Science.gov

Sample records for nordheim integral treatment

  1. Fowler-Nordheim characteristics of electron irradiated MOS capacitors

    SciTech Connect

    Candelori, A.; Paccagnella, A.; Cammarata, M.; Ghidini, G.; Fuochi, P.G.

    1998-12-01

    MOS capacitors with 8 nm thick oxides have been irradiated by an 8 MeV LINAC electron beam. C-V and I-V measurements have shown a positive trapped charge, higher for irradiation performed under negative gate bias, as a consequence of preferential charge recombination at the cathodic interface. No saturation of the positive trapped charge is measured up to 20 Mrad(Si). Neutral defects induced by irradiation have been studied, by performing positive and negative Fowler-Nordheim injection. The distribution of neutral defects is similar to that of trapped holes, indicating a correlation between trapped holes and neutral defects. Electrical stresses performed after irradiation have shown that the accumulation kinetics of oxide defects is similar in both unirradiated and irradiated devices.

  2. Fowler Nordheim theory of carbon nanotube based field emitters

    NASA Astrophysics Data System (ADS)

    Parveen, Shama; Kumar, Avshish; Husain, Samina; Husain, Mushahid

    2017-01-01

    Field emission (FE) phenomena are generally explained in the frame-work of Fowler Nordheim (FN) theory which was given for flat metal surfaces. In this work, an effort has been made to present the field emission mechanism in carbon nanotubes (CNTs) which have tip type geometry at nanoscale. High aspect ratio of CNTs leads to large field enhancement factor and lower operating voltages because the electric field strength in the vicinity of the nanotubes tip can be enhanced by thousand times. The work function of nanostructure by using FN plot has been calculated with reverse engineering. With the help of modified FN equation, an important formula for effective emitting area (active area for emission of electrons) has been derived and employed to calculate the active emitting area for CNT field emitters. Therefore, it is of great interest to present a state of art study on the complete solution of FN equation for CNTs based field emitter displays. This manuscript will also provide a better understanding of calculation of different FE parameters of CNTs field emitters using FN equation.

  3. Tuning contact transport mechanisms in bilayer MoSe2 transistors up to Fowler-Nordheim regime

    NASA Astrophysics Data System (ADS)

    Mouafo, L. D. N.; Godel, F.; Froehlicher, G.; Berciaud, S.; Doudin, B.; Venkata Kamalakar, M.; Dayen, J.-F.

    2017-03-01

    Atomically thin molybdenum diselenide (MoSe2) is an emerging two-dimensional (2D) semiconductor with significant potential for electronic, optoelectronic, spintronic applications and a common platform for their possible integration. Tuning interface charge transport between such new 2D materials and metallic electrodes is a key issue in 2D device physics and engineering. Here, we report tunable interface charge transport in bilayer MoSe2 field effect transistors with Ti/Au contacts showing high on/off ratio up to 107 at room temperature. Our experiments reveal a detailed map of transport mechanisms obtained by controlling the interface band bending profile via temperature, gate and source-drain bias voltages. This comprehensive investigation leads to demarcating regimes and tuning in transport mechanisms while controlling the interface barrier profile. The careful analysis allows us to identify thermally activated regime at low carrier density, and Schottky barrier driven mechanisms at higher carrier density demonstrating the transition from low-field direct tunneling/ thermionic emission to high-field Fowler-Nordheim tunneling. Furthermore, we show that the transition voltage V trans to Fowler-Nordheim correlates directly to the difference between the chemical potential of the metal electrode and the conduction band minimum in the 2D semiconductor, which opens up opportunities for new theoretical and experimental investigations. Our approach being generic can be extended to other 2D materials, and the possibility of tuning contact transport regimes is promising for designing MoSe2 device applications.

  4. Special features of Fowler-Nordheim stress degradation of SiC-MOSFETs

    NASA Astrophysics Data System (ADS)

    Murakami, Eiichi; Oda, Kazuhiro; Takeshita, Tatsuya

    2016-04-01

    SiC-MOSFETs have been markedly developed, and the main issues remaining are high-temperature stability and gate-oxide integrity. In this paper, we report special features of I ds-V gs and I g-V gs characteristics of commercially available SiC-MOSFETs during high-gate-voltage and high-temperature stress. Moreover, we introduce simple analytical models that reveal the effects of the trapped charges on the characteristics. Interface states around the conduction-band edge are suggested to be the key mechanisms of Fowler-Nordheim stress degradation (FN degradation) as well as negative bias temperature instability (NBTI), which affects both mobility and carrier density. Hole trapping is also important in FN degradation as well as NBTI. Near-interfacial electron trapping and detrapping found in positive bias temperature instability (PBTI) is also observed in FN degradation. A continuous I g increase during FN stress, which is the most specific to SiC-MOSFETs, is related to the observation that near-interfacial electron trapping has little effect on FN tunneling.

  5. Support Systems for Treatment Integrity

    ERIC Educational Resources Information Center

    Goense, Pauline Brigitta; Boendermaker, Leonieke; van Yperen, Tom

    2016-01-01

    Objective: This systematic review evaluates the content of effective support provided to practitioners of evidence-based interventions in order to establish and maintain treatment integrity. Method: Four articles covering six outcome studies are included in this review, these studies (1) adequately operationalized treatment integrity procedures…

  6. Support Systems for Treatment Integrity

    ERIC Educational Resources Information Center

    Goense, Pauline Brigitta; Boendermaker, Leonieke; van Yperen, Tom

    2016-01-01

    Objective: This systematic review evaluates the content of effective support provided to practitioners of evidence-based interventions in order to establish and maintain treatment integrity. Method: Four articles covering six outcome studies are included in this review, these studies (1) adequately operationalized treatment integrity procedures…

  7. Fowler-Nordheim emission modified by laser pulses in the adiabatic regime

    NASA Astrophysics Data System (ADS)

    Rokhlenko, A.; Lebowitz, J. L.

    2016-06-01

    We investigate enhanced field emission due to a continuous or pulsed oscillating field added to a constant electric field E at the emitter surface. When the frequency of oscillation, field strength, and property of the emitter material satisfy the Keldysh condition γ<1 /2 , one can use the adiabatic approximation for treating the oscillating field, i.e., consider the tunneling through the instantaneous Fowler-Nordheim barrier created by both fields. Due to the great sensitivity of the emission to the field strength, the average tunneling current can be much larger than the current produced by only the constant field. We carry out the computations for arbitrary strong constant electric fields, beyond the commonly used Fowler-Nordheim approximation which exhibit, in particular, an important property of the wave function inside the potential barrier where it is found to be monotonically decreasing without oscillations.

  8. High resolution Fowler-Nordheim field emission maps of thin silicon oxide layers

    NASA Astrophysics Data System (ADS)

    Ruskell, Todd G.; Workman, Richard K.; Chen, Dong; Sarid, Dror; Dahl, Sarah; Gilbert, Stephen

    1996-01-01

    An improved method for characterizing thin oxide films using Fowler-Nordheim field emission is reported. The method uses a conducting-tip atomic force microscope with dual feedback systems, one for the topography and a second for the field emission bias voltage. Images of the voltage required to maintain a 10 pA emission current through a 3 nm oxide film thermally grown on p-type Si(100) demonstrate a spatial resolution of 8 nm.

  9. Integrated nonthermal treatment system study

    SciTech Connect

    Biagi, C.; Bahar, D.; Teheranian, B.; Vetromile, J.; Quapp, W.J.; Bechtold, T.; Brown, B.; Schwinkendorf, W.; Swartz, G.

    1997-01-01

    This report presents the results of a study of nonthermal treatment technologies. The study consisted of a systematic assessment of five nonthermal treatment alternatives. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The alternatives considered were innovative nonthermal treatments for organic liquids and sludges, process residue, soil and debris. Vacuum desorption or various washing approaches are considered for treatment of soil, residue and debris. Organic destruction methods include mediated electrochemical oxidation, catalytic wet oxidation, and acid digestion. Other methods studied included stabilization technologies and mercury separation of treatment residues. This study is a companion to the integrated thermal treatment study which examined 19 alternatives for thermal treatment of MLLW waste. The quantities and physical and chemical compositions of the input waste are based on the inventory database developed by the US Department of Energy. The Integrated Nonthermal Treatment Systems (INTS) systems were evaluated using the same waste input (2,927 pounds per hour) as the Integrated Thermal Treatment Systems (ITTS). 48 refs., 68 figs., 37 tabs.

  10. Nordheim-Gorter like behavior and one carrier conduction in a quasi-one-dimensional system

    NASA Astrophysics Data System (ADS)

    Datta, T.; Hermann, A. M.; Deck, R. J.; Somoano, R. B.

    1980-09-01

    We report the extension and observation of Nordheim-Gorter type scaling of the thermoelectric power with the d.c. conductivity for the system of quasi-one-dimensional (QOD) conductors, (TTF) 12(SeCN) 7, (TTF) 12(SCN) 7, (TTF) 3(Cl) 2 and (TTF) 7(I) 5. The consideration of additional scattering processes for one carrier transport leads to a thermopower which scales linearly with conductivity. Furthermore, such a TEP vs conductivity (or resistivity) analysis will identify single carrier (or bi-carrier) transport in other QOD systems as well.

  11. Transition from Fowler-Nordheim field emission to space charge limited current density

    NASA Astrophysics Data System (ADS)

    Feng, Y.; Verboncoeur, J. P.

    2006-07-01

    The Fowler-Nordheim law gives the current density extracted from a surface under strong fields, by treating the emission of electrons from a metal-vacuum interface in the presence of an electric field normal to the surface as a quantum mechanical tunneling process. Child's law predicts the maximum transmitted current density by considering the space charge effect. When the electric field becomes high enough, the emitted current density will be limited by Child's law. This work analyzes the transition of the transmitted current density from the Fowler-Nordheim law to Child's law space charge limit using a one-dimensional particle-in-cell code. Also studied is the response of the emission model to strong electric fields near the transition point. We find the transition without geometrical effort is smooth and much slower than reported previously [J. P. Barbour, W. W. Dolan, J. K. Trolan, E. E. Martin, and W. P. Dyke, Phys. Rev. 92, 45 (1953)]. We analyze the effects of geometric field enhancement and work function on the transition. Using our previous model for effective field enhancement [Y. Feng and J. P. Verboncoeur, Phys. Plasmas 12, 103301 (2005)], we find the geometric effect dominates, and enhancement β >10 can accelerate the approach to the space charge limit at practical electric field. A damped oscillation near the local plasma frequency is observed in the transient system response.

  12. Transition from Fowler-Nordheim field emission to space charge limited current density

    SciTech Connect

    Feng, Y.; Verboncoeur, J. P.

    2006-07-15

    The Fowler-Nordheim law gives the current density extracted from a surface under strong fields, by treating the emission of electrons from a metal-vacuum interface in the presence of an electric field normal to the surface as a quantum mechanical tunneling process. Child's law predicts the maximum transmitted current density by considering the space charge effect. When the electric field becomes high enough, the emitted current density will be limited by Child's law. This work analyzes the transition of the transmitted current density from the Fowler-Nordheim law to Child's law space charge limit using a one-dimensional particle-in-cell code. Also studied is the response of the emission model to strong electric fields near the transition point. We find the transition without geometrical effort is smooth and much slower than reported previously [J. P. Barbour, W. W. Dolan, J. K. Trolan, E. E. Martin, and W. P. Dyke, Phys. Rev. 92, 45 (1953)]. We analyze the effects of geometric field enhancement and work function on the transition. Using our previous model for effective field enhancement [Y. Feng and J. P. Verboncoeur, Phys. Plasmas 12, 103301 (2005)], we find the geometric effect dominates, and enhancement {beta}>10 can accelerate the approach to the space charge limit at practical electric field. A damped oscillation near the local plasma frequency is observed in the transient system response.

  13. A model for effective field enhancement for Fowler-Nordheim field emission

    SciTech Connect

    Feng, Y.; Verboncoeur, J.P.

    2005-10-01

    The local field enhancement factor {beta} is often introduced in the Fowler-Nordheim equation to represent the geometrical effects at the surface of the cathode, where {beta}(s)=E{sub n}(s)/E{sub 0} for macroscopic applied field E{sub 0}. Local variation of {beta} determines the local normal surface electric field, E{sub n}(s), resulting in local dependence of injection current by the Fowler-Nordheim law. In computational models, it is impractical to determine the time-dependent local surface field each time step on a microscopic space scale. Effective {beta} is introduced in this paper which allows us to study the emission properties at a macroscopic scale. Microscopic (subgrid) local effective {beta} is calculated only at the initial time step, and then the effective {beta} can be recomputed for different surface electrical field through this model. The model allows reduction of dimensionality as well as the ability to include subgrid effects. The model is demonstrated on fundamental cases and compared to a calculation with a mesh fine enough to resolve the geometric features.

  14. V-shaped metallic-wire cantilevers for combined atomic force microscopy and Fowler-Nordheim imaging

    NASA Astrophysics Data System (ADS)

    Peterson, Charles A.; Workman, Richard K.; Yao, Xiaowei; Hunt, Jeffery P.; Sarid, Dror

    1998-12-01

    A method for fabricating V-shaped cantilevers from a flattened Pt/Ir metal wire for combined atomic force microscopy and Fowler-Nordheim imaging is described. These novel cantilevers have been found to be more robust then conventional ones used for scanning capacitance and magnetic force microscopy as their conductivity is maintained even after a large number of surface scans. The use of a V-shaped geometry improves on earlier single-beam geometries by reducing rms imaging noise. Characterization of these cantilevers and combined atomic force microscopy and Fowler-Nordheim images are reported.

  15. On the Cauchy Problem for the Homogeneous Boltzmann-Nordheim Equation for Bosons: Local Existence, Uniqueness and Creation of Moments

    NASA Astrophysics Data System (ADS)

    Briant, Marc; Einav, Amit

    2016-06-01

    The Boltzmann-Nordheim equation is a modification of the Boltzmann equation, based on physical considerations, that describes the dynamics of the distribution of particles in a quantum gas composed of bosons or fermions. In this work we investigate the Cauchy theory of the spatially homogeneous Boltzmann-Nordheim equation for bosons, in dimension d≥slant 3. We show existence and uniqueness locally in time for any initial data in L^∞ (1+| v| ^s) with finite mass and energy, for a suitable s, as well as the instantaneous creation of moments of all order.

  16. Modifications of Fowler-Nordheim injection characteristics in {gamma} irradiated MOS devices

    SciTech Connect

    Scarpa, A.; Paccagnella, A.; Montera, F.; Candelori, A.; Ghibaudo, G.; Pananakakis, G.; Fuochi, P.G.

    1998-06-01

    In this work the authors have investigated how gamma irradiation affects the tunneling conduction mechanism of a 20 nm thick oxide in MOS capacitors. The radiation induced positive charge is rapidly compensated by the injected electrons, and does not impact the gate current under positive injection after the first current-voltage measurement. Only a transient stress induced leakage current at low gate bias is observed. Instead, a radiation induced negative charge has been observed near the polysilicon gate, which enhances the gate voltage needed for Fowler-Nordheim conduction at negative gate bias. No time decay of this charge has been observed. Such charges slightly modify the trapping kinetics of negative charge during subsequent electrical stresses performed at constant current condition.

  17. Analytic expression for the Fowler-Nordheim V- I characteristic including the series resistance effect

    NASA Astrophysics Data System (ADS)

    Miranda, E.; Palumbo, F.

    2011-07-01

    It is shown in this communication that the Fowler-Nordheim (FN) tunneling expression for the current-voltage ( I- V) characteristic can be analytically inverted so that an exact expression for the voltage-current ( V- I) characteristic can be obtained. The solution of the resulting implicit equation is found using the Lambert W function, i.e. the solution of the transcendental equation we w = x. The reported expressions are supported by experimental I- V curves measured in thin (≈5 nm) SiO 2 films in MOS capacitors. The analysis includes the case of a tunneling oxide with a large series resistance. For practical purposes, a closed-form expression for W based on a Padé-type approximation is also provided.

  18. A simple method for determination of Fowler-Nordheim tunnelling parameters

    NASA Astrophysics Data System (ADS)

    Casados-Cruz, G.; Reyes-Barranca, M. A.; Moreno-Cadenas, J. A.

    2011-05-01

    A simple technique for extracting the Fowler-Nordheim (FN) tunnelling parameters is proposed. It consists of measuring the Drain-Source current of a floating gate transistor while a linear ramp voltage is applied to a simple injector structure attached to the transistor's floating gate. Such a test device is fabricated using a standard CMOS process. The parameters obtained can be used in a freely available electrical simulator as SPICE3f5 (NGSPICE), but in general it can be easily adapted to other SPICE-like programs. We describe the technique step-by-step and a comparison is made of simulated and measured FN tunnelling parameters, for a floating gate transistor with tunnelling injectors. A good agreement has been found between experimental and simulated data.

  19. Fowler-Nordheim tunneling induced charge transfer plasmons between nearly touching nanoparticles.

    PubMed

    Wu, Lin; Duan, Huigao; Bai, Ping; Bosman, Michel; Yang, Joel K W; Li, Erping

    2013-01-22

    Reducing the gap between two metal nanoparticles down to atomic dimensions uncovers novel plasmon resonant modes. Of particular interest is a mode known as the charge transfer plasmon (CTP). This mode has been experimentally observed in touching nanoparticles, where charges can shuttle between the nanoparticles via a conductive path. However, the CTP mode for nearly touching nanoparticles has only been predicted theoretically to occur via direct tunneling when the gap is reduced to ~0.4 nm. Because of challenges in fabricating and characterizing gaps at these dimensions, experiments have been unable to provide evidence for this plasmon mode that is supported by tunneling. In this work, we consider an alternative tunneling process, that is, the well-known Fowler-Nordheim (FN) tunneling that occurs at high electric fields, and apply it for the first time in the theoretical investigation of plasmon resonances between nearly touching nanoparticles. This new approach relaxes the requirements on gap dimensions, and intuitively suggests that with a sufficiently high-intensity irradiation, the CTP can be excited via FN tunneling for a range of subnanometer gaps. The unique feature of FN tunneling induced CTP is the ability to turn on and off the charge transfer by varying the intensity of an external light source, and this could inspire the development of novel quantum devices.

  20. From Fowler-Nordheim to Nonequilibrium Green's Function Modeling of Tunneling

    NASA Astrophysics Data System (ADS)

    Ilatikhameneh, Hesameddin; Salazar, Ramon B.; Klimeck, Gerhard; Rahman, Rajib; Appenzeller, Joerg

    2016-07-01

    In this work, an analytic model is proposed which provides in a continuous manner the current-voltage characteristic (I-V) of high performance tunneling field-effect transistors (TFETs) based on direct bandgap semiconductors. The model provides closed-form expressions for I-V based on: 1) a modified version of the well-known Fowler-Nordheim (FN) formula (in the ON-state), and 2) an equation which describes the OFF-state performance while providing continuity at the ON/OFF threshold by means of a term introduced as the "continuity factor". It is shown that traditional approaches such as FN are accurate in TFETs only through correct evaluation of the total band bending distance and the "tunneling effective mass". General expressions for these two key parameters are provided. Moreover, it is demonstrated that the tunneling effective mass captures both the ellipticity of evanescent states and the dual (electron/hole) behavior of the tunneling carriers, and it is further shown that such a concept is even applicable to semiconductors with nontrivial energy dispersion. Ultimately, it is found that the I-V characteristics obtained by using this model are in close agreement with state-of-the-art quantum transport simulations both in the ON- and OFF-state, thus providing validation of the analytic approach.

  1. Impact of Treatment Integrity on Intervention Effectiveness

    ERIC Educational Resources Information Center

    Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

    2012-01-01

    Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

  2. Impact of Treatment Integrity on Intervention Effectiveness

    ERIC Educational Resources Information Center

    Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

    2012-01-01

    Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

  3. Treatment Integrity: Revisiting Some Big Ideas

    ERIC Educational Resources Information Center

    Greenwood, Charles R.

    2009-01-01

    The contributors to this special issue have helped everyone consider the next steps in building a research and practice agenda regarding the use of treatment integrity. Such an agenda must converge with the big ideas that link treatment integrity to the effectiveness of evidence-based practices (EBPs), and ultimately that of the profession. In…

  4. Advances in Treatment Integrity Research: Multidisciplinary Perspectives on the Conceptualization, Measurement, and Enhancement of Treatment Integrity

    ERIC Educational Resources Information Center

    Schulte, Ann C.; Easton, Julia E.; Parker, Justin

    2009-01-01

    Documenting treatment integrity is an important issue in research and practice in any discipline concerned with prevention and intervention. However, consensus concerning the dimensions of treatment integrity and how they should be measured has yet to emerge. Advances from three areas in which significant treatment integrity work has taken…

  5. INTEGRATED WATER TREATMENT SYSTEM PERFORMANCE EVALUATION

    SciTech Connect

    SEXTON RA; MEEUWSEN WE

    2009-03-12

    This document describes the results of an evaluation of the current Integrated Water Treatment System (IWTS) operation against design performance and a determination of short term and long term actions recommended to sustain IWTS performance.

  6. Waste treatment integration in space

    NASA Technical Reports Server (NTRS)

    Baresi, L.; Kern, R.

    1991-01-01

    The circumstances and criteria for space-based waste treatment bioregenerative life-support systems differ in many ways from those needed in terrestrial applications. In fact, the term "waste" may not even be appropriate in the context of nearly closed, cycling, ecosystems such as those under consideration. Because of these constraints there is a need for innovative approaches to the problem of "materials recycling". Hybrid physico-chemico-biological systems offer advantages over both strictly physico-chemico or biological approaches that would be beneficial to material recycling. To effectively emulate terrestrial cycling, the use of various microbial consortia ("assemblies of interdependent microbes") should be seriously considered for the biological components of such systems. This paper will examine the use of consortia in the context of a hybrid-system for materials recycling in space.

  7. Waste treatment integration in space.

    PubMed

    Baresi, L; Kern, R

    1991-10-01

    The circumstances and criteria for space-based waste treatment bioregenerative life-support systems differ in many ways from those needed in terrestrial applications. In fact, the term "waste" may not even be appropriate in the context of nearly closed, cycling, ecosystems such as those under consideration. Because of these constraints there is a need for innovative approaches to the problem of "materials recycling". Hybrid physico-chemico-biological systems offer advantages over both strictly physico-chemico or biological approaches that would be beneficial to material recycling. To effectively emulate terrestrial cycling, the use of various microbial consortia ("assemblies of interdependent microbes") should be seriously considered for the biological components of such systems. This paper will examine the use of consortia in the context of a hybrid-system for materials recycling in space.

  8. Integrating spirituality into alcohol treatment.

    PubMed

    Delaney, Harold D; Forcehimes, Alyssa A; Campbell, William P; Smith, Bruce W

    2009-02-01

    Spirituality is presumed by millions of Americans to be directly relevant to problems of alcohol abuse. We summarize findings regarding the role of religion and spirituality in the prevention and treatment of substance abuse and present a case illustration. We also consider mechanisms responsible for these effects. We offer advice about why, by whom, and how religion and spirituality should be discussed with clients with substance use disorders. In a recent clinical trial, therapists trained in a client-centered approach to facilitate exploration of spirituality fostered clients' use of spiritual practices. We suggest that the therapist's ability to skillfully engage clients in a discussion of spirituality is largely determined by how the therapist balances the dual roles of authoritative expert and evocative facilitator.

  9. Waste treatment integration in space

    NASA Technical Reports Server (NTRS)

    Baresi, L.; Kern, R.

    1991-01-01

    The circumstances and criteria for space-based waste treatment bioregenerative life-support systems differ in many ways from those needed in terrestrial applications. In fact, the term "waste" may not even be appropriate in the context of nearly closed, cycling, ecosystems such as those under consideration. Because of these constraints there is a need for innovative approaches to the problem of "materials recycling". Hybrid physico-chemico-biological systems offer advantages over both strictly physico-chemico or biological approaches that would be beneficial to material recycling. To effectively emulate terrestrial cycling, the use of various microbial consortia ("assemblies of interdependent microbes") should be seriously considered for the biological components of such systems. This paper will examine the use of consortia in the context of a hybrid-system for materials recycling in space.

  10. Integrating Primary Medical Care With Addiction Treatment

    PubMed Central

    Weisner, Constance; Mertens, Jennifer; Parthasarathy, Sujaya; Moore, Charles; Lu, Yun

    2010-01-01

    Context The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment. Objective To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse–related medical conditions (SAMCs). Design Randomized controlled trial conducted between April 1997 and December 1998. Setting and Patients Adult men and women (n=592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif. Interventions Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n=285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n=307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available. Main Outcome Measures Abstinence outcomes, treatment utilization, and costs 6 months after randomization. Results Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P=.18). For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P=.23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P=.19). However, patients with SAMCs (n=341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%, P=.006; odds ratio [OR], 1.90; 95% confidence interval [CI], 1.22-2.97). This was true for both those with medical (OR, 3.38; 95% CI, 1.68-6.80) and psychiatric (OR, 2.10; 95% CI, 1

  11. Treatment Integrity Assessment in the Schools: An Evaluation of the Treatment Integrity Planning Protocol

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Kratochwill, Thomas R.

    2009-01-01

    The Treatment Integrity Planning Protocol (TIPP) provides a structured process for collaboratively creating a treatment integrity assessment within a consultation framework. The authors evaluated the effect of the TIPP on the implementation of an intervention designed to improve the consistency of students' mathematics performance. Treatment…

  12. Treatment Integrity Assessment in the Schools: An Evaluation of the Treatment Integrity Planning Protocol

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Kratochwill, Thomas R.

    2009-01-01

    The Treatment Integrity Planning Protocol (TIPP) provides a structured process for collaboratively creating a treatment integrity assessment within a consultation framework. The authors evaluated the effect of the TIPP on the implementation of an intervention designed to improve the consistency of students' mathematics performance. Treatment…

  13. Barriers to infertility treatment: an integrated study.

    PubMed

    Mosalanejad, Leili; Parandavar, Nehle; Abdollahifard, Sareh

    2013-11-25

    Infertility is one of the most important events in life. Despite the negative impact of infertility, a significant number of women struggling to conceive do not consult a physician and do not fallow up infertility treatment. This integrated study aimed to investigate a large amount of factors which influenced discontinuation of infertility treatment. This integrated study (qualitative - quantitative study) was done on infertile women who had referred to infertility center in Jahrom University of medical sciences using purposive sampling. In the first study, data were collected from a valid questionnaire with 22 questions in a 5-point likert scale about barriers to infertility treatments and in the second study, as a phenomenology approach, data collection was done using deep unstructured interviews and focused groups were aimed to identify deep individual experiences about it. major barriers to infertility treatments included the probability of treatment failure (52.5%), couple's age and possibility of high risk pregnancy (51.5%), Painfulness of some treatment methods such as laparoscopy (50.5%). Qualitative results led to the identification of three main themes: Nature of treatment, negative thinking, social and cultural factors. As a result, we suggest family education and enrichment of cultural context in the field of infertility; infertile people would be willing to pursue infertility treatments.

  14. Barriers to Infertility Treatment: An Integrated Study

    PubMed Central

    Mosalanejad, Leili; Parandavar, Nehle; Abdollahifard, Sareh

    2014-01-01

    Background: Infertility is one of the most important events in life. Despite the negative impact of infertility, a significant number of women struggling to conceive do not consult a physician and do not fallow up infertility treatment. This integrated study aimed to investigate a large amount of factors which influenced discontinuation of infertility treatment. Methods: This integrated study (qualitative – quantitative study) was done on infertile women who had referred to infertility center in Jahrom University of medical sciences using purposive sampling. In the first study, data were collected from a valid questionnaire with 22 questions in a 5-point likert scale about barriers to infertility treatments and in the second study, as a phenomenology approach, data collection was done using deep unstructured interviews and focused groups were aimed to identify deep individual experiences about it. Results: major barriers to infertility treatments included the probability of treatment failure (52.5%), couple’s age and possibility of high risk pregnancy (51.5%), Painfulness of some treatment methods such as laparoscopy (50.5%). Qualitative results led to the identification of three main themes: Nature of treatment, negative thinking, social and cultural factors. Conclusion: As a result, we suggest family education and enrichment of cultural context in the field of infertility; infertile people would be willing to pursue infertility treatments. PMID:24373278

  15. [Integrated diagnosis and treatment of scar].

    PubMed

    Cen, Y; Chen, J J

    2016-11-20

    Scar is the common disease in the field of burn and plastic surgery, and its diagnosis and treatment should be involved in overwhelming majority hospitals. There are many substandard methods and medical hidden dangers in diagnosis and treatment of scar, due to the unevenness of doctors' clinical experience. According to the classification of integral scar and diabrotic scar, the problems related to diagnosis and treatment of scar are systemically summarized and normalized in this article for decrease in the incidence of adverse events and medical hidden dangers.

  16. Integrated odour modelling for sewage treatment works.

    PubMed

    Gostelow, P; Parsons, S A; Lovell, M

    2004-01-01

    Odours from sewage treatment works are a significant source of environmental annoyance. There is a need for tools to assess the degree of annoyance caused, and to assess strategies for mitigation of the problem. This is the role of odour modelling. Four main stages are important in the development of an odour problem. Firstly, the odorous molecules must be formed in the liquid phase. They must then transfer from the liquid to the gaseous phase. They are then transported through the atmosphere to the population surrounding the odour source, and are then perceived and assessed by that population. Odour modelling as currently practised tends to concentrate on the transportation of odorants through the atmosphere, with the other areas receiving less attention. Instead, odour modelling should consider each stage in an integrated manner. This paper describes the development of integrated odour models for annoyance prediction. The models describe the liquid-phase transformations and emission of hydrogen sulphide from sewage treatment processes. Model output is in a form suitable for integration with dispersion models, the predictions of which can in turn be used to indicate the probability of annoyance. The models have been applied to both hypothetical and real sewage treatment works cases. Simulation results have highlighted the potential variability of emission rates from sewage treatment works, resulting from flow, quality and meteorological variations. Emission rate variations can have significant effects on annoyance predictions, which is an important finding, as they are usually considered to be fixed and only meteorological variations are considered in predicting the odour footprint. Areas for further development of integrated odour modelling are discussed, in particular the search for improved links between analytical and sensory measurements, and a better understanding of dose/response relationships for odour annoyance.

  17. Treatment of pathological gambling - integrative systemic model.

    PubMed

    Mladenović, Ivica; Lažetić, Goran; Lečić-Toševski, Dušica; Dimitrijević, Ivan

    2015-03-01

    Pathological gambling was classified under impulse control disorders within the International Classification of Diseases (ICD-10) (WHO 1992), but the most recent Diagnostic and Statistical Manual, 5th edition (DSM-V), (APA 2013), has recognized pathological gambling as a first disorder within a new diagnostic category of behavioral addictions - Gambling disorder. Pathological gambling is a disorder in progression, and we hope that our experience in the treatment of pathological gambling in the Daily Hospital for Addictions at The Institute of Mental Health, through the original "Integrative - systemic model" would be of use to colleagues, dealing with this pathology. This model of treatment of pathological gambling is based on multi-systemic approach and it primarily represents an integration of family and cognitive-behavioral therapy, with traces of psychodynamic, existential and pharmacotherapy. The model is based on the book "Pathological gambling - with self-help manual" by Dr Mladenovic and Dr Lazetic, and has been designed in the form of a program that lasts 10 weeks in the intensive phase, and then continues for two years in the form of "extended treatment" ("After care"). The intensive phase is divided into three segments: educational, insight with initial changes and analysis of the achieved changes with the definition of plans and areas that need to be addressed in the extended treatment. "Extended treatment" lasts for two years in the form of group therapy, during which there is a second order change of the identified patient, but also of other family members. Pathological gambling has been treated in the form of systemic-family therapy for more than 10 years at the Institute of Mental Health (IMH), in Belgrade. For second year in a row the treatment is carried out by the modern "Integrative-systemic model". If abstinence from gambling witihin the period of one year after completion of the intensive phase of treatment is taken as the main criterion of

  18. Conceptual and Methodological Issues in Treatment Integrity Measurement

    ERIC Educational Resources Information Center

    McLeod, Bryce D.; Southam-Gerow, Michael A.; Weisz, John R.

    2009-01-01

    This special series focused on treatment integrity in the child mental health and education field is timely. The articles do a laudable job of reviewing (a) the current status of treatment integrity research and measurement, (b) existing conceptual models of treatment integrity, and (c) the limitations of prior research. Overall, this thoughtful…

  19. Conceptual and Methodological Issues in Treatment Integrity Measurement

    ERIC Educational Resources Information Center

    McLeod, Bryce D.; Southam-Gerow, Michael A.; Weisz, John R.

    2009-01-01

    This special series focused on treatment integrity in the child mental health and education field is timely. The articles do a laudable job of reviewing (a) the current status of treatment integrity research and measurement, (b) existing conceptual models of treatment integrity, and (c) the limitations of prior research. Overall, this thoughtful…

  20. The Fowler-Nordheim behavior and mechanism of photo-sensitive field from SnS{sub 2} nanosheets

    SciTech Connect

    Suryawanshi, Sachin R.; Chaudhari, Nilima S.; Warule, Sambhaji S.; More, Mahendra A.

    2015-06-24

    Here in, we report photo-sensitive field emission measurements of SnS{sub 2} nanosheets at base pressure of ∼1×10{sup −8} mbar are reported. The nonlinear Fowler-Nordheim (F-N) plot is elucidate according to a (F-N) model of calculation based on shift in a saturation of conduction band current density after light illumination and prevalence of valence band current density at high electric field values. The model of calculation suggests that the slope variation before and after visible light illumination of the F-N plot, in the high-field and low-field regions, does not depend on the magnitude of saturation but also depend on charge carrier (electron) concentration get increased in conduction band. The F-N model of calculation is important for the fundamental understanding of the photo-sensitive field emission mechanism of semiconducting SnS{sub 2}. The replicate F-N plots exhibit similar features to those observed experimentally. The model calculation suggests that the nonlinearity of the F-N plot is a characteristic of the photo-enhanced energy band structure of the photo-sensitive semiconductor material.

  1. Use of Millikan-Lauritsen plots, rather than Fowler-Nordheim plots, to analyze field emission current-voltage data

    NASA Astrophysics Data System (ADS)

    Forbes, Richard G.

    2009-06-01

    In the late 1920s, two forms of data plot were used to analyze the current-voltage (i-V) data obtained in experiments on cold field electron emission (CFE). Millikan-Lauritsen (ML) plots have the form [ln{i } versus 1/V]; Fowler-Nordheim (FN) plots have the form [ln{i /V2} versus 1/V]. In both cases common logarithms may be used instead. For historical reasons, it has become customary to use FN plots; but recent mathematical developments in CFE theory made these historical reasons less valid than they formerly were. ML plots are in fact easier to understand and use, and are more flexible when it is wanted to make corrections for all physical sources of voltage dependence in the data, or to estimate uncertainties in derived parameter values when the precise forms of voltage dependences are not known. This paper summarizes historical and recent background and argues that ML plots should now replace FN plots as the basic method of analyzing CFE i-V data (or related data involving current densities and/or fields). A formula for the interpretation of ML plot slopes is presented and discussed, and examples are given of its use.

  2. Fowler-Nordheim electron tunneling mechanism in Ni/SiO2/n-4H SiC MOS devices

    NASA Astrophysics Data System (ADS)

    Kodigala, Subba Ramaiah; Chattopadhyay, S.; Overton, C.; Ardoin, I.

    2015-12-01

    The Ni/SiO2/n-type 4H SiC MOS devices have been fabricated for microelectronic device applications. The SiO2 layer employed in the MOS devices is grown by wet thermal oxidation process. The current-field characteristics of Ni/SiO2/n-type 4H SiC MOS devices are quiet interestingly studied by employing Fowler Nordheim (FN) conduction tunneling model, which is verified by theoretical simulation. It is learnt that the tunneling current through the barrier in the MOS devices promptly obeys the FN conduction tunneling mechanism. The simulation results show that the current in the MOS device increases and barrier height decreases with increasing temperature and internal electric field. Therefore, the correction factor for the barrier height of n-type 4H SiC/SiO2 MOS device due to the influence of both the temperature and internal electric field is employed. The barrier height observed by the experiments is apparently smaller than the simulated one of an ideal MOS device. However, after employing all the correction factors to the barrier height, the simulated current-field curves fairly coincide with the experimental results. The reason for obtaining smaller experimental barrier height for MOS devices is substantially explored with the support of current-field (J-F) analysis. On the other hand, this article comprehensively addresses the effects of quantum mechanical, interface trap density and thickness of 4H-SiC on the barrier height.

  3. [Reflection on treatment of acquired immunodeficiency syndrome by integrative medicine].

    PubMed

    Wang, Dan-Ni

    2012-02-01

    The current situation of Chinese medicine and Western medicine treatment of acquired immunodeficiency syndrome (AIDS) has made the integrative medicine treatment of AIDS an important treatment strategy. Integrative medicine treatment of AIDS has made certain achievements in clinical research, basic research, and other aspects. It has good mass foundation and curative efficacy, as well as insufficiency. I hope integrative medicine can be brought into full play in the treatment of AIDS and make breakthrough progress.

  4. Enhanced integrated nonthermal treatment system study

    SciTech Connect

    Biagi, C.; Schwinkendorf, B.; Teheranian, B.

    1997-02-01

    The purpose of the Enhanced Nonthermal Treatment Systems (ENTS) study is to evaluate alternative configurations of one of the five systems evaluated in the Integrated Nonthermal Treatment Systems (INTS) study. Five alternative configurations are evaluated. Each is designed to enhance the final waste form performance by replacing grout with improved stabilization technologies, or to improve system performance by improving the destruction efficiency for organic contaminants. AU enhanced systems are alternative configurations of System NT-5, which has the following characteristics: Nonthermal System NT-5: (1) catalytic wet oxidation (CWO) to treat organic material including organic liquids, sludges, and soft (or combustible) debris, (2) thermal desorption of inorganic sludge and process residue, (3) washing of soil and inorganic debris with treatment by CWO of removed organic material, (4) metal decontamination by abrasive blasting, (5) stabilization of treated sludge, soil, debris, and untreated debris with entrained contamination in grout, and (6) stabilization of inorganic sludge, salts and secondary waste in polymer. System NT-5 was chosen because it was designed to treat combustible debris thereby minimizing the final waste form volume, and because it uses grout for primary stabilization. The enhanced nonthermal systems were studied to determine the cost and performance impact of replacing grout (a commonly used stabilization agent in the DOE complex) with improved waste stabilization methods such as vitrification and polymer.

  5. Enhancing Treatment Integrity Maintenance through Fading with Indiscriminable Contingencies

    ERIC Educational Resources Information Center

    Gross, Thomas J.; Duhon, Gary J.; Doerksen-Klopp, Bethany

    2014-01-01

    School psychologists are often asked to develop treatment to remediate students' academic skills or social behavior problems. When teachers implement treatment recommendations with high levels of treatment integrity, students benefit. Treatment integrity has been enhanced by use of direct training, performance feedback, and negative…

  6. Enhancing Treatment Integrity Maintenance through Fading with Indiscriminable Contingencies

    ERIC Educational Resources Information Center

    Gross, Thomas J.; Duhon, Gary J.; Doerksen-Klopp, Bethany

    2014-01-01

    School psychologists are often asked to develop treatment to remediate students' academic skills or social behavior problems. When teachers implement treatment recommendations with high levels of treatment integrity, students benefit. Treatment integrity has been enhanced by use of direct training, performance feedback, and negative…

  7. Integrated radwaste treatment system. Final report

    SciTech Connect

    Baker, M.N.; Houston, H.M.

    1997-10-01

    In May 1988, the West Valley Demonstration Project (WVDP) began pretreating liquid high-level radioactive waste (HLW). This HLW was produced during spent nuclear fuel reprocessing operations that took place at the Western New York Nuclear Service Center from 1966 to 1972. Original reprocessing operations used plutonium/uranium extraction (PUREX) and thorium extraction (THOREX) processes to recover usable isotopes from spent nuclear fuel. The PUREX process produced a nitric acid-based waste stream, which was neutralized by adding sodium hydroxide to it. About two million liters of alkaline liquid HLW produced from PUREX neutralization were stored in an underground carbon steel tank identified as Tank 8D-2. The THOREX process, which was used to reprocess one core of mixed uranium-thorium fuel, resulted in about 31,000 liters of acidic waste. This acidic HLW was stored in an underground stainless steel tank identified as Tank 8D-4. Pretreatment of the HLW was carried out using the Integrated Radwaste Treatment System (IRTS), from May 1988 until May 1995. This system was designed to decontaminate the liquid HLW, remove salts from it, and encapsulate the resulting waste into a cement waste form that achieved US Nuclear Regulatory Commission (NRC) criteria for low-level waste (LLW) storage and disposal. A thorough discussion of IRTS operations, including all systems, subsystems, and components, is presented in US Department of Energy (DOE) Topical Report (DOE/NE/44139-68), Integrated Radwaste Treatment System Lessons Learned from 2 1/2 Years of Operation. This document also presents a detailed discussion of lessons learned during the first 2 1/2 years of IRTS operation. This report provides a general discussion of all phases of IRTS operation, and presents additional lessons learned during seven years of IRTS operation.

  8. Enhanced Fowler-Nordheim tunneling effect in nanocrystallite Si based LED with interfacial Si nano-pyramids.

    PubMed

    Lin, Gong-Ru; Lin, Chun-Jung; Lin, Chi-Kuan

    2007-03-05

    The premier observation on the enhanced light emission from such a metal-SiO(x)-Si light emitting diode (MOSLED) with Si nano-pyramids at SiO(x)/Si interface is demonstrated at low biases. The Si nano-pyramids exhibits capability in providing the roughness of the SiO(x)/Si interface, and improving the Fowler-Nordheim (F-N) tunneling mechanism based carrier injection through the novel SiO(x)/nano-Si-pyramid/Si structure. HRTEM analysis reveals a precisely controllable size and concentration of the crystallized interfacial Si nano-pyramids at 10nm(height)x10nm(width) and within the range of 10(8)-10(11) cm(-2), respectively. With these Si nano-pyramids at a surface density of up to 1012/cm(2), the F-N tunneling threshold can be reduce from 7 MV/cm to 1.4 MV/cm. The correlation between surface density of the interfacial Si nano-pyramids and the threshold F-N tunneling field has been elucidated. Such a turn-on reduction essentially provides a less damaged SiO(x)/Si interface as the required bias for the electroluminescence of the MOSLED is greatly decreased, which thus suppresses the generation of structural damage related radiant defects under a lower biased condition and leads to a more stable near-infrared electroluminescence with a narrowing linewidth and an operating lifetime lengthened to >3 hours. An output EL power of nearly 150 nW under a biased voltage of 75 V and current density of 32 mA/cm(2) is reported for the first time.

  9. Extraction of emission parameters for large-area field emitters, using a technically complete Fowler-Nordheim-type equation

    NASA Astrophysics Data System (ADS)

    Forbes, Richard G.

    2012-03-01

    In papers on cold field electron emission from large-area field emitters (LAFEs), it has become widespread practice to publish a misleading Fowler-Nordheim-type (FN-type) equation. This equation over-predicts the LAFE-average current density by a large highly variable factor thought to usually lie between 103 and 109. This equation, although often referenced to FN’s 1928 paper, is a simplified equation used in undergraduate teaching, does not apply unmodified to LAFEs and does not appear in the 1928 paper. Technological LAFE papers often do not cite any theoretical work more recent than 1928, and often do not comment on the discrepancy between theory and experiment. This usage has occurred widely, in several high-profile American and UK applied-science journals (including Nanotechnology), and in various other places. It does not inhibit practical LAFE development, but can give a misleading impression of potential LAFE performance to non-experts. This paper shows how the misleading equation can be replaced by a conceptually complete FN-type equation that uses three high-level correction factors. One of these, or a combination of two of them, may be useful as an additional measure of LAFE quality; this paper describes a method for estimating factor values using experimental data and discusses when it can be used. Suggestions are made for improved engineering practice in reporting LAFE results. Some of these should help to prevent situations arising whereby an equation appearing in high-profile applied-science journals is used to support statements that an engineering regulatory body might deem to involve professional negligence.

  10. Extraction of emission parameters for large-area field emitters, using a technically complete Fowler-Nordheim-type equation.

    PubMed

    Forbes, Richard G

    2012-03-09

    In papers on cold field electron emission from large-area field emitters (LAFEs), it has become widespread practice to publish a misleading Fowler-Nordheim-type (FN-type) equation. This equation over-predicts the LAFE-average current density by a large highly variable factor thought to usually lie between 10(3) and 10(9). This equation, although often referenced to FN's 1928 paper, is a simplified equation used in undergraduate teaching, does not apply unmodified to LAFEs and does not appear in the 1928 paper. Technological LAFE papers often do not cite any theoretical work more recent than 1928, and often do not comment on the discrepancy between theory and experiment. This usage has occurred widely, in several high-profile American and UK applied-science journals (including Nanotechnology), and in various other places. It does not inhibit practical LAFE development, but can give a misleading impression of potential LAFE performance to non-experts. This paper shows how the misleading equation can be replaced by a conceptually complete FN-type equation that uses three high-level correction factors. One of these, or a combination of two of them, may be useful as an additional measure of LAFE quality; this paper describes a method for estimating factor values using experimental data and discusses when it can be used. Suggestions are made for improved engineering practice in reporting LAFE results. Some of these should help to prevent situations arising whereby an equation appearing in high-profile applied-science journals is used to support statements that an engineering regulatory body might deem to involve professional negligence.

  11. A Systematic Framework for Addressing Treatment Integrity in School Settings

    ERIC Educational Resources Information Center

    Kupzyk, Sara; Shriver, Mark D.

    2016-01-01

    School psychologists are tasked with ensuring treatment integrity because the level of intervention implementation affects decisions about student progress. Treatment integrity includes multiple dimensions that may impact the effectiveness of an intervention including adherence, dosage, quality, and engagement. Unfortunately, treatment integrity…

  12. A Systematic Framework for Addressing Treatment Integrity in School Settings

    ERIC Educational Resources Information Center

    Kupzyk, Sara; Shriver, Mark D.

    2016-01-01

    School psychologists are tasked with ensuring treatment integrity because the level of intervention implementation affects decisions about student progress. Treatment integrity includes multiple dimensions that may impact the effectiveness of an intervention including adherence, dosage, quality, and engagement. Unfortunately, treatment integrity…

  13. K West integrated water treatment system subproject safety analysis document

    SciTech Connect

    SEMMENS, L.S.

    1999-02-24

    This Accident Analysis evaluates unmitigated accident scenarios, and identifies Safety Significant and Safety Class structures, systems, and components for the K West Integrated Water Treatment System.

  14. Integration of antiretroviral therapy with tuberculosis treatment.

    PubMed

    Abdool Karim, Salim S; Naidoo, Kogieleum; Grobler, Anneke; Padayatchi, Nesri; Baxter, Cheryl; Gray, Andrew L; Gengiah, Tanuja; Gengiah, Santhanalakshmi; Naidoo, Anushka; Jithoo, Niraksha; Nair, Gonasagrie; El-Sadr, Wafaa M; Friedland, Gerald; Abdool Karim, Quarraisha

    2011-10-20

    We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, the timing for the initiation of ART during tuberculosis treatment remains unresolved. We conducted a three-group, open-label, randomized, controlled trial in South Africa involving 642 ambulatory patients, all with tuberculosis (confirmed by a positive sputum smear for acid-fast bacilli), human immunodeficiency virus infection, and a CD4+ T-cell count of less than 500 per cubic millimeter. Findings in the earlier-ART group (ART initiated within 4 weeks after the start of tuberculosis treatment, 214 patients) and later-ART group (ART initiated during the first 4 weeks of the continuation phase of tuberculosis treatment, 215 patients) are presented here. At baseline, the median CD4+ T-cell count was 150 per cubic millimeter, and the median viral load was 161,000 copies per milliliter, with no significant differences between the two groups. The incidence rate of the acquired immunodeficiency syndrome (AIDS) or death was 6.9 cases per 100 person-years in the earlier-ART group (18 cases) as compared with 7.8 per 100 person-years in the later-ART group (19 cases) (incidence-rate ratio, 0.89; 95% confidence interval [CI], 0.44 to 1.79; P=0.73). However, among patients with CD4+ T-cell counts of less than 50 per cubic millimeter, the incidence rates of AIDS or death were 8.5 and 26.3 cases per 100 person-years, respectively (incidence-rate ratio, 0.32; 95% CI, 0.07 to 1.13; P=0.06). The incidence rates of the immune reconstitution inflammatory syndrome (IRIS) were 20.1 and 7.7 cases per 100 person-years, respectively (incidence-rate ratio, 2.62; 95% CI, 1.48 to 4.82; P<0.001). Adverse events requiring a switching of antiretroviral drugs occurred in 10 patients in the earlier-ART group and 1 patient in the later-ART group (P=0.006). Early initiation of ART in patients with CD4+ T-cell counts of less than 50 per cubic millimeter increased AIDS

  15. Determination of Fowler-Nordheim tunneling parameters in Metal-Oxide-Semiconductor structure including oxide field correction using a vertical optimization method

    NASA Astrophysics Data System (ADS)

    Toumi, S.; Ouennoughi, Z.; Strenger, K. C.; Frey, L.

    2016-08-01

    Current conduction mechanisms through a Metal-Oxide-Semiconductor structure are characterized via Fowler-Nordheim (FN) plots. The extraction of the FN parameters like the electron/hole effective mass in oxide mox and in semiconductor msc, the barrier height at the semiconductor-oxide interface ϕB, and the correction oxide voltage Vcorr for a MOS structure is made using a vertical optimization process on the current density without any assumption about ϕB or mox. An excellent agreement is obtained between the FN plots calculated with the FN parameters extracted using a vertical optimization process with the experimental one.

  16. Treatment Integrity in Behavioral Consultation: Measurement, Promotion, and Outcomes

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Kratochwill, Thomas R.

    2008-01-01

    The purpose of this article is to provide an overview of the current state of research in the area of treatment integrity as it relates to behavioral consultation. To this end, four primary topics are discussed. First, a rationale for why treatment integrity is an important professional and methodological concern is presented. Second,…

  17. Effects of Verbal and Graphed Feedback on Treatment Integrity

    ERIC Educational Resources Information Center

    Zoder-Martell, Kimberly; Dufrene, Brad; Sterling, Heather; Tingstrom, Daniel; Blaze, John; Duncan, Neelima; Harpole, Lauren

    2013-01-01

    Treatment integrity is the degree to which an intervention is implemented as designed and is critical for concluding whether the intervention is responsible for treatment outcomes. This study aimed to add to the integrity literature by examining graphed performance feedback alone and in conjunction with verbal performance feedback for increasing…

  18. An Evaluation of the Observer Effect on Treatment Integrity in a Day Treatment Center for Children

    ERIC Educational Resources Information Center

    Howard, Monica R.; Burke, Raymond V.; Allen, Keith D.

    2013-01-01

    Treatment integrity is an important concern in treatment centers but is often overlooked. Performance feedback is a well-established approach to improving treatment integrity, but is underused and undervalued. One way to increase its value to treatment centers may be to expose unrealized benefits on the observer who collects the performance…

  19. An Evaluation of the Observer Effect on Treatment Integrity in a Day Treatment Center for Children

    ERIC Educational Resources Information Center

    Howard, Monica R.; Burke, Raymond V.; Allen, Keith D.

    2013-01-01

    Treatment integrity is an important concern in treatment centers but is often overlooked. Performance feedback is a well-established approach to improving treatment integrity, but is underused and undervalued. One way to increase its value to treatment centers may be to expose unrealized benefits on the observer who collects the performance…

  20. Barriers to Implementing Treatment Integrity Procedures: Survey of Treatment Outcome Researchers

    ERIC Educational Resources Information Center

    Perepletchikova, Francheska; Hilt, Lori M.; Chereji, Elizabeth; Kazdin, Alan E.

    2009-01-01

    Treatment integrity refers to implementing interventions as intended. Treatment integrity is critically important for experimental validity and for drawing valid inferences regarding the relationship between treatment and outcome. Yet, it is rarely adequately addressed in psychotherapy research. The authors examined barriers to treatment integrity…

  1. [AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders].

    PubMed

    Schlüter-Müller, Susanne

    2017-07-01

    AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders Personality disorders are patterns of maladaptive personality traits that have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe, but treatable mental disorder. Identity disturbance is seen as the central construct for detecting severe personality pathology - and, most notably, borderline personality disorder - in adults and adolescents. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning whereas identity diffusion is viewed as a lack of integration of the concept of the self and significant others. It is seen as the basis for subsequent personality pathology, including that of borderline personality disorder. Although BPD has its onset in adolescence and emerging adulthood the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Adolescent Identity Treatment (AIT) is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, a behavior-oriented homeplan and intensive family work is part of AIT.

  2. The particle production at the event horizon of a black hole as gravitational Fowler-Nordheim emission in uniformly accelerated frame, in the non-relativistic scenario

    NASA Astrophysics Data System (ADS)

    De, Sanchari; Ghosh, Sutapa; Chakrabarty, Somenath

    2015-11-01

    In the conventional scenario, the Hawking radiation is believed to be a tunneling process at the event horizon of the black hole. In the quantum field theoretic approach the Schwinger's mechanism is generally used to give an explanation of this tunneling process. It is the decay of quantum vacuum into particle anti-particle pairs near the black hole surface. However, in a reference frame undergoing a uniform accelerated motion in an otherwise flat Minkowski space-time geometry, in the non-relativistic approximation, the particle production near the event horizon of a black hole may be treated as a kind of Fowler-Nordheim field emission, which is the typical electron emission process from a metal surface under the action of an external electrostatic field. This type of emission from metal surface is allowed even at extremely low temperature. It has been noticed that in one-dimensional scenario, the Schrödinger equation satisfied by the created particle (anti-particle) near the event horizon, can be reduced to a differential form which is exactly identical with that obeyed by an electron immediately after the emission from the metal surface under the action of a strong electrostatic field. The mechanism of particle production near the event horizon of a black hole is therefore identified with Schwinger process in relativistic quantum field theory, whereas in the non-relativistic scenario it may be interpreted as Fowler-Nordheim emission process, when observed from a uniformly accelerated frame.

  3. Summary of comparative results integrated nonthermal treatment and integrated thermal treatment systems studies

    SciTech Connect

    1996-12-01

    In July 1994, the Idaho National Engineering Laboratory (INEL), under a contract from U.S. Department of Energy`s (DOE) Environment Management Office of Science and Technology (OST, EM-50) published a report entitled {open_quotes}Integrated Thermal Treatment System Study - Phase 1 Results{close_quotes} (EGG-MS-11211). This report was the culmination of over a year of analysis involving scientists and engineers within the DOE complex and from private industry. The purpose of that study was {open_quotes}to conduct a systematic engineering evaluation of a variety of mixed low level waste (MLLW) treatment system alternatives.{close_quotes} The study also {open_quotes}identified the research and development, demonstrations, and testing and evaluation needed to assure unit operability in the most promising alternative system.{close_quotes} This study evaluated ten primary thermal treatment technologies, organized into complete {open_quotes}cradle-to-grave{close_quotes} systems (including complete engineering flow sheets), to treat DOE MLLW and calculated mass balances and 20-year total life cycle costs (TLCC) for all systems. The waste input used was a representative heterogenous mixture of typical DOE MLLW. An additional study was conducted, and then, based on response to these studies, additional work was started to investigate and evaluate non-thermal treatment options on a footing comparable to the effort devoted to thermal options. This report attempts to present a summary overview of the thermal and non-thermal treatment technologies which were examined in detail in the process of the above mentioned reviews.

  4. Integrated design of sewers and wastewater treatment plants.

    PubMed

    Vollertsen, J; Hvitved-Jacobsen, T; Ujang, Z; Talib, S A

    2002-01-01

    Sewer system design must be integrated with wastewater treatment plant design when moving towards a more sustainable urban wastewater management. This integration allows an optimization of the design of both systems to achieve a better and more cost-effective wastewater management. Hitherto integrated process design has not been an option because the tools to predict in-sewer wastewater transformations have been inadequate. In this study the WATS model--being a new and validated tool for in-sewer microbial process simulations--is presented and its application for integrated sewer and treatment plant design is exemplified. A case study on a Malaysian catchment illustrates this integration. The effects of centralization of wastewater treatment and the subsequently longer transport distances are addressed. The layout of the intercepting sewer is optimized to meet the requirements of different treatment scenarios.

  5. Integrating Fuel Treatments into Comprehensive Ecosystem Management

    Treesearch

    Kevin Hyde; Greg Jones; Robin Silverstein; Keith Stockmann; Dan Loeffler

    2006-01-01

    To plan fuel treatments in the context of comprehensive ecosystem management, forest managers must meet multiple-use and environmental objectives, address administrative and budget constraints, and reconcile performance measures from multiple policy directives. We demonstrate a multiple criteria approach to measuring success of fuel treatments used in the Butte North...

  6. Barriers to Implementing Treatment Integrity Procedures in School Psychology Research: Survey of Treatment Outcome Researchers

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; DiGennaro Reed, Florence D.

    2012-01-01

    Treatment integrity data are essential to drawing valid conclusions in treatment outcome studies. Such data, however, are not always included in peer-reviewed research articles in school psychology or related fields. To gain a better understanding of why treatment integrity data are lacking in the school psychology research, we surveyed the…

  7. Barriers to Implementing Treatment Integrity Procedures in School Psychology Research: Survey of Treatment Outcome Researchers

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; DiGennaro Reed, Florence D.

    2012-01-01

    Treatment integrity data are essential to drawing valid conclusions in treatment outcome studies. Such data, however, are not always included in peer-reviewed research articles in school psychology or related fields. To gain a better understanding of why treatment integrity data are lacking in the school psychology research, we surveyed the…

  8. Integrated treatment options for male perpetrators of intimate partner violence.

    PubMed

    Crane, Cory A; Easton, Caroline J

    2017-01-01

    Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach. We reviewed the partner violence literature for detailed reports of traditional as well as innovative, integrated treatment approaches. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered. Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options. We have advanced several recommendations, including the development of and exclusive reliance upon empirically supported treatments, conducting a thorough risk and needs assessment of the offender and the immediate family to facilitate appropriate treatment referrals, integrating content to foster the offender's internal motivation to change maladaptive behaviours, and attempting to minimise offender treatment burdens through the strategic use of integrated treatment models. Intimate partner violence is a complicated and nuanced problem that is perpetrated by a heterogeneous population and requires greater variability in integrated treatment options. [Crane CA, Easton CJ. Integrated treatment options for male perpetrators of intimate partner violence. Drug Alcohol Rev 2017;36:24-33]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  9. [Social integration after 4 years of heroin-assisted treatment].

    PubMed

    Verthein, U; Schäfer, I; Degkwitz, P

    2013-08-01

    Studies from several countries have by now shown the effectiveness of heroin-assisted treatment in comparison to methadone treatment. However, only few long-term results exist, and in particular data with a focus on social integration of the patients are scarce. The study analyzes the course of long-term social integration among the patients of the German diamorphine study. Individual changes in health, drug use and social integration among patients who had participated in a 4-year diamorphine treatment (n=156) were described and statistically tested by means of repeated measures analyses. The criteria used are based on the instruments OTI-HSS and SCL-90-R, on medical findings, urinalyses, and on variables as well as composite scores from the European Addiction Severity Index. In all domains significant improvements were found after long-term treatment. The percentage of patients employed or currently working had increased 3-fold up to 40% after 4 years. Moreover, the living situation and leisure behaviour improved, and criminal activities declined markedly. The main influencing factor for successful social integration after 4 years of treatment is the ability to work. Heroin-assisted treatment is a long-term effective treatment for severely dependent opiate addicts with respect to stabilization of health, reduction of illegal drug use and improvement of social integration. Furthermore, the results show that processes of social (re-)integration of drug users take time. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Phosphorus removal from secondary effluents through integrated constructed treatment system.

    PubMed

    Xiong, Jibing; Qin, Yong; Mahmood, Qaisar; Liu, Hanhu; Yang, Dejun

    2011-01-01

    The treatment capacity of an integrated constructed treatment system (CTS) was explored which was designed to reduce phosphorus (P) from secondary effluents. The integrated CTS was combined with vertical-flow constructed wetland, floating bed and sand filter. The vertical wetland was filled from the bottom to the top with gravels, steel slag and peat. Vetiverzizanioides (L.) Nash was selected to grow in the vertical constructed wetland while Coixlacrymajobi L. was grown in floating bed. The results suggested that integrated CTS displayed excellent removal efficiency for chemical oxygen demand (COD), dissolved phosphorus (DP), and total phosphorus (TP). The average COD removal efficiency of the integrated CTS was 90.45% after 40 days of operation, the average DP and TP removal efficiencies of the integrated CTS were 97.43% and 96.40%, respectively. The integrated CTS has good potential in removing COD as well as P from secondary effluents. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. [Assessing environmental and economical benefits of integrated sewage treatment systems].

    PubMed

    Li, Jin-rong; Zhang, Xiao-hong; Zhang, Hang-bin; Pan, Heng-yu; Liu, Qiang

    2015-08-01

    Sewage treatment, treated water treatment and sludge treatment are three basic units of an integrated sewage treatment system. This work assessed the influence of reusing or discharge of treated water and sludge landfill or compost on the sustainability of an integrated sewage treatment system using emergy analysis and newly proposed emergy indicators. This system's value included its environmental benefits and the products. Environmental benefits were the differences of the environmental service values before and after sewage treatment. Due to unavailability of data of the exchanged substance and energy in the internal system, products' values were attained by newly proposed substitution values. The results showed that the combination of sewage treatment, treated water reuse and sludge landfill had the strongest competitiveness, while the combination of sewage treatment, treated water reuse and earthworm compost was the most sustainable. Moreover, treated water reuse and earthworm compost were helpful for improving the sustainability of the integrated sewage treatment system. The quality of treated water and local conditions should be also considered when implementing the treated water reuse or discharge. The resources efficiency of earthworm compost unit needed to be further improved. Improved emergy indices were more suitable for integrated sewage treatment systems.

  12. [Integrated use of psychotherapeutic treatment methods in therapy of alcoholism].

    PubMed

    Scholz, H; McCutchan, J

    1998-01-01

    The treatment of alcoholism is more promising than commonly assumed. Its success is based on the acceptance of a long-term treatment concept over a period of approximately 2 years, the willingness to differentiate between the individual treatment courses according to their underlying individual psychopathologies as well as adapting treatment measures to the actual phases during restitution. Many years of experience with various psychotherapeutic methods have proven that not so much one certain method, but their integrative application depending on the individual situation is relevant to treatment success. Thus, during treatment, a change between supportive, confrontative, systemic and family therapy-oriented elements can occur.

  13. Fabrication of reproducible sub-5 nm nanogaps by a focused ion beam and observation of Fowler-Nordheim tunneling

    SciTech Connect

    Li, Hu; Wani, Ishtiaq H.; Hayat, Aqib; Leifer, Klaus; Jafri, S. Hassan M.

    2015-09-07

    Creating a stable high resistance sub-5 nm nanogap in between conductive electrodes is one of the major challenges in the device fabrication of nano-objects. Gap-sizes of 20 nm and above can be fabricated reproducibly by the precise focusing of the ion beam and careful milling of the metallic lines. Here, by tuning ion dosages starting from 4.6 × 10{sup 10} ions/cm and above, reproducible nanogaps with sub-5 nm sizes are milled with focused ion beam. The resistance as a function of gap dimension shows an exponential behavior, and Fowler-Nordheim tunneling effect was observed in nanoelectrodes with sub-5 nm nanogaps. The application of Simmon's model to the milled nanogaps and the electrical analysis indicates that the minimum nanogap size approaches to 2.3 nm.

  14. The consequences of dependence between the formal area efficiency and the macroscopic electric field on linearity behavior in Fowler-Nordheim plots

    NASA Astrophysics Data System (ADS)

    de Assis, Thiago A.; Dall'Agnol, Fernando F.; Andrade, Roberto F. S.

    2016-09-01

    This work presents a theoretical explanation for a crossover in the linear behavior in Fowler-Nordheim (FN) plots based on orthodox cold field electron emission (CFE) experimental data. It is characterized by a clear change in the decay rate of usually single-slope FN plots, and has been reported when non-uniform nano-emitters are subject to high macroscopic electric field F M. We assume that the number of emitting spots, which defines an apparent formal area efficiency of CFE surfaces, depends on the macroscopic electric field. Non-uniformity is described by local enhancement factors ≤ft\\{{γj}\\right\\} , which are randomly assigned to each distinct emitter of a conducting CFE surface, from a discrete probability distribution ρ ≤ft({γj}\\right) , with j  =  1, 2. It is assumed that ρ ≤ft({γ1}\\right)<ρ ≤ft({γ2}\\right) , and that {γ1}>{γ2} . The local current density is evaluated by considering a usual Schottky-Nordheim barrier. The results reproduce the two distinct slope regimes in FN plots when {{F}\\text{M}}\\in [2, 20] V μm-1 and are analyzed by taking into account the apparent formal area efficiency, the distribution ρ, and the slopes in the corresponding FN plot. Finally, we remark that our results from numerical solution of Laplace’s equation, for an array of conducting nano-emitters with uniform apex radii 50 nm but different local height, supports our theoretical assumptions and could used in orthodox CFE experiments to test our predictions.

  15. Spiritually Integrated Treatment of Depression: A Conceptual Framework

    PubMed Central

    Peteet, John R.

    2012-01-01

    Many studies have found an inverse correlation between religious/spiritual involvement and depression. Yet several obstacles impede spiritually integrated treatment of depressed individuals. These include specialization and fragmentation of care, inexperience of clinicians and spiritual care providers, ideological bias, boundary and ethical concerns, and the lack of an accepted conceptual framework for integrated treatment. Here I suggest a framework for approaching these obstacles, constructed from a unified view of human experience (having emotional, existential, and spiritual dimensions); spirituality seen as a response to existential concerns (in domains such as identity, hope, meaning/purpose, morality, and autonomy in relation to authority, which are frequently distorted and amplified in depression); a rationale for locating spiritually oriented approaches within a clinician's assessment, formulation, and treatment plan; and recognition of the challenges and potential pitfalls of integrated treatment. PMID:22577530

  16. A new integrated technique for the supportive treatment of sepsis.

    PubMed

    Hartmann, Jens; Harm, Stephan

    2017-03-06

    Although there has been continuous, intensive research for many years in the field of sepsis treatment, currently available treatment options are limited, and there is still a lack of systems that efficiently remove endotoxins as well as mediators. Here, we discuss a newly developed, integrated technique that combines different aspects for their use in extracorporeal blood purification for the supportive treatment of liver failure and sepsis.

  17. Clinical guide to periodontology: part 3. Multidisciplinary integrated treatment.

    PubMed

    Palmer, R M; Ide, M; Floyd, P D

    2014-05-01

    The establishment of periodontal health should be a primary aim in all treatment plans. The methods by which this can be achieved have been dealt with in previous chapters, but there are a number of situations where integration of these treatment methods with other dental disciplines needs to be clarified. To simplify matters this chapter will consider periodontal implications in three main areas: treatment of drifted anterior teeth, pre-restorative procedures and replacement of missing teeth.

  18. [Integral treatment of congenital Chagas disease: the Bolivian experience ].

    PubMed

    Suárez, Eduardo; Alonso-Vega, Cristina; Torrico, Faustino; Córdova, Marisol

    2005-01-01

    We have analyzed the response to the treatment with benznidazol in newborns and nurslings in the Hospital Materno Infantil Germán Urquidi of Cochabamba, Bolivia, between 1999 and 2002. It is important an integral treatment of the nursling with a subsequent information directed to the family. The response was close to 100% when the treatment was correctly administrated. They were not adverse effects and the detected biochemical alterations did not present clinical significance.

  19. Mentoring treatment teams to integrate behavioral and psychopharmacological treatments in developmental disabilities.

    PubMed

    Singh, Nirbhay N; Wahler, Robert G; Sabaawi, Mohamed; Goza, Amanda B; Singh, Subhashni D; Molina, Enrique J; Winton, Alan S W; Strand, Paul S; Hill, Oliver W; Singh, Judy; Barber, Jack W; El-Sabaawi, Mohamed; Dumas, Jean

    2002-01-01

    Individuals with developmental disabilities often have a concomitant psychiatric disorder severe enough to require treatment. The behavioral endpoint of psychiatric disorders may require integrated behavioral and psychopharmacological treatments to stabilize their condition and enhance their quality of life. We used a mindfulness-based mentoring model to facilitate the integration of behavioral and psychopharmacological treatments at the treatment team level. Using a multiple baseline design across treatment teams, we assessed the degree of integration of these two treatment modalities using a 23-item rating scale, and then introduced mentoring successively across the three treatment teams. Following mentoring, six follow-up assessments at monthly intervals were undertaken to assess functioning of the treatment teams in the absence of mentoring. The low levels of integration of behavioral and psychopharmacological treatments occurring during baseline improved significantly within each team commensurate with the mentoring. Further, the enhanced treatment team functioning was maintained during a 6-month follow-up period. Mentoring of treatment teams may be an effective first step in integrating behavioral and psychopharmacological treatments that are deemed essential in the care and treatment of individuals with developmental disabilities and mental illness.

  20. Treatment of domain integrals in boundary element methods

    SciTech Connect

    Nintcheu Fata, Sylvain

    2012-01-01

    A systematic and rigorous technique to calculate domain integrals without a volume-fitted mesh has been developed and validated in the context of a boundary element approximation. In the proposed approach, a domain integral involving a continuous or weakly-singular integrand is first converted into a surface integral by means of straight-path integrals that intersect the underlying domain. Then, the resulting surface integral is carried out either via analytic integration over boundary elements or by use of standard quadrature rules. This domain-to-boundary integral transformation is derived from an extension of the fundamental theorem of calculus to higher dimension, and the divergence theorem. In establishing the method, it is shown that the higher-dimensional version of the first fundamental theorem of calculus corresponds to the well-known Poincare lemma. The proposed technique can be employed to evaluate integrals defined over simply- or multiply-connected domains with Lipschitz boundaries which are embedded in an Euclidean space of arbitrary but finite dimension. Combined with the singular treatment of surface integrals that is widely available in the literature, this approach can also be utilized to effectively deal with boundary-value problems involving non-homogeneous source terms by way of a collocation or a Galerkin boundary integral equation method using only the prescribed surface discretization. Sample problems associated with the three-dimensional Poisson equation and featuring the Newton potential are successfully solved by a constant element collocation method to validate this study.

  1. Hanford Site waste treatment/storage/disposal integration

    SciTech Connect

    MCDONALD, K.M.

    1999-02-24

    In 1998 Waste Management Federal Services of Hanford, Inc. began the integration of all low-level waste, mixed waste, and TRU waste-generating activities across the Hanford site. With seven contractors, dozens of generating units, and hundreds of waste streams, integration was necessary to provide acute waste forecasting and planning for future treatment activities. This integration effort provides disposition maps that account for waste from generation, through processing, treatment and final waste disposal. The integration effort covers generating facilities from the present through the life-cycle, including transition and deactivation. The effort is patterned after the very successful DOE Complex EM Integration effort. Although still in the preliminary stages, the comprehensive onsite integration effort has already reaped benefits. These include identifying significant waste streams that had not been forecast, identifying opportunities for consolidating activities and services to accelerate schedule or save money; and identifying waste streams which currently have no path forward in the planning baseline. Consolidation/integration of planned activities may also provide opportunities for pollution prevention and/or avoidance of secondary waste generation. A workshop was held to review the waste disposition maps, and to identify opportunities with potential cost or schedule savings. Another workshop may be held to follow up on some of the long-term integration opportunities. A change to the Hanford waste forecast data call would help to align the Solid Waste Forecast with the new disposition maps.

  2. Review of the integrated thermal and nonthermal treatment system studies

    SciTech Connect

    Durrani, H.A.; Schmidt, L.J.; Erickson, T.A.; Sondreal, E.A.; Erjavec, J.; Steadman, E.N.; Fabrycky, W.J.; Wilson, J.S.; Musich, M.A.

    1996-07-01

    This report analyzes three systems engineering (SE) studies performed on integrated thermal treatment systems (ITTSs) and integrated nonthermal treatment systems (INTSs) for the remediation of mixed low-level waste (MLLW) stored throughout the US Department of Energy (DOE) weapons complex. The review was performed by an independent team of nine researchers from the Energy and Environmental Research Center (EERC), Science Applications International Corporation (SAIC), the Waste Policy Institute (WPI), and Virginia Tech (VT). The three studies reviewed were as follows: Integrated Thermal Treatment System Study, Phase 1--issued July 1994; Integrated Thermal Treatment System Study, Phase 2--issued February 1996; and Integrated Nonthermal Treatment System Study--drafted March 1996. The purpose of this review was to (1) determine whether the assumptions taken in the studies might bias the resulting economic evaluations of both thermal and nonthermal systems, (2) identify the critical areas of the studies that would benefit from further investigation, and (3) develop a standard template that could be used in future studies to produce sound SE applications.

  3. Review of the integrated thermal and nonthermal treatment system studies

    SciTech Connect

    1996-08-01

    This report contains a review and evaluation of three systems analysis studies performed by LITCO on integrated thermal treatment systems and integrated nonthermal treatment systems for the remediation of mixed low-level waste stored throughout the US Department of Energy weapons complex. The review was performed by an independent team of nine researchers from the Energy and Environmental Research Center, Science Applications International Corporation, the Waste Policy Institute, and Virginia Tech. The three studies reviewed were as follows: Integrated Thermal Treatment System Study, Phase 1--issued July 1994; Integrated Thermal Treatment System Study, Phase 2--issued February 1996; and Integrated Nonthermal Treatment System Study--drafted March 1996. The purpose of this review was to (1) determine whether the assumptions of the studies were adequate to produce an unbiased review of both thermal and nonthermal systems, (2) to identify the critical areas of the studies that would benefit from further investigation, and (3) to develop a standard template that could be used in future studies to assure a sound application of systems engineering.

  4. Biological treatment and ozone oxidation: Integration or coupling?

    PubMed

    Di Iaconi, Claudio

    2012-02-01

    Wastewaters generated by many economically relevant industrial activities contain recalcitrant organic compounds which pass unaltered through biological stage of the treatment plant making it difficult to meet the discharge limits currently in force. Therefore, an additional treatment is usually required to remove these compounds. In this study, the application of ozonation together with biological treatment was investigated. In particular, the effectiveness of biological degradation followed by or integrated with ozonation for treating the effluents produced by three environmentally relevant activities (i.e., leather and textile processing and municipal waste landfilling) are compared in the present paper. The results show that biological treatment followed by ozonation does not guarantee depurative levels sufficient for discharge for landfill leachates and tannery wastewater. On the contrary, thanks to the synergy between biological degradation and ozonation, integrated treatment significantly improves the process performance for all the investigated wastewaters, thus allowing the discharge limits to be met. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Process modeling for the Integrated Nonthermal Treatment System (INTS) study

    SciTech Connect

    Brown, B.W.

    1997-04-01

    This report describes the process modeling done in support of the Integrated Nonthermal Treatment System (INTS) study. This study was performed to supplement the Integrated Thermal Treatment System (ITTS) study and comprises five conceptual treatment systems that treat DOE contract-handled mixed low-level wastes (MLLW) at temperatures of less than 350{degrees}F. ASPEN PLUS, a chemical process simulator, was used to model the systems. Nonthermal treatment systems were developed as part of the INTS study and include sufficient processing steps to treat the entire inventory of MLLW. The final result of the modeling is a process flowsheet with a detailed mass and energy balance. In contrast to the ITTS study, which modeled only the main treatment system, the INTS study modeled each of the various processing steps with ASPEN PLUS, release 9.1-1. Trace constituents, such as radionuclides and minor pollutant species, were not included in the calculations.

  6. [Integration of nutritional care into cancer treatment: need for improvement].

    PubMed

    Joly, Caroline; Jacqueline-Ravel, Nathalie; Pugliesi-Rinaldi, Angela; Bigler-Perrotin, Lucienne; Chikhi, Marinette; Dietrich, Pierre-Yves; Dulguerov, Pavel; Miralbell, Raymond; Picard-Kossovsky, Michel; Seium, Yodit; Thériault, Michel; Pichard, Claude

    2011-11-16

    Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects.

  7. Assessing Treatment Integrity in Alcohol Behavioral Couple Therapy.

    PubMed

    Hallgren, Kevin A; Crotwell, Shirley M; Muñoz, Rosa E; Gius, Becky K; McCrady, Barbara S; Ladd, Benjamin O; Epstein, Elizabeth E

    2016-06-01

    Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for alcohol use disorders. Coding treatment integrity can shed light on the active ingredients of ABCT, but there are no published studies of treatment integrity instruments for ABCT. The present study describes the development and initial reliability of the Treatment Integrity Rating System - Couples Version (C-TIRS) for ABCT. The C-TIRS was used to rate 284 first- and mid-treatment ABCT sessions of 188 couples in four randomized clinical trials. Average inter-rater reliability for distinguishing ratings between C-TIRS items was fair-to-good for quantity items (intraclass correlation [ICC] = 0.64) and poor-to-fair for quality items (ICC = 0.41). Five C-TIRS subscales were defined a priori to measure treatment components involving cognitive-behavioral therapy, spouse involvement, couple therapy, common therapeutic factors, and overall adherence to the treatment protocol and had adequate internal reliability (α = 0.74-0.89). Inter-rater reliability was fair to good on seven of ten scales but poor on three scales (ICC range = 0.17-0.72). The C-TIRS was designed to provide information about quantity and quality of the delivery of ABCT components; however, further refinement of the C-TIRS is warranted before it should be used in frontline practice. Clinical implications and recommendations for future research are discussed.

  8. A Comparison of Treatment Integrity Assessment Methods for Behavioral Intervention

    ERIC Educational Resources Information Center

    Koh, Seong A.

    2010-01-01

    The purpose of this study was to examine the similarity of outcomes from three different treatment integrity (TI) methods, and to identify the method which best corresponded to the assessment of a child's behavior. Six raters were recruited through individual contact via snowball sampling. A modified intervention component list and 19 video clips…

  9. Improving Treatment Integrity through a Functional Approach to Intervention Support

    ERIC Educational Resources Information Center

    Liaupsin, Carl J.

    2015-01-01

    A functional approach to intervention planning has been shown to be effective in reducing problem behaviors and promoting appropriate behaviors in children and youth with behavior disorders. When function-based intervention plans are not successful, it is often due to issues of treatment integrity in which teachers omit or do not sufficiently…

  10. A Comparison of Treatment Integrity Assessment Methods for Behavioral Intervention

    ERIC Educational Resources Information Center

    Koh, Seong A.

    2010-01-01

    The purpose of this study was to examine the similarity of outcomes from three different treatment integrity (TI) methods, and to identify the method which best corresponded to the assessment of a child's behavior. Six raters were recruited through individual contact via snowball sampling. A modified intervention component list and 19 video clips…

  11. A Treatment Integrity Analysis of Function-Based Intervention

    ERIC Educational Resources Information Center

    Wood, Brenna K.; Umbreit, John; Liaupsin, Carl J.; Gresham, Frank M.

    2007-01-01

    This study examined whether direct, interval-by-interval measures of treatment integrity would make it possible to distinguish whether equivocal intervention results could be attributed to the intervention itself, or to poor implementation. Josh, an eight-year-old 3rd grader, performed at or slightly above his peers' academically, yet engaged in…

  12. Changing Donor Funding and the Challenges of Integrated HIV Treatment.

    PubMed

    Nattrass, Nicoli; Hodes, Rebecca; Cluver, Lucie

    2016-07-01

    Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities.

  13. Integrating translational neuroscience to improve drug abuse treatment for adolescents.

    PubMed

    Boyce, Cheryl Anne; Lynne-Landsman, Sarah D

    2013-06-01

    Adolescence is an exciting and challenging period of maturation, rapid brain development, and developmental changes in neurobiological, neurocognitive, and neurobehavioral processes. Although behavioral therapies available for adolescent substance abuse have increased, effectiveness research in this area lags considerably behind that of clinical research on treatment for drug-abusing adults. Behavioral treatment approaches show significant promise for treating drug-abusing adolescents, but many have not incorporated innovations in neuroscience on brain development, cognitive processes, and neuroimaging. Linking developmental neuroscience with behavioral treatments can create novel drug abuse interventions and increase the effectiveness of existing interventions for substance-abusing adolescents. Contemporary research on brain development, cognition, and neuroscience is ripe for translation to inform developmentally sensitive drug abuse treatments for adolescents. Neuroscientists and interventionists are challenged to build mutual collaborations for integration of neuroscience and drug abuse treatment for adolescents. 2013 APA, all rights reserved

  14. Integrative Treatment of Pediatric Obesity: Psychological and Spiritual Considerations

    PubMed Central

    Boisvert, Jennifer A.; Harrell, W. Andrew

    2015-01-01

    This article presents an integrative approach to the problem of pediatric obesity, which is a multifaceted medical condition that is epidemic in the United States and elsewhere in the world. In this article, definitions of pediatric obesity are provided, and its prevalence, etiological factors, medical complications, and comorbidities are reviewed. Psychological and spiritual factors associated with pediatric obesity are discussed, together with their importance to integrative treatment. This review suggests that the use of psychological interventions, such as cognitive behavioral therapy (CBT) and animal-assisted therapy (AAT), can be considered in conjunction with medical and educational interventions to treat pediatric obesity successfully. PMID:26770130

  15. [Integral treatment of children with dyslexia--40 years experience].

    PubMed

    Stošljević, Miodrag; Odović, Gordana; Adamović, Milosav

    2012-01-01

    Dyslexia represents a significant pediatric problem requiring prompt and appropriate treatment. The aim of this study was to examine the significance of integral rehabilitation approach in treating dyslexia of children. Objectives of the study were accomplished on a sample of 300 children, aged 11-15 years, with etiologically variable dyslexia. The results gained from the integral treatment of children with dyslexia were more successful than those obtained from isolated logaoedic treatment, when compared in 10-15 examined variables; replacement of graphically similar letters (p = 0.000), replacement of syllables (p = 0.010), replacement of words--guessing (p = 0.019), structural errors--displacement or insertion (p = 0.038), adding letters and syllables (p = 0.001), repeating of word parts (p = 0.001), reading of a word in several wrong ways (p = 0.001), omission of words and whole lines (p = 0.000), returning to already read line (p = 0.000), level of dyslexia (p = 0.000). Dyslexia requires a multidisciplinary therapeutic approach in which integral rehabilitation treatment has an exceptionally large significance.

  16. Evaluation of treatment integrity errors on mand acquisition.

    PubMed

    Pence, Sacha T; St Peter, Claire C

    2015-09-01

    Manding allows individuals to access reinforcers in their environment. Caregivers may not implement mand-training programs as designed, which could result in decreased mand proficiency. This study evaluated the effects of delivery of the incorrect item (Experiment 1) and response-independent item delivery (Experiment 2) across 4 levels of treatment integrity (0%, 40%, 70%, and 100%) on mand acquisition with individuals with developmental disabilities. During Experiment 1, 2 of the 3 participants acquired the mand fastest during 100% integrity. Delivery of the incorrect item was detrimental to acquisition, but effects were idiosyncratic. During Experiment 2, all participants acquired the mand trained with 100% integrity fastest, followed by the mand trained with 70% integrity. None of the participants acquired the mands trained with 40% and 0% integrity, suggesting that delivery of the item independent of responding was detrimental to acquisition. For mand training to be most effective, caregivers must implement mand training with high levels of integrity. © Society for the Experimental Analysis of Behavior.

  17. Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol.

    PubMed

    Hogue, Aaron; Bobek, Molly; Tau, Gregory Z; Levin, Frances R

    2014-10-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions.

  18. Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

    PubMed Central

    Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.

    2014-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817

  19. An Experimental Examination of the Impact of Choice of Treatment Components on Treatment Integrity

    ERIC Educational Resources Information Center

    Andersen, Melissa; Daly, Edward J., III

    2013-01-01

    Although there is a growing body of research on the use of performance feedback to improve treatment integrity, antecedent interventions have received little attention. Antecedent interventions are simple to use and have a strong research base. This study examined the effects of offering teachers choice of treatment components. A choice condition…

  20. An Experimental Examination of the Impact of Choice of Treatment Components on Treatment Integrity

    ERIC Educational Resources Information Center

    Andersen, Melissa; Daly, Edward J., III

    2013-01-01

    Although there is a growing body of research on the use of performance feedback to improve treatment integrity, antecedent interventions have received little attention. Antecedent interventions are simple to use and have a strong research base. This study examined the effects of offering teachers choice of treatment components. A choice condition…

  1. Treatment provision for gambling disorder in Britain: call for an integrated addictions treatment and commissioning model

    PubMed Central

    George, Sanju; Bowden-Jones, Henrietta

    2016-01-01

    Treatment provision for individuals with gambling problems in Britain is at best inadequate. Here we call for gambling treatment provision to be integrated into mainstream drug and alcohol services, and for its commissioning responsibilities to fall under local public health departments. PMID:27280028

  2. The role of Hurst exponent on cold field electron emission from conducting materials: from electric field distribution to Fowler-Nordheim plots

    PubMed Central

    de Assis, T. A.

    2015-01-01

    This work considers the effects of the Hurst exponent (H) on the local electric field distribution and the slope of the Fowler-Nordheim (FN) plot when considering the cold field electron emission properties of rough Large-Area Conducting Field Emitter Surfaces (LACFESs). A LACFES is represented by a self-affine Weierstrass-Mandelbrot function in a given spatial direction. For 0.1 ≤ H < 0.5, the local electric field distribution exhibits two clear exponential regimes. Moreover, a scaling between the macroscopic current density () and the characteristic kernel current density (), , with an H-dependent exponent , has been found. This feature, which is less pronounced (but not absent) in the range where more smooth surfaces have been found (), is a consequence of the dependency between the area efficiency of emission of a LACFES and the macroscopic electric field, which is often neglected in the interpretation of cold field electron emission experiments. Considering the recent developments in orthodox field emission theory, we show that the exponent must be considered when calculating the slope characterization parameter (SCP) and thus provides a relevant method of more precisely extracting the characteristic field enhancement factor from the slope of the FN plot. PMID:26035290

  3. Integrated thermal treatment systems study. Internal review panel report

    SciTech Connect

    Cudahy, J.; Escarda, T.; Gimpel, R.

    1995-04-01

    The U.S. Department of Energy (DOE) Office of Technology Development (OTD) commissioned two studies to evaluate nineteen thermal treatment technologies for treatment of DOE mixed low-level waste. These studies were called the Integrated Thermal Treatment System (ITTS) Phase I and Phase II. With the help of the DOE Office of Environmental Management (EM) Mixed Waste Focus Group, OTD formed an ITTS Internal Review Panel to review and comment on the ITTS studies. This Panel was composed of scientists and engineers from throughout the DOE complex, the U.S. Environmental Protection Agency, the California EPA, and private experts. The Panel met from November 15-18, 1994 to review the ITTS studies and to make recommendations on the most promising thermal treatment systems for DOE mixed low-level wastes and on research and development necessary to prove the performance of the technologies. This report describes the findings and presents the recommendations of the Panel.

  4. Review of the integrated thermal and nonthermal treatment system studies

    SciTech Connect

    1996-10-01

    This report contains a review and evaluation of three systems analysis studies performed by LITCO on integrated thermal treatment systems and integrated nonthermal treatment systems for the remediation of mixed low-level waste stored throughout the US Department of Energy weapons complex. The review was performed by an independent team of nine researchers from the Energy and Environmental Research Center, Science Applications International Corporation, the Waste Policy Institute, and Virginia Tech. The purpose of this review was to (1) determine whether the assumptions of the studies were adequate to produce an unbiased review of both thermal and nonthermal systems, (2) to identify the critical areas of the studies that would benefit from further investigation, and (3) to develop a standard template that could be used in future studies to assure a sound application of systems engineering.

  5. Integrated thermal treatment system sudy: Phase 2, Results

    SciTech Connect

    Feizollahi, F.; Quapp, W.J.

    1995-08-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study, the results of which have been published as an interim report, examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 2 systems. The assumptions and methods were the same as for the Phase 1 study. The quantities, and physical and chemical compositions, of the input waste used in he Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr).

  6. Mixed Waste Treatment Project: Computer simulations of integrated flowsheets

    SciTech Connect

    Dietsche, L.J.

    1993-12-01

    The disposal of mixed waste, that is waste containing both hazardous and radioactive components, is a challenging waste management problem of particular concern to DOE sites throughout the United States. Traditional technologies used for the destruction of hazardous wastes need to be re-evaluated for their ability to handle mixed wastes, and in some cases new technologies need to be developed. The Mixed Waste Treatment Project (MWTP) was set up by DOE`s Waste Operations Program (EM30) to provide guidance on mixed waste treatment options. One of MWTP`s charters is to develop flowsheets for prototype integrated mixed waste treatment facilities which can serve as models for sites developing their own treatment strategies. Evaluation of these flowsheets is being facilitated through the use of computer modelling. The objective of the flowsheet simulations is to provide mass and energy balances, product compositions, and equipment sizing (leading to cost) information. The modelled flowsheets need to be easily modified to examine how alternative technologies and varying feed streams effect the overall integrated process. One such commercially available simulation program is ASPEN PLUS. This report contains details of the Aspen Plus program.

  7. Integrated thermal treatment system study: Phase 1 results. Volume 1

    SciTech Connect

    Feizollahi, F.; Quapp, W.J.; Hempill, H.G.; Groffie, F.J.

    1994-07-01

    An integrated systems engineering approach is used for uniform comparison of widely varying thermal treatment technologies proposed for management of contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. Ten different systems encompassing several incineration design options are studied. All subsystems, including facilities, equipment, and methods needed for integration of each of the ten systems are identified. Typical subsystems needed for complete treatment of MLLW are incoming waste receiving and preparation (characterization, sorting, sizing, and separation), thermal treatment, air pollution control, primary and secondary stabilization, metal decontamination, metal melting, mercury recovery, lead recovery, and special waste and aqueous waste treatment. The evaluation is performed by developing a preconceptual design package and planning life-cycle cost (PLCC) estimates for each system. As part of the preconceptual design process, functional and operational requirements, flow sheets and mass balances, and conceptual equipment layouts are developed for each system. The PLCC components estimated are technology development, production facility construction, pre-operation, operation and maintenance, and decontamination and decommissioning. Preconceptual design data and other technology information gathered during the study are examined and areas requiring further development, testing, and evaluation are identified and recommended. Using a qualitative method, each of the ten systems are ranked.

  8. Integrating psychotherapy and pharmacotherapy in the treatment of premature ejaculation

    PubMed Central

    Ciocca, Giacomo; Limoncin, Erika; Mollaioli, Daniele; Gravina, Giovanni Luca; Di Sante, Stefania; Carosa, Eleonora; Lenzi, Andrea; Jannini, Emmanuele A.

    2013-01-01

    Objectives To describe the different approaches to the treatment of premature ejaculation (PE), with a final focus on integrated treatment, as conventional theories and therapies for PE are based on an organic or psychogenic dichotomy. Methods We list the principal hypotheses of the causes and therapy of PE on the basis of psychological and medical perspectives, after identifying all relevant studies available on Medline up to 2012. Results The cognitive feedback from PE can lead to a ‘performance anxiety’, which can combine with other conditions to further impair ejaculatory control. For these reasons, a psychological approach is always useful in treating PE, the most useful of which are sex therapy and behavioural therapy. For pharmacological treatment, reports suggest that dapoxetine (60 mg) significantly improves the control of the ejaculatory reflex, and it thus represents the first-line officially approved pharmacotherapy for PE. Conclusions A holistic approach which considers the biological, psychological and relational aspects is the advised treatment for PE. Integrated medical and psycho-sexological therapy requires a mutual understanding of and respect for the different disciplines involved in sexology. In this aspect two very important roles are those of the physician and the psychologist. PMID:26558097

  9. Toward Developing a Science of Treatment Integrity: Introduction to the Special Series

    ERIC Educational Resources Information Center

    Hagermoser Sanetti, Lisa M.; Kratochwill, Thomas R.

    2009-01-01

    Treatment integrity (also referred to as "treatment fidelity," "intervention integrity," and "procedural reliability") is an important methodological concerning both research and practice because treatment integrity data are essential to making valid conclusions regarding treatment outcomes. Despite its relationship to validity, treatment…

  10. Toward Developing a Science of Treatment Integrity: Introduction to the Special Series

    ERIC Educational Resources Information Center

    Hagermoser Sanetti, Lisa M.; Kratochwill, Thomas R.

    2009-01-01

    Treatment integrity (also referred to as "treatment fidelity," "intervention integrity," and "procedural reliability") is an important methodological concerning both research and practice because treatment integrity data are essential to making valid conclusions regarding treatment outcomes. Despite its relationship to validity, treatment…

  11. Simulation of wastewater treatment plant within integrated urban wastewater models.

    PubMed

    Heusch, S; Kamradt, B; Ostrowski, M

    2010-01-01

    In the federal state of Hesse in Germany the application of an integrated software modelling framework is becoming part of the planning process to attain legal approval for the operation of combined sewer systems. The software allows for parallel simulation of flow and water quality routing in the sewer system and in receiving rivers. It combines existing pollution load model approaches with a simplified version of the River Water Quality Model No. 1 (RWQM1). Comprehensive simulation of the wastewater treatment plant (WWTP) is not considered yet. The paper analyses alternatives for the implementation of a WWTP module to model activated sludge plants. For both primary and secondary clarifiers as well as for the activated sludge process concepts for the integration into the existing software framework were developed. The activated sludge concept which uses a linearized version of the well known ASM1 model is presented in detail.

  12. Integrative Treatments to Reduce Risk for Cardiovascular Disease

    PubMed Central

    Bradley, Ryan; Oberg, Erica

    2010-01-01

    Recognizing the contribution and interrelatedness of lipoprotein risk factors is critical to prioritizing treatment strategies for cardiovascular risk reduction. Lipoprotein factors still dominate risk for developing cardiovascular disease, including myocardial infarction. Some emerging risk factors such as C-reactive protein are gaining acceptance due to recent prospective clinical trials demonstrating clinical benefit in reducing these markers. Other emerging risk factors, including lipoprotein particle size, remain to be validated. In this second article of a 2-part series, we will begin with a review of formal risk assessment, discussing the contribution of multiple “risky” and “healthy” components that play a part in overall cardiovascular health. Following risk assessment, we will discuss evidence-based integrative therapies that can be used to modify any risky lipoprotein and inflammatory patient profiles, including medications, functional foods, supplements, and lifestyle approaches. The focus is on low-density lipoproteins, high-density lipoproteins, triglycerides, and C-reactive protein. Understanding the interrelatedness of lipoprotein risk factors, and finding efficient methods of treating multiple risk factors simultaneously, will not only improve the long-term health of patients but will also save on the expenditure of healthcare dollars for unnecessary testing and ineffective treatments. Integrative practitioners who understand the contribution of lifestyle factors, and who have numerous effective treatment options at their disposal, are well positioned to counsel patients on cardiovascular disease prevention. PMID:21461347

  13. Integrated thermal treatment system study -- Phase 2 results. Revision 1

    SciTech Connect

    Feizollahi, F.; Quapp, W.J.

    1996-02-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 1 systems. The alternatives evaluated were: rotary kiln, slagging kiln, plasma furnace, plasma gasification, molten salt oxidation, molten metal waste destruction, steam gasification, Joule-heated vitrification, thermal desorption and mediated electrochemical oxidation, and thermal desorption and supercritical water oxidation. The quantities, and physical and chemical compositions, of the input waste used in the Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr). 28 refs., 88 figs., 41 tabs.

  14. Toward Treatment Integrity: Developing an Approach to Measure the Treatment Integrity of a Dialectical Behavior Therapy Intervention With Homeless Youth in the Community.

    PubMed

    McCay, Elizabeth; Carter, Celina; Aiello, Andria; Quesnel, Susan; Howes, Carol; Johansson, Bjorn

    2016-10-01

    The current paper discusses an approach to measuring treatment integrity of dialectical behavioral therapy (DBT) when implemented within two programs providing services to street-involved youth in the community. Measuring treatment integrity is a critical component of effective implementation of evidence-based interventions in clinical practice, since sound treatment integrity increases confidence in client outcomes and intervention replicability. Despite being an essential part of implementation science, few studies report on treatment integrity, with limited research addressing either measurement tools or maintenance of treatment integrity. To address the lack of available treatment integrity measures, researchers in the current study developed and piloted a treatment integrity measure which pertain to the individual and group components of DBT. A total of 20 recordings were assessed using the treatment integrity measure. Results indicate that the community agency staff (e.g. youth workers, social workers & nurses) implemented the intervention as intended; increasing confidence in the outcome variables, the staffs' training and the replicability of the intervention. This article offers one approach to addressing treatment integrity when implementing evidence-based interventions, such as DBT in a community setting, and discusses the need for effective and feasible integrity measures that can be adopted in order to strengthen mental health practice in community settings. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Integrated care for pregnant women on methadone maintenance treatment

    PubMed Central

    Ordean, Alice; Kahan, Meldon; Graves, Lisa; Abrahams, Ronald; Boyajian, Talar

    2013-01-01

    Abstract Objective To describe the characteristics of a national cohort of pregnant women on methadone maintenance treatment (MMT) and to provide treatment outcome data for integrated care programs. Design Retrospective chart review. Setting Three different integrated care programs in geographically distinct cities: the Toronto Centre for Substance Use in Pregnancy in Toronto, Ont; the Herzl Family Practice Centre in Montreal, Que; and the Sheway clinic in Vancouver, BC. Participants Pregnant women meeting criteria for opioid dependence and attending an integrated care program between 1997 and 2009. Women were excluded if they were on MMT only for chronic pain. Main outcome measures Patient demographic characteristics, concurrent medical and psychiatric disorders, and substance use outcome data. Results A total of 102 opioid-dependent pregnancies were included. The mean age was 29.7 years and 64% of women were white. Women in Montreal were more likely to have partners and had fewer children. Differences in living and housing situations among the sites tended to resolve by the time of delivery. Almost half of this cohort tested positive for hepatitis C. Women had a high prevalence of depression and anxiety across all sites. Half of this cohort was on MMT before conception and for the other half, MMT was initiated at a mean gestational age of 20.7 weeks, resulting in a mean dose of 82.4 mg at delivery. At the first visit, polysubstance use was common. Prescription opioid use was more frequent in Toronto and heroin use was more prevalent in Vancouver and Montreal. For the entire population, significant reductions were found by the time of delivery for illicit (P < .001) and prescription opioids (P = .001), cocaine (P < .001), marijuana (P = .009), and alcohol use (P < .001). Conclusion Despite geographic differences, all 3 integrated care programs have been associated with significant decreases in substance use in pregnant opioid-dependent women. PMID:24130301

  16. Integrated pharmacologic treatment of attention-deficit hyperactivity disorder (ADHD).

    PubMed

    Horst, Robert O; Hendren, Robert L

    2005-01-01

    This article is a review of what is currently known about optimal treatments for patients with attention-deficit hyperactivity disorder (ADHD). It begins with a description of assessment techniques and the differential diagnosis, which includes learning disorders, anxiety disorders, and bipolar disorder. The high rate of comorbidity in patients with ADHD and the impact of comorbidity on treatment decisions are also discussed. Detailed descriptions of various pharmacologic treatments are provided, including a description of the role of combination pharmacotherapy and the integration of nonpharmacologic therapy. A decision-making model for selecting the most appropriate pharmacologic therapy versus combining pharmacotherapy with psychosocial interventions is described. The advantages and disadvantages of various pharmacologic agents--including long-acting stimulants and atomoxetine--are examined. Particular attention is paid to the recent Multimodal Treatment Study of Attention-Deficit Hyperactivity Disorder, sponsored by the National Institute of Mental Health, which includes a comparison of long-term pharmacotherapy, behavioral therapy, or a combination thereof, as well as an evaluation of the role of community-based therapy (i.e., treatment as usual). This article focuses on children and adolescents, because most of the research on ADHD has been conducted in this age group. However, a brief section on adults is also provided.

  17. Integrated Waste Treatment Unit GFSI Risk Management Plan

    SciTech Connect

    W. A. Owca

    2007-06-21

    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP).

  18. West Valley operation of an integrated radwaste treatment system

    SciTech Connect

    Valenti, P.J.; Cwynar, J.C.; Gessner, R.F.

    1989-01-01

    The US Department of Energy is charged with the solidification of high-level liquid waste remaining from nuclear fuel reprocessing activities, which were conducted at West Valley, New York, between 1966 and 1972. One important aspect of the project's fully integrated waste program is the management of low-level wastes (LLWs) that result from treating high-level waste. At the West Valley Demonstration Project, {approximately}650,000 gal of high-level radioactive waste is stored in an underground tank. The waste has separated into two phases, i.e., a liquid or supernatant that comprises 90% of this 650,000 gal and a 10% layer of sludge on the bottom of the tank. Estimates based on radiochemical analysis show that the supernatant contains {approximately}7.4 million Ci of predominantly {sup 137}Cs. The purpose of the integrated radwaste treatment system (IRTS) is to remove as much {sup 137}Cs as possible from the supernatant by utilizing an ion exchange technique and to solidify the remaining liquid into a certifiable class C cement LLW form that meets the waste form criteria specified in the US Nuclear Regulatory Commission's (NRC's) 10CFR61. Waste is to be solidified in 71-gal square drums and remotely handled and stored on-site until determination of final disposition. This paper describes the very successful experiences gained in the treatment and solidification of the LLW stream produced as well as the processes and controls employed on the cemented waste.

  19. Treatment Integrity in Psychotherapy Research: Analysis of the Studies and Examination of the Associated Factors

    ERIC Educational Resources Information Center

    Perepletchikova, Francheska; Treat, Teresa A.; Kazdin, Alan E.

    2007-01-01

    Treatment integrity refers to the degree to which an intervention is delivered as intended. Two studies evaluated the adequacy of treatment integrity procedures (including establishing, assessing, evaluating, and reporting integrity; therapist treatment adherence; and therapist competence) implemented in psychotherapy research, as well as…

  20. [Home treatment--a treatment model of integrated care in Hamburg].

    PubMed

    Schöttle, Daniel; Ruppelt, Friederike; Karow, Anne; Lambert, Martin

    2015-03-01

    Treatment models like "Crisis Resolution and Hometreatment (CRHT)" or "Assertive Community Treatment" (ACT), were found to be effective, enhancing the qualitative level of treatment for patients with severe mental disorders. In Germany, these are implemented only sporadically until today, often as part of a cross-sectoral Integrated Care (IC) treatment system. We will present the implementation of an "Assertive Community Treatment" embedded into an IC-treatment model in Hamburg and discuss the 3-year-outcomes. The IC-treatment model has been designed for severe mentally ill patients with psychotic disorders. Since May 2007 the model is financed by different health insurances as a managed-care "capitation-model" and its effectiveness gets continuously evaluated. The model proved to be effective in earlier studies were compared with standard care low rates of service disengagement were found as well as significantly improved psychopathology, psychosocial functioning, quality of life, satisfaction with care and adherence, while being cost effective. The rates of involuntary admissions declined to 10% in comparison to the years before. In 2011 the model was specified to the indication "first-episode adolescents and young adults in the age of 12-29" in a government-funded study "Integrated Care in Early Psychosis, ICEP Study". In this study an interdisciplinary team of child, adolescent and adult psychiatrists was implemented and since 2012 it is financed by the involved health insurances throughout an expansion of the §140 SGB V agreement.

  1. An Integrated System for the Treatment of Coal Conversion Wastewater

    SciTech Connect

    Henry Y. Wang; Keeran R. Srinivasan

    1999-02-25

    Treatment of mixed waste from coal conversion wastewaters involves the degradation of toxic organics and the removal of heavy metals. An integrated and cost-effective treatment scheme that can implement such a process is considered essential to promote continued development and growth of coal conversion processes without any deleterious effects on our ecosystem. We have recently developed a pH-dependent, reversible heavy metal adsorption/desorption process which promises to be a cost-effective alternative to the treatment and disposal options currently in place for these inorganic contaminants. Our work shows that: (1) Polydisperse, industrial-grade surfactants can be used in the development of novel, surfactant-coated smectitic clays containing up to 50% by weight of adsorbed surfactant, (2) Reversible adsorption and resorption of cationic (CU(II) and Cd(II)) and anionic (Cr(VI)) heavy metals from their respective aqueous solutions onto these surfactant-modified smectites can be effected using pH of the medium as a switch, and (3) These surfactant-modified smectites can be repeatedly used (up to 5 times) with only a minimal loss in their adsorption potency and with very little leaching of the adsorbed surfactants.

  2. Integrating electrodermal biofeedback into pharmacologic treatment of grand mal seizures

    PubMed Central

    Scrimali, Tullio; Tomasello, Damiana; Sciuto, Massimo

    2015-01-01

    Electrodermal activity (EDA) and electrodermal biofeedback, when integrated with pharmacologic treatments, indicate promising methods for the treatment of grand mal seizures. They can be used to monitor patient arousal and help patients learn new strategies to better cope with stress and anxiety. Our proposed method can possibly reduce the number of crises for patients who are dependent on pharmacologic therapy and can improve their quality of life. This article describes the scientific background of electrodermal monitoring and electrodermal biofeedback for patients affected by grand mal seizures. In this study, we have reported a clinical case study. The patient was treated for 2 years with electrodermal biofeedback to augment pharmacologic treatments. The trial has been designed in accordance with “n = 1 case study research”. Our results have shown that our methods could achieve a significant reduction in grand mal seizures and sympathetic arousal when applied. The patient under consideration was also relaxed and exhibited greater competency to cope with stress. Additionally, the patient’s sense of mastery and self-efficacy was enhanced. PMID:26029078

  3. A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders.

    PubMed

    Addison, Laura R; Piazza, Cathleen C; Patel, Meeta R; Bachmeyer, Melanie H; Rivas, Kristi M; Milnes, Suzanne M; Oddo, Jackie

    2012-01-01

    We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.

  4. A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

    PubMed Central

    Addison, Laura R; Piazza, Cathleen C; Patel, Meeta R; Bachmeyer, Melanie H; Rivas, Kristi M; Milnes, Suzanne M; Oddo, Jackie

    2012-01-01

    We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important. PMID:23060661

  5. Path integral treatment of a noncentral electric potential

    NASA Astrophysics Data System (ADS)

    Ghoumaid, Ali; Benamira, Farid; Guechi, Larbi; Khiat, Zohra

    2013-01-01

    We present a rigorous path integral treatment of a dynamical system in the axially symmetric potential V(r,θ ) = V(r) + tfrac{1} {{r^2 }}V(θ ) . It is shown that the Green's function can be calculated in spherical coordinate system for V(θ ) = frac{{hbar ^2 }} {{2μ }}frac{{γ + β sin ^2 θ + α sin ^4 θ }} {{sin ^2 θ \\cos ^2 θ }} . As an illustration, we have chosen the example of a spherical harmonic oscillator and also the Coulomb potential for the radial dependence of this noncentral potential. The ring-shaped oscillator and the Hartmann ring-shaped potential are considered as particular cases. When α = β = γ = 0, the discrete energy spectrum, the normalized wave function of the spherical oscillator and the Coulomb potential of a hydrogen-like ion, for a state of orbital quantum number l ≥ 0, are recovered.

  6. [Familial hypercholesterolemia: why screening, counselling and treatment should be integrated].

    PubMed

    Roeters van Lennep, Jeanine E; Visseren, Frank L J; Jira, Petr E

    2015-01-01

    Familial hypercholesterolemia (FH) is a monogenic autosomal dominant disorder. FH is the most common hereditary cause of raised serum cholesterol levels and is associated with an increased risk of premature cardiovascular disease (CVD). This disorder is known to have a genetic cause, and effective drug therapies exist for patients with FH. Successful cascade screening, within the framework of a national screening programme, gave the Netherlands an international role as model and pioneer as far as FH detection is concerned. With the ending of this screening programme as of 1 January 2014 the care for FH patients, including screening and counselling has had to be incorporated within the basic Dutch healthcare insurance system. It is essential that detection of FH should continue in as efficient and cost-effective a manner as possible. Our proposal is that this detection should be performed and co-ordinated by those treating patients with FH so that FH screening, counselling and treatment are integrated.

  7. Integrating Multiscale Modeling with Drug Effects for Cancer Treatment.

    PubMed

    Li, Xiangfang L; Oduola, Wasiu O; Qian, Lijun; Dougherty, Edward R

    2015-01-01

    In this paper, we review multiscale modeling for cancer treatment with the incorporation of drug effects from an applied system's pharmacology perspective. Both the classical pharmacology and systems biology are inherently quantitative; however, systems biology focuses more on networks and multi factorial controls over biological processes rather than on drugs and targets in isolation, whereas systems pharmacology has a strong focus on studying drugs with regard to the pharmacokinetic (PK) and pharmacodynamic (PD) relations accompanying drug interactions with multiscale physiology as well as the prediction of dosage-exposure responses and economic potentials of drugs. Thus, it requires multiscale methods to address the need for integrating models from the molecular levels to the cellular, tissue, and organism levels. It is a common belief that tumorigenesis and tumor growth can be best understood and tackled by employing and integrating a multifaceted approach that includes in vivo and in vitro experiments, in silico models, multiscale tumor modeling, continuous/discrete modeling, agent-based modeling, and multiscale modeling with PK/PD drug effect inputs. We provide an example application of multiscale modeling employing stochastic hybrid system for a colon cancer cell line HCT-116 with the application of Lapatinib drug. It is observed that the simulation results are similar to those observed from the setup of the wet-lab experiments at the Translational Genomics Research Institute.

  8. Integration of freshwater environmental policies and wastewater treatment plant management.

    PubMed

    Corominas, Lluís; Acuña, Vicenç; Ginebreda, Antoni; Poch, Manel

    2013-02-15

    In the last decade the political awareness of river water quality issues has grown substantially over the world and legislation is accordingly adapting. In the European Union (EU), two different directives regulate separately the characteristics of the discharged water and the chemical status of the receiving freshwater ecosystem. On the one hand, the characteristics of the urban effluents are regulated by the EU Directive 91/271/EEC, which defines limits on different elements set in the form of both static emission limits and minimum percentage load reductions. On the other hand, the characteristics of the receiving freshwater ecosystems are described in the EU Water Framework Directive (2000/60/EEC), which sets minimum 'good' chemical and ecological status in water bodies that should be achieved by 2015, and aims for an ecosystem-based management. With the support of an example, we show that there is a gap in these EU environmental policies leading to non-integrated management, which may result on adverse environmental and economical consequences. We believe that these policies should be updated and tuned to account for an integrated perspective, allowing a more efficient and sustainable management of wastewater treatment plants, maximizing the ecological, economical and social benefits of the system as a whole. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. Integrated chemical-biological treatment of benzo[a]pyrene

    SciTech Connect

    Zeng, Yu; Hong, P.K.A.; Wavrek, D.A.

    2000-03-01

    Benzo[a]pyrene of natural and anthropogenic sources is one of the toxic, mutagenic, polycyclic aromatic hydrocarbons (PAHs) listed as priority pollutants. This study focuses on an integrated treatment of benzo[a]pyrene involving sequential chemical oxidation and biological degradation. The objectives are to (1) provide mechanistic details in the ozone-mediated degradation of benzo[a]pyrene in the aqueous phase, (2) test the biodegradability of resultant intermediates, and (3) test the feasibility for the coupled chemical-biological treatment of the five-ring PAH. Batch and packed column reactors were used to examine the degradation pathways of benzo[a]pyrene subject to ozonation in the aqueous phase. After different ozonation times, samples containing reaction intermediates and byproducts from both reactors were collected, identified for organic contents, and further biologically inoculated to determine their biodegradability. The O{sub 3}-pretreated samples were incubated for 5, 10, 15, and 20 days; afterward biochemical oxygen demand (BOD), chemical oxygen demand (COD), and E. coli toxicity tests were conducted along with qualitative and quantitative determinations of benzo[a]pyrene, intermediates, and reaction products by GC/FID and GC/MS methods. Prevalent intermediates identified at different stages included ring-opened aldehydes, phthalic derivatives, and aliphatics. The degradation of benzo[a]pyrene is primarily initiated via O{sub 3}-mediated ring-opening, followed by O{sub 3} and hydroxyl radical fragmentation, and ultimately brought to complete mineralization primarily via hydroxyl radicals. Intermediates formed during chemical oxidation were biodegradable with a measured first-order rate constant (k{sub 0}) of 0.18 day{sup {minus}1}. The integrated chemical-biological system seems feasible for treating recalcitrant compounds, while pretreatment by chemical oxidation appears useful in promoting soluble intermediates from otherwise highly insoluble

  10. Independent peer review panel report on the integrated nonthermal treatment systems study and the comparison of integrated thermal and integrated nonthermal treatment systems for mixed low level waste

    SciTech Connect

    1996-08-01

    The US Department of Energy`s (DOE) Office of Environmental Management (EM) Office of Science and Technology (OST) has conducted studies of integrated thermal treatment systems and integrated nonthermal treatment systems (INTS) for treating contact handled, alpha and non-alpha mixed low level radioactive waste (MLLW). The MLLW in the DOE complex consists of a wide variety of organic and inorganic solids and liquids contaminated with radioactive substances. Treatment systems are needed to destroy organic material and stabilize residues prior to land disposal. In May 1996 the Deputy Assistant Secretary for OST appointed an Independent Peer Review Panel to: (1) review and comment on the INTS Study; (2) make recommendations on the most promising thermal and nonthermal treatment systems; (3) make recommendations on research and development necessary to prove the performance of nonthermal and thermal technologies; and (4) review and comment on the preliminary draft of the ITTS/INTS Comparison Report. This report presents the primary conclusions and recommendations based on the review of the INTS study and the comparison report. System selection, overviews, comparisons, cost estimations and sensitivity analyses, and recommended R and D engineering needs are then described and discussed.

  11. Portal dosimetry for VMAT using integrated images obtained during treatment.

    PubMed

    Bedford, James L; Hanson, Ian M; Hansen, Vibeke Nordmark

    2014-02-01

    Portal dosimetry provides an accurate and convenient means of verifying dose delivered to the patient. A simple method for carrying out portal dosimetry for volumetric modulated arc therapy (VMAT) is described, together with phantom measurements demonstrating the validity of the approach. Portal images were predicted by projecting dose in the isocentric plane through to the portal image plane, with exponential attenuation and convolution with a double-Gaussian scatter function. Appropriate parameters for the projection were selected by fitting the calculation model to portal images measured on an iViewGT portal imager (Elekta AB, Stockholm, Sweden) for a variety of phantom thicknesses and field sizes. This model was then used to predict the portal image resulting from each control point of a VMAT arc. Finally, all these control point images were summed to predict the overall integrated portal image for the whole arc. The calculated and measured integrated portal images were compared for three lung and three esophagus plans delivered to a thorax phantom, and three prostate plans delivered to a homogeneous phantom, using a gamma index for 3% and 3 mm. A 0.6 cm(3) ionization chamber was used to verify the planned isocentric dose. The sensitivity of this method to errors in monitor units, field shaping, gantry angle, and phantom position was also evaluated by means of computer simulations. The calculation model for portal dose prediction was able to accurately compute the portal images due to simple square fields delivered to solid water phantoms. The integrated images of VMAT treatments delivered to phantoms were also correctly predicted by the method. The proportion of the images with a gamma index of less than unity was 93.7% ± 3.0% (1SD) and the difference between isocenter dose calculated by the planning system and measured by the ionization chamber was 0.8% ± 1.0%. The method was highly sensitive to errors in monitor units and field shape, but less sensitive to

  12. Portal dosimetry for VMAT using integrated images obtained during treatment

    SciTech Connect

    Bedford, James L. Hanson, Ian M.; Hansen, Vibeke Nordmark

    2014-02-15

    Purpose: Portal dosimetry provides an accurate and convenient means of verifying dose delivered to the patient. A simple method for carrying out portal dosimetry for volumetric modulated arc therapy (VMAT) is described, together with phantom measurements demonstrating the validity of the approach. Methods: Portal images were predicted by projecting dose in the isocentric plane through to the portal image plane, with exponential attenuation and convolution with a double-Gaussian scatter function. Appropriate parameters for the projection were selected by fitting the calculation model to portal images measured on an iViewGT portal imager (Elekta AB, Stockholm, Sweden) for a variety of phantom thicknesses and field sizes. This model was then used to predict the portal image resulting from each control point of a VMAT arc. Finally, all these control point images were summed to predict the overall integrated portal image for the whole arc. The calculated and measured integrated portal images were compared for three lung and three esophagus plans delivered to a thorax phantom, and three prostate plans delivered to a homogeneous phantom, using a gamma index for 3% and 3 mm. A 0.6 cm{sup 3} ionization chamber was used to verify the planned isocentric dose. The sensitivity of this method to errors in monitor units, field shaping, gantry angle, and phantom position was also evaluated by means of computer simulations. Results: The calculation model for portal dose prediction was able to accurately compute the portal images due to simple square fields delivered to solid water phantoms. The integrated images of VMAT treatments delivered to phantoms were also correctly predicted by the method. The proportion of the images with a gamma index of less than unity was 93.7% ± 3.0% (1SD) and the difference between isocenter dose calculated by the planning system and measured by the ionization chamber was 0.8% ± 1.0%. The method was highly sensitive to errors in monitor units and

  13. Portal dosimetry for VMAT using integrated images obtained during treatment

    SciTech Connect

    Bedford, James L. Hanson, Ian M.; Hansen, Vibeke Nordmark

    2014-02-15

    Purpose: Portal dosimetry provides an accurate and convenient means of verifying dose delivered to the patient. A simple method for carrying out portal dosimetry for volumetric modulated arc therapy (VMAT) is described, together with phantom measurements demonstrating the validity of the approach. Methods: Portal images were predicted by projecting dose in the isocentric plane through to the portal image plane, with exponential attenuation and convolution with a double-Gaussian scatter function. Appropriate parameters for the projection were selected by fitting the calculation model to portal images measured on an iViewGT portal imager (Elekta AB, Stockholm, Sweden) for a variety of phantom thicknesses and field sizes. This model was then used to predict the portal image resulting from each control point of a VMAT arc. Finally, all these control point images were summed to predict the overall integrated portal image for the whole arc. The calculated and measured integrated portal images were compared for three lung and three esophagus plans delivered to a thorax phantom, and three prostate plans delivered to a homogeneous phantom, using a gamma index for 3% and 3 mm. A 0.6 cm{sup 3} ionization chamber was used to verify the planned isocentric dose. The sensitivity of this method to errors in monitor units, field shaping, gantry angle, and phantom position was also evaluated by means of computer simulations. Results: The calculation model for portal dose prediction was able to accurately compute the portal images due to simple square fields delivered to solid water phantoms. The integrated images of VMAT treatments delivered to phantoms were also correctly predicted by the method. The proportion of the images with a gamma index of less than unity was 93.7% ± 3.0% (1SD) and the difference between isocenter dose calculated by the planning system and measured by the ionization chamber was 0.8% ± 1.0%. The method was highly sensitive to errors in monitor units and

  14. Integrated treatment of PAH contaminated soil by soil washing, ozonation and biological treatment.

    PubMed

    Haapea, Pia; Tuhkanen, Tuula

    2006-08-21

    The aim of the study was to optimise three different treatment methods and to find out if the integration of soil washing, ozonation and biological treatment could be a feasible method for the remediation of aged oil contaminated with PAHs. Three different ozone doses and soil washing were studied in different pHs in order to assess their effect to the degradation and enhancement of biodegradability of PAH in the soil and water phase. Main target of the study was to find out a method with which the PAH concentrations could be decreased below the Finnish guideline level for total PAHs. In this case, the initial concentration of PAHs was 1200 mg kg(-1) and therefore almost 85% degradation of PAHs was required. Any of the methods studied was not able to reach this target level alone, but by several combinations of the methods studied achieved 90% reduction of PAHs. The consumption of ozone was 5-10 times lower in the integrated treatments of soil washing, ozonation and biological treatment than without prewashing.

  15. Integrating smoking cessation into substance use disorder treatment for military veterans: measurement and treatment engagement efforts.

    PubMed

    Shealy, Suzanne E; Winn, Jaime L

    2014-02-01

    Military personnel and veterans smoke at higher rates than the general population, compromising physical performance readiness and health (Committee on Smoking Cessation in Military and Veteran Populations & Institute of Medicine, 2009). While efforts are being made within both the Department of Defense and the Veterans' Administration (VA) hospitals to prevent onset, change the smoking culture, and promote smoking cessation; smoking rates are increasing among combat deployed service members, and smoking rates are particularly high among veterans with mental health and other substance use disorders (McFall, 2006). Recent research supports making smoking cessation widely available and integrated with other forms of care (Gierisch et al., 2012; McFall et al., 2010). This paper describes the efforts of one VA substance use disorder (SUD) treatment program to integrate smoking cessation in routine care, including assessment of tobacco use and motivation and intention to quit via the proposed Nic-BAM assessment. Our team was 100% successful in incorporating the Nic-BAM into our regular assessment of treatment program participants. This suggests that staff members are amenable to assessing for tobacco addiction alongside other substance addictions. Although smoking did not decrease according to the Nic-BAM, an increase in the use of nicotine-replacement products suggests that participants are willing to initiate a quit attempt during SUD treatment. The availability of new evidence-based approaches for integration of tobacco cessation with mental health and SUD treatment may help to enhance programmatic efforts. Environmental changes are needed to fully incorporate tobacco recovery into SUD programming, and additional resources may include peer support specialists. © 2013.

  16. New treatment approaches: integrating new media in the treatment of war and torture victims.

    PubMed

    Knaevelsrud, Christine; Wagner, Birgit; Karl, Ankel; Mueller, Julia

    2007-01-01

    The diagnostic process and treatment of victims of war and torture is associated with a number of difficulties. This article will provide an overview of three different approaches on how the new media may be integrated into the treatment of survivors of torture and war to face some of the challenges. Illiteracy is a common problem and makes it difficult to apply standardized psychological assessment procedures. Also, the majority of survivors of torture and war do not have access to any psychotherapeutic treatment due to geographical limitations or limitations concerning psychotherapeutic treatment capacity. Furthermore, chronic psychological disorders such as (complex) Posttraumatic Stress Disorder (PTSD) are often seen with comorbid chronic pain disorders, which present a therapeutic challenge. The Treatment Center for Torture Victims, Berlin, in cooperation with the University of Zurich, developed a number of approaches to address these challenges: 1) MultiCASI - to standardize the diagnostic process an audiovisual diagnostic tool was developed which allows illiterate individuals to answer standardized psychological questionnaires whithout the help of interpreters; 2) A virtual treatment center for posttraumatic stress disorder for traumatized patients in Iraq and other Arab speaking postconflict countries; 3) Utility of Biofeedback (BF) in chronic (somatoform) pain and in traumatized patients: to address the chronic pain syndrome presented by most survivors, a biofeedback supported cognitive-behavioral therapy approach was developed and successfully tested in a pilot study.

  17. Integrating Function-Directed Treatments into Palliative Care.

    PubMed

    Cheville, Andrea L; Morrow, Melissa; Smith, Sean Robinson; Basford, Jeffrey R

    2017-09-01

    The growing acceptance of palliative care has created opportunities to increase the use of rehabilitation services among populations with advanced disease, particularly those with cancer. Broader delivery has been impeded by the lack of a shared definition for palliative rehabilitation and a mismatch between patient needs and established rehabilitation service delivery models. We propose the definition that, in the advanced cancer population, palliative rehabilitation is function-directed care delivered in partnership with other clinical disciplines and aligned with the values of patients who have serious and often incurable illnesses in contexts marked by intense and dynamic symptoms, psychological stress, and medical morbidity to realize potentially time-limited goals. Although palliative rehabilitation is most often delivered by inpatient physical medicine and rehabilitation consultation/liaison services and by physical therapists in skilled nursing facilities, outcomes in these settings have received little scrutiny. In contrast, outpatient cancer rehabilitation programs have gained robust evidentiary support attesting to their benefits across diverse settings. Advancing palliative rehabilitation will require attention to historical barriers to the uptake of cancer rehabilitation services, which include the following: patient and referring physicians' expectation that effective cancer treatment will reverse disablement; breakdown of linear models of disablement due to presence of concurrent symptoms and psychological distress; tension between reflexive palliation and impairment-directed treatment; palliative clinicians' limited familiarity with manual interventions and rehabilitation services; and challenges in identifying receptive patients with the capacity to benefit from rehabilitation services. The effort to address these admittedly complex issues is warranted, as consideration of function in efforts to control symptoms and mood is vital to optimize

  18. Integration of alternative feedstreams for biomass treatment and utilization

    DOEpatents

    Hennessey, Susan Marie [Avondale, PA; Friend, Julie [Claymont, DE; Dunson, Jr., James B.; Tucker, III, Melvin P.; Elander, Richard T [Evergreen, CO; Hames, Bonnie [Westminster, CO

    2011-03-22

    The present invention provides a method for treating biomass composed of integrated feedstocks to produce fermentable sugars. One aspect of the methods described herein includes a pretreatment step wherein biomass is integrated with an alternative feedstream and the resulting integrated feedstock, at relatively high concentrations, is treated with a low concentration of ammonia relative to the dry weight of biomass. In another aspect, a high solids concentration of pretreated biomass is integrated with an alternative feedstream for saccharifiaction.

  19. Treatment integrity in school-wide programs: a review of the literature (1993-2012).

    PubMed

    Bruhn, Allison L; Hirsch, Shanna E; Lloyd, John W

    2015-10-01

    We assessed the reporting of treatment integrity in school-wide prevention programs in K-12 schools. This review was designed to determine (a) the extent to which treatment integrity was reported in school-wide prevention and intervention programs and how the reporting varied by research design, year, and journal; and (b) the procedures (e.g., method, frequency, informant) used to collect treatment integrity data. Results indicated that fewer than half of the studies in the review (n = 36, 45.6 %) measured and reported treatment integrity. Those studies reporting treatment integrity often used multiple methods and informants. Reporting treatment integrity in this body of literature has increased steadily over time.

  20. Integrative Treatment of Reflux and Functional Dyspepsia in Children

    PubMed Central

    Yeh, Ann Ming; Golianu, Brenda

    2014-01-01

    Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications—such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture. PMID:27417471

  1. Evolution of the Treatment Integrity Concept: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Gresham, Frank M.

    2009-01-01

    The concept of treatment integrity cuts across a diversity of fields involved with providing treatments or interventions to individuals. In medical treatments, the concept of "treatment compliance" or "treatment adherence" is an important and problematic issue. In the field of nutrition, the concept of "dietary adherence" is important for…

  2. Evolution of the Treatment Integrity Concept: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Gresham, Frank M.

    2009-01-01

    The concept of treatment integrity cuts across a diversity of fields involved with providing treatments or interventions to individuals. In medical treatments, the concept of "treatment compliance" or "treatment adherence" is an important and problematic issue. In the field of nutrition, the concept of "dietary adherence" is important for…

  3. Rolfing structural integration treatment of cervical spine dysfunction.

    PubMed

    James, Helen; Castaneda, Luis; Miller, Marilyn E; Findley, Thomas

    2009-07-01

    Misalignments in the body compromise the architectural integrity. At the tissue level, fascia shortens and thickens as the body engages in compensatory strategies to maintain itself upright; these changes are known as myofascial contractions. In physical therapy, there are several methods by which practitioners treat neck dysfunction. However, studies showing the effect of those techniques are limited. The purpose of this study was to investigate the effect of rolfing structural integration (RSI) in neck motion and pain levels of 31 subjects who received RSI. RSI is a type of therapy that focuses on aligning the human body with gravity. This retrospective study, over a period of 3 years of clinical practice, analyzes changes in motion and pain levels at the neck for 31 subjects who completed the RSI in 10 basic sessions. Participants were evaluated before and after they received RSI. The data collected included: age, sex, occupation, referral source, diagnosis, height, weight, photographs of postural views, range of motion (ROM), pain, and functional complaints. ROM was assessed with the use of an arthordial protractor. Data analysis using three-way analysis of variance (ANOVA) tested the hypothesis at a significance of 0.5. The mean pain levels and active range of motion (AROM) of the neck before RSI significantly changed after the treatment (p<0.5): there was a decrease in pain and an increase in AROM. Pain levels/AROM-Age within-subject effect demonstrated significant difference only in pain at best and rotation right; the mean pain levels in the older group decreased by 67%, and the mean AROM for rotation right in the younger group increased by 34%. In this sample, pain now was reduced more than pain best and pain worst. Increased motion for lateral flexion was more than rotation, extension, and flexion. This investigation demonstrates that the basic 10 sessions of RSI, when applied by a physical therapist with advanced RSI certification, is capable of

  4. Effects of treatment-integrity failures on a response-cost procedure.

    PubMed

    St Peter, Claire C; Byrd, Jeffrey D; Pence, Sacha T; Foreman, Apral P

    2016-06-01

    Effects of incorrect or partial implementation (poor treatment integrity) on response cost are largely unknown. We evaluated reduced treatment integrity during response cost on rates of 2 concurrently available responses. College students earned points by clicking on either a black circle or a red circle on a computer screen. Experiment 1 compared 2 types of treatment-integrity failures (omission and commission errors) across 2 levels of integrity (20% and 50%). Compared to 100% integrity conditions, omission errors did not suppress responding to the same extent, and commission errors reduced target responding but also decreased rates of alternative behavior. Experiment 2 compared the effects of 20% and 50% omission errors within subjects. Implementation at 50% integrity adequately suppressed responding, but treatment effects were lost at 20% integrity. There may be a critical level at which response cost must be implemented to suppress responding, which has important implications for application. © 2016 Society for the Experimental Analysis of Behavior.

  5. The perturbative approach to path integrals: A succinct mathematical treatment

    NASA Astrophysics Data System (ADS)

    Nguyen, Timothy

    2016-09-01

    We study finite-dimensional integrals in a way that elucidates the mathematical meaning behind the formal manipulations of path integrals occurring in quantum field theory. This involves a proper understanding of how Wick's theorem allows one to evaluate integrals perturbatively, i.e., as a series expansion in a formal parameter irrespective of convergence properties. We establish invariance properties of such a Wick expansion under coordinate changes and the action of a Lie group of symmetries, and we use this to study essential features of path integral manipulations, including coordinate changes, Ward identities, Schwinger-Dyson equations, Faddeev-Popov gauge-fixing, and eliminating fields by their equation of motion. We also discuss the asymptotic nature of the Wick expansion and the implications this has for defining path integrals perturbatively and nonperturbatively.

  6. Toward an Integrative Approach to Assessment and Treatment Planning in Family Therapy.

    ERIC Educational Resources Information Center

    Olsen, David C.

    The rapid increase in literature and modalities of family therapy has made it difficult for counselors working with families to find an integrative approach to assessment and treatment planning. As a result, many counselors move from one paradigm to another without attempting to integrate approaches. This paper attempts to integrate five paradigms…

  7. Does Treatment Integrity Matter in Promoting Learning among Children with Developmental Disabilities?

    ERIC Educational Resources Information Center

    Odluyurt, Serhat; Tekin-Iftar, Elif; Adalioglu, Iclal

    2012-01-01

    The purpose of this study was to compare the effects of simultaneous prompting instruction with high and low treatment integrity on the learning of children with developmental disabilities. Low treatment integrity was defined as not delivering a controlling prompt during 30% of the teaching trials. Three preschool children with autism and…

  8. Treatment Integrity Assessment: How Estimates of Adherence, Quality, and Exposure Influence Interpretation of Implementation

    ERIC Educational Resources Information Center

    Hagermoser Sanetti, Lisa M.; Fallon, Lindsay M.

    2011-01-01

    The assessment of treatment integrity is important for determining the effectiveness of an intervention. Treatment integrity, a multidimensional construct, can be evaluated in two ways: by session or component. In this study, adherence, quality, and exposure data are estimated using permanent product data from implementation of the PAX Good…

  9. An Evaluation of Programmed Treatment-integrity Errors during Discrete-trial Instruction

    ERIC Educational Resources Information Center

    Carroll, Regina A.; Kodak, Tiffany; Fisher, Wayne W.

    2013-01-01

    This study evaluated the effects of programmed treatment-integrity errors on skill acquisition for children with an autism spectrum disorder (ASD) during discrete-trial instruction (DTI). In Study 1, we identified common treatment-integrity errors that occur during academic instruction in schools. In Study 2, we simultaneously manipulated 3…

  10. Incorporating Applied Behavior Analysis to Assess and Support Educators' Treatment Integrity

    ERIC Educational Resources Information Center

    Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Fallon, Lindsay M.

    2017-01-01

    For evidence-based interventions to be effective for students they must be consistently implemented, however, many teachers struggle with treatment integrity and require support. Although many implementation support strategies are research based, there is little empirical guidance about the types of treatment integrity, implementers, and contexts…

  11. Effects of Treatment Integrity Failures during Differential Reinforcement of Alternative Behavior: A Translational Model

    ERIC Educational Resources Information Center

    Pipkin, Claire St. Peter; Vollmer, Timothy R.; Sloman, Kimberly N.

    2010-01-01

    Differential reinforcement of alternative behavior (DRA) is used frequently as a treatment for problem behavior. Previous studies on treatment integrity failures during DRA suggest that the intervention is robust, but research has not yet investigated the effects of different types of integrity failures. We examined the effects of two types of…

  12. Integrating Surgery Into Treatment Paradigms for Organ Preservation: Tailoring Treatment to Biology Improves Outcomes

    SciTech Connect

    Wolf, Gregory T.

    2007-10-01

    Purpose: Neoadjuvant chemotherapy was introduced into treatment paradigms for curable head and neck cancer in the early 1970s in an effort to reduce the magnitude of mutilating surgery and to provide a rationale for adjuvant systemic chemotherapy in patients who responded to initial chemotherapy. The large number of trials that followed failed to demonstrate improved survival when neoadjuvant chemotherapy was added to conventional surgery or radiation. Importantly, a consistent observation in these neoadjuvant trials was the significant association of clinical tumor response to neoadjuvant therapy and favorable prognosis. Results: The findings led to development of a new treatment paradigm that was based on the hypothesis that the biology of an individual cancer is more predictive of response to specific therapy and overall outcome than is anatomic tumor site or extent, and on the corollary that matching treatment modality to biology will improve overall survival rates. Conclusions: This report identifies key findings that are important in the design and analysis of organ preservation trials and biologic markers predictive of response and outcomes. Ongoing studies incorporating biomarkers such as p53, Bcl-xL, HPV, EGFR, COX-2, and tumor promoter gene methylation are underway and will identify new targets for molecular manipulation, response monitoring, and tumor imaging that could allow real-time changes in how we integrate the various components of multi-modal therapy.

  13. A Descriptive Evaluation of Long-Term Treatment Integrity

    ERIC Educational Resources Information Center

    Arkoosh, Maire Kathryn; Derby, K. Mark; Wacker, David P.; Berg, Wendy; McLaughlin, T. F.; Barretto, Anjali

    2007-01-01

    The validity of selecting treatment contingencies on the basis of the results obtained through functional analysis is well documented. However, a number of second-generation questions have emerged: For example, what are the parameters required to achieve desired treatment outcomes? More specifically, what is the degree of treatment integrity…

  14. Developing an integrated treatment for substance use and depression using cognitive-behavioral therapy.

    PubMed

    Osilla, Karen Chan; Hepner, Kimberly A; Muñoz, Ricardo F; Woo, Stephanie; Watkins, Katherine

    2009-12-01

    Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. We developed a group-based cognitive-behavioral (CBT) integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (n = 7) and semistructured interviews with counselors (n = 2) and administrators (n = 3). Using CBT as a treatment approach to integrate the treatment was widely accepted by clients, counselors, and administrators. Clients stated the treatment was applicable to multiple aspects of their lives and allowed them to recognize their clinical improvements over time. Counselors and administrators discussed challenges for long-term feasibility. Key decisions used to develop the treatment and recommendations for implementing integrated care in SUD settings are discussed.

  15. A view from Riggs: treatment resistance and patient authority-IX. Integrative psychodynamic treatment of psychotic disorders.

    PubMed

    Tillman, Jane G

    2008-01-01

    Psychotic spectrum disorders present treatment challenges for patients, families, and clinicians. This article addresses the history of the dualism in the field between biological and psychological approaches to mental disorders, and surveys the contemporary literature about the etiology and treatment of psychotic spectrum disorders. An integrative approach to treatment derived from work at Austen Riggs with previously treatment refractory patients with psychotic spectrum disorders is described that combines individual psycho- dynamic psychotherapy, psychopharmacology, family systems approaches, and intensive psychosocial engagement. Helping patients develop their own authority to join the treatment, use relationships for learning, and understand the meaning of their symptoms is central to the treatment at Austen Riggs. An extended case vignette of a patient diagnosed with a schizoaffective disorder is presented illustrating this integrative psychodynamic treatment approach.

  16. Integrating Treatment of Posttraumatic Stress Disorder and Substance Use Disorder

    ERIC Educational Resources Information Center

    Ford, Julian D.; Russo, Eileen M.; Mallon, Sharon D.

    2007-01-01

    Historically, administrators and clinicians have been hesitant to address posttraumatic stress disorder (PTSD) in the treatment of substance use disorders (SUDs). However, research shows that SUD treatment recruitment and outcomes may be adversely affected if co-occurring PTSD is left untreated. The authors provide guidelines for screening and…

  17. Self-administered behavior modification to reduce nail biting: incorporating simple technology to ensure treatment integrity.

    PubMed

    Craig, Andrew R

    2010-01-01

    Habitual behaviors, such as problematic nail biting, are a common target for self-managed behavior-modification programs. The current self-experiment used self-monitoring in conjunction with a self-managed differential-reinforcement procedure for the treatment of problematic nail biting. A simple picture-comparison procedure allowed an independent observer to assist in monitoring treatment progress and outcomes and to ensure treatment integrity. Results provide support that the overall treatment package was successful in decreasing the occurrence of nail biting. Moreover, the treatment-integrity procedure enabled full-day monitoring to take place with limited requirement of a secondary observer.

  18. Integrative Treatment of Personality Disorder. Part I: Psychotherapy.

    PubMed

    Jovanovic, Mirjana Divac; Svrakic, Dragan

    2017-03-01

    In this paper, we outline the concept of integrative therapy of borderline personality, also referred to as fragmented personality, which we consider to be the core psychopathology underlying all clinical subtypes of personality disorder. Hence, the terms borderline personality, borderline disorder, fragmented personality, and personality disorder are used interchangeably, as synonyms. Our integrative approach combines pharmacotherapy and psychotherapy, each specifically tailored to accomplish a positive feedback modulation of their respective effects. We argue that pharmacotherapy and psychotherapy of personality disorder complement each other. Pharmacological control of disruptive affects clears the stage, in some cases builds the stage, for the psychotherapeutic process to take place. In turn, psychotherapy promotes integration of personality fragments into more cohesive structures of self and identity, ultimately establishing self-regulation of mood and anxiety. We introduce our original method of psychotherapy, called reconstructive interpersonal therapy (RIT). The RIT integrates humanistic-existential and psychodynamic paradigms, and is thereby designed to accomplish a deep reconstruction of core psychopathology within the setting of high structure. We review and comment the current literature on the strategies, goals, therapy process, priorities, and phases of psychotherapy of borderline disorders, and describe in detail the fundamental principles of RIT.

  19. Test Driving Interventions to Increase Treatment Integrity and Student Outcomes

    ERIC Educational Resources Information Center

    Dart, Evan H.; Cook, Clayton R.; Collins, Tai A.; Gresham, Frank M.; Chenier, Jeffrey S.

    2012-01-01

    Behavioral consultation has been shown to be an effective way for school psychologists to work with teachers in implementing interventions for student problem behavior. Some teachers are resistant to the behavioral consultation process and thereby fail to implement agreed upon interventions with integrity, which is problematic considering the…

  20. Integrating Cognitive Behavioral Therapy and Pharmacotherapy in the Treatment of Adolescent Depression

    ERIC Educational Resources Information Center

    Ginsburg, Golda S.; Albano, Anne Marie; Findling, Robert L.; Kratochvil, Christopher; Walkup, John

    2005-01-01

    Recent evidence from the Treatment for Adolescents With Depression Study (TADS) suggests that combining cognitive behavioral and pharmacological treatments holds the most promise for ameliorating depression among adolescents. This article describes lessons learned during the TADS trial about how to integrate these two treatments in the care of…

  1. Policy implications of integrating buprenorphine/naloxone treatment and HIV care.

    PubMed

    Finkelstein, Ruth; Netherland, Julie; Sylla, Laurie; Gourevitch, Marc N; Cajina, Adan; Cheever, Laura

    2011-03-01

    Researchers, practitioners, and policymakers have long recognized the potential benefits of providing integrated substance abuse and medical care services, particularly for special populations such as people living with HIV/AIDS. Buprenorphine, an office-based pharmacological treatment for opioid dependence, offers new opportunities for integrating drug treatment into HIV care settings. However, the historical separation between the drug treatment and medical care systems has resulted in a host of policy barriers. The Buprenorphine and HIV Care Evaluation and Support initiative, a multisite demonstration project to assess the feasibility and effectiveness of integrating buprenorphine/naloxone into HIV care settings, provided an opportunity to evaluate if and how policy barriers affect efforts to integrate HIV care and addiction treatment. We found that financing issues, workforce and training issues, and the operational consequences of some conceptual differences between HIV care and addiction treatment are barriers to the full integration of buprenorphine into HIV care. We recommend changes to financing and reimbursement policies, programs to strengthen the addiction treatment skills of physicians, and cross training between the fields of addiction, medicine, drug treatment, and HIV medicine. By addressing some of the policy barriers to integration, this promising new treatment can help the thousands of people living with HIV/AIDS who are also opioid dependent.

  2. Conservative integrated treatment of adhesive capsulitis of the shoulder

    PubMed Central

    RUSSO, ADRIANO; ARRIGHI, ANNALISA; VIGNALE, LUIGI; MOLFETTA, LUIGI

    2014-01-01

    Purpose the aim of this study was to present the results of a conservative treatment for adhesive capsulitis based on an original protocol of combined pharmacological and rehabilitation treatment. Methods fifty-two patients with idiopathic adhesive capsulitis were enrolled in the present study. The treatment protocol included the use of hyaluronic acid and anaesthetic periarticular and intra-articular injections followed by a specific program of capsule and muscle stretching. Results the results of this treatment showed complete recovery of range of motion (ROM) in 50 of the 52 cases. The mean pre-treatment ROM values were: 85° for forward elevation, 75° for abduction, 25° for external rotation, and 15° for internal rotation. The post-treatment mean ROM values showed marked improvements: 175° for forward elevation, 175° for abduction, 87.5° for external rotation and 75° for internal rotation. Conclusions conservative treatment of adhesive capsulitis based on a combined pharmacological and rehabilitation approach was found to be effective in resolving pain and stiffness in 96% of the patients. Level of evidence level IV, therapeutic case series. PMID:25606536

  3. New perspectives in treatment decision for integrated management of rectal cancer: multimodal research for multimodal treatments

    PubMed Central

    VALENTINI, V.; CELLINI, F.

    2014-01-01

    Rectal cancer management improved results in the last thirty-five applying new integrated treatment options. Preoperative radiochemotherapy or radiotherapy alone joined to the modern surgery gaining significant improvement of outcomes. Nevertheless, a definitive conclusion about superiority of one on the other in term of survival and toxicity is still lacking, and further improvement is in general required and seems obtainable. The need for a wide sharing of the accumulated knowledge is represented by the consensus conferences that over the years summarizes the state of the art for the management of rectal cancer. One of the most promising opportunities comes from the attempt of characterization of the tumor heterogeneity. An always-increasing number of new parameters come from different sources including genomic, imaging, pathological features and many others. The need of new informatics technologies able to handle and continuously incorporate new inputs derived from the evidences is also imperative. The combined use of large shared databases and “learning models” could allow generating and rapidly testing new hypotheses, providing further survival improvement in the next years. PMID:24979100

  4. High-level-waste treatment at West Valley: integrated radwaste treatment system

    SciTech Connect

    Baker, M.N. )

    1992-01-01

    The West Valley Site was the location of the only operating nuclear fuel reprocessing plant in the United States. A private firm operated the facility from 1966 to 1972, processing 640 tonnes of commercial and defense fuels using the plutonium uranium reduction extraction (Purex) process. Approximately 2.1 million liters of liquid reprocessing waste resulted from this operation. These wastes were stored in an underground storage tank. The integrated radwaste treatment system (IRTS) began operation in May 1988. This is a liquid waste pretreatment system designated to decontaminate the high-level liquid waste (HLLW), forming a low-level liquid waste (LLLW). The LLLW is encapsulated in cement, poured into 71-gal square drums and stored in a remotely operated shielded retrievable storage location. From May 1988 through November 1990, the IRTS decontaminated 450,000 gal of HLLW, encapsulating the resulting concentrates into 10,393, 71-gal square drums. All of the technical difficulties encountered during 2 1/2 yr of processing were resolved using available technology without compromising safety or product quality. There was no abnormal or unacceptable personnel exposure during this processing period.

  5. Evaluating an Integrated Support Model for Increasing Treatment Plan Implementation Following Consultation in Schools.

    PubMed

    Noell, George H; Volz, Jennifer R; Henderson, Marie Y; Williams, Kashunda L

    2017-02-20

    This study examined the percentage of steps implemented from treatment plans following consultation with teachers. Interventions were implemented for 39 elementary school students referred for consultation and treatment for challenging behavior or academic deficits. An integrated support model that included antecedent social influence and planning combined with follow-up performance feedback was compared to weekly structured follow-up interviews. Participating teacher-student dyads were randomly assigned to conditions. Integrated support produced superior treatment implementation and child outcomes compared to weekly follow-up meetings. In contrast, teachers' ratings of consultants' effectiveness, treatment acceptability, and treatment implementation were undifferentiated across conditions. Treatment plan implementation and child behavioral outcomes were statistically significantly correlated. Treatment acceptability and implementation were not correlated at a statistically significant level. The implications of these findings for consultation and treatment research and practice are discussed. (PsycINFO Database Record

  6. Integrated Passive Biological Treatment System/ Mine Waste Technology Program Report #16

    EPA Science Inventory

    This report summarizes the results of the Mine Waste Technology Program (MWTP) Activity III, Project 16, Integrated, Passive Biological Treatment System, funded by the United States Environmental Protection Agency (EPA) and jointly administered by EPA and the United States Depar...

  7. Tomorrow`s energy today for cities and counties -- Alternative wastewater treatment: Advanced Integrated Pond systems

    SciTech Connect

    Not Available

    1993-10-01

    This report provides a discussion of the design, construction, operation, and maintenance of the Advanced Integrated Pond System as an alternative for other more costly municipal waste water treatment plants.

  8. Integrated Passive Biological Treatment System/ Mine Waste Technology Program Report #16

    EPA Science Inventory

    This report summarizes the results of the Mine Waste Technology Program (MWTP) Activity III, Project 16, Integrated, Passive Biological Treatment System, funded by the United States Environmental Protection Agency (EPA) and jointly administered by EPA and the United States Depar...

  9. Starting the water treatment system at the putilovo cogeneration station constructed using integrated membrane technologies

    NASA Astrophysics Data System (ADS)

    Gromov, S. L.; Tropina, D. V.; Arkhipova, O. V.

    2011-07-01

    A new process diagram of a water treatment unit constructed using integrated membrane technologies and serving for replenishing losses of steam and condensate for a PGU-180 combined-cycle power unit is presented.

  10. An Evaluation of the "Treatment Integrity Planning Protocol" and Two Schedules of Treatment Integrity Self-Report: Impact on Implementation and Report Accuracy

    ERIC Educational Resources Information Center

    Hagermoser Sanetti, Lisa M.; Kratochwill, Thomas R.

    2011-01-01

    The evidence-based practice movement has focused on identifying, disseminating, and promoting the adoption of evidence-based interventions. Despite advances in this movement, numerous barriers, such as the lack of treatment integrity assessment methods, remain as challenges in implementation. Accurate teacher self-report could be an efficient…

  11. Exact path integral treatment of a diatomic molecule potential

    SciTech Connect

    Benamira, F.; Guechi, L.; Mameri, S.; Sadoun, M. A.

    2007-03-15

    A rigorous evaluation of the path integral for Green's function associated with a four-parameter potential for a diatomic molecule is presented. A closed form of Green's function is obtained for different shapes of this potential. When the deformation parameter {lambda} is {lambda}<0 or 0<{lambda}<1, it is found that the quantization conditions are transcendental equations that require a numerical solution. For {lambda}{>=}1 and r set-membership sign](1/{eta})ln {lambda},{infinity}[, the energy spectrum and the normalized wave functions of the bound states are derived. Particular cases of this potential which appear in the literature are also briefly discussed.

  12. Integrated Psychosocial and Opioid-Antagonist Treatment for Alcohol Dependence: A Systematic Review of Controlled Evaluations

    ERIC Educational Resources Information Center

    Vaughn, Michael G.; Howard, Matthew O.

    2004-01-01

    Methodological characteristics and outcomes of 14 controlled clinical investigations of integrated psychosocial and opioid-antagonist alcohol dependence treatment were evaluated. The 14 studies were identified through computerized bibliographic and manual literature searches. Clients receiving integrated psychosocial and opioid-antagonist…

  13. An Integrated Evaluation of Nonspeech Oral Motor Treatments

    ERIC Educational Resources Information Center

    Powell, Thomas W.

    2008-01-01

    Purpose: This article functions as an epilogue to the clinical forum examining the use of nonspeech oral motor treatments (NSOMTs) to remediate speech sound disorders in children. Method: Conclusions to eight clinical questions are formed based on the findings that were reported in the clinical forum. Theoretical and clinical challenges are also…

  14. Integrating Fieldwork into Employment Counseling for Methadone-Treatment Patients

    ERIC Educational Resources Information Center

    Blankertz, Laura; Spinelli, Michael; Magura, Stephen; Bali, Priti; Madison, Elizabeth M.; Staines, Graham L.; Horowitz, Emily; Guarino, Honoria; Grandy, Audrey; Fong, Chunki; Gomez, Augustin; Dimun, Amy; Friedman, Ellen

    2005-01-01

    An innovative employment counseling model, Customized Employment Supports, was developed for methadone-treatment patients, a population with historically low employment rates. The effectiveness of a key component of the model, "vocational fieldwork," the delivery of services in the community rather than only within the clinic, was assessed through…

  15. An Integrated Evaluation of Nonspeech Oral Motor Treatments

    ERIC Educational Resources Information Center

    Powell, Thomas W.

    2008-01-01

    Purpose: This article functions as an epilogue to the clinical forum examining the use of nonspeech oral motor treatments (NSOMTs) to remediate speech sound disorders in children. Method: Conclusions to eight clinical questions are formed based on the findings that were reported in the clinical forum. Theoretical and clinical challenges are also…

  16. DEMONSTRATION OF AN INTEGRATED, PASSIVE BIOLOGICAL TREATMENT PROCESS FOR AMD

    EPA Science Inventory

    An innovative, cost-effective, biological treatment process has been designed by MSE Technology Applications, Inc. to treat acid mine drainage (AMD). A pilot-scale demonstration is being conducted under the Mine Waste Technology Program using water flowing from an abandoned mine ...

  17. DEMONSTRATION OF AN INTEGRATED, PASSIVE BIOLOGICAL TREATMENT PROCESS FOR AMD

    EPA Science Inventory

    An innovative, cost-effective, biological treatment process has been designed by MSE Technology Applications, Inc. to treat acid mine drainage (AMD). A pilot-scale demonstration is being conducted under the Mine Waste Technology Program using water flowing from an abandoned mine ...

  18. Treatment Integrity Assessment of a Daily Report Card Intervention: A Preliminary Evaluation of Two Methods and Frequencies

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Chafouleas, Sandra M.; O'Keeffe, Breda V.; Kilgus, Stephen P.

    2013-01-01

    Although intuitively appealing, teacher self-report of treatment integrity is not currently recommended as a method for collecting treatment integrity data. Education researchers have not, however, evaluated features of a treatment integrity self-reporting system that may facilitate accurate self-report. In this preliminary investigation, four…

  19. Treatment Integrity Assessment of a Daily Report Card Intervention: A Preliminary Evaluation of Two Methods and Frequencies

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Chafouleas, Sandra M.; O'Keeffe, Breda V.; Kilgus, Stephen P.

    2013-01-01

    Although intuitively appealing, teacher self-report of treatment integrity is not currently recommended as a method for collecting treatment integrity data. Education researchers have not, however, evaluated features of a treatment integrity self-reporting system that may facilitate accurate self-report. In this preliminary investigation, four…

  20. Methane from an integrated hyacinth treatment anaerobic digestion facility

    SciTech Connect

    Hayes, T.D.; Chynoweth, D.P.; Reddy, K.R.; Schwegler, B.

    1985-08-01

    Results to date indicate that the Hyacinth Project could lead to the production of cost-competitive methane from a hyacinth wastewater treatment system. An information base from the project will be available by the end of 1985 to support a decision on whether methane generation from a hyacinth facility is sufficiently attractive for communities and gas companies to pursue at a commercial scale. If the economics are promising, construction of a full-scale plant could begin in the late 1980s. The project could ultimately provide a low-cost supplemental source of pipeline-quality gas while offering a cost-effective wastewater treatment alternative. 9 references, 4 figures, 2 tables.

  1. Pesticide and toxicity reduction using an integrated vegetated treatment system.

    PubMed

    Anderson, Brian; Phillips, Bryn; Hunt, John; Largay, Bryan; Shihadeh, Rami; Tjeerdema, Ronald

    2011-05-01

    The California, USA, central coast is one of the most productive agricultural areas in the world, and numerous stakeholders are working there to implement conservation practices to reduce contaminated runoff. Practices include vegetated treatment systems (VTS) designed to promote contaminant reduction and breakdown. The current study evaluated the effectiveness of a vegetated drainage ditch incorporating a sedimentation basin, a vegetated section, and a Landguard organophosphate-A (OP-A) enzyme dosing system. The VTS was constructed on a working farm and was designed to remove organophosphate and pyrethroid pesticides, the primary pesticides causing toxicity in Salinas Valley watersheds. The present study was conducted during five separate irrigation events on tailwater runoff containing mixtures of pesticides and suspended sediments. Water samples were collected at four stations within the system, and these were subjected to chemical analyses and tested for toxicity to Ceriodaphnia dubia. All inflow samples were highly toxic to C. dubia, and this was largely because of diazinon. Treatment of diazinon-contaminated runoff was only partially effective using aquatic vegetation. All diazinon remaining after vegetated treatment was effectively removed after treatment with the Landguard OP-A enzyme. Chemical analysis of the VTS water samples showed that pyrethroid and organochlorine pesticide concentrations in water were greatly reduced in the sedimentation section of the ditch, and these pesticides were further reduced in the vegetated section of the ditch. The overall conclusion from these analyses is that the VTS was effective at reducing the more hydrophobic organochlorine and pyrethroid pesticides from water. The water-soluble pesticide diazinon was not sufficiently removed during the VTS residence times observed in this study; however, residual diazinon was effectively removed using Landguard OP-A.

  2. Integrating Temporal Pattern Mining in Ischemic Stroke Prediction and Treatment Pathway Discovery for Atrial Fibrillation.

    PubMed

    Guo, Shijing; Li, Xiang; Liu, Haifeng; Zhang, Ping; Du, Xin; Xie, Guotong; Wang, Fei

    2017-01-01

    Atrial fibrillation (AF) is associated with an increased risk of acute ischemic stroke (AIS). Accurately predicting AIS and planning effective treatment pathways for AIS prevention are crucial for AF patients. Because of the temporality of patients' disease progressions, sequential disease and treatment patterns have the potential to improve risk prediction performance and contribute to effective treatment pathways. This paper integrates temporal pattern mining into the AF study of AIS prediction and treatment pathway discovery. We combine temporal pattern mining with feature selection to identify temporal risk factors that have predictive ability, and integrate temporal pattern mining with treatment efficacy analysis to discover temporal treatment patterns that are statistically effective. Results show that our approach has identified new potential temporal risk factors for AIS that can improve the prediction performance, and has discovered treatment pathway patterns that are statistically effective to prevent AIS for AF patients.

  3. Integrating spiritual and Western treatment modalities in a Native American substance user center: provider perspectives.

    PubMed

    Moghaddam, Jacquelene F; Momper, Sandra L

    2011-01-01

    Few studies examine how traditional Native American and Western healing practices are being integrated in Native American substance user treatment centers. Data are presented from a 2008 study of providers of integrated substance user treatment for Native Americans at an urban Western US center. Nineteen semistructured interviews were conducted to examine 10 providers' views of the integration of traditional and Western healing and the impact on recovery for clients. We used a grounded theory approach to data analysis with manual and NVivo codes and themes developed. Limitations and implications for practice are discussed.

  4. Integrating Spiritual and Western Treatment Modalities in a Native American Substance User Center: Provider Perspectives

    PubMed Central

    Moghaddam, Jacquelene F.; Momper, Sandra L.

    2014-01-01

    Few studies examine how traditional Native American and Western healing practices are being integrated in Native American substance user treatment centers. Data are presented from a 2008 study of providers of integrated substance user treatment for Native Americans at an urban Western US center. Nineteen semi-structured interviews were conducted to examine 10 providers’ views of the integration of traditional and Western healing and the impact on recovery for clients. We used a grounded theory approach to data analysis with manual and NVivo codes and themes developed. Limitations and implications for practice are discussed. PMID:21810077

  5. Non-communicable diseases and HIV care and treatment: models of integrated service delivery.

    PubMed

    Duffy, Malia; Ojikutu, Bisola; Andrian, Soa; Sohng, Elaine; Minior, Thomas; Hirschhorn, Lisa R

    2017-08-01

    Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients. © 2017 John Wiley & Sons Ltd.

  6. The Protected Addiction: Exploring Staff Beliefs toward Integrating Tobacco Dependence into Substance Abuse Treatment Services

    ERIC Educational Resources Information Center

    Teater, Barbra; Hammond, Gretchen Clark

    2009-01-01

    Survey research was used to explore the beliefs of 963 staff members regarding the myths to treating tobacco dependence and the integration of tobacco dependence into substance abuse treatment programs. The staff represented a mixture of residential, outpatient, and prevention-based gender-specific (women only) treatment centers throughout Ohio.…

  7. Using Performance Feedback to Improve Treatment Integrity of Classwide Behavior Plans: An Investigation of Observer Reactivity

    ERIC Educational Resources Information Center

    Codding, Robin S.; Livanis, Andrew; Pace, Gary M.; Vaca, Leslie

    2008-01-01

    The current study replicated the positive effects of performance feedback on treatment integrity and extended previous work by examining reactivity using a multiple baseline design with alternating treatments for observer-present and observer-absent conditions on teachers' implementation of a classwide behavior plan. No differences were found…

  8. Treatment Integrity Enhancement via Performance Feedback Conceptualized as an Exercise in Social Influence

    ERIC Educational Resources Information Center

    Erchul, William P.

    2013-01-01

    This commentary is in response to the article "Effects of Verbal and Written Performance Feedback on Treatment Adherence" (Kaufman, Codding, Markus, Tryon, & Kyse, this issue). The overall recommendation to those who study treatment integrity using performance feedback methods is to incorporate theories and research on social…

  9. The Protected Addiction: Exploring Staff Beliefs toward Integrating Tobacco Dependence into Substance Abuse Treatment Services

    ERIC Educational Resources Information Center

    Teater, Barbra; Hammond, Gretchen Clark

    2009-01-01

    Survey research was used to explore the beliefs of 963 staff members regarding the myths to treating tobacco dependence and the integration of tobacco dependence into substance abuse treatment programs. The staff represented a mixture of residential, outpatient, and prevention-based gender-specific (women only) treatment centers throughout Ohio.…

  10. Integration of second cancer risk calculations in a radiotherapy treatment planning system

    NASA Astrophysics Data System (ADS)

    Hartmann, M.; Schneider, U.

    2014-03-01

    Second cancer risk in patients, in particular in children, who were treated with radiotherapy is an important side effect. It should be minimized by selecting an appropriate treatment plan for the patient. The objectives of this study were to integrate a risk model for radiation induced cancer into a treatment planning system which allows to judge different treatment plans with regard to second cancer induction and to quantify the potential reduction in predicted risk. A model for radiation induced cancer including fractionation effects which is valid for doses in the radiotherapy range was integrated into a treatment planning system. From the three-dimensional (3D) dose distribution the 3D-risk equivalent dose (RED) was calculated on an organ specific basis. In addition to RED further risk coefficients like OED (organ equivalent dose), EAR (excess absolute risk) and LAR (lifetime attributable risk) are computed. A risk model for radiation induced cancer was successfully integrated in a treatment planning system. Several risk coefficients can be viewed and used to obtain critical situations were a plan can be optimised. Risk-volume-histograms and organ specific risks were calculated for different treatment plans and were used in combination with NTCP estimates for plan evaluation. It is concluded that the integration of second cancer risk estimates in a commercial treatment planning system is feasible. It can be used in addition to NTCP modelling for optimising treatment plans which result in the lowest possible second cancer risk for a patient.

  11. Minimizing dioxin emissions from integrated MSW thermal treatment.

    PubMed

    Cheung, Wai Hung; Lee, Vinci K C; McKay, Gordon

    2007-03-15

    The combustion of wastes has very significant benefits in reducing the volume of waste materials and producing energy. However, combustion processes produce emissions, which must be below the Best Practical Means (BPM) specified legislative limits. Several wastes, such as tires and meat meal, have been successfully combusted in cement kilns, up to 20% w/w, while retaining emission standards well below legislative limits. In the case of municipal solid waste (MSW) the introduction of large amounts of MSW into cement kilns is not practical because the additional kiln volume required is too great, the large amounts of ash generated will affect the cement clinker quality, and it would be difficult to sustain the required very high clinkering temperature of 1500 degrees C with large quantities of low calorific value MSW. A completely novel process, termed the Co-Co process, has been developed, integrating MSW combustion in a synergistic fashion with the cement production. This process is based on combining the cement "front-end" calcination reaction and incorporating it with a high temperature, at 1200 degrees C, combustion process, providing a giant acid gas scrubber. A pilot plant was designed, constructed, and operated to demonstrate the benefits of the Co-Co process. The pilot plant achieved emissions minimization: dioxins were typically 0.5-1% of the European BPM limits, HCl, SOx, NOx, and particulates were 15, 10, 20, and 25% of BPM limits, respectively. Heavy metals were typically below 25% of BPM limit values.

  12. [Integrative treatment of instable diabetes mellitus: education or psychotherapy?].

    PubMed

    Leweke, Frank; Kurth, Regina; Milch, Wolfgang; Brosig, Burkhard

    2004-01-01

    The term "brittle diabetes" describes a subtype of instable type-I diabetes, characterized by high variations of blood sugar without any evident cause and despite careful clinical management. Clear guidelines for a precise definition of the condition are still lacking; this fosters insecurities concerning diagnosis and therapy of the disease. Psychosocial influences, triggering these conditions, were discussed. The patient-doctor-relationship appears to be tensed due to an often missing compliance. Using a paradigmatic case study as background, the specific diagnostic and therapeutic problems in brittle diabetes were presented. Brittle diabetes advocates a close cooperation between internal and psychosomatic medicine units and a combination of patient education and psychotherapy. Seen under a psychosomatic paradigm, brittle diabetes can be detected early and effective treatment may avoid further complications in these young patients.

  13. Formulation and treatment: integrating religion and spirituality in clinical practice.

    PubMed

    Josephson, Allan M

    2004-01-01

    Developing scientifically sound and clinically meaningful case formulations is so challenging that it may verge on becoming a "lost art." Pressures (scientific, economic, and cultural) remain that prevent child and adolescent psychiatrists from getting a complete understanding of the patient and family. Including a strong consideration of data related to religion, spirituality, and worldview may seem only to complicate an already arduous task. The clinician who includes these factors in treatment is faced with decisions of when to discuss these issues, how to discuss them and in what depth, and finally, when to refer to a religious/spiritual professional. Nonetheless, the importance of these factors in the lives of many children and families leaves no option but to address them as directly as possible. It is well worth the effort and, in many cases, will open new areas for clinical improvement in patients.

  14. Treatment of panic and agoraphobia. An integrative review.

    PubMed

    Mattick, R P; Andrews, G; Hadzi-Pavlovic, D; Christensen, H

    1990-09-01

    There is now agreement about the clinical features of panic disorder and agoraphobia but less agreement about treatment because of controversy over whether the disorder is primarily biological or psychological. The authors were requested to produce an impartial review for continuing education and peer review. We chose to do this by using a quantitative review procedure, by providing a bibliography of studies, and by a literature review. We found that symptoms of panic and phobia did not change significantly while on wait-list control or while receiving placebo. The evidence for the efficacy of the low-potency benzodiazepines or of monoamine oxidase inhibitors was limited. It was also clear that only limited improvement can be expected from behavior therapies that do not involve exposure to the symptoms of panic or to the feared situation. Symptoms of panic, as well as the frequency of spontaneous panic, were shown to be substantially improved following imipramine, high-potency benzodiazepines such as alprazolam, exposure in vivo (especially if a cognitive anxiety management procedure was used), and the combination of imipramine and exposure in vivo. The effects on panic produced by the exposure therapies (with or without imipramine) were maintained over long follow-up periods. Imipramine, alprazolam, exposure therapy, and imipramine plus exposure each produced significant improvements in phobias. In the short term and in the long term, the larger improvements in phobias were associated with exposure therapy, particularly if used in combination with imipramine. We conclude that it would be unwise to theorize about the etiology of this disorder on the basis of response to a specific treatment because, both at the meta-analytic level and from the review of individual studies, it is clear that both drug and nondrug therapies can produce substantial and long-lasting changes in panic and in phobias.

  15. Integrated Treatment to Achieve Functional Recovery for First-Episode Psychosis

    PubMed Central

    Valencia, Marcelo; Juarez, Francisco; Ortega, Hector

    2012-01-01

    This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: N = 39) or to medication alone (control group: N = 34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to 58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group. PMID:22970366

  16. The Effects of Varying Levels of Treatment Integrity on Child Compliance during Treatment with a Three-Step Prompting Procedure

    ERIC Educational Resources Information Center

    Wilder, David A.; Atwell, Julie; Wine, Byron

    2006-01-01

    The effects of three levels of treatment integrity (100%, 50%, and 0%) on child compliance were evaluated in the context of the implementation of a three-step prompting procedure. Two typically developing preschool children participated in the study. After baseline data on compliance to one of three common demands were collected, a therapist…

  17. Integration of chemical and biological treatments for textile industry wastewater: a possible zero-discharge system.

    PubMed

    Lee, H H; Chen, G; Yue, P L

    2001-01-01

    Theoretical and experimental studies have established that integrated treatment systems (mostly chemical and biological) for various industrial wastewaters can achieve better quality of treatment and can be cost-effective. In the present study, the objective is to minimize the use of process water in the textile industry by an economical recycle and reuse scheme. The textile wastewater was first characterized in terms of COD, BOD5, salinity and color. In order to recycle such wastewater, the contaminants should be mineralized and/or removed according to the reusable textile water quality standards. Typical results show that this is achievable. An economic analysis has been conducted on the proposed integrated system. The economic analysis shows that the integrated system is economically more attractive than any of the single treatment technologies for achieving the same target of treatment. The information presented in this paper provides a feasible option for the reduction of effluent discharges in the textile industry.

  18. Advances in Applying Treatment Integrity Research for Dissemination and Implementation Science: Introduction to Special Issue

    PubMed Central

    Southam-Gerow, Michael A.; McLeod, Bryce D.

    2013-01-01

    This special series focuses upon the ways in which research on treatment integrity, a multidimensional construct including assessment of the content and quality of a psychosocial treatment delivered to a client as well as relational elements, can inform dissemination and implementation science. The five articles for this special series illustrate how treatment integrity concepts and methods can be applied across different levels of the mental health service system to advance dissemination and implementation science. In this introductory article, we provide an overview of treatment integrity research and describe three broad conceptual models that are relevant to the articles in the series. We conclude with a brief description of each of the five articles in the series. PMID:23970819

  19. A close look at an integrative treatment package for Bell's palsy in Korea.

    PubMed

    Lee, Seung Min Kathy; Lee, Suji; Park, Jun Hyeong; Park, Jongbae J; Lee, Sanghoon

    2017-02-01

    To provide an overview of the integrative treatment package for Bell's palsy provided at Kyung Hee University Korean Medicine Hospital (KHU KMH). The Facial Palsy Center at KHU KMH has been providing integrative treatment for Bell's palsy patients during the past three decades. Within 72 h of symptom onset, corticosteroids are recommended but complementary treatment including acupuncture and herbal medicine can be used to help suppress inflammation and nerve degeneration. If patients suffer from postauricular pain, pharmacopuncture and cupping is utilized. During the subacute or chronic periods, different acupuncture types are selected accordingly, and herbal medicine and moxibustion helps to improve immune functions and relieve accessory symptoms. Qigong programs are also provided to help relieve facial tension and paralysis. Although rigorous research is warranted, with limited treatment options, we highly suggest that it is worth applying integrative medicine to Bell's palsy patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Integrated approach to treatment-resistant atrial fibrillation: additional value of acupuncture

    PubMed Central

    Jonkman, F A M; Jonkman-Buidin, M L

    2013-01-01

    A 62-year-old patient with chronic bronchitis had treatment-resistant atrial fibrillation. Electrical cardioversion was performed, but sinus rhythm (SR) lasted only for some minutes. Administration of amiodarone was withheld in favour of a course of acupuncture treatment in order to increase the success rate of a second attempt of electrical cardioversion. After two acupuncture treatments, spontaneous conversion to SR occurred. Relapses into atrial fibrillation in the following five winters, associated with attacks of bronchitis, also responded to acupuncture. The mechanisms of action of the acupuncture treatment and the value of this integrated approach to treatment are discussed. PMID:23884291

  1. Integrated approach to treatment-resistant atrial fibrillation: additional value of acupuncture.

    PubMed

    Jonkman, F A M; Jonkman-Buidin, M L

    2013-09-01

    A 62-year-old patient with chronic bronchitis had treatment-resistant atrial fibrillation. Electrical cardioversion was performed, but sinus rhythm (SR) lasted only for some minutes. Administration of amiodarone was withheld in favour of a course of acupuncture treatment in order to increase the success rate of a second attempt of electrical cardioversion. After two acupuncture treatments, spontaneous conversion to SR occurred. Relapses into atrial fibrillation in the following five winters, associated with attacks of bronchitis, also responded to acupuncture. The mechanisms of action of the acupuncture treatment and the value of this integrated approach to treatment are discussed.

  2. Low-pressure membrane integrity tests for drinking water treatment: A review.

    PubMed

    Guo, H; Wyart, Y; Perot, J; Nauleau, F; Moulin, P

    2010-01-01

    Low-pressure membrane systems, including microfiltration (MF) and ultrafiltration (UF) membranes, are being increasingly used in drinking water treatments due to their high level of pathogen removal. However, the pathogen will pass through the membrane and contaminate the product if the membrane integrity is compromised. Therefore, an effective on-line integrity monitoring method for MF and UF membrane systems is essential to guarantee the regulatory requirements for pathogen removal. A lot of works on low-pressure membrane integrity tests have been conducted by many researchers. This paper provides a literature review about different low-pressure membrane integrity monitoring methods for the drinking water treatment, including direct methods (pressure-based tests, acoustic sensor test, liquid porosimetry, etc.) and indirect methods (particle counting, particle monitoring, turbidity monitoring, surrogate challenge tests). Additionally, some information about the operation of membrane integrity tests is presented here. It can be realized from this review that it remains urgent to develop an alternative on-line detection technique for a quick, accurate, simple, continuous and relatively inexpensive evaluation of low-pressure membrane integrity. To better satisfy regulatory requirements for drinking water treatments, the characteristic of this ideal membrane integrity test is proposed at the end of this paper.

  3. A novel, integrated treatment system for coal wastewaters

    SciTech Connect

    Wang, H.Y.; Srinivasan, K.R.

    1991-01-01

    This is the first quarterly report of the above project. The aims of this study are to develop, characterize and optimize a novel treatment scheme that would be effective simultaneously against the toxic organics and the inorganics present in coal conversion wastewaters. The initial phase of the work has been focused on the development of modified clays for use in the selective removal and recovery of heavy metals such as Cd, Cu, chromate and selenate. The results presented here show that a surfactant-modified clay adsorbs Cd strongly at a pH of 8.5 and poorly at pH 4.0. Further, the adsorption of Cd on modified clay is unaffected by the ionic strength of the medium. In the case of Cu, it has been shown that the metal forms a complex with alkyl diamines in aqueous solutions at a pH of 6.0 and does not bind to these surfactants at a lower pH of 3.0. These findings are a preliminary indication that the surface and solution chemistry of amine surfactants can be gainfully modified to adsorb and desorb cationic heavy metals.

  4. A novel, integrated treatment systems for coal wastewaters

    SciTech Connect

    Wang, H.Y.; Srinivasan, K.R.

    1992-01-01

    The aims of this study are to develop, characterize and optimize a novel treatment scheme that would be effective simultaneously against the toxic organics and heavy metals present in coal conversion wastewaters. Hec-CBDA-DT, a modified hectorite containing a mixed bilayer of a cationic (CBDA) and a diamine (DT) type surfactants, was shown to adsorb simultaneously heavy metals such as Cu[sup 2+] and Cd[sup 2+] and toxic organics such as chlorophenols. The pH dependence of the adsorption of chlorophenols on Hec-CBDA-DT suggested hydrophobic partitioning, counterion adsorption and hydrogen-bond interaction of the phenolate ions with the surface diamine groups as the possible mechanisms of sorption. Adsorption of Cu[sup 2+] by Hec-CBDA-DT was shown to be only slightly affected by a large excess of counterions, thus indicating that Cu[sup 2+] adsorbed specifically to the surface. A second type of modified clay, Hec-CBDA-Palmitic Acid (Hec-CBDA-PA) adsorbed both Cu[sup 2+] and Cd[sup 2+] strongly. However, the pH optima for adsorption were 6.0 and 8.0 respectively in the case of Cu[sup 2+] and Cd[sup 2+]. It is inferred that the mechanisms of adsorption of these two metal ions to Hec-CBDA-PA are different, specific and counterion binding respectively in the case of Cu and Cd ions.

  5. A novel integrated treatment system for coal wastewaters

    SciTech Connect

    Wang, H.Y.; Srinivasan, K.R.

    1992-01-01

    The aims of this study are to develop, characterize and optimize a novel treatment scheme that would be effective simultaneously against the toxic organics and heavy metals present in coal conversion wastewaters. To remove and recover heavy metals from wastewaters, four different types of surfactant-clay complexes have been prepared using hectored or montmorillonite as the base clays. The adsorbent is prepared by first coating the clay surface, upto a monolayer, with a cationic surfactant, CBDA, to which an amine, (DT), or a carboxylic acid (Palmitic acid, PA) is anchored using hydrophobic effect to form a mixed bilayer. Such an arrangement is expected to locate the functional groups in metal adsorption at the solid-solution interface. Complexes based on hectored are shown to adsorb Cu{sup 2+} ions more strongly than the ones based on montmorillonite. The rate of adsorption of Cu{sup 2+} ions is quite rapid and the adsorbed amount levels off in less than 2 hrs. The optimum pH for metal adsorption is around 6.5 and the amount of metal adsorbed declines sharply on the lower pH side of the pH optimum, suggesting that removal and recovery of adsorbed metal ions can be effected by a slight pH shift.

  6. A novel, integrated treatment system for coal wastewaters

    SciTech Connect

    Wang, H.Y.; Srinivasan, K.R.

    1992-01-01

    The aims of this study are to develop, characterize and optimize a novel treatment scheme that would be effective simultaneously against the toxic organics and the heavy metals present in coal conversion wastewaters. Hec-CBDA-DT, (HCDT), a modified hectorite containing a mixed bilayer of a cationic (CBDA) and a dismine (DT) type surfactants, has been shown to adsorb Cr (VI) strongly at PH below 5.0. A second kind of a modified clay, montmorillonite-DT, (MONT-DT), in which the protonated form of the diamine is directly attached to the negative sites of clay surface, has also been found to adsorb CR(VI) as strongly as Hec-CBDA-DT at a pH of 4.5. The adsorption of Cr (VI) onto these two modified-clays is strongly inhibited by an increase in the ionic strength of the medium. It is inferred that the main mechanism of adsorption of CR(VI) onto these two clay complexes is of the counterion. Preliminary data on the partitioning of phenanthrene, a three-ringed polyaromatic hydrocarbon (PAH), reveal that organic carbon located on the external surfaces of clay complexes is more effective in partitioning nonionic, toxic organic compounds.

  7. Comparison of behavioral intervention and sensory-integration therapy in the treatment of challenging behavior.

    PubMed

    Devlin, Sarah; Healy, Olive; Leader, Geraldine; Hughes, Brian M

    2011-10-01

    The objective of the current study was to compare the effects of sensory-integration therapy (SIT) and a behavioral intervention on rates of challenging behavior (including self-injurious behavior) in four children diagnosed with Autism Spectrum Disorder. For each of the participants a functional assessment was conducted to identify the variables maintaining challenging behavior. Results of these assessments were used to design function-based behavioral interventions for each participant. Recommendations for the sensory-integration treatment were designed by an Occupational Therapist, trained in the use of sensory-integration theory and techniques. The sensory-integration techniques were not dependent on the results of the functional assessments. The study was conducted within an alternating treatments design, with initial baseline and final best treatment phase. For each participant, results demonstrated that the behavioral intervention was more effective than the sensory integration therapy in the treatment of challenging behavior. In the best treatment phase, the behavioral intervention alone was implemented and further reduction was observed in the rate of challenging behavior. Analysis of saliva samples revealed relatively low levels of cortisol and very little stress-responsivity across the SIT condition and the behavioral intervention condition, which may be related to the participants' capacity to perceive stress in terms of its social significance.

  8. Review of the integrated thermal and nonthermal treatment system studies. Final report

    SciTech Connect

    1996-10-01

    This report contains a review and evaluation of three systems analysis studies performed by LITCO on integrated thermal treatment systems and integrated nonthermal treatment systems for the remediation of mixed low-level waste stored throughout the US Department of Energy weapons complex. The review was performed by an independent team of nine researchers from the Energy and Environmental Research Center, Science Applications International Corporation, the Waste Policy Institute, and Virginia Tech. The three studies reviewed were as follows: Integrated Thermal Treatment System Study, Phase 1 -- issued July 1994; Integrated Thermal Treatment System Study, Phase 2 -- issued February 1996; and Integrated Nonthermal Treatment System Study -- drafted March 1996. The purpose of this review was to (1) determine whether the assumptions of the studies were adequate to produce an unbiased review of both thermal and nonthermal systems, (2) to identify the critical areas of the studies that would benefit from further investigation, and (3) to develop a standard template that could be used in future studies to assure a sound application of systems engineering.

  9. Verification of Fowler-Nordheim electron tunneling mechanism in Ni/SiO2/n-4H SiC and n+ poly-Si/SiO2/n-4H SiC MOS devices by different models

    NASA Astrophysics Data System (ADS)

    Kodigala, Subba Ramaiah

    2016-11-01

    This article emphasizes verification of Fowler-Nordheim electron tunneling mechanism in the Ni/SiO2/n-4H SiC MOS devices by developing three different kinds of models. The standard semiconductor equations are categorically solved to obtain the change in Fermi energy level of semiconductor with effect of temperature and field that extend support to determine sustainable and accurate tunneling current through the oxide layer. The forward and reverse bias currents with variation of electric field are simulated with help of different models developed by us for MOS devices by applying adequate conditions. The latter is quite different from former in terms of tunneling mechanism in the MOS devices. The variation of barrier height with effect of quantum mechanical, temperature, and fields is considered as effective barrier height for the generation of current-field (J-F) curves under forward and reverse biases but quantum mechanical effect is void in the latter. In addition, the J-F curves are also simulated with variation of carrier concentration in the n-type 4H SiC semiconductor of MOS devices and the relation between them is established.

  10. Psychosomatic patients in integrated care: Which treatment mediators do we have to focus on?

    PubMed

    Parth, Karoline; Rosar, Ania; Stastka, Kurt; Storck, Timo; Löffler-Stastka, Henriette

    2016-01-01

    The field of psychosomatics has gained increasing significance; it has been struggling to establish its position as either an independent discipline or a subdomain of specific areas such as internal medicine or psychiatry. However, the rise of psychosomatic syndromes and disease patterns as well as an increase of specific integrated psychosomatic wards is a clear indication for the growing importance of interdisciplinary approaches to psychosomatic disorders. The study presents data from an 8-week inpatient treatment at a psychosomatic facility and investigates whether patients improved in their subjective symptom experience. A complex treatment approach, ranging from pharmacological treatment and group and individual psychotherapy to physiotherapy and ergotherapy was integrated into this intervention. In essence, containment of intrapsychic aggression derivatives played a central role in the treatment of psychosomatic symptoms. A significant factor contributing to a successful treatment is the doctor-patient relationship. All these factors were investigated in the present study.

  11. Integrating Buprenorphine Into an Opioid Treatment Program: Tailoring Care for Patients With Opioid Use Disorders

    PubMed Central

    Polydorou, Soteri; Ross, Stephen; Coleman, Peter; Duncan, Laura; Roxas, Nichole; Thomas, Anil; Mendoza, Sonia; Hansen, Helena

    2016-01-01

    Objectives This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP). Methods This case study presents the authors’ experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735). Results Integration of BMT into an OTP offered patients the flexibility to transition between intensive structured care and primary care or outpatient psychiatry according to need. Main barriers encountered were regulations, clinical logistics of dispensing medications, internal cost and reimbursement issues, and professional and cultural resistance. Conclusions Buprenorphine integration offers a model for other OTPs to facilitate partnerships among primary care and mental health clinics to better serve diverse patients with varying clinical needs and with varying levels of social support. PMID:27745534

  12. Interpersonal, cognitive analytic and other integrative therapies versus treatment as usual for depression

    PubMed Central

    Churchill, Rachel; Davies, Philippa; Caldwell, Deborah; Moore, Theresa HM; Jones, Hannah; Lewis, Glyn; Hunot, Vivien

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all integrative therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different integrative therapies (IPT, CAT, psychodynamic-interpersonal therapy, cognitive behavioural analysis system of psychotherapy and counselling) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all integrative therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression. PMID:25411560

  13. EFFECTS OF TREATMENT INTEGRITY FAILURES DURING DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR: A TRANSLATIONAL MODEL

    PubMed Central

    Peter Pipkin, Claire St; Vollmer, Timothy R; Sloman, Kimberly N

    2010-01-01

    Differential reinforcement of alternative behavior (DRA) is used frequently as a treatment for problem behavior. Previous studies on treatment integrity failures during DRA suggest that the intervention is robust, but research has not yet investigated the effects of different types of integrity failures. We examined the effects of two types of integrity failures on DRA, starting with a human operant procedure and extending the results to children with disabilities in a school setting. Human operant results (Experiment 1) showed that conditions involving reinforcement for problem behavior were more detrimental than failing to reinforce appropriate behavior alone, and that condition order affected the results. Experiments 2 and 3 replicated the effects of combined errors and sequence effects during actual treatment implementation. PMID:20808495

  14. Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

    PubMed Central

    Farrell, Caitlin; Sorensen-Alawad, Amy; Palmisano, Joseph N.; Chaisson, Christine; Walley, Alexander Y.

    2014-01-01

    Abstract The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs. PMID:24428768

  15. Identity: empirical contribution. Changes in the identity integration of adolescents in treatment for personality disorders.

    PubMed

    Feenstra, Dine J; Hutsebaut, Joost; Verheul, Roel; van Limbeek, Jacques

    2014-02-01

    A renewed interest in identity as one of the core markers of personality disorders has been introduced by the DSM-5 Level of Personality Functioning Scale. However, little is known about the utility of the construct of identity in children and adolescents. This study aimed to broaden the knowledge of identity integration as a core component of personality functioning in adolescents. The authors investigated levels of identity integration, as measured by the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), in adolescents in both normal (n = 406) and clinical populations (n = 285). Furthermore, changes in levels of identity integration during treatment were investigated in a clinical subsample (n = 76). Levels of identity integration were not associated with age. They were, however, associated with the absence or presence of personality pathology. Most adolescents receiving inpatient psychotherapy gradually changed toward more healthy levels of identity integration; a significant number, however, remained at maladaptive levels of identity functioning after intensive psychotherapy.

  16. Uniting adolescent neuroimaging and treatment research: Recommendations in pursuit of improved integration

    PubMed Central

    Feldstein Ewing, Sarah W.; Tapert, Susan F.; Molina, Brooke S.G.

    2016-01-01

    Many clinicians who provide mental health treatment find developmental neuroscience discoveries to be exciting. However, the utility of these findings often seem far removed from everyday clinical care. Thus, the goal of this article is to offer a bridge to connect the fields of applied adolescent treatment and developmental neuroscience investigation. An overview of the relevance of developmental neuroscience in adolescent direct practice and a rationale for how and why this integration could benefit adolescent treatment outcomes is provided. Finally, a series of practical suggestions is generated for enhancing collaborative, interdisciplinary work that ultimately advances treatment response for this important clinical population. PMID:26748378

  17. Integration and its discontents: substance abuse treatment in the Oregon Health Plan.

    PubMed

    Laws, Katherine E; Gabriel, Roy M; McFarland, Bentson H

    2002-01-01

    With the creation of the Oregon Health Plan (OHP) in 1994, Oregon placed its Medicaid program under a managed care system. This paper examines the managed care practices of seven health plans serving OHP enrollees between 1996 and 1998. Results indicated that the original vision of integrating substance abuse treatment services with physical care for OHP enrollees evolved into a multilayered, carved-out approach. Factors working against integration included changes in the administration and management of the chemical dependency benefit, financial losses by health plans, and lack of training and incentives for physicians to refer clients to substance abuse treatment.

  18. Enhancing the Developmental Appropriateness of Treatment for Depression in Youth: Integrating the Family in Treatment

    PubMed Central

    Tompson, Martha C.; Boger, Kathryn Dingman; Asarnow, Joan R.

    2016-01-01

    Youth depression is an impairing and frequently recurrent and persistent disorder that impacts current and later development, resulting in high social and economic costs. Depression and interpersonal stress are frequently transactional, with depression powerfully negatively impacting relationships and relationship stress negatively impacting the course and outcome of depression. In this context, treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article has three objectives. It first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on the role of family involvement in treatment. Second, it discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Third, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt. PMID:22537731

  19. White matter integrity in obstructive sleep apnea before and after treatment.

    PubMed

    Castronovo, Vincenza; Scifo, Paola; Castellano, Antonella; Aloia, Mark S; Iadanza, Antonella; Marelli, Sara; Cappa, Stefano F; Strambi, Luigi Ferini; Falini, Andrea

    2014-09-01

    Obstructive sleep apnea (OSA) is commonly associated with cognitive and functional deficits, some of which are resolved after continuous positive airway pressure (CPAP) treatment. The investigation of brain structural changes before and after treatment could provide deep insights into the pathogenesis and the reversibility of this disorder. We hypothesized that severe OSA patients would have altered white matter (WM) integrity and cognition and that treatment would improve both the structural damage and the cognitive impairment. Prospective clinical study. The Sleep Disorders Center and the Center of Excellence in High-Field Magnetic Resonance Imaging at Vita-Salute San Raffaele University, Milan, Italy. Seventeen never-treated consecutive OSA patients were evaluated before and after treatment (after 3 and 12 months) and compared to 15 matched healthy controls. CPAP. WM integrity measured by diffusion tensor imaging (DTI) and cognitive performance (measured with neuropsychological testing) before and after 3 and 12 months of CPAP. Results in pre-treatment OSA patients showed impairments in most cognitive areas, mood and sleepiness that were associated with diffuse reduction of WM fiber integrity reflected by diminished fractional anisotropy (FA) and mean diffusivity (MD) in multiple brain areas. After 3 months of CPAP, only limited changes of WM were found. However, over the course of 12 months CPAP treatment, an almost complete reversal of WM abnormalities in all the affected regions was observed in patients who were compliant with treatment. Significant improvements involving memory, attention, and executive-functioning paralleled WM changes after treatment. Changes of WM DTI "signatures" of brain pathology in OSA patients are appreciable over the course of 12-month treatment with CPAP in most of the regions involved. Recovery of cognitive deficits after treatment is consistent with the presence of a reversible structural neural injury in OSA in patients who were

  20. Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout.

    PubMed

    Szafranski, Derek D; Snead, Alexandra; Allan, Nicholas P; Gros, Daniel F; Killeen, Therese; Flanagan, Julianne; Pericot-Valverde, Irene; Back, Sudie E

    2017-10-01

    High rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have been noted in veteran populations. Fortunately, there are a number of evidence-based psychotherapies designed to address comorbid PTSD and SUD. However, treatments targeting PTSD and SUD simultaneously often report high dropout rates. To date, only one study has examined predictors of dropout from PTSD/SUD treatment. To address this gap in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Participants were 51 male and female veterans diagnosed with current PTSD and SUD. All participants completed at least one session of a cognitive-behavioral treatment (COPE) designed to simultaneously address PTSD and SUD symptoms. Of the 51 participants, 22 (43.1%) dropped out of treatment prior to completing the full 12 session COPE protocol. Results indicated that the majority of dropout (55%) occurred after session 6, with the largest amount of dropout occurring between sessions 9 and 10. Results also indicated a marginally significant relationship between greater baseline PTSD symptom severity and premature dropout. These findings highlight inconsistencies related to timing and predictors of dropout, as well as the dearth of information noted about treatment dropout within PTSD and SUD literature. Suggestions for procedural changes, such as implementing continual symptom assessments during treatment and increasing dialog between provider and patient about dropout were made with the hopes of increasing consistency of findings and eventually reducing treatment dropout. Published by Elsevier Ltd.

  1. Generalizability of Multiple Measures of Treatment Integrity: Comparisons among Direct Observation, Permanent Products, and Self-Report

    ERIC Educational Resources Information Center

    Gresham, Frank M.; Dart, Evan H.; Collins, Tai A.

    2017-01-01

    The concept of treatment integrity is an essential component to databased decision making within a response-to-intervention model. Although treatment integrity is a topic receiving increased attention in the school-based intervention literature, relatively few studies have been conducted regarding the technical adequacy of treatment integrity…

  2. Integrating Art into Group Treatment for Adults with Post-Traumatic Stress Disorder from Childhood Sexual Abuse: A Pilot Study

    ERIC Educational Resources Information Center

    Becker, Carol-Lynne J.

    2015-01-01

    Current research supports the use of exposure-based treatments for posttraumatic stress disorder (PTSD) and integrated treatments show potential for enhanced symptom reduction. This pilot study developed a manualized group treatment integrating art interventions with exposure, grounding, and narrative therapy for five adults with PTSD who were…

  3. Integrating Art into Group Treatment for Adults with Post-Traumatic Stress Disorder from Childhood Sexual Abuse: A Pilot Study

    ERIC Educational Resources Information Center

    Becker, Carol-Lynne J.

    2015-01-01

    Current research supports the use of exposure-based treatments for posttraumatic stress disorder (PTSD) and integrated treatments show potential for enhanced symptom reduction. This pilot study developed a manualized group treatment integrating art interventions with exposure, grounding, and narrative therapy for five adults with PTSD who were…

  4. Integration of buprenorphine/naloxone treatment into HIV clinical care: lessons from the BHIVES collaborative.

    PubMed

    Weiss, Linda; Netherland, Julie; Egan, James E; Flanigan, Timothy P; Fiellin, David A; Finkelstein, Ruth; Altice, Frederick L

    2011-03-01

    Replication of effective practices requires detailed descriptions of implementation processes, barriers and facilitators, and lessons learned. The experiences of physicians leading the Buprenorphine HIV Evaluation and Support initiative provides valuable information for other HIV providers seeking to integrate medication-assisted treatment services into HIV clinical care. Evaluation staff conduced site visits to the 10 funded Buprenorphine HIV Evaluation and Support programs to better understand buprenorphine/naloxone (bup/nx) integration practices; services offered; staffing; provider experiences with and perceptions of bup/nx; perceived barriers, facilitators, and sustainability; and recommendations regarding replication of integrated care program components. Interviews with site principal investigators conducted during the last year of program implementation were transcribed, coded, and analyzed according to both pre-identified and emerging themes. Integrated bup/nx and HIV treatment was successfully introduced to community and hospital-based clinics under the direction of infectious disease, psychiatry, and general internal medicine physicians. All but 1 of the principal investigators interviewed were highly satisfied with integrated HIV and bup/nx treatment, and all anticipated continued provision of the service. Multiple prescribers were necessary to ensure sufficient coverage and a bup/nx coordinator (eg, nurse, counselor) was seen as essential to the provision of quality care. Ongoing challenges included multisubstance use and mental health issues among patients; limited adoption of bup/nx treatment among colleagues; and the necessity of incorporating new procedures, including urine toxicology testing into established practice. Findings suggest that integrated bup/nx treatment and HIV care is acceptable to providers and feasible in a variety of practice settings.

  5. Enhancing Entrance into PTSD Treatment for Post-Deployment Veterans through Collaborative/Integrative Care

    DTIC Science & Technology

    2011-01-01

    of early identification and treatment. The Veterans Health Administration (VHA)’s Primary Care Mental Health Integration (PCMHI) program aims to...resources, increases continuity of care, and increases treatment access for OEF/OIF/OND veterans. KEYWORDS Collaborative care, PTSD, Mental health ...signifi- cant psychiatric and psychosocial difficulties. Approximately 25% to 37% of returning veterans have received a mental health diagnosis, and greater

  6. A simple method of independent treatment time verification in gamma knife radiosurgery using integral dose

    SciTech Connect

    Jin Jianyue; Drzymala, Robert; Li Zuofeng

    2004-12-01

    The purpose of this study is to develop a simple independent dose calculation method to verify treatment plans for Leksell Gamma Knife radiosurgery. Our approach uses the total integral dose within the skull as an end point for comparison. The total integral dose is computed using a spreadsheet and is compared to that obtained from Leksell GammaPlan registered . It is calculated as the sum of the integral doses of 201 beams, each passing through a cylindrical volume. The average length of the cylinders is estimated from the Skull-Scaler measurement data taken before treatment. Correction factors are applied to the length of the cylinder depending on the location of a shot in the skull. The radius of the cylinder corresponds to the collimator aperture of the helmet, with a correction factor for the beam penumbra and scattering. We have tested our simple spreadsheet program using treatment plans of 40 patients treated with Gamma Knife registered in our center. These patients differ in geometry, size, lesion locations, collimator helmet, and treatment complexities. Results show that differences between our calculations and treatment planning results are typically within {+-}3%, with a maximum difference of {+-}3.8%. We demonstrate that our spreadsheet program is a convenient and effective independent method to verify treatment planning irradiation times prior to implementation of Gamma Knife radiosurgery.

  7. Measuring collaboration and integration activities in criminal justice and substance abuse treatment agencies.

    PubMed

    Fletcher, Bennett; Lehman, Wayne; Wexler, Harry; Melnick, Gerald; Taxman, Faye; Young, Douglas

    2009-08-01

    Individuals with substance abuse problems who are involved in the criminal justice system frequently need community-based drug and alcohol abuse treatment and other services. To reduce the risk of relapse to illicit drugs and criminal recidivism, criminal justice agencies may need to establish collaborations with substance abuse treatment and other community-based service providers. Although there are many variations of interorganizational relationships, the nature of these interagency collaborations among justice agencies and treatment providers has received little systematic study. As a first step,we present an instrument to measure interagency collaboration and integration activities using items in the National Criminal Justice Treatment Practices Surveys conducted as part of the Criminal Justice Drug Abuse Treatment Studies(CJ-DATS). Collaboration and integration activities related to drug-involved offenders were examined between substance abuse treatment providers, correctional agencies, and the judiciary. The measurement scale reliably identified two levels of collaboration: less structured, informal networking and coordination and more structured and formalized levels of cooperation and collaboration. An illustration of the use of the systems integration tool is presented.

  8. Homeopathic and integrative treatment for feline hyperthyroidism--four cases (2006-2010).

    PubMed

    Chapman, Sara Fox

    2011-10-01

    Hyperthyroidism is a frequent veterinary problem, particularly in elderly cats. Homeopathic treatment and other integrative modalities were provided for four hyperthyroid cats whose owners did not want conventional treatment. Symptomatic homeopathic treatment with Thyroidinum was helpful in one cat. All cats were prescribed an appropriate individualized homeopathic remedy. All four cats showed resolution of clinical signs; three attained normal thyroid hormone levels. Three cats later received acupuncture and/or herbal medicines; two cats later received symptomatic homeopathic remedies. Two cats are thriving after over 3.5 and 4.25 years of treatment; two were euthanized for unrelated problems after 3 and 4 years of treatment. Homeopathic and complementary therapies avoid the potential side effects of methimazole and surgical thyroidectomy, they are less costly than radioactive iodine treatment, and they provide an option for clients who decline conventional therapies. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  9. Integrating psychoanalysis and psychopharmacology: a review of the literature of combined treatment for affective disorders.

    PubMed

    Lebovitz, Phil S

    2004-01-01

    Affective distress has been a double-edged sword in psychoanalytic treatment. Motivation for treatment develops when emotional discomfort reaches a threshold of intolerable pain. When distress rises above a certain limit, the patient becomes flooded and overwhelmed by affects that severely compromise his/her capability of utilizing psychoanalytic treatment. The psychoanalytic therapist's dilemma has been whether prescribing medication facilitates treatment or undermines and/or distorts treatment with destructive consequences. The efficacy of combining pharmacotherapy and psychoanalytic therapy is more firmly validated by recent studies. The focus shifts now toward the indications, and contraindications, for integrated treatment. An essential issue remaining is whether, and when, the treating analyst should be the prescribing analyst.

  10. An Integrated Model for Identifying Linkages Between the Management of Fuel Treatments, Fire and Ecosystem Services

    NASA Astrophysics Data System (ADS)

    Bart, R. R.; Anderson, S.; Moritz, M.; Plantinga, A.; Tague, C.

    2015-12-01

    Vegetation fuel treatments (e.g. thinning, prescribed burning) are a frequent tool for managing fire-prone landscapes. However, predicting how fuel treatments may affect future wildfire risk and associated ecosystem services, such as forest water availability and streamflow, remains a challenge. This challenge is in part due to the large range of conditions under which fuel treatments may be implemented, as response is likely to vary with species type, rates of vegetation regrowth, meteorological conditions and physiographic properties of the treated site. It is also due to insufficient understanding of how social factors such as political pressure, public demands and economic constraints affect fuel management decisions. To examine the feedbacks between ecological and social dimensions of fuel treatments, we present an integrated model that links a biophysical model that simulates vegetation and hydrology (RHESSys), a fire spread model (WMFire) and an empirical fuel treatment model that accounts for agency decision-making. We use this model to investigate how management decisions affect landscape fuel loads, which in turn affect fire severity and ecosystem services, which feedback to management decisions on fuel treatments. We hypothesize that this latter effect will be driven by salience theory, which predicts that fuel treatments are more likely to occur following major wildfire events. The integrated model provides a flexible framework for answering novel questions about fuel treatments that span social and ecological domains, areas that have previously been treated separately.

  11. Synthesis and Integration of Pre-treatment Results from the Missouri Ozark Forest Ecosystem Project

    Treesearch

    Wendy K. Gram; Victoria L. Sork; Robert J. Marquis

    1997-01-01

    Integrating results across disciplines is a critical component of ecosystem management and research. The common research sites, landscape-scale experimental design, and breadth of research subjects in Missouri Ozark Forest Ecosystem Project provide circumstances conducive for addressing multidisciplinary questions. Our objectives were to (1) summarize the treatment and...

  12. Successful Integrative Medicine Assessment and Treatment of Chronic Pain Associated With Breast Surgery

    PubMed Central

    Chung, Myung Kyu

    2017-01-01

    Presented is the first reported case series of chronic neck and back pain associated with breast scars from breast surgery and successfully treated with an integrative medicine assessment and treatment approach, which included the assessment technique of autonomic response testing and the scar therapy technique of neural therapy. Implications for nursing practice are discussed. PMID:27782920

  13. [Recognizing prevention and treatment of burn sepsis with the concept of holistic integrative medicine].

    PubMed

    Huan, J N

    2017-04-20

    Sepsis remains a major cause of death in severe burns. The effect of sepsis management is influenced by its complicated pathophysiologic changes. In order to improve the outcome of burn sepsis, the predisposing factor of sepsis after burn analyzed by advanced technology, the early prevention, antibiotics therapy, and combined treatment in severe burns with sepsis are discussed using the concept of holistic integrative medicine.

  14. K West Basin Integrated Water Treatment System (IWTS) E-F Annular Filter Vessel Accident Calculations

    SciTech Connect

    RITTMANN, P.D.

    1999-10-07

    Three bounding accidents postdated for the K West Basin integrated water treatment system are evaluated against applicable risk evaluation guidelines. The accidents are a spray leak during fuel retrieval, spray leak during backflushing, and a hydrogen explosion. Event trees and accident probabilities are estimated. In all cases, the unmitigated dose consequences are below the risk evaluation guidelines.

  15. A Comparison of Constant Time Delay Instruction with High and Low Treatment Integrity

    ERIC Educational Resources Information Center

    Tekin Iftar, Elif; Kurt, Onur; Cetin, Ozlem

    2011-01-01

    Time delay (TD) procedure is an effective procedure in teaching various skills to children with developmental disabilities. Moreover, research has shown that it is used with high treatment integrity (HTI). However, there are several barriers which may prevent delivery instruction with HTI. Therefore, this study was designed to compare the…

  16. K West Basin Integrated Water Treatment System (IWTS) E-F Annular Filter Vessel Accident Calculations

    SciTech Connect

    PIEPHO, M.G.

    2000-01-10

    Four bounding accidents postulated for the K West Basin integrated water treatment system are evaluated against applicable risk evaluation guidelines. The accidents are a spray leak during fuel retrieval, spray leak during backflushing a hydrogen explosion, and a fire breaching filter vessel and enclosure. Event trees and accident probabilities are estimated. In all cases, the unmitigated dose consequences are below the risk evaluation guidelines.

  17. A Randomized, Controlled Trial of Integrated Home-School Behavioral Treatment for ADHD, Predominantly Inattentive Type

    ERIC Educational Resources Information Center

    Pfiffner, Linda J.; Mikami, Amori Yee; Huang-Pollock, Cynthia; Easterlin, Barbara; Zalecki, Christine; McBurnett, Keith

    2007-01-01

    Objective: To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school (Child Life and Attention Skills Program) with attention-deficit/hyperactivity disorder (ADHD) predominantly inattentive type (ADHD-I). Method: Sixty-nine children ages 7 to 11 years were randomized to the Child Life and Attention Skills…

  18. Examining the Influence of Treatment Integrity: Accuracy of Daily Report Card Intervention Implementation and Student Outcome

    ERIC Educational Resources Information Center

    Vujnovic, Rebecca Kate

    2010-01-01

    Given the deficits associated with ADHD and the significant prevalence, it is important to explore evidence based treatments for ADHD in the classroom and the efficacy with which the classroom teachers implement such interventions. The current investigation is a secondary analysis to investigate the integrity of a Daily Report Card (DRC)…

  19. Effects of Varied Levels of Treatment Integrity on Appropriate Toy Manipulation in Children with Autism

    ERIC Educational Resources Information Center

    Groskreutz, Nicole C.; Groskreutz, Mark P.; Higbee, Thomas S.

    2011-01-01

    We assessed the effects of varying the treatment integrity of a prompting procedure on appropriate toy manipulation in two preschool-aged children with autism. Following an assessment to identify toys with high levels of inappropriate toy manipulation, each of three toys was associated with implementation of the prompting procedure at a different…

  20. Preliminary design report for the K basins integrated water treatment system

    SciTech Connect

    Pauly, T.R., Westinghouse Hanford

    1996-08-12

    This Preliminary Design Report (PDR) provides a revised concept for the K Basins Integrated Water Treatment Systems (IWTS). This PDR incorporates the 11 recommendations made in a May 1996 Value Engineering session into the Conceptual Design, and provides new flow diagrams, hazard category assessment, cost estimate, and schedule for the IWTS Subproject.

  1. Integrated Educational and Mental Health Services within a Day Treatment Setting.

    ERIC Educational Resources Information Center

    Francis, Greta; Radka, Dale F.

    This paper discusses the integration of educational and mental health services for children and adolescents within a psychiatric day treatment setting at the Bradley School housed in a private psychiatric hospital affiliated with Brown University in Rhode Island. A full range of mental health services are used, and therapies are delivered in the…

  2. Increasing Treatment Integrity through Negative Reinforcement: Effects on Teacher and Student Behavior

    ERIC Educational Resources Information Center

    DiGennaro, Florence D.; Martens, Brian K.; McIntyre, Laura Lee

    2005-01-01

    The current study examined the extent to which treatment integrity was increased and maintained for 4 teachers in their regular classroom settings as a result of performance feedback and negative reinforcement. Teachers received daily written feedback about their accuracy in implementing an intervention and were able to avoid meeting with a…

  3. An Assessment of Treatment Integrity in Behavioral Intervention Studies Conducted with Persons with Mental Retardation

    ERIC Educational Resources Information Center

    Wheeler, John J.; Mayton, Michael R.; Carter, Stacy L.; Chitiyo, Morgan; Menendez, Anthony L.; Huang, Ann

    2009-01-01

    The purpose of this study was to assess the degree to which behavioral intervention studies conducted with persons with mental retardation operationally defined the independent variables and evaluated and reported measures of treatment integrity. The study expands the previous work in this area reported by Gresham, Gansle, and Noell (1993) and…

  4. Treatment Integrity of Interventions with Children in the School Psychology Literature from 1995 to 2008

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Gritter, Katie L.; Dobey, Lisa M.

    2011-01-01

    Increased accountability in education has resulted in a focus on implementing interventions with strong empirical support. Both student outcome and treatment integrity data are needed to draw valid conclusions about intervention effectiveness. Reviews of the literature in other fields (e.g., applied behavior analysis, prevention science) suggest…

  5. Assessing Treatment Integrity in Acceptance and Commitment Therapy: Strategies and Suggestions

    ERIC Educational Resources Information Center

    Plumb, Jennifer C.; Vilardaga, Roger

    2010-01-01

    In this paper, we briefly review the current literature on treatment integrity and discuss the relevance of this procedure for detecting, measuring and ensuring that the proposed mechanisms of change in cognitive behavior therapy, in this case of acceptance and commitment therapy (ACT; S.C. Hayes, Strosahl, & Wilson, 1999), take place. We discuss…

  6. An Assessment of Treatment Integrity in Behavioral Intervention Studies Conducted with Persons with Mental Retardation

    ERIC Educational Resources Information Center

    Wheeler, John J.; Mayton, Michael R.; Carter, Stacy L.; Chitiyo, Morgan; Menendez, Anthony L.; Huang, Ann

    2009-01-01

    The purpose of this study was to assess the degree to which behavioral intervention studies conducted with persons with mental retardation operationally defined the independent variables and evaluated and reported measures of treatment integrity. The study expands the previous work in this area reported by Gresham, Gansle, and Noell (1993) and…

  7. Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism

    ERIC Educational Resources Information Center

    Fallon, Lindsay M.; Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Feinberg, Adam B.; Kratochwill, Thomas R.

    2016-01-01

    Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way…

  8. The Effect of Sensory Integration Treatment on Children with Multiple Disabilities.

    ERIC Educational Resources Information Center

    Din, Feng S.; Lodato, Donna M.

    Six children with multiple disabilities (ages 5 to 8) participated in this evaluation of the effect of sensory integration treatment on sensorimotor function and academic learning. The children had cognitive abilities ranging from sub-average to significantly sub-average, three were non-ambulatory, one had severe behavioral problems, and each…

  9. Increasing Teacher Treatment Integrity through Performance Feedback Provided by School Personnel

    ERIC Educational Resources Information Center

    Hagermoser Sanetti, Lisa M.; Fallon, Lindsay M.; Collier-Meek, Melissa A.

    2013-01-01

    When implementing behavioral interventions in educational settings, some implementers need support to maintain high levels of treatment integrity. Performance feedback has a large body of research supporting it as a strategy for improving teachers' implementation of classroom interventions. However, in most prior studies, performance feedback has…

  10. Treatment Integrity of Interventions with Children in the School Psychology Literature from 1995 to 2008

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Gritter, Katie L.; Dobey, Lisa M.

    2011-01-01

    Increased accountability in education has resulted in a focus on implementing interventions with strong empirical support. Both student outcome and treatment integrity data are needed to draw valid conclusions about intervention effectiveness. Reviews of the literature in other fields (e.g., applied behavior analysis, prevention science) suggest…

  11. A Comparison of Sensory Integrative and Behavioral Therapies as Treatment for Pediatric Feeding Disorders

    ERIC Educational Resources Information Center

    Addison, Laura R.; Piazza, Cathleen C.; Patel, Meeta R.; Bachmeyer, Melanie H.; Rivas, Kristi M.; Milnes, Suzanne M.; Oddo, Jackie

    2012-01-01

    We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory…

  12. Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism

    ERIC Educational Resources Information Center

    Fallon, Lindsay M.; Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Feinberg, Adam B.; Kratochwill, Thomas R.

    2016-01-01

    Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way…

  13. A Randomized, Controlled Trial of Integrated Home-School Behavioral Treatment for ADHD, Predominantly Inattentive Type

    ERIC Educational Resources Information Center

    Pfiffner, Linda J.; Mikami, Amori Yee; Huang-Pollock, Cynthia; Easterlin, Barbara; Zalecki, Christine; McBurnett, Keith

    2007-01-01

    Objective: To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school (Child Life and Attention Skills Program) with attention-deficit/hyperactivity disorder (ADHD) predominantly inattentive type (ADHD-I). Method: Sixty-nine children ages 7 to 11 years were randomized to the Child Life and Attention Skills…

  14. A Comparison of Sensory Integrative and Behavioral Therapies as Treatment for Pediatric Feeding Disorders

    ERIC Educational Resources Information Center

    Addison, Laura R.; Piazza, Cathleen C.; Patel, Meeta R.; Bachmeyer, Melanie H.; Rivas, Kristi M.; Milnes, Suzanne M.; Oddo, Jackie

    2012-01-01

    We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory…

  15. Effects of Varied Levels of Treatment Integrity on Appropriate Toy Manipulation in Children with Autism

    ERIC Educational Resources Information Center

    Groskreutz, Nicole C.; Groskreutz, Mark P.; Higbee, Thomas S.

    2011-01-01

    We assessed the effects of varying the treatment integrity of a prompting procedure on appropriate toy manipulation in two preschool-aged children with autism. Following an assessment to identify toys with high levels of inappropriate toy manipulation, each of three toys was associated with implementation of the prompting procedure at a different…

  16. [Integrated treatment of cleft lip and palate. Organization of a treatment team].

    PubMed

    Sánchez-Ruiz, I; González Landa, G; Pérez González, V; Díez Rodríguez, R; López-Cedrún, J L; Miró Viar, J; García Miñaur, S; de Celis Vara, R; Sánchez Fernández, L

    1999-01-01

    Collect the team experience in the treatment of children with cleft lip and palate, indicating the evolution of the team composition, advantages and improvement aspects, trying to transmit the need of team treatment. The Bilbao cleft palate team was created in 1983, since then a cleft palate clinic, a parents group and a unit of velopharyngeal function has been developed. At present the team is composed by: pediatric reconstructor surgeon, speech therapist, orthodontist, dentist, pediatrician, ENT, maxillofacial surgeon, dismorphologyst, geneticist, nursing. One of the achievements has been the data unification, obtaining speech cephalometrics, photographic dental casts and video images with prospective view. At this time 403 cleft lip and palate children have been intervened, being essential the transdisciplinar team approach between surgeon, speech therapist and orthodontist. The importance of the team coordinator is pointed. The results of an audit of the two stage cleft palate closure in complete unilateral cleft lip and palate have obligated us to vary our surgical policy. The unresolved aspects are the lack of multidisciplinary team recognition at official level and the non existence of orthodontist in staff, without cost coverage of this treatment by public health system. In our experience the team treatment of cleft lip and palate has resulted in improvement of the clinic results, treatment protocols and training.

  17. Family-Based Cognitive-Behavioral Treatments for Suicidal Adolescents and their Integration with Individual Treatment

    ERIC Educational Resources Information Center

    Wells, Karen C.; Heilbron, Nicole

    2012-01-01

    A considerable research base underscores the importance of family functioning in the risk for and treatment of adolescent suicidal thoughts and behaviors. This paper reviews the extant empirical literature documenting associations between features of the family context and adolescent suicidal thoughts and behaviors. A case example is provided to…

  18. The Relationship between Pre-Treatment Clinical Profile and Treatment Outcome in an Integrated Stuttering Program

    ERIC Educational Resources Information Center

    Huinck, Wendy J.; Langevin, Marilyn; Kully, Deborah; Graamans, Kees; Peters, Herman F. M.; Hulstijn, Wouter

    2006-01-01

    A procedure for subtyping individuals who stutter and its relationship to treatment outcome is explored. Twenty-five adult participants of the Comprehensive Stuttering Program (CSP) were classified according to: (1) stuttering severity and (2) severity of negative emotions and cognitions associated with their speech problem. Speech characteristics…

  19. Family-Based Cognitive-Behavioral Treatments for Suicidal Adolescents and their Integration with Individual Treatment

    ERIC Educational Resources Information Center

    Wells, Karen C.; Heilbron, Nicole

    2012-01-01

    A considerable research base underscores the importance of family functioning in the risk for and treatment of adolescent suicidal thoughts and behaviors. This paper reviews the extant empirical literature documenting associations between features of the family context and adolescent suicidal thoughts and behaviors. A case example is provided to…

  20. Hole injection and dielectric breakdown in 6H-SiC and 4H-SiC metal-oxide-semiconductor structures during substrate electron injection via Fowler-Nordheim tunneling

    NASA Astrophysics Data System (ADS)

    Samanta, Piyas; Mandal, Krishna C.

    2015-12-01

    Hole injection into silicon dioxide (SiO2) films (8-40 nm thick) is investigated for the first time during substrate electron injection via Fowler-Nordheim (FN) tunneling in n-type 4H- and 6H-SiC (silicon carbide) based metal-oxide-semiconductor (MOS) structures at a wide range of temperatures (T) between 298 and 598 K and oxide electric fields Eox from 6 to 10 MV/cm. Holes are generated in heavily doped n-type polycrystalline silicon (n+ -polySi) gate serving as the anode as well as in the bulk silicon dioxide (SiO2) film via hot-electron initiated band-to-band ionization (BTBI). In absence of oxide trapped charges, it is shown that at a given temperature, the hole injection rates from either of the above two mechanisms are higher in n-4H-SiC MOS devices than those in n-6H-SiC MOS structures when compared at a given Eox and SiO2 thickness (tox). On the other hand, relative to n-4H-SiC devices, n-6H-SiC structures exhibit higher hole injection rates for a given tox during substrate electron injection at a given FN current density je,FN throughout the temperature range studied here. These two observations clearly reveal that the substrate material (n-6H-SiC and n-4H-SiC) dependencies on time-to-breakdown (tBD) or injected charge (electron) to breakdown (QBD) of the SiO2 film depend on the mode of FN injections (constant field/voltage and current) from the substrate which is further verified from the rigorous device simulation as well.

  1. Developing an Integrated Treatment for Substance Use and Depression Using Cognitive Behavioral Therapy

    PubMed Central

    Osilla, Karen Chan; Hepner, Kimberly A.; Muñoz, Ricardo F.; Woo, Stephanie; Watkins, Katherine

    2010-01-01

    Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. Using a Cognitive Behavioral Therapy (CBT) approach, we developed a group-based integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings, and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (N=7) and semi-structured interviews with counselors (N=2) and administrators (N=3). Using CBT as a treatment approach was widely accepted by clients, counselors and administrators. Clients stated the treatment was applicable to multiple aspects of their lives and allowed them to recognize their clinical improvements over time. Counselors and administrators discussed challenges for long-term feasibility. Key decisions used to develop the treatment and recommendations for implementing integrated care in SUD settings are discussed. PMID:19540701

  2. Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped Care.

    PubMed

    Choi-Kain, Lois W; Albert, Elizabeth B; Gunderson, John G

    2016-01-01

    After participating in this activity, learners should be better able to:• Evaluate evidence-based therapies for borderline personality disorder Several manualized psychotherapies for treating borderline personality disorder (BPD) have been validated in randomized, controlled trials. Most of these approaches are highly specialized, offering different formulation of BPD and different mechanisms by which recovery is made possible. Mental health clinicians are challenged by the degree of specialization and clinical resources that these approaches require in their empirically validated adherent forms. While these effective treatments have renewed optimism for the treatment of BPD, clinicians may feel limited in their ability to offer any of them or may integrate an eclectic assortment of features from the different treatments. This article will evaluate four major evidence-based treatments for BPD-dialectical behavioral therapy, mentalization-based treatment, transference-focused psychotherapy, and General Psychiatric Management-and possible modes of implementation in adherent and integrative forms. Models of implementing these diverse treatment approaches will be evaluated, and the potential advantages of combining evidence-based treatments will be discussed, along with some cautionary notes. A proposal for providing stepwise care through assessment of clinical severity will be presented as a means of achieving system-wide changes and greater access to care.

  3. Integrated trauma treatment in correctional health care and community-based treatment upon reentry.

    PubMed

    Wallace, Barbara C; Conner, Latoya C; Dass-Brailsford, Priscilla

    2011-10-01

    Given the crisis of mass incarceration in the United States and the high prevalence of trauma histories among those incarcerated, it is imperative to improve service delivery to inmates in correctional facilities and to those undergoing reentry in community-based treatment settings. This article provides trauma definitions and categories, describes the sequelae of trauma, reviews research on the high prevalence of incarceration in this nation, and reviews research on the high prevalence of trauma among the incarcerated. This article also provides a menu of evidence-based and promising treatment approaches to address the overlap among trauma, mental illness, substance abuse, and behavioral problems. A synthesis of research via seven points is meant to guide practitioner and policy responses to the national challenge of meeting the needs of those undergoing reentry.

  4. Performance evaluation of integrated solid-liquid wastes treatment technology in palm oil industry

    NASA Astrophysics Data System (ADS)

    Amelia, J. R.; Suprihatin, S.; Indrasti, N. S.; Hasanudin, U.; Fujie, K.

    2017-05-01

    The oil palm industry significantly contributes to environmental degradation if without waste management properly. The newest alternative waste management that might be developed is by utilizing the effluent of POME anaerobic digestion with EFB through integrated anaerobic decomposition process. The aim of this research was to examine and evaluate the integrated solid-liquid waste treatment technology in the view point of greenhouse gasses emission, compost, and biogas production. POME was treated in anaerobic digester with loading rate about 1.65 gCOD/L/day. Treated POME with dosis of 15 and 20 L/day was sprayed to the anaerobic digester that was filled of 25 kg of EFB. The results of research showed that after 60 days, the C/N ratio of EFB decreased to 12.67 and 10.96 for dosis of treated POME 15 and 20 L/day, respectively. In case of 60 day decomposition, the integrated waste treatment technology could produce 51.01 and 34.34 m3/Ton FFB which was equivalent with 636,44 and 466,58 kgCO2e/ton FFB for dosis of treated POME 15 and 20 L/day, respectively. The results of research also showed that integrated solid-liquid wastes treatment technology could reduce GHG emission about 421.20 and 251.34 kgCO2e/ton FFB for dosis of treated POME 15 and 20 L/day, respectively.

  5. Human health benefits and burdens of a pharmaceutical treatment: Discussion of a conceptual integrated approach.

    PubMed

    Debaveye, Sam; De Soete, Wouter; De Meester, Steven; Vandijck, Dominique; Heirman, Bert; Kavanagh, Shane; Dewulf, Jo

    2016-01-01

    The effects of a pharmaceutical treatment have until now been evaluated by the field of Health Economics on the patient health benefits, expressed in Quality-Adjusted Life Years (QALYs) versus the monetary costs. However, there is also a Human Health burden associated with this process, resulting from emissions that originate from the pharmaceutical production processes, Use Phase and End of Life (EoL) disposal of the medicine. This Human Health burden is evaluated by the research field of Life Cycle Assessment (LCA) and expressed in Disability-Adjusted Life Years (DALYs), a metric similar to the QALY. The need for a new framework presents itself in which both the positive and negative health effects of a pharmaceutical treatment are integrated into a net Human Health effect. To do so, this article reviews the methodologies of both Health Economics and the area of protection Human Health of the LCA methodology and proposes a conceptual framework on which to base an integration of both health effects. Methodological issues such as the inclusion of future costs and benefits, discounting and age weighting are discussed. It is suggested to use the structure of an LCA as a backbone to cover all methodological challenges involved in the integration. The possibility of monetizing both Human Health benefits and burdens is explored. The suggested approach covers the main methodological aspects that should be considered in an integrated assessment of the health effects of a pharmaceutical treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. White matter integrity and executive abilities following treatment with tetrahydrobiopterin (BH4) in individuals with phenylketonuria.

    PubMed

    White, Desirée A; Antenor-Dorsey, Jo Ann V; Grange, Dorothy K; Hershey, Tamara; Rutlin, Jerrel; Shimony, Joshua S; McKinstry, Robert C; Christ, Shawn E

    2013-11-01

    Tetrahydrobiopterin (BH(4)) lowers blood phenylalanine (Phe) in individuals with PKU who are responders, but its effects on the brain and cognition have not been explored thoroughly. We examined blood Phe, microstructural white matter integrity, and executive abilities in 12 BH(4) responders before (i.e., baseline) and after (i.e., follow-up) six months of treatment with BH(4). Compared with baseline, Phe in these responders decreased by 51% during a 4 week screening period after initiation of treatment and remained lowered by 37% over the 6 month follow-up period. Significant improvements in white matter integrity, evaluated by mean diffusivity from diffusion tensor imaging, were also found following six months of treatment. Improvements in executive abilities were not identified, although six months may have been a period too brief for changes in cognition to follow changes in the brain. To our knowledge, our study is the first to explore relationships among Phe, white matter integrity, executive abilities, and BH(4) treatment within a single study. © 2013.

  7. Integrating evidence-based treatments with individual needs in an outpatient facility for eating disorders.

    PubMed

    Schaffner, Angela D; Buchanan, Linda P

    2008-01-01

    The purpose of this study was to evaluate the effectiveness of a day treatment program for 77 women diagnosed with eating disorders. The program utilizes an integrative approach, combining evidence-based treatments such as cognitive-behavioral therapy with clinical experience and additional multimodal interventions based on individual needs. Three modes of treatment used in the program (group therapy, family therapy, and individual therapy) and two levels of treatment (partial hospitalization and intensive outpatient) are described in detail. The effectiveness of the treatment program was evaluated by comparing pre-treatment and post-treatment data on outcome measures for eating disorder attitudes, personality characteristics, and symptoms, as well as depressive symptoms and anxiety symptoms. Results indicated that after an average of 12.8 weeks of treatment, patients reported a significant reduction in eating disorder symptoms, depressive symptoms, and anxiety symptoms, and a significant increase in weight at post-treatment. Implications of these findings and directions for future research are discussed.

  8. Integrative and behavioral approaches to the treatment of cancer-related neuropathic pain.

    PubMed

    Cassileth, Barrie R; Keefe, Francis J

    2010-01-01

    Integrative oncology is the synthesis of mainstream cancer care and evidence-based complementary therapies. Complementary strategies include massage therapies, acupuncture, fitness, and mind-body techniques, which take advantage of the reciprocal relationship between the mind and body. Neuropathic pain--and pain more generally--is part of a complex process involving the whole physical and psychosocial being, therefore requiring an integrative management approach. Several studies have demonstrated, for example, that social context plays an important role in the perception of pain and that a patient's coping strategies can influence the persistence of pain. In this article, we briefly describe research illustrating the promise of integrative approaches for the treatment of cancer-related neuropathic pain.

  9. [Integrity].

    PubMed

    Gómez Rodríguez, Rafael Ángel

    2014-01-01

    To say that someone possesses integrity is to claim that that person is almost predictable about responses to specific situations, that he or she can prudentially judge and to act correctly. There is a closed interrelationship between integrity and autonomy, and the autonomy rests on the deeper moral claim of all humans to integrity of the person. Integrity has two senses of significance for medical ethic: one sense refers to the integrity of the person in the bodily, psychosocial and intellectual elements; and in the second sense, the integrity is the virtue. Another facet of integrity of the person is la integrity of values we cherish and espouse. The physician must be a person of integrity if the integrity of the patient is to be safeguarded. The autonomy has reduced the violations in the past, but the character and virtues of the physician are the ultimate safeguard of autonomy of patient. A field very important in medicine is the scientific research. It is the character of the investigator that determines the moral quality of research. The problem arises when legitimate self-interests are replaced by selfish, particularly when human subjects are involved. The final safeguard of moral quality of research is the character and conscience of the investigator. Teaching must be relevant in the scientific field, but the most effective way to teach virtue ethics is through the example of the a respected scientist.

  10. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options.

    PubMed

    Diener, Hans-Christoph; Solbach, Kasja; Holle, Dagny; Gaul, Charly

    2015-08-01

    Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.

  11. Treatment impact of an integrated sex offender program as measured by J-SOAP-II.

    PubMed

    Rehfuss, Mark C; Underwood, Lee A; Enright, Morgan; Hill, Savannah; Marshall, Rod; Tipton, Paula; West, Laura; Warren, Kellie

    2013-04-01

    Despite the increase in juvenile sex offending in society and the significant growth in the number of treatment programs, relatively few studies have examined the effectiveness of these programs. This study examined the effectiveness of an integrated sex offender program on a sample of 309 adjudicated male sex offenders in a juvenile correctional facility using the dynamic scale score of the Juvenile Sex Offender Assessment Protocol II (J-SOAP-II). The youth participated in one of the three treatment groups characterized by length of treatment and risk of recidivism: low risk (0 to 9 months), moderate risk (9 to 23 months), and high risk (23 to 56 months). A significant decrease in the dynamic scale scores of the J-SOAP-II was found only for the moderate treatment group (9 to 23 months).

  12. Complementary Therapies for Significant Dysfunction from Tinnitus: Treatment Review and Potential for Integrative Medicine

    PubMed Central

    Wolever, Ruth Q.; Price, Rebecca; Hazelton, A. Garrett; Dmitrieva, Natalia O.; Bechard, Elizabeth M.; Shaffer, Janet K.; Tucci, Debara L.

    2015-01-01

    Tinnitus is a prevalent and costly chronic condition; no universally effective treatment exists. Only 20% of patients who report tinnitus actually seek treatment, and when treated, most patients commonly receive sound-based and educational (SBE) therapy. Additional treatment options are necessary, however, for nonauditory aspects of tinnitus (e.g., anxiety, depression, and significant interference with daily life) and when SBE therapy is inefficacious or inappropriate. This paper provides a comprehensive review of (1) conventional tinnitus treatments and (2) promising complementary therapies that have demonstrated some benefit for severe dysfunction from tinnitus. While there has been no systematic study of the benefits of an Integrative Medicine approach for severe tinnitus, the current paper reviews emerging evidence suggesting that synergistic combinations of complementary therapies provided within a whole-person framework may augment SBE therapy and empower patients to exert control over their tinnitus symptoms without the use of medications, expensive devices, or extended programs. PMID:26457113

  13. 01. Interprofessional, Integrative Treatment of Oncology Patients at a Large Midwestern Community Health System

    PubMed Central

    Piant, Patricia; Walker, Charlotte; Beck, Carole; Chamness, John

    2013-01-01

    Focus Area: Integrative Approaches to Care The Integrative Medicine team at NorthShore University Health System has practiced together for the past 12 years, with a majority of our clientele dealing with oncology issues. We follow patients through the various stages of their cancer treatments, from prevention of cancer, to time of diagnosis, chemotherapy, radiation, surgery, rehabilitation, survivorship, recurrence, and hospice and palliative care. Based on the framework of treating a patient with cancer, our panelists will discuss each of their treatment strategies, ranging from bodywork, energy work, traditional Chinese medicine, counseling, guided imagery, herbal and nutritional supplements, and hospice and palliative care. We also will discuss the administrative and financial miracles that make it all happen as seamlessly as possible while increasing access to care for those who cannot afford these services.

  14. An integrated prediction and optimization model of biogas production system at a wastewater treatment facility.

    PubMed

    Akbaş, Halil; Bilgen, Bilge; Turhan, Aykut Melih

    2015-11-01

    This study proposes an integrated prediction and optimization model by using multi-layer perceptron neural network and particle swarm optimization techniques. Three different objective functions are formulated. The first one is the maximization of methane percentage with single output. The second one is the maximization of biogas production with single output. The last one is the maximization of biogas quality and biogas production with two outputs. Methane percentage, carbon dioxide percentage, and other contents' percentage are used as the biogas quality criteria. Based on the formulated models and data from a wastewater treatment facility, optimal values of input variables and their corresponding maximum output values are found out for each model. It is expected that the application of the integrated prediction and optimization models increases the biogas production and biogas quality, and contributes to the quantity of electricity production at the wastewater treatment facility. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Integrating tobacco cessation treatment into mental health care for patients with posttraumatic stress disorder.

    PubMed

    McFall, Miles; Atkins, David C; Yoshimoto, Dan; Thompson, Charles E; Kanter, Evan; Malte, Carol A; Saxon, Andrew J

    2006-01-01

    The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression.

  16. Integration of advanced oxidation processes at mild conditions in wet scrubbers for odourous sulphur compounds treatment.

    PubMed

    Vega, Esther; Martin, Maria J; Gonzalez-Olmos, Rafael

    2014-08-01

    The effectiveness of different advanced oxidation processes on the treatment of a multicomponent aqueous solution containing ethyl mercaptan, dimethyl sulphide and dimethyl disulphide (0.5 mg L(-1) of each sulphur compound) was investigated with the objective to assess which one is the most suitable treatment to be coupled in wet scrubbers used in odour treatment facilities. UV/H2O2, Fenton, photo-Fenton and ozone treatments were tested at mild conditions and the oxidation efficiency obtained was compared. The oxidation tests were carried out in magnetically stirred cylindrical quartz reactors using the same molar concentration of oxidants (hydrogen peroxide or ozone). The results show that ozone and photo-Fenton are the most efficient treatments, achieving up to 95% of sulphur compounds oxidation and a mineralisation degree around 70% in 10 min. Furthermore, the total costs of the treatments taking into account the capital and operational costs were also estimated for a comparative purpose. The economic analysis revealed that the Fenton treatment is the most economical option to be integrated in a wet scrubber to remove volatile organic sulphur compounds, as long as there are no space constraints to install the required reactor volume. In the case of reactor volume limitation or retrofitting complexities, the ozone and photo-Fenton treatments should be considered as viable alternatives.

  17. Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.

    PubMed

    Barnett, Paul G; Jeffers, Abra; Smith, Mark W; Chow, Bruce K; McFall, Miles; Saxon, Andrew J

    2016-03-01

    We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD). Smoking veterans receiving care for PTSD (N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars. The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care (P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care (P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY. Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  18. Promotoras' roles in integrative validity and treatment fidelity efforts in randomized controlled trials.

    PubMed

    Keller, Colleen; Records, Kathie; Coe, Kathryn; Ainsworth, Barbara; Vega López, Sonia; Nagle-Williams, Allison; Permana, Paska

    2012-01-01

    Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts. This article describes a 48-week randomized controlled trial Madres para la Salud (Mothers for Health) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity. Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat, systemic and fat tissue inflammation, and depression symptoms. The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention, and a promotora model to incorporate initial and ongoing fidelity monitoring.

  19. Oral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients.

    PubMed

    Gual-Frau, Josep; Abad, Carlos; Amengual, María J; Hannaoui, Naim; Checa, Miguel A; Ribas-Maynou, Jordi; Lozano, Iris; Nikolaou, Alexandros; Benet, Jordi; García-Peiró, Agustín; Prats, Juan

    2015-09-01

    Infertile males with varicocele have the highest percentage of sperm cells with damaged DNA, compared to other infertile groups. Antioxidant treatment is known to enhance the integrity of sperm DNA; however, there are no data on the effects in varicocele patients. We thus investigated the potential benefits of antioxidant treatment specifically in grade I varicocele males. Twenty infertile patients with grade I varicocele were given multivitamins (1500 mg L-Carnitine, 60 mg vitamin C, 20 mg coenzyme Q10, 10 mg vitamin E, 200 μg vitamin B9, 1 μg vitamin B12, 10 mg zinc, 50 μg selenium) daily for three months. Semen parameters including total sperm count, concentration, progressive motility, vitality, and morphology were determined before and after treatment. In addition, sperm DNA fragmentation and the amount of highly degraded sperm cells were analyzed by Sperm Chromatin Dispersion. After treatment, patients showed an average relative reduction of 22.1% in sperm DNA fragmentation (p = 0.02) and had 31.3% fewer highly degraded sperm cells (p = 0.07). Total numbers of sperm cells were increased (p = 0.04), but other semen parameters were unaffected. These data suggest that sperm DNA integrity in grade I varicocele patients may be improved by oral antioxidant treatment.

  20. A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment

    SciTech Connect

    Pienaar, Elsje; Cilfone, Nicholas A.; Lin, Philana Ling; Dartois, Veronique; Mattila, Joshua T.; Butler, J. Russell; Flynn, JoAnne L.; Kirschner, Denise E.; Linderman, Jennifer J.

    2014-12-08

    While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic. In this paper, we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. In conclusion, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome.

  1. A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment.

    PubMed

    Pienaar, Elsje; Cilfone, Nicholas A; Lin, Philana Ling; Dartois, Véronique; Mattila, Joshua T; Butler, J Russell; Flynn, JoAnne L; Kirschner, Denise E; Linderman, Jennifer J

    2015-02-21

    While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic. Here we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. Finally, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome.

  2. Two Models of Integrating Buprenorphine Treatment and Medical Staff within Formerly "Drug-Free" Outpatient Programs.

    PubMed

    Monico, Laura; Schwartz, Robert P; Gryczynski, Jan; O'Grady, Kevin E; Mitchell, Shannon Gwin

    2016-01-01

    "Drug-free" outpatient programs deliver treatment to the largest number of patients of all treatment modalities in the U.S., providing a significant opportunity to expand access to medication treatments for substance use disorders. This analysis examined staff perceptions of organizational dynamics associated with the delivery of buprenorphine maintenance within three formerly "drug-free" outpatient treatment programs. Semi-structured interviews (N = 15) were conducted with counseling and medical staff, and respondents were predominantly African American (n = 11) and female (n = 12). Themes and concepts related to medical staff integration emerged through an inductive and iterative coding process using Atlas.ti qualitative analysis software. Two treatment clinics incorporated buprenorphine maintenance into their programs using a co-located model of care. Their staff generally reported greater intra-organizational discord regarding the best ways to combine medication and counseling compared to the clinic using an integrated model of care. Co-located program staff reported less communication between medical and clinical staff, which contributed to some uncertainty about proper dosing and concerns about the potential for medication diversion. Clinics that shift from "drug-free" to incorporating buprenorphine maintenance should consider which model of care they wish to adapt and how to train staff and structure staff communication.

  3. An integrated sandstone acidizing fluid selection and simulation to optimize treatment design

    SciTech Connect

    Sumotarto, U.; Hill, A.D.; Sepehrnoori, K.

    1995-12-31

    An optimized design of a matrix treatment involves fluid selection and acidizing simulations to predict the outcome of the treatment. Many matrix acidizing treatment designs and fluid selections have been successfully accomplished by utilizing expert system technology. However, none of these present a complete and optimized result (i.e., by utilizing the output of the expert system to predict the acidizing outcome using an acidizing numerical simulator). In the meantime, several acidizing computer simulation studies have been conducted separately. This paper presents a study which integrates the treatment design, particularly the fluid selection process, and acidizing simulation for sandstone formations. Required parameters for sandstone acidizing such as acid type, concentration, volume, and injection rate/pressure are first selected using an expert system. The output from the expert system is further used for the input to an acidizing numerical simulator (UTACID). A new sandstone acidizing reaction model, appropriate for a high-temperature environment, and anisotropic medium have been implemented into UTACID to enhance the performance of the simulator. The expert system and the simulator have been integrated to provide an optimization tool for sandstone acidizing treatment design and simulation.

  4. A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment

    PubMed Central

    Pienaar, Elsje; Cilfone, Nicholas A.; Lin, Philana Ling; Dartois, Véronique; Mattila, Joshua T.; Butler, Russ; Flynn, JoAnne L.; Kirschner, Denise E.; Linderman, Jennifer J.

    2014-01-01

    While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic. Here we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. Finally, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome. PMID:25497475

  5. Integrated constructed wetland systems: design, operation, and performance of low-cost decentralized wastewater treatment systems.

    PubMed

    Behrends, L L; Bailey, E; Jansen, P; Houke, L; Smith, S

    2007-01-01

    Several different types of constructed wetland systems are being used as decentralized treatment systems including surface-flow, subsurface-flow, vertical-flow, and hybrid systems. Archetypical wetland systems have design strengths and weaknesses, and therefore it should be possible to design combined (integrated) systems to optimize a number of important treatment processes. This study provides comparative efficacy data for two integrated wetland treatment systems (IWTS) designed to enhance treatment of medium strength wastewater generated from a pilot-scale intensive fish farm. Results from the twenty eight months study included consistently high removal of COD (84% +) and ammonia nitrogen (93%) in both systems. Initially, phosphorus removal was also high (>90%) in both systems, but removal efficacy declined significantly over time. Nitrate removal was significantly better in the system that provided sequential aerobic and anoxic environments. Short hydraulic retention times coupled with sustained removal of COD and ammonia indicate that the ReCip components could be a least-cost wastewater treatment technology in the decentralized market sector.

  6. A Two-site Randomized Clinical Trial of Integrated Psychosocial Treatment for ADHD-Inattentive Type

    PubMed Central

    Pfiffner, Linda J.; Hinshaw, Stephen P.; Owens, Elizabeth; Zalecki, Christine; Kaiser, Nina M.; Villodas, Miguel; McBurnett, Keith

    2014-01-01

    Objective This study evaluated the efficacy of the Child Life and Attention Skills (CLAS) program, a behavioral psychosocial treatment integrated across home and school, for youth with Attention Deficit Hyperactivity Disorder-Inattentive Type (ADHD-I). Method In a two-site randomized controlled trial, 199 children (ages 7-11) were randomized to CLAS (N=74), parent-focused treatment (PFT, N=74), or treatment as usual (TAU, N=51). We compared groups on parent and teacher ratings of inattention symptoms, organizational skills, social skills, and global improvement at post-treatment, and also at follow-up during the subsequent school year. Results CLAS resulted in greater improvements in teacher-reported inattention, organizational skills, social skills, and global functioning relative to both PFT and TAU at post-treatment. Parents of children in CLAS reported greater improvement in organizational skills than PFT and greater improvements on all outcomes relative to TAU at post-treatment. Differences between CLAS and TAU were maintained at follow-up for most parent-reported measures but were not significant for teacher-reported outcomes. Conclusions These findings extend support for CLAS across two study sites, revealing that integrating parent, teacher, and child treatment components, specifically adapted for ADHD-I, is superior to parent training alone and to usual care. Direct involvement of teachers and children in CLAS appears to amplify effects at school and home and underscores the importance of coordinating parent, teacher, and child treatment components for cross-setting effects on symptoms and impairment associated with ADHD-I. PMID:24865871

  7. Review of Liebman et al.'s 'An integrated treatment program for anorexia nervosa'.

    PubMed

    Wright, Shelagh

    2006-07-01

    This article reviews the paper by Liebman, Minuchin, and Baker (1974) describing the use of a family meal as part of an integrated treatment approach for anorexia nervosa. The ideas laid out in the paper are described and discussed in terms of the understanding of anorexia nervosa at the time as well as placed in a current clinical and theoretical context. A comment is made on whether or not, in this author's opinion, the paper stands 'the test of time'.

  8. Modulating Wnt Signaling Pathway to Enhance Allograft Integration in Orthopaedic Trauma Treatment

    DTIC Science & Technology

    2012-10-01

    neutralizing the LRP5/Wnt pathway inhibitors Sost or DKK1 with monoclonal antibodies will enhance allograft integration to the host bone. The proposed work in...endpoints. Aim 2: Determine the effect of modulating the LRP-5/Wnt pathway with anti- Dkk1 monoclonal antibody on allograft incorporation in a rat...time point, saline/anti-Sost/Anti- Dkk1 ; N=16 each treatment) have been treated, samples harvested and banked for analysis. In vivo radiographs as

  9. [Establishment of diagnosis and treatment patterns of holistic integrated medicine for neuro-ophthalmology].

    PubMed

    Wang, Yanling

    2014-12-01

    Neuro-ophthalmology, as an interdisciplinary, covers at least three disciplines- ophthalmology, neurology and neurosurgery. With limited knowledge in each discipline, doctors often make misdiagnoses for neuro-ophthalmology diseases. Therefore, it is imperative to abandon the distinction between disciplines and combine all the knowledge to diagnose and treat patients in patterns of holistic integrated medicine in order to effectively improve the diagnosis and treatment of neuro-ophthalmology.

  10. Adverse Effect of Superovulation Treatment on Maturation, Function and Ultrastructural Integrity of Murine Oocytes

    PubMed Central

    Lee, Myungook; Ahn, Jong Il; Lee, Ah Ran; Ko, Dong Woo; Yang, Woo Sub; Lee, Gene; Ahn, Ji Yeon; Lim, Jeong Mook

    2017-01-01

    Regular monitoring on experimental animal management found the fluctuation of ART outcome, which showed a necessity to explore whether superovulation treatment is responsible for such unexpected outcome. This study was subsequently conducted to examine whether superovulation treatment can preserve ultrastructural integrity and developmental competence of oocytes following oocyte activation and embryo culture. A randomized study using mouse model was designed and in vitro development (experiment 1), ultrastructural morphology (experiment 2) and functional integrity of the oocytes (experiment 3) retrieved after PMSG/hCG injection (superovulation group) or not (natural ovulation; control group) were evaluated. In experiment 1, more oocytes were retrieved following superovulation than following natural ovulation, but natural ovulation yielded higher (p < 0.0563) maturation rate than superovulation. The capacity of mature oocytes to form pronucleus and to develop into blastocysts in vitro was similar. In experiment 2, a notable (p < 0.0186) increase in mitochondrial deformity, characterized by the formation of vacuolated mitochondria, was detected in the superovulation group. Multivesicular body formation was also increased, whereas early endosome formation was significantly decreased. No obvious changes in other microorganelles, however, were detected, which included the formation and distribution of mitochondria, cortical granules, microvilli, and smooth and rough endoplasmic reticulum. In experiment 3, significant decreases in mitochondrial activity, ATP production and dextran uptake were detected in the superovulation group. In conclusion, superovulation treatment may change both maturational status and functional and ultrastuctural integrity of oocytes. Superovulation effect on preimplantation development can be discussed. PMID:28756654

  11. Adverse Effect of Superovulation Treatment on Maturation, Function and Ultrastructural Integrity of Murine Oocytes.

    PubMed

    Lee, Myungook; Ahn, Jong Il; Lee, Ah Ran; Ko, Dong Woo; Yang, Woo Sub; Lee, Gene; Ahn, Ji Yeon; Lim, Jeong Mook

    2017-08-01

    Regular monitoring on experimental animal management found the fluctuation of ART outcome, which showed a necessity to explore whether superovulation treatment is responsible for such unexpected outcome. This study was subsequently conducted to examine whether superovulation treatment can preserve ultrastructural integrity and developmental competence of oocytes following oocyte activation and embryo culture. A randomized study using mouse model was designed and in vitro development (experiment 1), ultrastructural morphology (experiment 2) and functional integrity of the oocytes (experiment 3) retrieved after PMSG/hCG injection (superovulation group) or not (natural ovulation; control group) were evaluated. In experiment 1, more oocytes were retrieved following superovulation than following natural ovulation, but natural ovulation yielded higher (p < 0.0563) maturation rate than superovulation. The capacity of mature oocytes to form pronucleus and to develop into blastocysts in vitro was similar. In experiment 2, a notable (p < 0.0186) increase in mitochondrial deformity, characterized by the formation of vacuolated mitochondria, was detected in the superovulation group. Multivesicular body formation was also increased, whereas early endosome formation was significantly decreased. No obvious changes in other microorganelles, however, were detected, which included the formation and distribution of mitochondria, cortical granules, microvilli, and smooth and rough endoplasmic reticulum. In experiment 3, significant decreases in mitochondrial activity, ATP production and dextran uptake were detected in the superovulation group. In conclusion, superovulation treatment may change both maturational status and functional and ultrastuctural integrity of oocytes. Superovulation effect on preimplantation development can be discussed.

  12. Using enhanced and integrated services to improve response to standard methadone treatment: changing the clinical infrastructure of treatment networks.

    PubMed

    Neufeld, Karin; Kidorf, Michael; King, Van; Stoller, Ken; Clark, Michael; Peirce, Jessica; Brooner, Robert K

    2010-03-01

    Outcomes are presented from opioid-dependent outpatients (N = 81) participating in a new community-based initiative designed to improve access to enhanced substance abuse and psychiatric services in a publicly supported methadone maintenance treatment network in Baltimore, MD. The initiative, entitled Community Access to Specialized Treatment (CAST), is located at the Addiction Treatment Services, a program within this network. Network programs referred patients engaged in unremitting drug use who are at risk for discharge to CAST, where they received methadone substitution, individual and group counseling within an adaptive platform, behavioral contingencies to reinforce adherence, and on-site psychiatric evaluation and care. Patients returned to their referring program after producing at least two consecutive weeks of drug-negative urine samples and full counseling adherence. CAST was well utilized by the community. Patients had high rates of adherence to scheduled individual and group counseling services (93% and 73%, respectively); 43% of referrals successfully completed the program in an average of 101 days. This community-wide service delivery approach is a novel alternative to integrating intensive substance abuse and psychiatric care at each program within a treatment network.

  13. Relationship between genotoxic effects of breast cancer treatments and patient basal DNA integrity.

    PubMed

    Ceballos, María Paula; Funes, Juan Capitaine; Massa, Estefanía; Cipulli, Germán; Gil, Alfonso Benitez; Funes, Carlos Capitaine; Tozzini, Roberto; Ghersevich, Sergio

    2014-01-01

    Radiotherapy and chemotherapy cause genotoxic side effects that are highly variable among patients. In this study, we evaluated DNA integrity using the comet assay in peripheral blood lymphocytes from breast cancer patients before ("pre-treatment patients"; n=47) and after ("post-treatment patients"; n=24) radiotherapy and/or chemotherapy treatment and from healthy donors (n=15). Comet evaluation was made by visual (types 0-4) and digital (percentage of DNA remaining in the comet head=% head DNA) analysis. The association between the level of DNA damage and cancer prognostic factors was assessed. The treatments caused a significant increase in DNA damage registered by both visual (p<0.001) and digital (p<0.001) analyses. No significant associations between the level of DNA damage in pre-treatment patients and cancer prognostic factors were found. A significant correlation between the comet results from each patient before and after treatment (r=0.64, p=0.001) was observed. The % head DNA in post-treatment samples from patients with a high level of DNA damage before treatment (30.3±3.1%, p<0.01) was lower than in post-treatment samples from patients with a low-to-medium level of DNA damage before therapy (49.2±4.4%). These results support the usefulness of the comet assay as a sensitive technique to evaluate basal DNA status and DNA damage caused by cancer treatments. The comet assay could contribute to treatment decisions, especially by taking into account the patient's basal DNA damage before therapy.

  14. Effects of integrated dental care on oral treatment needs in residents of nursing homes older than 70 years.

    PubMed

    Gerritsen, Paul; Cune, Marco; van der Bilt, Andries; Abbink, Jan; de Putter, Cornelis

    2015-01-01

    To determine effects of integrated dental care in older nursing home residents. In three nursing homes offering integrated dental care, we studied the oral treatment need of 355 residents older than 70 years. To determine effects of integrated care, we discriminated between short-stay residents (≤6 months) and long-term residents (>6 months). Treatment need, determined intraorally by two dentists, remains high among short-stay residents (78%) and long-term residents (67%). The association between treatment need and length of stay was not significantly affected by indication for stay (somatic vs. psychogeriatric). All dentate residents needed oral treatment, except one long-term resident. However, among edentulous residents, particularly with a psychogeriatric indication for stay, treatment need appeared to reduce significantly in time, from 74% to 57%. Despite integrated dental care, oral treatment need remains in virtually all dentate residents and more than half of edentulous residents. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

  15. An integrated treatment delivery system for CSRS and CSRT and clinical applications.

    PubMed

    Shiu, A; Parker, B; Ye, J-S; Lii, J

    2003-01-01

    An integrated treatment delivery system for conformal stereotactic radiosurgery (CSRS) and radiotherapy (CSRT) has been developed through a collaboration involving Siemens Medical Systems, Inc., Tyco/Radionics, Inc., and The University of Texas M. D. Anderson Cancer Center. The system consists of a 6-MV linear accelerator (LINAC) equipped with a Tyco/Radionics miniature multileaf collimator (mMLC). For the conventional SRS treatment, the circular collimator housing can be attached to the opening window of the mMLC. The treatment delivery system is integrated with a radiotherapy treatment planning system and a record-and-verify system. The purpose of this study is to report the characteristics, performance, benefits, and the clinical applications of this delivery system. The technical specifications of the LINAC and mMLC were tested, and all the specifications were met. The 80% to 20% penumbral width for each mMLC leaf is approximately 3 mm and is nearly independent of the off-axis positions of a leaf. The maximum interleaf leakage is 1.4% (1.1% on average) and the maximum intra-leaf leakage is 1.0% (0.9% on average). The leaf position precision is better than 0.5 mm for all the leaves. The integration of the SRS/SRT treatment planning system, mMLC, and LINAC has been evaluated successfully for transferring the patient treatment data file through radiotherapy treatment planning system to the patient information and treatment record-and-verify server and the mMLC controller. Subsequently, the auto-sequential treatment delivery for SRS, CSRS/CSRT, and the step-and-shoot intensity-modulated radiotherapy has also been tested successfully. The accuracy of dose delivery was evaluated for a 2-cm spherical target in a Radiological Physics Center SRS head phantom with GAFChromic films and TLD. Five non-coplanar arcs, using a 2-cm diameter circular collimator, were used for this simulation treatment. The accuracy to aim the center of the spherical target was within 0.5 mm and

  16. Integration

    ERIC Educational Resources Information Center

    Kalyn, Brenda

    2006-01-01

    Integrated learning is an exciting adventure for both teachers and students. It is not uncommon to observe the integration of academic subjects such as math, science, and language arts. However, educators need to recognize that movement experiences in physical education also can be linked to academic curricula and, may even lead the…

  17. Integrated demonstration of molten salt oxidation with salt recycle for mixed waste treatment

    SciTech Connect

    Hsu, P.C.

    1997-11-01

    Molten Salt Oxidation (MSO) is a thermal, nonflame process that has the inherent capability of completely destroying organic constituents of mixed wastes, hazardous wastes, and energetic materials while retaining inorganic and radioactive constituents in the salt. For this reason, MSO is considered a promising alternative to incineration for the treatment of a variety of organic wastes. Lawrence Livermore National Laboratory (LLNL) has prepared a facility and constructed an integrated pilot-scale MSO treatment system in which tests and demonstrations are performed under carefully controlled (experimental) conditions. The system consists of a MSO processor with dedicated off-gas treatment, a salt recycle system, feed preparation equipment, and equipment for preparing ceramic final waste forms. This integrated system was designed and engineered based on laboratory experience with a smaller engineering-scale reactor unit and extensive laboratory development on salt recycle and final forms preparation. In this paper we present design and engineering details of the system and discuss its capabilities as well as preliminary process demonstration data. A primary purpose of these demonstrations is identification of the most suitable waste streams and waste types for MSO treatment.

  18. An integrated anaerobic digestion and UV photocatalytic treatment of distillery wastewater.

    PubMed

    Apollo, Seth; Onyango, Maurice S; Ochieng, Aoyi

    2013-10-15

    Anaerobic up-flow fixed bed reactor and annular photocatalytic reactor were used to study the efficiency of integrated anaerobic digestion (AD) and ultraviolet (UV) photodegradation of real distillery effluent and raw molasses wastewater (MWW). It was found that UV photodegradation as a stand-alone technique achieved colour removal of 54% and 69% for the distillery and MWW, respectively, with a COD reduction of <20% and a negligible BOD reduction. On the other hand, AD as a single treatment technique was found to be effective in COD and BOD reduction with efficiencies of above 75% and 85%, respectively, for both wastewater samples. However, the AD achieved low colour removal efficiency, with an increase in colour intensity of 13% recorded when treating MWW while a colour removal of 51% was achieved for the distillery effluent. The application of UV photodegradation as a pre-treatment method to the AD process reduced the COD removal and biogas production efficiency. However, an integration in which UV photodegradation was employed as a post-treatment to the AD process achieved high COD removal of above 85% for both wastewater samples, and colour removal of 88% for the distillery effluent. Thus, photodegradation can be employed as a post-treatment technique to an AD system treating distillery effluent for complete removal of the biorecalcitrant and colour imparting compounds. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Integrated radwaste treatment system lessons learned from 2{1/2} years of operation

    SciTech Connect

    Baker, M.N.; Fussner, R.J.

    1997-05-01

    The Integrated Radwaste Treatment System (IRTS) at the West Valley Demonstration Project (WVDP) is a pretreatment scheme to reduce the amount of salts in the high-level radioactive waste (vitrification) stream. Following removal of cesium-137 (Cs-137) by ion-exchange in the Supernatant Treatment System (STS), the radioactive waste liquid is volume-reduced by evaporation. Trace amounts of Cs-137 in the resulting distillate are removed by ion-exchange, then the distillate is discharged to the existing plant water treatment system. The concentrated product, 37 to 41 percent solids by weight, is encapsulated in cement producing a stable, low-level waste form. The Integrated Radwaste Treatment System (IRTS) operated in this mode from May 1988 through November 1990, decontaminating 450,000 gallons of high-level waste liquid; evaporating and encapsulating the resulting concentrates into 10,393 71-gallon square drums. A number of process changes and variations from the original operating plan were required to increase the system flow rate and minimize waste volumes. This report provides a summary of work performed to operate the IRTS, including system descriptions, process highlights, and lessons learned.

  20. Service Utilization Patterns as Predictors of Response to Trauma-Informed Integrated Treatment for Women With Co-occurring Disorders

    PubMed Central

    Gilbert, Allison R.; Morrissey, Joseph P.; Domino, Marisa E.

    2012-01-01

    Objective The current study examined whether clinical responses to an integrated treatment intervention among women with co-occurring disorders and histories of abuse varied according to their service use patterns at baseline. Methods Data were from a national, multi-site, integrated treatment intervention study in 1998-2003. Analyses included 999 study participants assigned to the integrated treatment group and who were symptomatic at baseline. Participants’ baseline service use activity was characterized according to five distinct baseline service use clusters. Logistic regression models estimated study participants’ odds of good clinical responses to integrated treatment at 12 months across the five service clusters. Results Participants with high levels of psychotropic medication and medical care use at baseline had significantly lower odds than low-intensity service users of having a good response to integrated treatment at 12 months on mental health, alcohol addiction, and posttraumatic stress measures. A majority of women in this group had serious medical illness or disability and were more likely than their counterparts with other service use patterns to have used homeless or domestic violence shelters. Conclusions Women who used high levels of medication and medical services appear to have faced especially difficult barriers in responding well to integrated treatment. Careful assessments of their mental health, trauma, and medical treatment needs may be required as part of integrated treatment in an effort to improve their response to integrated treatment, clinical outcomes and well-being. This information can also be used to target integrated treatment to women who are likely to respond positively and achieve meaningful improvements in their functioning. PMID:22368532

  1. Nutrient removal and biodiesel production by integration of freshwater algae cultivation with piggery wastewater treatment.

    PubMed

    Zhu, Liandong; Wang, Zhongming; Shu, Qing; Takala, Josu; Hiltunen, Erkki; Feng, Pingzhong; Yuan, Zhenhong

    2013-09-01

    An integrated approach, which combined freshwater microalgae Chlorella zofingiensis cultivation with piggery wastewater treatment, was investigated in the present study. The characteristics of algal growth, lipid and biodiesel production, and nutrient removal were examined by using tubular bubble column photobioreactors to cultivate C. zofingiensis in piggery wastewater with six different concentrations. Pollutants in piggery wastewater were efficiently removed among all the treatments. The specific growth rate and biomass productivity were different among all the cultures. As the initial nutrient concentration increased, the lipid content of C. zofingiensis decreased. The differences in lipid and biodiesel productivity of C. zofingiensis among all the treatments mainly resulted from the differences in biomass productivity. It is worthy of note that the diluted piggery wastewater with 1900 mg L(-1) COD provided an optimal nutrient concentration for C. zofingiensis cultivation, where the advantageous nutrient removal and the highest productivities of biomass, lipid and biodiesel were presented. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Integrative behavioral couple therapy: an acceptance-based, promising new treatment for couple discord.

    PubMed

    Jacobson, N S; Christensen, A; Prince, S E; Cordova, J; Eldridge, K

    2000-04-01

    Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord.

  3. Integrated Thermal Treatment Systems study: US Department of Energy Internal Review Panel report

    SciTech Connect

    Cudahy, J.; Escarda, T.; Gimpel, R.

    1995-04-01

    The U.S. Department of Energy`s (DOE) Office of Technology Development (OTD) commissioned two studies to uniformly evaluate nineteen thermal treatment technologies. These studies were called the Integrated Thermal Treatment System (ITTS) Phase I and Phase II. With the advice and guidance of the DOE Office of Environmental Management`s (EM`s) Mixed Waste Focus Group, OTD formed an ITTS Internal Review Panel, composed of scientists and engineers from throughout the DOE complex, the U.S. Environmental Protection Agency (EPA), the California EPA, and private experts. The Panel met from November 15-18, 1994, to review and comment on the ITTS studies, to make recommendations on the most promising thermal treatment systems for DOE mixed low level wastes (MLLW), and to make recommendations on research and development necessary to prove the performance of the technologies on MLLW.

  4. Evaluating integrated strategies for robust treatment of high saline piggery wastewater.

    PubMed

    Kim, Hyun-Chul; Choi, Wook Jin; Chae, A Na; Park, Joonhong; Kim, Hyung Joo; Song, Kyung Guen

    2016-02-01

    In this study, we integrated physicochemical and biological strategies for the robust treatment of piggery effluent in which high levels of organic constituents, inorganic nutrients, color, and salts remained. Piggery effluent that was stabilized in an anaerobic digester was sequentially coagulated, micro-filtered, and air-stripped prior to biological treatment with mixotrophic algal species that showed tolerance to high salinity (up to 4.8% as Cl(-)). The algae treatment was conducted with continuous O2 supplementation instead of using the combination of high lighting and CO2 injection. The microalga Scenedesmus quadricauda employed as a bio-agent was capable of assimilating both nitrogen (222 mg N g cell(-1) d(-1)) and phosphorus (9.3 mg P g cell(-1) d(-1)) and utilizing dissolved organics (2053 mg COD g cell(-1) d(-1)) as a carbon source in a single treatment process under the heterotrophic growth conditions. The heterotrophic growth of S. quadricauda proceeded rapidly by directly incorporating organic substrate in the oxidative assimilation process, which coincided with the high productivity of algal biomass, accounting for 2.4 g cell L(-1) d(-1). The algae-treated wastewater was subsequently ozonated to comply with discharge permits that limit color in the effluent, which also resulted in improved biodegradability of residual organics. The integrated treatment scheme proposed in this study also achieved 89% removal of COD, 88% removal of TN, and 60% removal of TP. The advantage of using the hybrid configuration suggests that this would be a promising strategy in full-scale treatment facilities for piggery effluent.

  5. Degradation of chlorinated paraben by integrated irradiation and biological treatment process.

    PubMed

    Wang, Shizong; Wang, Jianlong; Sun, Yuliang

    2017-03-15

    Chlorinated paraben, namely, methyl 3, 5-dichloro-4-hydroxybenzoate (MDHB) is the by-product of chlorination disinfection of paraben and frequently detected in the aquatic environments, which exhibited higher persistence and toxicity than paraben itself. In this paper, the combined irradiation and biological treatment process was employed to investigate the removal of MDHB from aqueous solution. The results showed that the removal efficiency of MDHB and total organic carbon (TOC) by irradiation process increased with radiation dose no matter what the initial concentration of MDHB was. The maximum removal efficiency of MDHB was 100%, 91.1%, 93%, respectively, for the initial concentration of MDHB of 1 mg/L, 5 mg/L and 10 mg/L with the radiation dose of 800 Gy. However, the maximum removal efficiency of TOC among all the experimental groups was only 15.3% obtained with the initial concentration of 1 mg/L at dose of 800 Gy. The subsequent biological treatment enhanced the mineralization of MDHB. The suitable radiation dose for the subsequent biological treatment was determined to be 600 Gy. In this case the removal efficiency of TOC increased to about 70%. Compared to the single biological treatment, the integrated irradiation and biological treatment significantly increase the degradation and mineralization of MDHB. Moreover, the dechlorination efficiency reached 77.4% during the integrated irradiation and biological treatment process. In addition, eight intermediates were identified during the combined process and the possible degradation pathway was proposed.

  6. An innovative integrated oxidation ditch with vertical circle (IODVC) for wastewater treatment.

    PubMed

    Xia, Shi-bin; Liu, Jun-xin

    2004-01-01

    The oxidation ditch process is economic and efficient for wastewater treatment, but its application is limited in case where land is costly due to its large land area required. An innovative integrated oxidation ditch with vertical circle (IODVC) system was developed to treat domestic and industrial wastewater aiming to save land area. The new system consists of a single-channel divided into two ditches(the top one and the bottom one by a plate), a brush, and an innovative integral clarifier. Different from the horizontal circle of the conventional oxidation ditch, the flow of IODVC system recycles from the top zone to the bottom zone in the vertical circle as the brush is running, and then the IODVC saved land area required by about 50% compared with a conventional oxidation ditch with an intrachannel clarifier. The innovative integral clarifier is effective for separation of liquid and solids, and is preferably positioned at the opposite end of the brush in the ditch. It does not affect the hydrodynamic characteristics of the mixed liquor in the ditch, and the sludge can automatically return to the down ditch without any pump. In this study, experiments of domestic and dye wastewater treatment were carried out in bench scale and in full scale, respectively. Results clearly showed that the IODVC efficiently removed pollutants in the wastewaters, i.e., the average of COD removals for domestic and dye wastewater treatment were 95% and 90%, respectively, and that the IODVC process may provide a cost effective way for full scale dye wastewater treatment.

  7. Integrated risk scoring model for predicting dynamic hip screw treatment outcome of intertrochanteric fracture.

    PubMed

    Hsu, Cheng-En; Huang, Kui-Chou; Lin, Tzu-Chieh; Tong, Kwok-Man; Lee, Mei-Hsuan; Chiu, Yung-Cheng

    2016-11-01

    Dynamic hip screw (DHS) is a common device for treating intertrochanteric fracture (ITF). Various risk factors have been reported to be associated with the operative treatment outcome. However, an integrated risk scoring prediction model is lacking. In this study, we aimed to develop a prediction model for treatment outcome of intertrochanteric fracture. We analyzed 442 AO/OTA 31-A1 and A2 fractures which were treated with DHS during the period January 2000 to June 2014 in a level I trauma center. Risk factors including age, gender, injured side, lag screw position, AO/OTA classification, tip-apex distance, postoperative lateral wall fracture, reduction patterns were analyzed to determine their influence on treatment outcome. Integrated risk scores of significant predictors were used to construct a prediction model. AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. The failure risk for low- and high-risk groups were significantly different (P<0.001) CONCLUSION: AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. We developed a model that integrates these factors to predict the treatment outcome, which had excellent prediction accuracy and discriminatory ability. The models may provide useful information for orthopedic doctors to identify patients who need early intervention as well as ITF patients who require more frequent follow-up in the postoperative period. Copyright © 2016. Published by Elsevier Ltd.

  8. Diagnosis and Treatment of Leprosy Reactions in Integrated Services - The Patients' Perspective in Nepal

    PubMed Central

    Raffe, Sonia F.; Thapa, Min; Khadge, Saraswoti; Tamang, Krishna; Hagge, Deanna; Lockwood, Diana N. J.

    2013-01-01

    Leprosy care has been integrated with peripheral health services, away from vertical programmes. This includes the diagnosis and management of leprosy reactions, which cause significant morbidity. We surveyed patients with leprosy reactions at two leprosy hospitals in Nepal to assess their experience of leprosy reaction management following integration to identify any gaps in service delivery. Methods Direct and referral patients with leprosy reactions were interviewed in two of Nepal's leprosy hospitals. We also collected quantitative and qualitative data from clinical examination and case-note review to document the patient pathway. Results Seventy-five patients were interviewed. On development of reaction symptoms 39% presented directly to specialist services, 23% to a private doctor, 17% to a district hospital, 10% to a traditional healer, 7% to a health post and 4% elsewhere. Those who presented directly to specialist services were 6.6 times more likely to start appropriate treatment than those presenting elsewhere (95% CI: 3.01 to 14.45). The average delay between symptom onset to commencing corticosteroids was 2.9 months (range 0–24 months). Obstacles to early presentation and treatment included diagnostic challenge, patients' lack of knowledge and the patients' view of health as a low priority. 40% received corticosteroids for longer than 12 weeks and 72% required an inpatient stay. Treatment follow-up was conducted at locations ranging from health posts to specialist hospitals. Inconsistency in the availability of corticosteroids peripherally was identified and 41% of patients treated for leprosy and a reaction on an outpatient basis attended multiple sites for follow-up treatment. Conclusion This study demonstrates that specialist services are necessary and continue to provide significant critical support within an integrated health system approach towards the diagnosis and management of leprosy reactions. PMID:23505585

  9. [Training model for integral treatment of patients with eating disorders resistant to change].

    PubMed

    Calvo Sagardoy, R; Gallego Morales, L T; García de Lorenzo y Mateos, A

    2012-01-01

    The need to find effective treatments for patients with Anorexia or Bulimia nervosa has led to the professionals who care for them to develop new forms of treatment that take into account the variables that cause resistance to change. Patients in this study (2006-2009) have the following characteristics: 340 patients who have 7 or more years of evolution and/or have tried numerous previous treatments without having succeeded in starting and / or maintaining the desired changes, that allowed them to recover steadily. As the proposed treatment, the patient-treatment team is based on the principles of the training model. It considers the patient holistically, it informs and provides him with resources to increase its commitment to change. Teaches the patient to take care physically and mentally as a way to regain their health and leave the disorder in a stable way. Includes family members as essential support in the recovery of their closest. Therapists require extensive experience in the treatment of ED, flexibility, ability to integrate with other team members even if they use different theoretical models, skills for group sessions, ability to handle negative emotions and frustration tolerance. Finally, the model presented below has been implemented, recovered patients whose stay in the disorder exceeded 15 years of development and led to permanent occupational disability.

  10. Integrated omics for the identification of key functionalities in biological wastewater treatment microbial communities.

    PubMed

    Narayanasamy, Shaman; Muller, Emilie E L; Sheik, Abdul R; Wilmes, Paul

    2015-05-01

    Biological wastewater treatment plants harbour diverse and complex microbial communities which prominently serve as models for microbial ecology and mixed culture biotechnological processes. Integrated omic analyses (combined metagenomics, metatranscriptomics, metaproteomics and metabolomics) are currently gaining momentum towards providing enhanced understanding of community structure, function and dynamics in situ as well as offering the potential to discover novel biological functionalities within the framework of Eco-Systems Biology. The integration of information from genome to metabolome allows the establishment of associations between genetic potential and final phenotype, a feature not realizable by only considering single 'omes'. Therefore, in our opinion, integrated omics will become the future standard for large-scale characterization of microbial consortia including those underpinning biological wastewater treatment processes. Systematically obtained time and space-resolved omic datasets will allow deconvolution of structure-function relationships by identifying key members and functions. Such knowledge will form the foundation for discovering novel genes on a much larger scale compared with previous efforts. In general, these insights will allow us to optimize microbial biotechnological processes either through better control of mixed culture processes or by use of more efficient enzymes in bioengineering applications. © 2015 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

  11. Integrated forward osmosis-membrane distillation process for human urine treatment.

    PubMed

    Liu, Qianliang; Liu, Caihong; Zhao, Lei; Ma, Weichao; Liu, Huiling; Ma, Jun

    2016-03-15

    This study demonstrated a forward osmosis-membrane distillation (FO-MD) hybrid system for real human urine treatment. A series of NaCl solutions at different concentrations were adopted for draw solutions in FO process, which were also the feed solutions of MD process. To establish a stable and continuous integrated FO-MD system, individual FO process with different NaCl concentrations and individual direct contact membrane distillation (DCMD) process with different feed temperatures were firstly investigated separately. Four stable equilibrium conditions were obtained from matching the water transfer rates of individual FO and MD processes. It was found that the integrated system is stable and sustainable when the water transfer rate of FO subsystem is equal to that of MD subsystem. The rejections to main contaminants in human urine were also investigated. Although individual FO process had relatively high rejection to Total Organic Carbon (TOC), Total Nitrogen (TN) and Ammonium Nitrogen (NH4(+)-N) in human urine, these contaminants could also accumulate in draw solution after long term performance. The MD process provided an effective rejection to contaminants in draw solution after FO process and the integrated system revealed nearly complete rejection to TOC, TN and NH4(+)-N. This work provided a potential treatment process for human urine in some fields such as water regeneration in space station and water or nutrient recovery from source-separated urine.

  12. Integrative Therapeutic Approaches for the Management and Control of Nausea in Children Undergoing Cancer Treatment.

    PubMed

    Momani, Tha'er G; Berry, Donna L

    2017-02-01

    Chemotherapy-induced nausea and vomiting (CINV) continues to be a common symptom experienced by children undergoing cancer treatment despite the use of contemporary antiemetics. Integrative therapeutic approaches in addition to standard pharmacologic antiemetic regimes offer potential to control CINV. The purpose of this review was to identify current evidence on integrative therapeutic approaches for the control of CINV in children with cancer. Online search engines (PubMed, CINAHL, PsychINFO) were queried using MESH terms. Titles, abstracts, and then full-text articles were reviewed for relevance to the review. The search resulted in 53 studies. Twenty-one studies met our review criteria. Integrative therapies identified included acupuncture/acupressure, aromatherapy, herbal supplements, hypnosis, and other cognitive behavioral interventions. Our review identified little information on the effectiveness and safety of most integrative therapeutic approaches for the control and management of CINV in children with cancer. However, evidence from adult cancer studies and some pediatric studies identify promising interventions for further testing.

  13. Current perspectives on preoperative integrated treatments for locally advanced rectal cancer: a review of agreement and controversies.

    PubMed

    Cellini, Francesco; Valentini, Vincenzo

    2012-08-01

    The optimal approach to the diagnosis and treatment of locally advanced rectal cancer involves multidisciplinary, integrated management. In the past 30 years, survival and freedom from disease have increased, but the ideal multidisciplinary management remains to be determined. The preferred integrated treatment modality is preoperative radio(chemo)therapy followed by total mesorectal excision. Certain aspects of this standard are still debated, and the European and American approaches vary. The chief recommendations per international guidelines are summarized, and the next generation of integrated treatments for locally advanced rectal cancer is discussed.

  14. Pollution control in pulp and paper industrial effluents using integrated chemical-biological treatment sequences.

    PubMed

    El-Bestawy, Ebtesam; El-Sokkary, Ibrahim; Hussein, Hany; Keela, Alaa Farouk Abu

    2008-11-01

    The main objective of the present study was to improve the quality of pulp and paper industrial wastewater of two local mills RAKTA and El-Ahlia, Alexandria, Egypt, and to bring their pollutant contents to safe discharge levels. Quality improvement was carried out using integrated chemical and biological treatment approaches after their optimization. Chemical treatment (alum, lime, and ferric chloride) was followed by oxidation using hydrogen peroxide and finally biological treatment using activated sludge (90 min for RAKTA and 60 min for El-Ahlia effluents). Chemical coagulation produced low-quality effluents, while pH adjustment during coagulation treatment did not enhance the quality of the effluents. Maximum removal of the tested pollutants was achieved using the integrated treatment and the pollutants recorded residual concentrations (RCs) of 34.67, 17.33, 0.13, and 0.43 mg/l and 15.0, 11.0, 0.0, and 0.13 mg/l for chemical oxygen demand (COD), biochemical oxygen demand (BOD5), tannin and lignin, and silica in RAKTA and El-Ahlia effluents, respectively, all of which were below their maximum permissible limits (MPLs) for the safe discharge into water courses. Specific oxygen uptake rate (SOUR) and sludge volume index (SVI) values reflect good conditions and healthy activated sludge. Based on the previous results, optimized conditions were applied as bench scale on the raw effluents of RAKTA and El-Ahlia via the batch chemical and the biological treatment sequences proposed. For RAKTA effluents, the sequence was as follows: (1) coagulation with 375 mg/l FeCl3, (2) oxidation with 50 mg/l hydrogen peroxide, and (3) biological treatment using activated sludge with 2,000 mg/l initial concentration and 90 min hydraulic retention time (HRT), while for El-Ahlia raw effluents, the sequence was (1) coagulation with 250 mg/l FeCl3, (2) oxidation with 45 mg/l hydrogen peroxide, and (3) biological treatment using activated sludge with 2,000 mg/l initial concentration and 60

  15. An Integrated Water Treatment Technology Solution for Sustainable Water Resource Management in the Marcellus Shale

    SciTech Connect

    Matthew Bruff; Ned Godshall; Karen Evans

    2011-04-30

    This Final Scientific/ Technical Report submitted with respect to Project DE-FE0000833 titled 'An Integrated Water Treatment Technology Solution for Sustainable Water Resource Management in the Marcellus Shale' in support of final reporting requirements. This final report contains a compilation of previous reports with the most current data in order to produce one final complete document. The goal of this research was to provide an integrated approach aimed at addressing the increasing water resource challenges between natural gas production and other water stakeholders in shale gas basins. The objective was to demonstrate that the AltelaRain{reg_sign} technology could be successfully deployed in the Marcellus Shale Basin to treat frac flow-back water. That objective has been successfully met.

  16. Integration of Power to Methane in a waste water treatment plant - A feasibility study.

    PubMed

    Patterson, Tim; Savvas, Savvas; Chong, Alex; Law, Ian; Dinsdale, Richard; Esteves, Sandra

    2017-09-08

    The integration of a biomethanation system within a wastewater treatment plant for conversion of CO2 and H2 to CH4 has been studied. Results indicate that the CO2 could be utilised to produce an additional 13,420m(3)/day of CH4, equivalent to approximately 133,826kWh of energy. The whole conversion process including electrolysis was found to have an energetic efficiency of 66.2%. The currently un-optimised biomethanation element of the process had a parasitic load of 19.9% of produced energy and strategies to reduce this to <5% are identified. The system could provide strategic benefits such as integrated management of electricity and gas networks, energy storage and maximising the deployment and efficiency of renewable energy assets. However, no policy or financial frameworks exist to attribute value to these increasingly important functions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Integrated Biomarker Responses of Effluents from Municipal Sewage Treatment Works in Goldfish

    NASA Astrophysics Data System (ADS)

    Lu, G. H.; Xia, J.; Zhang, H. Z.; Wang, C.

    2010-11-01

    The organic toxicants were extracted from the effluents from municipal sewage treatment works (STWs) in Nanjing (Chengbei, Suojincun and Jiangxinzhou STWs) by using solid phase extraction. AChE, GST, EROD, GPx and Na+/K+-ATPase activities in goldfish (Carassius auratus) were determmed after exposure of the extracted components. The extracts of water samples from the three STWs induced AChE, GST, EROD and Na+/K+-ATPase activities. The responses of enzymatic activities were mostly significant for those exposures of intermediate polar components, weakly polar components and/or nonpolar hexane extracts. Integrated biomarker response (IBR) index were calculated and used to evaluate an integrated impact of organic toxicants from different sampling sites. The order of negative biological effects of the three STWs was Jiangxinzhou>Chengbei>Suojincun.

  18. How Does Scale of Implementation Impact the Environmental Sustainability of Wastewater Treatment Integrated with Resource Recovery?

    PubMed

    Cornejo, Pablo K; Zhang, Qiong; Mihelcic, James R

    2016-07-05

    Energy and resource consumptions required to treat and transport wastewater have led to efforts to improve the environmental sustainability of wastewater treatment plants (WWTPs). Resource recovery can reduce the environmental impact of these systems; however, limited research has considered how the scale of implementation impacts the sustainability of WWTPs integrated with resource recovery. Accordingly, this research uses life cycle assessment (LCA) to evaluate how the scale of implementation impacts the environmental sustainability of wastewater treatment integrated with water reuse, energy recovery, and nutrient recycling. Three systems were selected: a septic tank with aerobic treatment at the household scale, an advanced water reclamation facility at the community scale, and an advanced water reclamation facility at the city scale. Three sustainability indicators were considered: embodied energy, carbon footprint, and eutrophication potential. This study determined that as with economies of scale, there are benefits to centralization of WWTPs with resource recovery in terms of embodied energy and carbon footprint; however, the community scale was shown to have the lowest eutrophication potential. Additionally, technology selection, nutrient control practices, system layout, and topographical conditions may have a larger impact on environmental sustainability than the implementation scale in some cases.

  19. Integrated basic treatment of activated carbon for enhanced CO2 selectivity

    NASA Astrophysics Data System (ADS)

    Adelodun, Adedeji Adebukola; Jo, Young-Min

    2013-12-01

    We attempted the use of three chemical agents viz nitric acid (HN), calcium nitrate (CaN) and calcium ethanoate (CaEt) to achieve enhanced CO2 selective adsorption by activated carbon (AC). In dry phase treatment, microporous coconut shell-based carbon (CS) exhibits higher CO2 capacity than coal-based. However, upon wet-phase pre-treatment, modified CS samples showed lesser CO2 adsorption efficiency. Surface characterization with X-ray photoelectron spectroscopy confirms the presence of calcium and amine species on the samples with integrated treatment (A-CaN). These samples recorded the highest low-level CO2 capture despite calcinated CaEt-doped samples (C-CaEt) showing the highest value for pure and high level CO2 adsorption capacities. The slope and linearity values of isobaric desorption were used to estimate the proportion of CO2 chemisorbed and heterogeneity of the adsorbents’ surfaces respectively. Consequently, integrated basic impregnation provides the most efficient adsorbents for selective adsorption of both indoor and outdoor CO2 levels.

  20. Integration and co-location of HIV/AIDS, tuberculosis and drug treatment services

    PubMed Central

    Sylla, Laurie; Bruce, R. Douglas; Kamarulzaman, Adeeba; Altice, Frederick L.

    2008-01-01

    Injection drug use (IDU) plays a critical role in the HIV epidemic in several countries throughout the world. In these countries, injection drug users are at significant risk for both HIV and tuberculosis, and active IDU negatively impacts treatment access, adherence and retention. Comprehensive strategies are therefore needed to effectively deliver preventive, diagnostic and curative services to these complex patient populations. We propose that developing co-located integrated care delivery systems should become the focus of national programmes as they continue to scale-up access to antiretroviral medications for drug users. Existing data suggest that such a programme will expand services for each of these diseases; increase detection of tuberculosis (TB) and HIV; improve medication adherence; increase entry into substance use treatment; decrease the likelihood of adverse drug events; and improve the effectiveness of prevention interventions. Key aspects of integration programmes include: co-location of services convenient to the patient; provision of effective substance use treatment, including pharmacotherapies; cross-training of generalist and specialist care providers; and provision of enhanced monitoring of drug-drug interactions and adverse side effects. Central to implementing this agenda will be fostering the political will to fund infrastructure and service delivery, expanding street-level outreach to IDUs, and training community health workers capable of cost effectively delivering these services. PMID:17689379

  1. Integrative Therapies in Anxiety Treatment with Special Emphasis on the Gut Microbiome

    PubMed Central

    Schnorr, Stephanie L.; Bachner, Harriet A.

    2016-01-01

    Over the past decade, research has shown that diet and gut health affects symptoms expressed in stress related disorders, depression, and anxiety through changes in the gut microbiota. Psycho-behavioral function and somatic health interaction have often been ignored in health care with resulting deficits in treatment quality and outcomes. While mental health care requires the professional training in counseling, psychotherapy and psychiatry, complimentary therapeutic strategies, such as attention to a nutritional and diverse diet and supplementation of probiotic foods, may be integrated alongside psychotherapy treatment models. Development of these alternative strategies is predicated on experimental evidence and diligent research on the biology of stress, fear, anxiety-related behaviors, and the gut-brain connection. This article provides a brief overview on biological markers of anxiety and the expanding nutritional literature relating to brain health and mental disorders. A case study demonstrates an example of a biopsychosocial approach integrating cognitive psychotherapy, dietary changes, and mindfulness activities, in treating symptoms of anxiety. This case study shows a possible treatment protocol to explore the efficacy of targeting the gut-brain-axis that may be used as an impetus for future controlled studies. PMID:27698624

  2. Integrative Therapies in Anxiety Treatment with Special Emphasis on the Gut Microbiome.

    PubMed

    Schnorr, Stephanie L; Bachner, Harriet A

    2016-09-01

    Over the past decade, research has shown that diet and gut health affects symptoms expressed in stress related disorders, depression, and anxiety through changes in the gut microbiota. Psycho-behavioral function and somatic health interaction have often been ignored in health care with resulting deficits in treatment quality and outcomes. While mental health care requires the professional training in counseling, psychotherapy and psychiatry, complimentary therapeutic strategies, such as attention to a nutritional and diverse diet and supplementation of probiotic foods, may be integrated alongside psychotherapy treatment models. Development of these alternative strategies is predicated on experimental evidence and diligent research on the biology of stress, fear, anxiety-related behaviors, and the gut-brain connection. This article provides a brief overview on biological markers of anxiety and the expanding nutritional literature relating to brain health and mental disorders. A case study demonstrates an example of a biopsychosocial approach integrating cognitive psychotherapy, dietary changes, and mindfulness activities, in treating symptoms of anxiety. This case study shows a possible treatment protocol to explore the efficacy of targeting the gut-brain-axis that may be used as an impetus for future controlled studies.

  3. A membrane-integrated advanced scheme for treatment of industrial wastewater: dynamic modeling towards scale up.

    PubMed

    Kumar, Ramesh; Pal, Parimal

    2013-08-01

    Modeling and simulation was carried out for an advanced membrane-integrated hybrid treatment process that ensures reuse of water with conversion and recovery of ammoniacal nitrogen as value-added struvite fertilizer from coke wastewater. While toxic cyanide was largely removed in a pre-chemical treatment unit using Fenton's reagents under optimized conditions, more than 95% of NH4(+)-N could be recovered as a valuable by-product called struvite through addition of appropriate doses of magnesium and phosphate salts. Water could be turned reusable through a polishing treatment by nanofiltration membranes in a largely fouling free membrane module following a biodegradation step. Mathematical modeling of such an integrated process was done with Haldane-Andrew approach for the associated microbial degradation of phenol by Pseudomonas putida. Residual NH4(+) was degraded by nitrification and denitrification following the modified Monod kinetics. The model could successfully predict the plant performance as reflected in reasonably low relative error (0.03-0.18) and high Willmott d-index (>0.98). Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Integrated thermal and nonthermal treatment technology and subsystem cost sensitivity analysis

    SciTech Connect

    Harvego, L.A.; Schafer, J.J.

    1997-02-01

    The U.S. Department of Energy`s (DOE) Environmental Management Office of Science and Technology (EM-50) authorized studies on alternative systems for treating contact-handled DOE mixed low-level radioactive waste (MLLW). The on-going Integrated Thermal Treatment Systems` (ITTS) and the Integrated Nonthermal Treatment Systems` (INTS) studies satisfy this request. EM-50 further authorized supporting studies including this technology and subsystem cost sensitivity analysis. This analysis identifies areas where technology development could have the greatest impact on total life cycle system costs. These areas are determined by evaluating the sensitivity of system life cycle costs relative to changes in life cycle component or phase costs, subsystem costs, contingency allowance, facility capacity, operating life, and disposal costs. For all treatment systems, the most cost sensitive life cycle phase is the operations and maintenance phase and the most cost sensitive subsystem is the receiving and inspection/preparation subsystem. These conclusions were unchanged when the sensitivity analysis was repeated on a present value basis. Opportunity exists for technology development to reduce waste receiving and inspection/preparation costs by effectively minimizing labor costs, the major cost driver, within the maintenance and operations phase of the life cycle.

  5. Integrated process control for recirculating cooling water treatment in the coal chemical industry.

    PubMed

    Pei, Y S; Guo, W; Yang, Z F

    2011-01-01

    This work focused on the integrated process of the recirculating cooling water (RCW) treatment to achieve approximate zero emission in the coal chemical industry. The benefits of fractional and comprehensive RCW treatment were quantified and qualified by using a water and mass balance approach. Limits of cycle of concentrations and some encountered bottlenecks were used to ascertain set target limits for different water sources. Makeup water was mixed with water produced from reverse osmosis (RO) in the proportion of 6:4, which notably reduced salts discharge. Side infiltration, which settled down suspended solids, can reduce energy consumption by over 40%. An automated on-line monitoring organic phosphorus inhibitor feed maintains the RCW system stability in comparison to the manual feed. Two-step electrosorb technology (EST) instead of an acid feed can lead cycle of concentration of water to reach 7.0. The wastewater from RO, EST and filter was transferred into a concentration treatment system where metallic ions were adsorbed by permanent magnetic materials. Separation of water and salts was completed by using a magnetic disc separator. Applying the integrated process in a coal chemical industry, a benefit of 1.60 million Yuan annually in 2 years was gained and approximate zero emission was achieved. Moreover, both technical and economic feasibility were demonstrated in detail.

  6. A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment

    DOE PAGES

    Pienaar, Elsje; Cilfone, Nicholas A.; Lin, Philana Ling; ...

    2014-12-08

    While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic.more » In this paper, we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. In conclusion, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome.« less

  7. Asynchronous collision integrators: Explicit treatment of unilateral contact with friction and nodal restraints

    PubMed Central

    Wolff, Sebastian; Bucher, Christian

    2013-01-01

    This article presents asynchronous collision integrators and a simple asynchronous method treating nodal restraints. Asynchronous discretizations allow individual time step sizes for each spatial region, improving the efficiency of explicit time stepping for finite element meshes with heterogeneous element sizes. The article first introduces asynchronous variational integration being expressed by drift and kick operators. Linear nodal restraint conditions are solved by a simple projection of the forces that is shown to be equivalent to RATTLE. Unilateral contact is solved by an asynchronous variant of decomposition contact response. Therein, velocities are modified avoiding penetrations. Although decomposition contact response is solving a large system of linear equations (being critical for the numerical efficiency of explicit time stepping schemes) and is needing special treatment regarding overconstraint and linear dependency of the contact constraints (for example from double-sided node-to-surface contact or self-contact), the asynchronous strategy handles these situations efficiently and robust. Only a single constraint involving a very small number of degrees of freedom is considered at once leading to a very efficient solution. The treatment of friction is exemplified for the Coulomb model. Special care needs the contact of nodes that are subject to restraints. Together with the aforementioned projection for restraints, a novel efficient solution scheme can be presented. The collision integrator does not influence the critical time step. Hence, the time step can be chosen independently from the underlying time-stepping scheme. The time step may be fixed or time-adaptive. New demands on global collision detection are discussed exemplified by position codes and node-to-segment integration. Numerical examples illustrate convergence and efficiency of the new contact algorithm. Copyright © 2013 The Authors. International Journal for Numerical Methods in

  8. Integrating virtual reality with activity management for the treatment of fibromyalgia: acceptability and preliminary efficacy.

    PubMed

    Garcia-Palacios, Azucena; Herrero, Rocio; Vizcaíno, Yolanda; Belmonte, Miguel A; Castilla, Diana; Molinari, Guadalupe; Baños, Rosa Maria; Botella, Cristina

    2015-06-01

    Cognitive-behavioral therapies (CBT) for fibromyalgia syndrome (FMS) are important interventions in the management of this condition. Empirical evidence reports that although the results are promising, further research is needed to respond more appropriately to these patients. This study focuses on exploring the use of Virtual Reality (VR) as an adjunct to the activity management component. The aim of this study is to present the results of a small-sized randomized controlled trial to test the preliminary efficacy and acceptability of this component. The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology. The sample was randomly allocated to 2 conditions: VR treatment and treatment as usual. Participants in the VR condition achieved significant improvements in the primary outcome: disability measured with the FIQ. The improvement was also significant in secondary outcomes, such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory: task persistence and exercise. There were no differences in other secondary outcome measures like pain intensity and interference and depression. Participants reported high satisfaction with the VR component. The effects were related to the psychological aspects targeted in the treatment. The component was well accepted by FMS patients referred from a public hospital. These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS.

  9. Integrated process analysis of treatment systems for mixed low level waste

    SciTech Connect

    Cooley, C.R.; Schwinkendorf, W.E. |; Bechtold, T.E.

    1997-10-01

    Selection of technologies to be developed for treatment of DOE`s mixed low level waste (MLLW) requires knowledge and understanding of the expected costs, schedules, risks, performance, and reliability of the total engineered systems that use these technologies. Thus, an integrated process analysis program was undertaken to identify the characteristics and needs of several thermal and nonthermal systems. For purposes of comparison, all systems were conceptually designed for a single facility processing the same amount of waste at the same rate. Thirty treatment systems were evaluated ranging from standard incineration to innovative thermal systems and innovative nonthermal chemical treatment. Treating 236 million pounds of waste in 20 years through a central treatment was found to be the least costly option with total life cycle cost ranging from $2.1 billion for a metal melting system to $3.9 billion for a nonthermal acid digestion system. Little cost difference exists among nonthermal systems or among thermal systems. Significant cost savings could be achieved by working towards maximum on line treatment time per year; vitrifying the final waste residue; decreasing front end characterization segregation and sizing requirements; using contaminated soil as the vitrifying agent; and delisting the final vitrified waste form from Resource Conservation and Recovery Act (RCRA) Land Disposal Restriction (LDR) requirements.

  10. Integrating assertive community treatment and illness management and recovery for consumers with severe mental illness.

    PubMed

    Salyers, Michelle P; McGuire, Alan B; Rollins, Angela L; Bond, Gary R; Mueser, Kim T; Macy, Veronica R

    2010-08-01

    This study examined the integration of two evidence-based practices for adults with severe mental illness: Assertive community treatment (ACT) and illness management and recovery (IMR) with peer specialists as IMR practitioners. Two of four ACT teams were randomly assigned to implement IMR. Over 2 years, the ACT-IMR teams achieved moderate fidelity to the IMR model, but low penetration rates: 47 (25.7%) consumers participated in any IMR sessions and 7 (3.8%) completed the program during the study period. Overall, there were no differences in consumer outcomes at the ACT team level; however, consumers exposed to IMR showed reduced hospital use over time.

  11. Introduction to the special feature on the integrated treatment of personality disorder.

    PubMed

    Dimaggio, Giancarlo; Livesley, John

    2012-02-01

    The solid evidence that personality disorders can be treated effectively goes side by side with, on the one hand, sparse evidence for disorders other than borderline and for personality disorders co-occurrent with one another, and, on the other hand, with a relative lack of knowledge about the actual effective mechanisms of change that underpin successful psychotherapies. In this introduction we present the rationale for this special feature, advocating for an integrated treatment of personality pathology in which empirically-supported strategies and techniques are selected from different traditions on the basis of the pragmatic principle of what works.

  12. Screening, brief intervention, and referral to treatment (SBIRT) as an integral part of nursing practice.

    PubMed

    Finnell, Deborah S; Nowzari, Shahrzad; Reimann, Brie; Fischer, Leigh; Pace, Elizabeth; Goplerud, Eric

    2014-01-01

    ABSTRACT. Substance use screening, brief intervention, and referral to treatment (SBIRT) should be an integral part of the scope of nursing practice. This commentary is an appeal for nurses to advance their knowledge and competencies related to SBIRT. The question of how to move SBIRT into the mainstream of nursing practice was posed to several leaders of federal agencies, health care and nursing organizations, nurse educators, and nurse leaders. The authors provide recommendations for moving this set of clinical strategies (i.e., SBIRT) into day-to-day nursing practice.

  13. Monitoring integrated energy systems at a waste water treatment plant in Maine

    SciTech Connect

    Fuller, D.R.; Wilke, D.A.; Thomas, P.L.; Lisa, A.J.

    1984-05-01

    A project was undertaken to monitor the performance of an integrated energy system at the Wilton, Maine, waste water treatment plant. These systems included active and passive solar heating, effluent heat recovery, digester gas generation, air-to-air heat recovery, and electricity generation using digester gas. To accomplish the monitoring, an instrumentation system was installed and data were collected over the period from May 1979 to March 1981. This instrumentation system includes solar pyranometers, hydronic BTU computers, electrical and gas meters, a weather station, and numerous temperature transmitters. Data for the solar and digester systems are available in both digital and analog forms.

  14. Theoretical treatment of reversible energy transfer reactions of metastable reactants: Modification of the integral encounter theory

    NASA Astrophysics Data System (ADS)

    Ivanov, Konstantin L.

    2005-08-01

    Corrections to the results of the integral encounter theory (IET) of reversible energy transfer reaction provided by two competing approaches of the modified encounter theory (MET) and the many-particle kernel-theory (MPK-theory) are considered in detail and compared with each other. The present treatment establishes that the MET is more preferable for improving the IET at higher reactant densities. Predictions of the MET and MPK-theory for the quantum yields of luminescence and quenching constants are compared with each other, reversible transfer kinetics from metastable reactant is studied in the framework of the MET.

  15. Integrating membrane filtration into bioelectrochemical systems as next generation energy-efficient wastewater treatment technologies for water reclamation: A review.

    PubMed

    Yuan, Heyang; He, Zhen

    2015-11-01

    Bioelectrochemical systems (BES) represent an energy-efficient approach for wastewater treatment, but the effluent still requires further treatment for direct discharge or reuse. Integrating membrane filtration in BES can achieve high-quality effluents with additional benefits. Three types of filtration membranes, dynamic membrane, ultrafiltration membrane and forward osmosis membrane that are grouped based on pore size, have been studied for integration in BES. The integration can be accomplished either in an internal or an external configuration. In an internal configuration, membranes can act as a separator between the electrodes, or be immersed in the anode/cathode chamber as a filtration component. The external configuration allows BES and membrane module to be operated independently. Given much progress and interest in the integration of membrane filtration into BES, this paper has reviewed the past studies, described various integration methods, discussed the advantages and limitations of each integration, and presented challenges for future development.

  16. An Integrated Microsystem for Real-Time Detection and Threshold-Activated Treatment of Bacterial Biofilms.

    PubMed

    Subramanian, Sowmya; Tolstaya, Ekaterina I; Winkler, Thomas E; Bentley, William E; Ghodssi, Reza

    2017-09-20

    Bacterial biofilms are the primary cause of infections in medical implants and catheters. Delayed detection of biofilm infections contributes to the widespread use of high doses of antibiotics, leading to the emergence of antibiotic-resistant bacterial strains. Accordingly, there is an urgent need for systems that can rapidly detect and treat biofilm infections in situ. As a step toward this goal, in this work we have developed for the first time a threshold-activated feedback-based impedance sensor-treatment system for combined real-time detection and treatment of biofilms. Specifically, we demonstrate the use of impedimetric sensing to accurately monitor the growth of Escherichia coli biofilms in microfluidic flow cells by measuring the fractional relative change (FRC) in absolute impedance. Furthermore, we demonstrate the use of growth measurements as a threshold-activated trigger mechanism to initiate successful treatment of biofilms using bioelectric effect (BE), applied through the same sensing electrode array. This was made possible through a custom program that (a) monitored the growth and removal of biofilms within the microfluidic channels in real-time and (b) enabled the threshold-based activation of BE treatment. Such BE treatment resulted in a ∼74.8 % reduction in average biofilm surface coverage as compared to the untreated negative control. We believe that this smart microsystem for integrated biofilm sensing and treatment will enable future development of autonomous biosensors optimized for accurate real-time detection of the onset of biofilms and their in situ treatment, directly on the surfaces of medical implants.

  17. The integration of nutrients, cyanobacterial biomass and toxins: from a multi-use reservoir through water treatment

    EPA Science Inventory

    This presentation is an integrated evaluation of cyanobacterial growth and toxin production, from a reservoir through drinking water treatment - where biomass and toxin removal are achieved. Data is generated by a variety of methods: online instrumentation for chlorophyll, diss...

  18. The integration of nutrients, cyanobacterial biomass and toxins: from a multi-use reservoir through water treatment

    EPA Science Inventory

    This presentation is an integrated evaluation of cyanobacterial growth and toxin production, from a reservoir through drinking water treatment - where biomass and toxin removal are achieved. Data is generated by a variety of methods: online instrumentation for chlorophyll, diss...

  19. Sustainable development and migration policies: their treatment within the Latin American economic integration blocks.

    PubMed

    Marmora, L

    1994-01-01

    Without an equal sharing of costs and benefits of natural and human resources worldwide, imbalances and lack of human development lead to migration within and between countries. Economic integration blocks in Latin America provide a context for shared development: in Central America, in the Andean Region, and in the Southern Cone. Over the past 60 years migration policy was based on national protectionism, labor supply, and/or occupation of territory. When economic conditions changed to market economies and world markets, migration policy was redefined. Each of the economic integration blocks has developed its own strategies. The Andean Agreement on Labor Migrations was established to determine the rules for bilateral and multilateral treatment of problems. In the Southern Cone bilateral agreements have been longstanding. Multilateral efforts were recently underway within the Southern Common Market and throughout the region. The Central American Organization for Migrations has spearheaded the adoption of a multilateral strategy. All three regions have made considerable progress in the last three years in constructing multilateral policies for economic integration. Government awareness has been the primary force in these policy changes. Government has come to an understanding that clear domestic and regional migration policies were lacking and that obsolete migration practices of the 1930s did not meet the needs of the 1990s. Migration policy was considered an instrument of development. Movement of economic factors or goods was considered equally with movement of labor. Migration policies must integrate the human rights of migrants into their definitions. Methods of facilitating the movements of populations need to be constructed within the computerization and modernization of the migration administration. Legalization of illegal immigrants has occurred among a number of countries. PROCAM and PRIMCOS were action programs which aimed to integrate migration and

  20. [Treatment of intrahepatic cholestasis with integrated traditional Chinese and Western medicine].

    PubMed

    Zhu, De-Zeng

    2004-11-01

    Intrahepatic cholestasis results from the disturbance of the structure and function of bile secretory apparatus in hepatic cells. At present, the mechanism of the disease is still not clearly understood. The currently used Western medicine for liver-protective, cholagogic and immuno-suppressive treatment are not effective enough. According to the theory of traditional Chinese medicine, moisture, heat, stasis and toxin are the main factors of the etiology and pathogenesis of the jaundice in patients with intrahepatic cholestasis. Therefore, clearing away heat to drain dampness, cooling blood to remove toxin, activating blood to resolve stasis, soothing liver and invigorating spleen should be adopted in the treatment. In order to increase the therapeutic effects, rational application of traditional Chinese herbs combined with Western medicine should be emphasized in treating the disease under the doctrine of integration of syndrome differentiation and disease differentiation.

  1. Integrated coagulation-trickling filter-ultrafiltration processes for domestic wastewater treatment and reclamation.

    PubMed

    Zhao, Qing-Liang; Zhong, Hui-Yuan; Liu, Jin-Li; Liu, Yu

    2012-01-01

    More and more research effort has been put into the development of affordable and high-efficiency wastewater reclamation technology for small communities. In this study, an integrated chemically enhanced primary treatment (CEPT), trickling filter (TF) and ultrafiltration (UF) process was developed with success. Coagulant produced from fly ash was used to enhance primary treatment, while trickling filter packed with coal cinder through four-layer structure without aeration was employed for further removal of COD and ammonium-nitrogen from the CEPT effluent. 95 and 88% removal of COD and ammonium were achieved, while total phosphorus (TP) and suspended solid (SS) were found to be removed completely at a coagulant dosage of 2.5 mL/L in the CEPT-TF-UF system. The product water can meet the standard of Reuse of Recycling Water for Urban Water Quality Standard for Urban Miscellaneous Water Consumption (GB/T 18920-2002, China).

  2. Integration of wet oxidation and nanofiltration for treatment of recalcitrant organics in wastewater

    SciTech Connect

    Hellenbrand, R.; Mantzavinos, D.; Metcalfe, I.S.; Livingston, A.G.

    1997-12-01

    Wet oxidation and nanofiltration are employed in an integrated system for the treatment of bioresistant industrial wastewaters. The partial oxidation products formed during a brief period of pretreatment in a low pressure WO reactor are separated by nanofiltration, and larger molecules are recycled into the reactor where they undergo further oxidation. Experiments were carried out with polyethylene glycol as a model compound in aqueous solution, representing polymer manufacture wastewater. The results demonstrate that by using a combination of an oxidative and a separative step, a higher selectivity of the overall process toward partial oxidation can be achieved. The permeate leaving the filtration step is mainly composed of short chain organic acids which could be readily biodegraded in a subsequent biological treatment, or discharged if concentrations are low.

  3. Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection.

    PubMed

    Patel, M R; Nana, M; Yotebieng, M; Tabala, M; Behets, F; Van Rie, A

    2014-06-01

    Five primary health care clinics in Kinshasa, Democratic Republic of Congo. To examine timing and predictors of delayed initiation of antiretroviral therapy (ART) during anti-tuberculosis treatment. Prospective observational cohort of adult patients receiving integrated treatment for tuberculosis (TB) and human immunodeficiency virus (HIV) who are expected to initiate ART at 1 month if CD4 count is <100 cells/mm(3) or if patient is World Health Organization (WHO) Clinical Stage 4 for reasons other than extra-pulmonary TB, at 2 months if CD4 count is 100-350 cells/mm(3), or at completion of anti-tuberculosis treatment if subsequently CD4 count is ≤ 350 cells/mm(3) or patient has WHO Clinical Stage 4. Of 492 patients, 235 (47.8%) experienced delayed initiation of ART: 171 (72.8%) initiated ART late, after a median delay of 12 days (interquartile range [IQR] 4-27) and 64 (27.2%) never initiated ART. Contraindication to any antiretroviral drug (aOR 2.91, 95%CI 1.22-6.95), lower baseline CD4 count (aOR 1.20, 95%CI 1.08-1.33/100 cells/mm(3)), TB drug intolerance (aOR 1.93, 95%CI 1.23-3.02) and non-disclosure of HIV infection (aOR 1.50, 95%CI 1.03-2.18) predicted delayed ART initiation. Despite fully integrated treatment, half of all patients experienced delayed ART initiation. Pragmatic approaches to ensure timely ART initiation in those at risk of delayed ART initiation are needed.

  4. Potential integration of wetland wastewater treatment with space life support systems.

    PubMed

    Nelson, M; Alling, A; Dempster, W F; Van Thillo, M; Allen, J P

    2002-01-01

    Subsurface-flow constructed wetlands for wastewater treatment and nutrient recycling have a number of advantages in planetary exploration scenarios: they are odorless, relatively low labor and low energy, assist in purification of water and recycling of atmospheric CO2, and can directly grow some food crops. This article presents calculations for integration of wetland wastewater treatment with a prototype ground-based experimental facility ("Mars on Earth") supporting four people showing that an area of 4-6 m2 may be sufficient to accomplish wastewater treatment and recycling. Discharge water from the wetland system can be used as irrigation water for the agricultural crop area, thus ensuring complete reclamation and utilization of nutrients within the bioregenerative life support system. Because the primary requirements for wetland treatment systems are warm temperatures and lighting, such bioregenerative systems can be integrated into space life support systems because heat from the lights may be used for temperature maintenance in the human living environment. Subsurface-flow wetlands can be modified for space habitats to lower space and mass requirements. Many of its construction requirements can eventually be met with use of in situ materials, such as gravel from the Mars surface. Because the technology does not depend on machinery and chemicals, and relies more on natural ecological mechanisms (microbial and plant metabolism), maintenance requirements (e.g., pumps, aerators, and chemicals) are minimized, and systems may have long operating lifetimes. Research needs include suitability of Martian soil and gravel for wetland systems, system sealing and liner options in a Mars base, and determination of wetland water quality efficiency under varying temperature and light regimes.

  5. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study

    PubMed Central

    2014-01-01

    Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation

  6. An integrated approach to energy recovery from biomass and waste: Anaerobic digestion-gasification-water treatment.

    PubMed

    Milani, M; Montorsi, L; Stefani, M

    2014-07-01

    The article investigates the performance of an integrated system for the energy recovery from biomass and waste based on anaerobic digestion, gasification and water treatment. In the proposed system, the organic fraction of waste of the digestible biomass is fed into an anaerobic digester, while a part of the combustible fraction of the municipal solid waste is gasified. Thus, the obtained biogas and syngas are used as a fuel for running a cogeneration system based on an internal combustion engine to produce electric and thermal power. The waste water produced by the integrated plant is recovered by means of both forward and inverse osmosis. The different processes, as well as the main components of the system, are modelled by means of a lumped and distributed parameter approach and the main outputs of the integrated plant such as the electric and thermal power and the amount of purified water are calculated. Finally, the implementation of the proposed system is evaluated for urban areas with a different number of inhabitants and the relating performance is estimated in terms of the main outputs of the system. © The Author(s) 2014.

  7. Integrating Field Spectra and Worldview-2 Data for Grapevine Productivity in Different Irrigation Treatments

    NASA Astrophysics Data System (ADS)

    Maimaitiyiming, M.; Bozzolo, A.; Wulamu, A.; Wilkins, J. L.

    2015-12-01

    Precision farming requires high spectral, spatial and temporal resolution remote sensing data to detect plant physiological changes. The higher spatial resolution is particularly as important as the spectral resolution for crop monitoring. It is important to develop data integration techniques between field or airborne hyperspectral data with spaceborne broad band multispectral images for plant productivity monitoring. To investigate varying rootstock and irrigation interactions, different irrigation treatments are implemented in a vineyard experimental site either i) unirrigated ii) full replacement of evapotranspiration (ET) iii) irrigated at 50 % of the potential ET. In summer 2014, we collected leaf and canopy spectra of the vineyard using field spectroscopy along with other plant physiological and nutritional variables. In this contribution, we integrate the field spectra and the spectral wavelengths of WorldView-2 to develop a predictive model for plant productivity,i.e., fruit quality and yield. First, we upscale field and canopy spectra to WorldView-2 spectral bands using radiative transfer simulations (e.g., MODTRAN). Then we develop remote sensing techniques to quantify plant productivity in different scenarios water stress by identifying the most effective and sensitive wavelengths, and indices that are capable of early detection of plant health and estimation of crop nutrient status. Finally we present predictive models developed from partial least square regression (PLSR) for plant productivity using spectral wavelengths and indices derived from integrated field and satellite remote sensing data.

  8. Structural elucidation of sorghum lignins from an integrated biorefinery process based on hydrothermal and alkaline treatments.

    PubMed

    Sun, Shao-Long; Wen, Jia-Long; Ma, Ming-Guo; Sun, Run-Cang

    2014-08-13

    An integrated process based on hydrothermal pretreatment (HTP) (i.e., 110-230 °C, 0.5-2.0 h) and alkaline post-treatment (2% NaOH at 90 °C for 2.0 h) has been performed for the production of xylooligosaccharide, lignin, and digestible substrate from sweet sorghum stems. The yield, purity, dissociation mechanisms, structural features, and structural transformations of alkali lignins obtained from the integrated process were investigated. It was found that the HTP process facilitated the subsequent alkaline delignification, releasing lignin with the highest yield (79.3%) and purity from the HTP residue obtained at 190 °C for 0.5 h. All of the results indicated that the cleavage of the β-O-4 linkages and degradation of β-β and β-5 linkages occurred under the harsh HTP conditions. Depolymerization and condensation reactions simultaneously occurred at higher temperatures (≥ 170 °C). Moreover, the thermostability of lignin was positively related to its molecular weight, but was also affected by the inherent structures, such as β-O-4 linkages and condensed units. These findings will enhance the understanding of structural transformations of the lignins during the integrated process and maximize the potential utilizations of the lignins in a current biorefinery process.

  9. One System Integrated Project Team Progress in Coordinating Hanford Tank Farms and the Waste Treatment Plant

    SciTech Connect

    Skwarek, Raymond J.; Harp, Ben J.; Duncan, Garth M.

    2013-12-18

    The One System Integrated Project Team (IPT) was formed at the Hanford Site in late 2011 as a way to improve coordination and itegration between the Hanford Tank Waste Treatment and Immobilization Plant (WTP) and the Tank Operations Contractor (TOC) on interfaces between the two projects, and to eliminate duplication and exploit opportunities for synergy. The IPT is composed of jointly staffed groups that work on technical issues of mutal interest, front-end design and project definition, nuclear safety, plant engineering system integration, commissioning, planning and scheduling, and environmental, safety, health and quality (ESH&Q) areas. In the past year important progress has been made in a number of areas as the organization has matured and additional opportunities have been identified. Areas covered in this paper include: Support for development of the Office of Envirnmental Management (EM) framework document to progress the Office of River Protection's (ORP) River Protection Project (RPP) mission; Stewardship of the RPP flowsheet; Collaboration with Savannah River Site (SRS), Savannah River National Laboratory (SRNL), and Pacific Northwest National Laboratory (PNNL); Operations programs integration; and, Further development of the waste acceptance criteria.

  10. Integration of microalgae systems at municipal wastewater treatment plants: implications for energy and emission balances.

    PubMed

    Menger-Krug, Eve; Niederste-Hollenberg, Jutta; Hillenbrand, Thomas; Hiessl, Harald

    2012-11-06

    Integrating microalgae systems (MAS) at municipal wastewater treatment plants (WWTPs) to produce of bioenergy offers many potential synergies. Improved energy balances provide a strong incentive for WWTPs to integrate MAS, but it is crucial that WWTPs maintain their barrier function to protect water resources. We perform a prospective analysis of energy and emission balances of a WWTP with integrated MAS, based on a substance flow analysis of the elements carbon (C), nitrogen (N), and phosphorus (P). These elements are the main ingredients of wastewater, and the key nutrients for algae growth. We propose a process design which relies solely on resources from wastewater with no external input of water, fertilizer or CO(2). The whole process chain, from cultivation to production of bioelectricity, takes place at the WWTP. Our results show that MAS can considerably improve energy balances of WWTPs without any external resource input. With optimistic assumptions, they can turn WWTPs into net energy producers. While intensive C recycling in MAS considerably improves the energy balance, we show that it also impacts on effluent quality. We discuss the importance of nonharvested biomass for effluent quality and highlight harvesting efficiency as key factor for energy and emission balances of MAS at WWTP.

  11. Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

    PubMed Central

    Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter

    2013-01-01

    Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. PMID:23431346

  12. Electronic health records: essential tools in integrating substance abuse treatment with primary care

    PubMed Central

    Tai, Betty; Wu, Li-Tzy; Clark, H Westley

    2012-01-01

    While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted. PMID:24474861

  13. Plankton composition, distribution and significance in a tropical integrated pilot constructed treatment wetland in Uganda.

    PubMed

    Luyiga, S; Kiwanuka, S

    2003-01-01

    The importance of the plankton community in wastewater treatment has been under-estimated for a long time, simply because of its biomass accumulation resulting in final release of organic matter back into the system after decomposition. In a two-year 3-month periodical study on a tropical integrated wastewater treatment constructed wetland, the phytoplankton role was tested and it has been shown that, through harvesting, the phytoplankton community plays a significant role in municipal wastewater treatment. The high phytobiomass, which was dominated by green algae (Chlorophyta), enhanced high levels of dissolved oxygen and high pH within the open ponds, and because of this, the system was found to be highly efficient in BOD5 (81%) and NH4+-N (93%) removal. The high pH enhanced ammonia volatilization within the open ponds. Regression statistics between the plankton community composition and some of the physicochemical parameters (BOD, NH4+-N, DO, pH) within the wetland system show a significant relationship. In conclusion, open treatment wetlands provide a wide variety of planktonic organisms as water quality improvement systems through the provision of oxygen and alteration of the pH for BOD5 and ammonium reduction respectively.

  14. Electronic health records: essential tools in integrating substance abuse treatment with primary care.

    PubMed

    Tai, Betty; Wu, Li-Tzy; Clark, H Westley

    2012-01-01

    While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.

  15. Treatment plan for integrating evidence-based decision making into dental education.

    PubMed

    Forrest, Jane L

    2006-03-01

    The aims of this paper are to present the findings from the scientific literature that discuss strategies that can contribute to a "best practices" treatment plan model for effectively integrating Evidence-Based Decision Making (EBDM) into curricula. MEDLINE, CINAHL, and HealthSTAR databases were searched, as was the Cochrane Database of Systematic Reviews. Studies and articles, ranging from systematic reviews to articles proposing models and recommendations for how to implement EBDM into curricula and faculty development were reviewed. Several common themes emerged and form the basis for a treatment plan model. The first step in developing any treatment plan is a thorough assessment of the current situation or problem. Recognizing that there are multiple phases to the assessment of an educational system, the focus of this paper will be to understand which teaching and learning strategies are most effective. These, in turn, will inform faculty of needed curricular changes and skill development training, requisites in order for them to prepare students to be successful in providing patient care using the best available evidence. Elements of a suggested treatment plan will be presented with the caveat that each dental school will need to develop an implementation plan based on an assessment of its own environment and needs.

  16. Alpine infrastructure in Central Europe: integral evaluation of wastewater treatment systems at mountain refuges.

    PubMed

    Weissenbacher, N; Mayr, E; Niederberger, T; Aschauer, C; Lebersorger, S; Steinbacher, G; Haberl, R

    2008-01-01

    Planning, construction and operation of onsite wastewater treatment systems at mountain refuges is a challenge. Energy supply, costly transport, limited water resources, unfavourable climate and load variations are only some of the problems that have to be faced. Additionally, legal regulations are different between and even within countries of the Alps. To ensure sustainability, integrated management of the alpine infrastructure management is needed. The energy and water supply and the wastewater and waste disposal systems and the cross-relations between them were analysed for 100 mountain refuges. Wastewater treatment is a main part of the overall 'mountain refuge' system. The data survey and first analyses showed the complex interaction of the wastewater treatment with the other infrastructure. Main criteria for reliable and efficient operation are training, technical support, user friendly control and a relatively simple system set up. Wastewater temperature, alkalinity consumption and high peak loads have to be considered in the planning process. The availability of power in terms of duration and connexion is decisive for the choice of the system. Further, frequency fluctuations may lead to damages to the installed aerators. The type of water source and the type of sanitary equipment influence the wastewater quantity and quality. Biosolids are treated and disposed separately or together with primary or secondary sludge from wastewater treatment dependent on the legal requirements.

  17. The use of superficial heat for treatment of temporomandibular disorders: an integrative review.

    PubMed

    Furlan, Renata Maria Moreira Moraes; Giovanardi, Raquel Safar; Britto, Ana Teresa Brandão de Oliveira e; Oliveira e Britto, Denise Brandão de

    2015-01-01

    To perform an integrative review of scientific bibliographic production on the use of superficial heat treatment for temporomandibular disorders. Research strategy : Literature review was accomplished on PubMed, LiLACS, SciELO, Bireme, Web of Science, and BBO databases. The following descriptors were used: hot temperature, hyperthermia induced, heat transference, temporomandibular joint, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, and their equivalents in Portuguese and Spanish. Articles that addressed the superficial heat for the treatment of temporomandibular disorders, published in English, Spanish, or Portuguese, between 1980 and 2013. The following data were collected: technique of applying superficial heat, duration of application, stimulated body area, temperature of the stimulus, frequency of application, and benefits. initially, 211 studies were found, but just 13 contemplated the proposed selection criteria. Data were tabulated and presented in chronological order. Several techniques for superficial heat application on treatment of temporomandibular disorders were found in the literature. The moist heat was the most widely used technique. Many studies suggested the application of heat for at least 20 minutes once a day. Most authors recommended the application of heat in facial and cervical regions. The heat treatment resulted in significant relief of pain, reduced muscle tension, improved function of the mandible, and increased mouth opening.

  18. An integrated Monte Carlo dosimetric verification system for radiotherapy treatment planning

    NASA Astrophysics Data System (ADS)

    Yamamoto, T.; Mizowaki, T.; Miyabe, Y.; Takegawa, H.; Narita, Y.; Yano, S.; Nagata, Y.; Teshima, T.; Hiraoka, M.

    2007-04-01

    An integrated Monte Carlo (MC) dose calculation system, MCRTV (Monte Carlo for radiotherapy treatment plan verification), has been developed for clinical treatment plan verification, especially for routine quality assurance (QA) of intensity-modulated radiotherapy (IMRT) plans. The MCRTV system consists of the EGS4/PRESTA MC codes originally written for particle transport through the accelerator, the multileaf collimator (MLC), and the patient/phantom, which run on a 28-CPU Linux cluster, and the associated software developed for the clinical implementation. MCRTV has an interface with a commercial treatment planning system (TPS) (Eclipse, Varian Medical Systems, Palo Alto, CA, USA) and reads the information needed for MC computation transferred in DICOM-RT format. The key features of MCRTV have been presented in detail in this paper. The phase-space data of our 15 MV photon beam from a Varian Clinac 2300C/D have been developed and several benchmarks have been performed under homogeneous and several inhomogeneous conditions (including water, aluminium, lung and bone media). The MC results agreed with the ionization chamber measurements to within 1% and 2% for homogeneous and inhomogeneous conditions, respectively. The MC calculation for a clinical prostate IMRT treatment plan validated the implementation of the beams and the patient/phantom configuration in MCRTV.

  19. [Effectiveness of an integrated treatment for severe personality disorders. A 36-month pragmatic follow-up].

    PubMed

    Lana, Fernando; Sánchez-Gil, Carmen; Ferrer, Laia; López-Patón, Nuria; Litvan, Lia; Marcos, Susana; Sierra, Ana C; Soldevilla, Joan M; Feixas, Guillem; Pérez, Víctor

    2015-01-01

    Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies. This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included. The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout. An integrated treatment for severe personality disorders could be effective in preventing reliance on readmissions, or prolonged hospital stays, when it is implemented by clinicians in ordinary clinical settings. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  20. An integrated system for the online monitoring of particle therapy treatment accuracy

    NASA Astrophysics Data System (ADS)

    Fiorina, E.

    2016-07-01

    Quality assurance in hadrontherapy remains an open issue that can be addressed with reliable monitoring of treatment accuracy. The INSIDE (INnovative SolutIons for DosimEtry in hadrontherapy) project aims to develop an integrated online monitoring system based on two dedicated PET panels and a tracking system, called Dose Profiler. The proposed solution is designed to operate in-beam and provide an immediate feedback on the particle range acquiring both photons produced by β+ decays and prompt secondary particle signals. Monte Carlo simulations cover an important role both in the system development, by confirming the design feasibility, and in the system operation, by understanding data. A FLUKA-based integrated simulation was developed taking into account the hadron beam structure, the phantom/patient features and the PET detector and Dose Profiler specifications. In addition, to reduce simulation time in signal generation on PET detectors, a two-step technique has been implemented and validated. The first PET modules were tested in May 2015 at the Centro Nazionale Adroterapia Oncologica (CNAO) in Pavia (Italy) with very satisfactory results: in-spill, inter-spill and post-treatment PET images were reconstructed and a quantitative agreement between data and simulation was found.

  1. Decentralized peri-urban wastewater treatment technologies assessment integrating sustainability indicators.

    PubMed

    Mena-Ulecia, Karel; Hernández, Heykel Hernández

    2015-01-01

    Selection of treatment technologies without considering the environmental, economic and social factors associated with each geographical context risks the occurrence of negative impacts that were not properly foreseen, working against the sustainable performance of the technology. The principal aim of this study was to evaluate 12 technologies for decentralized treatment of domestic wastewater applicable to peri-urban communities using sustainability approaches and, at the same time, continuing a discussion about how to address a more integrated assessment of overall sustainability. For this, a set of 13 indicators that embody the environmental, economic and social approach for the overall sustainability assessment were used by means of a target plot diagram as a tool for integrating indicators that represent a holistic analysis of the technologies. The obtained results put forward different degrees of sustainability, which led to the selection of: septic tank+land infiltration; up-flow anaerobic reactor+high rate trickling filter and septic tank+anaerobic filter as the most sustainable and attractive technologies to be applied in peri-urban communities, according to the employed indicators.

  2. The Motivational Interviewing Treatment Integrity Code (MITI 4): Rationale, preliminary reliability and validity

    PubMed Central

    Rowell, L.N.; Manuel, Jennifer K.; Ernst, Denise; Houck, Jon M.

    2017-01-01

    The Motivational Interviewing Treatment Integrity Code has been revised to address new evidence-based elements of motivational interviewing (MI). This new version (MITI 4) includes new global ratings to assess clinician’s attention to client language, increased rigor in assessing autonomy support and client choice, and items to evaluate the use of persuasion when giving information and advice. Method: Four undergraduate, non-professional raters were trained in the MITI and used it to review 50 audiotapes of clinicians conducting MI in actual treatments sessions. Both kappa and intraclass correlation indices were calculated for all coders, for the best rater pair and for a 20% randomly selected sample from the best rater pair. Results: Reliability across raters, with the exception of Emphasize Autonomy and % Complex Reflections, were in the good to excellent range. Reliability estimates decrease when smaller samples are used and when fewer raters contribute. Conclusion: The advantages and drawbacks of this revision are discussed including implications for research and clinical applications. The MITI 4.0 represents a reliable method for assessing the integrity of MI including both the technical and relational components of the method. PMID:26874558

  3. BOLD fMRI integration into radiosurgery treatment planning of cerebral vascular malformations

    SciTech Connect

    Stancanello, Joseph; Cavedon, Carlo; Francescon, Paolo; Causin, Francesco; Avanzo, Michele; Colombo, Federico; Cerveri, Pietro; Ferrigno, Giancarlo; Uggeri, Fulvio

    2007-04-15

    Functional magnetic resonance imaging (fMRI) is used to distinguish areas of the brain responsible for different tasks and functions. It is possible, for example, by using fMRI images, to identify particular regions in the brain which can be considered as 'functional organs at risk' (fOARs), i.e., regions which would cause significant patient morbidity if compromised. The aim of this study is to propose and validate a method to exploit functional information for the identification of fOARs in CyberKnife (Accuray, Inc., Sunnyvale, CA) radiosurgery treatment planning; in particular, given the high spatial accuracy offered by the CyberKnife system, local nonrigid registration is used to reach accurate image matching. Five patients affected by arteriovenous malformations (AVMs) and scheduled to undergo radiosurgery were scanned prior to treatment using computed tomography (CT), three-dimensional (3D) rotational angiography (3DRA), T2 weighted and blood oxygenation level dependent echo planar imaging MRI. Tasks were chosen on the basis of lesion location by considering those areas which could be potentially close to treatment targets. Functional data were superimposed on 3DRA and CT used for treatment planning. The procedure for the localization of fMRI areas was validated by direct cortical stimulation on 38 AVM and tumor patients undergoing conventional surgery. Treatment plans studied with and without considering fOARs were significantly different, in particular with respect to both maximum dose and dose volume histograms; consideration of the fOARs allowed quality indices of treatment plans to remain almost constant or to improve in four out of five cases compared to plans with no consideration of fOARs. In conclusion, the presented method provides an accurate tool for the integration of functional information into AVM radiosurgery, which might help to minimize undesirable side effects and to make radiosurgery less invasive.

  4. A systematic review of yoga interventions as integrative treatment in breast cancer.

    PubMed

    Sharma, Manoj; Lingam, Vimala Charitha; Nahar, Vinayak K

    2016-12-01

    Breast cancer is a significant public health problem all over the world. The treatment of breast cancer has many side effects. Yoga has been suggested as an integrative form of therapy for breast cancer. The purpose of this study was to systematically review yoga interventions for breast cancer and determine the efficacy of these interventions as integrative modalities of treatment in altering various outcomes related to breast cancer. Studies were included if (1) exclusively targeted breast cancer patients; (2) published between 2013 and May 2016; (3) written in the English language; (4) published in a peer-reviewed journals indexed in MEDLINE (PubMed), CINAHL, ERIC and Alt Health Watch; (5) they used any type of yoga as a part of or the whole intervention; and (6) utilized a quantitative design for evaluation. A total of 23 interventions met the inclusion criteria. Majority of the studies had been done in USA (n = 9), followed by Germany (n = 3), India (n = 3) and Turkey (n = 2). One study each was from Australia, Canada, Iran, Taiwan, Poland, and UK. Twenty-two of the 23 interventions had statistically significant changes in studied outcome measures. Despite the limitations of wide variabilities in sample size, lack of standardized approach in conducting yoga, multiplicity of outcome measures, varying durations of interventions and lack of using behavioral theories, yoga as an integrative form of therapy for breast cancer is a promising approach. More interventions utilizing yoga need to be tested.

  5. Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study

    PubMed Central

    Gielen, Nele; Krumeich, Anja; Havermans, Remco C.; Smeets, Feikje; Jansen, Anita

    2014-01-01

    Background Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so. Objective This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients. Method A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer. Results Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported. Conclusions It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD. PMID:24511368

  6. Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia.

    PubMed

    Shin, Sonya; Livchits, Viktoria; Connery, Hilary Smith; Shields, Alan; Yanov, Sergei; Yanova, Galina; Fitzmaurice, Garrett M; Nelson, Adrianne K; Greenfield, Shelly F

    2013-08-01

    To test the feasibility and effectiveness of brief counseling intervention (BCI) and naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia. Using a factorial randomized controlled trial design, patients were randomized into: naltrexone (NTX), brief behavioral compliance enhancement therapy (BBCET), treatment as usual (TAU) and BCI. In the Tomsk Oblast, hospitalized TB patients diagnosed with alcohol use disorders (AUDs) by the DSM-IV were referred at the start of TB treatment. Of the 196 participants, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease) and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%); 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day. Primary outcomes were 'favorable' TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as four drinks per day and five drinks per day for women and men, respectively, and TB adherence, measured as percentage of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on 'intention-to-treat' was performed for multivariable analysis. Primary TB and alcohol end-points between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n = 111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P = 0.02). In Tomsk Oblast, Russia, tuberculosis patients with severe alcohol use disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved

  7. Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial.

    PubMed

    Meyer, Björn; Berger, Thomas; Caspar, Franz; Beevers, Christopher G; Andersson, Gerhard; Weiss, Mario

    2009-05-11

    Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training. To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial. There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Complete analyses and intention-to-treat analyses were performed. Of 396 participants, 216 (55%) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohen's d = .64 (CI 95% = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohen's d = .64, 95% (CI 95% = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohen's d = .30, CI 95% = 0.05 - 0.55; WSA: Cohen's d = .36, CI 95% = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95% = 2.90 - 18.19) and recovered more often (OR = 17.3, 95% CI 2.3 - 130). More than 80% of

  8. The BraveNet prospective observational study on integrative medicine treatment approaches for pain.

    PubMed

    Abrams, Donald I; Dolor, Rowena; Roberts, Rhonda; Pechura, Constance; Dusek, Jeffery; Amoils, Sandi; Amoils, Steven; Barrows, Kevin; Edman, Joel S; Frye, Joyce; Guarneri, Erminia; Kligler, Ben; Monti, Daniel; Spar, Myles; Wolever, Ruth Q

    2013-06-24

    Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (-23%) and interference (-28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. ClinicalTrials.gov, NCT01186341.

  9. Initial Findings From Project Recover: Overcoming Co-Occurring Eating Disorders and Posttraumatic Stress Disorder Through Integrated Treatment.

    PubMed

    Trottier, Kathryn; Monson, Candice M; Wonderlich, Stephen A; Olmsted, Marion P

    2017-04-01

    This pilot study is the initial investigation of an integrated cognitive behavioral therapy (CBT) for co-occurring eating disorders (ED) and posttraumatic stress disorder (PTSD). Following a course of intensive hospital-based ED treatment focused on ED behavioral symptom interruption, 10 individuals with ED-PTSD received 16 sessions of CBT that focused on maintaining improvements in ED symptoms outside of the hospital environment and integrated cognitive processing therapy for PTSD. We hypothesized that the treatment would be associated with significant improvements in PTSD symptoms, depression, and anxiety, as well as sustained improvements in ED symptomatology. There were statistically significant improvements in clinician-rated PTSD symptoms (gav = 4.58), depression (gav = 1.37), and anxiety (gav = 1.00). As expected, there was no statistically significant change in ED cognitions (gav = .28). Reliable change analyses revealed that only 1 participant experienced deterioration in ED cognitions over the course of the integrated treatment. Of the 9 participants who were remitted from behavioral ED symptoms at the end of intensive treatment/beginning of the integrated treatment, 8 remained behaviorally remitted at poststudy treatment, which is encouraging given the high rate of rapid relapse following intensive ED treatment. Findings from this study provide preliminary support for the efficacy of an integrated CBT for ED-PTSD. Copyright © 2017 International Society for Traumatic Stress Studies.

  10. Integrated Treatment and Storage Solutions for Solid Radioactive Waste at the Russian Shipyard Near Polyarny

    SciTech Connect

    Griffith, A.; Engoy, T.; Endregard, M.; Busmundrud, O.; Schwab, P.; Nazarian, A.; Krumrine, P.; Backe, S.; Gorin, S.; Evans, B.

    2002-02-27

    Russian Navy Yard No. 10 (Shkval), near the city of Murmansk, has been designated as the recipient for Solid Radioactive Waste (SRW) pretreatment and storage facilities under the Arctic Military Environmental Cooperation (AMEC) Program. This shipyard serves the Northern Fleet by servicing, repairing, and dismantling naval vessels. Specifically, seven nuclear submarines of the first and second generation and Victor class are laid up at this shipyard, awaiting defueling and dismantlement. One first generation nuclear submarine has already been dismantled there, but recently progress on dismantlement has slowed because all the available storage space is full. SRW has been placed in metal storage containers, which have been moved outside of the actual storage site, which increases the environmental risks. AMEC is a cooperative effort between the Russian Federation, Kingdom of Norway and the United States. AMEC Projects 1.3 and 1.4 specifically address waste treatment and storage issues. Various waste treatment options have been assessed, technologies selected, and now integrated facilities are being designed and constructed to address these problems. Treatment technologies that are being designed and constructed include a mobile pretreatment facility comprising waste assay, segregation, size reduction, compaction and repackaging operations. Waste storage technologies include metal and concrete containers, and lightweight modular storage buildings. This paper focuses on the problems and challenges that are and will be faced at the Polyarninsky Shipyard. Specifically, discussion of the waste quantities, types, and conditions and various site considerations versus the various technologies that are to be employed will be provided. A systems approach at the site is being proposed by the Russian partners, therefore integration with other ongoing and planned operations at the site will also be discussed.

  11. Effect of Practice Integration between Urologists and Radiation Oncologists on Prostate Cancer Treatment Patterns

    PubMed Central

    Bekelman, Justin E.; Suneja, Gita; Guzzo, Thomas; Evan Pollack, Craig; Armstrong, Katrina; Epstein, Andrew J.

    2013-01-01

    Purpose National attention has focused on whether urology-radiation oncology practice integration – known as integrated prostate cancer centers (IPCCs) – contributes to use of intensity-modulated radiation therapy (IMRT), a common and expensive treatment for prostate cancer. Methods We examined prostate cancer treatment patterns pre- and post-conversion of a urology practice to an IPCC in July, 2006. Using the SEER-Medicare database, we identified patients age ≥ 65 years diagnosed in one state-wide registry with non-metastatic prostate cancer between 2004 and 2007 and classified patients into 3 groups: (1) those seen by IPCC physicians (exposure group); (2) those living in the same hospital referral region (HRR) and not seen by IPCC physicians (HRR-control group); and (3) those living elsewhere in the state (state-control group). We compared changes in treatment among the 3 groups, adjusting for patient, clinical, and socio-economic factors. Results Compared with the 8.1 percentage point (ppt) increase in adjusted IMRT use in the state-control group, IMRT increased 20.3 ppts (95% confidence interval [CI] 13.4, 27.1) in the IPCC group and 19.2 ppts (95% CI 9.6, 28.9) in the HRR-control group. Androgen-deprivation therapy (ADT), for which Medicare reimbursement declined sharply, decreased similarly in the IPCC and HRR-control groups. Prostatectomy declined significantly in the IPCC group. Conclusions Coincident with the conversion of a urology group practice to an IPCC, we observed increases in IMRT and decreases in ADT among patients seen by IPCC physicians and those seen in the surrounding healthcare market that were not observed in the remainder of the state. PMID:23399652

  12. Plant-integrated measurement of greenhouse gas emissions from a municipal wastewater treatment plant.

    PubMed

    Yoshida, Hiroko; Mønster, Jacob; Scheutz, Charlotte

    2014-09-15

    Wastewater treatment plants (WWTPs) contribute to anthropogenic greenhouse gas (GHG) emissions. Due to its spatial and temporal variation in emissions, whole plant characterization of GHG emissions from WWTPs face a number of obstacles. In this study, a tracer dispersion method was applied to quantify plant-integrated, real-time emissions of methane and nitrous oxides. Two mobile cavity ring-down spectroscopy sampling devices were used to record downwind gas concentrations emitted from a municipal WWTP situated in Copenhagen, Denmark. This plant is equipped to remove biological nitrogen and employs anaerobic digestion for sludge stabilization. Over the course of nine measurement campaigns, a wide range of emissions were detected: methane from 4.99 kg h(-1) up to 92.3 kg h(-1) and nitrous oxide from below the detection limit (0.37 kg h(-1)) up to 10.5 kg h(-1). High emissions were observed during periods experiencing operational problems, such as during foaming events in anaerobic digesters and during sub-optimal operation of biological nitrogen removal in the secondary treatment of wastewater. Methane emissions detected during measurement campaigns corresponded to 2.07-32.7% of the methane generated in the plant. As high as 4.27% of nitrogen entering the WWTP was emitted as nitrous oxide under the sub-optimal operation of biological treatment processes. The study shows that the unit process configuration, as well as the operation of the WWTP, determines the rate of GHG emission. The applied plant-integrated emission measurement method could be used to ease the burden of quantifying GHG emissions from WWTPs for reporting purposes and could contribute to the development of more accurate depictions of environmental performance of WWTPs.

  13. Affect integration as a predictor of change: affect consciousness and treatment response in open-ended psychotherapy.

    PubMed

    Solbakken, Ole André; Hansen, Roger Sandvik; Havik, Odd E; Monsen, Jon Trygve

    2012-01-01

    The present study investigated the relationship between baseline levels of affect integration and the magnitude of change during and after open-ended psychotherapy. Affect integration reflects the capacity for accessing and utilizing the adaptive properties of affects for personal adjustment, along with the more general capability of tolerating and regulating affective activation. It is thus a capacity with relevance for the postulated mechanisms of change in various treatment modalities. Overall, the results indicated that patients with more severe problems in affect integration had larger improvements in symptoms, interpersonal and personality problems in open-ended treatment than those with less severe problems. This was also the case when examining the predictive effects of the integration of specific affects on changes in interpersonal relatedness. It was indicated that increasing problems with the integration of discrete affects were associated with distinct patterns of change in different interpersonal problem domains.

  14. Nutrient removal and biogas upgrading by integrating freshwater algae cultivation with piggery anaerobic digestate liquid treatment.

    PubMed

    Xu, Jie; Zhao, Yongjun; Zhao, Guohua; Zhang, Hui

    2015-08-01

    An integrated approach that combined freshwater microalgae Scenedesmus obliquus (FACHB-31) cultivation with piggery anaerobic digestate liquid treatment was investigated in this study. The characteristics of algal growth, biogas production, and nutrient removal were examined using photobioreactor bags (PBRbs) to cultivate S. obliquus (FACHB-31) in digestate with various digestate dilutions (the concentration levels of 3200, 2200, 1600, 1200, 800, and 400 mg L(-1) chemical oxygen demand (COD)) during 7-day period. The effects of the level of pollutants on nutrient removal efficiency and CO2 removal process were investigated to select the optimum system for effectively upgrade biogas and simultaneously reduce the nutrient content in digestate. The treatment performance displayed that average removal rates of COD, total nitrogen (TN), total phosphorous (TP), and CO2 were 61.58-75.29, 58.39-74.63, 70.09-88.79, and 54.26-73.81 %, respectively. All the strains grew well under any the dilution treatments. With increased initial nutrient concentration to a certain range, the CO4 content (v/v) of raw biogas increased. Differences in the biogas enrichment of S. obliquus (FACHB-31) in all treatments mainly resulted from variations in biomass productivity and CO2 uptake. Notably, the diluted digestate sample of 1600 mg L(-1) COD provided an optimal nutrient concentration for S. obliquus (FACHB-31) cultivation, where the advantageous nutrient and CO2 removals, as well as the highest productivities of biomass and biogas upgrading, were revealed. Results showed that microalgal biomass production offered real opportunities to address issues such as CO2 sequestration, wastewater treatment, and biogas production.

  15. Integrated chemical treatment of municipal wastewater using waste hydrogen peroxide and ultraviolet light

    NASA Astrophysics Data System (ADS)

    Bhatti, Zulfiqar Ahmed; Mahmood, Qaisar; Raja, Iftikhar Ahmad; Malik, Amir Haider; Rashid, Naim; Wu, Donglei

    Dilemmas like water shortage, rapid industrialization, growing human population and related issues have seriously affected human health and environmental sustainability. For conservation and sustainable use of our water resources, innovative methods for wastewater treatment are continuously being explored. Advance Oxidation Processes (AOPs) show a promising approach to meet specific objectives of municipal wastewater treatment (MWW). The MWW samples were pretreated with Al 2(SO 4) 4·8H 2O (Alum) at different doses 4, 8, 12-50 mg/L to enhance the sedimentation. The maximum COD removal was observed at alum treatments in range of 28-32 mg/L without increasing total dissolved solids (TDS). TDS were found to increase when the alum dose was increased from 32-40 mg/L. In the present study, the optimum alum dose of 30 mg/L for 3 h of sedimentation and subsequent integrated H 2O 2/UV treatment was applied (using 2.5 mL/L of 40% waste H 2O 2 and 35% fresh H 2O 2 separately). Organic and inorganic pollutants, contributing towards chemical oxygen demand (COD), biological oxygen demand (BOD), turbidity and total dissolved solids were degraded by H 2O 2/UV. About 93% COD, 90% BOD and 83% turbidity reduction occurred when 40% waste H 2O 2 was used. When using fresh H 2O 2, 63% COD, 68% BOD and 86% turbidity reduction was detected. Complete disinfection of coliform bacteria occurred by using 40% H 2O 2/UV. The most interesting part of this research was to compare the effectiveness of waste H 2O 2 with fresh H 2O 2. Waste H 2O 2 generated from an industrial process of disinfection was found more effective in the treatment of MWW than fresh 35% H 2O 2.

  16. Integrated care pathway for rectal cancer treatment: health care resource utilization, costs, and outcomes.

    PubMed

    Kobayashi, Silvia T; Diz, Maria D P E; Campolina, Alessandro G; De Soárez, Patricia C; Ribeiro, Ulysses; Nahas, Sergio C; Vasconcelos, Karina G M C; Capareli, Fernanda; Cecconello, Ivan; Hoff, Paulo M

    2017-06-01

    Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group). We assessed times between treatment steps and quantified the resources utilized, as well as their costs. There were 112 patients in the Pre-MFC20 group and 218 in the MFC20 group. The mean treatment intervals were significantly shorter in the MFC20 group - from the first medical consultation to nCRT (48.3 vs. 87.5 days; P < 0.001); and from nCRT to surgery (14.8 vs. 23.0 weeks; P < 0.001) - as was the mean total treatment time (192.0 vs. 290.2 days; P < 0.001). Oncology consultations, computed tomography, MRI, and radiotherapy sessions were utilized more frequently in the Pre-MFC20 group (P < 0.001). The median per-patient cost was US$11 180.92 in the Pre-MFC20 group, compared with US$10 412.88 in the MFC20 group (P = 0.125). Daily hospital charges and consultations were the major determinants of the total cost of the treatment. There was no statistical difference in overall survival in the time periods examined. Implementation of a rectal cancer ICP reduced all treatment intervals and promoted rational utilization of oncology consultations and imaging, without increment in per-patient costs or detrimental effects in overall survival.

  17. Multiparametric Evaluation of Treatment Response to Neoadjuvant Chemotherapy in Breast Cancer Using Integrated PET/MR.

    PubMed

    Wang, Jane; Shih, Tiffany Ting-Fang; Yen, Ruoh-Fang

    2017-07-01

    The aim of this study was to investigate whether integrated PET/MR system can predict the treatment response to neoadjuvant chemotherapy (NAC) early in the course of breast cancer treatment. Fourteen women with newly diagnosed invasive breast cancer (median age, 54.5 years) were recruited. Each participant underwent 2 PET/MR studies. Study 1 was pre-NAC; study 2 was early in NAC treatment (after the first or second cycle). PET parameters included SUVmax and total lesion glycolysis (TLG). MRI parameters included choline signal-to-noise ratio (ChoSNR), peak enhancement ratio (PER), and the minimum apparent diffusion coefficient (ADCmin). The pathologic response was categorized as a pathologic complete response or residual cellularity of less than 10% (group 1) and residual cellularity of 10% or greater (group 2). The accuracy of the NAC response prediction was obtained by receiver operating characteristic analysis. Group 1 showed a greater reduction of SUVmax (percentage change, [INCREMENT]% SUVmax, P = 0.013; area under the receiver operating characteristic curve [AUC], 0.898), TLG ([INCREMENT]%TLG, P = 0.018; AUC = 0.878), and PER ([INCREMENT]% PER, P = 0.035; AUC = 0.837) than did group 2. The ChoSNR, ADCmin, [INCREMENT]%ChoSNR, and [INCREMENT]%ADCmin did not differ significantly between the 2 groups. The hybrid markers, [INCREMENT]%SUVmax/[INCREMENT]%ADCmin (AUC = 0.976) and [INCREMENT]%TLG/[INCREMENT]%ADCmin (AUC = 0.905), showed greater accuracy in predicting NAC response than the individual PET/MR parameters. The PET/MR parameters can predict the NAC response early in the course of breast cancer treatment. The hybrid markers more accurately predicted treatment response than the individual PET/MR parameters.

  18. Integrating Theory and Research: The Development of a Research-Based Treatment Program for Juvenile Male Sex Offenders

    ERIC Educational Resources Information Center

    Calley, Nancy G.

    2007-01-01

    A research-based treatment model designed to effectively address identified factors related to juvenile sexual offending behaviors is presented. Current research, theory, and national standards related to juvenile sexual offending are each explored with the treatment model reflecting an integration of these 3 components. The use of counseling…

  19. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

    PubMed

    Folbert, E C; Hegeman, J H; Vermeer, M; Regtuijt, E M; van der Velde, D; Ten Duis, H J; Slaets, J P

    2017-01-01

    To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail

  20. Treatment of high strength distillery wastewater (cherry stillage) by integrated aerobic biological oxidation and ozonation.

    PubMed

    Beltrán, F J; Alvarez, P M; Rodríguez, E M; García-Araya, J F; Rivas, J

    2001-01-01

    The performance of integrated aerobic digestion and ozonation for the treatment of high strength distillery wastewater (i.e., cherry stillage) is reported. Experiments were conducted in laboratory batch systems operating in draw and fill mode. For the biological step, activated sludge from a municipal wastewater treatment facility was used as inoculum, showing a high degree of activity to distillery wastewater. Thus, BOD and COD overall conversions of 95% and 82% were achieved, respectively. However, polyphenol content and absorbance at 254 nm (A(254)) could not be reduced more than 35% and 15%, respectively, by means of single biological oxidation. By considering COD as substrate, the aerobic digestion process followed a Contois' model kinetics, from which the maximum specific growth rate of microorganisms (mu(max)) and the inhibition factor, beta, were then evaluated at different conditions of temperature and pH. In the combined process, the effect of a post-ozonation stage was studied. The main goals achieved by the ozonation step were the removal of polyphenols and A(254). Therefore, ozonation was shown to be an appropriate technology to aid aerobic biological oxidation in the treatment of cherry stillage.

  1. Integrated system for the treatment of oxides of nitrogen from flue gases

    SciTech Connect

    Sanjoy Barman; Ligy Philip

    2006-02-01

    A novel and effective system was developed for the complete treatment of NOx from flue gases. The system consisted of photocatalytic or ozone oxidation of NOx, followed by scrubbing and biological denitrification. Maximum photocatalytic oxidation of NOx was achieved while using powdered TiO{sub 2} at a catalytic loading rate of 10 g/h, relative humidity of 50%, and a space time of 10 s. The used catalyst was regenerated and reused. A total of 72% of oxidized NO was recovered as HNO{sub 3}/HNO{sub 2} in the regeneration process. Stoichiometrically, 10% excess ozone was able to affect 100% oxidation of NO to NO{sub 2}. Presence of SO{sub 2} adversely influenced the oxidation of NO by ozone. The scrubbing of NO was effective with distilled water. Heterotrophic denitrifiers were able to denitrify the leachate with an efficiency of 90%, using sewage (COD 450 mg/L) as electron donor. The new integrated treatment system seems to be a promising alternative for complete treatment of NOx from flue gases. 29 refs., 7 figs., 2 tabs.

  2. An integrated decision making approach for assessing healthcare waste treatment technologies from a multiple stakeholder.

    PubMed

    Shi, Hua; Liu, Hu-Chen; Li, Ping; Xu, Xue-Guo

    2017-01-01

    With increased worldwide awareness of environmental issues, healthcare waste (HCW) management has received much attention from both researchers and practitioners over the past decade. The task of selecting the optimum treatment technology for HCWs is a challenging decision making problem involving conflicting evaluation criteria and multiple stakeholders. In this paper, we develop an integrated decision making framework based on cloud model and MABAC method for evaluating and selecting the best HCW treatment technology from a multiple stakeholder perspective. The introduced framework deals with uncertain linguistic assessments of alternatives by using interval 2-tuple linguistic variables, determines decision makers' relative weights based on the uncertainty and divergence degrees of every decision maker, and obtains the ranking of all HCW disposal alternatives with the aid of an extended MABAC method. Finally, an empirical example from Shanghai, China, is provided to illustrate the feasibility and effectiveness of the proposed approach. Results indicate that the methodology being proposed is more suitable and effective to handle the HCW treatment technology selection problem under vague and uncertain information environment.

  3. Integrating microalgae tertiary treatment into activated sludge systems for energy and nutrients recovery from wastewater.

    PubMed

    Arias, Dulce Maria; Solé-Bundó, Maria; Garfí, Marianna; Ferrer, Ivet; García, Joan; Uggetti, Enrica

    2017-09-20

    In this study, microalgae digestate and secondary effluent were used to grow microalgae in a tertiary wastewater treatment, and then, the biomass was co-digested for biogas generation. A 30L closed-photobioreactor was used for microalgae cultivation. The biomass, mainly composed by Scenedesmus sp., reached and maintained a concentration of 1.1gTSS/L during 30days. A complete removal of N-NH4(+) and P-PO4(3-) and high nitrates and organic matter removals were achieved (58% N-NO3(-) and 70% COD) with 8d of HRT. The potential biogas production of the cultivated microalgae was determined in batch tests. To improve their biodegradability, a novel method combining their co-digestion with activated sludge after a simultaneous autohydrolysis co-pretreatment was evaluated. After the co-pretreatment, the methane yield increased by 130%. Thus, integrating microalgae tertiary treatment into activated sludge systems is a promising and feasible solution to recover energy and nutrients from waste, improving wastewater treatment plants sustainability. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Performance evaluation of vinasse treatment plant integrated with physico-chemical methods.

    PubMed

    Ojha, Sanjay Kumar; Mishra, Snehasish; Kumar, Satish; Mohanty, Shakti Shankar; Sarkar, Biplab; Singh, Monika; Chaudhury, Gautam Roy

    2015-11-01

    With an objective to assess environmental management criteria of a vinasse treatment plant (VTP) and to evaluate the critical environmental parameters, a study was undertaken in a multi-product (packaged apple juice, distillery, brewery, packaged drinking water) brewery-cum-distillery unit. The facility with a volumetric loading rate of 11-15 kg COD m(-3).day, 3.6-4.5 h hydraulic retention time and 20 g l(-1) VSS had a scientifically managed technically sound effluent treatment system. While the water quality parameters were found within the acceptable limits, there was 99.07% reduction in BOD, from 43140.0 to 398.0 mg l(-1) and 98.61% reduction in COD from 98003.0 to 1357.0 mg l(-1). There was appreciable improvement in mixed liquor suspended solids (MLSS), mixed liquorvolatile suspended solids (MLVSS) and sludge volume index (SVI). A striking feature was the integrated aerobic-anaerobic highly efficient Up-flow Anaerobic Sludge Blanket (UASB) treatment for biodegradation and energy production that reduced energy and space needs, producing utilisable end-products and net savings on the operational cost. The end-point waste management included terminal products such as fertile sludge, cattle feed supplement, recyclable water and biogas. Vast lagoons with combined aerobic-anaerobic approaches, biogasification unit, sludge recovery, remediated irrigable water were the notable attributes.

  5. Energy-nutrients-water nexus: integrated resource recovery in municipal wastewater treatment plants.

    PubMed

    Mo, Weiwei; Zhang, Qiong

    2013-09-30

    Wastewater treatment consumes large amounts of energy and materials to comply with discharge standards. At the same time, wastewater contains resources, which can be recovered for secondary uses if treated properly. Hence, the goal of this paper is to review the available resource recovery methods onsite or offsite of municipal wastewater treatment plants. These methods are categorized into three major resource recovery approaches: onsite energy generation, nutrient recycling and water reuse. Under each approach, the review provides the advantages and disadvantages, recovery potentials and current application status of each method, as well as the synthesized results of the life cycle studies for each approach. From a comprehensive literature review, it was found that, in addition to technology improvements, there is also a need to evaluate the applications of the resource recovery methods in wastewater treatment plants from a life cycle perspective. Future research should investigate the integration of the resource recovery methods to explore the combined benefits and potential tradeoffs of these methods under different scales.

  6. Integrated monitoring technologies for the management of a Soil-Aquifer-Treatment (SAT) system.

    NASA Astrophysics Data System (ADS)

    Papadopoulos, Alexandros; Kallioras, Andreas; Kofakis, Petros; Bumberger, Jan; Schmidt, Felix; Athanasiou, Georgios; Uzunoglou, Nikolaos; Amditis, Angelos; Dietrich, Peter

    2016-04-01

    Artificial recharge of groundwater has an important role to play in water reuse as treated wastewater effluent can be infiltrated into the ground for aquifer recharge. As the effluent moves through the soil and the aquifer, it undergoes significant quality improvements through physical, chemical, and biological processes in the underground environment. Collectively, these processes and the water quality improvement obtained are called soil-aquifer-treatment (SAT) or geopurification. The pilot site of Lavrion Technological & Cultural Park (LTCP) of the National Technical University of Athens (NTUA), involves the employment of plot infiltration basins at experimental scale, which will be using waters of impaired quality as a recharge source, and hence acting as a Soil-Aquifer-Treatment, SAT, system. Τhe LTCP site will be employed as a pilot SAT system complemented by new technological developments, which will be providing continuous monitoring of the quantitative and qualitative characteristics of infiltrating groundwater through all hydrologic zones (i.e. surface, unsaturated and saturated zone). This will be achieved by the development and installation of an integrated system of prototype sensing technologies, installed on-site, and offering a continuous evaluation of the performance of the SAT system. An integrated approach of the performance evaluation of any operating SAT system should aim at parallel monitoring of all hydrologic zones, proving the sustainability of all involved water quality treatment processes within unsaturated and saturated zone. Hence a prototype system of Time and Frequency Domain Reflectometry (TDR & FDR) sensors is developed and will be installed, in order to achieve continuous quantitative monitoring of the unsaturated zone through the entire soil column down to significant depths below the SAT basin. Additionally, the system contains two different radar-based sensing systems that will be offering (i) identification of preferential

  7. Integrated monitoring technologies for the management of a Soil-Aquifer-Treatment (SAT) system

    NASA Astrophysics Data System (ADS)

    Kallioras, Andreas; Kofakis, Petros; Bumberger, Jan; Athanasiou, Georgios; Schimdt, Felix; Apostolopoulos, Georgios; Uzunoglou, Nikolaos; Dietrich, Peter; Schuth, Christoph

    2015-04-01

    Artificial recharge of groundwater has an important role to play in water reuse as treated wastewater effluent can be infiltrated into the ground for aquifer recharge. As the effluent moves through the soil and the aquifer, it undergoes significant quality improvements through physical, chemical, and biological processes in the underground environment. Collectively, these processes and the water quality improvement obtained are called soil-aquifer-treatment (SAT) or geopurification. The pilot site of Lavrion Technological & Cultural Park (LTCP) of the National Technical University of Athens (NTUA), involves the employment of plot infiltration basins at experimental scale, which will be using waters of impaired quality as a recharge source, and hence acting as a Soil-Aquifer-Treatment, SAT, system. Τhe LTCP site will be employed as a pilot SAT system complemented by new technological developments, which will be providing continuous monitoring of the quantitative and qualitative characteristics of infiltrating groundwater through all hydrologic zones (i.e. surface, unsaturated and saturated zone). This will be achieved by the development and installation of an integrated system of prototype sensing technologies, installed on-site, and offering a continuous evaluation of the performance of the SAT system. An integrated approach of the performance evaluation of any operating SAT system should aim at parallel monitoring of all hydrologic zones, proving the sustainability of all involved water quality treatment processes within unsaturated and saturated zone. Hence a prototype system of Time and Frequency Domain Reflectometry (TDR & FDR) sensors is developed and will be installed, in order to achieve continuous quantitative monitoring of the unsaturated zone through the entire soil column down to significant depths below the SAT basin. Additionally, the system contains two different radar-based sensing systems that will be offering (i) identification of preferential

  8. Research on common methods for evaluating the operation effect of integrated wastewater treatment facilities of iron and steel enterprises

    NASA Astrophysics Data System (ADS)

    Bingsheng, Xu

    2017-04-01

    Considering the large quantities of wastewater generated from iron and steel enterprises in China, this paper is aimed to research the common methods applied for evaluating the integrated wastewater treatment effect of iron and steel enterprises. Based on survey results on environmental protection performance, technological economy, resource & energy consumption, services and management, an indicator system for evaluating the operation effect of integrated wastewater treatment facilities is set up. By discussing the standards and industrial policies in and out of China, 27 key secondary indicators are further defined on the basis of investigation on main equipment and key processes for wastewater treatment, so as to determine the method for setting key quantitative and qualitative indicators for evaluation indicator system. It is also expected to satisfy the basic requirements of reasonable resource allocation, environmental protection and sustainable economic development, further improve the integrated wastewater treatment effect of iron and steel enterprises, and reduce the emission of hazardous substances and environmental impact.

  9. Treatment integrity of school-based interventions with children in the journal of applied behavior analysis 1991-2005.

    PubMed

    McIntyre, Laura Lee; Gresham, Frank M; DiGennaro, Florence D; Reed, Derek D

    2007-01-01

    We reviewed all school-based experimental studies with individuals 0 to 18 years published in the Journal of Applied Behavior Analysis (JABA) between 1991 and 2005. A total of 142 articles (152 studies) that met review criteria were included. Nearly all (95%) of these experiments provided an operational definition of the independent variable, but only 30% of the studies provided treatment integrity data. Nearly half of studies (45%) were judged to be at high risk for treatment inaccuracies. Treatment integrity data were more likely to be included in studies that used teachers, multiple treatment agents, or both. Although there was a substantial increase in reporting operational definitions of independent variables, results suggest that there was only a modest improvement in reported integrity over the past 30 years of JABA studies. Recommendations for research and practice are discussed.

  10. Treatment Integrity of School-Based Interventions with Children in the Journal of Applied Behavior Analysis 1991-2005

    PubMed Central

    Lee McIntyre, Laura; Gresham, Frank M; DiGennaro, Florence D; Reed, Derek D

    2007-01-01

    We reviewed all school-based experimental studies with individuals 0 to 18 years published in the Journal of Applied Behavior Analysis (JABA) between 1991 and 2005. A total of 142 articles (152 studies) that met review criteria were included. Nearly all (95%) of these experiments provided an operational definition of the independent variable, but only 30% of the studies provided treatment integrity data. Nearly half of studies (45%) were judged to be at high risk for treatment inaccuracies. Treatment integrity data were more likely to be included in studies that used teachers, multiple treatment agents, or both. Although there was a substantial increase in reporting operational definitions of independent variables, results suggest that there was only a modest improvement in reported integrity over the past 30 years of JABA studies. Recommendations for research and practice are discussed. PMID:18189097

  11. HIV-K: an Integrative Knowledge Base for Semantic Integration of AIDS-related Malignancy Data and Treatment Outcomes

    PubMed Central

    Tirado-Ramos, A.; Saltz, Joel; Lechowicz, Mary Jo

    2011-01-01

    Technological innovations such as web services and collaborative Grid platforms like caGrid can create opportunities to converge the worlds of health care and clinical research, by facilitating access and integration of HIV-related malignancy clinical and outcomes data at more sophisticated, semantic levels. At the same time, large numbers of randomized clinical trial and outcomes data on AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (nADM) have been produced during the last few years. There is still much work to do, though, on obtaining clear conclusions from the integration of such information. This is a white paper on work in progress from Emory University’s HIV/AIDS related malignancy data integrative knowledge base project (HIV-K). We are working to increase the understanding of available clinical trial data and outcomes of ADM such as lymphoma, as well as nADM such as anal cancer, Hodgkin lymphoma, or liver cancer. Our hypothesis is that, by creating prototypes of tools for semantics-enabled integrative knowledge bases for HIV/AIDS-related malignancy data, we will facilitate the identification of patterns and potential new overall evidence, as well as the linking of integrated data and results to registries of interest. PMID:20543443

  12. Evaluation of an integrated continuous stirred microbial electrochemical reactor: Wastewater treatment, energy recovery and microbial community.

    PubMed

    Wang, Haiman; Qu, Youpeng; Li, Da; Zhou, Xiangtong; Feng, Yujie

    2015-11-01

    A continuous stirred microbial electrochemical reactor (CSMER) was developed by integrating anaerobic digestion (AD) and microbial electrochemical system (MES). The system was capable of treating high strength artificial wastewater and simultaneously recovering electric and methane energy. Maximum power density of 583±9, 562±7, 533±10 and 572±6 mW m(-2) were obtained by each cell in a four-independent circuit mode operation at an OLR of 12 kg COD m(-3) d(-1). COD removal and energy recovery efficiency were 87.1% and 32.1%, which were 1.6 and 2.5 times higher than that of a continuous stirred tank reactor (CSTR). Larger amount of Deltaproteobacteria (5.3%) and hydrogenotrophic methanogens (47%) can account for the better performance of CSMER, since syntrophic associations among them provided more degradation pathways compared to the CSTR. Results demonstrate the CSMER holds great promise for efficient wastewater treatment and energy recovery.

  13. [Implementation in Quebec of the Integrated Psychological Treatment (IPT) for people with schizophrenia: five years later].

    PubMed

    Briand, Catherine; Reinharz, Daniel; Lesage, Alain; Nicole, Luc; Stip, Emmanuel; Lalonde, Pierre; Villeneuve, Kathe; Planet-Sultan, Sarah

    2010-01-01

    This article examines the adoption in Québec of the evidence-based practice, Integrated Psychological Treatment (IPT) of people with schizophrenia and the longevity of this practice within nine clinical milieus in a context of transformation of services. A team of researchers of the Centre de recherche Fernand Seguin has closely followed the implementation and the maintenance of the IPT in nine clinical milieus. More specifically, this article presents the factors that have contributed, on a five year period, to the maintenance (or not) of the IPT in these settings. It raises the important question of longevity of an approach that is specialized and specific to a clientele in contexts of transformation of services.

  14. Integrated catalytic wet air oxidation and biological treatment of wastewater from Vitamin B 6 production

    NASA Astrophysics Data System (ADS)

    Kang, Jianxiong; Zhan, Wei; Li, Daosheng; Wang, Xiaocong; Song, Jing; Liu, Dongqi

    This study investigated the feasibility of coupling a catalytic wet air oxidation (CWAO), with CuO/Al 2O 3 as catalyst, and an anaerobic/aerobic biological process to treat wastewater from Vitamin B 6 production. Results showed that the CWAO enhanced the biodegradability (BOD 5/COD) from 0.10 to 0.80. The oxidized effluents with COD of 10,000 mg l -1 was subjected to subsequent continuous anaerobic/aerobic oxidation, and 99.3% of total COD removal was achieved. The quality of the effluent obtained met the discharge standards of water pollutants for pharmaceutical industry Chemical Synthesis Products Category (GB21904-2008), and thereby it implies that the integrated CWAO and anaerobic/aerobic biological treatment may offer a promising process to treat wastewater from Vitamin B 6 production.

  15. Integrated surgical protocol for the treatment of the infected diabetic foot.

    PubMed

    Caravaggi, C

    2012-02-01

    Diabetes is a chronic disease with a worldwide increasing trend. Feet complication, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than 1 million of leg amputations every year. Foot infection can dramatically improve the risk of amputation. Although many ulcer classification systems have been proposed to stratify the severity of infectious process the problem of the definition of a correct therapeutic approach to different clinical pictures still remains unresolved. A diabetic foot triage and an integrated surgical protocol are proposed to try identifying a diagnostic flowchart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Goals and technical aspects of emergent and elective surgical procedures in diabetic foot are analysed to evaluate critical aspects and to suggest proper surgical choices.

  16. An endoscope with integrated transparent bioelectronics and theranostic nanoparticles for colon cancer treatment

    PubMed Central

    Lee, Hyunjae; Lee, Youngsik; Song, Changyeong; Cho, Hye Rim; Ghaffari, Roozbeh; Choi, Tae Kyu; Kim, Kyung Hoon; Lee, Young Bum; Ling, Daishun; Lee, Hyuk; Yu, Su Jong; Choi, Seung Hong; Hyeon, Taeghwan; Kim, Dae-Hyeong

    2015-01-01

    The gastrointestinal tract is a challenging anatomical target for diagnostic and therapeutic procedures for bleeding, polyps and cancerous growths. Advanced endoscopes that combine imaging and therapies within the gastrointestinal tract provide an advantage over stand-alone diagnostic or therapeutic devices. However, current multimodal endoscopes lack the spatial resolution necessary to detect and treat small cancers and other abnormalities. Here we present a multifunctional endoscope-based interventional system that integrates transparent bioelectronics with theranostic nanoparticles, which are photoactivated within highly localized space near tumours or benign growths. These advanced electronics and nanoparticles collectively enable optical fluorescence-based mapping, electrical impedance and pH sensing, contact/temperature monitoring, radio frequency ablation and localized photo/chemotherapy, as the basis of a closed-loop solution for colon cancer treatment. In vitro, ex vivo and in vivo experiments highlight the utility of this technology for accurate detection, delineation and rapid targeted therapy of colon cancer or precancerous lesions. PMID:26616435

  17. An endoscope with integrated transparent bioelectronics and theranostic nanoparticles for colon cancer treatment.

    PubMed

    Lee, Hyunjae; Lee, Youngsik; Song, Changyeong; Cho, Hye Rim; Ghaffari, Roozbeh; Choi, Tae Kyu; Kim, Kyung Hoon; Lee, Young Bum; Ling, Daishun; Lee, Hyuk; Yu, Su Jong; Choi, Seung Hong; Hyeon, Taeghwan; Kim, Dae-Hyeong

    2015-11-30

    The gastrointestinal tract is a challenging anatomical target for diagnostic and therapeutic procedures for bleeding, polyps and cancerous growths. Advanced endoscopes that combine imaging and therapies within the gastrointestinal tract provide an advantage over stand-alone diagnostic or therapeutic devices. However, current multimodal endoscopes lack the spatial resolution necessary to detect and treat small cancers and other abnormalities. Here we present a multifunctional endoscope-based interventional system that integrates transparent bioelectronics with theranostic nanoparticles, which are photoactivated within highly localized space near tumours or benign growths. These advanced electronics and nanoparticles collectively enable optical fluorescence-based mapping, electrical impedance and pH sensing, contact/temperature monitoring, radio frequency ablation and localized photo/chemotherapy, as the basis of a closed-loop solution for colon cancer treatment. In vitro, ex vivo and in vivo experiments highlight the utility of this technology for accurate detection, delineation and rapid targeted therapy of colon cancer or precancerous lesions.

  18. Designing a concept for an IT-infrastructure for an integrated research and treatment center.

    PubMed

    Stäubert, Sebastian; Winter, Alfred; Speer, Ronald; Löffler, Markus

    2010-01-01

    Healthcare and medical research in Germany are heading to more interconnected systems. New initiatives are funded by the German government to encourage the development of Integrated Research and Treatment Centers (IFB). Within an IFB new organizational structures and infrastructures for interdisciplinary, translational and trans-sectoral working relationship between existing rigid separated sectors are intended and needed. This paper describes how an IT-infrastructure of an IFB could look like, what major challenges have to be solved and what methods can be used to plan such a complex IT-infrastructure in the field of healthcare. By means of project management, system analyses, process models, 3LGM2-models and resource plans an appropriate concept with different views is created. This concept supports the information management in its enterprise architecture planning activities and implies a first step of implementing a connected healthcare and medical research platform.

  19. Cancer prevention today: from healthy lifestyle and early detection to integrative multidisciplinary prevention and treatment.

    PubMed

    Ryabchenko, N

    2010-07-01

    Cancer prevention is recognized to be one the most efficient strategy in reducing cancer incidence and mortality. The world leading experts in the field of basic, clinical, epidemiologic and behavioral science presented their most innovative and promising findings and achievements during the Eighth Annual AACR International Conference on Frontiers in Cancer Prevention Research held from December 6-9, 2009, in Houston, TX, USA. In total around 800 participants from all over the world took an active part in the rich variety of the Conference session formats covering wide area of the most vital cancer research problems with strong emphasis on the early detection research, the latest developments in the tumor microenvironment, international prevention mechanisms, integrative prevention, targeted prevention and treatment, and efficient implementation of basic sciences into clinical practice.

  20. Integrative approach for the treatment of PTSD in 9/11 first responders: Three core techniques

    PubMed Central

    Haugen, Peter T.; Splaun, Allison Keisler; Evces, Mark R.; Weiss, Daniel S.

    2014-01-01

    We describe an integrative psychotherapy for first responders to the September 11, 2001 terrorist attack, including those who continue to be psychologically impacted by these events, most of whom meet criteria for a diagnosis of PTSD. Three core techniques utilized in this treatment are described: (a) an emphasis on meaning making, particularly regarding the traumatic event; (b) focus on the most affect-laden components of the traumatic exposure; and (c) identifying and challenging the implicit strategies used by individuals to avoid discussion of components of their traumatic memories and the attendant negative affect. For each intervention, a theoretical rationale and the presumed mechanism of operation are presented. We discuss the clinical and research implications of this intervention. PMID:24000847

  1. Integrated modelling of transitions in mechanical conditions during casting and heat treatment

    NASA Astrophysics Data System (ADS)

    Thorborg, J.; Klinkhammer, J.; Heitzer, M.

    2015-06-01

    The mechanical material behaviour of a cast component changes significantly during casting and heat treatment. The big difference in temperature levels during the different process steps causes different deformation mechanisms to be active. The thermal gradients promote transient stresses that can lead to inelastic deformations, residual stresses and in some cases to defects in the final part. It is a big challenge to make a reasonable transition in the mechanical model, and hence material data, when modelling several different coupled process steps. It is important to use an integrated approach where the transition is included in the full load history of the part. When industrial examples are considered, the sequence of process steps typically also changes the thermal and mechanical boundary conditions significantly e.g. going from being mechanically constrained during casting to being supported point-wise during the heat treatment process. This change includes mapping of results and obtaining equilibrium in a new global system, where the further reaction forces from the supports must be handled with contact conditions to e.g. predict deformations due to gravity during solution heat treatment. The work presented in this paper is focused on modelling the mechanical fields, taking into account the changes in the mechanical material model at different temperature levels, and the transition in mechanical behaviour when the microstructure is changing during the different steps of the heat treatment process. The approach used is based on a unified model where creep effects are considered at high temperature and rate effects are included in general during cooling. Proposals are made to include cooling rate sensitivity, annealing and precipitation hardening via modification of mechanical properties in the different process steps.

  2. An integrative review on women living with obstetric fistula and after treatment experiences.

    PubMed

    Mafo Degge, Hannah; Hayter, Mark; Laurenson, Mary

    2017-06-01

    To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. Obstetric fistula is an injury most commonly resulting from a prolonged labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women's experience is required to inform holistic approaches for care and prevention. A search of literature was conducted on databases of EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; and websites of international organizations such as Women's Dignity Project and EngenderHealth. Keywords, Inclusion and exclusion criteria were defined and 25 articles published between 2004 to January 2015 were identified. An integrative review of 25 articles was carried out. Three broad themes were identified: Challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fistula repair. Living with a fistula presents multidimensional consequences affecting women, families and communities. Accessing treatment is difficult and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being continent thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Post repair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore further research is required to support its benefits; and for policy development to meet care provision for women with fistula. The review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas

  3. Disability among Attendees with Schizophrenia in a Nigerian Hospital: Further Evidence for Integrated Rehabilitative Treatment Designs

    PubMed Central

    Olagunju, Andrew Toyin; Adegbaju, Dapo Adebowale; Uwakwe, Richard

    2016-01-01

    Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II) was used to assess for disability in all participants. Different degrees of disability based on WHODAS-II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007), unemployment status (P=0.003), remittance source of income (P=0.034) and ethnicity (P=0.017); conversely, less number of children (P=0.033), less amount spent on treatment (P<0.001) and lower BPRS score (P<0.001) correlated negatively with high level of disability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted. PMID:28217272

  4. NOTE: Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment

    NASA Astrophysics Data System (ADS)

    Zhu, X.; Bourland, J. D.; Yuan, Y.; Zhuang, T.; O'Daniel, J.; Thongphiew, D.; Wu, Q. J.; Das, S. K.; Yoo, S.; Yin, F. F.

    2009-09-01

    This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 °C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii ~1.5 cm and length ~4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.

  5. Disability among Attendees with Schizophrenia in a Nigerian Hospital: Further Evidence for Integrated Rehabilitative Treatment Designs.

    PubMed

    Olagunju, Andrew Toyin; Adegbaju, Dapo Adebowale; Uwakwe, Richard

    2016-11-23

    Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II) was used to assess for disability in all participants. Different degrees of disability based on WHODAS-II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007), unemployment status (P=0.003), remittance source of income (P=0.034) and ethnicity (P=0.017); conversely, less number of children (P=0.033), less amount spent on treatment (P<0.001) and lower BPRS score (P<0.001) correlated negatively with high level of disability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted.

  6. Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment.

    PubMed

    Zhu, X; Bourland, J D; Yuan, Y; Zhuang, T; O'Daniel, J; Thongphiew, D; Wu, Q J; Das, S K; Yoo, S; Yin, F F

    2009-09-07

    This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 degrees C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii approximately 1.5 cm and length approximately 4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.

  7. Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine

    NASA Astrophysics Data System (ADS)

    Zhang, Wenjuan; Tao, Qin; Guo, Zihu; Fu, Yingxue; Chen, Xuetong; Shar, Piar Ali; Shahen, Mohamed; Zhu, Jinglin; Xue, Jun; Bai, Yaofei; Wu, Ziyin; Wang, Zhenzhong; Xiao, Wei; Wang, Yonghua

    2016-09-01

    Though cardiovascular diseases (CVDs) and gastrointestinal disorders (GIDs) are different diseases associated with different organs, they are highly correlated clinically. Importantly, in Traditional Chinese Medicine (TCM), similar treatment strategies have been applied in both diseases. However, the etiological mechanisms underlying them remain unclear. Here, an integrated systems pharmacology approach is presented for illustrating the molecular correlations between CVDs and GIDs. Firstly, we identified pairs of genes that are associated with CVDs and GIDs and found that these genes are functionally related. Then, the association between 115 heart meridian (HM) herbs and 163 stomach meridian (SM) herbs and their combination application in Chinese patent medicine was investigated, implying that both CVDs and GIDs can be treated by the same strategy. Exemplified by a classical formula Sanhe Decoration (SHD) treating chronic gastritis, we applied systems-based analysis to introduce a drug-target-pathway-organ network that clarifies mechanisms of different diseases being treated by the same strategy. The results indicate that SHD regulated several pathological processes involved in both CVDs and GIDs. We experimentally confirmed the predictions implied by the effect of SHD for myocardial ischemia. The systems pharmacology suggests a novel integrated strategy for rational drug development for complex associated diseases.

  8. Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine.

    PubMed

    Zhang, Wenjuan; Tao, Qin; Guo, Zihu; Fu, Yingxue; Chen, Xuetong; Shar, Piar Ali; Shahen, Mohamed; Zhu, Jinglin; Xue, Jun; Bai, Yaofei; Wu, Ziyin; Wang, Zhenzhong; Xiao, Wei; Wang, Yonghua

    2016-09-06

    Though cardiovascular diseases (CVDs) and gastrointestinal disorders (GIDs) are different diseases associated with different organs, they are highly correlated clinically. Importantly, in Traditional Chinese Medicine (TCM), similar treatment strategies have been applied in both diseases. However, the etiological mechanisms underlying them remain unclear. Here, an integrated systems pharmacology approach is presented for illustrating the molecular correlations between CVDs and GIDs. Firstly, we identified pairs of genes that are associated with CVDs and GIDs and found that these genes are functionally related. Then, the association between 115 heart meridian (HM) herbs and 163 stomach meridian (SM) herbs and their combination application in Chinese patent medicine was investigated, implying that both CVDs and GIDs can be treated by the same strategy. Exemplified by a classical formula Sanhe Decoration (SHD) treating chronic gastritis, we applied systems-based analysis to introduce a drug-target-pathway-organ network that clarifies mechanisms of different diseases being treated by the same strategy. The results indicate that SHD regulated several pathological processes involved in both CVDs and GIDs. We experimentally confirmed the predictions implied by the effect of SHD for myocardial ischemia. The systems pharmacology suggests a novel integrated strategy for rational drug development for complex associated diseases.

  9. Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine

    PubMed Central

    Zhang, Wenjuan; Tao, Qin; Guo, Zihu; Fu, Yingxue; Chen, Xuetong; Shar, Piar Ali; Shahen, Mohamed; Zhu, Jinglin; Xue, Jun; Bai, Yaofei; Wu, Ziyin; Wang, Zhenzhong; Xiao, Wei; Wang, Yonghua

    2016-01-01

    Though cardiovascular diseases (CVDs) and gastrointestinal disorders (GIDs) are different diseases associated with different organs, they are highly correlated clinically. Importantly, in Traditional Chinese Medicine (TCM), similar treatment strategies have been applied in both diseases. However, the etiological mechanisms underlying them remain unclear. Here, an integrated systems pharmacology approach is presented for illustrating the molecular correlations between CVDs and GIDs. Firstly, we identified pairs of genes that are associated with CVDs and GIDs and found that these genes are functionally related. Then, the association between 115 heart meridian (HM) herbs and 163 stomach meridian (SM) herbs and their combination application in Chinese patent medicine was investigated, implying that both CVDs and GIDs can be treated by the same strategy. Exemplified by a classical formula Sanhe Decoration (SHD) treating chronic gastritis, we applied systems-based analysis to introduce a drug-target-pathway-organ network that clarifies mechanisms of different diseases being treated by the same strategy. The results indicate that SHD regulated several pathological processes involved in both CVDs and GIDs. We experimentally confirmed the predictions implied by the effect of SHD for myocardial ischemia. The systems pharmacology suggests a novel integrated strategy for rational drug development for complex associated diseases. PMID:27597117

  10. Acupuncture in Uganda: A Research Letter on the Integration of Acupuncture With Conventional Biomedical Treatments

    PubMed Central

    Kirschner, Kathia; Mandell, Richard; Knowlton, Janelle; Romeo, Melissa J.

    2014-01-01

    The PanAfrican Acupuncture Project (PAAP) was created in 2001 and is a volunteer-based not-for-profit training organization. It encourages community empowerment and wellness through training local healthcare providers how to use simple, effective acupuncture protocols to treat the symptoms of HIV/ AIDS, malaria, tuberculosis, and other chronic conditions. A manual explains the theory of acupuncture and the techniques associated with it in clear and simple terms with specific acupuncture protocols associated with the signs and symptoms of illnesses commonly seen in Uganda. PAAP maintains contact with the trainees to provide ongoing support through: (1) three week-long meetings per year, (2) ongoing contact with the PAAP local coordinator, and (3) electronic communications including email, text messaging, and Facebook communication. A primary focus is to help integrate acupuncture into the local context and current public-health system. This is accomplished by working with local governmental and nongovernmental agencies and healthcare facilities to improve access to and effectiveness of care through collaboration with Western and traditional healthcare modalities. The integration of acupuncture and other traditional complementary and alternative medicines (TCAMs) in the international public health sector at the level of local health workers can increase access to treatment in a sustainable manner while also building the confidence and self-worth of the public health-care practitioners. PMID:25105080

  11. Integrated monitoring and assessment of soil restoration treatments in the Lake Tahoe Basin.

    PubMed

    Grismer, M E; Schnurrenberger, C; Arst, R; Hogan, M P

    2009-03-01

    Revegetation and soil restoration efforts, often associated with erosion control measures on disturbed soils, are rarely monitored or otherwise evaluated in terms of improved hydrologic, much less, ecologic function and longer term sustainability. As in many watersheds, sediment is a key parameter of concern in the Tahoe Basin, particularly fine sediments less than about ten microns. Numerous erosion control measures deployed in the Basin during the past several decades have under-performed, or simply failed after a few years and new soil restoration methods of erosion control are under investigation. We outline a comprehensive, integrated field-based evaluation and assessment of the hydrologic function associated with these soil restoration methods with the hypothesis that restoration of sustainable function will result in longer term erosion control benefits than that currently achieved with more commonly used surface treatment methods (e.g. straw/mulch covers and hydroseeding). The monitoring includes cover-point and ocular assessments of plant cover, species type and diversity; soil sampling for nutrient status; rainfall simulation measurement of infiltration and runoff rates; cone penetrometer measurements of soil compaction and thickness of mulch layer depths. Through multi-year hydrologic and vegetation monitoring at ten sites and 120 plots, we illustrate the results obtained from the integrated monitoring program and describe how it might guide future restoration efforts and monitoring assessments.

  12. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility.

    PubMed

    Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

    2004-01-01

    The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

  13. An Integrated Neuroscience Perspective on Formulation and Treatment Planning for Posttraumatic Stress Disorder: An Educational Review.

    PubMed

    Ross, David A; Arbuckle, Melissa R; Travis, Michael J; Dwyer, Jennifer B; van Schalkwyk, Gerrit I; Ressler, Kerry J

    2017-04-01

    Posttraumatic stress disorder (PTSD) is a common psychiatric illness, increasingly in the public spotlight in the United States due its prevalence in the soldiers returning from combat in Iraq and Afghanistan. This educational review presents a contemporary approach for how to incorporate a modern neuroscience perspective into an integrative case formulation. The article is organized around key neuroscience "themes" most relevant for PTSD. Within each theme, the article highlights how seemingly diverse biological, psychological, and social perspectives all intersect with our current understanding of neuroscience. Any contemporary neuroscience formulation of PTSD should include an understanding of fear conditioning, dysregulated circuits, memory reconsolidation, epigenetics, and genetic factors. Fear conditioning and other elements of basic learning theory offer a framework for understanding how traumatic events can lead to a range of behaviors associated with PTSD. A circuit dysregulation framework focuses more broadly on aberrant network connectivity, including between the prefrontal cortex and limbic structures. In the process of memory reconsolidation, it is now clear that every time a memory is reactivated it becomes momentarily labile-with implications for the genesis, maintenance, and treatment of PTSD. Epigenetic changes secondary to various experiences, especially early in life, can have long-term effects, including on the regulation of the hypothalamic-pituitary-adrenal axis, thereby affecting an individual's ability to regulate the stress response. Genetic factors are surprisingly relevant: PTSD has been shown to be highly heritable despite being definitionally linked to specific experiences. The relevance of each of these themes to current clinical practice and its potential to transform future care are discussed. Together, these perspectives contribute to an integrative, neuroscience-informed approach to case formulation and treatment planning. This may

  14. Tracing pharmaceuticals in a municipal plant for integrated wastewater and organic solid waste treatment.

    PubMed

    Jelic, Aleksandra; Fatone, Francesco; Di Fabio, Silvia; Petrovic, Mira; Cecchi, Franco; Barcelo, Damia

    2012-09-01

    The occurrence and removal of 42 pharmaceuticals, belonging to different therapeutic groups (analgesics and anti-inflammatory drugs, anti-ulcer agent, psychiatric drugs, antiepileptic drug, antibiotics, ß-blockers, diuretics, lipid regulator and cholesterol lowering statin drugs and anti-histamines), were studied in the wastewater and sewage sludge trains of a full scale integrated treatment plant. The plant employs a biological nutrient removal (BNR) process for the treatment of municipal wastewater, and a single-stage mesophilic anaerobic co-digestion for the treatment of wasted activated sludge mixed with the organic fraction of municipal solid waste (OFMSW), followed by a short-cut nitrification-denitrification of the anaerobic supernatant in a sequential batch reactor. Influent and effluent wastewater, as well as thickened, digested and treated sludge were sampled and analyzed for the selected pharmaceuticals in order to study their presence and fate during the treatment. Twenty three compounds were detected in influent and effluent wastewater and eleven in sludge. Infiltration of groundwater in the sewer system led to a dilution of raw sewage, resulting in lower concentrations in wastewater (up to 0.7 μg/L in influent) and sludge (70 ng/g d.w.). Due to the dilution, overall risk quotient for the mixture of pharmaceuticals detected in effluent wastewater was less than one, indicating no direct risk for the aquatic environment. A wide range of removal efficiencies during the treatment was observed, i.e. <20% to 90%. The influent concentrations of the target pharmaceuticals, as polar compounds, were undoubtedly mostly affected by BNR process in the wastewater train, and less by anaerobic-co-digestion. Mass balance calculations showed that less than 2% of the total mass load of the studied pharmaceuticals was removed by sorption. Experimentally estimated distribution coefficients (<500 L/kg) also indicated that the selected pharmaceuticals preferably remain in

  15. Integrative Families and Systems Treatment: A Middle Path toward Integrating Common and Specific Factors in Evidence-Based Family Therapy

    ERIC Educational Resources Information Center

    Fraser, J. Scott; Solovey, Andrew D.; Grove, David; Lee, Mo Yee; Greene, Gilbert J.

    2012-01-01

    A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility…

  16. Integrative Families and Systems Treatment: A Middle Path toward Integrating Common and Specific Factors in Evidence-Based Family Therapy

    ERIC Educational Resources Information Center

    Fraser, J. Scott; Solovey, Andrew D.; Grove, David; Lee, Mo Yee; Greene, Gilbert J.

    2012-01-01

    A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility…

  17. Is Specialized Integrated Treatment for Comorbid Anxiety, Depression and Alcohol Dependence Better than Treatment as Usual in a Public Hospital Setting?

    PubMed

    Morley, K C; Baillie, A; Leung, S; Sannibale, C; Teesson, M; Haber, P S

    2016-07-01

    To assess the effectiveness of a 12 week specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Out of 86 patients meeting the inclusion criteria for alcohol dependence with suspicion of comorbid anxiety and/or depressive disorder, 57 completed a 3-week stabilization period (abstinence or significantly reduced consumption). Of these patients, 37 (65%) met a formal diagnostic assessment of an anxiety and/or depressive disorder and were randomized to either (a) integrated intervention (cognitive behavioural therapy) for alcohol, anxiety and/or depression, or (b) usual counselling care for alcohol problems. Intention-to-treat analyses revealed a beneficial treatment effect of integrated treatment relative to usual counselling care for the number of days to relapse (χ(2) = 6.42, P < 0.05) and lapse (χ(2) = 10.73, P < 0.01). In addition, there was a significant interaction effect of treatment and time for percentage days of abstinence (P < 0.05). For heavy drinking days, the treatment effect was mediated by changes in DASS anxiety (P < 0.05). There were no significant treatment interaction effects for DASS depression or anxiety symptoms. These results provide support for integrated care in improving drinking outcomes for patients with alcohol dependence and comorbid depression/anxiety disorder. ClinicalTrials.gov Identifier: NCT01941693. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

  18. The BraveNet prospective observational study on integrative medicine treatment approaches for pain

    PubMed Central

    2013-01-01

    Background Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. Methods Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. Results Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. Conclusions Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. Trial Registration ClinicalTrials.gov, NCT

  19. Metabolic cardiology: an integrative strategy in the treatment of congestive heart failure.

    PubMed

    Sinatra, Stephen T

    2009-01-01

    Congestive heart failure (CHF) and dilated cardiomyopathy are life-threatening conditions in which the heart muscle is so weak that effective pulsatile action is compromised. Pulmonary vascular congestion and swelling in the lower extremities as well as in the liver and lining of the gastrointestinal tract frequently cause overwhelming symptoms and disability. Millions of Americans suffer from CHF, and more than 500,000 cases are diagnosed annually. Cardiovascular diseases such as hypertension with left ventricular hypertrophy, valvular heart disease, coronary artery disease, myocarditis, and various cardiomyopathies can lead to the progressive onset of CHF. The purpose of this communication article is to introduce metabolic cardiology as a vital therapeutic strategy utilizing nutritional biochemical interventions that preserve and promote adenosine triphosphate (ATP) production. Treatment options that incorporate metabolic interventions targeted to preserve energy substrates (D-ribose) or accelerate ATP turnover (L-carnitine and coenzyme Q10) are indicated for at-risk populations or patients at any stage of CHF. The integration of these metabolic supports provides the missing link in CHF treatment that has been eluding physicians for decades.

  20. Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability.

    PubMed

    Wang, Xu; McCarty, Perry L; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

    2015-02-03

    Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries.

  1. Integration of Treatment Innovation Planning and Implementation: Strategic Process Models and Organizational Challenges

    PubMed Central

    Lehman, Wayne E. K.; Simpson, D. Dwayne; Knight, Danica K.; Flynn, Patrick M.

    2015-01-01

    Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A 2-phase procedural approach is therefore presented based on the integration of TCU models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. PMID:21443294

  2. Treatment of Oil Wastewater and Electricity Generation by Integrating Constructed Wetland with Microbial Fuel Cell.

    PubMed

    Yang, Qiao; Wu, Zhenxing; Liu, Lifen; Zhang, Fengxiang; Liang, Shengna

    2016-11-01

    Conventional oil sewage treatment methods can achieve satisfactory removal efficiency, but energy consumption problems during the process of oil sewage treatment are worth attention. The integration of a constructed wetland reactor and a microbial fuel cell reactor (CW-MFC) to treat oil-contaminated wastewater, compared with a microbial fuel cell reactor (MFC) alone and a constructed wetland reactor (CW) alone, was explored in this research. Performances of the three reactors including chemical oxygen demand (COD), oil removal, and output voltage generation were continuously monitored. The COD removals of three reactors were between 73% and 75%, and oil removals were over 95.7%. Compared with MFC, the CW-MFC with a MnO₂ modified cathode produced higher power density and output voltage. Maximum power densities of CW-MFC and MFC were 3868 mW/m³ (102 mW/m²) and 3044 mW/m³ (80 mW/m²), respectively. The plants in CW-MFC play a positive role for reactor cathode potential. Both plants and cathode modification can improve reactor performance of electricity generation.

  3. A flux-enhancing forward osmosis-nanofiltration integrated treatment system for the tannery wastewater reclamation.

    PubMed

    Pal, Parimal; Chakrabortty, Sankha; Nayak, Jayato; Senapati, Suman

    2017-06-01

    Effective treatment of tannery wastewater prior to discharge to the environment as per environmental regulations remains a big challenge despite efforts to bring down the concentrations of the pollutants which are often quite high as measured in terms of chemical oxygen demand (7800 mg/L), total dissolved solids (5400 mg/L), chloride (4260 mg/L), sulphides (250 mg/L) and chromium. A pilot-scale forward osmosis and nanofiltration integrated closed loop system was developed for continuous reclamation of clean water from tannery wastewater at a rate of 52-55 L/m(2)/h at 1.6 bar pressure. The low-cost draw solution was 0.8 M NaCl solution. Continuous recovery for recycling the draw solute was done by nanofiltration of diluted draw solution at an operating pressure of 12 bar and volumetric cross-flow rate of 700 L/h. Fouling study revealed that the specific flat-sheet design of cross-flow forward osmosis module with counter current flow of feed and draw solution prevents the build-up of concentration polarization, thus enabling long-term filtration in continuous mode of operation without significant membrane fouling. This study culminates in the development of a compact, efficient and low-cost industrial wastewater treatment and reclamation technology.

  4. Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies.

    PubMed

    Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon

    2016-06-01

    An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level.

  5. An Integrated Human/Murine Transcriptome and Pathway Approach To Identify Prenatal Treatments For Down Syndrome

    PubMed Central

    Guedj, Faycal; Pennings, Jeroen LA; Massingham, Lauren J.; Wick, Heather C.; Siegel, Ashley E.; Tantravahi, Umadevi; Bianchi, Diana W.

    2016-01-01

    Anatomical and functional brain abnormalities begin during fetal life in Down syndrome (DS). We hypothesize that novel prenatal treatments can be identified by targeting signaling pathways that are consistently perturbed in cell types/tissues obtained from human fetuses with DS and mouse embryos. We analyzed transcriptome data from fetuses with trisomy 21, age and sex-matched euploid controls, and embryonic day 15.5 forebrains from Ts1Cje, Ts65Dn, and Dp16 mice. The new datasets were compared to other publicly available datasets from humans with DS. We used the human Connectivity Map (CMap) database and created a murine adaptation to identify FDA-approved drugs that can rescue affected pathways. USP16 and TTC3 were dysregulated in all affected human cells and two mouse models. DS-associated pathway abnormalities were either the result of gene dosage specific effects or the consequence of a global cell stress response with activation of compensatory mechanisms. CMap analyses identified 56 molecules with high predictive scores to rescue abnormal gene expression in both species. Our novel integrated human/murine systems biology approach identified commonly dysregulated genes and pathways. This can help to prioritize therapeutic molecules on which to further test safety and efficacy. Additional studies in human cells are ongoing prior to pre-clinical prenatal treatment in mice. PMID:27586445

  6. Integration of photocatalysis and biological treatment for azo dye removal--application to AR183.

    PubMed

    Chebli, Derradji; Fourcade, Florence; Brosillon, Stephan; Nacef, Saci; Amrane, Abdeltif

    2011-04-01

    The feasibility of coupling photocatalysis with biological treatment to treat effluents containing azo dyes was examined in this work. With this aim, the degradation of Acid Red 183 was investigated. The very low biodegradability of AR183 was confirmed beforehand by measuring the biological oxygen demand (BOD5). Photocatalysis experiments were carried out in a closed-loop step photoreactor. The reactor walls were covered by TiO2 catalyst coated on non-woven paper, and the effluent flowed over the photocatalyst as a thin falling film. The removal of the dye was 82.7% after 4 h, and a quasi-complete decolorization (98.5%) was obtained for 10 h of irradiation (initial concentration 100 mg L(-1)). The decrease in concentration followed pseudo-first-order kinetics, with a constant k of 0.47 h(-1). Mineralization and oxidation yields were 80% and 75%, respectively, after 10 h of pretreatment. Therefore, even if target compound oxidation occurs (COD removal), indicating a modification to the chemical structure, the concomitant high mineralization was not in favour of subsequent microbial growth. The BOD5 measurement confirmed the non-biodegradability of the irradiated solution, which remained toxic since the EC50 decreased from 35 to 3 mg L(-1). The proposed integrated process appeared, therefore, to be not relevant for the treatment of AR183. However, this result should be confirmed for other azo dyes.

  7. Integration of treatment innovation planning and implementation: strategic process models and organizational challenges.

    PubMed

    Lehman, Wayne E K; Simpson, D Dwayne; Knight, Danica K; Flynn, Patrick M

    2011-06-01

    Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A two-phase procedural approach is therefore presented based on the integration of Texas Christian University (TCU) models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings.

  8. Treatment of vegetable oily wastewater using an integrated microfiltration-reverse osmosis system.

    PubMed

    Yu, Xiaoli; Zhong, Zhaoxiang; Xing, Weihong

    2010-01-01

    Vegetable oil processing plants and catering trade often generate a large amount of oil-containing wastewater, which causes serious environmental problems. The objective of this work was to explore the feasibility of vegetable oil wastewater treatment with an integrated microfiltration-reverse osmosis (MF-RO) process. The influence of operational parameters on the separation behaviors were investigated in MF process. In MF continuous process the steady flux was around 90 (L/m(2) h) when the concentrated multiple reached 16, and the oil content in permeate was less than 12 mg/L. In the RO continuous process, antifouling membrane was used to treat permeate from the ceramic membrane process in order to improve the water quality. The RO process had a permeate flux of 24 (L/m(2) h) and water recovery rate of 95%. The permeate from the RO stage was free of oil, and its TOC and conductivity were less than 0.6 mg/L and 50 micros/cm, respectively. The results demonstrated that the two stage membrane process combining MF and RO is highly efficient in the treatment of oil-containing wastewater.

  9. Integrated community-directed treatment for the control of onchocerciasis, schistosomiasis and intestinal helminths infections in Uganda: advantages and disadvantages.

    PubMed

    Ndyomugyenyi, Richard; Kabatereine, Narcis

    2003-11-01

    Onchocerciasis is co-endemic with schistosomiasis and intestinal helminths infections, which are all diseases of the rural and the poorest communities in Africa. Community-directed treatment (ComDT) for the control of onchocerciasis is the only functional health approach in most of these communities and the strategy has proven to be effective for onchocerciasis control. This study was conducted to assess the feasibility of integrating ComDT with ivermectin for the control of onchocerciasis, and with praziquantel (PZQ) and mebendazole (MBD) for the control of schistosomiasis and intestinal helminths infections in children aged 5-14 years, and to assess advantages and disadvantages of the integrated ComDT over the routine ComDT and the school-based treatment approach. Integrated ComDT achieved higher treatment coverage (85%) for PZQ and MBD than the school-based treatment approach (79%) among children aged 5-14 years (P = 0.03). There were more reported adverse reactions after treatment with a combination of PZQ and MBD in the school-based treatment approach (33%) than for the combination of ivermectin and MBD on day 1 and PZQ on day 2 in the integrated ComDT (18%). However, all adverse reactions were mild (headache, nausea/vomiting and abdominal pain). The integrated ComDT also achieved higher ivermectin treatment coverage for all ages (81.3%) than routine ComDT (77.2%) (P = 0.0003). To achieve even better coverage for PZQ and MBD among the targeted high risk groups, integrated ComDT should treat all age groups in areas where the prevalence of schistosomiasis and intestinal helminths infections is >50%. This would minimize the shortage of the drugs targeted to treat the high risk groups, as the non-targeted groups, will inevitably demand and receive the treatment from the distributors. The results of this study show that PZQ and MBD treatment for the control of schistosomiasis and intestinal helminths, respectively, can be integrated with ivermectin treatment for

  10. Advanced treatment of biologically pretreated coal gasification wastewater by a novel integration of catalytic ultrasound oxidation and membrane bioreactor.

    PubMed

    Jia, Shengyong; Han, Hongjun; Zhuang, Haifeng; Xu, Peng; Hou, Baolin

    2015-01-01

    Laboratorial scale experiments were conducted to investigate a novel system integrating catalytic ultrasound oxidation (CUO) with membrane bioreactor (CUO-MBR) on advanced treatment of biologically pretreated coal gasification wastewater. Results indicated that CUO with catalyst of FeOx/SBAC (sewage sludge based activated carbon (SBAC) which loaded Fe oxides) represented high efficiencies in eliminating TOC as well as improving the biodegradability. The integrated CUO-MBR system with low energy intensity and high frequency was more effective in eliminating COD, BOD5, TOC and reducing transmembrane pressure than either conventional MBR or ultrasound oxidation integrated MBR. The enhanced hydroxyl radical oxidation, facilitation of substrate diffusion and improvement of cell enzyme secretion were the mechanisms for CUO-MBR performance. Therefore, the integrated CUO-MBR was the promising technology for advanced treatment in engineering applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial

    PubMed Central

    Slesnick, Natasha; Kang, Min Ju

    2008-01-01

    While many studies provide useful information on the risk behaviors in which homeless youth engage, few prior studies evaluate Human Immunodeficiency Virus (HIV) risk related reduction strategies. In this study, homeless youth (n = 180) were recruited from a drop-in center and randomly assigned to one of two conditions, either an integrated individual cognitive-behavioral treatment and HIV prevention intervention that focused on skills building and education or to treatment as usual. All youth were assessed at entry into the program and at 3 and 6 month follow-up points. Findings showed an interaction between treatment condition, age and time. In the interaction, youth assigned to the integrated treatment reported greater condom usage than youth assigned to treatment as usual, with younger youth assigned to treatment as usual showing no change in condom use. The number of sexual partners reported by youth in both treatment conditions was also reduced over time. However, youth in both conditions continued to engage in other high-risk behaviors. The integrated treatment findings are promising and suggest that interventions which target both HIV risk behavior in addition to other life areas (substance use, mental health and housing) among homeless youth may be necessary in order to significantly impact high-risk behaviors among this unique group. PMID:17940861

  12. Evaluation of an integrated group cognitive-behavioral treatment for comorbid mood, anxiety, and substance use disorders: A pilot study.

    PubMed

    Milosevic, Irena; Chudzik, Susan M; Boyd, Susan; McCabe, Randi E

    2017-03-01

    This paper presents the development and preliminary evaluation of an integrated group cognitive-behavioral treatment (CBT) for comorbid mood, anxiety, and substance use disorders. The 12-session, manualized treatment was developed collaboratively by a mental health program in a teaching hospital and a community-based addictions service and administered in both settings. Results from an uncontrolled effectiveness trial of 29 treatment completers suggest that integrated group CBT may reduce stress and alcohol use symptoms and improve substance refusal self-efficacy. Changes in symptoms of anxiety, depression, and drug use were not significant, although the effect size for anxiety reduction was in the medium range. Nonetheless, the clinical significance of treatment effects on mood, anxiety, and substance use symptoms was modest. Changes in coping skills and quality of life were not significant, although medium-to-large effects were observed for changes in several coping skills. Participants reported being highly satisfied with treatment, found the treatment strategies to be useful, and noted an improvement in their functioning, particularly socially. Methodological and sample size limitations warrant more rigorous follow-up investigations of this treatment. Results are considered in the context of the current literature on integrated psychological treatments for these common comorbidities.

  13. White matter integrity as a link in the association between motivation to abstain and treatment outcome in adolescent substance users.

    PubMed

    Chung, Tammy; Pajtek, Stefan; Clark, Duncan B

    2013-06-01

    Readiness to change constitutes an important treatment target. This study examined white matter (WM) integrity as a possible link in the pathway between motivation to abstain and treatment outcome. Adolescents (age 14-18 years, n = 32) were recruited from intensive outpatient (IOP) substance use treatment and reported on motivation to abstain from alcohol and marijuana shortly after treatment admission (i.e., at baseline). Diffusion tensor imaging data were collected approximately 7 weeks after starting IOP and were used to quantify WM integrity (indexed by fractional anisotropy, FA) using a region of interest (ROI) approach. Treatment outcomes were assessed 6 months after baseline. Indirect effects analyses tested FA in prefrontal, orbitofrontal, and temporal ROIs as a linking variable in the pathway from motivation to abstain to alcohol and marijuana outcomes. Bivariate correlations indicated that greater motivation to abstain from alcohol was associated with lower FA in prefrontal, orbitofrontal, and temporal ROIs and that lower FA in these three ROIs was associated with greater 6-month alcohol problem severity. The indirect effect of FA was significant for the prefrontal ROI in the pathway from motivation to outcome for alcohol. FA values were not associated with motivation to abstain from marijuana or marijuana-related outcomes. Results suggest that lower WM integrity, particularly in the prefrontal brain region, may help to explain greater alcohol problem severity at 6 months despite higher motivation to abstain from alcohol. Interventions that aim to enhance WM integrity warrant attention to improve adolescent treatment outcomes. 2013 APA, all rights reserved

  14. Towards integration of PET/MR hybrid imaging into radiation therapy treatment planning

    SciTech Connect

    Paulus, Daniel H.; Thorwath, Daniela; Schmidt, Holger; Quick, Harald H.

    2014-07-15

    Purpose: Multimodality imaging has become an important adjunct of state-of-the-art radiation therapy (RT) treatment planning. Recently, simultaneous PET/MR hybrid imaging has become clinically available and may also contribute to target volume delineation and biological individualization in RT planning. For integration of PET/MR hybrid imaging into RT treatment planning, compatible dedicated RT devices are required for accurate patient positioning. In this study, prototype RT positioning devices intended for PET/MR hybrid imaging are introduced and tested toward PET/MR compatibility and image quality. Methods: A prototype flat RT table overlay and two radiofrequency (RF) coil holders that each fix one flexible body matrix RF coil for RT head/neck imaging have been evaluated within this study. MR image quality with the RT head setup was compared to the actual PET/MR setup with a dedicated head RF coil. PET photon attenuation and CT-based attenuation correction (AC) of the hardware components has been quantitatively evaluated by phantom scans. Clinical application of the new RT setup in PET/MR imaging was evaluated in anin vivo study. Results: The RT table overlay and RF coil holders are fully PET/MR compatible. MR phantom and volunteer imaging with the RT head setup revealed high image quality, comparable to images acquired with the dedicated PET/MR head RF coil, albeit with 25% reduced SNR. Repositioning accuracy of the RF coil holders was below 1 mm. PET photon attenuation of the RT table overlay was calculated to be 3.8% and 13.8% for the RF coil holders. With CT-based AC of the devices, the underestimation error was reduced to 0.6% and 0.8%, respectively. Comparable results were found within the patient study. Conclusions: The newly designed RT devices for hybrid PET/MR imaging are PET and MR compatible. The mechanically rigid design and the reproducible positioning allow for straightforward CT-based AC. The systematic evaluation within this study provides the

  15. Towards integration of PET/MR hybrid imaging into radiation therapy treatment planning.

    PubMed

    Paulus, Daniel H; Thorwath, Daniela; Schmidt, Holger; Quick, Harald H

    2014-07-01

    Multimodality imaging has become an important adjunct of state-of-the-art radiation therapy (RT) treatment planning. Recently, simultaneous PET/MR hybrid imaging has become clinically available and may also contribute to target volume delineation and biological individualization in RT planning. For integration of PET/MR hybrid imaging into RT treatment planning, compatible dedicated RT devices are required for accurate patient positioning. In this study, prototype RT positioning devices intended for PET/MR hybrid imaging are introduced and tested toward PET/MR compatibility and image quality. A prototype flat RT table overlay and two radiofrequency (RF) coil holders that each fix one flexible body matrix RF coil for RT head/neck imaging have been evaluated within this study. MR image quality with the RT head setup was compared to the actual PET/MR setup with a dedicated head RF coil. PET photon attenuation and CT-based attenuation correction (AC) of the hardware components has been quantitatively evaluated by phantom scans. Clinical application of the new RT setup in PET/MR imaging was evaluated in anin vivo study. The RT table overlay and RF coil holders are fully PET/MR compatible. MR phantom and volunteer imaging with the RT head setup revealed high image quality, comparable to images acquired with the dedicated PET/MR head RF coil, albeit with 25% reduced SNR. Repositioning accuracy of the RF coil holders was below 1 mm. PET photon attenuation of the RT table overlay was calculated to be 3.8% and 13.8% for the RF coil holders. With CT-based AC of the devices, the underestimation error was reduced to 0.6% and 0.8%, respectively. Comparable results were found within the patient study. The newly designed RT devices for hybrid PET/MR imaging are PET and MR compatible. The mechanically rigid design and the reproducible positioning allow for straightforward CT-based AC. The systematic evaluation within this study provides the technical basis for the clinical

  16. Abnormal functional integration of thalamic low frequency oscillation in the BOLD signal after acute heroin treatment.

    PubMed

    Denier, Niklaus; Schmidt, André; Gerber, Hana; Vogel, Marc; Huber, Christian G; Lang, Undine E; Riecher-Rossler, Anita; Wiesbeck, Gerhard A; Radue, Ernst-Wilhelm; Walter, Marc; Borgwardt, Stefan

    2015-12-01

    Heroin addiction is a severe relapsing brain disorder associated with impaired cognitive control, including deficits in attention allocation. The thalamus has a high density of opiate receptors and is critically involved in orchestrating cortical activity during cognitive control. However, there have been no studies on how acute heroin treatment modulates thalamic activity. In a cross-over, double-blind, vehicle-controlled study, 29 heroin-maintained outpatients were studied after heroin and placebo administration, while 20 healthy controls were included for the placebo condition only. Resting-state functional magnetic resonance imaging was used to analyze functional integration of the thalamus by three different resting state analysis techniques. Thalamocortical functional connectivity (FC) was analyzed by seed-based correlation, while intrinsic thalamic oscillation was assessed by analysis of regional homogeneity (ReHo) and the fractional amplitude of low frequency fluctuations (fALFF). Relative to the placebo treatment and healthy controls, acute heroin administration reduced thalamocortical FC to cortical regions, including the frontal cortex, while the reductions in FC to the mediofrontal cortex, orbitofrontal cortex, and frontal pole were positively correlated with the plasma level of morphine, the main psychoactive metabolite of heroin. Furthermore, heroin treatment was associated with increased thalamic ReHo and fALFF values, whereas fALFF following heroin exposure correlated negatively with scores of attentional control. The heroin-associated increase in fALFF was mainly dominated by slow-4 (0.027-0.073 Hz) oscillations. Our findings show that there are acute effects of heroin within the thalamocortical system and may shed new light on the role of the thalamus in cognitive control in heroin addiction. Future research is needed to determine the underlying physiological mechanisms and their role in heroin addiction.

  17. Simulation of integrated pollutant removal (IPR) water-treatment system using ASPEN Plus

    SciTech Connect

    Harendra, Sivaram; Oryshcyhn, Danylo [U.S. DOE Ochs, Thomas [U.S. DOE Gerdemann, Stephen; Clark, John

    2013-01-01

    Capturing CO2 from fossil fuel combustion provides an opportunity for tapping a significant water source which can be used as service water for a capture-ready power plant and its peripherals. Researchers at the National Energy Technology Laboratory (NETL) have patented a process—Integrated Pollutant Removal (IPR®)—that uses off-the-shelf technology to produce a sequestration ready CO2 stream from an oxy-combustion power plant. Water condensed from oxy-combustion flue gas via the IPR system has been analyzed for composition and an approach for its treatment—for in-process reuse and for release—has been outlined. A computer simulation model in ASPEN Plus has been developed to simulate water treatment of flue gas derived wastewater from IPR systems. At the field installation, water condensed in the IPR process contains fly ash particles, sodium (largely from spray-tower buffering) and sulfur species as well as heavy metals, cations, and anions. An IPR wastewater treatment system was modeled using unit operations such as equalization, coagulation and flocculation, reverse osmosis, lime softening, crystallization, and pH correction. According to the model results, 70% (by mass) of the inlet stream can be treated as pure water, the other 20% yields as saleable products such as gypsum (CaSO4) and salt (NaCl) and the remaining portion is the waste. More than 99% of fly ash particles are removed in the coagulation and flocculation unit and these solids can be used as filler materials in various applications with further treatment. Results discussed relate to a slipstream IPR installation and are verified experimentally in the coagulation/flocculation step.

  18. Effective cancer laser-therapy design through the integration of nanotechnology and computational treatment planning models

    NASA Astrophysics Data System (ADS)

    Fisher, Jessica W.; Rylander, Marissa Nichole

    2008-02-01

    Laser therapies can provide a minimally invasive treatment alternative to surgical resection of tumors. However, the effectiveness of these therapies is limited due to nonspecific heating of target tissue which often leads to healthy tissue injury and extended treatment durations. These therapies can be further compromised due to heat shock protein (HSP) induction in tumor regions where non-lethal temperature elevation occurs, thereby imparting enhanced tumor cell viability and resistance to subsequent chemotherapy and radiation treatments. Introducing multi-walled nanotubes (MWNT) into target tissue prior to laser irradiation increases heating selectivity permitting more precise thermal energy delivery to the tumor region and enhances thermal deposition thereby increasing tumor injury and reducing HSP expression induction. This study investigated the impact of MWNT inclusion in untreated and laser irradiated monolayer cell culture and cell phantom model. Cell viability remained high for all samples with MWNT inclusion and cells integrated into alginate phantoms, demonstrating the non-toxic nature of both MWNTs and alginate phantom models. Following, laser irradiation samples with MWNT inclusion exhibited dramatic temperature elevations and decreased cell viability compared to samples without MWNT. In the cell monolayer studies, laser irradiation of samples with MWNT inclusion experienced up-regulated HSP27, 70 and 90 expression as compared to laser only or untreated samples due to greater temperature increases albeit below the threshold for cell death. Further tuning of laser parameters will permit effective cell killing and down-regulation of HSP. Due to optimal tuning of laser parameters and inclusion of MWNT in phantom models, extensive temperature elevations and cell death occurred, demonstrating MWNT-mediated laser therapy as a viable therapy option when parameters are optimized. In conclusion, MWNT-mediated laser therapies show great promise for effective

  19. Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.

    PubMed

    Wolff, Nancy; Huening, Jessica; Shi, Jing; Frueh, B Christopher; Hoover, Donald R; McHugo, Gregory

    2015-03-01

    A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD

  20. Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men

    PubMed Central

    Wolff, Nancy; Huening, Jessica; Shi, Jing; Frueh, B. Christopher; Hoover, Donald R.; McHugo, Gregory

    2015-01-01

    A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n = 230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n = 142) or by preference (n = 88) to receive SS or M-TREM, with a waitlist group of (n = 93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co

  1. Enhanced treatment of coking wastewater containing phenol, pyridine, and quinoline by integration of an E-Fenton process into biological treatment.

    PubMed

    Xue, Lanlan; Liu, Jiaxin; Li, Meidi; Tan, Liang; Ji, Xiangyu; Shi, Shengnan; Jiang, Bei

    2017-03-01

    In this study, the pyridine and quinoline could be cometabolically degraded by phenol-cultivated Comamonas sp. strain JB(strain JB). The integration of magnetically immobilized cells of JB and an E-Fenton process into one entity has been designed to prepare a novel integration system to improve the treatment efficiency of phenol, pyridine, and quinoline in coking wastewater. The optimal pH for the integration system was 3.5. Degradation rates of phenol, pyridine, quinoline, and COD by the integration system were significantly exceeded the sum degradation rates of the single E-Fenton process and magnetically immobilized cells at the optimal voltage of 1 V. During the 6 cycles, the integration system still showed higher degradation rates than that by the single magnetically immobilized cells for all the compounds. These findings demonstrated that a synergistic effect existed between the biological treatment and the E-Fenton process, and the applied voltage in the integration system played the key roles in the synergistic effect, which not only electrogenerated H2O2 but also improved the activity of phenol hydroxylase and strain JB concentration.

  2. The cost of integrated HIV care and buprenorphine/naloxone treatment: results of a cross-site evaluation.

    PubMed

    Schackman, Bruce R; Leff, Jared A; Botsko, Michael; Fiellin, David A; Altice, Fredrick L; Korthuis, P Todd; Sohler, Nancy; Weiss, Linda; Egan, James E; Netherland, Julie; Gass, Jonathan; Finkelstein, Ruth

    2011-03-01

    Implementing integrated HIV and buprenorphine/naloxone treatment requires cost estimates to plan and obtain funding. We identified costs incurred at HIV clinical sites participating in a cross-site evaluation of integrated care that followed patients for 1 year. Costs include labor, overhead, and urine toxicology analyses (clinic perspective), buprenorphine/naloxone (payer perspective) and patient time and transportation (patient perspective). Sites provided resource utilization quarterly, and providers estimated time required for each activity. With site as the unit of analysis, results are reported as median (range) of average site costs in 2008 US dollars. The median number of monthly provider encounters for integrated care patients was 3.2 (1.5-13.3) compared with 1.7 (1.1-4.2) for similar patients not in integrated care, but integrated care patients had fewer physician encounters. Median monthly clinic costs per integrated care patient were $136 ($67-$677) for labor and overhead and $8 ($2-$23) for toxicology analyses, $22 higher than clinic costs for patients not in integrated care. Median monthly costs for buprenorphine/naloxone were $209 ($165-$272), and monthly patient costs in integrated care were $11 ($1-$54) higher. Integrated HIV and buprenorphine/naloxone treatment requires different resources, including costs that are not third-party reimbursed. Implementing integrated care will require funding for training and for new staff such as buprenorphine coordinators, in addition to reimbursement for buprenorphine/naloxone. Further research is needed to identify potential cost offsets outside of the clinic setting.

  3. Integration of biopolymer production with process water treatment at a sugar factory.

    PubMed

    Anterrieu, Simon; Quadri, Luca; Geurkink, Bert; Dinkla, Inez; Bengtsson, Simon; Arcos-Hernandez, Monica; Alexandersson, Tomas; Morgan-Sagastume, Fernando; Karlsson, Anton; Hjort, Markus; Karabegovic, Lamija; Magnusson, Per; Johansson, Peter; Christensson, Magnus; Werker, Alan

    2014-06-25

    The present investigation has focused on generating a surplus denitrifying biomass with high polyhydroxyalkanoate (PHA) producing potential while maintaining water treatment performance in biological nitrogen removal. The motivation for the study was to examine integration of PHA production into the water treatment and residuals management needs at the Suiker Unie sugar beet factory in Groningen, the Netherlands. At the factory, process waters are treated in nitrifying-denitrifying sequencing batch reactors (SBRs) to remove nitrogen found in condensate. Organic slippage (COD) in waters coming from beet washing is the substrate used for denitrification. The full-scale SBR was mimicked at laboratory scale. In two parallel laboratory scale SBRs, a mixed-culture biomass selection strategy of anoxic-feast and aerobic-famine was investigated using the condensate and wash water from Suiker Unie. One laboratory SBR was operated as conventional activated sludge with long solids retention time similar to the full-scale (SRT >16 days) while the other SBR was a hybrid biofilm-activated sludge (IFAS) process with short SRT (4-6 days) for the suspended solids. Both SBRs were found to produce biomass with augmented PHA production potential while sustaining process water treatment for carbon, nitrogen and phosphorus for the factory process waters. PHA producing potential in excess of 60 percent g-PHA/g-VSS was achieved with the lab scale surplus biomass. Surplus biomass of low (4-6 days) and high (>16 days) solids retention time yielded similar results in PHA accumulation potential. However, nitrification performance was found to be more robust for the IFAS SBR. Assessment of the SBR microbial ecology based on 16sDNA and selected PHA synthase genes at full-scale in comparison to biomass from the laboratory scale SBRs suggested that the full-scale process was enriched with a PHA storing microbial community. However, structure-function relationships based on RNA levels for the

  4. Collaborative behavioral management: integration and intensification of parole and outpatient addiction treatment services in the Step'n Out study.

    PubMed

    Friedmann, Peter D; Rhodes, Anne G; Taxman, Faye S

    2009-09-01

    Integration of community parole and addiction treatment holds promise for optimizing the participation of drug-involved parolees in re-entry services, but intensification of services might yield greater rates of technical violations. Collaborative behavioral management (CBM) integrates the roles of parole officers and treatment counselors to provide role induction counseling, contract for pro-social behavior, and to deliver contingent reinforcement of behaviors consistent with contracted objectives. Attendance at both parole and addiction treatment are specifically reinforced. The Step'n Out study of the Criminal Justice-Drug Abuse Treatment Studies (CJ-DATS) randomly allocated 486 drug-involved parolees to either collaborative behavioral management or traditional parole with 3-month and 9-month follow-up. Bivariate and multivariate regression models found that, in the first 3 months, the CBM group had more parole sessions, face-to-face parole sessions, days on which parole and treatment occurred on the same day, treatment utilization and individual counseling, without an increase in parole violations. We conclude that CBM integrated parole and treatment as planned, and intensified parolees' utilization of these services, without increasing violations.

  5. Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: a randomized controlled trial.

    PubMed

    Rapee, Ronald M; MacLeod, Colin; Carpenter, Leigh; Gaston, Jonathan E; Frei, Jacqueline; Peters, Lorna; Baillie, Andrew J

    2013-05-01

    The aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia. 134 participants (M age-32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat. At the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all p's>0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d=0.34 to d=1.90). The current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain

    PubMed Central

    Dunsford, Angela; Kumar, Saravana; Clarke, Sarah

    2011-01-01

    Low back pain (LBP) is a major health issue with significant socioeconomic implications in most Western countries. Many forms of treatment have been proposed and investigated in the past, with exercise being a commonly prescribed intervention. Within allied health, in particular physiotherapy, there has been a growing movement that recognizes the role of the McKenzie method in treating LBP. Within the McKenzie framework, directional preference (DP) exercises are one such intervention, with preliminary data demonstrating its effectiveness in the management of LBP. In this paper, we aim to integrate the evidence from current research, identified using a systematic review, and utilize a practical real-life case scenario to outline how evidence from the literature can be implemented in clinical practice. The findings from the systematic review indicate that DP exercises may have positive effects in the management of LBP. While the body of evidence to support this is limited (only four studies) and therefore modest at best, it does provide some emerging evidence to support the use of DP exercises in clinical practice. Despite this, gaps also persist in the literature on DP exercises, and this relates to the exercise parameters and the compliance rates. Recognizing this dichotomy (modest evidence in some areas and evidence gaps in other areas), which is likely to confront health practitioners, using a practical approach with a real-life clinical scenario, we outline how the evidence from the systematic review can be implemented in clinical practice. This approach builds on the philosophy of evidence-based practice of integrating research evidence with clinical expertise and patient values. PMID:22135496

  7. Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain.

    PubMed

    Dunsford, Angela; Kumar, Saravana; Clarke, Sarah

    2011-01-01

    Low back pain (LBP) is a major health issue with significant socioeconomic implications in most Western countries. Many forms of treatment have been proposed and investigated in the past, with exercise being a commonly prescribed intervention. Within allied health, in particular physiotherapy, there has been a growing movement that recognizes the role of the McKenzie method in treating LBP. Within the McKenzie framework, directional preference (DP) exercises are one such intervention, with preliminary data demonstrating its effectiveness in the management of LBP. In this paper, we aim to integrate the evidence from current research, identified using a systematic review, and utilize a practical real-life case scenario to outline how evidence from the literature can be implemented in clinical practice. The findings from the systematic review indicate that DP exercises may have positive effects in the management of LBP. While the body of evidence to support this is limited (only four studies) and therefore modest at best, it does provide some emerging evidence to support the use of DP exercises in clinical practice. Despite this, gaps also persist in the literature on DP exercises, and this relates to the exercise parameters and the compliance rates. Recognizing this dichotomy (modest evidence in some areas and evidence gaps in other areas), which is likely to confront health practitioners, using a practical approach with a real-life clinical scenario, we outline how the evidence from the systematic review can be implemented in clinical practice. This approach builds on the philosophy of evidence-based practice of integrating research evidence with clinical expertise and patient values.

  8. IMPORTANCE OF INTEGRATED MANAGEMENT SYSTEM APPLIED IN HEALTH ESTABLISHMENTS IN ORDER TO RAISE TREATMENT QUALITY.

    PubMed

    Dodić, Biljana; Miljković, Tatjana; Bjelobrk, Marija; Cemerlic Ađić, Nada; Ađić, Filip; Dodić, Slobodan

    2016-01-01

    The term "management" is best characterized as "managing" economic or social processes to achieve objectives through a rational use of material and immaterial resources by applying the principles, functions, and management methods. This study has been aimed at evaluating the value of an integrated quality management system implemented at the Institute of Cardiovascular Diseases of Vojvodina to improve the quality of treatment. In the period from 2008 to 2010 about 40 employees from the Institute of Cardiovascular Diseases of Vojvodina attended various courses given by the lecturers of the Faculty of Technical Sciences, where the function and significance of the "International Standards Organization" were explained, after which standards of interest were implemented at the Institute of Cardiovascular Diseases of Vojvodina. The Department of Cardiology has introduced 11 cardiac procedures with 5 special instructions, 14 general procedures, and 7 specific procedures with 2 instructions. The Department of Cardiac Surgery has introduced 7 procedures to be implemented. The "Vojvodina score" model was put into practice for the perioperative evaluation of cardiac surgery risk. During 2014, the Institute of Cardiovascular Diseases ofVojvodina obtained accreditation for the period of 7 years. The integrated quality management system must be applied in order to achieve a high level of health care in the shortest possible time and with the least possible consumption of material and human resources. The application of this system in practice gives a realistic insight into the working processes and facilitates their functioning. It demands and requires constant monitoring of the system efficiency along with continuous changes and improvements of all elements of the working processes and functional units.

  9. Integrated biological and physiochemical treatment process for nitrate and fluoride removal.

    PubMed

    Mekonen, A; Kumar, P; Kumar, A

    2001-09-01

    The feasibility of an integrated biological and physiochemical water treatment process for nitrate and fluoride removal has been evaluated. It consisted of two sequencing batch reactors (SBRs) in series. Performance of the process in the treatment of 24 synthetic water samples having nitrate concentrations of 40, 80, 120, 160, 200, and 250 mg/l (as N) and fluoride concentrations of 6, 10, 15, and 20 mg/l at different combinations was studied. Denitrification followed by defluoridation proved to be the best sequence of treatment. In all cases nitrate could be reduced to an acceptable level of less than 10 mg/l (as N) at 3, 5, and 7 h hydraulic retention times (HRTs) depending on its initial concentration. Fluoride concentrations up to 15 mg/l associated with nitrate concentrations up to 80 mg/l (as N) could be reduced acceptable 1.5 mg/l by alum-PAC slurry using alum doses up 850 mg/l [as Al2(SO4)3 x 16H2O] along with 100 mg/l of powdered activated carbon (PAC). Additional alkalinity produced during denitrification was used up during defluoridation for maintenance of pH avoiding the need for lime addition. On the other hand, residual organics, turbidity, and sulfide present in the denitrified water are removed by alum and PAC at the defluoridation stage along with fluoride, eliminating the need for an additional post-treatment step. At higher nitrate concentrations (> or = 120 mg/l as N), the alkalinity produced at the denitrification stage was in the range of 715-1175 mg/l as CaCO3. This excessive alkalinity inhibited reduction of fluoride to the level of 1.5 mg/l at the defluoridation stage, using alum doses up to 900 mg/l along with 100 mg/l of PAC. In all cases a fluoride concentration of 20 mg/l in water could not be reduced to the acceptable level of 1.5 mg/l.

  10. Integration of Three-Dimensional Rotational Angiography in Radiosurgical Treatment Planning of Cerebral Arteriovenous Malformations

    SciTech Connect

    Conti, Alfredo; Pontoriero, Antonio; Farago, Giuseppe; Midili, Federica; Siragusa, Carmelo; Granata, Francesca; Pitrone, Antonio; De Renzis, Costantino; Longo, Marcello; Tomasello, Francesco

    2011-11-01

    Purpose: Accuracy in delineating the target volume is a major issue for successful stereotactic radiosurgery for arteriovenous malformations. The aim of the present study was to describe a method to integrate three-dimensional (3D) rotational angiography ( (3DRA)) into CyberKnife treatment planning and to investigate its potential advantages compared with computed tomography angiography (CTA) and magnetic resonance angiography. Methods and Materials: A total of 20 patients with a diagnosis of cerebral arteriovenous malformation were included in the present study. All patients underwent multislice computed tomography and 3D-volumetric CTA, (3DRA), and 3D magnetic resonance angiography. The contouring of the target and critical volumes was done separately using CTA and thereafter directly using (3DRA). The composite, conjoint, and disjoint volumes were measured. Results: The use of CTA or (3DRA) resulted in significant differences in the target and critical volumes. The target volume averaged 3.49 {+-} 3.01 mL measured using CTA and 3.26 {+-} 2.93 mL measured using (3DRA), for a difference of 8% (p < .05). The conjoint and disjoint volume analysis showed an 88% volume overlap. The qualitative evaluation showed that the excess volume obtained using CTA was mostly tissue surrounding the nidus and venous structures. The mean contoured venous volume was 0.67 mL measured using CTA and 0.88 mL (range, 0.1-2.7) measured using (3DRA) (p < .05). Conclusions: (3DRA) is a volumetric angiographic study that can be integrated into computer-based treatment planning. Although whether (3DRA) provides superior accuracy has not yet been proved, its high spatial resolution is attractive and offers a superior 3D view. This allows a better 3D understanding of the target volume and distribution of the radiation doses within the volume. Additional technical efforts to improve the temporal resolution and the development of software tools aimed at improving the performance of 3D contouring

  11. Initial evaluation of an integrated treatment for comorbid PTSD and smoking using a nonconcurrent, multiple-baseline design.

    PubMed

    Feldner, Matthew T; Smith, Rose C; Monson, Candice M; Zvolensky, Michael J

    2013-09-01

    The present study examined an integrated treatment for comorbid posttraumatic stress disorder (PTSD) and smoking entitled "Smoke-Free to Overcome PTSD: An Integrated Treatment" (STOP IT program). A nonconcurrent multiple-baseline design was used with six community-recruited adult smokers with PTSD to investigate both patient acceptance of the treatment and its initial efficacy on both PTSD and smoking. Potential order effects of exposure-based and affect management components were also examined. A gold-standard assessment strategy that included the Clinician Administered PTSD Scale (Blake et al., 1995) and biochemical verification of self-reported smoking status was employed to measure primary targets of treatment. Results suggested that the STOP IT program was well tolerated. There were clinically significant improvements in PTSD outcomes, but only temporary reductions in smoking. Participants' relatively low posttreatment smoking levels increased by the follow-up assessment, although not to baseline levels. Treatment component order did not appear to affect treatment outcomes, but those who were assigned to the exposure-focused writing prior to affect management training condition appeared more likely to discontinue treatment before beginning exposure. These preliminary data support the safety, acceptability, and potential efficacy of the STOP IT program. Future investigation of the STOP IT program should include testing the incremental efficacy of increasing the dose of smoking-focused intervention, as well as randomized controlled tests of the treatment that employ gold standards for treatment outcome research. Copyright © 2013. Published by Elsevier Ltd.

  12. A community-based organization's integration of HIV and substance abuse treatment services for ex-offenders.

    PubMed

    Strauss, Danielle

    2006-01-01

    This paper explores the point of intersection of the substance abuse treatment and HIV services industries with the criminal justice system. Section I reviews the literature and "best practices" that have integrated substance abuse treatment and HIV care and prevention services for ex-offenders and which informed the development of a community- based organization's initiative, the VIP STRIVE Project. Section II presents a brief history of VIP in the context of its ability to adapt to its environment and to the changing needs of its target population,with specific reference to the development of HIV and substance abuse treatment services for members of the criminal justice population. The concluding section brings the two previous sections together by explaining how the VIP STRIVE Project can assist VIP in enhancing its capacity to integrate its substance abuse treatment and HIV services in order to improve services for this target population.

  13. Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

    SciTech Connect

    Yang, Bo; Wei, Xian-ding; Zhao, Yu-tian; Ma, Chang-Ming

    2014-07-01

    To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16 Gy) and 9-MeV electrons (34 Gy) for the upper supraclavicular region. The common prescription dose was 50 Gy/25 Fx/5 W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V{sub 30} of the ipsilateral lung and V{sub 10}, V{sub 30}, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V{sub 5} and V{sub 10} of the ipsilateral lung and V{sub 5} of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.

  14. Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy.

    PubMed

    Yang, Bo; Wei, Xian-Ding; Zhao, Yu-Tian; Ma, Chang-Ming

    2014-01-01

    To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16Gy) and 9-MeV electrons (34Gy) for the upper supraclavicular region. The common prescription dose was 50Gy/25Fx/5W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V30 of the ipsilateral lung and V10, V30, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V5 and V10 of the ipsilateral lung and V5 of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region. Copyright © 2014 American Association of Medical

  15. TH-A-BRF-09: Integration of High-Resolution MRSI Into Glioblastoma Treatment Planning

    SciTech Connect

    Schreibmann, E; Cordova, J; Shu, H; Crocker, I; Curran, W; Holder, C; Shim, H

    2014-06-15

    Purpose: Identification of a metabolite signature that shows significant tumor cell infiltration into normal brain in regions that do not appear abnormal on standard MRI scans would be extremely useful for radiation oncologists to choose optimal regions of brain to treat, and to quantify response beyond the MacDonald criteria. We report on integration of high-resolution magnetic resonance spectroscopic imaging (HR-MRSI) with radiation dose escalation treatment planning to define and target regions at high risk for recurrence. Methods: We propose to supplement standard MRI with a special technique performed on an MRI scanner to measure the metabolite levels within defined volumes. Metabolite imaging was acquired using an advanced MRSI technique combining 3D echo-planar spectroscopic imaging (EPSI) with parallel acquisition (GRAPPA) using a multichannel head coil that allows acquisition of whole brain metabolite maps with 108 μl resolution in 12 minutes implemented on a 3T MR scanner. Elevation in the ratio of two metabolites, choline (Cho, elevated in proliferating high-grade gliomas) and N-acetyl aspartate (NAA, a normal neuronal metabolite), was used to image infiltrating high-grade glioma cells in vivo. Results: The metabolite images were co-registered with standard contrast-enhanced T1-weighted MR images using in-house registration software and imported into the treatment-planning system. Regions with tumor infiltration are identified on the metabolic images and used to create adaptive IMRT plans that deliver a standard dose of 60 Gy to the standard target volume and an escalated dose of 75 Gy (or higher) to the most suspicious regions, identified as areas with elevated Cho/NAA ratio. Conclusion: We have implemented a state-of-the-art HR-MRSI technology that can generate metabolite maps of the entire brain in a clinically acceptable scan time, coupled with introduction of an imaging co-registration/ analysis program that combines MRSI data with standard imaging

  16. Treatment of Ductal Carcinoma In Situ Among Patients Cared for in Large Integrated Health Plans

    PubMed Central

    Haque, Reina; Achacoso, Ninah S.; Fletcher, Suzanne W.; Nekhlyudov, Larissa; Collins, Laura C.; Schnitt, Stuart J.; Quesenberry, Charles P.; Habel, Laurel A.

    2013-01-01

    Objective To examine whether use of adjuvant therapy varies by race/ethnicity among patients with ductal carcinoma in situ (DCIS) at 3 integrated health plan delivery sites based in California and Massachusetts. Study Design Cross-sectional study nested within a cohort of women diagnosed as having DCIS between 1990 and 2001. Methods We reviewed medical records of 3000 non-Hispanic white (69%), black (10%), Hispanic (9%), and Asian or Pacific Islander (12%) women diagnosed as having DCIS between 1990 and 2001 and treated with breast-conserving therapy. χ2 Test and multinomial logistic regression analysis were used to examine the association between race/ethnicity and use of adjuvant treatments after controlling for patient and clinical variables, including certain pathologic factors. Results We found no significant differences in DCIS adjuvant treatment among racial/ethnic groups in bivariate or multinomial analyses after adjusting for demographic characteristics, comorbidity, and clinical factors. Minority women were as likely to undergo adjuvant radiation therapy as non-Hispanic white women. However, women 70 years or older (odds ratio, 0.40; 95% confidence interval, 0.31–0.51) and women who lived in areas with low geocoded median family income (odds ratio, 0.65; 95% confidence interval, 0.48–0.89) were less likely to receive adjuvant radiation therapy. Tumor size and comedo histologic growth pattern were associated with increased likelihood of receiving radiation therapy. Conclusion Use of adjuvant therapy by minority women in these managed care plans is similar to that by non-Hispanic white women, although use was less among older women and among women who lived in poorer neighborhoods. PMID:20469955

  17. Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability

    PubMed Central

    Wang, Xu; McCarty, Perry L.; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

    2015-01-01

    Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries. PMID:25605884

  18. Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans.

    PubMed

    Tsan, Jack Y; Zeber, John E; Stock, Eileen M; Sun, Fangfang; Copeland, Laurel A

    2012-11-01

    Despite the high prevalence of posttraumatic stress disorder (PTSD) and medical comorbidity among veterans from Iraq/Afghanistan (OEF/OIF), keeping these patients engaged in health care is challenging. Primary Care-Mental Health Integration (PC-MHI), an initiative in the Veterans Health Administration (VA), sought to improve access to mental health care from within primary care. This study examined the lag between first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-term (subsequent year) and long-term (4 years later) use of VA. We identified 2,470 OEF/OIF veterans receiving care during fiscal year 2006 (FY06) in a regional VA health care system. Unconditional survival analysis modeled time to next mental/medical visit and logistic regression modeled short- and long-term care as a function of PC-MHI, demographics, and clinical covariates. Of 181 patients in the PC-MHI program, 60%/18% returned for mental/medical care within 1 month, and 82%/74% within 1 year. Sixty-one percent (1,503) were still using the VA in FY09. Short-term mental care was related to prior-year PC-MHI. Consistent correlates of short- and long-term mental/medical care included physical comorbidity and Priority 1 status. Most patients attended mental health appointments subsequent to PC-MHI, and PC-MHI was correlated with mental health treatment retention in adjusted models for our cohort. Need for treatment, notably VA Priority 1 status and physical comorbidity, were the primary correlates of care-seeking. Developing innovative approaches to engaging new veterans in care remains imperative as multiple options will be necessary to meet the needs of these complex patients.

  19. Integrated treatment vs. treatment-as-usual for recent onset schizophrenia; 12 year follow-up on a randomized controlled trial.

    PubMed

    Sigrúnarson, Víðir; Gråwe, Rolf W; Morken, Gunnar

    2013-07-30

    The aim of this study is to compare the 12-year follow-up effects on in- and outpatient services of 2 years of integrated treatment for recent-onset schizophrenia versus treatment as usual in a randomized controlled trial. 50 patients aged 18-35 years were randomized to Integrated Treatment (IT) (N = 30) or Treatment-as-Usual (TAU) (N = 20) for two years. TAU comprised optimal pharmacotherapy and outreach assertive treatment, while IT also included cognitive-behavioural family treatment, skills training, strategies for residual psychotic and non-psychotic problems and home-based crisis management. There were no differences in number of days in hospital, time to readmission, number of admittances to psychiatric wards, number of involuntarily psychiatric admissions or number of outpatient contacts over a period of 12 years following the initial 2-year treatment trial. Fewer patients in the IT group were, however, involuntary admitted to hospital in the period. The intensive two-year psychosocial intervention seemed to have little long-term effects on use of in- and outpatient services. Current Controlled Trials: NCT00184509.

  20. The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

    PubMed Central

    2011-01-01

    Background There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this. Methods An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate. Results A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who

  1. Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos.

    PubMed

    Horevitz, Elizabeth; Organista, Kurt C; Arean, Patricia A

    2015-08-01

    Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral). The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients. English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment. Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seem important to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.

  2. An innovative integrated system utilizing solar energy as power for the treatment of decentralized wastewater.

    PubMed

    Han, Changfu; Liu, Junxin; Liang, Hanwen; Guo, Xuesong; Li, Lin

    2013-02-01

    This article reports an innovative integrated system utilizing solar energy as power for decentralized wastewater treatment, which consists of an oxidation ditch with double channels and a photovoltaic (PV) system without a storage battery. Because the system operates without a storage battery, which can reduce the cost of the PV system, the solar radiation intensity affects the amount of power output from the PV system. To ensure that the power output is sufficient in all different weather conditions, the solar radiation intensity of 78 W/m2 with 95% confidence interval was defined as a threshold of power output for the PV system according to the monitoring results in this study, and a step power output mode was used to utilize the solar energy as well as possible. The oxidation ditch driven by the PV system without storage battery ran during the day and stopped at night. Therefore, anaerobic, anoxic and aerobic conditions could periodically appear in the oxidation ditch, which was favorable to nitrogen and phosphate removal from the wastewater. The experimental results showed that the system was efficient, achieving average removal efficiencies of 88% COD, 98% NH4+-N, 70% TN and 83% TP, under the loading rates of 140 mg COD/(g MLSS x day), 32 mg NH4+-N/(g MLSS x day), 44 mg TN/(g MLSS x day) and 5 mg TP/(g MLSS x day).

  3. The advanced EctoSys electrolysis as an integral part of a ballast water treatment system.

    PubMed

    Echardt, J; Kornmueller, A

    2009-01-01

    A full-scale 500 m(3)/h ballast water treatment system was tested according to the landbased type approval procedure of the International Maritime Organization (IMO). The system consists of disc filters followed by the advanced EctoSys electrolysis as an integral part for disinfection. The test water quality exceeded by far the minimum requirements for type approval testing. Due to the properties of the special electrodes used together with the striking disinfection effect, the disinfectants assumed to be produced inline by the EctoSys cell in river water were hydroxyl radicals, while in brackish water additionally chlorine and consequently the more stable bromine were formed. In river water, no residual oxidants could be detected in accordance with the assumed production of not responding, highly-reactive and short-living hydroxyl radicals. Accordingly, disinfection byproduct (DBP) formation was very low and close to the limit of quantification in river water. While in brackish water, initial residual oxidant concentrations were maximum 2 mg/L as chlorine and mostly brominated DBP (especially bromoform and bromate) were found. Overall considering this worst case test approach, the DBP concentrations of the treated effluents were below or in the range of the WHO Drinking Water Guideline values and therefore evaluated as acceptable for discharge to the environment. The stringent discharge standard by IMO concerning viable organisms was fully met in river and brackish water, proving the disinfection efficiency of the EctoSys electrolysis against smaller plankton and bacteria.

  4. The relationship of scoring treatment and age in perceptual-integrative performance.

    PubMed

    Klodin, V M

    1976-07-01

    The present study was designed to reexamine the hypothesis that timed perceptual-integrative performance tests are negatively biased measures of the abilities of the elderly. Unlike an earlier study by Doppelt and Wallace (1955) which did not support this hypothesis, the current study consisted of a college-age group in addition to the elderly group, and also included an additional scoring treatment. Each subject was tested with the WAIS Block Design and Object Assembly. Tests were scored in three ways: (1) Standard scoring (WAIS Manual); (2) "regular" scoring (timed, omitting bonus points); (3) "Irregular" scoring (untimed, omitting bonus points). For both tests, Age, Scoring, and the Age by Scoring ineraction were significant. Post hoc analyses for significant effects suggest that the elderly are helped most by additional solution time, whereas younger adults derive greater benefits from the bonus points for quick performance. The results also suggest that subjects must be of sufficiently high ability to effectively use increased or unlimited solution time.

  5. [The Integrated Psychological Treatment (IPT) program in an ambulatory psychiatric context: a clinical study].

    PubMed

    Zanello, Adriano; Merlo, Marco

    2004-01-01

    Among the actual rehabilitation programs offered to patients with schizophrenic disorders, the IPT (Integrated Psychological Treatment) is one paradigm which combines cognitive and psychosocial strategies. A solid body of evidence, derived from controlled studies, indicates that IPT improves cognitive and social functioning and reduces symptoms severity. Nevertheless, little is known about its efficacy in routine clinical conditions. In this article, the authors address this issue. Our clinical experience with IPT in an ambulatory psychiatric service is presented. The results show that only few patients find useful to participate to all IPT strategies. Patients who refuse or accept to be enrolled in this rehabilitation program share the same demographic, clinical., symptoms and cognitive characteristics. After two years, the outcome of these two groups is similar when we consider the rate of readmissions, the number of hospitalisations, the length of stay and the number of suicides. These observations suggest that IPT strategies in clinical routine are probably less efficient than in well controlled studies. They also raise the question to define an individualised rehabilitation program that fits particular patients' needs.

  6. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey.

    PubMed

    D'Aunno, Thomas; Friedmann, Peter D; Chen, Qixuan; Wilson, Donna M

    2015-08-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system.

  7. Sewage treatment in integrated system of UASB reactor and duckweed pond and reuse for aquaculture.

    PubMed

    Mohapatra, D P; Ghangrekar, M M; Mitra, A; Brar, S K

    2012-06-01

    The performance of a laboratory-scale upflow anaerobic sludge blanket (UASB) reactor and a duckweed pond containing Lemna gibba was investigated for suitability for treating effluent for use in aquaculture. While treating low-strength sewage having a chemical oxygen demand (COD) of typically less than 200 mg/L, with an increase in hydraulic retention time (HRT) from 10.04 to 33.49 h, COD removal efficiency of the UASB reactor decreased owing to a decrease in organic loading rate (OLR) causing poor mixing in the reactor. However, even at the lower OLR (0.475 kg COD/(m3 x d)), the UASB reactor gave a removal efficiency of 68% for COD and 74% for biochemical oxygen demand (BOD). The maximum COD, BOD, ammonia-nitrogen and phosphate removal efficiencies of the duckweed pond were 40.77%, 38.01%, 61.87% and 88.57%, respectively. Decreasing the OLR by increasing the HRT resulted in an increase in efficiency of the duckweed pond for removal of ammonia-nitrogen and phosphate. The OLR of 0.005 kg COD/(m2 x d) and HRT of 108 h in the duckweed pond satisfied aquaculture quality requirements. A specific growth rate of 0.23% was observed for tilapia fish fed with duckweed harvested from the duckweed pond. The economic analysis proved that it was beneficial to use the integrated system of a UASB reactor and a duckweed pond for treatment of sewage.

  8. The design, construction, and operation of the Integrated Radwaste Treatment System (IRTS) Drum Cell

    SciTech Connect

    Landau, B.; Russillo, A.; Frank, D.; Garland, D.

    1989-12-01

    This report describes the design, construction, and the operation of the Integrated Radwaste Treatment Systems (IRTS) Drum Cell at the West Valley Demonstration Project (WVDP), West Valley, New York. The IRTS Drum Cell was designed to provide a shielded, secure storage area for the remote handling and placement of low-level Class C radioactive waste produced in the IRTS. The Drum Cell was designed to contain up to approximately 8,804 drums from decontaminated supernatant processing. This waste is to be poured into 0.27m{sup 3} in a temperature controlled environment to ensure the cement will not be subjected to freezing and thawing cycles. A Temporary Weather Structure (TWS), a pre-engineered building, now encloses the Drum Cell and associated equipment so that remote waste-handling and placement operations can continue without regard to weather conditions. The Drum Cell was designed so that this TWS could be removed and the low-level waste entombed in place. Final disposition of this low-level waste is currently being evaluated in an Environmental Impact Statement (EIS). 10 refs., 11 figs., 1 tab.

  9. Organizational Factors Influencing Implementation of Evidence-Based Practices for Integrated Treatment in Behavioral Health Agencies

    PubMed Central

    Bonham, Caroline A.; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A.

    2014-01-01

    Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities. PMID:24772411

  10. Integrated production of polyhydroxyalkanoates (PHAs) with municipal wastewater and sludge treatment at pilot scale.

    PubMed

    Morgan-Sagastume, F; Hjort, M; Cirne, D; Gérardin, F; Lacroix, S; Gaval, G; Karabegovic, L; Alexandersson, T; Johansson, P; Karlsson, A; Bengtsson, S; Arcos-Hernández, M V; Magnusson, P; Werker, A

    2015-04-01

    A pilot-scale process was operated over 22 months at the Brussels North Wastewater Treatment Plant (WWTP) in order to evaluate polyhydroxyalkanoate (PHA) production integration with services of municipal wastewater and sludge management. Activated sludge was produced with PHA accumulation potential (PAP) by applying feast-famine selection while treating the readily biodegradable COD from influent wastewater (average removals of 70% COD, 60% CODsol, 24% nitrogen, and 46% phosphorus). The biomass PAP was evaluated to be in excess of 0.4gPHA/gVSS. Batch fermentation of full-scale WWTP sludge at selected temperatures (35, 42 and 55 °C) produced centrate (6-9.4 gCODVFA/L) of consistent VFA composition, with optimal fermentation performance at 42 °C. Centrate was used to accumulate PHA up to 0.39 gPHA/gVSS. The centrate nutrients are a challenge to the accumulation process but producing a biomass with 0.5 gPHA/gVSS is considered to be realistically achievable within the typically available carbon flows at municipal waste management facilities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Treatment of municipal wastewater using a contact oxidation filtration separation integrated bioreactor.

    PubMed

    Li, Z H; Yang, K; Yang, X J; Li, L

    2010-05-01

    A new contact oxidation filtration separation integrated bioreactor (CFBR) was used to treat municipal wastewater. The CFBR was made up of a biofilm reactor (the upper part of the CFBR) and a gravitational filtration bed (the lower part of the CFBR). Polyacrylonitrile balls (50mm diameter, 237 m(2)/m(3) specific surface, 90% porosity, and 50.2% packing rate) were filled into the biofilm reactor as biofilm attaching materials and anthracite coal (particle size 1-2mm, packing density 0.947 g/cm(3), non-uniform coefficient (K(80)=d(80)/d(10))<2.0) was placed into the gravitational filtration bed as filter media. At an organic volumetric loading rate of 2.4 kg COD/(m(3)d) and an initial filtration velocity of 5m/h in the CFBR, the average removal efficiencies of COD, ammonia nitrogen, total nitrogen and turbidity were 90.6%, 81.4%, 64.6% and 96.7% respectively, but the treatment process seemed not to be effective in phosphorus removal. The average removal efficiency of total phosphorus was 60.1%. Additionally, the power consumption of the CFBR was less than 0.15 kWh/m(3) of wastewater treated, and less than 1.5 kWh/kg BOD(5) removal. Copyright 2010 Elsevier Ltd. All rights reserved.

  12. An integrated genomic approach to the assessment and treatment of acute myeloid leukemia.

    PubMed

    Godley, Lucy A; Cunningham, John; Dolan, M Eileen; Huang, R Stephanie; Gurbuxani, Sandeep; McNerney, Megan E; Larson, Richard A; Leong, Hoyee; Lussier, Yves; Onel, Kenan; Odenike, Olatoyosi; Stock, Wendy; White, Kevin P; Le Beau, Michelle M

    2011-04-01

    Traditionally, new scientific advances have been applied quickly to the leukemias based on the ease with which relatively pure samples of malignant cells can be obtained. Currently, our arsenal of approaches used to characterize an individual's acute myeloid leukemia (AML) combines hematopathologic evaluation, flow cytometry, cytogenetic analysis, and molecular studies focused on a few key genes. The advent of high-throughput methods capable of full-genome evaluation presents new options for a revolutionary change in the way we diagnose, characterize, and treat AML. Next-generation DNA sequencing techniques allow full sequencing of a cancer genome or transcriptome, with the hope that this will be affordable for routine clinical care within the decade. Microarray-based testing will define gene and miRNA expression, DNA methylation patterns, chromosomal imbalances, and predisposition to disease and chemosensitivity. The vision for the future entails an integrated and automated approach to these analyses, bringing the possibility of formulating an individualized treatment plan within days of a patient's initial presentation. With these expectations comes the hope that such an approach will lead to decreased toxicities and prolonged survival for patients.

  13. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

    PubMed Central

    D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

    2016-01-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

  14. Integrating composting and vermicomposting in the treatment and bioconversion of biosolids.

    PubMed

    Ndegwa, P M; Thompson, S A

    2001-01-01

    Traditional thermophilic composting is commonly adopted for treatment of organic wastes or for production of organic/natural fertilizers. A related technique, called vermicomposting (using earthworms to breakdown the organic wastes) is also becoming popular. These two techniques have their inherent advantages and disadvantages. The integrated approach suggested in this study borrows pertinent attributes from each of these two processes and combines them to enhance the overall process and improve the products qualities. Two approaches investigated in this study are: (1) pre-composting followed by vermicomposting, and (2) pre-vermicomposting followed by composting. The substrate was biosolids (activated sewage sludge) with mixed paper-mulch as the carbon base. Eisenia fetida (red wigglers) was the species of earthworms used in the vermicomposting processes. The results indicate that, a system that combines the two processes not only shortens stabilization time, but also improves the products quality. Combining the two systems resulted in a product that was more stable and consistent (homogenous), had less potential impact on the environment and for compost-vermicomposting (CV) system, the product met the pathogen reduction requirements.

  15. An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

    PubMed Central

    2012-01-01

    Background The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS) hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model. Discussion The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1) Working with an initial model 2) Unfolding the different treatment philosophies 3) Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme) 4) Phrasing the common assumptions for an integrative MS program theory 5) Developing the integrative MS program theory 6) Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment. Summary An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level. PMID:22524586

  16. A Preliminary Study in Applying the Function-Based Intervention Decision Model in Consultation to Increase Treatment Integrity

    ERIC Educational Resources Information Center

    Gann, Candace J.; Kunnavatana, S. Shanun

    2016-01-01

    This preliminary study investigated the use of the Function-Based Intervention Decision Model (Decision Model; Umbreit, Ferro, Liaupsin, & Lane, 2007) to improve teacher treatment integrity for a function-based classroom management plan. The participants were a special education teacher and three elementary-age students receiving special…

  17. Integrative and Biopsychosocial Therapy: Maximizing Treatment Outcomes with Individuals and Couples. The Family Psychology and Counseling Series.

    ERIC Educational Resources Information Center

    Sperry, Len, Ed.

    In the current therapeutic climate it is essential for mental health professionals to address biological and health issues along with social and psychological issues in their care delivery. The increasing economic and professional need for integrative treatment has necessitated the trend toward biopsychosocial approaches to maximize treatment…

  18. Errors of Omission and Commission during Alternative Reinforcement of Compliance: The Effects of Varying Levels of Treatment Integrity

    ERIC Educational Resources Information Center

    Leon, Yanerys; Wilder, David A.; Majdalany, Lina; Myers, Kristin; Saini, Valdeep

    2014-01-01

    We conducted two experiments to evaluate the effects of errors of omission and commission during alternative reinforcement of compliance in young children. In Experiment 1, we evaluated errors of omission by examining two levels of integrity during alternative reinforcement (20 and 60%) for child compliance following no treatment (baseline) versus…

  19. The Effects of Self-Monitoring and Performance Feedback on the Treatment Integrity of Behavior Intervention Plan Implementation and Generalization

    ERIC Educational Resources Information Center

    Mouzakitis, Angela; Codding, Robin S.; Tryon, Georgiana

    2015-01-01

    Accurate implementation of individualized behavior intervention plans (BIPs) is a critical aspect of evidence-based practice. Research demonstrates that neither training nor consultation is sufficient to improve and maintain high rates of treatment integrity (TI). Therefore, evaluation of ongoing support strategies is needed. The purpose of this…

  20. Errors of Omission and Commission during Alternative Reinforcement of Compliance: The Effects of Varying Levels of Treatment Integrity

    ERIC Educational Resources Information Center

    Leon, Yanerys; Wilder, David A.; Majdalany, Lina; Myers, Kristin; Saini, Valdeep

    2014-01-01

    We conducted two experiments to evaluate the effects of errors of omission and commission during alternative reinforcement of compliance in young children. In Experiment 1, we evaluated errors of omission by examining two levels of integrity during alternative reinforcement (20 and 60%) for child compliance following no treatment (baseline) versus…

  1. The Effects of Self-Monitoring and Performance Feedback on the Treatment Integrity of Behavior Intervention Plan Implementation and Generalization

    ERIC Educational Resources Information Center

    Mouzakitis, Angela; Codding, Robin S.; Tryon, Georgiana

    2015-01-01

    Accurate implementation of individualized behavior intervention plans (BIPs) is a critical aspect of evidence-based practice. Research demonstrates that neither training nor consultation is sufficient to improve and maintain high rates of treatment integrity (TI). Therefore, evaluation of ongoing support strategies is needed. The purpose of this…

  2. Family Assessment/Treatment/Evaluation Methods Integrated for Helping Teen Suicide Attempters/Families in Short Term Psychiatric Hospitalization Programs.

    ERIC Educational Resources Information Center

    Shepard, Suzanne

    The assessment process can be integrated with treatment and evaluation for helping teenage suicide attempters and families in short term psychiatric hospitalization programs. The method is an extremely efficient way for the therapist to work within a given time constraint. During family assessment sufficient information can be gathered to…

  3. A Preliminary Study in Applying the Function-Based Intervention Decision Model in Consultation to Increase Treatment Integrity

    ERIC Educational Resources Information Center

    Gann, Candace J.; Kunnavatana, S. Shanun

    2016-01-01

    This preliminary study investigated the use of the Function-Based Intervention Decision Model (Decision Model; Umbreit, Ferro, Liaupsin, & Lane, 2007) to improve teacher treatment integrity for a function-based classroom management plan. The participants were a special education teacher and three elementary-age students receiving special…

  4. How to integrate the good lives model into treatment programs for sexual offending: an introduction and overview.

    PubMed

    Willis, Gwenda M; Yates, Pamela M; Gannon, Theresa A; Ward, Tony

    2013-04-01

    The good lives model (GLM) represents a new theoretical framework informing sex offender treatment programs; however, substantial variation has been observed in terms of how GLM-related ideas and practices have been applied. Integrated appropriately, the GLM offers potential for improving outcomes of programs following a cognitive-behavioral therapy (CBT) approach and operating according to a narrow operationalization of risk, need, responsivity (RNR) principles. Conversely, misguided or otherwise poor integration could increase the very risk practitioners work to prevent and manage. The purpose of this article is to provide an introduction and overview on how to integrate the GLM into treatment using CBT and RNR. The authors describe clinical implications of the GLM as they relate to program aims and orientation, assessment and intervention planning, content, and delivery.

  5. Culturally informed and flexible family-based treatment for adolescents: a tailored and integrative treatment for Hispanic youth.

    PubMed

    Santisteban, Daniel A; Mena, Maite P

    2009-06-01

    The increasing utilization of evidence-based treatments has highlighted the need for treatment development efforts that can craft interventions that are effective with Hispanic substance abusing youth and their families. The list of evidence-based treatments is extremely limited in its inclusion of interventions that are explicitly responsive to the unique characteristics and treatment needs of young Hispanics and that have been rigorously tested with this population. Some treatments that have been tested with Hispanics do not articulate the manner in which cultural characteristics and therapy processes interact. Other treatments have emphasized the important role of culture but have not been tested rigorously. The value of well designed interventions built upon an appreciation for unique patient characteristics was highlighted by Beutler et al. (1996) when they argued that "psychotherapy is comprised of a set of complex tasks, and practitioners need comprehensive knowledge of how different processes used in psychotherapy interact with patient characteristics in order to make treatment decisions that will maximize and optimize therapeutic power" (p. 30). A focus on how treatment processes interact with patient characteristics is particularly relevant in the Hispanic population because of the considerable heterogeneity beneath the Hispanic umbrella. Our new program of clinical research focuses on articulating how the varied profiles with regard to immigration stressors, acculturation processes, values clashes, sense of belonging to the community, discrimination, and knowledge about issues important to adolescent health can be more effectively addressed by a culturally informed treatment.

  6. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

    PubMed

    Greenlee, Heather; DuPont-Reyes, Melissa J; Balneaves, Lynda G; Carlson, Linda E; Cohen, Misha R; Deng, Gary; Johnson, Jillian A; Mumber, Matthew; Seely, Dugald; Zick, Suzanna M; Boyce, Lindsay M; Tripathy, Debu

    2017-05-06

    Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society. © 2017 American Cancer Society.

  7. Advanced treatment of biologically pretreated coal gasification wastewater by a novel integration of heterogeneous catalytic ozonation and biological process.

    PubMed

    Zhuang, Haifeng; Han, Hongjun; Jia, Shengyong; Hou, Baolin; Zhao, Qian

    2014-08-01

    Advanced treatment of biologically pretreated coal gasification wastewater (CGW) was investigated employing heterogeneous catalytic ozonation integrated with anoxic moving bed biofilm reactor (ANMBBR) and biological aerated filter (BAF) process. The results indicated that catalytic ozonation with the prepared catalyst (i.e. MnOx/SBAC, sewage sludge was converted into sludge based activated carbon (SBAC) which loaded manganese oxides) significantly enhanced performance of pollutants removal by generated hydroxyl radicals. The effluent of catalytic ozonation process was more biodegradable and less toxic than that in ozonation alone. Meanwhile, ANMBBR-BAF showed efficient capacity of pollutants removal in treatment of the effluent of catalytic ozonation at a shorter reaction time, allowing the discharge limits to be met. Therefore, the integrated process with efficient, economical and sustainable advantages was suitable for advanced treatment of real biologically pretreated CGW. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Culturally Informed and Flexible Family-Based Treatment for Adolescents: A Tailored and Integrative Treatment for Hispanic Youth

    PubMed Central

    Santisteban, Daniel; Mena, Maite P.

    2009-01-01

    The increasing utilization of evidence-based treatments has highlighted the need for interventions that are effective with Hispanic substance abusing youth and families. The list of evidence-based treatments is limited in its inclusion of interventions that are responsive to the unique characteristics and treatment needs of young Hispanics and that have been tested with this population. Some treatments that have been tested with Hispanics do not articulate the manner in which cultural characteristics and therapy processes interact. Other treatments have emphasized the important role of culture but have not been tested rigorously. The value of well designed interventions built upon an appreciation for unique patient characteristics was highlighted by Beutler et al.,1996 when they argued that “psychotherapy is comprised of a set of complex tasks, and practitioners need comprehensive knowledge of how different processes used in psychotherapy interact with patient characteristics in order to make treatment decisions that will maximize and optimize therapeutic power” (page 30). A focus on how treatment processes interact with patient characteristics is particularly relevant in the Hispanic population because of the considerable heterogeneity beneath the Hispanic umbrella. Our new program of clinical research focuses on articulating how the varied profiles with regard to immigration stressors, acculturation processes, values clashes, sense of belonging to the community, discrimination, and knowledge about issues important to adolescent health, can be more effectively addressed by a culturally informed treatment. PMID:19579908

  9. [Integration of drug therapy and psychotherapy concepts in treatment of depression].

    PubMed

    Scholz, H; Schautzer, F

    1998-01-01

    The treatment of depressive disorders comprises an adequate pharmacological as well as psychotherapeutical intervention. The following article will demonstrate pragmatic treatment steps and corresponding problems in relation to the time context of the disorder as well as the treatment (1. Initial contact 2. First control, 3. Intermediate treatment phase. 4. Treatment termination). Without introducing innovative treatment techniques, basic biological assumptions as well as psychological aspects of depressive disorders are combined in a pragmatic way. Furthermore, new developments in psychopharmacology are taken into regard.

  10. Institutional profile: integrated center for research and treatment of vertigo, balance and ocular motor disorders.

    PubMed

    Brandt, Thomas; Zwergal, Andreas; Jahn, Klaus; Strupp, Michael

    2010-01-01

    In 2009 the German BMBF (German Ministry of Education and Research) established an Integrated Center for Research and Treatment (IFB(LMU)) of Vertigo, Balance and Ocular Motor Disorders in Munich. After the 10-year period of funding by the BMBF, it is envisioned that the (IFB(LMU)) will continue over the long term with the joint support of the University Hospital, the Medical Faculty, and the Bavarian State. Vertigo is one of the most common complaints in medicine. Despite its high prevalence, patients with vertigo generally receive either inappropriate or inadequate treatment. This deplorable situation is internationally well known and its causes are multiple: insufficient interdisciplinary cooperation, no standardized diagnostics and therapy, the failure to translate findings of basic science into clinical applications, and the scarcity of clinical multicenter studies. The (IFB(LMU)) will constitute a suitable tool with which these structural, clinical, and scientific deficits can be overcome. It will also make possible the establishment of an international interdisciplinary referral center. Munich has become the site of a unique concentration of leading experts on vertigo, balance and ocular motor disorders, both in the clinical and basic sciences. Academic structures have paved the way for the creation of an interdisciplinary horizontal network that also allows structured, vertical academic career paths via the Bachelor's and Master's degree programs in Neuroscience, a Graduate School of Systemic Neurosciences, and the Munich Center for Neurosciences - Brain and Mind. The (IFB(LMU)) has the following objectives as regards structure and content: to create an independent patient-oriented clinical research center under the auspices of the Medical Faculty but with autonomous administration and budget; to overcome existing clinical and academic barriers separating the traditional specializations; to establish a standardized interdisciplinary longitudinal and

  11. [Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders].

    PubMed

    Brandt, T; Zwergal, A; Jahn, K; Strupp, M

    2009-08-01

    The German BMBF (German Ministry of Education and Research) has decided to establish an Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders (IFB(LMU)) in Munich in 2010. After funding over a 10-year period, the long-term continuation of the IFB(LMU) by the medical faculty and the hospital is envisioned. Vertigo is one of the most common complaints in medicine. Despite its high prevalence patients with vertigo generally receive either inappropriate or inadequate treatment. This deplorable situation is internationally well known and its causes are multiple: insufficient interdisciplinary cooperation, no standardized diagnostics and therapy, the failure to translate findings of basic science into clinical applications and the scarcity of clinical multicenter studies. The IFB(LMU) will constitute a suitable tool with which these structural, clinical, and scientific deficits can be overcome. It will also make possible the establishment of an international interdisciplinary referral center. Munich has become the site of a unique concentration of leading experts on vertigo, balance and ocular motor disorders, both in the clinical and basic sciences. Academic structures have paved the way for the creation of an interdisciplinary horizontal network that also allows structured, vertical academic career paths via the Bachelor's and Master's degree programs in neuroscience, a Graduate School of Systemic Neurosciences, and the Munich Center for Neuroscience "Brain and Mind". The IFB(LMU) has the following objectives with regard to structure and content: to create an independent patient-oriented clinical research center under the auspices of the Medical Faculty but with autonomic administration and budget; to overcome existing clinical and academic barriers separating the traditional specializations, to establish a standardized interdisciplinary longitudinal and transversal network at one site for the management of patients. This should

  12. Integration of an innovative biological treatment with physical or chemical disinfection for wastewater reuse.

    PubMed

    De Sanctis, Marco; Del Moro, Guido; Levantesi, Caterina; Luprano, Maria Laura; Di Iaconi, Claudio

    2016-02-01

    In the present paper, the effectiveness of a Sequencing Batch Biofilter Granular Reactor (SBBGR) and its integration with different disinfection strategies (UV irradiation, peracetic acid) for producing an effluent suitable for agricultural use was evaluated. The plant treated raw domestic sewage, and its performances were evaluated in terms of the removal efficiency of a wide group of physical, chemical and microbiological parameters. The SBBGR resulted really efficient in removing suspended solids, COD and nitrogen with an average effluent concentration of 5, 32 and 10 mg/L, respectively. Lower removal efficiency was observed for phosphorus with an average concentration in the effluent of 3 mg/L. Plant effluent was also characterized by an average electrical conductivity and sodium adsorption ratio of 680 μS/cm and 2.9, respectively. Therefore, according to these gross parameters, the SBBGR effluent was conformed to the national standards required in Italy for agricultural reuse. Moreover, disinfection performances of the SBBGR was higher than that of conventional municipal wastewater treatment plants and met the quality criteria suggested by WHO (Escherichia coli<1000 CFU/100 mL) for agricultural reuse. In particular, the biological treatment by SBBGR removed 3.8±0.4 log units of Giardia lamblia, 2.8±0.8 log units of E. coli, 2.5±0.7 log units of total coliforms, 2.0±0.3 log units of Clostridium perfringens, 2.0±0.4 log units of Cryptosporidium parvum and 1.7±0.7 log units of Somatic coliphages. The investigated disinfection processes (UV and peracetic acid) resulted very effective for total coliforms, E. coli and somatic coliphages. In particular, a UV radiation and peracetic acid doses of 40 mJ/cm(2) and 1 mg/L respectively reduced E. coli content in the effluent below the limit for agricultural reuse in Italy (10 CFU/100 mL). Conversely, they were both ineffective on C.perfringens spores.

  13. Process engineering design of pathological waste incinerator with an integrated combustion gases treatment unit.

    PubMed

    Shaaban, A F

    2007-06-25

    Management of medical wastes generated at different hospitals in Egypt is considered a highly serious problem. The sources and quantities of regulated medical wastes have been thoroughly surveyed and estimated (75t/day from governmental hospitals in Cairo). From the collected data it was concluded that the most appropriate incinerator capacity is 150kg/h. The objective of this work is to develop the process engineering design of an integrated unit, which is technically and economically capable for incinerating medical wastes and treatment of combustion gases. Such unit consists of (i) an incineration unit (INC-1) having an operating temperature of 1100 degrees C at 300% excess air, (ii) combustion-gases cooler (HE-1) generating 35m(3)/h hot water at 75 degrees C, (iii) dust filter (DF-1) capable of reducing particulates to 10-20mg/Nm(3), (iv) gas scrubbers (GS-1,2) for removing acidic gases, (v) a multi-tube fixed bed catalytic converter (CC-1) to maintain the level of dioxins and furans below 0.1ng/Nm(3), and (vi) an induced-draft suction fan system (SF-1) that can handle 6500Nm(3)/h at 250 degrees C. The residence time of combustion gases in the ignition, mixing and combustion chambers was found to be 2s, 0.25s and 0.75s, respectively. This will ensure both thorough homogenization of combustion gases and complete destruction of harmful constituents of the refuse. The adequate engineering design of individual process equipment results in competitive fixed and operating investments. The incineration unit has proved its high operating efficiency through the measurements of different pollutant-levels vented to the open atmosphere, which was found to be in conformity with the maximum allowable limits as specified in the law number 4/1994 issued by the Egyptian Environmental Affairs Agency (EEAA) and the European standards.

  14. Fixed capital investments for the uranium soils integrated demonstration soil treatment technologies

    SciTech Connect

    Douthat, D.M.; Armstrong, A.Q.; Stewart, R.N.

    1995-05-01

    The development of a nuclear industry in the United States required mining, milling, and fabricating a large variety of uranium products. One of these products was purified uranium metal which was used in the Savannah River and Hanford Site reactors. Most of this feed material was produced at the United States Department of Energy (DOE) facility formerly called the Feed Materials Production Center at Fernald, Ohio. During operation of this facility, soils became contaminated with uranium from a variety of sources. To address remediation and management of uranium-contaminated soils at sites owned by DOE, the Uranium Soils Integrated Demonstration (USID) Program was formed to evaluate and compare the versatility, efficiency, and economics of various technologies that may be combined into systems designed to characterize and remediate uranium contaminated soils. The USID Program has five major tasks in developing and demonstrating these technologies. Each must be able to (1) characterize the uranium in soil, (2) decontaminate or remove uranium from soil, (3) treat or dispose of resulting waste streams, (4) meet necessary state and federal regulations, and (5) meet performance assessment objectives. The role of the performance assessment objectives is to provide the information necessary to conduct evaluations of the technologies. These performance assessments provide the basis for selecting the optimum system for remediation of large areas contaminated with uranium. One of the performance assessment tasks is to address the economics of full-scale implementation of soil treatment technologies developed by the USID Program. The cost of treating contaminated soil is one of the criteria used in the decision-making process for selecting remedial alternatives.

  15. Construction of an integrated surgical suite in a military treatment facility.

    PubMed

    Acevedo, Anibal L

    2009-01-01

    The OR has long existed as a highly specialized and distinct entity within a hospital. Recent technological advances have allowed the OR to be seamlessly integrated with the larger hospital and, in a virtual sense, with the world. The modern, integrated OR can enhance patients' surgical experiences, improve surgeons' control of OR technology, and increase OR efficiency by reducing surgical times. The Naval Medical Center in San Diego, California, is one of the first military health care systems in the southwest to build a fully integrated, voice-controlled OR. The renovation project transformed 12 ORs into fully integrated surgical suites.

  16. Performance evaluation of a full-scale coke oven wastewater treatment plant in an integrated steel plant.

    PubMed

    Kumar, M Suresh; Vaidya, A N; Shivaraman, N; Bal, A S

    2003-01-01

    Wastewater generated during coke-oven gas cleaning operations in the integrated steel plant contains phenol, cyanide, thiocyanate, and also oil and grease. Although the activated sludge process is widely practiced for biological treatment of coke-oven wastewater, it was observed during the evaluation of performance of full scale coke-oven wastewater treatment plant that oil contamination and poor sludge settleability had resulted in poor maintenance of the activated sludge process. Keeping these aspects in view, treatability studies were conducted and an alternative treatment process is proposed. With these corrective measures the coke-oven wastewater treatment plant will give desired performance. In this paper we present results of the performance evaluation, data on treatability studies and alternative treatment process scheme.

  17. Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives

    PubMed Central

    Drožđek, Boris

    2015-01-01

    Background Research shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions. Objective To draw clinicians’ attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma. Method Based on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed. Results The Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments. Conclusion The field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and

  18. Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

    PubMed Central

    Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

    2015-01-01

    Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

  19. Integration of biotechnological wastewater treatment units in textile finishing factories: from end of the pipe solutions to combined production and wastewater treatment units.

    PubMed

    Feitkenhauer, H; Meyer, U

    2001-08-23

    Increasing costs for water, wastewater and energy put pressure on textile finishing plants to increase the efficiency of wet processing. An improved water management can decrease the use of these resources and is a prerequisite for the integration of an efficient, anaerobic on-site pretreatment of effluents that will further cut wastewater costs. A two-phase anaerobic treatment is proposed, and successful laboratory experiments with model effluents from the cotton finishing industry are reported. The chemical oxygen demand of this wastewater was reduced by over 88% at retention times of 1 day or longer. The next step to boost the efficiency is to combine the production and wastewater treatment. The example of cotton fabric desizing (removing size from the fabric) illustrates how this final step of integration uses the acidic phase bioreactor as a part of the production and allows to close the water cycle of the system.

  20. Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients - a pragmatic randomized controlled trial

    PubMed Central

    2013-01-01

    Background To evaluate and compare effects of an integrative treatment (IT), therapeutic acupuncture (TA), and conventional treatment (CT) in alleviating symptoms of anxiety and depression in psychologically distressed primary care patients. Methods An open, pragmatic randomized controlled trial comparing the three treatment regimens at four and eight weeks after treatment. The study sample consisted of 120 adults (40 per treatment arm) aged 20 to 55 years referred from four different primary health care centres in western Sweden for psychological distress. Psychological distress was evaluated at baseline, and after 4 and 8 weeks of treatment using the Hospital Anxiety and Depression scale (HAD). Treatment sessions lasted about 60 minutes in IT and 45 minutes in TA. Results No baseline differences were found between groups on HAD depression or anxiety. HAD anxiety and depression decreased significantly more in the IT and TA groups than in the CT group both after 4 and 8 weeks of treatment, but not between IT and TA. Improvements in the TA and IT groups were large and clinically significant, whereas CT effects were small and clinically non-significant. Conclusions Both IT and TA appear to be beneficial in reducing anxiety and depression in primary care patients referred for psychological distress, whereas CT does not. These results need to be confirmed in larger, longer-term studies addressing potentially confounding design issues in the present study. Trial registration ISRCTN trial number NCT01631500. PMID:24200100