Science.gov

Sample records for multidisciplinary public approach

  1. Halitosis: the multidisciplinary approach

    PubMed Central

    Bollen, Curd ML; Beikler, Thomas

    2012-01-01

    Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover, halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear–nose–throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear–nose–throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo. Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins. PMID:22722640

  2. Halitosis: the multidisciplinary approach.

    PubMed

    Bollen, Curd M L; Beikler, Thomas

    2012-06-01

    Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

  3. Breakfast: a multidisciplinary approach.

    PubMed

    Affinita, Antonio; Catalani, Loredana; Cecchetto, Giovanna; De Lorenzo, Gianfranco; Dilillo, Dario; Donegani, Giorgio; Fransos, Lucia; Lucidi, Fabio; Mameli, Chiara; Manna, Elisa; Marconi, Paolo; Mele, Giuseppe; Minestroni, Laura; Montanari, Massimo; Morcellini, Mario; Rovera, Giuseppe; Rotilio, Giuseppe; Sachet, Marco; Zuccotti, Gian Vincenzo

    2013-07-10

    The role of breakfast as an essential part of an healthy diet has been only recently promoted even if breakfast practices were known since the Middle Age. The growing scientific evidences on this topic are extremely sector-based nevertheless breakfast could be regarded from different point of views and from different expertises. This approach, that take into account history, sociology, anthropology, medicine, psychology and pedagogy, is useful to better understand the value of this meal in our culture. The aim of this paper was to analyse breakfast-related issues based on a multidisciplinary approach with input by specialists from different fields of learning. Breakfast is now recommended as part of a diet because it is associated with healthier macro- and micronutrient intakes, body mass index and lifestyle. Moreover recent studies showed that breakfast improves cognitive function, intuitive perception and academic performance. Research demonstrates the importance of providing breakfast not only to children but in adults and elderly too. Although the important role breakfast plays in maintaining the health, epidemiological data from industrialised countries reveal that many individuals either eat a nutritionally unhealthy breakfast or skip it completely. The historical, bio-psychological and educational value of breakfast in our culture is extremely important and should be recognized and stressed by the scientific community. Efforts should be done to promote this practice for the individual health and well-being.

  4. Breakfast: a multidisciplinary approach

    PubMed Central

    2013-01-01

    Background The role of breakfast as an essential part of an healthy diet has been only recently promoted even if breakfast practices were known since the Middle Age. The growing scientific evidences on this topic are extremely sector-based nevertheless breakfast could be regarded from different point of views and from different expertises. This approach, that take into account history, sociology, anthropology, medicine, psychology and pedagogy, is useful to better understand the value of this meal in our culture. The aim of this paper was to analyse breakfast-related issues based on a multidisciplinary approach with input by specialists from different fields of learning. Discussion Breakfast is now recommended as part of a diet because it is associated with healthier macro- and micronutrient intakes, body mass index and lifestyle. Moreover recent studies showed that breakfast improves cognitive function, intuitive perception and academic performance. Research demonstrates the importance of providing breakfast not only to children but in adults and elderly too. Although the important role breakfast plays in maintaining the health, epidemiological data from industrialised countries reveal that many individuals either eat a nutritionally unhealthy breakfast or skip it completely. Summary The historical, bio-psychological and educational value of breakfast in our culture is extremely important and should be recognized and stressed by the scientific community. Efforts should be done to promote this practice for the individual health and well-being. PMID:23842429

  5. Multidisciplinary approach to obesity.

    PubMed

    Donini, L M; Donini, M L; Savina, C; Castellaneta, E; Coletti, C; Paolini, M; Scavone, L; Civale, C; Ceccarelli, P; Zaninotto, S; Tineri, M; Grossi, G; De Felice, M R; Cannella, C

    2009-03-01

    Obesity, associated with morbidity and mortality, is a complex disorder, characterised by an increase in fat mass (FM). Most authors agree in considering essential an integrated treatment made up of nutritional intervention, physical reconditioning programme and cognitive-behavioural psychotherapy. However, the feasibility is problematic and data in literature confirming the validity of this approach are poor. To verify the efficacy of a multidimensional approach (Nutritional Psycho-Physical Reconditioning - NPPR) in obesity treatment. All patients admitted from June 2002 to June 2004 (464 subjects) ranged from 18 to 65 years old, with a body mass index (BMI) >30 kg/m2 were included in the programme. After the nutritional status evaluation a standard dietetic treatment (group N) or an integrated and multidisciplinary obesity treatment (group NPPR) was proposed. In group NPPR treatment duration was significantly higher (142.6+/-26 vs 48.6+/-55 days - p=0.000), while the drop-out amount was definitely lower (5.5 vs 54.4%; p=0.000). Weight loss compared to the initial weight and the difference between initial and final FM resulted significantly higher in group NNPR. Subjects in NPPR obtained a higher increase in the distance covered in a 6-minute walk test (59.9+/-19 vs 40.5+/-17 m; p=0.04) and in muscular strength. State and trait anxiety, mood and quality of life scores improved in NPPR subjects while remained substantially stable in group N. An integrated approach to obesity is the way to be pursued in order to obtain important and at least short-term results.

  6. Multidisciplinary approaches to solar hydrogen

    PubMed Central

    Bren, Kara L.

    2015-01-01

    This review summarizes three different approaches to engineering systems for the solar-driven evolution of hydrogen fuel from water: molecular, nanomaterials and biomolecular. Molecular systems have the advantage of being highly amenable to modification and detailed study and have provided great insight into photophysics, electron transfer and catalytic mechanism. However, they tend to display poor stability. Systems based on nanomaterials are more robust but also are more difficult to synthesize in a controlled manner and to modify and study in detail. Biomolecular systems share many properties with molecular systems and have the advantage of displaying inherently high efficiencies for light absorption, electron–hole separation and catalysis. However, biological systems must be engineered to couple modules that capture and convert solar photons to modules that produce hydrogen fuel. Furthermore, biological systems are prone to degradation when employed in vitro. Advances that use combinations of these three tactics also are described. Multidisciplinary approaches to this problem allow scientists to take advantage of the best features of biological, molecular and nanomaterials systems provided that the components can be coupled for efficient function. PMID:26052425

  7. Salmonella typhimurium in the Australian egg industry: Multidisciplinary approach to addressing the public health challenge and future directions.

    PubMed

    Chousalkar, Kapil K; Sexton, Margaret; McWhorter, Andrea; Hewson, Kylie; Martin, Glen; Shadbolt, Craig; Goldsmith, Paul

    2017-08-13

    In Australia, numerous egg-related human Salmonella typhimurium outbreaks have prompted significant interest among public health authorities and the egg industry to jointly address this human health concern. Nationwide workshops on Salmonella and eggs were conducted in Australia for egg producers and regulatory authorities. State and national regulators represented Primary Production, Communicable Disease Control, Public Health and Food Safety, and Food Standards Australia and New Zealand. All attendees participated in discussions aimed at evaluating current evidence-based information, issues related to quality of egg production, and how to ensure safe eggs in the supply chain, identifying research gaps and practical recommendations. The perceptions from egg producers and regulatory authorities from various states were recorded during the workshops. We presented the issues discussed during the workshops, including Salmonella in the farm environment, Salmonella penetration across eggshell, virulence in humans, food/egg handling in the supply chain, and intervention strategies. We also discussed the perceptions from egg producers and regulators. Recommendations placed emphasis on the future research needs, communication between industry and regulatory authorities, and education of food handlers. Communication between regulators and industry is pivotal to control egg-borne S. typhimurium outbreaks, and collaborative efforts are required to design effective and appropriate control strategies.

  8. Multidisciplinary Approach to Aerospike Nozzle Design

    NASA Technical Reports Server (NTRS)

    Korte, J. J.; Salas, A. O.; Dunn, H. J.; Alexandrov, N. M.; Follett, W. W.; Orient, G. E.; Hadid, A. H.

    1997-01-01

    A model of a linear aerospike rocket nozzle that consists of coupled aerodynamic and structural analyses has been developed. A nonlinear computational fluid dynamics code is used to calculate the aerodynamic thrust, and a three-dimensional finite-element model is used to determine the structural response and weight. The model will be used to demonstrate multidisciplinary design optimization (MDO) capabilities for relevant engine concepts, assess performance of various MDO approaches, and provide a guide for future application development. In this study, the MDO problem is formulated using the multidisciplinary feasible (MDF) strategy. The results for the MDF formulation are presented with comparisons against separate aerodynamic and structural optimized designs. Significant improvements are demonstrated by using a multidisciplinary approach in comparison with the single-discipline design strategy.

  9. Multidisciplinary Approach to Linear Aerospike Nozzle Optimization

    NASA Technical Reports Server (NTRS)

    Korte, J. J.; Salas, A. O.; Dunn, H. J.; Alexandrov, N. M.; Follett, W. W.; Orient, G. E.; Hadid, A. H.

    1997-01-01

    A model of a linear aerospike rocket nozzle that consists of coupled aerodynamic and structural analyses has been developed. A nonlinear computational fluid dynamics code is used to calculate the aerodynamic thrust, and a three-dimensional fink-element model is used to determine the structural response and weight. The model will be used to demonstrate multidisciplinary design optimization (MDO) capabilities for relevant engine concepts, assess performance of various MDO approaches, and provide a guide for future application development. In this study, the MDO problem is formulated using the multidisciplinary feasible (MDF) strategy. The results for the MDF formulation are presented with comparisons against sequential aerodynamic and structural optimized designs. Significant improvements are demonstrated by using a multidisciplinary approach in comparison with the single- discipline design strategy.

  10. Placenta accreta and anesthesia: A multidisciplinary approach.

    PubMed

    Khokhar, R S; Baaj, J; Khan, M U; Dammas, F A; Rashid, N

    2016-01-01

    Placenta accreta (an abnormally adherent placenta) is one of the two leading causes of peripartum hemorrhage and the most common indication for peripartum hysterectomy. Placenta accreta may be associated with significant maternal hemorrhage at delivery owing to the incomplete placental separation. When placenta accreta is diagnosed before delivery, a multidisciplinary approach may improve patient outcome.

  11. Acute mesenteric ischemia: current multidisciplinary approach.

    PubMed

    Savlania, Ajay; Tripathi, Ramesh K

    2017-04-01

    The aim of this review was to describe and discuss the mechanisms of acute mesenteric ischemia (AMI) and the rationale and conduct of currently available endovascular and open surgical techniques in its management. We also propose an algorithm to support the current multidisciplinary approach in decision-making for mesenteric revascularization to manage this high-risk entity.

  12. A multidisciplinary approach to improving revenue integrity.

    PubMed

    Craghead, Todd; Liston, Eric

    2014-03-01

    Intermountain Healthcare's journey toward a modern revenue integrity process began with five key steps: building a multidisciplinary team, developing department-specific charge-capture teams, providing ongoing education and training on best practices for revenue integrity, leveraging new technology and business support services, establishing a proactive approach to managing audits and compliance.

  13. Multidisciplinary Approaches in Evolutionary Linguistics

    ERIC Educational Resources Information Center

    Gong, Tao; Shuai, Lan; Wu, Yicheng

    2013-01-01

    Studying language evolution has become resurgent in modern scientific research. In this revival field, approaches from a number of disciplines other than linguistics, including (paleo)anthropology and archaeology, animal behaviors, genetics, neuroscience, computer simulation, and psychological experimentation, have been adopted, and a wide scope…

  14. Multidisciplinary Approaches in Evolutionary Linguistics

    ERIC Educational Resources Information Center

    Gong, Tao; Shuai, Lan; Wu, Yicheng

    2013-01-01

    Studying language evolution has become resurgent in modern scientific research. In this revival field, approaches from a number of disciplines other than linguistics, including (paleo)anthropology and archaeology, animal behaviors, genetics, neuroscience, computer simulation, and psychological experimentation, have been adopted, and a wide scope…

  15. Multidisciplinary approach of colorectal cancer liver metastases

    PubMed Central

    Fiorentini, Giammaria; Sarti, Donatella; Aliberti, Camillo; Carandina, Riccardo; Mambrini, Andrea; Guadagni, Stefano

    2017-01-01

    Large bowel cancer is a worldwide public health challenge. More than one third of patients present an advanced stage of disease at diagnosis and the liver is the most common site of metastases. Selection criteria for early diagnosis, chemotherapy and surgery have been recently expanded. The definition of resectability remains unclear. The presence of metastases is the most significant prognostic factor. For this reason the surgical resection of hepatic metastases is the leading treatment. The most appropriate resection approach remains to be defined. The two step and simultaneous resection processes of both primary and metastases have comparable survival long-term outcomes. The advent of targeted biological chemotherapeutic agents and the development of loco-regional therapies (chemoembolization, thermal ablation, arterial infusion chemotherapy) contribute to extend favorable results. Standardized evidence-based protocols are missing, hence optimal management of hepatic metastases should be single patient tailored and decided by a multidisciplinary team. This article reviews the outcomes of resection, systemic and loco-regional therapies of liver metastases originating from large bowel cancer. PMID:28638789

  16. [Tooth erosion - a multidisciplinary approach].

    PubMed

    Strużycka, Izabela; Rusyan, Ewa; Bogusławska-Kapała, Agnieszka

    2016-02-01

    During the last decades, an increasingly greater interest in dental erosion has been observed in clinical dental practice, in dental public health and in dental research because prevalence of erosive tooth wear is still increasing especially in young age group of population. Erosive tooth wear is a multifactorial etiology process characterized by progressive loss of hard dental tissue. It is defined as the exogenous and/or endogenous acids dissolution of the dental tissue, without bacterial involvement. In the development of dental erosive wear, interactions are required which include chemical, biological, behavioral, diet, time, socioeconomic, knowledge, education, and general health factors. Examples of risk groups could be patients with eating disorders, like anorexia nervosa or bulimia nervosa, gastroesophageal reflux disease, chronic alcohol abuse or dependence. Special nutrition habits groups with high consumption of soft or sport drinks, special diets like vegetarian, vegan or raw food diet, the regular intake of drugs, medications and food supplements can also increase the risk for dental erosion. Comprehensive knowledge of the different risk and protective factors is a perquisite for initiating adequate preventive measures. © 2016 MEDPRESS.

  17. Multidisciplinary approaches to climate change questions

    USGS Publications Warehouse

    Middleton, Beth A.; LePage, Ben A.

    2011-01-01

    Multidisciplinary approaches are required to address the complex environmental problems of our time. Solutions to climate change problems are good examples of situations requiring complex syntheses of ideas from a vast set of disciplines including science, engineering, social science, and the humanities. Unfortunately, most ecologists have narrow training, and are not equipped to bring their environmental skills to the table with interdisciplinary teams to help solve multidisciplinary problems. To address this problem, new graduate training programs and workshops sponsored by various organizations are providing opportunities for scientists and others to learn to work together in multidisciplinary teams. Two examples of training in multidisciplinary thinking include those organized by the Santa Fe Institute and Dahlem Workshops. In addition, many interdisciplinary programs have had successes in providing insight into climate change problems including the International Panel on Climate Change, the Joint North American Carbon Program, the National Academy of Science Research Grand Challenges Initiatives, and the National Academy of Science. These programs and initiatives have had some notable success in outlining some of the problems and solutions to climate change. Scientists who can offer their specialized expertise to interdisciplinary teams will be more successful in helping to solve the complex problems related to climate change.

  18. A Multidisciplinary Approach to Sustainable Management of Watershed Resources

    EPA Science Inventory

    The lack of integration in the study and management of water resource problems suggests the need for a multidisciplinary approach. As practiced in the Shepherd Creek stormwater management study (Cincinnati OH), we envision a multidisciplinary approach involving economic incentive...

  19. A Multidisciplinary Approach to Sustainable Management of Watershed Resources

    EPA Science Inventory

    The lack of integration in the study and management of water resource problems suggests the need for a multidisciplinary approach. As practiced in the Shepherd Creek stormwater management study (Cincinnati OH), we envision a multidisciplinary approach involving economic incentive...

  20. A multidisciplinary approach for improving outcomes.

    PubMed

    Sierchio, Grace P

    2003-01-01

    The healthcare environment has been impacted tremendously by higher patient acuity, cost-cutting measures, an increase in litigation, and increased expectations by an educated generation of healthcare consumers. This has led to the need to continually measure, assess, and improve quality. These activities must consider not only patient clinical outcomes, but also customer service ratings and financial outcomes. Quality improvement requires a collaborative approach to succeed, and the need to build a cohesive and effective multidisciplinary team is critical for positive outcomes. Strategies to build a culture of teamwork include incorporating total quality management principles into every level of the organization, seeking participation from every discipline and level of the organization, and recognizing employees for their efforts. Infusion nurses have an excellent opportunity to contribute their expertise to any multidisciplinary team that impacts the outcomes of infusion patients. In addition, team-building and quality improvement may prove to be excellent career moves for infusion nurses looking to further specialize their practice.

  1. A multidisciplinary approach to short bowel syndrome.

    PubMed

    Denegri, Andrea; Paparo, Francesco; Denegri, Roberto; Revelli, Matteo; Frascio, Marco; Rollandi, Gian Andrea; Fornaro, Rosario

    2014-01-01

    Short bowel syndrome is a complex clinical picture, characterized by signs and symptoms of malabsorption and subsequent malnutrition, which often occurs after extensive bowel resections. Short bowel syndrome's treatment must begin together with the planning of the first surgery, especially for disease that may need multiple interventions. Patients with short bowel should be individually managed because they all are different in diagnosis, length of the remaining bowel and in psychosocial characteristics. For all these reasons, a multidisciplinary approach between the various specialists is therefore needed.

  2. Climate Change: A Multidisciplinary Approach, Second Edition

    NASA Astrophysics Data System (ADS)

    Kirk-Davidoff, Daniel

    2008-07-01

    William Burroughs, who died in November 2007, was a wonderfully clear and evocative writer. Chapter 3 of his last work, Climate Change: A Multidisciplinary Approach, begins with the loveliest four-paragraph description of the general circulation of the Earth's atmosphere I have ever encountered. His writing also shines in his descriptions of the climate record of the past few thousand years, and in his introduction to the measurement of climate change. Unfortunately, the book is marred by inconsistencies in its treatment of climate dynamics, as well as by a number of idiosyncratic choices of emphasis that detract from the book's quality as a general introduction to the science of climate change.

  3. Dynamically Reconfigurable Approach to Multidisciplinary Problems

    NASA Technical Reports Server (NTRS)

    Alexandrov, Natalie M.; Lewis, Robert Michael

    2003-01-01

    The complexity and autonomy of the constituent disciplines and the diversity of the disciplinary data formats make the task of integrating simulations into a multidisciplinary design optimization problem extremely time-consuming and difficult. We propose a dynamically reconfigurable approach to MDO problem formulation wherein an appropriate implementation of the disciplinary information results in basic computational components that can be combined into different MDO problem formulations and solution algorithms, including hybrid strategies, with relative ease. The ability to re-use the computational components is due to the special structure of the MDO problem. We believe that this structure can and should be used to formulate and solve optimization problems in the multidisciplinary context. The present work identifies the basic computational components in several MDO problem formulations and examines the dynamically reconfigurable approach in the context of a popular class of optimization methods. We show that if the disciplinary sensitivity information is implemented in a modular fashion, the transfer of sensitivity information among the formulations under study is straightforward. This enables not only experimentation with a variety of problem formations in a research environment, but also the flexible use of formulations in a production design environment.

  4. Multidisciplinary treatment approach in Treacher Collins syndrome.

    PubMed

    Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

    2012-01-01

    Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

  5. The Future of Public Relations: A Multi-Disciplinary Analysis.

    ERIC Educational Resources Information Center

    Neff, Bonita Dostal

    Literature reviews have indicated there is a lack of data on public relations curriculum development for communication and business departments. Observations have been reported of "spectacular" growth in public relations courses in communication (Grunig, 1989). The first multi-disciplinary survey (3,201 college and university catalogs)…

  6. [Low back pain during pregnancy. Multidisciplinary approach].

    PubMed

    Gallo-Padilla, D; Gallo-Padilla, C; Gallo-Vallejo, F J; Gallo-Vallejo, J L

    2016-09-01

    After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. [Multidisciplinary approach to counseling in Huntington's disease].

    PubMed

    Dangoor, N; Gazit, E; Sade, M; Zimin, B; Frydman, M

    1995-06-15

    The recent cloning of the Huntington's disease gene now allows definitive presymptomatic and even prenatal testing. This achievement has posed a considerable challenge for the genetic counselor. We present the multidisciplinary approach implemented in our center, and experience in our first 13 diagnoses. Individuals at risk undergo neuropsychiatric evaluation, genetic counseling, molecular studies, post-counselling follow-up and support according to the protocols suggested by the International Huntington's Disease Association. Molecular studies of cytosine-arginine-guanine repeats showed that 4 individuals and 1 at-risk fetus were unaffected and 6 at-risk individuals, including the mother of the fetus, had inherited the disease mutation. The diagnosis was excluded in 2 individuals clinically suspected of Huntington's disease. All but 1 of those investigated had accepted, and adapted to the new reality. The exception was a carrier who asked to discontinue the contact a week after being informed of the results.

  8. Multidisciplinary approach to giant paratesticular liposarcoma

    PubMed Central

    Sopeña-Sutil, Raquel; Silan, Francesco; Butron-Vila, Maria Teresa; Guerrero-Ramos, Felix; Lagaron-Comba, Emilio; Passas-Martinez, Juan

    2016-01-01

    Primary paratesticular tumours are very rare and the spermatic cord (SCT) is the most frequent site of origin, with 20% of malignancy. Although liposarcoma is the most frequent histotype (46.6 %), less than 200 cases have been reported in the literature. We report the case of a 56-year-old man who presented a giant scrotal mass of 25 years of evolution and measuring 40 × 40 cm. It could be considered the greatest paratesticular liposarcoma described to date. Computed tomogaphy (CT) revealed mass features consistent with liposarcoma and the simultaneous presence of bilateral inguinal hernia with bladder involvement. A multidisciplinary approach was taken to remove the mass, solve the hernia, and provide functional results. PMID:27695588

  9. Pediatric pain management: the multidisciplinary approach.

    PubMed

    Odell, Shannon; Logan, Deirdre E

    2013-11-11

    Chronic pain in children and adolescents is a growing problem and one that is increasingly being addressed with multidisciplinary treatment teams. This review summarizes different multidisciplinary clinics, focusing specifically on intensive pediatric pain rehabilitation centers. This review offers a summary of the challenges faced by these programs and areas for future study.

  10. Arthrogryposis in infancy, multidisciplinary approach: case report

    PubMed Central

    2013-01-01

    Background Arthrogryposis multiplex congenita is an etiopathogenetically heterogeneous disorder characterised by non-progressive multiple intra-articular contractures, which can be recognised at birth. The frequency is estimated at 1 in 3,000 newborns. Etiopathogenesis of arthrogryposis is multifactorial. Case presentation We report first 26 weeks of life of a boy with severe arthrogryposis. Owing to the integrated rehabilitation approach and orthopaedic treatment a visible improvement in the range of motion as well as the functionality of the child was achieved. This article proposes a cooperation of various specialists: paediatrician, orthopaedist, specialist of medical rehabilitation and physiotherapist. Conclusions Rehabilitation of a child with arthrogryposis should be early, comprehensive and multidisciplinary. Corrective treatment of knee and hip joints in infants with arthrogryposis should be preceded by the ultrasound control. There are no reports in the literature on the ultrasound imaging techniques which can be used prior to the planned orthopaedic and rehabilitative treatment in infants with arthrogryposis. The experience of our team indicates that such an approach allows to minimise the diagnostic errors and to maintain an effective treatment without the risk of joint destabilisation. PMID:24215600

  11. Arthrogryposis in infancy, multidisciplinary approach: case report.

    PubMed

    Binkiewicz-Glinska, Anna; Sobierajska-Rek, Agnieszka; Bakula, Stanislaw; Wierzba, Jolanta; Drewek, Konrad; Kowalski, Ireneusz M; Zaborowska-Sapeta, Katarzyna

    2013-11-11

    Arthrogryposis multiplex congenita is an etiopathogenetically heterogeneous disorder characterised by non-progressive multiple intra-articular contractures, which can be recognised at birth. The frequency is estimated at 1 in 3,000 newborns. Etiopathogenesis of arthrogryposis is multifactorial. We report first 26 weeks of life of a boy with severe arthrogryposis. Owing to the integrated rehabilitation approach and orthopaedic treatment a visible improvement in the range of motion as well as the functionality of the child was achieved. This article proposes a cooperation of various specialists: paediatrician, orthopaedist, specialist of medical rehabilitation and physiotherapist. Rehabilitation of a child with arthrogryposis should be early, comprehensive and multidisciplinary. Corrective treatment of knee and hip joints in infants with arthrogryposis should be preceded by the ultrasound control. There are no reports in the literature on the ultrasound imaging techniques which can be used prior to the planned orthopaedic and rehabilitative treatment in infants with arthrogryposis. The experience of our team indicates that such an approach allows to minimise the diagnostic errors and to maintain an effective treatment without the risk of joint destabilisation.

  12. An Overview of Three Approaches to Multidisciplinary Aeropropulsion Simulations

    NASA Technical Reports Server (NTRS)

    Lawrence, Charles

    1997-01-01

    The broad scope of aeropropulsion multidisciplinary applications necessitates that a collection of approaches, with distinct capabilities, be developed. Three general approaches to multidisciplinary simulations have been identified. The three approaches; loosely coupled, coupled process, and multiphysics, provide a comprehensive collection of capabilities for multidisciplinary aeropropulsion analysis. At the data access level, or loosely coupled approach of coupling, existing disciplinary simulations are run, data is generated, and made available and used for subsequent analysis. The data must be in the correct format for implementation by the subsequent analysis but the subsequent code need not directly communicate with the previous code. At the process level, or coupled process approach of coupling, individual disciplinary codes are used, similarly to the loosely coupled approach, however, in the coupled process approach the disciplinary codes need to run concurrently with each other. The system of equation coupled approach, or multiphysics approach, addresses those applications whose characteristics require that the disciplines be coupled at the fundamental equation level to accurately, or more efficiently, capture the multidisciplinary physics of the problem. No one of these approaches, by itself, addresses all of the community needs in this area. However, collectively the three approaches encompass all of the multidisciplinary applications which have been identified thus far. Multiple approaches to multidisciplinary simulations will be needed as long as the applications and their requirements remain as diverse as they currently are today.

  13. Using Sustainability Themes and Multidisciplinary Approaches to Enhance STEM Education

    ERIC Educational Resources Information Center

    Rogers, Michael; Pfaff, Thomas; Hamilton, Jason; Erkan, Ali

    2015-01-01

    Purpose: The purpose of this paper is to report on the Multidisciplinary Sustainability Education Project (MSEP) as a framework using sustainability-themed education modules to introduce students to the need for multidisciplinary approaches to solving twenty-first-century problems while retaining traditional course strengths and content.…

  14. Using Sustainability Themes and Multidisciplinary Approaches to Enhance STEM Education

    ERIC Educational Resources Information Center

    Rogers, Michael; Pfaff, Thomas; Hamilton, Jason; Erkan, Ali

    2015-01-01

    Purpose: The purpose of this paper is to report on the Multidisciplinary Sustainability Education Project (MSEP) as a framework using sustainability-themed education modules to introduce students to the need for multidisciplinary approaches to solving twenty-first-century problems while retaining traditional course strengths and content.…

  15. New Approaches to HSCT Multidisciplinary Design and Optimization

    NASA Technical Reports Server (NTRS)

    Schrage, Daniel P.; Craig, James I.; Fulton, Robert E.; Mistree, Farrokh

    1999-01-01

    New approaches to MDO have been developed and demonstrated during this project on a particularly challenging aeronautics problem- HSCT Aeroelastic Wing Design. To tackle this problem required the integration of resources and collaboration from three Georgia Tech laboratories: ASDL, SDL, and PPRL, along with close coordination and participation from industry. Its success can also be contributed to the close interaction and involvement of fellows from the NASA Multidisciplinary Analysis and Optimization (MAO) program, which was going on in parallel, and provided additional resources to work the very complex, multidisciplinary problem, along with the methods being developed. The development of the Integrated Design Engineering Simulator (IDES) and its initial demonstration is a necessary first step in transitioning the methods and tools developed to larger industrial sized problems of interest. It also provides a framework for the implementation and demonstration of the methodology. Attachment: Appendix A - List of publications. Appendix B - Year 1 report. Appendix C - Year 2 report. Appendix D - Year 3 report. Appendix E - accompanying CDROM.

  16. New Approaches to HSCT Multidisciplinary Design and Optimization

    NASA Technical Reports Server (NTRS)

    Schrage, Daniel P.; Craig, James I.; Fulton, Robert E.; Mistree, Farrokh

    1999-01-01

    New approaches to MDO have been developed and demonstrated during this project on a particularly challenging aeronautics problem- HSCT Aeroelastic Wing Design. To tackle this problem required the integration of resources and collaboration from three Georgia Tech laboratories: ASDL, SDL, and PPRL, along with close coordination and participation from industry. Its success can also be contributed to the close interaction and involvement of fellows from the NASA Multidisciplinary Analysis and Optimization (MAO) program, which was going on in parallel, and provided additional resources to work the very complex, multidisciplinary problem, along with the methods being developed. The development of the Integrated Design Engineering Simulator (IDES) and its initial demonstration is a necessary first step in transitioning the methods and tools developed to larger industrial sized problems of interest. It also provides a framework for the implementation and demonstration of the methodology. Attachment: Appendix A - List of publications. Appendix B - Year 1 report. Appendix C - Year 2 report. Appendix D - Year 3 report. Appendix E - accompanying CDROM.

  17. Heat waves in Africa and India: a multidisciplinary approach.

    NASA Astrophysics Data System (ADS)

    Janicot, Serge; Moron, Vincent; Oueslati, Boutheina; Pohl, Benjamin; Rome, Sandra; Lalou, Richard; Dos Santos, Stéphanie

    2017-04-01

    While the heat wave impacts on public health have been widely addressed in developed countries, less effort has been made to detect them and evaluate their impacts in least developed countries, especially in Africa and to a lesser extent in India, where climate is warmer and adaptation capacities are low. Climate and epidemiologic analyses show however that this problem is already present and climate projections indicate that such events should increase in frequency and intensity in the coming decades. However climate models display important temperature and radiative biases over this region, which must be reduced to provide robust information on the future evolution of heat waves. Moreover early warning systems have to face up to institutional malfunctions. This talk lays the elements for a multidisciplinary approach of tackling heat wave occurrences.

  18. Charting Multidisciplinary Team External Dynamics Using a Systems Thinking Approach

    NASA Technical Reports Server (NTRS)

    Barthelemy, Jean-Francois; Waszak, Martin R.; Jones, Kenneth M.; Silcox, Richard J.; Silva, Walter A.; Nowaczyk, Ronald H.

    1998-01-01

    Using the formalism provided by the Systems Thinking approach, the dynamics present when operating multidisciplinary teams are examined in the context of the NASA Langley Research and Technology Group, an R&D organization organized along functional lines. The paper focuses on external dynamics and examines how an organization creates and nurtures the teams and how it disseminates and retains the lessons and expertise created by the multidisciplinary activities. Key variables are selected and the causal relationships between the variables are identified. Five "stories" are told, each of which touches on a different aspect of the dynamics. The Systems Thinking Approach provides recommendations as to interventions that will facilitate the introduction of multidisciplinary teams and that therefore will increase the likelihood of performing successful multidisciplinary developments. These interventions can be carried out either by individual researchers, line management or program management.

  19. [Ectopia cordis: multidisciplinary approach with successful result].

    PubMed

    Serrano Gómez, Servando Germán; Bermlúez Sosa, Marco Tulio; Palma Hernández, Emigdio; del Castillo Salceda, Luis Fernando; Pinzón Muslera, Otto; Hernández Cortés, Bernardino; Méndez Machado, Gustavo

    2006-08-01

    Ectopia cordis is a pathology in which the heart is complete or partially outside of the thoracic cavity. It represents a challenge for the diagnosis and handling because of its high perinatal mortality. We present the first case of thoracic ectopia cordis with prenatal diagnostic (27th week), its multidisciplinary handling at Hospital de Ginecopediatria núm. 71 of the Centro Medico Nacional Adolfo Ruiz Cortines, IMSS, in Veracruz, Mexico. We communicate the case of a 24 year-old woman referred by her correspondent medical unit with the diagnosis of 23.6 weeks pregnancy with suspicion of heart malformation by ultrasound. The pregnancy was followed-up until the 38th week, when it was programmed a caesarean section. The newborn had ectopia cordis, which was treated at the moment of birth. In this article, we present pictures of the heart defect as well as its evolution. The up-to-date bibliography is revised about the medical profile and treatment. The handling of the ectopia cordis includes an appropriate prenatal diagnosis through echocardiograph, a multidisciplinary perinatal team, to program the caesarean operation, aseptic handling of the newborn, immediate correction of the wall defect with skin torn piece without trying to correct the costal grill, specific hemodynamic cares, to reprogramme a correction of associated defects.

  20. A multidisciplinary approach for the management of hypodontia: case report

    PubMed Central

    do VALLE, Accácio Lins; LORENZONI, Fabio C; MARTINS, Leandro Moura; do VALLE, Caio Vinícius Martins; HENRIQUES, José Fernando Castanha; de ALMEIDA, Ana Lúcia Pompéia Fraga; PEGORARO, Luiz Fernando

    2011-01-01

    Hypodontia is the congenital absence of one or more teeth and may affect permanent teeth. Several options are indicated to treat hypodontia, including the maintenance of primary teeth or space redistribution for restorative treatment with partial adhesive bridges, tooth transplantation, and implants. However, a multidisciplinary approach is the most important requirement for the ideal treatment of hypodontia. This paper describes a multidisciplinary treatment plan for congenitally missing permanent mandibular second premolars involving orthodontics, implantology and prosthodontic specialties. PMID:21986661

  1. A multidisciplinary approach for the management of hypodontia: case report.

    PubMed

    Valle, Accácio Lins do; Lorenzoni, Fabio C; Martins, Leandro Moura; Valle, Caio Vinícius Martins do; Henriques, José Fernando Castanha; Almeida, Ana Lúcia Pompéia Fraga de; Pegoraro, Luiz Fernando

    2011-10-01

    Hypodontia is the congenital absence of one or more teeth and may affect permanent teeth. Several options are indicated to treat hypodontia, including the maintenance of primary teeth or space redistribution for restorative treatment with partial adhesive bridges, tooth transplantation, and implants. However, a multidisciplinary approach is the most important requirement for the ideal treatment of hypodontia. This paper describes a multidisciplinary treatment plan for congenitally missing permanent mandibular second premolars involving orthodontics, implantology and prosthodontic specialties.

  2. Juvenile Fibromyalgia: A Multidisciplinary Approach to Treatment.

    PubMed

    Tesher, Melissa S

    2015-06-01

    A 14-year-old boy presented with months of severe widespread musculoskeletal pain. He was profoundly fatigued and unable to attend school. Laboratory evaluation, including complete blood count, comprehensive metabolic panel, inflammatory markers, and thyroid function, was unrevealing. Physical examination was also normal except for multiple tender points. The patient was diagnosed with juvenile primary fibromyalgia syndrome and referred for multidisciplinary treatment including physical therapy, exercise, and counseling, and his daily functioning gradually improves. Juvenile fibromyalgia is a complex syndrome that often severely limits patients' activities and can impede normal adolescent development. Effective treatment requires an understanding of the biologic, psychologic, and social factors contributing to the perpetuation of chronic pain. The author reviews the diagnostic criteria, pathophysiology, and treatment of juvenile fibromyalgia. Medications, particularly antidepressants and anticonvulsants, can be useful adjuncts to therapy. However, multimodal pain management including intensive physical therapy, exercise, counseling, and sleep hygiene is most effective in treating fibromyalgia.

  3. [Multidisciplinary approach for deep endometriosis: interests and organization].

    PubMed

    Dell'oro, M; Collinet, P; Robin, G; Rubod, C

    2013-01-01

    Deep endometriosis is a frequent disease that affects reproductive age women. This disease is characterized by the presence of functional endometrium-like tissue outside the uterus. The common sites of extragenital endometriosis are the bowel and the urinary tract. This disease is also associated with infertility. Furthermore, this disease can cause physical and psychological damage. Therefore, it is really important to develop a multidisciplinary approach in the aim to offer the appropriate treatment. The multidisciplinary team approach for endometriosis is developing to improve the understanding of endometriosis and a multidisciplinary committee for endometriosis was developed in our center. During this meeting, gynecologic, digestive surgeons, urologist, radiologist, procreative medical assistance physicians analyse the case. The role of surgery, before, after or as an alternative to in vitro fertilization (IVF) must be defined. The role of the medical treatment before or after the surgery, before the IVF shall be discussed in order to propose the optimal treatment. In fact, radical surgery is no more recommended and minimally invasive conservative surgery is encouraged in order to preserve the fertility. The multidisciplinary approach permits an appropriate optimal and personalised management of this multifocal disease. The multidisciplinary team approach helps in the development of evidence-based guidelines for the diagnosis and management of endometriosis.

  4. A Multidisciplinary Approach to Literacy through Picture Books and Drama

    ERIC Educational Resources Information Center

    Burke, Anne; Peterson, Shelley Stagg

    2007-01-01

    Anne Burke and Shelley Stagg Peterson argue that "picture books offer a medium for teaching visual and critical literacy across the curriculum." To support this idea, they describe a multidisciplinary unit on World War II that pushes high school students to utilize visual and print literacies to analyze, comprehend, and relate to public events and…

  5. Integrated multidisciplinary diagnostic approach for dementia care: randomised controlled trial.

    PubMed

    Wolfs, Claire A G; Kessels, Alfons; Dirksen, Carmen D; Severens, Johan L; Verhey, Frans R J

    2008-04-01

    An integrated multidisciplinary approach to dementia is often recommended but has rarely been evaluated. To evaluate the clinical effects of an integrated multidisciplinary diagnostic facility for psychogeriatric patients. Patients suspected of having complex psychogeriatric problems were randomly allocated to the intervention (n=137) or to treatment as usual (n=93). They were assessed at baseline, and at 6 months and 12 months follow-up by means of personal interviews with the patient's proxy. The primary outcome was health-related quality of life, assessed using the visual analogue scale (VAS) of the EuroQd measure, EQ-5D. Health-related quality of life had improved at 6 months in the intervention group, whereas that of the control group had decreased. Furthermore, more patients in the intervention group experienced a clinically relevant improvement of 10 points or more on the VAS at both follow-up measurements. An integrated multidisciplinary approach improves dementia care.

  6. Determinants of Food Safety Risks: A Multi-disciplinary Approach

    ERIC Educational Resources Information Center

    Knight, Andrew; Warland, Rex

    2005-01-01

    This research employs a multi-disciplinary approach by developing a model that draws upon psychometric, cultural, and reflexive modernization perspectives of risk perception. Using data from a 1999 national telephone survey, we tested our model on three food risks ? pesticides, Salmonella, and fat. Results showed that perceptions of risks do vary…

  7. Determinants of Food Safety Risks: A Multi-disciplinary Approach

    ERIC Educational Resources Information Center

    Knight, Andrew; Warland, Rex

    2005-01-01

    This research employs a multi-disciplinary approach by developing a model that draws upon psychometric, cultural, and reflexive modernization perspectives of risk perception. Using data from a 1999 national telephone survey, we tested our model on three food risks ? pesticides, Salmonella, and fat. Results showed that perceptions of risks do vary…

  8. Multidisciplinary Approach to the Management of Myopathies

    PubMed Central

    M. King, Wendy; Kissel, John T.

    2013-01-01

    Purpose of Review Aside from some inflammatory myopathies and very few genetic disorders, there are no therapies that make most patients with myopathies stronger. Consequently, the management of these patients can be frustrating for patients and their families as well as the clinicians taking care of them. Treatment of these patients must involve a comprehensive approach focused on limiting the secondary effects of skeletal muscle weakness, managing comorbidities associated with specific diseases, and, most importantly, optimizing patients’ functional abilities and quality of life in terms of their ability to accomplish activities of daily living. While the approach to each patient differs depending on their disease, certain common themes can be addressed in each patient. This review highlights an approach centered on four conceptual themes (“the Four S’s”): Strength therapies, Supportive care, Symptomatic therapies, and pSychological support. Recent Findings Although relatively few well-designed studies have been done that highlight conservative management of patients with various myopathies, an emerging literature helps guide the clinician in certain key areas, especially in relation to cardiac and pulmonary management of these patients. Summary While disease-altering therapies have proven elusive for many muscle diseases, a multimodal approach to the conservative and supportive care of these patients can markedly improve their quality of life. Pharmacologic treatment options for specific myopathies will not be addressed in this article but are covered elsewhere in this issue of CONTINUUM. PMID:24305452

  9. Multidisciplinary approaches to stimulate wound healing.

    PubMed

    Businaro, Rita; Corsi, Mariangela; Di Raimo, Tania; Marasco, Sergio; Laskin, Debra L; Salvati, Bruno; Capoano, Raffaele; Ricci, Serafino; Siciliano, Camilla; Frati, Giacomo; De Falco, Elena

    2016-08-01

    New civil wars and waves of terrorism are causing crucial social changes, with consequences in all fields, including health care. In particular, skin injuries are evolving as an epidemic issue. From a physiological standpoint, although wound repair takes place more rapidly in the skin than in other tissues, it is still a complex organ to reconstruct. Genetic and clinical variables, such as diabetes, smoking, and inflammatory/immunological pathologies, are also important risk factors limiting the regenerative potential of many therapeutic applications. Therefore, optimization of current clinical strategies is critical. Here, we summarize the current state of the field by focusing on stem cell therapy applications in wound healing, with an emphasis on current clinical approaches being developed. These involve protocols for the ex vivo expansion of adipose tissue-derived mesenchymal stem cells by means of a patented Good Manufacturing Practice-compliant platelet lysate. Combinations of multiple strategies, including genetic modifications and stem cells, biomimetic scaffolds, and novel vehicles, such as nanoparticles, are also discussed as future approaches. © 2016 New York Academy of Sciences.

  10. Multidisciplinary team approach to end-stage dialysis access patients.

    PubMed

    Kensinger, Clark; Brownie, Evan; Bream, Peter; Moore, Derek

    2015-11-01

    The hemodialysis reliable outflow (HeRO) access device is a permanent dialysis graft used in patients with central venous obstruction. Given the complexity of care related to end-stage dialysis access (ESDA) patients, a multidisciplinary approach has been used to achieve operative success of HeRO graft placement. The single-center retrospective review included adult patients that were seen in ESDA clinic who underwent a HeRO graft placement from September 2010-September 2014 under the care of a team consisting of a nephrologist, an interventional radiologist, and a surgeon. The effectiveness of the multidisciplinary approach was evaluated using outcome variables including successful HeRO graft placement, operative complications, the rate of obtaining central venous access, and advanced endovascular maneuvers performed by interventional radiology to obtain central venous access. A multidisciplinary approach has been used in 33 ESDA patients. Access to the right atrium was achieved in 100% of cases. Fifty-eight percent of patients required advanced endovascular maneuvers in the interventional radiology suite to obtain central venous access. Successful HeRO graft placement was achieved in 94% (31 of 33) of the study population. No intraoperative complications were encountered. Median primary and secondary patency rates were 83 d (interquartile range: 45-170) and 345 d (interquartile range: 146-579) per HeRO graft placement, respectively. Primary and secondary patency rates at 60 d were 70% (23 of 33) and 79% (26 of 33), respectively. In this difficult patient population, a multidisciplinary team can provide a unique and collaborative approach to HeRO graft placement in patients with complex central venous outflow obstruction. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Multidisciplinary approach to transvenous lead extraction: a single center's experience.

    PubMed

    Maus, Timothy M; Shurter, Jesse; Nguyen, Liem; Birgersdotter-Green, Ulrika; Pretorius, Victor

    2015-04-01

    To evaluate the success and complication rates of a single center's multidisciplinary approach to transvenous lead extraction. One university hospital. One hundred ninety-five patients scheduled for transvenous lead extraction. A multidisciplinary approach to transvenous lead extraction involving cardiac surgery, electrophysiology, perfusion, and cardiac anesthesiology. A case series of 351 lead extractions performed in 195 patients over a 42-month period. Indications, success rates, and complication rates were tracked and retrospectively evaluated and reported. Indications for lead extraction included 53.3% because of lead malfunction, 36.9% because of infection, with the remaining 9.7% from other categories such as venous stenosis. The lead extraction rate was 99.7%, with complete removal in 97.7%. The overall major complication rate was 3.08%. After an initial 1-year period of performing lead extractions, the overall major complication rate reduced to 1.23%. Transvenous lead extraction generally is a safe procedure, but not without complications. A multidisciplinary approach involving cardiac surgery, electrophysiology, and cardiac anesthesiology allows for successful management and the ability to rapidly manage major complications. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. A multidisciplinary approach to solving computer related vision problems.

    PubMed

    Long, Jennifer; Helland, Magne

    2012-09-01

    This paper proposes a multidisciplinary approach to solving computer related vision issues by including optometry as a part of the problem-solving team. Computer workstation design is increasing in complexity. There are at least ten different professions who contribute to workstation design or who provide advice to improve worker comfort, safety and efficiency. Optometrists have a role identifying and solving computer-related vision issues and in prescribing appropriate optical devices. However, it is possible that advice given by optometrists to improve visual comfort may conflict with other requirements and demands within the workplace. A multidisciplinary approach has been advocated for solving computer related vision issues. There are opportunities for optometrists to collaborate with ergonomists, who coordinate information from physical, cognitive and organisational disciplines to enact holistic solutions to problems. This paper proposes a model of collaboration and examples of successful partnerships at a number of professional levels including individual relationships between optometrists and ergonomists when they have mutual clients/patients, in undergraduate and postgraduate education and in research. There is also scope for dialogue between optometry and ergonomics professional associations. A multidisciplinary approach offers the opportunity to solve vision related computer issues in a cohesive, rather than fragmented way. Further exploration is required to understand the barriers to these professional relationships. © 2012 The College of Optometrists.

  13. [Subarachnoid hemorrhage: epidemiology, social impact and a multidisciplinary approach].

    PubMed

    Ingelmo Ingelmo, I; Fàbregas Julià, N; Rama-Maceiras, P; Hernández-Palazón, J; Rubio Romero, R; Carmona Aurioles, J

    2010-12-01

    Cerebrovascular disease, whether ischemic or hemorrhagic, is a worldwide problem, representing personal tragedy, great social and economic consequences, and a heavy burden on the health care system. Estimated to be responsible for up to 10% of mortality in industrialized countries, cerebrovascular disease also affects individuals who are still in the workforce, with consequent loss of productive years. Subarachnoid hemorrhage (SAH) is a type of cerebrovascular accident that leads to around 5% of all strokes. SAH is most often due to trauma but may also be spontaneous, in which case the cause may be a ruptured intracranial aneurysm (80%) or arteriovenous malformation or any other abnormality of the blood or vessels (20%). Although both the diagnosis and treatment of aneurysmal SAH has improved in recent years, related morbidity and mortality remains high: 50% of patients die from the initial hemorrhage or later complications. If patients whose brain function is permanently damaged are added to the count, the percentage of cases leading to severe consequences rises to 70%. The burden of care of patients who are left incapacitated by SAH falls to the family or to private and public institutions. The economic cost is considerable and the loss of quality of life for both the patient and the family is great. Given the magnitude of this problem, the provision of adequate prophylaxis is essential; also needed are organizational models that aim to reduce mortality as well as related complications. Aneurysmal SAH is a condition which must be approached in a coordinated, multidisciplinary way both during the acute phase and throughout rehabilitation in order to lower the risk of unwanted outcomes.

  14. Execution of Multidisciplinary Design Optimization Approaches on Common Test Problems

    NASA Technical Reports Server (NTRS)

    Balling, R. J.; Wilkinson, C. A.

    1997-01-01

    A class of synthetic problems for testing multidisciplinary design optimization (MDO) approaches is presented. These test problems are easy to reproduce because all functions are given as closed-form mathematical expressions. They are constructed in such a way that the optimal value of all variables and the objective is unity. The test problems involve three disciplines and allow the user to specify the number of design variables, state variables, coupling functions, design constraints, controlling design constraints, and the strength of coupling. Several MDO approaches were executed on two sample synthetic test problems. These approaches included single-level optimization approaches, collaborative optimization approaches, and concurrent subspace optimization approaches. Execution results are presented, and the robustness and efficiency of these approaches an evaluated for these sample problems.

  15. Managing the pediatric patient with celiac disease: a multidisciplinary approach

    PubMed Central

    Isaac, Daniela Migliarese; Wu, Jessica; Mager, Diana R; Turner, Justine M

    2016-01-01

    Celiac disease (CD) is an autoimmune reaction to gluten, leading to intestinal inflammation, villous atrophy, and malabsorption. It is the most common autoimmune gastrointestinal disorder, with an increasing prevalence. A life-long gluten-free diet (GFD) is an effective treatment to alleviate symptoms, normalize autoantibodies, and heal the intestinal mucosa in patients with CD. Poorly controlled CD poses a significant concern for ongoing malabsorption, growth restriction, and the long-term concern of intestinal lymphoma. Achieving GFD compliance and long-term disease control poses a challenge, with adolescents at particular risk for high rates of noncompliance. Attention has turned toward innovative management strategies to improve adherence and achieve better disease control. One such strategy is the development of multidisciplinary clinic approach, and CD is a complex life-long disease state that would benefit from a multifaceted team approach as recognized by multiple national and international bodies, including the National Institutes of Health. Utilizing the combined efforts of the pediatric gastroenterologist, registered dietitian, registered nurse, and primary care provider (general practitioner or general pediatrician) in a CD multidisciplinary clinic model will be of benefit for patients and families in optimizing diagnosis, provision of GFD teaching, and long-term adherence to a GFD. This paper discusses the benefits and proposed structure for multidisciplinary care in improving management of CD. PMID:27785047

  16. Managing the pediatric patient with celiac disease: a multidisciplinary approach.

    PubMed

    Isaac, Daniela Migliarese; Wu, Jessica; Mager, Diana R; Turner, Justine M

    2016-01-01

    Celiac disease (CD) is an autoimmune reaction to gluten, leading to intestinal inflammation, villous atrophy, and malabsorption. It is the most common autoimmune gastrointestinal disorder, with an increasing prevalence. A life-long gluten-free diet (GFD) is an effective treatment to alleviate symptoms, normalize autoantibodies, and heal the intestinal mucosa in patients with CD. Poorly controlled CD poses a significant concern for ongoing malabsorption, growth restriction, and the long-term concern of intestinal lymphoma. Achieving GFD compliance and long-term disease control poses a challenge, with adolescents at particular risk for high rates of noncompliance. Attention has turned toward innovative management strategies to improve adherence and achieve better disease control. One such strategy is the development of multidisciplinary clinic approach, and CD is a complex life-long disease state that would benefit from a multifaceted team approach as recognized by multiple national and international bodies, including the National Institutes of Health. Utilizing the combined efforts of the pediatric gastroenterologist, registered dietitian, registered nurse, and primary care provider (general practitioner or general pediatrician) in a CD multidisciplinary clinic model will be of benefit for patients and families in optimizing diagnosis, provision of GFD teaching, and long-term adherence to a GFD. This paper discusses the benefits and proposed structure for multidisciplinary care in improving management of CD.

  17. Multidisciplinary approach for the rehabilitation of dentoalveolar trauma.

    PubMed

    Ustün, Yakup; Esen, Emin; Toroğlu, M Serdar; Akova, Tolga

    2004-10-01

    Satisfactory dental rehabilitation of dentoalveolar trauma requires intense effort and time. Usually multidisciplinary treatment planning and teamwork are necessary to deal with multitask problems associated with these cases. Dental implants have been successfully used for replacement of missing teeth, but in trauma cases insufficient alveolar bone hinders implantation. In this report we present the multidisciplinary approach for the treatment of a trauma case. Maxillary segmental alveolar osteotomy in conjunction with interpositional and onlay bone grafting was performed to prepare the site for placement of osseointegrated implants. Titanium microplate and screws were used to provide orthodontic anchorage for intrusion of the extruded mandibular incisors. The patient was rehabilitated by implant supported fixed partial denture 6 months after implant placement.

  18. Assessing and evaluating multidisciplinary translational teams: a mixed methods approach.

    PubMed

    Wooten, Kevin C; Rose, Robert M; Ostir, Glenn V; Calhoun, William J; Ameredes, Bill T; Brasier, Allan R

    2014-03-01

    A case report illustrates how multidisciplinary translational teams can be assessed using outcome, process, and developmental types of evaluation using a mixed-methods approach. Types of evaluation appropriate for teams are considered in relation to relevant research questions and assessment methods. Logic models are applied to scientific projects and team development to inform choices between methods within a mixed-methods design. Use of an expert panel is reviewed, culminating in consensus ratings of 11 multidisciplinary teams and a final evaluation within a team-type taxonomy. Based on team maturation and scientific progress, teams were designated as (a) early in development, (b) traditional, (c) process focused, or (d) exemplary. Lessons learned from data reduction, use of mixed methods, and use of expert panels are explored.

  19. Managing the patient with osteogenesis imperfecta: a multidisciplinary approach

    PubMed Central

    Marr, Caroline; Seasman, Alison; Bishop, Nick

    2017-01-01

    Osteogenesis imperfecta (OI) is a heterogeneous heritable connective tissue disorder characterized by low bone density. The type and severity of OI are variable. The primary manifestations are fractures, bone deformity, and bone pain, resulting in reduced mobility and function to complete everyday tasks. OI affects not only the physical but also the social and emotional well-being of children, young people, and their families. As such, medical, surgical, and allied health professionals’ assessments all play a role in the management of these children. The multidisciplinary approach to the treatment of children and young people living with OI seeks to provide well-coordinated, comprehensive assessments, and interventions that place the child and family at the very center of their care. The coordinated efforts of a multidisciplinary team can support children with OI to fulfill their potential, maximizing function, independence, and well-being. PMID:28435282

  20. The importance of a multidisciplinary approach to hepatocellular carcinoma

    PubMed Central

    Siddique, Osama; Yoo, Eric R; Perumpail, Ryan B; Perumpail, Brandon J; Liu, Andy; Cholankeril, George; Ahmed, Aijaz

    2017-01-01

    Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners. In most cases, HCC is diagnosed by abdominal imaging studies, preferably with a triphasic computed tomography scan of the abdomen or magnetic resonance imaging of the abdomen. Histopathological diagnosis using a guided liver biopsy may be needed in noncirrhotic patients or when radiological diagnostic criteria are not fulfilled in the setting of cirrhosis. The Barcelona Clinic Liver Cancer staging system facilitates a standardized therapeutic strategy based on the tumor burden, extent of metastasis, severity of hepatic decompensation, comorbid medical illnesses, functional status of patient, HCC-related symptoms, and preference of the patient. Treatment options include curative surgery (hepatic resection and liver transplantation) and palliative measures (radiofrequency ablation, transarterial chemoembolization, and chemotherapy with sorafenib). The role of the multidisciplinary team is crucial in promptly reconfirming the diagnosis, staging the HCC, and formulating an individualized treatment plan. In potential liver transplant candidates, timely liver transplant evaluation and coordinating bridging/downsizing treatment modalities, such as radiofrequency ablation and transarterial chemoembolization, can be time-consuming. In summary, a multidisciplinary team approach provides a timely, individualized treatment plan, which can vary from curative surgery in patients with early-stage HCC to palliative

  1. Multidisciplinary approach to traumatized teeth: a case report.

    PubMed

    Yüzügüllü, Bulem; Polat, Omür; Ungör, Mete

    2008-10-01

    Treatment of crown fractures often requires a multidisciplinary approach. In the anterior teeth, reestablishment of proper esthetics and function is quite important for the patient. However, crown-root fractures with fracture line below the gingival attachment or alveolar bone crest presents restorative difficulties. This case report presents a cervical tooth fracture that had been treated with minimal invasive approach with different disciplines. The tooth had endodontic treatment and a glass-fiber post, and a composite core was accomplished. Then, the tooth was extruded to the desired level with orthodontic forced eruption before definitive restoration.

  2. Can a multi-disciplinary assessment approach improve outcomes for children with attention deficit hyperactivity disorder?

    PubMed

    Bor, William; Heath, Fiona; Heussler, Honey; Reuter, Rebecca; Perrett, Carmel; Lee, Erica

    2013-10-01

    Public, consumer and professional views about attention deficit hyperactivity disorder, its assessment and treatment - especially with medication - remain a highly contested domain. Parents in particular express disquiet with services. One response to this tension is a multidisciplinary evaluation. Parental and education perceptions of this process have not been evaluated previously. A community multidisciplinary approach was assessed in terms of diagnostic outcomes and client satisfaction. A comprehensive multidisciplinary structured assessment of the first 50 referred children with severe attentional problems was documented. Demographic and symptom/behavioural profiles, developmental history and indicated multi-disciplinary evaluation were recorded. A team consensus process arrived at diagnostic classification. Post-assessment satisfaction of parents and school staff was surveyed. Thirteen children (26%) were diagnosed with attention deficit hyperactivity disorder and three commenced stimulants. The majority of parents and educators were satisfied with the service. A multidisciplinary assessment clinic for children presenting with attention problems resulted in minimal prescribing. Overall, education staff and parents were satisfied with the service. The model may be a suitable response to the multiple concerns in the community.

  3. The added value of a multidisciplinary approach in diagnosing dementia: a review.

    PubMed

    Wolfs, Claire A G; Dirksen, Carmen D; Severens, Johan L; Verhey, Frans R J

    2006-03-01

    The impact of dementia constitutes a major public health challenge to our society. A multidisciplinary approach to dementia is generally recommended. The objective of this review is to give an overview of the reported empirical studies on the added value of a multidisciplinary approach to diagnosing dementia, i.e. whether differences can be found between diagnostic multidisciplinary approaches, and/or monodisciplinary ones with respect to the diagnostic outcomes, the impact of diagnostics and their effects on quality of life and costs. Critical review of studies which involve a multidisciplinary assessment of dementia. Literature was systematically searched in a number of international databases (Medline, PsychInfo, Pubmed and EconLit). A first selection was based on screening titles by one author. Interrater reliability was determined by scoring all abstracts by two authors. The reliability of selecting full articles was based on scoring a random sample by two authors. Kappa values were calculated. The Kappa statistic (k) was also used as an indicator of the diagnostic agreement between single disciplines and multidisciplinary teams. Five studies were identified as relevant for the purpose of this review. The most important outcome was the level of diagnostic agreement between single disciplines and multidisciplinary teams (MTs). Overall, there was substantial agreement (kappa: 0.37-0.76) on the diagnosis dementia (syndrome), but not on the subtypes (aetiology) (AD: 0.26-0.60; VD: 0.35-0.52; depression: 0.30-0.46). Diagnoses also differed between the disciplines. Merely studies on diagnostic accuracy were found, all using different reference standards. Kappa values were chosen as outcome measure and every diagnosis was considered of equal value. Therefore, the added value could not definitively be demonstrated. However, the potential added value of a multidisciplinary approach to diagnosing dementia probably lies in the ability to differentiate among the subtypes

  4. Benign triton tumor: multidisciplinary approach to diagnosis and treatment.

    PubMed

    Thakrar, Raj; Robson, Caroline D; Vargas, Sara O; Meara, John G; Rahbar, Reza; Smith, Edward R

    2014-01-01

    Benign Triton tumor (neuromuscular choristoma) is a rare mass that most commonly occurs as a multinodular expansion of tissue in or around large nerves. Intracranial occurrence is uncommon. We report on a 4-year-old girl presenting with a right-sided facial mass and trismus. Imaging revealed a large, complex mass extending from the ventral aspect of the pons, along the trigeminal nerve, through the foramen ovale, and into the right infratemporal fossa. The lesion was partially enhancing, invaded adjacent infratemporal musculature, was associated with marked overgrowth of the right coronoid process, and induced bony erosion of the middle cranial fossa. After needle biopsy, a multidisciplinary team, including plastic surgery, otolaryngology, and neurosurgery, performed a combined, multistep, single-day surgical approach for resection. Unique to this case was the resection of the coronoid process, a modified middle fossa intradural and extradural approach, coupled with a transfacial infratemporal approach. Microscopically, the resected tissue showed skeletal muscle, fibrous tissue, and nerve in a disorganized arrangement characteristic of a benign Triton tumor. We present this case to illustrate diagnostic clues and pitfalls in the preoperative evaluation of a benign Triton tumor. We also highlight the pathologist's role as a partner in a multidisciplinary approach to diagnosis and treatment of this rare pediatric mass, potentially the largest Triton tumor in the head reported to date.

  5. Theoretical Description of Teaching-Learning Processes: A Multidisciplinary Approach

    NASA Astrophysics Data System (ADS)

    Bordogna, Clelia M.; Albano, Ezequiel V.

    2001-09-01

    A multidisciplinary approach based on concepts from sociology, educational psychology, statistical physics, and computational science is developed for the theoretical description of teaching-learning processes that take place in the classroom. The emerging model is consistent with well-established empirical results, such as the higher achievements reached working in collaborative groups and the influence of the structure of the group on the achievements of the individuals. Furthermore, another social learning process that takes place in massive interactions among individuals via the Internet is also investigated.

  6. Theoretical description of teaching-learning processes: a multidisciplinary approach.

    PubMed

    Bordogna, C M; Albano, E V

    2001-09-10

    A multidisciplinary approach based on concepts from sociology, educational psychology, statistical physics, and computational science is developed for the theoretical description of teaching-learning processes that take place in the classroom. The emerging model is consistent with well-established empirical results, such as the higher achievements reached working in collaborative groups and the influence of the structure of the group on the achievements of the individuals. Furthermore, another social learning process that takes place in massive interactions among individuals via the Internet is also investigated.

  7. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis

    PubMed Central

    Palejwala, Sheri K.; Zangeneh, Tirdad T.; Goldstein, Stephen A.; Lemole, G. Michael

    2016-01-01

    Background: Rhinocerebral mucormycosis occurs in immunocompromised hosts with uncontrolled diabetes, solid organ transplants, and hematologic malignancies. Primary disease is in the paranasal sinuses but often progresses intracranially, via direct extension or angioinvasion. Rhinocerebral mucormycosis is rapidly fatal with a mortality rate of 85%, even when maximally treated with surgical debridement, antifungal therapy, and correction of underlying processes. Methods: We performed a retrospective chart review of patients with rhinocerebral mucormycosis from 2011 to 2014. These patients were analyzed for symptoms, surgical and medical management, and outcome. We found four patients who were diagnosed with rhinocerebral mucormycosis. All patients underwent rapid aggressive surgical debridement and were started on antifungal therapy on the day of diagnosis. Overall, we observed a mortality rate of 50%. Results: An early aggressive multidisciplinary approach with surgical debridement, antifungal therapy, and correction of underlying disease have been shown to improve survivability in rhinocerebral mucormycosis. Conclusion: A multidisciplinary approach to rhinocerebral mucormycosis with otolaryngology, neurosurgery, and ophthalmology, infectious disease and medical intensivists can help reduce mortality in an otherwise largely fatal disease. Even despite these measures, outcomes remain poor, and a high index of suspicion must be maintained in at-risk populations, in order to rapidly execute a multifaceted approach. PMID:27280057

  8. Menkes disease: what a multidisciplinary approach can do

    PubMed Central

    Ojha, Rahul; Prasad, Asuri N

    2016-01-01

    Disorders of copper homeostasis are currently recognized across the life span. Their recognition and links to human disease have spanned several decades, beginning with the recognition of a degenerative disorder in the offspring of sheep grazing in copper-deficient pastures, through to the description of infants suffering from a progressive neurodegenerative disorder characterized by epileptic seizures, developmental regression, failure to thrive, and an unusual hair quality (giving the condition its distinctive label of “kinky hair disease”). In this review, we trace the historical background and describe the biochemistry and physiology of copper metabolism and transport, inheritance patterns, molecular genetics, and genotype–phenotype correlations based on current understanding of the disorder. It is clear from the clinical presentations and variants that disorders of copper homeostasis include phenotypes ranging from mild occipital horn syndrome to intermediate and severe forms of classical Menkes disease. The symptoms involve multiple organ systems such as brain, lung, gastrointestinal tract, urinary tract, connective tissue, and skin. A multisystem disorder needs a multidisciplinary approach to care, as treatment interventions permit longer survival for some individuals. Animal models have been developed to help screen treatment options and provide a better understanding of these disorders in the laboratory. Finally, we propose a multidisciplinary approach to promote continued research (both basic and clinical) to improve survival, quality of life, and care for these conditions. PMID:27574440

  9. Recreating an esthetically and functionally acceptable dentition: a multidisciplinary approach.

    PubMed

    Goyal, Mukesh Kumar; Goyal, Shelly; Hegde, Veena; Balkrishana, Dhanasekar; Narayana, Aparna I

    2013-01-01

    Patients today demand a youthful, attractive smile with comfortable functional acceptance. The complete oral rehabilitation of patients with a functionally compromised dentition frequently involves a multidisciplinary approach and presents a considerable clinical challenge. To a great extent, proper patient selection and careful interdisciplinary treatment planning, including acknowledgment of the patient's perceived needs, reasons for seeking services, financial ability, and socioeconomic profile, can govern the predictability of successful restorations. This clinical report describes a successful interdisciplinary approach for the management of a severely worn dentition with reduced vertical dimension of occlusion. Treatment modalities included periodontal crown lengthening procedures, endodontic treatment followed by post and core restorations, and prosthetic rehabilitation for severe tooth surface loss and reduced vertical dimension of occlusion comprising metal-ceramic restorations in esthetic zones and full-metal restorations in posterior regions.

  10. Managing the pediatric patient with refractory asthma: a multidisciplinary approach

    PubMed Central

    Cook, James; Beresford, Fran; Fainardi, Valentina; Hall, Pippa; Housley, Georgie; Jamalzadeh, Angela; Nightingale, Michelle; Winch, David; Bush, Andrew; Fleming, Louise; Saglani, Sejal

    2017-01-01

    Children with asthma that is refractory to high levels of prescribed treatment are described as having problematic severe asthma. Those in whom persistent symptoms result from a failure of basic asthma management are described as having “difficult asthma”, while those who remain symptomatic despite these factors having been addressed are described as having “severe therapy-resistant asthma” (STRA). The majority of children have difficult asthma; asthma that is poorly controlled because of a failure to get the basics of asthma management right. Modifiable factors including nonadherence to medication, persistent adverse environmental exposures, and psychosocial factors often contribute to poor control in these patients. As our skill in identifying and addressing modifiable factors has improved, we have found that a progressively smaller proportion of our clinic patients is categorized as having true STRA, resulting in an infrequent resort to escalation of treatment. Many of the modifiable factors associated with the diagnosis of difficult asthma can be identified in a general pediatric clinic. Characterization of more complex factors, however, requires the time, skill, and expertise of multiple health care professionals within the asthma multidisciplinary team. In this review, we will describe the structured approach adopted by The Royal Brompton Hospital in the management of the child with problematic severe asthma. We highlight the roles of members of the multidisciplinary team at various stages of assessment and focus on prominent themes in the identification and treatment of modifiable factors. PMID:28461761

  11. A Multidisciplinary Approach to Mixer-Ejector Analysis and Design

    NASA Technical Reports Server (NTRS)

    Hendricks, Eric, S.; Seidel, Jonathan, A.

    2012-01-01

    The design of an engine for a civil supersonic aircraft presents a difficult multidisciplinary problem to propulsion system engineers. There are numerous competing requirements for the engine, such as to be efficient during cruise while yet quiet enough at takeoff to meet airport noise regulations. The use of mixer-ejector nozzles presents one possible solution to this challenge. However, designing a mixer-ejector which will successfully address both of these concerns is a difficult proposition. Presented in this paper is an integrated multidisciplinary approach to the analysis and design of these systems. A process that uses several low-fidelity tools to evaluate both the performance and acoustics of mixer-ejectors nozzles is described. This process is further expanded to include system-level modeling of engines and aircraft to determine the effects on mission performance and noise near airports. The overall process is developed in the OpenMDAO framework currently being developed by NASA. From the developed process, sample results are given for a notional mixer-ejector design, thereby demonstrating the capabilities of the method.

  12. Cardiac amyloidosis: the importance of a multidisciplinary approach.

    PubMed

    Gómez-Bueno, Manuel; Segovia, Javier; García-Pavía, Pablo; Barceló, Juan M; Krsnik, Isabel; Sánchez-Turrión, Víctor; Salas, Clara; Alonso-Pulpón, Luis

    2009-06-01

    Cardiac amyloidosis is associated with the interstitial deposition of abnormal protein in the myocardium, which can lead to a form of restrictive cardiomyopathy with a poor prognosis. This protein can have a number of different origins, which give rise to various subtypes of amyloidosis that have different prognoses and that require different therapeutic approaches. Drugs commonly used in heart failure have little effect in amyloidosis and the use of heart transplantation is controversial because amyloidosis is a multi-organ disease and because there is a possibility of disease recurrence in the graft. The use of new techniques to identify the specific amyloidosis subtype, the emergence of novel ways of preventing or decreasing amyloid production, the ability to monitor responses to therapy and, above all, the introduction of multidisciplinary teams that can implement a combination of therapies, including multiple organ transplantation, have contributed to a substantial improvement in the prognosis of this disease.

  13. Ethnobotany of Mallorca (Balearic islands): a multidisciplinary approach.

    PubMed

    Carrió, Esperança; Vallès, Joan

    2012-09-01

    In this communication, we provide some basic methodological and practical ideas for plant knowledge comparisons among different predefined natural regions of the Mediterranean island of Mallorca, in the frame of an ongoing project in this area. The final goal of this work is to present a tool to find out to what extent plant knowledge is similar in the different regions. We use an uncommon approach to ethnobotanical studies in terms of multidisciplinary methodology. We base our arguments on social anthropology methods, using a diversity index (the Sorensen similarity coefficient), and we also explain the botanical part of the investigation. Our preliminary results reveal few differences among the three natural regions considered on the island, which we believe could find their explanation in geographic, botanical and cultural aspects.

  14. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach

    PubMed Central

    2013-01-01

    The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem. Since symptoms and signs are non specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Diagnostic strategy should be based on clinical evaluation of the probability of PE. The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. Additional testing is necessary when the test results are inconsistent with clinical probability. The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. The aim of this review is to provide clinicians a practical diagnostic and therapeutic management approach using evidence from the literature. PMID:24354912

  15. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach.

    PubMed

    Lavorini, Federico; Di Bello, Vitantonio; De Rimini, Maria Luisa; Lucignani, Giovanni; Marconi, Letizia; Palareti, Gualtiero; Pesavento, Raffaele; Prisco, Domenico; Santini, Massimo; Sverzellati, Nicola; Palla, Antonio; Pistolesi, Massimo

    2013-12-19

    The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem. Since symptoms and signs are non specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Diagnostic strategy should be based on clinical evaluation of the probability of PE. The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. Additional testing is necessary when the test results are inconsistent with clinical probability. The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. The aim of this review is to provide clinicians a practical diagnostic and therapeutic management approach using evidence from the literature.

  16. A multidisciplinary approach for the treatment of GIST liver metastasis

    PubMed Central

    Radkani, Pejman; Ghersi, Marcelo M; Paramo, Juan C; Mesko, Thomas W

    2008-01-01

    Background Advanced gastrointestinal stromal tumors (GISTs) can metastasize and recur after a long remission period, resulting in serious morbidity, mortality, and complex management issues. Case presentation A 67-year-old woman presented with epigastric fullness, mild jaundice and weight loss with a history of a bowel resection 7 years prior for a primary GIST of the small bowel. The finding of a heterogeneous mass 15.5 cm in diameter replacing most of the left lobe of the liver by ultrasonography and CT, followed by positive cytological studies revealed a metastatic GIST. Perioperative optimization of the patient's nutritional status along with biliary drainage, and portal vein embolization were performed. Imatinib was successful in reducing the tumor size and facilitating surgical resection. Conclusion A well-planned multidisciplinary approach should be part of the standard management of advanced or metastatic GIST. PMID:18471285

  17. Multidisciplinary Approach for Patients Hospitalized With Heart Failure.

    PubMed

    Frankenstein, Lutz; Fröhlich, Hanna; Cleland, John G F

    2015-10-01

    Acute heart failure describes the rapid deterioration, over minutes, days or hours, of symptoms and signs of heart failure. Its management is an interdisciplinary challenge that requires the cooperation of various specialists. While emergency providers, (interventional) cardiologists, heart surgeons, and intensive care specialists collaborate in the initial stabilization of acute heart failure patients, the involvement of nurses, discharge managers, and general practitioners in the heart failure team may facilitate the transition from inpatient care to the outpatient setting and improve acute heart failure readmission rates. This review highlights the importance of a multidisciplinary approach to acute heart failure with particular focus on the chain-of-care delivered by the various services within the healthcare system. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Clinical features and multidisciplinary approaches to dementia care

    PubMed Central

    Grand, Jacob HG; Caspar, Sienna; MacDonald, Stuart WS

    2011-01-01

    Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1) Alzheimer’s disease; 2) vascular dementias; 3) frontotemporal dementias; and 4) dementia with Lewy bodies/Parkinson’s disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of pathological burden. Future research goals are outlined, with a call to action for social policy initiatives that promote preventive lifestyle behaviors, and healthcare programs that will support the growing number of individuals affected by

  19. Wanted: interdisciplinary, multidisciplinary, and knowledge translation and exchange training for students of public health.

    PubMed

    Mishra, Lipi; Banerjee, Ananya T; MacLennan, Mary E; Gorczynski, Paul F; Zinszer, Kate A

    2011-01-01

    Students vocalized their concern with public health training programs in Canada at the 2010 CPHA Centennial Conference. Given these concerns, we reviewed the objectives and curricula of public health graduate (master's) programs in Canada. Our objective was to understand to what extent public and population health graduate programs in Canada support interdisciplinary, multidisciplinary and knowledge translation and exchange (KTE) training. This was achieved through a review of all public and population health master's programs in Canada identified from the public health graduate programs listed on the Public Health Agency of Canada website (n = 33) plus an additional four programs that were not originally captured on the list. Of the 37 programs reviewed, 28 (76%) stated that interdisciplinary, multidisciplinary or cross-disciplinary training opportunities are of value to their program, with 12 programs (32%) providing multidisciplinary or interdisciplinary training opportunities in their curriculum. Only 14 (38%) of the 37 programs provided value statements of KTE activities in their program goals or course objectives, with 10 (27%) programs offering KTE training in their curriculum. This review provides a glimpse into how public health programs in Canada value and support interdisciplinary and multidisciplinary collaboration as well as KTE activities.

  20. Oral allergy syndrome--the need of a multidisciplinary approach.

    PubMed

    Kelava, Nikolina; Lugović-Mihić, Liborija; Duvancić, Tomislav; Romić, Renata; Situm, Mirna

    2014-06-01

    Oral allergy syndrome (OAS) is one of the most common types of food allergy. The syndrome includes itching and swelling of the lips, palate and tongue, usually after consuming fresh fruits and vegetables. The underlying pathogenic mechanism is cross-reactivity between IgE antibodies specific to pollen, and antigens in food, such as fresh fruits, vegetables and nuts that are structurally similar to pollen. Both pollen and food antigens can bind to IgE and trigger type I immune reaction. Diagnosis is primarily based on the patient's history, and confirmed by skin tests, in vitro tests, and oral provocation tests. Differential diagnoses include many diseases (such as burning mouth syndrome, angioedema, hay fever, various other oral diseases, etc.), and for this reason a multidisciplinary approach is necessary, as different specialists need to be involved in the diagnostic procedure. Therapy includes avoiding, or thermal processing of, fruit and vegetables known to trigger a reaction, and antihistamine medications. If a more severe anaphylactic reaction develops, more aggressive therapy is required. The goal of this article is to present OAS, its etiopathogenesis, clinical picture, and symptoms, diagnostic approach and therapy for OAS.

  1. Treatment of menstrual migraine; multidisciplinary or mono-disciplinary approach.

    PubMed

    Witteveen, Hester; van den Berg, Peter; Vermeulen, Guus

    2017-12-01

    The aim of this study was to compare a multidisciplinary approach of menstrual (related) migraine, combining the neurological and gynaecological consultation, to a mono-disciplinary approach involving neurological treatment. There is a clear relationship between the menstruation cycle and the occurrence of migraine (menstrual migraine). Nowadays the treatment of menstrual (related) migraine is performed by a neurologist. A treatment with attention to hormonal treatment seems more convenient. This retrospective study was performed in a cohort using data of 88 women with menstrual (related) migraine who visited the menstrual migraine clinic between 2012 and 2014 (intervention group). The results were compared to a historical control group, which consisted of women with menstrual (related) migraine who were treated before 2012 and received a mono-disciplinary approach. In the intervention group the Headache Impact (HIT) score significantly improved (65 to 59 points). The mean headache days per month declined significantly (from 6 to 3.83 days) and these women needed less use of pain medication. In the control group the decline in HIT score was less striking (65 to 63.5 points) and the mean headache days per month increased (6 to 6,5 days). It appeared that 20 out of 27 patients in the control group required a gynaecological consultation in course of time. A multidisicplinary treatment of women with menstrual (related) migraine gives better results compared to a mono-disciplinary approach. These results should be interpreted with caution as we performed a retrospective study with a relative small control group.

  2. Exploring an herbal "wonder cure" for cancer: a multidisciplinary approach.

    PubMed

    Ben-Arye, Eran; Mahajna, Jamal; Aly, Radi; Ali-Shtayeh, Mohammed Saleem; Bentur, Yedidia; Lev, Efraim; Deng, Gary; Samuels, Noah

    2016-07-01

    The unmonitored use of herbal medicinal remedies by patients with cancer presents a significant challenge to oncology healthcare professionals. We describe an increasingly popular herbal "wonder drug," Ephedra foeminea (Alanda in Arabic), whose use has spread from the Palestinian patient population throughout the Middle East. We conducted a multicentered and multidisciplinary collaborative research effort in order to understand the potential benefits and harms of this popular herbal remedy. We conducted an in-depth search of the medical literature, both traditional and modern, for any mention of the clinical use of Alanda for the treatment of cancer. We then tested the remedy, first for toxic ephedra alkaloid components and then for anticancer effects, as well as effects on the cytotoxic activity of chemotherapy agents (cisplatin and carboplatin) on breast cancer cell cultures. We found no mention in the literature, both conventional and traditional, on the use of Alanda for the treatment of cancer. Laboratory testing did not find any toxic components (i.e., ephedra alkaloids) in the preparation. However, in vitro exposure to Alanda led to a reduced cytotoxic effect of chemotherapy on breast cancer cell cultures. The use of an integrative ethnobotanical, laboratory and clinical research-based approach can be extremely helpful when providing nonjudgmental and evidence-based guidance to patients with cancer, especially on the use of traditional herbal medicine. The effectiveness and safety of these products need to be examined by integrative physicians who are dually trained in both complementary medicine and supportive cancer care.

  3. Take a Multidisciplinary, Team-based Approach on Elder Abuse.

    PubMed

    2016-07-01

    While EDs are well positioned to identify incidents of elder abuse, providers often miss the opportunity. Experts say providers find only one in every 24 cases, and that the pendulum must swing toward over-detection. Investigators acknowledge elder abuse is difficult to confirm, given that disease processes can explain some of the signs. Further, older adults are often reluctant to report abuse because they fear they will be removed from their homes or separated from their caregivers. Given the complexity involved with addressing the issue, investigators recommend EDs establish a multidisciplinary approach to the problem. Providing great care to a victim of elder abuse requires time and setting up a circumstance whereby one can actually communicate with the patient reliably and alone. While most states require providers to report suspected cases of elder abuse to Adult Protective Services, there is little evidence this requirement has incentivized more reports in the same way a similar requirement has prompted providers to report cases of suspected child abuse. Investigators advise ED leaders to train and empower every member of their team to identify potential signs of elder abuse.

  4. Treatment timing and multidisciplinary approach in Apert syndrome

    PubMed Central

    Fadda, Maria Teresa; Ierardo, Gaetano; Ladniak, Barbara; Di Giorgio, Gianni; Caporlingua, Alessandro; Raponi, Ingrid; Silvestri, Alessandro

    2015-01-01

    Summary Apert syndrome is a rare congenital disorder characterized by craniosynostosis, midface hypoplasia and symmetric syndactyly of hands and feet. Abnormalities associated with Apert syndrome include premature fusion of coronal sutures system (coronal sutures and less frequently lambdoid suture) resulting in brachiturricephalic dismorphism and impaired skull base growth. After this brief explanation it is clear that these anatomical abnormalities may have a negative impact on the ability to perform essential functions. Due to the complexity of the syndrome a multidisciplinary (respiratory, cerebral, maxillo-mandibular, dental, ophthalmic and orthopaedic) approach is necessary in treating the psychological, aesthetic and functional issues. The aim of this paper is to analyse the different functional issues and surgical methods trying to enhance results through a treatment plan which includes different specialities involved in Apert syndrome treatment. Reduced intellectual capacity is associated to the high number of general anaesthesia the small patients are subject to. Therefore the diagnostic and therapeutic treatment plan in these patients has established integrated and tailored surgical procedures based on the patients’ age in order to reduce the number of general anaesthesia, thus simplifying therapy for both Apert patients and their family members. PMID:26330906

  5. Sickle cell retinopathy: improving care with a multidisciplinary approach.

    PubMed

    Menaa, Farid; Khan, Barkat Ali; Uzair, Bushra; Menaa, Abder

    2017-01-01

    Sickle cell retinopathy (SCR) is the most representative ophthalmologic complication of sickle cell disease (SCD), a hemoglobinopathy affecting both adults and children. SCR presents a wide spectrum of manifestations and may even lead to irreversible vision loss if not properly diagnosed and treated at the earliest. Over the past decade, multidisciplinary research developments have focused upon systemic, genetic, and ocular risk factors of SCR, enabling the clinician to better diagnose and manage these patients. In addition, newer imaging and testing modalities, such as spectral domain-optical coherence tomography angiography, have resulted in the detection of subclinical retinopathy related to SCD. Innovative therapy includes intravitreal injection of an anti-vascular endothelial growth factor (eg, Lucentis(®) [ranibizumab] or Eylea(®) [aflibercept]) which appears comparatively safe and efficient, and may be combined with laser photocoagulation (LPC) for proliferative SCR. The effect of LPC alone does not significantly lead to the regression of advanced SCR, although it helps in avoiding hemorrhage and sight loss. This comprehensive article is based on 10-years retrospective (2007-2017) studies. It aims to present advances and recommendations in SCR theranostics while pointing out the requirement of combinatorial approaches for better management of SCR patients. To reach this goal, we identified and analyzed randomized original and review articles, clinical trials, non-randomized intervention studies, and observational studies using specified keywords in various databases (eg, Medline, Embase, Cochrane, ClinicalTrials.gov).

  6. Treatment timing and multidisciplinary approach in Apert syndrome.

    PubMed

    Fadda, Maria Teresa; Ierardo, Gaetano; Ladniak, Barbara; Di Giorgio, Gianni; Caporlingua, Alessandro; Raponi, Ingrid; Silvestri, Alessandro

    2015-01-01

    Apert syndrome is a rare congenital disorder characterized by craniosynostosis, midface hypoplasia and symmetric syndactyly of hands and feet. Abnormalities associated with Apert syndrome include premature fusion of coronal sutures system (coronal sutures and less frequently lambdoid suture) resulting in brachiturricephalic dismorphism and impaired skull base growth. After this brief explanation it is clear that these anatomical abnormalities may have a negative impact on the ability to perform essential functions. Due to the complexity of the syndrome a multidisciplinary (respiratory, cerebral, maxillo-mandibular, dental, ophthalmic and orthopaedic) approach is necessary in treating the psychological, aesthetic and functional issues. The aim of this paper is to analyse the different functional issues and surgical methods trying to enhance results through a treatment plan which includes different specialities involved in Apert syndrome treatment. Reduced intellectual capacity is associated to the high number of general anaesthesia the small patients are subject to. Therefore the diagnostic and therapeutic treatment plan in these patients has established integrated and tailored surgical procedures based on the patients' age in order to reduce the number of general anaesthesia, thus simplifying therapy for both Apert patients and their family members.

  7. Multi-disciplinary approach for enhancing orthodontic esthetics - case report.

    PubMed

    Kalia, Ajit; Mirdehghan, Nasim; Khandekar, Sonali; Patil, Wasu

    2015-01-01

    In contemporary dental care, an increasing number of adult patients are now seeking orthodontic treatment with the primary motive of improvement in appearance and achievement of esthetic smile. Proper recognition of the dental and facial defects at the outset of treatment is the most important key to esthetic success and is essential in satisfying the patient's needs. By following the rules of Golden proportion smiles can be made attractive, harmonious, symmetrical, and proportionate. Consisted of 22-year-old girl who came for treatment of crowding in maxillary and mandibular arches, abnormal overjet and overbite and had unesthetic peg lateral. Non-extraction therapy was carried out since the patient had good soft tissue drape, alignment was achieved by expanding the arches and moving teeth in ideal axial inclination. Esthetic smile was attained using composite buildup of upper right peg lateral and minor adjunctive surgery (full thickness periodontal graft) on lower right central incisor. The present case report orchestrates interrelationship between various branches of dentistry and orthodontics. It exhibits how multidisciplinary approach can be used to achieve ideal dental esthetics in a 22-year-old girl who was successfully treated for peg shaped lateral incisor, gingival recession, and unesthetic smile.

  8. Ceramic laminate veneers: clinical procedures with a multidisciplinary approach.

    PubMed

    Veneziani, Marco

    2017-01-01

    Complex cases with high esthetic needs represent a challenge for clinicians. A multidisciplinary approach is vital to achieve the planned result. New technological devices are needed to facilitate the collaboration between the clinical team members and to develop a fluent and effective diagnostic and therapeutic pathway. This article describes a well-defined protocol for the treatment of complex esthetic cases with the use of ceramic laminate veneers. The protocol involves different branches of dentistry: periodontal therapy, mucogingival surgery, restorative dentistry, orthodontics, and prosthodontics. Each step of the protocol should be executed in a very strict order: intra- and extraoral esthetic analysis of the patient, with photographs; digital previsualization by means of Digital Smile Design (DSD); clinical previsualization by means of a mock-up; orthodontic, mucogingival, and endodontic treatments, if needed; minimally invasive tooth preparation, driven by a mock-up and silicone indices; manufacture of ceramic laminate veneers; try-in and adhesive cementation. In this article, this protocol is illustrated by a clinical case report in which all the above-mentioned steps were carried out. The finalization was obtained by means of state-of-the-art adhesive techniques and ceramic laminate veneers. The correct use of modern materials, in combination with rigorous adhesive procedures, allows for a minimally invasive and highly esthetic treatment, with adequate function and a perfect integration that is in harmony with the patient's face.

  9. Implementing a Multidisciplinary Approach to Treating Tuberous Sclerosis Complex

    PubMed Central

    Poretti, Andrea

    2017-01-01

    Objective: Tuberous sclerosis complex is expressed throughout the body, resulting in a range of clinical manifestations that can be challenging to manage. Results: The authors report a patient who presented at age 3.5 years with several suspected seizures and was diagnosed with tuberous sclerosis complex following the discovery of numerous bilateral cortical tubers and subependymal nodules on magnetic resonance imaging. Interdisciplinary, comprehensive care was recommended; this included ongoing surveillance to monitor for the development of tuberous sclerosis complex–associated conditions. Approximately 2 years later, the patient began exhibiting aggressive and self-injurious behavior, and a subependymal giant cell astrocytoma was discovered. After everolimus was initiated, he demonstrated less aggression, had ceased self-injurious behavior, and subependymal giant cell astrocytoma growth stabilized. Conclusions: This case highlights the importance of a multidisciplinary approach to care in tuberous sclerosis complex, which ensures the early detection and appropriate treatment of clinical manifestations that may arise during the course of the patient’s life. PMID:28856172

  10. Sickle cell retinopathy: improving care with a multidisciplinary approach

    PubMed Central

    Menaa, Farid; Khan, Barkat Ali; Uzair, Bushra; Menaa, Abder

    2017-01-01

    Sickle cell retinopathy (SCR) is the most representative ophthalmologic complication of sickle cell disease (SCD), a hemoglobinopathy affecting both adults and children. SCR presents a wide spectrum of manifestations and may even lead to irreversible vision loss if not properly diagnosed and treated at the earliest. Over the past decade, multidisciplinary research developments have focused upon systemic, genetic, and ocular risk factors of SCR, enabling the clinician to better diagnose and manage these patients. In addition, newer imaging and testing modalities, such as spectral domain-optical coherence tomography angiography, have resulted in the detection of subclinical retinopathy related to SCD. Innovative therapy includes intravitreal injection of an anti-vascular endothelial growth factor (eg, Lucentis® [ranibizumab] or Eylea® [aflibercept]) which appears comparatively safe and efficient, and may be combined with laser photocoagulation (LPC) for proliferative SCR. The effect of LPC alone does not significantly lead to the regression of advanced SCR, although it helps in avoiding hemorrhage and sight loss. This comprehensive article is based on 10-years retrospective (2007–2017) studies. It aims to present advances and recommendations in SCR theranostics while pointing out the requirement of combinatorial approaches for better management of SCR patients. To reach this goal, we identified and analyzed randomized original and review articles, clinical trials, non-randomized intervention studies, and observational studies using specified keywords in various databases (eg, Medline, Embase, Cochrane, ClinicalTrials.gov).

  11. Early treatment of unilateral temporomandibular joint ankylosis: a multidisciplinary approach.

    PubMed

    Ataç, Mustafa Sancar; Çakir, Merve; Yücel, Ergun; Gazioğlu, Çagri; Akkaya, Sevil

    2014-05-01

    Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years.

  12. A multidisciplinary approach improves infection rates in pediatric spine surgery.

    PubMed

    Ballard, Michael R; Miller, Nancy H; Nyquist, Ann-Christine; Elise, Benefield; Baulesh, David M; Erickson, Mark A

    2012-01-01

    Surgical site infections (SSI) associated with elective pediatric spinal surgery are a commonly reported complication, increasing hospital length of stay, readmissions, operations, and financial costs. In July 2007, a multidisciplinary task force, designated Target Zero, was created to address this issue and establish prevention protocols at our institution. A consecutive series of 394 patient charts from April 2006 to September 2008 were retrospectively reviewed to identify patients who developed an SSI secondary to elective spinal surgery. Four cohorts were evaluated; high-risk (HR) and low-risk (LR) patients who underwent surgery before (April 2006 to June 2007) and after (July 2007 to September 2008) Target Zero initiation. The definition of HR included diagnoses of cerebral palsy, spina bifida, muscle disease, paralytic deformities, and vertebral column resections. Patients were followed for 1 year to meet The Center for Disease Control-National Health Safety Network's definition of an SSI with an implantable device. Overall infection rates were determined for each group and compared statistically. A total of 192 patients (70 HR and 122 LR) underwent surgery before, and 202 patients (92 HR and 110 LR) underwent surgery after Target Zero initiation. Overall infection rates were reduced from 7.8% to 4.5% (P=0.203), 12.9% to 6.5% (P=0.183), and 4.9% to 2.7% (P=0.505) for all patients, HR patients, and LR patients, respectively. The relative risk reduction was 43.0% for all patients, 49.3% for HR patients, and 44.6% for LR patients. Although decreases in overall infection rates were not statistically significant, the results from Target Zero were shown to be clinically meaningful with a relative risk reduction approaching 50% overall and in defined subgroups. Based on the number needed to treat analysis, 1 infection in every 16 patients within the HR group, and 1 in 30 overall, was prevented up to 1 year postoperatively. This study is the first to document the

  13. A MULTIDISCIPLINARY APPROACH TO STORMWATER MANAGEMENT AT THE WATERSHED SCALE.

    EPA Science Inventory

    Stormwater runoff from extensive impervious surfaces in urban and suburban areas has led to human safety risks and stream ecosystem impairment, triggering an interest in watershed-scale retrofit stormwater management. Such stormwater management is of multidisciplinary relevance, ...

  14. A MULTIDISCIPLINARY APPROACH TO STORMWATER MANAGEMENT AT THE WATERSHED SCALE.

    EPA Science Inventory

    Stormwater runoff from extensive impervious surfaces in urban and suburban areas has led to human safety risks and stream ecosystem impairment, triggering an interest in watershed-scale retrofit stormwater management. Such stormwater management is of multidisciplinary relevance, ...

  15. A MULTIDISCIPLINARY APPROACH TO STORMWATER MANAGEMENT AT THE catchment SCALE

    EPA Science Inventory

    Stormwater runoff from extensive impervious surfaces in urban and suburban areas has led to human safety risks and stream ecosystem impairment, triggering an interest in catchment-scale retrofit stormwater management. Such stormwater management is of multidisciplinary relevance, ...

  16. A MULTIDISCIPLINARY APPROACH TO STORMWATER MANAGEMENT AT THE catchment SCALE

    EPA Science Inventory

    Stormwater runoff from extensive impervious surfaces in urban and suburban areas has led to human safety risks and stream ecosystem impairment, triggering an interest in catchment-scale retrofit stormwater management. Such stormwater management is of multidisciplinary relevance, ...

  17. Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience.

    PubMed

    Haliloglu, Ozlem; Kuruoglu, Enis; Ozkaya, Hande Mefkure; Keskin, Fatma Ela; Gunaldi, Omur; Oz, Buge; Gazioglu, Nurperi; Kadioglu, Pinar; Tanriover, Necmettin

    2016-04-01

    Acromegaly is a multisystemic disease that requires a multidisciplinary approach. The aim of this study was to determine early and late remissions of patients who underwent surgery at our center and to evaluate relations between pathologic and radiologic properties of adenoma and medical and radiosurgical treatments with remissions. The medical records of 103 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery in Cerrahpasa Medical Faculty, Istanbul University, between 2007 and 2014 were reviewed. Clinical, biochemical, radiologic, and pathologic properties were determined. The total median follow-up time was 38 months [interquartile range: 24-53.5 months]. Thirty-two percent of the adenomas were microadenomas and 68% were macroadenomas The early remission rate was 51.5% and late remission was 75.2%. The sellar floor invasion was significantly lower in patients with early and late remissions (P = 0.01 and P = 0.009, respectively). The initial growth hormone (GH; P < 0.001), first-day GH (P = 0.03), 3-month GH (P = 0.001), insulin-like growth factor-1 (P = 0.004), and 6-month insulin-like growth factor-1 (P = 0.02) levels were significantly greater in patients with sellar floor invasion. The late remission rates (P = 0.004) were greter and reoperation needs (P = 0.05) were lower in patients with Ki-67 <3% than in patients with ≥3%. Seventy (68.6%) patients needed medical therapy during follow-up. Late remission was achieved using a multidiciplinary approach in 75.2% of 103 patients with acromegaly, and young age, male sex, high Ki-67 and mitosis indices, and cavernous sinus and sellar-floor invasion had negative effects on clinical and biochemical control of the disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Diversity in Collaborative Research Communities: A Multicultural, Multidisciplinary Thesis Writing Group in Public Health

    ERIC Educational Resources Information Center

    Guerin, Cally; Xafis, Vicki; Doda, Diana V.; Gillam, Marianne H.; Larg, Allison J.; Luckner, Helene; Jahan, Nasreen; Widayati, Aris; Xu, Chuangzhou

    2013-01-01

    Writing groups for doctoral students are generally agreed to provide valuable learning spaces for Ph.D. candidates. Here an academic developer and the eight members of a writing group formed in a Discipline of Public Health provide an account of their experiences of collaborating in a multicultural, multidisciplinary thesis writing group. We…

  19. Public Law 99-457: Facilitating Family Participation on the Multidisciplinary Team.

    ERIC Educational Resources Information Center

    Nash, James K.

    1990-01-01

    This paper presents the requirements for family participation on multidisciplinary teams under Public Law 99-457, reviews literature on family participation on teams working with handicapped children, identifies factors that influence team functioning, and suggests how team members can facilitate family involvement. (Author/JDD)

  20. Diversity in Collaborative Research Communities: A Multicultural, Multidisciplinary Thesis Writing Group in Public Health

    ERIC Educational Resources Information Center

    Guerin, Cally; Xafis, Vicki; Doda, Diana V.; Gillam, Marianne H.; Larg, Allison J.; Luckner, Helene; Jahan, Nasreen; Widayati, Aris; Xu, Chuangzhou

    2013-01-01

    Writing groups for doctoral students are generally agreed to provide valuable learning spaces for Ph.D. candidates. Here an academic developer and the eight members of a writing group formed in a Discipline of Public Health provide an account of their experiences of collaborating in a multicultural, multidisciplinary thesis writing group. We…

  1. Modeling Mantle Heterogeneity Development in Earth's Mantle Using Multidisciplinary Approaches

    NASA Astrophysics Data System (ADS)

    de Silva, S. M. S.; Finlayson, V.; Gu, T.; Li, M.; Lithgow-Bertelloni, C. R.; Cormier, V. F.

    2014-12-01

    The process of subduction provides continuous chemical and thermal heterogeneity to Earth's mantle. How heterogeneity is stirred, stretched and distributed depends on the detail of mantle convection as well as chemical and physical properties of mantle materials. Seismic observations have revealed heterogeneities in Earth's mantle at varying scales. Seismic velocities are controlled by physical parameters such as density, bulk modulus and shear modulus, which are a function of temperature, pressure and composition. Thus, understanding the origin of seismic heterogeneities play an important role in understanding the thermal and chemical state of the present Earth's mantle. Originating from the CIDER 2014 workshop, our goal is to take a multidisciplinary approach to tackle a variety of questions, foremost what length scales of heterogeneity might we expect from the convecting process and how do they manifest themselves in seismic imaging. This touches upon fundamental issues such as the composition of the mantle, the nature of stirring and mixing, and the nature of large-scale mantle upwellings (LLSVPs). We will investigate the development of heterogeneity in response to various compositions and redox states using existing and new thermochemical mantle convection simulations, and test the sensitivity of seismic measurements to different length scales of chemical heterogeneity. We try to reconcile large differences in length scales of heterogeneity as well as fractional perturbations of seismic velocity and density predicted by tomography and scattering seismic experiments. Preliminary results from the CIDER workshop initiate with conversion of geodynamic models to profiles of seismic velocity and density which are then taken as input models to predict multiply scattered, high frequency, P wave coda envelopes synthesized by a radiative transport technique. The predicted sensitivity of P coda envelopes to varying chemical compositions and heterogeneity length scales

  2. Philosophizing about Teacher Dissatisfaction: A Multidisciplinary Hermeneutic Approach

    ERIC Educational Resources Information Center

    Santoro, Doris A.

    2015-01-01

    In this methodological reflection, I describe the multidisciplinary hermeneutic process of philosophizing about teacher dissatisfaction. I discuss how philosophy serves as a starting point for interpretive work based on interviews with former teachers and readings of qualitative and quantitative research on teacher attrition and dissatisfaction.…

  3. Philosophizing about Teacher Dissatisfaction: A Multidisciplinary Hermeneutic Approach

    ERIC Educational Resources Information Center

    Santoro, Doris A.

    2015-01-01

    In this methodological reflection, I describe the multidisciplinary hermeneutic process of philosophizing about teacher dissatisfaction. I discuss how philosophy serves as a starting point for interpretive work based on interviews with former teachers and readings of qualitative and quantitative research on teacher attrition and dissatisfaction.…

  4. The multidisciplinary management of hypodontia: a team approach.

    PubMed

    Gill, D S; Barker, C S

    2015-02-16

    Hypodontia is a frequently encountered condition within general dental practice. Its successful management involves the interplay of a number of clinicians. The general dental practitioner plays a key role in the management of patients. The aim of this short article is to outline some of the principles of the multidisciplinary management of hypodontia with an emphasis on orthodontic treatment.

  5. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients.

    PubMed

    Conigliaro, Paola; Chimenti, Maria Sole; Ascolani, Marta; Triggianese, Paola; Novelli, Lucia; Onali, Sara; Lolli, Elisabetta; Calabrese, Emma; Petruzziello, Carmelina; Pallone, Francesco; Perricone, Roberto; Biancone, Livia

    2016-02-01

    onset in the last two years in conjunction with the establishment of the GI-Rhe clinic. Multidisciplinary approach improved management of rheumatic disorders in IBD patients allowing a more comprehensive care.

  6. Teaching culturally sensitive care to dental students: a multidisciplinary approach.

    PubMed

    Donate-Bartfield, Evelyn; Lobb, William K; Roucka, Toni M

    2014-03-01

    Dental schools must prepare future dentists to deliver culturally sensitive care to diverse patient populations, but there is little agreement on how best to teach these skills to students. This article examines this question by exploring the historical and theoretical foundations of this area of education in dentistry, analyzes what is needed for students to learn to provide culturally sensitive care in a dental setting, and identifies the discipline-specific skills students must master to develop this competence. The problems associated with single-discipline, lecture-based approaches to teaching culturally sensitive care are outlined, and the advantages of an interdisciplinary, patient-centered, skills-based approach to teaching culturally sensitive care are described. The authors advocate for an approach to teaching culturally sensitive care that builds upon learning in the behavioral sciences, ethics, and public health. Component skills and perspectives offered by each of these curriculum areas are identified, and their contributions to the teaching of culturally sensitive care are described. Finally, the need to consider the timing of this instruction in the dental curriculum is examined, along with instructional advantages associated with an approach that is shared by faculty across the curriculum.

  7. Diabetic foot - the need for comprehensive multidisciplinary approach.

    PubMed

    Korzon-Burakowska, Anna; Dziemidok, Piotr

    2011-01-01

    Diabetes mellitus is considered to be civilization disease development of which is influenced by environmental changes. Diabetic foot (ulceration, infection, gangrene) is one of the most disabling complication of diabetes mellitus. It contributes to the increased mortality and cardiovascular death. It also frequently leads to depression, social exclusion and physical impairment. Risk factors of diabetic foot are as follows: age, race, sex, duration of diabetes, biomechanical factors, level of glycemia, smoking habits. According to international standards diabetic foot can be successfully treated only by the multidisciplinary team which can provide more comprehensive and integrated care as compared to ordinary medical team or single specialist. Multidisciplinary team consists of: diabetologist, shoemaker, orthopedist, psychologist, surgeons both vascular and general, podologists, radiologists, educators, nurses and rehabilitation team. Such coordinated attitude to a patient may be the future solution for any civilization and environment-related disease requiring treatment which cannot be successfully provided by any ordinary medical team.

  8. Management of low back pain in computer users: A multidisciplinary approach

    PubMed Central

    Shete, Kiran M.; Suryawanshi, Prachi; Gandhi, Neha

    2012-01-01

    Background: Low back pain is a very common phenomenon in computer users. More than 80% people using computers for more than 4 h complain of back pain. Objective: To compare the effectiveness of multidisciplinary treatment approach and conventional treatment approach amongst computer users. Materials and Methods: A prospective interventional study was carried out at a private spine clinic amongst the computer users with the complaint of low back pain. The study participants were randomly distributed in two groups. The first group comprised the study participants treated by conventional approach and the second group was treated by multidisciplinary approach. Primary outcomes analyzed were pain intensity, sick leave availed, and quality of life. Statistical analysis was done using proportions, unpaired “t” test, and Wilcoxon signed-rank test. Results: Totally 44 study participants were randomly assigned to groups I and II, and each group had 22 study participants. Intensity of pain was reduced significantly in the group treated by multidisciplinary approach (t = 5.718; P = 0.0001). Similarly only 4 (19.19%) of the study participants of the group treated by multidisciplinary approach availed sick leave due to low back pain, while 14 (63.63%) study participants availed sick leave in the other group (P = 0.02). The quality of life amongst the study participants treated by multidisciplinary approach was significantly improved compared to the group treated by conventional approach (t = 7.037; P = 0.0001). Conclusion and Recommendation: The multidisciplinary treatment approach was better than the conventional treatment approach in low back pain cases when some factors like pain and quality of life were assessed. The multidisciplinary approach for treatment of low back pain should be promoted over conventional approach. Larger studies are required to confirm the findings in different settings. PMID:23741122

  9. Culture, Health, and Science: A Multidisciplinary Liberal Arts Alternative to the Public Health Major.

    PubMed

    Morgan, Lynn M; Knight, Sabina; Gubrium, Aline C

    2016-01-01

    Since the 2003 call by the Institute of Medicine to educate undergraduates in public health, various models have emerged for incorporating public health into the liberal arts and sciences. One model is a professionalized public health major that uses core public health competencies to prepare a workforce of health professionals. A second model offers a broad-based public health major rooted in liberal arts principles, resisting the utilitarian trend toward human capital formation. A third model resists even the label of "public health," preferring instead to introduce undergraduates to many ways of analyzing human health and healing. The multidisciplinary Culture, Health, and Science Program, based on six key commitments for preparing liberal arts students to analyze health and respond to global health challenges, is offered as an alternative to the public health major. © The Author(s) 2016.

  10. Importance of multidisciplinary approach in diagnosis of histoplasmosis*

    PubMed Central

    de Oliveira, Patricia Botini; de Abreu, Marilda Aparecida Milanez Morgado; Mattos, Antônio Luiz de Arruda

    2016-01-01

    A patient with systemic involvement, initially treated as tuberculosis, is presented in this report. There were only two painful subcutaneous nodules, from which we arrived at the correct diagnosis of histoplasmosis. The patient was attended by several experts in the fields of infectious diseases, nephrology and internal medicine, but the diagnosis was only possible after dermatological examination and skin biopsy. This case values multidisciplinary interaction between dermatologists and other medical areas for diagnosis of cases with atypical manifestations. PMID:27438207

  11. A multidisciplinary team care approach improves outcomes in high-risk pediatric neuroblastoma patients.

    PubMed

    Chang, Hsiu-Hao; Liu, Yen-Lin; Lu, Meng-Yao; Jou, Shiann-Tarng; Yang, Yung-Li; Lin, Dong-Tsamn; Lin, Kai-Hsin; Tzen, Kai-Yuan; Yen, Ruoh-Fang; Lu, Ching-Chu; Liu, Chia-Ju; Peng, Steven Shinn-Forng; Jeng, Yung-Ming; Huang, Shiu-Feng; Lee, Hsinyu; Juan, Hsueh-Fen; Huang, Min-Chuan; Liao, Yung-Feng; Lee, Ya-Ling; Hsu, Wen-Ming

    2017-01-17

    We assessed the impact of a multidisciplinary team care program on treatment outcomes in neuroblastoma patients. Newly diagnosed neuroblastoma patients received treatment under the Taiwan Pediatric Oncology Group (TPOG) N2002 protocol at the National Taiwan University Hospital beginning in 2002. A multidisciplinary team care approach that included nurse-led case management for patients treated under this protocol began in January 2010. Fifty-eight neuroblastoma patients, including 29 treated between 2002 and 2009 (Group 1) and 29 treated between 2010 and 2014 (Group 2), were enrolled in the study. The 5-year overall survival (OS) and event-free survival (EFS) rates for all 58 patients were 59% and 54.7%, respectively. Group 2 patients, who were treated after implementation of the multidisciplinary team care program, had better 3-year EFS (P = 0.046), but not OS (P = 0.16), rates than Group 1 patients. In a multivariate analysis, implementation of the multidisciplinary team approach was the only significant independent prognostic factor for neuroblastoma patients. In further subgroup analyses, the multidisciplinary team approach improved EFS, but not OS, in patients with stage 4 disease, those in the high-risk group, and those with non-MYCN amplified tumors. These data indicate a multidisciplinary team care approach improved survival outcomes in high-risk neuroblastoma patients. However, further investigation will be required to evaluate the long-term effects of this approach over longer follow-up periods.

  12. Robin sequence: what the multidisciplinary approach can do

    PubMed Central

    Cohen, Stephanie M; Greathouse, S Travis; Rabbani, Cyrus C; O’Neil, Joseph; Kardatzke, Matthew A; Hall, Tasha E; Bennett, William E; Daftary, Ameet S; Matt, Bruce H; Tholpady, Sunil S

    2017-01-01

    Robin sequence (RS) is a commonly encountered triad of micrognathia, glossoptosis, and airway obstruction, with or without a cleft palate. The management of airway obstruction is of paramount importance, and multiple reviews and retrospective series outline the diagnosis and treatment of RS. This article focuses on the multidisciplinary nature of RS and the specialists’ contributions and thought processes regarding the management of the RS child from birth to skeletal maturity. This review demonstrates that the care of these children extends far beyond the acute airway obstruction and that thorough monitoring and appropriate intervention are required to help them achieve optimal outcomes. PMID:28392703

  13. [Secondary lymphedema--the importance of a multidisciplinary team approach].

    PubMed

    Heldenberg, Eitan; Bass, Arie

    2013-03-01

    Secondary lymphedema is the most common type of lymphedema. Malignancy, mainly breast carcinoma, is the main cause of upper extremity lymphedema, while groin dissection, irradiation and trauma are the cause of lower extremity lymphedema. Early recognition of the pathology followed by early referral to a vascular surgeon, leading a multidisciplinary team, who takes care of those patients, can prevent a miserable Life from these patients. Lifelong commitment of the patients, prolonged financial support of the health insurance supplier, as well as team work of the group taking care of the patient, is the only way to help these patients.

  14. [Global brain metastases management strategy: a multidisciplinary-based approach].

    PubMed

    Métellus, P; Tallet, A; Dhermain, F; Reyns, N; Carpentier, A; Spano, J-P; Azria, D; Noël, G; Barlési, F; Taillibert, S; Le Rhun, É

    2015-02-01

    Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources. Copyright © 2015. Published by Elsevier SAS.

  15. New Approaches to HSCT Multidisciplinary Design and Optimization

    NASA Technical Reports Server (NTRS)

    Schrage, D. P.; Craig, J. I.; Fulton, R. E.; Mistree, F.

    1996-01-01

    The successful development of a capable and economically viable high speed civil transport (HSCT) is perhaps one of the most challenging tasks in aeronautics for the next two decades. At its heart it is fundamentally the design of a complex engineered system that has significant societal, environmental and political impacts. As such it presents a formidable challenge to all areas of aeronautics, and it is therefore a particularly appropriate subject for research in multidisciplinary design and optimization (MDO). In fact, it is starkly clear that without the availability of powerful and versatile multidisciplinary design, analysis and optimization methods, the design, construction and operation of im HSCT simply cannot be achieved. The present research project is focused on the development and evaluation of MDO methods that, while broader and more general in scope, are particularly appropriate to the HSCT design problem. The research aims to not only develop the basic methods but also to apply them to relevant examples from the NASA HSCT R&D effort. The research involves a three year effort aimed first at the HSCT MDO problem description, next the development of the problem, and finally a solution to a significant portion of the problem.

  16. Multidisciplinary approach to congenital Toxoplasma infection: an Italian nationwide survey.

    PubMed

    Tomasoni, Lina R; Meroni, Valeria; Bonfanti, Carlo; Bollani, Lina; Lanzarini, Paolo; Frusca, Tiziana; Castelli, Francesco

    2014-07-01

    Italy provides a free voluntary serological screening for toxoplasmosis in pregnancy supported by public health system, as there is an estimated congenital toxoplasmosis rate of 1-2/10,000. The aim of this study was to make an inventory of diagnostic and therapeutic protocols in use in Italy in the absence of a national guideline. A semistructured questionnaire was distributed to AMCLI (Italian Association of Clinical Microbiologists) members who were asked to involve other specialists to fill in the form. Data from 26 centers show: a) a general use of the IgG avidity test to solve diagnosis in IgG/IgM positive, pregnant women; b) a widespread attitude to spyramicin antenatal treatment in suspected, unconfirmed maternal infection; c) avoidance of invasive antenatal diagnosis only in suspected early or late (>24 weeks), even confirmed, maternal infection d) fetal diagnosis performed by PCR assays on amniotic fluid; e) variability of both indications and dosage of pyrimethamine-sulfadiazine (P-S) as fetal treatment; f) use of comparative mother and newborn IgG/IgM Immuneblot in most centers; g) no diagnostic tests performed on placenta and cord blood; h) spyramicin is no longer used in congenital infections; i) no P-S-based treatment for children at high risk of congenital infection (late maternal infection) in the absence of diagnosis. As there is the opportunity to test pregnant women for Toxoplasma gondii infection in Italy free of charge, standardized diagnostic and therapeutic national guidelines would focus on a more uniform approach.

  17. Salvaging the Infected Breast Tissue Expander: A Standardized Multidisciplinary Approach

    PubMed Central

    Selber, Jesse C.; Crosby, Melissa; Raad, Issam I.; Butler, Charles E.; Villa, Mark T.; Kronowitz, Steven J.; Clemens, Mark W.; Garvey, Patrick; Yang, Wei; Baumann, Donald P.

    2016-01-01

    Background: Infections of breast tissue expander (TE) are complex, often requiring TE removal and hospitalization, which can delay further adjuvant therapy and add to the overall costs of breast reconstruction. Therefore, to reduce the rate of TE removal, hospitalization, and costs, we created a standardized same-day multidisciplinary outpatient quality improvement protocol for diagnosing and treating patients with early signs of TE infection. Methods: We prospectively evaluated 26 consecutive patients who developed a surgical site infection between February 2013 and April 2014. On the same day, patients were seen in the Plastic Surgery and Infectious Diseases clinics, underwent breast ultrasonography with or without periprosthetic fluid aspiration, and were prescribed a standardized empiric oral or intravenous antimicrobial regimen active against biofilm-embedded microorganisms. All patients were managed as per our established treatment algorithm and were followed up for a minimum of 1 year. Results: TEs were salvaged in 19 of 26 patients (73%). Compared with TE-salvaged patients, TE-explanted patients had a shorter median time to infection (20 vs 40 days; P = 0.09), a significantly higher median temperature at initial presentation [99.8°F; interquartile range (IQR) = 2.1 vs 98.3°F; IQR = 0.4°F; P = 0.01], and a significantly longer median antimicrobial treatment duration (28 days; IQR = 27 vs 21 days; IQR = 14 days; P = 0.05). The TE salvage rates of patients whose specimen cultures yielded no microbial growth, Staphylococcus species, and Pseudomonas were 92%, 75%, and 0%, respectively. Patients who had developed a deep-seated pocket infection were significantly more likely than those with superficial cellulitis to undergo TE explantation (P = 0.021). Conclusions: Our same-day multidisciplinary diagnostic and treatment algorithm not only yielded a TE salvage rate higher than those previously reported but also decreased the rate of hospitalization, decreased

  18. Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis.

    PubMed

    Jiménez-Almonacid, Pedro; Gruss, Enrique; Jiménez-Toscano, Marta; Lasala, Manuel; Rueda, José A; Vega, Laura; Rodríguez, Gil; de La Cruz, Raúl; Pardo, Mar; Fernández, Beatriz; López, Paula; Martín-Cavana, Jaime; Quintáns, Antonio

    2013-01-01

    Top analize the clinic results of the implantation of a multidisciplinary protocol to maintain permeability of the arteriovenous hemodialysis grafts (AVG). Prospective recording of all interventions (radiological and surgical) on AVG dysfunction in the 1999-2007 period. The AVG stenosis were always treated by percutaneous angioplasty (PA) except stenosis recurrence in less than three months or persistence after PA. The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary. Complications, primary and secondary AVG patency were reviewed. Ninety six dysfunction AVG were collected for study. All of them were 6x40 mm standard wall PTFE (Gore-Tex®). Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration. During the study, 52 PTFE bridges, 109 surgical thrombectomies, 131 PA, and 15 stents were needed to maintain FAVP permeability. Primay patency was 73.68%, 60.21% and 37.52% at one, two and three years respectively. Secondary patency was 89.49%, 84.07% and 66.84% at one, two and three years respectively. We avoid a central venous catheter (CVC) in the 80% of intervention for thrombosis dysfunction. No surgical or radiological related deaths occurred. Median hospital admission related with AVG thrombosis was 0.03/patient/year. The application of a combined protocol for the treatment of AVG dysfunction and thrombosis, according to DOQI recomendations obtains good results in AVG patency in our experience.

  19. Multidisciplinary approaches to understanding collective cell migration in developmental biology

    PubMed Central

    Schumacher, Linus J.; Kulesa, Paul M.; McLennan, Rebecca; Baker, Ruth E.; Maini, Philip K.

    2016-01-01

    Mathematical models are becoming increasingly integrated with experimental efforts in the study of biological systems. Collective cell migration in developmental biology is a particularly fruitful application area for the development of theoretical models to predict the behaviour of complex multicellular systems with many interacting parts. In this context, mathematical models provide a tool to assess the consistency of experimental observations with testable mechanistic hypotheses. In this review, we showcase examples from recent years of multidisciplinary investigations of neural crest cell migration. The neural crest model system has been used to study how collective migration of cell populations is shaped by cell–cell interactions, cell–environmental interactions and heterogeneity between cells. The wide range of emergent behaviours exhibited by neural crest cells in different embryonal locations and in different organisms helps us chart out the spectrum of collective cell migration. At the same time, this diversity in migratory characteristics highlights the need to reconcile or unify the array of currently hypothesized mechanisms through the next generation of experimental data and generalized theoretical descriptions. PMID:27278647

  20. A multidisciplinary approach to information and critical appraisal instruction.

    PubMed Central

    Dorsch, J L; Frasca, M A; Wilson, M L; Tomsic, M L

    1990-01-01

    The formulation of clinical decisions based on evidence requires the ability to locate information and evaluate it critically. A ten-week critical appraisal course for third-year medical students, taught cooperatively by library and Department of Medicine faculty, integrates education in the selection, evaluation, and application of information to patient care. The course is distinctive in that information management skills are taught by a multidisciplinary team in a problem-based format as part of the compulsory medical curriculum. Medical faculty provided instruction in reading and evaluating research methodology, as well as statistical analyses in published reports, using clinical scenarios and related journal articles at weekly sessions. Library faculty provided instruction in locating pertinent research on a sample clinical problem using standard printed and computerized indexes and local library resources, and presented criteria for selecting the most useful and significant works from those retrieved. Library faculty also met individually with students to provide instruction in online literature searching. Based on formal evaluation and informal feedback, the course was well received; it effectively presents the literature search as an integral part of critical appraisal of the medical literature and of the clinical decision-making process. PMID:2295011

  1. Multidisciplinary approach to converting power chair into motorized prone cart.

    PubMed

    Brose, Steven W; Wali, Eisha

    2014-01-01

    Pressure ulcers remain a major source of morbidity and mortality in veterans with neurologic impairment. Management of pressure ulcers typically involves pressure relief over skin regions containing wounds, but this can lead to loss of mobility and independence when the wounds are located in regions that receive pressure from sitting. An innovative, low-cost, multidisciplinary effort was undertaken to maximize quality of life in a veteran with a thoracic-4 level complete spinal cord injury and a stage 4 ischial wound. The person's power wheelchair was converted into a motorized prone cart, allowing navigation of the Department of Veterans Affairs spinal cord injury hospital ward and improved socialization while relieving pressure on the wound. Physical and occupational therapy assisted with the reconfiguration of the power chair and verified safe transfers into the chair and driving of the device. Psychology verified positive psychosocial benefit, while nursing and physician services verified an absence of unwanted pain or skin injury resulting from use of the device. Further investigation of ways to apply this technique is warranted to improve the quality of life of persons with pressure ulcers.

  2. The identification of a dismembered human body: a multidisciplinary approach.

    PubMed

    Bilge, Yaşar; Kedici, P Sema; Alakoç, Yeşim Dogan; Ulküer, K Uner; Ilkyaz, Yücel Y

    2003-11-26

    A criminal case was directed to a multidisciplinary forensic team for identification, concerning a victim whose head, having two gunshot wounds, had been separated by a sharp instrument and was recovered 6 months later. The purpose of this research was to determine the sex and age of the victim for human identification. Primarily, macroscopic examination of the skull, tooth, and DNA analysis was conducted for sex determination. A rough assessment of age was made from the skull based on anthropological findings, however a more definitive result of age estimation was determined utilizing dental morphology. The dental data showed an age range of 32-37 from the mineral examination and the formulation of microscopic measurements. The results obtained from the skull and dental analysis matched with the physical characteristics of the victim's body, the known personal data of this person, and with the superposition of the photos gathered by a formal request. Besides, the result of DNA profiling of the victim showed male gender and direct relationship with the victim's presumed wife and daughter. Generally, research on human identification consists of sex and age determination. The sex characteristics can be precisely proved from DNA tests. However, age can be estimated by skeletal, and dental analysis. In this case the performed sex and age analysis lead the research to the selective matching of the missing person's identity.

  3. Locally advanced rectal cancer: The importance of a multidisciplinary approach

    PubMed Central

    Berardi, Rossana; Maccaroni, Elena; Onofri, Azzurra; Morgese, Francesca; Torniai, Mariangela; Tiberi, Michela; Ferrini, Consuelo; Cascinu, Stefano

    2014-01-01

    Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens. PMID:25516638

  4. Multidisciplinary approaches to understanding collective cell migration in developmental biology.

    PubMed

    Schumacher, Linus J; Kulesa, Paul M; McLennan, Rebecca; Baker, Ruth E; Maini, Philip K

    2016-06-01

    Mathematical models are becoming increasingly integrated with experimental efforts in the study of biological systems. Collective cell migration in developmental biology is a particularly fruitful application area for the development of theoretical models to predict the behaviour of complex multicellular systems with many interacting parts. In this context, mathematical models provide a tool to assess the consistency of experimental observations with testable mechanistic hypotheses. In this review, we showcase examples from recent years of multidisciplinary investigations of neural crest cell migration. The neural crest model system has been used to study how collective migration of cell populations is shaped by cell-cell interactions, cell-environmental interactions and heterogeneity between cells. The wide range of emergent behaviours exhibited by neural crest cells in different embryonal locations and in different organisms helps us chart out the spectrum of collective cell migration. At the same time, this diversity in migratory characteristics highlights the need to reconcile or unify the array of currently hypothesized mechanisms through the next generation of experimental data and generalized theoretical descriptions.

  5. [Sensory functions and Alzheimer's disease: a multi-disciplinary approach].

    PubMed

    Kenigsberg, Paul-Ariel; Aquino, Jean-Pierre; Berard, Alain; Boucart, Muriel; Bouccara, Didier; Brand, Gérard; Charras, Kevin; Garcia-Larrea, Luis; Gzil, Fabrice; Krolak-Salmon, Pierre; Madjlessi, Arach; Malaquin-Pavan, Évelyne; Penicaud, Luc; Platel, Hervé; Pozzo, Thierry; Reintjens, Christophe; Salmon, Éric; Vergnon, Laurent; Robert, Philippe

    2015-09-01

    Relations between sensory functions and Alzheimer's disease are still under-explored. To understand them better, the Fondation Médéric Alzheimer has brought together a multi-disciplinary expert group. Aristote's five senses must be enhanced by today's knowledge of proprioception, motor cognition and pain perception. When cognition breaks down, the person with dementia perceives the world around her with her sensory experience, yet is unable to integrate all this information to understand the context. The treatment of multiple sensory inputs by the brain is closely linked to cognitive processes. Sensory deficits reduce considerably the autonomy of people with dementia in their daily life and their relations with others, increase their social isolation and the risk of accidents. Professionals involved with neurodegenerative diseases remain poorly aware of sensory deficits, which can bias the results of cognitive tests. However, there are simple tools to detect these deficits, notably for vision, hearing and balance disorders, which can be corrected. Many interventions for cognitive rehabilitation or quality of life improvement are based on sensory functions. The environment of people with dementia must be adapted to become understandable, comfortable, safe and eventually therapeutic.

  6. Locally advanced rectal cancer: the importance of a multidisciplinary approach.

    PubMed

    Berardi, Rossana; Maccaroni, Elena; Onofri, Azzurra; Morgese, Francesca; Torniai, Mariangela; Tiberi, Michela; Ferrini, Consuelo; Cascinu, Stefano

    2014-12-14

    Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.

  7. RESTORING SUBURBAN WATERSHEDS USING A MULTIDISCIPLINARY APPROACH TO STORMWATER MANAGEMENT

    EPA Science Inventory

    In mixed-use, suburban watersheds, stormwater runoff from impervious surfaces on both public and private property impairs stream ecosystems. Decentralized stormwater management, which distributes stormwater infiltration and retention devices throughout watersheds, is more effect...

  8. RESTORING SUBURBAN WATERSHEDS USING A MULTIDISCIPLINARY APPROACH TO STORMWATER MANAGEMENT

    EPA Science Inventory

    In mixed-use, suburban watersheds, stormwater runoff from impervious surfaces on both public and private property impairs stream ecosystems. Decentralized stormwater management, which distributes stormwater infiltration and retention devices throughout watersheds, is more effect...

  9. A multidisciplinary team approach minimises prophylactic mastectomy rates.

    PubMed

    Leff, D R; Ho, C; Thomas, H; Daniels, R; Side, L; Lambert, F; Knight, J; Griffiths, M; Banwell, M; Aitken, J; Clayton, G; Dua, S; Shaw, A; Smith, S; Ramakrishnan, V

    2015-08-01

    Prophylactic mastectomy (PM) has become increasingly common but is not without complications especially if accompanied by reconstructive surgery. In patients with sporadic unilateral breast cancer, contralateral PM offers no survival advantage. Multidisciplinary team (MDT) communication and interaction may facilitate shared decision-making and curtail PM rates. The aim of this study was investigate the effect of a regional MDT meeting on PM decision-making. We conducted an observational study involving retrospective review of prospectively recorded MDT meeting records for a 151 patient requests for PM from 2011 to 2014. Final MDT decisions were recorded as PM 'accepted', 'declined' or 'pending'. For MDT sanctioned requests, the factors justifying PM were recorded. Where PM was declined, justification for MDT refusal was sought and recorded. Approximately half of all requests for PM have been upheld (53.0%) and 1/3 of requests have been declined (32.5%). Of those declined, low risk of contralateral breast cancer versus relatively high risk of systemic relapse were commonly cited as justification for PM refusal (45.7%). A proportion of patients who initiated PM discussion subsequently changed their minds (19.6%), or failed to attend clinic appointments (6.5%). Some patients were deemed medically unfit for complex reconstructive surgery (13%), or were declined on the basis of an apparent cosmetic drive for surgery (6.5%), concerns regarding depression or anxiety (2.2%) and/or if family history could not be substantiated (6.5%). MDT meetings facilitate cross-specialty interrogation of requests for PM, minimise unnecessary surgery and restrict PM to those likely to derive maximum benefit. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Multidisciplinary research in public health: a case study of research on access to green space.

    PubMed

    Kessel, A; Green, J; Pinder, R; Wilkinson, P; Grundy, C; Lachowycz, K

    2009-01-01

    perceptions and understandings of what is being accessed and how it should be used. This study has also illustrated the ways in which multiple methods can be integrated in public health research, and the merits of different approaches to undertaking multidisciplinary work of this type.

  11. OTHER: A multidisciplinary approach to the search for other inhabited worlds

    NASA Astrophysics Data System (ADS)

    Funes, J.; Lares, M.; De los Rios, M.; Martiarena, M.; Ahumada, A. V.

    2017-10-01

    We present project OTHER (Otros mundos, tierra, humanidad, and espacio remoto), a multidisciplinary laboratory of ideas, that addresses questions related to the scientific search for extraterrestrial intelligent life such as: what is life? how did it originate? what might be the criteria that we adopt to identify what we might call an extraterrestrial civilization? As a starting point, we consider the Drake equation which offers a platform from which to address these questions in a multidisciplinary approach. As part of the project OTHER, we propose to develop and explain the last two parameters of the Drake equation that we call the cultural factors: the fraction of intelligent civilizations that want or seek to communicate , and the average life time of the same, . The innovation of the project OTHER is the multidisciplinary approach in the context of the Argentine community. Our goal is to provide new ideas that could offer new perspectives on the old question: Are we alone?

  12. The Multi-Disciplinary Approach in History and Ethnic Studies.

    ERIC Educational Resources Information Center

    Balogh, Sandor

    1980-01-01

    Considers the fractionalization of the social science disciplines indicating that this clear delineation of intellectual territory is important to research, but that in information assimilation and dissemination an interdisciplinary approach is more appropriate. Recommends two approaches to interdisciplinary studies based around history and ethnic…

  13. Saving Lives through visual health communication: a multidisciplinary team approach.

    PubMed

    Wressell, Adrian; Twaites, Heidi; Taylor, Stephen; Hartland, Dan; Gove-Humphries, Theo

    2014-10-01

    Saving Lives is a public health awareness charity that aims to educate the UK public about HIV and encourage testing for the virus. In May 2011 Saving Lives contacted the Medical Illustration department at Heart of England NHS Foundation Trust to discuss the idea of working together to develop a national HIV awareness campaign. A number of local sporting celebrities were invited to a studio photography session. All the sports stars and celebrities were photographed on a Mamiya 645 AFDII camera, with PhaseOne P30 + digital back, using prime 35 mm, 55 mm and 80 mm lenses. During the photography sessions, the team's film maker captured video footage of the subjects being photographed. Once the final avengers' graphical composition had been created, it was applied to the posters, billboards and public transport signs for the campaign. In the three-month period following the campaign launch, survey research was carried out, the initial data being recorded by a questionnaire which was provided to each of the 1800 patients attending the Heartlands Hospital sexual health clinic for HIV testing. Following the launch of the initial campaign, the Saving Lives team continues to produce material to assist in the promotion of the charity and its message. Its success has led to it becoming an on-going long-term project, and to date the team have photographed and filmed 33 sporting stars and visited numerous sporting institutes.

  14. Child Sexual Abuse and the Multidisciplinary Team Approach: Contradictions in Practice.

    ERIC Educational Resources Information Center

    Jacobson, Maxine

    2001-01-01

    Explores the ways in which shifting meanings of childhood and constructions of sexually abused children and the structuring of team practice pose problems for multidisciplinary team members. Argues that understanding child sexual abuse and developing community-based practice approaches must be informed by broader perspectives. Suggests a model of…

  15. The Development of a Multi-Disciplinary Educational Programme in Biomedical Diagnostics: A Novel Approach

    ERIC Educational Resources Information Center

    MacCormac, Aoife; O'Brien, Emma; O'Kennedy, Richard

    2011-01-01

    This paper describes the development of a taught Master's course in biomedical diagnostics using a novel multi-disciplinary approach. This course, the first of its kind in Ireland, covers the science and technology underlying the development of medical diagnostic devices that detect early markers of diseases such as cancer. The ethical impact of…

  16. The Development of a Multi-Disciplinary Educational Programme in Biomedical Diagnostics: A Novel Approach

    ERIC Educational Resources Information Center

    MacCormac, Aoife; O'Brien, Emma; O'Kennedy, Richard

    2011-01-01

    This paper describes the development of a taught Master's course in biomedical diagnostics using a novel multi-disciplinary approach. This course, the first of its kind in Ireland, covers the science and technology underlying the development of medical diagnostic devices that detect early markers of diseases such as cancer. The ethical impact of…

  17. Perspectives in the Education of Disadvantaged Children; A Multidisciplinary Approach.

    ERIC Educational Resources Information Center

    Cowles, Milly, Ed.

    A collection of original papers presents an interdisciplinary approach to the education of disadvantaged children. The volume, prepared especially for preservice and inservice teachers, is divided into three sections--poverty and its effects, the children of poverty, and educational implications. The first two parts deal with such areas as…

  18. Starting an ePortfolio: A Multi-Disciplinary Approach

    ERIC Educational Resources Information Center

    Zinger, Lana; Sinclair, Alicia

    2014-01-01

    ePortfolio integrates technology with a student's academic course work and have increasingly become an integral part of higher education curriculum. They allow students to showcase their academic work in a fresh way on a digital platform. Traditionally, however, ePortfolio is implemented from a single discipline approach. This project aimed to…

  19. Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management.

    PubMed

    Ellis, Michael J; Cordingley, Dean; Girardin, Richard; Ritchie, Lesley; Johnston, Janine

    The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

  20. Optimizing treatment for men with advanced prostate cancer: expert recommendations and the multidisciplinary approach.

    PubMed

    Fitzpatrick, John M; Anderson, John; Sternberg, Cora N; Fleshner, Neil; Fizazi, Karim; Rébillard, Xavier; Dogliotti, Luigi; Conti, Giario; Turesson, Ingela; James, Nicholas; Heidenreich, Axel; Solsona, Eduardo; Guillem, Vicente; Herchenhorn, Daniel; Moul, Judd; van Moorselaar, Jeroen; Coetzee, Lance J E; Wilson, Andrew; Bamias, Aristotelis; De Wit, Ronald; Chrisofos, Michael

    2008-10-01

    A multidisciplinary panel of 20 international experts, including urologists, radiation oncologists, and medical oncologists, convened during the Advanced Prostate Cancer Multidisciplinary Team meeting in Rome, Italy, in January 2007, to discuss the multidisciplinary team approach and current patterns of care for patients with hormone-refractory prostate cancer (HRPC). During the meeting, the experts discussed several definitions currently used in prostate cancer management, including those for senior adult patients. In addition, the panel reviewed a series of patient case studies in order to provide feedback on current treatment practices and to identify possible strategies for best practice. It was stressed that treatment decisions for senior adult patients should not be based solely on patient age. Additionally, although historically treatment decisions for advanced prostate cancer have focused on palliative care, given the survival benefit associated with docetaxel-based chemotherapy across patient subgroups, more men are likely to be offered chemotherapy for advanced-stage disease in the future.

  1. A multidisciplinary approach to optimization of controlled space structures

    NASA Technical Reports Server (NTRS)

    Woodard, Stanley E.; Padula, Sharon L.; Graves, Philip C.; James, Benjamin B.

    1990-01-01

    A fundamental problem facing controls-structures analysts is a means of determining the trade-offs between structural design parameters and control design parameters in meeting some particular performance criteria. Developing a general optimization-based design methodology integrating the disciplines of structural dynamics and controls is a logical approach. The objective of this study is to develop such a method. Classical design methodology involves three phases. The first is structural optimization, wherein structural member sizes are varied to minimize structural mass, subject to open-loop frequency constraints. The next phase integrates control and structure design with control gains as additional design variables. The final phase is analysis of the 'optimal' integrated design phase considering 'real' actuators and 'standard' member sizes. The control gains could be further optimized for fixed structure, and actuator saturation constraints could be imposed. However, such an approach does not take full advantage of opportunities to tailor the structure and control system design as one system.

  2. Preventing chronic obstructive pulmonary disease: a multidisciplinary approach.

    PubMed

    Aronovitch, M; Groszman, M

    1980-10-01

    Chemoprophylaxis, combined with prolonged treatment of bronchospasm, in patients with incipient or minimal obstructive chest disease has shown promising results in 30 patients. Physicians should include in their regular examination some means of early detection for chronic obstructive pulmonary diseases and in suitable cases institute chemoprophylaxis during the winter, as well as preventive vaccinations. In addition, longterm treatment of bronchial problems should be continued. This combined approach will help prevent recurrent infections which accelerate the progress of chronic obstructive chest disease.

  3. Bridging Disparity: A Multidisciplinary Approach for Influenza Vaccination in an American Indian Community

    PubMed Central

    Traeger, Marc; Thompson, Alette; Dickson, Elizabeth; Provencio, Augustine

    2006-01-01

    Objectives. The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influenza vaccination campaign during the 2002–2003 influenza season to bridge the vaccination gap between American Indians and Alaska Natives and the US population as a whole. Methods. In our vaccination program, we used a multidisciplinary approach that included staff and community education, standing orders, vaccination of hospitalized patients, and employee, outpatient, community, and home vaccinations without financial barriers. Results. WRSU influenza vaccination coverage rates among persons aged 65 years and older, those aged 50 to 64 years, and those with diabetes were 71.8%, 49.6%, and 70.2%, respectively, during the 2002–2003 influenza season. We administered most vaccinations to persons aged 65 years and older through the outpatient clinics (63.6%) and public health nurses (30.0%). The WRSU employee influenza vaccination rate was 72.8%. Conclusions. We achieved influenza vaccination rates in targeted groups of an American Indian population that are comparable to or higher than rates in other US populations. Our system may be a useful model for other facilities attempting to bridge disparity for influenza vaccination. PMID:16571714

  4. Consumer trust in food safety--a multidisciplinary approach and empirical evidence from Taiwan.

    PubMed

    Chen, Mei-Fang

    2008-12-01

    Food scandals that happened in recent years have increased consumers' risk perceptions of foods and decreased their trust in food safety. A better understanding of the consumer trust in food safety can improve the effectiveness of public policy and allow the development of the best practice in risk communication. This study proposes a research framework from a psychometric approach to investigate the relationships between the consumer's trust in food safety and the antecedents of risk perceptions of foods based on a reflexive modernization perspective and a cultural theory perspective in the hope of benefiting the future empirical study. The empirical results from a structural equation modeling analysis of Taiwan as a case in point reveal that this research framework based on a multidisciplinary perspective can be a valuable tool for a growing understanding of consumer trust in food safety. The antecedents in the psychometric research framework comprised reflexive modernization factors and cultural theory factors have all been supported in this study except the consumer's perception of pessimism toward food. Moreover, the empirical results of repeated measures analysis of variance give more detailed information to grasp empirical implications and to provide some suggestions to the actors and institutions involved in the food supply chain in Taiwan.

  5. Escherichia coli diseases in Latin America-a 'One Health' multidisciplinary approach.

    PubMed

    Torres, Alfredo G

    2017-03-01

    The emergence and evolution of pathogenic Escherichia coli strains associated with animal and human infections continues being a topic of active investigation in recent years. Latin America has responded to this thread establishing the Latin American Coalition for Escherichia coli Research (LACER), a multidisciplinary group of scientists applying principles of the One Health initiative. LACER is integrating animal, human and environmental health for the mutual benefit of all, while reducing the impact of human disease. Here, I depict the usefulness of this approach by providing three examples from several priority areas in E. coli research and comparing them to the activities performed by LACER, which are enhancing collaborative efforts in biomedical research and providing a translational platform to connect with epidemiological studies and public health policy makers. The manuscript concludes with a brief historical description regarding the establishment of LACER, emphasizing the importance of collaboration between health professionals of different international organizations and not only across one specific country, to effectively combat current and future E. coli infections. The benefits of utilizing 'One Health' concepts in the establishment of LACER should encourage other professionals studying zoonotic or environmentally acquired human infections to implement effective international collaborations to combat common problems. © FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. A multi-disciplinary approach to congenitally missing anterior teeth.

    PubMed

    Galler, David; Quiong, Caroline; Galler, Jeffrey

    2009-01-01

    Congenitally missing teeth are not an unusual occurrence. What makes this case study unique is the combination of restorative challenges offered. The patient presented with the permanent upper right cuspid and lower anterior right and left central incisors congenitally missing, and with an underdeveloped upper right lateral incisor. Distinctive existing occlusion and tooth alignment difficulties precluded a simple approach of merely extracting the residual primary teeth and replacing the missing teeth prosthetically. Using orthodontics to create ideal interocclusal and interarch space was critical in preparing this case for prosthetic restoration.

  7. Teaching science and ethics to undergraduates: a multidisciplinary approach.

    PubMed

    McGowan, Alan H

    2013-06-01

    The teaching of the ethical implications of scientific advances in science courses for undergraduates has significant advantages for both science and non-science majors. The article describes three courses taught by the author as examples of the concept, and examines the disadvantages as well as the advantages. A significant advantage of this approach is that many students take the courses primarily because of the ethical component who would not otherwise take science. A disadvantage is less time in the course for the science; arguably, this is outweighed by the greater retention of the science when it is put into context.

  8. Multidisciplinary Design Optimization Under Uncertainty: An Information Model Approach (PREPRINT)

    DTIC Science & Technology

    2011-03-01

    and c ∈ R, which is easily solved using the MatLab function fmincon. The reader is cautioned not to optimize over (t, p, c). Our approach requires a...would have to be expanded. The fifteen formulas can serve as the basis for numerical simulations, an easy task using MatLab . 5.3 Simulation of the higher...Design 130, 2008, 081402-1 – 081402-12. [32] M. Loève, ” Fonctions aléatoires du second ordre,” Suplement to P. Lévy, Pro- cessus Stochastiques et

  9. Overcoming obstacles to establish a multidisciplinary team approach to hepatobiliary diseases: a working model in a Caribbean setting.

    PubMed

    Cawich, Shamir O; Johnson, Peter B; Shah, Sundeep; Roberts, Patrick; Arthurs, Milton; Murphy, Trevor; Bonadie, Kimon O; Crandon, Ivor W; Harding, Hyacinth E; Abu Hilal, Mohammed; Pearce, Neil W

    2014-01-01

    By providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes. This discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles. Despite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

  10. A multidisciplinary approach to scars: a narrative review

    PubMed Central

    Zanier, Emiliano; Bordoni, Bruno

    2015-01-01

    The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm – both manual and psychophysical relaxing techniques – and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines. PMID:26316774

  11. A multidisciplinary approach to scars: a narrative review.

    PubMed

    Zanier, Emiliano; Bordoni, Bruno

    2015-01-01

    The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm - both manual and psychophysical relaxing techniques - and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines.

  12. A Multidisciplinary Approach to Castleman Disease of the Neck.

    PubMed

    Shams, Alexandra A; Ahmed, Mostafa M; Scalzitti, Nicholas J; Howell, Della L; Hall, Jordan M; Ritter, John L; Maturo, Stephen C

    2016-02-01

    Castleman disease (CD) is a rare lymphoproliferative disorder that occurs in adults and rarely in the pediatric population. The disease is characterized by slowly enlarging masses that can form anywhere within the lymphatic system. It is an uncommon cause of a neck mass in both children and adults that presents insidiously and nonspecifically. A 21-year-old woman was referred to the otolaryngology service because of an asymptomatic neck mass found incidentally on computed tomographic imaging 15 months earlier. On repeat imaging, the lesion was characterized as a homogenously enhancing soft tissue mass and appeared stable in size compared with previous studies. Given the nondiagnostic radiologic features, tissue sampling was pursued, first using fine-needle aspiration and ultimately excisional biopsy. The excision revealed histopathology consistent with unicentric, hyaline-vascular CD. Excision is the gold standard for treatment of this variant of CD. The patient was referred to the hematology/oncology service but was subsequently lost to follow-up. This case illustrates a rare cause of a neck mass in a young adult and exemplifies the extremely broad differential in this setting. In addition, it highlights the importance of a systematic and thorough approach to diagnosing neck masses in children and adults.

  13. Health care multidisciplinary teams: The sociotechnical approach for an integrated system-wide perspective.

    PubMed

    Marsilio, Marta; Torbica, Aleksandra; Villa, Stefano

    The current literature on the enabling conditions of multidisciplinary teams focuses on the singular dimensions of the organizations (i.e., human resources, clinical pathways, objects) without shedding light on to the way in which these organizational factors interact and mutually influence one another. Drawing on a system perspective of organizations, the authors analyze the organizational patterns that promote and support multidisciplinary teams and how they interrelate and interact to enforce the organization work system. The authors develop a modified sociotechnical system (STS) model to understand how the two dimensions of technical (devices/tools, layout/organization of space, core process standardization) and social (organizational structure, management of human resources and operations) can facilitate the implementation of multidisciplinary teams in health care. The study conducts an empirical analysis based on a sample of hospital adopters of transcatheter aortic valve implantation using the revised STS model. The modified STS model applied to the case studies improves our understanding of the critical implementation factors of a multidisciplinary approach and the importance of coordinating radical changes in the technical and the social subsystems of health care organizations. The analysis informs that the multidisciplinary effort is not a sequential process and that the interplay between the two subsystems needs to be managed efficaciously as an integrated organizational whole to deliver the goals set. Hospital managers must place equal focus on the closely interrelated technical and social dimensions by investing in (a) shared layouts and spaces that cross the boundaries of the specialized health care units, (b) standardization of the core processes through the implementation of local clinical pathways, (c) structured knowledge management mechanisms, (d) the creation of clinical directorates, and (e) the design of a planning and budgeting system that

  14. A multidisciplinary approach to overreaching detection in endurance trained athletes.

    PubMed

    Le Meur, Yann; Hausswirth, Christophe; Natta, Françoise; Couturier, Antoine; Bignet, Frank; Vidal, Pierre Paul

    2013-02-01

    In sport, high training load required to reach peak performance pushes human adaptation to their limits. In that process, athletes may experience general fatigue, impaired performance, and may be identified as overreached (OR). When this state lasts for several months, an overtraining syndrome is diagnosed (OT). Until now, no variable per se can detect OR, a requirement to prevent the transition from OR to OT. It encouraged us to further investigate OR using a multivariate approach, including physiological, biomechanical, cognitive, and perceptive monitoring. Twenty-four highly trained triathletes were separated into an overload group and a normo-trained group (NT) during 3 wk of training. Given the decrement of their running performance, 11 triathletes were diagnosed as OR after this period. A discriminant analysis showed that the changes of eight parameters measured during a maximal incremental test could explain 98.2% of the OR state (lactatemia, heart rate, biomechanical parameters and effort perception). Variations in heart rate and lactatemia were the two most discriminating factors. When the multifactorial analysis was restricted to these variables, the classification score reached 89.5%. Catecholamines and creatine kinase concentrations at rest did not change significantly in both groups. Running pattern was preserved and cognitive performance decrement was observed only at exhaustion in OR subjects. This study showed that monitoring various variables is required to prevent the transition between NT and OR. It emphasized that an OR index, which combines heart rate and blood lactate concentration changes after a strenuous training period, could be helpful to routinely detect OR.

  15. A Multidisciplinary Approach to High Throughput Nuclear Magnetic Resonance Spectroscopy

    PubMed Central

    Pourmodheji, Hossein; Ghafar-Zadeh, Ebrahim; Magierowski, Sebastian

    2016-01-01

    Nuclear Magnetic Resonance (NMR) is a non-contact, powerful structure-elucidation technique for biochemical analysis. NMR spectroscopy is used extensively in a variety of life science applications including drug discovery. However, existing NMR technology is limited in that it cannot run a large number of experiments simultaneously in one unit. Recent advances in micro-fabrication technologies have attracted the attention of researchers to overcome these limitations and significantly accelerate the drug discovery process by developing the next generation of high-throughput NMR spectrometers using Complementary Metal Oxide Semiconductor (CMOS). In this paper, we examine this paradigm shift and explore new design strategies for the development of the next generation of high-throughput NMR spectrometers using CMOS technology. A CMOS NMR system consists of an array of high sensitivity micro-coils integrated with interfacing radio-frequency circuits on the same chip. Herein, we first discuss the key challenges and recent advances in the field of CMOS NMR technology, and then a new design strategy is put forward for the design and implementation of highly sensitive and high-throughput CMOS NMR spectrometers. We thereafter discuss the functionality and applicability of the proposed techniques by demonstrating the results. For microelectronic researchers starting to work in the field of CMOS NMR technology, this paper serves as a tutorial with comprehensive review of state-of-the-art technologies and their performance levels. Based on these levels, the CMOS NMR approach offers unique advantages for high resolution, time-sensitive and high-throughput bimolecular analysis required in a variety of life science applications including drug discovery. PMID:27294925

  16. A Multidisciplinary Approach to High Throughput Nuclear Magnetic Resonance Spectroscopy.

    PubMed

    Pourmodheji, Hossein; Ghafar-Zadeh, Ebrahim; Magierowski, Sebastian

    2016-06-09

    Nuclear Magnetic Resonance (NMR) is a non-contact, powerful structure-elucidation technique for biochemical analysis. NMR spectroscopy is used extensively in a variety of life science applications including drug discovery. However, existing NMR technology is limited in that it cannot run a large number of experiments simultaneously in one unit. Recent advances in micro-fabrication technologies have attracted the attention of researchers to overcome these limitations and significantly accelerate the drug discovery process by developing the next generation of high-throughput NMR spectrometers using Complementary Metal Oxide Semiconductor (CMOS). In this paper, we examine this paradigm shift and explore new design strategies for the development of the next generation of high-throughput NMR spectrometers using CMOS technology. A CMOS NMR system consists of an array of high sensitivity micro-coils integrated with interfacing radio-frequency circuits on the same chip. Herein, we first discuss the key challenges and recent advances in the field of CMOS NMR technology, and then a new design strategy is put forward for the design and implementation of highly sensitive and high-throughput CMOS NMR spectrometers. We thereafter discuss the functionality and applicability of the proposed techniques by demonstrating the results. For microelectronic researchers starting to work in the field of CMOS NMR technology, this paper serves as a tutorial with comprehensive review of state-of-the-art technologies and their performance levels. Based on these levels, the CMOS NMR approach offers unique advantages for high resolution, time-sensitive and high-throughput bimolecular analysis required in a variety of life science applications including drug discovery.

  17. Controlling rabies through a multidisciplinary, public health system in Trujillo, La Libertad, Peru.

    PubMed

    Seneschall, Charlotte; Luna-Farro, Maria

    2013-10-01

    Rabies remains endemic in Peru. In 1983, Latin America and the Caribbean promised to eliminate canine-transmitted rabies from the continent. This led to Peru introducing a multidisciplinary public health system for controlling and managing rabies across the country. The system consists of mass canine vaccination campaigns, post exposure prophylaxis and monitoring aggressor animals for signs of rabies. The Peruvian city of Trujillo, La Libertad, is an urban area where dogs are the principal reservoir for rabies. The disease burden of rabies in Trujillo, La Libertad is currently minimal, with no rabies cases in humans for over 10 years, and only three canine cases. No human deaths due to rabies have occurred for several decades. From this it can be inferred that antirabies systems such as this do have real effects in reducing cases of human rabies at a grass roots level.

  18. Controlling rabies through a multidisciplinary, public health system in Trujillo, La Libertad, Peru

    PubMed Central

    Seneschall, Charlotte; Luna-Farro, Maria

    2013-01-01

    Rabies remains endemic in Peru. In 1983, Latin America and the Caribbean promised to eliminate canine-transmitted rabies from the continent. This led to Peru introducing a multidisciplinary public health system for controlling and managing rabies across the country. The system consists of mass canine vaccination campaigns, post exposure prophylaxis and monitoring aggressor animals for signs of rabies. The Peruvian city of Trujillo, La Libertad, is an urban area where dogs are the principal reservoir for rabies. The disease burden of rabies in Trujillo, La Libertad is currently minimal, with no rabies cases in humans for over 10 years, and only three canine cases. No human deaths due to rabies have occurred for several decades. From this it can be inferred that antirabies systems such as this do have real effects in reducing cases of human rabies at a grass roots level. PMID:24392679

  19. The role of the Faculty of Public Health (Medicine) in developing a multidisciplinary public health profession in the UK.

    PubMed

    Griffiths, Sian; Crown, June; McEwen, Jim

    2007-06-01

    The Faculty of Public Health (FPH) started out its life as the Faculty of Community Medicine. Its initial membership was drawn from the ranks of Medical Officers of Health (MOsH), medical administrators and consultants working in communicable disease. Born under the aegis of the three Royal Colleges of Physicians, it was de facto for members of the medical profession. This was despite the intention of some of the prime movers in its creation that its membership should reflect the multidisciplinary nature of specialist public health. As such, whilst the Faculty's establishment was indeed a triumph, the triumph was only partial, since many senior public health professionals were precluded from full membership. Over the years this situation has changed, but the road to the Faculty's current open policy, based on achieving public health excellence rather than holding a professional badge, has not been a smooth one. The fears of many medical members that the specialty would be down graded through opening up its membership posed successive presidents with many, often justifiable, challenges. In this article we, former presidents, reflect on the key events during our successive tenures.

  20. Multidisciplinary approach to evaluating welfare of veal calves in commercial facilities.

    PubMed

    Stull, C L; McDonough, S P

    1994-09-01

    Due to pending legislation and public concerns, a multidisciplinary approach was designed to investigate the welfare of special-fed veal calves in commercial veal facilities. Concerns included housing conditions, dietary regimens, management practices, and behavioral aspects imposed on special-fed calves. Four categories of parameters including environment and housing, nutrition, health and stress, and behavior provided a broad base of evaluating veal systems. Observations and samples were collected on 550 Holstein bull calves located in 10 commercial veal facilities. Each facility was visited to collect data during wk 0 (week of arrival of the calves), 2, 4, 8, 12, and 16. Nine facilities used individual stalls 48 to 55 cm in width with tethers attached to the front of the stalls. One facility housed 30 calves in group pens after obtaining calves at 8 wk of age. Ammonia, carbon monoxide, and hydrogen sulfide gas did not exceed the permissible limit for humans in any facility. All facilities exceeded the 2-foot-candle recommendation for lighting. The average daily gain of calves was .85 kg during wk 0 to 8 and 1.18 kg during wk 8 to 16. Dietary iron levels decreased from 209 ppm at wk 0 to 32 ppm at wk 16. At 16 wk, 25% of calves were marginally anemic and 10% clinically anemic. Overall mortality was 4.2%. Stress indices such as plasma cortisol concentrations or neutrophil to lymphocyte ratios declined as calves approached market weight. In either pens or stalls, calves spent approximately 25 and 75% of time in standing and lying positions, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. OECI accreditation at Veneto Institute of Oncology IOV -- IRCCS, general framework and multidisciplinary approach.

    PubMed

    Chiusole, Daniela; Cioffredi, Piero; Basso, Umberto; Bortolami, Alberto; Crivellari, Gino; Gennaro, Gisella; Spina, Romina; Opocher, Giuseppe

    2015-01-01

    The aim of this article is to describe the accreditation process of the Veneto Institute of Oncology (IOV-IRCCS) according to the Organisation of European Cancer Institutes (OECI) model, with particular reference to the standards for the multidisciplinary approach. Through the analysis of the process and the activities of each multidisciplinary team (MDT) and the development, at a regional level, of diagnostic, therapeutic, and care pathways (PDTA), all the necessary steps to meet the OECI standards have been determined. Adjustment is ongoing. We are working on the inclusion of the MDT registration forms in the electronic medical records and on the possibility to extend the OECI model to the MDT not based at IOV, but participated in by IOV professionals. The sarcoma MDT has achieved results demonstrating that the OECI framework has allowed the professionals involved in the multidisciplinary meeting to systematically share the clinical information of the patient, who can benefit from better continuity of care. The model has also provided greater clarity in the management of patients who are enrolled in clinical trials and deviate from Guide Lines (GL)/PDTA. The accreditation process according to the OECI model has added value to the IOV's already well-developed multidisciplinary activities.

  2. Seasonal hazards and health risks in lower-income countries: field testing a multi-disciplinary approach.

    PubMed

    Few, Roger; Lake, Iain; Hunter, Paul R; Tran, Pham Gia; Thien, Vu Trong

    2009-12-21

    Understanding how risks to human health change as a result of seasonal variations in environmental conditions is likely to become of increasing importance in the context of climatic change, especially in lower-income countries. A multi-disciplinary approach can be a useful tool for improving understanding, particularly in situations where existing data resources are limited but the environmental health implications of seasonal hazards may be high. This short article describes a multi-disciplinary approach combining analysis of changes in levels of environmental contamination, seasonal variations in disease incidence and a social scientific analysis of health behaviour. The methodology was field-tested in a peri-urban environment in the Mekong Delta, Vietnam, where poor households face alternate seasonal extremes in the local environment as the water level in the Delta changes from flood to dry season. Low-income households in the research sites rely on river water for domestic uses, including provision of drinking water, and it is commonly perceived that the seasonal changes alter risk from diarrhoeal diseases and other diseases associated with contamination of water. The discussion focuses on the implementation of the methodology in the field, and draws lessons from the research process that can help in refining and developing the approach for application in other locations where seasonal dynamics of disease risk may have important consequences for public health.

  3. A patient-centered network approach to multidisciplinary-guideline development: a process evaluation

    PubMed Central

    2014-01-01

    Background Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals’ experiences, and time invested. Methods The network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. The guideline development addressed patient-centered, organizational, and medical-technical key questions derived from interviews with patients and professionals. These questions were elaborated and distributed among the groups. We evaluated the project performance, participants’ perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key figures, and a written questionnaire survey among 35 participants. Results Within 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. The multidisciplinary guideline included recommendations for the main medical-technical matters and for organizational and patient-centered issues in clinical care pathways. The project was carried out as planned except for minor modifications and three extra consensus meetings. The participants were enthusiastic about the approach, the respect for autonomy, the project coordinator’s role, and patient

  4. A patient-centered network approach to multidisciplinary-guideline development: a process evaluation.

    PubMed

    Den Breejen, Elvira M E; Hilbink, Mirrian A H W; Nelen, Willianne L D M; Wiersma, Tjerk J; Burgers, Jako S; Kremer, Jan A M; Hermens, Rosella P M G

    2014-06-04

    Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals' experiences, and time invested. The network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. The guideline development addressed patient-centered, organizational, and medical-technical key questions derived from interviews with patients and professionals. These questions were elaborated and distributed among the groups. We evaluated the project performance, participants' perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key figures, and a written questionnaire survey among 35 participants. Within 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. The multidisciplinary guideline included recommendations for the main medical-technical matters and for organizational and patient-centered issues in clinical care pathways. The project was carried out as planned except for minor modifications and three extra consensus meetings. The participants were enthusiastic about the approach, the respect for autonomy, the project coordinator's role, and patient involvement. Suggestions for

  5. Multidisciplinary Treatment Approach in a Patient with History of Nasopharyngeal Carcinoma

    PubMed Central

    Yavuz, Atacan; Ağralı, Ömer Birkan; Çalışkan, Zeynep Lale; Türkaydın, Dilek; Sertgöz, Atilla; Doğan, Başak

    2014-01-01

    Radiotherapy in NPC patients has side effects on the dentition, which affects quality of life dramatically. This case report presents multidisciplinary dental treatment approach in a 17-year-old male patient with a history of nasopharyngeal carcinoma (NPC), which was treated with chemotherapy and radiotherapy. The adolescent patient applied to dental hospital 4 years after the radiotherapy with aesthetic and functional problems on dentition affecting psychological, social, and physical aspects of his life. The dentition of the patient demonstrated the severe destruction as a devastating side effect of radiotherapy. With a successful multidisciplinary approach, our patient's aesthetics, function, and self-confidence were obtained. Well-established procedures, which include preventative care and maintenance, can reduce the duration and expenses of the treatment and help in challenging the life-long complications of radiotherapy. PMID:24523971

  6. A multidisciplinary approach to providing care to adolescents with spinal cord trauma resulting from all-terrain vehicle accidents.

    PubMed

    Rhodes, Leslie N; Weatherford, Blakely; Locke, Lindsey N; Chung, Hoi Sing; Tidwell, Chrisla; Paton, Elizabeth; Lee, Shirleatha

    2015-01-01

    All-terrain vehicle accidents that affect the spine can lead to complex injuries in adolescents. This requires that many subspecialties work together on a multidisciplinary team to improve patient outcomes. Our case presentation will examine the multidisciplinary approach to care required for an 11-year-old adolescent involved in an all-terrain vehicle accident that resulted in traumatic spinal cord injury.

  7. Traditional or centralized models of diabetes care: the multidisciplinary diabetes team approach.

    PubMed

    Bratcher, Christina R; Bello, Elizabeth

    2011-11-01

    Specialized diabetes care (SDC) centers utilize a multidisciplinary diabetes team to provide patients with highly individualized care. Patients at SDC centers receive their integrated diabetes care in one place--the "one-stop" approach. The components of the SDC center model are: medical care; individualized diabetes education; nutrition; exercise and lifestyle coaching; counseling; monitoring of drug effects. This model results in improved patient outcomes and reduced overall costs.

  8. The effectiveness of a multidisciplinary, team-based approach to cesarean hysterectomy in modern obstetric practice.

    PubMed

    Gillespie, Caitlin; Sangi-Haghpeykar, Haleh; Munnur, Uma; Suresh, Maya S; Miller, Harold; Hawkins, Shannon M

    2017-04-01

    To examine the effectiveness of a multidisciplinary, team-based approach to management of cesarean hysterectomy. In a retrospective chart review, data were analyzed from a quality assurance database of hysterectomies performed after cesarean delivery at one institution in the USA. Patients were identified through billing codes for cesarean delivery, cross-referenced to codes for hysterectomy. Demographic, reproductive, and outcome data were compared before (2000-2005) and after (2011-2013) implementation of a multidisciplinary team-based protocol. Across the two study periods, 107 cesarean hysterectomies were identified (69 pre-implementation, 38 post-implementation). In univariate analysis, the post-implementation group had fewer days in surgical intensive care than did the pre-implementation group (0.21 ± 0.41 vs 1.04 ± 2.44 days; P=0.011), and a lower frequency of febrile morbidity (4 [11%] vs 22 [32%]; P=0.033]. In multivariate analysis with adjustment for potential confounders, the likelihood of postoperative febrile morbidity was higher during the pre-implementation than the post-implementation period (adjusted odds ratio 3.5, 95% confidence interval 1.09-13.65; P=0.048). Outcomes were improved after the multidisciplinary team-based approach to cesarean hysterectomy was implemented. Team-based approaches to care of women undergoing cesarean hysterectomy are important to improve outcomes. © 2017 International Federation of Gynecology and Obstetrics.

  9. [Overview on method and strategy of therapeutic material basis in traditional Chinese medicine by multidisciplinary approach].

    PubMed

    Li, Ya-mei; Du, Zhi-min

    2015-05-01

    Traditional Chinese medicine (TCM) has a good reputation for preventing or healing diseases in clinic due to its higher efficacy, minor toxicity and abundant resources. Screening bioactive components in TCMs is not only crucial for clarifying their action mechanisms, but also the basis of their safety and quality control. TCM is characterized by multiple components, multiple targets and multiple mechanisms, however the complex composition of TCM makes it difficult to study the therapeutic material basis which has become the bottleneck in the process of its modernization and internationalization. Recently, with the rapid development of modern technologies and the unceasing progress of various disciplines, multidisciplinary approach, such as analytical chemistry, chemistry of TCM, pharmacology, cell biology, systems biology and bioinformatics has been successfully applied to the study of TCM. Multidisciplinary approach realizes the communication and interaction of multi-discipline, and accelerates the research and development of TCM. This review summarizes the application of multidisciplinary approach which may have certain potential of bringing new thoughts to TCM research and provide references for screening and identification of therapeutic material basis of TCMs.

  10. Shades of Grey: The Need for a Multi-disciplinary Approach to Research Investigating Alcohol and Ageing

    PubMed Central

    Wilkinson, Celia; Dare, Julie

    2014-01-01

    This paper calls for an increase in multi-disciplinary research on the issue of alcohol and ageing, to ensure public health interventions reflect the complex and diverse needs of older drinkers. Older people (65+ years) represent a unique segment of the population; compared to adolescents and younger people, they are more likely to have a range of co-morbid conditions and be taking prescribed medication, and are more physiologically vulnerable to the effects of alcohol. This suggests that from a public health perspective, alcohol use by older people is problematic. However, as with younger people, alcohol use is closely associated with socialisation and social engagement. While social engagement is important at all stages of life, it is particularly critical as people age, when many of the formal social roles which provide a catalyst for social integration shift or are lost. Currently, however, there is little evidence of an integrated public health response to the complex issue of alcohol and ageing. That is, what is needed is a concurrent acknowledgement of the health problems that may be associated with contraindicated alcohol use, versus the potential health benefits that can accrue from social drinking. This will require a holistic rather than reductionist approach that integrates biomedical and social science insights to develop a more comprehensive and nuanced understanding of the implications of alcohol use amongst diverse populations of older people. Significance for public health With the rapid ageing of the global population and concerns about recent increases in the consumption of alcohol amongst older people, the issue of alcohol and ageing is becoming an important public health issue. However, there remains little research that adopts a holistic multi-disciplinary perspective. Such research is important and may offer the best way forward in terms of unravelling the complexity of competing risks and benefits associated with low to moderate drinking

  11. Multi-Disciplinary Approach to Trace Contamination of Streams and Beaches

    USGS Publications Warehouse

    Nickles, James

    2008-01-01

    Concentrations of fecal-indicator bacteria in urban streams and ocean beaches in and around Santa Barbara occasionally can exceed public-health standards for recreation. The U.S. Geological Survey (USGS), working with the City of Santa Barbara, has used multi-disciplinary science to trace the sources of the bacteria. This research is helping local agencies take steps to improve recreational water quality. The USGS used an approach that combined traditional hydrologic and microbiological data, with state-of-the-art genetic, molecular, and chemical tracer analysis. This research integrated physical data on streamflow, ground water, and near-shore oceanography, and made extensive use of modern geophysical and isotopic techniques. Using those techniques, the USGS was able to evaluate the movement of water and the exchange of ground water with near-shore ocean water. The USGS has found that most fecal bacteria in the urban streams came from storm-drain discharges, with the highest concentrations occurring during storm flow. During low streamflow, the concentrations varied as much as three-fold, owing to variable contribution of non-point sources such as outdoor water use and urban runoff to streamflow. Fecal indicator bacteria along ocean beaches were from both stream discharge to the ocean and from non-point sources such as bird fecal material that accumulates in kelp and sand at the high-tide line. Low levels of human-specific Bacteroides, suggesting fecal material from a human source, were consistently detected on area beaches. One potential source, a local sewer line buried beneath the beach, was found not to be responsible for the fecal bacteria.

  12. Medical Child Abuse (Munchausen Syndrome by Proxy): Multidisciplinary Approach from a Pediatric Gastroenterology Perspective.

    PubMed

    Ali-Panzarella, Andrea Z; Bryant, Tamika J; Marcovitch, Hannah; Lewis, Jeffery D

    2017-04-01

    We highlight the need for a multidisciplinary approach to the diagnosis of medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), and review our experience focusing on the variety of symptoms that often present to the pediatric gastroenterologist many months before the diagnosis is made. Recent literature on medical child abuse, mostly case reports, is markedly limited, highlighting a need for increased research on this topic. Articles agree on the value of a multidisciplinary approach to these cases and the importance of involving professionals outside the hospital setting. Given the technology-dependent nature of our current society, the use of social media to aid in making the diagnosis has emerged. Review of the literature shows that there are almost no data on long-term outcomes of the victims or perpetrators of MSP. Making the diagnosis of MSP involves a complicated process of piecing together inconsistencies among the history, examination, and clinical presentation. The diagnosis remains difficult and is not often considered during early presentation of symptoms. Once MSP is suspected, it is important that a multidisciplinary process is used, incorporating input from various sources: the outpatient care structure, the hospital, non-hospital agencies such as school and child protective services, and non-traditional sources such as social media. In our experience, a multidisciplinary approach augmented by thoughtful inpatient surveillance provides the greatest opportunity for confirming or excluding MSP. Pediatric gastroenterology is one of the most common services consulted prior to diagnosis and presents an opportunity for early intervention.

  13. A multi-disciplinary approach for the structural monitoring of Cultural Heritages in a seismic area

    NASA Astrophysics Data System (ADS)

    Fabrizia Buongiorno, Maria; Musacchio, Massimo; Guerra, Ignazio; Porco, Giacinto; Stramondo, Salvatore; Casula, Giuseppe; Caserta, Arrigo; Speranza, Fabio; Doumaz, Fawzi; Giovanna Bianchi, Maria; Luzi, Guido; Ilaria Pannaccione Apa, Maria; Montuori, Antonio; Gaudiosi, Iolanda; Vecchio, Antonio; Gervasi, Anna; Bonali, Elena; Romano, Dolores; Falcone, Sergio; La Piana, Carmelo

    2014-05-01

    In the recent years, the concepts of seismic risk vulnerability and structural health monitoring have become very important topics in the field of both structural and civil engineering for the identification of appropriate risk indicators and risk assessment methodologies in Cultural Heritages monitoring. The latter, which includes objects, building and sites with historical, architectural and/or engineering relevance, concerns the management, the preservation and the maintenance of the heritages within their surrounding environmental context, in response to climate changes and natural hazards (e.g. seismic, volcanic, landslides and flooding hazards). Within such a framework, the complexity and the great number of variables to be considered require a multi-disciplinary approach including strategies, methodologies and tools able to provide an effective monitoring of Cultural Heritages form both scientific and operational viewpoints. Based on this rationale, in this study, an advanced, technological and operationally-oriented approach is presented and tested, which enables measuring and monitoring Cultural Heritage conservation state and geophysical/geological setting of the area, in order to mitigate the seismic risk of the historical public goods at different spatial scales*. The integration between classical geophysical methods with new emerging sensing techniques enables a multi-depth, multi-resolution, and multi-scale monitoring in both space and time. An integrated system of methodologies, instrumentation and data-processing approaches for non-destructive Cultural Heritage investigations is proposed, which concerns, in detail, the analysis of seismogenetic sources, the geological-geotechnical setting of the area and site seismic effects evaluation, proximal remote sensing techniques (e.g. terrestrial laser scanner, ground-based radar systems, thermal cameras), high-resolution aerial and satellite-based remote sensing methodologies (e.g. aeromagnetic surveys

  14. Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

    PubMed Central

    Gillespie, Brigid M; Kang, Evelyn; Roberts, Shelley; Lin, Frances; Morley, Nicola; Finigan, Tracey; Homer, Allison; Chaboyer, Wendy

    2015-01-01

    Purpose To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs). Materials and methods An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI. Results and discussion In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention. Conclusion Patient-centered interventions aimed at increasing patient participation in SSI prevention and evaluating the contributions of allied health professionals in team-based SSI prevention requires future research. PMID:26508870

  15. Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review.

    PubMed

    Gillespie, Brigid M; Kang, Evelyn; Roberts, Shelley; Lin, Frances; Morley, Nicola; Finigan, Tracey; Homer, Allison; Chaboyer, Wendy

    2015-01-01

    To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs). An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI. In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention. Patient-centered interventions aimed at increasing patient participation in SSI prevention and evaluating the contributions of allied health professionals in team-based SSI prevention requires future research.

  16. Sudden cardiac death in forensic medicine – Swiss recommendations for a multidisciplinary approach.

    PubMed

    Wilhelm, Matthias; Bolliger, Stephan A; Bartsch, Christine; Fokstuen, Siv; Gräni, Christoph; Martos, Viktor; Medeiros Domingo, Argelia; Osculati, Antonio; Rieubland, Claudine; Sabatasso, Sara; Saguner, Ardan M; Schyma, Christian; Tschui, Joelle; Wyler, Daniel; Bhuiyan, Zahurul A; Fellmann, Florence; Michaud, Katarzyna

    2015-01-01

    Sudden cardiac death (SCD) is by definition unexpected and cardiac in nature. The investigation is almost invariably performed by a forensic pathologist. Under these circumstances the role of the forensic pathologist is twofold: (1.) to determine rapidly and efficiently the cause and manner of death and (2.) to initiate a multidisciplinary process in order to prevent further deaths in existing family members. If the death is determined to be due to "natural" causes the district attorney in charge often refuses further examinations. However, additional examinations, i.e. extensive histopathological investigations and/or molecular genetic analyses, are necessary in many cases to clarify the cause of death. The Swiss Society of Legal Medicine created a multidisciplinary working group together with clinical and molecular geneticists and cardiologists in the hope of harmonising the approach to investigate SCD. The aim of this paper is to close the gap between the Swiss recommendations for routine forensic post-mortem cardiac examination and clinical recommendations for genetic testing of inherited cardiac diseases; this is in order to optimise the diagnostic procedures and preventive measures for living family members. The key points of the recommendations are (1.) the forensic autopsy procedure for all SCD victims under 40 years of age, (2.) the collection and storage of adequate samples for genetic testing, (3.) communication with the families, and (4.) a multidisciplinary approach including cardiogenetic counselling.

  17. Aorta Balloon Occlusion in Trauma: Three Cases Demonstrating Multidisciplinary Approach Already on Patient’s Arrival to the Emergency Room

    SciTech Connect

    Hörer, Tal M.; Hebron, Dan; Swaid, Forat; Korin, Alexander; Galili, Offer; Alfici, Ricardo; Kessel, Boris

    2016-02-15

    PurposeTo describe the usage of aortic balloon occlusion (ABO), based on a multidisciplinary approach in severe trauma patients, emphasizing the role of the interventional radiologist in primary trauma care.MethodsWe briefly discuss the relevant literature, the technical aspects of ABO in trauma, and a multidisciplinary approach to the bleeding trauma patient. We describe three severely injured trauma patients for whom ABO was part of initial trauma management.ResultsThree severely injured multi-trauma patients were treated by ABO as a bridge to surgery and embolization. The procedures were performed by an interventional radiologist in the early stages of trauma management.ConclusionsThe interventional radiologist and the multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.

  18. Management of veno-occlusive disease: the multidisciplinary approach to care.

    PubMed

    Wallhult, Elisabeth; Kenyon, Michelle; Liptrott, Sarah; Mank, Arno; Ní Chonghaile, Mairéad; Babic, Aleksandra; Bijkerk, Jacobine; Bompoint, Caroline; Corbacioglu, Selim; de Weijer, Roel; Fink, Claudia; Marktel, Sarah; Soni, Vivek; Sprenger, Sarah; Arjona, Eugenia Trigoso; Mohty, Mohamad

    2017-04-01

    Although it is considered a relatively rare disorder, veno-occlusive disease (VOD) is one of the main causes of overall, non-relapse mortality associated with haematopoietic stem cell transplantation (HSCT). This article, based on the consensus opinion of haemato-oncology nurses, haemato-oncologists and pharmacists from both adult and paediatric services at the VOD International Multi-Disciplinary Advisory Board at the European Society for Blood and Marrow Transplantation (EBMT) meeting, Istanbul, 2015, aims to explore the multidisciplinary approach to care for the management of VOD, with an emphasis on current challenges in this area. The careful monitoring of HSCT patients allows early detection of the symptoms associated with VOD and timely treatment, ultimately improving patient outcomes. As part of a multidisciplinary team, nurses have an essential role to play, from pretransplant assessment to medical management and overall care of the patient. Physicians and pharmacists have a responsibility to facilitate education and training so that nurses can work effectively within that team.

  19. The importance of a multidisciplinary approach for solid earth geophysics in Seafloor Observatories data analysis

    NASA Astrophysics Data System (ADS)

    Embriaco, Davide; De Caro, Mariagrazia; De Santis, Angelo; Etiope, Giuseppe; Frugoni, Francesco; Giovanetti, Gabriele; Lo Bue, Nadia; Marinaro, Giuditta; Monna, Stephen; Montuori, Caterina; Sgroi, Tiziana; Beranzoli, Laura; Favali, Paolo

    2016-04-01

    Continuous time-series in deep ocean waters are the basis for an original approach in ocean exploration. The observation of phenomena variability over time is key to understanding many Earth processes, among which: hydrothermal systems, active tectonics, and ecosystem life cycles. Geo-hazards at sea have often been studied with a single-parameter approach on a short time-scale, but it is now becoming clear that to understand these phenomena and, specifically, to identify precursors to very energetic events, such as mega-earthquakes, tsunamis and volcanic eruptions, continuous long-term multiparameter monitoring is strongly needed. In fact, given a signal of interest, by using several sensors recording simultaneously it is possible to identify the contribution of different sources to this signal, and to be less prone to false associations. In Europe, large cabled systems with marine sensors are being developed for near real-time and real-time long-term monitoring of ocean processes within the EMSO (European Multidisciplinary Seafloor and water column Observatory www.emso-eu.org) Research Infrastructure. Obtaining good quality long-term multiparameter data from sensors on-board seafloor observatories, which are the base of a multidisciplinary approach, is a challenging task. We describe the main steps we have taken to retrieve good quality multiparametric data acquired by GEOSTAR class seafloor observatories, both standalone and cabled, deployed at various sites offshore European coast during the last decade. Starting from this data we show the application of a multidisciplinary approach with some examples coming from experiments in EMSO sites.

  20. Air pollution and detrimental effects on children's brain. The need for a multidisciplinary approach to the issue complexity and challenges.

    PubMed

    Calderón-Garcidueñas, Lilian; Torres-Jardón, Ricardo; Kulesza, Randy J; Park, Su-Bin; D'Angiulli, Amedeo

    2014-01-01

    Millions of children in polluted cities are showing brain detrimental effects. Urban children exhibit brain structural and volumetric abnormalities, systemic inflammation, olfactory, auditory, vestibular and cognitive deficits v low-pollution controls. Neuroinflammation and blood-brain-barrier (BBB) breakdown target the olfactory bulb, prefrontal cortex and brainstem, but are diffusely present throughout the brain. Urban adolescent Apolipoprotein E4 carriers significantly accelerate Alzheimer pathology. Neurocognitive effects of air pollution are substantial, apparent across all populations, and potentially clinically relevant as early evidence of evolving neurodegenerative changes. The diffuse nature of the neuroinflammation and neurodegeneration forces to employ a weight of evidence approach incorporating current clinical, cognitive, neurophysiological, radiological and epidemiological research. Pediatric air pollution research requires extensive multidisciplinary collaborations to accomplish a critical goal: to protect exposed children through multidimensional interventions having both broad impact and reach. Protecting children and teens from neural effects of air pollution should be of pressing importance for public health.

  1. OUTCOME OF IMPLEMENTATION OF A MULTIDISCIPLINARY TEAM APPROACH TO THE CARE OF PATIENTS AFTER TRANSSPHENOIDAL SURGERY

    PubMed Central

    Carminucci, Arthur S.; Ausiello, John C.; Page-Wilson, Gabrielle; Lee, Michelle; Good, Laura; Bruce, Jeffrey N.; Freda, Pamela U.

    2016-01-01

    Objective Transsphenoidal surgery (TS) for sellar lesions is an established and safe procedure, but complications can occur, particularly involving the neuroendocrine system. We hypothesized that postoperative care of TS patients would be optimized when performed by a coordinated team including a pituitary neurosurgeon, endocrinologists, and a specialty nurse. Methods We implemented a formalized, multidisciplinary team approach and standardized postoperative protocols for the care of adult patients undergoing TS by a single surgeon (J.N.B.) at our institution beginning in July 2009. We retrospectively compared the outcomes of 214 consecutive TS-treated cases: 113 cases prior to and 101 following the initiation of the team approach and protocol implementation. Outcomes assessed included the incidence of neurosurgical and endocrine complications, length of stay (LOS), and rates of hospital readmission and unscheduled clinical visits. Results The median LOS decreased from 3 days preteam to 2 days postteam (P<.01). Discharge occurred on postoperative day 2 in 46% of the preteam group patients compared to 69% of the postteam group (P<.01). Rates of early postoperative diabetes insipidus (DI) and readmissions within 30 days for syndrome of inappropriate antidiuretic hormone (SIADH) or other complications did not differ between groups. Conclusion Implementation of a multidisciplinary team approach was associated with a reduction of LOS. Despite earlier discharge, postoperative outcomes were not compromised. The endocrinologist is central to the success of this team approach, which could be successfully applied to care of patients undergoing TS, as well as other types of endocrine surgery at other centers. PMID:26437216

  2. Minnesota plan for nonsmoking and health: multidisciplinary approach to risk factor control.

    PubMed

    Dean, A G; Shultz, J M; Gust, S W; Harty, K C; Moen, M E

    1986-01-01

    In 1981, the Minnesota Department of Health began a long-term program to control risk factors for the major health problems of the State as determined by an expert committee. The methods chosen to initiate programs were social, economic, and epidemiologic background research and a multidisciplinary statewide planning process. Smoking was considered the most important problem. During 1983-84, department staff members analyzed the epidemiology and economics of smoking in Minnesota and reviewed the literature on methods of smoking control. They and a multidisciplinary technical committee prepared a coordinated plan to increase the prevalence of nonsmoking in Minnesota. The 39 recommendations address mass communication and marketing, educational programs in schools, public and private regulation, economic disincentives through taxation, and funding of programs and evaluation of results. The Minnesota Plan for Nonsmoking and Health was released in September 1984. During the first half year, the plan provided material for formation of a coalition of health organizations to promote nonsmoking. In June 1985, the Minnesota Legislature passed the Omnibus Nonsmoking and Disease Prevention Act, which provides $4 million over 2 years for promotion of nonsmoking through education, regulation, and public communications. These intervention activities will be funded by a portion of a 5-cent increase in cigarette excise tax. The foundations have been laid for what may be the most comprehensive statewide nonsmoking program in the United States.

  3. One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach.

    PubMed

    Samra, Jaswinder S; Bachmann, Raul Alvarado; Choi, Julian; Gill, Anthony; Neale, Michael; Puttaswamy, Vikram; Bell, Cameron; Norton, Ian; Cho, Sarah; Blome, Steven; Maher, Ritchie; Gananadha, Sivakumar; Hugh, Thomas J

    2011-08-01

    Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers. This, however, is a major undertaking in most patients and is associated with a significant morbidity and mortality. A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis, resection rate, mortality and morbidity. We undertook the study to assess the effect of this approach on diagnosis, resection rates and short-term outcomes such as morbidity and mortality. A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed. All cases were discussed at a multidisciplinary meeting comprising surgeons, gastroenterologists, radiologists, oncologists, radiation oncologists, pathologists and nursing staff. A standardized investigation and management algorithm was followed. Complications were graded according to the Clavien-Dindo classification. A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%). Sixty-one patients (34%) required either a vascular or an additional organ resection. Eighty-nine patients experienced complications, of which the commonest was blood transfusion (12%). Thirty-four patients (19%) had major complications, i.e. grade 3 or above. There was no in-hospital, 30-day or 60-day mortality. Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality. The surgeon's role should be careful patient selection, intensive preoperative investigations, use of a team approach, and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients.

  4. Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant Chest Wall Tumors.

    PubMed

    Khalil, Haitham H; Malahias, Marco N; Balasubramanian, Balapathiran; Djearaman, Madava G; Naidu, Babu; Grainger, Melvin F; Kalkat, Maninder

    2016-07-01

    Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes. Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009-2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning. Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm(2) (mean, 154 cm(2)). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%). Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction.

  5. Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant Chest Wall Tumors

    PubMed Central

    Malahias, Marco N.; Balasubramanian, Balapathiran; Djearaman, Madava G.; Naidu, Babu; Grainger, Melvin F.; Kalkat, Maninder

    2016-01-01

    Background: Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes. Methods: Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009–2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning. Results: Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm2 (mean, 154 cm2). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%). Conclusions: Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction. PMID:27536488

  6. Recognition and rehabilitation of the female athlete triad/tetrad: a multidisciplinary approach.

    PubMed

    Temme, Kate E; Hoch, Anne Z

    2013-01-01

    While the benefits of physical activity are numerous, the female athlete triad poses a significant health risk to young athletes. Emerging research links the triad to endothelial dysfunction--a sentinel event in cardiovascular disease--suggesting that this complex interplay of metabolic and endocrine factors may be described more accurately as a tetrad. Effective treatment of the triad/tetrad requires a multidisciplinary approach. Emphasis must be placed on prevention, recognition, and treatment of triad for the promotion of healthy nutritional and activity profiles in female athletes across their lifespans.

  7. Changing sedation practices in the intensive care unit--protocol implementation, multifaceted multidisciplinary approach and teamwork.

    PubMed

    Arabi, Yaseen; Haddad, Samir; Hawes, Rebecca; Moore, Theresa; Pillay, Monica; Naidu, Brintha; Issa, Anwar; Yeni, Barbara; Grant, Craig; Alshimemeri, Abdullah

    2007-06-01

    Sedation protocols have demonstrated effectiveness in improving ICU sedation practices. However, the importance of multifaceted multidisciplinary approach on the success of such protocols has not been fully examined. The study was conducted in a tertiary care medical-surgical ICU as a prospective, 4-pronged, observational study describing a quality improvement initiative that employs 2 types of controlled comparisons: a "before and after" comparison related to intense education of ICU clinicians and nurses about sedation and analgesia in the ICU, and a comparison of protocolized versus non-protocolized care. Patients were assigned alternatively to receive sedation by a goal-directed protocol using the Riker Sedation-Agitation Scale (SAS) or by standard practice. A multifaceted multidisciplinary educational program was initiated including the use of point of use reminders, directed educational efforts, and opinion leaders. This included several lectures and in-services and the routine availability of at least one member of this group to answer questions. We included all consecutive patients receiving mechanical ventilation, who were judged by their treating team to require intravenous sedation. The following data was collected: demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score and Simplified Acute Physiology score (SAPS) II, daily doses of analgesics and sedatives, duration of mechanical ventilation, ICU length of stay (LOS) and ventilator associated pneumonia (VAP) incidence. To examine the effect of the multifaceted multidisciplinary approach, we compared the first 3 months to the second 3 months in the following 4 groups: G1 no protocol group in the first 3 months, G2 protocol group in first 3 months, G3 no protocol group in the second 3 months, G4 protocol group in the second 3 months. After ICU day 3, SAS in the groups G2, G3 and G4 became higher than in G1 reflecting "lighter" levels of sedation. There were significant reductions

  8. Partnership for Diversity: A Multidisciplinary Approach to Nurturing Cultural Competence at an Emerging Medical School.

    PubMed

    Swanberg, Stephanie M; Abuelroos, Dena; Dabaja, Emman; Jurva, Stephanie; Martin, Kimberly; McCarron, Joshua; Reed-Hendon, Caryn; Yeow, Raymond Y; Harriott, Melphine M

    2015-01-01

    Fostering cultural competence in higher education institutions is essential, particularly in training future health care workers to care for diverse populations. The opportunity to explore techniques to address diversity and cultural competence at a new medical school was undertaken by a multidisciplinary team of librarians, faculty, staff, and medical students. From 2011 to 2015, the team sponsored a voluntary programming series to promote cultural competence and raise awareness of health care disparities for the medical school. Thirteen events were hosted with 562 participants across all. This approach to diversity proved effective and could be adapted in any higher education setting.

  9. Multidisciplinary approach to identification and remedial intervention for adverse late effects of cancer therapy

    SciTech Connect

    McCalla, J.L.

    1985-03-01

    Because of advances in surgical technique, radiation therapy, and combined chemotherapy regimens, there has been a dramatic improvement in the survival of children with pediatric malignancies. All treatment modalities are associated with adverse effects that may be manifested months to years after therapy. This article has provided an overview of the physiologic and psychologic adverse effects of antineoplastic therapy and described the multidisciplinary approach used by one institution to identify and initiate appropriate remedial intervention. Nurses can learn to assist in the identification of adverse late effects, provide support to the family, and facilitate appropriate intervention.

  10. Noise and Oscillations in Biological Systems: Multidisciplinary Approach Between Experimental Biology, Theoretical Modelling and Synthetic Biology

    NASA Astrophysics Data System (ADS)

    Ullner, E.; Ares, S.; Morelli, L. G.; Oates, A. C.; Jülicher, F.; Nicola, E.; Heussen, R.; Whitmore, D.; Blyuss, K.; Fryett, M.; Zakharova, A.; Koseska, A.; Nene, N. R.; Zaikin, A.

    2012-10-01

    Rapid progress of experimental biology has provided a huge flow of quantitative data, which can be analyzed and understood only through the application of advanced techniques recently developed in theoretical sciences. On the other hand, synthetic biology enabled us to engineer biological models with reduced complexity. In this review we discuss that a multidisciplinary approach between this sciences can lead to deeper understanding of the underlying mechanisms behind complex processes in biology. Following the mini symposia "Noise and oscillations in biological systems" on Physcon 2011 we have collected different research examples from theoretical modeling, experimental and synthetic biology.

  11. Predicting ectotherm disease vector spread—benefits from multidisciplinary approaches and directions forward

    NASA Astrophysics Data System (ADS)

    Thomas, Stephanie Margarete; Beierkuhnlein, Carl

    2013-05-01

    The occurrence of ectotherm disease vectors outside of their previous distribution area and the emergence of vector-borne diseases can be increasingly observed at a global scale and are accompanied by a growing number of studies which investigate the vast range of determining factors and their causal links. Consequently, a broad span of scientific disciplines is involved in tackling these complex phenomena. First, we evaluate the citation behaviour of relevant scientific literature in order to clarify the question "do scientists consider results of other disciplines to extend their expertise?" We then highlight emerging tools and concepts useful for risk assessment. Correlative models (regression-based, machine-learning and profile techniques), mechanistic models (basic reproduction number R 0) and methods of spatial regression, interaction and interpolation are described. We discuss further steps towards multidisciplinary approaches regarding new tools and emerging concepts to combine existing approaches such as Bayesian geostatistical modelling, mechanistic models which avoid the need for parameter fitting, joined correlative and mechanistic models, multi-criteria decision analysis and geographic profiling. We take the quality of both occurrence data for vector, host and disease cases, and data of the predictor variables into consideration as both determine the accuracy of risk area identification. Finally, we underline the importance of multidisciplinary research approaches. Even if the establishment of communication networks between scientific disciplines and the share of specific methods is time consuming, it promises new insights for the surveillance and control of vector-borne diseases worldwide.

  12. Predicting ectotherm disease vector spread--benefits from multidisciplinary approaches and directions forward.

    PubMed

    Thomas, Stephanie Margarete; Beierkuhnlein, Carl

    2013-05-01

    The occurrence of ectotherm disease vectors outside of their previous distribution area and the emergence of vector-borne diseases can be increasingly observed at a global scale and are accompanied by a growing number of studies which investigate the vast range of determining factors and their causal links. Consequently, a broad span of scientific disciplines is involved in tackling these complex phenomena. First, we evaluate the citation behaviour of relevant scientific literature in order to clarify the question "do scientists consider results of other disciplines to extend their expertise?" We then highlight emerging tools and concepts useful for risk assessment. Correlative models (regression-based, machine-learning and profile techniques), mechanistic models (basic reproduction number R0) and methods of spatial regression, interaction and interpolation are described. We discuss further steps towards multidisciplinary approaches regarding new tools and emerging concepts to combine existing approaches such as Bayesian geostatistical modelling, mechanistic models which avoid the need for parameter fitting, joined correlative and mechanistic models, multi-criteria decision analysis and geographic profiling. We take the quality of both occurrence data for vector, host and disease cases, and data of the predictor variables into consideration as both determine the accuracy of risk area identification. Finally, we underline the importance of multidisciplinary research approaches. Even if the establishment of communication networks between scientific disciplines and the share of specific methods is time consuming, it promises new insights for the surveillance and control of vector-borne diseases worldwide.

  13. [Multidisciplinary approach of the obese child to the dietary residency of "Clairs Vallons"].

    PubMed

    Vande Weyer, M; Bolterys, S; Guzman, E

    2005-09-01

    of the symptom. The therapeutic work to the Dietary Residency of "Clairs Vallons" consists therefore in a global approach of the child within a multidisciplinary team (pediatrician, dietitian, psychologist, physiotherapist, social assistant, orthofenist, educator and teacher) all united around the concept "to eat happy".

  14. [The contribution of legal medicine in child protection: Presentation of a multidisciplinary approach].

    PubMed

    Hiquet, J; Christin, E; Dubourg, O; Fougas, J; Baup, C; Brunet, G; Millington, J; Grosleron, N; Gromb-Monnoyeur, S

    2016-12-01

    Maltreatment is a complex issue and therefore, requires a multidisciplinary approach, which has been commonly used in North America since the 1980s but remains unsystematic in France. Since 1999, the Centre d'Accueil en Urgence des Victimes d'Agression (emergency unit for victims of assault) of the Bordeaux University Hospital has brought together various medical, paramedical, and social actors on this issue. A standardized psychosocial assessment procedure has been introduced and is detailed in this paper, and was consistently conducted in all cases of suspicion of abuse on a minor. The authors studied 74 cases of minors having undergone a psychosocial assessment following suspicions of maltreatment between 1 July 2014 and 30 June 2015 that were not referred to the courts. Forty-five girls and 29 boys, mean age 7 years, claiming mainly (75 %) to have been subjected to sexual violence, were addressed to us by internal partners (n=15) and external partners (n=37) and 22 who came to our unit by self-referral. Following our assessment, 35 returned to their home and 36 went to court following a police complaint (n=17) and a report filed to the public prosecutor of the Republic (n=19). Three of these cases were subjected to a report on matters of concern sent to the departmental council. Given the absence of a national consensus on the methodology used for assessing suspicions of maltreatment on minors, our psychosocial assessment can facilitate the task with its peer review as well as the detection and judicialization of the maltreatment. The authors also highlight the recent modification of article 226-14 of the Penal Code, which aims at protecting professionals reporting matters to legal authorities from any legal proceeding, except if it is established that the individual did not act in good faith. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Effects of a Multidisciplinary Approach to Improve Volume of Diagnostic Material in CT-Guided Lung Biopsies

    PubMed Central

    Ferguson, Philip E.; Sales, Catherine M.; Hodges, Dalton C.; Sales, Elizabeth W.

    2015-01-01

    Background Recent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This paper quantifies the effect of a multidisciplinary strategy implemented to optimize and increase tissue volume in CT-guided transthoracic needle core lung biopsies. The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory. This study quantifies the effects of strategies #1 and #2. Design This retrospective analysis comparing CT-guided lung biopsies from 2007 and 2012 (before and after multidisciplinary approach implementation) was performed at a single institution. Patient medical records were reviewed and main variables analyzed include biopsy sample size, radiologist, number of blocks submitted, diagnosis, and complications. The biopsy sample size measured was considered to be directly proportional to tissue volume in the block. Results Biopsy sample size increased 2.5 fold with the average total biopsy sample size increasing from 1.0 cm (0.9–1.1 cm) in 2007 to 2.5 cm (2.3–2.8 cm) in 2012 (P<0.0001). The improvement was statistically significant for each individual radiologist. During the same time, the rate of pneumothorax requiring chest tube placement decreased from 15% to 7% (P = 0.065). No other major complications were identified. The proportion of tumor within the biopsy material was similar at 28% (23%–33%) and 35% (30%–40%) for 2007 and 2012, respectively. The number of cases with at least two blocks available for testing increased from 10.7% to 96.4% (P<0.0001). Conclusions The effect of this multidisciplinary strategy to CT

  16. Intrapericardial teratoma in a low birth weight preterm infant: a successful multidisciplinary approach.

    PubMed

    Iacona, Gabriele M; Barber, Miguel A; Medina, Margarita; Abella, Raul

    2011-02-01

    We report the case of an intrapericardial teratoma, a rare tumour in infants, prenatally diagnosed and successfully treated thanks to a multidisciplinary approach. An intrapericardial cystic mass (2.5 cm) with pericardial effusion was identified in a foetus at 32 weeks gestational age (GA). Intrauterine pericardiocentesis was performed immediately (40 ml) and repeated at 33 weeks (25 ml) and then at 34 weeks GA, just before birth (36 ml). Considering the rapid growth of the mass and the risk of hydrops, vaginal delivery was induced. A baby girl weighing 1.98 kg was born without cardiorespiratory compromise. Echocardiography and thoracic CT-scan located the 4.0×3.0 cm cystic mass between the left atrial appendage and the left superior pulmonary vein. At three days of life, the mass was completely removed without cardiobypass. It arose from the ascending aorta. Postoperative course was uneventful. Pathology diagnosed an immature intrapericardial teratoma. As long-term follow-up is required, alpha-fetoprotein can be a valid tool to monitor a possible recurrence. A multidisciplinary approach allows successful prenatal management and postnatal tumour surgery.

  17. TMJ Ankylosis: Multidisciplinary Approach of Treatment for Dentofacial Enhancement-A Case Report.

    PubMed

    Vibhute, Pavankumar Janardan; Bhola, Nitin; Borle, Rajiv M

    2011-01-01

    This report describes the multidisciplinary phasewise treatment of a 20-year-old female patient having unilateral right TMJ bony (true) ankylosis whose mouth opening was restricted to 2 mm and mandibular retrognathism; additionally, she was also suffering from speech problems, snoring, difficulty in breathing, and low level of self-esteem and self-confidence. Bilateral gap arthroplasty and temporalis myofascial graft interpositioning through preauricular approach were done in surgical phase followed by the aggressive jaw physiotherapy in postsurgical period. Oral prophylaxis and restorations were followed by the fixed orthodontic therapy to resolve bimaxillary protrusion. Advancement sliding genioplasty was performed to enhance the chin button. Speech therapy and psychological counseling were also performed from time to time to boost up the self-esteem and self-confidence. At the end of treatment, facial esthetics was improved considerably and patient got over the impact of disfigurement, impaired functions, and psychosocial stigma. Rationale to use the multidisciplinary team approach in treatment of such cases is discussed.

  18. Neonatal abstinence syndrome: evaluating the effectiveness of an evidence-based multidisciplinary care approach.

    PubMed

    Saunders, Carla; King, Terry; Smith, Sheri; Buchheit, John; Cook, Kyle; Edds, Jill; Mefford, Linda

    2014-01-01

    An evidence-based, multidisciplinary neonatal abstinence syndrome protocol was developed using a stepwise continuous quality improvement (CQI) approach with the goal of standardizing care procedures for these infants. A retrospective secondary data analysis was performed to evaluate the differential effects of each step of the CQI project on 4 key clinical outcome measures: length of stay (total and post-opioid wean), weaning time from opioids, and use of adjunct medications. Data were analyzed from 386 newborn infants with a diagnosis of neonatal abstinence syndrome undergoing treatment in a level III neonatal intensive care unit. After implementation of a pharmacologic weaning protocol as a foundational first step of the CQI project, the weaning time from opioids remained stable throughout each of the subsequent CQI steps (P = .905). The overall total neonatal intensive care unit length of stay was reduced by 10.35 days (P = .002), and the length of neonatal intensive care unit stay after completing wean from opioids was reduced by 2.79 days (P < .001). Use of adjunct medications also decreased from 30.1% of infants at the initiation of the CQI project to 24.5% at the completion of the project (P = .020). These findings indicate that this multidisciplinary treatment approach led to an overall improved efficiency of both opioid weaning and symptom management for these infants.

  19. Invasive placental disease: the impact of a multi-disciplinary team approach to management.

    PubMed

    Smulian, John C; Pascual, Ana-Liza; Hesham, Helai; Qureshey, Emma; Bijoy Thomas, M; Depuy, Amy M; Flicker, Amanda B; Scorza, William E

    2017-06-01

    To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD). This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan. Outcomes were compared between cases delivered prior to and after the MDT process was started. There were 47 pregnancies with IPD, of which 31 (66.0%) were suspected antenatally and 40 (85.1%) had a prior uterine surgery. An MDT approach was performed in 19 (40.4%) cases. In the MDT group, there were longer operative times (260 min versus 181 min, p = 0.0001), less blood loss (1200 mL versus 2500 mL, p = 0.009), less administration of blood products (47.4% versus 85.7%, p = 0.005), and higher intraoperative lowest mean arterial pressures (MAPs) (57 mmHg versus 48 mmHg, p = 0.002, when compared to the No-MDT (n = 28) approach. No differences were found for other outcomes. Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.

  20. A Multidisciplinary Approach with Hyperbaric Oxygen Therapy Improve Outcome in Snake Bite Injuries

    PubMed Central

    Korambayil, Pradeoth Mukundan; Ambookan, Prashanth Varkey; Abraham, Siju Varghese; Ambalakat, Ajay

    2015-01-01

    Aim: Snakebite injuries are common in tropical India among those who are involved in outdoor activities. These injuries results in cellulitis, gangrene at the bite area, bleeding manifestations, compartment syndrome, regional lymphadenopathy, septicemia, hypotension, and disseminated intravascular coagulation (DIC) resulting in significant morbidity and mortality. The purpose of this study is to share our experience of multidisciplinary approach in the management of snakebite injuries of the extremities with various treatment modalities including hyperbaric oxygen (HBO) therapy, surgical debridement, and soft tissue reconstruction to provide an effective treatment for snake bite injuries. Methods: The study was conducted in the Department of Plastic Surgery, during the period October 2012–December 2014, wherein all the patients who were admitted with snakebite injuries were enrolled and the patients treated in plastic surgery department were included into the study. Out of total 766 patients, there were 323 patients treated with anti snake venom (ASV) and 29 died among the treated patients; 205 patients belonged to pediatric age group. Results: Out of 112 patients referred to Department of Plastic Surgery, 50 cases presented with cellulitis, 24 patients with compartment syndrome, and 38 patients were referred for the management of soft tissue cover over the extremities. Among 112 patients, 77 involved the lower extremity and 35 the upper extremity. Conclusion: Multidisciplinary approach including hyperbaric oxygen (HBO) therapy improves outcome in the management of snakebite injuries of the extremities. PMID:26862269

  1. A Multidisciplinary Approach with Hyperbaric Oxygen Therapy Improve Outcome in Snake Bite Injuries.

    PubMed

    Korambayil, Pradeoth Mukundan; Ambookan, Prashanth Varkey; Abraham, Siju Varghese; Ambalakat, Ajay

    2015-01-01

    Snakebite injuries are common in tropical India among those who are involved in outdoor activities. These injuries results in cellulitis, gangrene at the bite area, bleeding manifestations, compartment syndrome, regional lymphadenopathy, septicemia, hypotension, and disseminated intravascular coagulation (DIC) resulting in significant morbidity and mortality. The purpose of this study is to share our experience of multidisciplinary approach in the management of snakebite injuries of the extremities with various treatment modalities including hyperbaric oxygen (HBO) therapy, surgical debridement, and soft tissue reconstruction to provide an effective treatment for snake bite injuries. The study was conducted in the Department of Plastic Surgery, during the period October 2012-December 2014, wherein all the patients who were admitted with snakebite injuries were enrolled and the patients treated in plastic surgery department were included into the study. Out of total 766 patients, there were 323 patients treated with anti snake venom (ASV) and 29 died among the treated patients; 205 patients belonged to pediatric age group. Out of 112 patients referred to Department of Plastic Surgery, 50 cases presented with cellulitis, 24 patients with compartment syndrome, and 38 patients were referred for the management of soft tissue cover over the extremities. Among 112 patients, 77 involved the lower extremity and 35 the upper extremity. Multidisciplinary approach including hyperbaric oxygen (HBO) therapy improves outcome in the management of snakebite injuries of the extremities.

  2. Multidisciplinary Approach to the Treatment of Concomitant Rectal and Vaginal Prolapse

    PubMed Central

    Jallad, Karl; Gurland, Brooke

    2016-01-01

    Rectal prolapse and vaginal prolapse have traditionally been treated as separate entities despite sharing a common pathophysiology. This compartmentalized approach often leads to frustration and suboptimal outcomes. In recent years, there has been a shift to a more patient-centered, multidisciplinary approach. Procedures to repair pelvic organ prolapse are divided into three categories: abdominal, perineal, and a combination of both. Most commonly, a combined minimally invasive abdominal sacral colpopexy and ventral rectopexy is performed to treat concomitant rectal and vaginal prolapse. Combining the two procedures adds little operative time and offers complete pelvic floor repair. The choice of minimally invasive abdominal prolapse repair versus perineal repair depends on the patient's comorbidities, previous surgeries, preference to avoid mesh, and physician's expertise. Surgeons should at least be able to identify these patients and provide the appropriate treatment or refer them to specialized centers. PMID:27247534

  3. Multidisciplinary Approach for Improved Outcomes in Secondary Cranial Reconstruction: Introducing the Pericranial-Onlay Cranioplasty Technique

    PubMed Central

    Gordon, Chad R.; Fisher, Mark; Liauw, Jason; Lina, Ioan; Puvanesarajah, Varun; Susarla, Srinivas; Coon, Alexander; Lim, Michael; Quinones-Hinojosa, Alfredo; Weingart, Jon; Colby, Geoffrey; Olivi, Alessandro; Huang, Judy

    2015-01-01

    BACKGROUND Although materials for secondary cranial reconstruction have evolved with time, the overall approach in terms of bone flap/implant reconstruction after necessary delay has remained constant. OBJECTIVE To present our cases series of 50 consecutive secondary cranial reconstruction patients and to describe a multidisciplinary cranioplasty approach developed to reduce morbidity, to minimize infection, and to improve aesthetic appearance. METHODS Standard technique teaches us to place the bone flap and/or alloplastic implant directly over the dura or dural protectant after scalp flap re-elevation. However, this procedure is fraught with high complication rates, including infection. While raising the previously incised scalp flap overlying the full-thickness calvarial defect, the dissection is performed within the loose areolar tissue plane beneath the galea aponeurosis, thus leaving vascularized pericranium intact over the dura. RESULTS A total of 50 consecutive patients were treated by the senior author encompassing 46 cranioplasties using the pericranial-onlay approach, along with 4 isolated temporal soft tissue reconstructions with liquid poly-methyl-methacrylate. Of the 46 cranioplasties (> 5 cm2), only 1 autologous bone flap developed deep infection necessitating bone flap removal (1 of 46, 2.17%; 95% confidence interval, 0.003–11.3). None of the alloplastic custom implants placed have developed any infection requiring removal. CONCLUSION This multidisciplinary approach illustrated in our case series, including our “pericranial-onlay” technique described here for the first time, has the potential to improve patient outcomes, to decrease perioperative morbidity, and to minimize costs associated with postoperative infections after secondary cranial reconstruction. PMID:24448187

  4. A multidisciplinary approach to therapeutic risk management of the suicidal patient

    PubMed Central

    Grant, Cynthia L; Lusk, Jaimie L

    2015-01-01

    As health care trends toward a system of care approach, providers from various disciplines strive to collaborate to provide optimal care for their patients. While a multidisciplinary approach to suicide risk assessment and management has been identified as important for reducing suicidality, standardized clinical guidelines for such an approach do not yet exist. In this article, the authors propose the adoption of the therapeutic risk management of the suicidal patient (TRMSP) to improve suicide risk assessment and management within multidisciplinary systems of care. The TRMSP, which has been fully articulated in previous articles, involves augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. Augmenting clinical risk assessments with reliable and valid structured instruments serves several functions, including ensuring important aspects of suicide are addressed, establishing a baseline for suicidal thoughts and behaviors, facilitating interprofessional communication, and mitigating risk. Similarly, a two-dimensional risk stratification qualifying suicide risk in terms of both severity and temporality can enhance communication across providers and settings and improve understanding of acute crises in the context of chronic risk. Finally, safety planning interventions allow providers and patients to collaboratively create a personally meaningful plan for managing a suicidal crisis that can be continually modified across time with multiple providers in different care settings. In a busy care environment, the TRMSP can provide concrete guidance on conducting clinically and medicolegally sound suicide risk assessment and management. This collaborative and comprehensive process would potentially improve care of patients with suicidality, optimize clinical resources, decrease unnecessary and costly admissions, and mitigate medicolegal risk. The TRMSP may

  5. Management of Charcot–Marie–Tooth disease: improving long-term care with a multidisciplinary approach

    PubMed Central

    McCorquodale, Donald; Pucillo, Evan M; Johnson, Nicholas E

    2016-01-01

    Charcot–Marie–Tooth (CMT) disease is the most common inherited neuropathy and one of the most common inherited diseases in humans. The diagnosis of CMT is traditionally made by the neurologic specialist, yet the optimal management of CMT patients includes genetic counselors, physical and occupational therapists, physiatrists, orthotists, mental health providers, and community resources. Rapidly developing genetic discoveries and novel gene discovery techniques continue to add a growing number of genetic subtypes of CMT. The first large clinical natural history and therapeutic trials have added to our knowledge of each CMT subtype and revealed how CMT impacts patient quality of life. In this review, we discuss several important trends in CMT research factors that will require a collaborative multidisciplinary approach. These include the development of large multicenter patient registries, standardized clinical instruments to assess disease progression and disability, and increasing recognition and use of patient-reported outcome measures. These developments will continue to guide strategies in long-term multidisciplinary efforts to maintain quality of life and preserve functionality in CMT patients. PMID:26855581

  6. An impacted central incisor due to supernumerary teeth: a multidisciplinary approach.

    PubMed

    Ferrazzano, G F; Cantile, T; Roberto, L; Baldares, S; Manzo, P; Martina, R

    2014-07-01

    Hyperdontia is a disorder of odontogenesis characterised by excess teeth. Many complications can be associated with supernumerary teeth, such as crowding, tooth displacement, diastema, deep caries, retention or impaction, delayed eruption or ectopic eruption of adjacent teeth, aesthetic problems, neuralgic manifestations, root resorption of adjacent teeth, and dentigerous cyst formation with significant bone destruction. Treatment of hyperdontia depends on the area and number of supernumerary teeth, and also on the presence of pathologic processes that can affect them and/or the teeth of the normal series that could be erupted, retained or impacted. The present case report describes the clinical management of two impacted supernumerary teeth, which impeded the eruption of the maxillary right central incisor in a paediatric patient. A multidisciplinary treatment approach was planned, including the surgical removal of the supernumerary teeth and the orthodontic correction of the unerupted permanent maxillary right central incisor. Combined surgical and orthodontic treatment resulted in an aesthetically pleasant and balanced occlusion. Thus, early multidisciplinary treatment is required for greater hard and soft tissue preservation.

  7. Symptomatic pain and fibromyalgia treatment through multidisciplinary approach for primary care.

    PubMed

    Gonzalez Gonzalez, Jaime; del Teso Rubio, Maria del Mar; Waliño Paniagua, Carmen Nelida; Criado-Alvarez, Juan Jose; Sanchez Holgado, Javier

    2015-01-01

    Fibromyalgia is a chronic disease of unknown etiology characterized by widespread muscle pain, with occupational, familial, social, physical and psychological performance involvement. The multidisciplinary approach to the disease leads to improvement in quality of life and symptomatology. To evaluate the improvement of activities of daily living (ADL) and quality of life following a multidisciplinary intervention (Health Primary Care and Occupational Therapy). Pretest-posttest study performed with a simple random sample of 21 patients with fibromyalgia (range 16-55 years). The measurement was performed with the Barthel scale (ADL), the scale of Lawton and Brody (IADL), the FIQ questionnaire, and no standardized surveys to assess the pre and post intervention situation. An intervention on motor skills (basic motor skills, pool exercise, outdoor exercise, restructuring, occupational performance and graded activity and intervention in ADL) was performed, combining pharmacological control of their symptoms and treatment. Fibromyalgia patients are not fully satisfied with their treatment; Primary Care receives a score of 6.89, and Hospital Care 5.79, improving the Barthel, Lawton and Brody and FIQ indexes, being statistically significant (p<.05). After the combined procedure the number of independent women in ADL and IADL increases. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  8. A Multidisciplinary Approach to Treating Obesity in a Community Health Centre.

    PubMed

    Kovač Blaž, Milena; Švab, Igor

    2015-12-01

    The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme. The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months. 346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction. The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.

  9. The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients

    PubMed Central

    Aoki, Shiro; Hirayama, Junko; Nakamori, Masahiro; Yoshikawa, Mineka; Nezu, Tomohisa; Kubo, Satoshi; Nagano, Yuka; Nagao, Akiko; Yamane, Naoya; Nishikawa, Yuichi; Takamoto, Megumi; Ueno, Hiroki; Ochi, Kazuhide; Maruyama, Hirofumi; Yamamoto, Hiromi; Matsumoto, Masayasu

    2016-01-01

    Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period) and after team organization (post period). Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01). Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19–0.84, p = 0.02). The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients. PMID:27138162

  10. Towards a multidisciplinary approach to understand and manage obesity and related diseases.

    PubMed

    Bischoff, Stephan C; Boirie, Yves; Cederholm, Tommy; Chourdakis, Michael; Cuerda, Cristina; Delzenne, Nathalie M; Deutz, Nicolaas E; Fouque, Denis; Genton, Laurence; Gil, Carmen; Koletzko, Berthold; Leon-Sanz, Miguel; Shamir, Raanan; Singer, Joelle; Singer, Pierre; Stroebele-Benschop, Nanette; Thorell, Anders; Weimann, Arved; Barazzoni, Rocco

    2017-08-01

    Overnutrition and sedentary lifestyle result in overweight or obesity defined as abnormal or excessive fat accumulation that may impair health. According to the WHO, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. In 2008, over 50% of both men and women in the WHO European Region were overweight, and approximately 23% of women and 20% of men were obese. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential disease-specific benefits from selected nutritional regimens. Obesity is usually accompanied by an increased muscle mass. This might explain why obesity, under particular circumstances such as cancer or high age, might have protective effects, a phenomenon named the 'obesity paradox'. However, loss of muscle mass or function can also occur, which is associated with poor prognosis and termed 'sarcopenic obesity'. Therefore, treatment recommendations may need to be individualized and adapted to co-morbidities. Since obesity is a chronic systemic disease it requires a multidisciplinary approach, both at the level of prevention and therapy including weight loss and maintenance. In the present personal review and position paper, authors from different disciplines including endocrinology, gastroenterology, nephrology, pediatrics, surgery, geriatrics, intensive care medicine, psychology and psychiatry, sports medicine and rheumatology, both at the basic science and clinical level, present their view on the topic and underline the necessity to provide a multidisciplinary approach, to address this epidemic. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  11. The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients.

    PubMed

    Aoki, Shiro; Hosomi, Naohisa; Hirayama, Junko; Nakamori, Masahiro; Yoshikawa, Mineka; Nezu, Tomohisa; Kubo, Satoshi; Nagano, Yuka; Nagao, Akiko; Yamane, Naoya; Nishikawa, Yuichi; Takamoto, Megumi; Ueno, Hiroki; Ochi, Kazuhide; Maruyama, Hirofumi; Yamamoto, Hiromi; Matsumoto, Masayasu

    2016-01-01

    Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period) and after team organization (post period). Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01). Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19-0.84, p = 0.02). The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.

  12. Designing eHealth that Matters via a Multidisciplinary Requirements Development Approach

    PubMed Central

    Wentzel, Jobke; Van Gemert-Pijnen, Julia EWC

    2013-01-01

    Background Requirements development is a crucial part of eHealth design. It entails all the activities devoted to requirements identification, the communication of requirements to other developers, and their evaluation. Currently, a requirements development approach geared towards the specifics of the eHealth domain is lacking. This is likely to result in a mismatch between the developed technology and end user characteristics, physical surroundings, and the organizational context of use. It also makes it hard to judge the quality of eHealth design, since it makes it difficult to gear evaluations of eHealth to the main goals it is supposed to serve. Objective In order to facilitate the creation of eHealth that matters, we present a practical, multidisciplinary requirements development approach which is embedded in a holistic design approach for eHealth (the Center for eHealth Research roadmap) that incorporates both human-centered design and business modeling. Methods Our requirements development approach consists of five phases. In the first, preparatory, phase the project team is composed and the overall goal(s) of the eHealth intervention are decided upon. Second, primary end users and other stakeholders are identified by means of audience segmentation techniques and our stakeholder identification method. Third, the designated context of use is mapped and end users are profiled by means of requirements elicitation methods (eg, interviews, focus groups, or observations). Fourth, stakeholder values and eHealth intervention requirements are distilled from data transcripts, which leads to phase five, in which requirements are communicated to other developers using a requirements notation template we developed specifically for the context of eHealth technologies. Results The end result of our requirements development approach for eHealth interventions is a design document which includes functional and non-functional requirements, a list of stakeholder values, and end

  13. Designing eHealth that Matters via a Multidisciplinary Requirements Development Approach.

    PubMed

    Van Velsen, Lex; Wentzel, Jobke; Van Gemert-Pijnen, Julia Ewc

    2013-06-24

    Requirements development is a crucial part of eHealth design. It entails all the activities devoted to requirements identification, the communication of requirements to other developers, and their evaluation. Currently, a requirements development approach geared towards the specifics of the eHealth domain is lacking. This is likely to result in a mismatch between the developed technology and end user characteristics, physical surroundings, and the organizational context of use. It also makes it hard to judge the quality of eHealth design, since it makes it difficult to gear evaluations of eHealth to the main goals it is supposed to serve. In order to facilitate the creation of eHealth that matters, we present a practical, multidisciplinary requirements development approach which is embedded in a holistic design approach for eHealth (the Center for eHealth Research roadmap) that incorporates both human-centered design and business modeling. Our requirements development approach consists of five phases. In the first, preparatory, phase the project team is composed and the overall goal(s) of the eHealth intervention are decided upon. Second, primary end users and other stakeholders are identified by means of audience segmentation techniques and our stakeholder identification method. Third, the designated context of use is mapped and end users are profiled by means of requirements elicitation methods (eg, interviews, focus groups, or observations). Fourth, stakeholder values and eHealth intervention requirements are distilled from data transcripts, which leads to phase five, in which requirements are communicated to other developers using a requirements notation template we developed specifically for the context of eHealth technologies. The end result of our requirements development approach for eHealth interventions is a design document which includes functional and non-functional requirements, a list of stakeholder values, and end user profiles in the form of

  14. A multidisciplinary approach for ocular rehabilitation following surgical treatment of retinoblastoma: One year follow-up

    PubMed Central

    Aggarwal, Himanshi; Kumar, Pradeep; Singh, Raghuwar D.; Baslas, Varun; Alvi, Habib A.; Jurel, Sunit

    2013-01-01

    Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually advanced at the time of detection, requiring enucleation to salvage the child's life. Just treating the patient for cancer is not enough; the cosmetic rehabilitation of these patients is equally important and it should always be an integral part of their treatment, to help them re-integrate in the aesthetic conscious society. Rehabilitating such patients require a multidisciplinary approach involving the combined and timely efforts of an ophthalmologist, paediatric oncologist and a skilled maxillofacial prosthodontist. This paper presents a case of 3½-year-old girl who had enucleation of her right eye due to retinoblastoma along with chemotherapy and radiotherapy at the age of 3 years. The patient was recalled regularly for follow-up at 3 month intervals for ophthalmic examinations and she was rehabilitated cosmetically with customised ocular prosthesis during the various stages of her developmental growth. PMID:24249955

  15. Pelvic radiculopathies, lumbosacral plexopathies, and neuropathies in oncologic disease: a multidisciplinary approach to a diagnostic challenge

    PubMed Central

    Berry, Jonathan; Nisbet, Angus; Bloomfield, David; Burkill, Guy

    2013-01-01

    Abstract The purpose of this article is to familiarize the reader with the anatomy of the major pelvic nerves and the clinical features of associated lumbosacral plexopathies. To demonstrate this we illustrate several cases of malignant lumbosacral plexopathy on computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography. A new lumbosacral plexopathy in a patient with a prior history of abdominal or pelvic malignancy is usually of malignant etiology. Biopsies may be required to definitively differentiate tumour from posttreatment fibrosis, and in cases of inconclusive sampling or where biopsies are not possible, follow-up imaging may be necessary. In view of the complexity of clinical findings often confounded by a history of prior surgery and/or radiotherapy, a multidisciplinary approach between oncologists, neurologists, and radiologists is often required for what can be a diagnostic challenge. PMID:24433993

  16. Multidisciplinary studies, systems approaches and parasite eco-epidemiology: something old, something new.

    PubMed

    Giraudoux, P; Raoul, F; Pleydell, D; Craig, P S

    2008-09-01

    Parasite requires an understanding of complex transmission systems where individual, population and environmental factors and their interactions can hardly been considered separately. Moreover, the importance of space and time in host population and parasite transmission processes is increasingly recognised. The present review illustrates how epidemiology and transmission ecology have evolved in a multidisciplinary framework to a systems approach that includes both spatial and temporal dimensions. Focusing on population processes, three significant challenges are discussed: (i) integration of landscape ecology concepts and modelling across time-space scales, (ii) development of molecular methods that permits easy parasite/host identification and process tracking (e.g. host and parasite movements), and (iii) integration of sociology methods to estimate zoonotic risk and exposure.

  17. The "resistant hypertension team": focus on a multidisciplinary approach to hypertension.

    PubMed

    Potthoff, Sebastian A; Rump, Lars C; Vonend, Oliver

    2013-05-01

    Renal denervation (RDN) as a catheter-based procedure was introduced in 2009. As a reinvention of an old concept this approach in treating resistant hypertension has been gathering an unprecedented momentum in the world of hypertension. The incredible success in introducing this technique, followed by its quick and wide distribution, introduced new challenges and requirements for hypertension centres in offering optimal patient care. The challenges of these new parameters and requirements have to be met not only by a multidisciplinary team of doctors who can provide excellent evaluation, treatment and follow-up of these patients, but also by the hypertension centres themselves, who wish to provide this treatment option to their patients.

  18. Multidisciplinary forensic approach--investigation of a neonaticide and alleged concomitant rape.

    PubMed

    Kahana, T; Penner, M; Nachman, R; Hiss, J

    2005-06-01

    In the case presented, a young woman claimed to have spontaneously aborted a 30-weeks old fetus conceived after being raped by her cousin. The police investigation was centred on a probable neonaticide, mitigated by a possible rape. In Israel, the crime of rape carries a heavy punishment similar to that of first degree murder. Thus the implementation of the most recent scientific forensic techniques is of paramount importance in charging or clearing a suspected rapist. The skeletonized fetal remains were found four months after the reputed abortion. The alleged neonaticide was supported by the results of the forensic clinical and anthropological examinations, while the rape accusation was dismissed by the results of the molecular biology identification of the skeletonized fetal remains. The aim of this report is to encourage the forensic community to apply a multi-disciplinary approach, thus maximizing the decision making competence of the courts of law.

  19. Improving Outcomes Following Extremity Trauma: The Need for a Multidisciplinary Approach.

    PubMed

    Stinner, Daniel J

    2016-11-01

    Extremity injuries contribute a significant amount to the overall disability of combat-injured soldiers. Tracking patient outcomes allows military health care providers to gain a better understanding of the disability associated with various injury patterns. Only recently have orthopedic surgeons begun to collect functional outcome measures, and perhaps even more importantly, have begun to collect patient-reported outcomes. There is a growing body of evidence demonstrating the importance of a multidisciplinary approach to optimize outcomes in patients following severe extremity trauma. Tracking the outcomes of these interventions longitudinally will ultimately provide the military surgeon with an evidence-based plan to treat severe combat-related extremity injuries, leading to optimal care for future combat injured patients. "However beautiful the strategy, you should occasionally look at the results."-Winston Churchill. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  20. Implementing a Multidisciplinary Approach to Treating Tuberous Sclerosis Complex: A Case Report.

    PubMed

    Gipson, Tanjala T; Poretti, Andrea

    2017-01-01

    Tuberous sclerosis complex is expressed throughout the body, resulting in a range of clinical manifestations that can be challenging to manage. The authors report a patient who presented at age 3.5 years with several suspected seizures and was diagnosed with tuberous sclerosis complex following the discovery of numerous bilateral cortical tubers and subependymal nodules on magnetic resonance imaging. Interdisciplinary, comprehensive care was recommended; this included ongoing surveillance to monitor for the development of tuberous sclerosis complex-associated conditions. Approximately 2 years later, the patient began exhibiting aggressive and self-injurious behavior, and a subependymal giant cell astrocytoma was discovered. After everolimus was initiated, he demonstrated less aggression, had ceased self-injurious behavior, and subependymal giant cell astrocytoma growth stabilized. This case highlights the importance of a multidisciplinary approach to care in tuberous sclerosis complex, which ensures the early detection and appropriate treatment of clinical manifestations that may arise during the course of the patient's life.

  1. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    PubMed Central

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  2. How to Boost the Breast Tumor Bed? A Multidisciplinary Approach in Eight Steps

    SciTech Connect

    Kirova, Youlia M. Fournier-Bidoz, Nathalie; Servois, Vincent; Laki, Fatima; Pollet, Guillaume A.; Salmon, Remy; Thomas, Alexandra; Dendale, Remi; Bollet, Marc A.; Campana, Francois M.D.; Fourquet, Alain

    2008-10-01

    Purpose: To describe a new procedure for breast radiotherapy that will improve tumor bed localization and radiotherapy treatment using a multidisciplinary approach. Patients and Methods: This pilot study was conducted by departments of radiation oncology, surgery, and radiology. A new procedure has been implemented, summarized as eight steps: from pre-surgery contrast CT to surgery, tumor bed planning target volume (PTV) determination, and finally breast and tumor bed irradiation. Results: Twenty patients presenting with T1N0M0 tumors were enrolled in the study. All patients underwent lumpectomy with the placement of surgical clips in the tumor bed region. During surgery, 1 to 5 clips were placed in the lumpectomy cavity before the plastic procedure. All patients underwent pre- and postoperative CT scans in the treatment position. The two sets of images were registered with a match-point registration. All volumes were contoured and the results evaluated. The PTV included the clips region, the gross tumor volume, and the surgical scar, with an overall margin of 5-10 mm in all directions, corresponding to localization and setup uncertainties. For each patient the boost PTV was discussed and compared with our standard forward-planned PTV. Conclusions: We demonstrate the feasibility of a tumor bed localization and treatment procedure that seems adaptable to routine practice. Our study shows the advantages of a multidisciplinary approach for tumor bed localization and treatment. The use of more than 1 clip associated with pre- to postoperative CT image registration allows better definition of the PTV boost volume.

  3. A case of small bowel mesenteric pneumatosis: A multidisciplinary approach to clinical interpretation and intervention

    PubMed Central

    Johnstone, Christopher; Salih, Tamir; Saha, Arin

    2016-01-01

    Introduction Pneumatosis of the small bowel mesentery is rare and the preserve of case reports. This case report describes the importance of a multi-disciplinary team (MDT) approach to rare pathologies. Case report A 78-year-old man presented to our unit with a two-day history of upper abdominal pain associated with nausea and intermittent vomiting. An urgent computed tomography (CT) scan was organised. The scan was grossly abnormal and difficult to interpret; it was reported as widespread intra-mural gas within the small bowel wall most likely secondary to extensive small bowel ischaemia. Although surgical intervention was very high risk (predicted P-possum mortality of over 60%) and there was a strong possibility that the patient would not recover from surgery, the disparity between clinical and radiological findings meant that a diagnostic laparoscopy was indicated. A diagnostic laparoscopy showed that the small bowel itself was normal but there was extensive gas within the mesentery, caused by a band adhesion which had eroded into the peritoneal layer of the small bowel mesentery. Discussion Pneumatosis of the small bowel mesentery is a pathological sign rather than a diagnosis and is characterised by gas within the mesenteric sleeves. It is likely associated with significant morbidity and therefore rarely observed as the majority with this sign would not be deemed suitable for surgical intervention. Conclusion The case highlights an unusual pathology, rare imaging findings, the importance of a multi-disciplinary approach and the value of clear communication and informed consent when considering major intervention or surgery. PMID:27082993

  4. A Case Report of Esthetic and Functional Correction of Maxillary Protrusion Using a Prosthodontics-Centered Multidisciplinary Approach.

    PubMed

    Xie, Cuiliu; Meng, Yukun

    2016-01-01

    Maxillary protrusion usually requires orthodontic therapy and orthognathic surgery. However, for some exceptional cases, a prosthodontics-centered multidisciplinary approach could serve as an alternative. This case report describes a 53-year-old patient with protrusive and proclined maxillary incisors, compensatory eruption of mandibular incisors, color and morphologic abnormalities of anterior teeth lip incompetence, and gummy smile. Final esthetic improvement was achieved in this patient by means of a multidisciplinary approach involving endodontic and periodontal procedures before prosthodontic treatment. Accurate diagnosis, comprehensive communication, a sophisticated treatment plan, and state-of-the-art therapeutic processes are all important factors for achieving a predictable esthetic result.

  5. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care

    PubMed Central

    Gupta, Priyanka; Gaines, Natalie; Sirls, Larry T.

    2015-01-01

    Interstitial cystitis/bladder pain syndrome (IC/BPS) is a complex syndrome that has long been treated with bladder directed therapies, which often fail to address the multiple underlying etiologies that can contribute to this disease process. This disease often involves symptoms that extend beyond the bladder and involve the pelvic floor making it crucial for clinicians to approach the patient using a multidisciplinary team. This article will discuss the underlying etiologies for IC/BPS and describe the multidisciplinary approach which we have found to be extremely successful in managing this patient population. PMID:26816861

  6. A multidisciplinary approach of the problem of noise nuisance in urban environment

    NASA Astrophysics Data System (ADS)

    Rabah, Derbal Cobis; Hamza, Zeghlache

    2002-05-01

    More often the problem of noise and sonic pollution, particularly in urban sites, is studied by different disciplines such as physics, the acoustics, the psychoacoustics, the medicine and others. It is independently of each other that these sciences are often approaching this subject. Some studies are carried out in laboratories taking noise as samples cut off their realistic context. Urban noise is studied as well by making an abstraction of the different contextual parameters by idealizing a rather complex sonic environment. The noise, according to this present approach, is suposed to react with surounding space, and it takes the form and the quality of the place by defining and requalifying it. It is found that the contextual aspects such as social, cultural or even symbolic dimensions modulate the listening conditions and the perception quality of the noise and even the living and the daily practice of the urban space. The multiparameter dimension study of the noise in an urban context is necessary to better work out the problem and to try to come up with some practical and efficient solutions. The little amount of studies based on such multidisciplinary approach, confort well our effort to go ahead with this methodological approach.

  7. Benefits and limitations of a multidisciplinary approach to individualized management of Cornelia de Lange syndrome and related diagnoses.

    PubMed

    January, Kathleen; Conway, Laura J; Deardorff, Matthew; Harrington, Ann; Krantz, Ian D; Loomes, Kathleen; Pipan, Mary; Noon, Sarah E

    2016-06-01

    Given the clinical complexities of Cornelia de Lange Syndrome (CdLS), the Center for CdLS and Related Diagnoses at The Children's Hospital of Philadelphia (CHOP) and The Multidisciplinary Clinic for Adolescents and Adults at Greater Baltimore Medical Center (GBMC) were established to develop a comprehensive approach to clinical management and research issues relevant to CdLS. Little work has been done to evaluate the general utility of a multispecialty approach to patient care. Previous research demonstrates several advantages and disadvantages of multispecialty care. This research aims to better understand the benefits and limitations of a multidisciplinary clinic setting for individuals with CdLS and related diagnoses. Parents of children with CdLS and related diagnoses who have visited a multidisciplinary clinic (N = 52) and who have not visited a multidisciplinary clinic (N = 69) were surveyed to investigate their attitudes. About 90.0% of multispecialty clinic attendees indicated a preference for multidisciplinary care. However, some respondents cited a need for additional clinic services including more opportunity to meet with other specialists (N = 20), such as behavioral health, and increased information about research studies (N = 15). Travel distance and expenses often prevented families' multidisciplinary clinic attendance (N = 41 and N = 35, respectively). Despite identified limitations, these findings contribute to the evidence demonstrating the utility of a multispecialty approach to patient care. This approach ultimately has the potential to not just improve healthcare for individuals with CdLS but for those with medically complex diagnoses in general. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach

    PubMed Central

    Inagaki, Elica; Farber, Alik; Eslami, Mohammad H.; Siracuse, Jeffrey J.; Rybin, Denis V.; Sarosiek, Shayna; Sloan, J. Mark; Kalish, Jeffrey

    2017-01-01

    Objective The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. Methods All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. Results In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P < .001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P < .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P = .9). Conclusions The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary

  9. Patient-centered Diabetes Care in Children: An Integrated, Individualized, Systems-oriented, and Multidisciplinary Approach

    PubMed Central

    Meusers, Michael; Quecke, Birgit; Hilgard, Dörte

    2013-01-01

    Background: Type 1 diabetes mellitus in children is associated with various medical, psychological, emotional, social, and organizational hurdles. Patient-centered disease management should address all patient-relevant issues in an individualized, systems-oriented, and multidisciplinary approach. Case: A 10-year-old girl with type 1 diabetes mellitus, a developmental disorder with motor and sensory dysfunction and dyscalculia was cared for full-time by her mother and an assistant nurse. Receiving standard intensified insulin therapy, she still had poor glucose control with frequent mild and severe hypoglycemic episodes. She was socially isolated and not able to attend peer activities and was frustrated with her situation. The mother was substantially stressed, and the child-mother relationship was endangered. The girl and her family were referred to an integrated, patient-centered, and highly individualized, multidisciplinary diabetic care program that offered self-management education courses and psychosomatic care. A core element was to switch the main focus from technical management and laboratory data to the girl and her specific problems, wishes, goals, needs, and conditions. The child became an active partner in management and decisions. The program offered age-appropriate activities. Consequently, the girl was able to successively self-manage her disease, resulting in a substantial improvement in glucose control, quality of life, satisfaction, and the relationship between mother and daughter. Conclusion: Increasing technical sophistication in diabetes management tends to lay the focus on biomedical outcomes. Improved medical and psychosocial results may be achieved when the patient and his or her needs, hurdles, goals, and psychological and social issues are made central to the care he or she receives. PMID:24278841

  10. Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

    PubMed Central

    Ellis, Michael J.; Leddy, John; Willer, Barry

    2016-01-01

    Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review, we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further evaluate this evolving pathophysiological approach. PMID:27605923

  11. A Systematic Approach for Quantitative Analysis of Multidisciplinary Design Optimization Framework

    NASA Astrophysics Data System (ADS)

    Kim, Sangho; Park, Jungkeun; Lee, Jeong-Oog; Lee, Jae-Woo

    An efficient Multidisciplinary Design and Optimization (MDO) framework for an aerospace engineering system should use and integrate distributed resources such as various analysis codes, optimization codes, Computer Aided Design (CAD) tools, Data Base Management Systems (DBMS), etc. in a heterogeneous environment, and need to provide user-friendly graphical user interfaces. In this paper, we propose a systematic approach for determining a reference MDO framework and for evaluating MDO frameworks. The proposed approach incorporates two well-known methods, Analytic Hierarchy Process (AHP) and Quality Function Deployment (QFD), in order to provide a quantitative analysis of the qualitative criteria of MDO frameworks. Identification and hierarchy of the framework requirements and the corresponding solutions for the reference MDO frameworks, the general one and the aircraft oriented one were carefully investigated. The reference frameworks were also quantitatively identified using AHP and QFD. An assessment of three in-house frameworks was then performed. The results produced clear and useful guidelines for improvement of the in-house MDO frameworks and showed the feasibility of the proposed approach for evaluating an MDO framework without a human interference.

  12. Teaching the bioinformatics of signaling networks: an integrated approach to facilitate multi-disciplinary learning.

    PubMed

    Korcsmaros, Tamas; Dunai, Zsuzsanna A; Vellai, Tibor; Csermely, Peter

    2013-09-01

    The number of bioinformatics tools and resources that support molecular and cell biology approaches is continuously expanding. Moreover, systems and network biology analyses are accompanied more and more by integrated bioinformatics methods. Traditional information-centered university teaching methods often fail, as (1) it is impossible to cover all existing approaches in the frame of a single course, and (2) a large segment of the current bioinformation can become obsolete in a few years. Signaling network offers an excellent example for teaching bioinformatics resources and tools, as it is both focused and complex at the same time. Here, we present an outline of a university bioinformatics course with four sample practices to demonstrate how signaling network studies can integrate biochemistry, genetics, cell biology and network sciences. We show that several bioinformatics resources and tools, as well as important concepts and current trends, can also be integrated to signaling network studies. The research-type hands-on experiences we show enable the students to improve key competences such as teamworking, creative and critical thinking and problem solving. Our classroom course curriculum can be re-formulated as an e-learning material or applied as a part of a specific training course. The multi-disciplinary approach and the mosaic setup of the course have the additional benefit to support the advanced teaching of talented students.

  13. A multidisciplinary approach for the management of pathologic tooth migration in a patient with moderately advanced periodontal disease.

    PubMed

    Kim, Young-Il; Kim, Myung-Jin; Choi, Jeom-Il; Park, Soo-Byung

    2012-04-01

    The physiologic tooth position is determined by interactions between the periodontal tissue and occlusal, tongue, and lip forces. Bone destruction resulting from chronic periodontal disease disturbs the equilibrium of these interactive balances, leading to pathologic tooth migration, often requiring multidisciplinary treatment approaches. The present case demonstrates a systematic periodontal-orthodontic-prosthetic treatment for achieving the optimal structural, functional, and esthetic outcomes.

  14. A multi-disciplinary approach to sugarcane research at the USDA, ARS, Sugarcane Research Unit in Houma

    USDA-ARS?s Scientific Manuscript database

    The mission of the Sugarcane Research Unit (SRU) is to provide research-based solutions that enhance the viability of domestic sugarcane industry. To accomplish this mission, SRU uses a multidisciplinary approach to develop improved varieties and environmentally friendly production strategies. Cons...

  15. Critical Education for Work: Multidisciplinary Approaches. Social and Policy Issues in Education: The David C. Anchin Series.

    ERIC Educational Resources Information Center

    Lakes, Richard D., Ed.

    This book expands the meaning of today's education for work by offering five multidisciplinary approaches--school-to-work transitions, gender equity, labor education, economic democracy, and vocational education--revealing the complexities of personal, social, and cultural transformation. "Critical Education for Work" (Richard D. Lakes)…

  16. Critical Education for Work: Multidisciplinary Approaches. Social and Policy Issues in Education: The David C. Anchin Series.

    ERIC Educational Resources Information Center

    Lakes, Richard D., Ed.

    This book expands the meaning of today's education for work by offering five multidisciplinary approaches--school-to-work transitions, gender equity, labor education, economic democracy, and vocational education--revealing the complexities of personal, social, and cultural transformation. "Critical Education for Work" (Richard D. Lakes)…

  17. Hannah's Feeding Journey: A Multidisciplinary Treatment Approach to Establishing Oral Acceptance for a Toddler with a Complex Medical History

    ERIC Educational Resources Information Center

    Dunn, Dena M.; Galbally, Sandra Lynn; Markowitz, Goldie; Pucci, Kristy N.; Brochi, Ligia; Cohen, Sherri Shubin

    2017-01-01

    This article presents the importance of multidisciplinary, family-centered care, and a developmental bio-psycho-social approach to treating feeding difficulties in a child with a complex medical history. Hannah spent the first 9 months of her life in the hospital and was discharged dependent on nasogastric tube feeding. Her journey to recovery…

  18. A multidisciplinary team case management approach reduces the burden of frequent asthma admissions.

    PubMed

    Burke, Hannah; Davis, Jenny; Evans, Sian; Flower, Laura; Tan, Andrew; Kurukulaaratchy, Ramesh J

    2016-07-01

    Up to 10% of asthmatics have "difficult asthma"; however, they account for 80% of asthma-related expenditure and run the highest risk of acute severe exacerbations. An estimated 75% of admissions for asthma are avoidable. Guidelines advise that these patients be managed by an experienced specialist multidisciplinary team (MDT). We aimed to assess the impact of a case management strategy delivered via specialist MDTs on acute healthcare utilisation of patients with frequent asthma admissions. An MDT (consultant, specialist nurse, physiotherapist and psychologist) case management strategy was introduced in 2010 at University Hospital Southampton Foundation Trust (Southampton, UK) to support patients with frequent asthma admissions during admission and then in clinic. To assess efficacy, we systematically searched the hospital database for patients acutely admitted for asthma on two or more occasions in 2010, 2011 and 2012. Data were collected retrospectively covering patient demographics, admission details, asthma severity and comorbidity. From 2010 to 2012, 84 patients were admitted on two or more occasions per year (80% female, mean body mass index 31 kg·m(-2) and 55% psychological comorbidity). After introducing an MDT approach repeat asthma admissions fell by 33% from 127 in 2010 to 84 in 2012 (p=0.0004). In addition, bed days fell by 52% from 895 in 2010 to 430 in 2010 (p=0.015). An MDT case management approach significantly reduces hospitalisation in difficult asthma patients with prior frequent admission.

  19. A multidisciplinary team case management approach reduces the burden of frequent asthma admissions

    PubMed Central

    Burke, Hannah; Davis, Jenny; Evans, Sian; Flower, Laura; Tan, Andrew

    2016-01-01

    Up to 10% of asthmatics have “difficult asthma”; however, they account for 80% of asthma-related expenditure and run the highest risk of acute severe exacerbations. An estimated 75% of admissions for asthma are avoidable. Guidelines advise that these patients be managed by an experienced specialist multidisciplinary team (MDT). We aimed to assess the impact of a case management strategy delivered via specialist MDTs on acute healthcare utilisation of patients with frequent asthma admissions. An MDT (consultant, specialist nurse, physiotherapist and psychologist) case management strategy was introduced in 2010 at University Hospital Southampton Foundation Trust (Southampton, UK) to support patients with frequent asthma admissions during admission and then in clinic. To assess efficacy, we systematically searched the hospital database for patients acutely admitted for asthma on two or more occasions in 2010, 2011 and 2012. Data were collected retrospectively covering patient demographics, admission details, asthma severity and comorbidity. From 2010 to 2012, 84 patients were admitted on two or more occasions per year (80% female, mean body mass index 31 kg·m−2 and 55% psychological comorbidity). After introducing an MDT approach repeat asthma admissions fell by 33% from 127 in 2010 to 84 in 2012 (p=0.0004). In addition, bed days fell by 52% from 895 in 2010 to 430 in 2010 (p=0.015). An MDT case management approach significantly reduces hospitalisation in difficult asthma patients with prior frequent admission. PMID:27730207

  20. Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach.

    PubMed

    Mao, Feng; Dong, Yi; Ji, Zhengbiao; Cao, Jiaying; Wang, Wen-Ping

    2017-01-01

    Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group (n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

  1. Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach

    PubMed Central

    Mao, Feng; Dong, Yi; Ji, Zhengbiao; Cao, Jiaying

    2017-01-01

    Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group (n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management. PMID:28133613

  2. Transthoracic approach for lesions involving the anterior dorsal spine: A multidisciplinary approach with good outcomes.

    PubMed

    Balasubramaniam, Srikant; Tyagi, Devendra K; Zafar, Sheikh H; Savant, Hemant V

    2016-01-01

    Anterior approach provides excellent visualization and access to the anterior thoracic spine. It may be used alone, in combination with a posterior midline approach or in a staged or sequential fashion. To analyse our institutional experience in transthoracic approaches and to determine the safety and benefit of this approach in our patient series. A total of 16 patients were operated for varying lesions of body of dorsal vertebra by the transthoracic approach. The study was for a period of 5 years from January 2011 to December 2015. Patients age ranged from 25 to 61 years with an average of 36.4 yrs. There were 7 males and 9 females. In our series 9 patients had Kochs spine, 4 patients were traumatic fracture spine and 3 had neoplastic lesion. Majority of patients had multiple symptoms with backache being present in all patients. There was one post operative mortality which was unrelated to surgery. One patient had post operative delayed kyphosis. Remaining patients improved in their symptoms following surgery. With careful coordination by thoracic surgeons, neurospinal surgeons and anaesthetists, the anterior spine approach for dorsal spine is safe and effective. Adequate preoperative evaluation should stratify the risk and institute measures to reduce it. Accurate surgical planning and careful surgical technique are the key to yield a good outcome and to reduce the risk of complications.

  3. Transthoracic approach for lesions involving the anterior dorsal spine: A multidisciplinary approach with good outcomes

    PubMed Central

    Balasubramaniam, Srikant; Tyagi, Devendra K; Zafar, Sheikh H; Savant, Hemant V

    2016-01-01

    Introduction: Anterior approach provides excellent visualization and access to the anterior thoracic spine. It may be used alone, in combination with a posterior midline approach or in a staged or sequential fashion. Aims: To analyse our institutional experience in transthoracic approaches and to determine the safety and benefit of this approach in our patient series. Materials and Methods: A total of 16 patients were operated for varying lesions of body of dorsal vertebra by the transthoracic approach. The study was for a period of 5 years from January 2011 to December 2015. Patients age ranged from 25 to 61 years with an average of 36.4 yrs. There were 7 males and 9 females. In our series 9 patients had Kochs spine, 4 patients were traumatic fracture spine and 3 had neoplastic lesion. Majority of patients had multiple symptoms with backache being present in all patients. Results: There was one post operative mortality which was unrelated to surgery. One patient had post operative delayed kyphosis. Remaining patients improved in their symptoms following surgery. Conclusion: With careful coordination by thoracic surgeons, neurospinal surgeons and anaesthetists, the anterior spine approach for dorsal spine is safe and effective. Adequate preoperative evaluation should stratify the risk and institute measures to reduce it. Accurate surgical planning and careful surgical technique are the key to yield a good outcome and to reduce the risk of complications. PMID:27891033

  4. A multi-disciplinary approach for the integrated assessment of water alterations under climate change

    NASA Astrophysics Data System (ADS)

    Sperotto, Anna; Torresan, Silvia; Molina, Jose Luis; Pulido Velazquez, Manuel; Critto, Andrea; Marcomini, Antonio

    2017-04-01

    Understanding the co-evolution and interrelations between natural and human pressures on water systems is required to ensure a sustainable management of resources under uncertain climate change conditions. To pursue multi-disciplinary research is therefore necessary to consider the multiplicity of stressors affecting water resources, take into account alternative perspectives (i.e. social, economic and environmental objective and priorities) and deal with uncertainty which characterize climate change scenarios. However, approaches commonly adopted in water quality assessment are predominantly mono-disciplinary, single-stressors oriented and apply concepts and models specific of different academic disciplines (e.g. physics, hydrology, ecology, sociology, economy) which, in fact, seldom shed their conceptual blinders failing to provide truly integrated results. In this context, the paper discusses the benefits and limits of adopting a multi-disciplinary approach where different knowledge domains collaborate and quantitative and qualitative information, coming from multiple conceptual and model-based research, are integrated in a harmonic manner. Specifically, Bayesian Networks are used as meta-modelling tool for structuring and combining the probabilistic information available in existing hydrological models, climate change and land use projections, historical observations and expert opinion. The developed network allows to perform a stochastic multi-risk assessment considering the interlacing between climate (i.e. irregularities in water regime) and land use changes (i.e. agriculture, urbanization) and their cascading impacts on water quality parameters (i.e. nutrients loadings). Main objective of the model is the development of multi-risk scenarios to assess and communicate the probability of not meeting a "Good chemical water status" over future timeframe taking into account projected climatic and not climatic conditions. The outcomes are finally used to identify

  5. Multidisciplinary team approach to traumatic spinal cord injuries: a single institution's quality improvement project.

    PubMed

    Alizo, Georgina; Sciarretta, Jason D; Gibson, Stefanie; Muertos, Keely; Holmes, Sharon; Denittis, Felicia; Cheatle, Joseph; Davis, John; Pepe, Antonio

    2017-04-10

    A stepwise multidisciplinary team (MDT) approach to the injured trauma patient has been reported to have an overall benefit, with reduction in mortality and improved morbidity. Based on clinical experience, we hypothesized that implementation of a dedicated Spinal Cord Injury Service (SCIS) would impact outcomes of a patient specific population on the trauma service. The trauma center registry was retrospectively queried, from January 2011 through December 2015, for patients presenting with a spinal cord injury. In 2013, a twice weekly rounding SCIS MDT was initiated. This new multidisciplinary service, the post-SCIS, was compared to the 2011-2012 pre-SCIS. The two groups were compared across patient demographics, mechanism of injury, surgical procedures, and disposition at discharge. The primary outcome was mortality. Secondary endpoints also included the incidence of complications, hospital length of stay (HLOS), ICU LOS, ventilator free days, and all hospital-acquired infectious complications. Logistic regression and Student's t test were used to analyze data. Ninety-five patients were identified. Of these patients, 41 (43%) pre-SCIS and 54 (57%) post-SCIS patients were compared. Mean age was 46.9 years and 79% male. Overall, adjusted mortality rate between the two groups was significant with the implementation of the post-SCIS (p = 0.033). In comparison, the post-SCIS revealed shorter HLOS (23 vs 34.8 days, p = 0.004), increased ventilator free days (20.2 vs 63.3 days, p < 0.001), and less nosocomial infections (1.8 vs 22%, p = 0.002). While the post-SCIS mean ICU LOS was shorter (12 vs 17.9 days, p = 0.089), this relationship was not significant. The application of an SCIS team in addition to the trauma service suggests that a structured coordinated approach can have an expected improvement in hospital outcomes and shorter length of stays. We believe that this clinical collaboration provides distinct specialist perspectives and, therefore

  6. A multidisciplinary methodological approach for slope stability assessment of an area prone to shallow landslides

    NASA Astrophysics Data System (ADS)

    Bordoni, Massimiliano; Meisina, Claudia; Valentino, Roberto; Bittelli, Marco; Battista Bischetti, Gian; Vercesi, Alberto; Chersich, Silvia; Giuseppina Persichillo, Maria

    2016-04-01

    Rainfall-induced shallow landslides are widespread slope instabilities phenomena in several hilly and mountainous contexts all over the world. Due to their high density of diffusion also in small areas, they can provoke important damages to terrains, infrastructures, buildings, and, sometimes, loss of human lives. Shallow landslides affect superficial soils of limited thickness (generally lower than 2 m), located above weathered or not bedrock levels. Their triggering mechanism is strictly linked to the hydrological response of the soils to rainfall events. Thus, it becomes fundamental a comprehensive analysis of the soil properties which can influence the susceptibility of a slope to shallow landslides. In this study, a multidisciplinary approach was followed for the characterization of the soils and the individuation of the triggering conditions in an area particularly prone to shallow failures, for slope stability assessment. This area corresponded to the hilly sector of North-Eastern Oltrepò Pavese (Lombardy Region, Northern Italy), where the density of shallow landslides is really high, reaching more than 36 landslides per km2. The soils of the study area were analyzed through a multidisciplinary characterization, which took into account for the main geotechnical, mechanical and mineralogical parameters and also for the main pedological features of the materials. This approach allowed for identifying the main features and the horizons which could influence the soil behavior in relation to the conditions that are preparatory to shallow landslides development. In a test-site slope, representative of the main geomorphological, geological and landslides distribution characteristics typical of the study area, a continuous in time monitoring of meteorological (rainfall amount, air temperature, air humidity, atmospheric pressure, net solar radiation, wind speed and direction) and hydrological (soil water content, pore water pressure) parameters was implemented. In

  7. Multidisciplinary approaches to understanding auditory hallucinations in schizophrenia and nonschizophrenia populations: the International Consortium on Hallucination Research.

    PubMed

    Waters, Flavie

    2012-06-01

    This special theme issue of Schizophrenia Bulletin presents a series of related articles focusing on auditory hallucinations, prepared by members of the International Consortium on Hallucination Research [InCoHR] working groups. The InCoHR is a large collaborative framework that serves as a platform for researchers to meet and collaborate on multidisciplinary projects relating to auditory hallucinations [AH] and discuss methodological issues facing transdiagnostic research. Laroi et al. observe the similarities in characteristic features of AHs in different clinical and nonclinical groups, but they also note that differences exist, reflecting the contribution of disease-related process. Waters et al. use findings of shared cognitive impairments across different diagnostic groups with AHs to propose a novel theoretical cognitive framework. Allen et al. describe that the neurobiological substrates of AHs include neural systems involved in language processing, as well as sensory and nonsensory brain regions and that studies are increasingly using fine-grain analysis of patients' characteristics in analyzing neuroimaging data. Ford et al. discuss different neurophysiological approaches and describes hallucination-related alterations in activity in temporal and frontal regions of the brain and particularly in auditory cortical areas. Finally, Sommer et al. review different treatment options for AHs in schizophrenia and other disorders, including pharmacological treatment, cognitive-behavioral therapy [CBT] and acceptance and commitment therapy [ACT], transcranial magnetic stimulation [TMS], and electroconvulsive therapy [ECT]. These related publications describe the current substance and direction of research on AHs across different diagnostic groups.

  8. 'Taking public health out of the ghetto': the policy and practice of multi-disciplinary public health in the United Kingdom.

    PubMed

    Evans, David

    2003-09-01

    Until recently, a medical qualification was required for senior public health posts in the UK National Health Service. Since 1997, the new Labour government has expressed its intention to take public health 'out of the ghetto' and to develop multi-disciplinary public health. In particular, it has announced the creation of a new senior professional role of specialist in public health equivalent to the consultant in public health medicine, and open to a range of disciplines. This paper asks 'what is really going on with the policy and practice of multi-disciplinary public health in the UK?' The answer draws on recent debates in the sociology of the professions, in particular the theoretical perspectives of Freidson (Profession of Medicine: a Study of the Sociology of Applied Knowledge, Dodd, Mead & Co, New York, 1970; Professional Powers: a Study of the Institutionalization of Formal Knowledge, University of Chicago Press, Chicago, 1986) and Larson (The Rise of Professionalism: a Sociological Analysis, University of California Press, Berkeley, 1977) concerning the 'professional project', Foucault's (Ideol. Consciousness 6 (1979) 5) notion of 'governmentality' and Harrison and Wood's (Public Admin. 77 (1999) 751) concept of 'manipulated emergence'. Key characteristics of the professional project are 'autonomy', the profession's ability to control its technical knowledge and application, and 'dominance', control over the work of others in the health care division of labour. Although useful as an explanatory framework for the period 1972-1997, the concept of the professional project does not easily explain the process of change since 1997. Here Foucault's concept of governmentality is helpful. Governmentality entails all those procedures, techniques, mechanisms, institutions and knowledges that empower political programmes. Professions are part of the process of governmentality, and their autonomy is always contingent upon the wider political context. Thus public health

  9. Analyzing public health policy: three approaches.

    PubMed

    Coveney, John

    2010-07-01

    Policy is an important feature of public and private organizations. Within the field of health as a policy arena, public health has emerged in which policy is vital to decision making and the deployment of resources. Public health practitioners and students need to be able to analyze public health policy, yet many feel daunted by the subject's complexity. This article discusses three approaches that simplify policy analysis: Bacchi's "What's the problem?" approach examines the way that policy represents problems. Colebatch's governmentality approach provides a way of analyzing the implementation of policy. Bridgman and Davis's policy cycle allows for an appraisal of public policy development. Each approach provides an analytical framework from which to rigorously study policy. Practitioners and students of public health gain much in engaging with the politicized nature of policy, and a simple approach to policy analysis can greatly assist one's understanding and involvement in policy work.

  10. Integrated therapeutic approaches in head and neck cancer: the importance of multidisciplinary team management.

    PubMed

    Perri, Francesco; Muto, Paolo; Aversa, Corrado; Daponte, Antonio; Della Vittoria, Giuseppina; Pepe, Stefano; Caponigro, Francesco

    2013-07-01

    Multidisciplinary team (MDT) is of paramount importance in the approach to patients with head and neck cancer. Its aim is to provide the best diagnostic work-up, tumor staging, and treatment. Furthermore, the prognosis of patients who are managed by MDT is usually better. MDT has a great value in all presentation settings. The role of the pathologist in the team is of utmost importance, in particular with regards to information provided on Human Papilloma Virus (HPV) status, which has a well acknowledged independent prognostic value mainly in oropharyngeal carcinoma. In early stage disease, namely in T1-2 N0 M0 patients, the meetings within the MDT mainly involve surgeons and radiation therapists. Surgery represents the mainstay of treatment, while radiation therapy is a suitable alternative, in particular in patients with advanced age, poor performance status and comorbidities. In locally advanced disease, surgeons, medical oncologists and radiotherapists are the key people, since different approaches have been carried out. In operable patients, adjuvant chemoradiation is indicated when resection margins are involved or close, or in presence of extracapsular nodal spread. Concurrent chemoradiotherapy, preceded or not by induction chemotherapy, is the favourite approach in this setting when surgery is strictly not indicated. In recurrent/metastatic disease chemotherapy and best supportive care are the main options, although local treatments, such as reirradiation and salvage surgery, are also worth considering. The standard chemotherapy treatment has finally evolved after about 30 years, and strong efforts are being pursued to further improve the outcome, mainly with the addition of new drugs.

  11. A multidisciplinary approach to fertility-sparing therapy for a rare vulvar tumor.

    PubMed

    Dicken, Cary L; Lieman, Harry J; Dayal, Ashlesha K; Mutyala, Subhakar; Einstein, Mark H

    2010-01-01

    Case report of a young woman with a rare vulvar malignancy who received treatment with a personalized multidisciplinary approach to balance management of her malignancy without compromising survival with her desire for future pregnancy. Case report. University hospital. A 33-year-old woman, gravida 2, para 1-0-1-1, who had a diagnosis of synovial cell sarcoma of the vulva and who desired future fertility. At multiple steps, treatment was planned to try to maximize fertility preservation without potentially affecting initial treatment, which included a radical hemivulvectomy with bilateral lymph node dissection, brachytherapy with interstitial needles (20 Gy), and external beam radiation therapy (50 Gy). Treatment and eradication of the malignancy and achievement of a successful subsequent pregnancy and live birth. The patient had no evidence of disease for 2 years after treatment. During that time she received preconception counseling by both a perinatologist and a reproductive endocrinologist. She conceived with the use of ultrasound monitoring to time intercourse specifically with ovulation from the contralateral ovary and had an uncomplicated pregnancy with a term delivery. By using several disciplines and subspecialists, this patient received personalized treatment for a rare cancer, focused at curing her cancer and optimizing her future fertility. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  12. Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Multidisciplinary Approach

    PubMed Central

    Inafuku, Hitoshi; Nakamoto, Tomoko; Taira, Yusuke; Taira, Rie; Tsubakimoto, Maho; Totsuka, Yuichi; Kuniyoshi, Yukio; Tamaki, Tomoko; Aoyama, Hajime

    2016-01-01

    Background. A rare case of low-grade endometrial stromal sarcoma (LG-ESS) extending to inferior vena cava (IVC) and cardiac chambers. Case Report. A 40-year-old woman had IVC tumor, which was incidentally detected by abdominal ultrasonography during a routine medical checkup. CT scan revealed a tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. The operation was performed, the heart and IVC were exposed, and cardiopulmonary bypass was initiated. A right atriotomy was performed, and the intracardiac mass was removed. Then the tumor in IVC and the right internal iliac vein were removed after longitudinal venotomies in the suprarenal and infrarenal vena cava, the right common iliac vein. Next the pelvis was explored. Tumors were found originating from the posterior wall of the uterus and continuing into both the right uterine and ovarian vein. The patient underwent total hysterectomy with bilateral salpingooophorectomy. Complete tumor resection was achieved. Histopathological analysis confirmed a diagnosis of LG-ESS. She showed no evidence of disease for 2 years and 3 months. Conclusions. Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation. PMID:27239357

  13. Translating clinical research of Molecular Biology into a personalized, multidisciplinary approach of colorectal cancer patients.

    PubMed

    Strambu, V; Garofil, D; Pop, F; Radu, P; Bratucu, M; Popa, F

    2014-03-15

    Although multimodal treatment has brought important benefit, there is still great heterogeneity regarding the indication and response to chemotherapy in Stage II and III, and individual variations related to both overall survival and toxicity of new therapies in metastatic disease or tumor relapse. Recent research in molecular biology led to the development of a large scale of genetic biomarkers, but their clinical use is not concordant with the high expectations. The Aim of this review is to identify and discuss the molecular markers with proven clinical applicability as prognostic and/or predictive factors in CRC and also to establish a feasible algorithm of molecular testing, as routine practice, in the personalized, multidisciplinary approach of colorectal cancer patients in our country. Despite the revolution that occurred in the field of molecular marker research, only Serum CEA, Immunohistochemical analysis of mismatch repair proteins and PCR testing for KRAS and BRAF mutations have confirmed their clinical utility in the management of colorectal cancer. Their implementation in the current practice should partially resolve some of the controversies related to this heterogenic pathology, in matters of prognosis in different TNM stages, stage II patient risk stratification, diagnosis of hereditary CRC and likelihood of benefit from anti EGFR therapy in metastatic disease. The proposed algorithms of molecular testing are very useful but still imperfect and require further validation and constant optimization.

  14. Evaluation of Neurologic Deficit Without Apparent Cause: The Importance of a Multidisciplinary Approach

    PubMed Central

    Smith, Harvey E; Rynning, Ralph E; Okafor, Chukwuka; Zaslavsky, James; Tracy, Joseph I; Ratliff, John; Harrop, James; Albert, Todd; Hilibrand, Alan; Anderson, Gregory; Sharan, Ashwini; Brown, Zoe; Vaccaro, Alexander R

    2007-01-01

    Background/Objective: A patient presenting with an acute neurologic deficit with no apparent etiology presents a diagnostic dilemma. A broad differential diagnosis must be entertained, considering both organic and psychiatric causes. Methods: A case report and thorough literature review of acute paraplegia after a low-energy trauma without a discernible organic etiology. Results: Diagnostic imaging excluded any bony malalignment or fracture and any abnormality on magnetic resonance imaging. When no organic etiology was identified, a multidisciplinary approach using neurology, psychiatry, and physical medicine and rehabilitation services was applied. Neurophysiologic testing confirmed the absence of an organic disorder, and at this juncture, diagnostic efforts focused on identifying any psychiatric disorder to facilitate appropriate treatment for this individual. The final diagnosis was malingering. Conclusions: The full psychiatric differential diagnosis should be considered in the evaluation of any patient with an atypical presentation of paralysis. A thorough clinical examination in combination with the appropriate diagnostic studies can confidently exclude an organic disorder. When considering a psychiatric disorder, the differential diagnosis should include conversion disorder and malingering, although each must remain a diagnosis of exclusion. Maintaining a broad differential diagnosis and involving multiple disciplines (neurology, psychiatry, social work, medical specialists) early in the evaluation of atypical paralysis may facilitate earlier diagnosis and initiation of treatment for the underlying etiology. PMID:18092568

  15. Diagnosis and underdiagnosis of comorbidities in psoriasis patients - need for a multidisciplinary approach*

    PubMed Central

    Duarte, Gleison Vieira; de Oliveira, Maria de Fátima S. P.; Follador, Ivonise; Silva, Thadeu Santo; de Carvalho Filho, Edgar Marcelino

    2016-01-01

    BACKGROUND Psoriasis is an immune-mediated disease that manifests predominantly in the skin, although systemic involvement may also occur. Although associated comorbidities have long been recognized and despite several studies indicating psoriasis as an independent risk factor for cardiovascular events, little has been done in general medical practice regardind screening. In the United States, less than 50% of clinicians are aware of these recommendations. OBJECTIVE To identify the prevalence of these comorbidities in 296 patients followed up at a university dermatology clinic. METHODS Systematically investigated comorbidity frequencies were compared with general practitioners' registry frequencies. Clinical features correlated with comorbidities were also investigated. RESULTS High prevalences of systematically investigated comorbidities such as hypertension (30%) and dyslipidemia (26.5%) were documented. Conversely, data from general practitioners' records showed that 33% of dyslipidemia cases were undiagnosed and indicated possible underdiagnosis of some comorbidities. Furthermore, an association was found between: the number of comorbidities and psoriasis duration, age and high body mass index an association was found between the number of comorbidities and psoriasis duration, age, high body mass index, waist circumference or waist-to-hip ratio. (p<0.05). CONCLUSION Disease duration, age and high body mass index, waist circumference or waist-to-hip ratio are possible criteria for choosing which patients should be screened for comorbidities. Underdiagnosis of comorbidities by general practitioners highlights the need for a multidisciplinary approach in psoriasis management. PMID:28099594

  16. Environmental assessment of Mangrove communities in Tarut Bay, Eastern Arabian Peninsula, based on multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Al-Ali, A. M.; Del Campo, A. G.; Rocha, C.

    2015-04-01

    Tarut Bay contains some of the most important mangrove forests in the Arabian Gulf countries, which are facing significant anthropogenic pressures. A multidisciplinary approach based on remote sensing, fieldwork, and chemical analysis was adopted in order to identify the pressures facing the mangrove communities in Tarut Bay and subsequently evaluate its current environmental condition. The analysis focused on the 2011 to 2014 timeframe in particular. The results indicate that the mangrove communities in Tarut Bay cover currently around 11.32 square km. Two major mangrove cover changes were identified in the area during the studied period, with a net loss of around 0.675 square km happening in the interim. The analysis adopted the Normalized Difference Vegetation Index (NDVI) to evaluate the temporal change in vegetation concentration. Moreover, the study evaluated the overall pollution condition of 19 mangrove communities in Tarut Bay to be medium based on the Pollution Load Index (PLI). Nevertheless, some of the mangrove communities in Tarut Bay are very healthy while others are very polluted and require immediate action to improve their pollution status. The findings of this work led to recommending mangrove improvement measures to address further deterioration and disappearance of mangrove communities, including the re-opening of natural inlets and avoiding residential developments on the mangrove coast.

  17. Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area

    PubMed Central

    Yoon, Sehoon; Lázaro, Hudson Alex

    2016-01-01

    A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery. PMID:27896193

  18. A scream from the past: a multidisciplinary approach in a concealment of a corpse found mummified.

    PubMed

    Gitto, Lorenzo; Bonaccorso, Luigi; Maiese, Aniello; dell'Aquila, Massimiliano; Arena, Vincenzo; Bolino, Giorgio

    2015-05-01

    When a mummified body is found, it requires the forensic pathologist to determine the manner and cause of death. The mummified body of an older man was found walled in an alcove in a silicon-sealed bedroom, in a semi-supine position with the back on the floor and the legs on the wall. Two plastic bags covered the body. Having removed the plastic bags, the body was fully wrapped in a brown adhesive tape. At the scene, there was no evidence of microfauna. The subject's son stated that after his father's death, he concealed the corpse in order to obtain his annual pension. A postmortem CT scan was performed before the autopsy, which excluded traumatic injuries. The autopsy together with the toxicological and microscopic findings helped us to understand the manner of death. In this case, the mummification process developed under specific environmental conditions and a multidisciplinary approach was required in order to solve it. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  19. The Manawatu aquifers, North Island, New Zealand: Clarification of hydrogeology using a multidisciplinary environmental tracer approach

    NASA Astrophysics Data System (ADS)

    Taylor, C. B.; Trompetter, V. J.; Brown, L. J.; Bekesi, G.

    2001-12-01

    A recently developed approach to carbon isotope methodology (process recognition via isotope diagrams) is applied in a multidisciplinary study of precipitation-recharged aquifers of the lowlands-plains area of the Manawatu (south-west North Island). Urban and rural areas rely on groundwater from the upper levels of a deep basin sequence comprising marine and terrestrial sediments of Pleistocene age. Hydrochemical and isotopic (18O, 3H, 13C and 14C) data are merged with known details of geology and hydrogeology to reveal two separate confined aquifers within the depth range to 200 m. The shallower of these, below unconfined, locally recharged groundwater, is recharged on the foothills of the Ruahine Range to the north-east of the study area; flow direction is NE-SW. The deeper confined aquifer is recharged on the Tararua Range to the immediate east; flow direction essentially is transverse (SE-NW) to that in the shallower aquifer. Two processes are identified as dominant contributors to concentration and isotopic composition of dissolved inorganic carbon (DIC), namely addition of CO2 from decay of organic materials and carbonate dissolution. Limitations of carbon isotope methods in determining residence times are illustrated by the data. Although the confined groundwater is essentially tritium-free, only a few samples showed conclusive evidence of significant ageing on the time-scale of 14C.

  20. [DiGeorge syndrome and vascular ring. An unusual association with multidisciplinary approach].

    PubMed

    Garcia, Pedro; Anjos, Rui; Abecassis, Miguel; Santos, José A Oliveira; Martins, F Maymone

    2009-01-01

    Velo-cardio-facial syndrome/DiGeorge/CATCH 22 is a spectrum of association, characterized by unusual face, cleft or incompetent palate, congenital heart disease with defects of the outflow tracts, absence of the thymus and parathyroid glands, often associated with developmental and behavioral disorders. This association is caused by a microdeletion in chromosome band 22q11.2. In a 4-month-old infant, with obstructive lower respiratory distress and poor weight gain since 2 months of age, truncus arteriosus was diagnosed and surgically corrected. On the postoperative period maintained dependency on mechanical ventilation, with persistent hypoventilation of the left lung. Fiberoptic bronchoscopy revealed complete obstruction of the left main bronchus by an extrinsic compression due to a vascular ring diagnosed by cardiac catheterization that showed a common anomalous origin of both right and left subclavian arteries and the ligamentum arteriosum. A second surgery by left lateral thoracotomy corrected the vascular ring. The maintenance of the collapse of the left main bronchus led to selective endobronchial stenting. The migration of the stent to the trachea, with acute respiratory distress, required emergent endoscopic removal of the stent. Thereafter, the evolution was uneventful. The association of DiGeorge syndrome with vascular ring is unusual. Unexpected evolution in these patients require a multidisciplinary technical approach for diagnosis and eventual emergent intervention.

  1. A multidisciplinary approach to assess the welfare of weaned pigs during transport at three space allowances.

    PubMed

    Sutherland, Mhairi A; Bryer, Pamela J; Davis, Brittany L; McGlone, John J

    2010-01-01

    Transport can be a stressful experience for pigs, especially in pigs simultaneously experiencing weaning stress. The objective of this study was to use a multidisciplinary approach to assess the welfare of weaned pigs during transport at 3 space allowances. A commercial semitrailer, fitted with compartments, provided 0.05, 0.06, and 0.07 m(2)/pig. The study recorded frequency of standing, lying, sitting, and standing-rearing on another pig during the entire duration of transport. Blood samples, body weights, and lesion scores were collected from a subset of pigs (n = 48 per space allowance) in each experimental compartment. Transport time for the pigs was 148.0 +/- 10.0 min to the wean-to-finishing site. Total white blood cell counts, cortisol, and several blood chemistry values increased (p < .05) after transport regardless of space allowance. Glucose and body weight decreased (p < .05) after transport regardless of space allowance. Space allowance influenced stand-rearing, sitting, standing, and lying behaviors in pigs. Combining behavioral and physiological measures of stress provides a robust picture of piglet welfare during transport at different space allowances.

  2. Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area.

    PubMed

    Yoon, Sehoon; Jeong, Euicheol; Lázaro, Hudson Alex

    2016-11-01

    A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

  3. Multidisciplinary Treatment Approach for Prosthetic Vascular Graft Infection in the Thoracic Aortic Area

    PubMed Central

    Watanabe, Yoshinori

    2015-01-01

    Prosthetic vascular graft infection in the thoracic aortic area is a rare but serious complication. Adequate management of the complication is essential to increase the chance of success of open surgery. While surgical site infection is suggested as the root cause of the complication, it is also related to decreased host tolerance, especially as found in elderly patients. The handling of prosthetic vascular graft infection has been widely discussed to date. This paper mainly provides a summary of literature reports published within the past 5 years to discuss issues related to multidisciplinary treatment approaches, including surgical site infection, timing of onset, diagnostic methods, causative pathogens, auxiliary diagnostic methods, antibiotic treatment, anti-infective structures of vascular prostheses, surgical treatment, treatment strategy against infectious aortic aneurysms, future surgical treatment, postoperative systemic therapy, and antimicrobial stewardship. A thorough understanding of these issues will enable us to prevent prosthetic vascular graft infection in the thoracic aortic area as far as possible. In the event of its occurrence, the early introduction of appropriate treatment is expected to cure the disease without worsening of the underlying pathological condition. PMID:26356686

  4. [Investigation of the sudden infant death syndrome: a multidisciplinary approach is required].

    PubMed

    Limelette, Anne; Boulagnon, Camille; Terrade, Caroline; N'guyen, Yohan; Guillard, Thomas; Andréoletti, Laurent; Garnotel, Roselyne; Digeon, Béatrice; De Champs, Christophe; Fornes, Paul; Lévêque, Nicolas

    2013-01-01

    The concept of sudden infant death syndrome (SIDS) is defined as the sudden, unexpected death of an infant less than a year old which remains unexplained after in-depth investigations comprising a complete autopsy, biological analyses, and a clinical examination of the circumstances surrounding the death. This definition underlines the importance of finding the cause of this disease in order to improve preventative measures to reduce the number of deaths due to sudden infant death syndrome. Among the causes of SIDS, pediatric infectious diseases may be neglected and must be systematically sought after. We report upon a SIDS death case of a four and a half month-old that occurred during his sleep. Following the absence of an evident cause of death a scientific autopsy was performed. The histological examination of pulmonary tissue revealed broncolitic lesions associated with numerous micro-abscesses. The post mortem microbiological analyses revealed evidence of an infection by the respiratory syncytial virus complicated by a bacterial infection due to Haemophilus influenzae. The case underlines the necessity of a multidisciplinary approach to researching SIDS, involving both clinicians and biologists, in order to determine the causes of these deaths.

  5. Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes.

    PubMed

    Fayanju, Oluwadamilola M; Mayo, Tinisha L; Spinks, Tracy E; Lee, Seohyun; Barcenas, Carlos H; Smith, Benjamin D; Giordano, Sharon H; Hwang, Rosa F; Ehlers, Richard A; Selber, Jesse C; Walters, Ronald; Tripathy, Debu; Hunt, Kelly K; Buchholz, Thomas A; Feeley, Thomas W; Kuerer, Henry M

    2016-08-01

    Value in healthcare-i.e., patient-centered outcomes achieved per healthcare dollar spent-can define quality and unify performance improvement goals with health outcomes of importance to patients across the entire cycle of care. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Contemporary breast cancer literature on treatment options, expected outcomes, and potential complications was extensively reviewed. Patient perspective was obtained via focus groups. Multidisciplinary physician teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration. Outcomes were divided into 3 tiers that reflect the entire cycle of care: (1) health status achieved, (2) process of recovery, and (3) sustainability of health. Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria and specifications for reporting. Patient data sources will include the Epic Systems EHR and validated patient-reported outcome questionnaires administered via our institution's patient portal. As healthcare costs continue to rise in the United States and around the world, a value-based approach with explicit, transparently reported patient outcomes will not only create opportunities for performance improvement but will also enable benchmarking across providers, healthcare systems, and even countries. Similar value-based breast cancer care frameworks are also being pursued internationally.

  6. Reproductive outcome of male carriers of chromosomal abnormalities: multidisciplinary approach for genetic counseling and its implications.

    PubMed

    Guo, K M; Wu, B; Wang, H B; Tian, R H

    2016-12-02

    Chromosomal abnormality is the most common genetic cause of infertility. Infertility, as a psychological problem, has received an increasing amount of attention. Psychological interventions have been shown to have beneficial effects on infertile patients with chromosomal abnormalities. The present study explored reproductive outcome of male carriers of chromosomal abnormalities, who accepted genetic counseling and psychological support. Cytogenetic analysis was performed using cultured peripheral blood lymphocytes and G-banding. The detection rate of chromosomal abnormalities was 10.3% in pre-pregnancy counseled males, with polymorphisms being most common, followed by 47,XXY and balanced translocation. Follow-up of 170 carriers with normozoospermia, after 3 years, showed that 94.7% of the cases resulted in live births. In the carriers of polymorphisms, balanced translocation, inv(9), Robertsonian translocation, inversion, and 47,XYY, live birth rates were 96.8, 85.7, 100, 83.3, 75, and 100%, respectively. Follow-up of 54 carriers with oligozoospermia or azoospermia, after 3 years, showed that 14.8% of the cases resulted in live births. In the carriers of 47,XXY with severe oligozoospermia or azoospermia, 80 or 5.9% of the cases resulted in live births, respectively. Therefore, timely psychological support would be beneficial and multidisciplinary approach should be preferentially considered for the management of individuals with chromosomal abnormalities.

  7. Collaborative multidisciplinary team approach to fertility issues among adolescent and young adult cancer patients.

    PubMed

    Nagel, Kim; Cassano, Jane; Wizowski, Lindsay; Neal, Michael S

    2009-08-01

    Cancer treatment and the field of reproductive technology have each made impressive advancements in the last decade. Improved cancer treatment and survival rates have increased the number of cancer survivors, who might benefit from an array of fertility preservation strategies provided by emerging and advanced assisted conception technology. The challenge becomes bridging the gap between these two separate disciplines to ultimately improve the quality of life for cancer survivors. This paper discusses the issues and process involved with bringing these two teams of health-care professionals together. This model provides a framework for coordinating efforts in providing fertility preservation options to patients undergoing treatment for cancer. Effective multidisciplinary teams that include: oncologists, nurses in the specialties of oncology and infertility, social workers, reproductive endocrinology and infertility specialists, andrologists, and embryologists are required to work together in order to achieve success. The result of this unique team approach is not only a cancer survivor, but one whose quality of life might be enhanced by being able to have a child of his or her own in the future.

  8. Multidisciplinary approaches and assessment techniques to better understand and enhance zoo nonhuman animal welfare.

    PubMed

    Siegford, Janice M

    2013-01-01

    Nonhuman animal welfare is a complex concept that encompasses an animal's biological functioning, emotional states, and opportunities to experience a natural life, including the performance of natural behaviors. Further, animal welfare can be viewed as quality of life from the perspective of the animal and thus must consider the animal's subjective experiences. Therefore, assessing and enhancing animal welfare should include multidisciplinary, scientific ventures that strive to create a complete picture of how animals' bodies and minds respond to both aversive and pleasant situations. Practical assessment of animal welfare should include outcome-based measures from the animal that provide information about the individual's welfare as well as resource-based measures that can help identify causes of or risk factors for poor welfare. Increasingly, scientists are examining the emotional states of animals as well as the impact of pain, pleasure, and consciousness on animal welfare. This article discusses approaches such as preference testing, instrumental learning, examination of space and resource use, and qualitative assessments of animal welfare that might be useful and practical for assessing and enhancing welfare in zoo settings.

  9. Multidisciplinary approach to childhood epilepsy: exploring the scientific rationale and practical aspects of implementation.

    PubMed

    Goldstein, Joshua; Plioplys, Sigita; Zelko, Frank; Mass, Sarah; Corns, Christine; Blaufuss, Robert; Nordli, Douglas

    2004-05-01

    The management of childhood epilepsy requires attention to more than seizure control because children with epilepsy often suffer from comorbidities that lead to an increased frequency of psychiatric disease, learning difficulties, and other problems of psychosocial development. These comorbidities can stem in part from the same genetic traits that determine seizure susceptibility. Thus, mutations affecting potassium, calcium, and sodium channels have been linked with epilepsy syndromes and affective and behavioral abnormalities. It is important to consider the effect of antiepilepsy drugs on comorbid conditions and the effect on seizures of drugs used to treat comorbidities. A number of antiepilepsy drugs are available that have minimal adverse cognitive effects, and some can have positive effects on mood and behavior. Epilepsy in a child is a condition that affects and is affected by the entire family situation. In addition to appropriate neuropsychologic evaluation, optimal management of childhood epilepsy also can require the involvement of the social worker, advanced practice nurse, and educational specialist. Many elements of the multidisciplinary team approach can be instituted by the child neurologist in community practice and at large, specialized epilepsy centers.

  10. Multidisciplinary approach of organic catatonia in children and adolescents may improve treatment decision making.

    PubMed

    Lahutte, Bertrand; Cornic, Françoise; Bonnot, Olivier; Consoli, Angèle; An-Gourfinkel, Isabelle; Amoura, Zahir; Sedel, Frédéric; Cohen, David

    2008-08-01

    Catatonia is an infrequent but severe condition in young people. Organic diseases may be associated and need to be investigated though no specific recommendations and guidelines are available. We extensively reviewed the literature of all the cases of organic catatonia in children and adolescents from January 1969 to June 2007. We screened socio-demographic characteristics, organic diagnosis, clinical characteristics and treatment. We found 38 cases of children and adolescents with catatonia due to an organic condition. The catatonic syndrome occurred in 21 (57%) females and 16 (43%) males. The mean age of patients was 14.5 years (+/-3.39) [range=7-18 years], and three died from their condition. The organic conditions included infectious diseases (N=10), neurological conditions (N=10), toxic induced states (N=12) and genetic conditions including inborn errors of metabolism (N=6). The onset was dominantly acute, and the clinical presentation most frequently stuporous. Although benzodiazepines were recommended as primary symptomatic treatment, they were rarely prescribed. In several cases, therapeutic approach was related to organic cause (e.g., plasma exchange in lupus erythematosus; copper chelators in Wilson's disease). Based on this review and on our own experience of catatonia in youth, we proposed a consensual and multidisciplinary diagnostic strategy to help practitioners to identify underlying organic diseases.

  11. Place of Arterial Embolization in Severe Blunt Hepatic Trauma: A Multidisciplinary Approach

    SciTech Connect

    Monnin, Valerie Sengel, Christian; Thony, Frederic; Bricault, Ivan; Voirin, David; Letoublon, Christian; Broux, Christophe; Ferretti, Gilbert

    2008-09-15

    This study evaluates the efficacy of arterial embolization (AE) for blunt hepatic traumas (BHT) as part of a combined management strategy based on the hemodynamic status of patients and CT findings. From 2000 to 2005, 84 patients were admitted to our hospital for BHT. Of these, 14 patients who had high-grade injuries (grade III [n = 2], grade IV [n = 9], grade V [n = 3]) underwent AE because of arterial bleeding and were included in the study. They were classified into three groups according to their hemodynamic status: (1) unresponsive shock, (2) shock improved with resuscitation, and (3) hemodynamic stability. Four patients (group 1) underwent, first, laparotomy with packing and, then, AE for persistent bleeding. Ten patients who were hemodynamically stable (group 1) or even unstable (group 2) underwent AE first, based on CT findings. AE was successful in all cases. The mortality rate was 7% (1/14). Only two angiography-related complications (gallbladder infarction) were reported. Liver-related complications (abdominal compartment syndrome and biliary complications) were frequent and often required secondary interventions. Our multidisciplinary approach for the management of BHT gives a main role to embolization, even for hemodynamically unstable patients. In this strategy AE is very efficient and has a low complication rate.

  12. Long-term weight loss maintenance for obesity: a multidisciplinary approach

    PubMed Central

    Montesi, Luca; El Ghoch, Marwan; Brodosi, Lucia; Calugi, Simona; Marchesini, Giulio; Dalle Grave, Riccardo

    2016-01-01

    The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient–therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called “lifestyle trainer” or “healthy lifestyle practitioner”) as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment. PMID:27013897

  13. Multi-disciplinary approach for enhancing orthodontic esthetics – case report

    PubMed Central

    Kalia, Ajit; Mirdehghan, Nasim; Khandekar, Sonali; Patil, Wasu

    2015-01-01

    Background In contemporary dental care, an increasing number of adult patients are now seeking orthodontic treatment with the primary motive of improvement in appearance and achievement of esthetic smile. Proper recognition of the dental and facial defects at the outset of treatment is the most important key to esthetic success and is essential in satisfying the patient’s needs. By following the rules of Golden proportion smiles can be made attractive, harmonious, symmetrical, and proportionate. Methodology Consisted of 22-year-old girl who came for treatment of crowding in maxillary and mandibular arches, abnormal overjet and overbite and had unesthetic peg lateral. Results Non-extraction therapy was carried out since the patient had good soft tissue drape, alignment was achieved by expanding the arches and moving teeth in ideal axial inclination. Esthetic smile was attained using composite buildup of upper right peg lateral and minor adjunctive surgery (full thickness periodontal graft) on lower right central incisor. Conclusion The present case report orchestrates interrelationship between various branches of dentistry and orthodontics. It exhibits how multidisciplinary approach can be used to achieve ideal dental esthetics in a 22-year-old girl who was successfully treated for peg shaped lateral incisor, gingival recession, and unesthetic smile. PMID:26316821

  14. Closing the Gaps and Filling the STEM Pipeline: A Multidisciplinary Approach

    NASA Astrophysics Data System (ADS)

    Doerschuk, Peggy; Bahrim, Cristian; Daniel, Jennifer; Kruger, Joseph; Mann, Judith; Martin, Cristopher

    2016-08-01

    There is a growing demand for degreed science, technology, engineering and mathematics (STEM) professionals, but the production of degreed STEM students is not keeping pace. Problems exist at every juncture along the pipeline. Too few students choose to major in STEM disciplines. Many of those who do major in STEM drop out or change majors. Females and minorities remain underrepresented in STEM. The success rate of college students who are from low-income background or first-generation students is much lower than that of students who do not face such challenges. Some of those who successfully complete their degree need help in making the transition to the workforce after graduation. A program at Lamar University takes a multidisciplinary approach to addressing these problems. It is designed to recruit, retain and transition undergraduates to careers in STEM, focusing its efforts on five science disciplines and on these "at-risk" students. The program was supported by a 5-year grant from the National Science Foundation and is supported through August 31, 2016 by Lamar University and a grant from ExxonMobil. A formal assessment plan documents the program's success. The program received an award from the Texas Higher Education Board for its contributions towards Closing the Gaps in Higher Education in Texas. This paper describes the program's theoretical framework, research questions, methods, evaluation plan, and instruments. It presents an analysis of the results achieved using these methods and implications for improvements to the program resulting from lessons learned.

  15. Invasive Squamous Cell Carcinoma of the Scalp and Calvarium: A Multidisciplinary Approach

    PubMed Central

    Podda, Silvio; Szymanski, Karen

    2016-01-01

    Objective: The correlation between immunosuppression-associated skin cancer and lymphoma has been well established. This includes squamous cell carcinoma and chronic lymphocytic leukemia. When a lesion requires excision, reconstruction can be challenging based on the depth and size of the tumor. We present a patient with chronic lymphocytic leukemia and invasive squamous cell carcinoma of the scalp that extended through the calvarium to the dura mater. His tumors were badly neglected for a long period of time and presented at an advanced stage. Methods: This type of reconstruction was performed utilizing a multidisciplinary approach. Our patient required calvarial reconstruction with titanium mesh, dural reconstruction, latissimus dorsi free flap, and an overlying skin graft. Results: The patient had appropriate resection of his tumor while maintaining flap viability. Postoperatively, he presented with excellent soft-tissue thickness and aesthetic result. Conclusion: We believe that this type of reconstruction was best, considering our patient had a significant scalp and calvarial defect at presentation. Using a latissimus dorsi free flap bestows a robust blood supply to help decrease infections and improve healing and circulation, especially in light of the need of further radiation therapy. PMID:27909467

  16. Training Multidisciplinary Scholars in Science Policy for Careers in Academia, Private Sector, and Public Service

    NASA Astrophysics Data System (ADS)

    Kenney, M. A.

    2015-12-01

    Regardless of a graduate student's ultimate career ambitions, it is becoming increasingly important to either develop skills to successfully transition into non-academic careers or to be able to understand the societal benefits of basic and applied research programs. In this talk I will provide my prospective -- from working in academia, the Federal government, and as an independent consultant -- about the training that we need for graduate students to navigate the jungle gym of career opportunities available (or not available) after they graduate. In particular, I will speak to the need for science policy training, in which scientific and coordination skills are put to use to help support societal decisions. I will assert that, to effectively train graduate students, it is necessary to provide experiences in multidisciplinary, policy-relevant scholarship to build marketable skills critical for a student's professional development.

  17. Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach.

    PubMed

    Inagaki, Elica; Farber, Alik; Eslami, Mohammad H; Siracuse, Jeffrey J; Rybin, Denis V; Sarosiek, Shayna; Sloan, J Mark; Kalish, Jeffrey

    2016-07-01

    The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P < .001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P < .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P = .9). The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved

  18. Reconstruction of 23 November 2013 Etna Eruption Source Parameters through a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Poret, Matthieu; Costa, Antonio; Corradini, Stefano; Merucci, Luca; Andronico, Daniele; Vulpiani, Gianfranco; Cristaldi, Antonio

    2017-04-01

    On 23 November 2013, Mt. Etna erupted producing the 17th paroxysmal episode of 2013. The eruption generated a buoyant plume that reached more than 10 km a.s.l. The volcanic cloud was dispersed by a wind oriented north-eastwards which drove the erupted tephra over an extending area starting from the slopes of the volcano (scoria and lapilli) to the Calabria and up to Puglia region (ash particles). The field samples were collected in proximal area but also in Calabria ( 160 km) and tephra sedimentation was reported in Salento, in Puglia region ( 400 km). Another source of information is the transmission of a pilot who reported the presence of volcanic ash over the Adriatic sea ( 30 km southwards the Albanian coasts) between 10.9 and 11.5 km a.s.l. on 23 November 2013 at 13:50 which likely corresponds to the top of the volcanic cloud made of aerosol and gas. This study aims at reconstructing the Eruption Source Parameters (ESP) of the paroxysm phase such as, the eruptive column height, the eruption duration, the Mass Eruption Rate (MER), the Total Erupted Mass (TEM), and the Total Grain-Size Distribution (TGSD) making use of a multidisciplinary approach. Tephra dispersal simulations were performed using the model Fall3D constraining the results against field deposits, ground-based Radar measurements, and the satellite (MSG-Seviri) retrievals. The three sets of observations are complementary covering the full range of the erupted particle sizes from centimetre to micrometre particles, allowing for a robust assessment of the ESP. Indeed, among the multidisciplinary procedure, the field observations helped to approximate the erupted mass and the coarse fraction of the TGSD, whereas the radar measurements provided an estimation of eruptive column height and MER, and the satellite was crucial to quantify the fine ash fraction (i.e. PM10) by tracking the evolution of the plume and its mass. The best-fit results are in agreement with previous estimations recently published

  19. A multi-disciplinary approach to medication safety and the implication for nursing education and practice.

    PubMed

    Adhikari, Radha; Tocher, Jennifer; Smith, Pam; Corcoran, Janet; MacArthur, Juliet

    2014-02-01

    Medication management is a complex multi-stage and multi-disciplinary process, involving doctors, pharmacists, nurses and patients. Errors can occur at any stage from prescribing, dispensing and administering, to recording and reporting. There are a number of safety mechanisms built into the medication management system and it is recognised that nurses are the final stage of defence. However, medication error still remains a major challenge to patient safety globally. This paper aims to illustrate two main aspects of medication safety practices that have been elicited from an action research study in a Scottish Health Board and three local Higher Education Institutions: firstly current medication safety practices in two clinical settings; and secondly pre and post-registration nursing education and teaching on medication safety. This paper is based on Phase One and Two of an Action Research project. An ethnography-style observational method, influenced by an Appreciative Inquiry (AI) approach was adapted to study the everyday medication management systems and practices of two hospital wards. This was supplemented by seven in-depth interviews with nursing staff, numerous informal discussions with healthcare professionals, two focus-groups, one peer-interview and two in-depth individual interviews with final year nursing students from three Higher Education Institutions in Scotland. This paper highlights the current positive practical efforts in medication safety practices in the chosen clinical areas. Nursing staff do employ the traditional 'five right' principles - right patient, right medication, right dose, right route and right time - for safe administration. Nursing students are taught these principles in their pre-registration nursing education. However, there are some other challenges remaining: these include the establishment of a complete medication history (reconciliation) when patients come to hospital, the provision of an in-depth training in

  20. The thoracoplastic approach to chest wall reconstruction: preliminary results of a multidisciplinary approach to minimize morbidity.

    PubMed

    Basta, Marten N; Fischer, John P; Lotano, Vincent E; Kovach, Stephen J

    2014-12-01

    Chest wall reconstruction remains challenging because of the variable nature of the defect. Muscle-sparing approaches have been described but are not widely applied today. The authors reviewed an institutional experience with chest wall reconstruction and describe the thoracoplastic approach, which aims to optimize flap selection. A retrospective review was conducted identifying all patients undergoing chest wall reconstruction performed by the senior author. Demographic information and operative characteristics were detailed and factors were analyzed for association with postoperative outcomes. Outcomes were also compared for conventional versus thoracoplastic groups. Forty-five patients underwent chest wall reconstruction at an average age of 54.2 ± 16.3 years. Sarcomas were most common (51 percent), followed by breast (16 percent) and lung (11 percent). The average number of ribs resected was 3.2 ± 1.4, with an average defect size of 212 ± 185 cm2. The most commonly used flaps included the latissimus dorsi and pectoralis major (72 percent). Mesh was incorporated in 58 percent of repairs and operative time was 6.2 ± 2.5 hours. The incidence of surgical complications was 23 percent, most commonly wound infection and nonhealing wound (20 percent). The thoracoplastic approach, used in 14 patients, demonstrated no differences in outcomes with follow-up of 14 months. Operative time was nearly identical, and the thoracoplastic group required significantly less blood products when transfused. Latissimus dorsi and pectoralis major flaps were used more frequently in the thoracoplastic group, although this did not reach significance (78.6 percent versus 69.2 percent). The thoracoplastic approach appears to be safe and effective when compared with conventional methods. Although definitive conclusions cannot be drawn, the authors' early experience is promising. The authors believe applying these principles improves aesthetic and functional outcomes and preserves the

  1. Multidisciplinary optimization

    SciTech Connect

    Dennis, J.; Lewis, R.M.; Cramer, E.J.; Frank, P.M.; Shubin, G.R.

    1994-12-31

    This talk will use aeroelastic design and reservoir characterization as examples to introduce some approaches to MDO, or Multidisciplinary Optimization. This problem arises especially in engineering design, where it is considered of paramount importance in today`s competitive global business climate. It is interesting to an optimizer because the constraints involve coupled dissimilar systems of parameterized partial differential equations each arising from a different discipline, like structural analysis, computational fluid dynamics, etc. Usually, these constraints are accessible only through pde solvers rather than through algebraic residual calculations as we are used to having. Thus, just finding a multidisciplinary feasible point is a daunting task. Many such problems have discrete variable disciplines, multiple objectives, and other challenging features. After discussing some interesting practical features of the design problem, we will give some standard ways to formulate the problem as well as some novel ways that lend themselves to divide-and-conquer parallelism.

  2. The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries.

    PubMed

    Bach, John A; Leskovan, John J; Scharschmidt, Thomas; Boulger, Creagh; Papadimos, Thomas J; Russell, Sarah; Bahner, David P; Stawicki, Stanislaw P A

    2017-01-01

    Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations. Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10.

  3. The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

    PubMed Central

    Bach, John A.; Leskovan, John J.; Scharschmidt, Thomas; Boulger, Creagh; Papadimos, Thomas J.; Russell, Sarah; Bahner, David P.; Stawicki, Stanislaw P. A.

    2017-01-01

    Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations. Republished with permission from: Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10. PMID:28382257

  4. Multidisciplinary Approach for Earthquake Atmospheric Precursors Validation by Joint Satellite and Ground Based Observations

    NASA Astrophysics Data System (ADS)

    Ouzounov, D. P.; Pulinets, S. A.; Hattori, K.; Liu, J. G.; Parrot, M.; Kafatos, M.; Yang, T. F.; Jhuang, H.; Taylor, P.; Ohyama, K.; Kon, S.

    2010-12-01

    Previous studies have shown that there were electromagnetic (EM) effects in the atmosphere/ionosphere caused by some strong earthquakes. Several major earthquakes are accompanied by an intensification of the vertical transport of charged aerosols in the lower atmosphere. These processes lead to the generation of external electric currents in specific regions of the atmosphere and the modifications, by DC electric fields, in the ionosphere-atmosphere electric circuit. Our methodology of integrated satellite terrestrial framework (ISTF) is based on the use of multi-sensor data and a cross-correlation between ground and satellite observations to record any atmospheric thermal anomalies and ionospheric perturbations associated with these activities. We record thermal infrared data from the Aqua, GOES, POES satellites and DEMETER provides space plasma variations related to the growth of the DC electric field. Simultaneously we continuously monitor ground-based multi-parameter GPS/TEC, ion concentration, radon, and magnetic field array data. We integrate these joint observations into the Lithosphere-Atmosphere-Ionosphere Coupling (LAIC) model. The significance of this combined satellite and ground-based analysis is that it permits us to generate hindcasts of historical seismicity in Japan, Taiwan (2003-2009) and recent catastrophic events in Italy (M6.3, 2009), Haiti (M7.0, 2010) and Chile (M8.8, 2010). This joint analysis of ground and satellite data during the time of major earthquakes has shown the presence of persistent anomalies in the atmosphere over regions of maximum stress (along plate boundaries), and are not of meteorological origin, since they are stationary over the same region. Our approach provides the framework for a multidisciplinary validation of earthquake precursors and we are looking forward to validating this approach over high seismicity regions.

  5. Obesity: a public health approach.

    PubMed

    Novak, Nicole L; Brownell, Kelly D

    2011-12-01

    Obesity is an epidemic that likely will worsen without substantive changes to the current environment. Although treatment of the individual has conventionally been the focus of the obesity field, prevention using a public health model will be essential for making progress on a population level. There are encouraging signs that communities across the country are acknowledging the complex causes of obesity and making impressive reforms to improve their health and that of their children. Public policy changes long have been used to combat infectious and chronic diseases and will be vital in the attempt to reduce the toll of poor diet, physical inactivity, and obesity.

  6. A multidisciplinary approach to the study of cultural heritage environments: Experience at the Palatina Library in Parma.

    PubMed

    Pasquarella, C; Balocco, C; Pasquariello, G; Petrone, G; Saccani, E; Manotti, P; Ugolotti, M; Palla, F; Maggi, O; Albertini, R

    2015-12-01

    The aim of this paper is to describe a multidisciplinary approach including biological and particle monitoring, and microclimate analysis associated with the application of the Computational Fluid Dynamic (CFD). This approach was applied at the Palatina historical library in Parma. Monitoring was performed both in July and in December, in the absence of visitors and operators. Air microbial monitoring was performed with active and passive methods. Airborne particles with a diameter of ≥0.3, ≥0.5, ≥1 and ≥5 μm/m3, were counted by a laser particle counter. The surface contamination of shelves and manuscripts was assessed with nitrocellulose membranes. A spore trap sampler was used to identify both viable and non-viable fungal spores by optical microscope. Microbiological contaminants were analyzed through cultural and molecular biology techniques. Microclimatic parameters were also recorded. An infrared thermal camera provided information on the surface temperature of the different building materials, objects and components. Transient simulation models, for coupled heat and mass-moisture transfer, taking into account archivist and general public movements, combined with the related sensible and latent heat released into the environment, were carried out applying the CFD-FE (Finite Elements) method. Simulations of particle tracing were carried out. A wide variability in environmental microbial contamination, both for air and surfaces, was observed. Cladosporium spp., Alternaria spp., Aspergillus spp., and Penicillium spp. were the most frequently found microfungi. Bacteria such as Streptomyces spp., Bacillus spp., Sphingomonas spp., and Pseudoclavibacter as well as unculturable colonies were characterized by molecular investigation. CFD simulation results obtained were consistent with the experimental data on microclimatic conditions. The tracing and distribution of particles showed the different slice planes of diffusion mostly influenced by the convective

  7. CERN's approach to public outreach

    NASA Astrophysics Data System (ADS)

    Landua, Rolf

    2016-03-01

    CERN's communication goes beyond publishing scientific results. Education and outreach are equally important ways of communicating with the general public, and in particular with the young generation. Over the last decade, CERN has significantly increased its efforts to accommodate the very large interest of the general public (about 300,000 visit requests per year), by ramping up its capacity for guided tours from 25,000 to more than 100,000 visitors per year, by creating six new of state-of-the-art exhibitions on-site, by building and operating a modern physics laboratory for school teachers and students, and by showing several traveling exhibitions in about 10 countries per year. The offer for school teachers has also been expanded, to 35-40 weeks of teacher courses with more than 1000 participants from more than 50 countries per year. The talk will give an overview about these and related activities.

  8. Exploring an herbal "wonder cure" for cancer: A multi-disciplinary approach

    PubMed Central

    Ben-Arye, Eran; Mahajna, Jamal; Aly, Radi; Ali-Shtayeh, Mohammed Saleem; Bentur, Yedidia; Lev, Efraim; Deng, Gary; Samuels, Noah

    2017-01-01

    Context and objectives The unmonitored use of herbal medicinal remedies by patients with cancer presents a significant challenge to oncology healthcare professionals. We describe an increasingly popular herbal "wonder drug", Ephedra foemina (Alanda in Arabic), whose use has spread from the Palestinian patient population throughout the Middle East. We conducted a multi-centered and multidisciplinary collaborative research effort in order to understand the potential benefits and harms of this popular herbal remedy. Methods We conducted an in-depth search of the medical literature, both traditional and modern, for any mention of the clinical use of Alanda for the treatment of cancer. We then tested the remedy, first for toxic ephedra alkaloid components and then for anti-cancer effects, as well as effects on the cytotoxic activity of chemotherapy agents (cisplatin, carboplatin) on breast cancer cell cultures. Results We found no mention in the literature, both conventional and traditional, on the use of Alanda for the treatment of cancer. Laboratory testing did not find any toxic components (i.e., ephedra alkaloids) in the preparation. However, in vitro exposure to Alanda led to a reduced cytotoxic effect of chemotherapy on breast cancer cell cultures. Conclusions The use of an integrative ethno-botanical, laboratory and clinical research-based approach can be extremely helpful when providing non-judgmental and evidence-based guidance to patients with cancer, especially on the use of traditional herbal medicine. The effectiveness and safety of these products need to be examined by integrative physicians (IPs) who are dually-trained in both complementary medicine and supportive cancer care. PMID:27155666

  9. Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach

    PubMed Central

    Dumitrescu, Bianca; van Helden, Svenjhalmar; ten Broeke, Rene; Nieuwenhuijzen-Kruseman, Arie; Wyers, Caroline; Udrea, Gabriela; Linden, Sjef van der; Geusens, Piet

    2008-01-01

    The aetiology of osteoporotic fractures is multifactorial, but little is known about the way to evaluate patients with a recent clinical fracture for the presence of secondary osteoporosis. The purpose of this study was to determine the prevalence of contributors to secondary osteoporosis in patients presenting with a clinical vertebral or non-vertebral fracture. Identifying and correcting these contributors will enhance treatment effect aimed at reducing the risk of subsequent fractures. In a multidisciplinary approach, including evaluation of bone and fall-related risk factors, 100 consecutive women (n = 73) and men (n = 27) older than 50 years presenting with a clinical vertebral or non-vertebral fracture and having osteoporosis (T-score ≤-2.5) were further evaluated clinically and by laboratory testing for the presence of contributors to secondary osteoporosis. In 27 patients, 34 contributors were previously known, in 50 patients 52 new contributors were diagnosed (mainly vitamin D deficiency in 42) and 14 needed further exploration because of laboratory abnormalities (mainly abnormal thyroid stimulating hormone in 9). The 57 patients with contributors were older (71 vs. 64 yrs, p < 0.01), had more vertebral deformities (67% vs. 44%, p < 0.05) and a higher calculated absolute 10-year risk for major (16.5 vs. 9.9%, p < 0.01) and for hip fracture (6.9 vs. 2.4%, p < 0.01) than patients without contributors. The presence of contributors was similar between women and men and between patients with fractures associated with a low or high-energy trauma. We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable. Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years. PMID:18680609

  10. Biotic and inorganic control on travertine deposition at Bullicame 3 spring (Viterbo, Italy): A multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Di Benedetto, F.; Montegrossi, G.; Minissale, A.; Pardi, L. A.; Romanelli, M.; Tassi, F.; Delgado Huertas, A.; Pampin, E. M.; Vaselli, O.; Borrini, D.

    2011-08-01

    A multidisciplinary characterization of an active thermal spring in central Italy has been undertaken with the aim of (i) ascertaining whether microbiological activity plays a relevant role in hot-depositing travertines and (ii) establishing an experimental protocol able to identify similar effects in fossil travertines. Water, gas, and travertine samples were investigated by chemical (ICP/MS, SEM/EDS), physical (DTA-DTG), isotopic (δ 18O, δD, and δ 13C), mineralogical (XRPD), and spectroscopic (EPR) techniques. Twenty-four samples (three for each phase) were collected every 5 °C temperature drop, along a ˜100 m long artificial channel near Viterbo ( Bullicame 3, Latium, central Italy). A microbiological characterization was carried out in parallel, sampling the channel every 10 °C temperature drop. The Bullicame 3 system is revealed to be composed of two markedly different subsystems: a water/gas interface, where a kinetically fast exchange allows equilibrium of components both in water and in gases; a solid/water interface, where travertine precipitation occurs, influenced by microbiological activity. A peculiar lattice shrinking of calcite was identified, as well as an anomalous value of the zero-field splitting parameter from the EPR measurements. The interpretation of these anomalies is confirmed by the identification of calcifying cyanobacteria throughout the channel path. Our results point out that microbiological activity can play a significant role in travertine deposition from hot springs. Furthermore, the proposed approach, representing a tool to identify crystal chemical remnants of past microbiological activity, could be applicable to fossil travertines.

  11. Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis

    PubMed Central

    Jeon, Sang-Beom; Ryoo, Seung Mok; Lee, Deok Hee; Kwon, Sun U.; Jang, Seongsoo; Lee, Eun-Jae; Lee, Sang Hun; Han, Jung Hee; Yoon, Mi Jeong; Jeong, Soo; Cho, Young-Uk; Jo, Sungyang; Lim, Seung-Bok; Kim, Joong-Goo; Lee, Han-Bin; Jung, Seung Chai; Park, Kye Won; Lee, Min-Hwan; Kang, Dong-Wha; Suh, Dae Chul; Kim, Jong S.

    2017-01-01

    Background and Purpose Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. Methods We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. Results A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). Conclusions SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours. PMID:28592785

  12. Efficient Multidisciplinary Analysis Approach for Conceptual Design of Aircraft with Large Shape Change

    NASA Technical Reports Server (NTRS)

    Chwalowski, Pawel; Samareh, Jamshid A.; Horta, Lucas G.; Piatak, David J.; McGowan, Anna-Maria R.

    2009-01-01

    The conceptual and preliminary design processes for aircraft with large shape changes are generally difficult and time-consuming, and the processes are often customized for a specific shape change concept to streamline the vehicle design effort. Accordingly, several existing reports show excellent results of assessing a particular shape change concept or perturbations of a concept. The goal of the current effort was to develop a multidisciplinary analysis tool and process that would enable an aircraft designer to assess several very different morphing concepts early in the design phase and yet obtain second-order performance results so that design decisions can be made with better confidence. The approach uses an efficient parametric model formulation that allows automatic model generation for systems undergoing radical shape changes as a function of aerodynamic parameters, geometry parameters, and shape change parameters. In contrast to other more self-contained approaches, the approach utilizes off-the-shelf analysis modules to reduce development time and to make it accessible to many users. Because the analysis is loosely coupled, discipline modules like a multibody code can be easily swapped for other modules with similar capabilities. One of the advantages of this loosely coupled system is the ability to use the medium- to high-fidelity tools early in the design stages when the information can significantly influence and improve overall vehicle design. Data transfer among the analysis modules are based on an accurate and automated general purpose data transfer tool. In general, setup time for the integrated system presented in this paper is 2-4 days for simple shape change concepts and 1-2 weeks for more mechanically complicated concepts. Some of the key elements briefly described in the paper include parametric model development, aerodynamic database generation, multibody analysis, and the required software modules as well as examples for a telescoping wing

  13. Gastrointestinal stromal tumors: evolving role of the multidisciplinary team approach in management.

    PubMed

    Reichardt, Peter; Morosi, Carlo; Wardelmann, Eva; Gronchi, Alessandro

    2012-08-01

    Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract arising from mesenchymal cells. Treatment options include surgical resection and medical therapy with imatinib. A summary of National Comprehensive Cancer Network and European Society of Medical Oncology clinical practice guidelines relating to GIST management are presented here. A multidisciplinary team of physicians is essential to the successful treatment of GIST. Evidence supports multidisciplinary team management with a gastroenterologist, surgeon, medical oncologist, pathologist and radiologist. Consultations between them are recommended to ensure optimal care of patients with GIST. The role for individual core team workers is highlighted. The benefits of multidisciplinary disease management of patients include reducing recurrent disease, optimizing timing of surgery and organ preservation, prolonging survival for the patient and enhancing response to targeted therapies.

  14. Multidisciplinary approach to "accidental" falls in the elderly: a case report.

    PubMed

    Galizia, Gianluigi; Testa, Gianluca; Mazzella, Francesca; Cacciatore, Francesco; Ungar, Andrea; Masotti, Giulio; Rengo, Franco; Abete, Pasquale

    2008-06-01

    Falls in the elderly are commonly and often wrongly identified as "accidental". We report a case of an elderly woman admitted to first aid for a trauma due to an accidental fall. Geriatric multidisciplinary evaluation revealed mild cognitive impairment associated with depressive symptoms; both findings made the anamnesis uncertain. Syncope algorithm was applied and "tachy-brady form of sick sinus syndrome" was diagnosed. Differential diagnosis between "accidental" and "apparently accidental" falls in elderly patients is very difficult but a multidisciplinary geriatric evaluation can clarify the correct diagnosis.

  15. A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

    PubMed Central

    Goodman, Daisy J.; Milliken, Catherine U.; Theiler, Regan N.; Nordstrom, Benjamin R.; Akerman, Sarah C.

    2016-01-01

    Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for co-occurring posttraumatic stress disorder in pregnant women who use substances, in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants. PMID:26457976

  16. A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report.

    PubMed

    Goodman, Daisy J; Milliken, Catherine U; Theiler, Regan N; Nordstrom, Benjamin R; Akerman, Sarah C

    2015-01-01

    Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for co-occurring posttraumatic stress disorder in pregnant women who use substances in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.

  17. Asymmetric connectivity of spawning aggregations of a commercially important marine fish using a multidisciplinary approach

    PubMed Central

    Jackson, Alexis; Marinone, Silvio Guido; Erisman, Brad; Moreno-Baez, Marcia; Girón-Nava, Alfredo; Pfister, Tad; Aburto-Oropeza, Octavio; Torre, Jorge

    2014-01-01

    Understanding patterns of larval dispersal is key in determining whether no-take marine reserves are self-sustaining, what will be protected inside reserves and where the benefits of reserves will be observed. We followed a multidisciplinary approach that merged detailed descriptions of fishing zones and spawning time at 17 sites distributed in the Midriff Island region of the Gulf of California with a biophysical oceanographic model that simulated larval transport at Pelagic Larval Duration (PLD) 14, 21 and 28 days for the most common and targeted predatory reef fish, (leopard grouper Mycteroperca rosacea). We tested the hypothesis that source–sink larval metapopulation dynamics describing the direction and frequency of larval dispersal according to an oceanographic model can help to explain empirical genetic data. We described modeled metapopulation dynamics using graph theory and employed empirical sequence data from a subset of 11 sites at two mitochondrial genes to verify the model predictions based on patterns of genetic diversity within sites and genetic structure between sites. We employed a population graph describing a network of genetic relationships among sites and contrasted it against modeled networks. While our results failed to explain genetic diversity within sites, they confirmed that ocean models summarized via graph and adjacency distances over modeled networks can explain seemingly chaotic patterns of genetic structure between sites. Empirical and modeled networks showed significant similarities in the clustering coefficients of each site and adjacency matrices between sites. Most of the connectivity patterns observed towards downstream sites (Sonora coast) were strictly asymmetric, while those between upstream sites (Baja and the Midriffs) were symmetric. The best-supported gene flow model and analyses of modularity of the modeled networks confirmed a pulse of larvae from the Baja Peninsula, across the Midriff Island region and towards the

  18. Biodiversity conservation: an example of a multidisciplinary approach to marine dispersal.

    PubMed

    Aliani, Stefano; Berta, Maristella; Borghini, Mireno; Carlson, Daniel; Conversi, Alessandra; Corgnati, Lorenzo; Griffa, Annalisa; Magaldi, Marcello Gatimu; Mantovani, Carlo; Marini, Simone; Mazzei, Luca; Suaria, Giuseppe; Vetrano, Anna

    The general aim of this paper is to present a possible multidisciplinary approach to the problem of connectivity among marine protected areas (MPAs) describing some of the mechanisms and vectors that control the dispersal of propagules among spatially distributed marine communities of MPAs in the Southern Adriatic Sea. A joint approach is described that focuses on (a) measurements of surface water current and model data integrated with a dedicated software (LAVA, LAgrangian Variational Analysis), (b) measurements of rafting objects and their evaluation as an alternative way to species dispersal, and (c) a tool to automatically monitor propagules and plankton species in the water column. Studies on the dynamics of water currents demonstrated that the Gargano area has the potential to supply dispersal propagules to the Southern Adriatic both along the Italian coastline and offshore across the basin, thus providing important services to the dispersal processes and the connectivity routes among MPAs. The natural dispersion is however enhanced by floating objects, on which entire marine communities are living and travelling. The number of these objects has greatly increased with the introduction of human litter: in the Adriatic, man-made litter composes nowadays the majority (79 %) of all floating objects, with this corresponding to an almost fourfold increase in the abundance of floating objects since pre-industrial times. Such enhanced dispersion may benefit transmission of propagules from MPAs along biodiversity corridors, but may also enhance the arrival of invasive species. The direct observation of organisms can provide information on the species distribution and mobility. New technology (GUARD-1 system) has been developed to automatically identify spatial or temporal distributions of selected species in the water column by image analysis. The system has so far successfully detected blooms of ctenophores in the water column and is now being tested for

  19. Methodological proposal for implementing an intervention to prevent pedestrian injuries, a multidisciplinary approach: the case of Cuernavaca, Morelos, Mexico.

    PubMed

    Rodríguez, Jorge M; Híjar Medina, Martha; Campuzano, Julio César; Bangdiwala, Shrikant I; Villaveces, Andrés

    2014-02-01

    To describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach. This study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998-2007), an analysis and geocoding of pedestrian injuries (2008-2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the 'best evidence' adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention. Between 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention. A combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.

  20. Multidisciplinary Perspectives on Higher Education for the Public Good. Number 1, 2005

    ERIC Educational Resources Information Center

    Martinez, Magdalena, Ed.; Pasque, Penny A., Ed.; Bowman, Nick, Ed.; Chambers, Tony, Ed.

    2005-01-01

    The National Forum on Higher Education for the Public Good, along with the American Association for Higher Education (AAHE), American College Personnel Association (ACPA), American Educational Research Association (AERA), Association for Institutional Research (AIR), and Association for the Study of Higher Education (ASHE), have committed…

  1. A Comprehensive, Multidisciplinary Approach to Providing Health Care for Children in Out-of-Home Care.

    ERIC Educational Resources Information Center

    Blatt, Steven D.; And Others

    1997-01-01

    Describes ENHANCE (Excellence in Health Care for Abused and Neglected Children) of Onondaga County, New York, a comprehensive, multidisciplinary clinic for children in out-of-home care involving pediatrics, child psychology, nursing, child development, and child welfare components. Also presents profiles of the health, mental health, and…

  2. Bio-events in the continental realm during the Cretaceous/Tertiary transition: a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Feist, Monique

    This study is a short progress report of a multidisciplinary cooperation. It deals with animal and plant biotas found in five nonmarine Maastrichtian-Paleocene sequences in southern Europe (southern France, north-east Spain). In addition, contributions on North America charophyte floras are taken into account.

  3. A Multidisciplinary Research Team Approach to Computer-Aided Drafting (CAD) System Selection. Final Report.

    ERIC Educational Resources Information Center

    Franken, Ken; And Others

    A multidisciplinary research team was assembled to review existing computer-aided drafting (CAD) systems for the purpose of enabling staff in the Design Drafting Department at Linn Technical College (Missouri) to select the best system out of the many CAD systems in existence. During the initial stage of the evaluation project, researchers…

  4. The Carolina Abecedarian Project: A Longitudinal and Multidisciplinary Approach to the Prevention of Developmental Retardation.

    ERIC Educational Resources Information Center

    Ramey, Craig T.; And Others

    This progress report describes the subjects, program and curriculum development, and collected psychological and medical data of the Carolina Abecedarian Project, an intervention program, begun in 1972. The purpose of this project is to bring together a multidisciplinary team of researchers to demonstrate that the developmental retardation of…

  5. A Multidisciplinary, Hospital-Based Team for Child Abuse Cases: A "Hands-on" Approach.

    ERIC Educational Resources Information Center

    Whitworth, Jay M.; And Others

    1981-01-01

    Describes a hospital-based program for providing consultation to persons who provide direct services in child abuse/neglect cases. Conceptual issues in multidisciplinary team formation and involvement are discussed. Some topics mentioned are types of service, follow-up, educational components, and long-term involvement with families. (DB)

  6. The Campus Lake Learning Community: Promoting a Multidisciplinary Approach to Environmental Problem Solving

    ERIC Educational Resources Information Center

    Walsh, Maud; Jenkins, Dorothy; Powell, Katrina; Rusch, Kelly

    2005-01-01

    A multidisciplinary learning community provided environmental management students the opportunity to work with students in different classes and majors to create designs for improving the appearance and environmental quality of a lake on a university campus. The experience increased student appreciation for the contribution of other disciplines in…

  7. Multidisciplinary approach for a patient with dentinogenesis imperfecta and anterior trauma.

    PubMed

    Roh, Won-Jong; Kang, Seung-Goo; Kim, Su-Jung

    2010-09-01

    Dentinogenesis imperfecta is an inherited dentinal dysplasia involving several risks for orthodontic treatment. This case report describes the multidisciplinary treatment of a 17-year-old girl whose Class II Division 1 malocclusion was complicated by dentinogenesis imperfecta type II and maxillary anterior trauma. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  8. Transformative Learning Approaches for Public Relations Pedagogy

    ERIC Educational Resources Information Center

    Motion, Judy; Burgess, Lois

    2014-01-01

    Public relations educators are frequently challenged by students' flawed perceptions of public relations. Two contrasting case studies are presented in this paper to illustrate how socially-oriented paradigms may be applied to a real-client project to deliver a transformative learning experience. A discourse-analytic approach is applied within the…

  9. Transformative Learning Approaches for Public Relations Pedagogy

    ERIC Educational Resources Information Center

    Motion, Judy; Burgess, Lois

    2014-01-01

    Public relations educators are frequently challenged by students' flawed perceptions of public relations. Two contrasting case studies are presented in this paper to illustrate how socially-oriented paradigms may be applied to a real-client project to deliver a transformative learning experience. A discourse-analytic approach is applied within the…

  10. Investigation of type-I interferon dysregulation by arenaviruses : a multidisciplinary approach.

    SciTech Connect

    Kozina, Carol L.; Moorman, Matthew Wallace; Branda, Catherine; Wu, Meiye; Manginell, Ronald Paul; Ricken, James Bryce; James, Conrad D.; Negrete, Oscar A.; Misra, Milind; Carson, Bryan D.

    2011-09-01

    This report provides a detailed overview of the work performed for project number 130781, 'A Systems Biology Approach to Understanding Viral Hemorrhagic Fever Pathogenesis.' We report progress in five key areas: single cell isolation devices and control systems, fluorescent cytokine and transcription factor reporters, on-chip viral infection assays, molecular virology analysis of Arenavirus nucleoprotein structure-function, and development of computational tools to predict virus-host protein interactions. Although a great deal of work remains from that begun here, we have developed several novel single cell analysis tools and knowledge of Arenavirus biology that will facilitate and inform future publications and funding proposals.

  11. A multidisciplinary approach for analysing landslide susceptibility in Abruzzo piedmont (Italy)

    NASA Astrophysics Data System (ADS)

    Sciarra, Marco; Urbano, Tullio; Coco, Laura

    2016-04-01

    Landslide susceptibility is the probability or likelihood that a landslide phenomenon happens in a specific area and in a not determined date, based on the correlation of controlling factors with distribution of past events. The present work presents a landslide susceptibility analysis assessment in the Feltrino Stream basin and minor surrounding coastal basins in south-eastern Abruzzo Region (Central Italy). The work was based on a multidisciplinary approach involving GIS (Geographic Information System) processing and geomorphological field survey. The study area, as well as the whole Italian Adriatic hills, is characterized by moderate to high landslide susceptibility, because of the complex geological, geomorphological and climatic features. Geologically, the bedrock is mainly characterised by marine deposits composed by clay-sandstone-conglomerate lithology belonging to Upper Pliocene - Lower Pleistocene, and locally by marine to continental transitional deposits belonging to Middle Pleistocene. The bedrock is largely covered by near-surface continental deposits composed by clay-silt-sand-gravel lithology ranging in age from Upper Pleistocene to Holocene. From the geomorphological viewpoint, the area is involved in different landslides phenomena (rock falls, rotational, translational and complex landslides, earth flows) which affect ~15% of the overall surface area. The landslide susceptibility study was carried out through a geostatistical analysis of landslides driver factors. Air-photos analysis was conducted for larger landslides and hillslope areas. The identified landslides were corroborated through a detailed geomorphological field survey. The methodology involved three main steps. Firstly, the main driver factors, directly or indirectly linked to slope instability, were defined and mapped by DTM processing, air-photos analysis and detailed geomorphological field survey. Morphological, geological and geomorphological factors were considered: slope

  12. Part 1: Participatory Ergonomics Approach to Waste Container Handling Utilizing a Multidisciplinary Team

    SciTech Connect

    Zalk, D.M.; Tittiranonda, P.; Burastero, S.; Biggs, T.W.; Perry, C.M.; Tageson, R.; Barsnick, L.

    2000-02-07

    This multidisciplinary team approach to waste container handling, developed within the Grassroots Ergonomics process, presents participatory ergonomic interpretations of quantitative and qualitative aspects of this process resulting in a peer developed training. The lower back, shoulders, and wrists were identified as frequently injured areas, so these working postures were a primary focus for the creation of the workers' training. Handling procedures were analyzed by the team to identify common cycles involving one 5 gallon (60 pounds), two 5 gallons (60 and 54 pounds), 30 gallon (216 pounds), and 55 gallon (482 pounds) containers: lowering from transporting to/from transport vehicles, loading/unloading on transport vehicles, and loading onto pallet. Eleven experienced waste container handlers participated in this field analysis. Ergonomic exposure assessment tools measuring these field activities included posture analysis, posture targeting, Lumbar Motion Monitor{trademark} (LMM), and surface electromyography (sEMG) for the erector spinae, infraspinatus, and upper trapezius muscles. Posture analysis indicates that waste container handlers maintained non-neutral lower back postures (flexion, lateral bending, and rotation) for a mean of 51.7% of the time across all activities. The right wrist was in non-neutral postures (radial, ulnar, extension, and flexion) a mean of 30.5% of the time and the left wrist 31.4%. Non-neutral shoulder postures (elevation) were the least common, occurring 17.6% and 14.0% of the time in the right and left shoulders respectively. For training applications, each cycle had its own synchronized posture analysis and posture target diagram. Visual interpretations relating to the peak force modifications of the posture target diagrams proved to be invaluable for the workers' understanding of LMM and sEMG results (refer to Part II). Results were reviewed by the team's field technicians and their interpretations were developed into ergonomic

  13. Multidisciplinary approach to assess the sensitivity of dwarf tomato plants to low-LET ionising radiation

    NASA Astrophysics Data System (ADS)

    De Micco, Veronica; De Pascale, Stefania; Aronne, Giovanna; Paradiso, Roberta; Vitaglione, Paola; Turano, Mimmo; Arena, Carmen

    Ionising radiation, acting alone or in interaction with microgravity and other environmental constraints, may affect plant at molecular, morpho-structural and physiological level. The intensity of the plant’s response depends on the properties of radiation and on the features of the plant itself. Indeed, different species are characterised by different susceptibility to radiation which may change during the life course. The aim of this research was to study the radiosensitivity to low-LET ionising radiation of plants of dwarf tomato (Solanum lycopersicum L. ‘Microtom’) at two phenological phases (vegetative and reproductive), within the purpose of analysing plants for consideration as candidates for Bioregenerative Life Support Systems (BLSS) in Space. To pursue this objective, plants of the cultivar Microtom were irradiated with different doses of X-rays either at the stage of the second true leaf (VP - vegetative phase) or when at least one flower was blossomed (RP - reproductive phase). Plant’s response to ionising radiation was assessed through a multidisciplinary approach combining genetic analyses, ecophysiological measurements, morpho-anatomical characterisation of leaves and fruits, nutritional analyses of fruits. Growth, molecular and morpho-functional traits were measured during plant development up to fruiting in both VP and RP plant groups, and compared with non-irradiated control plants. Plant growth was monitored weekly recording parameters such as plant height, number of leaves, leaf area, flowering and fruiting rate. Potential DNA alterations were explored through Random Amplified Polymorphic DNA (RAPD) technique. The efficiency of the photosynthetic apparatus was evaluated by determining photosynthetic pigment composition, photochemistry and leaf gas exchanges. Leaf and fruit structure were analysed through light and epi-fluorescence microscopy. Leaf anatomical traits related to photosynthetic efficiency, and to structural radioprotection

  14. Contribution of soil fauna to soil functioning in degraded environments: a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Gargiulo, Laura; Mele, Giacomo; Moradi, Jabbar; Kukla, Jaroslav; Jandová, Kateřina; Frouz, Jan

    2016-04-01

    . All replicates were subjected to soil respiration measurement by means of chemical titration method. Then some replicates were destructively analyzed for PLFA and ergosterol and others were used for the 3D soil image analysis of the soil pore system. The soil cores were imaged using X-ray microtomography and three-dimensional image processing was performed in order to obtain 3D reconstructions and preliminary analysis of the identified biopores. The experimental approach used in this multidisciplinary study showed a promising potential to provide new useful information about the widely differentiated contribution of many types of macrofauna to the formation of the soil pore system and to the development of the soil microbial functions in different types of environments.

  15. Multidisciplinary approach to increasing Resilience in communities versus the hydrogeological and volcanic risk

    NASA Astrophysics Data System (ADS)

    Avvisati, Gala; Colucci, Orazio; Marotta, Enrica; Masucci, Armando; Nave, Rosella; Peluso, Rosario; Tomasone, Mario

    2017-04-01

    A given area may be exposed to different natural hazards, such as landslides, floods, earthquakes, volcanic events etc. which could affect usual human activities at many levels. The goal of our work is to increase the resilience level in communities exposed to natural hazards through an innovative and multidisciplinary research approach integrating engineering, geological, medical and sociological skills. We are going to use an analytical approach to consider simultaneously the Natural Environment and their dwellers, taking into account the sanitary protocols. We'll start by studying the hazards to which the Natural Environment could be exposed evaluating the deriving risks level trough technical studies. For each scenario it's vital to assess the defining aspects such as magnitude and frequency, through a statistical analysis of the specific data-bases in possession of relevant Authorities in charge. Regarding the Inhabitants, it's also vital to analyse the dwellers Risk Perception and their Historical Resilience through a sociological and psychological approach, in order to define the specific information and education program on natural risks. This study is of particular relevance, as even the most advanced risk management plan could fail if locals are not aware and informed about it. A correct disaster management policy must consider the medics role as paramount. Emergency first aid and emergency medicine are to be considered specific field of partitioning, and to be seen as the most appropriate way to deal with a dire situation, especially when the resources vs. magnitude of event ratio is low. The study of best practices helping to improve the resilience and reaction of areas exposed to different natural hazards with different socio-cultural layers is hence crucial. A possible model is to directly involve the residents into controlling the environment and improving/detailing the risks' and emergency areas mapping. These make the population more aware of both

  16. Current multidisciplinary oncology series

    PubMed Central

    Sebio, Ana

    2014-01-01

    “Cancers of the Colon and Rectum: A Multidisciplinary Approach to Diagnosis and Management” represents a truly multidisciplinary compendium of the management of these tumors that will be of value both for any physician involved in providing care for colorectal cancer (CRC) patients as well as for trainees of many medical disciplines.

  17. Multidisciplinary Approach in Hepatocellular Carcinoma in a Level II Hospital: The First Decade of Hospital Universitario Fundacion Alcorcon.

    PubMed

    Loinaz Segurola, C; LIedó Navarro, J L; Burgos, R de la Cruz; Martín Ríos, D; Ochando Cerdán, F; Alonso López, S; Martel Villagrán, J; Gutiérrez Garcia, M L; Fernandez Cebrián, J M; Fernández Rodríguez, C

    2015-06-01

    Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.

  18. Proper function, phonetics, and aesthetics achieved with implant-supported restorations: a multidisciplinary approach.

    PubMed

    Smiler, D G; Finley, J M; Melton, B

    1995-01-01

    In a multidisciplinary restoration of the edentulous patient, close cooperation of involved personnel is essential during the treatment planning and the restorative procedures. This presentation is an overview of the rehabilitation of the edentulous maxilla, posterior maxilla, and the challenges of the single tooth implant-supported restorations. The prerequisite of teamwork is emphasized, past achievements and benefits of this treatment modality are reviewed, and three prosthetic challenges addressed. Clinical cases are used to illustrate the presentation.

  19. Improving Scientific Communication and Publication Output in a Multidisciplinary Laboratory: Changing Culture Through Staff Development Workshops

    SciTech Connect

    Noonan, Christine F.; Stratton, Kelly G.

    2015-07-13

    Communication plays a fundamental role in science and engineering disciplines. However, many higher education programs provide little, if any, technical communication coursework. Without strong communication skills scientists and engineers have less opportunity to publish, obtain competitive research funds, or grow their careers. This article describes the role of scientific communication training as an innovative staff development program in a learning-intensive workplace – a national scientific research and development laboratory. The findings show that involvement in the workshop has increased overall participating staff annual publications by an average of 61 percent compared to their pre-workshop publishing performance as well as confidence level in their ability to write and publish peer-reviewed literature. Secondary benefits include improved information literacy skills and the development of informal communities of practice. This work provides insight into adult education in the workplace.

  20. Feed Safe: a multidisciplinary partnership approach results in a successful mobile application for breastfeeding mothers.

    PubMed

    White, Becky; White, James; Giglia, Roslyn; Tawia, Susan

    2016-05-30

    Issue addressed: Mobile applications are increasingly being used in health promotion initiatives. Although there is evidence that developing these mobile health applications in multidisciplinary teams is good practice, there is a gap in the literature with respect to evaluation of the process of this partnership model and how best to disseminate the application into the community. The aim of this paper is twofold, to describe the partnership model in which the Feed Safe application was developed and to investigate what worked in terms of dissemination.Methods: The process of working in partnership was measured using the VicHealth partnership analysis tool for health promotion. The dissemination strategy and reach of the application was measured using both automated analytics data and estimates of community-initiated promotion.Results: The combined average score from the partnership analysis tool was 138 out of a possible 175. A multipronged dissemination strategy led to good uptake of the application among Australian women.Conclusions: Multidisciplinary partnership models are important in the development of health promotion mobile applications. Recognising and utilising the skills of each partner organisation can help expand the reach of mobile health applications into the Australian population and aid in good uptake of health promotion resources.So what?: Developing mobile applications in multidisciplinary partnerships is good practice and can lead to wide community uptake of the health promotion resource.

  1. Integral multidisciplinary approach in a patient with chronic complete spinal cord injury and hip disarticulation

    PubMed Central

    Quinzaños-Fresnedo, J; Rodríguez-Reyes, G; Mendoza-Cosío, C; Pérez-Zavala, R; Márquez-Guitérrez, E A; Hernández-Sandoval, S

    2015-01-01

    Study design: Case report. Objectives: To highlight the importance of the integral multidisciplinary management of a patient with complete chronic spinal cord injury and hip disarticulation secondary to pressure ulcers (PU). Setting: Mexico City. Methods: The case of a 40-year-old male violinist with a spinal cord injury, American Spinal Injury Association Impairment Scale A and neurological level T4, is reported. The patient initiated with bilateral ischiatic, left trochanteric and sacral PU. The ulcers were complicated with infection with sluggish evolution. Thus, it was decided a multidisciplinary management by means of left hip disarticulation and elaboration of a cosmetic prosthesis and the manufacture of a viscous elastic foam cushion for the prevention of new PU. The patient was quickly included in his professional and social activities. Conclusion: This study proves that multidisciplinary management of patients with spinal cord injury with complications such as the presence of PU that are resistant to noninvasive treatment can be the solution for the patient’s reintegration into their normal life with adequate quality of life. PMID:28053719

  2. Integral multidisciplinary approach in a patient with chronic complete spinal cord injury and hip disarticulation.

    PubMed

    Quinzaños-Fresnedo, J; Rodríguez-Reyes, G; Mendoza-Cosío, C; Pérez-Zavala, R; Márquez-Guitérrez, E A; Hernández-Sandoval, S

    2015-01-01

    Case report. To highlight the importance of the integral multidisciplinary management of a patient with complete chronic spinal cord injury and hip disarticulation secondary to pressure ulcers (PU). Mexico City. The case of a 40-year-old male violinist with a spinal cord injury, American Spinal Injury Association Impairment Scale A and neurological level T4, is reported. The patient initiated with bilateral ischiatic, left trochanteric and sacral PU. The ulcers were complicated with infection with sluggish evolution. Thus, it was decided a multidisciplinary management by means of left hip disarticulation and elaboration of a cosmetic prosthesis and the manufacture of a viscous elastic foam cushion for the prevention of new PU. The patient was quickly included in his professional and social activities. This study proves that multidisciplinary management of patients with spinal cord injury with complications such as the presence of PU that are resistant to noninvasive treatment can be the solution for the patient's reintegration into their normal life with adequate quality of life.

  3. Dynamics of organic matter and microbial populations in amended soil: a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Gigliotti, Giovanni; Pezzolla, Daniela; Zadra, Claudia; Albertini, Emidio; Marconi, Gianpiero; Turchetti, Benedetta; Buzzini, Pietro

    2013-04-01

    The application of organic amendments to soils, such as pig slurry, sewage sludge and compost is considered a tool for improving soil fertility and enhancing C stock. The addition of these different organic materials allows a good supply of nutrients for plants but also contributes to C sequestration, affects the microbial activity and the transformation of soil organic matter (SOM). Moreover, the addition of organic amendment has gained importance as a source of greenhouse gas (GHG) emissions and then as a cause of the "Global Warming". Therefore, it is important to investigate the factors controlling the SOM mineralization in order to improve soil C sequestration and decreasing at the same time the GHG emissions. The quality of organic matter added to the soil will play an important role in these dynamics, affecting the microbial activity and the changes in microbial community structure. A laboratory, multidisciplinary experiment was carried out to test the effect of the amendment by anaerobic digested livestock-derived organic materials on labile organic matter evolution and on dynamics of microbial population, this latter both in terms of consistence of microbial biomass, as well as in terms of microbial biodiversity. Different approaches were used to study the microbial community structure: chemical (CO2 fluxes, WEOC, C-biomass, PLFA), microbiological (microbial enumeration) and molecular (DNA extraction and Roche 454, Next Generation Sequencing, NGS). The application of fresh digestate, derived from the anaerobic treatment of animal wastes, affected the short-term dynamics of microbial community, as reflected by the increase of CO2 emissions immediately after the amendment compared to the control soil. This is probably due to the addition of easily available C added with the digestate, demonstrating that this organic material was only partially stabilized by the anaerobic process. In fact, the digestate contained a high amounts of available C, which led to

  4. Multidisciplinary approach to evaluate flood damage for residential buildings: first results in Northern Italy

    NASA Astrophysics Data System (ADS)

    Luino, Fabio

    2015-04-01

    the aims was to provide public administrations a management tool to help them use damage information. For this purpose a GIS-based model was created that can simulate flood events and evaluate potential direct economic loss due to a catastrophe based on thorough land knowledge coupled with the description of various physical elements of the natural event. The multidisciplinary method can be summarized in the following steps: 1) Event description: definition of flood parameters (flooded area and water level). This definition is possible because of real-time measurements or event simulation through a hydraulic model; 2) Identifying the affected assets in the flooded area; 3) Evaluation of the degree of damage to the exposed elements as a function of event magnitude identified from the measurement of floodwater depths of an event; 4) Attribution of an economic value to exposed assets. Quantification of economic loss by multiplying the economic value of damaged assets and the degree of damage. The methodology can be used to estimate the damage from the impact of floodwater on exposed elements (direct damage) and to quantify the resulting economic loss (tangible damage).

  5. Air pollution and detrimental effects on children’s brain. The need for a multidisciplinary approach to the issue complexity and challenges

    PubMed Central

    Calderón-Garcidueñas, Lilian; Torres-Jardón, Ricardo; Kulesza, Randy J.; Park, Su-Bin; D’Angiulli, Amedeo

    2014-01-01

    Millions of children in polluted cities are showing brain detrimental effects. Urban children exhibit brain structural and volumetric abnormalities, systemic inflammation, olfactory, auditory, vestibular and cognitive deficits v low-pollution controls. Neuroinflammation and blood-brain-barrier (BBB) breakdown target the olfactory bulb, prefrontal cortex and brainstem, but are diffusely present throughout the brain. Urban adolescent Apolipoprotein E4 carriers significantly accelerate Alzheimer pathology. Neurocognitive effects of air pollution are substantial, apparent across all populations, and potentially clinically relevant as early evidence of evolving neurodegenerative changes. The diffuse nature of the neuroinflammation and neurodegeneration forces to employ a weight of evidence approach incorporating current clinical, cognitive, neurophysiological, radiological and epidemiological research. Pediatric air pollution research requires extensive multidisciplinary collaborations to accomplish a critical goal: to protect exposed children through multidimensional interventions having both broad impact and reach. Protecting children and teens from neural effects of air pollution should be of pressing importance for public health. PMID:25161617

  6. How a multidisciplinary 'One Health' approach can combat the tick-borne pathogen threat in Europe.

    PubMed

    Vayssier-Taussat, Muriel; Cosson, Jean François; Degeilh, Brigitte; Eloit, Marc; Fontanet, Arnaud; Moutailler, Sara; Raoult, Didier; Sellal, Eric; Ungeheuer, Marie-Noelle; Zylbermann, Patrick

    2015-01-01

    In Europe, ticks are the major arthropod vectors of disease agents to humans and domestic animals. They are capable of transmitting many pathogens most of which have been discovered or identified as tick-borne pathogens in the last 20 years. In recent years, unexplained syndromes occurring after a tick bite have become an increasingly important issue in public and animal health. Ticks and wildlife (the main reservoir of tick-borne pathogens) are highly susceptible to global environmental and socio-economic changes, which in turn may lead to an increased burden of tick-borne diseases. In this review, we explain the importance of a 'One Health' approach to better combat tick-borne diseases.

  7. Multidisciplinary approach to evaluate landslide susceptibility along highway in northern Calabria, Italy

    NASA Astrophysics Data System (ADS)

    Muto, Francesco; Conforti, Massimo; Critelli, Salvatore; Fabbricatore, Davide; Filomena, Luciana; Rago, Valeria; Robustelli, Gaetano; Scarciglia, Fabio; Versace, Pasquale

    2014-05-01

    The interaction of landslides with linear infrastructures is often the cause of disasters. In Italy landslide impact on roads, railways and buildings cause millions of Euro per year in damage and restoration as well. The proposed study is aimed to the landslide susceptibility evaluation using a multidisciplinary approach: geological and geomorphological survey, statistical analysis and GIS technique, along a section of highway "A3 (Salerno-Reggio Calabria)" between Cosenza Sud and Altilia, northern Calabria. This study is included in a wider research project, named: PON01-01503, Landslides Early Warning-Sistemi integrati per il monitoraggio e la mitigazione del rischio idrogeologico lungo le grandi vie di comunicazione - aimed at the hydrogeological risk mitigation and at the early warning along the highways. The work was first based on air-photo interpretations and field investigations, in order to realize the geological map, geomorphological map and landslide inventory map. In the study area the geomorphology is strongly controlled by its bedrock geology and tectonics. The bedrock geology consists of Neogene sedimentary rocks that cover a thick stack of allochthonous nappes. These nappes consist of crystalline rocks mainly gneiss, phyllite and schist. A total of 835 landslides were mapped and the type of movement are represented mainly by slides and complex and subordinately flow. In order to estimate and validate landslide susceptibility the landslides were divided in two group. One group (training set) was used to prepare susceptibility map and the second group (validation set) to validate the map. Then, the selection of predisposing factors was performed, according with the geological and geomorphological settings of the study area: lithology, distance from tectonic elements, land use, slope, aspect, stream power index (SPI) and plan curvature. In order to evaluate landslide susceptibility Conditional Analysis was applied to Unique Conditions Units (UCUs

  8. Mobile tele-medicine systems in the multidisciplinary approach of diabetes management : the remote prevention of diabetes complications.

    PubMed

    Mammas, Constantinos S; Geropoulos, Spyros; Markou, Georgia; Saatsakis, George; Lemonidou, Chryssa; Tentolouris, Nikolaos

    2014-01-01

    Evaluation of feasibility and reliability of Mobile-Telemedicine Systems (M-TS) in the remote prevention of diabetes related complications. A feasibility-reliability evaluation based on a simulating experimentation by ten specialists (N=10) who examined a diabetic patient on the electronic space of a mobile experimental telemedicine system (MU-Exp.-TS). I. Remote prevention of diabetic foot and other diabetes related complications is feasible (acceptability: 89-100%). II. Remote ulcer classification and diabetic foot amputation risk estimation: Accuracy=89%. The proposed MU-TS based multidisciplinary approach and prevention of diabetes related complications is feasible while that of diabetic foot is both feasible and reliable.

  9. The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis.

    PubMed

    Streiff, Michael B; Lau, Brandyn D; Hobson, Deborah B; Kraus, Peggy S; Shermock, Kenneth M; Shaffer, Dauryne L; Popoola, Victor O; Aboagye, Jonathan K; Farrow, Norma A; Horn, Paula J; Shihab, Hasan M; Pronovost, Peter J; Haut, Elliott R

    2016-12-01

    Venous thromboembolism (VTE) is an important cause of preventable harm in hospitalized patients. The critical steps in delivery of optimal VTE prevention care include (1) assessment of VTE and bleeding risk for each patient, (2) prescription of risk-appropriate VTE prophylaxis, (3) administration of risk-appropriate VTE prophylaxis in a patient-centered manner, and (4) continuously monitoring outcomes to identify new opportunities for learning and performance improvement. To ensure that every hospitalized patient receives VTE prophylaxis consistent with their individual risk level and personal care preferences, we organized a multidisciplinary task force, the Johns Hopkins VTE Collaborative. To achieve the goal of perfect prophylaxis for every patient, we developed evidence-based, specialty-specific computerized clinical decision support VTE prophylaxis order sets that assist providers in ordering risk-appropriate VTE prevention. We developed novel strategies to improve provider VTE prevention ordering practices including face-to-face performance reviews, pay for performance, and provider VTE scorecards. When we discovered that prescription of risk-appropriate VTE prophylaxis does not ensure its administration, our multidisciplinary research team conducted in-depth surveys of patients, nurses, and physicians to design a multidisciplinary patient-centered educational intervention to eliminate missed doses of pharmacologic VTE prophylaxis that has been funded by the Patient Centered Outcomes Research Institute. We expect that the studies currently underway will bring us closer to the goal of perfect VTE prevention care for every patient. Our learning journey to eliminate harm from VTE can be applied to other types of harm. Journal of Hospital Medicine 2016;11:S8-S14. © 2016 Society of Hospital Medicine.

  10. Static, Dynamic and Semantic Dimensions: Towards a Multidisciplinary Approach of Social Networks Analysis

    NASA Astrophysics Data System (ADS)

    Thovex, Christophe; Trichet, Francky

    The objective of our work is to extend static and dynamic models of Social Networks Analysis (SNA), by taking conceptual aspects of enterprises and institutions social graph into account. The originality of our multidisciplinary work is to introduce abstract notions of electro-physic to define new measures in SNA, for new decision-making functions dedicated to Human Resource Management (HRM). This paper introduces a multidimensional system and new measures: (1) a tension measure for social network analysis, (2) an electrodynamic, predictive and semantic system for recommendations on social graphs evolutions and (3) a reactance measure used to evaluate the individual stress at work of the members of a social network.

  11. Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol

    PubMed Central

    Dreijer, Albert R; Kruip, Marieke J H A; Diepstraten, Jeroen; Polinder, Suzanne; Brouwer, Rolf; Leebeek, Frank W G; Vulto, Arnold G; van den Bemt, Patricia M L A

    2016-01-01

    Introduction Antithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation. Methods and analysis In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective. Ethics and dissemination This protocol was

  12. Implementing critical pathways and a multidisciplinary team approach to cardiovascular disease management.

    PubMed

    Peterson, Eric D; Albert, Nancy M; Amin, Alpesh; Patterson, J Herbert; Fonarow, Gregg C

    2008-09-08

    According to several medical registries, there is a need to improve the care of post-myocardial infarction (MI) patients, especially those with left ventricular dysfunction (LVD) and heart failure. This can potentially be achieved by implementing disease management programs, which include critical pathways, patient education, and multidisciplinary hospital teams. Currently, algorithms for critical pathways, including discharge processes, are lacking for post-MI LVD patients. Such schemes can increase the use of evidence-based medicines proved to reduce mortality. Educational programs are aimed at increasing patients' awareness of their condition, promoting medication compliance, and encouraging the adoption of healthy behaviors; such programs have been shown to be effective in improving outcomes of post-MI LVD patients. Reductions in all-cause hospitalizations and medical costs as well as improved survival rates have been observed when a multidisciplinary team (a nurse, a pharmacist, and a hospitalist) is engaged in patient care. In addition, the use of the "pay for performance" method, which can be advantageous for patients, physicians, and hospitals, may potentially improve the care of post-MI patients with LVD.

  13. A Multidisciplinary Approach to Full Mouth Rehabilitation and Solving the Dilemma of Wriggling Dentures- A Case Report

    PubMed Central

    Nidawani, Prakash; Galagali, Girish; Reddy, E Srinivas; Behera, Sidhartha S P

    2014-01-01

    A successful management of full mouth rehabilitation demands a multi-disciplinary approach for its long lasting success. The present case report is intended to give an insight into the use of multiple treatment modalities to achieve a balanced, efficient and biomechanically successful prosthodontic treatment with acceptable aesthetics. Treatment of a maxillary and mandibular bilateral distal free end edentulous arch along with upper and lower anterior teeth requires plenty of contemporary and conventional prosthodontic treatment modalities. Management of distal extension situation provides complexity of biomechanical problems due to the three dimensional movements of the distal extension denture. A distal most implant can convert a distal extension RPD from a tooth and tissue supported prosthesis to a tooth and implant supported prosthesis which provides a definite stop thus enhancing the retention and stability of the prosthesis, eliminating the problems often associated with a tooth and tissue supported distal extension RPD. How to cite the article: Nidawani P, Galagali G, Reddy ES, Behera SS. A Multidisciplinary Approach to Full Mouth Rehabilitation and Solving the Dilemma of Wriggling Dentures- A Case Report. J Int Oral Health 2014;6(2):136-40. PMID:24876716

  14. Factors influencing the effectiveness of inservice education on the utilization of a multidisciplinary approach to environmental education

    SciTech Connect

    Lakshmanan, L.F.

    1983-01-01

    The purpose of this study was to develop an inservice model for the systematic inclusion of environmental concepts in the elementary curriculum and to assess the effectiveness of the model in increasing the amount of environmental education in the elementary classroom. The model was based on a multi-disciplinary approach to environmental education and the utilization of peer consultants as inservice trainers. Development of the model involved: identification of a list of basic environmental concepts, development of a sequence of activities which would promote maximum participant involvement, and training of classroom teachers to serve as peer consultants. A three-group, pre-test-post-test research design was utilized to test the effectiveness of the model. Subjects were elementary teachers in the Memphis City Schools. Results of this study indicate that two-hour inservice training in a multi-disciplinary approach to environmental education is not effective in producing a significant change in the attitudes and teaching behavior of elementary teachers. However, inservice groups consulted by specially-trained peers report teaching more environmental concepts than groups consulted by experts. The peer-consulted groups also tend to evaluate the inservice program significantly higher than the expert consulted groups. Finally, there appears to be a significant association between the teacher's perception of principal support and the number of environmental concepts taught.

  15. Identification of kinship and occupant status in Mongolian noble burials of the Yuan Dynasty through a multidisciplinary approach

    PubMed Central

    Cui, Yinqiu; Song, Li; Wei, Dong; Pang, Yuhong; Wang, Ning; Ning, Chao; Li, Chunmei; Feng, Binxiao; Tang, Wentao; Li, Hongjie; Ren, Yashan; Zhang, Chunchang; Huang, Yanyi; Hu, Yaowu; Zhou, Hui

    2015-01-01

    The Yuan Dynasty (AD 1271–1368) was the first dynasty in Chinese history where a minority ethnic group (Mongols) ruled. Few cemeteries containing Mongolian nobles have been found owing to their tradition of keeping burial grounds secret and their lack of historical records. Archaeological excavations at the Shuzhuanglou site in the Hebei province of China led to the discovery of 13 skeletons in six separate tombs. The style of the artefacts and burials indicate the cemetery occupants were Mongol nobles. However, the origin, relationships and status of the chief occupant (M1m) are unclear. To shed light on the identity of the principal occupant and resolve the kin relationships between individuals, a multidisciplinary approach was adopted, combining archaeological information, stable isotope data and molecular genetic data. Analysis of autosomal, mitochondrial and Y-chromosomal DNA show that some of the occupants were related. The available evidence strongly suggests that the principal occupant may have been the Mongol noble Korguz. Our study demonstrates the power of a multidisciplinary approach in elucidating information about the inhabitants of ancient historical sites. PMID:25487330

  16. Identification of kinship and occupant status in Mongolian noble burials of the Yuan Dynasty through a multidisciplinary approach.

    PubMed

    Cui, Yinqiu; Song, Li; Wei, Dong; Pang, Yuhong; Wang, Ning; Ning, Chao; Li, Chunmei; Feng, Binxiao; Tang, Wentao; Li, Hongjie; Ren, Yashan; Zhang, Chunchang; Huang, Yanyi; Hu, Yaowu; Zhou, Hui

    2015-01-19

    The Yuan Dynasty (AD 1271-1368) was the first dynasty in Chinese history where a minority ethnic group (Mongols) ruled. Few cemeteries containing Mongolian nobles have been found owing to their tradition of keeping burial grounds secret and their lack of historical records. Archaeological excavations at the Shuzhuanglou site in the Hebei province of China led to the discovery of 13 skeletons in six separate tombs. The style of the artefacts and burials indicate the cemetery occupants were Mongol nobles. However, the origin, relationships and status of the chief occupant (M1m) are unclear. To shed light on the identity of the principal occupant and resolve the kin relationships between individuals, a multidisciplinary approach was adopted, combining archaeological information, stable isotope data and molecular genetic data. Analysis of autosomal, mitochondrial and Y-chromosomal DNA show that some of the occupants were related. The available evidence strongly suggests that the principal occupant may have been the Mongol noble Korguz. Our study demonstrates the power of a multidisciplinary approach in elucidating information about the inhabitants of ancient historical sites. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  17. A multidisciplinary approach to full mouth rehabilitation and solving the dilemma of wriggling dentures- a case report.

    PubMed

    Nidawani, Prakash; Galagali, Girish; Reddy, E Srinivas; Behera, Sidhartha S P

    2014-04-01

    A successful management of full mouth rehabilitation demands a multi-disciplinary approach for its long lasting success. The present case report is intended to give an insight into the use of multiple treatment modalities to achieve a balanced, efficient and biomechanically successful prosthodontic treatment with acceptable aesthetics. Treatment of a maxillary and mandibular bilateral distal free end edentulous arch along with upper and lower anterior teeth requires plenty of contemporary and conventional prosthodontic treatment modalities. Management of distal extension situation provides complexity of biomechanical problems due to the three dimensional movements of the distal extension denture. A distal most implant can convert a distal extension RPD from a tooth and tissue supported prosthesis to a tooth and implant supported prosthesis which provides a definite stop thus enhancing the retention and stability of the prosthesis, eliminating the problems often associated with a tooth and tissue supported distal extension RPD. How to cite the article: Nidawani P, Galagali G, Reddy ES, Behera SS. A Multidisciplinary Approach to Full Mouth Rehabilitation and Solving the Dilemma of Wriggling Dentures- A Case Report. J Int Oral Health 2014;6(2):136-40.

  18. Fine needle biopsy with cytology in paediatrics: the importance of a multidisciplinary approach and the role of ancillary techniques.

    PubMed

    Barroca, H; Bom-Sucesso, M

    2014-02-01

    Fine needle biopsy (FNB) with cytology has long been regarded as an excellent technique as the first choice for diagnosing adult tumours. Being an inexpensive minimally invasive technique with high accuracy and diagnostic immediacy through rapid on-site evaluation, it is also ideal for implementation in the paediatric setting, particularly in developing countries. Furthermore, it allows complementary and advanced procedures such as flow cytometry, polymerase chain reaction (PCR) or fluorescence in situ hybridization (FISH), among others, which enhances the diagnostic capacity of this technique and gives it a key role in risk stratification and therapeutic decision-making for several tumours. The advantages of FNB are optimized in the setting of a multidisciplinary team where cytologist, clinician and radiologist play leading roles. Paediatric tumours are rare and most ancillary techniques are cost-effective but complex to be implemented in small centres with limited experience in paediatric pathology. Therefore reference centres are essential, in order to establish teams with extensive experience and expertise. Hence, any child with a suspected malignancy should be directly referred to a paediatric oncology unit. Focusing on a practical approach to the assessment of paediatric lymphadenopathies and non-central nervous system solid tumours we review the effectiveness of FNB as applied concurrently with ancillary techniques in a multidisciplinary approach to the diagnosis, prognosis and therapeutic decisions of paediatric tumours and tumour-like lesions.

  19. Svalbard Integrated Arctic Earth Observing System (sios): Facilitating Easy Access to Multidisciplinary Arctic Data Through the Brokering Approach.

    NASA Astrophysics Data System (ADS)

    Bye, B. L.; Godøy, Ø.

    2014-12-01

    Environmental and climate changes are important elements of our global challenges. They are observed at a global scale and in particular in the Arctic. In order to give better estimates of the future changes, the Arctic has to be monitored and analyzed by a multi-disciplinary observation system that will improve Earth System Models. The best chance to achieve significant results within a relatively short time frame is found in regions with a large natural climate gradient, and where processes sensitive to the expected changes are particularly important. Svalbard and the surrounding ocean areas fulfil all these criteria. The vision for SIOS is to be a regional observational system for long term acquisition and proliferation of fundamental knowledge on global environmental change within an Earth System Science perspective in and around Svalbard. SIOS will systematically develop and implement methods for how observational networks are to be construed. The distributed SIOS data management system (SDMS) will be implemented through a combination of technologies tailored to the multi-disciplinary nature of the Arctic data. One of these technologies is The Brokering approach or "Framework". The Brokering approach provides a series of services such as discovery, access, transformation and semantics support to enable translation from one discipline/culture to another. This is exactly the challenges the SDMS will have to handle and thus the Brokering approach is integrated in the design of the system. A description of the design strategy for the SDMS that includes The Brokering approach will be presented. The design and implementation plans for the SDMS are based on research done in the EU funded ESFRI project SIOS and examples of solutions for interoperable systems producing Arctic datasets and products coordinated through SIOS will be showcased. The reported experience from SIOS brokering approach will feed into the process of developing a sustainable brokering governance

  20. Minding the Genes: a Multidisciplinary Approach towards Genetic Assessment of Cardiovascular Disease.

    PubMed

    Rhodes, Ashley; Rosman, Lindsey; Cahill, John; Ingles, Jodie; Murray, Brittney; Tichnell, Crystal; James, Cynthia A; Sears, Samuel F

    2016-09-30

    Genetic assessment for inherited cardiovascular disease (CVD) is increasingly available, due in part to rapid innovations in genetic sequencing technologies. While genetic testing is aimed at reducing uncertainty, it also produces awareness of potential medical conditions and can leave patients feeling uncertain about their risk, especially if there are ambiguous results. This uncertainty can produce psychological distress for patients and their families undergoing the assessment process. Additionally, patients may experience psychological distress related to living with inherited CVD. In order to more effectively manage the psychosocial challenges related to genetic assessment for CVD, a multidisciplinary model expanded to include psychologists and other allied health professionals is outlined. A case study is provided to illustrate how psychological distress can manifest in a patient living with inherited CVD, as well as proposed psychological management of this patient. Finally, a guide for genetic counselors is provided to aid in identifying and managing common psychological reactions to genetic assessment for CVD.

  1. Radium 223 dichloride: a multidisciplinary approach to metastatic castration-resistant prostate cancer.

    PubMed

    Borsò, Elisa; Boni, Giuseppe; Galli, Luca; Ricci, Sergio; Farnesi, Azzurra; Mazzarri, Sara; Cianci, Claudia; Mariani, Giuliano; Falcone, Alfredo

    2015-01-01

    The role of nuclear medicine physicians in the multidisciplinary team for the management of patients with prostate cancer has been restricted because of a lack of available tools. The only drugs approved to relieve pain related to bone metastases were β-emitting radiopharmaceuticals. These drugs did not prove to prolong survival when used as single agent and resulted associated with important adverse events. This situation has changed with the introduction of radium 223 because of evidence of improved survival in patients, the good safety profile and the opportunity to avoid clonal selection of tumor cells. Cooperation among physicians involved in cancer management will lead to improvements in the treatment of bone metastases due to prostate cancer and is thought to extend to other tumor types.

  2. Delivery and management of a preterm infant in the burn unit: a multidisciplinary approach.

    PubMed

    Rodriguez, Omar; Cooma, Ruby; Cooper, Michael; Roth, Philip

    2015-05-01

    Burns during pregnancy can have profound effects on both the mother and her fetus. While the mother can suffer cardiovascular collapse, infection, hemorrhage and inhalation injury with respiratory failure, the fetus is affected through the placenta by all of these changes as well as by the transfer of drugs administered to the mother. We report a case of severely burned female patient at 29 weeks gestation, who, due to deteriorating maternal condition, was delivered and managed at 32 weeks gestation by a multidisciplinary team. To the best of our knowledge this is the first reported case of a preterm infant delivered in a burn unit. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  3. ID migraine questionnaire in temporomandibular disorders with craniofacial pain: a study by using a multidisciplinary approach.

    PubMed

    Di Paolo, Carlo; Di Nunno, Anna; Vanacore, Nicola; Bruti, Gianluca

    2009-08-01

    To evaluate the prevalence of migraine and related disability and the role of ID migraine questionnaire as a screening tool in patients with temporomandibular disorders (TMDs) and craniofacial pain (CFP). TMDs patients with CFP underwent stomatognathic (RDC/TMD criteria) and neurological visits (IHS criteria, 2004). ID migraine questionnaire and MIgraine Disability Assessment Scale (MIDAS) were also administered. Out of 45 patients, 69% met diagnosis of migraine plus chronic tension-type headache (CTTH); 9% presented CTTH and 20% were migraineurs. Out of 39 migraineurs who completed MIDAS, 56% presented the highest disability grade. Out of 37 patients who completed ID migraine questionnaire, 32 resulted affected by probable migraine with a diagnostic sensibility and specificity of 94% and 100%, respectively. Our findings showed a clinical association between TMDs and migraine. We support a clinical role of ID migraine and MIDAS in TMDs patients with CFP and we underline the importance of a multidisciplinary evaluation in this group of migraineurs.

  4. Coronary artery imaging with multidetector computed tomography: a call for an evidence-based, multidisciplinary approach.

    PubMed

    Schoenhagen, Paul; Stillman, Arthur E; Garcia, Mario J; Halliburton, Sandra S; Tuzcu, E Murat; Nissen, Steven E; Modic, Michael T; Lytle, Bruce W; Topol, Eric J; White, Richard D

    2006-05-01

    Modern multidetector computed tomography systems are capable of a comprehensive assessment of the cardiovascular system, including noninvasive assessment of coronary anatomy. Multidetector computed tomography is expected to advance the role of noninvasive imaging for coronary artery disease, but clinical experience is still limited. Clinical guidelines are necessary to standardize scanner technology and appropriate clinical applications for coronary computed tomographic angiography. Further evaluation of this evolving technology will benefit from cooperation between different medical specialties, imaging scientists, and manufacturers of multidetector computed tomography systems, supporting multidisciplinary teams focused on the diagnosis and treatment of early and advanced stages of coronary artery disease. This cooperation will provide the necessary education, training, and guidelines for physicians and technologists assuring standard of care for their patients.

  5. Methodologies for sustaining barcode medication administration compliance. A multi-disciplinary approach.

    PubMed

    McNulty, Judy; Donnelly, Eileen; Iorio, Kris

    2009-01-01

    Numerous recent studies have looked at how nursing workarounds and technology failures can undermine the patient safety benefits of barcode medication administration (BCMA) systems. This article will discuss how Solaris Health System in Edison, NJ, methodically addressed these challenges to achieve and sustain 95 percent compliance with BCMA, one of two major initiatives of the non-profit Solaris Patient Safety Institute, which was established to research best practices that could be shared with other organizations. Through meetings and interviews with frontline nurses and their managers, a multidisciplinary team (pharmacy, IT, nursing) identified 12 educational, technological and process-oriented issues, then developed concrete action plans to address each one (e.g., one-on-one software and device training, additional wireless access points, a "hard stop" to require scanning the patient's wristband). Key success factors included demonstrating executive dedication, creating a culture of ownership by engaging frontline nurses in solution design and providing a strong support system.

  6. The importance of a multidisciplinary approach in the treatment of mutilating electrical injury: a case study.

    PubMed

    Lipový, B; Rihová, H; Kaloudová, Y; Suchánek, I; Gregorová, N; Hokynková, A; Jelínková, Z; Agalarev, V

    2010-01-01

    Electrical burns are not ranked among the most frequent type of injuries, but they have the most devastating potential of all thermal injuries and often cause lifelong stigmatization. Those primarily affected are young males: work injuries predominate. An electrical burn is a specific nosological unit that has multiple acute and chronic abnormal manifestations. In this study we describe the case of a young man who suffered an electrical injury after contact with a high-voltage line (22,000 volts) while paragliding. This contact was followed by a 10 m fall. In our work we present the need for multidisciplinary cooperation along with the opportunities, problems and risks that accompany the treatment of this type of injury.

  7. Cancer Portal Project: A Multidisciplinary Approach to Cancer Care Among Hispanic Patients

    PubMed Central

    Gany, Francesca; Ramirez, Julia; Nierodzick, Mary Lynn; McNish, Thelma; Lobach, Iryna; Leng, Jennifer

    2011-01-01

    Purpose: This study investigates the impact of a multilingual, multidisciplinary team targeting social and economic determinants of cancer treatment adherence among at-risk Hispanic immigrants. Methods: Patients were recruited at 10 hospital-based cancer clinics in New York City between December 2008 and November 2009. This is a nested cohort study of Hispanic patients and their sociodemographic characteristics, areas of needed assistance, and reported impact of meeting service needs on keeping appointments. At the core of the intervention is the trained, bilingual Portal Access Facilitator, who assesses needs and synchronizes an individualized set of transdisciplinary services for each patient. Results: A total of 328 Hispanic patients participated in the study. Of these, 89% preferred to speak Spanish in the health care setting, and 17% had no health insurance. The most common cancer diagnosis among participants was breast cancer (35%) followed by GI (17%) and gynecologic (16%) cancers. Patients most commonly requested financial support (59%), food support (37%), transportation assistance (21%), social work services (14%), psychosocial support (6%), help with health insurance issues (5%), and legal services (5%). In a follow-up assessment of high-need patients in urgent need of financial support, 86% reported that portal services helped them attend cancer care and treatment appointments, and 72% reported that portal services decreased worry about their care. Conclusion: Most patients reported that financial, social, and logistical support would help them attend their appointments for cancer care and treatment. Further multidisciplinary interventions should be implemented and evaluated to address social and economic determinants in cancer care for this population. PMID:21532808

  8. A multidisciplinary approach for developing an assessment tool for touch screen devices.

    PubMed

    Danial-Saad, Alexandra; Chiari, Lorenzo

    2017-09-14

    The aim of this study was to describe the processes of reaching consensus regarding the assessment of the user's skills required to operate various touch screen devices. A five-step procedure was used to collect and validate the required skills by a multidisciplinary team of 52 experts. Content validity was calculated to determine the agreement levels between the experts. A comparison was made between the discipline groups in order to test correlation between each group and their choice of specific clusters of tasks. The final consensus set by the experts' recommendations included 15 domains and 50 skills/measurements. The result of Cronbach's α test for the final assessment questionnaire (50 skills/measurements) was 0.94, which indicates a high degree of internal consistency. The results of Kruskal-Wallis's test showed the lack of any significant difference between agreements of the clinicians and the technicians groups, but significant differences were found between the educators and the clinicians groups. The assessment questionnaire, in its current form, can be used by clinicians and it is expected to help in developing an objective assessment tool to quantify the performance and touch characteristics of individuals with varying abilities and disabilities, in order to enhance accessibility of touch screen technology. Implications for Rehabilitation Collecting and creating the required knowledge needed for assessing the user's skills for operating touch screen devices. The created knowledge helps clinicians to focus on the essential skills and measurements needed for a comprehensive assessment of the individual's abilities and disabilities while operating touch screen devices. The results of the assessment can be used as recommendations for enhancing accessibility of touch screen devices for various disabilities. This knowledge is expected to help in developing an application that provides an objective assessment tool. The study emphasizes the importance of

  9. Ebola a reality of modern Public Health; need for Surveillance, Preparedness and Response Training for Health Workers and other multidisciplinary teams: a case for Uganda

    PubMed Central

    Bazeyo, William; Bagonza, James; Halage, Ali; Okure, Gildo; Mugagga, Malimbo; Musoke, Robert; Tumwebaze, Mathias; Tusiime, Suzan; Ssendagire, Steven; Nabukenya, Immaculate; Pande, Steven; Aanyu, Christine; Etajak, Samuel; Rutebemberwa, Elizeus

    2015-01-01

    Introduction West Africa is experiencing the largest ever reported Ebola outbreak. Over 20,000 people have been infected of which about 9000 have died. It is possible that lack of community understanding of the epidemic and lack of institutional memory and inexperienced health workers could have led to the rapid spread of the disease. In this paper, we share Uganda's experiences on how the capacity of health workers and other multidisciplinary teams can be improved in preparing and responding to Ebola outbreaks. Methods Makerere University School of Public Health in collaboration with the Ministry of Health and the African Field Epidemiology Network (AFENET), trained health care workers and other multidisciplinary teams from six border districts of Uganda so as to increase their alertness and response capabilities towards Ebola. We used participatory training methods to impart knowledge and skills and guided participants to develop district epidemic response plans. Communities were sensitized about Ebola through mass media, IEC materials, and infection control and prevention materials were distributed in districts. Results We trained 210 health workers and 120 other multidisciplinary team members on Ebola surveillance, preparedness and response. Evaluation results demonstrated a gain in knowledge and skills. Communities were sensitized about Ebola and Districts received person protective equipments and items for infection prevention. Epidemic Preparedness and Response plans were also developed. Conclusion Training of multidisciplinary teams improves the country's preparedness, alertness and response capabilities in controlling Ebola. West African countries experiencing Ebola outbreaks could draw lessons from the Uganda experience to contain the outbreak. PMID:26301008

  10. Successful management of Barth syndrome: a systematic review highlighting the importance of a flexible and multidisciplinary approach

    PubMed Central

    Reynolds, Stacey

    2015-01-01

    This review describes and summarizes the available evidence related to the treatment and management of Barth syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to identify articles published between December 2004 and January 2015. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS) approach was used to guide the article selection and evaluation process. Of the 128 articles screened, 28 articles matched the systematic review inclusion criteria. The results of this review indicate the need for a flexible and multidisciplinary approach to manage the symptoms most commonly associated with Barth syndrome. It is recommended that a comprehensive care team should include individuals with Barth syndrome, their family members and caregivers, as well as medical, rehabilitative, nutritional, psychological, and educational professionals. The evidence for specific treatments, therapies, and techniques for individuals with Barth syndrome is currently lacking in both quality and quantity. PMID:26251611

  11. What Do We Tell People to Do during Earthquake Shaking in Emerging Countries? A Multidisciplinary Approach

    NASA Astrophysics Data System (ADS)

    Tucker, B. E.; Rodgers, J. E.; Tobin, L. T.; Cedillos, V.; Tshering, K. D.; Kumar, H.; Jomo, J.

    2015-12-01

    Providing advice on what to do during shaking in developing nations with high earthquake hazard and vulnerable buildings is a daunting task at the intersection of public policy and science. In areas where most buildings are masonry, earthen or concrete and are at high risk of collapse in strong shaking, advice may differ from the "Drop, Cover and Hold On" message given where residential construction is light timber (less lethal) and building codes are enforced. People in emerging countries are often unsure whether to evacuate or "run out" of the building, or to remain inside and protect oneself with Drop, Cover and Hold On, going to a marked "Safe Zone" or one of several other actions. GeoHazards International approached this problem by bringing together scientific research from multiple disciplines: seismology, epidemiology, structural engineering, risk communication, and sociology. We brought together researchers and practitioners, who applied scientific principles and professional judgment to the limited data on effectiveness of various protective actions in emerging countries. We developed guidance on what message creators and policymakers should consider; the process for developing message content and forms; and the people to involve. A responsible message must account for not only the local tectonic environment and site conditions, but also building vulnerability, the presence of safe open space, how people are killed and injured in earthquakes, population exposure, and the beliefs, customs and social context that affect how messages are received and acted upon. We found that local agencies should make a policy decision on the appropriate action, based on local scientific and technical information, because no one protective action will protect the majority in every context. The safest specific action varies according to where people are located, whether they will be safer where they are or by moving, and whether they can make it to the safer place before

  12. [Effects of a Multi-disciplinary Approached, Empowerment Theory Based Self-management Intervention in Older Adults with Chronic Illness].

    PubMed

    Park, Chorong; Song, Misoon; Cho, Belong; Lim, Jaeyoung; Song, Wook; Chang, Heekyung; Park, Yeon-Hwan

    2015-04-01

    The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness. A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function. Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups. The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.

  13. A Multidisciplinary Approach to Research in Small-Scale Societies: Studying Emotions and Facial Expressions in the Field

    PubMed Central

    Crivelli, Carlos; Jarillo, Sergio; Fridlund, Alan J.

    2016-01-01

    Although cognitive science was multidisciplinary from the start, an under-emphasis on anthropology has left the field with limited research in small scale, indigenous societies. Neglecting the anthropological perspective is risky, given that once-canonical cognitive science findings have often been shown to be artifacts of enculturation rather than cognitive universals. This imbalance has become more problematic as the increased use of Western theory-driven approaches, many of which assume human uniformity (“universality”), confronts the absence of a robust descriptive base that might provide clarifying or even contrary evidence. We highlight the need for remedies to such shortcomings by suggesting a two-fold methodological shift. First, studies conducted in indigenous societies can benefit by relying on multidisciplinary research groups to diminish ethnocentrism and enhance the quality of the data. Second, studies devised for Western societies can readily be adapted to the changing settings encountered in the field. Here, we provide examples, drawn from the areas of emotion and facial expressions, to illustrate potential solutions to recurrent problems in enhancing the quality of data collection, hypothesis testing, and the interpretation of results. PMID:27486420

  14. A Multidisciplinary Approach to Research in Small-Scale Societies: Studying Emotions and Facial Expressions in the Field.

    PubMed

    Crivelli, Carlos; Jarillo, Sergio; Fridlund, Alan J

    2016-01-01

    Although cognitive science was multidisciplinary from the start, an under-emphasis on anthropology has left the field with limited research in small scale, indigenous societies. Neglecting the anthropological perspective is risky, given that once-canonical cognitive science findings have often been shown to be artifacts of enculturation rather than cognitive universals. This imbalance has become more problematic as the increased use of Western theory-driven approaches, many of which assume human uniformity ("universality"), confronts the absence of a robust descriptive base that might provide clarifying or even contrary evidence. We highlight the need for remedies to such shortcomings by suggesting a two-fold methodological shift. First, studies conducted in indigenous societies can benefit by relying on multidisciplinary research groups to diminish ethnocentrism and enhance the quality of the data. Second, studies devised for Western societies can readily be adapted to the changing settings encountered in the field. Here, we provide examples, drawn from the areas of emotion and facial expressions, to illustrate potential solutions to recurrent problems in enhancing the quality of data collection, hypothesis testing, and the interpretation of results.

  15. Multidisciplinary Optimization Approach for Design and Operation of Constrained and Complex-shaped Space Systems

    NASA Astrophysics Data System (ADS)

    Lee, Dae Young

    The design of a small satellite is challenging since they are constrained by mass, volume, and power. To mitigate these constraint effects, designers adopt deployable configurations on the spacecraft that result in an interesting and difficult optimization problem. The resulting optimization problem is challenging due to the computational complexity caused by the large number of design variables and the model complexity created by the deployables. Adding to these complexities, there is a lack of integration of the design optimization systems into operational optimization, and the utility maximization of spacecraft in orbit. The developed methodology enables satellite Multidisciplinary Design Optimization (MDO) that is extendable to on-orbit operation. Optimization of on-orbit operations is possible with MDO since the model predictive controller developed in this dissertation guarantees the achievement of the on-ground design behavior in orbit. To enable the design optimization of highly constrained and complex-shaped space systems, the spherical coordinate analysis technique, called the "Attitude Sphere", is extended and merged with an additional engineering tools like OpenGL. OpenGL's graphic acceleration facilitates the accurate estimation of the shadow-degraded photovoltaic cell area. This technique is applied to the design optimization of the satellite Electric Power System (EPS) and the design result shows that the amount of photovoltaic power generation can be increased more than 9%. Based on this initial methodology, the goal of this effort is extended from Single Discipline Optimization to Multidisciplinary Optimization, which includes the design and also operation of the EPS, Attitude Determination and Control System (ADCS), and communication system. The geometry optimization satisfies the conditions of the ground development phase; however, the operation optimization may not be as successful as expected in orbit due to disturbances. To address this issue

  16. Effectiveness of three treatment strategies on occupational limitations and quality of life for patients with non-specific chronic low back pain: Is a multidisciplinary approach the key feature to success: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Chronic low back pain (cLBP) is a significant public health problem, being the primary cause of work absenteeism, as well as affecting sufferers’ quality of life, in industrialized society. International guidelines recommend intensive multidisciplinary approaches for patients with cLBP. However, these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements. Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients. It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost. The aim of this study is to compare three programs with various levels of intensity and multidisciplinary. Methods/Design This paper describes the protocol for a prospective, randomized, controlled, clinical trial in working aged patients with cLBP. Three treatment strategies are compared: (1) intensive and multidisciplinary program conducted in a rehabilitation center; (2) less intensive outpatient program conducted by a private physiotherapist; (3) mixed strategy combining the same out program with a multidisciplinary intervention. The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program. The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs. The intervention part of the trial programs will take 5 weeks and observational follow-up will take 12 months. The sample size will be 180 participants (60 for each arm). The project has been approved by the Ethical Committee of Angers Hospital, France. Discussion On the hypothesis that a multidisciplinary

  17. Cycles of Change and Challenges for Health Professions Involved in Multidisciplinary Approaches to Prevention. (1993 AAHE Scholar Address. AAHPERD Convention, Washington, D.C.).

    ERIC Educational Resources Information Center

    Stone, Elaine J.

    1993-01-01

    Provides an overview of professions working in multidisciplinary health promotion and disease prevention efforts, focusing on medical specialties, public health, behavioral medicine, health psychology, health education, and health behavior. Major challenges general to all the fields include reimbursement, priorities, professional preparation,…

  18. Cycles of Change and Challenges for Health Professions Involved in Multidisciplinary Approaches to Prevention. (1993 AAHE Scholar Address. AAHPERD Convention, Washington, D.C.).

    ERIC Educational Resources Information Center

    Stone, Elaine J.

    1993-01-01

    Provides an overview of professions working in multidisciplinary health promotion and disease prevention efforts, focusing on medical specialties, public health, behavioral medicine, health psychology, health education, and health behavior. Major challenges general to all the fields include reimbursement, priorities, professional preparation,…

  19. Increasing Efficiency in Evaluation of Chronic Cough: A Multidisciplinary, Collaborative Approach.

    PubMed

    Patton, Cynthia M; Lim, Kaiser G; Ramlow, Luke W; White, Kathleen M

    2015-01-01

    Chronic cough is the most common reason for medical office visits in the United States. The typical patient has coughed more than 8 years and seen many specialists. This quality improvement project is an ambulatory clinic redesign to deliver efficient, patient-centered care with interspecialty collaboration. Methodology included the Institute for Healthcare Improvement collaborative model focused on Lean/Six Sigma and ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) Change Management. Interventions targeted education to referring providers, implementation of software changes, building a collaborative interdepartmental scheduling decision tree, and an interclinic dashboard enhancing communication and decision support. Outcome measures compare group resource utilization, evidenced by the total number of specialist referrals for same indication of chronic cough (International Classification of Diseases, Ninth Revision: 786.2), and length of time to complete evaluation. A retrospective review of 165 medical records yielded 2 groups, "current care" (n = 67) and "intervention" (n = 68). The number of specialist referrals per patient was reduced in the intervention group (M = 1.22, SD = 0.48) compared with the current care group (M = 3.33, SD = 1.02). Length of itinerary was reduced in the intervention group (M = 11.90, SD = 12.13, GM = 6.82) compared with the current care group (M = 126.93, SD = 158.13, GM = 54.8). Multidisciplinary collaboration, communication, coordinating diagnosis, and management of multifactorial conditions, such as chronic cough, are associated with lower costs and decreased utilization of health care resources.

  20. Mad dogs, vampires, and zombie ants: a multidisciplinary approach to teaching neuroscience, behavior, and microbiology.

    PubMed

    Esteban, David J; Holloway, Kevin S

    2015-01-01

    Viruses, parasites, and some bacteria use host organisms to complete their lifecycle. These infectious agents are able to hijack host processes to replicate and transmit to the next host. While we tend to think of infections as just making us sick, they are also capable of changing host behavior. In fact, many infectious agents are able to mediate host behavior in ways that can enhance transmission of the disease. In this course we explore the process of host behavior mediation by infectious agents, combining aspects of multiple fields including neurobiology, animal behavior, infectious disease microbiology, and epidemiology. The goals for this course are: 1) To explore the neurological and behavioral effects of infectious organisms on their hosts, in particular pathogen mediation of host behavior to the benefit of the pathogen, 2) to introduce students to primary literature in a multidisciplinary field, and 3) when applicable, to address cultural/historical/mythological perspectives that might alter societal norms and pressures and influence the impact of the biological processes of behavior modification by infections.

  1. Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

    PubMed Central

    Fall, Andrew

    2016-01-01

    Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome. PMID:27413564

  2. Human race as indicator of 3D planning of soft tissue of face and multidisciplinary approach.

    PubMed

    Nadazdyova, A; Samohyl, M; Stefankova, E; Pintesova, S; Stanko, P

    2017-01-01

    The aim of this study was to determine the optimal parameters for 3D soft tissue planning for ortognatic treatment by gender and increases the effectiveness of multidisciplinary cooperation. Craniofacial parameters which were analysed: nose breadth (al-al), bi-entocanthion breadth (en-en), bi-zygomatic breadth (zy-zy), bi-gonial breadth (go-go), total facial height (n-gn), mouth breadth (ch-ch), morphologic face height (sn-gn), upper-lip height (Ls-Stm), lower-lip height (Stm-Li) and pupils - mid-face (right). The statistically significant level was determined at p values < 0.05. We have determined the optimal parameters of chosen proportions for men and women as the common goal for ortodontist and maxilofacial surgeon. The gender and age influenced the variability of following parameters: bi-gonial breadth, total facial height and morphologic face height. The soft tissue values for craniofacial parameters can be used to identify the surgical-orthodontic goal for patient - europoid race. Due to the immigration and the mix of races it is necessary to take this fact into account (Tab. 3, Fig. 1, Ref. 41).

  3. Mad Dogs, Vampires, and Zombie Ants: A Multidisciplinary Approach to Teaching Neuroscience, Behavior, and Microbiology

    PubMed Central

    Esteban, David J.; Holloway, Kevin S.

    2015-01-01

    Viruses, parasites, and some bacteria use host organisms to complete their lifecycle. These infectious agents are able to hijack host processes to replicate and transmit to the next host. While we tend to think of infections as just making us sick, they are also capable of changing host behavior. In fact, many infectious agents are able to mediate host behavior in ways that can enhance transmission of the disease. In this course we explore the process of host behavior mediation by infectious agents, combining aspects of multiple fields including neurobiology, animal behavior, infectious disease microbiology, and epidemiology. The goals for this course are: 1) To explore the neurological and behavioral effects of infectious organisms on their hosts, in particular pathogen mediation of host behavior to the benefit of the pathogen, 2) to introduce students to primary literature in a multidisciplinary field, and 3) when applicable, to address cultural/historical/mythological perspectives that might alter societal norms and pressures and influence the impact of the biological processes of behavior modification by infections. PMID:25838806

  4. Evaluation and management of disorders of sex development: multidisciplinary approach to a complex diagnosis.

    PubMed

    Moshiri, Mariam; Chapman, Teresa; Fechner, Patricia Y; Dubinsky, Theodore J; Shnorhavorian, Margarett; Osman, Sherif; Bhargava, Puneet; Katz, Douglas S

    2012-10-01

    Various disorders of sex development (DSD) result in abnormal development of genitalia, which may be recognized at prenatal ultrasonography, immediately after birth, or later in life. Current methods for diagnosing DSD include a thorough physical examination, laboratory tests to determine hormone levels and identify chromosomal abnormalities, and radiologic imaging of the genitourinary tract and adjacent organs. Because of the complex nature of DSD, the participation of a multidisciplinary team is required to address the patient's medical needs as well as any psychosocial issues that the patient or the family may encounter after the diagnosis. The first step in the management of DSD is sex assignment, which is based on factors such as the genotype; the presence, location, and appearance of reproductive organs; the potential for fertility; and the cultural background and beliefs of the patient's family. The primary goal of sex assignment is to achieve the greatest possible consistency between the patient's assigned sex and his or her gender identity. Once the sex is assigned, the next step in management might be surgery, hormone therapy, or no intervention at all. Patients with ovotesticular DSD and gonadal dysgenesis may require a gonadectomy, followed by reconstructive surgery. Some patients may need hormone replacement therapy during puberty. An understanding of the immediacy of families' need for sex assignment and clinicians' need for reliable diagnostic imaging results will help radiologists participate effectively in the prenatal and postnatal assessment of patients with DSD. © RSNA, 2012.

  5. Multidisciplinary Approach for the Treatment of Horizontal Root-Fractured Maxillary Anterior Teeth

    PubMed Central

    Uzuntas, Ceren Feriha; Safaralizadeh, Reza; Demirel, Gulbike; Sevimay, Semra

    2014-01-01

    Dental trauma can lead to a wide range of injuries of which crown and root fractures are examples. Crown-root fractures often need complex treatment planning. This case report describes the use of MTA in the multidisciplinary management of a patient with a horizontally fractured central incisor and luxation in a different central incisor. A 42-year-old female patient presented within 1 h of receiving direct trauma to her maxillary area. Clinical examination revealed that the right and left maxillary central incisors presented mobility and sensitivity to percussion and palpation but no sensitivity to thermal stimulations. Occlusal displacement with extrusion in the left maxillary central incisor and luxation in the right maxillary central incisor was observed. Radiographic examination revealed horizontal root fracture at the apical third of the left maxillary central incisor. Root fracture in the right maxillary incisor was not observed. Endodontic and aesthetic restorative treatments were completed. MTA showed a good long-term outcome when used in root-fractured and luxated teeth. In addition, composite resin restoration provided satisfactory aesthetic results even after 15 months. PMID:25485158

  6. A multidisciplinary approach to the management of anterior mediastinal masses in children.

    PubMed

    Acker, Shannon N; Linton, Jacqueline; Tan, Gee Mei; Garrington, Timothy P; Bruny, Jennifer; Hilden, Joanne M; Hoffman, Lindsey M; Partrick, David A

    2015-05-01

    Anterior mediastinal masses (AMM) pose a diagnostic challenge to surgeons, oncologists, anesthesiologists, intensivists, and interventional radiologists as induction of general anesthesia can cause airway obstruction and cardiovascular collapse. We hypothesized that in the majority of patients, diagnosis can be obtained through biopsy of extrathoracic tissue. We performed a retrospective review of all patients in the solid tumor oncology clinic with a diagnosis of AMM between 2002 and 2012 including preoperative evaluation and management prior to obtaining a tissue diagnosis, clinical course and complications. We identified 69 patients with AMM (mean age 12.2±4.4years, 64% male) secondary to Hodgkin lymphoma (34), Non-Hodgkin lymphoma (26), and other diagnoses (9). The majority of patients (56, 81.2%) underwent biopsy of tissue outside of the mediastinal mass. Local anesthesia with sedation was used for successful biopsy in 21 (30%) patients. Four (5.8%) required repeat biopsy due to inadequate sample obtained at initial procedure. Three (4.4%) suffered respiratory complications with no fatalities or severe complications. Our data demonstrate that in the majority of children with AMM, tissue biopsy can be successfully obtained from tissue outside of the mass itself with minimal complications and highlight the importance of multidisciplinary preoperative planning to minimize anesthetic risks. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. A multidisciplinary combinatorial approach for tuning promising hydrogen storage materials towards automotive applications.

    PubMed

    Amieiro-Fonseca, A; Ellis, S R; Nuttall, C J; Hayden, B E; Guerin, S; Purdy, G; Soulié, J P; Callear, S K; Culligan, S D; David, W I F; Edwards, P P; Jones, M O; Johnson, S R; Pohl, A H

    2011-01-01

    HyStorM is a multidisciplinary hydrogen-storage project aiming to synthesise and tune materials hydrogen storage properties for automotive applications. Firstly, unique high-throughput combinatorial thin-film technologies are used to screen materials' hydrogen storage properties. Then promising thin-film candidate compositions are synthesised and examined in the bulk. In this paper, we report on our results within the ternary compositions Mg-Ti-B and Ca-Ti-B. Primary screening of the Mg-Ti-B ternary identified a high capacity hotspot corresponding to Mg0.36Ti0.06B0.58, with 10.6 wt% H2 capacity. Partial reversibility has been observed for this material in the thin-film. Bulk Ti-doped Mg(BH4)2 composites show rehydrogenation to MgH2 under the conditions used. The synthesised thin-film Ca-Ti-B ternary showed only low hydrogen storage capacities. In the bulk, Ti-doping experiments on Ca(BH4)2 demonstrated reversible storage capacities up to 5.9 wt% H2. Further characterisation experiments are required to decipher the role of the Ti-dopant in these systems in both films and in the bulk.

  8. Gorlin-Goltz syndrome--a medical condition requiring a multidisciplinary approach.

    PubMed

    Kiwilsza, Małgorzata; Sporniak-Tutak, Katarzyna

    2012-09-01

    Gorlin-Goltz syndrome is a rare genetic condition showing a variable expressiveness. It is inherited in a dominant autosomal way. The strongest characteristic of the disease includes multiple basal cell carcinomas, jaw cysts, palmar and plantar pits, skeletal abnormalities and other developmental defects. Owing to the fact that the condition tends to be a multisystemic disorder, familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis. It will also enable them to apply adequate methods of treatment and secondary prevention. In this study, we present symptoms of the disease, its diagnostic methods and currently used treatments. We searched 2 scientific databases: Medline (EBSCO) and Science Direct, for the years 1996 to 2011. In our search of abstracts, key words included nevoid basal cell carcinoma syndrome and Gorlin-Goltz syndrome. We examined 287 studies from Medline and 80 from Science Direct, all published in English. Finally, we decided to use 60 papers, including clinical cases and literature reviews. Patients with Gorlin-Goltz syndrome need particular multidisciplinary medical care. Knowledge of multiple and difficult to diagnose symptoms of the syndrome among professionals of various medical specialties is crucial. The consequences of the disease pose a threat to the health and life of patients. Therefore, an early diagnosis creates an opportunity for effective prevention and treatment of the disorder. Prevention is better than cure.

  9. Forced orthodontic extrusion and use of CAD/CAM for reconstruction of grossly destructed crown: A multidisciplinary approach

    PubMed Central

    Kumar, Rahul; Patil, Suvarna

    2012-01-01

    The aim of this study is to present a report of a case where forced orthodontic extrusion and computer-aided design and computer-aided manufacturing (CAD/CAM) technique was used for reconstruction of right maxillary central incisor with grossly destructed crown. Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown. After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion. This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis. PMID:22557823

  10. Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: a case report.

    PubMed

    de Castro, José Carlos Monteiro; Poi, Wilson Roberto; Pedrini, Denise; Tiveron, Adelisa Rodolfo Ferreira; Brandini, Daniela Atili; de Castro, Mara Antônio Monteiro

    2011-10-01

    Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central incisor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite resin veneer on the traumatized tooth.

  11. [A Case of a Multidisciplinary Team Approach to Serious Hand-Foot Syndrome Induced by High-Dose Cytarabine Therapy].

    PubMed

    Sakurada, Hiroaki; Aoi, Miki; Yuge, Masaaki; Sugimura, Yuriko; Kitamura, Kunio; Yamamura, Masumi; Tachi, Tomoya; Teramachi, Hitomi

    2016-07-01

    A 40's year-old female patient with acute myeloblastic leukemia received high-dose cytarabine(HD-Ara-C)as her third induction therapy. Because the pharmacist in charge noticed on a prior interview that she had experienced a mild skin eruption similar to hand-foot syndrome(HFS)in the previous round oftherapy(idarubicin and cytarabine), heparinoid lotion and hypoallergenic soap were used to prevent HFS. However, HFS occurred on day 3, and further developed on day 6 to grade 3 with painful erythema, swelling, and paresthesia affecting the entire surface of both hands. We cared for her with moisturization, lifestyle guidance, rotation of steroid ointment, and occlusive dressing techniques according to a multidisciplinary team approach composed ofa hematologist, dermatologist, pharmacist, and nurse. Her symptoms resolved on day 40.

  12. A multidisciplinary approach to the management of temporomandibular joint ankylosis in a sickle-cell anemia patient in a resource-limited setting

    PubMed Central

    Braimah, Ramat Oyebunmi; Oladejo, Taoreed; Olarinoye, Timothy Oyetunde; Adetoye, Adedapo Omowonuola; Osho, Patrick Olanrewaju

    2016-01-01

    This report describes the multidisciplinary management of a 35-year-old female sickle-cell anemia patient who had unilateral bony ankylosis of the left temporomandibular joint secondary to septic arthritis. She was managed by a team comprising of maxillofacial surgeons, anesthetists, otorhinolaryngologist, and hematologist. Unilateral left interpositional arthroplasty and ipsilateral coronoidectomy through a postrami approach were done and followed by aggressive jaw physiotherapy in the postsurgical period. No perioperative morbidity was encountered. Mouth opening of 3.5 cm was achieved and maintained 7 months after surgery. Challenges and rationale for the use of a multidisciplinary team approach in treatment of such cases were discussed. PMID:27563622

  13. A multidisciplinary approach to the management of temporomandibular joint ankylosis in a sickle-cell anemia patient in a resource-limited setting.

    PubMed

    Braimah, Ramat Oyebunmi; Oladejo, Taoreed; Olarinoye, Timothy Oyetunde; Adetoye, Adedapo Omowonuola; Osho, Patrick Olanrewaju

    2016-01-01

    This report describes the multidisciplinary management of a 35-year-old female sickle-cell anemia patient who had unilateral bony ankylosis of the left temporomandibular joint secondary to septic arthritis. She was managed by a team comprising of maxillofacial surgeons, anesthetists, otorhinolaryngologist, and hematologist. Unilateral left interpositional arthroplasty and ipsilateral coronoidectomy through a postrami approach were done and followed by aggressive jaw physiotherapy in the postsurgical period. No perioperative morbidity was encountered. Mouth opening of 3.5 cm was achieved and maintained 7 months after surgery. Challenges and rationale for the use of a multidisciplinary team approach in treatment of such cases were discussed.

  14. Public Libraries and Internet Public Access Models: Describing Possible Approaches.

    ERIC Educational Resources Information Center

    Tomasello, Tami K.; McClure, Charles R.

    2002-01-01

    Discusses ways of providing Internet access to the general public and analyzes eight models currently in use: public schools, public libraries, cybermobiles, public housing, community technology centers, community networks, kiosks, and cyber cafes. Concludes that public libraries may wish to develop collaborative strategies with other…

  15. Public Libraries and Internet Public Access Models: Describing Possible Approaches.

    ERIC Educational Resources Information Center

    Tomasello, Tami K.; McClure, Charles R.

    2002-01-01

    Discusses ways of providing Internet access to the general public and analyzes eight models currently in use: public schools, public libraries, cybermobiles, public housing, community technology centers, community networks, kiosks, and cyber cafes. Concludes that public libraries may wish to develop collaborative strategies with other…

  16. A multidisciplinary approach for the conservation of a building of the seventeenth century

    NASA Astrophysics Data System (ADS)

    Angelini, E.; Grassini, S.; Corbellini, S.; Parvis, M.; Piantanida, M.

    2010-09-01

    A long-term multidisciplinary conservation study is actually in progress inside the Villa della Regina, a prestigious Savoy residence built in the seventeenth century and recently restored. The walls of some rooms of the Villa are decorated with precious tin-mercury mirrors, that are baked with a reflective coating constituted of a tin-mercury compound surrounded by liquid mercury. The reflective layer is very soft, thus any restoration is difficult to be performed and can lead to a complete destruction of the artifact. Amalgam corrosion is a very slow process and, although there is no way to prevent the oxidation of the reflective layer, the conservation state of the artifacts may be improved by keeping them in a controlled environment. For this reason, a monitoring system has been designed and installed that is based on a wireless network of extremely compact sensors, for temperature and relative humidity measurements. The sensors have been specifically designed to satisfy the requirements for use in cultural heritage field and the system allows one to automatically collect the data that can be analyzed with the final aim to establish a correlation between the environmental conditions and the conservation state of the artifacts. A restoration has been carried out by producing in situ an amalgam inlay on the corroded area to slow down the release of liquid mercury in order to avoid also possible unsafe conditions for staff and visitors. In addition, a sensor has been developed which is based on a prototypical plastic optical fiber for the detection of low concentration Hg vapors to ensure the safe conditions in the Villa rooms. The sensor is being tested in laboratory.

  17. Psychiatric Approaches for Disorders of Sex Development: Experience of a Multidisciplinary Team

    PubMed Central

    Özbaran, Burcu; Özen, Samim; Gökşen, Damla; Korkmaz, Özlem; Onay, Hüseyin; Özkınay, Ferda; Çoğulu, Özgür; Erermiş, Serpil; Köse, Sezen; Avanoğlu, Ali; Ulman, İbrahim; Darcan, Şükran

    2013-01-01

    Objective: Disorders of sex development (DSD) are a group of congenital medical conditions that affect life as a whole. In this study, we aimed to reflect the experience of a multidisciplinary team in the clinical/psychiatric follow-up of a group of children and adolescents with DSD. Methods: The study group consisted of 51 patients diagnosed with DSD. The Kiddie-Schedule for Affective Disorders and Schizophrenia, Wechsler Intelligence Scale for Children-Revised, Draw a Person Test and Children’s Apperception Test, and the Clinical Global Impression Scale (CGIS) were used for psychiatric evaluations. Results: The mean age of the patients was 7.8 years (median: 7.8; min: 1.0; max: 18.0). Genetic evaluation showed 46,XX configuration in 15 patients (29.4%) and 46,XY in 35 (68.6%). One patient (2.0%) was diagnosed to have a sex chromosome disorder. Forty patients (78.4%) had no problems with their given gender identity and gender role. Thirty-four (66.7%) patients had normal intellectual capacity. Twenty-eight (54.9%) patients did not have any psychiatric problem. Depression, anxiety disorders, attention deficit/hyperactivity disorder, and adjustment disorders were the common diagnoses. The mean score of symptom severity on CGIS-severity-baseline was 6.15±0.68 and after one year, it was 1.46±0.51 (Z=-3.236 p=0.001). The mean score of CGI–Improvement was 1.23±0.44. Conclusion: It is important to identify and treat the psychiatric disorders encountered in patients with DSD. A psychiatrist needs to be included in the professional team following these patients. Examination and observation results need to be shared by holding periodic team meetings to establish a wholesome point of view for every unique child. Conflict of interest:None declared. PMID:24379031

  18. Mud volcanoes in central Italy: Subsoil characterization through a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Rainone, M. L.; Rusi, S.; Torrese, P.

    2015-04-01

    Mud volcanoes are common geological phenomenons observed worldwide as in Italy. They are well described in the scientific literature for their morphological, tectonic and hydrogeological features. They represent not only a relevant geological and geomorphological interest but also not negligible elements of hazard and risk associated with the presence of soft and pliable sediments and with the possible unexpected emission of gas and mud. Therefore, the understanding of their structure and hydrogeological circuits in the subsurface is an important key to define hazard and risk conditions in the adjacent areas. This paper deals with a multidisciplinary study including geophysical and hydrochemical surveys undertaken at the Pineto (central Italy) mud volcano site to achieve an interpretative conceptual model explaining the shallow upward migration of deep mud fluids. Shallow electrical and seismic imaging of the mud volcano was obtained using two dimensional and three dimensional (2D-3D) electrical resistivity tomography and 2D reflection seismic surveys. The hydrochemical properties of the rising fluids were assessed by means of seasonal measurements of the chemical-physical parameters, the concentrations of major ions, and some natural isotopes. This mud volcano or mud lump appears as a dome of about 15 × 10 m in size. The height of the crater is 2 m approximately, while the diameter of the crater is 2.5 m. Emission of fluids and solids (cold brine, mud, gas) occurs from this crater. Upper Pliocene-lower Pleistocene foredeep pelitic deposits (over-compacted clays with silty-sandy levels) overlain by clayey-silty deposits crop out in the area. The survey results seem to reveal that the uprising of deep fluids does not occur exactly below the mud volcano at present. Instead, a high conductivity body is present within a fractured zone in the pelitic deposits at 60 m approximately to the ENE. The probable occurrence of a high permeability layer approximately between 20

  19. [Public Health as an Applied, Multidisciplinary Subject: Is Research-Based Learning the Answer to Challenges in Learning and Teaching?

    PubMed

    Gerhardus, A; Schilling, I; Voss, M

    2016-06-06

    Public health education aims at enabling students to deal with complex health-related challenges using appropriate methods based on sound theoretical understanding. Virtually all health-related problems in science and practice require the involvement of different disciplines. However, the necessary interdisciplinarity is only partly reflected in the curricula of public health courses. Also theories, methods, health topics, and their application are often taught side-by-side and not together. For students, it can become an insurmountable challenge to integrate the different disciplines ("horizontal integration") and theories, methods, health topics, and their application ("vertical integration"). This situation is specific for education in public health but is representative for other interdisciplinary fields as well. Several approaches are available to achieve the horizontal integration of different disciplines and vertical integration of theories, methods, health topics, and their application. A curriculum that is structured by topics, rather than disciplines might be more successful in integrating different disciplines. Vertical integration can be achieved by research-based learning. Research-based learning places a student-led research project at the centre of teaching. Students choose a topic and a research question, raise their own questions for theories and methods and will hopefully cross the seeming chasm between science and practice. Challenges of research-based learning are enhanced demands on students, teachers and curriculum design.

  20. Ten years of a multidisciplinary diabetic foot team approach in Sao Paulo, Brazil

    PubMed Central

    Batista, Fábio; Augusto Magalhães, Antonio; Gamba, Mônica; Nery, Caio; Cardoso, Cristina

    2010-01-01

    Diabetes mellitus can cause devastating foot problems including loss of protective sensation with subsequent ulcerations and amputations. The natural history and pathophysiology of diabetic foot ulcers is best understood and managed by a multiprofessional team approach. The main factors for prevention and treatment of these devastating diabetic foot conditions are shown, with special attention to education of the patient. This approach decreases the morbidity of the disease, besides its economical and social feasibility. PMID:22396805

  1. Zoonoses and vector-borne diseases in Croatia - a multidisciplinary approach.

    PubMed

    Markotić, Alemka; Krajinović, Lidija Cvetko; Margaletić, Josip; Turk, Nenad; Miletić-Medved, Marica; Zmak, Ljiljana; Janković, Mateja; Kurolt, Ivan-Christian; Soprek, Silvija; Daković Rode, Oktavija; Milas, Zoran; Puljiz, Ivan; Ledina, Dragan; Hukić, Mirsada; Kuzman, Ilija

    2009-01-01

    Emerging and re-emerging infectious diseases create constant and serious concerns for public health. The majority of emerging infectious diseases (EID) are wildlife zoonotic diseases and vector-borne diseases. Croatia has a long tradition in the control, management and research of EID zoonotic diseases and vector-borne diseases. There has also been a long and advantageous tradition in the collaboration of different experts and professionals in EID research in Croatia involving physician clinicians in infectious diseases, microbiologists, pathologists, veterinarians and animal scientists, ecologists, forestry experts, wildlife scientists, public health specialists and epidemiologists and laboratory scientists. The University Hospital for Infectious Diseases in Zagreb established the Centre for Emerging and Re-emerging Infectious Diseases in liaison with national and international partners from Europe and the United States. This Centre is working in line with the 'One Health initiative' which recognises the inter-relationships between human, animal and environmental health.

  2. Multi-disciplinary approach in volcanic areas: case study of Kamchatka, Far East of Russia

    NASA Astrophysics Data System (ADS)

    Kuznetsova, Elena

    2017-04-01

    overlooked (Kuznetsova et al., 2012). Of particular importance in understanding the thermal behavior of frozen soils is a knowledge of their unfrozen water content. In the glacier interlayers the unfrozen water between ice and particles can work as lubricants to modify the stress transfer at the contacts between ice-particle and particle-particle through indirect influence on relaxing the interaction between particles and ice (Moore, 2014). The paper discusses the application of multidisciplinary research on volcanic material covering permafrost and glaciers in volcanic areas. In cold environments, volcanic ash is widely used in different science disciplines in process-based studies examining paleoclimate reconstruction; the influence of permafrost aggradation and degradation; influence of tephra on snow and ice ablation; glacier fluctuations, volcanic glass weathering and new minerals formation (e.g. allophane, palagonite). The special properties of volcanic ash are critically reviewed particularly in relation to recent research in Kamchatka in the Far East of Russia. Of particular importance are the thermal properties and the unfrozen water contents of ash layers and the rate at which the weathering of volcanic glass takes place.

  3. Characterization of a small-scale drainage basin in Central Portugal - a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Correia, Carla G.; Azevedo, José Manuel; Rodrigues, Nelson V.; Figueiredo, Fernando P. O.

    2015-04-01

    This study presents a multidisciplinary characterization of a small-scale watershed encompassing its topography, geology, local and regional tectonics, morphometry of the drainage system, soil type, land use and climatology. All this parameters are important controllers of the groundwater circulation and storage, as well as the localization of the recharge areas. It also identifies the piezometric changes, the upper (or phreatic) aquifer flow and the major recharge areas. Simultaneously, it includes the hydrochemical classification and the active hydrogeochemical processes occurring on the local aquifers. The combined analysis of these data is necessary for interpreting the hydrodynamics of the local aquifer units. The research focused on the surrounding domains of Olhos da Fervença spring, particularly in the Fervença watershed, a small-scale drainage basin close to Cantanhede city (Coimbra District, Portugal). This watershed is located on a rural area within the Vouga hydrographic basin. The methodology included: (1) delimitation of the watershed; (2) geometric (or physiographic) characterization of the basin; (3) analysis of the digital elevation model to quantify the slopes and to detect structural alignments that influence the surface and groundwater flow; (4) geologic characterization of the basin; (5) description of the soil type and the land use; (6) classification of the regional climatic conditions; (7) inventory and regular hydrogeologic characterization of wells (diameter, depth, wellhead and piezometry); (8) elaboration of piezometric maps in order to identify the groundwater flow; (9) groundwater sampling and in situ measurement of physico-chemical parameters (pH, groundwater temperature, specific electrical conductivity, Eh, dissolved oxygen, HCO3); (10) conducting laboratorial hydrochemical analyzes (Cl, NO3, SO4, PO4, Ca, Na, Mg, K, Fe, Mn, Al); (11) groundwater classification, hydrochemical interpretation and identification of the water

  4. Where do adaptive shifts occur during invasion A multidisciplinary approach to unravel cold adaptation in a tropical ant species invading the Mediterranean zone

    USDA-ARS?s Scientific Manuscript database

    Although evolution is now recognized as improving the invasive success of populations, where and when key adaptation event(s) occur often remains unclear. Here we used a multidisciplinary approach to disentangle the eco-evolutionary scenario of invasion of a Mediterranean zone (i.e. Israel) by the t...

  5. Perspectives on a Multidisciplinary Team Approach to Implementation of Planned Emergent Use Research

    PubMed Central

    Racedo Africano, Carlos J.; De Moraes, Alice Gallo; Smischney, Nathan J.

    2015-01-01

    In this paper we present the viewpoints of three members of a research team, on the approach to teamwork in the development of an emergent use clinical trial when dealing with diversity of opinions, in order to facilitate stakeholder buy-in. We also discuss a specific approach to the coordination of the team members, which in our opinion had a positive impact on the implementation of the project. We also comment on the influence of the team organization in the timeline and completion of a clinical trial. We hope to start a conversation on team dynamics in the design of clinical trials, especially in the context of emergent use research. PMID:26386913

  6. Perspectives on a Multidisciplinary Team Approach to Implementation of Planned Emergent Use Research.

    PubMed

    Racedo Africano, Carlos J; Gallo de Moraes, Alice; Smischney, Nathan J

    2015-09-19

    In this paper we present the viewpoints of three members of a research team, on the approach to teamwork in the development of an emergent use clinical trial when dealing with diversity of opinions, in order to facilitate stakeholder buy-in. We also discuss a specific approach to the coordination of the team members, which in our opinion had a positive impact on the implementation of the project. We also comment on the influence of the team organization in the timeline and completion of a clinical trial. We hope to start a conversation on team dynamics in the design of clinical trials, especially in the context of emergent use research.

  7. A MULTIDISCIPLINARY APPROACH TO THE REHABILITATION OF A COLLEGIATE FOOTBALL PLAYER FOLLOWING ANKLE FRACTURE: A CASE REPORT

    PubMed Central

    Kaplan, Lee D.; Musto, Tony; Gaunaurd, Ignacio A.; Gailey, Robert S.; Kelley, William P.; Alemi, Timothy J.; Espinosa, Braulio; Mandler, Eli; Scavo, Vincent A.; West, Dustin C.

    2016-01-01

    ABSTRACT Background and Purpose Multiple rehabilitation factors including overall wellness need to be considered when an athlete returns to sport after an injury. The purpose of this case report is to describe a multidisciplinary approach for return to sport of a Division I collegiate football player following a traumatic ankle fracture requiring surgical repair. The assessment and treatment approach included the use of a performance-based physical therapy outcome measure, self-reported functional abilities, body composition assessments, and nutritional counseling. Case Description A 21 year-old running back fractured his lateral malleolus due to a mechanism of injury of excessive eversion with external rotation of the ankle. Surgical intervention included an open reduction internal fixation (ORIF) of the fibula and syndesmosis. In addition to six months of rehabilitation, the patient received consultations from the team sports nutritionist specialist to provide dietary counseling and body composition testing. The Comprehensive High-level Activity Mobility Predictor-Sport (CHAMP-S), a performance-based outcome measure, self-report on the Foot and Ankle Disability Index (FADI-ADL, FADI-S), and body composition testing using whole body densitometry (BOD POD®), were administered throughout rehabilitation. Outcomes The subject was successfully rehabilitated, returned to his starting role, and subsequently was drafted by a National Football League (NFL) franchise. High-level mobility returned to above pre-injury values, achieving 105% of his preseason CHAMP-S score at discharge. Self-reported function on the FADI-ADL and FADI-Sport improved to 100% at discharge. Body fat percentages decreased (13.3% to 11.9%) and fat mass decreased (12.0 kg to 11.0kg). Lean body mass (78.1 kg to 81.5 kg) and lbm/in increased (1.14 kg/in to 1.19 kg/in). His BMI changed from 29.8 kg/m2 to 30.6 kg/m2. Discussion This case report illustrates the positive effects of a

  8. A MULTIDISCIPLINARY APPROACH TO THE REHABILITATION OF A COLLEGIATE FOOTBALL PLAYER FOLLOWING ANKLE FRACTURE: A CASE REPORT.

    PubMed

    Feigenbaum, Luis A; Kaplan, Lee D; Musto, Tony; Gaunaurd, Ignacio A; Gailey, Robert S; Kelley, William P; Alemi, Timothy J; Espinosa, Braulio; Mandler, Eli; Scavo, Vincent A; West, Dustin C

    2016-06-01

    Multiple rehabilitation factors including overall wellness need to be considered when an athlete returns to sport after an injury. The purpose of this case report is to describe a multidisciplinary approach for return to sport of a Division I collegiate football player following a traumatic ankle fracture requiring surgical repair. The assessment and treatment approach included the use of a performance-based physical therapy outcome measure, self-reported functional abilities, body composition assessments, and nutritional counseling. A 21 year-old running back fractured his lateral malleolus due to a mechanism of injury of excessive eversion with external rotation of the ankle. Surgical intervention included an open reduction internal fixation (ORIF) of the fibula and syndesmosis. In addition to six months of rehabilitation, the patient received consultations from the team sports nutritionist specialist to provide dietary counseling and body composition testing. The Comprehensive High-level Activity Mobility Predictor-Sport (CHAMP-S), a performance-based outcome measure, self-report on the Foot and Ankle Disability Index (FADI-ADL, FADI-S), and body composition testing using whole body densitometry (BOD POD®), were administered throughout rehabilitation. The subject was successfully rehabilitated, returned to his starting role, and subsequently was drafted by a National Football League (NFL) franchise. High-level mobility returned to above pre-injury values, achieving 105% of his preseason CHAMP-S score at discharge. Self-reported function on the FADI-ADL and FADI-Sport improved to 100% at discharge. Body fat percentages decreased (13.3% to 11.9%) and fat mass decreased (12.0 kg to 11.0kg). Lean body mass (78.1 kg to 81.5 kg) and lbm/in increased (1.14 kg/in to 1.19 kg/in). His BMI changed from 29.8 kg/m(2) to 30.6 kg/m(2). This case report illustrates the positive effects of a multidisciplinary approach where combining physical therapy and

  9. Oncology Teaching: A Multidisciplinary Approach for Second-Year Medical Students

    ERIC Educational Resources Information Center

    Elkort, Richard; Mozden, Peter J.

    1975-01-01

    A Boston University School of Medicine course in oncology is described which covers basic science correlates, diagnostic approaches, treatment modalities, and psycho-social aspects. Based on five years experience, the course is considered a successful means of correlating basic and clinical information for second- and third-year medical students.…

  10. Oncology Teaching: A Multidisciplinary Approach for Second-Year Medical Students

    ERIC Educational Resources Information Center

    Elkort, Richard; Mozden, Peter J.

    1975-01-01

    A Boston University School of Medicine course in oncology is described which covers basic science correlates, diagnostic approaches, treatment modalities, and psycho-social aspects. Based on five years experience, the course is considered a successful means of correlating basic and clinical information for second- and third-year medical students.…

  11. A multidisciplinary approach directed towards the commercial release of transgenic herbicide-tolerant rice in Costa Rica.

    PubMed

    Espinoza-Esquivel, Ana M; Arrieta-Espinoza, Griselda

    2007-10-01

    This review discusses a multidisciplinary and multicomponent approach leading to the development and commercial release of transgenic Costa Rican rice varieties tolerant to the herbicide gluphosinate ammonium. We describe the field evaluations of the transgenic lines and their potential environmental impact, focusing on gene flow, particularly in relation to native wild Oryza species and weedy rice, based on trials performed in compliance with the national regulatory requirements of the country. We also present a socio-economic analysis of rice production in Costa Rica and the economic benefits of genetically modified (GM) rice as well as an environmental risk-benefit analysis for the deployment of GM rice. Additionally, food safety evaluation, intellectual property management, requirements for deregulation, and options for the commercialization of the new varieties are discussed. We also present results from a national survey aimed at assessing the level of support for GM crops in Costa Rica as this forms an integral component of our approach. Taken together, our results demonstrate that the adoption of these genetically improved rice varieties will provide clear benefits to Costa Rican rice growers and consumers.

  12. Multidisciplinary Approach to Flood Forecasting on the Base of Earth Observation Data and Hydrological Modelling

    NASA Astrophysics Data System (ADS)

    Zelentsov, Viacheslav; Potryasaev, Semen; Sokolov, Boris

    2016-08-01

    In this paper a new approach to the creation of short- term forecasting systems of river flooding is being further developed. It provides highly accurate forecasting results due to operative obtaining and integrated processing of the remote sensing and ground- based water flow data in real time. Forecasting of flood areas and depths is performed on a time interval of 12 to 48 hours to be able to perform the necessary steps to alert and evacuate the population. Forecast results are available as web services. The proposed system extends traditional separate methods based on satellite monitoring or modeling of a river's physical processes, by using an interdisciplinary approach, integration of different models and technologies, and through intelligent choice of the most suitable models for a flood forecasting.

  13. A multidisciplinary, science-based approach to the economics of climate change.

    PubMed

    Carlin, Alan

    2011-04-01

    Economic analyses of environmental mitigation and other interdisciplinary public policy issues can be much more useful if they critically examine what other disciplines have to say, insist on using the most relevant observational data and the scientific method, and examine lower cost alternatives to the change proposed. These general principles are illustrated by applying them to the case of climate change mitigation, one of the most interdisciplinary of public policy issues. The analysis shows how use of these principles leads to quite different conclusions than those of most previous such economic analyses, as follows: The economic benefits of reducing CO(2) emissions may be about two orders of magnitude less than those estimated by most economists because the climate sensitivity factor (CSF) is much lower than assumed by the United Nations because feedback is negative rather than positive and the effects of CO(2) emissions reductions on atmospheric CO(2) appear to be short rather than long lasting. The costs of CO(2) emissions reductions are very much higher than usually estimated because of technological and implementation problems recently identified. Geoengineering such as solar radiation management is a controversial alternative to CO(2) emissions reductions that offers opportunities to greatly decrease these large costs, change global temperatures with far greater assurance of success, and eliminate the possibility of low probability, high consequence risks of rising temperatures, but has been largely ignored by economists. CO(2) emissions reductions are economically unattractive since the very modest benefits remaining after the corrections for the above effects are quite unlikely to economically justify the much higher costs unless much lower cost geoengineering is used.The risk of catastrophic anthropogenic global warming appears to be so low that it is not currently worth doing anything to try to control it, including geoengineering.

  14. A Multidisciplinary, Science-Based Approach to the Economics of Climate Change

    PubMed Central

    Carlin, Alan

    2011-01-01

    Economic analyses of environmental mitigation and other interdisciplinary public policy issues can be much more useful if they critically examine what other disciplines have to say, insist on using the most relevant observational data and the scientific method, and examine lower cost alternatives to the change proposed. These general principles are illustrated by applying them to the case of climate change mitigation, one of the most interdisciplinary of public policy issues. The analysis shows how use of these principles leads to quite different conclusions than those of most previous such economic analyses, as follows: The economic benefits of reducing CO2 emissions may be about two orders of magnitude less than those estimated by most economists because the climate sensitivity factor (CSF) is much lower than assumed by the United Nations because feedback is negative rather than positive and the effects of CO2 emissions reductions on atmospheric CO2 appear to be short rather than long lasting.The costs of CO2 emissions reductions are very much higher than usually estimated because of technological and implementation problems recently identified.Geoengineering such as solar radiation management is a controversial alternative to CO2 emissions reductions that offers opportunities to greatly decrease these large costs, change global temperatures with far greater assurance of success, and eliminate the possibility of low probability, high consequence risks of rising temperatures, but has been largely ignored by economists.CO2 emissions reductions are economically unattractive since the very modest benefits remaining after the corrections for the above effects are quite unlikely to economically justify the much higher costs unless much lower cost geoengineering is used.The risk of catastrophic anthropogenic global warming appears to be so low that it is not currently worth doing anything to try to control it, including geoengineering. PMID:21695026

  15. An interdisciplinary approach to teaching in a multi-disciplinary context - A model for teaching geociences?

    NASA Astrophysics Data System (ADS)

    Salmun, H.

    2015-12-01

    As a major component of an NSF-funded STEM program, a seminar-style course called the Catalyst Seminar was developed and offered over three consecutive semesters. The program included undergraduate students in the geosciences, computer science, mathematics and physics. The Catalyst Seminar was designed to expose scholars to the interdisciplinary research options and careers in these disciplines. The Seminar also provided a venue for scholars to meet regularly, build a sense of community and to engage in research projects that would enhance their preparation for multi and interdisciplinary careers in the sciences. The first semester of the Seminar was devoted to Exposure and Connections, accomplished through lectures by invited speakers on topics related to the disciplines participating in the Program. Scholars were required to read journal articles related to the lectures and to write a final short paper reflecting on the experience, all activities that are known to students at this level. Overall, this was a somewhat passive learning approach to research in classrooms. In the following two semesters a more active approach to engage students in interdisciplinary research was used. Students were asked to take ownership of their learning process through disciplinary and interdisciplinary engagement in a project. In one semester this process was guided by the seminar coordinator who was in charge of selecting and leading the 'research project' which although challenging to scholars, was 'safe' enough that answers were readily available. In the other semester the approach was student-centered, with a coordinator that merely facilitated the formation of interdisciplinary research teams that took complete charge of the entire research enterprise. I will discuss our observations and assessment of the outcomes of this instructional experience with relation to the teaching of geoscience, in particular to attracting students into this field.

  16. Caudal Duplication Syndrome: the Vital Role of a Multidisciplinary Approach and Staged Correction

    PubMed Central

    Samuk, Inbal; Levitt, Marc; Dlugy, Elena; Kravarusic, Dragan; Ben-Meir, David; Rajz, Gustavo; Konen, Osnat; Freud, Enrique

    2015-01-01

    Caudal duplication syndrome is a rare entity that describes the association between congenital anomalies involving caudal structures and may have a wide spectrum of clinical manifestations. A full-term male presented with combination of anomalies including anorectal malformation, duplication of the colon and lower urinary tract, split of the lower spine, and lipomyelomeningocele with tethering of the cord. We report this exceptional case of caudal duplication syndrome with special emphasis on surgical strategy and approach combining all disciplines involved. The purpose of this report is to present the pathology, assessment, and management strategy of this complex case. PMID:28018799

  17. Craniofacial/Neurosurgery: a multidisciplinary approach to the repair of meningoencephaloceles in a third world country.

    PubMed

    Hack, Judith; Pieper, Daniel

    2011-08-01

    The repair of meningoencephaloceles in a third world country does not have to be an unrealized goal. Utilizing a team of specialized experienced physicians to provide the treatment, patient selection, comprehensive planning for all surgical variability, and cooperative management of the patients postoperatively with the hosting physicians is essential to the success of these surgeries. In 2007, a team of physicians, including a neurosurgeon, a craniofacial surgeon, a neurosurgical resident, and nursing personnel, traveled for the first time to Davao, in the Philippines, to repair and reconstruct four patients with meningoencephalocele. The planning, surgical approach, and outcome of the repair of this defect are discussed in this article.

  18. Massive Hemorrhage from Ectopic Duodenal Varices: Importance of a Multidisciplinary Approach

    PubMed Central

    House, Tyler; Webb, Patrick; Baarson, Chad

    2017-01-01

    Duodenal variceal bleeding is an uncommon complication of portal hypertension that can easily go unrecognized and reach mortality rates as high as 40%. Cirrhosis is the most common cause of duodenal varices. In most cases, duodenal varices occur concomitantly with esophageal varices, further complicating identification with initial endoscopy. Although many modalities have been explored with respect to management and treatment approaches, guidelines have yet to be established owing to the infrequency in which bleeding occurs from ectopic duodenal varices. We present a case of massive duodenal variceal hemorrhage that highlights the complexity of initial diagnosis and ultimately required a transesophageal intrahepatic portosystemic shunt with coil embolization for control of bleeding. PMID:28203136

  19. Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants?

    PubMed

    de Avila, Érica Dorigatti; de Molon, Rafael Scaf; de Assis Mollo, Francisco; de Barros, Luiz Antonio Borelli; Capelozza Filho, Leopoldino; de Almeida Cardoso, Mauricio; Cirelli, Joni Augusto

    2012-11-01

    Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, an interdisciplinary approach should be observed during the diagnosis, prognosis, and treatment plan to provide a result with good predictability and meet the esthetic and functional expectations of the patient. The present study describes a case of a young patient with tooth agenesis of maxillary lateral incisors, which was conducted with an integrated planning. After 5-year follow-up of 2 fixed implant-supported prostheses, clinical and radiographic examination showed the treatment to be successful.

  20. Follicular dendritic cell sarcoma of mediastinum: a key role of radiotherapy in a multidisciplinary approach.

    PubMed

    Spatola, Corrado; Migliore, Marcello; Emanuele Liardo, Rocco Luca; Bevilacqua, Roberta; Luigi, Raffaele; Vincenzo, Salamone; Tocco, Alessandra; Pagana, Antonio; Militello, Carmelo; Calvo, Damiano; Criscione, Alessandra; Privitera, Giuseppe

    2015-01-01

    Follicular dendritic cell sarcoma is a rare and aggressive tumor and its management is a major clinical challenge. Surgery is considered the mainstay of treatment and no adjuvant approach has demonstrated the ability to reduce the rate of relapses. We report on a case of a man with a 26-year clinical history of mediastinal follicular dendritic cell sarcoma, with several relapses after multiple surgical interventions. The impact of chemotherapy was very small, unlike the radiation therapy that was performed twice, with an interval time of 8 years, through an intensity-modulated technique and an altered fractionation schedule.

  1. Caudal Duplication Syndrome: the Vital Role of a Multidisciplinary Approach and Staged Correction.

    PubMed

    Samuk, Inbal; Levitt, Marc; Dlugy, Elena; Kravarusic, Dragan; Ben-Meir, David; Rajz, Gustavo; Konen, Osnat; Freud, Enrique

    2016-12-01

    Caudal duplication syndrome is a rare entity that describes the association between congenital anomalies involving caudal structures and may have a wide spectrum of clinical manifestations. A full-term male presented with combination of anomalies including anorectal malformation, duplication of the colon and lower urinary tract, split of the lower spine, and lipomyelomeningocele with tethering of the cord. We report this exceptional case of caudal duplication syndrome with special emphasis on surgical strategy and approach combining all disciplines involved. The purpose of this report is to present the pathology, assessment, and management strategy of this complex case.

  2. Multidisciplinary design and analytic approaches to advance prospective research on the multilevel determinants of child health.

    PubMed

    Johnson, Sara B; Little, Todd D; Masyn, Katherine; Mehta, Paras D; Ghazarian, Sharon R

    2017-06-01

    Characterizing the determinants of child health and development over time, and identifying the mechanisms by which these determinants operate, is a research priority. The growth of precision medicine has increased awareness and refinement of conceptual frameworks, data management systems, and analytic methods for multilevel data. This article reviews key methodological challenges in cohort studies designed to investigate multilevel influences on child health and strategies to address them. We review and summarize methodological challenges that could undermine prospective studies of the multilevel determinants of child health and ways to address them, borrowing approaches from the social and behavioral sciences. Nested data, variation in intervals of data collection and assessment, missing data, construct measurement across development and reporters, and unobserved population heterogeneity pose challenges in prospective multilevel cohort studies with children. We discuss innovations in missing data, innovations in person-oriented analyses, and innovations in multilevel modeling to address these challenges. Study design and analytic approaches that facilitate the integration across multiple levels, and that account for changes in people and the multiple, dynamic, nested systems in which they participate over time, are crucial to fully realize the promise of precision medicine for children and adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. New approaches to shock and trauma research: learning from multidisciplinary exchange.

    PubMed

    Neugebauer, E A M; Tjardes, T

    2004-05-01

    Our understanding of the complex network of pathophysiology after multiple injury is limited. It is proposed to overcome the limitations of the traditional linear reductionism approach by merging the expertise of biology and medicine with other disciplines such as mathematics, physics and computer science. We organized a two-days-workshop, where surgeons and surgical scientists explained the problem from the medical (pathophysiological) perspective to a well selected group of German applied mathematicians and computer scientists. Vice versa they presented and discussed their approaches to complex system analysis. Physicians found it difficult to develop questions and concepts that go beyond the classic mechanistic thinking. Well formulated questions are the most important prerequisites for successful application of mathematical tools. The possibilities and borders of Artificial Neural Networks (ANN), Hidden Markow Models (HMM), Agent Based Models (ABM), differential equations for problem solving were discussed. There is no master model for all aspects of pathophysiology, however, application of the models to specific problems is mandatory. Future breakthroughs can only be expected if we overcome language problems between disciplines. This cross talk was considered by all participants as a most important step.

  4. A multi-disciplinary approach for the integrated assessment of multiple risks in delta areas.

    NASA Astrophysics Data System (ADS)

    Sperotto, Anna; Torresan, Silvia; Critto, Andrea; Marcomini, Antonio

    2016-04-01

    The assessment of climate change related risks is notoriously difficult due to the complex and uncertain combinations of hazardous events that might happen, the multiplicity of physical processes involved, the continuous changes and interactions of environmental and socio-economic systems. One important challenge lies in predicting and modelling cascades of natural and man -made hazard events which can be triggered by climate change, encompassing different spatial and temporal scales. Another regard the potentially difficult integration of environmental, social and economic disciplines in the multi-risk concept. Finally, the effective interaction between scientists and stakeholders is essential to ensure that multi-risk knowledge is translated into efficient adaptation and management strategies. The assessment is even more complex at the scale of deltaic systems which are particularly vulnerable to global environmental changes, due to the fragile equilibrium between the presence of valuable natural ecosystems and relevant economic activities. Improving our capacity to assess the combined effects of multiple hazards (e.g. sea-level rise, storm surges, reduction in sediment load, local subsidence, saltwater intrusion) is therefore essential to identify timely opportunities for adaptation. A holistic multi-risk approach is here proposed to integrate terminology, metrics and methodologies from different research fields (i.e. environmental, social and economic sciences) thus creating shared knowledge areas to advance multi risk assessment and management in delta regions. A first testing of the approach, including the application of Bayesian network analysis for the assessment of impacts of climate change on key natural systems (e.g. wetlands, protected areas, beaches) and socio-economic activities (e.g. agriculture, tourism), is applied in the Po river delta in Northern Italy. The approach is based on a bottom-up process involving local stakeholders early in different

  5. The Seine system: introduction to a multidisciplinary approach of the functioning of a regional river system.

    PubMed

    Billen, Gilles; Garnier, Josette; Mouchel, Jean-Marie; Silvestre, Marie

    2007-04-01

    The Seine basin (France) is dominated by the megalopolis of Paris (10 millions inhabitants), surrounded by intensive agricultural areas: it represents an important example of regional territory strongly affected by anthropogenic activity. In the scope of the PIREN-Seine program, an interdisciplinary study of this basin was conducted. This paper introduces a special issue of the Science of the Total Environment devoted to the results of this program. It summarizes the main features of the Seine river system, the physical characteristics of its drainage network and its watershed, and the nature and spatial distribution of human activities. The scientific approaches used for the study of the system are described, emphasizing the role of material budgeting, mathematical modeling and historical reconstruction. Some functional characteristics of the Seine watershed and drainage network are summarized, showing that the system is now essentially controlled by anthropogenic constraints.

  6. Modeling the surface and interior structure of comet nuclei using a multidisciplinary approach

    NASA Technical Reports Server (NTRS)

    Odell, C. R.; Dakoulas, Panos C.; Pharr, George M.

    1991-01-01

    The goal was to investigate the structural properties of the surface of comet nucleus and how the surface should change with time under effect of solar radiation. The basic model that was adopted was that the nucleus is an aggregate of frosty particles loosely bound together, so that it is essentially a soil. The nucleus must mostly be composed of dust particles. The observed mass ratios of dust to gas in the coma is never much greater than unity, but this ratio is probably a much lower limit than that of the nucleus because it is vastly easier to remove the gaseous component by sublimation than by carrying off the dust. Therefore the described models assumed that the particles in the soil were frost covered grains of submicron basic size, closely resembling the interstellar grains. The surface properties of such a nucleus under the effects of heating and cooling as the nucleus approaches and recedes from the Sun generally characterized.

  7. The coexistence of paroxysmal hemicrania and temporomandibular disorder: importance of multidisciplinary approach.

    PubMed

    Porporatti, André Luis; Costa, Yuri Martins; Bonjardim, Leonardo Rigoldi; Stuginski-Barbosa, Juliana; Conti, Paulo César Rodrigues; Martori, Alexandre Henrique

    2014-01-01

    Paroxysmal hemicrania (PH) is a trigeminal autonomic cephalalgia, a rare primary headache characterized by unilateral periorbital and/or temporal attacks of severe intensity and short duration. In this situation, the determination of a correct diagnosis is crucial for the establishment of a proper management strategy. In the case of head and facial pain, this step is usually a big challenge since many conditions share the same features, as some primary headaches and temporomandibular disorders (TMD). The relationship between PH and TMD has not been determined. This paper describes a case of a female patient diagnosed with TMD and presenting concomitant headache attacks fulfilling the International Headache Society's criteria for PH. It is also emphasized the importance of dentist in this scenario, for many times responsible for the initial diagnosis of facial/head pain. Moreover, it is presented an integrated and simultaneously approach of both conditions, PH and TMD.

  8. People for sale: the need for a multidisciplinary approach towards human trafficking.

    PubMed

    Van Impe, K

    2000-01-01

    The article addresses the question of how to develop appropriate measures to tackle trafficking in women, based on the findings of a study of trafficking between the Philippines and Belgium. It argues that there is no easy or unidimensional solution to human trafficking, since it is influenced by a complex set of factors, often working in combination with one another. It concludes that control measures alone cannot stop the flow of trafficking in women and that a legal approach which relies solely on one type of legislation would be too narrow. An effective strategy must combine and balance punitive measures with protection of human rights, stricter border control and the removal of the root causes of irregular movements. Measures must be agreed and coordinated between origin, transit and receiving countries.

  9. A Multi-Disciplinary Approach to Tsunami Disaster Prevention in Java, Indonesia

    NASA Astrophysics Data System (ADS)

    Horns, D. M.; Hall, S.; Harris, R. A.

    2016-12-01

    The island of Java in Indonesia is the most densely populated island on earth, and is situated within one of the most tectonically active regions on the planet. Deadly tsunamis struck Java in 1994 and 2006. We conducted an assessment of tsunami hazards on the south coast of Java using a team of geologists, public health professionals, and disaster education specialists. The social science component included tsunami awareness surveys, education in communities and schools, evacuation drills, and evaluation. We found that the evacuation routes were generally appropriate for the local hazard, and that most people were aware of the routes and knew how to use them. However, functional tsunami warning systems were lacking in most areas and knowledge of natural warning signs was incomplete. We found that while knowledge of when to evacuate improved after our educational lesson, some incorrect beliefs persisted (e.g. misconceptions about types of earthquakes able to generate tsunamis and how far inland tsunamis can reach). There was a general over-reliance on government to alert when evacuation is needed as well as reluctance on the part of local leaders to take initiative to sound tsunami alerts. Many people on earth who are at risk of tsunamis live in areas where the government lacks resources to maintain a functional tsunami warning system. The best hope for protecting those people is direct education working within the local cultural belief system. Further collaboration is needed with government agencies to design consistent and repeated messages challenging misperceptions about when to evacuate and to encourage individuals to take personal responsibility based on natural warning signs.

  10. Incorporating the Performing Arts and Museum Exhibit Development in a Multidisciplinary Approach to Science Learning for Teenage Youth

    NASA Astrophysics Data System (ADS)

    Porro, I.; Dussault, M.; Barros-Smith, R.; Wise, D.; LeBlanc, D.

    2012-08-01

    It is not unusual for science educators to experience frustration in implementing learning initiatives for teenage youth who are not already hooked with science. Such frustration may lead them to focus their attention on different audiences, missing an opportunity to break the chain of science apathy among these youth. Youth's apparent lack of interest in science is associated with behavior typical of adolescence and the inadequacy of many science programs to adapt to meet the need of this audience. Teenage youth identify effective programs as those that engage them in challenging but fun activities and that contribute to their social development. Youth are looking for opportunities for skills and knowledge development that are otherwise unavailable to them in or out of school, and for positive relationships with adults with unique expertise in science and other fields. The Youth Astronomy Apprenticeship (YAA) has been successful in reaching out to teenage youth through the implementation of a model that incorporates principles of positive youth development in a multidisciplinary approach to science education. The project-based outcome of YAA participation is the creation and implementation of artistic performances, planetarium shows, museum exhibits, and even entertaining PowerPoint presentations.

  11. A multidisciplinary approach to reservoir subdivision of the Maastrichtian chalk in the Dan field, Danish North Sea

    SciTech Connect

    Kristensen, L.; Dons, T.; Schioler, P.

    1995-11-01

    Correlation of wireline log data from the North Sea chalk reservoirs is frequently hampered by rather subtle log patterns in the chalk section due to the apparent monotonous nature of the chalk sediments, which may lead to ambiguous correlations. This study deals with a correlation technique based on an integration of biostratigraphic data, seismic interpretation, and wireline log correlation; this technique aims at producing a consistent reservoir subdivision that honors both the well data and the seismic data. This multidisciplinary approach has been used to subdivide and correlate the Maastrichtian chalk in the Dan field. The biostratigraphic subdivision is based on a new detailed dinoflagellate study of core samples from eight wells. Integrating the biostratigraphic results with three-dimensional seismic data allows recognition of four stratigraphic units within the Maastrichtian, bounded by assumed chronostratigraphic horizons. This subdivision is further refined by adding a seismic horizon and four horizons from wireline log correlations, establishing a total of nine reservoir units. The approximate chronostratigraphic nature of these units provides an improved interpretation of the depositional and structural patterns in this area. The three upper reservoir units pinch out and disappear in a northeasterly direction across the field. We interpret this stratal pattern as reflecting a relative sea level fall or regional basinal subsidence during the latest Maastrichtian, possibly combined with local synsedimentary uplift due to salt tectonics. Isochore maps indicate that the underlying six non-wedging units are unaffected by salt tectonics.

  12. Late Quaternary cave bears and brown bears in Europe: implications for distribution, chronology, and extinction based on a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Pacher, Martina

    2010-05-01

    Cave bear remains are one of the most numerous fossils found in European caves. Despite their frequency of occurrence, many aspects of cave bear palaeontology still remain poorly understood. New methodological approaches and ongoing studies led to controversial results and discussion about its taxonomy, palaeoecology, and final extinction. Are we dealing with one single or several species of cave bears? Was cave bear exclusively vegetarian or after all more omnivorous? Did he go extinct before or after the Late Glacial Maximum? Was cave bear restricted to Europe or did he also occur in Asia? Late Pleistocene brown bears, on the other hand, are often rare and little is known about the possible co-occurrence of cave and brown bears during the Late Pleistocene. Based on direct radiocarbon dates the distribution pattern of both, cave and brown bears is reconstructed during the Late Pleistocene in Europe. In addition, the reasons for the achieved pattern will be tested leading to the main question - why did cave bear become extinct while brown bears survived until today? To answer this question palaeobiological data of Late Pleistocene cave and brown bears will be tested against results from isotope analyses, while aDNA data may contribute to the question of distinct local population or even species of bears. The current state of evidence will be presented and on the basis of resulting pattern implications for further multi-disciplinary studies will be discussed.

  13. A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: An update.

    PubMed

    Vera-Garcia, Elisa; Mayoral-Cleries, Fermín; Vancampfort, Davy; Stubbs, Brendon; Cuesta-Vargas, Antonio I

    2015-10-30

    This systematic review summarizes the most recent evidence from randomized controlled trials (RCTs) considering the effectiveness of physical therapy interventions (aerobic exercises, strength exercises, relaxation training, basic body awareness exercises, or a combination of these) within the multidisciplinary management of schizophrenia. Two authors searched PubMed, PsycINFO, EMBASE, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cochrane Library considering RCTs published from July 1, 2011-October 1, 2014. Thirteen RCTs representing 549 participants met the inclusion criteria. Overall, the results demonstrate that aerobic exercise significantly reduces psychiatric symptoms, potentially improves mental and physical quality of life and reduces metabolic risk and weight. Specifically, yoga reduces psychiatric symptoms, whilst Tai-chi and progressive muscle relaxation may also have benefits to patients. Two RCTs reported on adverse events. No adverse event was observed supporting the notion that physical therapy is safe in people with schizophrenia. There was considerable heterogeneity in the design, implementation and outcomes in the included studies precluding a meaningful meta-analysis. In general, the quality of physical therapy RCTS is improving and current research demonstrates that physical therapy approaches are valuable interventions and can help improve the psychiatric, physical and quality of life of people with schizophrenia.

  14. Multidisciplinary approach in the management of absolute trismus with bilateral temporomandibular joint replacements for a patient with juvenile idiopathic arthritis.

    PubMed

    Fanaras, Nikolaos; Parry, Nicholas S; Matthews, N Shaun

    2014-11-01

    Juvenile idiopathic arthritis (JIA) is an exclusion diagnosis that gathers together all forms of arthritis that begin before the age of 16 years, persist for more than 6 weeks and are of unknown origin. We present the case of a 42 year old woman with a 20 year history of absolute trismus, secondary to bilateral temporomandibular joint (TMJ) ankylosis caused by JIA. The trismus resulted in grossly compromised oral hygiene and limited the patient to a semi-solid diet. JIA also affected her neck leading to a severe cervico-thoracic kyphosis. The patient who had been wheelchair bound developed severe lymphoedema of both lower limbs, complicating the pre-operative work up further. This particularly challenging case required input from specialists in anaesthetics, neurosurgery, special care dentistry, intensive care and maxillofacial surgery. Treatment consisted of ankylosis release, dental clearance and bilateral alloplastic replacement of her TMJs with custom implants. A full range of hinge movement and good functional outcome was achieved. This case presents the multidisciplinary approach to a severely compromised patient and illustrates the pre-, intra- and postoperative management of bilateral TMJ ankylosis with bespoke implants. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Introducing Astrophysics and Cosmology as Part of Multidisciplinary Approaches to Liberal Arts Courses Addressing "The Big Questions" of Human Experience

    NASA Astrophysics Data System (ADS)

    Wesney, J. C.

    2012-08-01

    There is an opportunity to bring college students to the exploration of the grandeur and wonder of the universe through the design and crafting of courses for the university and liberal arts curricula that would develop multidisciplinary perspectives within the frames of reference of astrophysics and cosmology. There is broad interest within colleges and universities to provide courses that examine "The Big Questions" of human experience from a variety of perspectives. The study of the history of discoveries and insights that we have gained through the development of astrophysics and cosmology provides course options for students to use to explore these questions. Such hybrid courses enable students to approach the questions of origins, human existence, appreciation of the natural world, appreciation of the universe at large, and the significance of our evolving comprehension of the universe from a variety of disciplinary perspectives, including those that border on the astrophysical and cosmological domains. There are within such courses opportunities to examine historical, philosophical, theological, and cultural perspectives as they intersect with our scientific understanding of where and who we are. The first of these courses at Sacred Heart University has been developed and presented for the past two years as part of the new Core Curriculum. The development of that course, entitled The Journey in the Physical Universe, will be discussed, and insights will be shared.

  16. Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis

    PubMed Central

    Mañá, Juan; Rubio-Rivas, Manuel; Villalba, Nadia; Marcoval, Joaquim; Iriarte, Adriana; Molina-Molina, María; Llatjos, Roger; García, Olga; Martínez-Yélamos, Sergio; Vicens-Zygmunt, Vanessa; Gámez, Cristina; Pujol, Ramón; Corbella, Xavier

    2017-01-01

    radiograph were indicators of good outcome. Sarcoidosis is a multisystem disease with protean clinical-radiographic manifestations. Although almost half of patients follow a spontaneous resolution or under treatment, a significant number of them may have several degrees of organ damage. This study emphasizes the value of a multidisciplinary approach and long-term follow-up by specialized teams in sarcoidosis. PMID:28723801

  17. King Charles` Star: A Multidisciplinary Approach To Dating The Supernova Known As Cassiopeia A

    NASA Astrophysics Data System (ADS)

    Lunn, Martin; Rakoczy, L.

    2011-01-01

    Few astronomical phenomena have been as studied as the supernova known as Cassiopeia A. Widely believed to have occurred in the latter half of the seventeenth century, it is also thought to have gone unrecorded. This paper will argue that Cas A did not go unobserved, but in fact was seen in Britain on May 29, 1630, and coincided with the birth of the future King Charles II of Great Britain. This `noon-day star’ is an important feature of Stuart/Restoration propaganda, the significance of which has been widely acknowledged by historians and literary experts. The argument here, however, is that in addition the historical accounts provide credible evidence for a genuine astronomical event, the nature of which must be explained. Combining documentary analysis with an overview of the current scientific thinking on dating supernova, the authors put forward their case for why Charles’ star should be recognized as a sighting of Cas A. Finally, it will be argued that a collaborative approach between the humanities and the sciences can be a valuable tool, not just in furthering our understanding of Cas A, but in the dating of supernovae in general.

  18. King Charles' Star: A Multidisciplinary Approach to Dating the Supernova Known as Cassiopeia A

    NASA Astrophysics Data System (ADS)

    Lunn, M.

    2012-06-01

    (Abstract only) Few astronomical phenomena have been as studied as the supernova known as Cassiopeia A. Widely believed to have occurred in the latter half of the seventeenth century, it is also thought to have gone unrecorded. This paper will argue that Cas A did not go unobserved, but in fact was seen in Britain on May 29, 1630, and coincided with the birth of the future King Charles II of Great Britain. This "noon-day star" is an important feature of Stuart/Restoration propaganda, the significance of which has been widely acknowledged by historians and literary experts. The argument here, however, is that in addition the historical accounts provide credible evidence for a genuine astronomical event, the nature of which must be explained. Combining documentary analysis with an overview of the current scientific thinking on dating supernovae, the authors put forward their case for why Charles' star should be recognized as a sighting of Cas A. Finally, it will be argued that a collaborative approach between the humanities and the sciences can be a valuable tool, not just in furthering our understanding of Cas A, but in the dating of supernovae in general.

  19. King Charles` Star: A Multidisciplinary Approach to Dating the Supernova Known as Cassiopeia A

    NASA Astrophysics Data System (ADS)

    Lunn, Martin

    2011-05-01

    Few astronomical phenomena have been as studied as the supernova known as Cassiopeia A. Widely believed to have occurred in the latter half of the seventeenth century, it is also thought to have gone unrecorded. This paper will argue that Cas A did not go unobserved, but in fact was seen in Britain on May 29, 1630, and coincided with the birth of the future King Charles II of Great Britain. This 'noon-day star' is an important feature of Stuart/Restoration propaganda, the significance of which has been widely acknowledged by historians and literary experts. The argument here, however, is that in addition the historical accounts provide credible evidence for a genuine astronomical event, the nature of which must be explained. Combining documentary analysis with an overview of the current scientific thinking on dating supernova, the authors put forward their case for why Charles' star should be recognized as a sighting of Cas A. Finally, it will be argued that a collaborative approach between the humanities and the sciences can be a valuable tool, not just in furthering our understanding of Cas A, but in the dating of supernovae in general.

  20. Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report

    PubMed Central

    Rispoli, Marco; Bergaminelli, Carlo; Nespoli, Moana Rossella; Esposito, Mariana; Mattiacci, Dario Maria; Corcione, Antonio; Buono, Salvatore

    2016-01-01

    Introduction A bloodless surgery can be desirable also for non Jehovah’s witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. Presentation of the case Our patient, a Jehovah’s witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. Discussion Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation. During surgery, controlled hypotension can help to obtain effective hemostasis. After surgery, clinicians monitored any possible active bleeding, using continuous noninvasive hemoglobin monitoring, limiting the blood loss due to serial in vitro testing. The optimization of cardiac index and delivery of oxygen were continued to grant a fast recovery. Conclusion Bloodless surgery is likely to gain popularity, and become standard practice for all patients. The need for transfusion should be targeted on individual case, avoiding strictly fixed limit often leading to unnecessary transfusion. PMID:27107502

  1. Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report.

    PubMed

    Rispoli, Marco; Bergaminelli, Carlo; Nespoli, Moana Rossella; Esposito, Mariana; Mattiacci, Dario Maria; Corcione, Antonio; Buono, Salvatore

    2016-01-01

    A bloodless surgery can be desirable also for non Jehovah's witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. Our patient, a Jehovah's witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation. During surgery, controlled hypotension can help to obtain effective hemostasis. After surgery, clinicians monitored any possible active bleeding, using continuous noninvasive hemoglobin monitoring, limiting the blood loss due to serial in vitro testing. The optimization of cardiac index and delivery of oxygen were continued to grant a fast recovery. Bloodless surgery is likely to gain popularity, and become standard practice for all patients. The need for transfusion should be targeted on individual case, avoiding strictly fixed limit often leading to unnecessary transfusion. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. Investigating the Pathogenesis of Severe Malaria: A Multidisciplinary and Cross-Geographical Approach

    PubMed Central

    Wassmer, Samuel C.; Taylor, Terrie E.; Rathod, Pradipsinh K.; Mishra, Saroj K.; Mohanty, Sanjib; Arevalo-Herrera, Myriam; Duraisingh, Manoj T.; Smith, Joseph D.

    2015-01-01

    More than a century after the discovery of Plasmodium spp. parasites, the pathogenesis of severe malaria is still not well understood. The majority of malaria cases are caused by Plasmodium falciparum and Plasmodium vivax, which differ in virulence, red blood cell tropism, cytoadhesion of infected erythrocytes, and dormant liver hypnozoite stages. Cerebral malaria coma is one of the most severe manifestations of P. falciparum infection. Insights into its complex pathophysiology are emerging through a combination of autopsy, neuroimaging, parasite binding, and endothelial characterizations. Nevertheless, important questions remain regarding why some patients develop life-threatening conditions while the majority of P. falciparum-infected individuals do not, and why clinical presentations differ between children and adults. For P. vivax, there is renewed recognition of severe malaria, but an understanding of the factors influencing disease severity is limited and remains an important research topic. Shedding light on the underlying disease mechanisms will be necessary to implement effective diagnostic tools for identifying and classifying severe malaria syndromes and developing new therapeutic approaches for severe disease. This review highlights progress and outstanding questions in severe malaria pathophysiology and summarizes key areas of pathogenesis research within the International Centers of Excellence for Malaria Research program. PMID:26259939

  3. [Impact of a multidisciplinary approach for monitoring prescribing of antibiotics in a hospital].

    PubMed

    Causse, R; Chouaid, C; Callaert, S; Le Paih, M F; Cohen, R; Thebault, A

    1998-09-19

    The aim of this study was to examine the impact of a rationalized antibiotic prescription program in a 600-bed hospital. The program was based on a local consensus policy, developed with the prescribers themselves, together with individual nominative dispensing (IDN) of the most costly antibiotics, and training/information programs aimed at institutional prescribers. The impact of the program was assessed in terms of the relevance of prescriptions (6-monthly audits), changes in the overall cost of anti-infectives, the average daily cost per hospital patient, and changes in the pattern of antimicrobial resistance among pathogens isolated in the institution. Reference recommendations were established for most clinical settings encountered in the hospital (104 for adults, 78 for children). The four audits conducted since June 1996 show that the rate of unjustified prescriptions has remained below 6%. The cost of antimicrobials has fallen regularly, both in absolute terms and as a proportion of total drug costs. Finally, resistance rates among the different pathogens studied have fallen or remained stable. Rationalization of antimicrobial chemotherapy in a short-stay hospital necessitates an institution-based policy with long-term objectives, a large initial investment and, above all, a participative approach among all prescribers.

  4. Investigating the Pathogenesis of Severe Malaria: A Multidisciplinary and Cross-Geographical Approach.

    PubMed

    Wassmer, Samuel C; Taylor, Terrie E; Rathod, Pradipsinh K; Mishra, Saroj K; Mohanty, Sanjib; Arevalo-Herrera, Myriam; Duraisingh, Manoj T; Smith, Joseph D

    2015-09-01

    More than a century after the discovery of Plasmodium spp. parasites, the pathogenesis of severe malaria is still not well understood. The majority of malaria cases are caused by Plasmodium falciparum and Plasmodium vivax, which differ in virulence, red blood cell tropism, cytoadhesion of infected erythrocytes, and dormant liver hypnozoite stages. Cerebral malaria coma is one of the most severe manifestations of P. falciparum infection. Insights into its complex pathophysiology are emerging through a combination of autopsy, neuroimaging, parasite binding, and endothelial characterizations. Nevertheless, important questions remain regarding why some patients develop life-threatening conditions while the majority of P. falciparum-infected individuals do not, and why clinical presentations differ between children and adults. For P. vivax, there is renewed recognition of severe malaria, but an understanding of the factors influencing disease severity is limited and remains an important research topic. Shedding light on the underlying disease mechanisms will be necessary to implement effective diagnostic tools for identifying and classifying severe malaria syndromes and developing new therapeutic approaches for severe disease. This review highlights progress and outstanding questions in severe malaria pathophysiology and summarizes key areas of pathogenesis research within the International Centers of Excellence for Malaria Research program.

  5. A multi-disciplinary approach to implementation science: the NIH-PEPFAR PMTCT implementation science alliance.

    PubMed

    Sturke, Rachel; Harmston, Christine; Simonds, R J; Mofenson, Lynne M; Siberry, George K; Watts, D Heather; McIntyre, James; Anand, Nalini; Guay, Laura; Castor, Delivette; Brouwers, Pim; Nagel, Joan D

    2014-11-01

    In resource-limited countries, interventions to prevent mother-to-child HIV transmission (PMTCT) have not yet realized their full potential health impact, illustrating the common gap between the scientific proof of an intervention's efficacy and effectiveness and its successful implementation at scale into routine health services. For PMTCT, this gap results, in part, from inadequate adaptation of PMTCT interventions to the realities of the implementation environment, including client and health care worker behaviors and preferences, health care policies and systems, and infrastructure and resource constraints. Elimination of mother-to-child HIV transmission can only be achieved through understanding of key implementation barriers and successful adaptation of scientifically proven interventions to the local environment. Central to such efforts is implementation science (IS), which aims to investigate and address major bottlenecks that impede effective implementation and to test new approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions. Advancing IS will require deliberate and strategic efforts to facilitate collaboration, communication, and relationship-building among researchers, implementers, and policy-makers. To speed the translation of effective PMTCT interventions into practice and advance IS more broadly, the US National Institutes of Health, in collaboration with the President's Emergency Plan for AIDS Relief launched the National Institutes of Health/President's Emergency Plan for AIDS Relief PMTCT IS Alliance, comprised of IS researchers, PMTCT program implementers, and policy-makers as an innovative platform for interaction and coordination.

  6. Unknown primary cancer of the head and neck: a multidisciplinary approach.

    PubMed

    Cerezo, Laura; Raboso, Eduardo; Ballesteros, Ana Isabel

    2011-02-01

    The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.

  7. Changing knowledge perspective in a changing world: The Adriatic multidisciplinary TDS approach

    NASA Astrophysics Data System (ADS)

    Bergamasco, Andrea; Carniel, Sandro; Nativi, Stefano; Signell, Richard P.; Benetazzo, Alvise; Falcieri, Francesco M.; Bonaldo, Davide; Minuzzo, Tiziano; Sclavo, Mauro

    2013-04-01

    The use and exploitation of the marine environment in recent years has been increasingly high, therefore calling for the need of a better description, monitoring and understanding of its behavior. However, marine scientists and managers often spend too much time in accessing and reformatting data instead of focusing on discovering new knowledge from the processes observed and data acquired. There is therefore the need to make more efficient our approach to data mining, especially in a world where rapid climate change imposes rapid and quick choices. In this context, it is mandatory to explore ways and possibilities to make large amounts of distributed data usable in an efficient and easy way, an effort that requires standardized data protocols, web services and standards-based tools. Following the US-IOOS approach, which has been adopted in many oceanographic and meteorological sectors, we present a CNR experience in the direction of setting up a national Italian IOOS framework (at the moment confined at the Adriatic Sea environment), using the THREDDS (THematic Real-time Environmental Distributed Data Services) Data Server (TDS). A TDS is a middleware designed to fill the gap between data providers and data users, and provides services allowing data users to find the data sets pertaining to their scientific needs, to access, visualize and use them in an easy way, without the need of downloading files to the local workspace. In order to achieve this results, it is necessary that the data providers make their data available in a standard form that the TDS understands, and with sufficient metadata so that the data can be read and searched for in a standard way. The TDS core is a NetCDF- Java Library implementing a Common Data Model (CDM), as developed by Unidata (http://www.unidata.ucar.edu), allowing the access to "array-based" scientific data. Climate and Forecast (CF) compliant NetCDF files can be read directly with no modification, while non-compliant files can

  8. Effectiveness of a multidisciplinary team approach to the prevention of readmission for acute glycaemic events.

    PubMed

    Simmons, D; Hartnell, S; Watts, J; Ward, C; Davenport, K; Gunn, E; Jenaway, A

    2015-10-01

    To describe the effect of a combined diabetes specialist/mental health team approach to prevent readmissions for acute glycaemic events among patients with diabetes. Consecutive patients with diabetes, readmitted to a single hospital for an acute glycaemic condition, were offered one or more diabetes (including assessment, education, medication, technology use and intensive support) and mental health (including assessment, training and therapies) interventions. The pilot service took place over 11 months, with the preceding 24 months and subsequent 8 months serving as control periods. Of the 58 patients admitted, 50 had Type 1 diabetes and were from within the hospital catchment area, and were discharged home. Of these, 32 (64%) had a pre-existing mental health issue and 14 (28%) had a complex social situation. In all, 96% of patients were met as an inpatient by a team member, and 94% accepted at least one intervention. The mean ±sd number of admissions per patient/month dropped from 0.12 ± 0.10 to 0.05 ± 0.10 (P < 0.001) during the intervention, increasing, once the intervention ended, to 0.16 ± 0.36 (P = 0.002). The mean ± sd length of stay similarly decreased and increased (0.6 ± 0.9 to 0.2 ± 0.7 days; P < 0.001 to 0.006) to 0.6 ± 1.4 days (P = 0.003) per patient/month) across the three periods, as did the mean ±sd tariff paid per patient/month (₤258.0 ± 374.0 vs ₤92.1 ± 245.0 vs ₤287.3 ± 563.8; P < 0.001 and P = 0.018, respectively). The mean ± sd HbA1c level dropped from 99 ± 22 to 92 ± 24 mmol/mol (11.2 ± 4.2% vs 10.6 ± 4.3%; P = 0.014) but did not increase after the intervention [89 ± 26 mmol/mol (10.4 ± 4.5%)]. The cost and long-term risks of hospitalization among patients with Type 1 diabetes and recurrent admissions can be reduced by a combined specialist diabetes/mental health team approach. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

  9. [Deficiencies and resources of working population in relation to age: a multidisciplinary approach].

    PubMed

    Volkoff, S

    2000-01-01

    The aging of the population as a whole and the later age at which young people start work are increasing the percentage of older employees. In situations where the working conditions are highly demanding, as in shiftwork, time-pressure jobs, and adaptation to modern technology or skill diversification, this demographic trend may cause serious problems. The way in which job constraints and demands are withstood at various ages should be considered in relation to health, which is often, whether implicitly or explicitly, a selection criterion in the work place. The connection between work and health can rarely be described by a single causal relationship and requires specific epidemiological methods. Moreover, a health problem linked to age can have a feedback effect on the manner in which a job is performed. While these problems do indeed arise in the areas of work and health, they are nonetheless usually symptoms of modifications that have taken place in the work activity itself. The ergonomic approach nevertheless allows us to improve our understanding of changes in work behavior as age increases, as experience is gained, and as skills are acquired. Men and women on the job are not passive spectators of the good or poor fit between the characteristics of their jobs and their own functional state. Consciously or unconsciously, they modify their operating modes (movements, work pace, posture, etc.), reduce their effort level in some subtasks, make more plans to avoid emergency situations, check the outcome of their actions so as to reduce errors that would be costly to correct, and adjust the distribution of tasks in cooperative and collective work situations. But these strategies can only be implemented if the work conditions and organization foster and promote them.

  10. Cyanotoxin occurrence and potentially toxin producing cyanobacteria in freshwaters of Greece: a multi-disciplinary approach.

    PubMed

    Gkelis, Spyros; Zaoutsos, Nikos

    2014-02-01

    Cyanobacteria harmful algal blooms (or CyanoHABs) represent one of the most conspicuous waterborne microbial hazards in aquatic environments mostly due to the production of harmful secondary metabolites, known as cyanotoxins. In freshwaters of Greece only the presence of microcystins (MCs) has been reported despite the increasing occurrence of species able to produce other cyanotoxins too. In this paper, we studied the occurrence of potentially toxic cyanobacteria in water samples collected from six lakes and reservoirs in Greece. A multi-technique approach was applied by the use of microscopy, molecular, and immunological methods. Cyanobacteria were found in all the sites ranging from 4.7 × 10³ to 5.3 × 10⁸ individuals L⁻¹, representing >70% of the total phytoplankton abundance. Microcystins (MCs), cylindrospermopsins (CYNs), and saxitoxins (STXs) were detected using ELISA, in concentrations ranging from 3.9 to 108 μg L⁻¹, from 0.3 to 2.8 μg L⁻¹ and from 0.4 to 1.2 μg L⁻¹, respectively. In half of the samples examined more than one cyanotoxins were detected. Our results document the first report on the occurrence of CYN and STX in freshwaters of Greece and show that potential STX producers are Cylindrospermopsis raciborskii and Aphanizomenon flos-aquae. Further studies are needed to assess potential CYN producers. This study provides further data on the distribution and toxicity of C. raciborskii and Aph. flos-aquae and documents a C. raciborskii dominated bloom producing STX in Europe. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. MATER - Pianeta Terra-Mare: an interactive and multidisciplinary approach to Geosphere sciences

    NASA Astrophysics Data System (ADS)

    Piangiamore, Giovanna Lucia; Fanelli, Emanuela; Furia, Stefania; Garau, Daniela; Merlino, Silvia; Musacchio, Gemma; Carla Centineo, Maria

    2016-04-01

    hydro-geological risk and climate change targeted to students from 8 to 14 years; Planet Sea was articulated in a series of laboratories on the physical-chemical properties ("a sustaining sea") and of the bio-ecological aspects ("a sea of resources") of the sea, engaging students from 4 to 14 years. Scientific conferences, targeted from teenagers and up and open to public, have been organized during the opening and closing weeks of the project, inside the "Week of Planet Earth" 2014 and 2015. The project was also a "peer-education experiment", where students of the High School "Pacinotti" (La Spezia) and of "ISA 10" (Lerici) and "ISA 2" (La Spezia) have played the role of guides in the interactive paths. MATER has reached ca. 1000 students and had excellent feedbacks from teachers and students, supported by questionnaires and press releases. Through the dedicated website, MATER is expected to reach a broader scholastic community, outside its local context. The project was a good example of cooperation of different territorial institutions/associations, working together to promote the culture of prevention and sustainability, involving future citizens to reflect on the values of appropriate behaviors and best practices towards an ethical and sustainable interaction between human activities with the geosphere.

  12. Surgical management of recurrent ovarian cancer: the advantage of collaborative surgical management and a multidisciplinary approach.

    PubMed

    Burton, Elizabeth; Chase, Dana; Yamamoto, Maki; de Guzman, Jayson; Imagawa, David; Berman, Michael L

    2011-01-01

    lymph node excision above the renal vessels; thus, collaboration with a surgical oncologist is a viable option. In this small descriptive study, the feasibility of this reasonably well-tolerated approach, with possible survival benefit, is documented. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. A perspective multidisciplinary geological approach for mitigation of effects due to the asbestos hazard

    NASA Astrophysics Data System (ADS)

    Vignaroli, Gianluca; Rossetti, Federico; Belardi, Girolamo; Billi, Andrea

    2010-05-01

    during rock fragmentation). Accordingly, we are confident that definition of an analytical protocol based on the geological attributes of the asbestos-bearing rocks may constitute a propaedeutical tool to evaluate the asbestos hazard in natural environments. This approach may have important implications for mitigation effects of the asbestos hazard from the medical field to the engineering operations.

  14. A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?

    PubMed

    Rosen, Michael J; Aydogdu, Kasim; Grafmiller, Kevin; Petro, Clayton C; Faiman, Gregg H; Prabhu, Ajita

    2015-08-01

    Obesity is a major risk factor for perioperative morbidity, especially for patients undergoing complex incisional hernia repair. The feasibility and effectiveness of medical weight loss programs prior to complex abdominal wall reconstruction have not been well characterized. Here, we report our experience collaborating with a medical weight loss specialist utilizing a protein sparing modified fast in order to optimize weight loss prior to complex abdominal wall reconstruction. Morbidly obese patients (body mass index (BMI) > 35 kg/m(2)) evaluated by our medical weight loss specialist prior to complex ventral hernia repair were identified within our prospective database. Our primary outcome measure was the amount of weight lost prior to surgical intervention. Our secondary outcome measure was to determine the maintenance of weight loss during long-term follow-up after the surgical intervention. A total of 25 patients with a BMI > 35 kg/m(2) were evaluated by our medical weight loss specialist prior to undergoing a planned incisional hernia repair. The mean weight of the patients preoperatively was 128 kg ± 25 (range 96-205 kg) (mean ± standard deviation), and the mean BMI was 49 kg/m(2) ± 10 (range 36-85). After completion of the preoperative modified protein sparing fast, the mean preoperative weight loss of the group was 24 kg ± 21 (range 2-80 kg). The overall change in BMI for the group prior to surgery was 9 kg/m(2) ± 8 (0.6 to 33). The percentage of excess BMI loss and total BMI loss preoperatively was 37 % ± 23 (2 to 83) and 18 % ± 12 (1 to 43), respectively. Of the 24 patients that initially lost weight in the program preoperatively, 22 (88 %) successfully maintained their weight loss for the entire study period for an average of 18 months. Collaboration with a medical weight loss specialist and a surgeon with a structured approach using a modified protein sparing fast can successfully result in meaningful weight

  15. What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach

    SciTech Connect

    Choi, Clara Y.H.; Chang, Steven D.; Gibbs, Iris C.; Adler, John R.; Harsh, Griffith R.; Atalar, Banu; Lieberson, Robert E.; Soltys, Scott G.

    2012-11-01

    Purpose: Single-modality treatment of large brain metastases (>2 cm) with whole-brain irradiation, stereotactic radiosurgery (SRS) alone, or surgery alone is not effective, with local failure (LF) rates of 50% to 90%. Our goal was to improve local control (LC) by using multimodality therapy of surgery and adjuvant SRS targeting the resection cavity. Patients and Methods: We retrospectively evaluated 97 patients with brain metastases >2 cm in diameter treated with surgery and cavity SRS. Local and distant brain failure (DF) rates were analyzed with competing risk analysis, with death as a competing risk. The overall survival rate was calculated by the Kaplain-Meier product-limit method. Results: The median imaging follow-up duration for all patients was 10 months (range, 1-80 months). The 12-month cumulative incidence rates of LF, with death as a competing risk, were 9.3% (95% confidence interval [CI], 4.5%-16.1%), and the median time to LF was 6 months (range, 3-17 months). The 12-month cumulative incidence rate of DF, with death as a competing risk, was 53% (95% CI, 43%-63%). The median survival time for all patients was 15.6 months. The median survival times for recursive partitioning analysis classes 1, 2, and 3 were 33.8, 13.7, and 9.0 months, respectively (p = 0.022). On multivariate analysis, Karnofsky Performance Status ({>=}80 vs. <80; hazard ratio 0.54; 95% CI 0.31-0.94; p = 0.029) and maximum preoperative tumor diameter (hazard ratio 1.41; 95% CI 1.08-1.85; p = 0.013) were associated with survival. Five patients (5%) required intervention for Common Terminology Criteria for Adverse Events v4.02 grade 2 and 3 toxicity. Conclusion: Surgery and adjuvant resection cavity SRS yields excellent LC of large brain metastases. Compared with other multimodality treatment options, this approach allows patients to avoid or delay whole-brain irradiation without compromising LC.

  16. Landscape and history: a multidisciplinary approach. Project Group Environmental History (P.G.E.H.).

    PubMed

    1999-12-01

    Human societies have inhabited parts of the Central European country of Austria for thousands of years. The development process shopping the landscape by this long period of human impact remains poorly understood. The present study is an attempt to research landscape history on a local scale and compares an alpine, pre-alpine and midland-village area in Austria. We have developed an appropriate concept to describe the landscape ecology features of the study areas in several stages of the past from 1733 on. The landscape analysis is based on the interpretation of different kinds of historical data (e.g., documents, maps) going back to the pre-industrial epoch, which has--at least in terms of landscape ecology--hardly been accessible until now. An important aim of the study is to localize the historical information in the landscape. Individual plots can be traced back even to the early 14th century. Based on the quality of the available historical data, the historical landscape is analysed with regard to categories such as form and intensity of land use, distribution of nutrients and water as well as the pattern of landscape elements and their ecological functions. The comparison of present stages with former ones yields detailed knowledge on the dynamics and stability of landscape structure. This approach allows present-day land units to be identified as a result of long-term development going back to Medieval times. The primary aim of the study is to analyze factors that bring about change or resist it by creating stability. We therefore examine factors coupling landscape structure, agricultural production and population development. For this reason, we have studied the people and the evidence for their labor over a period of 400 years (1400-1800). Besides demographic data of the 18th and 19th century, historical registrar material has been collected; it enabled the land tenures to be reconstructed from the 15th to the 19th century. This type of data is a valuable

  17. PREFACE: Water Interfaces in Physics Chemistry and Biology: a multi-disciplinary approach

    NASA Astrophysics Data System (ADS)

    Bellissent-Funel, Marie-Claire; Dore, John

    2009-07-01

    This 5-day meeting, sponsored by the European Science Foundation (ESF) in partnership with the Fonds zur Förderung der wissenschaftlichen Forschung in Österreich (FWF) was organised by Marie-Claire Bellissent-Funel (Lab. Léon Brillouin (CEA-CNRS), CEA Saclay) and John Dore (School of Physical Sciences, University of Kent). It took place in the Universitatszcentrum (University of Innsbruck), in the ski resort of Obergurgl, Austria, from 8-13 December 2007. The main aim of the meeting was to bring together various groups working on the characteristics of water in a wide range of different conditions, particularly in relation to the difference in behaviour of bulk water and water in close proximity to an interface. Another focus was on the properties of 'solid water' and the free time during the afternoon provided a good opportunity for studying ice interfaces in a different context as the snow conditions were good for ski-ing! An outline of the programme is contained in the PDF file associated with this preface. There was a wide representation encompassing 30 countries and 130 scientists drawn from different science disciplines. Furthermore there was a good range of young scientists, who made an excellent contribution to the poster session. There were, of course, many animated discussions away from the conference room and the feedback forms showed that almost everyone (96%!) felt that they had enjoyed the sessions and had learned something new. There was support for a further conference on this theme in the future. Inevitably, many of the speakers presented information that was in preparation for publication elsewhere and therefore our compilation of some papers in this brief report is not fully representative of the range of topics discussed at the meeting. Further information on specific work reported at the meeting can be obtained by following the author list through the Web of Science or by contacting the authors directly. We report eight short papers from the

  18. Implementing Universal Design Strategies in Municipalities - A Multidisciplinary Approach to Universal Design and Public Health.

    PubMed

    Jensen, Roger

    2016-01-01

    Based on a national program, the regional authorities stimulated each of the 18 municipalities in Telemark 2012-15 to plan and build promenades with universal design. The cooperation between different disciplines was an important factor for good results. The project continues from 2016.

  19. The Direct Assessment of Competence for Degrees in Large Public Universities: A Multidisciplinary Approach.

    ERIC Educational Resources Information Center

    Merrill, John R.

    The concept of attainment requirement and the development and assessment of attainment requirements for natural science majors is discussed. Structures involving several different kinds and levels of terminal and generic attainment are presented. The implications of such levels of attainment and performance standards for assessment strategies are…

  20. Public health assessments in disaster settings: recommendations for a multidisciplinary approach.

    PubMed

    Malilay, J

    2000-01-01

    Rapid assessments of needs and health status have been conducted by the U.S. Centers for Disease Control and Prevention (CDC) in natural disaster settings for gathering information about the status of affected populations during emergencies. A review of eight such assessments (6 from hurricanes, 1 from an ice storm, and 1 from an earthquake) examines current methods and applications, and describes the use of results by policy makers so assessments in post-disaster settings can be improved. Because the results of assessments greatly influence the nature of relief activities, a review can: 1) ascertain strengths and limitations; 2) examine the methods; and 3) ascertain the utility of results and their use by policy makers. This review compares assessments for similarities and differences: 1) across disaster types; 2) within similar disasters; 3) by timing when the assessments are conducted; and 4) in domestic and international settings. The review also identifies decision-making actions that result from the assessments, and suggests direction for future applications. Assessments reported in CDC's Morbidity and Mortality Weekly Report from 1980 through 1999 were reviewed because they applied a systematic methodology in data collection. They were compared descriptively for study characteristics and content areas. Of 13 assessments identified from six reports, eight were reviewed because they focused on initial assessments, rather than on repeated studies. Of the eight, six pertained to hurricanes; one to an ice storm; and one to an earthquake. Seven (88%) were performed during or after the third day post-impact (range: 1-70 days, median: 7 days). All eight addressed demographics, morbidity, and water availability; seven concerned food, sanitation, and transportation; and six queried access to medical care and electricity. Of the three assessments conducted more than 10 days post-event, two addressed vulnerable children, the elderly, pregnant and lactating women, and migrant workers; two singled storm preparation and evacuation behavior; and one concerned mental health, preventive health care, and social programs. Only one, after an earthquake, asked about disaster-related deaths in household members. Two were international assessments and both were performed at least 60 days post-event. All eight provided estimates of proportions of needs based on survey respondents; none, however, extrapolated the proportions to estimate the magnitude of needs for populations at risk. Of the eight, five confirmed a policy decision, such as accelerating delivery of food supplies. Assessments typically were conducted within 1 week after the precipitating event occurred. Most, performed within 3-10 days, focused on demographics, health status, food and water, and restoration of utilities. Three assessments, conducted > 1 month later, concerned long-term planning. Only one was performed < 72 hours post-event. Five assessments resulted in policy actions to guide relief activities. Increasing application of health assessments provides: 1) impetus for improving current methodologies; 2) standardizing collection instruments; 3) involving other sectors in emergency relief; and 4) ensuring useful information for decision makers.

  1. Hydraulic properties of siliciclastic geothermal reservoir rocks under triaxial stress conditions, a multidisciplinary approach.

    NASA Astrophysics Data System (ADS)

    Bakker, Richard; Gholizadeh Doonechaly, Nima; Bruhn, David

    2017-04-01

    . Anisotropy results in permeability parallel to bedding to be roughly one order of magnitude higher than perpendicular to it. Based on the collected data, the validity of the available exponential permeability-porosity-stress relationship is assessed and the model parameters with the best fitting characteristic is chosen for the selected formation. The established relationship is then used as an input for field scale numerical simulation of cold fluid circulation in Buntsandstein formation to predict the reservoir behavior over longer term of fluid circulation. The Finite Element Method is used to evaluate the reservoir behaviour during injection/production of the cold/hot fluid in a fully coupled poro-thermo-elastic environment. Weighted residual method is used for deriving the weak formulation of the mass-, momentum- and energy balance equations. Consequently the standard Galerkin approach is used for spatial discretization of the weak formulas. Temporal discretization is also carried out in a fully implicit manner to avoid the time-stepping limitation. The preliminary results of this study show a promising capacity of heat extraction from the Buntsandstein formation as a geothermal reservoir within western Netherlands.

  2. Temporal changes of spatial soil moisture patterns: controlling factors explained with a multidisciplinary approach

    NASA Astrophysics Data System (ADS)

    Martini, Edoardo; Wollschläger, Ute; Kögler, Simon; Behrens, Thorsten; Dietrich, Peter; Reinstorf, Frido; Schmidt, Karsten; Weiler, Markus; Werban, Ulrike; Zacharias, Steffen

    2016-04-01

    different hydrologic conditions and the factors controlling the temporal variability of the ECa-soil moisture relationship. The approach provided valuable insight into the time-varying contribution of local and nonlocal factors to the characteristic spatial patterns of soil moisture and the transition mechanisms. The spatial organization of soil moisture was controlled by different processes in different soil horizons, and the topsoil's moisture did not mirror processes that take place within the soil profile. Results show that, for the Schäfertal hillslope site which is presumed to be representative for non-intensively managed soils with moderate clay content, local soil properties (e.g., soil texture and porosity) are the major control on the spatial pattern of ECa. In contrast, the ECa-soil moisture relationship is small and varies over time indicating that ECa is not a good proxy for soil moisture estimation at the investigated site.Occasionally observed stronger correlations between ECa and soil moisture may be explained by background dependencies of ECa to other state variables such as pore water electrical conductivity. The results will help to improve conceptual understanding for hydrological model studies at similar or smaller scales, and to transfer observation concepts and process understanding to larger or less instrumented sites, as well as to constrain the use of EMI-based ECa data for hydrological applications.

  3. Helix Nebula - the Science Cloud: a public-private partnership to build a multidisciplinary cloud platform for data intensive science

    NASA Astrophysics Data System (ADS)

    Jones, Bob; Casu, Francesco

    2013-04-01

    The feasibility of using commercial cloud services for scientific research is of great interest to research organisations such as CERN, ESA and EMBL, to the suppliers of cloud-based services and to the national and European funding agencies. Through the Helix Nebula - the Science Cloud [1] initiative and with the support of the European Commission, these stakeholders are driving a two year pilot-phase during which procurement processes and governance issues for a framework of public/private partnership will be appraised. Three initial flagship use cases from high energy physics, molecular biology and earth-observation are being used to validate the approach, enable a cost-benefit analysis to be undertaken and prepare the next stage of the Science Cloud Strategic Plan [2] to be developed and approved. The power of Helix Nebula lies in a shared set of services for initially 3 very different sciences each supporting a global community and thus building a common e-Science platform. Of particular relevance is the ESA sponsored flagship application SuperSites Exploitation Platform (SSEP [3]) that offers the global geo-hazard community a common platform for the correlation and processing of observation data for supersites monitoring. The US-NSF Earth Cube [4] and Ocean Observatory Initiative [5] (OOI) are taking a similar approach for data intensive science. The work of Helix Nebula and its recent architecture model [6] has shown that is it technically feasible to allow publicly funded infrastructures, such as EGI [7] and GEANT [8], to interoperate with commercial cloud services. Such hybrid systems are in the interest of the existing users of publicly funded infrastructures and funding agencies because they will provide "freedom of choice" over the type of computing resources to be consumed and the manner in which they can be obtained. But to offer such freedom-of choice across a spectrum of suppliers, various issues such as intellectual property, legal responsibility

  4. BOOK REVIEW: The Gravitational Million-Body Problem: A Multidisciplinary Approach to Star Cluster Dynamics

    NASA Astrophysics Data System (ADS)

    Heggie, D.; Hut, P.

    2003-10-01

    focus on N = 106 for two main reasons: first, direct numerical integrations of N-body systems are beginning to approach this threshold, and second, globular star clusters provide remarkably accurate physical instantiations of the idealized N-body problem with N = 105 - 106. The authors are distinguished contributors to the study of star-cluster dynamics and the gravitational N-body problem. The book contains lucid and concise descriptions of most of the important tools in the subject, with only a modest bias towards the authors' own interests. These tools include the two-body relaxation approximation, the Vlasov and Fokker-Planck equations, regularization of close encounters, conducting fluid models, Hill's approximation, Heggie's law for binary star evolution, symplectic integration algorithms, Liapunov exponents, and so on. The book also provides an up-to-date description of the principal processes that drive the evolution of idealized N-body systems - two-body relaxation, mass segregation, escape, core collapse and core bounce, binary star hardening, gravothermal oscillations - as well as additional processes such as stellar collisions and tidal shocks that affect real star clusters but not idealized N-body systems. In a relatively short (300 pages plus appendices) book such as this, many topics have to be omitted. The reader who is hoping to learn about the phenomenology of star clusters will be disappointed, as the description of their properties is limited to only a page of text; there is also almost no discussion of other, equally interesting N-body systems such as galaxies(N approx 106 - 1012), open clusters (N simeq 102 - 104), planetary systems, or the star clusters surrounding black holes that are found in the centres of most galaxies. All of these omissions are defensible decisions. Less defensible is the uneven set of references in the text; for example, nowhere is the reader informed that the classic predecessor to this work was Spitzer's 1987 monograph

  5. A New Approach in Public Budgeting: Citizens' Budget

    ERIC Educational Resources Information Center

    Bilge, Semih

    2015-01-01

    Change and transformation in the understanding and definition of citizenship has led to the emergence of citizen-oriented public service approach. This approach also raised a new term and concept in the field of public budgeting because of the transformation in the processes of public budgeting: citizens' budget. The citizens' budget which seeks…

  6. The journey from opposition to recovery from eating disorders: multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches

    PubMed Central

    2013-01-01

    Background In the world of today’s of ever-briefer therapies and interventions, people often seem more interested in outcome than process. This paper focuses on the processes used by a multidisciplinary team in the journey from opposition to change to recovery from eating disorders. The approach outlined is most relevant to those with severe and enduring illness. Methods This paper describes a five-phase journey from eating-disorder disability and back to health as it occurs for patients in a community-based facility. This integrative model uses narrative and motivational interviewing counseling weaved into traditional approaches. It approaches illness from a transdiagnostic orientation, addressing the dynamics and needs demanded by the comorbidities and at the same time responding effectively in a way that reduces the influence of the eating disorder. The treatment described involves a five-phase journey: Preliminary phase (choosing a shelter of understanding); Phase 1: from partial recognition to full acknowledgment; Phase 2: from acknowledgment to clear cognitive stance against the eating disorder; Phase 3: towards clear stance against the “patient” status; Phase 4: towards re-authoring life and regaining self-agency; Phase 5: towards recovery and maintenance. Results In a longitudinal study of patients with a severe and debilitating eating disorder treated with this approach. The drop-out rate was less than 10%. This was during the first two months of treatment for those diagnosed with bulimia nervosa, and this was higher than in those diagnosed with anorexia nervosa. At the end of treatment (15 months to 4 years later) 65% of those treated with anorexia nervosa and 81% of those treated with bulimia nervosa were either in a fully recovered state or in much improved. At the four-year follow-up, 68% of those diagnosed with anorexia nervosa and 83% of those diagnosed with bulimia nervosa were categorized as either fully recovered or much improved. All

  7. Multidisciplinary Approach in the Management of a Complex Case: Implant-Prosthetic Rehabilitation of a Periodontal Smoking Patient with Partial Edentulism, Malocclusion, and Aesthetic Diseases.

    PubMed

    Lanza, Alessandro; Di Francesco, Fabrizio; De Marco, Gennaro; Scognamiglio, Fabio; Aruta, Valeria; Itro, Angelo

    2017-01-01

    Complex periprosthetic cases are considered as challenges by clinicians. Clinical and radiographic parameters should be considered separately to make the right choice between an endodontically or periodontally compromised treated tooth and implant. Therefore, in order to decide whether the tooth is safe or not, data that have to be collected are specific parameters of both the patient and the clinician. In addition, the presence of periodontal, prosthetic, and orthodontic diseases requires patients to be set in multidisciplinary approach. The aim of this case report is to describe how the multidisciplinary approach could be the best way to manage difficult cases of implant-prosthetic rehabilitation. How to rehabilitate with fixed prosthesis on natural teeth and dental implants a smoker patient who presents with active periodontitis, multiple edentulous areas, dental malocclusion, and severe aesthetic problems was also described.

  8. Multidisciplinary Approach in the Management of a Complex Case: Implant-Prosthetic Rehabilitation of a Periodontal Smoking Patient with Partial Edentulism, Malocclusion, and Aesthetic Diseases

    PubMed Central

    Di Francesco, Fabrizio; De Marco, Gennaro; Scognamiglio, Fabio; Aruta, Valeria; Itro, Angelo

    2017-01-01

    Complex periprosthetic cases are considered as challenges by clinicians. Clinical and radiographic parameters should be considered separately to make the right choice between an endodontically or periodontally compromised treated tooth and implant. Therefore, in order to decide whether the tooth is safe or not, data that have to be collected are specific parameters of both the patient and the clinician. In addition, the presence of periodontal, prosthetic, and orthodontic diseases requires patients to be set in multidisciplinary approach. The aim of this case report is to describe how the multidisciplinary approach could be the best way to manage difficult cases of implant-prosthetic rehabilitation. How to rehabilitate with fixed prosthesis on natural teeth and dental implants a smoker patient who presents with active periodontitis, multiple edentulous areas, dental malocclusion, and severe aesthetic problems was also described. PMID:28421148

  9. The role of a multidisciplinary approach in the choice of the best surgery approach in a super-super-obesity case.

    PubMed

    Orlando, Giulio; Gervasi, Rita; Luppino, Ileana M; Vitale, Mario; Amato, Bruno; Silecchia, Gianfranco; Puzziello, Alessandro

    2014-01-01

    Obesity is a multifactorial chronic disease caused by a combination of hereditary, metabolic, dietary, cultural, social and psychological factors. Conservative treatments, such as diet and physical exercises, revealed a lack of long-term efficacy in patients with an extremely high BMI (>60 kg/m(2)). We present a multidisciplinary approach in a patient with an extremely high BMI: a twenty-one years old woman with a BMI 102 kg/m(2) (body weight 313 kg × height 175 cm) disabled to walk with severe depression and a psychological pattern of sweet eater and binge eating disorder. She was also amenorrheic and suffered from metabolic syndrome. The psychological assessment and the social-familial support were defined as priorities. Afterward, physical rehabilitation, behavior therapy, hypocaloric diet followed by intragastric balloon were planned as preoperative treatment. Finally a surgical program was scheduled: Sleeve Gastrectomy as first step of Biliopancreatic Diversion with Duodenal Switch. Sixteenth months after the Sleeve Gastrectomy the weight was 130 kg (Excess Weight Loss = 74%) with a resumption of the menstrual cycle and a normalization of the metabolic syndrome. Due to the results obtained with both surgery and an excellent psychological supporting network we decided not to perform the expected Biliopancreatic Diversion with Duodenal Switch. The timing of bariatric surgery in superobesity patients is a milestone, but the cooperation among the specialists is essential for the choice of the best successful surgery. The multidisciplinary team should point to a comprehensive tailored management, considering motivation, compliance and adherence to a long-term follow-up as the keys for surgical success. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  10. A multidisciplinary approach to the identification and evaluation of novel concepts for deeply buried hardened target defeat

    NASA Astrophysics Data System (ADS)

    Branscome, Ewell Caleb

    During the Cold War, Deeply Buried Hardened Targets (DBHTs) and the assets they protected were of great strategic and tactical concern to the Department of Defense. Megaton-class nuclear warheads were the only viable means of attacking many of these facilities, and even so, a small subset of DBHTs was anticipated to be robust even in the face of such an attack. Post Cold War, the threat posed by DBHTs has not disappeared. Rather, the conventional warfare advantages of the United States have led to an increasing emphasis by potential adversaries on the construction and use of hardened facilities such as DBHTs for protection of both conventional and unconventional assets. Further, the shift in perceived relative risk to the United States' national security from large scale all-out nuclear attack towards very limited attack by Weapons of Mass Destruction (WMD) has led some to hypothesize that "self-deterrence" may diminish the strategic value of current inventory nuclear weapons. The objective of the work described was to identify and explore a paradigm shifting solution that could offer leap-ahead capabilities to counter current and future DBHT threats while mitigating or eliminating the "self-deterrence" issue. Systematic evaluation of DHBT defeat alternatives lead to the selection of a thermal subterrene as a hypothetical means of providing such a capability. A number of possible implementation alternatives for a thermal subterrene were investigated, resulting in the identification of the RadioIsotope Powered Thermal Penetrator (RIPTP) concept for providing an effectively unlimited hard rock penetration capability using near-term technologies. However, the proposed approach was novel and thus required formulation and application of a physics based multidisciplinary analysis code to enable evaluation of lv design alternatives and analysis of performance. Technical considerations identified as important to the feasibility of a RIPTP for DBHT defeat included: packing

  11. Multidisciplinary assessment and treatment of self-injurious behavior in autism spectrum disorder and intellectual disability: integration of psychological and biological theory and approach.

    PubMed

    Minshawi, Noha F; Hurwitz, Sarah; Morriss, Danielle; McDougle, Christopher J

    2015-06-01

    The objective of this review is to consider the psychological (largely behavioral) and biological [neurochemical, medical (including genetic), and pharmacological] theories and approaches that contribute to current thinking about the etiology and treatment of self-injurious behavior (SIB) in individuals with autism spectrum disorder and/or intellectual disability. Algorithms for the assessment and treatment of SIB in this context, respectively, from a multidisciplinary, integrative perspective are proposed and challenges and opportunities that exist in clinical and research settings are discussed.

  12. Forced orthodontic extrusion and use of CAD/CAM technique for reconstruction of a maxillary central incisor with a severely damaged crown: rehabilitation with a multidisciplinary approach.

    PubMed

    Kumar, Rahul; Patil, Suvarna

    2012-01-01

    Dentists encounter fractured anterior teeth on a regular basis. Various methods have been reported in the literature for rehabilitation of an extremely compromised tooth. This report presents a case where esthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach: conventional endodontic treatment followed by orthodontic extrusion and final restoration using a CAD /CAM-fabricated one-piece milled zirconia post and core with a full-coverage zirconia crown.

  13. Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis.

    PubMed

    Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

    2017-01-01

    Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services.

  14. Multisectoral approach for promoting public health.

    PubMed

    Salunke, Subhash; Lal, Dharmesh Kumar

    2017-01-01

    Multisectoral approach (MSA) refers to deliberate collaboration among various stakeholder groups (e.g., government, civil society, and private sector) and sectors (e.g., health, environment, and economy) to jointly achieve a policy outcome. By engaging multiple sectors, partners can leverage knowledge, expertise, reach, and resources, benefiting from their combined and varied strengths as they work toward the shared goal of producing better health outcomes. Improving public health (PH) is challenging because of the size of its population and wide variation in geography. MSA help in addressing identified health issues in focused way as it helps in pooling the resources and formulating the common objectives. One of the major advantages is optimization of usage of resources by avoiding duplication of inputs and activities which tremendously improve program effectiveness and efficiency. Willingness at the leadership and mandate at the policy level are necessary to plan and execute the successful multisectoral coordination. All the major stakeholders require to share the common vision and perspective. Developing institutional mechanism is utmost requirement as it will standardize the processes of intersectoral coordination (ISC). Creation of PH cadre is strategic move to meet the major health challenges being faced by the health system, and it would be anchor of establishing systematic ISC. There are many national and international examples of MSA applications such as for malaria elimination, tobacco control, HIV/AIDS prevention, Finland's community-based cardiovascular disease prevention project (North Karelia Project), and Singapore's Health Promotion Board. Promotion of MSA within the health system and with other ministries is seen as an important measure for effective implementation and improving efficiency.

  15. Approaches to Translation of Chinese Publicity Materials

    ERIC Educational Resources Information Center

    Yin, Lu

    2009-01-01

    Chinese publicity materials are the windows for foreigners to know about China. There has been some problems in the translation for publicity materials both made by the enterprises and government departments. Especially for the growing international communication, the dispute between Chinese and its foreign counterpart is increasingly coming into…

  16. A multi-disciplinary approach to study coastal complex landslides: the case of Torino di Sangro (Central Italy)

    NASA Astrophysics Data System (ADS)

    Sciarra, Marco; Carabba, Luigi; Urbano, Tullio; Calista, Monia

    2016-04-01

    This work illustrates the studies carried out on a complex landslide phenomenon between the Sangro and Osento River's mouths, near Torino di Sangro village in Southern Abruzzo Region (Italy). Historical activity of this landslide is well-documented since 1916; the activation/reactivation of the movements caused several interruptions of a national railway and the damage of few houses. The Torino di Sangro case study can be regarded as representative of many large landslides distributed along the central Adriatic coast (e.g., Ancona, Ortona, Vasto and Petacciato Landslides) that affect densely populated urban areas with a large amount of man-made infrastructure. The main controlling factors of these large and deep-seated landslides are still debated. From the geological and geomorphological viewpoint, the central Adriatic coast is characterized by a low-relief landscape (mesa) carved on clay-sandstone-conglomerate bedrock belonging to the Upper Pliocene - Lower Pleistocene marine deposits and locally to the Middle Pleistocene marine to continental transitional deposits. This high coast is widely affected by slope instability (rock falls, rotational, complex and shallow landslides) on both active and inactive sea cliffs, the first being mainly affected by wave-cut erosion and the latter influenced by heavy rainfall and changes of pore pressure. The main landslide has the typical characteristics of a deep-seated gravitation deformation. The landslide study was based on a multidisciplinary approach including: 1) definition and GIS mapping of geology and geomorphology factors (slope, aspect, topographic curvature, bedrock lithology, near-surface deposits, deposit thickness and land use), by means of DTM processing, multi-temporal analysis, and large-scale geomorphological field survey; 2) monitoring system in the landslide; 3) application of empiric models for the analysis of unstable sandstone-conglomerate escarpments; 4) slope stability analysis performed using a

  17. Overcoming challenges in nonmarine stratigraphy using a multidisciplinary approach: an example from Mesozoic basins of eastern Australia

    NASA Astrophysics Data System (ADS)

    Wainman, Carmine; McCabe, Peter

    2017-04-01

    Continental sedimentary strata are particularly challenging to correlate within and between basins. In fluvio-lacustrine facies significant lateral variations over short distances limit the application of classical correlation techniques on a regional scale. This is particularly the case in the extensive continental successions of eastern Australian Mesozoic basins. Strata in these basins were deposited at high latitudes (>75°S) at a time when relatively temperate conditions prevailed as indicated by major coal accumulations and a rich diversity of palynofloras. These successions are characterized by thin (<0.4m), laterally discontinuous coal beds that can rarely be correlated for more than 5km. Without regional marker beds it is difficult to correlate or even pick regional unconformities using well log signatures or core. The need for a multidisciplinary approach is therefore essential to overcome these issues. A combination of palynology, sedimentology, and radiometric dating of zircon-bearing air-fall tuffs and volcaniclastic sandstones provides new insights on the stratigraphic framework of the Eromanga, Surat and Clarence-Moreton Basins. U-Pb ages were acquired from zircons in 30 tuff beds using the "CA (Chemical Abrasion)-TIMS" methodology. This technique gives dates for individual tuff beds to within +/- 40,000 years. Thirty U-Pb CA-TIMS zircon ages (168-149Ma) were calculated from 13 wells from the three basins. From this data set, several chronostratigraphic datums were defined for correlation across the basins. These datums are each defined within time intervals of less than 420kyr. For the first time, it is now possible to correlate these Jurassic strata with high precision over thousands of kilometers and across multiple basins. The newly constructed chronostratigraphic framework reveals inconsistencies in previous correlation of lithostratigraphic units and identification of regional unconformities. It also demonstrates the diachronous nature of the

  18. Multidisciplinary Approaches to Educational Research: Case Studies from Europe and the Developing World. Routledge Research in Education

    ERIC Educational Resources Information Center

    Rizvi, Sadaf, Ed.

    2011-01-01

    This book provides an original perspective on a range of controversial issues in educational and social research through case studies of multi-disciplinary and mixed-method research involving children, teachers, schools and communities in Europe and the developing world. These case studies from researchers "across continents" and…

  19. Multi-Disciplinary Approaches to Pupil Behaviour in School--The Role of Evaluation in Service Delivery

    ERIC Educational Resources Information Center

    Hartnell, Naomi

    2010-01-01

    This study evaluates the work of a multi-disciplinary Behaviour Support Team developed to support schools in managing problematic behaviour. An evidence base to inform future service delivery is developed, using a model of evaluation which incorporates both quantitative, outcome data and more explanatory qualitative data, incorporating the views…

  20. Multi-Disciplinary Approaches to Pupil Behaviour in School--The Role of Evaluation in Service Delivery

    ERIC Educational Resources Information Center

    Hartnell, Naomi

    2010-01-01

    This study evaluates the work of a multi-disciplinary Behaviour Support Team developed to support schools in managing problematic behaviour. An evidence base to inform future service delivery is developed, using a model of evaluation which incorporates both quantitative, outcome data and more explanatory qualitative data, incorporating the views…

  1. A Multidisciplinary Approach to Educating Preschool Children with Optic Nerve Hypoplasia and Septo-Optic Nerve Dysplasia.

    ERIC Educational Resources Information Center

    Bahar, Cheryl; Brody, Jill; McCann, Mary Ellen; Mendiola, Rosalinda; Slott, Gayle

    2003-01-01

    This article discusses the observations and experiences of a multidisciplinary team at the Blind Childrens Center in Los Angeles, which works specifically with children from birth to 5 years of age who have been diagnosed with optic nerve hypoplasia and may have septo-optic displasia. Strategies for educational interventions are explained.…

  2. Multidisciplinary Approaches to Educational Research: Case Studies from Europe and the Developing World. Routledge Research in Education

    ERIC Educational Resources Information Center

    Rizvi, Sadaf, Ed.

    2011-01-01

    This book provides an original perspective on a range of controversial issues in educational and social research through case studies of multi-disciplinary and mixed-method research involving children, teachers, schools and communities in Europe and the developing world. These case studies from researchers "across continents" and…

  3. Multidisciplinary Approach to the Treatment of Obese Adolescents: Effects on Cardiovascular Risk Factors, Inflammatory Profile, and Neuroendocrine Regulation of Energy Balance

    PubMed Central

    Dâmaso, Ana Raimunda; de Piano, Aline; Campos, Raquel Munhoz da Silveira; Corgosinho, Flávia Campos; Siegfried, Wolfgang; Caranti, Danielle Arisa; Masquio, Deborah Cristina Landi; Carnier, June; Sanches, Priscila de Lima; Leão da Silva, Patrícia; Nascimento, Cláudia Maria Oller; Oyama, Lila Missae; Dantas, Alexandre Dâmaso Aguilera; de Mello, Marco Túlio; Tufik, Sergio; Tock, Lian

    2013-01-01

    The prevention of obesity and health concerns related to body fat is a major challenge worldwide. The aim of this study was to investigate the role of a medically supervised, multidisciplinary approach, on reduction in the prevalence of obesity related comorbidities, inflammatory profile, and neuroendocrine regulation of energy balance in a sample of obese adolescents. A total of 97 postpuberty obese adolescents were enrolled in this study. Body composition, neuropeptides, and adipokines were analysed. The metabolic syndrome was defined by the International Diabetes Federation (IDF). The abdominal ultrasonography was performed to measure visceral, subcutaneous fat and hepatic steatosis. All measures were performed at baseline and after one year of therapy. The multidisciplinary management promoted the control of obesity reducing body fat mass. The prevalence of metabolic syndrome, asthma, nonalcoholic fatty liver disease (NAFLD), binge eating, and hyperleptinemia was reduced. An improvement in the inflammatory profile was demonstrated by an increase in anti-inflammatory adiponectin and reduction in proinflammatory adipokines, plasminogen activator inhibitor-1, interleukin-6 concentrations, and in the Lep/Adipo ratio. Moreover, a reduction in the AgRP and an increase in the alfa-MSH were noted. The multidisciplinary approach not only reduced obesity but also is efficacious in cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance. PMID:24285955

  4. NEMO-SN1 seafloor observatory at EMSO Western Ionian Sea site: a multidisciplinary approach for geophysical, oceanographic and environmental studies.

    NASA Astrophysics Data System (ADS)

    Embriaco, Davide; Marinaro, Giuditta; Monna, Stephen; Lo Bue, Nadia; Giovanetti, Gabriele; De Caro, Mariagrazia; De Santis, Angelo; Sgroi, Tiziana; Frugoni, Francesco; Montuori, Caterina; Riccobene, Giorgio; Viola, Salvo; Sciacca, Virginia; Pulvirenti, Sara; Caruso, Francesco; Simeone, Francesco; Chierici, Francesco; D'Amico, Antonio; Beranzoli, Laura; Favali, Paolo

    2017-04-01

    The Western Ionian Sea is one of the sites of the European Multidisciplinary Seafloor and water-column Observatory Research Infrastructure (EMSO). A prototype of a cabled deep-sea observatory (NEMO-SN1) was set up and has been operational in real-time since 2005 at 2100 m depth, 25 km off the harbour of Catania. In 2012 the observatory was upgraded to a fully integrated system for multidisciplinary deep-sea science, capable to transmit and distribute data in real time to the scientific community and to the general public. NEMO-SN1 hosts a large number of sensors to monitor and study oceanographic, environmental parameters (CTD, ADCP, current meter), and geophysical phenomena (hydrophones, accelerometer, gravity meter, magnetometers, seismometer, pressure gauges). Ocean noise monitoring and identification of biological acoustic sources in deep sea have also been possible with hydrophones working at low and high frequencies. The whole system was connected and powered from shore, by means of the electro-optical cable net installed at the East Sicily Site Infrastructure, and synchronised with GPS time. Sensors data sampling is performed underwater and transmitted via optical fibre link. A dedicated computing and networking infrastructure for data acquisition, storage and distribution through the internet has been also operative. Some examples of seafloor data analyses will be described to show the importance of such an integrated multidisciplinary infrastructure to geophysical, oceanographic and environmental studies.

  5. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

    PubMed

    St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

    2015-12-01

    To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

  6. Computational prediction of multidisciplinary team decision-making for adjuvant breast cancer drug therapies: a machine learning approach.

    PubMed

    Lin, Frank P Y; Pokorny, Adrian; Teng, Christina; Dear, Rachel; Epstein, Richard J

    2016-12-01

    Multidisciplinary team (MDT) meetings are used to optimise expert decision-making about treatment options, but such expertise is not digitally transferable between centres. To help standardise medical decision-making, we developed a machine learning model designed to predict MDT decisions about adjuvant breast cancer treatments. We analysed MDT decisions regarding adjuvant systemic therapy for 1065 breast cancer cases over eight years. Machine learning classifiers with and without bootstrap aggregation were correlated with MDT decisions (recommended, not recommended, or discussable) regarding adjuvant cytotoxic, endocrine and biologic/targeted therapies, then tested for predictability using stratified ten-fold cross-validations. The predictions so derived were duly compared with those based on published (ESMO and NCCN) cancer guidelines. Machine learning more accurately predicted adjuvant chemotherapy MDT decisions than did simple application of guidelines. No differences were found between MDT- vs. ESMO/NCCN- based decisions to prescribe either adjuvant endocrine (97%, p = 0.44/0.74) or biologic/targeted therapies (98%, p = 0.82/0.59). In contrast, significant discrepancies were evident between MDT- and guideline-based decisions to prescribe chemotherapy (87%, p < 0.01, representing 43% and 53% variations from ESMO/NCCN guidelines, respectively). Using ten-fold cross-validation, the best classifiers achieved areas under the receiver operating characteristic curve (AUC) of 0.940 for chemotherapy (95% C.I., 0.922-0.958), 0.899 for the endocrine therapy (95% C.I., 0.880-0.918), and 0.977 for trastuzumab therapy (95% C.I., 0.955-0.999) respectively. Overall, bootstrap aggregated classifiers performed better among all evaluated machine learning models. A machine learning approach based on clinicopathologic characteristics can predict MDT decisions about adjuvant breast cancer drug therapies. The discrepancy between MDT- and guideline-based decisions

  7. Multi-Disciplinary Data Services: Standards-based Coverage Services Fostering Integration; The EarhServer approach

    NASA Astrophysics Data System (ADS)

    Beccati, Alan; Baumann, Peter

    2014-05-01

    Within the EU coordinated efforts to build the spatial data infrastructures for hosting the ever growing datasets collected within, around and beyond our planet, the EarthServer project involves five data providers. Four of these providers host data in the geoscience domain and one on planetary science. All of them are providing data over web services interfaces; among others, we focus on the Web Coverage Service (WCS) and the Web Coverage Processing Service (WCPS) interfaces. A peculiar characteristic of both these interfaces is the reliance on a standard open data model to represent content: the GML Coverage Application Profile (GMLCOV) standard. This standard defines a data model well suited for spatio-temporal data in a semantically rich, machine readable way. The data can be laid out along multiple axes, allowing for high domain dimensionality and each data value can be structured, allowing advanced grouping of measurements. The semantically rich data model allows automated collection and indexing of data service offerings. In particular, the rangeType element (an swe:DataRecord instance) provides knowledge about the structure of each measurement offered in a coverage. Collection of this information into a catalog allows knowing, for example, in which data services a given physical property or measurement type is accessible, among several data provider offerings. Harvesting such metadata and making it available to answer searches over the web is an activity being tackled by one of the project partners. A joint effort is directed towards definition of a query system that builds on top of such harvested catalog and leverages the query language approach in processing data provided by the WCPS interface. Answering a request which addresses metadata while also giving processing directives, with mixed data/metadata queries is the focus of such effort with the aim of performing advanced, provider independent, data analysis in a compact way. The development of a mixed

  8. Establishing a framework for building multidisciplinary programs

    PubMed Central

    Meguid, Cheryl; Ryan, Carrie E; Edil, Barish H; Schulick, Richard D; Gajdos, Csaba; Boniface, Megan; Schefter, Tracey E; Purcell, W Thomas; McCarter, Martin

    2015-01-01

    While most providers support the concept of a multidisciplinary approach to patient care, challenges exist to the implementation of successful multidisciplinary clinical programs. As patients become more knowledgeable about their disease through research on the Internet, they seek hospital programs that offer multidisciplinary care. At the University of Colorado Hospital, we utilize a formal multidisciplinary approach across a variety of clinical settings, which has been beneficial to patients, providers, and the hospital. We present a reproducible framework to be used as a guide to develop a successful multidisciplinary program. PMID:26664132

  9. Scleroderma and pulmonary hypertension complicating two pregnancies: use of neuraxial anesthesia, general anesthesia, epoprostenol and a multidisciplinary approach for cesarean delivery.

    PubMed

    Moaveni, D; Cohn, J; Brodt, J; Hoctor, K; Ranasinghe, J

    2015-11-01

    Literature regarding the anesthetic care of patients with scleroderma during labor and delivery is limited to remote case reports. No recent publications provide information on the anesthetic management of patients with coexisting pulmonary hypertension. This report describes the anesthetic and multidisciplinary management of two pregnant patients with concomitant scleroderma and pulmonary hypertension undergoing cesarean delivery; one with neuraxial anesthesia and one with general anesthesia. Considerations for neuraxial and general anesthesia in patients with concurrent scleroderma and pulmonary hypertension are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. An approach toward public hospital performance assessment

    PubMed Central

    Nwagbara, Vitalis Chukwudi; Rasiah, Rajah; Aslam, Md. Mia

    2016-01-01

    Abstract Background: Public hospitals have come under heavy scrutiny across the world owing to rising expenditures. However, much of the focus has been on cutting down costs to raise efficiency levels. Although not denying the importance of efficiency measures, this article targets a performance issue that is relevant to address the quality of services rendered in public hospitals. Thus, it is important to focus on the effectiveness of resource utilization in these hospitals. Consequently, this article seeks to examine the impact of average length of stay (ALOS) and bed turnover rates (BTR) on bed occupancy rates (BOR). Methods: Public hospital inpatient utilization records during the period 2006 to 2013 were gathered from the Ministry of Health, Malaysia. A 2-step generalized method of moments (GMM) statistical method was used to analyze the data. BOR was adopted as the dependent variable, whereas BTR and ALOS were used as the explanatory variables. The logarithm of total bed count (BED), admission (ADM), and patient days (PD) was deployed as control variables. Three regression models were developed to explore the correlates of BOR as a hospital performance measure. Ethics committee approval was waived because no patients were identified in the study. Results: The statistical analyses show that ALOS and BTR are inversely correlated with BOR, with both coefficients significant at 1%. The control variables of BED, ADM, and PD had the right positive signs and they were significant in both sets of equations. Hence, reducing ALOS and BTR can help raise performance of public hospitals in Malaysia. Conclusion: In light of the robust results obtained, this study offers implications for improving public hospital performance. It shows a need to reduce ALOS and BTR in public hospitals to improve BOR. PMID:27603363

  11. Reclaiming Public Education: Common Sense Approaches

    ERIC Educational Resources Information Center

    Cornett, Bob

    2015-01-01

    Bob Cornett, a former state budget director for Kentucky, describes himself as a "retired bureaucrat." But as a parent, grandparent, and a person who has been involved in education reform for more than 20 years, he's come to understand that, if public education policies are to be corrected, the impetus has to come from the citizenry. In…

  12. Multidisciplinary Management of Hypodontia.

    PubMed

    O'Sullivan, Michael; O'Connell, Brian

    2017-02-28

    Patients with hypodontia require a wide range of treatment, ranging from single tooth replacement to the restoration of multiple edentulous spaces in both arches. Treatment should involve an interdisciplinary team, as no dental speciality possesses the range of expertise required to optimally treat this patient population. This paper presents principles of treatment, key factors of assessment and multidisciplinary approaches to management of the hypodontia patient, including contributions from conservative dentistry.

  13. A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement.

    PubMed

    Aiello, Francesco A; Judelson, Dejah R; Messina, Louis M; Indes, Jeffrey; FitzGerald, Gordon; Doucet, Danielle R; Simons, Jessica P; Schanzer, Andres

    2016-08-01

    Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes

  14. Optimal Design of Integrated Systems Health Management (ISHM) Systems for improving safety in NASA's Exploration Vehicles: A Two-Level Multidisciplinary Design Approach

    NASA Technical Reports Server (NTRS)

    Tumer, Irem; Mehr, Ali Farhang

    2005-01-01

    In this paper, a two-level multidisciplinary design approach is described to optimize the effectiveness of ISHM s. At the top level, the overall safety of the mission consists of system-level variables, parameters, objectives, and constraints that are shared throughout the system and by all subsystems. Each subsystem level will then comprise of these shared values in addition to subsystem-specific variables, parameters, objectives and constraints. A hierarchical structure will be established to pass up or down shared values between the two levels with system-level and subsystem-level optimization routines.

  15. Advancing insights into methods for studying environment-health relationships: a multidisciplinary approach to understanding Legionnaires' disease.

    PubMed

    Dunn, Christine E; Bhopal, Raj S; Cockings, Samantha; Walker, David; Rowlingson, Barry; Diggle, Peter

    2007-09-01

    Recent years have witnessed important advances in the analysis of spatially referenced health data. This paper uses GIS and point pattern modelling to address previously unanswered questions regarding the spatial epidemiology of Legionnaires' disease. We demonstrate a distance effect for proximity of residence to cooling towers; mixed support for a directional effect; and some evidence relating to multiple sources. In uncovering complex conceptual and technical problems in the spatial modelling of infection risk we also extended the limits of existing point pattern techniques. We advocate further multidisciplinary research to advance methodological developments for understanding spatial environment-health relationships.

  16. Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach.

    PubMed

    Chamberlain, Mark; Dwyer, Rebecca

    2015-01-01

    Pre-operative assessment of complex surgical patients can be a lengthy process, albeit essential to minimise complication rates. In a tertiary referral unit specialising in the surgical repair of entercutaneous fistulas, a baseline audit revealed an average in-patient length of stay of 30.1 days, mainly caused by poor co-ordination between specialities. After the introduction of a weekly multi-disciplinary team meeting and the formalisation of a patient pathway, this admission length was reduced to 5.7 days (p<0.01), resulting in significant savings to the department.

  17. Public Health Approaches and the Human Enhancement Debate.

    PubMed

    Brummett, Abram

    2016-01-01

    Some contributors to the cognitive enhancement (CE) debate claim to take a "public health" approach. However, authors who use this stance end up offering very different recommendations for CE. Some argue for bioconservatism, others for transhumanism-all in the name of "public health." This article argues that these inconsistencies occur because a "public health approach" is far too vague. Furthermore, public health approaches are silent on an issue that drives a great deal of the disagreement over CE: differences in anthropology. How one feels about CE will be influenced by whether one believes there are aspects of human nature that we ought never tamper with, or whether human nature is just another rung on the ladder to ever greater forms of life. Whether one sees humanity as something to be preserved or overcome will drive one's view of CE, and this is an issue about which public health as far too little to say.

  18. The Public Health Approach to Eliminating Disparities in Health

    PubMed Central

    Satcher, David; Higginbotham, Eve J.

    2008-01-01

    Reducing and eliminating disparities in health is a matter of life and death. Each year in the United States, thousands of individuals die unnecessarily from easily preventable diseases and conditions. It is critical that we approach this problem from a broad public health perspective, attacking all of the determinants of health: access to care, behavior, social and physical environments, and overriding policies of universal access to care, physical education in schools, and restricted exposure to toxic substances. We describe the historical background for recognizing and addressing disparities in health, various factors that contribute to disparities, how the public health approach addresses such challenges, and two successful programs that apply the public health approach to reducing disparities in health. Public health leaders must advocate for public health solutions to eliminate disparities in health. PMID:18235057

  19. The Public Health Approach to Eliminating Disparities in Health

    PubMed Central

    Satcher, David; Higginbotham, Eve J.

    2008-01-01

    Reducing and eliminating disparities in health is a matter of life and death. Each year in the United States, thousands of individuals die unnecessarily from easily preventable diseases and conditions. It is critical that we approach this problem from a broad public health perspective, attacking all of the determinants of health: access to care, behavior, social and physical environments, and overriding policies of universal access to care, physical education in schools, and restricted exposure to toxic substances. We describe the historical background for recognizing and addressing disparities in health, various factors that contribute to disparities, how the public health approach addresses such challenges, and two successful programs that apply the public health approach to reducing disparities in health. Public health leaders must advocate for public health solutions to eliminate disparities in health. PMID:18687626

  20. Alternate Sources of Revenues for Public Schools: A Marketing Approach.

    ERIC Educational Resources Information Center

    Dembowski, Frederick; Biros, Janice

    1984-01-01

    After analyzing the causes of public education's current fiscal crisis, this article offers a marketing approach to educational management as a possible long range solution. A model marketing plan is outlined and some applications for raising revenues are identified. (MJL)

  1. Alternate Sources of Revenues for Public Schools: A Marketing Approach.

    ERIC Educational Resources Information Center

    Dembowski, Frederick; Biros, Janice

    1984-01-01

    After analyzing the causes of public education's current fiscal crisis, this article offers a marketing approach to educational management as a possible long range solution. A model marketing plan is outlined and some applications for raising revenues are identified. (MJL)

  2. Public Health Approach to the Study of Mental Retardation

    ERIC Educational Resources Information Center

    Chapman, Derek A.; Scott, Keith G.; Stanton-Chapman, Tina L.

    2008-01-01

    We applied a public health approach to the study of mental retardation by providing a basic descriptive epidemiological analysis using a large statewide linked birth and public school record database (N = 327,831). Sociodemographic factors played a key role across all levels of mental retardation. Birthweight less than 1000 g was associated with…

  3. Public Health Approach to the Study of Mental Retardation

    ERIC Educational Resources Information Center

    Chapman, Derek A.; Scott, Keith G.; Stanton-Chapman, Tina L.

    2008-01-01

    We applied a public health approach to the study of mental retardation by providing a basic descriptive epidemiological analysis using a large statewide linked birth and public school record database (N = 327,831). Sociodemographic factors played a key role across all levels of mental retardation. Birthweight less than 1000 g was associated with…

  4. Young Public Manager in Romania--A New Approach

    ERIC Educational Resources Information Center

    Lucking, Richard; Profiroiu, Marius; Andrei, Tudorel

    2006-01-01

    This paper addresses issues of civil service development, in the context of public administration reform. There are, in the countries of the old and new Europes, a wide variety of approaches to training and development in the public service, and the issues raised here are based on the experience and lessons of the Young Professionals Scheme in…

  5. Multidisciplinary approach to the management of children with female genital mutilation (FGM) or suspected FGM: service description and case series

    PubMed Central

    Creighton, Sarah M; Dear, Joanna; de Campos, Claudia; Williams, Louise; Hodes, Deborah

    2016-01-01

    Objective To describe the first dedicated clinic in the UK for children with suspected or confirmed female genital mutilation (FGM) including referral patterns, clinical findings and subsequent management. Design and setting A prospective study of all children seen in a dedicated multidisciplinary FGM clinic for children over a 1-year period. Population Patients aged under 18 years referred for clinical assessment or for a second opinion on Digital Versatile Disc (DVD) images. Methods and main outcome measures Data were collected on reasons for referral, demography, genital examination findings including FGM type, and clinical recommendations. Results 38 children were referred of whom 18 (47%) had confirmed FGM; most frequently type 4 (61%). Social care and police referred 78% of cases. According to UK law FGM had been performed illegally in three cases. Anonymous information given to the police led to the referral of six children, none of whom had had FGM. Conclusions Mandatory reporting and increased media attention may increase the numbers of referrals of children with suspected FGM. This patient group have complex needs and management in a dedicated multidisciplinary service is essential. Paediatricians and gynaecologists should have the skills to carry out the consultation and detect all types of FGM including type 4 which was the most common type seen in this series. This is the first dedicated FGM service for children in the UK and similar clinics in high-prevalence areas should be established. PMID:26928027

  6. Multidisciplinary approach on rehabilitation of primary teeth traumatism repercussion on the permanent successor: 6-year follow-up case report.

    PubMed

    Mello-Moura, A C V; Bonini, G A V C; Suga, S S; Navarro, R S; Wanderley, M T

    2009-01-01

    Traumatic lesions in primary teeth are frequent in pediatric patients and can cause problems both to the deciduous tooth and permanent successor. The impact strength on deciduous tooth can reach the growing permanent tooth, affecting its morphology, structure and position, or even hampering its proper development. This report describes an aesthetic-functional rehabilitation process in an 8 year 10 month old boy during a multidisciplinary treatment held at the Clinical Center of Dental Trauma in Primary Teeth of the Pediatric Dentistry of Dental College of University of São Paulo, Brazil. The patient presented bilateral posterior cross bite and the permanent left upper central incisor with ectopic eruption and enamel hypoplasy, preceded by avulsion of element 61, occurred when the patient was 1.6 years old. After diagnosis and treatment planning, a quick expansion of jaws was recommended with Hass-type rapid expander and orthodontic leveling with fixed braces. Due to the ectopic eruption, the gingival contour had been altered and hypertrophia was found, compromising aesthetics and avoiding local hygienic procedures. Gingivoplasty was carried out with high-intensity Diode Laser, followed by aesthetic restoration with compound resin. It was concluded that after deciduous teeth traumatism it is important that the patient undergoes clinic and radiographic assistance until the permanent teeth erupt so that an adequate multidisciplinary treatment can be offered to the patient.

  7. Radium-223 dichloride: illustrating the benefits of a multidisciplinary approach for patients with metastatic castration-resistant prostate cancer

    PubMed Central

    Renzulli, Joseph F; Collins, Jennifer; Mega, Anthony

    2015-01-01

    Improving options for patients with metastatic castration-resistant prostate cancer (mCRPC) provide latitude in designing treatment plans that meet patients’ medical needs and personal goals. The field’s rapid evolution opens avenues for contributions by multiple medical specialties and requires considering more options to ensure that each patient receives the most appropriate care. A multidisciplinary clinic (MDC) focusing on patients with cancers of the genitourinary tract demonstrates an efficient and cost-effective means of integrating the diverse professional knowledge and skills needed to develop an optimal patient treatment plan. As a guide to establishing an MDC for patients with mCRPC, this article describes the operation of the Genitourinary MDC at The Miriam Hospital in Providence, RI – specifically, the successful incorporation of radium-223 dichloride (radium-223) into the treatment algorithm for men with mCRPC and symptomatic bone metastases. Radium-223 is a new treatment that, unlike earlier radionuclide therapies, has shown a survival advantage in a large randomized phase 3 trial (ALSYMPCA). The overall survival benefit was comparable to that of newer immuno-and hormonal therapies in similar populations. Radium-223 treatment also delayed onset of symptomatic skeletal events. Both benefits were independent of prior docetaxel therapy or concurrent bisphosphonate use. In our clinic, radium-223 is used primarily to extend patient survival. Patient selection, patient management, and treatment sequencing are discussed here in the context of a multidisciplinary environment. PMID:26089679

  8. A personalist approach to public-health ethics.

    PubMed

    Petrini, Carlo; Gainotti, Sabina

    2008-08-01

    First we give an overview of the historical development of public health. Then we present some public-health deontology codes and some ethical principles. We highlight difficulties in defining ethics for public health, with specific reference to three of them that concern: (i) the adaptability to public health of the classical principles of bioethics; (ii) the duty to respect and safeguard the individual while acting within the community perspective that is typical of public health; and (iii) the application-oriented nature of public health and the general lack of attention towards the ethical implications of collective interventions (compared with research). We then mention some proposals drafted from North American bioethics "principles" and utilitarian, liberal and communitarian views. Drawing from other approaches, personalism is outlined as being the theory that offers a consistent set of values and alternative principles that are relevant for public health.

  9. Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach

    PubMed Central

    Jonely, Holly; Brismée, Jean-Michel; Desai, Mehul J; Reoli, Rachel

    2015-01-01

    Background and purpose: Sacroiliac joint pain and dysfunction affect 15–25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. Case description: A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. Outcomes: The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient’s Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient’s rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. Discussion: A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up. PMID:26309378

  10. The role of the Arrhythmia Team, an integrated, multidisciplinary approach to treatment of patients with cardiac arrhythmias: results of the European Heart Rhythm Association survey.

    PubMed

    Fumagalli, Stefano; Chen, Jian; Dobreanu, Dan; Madrid, Antonio Hernandez; Tilz, Roland; Dagres, Nikolaos

    2016-04-01

    Management of patients with cardiac arrhythmias is increasingly complex because of continuous technological advance and multifaceted clinical conditions associated with ageing of the population, the presence of co-morbidities and the need for polypharmacy. The aim of this European Heart Rhythm Association Scientific Initiatives Committee survey was to provide an insight into the role of the Arrhythmia Team, an integrated, multidisciplinary approach to management of patients with cardiac arrhythmias. Forty-eight centres from 18 European countries replied to the Web-based questionnaire. The presence of an Arrhythmia Team was reported by 44% of the respondents, whereas 17% were not familiar with this term. Apart from the electrophysiologist, health professionals who should belong to such teams, according to the majority of the respondents, include a clinical cardiologist, a nurse, a cardiac surgeon, a heart failure specialist, a geneticist, and a geriatrician. Its main activity should be dedicated to the management of patients with complex clinical conditions or refractory or inherited forms of arrhythmias. When present, the Arrhythmia Team was considered helpful by 95% of respondents; the majority of centres (79%) agreed that it should be implemented. The Arrhythmia Team seems to be connected to important expectations in the management of cardiac arrhythmias. The efficacy of such an integrated and multidisciplinary approach should be encouraged and tested in clinical practice.

  11. A multidisciplinary team approach to two-stage revision for the infected hip replacement: a minimum five-year follow-up study.

    PubMed

    Ibrahim, M S; Raja, S; Khan, M A; Haddad, F S

    2014-10-01

    We report the five year outcomes of a two-stage approach for infected total hip replacement. This is a single-surgeon experience at a tertiary centre where the more straightforward cases are treated using single-stage exchange. This study highlights the vital role of the multidisciplinary team in managing these cases. A total of 125 patients (51 male, 74 female) with a mean age of 68 years (42 to 78) were reviewed prospectively. Functional status was assessed using the Harris hip score (HHS). The mean HHS improved from 38 (6 to 78.5) pre-operatively to 81.2 (33 to 98) post-operatively. Staphylococcus species were isolated in 85 patients (68%). The rate of control of infection was 96% at five years. In all, 19 patients died during the period of the study. This represented a one year mortality of 0.8% and an overall mortality of 15.2% at five years. No patients were lost to follow-up. We report excellent control of infection in a series of complex patients and infections using a two-stage revision protocol supported by a multidisciplinary approach. The reason for the high rate of mortality in these patients is not known.

  12. Structure and hydrogeochemical functioning of a sparkling natural mineral water system determined using a multidisciplinary approach: a case study from southern France

    NASA Astrophysics Data System (ADS)

    Maréchal, J. C.; Lachassagne, P.; Ladouche, B.; Dewandel, B.; Lanini, S.; Le Strat, P.; Petelet-Giraud, E.

    2013-12-01

    Natural mineral waters (NMW), often used to produce bottled water, are of high socio-economic interest and need appropriate management to ensure the sustainability of the resource. A complex sparkling NMW system at La Salvetat, southern France, was investigated using a multidisciplinary approach. Geological and geophysical investigations, pumping test analyses, time-series signal processing, hydrogeochemical and isotopic data (both stable and radiogenic), and numerical modelling provided complementary information on the geometry, hydrodynamic characteristics and functioning of this mineral system. The conceptual model consists of a compartmentalized reservoir characterized by two subvertical, parallel deeply rooted hydraulically independent permeable structures that are fed by deep CO2-rich crustal fluids. The non-mineralized shallow aquifer system corresponds to a fissured layer within the weathered zone that is recharged by leakage from the overlying saprolite. This surficial aquifer responds rapidly to recharge (40-80 days), whereas the deep system's response to recharge is much longer (up to 120 days). This research demonstrates the need for multidisciplinary approaches and modelling (quantity, hydrochemistry) for understanding complex NMW systems. This knowledge is already being applied by the bottling company that manages the resource at La Salvetat, and would be useful for conceptualising other NMW sites.

  13. The AFHSC-Division of GEIS Operations Predictive Surveillance Program: a multidisciplinary approach for the early detection and response to disease outbreaks

    PubMed Central

    2011-01-01

    The Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System Operations (AFHSC-GEIS) initiated a coordinated, multidisciplinary program to link data sets and information derived from eco-climatic remote sensing activities, ecologic niche modeling, arthropod vector, animal disease-host/reservoir, and human disease surveillance for febrile illnesses, into a predictive surveillance program that generates advisories and alerts on emerging infectious disease outbreaks. The program’s ultimate goal is pro-active public health practice through pre-event preparedness, prevention and control, and response decision-making and prioritization. This multidisciplinary program is rooted in over 10 years experience in predictive surveillance for Rift Valley fever outbreaks in Eastern Africa. The AFHSC-GEIS Rift Valley fever project is based on the identification and use of disease-emergence critical detection points as reliable signals for increased outbreak risk. The AFHSC-GEIS predictive surveillance program has formalized the Rift Valley fever project into a structured template for extending predictive surveillance capability to other Department of Defense (DoD)-priority vector- and water-borne, and zoonotic diseases and geographic areas. These include leishmaniasis, malaria, and Crimea-Congo and other viral hemorrhagic fevers in Central Asia and Africa, dengue fever in Asia and the Americas, Japanese encephalitis (JE) and chikungunya fever in Asia, and rickettsial and other tick-borne infections in the U.S., Africa and Asia. PMID:21388561

  14. Ethical Issues for Public Health Approaches to Obesity.

    PubMed

    Azevedo, Suzanna M; Vartanian, Lenny R

    2015-09-01

    Obesity is a major public health concern worldwide. Because individual-level interventions have been unsuccessful at curbing obesity rates, there is an emphasis on public health approaches. In addition to testing the effectiveness of any public health interventions, it is important to consider the ethical implications of these interventions in order to protect the public's rights and promote overall well-being. In this paper, we review public health approaches to obesity in three broad domains (changes to the socio-communicative environment, changes to the economic environment, and changes to the physical environment/access) and consider the potential ethical issues that arise in each of those domains. We suggest that interventions that target the physical environment/access (making it easier for people to engage in healthy behaviors), that target the entire population (rather than just individuals with obesity), and that focus on health behaviors (rather than on weight) have the least potential for ethical concerns.

  15. A multidisciplinary environmental integrated approach to better understand the Tegnue Reefs formation, offshore Chioggia, Northern