anchor-based approach to identify the minimal clinically important difference (MCID) for improvement and deterioration for ESAS physical, emotional, and total symptom distress scores. In this multicenter prospective study, we asked patients with advanced cancer to complete their ESAS at the first clinic visit and at a second visit three weeks later. The anchor for MCID determination was Patient's Global Impression regarding their physical, emotional, and overall symptom burden ("better," "about the same," or "worse"). We identified the optimal sensitivity/specificity cutoffs for both improvement and deterioration for the three ESAS scores and also determined the within-patient changes. A total of 796 patients were enrolled from six centers. The ESAS scores had moderate responsiveness, with area under the receiver operating characteristic curve between 0.69 and 0.76. Using the sensitivity-specificity approach, the optimal cutoffs for ESAS physical, emotional, and total symptom distress scores were ≥3/60, ≥2/20, and ≥3/90 for improvement, and ≤-4/60, ≤-1/20, and ≤-4/90 for deterioration, respectively. These cutoffs had moderate sensitivities (59%-68%) and specificities (62%-80%). The within-patient change approach revealed the MCID cutoffs for improvement/deterioration to be 3/-4.3 for the physical score, 2.4/-1.8 for the emotional score, and 5.7/-2.9 for the total symptom distress score. We identified the MCIDs for physical, emotional, and total symptom distress scores, which have implications for interpretation of symptom response in clinical trials. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Minimal promoter systems reveal the importance of conserved residues in the B-finger of human transcription factor IIB.

    PubMed

    Thompson, Nancy E; Glaser, Bryan T; Foley, Katherine M; Burton, Zachary F; Burgess, Richard R

    2009-09-11

    The "B-finger" of transcription factor IIB (TFIIB) is highly conserved and believed to play a role in the initiation process. We performed alanine substitutions across the B-finger of human TFIIB, made change-of-charge mutations in selected residues, and substituted the B-finger sequence from other organisms. Mutant proteins were examined in two minimal promoter systems (containing only RNA polymerase II, TATA-binding protein, and TFIIB) and in a complex system, using TFIIB-immunodepleted HeLa cell nuclear extract (NE). Mutations in conserved residues located on the sides of the B-finger had the greatest effect on activity in both minimal promoter systems, with mutations in residues Glu-51 and Arg-66 eliminating activity. The double change-of-charge mutant (E51R:R66E) did not show activity in either minimal promoter system. Mutations in the nonconserved residues at the tip of the B-finger did not significantly affect activity. However, all of the mutations in the B-finger showed at least 25% activity in the HeLa cell NE. Chimeric proteins, containing B-finger sequences from species with conserved residues on the side of the B-finger, showed wild-type activity in a minimal promoter system and in the HeLa cell NE. However, chimeric proteins whose sequence showed divergence on the sides of the B-finger had reduced activity. Transcription factor IIF (TFIIF) partially restored activity of the inactive mutants in the minimal promoter system, suggesting that TFIIF in HeLa cell NE helps to rescue the inactive mutations by interacting with either the B-finger or another component of the initiation complex that is influenced by the B-finger.

  11. Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report.

    PubMed

    Florens, N; Lemoine, S; Guebre-Egziabher, F; Valour, F; Kanitakis, J; Rabeyrin, M; Juillard, L

    2017-02-06

    There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis. A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids. We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.

  12. Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: A prospective, multicenter study.

    PubMed

    Hui, David; Shamieh, Omar; Paiva, Carlos Eduardo; Perez-Cruz, Pedro Emilio; Kwon, Jung Hye; Muckaden, Mary Ann; Park, Minjeong; Yennu, Sriram; Kang, Jung Hun; Bruera, Eduardo

    2015-09-01

    The Edmonton Symptom Assessment Scale (ESAS) is widely used for symptom assessment in clinical and research settings. A sensitivity-specificity approach was used to identify the minimal clinically important difference (MCID) for improvement and deterioration for each of the 10 ESAS symptoms. This multicenter, prospective, longitudinal study enrolled patients with advanced cancer. ESAS was measured at the first clinic visit and at a second visit 3 weeks later. For each symptom, the Patient's Global Impression ("better," "about the same," or "worse") was assessed at the second visit as the external criterion, and the MCID was determined on the basis of the optimal cutoff in the receiver operating characteristic (ROC) curve. A sensitivity analysis was conducted through the estimation of MCIDs with other approaches. For the 796 participants, the median duration between the 2 study visits was 21 days (interquartile range, 18-28 days). The area under the ROC curve varied from 0.70 to 0.87, and this suggested good responsiveness. For all 10 symptoms, the optimal cutoff was ≥1 point for improvement and ≤-1 point for deterioration, with sensitivities of 59% to 85% and specificities of 69% to 85%. With other approaches, the MCIDs varied from 0.8 to 2.2 for improvement and from -0.8 to -2.3 for deterioration in the within-patient analysis, from 1.2 to 1.6 with the one-half standard deviation approach, and from 1.3 to 1.7 with the standard error of measurement approach. ESAS was responsive to change. The optimal cutoffs were ≥1 point for improvement and ≤-1 point for deterioration for each of the 10 symptoms. Our findings have implications for sample size calculations and response determination. © 2015 American Cancer Society.

  13. The meaning of it all: evaluating knowledge of Minimal Clinically Important Difference (MCID) among chiropractic students

    PubMed Central

    Wates, Rebecca J.; Woodruff, Ike; Pfefer, Mark T.

    2016-01-01

    Introduction: Patient-reported outcome measures are frequently used to monitor patient progress during chiropractic care, yet student interns utilizing such assessments are unfamiliar with what magnitude of change (MCID) is considered beneficial to the patient. Objective: This work seeks to determine chiropractic intern knowledge of MCID. Methods: A five-item survey was administered to 104 chiropractic student interns. Results: Nearly one-third of the interns correctly defined the MCID acronym, and approximately one-third of the interns knew at least one MCID value for the outcome assessments in the EHR. Surprisingly, 20% of the interns reported knowledge of at least one MCID value, but answered incorrectly pertaining to the MCID acronym. Conclusion: Student interns value patient perception, but have limited knowledge of MCID values. Addressing this gap will improve their understanding of patient progress and inform their treatment decisions both in the outpatient clinic and in their practices following graduation. PMID:27713580

  14. Development of minimal-change glomerular disease and Hashimoto's thyroiditis during the treatment of sarcoidosis.

    PubMed

    Ando, Fumiaki; Okado, Tomokazu; Sohara, Eisei; Rai, Tatemitsu; Uchida, Shinichi; Sasaki, Sei

    2013-11-01

    Minimal-change glomerular disease, sarcoidosis and autoimmune thyroid disease rarely occur in the same patient. We herein report a patient in which minimal-change glomerular disease and Hashimoto's thyroiditis developed during the treatment of sarcoidosis with steroids. A 66-year-old female was admitted to our hospital with symptoms of nephrotic syndrome. Nine months before admission, she was diagnosed as having ocular and pulmonary sarcoidosis, for which prednisolone at an initial dose of 40 mg/day was started. When the dose of prednisolone was tapered to 20 mg/day, she noticed swelling of the lower extremities. Examination confirmed the simultaneous occurrence of minimal-change glomerular disease and Hashimoto's thyroiditis, which were diagnosed based on kidney histology, ultrasonography of the thyroid gland and positive antithyroglobulin antibodies. We used intravenous methylprednisolone pulse therapy followed by 40 mg/day oral prednisolone. The patient achieved complete remission of nephrotic syndrome and steroids were tapered without relapse.

  15. The importance of cognitive errors in diagnosis and strategies to minimize them.

    PubMed

    Croskerry, Pat

    2003-08-01

    In the area of patient safety, recent attention has focused on diagnostic error. The reduction of diagnostic error is an important goal because of its associated morbidity and potential preventability. A critical subset of diagnostic errors arises through cognitive errors, especially those associated with failures in perception, failed heuristics, and biases; collectively, these have been referred to as cognitive dispositions to respond (CDRs). Historically, models of decision-making have given insufficient attention to the contribution of such biases, and there has been a prevailing pessimism against improving cognitive performance through debiasing techniques. Recent work has catalogued the major cognitive biases in medicine; the author lists these and describes a number of strategies for reducing them ("cognitive debiasing"). Principle among them is metacognition, a reflective approach to problem solving that involves stepping back from the immediate problem to examine and reflect on the thinking process. Further research effort should be directed at a full and complete description and analysis of CDRs in the context of medicine and the development of techniques for avoiding their associated adverse outcomes. Considerable potential exists for reducing cognitive diagnostic errors with this approach. The author provides an extensive list of CDRs and a list of strategies to reduce diagnostic errors.

  16. Clinically important change in quality of life in epilepsy

    PubMed Central

    Wiebe, S; Matijevic, S; Eliasziw, M; Derry, P

    2002-01-01

    Background: Health related quality of life (HRQOL) is increasingly recognised as an important outcome in epilepsy. However, interpretation of HRQOL data is difficult because there is no agreement on what constitutes a clinically important change in the scores of the various instruments. Objectives: To determine the minimum clinically important change, and small, medium, and large changes, in broadly used epilepsy specific and generic HRQOL instruments. Methods: Patients with difficult to control focal epilepsy (n = 136) completed the QOLIE-89, QOLIE-31, SF-36, and HUI-III questionnaires twice, six months apart. Patient centred estimates of minimum important change, and of small, medium, and large change, were assessed on self administered 15 point global rating scales. Using regression analysis, the change in each HRQOL instrument that corresponded to the various categories of change determined by patients was obtained. The results were validated in a subgroup of patients tested at baseline and at nine months. Results: The minimum important change was 10.1 for QOLIE-89, 11.8 for QOLIE-31, 4.6 for SF-36 MCS, 3.0 for SF-36 physical composite score, and 0.15 for HUI-III. All instruments differentiated between no change and minimum important change with precision, and QOLIE-89 and QOLIE-31 also distinguished accurately between minimum important change and medium or large change. Baseline HRQOL scores and the type of treatment (surgical or medical) had no impact on any of the estimates, and the results were replicated in the validation sample. Conclusions: These estimates of minimum important change, and small, medium, and large changes, in four HRQOL instruments in patients with epilepsy are robust and can distinguish accurately among different levels of change. The estimates allow for categorisation of patients into various levels of change in HRQOL, and will be of use in assessing the effect of interventions in individual patients. PMID:12122166

  17. Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference.

    PubMed

    Huang, Minxuan; Chan, Kitty S; Zanni, Jennifer M; Parry, Selina M; Neto, Saint-Clair G B; Neto, Jose A A; da Silva, Vinicius Z M; Kho, Michelle E; Needham, Dale M

    2016-12-01

    To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. Clinimetric analysis. Five international datasets from the United States, Australia, and Brazil. Eight hundred nineteen ICU patients. None. Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses. The Functional Status Score for the ICU demonstrated good to excellent internal consistency. There was good convergent and discriminant validity, with significant and positive correlations (r = 0.30-0.95) between Functional Status Score for the ICU and other physical function measures, and generally weaker correlations with nonphysical measures (|r| = 0.01-0.70). Known group validity was demonstrated by significantly higher Functional Status Score for the ICU scores among patients without ICU-acquired weakness (Medical Research Council sum score, ≥ 48 vs < 48) and with hospital discharge to home (vs healthcare facility). Functional Status Score for the ICU at ICU discharge predicted post-ICU hospital length of stay and discharge location. Responsiveness was supported via increased Functional Status Score for the ICU scores with improvements in muscle strength. Distribution-based methods indicated a minimal important difference of 2.0-5.0. The Functional Status Score for the ICU has good internal consistency and is a valid and responsive measure of physical function for ICU patients. The estimated minimal important difference can be used in sample size calculations and in interpreting studies comparing the physical function of groups of ICU patients.

  18. Minimal important differences and response shift in health-related quality of life; a longitudinal study in patients with multiple myeloma.

    PubMed

    Kvam, Ann K; Wisløff, Finn; Fayers, Peter M

    2010-08-03

    We previously reported that changes of 6-17 percent in the EORTC QLQ-C30 scores are regarded important by patients with multiple myeloma and thus may be considered as Minimal Important Differences (MIDs). However, patients' internal standard of measurement may have changed over time (response shift, RS). In the present work, we evaluated whether myeloma patients experience RS and if this could affect the MID-estimates. Between 2006 and 2008, 239 patients with multiple myeloma completed the EORTC QLQ-C30 at baseline (T1) and after three months (T2). At T2, patients were asked if they had noticed any change in the domains pain, fatigue, physical function and global quality of life. They were also asked to give a retrospective judgment of their baseline values on all the four domains. We found clear evidence of RS in myeloma patients. However, there were differences in both magnitude and direction between patients who stated that they improved and those who deteriorated. Deteriorating patients retrospectively reported better health-related quality of life at T1 for the domains pain, fatigue and physical function. In these patients, MIDs adjusted for RS were observed to increase up to 12 percentage points. In contrast, for patients stating that they improved, we only found evidence of statistically significant RS in the domain global quality of life. MIDs estimated from pre-test/post-test data appeared to be robust against RS in patients reporting improvement over 3-months. This could indicate that RS has a minimal impact on the results in patients who respond to treatment, and that RS may not have an important impact on interpretation of changes reported in clinical trials where an improvement occurs.Although the effect sizes of the RSs were small, RS in deteriorating patients may have an important impact on the interpretation of changes reported in clinical trials.

  19. Minimizing the regrets of long-term urban floodplain management decisions under deeply uncertain climate change

    NASA Astrophysics Data System (ADS)

    Hecht, J. S.; Kirshen, P. H.; Vogel, R. M.

    2016-12-01

    Making long-term floodplain management decisions under uncertain climate change is a major urban planning challenge of the 21stcentury. To support these efforts, we introduce a screening-level optimization model that identifies adaptation portfolios by minimizing the regrets associated with their flood-control and damage costs under different climate change trajectories that are deeply uncertain, i.e. have probabilities that cannot be specified plausibly. This mixed integer program explicitly considers the coupled damage-reduction impacts of different floodwall designs and property-scale investments (first-floor elevation, wet floodproofing of basements, permanent retreat and insurance), recommends implementation schedules, and assesses impacts to stakeholders residing in three types of homes. An application to a stylized municipality illuminates many nonlinear system dynamics stemming from large fixed capital costs, infrastructure design thresholds, and discharge-depth-damage relationships. If stakeholders tolerate mild damage, floodwalls that fully protect a community from large design events are less cost-effective than portfolios featuring both smaller floodwalls and property-scale measures. Potential losses of property tax revenue from permanent retreat motivate municipal property-tax initiatives for adaptation financing. Yet, insurance incentives for first-floor elevation may discourage locally financed floodwalls, in turn making lower-income residents more vulnerable to severe flooding. A budget constraint analysis underscores the benefits of flexible floodwall designs with low incremental expansion costs while near-optimal solutions demonstrate the scheduling flexibility of many property-scale measures. Finally, an equity analysis shows the importance of evaluating the overpayment and under-design regrets of recommended adaptation portfolios for each stakeholder and contrasts them to single-scenario model results.

  20. A study of predictive validity, responsiveness, and minimal clinically important difference of arm accelerometer in real-world activity of patients with chronic stroke.

    PubMed

    Chen, Hao-Ling; Lin, Keh-Chung; Hsieh, Yu-Wei; Wu, Ching-Yi; Liing, Rong-Jiuan; Chen, Chia-Ling

    2017-06-01

    To investigate the predictive validity, responsiveness, and minimal clinically important difference of arm accelerometer in real-world activity of patients with chronic stroke. Validation and psychometric study. Three medical centers. Patients with chronic stroke came from three separated randomized controlled trials. Patients with stroke received upper extremity rehabilitation programs for four weeks. Real-world arm movements were measured by an arm accelerometer and three clinical measurement tools-the Motor Activity Log, Stroke Impact Scale, and Nottingham Extended Activities of Daily Living-administered before and after treatment. A total of 82 subjects were recruited in the study (mean age: 55.32 years; mean score of Fugl-Meyer Assessment: 39.91). Correlations between the arm accelerometer and three clinical measurement tools were fair to moderate (Pearson's r = 0.47, 0.42, and 0.34, respectively). The correlation between the arm accelerometer and the quality of use of Motor Activity Log subscale was moderate to good (Pearson's r = 0.57). The responsiveness of the arm accelerometer from pretreatment to posttreatment was medium (standardized response mean = 0.72). The minimal clinically important difference range for the arm accelerometer was 547-751 mean counts. The arm accelerometer demonstrated acceptable predictive validity and responsiveness in patients with chronic stroke. The affected arm activity measured by the arm accelerometer was sensitive to change. The change score of a patient with chronic stroke on the arm accelerometer should reach 574-751 mean counts to be regarded as a minimal clinically important difference.

  1. Why is there resistance to change and how can it be minimized?

    PubMed

    Somani, S M; Galle, B W; Roberts, A W

    1981-12-01

    The ability to implement change, as an administrative skill, is essential in effectively promoting progressive pharmacy practice. Often, pharmacy managers want to implement change but do not know how to approach the process without encountering much resistance from the staff. There are various sources of resistance that need to be recognized, including lack of trust, inaccurate or incomplete information, and potential loss. A pharmacy manager can take different approaches to minimize this resistance, depending on the organization and his or her management style. A pharmacy manager can use the techniques cited to turn the uncertainties of change into established gains and employee commitment.

  2. Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods.

    PubMed

    Naylor, J M; Mills, K; Buhagiar, M; Fortunato, R; Wright, R

    2016-09-13

    The 6-minute walk test (6MWT) is a commonly used metric for measuring change in mobility after knee arthroplasty, however, what is considered an improvement after surgery has not been defined. The determination of important change in an outcome assessment tool is controversial and may require more than one approach. This study, nested within a combined randomised and observational trial, aimed to define a minimal important improvement threshold for the 6MWT in a knee arthroplasty cohort through a triangulation of methods including patient-perceived anchor-based thresholds and distribution-based thresholds. Individuals with osteoarthritis performed a 6MWT pre-arthroplasty then at 10 and 26 weeks post-surgery. Each rated their perceived improvement in mobility post-surgery on a 7-point transition scale anchored from "much better" to "much worse". Based on these responses the cohort was dichotomised into 'improved' and 'not improved'. The thresholds for patient-perceived improvements were then identified using two receiver operating curve methods producing sensitivity and specificity indices. Distribution-based change thresholds were determined using two methods utilising effect size (ES). Agreement between the anchor- and distribution-based methods was assessed using kappa. One hundred fifty-eight from 166 participants in the randomised cohort and 222 from 243 in the combined randomised and observational cohort were included at 10 and 26 weeks, respectively. The slightly or more patient-perceived improvement threshold at 26 weeks (an absolute improvement of 26 m) was the only one to demonstrate sensitivity and specificity results both better than chance. At 10- and 26-weeks, the ES based on the mean change score divided by the baseline standard deviation (SD), was an absolute change of 24.5 and 37.9 m, respectively. The threshold based on a moderate ES (a 0.5 SD of the baseline score) was a change of 55.0 and 55.4 m at 10- and 26-weeks, respectively. The level

  3. Secukinumab treatment in rheumatoid arthritis is associated with incremental benefit in the clinical outcomes and HRQoL improvements that exceed minimally important thresholds

    PubMed Central

    2014-01-01

    Background The primary aim of rheumatoid arthritis (RA) treatment is to induce remission, the absence of disease activity. The objective of this study was to explore the association between clinical endpoints used to gauge RA treatment efficacy and patient-reported outcomes of health-related quality of life, fatigue, and physical function in RA patients treated with secukinumab in a phase 2 randomized controlled trial (RCT). Method Adult RA patients (n = 237) with incomplete responses to methotrexate were randomized equally to receive monthly s.c. injections of secukinumab 25 mg, 75 mg, 150 mg, 300 mg or placebo. Clinical endpoints used in this study included the ACR response criteria and its components and simplified disease activity score. Patient-reported outcomes (PRO) included Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study Short Form-36 [SF-36] Survey, and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Patients were categorized into mutually exclusive groups according to the magnitude and direction of change from baseline to week 16 in each clinical endpoint. Definitions of minimal important differences [MID] in each clinical endpoint were used to categorize patients, as well as thresholds beyond MID. Mean changes from baseline to week 16 were computed for each PRO and analyses of variance to test the differences in PRO changes observed across groups of patients that differed in each clinical endpoint. Analyses were limited to patients randomized to secukinumab treatment. All dose groups were combined (n = 187). Results Mean changes from baseline in each PRO differed significantly across groups of patients in the expected direction. With few exceptions, there was considerable agreement between clinical endpoints and PROs concerning the magnitude of change defined as clinically meaningful. More importantly, results demonstrated that greater improvements in clinical endpoints were

  4. Renal manifestations of human brucellosis: First report of minimal change disease.

    PubMed

    Sabanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Tsotsiou, Eleni; Kalaitzoglou, Asterios; Kavlakoudis, Christos; Vasileiou, Sotirios

    2016-05-01

    Human brucellosis is considered a great example of the complexity of clinical manifestations possibly affecting multiple organs or systems. Renal manifestations of human brucellosis have been documented in few case reports and one case series. Herein, we present a case of Nephrotic syndrome (NS) due to minimal change disease in the course of acute brucellosis. A 53-year-old male farmer was admitted to our department with acute brucellosis and NS. Renal biopsy revealed minimal change disease. Combined treatment with prednisone (1 mg/kg), rifampicin (600 mg/day), and doxycycline (200 mg/day) was initiated. Complete remission of NS was achieved at the end of the fourth week. One year later, the patient remained in complete remission of NS without any sign of relapse of brucellosis.

  5. Early changes in contractility indices and fibrosis in two minimally invasive congestive heart failure models.

    PubMed

    de Souza Vilarinho, Karlos Alexandre; Petrucci, Orlando; Baker, R Scott; Vassallo, José; Schenka, André Almeida; Duffy, Jodie Y; de Oliveira, Pedro Paulo Martins; Vieira, Reinaldo Wilson

    2010-02-01

    not present. The two heart failure models we describe were relatively simple to create and maintain, minimally invasive, accurate, inexpensive and, importantly, had a low mortality rate. These models rapidly induced deterioration of contractility indices and onset of fibrosis, the hallmarks of early myocardial dysfunction associated with heart failure. Sonomicrometry assessments were able to detect early contractility changes prior to clinical signs. Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  6. Phenotypic changes in acute myeloid leukaemia: implications in the detection of minimal residual disease.

    PubMed Central

    Macedo, A; San Miguel, J F; Vidriales, M B; López-Berges, M C; García-Marcos, M A; Gonzalez, M; Landolfi, C; Orfão, A

    1996-01-01

    AIM: To explore the role of phenotypic changes as possible limiting factors in the immunological detection of minimal residual disease in patients with acute myeloid leukaemia (AML). METHODS: 20 relapses were evaluated, with special attention to changes in the criteria used for the definition of a phenotype as "aberrant". In all cases the same monoclonal antibody and fluorochrome were used at diagnosis and in relapse. RESULTS: Six out of the 16 patients showed aberrant phenotypes at diagnosis. At relapse, no changes in the aberrant phenotypes were detected in most of the patients; nevertheless, in two of the four patients with asynchronous antigen expression this aberration disappeared at relapse. At diagnosis in both cases there were already small blast cell subpopulations showing the phenotype of leukaemic cells at relapse. Ten out of the 16 cases analysed showed significant changes in the expression of at least one of the markers analysed. CONCLUSIONS: At relapse in AML the "leukaemic phenotypes" usually remained unaltered, while other phenotypic features--not relevant for distinguishing leukaemic blast cells among normal progenitors--changed frequently; however, they were not a major limitation in the immunological detection of minimal residual disease. PMID:8666678

  7. Weight change among people randomized to minimal intervention control groups in weight loss trials.

    PubMed

    Johns, David J; Hartmann-Boyce, Jamie; Jebb, Susan A; Aveyard, Paul

    2016-04-01

    Evidence on the effectiveness of behavioral weight management programs often comes from uncontrolled program evaluations. These frequently make the assumption that, without intervention, people will gain weight. The aim of this study was to use data from minimal intervention control groups in randomized controlled trials to examine the evidence for this assumption and the effect of frequency of weighing on weight change. Data were extracted from minimal intervention control arms in a systematic review of multicomponent behavioral weight management programs. Two reviewers classified control arms into three categories based on intensity of minimal intervention and calculated 12-month mean weight change using baseline observation carried forward. Meta-regression was conducted in STATA v12. Thirty studies met the inclusion criteria, twenty-nine of which had usable data, representing 5,963 participants allocated to control arms. Control arms were categorized according to intensity, as offering leaflets only, a single session of advice, or more than one session of advice from someone without specialist skills in supporting weight loss. Mean weight change at 12 months across all categories was -0.8 kg (95% CI -1.1 to -0.4). In an unadjusted model, increasing intensity by moving up a category was associated with an additional weight loss of -0.53 kg (95% CI -0.96 to -0.09). Also in an unadjusted model, each additional weigh-in was associated with a weight change of -0.42 kg (95% CI -0.81 to -0.03). However, when both variables were placed in the same model, neither intervention category nor number of weigh-ins was associated with weight change. Uncontrolled evaluations of weight loss programs should assume that, in the absence of intervention, their population would weigh up to a kilogram on average less than baseline at the end of the first year of follow-up. © 2016 The Authors Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

  8. Weight change among people randomized to minimal intervention control groups in weight loss trials

    PubMed Central

    Johns, David J.; Hartmann‐Boyce, Jamie; Jebb, Susan A.; Aveyard, Paul

    2016-01-01

    Objective Evidence on the effectiveness of behavioral weight management programs often comes from uncontrolled program evaluations. These frequently make the assumption that, without intervention, people will gain weight. The aim of this study was to use data from minimal intervention control groups in randomized controlled trials to examine the evidence for this assumption and the effect of frequency of weighing on weight change. Methods Data were extracted from minimal intervention control arms in a systematic review of multicomponent behavioral weight management programs. Two reviewers classified control arms into three categories based on intensity of minimal intervention and calculated 12‐month mean weight change using baseline observation carried forward. Meta‐regression was conducted in STATA v12. Results Thirty studies met the inclusion criteria, twenty‐nine of which had usable data, representing 5,963 participants allocated to control arms. Control arms were categorized according to intensity, as offering leaflets only, a single session of advice, or more than one session of advice from someone without specialist skills in supporting weight loss. Mean weight change at 12 months across all categories was −0.8 kg (95% CI −1.1 to −0.4). In an unadjusted model, increasing intensity by moving up a category was associated with an additional weight loss of −0.53 kg (95% CI −0.96 to −0.09). Also in an unadjusted model, each additional weigh‐in was associated with a weight change of −0.42 kg (95% CI −0.81 to −0.03). However, when both variables were placed in the same model, neither intervention category nor number of weigh‐ins was associated with weight change. Conclusions Uncontrolled evaluations of weight loss programs should assume that, in the absence of intervention, their population would weigh up to a kilogram on average less than baseline at the end of the first year of follow‐up. PMID:27028279

  9. Distribution-based estimates of minimal important difference for hospital anxiety and depression scale and impact of event scale-revised in survivors of acute respiratory failure.

    PubMed

    Chan, Kitty S; Aronson Friedman, Lisa; Bienvenu, O Joseph; Dinglas, Victor D; Cuthbertson, Brian H; Porter, Richard; Jones, Christina; Hopkins, Ramona O; Needham, Dale M

    2016-01-01

    This study will estimate distribution-based minimal important difference (MID) for the Hospital Anxiety and Depression Scale anxiety (HADS-A) and depression (HADS-D) subscales, and the Impact of Event Scale-Revised (IES-R) in survivors of acute respiratory failure (ARF). Secondary analyses of data from two US and three UK studies of ARF survivors (total N=1223). HADS-D and HADS-A were used to assess depression and anxiety symptoms. IES-R assessed post-traumatic stress disorder symptoms. Standard error of measurement, minimal detectable change90, 0.5 standard deviation (S.D.), and 0.2 S.D. were used to estimate MID for the combined sample, by studies, 6- and 12-month follow-ups, country and mental health condition. Overall, MID estimates converged to 2.0-2.5 for the HADS-A, 1.9-2.3 for the HADS-D and 0.17-0.18 for the IES-R. MID estimates were comparable across studies, follow-up, country and mental health condition. Among ARF survivors, 2.0-2.5 is a reasonable range for the MID for both HADS subscales, and 0.2 is reasonable for IES-R. Until anchor-based MIDs for these instruments are available, these distribution-based estimates can help researchers plan future studies and interpret the clinical importance of findings in ARF patient populations. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Distribution-Based Estimates of Minimal Important Difference for Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised in Survivors of Acute Respiratory Failure

    PubMed Central

    Chan, Kitty S.; Friedman, Lisa Aronson; Bienvenu, O. Joseph; Dinglas, Victor D.; Cuthbertson, Brian H.; Porter, Richard; Jones, Christina; Hopkins, Ramona O.; Needham, Dale M.

    2016-01-01

    Objective This study will estimate distribution-based minimal important difference (MID) for the Hospital Anxiety and Depression Scale anxiety (HADS-A) and depression (HADS-D) subscales, and the Impact of Event Scale-Revised IES-R in survivors of acute respiratory failure (ARF). Methods Secondary analyses of data from two U.S. and three U.K. studies of ARF survivors (Total N=1,223). HADSD and HADS-A were used to assess depression and anxiety symptoms. IES-R assessed PTSD symptoms. Standard error of measurement (SEM), minimal detectable change90 (MDC90), 0.5 standard deviation (SD), and 0.2 SD were used to estimate MID for the combined sample, by studies, 6- and 12-month follow-ups, country and mental health condition. Results Overall, MID estimates converged to 2.0-2.5 for the HADS-A, 1.9-2.3 for the HADS-D, and 0.17-0.18 for the IES-R. MID estimates were comparable across studies, follow-up, country and mental health condition. Conclusion Among ARF survivors, 2.0-2.5 is a reasonable range for the MID for both HADS subscales and 0.2 is reasonable for IES-R. Until anchor-based MIDs for these instruments are available, these distribution-based estimates can help researchers plan future studies and interpret the clinical importance of findings in ARF patient populations. PMID:27638969

  11. Minimal important differences and response shift in health-related quality of life; a longitudinal study in patients with multiple myeloma

    PubMed Central

    2010-01-01

    Background We previously reported that changes of 6-17 percent in the EORTC QLQ-C30 scores are regarded important by patients with multiple myeloma and thus may be considered as Minimal Important Differences (MIDs). However, patients' internal standard of measurement may have changed over time (response shift, RS). In the present work, we evaluated whether myeloma patients experience RS and if this could affect the MID-estimates. Methods Between 2006 and 2008, 239 patients with multiple myeloma completed the EORTC QLQ-C30 at baseline (T1) and after three months (T2). At T2, patients were asked if they had noticed any change in the domains pain, fatigue, physical function and global quality of life. They were also asked to give a retrospective judgment of their baseline values on all the four domains. Results We found clear evidence of RS in myeloma patients. However, there were differences in both magnitude and direction between patients who stated that they improved and those who deteriorated. Deteriorating patients retrospectively reported better health-related quality of life at T1 for the domains pain, fatigue and physical function. In these patients, MIDs adjusted for RS were observed to increase up to 12 percentage points. In contrast, for patients stating that they improved, we only found evidence of statistically significant RS in the domain global quality of life. Conclusions MIDs estimated from pre-test/post-test data appeared to be robust against RS in patients reporting improvement over 3-months. This could indicate that RS has a minimal impact on the results in patients who respond to treatment, and that RS may not have an important impact on interpretation of changes reported in clinical trials where an improvement occurs. Although the effect sizes of the RSs were small, RS in deteriorating patients may have an important impact on the interpretation of changes reported in clinical trials. Trial registration The study is registered at clinicaltrials

  12. 78 FR 69288 - Import Administration; Change of Agency Name

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-19

    ... internal department organizational orders, changed the name of ``Import Administration'' to ``Enforcement... Department of Commerce, through internal Department Organizational Order 10-3 (effective September 18, 2013) and Department Organizational Order 40-1, (effective September 19, 2013), to consolidate and...

  13. 78 FR 62417 - Import Administration; Change of Agency Name

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ...), through internal department organizational orders, changed the name of ``Import Administration'' to... the decision by the Department, through internal Department Organizational Orders 10-3 (effective September 18, 2013) and Department Organizational Order 40-1, (effective September 19, 2013), to consolidate...

  14. Name Changes for Fungi of Medical Importance, 2012 to 2015.

    PubMed

    Warnock, David W

    2017-01-01

    This article lists proposed new or revised species names and classification changes associated with fungi of medical importance for the years 2012 through 2015. While many of the revised names listed have been widely adopted without further discussion, some may take longer to achieve more general usage. Copyright © 2016 American Society for Microbiology.

  15. 9 CFR 94.19 - Restrictions on importation from BSE minimal-risk regions of meat and edible products from...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... minimal-risk regions of meat and edible products from ruminants. 94.19 Section 94.19 Animals and Animal... BSE minimal-risk regions of meat and edible products from ruminants. Except as provided in § 94.18 and... derived from bovines that have been subject to a ruminant feed ban equivalent to the...

  16. 9 CFR 94.19 - Restrictions on importation from BSE minimal-risk regions of meat and edible products from...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... minimal-risk regions of meat and edible products from ruminants. 94.19 Section 94.19 Animals and Animal... BSE minimal-risk regions of meat and edible products from ruminants. Except as provided in § 94.18 and... derived from bovines that have been subject to a ruminant feed ban equivalent to the...

  17. 9 CFR 94.19 - Restrictions on importation from BSE minimal-risk regions of meat and edible products from...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... minimal-risk regions of meat and edible products from ruminants. 94.19 Section 94.19 Animals and Animal... BSE minimal-risk regions of meat and edible products from ruminants. Except as provided in § 94.18 and... derived from bovines that have been subject to a ruminant feed ban equivalent to the...

  18. 9 CFR 94.19 - Restrictions on importation from BSE minimal-risk regions of meat and edible products from...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... minimal-risk regions of meat and edible products from ruminants. 94.19 Section 94.19 Animals and Animal... BSE minimal-risk regions of meat and edible products from ruminants. Except as provided in § 94.18 and... derived from bovines that have been subject to a ruminant feed ban equivalent to the...

  19. Meta-analysis on continuous outcomes in minimal important difference units: an application with appropriate variance calculations.

    PubMed

    Shrier, Ian; Christensen, Robin; Juhl, Carsten; Beyene, Joseph

    2016-12-01

    To compare results from meta-analyses for mean differences in minimal important difference (MID) units (MDMID), when MID is treated as a random variable vs. a constant. Meta-analyses of published data. We calculated the variance of MDMID as a random variable using the delta method and as a constant. We assessed performance under different assumptions. We compare meta-analysis results from data originally used to present the MDMID and data from osteoarthritis studies using different domain instruments. Depending on the data set and depending on the values of rho and coefficient of variation of the MID (CoVMID), estimates of treatment effect and P-values between an approach considering the MID as a constant vs. as a random variable may differ appreciably. Using our data sets, we provide examples of the potential magnitude. When rho = 0.5 and CoVMID = 0.8, considering MID as a constant overestimated the treatment effect by 33-110% and decreased the P-value for heterogeneity from above 0.95 to below 0.08. When rho = 0.8 and CoVMID = 0.5, the magnitude of the effects was similar. Considering MID as a random variable avoids unrealistic assumptions and provides more appropriate treatment effect estimates. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Estimation of minimally important differences in the EQ-5D and SF-6D indices and their utility in stroke.

    PubMed

    Kim, Sang-Kyu; Kim, Seon-Ha; Jo, Min-Woo; Lee, Sang-il

    2015-03-09

    The aim of the present study was to estimate minimally important differences (MIDs) in EQ-5D and SF-6D indices and to explore the responsiveness of EQ-5D and SF-6D indices in stroke. We used observational longitudinal survey data of EQ-5D and SF-36 that were administered to stroke patients at baseline and at 10 months. A range of MIDs for both indexes was estimated using anchor-based approaches. The modified Rankin scale and the Barthel index were used as an anchor. The MID estimates for EQ-5D ranged from 0.08 to 0.12 and those for SF-6D ranged from 0.04 to 0.14 in stroke patients. The MID values for these two utility measures differed in absolute magnitude, as the SF-6D index has wider range that that of the EQ-5D index. The MID values for these two utility measures differed in absolute magnitude, as the SF-6D index has wider range that that of the EQ-5D index. These MID estimates may assist the interpretation of health related quality of life assessments related to health care intervention in stroke patients.

  1. Minimal Change Nephrotic Syndrome Which Was Most Likely Caused by Chronic Sinusitis.

    PubMed

    Iwatani, Hirotsugu; Mori, Daisuke; Yamamoto, Satoko; Nakano, Chikako; Yamamoto, Ryohei; Masumura, Chisako; Shikina, Takashi; Imai, Takao; Inohara, Hidenori; Rakugi, Hiromi; Isaka, Yoshitaka

    2015-01-01

    A 33-year-old Japanese man was admitted with severe edema, and a renal biopsy confirmed minimal change nephrotic syndrome (MCNS). CT revealed his severe chronic sinusitis, and he first received antimicrobial therapy, which resulted in decreased proteinuria. The surgical operation for sinusitis resulted in the complete disappearance of proteinuria without corticosteroid or immunosuppressant therapy within one week. MCNS may be triggered by infection, but there are no previously reported cases of MCNS that is completely remitted by infection control alone. Therefore, we herein report the first case of MCNS that attained complete remission following therapy for chronic sinusitis alone, which suggests a strong etiology of chronic sinusitis for MCNS.

  2. Responsiveness and Minimally Important Differences for 4 Patient-Reported Outcomes Measurement Information System Short Forms: Physical Function, Pain Interference, Depression, and Anxiety in Knee Osteoarthritis.

    PubMed

    Lee, Augustine C; Driban, Jeffrey B; Price, Lori Lyn; Harvey, William F; Rodday, Angie Mae; Wang, Chenchen

    2017-09-01

    Patient-Reported Outcomes Measurement Information System (PROMIS) instruments can provide valid, interpretable measures of health status among adults with osteoarthritis (OA). However, their ability to detect meaningful change over time is unknown. We evaluated the responsiveness and minimally important differences (MIDs) for 4 PROMIS Short Forms: Physical Function, Pain Interference, Depression, and Anxiety. We analyzed adults with symptomatic knee OA from our randomized trial comparing Tai Chi and physical therapy. Using baseline and 12-week scores, responsiveness was evaluated according to consensus standards by testing 6 a priori hypotheses of the correlations between PROMIS and legacy change scores. Responsiveness was considered high if ≥5 hypotheses were confirmed, and moderate if 3 or 4 were confirmed. MIDs were evaluated according to prospective change for people achieving previously-established MID on legacy comparators. The lowest and highest MIDs meeting a priori quality criteria formed a MID range for each PROMIS Short Form. Among 165 predominantly female (70%) and white (57%) participants, mean age was 61 years and body mass index was 33. PROMIS Physical Function had 5 confirmed hypotheses and Pain Interference, Depression, and Anxiety had 3 or 4. MID ranges were: Depression = 3.0 to 3.1; Anxiety = 2.3 to 3.4; Physical Function = 1.9 to 2.2; and Pain Interference = 2.35 to 2.4. PROMIS Physical Function has high responsiveness, and Depression, Anxiety, and Pain Interference have moderate responsiveness among adults with knee OA. We established the first MIDs for PROMIS in this population, and provided an important standard of reference to better apply or interpret PROMIS in future trials or clinical practice. This study examined whether PROMIS Short Form instruments (Physical Function, Pain Interference, Depression, and Anxiety) were able to detect change over time among adults with knee OA, and provided minimally important change estimates

  3. Flavor-changing Higgs decays in grand unification with minimal flavor violation

    NASA Astrophysics Data System (ADS)

    Baek, Seungwon; Tandean, Jusak

    2016-12-01

    We consider the flavor-changing decays of the Higgs boson in a grand unified theory framework which is based on the SU(5) gauge group and implements the principle of minimal flavor violation. This allows us to explore the possibility of connecting the tentative hint of the Higgs decay h→ μ τ recently reported in the CMS experiment to potential new physics in the quark sector. We look at different simple scenarios with minimal flavor violation in this context and how they are subject to various empirical restrictions. In one specific case, the relative strengths of the flavor-changing leptonic Higgs couplings are determined mainly by the known quark mixing parameters and masses, and a branching fraction B(h→ μ τ )˜ 1% is achievable without the couplings being incompatible with the relevant constraints. Upcoming data on the Higgs leptonic decays and searches for the μ → eγ decay with improved precision can offer further tests on this scenario.

  4. Seasonal singing of a songbird living near the equator correlates with minimal changes in day length.

    PubMed

    Quispe, Rene; Protazio, João Marcelo Brazão; Gahr, Manfred

    2017-08-22

    Behaving in accordance with natural cycles is essential for survival. Birds in the temperate regions use the changes of day length to time their behavior. However, at equatorial latitudes the photoperiod remains almost constant throughout the year, and it is unclear which cues songbirds use to regulate behaviors, such as singing. Here, we investigated the timing of dawn-song of male silver-beaked tanagers in the equatorial lowland Amazonas over two years. In this region, birds experience around nine minutes of annual day length variation, with sunrise times varying by 32 minutes over the year. We show that the seasonal timing of dawn-song was highly regular between years, and was strongly correlated with slight increases in day length. During the singing season the daily dawn-song onset was precisely aligned to variations in twilight time. Thus, although photoperiodic changes near the equator are minimal, songbirds can use day length variation to time singing.

  5. Construct Validity and Minimal Important Difference of 6-Minute Walk Distance in Survivors of Acute Respiratory Failure

    PubMed Central

    Pfoh, Elizabeth R.; Denehy, Linda; Elliott, Doug; Holland, Anne E.; Dinglas, Victor D.; Needham, Dale M.

    2015-01-01

    OBJECTIVE: The 6-min walk distance (6MWD), a widely used test of functional capacity, has limited evidence of construct validity among patients surviving acute respiratory failure (ARF) and ARDS. The objective of this study was to examine construct validity and responsiveness and estimate minimal important difference (MID) for the 6MWD in patients surviving ARF/ARDS. METHODS: For this secondary data analysis of four international studies of adult patients surviving ARF/ARDS (N = 641), convergent and discriminant validity, known group validity, predictive validity, and responsiveness were assessed. MID was examined using anchor- and distribution-based approaches. Analyses were performed within studies and at various time points after hospital discharge to examine generalizability of findings. RESULTS: The 6MWD demonstrated good convergent and discriminant validity, with moderate to strong correlations with physical health measures (|r| = 0.36-0.76) and weaker correlations with mental health measures (|r| = 0.03-0.45). Known-groups validity was demonstrated by differences in 6MWD between groups with differing muscle strength and pulmonary function (all P < .01). Patients reporting improved function walked farther, supporting responsiveness. 6MWD also predicted multiple outcomes, including future mortality, hospitalization, and health-related quality of life. The 6MWD MID, a small but consistent patient-perceivable effect, was 20 to 30 m. Findings were similar for 6MWD % predicted, with an MID of 3% to 5%. CONCLUSIONS: In patients surviving ARF/ARDS, the 6MWD is a valid and responsive measure of functional capacity. The MID will facilitate planning and interpretation of future group comparison studies in this population. PMID:25742048

  6. Minimally Important Differences in Patient or Proxy-Reported Outcome Studies Relevant to Children: A Systematic Review.

    PubMed

    Ebrahim, Shanil; Vercammen, Kelsey; Sivanand, Arunima; Guyatt, Gordon H; Carrasco-Labra, Alonso; Fernandes, Ricardo M; Crawford, Mark W; Nesrallah, Gihad; Johnston, Bradley C

    2017-03-01

    No study has characterized and appraised all anchor-based minimally important differences (MIDs) associated with patient-reported outcome (PRO) instruments in pediatric studies. To complete a comprehensive systematic survey and appraisal of published anchor-based MIDs associated with PRO instruments used in children. Medline, Embase, and PsycINFO (1989 to February 11, 2015). Studies reporting empirical ascertainment of anchor-based MIDs among PROs used in pediatric care. All pertinent data items related to the characteristics of PRO instruments, anchors, and MIDs. Of 4179 unique citations, 30 studies (including 32 cohorts) proved eligible and reported on 28 unique PROs (8 generic, 13 disease-specific, 5 symptoms-specific, 2 function-specific), with 9 (32%) classified as patient-reported, 11 (39%) proxy-reported, and 8 (29%) both patient- and proxy-reported. Of the 30 studies, we rated 14 (44%) as providing highly credible estimates of the MID. Most cohorts (n = 20, 62%) recorded patients' direct response to the target PRO and the use of an independent standard of comparison (n = 25, 78%). Most, however, failed to effectively report measurement properties of the anchor (n = 24, 75%). We have not yet addressed the measurement properties of instrument to measure credibility; our search was restricted to 3 electronic sources, and we used a single data abstractor. Our study found 28 PROs that have been developed for children, with fewer than half providing credible estimates. Clinicians, clinical trialists, systematic reviewers, and guideline developers seeking to effectively summarize and interpret results of studies addressing PROs in child health are likely to find our comprehensive compendium of MIDs of use, both in providing best estimates of MIDs and identifying credible estimates. Copyright © 2017 by the American Academy of Pediatrics.

  7. Evaluating the reliability, validity and minimally important difference of the Taiwanese version of the diabetes quality of life (DQOL) measurement

    PubMed Central

    Huang, I-Chan; Liu, Jung-Hua; Wu, Albert W; Wu, Ming-Yen; Leite, Walter; Hwang, Chyng-Chuang

    2008-01-01

    Background Few diabetes HRQOL instruments are available in Chinese language. We tested psychometric properties of a Diabetes Quality of Life (DQOL) in Chinese language for diabetes patients in Taiwan and estimated its minimally important differences (MIDs). Methods Data were collected from 337 patients treated in diabetes clinics of a Taiwan teaching hospital. Pearson's correlations among domain scores of the DQOL (satisfaction, impact, and worry), the D-39S (a diabetes-specific instrument, including domains of diabetes control, energy and mobility, social burden and anxiety and worry, and sexual functioning) and the RAND-12 (a generic instrument, including physical health composite (PHC) and mental health composite (MHC)) were estimated to determine convergent/discriminant validity. Known-groups validity was examined using 2-hour postprandial plasma glucose (2 h PPG), hemoglobin A1c (HbA1c)) and presence of complications (retinopathy, neuropathy, and diabetic foot complications rather than the known groups of cardiovascular and cerebrovascular complications). We used a combined anchor- and distribution-based approach to establish MIDs. Results The DQOL scores were more strongly correlated with the physical domains of the D-39S (diabetes control and energy and mobility) and RAND-12 PHC than psychological domains of the D-39S (social burden, anxiety and worry, and sexual functioning) and RAND-12 MHC. The DQOL showed satisfactory discriminative ability for the known groups of 2 h PPG and HbA1c (effect size (ES) ≥ 0.2) and retinopathy, neuropathy, and diabetic foot complications (ES ≥ 0.3), but less satisfactory for the known groups of cardiovascular and cerebrovascular complications. MIDs for the DQOL domains were 3–5 points for satisfaction, 4–5 points for impact, 6–8 points for worry, and 3–4 points for overall HRQOL. Conclusion We validated a DQOL in Chinese language for diabetes patients in Taiwan and provided MIDs to facilitate the measure of

  8. Validity, cut-points, and minimally important differences for two hot flash-related daily interference scales.

    PubMed

    Carpenter, Janet S; Bakoyannis, Giorgos; Otte, Julie L; Chen, Chen X; Rand, Kevin L; Woods, Nancy; Newton, Katherine; Joffe, Hadine; Manson, JoAnn E; Freeman, Ellen W; Guthrie, Katherine A

    2017-08-01

    To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales. We analyzed baseline and postrandomization patient-reported data pooled across three randomized trials aimed at reducing vasomotor symptoms (VMS) in 899 midlife women. Trials were conducted across five MsFLASH clinical sites between July 2009 and October 2012. We eliminated HFRDIS items based on experts' content validity ratings and confirmatory factor analysis, and evaluated cut-points and established MIDs by mapping HFRDIS and HFI to other measures. The three-item HFI (interference with sleep, mood, and concentration) demonstrated strong internal consistency (alphas of 0.830 and 0.856), showed good fit to the unidimensional "hot flash interference factor," and strong convergent validity with HFRDIS scores, diary VMS, and menopausal quality of life. For both scales, cut-points of mild (0-3.9), moderate (4-6.9), and severe (7-10) interference were associated with increasing diary VMS ratings, sleep, and anxiety. The average MID was 1.66 for the HFRDIS and 2.34 for the HFI. The HFI is a brief assessment of VMS interference and will be useful in busy clinics to standardize VMS assessment or in research studies where response burden may be an issue. The scale cut-points and MIDs should prove useful in targeting those most in need of treatment, monitoring treatment response, and interpreting existing and future research findings.

  9. Minimally important differences were estimated for six PROMIS-Cancer scales in advanced-stage cancer patients

    PubMed Central

    Eton, David T.; Garcia, Sofia F.; Cella, David

    2011-01-01

    Objective We combined anchor- and distribution-based methods to establish minimally important differences (MIDs) for six PROMIS-Cancer scales in advanced-stage cancer patients. Study Design and Setting Participants completed six PROMIS-Cancer scales and 23 anchor measures at an initial (n=101) and follow-up (n=88) assessment 6 to 12 weeks later. Three a priori criteria were used to identify useable cross-sectional and longitudinal anchor-based MID estimates. The mean standard error of measurement was also computed for each scale. The focus of the analysis was on IRT-based MIDs estimated on a T-score scale. Raw score MIDs were estimated for comparison purposes. Results Many cross-sectional (64%) and longitudinal (73%) T-score anchor-based MID estimates were excluded because they did not meet a priori criteria. The following are recommended T-score MID ranges: 17-item Fatigue (2.5–4.5), 7-item Fatigue (3.0–5.0), 10-item Pain Interference (4.0–6.0), 10-item Physical Functioning (4.0–6.0), 9-item Emotional Distress-Anxiety (3.0–4.5), and 10-item Emotional Distress-Depression (3.0–4.5). Effect sizes corresponding to these MIDs averaged between 0.40 and 0.63. Conclusions This study is the first to address MIDs for PROMIS measures. Studies are currently being conducted to confirm these MIDs in other patient populations and to determine whether these MIDs vary by patients’ level of functioning. PMID:21447427

  10. Evaluating the reliability, validity and minimally important difference of the Taiwanese version of the diabetes quality of life (DQOL) measurement.

    PubMed

    Huang, I-Chan; Liu, Jung-Hua; Wu, Albert W; Wu, Ming-Yen; Leite, Walter; Hwang, Chyng-Chuang

    2008-10-28

    Few diabetes HRQOL instruments are available in Chinese language. We tested psychometric properties of a Diabetes Quality of Life (DQOL) in Chinese language for diabetes patients in Taiwan and estimated its minimally important differences (MIDs). Data were collected from 337 patients treated in diabetes clinics of a Taiwan teaching hospital. Pearson's correlations among domain scores of the DQOL (satisfaction, impact, and worry), the D-39S (a diabetes-specific instrument, including domains of diabetes control, energy and mobility, social burden and anxiety and worry, and sexual functioning) and the RAND-12 (a generic instrument, including physical health composite (PHC) and mental health composite (MHC)) were estimated to determine convergent/discriminant validity. Known-groups validity was examined using 2-hour postprandial plasma glucose (2 h PPG), hemoglobin A1c (HbA1c)) and presence of complications (retinopathy, neuropathy, and diabetic foot complications rather than the known groups of cardiovascular and cerebrovascular complications). We used a combined anchor- and distribution-based approach to establish MIDs. The DQOL scores were more strongly correlated with the physical domains of the D-39S (diabetes control and energy and mobility) and RAND-12 PHC than psychological domains of the D-39S (social burden, anxiety and worry, and sexual functioning) and RAND-12 MHC. The DQOL showed satisfactory discriminative ability for the known groups of 2 h PPG and HbA1c (effect size (ES) > or = 0.2) and retinopathy, neuropathy, and diabetic foot complications (ES > or = 0.3), but less satisfactory for the known groups of cardiovascular and cerebrovascular complications. MIDs for the DQOL domains were 3-5 points for satisfaction, 4-5 points for impact, 6-8 points for worry, and 3-4 points for overall HRQOL. We validated a DQOL in Chinese language for diabetes patients in Taiwan and provided MIDs to facilitate the measure of diabetes HRQOL.

  11. The Clinical Importance of Changes in Diabetic Retinopathy Severity Score.

    PubMed

    Ip, Michael S; Zhang, Jiameng; Ehrlich, Jason S

    2017-05-01

    To investigate the clinical importance of changes in diabetic retinopathy severity score (DRSS) in patients with diabetic macular edema (DME) treated with intravitreal ranibizumab. Post hoc analysis of the phase III RIDE and RISE studies of ranibizumab for treatment of DME. Four hundred sixty-eight eyes treated with ranibizumab from randomization with gradable DRSS on baseline fundus photographs. Visual and anatomic outcomes were examined in eyes grouped according to DRSS change from baseline to month 24. Mean best-corrected visual acuity (BCVA) letter score change, proportion of patients with 15 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letter score change, mean contrast sensitivity change, proportion of patients with resolved macular edema, and leakage on fluorescein angiography. Most (56.8%) patients treated with ranibizumab experienced 1-step or more improvement in DRSS from baseline to month 24; 40.0% had no change, and 3.2% experienced DRSS worsening. Patients with DRSS stability or improvement had greater mean BCVA letter score changes (+15.1, +14.2, +11.3, and +11.2 letters for ≥3-step improvement, ≥2-step improvement, 1-step improvement, and no DRSS change, respectively) compared with +5.0 letters in patients who had any DRSS worsening. Best-corrected visual acuity letter score gain of 15 letters or more was more common in patients with 2-step or 3-step or more DRSS improvement (51.9% and 44.6%, respectively) compared with those with a 1-step DRSS improvement, no change, or worsening (37.9%, 39.6%, and 26.7%, respectively). A loss of 15 letters or more in BCVA was more common in patients with any DRSS worsening (13.3%) compared with patients who had stable or improved DRSS (0%-2.8%). Resolution of macular edema was more common in patients with DRSS improvement: 84.2%, 87.7%, and 92.3% of patients with 1-step, 2-step or more, and 3-step or more improvement in DRSS achieved central foveal thickness of 250 μm or less, compared with

  12. How Desert Storm changed U. S. oil imports

    SciTech Connect

    Not Available

    1992-04-30

    During the past two years, US petroleum imports shrank because of economic recession. There were significant changes in the shares of the shrunken pie because of the Persian Gulf War. This issue of Energy Detente compares US crude and refined product imports by hemisphere and by country during 1991 and 1989. These trends are likely to be reversed for short and long term reasons discussed inside. US dependence on Western Hemisphere countries increased by 0.6%, Venezuela accounting for 17% more imports in 1991 than 1989 and Canada and Mexico 11% and 4% more, respectively. This issue also presents the following: (1) the ED Refining Netback Data Series for the US Gulf and West Coasts, Rotterdam, and Singapore as of April 10, 1992; and (2) the ED Fuel Price/Tax Series for countries of the Eastern Hemisphere, April 1992 Edition.

  13. The reaction of serpins with proteinases involves important enthalpy changes.

    PubMed

    Boudier, C; Bieth, J G

    2001-08-21

    When active serpins are proteolytically inactivated in a substrate-like reaction, they undergo an important structural transition with a resultant increase in their conformational stability. We have used microcalorimetry to show that this conformational alteration is accompanied by an important enthalpy change. For instance, the cleavage of alpha(1)-proteinase inhibitor by Pseudomonas aeruginosa elastase, Staphylococcus aureus V8 proteinase, or papain and that of antithrombin by leukocyte elastase are characterized by large enthalpy changes (DeltaH = -53 to -63 kcal mol(-1)). The former reaction also has a large and negative heat capacity (DeltaC(p)() = -566 cal K(-1) mol(-1)). In contrast, serpins release significantly less heat when they act as proteinase inhibitors. For example, the inhibition of pancreatic elastase, leukocyte elastase, and pancreatic chymotrypsin by alpha(1)-proteinase inhibitor and that of pancreatic trypsin and coagulation factor Xa by antithrombin are accompanied by a DeltaH of -20 to -31 kcal mol(-1). We observe no heat release upon proteolytic cleavage of inactive serpins or following inhibition of serine proteinases by canonical inhibitors or upon acylation of chymotrypsin by N-trans-cinnamoylimidazole. We suggest that part of the large enthalpy change that occurs during the structural transition of serpins is used to stabilize the proteinase in its inactive state.

  14. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

    PubMed Central

    Paulsen, Aksel

    2014-01-01

    Background and purpose The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D. Patients and methods THA patients from 16 different departments received 2 PROs and additional questions preoperatively and 1 year postoperatively. The PROs included were the HOOS subscales pain (HOOS Pain), physical function short form (HOOS-PS), and hip-related quality of life (HOOS QoL), and the EQ-5D. MCII and PASS were estimated using multiple anchor-based approaches. Results Of 1,837 patients available, 1,335 answered the preoperative PROs, and 1,288 of them answered the 1-year follow-up. The MCIIs and PASSs were estimated to be: 24 and 91 (HOOS Pain), 23 and 88 (HOOS-PS), 17 and 83 (HOOS QoL), 0.31 and 0.92 (EQ-5D Index), and 23 and 85 (EQ-VAS), respectively. MCIIs corresponded to a 38–55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57–91% of the maximum score in THA patients 1 year after surgery. Interpretation This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide for future MCII and PASS estimations in other contexts. The cutoff points may serve as reference values in registry settings. PMID:24286564

  15. Longitudinal psychometric attributes, responsiveness, and importance of change: An approach using the SCOPA-Psychosocial questionnaire.

    PubMed

    Martínez-Martin, Pablo; Carod-Artal, Francisco Javier; da Silveira Ribeiro, Luciola; Ziomkowski, Sofia; Vargas, Antonio Pedro; Kummer, Wladimir; Mesquita, Hudson Mourão

    2008-08-15

    The objective of this study was to illustrate the analysis of longitudinal validity, responsiveness, and importance of change, using the SCOPA-Psychosocial Questionnaire (SCOPA-PS) as a source of empirical data. Sixty-seven patients with PD in Hoehn and Yahr (HY) stage 2 were followed up for 1 year and assessed by means of the Schwab and England Scale, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS), PDQ-39, and SCOPA-PS. A range of methods was applied to enable each of the target attributes to be analyzed from different conceptual stances. The SCOPA-PS displayed satisfactory acceptability (no floor or ceiling effect), internal consistency (alpha = 0.80-0.84), convergent validity (r(S) = 0.70-0.82 with PDQ-39), and precision (SEM = 8.80), both at baseline and at the end of follow-up. The threshold value for significant change ranged from 17.25 (1.96 SEM) to 24.39 (Smallest real difference and Reliable change index). Threshold values for a clinically meaningful change were 0.73-1.26 (effect size, standardized response mean, responsiveness statistic). Change in SCOPA-PS scores correlated strongly with change in total UPDRS, HADS, and PDQ-39 scores, and reliably detected 70% of cases that worsened according to the PDQ-39. The minimally important change (MIC) for "minimally impaired" patients as per the PDQ39 was 8.30-9.10 points. Indices such as 1.96 SEM, effect size, and correlation with the change in other measures provide useful information about different concepts of responsiveness. The MIC should be determined for each specific setting, using distribution- and anchor-based methods. The SCOPA-PS showed satisfactory longitudinal attributes and responsiveness in stage-2 Brazilian patients with PD across 1 year of follow-up. (c) 2008 Movement Disorder Society.

  16. Rifampicin-induced minimal change disease is improved after cessation of rifampicin without steroid therapy.

    PubMed

    Park, Dong Hyuk; Lee, Sul A; Jeong, Hyeon Joo; Yoo, Tae-Hyun; Kang, Shin-Wook; Oh, Hyung Jung

    2015-03-01

    There are several reports to demonstrate that rifampicin, a major anti-tuberculosis agent, is associated with some adverse renal effects, with a few cases of rifampicin-induced minimal change disease (MCD). In the present case, a 68-year-old female presented with nausea, vomiting, foamy urine, general weakness and edema. She had been taking rifampicin for 4 weeks due to pleural tuberculosis. The patient had no proteinuria before the anti-tuberculosis agents were started, but urine tests upon admission showed heavy proteinuria with a 24-h urinary protein of 9.2 g/day, and serum creatinine, albumin, and total cholesterol levels were 1.36 mg/dL, 2.40 g/dL, and 283 mg/dL, respectively. MCD was diagnosed, and the patient achieved complete remission after cessation of rifampicin without undergoing steroid therapy.

  17. Rifampicin-Induced Minimal Change Disease Is Improved after Cessation of Rifampicin without Steroid Therapy

    PubMed Central

    Park, Dong Hyuk; Lee, Sul A; Jeong, Hyeon Joo; Yoo, Tae-Hyun; Kang, Shin-Wook

    2015-01-01

    There are several reports to demonstrate that rifampicin, a major anti-tuberculosis agent, is associated with some adverse renal effects, with a few cases of rifampicin-induced minimal change disease (MCD). In the present case, a 68-year-old female presented with nausea, vomiting, foamy urine, general weakness and edema. She had been taking rifampicin for 4 weeks due to pleural tuberculosis. The patient had no proteinuria before the anti-tuberculosis agents were started, but urine tests upon admission showed heavy proteinuria with a 24-h urinary protein of 9.2 g/day, and serum creatinine, albumin, and total cholesterol levels were 1.36 mg/dL, 2.40 g/dL, and 283 mg/dL, respectively. MCD was diagnosed, and the patient achieved complete remission after cessation of rifampicin without undergoing steroid therapy. PMID:25684013

  18. Managing Obesity in Pregnancy: A Change in Focus from Harm Minimization to Prevention.

    PubMed

    Grivell, Rosalie M; O'Brien, Cecelia M; Dodd, Jodie M

    2016-03-01

    Obesity represents a significant global health problem, contributing to the overall burden of disease worldwide and a 30% increase in cost of health care provision. Over 50% of women who enter pregnancy are classified as overweight or obese resulting in short and long term effects on maternal and child health outcomes.There is a substantial amount of literature focusing on interventions in the antenatal period have been associated with modest changes in weight gain during pregnancy. There has been little effect on clinical pregnancy and birth outcomes.The article discusses the evidence supporting the shift from harm minimization via antenatal intervention, to one of prevention by targeting the time prior to conception to optimize maternal weight. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  19. Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients.

    PubMed

    Curtis, J R; Yang, S; Chen, L; Pope, J E; Keystone, E C; Haraoui, B; Boire, G; Thorne, J C; Tin, D; Hitchon, C A; Bingham, C O; Bykerk, V P

    2015-10-01

    Simplified measures to quantify rheumatoid arthritis (RA) disease activity are increasingly used. The minimum clinically important differences (MCID) for some measures, such as the Clinical Disease Activity Index (CDAI), have not been well-defined in real-world clinic settings, especially for early RA patients with low/moderate disease activity. Data from Canadian Early Arthritis Cohort patients were used to examine absolute change in CDAI in the first year after enrollment, stratified by disease activity. MCID cut points were derived to optimize the sum of sensitivity and specificity versus the gold standard of patient self-reported improvement or worsening. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated against patient self-reported improvement (gold standard) and for change in pain, Health Assessment Questionnaire (HAQ), and Disease Activity Score in 28 joints (DAS28) improvement. Discrimination was examined using the area under receiver operator curves. Similar methods were used to evaluate MCIDs for worsening for patients who achieved low disease activity. A total of 578 patients (mean ± SD age 54.1 ± 15.3 years, 75% women, median [interquartile range] disease duration 5.3 [3.3, 8.0] months) contributed 1,169 visit pairs to the improvement analysis. The MCID cut points for improvement were 12 (patients starting in high disease activity: CDAI >22), 6 (moderate: CDAI 10-22), and 1 (low disease activity: CDAI <10). Performance characteristics were acceptable using these cut points for pain, HAQ, and DAS28. The MCID for CDAI worsening among patients who achieved low disease activity was 2 units. These minimum important absolute differences in CDAI can be used to evaluate improvement and worsening and increase the utility of CDAI in clinical practice. © 2015, American College of Rheumatology.

  20. Alveolar dimensional changes relevant to implant placement after minimally traumatic tooth extraction with primary closure.

    PubMed

    Carranza, Nelson; Bonta, Hernan; Gualtieri, Ariel F; Rojas, Mariana A; Galli, Federico G; Caride, Facundo

    2016-09-01

    The purpose of this study is to evaluate the dimensional changes that occur in the alveolar ridge after minimally traumatic tooth extraction by means of computed tomography (CT), with special focus on the portion of bone supporting the gingival zenith. Twenty subjects with indication for singlerooted tooth extraction and preserved alveolar walls were selected for this study. After a minimally traumatic extraction, two CT scans were performed; the first within 24 hours postextraction (TC1) and the second 6 months (TC2) later. A radiographic guide with a radiopaque marker was used to obtain references that enabled accurate measurements over time, in both vertical and horizontal directions. The bone crest immediately apical to the gingival zenith was identified and termed "osseous zenith". The displacement of the osseous zenith in horizontal and vertical direction was analyzed and correlated with several alveolar anatomical variables with the aim of identifying possible predictors for bone remodeling. Dimensional changes that occur in postextraction sockets within a 6month period showed significant vertical and horizontal displacement of the osseous zenith (p<0.001). Mean vertical resorption was 2.1 ± 1.7 mm, with a median of 1.9 mm and a range of 0.2 to 7.5 mm. Mean horizontal resorption was 1.8 ± 0.8 mm with a median of 1.7 mm and a range of 0.6 to 4.4 mm. However, no correlation was found between the width of the facial alveolar crest and the displacement of the osseous zenith. The results of the present study showed that if the width of the facial crest at the apicalcoronal midpoint is less than 0.7 mm, a high degree of displacement of the osseous zenith (> 3 mm) should be expected. The present study suggests that the width of the alveolar crest at its midlevel, rather than crestal width, may be correlated with the displacement of the osseous zenith.

  1. Reliability and minimal detectable change of the weight-bearing lunge test: A systematic review.

    PubMed

    Powden, Cameron J; Hoch, Johanna M; Hoch, Matthew C

    2015-08-01

    Ankle dorsiflexion range of motion (DROM) is often a point of emphasis during the rehabilitation of lower extremity pathologies. With the growing popularity of weight-bearing DROM assessments, several versions of the weight-bearing lunge (WBLT) test have been developed and numerous reliability studies have been conducted. The purpose of this systematic review was to critically appraise and synthesize the studies which examined the reliability and responsiveness of the WBLT to assess DROM. A systematic search of PubMed and EBSCO Host databases from inception to September 2014 was conducted to identify studies whose primary aim was assessing the reliability of the WBLT. The Quality Appraisal of Reliability Studies assessment tool was utilized to determine the quality of included studies. Relative reliability was examined through intraclass correlation coefficients (ICC) and responsiveness was evaluated through minimal detectable change (MDC). A total of 12 studies met the eligibility criteria and were included. Nine included studies assessed inter-clinician reliability and 12 included studies assessed intra-clinician reliability. There was strong evidence that inter-clinician reliability (ICC = 0.80-0.99) as well as intra-clinician reliability (ICC = 0.65-0.99) of the WBLT is good. Additionally, average MDC scores of 4.6° or 1.6 cm for inter-clinician and 4.7° or 1.9 cm for intra-clinician were found, indicating the minimal change in DROM needed to be outside the error of the WBLT. This systematic review determined that the WBLT, regardless of method, can be used clinically to assess DROM as it provides consistent results between one or more clinicians and demonstrates reasonable responsiveness. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. A better prediction of conformational changes of proteins using minimally connected network models

    NASA Astrophysics Data System (ADS)

    Ahmadi Toussi, Cyrus; Soheilifard, Reza

    2016-12-01

    Elastic network models have recently been used for studying low-frequency collective motions of proteins. These models simplify the complexity that arises from normal mode analysis by considering a simplified potential involving a few parameters. Two common parameters in most of the elastic network models are cutoff radius and force constant. Although the latter has been studied extensively and even elaborate new models were introduced, for the former usually an ad-hoc cutoff radius is considered. Moreover, the quality of the network models is usually assessed by evaluating their prediction against experimental B-factors. In this work, we consider various common elastic network models with different cutoff radii and assess them by their ability to predict conformational changes of proteins in complexes from unbound to bound state. This prediction is performed by perturbing the unbound structure using a number of low-frequency normal modes of its network model to optimally fit the bound structure. We evaluated a dataset of 30 proteins with distinct unbound and bound structures using this criterion. The results showed that, opposed to the common calibration process based on B-factors, a meaningful relationship exists between the quality of the prediction and model parameters. It was shown that the cutoff radius has a major role in this prediction and minimally connected network models, which use the shortest cutoff radius for which the network is stable, give the best results. It was also shown that by considering the first ten normal modes, the conformational changes can be predicted by about 25 percent. Hence, the evaluation process was extended to the case of considering the contribution of all normal modes in the prediction. The results indicated that minimally connected network models are superior, despite their simplicity, when any number of modes are considered in the prediction.

  3. Biochemical and microbial changes during the storage of minimally processed cantaloupe.

    PubMed

    Lamikanra, O; Chen, J C; Banks, D; Hunter, P A

    2000-12-01

    The effect of storage time on pH, titratable acidity, degrees Brix, organic acids, sugars, amino acids, and color of minimally processed cantaloupe melon (Cucumis melo L. var. reticulatus Naud. cv. Mission) was determined at 4 degrees C and 20 degrees C. Changes in most of the biochemical parameters with storage time were relatively slow at the lower temperature. At 20 degrees C, a 17% loss in soluble solids and a 2-fold increase in acidity occurred after 2 days. Organic acid content also increased considerably with time at this temperature as a result of the production of lactic acid. Oxalic, citric, malic, and succinic acids were the organic acids, and glucose, fructose, and sucrose were the sugars present in the freshly cut cantaloupe. Malic acid concentration decreased concurrently with lactic acid production indicating the possible involvement of anaerobic malo-lactic fermentation along with sugar utilization by lactic acid bacteria. The effect of storage on microbial growth was determined at 4, 10, and 20 degrees C. Gram-negative stained rods grew at a slower rate at 4 degrees C and 10 degrees C than the Gram-positive mesophilic bacteria that dominated microorganism growth at 20 degrees C. Eighteen amino acids were identified in fresh cantaloupe: aspartic acid, glutamic acid, asparagine, serine, glutamine, glycine, histidine, arginine, threonine, alanine, proline, tyrosine, valine, methionine, isoleucine, leucine, phenyl alanine, and lysine. The dominant amino acids were aspartic acid, glutamic acid, arginine, and alanine. Total amino acid content decreased rapidly at 20 degrees C, but only a slight decrease occurred at 4 degrees C after prolonged storage. Changes in lightness (L), chroma, and hue at both temperatures indicate the absence of browning reactions. The results indicate the potential use of lactic acid and lactic acid bacteria as quality control markers in minimally processed fruits.

  4. Estimating heart shift and morphological changes during minimally invasive cardiac interventions

    NASA Astrophysics Data System (ADS)

    Linte, Cristian A.; Carias, Mathew; Cho, Daniel S.; Pace, Danielle F.; Moore, John; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Peters, Terry M.

    2010-02-01

    Image-guided interventions rely on the common assumption that pre-operative information can depict intraoperative morphology with sufficient accuracy. Nevertheless, in the context of minimally invasive cardiac therapy delivery, this assumption loses ground; the heart is a soft-tissue organ prone to changes induced during access to the heart and especially intracardiac targets. In addition to its clinical value for cardiac interventional guidance and assistance with the image- and model-to-patient registration, here we show how ultrasound imaging may be used to estimate changes in the heart position and morphology of structures of interest at different stages in the procedure. Using a magnetically tracked 2D transesophageal echocardiography transducer, we acquired in vivo images of the heart at different stages during the procedural workflow of common minimally invasive cardiac procedures, including robot-assisted coronary artery bypass grafting, mitral valve replacement/repair, or modelenhanced US-guided intracardiac interventions, all in the coordinate system of the tracking system. Anatomical features of interest (mitral and aortic valves) used to register the pre-operative anatomical models to the intraoperative coordinate frame were identified from each dataset. This information allowed us to identify the global position of the heart and also characterize the valvular structures at various peri-operative stages, in terms of their orientation, size, and geometry. Based on these results, we can estimate the differences between the preand intra-operative anatomical features, their effect on the model-to-subject registration, and also identify the need to update or optimize any pre-operative surgical plan to better suit the intra-operative procedure workflow.

  5. Cost-effectiveness of minimal contact education strategies for cholesterol change.

    PubMed

    Gans, Kim M; Burkholder, Gary J; Risica, Patricia M; Harrow, Brooke; Lasater, Thomas M

    2006-01-01

    To compare the effectiveness and cost effectiveness of minimal contact nutrition interventions that varied in intensity on lowering total blood cholesterol (BC) levels. A randomized trial in which public, work, religious, and medical sites were randomly assigned to one of six minimal-contact nutrition interventions for lowering total BC. 36 public, work, religious, and medical sites in southern New England (total sites = 144). The number of eligible participants at baseline was 10,144, which included 1425 Hispanics, who were over-recruited for this study. One of six brief interventions was provided to participants: 1) feedback tip sheet only; 2) tip sheet plus Rate Your Plate (RYP); 3) tip sheet, RYP, plus Let's Eat Kit (LEK); 4) all written materials plus CD audio intervention (AUD); 5) all written materials plus counseling from a trained lay person (LAY-C); and 6) all written materials plus counseling by a nutritionist (NUT-C). The educational materials were adapted to be culturally and linguistically appropriate for a Hispanic audience, and the counselors for the Hispanic participants were bilingual. Total blood cholesterol levels were measured using fingerstick methods at baseline, 3 months, and 12 months after the intervention. Blood cholesterol (BC) was significantly reduced from baseline to 12-month follow-up among most experimental groups. Only LAY-C and NUT-C conditions demonstrated significant BC reductions at three months. The BC change in the NUT-C group was statistically different from the feedback only condition at three months only. At three-month followup, BC was reduced 1.6% for the total sample, 2.8% for participants with borderline-high BC levels, and 3.4% for participants with high BC. Generally, the two conditions receiving counseling resulted in the largest percentage changes in BC levels. When examining BC change data by ethnicity, Hispanic participants in the audio condition achieved the largest overall 12-month change (4%). Generally, total

  6. Minimal change of thermal continentality in Slovakia within the period 1961-2013

    NASA Astrophysics Data System (ADS)

    Vilček, Jozef; Škvarenina, Jaroslav; Vido, Jaroslav; Nalevanková, Paulína; Kandrík, Radoslav; Škvareninová, Jana

    2016-08-01

    Thermal continentality plays an important role not only in the basic characterisation of the climate in particular regions but also in the phytogeographic distribution of plants and ecosystem formation. Due to ongoing climate change, questions surrounding the changes of thermal continentality are very relevant. Therefore, the aim of this study is to investigate the characteristics of thermal continentality and its temporal changes in the Slovak Republic between the years of 1961 and 2013. The study was carried out on several meteorological stations selected in respect to the geographical and geomorphological heterogeneity of Slovakia. Our results show that the continentality of Slovakia increased in the period 1961 to 2013; however, this trend is not significant. These non-significant trends are confirmed at all the stations. Nevertheless, it is necessary to be aware of this signal, especially because these changes could cause changes in ecosystem formation in future.

  7. Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease

    PubMed Central

    Shendi, Ali M.; Salama, Alan D.; Khosravi, Maryam; Connolly, John O.; Trompeter, Richard

    2016-01-01

    Abstract Aim Treatment of frequently relapsing or steroid‐dependent minimal change disease (MCD) in children and adults remains challenging. Glucocorticoids and/or other immunosuppressive agents are the mainstay of treatment, but patients often experience toxicity from prolonged exposure and may either become treatment dependent and/or resistant. Increasing evidence suggests that rituximab (RTX) can be a useful alternative to standard immunosuppression and allow withdrawal of maintenance immunosuppressants; however, data on optimal treatment regimens, long‐term efficacy and safety are still limited. Methods We undertook a prospective study of RTX to allow immunosuppression minimization in 15 young adults with frequently relapsing or steroid‐dependent, biopsy‐proven MCD. All patients were in remission at the start of treatment and on a calcineurin inhibitor. Two doses of RTX (1 gr) were given 6 months apart. A subset of patients also received an additional dose 12 months later, in order to examine the benefit of re‐treatment. Biochemical and clinical parameters were monitored over an extended follow‐up period of up to 43 months. Results Median steroid‐free survival after RTX was 25 months (range 4–34). Mean relapse frequency decreased from 2.60 ± 0.28 to 0.4 ± 0.19 (P < 0.001) after RTX. Seven relapses occurred, five of which (71%) when CD19 counts were greater than 100 µ. Immunoglobulin levels remained unchanged, and no major side effects were observed throughout the follow‐up period. Conclusions Rituximab therapy is effective at maintaining prolonged steroid‐free remission and reducing relapse frequency in this group of patients. Our study lends further support for the role of RTX in the treatment of patients with frequently relapsing or steroid‐dependent MCD. PMID:26860320

  8. Reliability and minimal detectable change in foot pressure measurements in typically developing children.

    PubMed

    Niiler, Timothy; Church, Chris; Lennon, Nancy; Henley, John; George, Ameeka; Taylor, Daveda; Montes, Angelica; Miller, Freeman

    2016-12-01

    In pedobarography, clinically meaningful comparison of measurements within or between subjects is limited by data variability and measurement error. This study aims to determine the components of the minimal detectable change (MDC) in impulse across all foot regions and the reliability of these measures. A convenience sample of foot pressures from 108 visits by normal, healthy subjects aged 2-17 years was studied. Each subject had three pedobarograph measurements taken per foot, with six subjects returning for a second visit for assessment of day-to-day variability. Using a five-region mask, segmental impulses were determined, and from these we obtained the coronal plane pressure index (CPPI). Inter-rater, intra-rater, and day-to-day data were analyzed using intraclass correlation coefficients (ICC) to quantify reliability. Variability of the data was analyzed to quantify the MDC. Inter- and intra-rater reliability was high for all measurements while variability was low, indicating small direct measurement error. Generally, the largest contributing factor to the MDC was day-to-day variability. Step-to-step variability was more dependent on foot segment than age although minor age-related changes were noted. Finally, the high relative variability in the CPPI and the medial mid foot impulse resulted in very high MDCs for these measures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Prospective evaluation of the reliability, validity, and minimally important difference of the functional assessment of cancer therapy-gastric (FACT-Ga) quality-of-life instrument.

    PubMed

    Garland, Sheila N; Pelletier, Guy; Lawe, Andrew; Biagioni, Bradly J; Easaw, Jay; Eliasziw, Michael; Cella, David; Bathe, Oliver F

    2011-03-15

    Recently, the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) was developed to measure the quality of life (QoL) of patients with gastric cancer. This newly developed instrument has not yet been validated. Eighty-two patients with gastric adenocarcinoma completed questionnaires at baseline. The FACT-Ga scores were measured as a function of disease stage and performance status, and they were correlated with the Medical Outcomes Study 36-item short-form health survey (SF-36), the Beck Depression Inventory-II, the Marlow-Crowne Social Desirability Scale, the Paulhus Deception Scale, and the State-Trait Anxiety Inventory. Patients received a second questionnaire 2 weeks after baseline to evaluate test-retest reliability and again at 3 months to evaluate the sensitivity of the FACT-Ga to changes in performance status and to estimate the minimally important differences in scores that represented meaningful change. The internal and test-retest reliability of the FACT-Ga instrument was adequate. With the exception of the social well being subscale, all FACT-Ga scores were correlated as hypothesized with other measures. Relevant components of the FACT-Ga were sensitive to changes in performance status. The current results indicated that the FACT-Ga provides a valid and reliable measurement of QoL in patients with gastric adenocarcinoma. It is a useful instrument for QoL assessment in clinical trials, and it also may be useful for the detection of significant changes in the QoL of individual patients. Copyright © 2010 American Cancer Society.

  10. Identification of Minimal Clinically Important Difference Scores of the PedsQL in Children, Adolescents, and Young Adults With Type 1 and Type 2 Diabetes

    PubMed Central

    Hilliard, Marisa E.; Lawrence, Jean M.; Modi, Avani C.; Anderson, Andrea; Crume, Tessa; Dolan, Lawrence M.; Merchant, Anwar T.; Yi-Frazier, Joyce P.; Hood, Korey K.

    2013-01-01

    OBJECTIVE To establish minimal clinically important difference (MCID) scores representing the smallest detectable change in quality of life (QOL), using the Pediatric Quality of Life Inventory (PedsQL) Generic Core and Diabetes Module among youth with diabetes and their parents, and to identify demographic and clinical correlates of QOL change over 1 year. RESEARCH DESIGN AND METHODS Participants in the SEARCH for Diabetes in Youth Study aged >5 years and parents of youth aged <18 years completed PedsQL surveys at their initial and 12-month study visits. MCIDs for each PedsQL module were calculated using one standard error of measurement. Demographic and clinical characteristics associated with QOL change were identified through multiple linear and logistic regression analyses. RESULTS The sample comprised 5,004 youth (mean age, 12.5 ± 4.7 years; mean diabetes duration, 3.4 ± 3.7 years). Of 100 possible points, PedsQL total score MCIDs for youth with type 1 and type 2 diabetes, respectively, were Generic Core, 4.88, 6.27 (parent) and 4.72, 5.41 (youth); Diabetes Module, 4.54, 6.06 (parent) and 5.27, 5.96 (youth). Among 1,402 youth with a follow-up visit, lower baseline QOL, male sex, private insurance, having type 1 diabetes, longer diabetes duration, and better glycemic control predicted improvements in youth- and parent-reported PedsQL total scores over 1 year. Clinically meaningful (≥1 MCID) improvements in total score for at least one PedsQL module were predicted by private insurance, lower BMI, and lower A1C at baseline. CONCLUSIONS These diabetes-specific reference points to interpret clinically meaningful change in PedsQL scores can be used in clinical care and research for youth with type 1 and type 2 diabetes. PMID:23340884

  11. Estimating minimal important differences for several scales assessing function and quality of life in patients with attention-deficit/hyperactivity disorder.

    PubMed

    Hodgkins, Paul; Lloyd, Andrew; Erder, M Haim; Setyawan, Juliana; Weiss, Margaret D; Sasané, Rahul; Nafees, Beenish

    2017-02-01

    Defining minimal important difference (MID) is critical to interpreting patient-reported outcomes data and treatment efficacy in clinical trials. This study estimates the MID for the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) and the Child Health and Illness Profile-Parent Report (CHIP-CE-PRF76) among parents of young people with attention-deficit/hyperactivity disorder (ADHD) in the UK. Parents of children (6-12 years; n=100) and adolescents (13-17 years; n=117) with ADHD completed a socio-demographic form, the CHIP-CE-PRF76, the WFIRS-P, and the Pediatric Quality of Life scale at baseline and 4 weeks later. At follow-up, a subset of parents completed anchor questions measuring change in the child/adolescent from baseline. MIDs were estimated using anchor-based and distribution-based methods, and separately for children and adolescents. The MID estimates for overall change in the WFIRS-P total score ranged from 11.31 (standard error of measurement) to 13.47 (anchor) for the total sample. The range of MID estimates for the CHIP-CE-PRF76 varied by domain: 6.80-7.41 (satisfaction), 6.18-7.34 (comfort), 5.60-6.72 (resilience), 6.06-7.57 (risk avoidance), and 4.00-5.63 (achievement) for the total sample. Overall, MID estimates for WFIRS-P MID and CHIP-CE-PRF76 were slightly higher for adolescents than for children. This study estimated MIDs for these instruments using several methods. The observed convergence of the MID estimates increases confidence in their reliability and could assist clinicians and decision makers in deriving meaningful interpretations of observed changes in the WFIRS-P and CHIP-CE in clinical trials and practice.

  12. [A case of AKI-caused minimal change nephrotic syndrome with concomitant pleuritis].

    PubMed

    Watanabe, Renya; Abe, Yasuhiro; Sasaki, Masaru; Hamauchi, Aki; Yasunaga, Tomoe; Kurata, Satoshi; Yasuno, Tetsuhiko; Ito, Kenji; Sasatomi, Yoshie; Hisano, Satoshi; Nakashima, Hitoshi

    2016-01-01

    A twenty-year-old man complaining of chest pain was diagnosed as nephrotic syndrome complicated with pleural effusion and ascites. Despite treatment with antibiotics, his fever and high inflammatory reaction persisted. After hospitalization, his urine volume decreased and renal function had deteriorated. As he was suffering from dyspnea, hemodialysis was performed together with chest drainage. His pleural effusion was exudative, and IVIG treatment was added to the antibiotic treatment. He was diagnosed as suspected developed minimal change nephrotic syndrome (MCNS) and administered prednisolone intravenously. His renal function ameliorated as a result of this treatment, enabling him to withdraw from hemodialysis. Inflammatory reaction gradually decreased and his general condition improved. The result of a renal biopsy examination carried out after the hemodialysis treatment confirmed MCNS, which suggested that MCNS had induced acute kidney injury (AKI) atypically in this case. Generally AKI is not induced by MCNS in youth, but it may occur under severe inflammatory conditions. Physicians should be aware that MCNS in young patients may lead to the development of AKI requiring hemodialysis treatment.

  13. A Unique Cause of Proteinuria in Pregnancy: Class II Lupus Nephritis with Concomitant Minimal Change Disease

    PubMed Central

    Kunjal, Ryan; Adam-Eldien, Rabie; Makary, Raafat; Jo-Hoy, Francois; Heilig, Charles W.

    2016-01-01

    We report the case of a 22-year-old African American female who presented to another facility for routine follow-up in the 34th week of pregnancy with lower extremity swelling and nephrotic-range proteinuria. Although she was normotensive, it was initially thought that she had preeclampsia. She was monitored carefully and delivery was induced at 37 weeks of gestation. She was transferred to our hospital, where she was diagnosed with systemic lupus erythematosus (SLE) based on clinical and laboratory criteria. Renal biopsy revealed a surprising finding of minimal change disease (MCD) concomitant with class II lupus nephritis (LN). She was managed with pulses and then tapering doses of steroid therapy with dramatic resolution of the nephrotic syndrome. This case demonstrates not only the rare de novo occurrence of SLE in pregnancy, but the unique finding of MCD coexisting with class II LN. We propose that altered T cell activity may be the link between these seemingly distinct entities. PMID:27781205

  14. Seasonal relapsing minimal change disease: a novel strategy for avoiding long-term immunosuppression.

    PubMed

    Lawrence, Christopher; Cook, H Terry; Lightstone, Liz

    2012-07-01

    We describe the case of a young woman with seasonal allergic rhinitis who presented with signs of a lower respiratory tract infection, acute renal impairment and the nephrotic syndrome, demonstrated on biopsy to be due to minimal change disease (MCD) with acute tubular injury. Following initiation of high-dose corticosteroids, her respiratory symptoms and renal impairment improved, and the nephrotic syndrome went rapidly into remission, but relapsed, off treatment, in a seasonal fashion. In view of significant side effects related to corticosteroids, relapses were treated with the calcineurin inhibitor tacrolimus with excellent effect, but the patient was keen to avoid the complications of medium-term immunosuppression and so the drug was weaned early. She relapsed for the second time, whilst off tacrolimus, at the same time of year as at her initial presentation. In subsequent years we have successfully managed this patient with seasonal relapsing MCD with seasonal prophylactic tacrolimus therapy. We discuss the natural history of MCD and treatment options and demonstrate the utility of a clear understanding of the natural history of the condition in order to predict disease relapse and tailor therapy to the individual patient.

  15. Minimizing impacts of land use change on ecosystem services using multi-criteria heuristic analysis.

    PubMed

    Keller, Arturo A; Fournier, Eric; Fox, Jessica

    2015-06-01

    Development of natural landscapes to support human activities impacts the capacity of the landscape to provide ecosystem services. Typically, several ecosystem services are impacted at a single development site and various footprint scenarios are possible, thus a multi-criteria analysis is needed. Restoration potential should also be considered for the area surrounding the permanent impact site. The primary objective of this research was to develop a heuristic approach to analyze multiple criteria (e.g. impacts to various ecosystem services) in a spatial configuration with many potential development sites. The approach was to: (1) quantify the magnitude of terrestrial ecosystem service (biodiversity, carbon sequestration, nutrient and sediment retention, and pollination) impacts associated with a suite of land use change scenarios using the InVEST model; (2) normalize results across categories of ecosystem services to allow cross-service comparison; (3) apply the multi-criteria heuristic algorithm to select sites with the least impact to ecosystem services, including a spatial criterion (separation between sites). As a case study, the multi-criteria impact minimization algorithm was applied to InVEST output to select 25 potential development sites out of 204 possible locations (selected by other criteria) within a 24,000 ha property. This study advanced a generally applicable spatial multi-criteria approach for 1) considering many land use footprint scenarios, 2) balancing impact decisions across a suite of ecosystem services, and 3) determining the restoration potential of ecosystem services after impacts.

  16. Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations.

    PubMed

    Devji, Tahira; Guyatt, Gordon H; Lytvyn, Lyubov; Brignardello-Petersen, Romina; Foroutan, Farid; Sadeghirad, Behnam; Buchbinder, Rachelle; Poolman, Rudolf W; Harris, Ian A; Carrasco-Labra, Alonso; Siemieniuk, Reed A C; Vandvik, Per O

    2017-05-11

    To identify the most credible anchor-based minimal important differences (MIDs) for patient important outcomes in patients with degenerative knee disease, and to inform BMJ Rapid Recommendations for arthroscopic surgery versus conservative management DESIGN: Systematic review. Estimates of anchor-based MIDs, and their credibility, for knee symptoms and health-related quality of life (HRQoL). MEDLINE, EMBASE and PsycINFO. We included original studies documenting the development of anchor-based MIDs for patient-reported outcomes (PROs) reported in randomised controlled trials included in the linked systematic review and meta-analysis and judged by the parallel BMJ Rapid Recommendations panel as critically important for informing their recommendation: measures of pain, function and HRQoL. 13 studies reported 95 empirically estimated anchor-based MIDs for 8 PRO instruments and/or their subdomains that measure knee pain, function or HRQoL. All studies used a transition rating (global rating of change) as the anchor to ascertain the MID. Among PROs with more than 1 estimated MID, we found wide variation in MID values. Many studies suffered from serious methodological limitations. We identified the following most credible MIDs: Western Ontario and McMaster University Osteoarthritis Index (WOMAC; pain: 12, function: 13), Knee injury and Osteoarthritis Outcome Score (KOOS; pain: 12, activities of daily living: 8) and EuroQol five dimensions Questionnaire (EQ-5D; 0.15). We were able to distinguish between more and less credible MID estimates and provide best estimates for key instruments that informed evidence presentation in the associated systematic review and judgements made by the Rapid Recommendation panel. CRD42016047912. 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/.

  17. Minimal changes of thyroid axis activity influence brain functions in young females affected by subclinical hypothyroidism.

    PubMed

    Menicucci, D; Sebastiani, L; Comparini, A; Pingitore, A; Ghelarducci, B; L'Abbate, A; Iervasi, G; Gemignani, A

    2013-03-01

    There is evidence of an association between thyroid hormones (TH) alterations and mental dysfunctions related to procedural and working memory functions, but the physiological link between these domains is still under debate, also for the presence of age as a confounding factor. Thus, we investigated the TH tuning of cerebral functions in young females affected by the borderline condition of subclinical hypothyroidism (SH) and in euthyroid females of the same age. The experiment consisted in the characterization of the affective state and cognitive abilities of the subjects by means of specific neuropsychological questionnaires, and of brain activity (EEG) in resting state and during the passive viewing of emotional video-clips. We found that SH had i) increased anxiety for Physical Danger; ii) better scores for both Mental Control and no-working-memory-related functions; iii) association between anxiety for Physical Danger and fT4 levels. Thus, in young adults, SH increases inward attention and paradoxically improves some cognitive functions. In addition, self-assessed questionnaires showed that SH had a greater susceptibility to unpleasant emotional stimulation. As for EEG data, SH compared to controls showed: i) reduction of alpha activity and of gamma left lateralization in resting state; ii) increased, and lateralized to the right, beta2 activity during stimulations. Both results indicated that SH have higher levels of arousal and greater susceptibility to negative emotion than controls. In conclusion, our study indicates that minimal changes in TH levels produce subtle but well-defined mental changes, thus encouraging further studies for the prediction of pathology evolution.

  18. Change in Water Cycle- Important Issue on Climate Earth System

    NASA Astrophysics Data System (ADS)

    Singh, Pratik

    Change in Water Cycle- Important Issue on Climate Earth System PRATIK KUMAR SINGH1 1BALDEVRAM MIRDHA INSTITUTE OF TECHNOLOGY,JAIPUR (RAJASTHAN) ,INDIA Water is everywhere on Earth and is the only known substance that can naturally exist as a gas, liquid, and solid within the relatively small range of air temperatures and pressures found at the Earth's surface.Changes in the hydrological cycle as a consequence of climate and land use drivers are expected to play a central role in governing a vast range of environmental impacts.Earth's climate will undergo changes in response to natural variability, including solar variability, and to increasing concentrations of green house gases and aerosols.Further more, agreement is widespread that these changes may profoundly affect atmospheric water vapor concentrations, clouds and precipitation patterns.As we know that ,a warmer climate, directly leading to increased evaporation, may well accelerate the hydrological cycle, resulting in an increase in the amount of moisture circulating through the atmosphere.The Changing Water Cycle programmer will develop an integrated, quantitative understanding of the changes taking place in the global water cycle, involving all components of the earth system, improving predictions for the next few decades of regional precipitation, evapotranspiration, soil moisture, hydrological storage and fluxes.The hydrological cycle involves evaporation, transpiration, condensation, precipitation, and runoff. NASA's Aqua satellite will monitor many aspects of the role of water in the Earth's systems, and will do so at spatial and temporal scales appropriate to foster a more detailed understanding of each of the processes that contribute to the hydrological cycle. These data and the analyses of them will nurture the development and refinement of hydrological process models and a corresponding improvement in regional and global climate models, with a direct anticipated benefit of more accurate weather and

  19. The minimally important difference for the Japanese version of the health assessment questionnaire in patients with rheumatoid arthritis in daily practice.

    PubMed

    Shidara, Kumi; Nakajima, Ayako; Inoue, Eisuke; Hoshi, Daisuke; Sugimoto, Naoki; Seto, Yohei; Tanaka, Eiichi; Ikari, Katsunori; Taniguchi, Atsuo; Yamanaka, Hisashi

    2017-05-01

    To validate the minimally important difference (MID) of physical function using the Japanese version of the Health Assessment Questionnaire (J-HAQ) in a cohort of rheumatoid arthritis (RA). Patients who participated in a cohort study in both October 2008 and April 2009 were analyzed. Patients self-rated their change in overall status over 6 months using a 5-point Likert scale ("much better", "somewhat better", "same", "somewhat worse", or "much worse"). The MID for J-HAQ score was defined as the mean J-HAQ score change in patients who rated themselves "somewhat better". An effect size (ES) of 0.2-0.5 was considered to be suitable for MID. A total of 4560 patients were analyzed. The mean (standard deviation [SD]) MID for J-HAQ score was -0.06 (0.29), corresponding to an ES of 0.08. As exploratory analysis, 1999 patients with a J-HAQ score ≥0.5 and 28-joint disease activity score (DAS28) ≥ 2.6 at baseline were assessed. The mean (SD) MID for J-HAQ score of these patients was 0.13 (0.01), corresponding to an ES of 0.21. The MID for J-HAQ score was 0.13 in patients with baseline J-HAQ score ≥0.5 and DAS28 ≥ 2.6. The MID for J-HAQ score was influenced by disease status and functional disability.

  20. Dendrin expression in glomerulogenesis and in human minimal change nephrotic syndrome.

    PubMed

    Dunér, Fredrik; Patrakka, Jaakko; Xiao, Zhijie; Larsson, Jenny; Vlamis-Gardikas, Alexios; Pettersson, Erna; Tryggvason, Karl; Hultenby, Kjell; Wernerson, Annika

    2008-08-01

    Dendrin is an 81-kD cytosolic protein hitherto described in the brain, where it is associated with the actin cytoskeleton. Recently, we found dendrin in foot processes of mouse glomerular podocytes. Here we describe its expression both during mouse glomerulogenesis and in the normal and diseased human kidney for the first time. Dendrin expression was characterized using RT-PCR and immunohistochemistry and semi-quantified using immunoelectron microscopy. In glomerulogenesis, dendrin mRNA and protein appeared first at the early capillary loop stage. It was concentrated to the pre-podocytes on the basal side of podocalyxin, an apical cell membrane marker. In human tissue, dendrin transcripts were detected in the brain and kidney. In the mature kidney dendrin localized solely in the podocytes, close to the filtration slit diaphragms. A comparison with the slit-associated protein zonula occludens-1 (ZO-1) was done in minimal change nephrotic syndrome (MCNS). Dendrin and ZO-1 were re-distributed from slit regions to the podocyte cytoplasm in areas with foot process effacement (FPE). In areas without FPE, dendrin and ZO-1 distributions were unchanged compared to controls. The total amounts of dendrin or ZO-1 markers were unchanged. This differs from nephrin that, according to our previous results, is also decreased in non-effaced areas. The expression of dendrin during glomerulogenesis and in the normal human kidney is similar to that previously shown for nephrin, which suggests that dendrin associates with the slit diaphragm complex. In MCNS patients, dendrin and ZO-1 are re-distributed within the podocytes. Whether this is a cause or a consequence of FPE remains unclear.

  1. Tacrolimus improves proteinuria remission in adults with cyclosporine A-resistant or -dependent minimal change disease.

    PubMed

    Xu, Dechao; Gao, Xiang; Bian, Rongrong; Mei, Changlin; Xu, Chenggang

    2017-03-01

    Cyclosporin A (CsA) is considered as an effective treatment option for steroid-resistant or-dependent patients with adult-onset minimal change disease (MCD). However, CsA resistance or dependence is also observed in these patients. Tacrolimus (TAC) is a calcineurin inhibitor that is potent in cytokine suppression. The authors aim to evaluate the efficacy and safety of TAC therapy in CsA-resistant and-dependent adult-onset MCD patients. Patients with adult-onset MCD were enrolled in our department from 2008 to 2012. All patients were demonstrated to be resistant to or dependent on CsA therapy. Prednisone (0.5 mg/kg per day) combined with TAC (0.05-0.1 mg/kg per day) were prescribed to these patients for at least 6 months. The primary outcome was complete or partial remission of proteinuria. Secondary outcomes included time required for complete or partial remission, adverse events, number of relapses, and TAC dosages. A total of 11 MCD patients were enrolled in this observational study. The numbers of patients who presented with resistance to or dependence on CsA were 7 and 4, respectively. The total remission rate was 90.9% (10/11) with the complete remission rate 72.7% (8/11). Most remission patients achieved remission during the first 2 months of TAC therapy. Patients who presented with dependence on CsA had achieved complete remission with TAC therapy, while outcomes for CsA-resistant patients were four complete remissions, two partial remissions and one resistance. The adverse events were observed in this study included infection, diarrhoea, and worsened hypertension. Five patients who had remission experienced relapse. Tacrolimus improves proteinuria remission in adults with CsA-resistant or -dependent MCD. © 2016 Asian Pacific Society of Nephrology.

  2. Trueness and Minimal Detectable Change of Smartphone Inclinometer Measurements of Shoulder Range of Motion.

    PubMed

    Boissy, Patrick; Diop-Fallou, Serigne; Lebel, Karina; Bernier, Mikael; Balg, Frederic; Tousignant-Laflamme, Yanick

    2017-06-01

    Digital inclinometer applications using data from embedded sensors on smartphone/multi-purpose pocket computers or "smart digital inclinometers" (SDIs) are now used to clinically assess range of motion (ROM). The objectives of this study were to assess, compared with a biomechanical gold standard (GS), the trueness and minimal detectable change (MDC) of shoulder range of motion (SROM) measurements obtained from an SDI. Twenty-five (n = 25) asymptomatic healthy participants performed three trials of shoulder flexion (SF), shoulder abduction (SA), and shoulder external rotation (SER) at full-range and mid-range. SROM was measured concurrently from sensor data (pitch, yaw, roll angles) from an iPod Touch installed on the posterior aspect of the humerus and 3D orientation of the upper arm obtained from an optical motion tracking system GS. The mean level of bias between SDI and the GS across all SROM measurements was 3.4°, with a 95% confidence interval varying between -8.9° and 15.8°. The mean and standard deviation absolute difference of SDI measurements with the GS were 5.8° ± 3.7° for SF, 8.7° ± 5.2° for SA, and 1.7° ± 1.4° for SER. The trueness of these values varied according to the movement. MDC was 1.9° for SF, 2° for SA, and 0.3° for SER. SROM measures in SER with an SDI seem to be accurate and robust for clinical use. However, SROM measures in other planes of motion should be interpreted with caution depending on the evaluation objective, the plane of motion assessed, and the range of ROM measured.

  3. Validity, Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Change of the Pediatric Motor Activity Log in Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Lin, Keh-chung; Chen, Hui-fang; Chen, Chia-ling; Wang, Tien-ni; Wu, Ching-yi; Hsieh, Yu-wei; Wu, Li-ling

    2012-01-01

    This study examined criterion-related validity and clinimetric properties of the Pediatric Motor Activity Log (PMAL) in children with cerebral palsy. Study participants were 41 children (age range: 28-113 months) and their parents. Criterion-related validity was evaluated by the associations between the PMAL and criterion measures at baseline and…

  4. Importance of dispersal routes that minimize open-ocean movement to the genetic structure of island populations.

    PubMed

    Harradine, E L; Andrew, M E; Thomas, J W; How, R A; Schmitt, L H; Spencer, P B S

    2015-12-01

    Islands present a unique scenario in conservation biology, offering refuge yet imposing limitations on insular populations. The Kimberley region of northwestern Australia has more than 2500 islands that have recently come into focus as substantial conservation resources. It is therefore of great interest for managers to understand the driving forces of genetic structure of species within these island archipelagos. We used the ubiquitous bar-shouldered skink (Ctenotus inornatus) as a model species to represent the influence of landscape factors on genetic structure across the Kimberley islands. On 41 islands and 4 mainland locations in a remote area of Australia, we genotyped individuals across 18 nuclear (microsatellite) markers. Measures of genetic differentiation and diversity were used in two complementary analyses. We used circuit theory and Mantel tests to examine the influence of the landscape matrix on population connectivity and linear regression and model selection based on Akaike's information criterion to investigate landscape controls on genetic diversity. Genetic differentiation between islands was best predicted with circuit-theory models that accounted for the large difference in resistance to dispersal between land and ocean. In contrast, straight-line distances were unrelated to either resistance distances or genetic differentiation. Instead, connectivity was determined by island-hopping routes that allow organisms to minimize the distance of difficult ocean passages. Island populations of C. inornatus retained varying degrees of genetic diversity (NA = 1.83 - 7.39), but it was greatest on islands closer to the mainland, in terms of resistance-distance units. In contrast, genetic diversity was unrelated to island size. Our results highlight the potential for islands to contribute to both theoretical and applied conservation, provide strong evidence of the driving forces of population structure within undisturbed landscapes, and identify the islands

  5. MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM

    PubMed Central

    BARCHI, Leandro Cardoso; JACOB, Carlos Eduardos; BRESCIANI, Cláudio José Caldas; YAGI, Osmar Kenji; MUCERINO, Donato Roberto; LOPASSO, Fábio Pinatel; MESTER, Marcelo; RIBEIRO-JÚNIOR, Ulysses; DIAS, André Roncon; RAMOS, Marcus Fernando Kodama Pertille; CECCONELLO, Ivan; ZILBERSTEIN, Bruno

    2016-01-01

    ABSTRACT Introduction: Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. Objective: To evaluate and summarize the current status of minimally invasive resection of gastric cancer. Methods: A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. Results: 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Conclusion: Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale. PMID:27438040

  6. Importance of coastal change variables in determining vulnerability to sea- and lake-level change

    USGS Publications Warehouse

    Pendleton, E.A.; Thieler, E.R.; Williams, S.J.

    2010-01-01

    In 2001, the U.S. Geological Survey began conducting scientific assessments of coastal vulnerability to potential future sea- and lake-level changes in 22 National Park Service sea- and lakeshore units. Coastal park units chosen for the assessment included a variety of geological and physical settings along the U.S. Atlantic, Pacific, Gulf of Mexico, Gulf of Alaska, Caribbean, and Great Lakes shorelines. This research is motivated by the need to understand and anticipate coastal changes caused by accelerating sea-level rise, as well as lake-level changes caused by climate change, over the next century. The goal of these assessments is to provide information that can be used to make long-term (decade to century) management decisions. Here we analyze the results of coastal vulnerability assessments for several coastal national park units. Index-based assessments quantify the likelihood that physical changes may occur based on analysis of the following variables: tidal range, ice cover, wave height, coastal slope, historical shoreline change rate, geomorphology, and historical rate of relative sea- or lake-level change. This approach seeks to combine a coastal system's susceptibility to change with its natural ability to adapt to changing environmental conditions, and it provides a measure of the system's potential vulnerability to the effects of sea- or lake-level change. Assessments for 22 park units are combined to evaluate relationships among the variables used to derive the index. Results indicate that Atlantic and Gulf of Mexico parks have the highest vulnerability rankings relative to other park regions. A principal component analysis reveals that 99% of the index variability can be explained by four variables: geomorphology, regional coastal slope, water-level change rate, and mean significant wave height. Tidal range, ice cover, and historical shoreline change are not as important when the index is evaluated at large spatial scales (thousands of kilometers

  7. Network rewiring is an important mechanism of gene essentiality change

    PubMed Central

    Kim, Jinho; Kim, Inhae; Han, Seong Kyu; Bowie, James U.; Kim, Sanguk

    2012-01-01

    Gene essentiality changes are crucial for organismal evolution. However, it is unclear how essentiality of orthologs varies across species. We investigated the underlying mechanism of gene essentiality changes between yeast and mouse based on the framework of network evolution and comparative genomic analysis. We found that yeast nonessential genes become essential in mouse when their network connections rapidly increase through engagement in protein complexes. The increased interactions allowed the previously nonessential genes to become members of vital pathways. By accounting for changes in gene essentiality, we firmly reestablished the centrality-lethality rule, which proposed the relationship of essential genes and network hubs. Furthermore, we discovered that the number of connections associated with essential and non-essential genes depends on whether they were essential in ancestral species. Our study describes for the first time how network evolution occurs to change gene essentiality. PMID:23198090

  8. Validation of test performance characteristics and minimal clinically important difference of the 6-minute walk test in patients with idiopathic pulmonary fibrosis.

    PubMed

    Nathan, Steven D; du Bois, Roland M; Albera, Carlo; Bradford, Williamson Z; Costabel, Ulrich; Kartashov, Alex; Noble, Paul W; Sahn, Steven A; Valeyre, Dominique; Weycker, Derek; King, Talmadge E

    2015-07-01

    The 6-minute walk test distance (6MWD) has been shown to be a valid and responsive outcome measure in patients with idiopathic pulmonary fibrosis (IPF). The analyses were based, however, on a single phase 3 trial and require validation in an independent cohort. To confirm the performance characteristics and estimates of minimal clinically important difference (MCID) of 6MWD in an independent cohort of patients with IPF. Patients randomized to placebo in the phase 3 CAPACITY trials who had a baseline 6MWD measurement were included in these analyses. The 6MWD and other functional parameters (lung function, dyspnea, and health-related quality of life) were measured at baseline and 24-week intervals. Validity and responsiveness were examined using Spearman correlation coefficients. The MCID was estimated using distribution- and anchor-based methods. The analysis comprised 338 patients. Baseline 6MWD was significantly correlated with lung function measures, patient-reported outcomes, and quality-of-life measures (validity). Compared with baseline 6MWD, change in 6MWD (responsiveness) showed stronger correlations with change in lung function parameters and quality-of-life measures. Dyspnea measured by the University of California San Diego Shortness of Breath Questionnaire showed the strongest correlations with 6MWD (baseline: coefficient -0.35; 48-week change: coefficient -0.37; both p < 0.001). The distribution-based analyses of MCID using standard error of measurement yielded an MCID of 37 m, and distribution-based analyses by effect size resulted in 29.2 m. The MCID by anchor-based analysis using criterion referencing (health events of hospitalization or death) was 21.7 m. The 6MWD is a valid and responsive clinical endpoint, which provides objective and clinically meaningful information regarding functional status and near-term prognosis. These results confirm previous findings in an independent cohort of patients with IPF. Copyright © 2015 The Authors

  9. [DSM-5: important changes in the field of addictive diseases].

    PubMed

    Heinz, A; Friedel, E

    2014-05-01

    There are two major changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) concerning the field of addiction. Firstly, the previous distinction between abuse and dependence has been abolished and both disorders are now subsumed under the category addiction and related disorders. Secondly, pathological gambling has now been included in the section of addiction with slight changes in diagnostic criteria. Both changes have major implications for the definition and conceptualization of what we call a psychiatric "disease" or "disorder", which have also been addressed in the introductory statement of DSM-5. Concerning the category of abuse that is now part of substance use disorders, there is a concern that a well-defined disorder ("dependence") is now mixed with a less well-defined syndrome ("abuse"). The inclusion of non-substance, behavioral addictions poses the danger of pathologizing a wide range of human behavior in future revisions of the classification. Both concerns are further addressed in this article.

  10. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:27729682

  11. Algorithm for detecting important changes in lidar point clouds

    NASA Astrophysics Data System (ADS)

    Korchev, Dmitriy; Owechko, Yuri

    2014-06-01

    Protection of installations in hostile environments is a very critical part of military and civilian operations that requires a significant amount of security personnel to be deployed around the clock. Any electronic change detection system for detection of threats must have high probability of detection and low false alarm rates to be useful in the presence of natural motion of trees and vegetation due to wind. We propose a 3D change detection system based on a LIDAR sensor that can reliably and robustly detect threats and intrusions in different environments including surrounding trees, vegetation, and other natural landscape features. Our LIDAR processing algorithm finds human activity and human-caused changes not only in open spaces but also in heavy vegetated areas hidden from direct observation by 2D imaging sensors. The algorithm processes a sequence of point clouds called frames. Every 3D frame is mapped into a 2D horizontal rectangular grid. Each cell of this grid is processed to calculate the distribution of the points mapped into it. The spatial differences are detected by analyzing the differences in distributions of the corresponding cells that belong to different frames. Several heuristic filters are considered to reduce false detections caused by natural changes in the environment.

  12. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:26405328

  13. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2013-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at bakerdan@wsu.edu. PMID:24421513

  14. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2013-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at bakerdan@wsu.edu. PMID:24421469

  15. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2013-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at bakerdan@wsu.edu. PMID:24421499

  16. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2014-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:24421565

  17. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:26912923

  18. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2013-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:24421552

  19. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2014-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:25673896

  20. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2014-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:25477570

  1. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:26823622

  2. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:25717211

  3. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2013-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at bakerdan@wsu.edu. PMID:24421539

  4. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2014-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:25477618

  5. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    2014-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:24623873

  6. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:26405346

  7. Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals

    PubMed Central

    Baker, Danial E.

    2015-01-01

    This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu. PMID:26448675

  8. Ice sheets play important role in climate change

    NASA Astrophysics Data System (ADS)

    Clark, Peter U.; MacAyeal, Douglas R.; Andrews, John T.; Bartlein, Patrick J.

    Ice sheets once were viewed as passive elements in the climate system enslaved to orbitally generated variations in solar radiation. Today, modeling results and new geologic records suggest that ice sheets actively participated in late-Pleistocene climate change, amplifying or driving significant variability at millennial as well as orbital timescales. Although large changes in global ice volume were ultimately caused by orbital variations (the Milankovitch hypothesis), once in existence, the former ice sheets behaved dynamically and strongly influenced regional and perhaps even global climate by altering atmospheric and oceanic circulation and temperature.Experiments with General Circulation Models (GCMs) yielded the first inklings of ice sheets' climatic significance. Manabe and Broccoli [1985], for example, found that the topographic and albedo effects of ice sheets alone explain much of the Northern Hemisphere cooling identified in paleoclimatic records of the last glacial maximum (˜21 ka).

  9. Therapeutic variability in adult minimal change disease and focal segmental glomerulosclerosis

    PubMed Central

    Fernandez-Juarez, Gema; Villacorta, Javier; Ruiz-Roso, Gloria; Panizo, Nayara; Martinez-Marín, Isabel; Marco, Helena; Arrizabalaga, Pilar; Díaz, Montserrat; Perez-Gómez, Vanessa; Vaca, Marco; Rodríguez, Eva; Cobelo, Carmen; Fernandez, Loreto; Avila, Ana; Praga, Manuel; Quereda, Carlos; Ortiz, Alberto

    2016-01-01

    Background Variability in the management of glomerulonephritis may negatively impact efficacy and safety. However, there are little/no data on actual variability in the treatment of minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) in adults. We assessed Spanish practice patterns for the management of adult nephrotic syndrome due to MCD or FSGS. The absence of reasonably good evidence on treatment for a disease often increases the variability substantially. Identification of evidence–practice gaps is the first necessary step in the knowledge-to-action cyclical process. We aim to analyse the real clinical practice in adults in hospitals in Spain and compare this with the recently released Kidney Disease: Improving Global Outcomes clinical practice guideline for glomerulonephritis. Methods Participating centres were required to include all adult patients (age >18 years) with a biopsy-proven diagnosis of MCD or FSGS from 2007 to 2011. Exclusion criteria included the diagnosis of secondary nephropathy. Results We studied 119 Caucasian patients with biopsy-proven MCD (n = 71) or FSGS (n = 48) from 13 Spanish hospitals. Of these patients, 102 received immunosuppressive treatment and 17 conservative treatment. The initial treatment was steroids, except in one patient in which mycophenolate mofetil was used. In all patients, the steroids were given as a single daily dose. The mean duration of steroid treatment at initial high doses was 8.7 ± 13.2 weeks and the mean global duration was 38 ± 32 weeks. The duration of initial high-dose steroids was <4 weeks in 41% of patients and >16 weeks in 10.5% of patients. We did find a weak and negative correlation between the duration of whole steroid treatment in the first episode and the number of the later relapses (r = −0.24, P = 0.023). There were 98 relapses and they were more frequent in MCD than in FSGs patients (2.10 ± 1.6 versus 1.56 ± 1.2; P = 0.09). The chosen treatment was mainly steroids (95

  10. Minimal clinical important difference (MCID) of the Thai Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL).

    PubMed

    Kulthanan, Kanokvalai; Chularojanamontri, Leena; Tuchinda, Papapit; Rujitharanawong, Chuda; Baiardini, Ilaria; Braido, Fulvio

    2016-06-01

    Chronic urticaria (CU) has negative impacts on patients' daily lives. The Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) evaluates quality of life impairment attitudes among chronic urticaria patients. Although the CU-Q2oL has been validated in several languages, the minimal clinical important difference (MCID) of the CU-Q2oL has never been determined. This study aimed to investigate the validity, reliability, responsiveness to change, and MCID of the Thai CU-Q2oL. The Thai CU-Q2oL was translated with permission from the authors of the original Italian version. The Thai CU-Q2oL, the validated Thai Dermatology Life Quality Index (DLQI), and the Urticaria Activity Score were assessed for 166 patients to evaluate validity and internal consistency. The three questionnaires were then administered to 124 patients to determine the test-retest reliability, responsiveness, and MCID of the Thai CU-Q2oL. The Thai CU-Q2oL contained only three domains, whereas the Italian version revealed six domains. Nevertheless, the total variance of the Thai CU-Q2oL (60.5%) was very close to that of the Italian version (60.0%). The validity of the Thai CU-Q2oL was shown by strong correlations between CU-Q2oL and DLQI scores. The Thai CU-Q2oL also had high internal consistency and test-retest reliability. Distribution-based, receiver operating characteristic analysis, and anchor-based approaches yielded MCID values of 3.9-8.0, 15, and 21.1, respectively. The Thai CU-Q2oL is a valid and reliable instrument. We propose that a difference in the Thai CU-Q2oL score of 15 (MCID) is the smallest change patients perceive as a meaningful improvement.

  11. Important change in service for international Eos delivery

    NASA Astrophysics Data System (ADS)

    Treby, Jill

    2012-01-01

    In direct response to member feedback about delays in delivery time and an overwhelming preference to read Eos online, print issues of Eos will no longer be mailed to members who have a delivery address outside the United States, effective with the 10 January 2012 issue. Our international members will continue to have access to the Eos electronic edition as well as recently introduced Web-only content. In addition, members who no longer receive a print copy of Eos will receive weekly e-alerts telling them when the newest issue is available online (several days before the cover date). Members with a mailing address in the United States also have the choice to opt out of the printed copy. Not only will this change allow us to better serve the needs of our international members, but also the cost savings will permit AGU to significantly increase investment in the other programs, products, and services that members value.

  12. [Possible changes in energy-minimizer mechanisms of locomotion due to chronic low back pain - a literature review].

    PubMed

    de Carvalho, Alberito Rodrigo; Andrade, Alexandro; Peyré-Tartaruga, Leonardo Alexandre

    2015-01-01

    One goal of the locomotion is to move the body in the space at the most economical way possible. However, little is known about the mechanical and energetic aspects of locomotion that are affected by low back pain. And in case of occurring some damage, little is known about how the mechanical and energetic characteristics of the locomotion are manifested in functional activities, especially with respect to the energy-minimizer mechanisms during locomotion. This study aimed: a) to describe the main energy-minimizer mechanisms of locomotion; b) to check if there are signs of damage on the mechanical and energetic characteristics of the locomotion due to chronic low back pain (CLBP) which may endanger the energy-minimizer mechanisms. This study is characterized as a narrative literature review. The main theory that explains the minimization of energy expenditure during the locomotion is the inverted pendulum mechanism, by which the energy-minimizer mechanism converts kinetic energy into potential energy of the center of mass and vice-versa during the step. This mechanism is strongly influenced by spatio-temporal gait (locomotion) parameters such as step length and preferred walking speed, which, in turn, may be severely altered in patients with chronic low back pain. However, much remains to be understood about the effects of chronic low back pain on the individual's ability to practice an economic locomotion, because functional impairment may compromise the mechanical and energetic characteristics of this type of gait, making it more costly. Thus, there are indications that such changes may compromise the functional energy-minimizer mechanisms. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  13. Importance of impacts scenarios for the adaptation of agriculture to climate change

    NASA Astrophysics Data System (ADS)

    Zullo, J.; Macedo, C.; Pinto, H. S.; Assad, E. D.; Koga Vicente, A.

    2012-12-01

    The great possibility that the climate is already changing, and the most drastic way possible, increases the challenge of agricultural engineering, especially in environmentally vulnerable areas and in regions where agriculture has a high economic and social importance. Knowledge of potential impacts that may be caused by changes in water and thermal regimes in coming decades is increasingly strategic, as they allow the development of techniques to adapt agriculture to climate change and therefore minimizes the risk of undesirable impacts, for example, in food and nutritional security. Thus, the main objective of this paper is to describe a way to generate impacts scenarios caused by anomalies of precipitation and temperature in the definition of climate risk zoning of an agricultural crop very important in the tropics, such as the sugar cane, especially in central-southern Brazil, which is one of its main world producers. A key point here is the choice of the climate model to be used, considering that 23 different models were used in the fourth IPCC report published in 2007. The number and range of available models requires the definition of criteria for choosing the most suitable for the preparation of the impacts scenarios. One way proposed and used in this work is based on the definition of two groups of models according to 27 technical attributes of them. The clustering of 23 models in two groups, with a model representing each group (UKMO_HadCM3 and MIROC3.2_medres), assists the generation and comparison of impacts scenarios, making them more representative and useful. Another important aspect in the generation of impacts scenarios is the estimate of the relative importance of the anomalies of precipitation and temperature, which are the most commonly used. To assess the relative importance of the anomalies are generated scenarios considering an anomaly at a time and both together. The impacts scenarios for a high emission of greenhouse gases (A2), from 2010

  14. MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM.

    PubMed

    Barchi, Leandro Cardoso; Jacob, Carlos Eduardos; Bresciani, Cláudio José Caldas; Yagi, Osmar Kenji; Mucerino, Donato Roberto; Lopasso, Fábio Pinatel; Mester, Marcelo; Ribeiro-Júnior, Ulysses; Dias, André Roncon; Ramos, Marcus Fernando Kodama Pertille; Cecconello, Ivan; Zilberstein, Bruno

    2016-01-01

    Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. To evaluate and summarize the current status of minimally invasive resection of gastric cancer. A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale. A cirurgia minimamente invasiva amplamente usada para tratar doenças benignas do aparelho digestivo, tornou-se o foco de intenso estudo nos últimos anos no campo da oncologia cirúrgica. Desde então, a experiência com este tipo de abordagem tem crescido, com o objetivo de fornecer os mesmos resultados oncológicos e sobrevivência à cirurgia convencional. Em relação ao câncer gástrico, o tratamento cirúrgico ainda é considerado o único tratamento curativo, considerando a extensão da

  15. Minimal clinically important differences in the EORTC QLQ-BM22 and EORTC QLQ-C15-PAL modules in patients with bone metastases undergoing palliative radiotherapy.

    PubMed

    Raman, Srinivas; Ding, Keyue; Chow, Edward; Meyer, Ralph M; Nabid, Abdenour; Chabot, Pierre; Coulombe, Genevieve; Ahmed, Shahida; Kuk, Joda; Dar, A Rashid; Mahmud, Aamer; Fairchild, Alysa; Wilson, Carolyn F; Wu, Jackson S Y; Dennis, Kristopher; DeAngelis, Carlo; Wong, Rebecca K S; Zhu, Liting; Brundage, Michael

    2016-10-01

    Validated tools for evaluating quality of life (QOL) in patients with bone metastases include the EORTC QLQ-BM22 and QLQ-C15-PAL modules. A statistically significant difference in metric scores may not be clinically significant. To aid in their interpretation, we performed analyses to determine the minimal clinically important differences (MCID) for these QOL instruments. Both anchor-based and distribution-based methods were used to determine the MCID among patients with bone metastases enrolled in a randomized phase III trial. For the anchor-based approach, overall QOL as measured by the QLQ-C15-PAL module was used as the anchor and only the subscales with moderate or better correlation were used for subsequent MCID analysis. In the anchor-based approach, patients were classified as improved, stable or deteriorated by the change in the overall QOL score from baseline to follow-up after 42 days. The MCID and confidence interval was then calculated for all subscales. In the distribution-based approach, the MCID was expressed as a proportion of the standard deviation and standard error measurement from the subscale score distribution. A total of 204 patients completed the questionnaires at baseline and follow-up. Only the dyspnea and insomnia subscales did not have at least moderate correlation with the overall QOL anchor. Using the anchor-based approach, 10/11 subscales had an MCID score significantly different than 0 for improvement and 3/11 subscales had a significant MCID score for deterioration. The magnitude of MCID scores was higher for improvement in comparison with deterioration. For improvement, the anchor-based approach showed good agreement with the distribution-based approach when using 0.5 SD as the MCID. However, there was greater lack of agreement between these approaches for deterioration. We present the MCID scores for the EORTC QLQ-BM22 and QLQ-C15-PAL QOL instruments. The results of this study can guide clinicians in the interpretation of these

  16. The quality of spine surgery from the patient's perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index.

    PubMed

    Mannion, A F; Porchet, F; Kleinstück, F S; Lattig, F; Jeszenszky, D; Bartanusz, V; Dvorak, J; Grob, D

    2009-08-01

    The Core Outcome Measures Index (COMI) is a reliable and valid instrument for assessing multidimensional outcome in spine surgery. The minimal clinically important score-difference (MCID) for improvement (MCID(imp)) was determined in one of the original research studies validating the instrument, but has never been confirmed in routine clinical practice. Further, the MCID for deterioration (MCID(det)) has never been investigated; indeed, this needs very large sample sizes to obtain sufficient cases with worsening. This study examined the MCIDs of the COMI in routine clinical practice. All patients undergoing surgery in our Spine Center since February 2004 were asked to complete the COMI before and 12 months after surgery. The COMI has one question each on back (neck) pain intensity, leg/buttock (arm/shoulder) pain intensity, function, symptom-specific well-being, general quality of life, work disability, and social disability, scored as a 0-10 index. At follow-up, patients also rated the global effectiveness of surgery, on a 5-point Likert scale. This was used as the external criterion ("anchor") in receiver operating characteristics (ROC) analyses to derive cut-off scores for individual improvement and deterioration. Twelve-month follow-up questionnaires were returned by 3,056 (92%) patients. The group mean COMI score change for patients declaring that the "operation helped" was a reduction of 3.1 points; the corresponding value for those whom it "did not help" was a reduction of 0.5 points. The group MCID(imp) was hence 2.6 points reduction; the corresponding group MCID(det) was 1.2 points increase (0.5 minus -0.7). The area under the ROC curve was 0.88 for MCID(imp) and 0.89 for MCID(det) (both P < 0.0001), indicating that the COMI had good discriminative ability. The cut-offs for individual improvement and deterioration, respectively, were > or =2.2 points decrease (sensitivity 81%, specificity 83%) and > or =0.3 points increase (sensitivity 83%, specificity 88

  17. The Effectiveness of an Educational Brochure as a Risk Minimization Activity to Communicate Important Rare Adverse Events to Health-Care Professionals.

    PubMed

    Bester, Nicolette; Di Vito-Smith, Michelle; McGarry, Theresa; Riffkin, Michael; Kaehler, Stefan; Pilot, Richard; Bwire, Robert

    2016-02-01

    Educational brochures are an important tool for communicating risk to health-care professionals. It is important to evaluate the impact of any risk minimization tool to understand the effectiveness of the strategy. The objective of this study was to assess the effectiveness (i.e., respondents' awareness and understanding of the communication) of a targeted educational brochure distributed to health-care professionals (HCPs) as a risk minimization strategy for the communication of new rare and important adverse events (AEs). A prospective, non-interventional, online survey was performed following distribution of a specifically designed brochure highlighting new and important adverse events to a targeted HCP population, consisting of known users of the target medicine, as represented by a commercial database. Predefined multiple-choice survey questions assessed overall HCP awareness of the brochure and understanding and retention of information in those HCPs who reported receiving the brochure. The educational brochure was sent to a total of 565 HCPs; 121 (21.4%) responded to the survey. The majority of respondents (95.0%) had previously prescribed or dispensed the target medicine. In all, 88 (72.7%) respondents said they had received the educational brochure, of whom 95.5% stated they had at least scanned the main points. More participants who had received the brochure (86.4% to 96.6%) answered the five individual survey questions correctly compared with those who did not (51.5% to 97.0%); this was significant for four out of five questions (P ≤ 0.005). Significantly more HCPs who received the brochure achieved the predefined pass rate (at least four of five questions answered correctly) compared with HCPs who did not receive the brochure (93.2% vs 57.6%, respectively; P = 0.000003). Distribution of targeted educational brochures may be an effective risk minimization strategy to raise HCP awareness of new rare and important AEs; educational brochures may also be

  18. [World population and development: an important change in perspective].

    PubMed

    Vallin, J

    1984-10-24

    The International Population Conference in Mexico City was much less controversial than the World Population Conference in Bucharest 10 years previously, in part because the message of Bucharest was widely accepted and in part because of changes that occurred in the demographic and economic situations in the succeeding decade. The UN medium population projection for 1985 has been proved quite accurate; it is not as alarming as the high projection but still represents a doubling of world population in less than 40 years. The control of fertility upon which the medium projection was predicated is well underway. The movement from high to low rates of fertility and mortality began in the 18th century in the industrial countries and lasted about 1 1/2 centuries during which the population surplus was dispersed throughout the world, especially in North and South America. The 2nd phase of movement from high to low rates currently underway in the developing countries has produced a far greater population increase. The proportion of the population in the developed areas of Europe, North America, the USSR, Japan, Australia, and New Zealand will decline from about 1/3 of the 2.5 billion world population of 1950 to 1/4 of the 3.7 billion of 1985, to 1/5 of the 4.8 billion of 2000, and probably 1/7 of the 10 billion when world population stabilizes at the end of the next century. The growth rates of developing countries are not homogeneous; the populations of China and India have roughly doubled in the past 35 years while that of Latin America has multiplied by 2 1/2. The population of Africa more than doubled in 35 years and will almost triple by 2025. The number of countries with over 50 million inhabitants, 9 in 1950, will increase from 19 in 1985 to 32 in 2025. The process of urbanization is almost complete in the industrialized countries, with about 75% of the population urban in 1985, but urban populations will continue to grow rapidly in the developing countries as rural

  19. Serial Tc-99m MAG3 renography evaluating the recovery of acute kidney injury associated with minimal change nephrotic syndrome.

    PubMed

    Kanazawa, Hidenori; Kotoda, Atsushi; Akimoto, Tetsu; Shinozaki, Takeshi; Inoue, Makoto; Sugimoto, Hideharu; Kusano, Eiji

    2013-01-01

    Acute kidney injury (AKI) is a well-recognized complication of minimal change nephrotic syndrome (MCNS). Previous reports support the concept that AKI associated with MCNS is reversible; however, information regarding the hemodynamic basis of AKI in MCNS is insufficient. We herein describe a case of AKI in a man with MCNS. In this case, monitoring the longitudinal changes in renal perfusion using serial Tc-99m-MAG3 renal scanning was beneficial for evaluating the pathophysiological background associated with the development of AKI. The potential impact of serial renal scanning in MCNS patients with AKI will also be discussed.

  20. 76 FR 30550 - Federal Management Regulation; Change in Consumer Price Index Minimal Value

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-26

    ... ADMINISTRATION 41 CFR Part 102-42 RIN 3090-AJ12 Federal Management Regulation; Change in Consumer Price Index..., to reflect changes in the Consumer Price Index for the immediately preceding 3-year period. The... published to provide transparency in the promulgation of Federal policies. C. Paperwork Reduction Act The...

  1. Assessing the Amount of Change in an Outcome Measure Is Not the Same as Assessing the Importance of Change

    PubMed Central

    Riddle, Daniel L.

    2013-01-01

    ABSTRACT Purpose: To determine whether a difference exists between patients' self-ratings of amount of change and their self-ratings of importance of change. Methods: Eighty-eight patients receiving treatment of low-back pain completed two global rating of change (GRC) scales 4 to 6 weeks after their initial assessments. The scales were similar in format, differing only in that one asked respondents about the amount of change and the other about the importance of change. Results: Our analysis was restricted to 86 patients who reported improvement or no change. The chance-corrected agreement between patients' self-ratings of amount of change and their self-ratings of importance of change was low (κ=0.35; 95% CI, 0.23–0.48). Of 47 disagreements, 44 reported a greater importance of change than amount of change and 3 reported a greater amount of change than importance of change. Conclusions: Assessing the amount of change is not the same as assessing the importance of change. When the goal is to estimate important change, the reference standard should direct patients to judge the importance of the change. PMID:24403694

  2. Assessing the amount of change in an outcome measure is not the same as assessing the importance of change.

    PubMed

    Stratford, Paul W; Riddle, Daniel L

    2013-01-01

    To determine whether a difference exists between patients' self-ratings of amount of change and their self-ratings of importance of change. Eighty-eight patients receiving treatment of low-back pain completed two global rating of change (GRC) scales 4 to 6 weeks after their initial assessments. The scales were similar in format, differing only in that one asked respondents about the amount of change and the other about the importance of change. Our analysis was restricted to 86 patients who reported improvement or no change. The chance-corrected agreement between patients' self-ratings of amount of change and their self-ratings of importance of change was low (κ=0.35; 95% CI, 0.23-0.48). Of 47 disagreements, 44 reported a greater importance of change than amount of change and 3 reported a greater amount of change than importance of change. Assessing the amount of change is not the same as assessing the importance of change. When the goal is to estimate important change, the reference standard should direct patients to judge the importance of the change.

  3. Changes of minimal erythema dose after water and salt water baths.

    PubMed

    Gambichler, T; Schröpl, F

    1998-01-01

    Knowledge about the influence of salt water baths on UV irradiation, especially balneophototherapy, is incomplete. The aim of this study was to investigate the influence of various concentrated salt solutions on the minimal erythema dose (MED). We determined the MEDdry (UVB) in 24 healthy, previously UV unexposed subjects on the inner forearm. Subjects were divided randomly into two groups of 12. Subsequently, the MEDwet was assessed on each forearm after 30 min tap water or 5% salt water bath (group A), respectively, or after 30 min 10% or 20% salt water bath (group B), respectively. Compared with the MEDdry, a significantly decreased MEDwet, was observed after all exposures (group A==>F = 18.94; P < 0.001; group B==>F = 11.73; P < 0.006). A maximal relative decrease in MEDdry of about 51.4% was observed after the 10% salt water bath. The 5% salt solution caused a modest relative decrease in MEDwet of 23.4%. We observed a markedly increased photosensitivity to UVB after all exposures, without a linear correlation between the MED and the salt water concentration. A determination of MED during balneophototherapy should be carried out after bathing in order to reduce the cumulative UV dose and to prevent acute photodamage.

  4. Changes in the regional homogeneity of resting-state brain activity in minimal hepatic encephalopathy.

    PubMed

    Chen, Hua-Jun; Zhu, Xi-Qi; Yang, Ming; Liu, Bin; Zhang, Yi; Wang, Yu; Teng, Gao-Jun

    2012-01-17

    Resting-state functional magnetic resonance imaging (fMRI) has facilitated the study of spontaneous brain activity by measuring low-frequency oscillations in blood-oxygen-level-dependent signals. Analyses of regional homogeneity (ReHo), which reflects the local synchrony of neural activity, have been used to reveal the mechanisms underlying the brain dysfunction in various neuropsychiatric diseases. However, it is not known whether the ReHo is altered in cirrhotic patients with minimal hepatic encephalopathy (MHE). We recruited 18 healthy controls and 18 patients with MHE. The ReHo was calculated to assess the strength of the local signal synchrony. Compared with the healthy controls, the patients with MHE had significantly decreased ReHo in the cuneus and adjacent precuneus, and left inferior parietal lobe, whereas the regions showing increased ReHo in patients with MHE included the left parahippocampal gyrus, right cerebellar vermis, and bilateral anterior cerebellar lobes. We found a positive correlation between the mean ReHo in the cuneus and adjacent precuneus and the score on the digit-symbol test in the patient group. In conclusion, the analysis of the regional homogeneity of resting-state brain activity may provide additional information with respect to a clinical definition of MHE.

  5. Suppression of protein inactivation during freezing by minimizing pH changes using ionic cryoprotectants.

    PubMed

    Krausková, Ľubica; Procházková, Jitka; Klašková, Martina; Filipová, Lenka; Chaloupková, Radka; Malý, Stanislav; Damborský, Jiří; Heger, Dominik

    2016-07-25

    Freezing and lyophilization are often used for stabilization of biomolecules; however, this sometimes results in partial degradation and loss of biological function in these molecules. In this study we examined the effect of freezing-induced acidity changes on denaturation of the model enzyme haloalkane dehalogenase under various experimental conditions. The effective local pH of frozen solutions is shown to be the key causal factor in protein stability. To preserve the activity of frozen-thawed enzymes, acidity changes were prevented by the addition of an ionic cryoprotectant, a compound which counteracts pH changes during freezing due to selective incorporation of its ions into the ice. This approach resulted in complete recovery of enzyme activity after multiple freeze-thaw cycles. We propose the utilization of ionic cryoprotectants as a new and effective cryopreservation method in research laboratories as well as in industrial processes. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve organic matter.

    PubMed

    Tartari, T; Guimarães, B M; Amoras, L S; Duarte, M A H; Silva e Souza, P A R; Bramante, C M

    2015-04-01

    To evaluate the effect of individual and combined use of sodium hypochlorite (NaOCl), etidronate (HEDP) and ethylenediaminetetraacetic acid (EDTA) in tissue dissolution. Sixty fragments of bovine muscle tissue were prepared and their weights determined on a precision scale. The samples were then distributed in the following groups (n = 10): G1 - saline solution (control); G2 - 17% EDTA; G3 - 18% HEDP; G4 - 2.5% NaOCl; G5 - mixture of 5% NaOCl + 17% EDTA; and G6 - mixture of 5% NaOCl + 18% HEDP. The specimens in each group were immersed in the solutions for 5, 10 and 15 min and reweighted at each time period. Analysis of variance (anova) and Tukey's multiple-comparison tests (α<0.05) were applied to identify the intragroup and intergroup differences. G1, G2, G3 and G5 did not dissolve the organic matter. G4 and G6 significantly reduced the weights of specimens at all periods. Amongst the groups, the difference in ability to dissolve organic matter was greater and significant in the following order G4 = G6 > G5 = G3 = G2 = G1 after 5 min of immersion and G4 > G6 > G5 = G3 = G2 = G1 after 10 and 15 min of immersion. The only solution capable of dissolving organic matter was NaOCl. In the mixtures analysed, this ability was arrested by EDTA; however, it was minimally affected by the HEDP, proving that this combination, if used during the biomechanical preparation, is able to dissolve of organic matter. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  7. Change in adiposity minimally affects the lipid profile in youth with recent onset type 1 diabetes.

    PubMed

    Shah, Amy S; Dolan, Lawrence M; Dabelea, Dana; Stafford, Jeanette M; D'Agostino, Ralph B; Mayer-Davis, Elizabeth J; Marcovina, Santica; Imperatore, Giuseppina; Wadwa, R Paul; Daniels, Stephen R; Reynolds, Kristi; Hamman, Richard F; Bowlby, Deborah A; Maahs, David M

    2015-06-01

    Dyslipidemia contributes to the increased risk of cardiovascular disease in persons with type 1 diabetes (T1D). Weight control is commonly recommended as a treatment for dyslipidemia. However, the extent to which decreases in weight affect the lipid profile in youth with T1D is not known. Therefore, we tested the hypothesis that decreases in body mass index z-score (BMIz) were associated with concomitant changes in the lipid profile in youth with T1D. We studied 1142 youth with incident T1D, who had at least two fasting lipid measurements over 2 yr (initial visit mean: age = 10.8 ± 3.9 yr, BMIz = 0.55 ± 0.97, T1D duration = 10.7 ± 7.6 months; 47.5% female, 77.9% non-Hispanic white) in the SEARCH for Diabetes in Youth Study. Longitudinal mixed models were used to examine the relationships between changes in BMIz and changes in total, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL cholesterol, and log triglycerides (TG) adjusted for initial age, sex, race/ethnicity, clinical site, season of study visit, T1D duration, and glycated hemoglobin A1c (HbA1c). We found that over 2 yr all lipid levels, except LDL-C, increased significantly (p < 0.05). Decreases in BMIz were associated with favorable changes in HDL-C and TG only and the magnitude of these changes depended on the initial BMIz value (interaction p < 0.05), so that greater improvements were seen in those with higher BMIz. Our data suggest that weight loss may be an effective, but limited, therapeutic approach for dyslipidemia in youth with T1D. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Changes in total ascorbic acid and carotenoids in minimally processed irradiated Arugula (Eruca sativa Mill) stored under refrigeration

    NASA Astrophysics Data System (ADS)

    Nunes, Tatiana Pacheco; Martins, Cecília Geraldes; Faria, Adelia Ferreira; Bíscola, Vanessa; de Oliveira Souza, Kátia Leani; Mercadante, Adriana Zerlotti; Cordenunsi, Beatriz Rosana; Landgraf, Mariza

    2013-09-01

    This work investigated the effects of irradiation (0, 1 and 2 kGy) on the content of bioactive compounds such as vitamin C and carotenoids with provitamin A activity in arugula during the storage at 5±1 °C for up to 13 and 16 days, respectively. The vitamin C content decreased in non-irradiated as well as irradiated (1 and 2 kGy) samples during the storage period. On the other hand, no significant change in the content of carotenoids with provitamin A activity was observed after irradiation or storage period. Thus, the irradiation had minimal detrimental effects on the contents of carotenoids in arugula.

  9. Minimal Change Nephrotic Syndrome Sequentially Complicated by Acute Kidney Injury and Painful Skin Ulcers due to Calciphylaxis

    PubMed Central

    Sato, Ryuta; Akimoto, Tetsu; Imai, Toshimi; Nakagawa, Saki; Okada, Mari; Miki, Atsushi; Takeda, Shinichi; Yamamoto, Hisashi; Saito, Osamu; Muto, Shigeaki; Kusano, Eiji; Nagata, Daisuke

    2016-01-01

    Calciphylaxis is rare cutaneous manifestation associated with painful skin ulceration and necrosis. It primarily occurs in patients with end-stage chronic kidney disease. In this report, we would like to show our experience with a male patient presenting with minimal change nephrotic syndrome that was sequentially complicated by acute kidney injury and painful ulcerative cutaneous lesions due to calciphylaxis. There seemed to be several contributing factors, including a disturbance of the patient's mineral metabolism and the systemic use of glucocorticoids and warfarin. Various concerns regarding the diagnostic and therapeutic conundrums that were encountered in the present case are also discussed. PMID:27853075

  10. Minimal evidence for consistent changes in maize DNA methylation patterns following environmental stress

    PubMed Central

    Eichten, Steven R.; Springer, Nathan M.

    2015-01-01

    DNA methylation is a chromatin modification that is sometimes associated with epigenetic regulation of gene expression. As DNA methylation can be reversible at some loci, it is possible that methylation patterns may change within an organism that is subjected to environmental stress. In order to assess the effects of abiotic stress on DNA methylation patterns in maize (Zea mays), seeding plants were subjected to heat, cold, and UV stress treatments. Tissue was later collected from individual adult plants that had been subjected to stress or control treatments and used to perform DNA methylation profiling to determine whether there were consistent changes in DNA methylation triggered by specific stress treatments. DNA methylation profiling was performed by immunoprecipitation of methylated DNA followed by microarray hybridization to allow for quantitative estimates of DNA methylation abundance throughout the low-copy portion of the maize genome. By comparing the DNA methylation profiles of each individual plant to the average of the control plants it was possible to identify regions of the genome with variable DNA methylation. However, we did not find evidence of consistent DNA methylation changes resulting from the stress treatments used in this study. Instead, the data suggest that there is a low-rate of stochastic variation that is present in both control and stressed plants. PMID:25999972

  11. Implication of Higgs mediated Flavour Changing Neutral Currents with Minimal Flavour Violation

    NASA Astrophysics Data System (ADS)

    Rebelo, M. N.

    2015-07-01

    We analise phenomenological implications of two Higgs doublet models with Higgs flavour changing neutral currents suppressed in the quark sector by small entries of the Cabibbo- Kokayashi-Maskawa matrix. This suppression occurs in a natural way since it is the result of a symmetry applied to the Lagrangian. These type of models were proposed some time ago by Branco Grimus and Lavoura. Our results clearly show that these class of models allow for new physical scalars, with masses which are reachable at the LHC. The imposed symmetry severely reduces the number of free parameters and allows for predictions. Therefore these models can eventually be proved right or eliminated experimentally.

  12. MINIMAL LIMB VOLUME CHANGE HAS A SIGNIFICANT IMPACT ON BREAST CANCER SURVIVORS

    PubMed Central

    Cormier, J.N.; Xing, Y.; Zaniletti, I.; Askew, R.L.; Stewart, B.R.; Armer, J.M.

    2010-01-01

    We sought to define the incidence, risk factors, symptoms, and quality of life (QOL) outcomes associated with various degrees of postoperative limb volume change (LVC). A prospective cohort study was performed obtaining serial limb volume measurements using a perometer on 269 women undergoing surgery for breast cancer. Four groups were created based on maximum LVC: none <5.0%, mild 5.0–9.9%, moderate 10.0–14.9%, and severe 15.0%. Symptoms and QOL were assessed. 81 (30.1%), 70 (26.0%), and 14 (5.2%) women developed mild, moderate, and severe LVC, respectively. Increases in body mass index (p<0.001) and post-operative complications (p=0.002) were associated with increasing LVC. Lower QOL scores were associated with a moderate LVC (OR=3.72, 95% CI, 1.29–10.73, p=0.015) and postoperative infections (OR=5.04, 95% CI, 1.73–14.70, p=0.003). LVC at 5.0% occurs in up to 61.3% of breast cancer survivors and is associated with a significant increase in symptoms and a change in reported quality of life. PMID:20218084

  13. Climate change inferred from borehole temperatures: minimal "snow effect" from North America

    NASA Astrophysics Data System (ADS)

    Bartlett, M. G.; Harris, R. N.; Chapman, D. S.

    2004-05-01

    Borehole temperature-depth profiles contain information about surface ground temperature histories over time scales of several centuries and in particular prior to the widespread availability of surface air temperature records [Huang et al, Nature, 2000; Harris and Chapman, GRL, 2001]. Borehole-based reconstructions on the regional and hemispheric scale yield significantly different magnitudes of warming in the past 500 years when compared to proxy-based reconstructions. Borehole reconstructions suggest that the Northern Hemisphere warming has been about 1.1 ° C while proxy methods indicate warming closer to 0.7 ° C [Mann et al, Nature, 1999]. One suggested reconciliation of borehole and proxy reconstructions is that long-term variations in seasonal snow cover may bias the borehole record. A spurious long-term warming signal relative to SAT trends could be introduced by alteration of the duration or onset of seasonal snow cover over the course of decades or longer. We have developed a "snow effect" model that predicts transient warming or cooling of the surface ground temperature due to changes in the onset, duration, and depth of snow events [Bartlett et al, in review]. We use our model to compute the response of ground temperatures at the regional scale to seasonal snow cover of the past century in North America. Snow and air temperature data used in the model come from the United States Historical Climatology Network (NOAA-NCDC NDP-070) and the Canadian Daily Climatic Dataset (CDCD). Results indicate that variations in snow onset and duration have had the greatest influence in Central North America, leading to ground warming on the order of 0.1-0.2 ° C / 100 yrs in this region relative to SAT trends. Other regions within North America have experienced negligible effects over the past century. We conclude that the magnitude of the snow effect in North America is insufficient to reconcile completely regional borehole and proxy reconstructions of climate change

  14. Favorable locations for piezo actuators in plates with good control effectiveness and minimal change in system dynamics

    NASA Astrophysics Data System (ADS)

    Dhuri, K. D.; Seshu, P.

    2007-12-01

    Placement and sizing of piezo actuators is normally based on control effectiveness. However, retrofitting of piezoelectric actuators alters the inherent stiffness/mass properties of the parent structure. In rotating structures, the additional mass due to piezo patches contributes to the centrifugal stiffening force. The parent structure is originally designed to have a certain natural frequency spectrum in relation to the disturbance excitation. In the event of failure of the active system, the dynamics of the structure with piezos (now rendered passive) will therefore become significant. Thus it will be helpful to determine locations for mounting piezo patches based on minimal natural frequency change yet with good control authority. In this study, a finite element based procedure for plate structures is presented. Favorable locations for mounting piezos based on minimal natural frequency changes are iteratively evolved from an initial configuration wherein the whole plate is covered with piezos. A modal controllability approach has been used for finding piezo mounting locations from a good controllability perspective. The procedure is demonstrated for simply supported square, swept-back, circular and rotating rectangular plates considering the first four modes.

  15. Designing for Change: Minimizing the Impact of Changing Requirements in the Later Stages of a Spaceflight Software Project

    NASA Technical Reports Server (NTRS)

    Allen, B. Danette

    1998-01-01

    In the traditional 'waterfall' model of the software project life cycle, the Requirements Phase ends and flows into the Design Phase, which ends and flows into the Development Phase. Unfortunately, the process rarely, if ever, works so smoothly in practice. Instead, software developers often receive new requirements, or modifications to the original requirements, well after the earlier project phases have been completed. In particular, projects with shorter than ideal schedules are highly susceptible to frequent requirements changes, as the software requirements analysis phase is often forced to begin before the overall system requirements and top-level design are complete. This results in later modifications to the software requirements, even though the software design and development phases may be complete. Requirements changes received in the later stages of a software project inevitably lead to modification of existing developed software. Presented here is a series of software design techniques that can greatly reduce the impact of last-minute requirements changes. These techniques were successfully used to add built-in flexibility to two complex software systems in which the requirements were expected to (and did) change frequently. These large, real-time systems were developed at NASA Langley Research Center (LaRC) to test and control the Lidar In-Space Technology Experiment (LITE) instrument which flew aboard the space shuttle Discovery as the primary payload on the STS-64 mission.

  16. Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change.

    PubMed

    Darmon, Michael; Diconne, Eric; Souweine, Bertrand; Ruckly, Stéphane; Adrie, Christophe; Azoulay, Elie; Clec'h, Christophe; Garrouste-Orgeas, Maïté; Schwebel, Carole; Goldgran-Toledano, Dany; Khallel, Hatem; Dumenil, Anne-Sylvie; Jamali, Samir; Cheval, Christine; Allaouchiche, Bernard; Zeni, Fabrice; Timsit, Jean-François

    2013-01-21

    To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders. Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively. A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality. One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.

  17. Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

    PubMed Central

    2013-01-01

    Introduction To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders. Methods Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively. Results A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality. Conclusions One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected. PMID:23336363

  18. Structures of minimal catalytic fragments of topoisomerase V reveals conformational changes relevant for DNA binding

    PubMed Central

    Rajan, Rakhi; Taneja, Bhupesh; Mondragón, Alfonso

    2010-01-01

    Summary Topoisomerase V is an archaeal type I topoisomerase that is unique among topoisomerases due to presence of both topoisomerase and DNA repair activities in the same protein. It is organized as an N-terminal topoisomerase domain followed by 24 tandem helix hairpin helix (HhH) motifs. Structural studies have shown that the active site is buried by the (HhH) motifs. Here we show that the N-terminal domain can relax DNA in the absence of any HhH motifs and that the HhH motifs are required for stable protein-DNA complex formation. Crystal structures of various topoisomerase V fragments show changes in the relative orientation of the domains mediated by a long bent linker helix, and these movements are essential for the DNA to enter the active site. Phosphate ions bound to the protein near the active site helped model DNA in the topoisomerase domain and shows how topoisomerase V may interact with DNA. PMID:20637419

  19. Minimizing the cost of keeping options open for conservation in a changing climate

    USGS Publications Warehouse

    Mills, Morena; Nicol, Samuel; Wells, Jessie A.; Lahoz-Monfort, José J.; Wintle, Brendan; Bode, Michael; Wardrop, Martin; Walshe, Terry; Probert, William J. M.; Runge, Michael C.; Possingham, Hugh P.; McDonald Madden, Eve

    2014-01-01

    Policy documents advocate that managers should keep their options open while planning to protect coastal ecosystems from climate-change impacts. However, the actual costs and benefits of maintaining flexibility remain largely unexplored, and alternative approaches for decision making under uncertainty may lead to better joint outcomes for conservation and other societal goals. For example, keeping options open for coastal ecosystems incurs opportunity costs for developers. We devised a decision framework that integrates these costs and benefits with probabilistic forecasts for the extent of sea-level rise to find a balance between coastal ecosystem protection and moderate coastal development. Here, we suggest that instead of keeping their options open managers should incorporate uncertain sea-level rise predictions into a decision-making framework that evaluates the benefits and costs of conservation and development. In our example, based on plausible scenarios for sea-level rise and assuming a risk-neutral decision maker, we found that substantial development could be accommodated with negligible loss of environmental assets. Characterization of the Pareto efficiency of conservation and development outcomes provides valuable insight into the intensity of trade-offs between development and conservation. However, additional work is required to improve understanding of the consequences of alternative spatial plans and the value judgments and risk preferences of decision makers and stakeholders.

  20. Structures of minimal catalytic fragments of topoisomerase V reveals conformational changes relevant for DNA binding.

    PubMed

    Rajan, Rakhi; Taneja, Bhupesh; Mondragón, Alfonso

    2010-07-14

    Topoisomerase V is an archaeal type I topoisomerase that is unique among topoisomerases due to presence of both topoisomerase and DNA repair activities in the same protein. It is organized as an N-terminal topoisomerase domain followed by 24 tandem helix-hairpin-helix (HhH) motifs. Structural studies have shown that the active site is buried by the (HhH) motifs. Here we show that the N-terminal domain can relax DNA in the absence of any HhH motifs and that the HhH motifs are required for stable protein-DNA complex formation. Crystal structures of various topoisomerase V fragments show changes in the relative orientation of the domains mediated by a long bent linker helix, and these movements are essential for the DNA to enter the active site. Phosphate ions bound to the protein near the active site helped model DNA in the topoisomerase domain and show how topoisomerase V may interact with DNA.

  1. Structures of Minimal Catalytic Fragments of Topoisomerase V Reveals Conformational Changes Relevant for DNA Binding

    SciTech Connect

    Rajan, Rakhi; Taneja, Bhupesh; Mondragón, Alfonso

    2010-12-03

    Topoisomerase V is an archaeal type I topoisomerase that is unique among topoisomerases due to presence of both topoisomerase and DNA repair activities in the same protein. It is organized as an N-terminal topoisomerase domain followed by 24 tandem helix-hairpin-helix (HhH) motifs. Structural studies have shown that the active site is buried by the (HhH) motifs. Here we show that the N-terminal domain can relax DNA in the absence of any HhH motifs and that the HhH motifs are required for stable protein-DNA complex formation. Crystal structures of various topoisomerase V fragments show changes in the relative orientation of the domains mediated by a long bent linker helix, and these movements are essential for the DNA to enter the active site. Phosphate ions bound to the protein near the active site helped model DNA in the topoisomerase domain and show how topoisomerase V may interact with DNA.

  2. Minimizing the cost of keeping options open for conservation in a changing climate.

    PubMed

    Mills, Morena; Nicol, Sam; Wells, Jessie A; Lahoz-Monfort, José J; Wintle, Brendan; Bode, Michael; Wardrop, Martin; Walshe, Terry; Probert, William J M; Runge, Michael C; Possingham, Hugh P; Madden, Eve McDonald

    2014-06-01

    Policy documents advocate that managers should keep their options open while planning to protect coastal ecosystems from climate-change impacts. However, the actual costs and benefits of maintaining flexibility remain largely unexplored, and alternative approaches for decision making under uncertainty may lead to better joint outcomes for conservation and other societal goals. For example, keeping options open for coastal ecosystems incurs opportunity costs for developers. We devised a decision framework that integrates these costs and benefits with probabilistic forecasts for the extent of sea-level rise to find a balance between coastal ecosystem protection and moderate coastal development. Here, we suggest that instead of keeping their options open managers should incorporate uncertain sea-level rise predictions into a decision-making framework that evaluates the benefits and costs of conservation and development. In our example, based on plausible scenarios for sea-level rise and assuming a risk-neutral decision maker, we found that substantial development could be accommodated with negligible loss of environmental assets. Characterization of the Pareto efficiency of conservation and development outcomes provides valuable insight into the intensity of trade-offs between development and conservation. However, additional work is required to improve understanding of the consequences of alternative spatial plans and the value judgments and risk preferences of decision makers and stakeholders. © 2014 Society for Conservation Biology.

  3. Changes in the colon microbiota and intestinal cytokine gene expression following minimal intestinal surgery

    PubMed Central

    Lapthorne, Susan; Bines, Julie E; Fouhy, Fiona; Dellios, Nicole L; Wilson, Guineva; Thomas, Sarah L; Scurr, Michelle; Stanton, Catherine; Cotter, Paul D; Pereira-Fantini, Prue M

    2015-01-01

    AIM: To investigate the impact of minor abdominal surgery on the caecal microbial population and on markers of gut inflammation. METHODS: Four week old piglets were randomly allocated to a no-surgery “control” group (n = 6) or a “transection surgery” group (n = 5). During the transection surgery procedure, a conventional midline incision of the lower abdominal wall was made and the small intestine was transected at a site 225 cm proximal to the ileocaecal valve, a 2 cm segment was removed and the intestine was re-anastomosed. Piglets received a polymeric infant formula diet throughout the study period and were sacrificed at two weeks post-surgery. Clinical outcomes including weight, stool consistency and presence of stool fat globules were monitored. High throughput DNA sequencing of colonic content was used to detect surgery-related disturbances in microbial composition at phylum, family and genus level. Diversity and richness estimates were calculated for the control and minor surgery groups. As disturbances in the gut microbial community are linked to inflammation we compared the gene expression of key inflammatory cytokines (TNF, IL1B, IL18, IL12, IL8, IL6 and IL10) in ileum, terminal ileum and colon mucosal extracts obtained from control and abdominal surgery groups at two weeks post-surgery. RESULTS: Changes in the relative abundance of bacterial species at family and genus level were confined to bacterial members of the Proteobacteria and Bacteroidetes phyla. Family level compositional shifts included a reduction in the relative abundance of Enterobacteriaceae (22.95 ± 5.27 vs 2.07 ± 0.72, P < 0.01), Bacteroidaceae (2.54 ± 0.56 vs 0.86 ± 0.43, P < 0.05) and Rhodospirillaceae (0.40 ± 0.14 vs 0.00 ± 0.00, P < 0.05) following transection surgery. Similarly, at the genus level, changes associated with transection surgery were restricted to members of the Proteobacteria and Bacteroidetes phyla and included decreased relative abundance of

  4. Twins Bed Rest Project: LBNP/Exercise Minimizes Changes in Lean Leg Mass, Strength and Endurance

    NASA Technical Reports Server (NTRS)

    Amorim, Fabiano T.; Schneider, Suzanne M.; Lee, Stuart M. C.; Boda, Wanda L.; Watenpaugh, Donald E.; Hargens, Alan R.

    2006-01-01

    Decreases in muscle strength and endurance frequently are observed in non-weightbearing conditions such as bed rest (BR), spaceflight or limb immobilization. Purpose: Ow purpose was to determine if supine treadmill exercise against simulated gravity, by application of lower body negative pressure (LBNP), prevents loss of lean leg mass, strength and endurance during 30 d of 6deg head-down bed rest (BR). Methods: Fifteen pairs of monozygous twins (8 male, 7 female pairs; 26+/-4 yrs; 170+/-12 cm; 62.6+/-11.3 kg; mean+/-SD) were subjects in the present study. One sibling of each pair of twins was randomly assigned to either an exercise (EX) or non-exercise (CON) group. The EX twin walked/jogged on a vertical treadmill within LBNP chamber 6 d/wk using a 40-min interval exercise protocol at 40-80% of pre-BR VO(sub 2peak). LBNP was adjusted individually for each subject such that footward force was between 1.0 and 1.2 times body weight (-53+/-5 mmHg LBNP). The CON twin performed no exercise during BR. Subjects performed isokinetic knee (60 and 120deg/s) and ankle (60deg/s) testing to assess strength and endurance (End) before and after BR. They also had their lean leg mass (L(sub mass)) evaluated by DEXA before and after BR. Results: Changes in peak torque (T(sub pk)) were smaller for flexion (flex) than for extension (ext) after BR and did not differ between groups. The CON group had larger decreases (P<0.05) in L(sub mass), knee and ankle ext T(sub pk), and knee ext End.

  5. Echocardiographic Evaluation of Changes in Cardiac Hemodynamics and Loading Conditions after Transthoracic Minimally Invasive Device Closure of Atrial Septal Defect

    PubMed Central

    Cao, Hua; Zhang, Gui-Can; Chen, Liang-Wan; Hu, Yun-Nan

    2015-01-01

    Purpose To evaluate transthoracic minimally invasive device closure of atrial septal defects by performing transthoracic echocardiography to measure changes in cardiac hemodynamics and loading conditions. Methods Between January 2012 and December 2012, we performed transthoracic minimally invasive device closure of atrial septal defects in 95 patients with secundum atrial septal defects (ASD), and performed transthoracic echocardiography to measure blood flow velocities at the tricuspid valve orifice and at the pulmonary valve orifice, sizes of the left and right atria and ventricles, right ventricular fractional area change, right ventricular Tei index, three-dimensional right ventricular ejection fraction, tricuspid annular plane systolic excursion and left ventricular ejection fractions before the procedure and 1 week, 3 months, and 1 year post-procedure. Results Varying degrees of improvement were observed post-procedure at later time points. The maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity-time integral, and A peak and E peak blood flow velocity at the tricuspid valve orifice decreased significantly post-procedure (P<0.05). In 3 months and 1 year’s follow-up, the inner diameter of the middle portion of the pulmonary artery, and diameters of the right atrium and right ventricle decreased significantly post-procedure (P<0.05). The diameters of the left atrium and left ventricle increased after the procedure (P<0.05). One week after the procedure, the right ventricular fractional area change, three-dimensional right ventricular ejection fraction, right ventricular Tei index and tricuspid annular plane systolic excursion had significantly reduced compared with the preoperative data (P<0.05). While these four parameters were still decreased at the 3 months and at 1 year’s follow-up, but the differences were not statistically significant compared with the 1 week’s postoperative data (P>0.05). One week post

  6. Implementing strategic change in a health care system: the importance of leadership and change readiness.

    PubMed

    Caldwell, David F; Chatman, Jennifer; O'Reilly, Charles A; Ormiston, Margaret; Lapiz, Margaret

    2008-01-01

    Shifts in the environment can compel health care organizations to change their strategies. However strategic change frequently fails because individuals do not adopt the behaviors necessary to successfully implement the new strategy. This study explores how three variables-agreement with new strategy, leaders' actions, and groups' general orientation toward change-can influence members of physician teams to take actions supporting a strategic shift aimed at improving patient satisfaction. Physicians in 37 specialty departments in a large health care organization were surveyed regarding their support for a new customer service initiative, the actions of department leaders, and generalized norms supporting change. The results of the survey were linked to changes in patient satisfaction for the department. Normative support for the specific strategic change was directly related to increased patient satisfaction 1 year later. The interaction between norms supporting change readiness and the quality of leadership was positively related to change in patient satisfaction. Successfully implementing a strategic change often requires getting individuals to change their behaviors. Leaders can enhance the results of the change by working to develop general norms such as teamwork and tolerance for mistakes that increase general readiness for change with the group.

  7. Minimally important differences were estimated for the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) instrument using a combination of distribution- and anchor-based approaches.

    PubMed

    Yost, K J; Cella, D; Chawla, A; Holmgren, E; Eton, D T; Ayanian, J Z; West, D W

    2005-12-01

    To estimate minimally important differences (MIDs) on the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) instrument using anchor- and distribution-based methods. Preliminary MIDs were generated for FACT-C scores based on published results for two samples (n = 60 and n = 63) from the FACT-C validation study. Preliminary MIDs were confirmed using data from a Phase II randomized controlled clinical trial (n = 104) and a population-based observational study (n = 568). MIDs were estimated for the colorectal cancer subscale (CCS); the FACT-C Trial Outcome Index (TOI-C), which is the sum of the CCS, physical well-being, and functional well-being subscales; and the FACT-C total score. Both cross-sectional and longitudinal analyses were used. MIDs were stable across the different patient samples. The recommended MIDs ranged from 2 to 3 points for the CCS, 4 to 6 points for the TOI-C, and 5 to 8 points for the FACT-C total score. MIDs can enhance the interpretability of FACT-C scores, and they can be used to provide a basis for sample size estimation and to determine clinical benefit in combination with other measures of efficacy. General guidelines for estimating MIDs for other FACT instruments are suggested.

  8. A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale.

    PubMed

    Eton, David T; Cella, David; Yost, Kathleen J; Yount, Susan E; Peterman, Amy H; Neuberg, Donna S; Sledge, George W; Wood, William C

    2004-09-01

    To determine distribution- and anchor-based minimal important difference (MID) estimates for four scores from the Functional Assessment of Cancer Therapy-Breast (FACT-B): the breast cancer subscale (BCS), Trial Outcome Index (TOI), FACT-G (the general version), and FACT-B. We used data from a Phase III clinical trial in metastatic breast cancer (ECOG study 1193; n=739) and a prospective observational study of pain in metastatic breast cancer (n=129). One third and one half of the standard deviation and 1 standard error of measurement were used as distribution-based criteria. Clinical indicators used to determine anchor-based differences included ECOG performance status, current pain, and response to treatment. FACT-B scores were responsive to performance status and pain anchors, but not to treatment response. By combining the results of distribution- and anchor-based methods, MID estimates were obtained: BCS=2-3 points, TOI=5-6 points, FACT-G=5-6 points, and FACT-B=7-8 points. Distribution- and anchor-based estimates of the MID do show convergence. These estimates can be used in combination with other measures of efficacy to determine meaningful benefit and provide a basis for sample size estimation in clinical trials.

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

    PubMed Central

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

    2013-01-01

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

  10. Minimization of first-turn losses by excited neutrals in charge-changing injection of accumulator rings

    SciTech Connect

    Jason, A.J.; Blind, B.; Channel, P.; Wang, Tai-Sen

    1994-07-01

    Substantial beam losses, due to production of excited neutrals by the foil stripper, have been observed to occur immediately after injection in accumulator rings that utilize charge-changing injection. A technique is proposed, based on experimental and theoretical results for excited-state production and stripping, that is potentially capable of reducing such losses by a factor greater than 10{sup 4}. In the technique, foil stripping occurs in a shaped magnetic field that resolves the excited atomic levels into immediately stripped states that are within ring acceptance and those that can be ejected from the ring. An added magnetic-mirror-field configuration is Proposed as an effective means of minimizing interactions between stripped electrons and the foil.

  11. Test-retest reliability and minimal detectable change scores of twelve functional fitness tests in adults with Down syndrome.

    PubMed

    Boer, P H; Moss, S J

    2016-01-01

    The purpose of the study was to explore the test-retest reliability and minimal detectable change of selected functional fitness test items in adults with Down syndrome. Forty-three adults with Down syndrome (24 men and 19 women) aged 18-50 years completed a battery of tests twice in a two-week period. The battery of tests consisted of two balance items, two flexibility items, five muscular strength and endurance items, two aerobic items, and one functional task. All items were considered valid and reliable tests in a general elderly or intellectually disabled population. The test-retest relative reliability for all repeated tests was assessed with intraclass correlation coefficient performing one-way analysis of variance. The test-retest absolute variability was measured by using the standard error of measurement (SEM) to calculate the minimal detectable change at the 90% confidence interval (MDC90). Reliability data was visualised with a Bland-Altman plot. All tests showed excellent intraclass correlation coefficients (ICC's>0.9). All SEM values demonstrated acceptable measurement precision (SEM

  12. Minimal change disease

    MedlinePlus

    ... blood vessels inside the nephron where blood is filtered to make urine and waste is removed. The ... with: ACE inhibitor medicines Blood pressure control Diuretics (water pills) You may also be told to reduce ...

  13. THE RELIABILITY, MINIMAL DETECTABLE CHANGE AND CONSTRUCT VALIDITY OF A CLINICAL MEASUREMENT FOR IDENTIFYING POSTERIOR SHOULDER TIGHTNESS

    PubMed Central

    Kolber, Morey J.

    2010-01-01

    Purpose/Background: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Therefore, clinicians and researchers must have a reliable and valid method for quantifying PST. The purpose of this study was to investigate the interrater reliability, minimal detectable change at the 90% confidence interval (MDC90) and construct validity of an inclinometric measurement designed to quantify PST. Methods: Two investigators each performed sidelying PST measurements on the non-dominant shoulder of 45 asymptomatic participants in a blinded repeated measures design. Upon completion of the PST measurements, one rater assessed active internal and external rotation for the validity component of the investigation. Results: Interrater reliability using an intraclass correlation coefficient (ICC) model 2,k was good (ICC 5 0.90). The MDC90 indicated that a change of greater than or equal to 9 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter-trial variability or measurement error. Construct validity was evaluated using active internal rotation for convergence and external rotation for discrimination. Construct validity was supported by a good to excellent relationship between PST and internal rotation (r 5 0.88) and by an inverse relationship between PST and external rotation (r 5 20.07). Conclusion: The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST when strict measurement protocols are adhered to. An advantage of this procedure lies in the ability to control scapular position to ensure motion is limited to the glenohumeral joint. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values. Clinicians and researchers should consider the MDC values presented when interpreting change values during

  14. Effects of minimal exercise and cognitive behavior modification on adherence, emotion change, self-image, and physical change in obese women.

    PubMed

    Annesi, J J

    2000-08-01

    The present investigation tested a 12-wk. treatment protocol which employed low intensity cardiovascular and resistance exercise as well as cognitive-behavior modification on 13 obese, previously sedentary women. Separate analyses were conducted on program maintenance, emotional change, and physiological change. Although self motivation was lower in the treatment group than in the control group (n=35), measures of exercise maintenance were significantly higher. Analyses within the treatment group only indicated significant improvements in measures of State Anxiety, Depression, Anger, Fatigue, Tension, and Vigor, also Health Evaluation, Body Area Satisfaction, and heightened Overweight Preoccupation, over the 12 weeks. Their feelings after individual bouts of exercise indicated significantly increased Positive Engagement, Revitalization, and Tranquility, and reduced Physical Exhaustion. Maximum volume of oxygen uptake (VO2max) significantly increased (2nd to 10th percentile), but not resting heart rate. No significant correlation was found between cardiorespiratory change and change in scores on depression and anxiety. No significant association was found between physiological change and change in body image. Preliminary evaluation of the minimal exercise treatment was given. The need to replicate findings with larger and different samples was emphasized.

  15. RELATIONSHIP BETWEEN ISOMETRIC THIGH MUSCLE STRENGTH AND MINIMAL CLINICALLY IMPORTANT DIFFERENCES (MCIDS) IN KNEE FUNCTION IN OSTEOARTHRITIS – DATA FROM THE OSTEOARTHRITIS INITIATIVE

    PubMed Central

    Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix

    2014-01-01

    Objective To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower limb function. Methods Isometric knee extensor and flexor strength of 4553 Osteoarthritis Initiative participants (2651 women/1902 men) was related to Western Ontario McMasters Universities (WOMAC) physical function scores by linear regression. Further, groups of Male and female participant strata with minimal clinically important differences (MCIDs) in WOMAC function scores (6/68) were compared across the full range of observed values, and to participants without functional deficits (WOMAC=0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Results Per regression equations, a 3.7% reduction in extensor and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and a 3.6%/4.8% reduction in men. For strength divided by body weight, reductions were 5.2%/6.7% in women and 5.8%/6.7% in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest non-linear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Conclusion Reductions of approximately 4% in isometric muscle strength and of 6% in strength/weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower limb function. PMID:25303012

  16. Implications of the minimal clinically important difference for health-related quality-of-life outcomes: a comparison of sample size requirements for an incontinence treatment trial.

    PubMed

    Halme, Alex S; Fritel, Xavier; Benedetti, Andrea; Eng, Ken; Tannenbaum, Cara

    2015-03-01

    Sample size calculations for treatment trials that aim to assess health-related quality-of-life (HRQOL) outcomes are often difficult to perform. Researchers must select a target minimal clinically important difference (MCID) in HRQOL for the trial, estimate the effect size of the intervention, and then consider the responsiveness of different HRQOL measures for detecting improvements. Generic preference-based HRQOL measures are usually less sensitive to gains in HRQOL than are disease-specific measures, but are nonetheless recommended to quantify an impact on HRQOL that can be translated into quality-adjusted life-years during cost-effectiveness analyses. Mapping disease-specific measures onto generic measures is a proposed method for yielding more efficient sample size requirements while retaining the ability to generate utility weights for cost-effectiveness analyses. This study sought to test this mapping strategy to calculate and compare the effect on sample size of three different methods. Three different methods were used for determining an MCID in HRQOL in patients with incontinence: 1) a global rating of improvement, 2) an incontinence-specific HRQOL instrument, and 3) a generic preference-based HRQOL instrument using mapping coefficients. The sample size required to detect a 20% difference in the MCID for the global rating of improvement was 52 per trial arm, 172 per arm for the incontinence-specific HRQOL outcome, and 500 per arm for the generic preference-based HRQOL outcome. We caution that treatment trials of conditions for which improvements are not easy to measure on generic HRQOL instruments will still require significantly greater sample size even when mapping functions are used to try to gain efficiency. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. EQ-5D-derived health utilities and minimally important differences for chronic health conditions: 2011 Commonwealth Fund Survey of Sicker Adults in Canada.

    PubMed

    Tsiplova, Kate; Pullenayegum, Eleanor; Cooke, Tim; Xie, Feng

    2016-12-01

    The purpose of the study is to estimate the EQ-5D-derived health utilities associated with selected chronic conditions (hypertension, heart disease, arthritis, asthma or COPD, cancer, diabetes, chronic back pain, and anxiety or depression) and to estimate minimally important differences (MID) based on the Commonwealth Fund Survey of Sicker Adults in Canada. We used a cross-sectional survey of 3765 sick adults in Canada conducted in 2011 by the Commonwealth Fund. Health utilities were calculated for the entire sample and for each of the eight chronic health conditions. An ordinary least squares regression was used to estimate the utility decrement associated with these conditions with and without adjustment for socio-demographic factors. The MIDs were estimated using the anchor- and distribution-based methods. The adjusted utility decrement varied from 0.028 (95 % confidence interval (CI) -0.049, -0.008) for diabetes to 0.124 (95 % CI -0.142, -0.105) for anxiety or depression. The anchor-based MID for the entire group was 0.044 (95 % CI 0.025, 0.062), and the distribution-based MID for the entire group was 0.091. The condition-specific MIDs using the distribution-based method ranged from 0.089 for cancer to 0.108 for asthma or COPD. The MID estimated by the distribution-based method was larger than the MID estimated by the anchor-based method, indicating that the choice of method matters. The impact of arthritis, anxiety or depression, and chronic back pain on health utility was substantial, all exceeding or approximating the MID estimated using either anchor- or distribution-based methods.

  18. Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients.

    PubMed

    Yost, Kathleen J; Eton, David T; Garcia, Sofia F; Cella, David

    2011-05-01

    We combined anchor- and distribution-based methods to establish minimally important differences (MIDs) for six Patient-Reported Outcomes Measurement Information System (PROMIS)-Cancer scales in advanced-stage cancer patients. Participants completed 6 PROMIS-Cancer scales and 23 anchor measures at an initial (n=101) assessment and a follow-up (n=88) assessment 6-12 weeks later. Three a priori criteria were used to identify usable cross-sectional and longitudinal anchor-based MID estimates. The mean standard error of measurement was also computed for each scale. The focus of the analysis was on item response theory-based MIDs estimated on a T-score scale. Raw score MIDs were estimated for comparison purposes. Many cross-sectional (64%) and longitudinal (73%) T-score anchor-based MID estimates were excluded because they did not meet a priori criteria. The following are the recommended T-score MID ranges: 17-item Fatigue (2.5-4.5), 7-item Fatigue (3.0-5.0), 10-item Pain Interference (4.0-6.0), 10-item Physical Functioning (4.0-6.0), 9-item Emotional Distress-Anxiety (3.0-4.5), and 10-item Emotional Distress-Depression (3.0-4.5). Effect sizes corresponding to these MIDs averaged between 0.40 and 0.63. This study is the first to address MIDs for PROMIS measures. Studies are currently being conducted to confirm these MIDs in other patient populations and to determine whether these MIDs vary by patients' level of functioning. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. The effect of minimal dietary changes with raisins in NAFLD patients with non-significant fibrosis: a randomized controlled intervention.

    PubMed

    Kaliora, Andriana C; Kokkinos, Alexander; Diolintzi, Anastacia; Stoupaki, Maria; Gioxari, Aristea; Kanellos, Panagiotis T; Dedoussis, George V Z; Vlachogiannakos, Jiannis; Revenas, Constantinos; Ladas, Spiros D; Karathanos, Vaios T

    2016-11-09

    Aiming at investigating the potential effect of minimal dietary changes in NAFLD patients with non-significant fibrosis, 55 patients with NAFLD were enrolled in a randomized controlled clinical trial. Patients were assigned into two isocaloric dietary treatment groups for 24 weeks: (a) nutritional counseling (Control arm, N = 27), (b) nutritional counseling with currants included (two fruit servings, 36 g per day), substituting snacks of similar caloric content (Currant arm, N = 28). Clinical tests, anthropometrics, inflammatory and oxidative stress markers were conducted pre- and post-intervention. A total of 50 patients completed the trial. Significant differences between the two arms post-intervention were observed in fasting glucose and in IL-6 levels, these being significantly decreased only in Currant patients. Body weight, BMI, HbA1c, CRP and EUS values decreased in both arms, differences being insignificant between the two arms post-intervention. Participants in the Currant arm had significantly reduced total body fat, WC and trunk fat. Ultrasound scanning improved significantly in patients snacking currants daily. Also, volunteers enrolled in the Currant arm showed a reduced intake of saturated fatty acids. Because BW regulation has been officially recognised as a treatment approach in NAFLD an additional analysis was repeated in patients adhering to this. Post-intervention, the decrease in IL-6 and in fasting glucose was significantly higher in Currant patients who lost BW compared to their counterparts in the Control arm. Conclusively, minimal modifications in snacking choices, such as the inclusion of dried grapes in diet, are beneficial in NAFLD patients with non-significant fibrosis.

  20. Test-retest reliability and the minimal detectable change for achilles tendon length: a panoramic ultrasound assessment.

    PubMed

    Ryan, Eric D; Rosenberg, Joseph G; Scharville, Michael J; Sobolewski, Eric J; Thompson, Brennan J; King, Gilbert E

    2013-12-01

    The purpose of the present study was to examine test-retest reliability and minimal detectable change (MDC) values for Achilles tendon (AT) length determined using panoramic ultrasound (US) imaging. Seventeen men (age = 21.0 ± 2.3 y) visited the laboratory on two separate days, where AT length was examined along the mid-longitudinal axis of the right lower leg with a portable B-mode panoramic US device. These measures were found to have acceptable reliability with intra-class correlation coefficient (ICC) and standard error of measurement (SEM) values of 0.954 and 4.43 mm (SEM% of the mean = 2.37%), respectively. In addition, the MDC for the panoramic US assessment of AT length was 12.27 mm (MDC% of the mean = 6.57%). These findings suggest that panoramic US imaging is a reliable technique for detection of clinically relevant changes in AT length and may therefore be a practical and time-efficient clinical tool for future studies examining AT length in vivo.

  1. Interpreting score differences in the SF-36 Vitality scale: using clinical conditions and functional outcomes to define the minimally important difference.

    PubMed

    Bjorner, Jakob B; Wallenstein, Gene V; Martin, Marie C; Lin, Peggy; Blaisdell-Gross, Bonnie; Tak Piech, Catherine; Mody, Samir H

    2007-04-01

    To propose the minimally important difference (MID) for the SF-36 Vitality (VT) scale by evaluating the association of score differences with clinical conditions and functional outcomes. Analyses were performed on data from the Medical Outcomes Study (n = 3445). The first analyses regressed VT scores (0-100 scale) on chronic conditions that cause fatigue in order to determine the impact of each condition on VT. The second set of analyses examined the relationship between baseline VT scores and other outcomes at baseline, 1-year, and 7-year follow-up. VT scores were significantly reduced in patients with anemia [5 points (95% CI 2-9 points)], CHF [6 (3-9) points], and COPD [6 (3-9) points]. Decreases in VT score were significantly associated with increased odds of negative outcomes, including inability to work due to health at baseline [OR (5 points) = 1.27 (95% CI 1.24-1.31), OR (10 points) = 1.62 (1.54-1.71)], job loss at 1 year [OR (5) = 1.13 (1.08-1.19), OR (10) = 1.28 (1.17-1.41)], hospitalization at 1 year [OR (5) = 1.08 (1.05-1.11), OR (10) = 1.17 (1.10-1.23)], short-term mortality [0-18 months-Hazard Ratio (HR) (5) = 1.10-1.71, HR (10) = 1.21-2.39, depending on VT level] and long-term mortality [19+ months-HR (5) = 1.05-1.31, HR (10) = 1.10-1.54]. The mortality risk increase was largest at low VT levels. VT decrements of 5-10 points were seen for diseases known to cause fatigue. Further, differences of 5-10 points in the VT score were associated with significant increased risk of negative outcomes. We recommend an MID of 5 points for analyses of groups with VT scores below average. For follow-up of individual patients, we recommend a 10-point difference as important.

  2. White Matter Integrity and Treatment-Based Change in Speech Performance in Minimally Verbal Children with Autism Spectrum Disorder

    PubMed Central

    Chenausky, Karen; Kernbach, Julius; Norton, Andrea; Schlaug, Gottfried

    2017-01-01

    We investigated the relationship between imaging variables for two language/speech-motor tracts and speech fluency variables in 10 minimally verbal (MV) children with autism. Specifically, we tested whether measures of white matter integrity—fractional anisotropy (FA) of the arcuate fasciculus (AF) and frontal aslant tract (FAT)—were related to change in percent syllable-initial consonants correct, percent items responded to, and percent syllable insertion errors (from best baseline to post 25 treatment sessions). Twenty-three MV children with autism spectrum disorder (ASD) received Auditory-Motor Mapping Training (AMMT), an intonation-based treatment to improve fluency in spoken output, and we report on seven who received a matched control treatment. Ten of the AMMT participants were able to undergo a magnetic resonance imaging study at baseline; their performance on baseline speech production measures is compared to that of the other two groups. No baseline differences were found between groups. A canonical correlation analysis (CCA) relating FA values for left- and right-hemisphere AF and FAT to speech production measures showed that FA of the left AF and right FAT were the largest contributors to the synthetic independent imaging-related variable. Change in percent syllable-initial consonants correct and percent syllable-insertion errors were the largest contributors to the synthetic dependent fluency-related variable. Regression analyses showed that FA values in left AF significantly predicted change in percent syllable-initial consonants correct, no FA variables significantly predicted change in percent items responded to, and FA of right FAT significantly predicted change in percent syllable-insertion errors. Results are consistent with previously identified roles for the AF in mediating bidirectional mapping between articulation and acoustics, and the FAT in its relationship to speech initiation and fluency. They further suggest a division of labor

  3. White Matter Integrity and Treatment-Based Change in Speech Performance in Minimally Verbal Children with Autism Spectrum Disorder.

    PubMed

    Chenausky, Karen; Kernbach, Julius; Norton, Andrea; Schlaug, Gottfried

    2017-01-01

    We investigated the relationship between imaging variables for two language/speech-motor tracts and speech fluency variables in 10 minimally verbal (MV) children with autism. Specifically, we tested whether measures of white matter integrity-fractional anisotropy (FA) of the arcuate fasciculus (AF) and frontal aslant tract (FAT)-were related to change in percent syllable-initial consonants correct, percent items responded to, and percent syllable insertion errors (from best baseline to post 25 treatment sessions). Twenty-three MV children with autism spectrum disorder (ASD) received Auditory-Motor Mapping Training (AMMT), an intonation-based treatment to improve fluency in spoken output, and we report on seven who received a matched control treatment. Ten of the AMMT participants were able to undergo a magnetic resonance imaging study at baseline; their performance on baseline speech production measures is compared to that of the other two groups. No baseline differences were found between groups. A canonical correlation analysis (CCA) relating FA values for left- and right-hemisphere AF and FAT to speech production measures showed that FA of the left AF and right FAT were the largest contributors to the synthetic independent imaging-related variable. Change in percent syllable-initial consonants correct and percent syllable-insertion errors were the largest contributors to the synthetic dependent fluency-related variable. Regression analyses showed that FA values in left AF significantly predicted change in percent syllable-initial consonants correct, no FA variables significantly predicted change in percent items responded to, and FA of right FAT significantly predicted change in percent syllable-insertion errors. Results are consistent with previously identified roles for the AF in mediating bidirectional mapping between articulation and acoustics, and the FAT in its relationship to speech initiation and fluency. They further suggest a division of labor between

  4. Change of ascending reticular activating system with recovery from vegetative state to minimally conscious state in a stroke patient

    PubMed Central

    Jang, Sung Ho; Chang, Chul Hoon; Jung, Young Jin; Seo, You Sung

    2016-01-01

    Abstract Rationale: We report on a stroke patient who showed change of the ascending reticular activating system (ARAS) concurrent with recovery from a vegetative state (VS) to a minimally conscious state (MCS), which was demonstrated on diffusion tensor tractography (DTT). Patient concerns: A 59-year-old male patient underwent CT-guided stereotactic drainage 3 times for management of intracerebral hemorrhage and intraventricular hemorrhage. Diagnosis: After 4 months from onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 6 and a Coma Recovery Scale-Revised score of 2. At 10 months after onset, his GCS score had recovered to 11 with a GRS-R score of 20, and he was able to perform rock–scissors–paper using his right hand according to verbal command. Interventions: On 10-month DTT, marked increased neural connectivity of the thalamic intralaminar nucleus (ILN) to the cerebral cortex was observed in both prefrontal cortexes and the right thalamus compared with 4-month DTT. However, no significant change was observed in the lower dorsal ARAS between the pontine reticular formation (PRF) and the thalamic ILN. In addition, the reconstructed lower ventral ARAS between the PRF and hypothalamus had disappeared in both hemispheres on 10-month DTT. Outcomes: Change of the ARAS was demonstrated in a stroke patient who showed recovery from a VS to an MCS. Lessons: It appeared that the prefrontal cortex and thalamus, which showed increased neural connectivity, contributed to recovery from a VS to an MCS in this patient. PMID:27930506

  5. Conformational changes in the selectivity filter of the open-state KcsA channel: an energy minimization study.

    PubMed

    Miloshevsky, Gennady V; Jordan, Peter C

    2008-10-01

    Potassium channels switch between closed and open conformations and selectively conduct K(+) ions. There are at least two gates. The TM2 bundle at the intracellular site is the primary gate of KcsA, and rearrangements at the selectivity filter (SF) act as the second gate. The SF blocks ion flow via an inactivation process similar to C-type inactivation of voltage-gated K(+) channels. We recently generated the open-state conformation of the KcsA channel. We found no major, possibly inactivating, structural changes in the SF associated with this massive inner-pore rearrangement, which suggests that the gates might act independently. Here we energy-minimize the open state of wild-type and mutant KcsA, validating in silico structures of energy-minimized SFs by comparison with crystallographic structures, and use these data to gain insight into how mutation, ion depletion, and K(+) to Na(+) substitution influence SF conformation. Both E71 or D80 protonations/mutations and the presence/absence of protein-buried water molecule(s) modify the H-bonding network stabilizing the P-loops, spawning numerous SF conformations. We find that the inactivated state corresponds to conformations with a partially unoccupied or an entirely empty SF. These structures, involving modifications in all four P-loops, are stabilized by H-bonds between amide H and carbonyl O atoms from adjacent P-loops, which block ion passage. The inner portions of the P-loops are more rigid than the outer parts. Changes are localized to the outer binding sites, with innermost site S4 persisting in the inactivated state. Strong binding by Na(+) locally contracts the SF around Na(+), releasing ligands that do not participate in Na(+) coordination, and occluding the permeation pathway. K(+) selectivity primarily appears to arise from the inability of the SF to completely dehydrate Na(+) ions due to basic structural differences between liquid water and the "quasi-liquid" SF matrix.

  6. Predictive value of readiness, importance, and confidence in ability to change drinking and smoking.

    PubMed

    Bertholet, Nicolas; Gaume, Jacques; Faouzi, Mohamed; Gmel, Gerhard; Daeppen, Jean-Bernard

    2012-08-29

    Visual analog scales (VAS) are sometimes used to assess change constructs that are often considered critical for change. 1.) To determine the association of readiness to change, importance of changing and confidence in ability to change alcohol and tobacco use at baseline with the risk for drinking (more than 21 drinks per week/6 drinks or more on a single occasion more than once per month) and smoking (one or more cigarettes per day) six months later. 2.) To determine the association of readiness, importance and confidence with alcohol (number of drinks/week, number of binge drinking episodes/month) and tobacco (number of cigarettes/day) use at six months. This is a secondary analysis of data from a multi-substance brief intervention randomized trial. A sample of 461 Swiss young men was analyzed as a prospective cohort. Participants were assessed at baseline and six months later on alcohol and tobacco use, and at baseline on readiness to change, importance of changing and confidence in ability to change constructs, using visual analog scales ranging from 1-10 for drinking and smoking behaviors. Regression models controlling for receipt of brief intervention were employed for each change construct. The lowest level (1-4) of each scale was the reference group that was compared to the medium (5-7) and high (8-10) levels. Among the 377 subjects reporting unhealthy alcohol use at baseline, mean (SD) readiness, importance and confidence to change drinking scores were 3.9 (3.0), 2.7 (2.2) and 7.2 (3.0), respectively. At follow-up, 108 (29%) reported no unhealthy alcohol use. Readiness was not associated with being risk-free at follow-up, but high importance (OR 2.94; 1.15, 7.50) and high confidence (OR 2.88; 1.46, 5.68) were. Among the 255 smokers at baseline, mean readiness, importance and confidence to change smoking scores were 4.6 (2.6), 5.3 (2.6) and 5.9 (2.7), respectively. At follow-up, 13% (33) reported no longer smoking. Neither readiness nor importance was

  7. The growing dependency in health care. Recent changes in medical technology imports and exports in Turkey.

    PubMed

    Semin, S; Güldal, D

    1996-01-01

    This study investigates recent changes related to the import and export of medical technology and their results in Turkey. Between 1980 and 1993 the number of medical technology imports in Turkey rose, and there was a parallel rise in its ratio to total imports and health expenditures. In contrast the ratio of medical technology exports to total exports decreased significantly in the same period. The liberalization of foreign trade and the changes of health services toward free market policy has caused growing import of medical technology in Turkey.

  8. Elastomer Change Out - Justification for minimizing the removal of elastomers in order to prevent cross contamination in a multiproduct facility.

    PubMed

    Parks, Michael; O'Dwyer, Niamh; Bollinger, Jeremy; Johnson, Alan; Goss, Brian; Wyman, Ned; Arroyo, Adeyma; Wood, Joseph; Willison-Parry, Derek

    2017-09-19

    The primary objective of any Biopharmaceutical Product Changeover (PCO) program is to employ control strategies before, during, and after the manufacturing process, as well as from the beginning of the lifecycle approach for the equipment and validation, which will minimize the opportunity for cross- contamination when switching between products. Evaluation of the need for an Elastomer Change Out (ECO) should be considered as a segment of an overall changeover assessment. Lifecycle systems (e.g. Preventive Maintenance (PM), Cleanability Coupon Testing, Good Engineering Practices, etc.) and procedures should be in place and data should be generated demonstrating the soft parts do not harbor residues from the previous product campaign(s). The determination of whether or not to replace elastomers/soft parts should be made in the context of all of these systems along with the proper assessment of Risk. By understanding the actual value of ECO in terms of the overall PCO program, and the other systems and procedures that are in place that protect against cross contamination, the need for ECO for every product changeover is not necessary. The purpose of this paper is to review the practice of ECO at product changeover, evaluate the need for an ECO using a risk based approach, and provide rationale for justifying the reduction or elimination of ECO at product changeover. Copyright © 2017, Parenteral Drug Association.

  9. Tubular B7-1 expression parallels proteinuria levels, but not clinical outcomes in adult minimal change disease patients

    PubMed Central

    Lee, Sung Woo; Baek, Seon Ha; Paik, Jin Ho; Kim, Sejoong; Na, Ki Young; Chae, Dong-Wan; Chin, Ho Jun

    2017-01-01

    B7-1 is thought to play a pathogenic role in minimal-change disease (MCD). Recently, however, doubts have arisen regarding the role of B7-1 expression in MCD. Therefore, we aimed to identify the presence and clinical significance of B7-1 expression in MCD patients. The study participants included 28 adult MCD patients for whom kidney specimens were available. The intensity of B7-1 expression was assessed by two independent specialists. We analysed the association between the intensity of B7-1 expression and clinicopathological variables. No B7-1 expression in the glomeruli was observed in any of the 28 patients. Unexpectedly, however, 75.0% of the patients exhibited tubular B7-1 expression, with 35.7% demonstrating weak positive expressions and 39.3% demonstrating strong positive expressions. The level of proteinuria significantly increased as the intensity of tubular B7-1 expression increased. We also found trends of increasing blood urea nitrogen and serum creatinine levels with increased intensity of tubular B7-1 expression. However, we could not observe definite differences in long- and short-term clinical outcomes depending on the intensity of tubular B7-1 expression. In conclusion, B7-1 was expressed in renal tubular cells but not in glomeruli in adult MCD patients. The intensity of tubular B7-1 expression paralleled proteinuria levels, but not clinical outcomes. PMID:28150736

  10. Electroencephalographic Changes Associated with Antinociceptive Actions of Lidocaine, Ketamine, Meloxicam, and Morphine Administration in Minimally Anaesthetized Dogs

    PubMed Central

    Hui Cheng, Chen; Meng, Goh Yong; Fakurazi, Sharida; Kaka, Asmatullah; Behan, Atique Ahmed

    2015-01-01

    Effects of ketamine and lidocaine on electroencephalographic (EEG) changes were evaluated in minimally anaesthetized dogs, subjected to electric stimulus. Six dogs were subjected to six treatments in a crossover design with a washout period of one week. Dogs were subjected to intravenous boluses of lidocaine 2 mg/kg, ketamine 3 mg/kg, meloxicam 0.2 mg/kg, morphine 0.2 mg/kg and loading doses of lidocaine 2 mg/kg followed by continuous rate infusion (CRI) of 50 and 100 mcg/kg/min, and ketamine 3 mg/kg followed by CRI of 10 and 50 mcg/kg/min. Electroencephalogram was recorded during electrical stimulation prior to any drug treatment (before treatment) and during electrical stimulation following treatment with the drugs (after treatment) under anaesthesia. Anaesthesia was induced with propofol and maintained with halothane at a stable concentration between 0.85 and 0.95%. Pretreatment median frequency was evidently increased (P < 0.05) for all treatment groups. Lidocaine, ketamine, and morphine depressed the median frequency resulting from the posttreatment stimulation. The depression of median frequency suggested evident antinociceptive effects of these treatments in dogs. It is therefore concluded that lidocaine and ketamine can be used in the analgesic protocol for the postoperative pain management in dogs. PMID:25695060

  11. Importance of sexuality in colorectal cancer: predictors, changes, and response to an intimacy enhancement intervention.

    PubMed

    Reese, Jennifer Barsky; Haythornthwaite, Jennifer A

    2016-10-01

    The primary objectives were (1) to examine the importance of sexuality within the self-view and cross-sectional correlates for 120 colorectal cancer patients and (2) to determine whether the importance of sexuality changed for 46 colorectal cancer patients and partners participating in an intimacy enhancement intervention. Two newly developed items assessed importance of sexuality within the self-view (1) currently and (2) before cancer; a calculated change score assessed perceived change. In the cross-sectional sample, associations between importance of sexuality and demographic and medical factors and sexual function status were examined. Intervention participants' importance ratings before and after participation were used to calculate effect sizes. For patients, importance of sexuality before cancer was greater (M = 65.7) than current importance (M = 56.8, p = .001). Greater current importance of sexuality was associated with partnered status, non-metastatic disease, and not being in treatment. Scoring in the sexually functional range was associated with greater current importance of sexuality for men and a smaller perceived change in importance for both men and women (p values <.05). Sexual function status also significantly predicted current importance independent of covariates. Small to medium effect sizes for intervention patients (.37) and partners (.60) were found for increases in importance of sexuality. Items showed evidence of test-retest reliability and construct validity. Coping with sexual concerns is important to those affected by colorectal cancer. Findings suggest that the importance of sexuality can decrease through colorectal cancer and associated sexual problems and can increase through participating in an intimacy-focused intervention.

  12. Serum permeability activity in steroid-resistant minimal change nephrotic syndrome is abolished by treatment of Hodgkin disease.

    PubMed

    Aggarwal, Nidhi; Batwara, Ruchika; McCarthy, Ellen T; Sharma, Ram; Sharma, Mukut; Savin, Virginia J

    2007-11-01

    A circulating permeability factor is present in some patients with minimal change nephrotic syndrome (MCNS) or focal segmental glomerulosclerosis. Nephrotic syndrome occurs in less than 1% of patients with Hodgkin disease. A substance derived from T lymphocytes may be responsible for proteinuria in these patients, but a circulating permeability factor was not shown. Serum permeability activity (P(alb)) of a young man who presented with MCNS was tested over 11 years. He first was treated with oral prednisone, then cyclosporine (CsA; 4 mg/kg/d). Two years after the initial diagnosis, during CsA-induced remission of nephrotic syndrome, Hodgkin disease was diagnosed and he underwent systemic chemotherapy with doxorubicin hydrochloride, bleomycin, vinblastine, and dacarbazine and radiation therapy. P(alb) was 0.67 before CsA therapy. Although CsA treatment decreased proteinuria to protein less than 100 mg/d, P(alb) did not change. P(alb) decreased to 0.19 within 2 weeks of initiation of chemotherapy for Hodgkin disease and has remained at less than 0.17 for the last 9 years. The patient, in remission from Hodgkin disease, has normal renal function and no detectable proteinuria. This is the first demonstration of the presence of P(alb) in a patient with MCNS and subsequent Hodgkin disease. It also is the first report that aggressive chemotherapy abolishes P(alb). Although the potential causal relationship between nephrotic syndrome and Hodgkin disease in this patient is not clear, the immediate decrease in P(alb) during treatment suggests that aggressive chemotherapy may be an effective treatment for patients with high P(alb) in steroid-resistant MCNS or focal segmental glomerulosclerosis.

  13. Reliability, Concurrent Validity, and Minimal Detectable Change for iPhone Goniometer App in Assessing Knee Range of Motion.

    PubMed

    Mehta, Saurabh P; Barker, Katherine; Bowman, Brett; Galloway, Heather; Oliashirazi, Nicole; Oliashirazi, Ali

    2016-11-28

    Much of the published works assessing the reliability of smartphone goniometer apps (SG) have poor generalizability since the reliability was assessed in healthy subjects. No research has established the values for standard error of measurement (SEM) or minimal detectable change (MDC) which have greater clinical utility to contextualize the range of motion (ROM) assessed using the SG. This research examined the test-retest reproducibility, concurrent validity, SEM, and MDC values for the iPhone goniometer app (i-Goni; June Software Inc., v.1.1, San Francisco, CA) in assessing knee ROM in patients with knee osteoarthritis or those after total knee replacement. A total of 60 participants underwent data collection which included the assessment of active knee ROM using the i-Goni and the universal goniometer (UG; EZ Read Jamar Goniometer, Patterson Medical, Warrenville, IL), knee muscle strength, and assessment of pain and lower extremity disability using quadruple numeric pain rating scale (Q-NPRS) and lower extremity functional scale (LEFS), respectively. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of the knee ROM assessed using the i-Goni and UG. Bland and Altman technique examined the agreement between these knee ROM. The SEM and MDC values were calculated for i-Goni assessed knee ROM to characterize the error in a single score and the index of true change, respectively. Pearson correlation coefficient examined concurrent relationships between the i-Goni and other measures. The ICC values for the knee flexion/extension ROM were superior for i-Goni (0.97/0.94) compared with the UG (0.95/0.87). The SEM values were smaller for i-Goni assessed knee flexion/extension (2.72/1.18 degrees) compared with UG assessed knee flexion/extension (3.41/1.62 degrees). Similarly, the MDC values were smaller for both these ROM for the i-Goni (6.3 and 2.72 degrees) suggesting smaller change required to infer true change in knee ROM. The i

  14. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    PubMed Central

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.; Dyer, Paul S.; Frisvad, Jens Christian; Geiser, David; Gräser, Yvonne; Guarro, Josep; Haase, Gerhard; Kwon-Chung, Kyung-Joo; Meyer, Wieland; Pitt, John I.; Samson, Robert A.; Tintelnot, Kathrin; Vitale, Roxana G.; Walsh, Thomas J.

    2014-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability. PMID:25297326

  15. Determining the importance of model calibration for forecasting absolute/relative changes in streamflow from LULC and climate changes

    USGS Publications Warehouse

    Niraula, Rewati; Meixner, Thomas; Norman, Laura M.

    2015-01-01

    Land use/land cover (LULC) and climate changes are important drivers of change in streamflow. Assessing the impact of LULC and climate changes on streamflow is typically done with a calibrated and validated watershed model. However, there is a debate on the degree of calibration required. The objective of this study was to quantify the variation in estimated relative and absolute changes in streamflow associated with LULC and climate changes with different calibration approaches. The Soil and Water Assessment Tool (SWAT) was applied in an uncalibrated (UC), single outlet calibrated (OC), and spatially-calibrated (SC) mode to compare the relative and absolute changes in streamflow at 14 gaging stations within the Santa Cruz River Watershed in southern Arizona, USA. For this purpose, the effect of 3 LULC, 3 precipitation (P), and 3 temperature (T) scenarios were tested individually. For the validation period, Percent Bias (PBIAS) values were >100% with the UC model for all gages, the values were between 0% and 100% with the OC model and within 20% with the SC model. Changes in streamflow predicted with the UC and OC models were compared with those of the SC model. This approach implicitly assumes that the SC model is “ideal”. Results indicated that the magnitude of both absolute and relative changes in streamflow due to LULC predicted with the UC and OC results were different than those of the SC model. The magnitude of absolute changes predicted with the UC and SC models due to climate change (both P and T) were also significantly different, but were not different for OC and SC models. Results clearly indicated that relative changes due to climate change predicted with the UC and OC were not significantly different than that predicted with the SC models. This result suggests that it is important to calibrate the model spatially to analyze the effect of LULC change but not as important for analyzing the relative change in streamflow due to climate change. This

  16. Importance of end-of-life support to minimize caregiver's regret during bereavement of the elderly for better subsequent adaptation to bereavement.

    PubMed

    Akiyama, Akiko; Numata, Kumiko; Mikami, Hiroshi

    2010-01-01

    This study examined whether the quality of end-of-life home medical care affected caregiver's psychological recovery from bereavement. We analyzed survey responses from an anonymous self-administered questionnaire from 147 bereaved family members (caregivers). Questionnaire content included information on the quality of end-of-life home medical care, feelings during bereavement and present feelings. Results showed that caregiver regret during bereavement was significantly associated with present feelings about loss regardless of the length of time after death of a loved one. Aspects of end-of-life support that were statistically significant at minimizing regret during bereavement were: (1) fulfilled home medical care service system, (2) peaceful death of the patient, and (3) providing direct care by the caregiver. These findings suggest that end-of-life support to minimize caregiver regret during bereavement was crucial for better subsequent adaptation to bereavement.

  17. Public Perception of Climate Change: The Importance of Knowledge and Cultural Worldviews.

    PubMed

    Shi, Jing; Visschers, Vivianne H M; Siegrist, Michael

    2015-12-01

    The importance of knowledge for lay people's climate change concerns has been questioned in recent years, as it had been suggested that cultural values are stronger predictors of concern about climate change than knowledge. Studies that simultaneously measured knowledge related to climate change and cultural values have, however, been missing. We conducted a mail survey in the German-speaking part of Switzerland (N = 1,065). Results suggested that cultural worldviews and climate-related knowledge were significantly related with people's concern about climate change. Also, cultural worldviews and climate-relevant knowledge appeared important for people's willingness to change behaviors and to accept climate change policies. In addition, different types of knowledge were found to have different impacts on people's concern about climate change, their willingness to change behaviors, and their acceptance of policies about climate change. Specifically, causal knowledge significantly increased concern about climate change and willingness to support climate-friendly policies. We therefore concluded that risk communication should focus on causal knowledge, provided this knowledge does not threaten cultural values.

  18. Nephrotic syndrome due to minimal change disease secondary to spider bite: clinico-pathological case of a non-described complication of latrodectism

    PubMed Central

    Enos, Daniel; Moreira, José Luis; Alvaredo, Fátima; Oddó, David

    2017-01-01

    Abstract The patient was an 18-year-old man who developed nephrotic syndrome after a ‘wheat spider’ bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism. PMID:28396739

  19. Nephrotic syndrome due to minimal change disease secondary to spider bite: clinico-pathological case of a non-described complication of latrodectism.

    PubMed

    Méndez, Gonzalo P; Enos, Daniel; Moreira, José Luis; Alvaredo, Fátima; Oddó, David

    2017-04-01

    The patient was an 18-year-old man who developed nephrotic syndrome after a 'wheat spider' bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism.

  20. WHICH CRIMINOGENIC NEED CHANGES ARE MOST IMPORTANT IN PROMOTING DESISTANCE FROM CRIME AND SUBSTANCE USE?

    PubMed Central

    WOODITCH, ALESE; TANG, LIANSHENG LARRY; TAXMAN, FAYE S.

    2014-01-01

    Andrews and Bonta identified the following criminogenic needs as important to reducing offending: substance use, antisocial cognition, antisocial associates, family and marital relations, employment, and leisure and recreational activities. This study examines dynamic criminogenic need changes across a 12-month period and identifies which need changes are the best predictors of criminal offending and illicit drug use among a sample of drug-involved probationers who participated in an intervention (N = 251). Probationers had significant changes in several need areas, and treatment participation moderated some changes. Probationers who had reductions in criminally involved family members they associate with, improved work performance, and decreased alcohol use had the greatest reductions in offending. Those who increased time spent engaged in leisure and recreational activities were less likely to self-report subsequent drug use. These findings suggest that certain dynamic need changes may be more important than others, and designing interventions to impact these needs might improve outcomes. PMID:24910480

  1. Impact of warm ischemia time on the change of split renal function after minimally invasive partial nephrectomy in Taiwanese patients.

    PubMed

    Li, Hung-Keng; Chung, Hsiao-Jen; Huang, Eric Y; Lin, Alex T; Chen, Kuang-Kuo

    2015-01-01

    Nephron-sparing surgery has become the standard treatment for T1 renal tumors. However, relevant data on the Taiwanese population are lacking, and most of the current literature uses global instead of split renal function (SRF) for postoperative renal function follow-up. We evaluated the postoperative renal function after minimally invasive partial nephrectomy in Taiwanese patients. We retrospectively reviewed our database from April 2004 to July 2012 and enrolled patients who received laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). The estimated glomerular filtration rate (eGFR) and SRF were calculated as representatives of renal function. The preoperative and 6- and 12-month postoperative renal functions were assessed. Freidman test was used to evaluate pre- and postoperative renal function changes; Wilcoxon test was used for comparing the renal function of each period. The 6- and 12-month postoperative SRF values were decreased compared with the preoperative values. Multivariate analysis revealed that older age was related to a lower postoperative eGFR, and a longer warm ischemia time was related to a decreased postoperative SRF. Patients with a warm ischemia time of >30 minutes were correlated with a larger mean tumor size, higher "preoperative aspects and dimensions used for an anatomical" score, greater amount of blood loss during the operation, longer postoperative hospital stay, and lower postoperative SRF compared with patients with a warm ischemia time of <30 minutes. Patients in the RPN group had shorter warm ischemia time and higher 6-month postoperative SRF compared with patients in the LPN group. SRF is more sensitive for postoperative follow-up than eGFR. Longer warm ischemia time is associated with poorer postoperative renal function. RPN is a safe and feasible alternative to LPN. Copyright © 2014. Published by Elsevier Taiwan.

  2. [Case of goodpasture syndrome associated with minimal change nephrotic syndrome (MCNS) in a patient with rheumatoid arthritis (RA)].

    PubMed

    Takeda, Yoko; Abe, Aya; Toki, Takeshi; Komaba, Hirotaka; Abe, Takaya; Umezu, Michio; Joh, Kensuke; Fukagawa, Masafumi

    2009-01-01

    In early June 2004, a 50-year-old female was admitted to the hospital for slight fever, general fatigue, hemoptysis, dyspnea, and renal dysfunction (serum creatinine[Cr] : 6.05 mg/dL). She had been treated with prednisolone (PSL : 10-20 mg/day) for RA. She was diagnosed with Goodpasture syndrome based on a high titer of anti-glomerular basement membrane antibody (87 EU), and pulmonary hemorrhage. The renal and pulmonary impairments were markedly improved by the pulse therapy, plasma exchange and temporary hemodialysis. However, the Cr level remained at 2.0 mg/dL, indicating nephrotic syndrome. Light microscopy with Periodic acid-Shiff(PAS) staining demonstrated global sclerosis in three of ten glomeruli. Five glomeruli showed the formation of cellular, and fibrocellular crescents, and the formation of fibrous crescents. Tubular damage and interstitial fibrosis were severe. Immunofluorescence microscopy disclosed major depositions of IgG in a linear pattern along the glomerular basement membrane(GBM). Electron microscopy revealed foot process effacement (>50%)and no electron-dense deposits. Therefore, we diagnosed Goodpasture syndrome associated with minimal change nephrotic syndrome (MCNS). Some reports have dealt with the association of RA and Goodpasture syndrome with D-penicillamine, and of RA and antineutrophil cytoplasmic antibodies (ANCA)-related vasculitis with pulmonary hemorrhage, but none has dealt with cases complicated with RA and Goodpasture syndrome associated with MCNS. Accordingly, whether or not there is a causal relationship between RA and Goodpasture syndrome remains obscure, but since the number of reported cases is small, experience with more cases is necessary to clarify this matter.

  3. [Landscape changes of ecotone of temperate and sub-tropical zone and its ecological importance].

    PubMed

    Hou, X

    2001-04-01

    The change process of ecotone of temperate and subtropical zone and its effect on development, transformation and permeation of chinese agriculture and techniques were discussed in this paper from the viewpoint of landscape ecology. In historical time, the boundary of the ecotone changed northward and southward as climate changed, which changed southward 1-2 latitude in cold period and northward 1-2 latitude in warm period. The ecotone had an obvious environment diversity and strong sensibility, and played important role as a landscape conduit and barrier in aspects of chinese agricultural heterogeneous permeation and heterogeneity creation of agricultural techniques and cultures.

  4. Responsiveness and minimally important difference for the patient-reported outcomes measurement information system (PROMIS) 20-item physical functioning short form in a prospective observational study of rheumatoid arthritis.

    PubMed

    Hays, Ron D; Spritzer, Karen L; Fries, James F; Krishnan, Eswar

    2015-01-01

    To estimate responsiveness (sensitivity to change) and minimally important difference (MID) for the Patient-Reported Outcomes Measurement Information System (PROMIS) 20-item physical functioning scale (PROMIS PF-20). The PROMIS PF-20, short form 36 (SF-36) physical functioning scale, and Health Assessment Questionnaire (HAQ) were administered at baseline, and 6 and 12 months later to a sample of 451 persons with rheumatoid arthritis. A retrospective change (anchor) item was administered at the 12-month follow-up. We estimated responsiveness between 12 months and baseline, and between 12 months and 6 months using one-way analysis of variance F-statistics. We estimated the MID for the PROMIS PF-20 using prospective change for people reporting getting 'a little better' or 'a little worse' on the anchor item. F-statistics for prospective change on the PROMIS PF-20, SF-36 and HAQ by the anchor item over 12 and 6 months (in parentheses) were 16.64 (14.98), 12.20 (7.92) and 10.36 (12.90), respectively. The MID for the PROMIS PF-20 was 2 points (about 0.20 of an SD). The PROMIS PF-20 is more responsive than two widely used ('legacy') measures. The MID is a small effect size. The measure can be useful for assessing physical functioning in clinical trials and observational studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study.

    PubMed

    Zhou, Yang; Li, Zili; Wang, Xiaoxia; Zou, Bingshuang; Zhou, Yanheng

    2016-02-01

    In this study, we aimed to compare treatment efficacy and postsurgical stability between minimal presurgical orthodontics and conventional presurgical orthodontics for patients with skeletal Class III malocclusion. Forty patients received minimal presurgical orthodontics (n = 20) or conventional presurgical orthodontics (n = 20). Lateral cephalograms were obtained before treatment, before orthognathic surgery, and at 1 week, 3 months, 6 months, and 12 months after surgery. Changes of overjet and mandibular incisal angle before surgery were greater in the conventional presurgical orthodontics group than in the minimal presurgical orthodontics group. Postsurgical horizontal changes in Points A and B, overjet, and mandibular incisal angle showed significant differences among the time points. Most of the horizontal and vertical relapses in the maxilla and the mandible occurred within the first 6 months in both groups. Minimal presurgical orthodontics and conventional presurgical orthodontics showed similar extents and directions of skeletal changes in patients with Class III malocclusion. However, orthodontists and surgeons should preoperatively consider the postsurgical counterclockwise rotation of the mandible when using minimal presurgical orthodontics. Close and frequent observations are recommended in the early postsurgical stages. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  6. Ecosystem response to climatic change: the importance of the cold season.

    PubMed

    Bokhorst, Stef; Bjerke, Jarle W; Tømmervik, Hans; Preece, Catherine; Phoenix, Gareth K

    2012-01-01

    Winter climate and snow cover are the important drivers of plant community development in polar regions. However, the impacts of changing winter climate and associated changes in snow regime have received much less attention than changes during summer. Here, we synthesize the results from studies on the impacts of extreme winter weather events on polar heathland and lichen communities. Dwarf shrubs, mosses and soil arthropods were negatively impacted by extreme warming events while lichens showed variable responses to changes in extreme winter weather events. Snow mould formation underneath the snow may contribute to spatial heterogeneity in plant growth, arthropod communities and carbon cycling. Winter snow cover and depth will drive the reported impacts of winter climate change and add to spatial patterns in vegetation heterogeneity. The challenges ahead lie in obtaining better predictions on the snow patterns across the landscape and how these will be altered due to winter climate change.

  7. Personality and social change: individual differences, life path, and importance attributed to the women's movement.

    PubMed

    Agronick, G S; Duncan, L E

    1998-06-01

    This article identifies antecedent characteristics of individuals who found the women's movement important and then shows how finding it important was associated with personality change. Eighty-six women provided personality and life data as college seniors in 1958 or 1960, prior to the onset of the women's movement, and in 1981, after the movement gained momentum. A combination of openness, ambition, and dissatisfaction, as assessed by California Psychological Inventory (CPI; H. Gough, 1957/1966) in college, and subsequent life path from ages 28 to 43 significantly predicted importance attributed to the women's movement (IWM). On CPI scales, IWM was associated with significant increases on scales including Dominance, Self-Acceptance, Empathy, Psychological Mindedness, and Achievement via Independence. Correlates of IWM with self-reported feelings at ages 33 and 43 and observer-based personality ratings at age 43 supplemented analyses of personality change. Findings support the utility of examining the impact of social change on personality.

  8. Predictive value of readiness, importance, and confidence in ability to change drinking and smoking

    PubMed Central

    2012-01-01

    Background Visual analog scales (VAS) are sometimes used to assess change constructs that are often considered critical for change. Aims of Study: 1.) To determine the association of readiness to change, importance of changing and confidence in ability to change alcohol and tobacco use at baseline with the risk for drinking (more than 21 drinks per week/6 drinks or more on a single occasion more than once per month) and smoking (one or more cigarettes per day) six months later. 2.) To determine the association of readiness, importance and confidence with alcohol (number of drinks/week, number of binge drinking episodes/month) and tobacco (number of cigarettes/day) use at six months. Methods This is a secondary analysis of data from a multi-substance brief intervention randomized trial. A sample of 461 Swiss young men was analyzed as a prospective cohort. Participants were assessed at baseline and six months later on alcohol and tobacco use, and at baseline on readiness to change, importance of changing and confidence in ability to change constructs, using visual analog scales ranging from 1–10 for drinking and smoking behaviors. Regression models controlling for receipt of brief intervention were employed for each change construct. The lowest level (1–4) of each scale was the reference group that was compared to the medium (5–7) and high (8–10) levels. Results Among the 377 subjects reporting unhealthy alcohol use at baseline, mean (SD) readiness, importance and confidence to change drinking scores were 3.9 (3.0), 2.7 (2.2) and 7.2 (3.0), respectively. At follow-up, 108 (29%) reported no unhealthy alcohol use. Readiness was not associated with being risk-free at follow-up, but high importance (OR 2.94; 1.15, 7.50) and high confidence (OR 2.88; 1.46, 5.68) were. Among the 255 smokers at baseline, mean readiness, importance and confidence to change smoking scores were 4.6 (2.6), 5.3 (2.6) and 5.9 (2.7), respectively. At follow-up, 13% (33) reported no longer

  9. Taxonomic update on proposed nomenclature and classification changes for bacteria of medical importance, 2016.

    PubMed

    Janda, J Michael

    2017-05-01

    A key aspect of medical, public health, and diagnostic microbiology laboratories is the accurate identification and rapid reporting and communication to medical staff regarding patients with infectious agents of clinical importance. Microbial taxonomy in the age of molecular diagnostics and phylogenetics creates changes in taxonomy at a logarithmic rate further complicating this process. This update focuses on the description of new species and classification changes proposed in 2016. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Some important issues to do with long-term sea level change.

    PubMed

    Woodworth, Philip L

    2006-04-15

    This paper gives an overview of several important issues concerned with the measurement and understanding of long-term sea level change, which is one of the most important topics in sea level science. The issues discussed span science, technology and our ability to fund and operate the national and global observation networks required for a proper understanding of long-term change and its impacts. Many of these topics were explored at a 'Celebration of UK sea level science' at the Royal Society on 16-17 February 2004, and are discussed further in a number of papers in this volume.

  11. Nitrogen deposition mediates the effects and importance of chance in changing biodiversity.

    PubMed

    Zhang, Ximei; Liu, Wei; Bai, Yongfei; Zhang, Guangming; Han, Xingguo

    2011-01-01

    Nitrogen deposition is changing biodiversity on Earth. We need to understand the underlying mechanisms to conserve biodiversity better. Both selection and chance are potential mechanisms, and they may operate concurrently. Then, what are the respective effects of selection and chance, what is their relative importance and how do they change with increasing nitrogen deposition rate? Here, we performed a 6-year nitrogen addition experiment (0-28 g N/m(2) /year) in a typical steppe ecosystem of Inner Mongolia to investigate the community structure of plants, bacteria and ammonia-oxidizing Archaea (AOA). We developed an experimentally based calculation method to first separate the structural variations between plots into the effects of selection (S) and chance (C), and then calculate their relative importance. Our results showed that as nitrogen addition rate increased, S for both plants and bacteria increased, but C for plants first increased and then decreased, and C for bacteria also increased; meanwhile, both S and C for AOA changed nonlinearly. As nitrogen addition rate increased, the importance of chance decreased on the whole for all these communities, but it decreased nonlinearly for plants and bacteria, with a local increase at certain intermediate rates. At all treatments, the importance of chance was <0.5 for plants, but >0.5 for AOA. These results demonstrated that nitrogen deposition changed biodiversity by mediating the effects and importance of chance, implicating different strategies should be adopted in conserving biodiversity according to nitrogen deposition rate and community properties.

  12. Determination of the Minimal Clinically Important Difference Scores for the Cystic Fibrosis Questionnaire-Revised Respiratory Symptom Scale in Two Populations of Patients With Cystic Fibrosis and Chronic Pseudomonas aeruginosa Airway Infection

    PubMed Central

    Quittner, Alexandra L.; Modi, Avani C.; Wainwright, Claire; Otto, Kelly; Kirihara, Jean; Montgomery, A. Bruce

    2009-01-01

    Background: The Cystic Fibrosis Questionnaire-Revised (CFQ-R) is a validated patient-reported outcome (PRO) containing both generic scales and scales specific to cystic fibrosis (CF). The minimal clinically important difference (MCID) score for a PRO corresponds to the smallest clinically relevant change a patient can detect. MCID scores for the CFQ-R respiratory symptom (CFQ-R-Respiratory) scale were determined using data from two 28 day, open-label, tobramycin inhalation solution (TIS) studies in patients with CF and chronic Pseudomonas aeruginosa airway infection. At study enrollment, patients in the study 1-exacerbation had symptoms indicative of pulmonary exacerbation (n = 84; < 14 years of age, 31 patients; ≥ 14 years of age, 53 patients); patients in study 2-stable had stable respiratory symptoms (n = 140; < 14 years of age, 14 patients; ≥ 14 years, 126 patients). Methods: The anchor-based method utilized a global rating-of-change questionnaire (GRCQ) that assessed patients' perceptions of change in their respiratory symptoms after TIS treatment. The mean change from baseline CFQ-R-Respiratory scores were mapped onto the GRCQ to estimate the MCID. The two distribution-based methods were as follows: (1) 0.5 SD of mean change in CFQ-R-Respiratory scores (baseline to end of TIS treatment); and (2) 1 SEM for baseline CFQ-R-Respiratory scores. Triangulation of these three estimates defined the MCIDs. Results: MCID scores were larger for patients in study 1-exacerbation (8.5 points) than for those in study 2-stable (4.0 points), likely reflecting differences in patient disease status (exacerbation/stable) between these studies. Conclusions: Patient benefit from new and current CF therapies can be evaluated using changes in CFQ-R-Respiratory scores. Using the MCID provides a systematic way to interpret these changes, and facilitates the identification of CF treatments that improve both symptoms and physiologic variables, potentially leading to better treatment

  13. Importance of early weight change in a pediatric weight management trial.

    PubMed

    Goldschmidt, Andrea B; Stein, Richard I; Saelens, Brian E; Theim, Kelly R; Epstein, Leonard H; Wilfley, Denise E

    2011-07-01

    Early weight change is associated with overall weight loss treatment response in adults but has been relatively unexplored in youth. We investigated the importance of early weight change in a pediatric weight control trial. Overweight children aged 7 to 12 years (n=204) participated in a randomized controlled trial of 2 weight maintenance treatments (MTs) after a 20-week family-based behavioral weight loss treatment (FBT). Hierarchical regression was used to investigate the relation between children's percentage weight change at sessions 4, 6, and 8 of FBT and BMI z-score reductions after FBT and at the 2-year follow-up. Correlations and hierarchical regression were used to identify child and parent factors associated with children's early weight change. Children's percentage weight change by FBT session 8 was the best predictor of BMI z-score reductions after FBT and at 2-year follow-up. Percentage weight change in children at session 8 was associated with better FBT attendance and with greater percentage weight change in parents at FBT session 8. Early weight change seems to be related to treatment response through the end of treatment and 2-year follow-up. Future research should include investigation of strategies to promote early weight change in children and parents and identification of mechanisms through which early weight change is related to overall treatment response. Copyright © 2011 by the American Academy of Pediatrics.

  14. Developmental changes in maternal education and minimal exposure effects on vocabulary in English- and Spanish-learning toddlers.

    PubMed

    Friend, Margaret; DeAnda, Stephanie; Arias-Trejo, Natalia; Poulin-Dubois, Diane; Zesiger, Pascal

    2017-12-01

    The current research follows up on two previous findings: that children with minimal dual-language exposure have smaller receptive vocabularies at 16months of age and that maternal education is a predictor of vocabulary when the dominant language is English but not when it is Spanish. The current study extends this research to 22-month-olds to assess the developmental effects of minimal exposure and maternal education on direct and parent-report measures of vocabulary size. The effects of minimal exposure on vocabulary size are no longer present at 22months of age, whereas maternal education effects remain but only for English speakers. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Spontaneous remission of therapy-resistant minimal change nephritis in an adult woman 12 years after onset of the disease.

    PubMed

    Raml, Anton; Sedlak, Martin; Schmekal, Bernhard; Stuby, Ulrike; Syre', Georg; Biesenbach, Georg

    2006-07-01

    A 23-year old woman was admitted to our hospital because of severe edema due to steroid resistant minimal change nephritis (MCN). The diagnosis was proven by renal biopsy nine years ago. At that time, steroid therapy led to a complete remission. Seven years later, patient was 22 years old, a relapse with severe nephrotic syndrome occurred. The diagnosis MCN was confirmed by a second renal biopsy. A combined therapy with prednisolone and cyclosporine A (CSA) led only to a partial reduction of protein excretion, the edema did not disappear. After 3 months, patient declined further therapy with CSA. On admission to our hospital, one year later in December 2000, the woman showed a severe nephrotic syndrome with edema and fluid lung, despite high doses of furosemide. Urinary protein excretion was 12.5 g/day, serum creatinine was increased to 1.4 mg/dl, the serum protein was reduced to 47 g/l. A repeated renal biopsy confirmed again the diagnosis MCN. Once again, a steroid bolus monotherapy over 4 weeks and an immunosuppressive therapy with CSA over 6 weeks had no effect on proteinuria. Further therapy regimes with mofetil mycophenolat, azathioprine, chlorambucil and cyclophosphamide over a period of 6-12 weeks of each regime was not well tolerated, proteinuria remained high with > 10 g/day. Moreover the patient suffered from severe edema despite furosemide infusions. Therefore, an additional mechanical ultrafiltration was performed 2-4 times monthly. Three months after the last immunosuppressive therapy the edema disappeared spontaneously, the diuretic therapy could be stopped. Serum creatinine was 0.8 mg/dl, protein in urine was still high with 9.8 g/day but serum protein for the first time was normal with 65 g/l. Three months later, the protein excretion was reduced to 0.48 g/l, and all other laboratory data were normal. Meanwhile, the woman has now enjoyed a complete second spontaneous remission for a period of three years.

  16. Minimal genetic change in Vibrio cholerae in Mozambique over time: Multilocus variable number tandem repeat analysis and whole genome sequencing.

    PubMed

    Garrine, Marcelino; Mandomando, Inácio; Vubil, Delfino; Nhampossa, Tacilta; Acacio, Sozinho; Li, Shan; Paulson, Joseph N; Almeida, Mathieu; Domman, Daryl; Thomson, Nicholas R; Alonso, Pedro; Stine, Oscar Colin

    2017-06-01

    Although cholera is a major public health concern in Mozambique, its transmission patterns remain unknown. We surveyed the genetic relatedness of 75 Vibrio cholerae isolates from patients at Manhiça District Hospital between 2002-2012 and 3 isolates from river using multilocus variable-number tandem-repeat analysis (MLVA) and whole genome sequencing (WGS). MLVA revealed 22 genotypes in two clonal complexes and four unrelated genotypes. WGS revealed i) the presence of recombination, ii) 67 isolates descended monophyletically from a single source connected to Wave 3 of the Seventh Pandemic, and iii) four clinical isolates lacking the cholera toxin gene. This Wave 3 strain persisted for at least eight years in either an environmental reservoir or circulating within the human population. Our data raises important questions related to where these isolates persist and how identical isolates can be collected years apart despite our understanding of high change rate of MLVA loci and the V. cholerae molecular clock.

  17. Hope and Climate Change: The Importance of Hope for Environmental Engagement among Young People

    ERIC Educational Resources Information Center

    Ojala, Maria

    2012-01-01

    Although many young people think climate change is an important societal issue, studies indicate that pessimism is quite common. Finding ways to instill hope could therefore be seen as vital. However, is hope positively related to engagement or is it only a sign of illusory optimism? The aim of the study was to explore if hope concerning climate…

  18. The Changing Importance of White Women's Economic Prospects for Assortative Mating

    ERIC Educational Resources Information Center

    Sweeney, Megan M.; Cancian, Maria

    2004-01-01

    Given recent changes in the labor force participation and economic standing of women, we ask whether a woman's position in the labor market has become a more important determinant of her position in the marriage market. Unlike much prior research on trends over time in assortative mating, we take an individual-level approach to the analysis and…

  19. Change in Moral Outlook Is an Important Topic of Environmental Education

    ERIC Educational Resources Information Center

    Suohua, Li

    2004-01-01

    It is a common recognition that humankind is facing an ecological environmental crisis. In order to protect the ecological system, to protect nature and thus to safeguard the continued existence of humankind, not only technological, economic, and managerial measures are needed, but more importantly, a change must take place in people's thinking so…

  20. What's a Good Job? The Importance of Employment Relationships. CPRN Study. Changing Employment Relationships Series.

    ERIC Educational Resources Information Center

    Lowe, Graham S.; Schellenberg, Grant

    The Changing Employment Relationships Project examined the importance of good employment relationships for workers, employers, and public policy. A nationally representative sample of 2,500 employed Canadians was surveyed, and 8 focus groups were conducted. The research findings were analyzed to explain the multidimensional nature of the…

  1. Hope and Climate Change: The Importance of Hope for Environmental Engagement among Young People

    ERIC Educational Resources Information Center

    Ojala, Maria

    2012-01-01

    Although many young people think climate change is an important societal issue, studies indicate that pessimism is quite common. Finding ways to instill hope could therefore be seen as vital. However, is hope positively related to engagement or is it only a sign of illusory optimism? The aim of the study was to explore if hope concerning climate…

  2. Change in Moral Outlook Is an Important Topic of Environmental Education

    ERIC Educational Resources Information Center

    Suohua, Li

    2004-01-01

    It is a common recognition that humankind is facing an ecological environmental crisis. In order to protect the ecological system, to protect nature and thus to safeguard the continued existence of humankind, not only technological, economic, and managerial measures are needed, but more importantly, a change must take place in people's thinking so…

  3. Dangerous climate change and the importance of adaptation for the Arctic's Inuit population

    NASA Astrophysics Data System (ADS)

    Ford, James D.

    2009-04-01

    The Arctic's climate is changing rapidly, to the extent that 'dangerous' climate change as defined by the United Nations Framework on Climate Change might already be occurring. These changes are having implications for the Arctic's Inuit population and are being exacerbated by the dependence of Inuit on biophysical resources for livelihoods and the low socio-economic-health status of many northern communities. Given the nature of current climate change and projections of a rapidly warming Arctic, climate policy assumes a particular importance for Inuit regions. This paper argues that efforts to stabilize and reduce greenhouse gas emissions are urgent if we are to avoid runaway climate change in the Arctic, but unlikely to prevent changes which will be dangerous for Inuit. In this context, a new policy discourse on climate change is required for Arctic regions—one that focuses on adaptation. The paper demonstrates that states with Inuit populations and the international community in general has obligations to assist Inuit to adapt to climate change through international human rights and climate change treaties. However, the adaptation deficit, in terms of what we know and what we need to know to facilitate successful adaptation, is particularly large in an Arctic context and limiting the ability to develop response options. Moreover, adaptation as an option of response to climate change is still marginal in policy negotiations and Inuit political actors have been slow to argue the need for adaptation assistance. A new focus on adaptation in both policy negotiations and scientific research is needed to enhance Inuit resilience and reduce vulnerability in a rapidly changing climate.

  4. Functional load and the lexicon: Evidence that syntactic category and frequency relationships in minimal lemma pairs predict the loss of phoneme contrasts in language change.

    PubMed

    Wedel, Andrew; Jackson, Scott; Kaplan, Abby

    2013-09-01

    All languages use individually meaningless, contrastive categories in combination to create distinct words. Despite their central role in communication, these "phoneme" contrasts can be lost over the course of language change. The century-old functional load hypothesis proposes that loss of a phoneme contrast will be inhibited in relation to the work that it does in distinguishing words. In a previous work we showed for the first time that a simple measure of functional load does significantly predict patterns of contrast loss within a diverse set of languages: the more minimal word pairs that a phoneme contrast distinguishes, the less likely those phonemes are to have merged over the course of language change. Here, we examine several lexical properties that are predicted to influence the uncertainty between word pairs in usage. We present evidence that (a) the lemma rather than surface-form count of minimal pairs is more predictive of merger; (b) the count of minimal lemma pairs that share a syntactic category is a stronger predictor of merger than the count of those with divergent syntactic categories, and (c) that the count of minimal lemma pairs with members of similar frequency is a stronger predictor of merger than that of those with more divergent frequencies. These findings support the broad hypothesis that properties of individual utterances influence long-term language change, and are consistent with findings suggesting that phonetic cues are modulated in response to lexical uncertainty within utterances.

  5. New insight into the pathogenesis of minimal change nephrotic syndrome: Role of the persistence of respiratory tract virus in immune disorders.

    PubMed

    Zhang, Hui; Wang, Zheng; Dong, Liqun; Guo, Yannan; Wu, Jin; Zhai, Songhui

    2016-07-01

    The pathogenesis of minimal change nephrotic syndrome (MCNS) is a complex clinical problem which, unfortunately, has been in need of significant breakthroughs for decades. Improved understanding of the mechanisms is important to develop effective treatment strategies. To our knowledge, the pathogenesis of MCNS is multifactorial, involving both intrinsic and extrinsic factors, reasonable to be regarded as a "long chain" cascade reaction. Current studies implicating that the disease could probably be caused by immune disorders, however, have focused merely on the middle or terminal of this "long chain". It remains unclear what really triggers the immune disorders. It is noteworthy that the close association of respiratory tract infection with the occurrence, relapse and aggravation of nephrotic syndrome has been confirmed for over two decades. Derived from what we demonstrated in earlier studies, that the persistence of respiratory tract virus may contribute to the onset and development of MCNS, this review summarizes current evidence investigating the possible mechanisms of viral persistence, and discusses the role of viral persistence in the pathogenesis of MCNS. The key point is: whether the persistence of respiratory tract virus results in immune disorders. The available evidence under review also highlight the fact that the background of genetic susceptibility to the disease was found in many patients, which could be triggered by extrinsic factors, e.g. by the infection of respiratory tract virus. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. The importance of phylogeny to the study of phenological response to global climate change.

    PubMed

    Davis, Charles C; Willis, Charles G; Primack, Richard B; Miller-Rushing, Abraham J

    2010-10-12

    Climate change has resulted in major changes in the phenology--i.e. the timing of seasonal activities, such as flowering and bird migration--of some species but not others. These differential responses have been shown to result in ecological mismatches that can have negative fitness consequences. However, the ways in which climate change has shaped changes in biodiversity within and across communities are not well understood. Here, we build on our previous results that established a link between plant species' phenological response to climate change and a phylogenetic bias in species' decline in the eastern United States. We extend a similar approach to plant and bird communities in the United States and the UK that further demonstrates that climate change has differentially impacted species based on their phylogenetic relatedness and shared phenological responses. In plants, phenological responses to climate change are often shared among closely related species (i.e. clades), even between geographically disjunct communities. And in some cases, this has resulted in a phylogenetically biased pattern of non-native species success. In birds, the pattern of decline is phylogenetically biased but is not solely explained by phenological response, which suggests that other traits may better explain this pattern. These results illustrate the ways in which phylogenetic thinking can aid in making generalizations of practical importance and enhance efforts to predict species' responses to future climate change.

  7. The importance of phylogeny to the study of phenological response to global climate change

    PubMed Central

    Davis, Charles C.; Willis, Charles G.; Primack, Richard B.; Miller-Rushing, Abraham J.

    2010-01-01

    Climate change has resulted in major changes in the phenology—i.e. the timing of seasonal activities, such as flowering and bird migration—of some species but not others. These differential responses have been shown to result in ecological mismatches that can have negative fitness consequences. However, the ways in which climate change has shaped changes in biodiversity within and across communities are not well understood. Here, we build on our previous results that established a link between plant species' phenological response to climate change and a phylogenetic bias in species' decline in the eastern United States. We extend a similar approach to plant and bird communities in the United States and the UK that further demonstrates that climate change has differentially impacted species based on their phylogenetic relatedness and shared phenological responses. In plants, phenological responses to climate change are often shared among closely related species (i.e. clades), even between geographically disjunct communities. And in some cases, this has resulted in a phylogenetically biased pattern of non-native species success. In birds, the pattern of decline is phylogenetically biased but is not solely explained by phenological response, which suggests that other traits may better explain this pattern. These results illustrate the ways in which phylogenetic thinking can aid in making generalizations of practical importance and enhance efforts to predict species' responses to future climate change. PMID:20819813

  8. Estimating the Importance of Private Adaptation to Climate Change in Agriculture: A Review of Empirical Methods

    NASA Astrophysics Data System (ADS)

    Moore, F.; Burke, M.

    2015-12-01

    A wide range of studies using a variety of methods strongly suggest that climate change will have a negative impact on agricultural production in many areas. Farmers though should be able to learn about a changing climate and to adjust what they grow and how they grow it in order to reduce these negative impacts. However, it remains unclear how effective these private (autonomous) adaptations will be, or how quickly they will be adopted. Constraining the uncertainty on this adaptation is important for understanding the impacts of climate change on agriculture. Here we review a number of empirical methods that have been proposed for understanding the rate and effectiveness of private adaptation to climate change. We compare these methods using data on agricultural yields in the United States and western Europe.

  9. Validity, reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-BESTest and brief-BESTest in patients with end-stage renal disease.

    PubMed

    Jácome, Cristina; Flores, Inês; Martins, Filipa; Castro, Conceição; McPhee, Charlotte C; Shepherd, Ellen; Demain, Sara; Figueiredo, Daniela; Marques, Alda

    2017-09-08

    This study determined the validity, test-retest reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) in patients with end-stage renal disease. A cross-sectional study with 74 patients with end-stage renal disease (male 66.2%; 63.9 ± 15.1 years old) was conducted. Participants were asked to report the number of falls during the previous 12 months and to complete the activity-specific balance confidence (ABC) scale. The BESTest was administered, and the Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC scale. Test-retest relative reliability and agreement were explored with the intraclass correlation coefficient (ICC) equation (2,1) and the Bland and Altman method. Minimal detectable changes at the 95% confidence level were established. Balance test scores were significantly correlated with each other (spearman's correlation = 0.89-0.92) and with the ABC scale (spearman's correlation = 0.49-0.59). Balance tests presented high test-retest reliability (ICC = 0.84-0.94), with no evidence of bias. Minimal detectable change values were 10.8 (expressed as a percentage 13.5%), 5.3 (23.7%) and 5.6 (34%) points for the BESTest, Mini-BESTest and Brief-BESTest, respectively. All tests are valid and reliable to assess balance in patients with end-stage renal disease. Nevertheless, based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended tests for this specific population. Implications for Rehabilitation Balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) are reliable and valid in patients with end stage renal disease (ESRD). The minimal detectable

  10. Ducks change wintering patterns due to changing climate in the important wintering waters of the Odra River Estuary.

    PubMed

    Marchowski, Dominik; Jankowiak, Łukasz; Wysocki, Dariusz; Ławicki, Łukasz; Girjatowicz, Józef

    2017-01-01

    Some species of birds react to climate change by reducing the distance they travel during migration. The Odra River Estuary in the Baltic Sea is important for wintering waterfowl and is where we investigated how waterbirds respond to freezing surface waters. The most abundant birds here comprise two ecological groups: bottom-feeders and piscivores. Numbers of all bottom-feeders, but not piscivores, were negatively correlated with the presence of ice. With ongoing global warming, this area is increasing in importance for bottom-feeders and decreasing for piscivores. The maximum range of ice cover in the Baltic Sea has a weak and negative effect on both groups of birds. Five of the seven target species are bottom-feeders (Greater Scaup Aythya marila, Tufted Duck A. fuligula, Common Pochard A. ferina, Common Goldeneye Bucephala clangula and Eurasian Coot Fulica atra), and two are piscivores (Smew Mergellus albellus and Goosander Mergus merganser). Local changes at the level of particular species vary for different reasons. A local decline of the Common Pochard may simply be a consequence of its global decline. Climate change is responsible for some of the local changes in the study area, disproportionately favoring some duck species while being detrimental to others.

  11. Ducks change wintering patterns due to changing climate in the important wintering waters of the Odra River Estuary

    PubMed Central

    Jankowiak, Łukasz; Wysocki, Dariusz; Ławicki, Łukasz; Girjatowicz, Józef

    2017-01-01

    Some species of birds react to climate change by reducing the distance they travel during migration. The Odra River Estuary in the Baltic Sea is important for wintering waterfowl and is where we investigated how waterbirds respond to freezing surface waters. The most abundant birds here comprise two ecological groups: bottom-feeders and piscivores. Numbers of all bottom-feeders, but not piscivores, were negatively correlated with the presence of ice. With ongoing global warming, this area is increasing in importance for bottom-feeders and decreasing for piscivores. The maximum range of ice cover in the Baltic Sea has a weak and negative effect on both groups of birds. Five of the seven target species are bottom-feeders (Greater Scaup Aythya marila, Tufted Duck A. fuligula, Common Pochard A. ferina, Common Goldeneye Bucephala clangula and Eurasian Coot Fulica atra), and two are piscivores (Smew Mergellus albellus and Goosander Mergus merganser). Local changes at the level of particular species vary for different reasons. A local decline of the Common Pochard may simply be a consequence of its global decline. Climate change is responsible for some of the local changes in the study area, disproportionately favoring some duck species while being detrimental to others. PMID:28785517

  12. The relative importance of predictors of body mass index change, overweight and obesity in adolescent girls.

    PubMed

    Rehkopf, David H; Laraia, Barbara A; Segal, Mark; Braithwaite, Dejana; Epel, Elissa

    2011-06-01

    To determine the relative importance of familial, dietary, behavioral, psychological and social risk factors for predicting body mass index (BMI) change, and onset of overweight and obesity among adolescent girls. Data from the NHLBI Growth and Health Study (n = 2 150), a longitudinal cohort of girls, were used to identify the most important predictors of change in BMI percentile between the ages of 9 and 19 years, and second, risk for becoming overweight and obese. Forty-one baseline predictors were assessed using a tree-based regression method (Random forest) to rank the relative importance of risk factors. The five factors that best predicted change in BMI percentile (p < 0.05) were related to family socio-economic position (income and parent education) and drive to restrict eating and weight (body dissatisfaction, drive for thinness and unhappiness with physical appearance). The factors that were statistically significant (p < 0.05) predictors of both onset of overweight and obesity were income, ineffectiveness and race. Family socio-economic position and emotion regulation appeared as the top predictors of both BMI change and onset of overweight and obesity. Our results build upon prior findings that policies to prevent the onset of obesity during adolescence be targeted towards girls from lower socio-economic position households. Our findings also suggest several novel psychological factors including ineffectiveness as predictors of obesity during adolescence. These predictive findings offer a direction for future inquiry into adolescent obesity etiology using causal methods.

  13. Short-term changes in plans to drink and importance of positive and negative alcohol consequences.

    PubMed

    Patrick, Megan E; Maggs, Jennifer L

    2008-06-01

    Experienced consequences predicted short-term changes in alcohol use plans and perceptions of the importance of alcohol-related consequences. Participants were 176 traditionally aged first-year university students who completed a 10-week telephone diary study (total weeks=1735). In multi-level models, men and students who experienced more positive and negative consequences on average planned to drink more and rated avoiding negative consequences as less important. Students who experienced more positive consequences rated them as more important (between-person analyses). Following weeks of experiencing relatively more positive drinking consequences, students planned to drink more and rated experiencing positive consequences as more important for the subsequent week (within-person analyses). Challenges for intervening in the ongoing formation of anticipatory cognitions regarding alcohol use are discussed.

  14. Update: US oil-import market. 1982 top 7 suppliers to US import market: how their shares changed since 1973

    SciTech Connect

    Not Available

    1983-03-09

    This issue updates the Energy Detente 7/09/82, which tracked US oil imports since the Arab Oil Embargo. Since then, the phrase oil glut became common even among cautious market analysts as many exporters, hard-pressed for petrodollars, produced much more than the market was prepared to absorb. To examine how the US import market has adjusted to this continued buyers market, the top seven suppliers of 1982 are tracked backwards through time. A graph shows the 1982 reversal of Mexico's and Saudi Arabia's positions in this market. The three main reasons for Mexico's strong present position in the US market are: crude costs and corresponding refined value; proximity to US refining centers; and strategic importance of Mexico's economic stability through oil sales. Interviews with various US refiners and other market observers confirm that these elements will persist during 1983, regardless of significant price cuts among OPEC and other producers. It is believed that the profitability of running heavy Maya crude in sophisticated plants will continue to look optimistic, and that Mexican crude sales to the Strategic Petroleum Reserve implies US government interest in Mexico's economic recovery, and in its stability in the light of civil wars being waged in Central America. This issue presents the Energy Detente (1) fuel price/tax series and (2) industrial fuel prices for March 1983 for countries of the Eastern Hemisphere. 6 figures, 8 tables.

  15. The Importance of Contexts in Strategies of Environmental Organizations with Regard to Climate Change

    PubMed

    Pleune

    1997-09-01

    / The purpose of the study was to investigate the extent to which strategies of environmental organizations depend on contexts. I examined this dependence by analyzing the strategies of five environmental organizations in the Netherlands with regard to climate change. These strategies were investigated over time and compared with the strategies these organizations had used in relation to ozone depletion and acidification. The results indicate that several of the organizations changed their strategies with respect to climate change over time. Furthermore, different strategies were used simultaneously in relation to the three problems. The findings suggest that strategies concerning climate change were to a considerable extent determined by the dominant framing of the problem in society. This framing was defined mainly by actors other than environmental organizations. The initial framing of climate change as a CO2 problem, which brought the issue into the energy debate, as well as the more general definition of the problem in the late 1980s as a greenhouse problem, were very important for determining the strategies of the organizations. It can be concluded that strategies of Dutch environmental organizations with regard to climate change were strongly dependent on the context.KEY WORDS: Environmental organization; Strategy; Climate change; Man-nature relationship; Problem definition; Context

  16. Offspring loss after male change in wild siamangs: the importance of abrupt weaning and male care.

    PubMed

    Morino, Luca; Borries, Carola

    2017-01-01

    Infanticide by males is assumed to promote permanent male-female associations, although its importance for social monogamy is still debated. We examined the consequences of male membership change in the largest socially monogamous primate, the siamang (Symphalangus syndactylus), a species that also forms polyandrous groups and where males may provide offspring care. We examine (a) the potential risk of infanticide by documenting changes in female-offspring relationships following male change, expecting abrupt weaning; and (b) the potential importance of male care and polyandry for offspring survival. We witnessed four male changes at Way Canguk Field Station (Indonesia) in groups where the youngest offspring was estimated to be about 2 years of age. We quantified aspects of mother-offspring relationships (interindividual distance, body contact, and nipple contact) and estimated the proportion of time being carried during travel (August 2007-April 2009). In the two groups into which new males immigrated, offspring were weaned abruptly, suggesting infanticide by males as a potential risk. Even though no attacks on infants by males were witnessed, both infants disappeared shortly after the male change. Another infant disappeared after its main carrier (a male) emigrated. Conversely, in a group where the resident subordinate male replaced the dominant male, the offspring experienced no change in care and survived the transition. These findings suggest that male immigration in hylobatids increases mortality risk for infants, emphasize the importance of offspring care, and cast doubts on prior classifications of 2-year-old siamangs as independently traveling individuals. © 2016 Wiley Periodicals, Inc.

  17. Global environmental change effects on ecosystems: the importance of land-use legacies.

    PubMed

    Perring, Michael P; De Frenne, Pieter; Baeten, Lander; Maes, Sybryn L; Depauw, Leen; Blondeel, Haben; Carón, María M; Verheyen, Kris

    2016-04-01

    One of the major challenges in ecology is to predict how multiple global environmental changes will affect future ecosystem patterns (e.g. plant community composition) and processes (e.g. nutrient cycling). Here, we highlight arguments for the necessary inclusion of land-use legacies in this endeavour. Alterations in resources and conditions engendered by previous land use, together with influences on plant community processes such as dispersal, selection, drift and speciation, have steered communities and ecosystem functions onto trajectories of change. These trajectories may be modulated by contemporary environmental changes such as climate warming and nitrogen deposition. We performed a literature review which suggests that these potential interactions have rarely been investigated. This crucial oversight is potentially due to an assumption that knowledge of the contemporary state allows accurate projection into the future. Lessons from other complex dynamic systems, and the recent recognition of the importance of previous conditions in explaining contemporary and future ecosystem properties, demand the testing of this assumption. Vegetation resurvey databases across gradients of land use and environmental change, complemented by rigorous experiments, offer a means to test for interactions between land-use legacies and multiple environmental changes. Implementing these tests in the context of a trait-based framework will allow biologists to synthesize compositional and functional ecosystem responses. This will further our understanding of the importance of land-use legacies in determining future ecosystem properties, and soundly inform conservation and restoration management actions. © 2015 John Wiley & Sons Ltd.

  18. Importance of choosing a change of support model for global reserves estimation

    SciTech Connect

    Lantuejoul, C.

    1988-11-01

    The practical problem considered here is: how can block distribution in an ore body be forecast from sample data. The task is arduous because information yielded by samples is too often insufficient to allow an accurate evaluation of blocks. In practice, necessary additional information is obtained via a model. Choosing that model is crucial; the value of results reflects the model, i.e., its adequacy to represent reality. In this paper, the importance of choosing the change of support model is illustrated with simulations and practical examples (especially deposits with a skewed sample distribution and a large spike at the origin). An attempt to quantify this importance is made also.

  19. Greenland during the last interglacial: the relative importance of insolation and oceanic changes

    NASA Astrophysics Data System (ADS)

    Pedersen, Rasmus A.; Langen, Peter L.; Vinther, Bo M.

    2016-09-01

    Insolation changes during the Eemian (the last interglacial period, 129 000-116 000 years before present) resulted in warmer than present conditions in the Arctic region. The NEEM ice core record suggests warming of 8 ± 4 K in northwestern Greenland based on stable water isotopes. Here we use general circulation model experiments to investigate the causes of the Eemian warming in Greenland. Simulations of the atmospheric response to combinations of Eemian insolation and preindustrial oceanic conditions and vice versa are used to disentangle the impacts of the insolation change and the related changes in sea surface temperatures and sea ice conditions. The changed oceanic conditions cause warming throughout the year, prolonging the impact of the summertime insolation increase. Consequently, the oceanic conditions cause an annual mean warming of 2 K at the NEEM site, whereas the insolation alone causes an insignificant change. Taking the precipitation changes into account, however, the insolation and oceanic changes cause more comparable increases in the precipitation-weighted temperature, implying that both contributions are important for the ice core record at the NEEM site. The simulated Eemian precipitation-weighted warming of 2.4 K at the NEEM site is low compared to the ice core reconstruction, partially due to missing feedbacks related to ice sheet changes and an extensive sea ice cover. Surface mass balance calculations with an energy balance model further indicate that the combination of temperature and precipitation anomalies leads to potential mass loss in the north and southwestern parts of the ice sheet. The oceanic conditions favor increased accumulation in the southeast, while the insolation appears to be the dominant cause of the expected ice sheet reduction. Consequently, the Eemian is not a suitable analogue for future ice sheet changes.

  20. Minimizing casualties in biological and chemical threats (war and terrorism): the importance of information to the public in a prevention program.

    PubMed

    Noy, Shabtai

    2004-01-01

    The most effective means of defending against biological or chemical warfare, whether in war or as a result of terror, is the use of primary prevention. The main goal of such a prevention program is to minimize the human loss by reducing the number of casualties (fatalities, physical wounds, and psychological injury). A secondary objective is to prevent the widespread sense of helplessness in the general population. These two aims complement each other. The more the public is active in defending itself, rather than viewing itself as helpless, the lesser the expected number of casualties of any kind. In order to achieve these two goals, educating the civilian population about risk factors and pointing out appropriate defensive strategies is critical. In the absence of an effective prevention program and active participation by the public, there is a high risk for massive numbers of physical and psychological casualties. An essential ingredient of any preventive program, which ultimately may determine the success or failure of all other protective actions, is early, gradual dissemination of information and guidance to the public, so that citizens can become active participants in the program. The public needs to be given information concerning the nature of the threat and effective methods of coping with it, should an unconventional attack occur. Lack of such adaptive behavior (such as wearing protective gear) is likely to bring about vast numbers of physical and psychological casualties. These large numbers may burden the medical, political, and public safety systems beyond their ability to manage. Failure to provide reasonable prevention and effective interventions can lead to a destruction of the social and emotional fabric of individuals and the society. Furthermore, inadequate preparation, education, and communication can result in the development of damaging mistrust of the political and military leadership, disintegration of social and political structures

  1. Determining the Importance of Calibration for Predicting Relative Changes in Streamflow from Land Use/Cover Changes

    NASA Astrophysics Data System (ADS)

    Niraula, R.; Meixner, T.; Norman, L. M.

    2012-12-01

    Human-induced land use/cover (LULC) change and climate change can have significant impacts on water quantity and quality. Prediction of impacts due to anticipated LULC and climate change on water in arid and semi-arid regions are crucial to understand due to scarce water resources. Watershed models are often used to analyze the effects of land use/cover and climate change on water resources, commonly in terms of relative changes; and provide important information for decision making. These models are often calibrated and validated with available data which can be time consuming and sometimes even very difficult. The objective of this study is to quantify the variation of estimated relative changes in streamflow associated with LULC with uncalibrated, single outlet calibrated and spatially-calibrated watershed model. Soil and Water Assessment Tool (SWAT) was applied in an uncalibrated, single outlet calibrated, and spatially-calibrated (at 7 USGS stream-gaging stations) mode to compare and quantify the relative change in terms of magnitude and direction of flow in a 9000 km2 semi-arid Santa Cruz watershed on the border of southern Arizona, United States, and northern Sonora, Mexico. While the average annual precipitation over the whole watershed is approximately 430 mm, the average annual discharge ranges between 0.17 and 2.64 m3/s. The effect due to three LULC scenarios, where urbanization is expected to increase from ~12% in 1999 to range of 35-40% in 2050 was analyzed. For the 7 USGS stations, all 3 calibration scenarios demonstrated an increase in predicted flow but magnitude of predicted change varied. The uncalibrated model predicted the increase from 4% to 15%, the single-outlet calibrated model predicted between 5% and 105%, and the spatially-calibrated model predicted the increase to be between 4% and 170%. While the results were similar between uncalibrated and single outlet calibration at some stations, the results were more similar to single outlet and

  2. Prognostic importance of weight change on short-term functional outcome in acute ischemic stroke.

    PubMed

    Kim, Yerim; Kim, Chi Kyung; Jung, Seunguk; Ko, Sang-Bae; Lee, Seung-Hoon; Yoon, Byung-Woo

    2015-10-01

    Controversy exists regarding the question of whether weight change decreases or increases the risk of mortality. The aim of this study was to evaluate the prognostic importance of weight change on short-term outcomes in acute ischemic stroke patients. A total of 654 patients with acute ischemic stroke were enrolled in this study from March 2010 to May 2013. We assessed the weight change of each participant between admission and discharge from the Department of Neurology. Weight change was defined as change ≥0·05 kg/baseline body mass index unit. We evaluated the short-term outcomes using a modified Rankin Scale at three-months after the onset of a stroke. Among the 654 patients, 35·2% were included in the weight-change group. Weight loss occurred in 24·6% of the participants during the hospital stay following the stroke, which lasted an average of nine-days. Compared with the weight-stable group, the pronounced weight-loss group had a higher risk of unfavorable outcomes (odds ratio 2·43; 95% confidence interval 1·12-5·25). Short-term weight loss after stroke appears to be more common than we expected, and our results suggest that it is associated with unfavorable functional outcomes. Therefore, clinical nutrition should be considered as a component of medical treatment and weight loss should be monitored as an indicator of malnutrition. © 2015 World Stroke Organization.

  3. The personal importance of being independent: associations with changes in disability and depressive symptoms.

    PubMed

    Monin, Joan K; Schulz, Richard; Martire, Lynn M; Connelly, Dyan; Czaja, Sara J

    2014-02-01

    This study examined the role of independence centrality (the personal importance of being functionally independent) in adapting to functional disability in persons with spinal cord injury (SCI). We assessed how changes in disability related to changes in depressive symptoms, the association between independence centrality and depressive symptoms, and the role of independence centrality in moderating the association between changes in disability and changes in depressive symptoms. Using data from a randomized controlled trial, we focused on 173 survivors of SCI who completed baseline and 12-month follow-up measures of independence centrality, disability (activities of daily living and instrumental activities of daily living needs), and depressive symptoms. Consistent with our predictions, increased disability was related to increased depressive symptoms, and higher independence centrality was associated with more depressive symptoms at baseline. Consistent with the life span theory of control, SCI survivors with high independence centrality experienced more depressive symptoms when disability increased, but less depressive symptoms when disability decreased. Survivors of SCI with low independence centrality were less affected by changing levels of disability. Persons with SCI with high independence centrality have higher levels of depressive symptoms and are more responsive to changes in functional status. Given the functional status trajectories of survivors of SCI, having low independence centrality may be adaptive because it facilitates disengagement from unattainable goals. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  4. Heat tolerance predicts the importance of species interaction effects as the climate changes.

    PubMed

    Diamond, Sarah E; Chick, Lacy; Penick, Clint A; Nichols, Lauren M; Cahan, Sara Helms; Dunn, Robert R; Ellison, Aaron M; Sanders, Nathan J; Gotelli, Nicholas J

    2017-07-01

    Few studies have quantified the relative importance of direct effects of climate change on communities versus indirect effects that are mediated thorough species interactions, and the limited evidence is conflicting. Trait-based approaches have been popular in studies of climate change, but can they be used to estimate direct versus indirect effects? At the species level, thermal tolerance is a trait that is often used to predict winners and losers under scenarios of climate change. But thermal tolerance might also inform when species interactions are likely to be important because only subsets of species will be able to exploit the available warmer climatic niche space, and competition may intensify in the remaining, compressed cooler climatic niche space. Here, we explore the relative roles of the direct effects of temperature change and indirect effects of species interactions on forest ant communities that were heated as part of a large-scale climate manipulation at high- and low-latitude sites in eastern North America. Overall, we found mixed support for the importance of negative species interactions (competition), but found that the magnitude of these interaction effects was predictable based on the heat tolerance of the focal species. Forager abundance and nest site occupancy of heat-intolerant species were more often influenced by negative interactions with other species than by direct effects of temperature. Our findings suggest that measures of species-specific heat tolerance may roughly predict when species interactions will influence responses to global climate change. © The Author 2017. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

  5. Population dynamics can be more important than physiological limits for determining range shifts under climate change.

    PubMed

    Fordham, Damien A; Mellin, Camille; Russell, Bayden D; Akçakaya, Reşit H; Bradshaw, Corey J A; Aiello-Lammens, Matthew E; Caley, Julian M; Connell, Sean D; Mayfield, Stephen; Shepherd, Scoresby A; Brook, Barry W

    2013-10-01

    Evidence is accumulating that species' responses to climate changes are best predicted by modelling the interaction of physiological limits, biotic processes and the effects of dispersal-limitation. Using commercially harvested blacklip (Haliotis rubra) and greenlip abalone (Haliotis laevigata) as case studies, we determine the relative importance of accounting for interactions among physiology, metapopulation dynamics and exploitation in predictions of range (geographical occupancy) and abundance (spatially explicit density) under various climate change scenarios. Traditional correlative ecological niche models (ENM) predict that climate change will benefit the commercial exploitation of abalone by promoting increased abundances without any reduction in range size. However, models that account simultaneously for demographic processes and physiological responses to climate-related factors result in future (and present) estimates of area of occupancy (AOO) and abundance that differ from those generated by ENMs alone. Range expansion and population growth are unlikely for blacklip abalone because of important interactions between climate-dependent mortality and metapopulation processes; in contrast, greenlip abalone should increase in abundance despite a contraction in AOO. The strongly non-linear relationship between abalone population size and AOO has important ramifications for the use of ENM predictions that rely on metrics describing change in habitat area as proxies for extinction risk. These results show that predicting species' responses to climate change often require physiological information to understand climatic range determinants, and a metapopulation model that can make full use of this data to more realistically account for processes such as local extirpation, demographic rescue, source-sink dynamics and dispersal-limitation. © 2013 John Wiley & Sons Ltd.

  6. Role of media and peers on body change strategies among adult men: is body size important?

    PubMed

    McCabe, Marita P; McGreevy, Shauna J

    2011-01-01

    There has been limited previous research that has examined the role of sociocultural influences on body change strategies among adult men. The current study investigated the role of specific types of messages (encouragement, teasing and modelling) from peers and the media on the strategies to change weight among adult men. Differences were evaluated between 526 men aged from 18 to 60 years from three groups (normal weight, overweight and obese) on body image, body change strategies and messages about their body received from peers and the media. Men were primarily drawn from United States, Australia and Europe. Results showed that messages received by men regarding losing weight or increasing muscle size differed according to weight. Body image and media messages were the strongest predictors of losing weight, whereas body image importance and messages from peers were the strongest predictors of increasing muscles. These findings highlight the importance of sociocultural influences on body change strategies among adult males. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

  7. Minimal Reduplication

    ERIC Educational Resources Information Center

    Kirchner, Jesse Saba

    2010-01-01

    This dissertation introduces Minimal Reduplication, a new theory and framework within generative grammar for analyzing reduplication in human language. I argue that reduplication is an emergent property in multiple components of the grammar. In particular, reduplication occurs independently in the phonology and syntax components, and in both cases…

  8. Minimal Reduplication

    ERIC Educational Resources Information Center

    Kirchner, Jesse Saba

    2010-01-01

    This dissertation introduces Minimal Reduplication, a new theory and framework within generative grammar for analyzing reduplication in human language. I argue that reduplication is an emergent property in multiple components of the grammar. In particular, reduplication occurs independently in the phonology and syntax components, and in both cases…

  9. The importance of employee participation and perceptions of changes in procedures in a teamworking intervention.

    PubMed

    Nielsen, Karina; Randall, Raymond

    2012-04-01

    The powerful positive results of implementing teamwork are not always achieved. It has been suggested that attempts to implement theories regarding teamwork do not always lead to those theories being put into practice, and as a result positive outcomes are not always found. The participation of employees in the development and implementation of an intervention may help to ensure that changes take place. In this longitudinal study (N = 583) of teamwork implementation in Denmark we examined the links between pre-intervention working conditions and well-being, levels of participation in planning and implementation, employees' reports of changes in procedures, and intervention outcomes. Pre-intervention levels of autonomy and job satisfaction predicted the degree of employee participation in the planning and implementation of the intervention. Pre-intervention well-being and social support were linked directly to the degree to which employees reported changes in existing work practices concerning teamwork. In addition, participation and changes in work procedures were significantly associated with post-intervention autonomy, social support and well-being. The results indicate that employee participation in intervention processes is crucial in what appears to be an important association with perceived changes in procedures and, therefore, in intervention outcomes.

  10. The relative importance of directional change, random walks, and stasis in the evolution of fossil lineages.

    PubMed

    Hunt, Gene

    2007-11-20

    The nature of evolutionary changes recorded by the fossil record has long been controversial, with particular disagreement concerning the relative frequency of gradual change versus stasis within lineages. Here, I present a large-scale, statistical survey of evolutionary mode in fossil lineages. Over 250 sequences of evolving traits were fit by using maximum likelihood to three evolutionary models: directional change, random walk, and stasis. Evolution in these traits was rarely directional; in only 5% of fossil sequences was directional evolution the most strongly supported of the three modes of change. The remaining 95% of sequences were divided nearly equally between random walks and stasis. Variables related to body size were significantly less likely than shape traits to experience stasis. This finding is in accord with previous suggestions that size may be more evolutionarily labile than shape and is consistent with some but not all of the mechanisms proposed to explain evolutionary stasis. In general, similar evolutionary patterns are observed across other variables, such as clade membership and temporal resolution, but there is some evidence that directional change in planktonic organisms is more frequent than in benthic organisms. The rarity with which directional evolution was observed in this study corroborates a key claim of punctuated equilibria and suggests that truly directional evolution is infrequent or, perhaps more importantly, of short enough duration so as to rarely register in paleontological sampling.

  11. The importance of employee participation and perceptions of changes in procedures in a teamworking intervention

    PubMed Central

    Nielsen, Karina; Randall, Raymond

    2012-01-01

    The powerful positive results of implementing teamwork are not always achieved. It has been suggested that attempts to implement theories regarding teamwork do not always lead to those theories being put into practice, and as a result positive outcomes are not always found. The participation of employees in the development and implementation of an intervention may help to ensure that changes take place. In this longitudinal study (N = 583) of teamwork implementation in Denmark we examined the links between pre-intervention working conditions and well-being, levels of participation in planning and implementation, employees’ reports of changes in procedures, and intervention outcomes. Pre-intervention levels of autonomy and job satisfaction predicted the degree of employee participation in the planning and implementation of the intervention. Pre-intervention well-being and social support were linked directly to the degree to which employees reported changes in existing work practices concerning teamwork. In addition, participation and changes in work procedures were significantly associated with post-intervention autonomy, social support and well-being. The results indicate that employee participation in intervention processes is crucial in what appears to be an important association with perceived changes in procedures and, therefore, in intervention outcomes. PMID:22745519

  12. The importance of role sending in the sensemaking of change agent roles.

    PubMed

    Tucker, Danielle A; Hendy, Jane; Barlow, James

    2015-01-01

    The purpose of this paper is to investigate what happens when a lack of role-sending results in ambiguous change agent roles during a large scale organisational reconfiguration. The authors consider the role of sensemaking in resolving role ambiguity of middle manager change agents and the consequences of this for organisational restructuring. Data were collected from a case study analysis of significant organisational reconfiguration across a local National Health Service Trust in the UK. Data consists of 82 interviews, complemented by analysis of over 100 documents and field notes from 51 hours of observations collected over five phases covering a three year period before, during and after the reconfiguration. An inductive qualitative analysis revealed the sensemaking processes by which ambiguity in role definition was resolved. The data explains how change agents collectively make sense of a role in their own way, drawing on their own experiences and views as well as cues from other organisational members. The authors also identified the organisational outcomes which resulted from this freedom in sensemaking. This study demonstrates that by leaving too much flexibility in the definition of the role, agents developed their own sensemaking which was subsequently very difficult to manipulate. In creating new roles, management first needs to have a realistic vision of the task and roles that their agents will perform, and second, to communicate these expectations to both those responsible for recruiting these roles and to the agents themselves. Much of the focus in sensemaking research has been on the importance of change agents' sensemaking of the change but there has been little focus on how change agents sensemake their own role in the change.

  13. Statistically and clinically important change of pain scores in patients with myogenous temporomandibular disorders.

    PubMed

    van Grootel, Robert J; van der Glas, Hilbert W

    2009-05-01

    A within-patient change in pain score after treatment is statistically 'reliable' when it exceeds the smallest detectable difference (SDD). The aims of the present study were (i) to determine SDD for scoring pain behavior on a 0-5 point adjectival scale, and (ii) to explore the relationship between SDD, clinically important difference (CID) and effect size (ES) following treatment of known efficacy, and to compare these parameters of pain behavior with those of VAS-scores of pain intensity [van Grootel RJ, van der Bilt A, van der Glas HW. Long-term reliable change of pain scores in individual myogenous TMD patients. Eur J Pain 2007;11:635-43]. SDD was determined using duplicate scores on pain behavior from a pre-treatment diary that was completed by 118 patients with myogenous temporomandibular disorders (TMD). CID was determined as the mean change in score following treatment, and Cohen's ES as the ratio between mean change and SD of baseline values. The SDDs were 2-3 units (40-60% of the scale range) for test-retest intervals of 1-13 days. CID was 1.13 units (22.6%) and ES was 1.38. The normalized SDD and CID values and ES were similar for VAS-scores of pain intensity, i.e., 38-49% (SDD), 24.2% (CID) and 1.09 (ES). Because reliable change (change>SDD) exceeds CID, the responsiveness of scoring of pain variables is low for detecting CID. The finding of ES values that are larger than 0.5 (ES for patients with chronic degenerative diseases [Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life. The remarkable universality of half a standard deviation. Med Care 2003;41:582-92]) suggests that for myogenous TMD (chronic pain not caused by somatic disease and with a large chance on recovery following treatment), there are higher expectations of what constitutes important change.

  14. The importance of climate change and nitrogen use efficiency for future nitrous oxide emissions from agriculture

    NASA Astrophysics Data System (ADS)

    Kanter, David R.; Zhang, Xin; Mauzerall, Denise L.; Malyshev, Sergey; Shevliakova, Elena

    2016-09-01

    Nitrous oxide (N2O) is an important greenhouse gas and ozone depleting substance. Previous projections of agricultural N2O (the dominant anthropogenic source) show emissions changing in tandem, or at a faster rate than changes in nitrogen (N) consumption. However, recent studies suggest that the carbon dioxide (CO2) fertilization effect may increase plant N uptake, which could decrease soil N losses and dampen increases in N2O. To evaluate this hypothesis at a global scale, we use a process-based land model with a coupled carbon-nitrogen cycle to examine how changes in climatic factors, land-use, and N application rates could affect agricultural N2O emissions by 2050. Assuming little improvement in N use efficiency (NUE), the model projects a 24%-31% increase in global agricultural N2O emissions by 2040-2050 depending on the climate scenario—a relatively moderate increase compared to the projected increases in N inputs (42%-44%) and previously published emissions projections (38%-75%). This occurs largely because the CO2 fertilization effect enhances plant N uptake in several regions, which subsequently dampens N2O emissions. And yet, improvements in NUE could still deliver important environmental benefits by 2050: equivalent to 10 Pg CO2 equivalent and 0.6 Tg ozone depletion potential.

  15. Complexities in the attribution of trends: disentangling drivers of change and the importance of metadata

    NASA Astrophysics Data System (ADS)

    Harrigan, Shaun; Murphy, Conor; Hall, Julia; Wilby, Rob

    2013-04-01

    The cause of trends detected in hydrological monitoring networks is rarely rigorously explored. Without the known driver(s) of change, information obtained from a trend analysis is of limited benefit in a planning and adaptation policy perspective. Here, using the Boyne catchment in Ireland as a case study, a more in-depth examination of both external and internal drivers of change is undertaken. A widely cited paper on this catchment reported a statistically significant step change in the mid 1970s and linked the cause of increased river flow post 1975 to a change in the North Atlantic Oscillation at that time. A detailed historic and metadata analysis suggested a more complex interplay of multiple drivers internally within the catchment. Most notably, an extensive arterial drainage scheme that was undertaken during the period 1969-86. In order to eliminate the influence of arterial drainage on river flow a model based approached was employed. River flow data from the pre-drainage period along with meteorological data was used to calibrate conceptual rainfall runoff models in order to reconstruct continuous flow series spanning the pre- and post-drainage eras. Model parameter and structure uncertainties were explored via three conceptually and structurally diverse models. A trend analysis was applied to both the recorded and simulated time series. To assess the impact of arterial drainage on trend direction and magnitude the Mann-Kendall and Theil-Sen Approach was utilised while step changes were assessed using the Rodionov Regime Shift Index. Results show that when the influence of arterial drainage is removed the previously detected change, attributed to a change in the North Atlantic Oscillation, was no longer present. It is therefore important to explore and understand better the causes of changes of river flow at the catchment scale. While detailed metadata assessments are time consuming and elimination of artificial changes difficult, these results show that

  16. The changing brain: Neuroscience and the enduring import of everyday experience.

    PubMed

    Pickersgill, Martyn; Martin, Paul; Cunningham-Burley, Sarah

    2015-10-01

    Discourses of 'neuroplasticity' have become increasingly apparent in the neurosciences and wider society. These connect with broader narratives about the 'changing brain' throughout the life-course. Here, we explore their presence in the talk of a range of publics. Their presence is indicative of how novel neuroscience is accepted, or not, by our participants. In particular, we suggest that any acceptance of the science relates to their personal and/or professional experiences of change (to their own or others' subjectivities) rather than to some intrinsic and widely-held significance of scientific concepts per se. Accordingly, we also submit that it is in part through the congruence of some neuroscientific claims to everyday experiences and perspectives that the former are rendered legible and salient. In this respect, 'lay' knowledge has considerable import for the wider cultural authorisation of that of 'experts'.

  17. The changing brain: Neuroscience and the enduring import of everyday experience

    PubMed Central

    Martin, Paul; Cunningham-Burley, Sarah

    2015-01-01

    Discourses of ‘neuroplasticity’ have become increasingly apparent in the neurosciences and wider society. These connect with broader narratives about the ‘changing brain’ throughout the life-course. Here, we explore their presence in the talk of a range of publics. Their presence is indicative of how novel neuroscience is accepted, or not, by our participants. In particular, we suggest that any acceptance of the science relates to their personal and/or professional experiences of change (to their own or others’ subjectivities) rather than to some intrinsic and widely-held significance of scientific concepts per se. Accordingly, we also submit that it is in part through the congruence of some neuroscientific claims to everyday experiences and perspectives that the former are rendered legible and salient. In this respect, ‘lay’ knowledge has considerable import for the wider cultural authorisation of that of ‘experts’. PMID:24598481

  18. Measurement of utility in asthma: evidence indicating that generic instruments may miss clinically important changes.

    PubMed

    Sullivan, Patrick W; Ghushchyan, Vahram H; Campbell, Jonathan D; Globe, Gary; Bender, Bruce; Magid, David J

    2016-12-01

    Accurate assessment of preference-based health-related quality of life is important in determining the value of asthma interventions. To examine the sensitivity and responsiveness of the EQ-5D and the AQL-5D to differences in asthma control measured by the Asthma Control Questionnaire (ACQ-5). The Observational Study of Asthma Control and Outcomes was a prospective survey of persistent asthma patients ≥12 years old in Kaiser Colorado. Patients received a survey three times in 1 year, including the ACQ-5, AQL-5D and EQ-5D-3L (including VAS). Censored Least Absolute Deviations (CLAD) and logistic regression were used, controlling for sociodemographics and smoking. There were 6666 completed surveys (1799 individuals completed all three survey waves). After controlling for covariates, each one-point increase in ACQ-5 was associated with a decrease of 0.066, 0.058, 0.074 and 6.12 in EQ-5D(US), EQ-5D(UK), AQL-5D and VAS scores. Uncontrolled asthma (ACQ-5 > 1.5) was associated with a decrease of 0.15, 0.17, 0.11 and 10, respectively (vs. ACQ ≤ 1.5). AQL-5D scores were statistically significantly different across categories of ACQ-5 scores of 0.5 (the minimum clinically important difference [MCID]), while EQ-5D scores were not significant across most categories. The AQL-5D appeared more robust to changes in control over time (responsiveness) compared to EQ-5D-3L. The AQL-5D appears more responsive to changes in asthma control over time and more sensitive to detecting differences corresponding to the ACQ-5 MCID than the EQ-5D-3L. Using the EQ-5D-3L without an asthma-specific measure such as the AQL-5D may miss clinically important changes in asthma control.

  19. Post Testicular Sperm Maturational Changes in the Bull: Important Role of the Epididymosomes and Prostasomes

    PubMed Central

    Caballero, Julieta; Frenette, Gilles; Sullivan, Robert

    2011-01-01

    After spermatogenesis, testicular spermatozoa are not able to fertilize an oocyte, they must undergo sequential maturational processes. Part of these essential processes occurs during the transit of the spermatozoa through the male reproductive tract. Since the sperm become silent in terms of translation and transcription at the testicular level, all the maturational changes that take place on them are dependent on the interaction of spermatozoa with epididymal and accessory gland fluids. During the last decades, reproductive biotechnologies applied to bovine species have advanced significantly. The knowledge of the bull reproductive physiology is really important for the improvement of these techniques and the development of new ones. This paper focuses on the importance of the sperm interaction with the male reproductive fluids to acquire the fertilizing ability, with special attention to the role of the membranous vesicles present in those fluids and the recent mechanisms of protein acquisition during sperm maturation. PMID:20981306

  20. Cardiac arrest due to drowning--changes over time and factors of importance for survival.

    PubMed

    Claesson, Andreas; Lindqvist, Jonny; Herlitz, Johan

    2014-05-01

    To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. The importance of parameterization when simulating the hydrologic response of vegetative land-cover change

    NASA Astrophysics Data System (ADS)

    White, Jeremy; Stengel, Victoria; Rendon, Samuel; Banta, John

    2017-08-01

    Computer models of hydrologic systems are frequently used to investigate the hydrologic response of land-cover change. If the modeling results are used to inform resource-management decisions, then providing robust estimates of uncertainty in the simulated response is an important consideration. Here we examine the importance of parameterization, a necessarily subjective process, on uncertainty estimates of the simulated hydrologic response of land-cover change. Specifically, we applied the soil water assessment tool (SWAT) model to a 1.4 km2 watershed in southern Texas to investigate the simulated hydrologic response of brush management (the mechanical removal of woody plants), a discrete land-cover change. The watershed was instrumented before and after brush-management activities were undertaken, and estimates of precipitation, streamflow, and evapotranspiration (ET) are available; these data were used to condition and verify the model. The role of parameterization in brush-management simulation was evaluated by constructing two models, one with 12 adjustable parameters (reduced parameterization) and one with 1305 adjustable parameters (full parameterization). Both models were subjected to global sensitivity analysis as well as Monte Carlo and generalized likelihood uncertainty estimation (GLUE) conditioning to identify important model inputs and to estimate uncertainty in several quantities of interest related to brush management. Many realizations from both parameterizations were identified as behavioral in that they reproduce daily mean streamflow acceptably well according to Nash-Sutcliffe model efficiency coefficient, percent bias, and coefficient of determination. However, the total volumetric ET difference resulting from simulated brush management remains highly uncertain after conditioning to daily mean streamflow, indicating that streamflow data alone are not sufficient to inform the model inputs that influence the simulated outcomes of brush

  2. Ongoing change of site conditions important for sustainable forest management planning

    NASA Astrophysics Data System (ADS)

    Bidló, András; Horváth, Adrienn; Gulyás, Krisztina; Gálos, Borbála

    2016-04-01

    Observed tree mortality of the last decades has shown that the vulnerable forest ecosystems are especially affected by the recurrent, long lasting droughts, heat waves and their consequences. From all site conditions climate is changing the fastest, in this way it can be the largest threatening factor in the 21st century. Beyond climate, soil characteristics are playing an important influencing role. Until now, silvicultural technologies and species preferences of many countries are prescribed by binding regulation based on climate conditions that are assumed to be constant over time. Therefore the aim of our research was to investigate the ongoing and projected change of site conditions that are considered to be of primary importance in terms of tree species selection. For a case study region in Hungary (Keszthely Mountains, near to Lake Balaton) long-term climate tendencies have been determined for the period 1961-2100, as well as a detailed soil sample analysis has been carried out including ~100 sites. Results show a 0.5 degree increase of temperature and a 6-7 % decrease of the precipitation amount for the summer months in the last decades. For the future, significant warming and drying of summers is expected. Decrease of the summer precipitation sum can exceed 25 % until the end of the century, probability of extreme hot days may increase. These tendencies together with the unfavourable soil conditions and biotic damages can be the reason of the ongoing forest dieback. One of the characteristic soil type of the region is rendzina with a thin topsoil layer and an unfavourable water holding capacity. These properties are limiting the amount of available water for plants, especially in case of intense precipitation events. Black pine stands planted on rendzinas after many years of grazing; therefore erosion may have played a significant role. Not only microclimate conditions but also soil types show a large diversity within a relatively small distance. However

  3. An experimental study on minimally occlusive laser-assisted vascular anastomosis in bypass surgery: the importance of temperature monitoring during laser welding procedures.

    PubMed

    Esposito, G; Rossi, F; Puca, A; Albanese, A; Sabatino, G; Matteini, P; Lofrese, G; Maira, G; Pini, R

    2010-01-01

    Laser welding has been proposed as an alternative technique to conventional stitching in microvascular anastomosis, with the advantages of improving the vascular healing process and reducing the risk of malfunction of a bypass. Our group recently proposed a laser-assisted end-to-side anastomotic technique, providing the advantages of laser welding and reducing the occlusion time of the recipient vessel, that is important in neurosurgical bypass procedures, in order to reduce the risk of cerebral ischemia. This in vivo study focuses on the control of the temperature dynamics developing in the welded tissue. A jugular vein graft was harvested and implanted on the rabbit carotid artery by means of two end-to-side anastomosis. Laser welding procedure was then carried out to implant the bypass. A real-time monitoring of the temperature during welding was performed with an infrared thermocamera, in order to control the laser-induced heating effect on the external surface of the vessel walls. The temperature analysis highlighted the dynamic of the heating effect in space and time and enabled us to define an optimal temperature range in operative conditions. The temperature control provided safe tissue heating confined within the directly irradiated area, with negligible damage to surrounding tissues, as well as effective sealing and welding of the vessel edges at the anastomotic sites. The average occlusion time of the carotid artery was about 11 minutes. After a follow-up of 30 days, all the bypasses were patent and no signs of thrombosis or leak point pressure were present, thus confirming the safety of this laser-assisted anastomotic procedure.

  4. Version changes in medical software: proposing minimal requirements for release notes and a version number convention - an operators' point of view.

    PubMed

    Ahlbrandt, Janko; Bott, Constantin; Moll, Peter; Naziyok, Tolga; Majeed, Raphael W; Röhrig, Rainer

    2015-01-01

    Medical software--like any other software--is susceptible to errors. To avoid false system behaviour or attenuate its consequences, system operators need to know about changes in the software. The goal of this proposal is to define terms and minimum requirements regarding documentation for a version change from the operator's point of view, especially in the domain of medical software or software as a medical device (SaMD). The results are a classification of version changes (Upgrade: breaks support for a rollback to a prior version, Major Update: either substantial configuration or user education needed, Minor Update: minor configuration or user information needed, Patch: collection of (small) changes that require neither configuration nor user information.). Additionally, minimal requirements for release notes are determined and a document structure recommended.

  5. Is climate an important driver of post-European vegetation change in the Eastern United States?

    PubMed

    Nowacki, Gregory J; Abrams, Marc D

    2015-01-01

    Many ecological phenomena combine to direct vegetation trends over time, with climate and disturbance playing prominent roles. To help decipher their relative importance during Euro-American times, we employed a unique approach whereby tree species/genera were partitioned into temperature, shade tolerance, and pyrogenicity classes and applied to comparative tree-census data. Our megadata analysis of 190 datasets determined the relative impacts of climate vs. altered disturbance regimes for various biomes across the eastern United States. As the Euro-American period (ca. 1500 to today) spans two major climatic periods, from Little Ice Age to the Anthropocene, vegetation changes consistent with warming were expected. In most cases, however, European disturbance overrode regional climate, but in a manner that varied across the Tension Zone Line. To the north, intensive and expansive early European disturbance resulted in the ubiquitous loss of conifers and large increases of Acer, Populus, and Quercus in northern hardwoods, whereas to the south, these disturbances perpetuated the dominance of Quercus in central hardwoods. Acer increases and associated mesophication in Quercus-Pinus systems were delayed until mid 20th century fire suppression. This led to significant warm to cool shifts in temperature class where cool-adapted Acer saccharum increased and temperature neutral changes where warm-adapted Acer rubrum increased. In both cases, these shifts were attributed to fire suppression rather than climate change. Because mesophication is ongoing, eastern US forests formed during the catastrophic disturbance era followed by fire suppression will remain in climate disequilibrium into the foreseeable future. Overall, the results of our study suggest that altered disturbance regimes rather than climate had the greatest influence on vegetation composition and dynamics in the eastern United States over multiple centuries. Land-use change often trumped or negated the impacts

  6. Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Determination of the minimal important difference in COPD

    PubMed Central

    Vaidya, Trija; de Bisschop, Claire; Beaumont, Marc; Ouksel, Hakima; Jean, Véronique; Dessables, François; Chambellan, Arnaud

    2016-01-01

    Background The 1-minute sit-to-stand (STS) test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD). There is a need to provide the minimal important difference (MID) of this test in pulmonary rehabilitation (PR). Methods COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC). Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods. Results Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD) (r=0.574; P<10−3), age (r=−0.453; P=0.001), being on long-term oxygen treatment (r=−0.454; P=0.017), and the QMVC (r=0.424; P=0.031). The multivariate analysis explained 75.8% of the variance of 1-minute STS repetitions. The improvement of the 1-minute STS repetitions at the end of PR was 3.8±4.2 (P<10−3). It was mainly correlated with the change in QMVC (r=0.572; P=0.004) and 6MWD (r=0.428; P=0.006). Using the distribution-based analysis, an MID of 1.9 (standard error of measurement method) or 3.1 (standard deviation method) was found. With the 6MWD as anchor, the receiver operating characteristic curve identified the MID for the change in 1-minute STS repetitions at 2.5 (sensibility: 80%, specificity: 60%) with area under curve of 0.716. Conclusion The 1-minute STS test is simple and sensitive to measure the efficiency of PR. An improvement of at least three repetitions is consistent with physical benefits after PR. PMID:27799759

  7. Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Determination of the minimal important difference in COPD.

    PubMed

    Vaidya, Trija; de Bisschop, Claire; Beaumont, Marc; Ouksel, Hakima; Jean, Véronique; Dessables, François; Chambellan, Arnaud

    2016-01-01

    The 1-minute sit-to-stand (STS) test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD). There is a need to provide the minimal important difference (MID) of this test in pulmonary rehabilitation (PR). COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC). Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods. Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD) (r=0.574; P<10(-3)), age (r=-0.453; P=0.001), being on long-term oxygen treatment (r=-0.454; P=0.017), and the QMVC (r=0.424; P=0.031). The multivariate analysis explained 75.8% of the variance of 1-minute STS repetitions. The improvement of the 1-minute STS repetitions at the end of PR was 3.8±4.2 (P<10(-3)). It was mainly correlated with the change in QMVC (r=0.572; P=0.004) and 6MWD (r=0.428; P=0.006). Using the distribution-based analysis, an MID of 1.9 (standard error of measurement method) or 3.1 (standard deviation method) was found. With the 6MWD as anchor, the receiver operating characteristic curve identified the MID for the change in 1-minute STS repetitions at 2.5 (sensibility: 80%, specificity: 60%) with area under curve of 0.716. The 1-minute STS test is simple and sensitive to measure the efficiency of PR. An improvement of at least three repetitions is consistent with physical benefits after PR.

  8. The importance to chondrocyte differentiation of changes in expression of the multiple inositol polyphosphate phosphatase.

    PubMed

    Hidaka, Kiyoshi; Kanematsu, Takashi; Caffrey, James J; Takeuchi, Hiroshi; Shears, Stephen B; Hirata, Masato

    2003-11-01

    It is important to both physiological and pathological osteogenesis to understand the significance of changes in gene expression in growth-plate chondrocytes that transit between the proliferative and hypertrophic states. MINPP is one such gene of interest. The Minpp protein dephosphorylates highly phosphorylated inositol signaling molecules InsP(5) and InsP(6). We show here that the ATDC5 chondrocyte progenitor cell line can recapitulate developmentally specific changes in MINPP expression previously only seen in longitudinal bone growth plates-both an initial 2-3-fold increase and a subsequent decrease back to initial levels during transition to hypertrophy. The increase in MINPP expression was accompanied by a 40% decrease in InsP(6) levels in ATDC5 cells. However, InsP(5) levels were not modified. Furthermore, throughout the hypertrophic phase, during which MINPP expression decreased, there were no alterations in InsP(5) and InsP(6) levels. We also created an ATDC5 line that stably overexpressed Minpp at 2-fold higher levels than in wild-type cells. This had no significant effect upon cellular levels of InsP(5) and InsP(6). Thus, substantial changes in MINPP expression can occur without a net effect upon InsP(5) and InsP(6) turnover in vivo. On the other hand, Minpp-overexpressing cells showed impaired chondrogenesis. We noted that the expression of alkaline phosphatase activity was inversely correlated with the expression of MINPP. The ATDC5 cells that overexpress Minpp failed to show an insulin-dependent increase in alkaline phosphatase levels, which presumably affects phosphate balance [J. Biol. Chem. 276 (2001) 33995], and may be the reason cellular differentiation was impaired. In any case, we conclude that Minpp is important to chondrocyte differentiation, but in a manner that is, surprisingly, independent of inositol polyphosphate turnover.

  9. The importance of chill rate when characterising colour change of lamb meat during retail display.

    PubMed

    Jacob, R H; Thomson, K L

    2012-02-01

    An experiment was conducted to compare the effect of two chilling rates (Con and Fast) on colour change of lamb meat during simulated retail display. Measurements were made on 3 muscles; LD (m. longisimuss dorsi), SM (m semimembranosus) and ST (m. semitendinous). Meat samples from 32 Merino crossbred lambs were vacuum packed and stored for 5 days at 2 °C, then cut and overwrapped in polyvinyl chloride film on black polystyrene trays, stored in a display cabinet at 4 °C with lights on and measured twice daily for 4 days, using a Hunterlab minilab 45/20L D65, aperture 10°. Sarcomere length was shorter, shear force higher and colour change greater in meat from the Fast treatment compared to the Con treatment. Colour differences between treatments were likely due to oxygenation (bloom) as well as oxidation effects. Chill rate is important when characterising colour change during display and should be considered in measurement protocols. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Implementing climate change mitigation in health services: the importance of context.

    PubMed

    Desmond, Sharon

    2016-10-01

    Academic interest in strategies to reduce the impact of health services on climate change is quickening. Research has largely focused on local innovations with little consideration of the contextual and systemic elements that influence sustainable development across health systems. A realistic framework specifically to guide decision-making by health care providers is still needed. To address this deficit, the literature is explored in relation to health services and climate change mitigation strategies, and the contextual factors that influence efforts to mitigate climate effects in health service delivery environments are highlighted. A conceptual framework is proposed that offers a model for the pursuit of sustainable development practice in health services. A set of propositions is advanced to provide a systems approach to assist decision-making by decoding the challenges faced in implementing sustainable health services. This has important implications for health care providers, funders and legislators since the financial, policy and regulatory environment of health care, along with its leadership and models of care generally conflict with carbon literacy and climate change mitigation strategies. © The Author(s) 2016.

  11. Quantifying area changes of internationally important wetlands due to water consumption in LCA.

    PubMed

    Verones, Francesca; Pfister, Stephan; Hellweg, Stefanie

    2013-09-03

    Wetlands harbor diverse species assemblages but are among the world's most threatened ecosystems. Half of their global area was lost during the last century. No approach currently exists in life cycle impact assessment that acknowledges the vulnerability and importance of wetlands globally and provides fate factors for water consumption. We use data from 1184 inland wetlands, all designated as sites of international importance under the Ramsar Convention, to develop regionalized fate factors (FF) for consumptive water use. FFs quantify the change of wetland area caused per m(3)/yr water consumed. We distinguish between surface water-fed and groundwater-fed wetlands and develop FFs for surface water and groundwater consumption. FFs vary over 8 (surface water-fed) and 6 (groundwater-fed) orders of magnitude as a function of the site characteristics, showing the importance of local conditions. Largest FFs for surface water-fed wetlands generally occur in hyper-arid zones and smallest in humid zones, highlighting the dependency on available surface water flows. FFs for groundwater-fed wetlands depend on hydrogeological conditions and vary largely with the total amount of water consumed from the aquifer. Our FFs translate water consumption into wetland area loss and thus become compatible with life cycle assessment methodologies of land use.

  12. Preservation of the nuchal ligament plays an important role in preventing unfavorable radiologic changes after laminoplasty.

    PubMed

    Sakaura, Hironobu; Hosono, Noboru; Mukai, Yoshihiro; Oshima, Kazuya; Iwasaki, Motoki; Yoshikawa, Hideki

    2008-07-01

    Prospective study. To examine whether preservation of the funicular section of the nuchal ligament attached to the C6 and C7 spinous processes could prevent unfavorable radiologic changes such as kyphotic deformity and destabilization at the C6/7 segment, and to investigate possible correlations between adverse radiologic changes and neurologic recovery or incidence of axial neck pain after laminoplasty in patients with cervical spondylotic myelopathy. Adverse radiologic changes after cervical laminoplasty have been reported to result from detachment of cervical extensor muscles. Subjects comprised 37 patients who underwent modified C3-6 laminoplasty. Our procedure preserves the funicular section of the nuchal ligament attached to the C6 and/or C7 spinous processes in addition to all muscles attached to the C2 and C7 spinous processes and the subaxial deep extensor muscles on the hinged side. The funicular section of the ligament attached only to the C7 spinous process was preserved in 18 patients (C7 group). This funicular section attaching both to the C7 and C6 spinous processes was preserved in 19 patients (C6+7 group). Radiologic and clinical data were prospectively collected. Postoperative loss of lordosis and destabilization at the C6/7 segment were significantly reduced in the C6+7 group compared with the C7 group. As of final follow-up, neurologic recovery was significantly poorer in the 3 patients with kyphosis than in the 34 patients with straight spinal alignment or lordosis. Frequencies of axial pain showed no significant differences between groups. This value did not vary with the differences in sagittal alignment. These results indicate that the preserved funicular section of the nuchal ligament attached both to the C6 and C7 spinous processes plays an important role in preventing undesirable radiologic changes after laminoplasty.

  13. Maternal weight change between 1 and 2 years postpartum: the importance of 1 year weight retention.

    PubMed

    Lipsky, Leah M; Strawderman, Myla S; Olson, Christine M

    2012-07-01

    Pregnancy weight gain may lead to long-term increases in maternal BMI for some women. The objective of this study was to examine maternal body weight change 1y-2y postpartum, and to compare classifications of 2y weight retention with and without accounting for 1y-2y weight gain. Early pregnancy body weight (EPW, first trimester) was measured or imputed, and follow-up measures obtained before delivery, 1 year postpartum (1y) and 2 years postpartum (2y) in an observational cohort study of women seeking prenatal care in several counties in upstate New York (n = 413). Baseline height was measured; demographic and behavioral data were obtained from questionnaires and medical records. Associations of 1y-2y weight change (kg) and 1y-2y weight gain (≥2.25 kg) with anthropometric, socioeconomic, and behavioral variables were evaluated using linear and logistic regressions. While mean ± SE 1y-2y weight change was 0.009 ± 4.6 kg, 1y-2y weight gain (≥2.25 kg) was common (n = 108, 26%). Odds of weight gain 1y-2y were higher for overweight (OR(adj) = 2.63, CI(95%) = 1.43-4.82) and obese (OR(adj) = 2.93, CI(95%) = 1.62-5.27) women than for women with BMI <25. Two year weight retention (2y-EPW ≥2.25 kg) was misclassified in 38% (n = 37) of women when 1y-2y weight gain was ignored. One year weight retention (1YWR) (1y-EPW) was negatively related to 1y-2y weight change (β(adj) ± SE = -0.28 ± 0.04, P < 0.001) and weight gain (≥2.25 kg) (OR(adj) = 0.91, CI(95%) = 0.87-0.95). Relations between 1y weight retention and 1y-2y weight change were attenuated for women with higher early pregnancy BMI. Weight change 1y-2y was predicted primarily by an inverse relation with 1y weight retention. The high frequency of weight gain has important implications for classification of postpartum weight retention.

  14. Spinal Cord Stimulation for Vegetative State and Minimally Conscious State: Changes in Consciousness Level and Motor Function.

    PubMed

    Yamamoto, Takamitsu; Watanabe, Mitsuru; Obuchi, Toshiki; Kobayashi, Kazutaka; Oshima, Hideki; Fukaya, Chikashi; Yoshino, Atsuo

    2017-01-01

    Twenty-one vegetative state (VS) patients and 10 minimally conscious state (MCS) patients were treated by spinal cord stimulation (SCS) following an electrophysiological evaluation 3 months or more after the onset of brain injury.A flexible four-contact cylindrical electrode was inserted into the epidural space of the cervical vertebrae, and placed at cervical levels C2-C4. Five-hertz stimulation was applied for 5 min every 30 min during the daytime at an intensity that produced muscle twitches of the upper extremities.Both the fifth wave in the auditory brainstem response (ABR) and N20 in the somatosensory evoked potential (SEP) were detected in 8 of the 21 VS patients and 9 of the 10 MCS patients. Of the 3 VS patients and 7 MCS patients who recovered following SCS therapy, all showed a preserved fifth wave in the ABR and N20 in the SEP, and all had received SCS therapy within 9 months after the onset of brain injury. Although the 3 patients who recovered from VS remained in a bedridden state, all 7 patients who recovered from MCS were able to emerge from the bedridden state within 12 months after the start of SCS.Five-hertz cervical SCS caused increased cerebral blood flow (CBF) and induced muscle twitches of the upper extremities, and MCS patients showed a remarkable recovery of consciousness and motor function in the upper extremities compared with the lower extremities. This SCS method could be a new neuromodulation and neurorehabilitation technique, and MCS patients may be good candidates for SCS therapy.

  15. Mutations M287L and Q266I in the Glycine Receptor α1 Subunit Change Sensitivity to Volatile Anesthetics in Oocytes and Neurons, but Not the Minimal Alveolar Concentration in Knockin Mice

    PubMed Central

    Borghese, Cecilia M.; Xiong, Wei; Oh, S. Irene; Ho, Angel; Mihic, S. John; Zhang, Li; Lovinger, David M.; Homanics, Gregg E.; Eger, Edmond I; Harris, R. Adron

    2012-01-01

    Background Volatile anesthetics (VAs) alter the function of key central nervous system proteins but it is not clear which, if any, of these targets mediates the immobility produced by VAs in the face of noxious stimulation. A leading candidate is the glycine receptor, a ligand-gated ion channel important for spinal physiology. VAs variously enhance such function, and blockade of spinal GlyRs with strychnine affects the minimal alveolar concentration (an anesthetic EC50) in proportion to the degree of enhancement. Methods We produced single amino acid mutations into the glycine receptorα1 subunit that increased (M287L, third transmembrane region) or decreased (Q266I, second transmembrane region) sensitivity to isoflurane in recombinant receptors, and introduced such receptors into mice. The resulting knockin mice presented impaired glycinergic transmission, but heterozygous animals survived to adulthood, and we determined the effect of isoflurane on glycine-evoked responses of brain stem neurons from the knockin mice, and the minimal alveolar concentration for isoflurane and other VAs in the immature and mature knockin mice. Results Studies of glycine-evoked currents in brain stem neurons from knock-in mice confirmed the changes seen with recombinant receptors. No increases in the minimal alveolar concentration were found in knockin mice, but the minimal alveolar concentration for isoflurane and enflurane (but not halothane) decreased in 2-week-old Q266I mice. This change is opposite to the one expected for a mutation that decreases the sensitivity to volatile anesthetics. Conclusion Taken together, these results indicate that glycine receptors containing the α1 subunit are not likely to be crucial for the action of isoflurane and other VAs. PMID:22885675

  16. Significant change events in psychodynamic psychotherapy: Is cognition or emotion more important?

    PubMed

    McCarthy, Kye L; Caputi, Peter; Grenyer, Brin F S

    2017-09-01

    Significant change events are helpful moments within a psychotherapy session that have been shown in previous research to relate strongly to outcome. They are special moments and therefore provide rich data for research into understanding therapeutic process. This study investigated clinical and linguistic features of these helpful moments using and comparing both human ratings and computerized text analysis strategies. Significant change events versus non-event passages were studied within 1195 word blocks of transcribed psychotherapy for 20 participants with diagnoses of comorbid depression and personality disorder. Significant events were determined manually by independent raters using the Helpful Aspects of Therapy (HAT) form linked to the Helpful Aspects of Experiential Therapy Content Analysis System (HAETCAS). Mergenthaler's Therapeutic Cycles Model (TCM)-computerized text analysis, identified significant events via linguistic markers. The Linguistic Inquiry and Word Count (LIWC) differentiated emotional and cognitive components. Significant events included statements reflecting emotional and cognitive awareness and insight, and moments of alliance strengthening. These events were saturated with both positive and negative emotion words, particularly anger and sadness, and more cognitive insight words. Significant moments of psychotherapeutic movement featured high therapeutic alliance. There was evidence of the integration or working through of positive and negative emotional content with cognitive insight - meaning both emotion and cognition were important in these interchanges. This study found that significant events in therapy were characterized by high levels of both emotional and cognitive language, and alliance strengthening. Linguistic analysis methods provide important data on psychotherapeutic processes which can be useful in guiding clinicians and improving treatment outcomes. © 2017 The British Psychological Society.

  17. The importance of vegetation change in the prediction of future tropical cyclone flood statistics

    NASA Astrophysics Data System (ADS)

    Irish, J. L.; Resio, D.; Bilskie, M. V.; Hagen, S. C.; Weiss, R.

    2015-12-01

    Global sea level rise is a near certainty over the next century (e.g., Stocker et al. 2013 [IPCC] and references therein). With sea level rise, coastal topography and land cover (hereafter "landscape") is expected to change and tropical cyclone flood hazard is expected to accelerate (e.g., Irish et al. 2010 [Ocean Eng], Woodruff et al. 2013 [Nature], Bilskie et al. 2014 [Geophys Res Lett], Ferreira et al. 2014 [Coast Eng], Passeri et al. 2015 [Nat Hazards]). Yet, the relative importance of sea-level rise induced landscape change on future tropical cyclone flood hazard assessment is not known. In this paper, idealized scenarios are used to evaluate the relative impact of one class of landscape change on future tropical cyclone extreme-value statistics in back-barrier regions: sea level rise induced vegetation migration and loss. The joint probability method with optimal sampling (JPM-OS) (Resio et al. 2009 [Nat Hazards]) with idealized surge response functions (e.g., Irish et al. 2009 [Nat Hazards]) is used to quantify the present-day and future flood hazard under various sea level rise scenarios. Results are evaluated in terms of their impact on the flood statistics (a) when projected flood elevations are included directly in the JPM analysis (Figure 1) and (b) when represented as additional uncertainty within the JPM integral (Resio et al. 2013 [Nat Hazards]), i.e., as random error. Findings are expected to aid in determining the level of effort required to reasonably account for future landscape change in hazard assessments, namely in determining when such processes are sufficiently captured by added uncertainty and when sea level rise induced vegetation changes must be considered dynamically, via detailed modeling initiatives. Acknowledgements: This material is based upon work supported by the National Science Foundation under Grant No. CMMI-1206271 and by the National Sea Grant College Program of the U.S. Department of Commerce's National Oceanic and

  18. Comparison of methylprednisolone plus prednisolone with prednisolone alone as initial treatment in adult-onset minimal change disease: a retrospective cohort study.

    PubMed

    Shinzawa, Maki; Yamamoto, Ryohei; Nagasawa, Yasuyuki; Oseto, Susumu; Mori, Daisuke; Tomida, Kodo; Hayashi, Terumasa; Izumi, Masaaki; Fukunaga, Megumu; Yamauchi, Atsushi; Tsubakihara, Yoshiharu; Isaka, Yoshitaka

    2014-06-06

    Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown. This multicenter retrospective cohort study included 125 adult-onset minimal change disease patients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models. During the median 3.6 years of observation (interquartile range=2.0-6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8-20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12-37) days (P<0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant

  19. Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease: A Retrospective Cohort Study

    PubMed Central

    Shinzawa, Maki; Yamamoto, Ryohei; Nagasawa, Yasuyuki; Oseto, Susumu; Mori, Daisuke; Tomida, Kodo; Hayashi, Terumasa; Izumi, Masaaki; Fukunaga, Megumu; Yamauchi, Atsushi; Tsubakihara, Yoshiharu

    2014-01-01

    Background and objectives Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown. Design, setting, participants, & measurements This multicenter retrospective cohort study included 125 adult-onset minimal change disease patients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models. Results During the median 3.6 years of observation (interquartile range=2.0–6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8–20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12–37) days (P<0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use

  20. Importance of hemodynamic forces as signals for exercise-induced changes in endothelial cell phenotype.

    PubMed

    Laughlin, M Harold; Newcomer, Sean C; Bender, Shawn B

    2008-03-01

    Current evidence indicates that the ability of physical activity to sustain a normal phenotype of arterial endothelial cells (ECs) plays a central role in the beneficial effects of exercise (Ex) on atherosclerotic disease. Here we evaluate the strength of evidence that shear stress (SS) and/or circumferential wall stress (stretch) are the primary signals, produced by bouts of Ex, that signal altered gene expression in arterial ECs, thereby resulting in a less atherogenic EC phenotype. Current literature indicates that SS is a signal for expression of antiatherogenic genes in cultured ECs, in ECs of isolated arteries, and in ECs of arteries in intact animals. Furthermore, SS levels in the arteries of humans during Ex are in the range that produces beneficial changes. In contrast, complex flow profiles within recirculation zones and/or oscillatory flow patterns can cause proatherogenic gene expression in ECs. In vivo evidence indicates that Ex decreases oscillatory flow/SS in some portions of the arterial tree but may increase oscillatory flow in other areas of the arterial tree. Circumferential wall stress can increase expression of some beneficial EC genes as well, but circumferential wall stress also increases production of reactive oxygen species and increases the expression of adhesion factors and other proatherogenic genes. Interactions of arterial pressure and fluid SS play an important role in arterial vascular health and likely contribute to how Ex bouts signal changes in EC gene expression. It is also clear that other local and circulating factors interact with these hemodynamic signals during Ex to produce the healthy arterial EC phenotype. We conclude that available evidence suggests that exercise signals formation of beneficial endothelial cell phenotype at least in part through changes in SS and wall stretch in the arteries.

  1. Decorin expression is important for age-related changes in tendon structure and mechanical properties

    PubMed Central

    Dunkman, Andrew A.; Buckley, Mark R.; Mienaltowski, Michael J.; Adams, Sheila M.; Thomas, Stephen J.; Satchell, Lauren; Kumar, Akash; Pathmanathan, Lydia; Beason, David P.; Iozzo, Renato V.; Birk, David E.; Soslowsky, Louis J.

    2013-01-01

    The aging population is at an increased risk of tendon injury and tendinopathy. Elucidating the molecular basis of tendon aging is crucial to understanding the age-related changes in structure and function in this vulnerable tissue. In this study, the structural and functional features of tendon aging are investigated. In addition, the roles of decorin and biglycan in the aging process were analyzed using transgenic mice at both mature and aged time points. Our hypothesis is that the increase in tendon injuries in the aging population is the result of altered structural properties that reduce the biomechanical function of the tendon and consequently increase susceptibility to injury. Decorin and biglycan are important regulators of tendon structure and therefore, we further hypothesized that decreased function in aged tendons is partly the result of altered decorin and biglycan expression. Biomechanical analyses of mature (day 150) and aged (day 570) patellar tendons revealed deteriorating viscoelastic properties with age. Histology and polarized light microscopy demonstrated decreased cellularity, alterations in tenocyte shape, and reduced collagen fiber alignment in the aged tendons. Ultrastructural analysis of fibril diameter distributions indicated an altered distribution in aged tendons with an increase of large diameter fibrils. Aged wild type tendons maintained expression of decorin which was associated with the structural and functional changes seen in aged tendons. Aged patellar tendons exhibited altered and generally inferior properties across multiple assays. However, decorin-null tendons exhibited significantly decreased effects of aging compared to the other genotypes. The amelioration of the functional deficits seen in the absence of decorin in aged tendons was associated with altered tendon fibril structure. Fibril diameter distributions in the decorin-null aged tendons were comparable to those observed in the mature wild type tendon with the absence

  2. Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports

    PubMed Central

    Andersen, Jack Gunnar; Stokke, Mali Victoria; Tennstrand, Anne Lise; Aamodt, Rolf; Heggelund, Thomas; Dahl, Fredrik A; Sandbæk, Gunnar; Hurlen, Petter

    2016-01-01

    Background Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Consultant radiologists in Norwegian hospitals frequently request second reads by colleagues in real time. Our objective was to estimate the frequency of clinically important changes to radiology reports produced by these prospectively obtained double readings. Methods We retrospectively compared the preliminary and final reports from 1071 consecutive double-read abdominal CT examinations of surgical patients at five public hospitals in Norway. Experienced gastrointestinal surgeons rated the clinical importance of changes from the preliminary to final report. The severity of the radiological findings in clinically important changes was classified as increased, unchanged or decreased. Results Changes were classified as clinically important in 146 of 1071 reports (14%). Changes to 3 reports (0.3%) were critical (demanding immediate action), 35 (3%) were major (implying a change in treatment) and 108 (10%) were intermediate (requiring further investigations). The severity of the radiological findings was increased in 118 (81%) of the clinically important changes. Important changes were made less frequently when abdominal radiologists were first readers, more frequently when they were second readers, and more frequently to urgent examinations. Conclusion A 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases. PMID:27013638

  3. Minimal cosmography

    NASA Astrophysics Data System (ADS)

    Piazza, Federico; Schücker, Thomas

    2016-04-01

    The minimal requirement for cosmography—a non-dynamical description of the universe—is a prescription for calculating null geodesics, and time-like geodesics as a function of their proper time. In this paper, we consider the most general linear connection compatible with homogeneity and isotropy, but not necessarily with a metric. A light-cone structure is assigned by choosing a set of geodesics representing light rays. This defines a "scale factor" and a local notion of distance, as that travelled by light in a given proper time interval. We find that the velocities and relativistic energies of free-falling bodies decrease in time as a consequence of cosmic expansion, but at a rate that can be different than that dictated by the usual metric framework. By extrapolating this behavior to photons' redshift, we find that the latter is in principle independent of the "scale factor". Interestingly, redshift-distance relations and other standard geometric observables are modified in this extended framework, in a way that could be experimentally tested. An extremely tight constraint on the model, however, is represented by the blackbody-ness of the cosmic microwave background. Finally, as a check, we also consider the effects of a non-metric connection in a different set-up, namely, that of a static, spherically symmetric spacetime.

  4. Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand

    PubMed Central

    Luque-Siles, Carmen; Gallego-Izquierdo, Tomas; Jímenez-Rejano, Jose Jesus; de-la-Orden, Susana Granados; Plaza-Manzano, Gustavo; López-Illescas-Ruiz, Africa; Ferragut-Garcías, Alejandro; Romero-Franco, Natalia; Martín-Casas, Patricia; Pecos-Martín, Daniel

    2016-01-01

    [Purpose] To examine the intrasession and intersession reliability and the absolute reliability of three functional dynamic tests—forward-lunge, step-up-over and sit-to-stand tests—using computerized dynamic posturography. [Subjects and Methods] An intra-test and test-retest, repeated measure study was designed. Forty-five healthy subjects twice carried out the forward-lunge test, step-up-over test, and sit-to-stand test on two days, one week apart. The intrasession and intersession reliabilities as judged by the intraclass correlation coefficient (ICC) and the minimal detectable change of the three functional tests were calculated. [Results] Excellent to very good intrasession reliability of the forward-lunge test (ICC range of 0.9–0.8) was found. Very good to good intrasession reliability of the step-up-over test (ICC range of 0.9–0.5) was found and very good intrasession reliability of the sit-to-stand test (ICC range of 0.8–0.7) was found. The minimal detectable change at the 95% confidence level of most of the measures was lower than 30%. [Conclusion] The forward-lunge, step-up-over and sit-to-stand tests are reliable measurement tools. PMID:28174457

  5. Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand.

    PubMed

    Luque-Siles, Carmen; Gallego-Izquierdo, Tomas; Jímenez-Rejano, Jose Jesus; de-la-Orden, Susana Granados; Plaza-Manzano, Gustavo; López-Illescas-Ruiz, Africa; Ferragut-Garcías, Alejandro; Romero-Franco, Natalia; Martín-Casas, Patricia; Pecos-Martín, Daniel

    2016-12-01

    [Purpose] To examine the intrasession and intersession reliability and the absolute reliability of three functional dynamic tests-forward-lunge, step-up-over and sit-to-stand tests-using computerized dynamic posturography. [Subjects and Methods] An intra-test and test-retest, repeated measure study was designed. Forty-five healthy subjects twice carried out the forward-lunge test, step-up-over test, and sit-to-stand test on two days, one week apart. The intrasession and intersession reliabilities as judged by the intraclass correlation coefficient (ICC) and the minimal detectable change of the three functional tests were calculated. [Results] Excellent to very good intrasession reliability of the forward-lunge test (ICC range of 0.9-0.8) was found. Very good to good intrasession reliability of the step-up-over test (ICC range of 0.9-0.5) was found and very good intrasession reliability of the sit-to-stand test (ICC range of 0.8-0.7) was found. The minimal detectable change at the 95% confidence level of most of the measures was lower than 30%. [Conclusion] The forward-lunge, step-up-over and sit-to-stand tests are reliable measurement tools.

  6. Age-Related Changes in Dynamic Postural Control and Attentional Demands are Minimally Affected by Local Muscle Fatigue

    PubMed Central

    Remaud, Anthony; Thuong-Cong, Cécile; Bilodeau, Martin

    2016-01-01

    Normal aging results in alterations in the visual, vestibular and somtaosensory systems, which in turn modify the control of balance. Muscle fatigue may exacerbate these age-related changes in sensory and motor functions, and also increase the attentional demands associated with dynamic postural control. The purpose of this study was to investigate the effect of aging on dynamic postural control and posture-related attentional demands before and after a plantar flexor fatigue protocol. Participants (young adults: n = 15; healthy seniors: n = 13) performed a dynamic postural task along the antero-posterior (AP) and the medio-lateral (ML) axes, with and without the addition of a simple reaction time (RT) task. The dynamic postural task consisted in following a moving circle on a computer screen with the representation of the center of pressure (COP). This protocol was repeated before and after a fatigue task where ankle plantar flexor muscles were targeted. The mean COP-target distance and the mean COP velocity were calculated for each trial. Cross-correlation analyses between the COP and target displacements were also performed. RTs were recorded during dual-task trials. Results showed that while young adults adopted an anticipatory control mode to move their COP as close as possible to the target center, seniors adopted a reactive control mode, lagging behind the target center. This resulted in longer COP-target distance and higher COP velocity in the latter group. Concurrently, RT increased more in seniors when switching from static stance to dynamic postural conditions, suggesting potential alterations in the central nervous system (CNS) functions. Finally, plantar flexor muscle fatigue and dual-tasking had only minor effects on dynamic postural control of both young adults and seniors. Future studies should investigate why the fatigue-induced changes in quiet standing postural control do not seem to transfer to dynamic balance tasks. PMID:26834626

  7. Age-Related Changes in Dynamic Postural Control and Attentional Demands are Minimally Affected by Local Muscle Fatigue.

    PubMed

    Remaud, Anthony; Thuong-Cong, Cécile; Bilodeau, Martin

    2015-01-01

    Normal aging results in alterations in the visual, vestibular and somtaosensory systems, which in turn modify the control of balance. Muscle fatigue may exacerbate these age-related changes in sensory and motor functions, and also increase the attentional demands associated with dynamic postural control. The purpose of this study was to investigate the effect of aging on dynamic postural control and posture-related attentional demands before and after a plantar flexor fatigue protocol. Participants (young adults: n = 15; healthy seniors: n = 13) performed a dynamic postural task along the antero-posterior (AP) and the medio-lateral (ML) axes, with and without the addition of a simple reaction time (RT) task. The dynamic postural task consisted in following a moving circle on a computer screen with the representation of the center of pressure (COP). This protocol was repeated before and after a fatigue task where ankle plantar flexor muscles were targeted. The mean COP-target distance and the mean COP velocity were calculated for each trial. Cross-correlation analyses between the COP and target displacements were also performed. RTs were recorded during dual-task trials. Results showed that while young adults adopted an anticipatory control mode to move their COP as close as possible to the target center, seniors adopted a reactive control mode, lagging behind the target center. This resulted in longer COP-target distance and higher COP velocity in the latter group. Concurrently, RT increased more in seniors when switching from static stance to dynamic postural conditions, suggesting potential alterations in the central nervous system (CNS) functions. Finally, plantar flexor muscle fatigue and dual-tasking had only minor effects on dynamic postural control of both young adults and seniors. Future studies should investigate why the fatigue-induced changes in quiet standing postural control do not seem to transfer to dynamic balance tasks.

  8. Importance of physical qualities for speed and change of direction ability in elite female soccer players.

    PubMed

    Emmonds, Stacey; Nicholson, G; Beggs, C; Jones, B; Bissas, A

    2017-07-17

    The purpose of this study was to determine the importance of physical qualities for speed and change of direction (CoD) ability in female soccer players. Data were collected on 10 female soccer players who were part of a professional English Women's Super League team. Player assessments included anthropometric (stature and body mass), body composition (dual-energy X-ray absorptiometry), speed (10m, 30m sprint), CoD ability (505 agility), aerobic (Yo-Yo Intermittent Recovery Test), lower-body strength (bilateral knee extensions) and power (countermovement jump [CMJ], squat jump [SJ], 30cm drop jump [DJ]) measures. The relationships between the variables were evaluated using eigenvector analysis and Pearson correlation analysis. Multiple linear regression revealed that the performance variables (10 and 20m speed, mean 505, and CoD deficit mean) can be predicted with almost 100% accuracy (i.e. adjusted R > 0.999) using various combinations of the predictor variables (DJ height, CMJ height, SJ height, lean body mass). An increase of one standard deviation (SD) in DJ height was associated with reductions of -5.636 and -9.082 SD in 10 m and 20 m sprint times. A one SD increase in CMJ also results in a reduction of -3.317 and -0.922 SD respectively in mean 505 and CoD deficit mean values. This study provides comparative data for professional English female soccer players that can be used by strength and conditioning coaches when monitoring player development and assessing the effectiveness of training programmes. Findings highlight the importance of developing reactive strength to improve speed and CoD ability in female soccer players.

  9. Volcanic Eruptions and Climate: Sulfates are More Important Than Halogens in Producing Climate Change

    NASA Astrophysics Data System (ADS)

    Robock, A.

    2007-12-01

    Large volcanic eruptions inject sulfur gases into the stratosphere, which convert to sulfate aerosols with an e- folding residence time of about one year. The radiative and chemical effects of this aerosol cloud produce responses in the climate system. Using examples from major eruptions of the past and results from experiments with numerical models of the climate system, this talk illustrates the major impacts. Volcanic eruptions produce global cooling, and are an important natural cause of interdecadal and interannual climate change. One of the most interesting volcanic effects is the "winter warming" of Northern Hemisphere continents following major tropical eruptions. During the winter in the Northern Hemisphere following every large tropical eruption of the past century, surface air temperatures over North America, Europe, and East Asia were warmer than normal, while they were colder over Greenland and the Middle East. This pattern and the coincident atmospheric circulation correspond to the positive phase of the Arctic Oscillation. High latitude eruptions in the Northern Hemisphere, while also producing global cooling, do not have the same impact on atmospheric dynamics. They weaken the Indian and African summer monsoon, and the effects can be seen in past records of flow in the Nile and Niger Rivers. In fact we can use records of the Nile River flow to provide an improved date for the Eldgjá eruption in Iceland, which we now date at 939 A.D. While halogens may have short term effects on ozone in plumes with high halogen concentrations, there is no evidence that they are important in the global climate response to volcanic eruptions.

  10. Minimal changes and missed opportunities: a decade look at nurse practitioners in the lower Mississippi River Delta states.

    PubMed

    Kippenbrock, Thomas; Buron, Bill; Odell, Ellen; Narcisse, Marie-Rachelle

    2014-01-01

    The U.S. southern region has one of most socioeconomically deprived and poorest health care outcomes in the county. The aims of this study were to determine changes of nurse practitioners (NPs) and their practice in lower Mississippi River Delta over the past decade and to examine differences of NPs' employment in health professional storage areas (HPSAs) and rural areas. A nonexperimental quantitative survey technique was used in the years 2000 and 2010. Other data sources included Health Resources and Services Administration that identified HPSA and the U.S. Census Bureau used to distinguish urban and rural areas. NPs are younger, and more are graduates of master's and doctorate degrees, but they are not reflective of the race they serve. Approximately, 25% of NPs worked in HPSA, and 50% worked in the rural area both in 2000 and in 2010. This proportion has remained blatantly steady during the past decade. Employment in rural health centers and family practice as a specialty declined; however, self-employment was on the rise. Nursing schools and health care institutions should be collaborating to develop plans and implementation strategies to recruit and retain NPs in the Mississippi River Delta rural and HPSAs.

  11. Internal recycling of respired CO 2 may be important for plant functioning under changing climate regimes.

    PubMed

    Bloemen, Jasper; McGuire, Mary Anne; Aubrey, Doug P; Teskey, Robert O; Steppe, Kathy

    2013-01-01

    Recent studies have provided evidence of a large flux of root-respired CO 2 in the transpiration stream of trees. In our study, we investigated the potential impact of this internal CO 2 transport on aboveground carbon assimilation and CO 2 efflux. To trace the transport of root-respired CO 2, we infused a (13)C label at the stem base of field-grown Populus deltoides Bartr. ex. Marsh trees. The (13)C label was transported to the top of the stem and throughout the crown via the transpiration stream. Up to 17% of the (13)C label was assimilated by chlorophyll-containing tissues. Our results provide evidence of a mechanism for recycling respired CO 2 within trees. Such a mechanism may have important implications for how plants cope with predicted increases in intensity and frequency of droughts. Here, we speculate on the potential significance of this recycling mechanism within the context of plant responses to climate change and plants currently inhabiting arid environments.

  12. Interface Psychology: Touchscreens Change Attribute Importance, Decision Criteria, and Behavior in Online Choice.

    PubMed

    Brasel, S Adam; Gips, James

    2015-09-01

    As the rise of tablets and smartphones move the dominant interface for digital content from mouse or trackpad to direct touchscreen interaction, work is needed to explore the role of interfaces in shaping psychological reactions to online content. This research explores the role of direct-touch interfaces in product search and choice, and isolates the touch element from other form factor changes such as screen size. Results from an experimental study using a travel recommendation Web site show that a direct-touch interface (vs. a more traditional mouse interface) increases the number of alternatives searched, and biases evaluations toward tangible attributes such as décor and furniture over intangible attributes such as WiFi and employee demeanor. Direct-touch interfaces also elevate the importance of internal and subjective satisfaction metrics such as instinct over external and objective metrics such as reviews, which in turn increases anticipated satisfaction metrics. Findings suggest that interfaces can strongly affect how online content is explored, perceived, remembered, and acted on, and further work in interface psychology could be as fruitful as research exploring the content itself.

  13. Interface Psychology: Touchscreens Change Attribute Importance, Decision Criteria, and Behavior in Online Choice

    PubMed Central

    Gips, James

    2015-01-01

    Abstract As the rise of tablets and smartphones move the dominant interface for digital content from mouse or trackpad to direct touchscreen interaction, work is needed to explore the role of interfaces in shaping psychological reactions to online content. This research explores the role of direct-touch interfaces in product search and choice, and isolates the touch element from other form factor changes such as screen size. Results from an experimental study using a travel recommendation Web site show that a direct-touch interface (vs. a more traditional mouse interface) increases the number of alternatives searched, and biases evaluations toward tangible attributes such as décor and furniture over intangible attributes such as WiFi and employee demeanor. Direct-touch interfaces also elevate the importance of internal and subjective satisfaction metrics such as instinct over external and objective metrics such as reviews, which in turn increases anticipated satisfaction metrics. Findings suggest that interfaces can strongly affect how online content is explored, perceived, remembered, and acted on, and further work in interface psychology could be as fruitful as research exploring the content itself. PMID:26348814

  14. A New Agility Test for Adults: Its Test-Retest Reliability and Minimal Detectable Change in Untrained Women and Men Aged 28-55.

    PubMed

    Manderoos, Sirpa A; Vaara, Mariitta E; Mäki, P Juhani; Mälkiä, Esko A; Aunola, Sirkka K; Karppi, Sirkka-Liisa

    2016-08-01

    Manderoos, SA, Vaara, ME, Mäki, PJ, Mälkiä, EA, Aunola, SK, and Karppi, S-L. A new agility test for adults: its test-retest reliability and minimal detectable change in untrained women and men aged 28-55. J Strength Cond Res 30(8): 2226-2234, 2016-The aims of this study were to present a new Agility Test for Adults (ATA), to investigate its test-retest reliability and to quantify minimal detectable change at the 95% confidence interval (MDC95). Both the relative and absolute reliabilities were evaluated. Altogether 52 healthy untrained volunteers (25 women: age 43.3 ± 6.6 years; 27 men: age 42.8 ± 7.2 years) were recruited into the study. The subjects performed 3 ATA tests repeated after 2 different intervals: the first test session was baseline, session 2 was a week later, and session 3 was half an hour after session 2. The intraclass correlation coefficient and the SEM of the performance time of ATA were 0.91 and 0.27 seconds (same day), 0.94 and 0.20 seconds (1 week) for women, and 0.95, 0.13 seconds, and 0.94, 0.19 seconds for men, respectively. MDC95 was 0.76 seconds (same day) and 0.56 seconds (1 week) for women, and respectively 0.37 and 0.51 seconds for men. The results showed that ATA is stable and reliable when evaluating agility characteristics in untrained adults. The properties of ATA make it appropriate for screening people to find early signs of declined agility and allow possibility to clinicians and physical trainers to monitor true changes in performance time at agility test by applying the knowledge of MDC95 coefficient. Furthermore, ATA can give tips for planning appropriate exercise programes to prevent clumsiness and falls with more serious consequences among aging people.

  15. The reliability, minimal detectable change and concurrent validity of a gravity-based bubble inclinometer and iphone application for measuring standing lumbar lordosis.

    PubMed

    Salamh, Paul A; Kolber, Morey

    2014-01-01

    To investigate the reliability, minimal detectable change (MDC90) and concurrent validity of a gravity-based bubble inclinometer (inclinometer) and iPhone® application for measuring standing lumbar lordosis. Two investigators used both an inclinometer and an iPhone® with an inclinometer application to measure lumbar lordosis of 30 asymptomatic participants. ICC models 3,k and 2,k were used for the intrarater and interrater analysis, respectively. Good interrater and intrarater reliability was present for the inclinometer with Intraclass Correlation Coefficients (ICC) of 0.90 and 0.85, respectively and the iPhone® application with ICC values of 0.96 and 0.81. The minimal detectable change (MDC90) indicates that a change greater than or equal to 7° and 6° is needed to exceed the threshold of error using the iPhone® and inclinometer, respectively. The concurrent validity between the two instruments was good with a Pearson product-moment coefficient of correlation (r) of 0.86 for both raters. Ninety-five percent limits of agreement identified differences ranging from 9° greater in regards to the iPhone® to 8° less regarding the inclinometer. Both the inclinometer and iPhone® application possess good interrater reliability, intrarater reliability and concurrent validity for measuring standing lumbar lordosis. This investigation provides preliminary evidence to suggest that smart phone applications may offer clinical utility comparable to inclinometry for quantifying standing lumbar lordosis. Clinicians should recognize potential individual differences when using these devices interchangeably.

  16. Changes in physiological and some nutritional, nutraceuticals, chemical-physical, microbiological and sensory quality minimally processed cactus pears cvs 'Bianca', 'Gialla' and 'Rossa' stored under passive modified atmosphere.

    PubMed

    Palma, Amedeo; Continella, Alberto; La Malfa, Stefano; D'Aquino, Salvatore

    2017-09-08

    Objective of this study was to compare the overall quality changes of minimally processed cactus pears cvs. 'Bianca', Gialla' and 'Rossa' stored at 4 °C for 10 d. Periodically in-package CO2 , O2 and C2 H4 were determined and fruit were assessed for overall quality changes (pH, acidity, sugars, phenolics, betacyanins and betaxantines, antioxidant capacity, colour, firmness, microbiological population and sensory attributes). In a preliminary study three different polymeric films were tested to select the most suitable to design a package with a short lag time to achieve steady state conditions. Results showed marked differences between measured in-package CO2 and O2 values and those calculated based on respiration of peeled fruit and film permeance to CO2 and O2 provided by manufactures. The sensory evaluation of packed fruit indicated in film BBT-Bolphane, which created a steady state in-package partial pressure for CO2 of 4.3-4.8 kPa and for O2 of 4.8-5.5 kPa, as best film. Results of in-package gas composition with the three cultivars were similar to those achieved in cv 'Gialla' with the preliminary test. All measured qualitative parameters changed slightly over the storage period for all cultivars and followed the same trend, despite significant differences existed among cultivars. This study clearly showed a similar physiological behavior of minimally processed 'Bianca', 'Gialla' and 'Rossa' cactus pears. Storage conditions optimal for one cultivar fit well for the others, thus mixing fruit of different cultivars in a package designed for one specific cultivar does not lead to relevant deviation from expected results. This article is protected by copyright. All rights reserved.

  17. The Importance of Change: Changes at a Teacher Education College in Israel--Declared and Perceived Aspects

    ERIC Educational Resources Information Center

    Mevorach, Miriam; Ezer, Hanna

    2010-01-01

    This study examines changes at a large teacher education college in Israel and considers how teacher educators perceive these changes. The research tools included protocols documenting formal meetings of college decision makers, questionnaires distributed among the college teaching faculty, analyzed quantitatively, and in-depth narrative…

  18. Principals Preparing for Change: The Importance of Reflection and Professional Learning

    ERIC Educational Resources Information Center

    Zimmerman, Judith A.

    2011-01-01

    Given the demands and constraints under which they work, it is critical for principals to determine their own readiness for change before undertaking the complex process of changing schools. Leaders can discover their change readiness by becoming reflective practitioners who know themselves and engage in professional learning. This informed…

  19. AO/NAO Response to Climate Change. 2; Relative Importance of Low- and High-Latitude Temperature Changes

    NASA Technical Reports Server (NTRS)

    Rind, D.; Perlwitz, J.; Lonergan, P.; Lerner, J.

    2005-01-01

    Using a variety of GCM experiments with various versions of the GISS model, we investigate how different aspects of tropospheric climate changes affect the extratropical Arctic Oscillation (AO)/North Atlantic Oscillation (NAO) circulation indices. The results show that low altitude changes in the extratropical latitudinal temperature gradient can have a strong impact on eddy forcing of the extratropical zonal wind, in the sense that when this latitudinal temperature gradient increases, it helps force a more negative AO/NAO phase. In addition, local conditions at high latitudes can stabilize/destabilize the atmosphere, inducing negative/positive phase changes. To the extent that there is not a large temperature change in the tropical upper troposphere (either through reduced tropical sensitivity at the surface, or limited transport of this change to high levels), the changes in the low level temperature gradient can provide the dominate influence on the extratropical circulation, so that planetary wave meridional refraction and eddy angular momentum transport changes become uncorrelated with potential vorticity transports. In particular, the climate change that produces the most positive NAO phase change would have substantial warming in the tropical upper troposphere over the Pacific Ocean, with high latitude warming in the North Atlantic. An increase in positive phase of these circulation indices is still more likely than not, but it will depend on the degree of tropical and high latitude temperature response and the transport of low level warming into the upper troposphere. These are aspects that currently differ among the models used for predicting the effects of global warning, contributing to the lack of consensus of future changes in the AO/NAO.

  20. AO/NAO Response to Climate Change. 2; Relative Importance of Low- and High-Latitude Temperature Changes

    NASA Technical Reports Server (NTRS)

    Rind, D.; Perlwitz, J.; Lonergan, P.; Lerner, J.

    2005-01-01

    Using a variety of GCM experiments with various versions of the GISS model, we investigate how different aspects of tropospheric climate changes affect the extratropical Arctic Oscillation (AO)/North Atlantic Oscillation (NAO) circulation indices. The results show that low altitude changes in the extratropical latitudinal temperature gradient can have a strong impact on eddy forcing of the extratropical zonal wind, in the sense that when this latitudinal temperature gradient increases, it helps force a more negative AO/NAO phase. In addition, local conditions at high latitudes can stabilize/destabilize the atmosphere, inducing negative/positive phase changes. To the extent that there is not a large temperature change in the tropical upper troposphere (either through reduced tropical sensitivity at the surface, or limited transport of this change to high levels), the changes in the low level temperature gradient can provide the dominate influence on the extratropical circulation, so that planetary wave meridional refraction and eddy angular momentum transport changes become uncorrelated with potential vorticity transports. In particular, the climate change that produces the most positive NAO phase change would have substantial warming in the tropical upper troposphere over the Pacific Ocean, with high latitude warming in the North Atlantic. An increase in positive phase of these circulation indices is still more likely than not, but it will depend on the degree of tropical and high latitude temperature response and the transport of low level warming into the upper troposphere. These are aspects that currently differ among the models used for predicting the effects of global warning, contributing to the lack of consensus of future changes in the AO/NAO.

  1. Age-related Changes in Tissue Signal Properties Within Cortical Areas Important for Word Understanding in 12- to 19-Month-Old Infants

    PubMed Central

    Travis, Katherine E.; Curran, Megan M.; Torres, Christina; Leonard, Matthew K.; Brown, Timothy T.; Dale, Anders M.; Elman, Jeffrey L.; Halgren, Eric

    2014-01-01

    Recently, our laboratory has shown that the neural mechanisms for encoding lexico-semantic information in adults operate functionally by 12–18 months of age within left frontotemporal cortices (Travis et al., 2011. Spatiotemporal neural dynamics of word understanding in 12- to 18-month-old-infants. Cereb Cortex. 8:1832–1839). However, there is minimal knowledge of the structural changes that occur within these and other cortical regions important for language development. To identify regional structural changes taking place during this important period in infant development, we examined age-related changes in tissue signal properties of gray matter (GM) and white matter (WM) intensity and contrast. T1-weighted surface-based measures were acquired from 12- to 19-month-old infants and analyzed using a general linear model. Significant age effects were observed for GM and WM intensity and contrast within bilateral inferior lateral and anterovental temporal regions, dorsomedial frontal, and superior parietal cortices. Region of interest (ROI) analyses revealed that GM and WM intensity and contrast significantly increased with age within the same left lateral temporal regions shown to generate lexico-semantic activity in infants and adults. These findings suggest that neurophysiological processes supporting linguistic and cognitive behaviors may develop before cellular and structural maturation is complete within associative cortices. These results have important implications for understanding the neurobiological mechanisms relating structural to functional brain development. PMID:23448869

  2. Response of a sludge-minimizing lab-scale BNR reactor when the operation is changed to real primary effluent from synthetic wastewater.

    PubMed

    Huang, Pei; Goel, Ramesh

    2015-09-15

    The activated sludge process is the most widely used treatment method for municipal wastewater. However, the excessive amount of biomass generated during the process is a major drawback. Earlier studies using the activated sludge process running in a biomass fasting and feasting mode demonstrated both nutrient removal and a minimization of biomass production. However, these studies were conducted using synthetic wastewater. In this study, we report findings from a lab-scale sludge-minimizing biological nutrient removing (BNR) reactor when its operation was changed from synthetic to real wastewater (primary effluent). Two lab-scale sequencing batch reactors, one in sludge minimization mode (hereafter called modified-SBR), and the other in conventional activated sludge mode (referred as control-SBR), were operated for more than 300 days. Both reactors were started and operated with synthetic feed. Gradually the feed to both reactors was changed to 100% primary effluent collected from a local full-scale wastewater treatment plant. Irrespective of the feed composition, more than 98% NH3-N removal was recorded in both SBRs. However, while 89% of the total dissolved phosphorus was removed from the 100% synthetic feed, only 80% of the total dissolved phosphorus was removed from the 100% primary effluent in both SBRs. The overall observed sludge reduction in the modified-SBR as compared to the control-SBR also decreased from 65% to 39% when the feed was changed from 100% synthetic to 100% primary effluent. The specific oxygen uptake rate for the modified-SBR was 80% higher than that for the control-SBR when the SBRs were fed with primary effluent wastewater. The modified-SBR showed a greater diversity of ammonia-oxidizing bacteria (AOBs) with synthetic wastewater as well as during the transition period than the control-SBR. Yet when the reactors were running on 100% real wastewater, only Nitrosomonas europaea/eutropha were identified in both SBRs. The nitrite

  3. How issue frames shape beliefs about the importance of climate change policy across ideological and partisan groups

    PubMed Central

    2017-01-01

    We use an experiment to examine whether the way in which climate change is framed affects individuals’ beliefs about its importance as a policy issue. We employ frames that emphasize national security, human rights, and environmental importance about the consequences of climate change. We find no evidence that issue frames have an overall effect on opinions about the importance of climate change policy. We do find some evidence that the effect of issue frames varies across ideological and partisan groups. Most notably, issue frames can lead Republicans and those on the political right to view climate change policy as less important. We conclude by discussing our findings relative to extant literature and considering the implications of our findings for those who seek to address the issue of climate change. PMID:28727842

  4. How issue frames shape beliefs about the importance of climate change policy across ideological and partisan groups.

    PubMed

    Singh, Shane P; Swanson, Meili

    2017-01-01

    We use an experiment to examine whether the way in which climate change is framed affects individuals' beliefs about its importance as a policy issue. We employ frames that emphasize national security, human rights, and environmental importance about the consequences of climate change. We find no evidence that issue frames have an overall effect on opinions about the importance of climate change policy. We do find some evidence that the effect of issue frames varies across ideological and partisan groups. Most notably, issue frames can lead Republicans and those on the political right to view climate change policy as less important. We conclude by discussing our findings relative to extant literature and considering the implications of our findings for those who seek to address the issue of climate change.

  5. A comparison of clinical, magnetic resonance imaging and pathological findings in dogs with gliomatosis cerebri, focusing on cases with minimal magnetic resonance imaging changes(‡).

    PubMed

    Bentley, R T; Burcham, G N; Heng, H G; Levine, J M; Longshore, R; Carrera-Justiz, S; Cameron, S; Kopf, K; Miller, M A

    2016-09-01

    The primary study objective was to determine whether clinical examination and magnetic resonance imaging (MRI) can underestimate canine gliomatosis cerebri (GC); we also investigated immunohistochemical features. Seven dogs with GC were studied; four recruited specifically because of minimal MRI changes. Neuroanatomic localization and the distribution of MRI, gross and sub-gross lesions were compared with the actual histological distribution of neoplastic cells. In six cases, clinical examination predicted focal disease and MRI demonstrated a single lesion or appeared normal. Neoplastic cells infiltrated many regions deemed normal by clinical examination and MRI, and were Olig2-positive and glial fibrillary acid protein-negative. Four dogs had concurrent gliomas. GC is a differential diagnosis for dogs with focal neurological deficits and a normal MRI or a focal MRI lesion. Canine GC is probably mainly oligodendrocytic. Type II GC, a solid glioma accompanying diffuse central nervous system neoplastic infiltration, occurs in dogs as in people. © 2014 John Wiley & Sons Ltd.

  6. The reliability and minimal detectable change of Timed Up and Go test in individuals with grade 1-3 knee osteoarthritis.

    PubMed

    Alghadir, Ahmad; Anwer, Shahnawaz; Brismée, Jean-Michel

    2015-07-30

    The Timed Up and Go (TUG) test is quick and easy tests to assess patients' functional mobility. However, its reliability in individuals with knee osteoarthritis (OA) has not been well established. The aims of this study were to determine the reliability and minimal detectable change of the TUG test in individuals with doubtful to moderate (Grade 1-3) knee OA. Sixty-five subjects (25 male, 40 female), aged 45-70 years, with knee OA participated. Inter-rater reliability was assessed using two observers at different times of the same day in an alternating order. Intra-rater reliability was assessed on two consecutive visits with a 2-day interval. The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated to determine statistically meaningful changes. Intra-rater and inter-rater reliability were 0.97 (95% confidence interval [CI], 0.95 - 0.98) and 0.96 (95% confidence interval [CI], 0.94 - 0.97), respectively. The MDC, based on measurements by a single rater and between raters, was 1.10 and 1.14 seconds, respectively. The TUG is a reliable test with adequate MDC for clinical use in individuals with doubtful to moderate knee OA.

  7. Relative importance of glacier contributions to streamflow in a changing climate

    USDA-ARS?s Scientific Manuscript database

    The role of glaciers and snow in climate change-affected runoff is evaluated by taking into account the carryover of runoff and of unmelted snow from one hydrological year to another. This water balance is computed for the present climate and for future climates with changed temperatures and precip...

  8. Importance of succession, harvest, and climate change in determining future composition in US Central Hardwood Forests

    Treesearch

    Wen J. Wang; Hong S. He; Frank R. Thompson; Jacob S. Fraser; Brice B. Hanberry; William D. Dijak

    2015-01-01

    Most temperate forests in U.S. are recovering from heavy exploitation and are in intermediate successional stages where partial tree harvest is the primary disturbance. Changes in regional forest composition in response to climate change are often predicted for plant functional types using biophysical process models. These models usually simplify the simulation of...

  9. A replicated climate change field experiment reveals rapid evolutionary response in an ecologically important soil invertebrate.

    PubMed

    Bataillon, Thomas; Galtier, Nicolas; Bernard, Aurelien; Cryer, Nicolai; Faivre, Nicolas; Santoni, Sylvain; Severac, Dany; Mikkelsen, Teis N; Larsen, Klaus S; Beier, Claus; Sørensen, Jesper G; Holmstrup, Martin; Ehlers, Bodil K

    2016-07-01

    Whether species can respond evolutionarily to current climate change is crucial for the persistence of many species. Yet, very few studies have examined genetic responses to climate change in manipulated experiments carried out in natural field conditions. We examined the evolutionary response to climate change in a common annelid worm using a controlled replicated experiment where climatic conditions were manipulated in a natural setting. Analyzing the transcribed genome of 15 local populations, we found that about 12% of the genetic polymorphisms exhibit differences in allele frequencies associated to changes in soil temperature and soil moisture. This shows an evolutionary response to realistic climate change happening over short-time scale, and calls for incorporating evolution into models predicting future response of species to climate change. It also shows that designed climate change experiments coupled with genome sequencing offer great potential to test for the occurrence (or lack) of an evolutionary response. © 2016 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

  10. The importance of assessing climate change vulnerability to address species conservation

    Treesearch

    Karen E. Bagne; Megan M. Friggens; Sharon J. Coe; Deborah M. Finch

    2014-01-01

    Species conservation often prioritizes attention on a small subset of "special status" species at high risk of extinction, but actions based on current lists of special status species may not effectively moderate biodiversity loss if climate change alters threats. Assessments of climate change vulnerability may provide a method to enhance identification of...

  11. Estimating the Effect of Climate Change on Crop Yields and Farmland Values: The Importance of Extreme Temperatures

    EPA Pesticide Factsheets

    This is a presentation titled Estimating the Effect of Climate Change on Crop Yields and Farmland Values: The Importance of Extreme Temperatures that was given for the National Center for Environmental Economics

  12. Public health implications of changing rodent importation patterns— United States, 1999–2013

    PubMed Central

    Lankau, Emily W.; Sinclair, Julie R.; Schroeder, Betsy A.; Galland, G. Gale; Marano, Nina

    2015-01-01

    Summary The United States imports a large volume of live wild and domestic animal species; these animals pose a demonstrated risk for introduction of zoonotic diseases. Rodents are imported for multiple purposes, including scientific research, zoo exhibits, and the pet trade. Current U.S. public health regulatory restrictions specific to rodent importation pertain only to those of African origin. To understand the impacts of these regulations and the potential public health risks of international rodent trade to the United States, we evaluated live rodent import records during 1999 –2013 by shipment volume and geographic origin, source (e.g., wild -caught versus captive-or commercially bred), intended purpose, and rodent taxonomy. Live rodent imports increased from 2,737 animals during 1999 to 173,761 animals during 2013. Increases in both the number and size of shipments contributed to this trend. The proportion of wild-captured imports declined from 75% during 1999 to <1% during 2013. Nearly all shipments during these years were imported for commercial purposes. Imports from Europe and other countries in North America experienced notable increases in volume. Gerbils and hamsters arriving from Europe and chinchillas, guinea pigs, and hamsters arriving from other countries in North America were predominant taxa underlying this trend . After 2003, African-origin imports became sporadic events under the federal permit process. These patterns suggest development of large -scale captive rodent breeding markets abroad for commercial sale in the United States. While the shift from wild-captured imports alleviates many conservation concerns and risks for novel disease emergence, such consolidated sourcing might elevate exposure risks for zoonotic diseases associated with high-density rodent breeding(e.g. , lymphocytic choriomeningitis or salmonellosis). A responsive border health system must periodically re-evaluate importation regulations in conjunction with key

  13. Interactions of Climate Change and Nitrogen Management for Optimizing Crop Productivity and Food Security while Minimizing Nitrogen Pollution and Greenhouse Gas Emissions

    NASA Astrophysics Data System (ADS)

    Davidson, E. A.; Suddick, E. C.

    2012-12-01

    Producing food, transportation, and energy for seven billion people has led to huge increases in use of synthetic nitrogen (N) fertilizers and fossil fuels, resulting in large releases of N as air and water pollution. In its numerous chemical forms, N plays a critical role in all aspects of climate change, including mitigation, adaptation, and impacts. Here we report on a multi-authored, interdisciplinary technical report on climate-nitrogen interactions submitted to the US National Climate Assessment as part of a Research Coordination Network activity. Management of the N cycle not only affects emissions of nitrous oxide (N2O) and nitrogen oxides (NOX), but also impacts carbon dioxide (CO2) and methane (CH4), through effects on carbon cycling processes in forests and soils and the effects on atmospheric reactions of ozone (O3) and CH4. While some of these direct and indirect N effects have a short-term cooling effect, the warming effects of N2O dominate at long time scales. The challenges of mitigating N2O emissions are substantially different from those for CO2 and CH4, because N is essential for food production, and over 80% of anthropogenic N2O emissions are from the agricultural sector. On one hand, improved agricultural nutrient management can confer some adaptive capacity of crops to climatic variability, but, on the other hand, increased climatic variability will render the task more difficult to manage nutrients for the optimization of crop productivity while minimizing N losses to the environment. Higher air temperatures will result in a "climate penalty" for air quality mitigation efforts, because larger NOX emissions reductions will be needed to achieve the same reductions of O3 pollution under higher temperatures, thus imposing further challenges to avoid harmful impacts on human health and crop productivity. Changes in river discharge, due to summer drought and to extreme precipitation events, will affect the transport of N from agricultural fields to

  14. The importance of considering shifts in seasonal changes in discharges when prediciting future phosphorus loads in streams

    USDA-ARS?s Scientific Manuscript database

    In this work, we hypothesize that phosphorus (P) concentrations in streams vary seasonally and with streamflow and that it is important to incorporate this variation when predicting changes in P loading associated with climate change. Our study area includes 14 watersheds with a range of land uses t...

  15. Taxonomic update on proposed nomenclature and classification changes for bacteria of medical importance, 2013-2014.

    PubMed

    Janda, J Michael

    2015-09-01

    A key aspect of medical, public health, and diagnostic microbiology laboratories is the accurate and rapid reporting and communications regarding infectious agents of clinical significance. Microbial taxonomy in the age of molecular diagnostics and phylogenetics causes changes in this taxonomy at a rapid rate further complicating this process. This review focuses on the description of new species and classification changes proposed over the past 2 years. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Taxonomic update on proposed nomenclature and classification changes for bacteria of medical importance, 2015.

    PubMed

    Janda, J Michael

    2016-10-01

    A key aspect of medical, public health, and diagnostic microbiology laboratories is the accurate and rapid reporting and communication regarding infectious agents of clinical significance. Microbial taxonomy in the age of molecular diagnostics and phylogenetics creates changes in taxonomy at a rapid rate further complicating this process. This update focuses on the description of new species and classification changes proposed in 2015. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Oxidation flux change on spermatozoa membrane in important pathologic conditions leading to male infertility.

    PubMed

    Wiwanitkit, V

    2008-06-01

    Free radicals or reactive oxygen species mediate their action through proinflammatory cytokines and this mechanism has been proposed as a common underlying factor for male infertility. There is extensive literature on oxidative stress and its role in male infertility and sperm DNA damage and its effects on assisted reproductive techniques. However, there has never been a report on the oxidation flux change in spermatozoa. Here, the author determined the oxidation flux change in such hypoxic cases, using the simulation test based on nanomedicine technique is used. Of interest, change of flux can be detected. The main pathogenesis should be the direct injury of membrane structure of spermatozoa by free radicals which can lead to sperm defect. Therefore, this work can support the finding that the oxidation flux change corresponding to oxygen pressure change in spermatozoa does not exist. However, the flux change can be seen if the membrane thickness of spermatozoa is varied. Thin membrane spermatozoa are more prone to oxidative stress than thick membrane ones. The defect in the enzymatic system within the spermatozoa should be a better explanation for vulnerability of spermatozoa to oxidative stress. The use of enzymatic modification technique by antioxidants can be useful alternative in management of male infertility.

  18. Public Health Implications of Changing Rodent Importation Patterns - United States, 1999-2013.

    PubMed

    Lankau, E W; Sinclair, J R; Schroeder, B A; Galland, G G; Marano, N

    2017-04-01

    The United States imports a large volume of live wild and domestic animal species; these animals pose a demonstrated risk for introduction of zoonotic diseases. Rodents are imported for multiple purposes, including scientific research, zoo exhibits and the pet trade. Current U.S. public health regulatory restrictions specific to rodent importation pertain only to those of African origin. To understand the impacts of these regulations and the potential public health risks of international rodent trade to the United States, we evaluated live rodent import records during 1999-2013 by shipment volume and geographic origin, source (e.g. wild-caught versus captive- or commercially bred), intended purpose and rodent taxonomy. Live rodent imports increased from 2737 animals during 1999 to 173 761 animals during 2013. Increases in both the number and size of shipments contributed to this trend. The proportion of wild-captured imports declined from 75% during 1999 to <1% during 2013. Nearly all shipments during these years were imported for commercial purposes. Imports from Europe and other countries in North America experienced notable increases in volume. Gerbils and hamsters arriving from Europe and chinchillas, guinea pigs and hamsters arriving from other countries in North America were predominant taxa underlying this trend. After 2003, African-origin imports became sporadic events under the federal permit process. These patterns suggest development of large-scale captive rodent breeding markets abroad for commercial sale in the United States. While the shift from wild-captured imports alleviates many conservation concerns and risks for novel disease emergence, such consolidated sourcing might elevate exposure risks for zoonotic diseases associated with high-density rodent breeding (e.g. lymphocytic choriomeningitis or salmonellosis). A responsive border health system must periodically re-evaluate importation regulations in conjunction with key stakeholders to ensure a

  19. Importance of Standardized DXA Protocol for Assessing Physique Changes in Athletes.

    PubMed

    Nana, Alisa; Slater, Gary J; Hopkins, Will G; Halson, Shona L; Martin, David T; West, Nicholas P; Burke, Louise M

    2016-06-01

    The implications of undertaking DXA scans using best practice protocols (subjects fasted and rested) or a less precise but more practical protocol in assessing chronic changes in body composition following training and a specialized recovery technique were investigated. Twenty-one male cyclists completed an overload training program, in which they were randomized to four sessions per week of either cold water immersion therapy or control groups. Whole-body DXA scans were undertaken with best practice protocol (Best) or random activity protocol (Random) at baseline, after 3 weeks of overload training, and after a 2-week taper. Magnitudes of changes in total, lean and fat mass from baseline-overload, overload-taper and baseline-taper were assessed by standardization (Δmean/SD). The standard deviations of change scores for total and fat-free soft tissue mass (FFST) from Random scans (2-3%) were approximately double those observed in the Best (1-2%), owing to extra random errors associated with Random scans at baseline. There was little difference in change scores for fat mass. The effect of cold water immersion therapy on baseline-taper changes in FFST was possibly harmful (-0.7%; 90% confidence limits ±1.2%) with Best scans but unclear with Random scans (0.9%; ±2.0%). Both protocols gave similar possibly harmful effects of cold water immersion therapy on changes in fat mass (6.9%; ±13.5% and 5.5%; ±14.3%, respectively). An interesting effect of cold water immersion therapy on training-induced changes in body composition might have been missed with a less precise scanning protocol. DXA scans should be undertaken with Best.

  20. Assessing Minimal Detectable Changes and Test-Retest Reliability of the Timed Up and Go Test and the 2-Minute Walk Test in Patients With Total Knee Arthroplasty.

    PubMed

    Yuksel, Ertugrul; Kalkan, Serpil; Cekmece, Senol; Unver, Bayram; Karatosun, Vasfi

    2017-02-01

    Two-minute walk test (2MWT) and the Timed Up and Go test (TUG) are simple, quick, and can be applied in a short time as part of the routine medical examination. They were shown to be reliable and valid tests in many patient groups. The aims of the present study were: (1) to determine test-retest reliability of data for the TUG and 2MWT and (2) to determine minimal detectable change (MDC) scores for the TUG and 2MWT in patients with TKA. Forty-eight patients with total knee arthroplasty, operated by the same surgeon, were included in this study. Patients performed trials for TUG and 2MWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The TUG and 2MWT showed an excellent test-retest reliability in this study. Intraclass correlation coefficient [ICC(2,1)] for TUG and 2MWT were 0.98 and 0.97, respectively. Standard error of measurement and MDC95 for TUG were 0.82 and 2.27, respectively. Standard error of measurement and MDC95 for 2MWT were 5.40 and 14.96, respectively. The TUG and 2MWT have an excellent test-retest reliability in patients with TKA. Clinicians and researchers can be confident that changes in TUG time above 2.27 seconds and changes in 2MWT distances above 14.96 meters, represent a "real" clinical change in an individual patient with TKA. We, therefore, recommend the use of these 2 tests as complementary outcome measures for functional evaluation in patients TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. On the importance of prompt oxygen changes for hypofractionated radiation treatments

    NASA Astrophysics Data System (ADS)

    Kissick, Michael; Campos, David; van der Kogel, Albert; Kimple, Randall

    2013-10-01

    This discussion is motivated by observations of prompt oxygen changes occurring prior to a significant number of cancer cells dying (permanently stopping their metabolic activity) from therapeutic agents like large doses of ionizing radiation. Such changes must be from changes in the vasculature that supplies the tissue or from the metabolic changes in the tissue itself. An adapted linear-quadratic treatment is used to estimate the cell survival variation magnitudes from repair and reoxygenation from a two-fraction treatment in which the second fraction would happen prior to significant cell death from the first fraction, in the large fraction limit. It is clear the effects of oxygen changes are likely to be the most significant factor for hypofractionation because of large radiation doses. It is a larger effect than repair. Optimal dose timing should be determined by the peak oxygen timing. A call is made to prioritize near real time measurements of oxygen dynamics in tumors undergoing hypofractionated treatments in order to make these treatments adaptable and patient-specific.

  2. Pathogenic marine microbes influence the effects of climate change on a commercially important tropical bivalve

    PubMed Central

    Turner, Lucy M.; Alsterberg, Christian; Turner, Andrew D.; Girisha, S. K.; Rai, Ashwin; Havenhand, Jonathan N.; Venugopal, M. N.; Karunasagar, Indrani; Godhe, Anna

    2016-01-01

    There is growing evidence that climate change will increase the prevalence of toxic algae and harmful bacteria, which can accumulate in marine bivalves. However, we know little about any possible interactions between exposure to these microorganisms and the effects of climate change on bivalve health, or about how this may affect the bivalve toxin-pathogen load. In mesocosm experiments, mussels, Perna viridis, were subjected to simulated climate change (warming and/or hyposalinity) and exposed to harmful bacteria and/or toxin-producing dinoflagellates. We found significant interactions between climate change and these microbes on metabolic and/or immunobiological function and toxin-pathogen load in mussels. Surprisingly, however, these effects were virtually eliminated when mussels were exposed to both harmful microorganisms simultaneously. This study is the first to examine the effects of climate change on determining mussel toxin-pathogen load in an ecologically relevant, multi-trophic context. The results may have considerable implications for seafood safety. PMID:27576351

  3. The importance of land cover change across urban-rural typologies for climate modeling.

    PubMed

    Vargo, Jason; Habeeb, Dana; Stone, Brian

    2013-01-15

    Land cover changes affect local surface energy balances by changing the amount of solar energy reflected, the magnitude and duration over which absorbed energy is released as heat, and the amount of energy that is diverted to non-heating fluxes through evaporation. However, such local influences often are only crudely included in climate modeling exercises, if at all. A better understanding of local land conversion dynamics can serve to inform inputs for climate models and increase the role for land use planning in climate management policy. Here we present a new approach for projecting and incorporating metropolitan land cover change into mesoscale climate and other environmental assessment models. Our results demonstrate the relative contributions of different land development patterns to land cover change and conversion and suggest that regional growth management strategies serving to increase settlement densities over time can have a significant influence on the rate of deforestation per unit of population growth. Employing the approach presented herein, the impacts of land conversion on climate change and on parallel environmental systems and services, such as ground water recharge, habitat provision, and food production, may all be investigated more closely and managed through land use planning.

  4. Obesity emergence in the Pacific islands: why understanding colonial history and social change is important.

    PubMed

    McLennan, Amy K; Ulijaszek, Stanley J

    2015-06-01

    Between 1980 and 2008, two Pacific island nations - Nauru and the Cook Islands - experienced the fastest rates of increasing BMI in the world. Rates were over four times higher than the mean global BMI increase. The aim of the present paper is to examine why these populations have been so prone to obesity increases in recent times. Three explanatory frames that apply to both countries are presented: (i) geographic isolation and genetic predisposition; (ii) small population and low food production capacity; and (iii) social change under colonial influence. These are compared with social changes documented by anthropologists during the colonial and post-colonial periods. Nauru and the Cook Islands. While islands are isolated, islanders are interconnected. Similarly, islands are small, but land use is socially determined. While obesity affects individuals, islanders are interdependent. New social values, which were rapidly propagated through institutions such as the colonial system of education and the cash economy, are today reflected in all aspects of islander life, including diet. Such historical social changes may predispose societies to obesity. Colonial processes may have put in place the conditions for subsequent rapidly escalating obesity. Of the three frameworks discussed, social change under colonial influence is not immutable to further change in the future and could take place rapidly. In theorising obesity emergence in the Pacific islands, there is a need to incorporate the idea of obesity being a product of interdependence and interconnectedness, rather than independence and individual choice.

  5. Structural changes in the minimal spanning tree and the hierarchical network in the Korean stock market around the global financial crisis

    NASA Astrophysics Data System (ADS)

    Nobi, Ashadun; Maeng, Seong Eun; Ha, Gyeong Gyun; Lee, Jae Woo

    2015-04-01

    This paper considers stock prices in the Korean stock market during the 2008 global financial crisis by focusing on three time periods: before, during, and after the crisis. Complex networks are extracted from cross-correlation coefficients between the normalized logarithmic return of the stock price time series of firms. The minimal spanning trees (MSTs) and the hierarchical network (HN) are generated from cross-correlation coefficients. Before and after the crisis, securities firms are located at the center of the MST. During the crisis, however, the center of the MST changes to a firm in heavy industry and construction. During the crisis, the MST shrinks in comparison to that before and that after the crisis. This topological change in the MST during the crisis reflects a distinct effect of the global financial crisis. The cophenetic correlation coefficient increases during the crisis, indicating an increase in the hierarchical structure during in this period. When crisis hits the market, firms behave synchronously, and their correlations are higher than those during a normal period.

  6. Adult and paediatric patients with minimal change nephrotic syndrome show no major alterations in glomerular expression of sulphated heparan sulphate domains.

    PubMed

    Wijnhoven, Tessa J M; Geelen, Joyce M; Bakker, Marinka; Lensen, Joost F M; Rops, Angelique L W M M; Kramer, Andrea B; Navis, Gerjan; van den Hoven, Mabel J W; van der Vlag, Johan; Berden, Jo H M; Wetzels, Jack F M; van den Heuvel, Lambert P W J; Monnens, Leo A H; van Kuppevelt, Toin H

    2007-10-01

    Minimal change nephrotic syndrome (MCNS) is the most frequent form of nephrotic syndrome in childhood. In the glomerular basement membrane (GBM) of adult patients with MCNS, a reduced expression of a specific heparan sulphate (HS) domain has been reported. In children with MCNS, urinary activity of the HS-degrading enzyme heparanase was increased. It is, therefore, possible that a decreased GBM HS expression is associated with the pathogenesis of proteinuria in patients with MCNS. In this study, HS in glomeruli of five adult and six paediatric patients with MCNS were analysed by immunofluorescence staining using four different antibodies, each defining a specific sulphated HS domain. The pediatric patients were subdivided into three groups depending on the presence or absence of podocyte foot process effacement, the level of proteinuria and prednisone administration at the time of the biopsy. In addition, kidneys of rats with adriamycin nephropathy (ADRN), a model for MCNS, were included in the study. Expression of sulphated HS domains was not aberrant in adult or paediatric patients compared with control subjects. Children with and without proteinuria had the same HS content. In contrast, rats with ADRN showed a decreased glomerular expression of sulphated HS domains. These results suggest that in patients with MCNS proteinuria is not associated with major changes in glomerular expression of sulphated HS domains.

  7. Use of glutaraldehyde and benzalkonium chloride for minimizing post-harvest physio-chemical and microbial changes responsible for sucrose losses in sugar cane.

    PubMed

    Singh, Pushpa; Arya, Namita; Tiwari, Priyanka; Suman, Archna; Rai, R K; Shrivastava, A K; Solomon, S

    2008-08-27

    Sugar cane is sensitive to enormous sucrose losses induced by physio-chemical and microbial changes, the severity being increased during the time lag between harvest and crushing in the mills. Minimization of the sucrose losses in the field is essential for better sugar recovery and prevention of sucrose losses. An experiment was conducted to evaluate the efficacy of glutaraldehyde and benzalkonium chloride for their effects on the microbial counts and physio-chemical changes responsible for sucrose losses. Glutaraldehyde and benzalkonium chloride (1000 + 250 ppm) reduced the losses in sucrose content to 7.1% as compared to the 30.8% loss in the control, thus improving the performance by 76.9%. The application of chemicals reduced the acid invertase activity (by 60%), lowered weight loss, titrable acidity, reducing sugars content, dextran, ethanol, and ethylene production and respiration rates. The application led to the reduction in the total bacterial, fungal, Leuconostoc, and yeast counts by 67.92, 51.3%, 26.08, and 51.2%, respectively.

  8. Reliability and minimal detectable change of spinal length and width measurements using the Flexicurve for usual standing posture in healthy young adults.

    PubMed

    Dunleavy, Kim; Mariano, Herman; Wiater, Timothy; Goldberg, Allon

    2010-01-01

    The purposes of this study were to: 1) investigate the inter-rater and intra-rater reliability of use of the Flexicurve for measurement of spinal length (L), thoracic (TL) and lumbar length (LL), thoracic (TW) and lumbar width (LW), and 2) quantify measurement error and minimal detectable change at the 95% CI (MDC95) for the same measurements. Flexicurve measurements of the thoracolumbar spine were recorded by two examiners in standing. Intra-class correlation coefficients were calculated to determine the intra- and inter-rater reliability. Measurement error and MDC95 were calculated to determine length and width measurements that would constitute real change in spinal curvature. Thoracolumbar length (L) measurements had the highest degree of intra-rater reliability (0.93), while TL, TW, LL, LW showed moderate to good intra-rater reliability (0.61-0.80). Inter-rater reliability for all measurements was moderate (0.58-0.72). Measurement error was moderate to high for TW, LL, and LW (15-25%), and low for L and TL (1-6%). The %MDC95 for TW, LL, and LW found in this study was high (>40%), but was low for L (3.5%). Thoracolumbar length measurement with the Flexicurve showed good intra-rater reliability, low measurement error, and low MDC95 and may be a useful measure in clinical practice.

  9. Proposed Approach for Reviewing Changes to Risk-Important Human Actions

    DTIC Science & Technology

    2000-10-01

    DISCLAIMER: This report was prepared as an account of work sponsored by an agency of the U.S. Government. Neither the U.S. Government nor any agency...failure of the new HA in question ( ACDF ^), and (3) the integrated risk due to the modification over the time that the change or modification is to be...LERF), respectively. These figures show a plant’s baseline risk on the x-axis and ACDF and ALERF due to a plant modification or change on the y-axis

  10. Abrupt Holocene climate change as an important factor for human migration in West Greenland.

    PubMed

    D'Andrea, William J; Huang, Yongsong; Fritz, Sherilyn C; Anderson, N John

    2011-06-14

    West Greenland has had multiple episodes of human colonization and cultural transitions over the past 4,500 y. However, the explanations for these large-scale human migrations are varied, including climatic factors, resistance to adaptation, economic marginalization, mercantile exploration, and hostile neighborhood interactions. Evaluating the potential role of climate change is complicated by the lack of quantitative paleoclimate reconstructions near settlement areas and by the relative stability of Holocene temperature derived from ice cores atop the Greenland ice sheet. Here we present high-resolution records of temperature over the past 5,600 y based on alkenone unsaturation in sediments of two lakes in West Greenland. We find that major temperature changes in the past 4,500 y occurred abruptly (within decades), and were coeval in timing with the archaeological records of settlement and abandonment of the Saqqaq, Dorset, and Norse cultures, which suggests that abrupt temperature changes profoundly impacted human civilization in the region. Temperature variations in West Greenland display an antiphased relationship to temperature changes in Ireland over centennial to millennial timescales, resembling the interannual to multidecadal temperature seesaw associated with the North Atlantic Oscillation.

  11. Relative importance of glacier contributions to water supply in a changing climate

    USDA-ARS?s Scientific Manuscript database

    The Snowmelt Runoff Model (SRM) was designed for simulation, forecasting, and future assessments, such as the effects of climate change. The most recent version of SRM uses the Microsoft Windows operating system and operates efficiently in the PC environment. A formalized algorithm for assessing ...

  12. Abrupt Holocene climate change as an important factor for human migration in West Greenland

    PubMed Central

    D’Andrea, William J.; Huang, Yongsong; Fritz, Sherilyn C.; Anderson, N. John

    2011-01-01

    West Greenland has had multiple episodes of human colonization and cultural transitions over the past 4,500 y. However, the explanations for these large-scale human migrations are varied, including climatic factors, resistance to adaptation, economic marginalization, mercantile exploration, and hostile neighborhood interactions. Evaluating the potential role of climate change is complicated by the lack of quantitative paleoclimate reconstructions near settlement areas and by the relative stability of Holocene temperature derived from ice cores atop the Greenland ice sheet. Here we present high-resolution records of temperature over the past 5,600 y based on alkenone unsaturation in sediments of two lakes in West Greenland. We find that major temperature changes in the past 4,500 y occurred abruptly (within decades), and were coeval in timing with the archaeological records of settlement and abandonment of the Saqqaq, Dorset, and Norse cultures, which suggests that abrupt temperature changes profoundly impacted human civilization in the region. Temperature variations in West Greenland display an antiphased relationship to temperature changes in Ireland over centennial to millennial timescales, resembling the interannual to multidecadal temperature seesaw associated with the North Atlantic Oscillation. PMID:21628586

  13. Robust Impacts of Climate Change in Europe and Why Study Scale is Important for Adaptation

    NASA Astrophysics Data System (ADS)

    Donnelly, C.; Andersson, J.; Olsson, J.; Bosshard, T.; Yang, W.; Berg, P.; Arheimer, B.

    2015-12-01

    Impacts of climate change on water resources in Europe have been studied using multiple climate, hydrological and downscaling models and at multiple scales. Although results seem to differ largely between these studies, robust qualitative results have emerged at the European scale. Generally, a drying trend coupled with more intense extremes (floods & droughts) is observed in southern Europe, whereas a wetting trend coupled with less intense extremes is observed in Northern Europe. The location of the change between wetting and drying leads to uncertainty of climate change impacts in central Europe. Also, temperature-related hydrological processes lead to more robust predictions than precipitation-related processes as climate models are more consistent for temperature. For European hydrology, this leads to more robust predictions in regions with snow-dominated hydrology and where evapotranspiration dominates the water cycle. Robust predictions of changes to the seasonality of discharge are seen in snow-dominated regions (Fennoscandinavia, Alps) while robust predictions of decreases in runoff are seen for the Iberian peninsula. While uncertainty in the projections mostly comes from climate uncertainty, predictions of impacts on soil moisture and low flows can be largely dependent on the choice of hydrological model where methods to estimate evapotranspiration and runoff differ widely. While the regional-scale results show some robustness, there can be large local-scale differences even where the same catchment is considered at different scales. Furthermore, understanding of uncertainties due to correction and downscaling procedures are only beginning to emerge. Our evaluations of bias-correction indicate that uncertainties vary considerably depending on the variable. The scale of uncertainty due to bias-correction can be similar to the projected climate changes and to the uncertainty from the climate models. In this presentation we put forward a new bottom-up method

  14. Insect Infestations Linked to Shifts in Microclimate: Important Climate Change Implications

    SciTech Connect

    Classen, Aimee T; Hart, Stephen C; Whitham, Thomas G; Cobb, Neil S; Koch, George W

    2005-01-01

    Changes in vegetation due to drought-influenced herbivory may influence microclimate in ecosystems. In combination with studies of insect resistant and susceptible trees, we used long-term herbivore removal experiments with two herbivores of pinon (Pinus edulis Endelm.) to test the general hypothesis that herbivore alteration of plant architecture affects soil microclimate, a major driver of ecosystem-level processes. The pinon needle scale (Matsucoccus acalyptus, Herbert) attacks needles of juvenile trees causing them to develop an open crown. In contrast, the stem-boring moth (Dioryctria albovittella Hulst.) kills the terminal shoots of mature trees, causing the crown to develop a dense form. Our studies focused on how the microclimate effects of these architectural changes are likely to accumulate over time. Three patterns emerged: (1) scale herbivory reduced leaf area index (LAI) of susceptible trees by 39%, whereas moths had no effect on LAI; (2) scale herbivory increased soil moisture and temperature beneath susceptible trees by 35 and 26%, respectively, whereas moths had no effect; and (3) scale and moth herbivory decreased crown interception of precipitation by 51 and 29%, respectively. From these results, we conclude: (1) the magnitude of scale effects on soil moisture and temperature is large, similar to global change scenarios, and sufficient to drive changes in ecosystem processes. (2) The larger sizes of moth-susceptible trees apparently buffered them from most microclimate effects of herbivory, despite marked changes in crown architecture. (3) The phenotypic expression of susceptibility or resistance to scale insects extends beyond plant-herbivore interactions to the physical environment.

  15. Catchment sensitivity to changing climate conditions: the importance of landscape characteristic

    NASA Astrophysics Data System (ADS)

    Teutschbein, C.; Karlsen, R.; Grabs, T.; Laudon, H.; Bishop, K. H.

    2014-12-01

    The scientific literature is full of studies analyzing future climate change impacts on hydrology with focus on individual catchments. However, we recently found that hydrologic behavior and specific discharge vary considerably even in neighboring and rather similar catchments under current climate conditions and that these variations are related to landscape characteristics. Therefore we hypothesize that these landscape characteristics also play a fundamental role for the sensitivity of a catchment to changing climate conditions. We analyzed the hydrological response of 14 neighboring catchments in Northern Sweden with slightly different topography, land cover, size and geology. Current (1981-2010) and future (2061-2090) streamflow was simulated with the HBV light model. Climate projections were based on 14 regional climate models (ENSEMBLES EU project) and bias-corrected with a distribution-mapping approach. Our simulations revealed that future spring flood peaks will occur much earlier and decrease by 13 to 32 %, whereas winter base flows will increase slightly. These changes are somewhat expected and mainly triggered by a projected increase in winter temperature, which leads to less snow accumulation on the ground. However, these values also highlight that there is a large variability amongst the catchments in their hydrological response to the same future climate conditions. For example, spring flood peaks in catchments without wetlands decrease by only 13 to 15 %, whereas catchments with wetlands show a spring flood peak reduction of 20 to 32 %. In addition to wetlands, we also identified lakes, peat soils and higher elevations as factors that seem to cause a stronger hydrological response to the climate change signal, whereas catchments dominated by forests, steeper slopes and till soils seem to be less strongly affected by a changing climate. Therefore, our results suggest that the sensitivity of catchments to future climate conditions is strongly linked to

  16. 78 FR 72570 - Import Administration; Change of Agency Name for Instruments and Apparatus for Educational and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-03

    ... Name for Instruments and Apparatus for Educational and Scientific Institutions AGENCY: Import... final form. List of Subjects 15 CFR Part 301 Instruments and apparatus for educational and scientific institutions. 15 CFR Part 303 Watches, Watch movements and jewelry program. PART 301--INSTRUMENTS AND...

  17. The changing pattern of imported malaria in British visitors to Kenya 1987-1990.

    PubMed Central

    Pryce, D I; Behrens, R H; Bradley, D J

    1993-01-01

    Following a sudden increase of imported malaria from Kenya in December 1989-January 1990, an investigation was set up to identify risk factors for travellers' malaria. A questionnaire asking for details of travel patterns and compliance with prophylaxis was sent to cases reported over the 6-month Kenyan winter period. Quarterly malaria attack rates between January 1987 and June 1991 were calculated and linked to meteorological conditions in Mombasa. The number of travellers to Kenya has doubled in the 4 years studied and the quarterly rates varied 4-fold over this period. There was no clear seasonal pattern of malaria in travellers, nor was there any clear relation of malaria to coastal rainfall. Compliance with chemoprophylaxis was poor, with only 16% of cases using currently advised regimens. While the annual malaria attack rate per 10,000 travellers decreased by 37% over the study period, the total numbers of malaria cases imported from Kenya rose by 61%, reflecting the increase in the numbers of travellers to the region. As the popularity of East Africa as a tourist destination continues to increase, Kenya will remain an important and significant source of malaria imported into the UK. PMID:8459379

  18. Changes in tree species importance following harvesting disturbance in north Mississippi between 1967 and 1994

    Treesearch

    Andrew J. Hartsell; James F. Rosson

    2007-01-01

    We used continuous forest inventory data from the Forest Inventory and Analysis unit of the U.S. Department of Agriculture, Forest Service to study the impacts of timber harvesting on species composition and species importance in a 26-county region in north Mississippi. The region was 59 percent forested and contained 1 965 223 ha of timberland. There were 524 upland...

  19. The Importance of the Concept of Self-Evaluation in the Changing Landscape of Education Policy

    ERIC Educational Resources Information Center

    McNamara, Gerry; O'Hara, Joe

    2008-01-01

    Recent decades have witnessed a remarkable rise in the regulation of public services and servants, education being a case in point. External evaluation and inspection has been an important element of this trend. Increasingly, however as the limitations of external surveillance systems have become clear the concept of internal or self-evaluation…

  20. The Importance of Autonomous Regulation for Students' Successful Translation of Intentions into Behavior Change via Planning.

    PubMed

    Cao, Dian Sheng; Lippke, Sonia; Liu, Wei

    2011-01-01

    Physical activity has a high prevention potential in adolescents. This study investigated the relations between physical activity and intention, autonomous regulation, and planning. We hypothesized that planning mediates the relationship between intention and behavior and that this mediation should depend on the level of autonomous regulation. Stratified randomization sampling method was administered to assemble a sample of N = 534 students among two schools in China. To test the hypothesis, autonomous regulation, intention, and physical activity were assessed at baseline as well as planning and follow-up physical activity four weeks after the pretest. A moderated mediation model confirmed that planning mediated the intention-behavior relation with the effect of planning being moderated by autonomous regulation. Study results demonstrated that autonomous regulation facilitated the translation of intention into behavior change via planning. To promote physical activity among adolescents, interventions targeting planning and autonomous regulation might facilitate successful translation of intentions into behavior change.

  1. Simulated Vegetation Response to Climate Change in California: The Importance of Seasonal Production Patterns

    NASA Astrophysics Data System (ADS)

    Kim, J. B.; Pitts, B.

    2013-12-01

    MC1 dynamic global vegetation model simulates vegetation response to climate change by simulating vegetation production, soil biogeochemistry, plant biogeography and fire. It has been applied at a wide range of spatial scales, yet the spatio-temporal patterns of simulated vegetation production, which drives the model's response to climate change, has not been examined in detail. We ran MC1 for California at a relatively fine scale, 30 arc-seconds, for the historical period (1895-2006) and for the future (2007-2100), using downscaled data from four CMIP3-based climate projections: A2 and B1 GHG emissions scenarios simulated by PCM and GFDL GCMs. The use of these four climate projections aligns our work with a body of climate change research work commissioned by the California Public Interest Energy Research (PIER) Program. The four climate projections vary not only in terms of changes in their annual means, but in the seasonality of projected climate change. We calibrated MC1 using MODIS NPP data for 2000-2011 as a guide, and adapting a published technique for adjusting simulated vegetation production by increasing the simulated plant rooting depths. We evaluated the simulation results by comparing the model output for the historical period with several benchmark datasets, summarizing by EPA Level 3 Ecoregions. Multi-year summary statistics of model predictions compare moderately well with Kuchler's potential natural vegetation map, National Biomass and Carbon Dataset, Leenhouts' compilation of fire return intervals, and, of course, the MODIS NPP data for 2000-2011. When we compared MC1's monthly NPP values with MODIS monthly GPP data (2000-2011), however, the seasonal patterns compared very poorly, with NPP/GPP ratio for spring (Mar-Apr-May) often exceeding 1, and the NPP/GPP ratio for summer (Jun-Jul-Aug) often flattening to zero. This suggests MC1's vegetation production algorithms are overly biased for spring production at the cost of summer production. We

  2. The importance of benthic-pelagic coupling for marine ecosystem functioning in a changing world.

    PubMed

    Griffiths, Jennifer R; Kadin, Martina; Nascimento, Francisco J A; Tamelander, Tobias; Törnroos, Anna; Bonaglia, Stefano; Bonsdorff, Erik; Brüchert, Volker; Gårdmark, Anna; Järnström, Marie; Kotta, Jonne; Lindegren, Martin; Nordström, Marie C; Norkko, Alf; Olsson, Jens; Weigel, Benjamin; Žydelis, Ramunas; Blenckner, Thorsten; Niiranen, Susa; Winder, Monika

    2017-01-28

    Benthic-pelagic coupling is manifested as the exchange of energy, mass, or nutrients between benthic and pelagic habitats. It plays a prominent role in aquatic ecosystems, and it is crucial to functions from nutrient cycling to energy transfer in food webs. Coastal and estuarine ecosystem structure and function are strongly affected by anthropogenic pressures; however, there are large gaps in our understanding of the responses of inorganic nutrient and organic matter fluxes between benthic habitats and the water column. We illustrate the varied nature of physical and biological benthic-pelagic coupling processes and their potential sensitivity to three anthropogenic pressures - climate change, nutrient loading, and fishing - using the Baltic Sea as a case study and summarize current knowledge on the exchange of inorganic nutrients and organic material between habitats. Traditionally measured benthic-pelagic coupling processes (e.g., nutrient exchange and sedimentation of organic material) are to some extent quantifiable, but the magnitude and variability of biological processes are rarely assessed, preventing quantitative comparisons. Changing oxygen conditions will continue to have widespread effects on the processes that govern inorganic and organic matter exchange among habitats while climate change and nutrient load reductions may have large effects on organic matter sedimentation. Many biological processes (predation, bioturbation) are expected to be sensitive to anthropogenic drivers, but the outcomes for ecosystem function are largely unknown. We emphasize how improved empirical and experimental understanding of benthic-pelagic coupling processes and their variability are necessary to inform models that can quantify the feedbacks among processes and ecosystem responses to a changing world.

  3. On the importance of changes in the gravity field on seismic recording at ultralong periods

    PubMed Central

    Okal, Emile A.

    1981-01-01

    The effect of changes in gravity induced by the Earth's deformation on seismic recording at ultralong periods is studied quantitatively for the low-order spheroidal modes of the Earth. Because this effect can either enhance or reduce the recorded amplitude of a mode, depending on its geometry, it may become nontrivial at the longest free-oscillation periods, and contribute to relative deviations of up to 17%. PMID:16592943

  4. Niche construction is an important component of a science of intentional change.

    PubMed

    O'Brien, Michael J

    2014-08-01

    Wilson and colleagues are correct that a modern theory of evolution must go beyond reliance on natural selection. Niche-construction theory, although it does not ignore selection, emphasizes the capacity of organisms to modify environmental states, often in a manner that suits their genotypes. Such matches are the dynamic products of a two-way process that involves organisms both responding to "problems" posed by their environments through selection and setting themselves new problems by changing environments through niche construction.

  5. Adaptation pathways of global wheat production: Importance of strategic adaptation to climate change.

    PubMed

    Tanaka, Akemi; Takahashi, Kiyoshi; Masutomi, Yuji; Hanasaki, Naota; Hijioka, Yasuaki; Shiogama, Hideo; Yamanaka, Yasuhiro

    2015-09-16

    Agricultural adaptation is necessary to reduce the negative impacts of climate change on crop yields and to maintain food production. However, few studies have assessed the course of adaptation along with the progress of climate change in each of the current major food producing countries. Adaptation pathways, which describe the temporal sequences of adaptations, are helpful for illustrating the timing and intensity of the adaptation required. Here we present adaptation pathways in the current major wheat-producing countries, based on sequential introduction of the minimum adaptation measures necessary to maintain current wheat yields through the 21st century. We considered two adaptation options: (i) expanding irrigation infrastructure; and (ii) switching crop varieties and developing new heat-tolerant varieties. We find that the adaptation pathways differ markedly among the countries. The adaptation pathways are sensitive to both the climate model uncertainty and natural variability of the climate system, and the degree of sensitivity differs among countries. Finally, the negative impacts of climate change could be moderated by implementing adaptations steadily according to forecasts of the necessary future adaptations, as compared to missing the appropriate timing to implement adaptations.

  6. Climate remains an important driver of post-European vegetation change in the eastern United States

    USGS Publications Warehouse

    Neil Pederson,; Anthony W. D’Amato,; James M. Dyer,; Foster, David R.; Goldblum, David; Hart, Justin L.; Hessl, Amy E.; Iverson, Louis R.; Jackson, Stephen T.; Martin-Benito, Dario; McCarthy, Brian C.; McEwan, Ryan W.; Mladenoff, David J.; Parker, Albert J.; Shuman, Bryan; Williams, John W.

    2014-01-01

    The influence of climate on forest change during the past century in the eastern United States was evaluated in a recent paper (Nowacki & Abrams, 2014) that centers on an increase in ‘highly competitive mesophytic hardwoods’ (Nowacki & Abrams, 2008) and a concomitant decrease in the more xerophytic Quercus species. Nowacki & Abrams (2014) concluded that climate change has not contributed significantly to observed changes in forest composition. However, the authors restrict their focus to a single element of climate: increasing temperature since the end of the Little Ice Age ca. 150 years ago. In their study, species were binned into four classifications (e.g., Acer saccharum – ‘cool-adapted’, Acer rubrum – ‘warm-adapted’) based on average annual temperature within each species range in the United States, reducing the multifaceted character of climate into a single, categorical measure. The broad temperature classes not only veil the many biologically relevant aspects of temperature (e.g., seasonal and extreme temperatures) but they may also mask other influences, both climatic (e.g., moisture sensitivity) and nonclimatic (e.g., competition).

  7. The ten most important changes in psychiatry since World War II.

    PubMed

    Micale, Mark S

    2014-12-01

    Writing the recent history of a subject is notoriously difficult because of the lack of perspective and impartiality. One way to gain insight and understanding into the recent past of a discipline of knowledge is to consult directly the living practitioners who actually experienced first-hand the major changing circumstances in the discipline during the period under study. This article seeks to explore the most significant changes occurring in Western, and especially American, psychiatry from the end of World War II up to the present by interrogating a representative selection of psychiatrists and psychologists about the subject. Over a three-year period, the author surveyed approximately 200 mental health experts on their perceptions of change in the world of psychiatric theory and practice during this enormously eventful 70-year period. After presenting the survey results, the article then attempts to analyse the answers that the author did (and did not) obtain from his poll-taking subjects. © The Author(s) 2014.

  8. Molecular changes in hepatic metabolism and transport in cirrhosis and their functional importance

    PubMed Central

    Dietrich, Christoph G; Götze, Oliver; Geier, Andreas

    2016-01-01

    Liver cirrhosis is the common endpoint of many hepatic diseases and represents a relevant risk for liver failure and hepatocellular carcinoma. The progress of liver fibrosis and cirrhosis is accompanied by deteriorating liver function. This review summarizes the regulatory and functional changes in phase I and phase II metabolic enzymes as well as transport proteins and provides an overview regarding lipid and glucose metabolism in cirrhotic patients. Interestingly, phase I enzymes are generally downregulated transcriptionally, while phase II enzymes are mostly preserved transcriptionally but are reduced in their function. Transport proteins are regulated in a specific way that resembles the molecular changes observed in obstructive cholestasis. Lipid and glucose metabolism are characterized by insulin resistance and catabolism, leading to the disturbance of energy expenditure and wasting. Possible non-invasive tests, especially breath tests, for components of liver metabolism are discussed. The heterogeneity and complexity of changes in hepatic metabolism complicate the assessment of liver function in individual patients. Additionally, studies in humans are rare, and species differences preclude the transferability of data from rodents to humans. In clinical practice, some established global scores or criteria form the basis for the functional evaluation of patients with liver cirrhosis, but difficult treatment decisions such as selection for transplantation or resection require further research regarding the application of existing non-invasive tests and the development of more specific tests. PMID:26755861

  9. The changing biodiversity of Alabama Drosophila: important impacts of seasonal variation, urbanization, and invasive species.

    PubMed

    Bombin, Andrei; Reed, Laura K

    2016-10-01

    Global warming and anthropogenic disturbances significantly influence the biosphere, tremendously increasing species extinction rates. In Central Alabama, we analyzed Drosophilidae species composition change nearly 100 years after the previous survey. We found ten Drosophilid species that were not reported during the last major biodiversity studies, two of which are invasive pests. In addition, we analyzed the influence of seasonal environmental variables characteristic of the subtropical climate zone on Drosophila abundance and biodiversity. We found a significant correlation between temperature and abundance of total Drosophila as well as for six of the seven most represented species individually, with a maximum abundance at intermediate temperatures (18-26°C). In addition, temperature was positively correlated with biodiversity of Drosophila. Precipitation produced a significant effect on the abundance of five species of Drosophila, with different optima for each species, but did not affect overall biodiversity. We concluded that in the subtropical climate zone of Central Alabama, seasonal temperature and precipitation changes produce a significant effect on Drosophila abundance and biodiversity, while local land use also impacts fly abundance, contributing to an apparent shift in species composition over the last century. We expect global climate change and other anthropogenic factors to further impact Drosophila species composition in the subtropical climate zone into the future.

  10. Carbon cycling under 300 years of land use change: importance of the secondary vegetation sink

    USGS Publications Warehouse

    Shevliakova, Elena; Pacala, Stephen W.; Malyshev, Sergey; Hurtt, George C.; Milly, P.C.D.; Caspersen, John P.; Sentman, Lori T.; Fisk, Justin P.; Wirth, Christian; Crevoisier, Cyril

    2009-01-01

    We have developed a dynamic land model (LM3V) able to simulate ecosystem dynamics and exchanges of water, energy, and CO2 between land and atmosphere. LM3V is specifically designed to address the consequences of land use and land management changes including cropland and pasture dynamics, shifting cultivation, logging, fire, and resulting patterns of secondary regrowth. Here we analyze the behavior of LM3V, forced with the output from the Geophysical Fluid Dynamics Laboratory (GFDL) atmospheric model AM2, observed precipitation data, and four historic scenarios of land use change for 1700-2000. Our analysis suggests a net terrestrial carbon source due to land use activities from 1.1 to 1.3 GtC/a during the 1990s, where the range is due to the difference in the historic cropland distribution. This magnitude is substantially smaller than previous estimates from other models, largely due to our estimates of a secondary vegetation sink of 0.35 to 0.6 GtC/a in the 1990s and decelerating agricultural land clearing since the 1960s. For the 1990s, our estimates for the pastures' carbon flux vary from a source of 0.37 to a sink of 0.15 GtC/a, and for the croplands our model shows a carbon source of 0.6 to 0.9 GtC/a. Our process-based model suggests a smaller net deforestation source than earlier bookkeeping models because it accounts for decelerated net conversion of primary forest to agriculture and for stronger secondary vegetation regrowth in tropical regions. The overall uncertainty is likely to be higher than the range reported here because of uncertainty in the biomass recovery under changing ambient conditions, including atmospheric CO2 concentration, nutrients availability, and climate. Copyright 2009 by the American Geophysical Union.

  11. Permafrost thaw and wildfire: Equally important drivers of boreal tree cover changes in the Taiga Plains, Canada

    NASA Astrophysics Data System (ADS)

    Helbig, M.; Pappas, C.; Sonnentag, O.

    2016-02-01

    Boreal forests cover vast areas of the permafrost zones of North America, and changes in their composition and structure can lead to pronounced impacts on the regional and global climate. We partition the variation in regional boreal tree cover changes between 2000 and 2014 across the Taiga Plains, Canada, into its main causes: permafrost thaw, wildfire disturbance, and postfire regrowth. Moderate Resolution Imaging Spectroradiometer Percent Tree Cover (PTC) data are used in combination with maps of historic fires, and permafrost and drainage characteristics. We find that permafrost thaw is equally important as fire history to explain PTC changes. At the southern margin of the permafrost zone, PTC loss due to permafrost thaw outweighs PTC gain from postfire regrowth. These findings emphasize the importance of permafrost thaw in controlling regional boreal forest changes over the last decade, which may become more pronounced with rising air temperatures and accelerated permafrost thaw.

  12. Tracking a Medically Important Spider: Climate Change, Ecological Niche Modeling, and the Brown Recluse (Loxosceles reclusa)

    PubMed Central

    Saupe, Erin E.; Papes, Monica; Selden, Paul A.; Vetter, Richard S.

    2011-01-01

    Most spiders use venom to paralyze their prey and are commonly feared for their potential to cause injury to humans. In North America, one species in particular, Loxosceles reclusa (brown recluse spider, Sicariidae), causes the majority of necrotic wounds induced by the Araneae. However, its distributional limitations are poorly understood and, as a result, medical professionals routinely misdiagnose brown recluse bites outside endemic areas, confusing putative spider bites for other serious conditions. To address the issue of brown recluse distribution, we employ ecological niche modeling to investigate the present and future distributional potential of this species. We delineate range boundaries and demonstrate that under future climate change scenarios, the spider's distribution may expand northward, invading previously unaffected regions of the USA. At present, the spider's range is centered in the USA, from Kansas east to Kentucky and from southern Iowa south to Louisiana. Newly influenced areas may include parts of Nebraska, Minnesota, Wisconsin, Michigan, South Dakota, Ohio, and Pennsylvania. These results illustrate a potential negative consequence of climate change on humans and will aid medical professionals in proper bite identification/treatment, potentially reducing bite misdiagnoses. PMID:21464985

  13. The importance of warm season warming to western U.S. streamflow changes

    USGS Publications Warehouse

    Das, T.; Pierce, D.W.; Cayan, D.R.; Vano, J.A.; Lettenmaier, D.P.

    2011-01-01

    Warm season climate warming will be a key driver of annual streamflow changes in four major river basins of the western U.S., as shown by hydrological model simulations using fixed precipitation and idealized seasonal temperature changes based on climate projections with SRES A2 forcing. Warm season (April-September) warming reduces streamflow throughout the year; streamflow declines both immediately and in the subsequent cool season. Cool season (October-March) warming, by contrast, increases streamflow immediately, partially compensating for streamflow reductions during the subsequent warm season. A uniform warm season warming of 3C drives a wide range of annual flow declines across the basins: 13.3%, 7.2%, 1.8%, and 3.6% in the Colorado, Columbia, Northern and Southern Sierra basins, respectively. The same warming applied during the cool season gives annual declines of only 3.5%, 1.7%, 2.1%, and 3.1%, respectively. Copyright 2011 by the American Geophysical Union.

  14. Changes in heart rate are important for thermoregulation in the varanid lizard Varanus varius.

    PubMed

    Seebacher, F; Grigg, G C

    2001-06-01

    Laboratory studies and a single field study have shown that heart rate in some reptiles is faster during heating than during cooling at any given body temperature. This phenomenon, which has been shown to reflect changes in peripheral blood flow, is shown here to occur in the lizard Varanus varius (lace monitor) in the wild. On a typical clear day, lizards emerged from their shelters in the morning to warm in the sun. Following this, animals were active, moving until they again entered a shelter in the evening. During their period of activity, body temperature was 34-36 degrees C in all six study animals (4.0-5.6 kg), but the animals rarely shuttled between sun and shade exposure. Heart rate during the morning heating period was significantly faster than during the evening cooling period. However, the ratio of heating to cooling heart rate decreased with increasing body temperature, being close to 2 at body temperatures of 22-24 degrees C and decreasing to 1.2-1.3 at body temperatures of 34-36 degrees C. There was a significant decrease in thermal time constants with increasing heart rate during heating and cooling confirming that changes in heart rate are linked to rates of heat exchange.

  15. Clinicopathological features, diagnosis, and treatment of IgA nephropathy with minimal change disease related to exposure to mercury-containing cosmetics: a case report
.

    PubMed

    Niu, Hong-Xin; Li, Shen-Heng; Li, Hong-Ying; Chen, Yi-Hua; Liu, Wei-Wei; Li, Pei-Lin; Long, Hai-Bo

    2017-04-01

    Membranous nephropathy and minimal change disease (MCD) have been involved in mercury-induced nephrotic syndrome. IgA nephropathy is not known to be a common pathological type. In the present article, we report a case of IgA nephropathy with MCD following exposure to mercury-containing skin lightening cream. The patient was a 39-year-old woman who presented with nephrotic syndrome. She had a 6-month history of using as many as 8 kinds of skin-lightening creams, and urinary mercury excretion was high. Renal biopsy revealed IgA nephropathy with MCD. The use of cosmetics was stopped and chelation therapy was given. After 4 courses (1 month) of chelation therapy, there was a complete remission of proteinuria and hematuria, and urine tests remained normal during the 5-year follow-up period. The unique clinical and pathological features of IgA nephropathy with MCD had raised the controversial question of whether MCD and IgA deposition are separate entities or a common pathophysiology. Repeated renal biopsy and similar cases were helpful and should be carried out as far as possible.
.

  16. Repeatability and Minimal Detectable Change in Longitudinal Median Nerve Excursion Measures During Upper Limb Neurodynamic Techniques in a Mixed Population: A Pilot Study Using Musculoskeletal Ultrasound Imaging.

    PubMed

    Paquette, Philippe; Lamontagne, Martin; Higgins, Johanne; Gagnon, Dany H

    2015-07-01

    This study determined test-retest reliability and minimum detectable change in longitudinal median nerve excursion during upper limb neurodynamic tests (ULNTs). Seven participants with unilateral or bilateral carpal tunnel syndrome and 11 healthy participants were randomly tested with two ULNTs (i.e., tensioner and slider). Each ULNT was performed three times each at 45° and 90° of shoulder abduction on two separate visits. Video sequences of median nerve excursion, recorded by a physical therapist using ultrasound imaging, were quantified using computer software. The generalizability theory, encompassing a G-Study and a D-study, measured the dependability coefficient (Φ) along with standard error of measurement (SEM) accuracy and allowed various testing protocols to be proposed. The highest reliability (Φ = 0.84) and lowest minimal measurement error (SEM = 0.58 mm) of the longitudinal median nerve excursion were reached during the ULNT-slider performed with 45° of shoulder abduction and when measures obtained from three different image sequences recorded during a single visit were averaged. It is recommended that longitudinal median nerve excursion measures computed from three separate image sequences recorded during a single visit be averaged in clinical practice. Ideally, adding a second visit (six image sequences) is also suggested in research protocols. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  17. A minimally invasive approach to spleen histopathology in dogs: A new method for follow-up studies of spleen changes in the course of Leishmania infantum infection.

    PubMed

    Santos, Silvana Ornelas; Fontes, Jonathan L M; Laranjeira, Daniela F; Vassallo, José; Barrouin-Melo, Stella Maria; Dos-Santos, Washington L C

    2016-10-01

    Severe forms of zoonotic visceral leishmaniosis (ZVL) are associated with disruption of the spleen structure. However, the study of spleen histology requires splenectomy or necropsy. In this work, we present a minimally invasive cell-block technique for studying spleen tissue histology in dogs with ZVL. We examined 13 dogs with and seven dogs without Leishmania infantum infection. The dogs with Leishmania infection had a lower frequency of lymphoid follicles (2/13, Fisher's test, P<0.02) and a higher density of plasma cells (score 3, Fisher's test, P<0.02) than uninfected dogs (5/7 exhibiting lymphoid follicles and a plasma cell score of 1). The dogs with Leishmania infection also presented with granulomas (8/13) and infected macrophages (5/13). These differences in the histological presentations of spleen tissue from infected and uninfected dogs corresponded to changes observed in conventional histology. Hence, the cell-block technique described here may be used in the follow-up care and study of dogs with ZVL and other diseases in both clinical practice and research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Test-Retest Reliability and Minimal Detectable Change of the Test of Visual Perceptual Skills-Third Edition in Patients With Stroke.

    PubMed

    Chiu, En-Chi; Wu, Wen-Chi; Chou, Chiung-Xia; Yu, Min-Yuan; Hung, Jen-Wen

    2016-11-01

    To examine the test-retest reliability, calculate minimal detectable change (MDC), and report internal consistency of the Test of Visual Perceptual Skills-Third Edition (TVPS-3) in patients with stroke. Repeated-measures design (at an interval of 2wk). Medical center. Patients (N=50) with chronic stroke who completed the TVPS-3. Not applicable. TVPS-3 that contains 7 subscales, namely, visual discrimination, visual memory, spatial relations, form constancy, sequential memory, visual figure-ground, and visual closure. The intraclass correlation coefficient value of the overall scale was .92 and those of the 7 subscales were .53 to .82. The MDC values of the overall scale and the subscales were 18.1 and 5.4 to 7.1, respectively. The MDC% value of the overall scale was 16.2% (<30%), showing acceptable random measurement error. However, the MDC% values of the subscales were 33.7% to 44.1% (>30%), indicating substantial random measurement errors. The Cronbach α of the 7 subscales were .71 to .89, indicating good internal consistency. Our results showed that the overall scale of the TVPS-3 had satisfactory test-retest reliability. However, the subscales demonstrated insufficient test-retest reliability. Therefore, the subscales should be used cautiously to explain the test results over repeated assessments in patients with stroke. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. Intra-Rater Reliability and Minimal Detectable Change of Vertical Ground Reaction Force Measurement during Gait and Half-Squat Tasks on Healthy Male Adults

    PubMed Central

    Fairus, Fariza Zainudin; Joseph, Leonard Henry; Omar, Baharudin; Ahmad, Johan; Sulaiman, Riza

    2016-01-01

    Background The understanding of vertical ground reaction force (VGRF) during walking and half-squatting is necessary and commonly utilised during the rehabilitation period. The purpose of this study was to establish measurement reproducibility of VGRF that reports the minimal detectable changes (MDC) during walking and half-squatting activity among healthy male adults. Methods 14 male adults of average age, 24.88 (5.24) years old, were enlisted in this study. The VGRF was assessed using the force plates which were embedded into a customised walking platform. Participants were required to carry out three trials of gait and half-squat. Each participant completed the two measurements within a day, approximately four hours apart. Results Measurements of VGRF between sessions presented an excellent VGRF data for walking (ICC Left = 0.88, ICC Right = 0.89). High reliability of VGRF was also noted during the half-squat activity (ICC Left = 0.95, ICC Right = 0.90). The standard errors of measurement (SEM) of VGRF during the walking and half-squat activity are less than 8.35 Nm/kg and 4.67 Nm/kg for the gait and half-squat task respectively. Conclusion The equipment set-up and measurement procedure used to quantify VGRF during walking and half-squatting among healthy males displayed excellent reliability. Researcher should consider using this method to measure the VGRF during functional performance assessment. PMID:27547111

  20. Strict sun protection results in minimal skin changes in a patient with xeroderma pigmentosum and a novel c.2009delG mutation in XPD (ERCC2).

    PubMed

    Emmert, Steffen; Ueda, Takahiro; Zumsteg, Urs; Weber, Peter; Khan, Sikandar G; Oh, Kyu-Seon; Boyle, Jennifer; Laspe, Petra; Zachmann, Karolin; Boeckmann, Lars; Kuschal, Christiane; Bircher, Andreas; Kraemer, Kenneth H

    2009-01-01

    We examined the clinical, molecular and genetic features of a 16-year-old boy (XP2GO) with xeroderma pigmentosum (XP) and progressive neurological symptoms. The parents are not consanguineous. Increased sun sensitivity led to the diagnosis of XP at 2 years of age and a strict UV protection scheme was implemented. Besides recurrent conjunctivitis and bilateral pterygium, only mild freckling was present on his lips. He shows absent deep tendon reflexes, progressive sensorineural deafness and progressive mental retardation. MRI shows diffuse frontal cerebral atrophy and dilated ventricles. Symptoms of trichothiodystrophy (brittle hair with a tiger-tail banding pattern on polarized microscopy) or Cockayne syndrome (cachectic dwarfism, cataracts, pigmentary retinopathy and spasticity) were absent. XP2GO fibroblasts showed reduced post-UV cell survival (D(37) = 3.8 J/m(2)), reduced nucleotide excision repair, reduced expression of XPD mRNA and an undetectable level of XPD protein. Mutational analysis of the XPD gene in XP2GO revealed two different mutations: a common p.Arg683Trp amino acid change (c.2047C>T) known to be associated with XP and a novel frameshift mutation c.2009delG (p.Gly670Alafs*39). The latter mutation potentially behaves as a null allele. While not preventing neurological degeneration, early diagnosis and rigorous sun protection can result in minimal skin disease without cancer in XP patients.

  1. Blood pressure in children with minimal change nephrotic syndrome during oedema and after steroid therapy: the influence of familial essential hypertension.

    PubMed

    Kontchou, Laure Monthe; Liccioli, Giulia; Pela, Ivana

    2009-01-01

    To verify the variations of blood pressure in children with minimal change nephrotic syndrome and to correlate the blood pressure with familial history of essential hypertension. We measured blood pressure in 49 prepubertal nephrotic children, 17 females and 32 males, in the first week of oedema, and after 4 weeks of ISKDC (International Study of Kidney Disease in Children) standard steroid therapy. The children were divided into two groups: one with and the other without familial history of essential hypertension. Among all the patients, 65% showed systolic and/or diastolic blood pressure higher than the 90th percentile at the first assessment. Among the children with a familial history of essential hypertension, in the oedematous phase of the nephrotic syndrome, 88% showed blood pressure higher than the 90th percentile and no children showed blood pressure lower than the 75th percentile. After therapy, the percentage of children with blood pressure higher than the 90th percentile was 52%. In the group with a negative familial history, at the onset 53% showed blood pressure over the 90th percentile. After 4 weeks of therapy, the percentage of children with blood pressure higher than the 90th percentile was 34%. Our study reveals the influence of familial essential hypertension in the oedematous phase of the nephrotic syndrome in children. (c) 2009 S. Karger AG, Basel.

  2. Minimal hepatic encephalopathy.

    PubMed

    Zamora Nava, Luis Eduardo; Torre Delgadillo, Aldo

    2011-06-01

    The term minimal hepatic encephalopathy (MHE) refers to the subtle changes in cognitive function, electrophysiological parameters, cerebral neurochemical/neurotransmitter homeostasis, cerebral blood flow, metabolism, and fluid homeostasis that can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy; the prevalence is as high as 84% in patients with hepatic cirrhosis. Physician does generally not perceive cirrhosis complications, and neuropsychological tests and another especial measurement like evoked potentials and image studies like positron emission tomography can only make diagnosis. Diagnosis of minimal hepatic encephalopathy may have prognostic and therapeutic implications in cirrhotic patients. The present review pretends to explore the clinic, therapeutic, diagnosis and prognostic aspects of this complication.

  3. Increasing measurement accuracy of age-related BOLD signal change: Minimizing vascular contributions by resting-state-fluctuation-of-amplitude scaling

    PubMed Central

    Kannurpatti, Sridhar S.; Motes, Michael A.; Rypma, Bart; Biswal, Bharat B.

    2012-01-01

    In this report we demonstrate a hemodynamic scaling method with resting-state fluctuation of amplitude (RSFA) in healthy adult younger and older subject groups. We show that RSFA correlated with breath hold (BH) responses throughout the brain in groups of younger and older subjects, that RSFA and BH performed comparably in accounting for age-related hemodynamic coupling changes, and yielded more veridical estimates of age-related differences in task-related neural activity. BOLD data from younger and older adults performing motor and cognitive tasks were scaled using RSFA and BH related signal changes. Scaling with RSFA and BH reduced the skew of the BOLD response amplitude distribution in each subject and reduced mean BOLD amplitude and variability in both age groups. Statistically significant differences in intra-subject amplitude variation across regions of activated cortex, and inter-subject amplitude variation in regions of activated cortex were observed between younger and older subject groups. Intra- and inter-subject variability differences were mitigated after scaling. RSFA, though similar to BH in minimizing skew in the un-scaled BOLD amplitude distribution, attenuated the neural activity related BOLD amplitude significantly less than BH. The amplitude and spatial extent of group activation were lower in the older than in the younger group prior to and after scaling. After accounting for vascular variability differences through scaling, age-related decreases in activation volume were observed during the motor and cognitive tasks. The results suggest that RSFA-scaled data yield age-related neural activity differences during task performance with negligible effects from non-neural (i.e., vascular) sources. PMID:20665721

  4. Reliability and minimal detectable change of a new treadmill-based progressive workload incremental test to measure cardiorespiratory fitness in manual wheelchair users.

    PubMed

    Gauthier, Cindy; Arel, Jasmine; Brosseau, Rachel; Hicks, Audrey L; Gagnon, Dany H

    2017-09-13

    Background Cardiorespiratory fitness training is commonly provided to manual wheelchair users (MWUs) in rehabilitation and physical activity programs, emphasizing the need for a reliable task-specific incremental wheelchair propulsion test. Objective Quantifying test-retest reliability and minimal detectable change (MDC) of key cardiorespiratory fitness measures following performance of a newly developed continuous treadmill-based wheelchair propulsion test (WPTTreadmill). Methods Twenty-five MWUs completed the WPTTreadmill on two separate occasions within one week. During these tests, participants continuously propelled their wheelchair on a motorized treadmill while the exercise intensity was gradually increased every minute until exhaustion by changing the slope and/or speed according to a standardized protocol. Peak oxygen consumption (VO2peak), carbon dioxide production (VCO2peak), respiratory exchange ratio (RERpeak), minute ventilation (VEpeak) and heart rate (HRpeak) were computed. Time to exhaustion (TTE) and number of increments completed were also measured. Intra-class correlation coefficients (ICC) were calculated to determine test-retest reliability. Standard error of measurement (SEM) and MDC90% values were calculated. Results Excellent test-retest reliability was reached for almost all outcome measures (ICC=0.91-0.76), except for RERpeak (ICC=0.58), which reached good reliability. TTE (ICC=0.89) and number of increments (ICC=0.91) also reached excellent test-retest reliability. For the main outcome measures (VO2peak and TTE), absolute SEM was 2.27 mL/kg/min and 0.76 minutes, respectively and absolute MDC90% was 5.30 mL/kg/min and 1.77 minutes, respectively. Conclusion The WPTTreadmill is a reliable test to assess cardiorespiratory fitness among MWUs. TTE and number of increments could be used as reliable outcome measures when VO2 measurement is not possible.

  5. Age-related changes in tissue signal properties within cortical areas important for word understanding in 12- to 19-month-old infants.

    PubMed

    Travis, Katherine E; Curran, Megan M; Torres, Christina; Leonard, Matthew K; Brown, Timothy T; Dale, Anders M; Elman, Jeffrey L; Halgren, Eric

    2014-07-01

    Recently, our laboratory has shown that the neural mechanisms for encoding lexico-semantic information in adults operate functionally by 12-18 months of age within left frontotemporal cortices (Travis et al., 2011. Spatiotemporal neural dynamics of word understanding in 12- to 18-month-old-infants. Cereb Cortex. 8:1832-1839). However, there is minimal knowledge of the structural changes that occur within these and other cortical regions important for language development. To identify regional structural changes taking place during this important period in infant development, we examined age-related changes in tissue signal properties of gray matter (GM) and white matter (WM) intensity and contrast. T1-weighted surface-based measures were acquired from 12- to 19-month-old infants and analyzed using a general linear model. Significant age effects were observed for GM and WM intensity and contrast within bilateral inferior lateral and anterovental temporal regions, dorsomedial frontal, and superior parietal cortices. Region of interest (ROI) analyses revealed that GM and WM intensity and contrast significantly increased with age within the same left lateral temporal regions shown to generate lexico-semantic activity in infants and adults. These findings suggest that neurophysiological processes supporting linguistic and cognitive behaviors may develop before cellular and structural maturation is complete within associative cortices. These results have important implications for understanding the neurobiological mechanisms relating structural to functional brain development. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  6. Changes in mitochondrial function are pivotal in neurodegenerative and psychiatric disorders: How important is BDNF?

    PubMed Central

    Markham, A; Bains, R; Franklin, P; Spedding, M

    2014-01-01

    The brain is at the very limit of its energy supply and has evolved specific means of adapting function to energy supply, of which mitochondria form a crucial link. Neurotrophic and inflammatory processes may not only have opposite effects on neuroplasticity, but also involve opposite effects on mitochondrial oxidative phosphorylation and glycolytic processes, respectively, modulated by stress and glucocorticoids, which also have marked effects on mood. Neurodegenerative processes show marked disorders in oxidative metabolism in key brain areas, sometimes decades before symptoms appear (Parkinson's and Alzheimer's diseases). We argue that brain-derived neurotrophic factor couples activity to changes in respiratory efficiency and these effects may be opposed by inflammatory cytokines, a key factor in neurodegenerative processes. Linked Articles This article is part of a themed issue on Mitochondrial Pharmacology: Energy, Injury & Beyond. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2014.171.issue-8 PMID:24720259

  7. Changes in mitochondrial function are pivotal in neurodegenerative and psychiatric disorders: how important is BDNF?

    PubMed

    Markham, A; Bains, R; Franklin, P; Spedding, M

    2014-04-01

    The brain is at the very limit of its energy supply and has evolved specific means of adapting function to energy supply, of which mitochondria form a crucial link. Neurotrophic and inflammatory processes may not only have opposite effects on neuroplasticity, but also involve opposite effects on mitochondrial oxidative phosphorylation and glycolytic processes, respectively, modulated by stress and glucocorticoids, which also have marked effects on mood. Neurodegenerative processes show marked disorders in oxidative metabolism in key brain areas, sometimes decades before symptoms appear (Parkinson's and Alzheimer's diseases). We argue that brain-derived neurotrophic factor couples activity to changes in respiratory efficiency and these effects may be opposed by inflammatory cytokines, a key factor in neurodegenerative processes. © 2013 The British Pharmacological Society.

  8. Intensive cardiovascular risk reduction induces sustainable changes in expression of genes and pathways important to vascular function.

    PubMed

    Ellsworth, Darrell L; Croft, Daniel T; Weyandt, Jamie; Sturtz, Lori A; Blackburn, Heather L; Burke, Amy; Haberkorn, Mary Jane; McDyer, Fionnuala A; Jellema, Gera L; van Laar, Ryan; Mamula, Kimberly A; Chen, Yaqin; Vernalis, Marina N

    2014-04-01

    Healthy lifestyle changes are thought to mediate cardiovascular disease risk through pathways affecting endothelial function and progression of atherosclerosis; however, the extent, persistence, and clinical significance of molecular change during lifestyle modification are not well known. We examined the effect of a rigorous cardiovascular disease risk reduction program on peripheral blood gene expression profiles in 63 participants and 63 matched controls to characterize molecular responses and identify regulatory pathways important to cardiovascular health. Dramatic changes in dietary fat intake (-61%; P<0.001 versus controls) and physical fitness (+34%; P<0.001) led to significant improvements in cardiovascular disease risk factors. Analysis of variance with false discovery rate correction for multiple testing (P<0.05) identified 26 genes after 12 weeks and 143 genes after 52 weeks that were differentially expressed from baseline in participants. Controls showed little change in cardiovascular disease risk factors or gene expression. Quantitative reverse transcription polymerase chain reaction validated differential expression for selected transcripts. Lifestyle modification effectively reduced expression of proinflammatory genes associated with neutrophil activation and molecular pathways important to vascular function, including cytokine production, carbohydrate metabolism, and steroid hormones. Prescription medications did not significantly affect changes in gene expression. Successful and sustained modulation of gene expression through lifestyle changes may have beneficial effects on the vascular system not apparent from traditional risk factors. Healthy lifestyles may restore homeostasis to the leukocyte transcriptome by downregulating lactoferrin and other genes important in the pathogenesis of atherosclerosis. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01805492.

  9. Bridging the Partisan Divide Over Climate Change: Messenger is as Important as the Message

    NASA Astrophysics Data System (ADS)

    Cater, M.

    2014-12-01

    In the United States, fewer than one-third of Republicans believe that climate change is driven significantly by burning fossil fuels. This despite unprecedented worldwide scientific consensus that it is. Over 13,000 peer reviewed scientific papers affirm it. Twenty-four deny it. Yet the Republican "disbelief" persists in part because of ideological bubbles that, according to analysis by the Marquette Law School, are deeper and more geographically based than ever before. More and more Americans are living in politically one-sided counties, with 51% of voters in the 2012 presidential race living in a county that was "partisan" - or 10 points redder or bluer than the U.S. as a whole. One in five lived in a county that was "extreme" - or 20 points redder or bluer than the country. With mainstream media contracting, opinion media exploding and the Internet increasingly giving us only what we want to hear, ideological bubbles are becoming more isolated and insulated than ever. Dan Kahan at Yale has discovered that these bubbles - the values and groups that hold them - have a greater impact on our perception of certain issues than scientific understanding. In fact, the more individuals become scientifically literate, the more they tend to use that information to confirm the view of their group. So the more conservative and more knowledgeable you are about climate change, the less convinced you will be that it is a problem. Countless scientific studies confirm people rely on those they trust. And conversely, they reject information coming from those they do not. To bridge the partisan divide, and break the ideological barriers to climate science, trusted leaders within conservative circles must engage and speak out. The conservative leaders I work with have transcended their ideological boundaries, understand the science largely because they have learned from people they trust, recognize the risk and have identified solutions that protect their conservative values.

  10. Genetic-Variation-Driven Gene-Expression Changes Highlight Genes with Important Functions for Kidney Disease.

    PubMed

    Ko, Yi-An; Yi, Huiguang; Qiu, Chengxiang; Huang, Shizheng; Park, Jihwan; Ledo, Nora; Köttgen, Anna; Li, Hongzhe; Rader, Daniel J; Pack, Michael A; Brown, Christopher D; Susztak, Katalin

    2017-06-01

    Chronic kidney disease (CKD) is a complex gene-environmental disease affecting close to 10% of the US population. Genome-wide association studies (GWASs) have identified sequence variants, localized to non-coding genomic regions, associated with kidney function. Despite these robust observations, the mechanism by which variants lead to CKD remains a critical unanswered question. Expression quantitative trait loci (eQTL) analysis is a method to identify genetic variation associated with gene expression changes in specific tissue types. We hypothesized that an integrative analysis combining CKD GWAS and kidney eQTL results can identify candidate genes for CKD. We performed eQTL analysis by correlating genotype with RNA-seq-based gene expression levels in 96 human kidney samples. Applying stringent statistical criteria, we detected 1,886 genes whose expression differs with the sequence variants. Using direct overlap and Bayesian methods, we identified new potential target genes for CKD. With respect to one of the target genes, lysosomal beta A mannosidase (MANBA), we observed that genetic variants associated with MANBA expression in the kidney showed statistically significant colocalization with variants identified in CKD GWASs, indicating that MANBA is a potential target gene for CKD. The expression of MANBA was significantly lower in kidneys of subjects with risk alleles. Suppressing manba expression in zebrafish resulted in renal tubule defects and pericardial edema, phenotypes typically induced by kidney dysfunction. Our analysis shows that gene-expression changes driven by genetic variation in the kidney can highlight potential new target genes for CKD development. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

  11. Climate change and temperature-linked hatchling mortality at a globally important sea turtle nesting site.

    PubMed

    Laloë, Jacques-Olivier; Cozens, Jacquie; Renom, Berta; Taxonera, Albert; Hays, Graeme C

    2017-11-01

    The study of temperature-dependent sex determination (TSD) in vertebrates has attracted major scientific interest. Recently, concerns for species with TSD in a warming world have increased because imbalanced sex ratios could potentially threaten population viability. In contrast, relatively little attention has been given to the direct effects of increased temperatures on successful embryonic development. Using 6603 days of sand temperature data recorded across 6 years at a globally important loggerhead sea turtle rookery-the Cape Verde Islands-we show the effects of warming incubation temperatures on the survival of hatchlings in nests. Incorporating published data (n = 110 data points for three species across 12 sites globally), we show the generality of relationships between hatchling mortality and incubation temperature and hence the broad applicability of our findings to sea turtles in general. We use a mechanistic approach supplemented b