Living with Multiple Health Problems: What Older Adults Should Know

MedlinePlus

... treatments may take longer than others to show benefits. You should also decide if you want to make all of your care decisions on your own or include others in the decision-making process. These can include spouses, family members, or ...

7 CFR 1437.13 - Multiple benefits.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Multiple benefits. 1437.13 Section 1437.13... General Provisions § 1437.13 Multiple benefits. (a) If a producer is eligible to receive payments under this part and benefits under any other program administered by the Secretary for the same crop loss...

7 CFR 1437.13 - Multiple benefits.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Multiple benefits. 1437.13 Section 1437.13... General Provisions § 1437.13 Multiple benefits. (a) If a producer is eligible to receive payments under this part and benefits under any other program administered by the Secretary for the same crop loss...

7 CFR 1437.13 - Multiple benefits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Multiple benefits. 1437.13 Section 1437.13... General Provisions § 1437.13 Multiple benefits. (a) If a producer is eligible to receive payments under this part and benefits under any other program administered by the Secretary for the same crop loss...

7 CFR 1437.13 - Multiple benefits.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Multiple benefits. 1437.13 Section 1437.13... General Provisions § 1437.13 Multiple benefits. (a) If a producer is eligible to receive payments under this part and benefits under any other program administered by the Secretary for the same crop loss...

7 CFR 1437.13 - Multiple benefits.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Multiple benefits. 1437.13 Section 1437.13... General Provisions § 1437.13 Multiple benefits. (a) If a producer is eligible to receive payments under this part and benefits under any other program administered by the Secretary for the same crop loss...

Multiple Paths to Mathematics Practice in Al-Kashi's Key to Arithmetic

NASA Astrophysics Data System (ADS)

Taani, Osama

2014-01-01

In this paper, I discuss one of the most distinguishing features of Jamshid al-Kashi's pedagogy from his Key to Arithmetic, a well-known Arabic mathematics textbook from the fifteenth century. This feature is the multiple paths that he includes to find a desired result. In the first section light is shed on al-Kashi's life and his contributions to mathematics and astronomy. Section 2 starts with a brief discussion of the contents and pedagogy of the Key to Arithmetic. Al-Kashi's multiple approaches are discussed through four different examples of his versatility in presenting a topic from multiple perspectives. These examples are multiple definitions, multiple algorithms, multiple formulas, and multiple methods for solving word problems. Section 3 is devoted to some benefits that can be gained by implementing al-Kashi's multiple paths approach in modern curricula. For this discussion, examples from two teaching modules taken from the Key to Arithmetic and implemented in Pre-Calculus and mathematics courses for preservice teachers are discussed. Also, the conclusions are supported by some aspects of these modules. This paper is an attempt to help mathematics educators explore more benefits from reading from original sources.

Assessing the Multiple Benefits of Clean Energy Chapter 1: Introduction

EPA Pesticide Factsheets

Chapter 1 of “Assessing the Multiple Benefits of Clean Energy” provides an introduction to the document. /meta name=DC.title content=Assessing the Multiple Benefits of Clean Energy Chapter 1: Introduction

Health Of Americans Who Must Work Longer To Reach Social Security Retirement Age.

PubMed

Choi, HwaJung; Schoeni, Robert F

2017-10-01

To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49-60, based on multiple measures of morbidity, than cohorts who could retire earlier. Project HOPE—The People-to-People Health Foundation, Inc.

Emerging growth factor receptor antagonists for the treatment of renal cell carcinoma.

PubMed

Zahoor, Haris; Rini, Brian I

2016-12-01

The landscape of systemic treatment for metastatic renal cell carcinoma (RCC) has dramatically changed with the introduction of targeted agents including vascular endothelial growth factor (VEGF) inhibitors. Recently, multiple new agents including growth factor receptor antagonists and a checkpoint inhibitor were approved for the treatment of refractory metastatic RCC based on encouraging benefit shown in clinical trials. Areas covered: The background and biological rationale of existing treatment options including a brief discussion of clinical trials which led to their approval, is presented. This is followed by reviewing the limitations of these therapeutic options, medical need to develop new treatments and major goals of ongoing research. We then discuss two recently approved growth factor receptor antagonists i.e. cabozantinib and lenvatinib, and a recently approved checkpoint inhibitor, nivolumab, and issues pertaining to drug development, and future directions in treatment of metastatic RCC. Expert opinion: Recently approved growth factor receptor antagonists have shown encouraging survival benefit but associated drug toxicity is a major issue. Nivolumab, a programmed death 1 (PD-1) checkpoint inhibitor, has similarly shown survival benefit and is well tolerated. With multiple options now available in this patient population, the right sequence of these agents remains to be determined.

Conceptual Green Infrastructure Design for Washington Street, City of Sanford

EPA Pesticide Factsheets

Summary of the Sanford Mill Yard Complex presents an opportunity to include green infrastructure practices in a land redevelopment initiative with relative ease while providing multiple benefits to the surrounding community.

New opportunities of real-world data from clinical routine settings in life-cycle management of drugs: example of an integrative approach in multiple sclerosis.

PubMed

Rothenbacher, Dietrich; Capkun, Gorana; Uenal, Hatice; Tumani, Hayrettin; Geissbühler, Yvonne; Tilson, Hugh

2015-05-01

The assessment and demonstration of a positive benefit-risk balance of a drug is a life-long process and includes specific data from preclinical, clinical development and post-launch experience. However, new integrative approaches are needed to enrich evidence from clinical trials and sponsor-initiated observational studies with information from multiple additional sources, including registry information and other existing observational data and, more recently, health-related administrative claims and medical records databases. To illustrate the value of this approach, this paper exemplifies such a cross-package approach to the area of multiple sclerosis, exploring also possible analytic strategies when using these multiple sources of information.

Concept of multiple-cell cavity for axion dark matter search

NASA Astrophysics Data System (ADS)

Jeong, Junu; Youn, SungWoo; Ahn, Saebyeok; Kim, Jihn E.; Semertzidis, Yannis K.

2018-02-01

In cavity-based axion dark matter search experiments exploring high mass regions, multiple-cavity design is under consideration as a method to increase the detection volume within a given magnet bore. We introduce a new idea, referred to as a multiple-cell cavity, which provides various benefits including a larger detection volume, simpler experimental setup, and easier phase-matching mechanism. We present the characteristics of this concept and demonstrate the experimental feasibility with an example of a double-cell cavity.

20 CFR 345.403 - Multiple base year employers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Multiple base year employers. 345.403 Section... INSURANCE ACT EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Benefit Charging § 345.403 Multiple base... than one base year employer shall be charged to the cumulative benefit balances of such employers, as...

20 CFR 345.403 - Multiple base year employers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Multiple base year employers. 345.403 Section... INSURANCE ACT EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Benefit Charging § 345.403 Multiple base... than one base year employer shall be charged to the cumulative benefit balances of such employers, as...

20 CFR 345.403 - Multiple base year employers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Multiple base year employers. 345.403 Section... INSURANCE ACT EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Benefit Charging § 345.403 Multiple base... than one base year employer shall be charged to the cumulative benefit balances of such employers, as...

20 CFR 345.403 - Multiple base year employers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Multiple base year employers. 345.403 Section... INSURANCE ACT EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Benefit Charging § 345.403 Multiple base... than one base year employer shall be charged to the cumulative benefit balances of such employers, as...

An Energy Storage Assessment: Using Optimal Control Strategies to Capture Multiple Services

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

Wu, Di; Jin, Chunlian; Balducci, Patrick J.

2015-09-01

This paper presents a methodology for evaluating benefits of battery storage for multiple grid applications, including energy arbitrage, balancing service, capacity value, distribution system equipment deferral, and outage mitigation. In the proposed method, at each hour, a look-ahead optimization is first formulated and solved to determine battery base operating point. The minute by minute simulation is then performed to simulate the actual battery operation. This methodology is used to assess energy storage alternatives in Puget Sound Energy System. Different battery storage candidates are simulated for a period of one year to assess different value streams and overall benefits, as partmore » of a financial feasibility evaluation of battery storage projects.« less

Higher levels of multiple ecosystem services are found in forests with more tree species

PubMed Central

Gamfeldt, Lars; Snäll, Tord; Bagchi, Robert; Jonsson, Micael; Gustafsson, Lena; Kjellander, Petter; Ruiz-Jaen, María C.; Fröberg, Mats; Stendahl, Johan; Philipson, Christopher D.; Mikusiński, Grzegorz; Andersson, Erik; Westerlund, Bertil; Andrén, Henrik; Moberg, Fredrik; Moen, Jon; Bengtsson, Jan

2013-01-01

Forests are of major importance to human society, contributing several crucial ecosystem services. Biodiversity is suggested to positively influence multiple services but evidence from natural systems at scales relevant to management is scarce. Here, across a scale of 400,000 km2, we report that tree species richness in production forests shows positive to positively hump-shaped relationships with multiple ecosystem services. These include production of tree biomass, soil carbon storage, berry production and game production potential. For example, biomass production was approximately 50% greater with five than with one tree species. In addition, we show positive relationships between tree species richness and proxies for other biodiversity components. Importantly, no single tree species was able to promote all services, and some services were negatively correlated to each other. Management of production forests will therefore benefit from considering multiple tree species to sustain the full range of benefits that the society obtains from forests. PMID:23299890

CDP-choline as a biological supplement during neurorecovery: a focused review.

PubMed

Arenth, Patricia M; Russell, Kathryn C; Ricker, Joseph H; Zafonte, Ross D

2011-06-01

Cytidine 5'-diphosphocholine (CDP-choline or citicoline) is a highly bioavailable compound with potential benefits for aiding neural repair and increasing acetylcholine levels in the central and peripheral nervous system. As a result, many researchers have investigated the use of CDP-choline for various types of neurological insult or conditions, including stroke, traumatic brain injury, and Alzheimer disease. Despite the fact that the safety of the compound has been verified across multiple international studies, evidence for efficacy remains less clear. This may be attributable, at least in part, to several issues, including a lack of randomized clinical trials, a lack of availability of the compound in the United States, and statistical power issues in reported trials. In addition, the fact that CDP-choline has multiple potential points of therapeutic impact makes it an exciting treatment option in theory but also complicates the analysis of efficacy in the sense that multiple mechanisms and time points must be evaluated. Although some clinical conditions do not appear to benefit from CDP-choline treatment, the majority of findings to date have suggested at least minor benefits of treatment. In this review we will examine the evidence in the published literature pertaining to use of CDP-choline in rehabilitation populations and briefly consider the work yet to be done. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Key Steps in the Special Review Process

EPA Pesticide Factsheets

EPA uses this process when it has reason to believe that the use of a pesticide may result in unreasonable adverse effects on people or the environment. Steps include comprehensive risk and benefit analyses and multiple Position Documents.

A Grounded Theory of Sexual Minority Women and Transgender Individuals' Social Justice Activism.

PubMed

Hagen, Whitney B; Hoover, Stephanie M; Morrow, Susan L

2018-01-01

Psychosocial benefits of activism include increased empowerment, social connectedness, and resilience. Yet sexual minority women (SMW) and transgender individuals with multiple oppressed statuses and identities are especially prone to oppression-based experiences, even within minority activist communities. This study sought to develop an empirical model to explain the diverse meanings of social justice activism situated in SMW and transgender individuals' social identities, values, and experiences of oppression and privilege. Using a grounded theory design, 20 SMW and transgender individuals participated in initial, follow-up, and feedback interviews. The most frequent demographic identities were queer or bisexual, White, middle-class women with advanced degrees. The results indicated that social justice activism was intensely relational, replete with multiple benefits, yet rife with experiences of oppression from within and outside of activist communities. The empirically derived model shows the complexity of SMW and transgender individuals' experiences, meanings, and benefits of social justice activism.

Including Students with Severe, Multiple Disabilities in General Physical Education

ERIC Educational Resources Information Center

Block, Martin E.; Klavina, Aija; Flint, Wayne

2007-01-01

Many children with severe disabilities never have the opportunity to try general physical education (GPE) because their Individualized Education Program (IEP) team feels that they will not be successful, will not benefit, or will not be safe. However, there are ways to safely, successfully, and meaningfully include children with severe…

Sustaining flows of crucial watershed resources

Treesearch

J. E. de Steiguer

2000-01-01

Watersheds are the source of a number of resources which are of benefit to society. These resources include water, timber, grazing, recreation, wildlife and others, often described as multiple-use resources. In addition, however, watersheds also produce a number of less tangible resources and uses, which are also socially important. These include amenity, option values...

The course of work absenteeism involving neck pain: a cohort study of Ontario lost-time claimants.

PubMed

Van Eerd, Dwayne; Côté, Pierre; Kristman, Vicki; Rezai, Mana; Hogg-Johnson, Sheilah; Vidmar, Marjan; Beaton, Dorcas

2011-05-20

Cohort study. To describe the course of lost-time claims involving neck pain in workers compensated by the Ontario Workplace Safety and Insurance Board (WSIB). The prevalence of neck pain in workers varies from 27.1% to 47.8%. Very little is known about the course of work absenteeism related to neck pain. Our cohort included 5761 injured workers with an incident lost-time claim to the WSIB in 1997 and 1998. Claimants were followed for 2 years. We measured the cumulative time on lost-time benefits using the Kaplan-Meier method and described the number and duration of episodes on benefits. The median cumulative time-on-benefits for the cohort was 13 days (95% CI: 13-14). The cumulative time on benefits was shorter for men than women and for younger than older workers. 14.2% of claimants experienced multiple episodes of work absenteeism during the 2 years after the initial claim. The median time on benefits for claimants with a single episode was 11 days (95% CI: 10-11). The median length of the first episode on benefits was longer for claimants with multiple episodes (19-22 days) compared with those with a single episode (11 days). Age was positively associated with longer time-on-benefits in claimants with a single episode of work absenteeism. Most injured workers who make a workers' compensation claim that involves neck pain do not make a second claim in the subsequent 2 years. However, an important minority (14.2%) experience multiple episodes of work absenteeism and these workers accrue 40.4% of all lost-time days. Recurrent claims involving neck pain represent a significant burden of disability in Ontario.

Which experimental systems should we use for human microbiome science?

PubMed

Douglas, Angela E

2018-03-01

Microbiome science is revealing that the phenotype and health of animals, including humans, depend on the sustained function of their resident microorganisms. In this essay, I argue for thoughtful choice of model systems for human microbiome science. A greater variety of experimental systems, including wider use of invertebrate models, would benefit biomedical research, while systems ill-suited to experimental and genetic manipulation can be used to address very limited sets of scientific questions. Microbiome science benefits from the coordinated use of multiple systems, which is facilitated by networks of researchers with expertise in different experimental systems.

Polyandry promotes enhanced offspring survival in decorated crickets.

PubMed

Ivy, Tracie M; Sakaluk, Scott K

2005-01-01

Although female multiple mating is ubiquitous in insects, its adaptive significance remains poorly understood. Benefits to multiple mating can accrue via direct material benefits, indirect genetic benefits, or both. We investigated the effects of multiple mating in the decorated cricket, Gryllodes sigillatus, by simultaneously varying the number of times that females mated and the number of different males with which they mated, measuring aspects of female fecundity and elements of offspring performance and viability. Multiple matings resulted in enhanced female fitness relative to single matings when females mated with different partners, but not when females mated repeatedly with the same male. Specifically, polyandrous females produced significantly more offspring surviving to reproductive maturity than did monogamous females mating once or mating repeatedly with the same male. These results suggest that the benefit females gain from multiple mating is influenced primarily by genetic and not material benefits.

Understanding the positive benefit:risk profile of alemtuzumab in relapsing multiple sclerosis: perspectives from the Alemtuzumab Clinical Development Program.

PubMed

Havrdova, Eva; Cohen, Jeffrey A; Horakova, Dana; Kovarova, Ivana; Meluzinova, Eva

2017-01-01

The introduction of high-efficacy therapies for relapsing-remitting multiple sclerosis has driven re-evaluation of treatment goals and benefit:risk considerations in treatment choice. In the alemtuzumab Phase II and III clinical trials, patients treated with alemtuzumab 12 mg versus subcutaneous interferon beta-1a demonstrated significantly reduced annualized relapse rates and improved magnetic resonance imaging outcomes, and were significantly more likely to achieve no evidence of disease activity and reduction in brain volume loss. In two of the studies, alemtuzumab-treated patients had a significantly reduced risk of 6-month confirmed disease worsening, compared with subcutaneous interferon beta-1a. Benefits were maintained throughout 5 years, with a majority of patients receiving no alemtuzumab retreatment or other disease-modifying therapy. Trial results support alemtuzumab's manageable, consistent safety profile in relapsing-remitting multiple sclerosis. Infusion-associated reactions, the most frequent adverse events (AEs), can be minimized by corticosteroid pretreatment, monitoring, and symptomatic management. Other AEs include infections and autoimmune events. Oral anti-herpes prophylaxis should be initiated on the first day of each alemtuzumab treatment course and continued according to local guidelines. Overall cancer risk was lower in the alemtuzumab clinical trials than in a reference population; however, continuing surveillance will determine if alemtuzumab may be associated with certain malignancies such as thyroid papillary carcinoma and melanoma, which are currently identified as potential risks. The post-approval risk management strategy includes a safety monitoring program. Autoimmune AEs (thyroid events, immune thrombocytopenia, nephropathies) can be detected in a timely manner with the monitoring program, which includes physician and patient education about the signs and symptoms, monthly renal and hematologic monitoring, and quarterly thyroid function monitoring for 48 months after the last alemtuzumab course. Education, vigilance by physicians and patients, and monthly laboratory monitoring are recommended to maintain alemtuzumab's positive benefit:risk profile.

Evidence for Near-Road Air Pollution Abatement by Tree Cover

EPA Science Inventory

Urbanized areas represent concentrated demand for ecosystem services to buffer hazards and promote healthful lifestyles. Urban tree cover has been linked to multiple local health benefits including clean air and water, flood and drought protection, heat mitigation, and opportuni...

Using Gaming To Help Nursing Students Understand Ethics.

ERIC Educational Resources Information Center

Metcalf, Barbara L.; Yankou, Dawn

2003-01-01

An ethics game involves nursing students in defending actions in ethics-based scenarios. Benefits include increased confidence, ability to see multiple perspectives, values clarification, and exposure to decision-making models, professional responsibilities, ethical principles, social expectations, and legal requirements. Difficulties include…

The Science of Serious Gaming: Exploring the Benefits of Science-Based Games in the Classroom

NASA Astrophysics Data System (ADS)

Kurtz, N.

2016-02-01

Finding ways to connect scientists with the classroom is an important part of sharing enthusiasm for science with the public. Utilizing the visual arts and serious gaming techniques has benefits for all participants including the engagement of multiple learning sectors and the involvement of whole-brain teaching methods. The activities in this presentation draw from real-world events that require higher level thinking strategies to discover and differential naturally occurring patterns.

Benefit transfer protocol for long-term health risk valuation: A case of surface water contamination

NASA Astrophysics Data System (ADS)

Kask, Susan B.; Shogren, Jason F.

1994-10-01

In response to scarce financial resources, economists have promoted the concept of benefit transfer as a cost-effective alternative to new nonmarket valuation studies. Recent discussion on benefit transfer for improved water quality has focused on recreational benefits. While useful, the discussion must now be expanded to include another key benefit from improved water quality: the reduction in risk to public health. This paper develops a protocol for benefit transfer of long-term health risk reduction and presents a case study for surface water contamination. Challenges such as the multiple sources of risk, the mortality and morbidity effects indicated by a variety of symptoms, the long latency period between cause and effect, and an individual's ability to privately or collectively reduce the probability or severity of the risk are discussed.

Slum Upgrading and Health Equity.

PubMed

Corburn, Jason; Sverdlik, Alice

2017-03-24

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Slum Upgrading and Health Equity

PubMed Central

Corburn, Jason; Sverdlik, Alice

2017-01-01

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits. PMID:28338613

Valuing the benefits of improved marine environmental quality under multiple stressors.

PubMed

Tuhkanen, Heidi; Piirsalu, Evelin; Nõmmann, Tea; Karlõševa, Aljona; Nõmmann, Sulev; Czajkowski, Mikołaj; Hanley, Nick

2016-05-01

Many marine ecosystems are under increasing pressure from multiple stressors. In the Baltic Sea, these stressors include oil and chemical spills from shipping, nutrient run-off from land and the introduction of non-indigenous species. All of these pressures have been growing over recent years. Increasing pressures lead to reductions in environmental quality, which produce negative effects on human well-being. In this paper, the choice experiment method is used to estimate the benefits to people in Estonia resulting from reductions in pressure from multiple stressors in the Baltic Sea. The main results show that, firstly, respondents have a positive, statistically-significant willingness to pay to reduce each of the three stressors analysed. Secondly, the average willingness to pay for the improvement in the quality of all Estonian marine waters to achieve Good Environmental Status is around 65 euro per household per year, with a 95% confidence interval of 48-77 euro. Thirdly, the greatest share of value of this total economic benefit is derived from the willingness to pay for reductions in the risk of large scale oil and chemical spills. Copyright © 2016 Elsevier B.V. All rights reserved.

Ten years of helicopter emergency medical services in Germany: do we still need the helicopter rescue in multiple traumatised patients?

PubMed

Andruszkow, Hagen; Hildebrand, Frank; Lefering, Rolf; Pape, Hans-Christoph; Hoffmann, Reinhard; Schweigkofler, Uwe

2014-10-01

Helicopter emergency medical service (HEMS) has been established in the preclinical treatment of multiple traumatised patients despite an ongoing controversy towards the potential benefit. Celebrating the 20th anniversary of TraumaRegister DGU(®) of the German Trauma Society (DGU) the presented study intended to provide an overview of HEMS rescue in Germany over the last 10 years analysing the potential beneficial impact of a nationwide helicopter rescue in multiple traumatised patients. We analysed TraumaRegister DGU(®) including multiple traumatised patients (ISS ≥ 16) between 2002 and 2012. In-hospital mortality was defined as main outcome. An adjusted, multivariate regression with 13 confounders was performed to evaluate the potential survival benefit. 42,788 patients were included in the present study. 14,275 (33.4%) patients were rescued by HEMS and 28,513 (66.6%) by GEMS. Overall, 66.8% (n=28,569) patients were transported to a level I trauma centre and 28.2% (n=12,052) to a level II trauma centre. Patients rescued by HEMS sustained a higher injury severity compared to GEMS (ISS HEMS: 29.5 ± 12.6 vs. 27.5 ± 11.8). Helicopter rescue teams performed more on-scene interventions, and mission times were increased in HEMS rescue (HEMS: 77.2 ± 28.7 min. vs. GEMS: 60.9 ± 26.9 min.). Linear regression analysis revealed that the frequency of HEMS rescue has decreased significantly between 2002 and 2012. In case of transportation to level I trauma centres a decrease of 1.7% per year was noted (p<0.001) while a decline of 1.6% per year (p<0.001) was measured for level II trauma centre admissions. According to multivariate logistic regression HEMS was proven a positive independent survival predictor between 2002 and 2012 (OR 0.863; 95%-CI 0.800-0.930; Nagelkerkes-R(2) 0.539) with only little differences between each year. This study was able to prove an independent survival benefit of HEMS in multiple traumatised patients during the last 10 years. Despite this fact, a constant decline of HEMS rescue missions was found in multiple trauma patients due to unknown reasons. We concluded that HEMS should be used more often in case of trauma in order to guarantee the proven benefit for multiple traumatised patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Business Planning for Parenthood.

ERIC Educational Resources Information Center

Spruell, Geraldine

1986-01-01

With more mothers than ever in the labor force, companies are realizing they must help workers deal with multiple roles. Employer-sponsored programs include day care centers, vouchers, and referrals; flextime; job sharing; extended leave, flexible benefits, and work-at-home plans; and support groups. (CH)

Preschool-Based Programs for Externalizing Problems

ERIC Educational Resources Information Center

Arnold, David H.; Brown, Sharice A.; Meagher, Susan; Baker, Courtney N.; Dobbs, Jennifer; Doctoroff, Greta L.

2006-01-01

Few mental health initiatives for young children have used classroom programs. Preschool-based efforts targeting externalizing behavior could help prevent conduct disorders. Additional benefits may include improved academic achievement and reduced risk for other mental health difficulties. Pro-grams that target multiple developmental domains are…

What happens to soil ecological properties when conservation reserve program land is disturbed

USDA-ARS?s Scientific Manuscript database

Each year, expiring Conservation Reserve Program (CRP) contracts results in the conversion of restored CRP land back to croplands, potentially reversing multiple ecological benefits including C sequestration potential and microbial biodiversity. We evaluated microbial community composition (fatty ac...

In search of real autonomy for fertility patients.

PubMed

Johnston, Josephine; Gusmano, Michael K; Patrizio, Pasquale

2015-07-01

Nearly one in eight infants in the United States is born preterm. A variety of factors are associated with preterm birth, including multiplicity. In the United States fertility treatments are currently associated with high rates of multiplicity, but these rates could be reduced significantly if changes can be made to fertility treatment policy and practice. These include reducing the financial pressure on patients to prioritize pregnancy chances over safety by expanding insurance coverage and altering the way we calculate success rates and insurance benefits so that two consecutive single embryo transfers is equivalent to one double embryo transfer.

Med Diet 4.0: the Mediterranean diet with four sustainable benefits.

PubMed

Dernini, S; Berry, E M; Serra-Majem, L; La Vecchia, C; Capone, R; Medina, F X; Aranceta-Bartrina, J; Belahsen, R; Burlingame, B; Calabrese, G; Corella, D; Donini, L M; Lairon, D; Meybeck, A; Pekcan, A G; Piscopo, S; Yngve, A; Trichopoulou, A

2017-05-01

To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns. A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined. The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet. By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

Three methods for integration of environmental risk into the benefit-risk assessment of veterinary medicinal products.

PubMed

Chapman, Jennifer L; Porsch, Lucas; Vidaurre, Rodrigo; Backhaus, Thomas; Sinclair, Chris; Jones, Glyn; Boxall, Alistair B A

2017-12-15

Veterinary medicinal products (VMPs) require, as part of the European Union (EU) authorization process, consideration of both risks and benefits. Uses of VMPs have multiple risks (e.g., risks to the animal being treated, to the person administering the VMP) including risks to the environment. Environmental risks are not directly comparable to therapeutic benefits; there is no standardized approach to compare both environmental risks and therapeutic benefits. We have developed three methods for communicating and comparing therapeutic benefits and environmental risks for the benefit-risk assessment that supports the EU authorization process. Two of these methods support independent product evaluation (i.e., a summative classification and a visual scoring matrix classification); the other supports a comparative evaluation between alternative products (i.e., a comparative classification). The methods and the challenges to implementing a benefit-risk assessment including environmental risk are presented herein; how these concepts would work in current policy is discussed. Adaptability to scientific and policy development is considered. This work is an initial step in the development of a standardized methodology for integrated decision-making for VMPs. Copyright © 2017 Elsevier B.V. All rights reserved.

Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis.

PubMed

Thomas, Katja; Proschmann, Undine; Ziemssen, Tjalf

2017-10-01

Fingolimod was the first oral and the first in class disease modifying treatment in multiple sclerosis that acts as sphingosine-1-phospathe receptor agonist. Since approval in 2010 there is a growing experience with fingolimod use in clinical practice, but also next-generation sphingosin-1-receptor agonists in ongoing clinical trials. Growing evidence demonstrates additional effects beyond impact on lymphocyte circulation, highlighting further promising targets in multiple sclerosis therapy. Areas covered: Here we present a systematic review using PubMed database searching and expert opinion on fingolimod use in clinical practice. Long-term data of initial clinical trials and post-marketing evaluations including long-term efficacy, safety, tolerability and management especially within growing disease modifying treatment options and pre-treatment constellation in multiple sclerosis patients are critically discussed. Furthermore novel findings in mechanism of actions and prospective on additional use in progressive forms in multiple sclerosis are presented. Expert opinion: There is an extensive long-term experience on fingolimod use in clinical practice demonstrating the favorable benefit-risk of this drug. Using a defined risk management approach experienced MS clinicians should apply fingolimod after critical choice of patients and review of clinical aspects. Further studies are essential to discuss additional benefit in progressive forms in multiple sclerosis.

Collaborative Orthopaedic Research Between and Within Institutions.

PubMed

Wolf, Brian R; Verma, Nikhil N; Spindler, Kurt P; Wright, Rick W

2017-02-15

Collaborative research is common in many medical disciplines; however, the field of orthopaedics has been relatively slow to adopt this type of research approach. Collaborative research efforts can occur between multiple institutions and, in some instances, may benefit from subspecialty society sponsorship. Collaborative research efforts between several research spheres within a single institution also can be advantageous. Collaborative research has many benefits, including a larger number of patients in studies, more power in the research, and better generalizability. In addition, collaborative research efforts allow resources to be pooled within and between institutions. The challenges of collaborative research include data management, funding, and the publication of manuscripts that have many authors.

Impact of cover crops on soil nitrate, crop yield and quality

USDA-ARS?s Scientific Manuscript database

There are multiple benefits of incorporating cover crops into current production systems including decreasing erosion, improving water infiltration, increasing soil organic matter and biological activity but in water limited areas caution should be utilized. A field study was established in the fal...

Biotechnological advances in the genetic improvement of Prunus domestica

USDA-ARS?s Scientific Manuscript database

Plum producers world-wide are facing multiple challenges including climate change, reductions in available labor, the need for reduced chemical inputs, the spread of native and exotic pests and pathogens, and consumer demands for improved fruit quality and health benefits. Meeting these challenges ...

Multi-scale monitoring for improved nutrient management

USDA-ARS?s Scientific Manuscript database

In many watersheds, monitoring at the outlet of small watersheds has not been able to demonstrate that conservation efforts have had any impact on stream water quality. Reasons are multiple including legacy issues, time for the conservation practices to have any benefit, temporal variability of weat...

Why we should build a Moon Village

NASA Astrophysics Data System (ADS)

Crawford, Ian A.

2017-12-01

A human-robotic "Moon Village" would offer significant scientific opportunities by providing an infrastructure on the lunar surface. An analogy would be the way in which human outposts in Antarctica facilitate research activities across multiple scientific disciplines on that continent. Scientific fields expected to benefit from a Moon Village will include: planetary science, astronomy, astrobiology, life sciences, and fundamental physics. In addition, a Moon Village will help develop the use of lunar resources, which will yield additional longer-term scientific benefits.

Local action on outdoor air pollution to improve public health.

PubMed

Vardoulakis, Sotiris; Kettle, Rachel; Cosford, Paul; Lincoln, Paul; Holgate, Stephen; Grigg, Jonathan; Kelly, Frank; Pencheon, David

2018-06-01

The National Institute for Health and Care Excellence, jointly with Public Health England, have developed a guideline on outdoor air pollution and its links to health. The guideline makes recommendations on local interventions that can help improve air quality and prevent a range of adverse health outcomes associated with road-traffic-related air pollution. The guideline was based on a rigorous assessment of the scientific evidence by an independent advisory committee, with input from public health professionals and other professional groups. The process included systematics reviews of the literature, expert testimonies and stakeholder consultation. The guideline includes recommendations for local planning, clean air zones, measures to reduce emissions from public sector transport services, smooth driving and speed reduction, active travel, and awareness raising. The guideline recommends taking a number of actions in combination, because multiple interventions, each producing a small benefit, are likely to act cumulatively to produce significant change. These actions are likely to bring multiple public health benefits, in addition to air quality improvements.

The road to treating smoldering multiple myeloma.

PubMed

Korde, Neha; Mailankody, Sham; Landgren, Ola

2014-09-01

The management of smoldering multiple myeloma (SMM) has been a challenge to clinicians, ever since the condition was first characterized in 1980. While the risk of progression to symptomatic myeloma is greater for SMM (10% per year) compared to MGUS (1% per year), several SMM patients remain asymptomatic for years without evidence of disease progression. Early clinical trials focusing on early treatment of SMM have been equivocal with no clear benefit. However, the last decade has seen a greater understanding of the pathogenesis of plasma cell disorders, including SMM, and development of better therapeutics. A recent randomized trial has provided evidence of clinical benefit with early treatment of high-risk SMM. In this review, we summarize issues related to the early treatment of SMM including risk stratification and possible outcomes with therapy initiation. In the context of reviewing recent clinical trial data supporting early treatment, we define challenges faced by clinicians and provide future directions to the road to treating SMM. Published by Elsevier Inc.

Benefit-Risk Analysis for Decision-Making: An Approach.

PubMed

Raju, G K; Gurumurthi, K; Domike, R

2016-12-01

The analysis of benefit and risk is an important aspect of decision-making throughout the drug lifecycle. In this work, the use of a benefit-risk analysis approach to support decision-making was explored. The proposed approach builds on the qualitative US Food and Drug Administration (FDA) approach to include a more explicit analysis based on international standards and guidance that enables aggregation and comparison of benefit and risk on a common basis and a lifecycle focus. The approach is demonstrated on six decisions over the lifecycle (e.g., accelerated approval, withdrawal, and traditional approval) using two case studies: natalizumab for multiple sclerosis (MS) and bedaquiline for multidrug-resistant tuberculosis (MDR-TB). © 2016 American Society for Clinical Pharmacology and Therapeutics.

Valuation of Electric Power System Services and Technologies

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

Kintner-Meyer, Michael C. W.; Homer, Juliet S.; Balducci, Patrick J.

Accurate valuation of existing and new technologies and grid services has been recognized to be important to stimulate investment in grid modernization. Clear, transparent, and accepted methods for estimating the total value (i.e., total benefits minus cost) of grid technologies and services are necessary for decision makers to make informed decisions. This applies to home owners interested in distributed energy technologies, as well as to service providers offering new demand response services, and utility executives evaluating best investment strategies to meet their service obligation. However, current valuation methods lack consistency, methodological rigor, and often the capabilities to identify and quantifymore » multiple benefits of grid assets or new and innovative services. Distributed grid assets often have multiple benefits that are difficult to quantify because of the locational context in which they operate. The value is temporally, operationally, and spatially specific. It varies widely by distribution systems, transmission network topology, and the composition of the generation mix. The Electric Power Research Institute (EPRI) recently established a benefit-cost framework that proposes a process for estimating multiple benefits of distributed energy resources (DERs) and the associated cost. This document proposes an extension of this endeavor that offers a generalizable framework for valuation that quantifies the broad set of values for a wide range of technologies (including energy efficiency options, distributed resources, transmission, and generation) as well as policy options that affect all aspects of the entire generation and delivery system of the electricity infrastructure. The extension includes a comprehensive valuation framework of monetizable and non-monetizable benefits of new technologies and services beyond the traditional reliability objectives. The benefits are characterized into the following categories: sustainability, affordability, and security, flexibility, and resilience. This document defines the elements of a generic valuation framework and process as well as system properties and metrics by which value streams can be derived. The valuation process can be applied to determine the value on the margin of incremental system changes. This process is typically performed when estimating the value of a particular project (e.g., value of a merchant generator, or a distributed photovoltaic (PV) rooftop installation). Alternatively, the framework can be used when a widespread change in the grid operation, generation mix, or transmission topology is to be valued. In this case a comprehensive system analysis is required.« less

Sport Activity for Health!! The Effects of Karate Participants' Involvement, Perceived Value, and Leisure Benefits on Recommendation Intention.

PubMed

Chang, Ying-Chih; Yeh, Tsu-Ming; Pai, Fan-Yun; Huang, Tai-Peng

2018-05-10

This study intends to discuss the effects of participants’ involvement, perceived value, and leisure benefits on recommendation intention in the sport of karate. The questionnaires were collected online by karate clubs on Facebook and included 369 valid participants. The research findings show that karate participants from different places of residence do not display significant differences in involvement, perceived value, leisure benefits, and recommendation intention. Furthermore, “attraction” in the involvement category reveals the highest mean, “paid spirit and energy being worthy” in perceived value appears as the highest mean, and “physiological benefits” in leisure benefits shows the highest mean. The Pearson correlation analysis result presents significant strong positive correlations between involvement, perceived value, leisure benefits, and recommendation intention. Finally, multiple regression analysis reveals that leisure benefits, except “physiological benefits”, show notably positive effects on recommendation intention. According to the research results, suggestions are proposed for the reference of karate teaching business managers, participants, and future research.

Exercising away the blues: can it help multiple sclerosis-related depression?

PubMed

Feinstein, Anthony; Rector, Neil; Motl, Robert

2013-12-01

The present review focuses on exercise as a treatment for depression in multiple sclerosis. While exercise has emerged as a potentially useful treatment in the general psychiatry-depression literature, the findings from a small number of multiple sclerosis-related treatment trials are equivocal. Methodological limitations, including the absence of depression as a primary endpoint, characterize all the studies completed to date. Given that limitations in study design can be rectified, it is time to put exercise to the test once more. Depressed multiple sclerosis patients and those involved in their care are looking for guidance here because the prevailing zeitgeist promotes the benefits of exercise to mood. But first, some clarity is needed.

Buffer$--An Economic Analysis Tool

Treesearch

Gary Bentrup

2007-01-01

Buffer$ is an economic spreadsheet tool for analyzing the cost-benefits of conservation buffers by resource professionals. Conservation buffers are linear strips of vegetation managed for multiple landowner and societal objectives. The Microsoft Excel based spreadsheet can calculate potential income derived from a buffer, including income from cost-share/incentive...

Advances in the genetic improvement of Prunus domestica utilizing genetic engineering

USDA-ARS?s Scientific Manuscript database

Plum producers world-wide are facing multiple challenges including climate change, reductions in available labor, the need for reduced chemical inputs, the spread of native and exotic pests and pathogens, and consumer demands for improved fruit quality and health benefits. Meeting these challenges ...

"Men Are in Front at Eating Time, but Not When It Comes to Rearing the Chicken": Unpacking the Gendered Benefits and Costs of Livestock Ownership in Kenya.

PubMed

Dumas, Sarah E; Maranga, Abena; Mbullo, Patrick; Collins, Shalean; Wekesa, Pauline; Onono, Maricianah; Young, Sera L

2018-03-01

Livestock can promote resilience in low-income communities through a number of pathways. Livestock development programs seek to amplify these benefits but often fail to consider the costs to intended beneficiaries or the effect of prevailing gender norms. To explore perceptions of livestock ownership among female smallholder livestock keepers in Nyanza Region, Kenya, and unpack how the distribution of livestock benefits and investments varies by gender within households. We used multiple ethnographic techniques, including Photovoice, a photo-elicitation interview method, focus group discussions, and pile sorts, with female smallholder livestock owners (n = 18) participating in an ongoing cohort study. Transcripts were coded using a combination of a priori constructs and grounded theory. We found that livestock benefited households by providing financial security, food security, social benefits, and human time and labor savings. However, these benefits largely promoted long-term household resilience rather than immediate gains. Livestock ownership also had major costs to household time and labor, which were overwhelmingly borne by women and children. Despite this investment, women had limited livestock ownership rights, decision-making power, control over income, or access to meat. Our findings suggest that livestock ownership requires significant investments of household time and labor, which disproportionately burden women. Prevailing gender inequalities may therefore constrain the net benefit of livestock ownership for many women and their households in some contexts. Livestock development programs must assess both program benefits and costs at multiple levels to ensure that women's participation in livestock production leads to improved individual and household outcomes.

The use of process mapping in healthcare quality improvement projects.

PubMed

Antonacci, Grazia; Reed, Julie E; Lennox, Laura; Barlow, James

2018-05-01

Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

Detection of person borne IEDs using multiple cooperative sensors

NASA Astrophysics Data System (ADS)

MacIntosh, Scott; Deming, Ross; Hansen, Thorkild; Kishan, Neel; Tang, Ling; Shea, Jing; Lang, Stephen

2011-06-01

The use of multiple cooperative sensors for the detection of person borne IEDs is investigated. The purpose of the effort is to evaluate the performance benefits of adding multiple sensor data streams into an aided threat detection algorithm, and a quantitative analysis of which sensor data combinations improve overall detection performance. Testing includes both mannequins and human subjects with simulated suicide bomb devices of various configurations, materials, sizes and metal content. Aided threat recognition algorithms are being developed to test detection performance of individual sensors against combined fused sensors inputs. Sensors investigated include active and passive millimeter wave imaging systems, passive infrared, 3-D profiling sensors and acoustic imaging. The paper describes the experimental set-up and outlines the methodology behind a decision fusion algorithm-based on the concept of a "body model".

A quantitative model of application slow-down in multi-resource shared systems

DOE PAGES

Lim, Seung-Hwan; Kim, Youngjae

2016-12-26

Scheduling multiple jobs onto a platform enhances system utilization by sharing resources. The benefits from higher resource utilization include reduced cost to construct, operate, and maintain a system, which often include energy consumption. Maximizing these benefits comes at a price-resource contention among jobs increases job completion time. In this study, we analyze slow-downs of jobs due to contention for multiple resources in a system; referred to as dilation factor. We observe that multiple-resource contention creates non-linear dilation factors of jobs. From this observation, we establish a general quantitative model for dilation factors of jobs in multi-resource systems. A job ismore » characterized by a vector-valued loading statistics and dilation factors of a job set are given by a quadratic function of their loading vectors. We demonstrate how to systematically characterize a job, maintain the data structure to calculate the dilation factor (loading matrix), and calculate the dilation factor of each job. We validate the accuracy of the model with multiple processes running on a native Linux server, virtualized servers, and with multiple MapReduce workloads co-scheduled in a cluster. Evaluation with measured data shows that the D-factor model has an error margin of less than 16%. We extended the D-factor model to capture the slow-down of applications when multiple identical resources exist such as multi-core environments and multi-disks environments. Finally, validation results of the extended D-factor model with HPC checkpoint applications on the parallel file systems show that D-factor accurately captures the slow down of concurrent applications in such environments.« less

A quantitative model of application slow-down in multi-resource shared systems

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

Lim, Seung-Hwan; Kim, Youngjae

Scheduling multiple jobs onto a platform enhances system utilization by sharing resources. The benefits from higher resource utilization include reduced cost to construct, operate, and maintain a system, which often include energy consumption. Maximizing these benefits comes at a price-resource contention among jobs increases job completion time. In this study, we analyze slow-downs of jobs due to contention for multiple resources in a system; referred to as dilation factor. We observe that multiple-resource contention creates non-linear dilation factors of jobs. From this observation, we establish a general quantitative model for dilation factors of jobs in multi-resource systems. A job ismore » characterized by a vector-valued loading statistics and dilation factors of a job set are given by a quadratic function of their loading vectors. We demonstrate how to systematically characterize a job, maintain the data structure to calculate the dilation factor (loading matrix), and calculate the dilation factor of each job. We validate the accuracy of the model with multiple processes running on a native Linux server, virtualized servers, and with multiple MapReduce workloads co-scheduled in a cluster. Evaluation with measured data shows that the D-factor model has an error margin of less than 16%. We extended the D-factor model to capture the slow-down of applications when multiple identical resources exist such as multi-core environments and multi-disks environments. Finally, validation results of the extended D-factor model with HPC checkpoint applications on the parallel file systems show that D-factor accurately captures the slow down of concurrent applications in such environments.« less

Congruence within the Parent-Teacher Relationship: Associations with Children's Functioning. CYFS Working Paper No. 2012-2

ERIC Educational Resources Information Center

Kim, Elizabeth Moorman; Minke, Kathleen M.; Sheridan, Susan M.; Koziol, Natalie; Ryoo, Ji Hoon; Rispoli, Kristin M.

2012-01-01

Meaningful interactions between families and schools benefit multiple facets of children's functioning including their academic, social, and behavioral adjustment. Positive relationships between parents and teachers predict children's enhanced social-emotional functioning and academic adjustment across time. Studies of parent-teacher relationships…

Helping Young People Engage with Scientists

ERIC Educational Resources Information Center

Leggett, Maggie; Sykes, Kathy

2014-01-01

There can be multiple benefits of scientists engaging with young people, including motivation and inspiration for all involved. But there are risks, particularly if scientists do not consider the interests and needs of young people or listen to what they have to say. We argue that "dialogue" between scientists, young people and teachers…

Useful Pedagogies or Financial Hardships? Interactive Response Technology (Clickers) in the Large College Classroom

ERIC Educational Resources Information Center

Boatright-Horowitz, Su L.

2009-01-01

Interactive response systems "clickers" can provide multiple benefits to the students and faculty who use them, including immediate performance feedback and greater student engagement in learning. My own exploration of this technology has yielded five pedagogically different types of polling questions, specifically measurement of student…

Connecting Children's eCulture to Curriculum: Implications for Educators

ERIC Educational Resources Information Center

Laverick, Deanna M.

2009-01-01

This article discusses the benefits of including "children's eCulture" in school curricula. "Children's eCulture" is the culture of children as it relates to electronics and technology. Integrating children's eCulture into formal learning experiences allows teachers to promote multiple literacies in their students. The article will describe the…

Absorbing Australian Culture through the Exchange Program at RMIT International University in Vietnam

ERIC Educational Resources Information Center

Chi, Nguyen Ho Phuong

2013-01-01

This paper outlines a case study of four Vietnamese students who have just completed their exchange semester at RMIT University, Melbourne. Results indicate that the students appreciate multiple benefits brought by this experience, including a developing sense of language use, responsibility, dependence, self-awareness, integration, and…

28 CFR 100.14 - Directly allocable costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... incurred for the same purpose in like circumstances have been included as a direct cost of that, or any... personnel administration within the engineering group). (2) Such allocation necessitates selecting a... selected so as to permit allocation of the grouping on the basis of the benefits accruing to the multiple...

The sequence of disease-modifying therapies in relapsing multiple sclerosis: safety and immunologic considerations.

PubMed

Pardo, Gabriel; Jones, David E

2017-12-01

The treatment landscape for relapsing forms of multiple sclerosis (RMS) has expanded considerably over the last 10 years with the approval of multiple new disease-modifying therapies (DMTs), and others in late-stage clinical development. All DMTs for RMS are believed to reduce central nervous system immune-mediated inflammatory processes, which translate into demonstrable improvement in clinical and radiologic outcomes. However, some DMTs are associated with long-lasting effects on the immune system and/or serious adverse events, both of which may complicate the use of subsequent therapies. When customizing a treatment program, a benefit-risk assessment must consider multiple factors, including the efficacy of the DMT to reduce disease activity, the short- and long-term safety and immunologic profiles of each DMT, the criteria used to define switching treatment, and the risk tolerance of each patient. A comprehensive benefit-risk assessment can only be achieved by evaluating the immunologic, safety, and efficacy data for DMTs in the controlled clinical trial environment and the postmarketing clinical practice setting. This review is intended to help neurologists make informed decisions when treating RMS by summarizing the known data for each DMT and raising awareness of the multiple considerations involved in treating people with RMS throughout the entire course of their disease.

Comparing multiple competing interventions in the absence of randomized trials using clinical risk-benefit analysis

PubMed Central

2012-01-01

Background To demonstrate the use of risk-benefit analysis for comparing multiple competing interventions in the absence of randomized trials, we applied this approach to the evaluation of five anticoagulants to prevent thrombosis in patients undergoing orthopedic surgery. Methods Using a cost-effectiveness approach from a clinical perspective (i.e. risk benefit analysis) we compared thromboprophylaxis with warfarin, low molecular weight heparin, unfractionated heparin, fondaparinux or ximelagatran in patients undergoing major orthopedic surgery, with sub-analyses according to surgery type. Proportions and variances of events defining risk (major bleeding) and benefit (thrombosis averted) were obtained through a meta-analysis and used to define beta distributions. Monte Carlo simulations were conducted and used to calculate incremental risks, benefits, and risk-benefit ratios. Finally, net clinical benefit was calculated for all replications across a range of risk-benefit acceptability thresholds, with a reference range obtained by estimating the case fatality rate - ratio of thrombosis to bleeding. Results The analysis showed that compared to placebo ximelagatran was superior to other options but final results were influenced by type of surgery, since ximelagatran was superior in total knee replacement but not in total hip replacement. Conclusions Using simulation and economic techniques we demonstrate a method that allows comparing multiple competing interventions in the absence of randomized trials with multiple arms by determining the option with the best risk-benefit profile. It can be helpful in clinical decision making since it incorporates risk, benefit, and personal risk acceptance. PMID:22233221

7 CFR 783.8 - Multiple benefits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SPECIAL PROGRAMS TREE ASSISTANCE PROGRAM § 783.8 Multiple benefits. Persons may not receive or retain payments for production losses from trees, vines and bushes under this part if they have been compensated...

Sexual Health Research With Young Black Men Who Have Sex With Men: Experiences of Benefits and Harms.

PubMed

Arrington-Sanders, Renata; Morgan, Anthony; Oidtman, Jessica; Dao, Ann; Moon, Margaret; Fortenberry, J Dennis; Ott, Mary A

2017-05-01

Young Black men who have sex with men (YBMSM) are often underrepresented in sexual health research because of concerns about safety, privacy, and the potential for research harms. Empirical data are needed to understand YBMSM experience of participating in research, benefits and harms (discomfort), to inform policy and regulatory decisions. Using qualitative methods, this article examines 50 YBMSM, aged 15-19 years, experiences of benefits/harms, challenges of participating in sexual health research, and contextual factors impacting research experiences. Participants were asked about benefits and harms experienced in answering questions about sexual orientation, first same-sex attraction, and same-sex sexual experiences after completing an in-depth interview. Interviews were transcribed and coded. Inductive open coding was used to identify themes within and between interviews. Participants were able to describe perceived direct benefits resulting from research interview participation, including awareness of risky sexual behaviors, a safe space to share early coming out stories and same-sex sexual experiences, and a sense of empowerment and comfort with one's sexual orientation. Indirect benefits described by participants included perceptions of helping others and the larger gay community. Few participants described harms (discomfort recalling experiences). Our data suggest that participating in qualitative sexual health research focused on sexual orientation, sexual attraction, and early same-sex sexual experiences may result in minimal harms for YBMSM and multiple benefits, including feeling more comfortable than in a general medical visit.

Massive Photons: An Infrared Regularization Scheme for Lattice QCD+QED.

PubMed

Endres, Michael G; Shindler, Andrea; Tiburzi, Brian C; Walker-Loud, André

2016-08-12

Standard methods for including electromagnetic interactions in lattice quantum chromodynamics calculations result in power-law finite-volume corrections to physical quantities. Removing these by extrapolation requires costly computations at multiple volumes. We introduce a photon mass to alternatively regulate the infrared, and rely on effective field theory to remove its unphysical effects. Electromagnetic modifications to the hadron spectrum are reliably estimated with a precision and cost comparable to conventional approaches that utilize multiple larger volumes. A significant overall cost advantage emerges when accounting for ensemble generation. The proposed method may benefit lattice calculations involving multiple charged hadrons, as well as quantum many-body computations with long-range Coulomb interactions.

How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care?

PubMed

Nambisan, Satish; Nambisan, Priya

2017-11-01

Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations? In this essay, we draw on two important concepts-co-creation (the joint creation of value by multiple parties such as a company and its customers) and digitalization (the application of new digital technologies and the ensuing changes in sociotechnical structures and relationships)-and propose a set of policies and strategies that health care organizations could adopt to ensure that benefits from technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals. © 2017 American Medical Association. All Rights Reserved.

Benefits of Delay Tolerant Networking for Earth Science Missions

NASA Technical Reports Server (NTRS)

Davis, Faith; Marquart, Jane; Menke, Greg

2012-01-01

To date there has been much discussion about the value of Delay Tolerant Networking (DTN) for space missions. Claims of various benefits, based on paper analysis, are good; however a benefits statement with empirical evidence to support is even better. This paper presents potential and actual advantages of using DTN for Earth science missions based on results from multiple demonstrations, conducted by the Communications, Standards, and Technology Laboratory (CSTL) at NASA Goddard Space Flight Center (GSFC). Demonstrations included two flight demonstrations using the Earth Observing Mission 1 (EO-1) and the Near Earth Network (NEN), a ground based demonstration over satellite links to the Internet Router in Space (IRIS) payload on Intelsat-14, and others using the NASA Tracking Data Relay Satellite System (TDRSS). Real and potential findings include increased flexibility and efficiency in science campaigns, reduced latency in a collaborative science scenario, and improved scientist-instrument communication and control.

Applying Spatial Audio to Human Interfaces: 25 Years of NASA Experience

NASA Technical Reports Server (NTRS)

Begault, Durand R.; Wenzel, Elizabeth M.; Godfrey, Martine; Miller, Joel D.; Anderson, Mark R.

2010-01-01

From the perspective of human factors engineering, the inclusion of spatial audio within a human-machine interface is advantageous from several perspectives. Demonstrated benefits include the ability to monitor multiple streams of speech and non-speech warning tones using a cocktail party advantage, and for aurally-guided visual search. Other potential benefits include the spatial coordination and interaction of multimodal events, and evaluation of new communication technologies and alerting systems using virtual simulation. Many of these technologies were developed at NASA Ames Research Center, beginning in 1985. This paper reviews examples and describes the advantages of spatial sound in NASA-related technologies, including space operations, aeronautics, and search and rescue. The work has involved hardware and software development as well as basic and applied research.

Cover crops in the upper midwestern United States: Simulated effect on nitrate leaching with artificial drainage

USDA-ARS?s Scientific Manuscript database

Fall-planted winter cover crops are an agricultural management practice with multiple benefits that includes reducing nitrate losses from artificially drained fields. While the practice is commonly used in the southern and eastern U.S., little is known about its efficacy in Midwestern states where a...

The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?

ERIC Educational Resources Information Center

Lyubomirsky, Sonja; King, Laura; Diener, Ed

2005-01-01

Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive…

Lead in urban soils - A real or perceived concern for urban agriculture

USDA-ARS?s Scientific Manuscript database

Urban agriculture is growing in cities across the U.S. and it has the potential to provide multiple benefits including increased food security. Concerns about soil contamination in urban areas can be an impediment to urban agriculture. Lead is the most common contaminant in urban areas. A review ...

Military Enlistments: What Can We Learn from Geographic Variation? Technical Report 620.

ERIC Educational Resources Information Center

Brown, Charles

Some economic variables were examined that affect enlistment decisions and therefore affect the continued success of the All-Volunteer Force. The study used a multiple regression, pooled cross-section/time-series model over the 1975-1982 period, including pay, unemployment, educational benefits, and recruiting resources as independent variables.…

77 FR 2724 - CVS Caremark Corporation; Analysis of Proposed Consent Order To Aid Public Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-19

... Medicare drug plans and Medicare Part D drugs. CVSC currently owns multiple subsidiaries, including RxAmerica, that offer Medicare Part D prescription drug plans. Medicare Part D is a prescription drug... Part D benefits, beneficiaries must enroll in a Medicare drug plan administered by an insurer or other...

Which U.S. Households Use Education Loans?

ERIC Educational Resources Information Center

Hsu, Chungwen; Fisher, Patti J.

2016-01-01

This empirical study uses the 2013 Survey of Consumer Finances (SCF) to investigate the characteristics of households that hold at least one loan for educational expenses. The benefit of using household-level data is that a single household may have education loans for multiple people in the household, including the household head, spouse/partner,…

Increasing Engagement of Students with Autism at Recess through Structured Work Systems

ERIC Educational Resources Information Center

O'Hara, Meghan; Hall, Laura J.

2014-01-01

Students with autism spectrum disorder (ASD) who attend public schools benefit from supplementary structure throughout their day, including during recess periods on the playground. The following study used a concurrent multiple-baseline design to evaluate the effects of a structured work system taught by the special education teacher using…

Learning and Motivational Benefits of Acronym Use in Introductory Psychology

ERIC Educational Resources Information Center

Stalder, Daniel R.

2005-01-01

Study 1 assessed students' use and perceptions of acronyms at 3 different exam times in 2 sections of Introduction to Psychology. Acronym use consistently predicted higher performance on acronym related exam items, and I partially discounted 2 possible confounds. Students rated acronyms as helpful in multiple ways, including increasing motivation…

Expanding site productivity research to sustain non-timber forest functions

Treesearch

D. Andrew Scott; James A. Burger; Barbara Crane

2006-01-01

Southern forests produce multiple products and services including timber, wildlife habitat, species bio- and genetic divenity, water quality and control, waste remediation, recreation, and carbon sequestration. All of these benefits must be produced in a sustainable manner to meet today's societal needs without compromising future needs. A forest site is...

Sport Activity for Health!! The Effects of Karate Participants’ Involvement, Perceived Value, and Leisure Benefits on Recommendation Intention

PubMed Central

Chang, Ying-Chih; Pai, Fan-Yun; Huang, Tai-Peng

2018-01-01

This study intends to discuss the effects of participants’ involvement, perceived value, and leisure benefits on recommendation intention in the sport of karate. The questionnaires were collected online by karate clubs on Facebook and included 369 valid participants. The research findings show that karate participants from different places of residence do not display significant differences in involvement, perceived value, leisure benefits, and recommendation intention. Furthermore, “attraction” in the involvement category reveals the highest mean, “paid spirit and energy being worthy” in perceived value appears as the highest mean, and “physiological benefits” in leisure benefits shows the highest mean. The Pearson correlation analysis result presents significant strong positive correlations between involvement, perceived value, leisure benefits, and recommendation intention. Finally, multiple regression analysis reveals that leisure benefits, except “physiological benefits”, show notably positive effects on recommendation intention. According to the research results, suggestions are proposed for the reference of karate teaching business managers, participants, and future research. PMID:29748459

Co-enrolment of Participants into Multiple Cancer Trials: Benefits and Challenges.

PubMed

Cafferty, F H; Coyle, C; Rowley, S; Berkman, L; MacKensie, M; Langley, R E

2017-07-01

Opportunities to enter patients into more than one clinical trial are not routinely considered in cancer research and experiences with co-enrolment are rarely reported. Potential benefits of allowing appropriate co-enrolment have been identified in other settings but there is a lack of evidence base or guidance to inform these decisions in oncology. Here, we discuss the benefits and challenges associated with co-enrolment based on experiences in the Add-Aspirin trial - a large, multicentre trial recruiting across a number of tumour types, where opportunities to co-enrol patients have been proactively explored and managed. The potential benefits of co-enrolment include: improving recruitment feasibility; increased opportunities for patients to participate in trials; and collection of robust data on combinations of interventions, which will ensure the ongoing relevance of individual trials and provide more cohesive evidence to guide the management of future patients. There are a number of perceived barriers to co-enrolment in terms of scientific, safety and ethical issues, which warrant consideration on a trial-by-trial basis. In many cases, any potential effect on the results of the trials will be negligible - limited by a number of factors, including the overlap in trial cohorts. Participant representatives stress the importance of autonomy to decide about trial enrolment, providing a compelling argument for offering co-enrolment where there are multiple trials that are relevant to a patient and no concerns regarding safety or the integrity of the trials. A number of measures are proposed for managing and monitoring co-enrolment. Ensuring acceptability to (potential) participants is paramount. Opportunities to enter patients into more than one cancer trial should be considered more routinely. Where planned and managed appropriately, co-enrolment can offer a number of benefits in terms of both scientific value and efficiency of study conduct, and will increase the opportunities for patients to participate in, and benefit from, clinical research. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

State-Level Community Benefit Regulation and Nonprofit Hospitals' Provision of Community Benefits.

PubMed

Singh, Simone R; Young, Gary J; Loomer, Lacey; Madison, Kristin

2018-04-01

Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009-11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals. Copyright © 2018 by Duke University Press.

Economic evaluation of distribution system smart grid investments

DOE PAGES

Onen, Ahmet; Cheng, Danling; Broadwater, Robert P.; ...

2014-12-31

This paper investigates economic benefits of smart grid automation investments. A system consisting of 7 substations and 14 feeders is used in the evaluation. Here benefits that can be quantified in terms of dollar savings are considered, termed “hard dollar” benefits. Smart Grid investment evaluations to be considered include investments in improved efficiency, more cost effective use of existing system capacity with automated switches, and coordinated control of capacitor banks and voltage regulators. These Smart Grid evaluations are sequentially ordered, resulting in a series of incremental hard dollar benefits. Hard dollar benefits come from improved efficiency, delaying large capital equipmentmore » investments, shortened storm restoration times, and reduced customer energy use. Analyses used in the evaluation involve hourly power flow analysis over multiple years and Monte Carlo simulations of switching operations during storms using a reconfiguration for restoration algorithm. The economic analysis uses the time varying value of the Locational Marginal Price. Algorithms used include reconfiguration for restoration involving either manual or automated switches and coordinated control involving two modes of control. Field validations of phase balancing and capacitor design results are presented. The evaluation shows that investments in automation can improve performance while at the same time lowering costs.« less

Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care

PubMed Central

Jackson, Carlos; Kasper, Elizabeth W.; Williams, Christianna

2016-01-01

Abstract Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P < 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. (Population Health Management 2016;19:163–170) PMID:26431255

Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits

PubMed Central

Cox, Daniel T. C.; Shanahan, Danielle F.; Hudson, Hannah L.; Fuller, Richard A.; Anderson, Karen; Hancock, Steven; Gaston, Kevin J.

2017-01-01

Exposure to nature provides a wide range of health benefits. A significant proportion of these are delivered close to home, because this offers an immediate and easily accessible opportunity for people to experience nature. However, there is limited information to guide recommendations on its management and appropriate use. We apply a nature dose-response framework to quantify the simultaneous association between exposure to nearby nature and multiple health benefits. We surveyed ca. 1000 respondents in Southern England, UK, to determine relationships between (a) nature dose type, that is the frequency and duration (time spent in private green space) and intensity (quantity of neighbourhood vegetation cover) of nature exposure and (b) health outcomes, including mental, physical and social health, physical behaviour and nature orientation. We then modelled dose-response relationships between dose type and self-reported depression. We demonstrate positive relationships between nature dose and mental and social health, increased physical activity and nature orientation. Dose-response analysis showed that lower levels of depression were associated with minimum thresholds of weekly nature dose. Nearby nature is associated with quantifiable health benefits, with potential for lowering the human and financial costs of ill health. Dose-response analysis has the potential to guide minimum and optimum recommendations on the management and use of nearby nature for preventative healthcare. PMID:28208789

Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits.

PubMed

Cox, Daniel T C; Shanahan, Danielle F; Hudson, Hannah L; Fuller, Richard A; Anderson, Karen; Hancock, Steven; Gaston, Kevin J

2017-02-09

Exposure to nature provides a wide range of health benefits. A significant proportion of these are delivered close to home, because this offers an immediate and easily accessible opportunity for people to experience nature. However, there is limited information to guide recommendations on its management and appropriate use. We apply a nature dose-response framework to quantify the simultaneous association between exposure to nearby nature and multiple health benefits. We surveyed ca. 1000 respondents in Southern England, UK, to determine relationships between (a) nature dose type, that is the frequency and duration (time spent in private green space) and intensity (quantity of neighbourhood vegetation cover) of nature exposure and (b) health outcomes, including mental, physical and social health, physical behaviour and nature orientation. We then modelled dose-response relationships between dose type and self-reported depression. We demonstrate positive relationships between nature dose and mental and social health, increased physical activity and nature orientation. Dose-response analysis showed that lower levels of depression were associated with minimum thresholds of weekly nature dose. Nearby nature is associated with quantifiable health benefits, with potential for lowering the human and financial costs of ill health. Dose-response analysis has the potential to guide minimum and optimum recommendations on the management and use of nearby nature for preventative healthcare.

Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base

PubMed Central

Landis, R. Clive; Brown, Jeremiah R.; Fitzgerald, David; Likosky, Donald S.; Shore-Lesserson, Linda; Baker, Robert A.; Hammon, John W.

2014-01-01

Abstract: A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture “self-identified” anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the “Outcomes 2010” consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory response. However, only a minority of papers (35 of 98 [35.7%]) demonstrated any clinical improvement to one or more of the predefined outcome measures (most frequently myocardial protection or length of intensive care unit stay). No single intervention was supported by strong level A evidence (multiple randomized controlled trials [RCTs] or meta-analysis) for clinical benefit. Interventions at level A evidence included off-pump surgery, minimized circuits, biocompatible circuit coatings, leukocyte filtration, complement C5 inhibition, preoperative aspirin, and corticosteroid prophylaxis. Interventions at level B evidence (single RCT) for minimizing inflammation included nitric oxide donors, C1 esterase inhibition, neutrophil elastase inhibition, propofol, propionyl-L-carnitine, and intensive insulin therapy. A secondary analysis revealed that suppression of at least one inflammatory marker was necessary but not sufficient to confer clinical benefit. The most effective interventions were those that targeted multiple inflammatory pathways. These observations are consistent with a “multiple hit” hypothesis, whereby clinically effective suppression of the systemic inflammatory response requires hitting multiple inflammatory targets simultaneously. Further research is warranted to evaluate if combinations of interventions that target multiple inflammatory pathways are capable of synergistically reducing inflammation and improving outcomes after cardiopulmonary bypass. PMID:26357785

Smoldering Multiple Myeloma

PubMed Central

Gao, Minjie; Yang, Guang; Kong, Yuanyuan; Wu, Xiaosong; Shi, Jumei

2015-01-01

Smoldering multiple myeloma (SMM) is an asymptomatic precursor stage of multiple myeloma (MM) characterized by clonal bone marrow plasma cells (BMPC) ≥ 10% and/or M protein level ≥ 30 g/L in the absence of end organ damage. It represents an intermediate stage between monoclonal gammopathy of undetermined significance (MGUS) and symptomatic MM. The risk of progression to symptomatic MM is not uniform, and several parameters have been reported to predict the risk of progression. These include the level of M protein and the percentage of BMPC, the proportion of immunophenotypically aberrant plasma cells, and the presence of immunoparesis, free light-chain (FLC) ratio, peripheral blood plasma cells (PBPC), pattern of serum M protein evolution, abnormal magnetic resonance imaging (MRI), cytogenetic abnormalities, IgA isotype, and Bence Jones proteinuria. So far treatment is still not recommended for SMM, because several trials suggested that patients with SMM do not benefit from early treatment. However, the Mateos et al. trial showed a survival benefit after early treatment with lenalidomide plus dexamethasone in patients with high-risk SMM. This trial has prompted a reevaluation of early treatment in an asymptomatic patient population. PMID:26000300

Comparison of FDMA and CDMA for second generation land-mobile satellite communications

NASA Technical Reports Server (NTRS)

Yongacoglu, A.; Lyons, R. G.; Mazur, B. A.

1990-01-01

Code Division Multiple Access (CDMA) and Frequency Division Multiple Access (FDMA) (both analog and digital) systems capacities are compared on the basis of identical link availabilities and physical propagation models. Parameters are optimized for a bandwidth limited, multibeam environment. For CDMA, the benefits of voice activated carriers, antenna discrimination, polarization reuse, return link power control and multipath suppression are included in the analysis. For FDMA, the advantages of bandwidth efficient modulation/coding combinations, voice activated carriers, polarization reuse, beam placement, and frequency staggering were taken into account.

Transactions at a Northeastern Supermarket Chain: Differences by Supplemental Nutrition Assistance Program Use.

PubMed

Franckle, Rebecca L; Moran, Alyssa; Hou, Tao; Blue, Dan; Greene, Julie; Thorndike, Anne N; Polacsek, Michele; Rimm, Eric B

2017-10-01

Although one in seven Americans receives Supplemental Nutrition Assistance Program (SNAP) benefits, little is known about how these benefits for food are spent because individual-level sales data are not publicly available. The purpose of this study is to compare transactions made with and without SNAP benefits at a large regional supermarket chain. Sales data were obtained from a large supermarket chain in the Northeastern U.S. for a period of 2 years (April 2012-April 2014). Multivariate multiple regression models were used to quantify relative differences in dollars spent on 31 predefined SNAP-eligible food categories. Analyses were completed in 2016. Transactions with SNAP benefit use included higher spending on less healthful food categories, including sugar-sweetened beverages ($1.08), red meat ($1.55), and convenience foods ($1.34), and lower spending on more healthful food categories, such as fruits (-$1.51), vegetables (-$1.35), and poultry (-$1.25) compared to transactions without SNAP benefit use. These findings provide objective data to compare purchases made with and without SNAP benefits. Next steps should be to test proposed SNAP modifications to determine whether they would have the intended effect of promoting healthier purchasing patterns among SNAP beneficiaries. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Meditation as an Adjunct to the Management of Multiple Sclerosis

PubMed Central

Levin, Adam B.; Hadgkiss, Emily J.; Weiland, Tracey J.; Jelinek, George A.

2014-01-01

Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. This review aims to critically analyse the current literature regarding meditation and MS. Methods. Four major databases were used to search for English language papers published before March 2014 with the terms MS, multiple sclerosis, meditation, and mindfulness. Results. 12 pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The current literature varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. Conclusion. All studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. Additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time. PMID:25105026

Billions for biodefense: federal agency biodefense funding, FY2009-FY2010.

PubMed

Franco, Crystal

2009-09-01

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series analyzed civilian biodefense funding by the federal government for fiscal years (FY) 2001 through 2009. This article updates those figures with budgeted amounts for FY2010, specifically analyzing the budgets and allocations for biodefense at the Departments of Health and Human Services, Defense, Homeland Security, Agriculture, and State; the Environmental Protection Agency; and the National Science Foundation. This year's article also provides an assessment of the proportion of the biodefense budget that serves multiple programmatic goals and benefits, including research into infectious disease pathogenesis and immunology, public health planning and preparedness, and disaster response efforts. The FY2010 federal budget for civilian biodefense totals $6.05 billion. Of that total, $4.96 billion is budgeted for programs that serve multiple goals and provide manifold benefits.

Mission control of multiple unmanned aerial vehicles: a workload analysis.

PubMed

Dixon, Stephen R; Wickens, Christopher D; Chang, Dervon

2005-01-01

With unmanned aerial vehicles (UAVs), 36 licensed pilots flew both single-UAV and dual-UAV simulated military missions. Pilots were required to navigate each UAV through a series of mission legs in one of the following three conditions: a baseline condition, an auditory autoalert condition, and an autopilot condition. Pilots were responsible for (a) mission completion, (b) target search, and (c) systems monitoring. Results revealed that both the autoalert and the autopilot automation improved overall performance by reducing task interference and alleviating workload. The autoalert system benefited performance both in the automated task and mission completion task, whereas the autopilot system benefited performance in the automated task, the mission completion task, and the target search task. Practical implications for the study include the suggestion that reliable automation can help alleviate task interference and reduce workload, thereby allowing pilots to better handle concurrent tasks during single- and multiple-UAV flight control.

Demonstration of Space Optical Transmitter Development for Multiple High Frequency Bands

NASA Technical Reports Server (NTRS)

Nguyen, Hung; Simons, Rainee; Wintucky, Edwin; Freeman, Jon

2013-01-01

As the demand for multiple radio frequency carrier bands continues to grow in space communication systems, the design of a cost-effective compact optical transmitter that is capable of transmitting selective multiple RF bands is of great interest, particularly for NASA Space Communications Network Programs. This paper presents experimental results that demonstrate the feasibility of a concept based on an optical wavelength division multiplexing (WDM) technique that enables multiple microwave bands with different modulation formats and bandwidths to be combined and transmitted all in one unit, resulting in many benefits to space communication systems including reduced size, weight and complexity with corresponding savings in cost. Experimental results will be presented including the individual received RF signal power spectra for the L, C, X, Ku, Ka, and Q frequency bands, and measurements of the phase noise associated with each RF frequency. Also to be presented is a swept RF frequency power spectrum showing simultaneous multiple RF frequency bands transmission. The RF frequency bands in this experiment are among those most commonly used in NASA space environment communications.

All of the above: When multiple correct response options enhance the testing effect.

PubMed

Bishara, Anthony J; Lanzo, Lauren A

2015-01-01

Previous research has shown that multiple choice tests often improve memory retention. However, the presence of incorrect lures often attenuates this memory benefit. The current research examined the effects of "all of the above" (AOTA) options. When such options are correct, no incorrect lures are present. In the first three experiments, a correct AOTA option on an initial test led to a larger memory benefit than no test and standard multiple choice test conditions. The benefits of a correct AOTA option occurred even without feedback on the initial test; for both 5-minute and 48-hour retention delays; and for both cued recall and multiple choice final test formats. In the final experiment, an AOTA question led to better memory retention than did a control condition that had identical timing and exposure to response options. However, the benefits relative to this control condition were similar regardless of the type of multiple choice test (AOTA or not). Results suggest that retrieval contributes to multiple choice testing effects. However, the extra testing effect from a correct AOTA option, rather than being due to more retrieval, might be due simply to more exposure to correct information.

Many shades of gray—The context-dependent performance of organic agriculture

PubMed Central

Seufert, Verena; Ramankutty, Navin

2017-01-01

Organic agriculture is often proposed as a more sustainable alternative to current conventional agriculture. We assess the current understanding of the costs and benefits of organic agriculture across multiple production, environmental, producer, and consumer dimensions. Organic agriculture shows many potential benefits (including higher biodiversity and improved soil and water quality per unit area, enhanced profitability, and higher nutritional value) as well as many potential costs including lower yields and higher consumer prices. However, numerous important dimensions have high uncertainty, particularly the environmental performance when controlling for lower organic yields, but also yield stability, soil erosion, water use, and labor conditions. We identify conditions that influence the relative performance of organic systems, highlighting areas for increased research and policy support. PMID:28345054

Improved Visual Cognition through Stroboscopic Training

PubMed Central

Appelbaum, L. Gregory; Schroeder, Julia E.; Cain, Matthew S.; Mitroff, Stephen R.

2011-01-01

Humans have a remarkable capacity to learn and adapt, but surprisingly little research has demonstrated generalized learning in which new skills and strategies can be used flexibly across a range of tasks and contexts. In the present work we examined whether generalized learning could result from visual–motor training under stroboscopic visual conditions. Individuals were assigned to either an experimental condition that trained with stroboscopic eyewear or to a control condition that underwent identical training with non-stroboscopic eyewear. The training consisted of multiple sessions of athletic activities during which participants performed simple drills such as throwing and catching. To determine if training led to generalized benefits, we used computerized measures to assess perceptual and cognitive abilities on a variety of tasks before and after training. Computer-based assessments included measures of visual sensitivity (central and peripheral motion coherence thresholds), transient spatial attention (a useful field of view – dual task paradigm), and sustained attention (multiple-object tracking). Results revealed that stroboscopic training led to significantly greater re-test improvement in central visual field motion sensitivity and transient attention abilities. No training benefits were observed for peripheral motion sensitivity or peripheral transient attention abilities, nor were benefits seen for sustained attention during multiple-object tracking. These findings suggest that stroboscopic training can effectively improve some, but not all aspects of visual perception and attention. PMID:22059078

Omega-3 polyunsaturated fatty acids for the prevention of cardiovascular disease: do formulation, dosage & comparator matter?

PubMed

DiNicolantonio, James J; Meier, Pascal; O'Keefe, James H

2013-01-01

Multiple trials over the past two decades testing omega-3 polyunsaturated fatty acids (PUFAs), containing eicosapentaenoic acid (EPA) and or docosahexaenoic acid (DHA), have shown substantial benefits for reducing major coronary heart disease (CHD) events, all-cause mortality, cardiovascular (CV) death, sudden cardiac death (SCD), and stroke. However, recent trials testing omega-3s have generally failed to confirm these benefits. While increased fish and fish oil intake among the general population, increased use of optimal medical therapy (including statins, aspirin, and modern antihypertensive medications) probably make it more challenging for fish oil supplementation to show additional benefits, there might be further explanations in the formulation, dosage, and comparator used in these recent omega-3 trials.

The Conference Proceedings of the 1997 Air Transport Research Group (ATRG) of the WCTR Society. Volume 2

NASA Technical Reports Server (NTRS)

Bowen, Brent D. (Editor); Oum,Tae Hoon (Editor)

1997-01-01

The topics discussed in the proceedings include: Airport pricing systems; Airport services and airport charging systems in the European Union; Multiple hub network choice in the European market; Marginal profitability in hub-and-spoke networks; Airline hubbing and hub region benefits; and new methods of airport finance in Japan.

Positive effects of afforestation efforts on the health of urban soils

Treesearch

Emily E. Oldfield; Alexander J. Felson; Stephen A. Wood; Richard A. Hallett; Michael S. Strickland; Mark A. Bradford

2014-01-01

Large-scale tree planting projects in cities are increasingly implemented as a strategy to improve the urban environment. Trees provide multiple benefits in cities, including reduction of urban temperatures, improved air quality, mitigation of storm-water run-off, and provision of wildlife habitat. How urban afforestation affects the properties and functions of urban...

Benefits of Using Planned Comparisons Rather Than Post Hoc Tests: A Brief Review with Examples.

ERIC Educational Resources Information Center

DuRapau, Theresa M.

The rationale behind analysis of variance (including analysis of covariance and multiple analyses of variance and covariance) methods is reviewed, and unplanned and planned methods of evaluating differences between means are briefly described. Two advantages of using planned or a priori tests over unplanned or post hoc tests are presented. In…

Stress and Depression among Older Residents in Religious Monasteries: Do Friends and God Matter?

ERIC Educational Resources Information Center

Bishop, Bishop J.

2008-01-01

The purpose of this investigation was to explore how friendship and attachment to God provide protective benefits against stress and depression. Participants included 235 men and women, age 64 and older, residing in religious monasteries affiliated with the Order of St. Benedict. Hierarchical multiple regression analyses were completed to assess…

A Free-Recall Demonstration versus a Lecture-Only Control: Learning Benefits

ERIC Educational Resources Information Center

Balch, William R.

2012-01-01

On their first class day, introductory psychology students took a 14-question multiple-choice pretest on several principles of memory including primacy, recency, storage, retrieval, counterbalancing, and the free-recall method. I randomly preassigned students to come at one of two different times to the second class, 2 days later, when they either…

Fisheries indicators, freshwater

USGS Publications Warehouse

Kwak, Thomas J.

2010-01-01

Freshwater fisheries exist among diverse ecosystems and fauna, provide societal benefits, and are influenced by human activities. Fisheries scientists assess the status and sustainability of fisheries by multiple approaches, including abundance and condition indices, population parameters, community indices, modeling, and surveys of habitat and human dimensions. The future sustainability of freshwater fisheries is limited not by available methods but by society’s will.

20 CFR 345.102 - Multiple employer limitation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Multiple employer limitation. 345.102 Section 345.102 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS General Provisions and Definitions § 345.102...

The need and approach for characterization - U.S. air force perspectives on materials state awareness

NASA Astrophysics Data System (ADS)

Aldrin, John C.; Lindgren, Eric A.

2018-04-01

This paper expands on the objective and motivation for NDE-based characterization and includes a discussion of the current approach using model-assisted inversion being pursued within the Air Force Research Laboratory (AFRL). This includes a discussion of the multiple model-based methods that can be used, including physics-based models, deep machine learning, and heuristic approaches. The benefits and drawbacks of each method is reviewed and the potential to integrate multiple methods is discussed. Initial successes are included to highlight the ability to obtain quantitative values of damage. Additional steps remaining to realize this capability with statistical metrics of accuracy are discussed, and how these results can be used to enable probabilistic life management are addressed. The outcome of this initiative will realize the long-term desired capability of NDE methods to provide quantitative characterization to accelerate certification of new materials and enhance life management of engineered systems.

What is the benefit of treatment with multiple lines of chemotherapy for patients with metastatic breast cancer? A retrospective cohort study.

PubMed

Bakker, J L; Wever, K; van Waesberghe, J H; Beeker, A; Meijers-Heijboer, H; Konings, I R; Verheul, H M W

2015-12-01

Despite the extensive clinical experience, it is still under debate to what extent patients with metastatic breast cancer (MBC) benefit from multiple lines of chemotherapy beyond standard first or second line treatment. Selection of patients with MBC who will benefit from treatment is crucial to improve outcome and reduce unnecessary toxicity. In this retrospective study, systemic treatment outcome for patients with metastatic MBC is being evaluated. We evaluated to what extent the clinical benefit of prior chemotherapy can predict the success of a subsequent treatment line. Ninety-one patients treated with chemotherapy for MBC between January 2005 and January 2009 were included in this study. Clinical characteristics of patients, choices of chemotherapy and response at first evaluation of every treatment line was evaluated based on radiologic and clinical data. Patients received multiple systemic cytotoxic and biological (combination) therapies. 30% of these patients received more than five consecutive systemic (combination) treatments. First line chemotherapy was mostly anthracycline-based, followed by taxanes, capecitabine and vinorelbine. The response rate (RR, complete response plus partial response according to RECIST 1.1) decreased from 20% (95% CI 11-28%) upon first line of treatment to 0% upon the fourth line. The clinical benefit rate (combining RR and stable disease) decreased from 85% (95% CI 78-93%) in the first to 54% (95% CI 26-67) upon the fourth line. 24% of the patients with clinical benefit at first evaluation did not receive a subsequent line of treatment when progressive disease occurred, while sixty-one percent of the patients with progressive disease at first evaluation of a treatment did not receive a subsequent line of chemotherapy. When applied, the efficacy of a subsequent line of treatment was similar for patients independent of previous treatment benefit. The clinical benefit at first evaluation from systemic treatment in MBC does not predict for subsequent treatment benefit in this retrospective analysis. The fact that 61% of patients did not receive subsequent treatment after previous treatment failure suggests that either clinical judgement is of critical value in selection of patients to prevent them from unnecessary toxicity or, alternatively indicates that based on the assumption that prior treatment failure predicts for lack of benefit undertreatment of patients occurs. Therefore, a more adequate clinical judgement tool or predictive biomarkers for response are urgently needed to improve treatment outcome. Copyright © 2015. Published by Elsevier Ltd.

The use of intelligent database systems in acute pancreatitis--a systematic review.

PubMed

van den Heever, Marc; Mittal, Anubhav; Haydock, Matthew; Windsor, John

2014-01-01

Acute pancreatitis (AP) is a complex disease with multiple aetiological factors, wide ranging severity, and multiple challenges to effective triage and management. Databases, data mining and machine learning algorithms (MLAs), including artificial neural networks (ANNs), may assist by storing and interpreting data from multiple sources, potentially improving clinical decision-making. 1) Identify database technologies used to store AP data, 2) collate and categorise variables stored in AP databases, 3) identify the MLA technologies, including ANNs, used to analyse AP data, and 4) identify clinical and non-clinical benefits and obstacles in establishing a national or international AP database. Comprehensive systematic search of online reference databases. The predetermined inclusion criteria were all papers discussing 1) databases, 2) data mining or 3) MLAs, pertaining to AP, independently assessed by two reviewers with conflicts resolved by a third author. Forty-three papers were included. Three data mining technologies and five ANN methodologies were reported in the literature. There were 187 collected variables identified. ANNs increase accuracy of severity prediction, one study showed ANNs had a sensitivity of 0.89 and specificity of 0.96 six hours after admission--compare APACHE II (cutoff score ≥8) with 0.80 and 0.85 respectively. Problems with databases were incomplete data, lack of clinical data, diagnostic reliability and missing clinical data. This is the first systematic review examining the use of databases, MLAs and ANNs in the management of AP. The clinical benefits these technologies have over current systems and other advantages to adopting them are identified. Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Improvement of surgical margin with a coupled saline-radio-frequency device for multiple colorectal liver metastases.

PubMed

Ogata, Satoshi; Kianmanesh, Reza; Varma, Deepak; Belghiti, Jacques

2005-01-01

Complete resection of colorectal liver metastases (LM) has been the only curative treatment. However, when LM are multiple and bilobar, only a few patients are candidates for curative surgery. We report on a 53-year-old woman with synchronous multiple and bilobar LM from sigmoidal cancer who became resectable after a multimodal strategy including preoperative systemic chemotherapy and two-step surgery. The spectacular decrease in tumor size after systemic chemotherapy led us to perform two-step surgery, including right portal-vein ligation and left liver metastasectomies, with a coupled saline-radiofrequency device, in order to improve the surgical margin. An extended right hepatectomy was performed later to remove the remaining right liver lesions. The patient was discharged after 28 days without major complication and was recurrence-free 14 months later. We conclude that improving the surgical margin with a coupled saline-radiofrequency device is feasible and effective, avoiding small remnant liver even after multiple tumorectomies. The multimodal strategy, including preoperative chemotherapy, two-step surgery, and tumorectomies, using a coupled saline-radiofrequency device, could increase the number of patients with diffuse bilobar liver metastases who can benefit from liver resection.

The Evidence for Dietary Interventions and Nutritional Supplements as Treatment Options in Multiple Sclerosis: a Review.

PubMed

Mische, Leah J; Mowry, Ellen M

2018-03-17

This review aims to critically evaluate published studies examining diets and nutritional supplements (excepting vitamin D) for the impact on prevention and prognosis of multiple sclerosis (MS). There is a negative relationship between the Mediterranean diet and vascular disease, and vascular co-morbidities are associated with a worse MS prognosis. Low-fat, fish-based diets, sodium-restricted diets, calorie restriction, the paleo diet, and gluten-free diets have been examined, mostly in observational studies; results are inconclusive. With regard to nutritional supplements, pilot data show a possible benefit of biotin with respect to disability worsening in people with progressive MS (PMS). The best designed randomized controlled trials (RCTs) for PUFA supplementation have not shown significant impact, but several weaker RCTs have. Many other nutritional supplements have been tested, including several anti-oxidants. While some early studies show positive results, no result has been definitive. Unfortunately, there is no strong evidence for a direct benefit of any given dietary intervention on MS risk or prognosis. However, due to its relationship with vascular co-morbidities, the Mediterranean diet has the strongest rationale for employment in PwMS. Higher-quality clinical trials are needed to ascertain the possible benefits of nutritional supplements.

Severe leptospirosis with multiple organ failure successfully treated by plasma exchange and high-volume hemofiltration.

PubMed

Bourquin, Vincent; Ponte, Belén; Hirschel, Bernard; Pugin, Jérôme; Martin, Pierre-Yves; Saudan, Patrick

2011-01-01

Background. Leptospirosis is a spirochetal zoonosis with complex clinical features including renal and liver failure. Case report. We report the case of a Swiss fisherman presenting with leptospirosis. After initial improvement, refractory septic shock and severe liver and kidney failure developed. The expected mortality was estimated at 90% with clinical scores. The patient underwent plasma exchanges and high-volume hemofiltration (HVHF) with complete recovery of hepatic and kidney functions. Discussion. Plasma exchanges and HVHF may confer survival benefit on patients with severe leptospirosis, refractory septic shock, and multiple-organ failure.

Battery Storage Evaluation Tool, version 1.x

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

2015-10-02

The battery storage evaluation tool developed at Pacific Northwest National Laboratory is used to run a one-year simulation to evaluate the benefits of battery storage for multiple grid applications, including energy arbitrage, balancing service, capacity value, distribution system equipment deferral, and outage mitigation. This tool is based on the optimal control strategies to capture multiple services from a single energy storage device. In this control strategy, at each hour, a lookahead optimization is first formulated and solved to determine the battery base operating point. The minute-by-minute simulation is then performed to simulate the actual battery operation.

EBR-II and TREAT Digitization Project

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

Griffith, George W.; Rabiti, Cristian

2015-09-01

Digitizing the technical drawings for EBR-II and TREAT provides multiple benefits. Moving the scanned or hard copy drawings to modern 3-D CAD (Computer Aided Drawing) format saves data that could be lost over time. The 3-D drawings produce models that can interface with other drawings to make complex assemblies. The 3-D CAD format can also include detailed material properties and parametric coding that can tie critical dimensions together allowing easier modification. Creating the new files from the old drawings has found multiple inconsistencies that are being flagged or corrected improving understanding of the reactor(s).

Chest Wall Trauma.

PubMed

Majercik, Sarah; Pieracci, Fredric M

2017-05-01

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

Green Tea Extracts Epigallocatechin-3-gallate for Different Treatments

PubMed Central

Chu, Chenyu; Deng, Jia

2017-01-01

Epigallocatechin-3-gallate (EGCG), a component extracted from green tea, has been proved to have multiple effects on human pathological and physiological processes, and its mechanisms are discrepant in cancer, vascularity, bone regeneration, and nervous system. Although there are multiple benefits associated with EGCG, more and more challenges are still needed to get through. For example, EGCG shows low bioactivity via oral administration. This review focuses on effects of EGCG, including anti-cancer, antioxidant, anti-inflammatory, anticollagenase, and antifibrosis effects, to express the potential of EGCG and necessity of further studies in this field. PMID:28884125

Michrohole Arrays Drilled with Advanced Abrasive Slurry Jet Technology to Efficiently Exploit Enhanced Geothermal Systems

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

Oglesby, Kenneth; Finsterle, Stefan; Zhang, Yingqi

2014-03-12

This project had two major areas of research for Engineered/ Enhanced Geothermal System (EGS) development - 1) study the potential benefits from using microholes (i.e., bores with diameters less than 10.16 centimeters/ 4 inches) and 2) study FLASH ASJ to drill/ install those microbores between a well and a fracture system. This included the methods and benefits of drilling vertical microholes for exploring the EGS reservoir and for installing multiple (forming an array of) laterals/ directional microholes for creating the in-reservoir heat exchange flow paths. Significant benefit was found in utilizing small microbore sized connecting bores for EGS efficiency andmore » project life. FLASH ASJ was deemed too complicated to optimally work in such deep reservoirs at this time.« less

Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis

PubMed Central

Lugaresi, Alessandra; di Ioia, Maria; Travaglini, Daniela; Pietrolongo, Erika; Pucci, Eugenio; Onofrj, Marco

2013-01-01

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system and mainly affects young adults. Its natural history has changed in recent years with the advent of disease-modifying drugs, which have been available since the early 1990s. The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. The aim of this review is to give a comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, to enable readers to draw their own conclusions regarding the risk-benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks. We performed a Medline literature search to identify studies on the treatment of MS with risk stratification and risk-benefit considerations. We focused our attention on studies of disease-modifying, immunomodulating, and immunosuppressive drugs, including monoclonal antibodies. Here we offer personal considerations, stemming from long-term experience in the treatment of MS and thorough discussions with other neurologists closely involved in the care of patients with the disease. MS specialists need to know not only the specific risks and benefits of single drugs, but also about drug interactions, either in simultaneous or serial combination therapy, and patient comorbidities, preferences, and fears. This has to be put into perspective, considering also the risks of untreated disease in patients with different clinical and radiological characteristics. There is no single best treatment strategy, but therapy has to be tailored to the patient. This is a time-consuming task, rich in complexity, and influenced by the attitude towards risk on the parts of both the patient and the clinical team. The broader the MS drug market becomes, the harder it will be for the clinician to help the patient decide which therapeutic strategy to opt for. PMID:23836975

Physical activity motivation and benefits in people with multiple sclerosis.

PubMed

Fasczewski, Kimberly S; Gill, Diane L; Rothberger, Sara M

2018-06-01

Multiple sclerosis is a degenerative neurological disease that affects 2.1 million people worldwide. There is no cure, but an expanding body of research supports the positive impact of physical activity and suggests physical activity has benefits for the individual's psychological and physical well-being. Using Self-Determination Theory as a framework, mixed methods with a focus on qualitative interviews were used to explore physical activity motivation and benefits with a sample of highly active people with multiple sclerosis (n = 15). Disability level ranged from not disabled to wheelchair bound with the majority of participants reporting minimal impact from multiple sclerosis. Survey data were collected using a number of open-ended questions along with measures of self-efficacy, self-determined motivation, physical activity, and quality of life. Additionally, eight individuals participated in semistructured telephone interviews focused on (a) motivation and strategies used to maintain physical activity and (b) the benefits and impact of physical activity in their lives. The main findings were consistent with Self-Determination Theory; participants described feelings of accomplishment and competence in both their physical activity and daily life, as well as a sense of independence and autonomy. Similarly, all participants cited benefits, and the main themes were enhanced satisfaction with life and an overall positive outlook on life. Results provide insight into the role of physical activity in a highly active sample and have implications for professionals working in physical activity settings with the multiple sclerosis population. Interventions aimed at increasing long-term physical activity adherence should focus on increasing autonomy and competence for physical activity in the individual and promoting potential increased quality of life outcomes from physical activity participation. Implications for Rehabilitation Multiple sclerosis is a chronic degenerative neurological disease that the individual lives with for a majority of the lifespan. Physical activity is one means that has been shown to aid is the control of multiple sclerosis symptoms. Increasing patient understanding of the benefits of using physical activity as a means to control multiple sclerosis symptoms may result in long-term physical activity adherence. Physical activity interventions that develop feelings of competence and independent choice in the patient may be more successful for long-term participation.

Developing image processing meta-algorithms with data mining of multiple metrics.

PubMed

Leung, Kelvin; Cunha, Alexandre; Toga, A W; Parker, D Stott

2014-01-01

People often use multiple metrics in image processing, but here we take a novel approach of mining the values of batteries of metrics on image processing results. We present a case for extending image processing methods to incorporate automated mining of multiple image metric values. Here by a metric we mean any image similarity or distance measure, and in this paper we consider intensity-based and statistical image measures and focus on registration as an image processing problem. We show how it is possible to develop meta-algorithms that evaluate different image processing results with a number of different metrics and mine the results in an automated fashion so as to select the best results. We show that the mining of multiple metrics offers a variety of potential benefits for many image processing problems, including improved robustness and validation.

Modeling the long-term effect of winter cover crops on nitrate transport in artificially drained fields across the Midwest U.S.

USDA-ARS?s Scientific Manuscript database

A fall-planted cover crop is a management practice with multiple benefits including reducing nitrate losses from artificially drained fields. We used the Root Zone Water Quality Model (RZWQM) to simulate the impact of a cereal rye cover crop on reducing nitrate losses from drained fields across five...

Wildlife Habitats in Managed Forests the Blue Mountains of Oregon and Washington

Treesearch

Jack Ward [Technical Editor] Thomas

1979-01-01

The Nation's forests are one of the last remaining natural habitats forterrestrial wildlife. Much of this vast forest resource has changed dramatically in the last 200 years and can no longer be considered wild. It is now managed for multiple use benefits, including timber production. Timber harvesting and roadbuilding now alter wildlife habitat more than any...

Strategies to achieve long-term benefits from multiple operational herbicide applications in lower coastal plain pine stands

Treesearch

Harold E. Quicke; Dwight K. Lauer

2010-01-01

Studies were installed on a range of soils to examine different post-plant herbaceous weed control timings following different site preparation timings with Chopper® herbicide. Chopper site preparation treatments were applied after bedding and included two application dates (August versus November). Pines were planted in winter following site preparation. Site...

Examining the Benefits and Challenges of Using Audience Response Systems: A Review of the Literature

ERIC Educational Resources Information Center

Kay, Robin H.; LeSage, Ann

2009-01-01

Audience response systems (ARSs) permit students to answer electronically displayed multiple choice questions using a remote control device. All responses are instantly presented, in chart form, then reviewed and discussed by the instructor and the class. A brief history of ARSs is offered including a discussion of the 26 labels used to identify…

Benefits, Challenges, and Perceptions of the Multiple Article Dissertation Format in Instructional Technology

ERIC Educational Resources Information Center

Thomas, Rebecca Arlene; West, Richard E.; Rich, Peter

2016-01-01

This study used survey data to investigate the benefits, challenges, perceptions, and current practices of the multiple article dissertation format in instructional technology. Online surveys were sent to current students, alumni, faculty, and department representatives of instructional technology programs, and data were analysed using qualitative…

Peer Assisted Study Sessions for Postgraduate International Students in Australia

ERIC Educational Resources Information Center

Zaccagnini, Melissa; Verenikina, Irina

2013-01-01

Peer Assisted Study Sessions (PASS), a peer led academic support program that has multiple documented academic, social, and transition benefits, is increasingly being utilised in Australian institutions. Whilst PASS has been evaluated from multiple angles in regard to the undergraduate cohort, there is limited research regarding the benefits of…

Multiple overlapping systematic reviews facilitate the origin of disputes: the case of thrombolytic therapy for pulmonary embolism.

PubMed

Riva, Nicoletta; Puljak, Livia; Moja, Lorenzo; Ageno, Walter; Schünemann, Holger; Magrini, Nicola; Squizzato, Alessandro

2018-05-01

To explore disagreements in multiple systematic reviews (SRs) assessing the benefit-to-harm ratio of thrombolytic therapy in patients with intermediate-risk pulmonary embolism (PE). MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Database of Abstracts and Reviews of Effectiveness were searched up to April 14, 2016. We included SRs and guidelines that evaluated thrombolytic therapy, compared with anticoagulation alone, in intermediate-risk PE. We calculated pooled risk ratio (RR) and absolute risk difference (RD), with interquartile range (IQR), for all-cause mortality, recurrent PE, and major bleeding. We marked the Pulmonary Embolism Thrombolysis trial, the largest trial, as a research milestone. Since its release in 2014, 12 SRs (2-15 included trials) and two major guidelines were published. Studies were concordant in reporting that thrombolysis reduced all-cause mortality (median RD -1.55%, IQR -1.60% to -1.40%; median RR 0.55, IQR 0.48-0.61). Discordant results were found for major bleeding (median RD 4.70%, IQR 0.90%-5.70%), with SRs reporting results in opposite directions. Relevant magnitude of effects and precision for benefits and harms were never prespecified. Fourteen evidence syntheses were published within 25 months. Conclusions suggested mortality reduction associated with thrombolytics. Therapy harm was more dispersed and alternatively considered. Interpretation of the benefit-to-harm ratio was elusive, and modest incremental advantages might or not be important, facilitating the origin of disputes. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating the multiple benefits of marine water quality improvements: how important are health risk reductions?

PubMed

Machado, Fernando S; Mourato, Susana

2002-07-01

Marine water pollution affects many recreational sites around the world. It has impacts not only on recreational activities but also on health risks for those who come into direct contact with the water. Few economic studies have explicitly considered the health risks of bathing in polluted marine waters and none have attempted to separate health benefits from other benefits of marine water quality improvements. This paper uses stated preference techniques to separately evaluate the multiple benefits of improving the quality of marine recreational waters at the Estoril Coast in Portugal. The results indicate that health risk reductions are only a small fraction of the total social benefits of water quality improvements.

Rapid Assessment of Ecosystem Service Co-Benefits of Biodiversity Priority Areas in Madagascar

PubMed Central

Andriamaro, Luciano; Cano, Carlos Andres; Grantham, Hedley S.; Hole, David; Juhn, Daniel; McKinnon, Madeleine; Rasolohery, Andriambolantsoa; Steininger, Marc; Wright, Timothy Max

2016-01-01

The importance of ecosystems for supporting human well-being is increasingly recognized by both the conservation and development sectors. Our ability to conserve ecosystems that people rely on is often limited by a lack of spatially explicit data on the location and distribution of ecosystem services (ES), the benefits provided by nature to people. Thus there is a need to map ES to guide conservation investments, to ensure these co-benefits are maintained. To target conservation investments most effectively, ES assessments must be rigorous enough to support conservation planning, rapid enough to respond to decision-making timelines, and often must rely on existing data. We developed a framework for rapid spatial assessment of ES that relies on expert and stakeholder consultation, available data, and spatial analyses in order to rapidly identify sites providing multiple benefits. We applied the framework in Madagascar, a country with globally significant biodiversity and a high level of human dependence on ecosystems. Our objective was to identify the ES co-benefits of biodiversity priority areas in order to guide the investment strategy of a global conservation fund. We assessed key provisioning (fisheries, hunting and non-timber forest products, and water for domestic use, agriculture, and hydropower), regulating (climate mitigation, flood risk reduction and coastal protection), and cultural (nature tourism) ES. We also conducted multi-criteria analyses to identify sites providing multiple benefits. While our approach has limitations, including the reliance on proximity-based indicators for several ES, the results were useful for targeting conservation investments by the Critical Ecosystem Partnership Fund (CEPF). Because our approach relies on available data, standardized methods for linking ES provision to ES use, and expert validation, it has the potential to quickly guide conservation planning and investment decisions in other data-poor regions. PMID:28006005

Risk-based zoning for urbanizing floodplains.

PubMed

Porse, Erik

2014-01-01

Urban floodplain development brings economic benefits and enhanced flood risks. Rapidly growing cities must often balance the economic benefits and increased risks of floodplain settlement. Planning can provide multiple flood mitigation and environmental benefits by combining traditional structural measures such as levees, increasingly popular landscape and design features (green infrastructure), and non-structural measures such as zoning. Flexibility in both structural and non-structural options, including zoning procedures, can reduce flood risks. This paper presents a linear programming formulation to assess cost-effective urban floodplain development decisions that consider benefits and costs of development along with expected flood damages. It uses a probabilistic approach to identify combinations of land-use allocations (residential and commercial development, flood channels, distributed runoff management) and zoning regulations (development zones in channel) to maximize benefits. The model is applied to a floodplain planning analysis for an urbanizing region in the Baja Sur peninsula of Mexico. The analysis demonstrates how (1) economic benefits drive floodplain development, (2) flexible zoning can improve economic returns, and (3) cities can use landscapes, enhanced by technology and design, to manage floods. The framework can incorporate additional green infrastructure benefits, and bridges typical disciplinary gaps for planning and engineering.

Decision Network for Blue Green Solutions to Influence Policy Impact Assessments

NASA Astrophysics Data System (ADS)

Mijic, A.; Theodoropoulos, G.; El Hattab, M. H.; Brown, K.

2017-12-01

Sustainable Urban Drainage Systems (SuDS) deliver ecosystems services that can potentially yield multiple benefits to the urban environment. These benefits can be achieved through optimising SUDS' integration with the local environment and water resources, creating so-called Blue Green Solutions (BGS). The BGS paradigm, however, presents several challenges, in particular quantifying the benefits and creating the scientific evidence-base that can persuade high-level decision-makers and stakeholders to implement BGS at large scale. This work presents the development of the easily implemented and tailored-made approach that allows a robust assessment of the BGS co-benefits, and can influence the types of information that are included in policy impact assessments. The Analytic Network Process approach is used to synthesise the available evidence on the co-benefits of the BGS. The approach enables mapping the interactions between individual BGS selection criteria, and creates a platform to assess the synergetic benefits that arise from components interactions. By working with Government departments and other public and private sector stakeholders, this work has produced a simple decision criteria-based network that will enable the co-benefits and trade-offs of BGS to be quantified and integrated into UK policy appraisals.

Benefit/cost comparison for utility SMES applications

NASA Astrophysics Data System (ADS)

Desteese, J. G.; Dagle, J. E.

1991-08-01

This paper summarizes eight case studies that account for the benefits and costs of superconducting magnetic energy storage (SMES) in system-specific utility applications. Four of these scenarios are hypothetical SMES applications in the Pacific Northwest, where relatively low energy costs impose a stringent test on the viability of the concept. The other four scenarios address SMES applications on high-voltage, direct-current (HVDC) transmission lines. While estimated SMES benefits are based on a previously reported methodology, this paper presents results of an improved cost-estimating approach that includes an assumed reduction in the cost of the power conditioning system (PCS) from approximately $160/kW to $80/kW. The revised approach results in all the SMES scenarios showing higher benefit/cost ratios than those reported earlier. However, in all but two cases, the value of any single benefit is still less than the unit's levelized cost. This suggests, as a general principle, that the total value of multiple benefits should always be considered if SMES is to appear cost effective in many utility applications. These results should offer utilities further encouragement to conduct more detailed analyses of SMES benefits in scenarios that apply to individual systems.

Medical Yoga Therapy

PubMed Central

Stephens, Ina

2017-01-01

Medical yoga is defined as the use of yoga practices for the prevention and treatment of medical conditions. Beyond the physical elements of yoga, which are important and effective for strengthening the body, medical yoga also incorporates appropriate breathing techniques, mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have shown that yoga can positively impact the body in many ways, including helping to regulate blood glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It also has been shown to have important psychological benefits, as the practice of yoga can help to increase mental energy and positive feelings, and decrease negative feelings of aggressiveness, depression and anxiety. PMID:28208599

Therapeutic potential of cannabis-related drugs.

PubMed

Alexander, Stephen P H

2016-01-04

In this review, I will consider the dual nature of Cannabis and cannabinoids. The duality arises from the potential and actuality of cannabinoids in the laboratory and clinic and the 'abuse' of Cannabis outside the clinic. The therapeutic areas currently best associated with exploitation of Cannabis-related medicines include pain, epilepsy, feeding disorders, multiple sclerosis and glaucoma. As with every other medicinal drug of course, the 'trick' will be to maximise the benefit and minimise the cost. After millennia of proximity and exploitation of the Cannabis plant, we are still playing catch up with an understanding of its potential influence for medicinal benefit. Copyright © 2015 Elsevier Inc. All rights reserved.

Exercise Benefits Coronary Heart Disease.

PubMed

Wang, Lei; Ai, Dongmei; Zhang, Ning

2017-01-01

Coronary heart disease (CHD) is a group of diseases that include: no symptoms, angina, myocardial infarction, ischemia cardiomyopathy and sudden cardiac death. And it results from multiple risks factors consisting of invariable factors (e.g. age, gender, etc.) and variable factors (e.g. dyslipidemia, hypertension, diabetes, smoking, etc.). Meanwhile, CHD could cause impact not only localized in the heart, but also on pulmonary function, whole-body skeletal muscle function, activity ability, psychological status, etc. Nowadays, CHD has been the leading cause of death in the world. However, many clinical researches showed that exercise training plays an important role in cardiac rehabilitation and can bring a lot of benefits for CHD patients.

Chapter 3: Assessing the Electric System Benefits of Clean Energy

EPA Pesticide Factsheets

Chapter 3 of Assessing the Multiple Benefits of Clean Energy presents detailed information about the energy system, specifically electricity benefits of clean energy, to help policy makers understand how to identify and assess these benefits based upon t

Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis

PubMed Central

Wiles, C; Newcombe, R; Fuller, K; Shaw, S; Furnival-Doran, J; Pickersgill, T; Morgan, A

2001-01-01

OBJECTIVES—To determine whether physiotherapy can improve mobility in chronic multiple sclerosis and whether there is a difference between treatment at home and as a hospital outpatient?
METHODS—A randomised controlled crossover trial was undertaken in patients with chronic multiple sclerosis who had difficulty walking and were referred from neurology clinics: allocation was to one of six permutations of three 8 week treatment periods separated by 8 week intervals: treatments consisted of physiotherapy at home, as an outpatient, or "no therapy". The main outcome measures were based on independent assessments at home and included mobility related disability (primary outcome: the Rivermead mobility index), gait impairments, arm function, mood, and subjective patient and carer ratings. Therapy was assessed by recording delivery, achievement of set targets, patient and carer preference, and cost.
RESULTS—On the Rivermead mobility index (scale 0-15) (primary outcome) there was a highly significant (p<0.001) treatment effect of 1.4-1.5 units favouring hospital or home based therapy over no therapy: this was supported by other measures of mobility, gait, balance, and the assessor's global "mobility change" score: there was no major difference between home and hospital. Carers preferred home treatment but neither they nor patients discerned greater benefit there. Estimated costs of home physiotherapy were £25/session and those at hospital were £18 (including £7 patient travel costs).
CONCLUSION—A course of physiotherapy is associated with improved mobility, subjective wellbeing, and improved mood in chronic multiple sclerosis compared with no treatment but benefit may only last a few weeks: there is little to choose between home and hospital based therapy but the first is more costly, mainly due to skilled staff travelling time.

 PMID:11160464

Addressing small sample size bias in multiple-biomarker trials: Inclusion of biomarker-negative patients and Firth correction.

PubMed

Habermehl, Christina; Benner, Axel; Kopp-Schneider, Annette

2018-03-01

In recent years, numerous approaches for biomarker-based clinical trials have been developed. One of these developments are multiple-biomarker trials, which aim to investigate multiple biomarkers simultaneously in independent subtrials. For low-prevalence biomarkers, small sample sizes within the subtrials have to be expected, as well as many biomarker-negative patients at the screening stage. The small sample sizes may make it unfeasible to analyze the subtrials individually. This imposes the need to develop new approaches for the analysis of such trials. With an expected large group of biomarker-negative patients, it seems reasonable to explore options to benefit from including them in such trials. We consider advantages and disadvantages of the inclusion of biomarker-negative patients in a multiple-biomarker trial with a survival endpoint. We discuss design options that include biomarker-negative patients in the study and address the issue of small sample size bias in such trials. We carry out a simulation study for a design where biomarker-negative patients are kept in the study and are treated with standard of care. We compare three different analysis approaches based on the Cox model to examine if the inclusion of biomarker-negative patients can provide a benefit with respect to bias and variance of the treatment effect estimates. We apply the Firth correction to reduce the small sample size bias. The results of the simulation study suggest that for small sample situations, the Firth correction should be applied to adjust for the small sample size bias. Additional to the Firth penalty, the inclusion of biomarker-negative patients in the analysis can lead to further but small improvements in bias and standard deviation of the estimates. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The Twenty-First Century Multiple Generation Workforce: Overlaps and Differences but Also Challenges and Benefits

ERIC Educational Resources Information Center

Helyer, Ruth; Lee, Dionne

2012-01-01

Purpose: The purpose of this paper is to explore the issues around a multiple generational workforce and more specifically, the challenges and benefits for education providers and employers. Design/methodology/approach: Reviewing research papers, analysing academic texts, interrogating market intelligence and contextualising case studies, the…

Anticancer Properties of Capsaicin Against Human Cancer.

PubMed

Clark, Ruth; Lee, Seong-Ho

2016-03-01

There is persuasive epidemiological and experimental evidence that dietary phytochemicals have anticancer activity. Capsaicin is a bioactive phytochemical abundant in red and chili peppers. While the preponderance of the data strongly indicates significant anticancer benefits of capsaicin, more information to highlight molecular mechanisms of its action is required to improve our knowledge to be able to propose a potential therapeutic strategy for use of capsaicin against cancer. Capsaicin has been shown to alter the expression of several genes involved in cancer cell survival, growth arrest, angiogenesis and metastasis. Recently, many research groups, including ours, found that capsaicin targets multiple signaling pathways, oncogenes and tumor-suppressor genes in various types of cancer models. In this review article, we highlight multiple molecular targets responsible for the anticancer mechanism of capsaicin. In addition, we deal with the benefits of combinational use of capsaicin with other dietary or chemotherapeutic compounds, focusing on synergistic anticancer activities. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Multiplicity of experimental approaches to therapy for genetic muscle diseases and necessity for population screening.

PubMed

Laing, Nigel G

2008-01-01

Currently a multiplicity of experimental approaches to therapy for genetic muscle diseases is being investigated. These include replacement of the missing gene, manipulation of the gene message, repair of the mutation, upregulation of an alternative gene and pharmacological interventions targeting a number of systems. A number of these approaches are in current clinical trials. There is considerable anticipation that perhaps more than one of the approaches will finally prove of clinical benefit, but there are many voices of caution. No matter which approaches might ultimately prove effective, there is a consensus that for most benefit to the patients it will be necessary to start treatment as early as possible. A consensus is also developing that the only way to do this is to implement population-based newborn screening to identify affected children shortly after birth. Population-based newborn screening is currently practised in very few places in the world and it brings with it implications for prevention rather than cure of genetic muscle diseases.

A Systematic Review of Nutritional Supplementation in HIV-Infected Children in Resource-Limited Settings.

PubMed

McHenry, Megan S; Dixit, Avika; Vreeman, Rachel C

2015-01-01

In resource-limited settings, malnutrition is the major cause of death in young children, but the precise benefits of nutritional supplementation for HIV-infected children are not well understood. Two researchers reviewed studies conducted in low- or middle-income countries that involved macro- and micronutrient supplementation in HIV-infected individuals ≤18 years. Fifteen studies focused on micronutrients, including vitamin A, zinc, multivitamins, and multiple-micronutrient supplementation. The 8 macronutrient studies focused on ready-to-use foods (4 studies), spirulina, whey protein, general food rations, and F75 and F100 starter formulas. Vitamin A was associated with improved mortality rates, ranging from 28% to 63%. Multiple-micronutrient supplementations were not associated with improvement of measured health outcomes. Ready-to-use foods were associated with improvement in certain anthropometrics. Periodic vitamin A supplementation is associated with reduced mortality. Macronutrient supplementation is linked to improved anthropometrics. More research is needed to determine how nutritional supplementation benefits this particularly vulnerable population. © The Author(s) 2014.

A Benefit-Risk Analysis Approach to Capture Regulatory Decision-Making: Multiple Myeloma.

PubMed

Raju, G K; Gurumurthi, Karthik; Domike, Reuben; Kazandjian, Dickran; Landgren, Ola; Blumenthal, Gideon M; Farrell, Ann; Pazdur, Richard; Woodcock, Janet

2018-01-01

Drug regulators around the world make decisions about drug approvability based on qualitative benefit-risk analysis. In this work, a quantitative benefit-risk analysis approach captures regulatory decision-making about new drugs to treat multiple myeloma (MM). MM assessments have been based on endpoints such as time to progression (TTP), progression-free survival (PFS), and objective response rate (ORR) which are different than benefit-risk analysis based on overall survival (OS). Twenty-three FDA decisions on MM drugs submitted to FDA between 2003 and 2016 were identified and analyzed. The benefits and risks were quantified relative to comparators (typically the control arm of the clinical trial) to estimate whether the median benefit-risk was positive or negative. A sensitivity analysis was demonstrated using ixazomib to explore the magnitude of uncertainty. FDA approval decision outcomes were consistent and logical using this benefit-risk framework. © 2017 American Society for Clinical Pharmacology and Therapeutics.

A look backward and forward in the regulatory and treatment history of multiple myeloma: Approval of novel-novel agents, new drug development, and longer patient survival.

PubMed

Kazandjian, Dickran; Landgren, Ola

2016-12-01

The past decade has seen significant advances in our understanding and treatment of multiple myeloma (MM) and its precursor diseases. These advances include gains in knowledge of the underlying pathobiology including molecular and cellular prognostic factors for disease progression. In parallel we have witnessed the availability of novel therapeutics. Together these advances have translated into improvements in long-term clinical benefit and survival in MM. Indeed, it has been shown that patients diagnosed in the last decade have experienced almost doubling of median survival time. We aim to review and give further insight into drug development and novel drug approvals that have revolutionized the treatment of MM. Published by Elsevier Inc.

Listening to food workers: Factors that impact proper health and hygiene practice in food service.

PubMed

Clayton, Megan L; Clegg Smith, Katherine; Neff, Roni A; Pollack, Keshia M; Ensminger, Margaret

2015-01-01

Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. To investigate food workers' perceptions of factors that impact proper food safety practice. Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice.

Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review.

PubMed

Finney, Andrew; Healey, Emma; Jordan, Joanne L; Ryan, Sarah; Dziedzic, Krysia S

2016-07-08

The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care. A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015. The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most promise used educational interventions delivered by GPs with reinforcement by practice nurses. There are currently very few studies that target multidisciplinary approaches suitable for OA across multiple joint sites, in primary care. A more consistent approach to outcome measurement in future studies of this nature should be considered to allow for better comparison.

The Benefits and Challenges of Multiple Health Behavior Change in Research and in Practice

PubMed Central

Prochaska, Judith J.; Nigg, Claudio R.; Spring, Bonnie; Velicer, Wayne F.; Prochaska, James O.

2009-01-01

Objective The major chronic diseases are caused by multiple risks, yet the science of multiple health behavior change (MHBC) is at an early stage, and factors that facilitate or impede scientists’ involvement in MHBC research are unknown. Benefits and challenges of MHBC interventions were investigated to strengthen researchers’ commitment and prepare them for challenges. Method An online anonymous survey was emailed to listservs of the Society of Behavioral Medicine between May 2006 and 2007. Respondents (N = 69) were 83% female; 94% held a doctoral degree; 64% were psychologists, 24% were in public health; 83% targeted MHBC in their work. Results A sample majority rated 23 of the 24 benefits, but only 1 of 31 challenge items, as very-to-extremely important. Those engaged in MHBC rated the total benefits significantly higher than respondents focused on single behaviors, F(1,69) = 4.21, p<.05, and rated the benefits significantly higher than the challenges: paired t(57) = 7.50, p<.001. The two groups did not differ in ratings of challenges. Conclusion It appears individuals focused solely on single behaviors do not fully appreciate the benefits that impress MHBC researchers; it is not that substantial barriers are holding them back. Benefits of MHBC interventions need emphasizing more broadly to advance this research area. PMID:19948184

Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis.

PubMed

Simpson, Robert; Simpson, Sharon; Wood, Karen; Mercer, Stewart W; Mair, Frances S

2018-01-01

Objectives To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable.

Effectiveness of transverse grooves in rigid pavement

NASA Astrophysics Data System (ADS)

Gurney, G. F.; Bryden, J. E.

1982-10-01

Transverse grooves were installed at 11 intersection approaches on worn rigid pavement to reduce a high rate of wet road accidents. In most cases, accident reductions were experienced only at intersections with multiple negative operational characteristics, including higher approach speeds, limited sight distances, and frequent vehicle stopping for turns or stop signs. Intersections with no more than one negative characteristic generally did not benefit from grooving.

Multimodal Sparse Coding for Event Detection

DTIC Science & Technology

2015-10-13

classification tasks based on single modality. We present multimodal sparse coding for learning feature representations shared across multiple modalities...The shared representa- tions are applied to multimedia event detection (MED) and evaluated in compar- ison to unimodal counterparts, as well as other...and video tracks from the same multimedia clip, we can force the two modalities to share a similar sparse representation whose benefit includes robust

Fitness consequences of female multiple mating: A direct test of indirect benefits

PubMed Central

2012-01-01

Background The observation that females mate multiply when males provide nothing but sperm - which sexual selection theory suggests is unlikely to be limiting - continues to puzzle evolutionary biologists. Here we test the hypothesis that multiple mating is prevalent under such circumstances because it enhances female fitness. We do this by allowing female Trinidadian guppies to mate with either a single male or with multiple males, and then tracking the consequences of these matings across two generations. Results Overall, multiply mated females produced 67% more F2 grand-offspring than singly mated females. These offspring, however, did not grow or mature faster, nor were they larger at birth, than F2 grand-offspring of singly mated females. Our results, however, show that multiple mating yields benefits to females in the form of an increase in the production of F1. The higher fecundity among multiply mated mothers was driven by greater production of sons but not daughters. However, contrary to expectation, individually, the offspring of multiply mated females do not grow at different rates than offspring of singly mated females, nor do any indirect fitness benefits or costs accrue to second-generation offspring. Conclusions The study provides strong evidence that multiple mating is advantageous to females, even when males contribute only sperm. This benefit is achieved through an increase in fecundity in the first generation, rather than through other fitness correlates such as size at birth, growth rate, time to sexual maturation and survival. Considered alongside previous work that female guppies can choose to mate with multiple partners, our results provide compelling evidence that direct fitness benefits underpin these mating decisions. PMID:22978442

Science@NASA: Direct to People Via the Internet

NASA Technical Reports Server (NTRS)

Koczor, R. J.; Phillips, T.; Whitaker, Ann F. (Technical Monitor)

2001-01-01

NASA's founding charter includes the requirement for reporting all scientific results to the public. This requirement is based on the principal that the exploration of space results in real benefits to humanity and that those benefits are to be shared as widely as practical. When NASA was founded, the traditional education and outreach methods were through the news media and the formal and informal (museums, planetariums exhibits, etc.) educational communities. With the nearly ubiquitous availability of the Internet, a third choice presents itself: communicating directly with individuals in their homes. This powerful approach offers benefits and pitfalls that must be addressed to be effective. This paper covers an integrated approach to providing high quality NASA research information to multiple audiences via a family of websites. The paper discuss the content generation, review, and production process and provide metrics on evaluating the results.

Developing Image Processing Meta-Algorithms with Data Mining of Multiple Metrics

PubMed Central

Cunha, Alexandre; Toga, A. W.; Parker, D. Stott

2014-01-01

People often use multiple metrics in image processing, but here we take a novel approach of mining the values of batteries of metrics on image processing results. We present a case for extending image processing methods to incorporate automated mining of multiple image metric values. Here by a metric we mean any image similarity or distance measure, and in this paper we consider intensity-based and statistical image measures and focus on registration as an image processing problem. We show how it is possible to develop meta-algorithms that evaluate different image processing results with a number of different metrics and mine the results in an automated fashion so as to select the best results. We show that the mining of multiple metrics offers a variety of potential benefits for many image processing problems, including improved robustness and validation. PMID:24653748

Benefits of the fire mitigation ecosystem service in the Great Dismal Swamp National Wildlife Refuge, Virginia, USA

USGS Publications Warehouse

Parthum, Bryan M.; Pindilli, Emily J.; Hogan, Dianna

2017-01-01

 The Great Dismal Swamp (GDS) National Wildlife Refuge delivers multiple ecosystem services, including air quality and human health via fire mitigation. Our analysis estimates benefits of this service through its potential to reduce catastrophic wildfire related impacts on the health of nearby human populations. We used a combination of high-frequency satellite data, ground sensors, and air quality indices to determine periods of public exposure to dense emissions from a wildfire within the GDS. We examined emergency department (ED) visitation in seven Virginia counties during these periods, applied measures of cumulative Relative Risk to derive the effects of wildfire smoke exposure on ED visitation rates, and estimated economic losses using regional Cost of Illness values established within the US Environmental Protection Agency BenMAP framework. Our results estimated the value of one avoided catastrophic wildfire in the refuge to be \\$3.69 million (2015 USD), or \\$306 per hectare of burn. Reducing the frequency or severity of extensive, deep burning peatland wildfire events has additional benefits not included in this estimate, including avoided costs related to fire suppression during a burn, carbon dioxide emissions, impacts to wildlife, and negative outcomes associated with recreation and regional tourism. We suggest the societal value of the public health benefits alone provides a significant incentive for refuge mangers to implement strategies that will reduce the severity of catastrophic wildfires.

Benefits of the fire mitigation ecosystem service in The Great Dismal Swamp National Wildlife Refuge, Virginia, USA.

PubMed

Parthum, Bryan; Pindilli, Emily; Hogan, Dianna

2017-12-01

The Great Dismal Swamp (GDS) National Wildlife Refuge delivers multiple ecosystem services, including air quality and human health via fire mitigation. Our analysis estimates benefits of this service through its potential to reduce catastrophic wildfire related impacts on the health of nearby human populations. We used a combination of high-frequency satellite data, ground sensors, and air quality indices to determine periods of public exposure to dense emissions from a wildfire within the GDS. We examined emergency department (ED) visitation in seven Virginia counties during these periods, applied measures of cumulative Relative Risk to derive the effects of wildfire smoke exposure on ED visitation rates, and estimated economic losses using regional Cost of Illness values established within the US Environmental Protection Agency BenMAP framework. Our results estimated the value of one avoided catastrophic wildfire in the refuge to be $3.69 million (2015 USD), or $306 per hectare of burn. Reducing the frequency or severity of extensive, deep burning peatland wildfire events has additional benefits not included in this estimate, including avoided costs related to fire suppression during a burn, carbon dioxide emissions, impacts to wildlife, and negative outcomes associated with recreation and regional tourism. We suggest the societal value of the public health benefits alone provides a significant incentive for refuge mangers to implement strategies that will reduce the severity of catastrophic wildfires. Published by Elsevier Ltd.

Cross-platform learning: on the nature of children's learning from multiple media platforms.

PubMed

Fisch, Shalom M

2013-01-01

It is increasingly common for an educational media project to span several media platforms (e.g., TV, Web, hands-on materials), assuming that the benefits of learning from multiple media extend beyond those gained from one medium alone. Yet research typically has investigated learning from a single medium in isolation. This paper reviews several recent studies to explore cross-platform learning (i.e., learning from combined use of multiple media platforms) and how such learning compares to learning from one medium. The paper discusses unique benefits of cross-platform learning, a theoretical mechanism to explain how these benefits might arise, and questions for future research in this emerging field. Copyright © 2013 Wiley Periodicals, Inc., A Wiley Company.

Experimental realization of entanglement in multiple degrees of freedom between two quantum memories.

PubMed

Zhang, Wei; Ding, Dong-Sheng; Dong, Ming-Xin; Shi, Shuai; Wang, Kai; Liu, Shi-Long; Li, Yan; Zhou, Zhi-Yuan; Shi, Bao-Sen; Guo, Guang-Can

2016-11-14

Entanglement in multiple degrees of freedom has many benefits over entanglement in a single one. The former enables quantum communication with higher channel capacity and more efficient quantum information processing and is compatible with diverse quantum networks. Establishing multi-degree-of-freedom entangled memories is not only vital for high-capacity quantum communication and computing, but also promising for enhanced violations of nonlocality in quantum systems. However, there have been yet no reports of the experimental realization of multi-degree-of-freedom entangled memories. Here we experimentally established hyper- and hybrid entanglement in multiple degrees of freedom, including path (K-vector) and orbital angular momentum, between two separated atomic ensembles by using quantum storage. The results are promising for achieving quantum communication and computing with many degrees of freedom.

Demographic, genetic, and environmental factors that modify disease course.

PubMed

Marrie, Ruth Ann

2011-05-01

As with susceptibility to disease, it is likely that multiple factors interact to influence the phenotype of multiple sclerosis and long-term disease outcomes. Such factors may include genetic factors, socioeconomic status, comorbid diseases, and health behaviors, as well as environmental exposures. An improved understanding of the influence of these factors on disease course may reap several benefits, such as improved prognostication, allowing us to tailor disease management with respect to intensity of disease-modifying therapies and changes in specific health behaviors, in the broad context of coexisting health issues. Such information can facilitate appropriately adjusted comparisons within and between populations. Elucidation of these factors will require careful study of well-characterized populations in which the roles of multiple factors are considered simultaneously. Copyright © 2011 Elsevier Inc. All rights reserved.

High-Performance, Radiation-Hardened Electronics for Space and Lunar Environments

NASA Technical Reports Server (NTRS)

Keys, Andrew S.; Adams, James H.; Cressler, John D.; Darty, Ronald C.; Johnson, Michael A.; Patrick, Marshall C.

2008-01-01

The Radiation Hardened Electronics for Space Environments (RHESE) project develops advanced technologies needed for high performance electronic devices that will be capable of operating within the demanding radiation and thermal extremes of the space, lunar, and Martian environment. The technologies developed under this project enhance and enable avionics within multiple mission elements of NASA's Vision for Space Exploration. including the Constellation program's Orion Crew Exploration Vehicle. the Lunar Lander project, Lunar Outpost elements, and Extra Vehicular Activity (EVA) elements. This paper provides an overview of the RHESE project and its multiple task tasks, their technical approaches, and their targeted benefits as applied to NASA missions.

Psychological determinants of exercise behavior of nursing students.

PubMed

Chan, Joanne Chung-Yan

2014-01-01

Though expected to be role models in health promotion, research has shown that nursing students often have suboptimal exercise behavior. This study explored the psychological factors associated with the exercise behavior of nursing students. A total of 195 first-year undergraduate nursing students completed a cross-sectional quantitative survey questionnaire, which included measures of their exercise behavior, the Physical Exercise Self-efficacy Scale, and the Exercise Barriers/Benefits Scale. The results showed that male students spent more time exercising and had higher exercise self-efficacy compared with female students, but there were no gender differences in the perceived barriers to or benefits of exercise. Fatigue brought on by exercising was the greatest perceived barrier to exercise, whereas increasing physical fitness and mental health were the greatest perceived benefits of exercise. Multiple linear regression showed that gender, exercise self-efficacy, perceived barriers to exercise, and perceived benefits of exercise were independent predictors of exercise behavior. Nurse educators can endeavor to promote exercise behavior among nursing students by highlighting the specific benefits of exercise, empowering students to overcome their perceived barriers to exercise, and enhancing students' exercise self-efficacy.

Barriers and benefits to using mobile health technology after operation: A qualitative study.

PubMed

Abelson, Jonathan S; Kaufman, Elinore; Symer, Matthew; Peters, Alexander; Charlson, Mary; Yeo, Heather

2017-09-01

Recently, mobile health technology has emerged as a promising avenue for improving physician-patient communication and patient outcomes. The objective of our study was to determine the public's perception of barriers and benefits to using mobile health technology technologies to enhance recovery after operation. We used the Empire State Poll to ask 2 open-ended questions to 800 participants assessing their perceptions of benefits and barriers to use mobile health technology after operation. All responses were coded independently, and any discrepancies were resolved by consensus. We used grounded theory to allow themes to arise from the codes. Interrater reliability was calculated using Cohen's Kappa. Participants identified a range of possible barriers to using mobile health technology apps after operation including: protecting personal health information, technology effectiveness and failure, preference for face-to-face interaction with their surgeon, level of effort required, and ability of the older adults to navigate mobile health technology. Participants identified multiple possible benefits including: better monitoring, improved communication with their surgeon, minimizing follow-up visits, improved convenience, and increased patient knowledge. In the study, 15% of all respondents stated there were no barriers whereas 6% stated there were no benefits. Participants were receptive to the many potential benefits of this technology to enhance not only their relationships with providers and the convenience of access, but also their health outcomes. We must address participants concerns about data security and their fears of losing a personal relationship with their doctor. Copyright © 2017 Elsevier Inc. All rights reserved.

Physical, Psychological and Emotional Benefits of Green Physical Activity: An Ecological Dynamics Perspective.

PubMed

Yeh, Hsiao-Pu; Stone, Joseph Antony; Churchill, Sarah May; Wheat, Jonathan Stephen; Brymer, Eric; Davids, Keith

2016-07-01

Increasing evidence supports the multiple benefits to physical, psychological and emotional wellbeing of green physical activity, a topic of increasing interest in the past decade. Research has revealed a synergistic benefit of green physical activity, which includes all aspects of exercise and physical activity in the presence of nature. Our theoretical analysis suggests there are three distinct levels of engagement in green physical activity, with each level reported to have a positive effect on human behaviours. However, the extent to which each level of green physical activity benefits health and wellbeing is assumed to differ, requiring confirmation in future research. This elucidation of understanding is needed because previous literature has tended to focus on recording empirical evidence rather than developing a sound theoretical framework to understand green physical activity effects. Here we propose an ecological dynamics rationale to explain how and why green physical activity might influence health and wellbeing of different population groups. This framework suggests a number of unexplored, interacting constraints related to types of environment and population groups, which shape reported levels of benefit of green physical activity. Further analysis is needed to clarify the explicit relationship between green physical activity and health and wellbeing, including levels of engagement, types of environmental constraints, levels of physical activity, adventure effects, skill effects and sampling of different populations.

The effects of Tai Chi on physical and psychosocial function among persons with multiple sclerosis: A systematic review.

PubMed

Taylor, Emily; Taylor-Piliae, Ruth E

2017-04-01

Conduct a systematic review to evaluate the effects of Tai Chi on physical and psychosocial function among individuals with Multiple Sclerosis. An electronic literature search of 12 databases using controlled vocabulary function and keywords from inception through August 2016. All Tai Chi intervention studies assessing physical and psychosocial function among persons with Multiple Sclerosis were included. Study quality was scored using an established tool examining 16 study elements (range=0-32). A total of 91 articles were retrieved, with 3 additional articles identified through reviewing bibliographies of relevant articles. A total of 8 studies (randomized controlled trials, n=3; quasi-experimental, n=5) enrolled 193 participants with Multiple Sclerosis. Studies were conducted in the USA (n=3), Europe (n=3), Iran, (n=1), and India (n=1). A total of 3 studies reported using the Yang style of Tai Chi (not specified, n=5 studies). The Tai Chi intervention averaged 27 sessions over 11 weeks. Study quality scores for the randomized controlled trials had a mean score of 23 (range 19-26), while quality scores for quasi-experimental studies had a mean score of 20 (range 13-26). Overall, participants enrolled in Tai Chi had better balance, gait and flexibility, less fatigue and depression, and better quality of life after the intervention; though mixed results were reported. The results indicate that Tai Chi is likely safe and may provide physical and psychosocial benefits in individuals with Multiple Sclerosis. Further research is needed using more rigorous study designs to assess the benefits of Tai Chi for individuals with Multiple Sclerosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Courses without classrooms.

PubMed

Boyer, S A

1999-01-01

There is an alternative to classroom lecture that provides faster, more complete instruction and introduces the learner to clinical application of skills in a safe environment. This teaching style uses multiple media to present professional, published resources that provide excellent quality, topic-specific information. The benefits of this type of teaching/learning module include improved use of student and instructor time, scheduling advantages, increased learning, revenue generation potential, and student empowerment. With this approach, a strong, sound educational base is built, and each course includes some degree or form of clinical application as a key component.

Imaging Evaluation of Acute Traumatic Brain Injury

PubMed Central

Mutch, Christopher A.; Talbott, Jason F.; Gean, Alisa

2016-01-01

SYNOPSIS Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Imaging plays an important role in the evaluation, diagnosis, and triage of patients with TBI. Recent studies suggest that it will also help predict patient outcomes. TBI consists of multiple pathoanatomical entities. Here we review the current state of TBI imaging including its indications, benefits and limitations of the modalities, imaging protocols, and imaging findings for each these pathoanatomic entities. We also briefly survey advanced imaging techniques, which include a number of promising areas of TBI research. PMID:27637393

Assessing the patient's mammogram experience.

PubMed

Dodendorf, Diane M; Deogun, Gurvinder K; Rodie, Amy Risch; Pol, Louis G

2004-01-01

This study overviews an operational blueprint that diagrams the activities and interactions of all participants in a typical screening mammography appointment in a large medical center. The blueprint is constructed from multiple sources of data collected from mammography patients, service providers in the radiology department, and medical records. The benefits from using patient perspectives, the insights gained from the blueprint development process, and the value of the resulting screening mammography appointment blueprint are included.

CEAP watershed assessments: accomplishments and opportunities for new advances

Treesearch

Lisa Durlancik; Mark Walbridge; Deanna Osmond; Roberta Parry

2016-01-01

The Conservation Effects Assessment Project (CEAP) was established in 2003 to document the effects and benefits of conservation practices. CEAP conducts assessments at multiple scales – national, regional, and watershed scale – on croplands, grazing lands and wetlands, and to address wildlife concerns. A major part of CEAP since its inception included a collection of...

Barriers and Facilitators Related to Participation in Aquafitness Programs for People with Multiple Sclerosis

PubMed Central

Kitchen, Kaitlyn; Nicoll, Kaley

2012-01-01

Exercise and leisure activities provide physical and psychosocial benefits to people with multiple sclerosis (MS) and can enhance their quality of life. In Winnipeg, Manitoba, Canada, people with MS have reported barriers to their participation in local MS-specific aquafitness (AF) programs. Therefore, a formal exploration of the accessibility of local AF programs for people with MS was undertaken. The purpose of this phenomenological study was to identify factors that facilitate or impede participation in AF programs by individuals with MS living in Winnipeg. Qualitative data were collected from a total of eight participants through one focus group (n = 7) and one in-depth interview (n = 1). The sample consisted of individuals with MS who were currently participating in AF programming as well as those who were not. Data were audio-recorded and transcribed verbatim, and thematic analysis was completed. Seven themes emerged regarding factors affecting participation in local AF programs. Barriers to participation included inadequate transportation, lack of one-on-one support, environmental inaccessibility, and fears associated with participation in the programs. Facilitators of participation included a knowledgeable instructor and experiencing physical and psychosocial benefits from the program. Information from this study was used locally to advocate for people with MS in order to increase participation in local AF programming. PMID:24453744

Comparative Evaluation of Financing Programs: Insights From California’s Experience

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

Deason, Jeff

Berkeley Lab examines criteria for a comparative assessment of multiple financing programs for energy efficiency, developed through a statewide public process in California. The state legislature directed the California Alternative Energy and Advanced Transportation Financing Authority (CAEATFA) to develop these criteria. CAEATFA's report to the legislature, an invaluable reference for other jurisdictions considering these topics, discusses the proposed criteria and the rationales behind them in detail. Berkeley Lab's brief focuses on several salient issues that emerged during the criteria development and discussion process. Many of these issues are likely to arise in other states that plan to evaluate the impactsmore » of energy efficiency financing programs, whether for a single program or multiple programs. Issues discussed in the brief include: -The stakeholder process to develop the proposed assessment criteria -Attribution of outcomes - such as energy savings - to financing programs vs. other drivers -Choosing the outcome metric of primary interest: program take-up levels vs. savings -The use of net benefits vs. benefit-cost ratios for cost-effectiveness evaluation -Non-energy factors -Consumer protection factors -Market transformation impacts -Accommodating varying program goals in a multi-program evaluation -Accounting for costs and risks borne by various parties, including taxpayers and utility customers, in cost-effectiveness analysis -How to account for potential synergies among programs in a multi-program evaluation« less

Refractory Pain Management in Amyloid-Associated Peripheral Neuropathy.

PubMed

Warner, Nafisseh S; Watson, James C; Bendel, Markus A; Moeschler, Susan M

2018-05-01

Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief. Scrambler therapy, a novel electrical stimulation modality, was used and was associated with substantial short-term but nonsustained benefit. Spinal cord stimulation was considered, but given his diffuse symptoms, it was deemed a less-than-optimal approach. Ultimately, an intrathecal drug delivery system was placed with infusion of hydromorphone, resulting in substantial pain reduction in all involved areas and with an improved adverse effect profile. This intervention resulted in immense improvement in the patient's quality of life, despite progression of his systemic amyloidosis. Severe pain in the setting of amyloid neuropathy is often difficult to treat. To our knowledge, this represents the first report of Scrambler therapy or an implanted intrathecal drug delivery system used for a patient with refractory amyloidosis-related neuropathic pain, resulting in substantial analgesic benefit and improved quality of life.

A Framework for Assessing the Value of Investments in Nonclinical Prevention

PubMed Central

Roehrig, Charles; Russo, Pamela

2015-01-01

We present a high-level framework to show the process by which an investment in primary prevention produces value. We define primary prevention broadly to include investments in any of the determinants of health. Although it builds on previously developed frameworks, ours incorporates several additional features. It distinguishes direct and upstream determinants of health, a distinction that can help identify, describe, and track the impact of a policy or program on health and health care costs. It recognizes multiple dimensions of value, including the need to establish the nonhealth value of investments whose objectives are not limited to improvements in health (and whose costs should not be attributed solely to the health benefits). Finally, it emphasizes the need to describe value from the perspectives of the multiple stakeholders that can influence such investments. PMID:26652216

A Framework for Assessing the Value of Investments in Nonclinical Prevention.

PubMed

Miller, George; Roehrig, Charles; Russo, Pamela

2015-12-10

We present a high-level framework to show the process by which an investment in primary prevention produces value. We define primary prevention broadly to include investments in any of the determinants of health. Although it builds on previously developed frameworks, ours incorporates several additional features. It distinguishes direct and upstream determinants of health, a distinction that can help identify, describe, and track the impact of a policy or program on health and health care costs. It recognizes multiple dimensions of value, including the need to establish the nonhealth value of investments whose objectives are not limited to improvements in health (and whose costs should not be attributed solely to the health benefits). Finally, it emphasizes the need to describe value from the perspectives of the multiple stakeholders that can influence such investments.

How PV system ownership can impact the market value of residential homes

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

Klise, Geoffrey Taylor; Johnson, Jamie L.

2014-01-01

There are multiple ways for a homeowner to obtain the electricity generating and savings benefits offered by a photovoltaic (PV) system. These include purchasing a PV system through various financing mechanisms, or by leasing the PV system from a third party with multiple options that may include purchase, lease renewal or PV system removal. The different ownership options available to homeowners presents a challenge to appraisal and real estate professionals during a home sale or refinance in terms of how to develop a value that is reflective of the PV systems operational characteristics, local market conditions, and lender and underwritermore » requirements. This paper presents these many PV system ownership options with a discussion of what considerations an appraiser must make when developing the contributory value of a PV system to a residential property.« less

New life to an old treatment: pegylated Interferon beta 1a in the management of multiple sclerosis.

PubMed

Ortiz, Miguel Angel; Espino-Paisan, Laura; Nunez, Concepcion; Alvarez-Lafuente, Roberto; Urcelay, Elena

2018-02-25

In the 1990s, the betainterferons and glatiramer acetate were introduced for treating relapsing-remitting multiple sclerosis. These medications have a demonstrated record of efficacy and safety, although they require frequent administration via injection and are only partially effective. The optimization of treatment in patients who do not respond adequately to this first-line therapy is essential for attaining the best long-term outcomes. Switching to the recently approved emergent therapies is a strategy to consider for treatment of patients with a suboptimal response. This review summarizes the mechanisms of action, clinical benefits, and safety profiles of current multiple sclerosis disease-modifying therapies, including highly efficacious monoclonal antibodies or convenient oral therapies. Although the first-line interferon beta exhibits a favorable benefit-to-risk profile, treatment compliance is compromised potentially due to its known adverse events and frequent injectable administration. Less frequent dosing and improved pharmacological properties have been achieved by reaction of interferon beta with chemically activated polyethylene glycol. Provided that none of the available therapies shows better effectiveness for all outcomes and their safety in clinical practice is a fundamental concern, the pegylated form of interferon beta seems to keep its place as a competitive therapeutic option. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models

PubMed Central

Eason, Christianne M.; Mazerolle, Stephanie M.; Goodman, Ashley

2017-01-01

Context: Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. Objective: To investigate the perceived benefits of and barriers in the medical and academic models. Design: Qualitative study. Setting: National Collegiate Athletic Association Divisions I, II, and III. Patients or Other Participants: A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. Data Collection and Analysis: We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. Results: In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). Conclusions: The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties. PMID:27977302

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models.

PubMed

Eason, Christianne M; Mazerolle, Stephanie M; Goodman, Ashley

2017-01-01

 Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models.  To investigate the perceived benefits of and barriers in the medical and academic models.  Qualitative study.  National Collegiate Athletic Association Divisions I, II, and III.  A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models.  We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility.  In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative).  The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

Multiple-hypothesis multiple-model line tracking

NASA Astrophysics Data System (ADS)

Pace, Donald W.; Owen, Mark W.; Cox, Henry

2000-07-01

Passive sonar signal processing generally includes tracking of narrowband and/or broadband signature components observed on a Lofargram or on a Bearing-Time-Record (BTR) display. Fielded line tracking approaches to date have been recursive and single-hypthesis-oriented Kalman- or alpha-beta filters, with no mechanism for considering tracking alternatives beyond the most recent scan of measurements. While adaptivity is often built into the filter to handle changing track dynamics, these approaches are still extensions of single target tracking solutions to multiple target tracking environment. This paper describes an application of multiple-hypothesis, multiple target tracking technology to the sonar line tracking problem. A Multiple Hypothesis Line Tracker (MHLT) is developed which retains the recursive minimum-mean-square-error tracking behavior of a Kalman Filter in a maximum-a-posteriori delayed-decision multiple hypothesis context. Multiple line track filter states are developed and maintained using the interacting multiple model (IMM) state representation. Further, the data association and assignment problem is enhanced by considering line attribute information (line bandwidth and SNR) in addition to beam/bearing and frequency fit. MHLT results on real sonar data are presented to demonstrate the benefits of the multiple hypothesis approach. The utility of the system in cluttered environments and particularly in crossing line situations is shown.

Unpacking the great transmission debate

NASA Astrophysics Data System (ADS)

Denning, Kathryn

2010-12-01

The debate about the wisdom of sending interstellar transmissions is well-known to those involved in SETI, and frustrating for many. Its tendency towards intractability is a result of multiple factors, including: different models of the scientist's role as citizen and/or leader; disparate ideas about society's readiness to cope with frontier science; variable political substrates, particularly ideas concerning individual freedom and state control; competing ideologies of globalization; and the perceived relative risks and benefits of contact. (Variations in the latter, i.e. assessments of the risks and benefits of contact, derive partly from different thinking styles, including tolerance for risk, and partly from inferences based upon episodes of biological and cultural contact on Earth.) Unpacking the debate into its components may be of use to those debating policy about SETI transmissions, or at the very least, help keep in focus what, precisely, the perennial arguments are really about.

Delegation in Long-term Care: Scope of practice or job description?

PubMed Central

Corazzini, Kirsten N.; Anderson, Ruth A.; Rapp, Carla Gene; Mueller, Christine; McConnell, Eleanor S.; Lekan, Deborah

2010-01-01

This study is a qualitative, descriptive study of how registered nurses (RNs) (N=33) in leadership roles in institutionalized long-term care settings delegate care, including their strategies and processes for delegating care, and their perceptions of barriers to effective delegation and potential benefits of delegation. Findings indicate two key approaches to delegation, including the “follow the job description” approach, emphasizing adherence to facility-level roles and job descriptions, and the “consider the scope of practice” approach, emphasizing consideration of multiple aspects of scope of practice and licensure, and the context of care. While the former resulted in more clarity and certainty for the RN, the latter facilitated a focus on quality of resident care outcomes as linked to the delegation process. Barriers to effective delegation were comparable among RNs using either approach to delegation, and almost all RNs could describe benefits of delegation for long-term care. PMID:25006330

Delegation in Long-term Care: Scope of practice or job description?

PubMed

Corazzini, Kirsten N; Anderson, Ruth A; Rapp, Carla Gene; Mueller, Christine; McConnell, Eleanor S; Lekan, Deborah

2010-05-31

This study is a qualitative, descriptive study of how registered nurses (RNs) (N=33) in leadership roles in institutionalized long-term care settings delegate care, including their strategies and processes for delegating care, and their perceptions of barriers to effective delegation and potential benefits of delegation. Findings indicate two key approaches to delegation, including the "follow the job description" approach, emphasizing adherence to facility-level roles and job descriptions, and the "consider the scope of practice" approach, emphasizing consideration of multiple aspects of scope of practice and licensure, and the context of care. While the former resulted in more clarity and certainty for the RN, the latter facilitated a focus on quality of resident care outcomes as linked to the delegation process. Barriers to effective delegation were comparable among RNs using either approach to delegation, and almost all RNs could describe benefits of delegation for long-term care.

The pedagogical potential of drawing and writing in a primary science multimodal unit

NASA Astrophysics Data System (ADS)

Wilson, Rachel E.; Bradbury, Leslie U.

2016-11-01

In consideration of the potential of drawing and writing as assessment and learning tools, we explored how early primary students used these modes to communicate their science understandings. The context for this study was a curricular unit that incorporated multiple modes of representation in both the presentation of information and production of student understanding with a focus on the structure and function of carnivorous plants (CPs). Two science teacher educators and two first-grade teachers in the United States co-planned and co-taught a multimodal science unit on CP structure and function that included multiple representations of Venus flytraps (VFTs): physical specimens, photographs, videos, text, and discussions. Pre- and post-assessment student drawings and writings were statistically compared to note significant changes, and pre- and post-assessment writings were qualitatively analysed to note themes in student ideas. Results indicate that students increased their knowledge of VFT structure and function and synthesised information from multiple modes. While students included more structures of the VFT in their drawings, they were better able to describe the functions of structures in their writings. These results suggest the benefits for student learning and assessment of having early primary students represent their science understandings in multiple modes.

Data Fusion in Wind Tunnel Testing; Combined Pressure Paint and Model Deformation Measurements (Invited)

NASA Technical Reports Server (NTRS)

Bell, James H.; Burner, Alpheus W.

2004-01-01

As the benefit-to-cost ratio of advanced optical techniques for wind tunnel measurements such as Video Model Deformation (VMD), Pressure-Sensitive Paint (PSP), and others increases, these techniques are being used more and more often in large-scale production type facilities. Further benefits might be achieved if multiple optical techniques could be deployed in a wind tunnel test simultaneously. The present study discusses the problems and benefits of combining VMD and PSP systems. The desirable attributes of useful optical techniques for wind tunnels, including the ability to accommodate the myriad optical techniques available today, are discussed. The VMD and PSP techniques are briefly reviewed. Commonalties and differences between the two techniques are discussed. Recent wind tunnel experiences and problems when combining PSP and VMD are presented, as are suggestions for future developments in combined PSP and deformation measurements.

Comparing the effects of different land management strategies across several land types on California's landscape carbon and associated greenhouse gas budgets

NASA Astrophysics Data System (ADS)

Di Vittorio, A. V.; Simmonds, M.; Nico, P. S.

2017-12-01

Land-based carbon sequestration and GreenHouse Gas (GHG) reduction strategies are often implemented in small patches and evaluated independently from each other, which poses several challenges to determining their potential benefits at the regional scales at which carbon/GHG targets are defined. These challenges include inconsistent methods, uncertain scalability to larger areas, and lack of constraints such as land ownership and competition among multiple strategies. To address such challenges we have developed an integrated carbon and GHG budget model of California's entire landscape, delineated by geographic region, land type, and ownership. This empirical model has annual time steps and includes net ecosystem carbon exchange, wildfire, multiple forest management practices including wood and bioenergy production, cropland and rangeland soil management, various land type restoration activities, and land cover change. While the absolute estimates vary considerably due to uncertainties in initial carbon densities and ecosystem carbon exchange rates, the estimated effects of particular management activities with respect to baseline are robust across these uncertainties. Uncertainty in land use/cover change data is also critical, as different rates of shrubland to grassland conversion can switch the system from a carbon source to a sink. The results indicate that reducing urban area expansion has substantial and consistent benefits, while the effects of direct land management practices vary and depend largely on the available management area. Increasing forest fuel reduction extent over the baseline contributes to annual GHG costs during increased management, and annual benefits after increased management ceases. Cumulatively, it could take decades to recover the cost of 14 years of increased fuel reduction. However, forest carbon losses can be completely offset within 20 years through increases in urban forest fraction and marsh restoration. Additionally, highly uncertain black carbon estimates dominate the overall GHG budget due to wildfire, forest management, and bioenergy production. Overall, this tool is well suited for exploring suites of management options and extents throughout California in order to quantify potential regional carbon sequestration and GHG emission benefits.

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

PubMed

Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

2016-01-20

Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Score Increase and Partial-Credit Validity When Administering Multiple-Choice Tests Using an Answer-Until-Correct Format

ERIC Educational Resources Information Center

Slepkov, Aaron D.; Vreugdenhil, Andrew J.; Shiell, Ralph C.

2016-01-01

There are numerous benefits to answer-until-correct (AUC) approaches to multiple-choice testing, not the least of which is the straightforward allotment of partial credit. However, the benefits of granting partial credit can be tempered by the inevitable increase in test scores and by fears that such increases are further contaminated by a large…

Experimental realization of entanglement in multiple degrees of freedom between two quantum memories

PubMed Central

Zhang, Wei; Ding, Dong-Sheng; Dong, Ming-Xin; Shi, Shuai; Wang, Kai; Liu, Shi-Long; Li, Yan; Zhou, Zhi-Yuan; Shi, Bao-Sen; Guo, Guang-Can

2016-01-01

Entanglement in multiple degrees of freedom has many benefits over entanglement in a single one. The former enables quantum communication with higher channel capacity and more efficient quantum information processing and is compatible with diverse quantum networks. Establishing multi-degree-of-freedom entangled memories is not only vital for high-capacity quantum communication and computing, but also promising for enhanced violations of nonlocality in quantum systems. However, there have been yet no reports of the experimental realization of multi-degree-of-freedom entangled memories. Here we experimentally established hyper- and hybrid entanglement in multiple degrees of freedom, including path (K-vector) and orbital angular momentum, between two separated atomic ensembles by using quantum storage. The results are promising for achieving quantum communication and computing with many degrees of freedom. PMID:27841274

A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence.

PubMed

Ohly, Heather; Gentry, Sarah; Wigglesworth, Rachel; Bethel, Alison; Lovell, Rebecca; Garside, Ruth

2016-03-25

School gardening programmes are increasingly popular, with suggested benefits including healthier eating and increased physical activity. Our objectives were to understand the health and well-being impacts of school gardens and the factors that help or hinder their success. We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181). We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative evidence used to produce a conceptual framework to illustrate how benefits might be accrued. Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on volunteers were thought to threaten success, while involvement with local communities and integration of gardening activities into the school curriculum were thought to support success. More robust quantitative research is needed to convincingly support the qualitative evidence suggesting wide ranging benefits from school gardens.

Oncology patient-reported claims: maximising the chance for success.

PubMed

Kitchen, H; Rofail, D; Caron, M; Emery, M-P

2011-01-01

To review Patient Reported Outcome (PRO) labelling claims achieved in oncology in Europe and in the United States and consider the benefits, and challenges faced. PROLabels database was searched to identify oncology products with PRO labelling approved in Europe since 1995 or in the United States since 1998. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) websites and guidance documents were reviewed. PUBMED was searched for articles on PRO claims in oncology. Among all oncology products approved, 22 were identified with PRO claims; 10 in the United States, 7 in Europe, and 5 in both. The language used in the labelling was limited to benefit (e.g. "…resulted in symptom benefits by significantly prolonging time to deterioration in cough, dyspnoea, and pain, versus placebo") and equivalence (e.g. "no statistical differences were observed between treatment groups for global QoL"). Seven products used a validated HRQoL tool; two used symptom tools; two used both; seven used single-item symptom measures (one was unknown). The following emerged as likely reasons for success: ensuring systematic PRO data collection; clear rationale for pre-specified endpoints; adequately powered trials to detect differences and clinically significant changes; adjusting for multiplicity; developing an a priori statistical analysis plan including primary and subgroup analyses, dealing with missing data, pooling multiple-site data; establishing clinical versus statistical significance; interpreting failure to detect change. End-stage patient drop-out rates and cessation of trials due to exceptional therapeutic benefit pose significant challenges to demonstrating treatment PRO improvement. PRO labelling claims demonstrate treatment impact and the trade-off between efficacy and side effects ultimately facilitating product differentiation. Reliable and valid instruments specific to the desired language, claim, and target population are required. Practical considerations include rationale for study endpoints, transparency in assumptions, and attention to subtle variations in data.

Oncology patient-reported claims: maximising the chance for success

PubMed Central

Kitchen, H; Rofail, D; Caron, M; Emery, M-P

2011-01-01

Objectives/purpose: To review Patient Reported Outcome (PRO) labelling claims achieved in oncology in Europe and in the United States and consider the benefits, and challenges faced. Methods: PROLabels database was searched to identify oncology products with PRO labelling approved in Europe since 1995 or in the United States since 1998. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) websites and guidance documents were reviewed. PUBMED was searched for articles on PRO claims in oncology. Results: Among all oncology products approved, 22 were identified with PRO claims; 10 in the United States, 7 in Europe, and 5 in both. The language used in the labelling was limited to benefit (e.g. “…resulted in symptom benefits by significantly prolonging time to deterioration in cough, dyspnoea, and pain, versus placebo”) and equivalence (e.g. “no statistical differences were observed between treatment groups for global QoL”). Seven products used a validated HRQoL tool; two used symptom tools; two used both; seven used single-item symptom measures (one was unknown). The following emerged as likely reasons for success: ensuring systematic PRO data collection; clear rationale for pre-specified endpoints; adequately powered trials to detect differences and clinically significant changes; adjusting for multiplicity; developing an a priori statistical analysis plan including primary and subgroup analyses, dealing with missing data, pooling multiple-site data; establishing clinical versus statistical significance; interpreting failure to detect change. End-stage patient drop-out rates and cessation of trials due to exceptional therapeutic benefit pose significant challenges to demonstrating treatment PRO improvement. Conclusions: PRO labelling claims demonstrate treatment impact and the trade-off between efficacy and side effects ultimately facilitating product differentiation. Reliable and valid instruments specific to the desired language, claim, and target population are required. Practical considerations include rationale for study endpoints, transparency in assumptions, and attention to subtle variations in data. PMID:22276055

The perceived benefits and barriers to exercise participation in persons with multiple sclerosis.

PubMed

Stroud, Nicole; Minahan, Clare; Sabapathy, Surendran

2009-01-01

The purpose of this study was to examine the perceived benefits and barriers to exercise participation in persons with multiple sclerosis (MS). A cross-sectional postal survey comprised of 93 adults with MS was conducted. Participants completed the Exercise Benefits and Barriers Scale (EBBS), Spinal Cord Injury Exercise Self-Efficacy Scale (EXSE), Multiple Sclerosis Impact Scale, Disease Steps Scale and International Physical Activity Questionnaire. Forty-three percent of the participants were classified as exercising individuals (EX group) as compared with non-exercising individuals (non-EX group). Participants in the EX group reported significantly higher scores on the EBBS and EXSE. Items related to physical performance and personal accomplishment were cited as the greatest perceived benefits to exercise participation and those items related to physical exertion as the greatest perceived barriers to both the EX and non-EX groups. When compared with previous studies conducted in the general population, the participants in the present study reported different perceived barriers to exercise participation. Furthermore, awareness of the benefits of physical activity is not sufficient to promote exercise participation in persons with MS. Perceived exercise self-efficacy is shown to play an important role in promoting exercise participation in persons with MS.

Science and Technology (S and T) Roadmap Collaboration between SMC, NASA, and Government Partners

NASA Technical Reports Server (NTRS)

Betser, Joseph; Ewart, Roberta; Chandler, Faith

2016-01-01

National Security Space (NSS) presents multi-faceted S and T challenges. We must continually innovate enterprise and information management; provide decision support; develop advanced materials; enhance sensor technology; transform communication technology; develop advanced propulsion and resilient space architectures and capabilities; and enhance multiple additional S and T domains. These challenges are best met by leveraging advanced S and T research and technology development from a number of DoD agencies and civil agencies such as NASA. The authors of this paper have engaged in these activities since 2006 and over the past decade developed multiple strategic S and T relationships. This paper highlights the Office of the Space Missile Systems Center (SMC) Chief Scientist (SMC/ST) collaboration with the NASA Office of Chief Technologist (NASA OCT), which has multiple S and T activities that are relevant to NSS. In particular we discuss the development of the Technology Roadmaps that benefit both Civil Space and NSS. Our collaboration with NASA OCT has been of mutual benefit to multiple participants. Some of the other DoD components include the Defense Advanced Research Projects agency (DARPA), Air Force Research Laboratory (AFRL), Naval Research Laboratory (NRL), The USAF Office of Chief Scientist, the USAF Science Advisory Board (SAB), Space and Naval Warfare Systems Command (SPAWAR), and a number of other services and agencies. In addition, the human talent is a key enabler of advanced S and T activities; it is absolutely critical to have a strong supply of talent in the fields of Science Technology, Engineering, and Mathematics (STEM). Consequently, we continually collaborate with the USAF Institute of Technology (AFIT), other service academies and graduate schools, and other universities and colleges. This paper highlights the benefits that result from such strategic S and T partnerships and recommends a way forward that will continually build upon these achievements into the future.

Considerations for multiple hypothesis correlation on tactical platforms

NASA Astrophysics Data System (ADS)

Thomas, Alan M.; Turpen, James E.

2013-05-01

Tactical platforms benefit greatly from the fusion of tracks from multiple sources in terms of increased situation awareness. As a necessary precursor to this track fusion, track-to-track association, or correlation, must first be performed. The related measurement-to-track fusion problem has been well studied with multiple hypothesis tracking and multiple frame assignment methods showing the most success. The track-to-track problem differs from this one in that measurements themselves are not available but rather track state update reports from the measuring sensors. Multiple hypothesis, multiple frame correlation systems have previously been considered; however, their practical implementation under the constraints imposed by tactical platforms is daunting. The situation is further exacerbated by the inconvenient nature of reports from legacy sensor systems on bandwidth- limited communications networks. In this paper, consideration is given to the special difficulties encountered when attempting the correlation of tracks from legacy sensors on tactical aircraft. Those difficulties include the following: covariance information from reporting sensors is frequently absent or incomplete; system latencies can create temporal uncertainty in data; and computational processing is severely limited by hardware and architecture. Moreover, consideration is given to practical solutions for dealing with these problems in a multiple hypothesis correlator.

Ensuring Payload Safety in Missions with Special Partnerships

NASA Technical Reports Server (NTRS)

Staubus, Calvert A.; Willenbring, Rachel C.; Blankenship, Michael D.

2016-01-01

The National Aeronautics and Space Administration (NASA) Expendable Launch Vehicle (ELV) payload space flight missions involve cooperative work between NASA and partners including spacecraft (or payload) contractors, universities, nonprofit research centers, Agency payload organization, Range Safety organization, Agency launch service organizations, and launch vehicle contractors. The role of NASA's Safety and Mission Assurance (SMA) Directorate is typically fairly straightforward, but when a mission's partnerships become more complex, to realize cost and science benefits (e.g., multi-agency payload(s) or cooperative international missions), the task of ensuring payload safety becomes much more challenging. This paper discusses lessons learned from NASA safety professionals working multiple-agency missions and offers suggestions to help fellow safety professionals working multiple-agency missions.

Multifunctional benefits of SuDS: techno-economic evaluation of decentralised solutions for urban water management

NASA Astrophysics Data System (ADS)

Mijic, Ana; Ossa-Moreno, Juan; Smith, Karl M.

2016-04-01

The increased frequency of extreme weather events associated with climate change poses a significant threat to the integrity and function of critical urban infrastructure - rail, road, telecommunications, power and water supply/sewerage networks. A key threat within the United Kingdom (UK) is the increased risk of pluvial flooding; the conventional approach of channeling runoff to an outfall has proven to be unsustainable during severe storm events. Green infrastructure, in the form of Sustainable Urban Drainage Systems (SuDS), has been proposed as a means of minimising the risk of pluvial flooding. However, despite their technical performance, SuDS uptake in the UK has not reached its full capacity yet, mostly due to reasons that go beyong the engineering realm. This work investigated the strategic role of SuDS retrofit in managing environmental risks to urban infrastructure in London at a catchment level, through an economic appraisal of multifunctional benefits. It was found that by including the multifunctional benefits of SuDS, the economic feasibility of the project improves considerably. The case study has also shown a mechanism towards achieving wider-scale SuDS retrofit, whereby the investments are split amongst multiple stakeholder groups by highlighting the additional benefits each group derives. Groups include water utilities and their users, local government and critical infrastructure owners. Finally, limitations to the existing cost-benefit methdology in the UK were identified, and recommendations made regarding incentives and governmental regulations to enhance the uptake of SuDS in London. The proposed methodology provides compelling and robust, cost-benefit based evidence of SUDS' effectiveness within the flood risk management planning framework, but also with regard to the additional benefits of Nature Based Solutions in urban environments.

Climate and Health Impacts of US Emissions Reductions Consistent with 2 C

NASA Technical Reports Server (NTRS)

Shindell, Drew T.; Lee, Yunha; Faluvegi, Greg

2016-01-01

An emissions trajectory for the US consistent with 2 C warming would require marked societal changes, making it crucial to understand the associated benefits. Previous studies have examined technological potentials and implementation costs and public health benefits have been quantified for less-aggressive potential emissions-reduction policies, but researchers have not yet fully explored the multiple benefits of reductions consistent with 2 C. We examine the impacts of such highly ambitious scenarios for clean energy and vehicles. US transportation emissions reductions avoid approx.0.03 C global warming in 2030 (0.15 C in 2100), whereas energy emissions reductions avoid approx.0.05-0.07 C 2030 warming (approx.0.25 C in 2100). Nationally, however, clean energy policies produce climate disbenefits including warmer summers (although these would be eliminated by the remote effects of similar policies if they were undertaken elsewhere). The policies also greatly reduce damaging ambient particulate matter and ozone. By 2030, clean energy policies could prevent approx.175,000 premature deaths, with approx.22,000 (11,000-96,000; 95% confidence) fewer annually thereafter, whereas clean transportation could prevent approx.120,000 premature deaths and approx.14,000 (9,000-52,000) annually thereafter. Near-term national benefits are valued at approx.US$250 billion (140 billion to 1,050billion) per year, which is likely to exceed implementation costs. Including longer-term, worldwide climate impacts, benefits roughly quintuple, becoming approx.5-10 times larger than estimated implementation costs. Achieving the benefits, however, would require both larger and broader emissions reductions than those in current legislation or regulations.

Incremental benefit of 3D transesophageal echocardiography: a case of a mass overlying a prosthetic mitral valve.

PubMed

Tauras, James M; Zhang, Zhihang; Taub, Cynthia C

2011-05-01

A young woman with a mechanical mitral valve and prosthetic mitral stenosis underwent multiple imaging modalities (including transthoracic ECHO, fluoroscopy, and two-dimensional transesophageal ECHO) to determine the cause of her stenosis. Only three-dimensional transesophageal echocardiography demonstrated the full size and extent of an obstructing mass on the strut and sewing ring of the prosthetic mitral valve. © 2011, Wiley Periodicals, Inc.

Neuropsychiatric development: two case reports about the use of dietary fish oils and/or choline supplementation in children.

PubMed

Woodbury, M M; Woodbury, M A

1993-06-01

Choline supplementation has been used with moderate success in subgroups of adult patients with neuropsychiatric and medical problems. The dietary fish oils have also been used in adults with hypercholesterolemia. We report on two young children with multiple neurodevelopmental delays, one who responded to choline and eicosapentaenoic acid, and the other to choline alone. A brief discussion about choline's metabolic pathways and benefits is included.

The Role of Herbs and Spices in Cancer Prevention

PubMed Central

Kaefer, Christine M.; Milner, John A.

2009-01-01

Historically herbs and spices have enjoyed a rich tradition of use for their flavor-enhancement characteristics and for their medicinal properties. The rising prevalence of chronic diseases world-wide and the corresponding rise in health care costs is propelling interest among researchers and the public for these food related items for multiple health benefits, including a reduction in cancer risk and modification of tumor behavior. A growing body of epidemiological and preclinical evidence points to culinary herbs and spices as minor dietary constituents with multiple anticancer characteristics. This review focuses on the anti-microbial, antioxidant, and anti-tumorigenic properties of herbs and spices, their ability to influence carcinogen bioactivation, and likely anticancer contributions. While culinary herbs and spices present intriguing possibilities for health promotion, more complete information is needed about the actual exposures to dietary components that are needed to bring about a response and the molecular target(s) for specific herbs and spices. Only after this information is obtained will it be possible to define appropriate intervention strategies to achieve maximum benefits from herbs and spices without eliciting ill-consequences. PMID:18499033

Use of a medication passport in a disabled child seen across many care settings

PubMed Central

Jubraj, Barry; Blair, Mitchel

2015-01-01

Written information for patients about their medicines has demonstrable benefits for their understanding and adherence. In the UK, no single, complete record of medications for individual patients can be guaranteed. Therefore, patients and carers are often relied on to recall the complete medication list, which can be a challenge given multiple and potentially stressful appointments. Wide-ranging feedback suggests that a medication ‘passport’ developed by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West London (NIHR CLAHRC NWL) has benefited elderly patients, who often attend many appointments where the current medication list may not be available. We describe the use of this passport (known as ‘My Medication Passport’—MMP) in a child with multiple disabilities. The practical advantages are explored, including the potential for a paediatric version to facilitate discussions around the administration of medicines. MMP is an early example of a useful tool to help children and young people, parents and carers to manage medicines more effectively. PMID:25716039

Use of a medication passport in a disabled child seen across many care settings.

PubMed

Jubraj, Barry; Blair, Mitchel

2015-02-25

Written information for patients about their medicines has demonstrable benefits for their understanding and adherence. In the UK, no single, complete record of medications for individual patients can be guaranteed. Therefore, patients and carers are often relied on to recall the complete medication list, which can be a challenge given multiple and potentially stressful appointments. Wide-ranging feedback suggests that a medication 'passport' developed by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West London (NIHR CLAHRC NWL) has benefited elderly patients, who often attend many appointments where the current medication list may not be available. We describe the use of this passport (known as 'My Medication Passport'--MMP) in a child with multiple disabilities. The practical advantages are explored, including the potential for a paediatric version to facilitate discussions around the administration of medicines. MMP is an early example of a useful tool to help children and young people, parents and carers to manage medicines more effectively. 2015 BMJ Publishing Group Ltd.

Proactive conservation management of an island-endemic bird species in the face of global change

USGS Publications Warehouse

Morrison, S.A.; Sillett, T. Scott; Ghalambor, Cameron K.; Fitzpatrick, J.W.; Graber, D.M.; Bakker, V.J.; Bowman, R.; Collins, C.T.; Collins, P.W.; Delaney, K.S.; Doak, D.F.; Koenig, Walter D.; Laughrin, L.; Lieberman, A.A.; Marzluff, J.M.; Reynolds, M.D.; Scott, J.M.; Stallcup, J.A.; Vickers, W.; Boyce, W.M.

2011-01-01

Biodiversity conservation in an era of global change and scarce funding benefits from approaches that simultaneously solve multiple problems. Here, we discuss conservation management of the island scrub-jay (Aphelocoma insularis), the only island-endemic passerine species in the continental United States, which is currently restricted to 250-square-kilometer Santa Cruz Island, California. Although the species is not listed as threatened by state or federal agencies, its viability is nonetheless threatened on multiple fronts. We discuss management actions that could reduce extinction risk, including vaccination, captive propagation, biosecurity measures, and establishing a second free-living population on a neighboring island. Establishing a second population on Santa Rosa Island may have the added benefit of accelerating the restoration and enhancing the resilience of that island's currently highly degraded ecosystem. The proactive management framework for island scrub-jays presented here illustrates how strategies for species protection, ecosystem restoration, and adaptation to and mitigation of climate change can converge into an integrated solution. ?? 2011 by American Institute of Biological Sciences. All rights reserved.

Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary?

PubMed Central

Peeken, Jan C.; Vaupel, Peter; Combs, Stephanie E.

2017-01-01

Hyperthermia (HT) is one of the hot topics that have been discussed over decades. However, it never made its way into primetime. The basic biological rationale of heat to enhance the effect of radiation, chemotherapeutic agents, and immunotherapy is evident. Preclinical work has confirmed this effect. HT may trigger changes in perfusion and oxygenation as well as inhibition of DNA repair mechanisms. Moreover, there is evidence for immune stimulation and the induction of systemic immune responses. Despite the increasing number of solid clinical studies, only few centers have included this adjuvant treatment into their repertoire. Over the years, abundant prospective and randomized clinical data have emerged demonstrating a clear benefit of combined HT and radiotherapy for multiple entities such as superficial breast cancer recurrences, cervix carcinoma, or cancers of the head and neck. Regarding less investigated indications, the existing data are promising and more clinical trials are currently recruiting patients. How do we proceed from here? Preclinical evidence is present. Multiple indications benefit from additional HT in the clinical setting. This article summarizes the present evidence and develops ideas for future research. PMID:28713771

Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space

PubMed Central

McCaffrey, Nikki; Agar, Meera; Harlum, Janeane; Karnon, Jonathon; Currow, David; Eckermann, Simon

2015-01-01

Introduction Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses—where outcomes are considered separately, with their joint relationship under uncertainty ignored—lead to incorrect inference regarding preferred strategies. Objective The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Methods Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. Results Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home ( 1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Conclusion Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and multiple effects under uncertainty across potential threshold values for effect, better informing net benefit assessment and related reimbursement and research decisions. PMID:25751629

Fertility Preservation for Pediatric Patients: Current State and Future Possibilities.

PubMed

Johnson, Emilie K; Finlayson, Courtney; Rowell, Erin E; Gosiengfiao, Yasmin; Pavone, Mary Ellen; Lockart, Barbara; Orwig, Kyle E; Brannigan, Robert E; Woodruff, Teresa K

2017-07-01

This review provides an overview of pediatric fertility preservation. Topics covered include the patient populations who could benefit, the current state of fertility preservation options and research, and considerations related to ethics and program development. A broad Embase® and PubMed® search was performed to identify publications discussing investigational, clinical, ethical and health care delivery issues related to pediatric fertility preservation. Relevant publications were reviewed and summarized. Populations who could benefit from fertility preservation in childhood/adolescence include oncology patients, patients with nononcologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development and transgender individuals. Peripubertal and postpubertal fertility preservation options are well established and include cryopreservation of oocytes, embryos or sperm. Prepubertal fertility preservation is experimental. Multiple lines of active research aim to develop technologies that will enable immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision making and the fact that fertility preservation procedures can be considered not medically necessary. Successful multidisciplinary fertility preservation care teams emphasize partnerships with adult colleagues, prioritize timely consultations and use standardized referral processes. Some aspects of fertility preservation are not covered by insurance and out-of-pocket costs can be prohibitive. Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide pediatric fertility preservation services, an appreciation for relevant ethical issues and cost. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Listening to food workers: Factors that impact proper health and hygiene practice in food service

PubMed Central

Clegg Smith, Katherine; Neff, Roni A.; Pollack, Keshia M.; Ensminger, Margaret

2015-01-01

Background Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. Objective To investigate food workers' perceptions of factors that impact proper food safety practice. Method Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Results Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Conclusion Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice. PMID:26243248

Meeting report: Estimating the benefits of reducing hazardous air pollutants--summary of 2009 workshop and future considerations.

PubMed

Gwinn, Maureen R; Craig, Jeneva; Axelrad, Daniel A; Cook, Rich; Dockins, Chris; Fann, Neal; Fegley, Robert; Guinnup, David E; Helfand, Gloria; Hubbell, Bryan; Mazur, Sarah L; Palma, Ted; Smith, Roy L; Vandenberg, John; Sonawane, Babasaheb

2011-01-01

Quantifying the benefits of reducing hazardous air pollutants (HAPs, or air toxics) has been limited by gaps in toxicological data, uncertainties in extrapolating results from high-dose animal experiments to estimate human effects at lower doses, limited ambient and personal exposure monitoring data, and insufficient economic research to support valuation of the health impacts often associated with exposure to individual air toxics. To address some of these issues, the U.S. Environmental Protection Agency held the Workshop on Estimating the Benefits of Reducing Hazardous Air Pollutants (HAPs) in Washington, DC, from 30 April to 1 May 2009. Experts from multiple disciplines discussed how best to move forward on air toxics benefits assessment, with a focus on developing near-term capability to conduct quantitative benefits assessment. Proposed methodologies involved analysis of data-rich pollutants and application of this analysis to other pollutants, using dose-response modeling of animal data for estimating benefits to humans, determining dose-equivalence relationships for different chemicals with similar health effects, and analysis similar to that used for criteria pollutants. Limitations and uncertainties in economic valuation of benefits assessment for HAPS were discussed as well. These discussions highlighted the complexities in estimating the benefits of reducing air toxics, and participants agreed that alternative methods for benefits assessment of HAPs are needed. Recommendations included clearly defining the key priorities of the Clean Air Act air toxics program to identify the most effective approaches for HAPs benefits analysis, focusing on susceptible and vulnerable populations, and improving dose-response estimation for quantification of benefits.

Retrieval Practice Benefits Deductive Inference

ERIC Educational Resources Information Center

Eglington, Luke G.; Kang, Sean H. K.

2018-01-01

Retrieval practice has been shown to benefit learning. However, the benefit has sometimes been attenuated with more complex materials that require integrating multiple units of information. Critically, Tran et al. "Psychonomic Bulletin & Review, 22," 135-140 (2015) found that retrieval practice improves sentence memory but not the…

Conceptual Learning with Multiple Graphical Representations: Intelligent Tutoring Systems Support for Sense-Making and Fluency-Building Processes

ERIC Educational Resources Information Center

Rau, Martina A.

2013-01-01

Most learning environments in the STEM disciplines use multiple graphical representations along with textual descriptions and symbolic representations. Multiple graphical representations are powerful learning tools because they can emphasize complementary aspects of complex learning contents. However, to benefit from multiple graphical…

Upgrading Existing Buildings to Universal Design. What Cost-Benefit Analyses Can Tell Us.

PubMed

Aslaksen, Finn

2016-01-01

This article is based on a project aimed at finding the benefits of different measures to upgrade existing public buildings and outdoor areas to be accessible for all. The study was initiated by The Ministry of Children and Equality. The ministry asked for a study of benefits based on a stated preferences (SP) method and an easy-to-complete calculation tool for CBA. In the project 18 commonly used measures and their typical costs were identified. The benefits of each measure were analysed in a stated preference study. The SP analyses included 9 multiple choices in 4 different sequences in an Internet based survey with 800 respondents. The project concluded that it is possible to use stated preferences survey to identify the respondent's valuation of measures to improve accessibility in existing buildings. Some of the measures have a high cost-/benefit ratio. The project report including the calculation manual is based on the average valuation for each measure. But in the background analyses (not referred in the report) there are also some analyses of valuations for target groups for the various measures. The target groups were defined for each measure based on information about the respondents' abilities and use of technical aids. The analyses presented in this paper indicate how valuation varies between the target groups and the average population. This is named the measures profile. Some measures have benefits for the target group that are only twice as high as for the average citizen while another type of measures has high benefits only the target group. The first type which has a wide profile often has high overall socioeconomic benefits, while the last group with a narrow profile more often has low overall socioeconomic benefits, but may be very important for certain user groups and therefore essential for the elimination of discrimination and exclusion of those groups.

Community-based school feeding during Indonesia's economic crisis: implementation, benefits, and sustainability.

PubMed

Studdert, Lisa J; Soekirman; Rasmussen, Kathleen M; Habicht, Jean-Pierre

2004-06-01

The Indonesian Government initiated a community-based national school-feeding program in 1996. Implementation was decentralized and involved multiple participants. In 1998 we evaluated the implementation of the program and the perceived benefits for community stakeholders using a survey of principals in 143 randomly selected schools and follow-up with in-depth interviews and observations in a subsample of 16 communities. The evaluation covered the period of the 1998 Asian economic crisis, affording the opportunity to assess its impact on the program. The program was implemented in all targeted schools, with excellent community participation. Feeding was sustained through the crisis, in spite of a dramatic escalation in food costs. The families of schoolchildren, farmers, and those who prepared food received economic benefits. The snacks replaced those sold at schools and were of better nutritional value. The children benefited because the snacks compensated for losses in the home diet resulting from the economic crisis. Characteristics of the program that may be important in explaining its success include the involvement of a range of community stakeholders, engagement with existing village administrative structures, scope for local community adaptation and innovation, and the use of local foods that dispersed benefits and ensured sustained implementation during the crisis.

Effects of threat management interactions on conservation priorities.

PubMed

Auerbach, Nancy A; Wilson, Kerrie A; Tulloch, Ayesha I T; Rhodes, Jonathan R; Hanson, Jeffrey O; Possingham, Hugh P

2015-12-01

Decisions need to be made about which biodiversity management actions are undertaken to mitigate threats and about where these actions are implemented. However, management actions can interact; that is, the cost, benefit, and feasibility of one action can change when another action is undertaken. There is little guidance on how to explicitly and efficiently prioritize management for multiple threats, including deciding where to act. Integrated management could focus on one management action to abate a dominant threat or on a strategy comprising multiple actions to abate multiple threats. Furthermore management could be undertaken at sites that are in close proximity to reduce costs. We used cost-effectiveness analysis to prioritize investments in fire management, controlling invasive predators, and reducing grazing pressure in a bio-diverse region of southeastern Queensland, Australia. We compared outcomes of 5 management approaches based on different assumptions about interactions and quantified how investment needed, benefits expected, and the locations prioritized for implementation differed when interactions were taken into account. Managing for interactions altered decisions about where to invest and in which actions to invest and had the potential to deliver increased investment efficiency. Differences in high priority locations and actions were greatest between the approaches when we made different assumptions about how management actions deliver benefits through threat abatement: either all threats must be managed to conserve species or only one management action may be required. Threatened species management that does not consider interactions between actions may result in misplaced investments or misguided expectations of the effort required to mitigate threats to species. © 2015 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of Society for Conservation Biology.

Comparison of the abbreviated minimal assessment of cognitive function in multiple sclerosis (aMACFIMS) and the brief international cognitive assessment for multiple sclerosis (BICAMS).

PubMed

Gromisch, Elizabeth S; Portnoy, Jeffrey G; Foley, Frederick W

2018-05-15

Cognitive impairment is a prevalent and often intrusive problem among persons with multiple sclerosis (PwMS). Valid and reliable assessments, including quick screening measures, are crucial. The Brief International Cognitive Assessment for MS (BICAMS) was developed for this reason. While it lends itself to use in locations where formal neuropsychological resources might be limited, it does not include measures of verbal fluency or executive functioning, domains assessed as part of the Minimal Assessment of Cognitive Function in MS (MACFIMS). Given previous evidence that shortened MACFIMS measures have strong criterion validity, this study aimed to determine which of these should be included in the abbreviated MACFIMS (aMACFIMS), and how the aMACFIMS compares to the BICAMS. One hundred forty-seven PwMS were included in the analyses. A stepwise logistic regression was used to determine the measures in the aMACFIMS. Receiver-operating-characteristic (ROC) curves assessed the classification accuracy, sensitivity, and specificity. The batteries' sensitivity, specificity, and predictive values were then compared. Compared to the BICAMS, the final aMACFIMS had higher specificity (87% versus 72%) and positive predictive value (86% versus 77%), but lower sensitivity (71% versus 81%). The aMACFIMS has several benefits, including reduced administration time and the addition of a verbal fluency/executive functioning measure. Copyright © 2018 Elsevier B.V. All rights reserved.

Exercise in the management of type 2 diabetes mellitus: what are the benefits and how does it work?

PubMed

Duclos, Martine; Virally, Marie-Laure; Dejager, Sylvie

2011-05-01

In this article, we examine the results from meta-analyses of studies that have focused on the effects of supervised exercise in patients with established type 2 diabetes mellitus. Exercise has been clearly demonstrated to have benefits on blood glucose control (average reduction of glycated hemoglobin, 0.6%) and cardiovascular risk factors. These benefits are observed independently of any change in body mass index and fat mass, and are also seen in older populations. Multiple mechanisms are involved, and the improved insulin-sensitizing effect of exercise training is not restricted to muscle but extends to hepatic and adipose tissue. However, while the benefits of exercise in type 2 diabetes management are undisputable, it is not as easy to draw correlations between clinical benefit and the amount of physical activity included in daily life. Recent studies have shown encouraging results with moderate increases in physical activity, which are feasible for most patients and are sufficient to induce sustained positive changes for 2 years. Thus, the benefits of structured and supervised exercise in patients with type 2 diabetes have been consistently demonstrated. Currently, the primary challenge is to determine how long-term increased physical activity can be durably implemented in a patient's daily life.

7 CFR 718.6 - Controlled substance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MARKETING QUOTAS, ACREAGE ALLOTMENTS, AND PRODUCTION ADJUSTMENT PROVISIONS APPLICABLE TO MULTIPLE PROGRAMS... four succeeding crop years, for any of the following USDA benefits: (i) Any payments or benefits under...

Economic Benefits of Green Infrastructure in Lancaster PA

EPA Pesticide Factsheets

This document outlines technical assistance for demonstrating how accounting for the multiple benefits of green infrastructure can provide a more complete assessment of infrastructure and community investments.

Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study.

PubMed

Swendeman, Dallas; Ramanathan, Nithya; Baetscher, Laura; Medich, Melissa; Scheffler, Aaron; Comulada, W Scott; Estrin, Deborah

2015-05-01

Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants. Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.

Chapter 4: Assessing the Air Pollution, Greenhouse Gas, Air Quality, and Health Benefits of Clean Energy Initiatives

EPA Pesticide Factsheets

Chapter 4 of Assessing the Multiple Benefits of Clean Energy helps state states understand the methods, models, opportunities, and issues associated with assessing the GHG, air pollution, air quality, and human health benefits of clean energy options.

Development of Antimicrobial Competencies and Training for Staff Hospital Pharmacists

PubMed Central

Crader, Marsha F.

2014-01-01

Antimicrobial stewardship is an important component in health care outcomes of all patients. Many institutions are seeking the best methods to incorporate antimicrobial stewardship strategies into their hospitals including pharmacy services. Multiple factors should be considered when beginning or expanding an antimicrobial stewardship program. The purpose of this article is to discuss the development of basic antibiotic competencies and training for staff pharmacists in a community hospital. The article includes an assessment of pharmacists’ knowledge pre education and post education, perception of benefits from an antibiotic education program, and learning needs and preferences. PMID:24421561

Performance of advanced missions using fusion propulsion

NASA Technical Reports Server (NTRS)

Friedlander, Alan; Mcadams, Jim; Schulze, Norm

1989-01-01

A quantitive evaluation of the premise that nuclear fusion propulsion offers benefits as compared to other propulsion technologies for carrying out a program of advanced exploration of the solar system and beyond is presented. Using a simplified analytical model of trajectory performance, numerical results of mass requirements versus trip time are given for robotic missions beyond the solar system that include flyby and rendezvous with the Oort cloud of comets and with the star system Alpha Centauri. Round trip missions within the solar system, including robotic sample returns from the outer planet moons and multiple asteroid targets, and manned Mars exploration are also described.

Multiple Benefits.

ERIC Educational Resources Information Center

Kreider, Beth

1997-01-01

Discusses the benefits of dome architecture for a community's middle- and high-school multi-purpose facility. The dome construction is revealed as being cost effective in construction and in maintenance and energy costs. (GR)

A counterfactual p-value approach for benefit-risk assessment in clinical trials.

PubMed

Zeng, Donglin; Chen, Ming-Hui; Ibrahim, Joseph G; Wei, Rachel; Ding, Beiying; Ke, Chunlei; Jiang, Qi

2015-01-01

Clinical trials generally allow various efficacy and safety outcomes to be collected for health interventions. Benefit-risk assessment is an important issue when evaluating a new drug. Currently, there is a lack of standardized and validated benefit-risk assessment approaches in drug development due to various challenges. To quantify benefits and risks, we propose a counterfactual p-value (CP) approach. Our approach considers a spectrum of weights for weighting benefit-risk values and computes the extreme probabilities of observing the weighted benefit-risk value in one treatment group as if patients were treated in the other treatment group. The proposed approach is applicable to single benefit and single risk outcome as well as multiple benefit and risk outcomes assessment. In addition, the prior information in the weight schemes relevant to the importance of outcomes can be incorporated in the approach. The proposed CPs plot is intuitive with a visualized weight pattern. The average area under CP and preferred probability over time are used for overall treatment comparison and a bootstrap approach is applied for statistical inference. We assess the proposed approach using simulated data with multiple efficacy and safety endpoints and compare its performance with a stochastic multi-criteria acceptability analysis approach.

Multiple and variable speed electrical generator systems for large wind turbines

NASA Technical Reports Server (NTRS)

Andersen, T. S.; Hughes, P. S.; Kirschbaum, H. S.; Mutone, G. A.

1982-01-01

A cost effective method to achieve increased wind turbine generator energy conversion and other operational benefits through variable speed operation is presented. Earlier studies of multiple and variable speed generators in wind turbines were extended for evaluation in the context of a specific large sized conceptual design. System design and simulation have defined the costs and performance benefits which can be expected from both two speed and variable speed configurations.

Nutraceuticals against Neurodegeneration: A Mechanistic Insight.

PubMed

Dadhania, Vivekkumar P; Trivedi, Priyanka P; Vikram, Ajit; Tripathi, Durga Nand

2016-01-01

The mechanisms underlying neurodegenerative disorders are complex and multifactorial; however, accumulating evidences suggest few common shared pathways. These common pathways include mitochondrial dysfunction, intracellular Ca2+ overload, oxidative stress and inflammation. Often multiple pathways co-exist, and therefore limit the benefits of therapeutic interventions. Nutraceuticals have recently gained importance owing to their multifaceted effects. These food-based approaches are believed to target multiple pathways in a slow but more physiological manner without causing severe adverse effects. Available information strongly supports the notion that apart from preventing the onset of neuronal damage, nutraceuticals can potentially attenuate the continued progression of neuronal destruction. In this article, we i) review the common pathways involved in the pathogenesis of the toxicants-induced neurotoxicity and neurodegenerative disorders with special emphasis on Alzheimer`s disease (AD), Parkinson`s disease (PD), Huntington`s disease (HD), Multiple sclerosis (MS) and Amyotrophic lateral sclerosis (ALS), and ii) summarize current research advancements on the effects of nutraceuticals against these detrimental pathways.

Nutraceuticals against Neurodegeneration: A Mechanistic Insight

PubMed Central

Dadhania, Vivekkumar P.; Trivedi, Priyanka P.; Vikram, Ajit; Tripathi, Durga Nand

2016-01-01

The mechanisms underlying neurodegenerative disorders are complex and multifactorial; however, accumulating evidences suggest few common shared pathways. These common pathways include mitochondrial dysfunction, intracellular Ca2+ overload, oxidative stress and inflammation. Often multiple pathways co-exist, and therefore limit the benefits of therapeutic interventions. Nutraceuticals have recently gained importance owing to their multifaceted effects. These food-based approaches are believed to target multiple pathways in a slow but more physiological manner without causing severe adverse effects. Available information strongly supports the notion that apart from preventing the onset of neuronal damage, nutraceuticals can potentially attenuate the continued progression of neuronal destruction. In this article, we i) review the common pathways involved in the pathogenesis of the toxicants-induced neurotoxicity and neurodegenerative disorders with special emphasis on Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), Multiple sclerosis (MS) and Amyotrophic lateral sclerosis (ALS), and ii) summarize current research advancements on the effects of nutraceuticals against these detrimental pathways. PMID:26725888

Reflections on Native Ethnography by a Nurse Researcher.

PubMed

Abdulrehman, Munib Said

2017-03-01

There are benefits and challenges associated with conducting research in a familiar setting, especially when the researcher is more an insider than an outsider. The aim of this article is to explore the author's experience as a native scholar conducting ethnographic research among the Swahili peoples of Lamu, Kenya. This article focuses on methodological issues related to conducting ethnographic research among the author's own people, including examining the issues of anthropological reflexivity as a native ethnographer and highlighting the author's experiences embodying multiple identities. Native ethnographers must consider the challenges associated with negotiating multiple roles in the research setting, especially in the presence of sociocultural factors such as gender stratification, complex kinship networks, socioeconomic hierarchies, illiteracy, and poverty. Embracing rather than being confused by the multiple levels of understanding native researchers bring to studies of their communities opens up new avenues of research and possibilities.

Evaluating New Technology.

PubMed

Carniol, Paul J; Heffelfinger, Ryan N; Grunebaum, Lisa D

2018-05-01

There are multiple complex issues to consider when evaluating any new technology. First evaluate the efficacy of the device. Then considering your patient population decide whether this technology brings an added benefit to your patients. If it meets these 2 criteria, then proceed to the financial analysis of acquiring this technology. The complete financial analysis has several important components that include but are not limited to cost, value, alternatives, return on investment, and associated marketing expense. Copyright © 2018 Elsevier Inc. All rights reserved.

Air Vehicle Integration and Technology Research (AVIATR). Task Order 0003: Condition-Based Maintenance Plus Structural Integrity (CBM+SI) Demonstration (April 2011 to August 2011)

DTIC Science & Technology

2011-08-01

investigated. Implementation of this technology into the maintenance framework depends on several factors, including safety of the structural system, cost... Maintenance Parameters The F-15 Program has indicated that, in practice , maintenance actions are generally performed on flight hour multiples of 200...Risk Analysis or the Perform Cost Benefit Analysis sections of the flowchart. 4.6. Determine System Configurations The current maintenance practice

Perceived Exercise Benefits and Barriers of Non-Exercising Female University Students in the United Kingdom

PubMed Central

Lovell, Geoff P; Ansari, Walid El; Parker, John K

2010-01-01

Many individuals do not engage in sufficient physical activity due to low perceived benefits and high perceived barriers to exercise. Given the increasing incidence of obesity and obesity related health disorders, this topic requires further exploration. We used the Exercise Benefits/Barriers Scale to assess perceived benefit and barrier intensities to exercise in 200 non-exercising female university students (mean age 19.3 years, SD = 1.06) in the UK. Although our participants were selected because they self reported themselves to be non-exercising, however they reported significantly higher perceived benefits from exercise than perceived barriers to exercise [t(199) = 6.18, p < 0.001], and their perceived benefit/barrier ratio was 1.33. The greatest perceived benefit from exercise was physical performance followed by the benefits of psychological outlook, preventive health, life enhancement, and then social interaction. Physical performance was rated significantly higher than all other benefits. Psychological outlook and preventive health were not rated significantly different, although both were significantly higher than life enhancement and social interaction. Life enhancement was also rated significantly higher than social interaction. The greatest perceived barrier to exercise was physical exertion, which was rated significantly higher than time expenditure, exercise milieu, and family discouragement barriers. Implications from this investigation for the design of physical activity programmes include the importance, for females, of a perception of high benefit/barrier ratio that could be conducive to participation in exercise. Applied interventions need to assist female students to ‘disengage’ from or overcome any perceived ‘unpleasantness’ of physical exertion during physical activity (decrease their perceived barriers), and to further highlight the multiple health and other benefits of regular exercising (increase their perceived benefits). PMID:20617003

Perceived exercise benefits and barriers of non-exercising female university students in the United Kingdom.

PubMed

Lovell, Geoff P; El Ansari, Walid; Parker, John K

2010-03-01

Many individuals do not engage in sufficient physical activity due to low perceived benefits and high perceived barriers to exercise. Given the increasing incidence of obesity and obesity related health disorders, this topic requires further exploration. We used the Exercise Benefits/Barriers Scale to assess perceived benefit and barrier intensities to exercise in 200 non-exercising female university students (mean age 19.3 years, SD = 1.06) in the UK. Although our participants were selected because they self reported themselves to be non-exercising, however they reported significantly higher perceived benefits from exercise than perceived barriers to exercise [t(199) = 6.18, p < 0.001], and their perceived benefit/barrier ratio was 1.33. The greatest perceived benefit from exercise was physical performance followed by the benefits of psychological outlook, preventive health, life enhancement, and then social interaction. Physical performance was rated significantly higher than all other benefits. Psychological outlook and preventive health were not rated significantly different, although both were significantly higher than life enhancement and social interaction. Life enhancement was also rated significantly higher than social interaction. The greatest perceived barrier to exercise was physical exertion, which was rated significantly higher than time expenditure, exercise milieu, and family discouragement barriers. Implications from this investigation for the design of physical activity programmes include the importance, for females, of a perception of high benefit/barrier ratio that could be conducive to participation in exercise. Applied interventions need to assist female students to 'disengage' from or overcome any perceived 'unpleasantness' of physical exertion during physical activity (decrease their perceived barriers), and to further highlight the multiple health and other benefits of regular exercising (increase their perceived benefits).

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

PubMed Central

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-01-01

There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. PMID:27239868

Factors influencing psychosocial adjustment and quality of life in Parkinson patients and informal caregivers.

PubMed

Navarta-Sánchez, María Victoria; Senosiain García, Juana M; Riverol, Mario; Ursúa Sesma, María Eugenia; Díaz de Cerio Ayesa, Sara; Anaut Bravo, Sagrario; Caparrós Civera, Neus; Portillo, Mari Carmen

2016-08-01

The influence that social conditions and personal attitudes may have on the quality of life (QoL) of Parkinson's disease (PD) patients and informal caregivers does not receive enough attention in health care, as a result of it not being clearly identified, especially in informal caregivers. The aim of this study was to provide a comprehensive analysis of psychosocial adjustment and QoL determinants in PD patients and informal caregivers. Ninety-one PD patients and 83 caregivers participated in the study. Multiple regression analyses were performed including benefit finding, coping, disease severity and socio-demographic factors, in order to determine how these aspects influence the psychosocial adjustment and QoL in PD patients and caregivers. Regression models showed that severity of PD was the main predictor of psychosocial adjustment and QoL in patients. Nevertheless, multiple regression analyses also revealed that coping was a significant predictor of psychosocial adjustment in patients and caregivers. Furthermore, psychosocial adjustment was significantly related to QoL in patients and caregivers. Also, coping and benefit finding were predictors of QoL in caregivers but not in patients. Multidisciplinary interventions aimed at improving PD patients' QoL may have more effective outcomes if education about coping skills, and how these can help towards a positive psychosocial adjustment to illness, were included, and targeted not only at patients, but also at informal caregivers.

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

PubMed

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-02-11

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. © 2016 by Kerman University of Medical Sciences.

Adverse Structural and Functional Effects of Marijuana on the Brain: Evidence Reviewed.

PubMed

Mandelbaum, David E; de la Monte, Suzanne M

2017-01-01

The growing use and legalization of cannabis are leading to increased exposures across all age groups, including in adolescence. The touting of its medicinal values stems from anecdotal reports related to treatment of a broad range of illnesses including epilepsy, multiple sclerosis, muscle spasms, arthritis, obesity, cancer, Alzheimer disease, Parkinson disease, post-traumatic stress, inflammatory bowel disease, and anxiety. However, anecdotal data and the high level of interest in this treatment must not obscure objective assessments of any potential and realized short- and long-term adverse effects of cannabis, particularly with respect to age of onset and chronicity of exposure. This critical review focuses on evidence-based research designed to assess both therapeutic benefits and harmful effects of cannabis exposure and is combined with an illustration of the neuropathologic findings in a fatal case of cannabis-induced psychosis. The literature and reported case provide strong evidence that chronic cannabis abuse causes cognitive impairment and damages the brain, particularly white matter, where cannabinoid 1 receptors abound. Contrary to popular perception, there are few objective data supporting preferential use of cannabis over conventional therapy for restoration of central nervous system structure and function in disease states such as multiple sclerosis, epilepsy, or schizophrenia. Additional research is needed to determine if subsets of individuals with various neurological and psychiatric diseases derive therapeutic benefits from cannabis. Copyright © 2016. Published by Elsevier Inc.

Modelling consequences of change in biodiversity and ...

EPA Pesticide Factsheets

This chapter offers an assessment of the rapidly changing landscape of methods assessing and forecasting the benefits that people receive from nature and how these benefits are shaped by institutions and various anthropogenic assets. There has been an explosion of activity in understanding and modeling the benefits that people receive from nature, and this explosion has provided a diversity of approaches that are both complementary and contradictory. However, there remain major gaps in what current models can do. They are not well suited to estimate most types of benefits at national, regional, or global scales. they are focused on decision analysis, but have not focused on implementation, learning, or dialogue. This hap in particular means that current models are not well suited to bridging among multiple knowledge systems, however, there are initial efforts made towards this goal. Furthermore, while participatory social-ecological scenarios are able to bridge multiple knowledge systems in their assessment and analysis of multiple ecosystem series, the social-ecological scenarios community is fragmented and not well connected. Consequently, IPBES has an excellent knowledge base to build upon, but a real investment in building a more integrated modeling and scenarios community of practice is needed to produce a more complete and useful toolbox of approaches to meet the needs of IPBES assessment and other assessment of nature benefits. This Chapter describes

NASA GES DISC Aerosol analysis and visualization services

NASA Astrophysics Data System (ADS)

Wei, J. C.; Ichoku, C. M.; Petrenko, M.; Yang, W.; Albayrak, A.; Zhao, P.; Johnson, J. E.; Kempler, S.

2015-12-01

Among the known atmospheric constituents, aerosols represent the greatest uncertainty in climate research. Satellite data products are important for a wide variety of applications that can bring far-reaching benefits to the science community and the broader society. These benefits can best be achieved if the satellite data are well utilized and interpreted. Unfortunately, this is not always the case, despite the abundance and relative maturity of numerous satellite-borne sensors routinely measure aerosols. There is often disagreement between similar aerosol parameters retrieved from different sensors, leaving users confused as to which sensors to trust for answering important science questions about the distribution, properties, and impacts of aerosols. Such misunderstanding may be avoided by providing satellite data with accurate pixel-level (Level 2) information, including pixel coverage area delineation and science team recommended quality screening for individual geophysical parameters. NASA Goddard Earth Sciences Data and Information Services Center (GES DISC) have developed multiple MAPSS applications as a part of Giovanni (Geospatial Interactive Online Visualization and Analysis Interface) data visualization and analysis tool - Giovanni-MAPSS and Giovanni-MAPSS_Explorer since 2007. The MAPSS database provides spatio-temporal statistics for multiple spatial spaceborne Level 2 aerosol products (MODIS Terra, MODIS Aqua, MISR, POLDER, OMI, CALIOP, SeaWiFS Deep Blue, and VIIRS) sampled over AERONET ground stations. In this presentation, I will demonstrate the improved features from Giovanni-MAPSS and introduce a new visualization service (Giovanni VizMAP) supporting various visualization and data accessing capabilities from satellite Level 2 data (non-aggregated and un-gridded) at high spatial resolution. Functionality will include selecting data sources (e.g., multiple parameters under the same measurement), defining area-of-interest and temporal extents, zooming, panning, overlaying, sliding, and data subsetting and reformatting.

Complexity Science Applications to Dynamic Trajectory Management: Research Strategies

NASA Technical Reports Server (NTRS)

Sawhill, Bruce; Herriot, James; Holmes, Bruce J.; Alexandrov, Natalia

2009-01-01

The promise of the Next Generation Air Transportation System (NextGen) is strongly tied to the concept of trajectory-based operations in the national airspace system. Existing efforts to develop trajectory management concepts are largely focused on individual trajectories, optimized independently, then de-conflicted among each other, and individually re-optimized, as possible. The benefits in capacity, fuel, and time are valuable, though perhaps could be greater through alternative strategies. The concept of agent-based trajectories offers a strategy for automation of simultaneous multiple trajectory management. The anticipated result of the strategy would be dynamic management of multiple trajectories with interacting and interdependent outcomes that satisfy multiple, conflicting constraints. These constraints would include the business case for operators, the capacity case for the Air Navigation Service Provider (ANSP), and the environmental case for noise and emissions. The benefits in capacity, fuel, and time might be improved over those possible under individual trajectory management approaches. The proposed approach relies on computational agent-based modeling (ABM), combinatorial mathematics, as well as application of "traffic physics" concepts to the challenge, and modeling and simulation capabilities. The proposed strategy could support transforming air traffic control from managing individual aircraft behaviors to managing systemic behavior of air traffic in the NAS. A system built on the approach could provide the ability to know when regions of airspace approach being "full," that is, having non-viable local solution space for optimizing trajectories in advance.

Perceived barriers and benefits to physical activity in colorectal cancer patients.

PubMed

Fisher, Abigail; Wardle, J; Beeken, R J; Croker, H; Williams, K; Grimmett, C

2016-02-01

There is emerging evidence for the benefits of physical activity (PA) post-diagnosis for colorectal cancer (CRC) survivors. However, population studies suggest activity levels in these patients are very low. Understanding perceived barriers and benefits to activity is a crucial step in designing effective interventions. Patients who were between 6 months and 5 years post-diagnosis with non-metastasised disease were identified from five London (UK) hospitals. Four hundred and ninety five completed a lifestyle survey that included open-ended questions on their perceived barriers (what things would stop you from doing more physical activity?) and benefits (what do you think you would gain from doing more physical activity?). Patients also recorded their activity levels using the Godin Leisure Time Exercise Questionnaire, along with sociodemographic and treatment variables. The most commonly reported barriers related to cancer and its treatments (e.g. fatigue). Age and mobility-related comorbidities (e.g. impaired mobility) were also frequently cited. Those who reported age and mobility as barriers, or reported any barrier, were significantly less active even after adjustment for multiple confounders. The most frequently reported benefits were physiological (e.g. improving health and fitness). Cancer-related benefits (such as prevention of recurrence) were rarely reported. Those perceiving physiological benefits or perceiving any benefits were more active in unadjusted models, but associations were not significant in adjusted models. We have identified important barriers and facilitators in CRC survivors that will aid in the design of theory-based PA interventions.

A questionnaire study to explore the views of people with multiple sclerosis of using smartphone technology for health care purposes.

PubMed

Griffin, Nicola; Kehoe, Maria

2018-06-01

Delivering interventions over the lifetime of people with chronic conditions is an international healthcare challenge. The benefits of technology in healthcare have been demonstrated in many health conditions. This study aims to seek the views of People with multiple sclerosis (MS) of the feasibility and perceived acceptability of smartphone use for healthcare purposes. Using SurveyMonkey™, respondents answered 21 items about their smartphone use and acceptance of smartphones in healthcare. Descriptive statistics were used to summarize data from closed questions. Content analysis was used for open questions. Most of the self-selected 197 respondents were female (138/197;70.1%), aged 42.78 ± 10.29 years, had relapsing-remitting MS (143/187;76.5%), and mobilized without an aid (154/197;78.17%). Most respondents reported having smartphone access (174/191;91.1%) and owning smartphones (167/192;86.97%). Perceived benefits of smartphones included improved healthcare access (119/190;62.63%) and greater independence (124/190;65.26%). The top three concerns included reduced contact with Healthcare Professionals (66/186;35.48%), data security (60/186;32.26%) and visual impairment (47/184;25.54%). These findings suggest that smartphone use is extensive, frequent, and acceptable for healthcare purposes in this self-selected sample. People with MS should be consulted during the design of smartphone-based interventions, as specific concerns were raised. Future studies should explore how this technology may be best used and implemented in practice. Implications for Rehabilitation Smartphones may have the potential to improve the implementation of best practice among people with multiple sclerosis (MS) This study found that smartphone use is widespread among people with MS, the majority of whom would accept using smartphones in healthcare. Some potential issues were raised, and would need to be considered during the development and implementation of smartphone-based interventions. Issues included potential lack of contact with health-care professionals, data security, and visual impairment.

Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions.

PubMed

Fried, Terri R; Tinetti, Mary E; Iannone, Lynne

2011-01-10

Clinicians are caring for an increasing number of older patients with multiple diseases in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process. Focus groups were conducted with 40 primary care clinicians (physicians, nurse practitioners, and physician assistants) in academic, community, and Veterans Affairs-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. The participants were concerned about their patients' ability to adhere to complex regimens derived from guideline-directed care. There was variability in beliefs regarding, and approaches to balancing, the benefits and harms of guideline-directed care. There was also variability regarding how the participants involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients' goals. The participants listed a number of barriers to making good treatment decisions, including the lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, the support of their subspecialist colleagues, and an altered reimbursement system.

The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions.

PubMed

Edwards, Thomas; Pilutti, Lara A

2017-08-01

There is evidence for the benefits of exercise training in persons with multiple sclerosis (MS). However, these benefits have primarily been established in individuals with mild-to-moderate disability (i.e., Expanded Disability Status Scale [EDSS] scores 1.0-5.5), rather than among those with significant mobility impairment. Further, the approaches to exercise training that have been effective in persons with mild-to-moderate MS disability may not be physically accessible for individuals with mobility limitations. Therefore, there is a demand for an evidence-base on the benefits of physically accessible exercise training approaches for managing disability in people with MS with mobility impairment. To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility disability. Four electronic databases (PubMed, EMBASE, OvidMEDLINE, and PsychINFO) were searched for relevant articles published up until October 2016. The review focused on English-language studies that examined the effect of exercise training in people with MS with severe mobility disability, characterized as the need for assistance in ambulation or EDSS score ≥ 6.0. The inclusion criteria involved full-text articles that: (i) included participants with a diagnosis of MS; (ii) included primarily participants with a reported EDSS score ≥ 6.0 and/or definitively described disability consistent with this level of neurological impairment; and (iii) implemented a prospective, structured exercise intervention. Data were analyzed using a descriptive approach and summarized by exercise training modality (conventional or adapted exercise training), and by outcome (disability, physical fitness, physical function, and symptoms and participation). Initially, 1164 articles were identified and after removal of duplicates, 530 articles remained. In total, 512 articles did not meet the inclusion criteria. 19 articles were included in the final review. Five studies examined conventional exercise training (aerobic and resistance training), and thirteen studies examined adapted exercise modalities including body-weight support treadmill training (BWSTT), total-body recumbent stepper training (TBRST), and electrical stimulation cycling (ESAC). Outcomes related to mobility, fatigue, and quality of life (QOL) were most frequently reported. Two of five studies examining conventional resistance exercise training reported significant improvements in physical fitness, physical function, and/or symptomatic and participatory outcomes. Nine of 13 studies examining adapted exercise training reported significant improvements in disability, physical fitness, physical function, and/or symptomatic and participatory outcomes. There is limited, but promising evidence for the benefits of exercise training in persons with MS with severe mobility disability. Considering the lack of effective therapeutic strategies for managing long-term disability accumulation, exercise training could be considered as an alternative approach. Further research is necessary to optimize the prescription and efficacy of exercise training for adults with MS with severe mobility disability. Copyright © 2017. Published by Elsevier B.V.

Complementary and alternative medicine: is there a role in multiple sclerosis?

PubMed

Yadav, Vijayshree; Bourdette, Dennis

2006-05-01

Despite effective conventional therapies for multiple sclerosis (MS), many people with MS explore complementary and alternative medicine (CAM) therapies for their symptoms. Common CAM therapies that people use include dietary modification, nutritional and herbal supplementation, and mind-body therapies. There is a revival of interest among MS researchers about the therapeutic potential of low-fat diet and essential fatty acid supplementation in MS. The efficacy of specific vitamin supplementation remains unclear. Recently, cannabis and yoga have been studied in more controlled studies and have provided evidence that they may have some benefit. The research on CAM therapies in MS is still exploratory, but considering peoples' interest and common use of these therapies, further research in this area is clearly warranted.

The Iodine Satellite (iSAT) Hall Thruster Demonstration Mission Concept and Development

NASA Technical Reports Server (NTRS)

Dankanich, John W.; Polzin, Kurt A.; Calvert, Derek; Kamhawi, Hani

2014-01-01

The use of iodine propellant for Hall thrusters has been studied and proposed by multiple organizations due to the potential mission benefits over xenon. In 2013, NASA Marshall Space Flight Center competitively selected a project for the maturation of an iodine flight operational feed system through the Technology Investment Program. Multiple partnerships and collaborations have allowed the team to expand the scope to include additional mission concept development and risk reduction to support a flight system demonstration, the iodine Satellite (iSAT). The iSAT project was initiated and is progressing towards a technology demonstration mission preliminary design review. The current status of the mission concept development and risk reduction efforts in support of this project is presented.

Assessment of Energy Storage Alternatives in the Puget Sound Energy System Volume 2: Energy Storage Evaluation Tool

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

Wu, Di; Jin, Chunlian; Balducci, Patrick J.

2013-12-01

This volume presents the battery storage evaluation tool developed at Pacific Northwest National Laboratory (PNNL), which is used to evaluate benefits of battery storage for multiple grid applications, including energy arbitrage, balancing service, capacity value, distribution system equipment deferral, and outage mitigation. This tool is based on the optimal control strategies to capture multiple services from a single energy storage device. In this control strategy, at each hour, a look-ahead optimization is first formulated and solved to determine battery base operating point. The minute by minute simulation is then performed to simulate the actual battery operation. This volume provide backgroundmore » and manual for this evaluation tool.« less

Learning Is the Journey: From Process Reengineering to Systemic Customer-Service Design at the United States Department of Veterans Affairs, Veterans Benefits Administration

DTIC Science & Technology

2013-05-23

This monograph borrows from multiple disciplines to argue for an organizational shift from process reengineering to system design to improve...government customer-service delivery. Specifically, the monograph proposes a transformation in claims processing within the Veterans Benefits Administration...required. The proposed system design is an attempt to place the disability claims process within a larger environment encompassing multiple dimensions of customers.

Valuing vaccines using value of statistical life measures.

PubMed

Laxminarayan, Ramanan; Jamison, Dean T; Krupnick, Alan J; Norheim, Ole F

2014-09-03

Vaccines are effective tools to improve human health, but resources to pursue all vaccine-related investments are lacking. Benefit-cost and cost-effectiveness analysis are the two major methodological approaches used to assess the impact, efficiency, and distributional consequences of disease interventions, including those related to vaccinations. Childhood vaccinations can have important non-health consequences for productivity and economic well-being through multiple channels, including school attendance, physical growth, and cognitive ability. Benefit-cost analysis would capture such non-health benefits; cost-effectiveness analysis does not. Standard cost-effectiveness analysis may grossly underestimate the benefits of vaccines. A specific willingness-to-pay measure is based on the notion of the value of a statistical life (VSL), derived from trade-offs people are willing to make between fatality risk and wealth. Such methods have been used widely in the environmental and health literature to capture the broader economic benefits of improving health, but reservations remain about their acceptability. These reservations remain mainly because the methods may reflect ability to pay, and hence be discriminatory against the poor. However, willingness-to-pay methods can be made sensitive to income distribution by using appropriate income-sensitive distributional weights. Here, we describe the pros and cons of these methods and how they compare against standard cost-effectiveness analysis using pure health metrics, such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs), in the context of vaccine priorities. We conclude that if appropriately used, willingness-to-pay methods will not discriminate against the poor, and they can capture important non-health benefits such as financial risk protection, productivity gains, and economic wellbeing. Copyright © 2014 Elsevier Ltd. All rights reserved.

New Technologies for Acquisition and 3-D Visualization of Geophysical and Other Data Types Combined for Enhanced Understandings and Efficiencies of Oil and Gas Operations, Deepwater Gulf of Mexico

NASA Astrophysics Data System (ADS)

Thomson, J. A.; Gee, L. J.; George, T.

2002-12-01

This presentation shows results of a visualization method used to display and analyze multiple data types in a geospatially referenced three-dimensional (3-D) space. The integrated data types include sonar and seismic geophysical data, pipeline and geotechnical engineering data, and 3-D facilities models. Visualization of these data collectively in proper 3-D orientation yields insights and synergistic understandings not previously obtainable. Key technological components of the method are: 1) high-resolution geophysical data obtained using a newly developed autonomous underwater vehicle (AUV), 2) 3-D visualization software that delivers correctly positioned display of multiple data types and full 3-D flight navigation within the data space and 3) a highly immersive visualization environment (HIVE) where multidisciplinary teams can work collaboratively to develop enhanced understandings of geospatially complex data relationships. The initial study focused on an active deepwater development area in the Green Canyon protraction area, Gulf of Mexico. Here several planned production facilities required detailed, integrated data analysis for design and installation purposes. To meet the challenges of tight budgets and short timelines, an innovative new method was developed based on the combination of newly developed technologies. Key benefits of the method include enhanced understanding of geologically complex seabed topography and marine soils yielding safer and more efficient pipeline and facilities siting. Environmental benefits include rapid and precise identification of potential locations of protected deepwater biological communities for avoidance and protection during exploration and production operations. In addition, the method allows data presentation and transfer of learnings to an audience outside the scientific and engineering team. This includes regulatory personnel, marine archaeologists, industry partners and others.

Assessing the Multiple Benefits of Clean Energy Full Report

EPA Pesticide Factsheets

Guidance for state energy, environmental, and economic policy makers to identify and quantify the many benefits of clean energy to support the development and implementation of cost-effective clean energy initiatives.

Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ ≥ 500: a simulation study.

PubMed

Kong, Chung Yin; Sigel, Keith; Criss, Steven D; Sheehan, Deirdre F; Triplette, Matthew; Silverberg, Michael J; Henschke, Claudia I; Justice, Amy; Braithwaite, R Scott; Wisnivesky, Juan; Crothers, Kristina

2018-04-19

Lung cancer is the leading cause of non-AIDS-defining cancer deaths among HIV-infected individuals. Although lung cancer screening with low-dose computed tomography (LDCT) is endorsed by multiple national organizations, whether HIV-infected individuals would have similar benefit as uninfected individuals from lung cancer screening is unknown. Our objective was to determine the benefits and harms of lung cancer screening among HIV-infected individuals. We modified an existing simulation model, the Lung Cancer Policy Model, for HIV-infected patients. Veterans Aging Cohort Study, Kaiser Permanente Northern California HIV Cohort, and medical literature. Target population: HIV-infected current and former smokers. Lifetime. Population. Annual LDCT screening from ages 45, 50, or 55 until ages 72 or 77 years. Benefits assessed included lung cancer mortality reduction and life-years gained; harms assessed included numbers of LDCT examinations, false-positive results, and overdiagnosed cases. For HIV-infected patients with CD4 at least 500 and 100% antiretroviral therapy adherence, screening using the Centers for Medicare & Medicaid Services criteria (age 55-77, 30 pack-years of smoking, current smoker or quit within 15 years of screening) would reduce lung cancer mortality by 18.9%, similar to the mortality reduction of uninfected individuals. Alternative screening strategies utilizing lower screening age and/or pack-years criteria increase mortality reduction, but require more LDCT examinations. Strategies assumed 100% screening adherence. Lung cancer screening reduces mortality in HIV-infected patients with CD4 at least l500, with a number of efficient strategies for eligibility, including the current Centers for Medicare & Medicaid Services criteria.

Optimization of a therapeutic protocol for intravenous injection of human mesenchymal stem cells after cerebral ischemia in adult rats.

PubMed

Omori, Yoshinori; Honmou, Osamu; Harada, Kuniaki; Suzuki, Junpei; Houkin, Kiyohiro; Kocsis, Jeffery D

2008-10-21

The systemic injection of human mesenchymal stem cells (hMSCs) prepared from adult bone marrow has therapeutic benefits after cerebral artery occlusion in rats, and may have multiple therapeutic effects at various sites and times within the lesion as the cells respond to a particular pathological microenvironment. However, the comparative therapeutic benefits of multiple injections of hMSCs at different time points after cerebral artery occlusion in rats remain unclear. In this study, we induced middle cerebral artery occlusion (MCAO) in rats using intra-luminal vascular occlusion, and infused hMSCs intravenously at a single 6 h time point (low and high cell doses) and various multiple time points after MCAO. From MRI analyses lesion volume was reduced in all hMSC cell injection groups as compared to serum alone injections. However, the greatest therapeutic benefit was achieved following a single high cell dose injection at 6 h post-MCAO, rather than multiple lower cell infusions over multiple time points. Three-dimensional analysis of capillary vessels in the lesion indicated that the capillary volume was equally increased in all of the cell-injected groups. Thus, differences in functional outcome in the hMSC transplantation subgroups are not likely the result of differences in angiogenesis, but rather from differences in neuroprotective effects.

Managing multiple diffuse pressures on water quality and ecological habitat: Spatially targeting effective mitigation actions at the landscape scale.

NASA Astrophysics Data System (ADS)

Joyce, Hannah; Reaney, Sim

2015-04-01

Catchment systems provide multiple benefits for society, including: land for agriculture, climate regulation and recreational space. Yet, these systems also have undesirable externalities, such as flooding, and the benefits they create can be compromised through societal use. For example, agriculture, forestry and urban land use practices can increase the export of fine sediment and faecal indicator organisms (FIO) delivered to river systems. These diffuse landscape pressures are coupled with pressures on the in stream temperature environment from projected climate change. Such pressures can have detrimental impacts on water quality and ecological habitat and consequently the benefits they provide for society. These diffuse and in-stream pressures can be reduced through actions at the landscape scale but are commonly tackled individually. Any intervention may have benefits for other pressures and hence the challenge is to consider all of the different pressures simultaneously to find solutions with high levels of cross-pressure benefits. This research presents (1) a simple but spatially distributed model to predict the pattern of multiple pressures at the landscape scale, and (2) a method for spatially targeting the optimum location for riparian woodland planting as mitigation action against these pressures. The model follows a minimal information requirement approach along the lines of SCIMAP (www.scimap.org.uk). This approach defines the critical source areas of fine sediment diffuse pollution, rapid overland flow and FIOs, based on the analysis of the pattern of the pressure in the landscape and the connectivity from source areas to rivers. River temperature was modeled using a simple energy balance equation; focusing on temperature of inflowing and outflowing water across a catchment. The model has been calibrated using a long term observed temperature record. The modelling outcomes enabled the identification of the severity of each pressure in relative rather than absolute sense at the landscape scale. Riparian woodland planting is proposed as one mitigation action to address these pressures. This planting disconnects the transfer of material from the landscape to the river channel by promoting increased infiltration and also provides river shading and hence decreases the rate of water heating. To identify the optimal locations for riparian woodland planting, a Monte Carlo based approach was used to identify multiple mitigation options and their influence on the pressures identified. These results were integrated into a decision support tool, which allows the user to explore the implications of individual and a set of pressures. This is achieved by allowing the user to change the importance of different pressures to identify the optimal locations for a custom combination of pressures. For example, reductions in flood risk can be prioritized over reductions in fine sediment. This approach provides an innovative way of identifying and targeting multiple diffuse pressures at the catchment scale simultaneously, which has presented a challenge in previous management efforts. The approach has been tested in the River Ribble Catchment, North West England.

Policy-Relevant Nonconvexities in the Production of Multiple Forest Benefits?

Treesearch

Stephen K. Swallow; Peter J. Parks; David N. Wear

1990-01-01

This paper challenges common assumptions about convexity in forest rotation models which optimize timber plus nontimber benefits. If a local optimum occurs earlier than the globally optimal age, policy based on marginal incentives may achieve suboptimal results. Policy-relevant nonconvexities are more likely if (i) nontimber benefits dominate for young stands while...

Benefit Coverage and Employee Cost: Critical Factors in Explaining Compensation Satisfaction.

ERIC Educational Resources Information Center

Dreher, George F.; And Others

1988-01-01

Examined joint effects of benefit coverage and costs borne by employees on multiple dimensions of compensation satisfaction among 2,925 highway patrol, state police, and department of public safety employees in eight states. Found that satisfaction with benefits increased with improved coverage and decreased with higher employee costs. Employees…

26 CFR 1.411(d)-3 - Section 411(d)(6) protected benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... effect is to decrease participants' accrued benefit as of that applicable amendment date. (iii) Multiple... a series of plan amendments that, when taken together, have the effect of reducing or eliminating a... period that, when taken together, have the effect of reducing or eliminating early retirement benefits or...

26 CFR 1.411(d)-3 - Section 411(d)(6) protected benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... effect is to decrease participants' accrued benefit as of that applicable amendment date. (iii) Multiple... a series of plan amendments that, when taken together, have the effect of reducing or eliminating a... period that, when taken together, have the effect of reducing or eliminating early retirement benefits or...

Maximizing the Gains and Minimizing the Pains of Diversity: A Policy Perspective.

PubMed

Galinsky, Adam D; Todd, Andrew R; Homan, Astrid C; Phillips, Katherine W; Apfelbaum, Evan P; Sasaki, Stacey J; Richeson, Jennifer A; Olayon, Jennifer B; Maddux, William W

2015-11-01

Empirical evidence reveals that diversity-heterogeneity in race, culture, gender, etc.-has material benefits for organizations, communities, and nations. However, because diversity can also incite detrimental forms of conflict and resentment, its benefits are not always realized. Drawing on research from multiple disciplines, this article offers recommendations for how best to harness the benefits of diversity. First, we highlight how two forms of diversity-the diversity present in groups, communities, and nations, and the diversity acquired by individuals through their personal experiences (e.g., living abroad)-enable effective decision making, innovation, and economic growth by promoting deeper information processing and complex thinking. Second, we identify methods to remove barriers that limit the amount of diversity and opportunity in organizations. Third, we describe practices, including inclusive multiculturalism and perspective taking, that can help manage diversity without engendering resistance. Finally, we propose a number of policies that can maximize the gains and minimize the pains of diversity. © The Author(s) 2015.

Lifelong antiretroviral therapy or HIV cure: The benefits for the individual patient.

PubMed

Buell, Kevin G; Chung, Christopher; Chaudhry, Zain; Puri, Aiysha; Nawab, Khizr; Ravindran, Rahul Prashanth

2016-01-01

There are an estimated 35 million people living with human immunodeficiency virus (HIV) globally, 19 million of whom are unaware of their HIV status and, in the absence of antiretroviral therapy (ART), will have a shortened life expectancy. Although ART remains the "gold standard" for treatment of HIV infection, the requirement for lifelong treatment poses multiple challenges for the patient. These include stigma, an untenable pill burden, side effects, and the threat of viral resistance in the case of non-compliance. This review evaluates the challenges of accessing, delivering, and sustaining ART for people living with HIV and will discuss the case for pursuing a goal of HIV cure, the potential benefits of such a cure for the individual patient, and the current potential candidates for such a cure.

Accounting for the Variation of Driver Aggression in the Simulation of Conventional and Advanced Vehicles

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

Neubauer, J.; Wood, E.

2013-01-01

Hybrid electric vehicles, plug-in hybrid electric vehicles, and battery electric vehicles offer the potential to reduce both oil imports and greenhouse gases, as well as to offer a financial benefit to the driver. However, assessing these potential benefits is complicated by several factors, including the driving habits of the operator. We focus on driver aggression, i.e., the level of acceleration and velocity characteristic of travel, to (1) assess its variation within large, real-world drive datasets, (2) quantify its effect on both vehicle efficiency and economics for multiple vehicle types, (3) compare these results to those of standard drive cycles commonlymore » used in the industry, and (4) create a representative drive cycle for future analyses where standard drive cycles are lacking.« less

Ecology and bioprospecting.

PubMed

Beattie, Andrew J; Hay, Mark; Magnusson, Bill; de Nys, Rocky; Smeathers, James; Vincent, Julian F V

2011-05-01

Bioprospecting is the exploration of biodiversity for new resources of social and commercial value. It is carried out by a wide range of established industries such as pharmaceuticals, manufacturing and agriculture as well as a wide range of comparatively new ones such as aquaculture, bioremediation, biomining, biomimetic engineering and nanotechnology. The benefits of bioprospecting have emerged from such a wide range of organisms and environments worldwide that it is not possible to predict what species or habitats will be critical to society, or industry, in the future. The benefits include an unexpected variety of products that include chemicals, genes, metabolic pathways, structures, materials and behaviours. These may provide physical blueprints or inspiration for new designs. Criticism aimed at bioprospecting has been addressed, in part, by international treaties and legal agreements aimed at stopping biopiracy and many activities are now funded by agencies that require capacity-building and economic benefits in host countries. Thus, much contemporary bioprospecting has multiple goals, including the conservation of biodiversity, the sustainable management of natural resources and economic development. Ecologists are involved in three vital ways: first, applying ecological principles to the discovery of new resources. In this context, natural history becomes a vast economic database. Second, carrying out field studies, most of them demographic, to help regulate the harvest of wild species. Third, emphasizing the profound importance of millions of mostly microscopic species to the global economy.

A bottom up approach to implementing multi-purpose mitigation measures for reducing flood risk and improving water quality in agricultural catchments

NASA Astrophysics Data System (ADS)

Wilkinson, M. E.; Quinn, P. F.; Jonczyk, J.; Burke, S.; Nicholson, A.; Barber, N.; Owen, G.; Palmer, M.

2012-04-01

A number of studies have suggested that there is evidence that modern land-use management practices have increased surface runoff at the local scale. There is an urgent need for interventions to reduce the risk of flooding whilst also delivering multiple benefits (doing more for less). There are many settlements, which regularly suffer from flooding, which would benefit from upstream mitigation measures. Interventions at the source of runoff generation can have a positive impact on the flood hydrograph downstream. An integrated approach to managing runoff can also have multiple benefits on pollution and ecology, which could lead to beneficial impacts at the catchment scale. Belford, a small community in Northumberland, UK has suffered from an increased number of flood events over the past ten years. There is currently support within the English and Welsh Environment Agency for sustainable flood management solutions such as storage ponds, wetlands, beaver dams and willow riparian features which are being trialled at Belford. These runoff attenuation features (RAFs) also have benefits to water quality, capture sediment and create new ecological zones. Although the process by which numerous RAFs were deployed in Belford proved initially difficult to achieve within the existing regulatory framework, an efficient uptake process is now supported by local regulators including several branches of the Environment Agency. The Belford runoff management framework provides a step by step guide to implementing mitigation measures in the Belford burn catchment and could be easily applied to other catchments at a similar scale. The approach is based on implementing mitigation measures through engaging with catchment stakeholders and using solid field science and management protocols.

TREATMENT OF METABOLIC ALTERATIONS IN POLYCYSTIC OVARY SYNDROME.

PubMed

Păvăleanu, Ioana; Gafiţanu, D; Popovici, Diana; Duceac, Letiţia Doina; Păvăleanu, Maricica

2016-01-01

Polycystic ovary syndrome is a common endocrinopathy characterized by oligo ovulation or anovulation, signs of androgen excess and multiple small ovarian cysts. It includes various metabolic abnormalities: insulin resistance, hyperinsulinemia, impaired glucose tolerance, visceral obesity, inflammation and endothelial dysfunction, hypertension and dyslipidemia. All these metabolic abnormalities have long-term implications. Treatment should be individualized and must not address a single sign or symptom. Studies are still needed to determine the benefits and the associated risks of the medication now available to practitioners.

Diagnosis and management of patients with clefts: a comprehensive and interdisciplinary approach.

PubMed

Hartzell, Larry D; Kilpatrick, Lauren A

2014-10-01

This article reviews the most current practice guidelines in the diagnosis and management of patients born with cleft lip and/or palate. Such patients frequently have multiple medical and social issues that benefit greatly from a team approach. Common challenges include feeding difficulty, nutritional deficiency, speech disorders, hearing problems, ear disease, dental anomalies, and both social and developmental delays, among others. Interdisciplinary evaluation and collaboration throughout a patient's development are essential. Copyright © 2014 Elsevier Inc. All rights reserved.

Factors Influencing Amount of Weekly Exercise Time in Colorectal Cancer Survivors.

PubMed

Chou, Yun-Jen; Lai, Yeur-Hur; Lin, Been-Ren; Liang, Jin-Tung; Shun, Shiow-Ching

Performing regular exercise of at least 150 minutes weekly has benefits for colorectal cancer survivors. However, barriers inhibit these survivors from performing regular exercise. The aim of this study was to explore exercise behaviors and significant factors influencing weekly exercise time of more than 150 minutes in colorectal cancer survivors. A cross-sectional study design was used to recruit participants in Taiwan. Guided by the ecological model of health behavior, exercise barriers were assessed including intrapersonal, interpersonal, and environment-related barriers. A multiple logistic regression was used to explore the factors associated with the amount of weekly exercise. Among 321 survivors, 57.0% of them had weekly exercise times of more than 150 minutes. The results identified multiple levels of significant factors related to weekly exercise times including intrapersonal factors (occupational status, functional status, pain, interest in exercise, and beliefs about the importance of exercise) and exercise barriers related to environmental factors (lack of time and bad weather). No interpersonal factors were found to be significant. Colorectal cancer survivors experienced low levels of physical and psychological distress. Multiple levels of significant factors related to exercise time including intrapersonal factors as well as exercise barriers related to environmental factors should be considered. Healthcare providers should discuss with their patients how to perform exercise programs; the discussion should address multiple levels of the ecological model such as any pain problems, functional status, employment status, and time limitations, as well as community environment.

Psychological Characteristics and Traits for Finding Benefit From Prostate Cancer: Correlates and Predictors.

PubMed

Pascoe, Elizabeth C; Edvardsson, David

Although beginning evidence suggests that the capacity to derive benefit from cancer-associated experiences may be influenced by some individual psychological characteristics and traits, little is known about predictors for finding benefit from prostate cancer. The aim of this study was to explore the correlates and predictors for finding benefit from prostate cancer among a sample of men undergoing androgen deprivation. Pearson correlation and multiple linear regression modeling were performed on data collected in an acute tertiary hospital outpatient setting (N = 209) between July 2011 and December 2013 to determine correlates and predictors for finding benefit from prostate cancer. Multiple linear regression modeling showed that while the 6 predictors of self-reported coping, depression, anxiety, distress, resilience, and hope explained 38% of the variance in finding benefit, coping provided the strongest and statistically significant predictive contribution. Self-reported coping was strongly predictive of finding benefit from prostate cancer, but questions remain about if subtypes of coping strategies can be more or less predictive of finding benefit. Self-reported levels of depression, anxiety, distress, resilience, and hope had a less predictive and nonsignificant role in finding benefit from prostate cancer and raise questions about their function in this subpopulation. The findings suggest that coping strategies can maximize finding benefit from prostate cancer. Knowledge of influential coping strategies for finding benefit from prostate cancer can be immensely valuable to support men in rebuilding positive meaning amid a changed illness reality. Developing practice initiatives that foster positive meaning-making coping strategies seems valuable.

Healthy Movements: Your Body's Mechanics

MedlinePlus

... devised improved treatments for movement disorders such as cerebral palsy and Parkinson’s disease. Joints are a common source ... which patients could benefit from surgery. People with cerebral palsy, Parkinson’s disease and multiple sclerosis could also benefit ...

The Population Benefit of Radiotherapy for Malignant Brain Tumors: Local Control and Survival Estimates for Guideline-Based Use.

PubMed

Hanna, Timothy Paul; Delaney, Geoffrey Paul; Barton, Michael Bernard

2016-09-01

To estimate the population benefit of radiotherapy (RT) for primary malignant brain tumors if evidence-based guidelines were routinely followed. This study investigated 5-year local control (LC) and 2- and 5-year overall survival (OS) benefits. RT benefit was the absolute proportional benefit of RT alone over no RT for radical indications, and over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemotherapy and RT over RT alone. Decision tree models were adapted to define the incidence of each indication. Citation databases were systematically queried for the highest level of evidence defining indication benefits. Meta-analysis was performed if there were multiple sources of the same evidence level, and deterministic and probabilistic sensitivity analysis was also performed. Among all patients with malignant brain tumors, 82% had indications for curative- or adjuvant-intent RT. The magnitude of benefit was based on level I or II evidence in 44% of all patients. A total of 25 relevant studies were used to quantify indication benefits. All RT benefit included in the model was irreplaceable. For malignant brain tumors, the estimated population benefit for RT alone was 9% for 5-year LC (95% CI, 7%-10%), 9% for 2-year OS (95% CI, 8%-11%), and 5% for 5-year OS (95% CI, 4%-5%). The incremental benefit of CRT was 1% for 5-year LC (95% CI, 0%-2%), 7% for 2-year OS (95% CI, 4%-11%), and 3% for 5-year OS (95% CI, 1%-5%). The model was robust in sensitivity analysis. When optimally used, RT provides an important benefit for many patients with malignant brain tumors. The model provided a robust means for estimating the magnitude of this benefit. Copyright © 2016 by the National Comprehensive Cancer Network.

Continuous Acoustic Sensing With an Unmanned Aerial Vehicle System for Anti-Submarine Warfare in a High-Threat Area

DTIC Science & Technology

2015-12-01

strive in multiple warfare areas. This research benefits not only the Navy, through enhancement of offensive warfighting by testing the next...multiple warfare areas. This research benefits not only the Navy, through enhancement of offensive warfighting by testing the next generation of...produce and definitely worth the research and testing to be a positive asset for the Navy. It not only can stay on station for an exponential amount of

A toolkit for incorporating genetics into mainstream medical services: Learning from service development pilots in England

PubMed Central

2010-01-01

Background As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. Methods Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. Results Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. Conclusions Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions. PMID:20470377

A toolkit for incorporating genetics into mainstream medical services: Learning from service development pilots in England.

PubMed

Bennett, Catherine L; Burke, Sarah E; Burton, Hilary; Farndon, Peter A

2010-05-14

As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions.

Active and passive surveillance of enoxaparin generics: a case study relevant to biosimilars.

PubMed

Grampp, Gustavo; Bonafede, Machaon; Felix, Thomas; Li, Edward; Malecki, Michael; Sprafka, J Michael

2015-03-01

This retrospective analysis assessed the capability of active and passive safety surveillance systems to track product-specific safety events in the USA for branded and generic enoxaparin, a complex injectable subject to immune-related and other adverse events (AEs). Analysis of heparin-induced thrombocytopenia (HIT) incidence was performed on benefit claims for commercial and Medicare supplemental-insured individuals newly treated with enoxaparin under pharmacy benefit (1 January 2009 - 30 June 2012). Additionally, spontaneous reports from the FDA AE Reporting System were reviewed to identify incidence and attribution of enoxaparin-related reports to specific manufacturers. Specific, dispensed products were identifiable from National Drug Codes only in pharmacy-benefit databases, permitting sensitive comparison of HIT incidence in nearly a third of patients treated with brand or generic enoxaparin. After originator medicine's loss of exclusivity, only 5% of spontaneous reports were processed by generic manufacturers; reports attributable to specific generics were approximately ninefold lower than expected based on market share. Claims data were useful for active surveillance of enoxaparin generics dispensed under pharmacy benefits but not for products administered under medical benefits. These findings suggest that the current spontaneous reporting system will not distinguish product-specific safety signals for products distributed by multiple manufacturers, including biosimilars.

Tai Chi exercise and the improvement of health and well-being in older adults.

PubMed

Yau, Matthew Kwai-sang

2008-01-01

Activity participation has a positive impact on both quantity and quality of life (QOL). Regular participations in physical, social, and cultural activities are associated with successful aging. There is considerable evidence that Tai Chi has positive health benefits; physical, psychosocial and therapeutic. Furthermore, Tai Chi does not only consist of a physical component, but also sociocultural, meditative components that are believed to contribute to overall well-being. This chapter describes the benefits of Tai Chi exercise for the older adults, particularly in terms of the psychosocial aspect. The perceived meanings, associated values and well-being, as well as the impact on QOL, of Tai Chi practice among the older adults in Hong Kong are also discussed. Tai Chi exercise is chosen by the elderly participants for its gentle and soft movements. Besides the physical aspect, the benefits they describe include lifestyle issues, as well as psychological and social benefits. Evidence points out that the improvements in physical and mental health through the practice of Tai Chi among the older adults are related to their perceived level of QOL. Findings from numerous studies support the belief that the practice of Tai Chi has multiple benefits to practitioners that are not only physical in nature. It is recommended as a strategy to promote successful aging.

Benefits, barriers and opinions on multidisciplinary team meetings: a survey in Swedish cancer care.

PubMed

Rosell, Linn; Alexandersson, Nathalie; Hagberg, Oskar; Nilbert, Mef

2018-04-05

Case review and discussion at multidisciplinary team meetings (MDTMs) have evolved into standard practice in cancer care with the aim to provide evidence-based treatment recommendations. As a basis for work to optimize the MDTMs, we investigated participants' views on the meeting function, including perceived benefits and barriers. In a cross-sectional study design, 244 health professionals from south Sweden rated MDTM meeting structure and function, benefits from these meetings and barriers to reach a treatment recommendation. The top-ranked advantages from MDTMs were support for patient management and competence development. Low ratings applied to monitoring patients for clinical trial inclusion and structured work to improve the MDTM. Nurses and cancer care coordinators did less often than physicians report involvement in the case discussions. Major benefits from MDTM were reported to be more accurate treatment recommendations, multidisciplinary evaluation and adherence to clinical guidelines. Major barriers to a joint treatment recommendation were reported to be need for supplementary investigations and insufficient pathology reports. Health professionals' report multiple benefits from MDTMs, but also define areas for improvement, e.g. access to complete information and clarified roles for the different health professions. The emerging picture suggests that structures for regular MDTM evaluations and increased focus on patient-related perspectives should be developed and implemented.

CheckMate 025 Randomized Phase 3 Study: Outcomes by Key Baseline Factors and Prior Therapy for Nivolumab Versus Everolimus in Advanced Renal Cell Carcinoma.

PubMed

Escudier, Bernard; Sharma, Padmanee; McDermott, David F; George, Saby; Hammers, Hans J; Srinivas, Sandhya; Tykodi, Scott S; Sosman, Jeffrey A; Procopio, Giuseppe; Plimack, Elizabeth R; Castellano, Daniel; Gurney, Howard; Donskov, Frede; Peltola, Katriina; Wagstaff, John; Gauler, Thomas C; Ueda, Takeshi; Zhao, Huanyu; Waxman, Ian M; Motzer, Robert J

2017-12-01

The randomized, phase 3 CheckMate 025 study of nivolumab (n=410) versus everolimus (n=411) in previously treated adults (75% male; 88% white) with advanced renal cell carcinoma (aRCC) demonstrated significantly improved overall survival (OS) and objective response rate (ORR). To investigate which baseline factors were associated with OS and ORR benefit with nivolumab versus everolimus. Subgroup OS analyses were performed using Kaplan-Meier methodology. Hazard ratios were estimated using the Cox proportional hazards model. Nivolumab 3mg/kg every 2 wk or everolimus 10mg once daily. The minimum follow-up was 14 mo. Baseline subgroup distributions were balanced between nivolumab and everolimus arms. Nivolumab demonstrated an OS improvement versus everolimus across subgroups, including Memorial Sloan Kettering Cancer Center (MSKCC) and International Metastatic Renal Cell Carcinoma Database Consortium risk groups; age <65 and ≥65 yr; one and two or more sites of metastases; bone, liver, and lung metastases; number of prior therapies; duration of prior therapy; and prior sunitinib, pazopanib, or interleukin-2 therapy. The benefit with nivolumab versus everolimus was noteworthy for patients with poor MSKCC risk (hazard ratio 0.48, 95% confidence interval 0.32-0.70). The mortality rate at 12 mo for all subgroups was lower with nivolumab compared with everolimus. ORR also favored nivolumab. The incidence of grade 3 or 4 treatment-related adverse events across subgroups was lower with nivolumab. Limitations include the post hoc analysis and differing sample sizes between groups. The trend for OS and ORR benefit with nivolumab for multiple subgroups, without notable safety concerns, may help to guide treatment decisions, and further supports nivolumab as the standard of care in previously treated patients with aRCC. We investigated the impact of demographic and pretreatment features on survival benefit and tumor response with nivolumab versus everolimus in advanced renal cell carcinoma (aRCC). Survival benefit and response were observed for multiple subgroups, supporting the use of nivolumab as a new standard of care across a broad range of patients with previously treated aRCC. The trial is registered on ClinicalTrials.gov as NCT01668784. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

A small molecule inhibitor of mutant IDH2 rescues cardiomyopathy in a D-2-hydroxyglutaric aciduria type II mouse model.

PubMed

Wang, Fang; Travins, Jeremy; Lin, Zhizhong; Si, Yaguang; Chen, Yue; Powe, Josh; Murray, Stuart; Zhu, Dongwei; Artin, Erin; Gross, Stefan; Santiago, Stephanie; Steadman, Mya; Kernytsky, Andrew; Straley, Kimberly; Lu, Chenming; Pop, Ana; Struys, Eduard A; Jansen, Erwin E W; Salomons, Gajja S; David, Muriel D; Quivoron, Cyril; Penard-Lacronique, Virginie; Regan, Karen S; Liu, Wei; Dang, Lenny; Yang, Hua; Silverman, Lee; Agresta, Samuel; Dorsch, Marion; Biller, Scott; Yen, Katharine; Cang, Yong; Su, Shin-San Michael; Jin, Shengfang

2016-11-01

D-2-hydroxyglutaric aciduria (D2HGA) type II is a rare neurometabolic disorder caused by germline gain-of-function mutations in isocitrate dehydrogenase 2 (IDH2), resulting in accumulation of D-2-hydroxyglutarate (D2HG). Patients exhibit a wide spectrum of symptoms including cardiomyopathy, epilepsy, developmental delay and limited life span. Currently, there are no effective therapeutic interventions. We generated a D2HGA type II mouse model by introducing the Idh2R140Q mutation at the native chromosomal locus. Idh2R140Q mice displayed significantly elevated 2HG levels and recapitulated multiple defects seen in patients. AGI-026, a potent, selective inhibitor of the human IDH2R140Q-mutant enzyme, suppressed 2HG production, rescued cardiomyopathy, and provided a survival benefit in Idh2R140Q mice; treatment withdrawal resulted in deterioration of cardiac function. We observed differential expression of multiple genes and metabolites that are associated with cardiomyopathy, which were largely reversed by AGI-026. These findings demonstrate the potential therapeutic benefit of an IDH2R140Q inhibitor in patients with D2HGA type II.

Selective reminding of prospective memory in Multiple Sclerosis.

PubMed

McKeever, Joshua D; Schultheis, Maria T; Sim, Tiffanie; Goykhman, Jessica; Patrick, Kristina; Ehde, Dawn M; Woods, Steven Paul

2017-04-19

Multiple sclerosis (MS) is associated with prospective memory (PM) deficits, which may increase the risk of poor functional/health outcomes such as medication non-adherence. This study examined the potential benefits of selective reminding to enhance PM functioning in persons with MS. Twenty-one participants with MS and 22 healthy adults (HA) underwent a neuropsychological battery including a Selective Reminding PM (SRPM) experimental procedure. Participants were randomly assigned to either: (1) a selective reminding condition in which participants learn (to criterion) eight prospective memory tasks in a Selective Reminding format; or (2) a single trial encoding condition (1T). A significant interaction was demonstrated, with MS participants receiving greater benefit than HAs from the SR procedure in terms of PM performance. Across diagnostic groups, participants in the SR conditions (vs. 1T conditions) demonstrated significantly better PM performance. Individuals with MS were impaired relative to HAs in the 1T condition, but performance was statistically comparable in the SR condition. This preliminary study suggests that selective reminding can be used to enhance PM cue detection and retrieval in MS. The extent to which selective reminding of PM is effective in naturalistic settings and for health-related behaviours in MS remains to be determined.

Enhancing Undergraduate Chemistry Learning by Helping Students Make Connections among Multiple Graphical Representations

ERIC Educational Resources Information Center

Rau, Martina A.

2015-01-01

Multiple representations are ubiquitous in chemistry education. To benefit from multiple representations, students have to make connections between them. However, connection making is a difficult task for students. Prior research shows that supporting connection making enhances students' learning in math and science domains. Most prior research…

Family medical leave. An employee benefit for working caregivers of elderly family members.

PubMed

Carruth, A K; Booth, D

1991-09-01

Future trends include a decrease in the number of adult children, an increase in the number of individuals over age 65, single parent families, working women, and individuals with no health care insurance. As more women with multiple roles and responsibilities enter and continue as part of the work force, employers recognize the need for support of family issues. Currently many employers lack initiative to make these needed changes. The occupational health nurses' role in relation to future policy for working caregivers includes assessment of how employment and caregiving impact work performance, job satisfaction, and health; and participation in defining public policy issues.

The risks and benefits of sun exposure 2016.

PubMed

Hoel, David G; Berwick, Marianne; de Gruijl, Frank R; Holick, Michael F

2016-01-01

Public health authorities in the United States are recommending that men, women and children reduce their exposure to sunlight, based on concerns that this exposure will promote skin cancer. On the other hand, data show that increasing numbers of Americans suffer from vitamin D deficiencies and serious health problems caused by insufficient sun exposure. The body of science concerning the benefits of moderate sun exposure is growing rapidly, and is causing a different perception of sun/UV as it relates to human health. Melanoma and its relationship to sun exposure and sunburn is not adequately addressed in most of the scientific literature. Reports of favorable health outcomes related to adequate serum 25(OH)D concentration or vitamin D supplementation have been inappropriately merged, so that benefits of sun exposure other than production of vitamin D are not adequately described. This review of recent studies and their analyses consider the risks and benefits of sun exposure which indicate that insufficient sun exposure is an emerging public health problem. This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis. The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D.

The "for-benefit" academic medical center: a solution for survival.

PubMed

Sabeti, Heerad; Kahn, Marc J; Sachs, Benjamin P

2015-05-01

Academic medical centers (AMCs) are the backbone of the U.S. health care system. They provide a disproportionate share of charity care and serve as a training ground for future physicians. Yet, AMCs face profound economic challenges, from changes in funding to changes in the health care market. To survive, many AMCs will need to form integrated health systems, a process expected to cost tens, if not hundreds, of millions of dollars. Nearly all AMCs are structured as not-for- profit entities, which places restrictions on their ability to forge partnerships, pursue joint ventures, and access private capital, often essential elements for forming such integrated systems. An alternative model known as the "for-benefit" corporation can allow AMCs to retain their important social mission and the other advantages of their not-for-profit status while allowing them flexibility and access to both investment and philanthropic capital. To pursue the for-benefit pathway, AMCs have two options-either they could work within the constraints of existing laws to restructure themselves as for-benefit entities, or they could create, under federal law, a new for-benefit AMC model, allowing for the orderly conversion of not-for-profit AMCs. Essential components of a for-benefit AMC include a social purpose, access to multiple forms of capital, the use of earnings to support its purpose, transparency, aligned compensation, and tax exemptions. Restructuring an AMC as a for-benefit entity enables it to both advance shareholder value and further the public good.

PVUSA: The value of photovoltaics in the distribution system. The Kerman Grid-Support Project

NASA Astrophysics Data System (ADS)

Wenger, Howard J.; Hoff, Thomas E.

1995-05-01

As part of the Photovoltaics for Utility Scale Applications Applications (PVUSA) Project Pacific Gas Electric Company (PG&E) built the Kerman 500-kW photovoltaic power plant. Located near the end of a distribution feeder in a rural section of Fresno County, the plant was not built so much to demonstrate PV technology, but to evaluate its interaction with the local distribution grid and quantify available nontraditional grid-support benefits (those other than energy and capacity). As demand for new generation began to languish in the 1980s, and siting and permitting of power plants and transmission lines became more involved, utilities began considering smaller, distributed power sources. Potential benefits include shorter construction lead time, less capital outlay, and better utilization of existing assets. The results of a PG&E study in 1990/1991 of the benefits from a PV system to the distribution grid prompted the PVUSA Project to construct a plant at Kerman. Completed in 1993, the plant is believed to be the first one specifically built to evaluate the multiple benefits to the grid of a strategically sited plant. Each of nine discrete benefits were evaluated in detail by first establishing the technical impact, then translating the results into present economic value. Benefits span the entire system from distribution feeder to the generation fleet. This work breaks new ground in evaluation of distributed resources, and suggests that resource planning practices be expanded to account for these non-traditional benefits.

Patient Preferences for Attributes of Multiple Sclerosis Disease-Modifying Therapies

PubMed Central

Loucks, Aimee; Gipson, Gregory; Zhong, Lixian; Bui, Christine; Miller, Elizabeth; Owen, Mary; Pelletier, Daniel; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles E.

2015-01-01

Background: Timely individualized treatment is essential to improving relapsing-remitting multiple sclerosis (RRMS) patient health outcomes, yet little is known about how patients make treatment decisions. We sought to evaluate RRMS patient preferences for risks and benefits of treatment. Methods: Fifty patients with RRMS completed conjoint analysis surveys with 16 hypothetical disease-modifying therapy (DMT) medication profiles developed using a fractional factorial design. Medication profiles were assigned preference ratings from 0 (not acceptable) to 10 (most favorable). Medication attributes included a range of benefits, adverse effects, administration routes, and market durations. Analytical models used linear mixed-effects regression. Results: Participants showed the highest preference for medication profiles that would improve their symptoms (β = 0.81–1.03, P < .001), not a proven DMT outcome. Preventing relapses, the main clinical trial outcome, was not associated with significant preferences (P = .35). Each year of preventing magnetic resonance imaging changes and disease symptom progression showed DMT preferences of 0.17 point (β = 0.17, P = .002) and 0.12 point (β = 0.12, P < .001), respectively. Daily oral administration was preferred over all parenteral routes (P < .001). A 1% increase in death or severe disability decreased relative DMT preference by 1.15 points (P < .001). Conclusions: Patient preference focused on symptoms and prevention of progression but not on relapse prevention, the proven drug outcome. Patients were willing to accept some level of serious risk for certain types and amounts of benefits, and they strongly preferred daily oral administration over all other options. PMID:25892977

Do multiple micronutrient interventions improve child health, growth, and development?

PubMed

Ramakrishnan, Usha; Goldenberg, Tamar; Allen, Lindsay H

2011-11-01

Micronutrient deficiencies are common and often co-occur in many developing countries. Several studies have examined the benefits of providing multiple micronutrient (MMN) interventions during pregnancy and childhood, but the implications for programs remain unclear. The key objective of this review is to summarize what is known about the efficacy of MMN interventions during early childhood on functional outcomes, namely, child health, survival, growth, and development, to guide policy and identify gaps for future research. We identified review articles including meta-analyses and intervention studies that evaluated the benefits of MMN interventions (3 or more micronutrients) in children (<5 y of age) using Pubmed and EMBASE. Several controlled trials (n = 45) and meta-analyses (n = 6) have evaluated the effects of MMN interventions primarily for child morbidity, anemia, and growth. Two studies found no effects on child mortality. The findings for respiratory illness and diarrhea are mixed, although suggestive of benefit when provided as fortified foods. There is evidence from several controlled trials (>25) and 2 meta-analyses that MMN interventions improve hemoglobin concentrations and reduce anemia, but the effects were small compared to providing only iron or iron with folic acid. Two recent meta-analyses and several intervention trials also indicated that MMN interventions improve linear growth compared to providing a placebo or single nutrients. Much less is known about the effects on MMN interventions during early childhood on motor and mental development. In summary, MMN interventions may result in improved outcomes for children in settings where micronutrient deficiencies are widespread.

Public voices in pharmaceutical deliberations: negotiating "clinical benefit" in the FDA's Avastin Hearing.

PubMed

Teston, Christa B; Graham, S Scott; Baldwinson, Raquel; Li, Andria; Swift, Jessamyn

2014-06-01

This article offers a hybrid rhetorical-qualitative discourse analysis of the FDA's 2011 Avastin Hearing, which considered the revocation of the breast cancer indication for the popular cancer drug Avastin. We explore the multiplicity of stakeholders, the questions that motivated deliberations, and the kinds of evidence presented during the hearing. Pairing our findings with contemporary scholarship in rhetorical stasis theory, Mol's (2002) construct of multiple ontologies, and Callon, Lascoumes, and Barthe's (2011) "hybrid forums," we demonstrate that the FDA's deliberative procedures elides various sources of evidence and the potential multiplicity of definitions for "clinical benefit." Our findings suggest that while the FDA invited multiple stakeholders to offer testimony, there are ways that the FDA might have more meaningfully incorporated public voices in the deliberative process. We conclude with suggestions for how a true hybrid forum might be deployed.

Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

PubMed

Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

2016-12-01

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

The health impact of residential retreats: a systematic review.

PubMed

Naidoo, Dhevaksha; Schembri, Adrian; Cohen, Marc

2018-01-10

Unhealthy lifestyles are a major factor in the development and exacerbation of many chronic diseases. Improving lifestyles though immersive residential experiences that promote healthy behaviours is a focus of the health retreat industry. This systematic review aims to identify and explore published studies on the health, wellbeing and economic impact of retreat experiences. MEDLINE, CINAHL and PsychINFO databases were searched for residential retreat studies in English published prior to February 2017. Studies were included if they were written in English, involved an intervention program in a residential setting of one or more nights, and included before-and-after data related to the health of participants. Studies that did not meet the above criteria or contained only descriptive data from interviews or case studies were excluded. A total of 23 studies including eight randomised controlled trials, six non-randomised controlled trials and nine longitudinal cohort studies met the inclusion criteria. These studies included a total of 2592 participants from diverse geographical and demographic populations and a great heterogeneity of outcome measures, with seven studies examining objective outcomes such as blood pressure or biological makers of disease, and 16 studies examining subjective outcomes that mostly involved self-reported questionnaires on psychological and spiritual measures. All studies reported post-retreat health benefits ranging from immediately after to five-years post-retreat. Study populations varied widely and most studies had small sample sizes, poorly described methodology and little follow-up data, and no studies reported on health economic outcomes or adverse effects, making it difficult to make definite conclusions about specific conditions, safety or return on investment. Health retreat experiences appear to have health benefits that include benefits for people with chronic diseases such as multiple sclerosis, various cancers, HIV/AIDS, heart conditions and mental health. Future research with larger numbers of subjects and longer follow-up periods are needed to investigate the health impact of different retreat experiences and the clinical populations most likely to benefit. Further studies are also needed to determine the economic benefits of retreat experiences for individuals, as well as for businesses, health insurers and policy makers.

Pricing of multiple dosage prescription medications: an analysis of the Ontario Drug Benefit Formulary.

PubMed

Lexchin, Joel

2009-07-01

This paper investigates the pricing strategy (perfect flat pricing, perfect monotonic pricing, intermediate) used for multiple dosage medications listed in the Ontario Drug Benefit Formulary. All multiple dosage solid medications containing a single active ingredient newly listed in the Ontario Drug Benefit Formulary between 1996 and 2005 were identified. The relationship between price and dosage was calculated using a previously developed method. Seventy-three multiple dosage medications were introduced. Where medications were equivalent to existing ones in most cases companies followed the pricing strategy used by therapeutically equivalent drugs already in the formulary. Where there were no equivalent products companies did not adopt any particular pricing strategy. There was no difference in the way that companies priced scored tablets versus unscored tablets and capsules or in the way that they priced drugs that had objective measurements of efficacy/effectiveness, for example blood pressure, versus those that did not have these measurements. When Monotonic pricing is used it leads to higher expenditures whereas flat pricing results in lower expenditures and offers more predictability in expenditures. Provincial governments should consider requiring flat pricing in return for formulary listing.

Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer.

PubMed

Liu, H; Wu, J; Xue, S; Zhang, Q; Ruan, Y; Sun, X; Xia, S

2013-08-01

To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumour (TURBT) and 2-micron continuous-wave laser resection (2-µm laser) techniques in the management of multiple nonmuscle-invasive bladder cancer (NMIBC), and to investigate long-term effects on tumour recurrence. Patients with multiple NMIBC were randomized to receive TURBT or 2-µm laser in a nonblinded manner. All patients received intravesical chemotherapy with epirubicin (40 mg/40 ml) for 8 weeks, beginning 1 week after surgery, followed with monthly maintenance therapy for 12 months. Three-year follow-up data of preoperative, operative and postoperative management were recorded. In total, 120 patients were included: 56 in the TURBT group and 64 in the 2-µm laser group. Intra- and postoperative complications (including bladder perforation, bleeding and irritation) were less frequently observed in the 2-µm laser group compared with the TURBT group. There were no significant differences in first time to recurrence, overall recurrence or occurrence of urethral strictures. The 2-µm laser resection method was more effective than TURBT in reducing rates of intra- and postoperative complications, but offered no additional benefit regarding tumour recurrence.

More Than Just Accuracy: A Novel Method to Incorporate Multiple Test Attributes in Evaluating Diagnostic Tests Including Point of Care Tests.

PubMed

Thompson, Matthew; Weigl, Bernhard; Fitzpatrick, Annette; Ide, Nicole

2016-01-01

Current frameworks for evaluating diagnostic tests are constrained by a focus on diagnostic accuracy, and assume that all aspects of the testing process and test attributes are discrete and equally important. Determining the balance between the benefits and harms associated with new or existing tests has been overlooked. Yet, this is critically important information for stakeholders involved in developing, testing, and implementing tests. This is particularly important for point of care tests (POCTs) where tradeoffs exist between numerous aspects of the testing process and test attributes. We developed a new model that multiple stakeholders (e.g., clinicians, patients, researchers, test developers, industry, regulators, and health care funders) can use to visualize the multiple attributes of tests, the interactions that occur between these attributes, and their impacts on health outcomes. We use multiple examples to illustrate interactions between test attributes (test availability, test experience, and test results) and outcomes, including several POCTs. The model could be used to prioritize research and development efforts, and inform regulatory submissions for new diagnostics. It could potentially provide a way to incorporate the relative weights that various subgroups or clinical settings might place on different test attributes. Our model provides a novel way that multiple stakeholders can use to visualize test attributes, their interactions, and impacts on individual and population outcomes. We anticipate that this will facilitate more informed decision making around diagnostic tests.

Meeting the challenge of interacting threats in freshwater ecosystems: A call to scientists and managers

USGS Publications Warehouse

Craig, Laura S.; Olden, Julian D.; Arthington, Angela; Entrekin, Sally; Hawkins, Charles P.; Kelly, John J.; Kennedy, Theodore A.; Maitland, Bryan M.; Rosi, Emma J.; Roy, Allison; Strayer, David L.; Tank, Jennifer L.; West, Amie O.; Wooten, Matthew S.

2017-01-01

Human activities create threats that have consequences for freshwater ecosystems and, in most watersheds, observed ecological responses are the result of complex interactions among multiple threats and their associated ecological alterations. Here we discuss the value of considering multiple threats in research and management, offer suggestions for filling knowledge gaps, and provide guidance for addressing the urgent management challenges posed by multiple threats in freshwater ecosystems. There is a growing literature assessing responses to multiple alterations, and we build off this background to identify three areas that require greater attention: linking observed alterations to threats, understanding when and where threats overlap, and choosing metrics that best quantify the effects of multiple threats. Advancing science in these areas will help us understand existing ecosystem conditions and predict future risk from multiple threats. Because addressing the complex issues and novel ecosystems that arise from the interaction of multiple threats in freshwater ecosystems represents a significant management challenge, and the risks of management failure include loss of biodiversity, ecological goods, and ecosystem services, we also identify actions that could improve decision-making and management outcomes. These actions include drawing insights from management of individual threats, using threat attributes (e.g., causes and spatio-temporal dynamics) to identify suitable management approaches, testing management strategies that are likely to be successful despite uncertainties about the nature of interactions among threats, avoiding unintended consequences, and maximizing conservation benefits. We also acknowledge the broadly applicable challenges of decision-making within a socio-political and economic framework, and suggest that multidisciplinary teams will be needed to innovate solutions to meet the current and future challenge of interacting threats in freshwater ecosystems. 

Intelligibility of clear speech: effect of instruction.

PubMed

Lam, Jennifer; Tjaden, Kris

2013-10-01

The authors investigated how clear speech instructions influence sentence intelligibility. Twelve speakers produced sentences in habitual, clear, hearing impaired, and overenunciate conditions. Stimuli were amplitude normalized and mixed with multitalker babble for orthographic transcription by 40 listeners. The main analysis investigated percentage-correct intelligibility scores as a function of the 4 conditions and speaker sex. Additional analyses included listener response variability, individual speaker trends, and an alternate intelligibility measure: proportion of content words correct. Relative to the habitual condition, the overenunciate condition was associated with the greatest intelligibility benefit, followed by the hearing impaired and clear conditions. Ten speakers followed this trend. The results indicated different patterns of clear speech benefit for male and female speakers. Greater listener variability was observed for speakers with inherently low habitual intelligibility compared to speakers with inherently high habitual intelligibility. Stable proportions of content words were observed across conditions. Clear speech instructions affected the magnitude of the intelligibility benefit. The instruction to overenunciate may be most effective in clear speech training programs. The findings may help explain the range of clear speech intelligibility benefit previously reported. Listener variability analyses suggested the importance of obtaining multiple listener judgments of intelligibility, especially for speakers with inherently low habitual intelligibility.

Modern perspectives on the health benefits of kefir in next generation sequencing era: Improvement of the host gut microbiota.

PubMed

Kim, Dong-Hyeon; Jeong, Dana; Kim, Hyunsook; Seo, Kun-Ho

2018-01-16

Kefir is a natural complex fermented milk product containing more than 50 species of probiotic bacteria and yeast, and has been demonstrated to have multiple properties conferring health benefits, including antiobesity, anti-hepatic steatosis, antioxidative, antiallergenic, antitumor, anti-inflammatory, cholesterol-lowering, constipation-alleviating, and antimicrobial properties. To better understand the underlying mechanisms of these benefits, we here review research on the effect of kefir (and kefir microorganisms) consumption to modulate the host gut microbiota. Owing to its excellent gastrointestinal resistance and colonization ability and wide ranges of microbial interaction, kefir has shown significant and wide-spectrum modulatory effects on the host gut microbiota. In particular, as a bacteria- and yeast-containing food, kefir can modulate both the gut microbiota and mycobiota. Since the association of this modulation with health benefit has only been addressed in a small number of recent studies thus far, further studies are needed to determine the precise mechanisms of the beneficial effects of kefir in relation to the modulation of the gut microbiota and mycobiota. Gaining this insight will surely help to take full advantage of this unique probiotic food.

Best Practices of Multiple-Time SmartWay Award Winners

EPA Pesticide Factsheets

This EPA presentations focus is on the SmartWay Excellence Awards multiple winners, their best practices in protecting the environment, incorporating sustainability and reducing carbon pollution, along with benefits of being a partner.

Multi-EMR Structured Data Entry Form: User-Acceptance Testing of a Prototype.

PubMed

Zavar, Abbas; Keshavjee, Karim

2017-01-01

Capturing standardized data from multiple EMRs at the point of care is highly desirable for a variety of uses, including quality improvement programs, multi-centered clinical trials and clinical decision support. In this paper, we describe the design, development and user acceptance testing of a prototype web-based form (the Form) that can integrate with multiple EMRs. We used the validated UTAUT questionnaire to assess the likelihood of uptake of the Form into clinical practice. The Form was found to be easy to use, elicits low anxiety, supports productivity and is perceived to have good support. Users would benefit from training and from better social signaling about the importance of using the Form in their practice. Making the Form more fun and interesting could help increase uptake.

Apatinib: a promising oral antiangiogenic agent in the treatment of multiple solid tumors.

PubMed

Scott, A J; Messersmith, W A; Jimeno, A

2015-04-01

Aberrant proangiogenic pathways have long been implicated in tumorigenesis and metastasis. Antiangiogenic therapies have shown efficacy in the treatment of a variety of solid tumors including lung, breast, colon, glioblastomas, and other solid tumor types. Apatinib, a small-molecule inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2), is an orally bioavailable agent currently being studied in multiple tumor types. Apatinib has shown a survival benefit in gastric cancer in a phase III trial and non-small cell lung cancer in a phase II trial. With a favorable side effect profile and improved outcomes, apatinib has demonstrated a substantial potential to augment therapeutic options in a variety of tumor types. Copyright 2015 Prous Science, S.A.U. or its licensors. All rights reserved.

Fabrication of Transition Edge Sensor Microcalorimeters for X-Ray Focal Planes

NASA Technical Reports Server (NTRS)

Chervenak, James A.; Adams, Joseph S.; Audley, Heather; Bandler, Simon R.; Betancourt-Martinez, Gabriele; Eckart, Megan E.; Finkbeiner, Fred M.; Kelley, Richard L.; Kilbourne, Caroline; Lee, Sang Jun;

The impact of commercial rapid respiratory virus diagnostic tests on patient outcomes and health system utilization.

PubMed

Ko, Fiona; Drews, Steven J

2017-10-01

Acute respiratory tract infections due to influenza A/B and respiratory syncytial virus (RSV) are major causes of morbidity and mortality globally. Rapid tests for detection of these pathogens include antigen detection point of care tests (POC) and newer easy to use molecular tests. From experience, these assays improve both laboratory workflow and assay interpretation issues. However, the question of the benefits of using rapid test technology compared to routine laboratory testing for respiratory viral pathogens is still often asked. Areas covered: Specifically, this review aims to; 1) identify clinical/patient indicators that can be measured prior to and following the implementation of rapid diagnostic test for influenza and RSV, 2) provide multiple perspectives on the extent of impact of a rapid diagnostic test, including direct and indirect outcomes, and 3) identify the technological advancements in the development of rapid testing, demonstrating a timeline that transitions from antigen-based assays to molecular assays. Expert commentary: Key benefits to the use of either antigen-based or molecular rapid tests for patient care, patient flow within institutions, as well as laboratory utilization are identified. Due to improved test characteristics, the authors feel that rapid molecular tests have greater benefits than antigen-based detection methods.

Neural Substrates Underlying Effort, Time, and Risk-Based Decision Making in Motivated Behavior

PubMed Central

Bailey, Matthew R.; Simpson, Eleanor H.; Balsam, Peter D

2016-01-01

All mobile organisms rely on adaptive motivated behavior to overcome the challenges of living in an environment in which essential resources may be limited. A variety of influences ranging from an organism’s environment, experiential history, and physiological state all influence a cost-benefit analysis which allows motivation to energize behavior and direct it toward specific goals. Here we review the substantial amount of research aimed at discovering the interconnected neural circuits which allow organisms to carry-out the cost-benefit computations which allow them to behave in adaptive ways. We specifically focus on how the brain deals with different types of costs, including effort requirements, delays to reward and payoff riskiness. An examination of this broad literature highlights the importance of the extended neural circuits which enable organisms to make decisions about these different types of costs. This involves Cortical Structures, including the Anterior Cingulate Cortex (ACC), the Orbital Frontal Cortex (OFC), the Infralimbic Cortex (IL), and prelimbic Cortex (PL), as well as the Baso-Lateral Amygdala (BLA), the Nucleus Accumbens (Nacc), the Ventral Pallidal (VP), the Sub Thalamic Nucleus (STN) among others. Some regions are involved in multiple aspects of cost-benefit computations while the involvement of other regions is restricted to information relating to specific types of costs. PMID:27427327

Neural substrates underlying effort, time, and risk-based decision making in motivated behavior.

PubMed

Bailey, Matthew R; Simpson, Eleanor H; Balsam, Peter D

2016-09-01

All mobile organisms rely on adaptive motivated behavior to overcome the challenges of living in an environment in which essential resources may be limited. A variety of influences ranging from an organism's environment, experiential history, and physiological state all influence a cost-benefit analysis which allows motivation to energize behavior and direct it toward specific goals. Here we review the substantial amount of research aimed at discovering the interconnected neural circuits which allow organisms to carry-out the cost-benefit computations which allow them to behave in adaptive ways. We specifically focus on how the brain deals with different types of costs, including effort requirements, delays to reward and payoff riskiness. An examination of this broad literature highlights the importance of the extended neural circuits which enable organisms to make decisions about these different types of costs. This involves Cortical Structures, including the Anterior Cingulate Cortex (ACC), the Orbital Frontal Cortex (OFC), the Infralimbic Cortex (IL), and prelimbic Cortex (PL), as well as the Baso-Lateral Amygdala (BLA), the Nucleus Accumbens (NAcc), the Ventral Pallidal (VP), the Sub Thalamic Nucleus (STN) among others. Some regions are involved in multiple aspects of cost-benefit computations while the involvement of other regions is restricted to information relating to specific types of costs. Copyright © 2016 Elsevier Inc. All rights reserved.

Partial budget of the discounted annual benefit of mastitis control strategies.

PubMed

Allore, H G; Erb, H N

1998-08-01

The objective of this study was to rank the benefits associated with various mastitis control strategies in simulated herds with intramammary infections caused by Streptococcus agalactiae, Streptococcus spp. other than Strep. agalactiae, Staphylococcus aureus, coagulase-negative staphylococci, and Escherichia coli. The control strategies tested were prevention, vaccination for E. coli, lactation therapy, and dry cow antibiotic therapy. Partial budgets were based on changes caused by mastitis control strategies from the mean values for milk, fat, and protein yields of the control herd and the number of cows that were culled under a fixed mastitis culling criterion. Each annual benefit (dollars per cow per year) of a mastitis control strategy was compared with the revenue for the control herd and was calculated under two different milk pricing plans (3.5% milk fat and multiple-component pricing), three net replacement costs, and three prevalences of pathogen-specific intramammary infection. Twenty replicates of each control strategy were run with SIMMAST (a dynamic discrete event stochastic simulation model) for 5 simulated yr. Rankings of discounted annual benefits differed only slightly according to milk pricing plans within a pathogen group but differed among the pathogen groups. Differences in net replacement costs for cows culled because of mastitis did not change the ranking of control strategies within a pathogen group. Both prevention and dry cow therapy were important mastitis control strategies. For herds primarily infected with environmental pathogens, strategies that included vaccination for mastitis caused by E. coli dominated strategies that did not include vaccination against this microorganism.

Methodologies for Investigating Performance Changes With Supplement Use.

PubMed

Burke, Louise M; Peeling, Peter

2018-03-01

Many expert sporting bodies now support a pragmatic acceptance of the use of performance supplements which have passed a risk:benefit analysis of being safe, effective, and permitted for use, while also being appropriate to the athlete's age and maturation in their sport. However, gaining evidence of the performance benefits of these supplements is a process challenged by the scarcity of research in relation to the number of available products, and the limitations of the poor quality of some studies. While meta-analyses and systematic reviews can help to provide information about the general use of performance supplements, the controlled scientific trial provides the basis on which these reviews are undertaken, as well as an opportunity to address more specific questions about supplement applications. Guidelines for the design of studies include the choice of well-trained athletes who are familiarized with performance tasks that have been chosen on their basis of their known reliability and validity. Supplement protocols should be chosen to maximize the likely benefits, and researchers should also make efforts to control confounding variables, while keeping conditions similar to real-life practices. Performance changes should be interpreted in light of what is meaningful to the outcomes of sporting competition. Issues that have been poorly addressed to date include the use of several supplements in combination and the use of the same supplement over successive events, both within a single, and across multiple competition days. Strategies to isolate and explain the variability of benefits to individuals are also a topic for future investigation.

Thoracic epidural analgesia in a child with multiple traumatic rib fractures.

PubMed

Keech, Brian M

2015-12-01

The morbidity and mortality associated with blunt thoracic trauma are significant and can be multisystem in nature. Of these, pulmonary complications, including ventilatory impairment secondary to pain, have been recognized to be the most consequential. Although several analgesic strategies have emerged, thoracic epidural analgesia (TEA) has arguably demonstrated superior efficacy and is used frequently in adults. Unfortunately, TEA is rarely used in children after blunt thoracic trauma, but may be of considerable benefit. This low rate of use likely reflects one or more of several factors potentially encountered when considering the use of TEA in pediatric chest wall trauma. Among them are (1) uncertainty regarding safety and efficacy; (2) the technical challenges of pediatric thoracic epidural placement, including technique and equipment concerns; and (3) drug selection, dosing, and toxicity. The following case review describes the successful application of TEA in a 4-year-old boy after multiple traumatic rib fractures and associated pneumothorax and pulmonary contusion. Copyright © 2015 Elsevier Inc. All rights reserved.

Precision medicine and personalising therapy in pulmonary hypertension: seeing the light from the dawn of a new era.

PubMed

Savale, Laurent; Guignabert, Christophe; Weatherald, Jason; Humbert, Marc

2018-06-30

Pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) include different cardiopulmonary disorders in which the interaction of multiple genes with environmental and behavioural factors modulates the onset and the progression of these severe conditions. Although the development of therapeutic agents that modulate abnormalities in three major pathobiological pathways for PAH has revolutionised our approach to the treatment of PAH, the long-term survival rate remains unsatisfactory. Accumulating evidence has underlined that clinical outcomes and responses to therapy in PAH are modified by multiple factors, including genetic variations, which will be different for each individual. Since precision medicine, also known as stratified medicine or personalised medicine, aims to better target intervention to the individual while maximising benefit and minimising harm, it has significant potential advantages. This article aims to assemble and discuss the different initiatives that are currently underway in the PH/PAH fields together with the opportunities and prospects for their use in the near future. Copyright ©ERS 2018.

Modelling Concentrating Solar Power with Thermal Energy Storage for Integration Studies (Presentation)

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

Hummon, M.; Jorgenson, J.; Denholm, P.

2013-10-01

Concentrating solar power with thermal energy storage (CSP-TES) can provide multiple benefits to the grid, including low marginal cost energy and the ability to levelize load, provide operating reserves, and provide firm capacity. It is challenging to properly value the integration of CSP because of the complicated nature of this technology. Unlike completely dispatchable fossil sources, CSP is a limited energy resource, depending on the hourly and daily supply of solar energy. To optimize the use of this limited energy, CSP-TES must be implemented in a production cost model with multiple decision variables for the operation of the CSP-TES plant.more » We develop and implement a CSP-TES plant in a production cost model that accurately characterizes the three main components of the plant: solar field, storage tank, and power block. We show the effect of various modelling simplifications on the value of CSP, including: scheduled versus optimized dispatch from the storage tank and energy-only operation versus co-optimization with ancillary services.« less

Modelling Concentrating Solar Power with Thermal Energy Storage for Integration Studies: Preprint

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

Hummon, M.; Denholm, P.; Jorgenson, J.

2013-10-01

Concentrating solar power with thermal energy storage (CSP-TES) can provide multiple benefits to the grid, including low marginal cost energy and the ability to levelize load, provide operating reserves, and provide firm capacity. It is challenging to properly value the integration of CSP because of the complicated nature of this technology. Unlike completely dispatchable fossil sources, CSP is a limited energy resource, depending on the hourly and daily supply of solar energy. To optimize the use of this limited energy, CSP-TES must be implemented in a production cost model with multiple decision variables for the operation of the CSP-TES plant.more » We develop and implement a CSP-TES plant in a production cost model that accurately characterizes the three main components of the plant: solar field, storage tank, and power block. We show the effect of various modelling simplifications on the value of CSP, including: scheduled versus optimized dispatch from the storage tank and energy-only operation versus co-optimization with ancillary services.« less

Management of comminuted proximal ulna fracture-dislocations using a multiplanar locking intramedullary nail.

PubMed

Edwards, Scott G; Argintar, Evan; Lamb, Joshua

2011-06-01

Intramedullary nails have been used for the fixation of olecranon fractures in an attempt to reduce the soft tissue irritation and resulting need for hardware removal seen with plating and tension banding. Further benefits include preservation of vascular supply, and increase stability and improved compression over some alternative techniques. Most intramedullary nails have been limited to simple olecranon fractures or osteotomies. One novel multiplanar, locking intramedullary nail, however, is indicated to stabilize all fracture patterns of the proximal ulna, including the coronoid. This particular locking nail has screws that radiate in multiple planes and form a fixed-angle lattice throughout the bone. The nail also has fixed-angle screws dedicated to the 3 parts of the coronoid: process tip, medial facet, and medial wall. This allows the nail to secure multiple fragments regardless of the fracture pattern's extent of instability. The objective of this article is to illustrate the recommended steps in reducing and stabilizing a comminuted proximal ulna fracture-dislocation using this multiplanar locking intramedullary nail.

Citizen Science: Data Sharing For, By, and With the Public

NASA Astrophysics Data System (ADS)

Wiggins, A.

2017-12-01

Data sharing in citizen science is just as challenging as it is for any other type of science, except that there are more parties involved, with more diverse needs and interests. This talk provides an overview of the challenges and current efforts to advance data sharing in citizen science, and suggests refocusing data management activities on supporting the needs of multiple audiences. Early work on data sharing in citizen science advocated applying the standards and practices of academia, which can only address the needs of one of several audiences for citizen science data, and academics are not always the primary audience. Practitioners still need guidance on how to better share data other key parties, such as participants and policymakers, and which data management practices to prioritize for addressing the needs of multiple audiences. The benefits to the project of investing scarce resources into data products and dissemination strategies for each target audience still remain variable, unclear, or unpredictable. And as projects mature and change, the importance of data sharing activities and audiences are likely to change as well. This combination of multiple diverse audiences, shifting priorities, limited resources, and unclear benefits creates a perfect storm of conditions to suppress data sharing. Nonetheless, many citizen science projects make the effort, with exemplars showing substantial returns on data stewardship investments, and international initiatives are underway to bolster the data sharing capacity of the field. To improve the state of data sharing in citizen science, strategic use of limited resources suggests prioritizing data management activities that support the needs of multiple audiences. These may include better transparency about data access and usage, and standardized reporting of broader impacts from secondary data users, to both reward projects and incentivize further data sharing.

Liquid biopsy: a step forward towards precision medicine in urologic malignancies.

PubMed

Di Meo, Ashley; Bartlett, Jenni; Cheng, Yufeng; Pasic, Maria D; Yousef, George M

2017-04-14

There is a growing trend towards exploring the use of a minimally invasive "liquid biopsy" to identify biomarkers in a number of cancers, including urologic malignancies. Multiple aspects can be assessed in circulating cell-free DNA, including cell-free DNA levels, integrity, methylation and mutations. Other prospective liquid biopsy markers include circulating tumor cells, circulating RNAs (miRNA, lncRNAs and mRNAs), cell-free proteins, peptides and exosomes have also emerged as non-invasive cancer biomarkers. These circulating molecules can be detected in various biological fluids, including blood, urine, saliva and seminal plasma. Liquid biopsies hold great promise for personalized medicine due to their ability to provide multiple non-invasive global snapshots of the primary and metastatic tumors. Molecular profiling of circulating molecules has been a stepping-stone to the successful introduction of several non-invasive multi-marker tests into the clinic. In this review, we provide an overview of the current state of cell-free DNA-based kidney, prostate and bladder cancer biomarker research and discuss the potential utility other circulating molecules. We will also discuss the challenges and limitations facing non-invasive cancer biomarker discovery and the benefits of this growing area of translational research.

Multiple Choice Items: How to Gain the Most out of Them.

ERIC Educational Resources Information Center

Talmir, Pinchas

1991-01-01

Describes how multiple-choice items can be designed and used as an effective diagnostic tool by avoiding their pitfalls and by taking advantage of their potential benefits. The following issues are discussed: correct' versus best answers; construction of diagnostic multiple-choice items; the problem of guessing; the use of justifications of…

26 CFR 54.9811-1 - Standards relating to benefits for mothers and newborns.

Code of Federal Regulations, 2013 CFR

2013-04-01

... benefits for mothers and newborns. (a) Hospital length of stay—(1) General rule. Except as provided in... in connection with childbirth for a mother or her newborn may not restrict benefits for the stay to... length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple...

26 CFR 54.9811-1 - Standards relating to benefits for mothers and newborns.

Code of Federal Regulations, 2012 CFR

2012-04-01

... benefits for mothers and newborns. (a) Hospital length of stay—(1) General rule. Except as provided in... in connection with childbirth for a mother or her newborn may not restrict benefits for the stay to... length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple...

26 CFR 54.9811-1 - Standards relating to benefits for mothers and newborns.

Code of Federal Regulations, 2014 CFR

2014-04-01

... benefits for mothers and newborns. (a) Hospital length of stay—(1) General rule. Except as provided in... in connection with childbirth for a mother or her newborn may not restrict benefits for the stay to... length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple...

Using a patient-centered approach to benefit-harm assessment in treatment decision-making: a case study in uveitis.

PubMed

Yu, Tsung; Holbrook, Janet T; Thorne, Jennifer E; Puhan, Milo A

2016-04-01

Synthesizing evidence from comparative effectiveness trials can be difficult because multiple outcomes of different importance are to be considered. The goal of this study was to demonstrate an approach to conducting quantitative benefit-harm assessment that considers patient preferences. We conducted a benefit-harm assessment using data from the Multicenter Uveitis Steroid Treatment Trial that compared corticosteroid implant versus systemic corticosteroids and immunosuppression in non-infectious intermediate, posterior, and panuveitis. We focused on clinical outcomes considered important to patients, including visual acuity, development of cataracts/glaucoma, need for eye surgery, prescription-requiring hypertension, hyperlipidemia, and infections. Patient preferences elicited in a recent survey were then incorporated into our assessment of the benefit-harm balance. Benefit-harm metrics were calculated for each time point that summarized the numbers of outcomes, caused or prevented by implant therapy versus systemic therapy if 1000 patients were treated. The benefit-harm metric was -129 (95% confidence interval: -242 to -14), -317 (-436 to -196), -390 (-514 to -264), and -526 (-687 to -368) at 6, 12, 18, and 24 months follow up, respectively, suggesting that systemic therapy may have a better benefit-harm balance. However, measures of quality of life for patients treated with implant therapy were found to be better than patients treated with systemic therapy over the same time period. Results of benefit-harm assessment were different from the prospectively collected quality of life data during trial follow up. Future studies should explore the reasons for such discrepancies and the strength and weakness of each method to assess treatment benefits and harms. Copyright © 2016 John Wiley & Sons, Ltd.

Using a patient-centered approach to benefit-harm assessment in treatment decision-making: a case study in uveitis

PubMed Central

Yu, Tsung; Holbrook, Janet T.; Thorne, Jennifer E.; Puhan, Milo A.

2017-01-01

Background Synthesizing evidence from comparative effectiveness trials can be difficult since multiple outcomes of different importance are to be considered. The goal of this study was to demonstrate an approach to conducting quantitative benefit-harm assessment that considers patient preferences. Methods We conducted a benefit-harm assessment using data from the Multicenter Uveitis Steroid Treatment Trial that compared corticosteroid implant versus systemic corticosteroids and immunosuppression in non-infectious intermediate, posterior, and panuveitis. We focused on clinical outcomes considered important to patients, including visual acuity, development of cataracts/glaucoma, need for eye surgery, prescription-requiring hypertension, hyperlipidemia and infections. Patient preferences elicited in a recent survey were then incorporated into our assessment of the benefit-harm balance. Results Benefit-harm metrics were calculated for each time point that summarized the numbers of outcomes, caused or prevented by implant therapy versus systemic therapy if 1000 patients were treated. The benefit-harm metric was -129 (95% CI: -242 to -14), -317 (-436 to -196), -390 (-514 to -264) and -526 (-687 to -368) at 6, 12, 18, and 24 months follow-up, respectively, suggesting that systemic therapy may have a better benefit-harm balance. However, measures of quality of life for patients treated with implant therapy were found to be better than patients treated with systemic therapy over the same time period. Conclusions Results of benefit-harm assessment were different from the prospectively collected quality of life data during trial follow-up. Future studies should explore the reasons for such discrepancies and the strength and weakness of each method to assess treatment benefits and harms. PMID:26798977

Battery energy-storage systems — an emerging market for lead/acid batteries

NASA Astrophysics Data System (ADS)

Cole, J. F.

Although the concept of using batteries for lead levelling and peak shaving has been known for decades, only recently have these systems become commercially viable. Changes in the structure of the electric power supply industry have required these companies to seek more cost-effective ways of meeting the needs of their customers. Through experience gained, primarily in the USA, batteries have been shown to provide multiple benefits to electric utilities. Also, lower maintenance batteries, more reliable electrical systems, and the availability of methods to predict costs and benefits have made battery energy-storage systems more attractive. Technology-transfer efforts in the USA have resulted in a willingness of electric utilities to install a number of these systems for a variety of tasks, including load levelling, peak shaving, frequency regulation and spinning reserve. Additional systems are being planned for several additional locations for similar applications, plus transmission and distribution deferral and enhanced power quality. In the absence of US champions such as the US Department of Energy and the Electric Power Research Institute, ILZRO is attempting to mount a technology-transfer programme to bring the benefits of battery energy-storage to European power suppliers. As a result of these efforts, a study group on battery energy-storage systems has been established with membership primarily in Germany and Austria. Also, a two-day workshop, prepared by the Electric Power Research Institute was held in Dublin. Participants included representatives of several European power suppliers. As a result, ESB National Grid of Ireland has embarked upon a detailed analysis of the costs and benefits of a battery energy-storage system in their network. Plans for the future include continuation of this technology-transfer effort, assistance in the Irish effort, and a possible approach to the European Commission for funding.

Swedish Massage: A Systematic Review of its Physical and Psychological Benefits.

PubMed

Barreto, Débora M; Batista, Marcus V A

2017-01-01

Context • Swedish massage is the systematic application of manual pressure and the movement of soft tissue, with rhythmical pressure and stroking to obtain or maintain health. Studies have revealed its many benefits. Objective • The aim of the current study was to determine the results of past studies that evaluated the benefits of Swedish massage for various populations and to highlight its relevance as an alternative medical practice in health promotion and disease prevention. Methods • The research team performed a review of the literature using the key terms massage, relaxation, and benefits of massage. Original case reports and literature reviews of manual therapy published from 2004 to 2014 were included in the current review. The search was conducted using the SciELO, PubMed, and Medline databases. Setting • The study was performed at the Central Library of the Federal University of Sergipe, in São Cristóvão, Sergipe, Brazil. Participants • Participants in the reviewed studies included varied populations, such as nurses in hospitals, infants and older children, pregnant women, older adults, and cancer patients. Results • A total of 4516 articles were identified for consideration through the electronic database searches. After screening, 117 potentially relevant articles were identified for full review, and 11 studies met the inclusion criteria. The studies showed beneficial results in most cases, including improved nasal breathing and cleanliness in children, reduced lower-back pain for nurses, and improved adrenocortical function in infants. Massage is not completely risk free, however, and should be done by a professional very cautiously. Conclusions • Swedish massage has shown beneficial effects for multiple populations and can be used as a therapy. Its use in disease prevention is highly recommended.

75 FR 8750 - Submission for OMB Review: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-25

... Department of Labor--Employee Benefits Security Administration (EBSA), Office of Management and Budget, Room... information technology, e.g., permitting electronic submission of responses. Agency: Employee Benefits... of Collection: Annual Report for Multiple Employer Welfare Arrangements (Form M-1). OMB Control...

Chapter 2: Assessing the Potential Energy Impacts of Clean Energy Initiatives

EPA Pesticide Factsheets

Chapter 2 of Assessing the Multiple Benefits of Clean Energy helps state energy, environmental, and economic policy makers identify and quantify the many benefits of clean energy to support the development and implementation of cost-effective clean energ

The impacts of freight mode splitting on congestion, risk, and delivery reliability.

DOT National Transportation Integrated Search

2012-09-01

Although splitting shipments across multiple delivery or transportation modes typically : increases total shipping costs as a result of diseconomies of scale, it may offer certain benefits : that can more than offset these costs. These benefits inclu...

Framing K-12 partnerships in order to make a difference.

PubMed

Hamos, James E

2006-06-01

The Health Professions Partnership Initiative (HPPI) furthered the establishment of partnerships between academic health centers and K-12 school systems. The present article contends that partnerships in efforts such as the HPPI exist in varying degrees of depth with deeper partnerships being those based in a concept of mutuality even as partners continue to maintain institutional identity. In the context of K-12 schools, the article reinforces the view that K-12 students, teachers, and administrators can benefit through partnership contexts, but also suggests that institutions of higher education-including academic health centers-should enter into partnerships because they benefit when they commit as stakeholders in the outcomes, not principally as altruistic good neighbors to the schools. Partnerships can continue to grow when multiple stakeholders accept mutual dependence as a norm, with goals, processes, and outcomes impacting each partner.

Accounting for the Variation of Driver Aggression in the Simulation of Conventional and Advanced Vehicles: Preprint

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

Neubauer, J.; Wood, E.

2013-03-01

Hybrid electric vehicles, plug-in hybrid electric vehicles, and battery electric vehicles offer the potential to reduce both oil imports and greenhouse gases, as well as to offer a financial benefit to the driver. However, assessing these potential benefits is complicated by several factors, including the driving habits of the operator. We focus on driver aggression, i.e., the level of acceleration and velocity characteristic of travel, to (1) assess its variation within large, real-world drive datasets, (2) quantify its effect on both vehicle efficiency and economics for multiple vehicle types, (3) compare these results to those of standard drive cycles commonlymore » used in the industry, and (4) create a representative drive cycle for future analyses where standard drive cycles are lacking.« less

Use of the Godin leisure-time exercise questionnaire in multiple sclerosis research: a comprehensive narrative review.

PubMed

Sikes, Elizabeth Morghen; Richardson, Emma V; Cederberg, Katie J; Sasaki, Jeffer E; Sandroff, Brian M; Motl, Robert W

2018-01-17

The Godin Leisure-Time Exercise Questionnaire has been a commonly applied measure of physical activity in research among persons with multiple sclerosis over the past decade. This paper provides a comprehensive description of its application and inclusion in research on physical activity in multiple sclerosis. This comprehensive, narrative review included papers that were published between 1985 and 2017, written in English, involved participants with multiple sclerosis as a primary population, measured physical activity, and cited one of the two original Godin papers. There is a broad scope of research that has included the Godin Leisure-Time Exercise Questionnaire in persons with multiple sclerosis. Overall, 8 papers evaluated its psychometric properties, 21 evaluated patterns of physical activity, 24 evaluated correlates or determinants of physical activity, 28 evaluated outcomes or consequences of physical activity, and 15 evaluated physical activity interventions. The Godin Leisure-Time Exercise Questionnaire is a valid self-report measure of physical activity in persons with multiple sclerosis, and further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity, and provides a sensitive outcome for measuring change in physical activity after an intervention. Implications for rehabilitation There is increasing interest in physical activity and its benefits in multiple sclerosis. The study of physical activity requires appropriate and standardized measures. The Godin Leisure-Time Exercise Questionnaire is a common self-report measure of physical activity for persons with multiple sclerosis. Godin Leisure-Time Exercise Questionnaire scores are reliable measures of physical activity in persons with multiple sclerosis. The Godin Leisure-Time Exercise Questionnaire further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity participation, and is an advantageous primary outcome for measuring change in physical activity in response to an intervention.

Genomic and Coexpression Analyses Predict Multiple Genes Involved in Triterpene Saponin Biosynthesis in Medicago truncatula[C][W

PubMed Central

Naoumkina, Marina A.; Modolo, Luzia V.; Huhman, David V.; Urbanczyk-Wochniak, Ewa; Tang, Yuhong; Sumner, Lloyd W.; Dixon, Richard A.

2010-01-01

Saponins, an important group of bioactive plant natural products, are glycosides of triterpenoid or steroidal aglycones (sapogenins). Saponins possess many biological activities, including conferring potential health benefits for humans. However, most of the steps specific for the biosynthesis of triterpene saponins remain uncharacterized at the molecular level. Here, we use comprehensive gene expression clustering analysis to identify candidate genes involved in the elaboration, hydroxylation, and glycosylation of the triterpene skeleton in the model legume Medicago truncatula. Four candidate uridine diphosphate glycosyltransferases were expressed in Escherichia coli, one of which (UGT73F3) showed specificity for multiple sapogenins and was confirmed to glucosylate hederagenin at the C28 position. Genetic loss-of-function studies in M. truncatula confirmed the in vivo function of UGT73F3 in saponin biosynthesis. This report provides a basis for future studies to define genetically the roles of multiple cytochromes P450 and glycosyltransferases in triterpene saponin biosynthesis in Medicago. PMID:20348429

(In)Visibility Online: The Benefits of Online Patient Forums for People with a Hidden Illness: The Case of Multiple Chemical Sensitivity (MCS).

PubMed

Phillips, Tarryn; Rees, Tyson

2018-06-01

Sufferers of medically unexplained conditions that are not observable in the clinic can experience multiple layers of invisibility: a lack of biomedical diagnosis; legal skepticism; political disinterest; and a loss of their prior social identity. For those with environmental sensitivities, this is compounded by literal hiddenness due to often being housebound. Drawing on an online survey of people with multiple chemical sensitivity, this article examines how the everyday experience of invisibility is mitigated by engaging with other patients online. Respondents used online forums to undertake various forms of "visibility work," including attempts to crystallize their suffering into something recognizable medically, legally, and politically, and to reconstruct an identity considered valid and deserving-although the therapeutic potential of online support was contingent on intra-group politics. This study demonstrates that online forums allow biomedicine's "invisible others" to struggle for alternative forms of recognition beyond the clinical gaze. © 2017 by the American Anthropological Association.

Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study.

PubMed

Craike, Melinda J; Hose, Kaye; Courneya, Kerry S; Harrison, Simon J; Livingston, Patricia M

2013-07-01

Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM. This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored. Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients treated with other therapies (e.g., chemotherapy, radiotherapy) were more likely to report pain as a barrier. Patients with MM experience debilitating effects of their condition and therapy, which influences their level and intensity of physical activity participation. Physical activity programs should be individualised; take into consideration gender differences and the impact of different types of therapy on physical activity; and focus on meeting the psychological, coping and recovery needs of patients.

Hypnosis Intervention Effects on Sleep Outcomes: A Systematic Review.

PubMed

Chamine, Irina; Atchley, Rachel; Oken, Barry S

2018-02-15

Sleep improvement is a promising target for preventing and modifying many health problems. Hypnosis is considered a cost-effective and safe intervention with reported benefits for multiple health conditions. There is a growing body of research assessing the efficacy of hypnosis for various health conditions in which sleep was targeted as a primary or secondary outcome. This review aimed to investigate the effects of hypnosis interventions on sleep, to describe the hypnotic procedures, and to evaluate potential adverse effects of hypnosis. We reviewed studies (prior to January 2017) using hypnosis in adults for sleep problems and other conditions comorbid with sleep problems, with at least one sleep outcome measure. Randomized controlled trials and other prospective studies were included. One hundred thirty-nine nonduplicate abstracts were screened, and 24 of the reviewed papers were included for qualitative analysis. Overall, 58.3% of the included studies reported hypnosis benefit on sleep outcomes, with 12.5% reporting mixed results, and 29.2% reporting no hypnosis benefit; when only studies with lower risk of bias were reviewed the patterns were similar. Hypnosis intervention procedures were summarized and incidence of adverse experiences assessed. Hypnosis for sleep problems is a promising treatment that merits further investigation. Available evidence suggests low incidence of adverse events. The current evidence is limited because of few studies assessing populations with sleep complaints, small samples, and low methodological quality of the included studies. Our review points out some beneficial hypnosis effects on sleep but more high-quality studies on this topic are warranted. © 2018 American Academy of Sleep Medicine

Endocannabinoid system modulator use in everyday clinical practice in the UK and Spain.

PubMed

García-Merino, Antonio

2013-02-01

Spasticity is a disabling complication of multiple sclerosis. Some commonly used oral medications include baclofen, tizanidine, anticonvulsants and benzodiazepines, but their benefits are modest. Sativex® (GW Pharmaceuticals PLC, Porton Down, UK; Laboratorios Almirall, SA, Barcelona, Spain) is a unique cannabinoid-based medicine with two main active ingredients; 9-δ-tetrahydrocannabinol, which acts mainly on cannabinoid 1 receptors in the CNS and plays a key role in the modulation of spasticity and spasms, and cannabidiol, which has different properties, including minimization of the psychoactivity associated with 9-δ-tetrahydrocannabinol. Sativex is indicated for symptomatic improvement in adult patients with moderate-to-severe multiple sclerosis-related spasticity who have not responded adequately to other first- or second-line antispasticity medications, and who demonstrate clinically significant improvement in spasticity-related symptoms during an initial trial of therapy. Over the past couple of years, Sativex has been approved for use in a number of European countries and ongoing postmarketing studies are evaluating the possible risks associated with Sativex treatment by systematically collecting all suspected adverse reactions that occur in patients from the start of treatment. Interim data from the UK as well as Spanish Sativex safety registries confirm that clinical benefit is maintained over the longer term despite the expected trend for deterioration owing to disease progression. Even after more than 2 years of use, no new safety/tolerability signals have emerged with Sativex, including no evidence of driving impairment and no relevant incidence of falls or other adverse events of concern, such as psychiatric or nervous system events. Sativex appears to be a well-tolerated and useful add-on therapy in patients who have not achieved an adequate response with traditional antispastic agents.

Network meta-analysis of multiple outcome measures accounting for borrowing of information across outcomes.

PubMed

Achana, Felix A; Cooper, Nicola J; Bujkiewicz, Sylwia; Hubbard, Stephanie J; Kendrick, Denise; Jones, David R; Sutton, Alex J

2014-07-21

Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on outcomes not directly considered by the studies included in the analysis. Accounting for the dependency between outcomes in a multivariate meta-analysis may or may not improve the precision of effect estimates from a network meta-analysis compared to analysing each outcome separately.

Carbon exchange by establishing biofuel crops in Central Illinois

USDA-ARS?s Scientific Manuscript database

Perennial grass biofuels may contribute to long-term carbon sequestration in soils, thereby providing a broad range of environmental benefits at multiple scales. To quantify those benefits, the carbon balance was investigated over three perennial grass biofuel crops miscanthus (Miscanthus giganteus)...

Postharvest changes in glycoalkaloid content of potatoes.

PubMed

Friedman, M; McDonald, G M

1999-01-01

Potatoes contain antinutritional and potentially toxic compounds including inhibitors of digestive enzymes, hemagglutinins, and glycoalkaloids. Solanum glycoalkaloids are reported to inhibit cholinesterase, disrupt cell membranes, and induce teratogenicity. In this overview, we describe the role of potatoes in the human diet, reported changes in glycoalkaloid content of fresh and processed potatoes during storage, under the influence of light and radiation, following mechanical damage, and as a result of food processing. Also covered are safety aspects and suggested research needs to develop a protocol that can be adopted by the potato producers and processors to minimize post-harvest synthesis of glycoalkaloids in potatoes. Reducing the glycoalkaloid content of potatoes will provide a variety of benefits extending from the farm to processing, shipping, marketing, and consumption of potatoes and potato products. A commercially available ELISA kit is described which permits rapid assay of glycoalkaloid content of parts of the potato plant including leaves, tubers, and peel, as well as processed potato products including french fries, chips, and skins. Understanding the multiple overlapping aspects of glycoalkaloids in the plant and in the diet will permit controlling postharvest glycoalkaloid production for the benefit of the producer and consumer.

Immunotherapeutics in Pediatric Autoimmune Central Nervous System Disease: Agents and Mechanisms.

PubMed

Nosadini, Margherita; Sartori, Stefano; Sharma, Suvasini; Dale, Russell C

2017-08-01

Beyond the major advances produced by careful clinical-radiological phenotyping and biomarker development in autoimmune central nervous system disorders, a comprehensive knowledge of the range of available immune therapies and a deeper understanding of their action should benefit therapeutic decision-making. This review discusses the agents used in neuroimmunology and their mechanisms of action. First-line treatments typically include corticosteroids, intravenous immunoglobulin, and plasmapheresis, while for severe disease second-line "induction" agents such as rituximab or cyclophosphamide are used. Steroid-sparing agents such as mycophenolate, azathioprine, or methotrexate are often used in potentially relapsing or corticosteroid-dependent diseases. Lessons from adult neuroimmunology and rheumatology could be translated into pediatric autoimmune central nervous system disease in the future, including the potential utility of monoclonal antibodies targeting lymphocytes, adhesion molecules for lymphocytic migration, cytokines or their receptors, or complement. Finally, many agents used in other fields have multiple mechanisms of action, including immunomodulation, with potential usefulness in neuroimmunology, such as antibiotics, psychotropic drugs, probiotics, gut health, and ketogenic diet. All currently accepted and future potential agents have adverse effects, which can be severe; therefore, a "risk-versus-benefit" determination should guide therapeutic decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

Health benefits of n-3 polyunsaturated fatty acids: eicosapentaenoic acid and docosahexaenoic acid.

PubMed

Siriwardhana, Nalin; Kalupahana, Nishan S; Moustaid-Moussa, Naima

2012-01-01

Marine-based fish and fish oil are the most popular and well-known sources of n-3 polyunsaturated fatty acids (PUFAs), namely, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These n-3 PUFAs are known to have variety of health benefits against cardiovascular diseases (CVDs) including well-established hypotriglyceridemic and anti-inflammatory effects. Also, various studies indicate promising antihypertensive, anticancer, antioxidant, antidepression, antiaging, and antiarthritis effects. Moreover, recent studies also indicate anti-inflammatory and insulin-sensitizing effects of these fatty acids in metabolic disorders. Classically, n-3 PUFAs mediate some of these effects by antagonizing n-6 PUFA (arachidonic acid)-induced proinflammatory prostaglandin E₂ (PGE₂) formation. Another well-known mechanism by which n-3 PUFAs impart their anti-inflammatory effects is via reduction of nuclear factor-κB activation. This transcription factor is a potent inducer of proinflammatory cytokine production, including interleukin 6 and tumor necrosis factor-α, both of which are decreased by EPA and DHA. Other evidence also demonstrates that n-3 PUFAs repress lipogenesis and increase resolvins and protectin generation, ultimately leading to reduced inflammation. Finally, beneficial effects of EPA and DHA in insulin resistance include their ability to increase secretion of adiponectin, an anti-inflammatory adipokine. In summary, n-3 PUFAs have multiple health benefits mediated at least in part by their anti-inflammatory actions; thus their consumption, especially from dietary sources, should be encouraged. Copyright © 2012 Elsevier Inc. All rights reserved.

Conducting environmental health research in the Arabian Middle East: lessons learned and opportunities.

PubMed

Yeatts, Karin B; El-Sadig, Mohamed; Ali, Habiba I; Al-Maskari, Fatma; Campbell, Alan; Ng, Shu Wen; Reeves, Lisa; Chan, Ronna L; Davidson, Christopher A; Funk, William E; Boundy, Maryanne G; Leith, David; Popkin, Barry; Gibson, Jacqueline Macdonald; Rusyn, Ivan; Olshan, Andrew F

2012-05-01

The Arabian Gulf nations are undergoing rapid economic development, leading to major shifts in both the traditional lifestyle and the environment. Although the pace of change is brisk, there is a dearth of environmental health research in this region. We describe challenges and successes of conducting an environmental epidemiologic study in the United Arab Emirates (UAE), a Gulf nation in the Middle East, with an inter-disciplinary team that includes in-country academic and government collaborators as well as U.S. academic collaborators. We present several issues, including study and data collection design, exposure assessment, scheduling and time coordination, quality assurance and quality control, and institutional review board protocols. These topics are considered in a cultural context. Benefits of this research included building linkages among multinational, interdisciplinary team members, generating data for local environmental decision making, and developing local epidemiologic research capacity. The Middle Eastern culture of hospitality greatly benefited the project team. Cultural differences impact multiple aspects of epidemiologic research and should be respectfully addressed. Conducting international population-based environmental research poses many challenges; these challenges can be met successfully with careful planning, cultural knowledge, and flexibility. Lessons learned are applicable to interdisciplinary research all over the world. The research conducted will benefit the environmental and public health agencies of the UAE and provide the nation's leadership with country-specific environmental health data that can be used to protect the public's health in a rapidly changing environment.

Conducting Environmental Health Research in the Arabian Middle East: Lessons Learned and Opportunities

PubMed Central

El-Sadig, Mohamed; Ali, Habiba I.; Al-Maskari, Fatma; Campbell, Alan; Ng, Shu Wen; Reeves, Lisa; Chan, Ronna L.; Davidson, Christopher A.; Funk, William E.; Boundy, Maryanne G.; Leith, David; Popkin, Barry; Gibson, Jacqueline MacDonald; Rusyn, Ivan; Olshan, Andrew F.

2012-01-01

Background: The Arabian Gulf nations are undergoing rapid economic development, leading to major shifts in both the traditional lifestyle and the environment. Although the pace of change is brisk, there is a dearth of environmental health research in this region. Objective: We describe challenges and successes of conducting an environmental epidemiologic study in the United Arab Emirates (UAE), a Gulf nation in the Middle East, with an inter-disciplinary team that includes in-country academic and government collaborators as well as U.S. academic collaborators. Discussion: We present several issues, including study and data collection design, exposure assessment, scheduling and time coordination, quality assurance and quality control, and institutional review board protocols. These topics are considered in a cultural context. Benefits of this research included building linkages among multinational, interdisciplinary team members, generating data for local environmental decision making, and developing local epidemiologic research capacity. The Middle Eastern culture of hospitality greatly benefited the project team. Conclusion: Cultural differences impact multiple aspects of epidemiologic research and should be respectfully addressed. Conducting international population-based environmental research poses many challenges; these challenges can be met successfully with careful planning, cultural knowledge, and flexibility. Lessons learned are applicable to interdisciplinary research all over the world. The research conducted will benefit the environmental and public health agencies of the UAE and provide the nation’s leadership with country-specific environmental health data that can be used to protect the public’s health in a rapidly changing environment. PMID:22356946

GUT MICROBIOTA, PREBIOTICS, PROBIOTICS, AND SYNBIOTICS IN MANAGEMENT OF OBESITY AND PREDIABETES: REVIEW OF RANDOMIZED CONTROLLED TRIALS.

PubMed

Barengolts, Elena

2016-10-01

To review the data from randomized controlled trials (RCTs) for the roles of microbiota, pre-, pro- and synbiotics in metabolic conditions (obesity, prediabetes, and diabetes mellitus type 2 [DM2]). Primary literature was reviewed on the topics including RCTs of pre-, pro- and synbiotics use for metabolic disease. Gut bacteria (microbiota) benefit digestion and have multiple other functions. Microbiota could increase harvesting of energy from the food and cause subclinical inflammation seen in metabolic disorders. Diet-related interventions including prebiotics, probiotics, and synbiotics (combining pre-and probiotics) may benefit metabolic conditions. Prebiotics are complex carbohydrates (i.e., dietary fiber). Results of RCTs of prebiotics suggested a neutral effect on body weight, decreased fasting and postprandial glucose, and improved insulin sensitivity and lipid profile. Some inflammation markers were reduced, sometimes substantially (20-30%). RCTs for probiotics demonstrated significant but small effects on body weight (<3%) and metabolic parameters. The effect was seen mostly with fermented milk or yogurt compared to capsule form, consumption for at least 8 weeks, and use of multiple rather than a single bacterial strain. Changes in microbiota were seen at times with both pre- and probiotics. Pickled and fermented foods, particularly vegetables and beans, could serve as a dietary source of pre-, pro-, and synbiotics. These foods showed possible benefits for morbidity and mortality in prospective cohort studies. Pre-, pro-, and synbiotics could prove useful, but further research is needed to clarify their clinical relevance for the prevention and management of metabolic disease. A1c = glycohemoglobin A1c CI = confidence interval CVD = cardiovascular disease GMB = gut (large bowel) microbiota DM2 = diabetes mellitus type 2 HOMA-IR = homeostatic model assessment of insulin resistance LDL = low-density lipoprotein LPS = lipopolysaccharide NAFLD = nonalcoholic fatty liver disease RCT = randomized controlled trial SMD = standardized mean difference TG = triglycerides.

Smartphone self-monitoring to support self-management among people living with HIV: Perceived benefits and theory of change from a mixed-methods, randomized pilot study

PubMed Central

Swendeman, Dallas; Ramanathan, Nithya; Baetscher, Laura; Medich, Melissa; Scheffler, Aaron; Comulada, W. Scott; Estrin, Deborah

2015-01-01

BACKGROUND Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). METHODS PLH (n=50), primarily African-American and Latino, were recruited from two AIDS services organizations and randomly assigned to daily smartphone (n=34) or bi-weekly web-survey only (n=16) self-monitoring for six weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine bi-weekly, open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. RESULTS Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, non-judgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than bi-weekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared to bi-weekly web-survey only participants. CONCLUSION Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption and sustainability. PMID:25867783

Criterion 6: Maintenance and enhancement of long-term multiple socioeconomic benefits to meet the needs of societies

Treesearch

Stephen R. Shifley; Francisco X. Aguilar; Nianfu Song; Susan I. Stewart; David J. Nowak; Dale D. Gormanson; W. Keith Moser; Sherri Wormstead; Eric J. Greenfield

2012-01-01

Forests provide an array of products and services that maintain and enhance benefits to our society and economy. Benefits derived from forests may be categorized into wood products, nontimber products and services, and ecosystem services. The value and volume of these products and services indicate the importance of forests for a wide variety of uses.Tracking values,...

A prospective study of risk-based colposcopy demonstrates improved detection of cervical precancers.

PubMed

Wentzensen, Nicolas; Walker, Joan; Smith, Katie; Gold, Michael A; Zuna, Rosemary; Massad, L Stewart; Liu, Angela; Silver, Michelle I; Dunn, S Terence; Schiffman, Mark

2018-06-01

Sensitivity for detection of precancers at colposcopy and reassurance provided by a negative colposcopy are in need of systematic study and improvement. We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. In all, 690 women aged 18-67 years referred to colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989). Up to 4 cervical biopsies were taken during colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16 + cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by colposcopy-guided biopsy during the colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2 + at baseline were abstracted from electronic medical records. The risk of detecting precancer ranged from 2-82% across 24 strata based on colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia <2 at baseline, 195 (54%) had follow-up cytology or histology data with a median follow-up time of 508 days. Lack of detection of precancer at initial colposcopy that included multiple biopsies predicted low risk of precancer during follow-up. Risk assessment at the colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening. Published by Elsevier Inc.

Enhancing healthcare sector coordination through infrastructure and logistics support.

PubMed

Zoraster, Richard M

2010-01-01

The International Response to the 2004 Southeast Asia Tsunami was noted to have multiple areas of poor coordination, and in 2005, the "Health Cluster"approach to coordination was formulated. However, the 2010 Haiti response suggests that many of the same problems continue and that there are significant limitations to the cluster meetings. These limitations include the inconsistent attendance, poor dissemination of information, and perceived lack of benefit to providers. This article proposes that healthcare coordination would be greatly improved with logistical support, leading to improved efficiency and outcomes for those affected by disasters.

Dramatic response to levetiracetam in post-ischaemic Holmes’ tremor

PubMed Central

Striano, P; Elefante, Andrea; Coppola, Antonietta; Tortora, Fabio; Zara, Federico; Minetti, Carlo

2009-01-01

Holmes’ tremor refers to an unusual combination of rest, postural and kinetic tremor of extremities. Common causes of Holmes’ tremor include stroke, trauma, vascular malformations and multiple sclerosis, with lesions involving the thalamus, brain stem or cerebellum. Although some drugs (eg, levodopa and dopaminergic drugs, clonazepam and propranolol) have been occasionally reported to give some benefit, medical treatment of Holmes’ tremor is unsatisfactory, and many patients require thalamic surgery to achieve satisfactory control. We report a patient in whom post-ischaemic Holmes’ tremor dramatically responded to levetiracetam treatment. PMID:21686707

Tips for a physician in getting the right job, part XXII: more on contract negotiations.

PubMed

Harolds, Jay A

2015-05-01

This article discusses contract negotiations on multiple issues including bonuses, restrictive covenants, and fringe benefits. However, the job seeker should be very careful about attempting to negotiate what is already a very good contract if he/she does not have alternative employment opportunities or is not a very strong candidate. In addition, often more important than the contract is the character of the people the job seeker would be working for. If the employers do not seem to be honorable, it is usually best to look elsewhere.

Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: implications for health education and research.

PubMed

Popova, Lucy; McDonald, Emily Anne; Sidhu, Sohrab; Barry, Rachel; Richers Maruyama, Tracey A; Sheon, Nicolas M; Ling, Pamela M

2017-10-01

To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. Semi-structured qualitative interviews. Denver, CO, USA. Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading. © 2017 Society for the Study of Addiction.

Fair Balance and Adequate Provision in Direct-to-Consumer Prescription Drug Online Banner Advertisements: A Content Analysis.

PubMed

Adams, Crystal

2016-02-18

The current direct-to-consumer advertising (DTCA) guidelines were developed with print, television, and radio media in mind, and there are no specific guidelines for online banner advertisements. This study evaluates how well Internet banner ads comply with existing Food and Drug Administration (FDA) guidelines for DTCA in other media. A content analysis was performed of 68 banner advertisements. A coding sheet was developed based on (1) FDA guidance documents for consumer-directed prescription drug advertisements and (2) previous DTCA content analyses. Specifically, the presence of a brief summary detailing the drug's risks and side effects or of a "major statement" identifying the drug's major risks, and the number and type of provisions made available to consumers for comprehensive information about the drug were coded. In addition, the criterion of "fair balance," the FDA's requirement that prescription drug ads balance information relating to the drug's risks with information relating to its benefits, was measured by numbering the benefit and risk facts identified in the ads and by examining the presentation of risk and benefit information. Every ad in the sample included a brief summary of risk information and at least one form of adequate provision as required by the FDA for broadcast ads that do not give audiences a brief summary of a drug's risks. No ads included a major statement. There were approximately 7.18 risk facts for every benefit fact. Most of the risks (98.85%, 1292/1307) were presented in the scroll portion of the ad, whereas most of the benefits (66.5%, 121/182) were presented in the main part of the ad. Out of 1307 risk facts, 1292 were qualitative and 15 were quantitative. Out of 182 benefit facts, 181 were qualitative and 1 was quantitative. The majority of ads showed neutral images during the disclosure of benefit and risk facts. Only 9% (6/68) of the ads displayed positive images and none displayed negative images when presenting risks facts. When benefit facts were being presented, 7% (5/68) showed only positive images. No ads showed negative images when the benefit facts were being presented. In the face of ambiguous regulatory guidelines for online banner promotion, drug companies appear to make an attempt to adapt to regulatory guidelines designed for traditional media. However, banner ads use various techniques of presentation to present the advertised drug in the best possible light. The FDA should formalize requirements that drug companies provide a brief summary and include multiple forms of adequate provision in banner ads.

Combined oral contraceptives: health benefits beyond contraception.

PubMed

Caserta, D; Ralli, E; Matteucci, E; Bordi, G; Mallozzi, M; Moscarini, M

2014-09-01

It has been recognized for over 50 years that combined oral contraceptives (COCs) are also capable of offering health benefits beyond contraception through the treatment and prevention of several gynaecological and medical disorders. During the last years a constant attention was given to the adverse effects of COCs, whereas their non-contraceptive benefits were underestimated. To date, most women are still unaware of the therapeutic uses of hormonal contraceptives, while on the contrary there is an extensive and constantly increasing of these non-contraceptive health benefits. This review summarizes the conditions of special interest for physicians, including dysmenorrhoea, menorrhagia, hyperandrogenism (acne, hirsutism, polycystic ovary syndrome), functional ovarian cysts, endometriosis, premenstrual syndrome, myomas, pelvic inflammatory disease, bone mineral density, benign breast disease and endometrial/ovarian and colorectal cancer. The benefits of COCs in rheumatoid arthritis, multiple sclerosis, menstrual migraine and in perimenopause have also been treated for more comprehensive information. Using COCs specifically for non-contraceptive indications is still outside the product licence in the majority of cases. We strongly believe that these aspects are not of minor relevance and they deserve a special consideration by health providers and by the mass media, which have the main responsibility in the diffusion of scientific information. Thus, counseling and education are necessary to help women make well-informed health-care decisions and it is also crucial to increase awareness among general practitioners and gynaecologists.

Original Research: The Benefits of Rapid Response Teams: Exploring Perceptions of Nurse Leaders, Team Members, and End Users.

PubMed

Stolldorf, Deonni P

2016-03-01

: The perceived benefits of rapid response teams (RRTs) influence whether RRTs are used and sustained. Perceived benefits are particularly important to sustaining RRTs when limited RRT data are shared with organizational members. Nurse leaders' perceptions of the benefits of RRTs likely influence their support, which is crucial for sustained RRT use. The perceptions of RRT members and end users similarly will affect use. But little is known regarding the perceptions of nurse leaders, RRT members, and RRT users in this regard.This study sought to explore and compare the perceptions of nurse leaders, RRT members, and RRT users regarding the benefits of RRTs.A qualitative, multiple-case study design was used. Semistructured interviews were conducted with nurse leaders, RRT members, and RRT users at four community hospitals, as part of a larger mixed-methods study examining RRT sustainability. Purposive and snowball sampling were used. Recruitment strategies included e-mail and listserv announcements, on-site presentations, direct personal contact, and a study flyer.All participants reported perceiving various ways that RRTs benefit the organization, staff members, and patients. Variations in the benefits perceived were observed between the three participant groups. Nurse leaders' perceptions tended to focus on macro-level benefits. RRT members emphasized the teaching and learning opportunities that RRTs offer. RRT users focused on the psychological support that RRTs can provide.Both similarities and differences were found between nurse leaders, RRT members, and RRT users regarding their perceptions of RRT benefits. Differences may be indicative of organizations' information-sharing processes; of variation in the priorities of nurse leaders, RRT members, and RRT users; and of the challenges nurses face daily in their work environments. Future research should investigate whether the perceived benefits of RRTs are borne out in actuality, as well as the relationships between the perceived benefits of RRTs and organizational and RRT characteristics.

Should ranchers value sagebrush? Why we need sagebrush

USDA-ARS?s Scientific Manuscript database

Sagebrush is an important native species that has potential benefits to ranchers who desire multiple services from their lands. Here, we outline how sagebrush benefits other range plants, improves forage and habitat for wildlife, and can be valuable for winter livestock grazing and revegetation....

Object-based benefits without object-based representations.

PubMed

Fougnie, Daryl; Cormiea, Sarah M; Alvarez, George A

2013-08-01

Influential theories of visual working memory have proposed that the basic units of memory are integrated object representations. Key support for this proposal is provided by the same object benefit: It is easier to remember multiple features of a single object than the same set of features distributed across multiple objects. Here, we replicate the object benefit but demonstrate that features are not stored as single, integrated representations. Specifically, participants could remember 10 features better when arranged in 5 objects compared to 10 objects, yet memory for one object feature was largely independent of memory for the other object feature. These results rule out the possibility that integrated representations drive the object benefit and require a revision of the concept of object-based memory representations. We propose that working memory is object-based in regard to the factors that enhance performance but feature based in regard to the level of representational failure. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Blood conservation in neonatal and pediatric populations.

PubMed

Wilson, J R; Gaedeke, M K

1996-05-01

Blood conservation in infants and children has benefits even beyond those seen with the adult populations. For instance, acquired blood borne diseases such as cytomegalovirus not only cause illness but also can have deleterious effects on the growth and development of infants and children. Decreasing blood transfusions is especially important in preventing sensitization over a lifetime, which may require further transfusion and even organ transplantation. A less striking benefit, but one equally as significant, is decreasing the occurrence of graft-versus-host disease when blood conservation negates the need for multiple transfusions. The limitation of alternative transfusion practices in children and infants increases the benefits of blood conservation. Autologous blood donation may be an alternative to allogeneic transfusion in older children, but is not possible with neonates who may be born anemic and who experience a normal physiologic anemia during the first 2 months of life. Critical care nurses are instrumental in helping blood conservation by understanding blood salvaging techniques, including correct collection techniques, noninvasive monitoring, evaluation of diagnostic sample needs, and administration of erythrocyte-stimulating factors.

Blastocyst transfer in human in vitro fertilization. A solution to the multiple pregnancy epidemic.

PubMed

Vidaeff, A C; Racowsky, C; Rayburn, W F

2000-07-01

Since the 1950s, the incidence of twin gestation has doubled and the incidence of triplets has increased approximately sevenfold in the United States. Of extreme concern is the fact that many of these multiple pregnancies are iatrogenic: 35% of twin gestations and 77% of higher-order pregnancies are the result of some form of infertility therapy. Anything that can be done to reduce the number of these multiple pregnancies would benefit our patients and society. Great hope is placed on emerging blastocyst technology, which has the potential of achieving higher pregnancy rates per embryo transfer while reducing the risk of multiple pregnancy. We present the evolution of the blastocyst transfer concept and the technical aspects involved. The article also outlines the experience with blastocyst culture and transfer at Brigham and Women's Hospital, Boston, and describes identifiers for application of blastocyst transfer. The number of eight-cell embryos on day 3 is an independent marker for the selection of patients who would benefit from transfer on day 5. With no eight-cell embryos on day 3, 0% and 33% pregnancies resulted from day 5 vs. day 3 transfers, suggesting that these cases would not benefit from day 5 transfer. When at least one eight-cell embryo is available, there is no difference in ongoing pregnancy rates between day 5 and day 3 transfers, but there is a significant decrease in multiple gestations with day 5 transfers.

Sit less and move more: perspectives of adults with multiple sclerosis.

PubMed

Aminian, Saeideh; Ezeugwu, Victor E; Motl, Robert W; Manns, Patricia J

2017-12-20

Multiple sclerosis is a chronic neurological disease with the highest prevalence in Canada. Replacing sedentary behavior with light activities may be a feasible approach to manage multiple sclerosis symptoms. This study explored the perspectives of adults with multiple sclerosis about sedentary behavior, physical activity and ways to change behavior. Fifteen adults with multiple sclerosis (age 43 ± 13 years; mean ± standard deviation), recruited through the multiple sclerosis Clinic at the University of Alberta, Edmonton, Canada, participated in semi-structured interviews. Interview audios were transcribed verbatim and coded. NVivo software was used to facilitate the inductive process of thematic analysis. Balancing competing priorities between sitting and moving was the primary theme. Participants were aware of the benefits of physical activity to their overall health, and in the management of fatigue and muscle stiffness. Due to fatigue, they often chose sitting to get their energy back. Further, some barriers included perceived fear of losing balance or embarrassment while walking. Activity monitoring, accountability, educational and individualized programs were suggested strategies to motivate more movement. Adults with multiple sclerosis were open to the idea of replacing sitting with light activities. Motivational and educational programs are required to help them to change sedentary behavior to moving more. IMPLICATIONS FOR REHABILITATION One of the most challenging and common difficulties of multiple sclerosis is walking impairment that worsens because of multiple sclerosis progression, and is a common goal in the rehabilitation of people with multiple sclerosis. The deterioration in walking abilities is related to lower levels of physical activity and more sedentary behavior, such that adults with multiple sclerosis spend 8 to 10.5 h per day sitting. Replacing prolonged sedentary behavior with light physical activities, and incorporating education, encouragement, and self-monitoring strategies are feasible approaches to manage the symptoms of multiple sclerosis.

Patient preferences for attributes of multiple sclerosis disease-modifying therapies: development and results of a ratings-based conjoint analysis.

PubMed

Wilson, Leslie S; Loucks, Aimee; Gipson, Gregory; Zhong, Lixian; Bui, Christine; Miller, Elizabeth; Owen, Mary; Pelletier, Daniel; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles E

2015-01-01

Timely individualized treatment is essential to improving relapsing-remitting multiple sclerosis (RRMS) patient health outcomes, yet little is known about how patients make treatment decisions. We sought to evaluate RRMS patient preferences for risks and benefits of treatment. Fifty patients with RRMS completed conjoint analysis surveys with 16 hypothetical disease-modifying therapy (DMT) medication profiles developed using a fractional factorial design. Medication profiles were assigned preference ratings from 0 (not acceptable) to 10 (most favorable). Medication attributes included a range of benefits, adverse effects, administration routes, and market durations. Analytical models used linear mixed-effects regression. Participants showed the highest preference for medication profiles that would improve their symptoms (β = 0.81-1.03, P < .001), not a proven DMT outcome. Preventing relapses, the main clinical trial outcome, was not associated with significant preferences (P = .35). Each year of preventing magnetic resonance imaging changes and disease symptom progression showed DMT preferences of 0.17 point (β = 0.17, P = .002) and 0.12 point (β = 0.12, P < .001), respectively. Daily oral administration was preferred over all parenteral routes (P < .001). A 1% increase in death or severe disability decreased relative DMT preference by 1.15 points (P < .001). Patient preference focused on symptoms and prevention of progression but not on relapse prevention, the proven drug outcome. Patients were willing to accept some level of serious risk for certain types and amounts of benefits, and they strongly preferred daily oral administration over all other options.

The influence of consumers' preferences and perceptions of oral solid dosage forms on their treatment.

PubMed

Ibrahim, Inas Rifaat; Ibrahim, Mohamed Izham Mohamed; Al-Haddad, Mahmoud Sa'di

2012-10-01

Beyond the direct pharmacological effect of medicines, preferences and perceptions toward a particular oral solid dosage form (OSDF) play a crucial role in recovery and may reduce adherence to the prescribed treatment. This study conducted to investigate the most preferred OSDF and the degree to which swallowing solid medication is an issue, to assess perceptions of the therapeutic benefits of the OSDF, and to find predictors of the most preferred OSDF. A cross-sectional study, through convenience sample method, was conducted to survey consumers visiting community pharmacies in Baghdad, Iraq. Data was collected by self-administered and pre-piloted questionnaires, and analyzed using Statistical Package for Social Science. Multiple logistic regression analysis and Chi-square tests were used at alpha level = 0.05. A total of 1,000 questionnaire were included in the analysis. Of all respondents, 52.9 % preferred capsule among other OSDF and this preference varied significantly with a number of socio-demographic factors. Ease of swallowing solid medication was the main issue which resulted in preferences for a particular form. A negative perception of the therapeutic benefits of the OSDF was found among 89.1 % of the consumers. Multiple logistic regression analysis indicated that gender, ease of swallowing, and perceptions of the therapeutic benefits of the OSDF were significant predictors of capsule preferences. Given the fact that consumers are the end users of medicines and their preferences may influence response to the treatment, efforts are worthwhile by the prescribers and medicines' manufactures to understand consumers' preferences of a particular dosage form in order to achieve successful therapy outcomes.

Impacts of conservation and human development policy across stakeholders and scales.

PubMed

Li, Cong; Zheng, Hua; Li, Shuzhuo; Chen, Xiaoshu; Li, Jie; Zeng, Weihong; Liang, Yicheng; Polasky, Stephen; Feldman, Marcus W; Ruckelshaus, Mary; Ouyang, Zhiyun; Daily, Gretchen C

2015-06-16

Ideally, both ecosystem service and human development policies should improve human well-being through the conservation of ecosystems that provide valuable services. However, program costs and benefits to multiple stakeholders, and how they change through time, are rarely carefully analyzed. We examine one of China's new ecosystem service protection and human development policies: the Relocation and Settlement Program of Southern Shaanxi Province (RSP), which pays households who opt voluntarily to resettle from mountainous areas. The RSP aims to reduce disaster risk, restore important ecosystem services, and improve human well-being. We use household surveys and biophysical data in an integrated economic cost-benefit analysis for multiple stakeholders. We project that the RSP will result in positive net benefits to the municipal government, and to cross-region and global beneficiaries over the long run along with environment improvement, including improved water quality, soil erosion control, and carbon sequestration. However, there are significant short-run relocation costs for local residents so that poor households may have difficulty participating because they lack the resources to pay the initial costs of relocation. Greater subsidies and subsequent supports after relocation are necessary to reduce the payback period of resettled households in the long run. Compensation from downstream beneficiaries for improved water and from carbon trades could be channeled into reducing relocation costs for the poor and sharing the burden of RSP implementation. The effectiveness of the RSP could also be greatly strengthened by early investment in developing human capital and environment-friendly jobs and establishing long-term mechanisms for securing program goals. These challenges and potential solutions pervade ecosystem service efforts globally.

Calibrated Multiple Event Relocations of the Central and Eastern United States

NASA Astrophysics Data System (ADS)

Yeck, W. L.; Benz, H.; McNamara, D. E.; Bergman, E.; Herrmann, R. B.; Myers, S. C.

2015-12-01

Earthquake locations are a first-order observable which form the basis of a wide range of seismic analyses. Currently, the ANSS catalog primarily contains published single-event earthquake locations that rely on assumed 1D velocity models. Increasing the accuracy of cataloged earthquake hypocenter locations and origin times and constraining their associated errors can improve our understanding of Earth structure and have a fundamental impact on subsequent seismic studies. Multiple-event relocation algorithms often increase the precision of relative earthquake hypocenters but are hindered by their limited ability to provide realistic location uncertainties for individual earthquakes. Recently, a Bayesian approach to the multiple event relocation problem has proven to have many benefits including the ability to: (1) handle large data sets; (2) easily incorporate a priori hypocenter information; (3) model phase assignment errors; and, (4) correct for errors in the assumed travel time model. In this study we employ bayseloc [Myers et al., 2007, 2009] to relocate earthquakes in the Central and Eastern United States from 1964-present. We relocate ~11,000 earthquakes with a dataset of ~439,000 arrival time observations. Our dataset includes arrival-time observations from the ANSS catalog supplemented with arrival-time data from the Reviewed ISC Bulletin (prior to 1981), targeted local studies, and arrival-time data from the TA Array. One significant benefit of the bayesloc algorithm is its ability to incorporate a priori constraints on the probability distributions of specific earthquake locations parameters. To constrain the inversion, we use high-quality calibrated earthquake locations from local studies, including studies from: Raton Basin, Colorado; Mineral, Virginia; Guy, Arkansas; Cheneville, Quebec; Oklahoma; and Mt. Carmel, Illinois. We also add depth constraints to 232 earthquakes from regional moment tensors. Finally, we add constraints from four historic (1964-1973) ground truth events from a verification database. We (1) evaluate our ability to improve our location estimations, (2) use improved locations to evaluate Earth structure in seismically active regions, and (3) examine improvements to the estimated locations of historic large magnitude earthquakes.

Cobedding in the NICU: a new adventure.

PubMed

Taylor, Cheryl R; LaMar, Kimberly L

2006-01-01

With advances in neonatal and obstetric care over the past few years, the number of premature, multiple-birth neonates entering NICUs has increased. As we have started to recognize the special bond that twins and higher multiples share, cobedding has emerged as an NICU practice. As with any change, the introduction of cobedding presents challenges in the NICU. Both the theoretical benefits anti the potential concerns are many. Although nursing staff and parents may be excited about the prospect of placing these infants in the same crib, careful investigation and planning are necessary for any new procedure. This article discusses the cobedding of multiples as implemented at the University of Michigan. As a new practice, cobedding warrants further research, especially regarding its proposed benefits and implementation in the NICU.

Resources for startup and growing businesses in the science and engineering sectors

NASA Astrophysics Data System (ADS)

Sabol, Joseph

2013-03-01

The American Chemical Society provides resources for members involved in forming startup and growing small businesses in the chemical and related sectors. In particular, the ACS Division of Small Chemical Businesses SCHB provides member benefits, informative programming at national and regional meetings, and networking opportunities for entrepreneurs. SCHB member benefits include listing in a directory of members' products and services, discounted expo booth rental at ACS national meetings, sponsorship to attend ACS leadership development courses, volunteer opportunities to shape and direct SCHB's operations, multiple social networking platforms, and professional networking opportunities with like-minded and similarly situated small business principals. SCHB's mission is ``To aid in the formation, development and growth of small chemical businesses.'' SCHB collaborates with other units in ACS, including local sections, the Chemical Entrepreneurship Council, the Division of Business Development & Management, Entrepreneurial Initiative, and Career Services. SCHB helps chemists gain skills to translate research into commercially successful products; build strong, growing companies that create jobs; and collaborate with professionals outside the chemical community. American Chemical Society, Division of Small Chemical Businesses

Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression.

PubMed

Hart, Stacey L; Vella, Lea; Mohr, David C

2008-03-01

While many patients with multiple sclerosis (MS) experience psychological problems, such as depression, benefit-finding is commonly reported. Using the Broaden-and-Build Model of positive emotions (Fredrickson, 2001) and the Expectancy-Value Model of optimism (Carver & Scheier, 1998) as two related, yet, distinct conceptual frameworks, this study examined positive affect and optimism as mediators of the relationship between improved depression and enhanced benefit-finding. MS patients (N=127), who participated in a larger, randomized clinical trial comparing two types of telephone psychotherapy for depression, were assessed at baseline, midtherapy (8 weeks), end of therapy (16 weeks), and 6- and 12-month posttherapy. Depression was measured with a telephone administered version of the Hamilton Rating Scale for Depression; Positive Affect was measured with the Positive Affect Subscale from the Positive and Negative Affect Scale; Optimism was measured with the Life Orientation Test-Revised; Benefit-Finding was measured with the revised version of the Stress-Related Growth Scale. Data were analyzed with multilevel random-effects models, controlling for time since MS diagnosis and type of treatment. Improved depression was associated with increased benefit-finding over time. The relationship between improved depression and benefit-finding was significantly mediated by both increased optimism and increased positive affect. Findings provide support to both theoretical models. Positivity appears to promote benefit-finding in MS. Copyright (c) 2008 APA, all rights reserved.

Qualitative aspects of representational competence among college chemistry students: Multiple representations and their role in the understanding of ideal gases

NASA Astrophysics Data System (ADS)

Madden, Sean Patrick

This study examined the role of multiple representations of chemical phenomena, specifically, the temperature-pressure relationship of ideal gases, in the problem solving strategies of college chemistry students. Volunteers included students enrolled in a first semester general chemistry course at a western university. Two additional volunteers from the same university were asked to participate and serve as models of greater sophistication. One was a senior chemistry major; another was a junior science writing major. Volunteers completed an initial screening task involving multiple representations of concentration and dilution concepts. Based on the results of this screening instrument a smaller set of subjects were asked to complete a think aloud session involving multiple representations of the temperature-pressure relationship. Data consisted of the written work of the volunteers and transcripts from videotaped think aloud sessions. The data were evaluated by the researcher and two other graduate students in chemical education using a coding scheme (Kozma, Schank, Coppola, Michalchik, and Allen. 2000). This coding scheme was designed to identify essential features of representational competence and differences in uses of multiple representations. The results indicate that students tend to have a strong preference for one type of representation. Students scoring low on representational competence, as measured by the rubric, ignored important features of some representations or acknowledged them only superficially. Students scoring higher on representational competence made meaningful connections among representations. The more advanced students, those who rated highly on representational competence, tended to use their preferred representation in a heuristic manner to establish meaning for other representations. The more advanced students also reflected upon the problem at greater length before beginning work. Molecular level sketches seemed to be the most difficult type of representation for students to interpret. Most subjects scored higher on representational competence when engaged in creating graphs and sketches than when evaluating provided representations. This study suggests that students may benefit from an instruction that emphasizes heuristic use of multiple representations in chemistry problem solving. An instructional strategy that makes use of a variety of representations and requires students to create their own representations may have measurable benefits to chemistry students.

The public health benefits of insulation retrofits in existing housing in the United States

PubMed Central

Levy, Jonathan I; Nishioka, Yurika; Spengler, John D

2003-01-01

Background Methodological limitations make it difficult to quantify the public health benefits of energy efficiency programs. To address this issue, we developed a risk-based model to estimate the health benefits associated with marginal energy usage reductions and applied the model to a hypothetical case study of insulation retrofits in single-family homes in the United States. Methods We modeled energy savings with a regression model that extrapolated findings from an energy simulation program. Reductions of fine particulate matter (PM2.5) emissions and particle precursors (SO2 and NOx) were quantified using fuel-specific emission factors and marginal electricity analyses. Estimates of population exposure per unit emissions, varying by location and source type, were extrapolated from past dispersion model runs. Concentration-response functions for morbidity and mortality from PM2.5 were derived from the epidemiological literature, and economic values were assigned to health outcomes based on willingness to pay studies. Results In total, the insulation retrofits would save 800 TBTU (8 × 1014 British Thermal Units) per year across 46 million homes, resulting in 3,100 fewer tons of PM2.5, 100,000 fewer tons of NOx, and 190,000 fewer tons of SO2 per year. These emission reductions are associated with outcomes including 240 fewer deaths, 6,500 fewer asthma attacks, and 110,000 fewer restricted activity days per year. At a state level, the health benefits per unit energy savings vary by an order of magnitude, illustrating that multiple factors (including population patterns and energy sources) influence health benefit estimates. The health benefits correspond to $1.3 billion per year in externalities averted, compared with $5.9 billion per year in economic savings. Conclusion In spite of significant uncertainties related to the interpretation of PM2.5 health effects and other dimensions of the model, our analysis demonstrates that a risk-based methodology is viable for national-level energy efficiency programs. PMID:12740041

Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice.

PubMed

Eckermann, Simon; Coelli, Tim

2013-01-01

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care. In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied. Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Predictive Biomarkers for Asthma Therapy.

PubMed

Medrek, Sarah K; Parulekar, Amit D; Hanania, Nicola A

2017-09-19

Asthma is a heterogeneous disease characterized by multiple phenotypes. Treatment of patients with severe disease can be challenging. Predictive biomarkers are measurable characteristics that reflect the underlying pathophysiology of asthma and can identify patients that are likely to respond to a given therapy. This review discusses current knowledge regarding predictive biomarkers in asthma. Recent trials evaluating biologic therapies targeting IgE, IL-5, IL-13, and IL-4 have utilized predictive biomarkers to identify patients who might benefit from treatment. Other work has suggested that using composite biomarkers may offer enhanced predictive capabilities in tailoring asthma therapy. Multiple biomarkers including sputum eosinophil count, blood eosinophil count, fractional concentration of nitric oxide in exhaled breath (FeNO), and serum periostin have been used to identify which patients will respond to targeted asthma medications. Further work is needed to integrate predictive biomarkers into clinical practice.

The relative contributions of processing speed and cognitive load to working memory accuracy in multiple sclerosis.

PubMed

Leavitt, Victoria M; Lengenfelder, Jean; Moore, Nancy B; Chiaravalloti, Nancy D; DeLuca, John

2011-06-01

Cognitive symptoms of multiple sclerosis (MS) include processing-speed deficits and working memory impairment. The precise manner in which these deficits interact in individuals with MS remains to be explicated. We hypothesized that providing more time on a complex working memory task would result in performance benefits for individuals with MS relative to healthy controls. Fifty-three individuals with clinically definite MS and 36 matched healthy controls performed a computerized task that systematically manipulated cognitive load. The interval between stimuli presentations was manipulated to provide increasing processing time. The results confirmed that individuals with MS who have processing-speed deficits significantly improve in performance accuracy when given additional time to process the information in working memory. Implications of these findings for developing appropriate cognitive rehabilitation interventions are discussed.

Biomedical imaging with THz waves

NASA Astrophysics Data System (ADS)

Nguyen, Andrew

2010-03-01

We discuss biomedical imaging using radio waves operating in the terahertz (THz) range between 300 GHz to 3 THz. Particularly, we present the concept for two THz imaging systems. One system employs single antenna, transmitter and receiver operating over multi-THz-frequency simultaneously for sensing and imaging small areas of the human body or biological samples. Another system consists of multiple antennas, a transmitter, and multiple receivers operating over multi-THz-frequency capable of sensing and imaging simultaneously the whole body or large biological samples. Using THz waves for biomedical imaging promises unique and substantial medical benefits including extremely small medical devices, extraordinarily fine spatial resolution, and excellent contrast between images of diseased and healthy tissues. THz imaging is extremely attractive for detection of cancer in the early stages, sensing and imaging of tissues near the skin, and study of disease and its growth versus time.

Multiple myeloma.

PubMed Central

MacLennan, I. C.; Drayson, M.; Dunn, J.

1994-01-01

Multiple myeloma occurs in over 2000 new patients in England and Wales each year. It presents most frequently as bone pain and patients tend to become dehydrated and may develop renal failure. No available treatment is curative, but about two thirds of patients achieve a stable response with low dose combination chemotherapy. Combination chemotherapy including doxorubicin and carmustine with the alkylating agents cyclophosphamide and melphalan achieve a higher stable response rate than conventional treatment with melphalan and prednisone without additional haematological toxicity. These responses are associated with loss of bone pain and patients remain symptom free for months without further treatment. Relapse occurs on average in a little under two years and, though second responses are frequently obtained, the disease eventually becomes refractory. This paper looks at who should be treated and the benefits that may be expected from the treatments available. PMID:8068084

Supporting Scientific Experimentation and Reasoning in Young Elementary School Students

NASA Astrophysics Data System (ADS)

Varma, Keisha

2014-06-01

Researchers from multiple perspectives have shown that young students can engage in the scientific reasoning involved in science experimentation. However, there is little research on how well these young students learn in inquiry-based learning environments that focus on using scientific experimentation strategies to learn new scientific information. This work investigates young children's science concept learning via inquiry-based instruction on the thermodynamics system in a developmentally appropriate, technology-supported learning environment. First- and third-grade students participate in three sets of guided experimentation activities that involve using handheld computers to measure change in temperature given different types of insulation materials. Findings from pre- and post-comparisons show that students at both grade levels are able to learn about the thermodynamics system through engaging in the guided experiment activities. The instruction groups outperformed the control groups on multiple measures of thermodynamics knowledge, and the older children outperform the younger children. Knowledge gains are discussed in the context of mental models of the thermodynamics system that include the individual concepts mentioned above and the relationships between them. This work suggests that young students can benefit from science instruction centered on experimentation activities. It shows the benefits of presenting complex scientific information authentic contexts and the importance of providing the necessary scaffolding for meaningful scientific inquiry and experimentation.

Continuous subcutaneous insulin infusion therapy and multiple daily insulin injections in type 1 diabetes mellitus: a comparative overview and future horizons.

PubMed

Thabit, Hood; Hovorka, Roman

2016-01-01

Continuous subcutaneous insulin infusion (CSII) therapy is currently accepted as a treatment strategy for type 1 diabetes. Transition from multiple daily injection therapy (MDI; including basal-bolus regimens) to CSII is based on expectations of better metabolic control and fewer hypoglycaemic events. Evidence to date has not been always conclusive. Evidence for CSII and MDI in terms of glycaemic control, hypoglycaemia and psychosocial outcomes is reviewed in the adult and paediatric population with type 1 diabetes. Findings from studies on threshold-based insulin pump suspension and predictive low glucose management (PLGM) are outlined. Limitations of current CSII application and future technological developments are discussed. Glycaemic control and quality of life (QOL) may be improved by CSII compared to MDI depending on baseline HbA1c and hypoglycaemia rates. Future studies are expected to provide evidence on clinical and cost effectiveness in those who will benefit the most. Training, structured education and support are important to benefit from CSII. Novel technological approaches linking continuous glucose monitoring (CGM) and CSII may help mitigate against frequent hypoglycaemia in those at risk. Development of glucose-responsive automated closed-loop insulin delivery systems may reduce the burden of disease management and improve outcomes in type 1 diabetes.

Applying the institutional review board data repository approach to manage ethical considerations in evaluating and studying medical education

PubMed Central

Thayer, Erin K.; Rathkey, Daniel; Miller, Marissa Fuqua; Palmer, Ryan; Mejicano, George C.; Pusic, Martin; Kalet, Adina; Gillespie, Colleen; Carney, Patricia A.

2016-01-01

Issue Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination. Approach IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes. Implications Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data. PMID:27443407

Integrative studies of cultural evolution: crossing disciplinary boundaries to produce new insights

PubMed Central

2018-01-01

Culture evolves according to dynamics on multiple temporal scales, from individuals' minute-by-minute behaviour to millennia of cultural accumulation that give rise to population-level differences. These dynamics act on a range of entities—including behavioural sequences, ideas and artefacts as well as individuals, populations and whole species—and involve mechanisms at multiple levels, from neurons in brains to inter-population interactions. Studying such complex phenomena requires an integration of perspectives from a diverse array of fields, as well as bridging gaps between traditionally disparate areas of study. In this article, which also serves as an introduction to the current special issue, we highlight some specific respects in which the study of cultural evolution has benefited and should continue to benefit from an integrative approach. We showcase a number of pioneering studies of cultural evolution that bring together numerous disciplines. These studies illustrate the value of perspectives from different fields for understanding cultural evolution, such as cognitive science and neuroanatomy, behavioural ecology, population dynamics, and evolutionary genetics. They also underscore the importance of understanding cultural processes when interpreting research about human genetics, neuroscience, behaviour and evolution. This article is part of the theme issue ‘Bridging cultural gaps: interdisciplinary studies in human cultural evolution’. PMID:29440515

Micronutrient deficiencies in pregnancy worldwide: health effects and prevention

PubMed Central

Gernand, Alison D.; Schulze, Kerry J.; Stewart, Christine P.; West, Keith P.; Christian, Parul

2016-01-01

Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences to the fetus. Examples of efficacious single micronutrient interventions include folic acid to prevent neural tube defects, iodine to prevent cretinism, zinc to reduce of preterm birth, and iron to reduce the risk of low birth weight. Folic acid and vitamin D might also increase birth weight. While extensive mechanism and association research links antenatal multiple micronutrients to plausible materno-fetal health advantages, hypothesized benefits have often been absent, minimal or unexpected in trials. These findings suggest a role for population context in determining health responses and extensive gaps in knowledge. Multiple micronutrient supplements reduce risks of being born low birth weight, small for gestational age or stillborn in undernourished settings, and justify micronutrient interventions with antenatal care. Measurable health effects of gestational micronutrient exposure may persist into childhood but few data exists on potential long-term benefits. In this Review, we discuss micronutrient intake recommendations, risks and consequences of deficiencies, and the effects of interventions with a particular emphasis on offspring. PMID:27032981

Integrative studies of cultural evolution: crossing disciplinary boundaries to produce new insights.

PubMed

Kolodny, Oren; Feldman, Marcus W; Creanza, Nicole

2018-04-05

Culture evolves according to dynamics on multiple temporal scales, from individuals' minute-by-minute behaviour to millennia of cultural accumulation that give rise to population-level differences. These dynamics act on a range of entities-including behavioural sequences, ideas and artefacts as well as individuals, populations and whole species-and involve mechanisms at multiple levels, from neurons in brains to inter-population interactions. Studying such complex phenomena requires an integration of perspectives from a diverse array of fields, as well as bridging gaps between traditionally disparate areas of study. In this article, which also serves as an introduction to the current special issue, we highlight some specific respects in which the study of cultural evolution has benefited and should continue to benefit from an integrative approach. We showcase a number of pioneering studies of cultural evolution that bring together numerous disciplines. These studies illustrate the value of perspectives from different fields for understanding cultural evolution, such as cognitive science and neuroanatomy, behavioural ecology, population dynamics, and evolutionary genetics. They also underscore the importance of understanding cultural processes when interpreting research about human genetics, neuroscience, behaviour and evolution.This article is part of the theme issue 'Bridging cultural gaps: interdisciplinary studies in human cultural evolution'. © 2018 The Author(s).

Efficacy of a Computer-Assisted Cognitive Rehabilitation Intervention in Relapsing-Remitting Multiple Sclerosis Patients: A Multicenter Randomized Controlled Trial

PubMed Central

Kosmidis, Mary H.; Zampakis, Petros; Malefaki, Sonia; Ntoskou, Katerina; Nousia, Anastasia; Bakirtzis, Christos; Papathanasopoulos, Panagiotis

2017-01-01

Cognitive impairment is frequently encountered in multiple sclerosis (MS) affecting between 40–65% of individuals, irrespective of disease duration and severity of physical disability. In the present multicenter randomized controlled trial, fifty-eight clinically stable RRMS patients with mild to moderate cognitive impairment and relatively low disability status were randomized to receive either computer-assisted (RehaCom) functional cognitive training with an emphasis on episodic memory, information processing speed/attention, and executive functions for 10 weeks (IG; n = 32) or standard clinical care (CG; n = 26). Outcome measures included a flexible comprehensive neuropsychological battery of tests sensitive to MS patient deficits and feedback regarding personal benefit gained from the intervention on four verbal questions. Only the IG group showed significant improvements in verbal and visuospatial episodic memory, processing speed/attention, and executive functioning from pre - to postassessment. Moreover, the improvement obtained on attention was retained over 6 months providing evidence on the long-term benefits of this intervention. Group by time interactions revealed significant improvements in composite cognitive domain scores in the IG relative to the demographically and clinically matched CG for verbal episodic memory, processing speed, verbal fluency, and attention. Treated patients rated the intervention positively and were more confident about their cognitive abilities following treatment. PMID:29463950

Speech recognition by bilateral cochlear implant users in a cocktail-party setting

PubMed Central

Loizou, Philipos C.; Hu, Yi; Litovsky, Ruth; Yu, Gongqiang; Peters, Robert; Lake, Jennifer; Roland, Peter

2009-01-01

Unlike prior studies with bilateral cochlear implant users which considered only one interferer, the present study considered realistic listening situations wherein multiple interferers were present and in some cases originating from both hemifields. Speech reception thresholds were measured in bilateral users unilaterally and bilaterally in four different spatial configurations, with one and three interferers consisting of modulated noise or competing talkers. The data were analyzed in terms of binaural benefits including monaural advantage (better-ear listening) and binaural interaction. The total advantage (overall spatial release) received was 2–5 dB and was maintained with multiple interferers present. This advantage was dominated by the monaural advantage, which ranged from 1 to 6 dB and was largest when the interferers were mostly energetic. No binaural-interaction benefit was found in the present study with either type of interferer (speech or noise). While the total and monaural advantage obtained for noise interferers was comparable to that attained by normal-hearing listeners, it was considerably lower for speech interferers. This suggests that bilateral users are less capable of taking advantage of binaural cues, in particular, under conditions of informational masking. Furthermore, the use of noise interferers does not adequately reflect the difficulties experienced by bilateral users in real-life situations. PMID:19173424

Multiple-choice pretesting potentiates learning of related information.

PubMed

Little, Jeri L; Bjork, Elizabeth Ligon

2016-10-01

Although the testing effect has received a substantial amount of empirical attention, such research has largely focused on the effects of tests given after study. The present research examines the effect of using tests prior to study (i.e., as pretests), focusing particularly on how pretesting influences the subsequent learning of information that is not itself pretested but that is related to the pretested information. In Experiment 1, we found that multiple-choice pretesting was better for the learning of such related information than was cued-recall pretesting or a pre-fact-study control condition. In Experiment 2, we found that the increased learning of non-pretested related information following multiple-choice testing could not be attributed to increased time allocated to that information during subsequent study. Last, in Experiment 3, we showed that the benefits of multiple-choice pretesting over cued-recall pretesting for the learning of related information persist over 48 hours, thus demonstrating the promise of multiple-choice pretesting to potentiate learning in educational contexts. A possible explanation for the observed benefits of multiple-choice pretesting for enhancing the effectiveness with which related nontested information is learned during subsequent study is discussed.

A method of decision analysis quantifying the effects of age and comorbidities on the probability of deriving significant benefit from medical treatments

PubMed Central

Bean, Nigel G.; Ruberu, Ravi P.

2017-01-01

Background The external validity, or generalizability, of trials and guidelines has been considered poor in the context of multiple morbidity. How multiple morbidity might affect the magnitude of benefit of a given treatment, and thereby external validity, has had little study. Objective To provide a method of decision analysis to quantify the effects of age and comorbidity on the probability of deriving a given magnitude of treatment benefit. Design We developed a method to calculate probabilistically the effect of all of a patient’s comorbidities on their underlying utility, or well-being, at a future time point. From this, we derived a distribution of possible magnitudes of treatment benefit at that future time point. We then expressed this distribution as the probability of deriving at least a given magnitude of treatment benefit. To demonstrate the applicability of this method of decision analysis, we applied it to the treatment of hypercholesterolaemia in a geriatric population of 50 individuals. We highlighted the results of four of these individuals. Results This method of analysis provided individualized quantifications of the effect of age and comorbidity on the probability of treatment benefit. The average probability of deriving a benefit, of at least 50% of the magnitude of benefit available to an individual without comorbidity, was only 0.8%. Conclusion The effects of age and comorbidity on the probability of deriving significant treatment benefits can be quantified for any individual. Even without consideration of other factors affecting external validity, these effects may be sufficient to guide decision-making. PMID:29090189

Suicide attempters examined in a Parisian Emergency Department: Contrasting characteristics associated with multiple suicide attempts or with the motive to die.

PubMed

Perquier, Florence; Duroy, David; Oudinet, Camille; Maamar, Alya; Choquet, Christophe; Casalino, Enrique; Lejoyeux, Michel

2017-07-01

Among patients examined after a suicide attempt in a Parisian emergency department, we aimed to compare individual characteristics of i) first time and multiple suicide attempters, ii) attempters whose principal motive was "to die" and attempters who had any other motive. Information regarding sociodemographics, clinical characteristics, prior mental health care and outgoing referral was collected in 168 suicide attempters using a standardized form. Associations of these variables with suicide attempt repetition (yes or no) and with the motive underlying the attempt (to die or not) were examined using descriptive statistics and multivariable logistic regression models. Multiple attempters were more likely to have no occupation and to report previous mental health care: mental health follow-up, psychiatric medication or psychiatric hospitalization. The motive to die was not associated with the risk of multiple suicide attempts but related to past suicidal ideation and to some specific precipitating factors, including psychiatric disorder. Patients who intended to die were also more likely to be referred to inpatient than to outpatient psychiatric care. Multiple attempters and attempters who desire to die might represent two distinct high-risk groups regarding clinical characteristics and care pathways. They would probably not benefit from the same intervention strategies. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Guiding phosphorus stewardship for multiple ecosystem services

USDA-ARS?s Scientific Manuscript database

Phosphorus is vital to agricultural production and water quality regulation. While the role of phosphorus in agriculture and water quality has been studied for decades, the benefits of sustainable phosphorus use and management for society due to its downstream impacts on multiple ecosystem services...

Protein carriers of conjugate vaccines

PubMed Central

Pichichero, Michael E

2013-01-01

The immunogenicity of polysaccharides as human vaccines was enhanced by coupling to protein carriers. Conjugation transformed the T cell-independent polysaccharide vaccines of the past to T cell-dependent antigenic vaccines that were much more immunogenic and launched a renaissance in vaccinology. This review discusses the conjugate vaccines for prevention of infections caused by Hemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis. Specifically, the characteristics of the proteins used in the construction of the vaccines including CRM, tetanus toxoid, diphtheria toxoid, Neisseria meningitidis outer membrane complex, and Hemophilus influenzae protein D are discussed. The studies that established differences among and key features of conjugate vaccines including immunologic memory induction, reduction of nasopharyngeal colonization and herd immunity, and antibody avidity and avidity maturation are presented. Studies of dose, schedule, response to boosters, of single protein carriers with single and multiple polysaccharides, of multiple protein carriers with multiple polysaccharides and conjugate vaccines administered concurrently with other vaccines are discussed along with undesirable consequences of conjugate vaccines. The clear benefits of conjugate vaccines in improving the protective responses of the immature immune systems of young infants and the senescent immune systems of the elderly have been made clear and opened the way to development of additional vaccines using this technology for future vaccine products. PMID:23955057

Safe adalimumab therapy for rheumatoid arthritis in a patient with pre-existing multiple myeloma.

PubMed

Mielke, Frank; Schweigert, Marcus

2008-04-01

We report on a patient with rheumatoid arthritis (RA) who was treated with adalimumab and retrospectively diagnosed as having a multiple myeloma. In addition to the determination of clinical symptoms, investigations included radiography of the thorax, spine, hands and feet, arthrosonography, determination of laboratory parameters (including C-reactive protein levels and presence of antibodies against cyclic citrullinated peptide), cytogenetics and electrocardiography. RA was initially diagnosed in 1988. Stage II and stage III RA were diagnosed for the left and right foot, respectively, in 1996. Joints of both hands were diagnosed with stage I RA; both wrists and some finger joints showed signs of synovitis. Plasmocytoma was diagnosed in 2004; however, investigation of medical records revealed evidence of multiple myeloma 8 years earlier, in 1996. RA was originally treated with gold, sulfasalazine, azathioprin and glucocorticoid. Methotrexate was later used in addition to cortisone and then in combination with a selective cyclo-oxygenase-2 inhibitor. A combination therapy consisting of adalimumab (40 mg every 2 weeks), methotrexate (15 mg weekly) and a cyclo-oxygenase-2 inhibitor (rofecoxib 25 mg daily until July 2004, etoricoxib 90 mg daily from October 2004) was started in November 2003. Adalimumab therapy was interrupted for 6 months owing to safety concerns, but was resumed after a careful risk-benefit assessment.

Reviewing the quality, health benefit and value for money of chemotherapy and targeted therapy for metastatic breast cancer.

PubMed

Pouwels, Xavier Ghislain Léon Victor; Ramaekers, Bram L T; Joore, Manuela A

2017-10-01

To provide an overview of model characteristics and outcomes of model-based economic evaluations concerning chemotherapy and targeted therapy (TT) for metastatic breast cancer (MBC); to assess the quality of the studies; to analyse the association between model characteristics and study quality and outcomes. PubMED and NHS EED were systematically searched. Inclusion criteria were as follows: English or Dutch language, model-based economic evaluation, chemotherapy or TT as intervention, population diagnosed with MBC, published between 2000 and 2014, reporting life years (LY) or quality-adjusted life-year (QALY) and an incremental cost-effectiveness ratio. General characteristics, model characteristics and outcomes of the studies were extracted. Quality of the studies was assessed through a checklist. 24 studies were included, considering 50 comparisons (20 concerning chemotherapy and 30 TT). Seven comparisons were represented in multiple studies. A health state-transition model including the following health states: stable/progression-free disease, progression and death was used in 18 studies. Studies fulfilled on average 14 out of the 26 items of the quality checklist, mostly due to a lack of transparency in reporting. Thirty-one per cent of the incremental net monetary benefit was positive. TT led to higher iQALY gained, and industry-sponsored studies reported more favourable cost-effectiveness outcomes. The development of a disease-specific reference model would improve the transparency and quality of model-based cost-effectiveness assessments for MBC treatments. Incremental health benefits increased over time, but were outweighed by the increased treatment costs. Consequently, increased health benefits led to lower value for money.

Diabetes and cardiovascular disease: the potential benefit of incretin-based therapies.

PubMed

Addison, Daniel; Aguilar, David

2011-04-01

The health burden of type 2 diabetes mellitus continues to increase worldwide. A substantial portion of this burden is due to the development of cardiovascular disease in patients with diabetes. Recent failures of clinical trials of intensive glucose control to reduce macrovascular events, coupled with reports of potential harm of certain diabetic therapy, have led to increased scrutiny as new diabetic therapies are developed. Incretin peptides are a group of gastrointestinal proteins that regulate glucose metabolism through multiple mechanisms, and incretin-based therapies have been developed to treat type 2 diabetes. These agents include glucagon-like peptide-1 (GLP-1) and dipeptidyl peptidase-IV (DPP-IV) inhibitors. In addition to effects on glucose homeostasis, growing evidence suggest that these peptides may also affect the cardiovascular system. In this review, we discuss recent findings concerning the potential, yet untested, benefits of incretin-based pharmacotherapy in the treatment of cardiovascular disease.

Utilizing Commercial Real Estate Owner and Investor Data to Analyze the Financial Performance of Energy Efficient, High-Performance Office Buildings

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

Cloutier, Deborah; Hosseini, Farshid; White, Andrew

Evidence has shown that owning and operating energy-efficient, high-performance, “green” properties results in multiple benefits including lower utility bills, higher rents, improved occupancy, and greater net operating income. However, it is difficult to isolate and control moderating factors to identify the specific drivers behind improved financial performance and value to investors that results from sustainability in real estate. DOE is interested in facilitating deeper investigation of the correlation between energy efficiency and financial performance, reducing data acquisition and matching challenges, and developing a stronger understanding of how sustainable design and energy efficiency impact value. DOE commissioned this pilot study tomore » test the logistical and empirical procedures required to establish a Commercial Real Estate Data Aggregation & Trends Analysis lab, determine the potential benefits available through the lab, and contribute to the existing body of evidence in this field.« less

The Deep Space Atomic Clock Mission

NASA Technical Reports Server (NTRS)

Ely, Todd A.; Koch, Timothy; Kuang, Da; Lee, Karen; Murphy, David; Prestage, John; Tjoelker, Robert; Seubert, Jill

2012-01-01

The Deep Space Atomic Clock (DSAC) mission will demonstrate the space flight performance of a small, low-mass, high-stability mercury-ion atomic clock with long term stability and accuracy on par with that of the Deep Space Network. The timing stability introduced by DSAC allows for a 1-Way radiometric tracking paradigm for deep space navigation, with benefits including increased tracking via utilization of the DSN's Multiple Spacecraft Per Aperture (MSPA) capability and full ground station-spacecraft view periods, more accurate radio occultation signals, decreased single-frequency measurement noise, and the possibility for fully autonomous on-board navigation. Specific examples of navigation and radio science benefits to deep space missions are highlighted through simulations of Mars orbiter and Europa flyby missions. Additionally, this paper provides an overview of the mercury-ion trap technology behind DSAC, details of and options for the upcoming 2015/2016 space demonstration, and expected on-orbit clock performance.

An experimental evaluation of monochromatic x-ray beam position monitors at diamond light source

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

Bloomer, Chris, E-mail: chris.bloomer@diamond.ac.uk; Rehm, Guenther; Dolbnya, Igor P.

Maintaining the stability of the X-ray beam relative to the sample point is of paramount importance for beamlines and users wanting to perform cutting-edge experiments. The ability to detect, and subsequently compensate for, variations in X-ray beam position with effective diagnostics has multiple benefits: a reduction in commissioning and start-up time, less ‘down-time’, and an improvement in the quality of acquired data. At Diamond Light Source a methodical evaluation of a selection of monochromatic X-ray Beam Position Monitors (XBPMs), using a range of position detection techniques, and from a range of suppliers, was carried out. The results of these experimentsmore » are presented, showing the measured RMS noise on the position measurement of each device for a given flux, energy, beam size, and bandwidth. A discussion of the benefits and drawbacks of each of the various devices and techniques is also included.« less

Nanoparticles from Degradation of Biodegradable Plastic Mulch

NASA Astrophysics Data System (ADS)

Flury, Markus; Sintim, Henry; Bary, Andy; English, Marie; Schaefer, Sean

2017-04-01

Plastic mulch films are commonly used in crop production. They provide multiple benefits, including control of weeds and insects, increase of soil and air temperature, reduction of evaporation, and prevention of soil erosion. The use of plastic mulch film in agriculture has great potential to increase food production and security. Plastic mulch films must be retrieved and disposed after usage. Biodegradable plastic mulch films, who can be tilled into the soil after usage offer great benefits as alternative to conventional polyethylene plastic. However, it has to be shown that the degradation of these mulches is complete and no micro- and nanoparticles are released during degradation. We conducted a field experiment with biodegradable mulches and tested mulch degradation. Mulch was removed from the field after the growing season and composted to facilitate degradation. We found that micro- and nanoparticles were released during degradation of the mulch films in compost. This raises concerns about degradation in soils as well.

Contributing to operations of community agencies through integrated fieldwork experiences.

PubMed

Klinger, Lisa; Bossers, Ann

2009-06-01

Occupational therapists are change agents who are well equipped to participate in community development. Community development projects can help agencies in many ways, including determining needs, educating stakeholders, developing novel programs, finding and creating resources, marketing the agency, and creating or implementing policy. In order for service agencies to profit, they need an understanding of the skills occupational therapists can offer. The best way to gain that knowledge may be through direct experience. This paper describes the benefits that flow to community agency partners and to occupational therapy students from an innovative, integrated fieldwork model that links students with service agencies. This approach has demonstrated many benefits to community partners, while allowing all students in an occupational therapy program to have community development experience. This is a cost-effective way to demonstrate the value of occupational therapy and to deliver multiple community development projects.

Group decision making with the analytic hierarchy process in benefit-risk assessment: a tutorial.

PubMed

Hummel, J Marjan; Bridges, John F P; IJzerman, Maarten J

2014-01-01

The analytic hierarchy process (AHP) has been increasingly applied as a technique for multi-criteria decision analysis in healthcare. The AHP can aid decision makers in selecting the most valuable technology for patients, while taking into account multiple, and even conflicting, decision criteria. This tutorial illustrates the procedural steps of the AHP in supporting group decision making about new healthcare technology, including (1) identifying the decision goal, decision criteria, and alternative healthcare technologies to compare, (2) structuring the decision criteria, (3) judging the value of the alternative technologies on each decision criterion, (4) judging the importance of the decision criteria, (5) calculating group judgments, (6) analyzing the inconsistency in judgments, (7) calculating the overall value of the technologies, and (8) conducting sensitivity analyses. The AHP is illustrated via a hypothetical example, adapted from an empirical AHP analysis on the benefits and risks of tissue regeneration to repair small cartilage lesions in the knee.

Endometrial Cancer and the Role of Lymphadenectomy.

PubMed

Clark, Leslie H; Soper, John T

2016-06-01

The role of lymph node dissection in early-stage endometrial cancer is highly debated, but staging and prognosis are dependent on knowledge of lymph node metastasis. We sought to review the available data on the use of lymph node assessment in presumed early-stage endometrial cancer. A comprehensive literature review was performed using MEDLINE, the Cochrane Collaborative Database, and PubMed. There is limited retrospective data that suggest a therapeutic benefit to lymphadenectomy. Prospective randomized trials have not shown a benefit to lymphadenectomy in low-risk patients, but found significant morbidity in patients undergoing lymphadenectomy. Selective lymph node assessment should be used in low-risk endometrial cancer. Sentinel lymph node assessment is emerging as a potential strategy for lymph node assessment. Selective use of lymphadenectomy in early-stage endometrial cancer can reduce the morbidity associated with lymph node dissection without compromising clinical outcomes. Multiple strategies are available including sentinel lymph nodes and risk factor based lymphadenectomy.

Moving Toward Space Internetworking via DTN: Its Operational Challenges, Benefits, and Management

NASA Technical Reports Server (NTRS)

Barkley, Erik; Burleigh, Scott; Gladden, Roy; Malhotra, Shan; Shames, Peter

2010-01-01

The international space community has begun to recognize that the established model for management of communications with spacecraft - commanded data transmission over individual pair-wise contacts - is operationally unwieldy and will not scale in support of increasingly complex and sophisticated missions such as NASA's Constellation project. Accordingly, the international Inter-Agency Operations Advisory Group (IOAG) ichartered a Space Internetworking Strategy Group (SISG), which released its initial recommendations in a November 2008 report. The report includes a recommendation that the space flight community adopt Delay-Tolerant Networking (DTN) to address the problem of interoperability and communication scaling, especially in mission environments where there are multiple spacecraft operating in concert. This paper explores some of the issues that must be addressed in implementing, deploying, and operating DTN as part of a multi-mission, multi-agency space internetwork as well as benefits and future operational scenarios afforded by DTN-based space internetworking.

The impact of embedding multiple modes of representation on student construction of chemistry knowledge

NASA Astrophysics Data System (ADS)

McDermott, Mark Andrew

2009-12-01

This study was designed to examine the impact of embedding multiple modes of representing science information on student conceptual understanding in science. Multiple representations refer to utilizing charts, graphs, diagrams, and other types of representations to communicate scientific information. This study investigated the impact of encouraging students to embed or integrate the multiple modes with text in end of unit writing-to-learn activities. A quasi-experimental design with four separate sites consisting of intact chemistry classes taught by different teachers at each site was utilized. At each site, approximately half of the classes were designated treatment classes and students in these classes participated in activities designed to encourage strategies to embed multiple modes within text in student writing. The control classes did not participate in these activities. All classes participated in identical end of unit writing tasks in which they were required to use at least one mode other than text, followed by identical end of unit assessments. This progression was then repeated for a second consecutive unit of study. Analysis of quantitative data indicated that in several cases, treatment classes significantly outperformed control classes both on measures of embeddedness in writing and on end of unit assessment measures. In addition, analysis at the level of individual students indicated significant positive correlations in many cases between measures of student embeddedness in writing and student performance on end of unit assessments. Three factors emerged as critical in increasing the likelihood of benefit for students from these types of activities. First, the level of teacher implementation and emphasis on the embeddedness lessons was linked to the possibility of conceptual benefit. Secondly, students participating in two consecutive lessons appeared to receive greater benefit during the second unit, inferring a cumulative benefit. Finally, differential impact of the degree of embeddedness on student performance was noted based on student's level of science ability prior to the initiation of study procedures.

Two approaches to incorporate clinical data uncertainty into multiple criteria decision analysis for benefit-risk assessment of medicinal products.

PubMed

Wen, Shihua; Zhang, Lanju; Yang, Bo

2014-07-01

The Problem formulation, Objectives, Alternatives, Consequences, Trade-offs, Uncertainties, Risk attitude, and Linked decisions (PrOACT-URL) framework and multiple criteria decision analysis (MCDA) have been recommended by the European Medicines Agency for structured benefit-risk assessment of medicinal products undergoing regulatory review. The objective of this article was to provide solutions to incorporate the uncertainty from clinical data into the MCDA model when evaluating the overall benefit-risk profiles among different treatment options. Two statistical approaches, the δ-method approach and the Monte-Carlo approach, were proposed to construct the confidence interval of the overall benefit-risk score from the MCDA model as well as other probabilistic measures for comparing the benefit-risk profiles between treatment options. Both approaches can incorporate the correlation structure between clinical parameters (criteria) in the MCDA model and are straightforward to implement. The two proposed approaches were applied to a case study to evaluate the benefit-risk profile of an add-on therapy for rheumatoid arthritis (drug X) relative to placebo. It demonstrated a straightforward way to quantify the impact of the uncertainty from clinical data to the benefit-risk assessment and enabled statistical inference on evaluating the overall benefit-risk profiles among different treatment options. The δ-method approach provides a closed form to quantify the variability of the overall benefit-risk score in the MCDA model, whereas the Monte-Carlo approach is more computationally intensive but can yield its true sampling distribution for statistical inference. The obtained confidence intervals and other probabilistic measures from the two approaches enhance the benefit-risk decision making of medicinal products. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Can CanMEDS competencies be developed in medical school anatomy laboratories? A literature review.

PubMed

Hefler, Joshua; Ramnanan, Christopher J

2017-06-16

The purpose of this literature review was to identify potential ways in which undergraduate medical anatomy education may be relevant to the CanMEDS Roles, a competency-based framework used throughout Canadian medical training. A scoping review of medical education literature was conducted in March 2017 for English language publications that included key words related to anatomy education and to key competencies formally described for each of the Roles in the CanMEDS 2015 framework. Indicated benefits were then collated, characterized, and synthesized for each CanMEDS Role. There were 71 studies identified describing original findings. Perceived benefits of anatomy education were most often identified for competencies related to the Medical Expert Role. Multiple studies also cited benefits related to the Scholar, Professional and Collaborator Roles. There was a lack of literature related to the Health Advocate, Communicator, and Leader Roles. The majority of benefits defined in the literature were limited to student perceptions rather than objectively measured outcomes. There is some evidence to suggest that anatomy education can facilitate the development of core competencies related to several CanMEDS Roles, outside of simply developing medical knowledge in the Medical Expert Role. Future studies need to develop methods to objectively assess outcomes related to these competencies.

Review of the neurological benefits of phytocannabinoids.

PubMed

Maroon, Joseph; Bost, Jeff

2018-01-01

Numerous physical, psychological, and emotional benefits have been attributed to marijuana since its first reported use in 2,600 BC in a Chinese pharmacopoeia. The phytocannabinoids, cannabidiol (CBD), and delta-9-tetrahydrocannabinol (Δ9-THC) are the most studied extracts from cannabis sativa subspecies hemp and marijuana. CBD and Δ9-THC interact uniquely with the endocannabinoid system (ECS). Through direct and indirect actions, intrinsic endocannabinoids and plant-based phytocannabinoids modulate and influence a variety of physiological systems influenced by the ECS. In 1980, Cunha et al . reported anticonvulsant benefits in 7/8 subjects with medically uncontrolled epilepsy using marijuana extracts in a phase I clinical trial. Since then neurological applications have been the major focus of renewed research using medical marijuana and phytocannabinoid extracts. Recent neurological uses include adjunctive treatment for malignant brain tumors, Parkinson's disease, Alzheimer's disease, multiple sclerosis, neuropathic pain, and the childhood seizure disorders Lennox-Gastaut and Dravet syndromes. In addition, psychiatric and mood disorders, such as schizophrenia, anxiety, depression, addiction, postconcussion syndrome, and posttraumatic stress disorders are being studied using phytocannabinoids. In this review we will provide animal and human research data on the current clinical neurological uses for CBD individually and in combination with Δ9-THC. We will emphasize the neuroprotective, antiinflammatory, and immunomodulatory benefits of phytocannabinoids and their applications in various clinical syndromes.

A complications-based clinical staging of obesity to guide treatment modality and intensity

PubMed Central

Daniel, Sunil; Soleymani, Taraneh; Garvey, William T.

2014-01-01

Purpose of review The current medical model for obesity management is BMI-centric because BMI is the predominant measure used to gauge disease severity, as well as indications for various treatment modalities. Recent advancements in therapy and understanding of the relationship between BMI and obesity-related complications call for a re-examination of this approach. Recent findings Advancements in treatment, including the recent approval of two new weight loss medications in the USA, have enabled development of new medical models for management of obesity. On the basis of accumulating data demonstrating the benefits of weight loss regarding multiple obesity-related complications (e.g., diabetes prevention, type 2 diabetes mellitus, cardiovascular disease risk, nonalcoholic steatohepatitis, sleep apnea), a complications-centric model is proposed that employs weight loss as a tool to treat and prevent obesity comorbidities. This model assures that the aggressiveness of therapy is commensurate with disease severity, and that therapy is directed at those obese patients who will benefit most from weight loss therapy. The treatment algorithm is comprehensive in addressing complications and quantitative when possible in the staging of risk or disease severity. Summary A complications-centric approach to obesity management identifies patients who will benefit most from weight loss, and optimizes patient outcomes, benefit/risk ratio, and the cost–effectiveness of interventions. PMID:23974764

Targeting Alertness to Improve Cognition in Older Adults: A Preliminary Report of Benefits in Executive Function and Skill Acquisition

PubMed Central

Van Vleet, Thomas M.; DeGutis, Joseph M.; Merzenich, Michael M.; Simpson, Gregory V.; Zomet, Ativ; Dabit, Sawsan

2016-01-01

Efficient self-regulation of alertness declines with age exacerbating normal declines in performance across multiple cognitive domains, including learning and skill acquisition. Previous cognitive intervention studies have shown that it is possible to enhance alertness in patients with acquired brain injury and marked attention impairments, and that this benefit generalizes to improvements in more global cognitive functions. In the current preliminary studies, we sought to test whether this approach, that targets both tonic (over a period of minutes) and phasic (moment-to-moment) alertness, can improve key executive functioning declines in older adults, and enhance the rate of skill acquisition. The results of both experiments 1 and 2 demonstrate that, compared to active control training, alertness training significantly enhanced performance in several validated executive function measures. In experiment 2, alertness training significantly improved skill acquisition compared to active control training in a well-characterized speed of processing task, with the largest benefits shown in the most challenging speed of processing blocks. The results of the current study suggest that targeting intrinsic alertness in cognitive training provides a novel approach to improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments. PMID:27372902

Can CanMEDS competencies be developed in medical school anatomy laboratories? A literature review

PubMed Central

Ramnanan, Christopher J.

2017-01-01

Objectives The purpose of this literature review was to identify potential ways in which undergraduate medical anatomy education may be relevant to the CanMEDS Roles, a competency-based framework used throughout Canadian medical training. Methods A scoping review of medical education literature was conducted in March 2017 for English language publications that included key words related to anatomy education and to key competencies formally described for each of the Roles in the CanMEDS 2015 framework. Indicated benefits were then collated, characterized, and synthesized for each CanMEDS Role. Results There were 71 studies identified describing original findings. Perceived benefits of anatomy education were most often identified for competencies related to the Medical Expert Role. Multiple studies also cited benefits related to the Scholar, Professional and Collaborator Roles. There was a lack of literature related to the Health Advocate, Communicator, and Leader Roles. The majority of benefits defined in the literature were limited to student perceptions rather than objectively measured outcomes. Conclusions There is some evidence to suggest that anatomy education can facilitate the development of core competencies related to several CanMEDS Roles, outside of simply developing medical knowledge in the Medical Expert Role. Future studies need to develop methods to objectively assess outcomes related to these competencies. PMID:28650843

The influence of cognitive dysfunction on benefit from learning and memory rehabilitation in MS: A sub-analysis of the MEMREHAB trial.

PubMed

Chiaravalloti, Nancy D; DeLuca, John

2015-10-01

This study examined the influence of processing speed (PS) on benefit from treatment with the modified Story Memory Technique(©) (mSMT), a behavioral intervention shown to improve new learning and memory in multiple sclerosis (MS). This double-blind, placebo-controlled, randomized clinical trial included 85 participants with clinically definite MS, 45 assigned to the treatment group and 40 to the placebo-control group. Participants completed baseline and follow-up neuropsychological assessment. The present study represents a post-hoc analysis to examine the role of PS on treatment efficacy. The treatment group showed a significantly improved CVLT learning slope relative to the placebo group post-treatment, after co-varying PS performance. SDMT performance was a significant predictor of benefit from mSMT treatment, beyond group assignment. Post-hoc analysis indicated a significant correlation between the SDMT and overall cognition, indicating that the SDMT may be serving as a proxy for overall cognitive impairment. Performance on measures of cognitive dysfunction aside from learning and memory impact the benefit of mSMT treatment. While the current study focused on PS as a critical factor, PS may be serving as a marker for generalized cognitive dysfunction. Implications for cognitive rehabilitation in MS are discussed. © The Author(s), 2015.

Advancing drug delivery systems for the treatment of multiple sclerosis.

PubMed

Tabansky, Inna; Messina, Mark D; Bangeranye, Catherine; Goldstein, Jeffrey; Blitz-Shabbir, Karen M; Machado, Suly; Jeganathan, Venkatesh; Wright, Paul; Najjar, Souhel; Cao, Yonghao; Sands, Warren; Keskin, Derin B; Stern, Joel N H

2015-12-01

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. It is characterized by demyelination of neurons and loss of neuronal axons and oligodendrocytes. In MS, auto-reactive T cells and B cells cross the blood-brain barrier (BBB), causing perivenous demyelinating lesions that form multiple discrete inflammatory demyelinated plaques located primarily in the white matter. In chronic MS, cortical demyelination and progressive axonal transections develop. Treatment for MS can be stratified into disease-modifying therapies (DMTs) and symptomatic therapy. DMTs aim to decrease circulating immune cells or to prevent these cells from crossing the BBB and reduce the inflammatory response. There are currently 10 DMTs approved for the relapsing forms of MS; these vary with regard to their efficacy, route and frequency of administration, adverse effects, and toxicity profile. Better drug delivery systems are being developed in order to decrease adverse effects, increase drug efficacy, and increase patient compliance through the direct targeting of pathologic cells. Here, we address the uses and benefits of advanced drug delivery systems, including nanoparticles, microparticles, fusion antibodies, and liposomal formulations. By altering the properties of therapeutic particles and enhancing targeting, breakthrough drug delivery technologies potentially applicable to multiple disease treatments may rapidly emerge.

Experience with Using Multiple Types of Visual Educational Tools during Problem-Based Learning.

PubMed

Kang, Bong Jin

2012-06-01

This study describes the experience of using multiple types of visual educational tools in the setting of problem-based learning (PBL). The author intends to demonstrate their roles in diverse and efficient ways of clinical reasoning and problem solving. Visual educational tools were introduced in a lecture that included their various types, possible benefits, and some examples. Each group made one mechanistic case diagram per week, and each student designed one diagnostic schema or therapeutic algorithm per week, based on their learning issues. The students were also told to provide commentary, which was intended to give insights into their truthfulness. Subsequently, the author administered a questionnaire about the usefulness and weakness of visual educational tools and the difficulties with performing the work. Also, the qualities of the products were assessed by the author. There were many complaints about the adequacy of the introduction of visual educational tools, also revealed by the many initial inappropriate types of products. However, the exercise presentation in the first week improved the level of understanding regarding their purposes and the method of design. In general, students agreed on the benefits of their help in providing a deep understanding of the cases and the possibility of solving clinical problems efficiently. The commentary was helpful in evaluating the truthfulness of their efforts. Students gave suggestions for increasing the percentage of their scores, considering the efforts. Using multiple types of visual educational tools during PBL can be useful in understanding the diverse routes of clinical reasoning and clinical features.

Clinical outcomes of WBRT plus EGFR-TKIs versus WBRT or TKIs alone for the treatment of cerebral metastatic NSCLC patients: a meta-analysis

PubMed Central

Hou, Bin; Zhou, Dong; Li, Jing-Meng; Lu, Xiao; Wu, Qiu-Ping; Dai, Ji-Gang

2017-01-01

Whether WBRT plus EGFR-TKIs has a greater survival benefit than EGFR-TKIs alone or WBRT alone remains controversial in NSCLC patients with multiple brain metastases. To rectify this, we conducted a systematic meta-analysis based on 9 retrospective studies and 1 randomized controlled study published between 2012 and 2016, comprising 1041 patients. Five studies were included in the comparison of WBRT plus EGFR-TKIs and EGFR-TKIs alone. The combined HR for OS of patients with EGFR mutation was 1.25 [95% CI 0.98–2.15; P = 0.08] and for intracranial PFS was 1.30 [95% CI 1.03–1.65; P = 0.03], which revealed that EGFR-TKIs alone produced a superior intracranial PFS than WBRT plus EGFR-TKIs. Five studies were included in the comparison of WBRT plus EGFR-TKIs and WBRT alone. The combined HR for OS, intracranial PFS and extracranial PFS were 0.52 [95% CI 0.37–0.75; P = 0.0004], 0.36 [95% CI 0.24–0.53; P < 0.001] and 0.52 [95% CI 0.38–0.71; P < 0.001], respectively, which revealed a significant benefit of WBRT plus EGFR-TKIs compared with WBRT alone. The results indicated that EGFR-TKIs alone should be the first option for the treatment of NSCLC patients with multiple BM, especially with EGFR mutation, since it provides similar OS and extracranial PFS but superior intracranial PFS compared with WBRT plus EGFR-TKIs. PMID:28915676

Clinical outcomes of WBRT plus EGFR-TKIs versus WBRT or TKIs alone for the treatment of cerebral metastatic NSCLC patients: a meta-analysis.

PubMed

Zheng, Hong; Liu, Quan-Xing; Hou, Bin; Zhou, Dong; Li, Jing-Meng; Lu, Xiao; Wu, Qiu-Ping; Dai, Ji-Gang

2017-08-22

Whether WBRT plus EGFR-TKIs has a greater survival benefit than EGFR-TKIs alone or WBRT alone remains controversial in NSCLC patients with multiple brain metastases. To rectify this, we conducted a systematic meta-analysis based on 9 retrospective studies and 1 randomized controlled study published between 2012 and 2016, comprising 1041 patients. Five studies were included in the comparison of WBRT plus EGFR-TKIs and EGFR-TKIs alone. The combined HR for OS of patients with EGFR mutation was 1.25 [95% CI 0.98-2.15; P = 0.08] and for intracranial PFS was 1.30 [95% CI 1.03-1.65; P = 0.03], which revealed that EGFR-TKIs alone produced a superior intracranial PFS than WBRT plus EGFR-TKIs. Five studies were included in the comparison of WBRT plus EGFR-TKIs and WBRT alone. The combined HR for OS, intracranial PFS and extracranial PFS were 0.52 [95% CI 0.37-0.75; P = 0.0004], 0.36 [95% CI 0.24-0.53; P < 0.001] and 0.52 [95% CI 0.38-0.71; P < 0.001], respectively, which revealed a significant benefit of WBRT plus EGFR-TKIs compared with WBRT alone. The results indicated that EGFR-TKIs alone should be the first option for the treatment of NSCLC patients with multiple BM, especially with EGFR mutation, since it provides similar OS and extracranial PFS but superior intracranial PFS compared with WBRT plus EGFR-TKIs.

eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State.

PubMed

Kip, Hanneke; Bouman, Yvonne H A; Kelders, Saskia M; van Gemert-Pijnen, Lisette J E W C

2018-01-01

Treatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients. To examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness. A systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients. The search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of. To overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth's potential, further research on development, implementation, and evaluation should be conducted.

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis.

PubMed

Johnson, Kurt L; Yorkston, Kathryn M; Klasner, Estelle R; Kuehn, Carrie M; Johnson, Erica; Amtmann, Dagmar

2004-02-01

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace. Qualitative research methodology comprising a series of semistructured interviews. Community-based setting. Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews. Not applicable. Accounts of personal experiences related to employment. Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working. Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.

Laughter and MIRTH (Methodical Investigation of Risibility, Therapeutic and Harmful): narrative synthesis.

PubMed

Ferner, R E; Aronson, J K

2013-12-12

To review the beneficial and harmful effects of laughter. Narrative synthesis. We searched Medline (1946 to June 2013) and Embase (1974 to June 2013) for reports of benefits or harms from laughter in humans, and counted the number of papers in each category. Benefits of laughter include reduced anger, anxiety, depression, and stress; reduced tension (psychological and cardiovascular); increased pain threshold; reduced risk of myocardial infarction (presumably requiring hearty laughter); improved lung function; increased energy expenditure; and reduced blood glucose concentration. However, laughter is no joke-dangers include syncope, cardiac and oesophageal rupture, and protrusion of abdominal hernias (from side splitting laughter or laughing fit to burst), asthma attacks, interlobular emphysema, cataplexy, headaches, jaw dislocation, and stress incontinence (from laughing like a drain). Infectious laughter can disseminate real infection, which is potentially preventable by laughing up your sleeve. As a side effect of our search for side effects, we also list pathological causes of laughter, among them epilepsy (gelastic seizures), cerebral tumours, Angelman's syndrome, strokes, multiple sclerosis, and amyotrophic lateral sclerosis or motor neuron disease. Laughter is not purely beneficial. The harms it can cause are immediate and dose related, the risks being highest for Homeric (uncontrollable) laughter. The benefit-harm balance is probably favourable. It remains to be seen whether sick jokes make you ill or jokes in bad taste cause dysgeusia, and whether our views on comedians stand up to further scrutiny.

Toxics Use Reduction in the Home: Lessons Learned from Household Exposure Studies

PubMed Central

Dunagan, Sarah C.; Dodson, Robin E.; Rudel, Ruthann A.; Brody, Julia G.

2010-01-01

Workers and fence-line communities have been the first to benefit from the substantial reductions in toxic chemical use and byproducts in industrial production resulting from the Massachusetts Toxics Use Reduction Act (TURA). As TURA motivates reformulation of products as well as retooling of production processes, benefits could extend more broadly to large-scale reductions in everyday exposures for the general population. Household exposure studies, including those conducted by Silent Spring Institute, show that people are exposed to complex mixtures of indoor toxics from building materials and a myriad of consumer products. Pollutants in homes are likely to have multiple health effects because many are classified as endocrine disrupting compounds (EDCs), with the ability to interfere with the body's hormone system. Product-related EDCs measured in homes include phthalates, halogenated flame retardants, and alkylphenols. Silent Spring Institute's chemical analysis of personal care and cleaning products confirms many are potential sources of EDCs, highlighting the need for a more comprehensive toxics use reduction (TUR) approach to reduce those exposures. Toxics use reduction targeted at EDCs in consumer products has the potential to substantially reduce occupational and residential exposures. The lessons that have emerged from household exposure research can inform improved chemicals management policies at the state and national levels, leading to safer products and widespread health and environmental benefits. PMID:21516227

Multiple Approaches to the Evaluation of Educational Reform: From Cost-Benefit to Power-Benefit Analysis.

ERIC Educational Resources Information Center

Paulston, Rolland G.

Theories or explanations of educational evaluation are discussed and categorized under two broad methodological headings, the objectivist and subjectivist epistemological orientations. They can be seen as potentially complementary empirical approaches that offer evaluators two methodological orientations to assess educational-reform outcomes.…

Sandia National Laboratories: Careers: Life at Sandia

Science.gov Websites

; Culture Work-Life Balance Special Programs Students and Postdocs Benefits and Perks Hiring Process Life at control my own career, and the incredible work-life balance." Daniel - Electrical and Computer offers meaningful work, unparalleled work-life balance, outstanding benefits, job stability, and multiple

Realizing the Potential of Ecosystem Services: A Framework for Relating Ecological Changes to Economic Benefits

EPA Science Inventory

An analysis framework to link ecological change to economic benefits for multiple stakeholders requires several key components. First, since we aim to support policy decisions, the framework should link a factor that can be controlled or influenced by policy (discharge limit, ca...

Comprehensive Benefit Platforms to Simplify Complex HR Processes

ERIC Educational Resources Information Center

Ehrsam, Hank

2012-01-01

Paying for employee turnover costs, data storage, and multiple layers of benefits can be difficult for fiscally constrained institutions, especially as budget cuts and finance-limiting legislation abound in school districts across the country. Many traditional paper-based systems have been replaced with automated, software-based services, helping…

Aspirin in Older Adults: Need for Wider Utilization in Secondary Prevention and Individual Clinical Judgments in Primary Prevention.

PubMed

Sehgal, Mandi; Wood, Sarah K; Ouslander, Joseph G; Hennekens, Charles H

2017-11-01

In the treatment or secondary prevention of cardiovascular disease (CVD), there is general consensus that the absolute benefits of aspirin far outweigh the absolute risks. Despite evidence from randomized trials and their meta-analyses, older adults, defined as aged 65 years or older, are less likely to be prescribed aspirin than their middle-aged counterparts. In primary prevention, the optimal utilization of aspirin is widely debated. There is insufficient randomized evidence among apparently healthy participants at moderate to high risk of a first CVD event, so general guidelines seem premature. Among older adults, randomized data are even more sparse but trials are ongoing. Further, older adults commonly take multiple medications due to comorbidities, which may increase deleterious interactions and side effects. Older adults have higher risks of occlusive events as well as bleeding. All these considerations support the need for individual clinical judgments in prescribing aspirin in the context of therapeutic lifestyle changes and other adjunctive drug therapies. These include statins for lipids and usually multiple drugs to achieve control of high blood pressure. As regards aspirin, the clinician should weigh the absolute benefit on occlusion against the absolute risk of bleeding. These issues should be considered with each patient to facilitate an informed and person-centered individual clinical judgment. The use of aspirin in primary prevention is particularly attractive because the drug is generally over the counter and, for developing countries where CVD is becoming the leading cause of death, is extremely inexpensive. The more widespread use of aspirin in older adults with prior CVD will confer net benefits to risks and even larger net benefits to costs in the United States as well as other developed and developing countries. In primary prevention among older adults, individual clinical judgments should be made by the health-care professional and each of his or her patients.

Designing personal exercise monitoring employing multiple modes of delivery: implications from a qualitative study on heart rate monitoring.

PubMed

Segerståhl, Katarina; Oinas-Kukkonen, Harri

2011-12-01

Various personal monitoring technologies have been introduced for supporting regular physical activity, which is of critical importance in reducing the risks of several chronic diseases. Recent studies suggest that combining multiple modes of delivery, such as text messages and mobile monitoring devices with web applications, holds potential for effectively supporting physical exercise. Of particular interest is how the functionality and content of these systems should be distributed across the different modes for successful outcomes. The aim of this study was to: (a) investigate how users incorporate a system employing two modes of delivery - a wearable heart rate monitor and a web service - into their training and (b) to analyze benefits and limitations in personal exercise monitoring and how they relate to the different modes in use. A qualitative field study employing diaries and semi-structured interviews was carried out with 30 participants who used a heart rate monitoring system comprising a wearable heart rate monitor, Polar FT60 and a web service, Polar Personal Trainer for a period of 21 days. The data were systematically analyzed to identify specific benefits and limitations associated with the system characteristics and modes as perceived by the end-users. The benefits include supporting exploratory learning, controlling target behavior, rectifying behaviors, motivation and logging support. The limitations are associated with information for validating the system, virtual coaching, task-technology fit, data integrity and privacy concerns. Mobile interfaces enable exploratory learning and controlling of target behaviors in situ, while web services can effectively support users' need for cognition within the early stages of adoption and long-term training with intelligent coaching functionality. This study explains several benefits and limitations in personal exercise monitoring. These can be addressed with crossmedial design, i.e., strategic distribution of functionality and content across modes within the system. Our findings suggest that personal exercise monitoring systems may be improved by more systematically combining mobile and web-based functionality. 2011 Elsevier Ireland Ltd. All rights reserved.

Addition of Rice Bran Arabinoxylan to Curcumin Therapy May Be of Benefit to Patients With Early-Stage B-Cell Lymphoid Malignancies (Monoclonal Gammopathy of Undetermined Significance, Smoldering Multiple Myeloma, or Stage 0/1 Chronic Lymphocytic Leukemia)

PubMed Central

Golombick, Terry; Diamond, Terrence H.; Manoharan, Arumugam; Ramakrishna, Rajeev

2016-01-01

Hypothesis. Prior studies on patients with early B-cell lymphoid malignancies suggest that early intervention with curcumin may lead to delay in progressive disease and prolonged survival. These patients are characterized by increased susceptibility to infections. Rice bran arabinoxylan (Ribraxx) has been shown to have immunostimulatory, anti-inflammatory, and proapoptotic effects. We postulated that addition of Ribraxx to curcumin therapy may be of benefit. Study design. Monoclonal gammopathy of undetermined significance (MGUS)/smoldering multiple myeloma (SMM) or stage 0/1 chronic lymphocytic leukemia (CLL) patients who had been on oral curcumin therapy for a period of 6 months or more were administered both curcumin (as Curcuforte) and Ribraxx. Methods. Ten MGUS/SMM patients and 10 patients with stage 0/1 CLL were administered 6 g of curcumin and 2 g Ribraxx daily. Blood samples were collected at baseline and at 2-month intervals for a period of 6 months, and various markers were monitored. MGUS/SMM patients included full blood count (FBC); paraprotein; free light chains/ratio; C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR); B2 microglobulin and immunological markers. Markers monitored for stage 0/1 CLL were FBC, CRP and ESR, and immunological markers. Results. Of 10 MGUS/SMM patients,5 (50%) were neutropenic at baseline, and the Curcuforte/Ribraxx combination therapy showed an increased neutrophil count, varying between 10% and 90% among 8 of the 10 (80%) MGUS/SMM patients. An additional benefit of the combination therapy was the potent effect in reducing the raised ESR in 4 (44%) of the MGUS/SMM patients. Conclusion. Addition of Ribraxx to curcumin therapy may be of benefit to patients with early-stage B-cell lymphoid malignancies. PMID:27154182

Informed actions: where to cost effectively manage multiple threats to species to maximize return on investment.

PubMed

Auerbach, Nancy A; Tulloch, Ayesha I T; Possingham, Hugh P

Conservation practitioners, faced with managing multiple threats to biodiversity and limited funding, must prioritize investment in different management actions. From an economic perspective, it is routine practice to invest where the highest rate of return is expected. This return-on-investment (ROI) thinking can also benefit species conservation, and researchers are developing sophisticated approaches to support decision-making for cost-effective conservation. However, applied use of these approaches is limited. Managers may be wary of “black-box” algorithms or complex methods that are difficult to explain to funding agencies. As an alternative, we demonstrate the use of a basic ROI analysis for determining where to invest in cost-effective management to address threats to species. This method can be applied using basic geographic information system and spreadsheet calculations. We illustrate the approach in a management action prioritization for a biodiverse region of eastern Australia. We use ROI to prioritize management actions for two threats to a suite of threatened species: habitat degradation by cattle grazing, and predation by invasive red foxes (Vulpes vulpes). We show how decisions based on cost-effective threat management depend upon how expected benefits to species are defined and how benefits and costs co-vary. By considering a combination of species richness, restricted habitats, species vulnerability, and costs of management actions, small investments can result in greater expected benefit compared with management decisions that consider only species richness. Furthermore, a landscape management strategy that implements multiple actions is more efficient than managing only for one threat, or more traditional approaches that don't consider ROI. Our approach provides transparent and logical decision support for prioritizing different actions intended to abate threats associated with multiple species; it is of use when managers need a justifiable and repeatable approach to investment.

A System for Distributing Real-Time Customized (NEXRAD-Radar) Geosciences Data

NASA Astrophysics Data System (ADS)

Singh, Satpreet; McWhirter, Jeff; Krajewski, Witold; Kruger, Anton; Goska, Radoslaw; Seo, Bongchul; Domaszczynski, Piotr; Weber, Jeff

2010-05-01

Hydrometeorologists and hydrologists can benefit from (weather) radar derived rain products, including rain rates and accumulations. The Hydro-NEXRAD system (HNX1) has been in operation since 2006 at IIHR-Hydroscience and Engineering at The University of Iowa. It provides rapid and user-friendly access to such user-customized products, generated using archived Weather Surveillance Doppler Radar (WSR-88D) data from the NEXRAD weather radar network in the United States. HNX1 allows researchers to deal directly with radar-derived rain products, without the burden of the details of radar data collection, quality control, processing, and format conversion. A number of hydrologic applications can benefit from a continuous real-time feed of customized radar-derived rain products. We are currently developing such a system, Hydro-NEXRAD 2 (HNX2). HNX2 collects real-time, unprocessed data from multiple NEXRAD radars as they become available, processes them through a user-configurable pipeline of data-processing modules, and then publishes processed products at regular intervals. Modules in the data processing pipeline encapsulate algorithms such as non-meteorological echo detection, range correction, radar-reflectivity-rain rate (Z-R) conversion, advection correction, merging products from multiple radars, and grid transformations. HNX2's implementation presents significant challenges, including quality-control, error-handling, time-synchronization of data from multiple asynchronous sources, generation of multiple-radar metadata products, distribution of products to a user base with diverse needs and constraints, and scalability. For content management and distribution, HNX2 uses RAMADDA (Repository for Archiving, Managing and Accessing Diverse Data), developed by the UCAR/Unidata Program Center in the Unites States. RAMADDA allows HNX2 to publish products through automation and gives users multiple access methods to the published products, including simple web-browser based access, and OpenDAP access. The latter allows a user to set up automation at his/her end, and fetch new data from HNX2 at regular intervals. HNX2 uses a two-dimensional metadata structure called a mosaic for managing metadata of the rain products. Currently, HNX2 is in pre-production state and is serving near real-time rain-rate map data-products for individual radars and merged data-products from seven radars covering the state of Iowa in the United States. These products then drive a rainfall-runoff model called CUENCAS, which is used as part of the Iowa Flood Center (housed at The University of Iowa) real-time flood forecasting system. We are currently developing a generalized scalable framework that will run on inexpensive hardware and will provide products for basins anywhere in the continental United States.

Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up.

PubMed

Louwerse, Ilse; Huysmans, Maaike A; van Rijssen, H Jolanda; van der Beek, Allard J; Anema, Johannes R

2018-01-18

Today, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics. We performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility. Mental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders. The main diagnosis for persons entitled to disability benefits was mental health problems, especially for young women. In a five-year follow-up, claim duration for disability benefits was long lasting for most claimants.

Looking beyond borders: integrating best practices in benefit-risk analysis into the field of food and nutrition.

PubMed

Tijhuis, M J; Pohjola, M V; Gunnlaugsdóttir, H; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken-Schröder, G; Poto, M; Tuomisto, J T; Ueland, O; White, B C; Holm, F; Verhagen, H

2012-01-01

An integrated benefit-risk analysis aims to give guidance in decision situations where benefits do not clearly prevail over risks, and explicit weighing of benefits and risks is thus indicated. The BEPRARIBEAN project aims to advance benefit-risk analysis in the area of food and nutrition by learning from other fields. This paper constitutes the final stage of the project, in which commonalities and differences in benefit-risk analysis are identified between the Food and Nutrition field and other fields, namely Medicines, Food Microbiology, Environmental Health, Economics and Marketing-Finance, and Consumer Perception. From this, ways forward are characterized for benefit-risk analysis in Food and Nutrition. Integrated benefit-risk analysis in Food and Nutrition may advance in the following ways: Increased engagement and communication between assessors, managers, and stakeholders; more pragmatic problem-oriented framing of assessment; accepting some risk; pre- and post-market analysis; explicit communication of the assessment purpose, input and output; more human (dose-response) data and more efficient use of human data; segmenting populations based on physiology; explicit consideration of value judgments in assessment; integration of multiple benefits and risks from multiple domains; explicit recognition of the impact of consumer beliefs, opinions, views, perceptions, and attitudes on behaviour; and segmenting populations based on behaviour; the opportunities proposed here do not provide ultimate solutions; rather, they define a collection of issues to be taken account of in developing methods, tools, practices and policies, as well as refining the regulatory context, for benefit-risk analysis in Food and Nutrition and other fields. Thus, these opportunities will now need to be explored further and incorporated into benefit-risk practice and policy. If accepted, incorporation of these opportunities will also involve a paradigm shift in Food and Nutrition benefit-risk analysis towards conceiving the analysis as a process of creating shared knowledge among all stakeholders. Copyright © 2011 Elsevier Ltd. All rights reserved.

Clinical dysphagia risk predictors after prolonged orotracheal intubation

PubMed Central

de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; de Andrade, Claudia Regina Furquim

2014-01-01

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population. PMID:24473554

Exploring the Associations Among Nutrition, Science, and Mathematics Knowledge for an Integrative, Food-Based Curriculum.

PubMed

Stage, Virginia C; Kolasa, Kathryn M; Díaz, Sebastián R; Duffrin, Melani W

2018-01-01

Explore associations between nutrition, science, and mathematics knowledge to provide evidence that integrating food/nutrition education in the fourth-grade curriculum may support gains in academic knowledge. Secondary analysis of a quasi-experimental study. Sample included 438 students in 34 fourth-grade classrooms across North Carolina and Ohio; mean age 10 years old; gender (I = 53.2% female; C = 51.6% female). Dependent variable = post-test-nutrition knowledge; independent variables = baseline-nutrition knowledge, and post-test science and mathematics knowledge. Analyses included descriptive statistics and multiple linear regression. The hypothesized model predicted post-nutrition knowledge (F(437) = 149.4, p < .001; Adjusted R = .51). All independent variables were significant predictors with positive association. Science and mathematics knowledge were predictive of nutrition knowledge indicating use of an integrative science and mathematics curriculum to improve academic knowledge may also simultaneously improve nutrition knowledge among fourth-grade students. Teachers can benefit from integration by meeting multiple academic standards, efficiently using limited classroom time, and increasing nutrition education provided in the classroom. © 2018, American School Health Association.

Uncertainty assessment of PM2.5 contamination mapping using spatiotemporal sequential indicator simulations and multi-temporal monitoring data.

PubMed

Yang, Yong; Christakos, George; Huang, Wei; Lin, Chengda; Fu, Peihong; Mei, Yang

2016-04-12

Because of the rapid economic growth in China, many regions are subjected to severe particulate matter pollution. Thus, improving the methods of determining the spatiotemporal distribution and uncertainty of air pollution can provide considerable benefits when developing risk assessments and environmental policies. The uncertainty assessment methods currently in use include the sequential indicator simulation (SIS) and indicator kriging techniques. However, these methods cannot be employed to assess multi-temporal data. In this work, a spatiotemporal sequential indicator simulation (STSIS) based on a non-separable spatiotemporal semivariogram model was used to assimilate multi-temporal data in the mapping and uncertainty assessment of PM2.5 distributions in a contaminated atmosphere. PM2.5 concentrations recorded throughout 2014 in Shandong Province, China were used as the experimental dataset. Based on the number of STSIS procedures, we assessed various types of mapping uncertainties, including single-location uncertainties over one day and multiple days and multi-location uncertainties over one day and multiple days. A comparison of the STSIS technique with the SIS technique indicate that a better performance was obtained with the STSIS method.

The sedimentological characteristics and geochronology of the marshes of Dauphin Island, Alabama

USGS Publications Warehouse

Ellis, Alisha M.; Smith, Christopher G.; Marot, Marci E.

2018-03-22

In August 2015, scientists from the U.S. Geological Survey, St. Petersburg Coastal and Marine Science Center collected 11 push cores from the marshes of Dauphin Island and Little Dauphin Island, Alabama. Sample site environments included high marshes, low salt marshes, and salt flats, and varied in distance from the shoreline. The sampling efforts were part of a larger study to assess the feasibility and sustainability of proposed restoration efforts for Dauphin Island, Alabama, and to identify trends in shoreline erosion and accretion. The data presented in this publication can provide a basis for assessing organic and inorganic sediment accumulation rates and temporal changes in accumulation rates over multiple decades at multiple locations across the island. This study was funded by the National Fish and Wildlife Foundation, via the Gulf Environmental Benefit Fund. This report serves as an archive for the sedimentological and geochemical data derived from the marsh cores. Downloadable data are available and include Microsoft Excel spreadsheets (.xlsx), comma-separated values (.csv) text files, JPEG files, and formal Federal Geographic Data Committee metadata in a U.S. Geological Survey data release.

Tiered analytics for purity assessment of macrocyclic peptides in drug discovery: Analytical consideration and method development.

PubMed

Qian Cutrone, Jingfang Jenny; Huang, Xiaohua Stella; Kozlowski, Edward S; Bao, Ye; Wang, Yingzi; Poronsky, Christopher S; Drexler, Dieter M; Tymiak, Adrienne A

2017-05-10

Synthetic macrocyclic peptides with natural and unnatural amino acids have gained considerable attention from a number of pharmaceutical/biopharmaceutical companies in recent years as a promising approach to drug discovery, particularly for targets involving protein-protein or protein-peptide interactions. Analytical scientists charged with characterizing these leads face multiple challenges including dealing with a class of complex molecules with the potential for multiple isomers and variable charge states and no established standards for acceptable analytical characterization of materials used in drug discovery. In addition, due to the lack of intermediate purification during solid phase peptide synthesis, the final products usually contain a complex profile of impurities. In this paper, practical analytical strategies and methodologies were developed to address these challenges, including a tiered approach to assessing the purity of macrocyclic peptides at different stages of drug discovery. Our results also showed that successful progression and characterization of a new drug discovery modality benefited from active analytical engagement, focusing on fit-for-purpose analyses and leveraging a broad palette of analytical technologies and resources. Copyright © 2017. Published by Elsevier B.V.

Uncertainty assessment of PM2.5 contamination mapping using spatiotemporal sequential indicator simulations and multi-temporal monitoring data

NASA Astrophysics Data System (ADS)

Yang, Yong; Christakos, George; Huang, Wei; Lin, Chengda; Fu, Peihong; Mei, Yang

2016-04-01

Because of the rapid economic growth in China, many regions are subjected to severe particulate matter pollution. Thus, improving the methods of determining the spatiotemporal distribution and uncertainty of air pollution can provide considerable benefits when developing risk assessments and environmental policies. The uncertainty assessment methods currently in use include the sequential indicator simulation (SIS) and indicator kriging techniques. However, these methods cannot be employed to assess multi-temporal data. In this work, a spatiotemporal sequential indicator simulation (STSIS) based on a non-separable spatiotemporal semivariogram model was used to assimilate multi-temporal data in the mapping and uncertainty assessment of PM2.5 distributions in a contaminated atmosphere. PM2.5 concentrations recorded throughout 2014 in Shandong Province, China were used as the experimental dataset. Based on the number of STSIS procedures, we assessed various types of mapping uncertainties, including single-location uncertainties over one day and multiple days and multi-location uncertainties over one day and multiple days. A comparison of the STSIS technique with the SIS technique indicate that a better performance was obtained with the STSIS method.

Environmental Determinants of Chronic Disease and Medical Approaches: Recognition, Avoidance, Supportive Therapy, and Detoxification

PubMed Central

Sears, Margaret E.; Genuis, Stephen J.

2012-01-01

The World Health Organization warns that chronic, noncommunicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neurocognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bioaccumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives—biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Healthcare practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity. PMID:22315626

Clinical dysphagia risk predictors after prolonged orotracheal intubation.

PubMed

Medeiros, Gisele Chagas de; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; Andrade, Claudia Regina Furquim de

2014-01-01

To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

SCORPION persistent surveillance system with universal gateway

NASA Astrophysics Data System (ADS)

Coster, Michael; Chambers, Jon; Winters, Michael; Belesi, Joe

2008-04-01

This paper addresses benefits derived from the universal gateway utilized in Northrop Grumman Systems Corporation's (NGSC) SCORPION, a persistent surveillance and target recognition system produced by the Xetron campus in Cincinnati, Ohio. SCORPION is currently deployed in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). The SCORPION universal gateway is a flexible, field programmable system that provides integration of over forty Unattended Ground Sensor (UGS) types from a variety of manufacturers, multiple visible and thermal electro-optical (EO) imagers, and numerous long haul satellite and terrestrial communications links, including the Army Research Lab (ARL) Blue Radio. Xetron has been integrating best in class sensors with this universal gateway to provide encrypted data exfiltration and remote sensor command and control since 1998. SCORPION data can be distributed point to point, or to multiple Common Operational Picture (COP) systems, including Command and Control Personal Computer (C2PC), Common Data Interchange Format for the Situational Awareness Display (CDIF/SAD), Force XXI Battle Command Brigade and Below (FBCB2), Defense Common Ground Systems (DCGS), and Remote Automated Position Identification System (RAPIDS).

Exposure to Multiple Languages Enhances Communication Skills in Infancy

ERIC Educational Resources Information Center

Liberman, Zoe; Woodward, Amanda L.; Keysar, Boaz; Kinzler, Katherine D.

2017-01-01

Early exposure to multiple languages can enhance children's communication skills, even when children are effectively monolingual (Fan, Liberman, Keysar & Kinzler, 2015). Here we report evidence that the social benefits of multilingual exposure emerge in infancy. Sixteen-month-old infants participated in a communication task that required…

Multiple-Transportable Carbohydrate Effect on Long-Distance Triathlon Performance.

PubMed

Rowlands, David S; Houltham, Stuart D

2017-08-01

The ingestion of multiple (2:1 glucose-fructose) transportable carbohydrate in beverages at high rates (>78 g·h) during endurance exercise enhances exogenous carbohydrate oxidation, fluid absorption, gut comfort, and performance relative to glucose alone. However, during long-distance endurance competition, athletes prefer a solid-gel-drink format, and the effect size of multiple-transportable carbohydrate is unknown. This study aimed to determine the effect of multiple-transportable carbohydrate on triathlon competition performance when ingested within bars, gels, and drinks. A double-blind randomized controlled trial was conducted within two national-body sanctioned half-ironman triathlon races held 3 wk apart in 74 well-trained male triathletes (18-60 yr; >2 yr competition experience). Carbohydrate comprising glucose/maltodextrin-fructose (2:1 ratio) or standard isocaloric carbohydrate (glucose/maltodextrin only) was ingested before (94 g) and during the cycle (2.5 g·km) and run (7.8 g·km) sections, averaging 78.6 ± 6.6 g·h, partitioned to bars (25%), gels (35%), and drink (40%). Postrace, 0- to 10-unit Likert-type scales were completed to assess gut comfort and energy. The trial returned low dropout rate (9%), high compliance, and sensitivity (typical error 2.2%). The effect of multiple-transportable carbohydrate on performance time was -0.53% (95% confidence interval = -1.30% to 0.24%; small benefit threshold = -0.54%), with likelihood-based risk analysis supporting adoption (benefit-harm ratio = 48.9%:0.3%; odds ratio = 285:1). Covariate adjustments for preexercise body weight and heat stress had negligible impact performance. Multiple-transportable carbohydrate possibly lowered nausea during the swim and bike; otherwise, effects on gut comfort and perceived energy were negligible. Multiple-transportable (2:1 maltodextrin/glucose-fructose) compared with single-transportable carbohydrate ingested in differing format provided a small benefit to long-distance triathlon performance, inferred as adoption worthy. Large sample in-competition randomized trials offer ecological validity, high participant throughput, compliance, and sensitivity for evaluation of health and performance interventions in athletes.

Improving Clinical Trial Efficiency: Thinking outside the Box.

PubMed

Mandrekar, Sumithra J; Dahlberg, Suzanne E; Simon, Richard

2015-01-01

Clinical trial design strategies have evolved over the past few years as a means to accelerate the drug development process so that the right therapies can be delivered to the right patients. Basket, umbrella, and adaptive enrichment strategies represent a class of novel designs for testing targeted therapeutics in oncology. Umbrella trials include a central infrastructure for screening and identification of patients, and focus on a single tumor type or histology with multiple subtrials, each testing a targeted therapy within a molecularly defined subset. Basket trial designs offer the possibility to include multiple molecularly defined subpopulations, often across histology or tumor types, but included in one cohesive design to evaluate the targeted therapy in question. Adaptive enrichment designs offer the potential to enrich for patients with a particular molecular feature that is predictive of benefit for the test treatment based on accumulating evidence from the trial. This review will aim to discuss the fundamentals of these design strategies, the underlying statistical framework, the logistical barriers of implementation, and, ultimately, the interpretation of the trial results. New statistical approaches, extensive multidisciplinary collaboration, and state of the art data capture technologies are needed to implement these strategies in practice. Logistical challenges to implementation arising from centralized assay testing, requirement of multiple specimens, multidisciplinary collaboration, and infrastructure requirements will also be discussed. This review will present these concepts in the context of the National Cancer Institute's precision medicine initiative trials: MATCH, ALCHEMIST, Lung MAP, as well as other trials such as FOCUS4.

Analysis of the uncertainty in the monetary valuation of ecosystem services--A case study at the river basin scale.

PubMed

Boithias, Laurie; Terrado, Marta; Corominas, Lluís; Ziv, Guy; Kumar, Vikas; Marqués, Montse; Schuhmacher, Marta; Acuña, Vicenç

2016-02-01

Ecosystem services provide multiple benefits to human wellbeing and are increasingly considered by policy-makers in environmental management. However, the uncertainty related with the monetary valuation of these benefits is not yet adequately defined or integrated by policy-makers. Given this background, our aim was to quantify different sources of uncertainty when performing monetary valuation of ecosystem services, in order to provide a series of guidelines to reduce them. With an example of 4 ecosystem services (i.e., water provisioning, waste treatment, erosion protection, and habitat for species) provided at the river basin scale, we quantified the uncertainty associated with the following sources: (1) the number of services considered, (2) the number of benefits considered for each service, (3) the valuation metrics (i.e. valuation methods) used to value benefits, and (4) the uncertainty of the parameters included in the valuation metrics. Results indicate that the highest uncertainty was caused by the number of services considered, as well as by the number of benefits considered for each service, whereas the parametric uncertainty was similar to the one related to the selection of valuation metric, thus suggesting that the parametric uncertainty, which is the only uncertainty type commonly considered, was less critical than the structural uncertainty, which is in turn mainly dependent on the decision-making context. Given the uncertainty associated to the valuation structure, special attention should be given to the selection of services, benefits and metrics according to a given context. Copyright © 2015 Elsevier B.V. All rights reserved.

Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis

PubMed Central

Schwendicke, Falk; Göstemeyer, Gerd

2017-01-01

Objectives Single-visit root canal treatment has some advantages over conventional multivisit treatment, but might increase the risk of complications. We systematically evaluated the risk of complications after single-visit or multiple-visit root canal treatment using meta-analysis and trial-sequential analysis. Data Controlled trials comparing single-visit versus multiple-visit root canal treatment of permanent teeth were included. Trials needed to assess the risk of long-term complications (pain, infection, new/persisting/increasing periapical lesions ≥1 year after treatment), short-term pain or flare-up (acute exacerbation of initiation or continuation of root canal treatment). Sources Electronic databases (PubMed, EMBASE, Cochrane Central) were screened, random-effects meta-analyses performed and trial-sequential analysis used to control for risk of random errors. Evidence was graded according to GRADE. Study selection 29 trials (4341 patients) were included, all but 6 showing high risk of bias. Based on 10 trials (1257 teeth), risk of complications was not significantly different in single-visit versus multiple-visit treatment (risk ratio (RR) 1.00 (95% CI 0.75 to 1.35); weak evidence). Based on 20 studies (3008 teeth), risk of pain did not significantly differ between treatments (RR 0.99 (95% CI 0.76 to 1.30); moderate evidence). Risk of flare-up was recorded by 8 studies (1110 teeth) and was significantly higher after single-visit versus multiple-visit treatment (RR 2.13 (95% CI 1.16 to 3.89); very weak evidence). Trial-sequential analysis revealed that firm evidence for benefit, harm or futility was not reached for any of the outcomes. Conclusions There is insufficient evidence to rule out whether important differences between both strategies exist. Clinical significance Dentists can provide root canal treatment in 1 or multiple visits. Given the possibly increased risk of flare-ups, multiple-visit treatment might be preferred for certain teeth (eg, those with periapical lesions). PMID:28148534

Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women’s Experiences

PubMed Central

Browall, Maria; Mijwel, Sara; Rundqvist, Helen; Wengström, Yvonne

2016-01-01

Background: In oncology, physical activity (PA) is recognized to improve psychological and physiological functions. Motivating women with breast cancer to sustain a physically active lifestyle is important for promoting positive health after diagnosis. To review and synthesize what is known about how women with breast cancer experience supervised and unsupervised PA during and after adjuvant treatment. PubMed, PsycINFO, and CINAHL were searched, yielding 994 citations. The final review included 17 articles published between 2004 and 2014 in English. The CASP (Critical Appraisal Skills Programme) instrument was used to appraise quality. Results: Exercise is experienced as a positive element with multiple benefits. However, maintaining a physically active lifestyle during and after chemotherapy is sometimes challenging. Reported benefits of PA include feeling empowered, and improving and reclaiming health. Facilitators to PA comprised exercising with peers and skilled instructors. Barriers included social factors and lack of information. Conclusions: Findings highlight the importance of incorporating PA programs from a patient experience perspective as routine treatment. Health care professionals play a crucial “gateway” role in providing information on implementation and benefits of PA. Providing support and educated advice about how to safely start or continue regular PA to minimize symptoms, reduce morbidity, and increase well-being during or after treatment is vital for women with breast cancer. Implications for Practice: Health care professionals need increased knowledge of the breast cancer patients’ perspectives on facilitators and barriers to PA during and after treatment, in order to provide sufficient support for women to stay physically active during a breast cancer illness. PMID:28008778

A multiple biomarker risk score for guiding clinical decisions using a decision curve approach.

PubMed

Hughes, Maria F; Saarela, Olli; Blankenberg, Stefan; Zeller, Tanja; Havulinna, Aki S; Kuulasmaa, Kari; Yarnell, John; Schnabel, Renate B; Tiret, Laurence; Salomaa, Veikko; Evans, Alun; Kee, Frank

2012-08-01

We assessed whether a cardiovascular risk model based on classic risk factors (e.g. cholesterol, blood pressure) could refine disease prediction if it included novel biomarkers (C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin I) using a decision curve approach which can incorporate clinical consequences. We evaluated whether a model including biomarkers and classic risk factors could improve prediction of 10 year risk of cardiovascular disease (CVD; chronic heart disease and ischaemic stroke) against a classic risk factor model using a decision curve approach in two prospective MORGAM cohorts. This included 7739 men and women with 457 CVD cases from the FINRISK97 cohort; and 2524 men with 259 CVD cases from PRIME Belfast. The biomarker model improved disease prediction in FINRISK across the high-risk group (20-40%) but not in the intermediate risk group, at the 23% risk threshold net benefit was 0.0033 (95% CI 0.0013-0.0052). However, in PRIME Belfast the net benefit of decisions guided by the decision curve was improved across intermediate risk thresholds (10-20%). At p(t) = 10% in PRIME, the net benefit was 0.0059 (95% CI 0.0007-0.0112) with a net increase in 6 true positive cases per 1000 people screened and net decrease of 53 false positive cases per 1000 potentially leading to 5% fewer treatments in patients not destined for an event. The biomarker model improves 10-year CVD prediction at intermediate and high-risk thresholds and in particular, could be clinically useful at advising middle-aged European males of their CVD risk.

Social capital as a key determinant of perceived benefits of community-based marine protected areas.

PubMed

Diedrich, Amy; Stoeckl, Natalie; Gurney, Georgina G; Esparon, Michelle; Pollnac, Richard

2017-04-01

Globally, marine protected areas (MPAs) have been relatively unsuccessful in meeting biodiversity objectives. To be effective, they require some alteration of people's use and access to marine resources, which they will resist if they do not perceive associated benefits. Stakeholders' support is crucial to ecological success of MPAs, and their support is likely to depend on their capacity to adapt to and benefit from MPAs. We examined the influence of social adaptive capacity (SAC) on perceived benefits of MPAs in Siquijor, Philippines, in the Coral Triangle. This region has substantial biodiversity and a population of over 120 million people, many of them dependent on marine resources for food and income. The region has many MPAs, most of which are managed under decentralized governance systems. We collected survey data from 540 households in 19 villages with associated MPAs. We evaluated the influence of multiple SAC variables (e.g., occupational multiplicity and social capital) on perceived benefits with decision trees (CHAID) and qualitatively analyzed this relationship with respect to types and recipients of benefits. Our models revealed the key role of social capital, particularly trust in leadership, in influencing perceptions of benefits (χ 2 = 14.762, p = 0.000). A path analysis revealed that perceptions of distributional equity were a key mechanism through which social capital affected perceived MPA benefits (root mean-square error of approximation = 0.050). Building social capital and equity within communities could lead to more effective management of MPAs and thus to expenditure of fewer resources relative to, for example, regulation enforcement. © 2016 Society for Conservation Biology.

MicrobeWorld Radio and Communications Initiative

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

Barbara Hyde

2006-11-22

MicrobeWorld is a 90-second feature broadcast daily on more than 90 public radio stations and available from several sources as a podcast, including www.microbeworld.org. The feature has a strong focus on the use and adapatbility of microbes as alternative sources of energy, in bioremediation, their role in climate, and especially the many benefits and scientific advances that have resulting from decoding microbial genomes. These audio features are permanantly archived on an educational outreach site, microbeworld.org, where they are linked to the National Science Education Standards. They are also being used by instructors at all levels to introduce students to themore » multiple roles and potential of microbes, including a pilot curriculum program for middle-school students in New York.« less

Multiple mating and its relationship to brood size in pregnant fishes versus pregnant mammals and other viviparous vertebrates

PubMed Central

Avise, John C.; Liu, Jin-Xian

2011-01-01

We summarize the literature on rates of multiple paternity and sire numbers per clutch in viviparous fishes vs. mammals, two vertebrate groups in which pregnancy is common but entails very different numbers of embryos (for species surveyed, piscine broods averaged >10-fold larger than mammalian litters). As deduced from genetic parentage analyses, multiple mating by the pregnant sex proved to be common in assayed species but averaged significantly higher in fish than mammals. However, within either of these groups we found no significant correlations between brood size and genetically deduced incidence of multiple mating by females. Overall, these findings offer little support for the hypothesis that clutch size in pregnant species predicts the outcome of selection for multiple mating by brooders. Instead, whatever factors promote multiple mating by members of the gestating sex seem to do so in surprisingly similar ways in live-bearing vertebrates otherwise as different as fish and mammals. Similar conclusions emerged when we extended the survey to viviparous amphibians and reptiles. One notion consistent with these empirical observations is that although several fitness benefits probably accrue from multiple mating, logistical constraints on mate-encounter rates routinely truncate multiple mating far below levels that otherwise could be accommodated, especially in species with larger broods. We develop this concept into a “logistical constraint hypothesis” that may help to explain these mating outcomes in viviparous vertebrates. Under the logistical constraint hypothesis, propensities for multiple mating in each species register a balance between near-universal fitness benefits from multiple mating and species-idiosyncratic logistical limits on polygamy. PMID:21482777

Enhancing CIDOC-CRM and compatible models with the concept of multiple interpretation

NASA Astrophysics Data System (ADS)

Van Ruymbeke, M.; Hallot, P.; Billen, R.

2017-08-01

Modelling cultural heritage and archaeological objects is used as much for management as for research purposes. To ensure the sustainable benefit of digital data, models benefit from taking the data specificities of historical and archaeological domains into account. Starting from a conceptual model tailored to storing these specificities, we present, in this paper, an extended mapping to CIDOC-CRM and its compatible models. Offering an ideal framework to structure and highlight the best modelling practices, these ontologies are essentially dedicated to storing semantic data which provides information about cultural heritage objects. Based on this standard, our proposal focuses on multiple interpretation and sequential reality.

Unlocking Flexibility: Integrated Optimization and Control of Multienergy Systems

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

Dall'Anese, Emiliano; Mancarella, Pierluigi; Monti, Antonello

Electricity, natural gas, water, and dis trict heating/cooling systems are predominantly planned and operated independently. However, it is increasingly recognized that integrated optimization and control of such systems at multiple spatiotemporal scales can bring significant socioeconomic, operational efficiency, and environmental benefits. Accordingly, the concept of the multi-energy system is gaining considerable attention, with the overarching objectives of 1) uncovering fundamental gains (and potential drawbacks) that emerge from the integrated operation of multiple systems and 2) developing holistic yet computationally affordable optimization and control methods that maximize operational benefits, while 3) acknowledging intrinsic interdependencies and quality-of-service requirements for each provider.

Climate mitigation is not the only benefit of a national energy system

NASA Astrophysics Data System (ADS)

Clack, C.

2016-12-01

Many speculate that the main driving force for a continental scale energy system is for climate mitigation. While this is a strong driver, there are multiple co-benefits that emerge from such a transition when purely driven by costs. These components could be managed within a planned system to provide a close-to-optimal solution that enhances the probability of realization. It is shown that these co-benefits of a continental scale electric system occur at costs lower than existing ones. That means there are multiple additional savings without extra costs or effort. The disadvantage is coordination between large geographic regions that could cause more complexity in planning. The main finding from different versions of the NEWS simulator is that carbon mitigation is enhanced by larger systems. In addition, there are increased jobs, reduced water consumption, Sulphur dioxide emissions, Nitrogen oxide emissions, a more distributed electric system and a lower cost of electricity.

The evolution of sex differences in mate searching when females benefit: new theory and a comparative test.

PubMed

McCartney, J; Kokko, H; Heller, K-G; Gwynne, D T

2012-03-22

Sexual selection is thought to have led to searching as a profitable, but risky way of males obtaining mates. While there is great variation in which sex searches, previous theory has not considered search evolution when both males and females benefit from multiple mating. We present new theory and link it with data to bridge this gap. Two different search protocols exist between species in the bush-cricket genus Poecilimon (Orthoptera): females search for calling males, or males search for calling females. Poecilimon males also transfer a costly nuptial food gift to their mates during mating. We relate variations in searching protocols to variation in nuptial gift size among 32 Poecilimon taxa. As predicted, taxa where females search produce significantly larger nuptial gifts than those where males search. Our model and results show that search roles can reverse when multiple mating brings about sufficiently strong material benefits to females.

Including safety-net providers in integrated delivery systems: issues and options for policymakers.

PubMed

Witgert, Katherine; Hess, Catherine

2012-08-01

Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals--which have long experience in caring for these vulnerable populations--will be included in integrated delivery systems. This issue brief explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in sup­porting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: (1) an emphasis on primary care; (2) coordination of all care, including behavioral, social, and public health services; and (3) accountability for population health outcomes.

Developing a Problem-Based Learning Simulation: An Economics Unit on Trade

ERIC Educational Resources Information Center

Maxwell, Nan L.; Mergendoller, John R.; Bellisimo, Yolanda

2004-01-01

This article argues that the merger of simulations and problem-based learning (PBL) can enhance both active-learning strategies. Simulations benefit by using a PBL framework to promote student-directed learning and problem-solving skills to explain a simulated dilemma with multiple solutions. PBL benefits because simulations structure the…

Critical Evaluation of Internet Resources for Teaching Trend and Variability in Bivariate Data

ERIC Educational Resources Information Center

Forster, Pat

2007-01-01

A search on the Internet for resources for teaching statistics yields multiple sites with data sets, projects, worksheets, applets, and software. Often these are made available without information on how they might benefit learning. This paper addresses potential benefits from resources that target trend and variability relationships in bivariate…

Using Translation Exercises in the Communicative EFL Writing Classroom

ERIC Educational Resources Information Center

Kim, Eun-Young

2011-01-01

Implementing process pedagogy in an L2 writing classroom has its own limits for students with low English proficiency. Although L1 writers commonly benefit from writing multiple drafts, most of the low English level Korean college students in my English composition class did not benefit from the revisions. This article introduces an innovative…

How a MUN Experience Meshes with the Liberal Arts and Management Education

ERIC Educational Resources Information Center

Lampton, Jolene A.

2011-01-01

This paper documents the multiplicative benefits from an experiential extracurricular activity--i.e., participation in a Model United Nations (MUN) Club. Management instructors are encouraged to sponsor such activities to give leadership training to students. The benefits are especially rich in liberal-arts institutions, like Park University,…

A targeted conservation approach for improving environmental quality: Multiple benefits and expanded opportunities

USDA-ARS?s Scientific Manuscript database

We all benefit from maintaining the quality of our water supplies, the productivity of our soils, and the quality of our outdoors for recreation. In areas of the country where agriculture is a key industry, sustaining these resources requires that we maintain healthy working landscapes and vibrant a...

Introducing Whole-Systems Design to First-Year Engineering Students with Case Studies

ERIC Educational Resources Information Center

Blizzard, Jackie; Klotz, Leidy; Pradhan, Alok; Dukes, Michael

2012-01-01

Purpose: A whole-systems approach, which seeks to optimize an entire system for multiple benefits, not isolated components for single benefits, is essential to engineering design for radically improved sustainability performance. Based on real-world applications of whole-systems design, the Rocky Mountain Institute (RMI) is developing educational…

The Invisible Student: Benefits and Challenges of Part-Time Doctoral Studies

ERIC Educational Resources Information Center

Bates, Peter; Goff, Lori

2012-01-01

This autoethnographic study explores the experiences of two part-time doctoral students as we document our journey of balancing our multiple competing roles. As we reflected and consulted the literature, we began to identify many benefits and challenges that part-time candidature brings to students, universities and employers. Through our…

Institutionalizing urban forestry as a "biotechnology" to improve environmental quality

Treesearch

David J. Nowak

2006-01-01

Urban forests can provide multiple environmental benefits. As urban areas expand, the role of urban vegetation in improving environmental quality will increase in importance. Quantification of these benefits has revealed that urban forests can significantly improve air quality. As a result, national air quality regulations are now willing to potentially credit tree...

Land-use planning for nearshore ecosystem services—the Puget Sound Ecosystem Portfolio Model

USGS Publications Warehouse

Byrd, Kristin

2011-01-01

The 2,500 miles of shoreline and nearshore areas of Puget Sound, Washington, provide multiple benefits to people—"ecosystem services"—including important fishing, shellfishing, and recreation industries. To help resource managers plan for expected growth in coming decades, the U.S. Geological Survey Western Geographic Science Center has developed the Puget Sound Ecosystem Portfolio Model (PSEPM). Scenarios of urban growth and shoreline modifications serve as model inputs to develop alternative futures of important nearshore features such as water quality and beach habitats. Model results will support regional long-term planning decisions for the Puget Sound region.

The economic value of remote sensing of earth resources from space: An ERTS overview and the value of continuity of service. Volume 4: Forestry, wildlife and rangeland

NASA Technical Reports Server (NTRS)

Andrews, J.; Stevenson, P.

1974-01-01

The economic value of ERS information in the resource management area of extensive use of living resources, forestry, wildlife, and rangeland, is determined. Timber and forage resources are quantitatively evaluated. It is shown that these resources have economic value in the tens of billions of dollars, but the economic benefits of improved management of the forests and rangelands are not limited to efficiency in the production of these commercial resources. Multiple-use values including watershed, wildlife, and recreation are also involved.

Polymer Chemistry

NASA Technical Reports Server (NTRS)

Williams, Martha; Roberson, Luke; Caraccio, Anne

2010-01-01

This viewgraph presentation describes new technologies in polymer and material chemistry that benefits NASA programs and missions. The topics include: 1) What are Polymers?; 2) History of Polymer Chemistry; 3) Composites/Materials Development at KSC; 4) Why Wiring; 5) Next Generation Wiring Materials; 6) Wire System Materials and Integration; 7) Self-Healing Wire Repair; 8) Smart Wiring Summary; 9) Fire and Polymers; 10) Aerogel Technology; 11) Aerogel Composites; 12) Aerogels for Oil Remediation; 13) KSC's Solution; 14) Chemochromic Hydrogen Sensors; 15) STS-130 and 131 Operations; 16) HyperPigment; 17) Antimicrobial Materials; 18) Conductive Inks Formulations for Multiple Applications; and 19) Testing and Processing Equipment.

Maternal abetalipoproteinemia resulting in multiple fetal anomalies.

PubMed

Seckeler, Michael D; Linden, Jennifer

2008-01-01

Abetalipoproteinemia is a rare genetic condition that results in an inability of the body to absorb dietary fats, including fat-soluble vitamins. Deficiencies of these vitamins are known to cause a wide range of clinical effects ranging from blindness to coagulopathy and neuropathy. We present the case of a child with multisystem anomalies born to a mother with abetalipoproteinemia and provide a brief review of the literature about vitamin A and fetal development. Mothers at high risk for vitamin deficiencies should be screened and counseled on the potential benefits, and risks, of vitamin supplementation. Copyright 2008 S. Karger AG, Basel.

The X-33 Extended Flight Test Range

NASA Technical Reports Server (NTRS)

Mackall, Dale A.; Sakahara, Robert; Kremer, Steven E.

1998-01-01

Development of an extended test range, with range instrumentation providing continuous vehicle communications, is required to flight-test the X-33, a scaled version of a reusable launch vehicle. The extended test range provides vehicle communications coverage from California to landing at Montana or Utah. This paper provides an overview of the approaches used to meet X-33 program requirements, including using multiple ground stations, and methods to reduce problems caused by reentry plasma radio frequency blackout. The advances used to develop the extended test range show other hypersonic and access-to-space programs can benefit from the development of the extended test range.

Results of the 2016 AORN Salary and Compensation Survey.

PubMed

Bacon, Donald R; Stewart, Kim A

2016-12-01

AORN conducted its 14th annual compensation survey for perioperative nurses in June 2016. A multiple regression model was used to examine how several variables, including job title, education level, certification, experience, and geographic region, affect nurse compensation. Comparisons between the 2016 data and data from previous years are presented. The effects of other forms of compensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on base compensation rates also are examined. Additional analyses explore the effect of the economic downturn on the perioperative work environment. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Results of the 2017 AORN Salary and Compensation Survey.

PubMed

Bacon, Donald R; Stewart, Kim A

2017-12-01

AORN conducted its 15th annual compensation survey for perioperative nurses in June 2017. A multiple regression model was used to examine how several variables, including job title, educational level, certification, experience, and geographic region, affect nurse compensation. Comparisons between the 2017 data and data from previous years are presented. The effects of other forms of compensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on base compensation rates are examined. Additional analyses explore the current state of the nursing shortage and the sources of job satisfaction and dissatisfaction. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

A therapeutic skating intervention for children with autism spectrum disorder.

PubMed

Casey, Amanda Faith; Quenneville-Himbeault, Gabriel; Normore, Alexa; Davis, Hanna; Martell, Stephen G

2015-01-01

The purpose of this study was to evaluate the effects of a highly structured therapeutic skating intervention on motor outcomes and functional capacity in 2 boys with autism spectrum disorder aged 7 and 10 years. This multiple-baseline, single-subject study assigned participants to three 1-hour skating sessions per week for 12 weeks focusing on skill and motor development. Multiple data points assessed (a) fidelity to the intervention and (b) outcomes measures including the Pediatric Balance Scale, Timed Up and Go, floor to stand, Six-Minute Walk Test, goal attainment, and weekly on-ice testing. Improvements were found in balance, motor behavior, and functional capacity by posttest with gains remaining above pretest levels at follow-up. Therapeutic skating may produce physical benefits for children with autism spectrum disorder and offer a viable, inexpensive community-based alternative to other forms of physical activity.

Effects of Type and Strength of Force Feedback on Movement Time in a Target Selection Task

NASA Technical Reports Server (NTRS)

Rorie, Robert Conrad; Vu, Kim-Phuong L.; Marayong, Panadda; Robles, Jose; Strybel, Thomas Z.; Battiste, Vernol

2013-01-01

Future cockpits will likely include new onboard technologies, such as cockpit displays of traffic information, to help support future flight deck roles and responsibilities. These new technologies may benefit from multimodal feedback to aid pilot information processing. The current study investigated the effects of multiple levels of force feedback on operator performance in an aviation task. Participants were presented with two different types of force feedback (gravitational and spring force feedback) for a discrete targeting task, with multiple levels of gain examined for each force feedback type. Approach time and time in target were recorded. Results suggested that the two highest levels of gravitational force significantly reduced approach times relative to the lowest level of gravitational force. Spring force level only affected time in target. Implications of these findings for the design of future cockpit displays will be discussed.

Metabolic Features of Multiple Myeloma.

PubMed

El Arfani, Chaima; De Veirman, Kim; Maes, Ken; De Bruyne, Elke; Menu, Eline

2018-04-14

Cancer is known for its cellular changes contributing to tumour growth and cell proliferation. As part of these changes, metabolic rearrangements are identified in several cancers, including multiple myeloma (MM), which is a condition whereby malignant plasma cells accumulate in the bone marrow (BM). These metabolic changes consist of generation, inhibition and accumulation of metabolites and metabolic shifts in MM cells. Changes in the BM micro-environment could be the reason for such adjustments. Enhancement of glycolysis and glutaminolysis is found in MM cells compared to healthy cells. Metabolites and enzymes can be upregulated or downregulated and play a crucial role in drug resistance. Therefore, this review will focus on changes in glucose and glutamine metabolism linked with the emergence of drug resistance. Moreover, metabolites do not only affect other metabolic components to benefit cancer development; they also interfere with transcription factors involved in proliferation and apoptotic regulation.

The role of insulin pump therapy for type 2 diabetes mellitus.

PubMed

Landau, Zohar; Raz, Itamar; Wainstein, Julio; Bar-Dayan, Yosefa; Cahn, Avivit

2017-01-01

Many patients with type 2 diabetes fail to achieve adequate glucose control despite escalation of treatment and combinations of multiple therapies including insulin. Patients with long-standing type 2 diabetes often suffer from the combination of severe insulin deficiency in addition to insulin resistance, thereby requiring high doses of insulin delivered in multiple injections to attain adequate glycemic control. Insulin-pump therapy was first introduced in the 1970s as an approach to mimic physiological insulin delivery and attain normal glucose in patients with type 1 diabetes. The recent years have seen an increase in the use of this technology for patients with type 2 diabetes. This article summarizes the clinical studies evaluating insulin pump use in patients with type 2 diabetes and discusses the benefits and shortcomings of pump therapy in this population. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Viewing the functional consequences of traumatic brain injury by using brain SPECT.

PubMed

Pavel, D; Jobe, T; Devore-Best, S; Davis, G; Epstein, P; Sinha, S; Kohn, R; Craita, I; Liu, P; Chang, Y

2006-03-01

High-resolution brain SPECT is increasingly benefiting from improved image processing software and multiple complementary display capabilities. This enables detailed functional mapping of the disturbances in relative perfusion occurring after TBI. The patient population consisted of 26 cases (ages 8-61 years)between 3 months and 6 years after traumatic brain injury.A very strong case can be made for the routine use of Brain SPECT in TBI. Indeed it can provide a detailed evaluation of multiple functional consequences after TBI and is thus capable of supplementing the clinical evaluation and tailoring the therapeutic strategies needed. In so doing it also provides significant additional information beyond that available from MRI/CT. The critical factor for Brain SPECT's clinical relevance is a carefully designed technical protocol, including displays which should enable a comprehensive description of the patterns found, in a user friendly mode.

Restarting and recentering genetic algorithm variations for DNA fragment assembly: The necessity of a multi-strategy approach.

PubMed

Hughes, James Alexander; Houghten, Sheridan; Ashlock, Daniel

2016-12-01

DNA Fragment assembly - an NP-Hard problem - is one of the major steps in of DNA sequencing. Multiple strategies have been used for this problem, including greedy graph-based algorithms, deBruijn graphs, and the overlap-layout-consensus approach. This study focuses on the overlap-layout-consensus approach. Heuristics and computational intelligence methods are combined to exploit their respective benefits. These algorithm combinations were able to produce high quality results surpassing the best results obtained by a number of competitive algorithms specially designed and tuned for this problem on thirteen of sixteen popular benchmarks. This work also reinforces the necessity of using multiple search strategies as it is clearly observed that algorithm performance is dependent on problem instance; without a deeper look into many searches, top solutions could be missed entirely. Copyright © 2016. Published by Elsevier Ireland Ltd.

Natural products as modulator of autophagy with potential clinical prospects.

PubMed

Wang, Peiqi; Zhu, Lingjuan; Sun, Dejuan; Gan, Feihong; Gao, Suyu; Yin, Yuanyuan; Chen, Lixia

2017-03-01

Natural compounds derived from living organisms are well defined for their remarkable biological and pharmacological properties likely to be translated into clinical use. Therefore, delving into the mechanisms by which natural compounds protect against diverse diseases may be of great therapeutic benefits for medical practice. Autophagy, an intricate lysosome-dependent digestion process, with implications in a wide variety of pathophysiological settings, has attracted extensive attention over the past few decades. Hitherto, accumulating evidence has revealed that a large number of natural products are involved in autophagy modulation, either inducing or inhibiting autophagy, through multiple signaling pathways and transcriptional regulators. In this review, we summarize natural compounds regulating autophagy in multifarious diseases including cancer, neurodegenerative diseases, cardiovascular diseases, metabolic diseases, and immune diseases, hoping to inspire further investigation of the underlying mechanisms of natural compounds and to facilitate their clinical use for multiple human diseases.

The use of lisuride in the treatment of multiple system atrophy with autonomic failure (Shy-Drager syndrome).

PubMed Central

Lees, A J; Bannister, R

1981-01-01

In a controlled trial lisuride, an ergolene derivative with dopamine receptor agonist properties was given maximum tolerated doses (2.4 mg/day) to seven patients with multiple system atrophy with autonomic failure (Shy-Drager syndrome). Improvement in Parkinsonian features occurred in only one patient and another patient who had been deriving marked benefit from levodopa treatment before the study began failed to respond to large doses of lisuride. Psychiatric side effects (including nightmares, isolated visual hallucinations and toxic confusional states) were the dose-limiting factor in six patients. A modest reduction in orthostatic hypotension occurred in two patients, one of whom had experienced an aggravation of this disturbance on levodopa and bromocriptine. Destruction of post-synaptic dopamine receptors and damage to central noradrenergic systems may offer an explanation for the lack of therapeutic effect of lisuride. PMID:7241162

Characterizing Effects and Benefits of Beam Defocus on High Energy Laser Performance Under Thermal Blooming and Turbulence Conditions for Air-to-Ground Engagements

DTIC Science & Technology

2008-04-29

Multiple aperture laser systems for thermal blooming environments,” Applied Optics, Vol. 22, No. 21 (1 November 1983), pp. 3366-3370. 42. Siegman ...CHARACTERIZING EFFECTS AND BENEFITS OF BEAM DEFOCUS ON HIGH ENERGY LASER PERFORMANCE UNDER THERMAL BLOOMING AND TURBULENCE CONDITIONS FOR AIR...States Government. AFIT / DS / ENS / 08-05 CHARACTERIZING EFFECTS AND BENEFITS OF BEAM DEFOCUS ON HIGH ENERGY LASER PERFORMANCE UNDER THERMAL

Enhanced entrainability of genetic oscillators by period mismatch

PubMed Central

Hasegawa, Yoshihiko; Arita, Masanori

2013-01-01

Biological oscillators coordinate individual cellular components so that they function coherently and collectively. They are typically composed of multiple feedback loops, and period mismatch is unavoidable in biological implementations. We investigated the advantageous effect of this period mismatch in terms of a synchronization response to external stimuli. Specifically, we considered two fundamental models of genetic circuits: smooth and relaxation oscillators. Using phase reduction and Floquet multipliers, we numerically analysed their entrainability under different coupling strengths and period ratios. We found that a period mismatch induces better entrainment in both types of oscillator; the enhancement occurs in the vicinity of the bifurcation on their limit cycles. In the smooth oscillator, the optimal period ratio for the enhancement coincides with the experimentally observed ratio, which suggests biological exploitation of the period mismatch. Although the origin of multiple feedback loops is often explained as a passive mechanism to ensure robustness against perturbation, we study the active benefits of the period mismatch, which include increasing the efficiency of the genetic oscillators. Our findings show a qualitatively different perspective for both the inherent advantages of multiple loops and their essentiality. PMID:23389900

Palatability and oral cavity tolerability of THC:CBD oromucosal spray and possible improvement measures in multiple sclerosis patients with resistant spasticity: a pilot study.

PubMed

Lus, Giacomo; Cantello, Roberto; Danni, Maura Chiara; Rini, Agusto; Sarchielli, Paola; Tassinari, Tiziana; Signoriello, Elisabetta

2018-04-01

Complaints about Δ 9 -tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray (Sativex ® ; GW Pharma Ltd, Salisbury, UK) in the management of multiple sclerosis spasticity include unpleasant taste and oral mucosal anomalies. This pilot study assessed the use of sugar-free chewing gum and/or a refrigerated bottle of THC:CBD oromucosal spray to mitigate these effects. Patients with multiple sclerosis spasticity (n = 52) at six sites in Italy who were receiving THC:CBD oromucosal spray and had associated oral mucosal effects were randomized into Group A (chewing gum; n = 15); Group B (cold bottle; n = 20); and Group C (cold bottle + chewing gum; n = 17). Taste perception in patients receiving chewing gum ± cold bottle intervention (Groups A and C combined) was significantly (p = 0.0001) improved from baseline to week 4 while maintaining spasticity control. Patient comfort, satisfaction and treatment adherence may benefit from these interventions.

Multiple function benefit - cost comparison of conservation buffer placement strategies

Treesearch

Z. Qiu; M.G. Dosskey

2012-01-01

Conservation buffers are considered to be effective practices for repairing impaired streams and restoring multiple ecosystem functions in degraded agricultural watersheds. Six different planning strategies for targeting their placement within watersheds were compared in terms of cost-effectiveness for environmental improvement in the 144 km² Neshanic River...

36 CFR 219.28 - Determination of land suitable for timber harvest.

Code of Federal Regulations, 2010 CFR

2010-07-01

... conditions and ecological sustainability, and is necessary to protect multiple-use values other than timber... justified by the ecological, social, or economic benefits considering physical, economic, and other... revision of the plan. (c) Lands where timber may be harvested for other multiple-use values. Except for...

An Explanation for the Use of Arrays to Promote the Understanding of Mental Strategies for Multiplication

ERIC Educational Resources Information Center

Day, Lorraine; Hurrell, Derek

2015-01-01

Lorraine Day and Derek Hurrell provide a convincing argument for using arrays to promote students' understandings of mental computation strategies for multiplication. They also provide a range of different examples that illustrate the benefits of arrays in the primary classroom.

Yoga research review.

PubMed

Field, Tiffany

2016-08-01

This paper is a review of empirical studies, review and meta-analysis publications on yoga from the last few years. The review includes demographics/prevalence of yoga as a practice, bibliometric analyses of the yoga publications and the use of yoga for physical fitness and cognitive function. Most of the studies reviewed here involve yoga effects on psychiatric and medical conditions. These include pregnancy, prenatal and postpartum depression; stress, PTSD, anxiety, and obesity; cardiovascular conditions including hypertension; pain syndromes including arthritis, headaches and low back pain; autoimmune conditions including asthma, type II diabetes and multiple sclerosis; immune conditions including HIV and breast cancer; and aging problems including balance, osteoporosis and Parkinson's. The methods and results of those studies are briefly summarized along with their limitations and suggestions for future research. Basically yoga has been more effective than control and waitlist control conditions, although not always more effective than treatment comparison groups such as other forms of exercise. More randomized controlled studies are needed in which yoga is compared to active exercise groups. Having established the physical and mental health benefits of yoga makes it ethically questionable to assign participants to inactive control groups. Shorter sessions should be investigated for cost-effectiveness and for daily practice. Multiple physical and physiological measures need to be added to the self-report research protocols and potential underlying mechanisms need to be further explored. In the interim, the studies reviewed here highlight the therapeutic effects of yoga, a practice that could come to be called yoga therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Multiple-etalon systems for the Advanced Technology Solar Telescope

NASA Technical Reports Server (NTRS)

Gary, G. Allen; Balasubramaniam, K. S.; Sigwarth, Michael

2003-01-01

Multiple etalon systems are discussed that meet the science requirements for a narrow-passband imaging system for the 4-meter National Solar Observatory (NSO)/Advance Technology Solar Telescope (ATST). A multiple etalon system can provide an imaging interferometer that works in four distinct modes: as a spectro-polarimeter, a filter-vector magnetograph, an intermediate-band imager, and broadband high-resolution imager. Specific dual and triple etalon configurations are described that provide a spectrographic passband of 2.0-3.5 micron and reduce parasitic light levels to 10(exp -4) as required for precise polarization measurement, e.g., Zeeman measurements of magnetic sensitive lines. A TESOS-like (Telecentric Etalon SOlar Spectrometer) triple etalon system provides a spectral purity of 10(exp -5). The triple designs have the advantage of reducing the finesse requirement on each etalon; allow the use of more stable blocking filters, and have very high spectral purity. A dual-etalon double-pass (Cavallini-like) system can provide a competing configuration. Such a dual-etalon design can provide high contrast. The selection of the final focal plane instrument will depend on a trade-off between an ideal instrument and practical reality. The trade study will include the number of etalons, their aperture sizes, complexities of the optical train, number of blocking filters, configuration of the electronic control system, computer interfaces, temperature controllers, etalon controllers, and their associated feedback electronics. The heritage of single and multiple etalon systems comes from their use in several observatories, including the Marshall Space Flight Center (MSFC) Solar Observatory, Sacramento Peak Observatory (NSO), and Kiepenheuer-Institut fur Sonnenphysik (KIS, Germany), Mees Solar Observatory (University of Hawaii), and Arcetri Astrophysical Observatory (Italy). The design of the ATST multiple etalon system will benefit from the experience gained at these observatories.

LabVIEW Task Manager v. 1.10.0

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

Vargo, Timothy D.

LabVIEW Task Manager is a debugging tool for use during code development in the National Instruments (NI) LabVIEW® IDE. While providing a dynamic & big-picture view of running code, an expandable/collapsible tree diagram displays detailed information (both static and dynamic) on all VIs in memory, belonging to a selected project/target. It allows for interacting with single or multiple selected VIs at a time, providing significant benefits while troubleshooting, and has the following features: Look & Feel similar to Windows® Task Manager; Selection of project/target; Lists all VIs in memory, grouped by class/library; Searches for and enumerates clones in memory; DropInmore » VI for including dynamically referenced clones (Clone Beacon); 'Refresh Now' (F5) re-reads all VIs in memory and adds new ones to the tree; Displays VI name, owning class/library, state, path, data size & code size; Displays VI FP Behavior, Reentrant?, Reentrancy Type, Paused? & Highlight?; Sort by any column, including by library name; Filter by item types vi, ctl, and vit/ctt; Filter out vi.lib and global VIs; Tracking of, and ability to toggle, execution highlighting on multiple selected VIs; Tracking of paused VIs with ability to Pause/Resume/TogglePause multiple selected VIs; DropIn VI for pausing on a condition; If a clone initiates a pause, a different pause symbol is used for all clones of that same reentrant original VI; Select multiple VIs and open or close their FPs or BDs; Double Click a VI from the tree to bring the BD (first choice) or FP to front, if already open; and Select multiple top-level VIs and Abort them.« less

Dietary interventions for multiple sclerosis.

PubMed

Farinotti, Mariangela; Vacchi, Laura; Simi, Silvana; Di Pietrantonj, Carlo; Brait, Lorenzo; Filippini, Graziella

2012-12-12

Clinical and experimental data suggest that certain dietary regimens, particularly those including polyunsaturated fatty acids (PUFAs) and vitamins, might improve outcomes in people with multiple sclerosis (MS). Diets and dietary supplements are much used by people with MS in the belief that they might improve disease outcomes and overcome the effectiveness limits of conventional treatments.This is an update of the Cochrane review "Dietary intervention for multiple sclerosis" (first published on The Cochrane Library 2007, Issue 1). To answer MS patients' questions regarding the efficacy and safety of dietary regimens for MS. Can changes in dietary habits be an effective intervention for MS patients? Are the potential side effects of these interventions known, and have they been measured? Are potential interactions between dietary interventions and other curative or symptomatic treatments known and have they been studied? We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register (November 2011), CENTRAL (The Cochrane Library 2011, Issue 4), MEDLINE (PubMed) (1966 to November 2011), EMBASE (embase.com) (1974 to November 2011) and reference lists of papers found. All controlled trials (randomised controlled trials (RCTs) and controlled clinical trials (CCTs)) on a specific dietary intervention, diet plan or dietary supplementation, except for vitamin D supplementation, compared to no dietary modification or placebo were eligible. Two review authors independently selected articles, assessed trial quality and extracted data. Data were entered and analysed in RevMan.Dichotomous data were summarised as relative risks (RR) with 95% confidence intervals (95% CI) using a random-effects model in the presence of heterogeneity (I² > 60%). Continuous data were analysed using weighted mean differences, determined by the difference between the pre- and post-intervention changes in the treatment and control groups. Six RCTs that investigated PUFAs emerged from the search strategy, accounting for 794 randomised patients.PUFAs did not have a significant effect on disease progression at 24 months. Omega-6 fatty acids (11 to 23 g/day linoleic acid) didn't show any benefit in 144 MS patients (RR 1.04, 95% CI 0.66 to 1.63). Linoleic acid (2.9 to 3.4 g/day) had no benefit in 65 chronic progressive MS patients (RR 0.78, 95% CI 0.43 to 1.42). Omega-3 fatty acids had no benefit in 292 relapsing remitting MS patients (RR 0.82, 95% CI 0.65 to 1.03, P = 0.08).Slight potential benefits in relapse outcomes were associated with omega-6 fatty acids in some studies, however these findings were limited by the reduced validity of the endpoints. No judgements about safety or patient-reported outcomes were possible. In general, trial quality was poor.No studies on vitamin supplementation and allergen-free diets were analysed as none met the eligibility criteria, mainly due to lack of clinical outcomes. PUFAs seem to have no major effect on the main clinical outcome in MS (disease progression), but they may tend to reduce the frequency of relapses over two years. However, the data that are available are insufficient to assess a real benefit or harm from PUFA supplementation because of their uncertain quality.Evidence on the possible benefits and risks of vitamin supplementation and antioxidant supplements in MS is lacking. More research is required to assess the effectiveness of dietary interventions in MS.

Impacts of conservation and human development policy across stakeholders and scales

PubMed Central

Li, Cong; Zheng, Hua; Li, Shuzhuo; Chen, Xiaoshu; Li, Jie; Zeng, Weihong; Liang, Yicheng; Polasky, Stephen; Feldman, Marcus W.; Ruckelshaus, Mary; Ouyang, Zhiyun; Daily, Gretchen C.

2015-01-01

Ideally, both ecosystem service and human development policies should improve human well-being through the conservation of ecosystems that provide valuable services. However, program costs and benefits to multiple stakeholders, and how they change through time, are rarely carefully analyzed. We examine one of China’s new ecosystem service protection and human development policies: the Relocation and Settlement Program of Southern Shaanxi Province (RSP), which pays households who opt voluntarily to resettle from mountainous areas. The RSP aims to reduce disaster risk, restore important ecosystem services, and improve human well-being. We use household surveys and biophysical data in an integrated economic cost–benefit analysis for multiple stakeholders. We project that the RSP will result in positive net benefits to the municipal government, and to cross-region and global beneficiaries over the long run along with environment improvement, including improved water quality, soil erosion control, and carbon sequestration. However, there are significant short-run relocation costs for local residents so that poor households may have difficulty participating because they lack the resources to pay the initial costs of relocation. Greater subsidies and subsequent supports after relocation are necessary to reduce the payback period of resettled households in the long run. Compensation from downstream beneficiaries for improved water and from carbon trades could be channeled into reducing relocation costs for the poor and sharing the burden of RSP implementation. The effectiveness of the RSP could also be greatly strengthened by early investment in developing human capital and environment-friendly jobs and establishing long-term mechanisms for securing program goals. These challenges and potential solutions pervade ecosystem service efforts globally. PMID:26082546

[Cost-effectiveness analysis of interferon beta-1b as treatment for patients with clinically isolated syndrome suggestive of multiple sclerosis in Spain].

PubMed

Piñol, C

2016-05-01

The BENEFIT study has demonstrated the benefits of early treatment with interferon beta 1b (IFNβ-1b). The objective of this study was to estimate the efficiency of early vs delayed IFNβ-1b treatment in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS) in Spain. A Markov model reflecting the social perspective was developed with time horizons ranging from 2 years to lifetime. A cohort of 1000 patients with CIS, whose health status had been measured on the Expanded Disability Symptom Scale (EDSS), included patients who received early IFNβ-1b treatment and those who did not. Data from the BENEFIT study were used to model EDSS progression and transitions to MS. Costs were estimated from published literature. Patient utilities were derived from EQ-5D data and published data. Mortality was estimated using life tables and EDSS data. Costs (€ at 2013 rates) and outcomes were discounted at 3% per annum. A probabilistic sensitivity analysis was performed. In the base case, both the incremental cost utility ratio (ICUR) and the incremental cost effectiveness ratio (ICER) of IFNβ-1b versus no treatment were dominant (more effective and less costly) from a social perspective. From the perspective of the Spanish Health System, the ICUR was € 40,702/QALY and the ICER was € 13/relapse avoided. Early treatment with IFNβ-1b after a CIS versus delayed treatment is efficient from a social perspective, but it may not be efficient from the perspective of the NHS which does not take non health-related costs into account. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Fair Balance and Adequate Provision in Direct-to-Consumer Prescription Drug Online Banner Advertisements: A Content Analysis

PubMed Central

2016-01-01

Background The current direct-to-consumer advertising (DTCA) guidelines were developed with print, television, and radio media in mind, and there are no specific guidelines for online banner advertisements. Objective This study evaluates how well Internet banner ads comply with existing Food and Drug Administration (FDA) guidelines for DTCA in other media. Methods A content analysis was performed of 68 banner advertisements. A coding sheet was developed based on (1) FDA guidance documents for consumer-directed prescription drug advertisements and (2) previous DTCA content analyses. Specifically, the presence of a brief summary detailing the drug’s risks and side effects or of a “major statement” identifying the drug’s major risks, and the number and type of provisions made available to consumers for comprehensive information about the drug were coded. In addition, the criterion of “fair balance,” the FDA’s requirement that prescription drug ads balance information relating to the drug’s risks with information relating to its benefits, was measured by numbering the benefit and risk facts identified in the ads and by examining the presentation of risk and benefit information. Results Every ad in the sample included a brief summary of risk information and at least one form of adequate provision as required by the FDA for broadcast ads that do not give audiences a brief summary of a drug’s risks. No ads included a major statement. There were approximately 7.18 risk facts for every benefit fact. Most of the risks (98.85%, 1292/1307) were presented in the scroll portion of the ad, whereas most of the benefits (66.5%, 121/182) were presented in the main part of the ad. Out of 1307 risk facts, 1292 were qualitative and 15 were quantitative. Out of 182 benefit facts, 181 were qualitative and 1 was quantitative. The majority of ads showed neutral images during the disclosure of benefit and risk facts. Only 9% (6/68) of the ads displayed positive images and none displayed negative images when presenting risks facts. When benefit facts were being presented, 7% (5/68) showed only positive images. No ads showed negative images when the benefit facts were being presented. Conclusions In the face of ambiguous regulatory guidelines for online banner promotion, drug companies appear to make an attempt to adapt to regulatory guidelines designed for traditional media. However, banner ads use various techniques of presentation to present the advertised drug in the best possible light. The FDA should formalize requirements that drug companies provide a brief summary and include multiple forms of adequate provision in banner ads. PMID:26892749

Modeling the Potential Effects of New Tobacco Products and Policies. A Dynamic Population Model for Multiple Product Use and Harm

DOE PAGES

Vugrin, Eric D.; Rostron, Brian L.; Verzi, Stephen J.; ...

2015-03-27

Background Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. Methods and Findings We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use formore » the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Conclusion Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.« less

Modeling the Potential Effects of New Tobacco Products and Policies: A Dynamic Population Model for Multiple Product Use and Harm

PubMed Central

Vugrin, Eric D.; Rostron, Brian L.; Verzi, Stephen J.; Brodsky, Nancy S.; Brown, Theresa J.; Choiniere, Conrad J.; Coleman, Blair N.; Paredes, Antonio; Apelberg, Benjamin J.

2015-01-01

Background Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. Methods and Findings We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Conclusion Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability. PMID:25815840

Modeling the potential effects of new tobacco products and policies: a dynamic population model for multiple product use and harm.

PubMed

Vugrin, Eric D; Rostron, Brian L; Verzi, Stephen J; Brodsky, Nancy S; Brown, Theresa J; Choiniere, Conrad J; Coleman, Blair N; Paredes, Antonio; Apelberg, Benjamin J

2015-01-01

Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.