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Sample records for objective structured clinical

  1. Objective Structured Clinical Examination (OSCE) Revisited.

    PubMed

    Gupta, Piyush; Dewan, Pooja; Singh, Tejinder

    2010-11-01

    Objective structured clinical examination (OSCE) was introduced in 1975 as a standardized tool for objectively assessing clinical competencies - including history-taking, physical examination, communication skills, data interpretation etc. It consists of a circuit of stations connected in series, with each station devoted to assessment of a particular competency using pre-determined guidelines or checklists. OSCE has been used as a tool for both formative and summative evaluation of medical graduate and postgraduate students across the globe. The use of OSCE for formative assessment has great potential as the learners can gain insights into the elements making up clinical competencies as well as feedback on personal strengths and weaknesses. However, the success of OSCE is dependent on adequacy of resources, including the number of stations, construction of stations, method of scoring (checklists and or global scoring), the number of students assessed, and adequate time and money. Lately, OSCE has drawn some criticism for its lack of validity, feasibility, practicality, and objectivity. There is evidence to show that many OSCEs may be too short to achieve reliable results. There are also currently no clear cut standards set for passing an OSCE. It is perceived that OSCEs test the students knowledge and skills in a compartmentalized fashion, rather than looking at the patient as a whole. This article focuses on the issues of validity, objectivity, reliability, and standard setting of OSCE. Presently, the Indian experiences with OSCE are limited and there is a need to sensitise the Indian faculty and students. A cautious approach is desired before it is considered as a supplementary tool to other methods of assessment for the summative examinations in Indian settings.

  2. Effects of test stress during an objective structured clinical examination

    PubMed Central

    Zhang, Niu; Rabatsky, Ali

    2015-01-01

    Objective The existence of test stress has been widely reported among professional students. To our knowledge, no studies exist that explore student stress response to objective structured clinical examinations. The aim of this study was to evaluate possible correlations between stress and objective structured clinical examination performance in a sample of chiropractic students. Methods A total of 116 students completed a 2-part questionnaire to assess test stress and the physiological symptoms and signs of stress. Heart rate, systolic blood pressure, and diastolic were measured during the physical examination laboratory class within the first 3 weeks and then again just prior to their objective structured clinical examination in week 5. Statistical tests were then performed for questionnaire data, heart rate and blood pressure differences, and correlation between the objective structured clinical examination grade and symptoms and signs. Results Questionnaire results showed that 5.1%–22.4% of students sometimes or often felt a certain degree of stress. More than 50% had 1 or more physiological symptoms and signs of stress. The objective structured clinical examination heart rate (75.23 ± 11.20 vs 68.16 ± 8.82, p < .001), systolic blood pressure (120.43 ± 9.59 vs 114.97 ± 11.83, p < .001), and diastolic blood pressure (73.00 ± 7.93 vs 69.32 ± 7.76, p < .001) were significantly higher than baseline. There were also negative linear correlations between objective structured clinical examination grades and physiological symptoms and signs and between objective structured clinical examination grades and feeling statement score. Conclusion The results support our hypothesis that chiropractic students experience stress when performing the objective structured clinical examination and that high levels of stress had a negative impact on performance. PMID:25806413

  3. Objective structured clinical examination (OSCE) in pharmacy education - a trend

    PubMed Central

    Shirwaikar, Annie

    2015-01-01

    Pharmacy education has undergone a radical change as it evolves towards becoming a more patient oriented profession. With a greater emphasis on problem based teaching and competency, the Objective Structured Clinical Examination (OSCE), supported by its reliability and validity became the gold standard for the evaluation of clinical skills of undergraduate students of medicine and pharmacy worldwide. Core competency evaluation has become a mandatory and critical norm for accountability of educational objectives as the traditional testing tools cannot evaluate clinical competence. Interpersonal and communication skills, professional judgment, skills of resolution etc., may be best assessed through a well- structured OSCE in comparison to oral examinations, multiple choice tests and other methods of assessment. Though OSCEs as an objective method of evaluation offer several advantages to both students and teachers, it also has disadvantages and pitfalls in implementation. This article reviews the OSCE as a trend in pharmacy education. PMID:26759616

  4. Developing a successful nursing Objective Structured Clinical Examination.

    PubMed

    McWilliam, Paula; Botwinski, Carol

    2010-01-01

    The evaluation of nursing students' clinical competencies is essential to the educational process. The Objective Structured Clinical Examination (OSCE) program was designed to assess students in a variety of health topics that may not be experienced during the assigned clinical rotation. Building on prior work, the purpose of this study was to examine specific aspects of the nursing OSCE toward developing a reliable and valid tool for evaluating selected students' clinical competencies.The following areas were investigated using an assessment design: the development of case scenarios and updates, the role and training of the standardized patient, and students' perceptions of the nursing OSCE experience. Recommendations are made for the variety of case scenarios, frequency of updates, methods by which standardized patients should be trained, remediation, and program requirements. Students were overwhelmingly favorable to perceived benefits of participation in OSCEs during their nursing education.

  5. Designing and implementing the objective structured clinical examination in anesthesiology.

    PubMed

    Hastie, Maya Jalbout; Spellman, Jessica L; Pagano, Parwane P; Hastie, Jonathan; Egan, Brian J

    2014-01-01

    Since its description in 1974, the Objective Structured Clinical Examination (OSCE) has gained popularity as an objective assessment tool of medical students, residents, and trainees. With the development of the anesthesiology residents' milestones and the preparation for the Next Accreditation System, there is an increased interest in OSCE as an evaluation tool of the six core competencies and the corresponding milestones proposed by the Accreditation Council for Graduate Medical Education.In this article the authors review the history of OSCE and its current application in medical education and in different medical and surgical specialties. They also review the use of OSCE by anesthesiology programs and certification boards in the United States and internationally. In addition, they discuss the psychometrics of test design and implementation with emphasis on reliability and validity measures as they relate to OSCE.

  6. Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations

    PubMed Central

    Austin, Zubin; Gregory, Paul; Tabak, Diana

    2006-01-01

    Objectives To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of “standardized patient” and “simulated patient” educational methodologies. Design The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course. Assessment Overall, students responded positively to the shift from “standardized” patients to “simulated” patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice. Conclusions Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs. PMID:17149448

  7. Examiners' perceptions of the objective structured clinical examination in colposcopy.

    PubMed

    Qureshi, N S

    2013-02-01

    Certification in Colposcopy by the British Society for Colposcopy and Cervical Pathology (BSCCP) and the Royal College of Obstetricians and Gynaecologists is a formal pre- requisite to the practice of colposcopy within the UK. This certification is awarded after passing an Objective Structured Clinical Examination (OSCE). The aim of the project is to explore examiners' perceptions of the OSCE examination in colposcopy and consider whether it is the right tool to differentiate between safe and unsafe practice in colposcopy. A case study research methodology was employed for the project, and questionnaires were sent to 30 examiners for OSCE in Colposcopy. The project also included conducting semi-structured interviews with two examiners, two trainees and a senior manager of the BSCCP. The questionnaire had a response rate of 28 (94%). The satisfaction rate among the examiners about the standard of questions in OSCE in Colposcopy was 93%, and 89% of the examiners would allow a candidate passing the examination to carry out a clinic in their absence. A total of 26 (94%) examiners thought that the examination was fit for purpose. It was suggested that testing of practical skills should also be made part of the examination. It seems OSCE in Colposcopy is perceived well both by the examiners and the candidates.

  8. Use of computer technology to modify objective structured clinical examinations.

    PubMed

    Holyfield, Lavern J; Bolin, Kenneth A; Rankin, Kathleen V; Shulman, Jay D; Jones, Daniel L; Eden, Becky DeSpain

    2005-10-01

    Objective structured clinical examinations (OSCEs) are multistationed clinical examinations that have been shown to be effective in testing students' ability to integrate the knowledge, skills, and attitudes acquired during their preclinical and clinical training and experiences. The original OSCE for the third-year Preventive Dentistry course at Baylor College of Dentistry was based on the traditional format consisting of four sections of twelve stations with a group of twelve students rotating through each of the sections simultaneously. This arrangement allowed for examination of one-half of the class. The other half of the class took the exam on an alternate date. To reduce the disruption caused by the students' moving from station to station and to allow for examination of the entire class in one setting, the traditional concept was modified using computer technology, and the twelve stations "moved" via a PowerPoint presentation while students remained stationary. Questions on both exams provided a means for testing data interpretation, diagnostic skills, and, to some extent, interpersonal skills. The overall atmosphere during the computer-based examination was less chaotic. Each student received identical instructions, explanations, and time allotments to respond to the information presented. The ratio of faculty to students required to monitor the exam was less than required for the traditional format. Additionally, since there was no need to allow time for student transition, the total time required to administer the exam was reduced. Thus, objective assessment of the entire class was accomplished using fewer faculty members and less class time and with less disruption for the students.

  9. Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations

    PubMed Central

    2017-01-01

    Objective. To evaluate whether a relationship exists between the degree of student state-anxiety and pass rates on moderate-to-high stakes objective structured clinical examinations (OSCE). Methods. Third-professional year (P3) students were assessed using the Speilberger State-Trait Anxiety Index (STAI) three weeks prior to their first moderate-to-high stakes OSCEs. Students’ OSCE station pass rates, individual station analytical scores, and the overall pass rate for the class were compared with student responses on STAI surveys to measure their association. Results. Seventy-three students (100%) provided consent to participate in the research; 64 (87%) sufficiently completed the STAI survey. Degree of student state-anxiety or train-anxiety was not associated with any of the outcomes assessed in this study. Overall pass rate, individual station pass rates, and station analytical checklist scores were not inversely correlated with state- or trait-anxiety scores. Conclusions. Efforts to assist students in OSCE performance should focus on means other than reducing associated anxiety. Future research in this area should focus on what interventions beyond instruction could be put in place to help students be more successful during OSCEs. PMID:28289297

  10. Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations.

    PubMed

    Longyhore, Daniel S

    2017-02-25

    Objective. To evaluate whether a relationship exists between the degree of student state-anxiety and pass rates on moderate-to-high stakes objective structured clinical examinations (OSCE). Methods. Third-professional year (P3) students were assessed using the Speilberger State-Trait Anxiety Index (STAI) three weeks prior to their first moderate-to-high stakes OSCEs. Students' OSCE station pass rates, individual station analytical scores, and the overall pass rate for the class were compared with student responses on STAI surveys to measure their association. Results. Seventy-three students (100%) provided consent to participate in the research; 64 (87%) sufficiently completed the STAI survey. Degree of student state-anxiety or train-anxiety was not associated with any of the outcomes assessed in this study. Overall pass rate, individual station pass rates, and station analytical checklist scores were not inversely correlated with state- or trait-anxiety scores. Conclusions. Efforts to assist students in OSCE performance should focus on means other than reducing associated anxiety. Future research in this area should focus on what interventions beyond instruction could be put in place to help students be more successful during OSCEs.

  11. Do Clinical Clerks Provide Candidates with Adequate Formative Assessment during Objective Structured Clinical Examinations?

    ERIC Educational Resources Information Center

    Reiter, Harold I.; Rosenfeld, Jack; Nandagopal, Kiruthiga; Eva, Kevin W.

    2004-01-01

    Context: Various research studies have examined the question of whether expert or non-expert raters, faculty or students, evaluators or standardized patients, give more reliable and valid summative assessments of performance on Objective Structured Clinical Examinations (OSCEs). Less studied has been the question of whether or not non-faculty…

  12. Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students?

    PubMed Central

    Park, Wan Beom; Kang, Seok Hoon; Lee, Yoon-Seong

    2015-01-01

    Abstract: Background: Clinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities. Methods: Sixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed. Results: Clinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA. Conclusions: OSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened. PMID:25647834

  13. Construct Validity of an Objective Structured Clinical Examination (OSCE) in Psychiatry: Associations with the Clinical Skills Examination and Other Indicators

    ERIC Educational Resources Information Center

    Park, Robin S.; Chibnall, John T.; Blaskiewicz, Robert J.; Furman, Gail E.; Powell, Jill K.; Mohr, Clinton J.

    2004-01-01

    Objective: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical…

  14. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    ERIC Educational Resources Information Center

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  15. The Reliability, Validity, and Usefulness of the Objective Structured Clinical Examination (OSCE) in Dental Education

    ERIC Educational Resources Information Center

    Graham, Roseanna

    2010-01-01

    This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this…

  16. Factors shaping e-feedback utilization following electronic Objective Structured Clinical Examinations.

    PubMed

    Ashby, Samantha E; Snodgrass, Suzanne H; Rivett, Darren A; Russell, Trevor

    2016-09-01

    The development of student-practitioners' practical clinical skills is essential in health professional education. Objective Structured Clinical Examinations are central to the assessment of students performing clinical procedures on simulated patients (actors). While feedback is considered core to learning providing timely, individualised student OSCE feedback is difficult. This study explored the perceptions of students about the multiple factors which shape the utility of e-feedback following an electronic Objective Structured Clinical Examinations, which utilized iPad and specialised software. The e-feedback was trialled in four courses within occupational therapy and physiotherapy pre-professional programs with a cohort of 204 students. Evaluation of student perceptions about feedback was collected using two surveys and eight focus groups. This data showed three factors shaped perceptions of the utility of e- Objective Structured Clinical Examinations feedback: 1) timely accessibility within one day of the assessment, 2) feedback demonstrating examiners' academic literacy and 3) feedback orientated to ways of improving future performance of clinical skills. The study found training in the provision of feedback using IPads and software is needed for examiners to ensure e-feedback meets students' needs for specific, future-oriented e-feedback and institutional requirements for justification of grades.

  17. Competency-Based Training: Objective Structured Clinical Exercises (OSCE) in Marriage and Family Therapy

    ERIC Educational Resources Information Center

    Miller, John K.

    2010-01-01

    The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical "Examination" (OSCE) is widely used in the medical profession to assess…

  18. Avatar-Mediated Home Safety Assessments: Piloting a Virtual Objective Structured Clinical Examination Station

    PubMed Central

    Andrade, Allen D.; Cifuentes, Pedro; Oliveira, Marcelo C.; Anam, Ramanakumar; Roos, Bernard A.; Ruiz, Jorge G.

    2011-01-01

    Background Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows. Methods We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's “home visit” was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist. Results The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as “excellent.” Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house. Conclusion The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting. PMID:23205205

  19. Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination

    PubMed Central

    Attridge, Rebecca L.; Tovar, John M.; Witte, Amy P.

    2015-01-01

    Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains. PMID:26690286

  20. Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination.

    PubMed

    Urteaga, Elizabeth M; Attridge, Rebecca L; Tovar, John M; Witte, Amy P

    2015-10-25

    Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

  1. An exploration of student midwives' experiences of the Objective Structured Clinical Examination assessment process.

    PubMed

    Barry, Maebh; Noonan, Maria; Bradshaw, Carmel; Murphy-Tighe, Sylvia

    2012-08-01

    This paper reports on a qualitative descriptive study that explored student midwives' experiences of the Objective Structured Clinical Examination assessment process for obstetric emergencies within a university setting. The development of fundamental clinical skills is an important component in preparing students to meet the responsibilities of a midwife. There is an international concern that the transfer of midwifery education into universities may impact on the development of midwifery clinical skills. Objective Structured Clinical Examinations (OSCEs) have the potential to promote integration and consolidation of skills prior to clinical placement. Twenty six students (n=36) from two midwifery programmes (BSc and Higher Diploma) participated in four focus groups and Burnard's (2006) framework was used for data analysis. Three main themes emerged following analysis: preparation for the OSCE assessment, the OSCE process and learning through simulating practice. Preparation for the OSCE's which included lectures, demonstrations, and practice of OSCE's facilitated by lecturers and by the students themselves, was considered central to the process. Learning via OSCEs was perceived to be more effective in comparison to other forms of assessment and prepared students for clinical practice. Positive aspects of the process and areas for improvement were identified. Using OSCE's increased the depth of learning for the students with the steps taken in preparation for the OSCE's proving to be a valuable learning tool. This study adds to the evidence on the use of OSCE's in midwifery education.

  2. Competency-based training: objective structured clinical exercises (OSCE) in marriage and family therapy.

    PubMed

    Miller, John K

    2010-07-01

    The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical Examination (OSCE) is widely used in the medical profession to assess clinical competence. These examinations involve using simulated clinical situations as a tool in conducting summative evaluations of trainee competence. This article describes an adaptation of the OSCE procedures for competency-based training of MFT students. Instead of using the procedures as a summative examination as is typical in medical education, this article proposes how to use them as formative exercises in the development of student competence. The development of the OSCE is discussed, including "blueprinting," focused competencies, procedures, and feedback protocols. The article concludes with suggestions of how to continue the development of the OSCE for evaluation in MFT education.

  3. The reliability, validity, and usefulness of the Objective Structured Clinical Examination (OSCE) in dental education

    NASA Astrophysics Data System (ADS)

    Graham, Roseanna

    This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this study included CDM's class of 2010 which consisted of 78 students. The overall reliability of the examination was measured via calculation of Cronbach's alpha. Content validity was examined through evaluation of the OSCE by three experienced clinical faculty members. Predictive validity was evaluated by correlating student grades on the OSCE to future clinical performance as measured by number of clinical points achieved during the third year of training. Student perceptions regarding the educational usefulness of the examination were evaluated through a 12-question Liken-type survey and focus group interviews analyzed using a phenomenological approach. Findings of the study indicated the OSCE was a highly reliable examination (alpha=0.86) with high content validity and a moderately high correlation to future clinical performance (r=.614, p<.0001). Overall, student perceptions of the educational usefulness of the OSCE were positive as based on their responses to a 5-point Likert scale (1=strongly disagree and 5=strongly agree). They reported that the exam required the ability to think critically and problem-solve (4.0 +/- 0.85), assessed clinically relevant skills (4.59 +/- 0.69), helped identify clinical weaknesses (4.16 +/- 0.90), and was a learning experience (4.58 +/- 0.84). Findings from the qualitative portion of the study identified four main themes including the student perception that the OSCE is a unique assessment experience that required integration and application of knowledge. Recommendations for the use of the OSCE to improve clinical teaching and the implications of this study relating to the expanded use of

  4. The use of objective structured clinical examination (OSCE) for evaluation and instruction in graduate medical education.

    PubMed

    Sloan, D A; Donnelly, M B; Schwartz, R W; Felts, J L; Blue, A V; Strodel, W E

    1996-06-01

    This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing performance by trainees at all levels, including medical students and chief residents; and estimating the impact of providing OSCE participants with immediate feedback about their performance. A comprehensive 210-min OSCE was administered to 53 surgical residents and 6 junior medical students. Faculty experts proctored all patient stations and provided immediate feedback to participants after the patient interaction segments (Part A). The participants then answered questions about the patients seen (Part B). The reliability of the OSCE was high (.91), identical to that of a previous resident OSCE with no feedback. The standard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical performance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences in clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0.01) by level of training. Most participants (74%) rated the OSCE as an above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to participants during the OSCE was positively received and did not perturb test reliability.

  5. Validation of a computer based objective structured clinical examination in the assessment of undergraduate dermatology courses.

    PubMed

    Kaliyadan, Feroze; Khan, Abdul Sattar; Kuruvilla, Joel; Feroze, Kaberi

    2014-01-01

    Many teaching centers have now adopted objective structured clinical examination (OSCE) as an assessment method for undergraduate dermatology courses. A modification of the standard OSCE in dermatology is computer based or electronic OSCE (eOSCE). We attempted to validate the use of a computer-based OSCE in dermatology in a group of fifth year medical students. The scores of the students in the computer-based OSCE showed a strong positive correlation with the scores on the clinical presentation (Pearson's co-efficient - 0.923, P value <0.000, significant at the 0.01 level) and a good correlation with overall scores of the student (Pearson's co-efficient - 0.728, P value <0.000, significant at the 0.01 level), indicating that this is a reliable method for assessment in dermatology. Generally, the students' feedback regarding the methods was positive.

  6. Students' feedback of objectively structured clinical examination: a private medical college experience.

    PubMed

    Khursheed, Iram; Usman, Yaseen; Usman, Jawaid

    2007-03-01

    The aim of the study was to evaluate undergraduate students' perceptions regarding Objectively Structured Clinical Examination (OSCE) to be used as a feedback to improve the assessment technique. At the end of OSCE, students were provided with a feedback questionnaire related to OSCE to obtain their views and comments. The feedback was obtained from two consecutive batches of third year medical students and was utilized to incorporate the improvements in the process, wherever possible. A great majority of students (93% from group 'A' and 95% from group 'B') regarded OSCE as a practical and useful assessment tool in early years of medical education. In this study, students appreciated OSCE and offered constructive feedback on structure and organization of the process. However, at some stations they felt that instructions were ambiguous and time allocation was inadequate for the assigned tasks. The overall feedback was very useful and facilitated a critical review of the process.

  7. Genetics objective structured clinical exams at the Maimonides Infants & Children's Hospital of Brooklyn, New York.

    PubMed

    Altshuler, Lisa; Kachur, Elizabeth; Krinshpun, Shifra; Sullivan, Deborah

    2008-11-01

    In 2003, the Maimonides Infants & Children's Hospital received a Title VII Residency Training in Primary Care grant to integrate genetic-specific competencies into postgraduate pediatrics education. As part of that endeavor, mandatory yearly genetics objective structured clinical exams (OSCEs) were instituted for third-year residents. This article reports on the first three years of experience with this innovative educational tool.After an overview of genetic concepts, dysmorphology, and communication styles, residents complete a five-station OSCE and receive feedback from standardized patients and from the faculty who observe them. After this clinical exercise, the residents participate in a small-group debriefing session to share strategies for effective communication and clinical case management and to discuss the ethical issues that arise with these genetic cases.In three years, 60 residents have completed the genetics OSCE program. Evaluation data demonstrate that the program has been effective in both introducing genetic-specific challenges and assessing residents' clinical skills. It has helped trainees self-identify both strengths and further training needs. Pre- and postsurveys among the trainees show increased comfort levels in performing 5 of 12 genetic-related clinical tasks.We conclude that genetics OSCEs are an enriching educational tool. Merely providing trainees and practicing physicians with the latest scientific information is unlikely to prepare them for counseling patients about complex genetic issues. Developing proficiency requires focused practice and effective feedback.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

  8. Developing a Framework for Objective Structured Clinical Examinations Using the Nominal Group Technique

    PubMed Central

    Crum, Matthew F.; White, Paul J.; Larson, Ian; Malone, Daniel T.; Manallack, David T.; Nicolazzo, Joseph A.; McDowell, Jennifer; Lim, Angelina S.; Kirkpatrick, Carl M.

    2016-01-01

    Objective. To use the nominal group technique to develop a framework to improve existing and develop new objective structured clinical examinations (OSCEs) within a four-year bachelor of pharmacy course. Design. Using the nominal group technique, a unique method of group interview that combines qualitative and quantitative data collection, focus groups were conducted with faculty members, practicing pharmacists, and undergraduate pharmacy students. Five draft OSCEs frameworks were suggested and participants were asked to generate new framework ideas. Assessment. Two focus groups (n=9 and n=7) generated nine extra frameworks. Two of these frameworks, one from each focus group, ranked highest (mean scores of 4.4 and 4.1 on a 5-point scale) and were similar in nature. The project team used these two frameworks to produce the final framework, which includes an OSCE in every year of the course, earlier implementation of teaching OSCEs, and the use of independent simulated patients who are not examiners. Conclusions. The new OSCE framework provides a consistent structure from course entry to exit and ensures graduates meet internship requirements. PMID:28090107

  9. Expanding the role of objectively structured clinical examinations in nephrology training.

    PubMed

    Prince, Lisa K; Abbott, Kevin C; Green, Felicidad; Little, Dustin; Nee, Robert; Oliver, James D; Bohen, Erin M; Yuan, Christina M

    2014-06-01

    Objectively structured clinical examinations (OSCEs) are widely used in medical education, but we know of none described that are specifically for nephrology fellowship training. OSCEs use simulation to educate and evaluate. We describe a technically simple, multidisciplinary, low-cost OSCE developed by our program that contains both examination and training features and focuses on management and clinical knowledge of rare hemodialysis emergencies. The emergencies tested are venous air embolism, blood leak, dialysis membrane reaction, and hemolysis. Fifteen fellows have participated in the OSCE as examinees and/or preceptors since June 2010. All have passed the exercise. Thirteen responded to an anonymous survey in July 2013 that inquired about their confidence in managing each of the 4 tested emergencies pre- and post-OSCE. Fellows were significantly more confident in their ability to respond to the emergencies after the OSCE. Those who subsequently saw such an emergency reported that the OSCE experience was somewhat or very helpful in managing the event. The OSCE tested and trained fellows in the recognition and management of rare hemodialysis emergencies. OSCEs and simulation generally deserve greater use in nephrology subspecialty training; however, collaboration between training programs would be necessary to validate such exercises.

  10. Reliability analysis of the objective structured clinical examination using generalizability theory

    PubMed Central

    Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

    2016-01-01

    Background The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. Methods An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. Results The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Conclusions Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements. PMID:27543188

  11. Reliability analysis of the objective structured clinical examination using generalizability theory.

    PubMed

    Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

    2016-01-01

    Background The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. Methods An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. Results The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Conclusions Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

  12. An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents

    PubMed Central

    Mangold, Karen A.; Jeffers, Justin M.; Burns, Rebekah A.; Trainor, Jennifer L.; Unti, Sharon M.; Eppich, Walter; Adler, Mark D.

    2015-01-01

    Background Residency programs are developing new methods to assess resident competence and to improve the quality of formative assessment and feedback to trainees. Simulation is a valuable tool for giving formative feedback to residents. Objective To develop an objective structured clinical examination (OSCE) to improve formative assessment of senior pediatrics residents. Methods We developed a multistation examination using various simulation formats to assess the skills of senior pediatrics residents in communication and acute resuscitation. We measured several logistical factors (staffing and program costs) to determine the feasibility of such a program. Results Thirty-one residents participated in the assessment program over a 3-month period. Residents received formative feedback comparing their performance to both a standard task checklist and to peers' performance. The program required 16 faculty members per session, and had a cost of $624 per resident. Conclusions A concentrated assessment program using simulation can be a valuable tool to assess residents' skills in communication and acute resuscitation and provide directed formative feedback. However, such a program requires considerable financial and staffing resources. PMID:26457159

  13. Measuring Professional Behaviour in Canadian Physical Therapy Students' Objective Structured Clinical Examinations: An Environmental Scan

    PubMed Central

    Ellerton, Cindy; Evans, Cathy

    2015-01-01

    ABSTRACT Purpose: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. Method: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. Results: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). Conclusions: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes. PMID:25931656

  14. An objective structured clinical exam to measure intrinsic CanMEDS roles

    PubMed Central

    Kassam, Aliya; Cowan, Michèle; Donnon, Tyrone

    2016-01-01

    Background The CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE) is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise. Method We developed the CanMEDS In-Training Exam (CITE), a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary) and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA) was used to investigate differences between year of residency, sex, and the type of residency program. Results In total, 63 residents participated in the CITE; 40 residents (63%) were from internal medicine programs, whereas the remaining 23 (37%) were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, p<0.05. Noninternal medicine residents scored higher in terms of the Professional competency overall, whereas internal medicine residents scored significantly higher in the Collaborator competency overall. Discussion The OSCE checklists developed for the assessment of intrinsic CanMEDS roles were functional, but the specific items within stations required more uniformity to be used between stations. More generic types of checklists may also improve correlations across stations. Conclusion An OSCE measuring intrinsic competence is feasible; however, further development of our cases and checklists is needed. We provide a model of how to develop an OSCE to measure intrinsic CanMEDS roles that educators may adopt as residency programs move

  15. Objective structured clinical examination for pharmacy students in Qatar: cultural and contextual barriers to assessment.

    PubMed

    Wilby, K J; Black, E K; Austin, Z; Mukhalalati, B; Aboulsoud, S; Khalifa, S I

    2016-07-10

    This study aimed to evaluate the feasibility and psychometric defensibility of implementing a comprehensive objective structured clinical examination (OSCE) on the complete pharmacy programme for pharmacy students in a Middle Eastern context, and to identify facilitators and barriers to implementation within new settings. Eight cases were developed, validated, and had standards set according to a blueprint, and were assessed with graduating pharmacy students. Assessor reliability was evaluated using inter-class coefficients (ICCs). Concurrent validity was evaluated by comparing OSCE results to professional skills course grades. Field notes were maintained to generate recommendations for implementation in other contexts. The examination pass mark was 424 points out of 700 (60.6%). All 23 participants passed. Mean performance was 74.6%. Low to moderate inter-rater reliability was obtained for analytical and global components (average ICC 0.77 and 0.48, respectively). In conclusion, OSCE was feasible in Qatar but context-related validity and reliability concerns must be addressed prior to future iterations in Qatar and elsewhere.

  16. Strategies for interprofessional education: the Interprofessional Team Objective Structured Clinical Examination for midwifery and medical students.

    PubMed

    Cullen, Lindsay; Fraser, Diane; Symonds, Ian

    2003-08-01

    This paper provides an overview of the processes involved in implementing an interprofessional education (IPE) strategy in a recently established School of Human Development at the University of Nottingham. The merger of the academic divisions of child health, midwifery, obstetrics and gynaecology was a deliberate initiative to create an organisational infrastructure intended to enhance opportunities for interprofessional collaborations in research and education. As a first step, a small group of academic midwives and obstetricians formed a project group to find the best way of facilitating IPE for medical and midwifery students at undergraduate level. A discussion is provided of the work the project group undertook to: determine an agreed definition of IPE; decide an action research approach was needed; determine the ways in which teaching and learning strategies were to be implemented, evaluated and compared; and identify the factors inhibiting and enhancing developments. Evaluations have demonstrated that the Interprofessional Team Objective Structured Clinical Examination (ITOSCE) focusing on intrapartum scenarios is effective in promoting interprofessional learning. Both medical and midwifery students and facilitators agree that team working and understanding each other's roles has been enhanced and that although resource intensive, IPE is worth the time and effort involved.

  17. Factors associated with medical student test anxiety in objective structured clinical examinations: a preliminary study

    PubMed Central

    2016-01-01

    Objectives To investigate attributes of medical students associated with their test anxiety on Objective Structured Clinical Examinations (OSCEs). Methods A cross-sectional study using a self-administered questionnaire was conducted of all Year 3 and 4 students at a private medical school in South Korea in 2014. This 53-item questionnaire consisted of factors pertaining to test anxiety on the OSCE identified from a review of relevant literature, which included students’ motivational beliefs and achievement emotions, perceived values of the OSCE, and attitude and orientation towards patients. Participants’ test anxiety levels were measured using the Korean Achievement Emotions Questionnaire. Participants rated their responses using a five-point Likert-type scale. Univariate analysis was performed to examine relationships between the variables. Results A total of 94 students completed the questionnaire (a 93% response rate). No differences in the participants’ test anxiety scores were observed across genders, entry-levels, or years in medical school. Participants’ test anxiety on the OSCE showed moderate association with their class-related achievement emotions (i.e., anxiety and boredom), where r = 0.46 and 0.32, p < 0.01, respectively, and weak negative associations with their patient-centeredness (r = -0.21, p < 0.05) and with their perceived values of the OSCE (r = -0.21, p < 0.05). Conclusions This study found some non-cognitive factors related to medical students’ test anxiety on the OSCE. These findings have implications for developing effective educational interventions for helping students cope with such a stress by enhancing our understanding of the various factors that influence their test anxiety in OSCEs. PMID:28035056

  18. Right person, right skills, right job: the contribution of objective structured clinical examinations in advancing staff nurse experts.

    PubMed

    Mitchell, Marion; Strube, Petra; Vaux, Amanda; West, Nicky; Auditore, Anthony

    2013-10-01

    Recruitment processes need to discriminate among candidates to ensure that the right person with the right skills is selected for advancement opportunities. An innovative recruitment process using an objective structured clinical examination grounded in best practice guidelines resulted in improved recruitment practices for senior nursing clinical expert roles. Candidates' skills, knowledge, and attitudes in the areas of patient focus, clinical expertise, teamwork, and leadership were assessed using a clinical simulation. Candidates achieving advancement were assessed at 6 months to validate the efficacy of the process.

  19. Exploration of Nursing Faculty Members' Lived Experiences of Objective Structured Clinical Examination (OSCE) in Undergraduate Nursing Education

    ERIC Educational Resources Information Center

    Obizoba, Cordelia O.

    2014-01-01

    The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…

  20. The interrater reliability of an objective structured practical examination in measuring the clinical reasoning ability of chiropractic students

    PubMed Central

    Rose, Kevin A.; Babajanian, Jesika

    2016-01-01

    Objective: The objective structured practical examination (OSPE) is a case-based assessment that can be used to assess the clinical reasoning ability of students. The reliability of using an OSPE for this purpose has not been reported in the literature. The objective of this study was to determine the interrater reliability of the OSPE in measuring the clinical reasoning ability of chiropractic students. Methods: Two examiners tested each student simultaneously when enough were available as a check for interrater reliability. The scores for students over 4 exam administrations were compiled, and we calculated an intraclass correlation coefficient (ICC) using 1-way random single measures. Results: Paired scores were available for 133 students. The ICC was .685, showing a fair-to-good level of agreement for faculty in assessing the clinical reasoning ability of chiropractic students using an OSPE. Conclusion: The OSPE can be a valuable tool for testing clinical reasoning abilities because it can simulate the decision-making process that needs to be implemented in clinical practice. Faculty members at our chiropractic college were able to achieve an acceptable level of reliability in measuring the clinical reasoning abilities of students using an OSPE. Other health professional programs may consider using this tool for assessing the clinical reasoning skills of their students. PMID:27115474

  1. Finding reality: the use of objective structured clinical examination (OSCE) in the assessment of mental health nursing students interpersonal skills.

    PubMed

    Anderson, Martin; Stickley, Theodore

    2002-09-01

    This paper presents the implementation of an objective structured clinical examination (OSCE) in the assessment of mental health nursing students' interpersonal skills. It begins by providing a rationale for the use of this instrument to assess such ski lls and offers a brief discussion of the development of OSCEs. The preparation and implementation of the OSCE is explored and both students' and tutors' reflections of the process are highlighted. The strengths and problems, particularly the use of an ac tor and video tape recordings are examined, in the light of other studies. The paper concludes by advocating the use of such an assessment tool as a formative exercise.

  2. Objective Structured Clinical Examination as an educational initiative for summative simulation competency evaluation of first-year student registered nurse anesthetists' clinical skills.

    PubMed

    Wunder, Linda L; Glymph, Derrick C; Newman, Johanna; Gonzalez, Vicente; Gonzalez, Juan E; Groom, Jeffrey A

    2014-12-01

    The use of simulation to imitate real-life scenarios reaches back many centuries. In the last decade, the use of simulation in healthcare has gained acceptance as a valuable tool for teaching and learning technical and nontechnical skills in healthcare. The use of simulation technology has moved medical education from the standard of pen and paper examinations to the assessment of clinical competency before caring for patients. The old thinking of "see one, do one, teach one" is behind us as healthcare works to create a culture of safety that holds healthcare personnel accountable. A current use of testing clinical competence is the use of Objective Structured Clinical Examination (OSCE) by physician training programs. As a testing tool, the OSCE has great potential to assess the clinical competence of students before they enter the clinical setting. The nurse anesthesia program at the authors' university has moved toward creating a formal assessment to ensure clinical competence of their student registered nurse anesthetists. In this article, we describe the development and implementation of an OSCE to ensure clinical competence of first-year student registered nurse anesthetists before they begin their clinical training.

  3. The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record

    PubMed Central

    Biagioli, Frances E.; Elliot, Diane L.; Palmer, Ryan T.; Graichen, Carla C.; Rdesinski, Rebecca E.; Kumar, Kaparaboyna Ashok; Galper, Ari B.; Tysinger, James W.

    2016-01-01

    Problem Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Approach Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. Outcomes The authors collected performance data for students (n = 71) at the first institution during academic years 2011–2013 and for students (n = 211) at the second institution during academic year 2013–2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students’ EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Next Steps Cross-institutional data comparisons will help determine whether differences in curricula affect students’ EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice. PMID:27332870

  4. A focus group study of the use of video-recorded simulated objective structured clinical examinations in nurse practitioner education.

    PubMed

    Barratt, Julian

    2010-05-01

    The objective structured clinical examination (OSCE) is a common method of clinical skills assessment used for advanced nurse practitioner students across the United Kingdom. The purpose of an advanced nursing OSCE is to assess a nurse practitioner student's competence and safety in the performance of commonly used advanced clinical practice skills. Students often feel nervous when preparing for and participating in an OSCE. Consideration of these identified anxieties led to the development of an alternative method of meeting students' OSCE learning and preparation needs; namely video-recorded simulated OSCEs. Video-recording was appealing for the following reasons: it provides a flexible usage of staff resources and time; OSCE performance mistakes can be rectified; it is possible to use the same video-recordings with multiple cohorts of students, and the recordings can be made conveniently available for students with video streaming on internet-based video-sharing sites or virtual learning environments. The aim of the study was to explore the value of using such recordings amongst nurse practitioner students, via online and face-to-face focus groups, to see if they are a suitable OSCE educational preparation technique. The study findings indicate that simulated OSCE video-recordings are an effective method for supporting nurse practitioner educational development.

  5. Implementation of an Electronic Objective Structured Clinical Exam for Assessing Practical Skills in Pre-Professional Physiotherapy and Occupational Therapy Programs: Examiner and Course Coordinator Perspectives

    ERIC Educational Resources Information Center

    Snodgrass, Suzanne J.; Ashby, Samantha E.; Rivett, Darren A.; Russell, Trevor

    2014-01-01

    Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and…

  6. The Objective Structured Clinical Examination (OSCE) as a strategy for assessing clinical competence in midwifery education in Ireland: a critical review.

    PubMed

    Smith, Valerie; Muldoon, Kathryn; Biesty, Linda

    2012-09-01

    In Ireland, to register as a midwife, all student midwives must be deemed competent to practice with the assessment of competence an essential component of midwifery education. A variety of assessment strategies, including observed practice, clinical interviews, portfolios of reflection, the Objective Structured Clinical Examination (OSCE) and written examination papers, are utilised to assess midwifery students' clinical competence. In this paper, a critical review of the OSCE as a strategy for assessing clinical competence in one third level institution in Ireland is offered. Although utilised for assessing competence across a range of areas (e.g. obstetric emergencies and pharmacology/drug administration), the use of the OSCE for assessing midwifery students' competence in lactation and infant feeding practices, as an example for this paper, is described. The advantages, disadvantages, validity and reliability of the OSCE, as an assessment strategy, are critically explored. Recognising that no single assessment strategy can provide all the information required to assess something as complex as clinical performance, the OSCE, when viewed alongside other forms of assessment, and with relevance to the topic under examination, may be considered a valuable strategy for enhancing the assessment of students' clinical competence, and for embracing diversity within midwifery education and training.

  7. An Advanced Objective Structured Clinical Examination Using Patient Simulators to Evaluate Pharmacy Students’ Skills in Physical Assessment

    PubMed Central

    Takamura, Norito; Ogata, Kenji; Setoguchi, Nao; Utsumi, Miho; Kourogi, Yasuyuki; Osaki, Takashi; Ozaki, Mineo; Sato, Keizo; Arimori, Kazuhiko

    2014-01-01

    Objective. To implement an advanced objective structured clinical examination (OSCE) in the curriculum and to evaluate Japanese pharmacy students’ skills in physical assessment such as measuring pulse and blood pressure, and assessing heart, lung, and intestinal sounds. Design. An advanced OSCE was implemented in a hospital pharmacy seminar as a compulsory subject. We programmed patient simulators with 21 different patient cases in which normal and abnormal physiological conditions were produced. The virtual patients were then used to evaluate the physical assessment skills of fifth-year pharmacy students. Assessment. Significant differences were observed between the average of all the detailed evaluations and the mean results for the following skills: pulse measurement, blood pressure measurement, deflating the cuff at a rate of 2-3 mmHg/sec, listening to heart sounds, and listening to lung sounds. Conclusion. Administering an advanced OSCE using virtual patients was an effective way of assessing pharmacy students’ skills in a realistic setting. Several areas in which pharmacy students require further training were identified. PMID:25657371

  8. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

    PubMed

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B

    2012-01-01

    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  9. Designing the objective structured clinical examination to cover all major areas of physical medicine and rehabilitation over 3 yrs.

    PubMed

    Garstang, Susan; Altschuler, Eric L; Jain, Sheela; Delisa, Joel A

    2012-06-01

    The Accreditation Council for Graduate Medical Education requires that training programs comprehensively evaluate residents in the six core Accreditation Council for Graduate Medical Education competencies. One of the ways we do this in our residency is by administering a nine-station Objective Structured Clinical Examination (OSCE) at the end of each year, which evaluates tasks such as history taking, focused physical examination, communication, professionalism, procedural skills, management, prescription writing, and understanding systems-based practice. We have classified our OSCE stations into what we consider key areas in our field and assessed these on a rotating basis over 3 yrs. This results in the assessment of 27 areas over the 3 yrs of residency. Structuring the OSCE as a series of stations over 3 yrs is an efficient method to evaluate residents' competencies that are required by the Accreditation Council for Graduate Medical Education and certifying boards. An analysis of OSCE scores when compared with American Board of Physical Medicine & Rehabilitation parts 1 and 2 scores and final summative resident evaluation scores reveals that OSCE results correlate with part 1 scores and final evaluation scores but do not show the same strong correlations with part 2 scores. We discuss the way the OSCE can complete other assessment techniques and ways to improve cases in the future.

  10. An objective structured clinical examination for the licentiate: report of the pilot project of the Medical Council of Canada.

    PubMed

    Reznick, R; Smee, S; Rothman, A; Chalmers, A; Swanson, D; Dufresne, L; Lacombe, G; Baumber, J; Poldre, P; Levasseur, L

    1992-08-01

    The Medical Council of Canada (MCC) administers a qualifying examination for the issuance of a license to practice medicine. To date, this examination does not test the clinical skills of history taking, physical examination, and communication. The MCC is implementing an objective structured clinical examination (OSCE) to test these skills in October 1992. A pilot examination was developed to test the feasibility, reliability, and validity of running a multisite, two-form, four-hour, 20-station OSCE for national licensure. In February 1991, 240 volunteer first- and second-year residents were tested at four sites. The candidates were randomly assigned to one of two forms of the test and one of two sites for two of the four sites. Generalizability analysis revealed that the variance due to form was 0.0 and that due to site was .16 compared with a total variance of 280.86. The reliabilities (inter-station) were .56 and .60 for the two forms. Station total-test score correlations, used to measure station validity, were significant for 38 of the 40 stations used (range .14-.60). The results of the OSCE correlated moderately with the MCC qualifying examination; these correlations were .32 and .35 for the two test forms. Content validity was assessed by postexamination questionnaires given to the physician examiners using a scale of 0 (low) to 10 (high). The physicians' mean ratings were: importance of the stations, 8.1 (SD, 1.8); success of the examination in testing core skills, 8.1 (SD, 1.6); and degree of challenge, 7.8 (SD, 2.1). The results indicate that a full-scale national administration of an OSCE for licensure is feasible using the model developed. Aspects of validity have been established and strategies to augment reliability have been developed.

  11. Use of interactive teaching methods in tobacco cessation program and examine it by using objective structured clinical exam

    PubMed Central

    Fernandez, Kevin; Pandve, Harshal T.; Debnath, Dhrubajyoti J.

    2013-01-01

    Background: Tobacco addiction is an important public health issue. It is important for health professional to counsel the tobacco users for cessation. Aim: To enhance communication skills of MBBS (Bachelor of Medicine and Bachelor of Surgery) students in counseling of tobacco users by using interactive teaching methods and examine it by using OSCE. Materials and Methods: It was a before and after comparison study. Communication skills of students were examined by standardized patients (investigators) by objective structured clinical examination (OSCE) method before and after intervention. All the students were trained to enhance the communication skills by role play, interactive session, anecdotes. Statistical analysis was done by using Paired t-test. Results: The difference in scores at all the 3 stations before and after the intervention and also global scores before and after the intervention was statistically highly significant (P = 0.0001). Conclusion and Recommendation: Communication skills of students in counseling tobacco users improved after they were given role play, interactive session, anecdotes. Similar model can be used to improve the communication/counseling skills in other important health hazards. PMID:24083278

  12. Key challenges for implementing a Canadian-based objective structured clinical examination (OSCE) in a Middle Eastern context

    PubMed Central

    Wilby, Kyle John; Diab, Mohammad

    2016-01-01

    Globalization of medical education is occurring at a rapid pace and many regions of the world are adapting curricula, teaching methods, and assessment tools from established programs. In the Middle East, the use of Objective Structured Clinical Examinations (OSCEs) is rare. The College of Pharmacy at Qatar University recently partnered with the University of Toronto and the Supreme Council of Health in Qatar to adapt policies and procedures of a Canadian-based OSCE as an exit-from-degree assessment for pharmacy students in Qatar. Despite many cultural and contextual barriers, the OSCE was implemented successfully and is now an integrated component of the pharmacy curriculum. This paper aims to provide insight into the adoption and implementation process by identifying four major cultural and contextual challenges associated with OSCEs: assessment tools, standardized actors, assessor calibration, and standard setting. Proposed solutions to the challenges are also given. Findings are relevant to international programs attempting to adapt OSCEs into their contexts, as well as Canadian programs facing increasing rates of cultural diversity within student and assessor populations. PMID:28344703

  13. Key challenges for implementing a Canadian-based objective structured clinical examination (OSCE) in a Middle Eastern context.

    PubMed

    Wilby, Kyle John; Diab, Mohammad

    2016-12-01

    Globalization of medical education is occurring at a rapid pace and many regions of the world are adapting curricula, teaching methods, and assessment tools from established programs. In the Middle East, the use of Objective Structured Clinical Examinations (OSCEs) is rare. The College of Pharmacy at Qatar University recently partnered with the University of Toronto and the Supreme Council of Health in Qatar to adapt policies and procedures of a Canadian-based OSCE as an exit-from-degree assessment for pharmacy students in Qatar. Despite many cultural and contextual barriers, the OSCE was implemented successfully and is now an integrated component of the pharmacy curriculum. This paper aims to provide insight into the adoption and implementation process by identifying four major cultural and contextual challenges associated with OSCEs: assessment tools, standardized actors, assessor calibration, and standard setting. Proposed solutions to the challenges are also given. Findings are relevant to international programs attempting to adapt OSCEs into their contexts, as well as Canadian programs facing increasing rates of cultural diversity within student and assessor populations.

  14. [Testing objective structured clinical evaluation (OSCE) for nursing students experience developed during the years 1995-2009].

    PubMed

    Sola Pola, Montserrat; Martínez Castela, Daniel; Molins I Mesalles, Ainhoa; Pulpón Segura, Anna M

    2011-01-01

    The objective structured clinical examination (OSCE) has been recognized as an effective evaluation tool in the health area and has been implemented by an important sector of educational institutions, the Faculty of Medicine and School of Nursing. The present article describes the OSCE organized by the Institute of Health Studies in collaboration with the University Schools of Catalan Nursing. Between the years of 2002 and 2009, OSCE annual exams took place with the participation of 1.803 students. The global results remained stable with a median grade of slightly less than 60%, and the competence component that evaluated communicative capacity was the one in which students obtained the best results. The reliability obtained surpassed the minimum recommended by international standards. It's important underline the positive value to the students of all aspects of the test. From this experience it seems evident that it would be useful to take advantage of the OSCE tests in order to show the students their strong points and ways to improve. We should highlight, not only as a goal but also as an opportunity the assessment by competencies that the European space of higher Education provides at the end of studies for a Nursing degree.

  15. Mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination to assess their competence in medicine administration.

    PubMed

    Hemingway, Steve; Stephenson, John; Roberts, Bronwyn; McCann, Terence

    2014-08-01

    The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.

  16. The development and evaluation of a computer-based resource to assist pre-registration nursing students with their preparation for objective structured clinical examinations (OSCEs).

    PubMed

    Bloomfield, Jacqueline; Fordham-Clarke, Carol; Pegram, Anne; Cunningham, Brent

    2010-02-01

    This paper presents a narrative discussion of an innovative, computer-based resource developed, implemented and evaluated by a small project team at a school of nursing and midwifery in London. The interactive resource was designed to assist first and second year pre-registration nursing students with both their clinical skills revision and formative preparation for Objective Structured Clinical Examinations and involved a small range of clinical skills. These included: skin assessment; hand hygiene; reading a drug prescription chart, weighing a baby and assessment of an intravenous cannulae site. The processes involved in the development of the tool are described and, the key drivers informing its development are identified. Although a formal research approach was not adopted a summary of feedback obtained from anonymous student evaluations is included. This provides important insights into the perceived usefulness of the tool and is discussed in light of the challenges and practicalities associated with the content development and technical issues. The paper concludes by identifying proposed future developments and wider applications of this innovative clinical skills education initiative within nursing and healthcare education.

  17. Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

    PubMed

    O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

    2008-09-01

    Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

  18. The Implementation and Development of an Objective Structured Clinical Examination in the Community Pharmacy Course of a Select Gulf-Region Academic Institution (Ras Al Khaimah College of Pharmaceutical Sciences): A Pilot Study

    ERIC Educational Resources Information Center

    Al-Azzawi, Amad Mohammed Jamil; Nagavi, B.G.; Hachim, Mahmood Y.; Mossa, Omar H.

    2016-01-01

    Background: Objective Structured Clinical Examinations (OSCEs) were used to assess translational pharmacotherapeutic skills of a Gulf-region representative academic institution. Aim: The aim of the current study was to assess the clinical skills of students enrolled within the third year Bachelor of Pharmacy (BPharm) programme within Ras Al…

  19. Clinical trial structures

    PubMed Central

    Evans, Scott R.

    2011-01-01

    Most errors in clinical trials are a result of poor planning. Fancy statistical methods cannot rescue design flaws. Thus careful planning with clear foresight is crucial. The selection of a clinical trial design structure requires logic and creativity. Common structural designs are discussed. PMID:21423788

  20. Object Recognition and Random Image Structure Evolution

    ERIC Educational Resources Information Center

    Sadr, Jvid; Sinha, Pawan

    2004-01-01

    We present a technique called Random Image Structure Evolution (RISE) for use in experimental investigations of high-level visual perception. Potential applications of RISE include the quantitative measurement of perceptual hysteresis and priming, the study of the neural substrates of object perception, and the assessment and detection of subtle…

  1. Designing Planar Deployable Objects via Scissor Structures.

    PubMed

    Zhang, Ran; Wang, Shiwei; Chen, Xuejin; Ding, Chao; Jiang, Luo; Zhou, Jie; Liu, Ligang

    2016-02-01

    Scissor structure is used to generate deployable objects for space-saving in a variety of applications, from architecture to aerospace science. While deployment from a small, regular shape to a larger one is easy to design, we focus on a more challenging task: designing a planar scissor structure that deploys from a given source shape into a specific target shape. We propose a two-step constructive method to generate a scissor structure from a high-dimensional parameter space. Topology construction of the scissor structure is first performed to approximate the two given shapes, as well as to guarantee the deployment. Then the geometry of the scissor structure is optimized in order to minimize the connection deflections and maximize the shape approximation. With the optimized parameters, the deployment can be simulated by controlling an anchor scissor unit. Physical deployable objects are fabricated according to the designed scissor structures by using 3D printing or manual assembly. We show a number of results for different shapes to demonstrate that even with fabrication errors, our designed structures can deform fluently between the source and target shapes.

  2. Structured Course Objects in a Digital Library

    NASA Technical Reports Server (NTRS)

    Maly, K.; Zubair, M.; Liu, X.; Nelson, M.; Zeil, S.

    1999-01-01

    We are developing an Undergraduate Digital Library Framework (UDLF) that will support creation/archiving of courses and reuse of existing course material to evolve courses. UDLF supports the publication of course materials for later instantiation for a specific offering and allows the addition of time-dependent and student-specific information and structures. Instructors and, depending on permissions, students can access the general course materials or the materials for a specific offering. We are building a reference implementation based on NCSTRL+, a digital library derived from NCSTRL. Digital objects in NCSTRL+ are called buckets, self-contained entities that carry their own methods for access and display. Current bucket implementations have a two level structure of packages and elements. This is not a rich enough structure for course objects in UDLF. Typically, courses can only be modeled as a multilevel hierarchy and among different courses, both the syntax and semantics of terms may vary. Therefore, we need a mechanism to define, within a particular library, course models, their constituent objects, and the associated semantics in a flexible, extensible way. In this paper, we describe our approach to define and implement these multilayered course objects. We use XML technology to emulate complex data structures within the NCSTRL+ buckets. We have developed authoring and browsing tools to manipulate these course objects. In our current implementation a user downloading an XML based course bucket also downloads the XML-aware tools: an applet that enables the user to edit or browse the bucket. We claim that XML provides an effective means to represent multi-level structure of a course bucket.

  3. Evaluation of a Problem-based Learning Workshop Using Pre- and Post-test Objective Structured Clinical Examinations and Standardized Patients.

    ERIC Educational Resources Information Center

    Davis, Paul; Kvern, Brent; Donen, Neil; Andrews, Elaine; Nixon, Olga

    2000-01-01

    Pre/posttest data on 40 physicians who completed problem-based clinical scenarios on osteoporosis revealed that 39 showed improvement or modest change in postworkshop scores, especially in terms of management of male patients, determination of risk factors, and use and interpretation of bone density tests. (SK)

  4. An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE).

    PubMed

    Paul, Fiona

    2010-09-01

    Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice.

  5. Search Path Evaluation Incorporating Object Placement Structure

    DTIC Science & Technology

    2007-12-20

    discussed. The application of this theoretical foundation and the numerical methods to other search paradigms Is also discussed. 14. SUBJECT TERMS 15... paradigms , object detection is said to occur with probability PD if it occurs anywhere within a predefined temporal interval or spatial region...distinctive the pattern is, the more interdependent the object placements become. Continue with the paradigm of placing the set M of NM known objects in the

  6. Improving International Research with Clinical Specimens: 5 Achievable Objectives

    PubMed Central

    LaBaer, Joshua

    2012-01-01

    Our increased interest in translational research has created a large demand for blood, tissue and other clinical samples, which find use in a broad variety of research including genomics, proteomics, and metabolomics. Hundreds of millions of dollars have been invested internationally on the collection, storage and distribution of samples. Nevertheless, many researchers complain in frustration about their inability to obtain relevant and/or useful samples for their research. Lack of access to samples, poor condition of samples, and unavailability of appropriate control samples have slowed our progress in the study of diseases and biomarkers. In this editorial, I focus on five major challenges that thwart clinical sample use for translational research and propose near term objectives to address them. They include: (1) defining our biobanking needs; (2) increasing the use of and access to standard operating procedures; (3) mapping inter-observer differences for use in normalizing diagnoses; (4) identifying natural internal protein controls; and (5) redefining the clinical sample paradigm by building partnerships with the public. In each case, I believe that we have the tools at hand required to achieve the objective within 5 years. Potential paths to achieve these objectives are explored. However we solve these problems, the future of proteomics depends on access to high quality clinical samples, collected under standardized conditions, accurately annotated and shared under conditions that promote the research we need to do. PMID:22998582

  7. Transforming Clinical Imaging Data for Virtual Reality Learning Objects

    ERIC Educational Resources Information Center

    Trelease, Robert B.; Rosset, Antoine

    2008-01-01

    Advances in anatomical informatics, three-dimensional (3D) modeling, and virtual reality (VR) methods have made computer-based structural visualization a practical tool for education. In this article, the authors describe streamlined methods for producing VR "learning objects," standardized interactive software modules for anatomical sciences…

  8. In pursuit of objective dry eye screening clinical techniques.

    PubMed

    Kanellopoulos, Anastasios John; Asimellis, George

    2016-01-01

    Dry eye is a multifactorial, progressive, and chronic disease of the tears and ocular surface. The disease is multi-factorial and has intermittent symptoms. Discomfort, visual disturbance, tear film instability with potential damage to the ocular surface, and increased tear film osmolarity are known associates. Dry eye is a common clinical problem for eye-care providers worldwide and there is a large number of clinical investigative techniques for the evaluation of dry eye. Despite this, however, there is no globally accepted guideline for dry eye diagnosis and none of the available tests may hold the title of the 'gold standard'. The majority of the techniques involved in the diagnosis of the disease, particularly for its early stages, has a large degree of subjectivity. The purpose of this article is to review existing dry eye investigative techniques and to present a new objective dry eye screening technique based on optical coherence tomography.

  9. Method for preventing micromechanical structures from adhering to another object

    DOEpatents

    Smith, J.H.; Ricco, A.J.

    1998-06-16

    A method for preventing micromechanical structures from adhering to another object includes the step of immersing a micromechanical structure and its associated substrate in a chemical species that does not stick to itself. The method can be employed during the manufacture of micromechanical structures to prevent micromechanical parts from sticking or adhering to one another and their associated substrate surface. 3 figs.

  10. Dystonia in childhood: clinical and objective measures and functional implications.

    PubMed

    Pavone, Larissa; Burton, Justin; Gaebler-Spira, Deborah

    2013-03-01

    Dystonia is a complex movement disorder that is challenging to identify and quantify. The aim of this article is to review the clinical scales, kinematic measures, and functional implications of dystonia. Clinical measures include the Barry-Albright Dystonia Scale, the Burke-Fahn-Marsden Movement Scale, the Unified Dystonia Rating Scale, the Global Dystonia Rating Scale, and the Movement Disorder-Childhood Rating Scale. The evidence, reliability, and validity of each scale will be outlined. The Hypertonia Assessment Tool will be discussed emphasizing the importance of discriminating hypertonia. The role of kinematic measures in analyzing dystonia will be explored, as well as the potential for its future clinical applications.

  11. Measuring venous insufficiency objectively in the clinical setting.

    PubMed

    Kelechi, Teresa J; Bonham, Phyllis A

    2008-09-01

    The purpose of this article is to propose a screening procedure to assess venous insufficiency with a hand-held photoplethysmography (PPG) instrument in the clinical setting. PPG is noninvasive technology that is used as part of venous assessment of the lower extremities. Although duplex ultrasound remains the industry gold standard for assessment, there are many situations in which access or expertise is not available. The measurement of venous refill time with PPG, one measure of venous insufficiency, is becoming increasingly more prevalent in research settings; however, PPG is underused in clinical settings. Rapid venous refill time clinical settings as a screening mechanism may provide useful data to augment diagnostic and therapeutic decision making. Future research is needed to establish a best-practice guideline for venous assessment in clinical settings to validate using PPG.

  12. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

    PubMed Central

    Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-01-01

    Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

  13. Detection and location of metallic objects imbedded in nonmetallic structures

    NASA Technical Reports Server (NTRS)

    Brown, R. L.; Neuschaefer, R. W.

    1968-01-01

    Small battery operated eddy current proximity measuring device detects and locates metal objects the size of a dime at distances up to one foot within nonmetallic structures. This device weighs approximately two pounds, occupies approximately 60 cubic inches, and is battery powered.

  14. Auditing clinical research data: objectives, applications and results.

    PubMed

    Justice, R L

    1983-01-01

    Formal auditing of clinical research data has become a standard contemporary practice within the pharmaceutical industry. Its basic purpose is to provide documentation relevant to an assessment of the quality and integrity of data collected in the course of a clinical trial. This paper outlines the audit procedures developed within one major pharmaceutical firm. These procedures require an intensive investigation of internal and external aspects of study management, records management, data entry, data analysis and statistical report preparation. A qualitative evaluation of the results achieved by this auditing procedure are presented.

  15. Hierarchical object parsing from structured noisy point clouds.

    PubMed

    Barbu, Adrian

    2013-07-01

    Object parsing and segmentation from point clouds are challenging tasks because the relevant data is available only as thin structures along object boundaries or other features, and is corrupted by large amounts of noise. To handle this kind of data, flexible shape models are desired that can accurately follow the object boundaries. Popular models such as active shape and active appearance models (AAMs) lack the necessary flexibility for this task, while recent approaches such as the recursive compositional models make model simplifications to obtain computational guarantees. This paper investigates a hierarchical Bayesian model of shape and appearance in a generative setting. The input data is explained by an object parsing layer which is a deformation of a hidden principal component analysis (PCA) shape model with Gaussian prior. The paper also introduces a novel efficient inference algorithm that uses informed data-driven proposals to initialize local searches for the hidden variables. Applied to the problem of object parsing from structured point clouds such as edge detection images, the proposed approach obtains state-of-the-art parsing errors on two standard datasets without using any intensity information.

  16. Object-oriented structures supporting remote sensing databases

    NASA Technical Reports Server (NTRS)

    Wichmann, Keith; Cromp, Robert F.

    1995-01-01

    Object-oriented databases show promise for modeling the complex interrelationships pervasive in scientific domains. To examine the utility of this approach, we have developed an Intelligent Information Fusion System based on this technology, and applied it to the problem of managing an active repository of remotely-sensed satellite scenes. The design and implementation of the system is compared and contrasted with conventional relational database techniques, followed by a presentation of the underlying object-oriented data structures used to enable fast indexing into the data holdings.

  17. Efficient Exact Inference With Loss Augmented Objective in Structured Learning.

    PubMed

    Bauer, Alexander; Nakajima, Shinichi; Muller, Klaus-Robert

    2016-08-19

    Structural support vector machine (SVM) is an elegant approach for building complex and accurate models with structured outputs. However, its applicability relies on the availability of efficient inference algorithms--the state-of-the-art training algorithms repeatedly perform inference to compute a subgradient or to find the most violating configuration. In this paper, we propose an exact inference algorithm for maximizing nondecomposable objectives due to special type of a high-order potential having a decomposable internal structure. As an important application, our method covers the loss augmented inference, which enables the slack and margin scaling formulations of structural SVM with a variety of dissimilarity measures, e.g., Hamming loss, precision and recall, Fβ-loss, intersection over union, and many other functions that can be efficiently computed from the contingency table. We demonstrate the advantages of our approach in natural language parsing and sequence segmentation applications.

  18. Remote object recognition by analysis of surface structure

    NASA Astrophysics Data System (ADS)

    Wurster, J.; Stark, H.; Olsen, E. T.; Kogler, K.

    1995-06-01

    We present a new algorithm for the discrimination of remote objects by their surface structure. Starting from a range-azimuth profile function, we formulate a range-azimuth matrix whose largest eigenvalues are used as discriminating features to separate object classes. A simpler, competing algorithm uses the number of sign changes in the range-azimuth profile function to discriminate among classes. Whereas both algorithms work well on noiseless data, an experiment involving real data shows that the eigenvalue method is far more robust with respect to noise than is the sign-change method. Two well-known methods based on surface structure, variance, and fractal dimension were also tested on real data. Neither method furnished the aspect invariance and the discriminability of the eigenvalue method.

  19. The objective structured interview for medical student selection

    PubMed Central

    Powis, D A; Neame, R L B; Bristow, T; Murphy, L B

    1988-01-01

    An objective structured interview is an integral part of the process of selecting and admitting applicants to study medicine at this university. During the nine years (to the end of 1986) that the interview has been used 1600 candidates were interviewed out of roughly 13 000 applicants, and from these, 584 students were admitted to the course. Analysis of the interview data was carried out based on two aspects of student progress: graduation with honours and failure to complete the course of study. The interview as a whole, and especially some of the subscales, appears to identify students who may fail to complete the course: it may also help to predict which students are likely to graduate with honours. PMID:3126966

  20. Tradeoff-based optimization criteria in clinical trials with multiple objectives and adaptive designs.

    PubMed

    Dmitrienko, Alex; Paux, Gautier; Pulkstenis, Erik; Zhang, Jianliang

    2016-01-01

    The article discusses clinical trial optimization problems in the context of mid- to late-stage drug development. Using the Clinical Scenario Evaluation approach, main objectives of clinical trial optimization are formulated, including selection of clinically relevant optimization criteria, identification of sets of optimal and nearly optimal values of the parameters of interest, and sensitivity assessments. The paper focuses on a class of optimization criteria arising in clinical trials with several competing goals, termed tradeoff-based optimization criteria, and discusses key considerations in constructing and applying tradeoff-based criteria. The clinical trial optimization framework considered in the paper is illustrated using two case studies based on a clinical trial with multiple objectives and a two-stage clinical trial which utilizes adaptive decision rules.

  1. Clinical simulation as a boundary object in design of health IT-systems.

    PubMed

    Rasmussen, Stine Loft; Jensen, Sanne; Lyng, Karen Marie

    2013-01-01

    Healthcare organizations are very complex, holding numerous stakeholders with various approaches and goals towards the design of health IT-systems. Some of these differences may be approached by applying the concept of boundary objects in a participatory IT-design process. Traditionally clinical simulation provides the opportunity to evaluate the design and the usage of clinical IT-systems without endangering the patients and interrupting clinical work. In this paper we present how clinical simulation additionally holds the potential to function as a boundary object in the design process. The case points out that clinical simulation provides an opportunity for discussions and mutual learning among the various stakeholders involved in design of standardized electronic clinical documentation templates. The paper presents and discusses the use of clinical simulation in the translation, transfer and transformation of knowledge between various stakeholders in a large healthcare organization.

  2. Subjective - Objective Sleep Comparisons and Discrepancies Among Clinically-Anxious and Healthy Children.

    PubMed

    Alfano, Candice A; Patriquin, Michelle A; De Los Reyes, Andres

    2015-10-01

    We compared subjective and objective sleep patterns and problems, and examined cross-method correspondence across parent reports, child reports, and actigraphy-derived sleep variables in clinically-anxious children and healthy controls. In a multi-site, cross-sectional study, 75 pre-adolescent children (6 to 11 years; M = 8.7 years; SD = 1.4; n = 39/52 % female) were examined including 39 with a diagnosis of primary generalized anxiety disorder (GAD) and 36 controls recruited from university-based clinics in Houston, TX and Washington, DC. Structured interviews, validated sleep questionnaires, and 1 week of actigraphy data were utilized. Despite subjective reports of significantly greater sleep problems among anxious children, actigraphy data revealed no significant differences between the groups. All parents estimated earlier bedtimes and greater total sleep duration relative to actigraphy, and all children endorsed more sleep problems than parents. With few exceptions, subjective reports exhibited low and non-significant correspondence with actigraphy-based sleep patterns and problems. Our findings suggest that high rates of sleep complaints found among children with GAD (and their parents) are not corroborated by objective sleep abnormalities, with the exception of marginally prolonged sleep onset latency compared to controls. Objective-subjective sleep discrepancies were observed in both groups but more apparent overall in the GAD group. Frequent complaints of sleep problems and daytime tiredness among anxious youth might more accurately reflect difficulties prior to the actual sleep period, cognitive-affective biases associated with sleep, and/or poor sleep quality. Findings highlight the importance of considering sleep from multiple perspectives.

  3. Structure and Evolution of Kuiper Belt Objects and Dwarf Planets

    NASA Astrophysics Data System (ADS)

    McKinnon, W. B.; Prialnik, D.; Stern, S. A.; Coradini, A.

    Kuiper belt objects (KBOs) accreted from a mélange of volatile ices, carbonaceous matter, and rock of mixed interstellar and solar nebular provenance. The transneptunian region, where this accretion took place, was likely more radially compact than today. This and the influence of gas drag during the solar nebula epoch argue for more rapid KBO accretion than usually considered. Early evolution of KBOs was largely the result of heating due to radioactive decay, the most important potential source being 26Al, whereas long-term evolution of large bodies is controlled by the decay of U, Th, and 40K. Several studies are reviewed dealing with the evolution of KBO models, calculated by means of one-dimensional numerical codes that solve the heat and mass balance equations. It is shown that, depending on parameters (principally rock content and porous conductivity), KBO interiors may have reached relatively high temperatures. The models suggest that KBOs likely lost ices of very volatile species during early evolution, whereas ices of less-volatile species should be retained in cold, less-altered subsurface layers. Initially amorphous ice may have crystallized in KBO interiors, releasing volatiles trapped in the amorphous ice, and some objects may have lost part of these volatiles as well. Generally, the outer layers are far less affected by internal evolution than the inner part, which in the absence of other effects (such as collisions) predicts a stratified composition and altered porosity distribution. Kuiper belt objects are thus unlikely to be "the most pristine objects in the solar system," but they do contain key information as to how the early solar system accreted and dynamically evolved. For large (dwarf planet) KBOs, long-term radiogenic heating alone may lead to differentiated structures -- rock cores, ice mantles, volatile-ice-rich "crusts," and even oceans. Persistence of oceans and (potential) volcanism to the present day depends strongly on body size and

  4. Assessment for learning with Objectively Structured Practical Examination in Biochemistry

    PubMed Central

    Jaswal, Shivani; Chattwal, Jugesh; Kaur, Jasbinder; Gupta, Seema; Singh, Tejinder

    2015-01-01

    Context: Despite a radical shift in assessment methodologies over the last decade, the majority of medical colleges still follow the Traditional Practical Examination (TPE). TPE raises concerns about examiner variability, standardization, and uniformity of assessment. To address these issues and in line with the notion of assessments as motivating what and how students learn, Objectively Structured Practical Examination (OSPE) was introduced, as an assessment modality. Despite its usefulness, awareness and motivation to use the same, still needs to be probed. Aims: To implement OSPE in the assessment of practical skills in biochemistry, and to know student and faculty perspectives regarding OSPE. Settings and Design: OSPE was introduced at the stage of formative assessment of practical skills, for 94 year one MBBS students. Subjects and Methods: Students were divided into two groups; the first group was evaluated by the traditional method and the second by OSPE. Students were crossed over on a second examination. The mean score obtained by both the methods was compared statistically. Students and faculty perspectives regarding OSPE were obtained by a questionnaire. Student performance was compared using “Bland–Altman technique,” and Student's t-test. Results: The mean scores of students was found to be significantly higher (P < 0.0001) when assessed with OSPE as compared to TPE. Number of students achieving >70% marks was also significantly higher with OSPE. Validity was supported by a significant correlation coefficient of comparison of marks by the two methods. Feedback from students and faculty indicated that they endorsed OSPE. Conclusions: This evaluation demonstrated the need for a structured approach to assessment. Going in line with the notion that assessment drives learning, introducing OSPE would help tailoring teaching-learning to optimize student satisfaction and learning. PMID:26380217

  5. Reconstruction of buried objects embedded in circular opaque structures

    NASA Astrophysics Data System (ADS)

    Persico, Raffaele; Gennarelli, Gianluca; Soldovieri, Francesco

    2014-05-01

    This contribution deals with the ground penetrating radar imaging of targets embedded in a visually opaque circular structure. The problem has practical relevance in civil engineering and archeological prospections, where structures of interest such as columns or pillars may have to be inspected in non-invasive way in order to detect the possible presence of anomalies (e.g. cracks, water infiltrations, and so on). In this framework, we investigate the possibility to inspect the circular region of interest thanks to a radar system composed by two antennas that are in contact with the structure and rotate simultaneously around it in order to illuminate and measure the field scattered by buried objects from multiple directions. Two different measurement strategies are examined. The first one is the multimonostatic configuration where the backscattered signal is collected by the transmitting antenna itself, as it moves along the circular observation line. The second acquisition strategy is the multibistatic one, with the transmitting and receiving antennas shifted by a constant angular offset of ninety degrees as they move around the column. From the mathematical viewpoint, the imaging problem is formulated as a linear inverse scattering one holding under Born approximation [1]. Furthermore, the Green's function of a homogeneous medium [2] is used to simplify the evaluation of the kernel of the integral equation. The inverse problem is then solved via the Truncated Singular Value Decomposition algorithm [3] in order to obtain a regularized solution. Tomographic reconstructions based on full-wave synthetic data generated by the Finite Difference Time Domain code GPRmax2D [4] are shown to assess the effectiveness of the reconstruction process. REFERENCES [1] W. C. Chew, Waves and fields in inhomogeneous media, IEEE Press, 1995. [2] R. F. Harrington, Time harmonic electromagnetic waves, McGraw-Hill, New York, USA, 1961. [3] M. Bertero and P. Boccacci, Introduction to

  6. The Development of Clinical Reasoning Skills: A Major Objective of the Anatomy Course

    ERIC Educational Resources Information Center

    Elizondo-Omana, Rodrigo E.; Lopez, Santos Guzman

    2008-01-01

    Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives:…

  7. Rapid Changes in the Structure of the BN Object

    NASA Technical Reports Server (NTRS)

    Danchi, William C.; Gezari, D. Y.; Greenhill, L. J.; Najita, J.; Monnier, J. D.; Tuthill, P. G.; Wishnow, E. H.; Townes, C. H.; Fisher, Richard R. (Technical Monitor)

    2001-01-01

    The BN/KL region in Orion is the archetypal region of high-mass star formation, radiating approx. 10(sup)5 Lsun and displaying promininent bulk outflows. In particular, there is no certain identification of the sources responsible for the high luminosity and outflows, and is the origin of a major explosive event (Shultz et al. 1999, ApJ, 511, 282). Using 18.7 and 12.5 micron data from observations in December 1999 and October 2000 made at the Keck I telescope, we discovered that the BN Object has a companion previously seen only at radio wavelengths (Menten & Reid 1995, ApJ, 445, L157). We call this companion B2 and it is about 1.5 arcsec West of the bright component. We also see changes in the shape of BN and the emission of "blobs" or "bullets" of material. While B2 remains unchanged and in the same place between the two epochs, there is an additional structure in BN to the South-South-East and the North-East, as well as a finger of material pointing North from B2 itself. Such a change has not been seen before in the infrared. We have looked very carefully at these images, calibrator images taken within a few minutes of the source images, as well as our previous images and cannot find any technical faults with the data. We explore the implications of these results, in particular, can these features be connected with previously observed "bullets" or "fingers" (see Allen & Burton 1993, for example), making BN a source for the bullets, implying they are not from IRc2 as previously thought? Or could they be produced by an interaction between material from BN and other sources such as IRc2?

  8. [Conscientious objection in the clinical setting. A proposal for its appropriate use].

    PubMed

    Couceiro, A; Seoane, J A; Hernando, P

    2011-01-01

    Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic.

  9. Hopf-algebraic structure of combinatorial objects and differential operators

    NASA Technical Reports Server (NTRS)

    Grossman, Robert; Larson, Richard G.

    1989-01-01

    A Hopf-algebraic structure on a vector space which has as basis a family of trees is described. Some applications of this structure to combinatorics and to differential operators are surveyed. Some possible future directions for this work are indicated.

  10. What is an Objective Structured Practical Examination in Anatomy?

    ERIC Educational Resources Information Center

    Yaqinuddin, Ahmed; Zafar, Muhammad; Ikram, Muhammad Faisal; Ganguly, Paul

    2013-01-01

    Assessing teaching-learning outcomes in anatomical knowledge is a complex task that requires the evaluation of multiple domains: theoretical, practical, and clinical knowledge. In general, theoretical knowledge is tested by a written examination system constituted by multiple choice questions (MCQs) and/or short answer questions (SAQ). The…

  11. A new standardized set of ecological pictures for experimental and clinical research on visual object processing.

    PubMed

    Viggiano, Maria Pia; Vannucci, Manila; Righi, Stefania

    2004-06-01

    A new set of 174 pictures in black-and-white, coloured and spatially filtered versions, taken from photographs of real objects belonging to different semantic categories, was realised for experimental and clinical research on visual object processing. Two samples, one of English speakers and one of Italian speakers, were tested in order to provide the normative data for each picture, in both black-and-white and coloured versions, in relation to familiarity, visual complexity and name agreement.

  12. Optical imaging via biological object internal structure contrasting

    NASA Astrophysics Data System (ADS)

    Podgaetsky, Vitaly M.; Tereshchenko, Sergei A.; Vorobiev, Nikolai S.; Tomilova, Larisa G.; Smirnov, Alexander V.; Ivanov, Andrei V.

    1995-01-01

    For successful application of laser tomography methods for earlier medical diagnostics the signal-to-noise ratio (contrast) must be increased. For this purpose it is possible to use the absorbing dyes. We have theoretically investigated optical imaging conditions in high scattering medium on a model object. In our experiments a YAG:Nd laser generating picosecond pulses was employed. Output radiation has been recorded by a high speed streak camera with 1.5 ps temporal resolution. The high stability of the laser and of measurement scheme characteristics was provided. We looked for the contrasting substances having tropism with pathologically changed tissue of the tumor. For this purpose some dyphthalocyanines were synthesized. The experiments with laboratory animals have demonstrated that saturated dye concentrations were noticeably lower than toxicologic dangerous concentration values. We have demonstrated a possibility of the contrasting for a model object. The experimental temporal profile of scattered radiation can be explained by the nonstationary two-flow theory.

  13. 3D genome structure modeling by Lorentzian objective function.

    PubMed

    Trieu, Tuan; Cheng, Jianlin

    2016-11-29

    The 3D structure of the genome plays a vital role in biological processes such as gene interaction, gene regulation, DNA replication and genome methylation. Advanced chromosomal conformation capture techniques, such as Hi-C and tethered conformation capture, can generate chromosomal contact data that can be used to computationally reconstruct 3D structures of the genome. We developed a novel restraint-based method that is capable of reconstructing 3D genome structures utilizing both intra-and inter-chromosomal contact data. Our method was robust to noise and performed well in comparison with a panel of existing methods on a controlled simulated data set. On a real Hi-C data set of the human genome, our method produced chromosome and genome structures that are consistent with 3D FISH data and known knowledge about the human chromosome and genome, such as, chromosome territories and the cluster of small chromosomes in the nucleus center with the exception of the chromosome 18. The tool and experimental data are available at https://missouri.box.com/v/LorDG.

  14. A component-based, distributed object services architecture for a clinical workstation.

    PubMed Central

    Chueh, H. C.; Raila, W. F.; Pappas, J. J.; Ford, M.; Zatsman, P.; Tu, J.; Barnett, G. O.

    1996-01-01

    Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces. PMID:8947744

  15. Language structure in the n -object naming game

    NASA Astrophysics Data System (ADS)

    Lipowski, Adam; Lipowska, Dorota

    2009-11-01

    We examine a naming game with two agents trying to establish a common vocabulary for n objects. Such efforts lead to the emergence of language that allows for an efficient communication and exhibits some degree of homonymy and synonymy. Although homonymy reduces the communication efficiency, it seems to be a dynamical trap that persists for a long, and perhaps indefinite, time. On the other hand, synonymy does not reduce the efficiency of communication but appears to be only a transient feature of the language. Thus, in our model the role of synonymy decreases and in the long-time limit it becomes negligible. A similar rareness of synonymy is observed in present natural languages. The role of noise, that distorts the communicated words, is also examined. Although, in general, the noise reduces the communication efficiency, it also regroups the words so that they are more evenly distributed within the available “verbal” space.

  16. Structuring Clinical Workflows for Diabetes Care

    PubMed Central

    Lasierra, N.; Oberbichler, S.; Toma, I.; Fensel, A.; Hoerbst, A.

    2014-01-01

    Summary Background Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows. Objectives The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes. Methods A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns. Results This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts. Conclusions The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view. PMID:25024765

  17. Organizational and Spatial Dynamics of Attentional Focusing in Hierarchically Structured Objects

    ERIC Educational Resources Information Center

    Yeari, Menahem; Goldsmith, Morris

    2011-01-01

    Is the focusing of visual attention object-based, space-based, both, or neither? Attentional focusing latencies in hierarchically structured compound-letter objects were examined, orthogonally manipulating global size (larger vs. smaller) and organizational complexity (two-level structure vs. three-level structure). In a dynamic focusing task,…

  18. GELLO: An Object-Oriented Query and Expression Language for Clinical Decision Support

    PubMed Central

    Sordo, Margarita; Ogunyemi, Omolola; Boxwala, Aziz A.; Greenes, Robert A.

    2003-01-01

    GELLO is a purpose-specific, object-oriented (OO) query and expression language [1]. GELLO is the result of a concerted effort of the Decision Systems Group (DSG) working with the HL7 Clinical Decision Support Technical Committee (CDSTC) to provide the HL7 community with a common format for data encoding and manipulation. GELLO will soon be submitted for ballot to the HL7 CDSTC for consideration as a standard. PMID:14728515

  19. Implementation of virtual medical record object model for a standards-based clinical decision support rule engine.

    PubMed

    Huang, Christine; Noirot, Laura A; Heard, Kevin M; Reichley, Richard M; Dunagan, Wm Claiborne; Bailey, Thomas C

    2006-01-01

    The Virtual Medical Record (vMR) is a structured data model for representing individual patient informations. Our implementation of vMR is based on HL7 Reference Information Model (RIM) v2.13 from which a minimum set of objects and attributes are selected to meet the requirement of a clinical decision support (CDS) rule engine. Our success of mapping local patient data to the vMR model and building a vMR adaptor middle layer demonstrate the feasibility and advantages of implementing a vMR in a portable CDS solution.

  20. Drawing skill is related to the efficiency of encoding object structure

    PubMed Central

    Perdreau, Florian; Cavanagh, Patrick

    2014-01-01

    Accurate drawing calls on many skills beyond simple motor coordination. A good internal representation of the target object's structure is necessary to capture its proportion and shape in the drawing. Here, we assess two aspects of the perception of object structure and relate them to participants' drawing accuracy. First, we assessed drawing accuracy by computing the geometrical dissimilarity of their drawing to the target object. We then used two tasks to evaluate the efficiency of encoding object structure. First, to examine the rate of temporal encoding, we varied presentation duration of a possible versus impossible test object in the fovea using two different test sizes (8° and 28°). More skilled participants were faster at encoding an object's structure, but this difference was not affected by image size. A control experiment showed that participants skilled in drawing did not have a general advantage that might have explained their faster processing for object structure. Second, to measure the critical image size for accurate classification in the periphery, we varied image size with possible versus impossible object tests centered at two different eccentricities (3° and 8°). More skilled participants were able to categorise object structure at smaller sizes, and this advantage did not change with eccentricity. A control experiment showed that the result could not be attributed to differences in visual acuity, leaving attentional resolution as a possible explanation. Overall, we conclude that drawing accuracy is related to faster encoding of object structure and better access to crowded details. PMID:25469216

  1. Drawing skill is related to the efficiency of encoding object structure.

    PubMed

    Perdreau, Florian; Cavanagh, Patrick

    2014-01-01

    Accurate drawing calls on many skills beyond simple motor coordination. A good internal representation of the target object's structure is necessary to capture its proportion and shape in the drawing. Here, we assess two aspects of the perception of object structure and relate them to participants' drawing accuracy. First, we assessed drawing accuracy by computing the geometrical dissimilarity of their drawing to the target object. We then used two tasks to evaluate the efficiency of encoding object structure. First, to examine the rate of temporal encoding, we varied presentation duration of a possible versus impossible test object in the fovea using two different test sizes (8° and 28°). More skilled participants were faster at encoding an object's structure, but this difference was not affected by image size. A control experiment showed that participants skilled in drawing did not have a general advantage that might have explained their faster processing for object structure. Second, to measure the critical image size for accurate classification in the periphery, we varied image size with possible versus impossible object tests centered at two different eccentricities (3° and 8°). More skilled participants were able to categorise object structure at smaller sizes, and this advantage did not change with eccentricity. A control experiment showed that the result could not be attributed to differences in visual acuity, leaving attentional resolution as a possible explanation. Overall, we conclude that drawing accuracy is related to faster encoding of object structure and better access to crowded details.

  2. [Clinical laboratory medicine: continuous amelioration with a book of objectives and satisfaction survey].

    PubMed

    Reix, Nathalie; Agin, Arnaud; Bahram, Seiamak; Dali-Youcef, Nassim; Grucker, Daniel; Jaulhac, Benoît; Lepiller, Quentin; Lessinger, Jean-Marc; Mauvieux, Laurent; Monier, Laurie; Schramm, Frédéric; Stoll-Keller, Françoise; Vallat, Laurent; Ludes, Bertrand; Candolfi, Ermanno; Filisetti, Denis

    2015-01-01

    We report in this publication the use of two educational tools, a questionnaire of satisfaction and a training book, to improve the training of students during their internship in clinical laboratory at the "Pôle de biologie des Hôpitaux universitaires de Strasbourg" in France. First, the ongoing training was assessed by the interns with a questionnaire measuring satisfaction. The analysis of this questionnaire identified four key points to improve: 1) define the teaching objectives, 2) organize the training with a schedule, 3) revise certain teaching methods and 4) ensure better integration of the students in the team of medical biologists. After this assessment, we implemented a training book to answer these four points. Indeed, the training book presents the objectives, the schedule of training, and how to validate the educational objectives. A new assessment was performed again using the same methodology. Results showed an improvement in student satisfaction from 74 to 88 %. The questionnaire of satisfaction and the training book are presented in this article. The aim of the assessment of training combined with the training book is to incite the actors of the training (students and teachers) to continually improve the training. The objectives of the Pôle de Biologie are to obtain an 80 % satisfaction rate during the 6 months trainings and to reduce or eliminate dissatisfaction, and finally to ensure the validation by students of 80 to 100 % of their predetermined objectives.

  3. 48 CFR 1815.404-471 - NASA structured approach for profit or fee objective.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false NASA structured approach for profit or fee objective. 1815.404-471 Section 1815.404-471 Federal Acquisition Regulations System... NEGOTIATION Contract Pricing 1815.404-471 NASA structured approach for profit or fee objective....

  4. Germ line genome editing in clinics: the approaches, objectives and global society

    PubMed Central

    2017-01-01

    Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed. PMID:26615180

  5. Germ line genome editing in clinics: the approaches, objectives and global society.

    PubMed

    Ishii, Tetsuya

    2017-01-01

    Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed.

  6. Multi-objective shape and material optimization of composite structures including damping

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Chamis, Christos C.

    1990-01-01

    A multi-objective optimal design methodology is developed for light-weight, low cost composite structures of improved dynamic performance. The design objectives include minimization of resonance amplitudes (or maximization of modal damping), weight, and material cost. The design vector includes micromechanics, laminate, and structural shape parameters. Performance constraints are imposed on static displacements, dynamic amplitudes, and natural frequencies. The effects of damping on the dynamics of composite structures are incorporated. Preliminary applications on a cantilever composite beam illustrated that only the proposed multi-objective optimization, as opposed to single objective functions, simultaneously improved all objectives. The significance of composite damping in the design of advanced composite structures was also demonstrated, indicating the design methods based on undamped dynamics may fail to improve the dynamic performance near resonances.

  7. Multi-objective shape and material optimization of composite structures including damping

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Chamis, C. C.

    1990-01-01

    A multi-objective optimal design methodology is developed for light-weight, low-cost composite structures of improved dynamic performance. The design objectives include minimization of resonance amplitudes (or maximization of modal damping), weight, and material cost. The design vector includes micromechanics, laminate, and structural shape parameters. Performance constraints are imposed on static displacements, dynamic amplitudes, and natural frequencies. The effects of damping on the dynamics of composite structures are incorporated. Preliminary applications on a cantilever composite beam illustrated that only the proposed multi-objective optimization, as opposed to single objective functions, simultaneously improved all objectives. The significance of composite damping in the design of advanced composite structures was also demonstrated, indicating that design methods based on undamped dynamics may fail to improve the dynamic performance near resonances.

  8. Loss of stored knowledge of object structure: implications for "category-specific" deficits.

    PubMed

    Turnbull, O H; Laws, K R

    2000-06-01

    Following a right-hemisphere lesion, the patient SM had impaired object recognition, with good elementary visual abilities, and could derive information about object structure. He was also impaired on all tasks tapping stored structural knowledge, even when tested in the verbal modality. This suggests that SM has a disorder affecting stored knowledge of object structure, though he remains able to assemble novel structural descriptions. His object recognition ability also appeared significantly worse for non-living things. By contrast, existing models relating to stored knowledge would predict that SM would show greater impairment with living things. We argue that SM's deficit reflects the loss of a type of structural knowledge that relates to the "within-item structural diversity" of items. It is argued that living things show less structural variation than objects in the natural world, and might arguably be easier to recognise, because the image of the to-be-recognised object would be similar to the stored representation. Hence, a deficit affecting this aspect of stored knowledge would differentially impact upon non-living things. This argument receives confirming independent support from the finding that normal subjects ratings for the within-item structural diversity of visual stimuli are (unlike other "critical" variables) significant predictors of SM's naming performance.

  9. Objective Bayesian fMRI analysis—a pilot study in different clinical environments

    PubMed Central

    Magerkurth, Joerg; Mancini, Laura; Penny, William; Flandin, Guillaume; Ashburner, John; Micallef, Caroline; De Vita, Enrico; Daga, Pankaj; White, Mark J.; Buckley, Craig; Yamamoto, Adam K.; Ourselin, Sebastien; Yousry, Tarek; Thornton, John S.; Weiskopf, Nikolaus

    2015-01-01

    Functional MRI (fMRI) used for neurosurgical planning delineates functionally eloquent brain areas by time-series analysis of task-induced BOLD signal changes. Commonly used frequentist statistics protect against false positive results based on a p-value threshold. In surgical planning, false negative results are equally if not more harmful, potentially masking true brain activity leading to erroneous resection of eloquent regions. Bayesian statistics provides an alternative framework, categorizing areas as activated, deactivated, non-activated or with low statistical confidence. This approach has not yet found wide clinical application partly due to the lack of a method to objectively define an effect size threshold. We implemented a Bayesian analysis framework for neurosurgical planning fMRI. It entails an automated effect-size threshold selection method for posterior probability maps accounting for inter-individual BOLD response differences, which was calibrated based on the frequentist results maps thresholded by two clinical experts. We compared Bayesian and frequentist analysis of passive-motor fMRI data from 10 healthy volunteers measured on a pre-operative 3T and an intra-operative 1.5T MRI scanner. As a clinical case study, we tested passive motor task activation in a brain tumor patient at 3T under clinical conditions. With our novel effect size threshold method, the Bayesian analysis revealed regions of all four categories in the 3T data. Activated region foci and extent were consistent with the frequentist analysis results. In the lower signal-to-noise ratio 1.5T intra-operative scanner data, Bayesian analysis provided improved brain-activation detection sensitivity compared with the frequentist analysis, albeit the spatial extents of the activations were smaller than at 3T. Bayesian analysis of fMRI data using operator-independent effect size threshold selection may improve the sensitivity and certainty of information available to guide neurosurgery

  10. Learning the 3-D structure of objects from 2-D views depends on shape, not format

    PubMed Central

    Tian, Moqian; Yamins, Daniel; Grill-Spector, Kalanit

    2016-01-01

    Humans can learn to recognize new objects just from observing example views. However, it is unknown what structural information enables this learning. To address this question, we manipulated the amount of structural information given to subjects during unsupervised learning by varying the format of the trained views. We then tested how format affected participants' ability to discriminate similar objects across views that were rotated 90° apart. We found that, after training, participants' performance increased and generalized to new views in the same format. Surprisingly, the improvement was similar across line drawings, shape from shading, and shape from shading + stereo even though the latter two formats provide richer depth information compared to line drawings. In contrast, participants' improvement was significantly lower when training used silhouettes, suggesting that silhouettes do not have enough information to generate a robust 3-D structure. To test whether the learned object representations were format-specific or format-invariant, we examined if learning novel objects from example views transfers across formats. We found that learning objects from example line drawings transferred to shape from shading and vice versa. These results have important implications for theories of object recognition because they suggest that (a) learning the 3-D structure of objects does not require rich structural cues during training as long as shape information of internal and external features is provided and (b) learning generates shape-based object representations independent of the training format. PMID:27153196

  11. Hierarchical organization in visual working memory: From global ensemble to individual object structure.

    PubMed

    Nie, Qi-Yang; Müller, Hermann J; Conci, Markus

    2017-02-01

    When remembering a natural scene, both detailed information about specific objects and summary representations such as the gist of a scene are encoded. However, formal models of change detection that are used to estimate working memory capacity, typically assume observers simply encode and maintain memory representations that are treated independently from one another without considering the (hierarchical) object or scene structure. To overcome this limitation, we present a hierarchical variant of the change detection task that attempts to formalize the role of object structure, thus, allowing for richer, more graded memory representations. We demonstrate that detection of a global-object change precedes local-object changes of hierarchical shapes to a large extent. Moreover, when systematically varying object repetitions between individual items at a global or a local level, memory performance declines mainly for repeated global objects, but not for repeated local objects, which suggests that ensemble (i.e., summary) representations are likewise biased toward a global level. In addition, this global memory precedence effect is shown to be independent from encoding durations, and mostly cannot be attributed to differences in saliency or shape discriminability at global/local object levels. This pattern of results is suggestive of a global/local difference occurring primarily during memory maintenance. Altogether, these findings challenge visual-working-memory (vWM) models that propose that a fixed number of objects can be remembered regardless of the individual object structure. Instead, our results support a hierarchical model that emphasizes the role for structured representations among objects in vWM.

  12. 30 CFR 77.403 - Mobile equipment; falling object protective structures (FOPS).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Mobile equipment; falling object protective... AREAS OF UNDERGROUND COAL MINES Safeguards for Mechanical Equipment § 77.403 Mobile equipment; falling... underground coal mines shall be provided with substantial falling object protective structures (FOPS)....

  13. Habit Reversal versus Object Manipulation Training for Treating Nail Biting: A Randomized Controlled Clinical Trial

    PubMed Central

    Ghanizadeh, Ahmad; Bazrafshan, Amir; Dehbozorgi, Gholamreza

    2013-01-01

    Objective This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature. Method Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n = 30), OMT (n = 30), and wait-list or control group (n = 31). The mean length of nail was considered as the main outcome. Results The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P < 0.001, P < 0.001, respectively). In long term, both OMT and HRT increased the mean length of nails (P < 0.01), but HRT was more effective than OMT (P < 0.021). The parent-reported frequency of nail biting did show similar results as to the mean length of nails assessment in long term. The number of children who completely stopped nail biting in HRT and OMT groups during three months was 8 and 7, respectively. This number was zero during one month for the wait-list group. Conclusion This trial showed that HRT is more effective than wait-list and OMT in increasing the mean length of nails of children and adolescents in long terms. PMID:24130603

  14. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy.

    PubMed

    Gherman; Goodwin; Leung; Byrne; Montoro

    1998-07-01

    Objective: To determine the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism (VTE).Methods: A retrospective review of VTE cases occurring between 1978 and 1996 was performed. Cases of deep venous thrombosis (DVT) and pulmonary embolism (PE) were identified by ICD-9 discharge diagnosis code and review of antepartum and coagulation laboratory databases. Study inclusion criteria required the objective diagnosis of VTE with either Doppler ultrasound, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or CT/MRI.Results: Among 268,525 deliveries there were 165 (0.06%) episodes of VTE (1/1627 births). There were 127 cases of DVT and 38 cases of PE. Only 14% (23/165) had a prior history of DVT or PE. Most DVTs occurred in the left leg (104/127, 81.9%). Nearly three quarters of the DVTs (95/127, 74.8%) occurred in the antepartum period. Among the antepartum DVT cases, half were detected prior to 15 weeks of gestation (47/95, 49.5%), with only 28 cases occurring after 20 weeks (P <.0001). The majority of the PEs occurred in the postpartum period (23/38, 60.5%). There were only 3 maternal deaths due to PE, all associated with cesarean section. Only 1 patient developed PE while on heparin therapy for DVT while 11 others had complications attributable to heparin use.Conclusion: Most pregnancy-related VTE occurs in the antepartum period. The risk of deep venous thrombosis appears to begin early in pregnancy, even before the second trimester. The highest risk period for pulmonary embolism is after cesarean delivery. Maternal complications of heparin anticoagulation during pregnancy are rare.

  15. Evaluating the Internal Structure of the Eysenck Personality Questionnaire: Objective Criteria.

    ERIC Educational Resources Information Center

    Helmes, Edward

    1989-01-01

    Objective criteria for evaluating the Eysenck Personality Inventory's internal structure are discussed. An approach based on targeted rotations and the test's scoring key is proposed as a means of providing common criteria. Data from earlier structure and test results for 195 undergraduates support the utility of 3 criteria developed. (SLD)

  16. Sub-diffraction phase-contrast imaging of transparent nano-objects by plasmonic lens structure.

    PubMed

    Yao, Na; Wang, Changtao; Tao, Xing; Wang, Yanqin; Zhao, Zeyu; Luo, Xiangang

    2013-04-05

    We propose a specially designed plasmonic lens structure to succeed in realizing sub-diffraction phase-contrast imaging of transparent nano-objects. The nano-objects are embedded inside the insulator layer of the metal-insulator-metal (MIM) plasmonic structure and have a small refractive index difference with respect to the transparent insulator layer. The excited surface plasmons in the MIM structure help to greatly enhance scattered light from the nano-objects and effectively suppress the transmitted illumination light. A spatial resolution of about 64 nm and a minimum distinguishable refractive index difference down to 0.05 are numerically demonstrated. For sub-diffraction phase-contrast imaging of irregular three-dimensional (3D) nanowires and nanocylinders, the optimized MIM structure shows much better performance in comparison with that of a superlens.

  17. ObStruct: a method to objectively analyse factors driving population structure using Bayesian ancestry profiles.

    PubMed

    Gayevskiy, Velimir; Klaere, Steffen; Knight, Sarah; Goddard, Matthew R

    2014-01-01

    Bayesian inference methods are extensively used to detect the presence of population structure given genetic data. The primary output of software implementing these methods are ancestry profiles of sampled individuals. While these profiles robustly partition the data into subgroups, currently there is no objective method to determine whether the fixed factor of interest (e.g. geographic origin) correlates with inferred subgroups or not, and if so, which populations are driving this correlation. We present ObStruct, a novel tool to objectively analyse the nature of structure revealed in Bayesian ancestry profiles using established statistical methods. ObStruct evaluates the extent of structural similarity between sampled and inferred populations, tests the significance of population differentiation, provides information on the contribution of sampled and inferred populations to the observed structure and crucially determines whether the predetermined factor of interest correlates with inferred population structure. Analyses of simulated and experimental data highlight ObStruct's ability to objectively assess the nature of structure in populations. We show the method is capable of capturing an increase in the level of structure with increasing time since divergence between simulated populations. Further, we applied the method to a highly structured dataset of 1,484 humans from seven continents and a less structured dataset of 179 Saccharomyces cerevisiae from three regions in New Zealand. Our results show that ObStruct provides an objective metric to classify the degree, drivers and significance of inferred structure, as well as providing novel insights into the relationships between sampled populations, and adds a final step to the pipeline for population structure analyses.

  18. Mid-fusiform activation during object discrimination reflects the process of differentiating structural descriptions.

    PubMed

    Liu, Xun; Steinmetz, Nicholas A; Farley, Alison B; Smith, Charles D; Joseph, Jane E

    2008-09-01

    The present study explored constraints on mid-fusiform activation during object discrimination. In three experiments, participants performed a matching task on simple line configurations, nameable objects, three dimensional (3-D) shapes, and colors. Significant bilateral mid-fusiform activation emerged when participants matched objects and 3-D shapes, as compared to when they matched two-dimensional (2-D) line configurations and colors, indicating that the mid-fusiform is engaged more strongly for processing structural descriptions (e.g., comparing 3-D volumetric shape) than perceptual descriptions (e.g., comparing 2-D or color information). In two of the experiments, the same mid-fusiform regions were also modulated by the degree of structural similarity between stimuli, implicating a role for the mid-fusiform in fine differentiation of similar visual object representations. Importantly, however, this process of fine differentiation occurred at the level of structural, but not perceptual, descriptions. Moreover, mid-fusiform activity was more robust when participants matched shape compared to color information using the identical stimuli, indicating that activity in the mid-fusiform gyrus is not driven by specific stimulus properties, but rather by the process of distinguishing stimuli based on shape information. Taken together, these findings further clarify the nature of object processing in the mid-fusiform gyrus. This region is engaged specifically in structural differentiation, a critical component process of object recognition and categorization.

  19. Determining the 3-D structure and motion of objects using a scanning laser range sensor

    NASA Astrophysics Data System (ADS)

    Nandhakumar, N.; Smith, Philip W.

    1993-12-01

    In order for the EVAHR robot to autonomously track and grasp objects, its vision system must be able to determine the 3-D structure and motion of an object from a sequence of sensory images. This task is accomplished by the use of a laser radar range sensor which provides dense range maps of the scene. Unfortunately, the currently available laser radar range cameras use a sequential scanning approach which complicates image analysis. Although many algorithms have been developed for recognizing objects from range images, none are suited for use with single beam, scanning, time-of-flight sensors because all previous algorithms assume instantaneous acquisition of the entire image. This assumption is invalid since the EVAHR robot is equipped with a sequential scanning laser range sensor. If an object is moving while being imaged by the device, the apparent structure of the object can be significantly distorted due to the significant non-zero delay time between sampling each image pixel. If an estimate of the motion of the object can be determined, this distortion can be eliminated; but, this leads to the motion-structure paradox - most existing algorithms for 3-D motion estimation use the structure of objects to parameterize their motions. The goal of this research is to design a rigid-body motion recovery technique which overcomes this limitation. The method being developed is an iterative, linear, feature-based approach which uses the non-zero image acquisition time constraint to accurately recover the motion parameters from the distorted structure of the 3-D range maps. Once the motion parameters are determined, the structural distortion in the range images is corrected.

  20. Structure and method for controlling the thermal emissivity of a radiating object

    DOEpatents

    DeSteese, John G.; Antoniak, Zenen I.; White, Michael; Peters, Timothy J.

    2004-03-30

    A structure and method for changing or controlling the thermal emissivity of the surface of an object in situ, and thus, changing or controlling the radiative heat transfer between the object and its environment in situ, is disclosed. Changing or controlling the degree of blackbody behavior of the object is accomplished by changing or controlling certain physical characteristics of a cavity structure on the surface of the object. The cavity structure, defining a plurality of cavities, may be formed by selectively removing material(s) from the surface, selectively adding a material(s) to the surface, or adding an engineered article(s) to the surface to form a new radiative surface. The physical characteristics of the cavity structure that are changed or controlled include cavity area aspect ratio, cavity longitudinal axis orientation, and combinations thereof. Controlling the cavity area aspect ratio may be by controlling the size of the cavity surface area, the size of the cavity aperture area, or a combination thereof. The cavity structure may contain a gas, liquid, or solid that further enhances radiative heat transfer control and/or improves other properties of the object while in service.

  1. Complex Network Clustering by a Multi-objective Evolutionary Algorithm Based on Decomposition and Membrane Structure

    NASA Astrophysics Data System (ADS)

    Ju, Ying; Zhang, Songming; Ding, Ningxiang; Zeng, Xiangxiang; Zhang, Xingyi

    2016-09-01

    The field of complex network clustering is gaining considerable attention in recent years. In this study, a multi-objective evolutionary algorithm based on membranes is proposed to solve the network clustering problem. Population are divided into different membrane structures on average. The evolutionary algorithm is carried out in the membrane structures. The population are eliminated by the vector of membranes. In the proposed method, two evaluation objectives termed as Kernel J-means and Ratio Cut are to be minimized. Extensive experimental studies comparison with state-of-the-art algorithms proves that the proposed algorithm is effective and promising.

  2. Complex Network Clustering by a Multi-objective Evolutionary Algorithm Based on Decomposition and Membrane Structure

    PubMed Central

    Ju, Ying; Zhang, Songming; Ding, Ningxiang; Zeng, Xiangxiang; Zhang, Xingyi

    2016-01-01

    The field of complex network clustering is gaining considerable attention in recent years. In this study, a multi-objective evolutionary algorithm based on membranes is proposed to solve the network clustering problem. Population are divided into different membrane structures on average. The evolutionary algorithm is carried out in the membrane structures. The population are eliminated by the vector of membranes. In the proposed method, two evaluation objectives termed as Kernel J-means and Ratio Cut are to be minimized. Extensive experimental studies comparison with state-of-the-art algorithms proves that the proposed algorithm is effective and promising. PMID:27670156

  3. Factor structure of the Spanish version of the Object-Spatial Imagery and Verbal Questionnaire.

    PubMed

    Campos, Alfredo; Pérez-Fabello, María José

    2011-04-01

    The reliability and factor structure of the Spanish version of the Object-Spatial Imagery and Verbal Questionnaire (OSIVQ) were assessed in a sample of 213 Spanish university graduates. The questionnaire measures three types of processing preferences (verbal, object imagery, and spatial imagery). Principal components analysis with varimax rotation identified three factors, corresponding to the three scales proposed in the original version, explaining 33.1% of the overall variance. Cronbach's alphas were .72, .77, and .81 for the verbal, object imagery, and spatial imagery scales, respectively.

  4. Cryo-EM structure of a 3D DNA-origami object

    PubMed Central

    Bai, Xiao-chen; Martin, Thomas G.; Scheres, Sjors H. W.; Dietz, Hendrik

    2012-01-01

    A key goal for nanotechnology is to design synthetic objects that may ultimately achieve functionalities known today only from natural macromolecular complexes. Molecular self-assembly with DNA has shown potential for creating user-defined 3D scaffolds, but the level of attainable positional accuracy has been unclear. Here we report the cryo-EM structure and a full pseudoatomic model of a discrete DNA object that is almost twice the size of a prokaryotic ribosome. The structure provides a variety of stable, previously undescribed DNA topologies for future use in nanotechnology and experimental evidence that discrete 3D DNA scaffolds allow the positioning of user-defined structural motifs with an accuracy that is similar to that observed in natural macromolecules. Thereby, our results indicate an attractive route to fabricate nanoscale devices that achieve complex functionalities by DNA-templated design steered by structural feedback. PMID:23169645

  5. Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment.

    PubMed

    Miller, S D W; Butler, M W; Meagher, F; Costello, R W; McElvaney, N G

    2007-03-01

    It can be challenging to teach and assess medical students successfully in the setting of a hospital ward using real patients. We describe a novel method of providing weekly formative clinical assessment and teaching to final year students on an acute medical ward: The Team Objective Structured Bedside Assessment (TOSBA). The TOSBA involves three groups of five students rotating through three ward-based stations (each station consists of an inpatient and facilitator). Each group spends 25 minutes at a bedside station where the facilitator asks consecutive students to perform one of five clinical tasks. Every student receives a standardised grade and is provided with educational feedback at each of the three stations. We report our 15-month experience using the TOSBA format to assess and teach a large number of medical students on a weekly basis. We discuss the advantages and potential drawbacks of our approach.

  6. Measurement of object structure from size-encoded images generated by optically-implemented Gabor filters.

    PubMed

    Sierra, Heidy; Zheng, Jing-Yi; Rabin, Bryan; Boustany, Nada N

    2012-12-17

    We use optical Fourier processing based on two dimensional (2D) Gabor filters to obtain size-encoded images which depict with 20nm sensitivity to size while preserving a 0.36μm spatial resolution, the spatial distribution of structural features within transparent objects. The size of the object feature measured at each pixel in the encoded image is determined by the optimal Gabor filter period, S(max), that maximizes the scattering signal from that location in the object. We show that S(max) (in μm) depends linearly on feature size (also in μm) over a size range from 0.11μm to 2μm. This linear response remains largely unchanged when the refractive index ratio is varied and can be predicted from numerical simulations of Gabor-filtered light scattering. Pixel histograms of the size-encoded images of isolated spheres and diatoms were used to generate highly resolved size distributions ("size spectra") exhibiting sharp peaks characterizing the known major structural features within the studied objects. Dynamic signal associated with changes in selected feature sizes within living cells is also demonstrated. Taken together, our data suggest that a label-free, direct and objective measurement of sample structure is enabled by the size-encoded images and associated pixel histograms generated from a calibrated optical processing microscope based on Gabor filtering.

  7. A Trial of the Objective Structured Practical Examination in Physiology at Melaka Manipal Medical College, India

    ERIC Educational Resources Information Center

    Abraham, Reem Rachel; Raghavendra, Rao; Surekha, Kamath; Asha, Kamath

    2009-01-01

    A single examination does not fulfill all the functions of assessment. The present study was undertaken to determine the reliability and student satisfaction regarding the objective structured practical examination (OSPE) as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university…

  8. 48 CFR 353.370-674 - Form HHS 674, Structured Approach Profit/Fee Objective.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Form HHS 674, Structured Approach Profit/Fee Objective. 353.370-674 Section 353.370-674 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS FORMS Illustrations of Forms 353.370-674 Form HHS...

  9. 48 CFR 353.370-674 - Form HHS 674, Structured Approach Profit/Fee Objective.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Form HHS 674, Structured Approach Profit/Fee Objective. 353.370-674 Section 353.370-674 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS FORMS Illustrations of Forms 353.370-674 Form HHS...

  10. 48 CFR 353.370-674 - Form HHS 674, Structured Approach Profit/Fee Objective.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Form HHS 674, Structured Approach Profit/Fee Objective. 353.370-674 Section 353.370-674 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS FORMS Illustrations of Forms 353.370-674 Form HHS...

  11. Design and Development of an Objective, Structured Management Examinations (OSMEs) on Management Skills among Pharmacy Students

    ERIC Educational Resources Information Center

    Augustine, Jill

    2016-01-01

    The purpose of this study was to design, develop, and administer an Objective, Structured Management Exam (OSME) on management skills for pharmacy students. Pharmacy preceptors for the University of Arizona College of Pharmacy participated in focus groups that identified business, management, and human resource skills needed by pharmacy graduates.…

  12. Orientation estimation of anatomical structures in medical images for object recognition

    NASA Astrophysics Data System (ADS)

    Bağci, Ulaş; Udupa, Jayaram K.; Chen, Xinjian

    2011-03-01

    Recognition of anatomical structures is an important step in model based medical image segmentation. It provides pose estimation of objects and information about "where" roughly the objects are in the image and distinguishing them from other object-like entities. In,1 we presented a general method of model-based multi-object recognition to assist in segmentation (delineation) tasks. It exploits the pose relationship that can be encoded, via the concept of ball scale (b-scale), between the binary training objects and their associated grey images. The goal was to place the model, in a single shot, close to the right pose (position, orientation, and scale) in a given image so that the model boundaries fall in the close vicinity of object boundaries in the image. Unlike position and scale parameters, we observe that orientation parameters require more attention when estimating the pose of the model as even small differences in orientation parameters can lead to inappropriate recognition. Motivated from the non-Euclidean nature of the pose information, we propose in this paper the use of non-Euclidean metrics to estimate orientation of the anatomical structures for more accurate recognition and segmentation. We statistically analyze and evaluate the following metrics for orientation estimation: Euclidean, Log-Euclidean, Root-Euclidean, Procrustes Size-and-Shape, and mean Hermitian metrics. The results show that mean Hermitian and Cholesky decomposition metrics provide more accurate orientation estimates than other Euclidean and non-Euclidean metrics.

  13. Differential visualisation of a spectrally selective structure of strongly scattering objects

    SciTech Connect

    Kuratov, A S; Rudenko, V N; Shuvalov, V V

    2014-07-31

    We describe a modification of the algorithm for the fast approximate solution of the diffuse optical tomography inverse problem. In this modification the amount of a priori (auxiliary) information necessary for the visualisation of the internal structure of the object is reduced by using a differential measurement scheme. The experiment is performed at two different wavelengths, and some a priori information, necessary to reconstruct only the spectrally selective component of the internal structure (the difference structure of the spatial distributions of the extinction coefficient at the wavelength employed), is replaced by the data of one of these measurements. (laser biophotonics)

  14. Data-Driven Hierarchical Structure Kernel for Multiscale Part-Based Object Recognition

    PubMed Central

    Wang, Botao; Xiong, Hongkai; Jiang, Xiaoqian; Zheng, Yuan F.

    2017-01-01

    Detecting generic object categories in images and videos are a fundamental issue in computer vision. However, it faces the challenges from inter and intraclass diversity, as well as distortions caused by viewpoints, poses, deformations, and so on. To solve object variations, this paper constructs a structure kernel and proposes a multiscale part-based model incorporating the discriminative power of kernels. The structure kernel would measure the resemblance of part-based objects in three aspects: 1) the global similarity term to measure the resemblance of the global visual appearance of relevant objects; 2) the part similarity term to measure the resemblance of the visual appearance of distinctive parts; and 3) the spatial similarity term to measure the resemblance of the spatial layout of parts. In essence, the deformation of parts in the structure kernel is penalized in a multiscale space with respect to horizontal displacement, vertical displacement, and scale difference. Part similarities are combined with different weights, which are optimized efficiently to maximize the intraclass similarities and minimize the interclass similarities by the normalized stochastic gradient ascent algorithm. In addition, the parameters of the structure kernel are learned during the training process with regard to the distribution of the data in a more discriminative way. With flexible part sizes on scale and displacement, it can be more robust to the intraclass variations, poses, and viewpoints. Theoretical analysis and experimental evaluations demonstrate that the proposed multiscale part-based representation model with structure kernel exhibits accurate and robust performance, and outperforms state-of-the-art object classification approaches. PMID:24808345

  15. The radio structure source of X-ray-selected BL Lacertae objects

    NASA Technical Reports Server (NTRS)

    Perlman, Eric S.; Stocke, John T.

    1993-01-01

    Arcsecond-size radio structure for a complete sample of 14 X-ray-selected BL Lac objects (XBLs) from the Einstein Extended Medium-Sensitivity Survey is presented. Most objects possess radio morphologies which are similar to those of nearby Fanaroff-Riley type 1 (FR 1) radio galaxies once the effects of surface brightness dimming and beam dilution as a function of redshift are taken into account. In order to test the beamed FR 1 hypothesis for BL Lac objects, the core and extended power levels are determined for these sources and compared with samples of radio-selected BL Lac objects (RBLs) and FR 1 from galaxies from the literature. RBLs and XBLs are found to possess extended (and thus unbeamed) power levels and the largest angular sizes similar to those of the FR 1 galaxies both supporting the beaming hypothesis and a common parent population for XBLs and RBLs.

  16. Dynamic structured illumination microscopy: Focused imaging and optical sectioning for moving objects

    NASA Astrophysics Data System (ADS)

    Krzewina, Leo G.; Kim, Myung K.

    2006-02-01

    Structured illumination microscopy (SIM) is a valuable tool for three-dimensional microscopy and has numerous applications in bioscience. Its success has been limited to static objects, though, as three sequential image acquisitions are required per final processed, focused image. To overcome this problem we have developed a multicolored grid which when used in tandem with a color camera is capable of performing SIM with just a single exposure. Images and movies demonstrating optical sectioning of three-dimensional objects are presented, and results of applying color SIM for wide-field focused imaging are compared to those of SIM. From computer modeling and analytical calculations a theoretical estimate of the maximum observable object velocity in both the lateral and axial directions is available, implying that the new method will be capable of imaging a variety of live objects. Sample images of the technique applied to lens paper and a pigeon feather are included to show both advantages and disadvantages of CSIM.

  17. DICOM Structured Reporting and Cancer Clinical Trials Results

    PubMed Central

    Clunie, David A

    2007-01-01

    The use of biomarkers derived from radiological images as surrogate end-points in therapeutic cancer clinical trials is well established. DICOM is the ubiquitous standard for the interchange of images for both clinical use as well as research. It also has capabilities for the exchange of image-related information, including categorical and quantitative information derived from images. The use of DICOM Structured Reporting for the encoding and interchange of clinical trial results in a standard manner is reviewed. PMID:19390663

  18. Development and Initial Testing of a Structured Clinical Observation Tool to Assess Pharmacotherapy Competence

    ERIC Educational Resources Information Center

    Young, John Q.; Lieu, Sandra; O'Sullivan, Patricia; Tong, Lowell

    2011-01-01

    Objective: The authors developed and tested the feasibility and utility of a new direct-observation instrument to assess trainee performance of a medication management session. Methods: The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) instrument was developed based on multiple sources of expertise and then implemented in 4…

  19. Management of Radioactive Spills in Nuclear Medicine; Teaching and Assessing with Objectively Structured Assessment of Technical Skills.

    PubMed

    Hussain, Riffat Parveen

    2015-01-01

    Routine work in nuclear medicine requires the careful elution of radioactivity and its subsequent, storage and handling. Though all effort is maintained to prevent any "spill" of this radioactivity, accidents are bound to happen. The response to this spill is a methodically worked out a plan that is written and adopted as a "standard operating procedure." This protocol is taught to all involved in the area of working as a mock drill/apprenticeship model. No formal evaluation of learning is in place except for the mock drills. The objectively structured assessment of technical skills (OSATS) is a variation on the Objective Structured Clinical Examination, which is a form of workplace based assessment. The OSATS is cited in the Accreditation Council of Graduate Medical Education evaluation toolbox on the website as the most desirable evaluation tool for the patient care topics. It is the objective of this paper is to introduce the "OSATS" for teaching, and assessment of the learning, of the protocol for the management of radioactive spill. As a review of the literature on the subject failed to reveal any such teaching protocol/material/document for this important technical skill, we hope that it may act as a landmark for the development of teaching and assessment of other technical skills also.

  20. [The Coordinating Centres for Clinical Trials Network. Objectives and significance for research sites].

    PubMed

    Bruns, I; Maier-Lenz, H; Wolff, S

    2009-04-01

    In the late 1990s a funding program was set up by the federal German government to help keep stride with developments in the international research arena. Within this programme, Coordinating Centres for Clinical Trials ("Koordinierungszentren für Klinische Studien", KKS) were established at 12 German universities aiming at supporting all processes of academic clinical trials according to international standards. A close network infrastructure was chosen in order to reap maximum benefit from synergy effects and to promote the harmonisation of standards. Continuing to grow, the KKS Network currently has 16 research institutions as members. More than 400 employees within the KKS Network provide scientific services to clinical trials at universities, hospitals and in industry. In cooperation with study clinics, surgeries, study groups and competence networks in medicine within Europe and beyond, the KKS supports many different research projects covering all areas of medicine. The KKS Network contributes expertise to legislative processes within Germany and Europe through its work in professional committees and working groups. A wide range of education and training concepts supports clinical research as a scientific field in its own right. After nearly ten years the KKS Network has established itself as an indispensable partner in the field of clinical research.

  1. Conditions for continuation of the efficient curve for multi-objective control-structure optimization

    NASA Technical Reports Server (NTRS)

    Rakowska, Joanna

    1992-01-01

    The paper describes the conditions for continuation of the efficient curve for bi-objective control-structure optimization of a ten-bar truss with two collocated sensors and actuators. The curve has been obtained with an active set algorithm using a homotopy method. The curve is discontinuous. A general stability theory has been implemented to determine sufficient conditions for the persistence of minima, and bifurcation theory has been used to characterize the possible points of discontinuity of the path.

  2. Miniature objective lens for array digital pathology: design improvement based on clinical evaluation

    NASA Astrophysics Data System (ADS)

    McCall, Brian; Pierce, Mark; Graviss, Edward A.; Richards-Kortum, Rebecca R.; Tkaczyk, Tomasz S.

    2016-03-01

    A miniature objective designed for digital detection of Mycobacterium tuberculosis (MTB) was evaluated for diagnostic accuracy. The objective was designed for array microscopy, but fabricated and evaluated at this stage of development as a single objective. The counts and diagnoses of patient samples were directly compared for digital detection and standard microscopy. The results were found to be correlated and highly concordant. The evaluation of this lens by direct comparison to standard fluorescence sputum smear microscopy presented unique challenges and led to some new insights in the role played by the system parameters of the microscope. The design parameters and how they were developed are reviewed in light of these results. New system parameters are proposed with the goal of easing the challenges of evaluating the miniature objective and maintaining the optical performance that produced the agreeable results presented without over-optimizing. A new design is presented that meets and exceeds these criteria.

  3. Description and status update on GELLO: a proposed standardized object-oriented expression language for clinical decision support.

    PubMed

    Sordo, Margarita; Boxwala, Aziz A; Ogunyemi, Omolola; Greenes, Robert A

    2004-01-01

    A major obstacle to sharing computable clinical knowledge is the lack of a common language for specifying expressions and criteria. Such a language could be used to specify decision criteria, formulae, and constraints on data and action. Al-though the Arden Syntax addresses this problem for clinical rules, its generalization to HL7's object-oriented data model is limited. The GELLO Expression language is an object-oriented language used for expressing logical conditions and computations in the GLIF3 (GuideLine Interchange Format, v. 3) guideline modeling language. It has been further developed under the auspices of the HL7 Clinical Decision Support Technical Committee, as a proposed HL7 standard., GELLO is based on the Object Constraint Language (OCL), because it is vendor-independent, object-oriented, and side-effect-free. GELLO expects an object-oriented data model. Although choice of model is arbitrary, standardization is facilitated by ensuring that the data model is compatible with the HL7 Reference Information Model (RIM).

  4. How Category Structure Influences the Perception of Object Similarity: The Atypicality Bias

    PubMed Central

    Tanaka, James William; Kantner, Justin; Bartlett, Marni

    2011-01-01

    Why do some faces appear more similar than others? Beyond structural factors, we speculate that similarity is governed by the organization of faces located in a multi-dimensional face space. To test this hypothesis, we morphed a typical face with an atypical face. If similarity judgments are guided purely by their physical properties, the morph should be perceived to be equally similar to its typical parent as its atypical parent. However, contrary to the structural prediction, our results showed that the morph face was perceived to be more similar to the atypical face than the typical face. Our empirical studies show that the atypicality bias is not limited to faces, but extends to other object categories (birds) whose members share common shape properties. We also demonstrate atypicality bias is malleable and can change subject to category learning and experience. Collectively, the empirical evidence indicates that perceptions of face and object similarity are affected by the distribution of stimuli in a face or object space. In this framework, atypical stimuli are located in a sparser region of the space where there is less competition for recognition and therefore, these representations capture a broader range of inputs. In contrast, typical stimuli are located in a denser region of category space where there is increased competition for recognition and hence, these representation draw a more restricted range of face inputs. These results suggest that the perceived likeness of an object is influenced by the organization of surrounding exemplars in the category space. PMID:22685441

  5. The impact of accretion material composition and properties on interior structure dynamics of Kuiper belt objects

    NASA Astrophysics Data System (ADS)

    Shchuko, Oleg; Shchuko, Svetlana D.; Kartashov, Daniil; Orosei, Roberto

    The building material of the forming Kuiper belt objects is supposed in the model to consist of solid dust material of protosolar cloud fringe regions and H2 O amorphous ice. A spheri-cally symmetric celestial body was being created as a result of accretion. The body's internal structure was determined by the composition and the properties of the accretion material and the evolution of the structure -by internal thermal processes. The accretion material compo-sition and structure have been studied, which provide now the existence of large icy Kuiper belt objects. Radionuclides 26 Al, 40 K, 232 Th, 235 U and 238 U embedded in solid dust matter particles have been main sources of radiogenic heat for the Kuiper belt object life time. The impact of the heat-and-power potentials of radiogenic heat sources on H2 O phase transition dynamics in the celestial body matter has been investigated. The parameter variation domains of these potentials have been found at which there can be formed areas partly or fully filled with H2 O of different phase states. In addition, the dynamic boundaries of areas have been determined where the ice component is presented by amorphous ice or cubic and hexagonal crystal ice. The parameter domains of celestial body accretion and radiogenic heat processes have been determined where the body evolution may have a catastrophic scenario up to its complete destruction.

  6. Play behaviours and play object preferences of young children with autistic disorder in a clinical play environment.

    PubMed

    Dominguez, Anna; Ziviani, Jenny; Rodger, Sylvia

    2006-01-01

    Play is the primary occupation of childhood and provides a potentially powerful means of assessing and treating children with autistic disorder. This study utilized a cross-sectional comparison design to investigate the nature of play engagement in children with AD (n = 24), relative to typically developing children (n = 34) matched for chronological age. Play behaviours were recorded in a clinical play environment. Videotapes comprising 15 minutes of the children's spontaneous play behaviour were analysed using time-interval analysis. The particular play behaviours observed and play objects used were coded. Differences in play behaviours (p < 0.0001) and play object preferences (p < 0.0001) were identified between the groups. Findings regarding play behaviour contribute to contention in the literature surrounding functional and symbolic play. Explanations for play object preferences are postulated. Recommendations are made regarding clinical application of findings in terms of enhancing assessment and intervention by augmenting motivation.

  7. Learning to explore the structure of kinematic objects in a virtual environment

    PubMed Central

    Buckmann, Marcus; Gaschler, Robert; Höfer, Sebastian; Loeben, Dennis; Frensch, Peter A.; Brock, Oliver

    2015-01-01

    The current study tested the quantity and quality of human exploration learning in a virtual environment. Given the everyday experience of humans with physical object exploration, we document substantial practice gains in the time, force, and number of actions needed to classify the structure of virtual chains, marking the joints as revolute, prismatic, or rigid. In line with current work on skill acquisition, participants could generalize the new and efficient psychomotor patterns of object exploration to novel objects. On the one hand, practice gains in exploration performance could be captured by a negative exponential practice function. On the other hand, they could be linked to strategies and strategy change. After quantifying how much was learned in object exploration and identifying the time course of practice-related gains in exploration efficiency (speed), we identified what was learned. First, we identified strategy components that were associated with efficient (fast) exploration performance: sequential processing, simultaneous use of both hands, low use of pulling rather than pushing, and low use of force. Only the latter was beneficial irrespective of the characteristics of the other strategy components. Second, we therefore characterized efficient exploration behavior by strategies that simultaneously take into account the abovementioned strategy components. We observed that participants maintained a high level of flexibility, sampling from a pool of exploration strategies trading the level of psycho-motoric challenges with exploration speed. We discuss the findings pursuing the aim of advancing intelligent object exploration by combining analytic (object exploration in humans) and synthetic work (object exploration in robots) in the same virtual environment. PMID:25904878

  8. STRUCTURED JETS IN BL LAC OBJECTS: EFFICIENT PeV NEUTRINO FACTORIES?

    SciTech Connect

    Tavecchio, Fabrizio; Ghisellini, Gabriele; Guetta, Dafne

    2014-09-20

    The origin of high-energy neutrinos (0.1–1 PeV range) detected by IceCube remains a mystery. In this work, we explore the possibility that efficient neutrino production can occur in structured jets of BL Lac objects, characterized by a fast inner spine surrounded by a slower layer. This scenario has been widely discussed in the framework of the high-energy emission models for BL Lac objects and radio galaxies. One of the relevant consequences of a velocity structure is the enhancement of the inverse Compton emission caused by the radiative coupling of the two zones. We show that a similar boosting could occur for the neutrino output of the spine through the photo-meson reaction of high-energy protons scattering off the amplified soft target photon field of the layer. Assuming the local density and the cosmological evolution of γ-ray BL Lac object derived from Fermi Large Area Telescope data, we calculate the expected diffuse neutrino intensity, which can match the IceCube data for a reasonable choice of parameters.

  9. 3D shape shearography with integrated structured light projection for strain inspection of curved objects

    NASA Astrophysics Data System (ADS)

    Anisimov, Andrei G.; Groves, Roger M.

    2015-05-01

    Shearography (speckle pattern shearing interferometry) is a non-destructive testing technique that provides full-field surface strain characterization. Although real-life objects especially in aerospace, transport or cultural heritage are not flat (e.g. aircraft leading edges or sculptures), their inspection with shearography is of interest for both hidden defect detection and material characterization. Accurate strain measuring of a highly curved or free form surface needs to be performed by combining inline object shape measuring and processing of shearography data in 3D. Previous research has not provided a general solution. This research is devoted to the practical questions of 3D shape shearography system development for surface strain characterization of curved objects. The complete procedure of calibration and data processing of a 3D shape shearography system with integrated structured light projector is presented. This includes an estimation of the actual shear distance and a sensitivity matrix correction within the system field of view. For the experimental part a 3D shape shearography system prototype was developed. It employs three spatially-distributed shearing cameras, with Michelson interferometers acting as the shearing devices, one illumination laser source and a structured light projector. The developed system performance was evaluated with a previously reported cylinder specimen (length 400 mm, external diameter 190 mmm) loaded by internal pressure. Further steps for the 3D shape shearography prototype and the technique development are also proposed.

  10. [Does clinical risk management require a structured conflict management?].

    PubMed

    Neumann, Stefan

    2015-01-01

    A key element of clinical risk management is the analysis of errors causing near misses or patient damage. After analyzing the causes and circumstances, measures for process improvement have to be taken. Process management, human resource development and other established methods are used. If an interpersonal conflict is a contributory factor to the error, there is usually no structured conflict management available which includes selection criteria for various methods of conflict processing. The European University Viadrina in Frankfurt (Oder) has created a process model for introducing a structured conflict management system which is suitable for hospitals and could fill the gap in the methodological spectrum of clinical risk management. There is initial evidence that a structured conflict management reduces staff fluctuation and hidden conflict costs. This article should be understood as an impulse for discussion on to what extent the range of methods of clinical risk management should be complemented by conflict management.

  11. Endpoint-finding algorithm for structured light metrology of large objects in cluttered environments

    NASA Astrophysics Data System (ADS)

    Bonanni, Pierino G.; de Bedout, Juan M.

    2002-02-01

    Imaging of objects under linear structured-light illumination is commonly performed to ascertain location, dimensions, and morphology. The method is particularly attractive for prismatic objects distinguished by a single flat surface, because the processing algorithm can focus on purely linear features, and need only search for abrupt discontinuities in those features. In this paper, we consider a steel mill gantry crane application, wherein the targets to be localized are large steel slabs illuminated by laser line projectors, imaged from very close range to preserve spatial resolution. Conventional Radon transform- based methods for locating target edges yield highly ambiguous results, due to an abundance of image clutter coupled with the limited view of the overall object. This paper presents a modified Radon transform-based method for locating the target edges defined by the laser lines, and makes use of coarse a priori knowledge of the line pattern to resolve ambiguous edge points caused by neighboring clutter. A one-dimensional derivative of the Radon transform is used to improve the localization of short line segments. The algorithm is robust to the case in which the target object appears off axis and the clutter dominates the field of view.

  12. Needle-based fluorescence endomicroscopy via structured illumination with a plastic, achromatic objective

    PubMed Central

    Kyrish, Matthew; Dobbs, Jessica; Jain, Shalini; Wang, Xiao; Yu, Dihua; Richards-Kortum, Rebecca

    2013-01-01

    Abstract. In order to diagnose cancer, a sample must be removed, prepared, and examined under a microscope, which is expensive, invasive, and time consuming. Fiber optic fluorescence endomicroscopy, where an image guide is used to obtain high-resolution images of tissue in vivo, has shown promise as an alternative to conventional biopsies. However, the resolution of standard endomicroscopy is limited by the fiber bundle sampling frequency and out-of-focus light. A system is presented which incorporates a plastic, achromatic objective to increase the sampling and which provides optical sectioning via structured illumination to reject background light. An image is relayed from the sample by a fiber bundle with the custom 2.1-mm outer diameter objective lens integrated to the distal tip. The objective is corrected for the excitation and the emission wavelengths of proflavine (452 and 515 nm). It magnifies the object onto the fiber bundle to improve the system’s lateral resolution by increasing the sampling. The plastic lenses were fabricated via single-point diamond turning and assembled using a zero alignment technique. Ex vivo images of normal and neoplastic murine mammary tissues stained with proflavine are captured. The system achieves higher contrast and resolves smaller features than standard fluorescence endomicroscopy. PMID:24002190

  13. Structural correlates of subjective and objective memory performance in multiple sclerosis.

    PubMed

    Pardini, Matteo; Bergamino, Maurizio; Bommarito, Giulia; Bonzano, Laura; Luigi Mancardi, Gian; Roccatagliata, Luca

    2014-04-01

    Subjective and objective memory deficits represent a frequent and ill-understood aspect of multiple sclerosis (MS), and a significant cause of disability and quality of life reduction. The aim of the study is to verify the role of hippocampal and temporal associative fibers' damage in MS-related memory complaints. To reach this aim, 25 patients with low disability relapsing-remitting MS and 19 healthy controls were included in the study. All subjects underwent 3D T1 structural imaging and Diffusion Tensor Imaging. Additionally, MS patients underwent neuropsychological evaluation of objective (Selective Reminding Test and Spatial Recall Test) and of subjective (Perceived Deficit Questionnaire, Retrospective and Prospective Memory Subscales) memory deficits. Normalized hippocampal volume (NHV) and mean Fractional Anisotropy (FA) for the uncinate fasciculus (UF) and for the ventral division of the cingulum bundle (VCB) were calculated for all subjects. We showed that, compared to controls, MS subjects presented with reduced right NHV and with reduced mean FA bilaterally in the UF and the VCB. In the MS group, verbal memory scores correlated with left NHV, spatial memory scores correlated with right NHV, while perceived retrospective and prospective memory deficits correlated with left VCB and left UF mean FA respectively. Our data confirm an early involvement of memory-related brain structures in MS patients. Our data suggest that verbal and nonverbal memory as well as perceived retrospective and prospective memory deficits are related to alterations of discrete anatomical structures in the low-disability phase of MS.

  14. Structural equation modeling in the context of clinical research

    PubMed Central

    2017-01-01

    Structural equation modeling (SEM) has been widely used in economics, sociology and behavioral science. However, its use in clinical medicine is quite limited, probably due to technical difficulties. Because SEM is particularly suitable for analysis of complex relationships among observed variables, it must have potential applications to clinical medicine. The article introduces basic ideas of SEM in the context of clinical medicine. A simulated dataset is employed to show how to do model specification, model fit, visualization and assessment of goodness-of-fit. The first example fits a SEM with continuous outcome variable using sem() function, and the second explores the binary outcome variable using lavaan() function. PMID:28361067

  15. [Strategies for classification of rehabilitation clinics based on structural equality].

    PubMed

    Koch, U; Tiefensee, J; Kawski, S; Arentewicz, G

    1998-06-01

    Comparison between clinics is a basic part of most quality assurance programmes. The classification of structurally similar clinics is a prerequisite for enabling comparisons between clinics according to quality criteria. As a part of the programme point 1 "structural quality" of the Pension insurance quality assurance programme in medical rehabilitation, a procedure was developed to classify clinics into structurally similar groups. For this purpose the data of the structure survey of the quality assurance programme was used. The first step was to check whether existing classification systems could be used, which made the need for a new classification procedure apparent. The 942 participating clinics were clustered according to a successive differentiation system employing only quality-neutral criteria, e.g., the indication group, the number of different indications, the part of AHB, number of beds, and the therapeutic focus. Further differentiation beyond indication group was necessary for the indications orthopaedics, cardiology, psychosomatics, addiction and neurology. The procedure is demonstrated using the indications orthopaedics and cardiology as examples.

  16. Objective structured practical examination (OSPE) in Forensic Medicine: students' point of view.

    PubMed

    Menezes, Ritesh G; Nayak, Vinod C; Binu, V S; Kanchan, Tanuj; Rao, P P Jagadish; Baral, Prakash; Lobo, Stany W

    2011-11-01

    The purpose of this study was to assess the attitudes of undergraduate medical students towards the objective structured practical examination (OSPE) in Forensic Medicine, in a medical college in Nepal. Participants included 59 undergraduate medical students of the 7th semester. Findings indicated that the OSPE was an acceptable tool considering the conduct of practical examination in Forensic Medicine at the undergraduate level. The overall mean attitude score was towards the favourable side. Students strongly agreed that the OSPE tested a wide range of skills. They also strongly agreed that it was a good form of examination as well as a learning experience. The introduction of the OSPE replacing the conventional method of practical examination in Forensic Medicine is a step in the right direction taken to objectively assess undergraduate medical students.

  17. Objective Sleep Structure and Cardiovascular Risk Factors in the General Population: The HypnoLaus Study

    PubMed Central

    Haba-Rubio, José; Marques-Vidal, Pedro; Andries, Daniela; Tobback, Nadia; Preisig, Martin; Vollenweider, Peter; Waeber, Gérard; Luca, Gianina; Tafti, Mehdi; Heinzer, Raphaël

    2015-01-01

    Study Objectives: To evaluate the association between objective sleep measures and metabolic syndrome (MS), hypertension, diabetes, and obesity. Design: Cross-sectional study. Setting: General population sample. Participants: There were 2,162 patients (51.2% women, mean age 58.4 ± 11.1). Interventions: Patients were evaluated for hypertension, diabetes, overweight/obesity, and MS, and underwent a full polysomnography (PSG). Measurements and Results: PSG measured variables included: total sleep time (TST), percentage and time spent in slow wave sleep (SWS) and in rapid eye movement (REM) sleep, sleep efficiency and arousal index (ArI). In univariate analyses, MS was associated with decreased TST, SWS, REM sleep, and sleep efficiency, and increased ArI. After adjustment for age, sex, smoking, alcohol, physical activity, drugs that affect sleep and depression, the ArI remained significantly higher, but the difference disappeared in patients without significant sleep disordered breathing (SDB). Differences in sleep structure were also found according to the presence or absence of hypertension, diabetes, and overweight/obesity in univariate analysis. However, these differences were attenuated after multivariate adjustment and after excluding subjects with significant SDB. Conclusions: In this population-based sample we found significant associations between sleep structure and metabolic syndrome (MS), hypertension, diabetes, and obesity. However, these associations were cancelled after multivariate adjustment. We conclude that normal variations in sleep contribute little if any to MS and associated disorders. Citation: Haba-Rubio J, Marques-Vidal P, Andries D, Tobback N, Preisig M, Vollenweider P, Waeber G, Luca G, Tafti M, Heinzer R. Objective sleep structure and cardiovascular risk factors in the general population: the HypnoLaus study. SLEEP 2015;38(3):391–400. PMID:25325467

  18. An integrated control/structure design method using multi-objective optimization

    NASA Technical Reports Server (NTRS)

    Gupta, Sandeep; Joshi, Suresh M.

    1991-01-01

    The benefits are demonstrated of a multiobjective optimization based control structure integrated design methodology. An application of the proposed CSI methodology to the integrated design of the Spacecraft COntrol Lab Experiment (SCOLE) configuration is presented. Integrated design resulted in reducing both the control performance measure and the mass. Thus, better overall performance is achieved through integrated design optimization. The mutliobjective optimization approach used provides Pareto optimal solutions by unconstrained minimization of a differentiable KS function. Furthermore, adjusting the parameters gives insight into the trade-offs involved between different objectives.

  19. Structural Model Tuning Capability in an Object-Oriented Multidisciplinary Design, Analysis, and Optimization Tool

    NASA Technical Reports Server (NTRS)

    Lung, Shun-fat; Pak, Chan-gi

    2008-01-01

    Updating the finite element model using measured data is a challenging problem in the area of structural dynamics. The model updating process requires not only satisfactory correlations between analytical and experimental results, but also the retention of dynamic properties of structures. Accurate rigid body dynamics are important for flight control system design and aeroelastic trim analysis. Minimizing the difference between analytical and experimental results is a type of optimization problem. In this research, a multidisciplinary design, analysis, and optimization [MDAO] tool is introduced to optimize the objective function and constraints such that the mass properties, the natural frequencies, and the mode shapes are matched to the target data as well as the mass matrix being orthogonalized.

  20. Structural Model Tuning Capability in an Object-Oriented Multidisciplinary Design, Analysis, and Optimization Tool

    NASA Technical Reports Server (NTRS)

    Lung, Shun-fat; Pak, Chan-gi

    2008-01-01

    Updating the finite element model using measured data is a challenging problem in the area of structural dynamics. The model updating process requires not only satisfactory correlations between analytical and experimental results, but also the retention of dynamic properties of structures. Accurate rigid body dynamics are important for flight control system design and aeroelastic trim analysis. Minimizing the difference between analytical and experimental results is a type of optimization problem. In this research, a multidisciplinary design, analysis, and optimization (MDAO) tool is introduced to optimize the objective function and constraints such that the mass properties, the natural frequencies, and the mode shapes are matched to the target data as well as the mass matrix being orthogonalized.

  1. TRENCADIS--a WSRF grid MiddleWare for managing DICOM structured reporting objects.

    PubMed

    Blanquer, Ignacio; Hernandez, Vicente; Segrelles, Damià

    2006-01-01

    The adoption of the digital processing of medical data, especially on radiology, has leaded to the availability of millions of records (images and reports). However, this information is mainly used at patient level, being the extraction of information, organised according to administrative criteria, which make the extraction of knowledge difficult. Moreover, legal constraints make the direct integration of information systems complex or even impossible. On the other side, the widespread of the DICOM format has leaded to the inclusion of other information different from just radiological images. The possibility of coding radiology reports in a structured form, adding semantic information about the data contained in the DICOM objects, eases the process of structuring images according to content. DICOM Structured Reporting (DICOM-SR) is a specification of tags and sections to code and integrate radiology reports, with seamless references to findings and regions of interests of the associated images, movies, waveforms, signals, etc. The work presented in this paper aims at developing of a framework to efficiently and securely share medical images and radiology reports, as well as to provide high throughput processing services. This system is based on a previously developed architecture in the framework of the TRENCADIS project, and uses other components such as the security system and the Grid processing service developed in previous activities. The work presented here introduces a semantic structuring and an ontology framework, to organise medical images considering standard terminology and disease coding formats (SNOMED, ICD9, LOINC..).

  2. Practical experience with graphical user interfaces and object-oriented design in the clinical laboratory.

    PubMed

    Wells, I G; Cartwright, R Y; Farnan, L P

    1993-12-15

    The computing strategy in our laboratories evolved from research in Artificial Intelligence, and is based on powerful software tools running on high performance desktop computers with a graphical user interface. This allows most tasks to be regarded as design problems rather than implementation projects, and both rapid prototyping and an object-oriented approach to be employed during the in-house development and enhancement of the laboratory information systems. The practical application of this strategy is discussed, with particular reference to the system designer, the laboratory user and the laboratory customer. Routine operation covers five departments, and the systems are stable, flexible and well accepted by the users. Client-server computing, currently undergoing final trials, is seen as the key to further development, and this approach to Pathology computing has considerable potential for the future.

  3. Characterization of the Interior Density Structure of Near Earth Objects with Muons

    NASA Astrophysics Data System (ADS)

    Prettyman, T. H.; Sykes, M. V.; Miller, R. S.; Pinsky, L. S.; Empl, A.; Nolan, M. C.; Koontz, S. L.; Lawrence, D. J.; Mittlefehldt, D. W.; Reddell, B. D.

    2015-12-01

    Near Earth Objects (NEOs) are a diverse population of short-lived asteroids originating from the main belt and Jupiter family comets. Some have orbits that are easy to access from Earth, making them attractive as targets for science and exploration as well as a potential resource. Some pose a potential impact threat. NEOs have undergone extensive collisional processing, fragmenting and re-accreting to form rubble piles, which may be compositionally heterogeneous (e.g., like 2008 TC3, the precursor to Almahata Sitta). At present, little is known about their interior structure or how these objects are held together. The wide range of inferred NEO macroporosities hint at complex interiors. Information about their density structure would aid in understanding their formation and collisional histories, the risks they pose to human interactions with their surfaces, the constraints on industrial processing of NEO resources, and the selection of hazard mitigation strategies (e.g., kinetic impactor vs nuclear burst). Several methods have been proposed to characterize asteroid interiors, including radar imaging, seismic tomography, and muon imaging (muon radiography and tomography). Of these, only muon imaging has the potential to determine interior density structure, including the relative density of constituent fragments. Muons are produced by galactic cosmic ray showers within the top meter of asteroid surfaces. High-energy muons can traverse large distances through rock with little deflection. Muons transmitted through an Itokawa-sized asteroid can be imaged using a compact hodoscope placed on or near the surface. Challenges include background rejection and correction for variations in muon production with surface density. The former is being addressed by hodoscope design. Surface density variations can be determined via radar or muon limb imaging. The performance of muon imaging is evaluated for prospective NEO interior-mapping missions.

  4. MBBS Student Perceptions about Physiology Subject Teaching and Objective Structured Practical Examination Based Formative Assessment for Improving Competencies

    ERIC Educational Resources Information Center

    Lakshmipathy, K.

    2015-01-01

    The objectives of the present study were to 1) assess student attitudes to physiology, 2) evaluate student opinions about the influence of an objective structured practical examination (OSPE) on competence, and 3) assess the validity and reliability of an indigenously designed feedback questionnaire. A structured questionnaire containing 16 item…

  5. Objective assessment of biomagnetic devices and alternative clinical therapies using infrared thermal imaging

    NASA Astrophysics Data System (ADS)

    Rockley, Graham J.

    2001-03-01

    The overwhelming introduction of magnetic devices and other alternative therapies into the health care market prompts the need for objective evaluation of these techniques through the use of infrared thermal imaging. Many of these therapies are reported to promote the stimulation of blood flow or the relief of pain conditions. Infrared imaging is an efficient tool to assess such changes in the physiological state. Therefore, a thermal imager can help document and substantiate whether these therapies are in fact providing an effective change to the local circulation. Thermal images may also indicate whether the change is temporary or sustained. As a specific case example, preliminary findings will be presented concerning the use of magnets and the effect they have on peripheral circulation. This will include a discussion of the recommended protocols for this type of infrared testing. This test model can be applied to the evaluation of other devices and therapeutic procedures which are reputed to affect circulation such as electro acupuncture, orthopedic footwear and topical ointments designed to relieve pain or inflammation.

  6. Proposal for a new objective method to evaluate low-level laser therapy efficacy in clinical practice

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Nicolescu, Alin; Pascu, Mihail-Lucian; Vlaiculescu, Mihaela; Ionescu, Elena

    2000-06-01

    Until now there is a lack of objective methods to evaluate the clinical efficacy of low level lasers (LLL). The reported results in this paper are showing that the cutaneous ultrasound could be a valuable method to be used in order to objectify the results obtained in low level laser therapy (LLLT). 52 patients with osteoarthritis were divided into three groups: Group A:19 patients treated with IR emitted laser diode, CW, 3mW power, 780 nm wavelengths. Group B: 18 patients treated with the same IR laser diode as above and He-Ne laser, CW, 2mW power. Group C: 14 patients exposed to placebo laser. To every patient was done cutaneous ultrasound before and after LLLT and we followed also the clinical evolution. The positive results meaning significant US favorable changes were found in 73.9 percent for group A and 77.7 percent for group B and 21.4 percent for PLACEBO group. We conclude that cutaneous ultrasound could be an objective method to appreciate the clinical efficacy of low power lasers.

  7. UGC 4599: Revealing the Extended Structure of a Hoag’s Object Analog with HERON

    NASA Astrophysics Data System (ADS)

    Fusco, Michael; Thilker, David A.; Wen, Fufang; Xia, Junjie; Storment, Stephen; Brosch, Noah; Longstaff, Francis; Kennefick, Julia D.; Rich, Robert Michael; Halos and Environments of Nearby galaxies (HERON) Team

    2017-01-01

    The Halos and Environments of Nearby Galaxies (HERON) survey utilizes a specialized telescope for imaging low surface brightness halos and galaxy environments. One such galaxy is UGC 4599, whose HERON images show improvements in observing the extended low luminosity structure as compared to previous studies. UGC 4599 is a nearby Hoag-Type Ring Galaxy with an extremely extended HI disk. Hoag's Object is characterized by a blue star-forming ring surrounding an older yellow nucleus. In the case of UGC 4599, the nuclear region was previously revealed to closely follow a De Vaucouleurs luminosity profile, suggesting the object to be at least elliptical-like. While previous photometric studies of UGC 4599 were focused mainly on the bright core and star forming ring of the galaxy, the HERON survey is able to probe the fainter, extended halo. With an eight hour integration time, we find spiral structure surrounding the core and ring of UGC 4599. The main ring of the galaxy is broken with an m=2 (180 degree) symmetry, suggesting a two armed spiral structure. However, once the core and ring of UGC 4599 are modeled with the software GALFIT, a well defined m=1 (single arm) spiral emerges, extending from the central region to several times the radius of the ring. Though the ring appears to break in two places, the spiral structure may be comprised of mainly one dominant arm. In late type galaxies, the pitch angle of spiral arms has been shown to correlate well with the mass of the central Supermassive Black Hole (SMBH) in an M-P relation. The pitch angle of the one arm spiral of UGC 4599 is measured to be roughly P=9 degrees, corresponding to a SMBH mass for UGC 4599 of between 107 and 108 solar masses (further constrained pitch angle measurements forthcoming). The outermost edge of UGC 4599 as detected in our imaging may be modeled as an extension of this one armed spiral, or as yet another ring feature. Due to many bright foreground stars, there is difficulty in ascertaining

  8. Lightweight object oriented structure analysis: tools for building tools to analyze molecular dynamics simulations.

    PubMed

    Romo, Tod D; Leioatts, Nicholas; Grossfield, Alan

    2014-12-15

    LOOS (Lightweight Object Oriented Structure-analysis) is a C++ library designed to facilitate making novel tools for analyzing molecular dynamics simulations by abstracting out the repetitive tasks, allowing developers to focus on the scientifically relevant part of the problem. LOOS supports input using the native file formats of most common biomolecular simulation packages, including CHARMM, NAMD, Amber, Tinker, and Gromacs. A dynamic atom selection language based on the C expression syntax is included and is easily accessible to the tool-writer. In addition, LOOS is bundled with over 140 prebuilt tools, including suites of tools for analyzing simulation convergence, three-dimensional histograms, and elastic network models. Through modern C++ design, LOOS is both simple to develop with (requiring knowledge of only four core classes and a few utility functions) and is easily extensible. A python interface to the core classes is also provided, further facilitating tool development.

  9. Student's perspectives on objective structured practical examination (OSPE) in Forensic Medicine - a report from India.

    PubMed

    Pramod Kumar, G N; Sentitoshi; Nath, Dhritiman; Menezes, Ritesh G; Kanchan, Tanuj

    2015-05-01

    The objective of the present study was to know the perceptions of students regarding objective structured practical examination (OSPE) as a tool for assessment in Forensic Medicine. The present study was conducted in the Department of Forensic Medicine and Toxicology, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. Undergraduate medical students of the 4th semester were enrolled in the study to know their perceptions regarding OSPE. The students were briefed regarding OSPE with a PowerPoint presentation and interaction. An examination was conducted using OSPE with10 stations and a total of 74 students participated in the study. The feedback was collected using a preformed proforma consisting of 12 items and analyzed. Most of the participants (82.4%) agreed that OSPE is a better method of examination than the conventional/traditional practical examination. The majority of the participants (77.0%) said that the OSPE covered wide range of knowledge than the conventional practical examination. A large number of students (63.5%) were of the opinion that the OSPE may be exhausting and stressful if number of stations are increased. Overall a larger proportion of the participants preferred OSPE over the conventional practical examination considering the various attributes examined in the study.

  10. A multi-objective evolutionary algorithm for protein structure prediction with immune operators.

    PubMed

    Judy, M V; Ravichandran, K S; Murugesan, K

    2009-08-01

    Genetic algorithms (GA) are often well suited for optimisation problems involving several conflicting objectives. It is more suitable to model the protein structure prediction problem as a multi-objective optimisation problem since the potential energy functions used in the literature to evaluate the conformation of a protein are based on the calculations of two different interaction energies: local (bond atoms) and non-local (non-bond atoms) and experiments have shown that those types of interactions are in conflict, by using the potential energy function, Chemistry at Harvard Macromolecular Mechanics. In this paper, we have modified the immune inspired Pareto archived evolutionary strategy (I-PAES) algorithm and denoted it as MI-PAES. It can effectively exploit some prior knowledge about the hydrophobic interactions, which is one of the most important driving forces in protein folding to make vaccines. The proposed MI-PAES is comparable with other evolutionary algorithms proposed in literature, both in terms of best solution found and the computational time and often results in much better search ability than that of the canonical GA.

  11. Scanning freeform objects by combining shape from silhouette and shape from line structured light

    NASA Astrophysics Data System (ADS)

    Xiong, Hanwei; Xu, Jun; Xu, Chenxi; Pan, Ming

    2014-12-01

    Freeform shape is usually designed by reverse engineering method thorough a 3D scanner, which is often expensive to most persons. The paper proposes a new scanning system combining shape from structured light and shape from silhouette, which can be implemented easily with low cost. The two methods are very complementary. For shape from silhouette, it can capture correct topological information of the object and obtain a closed envelop, and for shape from hand-held laser line, precise point clouds with some holes can be obtained. To gain their complementary advantages, a new data fusion strategy based a mesh energy functional is proposed to integrate the information from the two scanning methods, in which the points resulted from laser light will attract closed envelop from silhouette. After fusion, the precision of shape from silhouette is increased, and the topological error of shape from structured light is corrected. The design details are introduced, and a toy model is used to test the new method, which is difficult to scan using other systems. The test results proof the validity of the new method.

  12. Origin of Rotating Ring Structures in the Strong Gravity of a Central Object.

    NASA Astrophysics Data System (ADS)

    Coppi, B.

    2006-04-01

    The origin of plasma rotating ring structures forming around a central object whose gravity is prevalent has been identified [1] through the analysis of thin equilibrium configurations that are immersed in a relatively weak external magnetic field and can carry internal toroidal currents. Unlike the case of the ``classical'' gaseous disk, in which the vertical equilibrium is maintained only by gravity, rings are maintained vertically by the Lorentz force and radially by gravity. The differential rotation is the sustaining factor of these ring structures and of the jets that may emerge from them. The rings are connected with the formation of a periodic sequence [2] of Field Reverse Configurations of the poloidal magnetic field, consisting of pairs of counter-streaming toroidal current channels. In magnetic field configurations that have been considered previously for accretion disks the magnetic field diffusion was assumed to be such that the Ferraro isorotation condition was not valid, while in our case it has a primary role. The relevant equilibria are not described by the Grad-Shafranov equation but by two non-linear coupled equations that have been solved analytically. These provide both the plasma pressure function and the magnetic surface function once a consistent plasma density function is chosen within a relatively narrow class. A two-fluid description of the same equilibria is given differentiating the relative roles of electrons and ions.[1] B. Coppi and F. Rousseau, to appear in Ap. J., April (2006). [2] B. Coppi, Phys. of Plasmas, 12, 057302 (2005).

  13. UAV-based urban structural damage assessment using object-based image analysis and semantic reasoning

    NASA Astrophysics Data System (ADS)

    Fernandez Galarreta, J.; Kerle, N.; Gerke, M.

    2014-09-01

    Structural damage assessment is critical after disasters but remains a challenge. Many studies have explored the potential of remote sensing data, but limitations of vertical data persist. Oblique imagery has been identified as more useful, though the multi-angle imagery also adds a new dimension of complexity. This paper addresses damage assessment based on multi-perspective, overlapping, very high resolution oblique images obtained with unmanned aerial vehicles (UAVs). 3-D point-cloud assessment for the entire building is combined with detailed object-based image analysis (OBIA) of façades and roofs. This research focuses not on automatic damage assessment, but on creating a methodology that supports the often ambiguous classification of intermediate damage levels, aiming at producing comprehensive per-building damage scores. We identify completely damaged structures in the 3-D point cloud, and for all other cases provide the OBIA-based damage indicators to be used as auxiliary information by damage analysts. The results demonstrate the usability of the 3-D point-cloud data to identify major damage features. Also the UAV-derived and OBIA-processed oblique images are shown to be a suitable basis for the identification of detailed damage features on façades and roofs. Finally, we also demonstrate the possibility of aggregating the multi-perspective damage information at building level.

  14. UAV-based urban structural damage assessment using object-based image analysis and semantic reasoning

    NASA Astrophysics Data System (ADS)

    Fernandez Galarreta, J.; Kerle, N.; Gerke, M.

    2015-06-01

    Structural damage assessment is critical after disasters but remains a challenge. Many studies have explored the potential of remote sensing data, but limitations of vertical data persist. Oblique imagery has been identified as more useful, though the multi-angle imagery also adds a new dimension of complexity. This paper addresses damage assessment based on multi-perspective, overlapping, very high resolution oblique images obtained with unmanned aerial vehicles (UAVs). 3-D point-cloud assessment for the entire building is combined with detailed object-based image analysis (OBIA) of façades and roofs. This research focuses not on automatic damage assessment, but on creating a methodology that supports the often ambiguous classification of intermediate damage levels, aiming at producing comprehensive per-building damage scores. We identify completely damaged structures in the 3-D point cloud, and for all other cases provide the OBIA-based damage indicators to be used as auxiliary information by damage analysts. The results demonstrate the usability of the 3-D point-cloud data to identify major damage features. Also the UAV-derived and OBIA-processed oblique images are shown to be a suitable basis for the identification of detailed damage features on façades and roofs. Finally, we also demonstrate the possibility of aggregating the multi-perspective damage information at building level.

  15. The clinical use of structural MRI in Alzheimer disease.

    PubMed

    Frisoni, Giovanni B; Fox, Nick C; Jack, Clifford R; Scheltens, Philip; Thompson, Paul M

    2010-02-01

    Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment.

  16. Transforming clinical imaging and 3D data for virtual reality learning objects: HTML5 and mobile devices implementation.

    PubMed

    Trelease, Robert B; Nieder, Gary L

    2013-01-01

    Web deployable anatomical simulations or "virtual reality learning objects" can easily be produced with QuickTime VR software, but their use for online and mobile learning is being limited by the declining support for web browser plug-ins for personal computers and unavailability on popular mobile devices like Apple iPad and Android tablets. This article describes complementary methods for creating comparable, multiplatform VR learning objects in the new HTML5 standard format, circumventing platform-specific limitations imposed by the QuickTime VR multimedia file format. Multiple types or "dimensions" of anatomical information can be embedded in such learning objects, supporting different kinds of online learning applications, including interactive atlases, examination questions, and complex, multi-structure presentations. Such HTML5 VR learning objects are usable on new mobile devices that do not support QuickTime VR, as well as on personal computers. Furthermore, HTML5 VR learning objects can be embedded in "ebook" document files, supporting the development of new types of electronic textbooks on mobile devices that are increasingly popular and self-adopted for mobile learning.

  17. Clinical, functional and structural determinants of central pain in syringomyelia.

    PubMed

    Hatem, Samar M; Attal, Nadine; Ducreux, Denis; Gautron, Michèle; Parker, Fabrice; Plaghki, Leon; Bouhassira, Didier

    2010-11-01

    . Patients with both spontaneous and evoked pain clearly differed from patients with spontaneous pain only. Patients with spontaneous pain only had more severe spinal cord damage, and the correlation between average daily pain intensity and fractional anisotropy of the full spinal cord was particularly strong in this subgroup of patients (Spearman's ρ = -0.93, P = 0.008). By contrast, patients with both spontaneous and evoked pain had not only less structural spinal cord damage, but also better preserved spinothalamic and lemniscal tracts on quantitative sensory testing and electrophysiological testing. These data showed, for the first time, a direct relationship between central neuropathic pain and objective markers of spinal cord damage, and confirmed the clinical relevance of 3D fibre tracking for the sensory assessment of patients with a spinal cord lesion.

  18. Introducing objective structured practical examination as a method of learning and evaluation for undergraduate pharmacology

    PubMed Central

    Vishwakarma, Kirti; Sharma, Mukesh; Matreja, Prithpal Singh; Giri, Vishal Prakash

    2016-01-01

    Objective: Assessment method can influence student learning. Use of objective structured practical examination (OSPE) has been reported in various institutes with great benefits. We evaluated OSPE for the assessment of practical skills in pharmacology examination for undergraduate medical students and compared it with conventional practical examination (CPE). Materials and Methods: After sensitizing the 2nd year MBBS students to OSPE, the students were divided into four batches with twenty students in each batch. Students were assessed by attending five OSPE stations, each for duration of 5 min. The effectiveness was assessed through a student’s feedback questionnaire and was checked for its reliability by Cronbach’s alpha. The result of OSPE was compared with that of CPE of the same batch. Results: Cronbach’s alpha of the feedback questionnaire was 0.71, with high internal consistency. The feedback given was categorized into three domains: cognitive, psychomotor, and affective, and an assessment was also done for its further use. In cognitive domain, 74% of the students felt that the questions asked and the syllabus taught were well correlated. In psychomotor domain, 81% agreed that it is excellent for assessing the applied part of the subject. Seventy percent of students opined that it was associated with lesser stress than CPE. On overall assessment, 76% rated this methodology as good/satisfactory and 23% as excellent in terms of better scoring. There was a significant difference in the mean score between the results of OSPE and CPE (P < 0.001, df = 158, confidence interval = 95%). Conclusion: OSPE is a feasible and skill enhancing tool for the assessment in pharmacology examinations for undergraduate students. PMID:28031608

  19. Correlative Nanoscale 3D Imaging of Structure and Composition in Extended Objects

    PubMed Central

    Xu, Feng; Helfen, Lukas; Suhonen, Heikki; Elgrabli, Dan; Bayat, Sam; Reischig, Péter; Baumbach, Tilo; Cloetens, Peter

    2012-01-01

    Structure and composition at the nanoscale determine the behavior of biological systems and engineered materials. The drive to understand and control this behavior has placed strong demands on developing methods for high resolution imaging. In general, the improvement of three-dimensional (3D) resolution is accomplished by tightening constraints: reduced manageable specimen sizes, decreasing analyzable volumes, degrading contrasts, and increasing sample preparation efforts. Aiming to overcome these limitations, we present a non-destructive and multiple-contrast imaging technique, using principles of X-ray laminography, thus generalizing tomography towards laterally extended objects. We retain advantages that are usually restricted to 2D microscopic imaging, such as scanning of large areas and subsequent zooming-in towards a region of interest at the highest possible resolution. Our technique permits correlating the 3D structure and the elemental distribution yielding a high sensitivity to variations of the electron density via coherent imaging and to local trace element quantification through X-ray fluorescence. We demonstrate the method by imaging a lithographic nanostructure and an aluminum alloy. Analyzing a biological system, we visualize in lung tissue the subcellular response to toxic stress after exposure to nanotubes. We show that most of the nanotubes are trapped inside alveolar macrophages, while a small portion of the nanotubes has crossed the barrier to the cellular space of the alveolar wall. In general, our method is non-destructive and can be combined with different sample environmental or loading conditions. We therefore anticipate that correlative X-ray nano-laminography will enable a variety of in situ and in operando 3D studies. PMID:23185554

  20. Creating Shareable Clinical Decision Support Rules for a Pharmacogenomics Clinical Guideline Using Structured Knowledge Representation.

    PubMed

    Linan, Margaret K; Sottara, Davide; Freimuth, Robert R

    2015-01-01

    Pharmacogenomics (PGx) guidelines contain drug-gene relationships, therapeutic and clinical recommendations from which clinical decision support (CDS) rules can be extracted, rendered and then delivered through clinical decision support systems (CDSS) to provide clinicians with just-in-time information at the point of care. Several tools exist that can be used to generate CDS rules that are based on computer interpretable guidelines (CIG), but none have been previously applied to the PGx domain. We utilized the Unified Modeling Language (UML), the Health Level 7 virtual medical record (HL7 vMR) model, and standard terminologies to represent the semantics and decision logic derived from a PGx guideline, which were then mapped to the Health eDecisions (HeD) schema. The modeling and extraction processes developed here demonstrate how structured knowledge representations can be used to support the creation of shareable CDS rules from PGx guidelines.

  1. Creating Shareable Clinical Decision Support Rules for a Pharmacogenomics Clinical Guideline Using Structured Knowledge Representation

    PubMed Central

    Linan, Margaret K.; Sottara, Davide; Freimuth, Robert R.

    2015-01-01

    Pharmacogenomics (PGx) guidelines contain drug-gene relationships, therapeutic and clinical recommendations from which clinical decision support (CDS) rules can be extracted, rendered and then delivered through clinical decision support systems (CDSS) to provide clinicians with just-in-time information at the point of care. Several tools exist that can be used to generate CDS rules that are based on computer interpretable guidelines (CIG), but none have been previously applied to the PGx domain. We utilized the Unified Modeling Language (UML), the Health Level 7 virtual medical record (HL7 vMR) model, and standard terminologies to represent the semantics and decision logic derived from a PGx guideline, which were then mapped to the Health eDecisions (HeD) schema. The modeling and extraction processes developed here demonstrate how structured knowledge representations can be used to support the creation of shareable CDS rules from PGx guidelines. PMID:26958298

  2. Energy-Efficient Heterogeneous Wireless Sensor Deployment with Multiple Objectives for Structural Health Monitoring.

    PubMed

    Liu, Chengyin; Jiang, Zhaoshuo; Wang, Fei; Chen, Hui

    2016-11-06

    Heterogeneous wireless sensor networks (HWSNs) are widely adopted in structural health monitoring systems due to their potential for implementing sophisticated algorithms by integrating a diverse set of devices and improving a network's sensing performance. However, deploying such a HWSN is still in a challenge due to the heterogeneous nature of the data and the energy constraints of the network. To respond to these challenges, an optimal deployment framework in terms of both modal information quality and energy consumption is proposed in this study. This framework generates a multi-objective function aimed at maximizing the quality of the modal information identified from heterogeneous data while minimizing the consumption of energy within the network at the same time. Particle swarm optimization algorithm is then implemented to seek solutions to the function effectively. After laying out the proposed sensor-optimization framework, a methodology is present to determine the clustering of the sensors to further conserve energy. Finally, a numerical verification is performed on a four-span pre-stressed reinforced concrete box-girder bridge. Results show that a set of strategically positioned heterogeneous sensors can maintain a balanced trade-off between the modal information accuracy and energy consumption. It is also observed that an appropriate cluster-tree network topology can further achieve energy saving in HWSNs.

  3. Energy-Efficient Heterogeneous Wireless Sensor Deployment with Multiple Objectives for Structural Health Monitoring

    PubMed Central

    Liu, Chengyin; Jiang, Zhaoshuo; Wang, Fei; Chen, Hui

    2016-01-01

    Heterogeneous wireless sensor networks (HWSNs) are widely adopted in structural health monitoring systems due to their potential for implementing sophisticated algorithms by integrating a diverse set of devices and improving a network’s sensing performance. However, deploying such a HWSN is still in a challenge due to the heterogeneous nature of the data and the energy constraints of the network. To respond to these challenges, an optimal deployment framework in terms of both modal information quality and energy consumption is proposed in this study. This framework generates a multi-objective function aimed at maximizing the quality of the modal information identified from heterogeneous data while minimizing the consumption of energy within the network at the same time. Particle swarm optimization algorithm is then implemented to seek solutions to the function effectively. After laying out the proposed sensor-optimization framework, a methodology is present to determine the clustering of the sensors to further conserve energy. Finally, a numerical verification is performed on a four-span pre-stressed reinforced concrete box-girder bridge. Results show that a set of strategically positioned heterogeneous sensors can maintain a balanced trade-off between the modal information accuracy and energy consumption. It is also observed that an appropriate cluster-tree network topology can further achieve energy saving in HWSNs. PMID:27827975

  4. A trial of the objective structured practical examination in physiology at Melaka Manipal Medical College, India.

    PubMed

    Abraham, Reem Rachel; Raghavendra, Rao; Surekha, Kamath; Asha, Kamath

    2009-03-01

    A single examination does not fulfill all the functions of assessment. The present study was undertaken to determine the reliability and student satisfaction regarding the objective structured practical examination (OSPE) as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university examination. The present study was undertaken in the Department of Physiology of Melaka Manipal Medical College, Manipal Campus, India. During the OSPE, students were made to rotate through 11 stations, of which 8 stations were composed of questions that tested their knowledge and critical thinking and 2 stations were composed of skills that students had to perform before the examiner. One station was kept as the rest station. Performance of the students was assessed by comparing the students' scores in the traditional practical examination (TPE) and OSPE using "Bland-Altman technique." Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire. The Bland-Altman plot showed that approximately 63% of the students showed a performance in the scores obtained using the OSPE and TPE within the acceptable limit of 8; 32% of the students scored much above the anticipated difference in the scores, and the rest scored below the anticipated difference in the scores on the OSPE and TPE. Feedback indicated that students were in favor of the OSPE compared with the TPE. Feedback from the students provided scope for improvement before the OSPE was administered for the first time in the forthcoming university examination.

  5. Chemistry of massive young stellar objects with a disk-like structure

    NASA Astrophysics Data System (ADS)

    Isokoski, K.; Bottinelli, S.; van Dishoeck, E. F.

    2013-06-01

    Aims: Our goal is to take an inventory of complex molecules in three well-known high-mass protostars for which disks or toroids have been claimed and to study the similarities and differences with a sample of massive young stellar objects (YSOs) without evidence of such flattened disk-like structures. With a disk-like geometry, UV radiation can escape more readily and potentially affect the ice and gas chemistry on hot-core scales. Methods: A partial submillimeter line survey, targeting CH3OH, H2CO, C2H5OH, HCOOCH3, CH3OCH3, CH3CN, HNCO, NH2CHO, C2H5CN, CH2CO, HCOOH, CH3CHO, and CH3CCH, was made toward three massive YSOs with disk-like structures, IRAS 20126+4104, IRAS 18089-1732, and G31.41+0.31. Rotation temperatures and column densities were determined by the rotation diagram method, as well as by independent spectral modeling. The molecular abundances were compared with previous observations of massive YSOs without evidence of any disk structure, targeting the same molecules with the same settings and using the same analysis method. Results: Consistent with previous studies, different complex organic species have different characteristic rotation temperatures and can be classified either as warm (>100 K) or cold (<100 K). The excitation temperatures and abundance ratios are similar from source to source and no significant difference can be established between the two source types. Acetone, CH3COCH3, is detected for the first time in G31.41+0.31 and IRAS 18089-1732. Temperatures and abundances derived from the two analysis methods generally agree within factors of a few. Conclusions: The lack of chemical differentiation between massive YSOs with and without observed disks suggest either that the chemical complexity is already fully established in the ices in the cold prestellar phase or that the material experiences similar physical conditions and UV exposure through outflow cavities during the short embedded lifetime. Appendices are available in electronic form

  6. Method and apparatus for detecting internal structures of bulk objects using acoustic imaging

    DOEpatents

    Deason, Vance A.; Telschow, Kenneth L.

    2002-01-01

    Apparatus for producing an acoustic image of an object according to the present invention may comprise an excitation source for vibrating the object to produce at least one acoustic wave therein. The acoustic wave results in the formation of at least one surface displacement on the surface of the object. A light source produces an optical object wavefront and an optical reference wavefront and directs the optical object wavefront toward the surface of the object to produce a modulated optical object wavefront. A modulator operatively associated with the optical reference wavefront modulates the optical reference wavefront in synchronization with the acoustic wave to produce a modulated optical reference wavefront. A sensing medium positioned to receive the modulated optical object wavefront and the modulated optical reference wavefront combines the modulated optical object and reference wavefronts to produce an image related to the surface displacement on the surface of the object. A detector detects the image related to the surface displacement produced by the sensing medium. A processing system operatively associated with the detector constructs an acoustic image of interior features of the object based on the phase and amplitude of the surface displacement on the surface of the object.

  7. Rapid development of entity-based data models for bioinformatics with persistence object-oriented design and structured interfaces.

    PubMed

    Ezra Tsur, Elishai

    2017-01-01

    Databases are imperative for research in bioinformatics and computational biology. Current challenges in database design include data heterogeneity and context-dependent interconnections between data entities. These challenges drove the development of unified data interfaces and specialized databases. The curation of specialized databases is an ever-growing challenge due to the introduction of new data sources and the emergence of new relational connections between established datasets. Here, an open-source framework for the curation of specialized databases is proposed. The framework supports user-designed models of data encapsulation, objects persistency and structured interfaces to local and external data sources such as MalaCards, Biomodels and the National Centre for Biotechnology Information (NCBI) databases. The proposed framework was implemented using Java as the development environment, EclipseLink as the data persistency agent and Apache Derby as the database manager. Syntactic analysis was based on J3D, jsoup, Apache Commons and w3c.dom open libraries. Finally, a construction of a specialized database for aneurysms associated vascular diseases is demonstrated. This database contains 3-dimensional geometries of aneurysms, patient's clinical information, articles, biological models, related diseases and our recently published model of aneurysms' risk of rapture. Framework is available in: http://nbel-lab.com.

  8. SEMCARE: Multilingual Semantic Search in Semi-Structured Clinical Data.

    PubMed

    López-García, Pablo; Kreuzthaler, Markus; Schulz, Stefan; Scherr, Daniel; Daumke, Philipp; Markó, Kornél; Kors, Jan A; van Mulligen, Erik M; Wang, Xinkai; Gonna, Hanney; Behr, Elijah; Honrado, Ángel

    2016-01-01

    The vast amount of clinical data in electronic health records constitutes a great potential for secondary use. However, most of this content consists of unstructured or semi-structured texts, which is difficult to process. Several challenges are still pending: medical language idiosyncrasies in different natural languages, and the large variety of medical terminology systems. In this paper we present SEMCARE, a European initiative designed to minimize these problems by providing a multi-lingual platform (English, German, and Dutch) that allows users to express complex queries and obtain relevant search results from clinical texts. SEMCARE is based on a selection of adapted biomedical terminologies, together with Apache UIMA and Apache Solr as open source state-of-the-art natural language pipeline and indexing technologies. SEMCARE has been deployed and is currently being tested at three medical institutions in the UK, Austria, and the Netherlands, showing promising results in a cardiology use case.

  9. The promise of computer-assisted auscultation in screening for structural heart disease and clinical teaching.

    PubMed

    Zühlke, L; Myer, L; Mayosi, B M

    2012-08-01

    Cardiac auscultation has been the central clinical tool for the diagnosis of valvular and other structural heart diseases for over a century. Physicians acquire competence in this technique through considerable training and experience. In Africa, however, we face a shortage of physicians and have the lowest health personnel-to-population ratio in the world. One of the proposed solutions for tackling this crisis is the adoption of health technologies and product innovations to support different cadres of health workers as part of task shifting. Computer-assisted auscultation (CAA) uses a digital stethoscope combined with acoustic neural networking to provide a visual display of heart sounds and murmurs, and analyses the recordings to distinguish between innocent and pathological murmurs. In so doing, CAA may serve as an objective tool for the screening of structural heart disease and facilitate the teaching of cardiac auscultation. This article reviews potential clinical applications of CAA.

  10. The Efficacy of Structural Priming on the Acquisition of Double Object Construction by Chinese EFL Learners

    ERIC Educational Resources Information Center

    Jiang, Lin; Huang, Kang

    2015-01-01

    Structural priming refers to the tendency of speakers to reuse the same structural pattern as one that was previously encountered (Bock, 1986). The effectiveness of structural priming has been an issue of much discussion in the field of second language acquisition over decades. This study aims at investigating the role of structural priming in…

  11. Envelope structure of deeply embedded young stellar objects in the Serpens Molecular Cloud.

    PubMed

    Hogerheijde, M R; van Dishoeck, E F; Salverda, J M; Blake, G A

    1999-03-01

    Aperture-synthesis and single-dish (sub-) millimeter molecular-line and continuum observations reveal in great detail the envelope structure of deeply embedded young stellar objects (SMM 1 = FIRS 1, SMM 2, SMM 3, SMM 4) in the densely star-forming Serpens Molecular Cloud. SMM 1, 3, and 4 show partially resolved (>2" = 800 AU) continuum emission in the beam of the Owens Valley Millimeter Array at lambda = 3.4-1.4 mm. The continuum visibilities accurately constrain the density structure in the envelopes, which can be described by a radial power law with slope -2.0 +/- 0.5 on scales of 300 to 8000 AU. Inferred envelope masses within a radius of 8000 AU are 8.7, 3.0, and 5.3 Msolar for SMM 1, 3, and 4, respectively. A point source with 20%-30% of the total flux at 1.1 mm is required to fit the observations on long baselines, corresponding to warm envelope material within approximately 100 AU or a circumstellar disk. No continuum emission is detected interferometrically toward SMM 2, corresponding to an upper limit of 0.2 Msolar assuming Td = 24 K. The lack of any compact dust emission suggests that the SMM 2 core does not contain a central protostar. Aperture-synthesis observations of the 13CO, C18O, HCO+, H13CO+, HCN, H13CN, N2H+ 1-0, SiO 2-1, and SO 2(2)-1(1) transitions reveal compact emission toward SMM 1, 3, and 4. SMM 2 shows only a number of clumps scattered throughout the primary field of view, supporting the conclusion that this core does not contain a central star. The compact molecular emission around SMM 1, 3, and 4 traces 5"-10" (2000-4000 AU) diameter cores that correspond to the densest regions of the envelopes, as well as material directly associated with the molecular outflow. Especially prominent are the optically thick HCN and HCO+ lines that show up brightly along the walls of the outflow cavities. SO and SiO trace shocked material, where their abundances may be enhanced by 1-2 orders of magnitude over dark-cloud values. A total of 31 molecular

  12. Envelope structure of deeply embedded young stellar objects in the Serpens Molecular Cloud

    NASA Technical Reports Server (NTRS)

    Hogerheijde, M. R.; van Dishoeck, E. F.; Salverda, J. M.; Blake, G. A.

    1999-01-01

    Aperture-synthesis and single-dish (sub-) millimeter molecular-line and continuum observations reveal in great detail the envelope structure of deeply embedded young stellar objects (SMM 1 = FIRS 1, SMM 2, SMM 3, SMM 4) in the densely star-forming Serpens Molecular Cloud. SMM 1, 3, and 4 show partially resolved (>2" = 800 AU) continuum emission in the beam of the Owens Valley Millimeter Array at lambda = 3.4-1.4 mm. The continuum visibilities accurately constrain the density structure in the envelopes, which can be described by a radial power law with slope -2.0 +/- 0.5 on scales of 300 to 8000 AU. Inferred envelope masses within a radius of 8000 AU are 8.7, 3.0, and 5.3 Msolar for SMM 1, 3, and 4, respectively. A point source with 20%-30% of the total flux at 1.1 mm is required to fit the observations on long baselines, corresponding to warm envelope material within approximately 100 AU or a circumstellar disk. No continuum emission is detected interferometrically toward SMM 2, corresponding to an upper limit of 0.2 Msolar assuming Td = 24 K. The lack of any compact dust emission suggests that the SMM 2 core does not contain a central protostar. Aperture-synthesis observations of the 13CO, C18O, HCO+, H13CO+, HCN, H13CN, N2H+ 1-0, SiO 2-1, and SO 2(2)-1(1) transitions reveal compact emission toward SMM 1, 3, and 4. SMM 2 shows only a number of clumps scattered throughout the primary field of view, supporting the conclusion that this core does not contain a central star. The compact molecular emission around SMM 1, 3, and 4 traces 5"-10" (2000-4000 AU) diameter cores that correspond to the densest regions of the envelopes, as well as material directly associated with the molecular outflow. Especially prominent are the optically thick HCN and HCO+ lines that show up brightly along the walls of the outflow cavities. SO and SiO trace shocked material, where their abundances may be enhanced by 1-2 orders of magnitude over dark-cloud values. A total of 31 molecular

  13. Health Services and Health Care Needs Fulfilled by Structured Clinical Programs for Children with Medical Complexity

    PubMed Central

    Kuo, Dennis Z.; Berry, Jay G.; Glader, Laurie; Morin, Melinda J.; Johaningsmeir, Sarah; Gordon, John

    2015-01-01

    Objective To describe family-reported health service needs of children with medical complexity, and to assess which needs are more often addressed in a tertiary care center-based structured clinical program for children with medical complexity. Study design Mailed survey to families of children with medical complexity enrolled in a structured-care program providing care coordination and oversight at one of three children’s hospitals. Outcomes included receipt of 14 specific health service needs. Paired t-tests compared unmet health care needs prior to and following program enrollment. Results 441 of 968 (46%) surveys were returned and analyzed. Respondents reported their children had a mean age of 7 (standard deviation 5) years. A majority of respondents reported the child had developmental delay (79%) and feeding difficulties (64%). Of respondents, 56% regarded the primary care provider as the primary point of contact for medical issues. Respondents reported an increase in meeting all fourteen health services needs after enrollment in a tertiary care center-based structured clinical program, including primary care checkups (82% v 96%), therapies (78% v 91%), mental health care (34% v 58%), respite care (56% v 75%), and referrals (51% v 83%) (all p<.001). Conclusions Tertiary care center-based structured clinical care programs for children with medical complexity may address and fulfill a broad range of health service needs that are not met in the primary care setting. PMID:26526361

  14. A real options approach to clinical faculty salary structure.

    PubMed

    Kahn, Marc J; Long, Hugh W

    2012-01-01

    One can use the option theory model originally developed to price financial opportunities in security markets to analyze many other economic arrangements such as the salary structures of clinical faculty in an academic medical center practice plan. If one views the underlying asset to be the portion (labeled "salary") of the economic value of the collections made for the care provided patients by the physician, then a salary guarantee can be considered a put option provided the physician, the guarantee having value to the physician only when the actual salary earned is less than the salary guarantee. Similarly, within an incentive plan, a salary cap can be thought of as a call option provided to the practice plan since a salary cap only has value to the practice plan when a physician's earnings exceed the cap. Further, based on analysis of prior earnings, the Black-Scholes options pricing model can be used both to price each option and to determine a financially neutral balance between a salary guarantee and a salary cap by equating the prices of the implied put and call options. We suggest that such analysis is superior to empirical methods for setting clinical faculty salary structure in the academic practice plan setting.

  15. Developing an Objective Structured Clinical Examination to Assess Work-Integrated Learning in Exercise Physiology

    ERIC Educational Resources Information Center

    Naumann, Fiona; Moore, Keri; Mildon, Sally; Jones, Philip

    2014-01-01

    This paper aims to develop a valid method to assess the key competencies of the exercise physiology profession acquired through work-integrated learning (WIL). In order to develop a competency-based assessment, the key professional tasks needed to be identified and the test designed so students' competency in different tasks and settings could be…

  16. Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison.

    PubMed

    Phillips, Donna; Pean, Christian A; Allen, Kathleen; Zuckerman, Joseph; Egol, Kenneth

    2016-12-21

    Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter.

  17. Introducing a Model for Optimal Design of Sequential Objective Structured Clinical Examinations

    ERIC Educational Resources Information Center

    Mortaz Hejri, Sara; Yazdani, Kamran; Labaf, Ali; Norcini, John J.; Jalili, Mohammad

    2016-01-01

    In a sequential OSCE which has been suggested to reduce testing costs, candidates take a short screening test and who fail the test, are asked to take the full OSCE. In order to introduce an effective and accurate sequential design, we developed a model for designing and evaluating screening OSCEs. Based on two datasets from a 10-station…

  18. [Using Objective Structured Clinical Examination (OSCE) across different levels of pediatric training].

    PubMed

    Di Lalla, Sandra; Manjarin, Mercedes; Torres, Fernando; Ossorio, María Fabiana; Wainsztein, Raquel; Ferrero, Fernando

    2014-01-01

    Antecedentes:Evaluar competencias profesionales es objetivo principal de todo programa de capacitación; el examen clínico objetivo estructurado (ECOE) es una herramienta útil para explorarlas. Objetivo:Describimos la implementación del ECOE en tres instancias de enseñanza de la pediatría (carrera de especialista, módulo pediatría del internado anual rotatorio, materia pediatría en el grado). Métodos: En relación con situaciones y patologías frecuentes en pediatría, se evaluaron conocimiento aplicado, juicio clínico y habilidad comunicacional. Resultados: En el posgrado el ECOE se aplica desde hace 8 años, examinando 330 alumnos, con 60%-82% de aprobación. En el Internado Anual Rotatorio el ECOE se emplea desde hace 2 años, examinando 12 alumnos, con 84% de aprobación. En el grado el ECOE se empleó sólo en una oportunidad, examinando 15 alumnos, con 93,4% de aprobación. Conclusión:En nuestra experiencia, a pesar de desafíos logísticos, la implementación del ECOE fue factible en distintas instancias de enseñanza de la pediatría.

  19. Correlating Photoreceptor Mosaic Structure to Clinical Findings in Stargardt Disease

    PubMed Central

    Razeen, Moataz M.; Cooper, Robert F.; Langlo, Christopher S.; Goldberg, Mara R.; Wilk, Melissa A.; Han, Dennis P.; Connor, Thomas B.; Fishman, Gerald A.; Collison, Frederick T.; Sulai, Yusufu N.; Dubra, Alfredo; Carroll, Joseph; Stepien, Kimberly E.

    2016-01-01

    Purpose To demonstrate a method for correlating photoreceptor mosaic structure with optical coherence tomography (OCT) and microperimetry findings in patients with Stargardt disease. Methods A total of 14 patients with clinically diagnosed Stargardt disease were imaged using confocal and split-detection adaptive optics scanning light ophthalmoscopy. Cone photoreceptors were identified manually in a band along the temporal meridian. Resulting values were compared to a normative database (n = 9) to generate cone density deviation (CDD) maps. Manual measurement of outer nuclear layer plus Henle fiber layer (ONL+HFL) thickness was performed, in addition to determination of the presence of ellipsoid zone (EZ) and interdigitation zone (IZ) bands on OCT. These results, along with microperimetry data, were overlaid with the CDD maps. Results Wide variation in foveal structure and CDD maps was seen within this small group. Disruption of ONL+HFL and/or IZ band was seen in all patients, with EZ band preservation in regions with low cone density in 38% of locations analyzed. Normality of retinal lamellar structure on OCT corresponded with cone density and visual function at 50/78 locations analyzed. Outer retinal tubulations containing photoreceptor-like structures were observed in 3 patients. Conclusions The use of CDD color-coded maps enables direct comparison of cone mosaic local density with other measures of retinal structure and function. Larger normative datasets and improved tools for automation of image alignment are needed. Translational Relevance The approach described facilitates comparison of complex multimodal data sets from patients with inherited retinal degeneration, and can be expanded to incorporate other structural imaging or functional testing. PMID:26981328

  20. The use of recurrent signals about adaptation for subsequent saccade programming depends on object structure.

    PubMed

    Doré-Mazars, Karine; Vergilino-Perez, Dorine; Collins, Thérèse; Bohacova, Katarina; Beauvillain, Cécile

    2006-10-03

    Executing sequences of accurate saccadic eye movements supposes the use of signals carrying information about the first saccade for updating the predetermined motor plan of the subsequent saccades. The present study examines the signals used in planning a second saccade when subjects made two successive saccades towards one long or two short peripheral objects displayed before the first saccade execution. Different first eye movement signals could be used: desired eye movement signals, representing the movement necessary for attaining the intended target, or actual eye movement signals, representing the movement actually executed. Experimental dissociation of desired and actual eye movement signals is made possible by adaptive modifications of the first saccade, obtained by transfer of single saccade adaptation, during which the motor vector was progressively modified in response to the systematic intra-saccadic step of a single target. Whether the second saccade used the actual eye movement signal to compensate or not for the adaptive changes in the first saccade depended on which object properties were relevant for saccade planning. Compensation was observed for saccades that aimed for a new object (between-object saccades) because adaptation modifies relative object location. No compensation was observed for saccades that explored an extended object (within-object saccades). Implications for the on-line control of subsequent eye movements are discussed.

  1. Distinct Roles for Medial Temporal Lobe Structures in Memory for Objects and Their Locations

    ERIC Educational Resources Information Center

    Buffalo, Elizabeth A.; Bellgowan, Patrick S. F.; Martin, Alex

    2006-01-01

    The ability to learn and retain novel information depends on a system of structures in the medial temporal lobe (MTL) including the hippocampus and the surrounding entorhinal, perirhinal, and parahippocampal cortices. Damage to these structures produces profound memory deficits; however, the unique contribution to memory of each of these…

  2. Parallel compression of data chunks of a shared data object using a log-structured file system

    DOEpatents

    Bent, John M.; Faibish, Sorin; Grider, Gary

    2016-10-25

    Techniques are provided for parallel compression of data chunks being written to a shared object. A client executing on a compute node or a burst buffer node in a parallel computing system stores a data chunk generated by the parallel computing system to a shared data object on a storage node by compressing the data chunk; and providing the data compressed data chunk to the storage node that stores the shared object. The client and storage node may employ Log-Structured File techniques. The compressed data chunk can be de-compressed by the client when the data chunk is read. A storage node stores a data chunk as part of a shared object by receiving a compressed version of the data chunk from a compute node; and storing the compressed version of the data chunk to the shared data object on the storage node.

  3. [Clinical research VIII. Structured review of an article].

    PubMed

    Talavera, Juan O; Rivas-Ruiz, Rodolfo

    2012-01-01

    There has been proposed several strategies to select an article under the assumption of quality and relevance. Mostly depend on the presence or absence of a number of features and others, depends of the judgment of other people. However, these strategies do not allow us to know the magnitude of the error contained within each article. And considering that there is not a perfect one, it is important to identify the magnitude of the error and the impact of this in the final result; consequently, it is necessary to develop skills that allow us to review a paper, identify potential errors, and generate a sense of the impact of it over the result. Using the information contained in Clinical Research Series I-VII, we have tried to show its application in a structured review of an article of causality beginning with the revision of the baseline, the maneuver and the outcome, with systematic errors (bias) generated in each section, followed by the appropriate of the statistical test and the sample size used, and finally, the clinical relevance.

  4. Incidental and context-responsive activation of structure- and function-based action features during object identification.

    PubMed

    Lee, Chia-lin; Middleton, Erica; Mirman, Daniel; Kalénine, Solène; Buxbaum, Laurel J

    2013-02-01

    Previous studies suggest that action representations are activated during object processing, even when task-irrelevant. In addition, there is evidence that lexical-semantic context may affect such activation during object processing. Finally, prior work from our laboratory and others indicates that function-based ("use") and structure-based ("move") action subtypes may differ in their activation characteristics. Most studies assessing such effects, however, have required manual object-relevant motor responses, thereby plausibly influencing the activation of action representations. The present work uses eyetracking and a Visual World Paradigm task without object-relevant actions to assess the time course of activation of action representations, as well as their responsiveness to lexical-semantic context. In two experiments, participants heard a target word and selected its referent from an array of four objects. Gaze fixations on nontarget objects signal activation of features shared between targets and nontargets. The experiments assessed activation of structure-based (Experiment 1) or function-based (Experiment 2) distractors, using neutral sentences ("S/he saw the....") or sentences with a relevant action verb (Experiment 1: "S/he picked up the...."; Experiment 2: "S/he used the...."). We observed task-irrelevant activations of action information in both experiments. In neutral contexts, structure-based activation was relatively faster-rising but more transient than function-based activation. Additionally, action verb contexts reliably modified patterns of activation in both Experiments. These data provide fine-grained information about the dynamics of activation of function-based and structure-based actions in neutral and action-relevant contexts, in support of the "Two Action System" model of object and action processing (e.g., Buxbaum & Kalénine, 2010).

  5. Innovative Language-Based & Object-Oriented Structured AMR Using Fortran 90 and OpenMP

    NASA Technical Reports Server (NTRS)

    Norton, C.; Balsara, D.

    1999-01-01

    Parallel adaptive mesh refinement (AMR) is an important numerical technique that leads to the efficient solution of many physical and engineering problems. In this paper, we describe how AMR programing can be performed in an object-oreinted way using the modern aspects of Fortran 90 combined with the parallelization features of OpenMP.

  6. OPM Scheme Editor 2: A graphical editor for specifying object-protocol structures

    SciTech Connect

    Chen, I-Min A.; Markowitz, V.M.; Pang, F.; Ben-Shachar, O.

    1993-07-01

    This document describes an X-window based Schema Editor for the Object-Protocol Model (OPM). OPM is a data model that supports the specification of complex object and protocol classes. objects and protocols are qualified in OPM by attributes that are defined over (associated with) value classes. Connections of object and protocol classes are expressed in OPM via attributes. OPM supports the specification (expansion) of protocols in terms of alternative and sequences of component (sub) protocols. The OPM Schema Editor allows specifying, displaying, modifying, and browsing through OPM schemas. The OPM Schema Editor generates an output file that can be used as input to an OPM schema translation tool that maps OPM schemas into definitions for relational database management systems. The OPM Schema Editor was implemented using C++ and the X11 based Motif toolkit, on Sun SPARCstation under Sun Unix OS 4.1. This document consists of the following parts: (1) A tutorial consisting of seven introductory lessons for the OPM Schema Editor. (2) A reference manual describing all the windows and functions of the OPM Schema Editor. (3) An appendix with an overview of OPM.

  7. Constructing a Validity Argument for the Objective Structured Assessment of Technical Skills (OSATS): A Systematic Review of Validity Evidence

    ERIC Educational Resources Information Center

    Hatala, Rose; Cook, David A.; Brydges, Ryan; Hawkins, Richard

    2015-01-01

    In order to construct and evaluate the validity argument for the Objective Structured Assessment of Technical Skills (OSATS), based on Kane's framework, we conducted a systematic review. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus, and selected reference lists through February 2013. Working in duplicate, we selected…

  8. Parallel checksumming of data chunks of a shared data object using a log-structured file system

    DOEpatents

    Bent, John M.; Faibish, Sorin; Grider, Gary

    2016-09-06

    Checksum values are generated and used to verify the data integrity. A client executing in a parallel computing system stores a data chunk to a shared data object on a storage node in the parallel computing system. The client determines a checksum value for the data chunk; and provides the checksum value with the data chunk to the storage node that stores the shared object. The data chunk can be stored on the storage node with the corresponding checksum value as part of the shared object. The storage node may be part of a Parallel Log-Structured File System (PLFS), and the client may comprise, for example, a Log-Structured File System client on a compute node or burst buffer. The checksum value can be evaluated when the data chunk is read from the storage node to verify the integrity of the data that is read.

  9. A stroboscopic structured illumination system used in dynamic 3D visualization of high-speed motion object

    NASA Astrophysics Data System (ADS)

    Su, Xianyu; Zhang, Qican; Li, Yong; Xiang, Liqun; Cao, Yiping; Chen, Wenjing

    2005-04-01

    A stroboscopic structured illumination system, which can be used in measurement for 3D shape and deformation of high-speed motion object, is proposed and verified by experiments. The system, present in this paper, can automatically detect the position of high-speed moving object and synchronously control the flash of LED to project a structured optical field onto surface of motion object and the shoot of imaging system to acquire an image of deformed fringe pattern, also can create a signal, set artificially through software, to synchronously control the LED and imaging system to do their job. We experiment on a civil electric fan, successful acquire a serial of instantaneous, sharp and clear images of rotation blade and reconstruct its 3D shapes in difference revolutions.

  10. WONKA: objective novel complex analysis for ensembles of protein-ligand structures.

    PubMed

    Bradley, A R; Wall, I D; von Delft, F; Green, D V S; Deane, C M; Marsden, B D

    2015-10-01

    WONKA is a tool for the systematic analysis of an ensemble of protein-ligand structures. It makes the identification of conserved and unusual features within such an ensemble straightforward. WONKA uses an intuitive workflow to process structural co-ordinates. Ligand and protein features are summarised and then presented within an interactive web application. WONKA's power in consolidating and summarising large amounts of data is described through the analysis of three bromodomain datasets. Furthermore, and in contrast to many current methods, WONKA relates analysis to individual ligands, from which we find unusual and erroneous binding modes. Finally the use of WONKA as an annotation tool to share observations about structures is demonstrated. WONKA is freely available to download and install locally or can be used online at http://wonka.sgc.ox.ac.uk.

  11. WONKA: objective novel complex analysis for ensembles of protein-ligand structures

    NASA Astrophysics Data System (ADS)

    Bradley, A. R.; Wall, I. D.; von Delft, F.; Green, D. V. S.; Deane, C. M.; Marsden, B. D.

    2015-10-01

    WONKA is a tool for the systematic analysis of an ensemble of protein-ligand structures. It makes the identification of conserved and unusual features within such an ensemble straightforward. WONKA uses an intuitive workflow to process structural co-ordinates. Ligand and protein features are summarised and then presented within an interactive web application. WONKA's power in consolidating and summarising large amounts of data is described through the analysis of three bromodomain datasets. Furthermore, and in contrast to many current methods, WONKA relates analysis to individual ligands, from which we find unusual and erroneous binding modes. Finally the use of WONKA as an annotation tool to share observations about structures is demonstrated. WONKA is freely available to download and install locally or can be used online at http://wonka.sgc.ox.ac.uk.

  12. Object Oriented Learning Objects

    ERIC Educational Resources Information Center

    Morris, Ed

    2005-01-01

    We apply the object oriented software engineering (OOSE) design methodology for software objects (SOs) to learning objects (LOs). OOSE extends and refines design principles for authoring dynamic reusable LOs. Our learning object class (LOC) is a template from which individualised LOs can be dynamically created for, or by, students. The properties…

  13. Multi-objective optimization of crop planting structure in irrigation area based on remote sensing technology

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In the regions short of water, the adjustment of cropping structure is also an important measure to save water in agriculture besides water-saving irrigation techniques and cultivation techniques. This paper describes a method of water saving and high efficient water usage by adjusting the differen...

  14. The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: a systematic review.

    PubMed

    Hall, Charlotte L; Valentine, Althea Z; Groom, Madeleine J; Walker, Gemma M; Sayal, Kapil; Daley, David; Hollis, Chris

    2016-07-01

    Attention-deficit hyperactivity disorder (ADHD) is typically diagnosed using clinical observation and subjective informant reports. Once children commence ADHD medication, robust monitoring is required to detect partial or non-responses. The extent to which neuropsychological continuous performance tests (CPTs) and objective measures of activity can clinically aid the assessment and titration process in ADHD is not fully understood. This review describes the current evidence base for the use of CPTs and objectively measured activity to support the diagnostic procedure and medication management for children with ADHD. Four databases (PsycINFO, Medline, Allied and Complementary Medicine (AMED), and PsycARTICLES) were systematically searched to understand the current evidence base for (1) the use of CPTs to aid clinical assessment of ADHD; (2) the use of CPTs to aid medication management; and (3) the clinical utility of objective measures of activity in ADHD. Sixty relevant articles were identified. The search revealed six commercially available CPTs that had been reported on for their clinical use. There were mixed findings with regard to the use of CPTs to assess and manage medication, with contrasting evidence on their ability to support clinical decision-making. There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation, which appears sensitive to medication effects and would also benefit from further research on their clinical utility. The findings suggest that combining CPTs and an objective measure of activity may be particularly useful as a clinical tool and worthy of further pursuit.

  15. Structure and Evolution of Kuiper Belt Objects: The Case for Compositional Classes

    NASA Astrophysics Data System (ADS)

    McKinnon, William B.; Prialnik, D.; Stern, S. A.

    2007-10-01

    Kuiper belt objects (KBOs) accreted from a mélange of ices, carbonaceous matter, and rock of mixed interstellar and solar nebular provenance. The transneptunian region, where this accretion took place, was likely more radially compact than today. This and the influence of gas drag during the solar nebula epoch argue for more rapid KBO accretion than usually considered. Early evolution of KBOs was largely the result of radiogenic heating, with both short-term and long-term contributions being potentially important. Depending on rock content and porous conductivity, KBO interiors may have reached relatively high temperatures. Models suggest that KBOs likely lost very volatile ices during early evolution, whereas less volatile ices should be retained in cold, less altered subsurface layers; initially amorphous ice may have crystallized in the interior as well, releasing trapped volatiles. Generally, KBOs should be stratified in terms of composition and porosity, albeit subject to impact disruption and collisional stripping. KBOs are thus unlikely to be "the most pristine objects in the Solar System.” Large (dwarf planet) KBOs may be fully differentiated. KBO surface color and compositional classes are usually discussed in terms of "nature vs. nurture,” i.e., a generic primordial composition vs. surface processing, but the true nature of KBOs also depends on how they have evolved. The broad range of albedos now found in the Kuiper belt, deep water-ice absorptions on some objects, evidence for differentiation of Pluto and 2003 EL61, and a range of densities incompatible with a single, primordial composition and variable porosity strongly imply significant, intrinsic compositional differences among KBOs. The interplay of formation zone (accretion rate), body size, and dynamical (collisional) history may yield KBO compositional classes (and their spectral correlates) that recall the different classes of asteroids in the inner Solar System, but whose members are

  16. Structured prediction models for RNN based sequence labeling in clinical text

    PubMed Central

    Jagannatha, Abhyuday N; Yu, Hong

    2016-01-01

    Sequence labeling is a widely used method for named entity recognition and information extraction from unstructured natural language data. In clinical domain one major application of sequence labeling involves extraction of medical entities such as medication, indication, and side-effects from Electronic Health Record narratives. Sequence labeling in this domain, presents its own set of challenges and objectives. In this work we experimented with various CRF based structured learning models with Recurrent Neural Networks. We extend the previously studied LSTM-CRF models with explicit modeling of pairwise potentials. We also propose an approximate version of skip-chain CRF inference with RNN potentials. We use these methodologies1 for structured prediction in order to improve the exact phrase detection of various medical entities. PMID:28004040

  17. Tracing the efficient curve for multi-objective control-structure optimization

    NASA Technical Reports Server (NTRS)

    Rakowska, J.; Haftka, R. T.; Watson, L. T.

    1992-01-01

    A recently developed active set algorithm for tracing parameterized optima is adapted to multiobjective optimization. The algorithm traces a path of Kuhn-Tucker points using homotopy curve tracking techniques, and is based on identifying and maintaining the set of active constraints. Second order necessary optimality conditions are used to determine nonoptimal stationary points on the path. In the bi-objective optimization case the algorithm is used to trace the curve of efficient solution (Pareto optima). As an example, the algorithm is applied to the simultaneous minimization of the weight and control force of a ten-bar truss with two collocated sensors and actuators, with some interesting results.

  18. Computing 3-D structure of rigid objects using stereo and motion

    NASA Technical Reports Server (NTRS)

    Nguyen, Thinh V.

    1987-01-01

    Work performed as a step toward an intelligent automatic machine vision system for 3-D imaging is discussed. The problem considered is the quantitative 3-D reconstruction of rigid objects. Motion and stereo are the two clues considered in this system. The system basically consists of three processes: the low level process to extract image features, the middle level process to establish the correspondence in the stereo (spatial) and motion (temporal) modalities, and the high level process to compute the 3-D coordinates of the corner points by integrating the spatial and temporal correspondences.

  19. Robust object tracking based on structural local sparsity via a global L2 norm constraint

    NASA Astrophysics Data System (ADS)

    Li, Meihui; Peng, Zhenming; Zhang, Ping

    2016-10-01

    In the structural local sparse model, every candidate derived from the particle filter framework is divided into several overlapping image patches. However, in the tracking process, the structural characteristics of the target may change due to alterations in appearance, resulting in unstable pooled features and therefore drifting and false tracking. We propose a method to correct the changed part of the target using atoms in the patched dictionary by adding a global constraint. If the target is corrupted, this constraint term will weaken the influence of variation and strengthen the stability of the pooled features. Otherwise, the method is based on the whole target and will protect its spatial continuity. Both qualitative and quantitative evaluations on challenging benchmark image sequences demonstrate that the proposed algorithm has excellent tracking behavior, displaying robustness and stability with little drifting on a target with altering appearance and partial occlusion.

  20. Polarization and Structure of Broad Absorption Line Quasi-Stellar Objects

    NASA Astrophysics Data System (ADS)

    Ogle, Patrick Michael

    This thesis is a spectropolarimetric survey of broad absorption line quasi-stellar objects (BAL QSO). We observed 36 BAL QSO at the Palomar and W. M. Keck Observatories. BAL QSO have higher polarization than other quasars, reinforcing the view that they are normal quasars viewed from an equatorial aspect. However, there is a wide distribution of polarization values, which may be due to intrinsic differences in the geometry or optical depth to scattering. No correlations are found among emission line or broad absorption line properties and continuum polarization, suggesting that these properties are regulated by internal differences unrelated to viewing angle. The continuum polarization of BAL QSO is weakly wavelength-dependent after correction for emission line dilution. In most objects, the polarisation rises to the blue, suggesting that dust scattering or absorption may be important. Broad emission line photons are polarized less than the continuum; and the position angle of the electric vector is rotated with respect to the continuum. The semi-forbidden C III) emission line is polarized differently than the C IV emission line, suggesting resonance scattering in the C III) emission line region. Resonantly scattered photons from the broad absorption line region are detected at high velocities red-ward and blue-ward of the C IV line center in the spectra of some objects. These photons are negatively polarized with respect to the continuum photons, showing that the broad absorption line region and the continuum scattering region are oriented perpendicular to each other. The polarization increases in the BAL troughs, due mainly to partial coverage of the central source by the broad absorption line region. The geometry of the intervening BAL clouds is skewed with respect to the continuum scattering region, which results in position angle rotations in the BAL. The variation of polarization with velocity in the BAL is consistent with a non-radial, accelerating outflow

  1. Integration of multi-objective structural optimization into cementless hip prosthesis design: Improved Austin-Moore model.

    PubMed

    Kharmanda, G

    2016-11-01

    A new strategy of multi-objective structural optimization is integrated into Austin-Moore prosthesis in order to improve its performance. The new resulting model is so-called Improved Austin-Moore. The topology optimization is considered as a conceptual design stage to sketch several kinds of hollow stems according to the daily loading cases. The shape optimization presents the detailed design stage considering several objectives. Here, A new multiplicative formulation is proposed as a performance scale in order to define the best compromise between several requirements. Numerical applications on 2D and 3D problems are carried out to show the advantages of the proposed model.

  2. Disks and Ring Structures Around Collapsed Objects Suitable for the Emergence of Jets

    NASA Astrophysics Data System (ADS)

    Coppi, B.

    2005-10-01

    The emergence of jets from plasma accretion disks surrounding for instance a black hole requires that the magnetic energy densities within the disk be significant relative to the plasma pressure. Thus the axisymmetric equilibrium configurations, that can form in the strong gravitational field of a central object and where the currents within differentially rotating disks can produce a ``crystal'' magnetic structureootnotetextB. Coppi, Phys. Plasmas 12, 057302 (2005), are shown to be characterized by strong modulations of the plasma density and pressure when the magnetic energy densities are comparable to the thermal energy densities. Moreover, when the external magnetic field in which the plasma is immersed is relatively weak, the internal currents can produce a configuration consisting of a sequence of plasma ring pairsootnotetextB. Coppi, F. Rousseau, M.I.T. (LNS) Report HEP05/01 (2005), submitted to Ap.J. The processes which can sustain these configurations are discussed.

  3. An Evolutionary Multi-objective Optimization of Market Structures Using PBIL

    NASA Astrophysics Data System (ADS)

    Li, Xinyang; Krause, Andreas

    We evaluate an agent-based model featuring near-zero-intelligence traders operating in a call market with a wide range of trading rules governing the determination of prices, which orders are executed as well as a range of parameters regarding market intervention by market makers and the presence of informed traders. We optimize these trading rules using a multi-objective population-based incremental learning (PIBL) algorithm seeking to maximize the trading price and minimize the bid-ask spread. Our results suggest that markets should choose a relatively large tick size unless concerns about either the bid-ask spread or the trading price are dominating. We also find that in contrast to trading rules in actual markets, reverse time priority is an optimal priority rule.

  4. Cytochrome P450 structure, function and clinical significance: A review.

    PubMed

    Palrasu, Manikandan; Nagini, Siddavaram

    2017-01-25

    The cytochrome P450 (CYP) enzymes are membrane-bound hemoproteins that play a pivotal role in the detoxification of xenobiotics, cellular metabolism and homeostasis. Induction or inhibition of CYP enzymes is a major mechanism that underlies drug-drug interactions. CYP enzymes can be transcriptionally activated by various xenobiotics and endogenous substrates through receptor-dependent mechanisms. CYP enzyme inhibition is a principal mechanism for metabolism-based drug-drug interactions. Many chemotherapeutic drugs can cause drug interactions due to their ability to either inhibit or induce the CYP enzyme system. Predictions based on in silico analyses followed by validation have identified several microRNAs that regulate CYPs. Genetic polymorphisms and epigenetic changes in CYP genes may be responsible for inter-individual and inter-ethnic variations in disease susceptibility and the therapeutic efficacy of drugs. Knowledge about the substrates, inducers, inhibitors of CYP isoforms, and the polymorphisms of CYP enzymes may be used as an aid by clinicians to determine therapeutic strategy, and treatment doses for drugs that are metabolized by CYP gene products. The present review is a comprehensive compilation of cytochrome P450 structure, function, pharmacogenetics, and pharmacoepigenetics and clinical significance.

  5. Assessment of Semi-Structured Clinical Interview for Mobile Phone Addiction Disorder

    PubMed Central

    Alavi, Seyyed Salman; Jannatifard, Fereshteh; Mohammadi Kalhori, Soroush; Sepahbodi, Ghazal; BabaReisi, Mohammad; Sajedi, Sahar; Farshchi, Mojtaba; KhodaKarami, Rasul; Hatami Kasvaee, Vahid

    2016-01-01

    Objective: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) classified mobile phone addiction disorder under “impulse control disorder not elsewhere classified”. This study surveyed the diagnostic criteria of DSM-IV-TR for the diagnosis of mobile phone addiction in correspondence with Iranian society and culture. Method: Two hundred fifty students of Tehran universities were entered into this descriptive-analytical and cross-sectional study. Quota sampling method was used. At first, semi- structured clinical interview (based on DSM-IV-TR) was performed for all the cases, and another specialist reevaluated the interviews. Data were analyzed using content validity, inter-scorer reliability (Kappa coefficient) and test-retest via SPSS18 software. Results: The content validity of the semi- structured clinical interview matched the DSM–IV-TR criteria for behavioral addiction. Moreover, their content was appropriate, and two items, including “SMS pathological use” and “High monthly cost of using the mobile phone” were added to promote its validity. Internal reliability (Kappa) and test–retest reliability were 0.55 and r = 0.4 (p<0. 01) respectively. Conclusion: The results of this study revealed that semi- structured diagnostic criteria of DSM-IV-TR are valid and reliable for diagnosing mobile phone addiction, and this instrument is an effective tool to diagnose this disorder. PMID:27437008

  6. Observing microscopic structures of a relativistic object using a time-stretch strategy

    NASA Astrophysics Data System (ADS)

    Roussel, E.; Evain, C.; Le Parquier, M.; Szwaj, C.; Bielawski, S.; Manceron, L.; Brubach, J.-B.; Tordeux, M.-A.; Ricaud, J.-P.; Cassinari, L.; Labat, M.; Couprie, M.-E.; Roy, P.

    2015-05-01

    Emission of light by a single electron moving on a curved trajectory (synchrotron radiation) is one of the most well-known fundamental radiation phenomena. However experimental situations are more complex as they involve many electrons, each being exposed to the radiation of its neighbors. This interaction has dramatic consequences, one of the most spectacular being the spontaneous formation of spatial structures inside electrons bunches. This fundamental effect is actively studied as it represents one of the most fundamental limitations in electron accelerators, and at the same time a source of intense terahertz radiation (Coherent Synchrotron Radiation, or CSR). Here we demonstrate the possibility to directly observe the electron bunch microstructures with subpicosecond resolution, in a storage ring accelerator. The principle is to monitor the terahertz pulses emitted by the structures, using a strategy from photonics, time-stretch, consisting in slowing-down the phenomena before recording. This opens the way to unpreceeded possibilities for analyzing and mastering new generation high power coherent synchrotron sources.

  7. Observing microscopic structures of a relativistic object using a time-stretch strategy

    PubMed Central

    Roussel, E.; Evain, C.; Le Parquier, M.; Szwaj, C.; Bielawski, S.; Manceron, L.; Brubach, J.-B.; Tordeux, M.-A.; Ricaud, J.-P.; Cassinari, L.; Labat, M.; Couprie, M.-E; Roy, P.

    2015-01-01

    Emission of light by a single electron moving on a curved trajectory (synchrotron radiation) is one of the most well-known fundamental radiation phenomena. However experimental situations are more complex as they involve many electrons, each being exposed to the radiation of its neighbors. This interaction has dramatic consequences, one of the most spectacular being the spontaneous formation of spatial structures inside electrons bunches. This fundamental effect is actively studied as it represents one of the most fundamental limitations in electron accelerators, and at the same time a source of intense terahertz radiation (Coherent Synchrotron Radiation, or CSR). Here we demonstrate the possibility to directly observe the electron bunch microstructures with subpicosecond resolution, in a storage ring accelerator. The principle is to monitor the terahertz pulses emitted by the structures, using a strategy from photonics, time-stretch, consisting in slowing-down the phenomena before recording. This opens the way to unpreceeded possibilities for analyzing and mastering new generation high power coherent synchrotron sources. PMID:26020859

  8. An object-oriented approach for parallel self adaptive mesh refinement on block structured grids

    NASA Technical Reports Server (NTRS)

    Lemke, Max; Witsch, Kristian; Quinlan, Daniel

    1993-01-01

    Self-adaptive mesh refinement dynamically matches the computational demands of a solver for partial differential equations to the activity in the application's domain. In this paper we present two C++ class libraries, P++ and AMR++, which significantly simplify the development of sophisticated adaptive mesh refinement codes on (massively) parallel distributed memory architectures. The development is based on our previous research in this area. The C++ class libraries provide abstractions to separate the issues of developing parallel adaptive mesh refinement applications into those of parallelism, abstracted by P++, and adaptive mesh refinement, abstracted by AMR++. P++ is a parallel array class library to permit efficient development of architecture independent codes for structured grid applications, and AMR++ provides support for self-adaptive mesh refinement on block-structured grids of rectangular non-overlapping blocks. Using these libraries, the application programmers' work is greatly simplified to primarily specifying the serial single grid application and obtaining the parallel and self-adaptive mesh refinement code with minimal effort. Initial results for simple singular perturbation problems solved by self-adaptive multilevel techniques (FAC, AFAC), being implemented on the basis of prototypes of the P++/AMR++ environment, are presented. Singular perturbation problems frequently arise in large applications, e.g. in the area of computational fluid dynamics. They usually have solutions with layers which require adaptive mesh refinement and fast basic solvers in order to be resolved efficiently.

  9. THE USE OF THE ANALYST AND THE SENSE OF BEING REAL: THE CLINICAL MEANING OF WINNICOTT'S "THE USE OF AN OBJECT".

    PubMed

    Fabozzi, Paolo

    2016-01-01

    "The Use of an Object and Relating through Identifications" (1968) represents Donald Winnicott's theoretical and clinical legacy. The author develops this concept from a clinical point of view, through the analysis of a woman with psychotic functioning. He reflects upon the dramatic quality of risks inherent in the processes linked to the use of the object with seriously disturbed patients. He explores different meanings of the analyst's survival, linking it to the analyst's response. The processes of the use of the object--that is, the encounter between the patient's potential destructiveness and the analyst's capacity to respond through his own judicious subjectivity--let the patient experience the analyst's capacity to keep his own subjectivity, authenticity, and creativity alive. It is starting from the traces of this live object that patients gradually form their own personal sense of being real.

  10. Evaluating the Internal Structure of the Eysenck Personality Questionnaire: Objective Criteria.

    PubMed

    Helmes, E

    1989-07-01

    Controversy over the internal structure of personality inventories has centered on appropriate methodology and has often been based on differing criteria among researchers. Much of this controversy has revolved in particular around the Eysenck Personality Questionnaire (EPQ) or other Eysenck tests. An approach based on targeted rotations and the test's scoring key is proposed as a means of providing common criteria. These are based on the number of items having their highest loading on their keyed scale, the mean loading of keyed items and the number of items having their highest loading on non-keyed scales. Several data sets from earlier studies are analyzed, together with a new set based on the responses to the EPQ of 195 undergraduates, using the proposed criteria. Results were very similar across samples and suggested specific weaknesses with two EPQ scales. This provided support for the utility of the three criteria.

  11. Differentially Rotating Structures and Angular Momentum Transport in the Prevalent Gravity of a Central Object*

    NASA Astrophysics Data System (ADS)

    Rousseau, F.; Coppi, B.

    2006-10-01

    The presence of angular momentum transport associated with an accretion process in an axisymmetric differentially rotating structure affects the equilibrium configuration that this can take and can introduce a toroidal Lorentz force with the associated poloidal current densities. All three components (vertical, radial and toroidal) of the total momentum conservation equation are considered. A sequence of ring solutions can be found by making use of the inequalities vNJ

  12. Thermophysical Fluid Dynamics: the Key to the Structures of Fluid Objects

    NASA Astrophysics Data System (ADS)

    Houben, H.

    2013-12-01

    It has become customary to model the hydrodynamics of fluid planets like Jupiter and Saturn by spinning up general circulation models until they reach a statistical steady state. This approach is physically sound, based on the thermodynamic expectation that the system will eventually achieve a state of maximum entropy, but the models have not been specifically designed for this purpose. Over the course of long integrations, numerical artifacts can drive the system to a state that does not correspond to the physically realistic end state. A different formulation of the governing equations promises better results. The equations of motion are recast as scalar conservation laws in which the diabatic and irreversible terms (both entropy-changing) are clearly identified. The balance between these terms defines the steady state of the system analytically, without the need for any temporal integrations. The conservation of mass in this system is trivial. Conservation of angular momentum replaces the zonal momentum equation and determines the zonal wind from a balance between the tidal torque and frictional dissipation. The principle of wave-mean flow non-interaction is preserved. Bernoulli's Theorem replaces the energy equation. The potential temperature structure is determined by the balance between work done against friction and heat transfer by convection and radiation. An equation of state and the traditional momentum equations in the meridional plane are sufficient to complete the model. Based on the assumption that the final state vertical and meridional winds are small compared to the zonal wind (in any case they are impossible to predict ab initio as they are driven by wave flux convergences), these last equations determine the pressure and density (and hence gravity) fields of the basic state. The thermal wind relation (in its most general form with the axial derivative of the zonal wind balancing the baroclinicity) is preserved. The model is not hydrostatic (in

  13. [Ibogaine - structure, influence on human body, clinical relevance].

    PubMed

    Zdrojewicz, Zygmunt; Kuszczak, Bartłomiej; Olszak, Natalia

    2016-07-29

    Ibogaine is a natural chemical compound, which belongs to the indole alkaloid family. It can be naturally found within the root bark of african plant Tabernanthe iboga. Ibogaine plays a significant role among tribal cultures. Ibogaine, in small amount, causes reduction of hunger, thirst and exhaustion. In bigger amount, however, it can cause intensive visions. Other effects include reduction or complete disappearance of absitnence symptoms visible in people addicted to the nicotine, alcohol, methamphetamine, cocaine or opioids, what has been scientifically proven after the tests on animals and small groups of people. After oral application, 80% of ibogaine is subjected to the Odemethylation into noribogaine; main catalyzing enzyme is cytochrome CYP2D6. Research suggests, that ibogaine acts in many places within central nervous system. NMDA receptors seem to play main role in its anti-addiction properties. It is important to mention the side effects of the compound, which are cardiotoxicity and neurotoxicity, what makes it harder to use its beneficial properties. Because of this, Ibogaine is included among the dangerous substance. However, there are a few clinics in the world which specializes in the use of the compound in order to interrupt the sypmtoms acute opioid withdrawal syndrome as well as a substance benficial in curing other addictions. There is more hope with synthetic derivatives of ibogaine, which although are less toxic still keep their anti-addiction properties. The aim is to collect the available knowledge related to the structure and effects on human body of alkaloid Tabernanthe iboga and consider the possibility of commercial medical use.

  14. Age structure and mortality of walleyes in Kansas reservoirs: Use of mortality caps to establish realistic management objectives

    USGS Publications Warehouse

    Quist, M.C.; Stephen, J.L.; Guy, C.S.; Schultz, R.D.

    2004-01-01

    Age structure, total annual mortality, and mortality caps (maximum mortality thresholds established by managers) were investigated for walleye Sander vitreus (formerly Stizostedion vitreum) populations sampled from eight Kansas reservoirs during 1991-1999. We assessed age structure by examining the relative frequency of different ages in the population; total annual mortality of age-2 and older walleyes was estimated by use of a weighted catch curve. To evaluate the utility of mortality caps, we modeled threshold values of mortality by varying growth rates and management objectives. Estimated mortality thresholds were then compared with observed growth and mortality rates. The maximum age of walleyes varied from 5 to 11 years across reservoirs. Age structure was dominated (???72%) by walleyes age 3 and younger in all reservoirs, corresponding to ages that were not yet vulnerable to harvest. Total annual mortality rates varied from 40.7% to 59.5% across reservoirs and averaged 51.1% overall (SE = 2.3). Analysis of mortality caps indicated that a management objective of 500 mm for the mean length of walleyes harvested by anglers was realistic for all reservoirs with a 457-mm minimum length limit but not for those with a 381-mm minimum length limit. For a 500-mm mean length objective to be realized for reservoirs with a 381-mm length limit, managers must either reduce mortality rates (e.g., through restrictive harvest regulations) or increase growth of walleyes. When the assumed objective was to maintain the mean length of harvested walleyes at current levels, the observed annual mortality rates were below the mortality cap for all reservoirs except one. Mortality caps also provided insight on management objectives expressed in terms of proportional stock density (PSD). Results indicated that a PSD objective of 20-40 was realistic for most reservoirs. This study provides important walleye mortality information that can be used for monitoring or for inclusion into

  15. Proposal for fulfilling strategic objectives of the U.S. Roadmap for national action on clinical decision support through a service-oriented architecture leveraging HL7 services.

    PubMed

    Kawamoto, Kensaku; Lobach, David F

    2007-01-01

    Despite their demonstrated effectiveness, clinical decision support (CDS) systems are not widely used within the U.S. The Roadmap for National Action on Clinical Decision Support, published in June 2006 by the American Medical Informatics Association, identifies six strategic objectives for achieving widespread adoption of effective CDS capabilities. In this manuscript, we propose a Service-Oriented Architecture (SOA) for CDS that facilitates achievement of these six objectives. Within the proposed framework, CDS capabilities are implemented through the orchestration of independent software services whose interfaces are being standardized by Health Level 7 and the Object Management Group through their joint Healthcare Services Specification Project (HSSP). Core services within this framework include the HSSP Decision Support Service, the HSSP Common Terminology Service, and the HSSP Retrieve, Locate, and Update Service. Our experiences, and those of others, indicate that the proposed SOA approach to CDS could enable the widespread adoption of effective CDS within the U.S. health care system.

  16. X-ray Powder Diffraction in Conservation Science: Towards Routine Crystal Structure Determination of Corrosion Products on Heritage Art Objects.

    PubMed

    Dinnebier, Robert E; Fischer, Andrea; Eggert, Gerhard; Runčevski, Tomče; Wahlberg, Nanna

    2016-06-08

    The crystal structure determination and refinement process of corrosion products on historic art objects using laboratory high-resolution X-ray powder diffraction (XRPD) is presented in detail via two case studies. The first material under investigation was sodium copper formate hydroxide oxide hydrate, Cu4Na4O(HCOO)8(OH)2∙4H2O (sample 1) which forms on soda glass/copper alloy composite historic objects (e.g., enamels) in museum collections, exposed to formaldehyde and formic acid emitted from wooden storage cabinets, adhesives, etc. This degradation phenomenon has recently been characterized as "glass induced metal corrosion". For the second case study, thecotrichite, Ca3(CH3COO)3Cl(NO3)2∙6H2O (sample 2), was chosen, which is an efflorescent salt forming needlelike crystallites on tiles and limestone objects which are stored in wooden cabinets and display cases. In this case, the wood acts as source for acetic acid which reacts with soluble chloride and nitrate salts from the artifact or its environment. The knowledge of the geometrical structure helps conservation science to better understand production and decay reactions and to allow for full quantitative analysis in the frequent case of mixtures.

  17. Scalability of surrogate-assisted multi-objective optimization of antenna structures exploiting variable-fidelity electromagnetic simulation models

    NASA Astrophysics Data System (ADS)

    Koziel, Slawomir; Bekasiewicz, Adrian

    2016-10-01

    Multi-objective optimization of antenna structures is a challenging task owing to the high computational cost of evaluating the design objectives as well as the large number of adjustable parameters. Design speed-up can be achieved by means of surrogate-based optimization techniques. In particular, a combination of variable-fidelity electromagnetic (EM) simulations, design space reduction techniques, response surface approximation models and design refinement methods permits identification of the Pareto-optimal set of designs within a reasonable timeframe. Here, a study concerning the scalability of surrogate-assisted multi-objective antenna design is carried out based on a set of benchmark problems, with the dimensionality of the design space ranging from six to 24 and a CPU cost of the EM antenna model from 10 to 20 min per simulation. Numerical results indicate that the computational overhead of the design process increases more or less quadratically with the number of adjustable geometric parameters of the antenna structure at hand, which is a promising result from the point of view of handling even more complex problems.

  18. Radiography with cosmic-ray and compact accelerator muons; Exploring inner-structure of large-scale objects and landforms.

    PubMed

    Nagamine, Kanetada

    2016-01-01

    Cosmic-ray muons (CRM) arriving from the sky on the surface of the earth are now known to be used as radiography purposes to explore the inner-structure of large-scale objects and landforms, ranging in thickness from meter to kilometers scale, such as volcanic mountains, blast furnaces, nuclear reactors etc. At the same time, by using muons produced by compact accelerators (CAM), advanced radiography can be realized for objects with a thickness in the sub-millimeter to meter range, with additional exploration capability such as element identification and bio-chemical analysis. In the present report, principles, methods and specific research examples of CRM transmission radiography are summarized after which, principles, methods and perspective views of the future CAM radiography are described.

  19. Radiography with cosmic-ray and compact accelerator muons; Exploring inner-structure of large-scale objects and landforms

    PubMed Central

    NAGAMINE, Kanetada

    2016-01-01

    Cosmic-ray muons (CRM) arriving from the sky on the surface of the earth are now known to be used as radiography purposes to explore the inner-structure of large-scale objects and landforms, ranging in thickness from meter to kilometers scale, such as volcanic mountains, blast furnaces, nuclear reactors etc. At the same time, by using muons produced by compact accelerators (CAM), advanced radiography can be realized for objects with a thickness in the sub-millimeter to meter range, with additional exploration capability such as element identification and bio-chemical analysis. In the present report, principles, methods and specific research examples of CRM transmission radiography are summarized after which, principles, methods and perspective views of the future CAM radiography are described. PMID:27725469

  20. Data from clinical notes: a perspective on the tension between structure and flexible documentation.

    PubMed

    Rosenbloom, S Trent; Denny, Joshua C; Xu, Hua; Lorenzi, Nancy; Stead, William W; Johnson, Kevin B

    2011-01-01

    Clinical documentation is central to patient care. The success of electronic health record system adoption may depend on how well such systems support clinical documentation. A major goal of integrating clinical documentation into electronic heath record systems is to generate reusable data. As a result, there has been an emphasis on deploying computer-based documentation systems that prioritize direct structured documentation. Research has demonstrated that healthcare providers value different factors when writing clinical notes, such as narrative expressivity, amenability to the existing workflow, and usability. The authors explore the tension between expressivity and structured clinical documentation, review methods for obtaining reusable data from clinical notes, and recommend that healthcare providers be able to choose how to document patient care based on workflow and note content needs. When reusable data are needed from notes, providers can use structured documentation or rely on post-hoc text processing to produce structured data, as appropriate.

  1. Transforming Clinical Imaging and 3D Data for Virtual Reality Learning Objects: HTML5 and Mobile Devices Implementation

    ERIC Educational Resources Information Center

    Trelease, Robert B.; Nieder, Gary L.

    2013-01-01

    Web deployable anatomical simulations or "virtual reality learning objects" can easily be produced with QuickTime VR software, but their use for online and mobile learning is being limited by the declining support for web browser plug-ins for personal computers and unavailability on popular mobile devices like Apple iPad and Android…

  2. The sugar scoring system for the Bender-Gestalt test: an objective approach that reflects clinical judgment.

    PubMed

    Parsons, L; Weinberg, S L

    1993-12-01

    Although several objective scoring systems have been developed for use with the abbreviated form of the Bender-Gestalt test of visuomotor development (Figures A, 1, 2, 4, 6, and 8), each has been criticized as being inadequate in some way or other. This paper reviews the inadequacies of these systems as described in the literature and presents the results of a small study designed to investigate the psychometric properties of a new objective scoring system, recently proposed by Sugar, which incorporates both quantitative and qualitative perspectives. The new system is shown to be psychometrically sound in validity and reliability. Additional advantages are described. The new system is recommended as a good, if not better, alternative to other, existing methods for scoring the Bender-Gestalt test.

  3. Generic design methodology for the development of three-dimensional structured-light sensory systems for measuring complex objects

    NASA Astrophysics Data System (ADS)

    Marin, Veronica E.; Chang, Wei Hao Wayne; Nejat, Goldie

    2014-11-01

    Structured-light (SL) techniques are emerging as popular noncontact approaches for obtaining three-dimensional (3-D) measurements of complex objects for real-time applications in manufacturing, bioengineering, and robotics. The performance of SL systems is determined by the emitting (i.e., projector) and capturing (i.e., camera) hardware components and the triangulation configuration between them and an object of interest. A generic design methodology is presented to determine optimal triangulation configurations for SL systems. These optimal configurations are determined with respect to a set of performance metrics: (1) minimizing the 3-D reconstruction errors, (2) maximizing the pixel-to-pixel correspondence between the projector and camera, and (3) maximizing the dispersion of the measured 3-D points within a measurement volume, while satisfying design constraints based on hardware and user-defined specifications. The proposed methodology utilizes a 3-D geometric triangulation model based on ray-tracing geometry and pin-hole models for the projector and camera. Using the methodology, a set of optimal system configurations can be determined for a given set of hardware components. The design methodology was applied to a real-time SL system for surface profiling of complex objects. Experiments were conducted with an optimal sensor configuration and its performance verified with respect to a nonoptimal hardware configuration.

  4. Spun-wrapped aligned nanofiber (SWAN) lithography for fabrication of micro/nano-structures on 3D objects

    NASA Astrophysics Data System (ADS)

    Ye, Zhou; Nain, Amrinder S.; Behkam, Bahareh

    2016-06-01

    Fabrication of micro/nano-structures on irregularly shaped substrates and three-dimensional (3D) objects is of significant interest in diverse technological fields. However, it remains a formidable challenge thwarted by limited adaptability of the state-of-the-art nanolithography techniques for nanofabrication on non-planar surfaces. In this work, we introduce Spun-Wrapped Aligned Nanofiber (SWAN) lithography, a versatile, scalable, and cost-effective technique for fabrication of multiscale (nano to microscale) structures on 3D objects without restriction on substrate material and geometry. SWAN lithography combines precise deposition of polymeric nanofiber masks, in aligned single or multilayer configurations, with well-controlled solvent vapor treatment and etching processes to enable high throughput (>10-7 m2 s-1) and large-area fabrication of sub-50 nm to several micron features with high pattern fidelity. Using this technique, we demonstrate whole-surface nanopatterning of bulk and thin film surfaces of cubes, cylinders, and hyperbola-shaped objects that would be difficult, if not impossible to achieve with existing methods. We demonstrate that the fabricated feature size (b) scales with the fiber mask diameter (D) as b1.5 ~ D. This scaling law is in excellent agreement with theoretical predictions using the Johnson, Kendall, and Roberts (JKR) contact theory, thus providing a rational design framework for fabrication of systems and devices that require precisely designed multiscale features.Fabrication of micro/nano-structures on irregularly shaped substrates and three-dimensional (3D) objects is of significant interest in diverse technological fields. However, it remains a formidable challenge thwarted by limited adaptability of the state-of-the-art nanolithography techniques for nanofabrication on non-planar surfaces. In this work, we introduce Spun-Wrapped Aligned Nanofiber (SWAN) lithography, a versatile, scalable, and cost-effective technique for

  5. Clinical and Biochemical Markers of Cardiovascular Structure and Function in Women With the Metabolic Syndrome.

    PubMed

    Velarde, Gladys P; Sherazi, Saadia; Kraemer, Dale F; Bravo-Jaimes, Katia; Butterfield, Ryan; Amico, Tonja; Steinmetz, Sherry D; Guzman, Maricela; Martin, Dale; Dodani, Sunita; Smith, Brian H

    2015-12-01

    The pathobiological impact of individual components of the metabolic syndrome (MS) on cardiac structural and functional parameters in women with isolated MS is not known. The objectives of this study were (1) to compare biochemical (prothrombotic, lipogenic, and inflammatory) and imaging (carotid intima-media thickening and basic cardiac structural measurements) markers in women with and without MS and (2) to examine if any of these markers associated or predicted cardiac structural differences between the 2 groups. This cross-sectional pilot study included 88 women with MS and 35 women without it. MS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Patients with diagnosis of diabetes were excluded. Compared with healthy subjects, women with MS had higher levels of intercellular adhesion molecule, myeloperoxidase, C-reactive protein, plasminogen activator inhibitor-1, leptin, apolipoprotein-B, and lower levels of apolipoprotein-A1 (p <0.001 for all). They also had higher mean ventricular septum, posterior wall thickness, left ventricular (LV) mass, carotid intima-media thickness (p <0.001 for all), and left atrial diameter (p = 0.015). In multivariable regression models, waist circumference and systolic blood pressure (BP) were significant predictors of: ventricular septum (p = 0.005 and p = 0.001, respectively), posterior wall thickness (p = 0.008 and p = 0.040, respectively), and LV mass (p <0.001 and p = 0.013, respectively). Significant predictors for carotid intima-media thickness were systolic BP, glucose, and leptin (p <0.0001, p = 0.034, and p = 0.002, respectively). In conclusion, there are significant clinical, biochemical, and cardiovascular structural differences in women with isolated MS compared with those without. Waist circumference and systolic BP had the strongest association with cardiac structural differences in this group of women.

  6. FDA perspective on objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia.

    PubMed

    Kumar, Allison; Brooks, Steven S; Cavanaugh, Kenneth; Zuckerman, Bram

    2009-12-01

    The article by Conte et al.(1) on behalf of the Society for Vascular Surgery (SVS) in this issue of the Journal of Vascular Surgery provides guidelines for improving the consistency and interpretability of clinical trials intended to evaluate treatment options for patients with critical limb ischemia (CLI). This article identifies a number of key challenges with conducting and comparing CLI trials, including the wide spectrum of clinical presentations that CLI encompasses, the use of disparate eligibility criteria and endpoint measurements, and logistical and economic considerations that can limit study initiation and completion. The authors propose definitions for a number of performance goals derived from historical surgical literature as a means of reducing the negative impact of these factors. The current editorial reviews aspects of this proposal from the perspective of the authors in terms of their understanding of the statutory obligations of the U.S. Food and Drug Administration (FDA) to regulate the marketing of cardiovascular devices based on valid scientific evidence.

  7. Reliability, performance characteristics, construct validity, and an initial clinical application of a visual object learning test (VOLT).

    PubMed

    Glahn, D C; Gur, R C; Ragland, J D; Censits, D M; Gur, R E

    1997-10-01

    Whereas verbal learning has received considerable attention by cognitive neuropsychology, spatial object learning has been more resistant to study. The paucity of visual learning data has hampered attempts to clarify if visual learning has unique features with specialized neural substrates. In schizophrenia, severe verbal learning impairment has been established, but lack of comparable visual learning measures has thwarted the dissociation of verbal and visual abilities. The Visual Object Learning Test (VOLT) was developed to examine aspects of visual-spatial learning and memory in a manner analogous to available verbal tests. Studies were performed to establish normative performance characteristics, convergent and divergent validity, and the sensitivity of the VOLT to detection of individual differences in normal (through sex and age) and pathologic variability (through persons with schizophrenia). The results indicated excellent internal consistency, convergent and divergent validity, and sensitivity to the effects of aging and pathology. Persons with schizophrenia were impaired in both learning and retention. The authors conclude that memory impairment in schizophrenia may not be specific to verbal learning.

  8. An objective biochemical assessment of therapeutic response in metastatic breast cancer: a study with external review of clinical data.

    PubMed Central

    Williams, M. R.; Turkes, A.; Pearson, D.; Griffiths, K.; Blamey, R. W.

    1990-01-01

    A series of tumour related markers have been examined in 179 patients receiving primary endocrine therapy for metastatic breast cancer. Significant correlations between therapeutic response (UICC criteria after 6 months of treatment) and appropriate alterations in serum concentrations of carcinoembryonic antigen, ferritin, c-reactive protein, orosomucoid and the erythrocyte sedimentation rate, have been observed when changes in these markers were examined only at high serum concentrations. By combining these five markers a 'therapeutic index' of response has been devised which can be employed at an early stage of treatment in more than 90% of patients, giving an overall sensitivity/specificity of 90%/78% for therapeutic response or disease stabilisation over a 6-month period. The design of an objective measurement of response, which is easy to perform, has the potential to replace the existing, largely subjective. UICC criteria for retrospective judgement of response, and may also be used to direct systemic endocrine therapy. PMID:2137007

  9. Comparison of single distance phase retrieval algorithms by considering different object composition and the effect of statistical and structural noise.

    PubMed

    Chen, R C; Rigon, L; Longo, R

    2013-03-25

    Phase retrieval is a technique for extracting quantitative phase information from X-ray propagation-based phase-contrast tomography (PPCT). In this paper, the performance of different single distance phase retrieval algorithms will be investigated. The algorithms are herein called phase-attenuation duality Born Algorithm (PAD-BA), phase-attenuation duality Rytov Algorithm (PAD-RA), phase-attenuation duality Modified Bronnikov Algorithm (PAD-MBA), phase-attenuation duality Paganin algorithm (PAD-PA) and phase-attenuation duality Wu Algorithm (PAD-WA), respectively. They are all based on phase-attenuation duality property and on weak absorption of the sample and they employ only a single distance PPCT data. In this paper, they are investigated via simulated noise-free PPCT data considering the fulfillment of PAD property and weakly absorbing conditions, and with experimental PPCT data of a mixture sample containing absorbing and weakly absorbing materials, and of a polymer sample considering different degrees of statistical and structural noise. The simulation shows all algorithms can quantitatively reconstruct the 3D refractive index of a quasi-homogeneous weakly absorbing object from noise-free PPCT data. When the weakly absorbing condition is violated, the PAD-RA and PAD-PA/WA obtain better result than PAD-BA and PAD-MBA that are shown in both simulation and mixture sample results. When considering the statistical noise, the contrast-to-noise ratio values decreases as the photon number is reduced. The structural noise study shows that the result is progressively corrupted by ring-like artifacts with the increase of structural noise (i.e. phantom thickness). The PAD-RA and PAD-PA/WA gain better density resolution than the PAD-BA and PAD-MBA in both statistical and structural noise study.

  10. Structural and diffusion imaging versus clinical assessment to monitor amyotrophic lateral sclerosis

    PubMed Central

    Cardenas-Blanco, Arturo; Machts, Judith; Acosta-Cabronero, Julio; Kaufmann, Joern; Abdulla, Susanne; Kollewe, Katja; Petri, Susanne; Schreiber, Stefanie; Heinze, Hans-Jochen; Dengler, Reinhard; Vielhaber, Stefan; Nestor, Peter J.

    2016-01-01

    Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects upper and lower motor neurons. Observational and intervention studies can be tracked using clinical measures such as the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) but for a complete understanding of disease progression, objective in vivo biomarkers of both central and peripheral motor pathway pathology are highly desirable. The aim of this study was to determine the utility of structural and diffusion imaging as central nervous system biomarkers compared to the standard clinical measure, ALSFRS-R, to track longitudinal evolution using three time-point measurements. N = 34 patients with ALS were scanned and clinically assessed three times at a mean of three month time intervals. The MRI biomarkers were structural T1-weighted volumes for cortical thickness measurement as well as deep grey matter volumetry, voxel-based morphometry and diffusion tensor imaging (DTI). Cortical thickness focused specifically on the precentral gyrus while quantitative DTI biomarkers focused on the corticospinal tracts. The evolution of imaging biomarkers and ALSFRS-R scores over time were analysed using a mixed effects model that accounted for the scanning interval as a fixed effect variable, and, the initial measurements and time from onset as random variables. The mixed effects model showed a significant decrease in the ALSFRS-R score, (p < 0.0001, and an annual rate of change (AROC) of − 7.3 points). Similarly, fractional anisotropy of the corticospinal tract showed a significant decrease (p = 0.009, AROC = − 0.0066) that, in turn, was driven by a significant increase in radial diffusivity combined with a trend to decrease in axial diffusivity. No significant change in cortical thickness of the precentral gyrus was found (p > 0.5). In addition, deep grey matter volumetry and voxel-based morphometry also identified no significant changes. Furthermore, the

  11. Surfactant-associated proteins: structure, function and clinical implications.

    PubMed

    Ketko, Anastasia K; Donn, Steven M

    2014-01-01

    Surfactant replacement therapy is now the standard of care for infants with respiratory distress syndrome. As the understanding of surfactant structure and function has evolved, surfactant-associated proteins are now understood to be essential components of pulmonary surfactant. Their structural and functional diversity detail the complexity of their contributions to normal pulmonary physiology, and deficiency states result in significant pathology. Engineering synthetic surfactant protein constructs has been a major research focus for replacement therapies. This review highlights what is known about surfactant proteins and how this knowledge is pivotal for future advancements in treating respiratory distress syndrome as well as other pulmonary diseases characterized by surfactant deficiency or inactivation.

  12. MBBS student perceptions about physiology subject teaching and objective structured practical examination based formative assessment for improving competencies.

    PubMed

    Lakshmipathy, K

    2015-09-01

    The objectives of the present study were to 1) assess student attitudes to physiology, 2) evaluate student opinions about the influence of an objective structured practical examination (OSPE) on competence, and 3) assess the validity and reliability of an indigenously designed feedback questionnaire. A structured questionnaire containing 16 item statements, 8 items on an Osgood's 5-point semantic differential scale and 8 items on a Likert's 5-point scale, was used. Options were assigned scores of 1-5 according to weightage. For Osgood's semantic differential scale items, a χ(2)-test was done to analyze student attitudes toward the subject. For Likert scale items, mean score and SD were calculated to analyze student opinions of the OSPE. Item validity was assessed by item analysis, and reliability was assessed by calculating Crohnbach's α. The subject as a whole was interesting to 82% of the students (n = 135). The theory was interesting to 75% of the students (n = 132) but complex to 42% (n = 118). The practical was interesting to 93% of the students (n = 134); 76% of the students (n = 104) felt that the practical was simple, whereas 4% felt it was complex. The OSPE was interesting to 79% of the students (n = 131); 57% of the students (n = 116) felt it was simple, whereas 24% found it complex. Components of the subject, intricateness, and student interests were strongly associated. Students chose options on a higher weight scale, favoring the OSPE. Items were found to be valid and reliable. In conclusion, the subject of physiology was interesting but not simple to understand. Student interests varied with the components of the subject, and the components of the subject had varied intricateness. Students were in favor of the OSPE for assessment. The questionnaire used for the study was valid and reliable.

  13. A new variable angled locking volar plate system for Colles' fracture: outcome study and time-course improvement of objective clinical variables.

    PubMed

    Yasuda, Masataka; Ando, Yoshiyuki

    2009-01-01

    Our purposes were to report the radiographic outcomes and complications of patients with Colles' fracture treated with the Nakashima locking volar plate system (variable angled distal screw locking mechanism) prospectively and to report the results of objective clinical variables such as grip strength and range of motion of the wrist prospectively at up to one year. This study consisted of eight men and 32 women for analysis of radiographic parameters (volar tilt, radial inclination and radial length) and complications. Radiographic parameters were measured pre-operatively, immediately post-operatively and at final follow-up visit. The average age at operation was 60.3 years old. Among them, we selected 25 cases (6 men and 19 women) whom we followed up at six weeks, three months, six months and one year post-operatively. The average age at operation in this group was 62 years old. We measured objective clinical variables (grip strength, forearm rotation, wrist extension/flexion) at each visit. Except for volar tilt, radiographic parameters revealed no significant changes between immediately post-operative radiographs and radiographs at final follow-up visit. Complications included loss of reduction in two cases. Objective clinical variables other than pronation measurement showed significant increase at each visit up to one year post-operatively. Satisfactory clinical and radiographic results were obtained by using this system. The variable angled distal fragment plating system appears to be a reliable construct for rigid fixation of Colles' fractures; however, technical errors can occur, as with other fixation systems. We demonstrated that the follow-up of Colles' fracture treated by our volar locking plate less than one year post-operative may be insufficient.

  14. The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups

    PubMed Central

    Twisk, Frank N. M.

    2014-01-01

    Although Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are used interchangeably, the diagnostic criteria define two distinct clinical entities. Cognitive impairment, (muscle) weakness, circulatory disturbances, marked variability of symptoms, and, above all, post-exertional malaise: a long-lasting increase of symptoms after a minor exertion, are distinctive symptoms of ME. This latter phenomenon separates ME, a neuro-immune illness, from chronic fatigue (syndrome), other disorders and deconditioning. The introduction of the label, but more importantly the diagnostic criteria for CFS have generated much confusion, mostly because chronic fatigue is a subjective and ambiguous notion. CFS was redefined in 1994 into unexplained (persistent or relapsing) chronic fatigue, accompanied by at least four out of eight symptoms, e.g., headaches and unrefreshing sleep. Most of the research into ME and/or CFS in the last decades was based upon the multivalent CFS criteria, which define a heterogeneous patient group. Due to the fact that fatigue and other symptoms are non-discriminative, subjective experiences, research has been hampered. Various authors have questioned the physiological nature of the symptoms and qualified ME/CFS as somatization. However, various typical symptoms can be assessed objectively using standardized methods. Despite subjective and unclear criteria and measures, research has observed specific abnormalities in ME/CFS repetitively, e.g., immunological abnormalities, oxidative and nitrosative stress, neurological anomalies, circulatory deficits and mitochondrial dysfunction. However, to improve future research standards and patient care, it is crucial that patients with post-exertional malaise (ME) and patients without this odd phenomenon are acknowledged as separate clinical entities that the diagnosis of ME and CFS in research and clinical practice is based upon accurate criteria and an objective assessment of characteristic symptoms

  15. EEG Characteristic Extraction Method of Listening Music and Objective Estimation Method Based on Latency Structure Model in Individual Characteristics

    NASA Astrophysics Data System (ADS)

    Ito, Shin-Ichi; Mitsukura, Yasue; Nakamura Miyamura, Hiroko; Saito, Takafumi; Fukumi, Minoru

    EEG is characterized by the unique and individual characteristics. Little research has been done to take into account the individual characteristics when analyzing EEG signals. Often the EEG has frequency components which can describe most of the significant characteristics. Then there is the difference of importance between the analyzed frequency components of the EEG. We think that the importance difference shows the individual characteristics. In this paper, we propose a new EEG extraction method of characteristic vector by a latency structure model in individual characteristics (LSMIC). The LSMIC is the latency structure model, which has personal error as the individual characteristics, based on normal distribution. The real-coded genetic algorithms (RGA) are used for specifying the personal error that is unknown parameter. Moreover we propose an objective estimation method that plots the EEG characteristic vector on a visualization space. Finally, the performance of the proposed method is evaluated using a realistic simulation and applied to a real EEG data. The result of our experiment shows the effectiveness of the proposed method.

  16. The use of objective structured self-assessment and peer-feedback (OSSP) for learning communication skills: evaluation using a controlled trial.

    PubMed

    Perera, Jennifer; Mohamadou, Galy; Kaur, Satpal

    2010-05-01

    Feedback is essential to guide students towards expected performance goals. The usefulness of teacher feedback on improving communication skills (CS) has been well documented. It has been proposed that self-assessment and peer-feedback has an equally important role to play in enhancing learning. This is the focus of this study. Objectively structured self-assessment and peer feedback (OSSP) was incorporated into small group CS teaching sessions of a group of semester one medical students who were learning CS for the first time, to minimise the influence of previous educational interventions. A control group matched for academic performance, gender and age was used to enable parallel evaluation of the innovation. A reflective log containing closed and open ended questions was used for OSSP. Facilitators and simulated patients provided feedback to students in both groups during CS learning as per routine practice. Student perceptions on OSSP and acceptability as a learning method were explored using a questionnaire. CS were assessed in both groups using objective structured clinical examination (OSCE) as per routine practice and assessors were blinded as to which group the student belonged. Mean total score and scores for specific areas of interview skills were significantly higher in the experimental group. Analysis of the questionnaire data showed that students gained fresh insights into specific areas such as empathy, addressing patients' concerns and interview style during OSSP which clearly corroborated the specific differences in scores. The free text comments were highly encouraging as to acceptability of OSSP, in spite of 67% being never exposed to formal self- and peer-assessment during pre-university studies. OSSP promotes effective CS learning and learner acceptability is high.

  17. A Four- and Five-Factor Structural Model for Wechsler Tests: Does It Really Matter Clinically?

    ERIC Educational Resources Information Center

    Schwartz, David M.

    2013-01-01

    The purpose of this commentary is to focus on the clinical utility of the four- and five-factor structural models for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). It provides a discussion of important considerations when evaluating the clinical utility of the…

  18. GuideView: Structured Multi-modal Delivery of Clinical Guidelines

    PubMed Central

    Iyengar, M. Sriram; Sarkar, Subhajit; Bacal, Kira; Defouw, Gregory; McCulley, Phyllis; Hurst, Victor

    2005-01-01

    GuideView is a system designed for structured, multimodal delivery of clinical guidelines. Clinical instructions are presented simultaneously in voice, text, pictures or video or animations. Users navigate using mouse-clicks and voice commands. An evaluation study performed at a medical simulation laboratory found that voice and video instructions were rated highly. PMID:16779279

  19. Plastic-Based Structurally Programmable Microfluidic Biochips for Clinical Diagnostics

    DTIC Science & Technology

    2005-05-01

    oxidation and doping of the generated PANI. A novel approach along with a structure- property study for ZrO2 and TiO2 filled PDMS was performed. A...derive the expression for pressure needed to overcome the passive valve as: ⎥ ⎥ ⎦ ⎤ ⎢ ⎢ ⎣ ⎡ ⎟⎟ ⎠ ⎞ ⎜⎜ ⎝ ⎛ +−⎟⎟ ⎠ ⎞ ⎜⎜ ⎝ ⎛ +=∆ 2211 2 1111) cos ...21 2 11) cos (2 ww P cl θσ (III-3) The passive valve shown in Figure III-23 is not an optimum geometry for the biochip

  20. Structure, function and clinical significance of transferrin receptors.

    PubMed

    Feelders, R A; Kuiper-Kramer, E P; van Eijk, H G

    1999-01-01

    Iron plays an essential role in a spectrum of metabolic processes. Cellular iron uptake is facilitated by transferrin receptor (TfR)-mediated endocytosis. In recent years more insight has been obtained in TfR physiology and the regulation of cellular iron homeostasis. The synthesis of TfR and the iron storage protein ferritin is regulated reciprocally at the post-transcriptional level according to the cellular iron status. As a result of externalization of TfR during the endocytic cycle, a soluble form of TfR can be detected in serum. The serum TfR (sTfR) level is closely related to erythroid TfR turnover and the prime determinants of the sTfR concentration are cellular iron demands and erythroid proliferation rate. In the absence of a hyperplastic erythropoiesis the sTfR level is a sensitive parameter of early tissue iron deficiency. The entire spectrum of body iron status can be assessed by measurement of serum ferritin and sTfR levels, with ferritin as marker of tissue iron stores and sTfR as index of tissue iron needs. The sTfR may be a promising tool to detect iron deficiency in inflammatory states and in the anaemia of chronic disease as its concentration is, in contrast to ferritin levels, not influenced by the acute phase response. Determination of sTfR levels may also improve assessment of body iron stores during pregnancy and in neonates. Finally, the sTfR may be a useful parameter to monitor erythropoiesis in various clinical settings, for instance in the prediction of the haematological response to erythropoietin treatment. However, standardization of the sTfR assay, with definition of reference and pathological ranges, is necessary for the definitive introduction of the sTfR as major parameter of iron metabolism.

  1. Medical image segmentation using object atlas versus object cloud models

    NASA Astrophysics Data System (ADS)

    Phellan, Renzo; Falcão, Alexandre X.; Udupa, Jayaram K.

    2015-03-01

    Medical image segmentation is crucial for quantitative organ analysis and surgical planning. Since interactive segmentation is not practical in a production-mode clinical setting, automatic methods based on 3D object appearance models have been proposed. Among them, approaches based on object atlas are the most actively investigated. A key drawback of these approaches is that they require a time-costly image registration process to build and deploy the atlas. Object cloud models (OCM) have been introduced to avoid registration, considerably speeding up the whole process, but they have not been compared to object atlas models (OAM). The present paper fills this gap by presenting a comparative analysis of the two approaches in the task of individually segmenting nine anatomical structures of the human body. Our results indicate that OCM achieve a statistically significant better accuracy for seven anatomical structures, in terms of Dice Similarity Coefficient and Average Symmetric Surface Distance.

  2. Parsec-scale H I absorption structure in a low-redshift galaxy seen against a compact symmetric object

    NASA Astrophysics Data System (ADS)

    Biggs, A. D.; Zwaan, M. A.; Hatziminaoglou, E.; Péroux, C.; Liske, J.

    2016-11-01

    We present global VLBI observations of the 21-cm transition of atomic hydrogen seen in absorption against the radio source J0855+5751. The foreground absorber (SDSS J085519.05+575140.7) is a dwarf galaxy at z = 0.026. As the background source is heavily resolved by VLBI, the data allow us to map the properties of the foreground H I gas with a spatial resolution of 2 pc. The absorbing gas corresponds to a single coherent structure with an extent >35 pc, but we also detect significant and coherent variations, including a change in the H I optical depth by a factor of 5 across a distance of ≲ 6 pc. The large size of the structure provides support for the Heiles & Troland model of the interstellar medium, as well as its applicability to external galaxies. The large variations in H I optical depth also suggest that caution should be applied when interpreting TS measurements from radio-detected DLAs. In addition, the distorted appearance of the background radio source is indicative of a strong jet-cloud interaction in its host galaxy. We have measured its redshift (z = 0.541 86) using optical spectroscopy on the William Herschel Telescope and this confirms that J0855+5751 is an FR II radio source with a physical extent of <1 kpc and supports the previous identification of this source as a compact symmetric object. These sources often show absorption associated with the host galaxy and we suggest that both H I and OH should be searched for in J0855+5751.

  3. Clinical judgment development using structured classroom reflective practice: a qualitative study.

    PubMed

    Glynn, Donna M

    2012-03-01

    This qualitative study examined the incorporation of "reflection-on-action" in a structured reflective classroom format as defined by Tanner's Clinical Judgment Model on the development of perceived clinical judgment and clinical confidence in Bachelor of Science nursing students. The qualitative results described the students' perceptions of the benefit of the intervention on their development of clinical judgment and clinical confidence. This research was an important contribution to the debate regarding the benefit of structured reflection in a classroom setting. By using reflection in the classroom, nurse educators may influence the education-practice gap and incorporate new pedagogies to strengthen the educational preparedness of nursing students to provide high-quality, competent, compassionate care to patients and their families.

  4. A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs.

    PubMed

    Zhou, Li; Collins, Sarah; Morgan, Stephen J; Zafar, Neelam; Gesner, Emily J; Fehrenbach, Martin; Rocha, Roberto A

    2016-01-01

    Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training.

  5. A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs

    PubMed Central

    Zhou, Li; Collins, Sarah; Morgan, Stephen J.; Zafar, Neelam; Gesner, Emily J.; Fehrenbach, Martin; Rocha, Roberto A.

    2016-01-01

    Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training. PMID:28269927

  6. The biomedical disciplines and the structure of biomedical and clinical knowledge.

    PubMed

    Nederbragt, H

    2000-11-01

    The relation between biomedical knowledge and clinical knowledge is discussed by comparing their respective structures. The knowledge of a disease as a biological phenomenon is constructed by the interaction of facts and theories from the main biomedical disciplines: epidemiology, diagnostics, clinical trial, therapy development and pathogenesis. Although these facts and theories are based on probabilities and extrapolations, the interaction provides a reliable and coherent structure, comparable to a Kuhnian paradigma. In the structure of clinical knowledge, i.e. knowledge of the patient with the disease, not only biomedical knowledge contributes to the structure but also economic and social relations, ethics and personal experience. However, the interaction between each of the participating "knowledges" in clinical knowledge is not based on mutual dependency and accumulation of different arguments from each, as in biomedical knowledge, but on competition and partial exclusion. Therefore, the structure of biomedical knowledge is different from that of clinical knowledge. This difference is used as the basis for a discussion in which the place of technology, evidence-based medicine and the gap between scientific and clinical knowledge are evaluated.

  7. LASER BIOLOGY AND MEDICINE: Visualisation of details of a complicated inner structure of model objects by the method of diffusion optical tomography

    NASA Astrophysics Data System (ADS)

    Tret'yakov, Evgeniy V.; Shuvalov, Vladimir V.; Shutov, I. V.

    2002-11-01

    An approximate algorithm is tested for solving the problem of diffusion optical tomography in experiments on the visualisation of details of the inner structure of strongly scattering model objects containing scattering and semitransparent inclusions, as well as absorbing inclusions located inside other optical inhomogeneities. The stability of the algorithm to errors is demonstrated, which allows its use for a rapid (2 — 3 min) image reconstruction of the details of objects with a complicated inner structure.

  8. A Marginal Structural Model Analysis for Loneliness: Implications for Intervention Trials and Clinical Practice

    PubMed Central

    VanderWeele, Tyler J.; Hawkley, Louise C.; Thisted, Ronald A.; Cacioppo, John T.

    2011-01-01

    Objective Clinical scientists, policy makers, and individuals must make decisions concerning effective interventions that address health-related issues. We use longitudinal data on loneliness and depressive symptoms and a new class of causal models to illustrate how empirical evidence can be used to inform intervention trial design and clinical practice. Methods Data were obtained from a population-based study of non-Hispanic Caucasians, African Americans and Latino Americans (N=229) born between 1935 and 1952. The UCLA-R and CES-D scales were used as measures of loneliness and depressive symptoms respectively. Marginal structural causal models were employed to evaluate the extent to which depressive symptoms depend not only on loneliness measured at a single point in time (as in prior studies of the effect of loneliness) but also on an individual's entire loneliness history. Results Our results indicate that if interventions to reduce loneliness by one standard deviation were made one and two years prior to assessing depressive symptoms, both would have an effect and would together result in an average reduction in depressive symptoms of 0.33 standard deviations (95% CI: 0.21, 0.44, P<0.0001). Conclusions The magnitude and persistence of these effects suggests that greater effort should be devoted to developing practical interventions on alleviating loneliness and that doing so could be useful in the treatment and prevention of depressive symptoms. In light of the persistence of the effects of loneliness, our results also suggests that, in the evaluation of interventions on loneliness, it may be important to allow for a considerable follow-up period in assessing outcomes. PMID:21443322

  9. Envelope structure on 700 AU scales and the molecular outflows of low-mass young stellar objects.

    PubMed

    Hogerheijde, M R; van Dishoeck, E F; Blake, G A; van Langevelde, H J

    1998-07-20

    Aperture synthesis observations of HCO+ J = 1-0, 13CO 1-0, and C18O 1-0 obtained with the Owens Valley Millimeter Array are used to probe the small-scale (5" approximately 700 AU) structure of the molecular envelopes of a well-defined sample of nine embedded low-mass young stellar objects in Taurus. The interferometer results can be understood in terms of: (1) a core of radius approximately or less than 1000 AU surrounding the central star, possibly flattened and rotating; (2) condensations scattered throughout the envelope that may be left over from the inhomogeneous structure of the original cloud core or that may have grown during collapse; and (3) material within the outflow or along the walls of the outflow cavity. Masses of the central cores are 0.001-0.1 M (solar), and agree well with dust continuum measurements. Averaged over the central 20" (3000 AU) region, an HCO+ abundance of 4 x 10(-8) is inferred, with a spread of a factor of 3 between the different sources. Reanalysis of previously presented single-dish data yields an HCO+ abundance of (5.0 +/- 1.7) x 10(-9), which may indicate an average increase by a factor of a few on the smaller scales sampled by the interferometer. Part of this apparent abundance variation could be explained by contributions from extended cloud emission to the single-dish C18O lines, and uncertainties in the assumed excitation temperatures and opacities. The properties of the molecular envelopes and outflows are further investigated through single-dish observations of 12CO J = 6-5, 4-3, and 3-2, 13CO 6-5 and 3-2, and C18O 3-2 and 2-1, obtained with the James Clerk Maxwell and IRAM 30 m telescopes, along with the Caltech Submillimeter Observatory. Ratios of the mid-J CO lines are used to estimate the excitation temperature, with values of 25-80 K derived for the gas near line centre. The outflow wings show a similar range, although Tex is enhanced by a factor of 2-3 in at least two sources. In contrast to the well-studied L1551

  10. Envelope structure on 700 AU scales and the molecular outflows of low-mass young stellar objects

    NASA Technical Reports Server (NTRS)

    Hogerheijde, M. R.; van Dishoeck, E. F.; Blake, G. A.; van Langevelde, H. J.

    1998-01-01

    Aperture synthesis observations of HCO+ J = 1-0, 13CO 1-0, and C18O 1-0 obtained with the Owens Valley Millimeter Array are used to probe the small-scale (5" approximately 700 AU) structure of the molecular envelopes of a well-defined sample of nine embedded low-mass young stellar objects in Taurus. The interferometer results can be understood in terms of: (1) a core of radius approximately or less than 1000 AU surrounding the central star, possibly flattened and rotating; (2) condensations scattered throughout the envelope that may be left over from the inhomogeneous structure of the original cloud core or that may have grown during collapse; and (3) material within the outflow or along the walls of the outflow cavity. Masses of the central cores are 0.001-0.1 M (solar), and agree well with dust continuum measurements. Averaged over the central 20" (3000 AU) region, an HCO+ abundance of 4 x 10(-8) is inferred, with a spread of a factor of 3 between the different sources. Reanalysis of previously presented single-dish data yields an HCO+ abundance of (5.0 +/- 1.7) x 10(-9), which may indicate an average increase by a factor of a few on the smaller scales sampled by the interferometer. Part of this apparent abundance variation could be explained by contributions from extended cloud emission to the single-dish C18O lines, and uncertainties in the assumed excitation temperatures and opacities. The properties of the molecular envelopes and outflows are further investigated through single-dish observations of 12CO J = 6-5, 4-3, and 3-2, 13CO 6-5 and 3-2, and C18O 3-2 and 2-1, obtained with the James Clerk Maxwell and IRAM 30 m telescopes, along with the Caltech Submillimeter Observatory. Ratios of the mid-J CO lines are used to estimate the excitation temperature, with values of 25-80 K derived for the gas near line centre. The outflow wings show a similar range, although Tex is enhanced by a factor of 2-3 in at least two sources. In contrast to the well-studied L1551

  11. Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area.

    PubMed

    Sterner, Eila; Fossum, Bjöörn; Berg, Elisabeth; Lindholm, Christina; Stark, André

    2014-08-01

    Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice.

  12. A Marginal Structural Model Analysis for Loneliness: Implications for Intervention Trials and Clinical Practice

    ERIC Educational Resources Information Center

    VanderWeele, Tyler J.; Hawkley, Louise C.; Thisted, Ronald A.; Cacioppo, John T.

    2011-01-01

    Objective: Clinical scientists, policymakers, and individuals must make decisions concerning effective interventions that address health-related issues. We use longitudinal data on loneliness and depressive symptoms and a new class of causal models to illustrate how empirical evidence can be used to inform intervention trial design and clinical…

  13. Artificial intelligence applied to the automatic analysis of absorption spectra. Objective measurement of the fine structure constant

    NASA Astrophysics Data System (ADS)

    Bainbridge, Matthew B.; Webb, John K.

    2017-01-01

    A new and automated method is presented for the analysis of high-resolution absorption spectra. Three established numerical methods are unified into one `artificial intelligence' process: a genetic algorithm (Genetic Voigt Profile FIT, gvpfit); non-linear least-squares with parameter constraints (vpfit); and Bayesian model averaging (BMA). The method has broad application but here we apply it specifically to the problem of measuring the fine structure constant at high redshift. For this we need objectivity and reproducibility. gvpfit is also motivated by the importance of obtaining a large statistical sample of measurements of Δα/α. Interactive analyses are both time consuming and complex and automation makes obtaining a large sample feasible. In contrast to previous methodologies, we use BMA to derive results using a large set of models and show that this procedure is more robust than a human picking a single preferred model since BMA avoids the systematic uncertainties associated with model choice. Numerical simulations provide stringent tests of the whole process and we show using both real and simulated spectra that the unified automated fitting procedure out-performs a human interactive analysis. The method should be invaluable in the context of future instrumentation like ESPRESSO on the VLT and indeed future ELTs. We apply the method to the zabs = 1.8389 absorber towards the zem = 2.145 quasar J110325-264515. The derived constraint of Δα/α = 3.3 ± 2.9 × 10-6 is consistent with no variation and also consistent with the tentative spatial variation reported in Webb et al. and King et al.

  14. Artificial intelligence applied to the automatic analysis of absorption spectra. Objective measurement of the fine structure constant.

    NASA Astrophysics Data System (ADS)

    Bainbridge, Matthew B.; Webb, John K.

    2017-01-01

    A new and automated method is presented for the analysis of high-resolution absorption spectra. Three established numerical methods are unified into one "artificial intelligence" process: a genetic algorithm (GVPFIT); non-linear least-squares with parameter constraints (VPFIT); and Bayesian Model Averaging (BMA). The method has broad application but here we apply it specifically to the problem of measuring the fine structure constant at high redshift. For this we need objectivity and reproducibility. GVPFIT is also motivated by the importance of obtaining a large statistical sample of measurements of Δα/α. Interactive analyses are both time consuming and complex and automation makes obtaining a large sample feasible. In contrast to previous methodologies, we use BMA to derive results using a large set of models and show that this procedure is more robust than a human picking a single preferred model since BMA avoids the systematic uncertainties associated with model choice. Numerical simulations provide stringent tests of the whole process and we show using both real and simulated spectra that the unified automated fitting procedure out-performs a human interactive analysis. The method should be invaluable in the context of future instrumentation like ESPRESSO on the VLT and indeed future ELTs. We apply the method to the zabs = 1.8389 absorber towards the zem = 2.145 quasar J110325-264515. The derived constraint of Δα/α = 3.3 ± 2.9 × 10-6 is consistent with no variation and also consistent with the tentative spatial variation reported in Webb et al. (2011) and King et al. (2012).

  15. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications

    PubMed Central

    Oakley, Paul A.; Harrison, Donald D.; Harrison, Deed E.; Haas, Jason W.

    2005-01-01

    BACKGROUND Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP®) methods, and (2) to compare the evidence for Diversified, SMT, and CBP®. METHODS Clinical control trials utilizing CBP® methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP® were rated and compared. RESULTS From the evidence from Clinical Control Trials on SMT and CBP®, there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP® (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS While CBP® Technique has approximately as much evidence-based support as SMT for neck pain, CBP® has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP® publications. PMID:17549209

  16. Adult separation anxiety: psychometric properties of a new structured clinical interview.

    PubMed

    Cyranowski, Jill M; Shear, M Katherine; Rucci, Paola; Fagiolini, Andrea; Frank, Ellen; Grochocinski, Victoria J; Kupfer, David J; Banti, Susanna; Armani, Antonella; Cassano, Giovanni

    2002-01-01

    Separation anxiety has traditionally been characterized and assessed as a disorder that is unique to childhood. Yet the core symptoms of separation anxiety, i.e. excessive and often disabling distress when faced with actual or perceived separation from major attachment figures, may persist or even arise during adulthood. We report on the psychometric properties of a new structured clinical interview designed to assess symptoms of separation anxiety as experienced both during childhood and adulthood. This instrument, called the Structured Clinical Interview for Separation Anxiety Symptoms (or SCI-SAS), was administered as part of an assessment battery to 91 adult psychiatric outpatients and 20 non-psychiatric controls. Results indicate that this instrument displays excellent psychometric properties, including good internal consistency, a clear factor structure, and exceptional levels of convergent and discriminate validity. These results highlight the feasibility and potential clinical utility of assessing age-appropriate symptoms of separation anxiety experienced during adulthood.

  17. Structural empowerment, job satisfaction, and turnover intention of Chinese clinical nurses.

    PubMed

    Cai, Chunfeng; Zhou, Zongkui

    2009-12-01

    The purpose of this study was to examine the levels of workplace structural empowerment perceived by Chinese clinical nurses, as well as to identify the relationship between nurses' perceptions of empowerment and job satisfaction, and turnover intention. A total of 189 staff nurses from two hospitals in central China completed a self-administered questionnaire. The results indicated that these nurses perceived moderate levels of workplace empowerment. Structural empowerment and job satisfaction were found to be negatively related to turnover intention. These findings have important implications for administrators providing an effective work environment for clinical nurses.

  18. Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden

    PubMed Central

    Geborek, P; Crnkic, M; Petersson, I; Saxne, T

    2002-01-01

    Objective: To explore the feasibility of prospectively monitoring treatment efficacy and tolerability of infliximab, etanercept, and leflunomide over a two year period in patients with established rheumatoid arthritis (RA) in clinical practice using a structured protocol. Methods: All patients with RA at seven centres in southern Sweden, for whom at least two disease modifying antirheumatic drugs, including methotrexate, had failed or not been tolerated, who started treatment with either infliximab, etanercept, or leflunomide were included. They were evaluated at predefined times using a standardised protocol including items required for evaluating response to the American College of Rheumatology (ACR) or EULAR criteria. All adverse events were recorded using World Health Organisation terminology. Concomitant treatment and survival while receiving a drug were recorded. Results: During the study 166 patients were treated with etanercept, 135 with infliximab, and 103 with leflunomide. Treatment response as determined by the ACR and EULAR response criteria was similar for the tumour necrosis factor (TNF) blockers. The TNF blockers performed significantly better than leflunomide both as determined by the response criteria and by survival on drug analysis. Thus 79% and 75% continued to receive etanercept or infliximab compared with 22% of patients who started leflunomide after 20 months. The spectrum of side effects did not differ from those previously reported in the clinical trials. The initial two year experience of a protocol for postmarketing surveillance of etanercept, infliximab, and leflunomide shows that a structured protocol with central data handling can be used in clinical practice for documenting the performance of newly introduced drugs. Conclusions: Efficacy data for the TNF blockers comply with results in clinical trials, whereas leflunomide appeared to perform worse than in clinical trials. Prolonged monitoring is required to identify possible rare side

  19. Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.

    PubMed

    Bourgois, Philippe; Holmes, Seth M; Sue, Kim; Quesada, James

    2017-03-01

    The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

  20. Structural properties of fracture haematoma: current status and future clinical implications.

    PubMed

    Wang, Xin; Friis, Thor; Glatt, Vaida; Crawford, Ross; Xiao, Yin

    2016-07-12

    Blood clots (haematomas) that form immediately following a bone fracture have been shown to be vital for the subsequent healing process. During the clotting process, a number of factors can influence the fibrin clot structure, such as fibrin polymerization, growth factor binding, cellular infiltration (including platelet retraction), protein concentrations and cytokines. The modulation of the fibrin clot structure within the fracture site has important clinical implications and could result in the development of multifunctional scaffolds that mimic the natural structure of a haematoma. Artificial haematoma structures such as these can be created from the patient's own blood and can therefore act as an ideal bone defect filling material for potential clinical application to accelerate bone regeneration. Copyright © 2016 John Wiley & Sons, Ltd.

  1. Atopy patch tests in young adult patients with atopic dermatitis and controls: dose-response relationship, objective reading, reproducibility and clinical interpretation.

    PubMed

    Bygum, Anette; Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

    2003-01-01

    The clinical interpretation and reproducibility of atopy patch tests was studied in 23 selected young adult patients with atopic dermatitis and 25 healthy controls using standard inhalant allergens. Non-invasive measurements were used for objective assessment of test reactions and the participants were retested after 6 weeks. Ten of 19 (53%) evaluable patients with atopic dermatitis had at least one positive atopy patch test. However, there was no clear clinical relevance of the atopy patch test results when related to patient history and distribution of dermatitis. Reproducible and dose-dependent results were obtained with Dermatophagoides pteronyssinus, grass and cat with a reproducibility rate of 0.69 to 0.81 in patients and 0.60-0.96 in controls. A unique finding was a significant positive correlation between a positive atopy patch test, allergen dose and increase in transepidermal water loss and erythema, while measurement of capacitance did not distinguish between positive and negative reactions. The results of the present study do not support the routine use of atopy patch tests in the evaluation of adult patients with atopic dermatitis.

  2. NOTE: Construction of a modified capacitive overlap MR coil for imaging of small animals and objects in a clinical whole-body scanner

    NASA Astrophysics Data System (ADS)

    Seierstad, T.; Røe, K.; Høvik, B.

    2007-11-01

    During the last two decades, there has been an explosive increase in the number of MR investigations involving genetically manipulated mice and rats. Many of the animal studies are performed in a more or less clinical environment, where whole-body MR scanners are the only option available. The quality and acquisition time of MR images have improved with the development of novel RF coil technologies. This communication describes the construction of a small inductively coupled capacitive overlap transmit-receive MR coil for imaging of small animals and objects in a clinical MR scanner. The MR coil presented here is a modified version of the bridged loop-gap coil and consists of two tube-shaped coupled resonance circuits, where the primary circuit partly encapsulates the imaging (secondary) circuit. By rotating the concentric primary coil relative to the secondary coil tuning over a range of several hundred kilohertz is obtained. The coil performance was characterized experimentally by acquiring high-resolution anatomical, diffusion and perfusion MR images as well as the acquisition of proton spectra of a mouse tumour.

  3. [Comparison of patient therapy adherence of two structural different memory clinics].

    PubMed

    Weih, M; Sulimma, A-K; Lehfeld, H; Niklewski, G; Sonnenberg, M; Richter-Schmidinger, T; Alexopoulos, P; Grässel, E; Kornhuber, J

    2009-04-01

    There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

  4. The Reasons for Heavy Drinking Questionnaire: Factor Structure and Validity in Alcohol-Dependent Adults Involved in Clinical Trials

    PubMed Central

    Adams, Zachary W.; Schacht, Joseph P.; Randall, Patrick; Anton, Raymond F.

    2016-01-01

    Objective: People consume alcohol at problematic levels for many reasons. These different motivational pathways may have different biological underpinnings. Valid, brief measures that discriminate individuals’ reasons for drinking could facilitate inquiry into whether varied drinking motivations account for differential response to pharmacotherapies for alcohol use disorders. The current study evaluated the factor structure and predictive validity of a brief measure of alcohol use motivations developed for use in randomized clinical trials, the Reasons for Heavy Drinking Questionnaire (RHDQ). Method: The RHDQ was administered before treatment to 265 participants (70% male) with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, in three pharmacotherapy randomized clinical trials. Principal components analysis was used in half the sample to determine the RHDQ factor structure. This structure was verified with confirmatory factor analysis in the second half of the sample. The factors derived from this analysis were evaluated with respect to alcohol dependence severity indices. Results: A two-factor solution was identified. Factors were interpreted as Reinforcement and Normalizing. Reinforcement scores were weakly to moderately associated with severity, whereas normalizing scores were moderately to strongly associated with severity. In all cases in which significant associations between RHDQ scores and severity indices were observed, the relationship was significantly stronger for normalizing than for reinforcing. Conclusions: The RHDQ is a promising brief assessment of motivations for heavy alcohol use, particularly in the context of randomized clinical trials. Additional research should address factor structure stability in non–treatment-seeking individuals and the RHDQ’s utility in detecting and accounting for changes in drinking behavior, including in response to intervention. PMID:26997195

  5. SeaDataNet : Pan-European infrastructure for marine and ocean data management - Project objectives, structure and components

    NASA Astrophysics Data System (ADS)

    Maudire, G.; Maillard, C.; Fichaut, M.; Manzella, G.; Schaap, D. M. A.

    2009-04-01

    SeaDataNet : Pan-European infrastructure for marine and ocean data management Project objectives, structure and components G. Maudire (1), C. Maillard (1), G. Manzella (2), M. Fichaut (1), D.M.A. Schaap (3), E. Iona (4) and the SeaDataNet consortium. (1) IFREMER, Brest, France (Gilbert.Maudire@ifremer.fr), (2) ENEA, La Spezia, Italy, (3) Mariene Informatie Service 'MARIS', Voorburg, The Netherlands, (4) Hellenic Centre for Marine Research-HCMR, Anavyssos, Greece. Since a large part of the earth population lives near the oceans or carries on activities directly or indirectly linked to the seas (fishery and aquaculture, exploitation of sea bottom resources, international shipping, tourism), knowledge of oceans is of primary importance for security and economy. However, observation and monitoring of the oceans remains difficult and expensive even if real improvements have been achieved using research vessels and submersibles, satellites and automatic observatories like buoys, floats and seafloor observatories transmitting directly to the shore using global transmission systems. More than 600 governmental or private organizations are active in observation of seas bordering Europe, but European oceanographic data are fragmented, not always validated and not always easily accessible. That highlights the need of international collaboration to tend toward a comprehensive view of ocean mechanisms, resources and changes. SeaDataNet is an Integrated research Infrastructure Initiative (I3) in European Union Framework Program 6 (2006 - 2011) to provide the data management system adapted both to the fragmented observation systems and to the users need for an integrated access to data, meta-data, products and services. Its major objectives are to: - encourage long-term archiving at national level to secure ocean data taking into account that all the observations made in the variable oceanic environment can never be remade if they are lost; - promote best practices for data

  6. The Vital Role of Patient Feedback in the Critical Assessment of a Patient-Centered Care Objective Structured Clinical Examination

    ERIC Educational Resources Information Center

    Rentfro, Allison Carothers

    2011-01-01

    Priorities in medical education have increasingly emphasized teaching skills and fostering attitudes related to patient-centered care (Beckman & Frankel, 2003; Haidet & Paterniti, 2003). The challenge for academic medical centers is to implement these competencies into their curriculum and assess the outcomes. Using a qualitative single…

  7. Clinical Application of the Mean Babbling Level and Syllable Structure Level

    ERIC Educational Resources Information Center

    Morris, Sherrill R.

    2010-01-01

    Purpose: This clinical exchange reviews two independent phonological assessment measures: mean babbling level (MBL) and syllable structure level (SSL). Both measures summarize phonetic inventory and syllable shape in a calculated average and have been used in research to describe the phonological abilities of children ages 9 to 36 months. An…

  8. Structural empowerment and professional nursing practice behaviors of baccalaureate nursing students in clinical learning environments.

    PubMed

    Livsey, Kae R

    2009-01-01

    This study examines the associations between professional behaviors of baccalaureate nursing students and student perceptions of select factors within the clinical learning environment, including the role of clinical faculty leadership. Participants (n=243) were recruited from a randomly selected list of 1000 members of the National Student Nurses Association (NSNA) among sixteen states within the Southern region of the United States. Results revealed a direct relationship exists between student perceptions of structural empowerment in their clinical learning environment and professional nursing practice behaviors among students. Also found was that relationships between variables in the model are significantly strengthened by student perceptions of strong leadership behaviors of clinical faculty. Findings from this study may assist nurse educators by contributing knowledge relevant to support/facilitate the transition of individuals from student nurses to professional registered nurses and, thus enhance the impact of professional nurses' contributions in healthcare delivery.

  9. A Pilot Clinical Trial to Objectively Assess the Efficacy of Electroacupuncture on Gait in Patients with Parkinson's Disease Using Body Worn Sensors

    PubMed Central

    Lei, Hong

    2016-01-01

    Background Gait disorder, a key contributor to fall and poor quality of life, represents a major therapeutic challenge in Parkinson’s disease (PD). The efficacy of acupuncture for PD remains unclear, largely due to methodological flaws and lack of studies using objective outcome measures. Objective To objectively assess the efficacy of electroacupuncture (EA) for gait disorders using body-worn sensor technology in patients with PD. Methods In this randomized pilot study, both the patients and assessors were masked. Fifteen PD patients were randomly assigned to an experimental group (n = 10) or to a control group (n = 5). Outcomes were assessed at baseline and after completion of three weekly EA treatments. Measurements included gait analysis during single-task habitual walking (STHW), dual-task habitual walking (DTHW), single-task fast walking (STFW), dual-task fast walking (DTFW). In addition, Unified Parkinson's Disease Rating Scale (UPDRS), SF-12 health survey, short Falls Efficacy Scale-International (FES-I), and visual analog scale (VAS) for pain were utilized. Results All gait parameters were improved in the experimental group in response to EA treatment. After adjustment by age and BMI, the improvement achieved statistical significant level for gait speed under STHW, STFW, and DTFW (9%-19%, p<0.05) as well as stride length during DTFW (9%, p = 0.037) and midswing speed during STFW (6%, p = 0.033). No significant changes were observed in the control group (p>0.110). The highest correlation between gait parameters and UPRDS scores at baseline was observed between gait speed during STFW and UPDRS II (r = -0.888, p = 0.004). The change in this gait parameter in response to active intervention was positively correlated with baseline UPDRS (r = 0.595, p = 0.057). Finally, comparison of responses to treatment between groups showed significant improvement, prominently in gait speed (effect size 0.32–1.16, p = 0.001). Conclusions This study provides the objective

  10. Clitics and Object Expression in the L3 Acquisition of Brazilian Portuguese: Structural Similarity Matters for Transfer

    ERIC Educational Resources Information Center

    Montrul, Silvina; Dias, Rejanes; Santos, Helade

    2011-01-01

    This article addresses the role of previously acquired languages in the acquisition of a third language (L3) in two experimental studies on object expression in Brazilian Portuguese (BP). Participants were English-speaking learners of BP as L3 with knowledge of Spanish as a second language (L2) and Spanish-speaking learners of BP with knowledge of…

  11. Crossed unilateral lesions of temporal lobe structures and cholinergic cell bodies impair visual conditional and object discrimination learning in monkeys.

    PubMed

    Barefoot, H C; Baker, H F; Ridley, R M

    2002-02-01

    Monkeys with excitotoxic lesions of the CA1/subiculum region in the right hemisphere and with immunotoxic lesions of the cholinergic cells of the diagonal band in the left hemisphere were impaired on a visual conditional task. In this task, correct choice of one of two objects depends on which of two background fields both objects are presented against, irrespective of the spatial positions of the objects. They were not impaired on simple object or shape discrimination tasks. The pattern of impairments is the same as that seen after bilateral excitotoxic lesions of CA1/subiculum, implying that the diagonal band lesion disables the ipsilateral CA1/subiculum. It also argues that CA1/subiculum, sustained by its cholinergic input, is necessary for some forms of nonspatial conditional learning. Addition of an inferotemporal (IT) cortical ablation to the left hemisphere did not affect simple visual discrimination learning, although all the monkeys then failed to learn a new visual conditional task. This demonstrates that intact IT cortex in only one hemisphere is sufficient to sustain simple visual discrimination learning but implies that the cholinergic input and the inferotemporal cortical input to the hippocampus both contribute to visual conditional learning. The subsequent addition of an immunotoxic lesion of the basal nucleus of Meynert in the right hemisphere resulted in an additional impairment on a difficult shape discrimination. This argues that it is the cholinergic projection to the inferotemporal cortex, rather than to the rest of the cortex, which contributes to visual discrimination learning and memory.

  12. How can we objectively categorise partnership type? A novel classification of population survey data to inform epidemiological research and clinical practice

    PubMed Central

    Mercer, C H; Jones, K G; Johnson, A M; Lewis, R; Mitchell, K R; Clifton, S; Tanton, C; Sonnenberg, P; Wellings, K; Cassell, J A; Estcourt, C S

    2017-01-01

    Background Partnership type is a determinant of STI risk; yet, it is poorly and inconsistently recorded in clinical practice and research. We identify a novel, empirical-based categorisation of partnership type, and examine whether reporting STI diagnoses varies by the resulting typologies. Methods Analyses of probability survey data collected from 15 162 people aged 16–74 who participated in Britain's third National Survey of Sexual Attitudes and Lifestyles were undertaken during 2010–2012. Computer-assisted self-interviews asked about participants' ≤3 most recent partners (N=14 322 partners/past year). Analysis of variance and regression tested for differences in partnership duration and perceived likelihood of sex again across 21 ‘partnership progression types’ (PPTs) derived from relationship status at first and most recent sex. Multivariable regression examined the association between reporting STI diagnoses and partnership type(s) net of age and reported partner numbers (all past year). Results The 21 PPTs were grouped into four summary types: ‘cohabiting’, ‘now steady’, ‘casual’ and ‘ex-steady’ according to the average duration and likelihood of sex again. 11 combinations of these summary types accounted for 94.5% of all men; 13 combinations accounted for 96.9% of all women. Reporting STI diagnoses varied by partnership-type combination, including after adjusting for age and partner numbers, for example, adjusted OR: 6.03 (95% CI 2.01 to 18.1) for men with two ‘casual’ and one ‘now steady’ partners versus men with one ‘cohabiting’ partner. Conclusions This typology provides an objective method for measuring partnership type and demonstrates its importance in understanding STI risk, net of partner numbers. Epidemiological research and clinical practice should use these methods and results to maximise individual and public health benefit. PMID:27535765

  13. The Structure of Clinical Consultation: A Case of Non-Native Speakers of English as Participants

    PubMed Central

    Bagheri, H.; Ibrahim, N. A.; Habil, H.

    2015-01-01

    Background: In many parts of the world, patients may find it difficult to visit doctors who share the same language and culture due to the intermingling of people and international recruitment of doctors among many other reasons. In these multilingual multicultural settings (MMSs), doctor-patient interactions face new communication challenges. This study aims to identify the structure of clinical consultation and its phases in an MMS where both doctors and patients are non-native speakers (NNSs) of English. Method: This study takes on a discourse analytic approach to examine the structure of clinical consultation as an activity type. 25 clinical consultation sessions between non-native speakers of English in a public healthcare centre in Malaysia were audio-recorded. Findings and Discussion: The results show that there are some deviations from the mainstream structure of clinical consultations although, in general, the pattern is compatible with previous studies. Deviations are particularly marked in the opening and closing phases of consultation. Conclusion: In almost all interactions, there is a straightforward manner of beginning medical consultations. The absence of greetings may have naturally reduced the length of talk. Hence, by directly entering medical talks, the doctors voice their concern on the curing aspects of the consultation rather than its caring facets. The preference of curing priority to caring is more goal-oriented and in alignment with the consultation as an activity type. PMID:25560336

  14. Clinical, Neurocognitive, Structural Imaging and Dermatogliphics in Schizophrenia According to Kraepelin Criteria

    PubMed Central

    GÜLEÇ, Hüseyin; ULUSOY KAYMAK, Semra; BİLİCİ, Mustafa; GANGAL, Ali; KAYIKÇ IOĞLU, Temel; SARI, Ahmet; TAN, Üner

    2013-01-01

    Introduction A century ago, Kraepelin stated that the distinctive feature of schizophrenia was progressive deterioration. Kraepelin criteria for schizophrenia are: (1) continuous hospitalization or complete dependence on others for obtaining basic necessities of life, (2) unemployment and (3) no remission for the past five years. We aimed to determine the clinical appearance and structural biological features of Kraepelinian schizophrenia. Methods The sample consisted of 17 Kraepelinian patients, 30 non-Kraepelinian schizophrenic patients and 43 healthy controls. The Clinical Global Impressions (CGI) and the Positive and Negative Syndrome Scales (PANSS) were used for clinical assessment. The Frontal Assessment Battery (FAB) and the Verbal Fluency and Color Trail Test (CTT) were included in the cognitive battery. Brain magnetic resonance imaging and dermatoglyphic measurements were performed for structural features. Result Duration of illness, hospitalization, suicide attempts, admission type, presence of a stressor and treatment choice were similar between the two patient groups. Treatment resistance and family history of schizophrenia were more common in Kraepelinian patients. PANSS and CGI subscales scores were also higher in this group. Only the category fluency and CTT-I were different in Kraepelinian patients in comparison to the other patient group. Structural findings were not different between the three groups. Conclusion Category fluency, which was lower in Kraepelinian patients, is an important marker of a degenerative process. The collection of severe clinical symptoms, family history of psychiatric illness and nonresponse to treatment in this particular group of patients points to the need to conduct further studies including cluster analysis in methodology.

  15. Feedback & Objectives

    ERIC Educational Resources Information Center

    Butterworth, James R.

    1975-01-01

    Industrial objectives, if they are employee oriented, produce feedback, and the motivation derived from the feedback helps reduce turnover. Feedback is the power to clarify objectives, to stimulate communication, and to motivate people. (Author/MW)

  16. Disambiguation of Similar Object-Place Paired Associations and the Roles of the Brain Structures in the Medial Temporal Lobe

    PubMed Central

    Byun, Jayoung

    2010-01-01

    Amnesic patients who have damage in the hippocampus and in associated areas in the medial temporal lobe suffer from remembering specific events that may or may not share similar objects and locations. Computational models, behavioral studies, and physiological findings all suggest that neural circuits in the hippocampus are suitable for representing seemingly similar events as distinctively different individual event memories. This article offers a selective review on this particular function of the hippocampus and its associates areas such as the perirhinal cortex, mostly centering upon lesion studies and physiological studies using animals. We also present recent experimental results showing that the dentate gyrus subfield of the hippocampus and perirhinal cortex are particularly important for discriminating similar paired associates between same objects and different locations, or vice versa. PMID:22110337

  17. Structural Neuroimaging of the Medial Temporal Lobe in Alzheimer's Disease Clinical Trials.

    PubMed

    Menéndez-González, Manuel; de Celis Alonso, Benito; Salas-Pacheco, José; Arias-Carrión, Oscar

    2015-01-01

    Atrophy in the medial temporal lobe (MTA) is being used as a criterion to support a diagnosis of Alzheimer's disease (AD). There are several structural neuroimaging approaches for quantifying MTA, including semiquantitative visual rating scales, volumetry (3D), planimetry (2D), and linear measures (1D). Current applications of structural neuroimaging in Alzheimer's disease clinical trials (ADCTs) incorporate it as a tool for improving the selection of subjects for enrollment or for stratification, for tracking disease progression, or providing evidence of target engagement for new therapeutic agents. It may also be used as a surrogate marker, providing evidence of disease-modifying effects. However, despite the widespread use of volumetric magnetic resonance imaging (MRI) in ADCTs, there are some important challenges and limitations, such as difficulties in the interpretation of results, limitations in translating results into clinical practice, and reproducibility issues, among others. Solutions to these issues may arise from other methodologies that are able to link the results of volumetric MRI from trials with conventional MRIs performed in routine clinical practice (linear or planimetric methods). Also of potential benefit are automated volumetry, using indices for comparing the relative rate of atrophy of different regions instead of absolute rates of atrophy, and combining structural neuroimaging with other biomarkers. In this review, authors present the existing structural neuroimaging approaches for MTA quantification. They then discuss solutions to the limitations of the different techniques as well as the current challenges of the field. Finally, they discuss how the current advances in AD neuroimaging can help AD diagnosis.

  18. Instructor and Dental Student Perceptions of Clinical Communication Skills via Structured Assessments.

    PubMed

    McKenzie, Carly T

    2016-05-01

    The aim of this study was to use structured assessments to assess dental students' clinical communication skills exhibited during patient appointments. Fourth-year dental students (n=55) at the University of Alabama at Birmingham evaluated their own interpersonal skills in a clinical setting utilizing the Four Habits Coding Scheme. An instructor also assessed student-patient clinical communication. These assessments were used to identify perceived strengths and weaknesses in students' clinical communication. Both instructor assessments and student self-assessments pinpointed the following clinical communication skills as effective the most often: patient greeting, avoidance of jargon, and non-verbal behavior. There was also relative agreement between instructor assessments and student self-assessments regarding clinical communication skills that were rated as not effective most frequently: ensuring patient comprehension, identification of patient feelings, and exploration of barriers to treatment. These resulted pointed to strengths and weaknesses in the portion of the curriculum designed to prepare students for effective provider-patient communication. These results may suggest a need for the school's current behavioral science curriculum to better address discussion of potential treatment barriers and patient feelings as well as techniques to ensure patient comprehension.

  19. Effects of cis-platinum chemotherapy on otoacoustic emissions: the development of an objective screening protocol. Third place--Resident Clinical Science Award 1998.

    PubMed

    Ress, B D; Sridhar, K S; Balkany, T J; Waxman, G M; Stagner, B B; Lonsbury-Martin, B L

    1999-12-01

    To develop an objective, fast, and simply performed screening protocol for cis -platinum (CP) ototoxicity, we compared the efficacy of screening with distortion-product otoacoustic emissions (DPOAEs) with the outcome of both conventional and ultra-high-frequency (UHF) audiometry. Baseline audiometric and DPOAE testing was performed in 66 patients, 33 of whom met criteria for inclusion in the final database. Comparisons were made between baseline measurements and those recorded before subsequent CP infusions. Outcomes were analyzed clinically and with paired repeated-measures analysis of variance. Results indicated that DPOAEs and UHF were better measures than conventional audiometry. Further, DPOAEs may be better suited for screening older patients receiving CP chemotherapy because DPOAEs are as sensitive as UHF and are present in a greater number of these patients. Screening with DPOAEs may be enhanced by testing only in the 3- to 5.2-kHz range, thus decreasing testing time. Higher time averages to increase the signal-to-noise ratio and use of this narrower bandwidth might also allow for accurate bedside testing.

  20. Narrowband Near-Infrared Imaging of Young Planetary Nebulae and Transition Objects: Probing Core and Halo Structures

    NASA Technical Reports Server (NTRS)

    Hora, Joseph L.; Latter, William B.

    1997-01-01

    The new images presented here have high spatial resolution and are very sensitive to low levels of emission. We compare our new data to existing imaging and spectroscopic data to give clues as to the structure and formation of planetary nebulae, the role of shocks, and the evolution of photon-dominated regions.

  1. The Effects of Varying Structure within a Prototypical Play Object on the Solitary Pretend Play of Preschool Children.

    ERIC Educational Resources Information Center

    Robinson, Clyde C.; Jackson, Ronald

    Claims about the relative holding-power and play-versatility of toys either low or high in amount of realistic detail, such as miniature metal cars, were tested in a solitary play environment with and without the use of props. Subjects were 36 middle-class preschool children. Results suggest that, when structure is varied within the toy prototype,…

  2. Clinical instructors' perceptions of structural and psychological empowerment in academic nursing environments.

    PubMed

    Wiens, Sandra; Babenko-Mould, Yolanda; Iwasiw, Carroll

    2014-05-01

    The study purpose was to explore clinical instructors' (CIs') perceptions of empowerment in academic nursing environments. Clinical instructors, often part-time faculty, facilitate learning in professional practice environments. However, they also need to function within the academic environment to learn about the curriculum and how students are to be evaluated. The qualitative description method was used to obtain an understanding of CIs' empowerment experiences and to interpret their perceptions within the frameworks of Kanter's structural empowerment and Spreitzer's psychological empowerment theories. Eight CIs from two nursing programs were interviewed for this study. The empowerment components of support and confidence were important, yet insufficient, in CIs' perceptions of their role effectiveness. An implication for CIs was slow development of confidence in their ability to facilitate student learning that was consistent with curriculum goals. Recommendations for CIs and academic faculty are offered to support and retain clinical faculty.

  3. [Botulism: structure and function of botulinum toxin and its clinical application].

    PubMed

    Oguma, Keiji; Yamamoto, Yumiko; Suzuki, Tomonori; Fatmawati, Ni Nengah Dwi; Fujita, Kumiko

    2012-08-01

    Clostridium botulinum produces seven immunological distinct poisonous neurotoxins, A to G, with molecular masses of approximately 150kDa. In acidic foods and culture fluid, the neurotoxins associate with non-toxic components, and form large complexes designated progenitor toxins. The progenitor toxins are found in three forms named LL, L, and M. These neurotoxins and progenitor toxins were purified, and whole nucleotide sequences of their structure genes were determined. In this manuscript, the structure and function of these toxins, and the application of these toxins to clinical usage have been described.

  4. Recognizing clinical entities in hospital discharge summaries using Structural Support Vector Machines with word representation features

    PubMed Central

    2013-01-01

    Background Named entity recognition (NER) is an important task in clinical natural language processing (NLP) research. Machine learning (ML) based NER methods have shown good performance in recognizing entities in clinical text. Algorithms and features are two important factors that largely affect the performance of ML-based NER systems. Conditional Random Fields (CRFs), a sequential labelling algorithm, and Support Vector Machines (SVMs), which is based on large margin theory, are two typical machine learning algorithms that have been widely applied to clinical NER tasks. For features, syntactic and semantic information of context words has often been used in clinical NER systems. However, Structural Support Vector Machines (SSVMs), an algorithm that combines the advantages of both CRFs and SVMs, and word representation features, which contain word-level back-off information over large unlabelled corpus by unsupervised algorithms, have not been extensively investigated for clinical text processing. Therefore, the primary goal of this study is to evaluate the use of SSVMs and word representation features in clinical NER tasks. Methods In this study, we developed SSVMs-based NER systems to recognize clinical entities in hospital discharge summaries, using the data set from the concept extration task in the 2010 i2b2 NLP challenge. We compared the performance of CRFs and SSVMs-based NER classifiers with the same feature sets. Furthermore, we extracted two different types of word representation features (clustering-based representation features and distributional representation features) and integrated them with the SSVMs-based clinical NER system. We then reported the performance of SSVM-based NER systems with different types of word representation features. Results and discussion Using the same training (N = 27,837) and test (N = 45,009) sets in the challenge, our evaluation showed that the SSVMs-based NER systems achieved better performance than the CRFs

  5. Multi-objective genetic algorithms based structural optimization and experimental investigation of the planet carrier in wind turbine gearbox

    NASA Astrophysics Data System (ADS)

    Yi, Pengxing; Dong, Lijian; Shi, Tielin

    2014-12-01

    To improve the dynamic performance and reduce the weight of the planet carrier in wind turbine gearbox, a multi-objective optimization method, which is driven by the maximum deformation, the maximum stress and the minimum mass of the studied part, is proposed by combining the response surface method and genetic algorithms in this paper. Firstly, the design points' distribution for the design variables of the planet carrier is established with the central composite design (CCD) method. Then, based on the computing results of finite element analysis (FEA), the response surface analysis is conducted to find out the proper sets of design variable values. And a multi-objective genetic algorithm (MOGA) is applied to determine the direction of optimization. As well, this method is applied to design and optimize the planet carrier in a 1.5MW wind turbine gearbox, the results of which are validated by an experimental modal test. Compared with the original design, the mass and the stress of the optimized planet carrier are respectively reduced by 9.3% and 40%. Consequently, the cost of planet carrier is greatly reduced and its stability is also improved.

  6. [Structure and process quality of multimodal pain therapy. Results of a survey of pain therapy clinics].

    PubMed

    Nagel, B; Pfingsten, M; Brinkschmidt, T; Casser, H-R; Gralow, I; Irnich, D; Klimczyk, K; Sabatowski, R; Schiltenwolf, M; Sittl, R; Söllner, W; Arnold, B

    2012-12-01

    Multimodal therapy has demonstrated good clinical effectiveness in the treatment of chronic pain syndromes. However, within the German health system a comprehensive and nationwide access to multimodal therapy is not available and further improvement is therefore necessary. In order to analyze the current status of multimodal therapy and specifically its structural and procedural requirements and qualities, a survey was carried out in 37 pain clinics with established multimodal treatment programs. An anonymous questionnaire was used for data collection. Results demonstrated that a substantial accordance was found between all pain clinics concerning requirements for space, facilities and staff. Structured multidisciplinary assessments were carried out by all pain clinics even though the amount of time allocated for this varied widely. The main focus of multimodal therapy in all facilities was based on a common philosophy with a cognitive-behavioral approach to reduce patient helplessness and avoidance behavior and to increase physical and psychosocial activities as well as to strengthen self-efficacy. Some differences in the ways and means to achieve these goals could be demonstrated in the various programs.

  7. The 'present state' examination and the structured clinical interview in Zulu.

    PubMed

    Buntting, B G; Wessels, W H

    1991-01-19

    The language, cultural and reality factors found to be important in the Zulu translation of the 'present state' examination (PSE) and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) are discussed and compared with a previous translation of the PSE in Xhosa. The psychopathological items of the PSE and SCID apply to Zulu-speaking patients and the instruments are valid in this setting.

  8. OCT imaging of osteoarthritic cartilage: structure, polarization sensitivity, and clinical feasibility

    NASA Astrophysics Data System (ADS)

    Li, Xing D.; Herrmann, Jurgen; Ghanta, Ravi K.; Pitris, Constantinos; Drexler, Wolfgang; Jesser, Christine; Stamper, Debra L.; Golden, David; Martin, Scott; Fujimoto, James G.; Brezinski, Mark E.

    1999-04-01

    This work demonstrates the feasibility of OCT for identifying early osteoarthritic pathology. In addition to structural abnormalities, changes in collagen fiber organization, an indicator of very early osteoarthritis, were assessed with a polarization sensitive OCT system. A portable, real time, modular OCT system, suitable for both laboratory and clinical settings, has been developed. Preliminary in vivo imaging results obtained during partial knee replacement surgery are discussed.

  9. Constrained Objects

    DTIC Science & Technology

    1993-11-28

    degrees of freedom. Within each object, the programmer’s job is to manage the degrees of freedom in the object by adding subobjects and constraints...other constraint satisfiction mechanisms such as propagation of values. However, Siri recomputes the state of an object by solving a combination of...languages need not be as complicated as they are; a small number of powerful constructs can do the job just as well, and perhaps more elegantly. 154

  10. Visual object affordances: object orientation.

    PubMed

    Symes, Ed; Ellis, Rob; Tucker, Mike

    2007-02-01

    Five experiments systematically investigated whether orientation is a visual object property that affords action. The primary aim was to establish the existence of a pure physical affordance (PPA) of object orientation, independent of any semantic object-action associations or visually salient areas towards which visual attention might be biased. Taken together, the data from these experiments suggest that firstly PPAs of object orientation do exist, and secondly, the behavioural effects that reveal them are larger and more robust when the object appears to be graspable, and is oriented in depth (rather than just frontally) such that its leading edge appears to point outwards in space towards a particular hand of the viewer.

  11. Topological defects and electro-convective flows in anisotropic fluids: A microfluidic platform for nano-objects tunable structuring

    NASA Astrophysics Data System (ADS)

    Provenzano, C.; Mazzulla, A.; Chiaravalloti, F.; Audia, B.; Cipparrone, G.

    2016-08-01

    Anisotropic fluids are a class of soft materials that offer wide possibilities for engineering a small scale laboratory; their physical properties can be manipulated on short length scale by appropriate confining conditions and external stimuli leading the systems across fascinating phenomena. In this work, two of these phenomena are combined to create a microfluidic platform for reconfigurable nanoparticles (NPs) patterning: the formation of topological defects and the electrically controlled convective flows. Here, the nanoscopic environments created by defects within liquid crystals have been used as linear nano-reservoirs of NPs. Afterwards, virtual channel flows that connect the linear reservoirs have been created by exploiting electro-convective rolls. The reported results reveal a strategy for managing nanometric objects based on anisotropic fluids and connected phenomena, proposing an unconventional microfluidic device characterized by switchable and contactless micro-channels.

  12. OGOLEM: Global cluster structure optimisation for arbitrary mixtures of flexible molecules. A multiscaling, object-oriented approach

    NASA Astrophysics Data System (ADS)

    Dieterich, Johannes M.; Hartke, Bernd

    2010-02-01

    In practical applications, global cluster structure optimisation has so far been limited largely to homogeneous clusters of atoms or small molecules, with little or no choice in the calculation of inter-particle forces. We eliminate these limitations by presenting a new program suite OGOLEM that is universal by design, both in cluster composition (including arbitrarily heterogeneous clusters of complicated molecules) and in its interfaces to force calculation backends. This is demonstrated by exemplary applications in two novel fields: strongly heterogeneous Lennard-Jones clusters (ternary, quaternary, quinary) and mixed clusters of the aminoglycoside Kanamycin A with sodium cations.

  13. Effects of structured written feedback by cards on medical students’ performance at Mini Clinical Evaluation Exercise (Mini-CEX) in an outpatient clinic

    PubMed Central

    HAGHANI, FARIBA; HATEF KHORAMI, MOHAMMAD; FAKHARI, MOHAMMAD

    2016-01-01

    Introduction Feedback cards are recommended as a feasible tool for structured written feedback delivery in clinical education while effectiveness of this tool on the medical students’ performance is still questionable.  The purpose of this study was to compare the effects of structured written feedback by cards as well as verbal feedback versus verbal feedback alone on the clinical performance of medical students at the Mini Clinical Evaluation Exercise (Mini-CEX) test in an outpatient clinic. Methods This is a quasi-experimental study with pre- and post-test comprising four groups in two terms of medical students’ externship. The students’ performance was assessed through the Mini-Clinical Evaluation Exercise (Mini-CEX) as a clinical performance evaluation tool. Structured written feedbacks were given to two experimental groups by designed feedback cards as well as verbal feedback, while in the two control groups feedback was delivered verbally as a routine approach in clinical education. Results By consecutive sampling method, 62 externship students were enrolled in this study and seven students were excluded from the final analysis due to their absence for three days. According to the ANOVA analysis and Post Hoc Tukey test,  no statistically significant difference was observed among the four groups at the pre-test, whereas a statistically significant difference was observed between the experimental and control groups at the post-test  (F = 4.023, p =0.012). The effect size of the structured written feedbacks on clinical performance was 0.19. Conclusion Structured written feedback by cards could improve the performance of medical students in a statistical sense. Further studies must be conducted in other clinical courses with longer durations. PMID:27382581

  14. Calcareous concretions and psammoma bodies in sputum smears: do these similar structures have different clinical significance?

    PubMed

    Martínez-Girón, Rafael; Martínez-Torre, Santiago; Tamargo-Peláez, María Luisa; López-Cabanilles, María Dolores; Torre-Bayón, Concepción

    2014-09-01

    Different noncellular elements, such as round concentric calcified laminated structures, may be found in sputum smears. If these structures appear isolated on the background of the smear, the term usually used to describe them is "calcareous concretions" (CC). On the contrary, when the structures are part of epithelial cell groups or small tissue fragments, the term used to describe them is "Psammoma bodies" (PB). The aim of this work is to establish the relationship between these structures and pulmonary disease, especially lung carcinoma, by searching for the presence of CC and/or PB in sputum smears. Our study has taken as a basis 16.716 sputum smears from 696 patients obtained during a 7-year period (2003-2009). After reviewing them, it was found that from the total, 66 cases (0.39%) contained round calcified structures, 57 of them (0.34%) corresponding to CC, and the remaining 9 ones (0.05%) corresponding to PB. From these 57 CC cases, 56 corresponded to benign entities, and only one was found with lung carcinoma. On the other hand, from the 9 PB cases all of them (100%) were related to lung adenocarcinoma. We conclude that, even having a similar morphological structure, these aforementioned calcified structures we have observed in sputum smears have different and relevant clinical significance.

  15. Educational Objectives.

    ERIC Educational Resources Information Center

    Hanover School System, MA.

    This statement of educational objectives was produced during the 1972-73 school year by the cooperative efforts of the teaching staff of the Hanover School System, Hanover, Massachusetts. The objectives were formulated by teachers working as a total group and in 13 committees: Health, Business, Music, Vocational Education, Reading, Mathematics,…

  16. Objective lens

    NASA Technical Reports Server (NTRS)

    Olczak, Eugene G. (Inventor)

    2011-01-01

    An objective lens and a method for using same. The objective lens has a first end, a second end, and a plurality of optical elements. The optical elements are positioned between the first end and the second end and are at least substantially symmetric about a plane centered between the first end and the second end.

  17. Detection of piluslike structures on clinical and environmental isolates of Vibrio vulnificus.

    PubMed Central

    Gander, R M; LaRocco, M T

    1989-01-01

    Twenty clinical isolates of Vibrio vulnificus were compared with 10 environmental strains by using electron microscopy and agglutination assays with human erythrocytes, guinea pig erythrocytes, and Saccharomyces cerevisiae. In addition, the isolates were tested for ability to adhere to the human epithelial cell lines HEp-2 and A549. When examined by electron microscopy, 16 (80%) of the 20 clinical isolates demonstrated the presence of piluslike structures; the composition of the bacterial populations ranged from 0 to 68% piliated cells. In contrast, only 3 (30%) of the 10 environmental isolates were piliated, with a range from 0 to 16% piliated cells. A significant association between the presence of piliated cells and the isolate source was found (P less than 0.05). None of the 30 strains agglutinated erythrocytes or yeast cells. V. vulnificus adherence results obtained with HEp-2 cells showed 10 (50%) of 20 clinical isolates and 0 (0%) of 10 environmental isolates with averages of greater than 10 adherent bacteria per cell, demonstrating a correlation between attachment and the isolate source (P less than 0.05). Selected strains were tested to determine whether methyl alpha-D-mannopyranoside, fructose, or alpha-L-(-)-fucose would inhibit bacterial adherence to HEp-2 cells. Multiple patterns of adherence inhibition were observed. Adherence to A549 cells showed 8 (40%) of 20 clinical isolates and 0 (0%) of 10 environmental strains with averages of greater than 10 adherent bacteria per cell. A statistical association between attachment and the isolate source was demonstrated (P less than 0.05). These data suggest that the presence of piluslike structures and the ability to adhere to human epithelial cell lines may be more closely associated with V. vulnificus isolates from clinical specimens than with environmental strains. Images PMID:2568368

  18. Self-imaging of transparent objects and structures in focusing of spatially phase-modulated laser radiation into a weakly absorbing medium

    SciTech Connect

    Bubis, E L

    2011-06-30

    Self-imaging of transparent objects and structures in focusing of a spatially phase-modulated laser beam into an extended weakly absorbing medium is described. The laser power level that is necessary for effective imaging corresponds to the illuminating beam power when thermal self-defocusing starts evolving in the medium. The effect can be described in terms of the ideology of Zernike's classical phase-contrast method. Edge enhancement in visualised images of transparent objects is experimentally demonstrated. Self-imaging of a microscopic object in the form of transparent letters and long-lived refractive-index fluctuations in liquid glycerol is shown. Due to the adaptivity of the process under consideration, unlike the classical case, self-imaging occurs also in the situations where a beam is displaced (undergoes random walk) as a whole in the Fourier plane, for example, in the presence of thermal flows. (image processing)

  19. Reduced-Order Modeling and Wavelet Analysis of Turbofan Engine Structural Response Due to Foreign Object Damage "FOD" Events

    NASA Technical Reports Server (NTRS)

    Turso, James A.; Lawrence, Charles; Litt, Jonathan S.

    2007-01-01

    The development of a wavelet-based feature extraction technique specifically targeting FOD-event induced vibration signal changes in gas turbine engines is described. The technique performs wavelet analysis of accelerometer signals from specified locations on the engine and is shown to be robust in the presence of significant process and sensor noise. It is envisioned that the technique will be combined with Kalman filter thermal/ health parameter estimation for FOD-event detection via information fusion from these (and perhaps other) sources. Due to the lack of high-frequency FOD-event test data in the open literature, a reduced-order turbofan structural model (ROM) was synthesized from a finite-element model modal analysis to support the investigation. In addition to providing test data for algorithm development, the ROM is used to determine the optimal sensor location for FOD-event detection. In the presence of significant noise, precise location of the FOD event in time was obtained using the developed wavelet-based feature.

  20. Reduced-Order Modeling and Wavelet Analysis of Turbofan Engine Structural Response Due to Foreign Object Damage (FOD) Events

    NASA Technical Reports Server (NTRS)

    Turso, James; Lawrence, Charles; Litt, Jonathan

    2004-01-01

    The development of a wavelet-based feature extraction technique specifically targeting FOD-event induced vibration signal changes in gas turbine engines is described. The technique performs wavelet analysis of accelerometer signals from specified locations on the engine and is shown to be robust in the presence of significant process and sensor noise. It is envisioned that the technique will be combined with Kalman filter thermal/health parameter estimation for FOD-event detection via information fusion from these (and perhaps other) sources. Due to the lack of high-frequency FOD-event test data in the open literature, a reduced-order turbofan structural model (ROM) was synthesized from a finite element model modal analysis to support the investigation. In addition to providing test data for algorithm development, the ROM is used to determine the optimal sensor location for FOD-event detection. In the presence of significant noise, precise location of the FOD event in time was obtained using the developed wavelet-based feature.

  1. The Structured Clinical Interview for DSM-5 Internet Gaming Disorder: Development and Validation for Diagnosing IGD in Adolescents

    PubMed Central

    Koo, Hoon Jung; Han, Doug Hyun; Park, Sung-Yong

    2017-01-01

    Objective This study aimed to develop and validate a Structured Clinical Interview for Internet Gaming Disorder (SCI-IGD) in adolescents. Methods First, we generated preliminary items of the SCI-IGD based on the information from the DSM-5 literature reviews and expert consultations. Next, a total of 236 adolescents, from both community and clinical settings, were recruited to evaluate the psychometric properties of the SCI-IGD. Results First, the SCI-IGD was found to be consistent over the time period of about one month. Second, diagnostic concordances between the SCI-IGD and clinician's diagnostic impression were good to excellent. The Likelihood Ratio Positive and the Likelihood Ratio Negative estimates for the diagnosis of SCI-IGD were 10.93 and 0.35, respectively, indicating that SCI-IGD was ‘very useful test’ for identifying the presence of IGD and ‘useful test’ for identifying the absence of IGD. Third, SCI-IGD could identify disordered gamers from non-disordered gamers. Conclusion The implications and limitations of the study are also discussed. PMID:28096871

  2. Trusted Objects

    SciTech Connect

    CAMPBELL,PHILIP L.; PIERSON,LYNDON G.; WITZKE,EDWARD L.

    1999-10-27

    In the world of computers a trusted object is a collection of possibly-sensitive data and programs that can be allowed to reside and execute on a computer, even on an adversary's machine. Beyond the scope of one computer we believe that network-based agents in high-consequence and highly reliable applications will depend on this approach, and that the basis for such objects is what we call ''faithful execution.''

  3. Proposal for a modified grading system based on mitotic index and Bcl2 provides objective determination of clinical outcome for patients with breast cancer.

    PubMed

    Abdel-Fatah, Tarek M A; Powe, Desmond G; Ball, Graham; Lopez-Garcia, Maria A; Habashy, Hany O; Green, Andrew R; Reis-Filho, Jorge S; Ellis, Ian O

    2010-12-01

    We hypothesized that the interaction between mitotic index (M) and Bcl2 could accurately discriminate between low- and high-grade breast cancer (BC) and provide a more objective measure of clinical outcome than histological grade, especially for patients with intermediate histological grade (G2), small size or oestrogen receptor (ER)-negative cancers. A well-characterized series of 1650 BCs with long-term follow-up was subjected to immunohistochemical analysis for Bcl2. Mitotic index (M) was assessed according to Nottingham Grading System (NGS) guidelines: M1: < 10 mitoses; M2: 10-18 mitoses; M3: > 18 mitoses. Results were validated in an independent series of patients (n = 245) uniformly treated with adjuvant anthracycline-based chemotherapy. Subsequently, BCs were classified according to the combined M/Bcl2 profile and compared with NGS. Multivariate Cox regression models using validated prognostic factors demonstrated that the subgroups defined by M/Bcl2 profile remained significantly associated with patients' outcome but also performed better than lymph node status and tumour size. Incorporation of the M/Bcl2 profile into the Nottingham Prognostic Index (NPI) reclassified twice as many patients into the excellent prognosis group, potentially improving decision-making and sparing patients unneeded systemic adjuvant therapy. Patients with M2-3/Bcl2- and M3/Bcl2+ (high risk) had a two- to three-fold increased risk of recurrence when treated with either adjuvant hormone therapy or anthracycline-based chemotherapy compared with those with M1/Bcl2 ± and M2/Bcl2+ (low risk) [HR = 3.4 (2.8-5.6); p < 0.0001 and HR = 2.3 (1.2-4.3); p = 0.0009]. In conclusion, a grading system defined by mitotic counting and Bcl2 expression accurately reclassified patients with NGS-G2, small tumour size or ER-negative cancers into two groups: low risk (NGS-G1-like) versus high risk (NGS-G3-like) of BC mortality and recurrence, improving prognosis and therapeutic planning.

  4. Examining the latent structure of worry and generalized anxiety in a clinical sample.

    PubMed

    Kertz, Sarah J; McHugh, R Kathryn; Lee, Josephine; Björgvinsson, Thröstur

    2014-01-01

    Generalized anxiety disorder (GAD) is characterized by "pathological" worry, suggesting that GAD worriers differ qualitatively from non-GAD worriers. However, results from taxometric studies of worry in undergraduate and community samples have been mixed and to date, no studies have utilized clinical samples. The current study examined the latent structure of worry and GAD symptoms in a diagnostically heterogeneous clinical sample. Indicators were selected from the Penn State Worry Questionnaire-Abbreviated (n=1175) and the GAD-7 (n=638) and submitted to three taxometric procedures: MAXCOV, MAMBAC, and L-Mode. Results from all three procedures suggested that both worry and generalized anxiety are best conceptualized as dimensional constructs. Findings also indicated that ongoing conceptualization, assessment, and treatment of worry and GAD may be hampered by the application of a categorical framework.

  5. Structural and biomechanical aspects of equine sacroiliac joint function and their relationship to clinical disease.

    PubMed

    Goff, L M; Jeffcott, L B; Jasiewicz, J; McGowan, C M

    2008-06-01

    Pain originating from the sacroiliac joint (SIJ) in horses has long been associated with poor performance, yet specific diagnosis of sacroiliac dysfunction (SID) has been difficult to achieve. Clinical presentation of SID appears to fall into two categories. The first, presenting as pain and poor performance, is responsive to local analgesia of periarticular structures with poorly defined pathology. The second presents primarily as poor performance with bony pathological changes as a result of chronic instability. Diagnostic tests based on biomechanics as well as manual provocation for SIJ pain have formed the basis of tests currently used to diagnose SIJ dysfunction in humans. This review summarises the anatomy and biomechanics of the equine SIJ and current biomechanical, innervation and motor control concepts in human SID. The relationship between abnormal SIJ motion and altered neuromotor control with clinical disease of the equine SIJ are discussed. Future utilisation of these principles to develop new diagnostic and management tools for the equine SID is promising.

  6. The Structured Clinical Interview for Complicated Grief: Reliability, Validity, and Exploratory Factor Analysis

    PubMed Central

    Bui, Eric; Mauro, Christine; Robinaugh, Donald J.; Skritskaya, Natalia A.; Wang, Yuanjia; Gribbin, Colleen; Ghesquiere, Angela; Horenstein, Arielle; Duan, Naihua; Reynolds, Charles; Zisook, Sidney; Simon, Naomi M.; Shear, M. Katherine

    2015-01-01

    Background Complicated grief (CG) has been recently included in the DSM-5, under the term “Persistent Complex Bereavement Disorder”, as a condition requiring further study. To our knowledge, no psychometric data on any structured clinical interview of CG is available to date. In this manuscript, we introduce the Structured Clinical Interview for CG (SCI-CG) a 31-item “SCID-like” clinician-administered instrument to assess the presence of CG symptoms. Methods Participants were 281 treatment-seeking adults with CG (77.9% (n=219) women, mean age = 52.4, SD = 17.8) who were assessed with the SCI-CG and measures of depression, posttraumatic stress, anxiety, functional impairment. Results The SCI-CG exhibited satisfactory internal consistency (α = .78), good test-retest reliability (Inter-class correlation [ICC] 0.68, 95% CI [0.60, 0.75]), and excellent inter-rater reliability (ICC=0.95, 95% CI [0.89, 0.98]). Exploratory factor analyses revealed that a five-factor structure, explaining 50.3% of the total variance, was the best fit for the data. Conclusions The clinician-rated SCI-CG demonstrates good internal consistency, reliability, and convergent validity in treatment-seeking individuals with CG and therefore can be a useful tool to assess CG. Although diagnostic criteria for CG have yet to be adequately validated, the SCI-CG may facilitate this process. The SCI-CG can now be used as a validated instrument in research and clinical practice. PMID:26061724

  7. Early object relations into new objects.

    PubMed

    Downey, T W

    2001-01-01

    Two strands of change are suggested by this review, one maturational, the other therapeutic or developmental (Hartmann and Kris, 1945). By "maturational" I mean to suggest energies that infuse the individual from earliest life in a manner that includes object relations, but for the healthy exercise of which object relations per se need not be of central and crucial importance. Within wide limits such energies may be delayed until growth conditions prevail without significant distortion of certain of the organism's ego functions. Therapeutic change is analogous to developmental change in that both involve the crucial presence of another to release energies. In therapeutic change these are energies that have been repressed beyond the reach of developmental dynamics. In everyday development crisis and synthesis alternate in conjunction with new and emerging objects to add to the psychological structures brought to the fore by maturation. In many instances, as we see with John, over time and in a less focussed manner, developmental changes can approximate therapeutic change and visa versa. Freud-Dann in their "experiment" pursued one line, in which the equipmental delay brought on by extremely adverse living circumstances was redressed by providing an interpersonally enriching, loving, developmentally facilitating milieu. The sketches of individual children and John's subsequent story provide a perspective into what becomes the stuff of growth and what remains the stuff of neurosis. The developmental reserves and ego resilience of these children were impressive but probably not extraordinary. Usual growth ensued as soon as they were provided with the rich soil of Bulldogs Bank instead of the desert sand of the Tereszin concentration camp. However, no one can escape such adverse circumstances without having taken in the stuff of neurosis. Affects and percepts that were not assimilatable or even available to consciousness at the time remain buried in the unconscious

  8. Factor Structure and Clinical Utility of the Beck Depression Inventory in Patients with Binge Eating Disorder and Obesity

    PubMed Central

    Udo, Tomoko; McKee, Sherry A.; Grilo, Carlos M.

    2015-01-01

    Objective The Beck Depression Inventory (BDI) is often used to assess depression symptoms, but its factor structure and clinical utility have not been evaluated in patients with binge eating disorder (BED) and obesity. Methods 882 treatment-seeking obese patients with BED were administered structured interviews (SCID-I/P) and completed self-report questionnaires. Results Exploratory and confirmatory factor analyses supported a brief 16-item BDI version with a three-factor structure (affective, attitudinal, and somatic). Both 21- and 16-item versions showed excellent internal consistency (both α=0.89) and had significant correlation patterns with different aspects of eating disorder psychopathology; three factors showed significant but variable associations with eating disorder psychopathology. Area under the curves (AUC) for both BDI versions were significant in predicting major depressive disorder (MDD; AUC=0.773 [16-item], 73.5% sensitivity/70.2% specificity, AUC=0.769 [21-item], 79.5% sensitivity/64.1% specificity) and mood disorders (AUC=0.763 [16-item], 67.1% sensitivity/71.5% specificity, AUC=0.769 [21-item], 84.2% sensitivity/55.7% specificity). 21-item BDI (cut-off score ≥16) showed higher negative predictive values (94.0% vs. 93.0% [MDD]; 92.4% vs. 88.3% [mood disorders]) than brief 16-item BDI (cut-off score ≥13). Conclusions Both BDI versions demonstrated moderate performance as a screening instrument for MDD/mood disorders in obese patients with BED. Advantages and disadvantages for both versions are discussed. A three-factor structure has potential to inform the conceptualization of depression features. PMID:25537344

  9. Cognitive impairment and structural brain changes in patients with clinically isolated syndrome at high risk for multiple sclerosis.

    PubMed

    Hynčicová, Eva; Vyhnálek, Martin; Kalina, Adam; Martinkovič, Lukáš; Nikolai, Tomáš; Lisý, Jiří; Hort, Jakub; Meluzínová, Eva; Laczó, Jan

    2017-03-01

    Patients with clinically isolated syndrome (CIS), unlike those with multiple sclerosis (MS), have a selective cognitive impairment which is not consistently related to structural brain changes. Our objective was to characterize a profile of cognitive impairment and its association with structural brain changes in patients with CIS who are at high risk of developing MS. Patients with CIS at high risk for MS on interferon-beta (n = 51) and age-, gender-, and education-matched controls (n = 44) underwent comprehensive neuropsychological testing and MRI brain scan with voxel-based morphometry. The CIS group had lower cognitive performance in verbal and nonverbal memory, information processing speed/attention/working memory, and executive and visuo-spatial functions compared to controls (p ≤ 0.040). Lower cognitive performance was present in 18-37 and 14-26% of patients with CIS at high risk for MS depending on the criteria used. Brain volume was reduced predominantly in fronto-temporal regions and the thalamus in the CIS group (p ≤ 0.019). Cognitive performance was not associated with structural brain changes except for the association between worse visuo-spatial performance and lower white matter volume in the CIS group (β = 0.29; p = 0.042). Our results indicated that patients with CIS at high risk for MS may have a pattern of lower cognitive performance and regional brain atrophy similar to that found in patients with MS. Lower cognitive performance may be present in up to one-third of patients with CIS at high risk for MS, but, unlike patients with MS, variability in their cognitive performance may lead to a lack of consistent associations with structural brain changes.

  10. Population genetic structure of clinical and environmental isolates of Blastomyces dermatitidis, Based on 27 Polymorphic Microsatellite Markers

    USGS Publications Warehouse

    Meece, J.K.; Anderson, J.L.; Fisher, M.C.; Henk, D.A.; Sloss, Brian L.; Reed, K.D.

    2011-01-01

    Blastomyces dermatitidis, a thermally dimorphic fungus, is the etiologic agent of North American blastomycosis. Clinical presentation is varied, ranging from silent infections to fulminant respiratory disease and dissemination to skin and other sites. Exploration of the population genetic structure of B. dermatitidis would improve our knowledge regarding variation in virulence phenotypes, geographic distribution, and difference in host specificity. The objective of this study was to develop and test a panel of microsatellite markers to delineate the population genetic structure within a group of clinical and environmental isolates of B. dermatitidis. We developed 27 microsatellite markers and genotyped B. dermatitidis isolates from various hosts and environmental sources (n = 112). Assembly of a neighbor-joining tree of allele-sharing distance revealed two genetically distinct groups, separated by a deep node. Bayesian admixture analysis showed that two populations were statistically supported. Principal coordinate analysis also reinforced support for two genetic groups, with the primary axis explaining 61.41% of the genetic variability. Group 1 isolates average 1.8 alleles/locus, whereas group 2 isolates are highly polymorphic, averaging 8.2 alleles/locus. In this data set, alleles at three loci are unshared between the two groups and appear diagnostic. The mating type of individual isolates was determined by PCR. Both mating type-specific genes, the HMG and ??-box domains, were represented in each of the genetic groups, with slightly more isolates having the HMG allele. One interpretation of this study is that the species currently designated B. dermatitidis includes a cryptic subspecies or perhaps a separate species. ?? 2011, American Society for Microbiology.

  11. Population genetic structure of clinical and environmental isolates of Blastomyces dermatitidis based on 27 polymorphic microsatellite markers

    USGS Publications Warehouse

    Meece, Jennifer K.; Anderson, Jennifer L.; Fisher, Matthew C.; Henk, Daniel A.; Sloss, Brian L.; Reed, Kurt D.

    2011-01-01

    Blastomyces dermatitidis, a thermally dimorphic fungus, is the etiologic agent of North American blastomycosis. Clinical presentation is varied, ranging from silent infections to fulminant respiratory disease and dissemination to skin and other sites. Exploration of the population genetic structure of B. dermatitidis would improve our knowledge regarding variation in virulence phenotypes, geographic distribution, and difference in host specificity. The objective of this study was to develop and test a panel of microsatellite markers to delineate the population genetic structure within a group of clinical and environmental isolates of B. dermatitidis. We developed 27 microsatellite markers and genotyped B. dermatitidis isolates from various hosts and environmental sources (n=112). Assembly of a neighbor-joining tree of allele-sharing distance revealed two genetically distinct groups, separated by a deep node. Bayesian admixture analysis showed that two populations were statistically supported. Principal coordinate analysis also reinforced support for two genetic groups, with the primary axis explaining 61.41% of the genetic variability. Group 1 isolates average 1.8 alleles/locus, whereas group 2 isolates are highly polymorphic, averaging 8.2 alleles/locus. In this data set, alleles at three loci are unshared between the two groups and appear diagnostic. The mating type of individual isolates was determined by PCR. Both mating type-specific genes, the HMG and α-box domains, were represented in each of the genetic groups, with slightly more isolates having the HMG allele. One interpretation of this study is that the species currently designated B. dermatitidis includes a cryptic subspecies or perhaps a separate species.

  12. Cost Structure and Clinical Outcome of a Stem Cell Transplantation Program in a Developing Country: The Experience in Northeast Mexico

    PubMed Central

    Heredia-Salazar, Alberto Carlos; Cantú-Rodríguez, Olga G.; Gutiérrez-Aguirre, Homero; Villarreal-Villarreal, César Daniel; Mancías-Guerra, Consuelo; Herrera-Garza, José Luís; Gómez-Almaguer, David

    2015-01-01

    Background and Objective. Hematopoietic stem cell transplantation (HSCT) in developing countries is cost-limited. Our primary goal was to determine the cost structure for the HSCT program model developed over the last decade at our public university hospital and to assess its clinical outcomes. Materials and Methods. Adults and children receiving an allogeneic hematopoietic stem cell transplant from January 2010 to February 2011 at our hematology regional reference center were included. Laboratory tests, medical procedures, chemotherapy drugs, other drugs, and hospitalization costs were scrutinized to calculate the total cost for each patient and the median cost for the procedure. Data regarding clinical evolution were incorporated into the analysis. Physician fees are not charged at the institution and therefore were not included. Results. Fifty patients were evaluated over a 1-year period. The total estimated cost for an allogeneic HSCT was $12,504. The two most expensive diseases to allograft were non-Hodgkin lymphoma ($11,760 ± $2,236) for the malignant group and thalassemia ($12,915 ± $5,170) for the nonmalignant group. Acute lymphoblastic leukemia ($11,053 ± 2,817) and acute myeloblastic leukemia ($10,251 ± $1,538) were the most frequent indications for HSCT, with 11 cases each. Median out-of-pocket expenses were $1,605, and 1-year follow-up costs amounted to $1,640, adding up to a total cost of $15,749 for the first year. The most expensive components were drugs and laboratory tests. Conclusion. Applying the cost structure described, HSCT is an affordable option for hematological patients living in a developing country. PMID:25746343

  13. Characterization of the horizontal structure of the tropical forest canopy using object-based LiDAR and multispectral image analysis

    NASA Astrophysics Data System (ADS)

    Dupuy, Stéphane; Lainé, Gérard; Tassin, Jacques; Sarrailh, Jean-Michel

    2013-12-01

    This article's goal is to explore the benefits of using Digital Surface Model (DSM) and Digital Terrain Model (DTM) derived from LiDAR acquisitions for characterizing the horizontal structure of different facies in forested areas (primary forests vs. secondary forests) within the framework of an object-oriented classification. The area under study is the island of Mayotte in the western Indian Ocean. The LiDAR data were the data originally acquired by an airborne small-footprint discrete-return LiDAR for the "Litto3D" coastline mapping project. They were used to create a Digital Elevation Model (DEM) at a spatial resolution of 1 m and a Digital Canopy Model (DCM) using median filtering. The use of two successive segmentations at different scales allowed us to adjust the segmentation parameters to the local structure of the landscape and of the cover. Working in object-oriented mode with LiDAR allowed us to discriminate six vegetation classes based on canopy height and horizontal heterogeneity. This heterogeneity was assessed using a texture index calculated from the height-transition co-occurrence matrix. Overall accuracy exceeds 90%. The resulting product is the first vegetation map of Mayotte which emphasizes the structure over the composition.

  14. Trial Design and Objectives for Castration-Resistant Prostate Cancer: Updated Recommendations From the Prostate Cancer Clinical Trials Working Group 3

    PubMed Central

    Morris, Michael J.; Stadler, Walter M.; Higano, Celestia; Basch, Ethan; Fizazi, Karim; Antonarakis, Emmanuel S.; Beer, Tomasz M.; Carducci, Michael A.; Chi, Kim N.; Corn, Paul G.; de Bono, Johann S.; Dreicer, Robert; George, Daniel J.; Heath, Elisabeth I.; Hussain, Maha; Kelly, Wm. Kevin; Liu, Glenn; Logothetis, Christopher; Nanus, David; Stein, Mark N.; Rathkopf, Dana E.; Slovin, Susan F.; Ryan, Charles J.; Sartor, Oliver; Small, Eric J.; Smith, Matthew Raymond; Sternberg, Cora N.; Taplin, Mary-Ellen; Wilding, George; Nelson, Peter S.; Schwartz, Lawrence H.; Halabi, Susan; Kantoff, Philip W.; Armstrong, Andrew J.

    2016-01-01

    Purpose Evolving treatments, disease phenotypes, and biology, together with a changing drug development environment, have created the need to revise castration-resistant prostate cancer (CRPC) clinical trial recommendations to succeed those from prior Prostate Cancer Clinical Trials Working Groups. Methods An international expert committee of prostate cancer clinical investigators (the Prostate Cancer Clinical Trials Working Group 3 [PCWG3]) was reconvened and expanded and met in 2012-2015 to formulate updated criteria on the basis of emerging trial data and validation studies of the Prostate Cancer Clinical Trials Working Group 2 recommendations. Results PCWG3 recommends that baseline patient assessment include tumor histology, detailed records of prior systemic treatments and responses, and a detailed reporting of disease subtypes based on an anatomic pattern of metastatic spread. New recommendations for trial outcome measures include the time to event end point of symptomatic skeletal events, as well as time to first metastasis and time to progression for trials in the nonmetastatic CRPC state. PCWG3 introduces the concept of no longer clinically benefiting to underscore the distinction between first evidence of progression and the clinical need to terminate or change treatment, and the importance of documenting progression in existing lesions as distinct from the development of new lesions. Serial biologic profiling using tumor samples from biopsies, blood-based diagnostics, and/or imaging is also recommended to gain insight into mechanisms of resistance and to identify predictive biomarkers of sensitivity for use in prospective trials. Conclusion PCWG3 moves drug development closer to unmet needs in clinical practice by focusing on disease manifestations most likely to affect prognosis adversely for therapeutics tested in both nonmetastatic and metastatic CRPC populations. Consultation with regulatory authorities is recommended if a trial is intended to seek

  15. Brain structures associated with executive functions during everyday events in a non-clinical sample.

    PubMed

    Takeuchi, Hikaru; Taki, Yasuyuki; Sassa, Yuko; Hashizume, Hiroshi; Sekiguchi, Atsushi; Fukushima, Ai; Kawashima, Ryuta

    2013-07-01

    Executive functions involve control processes such as goal-oriented planning, flexible strategy generation, sustaining set maintenance, self-monitoring, and inhibition. Executive functions during everyday events (EFEEs) are distinct from those measured under laboratory settings; the former can be severely impaired while the latter remain intact. Non-routine everyday problems due to executive dysfunctions affect individual functioning in everyday life and are of great clinical interest. Despite the importance of anatomical bases underlying better EFEEs, such bases have never been investigated among non-clinical samples. Using voxel-based morphometry to measure regional gray matter volume (rGMV) and regional white matter volume (rWMV) and diffusion tensor imaging to determine fractional anisotropy values, we identified the anatomical correlates of better EFEEs using the Dysexecutive Questionnaire in 303 normal young subjects (168 men and 135 women). Better EFEEs were associated with a smaller rGMV in the orbitofrontal cortex (OFC) spread across Brodmann areas (BA) 25, 11, and 12 and larger rWMV in the WM area of OFC adjacent to BA 11. Furthermore, individual EFEEs were positively associated with rWMV in the temporal areas, primarily the inferior longitudinal fasciculus and inferior fronto-occipital fasciculus, the latter of which connects OFC and posterior regions. Thus, our findings suggest that brain structures involving OFC, together with other regions, contribute to the maintenance of effective EFEEs among non-clinical subjects.

  16. Structure-function relationships and clinical applications of L-asparaginases.

    PubMed

    Labrou, N E; Papageorgiou, A C; Avramis, V I

    2010-01-01

    L-asparaginase (L-ASNase, EC 3.5.1.1) catalyzes the hydrolysis of the non-essential amino acid L-Asn to LAsp and ammonia and is widely used for the treatment of haematopoetic diseases such as acute lymphoblastic leukaemia (ALL) and lymphomas. Therapeutic forms of L-ASNase come from different biological sources (primarily E. coli and Erwinia chrysanthemi). It is well established that the various preparations have different biochemical pharmacology properties, and different tendency to induce side-effects. This is due to different structural, physicochemical and kinetic properties of L-ASNases from the various biological sources. Understanding these properties of various L-ASNases would allow a better decipherment of their catalytic and therapeutic features, thus enabling more accurate predictions of the behaviour of these enzymes under a variety of therapeutic conditions. In addition, detailed understanding of the catalytic mechanism of L-ASNases might permit the design of new forms of L-ASNases with optimal biochemical properties for clinical applications. In this paper we review the available biochemical and pharmacokinetic information of the therapeutic forms of bacterial L-ASNases, and focus on a detailed description of structure, function and clinical applications of these enzymes.

  17. Initial clinical experience using the EchoNavigator®-system during structural heart disease interventions

    PubMed Central

    Balzer, Jan; Zeus, Tobias; Hellhammer, Katharina; Veulemans, Verena; Eschenhagen, Silke; Kehmeier, Eva; Meyer, Christian; Rassaf, Tienush; Kelm, Malte

    2015-01-01

    AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions. METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and MitraClip® procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the EchoNavigator®-system. RESULTS: The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical structures. CONCLUSION: The EchoNavigator®-system is a feasible and safe tool for guidance of interventional procedures in structural heart disease. This innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety, accuracy, and efficacy of percutaneous interventions in the catheter laboratory. PMID:26413233

  18. New Structural Templates for Clinically Validated and Novel Targets in Antimicrobial Drug Research and Development.

    PubMed

    Klahn, Philipp; Brönstrup, Mark

    2016-01-01

    The development of bacterial resistance against current antibiotic drugs necessitates a continuous renewal of the arsenal of efficacious drugs. This imperative has not been met by the output of antibiotic research and development of the past decades for various reasons, including the declining efforts of large pharma companies in this area. Moreover, the majority of novel antibiotics are chemical derivatives of existing structures that represent mostly step innovations, implying that the available chemical space may be exhausted. This review negates this impression by showcasing recent achievements in lead finding and optimization of antibiotics that have novel or unexplored chemical structures. Not surprisingly, many of the novel structural templates like teixobactins, lysocin, griselimycin, or the albicidin/cystobactamid pair were discovered from natural sources. Additional compounds were obtained from the screening of synthetic libraries and chemical synthesis, including the gyrase-inhibiting NTBI's and spiropyrimidinetrione, the tarocin and targocil inhibitors of wall teichoic acid synthesis, or the boronates and diazabicyclo[3.2.1]octane as novel β-lactamase inhibitors. A motif that is common to most clinically validated antibiotics is that they address hotspots in complex biosynthetic machineries, whose functioning is essential for the bacterial cell. Therefore, an introduction to the biological targets-cell wall synthesis, topoisomerases, the DNA sliding clamp, and membrane-bound electron transport-is given for each of the leads presented here.

  19. Effects of the SpeechEasy on Objective and Perceived Aspects of Stuttering: A 6-Month, Phase I Clinical Trial in Naturalistic Environments

    ERIC Educational Resources Information Center

    Pollard, Ryan; Ellis, John B.; Finan, Don; Ramig, Peter R.

    2009-01-01

    Purpose: Effects of the SpeechEasy when used under extraclinical conditions over several months were investigated. Primary purposes were to help establish Phase I level information about the therapeutic utility of the SpeechEasy and to compare those results with previous findings obtained in laboratory and clinical settings. Method: Eleven adults…

  20. A structural equation model relating objective and subjective masticatory function and oral health-related quality of life in patients with removable partial dentures.

    PubMed

    Fueki, K; Yoshida, E; Igarashi, Y

    2011-02-01

    The aim of this study was to investigate the relationships between objective masticatory function with respect to masticatory performance and food mixing ability, patients' perception of chewing ability and oral health-related quality of life (OHRQoL). Partially dentate patients with removable partial dentures (n = 131, mean age 67·1 year) participated in the study. Four tests were performed to evaluate objective and subjective masticatory function and OHRQoL. Masticatory performance and food mixing ability were assessed using peanuts or a two-coloured wax cube as test items. Patients' perception of chewing ability was rated using a food intake questionnaire. OHRQoL was measured using the Japanese version of the oral health impact profile. A structural equation model was constructed based on hypothesis in which objective masticatory function would be related to OHRQoL via perceived chewing ability as a mediator. Structural equation modelling analysis found a statistically significant medium effect of perceived chewing ability on OHRQoL and statistically significant medium or small effects of masticatory performance on perceived chewing ability and OHRQoL (P < 0·05); however, the effect of food mixing ability on perceived chewing ability or OHRQoL was not statistically significant (P > 0·05). A fit index indicated that the model fitted well to the data (Goodness-of-fit index = 0·99). These results suggest that perceived chewing ability is a critical factor for OHRQoL and that masticatory performance rather than food mixing ability is important for perceived chewing ability and OHRQoL in patients with removable partial dentures.

  1. Quantum origins of objectivity

    NASA Astrophysics Data System (ADS)

    Horodecki, R.; Korbicz, J. K.; Horodecki, P.

    2015-03-01

    In spite of all of its successes, quantum mechanics leaves us with a central problem: How does nature create a bridge from fragile quanta to the objective world of everyday experience? Here we find that a basic structure within quantum mechanics that leads to the perceived objectivity is a so-called spectrum broadcast structure. We uncover this based on minimal assumptions, without referring to any dynamical details or a concrete model. More specifically, working formally within the decoherence theory setting with multiple environments (called quantum Darwinism), we show how a crucial for quantum mechanics notion of nondisturbance due to Bohr [N. Bohr, Phys. Rev. 48, 696 (1935), 10.1103/PhysRev.48.696] and a natural definition of objectivity lead to a canonical structure of a quantum system-environment state, reflecting objective information records about the system stored in the environment.

  2. Relationship Between Foveal Cone Structure and Clinical Measures of Visual Function in Patients With Inherited Retinal Degenerations

    PubMed Central

    Ratnam, Kavitha; Carroll, Joseph; Porco, Travis C.; Duncan, Jacque L.; Roorda, Austin

    2013-01-01

    Purpose. To study the relationship between cone spacing and density and clinical measures of visual function near the fovea. Methods. High-resolution images of the photoreceptor mosaic were obtained with adaptive optics scanning laser ophthalmoscopy from 26 patients with inherited retinal degenerations. Cone spacing measures were made close to or at the foveal center (mean [SD] eccentricity, 0.02 [0.03] degree; maximum eccentricity, 0.13 degree) and were converted to Z-scores, fraction of cones, and percentage-of-cones-below-average compared with normal values for each location (based on 37 age-similar visually normal eyes). Z-scores and percentage of cones below average were compared with best-corrected visual acuity (VA) and foveal sensitivity. Results. Visual acuity was significantly correlated with cone spacing (Spearman rank correlation ρ = −0.60, P = 0.003) and was preserved (≥80 letters), despite cone density measures that were 52% below normal. Foveal sensitivity showed significant correlation with cone spacing (ρ = −0.47, P = 0.017) and remained normal (≥35 decibels), despite density measures that were approximately 52% to 62% below normal. Conclusions. Cone density was reduced by up to 62% below normal at or near the fovea in eyes with VA and sensitivity that remained within normal limits. Despite a significant correlation with foveal cone spacing, VA and sensitivity are insensitive indicators of the integrity of the foveal cone mosaic. Direct, objective measures of cone structure may be more sensitive indicators of disease severity than VA or foveal sensitivity in eyes with inherited retinal degenerations. (ClinicalTrials.gov number, NCT00254605.) PMID:23908179

  3. Application of CYP3A4 in vitro data to predict clinical drug–drug interactions; predictions of compounds as objects of interaction

    PubMed Central

    Youdim, Kuresh A; Zayed, Aref; Dickins, Maurice; Phipps, Alex; Griffiths, Michelle; Darekar, Amanda; Hyland, Ruth; Fahmi, Odette; Hurst, Susan; Plowchalk, David R; Cook, Jack; Guo, Feng; Obach, R Scott

    2008-01-01

    AIMS The aim of this study was to explore and optimize the in vitro and in silico approaches used for predicting clinical DDIs. A data set containing clinical information on the interaction of 20 Pfizer compounds with ketoconazole was used to assess the success of the techniques. METHODS The study calculated the fraction and the rate of metabolism of 20 Pfizer compounds via each cytochrome P450. Two approaches were used to determine fraction metabolized (fm); 1) by measuring substrate loss in human liver microsomes (HLM) in the presence and absence of specific chemical inhibitors and 2) by measuring substrate loss in individual cDNA expressed P450s (also referred to as recombinant P450s (rhCYP)) The fractions metabolized via each CYP were used to predict the drug–drug interaction due to CYP3A4 inhibition by ketoconazole using the modelling and simulation software SIMCYP®. RESULTS When in vitro data were generated using Gentest supersomes, 85% of predictions were within two-fold of the observed clinical interaction. Using PanVera baculosomes, 70% of predictions were predicted within two-fold. In contrast using chemical inhibitors the accuracy was lower, predicting only 37% of compounds within two-fold of the clinical value. Poorly predicted compounds were found to either be metabolically stable and/or have high microsomal protein binding. The use of equilibrium dialysis to generate accurate protein binding measurements was especially important for highly bound drugs. CONCLUSIONS The current study demonstrated that the use of rhCYPs with SIMCYP® provides a robust in vitro system for predicting the likelihood and magnitude of changes in clinical exposure of compounds as a consequence of CYP3A4 inhibition by a concomitantly administered drug. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Numerous retrospective analyses have shown the utility of in vitro systems for predicting potential drug–drug interactions (DDIs). Prediction of DDIs from in vitro data is commonly

  4. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description.

    PubMed

    Spitzer, R L; Williams, J B; Gibbon, M; First, M B

    1992-08-01

    The history, rationale, and development of the Structured Clinical Interview for DSM-III-R (SCID) is described. The SCID is a semistructured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can be adapted for use in studies in which particular diagnoses are not of interest. Using a decision tree approach, the SCID guides the clinician in testing diagnostic hypotheses as the interview is conducted. The output of the SCID is a record of the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence.

  5. The Structure and Clinical Roles of MicroRNA in Colorectal Cancer

    PubMed Central

    2016-01-01

    Colorectal cancer (CRC) is one of the most prevalent types of malignancies, particularly among individuals aged between 50 and 75. The global incidence of CRC has been steadily on the rise due in no small part to an aging population and a shift in lifestyle as well as eating habits. MicroRNAs are a group of small, noncoding, and endogenous RNA molecules that have recently emerged as key players in a broad range of pathological pathways. Moreover, dysregulation of microRNAs has been implicated in cancer development and metastasis. This review is intended to provide a brief overview of the structure, functions, and clinical roles of microRNAs. In particular, the review will focus on the discovery, the underlying mechanistic roles, and the diagnostic as well as therapeutic potentials of CRC-specific miRNAs. PMID:28115926

  6. Clinical, genetic, and structural basis of congenital adrenal hyperplasia due to 11β-hydroxylase deficiency.

    PubMed

    Khattab, Ahmed; Haider, Shozeb; Kumar, Ameet; Dhawan, Samarth; Alam, Dauood; Romero, Raquel; Burns, James; Li, Di; Estatico, Jessica; Rahi, Simran; Fatima, Saleel; Alzahrani, Ali; Hafez, Mona; Musa, Noha; Razzghy Azar, Maryam; Khaloul, Najoua; Gribaa, Moez; Saad, Ali; Charfeddine, Ilhem Ben; Bilharinho de Mendonça, Berenice; Belgorosky, Alicia; Dumic, Katja; Dumic, Miroslav; Aisenberg, Javier; Kandemir, Nurgun; Alikasifoglu, Ayfer; Ozon, Alev; Gonc, Nazli; Cheng, Tina; Kuhnle-Krahl, Ursula; Cappa, Marco; Holterhus, Paul-Martin; Nour, Munier A; Pacaud, Daniele; Holtzman, Assaf; Li, Sun; Zaidi, Mone; Yuen, Tony; New, Maria I

    2017-03-07

    Congenital adrenal hyperplasia (CAH), resulting from mutations in CYP11B1, a gene encoding 11β-hydroxylase, represents a rare autosomal recessive Mendelian disorder of aberrant sex steroid production. Unlike CAH caused by 21-hydroxylase deficiency, the disease is far more common in the Middle East and North Africa, where consanguinity is common often resulting in identical mutations. Clinically, affected female newborns are profoundly virilized (Prader score of 4/5), and both genders display significantly advanced bone ages and are oftentimes hypertensive. We find that 11-deoxycortisol, not frequently measured, is the most robust biochemical marker for diagnosing 11β-hydroxylase deficiency. Finally, computational modeling of 25 missense mutations of CYP11B1 revealed that specific modifications in the heme-binding (R374W and R448C) or substrate-binding (W116C) site of 11β-hydroxylase, or alterations in its stability (L299P and G267S), may predict severe disease. Thus, we report clinical, genetic, hormonal, and structural effects of CYP11B1 gene mutations in the largest international cohort of 108 patients with steroid 11β-hydroxylase deficiency CAH.

  7. Structure Based In Silico Analysis of Quinolone Resistance in Clinical Isolates of Salmonella Typhi from India

    PubMed Central

    Sharma, Priyanka; Sharma, Sujata; Singh, Tej P.; Kapil, Arti; Kaur, Punit

    2015-01-01

    Enteric fever is a major cause of morbidity in several parts of the Indian subcontinent. The treatment for typhoid fever majorly includes the fluoroquinolone group of antibiotics. Excessive and indiscriminate use of these antibiotics has led to development of acquired resistance in the causative organism Salmonella Typhi. The resistance towards fluoroquinolones is associated with mutations in the target gene of DNA Gyrase. We have estimated the Minimum Inhibitory Concentration (MIC) of commonly used fluoroquinolone representatives from three generations, ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin, for 100 clinical isolates of Salmonella Typhi from patients in the Indian subcontinent. The MICs have been found to be in the range of 0.032 to 8 μg/ml. The gene encoding DNA Gyrase was subsequently sequenced and point mutations were observed in DNA Gyrase in the quinolone resistance determining region comprising Ser83Phe/Tyr and Asp87Tyr/Gly. The binding ability of these four fluoroquinolones in the quinolone binding pocket of wild type as well as mutant DNA Gyrase was computationally analyzed by molecular docking to assess their differential binding behaviour. This study has revealed that mutations in DNA Gyrase alter the characteristics of the binding pocket resulting in the loss of crucial molecular interactions and consequently decrease the binding affinity of fluoroquinolones with the target protein. The present study assists in understanding the underlying molecular and structural mechanism for decreased fluoroquinolone susceptibility in clinical isolates as a consequence of mutations in DNA Gyrase. PMID:25962113

  8. Reexamination of the MASC factor structure and discriminant ability in a mixed clinical outpatient sample.

    PubMed

    Grills-Taquechel, Amie E; Ollendick, Thomas H; Fisak, Brian

    2008-01-01

    Anxiety problems in youth are common, suggesting the need for developmentally appropriate and psychometrically sound measures in this area. The Multidimensional Anxiety Scale for Children (MASC) was created with this goal in mind, but has yet to be examined with samples representative of youth typically seen in clinical settings. Two hundred and sixty-two outpatient youth with mixed clinical presentations completed the MASC, a measure that includes a total anxiety score, as well as subscale scores for social anxiety, harm avoidance, separation anxiety/panic, and physical symptoms of anxiety. Internal consistency, means, and factor structure were comparable to that reported previously. Model invariance was supported across gender, diagnosis, and age. The MASC total score significantly differentiated children who received anxiety disorder diagnoses from those who did not. The social anxiety subscale significantly predicted social phobia and the harm avoidance subscale significantly predicted generalized anxiety disorder. Further support was found for the MASC. However, caution should be exercised given mixed discriminant ability findings. That is, the MASC seems best suited as a screening instrument for anxiety and when used in conjunction with a multiple method/informant assessment approach.

  9. Valuing structured professional judgment: predictive validity, decision-making, and the clinical-actuarial conflict.

    PubMed

    Falzer, Paul R

    2013-01-01

    Structured professional judgment (SPJ) has received considerable attention as an alternative to unstructured clinical judgment and actuarial assessment, and as a means of resolving their ongoing conflict. However, predictive validity studies have typically relied on receiver operating characteristic (ROC) analysis, the same technique commonly used to validate actuarial assessment tools. This paper presents SPJ as distinct from both unstructured clinical judgment and actuarial assessment. A key distinguishing feature of SPJ is the contribution of modifiable factors, either dynamic or protective, to summary risk ratings. With modifiable factors, the summary rating scheme serves as a prognostic model rather than a classification procedure. However, prognostic models require more extensive and thorough predictive validity testing than can be provided by ROC analysis. It is proposed that validation should include calibration and reclassification techniques, as well as additional measures of discrimination. Several techniques and measures are described and illustrated. The paper concludes by tracing the limitations of ROC analysis to its philosophical foundation and its origin as a statistical theory of decision-making. This foundation inhibits the performance of crucial tasks, such as determining the sufficiency of a risk assessment and examining the evidentiary value of statistical findings. The paper closes by noting a current effort to establish a viable and complementary relationship between SPJ and decision-making theory.

  10. [Clinical research. XIII. Research design contribution in the structured revision of an article].

    PubMed

    Talavera, Juan O; Rivas-Ruiz, Rodolfo

    2013-01-01

    The quality of information obtained in accordance to research design is integrated to the revision structured in relation to the causality model, used in the article "Reduction in the Incidence of Nosocomial Pneumonia Poststroke by Using the 'Turn-mob' Program", which corresponds to a clinical trial design. Points to identify and analyze are ethical issues in order to safeguard the security and respect for patients, randomization that seek to create basal homogeneous groups, subjects with the same probability of receiving any of the maneuvers in comparison, with the same pre maneuver probability of adherence, and which facilitate the blinding of outcome measurement and the distribution between groups of subjects with the same probability of leaving the study for reasons beyond the maneuvers. Other aspects are the relativity of comparison, the blinding of the maneuver, the parallel application of comparative maneuver, early stopping, and analysis according to the degree of adherence. The analysis in accordance with the design is complementary, since it is done based on the architectural model of causality, and the statistical and clinical relevance consideration.

  11. Structure based in silico analysis of quinolone resistance in clinical isolates of Salmonella Typhi from India.

    PubMed

    Kumar, Manoj; Dahiya, Sushila; Sharma, Priyanka; Sharma, Sujata; Singh, Tej P; Kapil, Arti; Kaur, Punit

    2015-01-01

    Enteric fever is a major cause of morbidity in several parts of the Indian subcontinent. The treatment for typhoid fever majorly includes the fluoroquinolone group of antibiotics. Excessive and indiscriminate use of these antibiotics has led to development of acquired resistance in the causative organism Salmonella Typhi. The resistance towards fluoroquinolones is associated with mutations in the target gene of DNA Gyrase. We have estimated the Minimum Inhibitory Concentration (MIC) of commonly used fluoroquinolone representatives from three generations, ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin, for 100 clinical isolates of Salmonella Typhi from patients in the Indian subcontinent. The MICs have been found to be in the range of 0.032 to 8 μg/ml. The gene encoding DNA Gyrase was subsequently sequenced and point mutations were observed in DNA Gyrase in the quinolone resistance determining region comprising Ser83Phe/Tyr and Asp87Tyr/Gly. The binding ability of these four fluoroquinolones in the quinolone binding pocket of wild type as well as mutant DNA Gyrase was computationally analyzed by molecular docking to assess their differential binding behaviour. This study has revealed that mutations in DNA Gyrase alter the characteristics of the binding pocket resulting in the loss of crucial molecular interactions and consequently decrease the binding affinity of fluoroquinolones with the target protein. The present study assists in understanding the underlying molecular and structural mechanism for decreased fluoroquinolone susceptibility in clinical isolates as a consequence of mutations in DNA Gyrase.

  12. The validity and clinical utility of structured diagnoses of antisocial personality disorder with forensic patients.

    PubMed

    Marin-Avellan, Luisa E; McGauley, Gillian A; Campbell, Colin D; Fonagy, Peter

    2014-08-01

    Current DSM-based instruments for personality disorders (PDs) limit the investigation of the course and outcome of treatment of these disorders. This study examined the validity of the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) in a sample of forensic PD patients. Results based on 66 participants indicated that the SWAP-200 Q-factors reduced the frequency of diagnostic comorbidity of PD categories by half compared with the SCID-II. Only the SWAP-200's Antisocial PD category showed good convergent and discriminant validity with respect to other instruments describing aspects of PD. The validity of the cutoff score for severe antisocial PD was confirmed, and this category predicted severe incidents in the hospital at 1 year of follow-up. A violence risk scale was constructed, which differentiated violent and nonviolent offenders. The results support the validity of the SWAP-200 and its potential clinical utility with forensic PD patients.

  13. Structural, Functional, and Clinical Characterization of a Novel PTPN11 Mutation Cluster Underlying Noonan Syndrome.

    PubMed

    Pannone, Luca; Bocchinfuso, Gianfranco; Flex, Elisabetta; Rossi, Cesare; Baldassarre, Giuseppina; Lissewski, Christina; Pantaleoni, Francesca; Consoli, Federica; Lepri, Francesca; Magliozzi, Monia; Anselmi, Massimiliano; Delle Vigne, Silvia; Sorge, Giovanni; Karaer, Kadri; Cuturilo, Goran; Sartorio, Alessandro; Tinschert, Sigrid; Accadia, Maria; Digilio, Maria C; Zampino, Giuseppe; De Luca, Alessandro; Cavé, Hélène; Zenker, Martin; Gelb, Bruce D; Dallapiccola, Bruno; Stella, Lorenzo; Ferrero, Giovanni B; Martinelli, Simone; Tartaglia, Marco

    2017-04-01

    Germline mutations in PTPN11, the gene encoding the Src-homology 2 (SH2) domain-containing protein tyrosine phosphatase (SHP2), cause Noonan syndrome (NS), a relatively common, clinically variable, multisystem disorder. Here, we report on the identification of five different PTPN11 missense changes affecting residues Leu(261) , Leu(262) , and Arg(265) in 16 unrelated individuals with clinical diagnosis of NS or with features suggestive for this disorder, specifying a novel disease-causing mutation cluster. Expression of the mutant proteins in HEK293T cells documented their activating role on MAPK signaling. Structural data predicted a gain-of-function role of substitutions at residues Leu(262) and Arg(265) exerted by disruption of the N-SH2/PTP autoinhibitory interaction. Molecular dynamics simulations suggested a more complex behavior for changes affecting Leu(261) , with possible impact on SHP2's catalytic activity/selectivity and proper interaction of the PTP domain with the regulatory SH2 domains. Consistent with that, biochemical data indicated that substitutions at codons 262 and 265 increased the catalytic activity of the phosphatase, while those affecting codon 261 were only moderately activating but impacted substrate specificity. Remarkably, these mutations underlie a relatively mild form of NS characterized by low prevalence of cardiac defects, short stature, and cognitive and behavioral issues, as well as less evident typical facial features.

  14. The population structure of drug-resistant Mycobacterium tuberculosis clinical isolates from Sichuan in China.

    PubMed

    Zhao, Yuding; Feng, Qin; Tang, Ke; Zhang, Congcong; Sun, Honghu; Luo, Tao; Yang, Zhirong; Couvin, David; Rastogi, Nalin; Sun, Qun

    2012-06-01

    China ranks second next to India among 22 high-burden countries despite decades' effort on tuberculosis (TB) control. The Sichuan province today contains the second-largest number of TB cases among Chinese provinces, where the prevalence of drug-resistant TB, especially MDR-TB, is much higher than the average level in eastern China. In this study, the population structure and the transmission characteristics of drug-resistant TB in Sichuan province were studied by spoligotyping and 24-locus Mycobacterial interspersed repetitive units-variable number tandem DNA repeats (MIRU-VNTR), applied to a total of 306 clinical isolates. Spoligotyping-based analysis showed that Beijing family represented 69.28% of all isolates and constituted the largest group (66.24%) of MDR-TB in Sichuan. The remaining isolates, accounting for 33.76% of MDR isolates, belonged to the ill-defined T family, Manu2, H3, LAM9, and other minor unassigned clades. The discriminatory power evaluated for spoligotyping was poor (HGI=0.595), but high for 24-locus MIRU-VNTRs (HGI=0.999). The number of the most discriminatory loci (h>0.6) was 12, including locus 424, 802, 960, 1644, 1955, 2163b, 2996, 3007, 3192, 3690, 4348 and 4052. It was concluded that 24-locus MIRU-VNTRs could be a more discriminatory tool for differentiating clinical isolates from Sichuan region. The small clustering size obtained from the current population structure analysis suggested that the high prevalence of drug-resistant TB in this region might be attributed partially to the acquired resistance due to inappropriate drug use rather than active transmission of drug-resistant TB (primary resistance).

  15. Objective Assessment of Hypernasality in Patients with Cleft Lip and Palate with the NasalView System: A Clinical Validation Study.

    PubMed

    Wermker, Kai; Jung, Susanne; Joos, Ulrich; Kleinheinz, Johannes

    2012-01-01

    Introduction. The objective of this investigation was to evaluate the reliability and validity of the NasalView system as a screening tool for hypernasality within the scope of a routine diagnostic procedure in cleft lip and palate patients. Material and Methods. In a collective of 95 patients with cleft and lip palate ranging from 4 to 25 years of age, hypernasality was exploited perceptually, patients were classified in four degrees, and nasalance was measured objectively with the NasalView system. Speech stimuli existed in one nasal and one nonnasal sentence; nasalance ratio and distance were calculated. Results. The test-retest error was within a range of 2%. Sensitivity ranged from 83.3% to 91.1% for the nonnasal sentence, from 70% to 78.4% for nasalance ratio and from 68.1% to 81.1% for nasalance distance. Specifity ranged from 87% to 93.1% for the nonnasal sentence, from 69.6% to 97.5% for nasalance ratio, and from 70.7% to 73.9% for nasalance distance. Conclusions. With a quick and gentle screening procedure, it is easily possible to identify hypernasal patients by an objective diagnostic tool of hypernasality, the NasalView system, with good reliability and validity.

  16. Setleis syndrome: clinical, molecular and structural studies of the first TWIST2 missense mutation.

    PubMed

    Rosti, R O; Uyguner, Z O; Nazarenko, I; Bekerecioglu, M; Cadilla, C L; Ozgur, H; Lee, B H; Aggarwal, A K; Pehlivan, S; Desnick, R J

    2015-11-01

    Setleis syndrome is characterized by bitemporal scar-like lesions and other characteristic facial features. It results from recessive mutations that truncate critical functional domains in the basic helix-loop-helix (bHLH) transcription factor, TWIST2, which regulates expression of genes for facial development. To date, only four nonsense or small deletion mutations have been reported. In the current report, the clinical findings in a consanguineous Turkish family were characterized. Three affected siblings had the characteristic features of Setleis syndrome. Homozygosity for the first TWIST2 missense mutation, c.326T>C (p.Leu109Pro), was identified in the patients. In silico analyses predicted that the secondary structure of the mutant protein was sustained, but the empirical force field energy increased to an unfavorable level with the proline substitution (p.Leu109Pro). On a crystallographically generated dimer, p.Leu109 lies near the dimer interface, and the proline substitution is predicted to hinder dimer formation. Therefore, p.Leu109Pro-TWIST2 alters the three dimensional structure and is unable to dimerize, thereby hindering the binding of TWIST2 to its target genes involved in facial development.

  17. A distributed, collaborative, structuring model for a clinical-guideline digital-library.

    PubMed

    Shahar, Yuval; Shalom, Erez; Mayaffit, Alon; Young, Ohad; Galperin, Maya; Martins, Susana; Goldstein, Mary

    2003-01-01

    The Digital Electronic Guideline Library (DeGeL) is a Web-based framework and a set of distributed tools that facilitate gradual conversion of clinical guidelines from free text, through semi-structured text, to a fully structured, executable representation. Thus, guidelines exist in a hybrid, multiple-format representation The three formats support increasingly sophisticated computational tasks. The tools perform semantic markup, classification, search, and browsing, and support computational modules that we are developing, for run-time application and retrospective quality assessment. We describe the DeGeL architecture and its collaborative-authoring authorization model, which is based on (1) multiple medical-specialty authoring groups, each including a group manager who controls group authorizations, and (2) a hierarchical authorization model based on the different functions involved in the hybrid guideline-specification process. We have implemented the core modules of the DeGeL architecture and demonstrated distributed markup and retrieval using the knowledge roles of two guidelines ontologies (Asbru and GEM). We are currently evaluating several of the DeGeL tools.

  18. CBCL Clinical Scales Discriminate ADHD Youth with Structured-Interview Derived Diagnosis of Oppositional Defiant Disorder (ODD)

    ERIC Educational Resources Information Center

    Biederman, Joseph; Ball, Sarah W.; Monuteaux, Michael C.; Kaiser, Roselinde; Faraone, Stephen V.

    2008-01-01

    Objective: To evaluate the association between the clinical scales of the child behavior checklist (CBCL) and the comorbid diagnosis of oppositional defiant disorder (ODD) in a large sample of youth with attention deficit hyperactivity disorder (ADHD). Method: The sample consisted of 101 girls and 106 boys ages 6 to 17 with ADHD. Conditional…

  19. A structural equation model to investigate the impact of missing occlusal units on objective masticatory function in patients with shortened dental arches.

    PubMed

    Fueki, K; Yoshida, E; Igarashi, Y

    2011-11-01

    The aim of this study was to investigate the impact of missing occlusal units (MOUs) on objective masticatory function with respect to food comminuting and mixing ability. Sixty partially dentate patients (mean age, 64·1 years) with shortened dental arches participated in the study. Food comminuting ability was assessed using a masticatory performance test with peanuts as a test food. Food mixing ability was assessed using a mixing ability test with a two-coloured wax cube. Maximum bite force (MBF) was measured using a pressure-sensitive film as a mediator for food comminuting and mixing ability. A structural equation model was constructed based on a hypothesis that MOUs would be associated with reduced MBF and impairment of food comminuting and mixing ability. Structural equation modelling analysis found significant direct effects of MOU on median particle size and mixing ability index (MAI) (P < 0·001). In addition, MOU had significant indirect effects on median particle size and MAI with MBF as a mediator (P < 0·05). These results suggest that decrease in occlusal platform area and reduced MBF because of MOUs are associated with the impairment of food comminution and mixing in patients with shortened dental arches.

  20. Fractional order PID control design for semi-active control of smart base-isolated structures: A multi-objective cuckoo search approach.

    PubMed

    Zamani, Abbas-Ali; Tavakoli, Saeed; Etedali, Sadegh

    2017-03-01

    Fractional order PID (FOPID) controllers are introduced as a general form of classical PID controllers using fractional calculus. As this controller provides good disturbance rejection and is robust against plant uncertainties it is appropriate for the vibration mitigation in structures. In this paper, an FOPID controller is designed to adjust the contact force of piezoelectric friction dampers for semi-active control of base-isolated structures during far-field and near-field earthquake excitations. A multi-objective cuckoo search algorithm is employed to tune the controller parameters. Considering the resulting Pareto optimal front, the best input for the FOPID controller is selected. For seven pairs of earthquakes and nine performance indices, the performance of the proposed controller is compared with those provided by several well-known control techniques. According to the simulation results, the proposed controller performs better than other controllers in terms of simultaneous reduction of the maximum base displacement and story acceleration for various types of earthquakes. Also, it provides acceptable responses in terms of inter-story drifts, root mean square of base displacements and floor acceleration. In addition, the evaluation of robustness for a stiffness uncertainty of ±10% indicates that the proposed controller gives a robust performance against such modeling errors.

  1. Factor structure of a Korean-language version of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in a clinical sample of clients with alcohol dependence.

    PubMed

    Chun, Young-Min; Cho, Sung-Min; Shin, Sung-Man

    2010-12-01

    The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is an instrument used to measure the level of motivation in regards to changing drinking and other addictive behaviors. While some initial factor analysis studies on the SOCRATES described a three-factor orthogonal structure of the scale, some other studies found a two-factor correlated structure. Therefore, the primary objective of the present study was to test the validity of the Korean language version of the instrument using a Korean population. The study examined the factor structure of the Korean version of the SOCRATES with clinical samples consisting of 219 inpatients and 271 outpatients with alcohol dependency. An exploratory factor analysis with an alpha factoring method revealed a three-factor correlated structure (i.e., Taking Steps, Recognition, and Ambivalence). The factorial structure of the SOCRATES Korean version corresponded almost exactly to that of its original French version as well as the German version. Moreover, confirmatory factor analyses showed that a three-factor correlated structure provided the best fit for the data.

  2. Unveiling the near-infrared structure of the massive-young stellar object NGC 3603 IRS 9A* with sparse aperture masking and spectroastrometry

    NASA Astrophysics Data System (ADS)

    Sanchez-Bermudez, J.; Hummel, C. A.; Tuthill, P.; Alberdi, A.; Schödel, R.; Lacour, S.; Stanke, T.

    2016-04-01

    Context. Contemporary theory holds that massive stars gather mass during their initial phases via accreting disk-like structures. However, conclusive evidence for disks has remained elusive for most massive young objects. This is mainly due to significant observational challenges: objects are rare and located at great distances within dusty, highly opaque environments. Incisive studies, even targeting individual objects, are therefore relevant to the progression of the field. NGC 3603 IRS 9A* is a young massive stellar object that is still surrounded by an envelope of molecular gas for which previous mid-infrared observations with long-baseline interferometry have provided evidence of a plausible disk of 50 mas diameter at its core. Aims: This work aims at a comprehensive study of the physics and morphology of IRS 9A at near-infrared wavelengths. Methods: New sparse aperture-masking interferometry data, taken with the near-infrared camera NACO of the Very Large Telescope (VLT) at Ks and L' wavelengths, were analyzed together with archival high-resolution H2 and Brγ lines obtained with the cryogenic high-resolution infrared schelle spectrograph (CRIRES). Results: The trends in the calibrated visibilities at Ks and L'-bands suggest the presence of a partially resolved compact object with an angular size of ≤30 mas at the core of IRS 9A, together with the presence of over-resolved flux. The spectroastrometric signal of the H2 line, obtained from the CRIRES spectra, shows that this spectral feature proceeds from the large-scale extended emission (~300 mas), while the Brγ line appears to be formed at the core of the object (~20 mas). To better understand the physics that drive IRS 9A, we have performed continuum radiative transfer modeling. Our best model supports the existence of a compact disk with an angular diameter of 20 mas, together with an outer envelope of 1'' exhibiting a polar cavity with an opening angle of ~30°. This model reproduces the MIR morphology

  3. Belt-hierarchic structure of th ring, satellite and planet systems: prediction S/2001 U1 and others objects in Solar system

    NASA Astrophysics Data System (ADS)

    Barkin, Yu. V.

    2003-04-01

    BELT-HIERARCHIC STRUCTURE OF THE RING, SATELLITE AND PLANET SYSTEMS: PREDICTION S/2001 U1 AND OTHERS OBJECTS IN SOLAR SYSTEM Yu.V.Barkin Sternberg Astronomical Institute, Moscow, Russia, barkin@sai.msu.ru Structure regularities of the planet and satellite systems have been studied. Statistic analysis of the distribution of the major semi-axes of the orbits of the planets, comets and centaurs of the Solar system, satellite and ring systems of Jupiter, Saturn, Neptune and Uran, exoplanet systems of the pulsars PSR 1257+12, PSR 1828-11 and of the main consequence star Ups And was fulfilled. The following empirical regularities were described [1]: 1) the bodies of systems are combined into hierarchic groups and main from them combine 5 companions; 2) differences of the major semi-axes of the neighboring orbits for bodies of every group are constant; 4) for main neighboring hierarchic group these distances are distinguished in 6 times increasing to external grope; 5) the filling of the gropes and some present changes in their structure are caused by the past catastrophes in corresponding systems. The special method of reconstruction of the catastrophes which had place in the life of the Solar system (SS) was developed. Suggested method has let us to explain uniformly observed values of the major semi-axes and average values of eccentricities of the planets. In particular the Pancul’s hypothesis about Jupiter formation from two giant protoplanets (Jupiter I and Jupiter II) was confirmed. The new empirical law of the filling of the orbits of the regular groups of the planets or satellites (or rings structures) of the hierarchic ordered systems of celestial bodies was established. It was shown that sum number of bodies is proportional to the value of catastrophic value of the eccentricities which are same for first, second ,.... and fifth orbits of all gropes. The theoretical numbers of bodies for pointed orbits practically coincide with their observed numbers in main

  4. Retinal Structures and Visual Cortex Activity are Impaired Prior to Clinical Vision Loss in Glaucoma

    PubMed Central

    Murphy, Matthew C.; Conner, Ian P.; Teng, Cindy Y.; Lawrence, Jesse D.; Safiullah, Zaid; Wang, Bo; Bilonick, Richard A.; Kim, Seong-Gi; Wollstein, Gadi; Schuman, Joel S.; Chan, Kevin C.

    2016-01-01

    Glaucoma is the second leading cause of blindness worldwide and its pathogenesis remains unclear. In this study, we measured the structure, metabolism and function of the visual system by optical coherence tomography and multi-modal magnetic resonance imaging in healthy subjects and glaucoma patients with different degrees of vision loss. We found that inner retinal layer thinning, optic nerve cupping and reduced visual cortex activity occurred before patients showed visual field impairment. The primary visual cortex also exhibited more severe functional deficits than higher-order visual brain areas in glaucoma. Within the visual cortex, choline metabolism was perturbed along with increasing disease severity in the eye, optic radiation and visual field. In summary, this study showed evidence that glaucoma deterioration is already present in the eye and the brain before substantial vision loss can be detected clinically using current testing methods. In addition, cortical cholinergic abnormalities are involved during trans-neuronal degeneration and can be detected non-invasively in glaucoma. The current results can be of impact for identifying early glaucoma mechanisms, detecting and monitoring pathophysiological events and eye-brain-behavior relationships, and guiding vision preservation strategies in the visual system, which may help reduce the burden of this irreversible but preventable neurodegenerative disease. PMID:27510406

  5. An investigation of objective and subjective types of binge eating episodes in a clinical sample of people with co-morbid obesity

    PubMed Central

    2013-01-01

    Background Objective binge eating episodes (OBEs) refer to binge eating on an unusually large amount of food and are the core symptom in current definitions of bulimia nervosa (BN) and binge eating disorder (BED). Subjective binge eating episodes (SBEs) refer to eating on a small or moderate amount of food (that is perceived as large) and like OBEs are associated with loss of control (LOC). Reaching consensus on what is considered a large amount of food can however be problematic and it remains unclear if the size of a binge is an essential component for defining a binge eating episode. The aim of this study was to compare the eating disorder features and general psychopathology of subjects reporting OBEs with those reporting only SBEs. Methods This is a retrospective secondary analysis of data from 70 obese participants at the recruitment phase of a multicentre trial for BED. Individuals who answered positively to the presence of binge eating and LOC over eating had their binge eating episodes further explored by interview and self-report. Two groups, those who reported current OBEs (with or without SBEs) and those who reported current SBEs only were compared for age, gender, marital status, body mass index (BMI), indicators of LOC over eating, severity of binge-eating and associated psychopathology. Results The majority of participants in both the OBE and SBE groups endorsed the experience of at least four indicators of LOC. There were no significant differences between the groups. Both groups had high levels of binge-eating severity, moderate severity of associated depressive symptoms and frequent psychiatric co-morbidity. Conclusion Treatment seeking participants with obesity who reported SBEs alone were similar to those who reported OBEs in terms of eating disorder features and general psychopathology. These findings suggest that classificatory systems of mental illnesses should consider introducing SBEs as a feature of the diagnostic criteria for binge eating

  6. The Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID): first psychometric evaluation in a Dutch sample of clinically referred youths.

    PubMed

    Roelofs, Jeffrey; Muris, Peter; Braet, Caroline; Arntz, Arnoud; Beelen, Imke

    2015-06-01

    The Structured Clinical Interview for DSM-IV Childhood Disorders (Kid-SCID) is a semi-structured interview for the classification of psychiatric disorders in children and adolescents. This study presents a first evaluation of the psychometric properties of the Kid-SCID in a Dutch sample of children and adolescents who had been referred to an outpatient treatment centre for mental health problems. Results indicated that the inter-rater reliability of the Kid-SCID classifications and the internal consistency of various (dimensional) criteria of the diagnoses were moderate to good. Further, for most Kid-SCID diagnoses, reasonable agreement between children and parents was found. Finally, the correspondence between the Kid-SCID and the final clinical diagnosis as established after the full intake procedure, which included the information as provided by the Kid-SCID, ranged from poor to good. Results are discussed in the light of methodological issues pertaining to the assessment of psychiatric disorders in youths. The Kid-SCID can generally be seen as a reliable and useful tool that can assist clinicians in carrying out clinical evaluations of children and adolescents.

  7. A membranous structure separating the adenohypophysis and neurohypophysis: an anatomical study and its clinical application for craniopharyngioma.

    PubMed

    Lu, Yun-Tao; Qi, Song-Tao; Xu, Jia-Ming; Pan, Jun; Shi, Jin

    2015-06-01

    OBJECT This study aimed to identify the membranous septation between the adeno- and neurohypophysis. The clinical impact of this septation in the surgical removal of infradiaphragmatic craniopharyngioma (Id-CP) is also clarified. METHODS The sellar regions from 8 fetal and 6 adult cadavers were dissected. After staining first with H & E and then with picro-Sirius red, the membranous structures were observed and measured under normal light and polarization microscopy. The pre- and postsurgical images and intraoperative procedures in 28 cases of childhood Id-CP were reviewed and analyzed. RESULTS There is a significant membranous septation (termed the adenoneurohypophysis septation [ANHS]) lying behind the intermediate lobe to separate the adeno- and neurohypophysis. The average thicknesses are 21.9 ± 16.9 μm and 79.1 ± 43.2 μm in fetal and adult heads, respectively. The median segment of the septation is significantly thicker than the upper and lower segments. The ANHS extends from the suprasellar pars tuberalis to the sellar floor, where it is fused with the pituitary capsule. During Id-CP surgery performed via a transcranial approach, the ANHS can be identified to reserve the neurohypophysis. Moreover, by understanding the anatomy of this membrane, the pituitary stalk was preserved in 3 patients (10.7%). CONCLUSIONS There is a significant membrane separating the anterior and posterior lobes of the pituitary gland, which lies behind the intermediate lobe. Understanding the anatomy of this septation is important for identifying and preserving the neurohypophysis and pituitary stalk during Id-CP surgery.

  8. Non-invasive cardiac assessment in high risk patients (The GROUND study): rationale, objectives and design of a multi-center randomized controlled clinical trial

    PubMed Central

    de Vos, Alexander M; Rutten, Annemarieke; van de Zaag-Loonen, Hester J; Bots, Michiel L; Dikkers, Riksta; Buiskool, Robert A; Mali, Willem P; Lubbers, Daniel D; Mosterd, Arend; Prokop, Mathias; Rensing, Benno J; Cramer, Maarten J; van Es, H Wouter; Moll, Frans L; van de Pavoordt, Eric D; Doevendans, Pieter A; Velthuis, Birgitta K; Mackaay, Albert J; Zijlstra, Felix; Oudkerk, Matthijs

    2008-01-01

    Background Peripheral arterial disease (PAD) is a common disease associated with a considerably increased risk of future cardiovascular events and most of these patients will die from coronary artery disease (CAD). Screening for silent CAD has become an option with recent non-invasive developments in CT (computed tomography)-angiography and MR (magnetic resonance) stress testing. Screening in combination with more aggressive treatment may improve prognosis. Therefore we propose to study whether a cardiac imaging algorithm, using non-invasive imaging techniques followed by treatment will reduce the risk of cardiovascular disease in PAD patients free from cardiac symptoms. Design The GROUND study is designed as a prospective, multi-center, randomized clinical trial. Patients with peripheral arterial disease, but without symptomatic cardiac disease will be asked to participate. All patients receive a proper risk factor management before randomization. Half of the recruited patients will enter the 'control group' and only undergo CT calcium scoring. The other half of the recruited patients (index group) will undergo the non invasive cardiac imaging algorithm followed by evidence-based treatment. First, patients are submitted to CT calcium scoring and CT angiography. Patients with a left main (or equivalent) coronary artery stenosis of > 50% on CT will be referred to a cardiologist without further imaging. All other patients in this group will undergo dobutamine stress magnetic resonance (DSMR) testing. Patients with a DSMR positive for ischemia will also be referred to a cardiologist. These patients are candidates for conventional coronary angiography and cardiac interventions (coronary artery bypass grafting (CABG) or percutaneous cardiac interventions (PCI)), if indicated. All participants of the trial will enter a 5 year follow up period for the occurrence of cardiovascular events. Sequential interim analysis will take place. Based on sample size calculations about

  9. Factor Structure of the Devereux Early Childhood Assessment Clinical Form in Low-Income Hispanic American Bilingual Preschool Children

    ERIC Educational Resources Information Center

    Oades-Sese, Geraldine V.; Kaliski, Pamela K.; Weiss, Karen

    2010-01-01

    The Devereux Early Childhood Assessment Clinical Form (DECA-C) is the first instrument to measure the social-emotional resilience of young children from ages 2 to 5 years. This study is an important step toward gathering validity evidence for the teacher-rated DECA-C. This is the first study to investigate the DECA-C factor structure and the first…

  10. Structural Equation Analyses of Clinical Subpopulation Differences and Comparative Treatment Outcomes: Characterizing the Daily Lives of Drug Addicts.

    ERIC Educational Resources Information Center

    Aiken, Leona S.; And Others

    1994-01-01

    Used structural equation modeling for comparative treatment outcome research conducted with heterogeneous clinical subpopulations within large multimodality treatment settings. Evaluated effect of early period of treatment on daily lives of 486 clients in 2 drug abuse treatment modalities (methadone maintenance and outpatient counseling).…

  11. A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence

    PubMed Central

    Anding, Kirsten; Bär, Thomas; Trojniak-Hennig, Joanna; Kuchinke, Simone; Krause, Rolfdieter; Rost, Jan M; Halle, Martin

    2015-01-01

    Objective Long-term studies regarding the effect of a structured physical exercise programme (SPEP) during haemodialysis (HD) assessing compliance and clinical benefit are scarce. Study design A single-centre clinical trial, non-randomised, investigating 46 patients with HD (63.2±16.3 years, male/female 24/22, dialysis vintage 4.4 years) performing an SPEP over 5 years. The SPEP (twice/week for 60 min during haemodialysis) consisted of a combined resistance (8 muscle groups) and endurance (supine bicycle ergometry) training. Exercise intensity was continuously adjusted to improvements of performance testing. Changes in endurance and resistance capacity, physical functioning and quality of life (QoL) were analysed over 1 year in addition to long-term adherence and economics of the programme over 5 years. Average power per training session, maximal strength tests (maximal exercise repetitions/min), three performance-based tests for physical function, SF36 for QoL were assessed in the beginning and every 6 months thereafter. Results 78% of the patients completed the programme after 1 year and 43% after 5 years. Participants were divided—according to adherence to the programme—into three groups: (1) high adherence group (HA, >80% of 104 training sessions within 12 months), (2) moderate adherence (MA, 60–80%), and 3. Low adherence group (LA, <60%)) with HA and MA evaluated quantitatively. One-year follow-up data revealed significant (p<0.05) improvement for both groups in all measured parameters: exercise capacity (HA: 55%, MA: 45%), strength (HA: >120%, MA: 40–50%), QoL in three scores of SF36 subscales and physical function in the three tests taken between 11% and 31%. Moreover, a quantitative correlation analysis revealed a close association (r=0.8) between large improvement of endurance capacity and weak physical condition (HA). Conclusions The exercise programme described improves physical function significantly and can be integrated

  12. Standardization of Course Plan and Design of Objective Structured Field Examination (OSFE) for the Assessment of Pharm.D. Student’s Community Pharmacy Clerkship Skills

    PubMed Central

    Monajjemzadeh, Farnaz; Shokri, Javad; Mohajel Nayebi, Ali Reza; Nemati, Mahboob; Azarmi, Yadollah; Charkhpour, Mohammad; Najafi, Moslem

    2014-01-01

    Purpose: This study was aimed to design Objective Structured Field Examination (OSFE) and also standardize the course plan of community pharmacy clerkship at Pharmacy Faculty of Tabriz University of Medical Sciences (Iran). Methods: The study was composed of several stages including; evaluation of the old program, standardization and implementation of the new course plan, design and implementation of OSFE, and finally results evaluation. Results: Lack of a fair final assessment protocol and proper organized educating system in various fields of community pharmacy clerkship skills were assigned as the main weaknesses of the old program. Educational priorities were determined and student’s feedback was assessed to design the new curriculum consisting of sessions to fulfill a 60-hour training course. More than 70% of the students were satisfied and successfulness and efficiency of the new clerkship program was significantly greater than the old program (P<0.05). In addition, they believed that OSFE was a suitable testing method. Conclusion: The defined course plan was successfully improved different skills of the students and OSFE was concluded as a proper performance based assessment method. This is easily adoptable by pharmacy faculties to improve the educational outcomes of the clerkship course. PMID:24511477

  13. Medical students' perception of the proposal for theme-based integrated multi-disciplinary objective structured practical examination in Saudi Arabia.

    PubMed

    Hassan, Mohammad Saleh; Yacoubi, Amel

    2016-01-01

    This study aimed to find the opinion of preclinical medical students concerning a new suggested approach for practical assessment. Fifty-three female students agreed to participate in this study, out of 87 registered students in years 2 and 3 of the basic science phase of the College of Medicine, Qassim University, Kingdom of Saudi Arabia. Full explanation was made to the students of theme-based integrated objective structured practical examination (TBI-OSPE), followed by distribution of a questionnaire to collect the students' opinions. The study was conducted in January 2015. Results showed that 78% of respondents were accepting of this new approach, and that only 5.7% rejected it. This difference was statistically significant (P<0.05). This study suggested a new model for assessment of preclinical students' competencies using the proposed tool (TBI-OSPE) rather than standard classical OSPE, particularly in curricula involving high levels of integration and theme-based problems. This form of assessment would more positively enhance learning.

  14. Numerical integration of gravitational field for general three-dimensional objects and its application to gravitational study of grand design spiral arm structure

    NASA Astrophysics Data System (ADS)

    Fukushima, Toshio

    2016-12-01

    We present a method to integrate the gravitational field for general three-dimensional objects. By adopting the spherical polar coordinates centred at the evaluation point as the integration variables, we numerically compute the volume integral representation of the gravitational potential and of the acceleration vector. The variable transformation completely removes the algebraic singularities of the original integrals. The comparison with exact solutions reveals around 15 digits accuracy of the new method. Meanwhile, the six digit accuracy of the integrated gravitational field is realized by around 106 evaluations of the integrand per evaluation point, which costs at most a few seconds at a PC with Intel Core i7-4600U CPU running at 2.10 GHz clock. By using the new method, we show the gravitational field of a grand design spiral arm structure as an example. The computed gravitational field shows not only spiral shaped details but also a global feature composed of a thick oblate spheroid and a thin disc. The developed method is directly applicable to the electromagnetic field computation by means of Coulomb's law, the Biot-Savart law, and their retarded extensions. Sample FORTRAN 90 programs and test results are electronically available.

  15. Medical students’ perception of the proposal for theme-based integrated multi-disciplinary objective structured practical examination in Saudi Arabia

    PubMed Central

    2016-01-01

    This study aimed to find the opinion of preclinical medical students concerning a new suggested approach for practical assessment. Fifty-three female students agreed to participate in this study, out of 87 registered students in years 2 and 3 of the basic science phase of the College of Medicine, Qassim University, Kingdom of Saudi Arabia. Full explanation was made to the students of theme-based integrated objective structured practical examination (TBI-OSPE), followed by distribution of a questionnaire to collect the students’ opinions. The study was conducted in January 2015. Results showed that 78% of respondents were accepting of this new approach, and that only 5.7% rejected it. This difference was statistically significant (P<0.05). This study suggested a new model for assessment of preclinical students’ competencies using the proposed tool (TBI-OSPE) rather than standard classical OSPE, particularly in curricula involving high levels of integration and theme-based problems. This form of assessment would more positively enhance learning. PMID:27044780

  16. [The root of the deep and fast ongoing evolution of both structure and methodology of clinical research].

    PubMed

    Tavazzi, Luigi

    2016-03-01

    The growing scientific knowledge and technology development are leading to radical changes in biological and medical research. The prevalent lines of development deal with a pragmatic evolution of controlled clinical trials, a massive diffusion of observational research, which is progressively incorporated in clinical practice, new models and designs of clinical research, the systematic use of information technology to build up vast networks of medical centers producing huge amounts of shared data to be managed through the big data methodology, personalized as well as precision medicine, a reshaped physician-patient relationship based on a co-working principle. All this is leading to profound changes in public health governance, a renewal of clinical epidemiology and prevention, a modified structure of several specific sectors of medical care, hopefully guided by scientific evidences. A few aspects of such an evolving picture are discussed in this article.

  17. Examining the factor structure of the Clinical Opiate Withdrawal Scale: A secondary data analysis from the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003

    PubMed Central

    Barbosa-Leiker, Celestina; McPherson, Sterling; Mamey, Mary Rose; Burns, G. Leonard; Layton, Matthew E.; Roll, John; Ling, Walter

    2015-01-01

    Background The Clinical Opiate Withdrawal Scale (COWS) is used to assess withdrawal in clinical trials and practice. The aims of this study were to examine the inter-item correlations and factor structure of the COWS in opioid-dependent men and women. Methods This is a secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network 0003, a randomized clinical trial that compared buprenorphine/naloxone tapering strategies. The trial included 11 sites in 10 US cities. Participants were opioid-dependent individuals (n=516) that had data on the COWS. The COWS at study baseline was analyzed in this study. Results Inter-item correlations showed weak to moderate relationships among the items. A 1-factor model did not fit the data for men (comparative fit index (CFI)=.801, root mean square error of approximation (RMSEA)=.073, weighted root mean square residual (WRMR)=1.132) or women (CFI=.694, RMSEA=.071, WRMR=.933), where resting pulse rate was not related to withdrawal for men, and yawning and gooseflesh skin was not related to withdrawal for women. A reduced model comprised of only the 8 items that were significantly related to the construct of withdrawal in both men and women, and an exploratory 2-factor model, were also assessed but not retained due to inconsistencies across gender. Conclusions When traditional psychometric models are applied to the COWS, it appears that the scale may not relate to a single underlying construct of withdrawal. Further research testing the hypothesized factor structure in other opioid-dependent samples is needed. PMID:25908321

  18. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research

    PubMed Central

    Clunie, David; Ulrich, Ethan; Bauer, Christian; Wahle, Andreas; Brown, Bartley; Onken, Michael; Riesmeier, Jörg; Pieper, Steve; Kikinis, Ron; Buatti, John; Beichel, Reinhard R.

    2016-01-01

    Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT) quantitative imaging (QI) biomarker development applied to head and neck cancer (HNC) treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM®) international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV) normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API) were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK) was improved to simplify the task of DICOM encoding by introducing new API abstractions

  19. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research.

    PubMed

    Fedorov, Andriy; Clunie, David; Ulrich, Ethan; Bauer, Christian; Wahle, Andreas; Brown, Bartley; Onken, Michael; Riesmeier, Jörg; Pieper, Steve; Kikinis, Ron; Buatti, John; Beichel, Reinhard R

    2016-01-01

    Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT) quantitative imaging (QI) biomarker development applied to head and neck cancer (HNC) treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM(®)) international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV) normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API) were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK) was improved to simplify the task of DICOM encoding by introducing new API abstractions

  20. The Structured Clinically Relevant Interview for Psychiatrists in Training (SCRIPT): A New Standardized Assessment Tool for Recruitment in the UK

    ERIC Educational Resources Information Center

    Rao, Rahul

    2007-01-01

    Objective: The multifaceted nature of training and the diverse backgrounds of potential Senior House Officers (Postgraduate Residents) require a novel approach to the selection of trainees wishing to pursue a career in psychiatry. The author reports the properties of a semi-structured interview (the SCRIPT) for assessing doctors short-listed for a…

  1. Reflective type objective based spectral-domain phase-sensitive optical coherence tomography for high-sensitive structural and functional imaging of cochlear microstructures through intact bone of an excised guinea pig cochlea

    NASA Astrophysics Data System (ADS)

    Subhash, Hrebesh M.; Wang, Ruikang K.; Chen, Fangyi; Nuttall, Alfred L.

    2013-03-01

    Most of the optical coherence tomographic (OCT) systems for high resolution imaging of biological specimens are based on refractive type microscope objectives, which are optimized for specific wave length of the optical source. In this study, we present the feasibility of using commercially available reflective type objective for high sensitive and high resolution structural and functional imaging of cochlear microstructures of an excised guinea pig through intact temporal bone. Unlike conventional refractive type microscopic objective, reflective objective are free from chromatic aberrations due to their all-reflecting nature and can support a broadband of spectrum with very high light collection efficiency.

  2. Population Structure of Clinical Pseudomonas aeruginosa from West and Central African Countries

    PubMed Central

    Cholley, Pascal; Ka, Roughyatou; Guyeux, Christophe; Thouverez, Michelle; Guessennd, Nathalie; Ghebremedhin, Beniam; Frank, Thierry; Bertrand, Xavier; Hocquet, Didier

    2014-01-01

    Background Pseudomonas aeruginosa (PA) has a non-clonal, epidemic population with a few widely distributed and frequently encountered sequence types (STs) called ‘high-risk clusters’. Clinical P. aeruginosa (clinPA) has been studied in all inhabited continents excepted in Africa, where a very few isolates have been analyzed. Here, we characterized a collection of clinPA isolates from four countries of West and Central Africa. Methodology 184 non-redundant isolates of clinPA from hospitals of Senegal, Ivory Coast, Nigeria, and Central African Republic were genotyped by MLST. We assessed their resistance level to antibiotics by agar diffusion and identified the extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) by sequencing. The population structure of the species was determined by a nucleotide-based analysis of the entire PA MLST database and further localized on the phylogenetic tree (i) the sequence types (STs) of the present collection, (ii) the STs by continents, (iii) ESBL- and MBL-producing STs from the MLST database. Principal Findings We found 80 distinct STs, of which 24 had no relationship with any known STs. ‘High-risk’ international clonal complexes (CC155, CC244, CC235) were frequently found in West and Central Africa. The five VIM-2-producing isolates belonged to CC233 and CC244. GES-1 and GES-9 enzymes were produced by one CC235 and one ST1469 isolate, respectively. We showed the spread of ‘high-risk’ international clonal complexes, often described as multidrug-resistant on other continents, with a fully susceptible phenotype. The MBL- and ESBL-producing STs were scattered throughout the phylogenetic tree and our data suggest a poor association between a continent and a specific phylogroup. Conclusions ESBL- and MBL-encoding genes are borne by both successful international clonal complexes and distinct local STs in clinPA of West and Central Africa. Furthermore, our data suggest that the spread of a ST could be

  3. Infants' Knowledge of Objects: Beyond Object Files and Object Tracking.

    ERIC Educational Resources Information Center

    Carey, Susan; Xu, Fei

    2001-01-01

    Examines evidence that the research community studying infants' object concept and the community concerned with adult object-based attention have been studying the same natural kind. Maintains that the discovery that the object representations of young infants are the same as the object files of mid-level visual cognition has implications for both…

  4. Objective assessment of clinical computerized thermal images

    NASA Astrophysics Data System (ADS)

    Anbar, Michael

    1991-06-01

    The efficacy of diagnostic thermal imaging, the visualization of abnormal distribution of temperature over the human skin, can be significantly augmented by computerized image processing procedures that overcome the limitations of subjective image assessment. This paper reviews diagnostic thermal imaging and describes common image processing approaches applicable to the analysis of static thermal images and of time series of images that provide diagnostic information about the dynamics of neurological regulation of skin temperature.

  5. The GuideView System for Interactive, Structured, Multi-modal Delivery of Clinical Guidelines

    NASA Technical Reports Server (NTRS)

    Iyengar, Sriram; Florez-Arango, Jose; Garcia, Carlos Andres

    2009-01-01

    GuideView is a computerized clinical guideline system which delivers clinical guidelines in an easy-to-understand and easy-to-use package. It may potentially enhance the quality of medical care or allow non-medical personnel to provide acceptable levels of care in situations where physicians or nurses may not be available. Such a system can be very valuable during space flight missions when a physician is not readily available, or perhaps the designated medical personnel is unable to provide care. Complex clinical guidelines are broken into simple steps. At each step clinical information is presented in multiple modes, including voice,audio, text, pictures, and video. Users can respond via mouse clicks or via voice navigation. GuideView can also interact with medical sensors using wireless or wired connections. The system's interface is illustrated and the results of a usability study are presented.

  6. Automatic recognition of disorders, findings, pharmaceuticals and body structures from clinical text: an annotation and machine learning study.

    PubMed

    Skeppstedt, Maria; Kvist, Maria; Nilsson, Gunnar H; Dalianis, Hercules

    2014-06-01

    Automatic recognition of clinical entities in the narrative text of health records is useful for constructing applications for documentation of patient care, as well as for secondary usage in the form of medical knowledge extraction. There are a number of named entity recognition studies on English clinical text, but less work has been carried out on clinical text in other languages. This study was performed on Swedish health records, and focused on four entities that are highly relevant for constructing a patient overview and for medical hypothesis generation, namely the entities: Disorder, Finding, Pharmaceutical Drug and Body Structure. The study had two aims: to explore how well named entity recognition methods previously applied to English clinical text perform on similar texts written in Swedish; and to evaluate whether it is meaningful to divide the more general category Medical Problem, which has been used in a number of previous studies, into the two more granular entities, Disorder and Finding. Clinical notes from a Swedish internal medicine emergency unit were annotated for the four selected entity categories, and the inter-annotator agreement between two pairs of annotators was measured, resulting in an average F-score of 0.79 for Disorder, 0.66 for Finding, 0.90 for Pharmaceutical Drug and 0.80 for Body Structure. A subset of the developed corpus was thereafter used for finding suitable features for training a conditional random fields model. Finally, a new model was trained on this subset, using the best features and settings, and its ability to generalise to held-out data was evaluated. This final model obtained an F-score of 0.81 for Disorder, 0.69 for Finding, 0.88 for Pharmaceutical Drug, 0.85 for Body Structure and 0.78 for the combined category Disorder+Finding. The obtained results, which are in line with or slightly lower than those for similar studies on English clinical text, many of them conducted using a larger training data set, show that

  7. Objective assessment of acne.

    PubMed

    Becker, Markus; Wild, Thomas; Zouboulis, Christos C

    A precise and reliable assessment of acne severity is unarguably the most essential clinical method when it comes to monitoring and choosing optimal treatment in the daily practice. Since the early 1960s, different severity assessment systems have been described in the literature. The two commonly used concepts are global gradings and lesion counting. Both systems have been controversially discussed as to which is more reliable and providing an objective outcome measurement tool; however, both have some subjectivity involved. More objective methods for assessing the severity of acne vulgaris include photography, fluorescence photography, polarized light photography, video microscopy, and multispectral imaging. Such techniques have limitations such as high cost, complex and sophisticated apparatus, and a sometimes time-consuming imaging process. There are newly developed technologies that could avoid the problems of inter- and intrarater subjectivity.

  8. Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi

    PubMed Central

    Arnold, Trisha; Brinkley-Rubinstein, Lauren; Chan, Philip A.; Perez-Brumer, Amaya; Bologna, Estefany S.; Beauchamps, Laura; Johnson, Kendra; Mena, Leandro; Nunn, Amy

    2017-01-01

    Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care. PMID:28222118

  9. A randomized comparison of video demonstration versus hands-on training of medical students for vacuum delivery using Objective Structured Assessment of Technical Skills (OSATS)

    PubMed Central

    Hilal, Ziad; Kumpernatz, Anne K.; Rezniczek, Günther A.; Cetin, Cem; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B.

    2017-01-01

    Abstract Background: To compare medical students’ skills for vaginal operative delivery by vacuum extraction (VE) after hands-on training versus video demonstration. Methods: We randomized medical students to an expert demonstration (group 1) or a hands-on (group 2) training using a standardized VE algorithm on a pelvic training model. Students were tested with a 40-item Objective Structured Assessment of Technical Skills (OSATS) scoring system after training and 4 days later. OSATS scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were secondary outcomes. We assessed the constructive validity of OSATS in this VE model comparing metric scores of experts and students. Results: In all, 137 students were randomized. OSATS scores were higher in group 2 (n = 63) compared with group 1 (n = 74) (32.89 ± 6.39 vs 27.51 ± 10.27, respectively; P < 0.0001). Global rating scale (1.49 ± 0.76 vs 2.33 ± 0.94, respectively; P < 0.0001), confidence (2.22 ± 0.75 vs 3.26 ± 0.94, respectively; P = 0.04), self-assessment (2.03 ± 0.62 vs 2.51 ± 0.77, respectively; P < 0.0001), and performance time (38.81 ± 11.58 seconds vs 47.23 ± 17.35 seconds, respectively; P = 0.001) also favored group 2. After 4 days, this effect persisted with OSATS scores still being significantly higher in group 2 (30.00 ± 6.50 vs 25.59 ± 6.09, respectively; P = 0.001). The assessed OSATS scores showed constructive validity. In a multiple linear regression analysis, group assignment independently influenced OSATS scores, whereas sex, handedness, sports activities, and type of curriculum were not independently associated with OSATS scores. Conclusions: Hands-on training is superior to video demonstration for teaching VE on a pelvic model. PMID:28296771

  10. Shape similarity, better than semantic membership, accounts for the structure of visual object representations in a population of monkey inferotemporal neurons.

    PubMed

    Baldassi, Carlo; Alemi-Neissi, Alireza; Pagan, Marino; Dicarlo, James J; Zecchina, Riccardo; Zoccolan, Davide

    2013-01-01

    The anterior inferotemporal cortex (IT) is the highest stage along the hierarchy of visual areas that, in primates, processes visual objects. Although several lines of evidence suggest that IT primarily represents visual shape information, some recent studies have argued that neuronal ensembles in IT code the semantic membership of visual objects (i.e., represent conceptual classes such as animate and inanimate objects). In this study, we investigated to what extent semantic, rather than purely visual information, is represented in IT by performing a multivariate analysis of IT responses to a set of visual objects. By relying on a variety of machine-learning approaches (including a cutting-edge clustering algorithm that has been recently developed in the domain of statistical physics), we found that, in most instances, IT representation of visual objects is accounted for by their similarity at the level of shape or, more surprisingly, low-level visual properties. Only in a few cases we observed IT representations of semantic classes that were not explainable by the visual similarity of their members. Overall, these findings reassert the primary function of IT as a conveyor of explicit visual shape information, and reveal that low-level visual properties are represented in IT to a greater extent than previously appreciated. In addition, our work demonstrates how combining a variety of state-of-the-art multivariate approaches, and carefully estimating the contribution of shape similarity to the representation of object categories, can substantially advance our understanding of neuronal coding of visual objects in cortex.

  11. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

    PubMed

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

    2013-01-01

    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

  12. Antisocial Personality Disorder Subscale (Chinese Version) of the Structured Clinical Interview for the DSM-IV Axis II disorders: validation study in Cantonese-speaking Hong Kong Chinese.

    PubMed

    Tang, D Y Y; Liu, A C Y; Leung, M H T; Siu, B W M

    2013-06-01

    OBJECTIVE. Antisocial personality disorder (ASPD) is a risk factor for violence and is associated with poor treatment response when it is a co-morbid condition with substance abuse. It is an under-recognised clinical entity in the local Hong Kong setting, for which there are only a few available Chinese-language diagnostic instruments. None has been tested for its psychometric properties in the Cantonese-speaking population in Hong Kong. This study therefore aimed to assess the reliability and validity of the Chinese version of the ASPD subscale of the Structured Clinical Interview for the DSM-IV Axis II Disorders (SCID-II) in Hong Kong Chinese. METHODS. This assessment tool was modified according to dialectal differences between Mainland China and Hong Kong. Inpatients in Castle Peak Hospital, Hong Kong, who were designated for priority follow-up based on their assessed propensity for violence and who fulfilled the inclusion criteria for the study, were recruited. To assess the level of agreement, best-estimate diagnosis made by a multidisciplinary team was compared with diagnostic status determined by the SCID-II ASPD subscale. The internal consistency, sensitivity, and specificity of the subscale were also calculated. RESULTS. The internal consistency of the subscale was acceptable at 0.79, whereas the test-retest reliability and inter-rater reliability showed an excellent and good agreement of 0.90 and 0.86, respectively. Best-estimate clinical diagnosis-SCID diagnosis agreement was acceptable at 0.76. The sensitivity, specificity, positive and negative predictive values were 0.91, 0.86, 0.83, and 0.93, respectively. CONCLUSION. The Chinese version of the SCID-II ASPD subscale is reliable and valid for diagnosing ASPD in a Cantonese-speaking clinical population.

  13. Paradoxical antifungal activity and structural observations in biofilms formed by echinocandin-resistant Candida albicans clinical isolates.

    PubMed

    Walraven, Carla J; Bernardo, Stella M; Wiederhold, Nathan P; Lee, Samuel A

    2014-02-01

    Echinocandin-resistant clinical isolates of Candida albicans have been reported, and key-hot spot mutations in the FKS1 gene, which encodes a major glucan synthase subunit, have been identified in these (caspofungin-resistant [CAS-R]) strains. Although these mutations result in phenotypic resistance to echinocandins in planktonic cells, there is little data on antifungal susceptibilities of CAS-R C. albicans strains within biofilms. Thus, we analyzed biofilms formed by 12 C. albicans CAS-R clinical strains in which we previously identified FKS1 hot-spot mutations and compared the sessile antifungal and paradoxical activity of anidulafungin (ANID), caspofungin (CAS), and micafungin (MICA). Biofilms were formed in a 96-well static microplate model and assayed using both tetrazolium-salt reduction and crystal violet assays, as well as examination by scanning electron microscopy. We first sought to assess biofilm formation and structure in these fks1 mutants and found that the biofilm mass and metabolic activities were reduced in most of the fks1 mutants as compared with reference strain SC5314. Structural analyses revealed that the fks1 mutant biofilms were generally less dense and had a clear predominance of yeast and pseudohyphae, with unusual "pit"-like cell surface structures. We also noted that sessile minimum inhibitory concentrations (MICs) to ANID, CAS, and MICA were higher than planktonic MICs of all but one strain. The majority of strains demonstrated a paradoxical effect (PE) to particular echinocandins, in either planktonic or sessile forms. Overall, biofilms formed by echinocandin-resistant clinical isolates demonstrated varied PEs to echinocandins and were structurally characterized by a preponderance of yeast, pseudohyphae, and pit-like structures.

  14. ARTEMIS Science Objectives

    NASA Technical Reports Server (NTRS)

    Sibeck, D. G.; Angelopoulos, V.; Brain, D. A.; Delory, G. T.; Eastwood, J. P.; Farrell, W. M.; Grimm, R. E.; Halekas, J. S.; Hasegawa, H.; Hellinger, P.; Khurana, K. K.; Lillis, R. J.; Oieroset, M.; Phan, T.-D.; Raeder, J.; Russell, C. T.; Schriver, D.; Slavin, J. A.; Travnicel, P. M.; Weygand, J. M.

    2011-01-01

    NASA's two spacecraft ARTEMIS mission will address both heliospheric and planetary research questions, first while in orbit about the Earth with the Moon and subsequently while in orbit about the Moon. Heliospheric topics include the structure of the Earth's magnetotail; reconnection, particle acceleration, and turbulence in the Earth's magnetosphere, at the bow shock, and in the solar wind; and the formation and structure of the lunar wake. Planetary topics include the lunar exosphere and its relationship to the composition of the lunar surface, the effects of electric fields on dust in the exosphere, internal structure of the Moon, and the lunar crustal magnetic field. This paper describes the expected contributions of ARTEMIS to these baseline scientific objectives.

  15. An Application of Cmaps in the Description of Clinical Information Structure and Logic in Electronic Health Records

    PubMed Central

    Helfgott, Maxwell A.; Novak, Joseph; Schanhals, Rick

    2012-01-01

    The development and implementation of competent and cost-effective computerized medical records that profoundly improve physician productivity and knowledge management will require the development of a new paradigm for the representation and analysis of medical knowledge and logic. Medical knowledge is acquired inductively by observing, measuring, and eliciting information from patients in a process that is investigational rather than transactional. Most, if not all, current approaches to health information technology (HIT) rely on a logic and data structure that imposes significant limitations on the ability of physicians to thoroughly and efficiently document and access empiric patient data because the information is almost invariably organized in a way which presumes, rather than makes explicit, the relationships of concepts and their meaning. Cmapping provides a graphical method of capturing and displaying expert content knowledge that is simple to comprehend and modify and provides a foundation for a dynamic, inductive, and inclusive method of clinical documentation and research. The basis of medical decision analysis along with representative samples of medical knowledge modeling in the Cmap format is presented. The knowledge structures that are captured in Cmaps can be expressed directly in propositional logic, enabling the capability to convert Cmapped clinical expressions to be used to define a description logic for clinical evidence documentation and analysis that can in turn be mapped to multiple natural languages. The described description logic approach can be used to formulate digital messages and documents and to automate the process of converting description specifications formulated in propositional logic into operational electronic health record solutions for capture and reporting of clinical encounters. It has also been demonstrated that using Cmaps to elicit content knowledge from physicians to build point-of-care clinical documentation screens

  16. An application of cmaps in the description of clinical information structure and logic in electronic health records.

    PubMed

    Brewer, Allen; Helfgott, Maxwell A; Novak, Joseph; Schanhals, Rick

    2012-09-01

    The development and implementation of competent and cost-effective computerized medical records that profoundly improve physician productivity and knowledge management will require the development of a new paradigm for the representation and analysis of medical knowledge and logic. Medical knowledge is acquired inductively by observing, measuring, and eliciting information from patients in a process that is investigational rather than transactional. Most, if not all, current approaches to health information technology (HIT) rely on a logic and data structure that imposes significant limitations on the ability of physicians to thoroughly and efficiently document and access empiric patient data because the information is almost invariably organized in a way which presumes, rather than makes explicit, the relationships of concepts and their meaning. Cmapping provides a graphical method of capturing and displaying expert content knowledge that is simple to comprehend and modify and provides a foundation for a dynamic, inductive, and inclusive method of clinical documentation and research. The basis of medical decision analysis along with representative samples of medical knowledge modeling in the Cmap format is presented. The knowledge structures that are captured in Cmaps can be expressed directly in propositional logic, enabling the capability to convert Cmapped clinical expressions to be used to define a description logic for clinical evidence documentation and analysis that can in turn be mapped to multiple natural languages. The described description logic approach can be used to formulate digital messages and documents and to automate the process of converting description specifications formulated in propositional logic into operational electronic health record solutions for capture and reporting of clinical encounters. It has also been demonstrated that using Cmaps to elicit content knowledge from physicians to build point-of-care clinical documentation screens

  17. Evaluation of Mother-Child Agreement and Factorial Structures of the SCARED Questionnaire in an Italian Clinical Sample

    PubMed Central

    Scaini, Simona; Ogliari, Anna; De Carolis, Ludovica; Bellodi, Laura; Di Serio, Clelia; Brombin, Chiara

    2017-01-01

    Background: A great part of the literature has confirmed the importance of both child and parents reports as source of factual information, especially for childhood emotional syndromes. In our study we aimed at: (i) calculating mother-child agreement and (ii) evaluating factorial structure of the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire in an Italian clinical sample. The novelty of this contribution is two-fold: first, from a clinical point of view, we investigated the parent-child agreement level and examined separately the factorial structures of both parent and child versions of the SCARED for the first time in an Italian clinical sample. Second, unlike previous studies, we used statistical approaches specifically suited to account for the ordinal nature of the collected variables. Method: In a clinical sample of 171 children and adolescents aged 8–18 and their mothers we evaluated inter-rater agreement using weighted kappa indices to assess agreement for each item belonging to a certain SCARED subscale. Exploratory factor analysis for ordinal data was then performed on the polychoric correlation matrix calculated on SCARED items. Differences in the numbers of symptoms reported by children and parents were evaluated as well. Results and Conclusions: Our results reveal moderate to strong mother-child agreement. A significant age effect is present. Two different factorial solutions emerged for parent and child SCARED versions (a 5 factor structure for parents and a 6 factor solution in the child version, including a new factor “Worry about Parents”). This study confirmed the importance of evaluating both child and parent reports in assessment protocols for anxiety disorders. Our findings could help clinicians to determine which information, and from which rater, must be accounted for in evaluating treatment decisions. Moreover, we find that patients characteristics, such as gender and age, should be taken into account when

  18. Shape Similarity, Better than Semantic Membership, Accounts for the Structure of Visual Object Representations in a Population of Monkey Inferotemporal Neurons

    PubMed Central

    DiCarlo, James J.; Zecchina, Riccardo; Zoccolan, Davide

    2013-01-01

    The anterior inferotemporal cortex (IT) is the highest stage along the hierarchy of visual areas that, in primates, processes visual objects. Although several lines of evidence suggest that IT primarily represents visual shape information, some recent studies have argued that neuronal ensembles in IT code the semantic membership of visual objects (i.e., represent conceptual classes such as animate and inanimate objects). In this study, we investigated to what extent semantic, rather than purely visual information, is represented in IT by performing a multivariate analysis of IT responses to a set of visual objects. By relying on a variety of machine-learning approaches (including a cutting-edge clustering algorithm that has been recently developed in the domain of statistical physics), we found that, in most instances, IT representation of visual objects is accounted for by their similarity at the level of shape or, more surprisingly, low-level visual properties. Only in a few cases we observed IT representations of semantic classes that were not explainable by the visual similarity of their members. Overall, these findings reassert the primary function of IT as a conveyor of explicit visual shape information, and reveal that low-level visual properties are represented in IT to a greater extent than previously appreciated. In addition, our work demonstrates how combining a variety of state-of-the-art multivariate approaches, and carefully estimating the contribution of shape similarity to the representation of object categories, can substantially advance our understanding of neuronal coding of visual objects in cortex. PMID:23950700

  19. Targeting and Structuring Information Resource Use: A Path toward Informed Clinical Decisions

    ERIC Educational Resources Information Center

    Mangrulkar, Rajesh S.

    2004-01-01

    A core skill for all physicians to master is that of information manager. Despite a rapidly expanding set of electronic and print-based information resources, clinicians continue to answer their clinical queries predominantly through informal or formal consultation. Even as new tools are brought to market, the majority of them present information…

  20. Use of conditional rule structure to automate clinical decision support: a comparison of artificial intelligence and deterministic programming techniques

    SciTech Connect

    Friedman, R.H.; Frank, A.D.

    1983-08-01

    A rule-based computer system was developed to perform clinical decision-making support within a medical information system, oncology practice, and clinical research. This rule-based system, which has been programmed using deterministic rules, possesses features of generalizability, modularity of structure, convenience in rule acquisition, explanability, and utility for patient care and teaching, features which have been identified as advantages of artificial intelligence (AI) rule-based systems. Formal rules are primarily represented as conditional statements; common conditions and actions are stored in system dictionaries so that they can be recalled at any time to form new decision rules. Important similarities and differences exist in the structure of this system and clinical computer systems utilizing artificial intelligence (AI) production rule techniques. The non-AI rule-based system posesses advantages in cost and ease of implementation. The degree to which significant medical decision problems can be solved by this technique remains uncertain as does whether the more complex AI methodologies will be required. 15 references.

  1. Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure.

    PubMed

    Glisson, Charles; Schoenwald, Sonja K; Kelleher, Kelly; Landsverk, John; Hoagwood, Kimberly Eaton; Mayberg, Stephen; Green, Philip

    2008-03-01

    The present study incorporates organizational theory and organizational characteristics in examining issues related to the successful implementation of mental health services. Following the theoretical foundations of socio-technical and cultural models of organizational effectiveness, organizational climate, culture, legal and service structures, and workforce characteristics are examined as correlates of therapist turnover and new program sustainability in a nationwide sample of mental health clinics. Results of General Linear Modeling (GLM) with the organization as the unit of analysis revealed that organizations with the best climates as measured by the Organizational Social Context (OSC) profiling system, had annual turnover rates (10%) that were less than half the rates found in organizations with the worst climates (22%). In addition, organizations with the best culture profiles sustained new treatment or service programs over twice as long (50 vs. 24 months) as organizations with the worst cultures. Finally, clinics with separate children's services units had higher turnover rates than clinics that served adults and children within the same unit. The findings suggest that strategies to support the implementation of new mental health treatments and services should attend to organizational culture and climate, and to the compatibility of organizational service structures with the demand characteristics of treatments.

  2. Solvent interaction analysis as a proteomic approach to structure-based biomarker discovery and clinical diagnostics.

    PubMed

    Zaslavsky, Boris Y; Uversky, Vladimir N; Chait, Arnon

    2016-01-01

    Proteins have several measurable features in biological fluids that may change under pathological conditions. The current disease biomarker discovery is mostly based on protein concentration in the sample as the measurable feature. Changes in protein structures, such as post-translational modifications and in protein-partner interactions are known to accompany pathological processes. Changes in glycosylation profiles are well-established for many plasma proteins in various types of cancer and other diseases. The solvent interaction analysis method is based on protein partitioning in aqueous two-phase systems and is highly sensitive to changes in protein structure and protein-protein- and protein-partner interactions while independent of the protein concentration in the biological sample. It provides quantitative index: partition coefficient representing changes in protein structure and interactions with partners. The fundamentals of the method are presented with multiple examples of applications of the method to discover and monitor structural protein biomarkers as disease-specific diagnostic indicators.

  3. Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis

    PubMed Central

    2016-01-01

    Purpose To design and implement flipped clinical training for undergraduate dental students in removable complete denture treatment and predict its effectiveness by comparing the assessment results of students trained by flipped and traditional methods. Methods Flipped training was designed by shifting the learning from clinics to learning center (phase I) and by preserving the practice in clinics (phase II). In phase I, student-faculty interactive session was arranged to recap prior knowledge. This is followed by a display of audio synchronized video demonstration of the procedure in a repeatable way and subsequent display of possible errors that may occur in treatment with guidelines to overcome such errors. In phase II, live demonstration of the procedure was given. Students were asked to treat three patients under instructor’s supervision. The summative assessment was conducted by applying the same checklist criterion and rubric scoring used for the traditional method. Assessment results of three batches of students trained by flipped method (study group) and three traditionally trained previous batches (control group) were taken for comparison by chi-square test. Results The sum of traditionally trained three batch students who prepared acceptable dentures (score: 2 and 3) and unacceptable dentures (score: 1) was compared with the same of flipped trained three batch students revealed that the number of students who demonstrated competency by preparing acceptable dentures was higher for flipped training (χ2=30.996 with p<0.001). Conclusion The results reveal the supremacy of flipped training in enhancing students competency and hence recommended for training various clinical procedures. PMID:27907980

  4. [Literature of so-called "clinical research": structure and trends, 1991-2010].

    PubMed

    Schubert, András; Somogyi, Anikó

    2014-11-30

    The authors studied trends and patterns in the literature of research labeled as clinical (i.e., having the word "clinical" in their title) in the period between 1991 and 2010. The main findings are: 1. The growth of the literature under study was somewhat stronger than that of the overall medical literature. 2. The dominance of the USA is strong but is challenged by some of the most rapidly developing countries (particularly in the Far-East region: China, Korea) in total production, and by the developed European countries in highly cited publications. The eminence of Italy is remarkable. 3. In comparing the medical fields, the most striking tendencies are the increase of oncology and the attenuation of internal medicine. Surgery is steadily growing in size but decreasing in its citation influence. 4. Word frequency studies support the ever growing weight of oncology and also of genetics. 5. Beyond the thematic changes, word frequency studies also reveal a substantial change in attitude: in the period under study more and more effort was made on emphasizing the usefulness, efficiency and risks of the results in contrast with the more descriptive, investigative approach of the past. The role of therapy is growing, the role of diagnostics is decreasing. The knowledge of these trends and patterns may orient health and science policy makers to cope appropriately with the ever changing world of clinical research.

  5. [Active clinical surveillance for detection of Legionnaires' disease: implications for health care structures].

    PubMed

    Marchesi, I; Bargellini, A; Cencetti, S; Concetti, S; Marchegiano, P; Cauteruccio, L; Casolari, C; Borella, P

    2007-01-01

    In an university hospital of about 900 beds, a clinical surveillance was activated to detect cases of Legionnaires' disease in patients affected by community and/or nosocomial-acquired pneumonia. In the hospital Legionella spp was detected in the hot water distribution system and various disinfecting and control procedures were adopted to reduce contamination. Contemporary, the clinical surveillance began with the systematic detection of Legionella urinary antigen among recovered pneumonia, seroconversion as confirmation test and the collection of respiratory secretions or other biological materials to isolate the microorganism in patients positive to the urinary antigen. From September 2003 to May 2005, 486 pneumonia were followed, 98 of which considered of nosocomial origin. In total, 15 cases of community-acquired Legionnaires' disease were detected by the urinary test, whereas no cases of nosocomial origin were found. The characteristics of the detected cases are described in comparison with the other pneumonia and the surveillance cost was evaluated. The systematic clinical surveillance for Legionella infections is feasible with limit costs, allows to detect community-acquired cases otherwise unknown and to ascertain the absence/presence of nosocomial-acquired pneumonia, irrespective of the environment contamination.

  6. Computerized mental health assessment in integrative health clinics: a cross-sectional study using structured interview.

    PubMed

    Leung, Sau Fong; French, Peter; Chui, Caroline; Arthur, David

    2007-12-01

    Computerized mental health assessment is gaining popularity. It enables the standardization of assessment of clinical problems, increases the capacity to collect sensitive or confidential information, facilitates personal assessment at one's own pace, and offers rapid screening of mental health status. The use of computer technology to conduct mental health assessment was an initiative proposed for two nurse-led integrative health clinics affiliated to a University in Hong Kong. It was intended to provide an efficient screening for depression, anxiety, alcohol abuse, and problem gambling common in the primary health-care settings to facilitate early intervention. This study was conducted to assess the effectiveness of using a computerized health assessment kiosk to perform mental health assessment. The assessment items were derived from an abbreviated World Health Organization Mental Disorders Checklist and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Pathological Gambling. The study involved an opportunity sample of 31 subjects who volunteered to complete the computerized mental health assessment during their waiting time in the clinics. The results showed that most subjects had positive feelings about using a computer to perform a mental health assessment and had increased understanding of their mental health. Suggestions made to improve computerized mental health assessments included touch screen, voice instructions, and enlarged print font size.

  7. Characterization of the microbunch time structure of proton pencil beams at a clinical treatment facility.

    PubMed

    Petzoldt, J; Roemer, K E; Enghardt, W; Fiedler, F; Golnik, C; Hueso-González, F; Helmbrecht, S; Kormoll, T; Rohling, H; Smeets, J; Werner, T; Pausch, G

    2016-03-21

    Proton therapy is an advantageous treatment modality compared to conventional radiotherapy. In contrast to photons, charged particles have a finite range and can thus spare organs at risk. Additionally, the increased ionization density in the so-called Bragg peak close to the particle range can be utilized for maximum dose deposition in the tumour volume. Unfortunately, the accuracy of the therapy can be affected by range uncertainties, which have to be covered by additional safety margins around the treatment volume. A real-time range and dose verification is therefore highly desired and would be key to exploit the major advantages of proton therapy. Prompt gamma rays, produced in nuclear reactions between projectile and target nuclei, can be used to measure the proton's range. The prompt gamma-ray timing (PGT) method aims at obtaining this information by determining the gamma-ray emission time along the proton path using a conventional time-of-flight detector setup. First tests at a clinical accelerator have shown the feasibility to observe range shifts of about 5 mm at clinically relevant doses. However, PGT spectra are smeared out by the bunch time spread. Additionally, accelerator related proton bunch drifts against the radio frequency have been detected, preventing a potential range verification. At OncoRay, first experiments using a proton bunch monitor (PBM) at a clinical pencil beam have been conducted. Elastic proton scattering at a hydrogen-containing foil could be utilized to create a coincident proton-proton signal in two identical PBMs. The selection of coincident events helped to suppress uncorrelated background. The PBM setup was used as time reference for a PGT detector to correct for potential bunch drifts. Furthermore, the corrected PGT data were used to image an inhomogeneous phantom. In a further systematic measurement campaign, the bunch time spread and the proton transmission rate were measured for several beam energies between 69 and 225 Me

  8. Characterization of the microbunch time structure of proton pencil beams at a clinical treatment facility

    NASA Astrophysics Data System (ADS)

    Petzoldt, J.; Roemer, K. E.; Enghardt, W.; Fiedler, F.; Golnik, C.; Hueso-González, F.; Helmbrecht, S.; Kormoll, T.; Rohling, H.; Smeets, J.; Werner, T.; Pausch, G.

    2016-03-01

    Proton therapy is an advantageous treatment modality compared to conventional radiotherapy. In contrast to photons, charged particles have a finite range and can thus spare organs at risk. Additionally, the increased ionization density in the so-called Bragg peak close to the particle range can be utilized for maximum dose deposition in the tumour volume. Unfortunately, the accuracy of the therapy can be affected by range uncertainties, which have to be covered by additional safety margins around the treatment volume. A real-time range and dose verification is therefore highly desired and would be key to exploit the major advantages of proton therapy. Prompt gamma rays, produced in nuclear reactions between projectile and target nuclei, can be used to measure the proton’s range. The prompt gamma-ray timing (PGT) method aims at obtaining this information by determining the gamma-ray emission time along the proton path using a conventional time-of-flight detector setup. First tests at a clinical accelerator have shown the feasibility to observe range shifts of about 5 mm at clinically relevant doses. However, PGT spectra are smeared out by the bunch time spread. Additionally, accelerator related proton bunch drifts against the radio frequency have been detected, preventing a potential range verification. At OncoRay, first experiments using a proton bunch monitor (PBM) at a clinical pencil beam have been conducted. Elastic proton scattering at a hydrogen-containing foil could be utilized to create a coincident proton-proton signal in two identical PBMs. The selection of coincident events helped to suppress uncorrelated background. The PBM setup was used as time reference for a PGT detector to correct for potential bunch drifts. Furthermore, the corrected PGT data were used to image an inhomogeneous phantom. In a further systematic measurement campaign, the bunch time spread and the proton transmission rate were measured for several beam energies between 69 and 225

  9. The use of structured reflective journal questions to promote fundamental development of clinical decision-making abilities of the first-semester nursing student.

    PubMed

    Croke, Eileen

    2004-01-01

    The ability to reflect is becoming a core competency in many nursing educational programs. A clinical journal assignment was developed for first-semester (novice) nursing students. The aim was to see if the process of reflection-on-action through the medium of journal writing promoted fundamental clinical decision-making abilities of the first semester nursing student. This author discusses components of the clinical decision-making process used to structure six clinical journal questions for use by the first semester nursing students during their clinical rotation. Exemplars of students' self-reported reflections are included.

  10. Turbulent wakes of fractal objects.

    PubMed

    Staicu, Adrian; Mazzi, Biagio; Vassilicos, J C; van de Water, Willem

    2003-06-01

    Turbulence of a windtunnel flow is stirred using objects that have a fractal structure. The strong turbulent wakes resulting from three such objects which have different fractal dimensions are probed using multiprobe hot-wire anemometry in various configurations. Statistical turbulent quantities are studied within inertial and dissipative range scales in an attempt to relate changes in their self-similar behavior to the scaling of the fractal objects.

  11. Higher order factor structure of the WISC-IV in a clinical neuropsychological sample.

    PubMed

    Bodin, Doug; Pardini, Dustin A; Burns, Thomas G; Stevens, Abigail B

    2009-09-01

    A confirmatory factor analysis was conducted examining the higher order factor structure of the WISC-IV scores for 344 children who participated in neuropsychological evaluations at a large children's hospital. The WISC-IV factor structure mirrored that of the standardization sample. The second order general intelligence factor (g) accounted for the largest proportion of variance in the first-order latent factors and in the individual subtests, especially for the working memory index. The first-order processing speed factor exhibited the most unique variance beyond the influence of g. The results suggest that clinicians should not ignore the contribution of g when interpreting the first-order factors.

  12. Stable feature selection for clinical prediction: exploiting ICD tree structure using Tree-Lasso.

    PubMed

    Kamkar, Iman; Gupta, Sunil Kumar; Phung, Dinh; Venkatesh, Svetha

    2015-02-01

    Modern healthcare is getting reshaped by growing Electronic Medical Records (EMR). Recently, these records have been shown of great value towards building clinical prediction models. In EMR data, patients' diseases and hospital interventions are captured through a set of diagnoses and procedures codes. These codes are usually represented in a tree form (e.g. ICD-10 tree) and the codes within a tree branch may be highly correlated. These codes can be used as features to build a prediction model and an appropriate feature selection can inform a clinician about important risk factors for a disease. Traditional feature selection methods (e.g. Information Gain, T-test, etc.) consider each variable independently and usually end up having a long feature list. Recently, Lasso and related l1-penalty based feature selection methods have become popular due to their joint feature selection property. However, Lasso is known to have problems of selecting one feature of many correlated features randomly. This hinders the clinicians to arrive at a stable feature set, which is crucial for clinical decision making process. In this paper, we solve this problem by using a recently proposed Tree-Lasso model. Since, the stability behavior of Tree-Lasso is not well understood, we study the stability behavior of Tree-Lasso and compare it with other feature selection methods. Using a synthetic and two real-world datasets (Cancer and Acute Myocardial Infarction), we show that Tree-Lasso based feature selection is significantly more stable than Lasso and comparable to other methods e.g. Information Gain, ReliefF and T-test. We further show that, using different types of classifiers such as logistic regression, naive Bayes, support vector machines, decision trees and Random Forest, the classification performance of Tree-Lasso is comparable to Lasso and better than other methods. Our result has implications in identifying stable risk factors for many healthcare problems and therefore can

  13. Nursing Clinical Documentation System Structured on NANDA-I, NOC, and NIC Classification Systems.

    PubMed

    Peres, Heloisa Helena C; de Almeida Lopes M da Cruz, Diná; Tellez, Michelle; de Cassia Gengo e Silva, Rita; dos S Diogo, Regina Celia; Ortiz, Diley Cardoso F; Ortiz, Dóris R

    2015-01-01

    Information is a key feature that health professionals need to exercise their profession with efficiency and quality. This study aims to present the experience of the usage of an electronic system for clinical documentation in nursing in a university hospital. It is a methodological research of technology production. The system was developed in four phases: Conception, Elaboration, Construction, and Transition, and was named Electronic Documentation System of the University of São Paulo Nursing Process (PROCEnf-USP™). The knowledge base of PROCEnf-USP™ was organized in hierarchy of domains and classes, according to NNN linkages.

  14. Structural and incremental validity of the Wechsler Adult Intelligence Scale-Fourth Edition with a clinical sample.

    PubMed

    Nelson, Jason M; Canivez, Gary L; Watkins, Marley W

    2013-06-01

    Structural and incremental validity of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV; Wechsler, 2008a) was examined with a sample of 300 individuals referred for evaluation at a university-based clinic. Confirmatory factor analysis indicated that the WAIS-IV structure was best represented by 4 first-order factors as well as a general intelligence factor in a direct hierarchical model. The general intelligence factor accounted for the most common and total variance among the subtests. Incremental validity analyses indicated that the Full Scale IQ (FSIQ) generally accounted for medium to large portions of academic achievement variance. For all measures of academic achievement, the first-order factors combined accounted for significant achievement variance beyond that accounted for by the FSIQ, but individual factor index scores contributed trivial amounts of achievement variance. Implications for interpreting WAIS-IV results are discussed.

  15. Hypothyroidism Side Effect in Patients Treated with Sunitinib or Sorafenib: Clinical and Structural Analyses.

    PubMed

    Shu, Mao; Zai, Xiaoli; Zhang, Beina; Wang, Rui; Lin, Zhihua

    2016-01-01

    Tyrosine kinase inhibitors (TKIs) provide more effective targeted treatments for cancer, but are subject to a variety of adverse effects, such as hypothyroidism. TKI-induced hypothyroidism is a highly complicated issue, because of not only the unrealized toxicological mechanisms, but also different incidences of individual TKI drugs. While sunitinib is suspected for causing thyroid dysfunction more often than other TKIs, sorafenib is believed to be less risky. Here we integrated clinical data and in silico drug-protein interactions to examine the pharmacological distinction between sunitinib and sorafenib. Statistical analysis on the FDA Adverse Event Reporting System (FAERS) confirmed that sunitinib is more concurrent with hypothyroidism than sorafenib, which was observed in both female and male patients. Then, we used docking method and identified 3 proteins specifically binding to sunitinib but not sorafenib, i.e., retinoid X receptor alpha, retinoic acid receptors beta and gamma. As potential off-targets of sunitinib, these proteins are well known to assemble with thyroid hormone receptors, which can explain the profound impact of sunitinib on thyroid function. Taken together, we established a strategy of integrated analysis on clinical records and drug off-targets, which can be applied to explore the molecular basis of various adverse drug reactions.

  16. Clinical evaluation of liver structure and function in humans exposed to halogenated hydrocarbons.

    PubMed Central

    Guzelian, P S

    1985-01-01

    An unresolved question is whether humans exposed to comparatively low doses of persistent environmental chemicals such as polyhalogenated biphenyls or organochlorine pesticides are at risk for injury to the liver. Cross-sectional epidemiologic studies suggest that these chemicals may produce statistically significant but clinically mild abnormalities in the commonly employed chemical tests of liver function. The few reports of human liver morphology reveal nonspecific changes reflecting effects of lipophilic chemicals. There is evidence that chemicals of this category in at least some doses cause induction of liver microsomal enzymes involved in biotransformation of foreign substances. This finding has been documented by measurements of the clearance of model drugs or the appearance in the urine of steroid metabolites or glucaric acid. Although a positive statistical correlation between the concentrations of these chemicals in serum and the serum gamma-glutamyltranspeptidase activity has been reported, the non-specificity of the latter enzyme precludes conclusion that this change is indicative of induction of liver microsomal enzymes. Although the effects of this type of environmental chemical are not indicative of progressive liver disease, only prospective clinical trials can resolve the issue of the risk for future development of liver malignancy. PMID:2411535

  17. Structural basis for effectiveness of siderophore-conjugated monocarbams against clinically relevant strains of Pseudomonas aeruginosa

    SciTech Connect

    Han, Seungil; Zaniewski, Richard P.; Marr, Eric S.; Lacey, Brian M.; Tomaras, Andrew P.; Evdokimov, Artem; Miller, J. Richard; Shanmugasundaram, Veerabahu

    2012-02-08

    Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen that causes nosocomial infections for which there are limited treatment options. Penicillin-binding protein PBP3, a key therapeutic target, is an essential enzyme responsible for the final steps of peptidoglycan synthesis and is covalently inactivated by {beta}-lactam antibiotics. Here we disclose the first high resolution cocrystal structures of the P. aeruginosa PBP3 with both novel and marketed {beta}-lactams. These structures reveal a conformational rearrangement of Tyr532 and Phe533 and a ligand-induced conformational change of Tyr409 and Arg489. The well-known affinity of the monobactam aztreonam for P. aeruginosa PBP3 is due to a distinct hydrophobic aromatic wall composed of Tyr503, Tyr532, and Phe533 interacting with the gem-dimethyl group. The structure of MC-1, a new siderophore-conjugated monocarbam complexed with PBP3 provides molecular insights for lead optimization. Importantly, we have identified a novel conformation that is distinct to the high-molecular-weight class B PBP subfamily, which is identifiable by common features such as a hydrophobic aromatic wall formed by Tyr503, Tyr532, and Phe533 and the structural flexibility of Tyr409 flanked by two glycine residues. This is also the first example of a siderophore-conjugated triazolone-linked monocarbam complexed with any PBP. Energetic analysis of tightly and loosely held computed hydration sites indicates protein desolvation effects contribute significantly to PBP3 binding, and analysis of hydration site energies allows rank ordering of the second-order acylation rate constants. Taken together, these structural, biochemical, and computational studies provide a molecular basis for recognition of P. aeruginosa PBP3 and open avenues for future design of inhibitors of this class of PBPs.

  18. A National Content Analysis of PhD Program Objectives, Structures, and Curricula: Do Programs Address the Full Range of Social Work's Needs?

    ERIC Educational Resources Information Center

    Drisko, James; Hunnicutt, Christie; Berenson, Laura

    2015-01-01

    The Group for the Advancement of Doctoral Education (GADE) promotes excellence in PhD education in Social Work. GADE's 2013 Quality Guidelines for PhD Programs heavily emphasize preparation for research. Little is known, however, about the details of the contemporary social work PhD program structure and curriculum. Several prior surveys have…

  19. Population genetic structure of Taenia solium from Madagascar and Mexico: implications for clinical profile diversity and immunological technology.

    PubMed

    Vega, Rodrigo; Piñero, Daniel; Ramanankandrasana, Bienvenue; Dumas, Michel; Bouteille, Bernard; Fleury, Agnes; Sciutto, Edda; Larralde, Carlos; Fragoso, Gladis

    2003-11-01

    Taenia solium is a cestode parasitic of humans and pigs that strongly impacts on public health in developing countries. Its larvae (cysticercus) lodge in the brain, causing neurocysticercosis, and in other tissues, like skeletal muscle and subcutaneous space, causing extraneuronal cysticercosis. Prevalences of these two clinical manifestations vary greatly among continents. Also, neurocysticercosis may be clinically heterogeneous, ranging from asymptomatic forms to severely incapacitating and even fatal presentation. Further, vaccine design and diagnosis technology have met with difficulties in sensitivity, specificity and reproducibility. Parasite diversity underlying clinical heterogeneity and technological difficulties is little explored. Here, T. solium genetic population structure and diversity was studied by way of random amplified polymorphic DNA in individual cysticerci collected from pigs in Madagascar and two regions in Mexico. The amplification profiles of T. solium were also compared with those of the murine cysticercus Taenia crassiceps (ORF strain). We show significant genetic differentiation between Madagascar and Mexico and between regions in Mexico, but less so between cysticerci from different localities in Mexico and none between cysticerci from different tissues from the same pig. We also found restricted genetic variability within populations and gene flow was estimated to be low between populations. Thus, genetic differentiation of T. solium suggests that different evolutionary paths have been taken and provides support for its involvement in the differential tissue distribution of cysticerci and varying degrees of severity of the disease. It may also explain difficulties in the development of vaccines and tools for immunodiagnosis.

  20. Hispanic ethnicity and Caucasian race: Relations with posttraumatic stress disorder's factor structure in clinic-referred youth.

    PubMed

    Contractor, Ateka A; Claycomb, Meredith A; Byllesby, Brianna M; Layne, Christopher M; Kaplow, Julie B; Steinberg, Alan M; Elhai, Jon D

    2015-09-01

    The severity of posttraumatic stress disorder (PTSD) symptoms is linked to race and ethnicity, albeit with contradictory findings (reviewed in Alcántara, Casement, & Lewis-Fernández, 2013; Pole, Gone, & Kulkarni, 2008). We systematically examined Caucasian (n = 3,767) versus non-Caucasian race (n = 2,824) and Hispanic (n = 2,395) versus non-Hispanic ethnicity (n = 3,853) as candidate moderators of PTSD's 5-factor model structural parameters (Elhai et al., 2013). The sample was drawn from the National Child Traumatic Stress Network's Core Data Set, currently the largest national data set of clinic-referred children and adolescents exposed to potentially traumatic events. Using confirmatory factor analysis, we tested the invariance of PTSD symptom structural parameters by race and ethnicity. Chi-square difference tests and goodness-of-fit values showed statistical equivalence across racial and ethnic groups in the factor structure of PTSD and in mean item-level indicators of PTSD symptom severity. Results support the structural invariance of PTSD's 5-factor model across the compared racial and ethnic groups. Furthermore, results indicated equivalent item-level severity across racial and ethnic groups; this supports the use of item-level comparisons across these groups.

  1. Comparative Evaluation for Brain Structural Connectivity Approaches: Towards Integrative Neuroinformatics Tool for Epilepsy Clinical Research

    PubMed Central

    Yang, Sheng; Tatsuoka, Curtis; Ghosh, Kaushik; Lacuey-Lecumberri, Nuria; Lhatoo, Samden D.; Sahoo, Satya S.

    2016-01-01

    Recent advances in brain fiber tractography algorithms and diffusion Magnetic Resonance Imaging (MRI) data collection techniques are providing new approaches to study brain white matter connectivity, which play an important role in complex neurological disorders such as epilepsy. Epilepsy affects approximately 50 million persons worldwide and it is often described as a disorder of the cortical network organization. There is growing recognition of the need to better understand the role of brain structural networks in the onset and propagation of seizures in epilepsy using high resolution non-invasive imaging technologies. In this paper, we perform a comparative evaluation of two techniques to compute structural connectivity, namely probabilistic fiber tractography and statistics derived from fractional anisotropy (FA), using diffusion MRI data from a patient with rare case of medically intractable insular epilepsy. The results of our evaluation demonstrate that probabilistic fiber tractography provides a more accurate map of structural connectivity and may help address inherent complexities of neural fiber layout in the brain, such as fiber crossings. This work provides an initial result towards building an integrative informatics tool for neuroscience that can be used to accurately characterize the role of fiber tract connectivity in neurological disorders such as epilepsy. PMID:27570685

  2. Factor structure of the SOCRATES in a clinical sample of adolescents.

    PubMed

    Maisto, Stephen A; Chung, Tammy A; Cornelius, Jack R; Martin, Christopher S

    2003-06-01

    This study investigated the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; W. R. Miller & J. S. Tonigan, 1996) in adolescents presenting for treatment of alcohol use disorder (AUD). The participants were 80 males and 43 females (mean age = 16.8 years) who presented for AUD treatment (95.1% outpatient, 4.9% inpatient). Participants completed assessments at baseline and 1 year and provided information on alcohol use and related variables monthly between these 2 assessments. Principal-components and confirmatory factor analyses of the baseline SOCRATES identified 2 factors, Taking Steps and Recognition, which showed good internal consistency and concurrent and predictive evidence of validity. The results were interpreted as supporting the use of the SOCRATES with clinical samples of adolescents.

  3. Structure and Measurement of Depression in Youth: Applying Item Response Theory to Clinical Data

    PubMed Central

    Cole, David A.; Cai, Li; Martin, Nina C.; Findling, Robert L; Youngstrom, Eric A.; Garber, Judy; Curry, John F.; Hyde, Janet S.; Essex, Marilyn J.; Compas, Bruce E.; Goodyer, Ian M.; Rohde, Paul; Stark, Kevin D.; Slattery, Marcia J.; Forehand, Rex

    2013-01-01

    Goals of the paper were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3403 clinic and nonclinic children and adolescents from 12 contributing samples, all of whom received the Kiddie Schedule of Affective Disorders and Schizophrenia for school-aged children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Results further demonstrated that utilization of IRT-based information about symptom severity and discriminability in the measurement of depression severity can reduce measurement error and increase measurement fidelity. PMID:21534696

  4. Albumin Homodimers in Patients with Cirrhosis: Clinical and Prognostic Relevance of a Novel Identified Structural Alteration of the Molecule

    PubMed Central

    Baldassarre, Maurizio; Domenicali, Marco; Naldi, Marina; Laggetta, Maristella; Giannone, Ferdinando A.; Biselli, Maurizio; Patrono, Daniela; Bertucci, Carlo; Bernardi, Mauro; Caraceni, Paolo

    2016-01-01

    Decompensated cirrhosis is associated to extensive post-transcriptional changes of human albumin (HA). This study aims to characterize the occurrence of HA homodimerization in a large cohort of patients with decompensated cirrhosis and to evaluate its association with clinical features and prognosis. HA monomeric and dimeric isoforms were identified in peripheral blood by using a HPLC-ESI-MS technique in 123 cirrhotic patients hospitalized for acute decompensation and 50 age- and sex-comparable healthy controls. Clinical and biochemical parameters were recorded and patients followed up to one year. Among the monomeric isoforms identified, the N- and C-terminal truncated and the native HA underwent homodimerization. All three homodimers were significantly more abundant in patients with cirrhosis, acute-on-chronic liver failure and correlate with the prognostic scores. The homodimeric N-terminal truncated isoform was independently associated to disease complications and was able to stratify 1-year survival. As a result of all these changes, the monomeric native HA was significantly decreased in patients with cirrhosis, being also associated with a poorer prognosis. In conclusion homodimerization is a novel described structural alteration of the HA molecule in decompensated cirrhosis and contributes to the progressive reduction of the monomeric native HA, the only isoform provided of structural and functional integrity. PMID:27782157

  5. Subjectivity, objectivity, and triangular space.

    PubMed

    Britton, Ronald

    2004-01-01

    The author reviews his ideas on subjectivity, objectivity, and the third position in the psychoanalytic encounter, particularly in clinical work with borderline and narcissistic patients. Using the theories of Melanie Klein and Wilfred Bion as a basis, the author describes his concept of triangular space. A case presentation of a particular type of narcissistic patient illustrates the principles discussed.

  6. Structural Mechanics Predictions Relating to Clinical Coronary Stent Fracture in a 5 Year Period in FDA MAUDE Database

    PubMed Central

    Everett, Kay D.; Conway, Claire; Desany, Gerard J.; Baker, Brian L.; Choi, Gilwoo; Taylor, Charles A.; Edelman, Elazer R.

    2016-01-01

    Endovascular stents are the mainstay of interventional cardiovascular medicine. Technological advances have reduced biological and clinical complications but not mechanical failure. Stent strut fracture is increasingly recognized as of paramount clinical importance. Though consensus reigns that fractures can result from material fatigue, how fracture is induced and the mechanisms underlying its clinical sequelae remain ill-defined. In this study, strut fractures were identified in the prospectively maintained Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience Database (MAUDE), covering years 2006–2011, and differentiated based on specific coronary artery implantation site and device configuration. These data, and knowledge of the extent of dynamic arterial deformations obtained from patient CT images and published data, were used to define boundary conditions for 3D finite element models incorporating multimodal, multi-cycle deformation. The structural response for a range of stent designs and configurations was predicted by computational models and included estimation of maximum principal, minimum principal and equivalent plastic strains. Fatigue assessment was performed with Goodman diagrams and safe/unsafe regions defined for different stent designs. Von Mises stress and maximum principal strain increased with multimodal, fully reversed deformation. Spatial maps of unsafe locations corresponded to the identified locations of fracture in different coronary arteries in the clinical database. These findings, for the first time, provide insight into a potential link between patient adverse events and computational modeling of stent deformation. Understanding of the mechanical forces imposed under different implantation conditions may assist in rational design and optimal placement of these devices. PMID:26467552

  7. Multi-objective optimization of typhoon inundation forecast models with cross-site structures for a water-level gauging network by integrating ARMAX with a genetic algorithm

    NASA Astrophysics Data System (ADS)

    Ouyang, Huei-Tau

    2016-08-01

    The forecasting of inundation levels during typhoons requires that multiple objectives be taken into account, including the forecasting capacity with regard to variations in water level throughout the entire weather event, the accuracy that can be attained in forecasting peak water levels, and the time at which peak water levels are likely to occur. This paper proposed a means of forecasting inundation levels in real time using monitoring data from a water-level gauging network. ARMAX was used to construct water-level forecast models for each gauging station using input variables including cumulative rainfall and water-level data from other gauging stations in the network. Analysis of the correlation between cumulative rainfall and water-level data makes it possible to obtain the appropriate accumulation duration of rainfall and the time lags associated with each gauging station. Analyses on cross-site water levels as well as on cumulative rainfall enable the identification of associate sites pertaining to each gauging station that share high correlations with regard to water level and low mutual information with regard to cumulative rainfall. Water-level data from the identified associate sites are used as a second input variable for the water-level forecast model of the target site. Three indices were considered in the selection of an optimal model: the coefficient of efficiency (CE), error in the stage of peak water level (ESP), and relative time shift (RTS). A multi-objective genetic algorithm was employed to derive an optimal Pareto set of models capable of performing well in the three objectives. A case study was conducted on the Xinnan area of Yilan County, Taiwan, in which optimal water-level forecast models were established for each of the four water-level gauging stations in the area. Test results demonstrate that the model best able to satisfy ESP exhibited significant time shift, whereas the models best able to satisfy CE and RTS provide accurate

  8. The structure of peritraumatic dissociation: a cross validation in clinical and nonclinical samples.

    PubMed

    Sijbrandij, Marit; Engelhard, Iris M; Opmeer, Brent C; van de Schoot, Rens; Carlier, Ingrid V E; Gersons, Berthold P R; Olff, Miranda

    2012-08-01

    Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma-exposed samples: (a) trauma-exposed police officers (N = 219); (b) trauma-exposed civilians (N = 158); and (c) treatment-seeking trauma-exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2-factor structure (CFIs .96-.98; RMSEAs .07-.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow-up only in the sample of police officers (R(2) = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.

  9. Endothelial nitric oxide synthase: From biochemistry and gene structure to clinical implications of NOS3 polymorphisms.

    PubMed

    Oliveira-Paula, Gustavo H; Lacchini, Riccardo; Tanus-Santos, Jose E

    2016-01-10

    Nitric oxide (NO) is an important vasodilator with a well-established role in cardiovascular homeostasis. While mediator is synthesized from L-arginine by neuronal, endothelial, and inducible nitric oxide synthases (NOS1,NOS3 and NOS2 respectively), NOS3 is the most important isoform for NO formation in the cardiovascular system. NOS3 is a dimeric enzyme whose expression and activity are regulated at transcriptional, posttranscriptional,and posttranslational levels. The NOS3 gene, which encodes NOS3, exhibits a number of polymorphic sites including single nucleotide polymorphisms (SNPs), variable number of tandem repeats (VNTRs), microsatellites, and insertions/deletions. Some NOS3 polymorphisms show functional effects on NOS3 expression or activity, thereby affecting NO formation. Interestingly, many studies have evaluated the effects of functional NOS3 polymorphisms on disease susceptibility and drug responses. Moreover, some studies have investigated how NOS3 haplotypes may impact endogenous NO formation and disease susceptibility. In this article,we carried out a comprehensive review to provide a basic understanding of biochemical mechanisms involved in NOS3 regulation and how genetic variations in NOS3 may translate into relevant clinical and pharmacogenetic implications.

  10. COGNITION, ACTION, AND OBJECT MANIPULATION

    PubMed Central

    Rosenbaum, David A.; Chapman, Kate M.; Weigelt, Matthias; Weiss, Daniel J.; van der Wel, Robrecht

    2012-01-01

    Although psychology is the science of mental life and behavior, it has paid little attention to the means by which mental life is translated into behavior. One domain where links between cognition and action have been explored is the manipulation of objects. This article reviews psychological research on this topic, with special emphasis on the tendency to grasp objects differently depending on what one plans to do with the objects. Such differential grasping has been demonstrated in a wide range of object manipulation tasks, including grasping an object in a way that reveals anticipation of the object's future orientation, height, and required placement precision. Differential grasping has also been demonstrated in a wide range of behaviors, including one-hand grasps, two-hand grasps, walking, and transferring objects from place to place as well as from person to person. The populations in whom the tendency has been shown are also diverse, including nonhuman primates as well as human adults, children, and babies. Meanwhile, the tendency is compromised in a variety of clinical populations and in children of a surprisingly advanced age. Verbal working memory is compromised as well if words are memorized while object manipulation tasks are performed; the recency portion of the serial position curve is reduced in this circumstance. In general, the research reviewed here points to rich connections between cognition and action as revealed through the study of object manipulation. Other implications concern affordances, Donders' Law, and naturalistic observation and the teaching of psychology. PMID:22448912

  11. A Structured Protocol Model of Depression Care versus Clinical Acumen: A Cluster Randomized Trial of the Effects on Depression Screening, Diagnostic Evaluation, and Treatment Uptake in Ugandan HIV Clinics

    PubMed Central

    Wagner, Glenn J.; Ngo, Victoria; Goutam, Prodyumna; Glick, Peter; Musisi, Seggane; Akena, Dickens

    2016-01-01

    Depression is common among people living with HIV, and it has consequences for both HIV prevention and treatment response, yet depression treatment is rarely integrated into HIV care in sub-Saharan Africa, partly due to the paucity of mental health professionals. We conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by medical providers: one that utilized a structured protocol, and one that relied on clinical acumen, in 10 HIV clinics in Uganda. Both models started with routine depression screening of all clients at triage using the 2-item Patient Health Questionnaire (PHQ-2), from which we enrolled 1252 clients (640 at structured protocol clinics, 612 at clinical acumen clinics) who had screened positive over 12 months. We compared the two models on (1) proportion of all client participants, and those clinically depressed (based on survey-administered 9-item PHQ-9>9), who received post-screening evaluation for depression using the PHQ-9; and (2) proportion of clinically depressed who were prescribed antidepressant therapy. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering; patient characteristics, clinic size and time fixed effects were included as covariates. Among all client participants, those in the structured protocol arm were far more likely to have received further evaluation by a medical provider using the PHQ-9 (84% vs. 49%; beta = .33; p = .01). Among the clinically depressed clients (n = 369), the advantage of the structured protocol model over clinical acumen was not statistically significant with regard to PHQ-9 depression evaluation (93% vs. 68%; beta = .21; p = .14) or prescription of antidepressants (69% vs. 58%; beta = .10; p = .50), in part because only 30% of clients who screened positive were clinically depressed. These findings reveal that in both models depression care practices were widely adopted by providers, and

  12. The Zoo Trip: Objecting to Objectives

    ERIC Educational Resources Information Center

    Poetter, Thomas S.

    2006-01-01

    In this article, the author objects to what curricularists and teachers often believe that meaningful activities in school have to be scripted, planned to the nth degree and assigned learning objectives and goals ahead of time, or they have no educational worth. Instead, he used Elliot Eisner's classic curriculum text, "The Educational…

  13. Object links in the repository

    NASA Technical Reports Server (NTRS)

    Beck, Jon; Eichmann, David

    1991-01-01

    Some of the architectural ramifications of extending the Eichmann/Atkins lattice-based classification scheme to encompass the assets of the full life-cycle of software development are explored. In particular, we wish to consider a model which provides explicit links between objects in addition to the edges connecting classification vertices in the standard lattice. The model we consider uses object-oriented terminology. Thus, the lattice is viewed as a data structure which contains class objects which exhibit inheritance. A description of the types of objects in the repository is presented, followed by a discussion of how they interrelate. We discuss features of the object-oriented model which support these objects and their links, and consider behavior which an implementation of the model should exhibit. Finally, we indicate some thoughts on implementing a prototype of this repository architecture.

  14. Review: Contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates.

    PubMed

    Costanza, A; Weber, K; Gandy, S; Bouras, C; Hof, P R; Giannakopoulos, P; Canuto, A

    2011-10-01

    Professional boxers and other contact sport athletes are exposed to repetitive brain trauma that may affect motor functions, cognitive performance, emotional regulation and social awareness. The term of chronic traumatic encephalopathy (CTE) was recently introduced to regroup a wide spectrum of symptoms such as cerebellar, pyramidal and extrapyramidal syndromes, impairments in orientation, memory, language, attention, information processing and frontal executive functions, as well as personality changes and behavioural and psychiatric symptoms. Magnetic resonance imaging usually reveals hippocampal and vermis atrophy, a cavum septum pellucidum, signs of diffuse axonal injury, pituitary gland atrophy, dilated perivascular spaces and periventricular white matter disease. Given the partial overlapping of the clinical expression, epidemiology and pathogenesis of CTE and Alzheimer's disease (AD), as well as the close association between traumatic brain injuries (TBIs) and neurofibrillary tangle formation, a mixed pathology promoted by pathogenetic cascades resulting in either CTE or AD has been postulated. Molecular studies suggested that TBIs increase the neurotoxicity of the TAR DNA-binding protein 43 (TDP-43) that is a key pathological marker of ubiquitin-positive forms of frontotemporal dementia (FTLD-TDP) associated or not with motor neurone disease/amyotrophic lateral sclerosis (ALS). Similar patterns of immunoreactivity for TDP-43 in CTE, FTLD-TDP and ALS as well as epidemiological correlations support the presence of common pathogenetic mechanisms. The present review provides a critical update of the evolution of the concept of CTE with reference to its neuropathological definition together with an in-depth discussion of the differential diagnosis between this entity, AD and frontotemporal dementia.

  15. [Objectivity of BSE symptoms using Bayes theorem].

    PubMed

    Hässig, M; Urech Hässig, B; Knubben-Schweizer, G

    2011-12-01

    In clinical epidemiology the Bayes theorem finds ever more use to render clinical acting more objective. It is shown that unusual examinations of BSE (bovine spongiform encephalopathy) as noise producing with ladle covers may quite objectively be evaluated. With the help of the likelihood ratio computed thereby, also a ranking of importance (clinical utility) of symptoms can be provided. The single most important symptom for BSE is photosensibility.

  16. Picturing Objects in Infancy

    ERIC Educational Resources Information Center

    Shinskey, Jeanne L.; Jachens, Liza J.

    2014-01-01

    Infants' transfer of information from pictures to objects was tested by familiarizing 9-month-olds (N = 31) with either a color or black-and-white photograph of an object and observing their preferential reaching for the real target object versus a distractor. One condition tested object recognition by keeping both objects visible, and the…

  17. Selecting a Reference Object

    ERIC Educational Resources Information Center

    Miller, Jared E.; Carlson, Laura A.; Hill, Patrick L.

    2011-01-01

    One way to describe the location of an object is to relate it to another object. Often there are many nearby objects, each of which could serve as a candidate to be the reference object. A common theoretical assumption is that features that make a given object salient relative to the candidate set are instrumental in determining which is selected.…

  18. Development of a metacognitive effort construct of empathy during clinical training: a longitudinal study of the factor structure of the Jefferson Scale of Empathy.

    PubMed

    Stansfield, R Brent; Schwartz, Alan; O'Brien, Celia Laird; Dekhtyar, Michael; Dunham, Lisette; Quirk, Mark

    2016-03-01

    Empathy is crucial for effective clinical care but appears to decline during undergraduate medical training. Understanding the nature of this decline is necessary for addressing it. The Jefferson Scale of Empathy (JSE) is used to measure medical students' clinical empathy attitudes. One recent study described a 3-factor model of the JSE. This model was found in responses from matriculating medical students, but little is known about how the factor structure of the scale changes during clinical training. The Learning Environment Study is a longitudinal prospective study of two cohorts from 28 medical schools. At matriculation and at the end of each subsequent year, students self-reported clinical empathy attitudes using the JSE. Data from 4,797 students were randomly partitioned for exploratory (EFA) and confirmatory factor analyses using responses from preclinical and clinical years of medical school. Five models were compared for confirmatory factor analysis: two null models for control, the recent 3-factor model, and the two models resulting from the EFAs of preclinical and clinical year responses. Preclinical year responses yielded a 3-factor model similar to the recent 3-factor model. Clinical year responses yielded a 4-factor model ("feelings," "importance," "ease," and "metacognitive effort") suggesting changes in the structure of clinical empathy attitudes over time. Metacognitive effort showed the largest decline over time. The model is a better fit for both preclinical and clinical responses and may provide more insight into medical students' clinical empathy attitudes than other models. The emergence of metacognitive effort in the clinical years suggests empathy may become more nuanced for students after clinical exposure and may account for much of the observed decline in clinical empathy attitudes.

  19. Breadth versus volume: Neurology outpatient clinic cases in medical education.

    PubMed

    Albert, Dara V; Blood, Angela D; Park, Yoon Soo; Brorson, James R; Lukas, Rimas V

    2016-06-01

    This study examined how volume in certain patient case types and breadth across patient case types in the outpatient clinic setting are related to Neurology Clerkship student performance. Case logs from the outpatient clinic experience of 486 students from The University of Chicago Pritzker School of Medicine, USA, participating in the 4week Neurology Clerkship from July 2008 to June 2013 were reviewed. A total of 12,381 patient encounters were logged and then classified into 13 diagnostic categories. How volume of cases within categories and the breadth of cases across categories relate to the National Board of Medical Examiners Clinical Subject Examination for Neurology and a Neurology Clerkship Objective Structured Clinical Examination was analyzed. Volume of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r=.290, p<.001), the Objective Structured Clinical Examination physical examination (r=.236, p=.011), and the Objective Structured Clinical Examination patient note (r=.238, p=.010). Breadth of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r=.231, p=.017), however was not significantly correlated with any component of the Objective Structured Clinical Examination. Volume of cases correlated with higher performance on measures of specialty knowledge and clinical skill. Fewer relationships emerged correlating breadth of cases and performance on the same measures. This study provides guidance to educators who must decide how much emphasis to place on volume versus breadth of cases in outpatient clinic learning experiences.

  20. Clinical efficacy of dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI)

    PubMed Central

    Leuthner, Kimberly D; Buechler, Kristin A; Kogan, David; Saguros, Agafe; Lee, H Stephen

    2016-01-01

    Acute bacterial skin and skin structure infections (ABSSSI) are a common disease causing patients to seek treatment through the health care system. With the continued increase of drug-resistant bacterial pathogens, these infections are becoming more difficult to successfully cure. Lipoglycopeptides have unique properties that allow the drug to remain active toward both common and challenging pathogens at the infected site for lengthy periods of time. Dalbavancin, a new lipoglycopeptide, provides two unique dosing regimens for the treatment of ABSSSI. The original regimen of 1,000 mg intravenous infusion followed by a 500 mg intravenous infusion after a week has been shown as safe and effective in multiple, randomized noninferiority trials. These studies also demonstrated that dalbavancin was similar to standard regimens in terms of both safety and tolerability. Recently a single 1,500 mg dose was demonstrated to be equivalent to the dalbavancin two-dose regimen for treating ABSSSI. With the introduction of dalbavancin, clinicians have the option to provide an intravenous antimicrobial agent shown to be as effective as traditional therapies, without requiring admission into the hospitals or prescribing a medication which may not be utilized optimally. Further understanding of dalbavancin and its unusual properties can provide unique treatment situations with potential benefits for both the patient and the overall health care system, which should be further explored. PMID:27354809

  1. Effects of adrenal cortex hormones on limbic structures: some experimental and clinical correlations related to depression.

    PubMed Central

    Dubrovsky, B

    1993-01-01

    Cushing's disorder and depression present overlapping although not identical psychological symptomatology. In turn, a subset of patients with affective disorders present with hypercortisolemia and disturbances, specifically disinhibition, of the hypothalamic hypophysio adrenal axis (HHAA). Memory disturbances, in particular, biasing toward negative contents, overlapping sleep abnormalities (marked reduction of stages 3 and 4) increased fatigue and loss of energy, attentional deficits and irritability, are just part of the common symptomatology presented by patients with both Cushing's disorder and depression. All of these behavioral manifestations are known to be affected by adrenal steroid hormones. There is consensus that hippocampal structures are a main target for adrenal steroid hormones; hence, these neural regions are some of the most likely mediators of the effects of corticoadrenal steroids on behavior. This paper proposes that an imbalance of adrenal steroids and their metabolites may play a fundamental role in the psychophysiopathology of Cushing's and depressive disorders. The imbalance of these hormones, especially at limbic sites, could distort mood and memory content affecting cognition based on recollection and present experiences. Reestablishing an adrenal balance could therefore be considered as a therapeutic aid in a subset of depressive disorders. PMID:8461280

  2. Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I)

    PubMed Central

    Sanchez-Villegas, Almudena; Schlatter, Javier; Ortuno, Felipe; Lahortiga, Francisca; Pla, Jorge; Benito, Silvia; Martinez-Gonzalez, Miguel A

    2008-01-01

    Background Depression assessment in population studies is usually based on depressive symptoms scales. However, the use of scales could lead to the choice of an arbitrary cut-off point depending on the sample characteristics and on the patient diagnosis. Thus, the use of a medical diagnosis of depression could be a more appropriate approach. Objective To validate a self-reported physician diagnosis of depression using the Structured Clinical Interview for DSM-IV (SCID-I) as Gold Standard and to assess the factors associated to a valid self-reported diagnosis. Methods The SUN Project is a cohort study based on university graduates followed-up through postal questionnaires. The response to the question included in the questionnaire: Have you ever been diagnosed of depression by a physician? was compared to that obtained through the SCID-I applied by a psychiatrist or a clinical psychologist. The percentages of confirmed depression and non-depression were assessed for the overall sample and according to several characteristics. Logistic regression models were fitted to ascertain the association between different factors and a correct classification regarding depression status. Results The percentage of confirmed depression was 74.2%; 95% confidence interval (95% CI) = 63.3–85.1. Out of 42 participants who did not report a depression diagnosis in the questionnaire, 34 were free of the disease (%confirmed non-depression = 81.1%; 95% CI = 69.1–92.9). The probability of being a true positive was higher among ex-smokers and non-smokers and among those overweight or obese but the differences were not statistically significant. Conclusion The validity of a self-reported diagnosis of depression in the SUN cohort is adequate. Thus, this question about depression diagnosis could be used in further investigations regarding this disease in this graduate cohort study. PMID:18558014

  3. Behavioral Objectives?-No!

    ERIC Educational Resources Information Center

    Ferguson, Bill L.

    1971-01-01

    Discusses his reasons for objecting to the use of behavioral objectives in education. Article is in response to Robert Blake's article on Behavioral Objectives and the Teaching of English" in English Education, Winter 1971. (RB)

  4. Internal Structure and Clinical Utility of the Anxiety Control Questionnaire-Revised (ACQ-R) Spanish Version.

    PubMed

    Osma, Jorge; Barrada, Juan Ramón; García-Palacios, Azucena; Navarro-Haro, María; Aguilar, Alejandra

    2016-10-03

    Perceived control has shown predictive value for anxiety severity symptoms as well as cognitive-behavior therapy outcomes. The most commonly used measure of perceived control is the Anxiety Control Questionnaire (ACQ), and more recently the ACQ Revised (ACQ-R). However, both questionnaires have shown structural inconsistencies among several studies. Also, although the ACQ and ACQ-R seem to be multidimensional instruments, a single total score have been commonly used. This study examined the internal structure of the ACQ-R Spanish version using exploratory factor and exploratory bi-factor analysis in a sample of 382 college students and 52 people diagnosed of panic disorder (with or without agoraphobia). Also, in this study we assessed the preliminary diagnostic value of the ACQ-R scores. The results indicated that the ACQ-R Spanish version structure consisted of two factors: one related with perceived control of internal emotional reactions (Emotion Control) and another related with perceived control of external events (Threat and Stress Control). Both specific factors can be adequately summarized by a general factor (General Anxiety Perception of Control; CFI = .973, TLI = .954, RMSEA = .039; p = .002), which accounted for 70% of the common explained variance. The correlations between the ACQ-R scores and with variables like anxiety (r = -.66) or anxiety sensitivity (r = -.50) presented the expected pattern of results. Either the two dimensions structure or the total score have proved to be a good tool to distinguish between participants with panic disorder and non-clinical samples (area under the curve = 0.79).

  5. How do students with dyslexia perform in extended matching questions, short answer questions and observed structured clinical examinations?

    PubMed

    Gibson, Sandra; Leinster, Samuel

    2011-08-01

    There are an increasing number of students with learning difficulties attending university, and currently much debate about the suitability and ability of students with dyslexia at both medical school and once they graduate into clinical practice. In this study we describe the performance of students with dyslexia compared to fellow students in extended matching questions (EMQ), short answer question (SAQ) and observed structured clinical examinations (OSCE) and discuss the implications of differences identified. End of year assessment results for 5 cohorts of medical students were analysed. Students with dyslexia did less well overall in all assessment types in year 1 but this difference was not evident in later years. Dyslexic students who were allowed extra time in written assessments did better than dyslexic students who did not have their assessment concessions in place. When station type within OSCE assessments was analysed students with dyslexia did less well in both examination skills and data interpretation stations in years 1, 2 & 3. In conclusion, differences in performance in written assessments are only evident early in training and may be partly due to delayed adjustment to medical school or implementation of assessment concessions. Performance in individual OSCE stations is dependent on station type. Why students with specific learning difficulties (SpLDs) perform less well in examination skills and data analysis OSCE stations requires further investigation.

  6. [Performance of the Self-Reporting Questionnaire as a psychiatric screening questionnaire: a comparative study with Structured Clinical Interview for DSM-IV-TR].

    PubMed

    Gonçalves, Daniel Maffasioli; Stein, Airton Tetelbon; Kapczinski, Flavio

    2008-02-01

    The SRQ (Self-Reporting Questionnaire) is a psychiatric screening tool that originally included 30 questions. The Brazilian version of SRQ-20 (a version that includes the 20 items for non-psychotic mental disorders) was validated in the early 1980s. The objective of the present study was to validate the Brazilian version of SRQ-20 and the 5 items for alcohol-related disorders as compared to the SCID-IV-TR (Structured Clinical Interview for DSM-IV-TR) as the gold standard. The study was conducted in Santa Cruz do Sul, a small town in southern Brazil, with 485 subjects (54.8% females, mean age 40.04 years). The 5 items for alcohol-related disorders showed low sensitivity (66%). The optimum cutoff value for SRQ-20 was 7/8, with 86.33% sensitivity and 89.31% specificity. The discriminant power of SRQ-20 for psychiatric screening was 0.9, and Cronbach's alpha was 0.86.

  7. Development and implementation of an automatic integration system for fibre optic sensors in the braiding process with the objective of online-monitoring of composite structures

    NASA Astrophysics Data System (ADS)

    Hufenbach, W.; Gude, M.; Czulak, A.; Kretschmann, Martin

    2014-04-01

    Increasing economic, political and ecological pressure leads to steadily rising percentage of modern processing and manufacturing processes for fibre reinforced polymers in industrial batch production. Component weights beneath a level achievable by classic construction materials, which lead to a reduced energy and cost balance during product lifetime, justify the higher fabrication costs. However, complex quality control and failure prediction slow down the substitution by composite materials. High-resolution fibre-optic sensors (FOS), due their low diameter, high measuring point density and simple handling, show a high applicability potential for an automated sensor-integration in manufacturing processes, and therefore the online monitoring of composite products manufactured in industrial scale. Integrated sensors can be used to monitor manufacturing processes, part tests as well as the component structure during product life cycle, which simplifies allows quality control during production and the optimization of single manufacturing processes.[1;2] Furthermore, detailed failure analyses lead to a enhanced understanding of failure processes appearing in composite materials. This leads to a lower wastrel number and products of a higher value and longer product life cycle, whereby costs, material and energy are saved. This work shows an automation approach for FOS-integration in the braiding process. For that purpose a braiding wheel has been supplemented with an appliance for automatic sensor application, which has been used to manufacture preforms of high-pressure composite vessels with FOS-networks integrated between the fibre layers. All following manufacturing processes (vacuum infiltration, curing) and component tests (quasi-static pressure test, programmed delamination) were monitored with the help of the integrated sensor networks. Keywords: SHM, high-pressure composite vessel, braiding, automated sensor integration, pressure test, quality control, optic

  8. Uniqueness Theorem for Black Objects

    SciTech Connect

    Rogatko, Marek

    2010-06-23

    We shall review the current status of uniqueness theorem for black objects in higher dimensional spacetime. At the beginning we consider static charged asymptotically flat spacelike hypersurface with compact interior with both degenerate and non-degenerate components of the event horizon in n-dimensional spacetime. We gave some remarks concerning partial results in proving uniqueness of stationary axisymmetric multidimensional solutions and winding numbers which can uniquely characterize the topology and symmetry structure of black objects.

  9. Structure-based prediction of subtype-selectivity of Histamine H3 receptor selective antagonists in clinical trials

    PubMed Central

    Kim, Soo-Kyung; Fristrup, Peter; Abrol, Ravinder; Goddard, William A.

    2011-01-01

    Histamine receptors (HRs) are excellent drug targets for the treatment of diseases such as schizophrenia, psychosis, depression, migraine, allergies, asthma ulcers, and hypertension. Among them, the human H3 Histamine receptor (hH3HR) antagonists have been proposed for specific therapeutic applications, including treatment of Alzheimer's disease, attention deficit hyperactivity disorder (ADHD), epilepsy, and obesity.1 However, many of these drug candidates cause undesired side effects through the cross-reactivity with other histamine receptor subtypes. In order to develop improved selectivity and activity for such treatments it would be useful to have the three dimensional structures for all four HRs. We report here the predicted structures of four HR subtypes (H1, H2, H3, and H4) using the GEnSeMBLE (GPCR Ensemble of Structures in Membrane BiLayer Environment) Monte Carlo protocol.2 sampling ~ 35 million combinations of helix packings to predict the 10 most stable packings for each of the four subtypes. Then we used these best 10 protein structures with the DarwinDock Monte Carlo protocol to sample ~ 50,000*20 poses to predict the optimum ligand-protein structures for various agonists and antagonists. We find that E2065.46 contributes most in binding H3 selective agonists (5, 6, 7) in agreement with experimental mutation studies. We also find that conserved E5.46/ S5.43 in both of hH3HR and hH4HR are involved in H3/ H4 subtype selectivity. In addition, we find that M3786.55 in hH3HR provides additional hydrophobic interactions different from hH4HR (the corresponding amino acid of T3236.55 in hH4HR) to provide additional subtype bias. From these studies we developed a pharmacophore model based on our predictions for known hH3HR selective antagonists in clinical study [ABT-239 1, GSK-189,254 2, PF-3654746 3, and BF2.649 (Tiprolisant) 4] that suggests critical selectivity directing elements are: the basic proton interacting with D1143.32, the spacer, the aromatic

  10. Do gender and age moderate the symptom structure of PTSD? Findings from a national clinical sample of children and adolescents.

    PubMed

    Contractor, Ateka A; Layne, Christopher M; Steinberg, Alan M; Ostrowski, Sarah A; Ford, Julian D; Elhai, Jon D

    2013-12-30

    A substantial body of evidence documents that the frequency and intensity of posttraumatic stress disorder (PTSD) symptoms are linked to such demographic variables as female sex (e.g., Kaplow et al., 2005) and age (e.g., Meiser-Stedman et al., 2008). Considerably less is known about relations between biological sex and age with PTSD's latent factor structure. This study systematically examined the roles that sex and age may play as candidate moderators of the full range of factor structure parameters of an empirically supported five-factor PTSD model (Elhai et al., 2011). The sample included 6591 trauma-exposed children and adolescents selected from the National Child Traumatic Stress Network's Core Data Set. Confirmatory factor analysis using invariance testing (Gregorich, 2006) and comparative fit index difference values (Cheung and Rensvold, 2002) reflected a mixed pattern of test item intercepts across age groups. The adolescent subsample produced lower residual error variances, reflecting less measurement error than the child subsample. Sex did not show a robust moderating effect. We conclude by discussing implications for clinical assessment, theory building, and future research.

  11. Nonclinical and Clinical Enterococcus faecium Strains, but Not Enterococcus faecalis Strains, Have Distinct Structural and Functional Genomic Features

    PubMed Central

    Kim, Eun Bae

    2014-01-01

    Certain strains of Enterococcus faecium and Enterococcus faecalis contribute beneficially to animal health and food production, while others are associated with nosocomial infections. To determine whether there are structural and functional genomic features that are distinct between nonclinical (NC) and clinical (CL) strains of those species, we analyzed the genomes of 31 E. faecium and 38 E. faecalis strains. Hierarchical clustering of 7,017 orthologs found in the E. faecium pangenome revealed that NC strains clustered into two clades and are distinct from CL strains. NC E. faecium genomes are significantly smaller than CL genomes, and this difference was partly explained by significantly fewer mobile genetic elements (ME), virulence factors (VF), and antibiotic resistance (AR) genes. E. faecium ortholog comparisons identified 68 and 153 genes that are enriched for NC and CL strains, respectively. Proximity analysis showed that CL-enriched loci, and not NC-enriched loci, are more frequently colocalized on the genome with ME. In CL genomes, AR genes are also colocalized with ME, and VF are more frequently associated with CL-enriched loci. Genes in 23 functional groups are also differentially enriched between NC and CL E. faecium genomes. In contrast, differences were not observed between NC and CL E. faecalis genomes despite their having larger genomes than E. faecium. Our findings show that unlike E. faecalis, NC and CL E. faecium strains are equipped with distinct structural and functional genomic features indicative of adaptation to different environments. PMID:24141120

  12. Automatic object recognition

    NASA Technical Reports Server (NTRS)

    Ranganath, H. S.; Mcingvale, Pat; Sage, Heinz

    1988-01-01

    Geometric and intensity features are very useful in object recognition. An intensity feature is a measure of contrast between object pixels and background pixels. Geometric features provide shape and size information. A model based approach is presented for computing geometric features. Knowledge about objects and imaging system is used to estimate orientation of objects with respect to the line of sight.

  13. Glycan analysis of Fonsecaea monophora from clinical and environmental origins reveals different structural profile and human antigenic response

    PubMed Central

    Burjack, Juliana R.; Santana-Filho, Arquimedes P.; Ruthes, Andrea C.; Riter, Daniel S.; Vicente, Vania A.; Alvarenga, Larissa M.; Sassaki, Guilherme L.

    2014-01-01

    Dematiaceous fungi constitute a large and heterogeneous group, characterized by having a dark pigment, the dihydroxynaftalen melanin—DHN, inside their cell walls. In nature they are found mainly as soil microbiota or decomposing organic matter, and are spread in tropical and subtropical regions. The fungus Fonsecaea monophora causes chromoblastomycosis in humans, and possesses essential mechanisms that may enhance pathogenicity, proliferation and dissemination inside the host. Glycoconjugates confer important properties to these pathogenic microorganisms. In this work, structural characterization of glycan structures present in two different strains of F. monophora MMHC82 and FE5p4, from clinical and environmental origins, respectively, was performed. Each one were grown on Minimal Medium (MM) and Czapeck-Dox (CD) medium, and the water soluble cell wall glycoconjugates and exopolysaccharides (EPS) were evaluated by NMR, methylation and principal component analysis (PCA). By combining the methylation and 2D NMR analyses, it was possible to visualize the glycosidic profiles of the complex carbohydrate mixtures. Significant differences were observed in β-D-Galf-(1→5) and (1→6) linkages, α- and β-D-Glcp-(1→3), (1→4), and (1→6) units, as well as in α-D-Manp. PCA from 1H-NMR data showed that MMHC82 from CD medium showed a higher variation in the cell wall carbohydrates, mainly related to O-2 substituted β-D-Galf (δ 106.0/5.23 and δ 105.3/5.23) units. In order to investigate the antigenic response of the glycoconjugates, these were screened against serum from chromoblastomycosis patients. The antigen which contained the cell wall of MMHC82 grown in MM had β-D-Manp units that promoted higher antigenic response. The distribution of these fungal species in nature and the knowledge of how cell wall polysaccharides and glycoconjugates structure vary, may contribute to the better understanding and the elucidation of the pathology caused by this fungus. PMID

  14. ADHD: Is Objective Diagnosis Possible?

    PubMed Central

    Johnson, Lynda G.

    2005-01-01

    Although attention deficit/hyperactivity disorder (ADHD) is one of the most common cognitive disorders, the usual diagnostic procedures pursued by psychiatrists, neurologists, pediatricians, and family practitioners are based largely, if not exclusively, on subjective assessments of perceived behavior. The recommended approaches to ADHD diagnosis are reviewed, first from the perspective of the various expert panels, and then from the research literature upon which those recommendations are based. The authors agree that ADHD is a clinical diagnosis, and that the assessment of subjective reports can be systematic. But they propose that objective data should also contribute to the clinical diagnosis of ADHD; and that new computerized assessment technology can generate objective cognitive data in an efficient and cost-effective way. Computerized tests can also improve the assessment of treatment response over time. PMID:21120096

  15. Bulimia and object relations: MMPI and Rorschach variables.

    PubMed

    Parmer, J C

    1991-04-01

    Rorschach and Minnesota Multiphasic Personality Inventory (MMPI) responses from persons vomiting to manage body weight and fat phobia were compared to those from a matched control group to determine the levels of personality structure. These responses were also contrasted with those of representative groups from normal and personality disordered populations. Findings were that the bulimic group's test protocols differed significantly from those of the control group, displaying evidence of serious cognitive slippage and dramatic, emotional and erratic personality structures arrested at the differentiation subphase of ego development. The clinical importance of timely developmental diagnosis and interventions designed to promote object constancy was discussed in light of these findings.

  16. Early Clinical Response as a Predictor of Late Treatment Success in Patients With Acute Bacterial Skin and Skin Structure Infections: Retrospective Analysis of 2 Randomized Controlled Trials.

    PubMed

    Nathwani, Dilip; Corey, Ralph; Das, Anita F; Sandison, Taylor; De Anda, Carisa; Prokocimer, Philippe

    2017-01-15

    In the treatment of acute bacterial skin and skin structure infections, pooled data from 2 clinical trials (N = 1333 patients) showed that programmatic and investigator-assessed early treatment success both had a high positive predictive value (94.3%-100.0%) for late clinical cure, including among hospitalized patients. The negative predictive value of programmatic early success was <20%. These exploratory findings require prospective real-world evaluation.

  17. Selecting a reference object.

    PubMed

    Miller, Jared E; Carlson, Laura A; Hill, Patrick L

    2011-07-01

    One way to describe the location of an object is to relate it to another object. Often there are many nearby objects, each of which could serve as a candidate to be the reference object. A common theoretical assumption is that features that make a given object salient relative to the candidate set are instrumental in determining which is selected. The current research tests this assumption, assessing the relative importance of spatial, perceptual, and functional-interactive features. Three experiments demonstrated that spatial features have the strongest influence on reference object selection, with the perceptual feature of color playing no significant role. Functional-interactive features were shown to be spatially dependent, having an influence only when the spatial configuration enabled an interaction between the located object and the reference object. These findings challenge the common perspective that salience in and of itself dictates reference object selection and argue for a reliance on spatial features.

  18. Use of Drop-In Clinic Versus Appointment-Based Care for LGBT Youth: Influences on the Likelihood to Access Different Health-Care Structures.

    PubMed

    Newman, Bernie S; Passidomo, Kim; Gormley, Kate; Manley, Alecia

    2014-06-01

    The structure of health-care service delivery can address barriers that make it difficult for lesbian, gay, bisexual, and transgender (LGBT) adolescents to use health services. This study explores the differences among youth who access care in one of two service delivery structures in an LGBT health-care center: the drop-in clinic or the traditional appointment-based model. Analysis of 578 records of LGBT and straight youth (aged 14-24) who accessed health care either through a drop-in clinic or appointment-based care within the first year of offering the drop-in clinic reveals patterns of use when both models are available. We studied demographic variables previously shown to be associated with general health-care access to determine how each correlated with a tendency to use the drop-in structure versus routine appointments. Once the covariates were identified, we conducted a logistic regression analysis to identify its association with likelihood of using the drop-in clinic. Insurance status, housing stability, education, race, and gender identity were most strongly associated with the type of clinic used. Youth who relied on Medicaid, those in unstable housing, and African Americans were most likely to use the drop-in clinic. Transgender youth and those with higher education were more likely to use the appointment-based clinic. Although sexual orientation and HIV status were not related to type of clinic used, youth who were HIV positive used the appointment-based clinic more frequently. Both routes to health care served distinct populations who often experience barriers to accessible, affordable, and knowledgeable care. Further study of the factors related to accessing health care may clarify the extent to which drop-in hours in a youth-friendly context may increase the use of health care by the most socially marginalized youth.

  19. Zero-Copy Objects System

    NASA Technical Reports Server (NTRS)

    Burleigh, Scott C.

    2011-01-01

    Zero-Copy Objects System software enables application data to be encapsulated in layers of communication protocol without being copied. Indirect referencing enables application source data, either in memory or in a file, to be encapsulated in place within an unlimited number of protocol headers and/or trailers. Zero-copy objects (ZCOs) are abstract data access representations designed to minimize I/O (input/output) in the encapsulation of application source data within one or more layers of communication protocol structure. They are constructed within the heap space of a Simple Data Recorder (SDR) data store to which all participating layers of the stack must have access. Each ZCO contains general information enabling access to the core source data object (an item of application data), together with (a) a linked list of zero or more specific extents that reference portions of this source data object, and (b) linked lists of protocol header and trailer capsules. The concatenation of the headers (in ascending stack sequence), the source data object extents, and the trailers (in descending stack sequence) constitute the transmitted data object constructed from the ZCO. This scheme enables a source data object to be encapsulated in a succession of protocol layers without ever having to be copied from a buffer at one layer of the protocol stack to an encapsulating buffer at a lower layer of the stack. For large source data objects, the savings in copy time and reduction in memory consumption may be considerable.

  20. [Historiography of medical objects].

    PubMed

    Cid, Felip

    2008-01-01

    It has become acceptable among historians of medicine to profess a predilection for the historiography of medical ideas. But it is justified all the same to ask whether the logical connection really caused the origin, the change, or the disappearance of the medical objects. The interaction of ideas and medical objects assure as much objectivity as possible. In consequence, the contents of the museums, medical objects, is an aspect rather that a branch of the history of medicine.

  1. Presentation on Instructional Objectives

    ERIC Educational Resources Information Center

    Naz, Bibi Asia

    2009-01-01

    "Learning can be defined as change in a student's capacity for performance as a result of experience" (Kenneth D. Moore). The intended changes should be specified in instructional objectives. Viewed in this context, an objective can be defined as a clear and unambiguous description of your instructional intent. An objective is not a…

  2. Teachers and Behavioral Objectives.

    ERIC Educational Resources Information Center

    Frey, Sherman

    A survey of 406 elementary, middle and secondary school teachers attending the 1973 summer session at Northern Illinois University was conducted to determine their familiarity with and exposure to behavioral objectives, their involvement in writing and using behavioral objectives, and their opinion of the effect of behavioral objectives on student…

  3. Behavioral Objectives for English

    ERIC Educational Resources Information Center

    Zoellner, Robert

    1972-01-01

    A review-critique of On Writing Behavioral Objectives for English, by John Maxwell and Anthony Lovat, in which behavioral objectives theory is dominated by a stimulus-response rather than a stimulus-response-reinforcement psychology. The reviewer questions whether behavioral objectives can be applied accurately and without distortion of meanings,…

  4. On the Crime Object

    ERIC Educational Resources Information Center

    Akutaev, Rasul M.; Magomedov, Guseyn B.

    2016-01-01

    The relevance of the research of this problem is caused by the theoretical and practical needs of a specific concept of the crime object as one of the corpus delicti signs essentially the determining and defining its object and objective side, thereby--the nature of socially dangerous act. Besides, being a facultative sign of corpus delicti, the…

  5. Objects in Motion

    ERIC Educational Resources Information Center

    Damonte, Kathleen

    2004-01-01

    One thing scientists study is how objects move. A famous scientist named Sir Isaac Newton (1642-1727) spent a lot of time observing objects in motion and came up with three laws that describe how things move. This explanation only deals with the first of his three laws of motion. Newton's First Law of Motion says that moving objects will continue…

  6. Learning Objects and Gerontology

    ERIC Educational Resources Information Center

    Weinreich, Donna M.; Tompkins, Catherine J.

    2006-01-01

    Virtual AGE (vAGE) is an asynchronous educational environment that utilizes learning objects focused on gerontology and a learning anytime/anywhere philosophy. This paper discusses the benefits of asynchronous instruction and the process of creating learning objects. Learning objects are "small, reusable chunks of instructional media" Wiley…

  7. International Union of Basic and Clinical Pharmacology. CI. Structures and Small Molecule Modulators of Mammalian Adenylyl Cyclases.

    PubMed

    Dessauer, Carmen W; Watts, Val J; Ostrom, Rennolds S; Conti, Marco; Dove, Stefan; Seifert, Roland

    2017-04-01

    Adenylyl cyclases (ACs) generate the second messenger cAMP from ATP. Mammalian cells express nine transmembrane AC (mAC) isoforms (AC1-9) and a soluble AC (sAC, also referred to as AC10). This review will largely focus on mACs. mACs are activated by the G-protein Gαs and regulated by multiple mechanisms. mACs are differentially expressed in tissues and regulate numerous and diverse cell functions. mACs localize in distinct membrane compartments and form signaling complexes. sAC is activated by bicarbonate with physiologic roles first described in testis. Crystal structures of the catalytic core of a hybrid mAC and sAC are available. These structures provide detailed insights into the catalytic mechanism and constitute the basis for the development of isoform-selective activators and inhibitors. Although potent competitive and noncompetitive mAC inhibitors are available, it is challenging to obtain compounds with high isoform selectivity due to the conservation of the catalytic core. Accordingly, caution must be exerted with the interpretation of intact-cell studies. The development of isoform-selective activators, the plant diterpene forskolin being the starting compound, has been equally challenging. There is no known endogenous ligand for the forskolin binding site. Recently, development of selective sAC inhibitors was reported. An emerging field is the association of AC gene polymorphisms with human diseases. For example, mutations in the AC5 gene (ADCY5) cause hyperkinetic extrapyramidal motor disorders. Overall, in contrast to the guanylyl cyclase field, our understanding of the (patho)physiology of AC isoforms and the development of clinically useful drugs targeting ACs is still in its infancy.

  8. Monitoring and analysis of the change process in curriculum mapping compared to the National Competency-based Learning Objective Catalogue for Undergraduate Medical Education (NKLM) at four medical faculties. Part I: Conducive resources and structures

    PubMed Central

    Lammerding-Koeppel, Maria; Giesler, Marianne; Gornostayeva, Maryna; Narciss, Elisabeth; Wosnik, Annette; Zipfel, Stephan; Griewatz, Jan; Fritze, Olaf

    2017-01-01

    Objective: After passing of the National Competency-based Learning Objectives Catalogue in Medicine (Nationaler Kompetenzbasierter Lernzielkatalog Medizin, [NKLM, retrieved on 22.03.2016]), the German medical faculties must take inventory and develop their curricula. NKLM contents are expected to be present, but not linked well or sensibly enough in locally grown curricula. Learning and examination formats must be reviewed for appropriateness and coverage of the competences. The necessary curricular transparency is best achieved by systematic curriculum mapping, combined with effective change management. Mapping a complex existing curriculum and convincing a faculty that this will have benefits is not easy. Headed by Tübingen, the faculties of Freiburg, Heidelberg, Mannheim and Tübingen take inventory by mapping their curricula in comparison to the NKLM, using the dedicated web-based MERLIN-database. This two-part article analyses and summarises how NKLM curriculum mapping could be successful in spite of resistance at the faculties. The target is conveying the widest possible overview of beneficial framework conditions, strategies and results. Part I of the article shows the beneficial resources and structures required for implementation of curriculum mapping at the faculties. Part II describes key factors relevant for motivating faculties and teachers during the mapping process. Method: The network project was systematically planned in advance according to steps of project and change management, regularly reflected on and adjusted together in workshops and semi-annual project meetings. From the beginning of the project, a grounded-theory approach was used to systematically collect detailed information on structures, measures and developments at the faculties using various sources and methods, to continually analyse them and to draw a final conclusion (sources: surveys among the project participants with questionnaires, semi-structured group interviews and

  9. Monitoring and analysis of the change process in curriculum mapping compared to the National Competency-based Learning Objective Catalogue for Undergraduate Medical Education (NKLM) at four medical faculties. Part I: Conducive resources and structures.

    PubMed

    Lammerding-Koeppel, Maria; Giesler, Marianne; Gornostayeva, Maryna; Narciss, Elisabeth; Wosnik, Annette; Zipfel, Stephan; Griewatz, Jan; Fritze, Olaf

    2017-01-01

    Objective: After passing of the National Competency-based Learning Objectives Catalogue in Medicine (Nationaler Kompetenzbasierter Lernzielkatalog Medizin, [NKLM, retrieved on 22.03.2016]), the German medical faculties must take inventory and develop their curricula. NKLM contents are expected to be present, but not linked well or sensibly enough in locally grown curricula. Learning and examination formats must be reviewed for appropriateness and coverage of the competences. The necessary curricular transparency is best achieved by systematic curriculum mapping, combined with effective change management. Mapping a complex existing curriculum and convincing a faculty that this will have benefits is not easy. Headed by Tübingen, the faculties of Freiburg, Heidelberg, Mannheim and Tübingen take inventory by mapping their curricula in comparison to the NKLM, using the dedicated web-based MERLIN-database. This two-part article analyses and summarises how NKLM curriculum mapping could be successful in spite of resistance at the faculties. The target is conveying the widest possible overview of beneficial framework conditions, strategies and results. Part I of the article shows the beneficial resources and structures required for implementation of curriculum mapping at the faculties. Part II describes key factors relevant for motivating faculties and teachers during the mapping process. Method: The network project was systematically planned in advance according to steps of project and change management, regularly reflected on and adjusted together in workshops and semi-annual project meetings. From the beginning of the project, a grounded-theory approach was used to systematically collect detailed information on structures, measures and developments at the faculties using various sources and methods, to continually analyse them and to draw a final conclusion (sources: surveys among the project participants with questionnaires, semi-structured group interviews and

  10. The neuroanatomy of autism spectrum disorder: An overview of structural neuroimaging findings and their translatability to the clinical setting.

    PubMed

    Ecker, Christine

    2017-01-01

    Autism spectrum disorder is a complex neurodevelopmental disorder, which is accompanied by differences in brain anatomy, functioning and brain connectivity. Due to its neurodevelopmental character, and the large phenotypic heterogeneity among individuals on the autism spectrum, the neurobiology of autism spectrum disorder is inherently difficult to describe. Nevertheless, significant progress has been made in characterizing the neuroanatomical underpinnings of autism spectrum disorder across the human life span, and in identifying the molecular pathways that may be affected in autism spectrum disorder. Moreover, novel methodological frameworks for analyzing neuroimaging data are emerging that make it possible to characterize the neuroanatomy of autism spectrum disorder on the case level, and to stratify individuals based on their individual phenotypic make up. While these approaches are increasingly more often employed in the research setting, their applicability in the clinical setting remains a vision for the future. The aim of the current review is to (1) provide a general overview of recent structural neuroimaging findings examining the neuroanatomy of autism spectrum disorder across the human life span, and in males and females with the condition, (2) highlight potential neuroimaging (bio)markers that may in the future be used for the stratification of autism spectrum disorder individuals into biologically homogeneous subgroups and (3) inform treatment and intervention strategies.

  11. Examination of the structural, convergent, and incremental validity of the Reynolds Intellectual Assessment Scales (RIAS) with a clinical sample.

    PubMed

    Nelson, Jason M; Canivez, Gary L

    2012-03-01

    Empirical examination of the Reynolds Intellectual Assessment Scales (RIAS; C. R. Reynolds & R. W. Kamphaus, 2003a) has produced mixed results regarding its internal structure and convergent validity. Various aspects of validity of RIAS scores with a sample (N = 521) of adolescents and adults seeking psychological evaluations at a university-based clinic were examined. Results from exploratory factor analysis indicated only 1 factor, and confirmatory factor analysis (CFA) indicated that the 1-factor model was a good fit and a better fit than the 2-factor model. Hierarchical factor analysis indicated the higher order, general intelligence factor accounted for the largest amount of variance. Correlations with other measures of verbal/crystallized and nonverbal/fluid intelligence were supportive of the convergent validity of the Verbal Intelligence Index but not the Nonverbal Intelligence Index. Joint CFA with these additional measures resulted in a superior fit of the 2-factor model compared with the 1-factor model, although the Odd-Item-Out subtest was found to be a poor measure of nonverbal/fluid intelligence. Incremental validity analyses indicated that the Composite Intelligence Index explained a medium to large portion of academic achievement variance; the NIX and VIX explained a small amount of remaining variance. Implications regarding interpretation of the RIAS when assessing similar individuals are discussed.

  12. Structural Integration as an Adjunct to Outpatient Rehabilitation for Chronic Nonspecific Low Back Pain: A Randomized Pilot Clinical Trial

    PubMed Central

    Jacobson, Eric E.; Meleger, Alec L.; Bonato, Paolo; Wayne, Peter M.; Langevin, Helene M.; Kaptchuk, Ted J.; Davis, Roger B.

    2015-01-01

    Structural Integration (SI) is an alternative method of manipulation and movement education. To obtain preliminary data on feasibility, effectiveness, and adverse events (AE), 46 outpatients from Boston area with chronic nonspecific low back pain (CNSLBP) were randomized to parallel treatment groups of SI plus outpatient rehabilitation (OR) versus OR alone. Feasibility data were acceptable except for low compliance with OR and lengthy recruitment time. Intent-to-treat data on effectiveness were analyzed by Wilcoxon rank sum, n = 23 per group. Median reductions in VAS Pain, the primary outcome, of −26 mm in SI + OR versus 0 in OR alone were not significantly different (P = 0.075). Median reductions in RMDQ, the secondary outcome, of −2 points in SI + OR versus 0 in OR alone were significantly different (P = 0.007). Neither the proportions of participants with nor the seriousness of AE were significantly different. SI as an adjunct to OR for CNSLBP is not likely to provide additional reductions in pain but is likely to augment short term improvements in disability with a low additional burden of AE. A more definitive trial is feasible, but OR compliance and recruitment might be challenging. This trial is registered with ClinicalTrials.gov (NCT01322399). PMID:25945112

  13. Complete Genome Sequence of Rothia mucilaginosa DY-18: A Clinical Isolate with Dense Meshwork-Like Structures from a Persistent Apical Periodontitis Lesion

    DTIC Science & Technology

    2010-09-25

    that R. mucilaginosa DY-18, a clinical isolate from a persistent apical periodontitis lesion, had biofilm -like structures. Similar structures were also...chromosome. Regarding stress responsive systems known to affect biofilm formation in many bacteria, DY-18 genome possessed only two sigma factor genes...complete genome of R. mucilaginosa species and our data raise the possibility that this organism regulates the biofilm phenotype through these stress

  14. Preceptors’ Self-Assessment of Their Ability to Perform the Learning Objectives of an Experiential Program

    PubMed Central

    2012-01-01

    Objective. To evaluate preceptors’ perception of their ability to perform the Structured Practical Experiences in Pharmacy (SPEP) learning objectives through a self-assessment activity. Methods. A self-assessment instrument consisting of 28 learning objectives associated with clinic, community, and hospital pharmacy practice experiences were developed. Preceptors rated their performance ability for each of the learning objectives using a 3-point Likert scale. Results. Of the 116 preceptors, 89 (77%) completed the self-assessment survey instrument. The overall preceptor responses to the items on performance of the 28 SPEP learning objectives ranged from good to excellent. Years of experience, practice experience setting, and involvement as a SPEP or SPEP and PharmD preceptor had no influence on their self-reported capabilities. Conclusion. Most preceptors rated their ability to perform the learning objectives for the structured practical experiences in pharmacy as high. Competency areas requiring further preceptor development were identified. PMID:23193333

  15. Reasoning about Function Objects

    NASA Astrophysics Data System (ADS)

    Nordio, Martin; Calcagno, Cristiano; Meyer, Bertrand; Müller, Peter; Tschannen, Julian

    Modern object-oriented languages support higher-order implementations through function objects such as delegates in C#, agents in Eiffel, or closures in Scala. Function objects bring a new level of abstraction to the object-oriented programming model, and require a comparable extension to specification and verification techniques. We introduce a verification methodology that extends function objects with auxiliary side-effect free (pure) methods to model logical artifacts: preconditions, postconditions and modifies clauses. These pure methods can be used to specify client code abstractly, that is, independently from specific instantiations of the function objects. To demonstrate the feasibility of our approach, we have implemented an automatic prover, which verifies several non-trivial examples.

  16. Ultrathin zoom telescopic objective.

    PubMed

    Li, Lei; Wang, Di; Liu, Chao; Wang, Qiong-Hua

    2016-08-08

    We report an ultrathin zoom telescopic objective that can achieve continuous zoom change and has reduced compact volume. The objective consists of an annular folded lens and three electrowetting liquid lenses. The annular folded lens undertakes the main part of the focal power of the lens system. Due to a multiple-fold design, the optical path is folded in a lens with the thickness of ~1.98mm. The electrowetting liquid lenses constitute a zoom part. Based on the proposed objective, an ultrathin zoom telescopic camera is demonstrated. We analyze the properties of the proposed objective. The aperture of the proposed objective is ~15mm. The total length of the system is ~18mm with a tunable focal length ~48mm to ~65mm. Compared with the conventional zoom telescopic objective, the total length has been largely reduced.

  17. Linking HIV-positive adolescents to care in 15 different clinics across the United States: creating solutions to address structural barriers for linkage to care.

    PubMed

    Philbin, Morgan M; Tanner, Amanda E; Duval, Anna; Ellen, Jonathan; Kapogiannis, Bill; Fortenberry, J Dennis

    2014-01-01

    Linkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering

  18. Do Clinical Evaluations in a Psychiatry Clerkship Favor Students with Positive Personality Characteristics?

    ERIC Educational Resources Information Center

    Chibnall, John T.; Blaskiewicz, Robert J.

    2008-01-01

    Objective: The authors examine associations of personality characteristics, National Board of Medical Examiners subject examination performance, and Objective Structured Clinical Examination performance with clinical evaluations of third-year medical students in a psychiatry clerkship. Methods: Students completed the Revised NEO Personality…

  19. Propelling Extended Objects

    ERIC Educational Resources Information Center

    Humbert, Richard

    2010-01-01

    A force acting on just part of an extended object (either a solid or a volume of a liquid) can cause all of it to move. That motion is due to the transmission of the force through the object by its material. This paper discusses how the force is distributed to all of the object by a gradient of stress or pressure in it, which creates the local…

  20. Moving Object Control System

    NASA Technical Reports Server (NTRS)

    Arndt, G. Dickey (Inventor); Carl, James R. (Inventor)

    2001-01-01

    A method is provided for controlling two objects relatively moveable with respect to each other. A plurality of receivers are provided for detecting a distinctive microwave signal from each of the objects and measuring the phase thereof with respect to a reference signal. The measured phase signal is used to determine a distance between each of the objects and each of the plurality of receivers. Control signals produced in response to the relative distances are used to control the position of the two objects.

  1. From inhibition of radiographic progression to maintaining structural integrity: a methodological framework for radiographic progression in rheumatoid arthritis and psoriatic arthritis clinical trials.

    PubMed

    Landewé, Robert; Strand, Vibeke; van der Heijde, Désirée

    2013-07-01

    Usually, a clinical trial in rheumatoid arthritis and psoriatic arthritis aiming to demonstrate that a new antirheumatic drug treatment can inhibit progression of structural damage has a 'superiority design': The new treatment is compared to placebo or to another active treatment. Currently, many new drug treatments have shown to be able to completely suppress progression (progression rates close to zero). For largely unknown reasons, during the last 10 years, radiographic progression rates in clinical trials have gradually decreased, so that progression rates in the comparator groups are often too low to demonstrate meaningful inhibition, and thus superiority of the new treatment. We here propose an alternative framework to demonstrate that new treatments have the ability to 'preserve structural integrity' rather than to 'inhibit radiographic progression'. Anno 2013, preserving structural integrity is conceptually more realistic than inhibiting radiographic progression.

  2. Crystal structures of the anticancer clinical candidates R115777 (Tipifarnib) and BMS-214662 complexed with protein farnesyltransferase suggest a mechanism of FTI selectivity.

    PubMed

    Reid, T Scott; Beese, Lorena S

    2004-06-08

    The search for new cancer therapeutics has identified protein farnesyltransferase (FTase) as a promising drug target. This enzyme attaches isoprenoid lipids to signal transduction proteins involved in growth and differentiation. The two FTase inhibitors (FTIs), R115777 (tipifarnib/Zarnestra) and BMS-214662, have undergone evaluation as cancer therapeutics in phase I and II clinical trials. R115777 has been evaluated in phase III clinical trials and shows indications for the treatment of blood and breast malignancies. Here we present crystal structures of R115777 and BMS-214662 complexed with mammalian FTase. These structures illustrate the molecular mechanism of inhibition and selectivity toward FTase over the related enzyme, protein geranylgeranyltransferase type I (GGTase-I). These results, combined with previous biochemical and structural analyses, identify features of FTase that could be exploited to modulate inhibitor potency and specificity and should aid in the continued development of FTIs as therapeutics for the treatment of cancer and parasitic infections.

  3. PREPARING INSTRUCTIONAL OBJECTIVES.

    ERIC Educational Resources Information Center

    MAGER, ROBERT F.

    THIS PROGRAMED TEXT INCLUDES A SELF-TEST OF ITS CONTENTS AND DEMONSTRATES HOW TO SPECIFY INSTRUCTIONAL OBJECTIVES BY BEHAVIOR OBSERVABLE IN A LEARNER, AND HOW TO WRITE OBJECTIVES, DEFINE DESIRED TERMINAL BEHAVIOR, AND STATE CRITERIA OF SUCCESSFUL LEARNING. THIS DOCUMENT IS AVAILABLE FOR $1.75 FROM FEARON PUBLISHERS, INC., 2165 PARK BLVD., PALO…

  4. Images of Axial Objects

    ERIC Educational Resources Information Center

    Rabal, Hector; Cap, Nelly; Trivi, Marcelo

    2011-01-01

    Imaging of three-dimensional objects by lenses and mirrors is sometimes poorly indicated in textbooks and can be incorrectly drawn. We stress a need to clarify the concept of longitudinal magnification, with simulated images illustrating distortions introduced along the optical axis. We consider all possible positions of the object for both a…

  5. Manipulator for hollow objects

    DOEpatents

    Cawley, William E.; Frantz, Charles E.

    1977-01-01

    A device for gripping the interior of a tubular object to pull it out of a body in which it has become stuck includes an expandable rubber tube having a plurality of metal cables lodged in the exterior of the rubber tube so as to protrude slightly therefrom, means for inflating the tube and means for pulling the tube longitudinally of the tubular object.

  6. Preparation of Learning Objectives.

    ERIC Educational Resources Information Center

    Bureau of Naval Personnel, Washington, DC.

    The material in this programed workbook is divided into three sections. Section one introduces the subject of learning objectives and explains their use and importance. Section two describes a U.S. Navy handbook on writing learning objectives and teaches the student how to use the handbook as a working reference guide. Section three provides the…

  7. Comparing Students' Feedback about Clinical Instruction with Their Performances.

    ERIC Educational Resources Information Center

    Anderson, David C.; And Others

    1991-01-01

    A study sought to correlate University of Minnesota, Minneapolis clinical medical students' performances in neurology on an objective structured clinical examination with previously and independently collected student feedback on teaching. Student evaluation of instruction was found to accurately reflect more effective teaching occurring at one of…

  8. Eye - foreign object in

    MedlinePlus

    ... KJ, Dennis WR, Hedges JR. Ophthalmologic procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency ... commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer ...

  9. Acoustic Characterization of Mesoscale Objects

    SciTech Connect

    Chinn, D; Huber, R; Chambers, D; Cole, G; Balogun, O; Spicer, J; Murray, T

    2007-03-13

    This report describes the science and engineering performed to provide state-of-the-art acoustic capabilities for nondestructively characterizing mesoscale (millimeter-sized) objects--allowing micrometer resolution over the objects entire volume. Materials and structures used in mesoscale objects necessitate the use of (1) GHz acoustic frequencies and (2) non-contacting laser generation and detection of acoustic waves. This effort demonstrated that acoustic methods at gigahertz frequencies have the necessary penetration depth and spatial resolution to effectively detect density discontinuities, gaps, and delaminations. A prototype laser-based ultrasonic system was designed and built. The system uses a micro-chip laser for excitation of broadband ultrasonic waves with frequency components reaching 1.0 GHz, and a path-stabilized Michelson interferometer for detection. The proof-of-concept for mesoscale characterization is demonstrated by imaging a micro-fabricated etched pattern in a 70 {micro}m thick silicon wafer.

  10. Clinical Librarianship. CE 668.

    ERIC Educational Resources Information Center

    Mosby, Margaret A.; Naisawald, Gretchen

    This course text outlines the objectives and content for a professional continuing education course on clinical medical librarianship. Following an introduction to the course, the history of clinical librarianship and several programs are described. The third section offers guidelines for setting goals and objectives for a clinical librarian…

  11. Methods and strategies of object localization

    NASA Technical Reports Server (NTRS)

    Shao, Lejun; Volz, Richard A.

    1989-01-01

    An important property of an intelligent robot is to be able to determine the location of an object in 3-D space. A general object localization system structure is proposed, some important issues on localization discussed, and an overview given for current available object localization algorithms and systems. The algorithms reviewed are characterized by their feature extracting and matching strategies; the range finding methods; the types of locatable objects; and the mathematical formulating methods.

  12. Object Locating System

    NASA Technical Reports Server (NTRS)

    Arndt, G. Dickey (Inventor); Carl, James R. (Inventor)

    2000-01-01

    A portable system is provided that is operational for determining, with three dimensional resolution, the position of a buried object or approximately positioned object that may move in space or air or gas. The system has a plurality of receivers for detecting the signal front a target antenna and measuring the phase thereof with respect to a reference signal. The relative permittivity and conductivity of the medium in which the object is located is used along with the measured phase signal to determine a distance between the object and each of the plurality of receivers. Knowing these distances. an iteration technique is provided for solving equations simultaneously to provide position coordinates. The system may also be used for tracking movement of an object within close range of the system by sampling and recording subsequent position of the object. A dipole target antenna. when positioned adjacent to a buried object, may be energized using a separate transmitter which couples energy to the target antenna through the medium. The target antenna then preferably resonates at a different frequency, such as a second harmonic of the transmitter frequency.

  13. The Friendly Object

    ERIC Educational Resources Information Center

    Prangnell, Peter

    1969-01-01

    If buildings and cities are made as friendly objects, they will invite and precipitate participation. They will stimulate our creative powers, which are the basis of growth in all our activities. (CK)

  14. Radiation from hard objects

    SciTech Connect

    Canavan, G.H.

    1997-02-01

    The inference of the diameter of hard objects is insensitive to radiation efficiency. Deductions of radiation efficiency from observations are very sensitive - possibly overly so. Inferences of the initial velocity and trajectory vary similarly, and hence are comparably sensitive.

  15. Object Oriented Modeling and Design

    NASA Technical Reports Server (NTRS)

    Shaykhian, Gholam Ali

    2007-01-01

    The Object Oriented Modeling and Design seminar is intended for software professionals and students, it covers the concepts and a language-independent graphical notation that can be used to analyze problem requirements, and design a solution to the problem. The seminar discusses the three kinds of object-oriented models class, state, and interaction. The class model represents the static structure of a system, the state model describes the aspects of a system that change over time as well as control behavior and the interaction model describes how objects collaborate to achieve overall results. Existing knowledge of object oriented programming may benefit the learning of modeling and good design. Specific expectations are: Create a class model, Read, recognize, and describe a class model, Describe association and link, Show abstract classes used with multiple inheritance, Explain metadata, reification and constraints, Group classes into a package, Read, recognize, and describe a state model, Explain states and transitions, Read, recognize, and describe interaction model, Explain Use cases and use case relationships, Show concurrency in activity diagram, Object interactions in sequence diagram.

  16. Intermediate BL Lac objects

    NASA Astrophysics Data System (ADS)

    Bondi, M.; Marchã, M. J. M.; Dallacasa, D.; Stanghellini, C.

    2001-08-01

    The 200-mJy sample, defined by Marchã et al., contains about 60 nearby, northern, flat-spectrum radio sources. In particular, the sample has proved effective at finding nearby radio-selected BL Lac objects with radio luminosities comparable to those of X-ray-selected objects, and low-luminosity flat-spectrum weak emission-line radio galaxies (WLRGs). The 200-mJy sample contains 23 BL Lac objects (including 6 BL Lac candidates) and 19 WLRGs. We will refer to these subsamples as the 200-mJy BL Lac sample and the 200-mJy WLRG sample, respectively. We have started a systematic analysis of the morphological pc-scale properties of the 200-mJy radio sources using VLBI observations. This paper presents VLBI observations at 5 and 1.6GHz of 14 BL Lac objects and WLRGs selected from the 200-mJy sample. The pc-scale morphology of these objects is briefly discussed. We derive the radio beaming parameters of the 200-mJy BL Lac objects and WLRGs and compare them with those of other BL Lac samples and with a sample of FR I radio galaxies. The overall broad-band radio, optical and X-ray properties of the 200-mJy BL Lac sample are discussed and compared with those of other BL Lac samples, radio- and X-ray-selected. We find that the 200-mJy BL Lac obje