Health workers cohort study: methods and study design.

PubMed

Denova-Gutiérrez, Edgar; Flores, Yvonne N; Gallegos-Carrillo, Katia; Ramírez-Palacios, Paula; Rivera-Paredez, Berenice; Muñoz-Aguirre, Paloma; Velázquez-Cruz, Rafael; Torres-Ibarra, Leticia; Meneses-León, Joacim; Méndez-Hernández, Pablo; Hernández-López, Rubí; Salazar-Martínez, Eduardo; Talavera, Juan O; Tamayo, Juan; Castañón, Susana; Osuna-Ramírez, Ignacio; León-Maldonado, Leith; Flores, Mario; Macías, Nayeli; Antúnez, Daniela; Huitrón-Bravo, Gerardo; Salmerón, Jorge

2016-01-01

To examine different health outcomes that are associated with specific lifestyle and genetic factors. From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples. A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese. Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.

Impact of the HEALTHY Study on Vending Machine Offerings in Middle Schools.

PubMed

Hartstein, Jill; Cullen, Karen W; Virus, Amy; El Ghormli, Laure; Volpe, Stella L; Staten, Myrlene A; Bridgman, Jessica C; Stadler, Diane D; Gillis, Bonnie; McCormick, Sarah B; Mobley, Connie C

2011-01-01

The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburg, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n=21 schools) or control (n=21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. At baseline, 15 intervention and 15 control schools had beverage and/or snack vending machines, compared with 11 intervention and 11 control schools at the end of the study. At the end of study, all of the intervention schools with beverage vending machines, but only one out of the nine control schools, met the beverage goal. The snack goal was met by all of the intervention schools and only one of the four control schools with snack vending machines. The HEALTHY study's vending machine beverage and snack goals were successfully achieved in intervention schools, reducing access to less healthy food items outside the school meals program. Although the effect of these changes on student diet, energy balance and growth is unknown, these results suggest that healthier options for snacks can successfully be offered in school vending machines.

Income Shocks and Adolescent Mental Health

ERIC Educational Resources Information Center

Baird, Sarah; de Hoop, Jacobus; Ozler, Berk

2013-01-01

We investigate the effects of a positive income shock on mental health among adolescent girls using evidence from a cash transfer experiment in Malawi. Offers of cash transfers strongly reduced psychological distress among baseline schoolgirls. However, these large beneficial effects declined with increases in the transfer amount offered to the…

Youth-Initiated HIV Risk and Substance Use Prevention Program.

ERIC Educational Resources Information Center

Goggin, K.; Metcalf, K.; Wise, D.; Kennedy, S.; Murray, T.; Burgess, D.; Reese-Smith, J.; Terhune, N.; Broadus, K.; Downes, A.; Buckendahl, H.

This study evaluates the first year of a novel HIV and substance use prevention program for inner city youth (Offering New Youth eXperiences--ONYX). Baseline and follow-up measures of knowledge, attitudes, and risk behaviors were administered seven months apart to 441 youth participating in the ONYX program. Youth (n=71) who provided data at both…

Unwrapping eddy current compensation: improved compensation of eddy current induced baseline shifts in high-resolution phase-contrast MRI at 9.4 Tesla.

PubMed

Espe, Emil K S; Zhang, Lili; Sjaastad, Ivar

2014-10-01

Phase-contrast MRI (PC-MRI) is a versatile tool allowing evaluation of in vivo motion, but is sensitive to eddy current induced phase offsets, causing errors in the measured velocities. In high-resolution PC-MRI, these offsets can be sufficiently large to cause wrapping in the baseline phase, rendering conventional eddy current compensation (ECC) inadequate. The purpose of this study was to develop an improved ECC technique (unwrapping ECC) able to handle baseline phase discontinuities. Baseline phase discontinuities are unwrapped by minimizing the spatiotemporal standard deviation of the static-tissue phase. Computer simulations were used for demonstrating the theoretical foundation of the proposed technique. The presence of baseline wrapping was confirmed in high-resolution myocardial PC-MRI of a normal rat heart at 9.4 Tesla (T), and the performance of unwrapping ECC was compared with conventional ECC. Areas of phase wrapping in static regions were clearly evident in high-resolution PC-MRI. The proposed technique successfully eliminated discontinuities in the baseline, and resulted in significantly better ECC than the conventional approach. We report the occurrence of baseline phase wrapping in PC-MRI, and provide an improved ECC technique capable of handling its presence. Unwrapping ECC offers improved correction of eddy current induced baseline shifts in high-resolution PC-MRI. Copyright © 2013 Wiley Periodicals, Inc.

Child Witness to Domestic Abuse: Baseline Data Analysis for a Seven-Year Prospective Study.

PubMed

Blair, Faye; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

2015-01-01

Children who witness the abuse of their mother by an intimate partner suffer negative effects on behavioral functioning. In this study, 300 abused women seeking services for abuse were interviewed regarding how often their child had witnessed the abuse. Baseline data for this study found that boys who witnessed abuse had externalizing and internalizing behavioral problems comparable to boys in clinical treatment. Girls did not display clinically significant behaviors. For evidence-based programs to interrupt the effect of witness to violence on children, empirical data that are gender-specific are needed. Findings support the need to screen mothers for abuse during well-child visits and offer education to all mothers on the possible effects of child witness to violence in the home.

An Appraisal of the Manpower Training Programs Established by Congress in the 1960's. Project Baseline Supplemental Report.

ERIC Educational Resources Information Center

Brandon, George L.

Offering an overview and informal appraisal of the Manpower Development and Training Act (MDTA) and its amendments since 1962, the study focuses on the vocational education program and the development of its legislation and administration. The 12 years of manpower training legislation from MDTA to the Comprehensive Employment and Training Act…

Disability Within US Public Health School and Program Curricula.

PubMed

Sinclair, Lisa Bundara; Tanenhaus, Rachel H; Courtney-Long, Elizabeth; Eaton, Danice K

2015-01-01

To describe the percentage of US public health schools and programs offering graduate-level courses with disability content as a potential baseline measurement for Healthy People 2020 objective DH-3 and compare the percentage of public health schools that offered disability coursework in 1999 with those in 2011. In 2011, using SurveyMonkey.com, cross-sectional information was collected from the deans, associate deans, directors, or chairpersons of master of public health-granting public health schools and programs that were accredited and listed with the Council on Education for Public Health. Two rounds of follow-up were conducted at 4-month intervals by e-mails and phone calls to program contacts who had not responded. The responses from schools and programs were calculated and compared. There were 78 responses (34 schools and 44 programs) for a response rate of 63%. Fifty percent of public health schools and programs offered some disability content within their graduate-level courses. A greater percentage of schools than programs (71% vs 34%; P = .003) offered some graduate-level disability coursework within their curricula. The percentage of schools that offered disability coursework was similar in 1999 and 2011. This assessment provides a potential baseline measurement for Healthy People 2020 objective DH-3. Future assessments should focus on clarifying disability content within courses and identifying capacity to offering disability training within public health schools and programs.

Protective Effects of Psychological Strengths Against Psychiatric Disorders Among Soldiers.

PubMed

Shrestha, Alice; Cornum, B G Rhonda; Vie, Loryana L; Scheier, Lawrence M; Lester, M A J Paul B; Seligman, Martin E P

2018-03-01

This study prospectively examined psychological strengths targeted in U.S. Army training programs as predictors of psychiatric diagnosis in active duty soldiers. At baseline, the cohort (140,584 soldiers) was without psychiatric disorder. Soldiers were then followed for 2 yr and classified as healthy, or acquiring a psychiatric diagnosis (adjustment disorder, anxiety disorder, depression, or post-traumatic stress disorder), or being prescribed psychotropic medication without a psychiatric diagnosis. Soldiers who remained healthy reported significantly higher strengths scores at baseline, compared with soldiers who were diagnosed with a psychiatric disorder. In addition, soldiers in the worst strengths decile were twice as likely to develop a psychiatric disorder, compared with soldiers in the top 50% on baseline strengths. Strengths afforded the greatest protection against depression. Offering tailored resilience training programs could help the Army steel vulnerable soldiers against the challenges of life, military training, and combat.

Behavior Problems among Cocaine Exposed Children: Role of Physiological Regulation and Parenting

PubMed Central

Finger, Brent; Schuetze, Pamela; Eiden, Rina D.

2014-01-01

This study examined interrelations between prenatal cocaine exposure, child autonomic regulation, parenting behavior and child sex on parent-reported behavior problems at 36 months of age. We hypothesized that respiratory sinus arrhythmia (RSA)1 at 13 months of age would mediate the relation between cocaine exposure and behavior problems. We also hypothesized that child sex, maternal negative affect, and maternal sensitivity observed at 13 months of age would moderate the relation between RSA and behavior problems. Results revealed that cocaine exposure predicted low baseline RSA and low RSA withdrawal during a negative affect task. Low baseline RSA, in turn, predicted fewer behavior problems offering support for an indirect association between cocaine exposure and behavior problems. The association between baseline RSA and behavior problems was further moderated by maternal negative affect such that high baseline RSA was more strongly related to behavior problems under conditions of high compared to low maternal negative affect. Results also revealed a near significant trend for baseline RSA to be more strongly related to behavior problems among boys than girls. These findings highlight several possible pathways toward behavior problems among cocaine exposed children. PMID:24480789

Static and dynamic modes of 810 nm diode laser hair removal compared: A clinical and histological study

PubMed Central

2017-01-01

Background and Aims Laser hair removal has recently become a major indication. Diode lasers have become commercially available offering two modes of application: a stamping or static mode, and a dynamic mode whereby the handpiece is continuously moved across the target tissue. The present study was designed to compare the efficacy of these two approaches clinically and histologically. Subjects and Methods Twenty-five subjects participated in the study, 12 males and 13 females, ages ranging from 20 to 57 yr (Mean age 41.6 yr). A baseline hair count was performed on both the target areas. The ms-pulsed diode laser delivered 810 nm via a handpiece with a cooled tip, offering both static and dynamic modes which were used on the subjects' left and right crura, respectively. Pain during treatment was assessed using a visual analog scale (VAS) and gross inspection was performed immediately after treatment for any abnormality in the treated skin. Hair counts were performed on both crura at 1 and 3 months after the treatment, and compared with the baseline counts. Biopsies were performed in the dynamic mode treated skin at baseline and at 1 month after the treatment, and assessed with light microscopy, immunohistochemistry and transmission electron microscopy (TEM). Results All subjects completed the study. Compared with baseline, hair counts were significantly lower at 1 and 3 months post-treatment with no significant difference between the static and dynamic laser depilation modes, nor in the severity of the pain experienced during the procedure. Histologically, degenerative changes in the hair follicles were noted immediately after laser treatment. At one month, cystic formation was seen in the hair follicles showing a strong tendency towards apoptotic cell death. Conclusions With the diode laser system and at the parameters used in the present study, high depilation efficacy was seen with no significant difference between the static and dynamic modes. Interestingly, good long-term depilation is probably a result of induced apoptotic cell death in the follicles rather than any other mechanism. PMID:28740327

Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial

PubMed Central

Kramer, Jan-Niklas; Kehr, Flavius; Wahle, Fabian; Elser, Niklas; Fleisch, Elgar

2016-01-01

Background Research has so far benefited from the use of pedometers in physical activity interventions. However, when public health institutions (eg, insurance companies) implement pedometer-based interventions in practice, people may refrain from participating due to privacy concerns. This might greatly limit the applicability of such interventions. Financial incentives have been successfully used to influence both health behavior and privacy concerns, and may thus have a beneficial effect on the acceptance of pedometer-based interventions. Objective This paper presents the design and baseline characteristics of a cluster-randomized controlled trial that seeks to examine the effect of financial incentives on the acceptance of and adherence to a pedometer-based physical activity intervention offered by a health insurance company. Methods More than 18,000 customers of a large Swiss health insurance company were allocated to a financial incentive, a charitable incentive, or a control group and invited to participate in a health prevention program. Participants used a pedometer to track their daily physical activity over the course of 6 months. A Web-based questionnaire was administered at the beginning and at the end of the intervention and additional data was provided by the insurance company. The primary outcome of the study will be the participation rate, secondary outcomes will be adherence to the prevention program, physical activity, and health status of the participants among others. Results Baseline characteristics indicate that residence of participants, baseline physical activity, and subjective health should be used as covariates in the statistical analysis of the secondary outcomes of the study. Conclusions This is the first study in western cultures testing the effectiveness of financial incentives with regard to a pedometer-based health intervention offered by a large health insurer to their customers. Given that the incentives prove to be effective, this study provides the basis for powerful health prevention programs of public health institutions that are easy to implement and can reach large numbers of people in need. PMID:27624645

Transtheoretical Model Based Exercise Counseling Combined with Music Skipping Rope Exercise on Childhood Obesity.

PubMed

Ham, Ok Kyung; Sung, Kyung Mi; Lee, Bo Gyeong; Choi, Hee Won; Im, Eun-Ok

2016-06-01

The purpose was to evaluate the effects of a transtheoretical model (TTM) based exercise counseling offered with music skipping rope exercise on components of the TTM (stages of change, decisional balance, and self-efficacy), body mass index, glucose, and lipid profile of overweight/obese children in Korea. This study used a nonequivalent pretest and posttest experimental study design. A total of 75 overweight/obese children participated in the study. Eight sessions of exercise counseling combined with music skipping rope exercise for 12 weeks were offered for children in the experimental group, while one session of exercise counseling with music skipping rope exercise for 12 weeks was offered for children in the control group. Outcomes were measured at baseline, and 6 months after the intervention. After the intervention, self-efficacy significantly improved among children in the experimental group (p = .049), while these children maintained their baseline BMI at 6-month follow-up (p > .05). Among children in the control group, BMI significantly increased (p < .05). Fasting blood sugar significantly increased for both groups after the intervention (p < .05). However, a greater increase was observed for the control group. Our study partially supports the hypothesis that a TTM-based exercise intervention is effective in maintaining BMI and improving self-efficacy of overweight/obese children. The TTM-based counseling combined with exercise classes has potential to control weight among overweight/obese children, while involvement of parents and children in the development of the theory-based intervention may generate further benefits regarding health and well-being of overweight/obese children. Copyright © 2016. Published by Elsevier B.V.

Using Landsat Time-Series and LiDAR to Inform Aboveground Forest Biomass Baselines in Northern Minnesota, USA

Treesearch

Ram K. Deo; Matthew B. Russell; Grant M. Domke; Christopher W. Woodall; Michael J. Falkowski; Warren B. Cohen

2017-01-01

The publicly accessible archive of Landsat imagery and increasing regional-scale LiDAR acquisitions offer an opportunity to periodically estimate aboveground forest biomass (AGB) from 1990 to the present to alignwith the reporting needs ofNationalGreenhouseGas Inventories (NGHGIs). This study integrated Landsat time-series data, a state-wide LiDAR dataset, and a recent...

What about money? Effect of small monetary incentives on enrollment, retention, and motivation to change behaviour in an HIV/STD prevention counselling intervention. The Project RESPECT Study Group.

PubMed

Kamb, M L; Rhodes, F; Hoxworth, T; Rogers, J; Lentz, A; Kent, C; MacGowen, R; Peterman, T A

1998-08-01

We studied the effect of small monetary incentives and non-monetary incentives of similar value on enrollment and participation in clinic based HIV/STD prevention counselling. We examined incident STDs to try to assess whether participants offered money may be less motivated to change risky behaviours than those offered other incentives. Patients from five US STD clinics were invited to enroll in a multisession risk reduction counselling intervention and, based on their enrollment date, were offered either $15 for each additional session or non-monetary incentives worth $15. The two incentive groups were compared on participants' enrollment, completion of intervention sessions, and new STDs over the 24 months after enrollment. Of 648 patients offered money, 198 (31%) enrolled compared with 160 (23%) of 696 patients offered other incentives (p = 0.002). Enrollees in the two incentive groups had similar baseline characteristics, including condom use. Of the 198 participants offered money, 109 (55%) completed all sessions compared with 59 (37%) of the participants offered other incentives (p < 0.0001). Comparing those offered money with those offered other incentives STD rates were similar after 6, 12, and 24 months. Small monetary incentives enhanced enrollment and participation compared with other incentives of similar value. Regardless of incentive offered, participants had similar post-enrollment STD rates, suggesting that the type of incentive does not adversely affect motivation to change behaviour. Money may be useful in encouraging high risk individuals to participate in and complete counselling or other public health interventions.

Geodesy by radio interferometry - Water vapor radiometry for estimation of the wet delay

NASA Technical Reports Server (NTRS)

Elgered, G.; Davis, J. L.; Herring, T. A.; Shapiro, I. I.

1991-01-01

An important source of error in VLBI estimates of baseline length is unmodeled variations of the refractivity of the neutral atmosphere along the propagation path of the radio signals. This paper presents and discusses the method of using data from a water vapor radiomete (WVR) to correct for the propagation delay caused by atmospheric water vapor, the major cause of these variations. Data from different WVRs are compared with estimated propagation delays obtained by Kalman filtering of the VLBI data themselves. The consequences of using either WVR data or Kalman filtering to correct for atmospheric propagation delay at the Onsala VLBI site are investigated by studying the repeatability of estimated baseline lengths from Onsala to several other sites. The repeatability obtained for baseline length estimates shows that the methods of water vapor radiometry and Kalman filtering offer comparable accuracies when applied to VLBI observations obtained in the climate of the Swedish west coast. For the most frequently measured baseline in this study, the use of WVR data yielded a 13 percent smaller weighted-root-mean-square (WRMS) scatter of the baseline length estimates compared to the use of a Kalman filter. It is also clear that the 'best' minimum elevationi angle for VLBI observations depends on the accuracy of the determinations of the total propagation delay to be used, since the error in this delay increases with increasing air mass.

Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: results from the CRUZA randomized trial.

PubMed

Allen, Jennifer D; Torres, Maria Idalí; Tom, Laura S; Leyva, Bryan; Galeas, Ana V; Ospino, Hosffman

2016-05-18

The CRUZA randomized trial tested the efficacy of an organizational-level intervention to increase the capacity of Catholic faith-based organizations (FBOs) serving Latinos to implement evidence-based strategies (EBS) for cancer control. Thirty-one Catholic parishes were enrolled. Twenty were randomized to a "capacity enhancement" (CE) intervention and 11 to a "standard dissemination" (SD) condition. Each received a Program Implementation Manual and Toolkit of materials culturally adapted for FBOs with Latino audiences for five types of EBS recommended by the US Preventive Services Community Guide. CE parishes were offered a menu of capacity-building activities over a 3-month period, while SD parishes were provided a one-time consultation by an Intervention Specialist. Baseline and follow-up surveys compared the number and types of EBS offered. At baseline, only one parish had offered any cancer-related program in the prior year, yet a third (36 %) had offered some other type of health program or service. At post-intervention follow-up, all parishes offered a greater number of EBS. The only statistically significant difference between CE and SD groups was the number of parishes offering small media interventions (90 % in CE, 64 % in SD; p < 0.05). All parishes increased the number of cancer control activities offered to their members. These findings suggest that Catholic parishes may already have capacity to implement EBS if they are appropriately adapted and packaged and may only require low levels of support to carry out programming. Further research is needed to examine the extent to which program offerings continued after the period of grant funding. Clinicaltrials.gov NCT01740219 .

A comparison of between- and within-subjects imitation designs.

PubMed

Kressley, Regina A; Knopf, Monika

2006-12-01

Two experimental methods, which have dominated the study of declarative memory in preverbal children with imitation tasks, namely the deferred imitation and elicited imitation paradigm, differ in the amount of physical contact with test stimuli afforded infants prior to a test for long-term recall. The current study assessed effects of pre- and post-demonstration contact with test stimuli on deferred imitation of novel, single-step unrelated actions with multiple objects by 8(1/2)- and 10(1/2)-month-old infants (N=50). The rate of target action completion after a delay remained consistent at both ages across different conditions of prior contact with test stimuli. This study shows that a within-subjects baseline appraisal is valid within certain experimental parameters and offers a more economical alternative. The results show furthermore that different experimental designs utilized to assess deferred imitation are highly comparable for the first year despite differences in determining baseline.

Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions.

PubMed

Vuijk, Richard; Arntz, Arnoud

2017-03-01

To our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD. Twelve adult individuals (age > 18 years) with ASD and at least one PD are given a treatment protocol consisting of 30 weekly offered sessions. A concurrent multiple baseline design is used with baseline varying from 4 to 9 weeks, after which weekly supportive sessions varying from 1 to 6 weeks start with the study therapist. After baseline and 1 to 6 supportive sessions, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, and schema modes are explored, and information about the treatment is given. This is followed by 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions: patients are vice versa and randomly assigned to the interventions. Finally, there is a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and report weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs, and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after supportive sessions, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II is administered during screening procedure, at 5- and at 10-month follow-up. The Netherlands National Trial Register NTR5788. Registered 01 April 2016.

Orbital service module systems analysis study documentation. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1978-01-01

Potentially feasible system concepts for providing additional power, thermal control, and attitude to the baseline orbiter were investigated in order to support a greater variety of space missions and to extend the orbiter's ability to remain in orbit. Results of these analyses include an incremental growth plan that offers the flexibility of adding capability as, and when, it is needed in order to satisfy emerging user requirements.

Flight prototype CO2 and humidity control system

NASA Technical Reports Server (NTRS)

Rudy, K. M.

1977-01-01

A regenerable CO2 and humidity control system is presently being developed for potential use on the space shuttle as an alternative to the baseline lithium hydroxide system. The system utilizes a sorbent material (designated HS-C) to adsorb CO2 and water vapor from the cabin atmosphere and desorb the CO2 and water vapor overboard when exposed to a space vacuum. Continuous operation is achieved by utilizing two beds which are alternately cycled between adsorption and desorption. A shuttle vehicle integration study showed that the HS-C system offers substantial weight advantages compared to the baseline shuttle orbiter expendable lithium hydroxide CO2 removal system for extended missions beyond the nominal design of four men for seven days. This study defined a system packaging envelope in the area presently occupied by the LiOH cartridges.

Baseline coral disease surveys within three marine parks in Sabah, Borneo.

PubMed

Miller, Jennifer; Sweet, Michael J; Wood, Elizabeth; Bythell, John

2015-01-01

Two of the most significant threats to coral reefs worldwide are bleaching and disease. However, there has been a scarcity of research on coral disease in South-East Asia, despite the high biodiversity and the strong dependence of local communities on the reefs in the region. This study provides baseline data on coral disease frequencies within three national parks in Sabah, Borneo, which exhibit different levels of human impacts and management histories. High mean coral cover (55%) and variable disease frequency (mean 0.25 diseased colonies m(-2)) were found across the three sites. Highest disease frequency (0.44 diseased colonies per m(2)) was seen at the site closest to coastal population centres. Bleaching and pigmentation responses were actually higher at Sipadan, the more remote, offshore site, whereas none of the other coral diseases detected in the other two parks were detected in Sipadan. Results of this study offer a baseline dataset of disease in these parks and indicate the need for continued monitoring, and suggest that coral colonies in parks under higher anthropogenic stressors and with lower coral cover may be more susceptible to contracting disease.

Impact of the HEALTHY Study on Vending Machine Offerings in Middle Schools

PubMed Central

Hartstein, Jill; Cullen, Karen W.; Virus, Amy; El Ghormli, Laure; Volpe, Stella L.; Staten, Myrlene A; Bridgman, Jessica C.; Stadler, Diane D.; Gillis, Bonnie; McCormick, Sarah B.; Mobley, Connie C.

2013-01-01

Purpose/Objectives The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. Methods Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburg, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n=21 schools) or control (n=21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. Results At baseline, 15 intervention and 15 control schools had beverage and/or snack vending machines, compared with 11 intervention and 11 control schools at the end of the study. At the end of study, all of the intervention schools with beverage vending machines, but only one out of the nine control schools, met the beverage goal. The snack goal was met by all of the intervention schools and only one of the four control schools with snack vending machines. Applications to Child Nutrition Professionals The HEALTHY study’s vending machine beverage and snack goals were successfully achieved in intervention schools, reducing access to less healthy food items outside the school meals program. Although the effect of these changes on student diet, energy balance and growth is unknown, these results suggest that healthier options for snacks can successfully be offered in school vending machines. PMID:23687471

Validation of the ERS standard citric acid cough challenge in healthy adult volunteers

PubMed Central

2010-01-01

Protocols measuring cough sensitivity can vary in terms of nebuliser, tussive agent, single and dose response. A definitive method for measuring cough sensitivity needs to be established. The ERS guidelines recommend the KoKo DigiDoser (KD) delivery system. Study aim, was to compare the reproducibility of this citric acid (CA) cough challenge and previously established Mefar dosimeter (MD) protocol. 39 (female 26) volunteers mean age (40.4 yrs) were randomised to either KD or MD. Intra-day and inter-day reproducibility was compared. We calculated the concentration of citric acid evoking 2 coughs (C2). The geometric mean C2 (95%CI) was similar for both KD and MD, of 263 (200,339) mM and 209 (151,288) mM respectively. The mean KD C2 was not significantly different. (F = 0.807, p = 0.93) from baseline over 1, 2, and 4 hrs however, the MD demonstrated significant variability (F = 7.85, P < 0.001) Measuring mean log C2 at baseline and at 2 weeks, the KD demonstrated a stronger intraclass correlation of log C2 at baseline with 2 week log C2, ICC = 0.70 than was shown with the Mefar, ICC = 0.41 Administering CA from KD offers a reproducible cough challenge in healthy volunteers. The results correlate well with the MD challenge but offer greater intra-day and inter-day reproducibility. Trial Registration Current controlled trials ISRCTN98385033 PMID:20698995

Advanced Active Thermal Control Systems Architecture Study

NASA Technical Reports Server (NTRS)

Hanford, Anthony J.; Ewert, Michael K.

1996-01-01

The Johnson Space Center (JSC) initiated a dynamic study to determine possible improvements available through advanced technologies (not used on previous or current human vehicles), identify promising development initiatives for advanced active thermal control systems (ATCS's), and help prioritize funding and personnel distribution among many research projects by providing a common basis to compare several diverse technologies. Some technologies included were two-phase thermal control systems, light-weight radiators, phase-change thermal storage, rotary fluid coupler, and heat pumps. JSC designed the study to estimate potential benefits from these various proposed and under-development thermal control technologies for five possible human missions early in the next century. The study compared all the technologies to a baseline mission using mass as a basis. Each baseline mission assumed an internal thermal control system; an external thermal control system; and aluminum, flow-through radiators. Solar vapor compression heat pumps and light-weight radiators showed the greatest promise as general advanced thermal technologies which can be applied across a range of missions. This initial study identified several other promising ATCS technologies which offer mass savings and other savings compared to traditional thermal control systems. Because the study format compares various architectures with a commonly defined baseline, it is versatile and expandable, and is expected to be updated as needed.

Quantifying Behavior Driven Energy Savings for Hotels

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

Dong, Bing; Wang, Na; Hooks, Edward

2016-08-12

Hotel facilities present abundant opportunities for energy savings. In the United States, there are around 25,000 hotels that spend on an average of $2,196 on energy costs per room each year. This amounts to about 6% of the total annual hotel operating cost. However, unlike offices, there are limited studies on establishing appropriate baselines and quantifying hotel energy savings given the variety of services and amenities, unpredictable customer behaviors, and the around-the-clock operation hours. In this study, we investigate behavior driven energy savings for three medium-size (around 90,000 sf2) hotels that offer similar services in different climate zones. We firstmore » used Department of Energy Asset Scoring Tool to establish baseline models. We then conducted energy saving analysis in EnergyPlus based on a behavior model that defines the upper bound and lower bound of customer and hotel staff behavior. Lastly, we presented a probabilistic energy savings outlook for each hotel. The analysis shows behavior driven energy savings up to 25%. We believe this is the first study to incorporate behavioral factors into energy analysis for hotels. It also demonstrates a procedure to quickly create tailored baselines and identify improvement opportunities for hotels.« less

Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology.

PubMed

Robbins, Reuben N; Mellins, Claude A; Leu, Cheng-Shiun; Rowe, Jessica; Warne, Patricia; Abrams, Elaine J; Witte, Susan; Stein, Dan J; Remien, Robert H

2015-06-01

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni-is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on antiretroviral therapy (ART) for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5-6 weeks after baseline), -clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10 % improvement for-participants and a decrease of 8 % for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches.

Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology

PubMed Central

Robbins, Reuben N.; Mellins, Claude A.; Leu, Cheng-Shiun; Rowe, Jessica; Warne, Patricia; Abrams, Elaine J.; Witte, Susan; Stein, Dan J.; Remien, Robert H.

2015-01-01

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on ART for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5–6 weeks after baseline), clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10% improvement for Masivukeni participants and a decrease of 8% for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches. PMID:25566763

Effects of baseline risk information on social and individual choices.

PubMed

Gyrd-Hansen, Dorte; Kristiansen, Ivar Sønbø; Nexøe, Jørgen; Nielsen, Jesper Bo

2002-01-01

This article analyzes preferences for risk reductions in the context of individual and societal decision making. The effect of information on baseline risk is analyzed in both contexts. The results indicate that if individuals are to imagine that they suffer from 1 low-risk and 1 high-risk ailment, and are offered a specified identical absolute risk reduction, a majority will ceteris paribus opt for treatment of the low-risk ailment. A different preference structure is elicited when priority questions are framed as social choices. Here, a majority will prefer to treat the high-risk group of patients. The preference reversal demonstrates the extent to which baseline risk information can influence preferences in different choice settings. It is argued that presentation of baseline risk information may induce framing effects that lead to nonoptimal resource allocations. A solution to this problem may be to not present group-specific baseline risk information when eliciting preferences.

The risk-stratified osteoporosis strategy evaluation study (ROSE): a randomized prospective population-based study. Design and baseline characteristics.

PubMed

Rubin, Katrine Hass; Holmberg, Teresa; Rothmann, Mette Juel; Høiberg, Mikkel; Barkmann, Reinhard; Gram, Jeppe; Hermann, Anne Pernille; Bech, Mickael; Rasmussen, Ole; Glüer, Claus C; Brixen, Kim

2015-02-01

The risk-stratified osteoporosis strategy evaluation study (ROSE) is a randomized prospective population-based study investigating the effectiveness of a two-step screening program for osteoporosis in women. This paper reports the study design and baseline characteristics of the study population. 35,000 women aged 65-80 years were selected at random from the population in the Region of Southern Denmark and-before inclusion-randomized to either a screening group or a control group. As first step, a self-administered questionnaire regarding risk factors for osteoporosis based on FRAX(®) was issued to both groups. As second step, subjects in the screening group with a 10-year probability of major osteoporotic fractures ≥15% were offered a DXA scan. Patients diagnosed with osteoporosis from the DXA scan were advised to see their GP and discuss pharmaceutical treatment according to Danish National guidelines. The primary outcome is incident clinical fractures as evaluated through annual follow-up using the Danish National Patient Registry. The secondary outcomes are cost-effectiveness, participation rate, and patient preferences. 20,904 (60%) women participated and included in the baseline analyses (10,411 in screening and 10,949 in control group). The mean age was 71 years. As expected by randomization, the screening and control groups had similar baseline characteristics. Screening for osteoporosis is at present not evidence based according to the WHO screening criteria. The ROSE study is expected to provide knowledge of the effectiveness of a screening strategy that may be implemented in health care systems to prevent fractures.

The impact of multiplex genetic testing on disease risk perceptions.

PubMed

Shiloh, S; deHeer, H D; Peleg, S; Hensley Alford, S; Skapinsky, K; Roberts, J S; Hadley, D W

2015-02-01

This study assessed the effects of multiplex genetic testing on disease risk perceptions among 216 healthy adults. Participants, aged 25-40, were recruited through the Multiplex Initiative, which offered a genetic susceptibility test for eight common diseases. Participants completed baseline telephone and web-based surveys prior to making the testing decision. Three months after the receipt of mailed test results, participants completed a follow-up telephone survey. Risk perceptions for the eight diseases were measured at baseline and follow-up, along with beliefs about genetic causation of those diseases. The main results were: (i) mean risk perceptions were considerably stable from baseline to follow-up; (ii) the best predictors of follow-up risk perceptions were the corresponding baseline perceptions and family history; and (iii) within-individuals, most participants increased or decreased their risk perceptions for specific diseases in concordance with the number of risk markers they carry, their family history and their beliefs about genetic causality of diseases. In conclusion, participants presented a vigilant approach to the interpretation of genetic test results, which provides reassurance with regard to a potential inflation of risk perceptions in the population because of multiplex genetic testing. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of Environmentally Friendly Refrigerant Options for Window Air Conditioners

DOE PAGES

Bansal, Pradeep; Shen, Bo

2015-03-12

This paper presents a technical assessment of environmentally friendly refrigerants as alternatives to R410A for window air conditioners. The alternative refrigerants that are studied for its replacement include R32, a mixture of R32/R125 with 90%/10% molar concentration, R600a, R290, R1234yf, R1234ze and R134a. Baseline experiments were performed on a window unit charged with R410A. The heat pump design model (HPDM) was modified and calibrated with the baseline data and was used to evaluate the comparative performance of the WAC with alternative refrigerants. The paper discusses the advantages and disadvantages of each refrigerants and their suitability for window air conditioners. Amongmore » all the refrigerants studied, R32 offers the best efficiency and the lowest Global Warming Potential (GWP), and hence its use will result in the overall environmental friendliness.« less

Manned orbital facility: A user's guide

NASA Technical Reports Server (NTRS)

1975-01-01

The salient conceptual features and expected evolution of the facility are discussed; the baseline design is offered as a model against which the reader can compare his needs. The overall program is discussed, supporting services and resources are described, and examples of typical payload applications are given. The general design features and configurations representing the baseline MOF developed and derived with due consideration given to applicable designs and subsystems such as those available in the Skylab, orbiter, and space lab vehicles.

Defense Information Systems Agency (DISA) GIG Convergence Master Plan 2012 (GCMP 2012). Volume 1

DTIC Science & Technology

2012-08-02

mapping, the complete DISA technical baseline, and the GIG Technical Guidance ( GTG ). The Department of Defense (DoD), as part of its IT Effectiveness...Guidance ( GTG ) to guide their development of service offerings, which are added to the technical baseline when approved by the CEP. 1.2. Background...corresponding hyperlinks; the complete set of GTPs is called the GIG Technical Guidance ( GTG ). These appendices also contain linkages between the GCMP

Feedback in web-based questionnaires as incentive to increase compliance in studies on lifestyle factors.

PubMed

Bälter, Olle; Fondell, Elinor; Bälter, Katarina

2012-06-01

We explored the use of feedback in interactive web-based questionnaires for collecting data on lifestyle factors in epidemiological studies. Here we report from a cohort study on lifestyle factors and upper respiratory tract infections among 1805 men and women. We introduced interactivity in the form of personalized feedback and feedback on a group level regarding dietary intake, physical activity and incidence of infections in web-based questionnaires as incentives for the respondents to continue answering questions and stay in the study. The study was performed in Sweden. All participants were randomly selected from the population registry. Personalized feedback was offered in the baseline questionnaire and feedback on a group level in the five follow-up questionnaires. In total, 88 % of the participants actively chose to get personalized feedback at least once in the baseline questionnaire. The follow-up questionnaires were sent by email and the overall compliance at each follow-up was 83-84 %, despite only one reminder. In total, 74 % completed all five follow-ups. However, the compliance was higher among those who chose feedback in the baseline questionnaire compared with those who did not choose feedback. The results show that it is possible to use feedback in web questionnaires and that it has the potential to increase compliance. The majority of the participants actively chose to take part in the personalized feedback in the baseline questionnaire and future research should focus on improving the design of the feedback, which may ultimately result in even higher compliance in research studies.

Laser space rendezvous and docking tradeoff

NASA Technical Reports Server (NTRS)

Adelman, S.; Levinson, S.; Raber, P.; Weindling, F.

1974-01-01

A spaceborne laser radar (LADAR) was configured to meet the requirements for rendezvous and docking with a cooperative object in synchronous orbit. The LADAR, configurated using existing pulsed CO2 laser technology and a 1980 system technology baseline, is well suited for the envisioned space tug missions. The performance of a family of candidate LADARS was analyzed. Tradeoff studies as a function of size, weight, and power consumption were carried out for maximum ranges of 50, 100, 200, and 300 nautical miles. The investigation supports the original contention that a rendezvous and docking LADAR can be constructed to offer a cost effective and reliable solution to the envisioned space missions. In fact, the CO2 ladar system offers distinct advantages over other candidate systems.

Feasibility, Acceptability, and Adherence with Short-Term HIV Preexposure Prophylaxis in Female Sexual Partners of Migrant Miners in Mozambique.

PubMed

Lahuerta, Maria; Zerbe, Allison; Baggaley, Rachel; Falcao, Joana; Ahoua, Laurence; DiMattei, Pietro; Morales, Fernando; Ramiro, Isaias; El-Sadr, Wafaa M

2017-12-01

Preexposure prophylaxis (PrEP) offers protection from HIV acquisition if taken as prescribed. We evaluated the feasibility, acceptability, and adherence with short-term PrEP among female sexual partners of migrant miners in Mozambique. HIV-negative female sexual partners of migrant miners were offered daily tenofovir/emtricitabine (TDF/FTC) for 6 weeks concurrent with miners' return home. Study visits occurred at baseline, week 4, 6, and 8. Dried blood spots (DBSs) were collected at week 4 and 6. Seventy-four women (median age: 42 years) were enrolled, 95% reported having 1 sexual partner and 80% reported never or rarely using condoms. At baseline, 41% had never tested for HIV; 65% were unaware of partners' HIV status. Of all women, 72 (97%) initiated PrEP, 7 (9%) discontinued PrEP before week 6; only 1 due to adverse events. Missed doses in the last week were self-reported by 8% and 3% of women at week 4 and 6, respectively. Of 66 (89%) women with DBS at week 4, 79% had detectable tenofovir diphosphate (TFV-DP) and 44% had levels consistent with ≥4 pills/wk (≥700 fmol/punch). Of 63 (88%) women with DBS at week 6, 76% had detectable TFV-DP and 42% had levels consistent with ≥4 pills/wk. In this first study assessing the use of short-term PrEP, a high percent of female partners of migrant workers initiated PrEP and had detectable DP levels during follow-up. Further efforts are needed to enhance adherence to ensure protection from HIV acquisition. Short-term PrEP offers promise for populations who are at high risk of HIV during specific periods of time.

Beamed energy propulsion

NASA Technical Reports Server (NTRS)

Shoji, James M.

1992-01-01

Beamed energy concepts offer an alternative for an advanced propulsion system. The use of a remote power source reduces the weight of the propulsion system in flight and this, combined with the high performance, provides significant payload gains. Within the context of this study's baseline scenario, two beamed energy propulsion concepts are potentially attractive: solar thermal propulsion and laser thermal propulsion. The conceived beamed energy propulsion devices generally provide low thrust (tens of pounds to hundreds of pounds); therefore, they are typically suggested for cargo transportation. For the baseline scenario, these propulsion system can provide propulsion between the following nodes: (1) low Earth orbit to geosynchronous Earth orbit; (2) low Earth orbit to low lunar orbit; (3) low lunar orbit to low Mars orbit--only solar thermal; and (4) lunar surface to low lunar orbit--only laser thermal.

Nicotine addiction management following surgery: a quality improvement approach in the post anesthesia care unit.

PubMed

Finegan, Barry A; Roblin, Daniel; Hammal, Fadi

2018-03-14

For smokers, hospital admission is accompanied by forced involuntary nicotine abstinence due to smoke-free site/grounds policies. An audit of patients admitted to our surgical wards revealed that identification of smoking status was inadequate and that nicotine addiction management (NAM) was infrequently offered. The project aimed to enhance both these metrics by initiating NAM in the post anesthesia care unit (PACU). Out of 744 patients admitted to our PACU in August 2015, 54% had their smoking status documented. The 200 patients (27%) out of the 744 were smokers and only 50% were offered NAM before discharge. PACU unit staff to determine the smoking status of every patient before discharge from the PACU (later changed to OR nursing staff) and, if a patient was identified as a smoker, to offer NRT (patch and mouth spray only) and initiate therapy prior to transfer of the patient to the ward. Data about number of patients admitted, presence of documented smoking status, number of identified smokers, and number offered/accepted nicotine replacement therapy (NRT) were collected at baseline and thereafter quarterly. Engaging video education sessions addressed the education gaps highlighted in a needs assessment. Identification of smoking status was made part of preoperative checklist and NRT was made available in post-operative recovery room. These interventions resulted in an increase in screening for tobacco use from 54% at baseline to 95% and the offer of NRT to smokers from 50 to 89%.

Pretreatment data is highly predictive of liver chemistry signals in clinical trials.

PubMed

Cai, Zhaohui; Bresell, Anders; Steinberg, Mark H; Silberg, Debra G; Furlong, Stephen T

2012-01-01

The goal of this retrospective analysis was to assess how well predictive models could determine which patients would develop liver chemistry signals during clinical trials based on their pretreatment (baseline) information. Based on data from 24 late-stage clinical trials, classification models were developed to predict liver chemistry outcomes using baseline information, which included demographics, medical history, concomitant medications, and baseline laboratory results. Predictive models using baseline data predicted which patients would develop liver signals during the trials with average validation accuracy around 80%. Baseline levels of individual liver chemistry tests were most important for predicting their own elevations during the trials. High bilirubin levels at baseline were not uncommon and were associated with a high risk of developing biochemical Hy's law cases. Baseline γ-glutamyltransferase (GGT) level appeared to have some predictive value, but did not increase predictability beyond using established liver chemistry tests. It is possible to predict which patients are at a higher risk of developing liver chemistry signals using pretreatment (baseline) data. Derived knowledge from such predictions may allow proactive and targeted risk management, and the type of analysis described here could help determine whether new biomarkers offer improved performance over established ones.

The ACTIVATE study: results from a group-randomized controlled trial comparing a traditional worksite health promotion program with an activated consumer program.

PubMed

Terry, Paul E; Fowles, Jinnet Briggs; Xi, Min; Harvey, Lisa

2011-01-01

PURPOSE. This study compares a traditional worksite-based health promotion program with an activated consumer program and a control program DESIGN. Group randomized controlled trial with 18-month intervention. SETTING. Two large Midwestern companies. SUBJECTS. Three hundred and twenty employees (51% response). INTERVENTION. The traditional health promotion intervention offered population-level campaigns on physical activity, nutrition, and stress management. The activated consumer intervention included population-level campaigns for evaluating health information, choosing a health benefits plan, and understanding the risks of not taking medications as prescribed. The personal development intervention (control group) offered information on hobbies. The interventions also offered individual-level coaching for high risk individuals in both active intervention groups. MEASURES. Health risk status, general health status, consumer activation, productivity, and the ability to evaluate health information. ANALYSIS. Multivariate analyses controlled for baseline differences among the study groups. RESULTS. At the population level, compared with baseline performance, the traditional health promotion intervention improved health risk status, consumer activation, and the ability to recognize reliable health websites. Compared with baseline performance, the activated consumer intervention improved consumer activation, productivity, and the ability to recognize reliable health websites. At the population level, however, only the activated consumer intervention improved any outcome more than the control group did; that outcome was consumer activation. At the individual level for high risk individuals, both traditional health coaching and activated consumer coaching positively affected health risk status and consumer activation. In addition, both coaching interventions improved participant ability to recognize a reliable health website. Consumer activation coaching also significantly improved self-reported productivity. CONCLUSION. An effective intervention can change employee health risk status and activation both at the population level and at the individual high risk level. However, program engagement at the population level was low, indicating that additional promotional strategies, such as greater use of incentives, need to be examined. Less intensive coaching can be as effective as more intensive, albeit both interventions produced modest behavior change and retention in the consumer activation arm was most difficult. Further research is needed concerning recruitment and retention methods that will enable populations to realize the full potential of activated consumerism.

Treatment decisions based on scalar and functional baseline covariates.

PubMed

Ciarleglio, Adam; Petkova, Eva; Ogden, R Todd; Tarpey, Thaddeus

2015-12-01

The amount and complexity of patient-level data being collected in randomized-controlled trials offer both opportunities and challenges for developing personalized rules for assigning treatment for a given disease or ailment. For example, trials examining treatments for major depressive disorder are not only collecting typical baseline data such as age, gender, or scores on various tests, but also data that measure the structure and function of the brain such as images from magnetic resonance imaging (MRI), functional MRI (fMRI), or electroencephalography (EEG). These latter types of data have an inherent structure and may be considered as functional data. We propose an approach that uses baseline covariates, both scalars and functions, to aid in the selection of an optimal treatment. In addition to providing information on which treatment should be selected for a new patient, the estimated regime has the potential to provide insight into the relationship between treatment response and the set of baseline covariates. Our approach can be viewed as an extension of "advantage learning" to include both scalar and functional covariates. We describe our method and how to implement it using existing software. Empirical performance of our method is evaluated with simulated data in a variety of settings and also applied to data arising from a study of patients with major depressive disorder from whom baseline scalar covariates as well as functional data from EEG are available. © 2015, The International Biometric Society.

The Scandinavian Solutions for Wellness study - a two-arm observational study on the effectiveness of lifestyle intervention on subjective well-being and weight among persons with psychiatric disorders.

PubMed

Porsdal, Vibeke; Beal, Catherine; Kleivenes, Ole Kristian; Martinsen, Egil W; Lindström, Eva; Nilsson, Harriet; Svanborg, Pär

2010-06-10

Solutions for Wellness (SfW) is an educational 3-month program concerning nutrition and exercise for persons with psychiatric disorders on psychotropic medication, who have weight problems. This observational study assessed the impact of SfW on subjective well-being, weight and waist circumference (WC). Data was collected at 49 psychiatric clinics. Where the SfW program was offered patients could enter the intervention group; where not, the control group. Subjective well-being was measured by the Subjective Well-being under Neuroleptics scale (SWN), at baseline, at the end of SfW participation, and at a follow-up 6 months after baseline. Demographic, disease and treatment data was also collected. 314 patients enrolled in the SfW group, 59 in the control group. 54% of the patients had schizophrenia, 67% received atypical antipsychotics, 56% were female. They averaged 41 +/- 12.06 years and had a BMI of 31.4 +/- 6.35. There were significant differences at baseline between groups for weight, SWN total score and other factors. Stepwise logistic models controlling for baseline covariates yielded an adjusted non-significant association between SfW program participation and response in subjective well-being (SWN increase). However, statistically significant associations were found between program participation and weight-response (weight loss or gain < 1 kg) OR = 2; 95% CI [1.1; 3.7] and between program participation and WC-response (WC decrease or increase < 2 cm) OR = 5; 95% CI [2.4; 10.3]), at 3 months after baseline. SfW program participation was associated with maintaining or decreasing weight and WC but not with improved subjective well-being as measured with the SWN scale.

Family planning in conflict: results of cross-sectional baseline surveys in three African countries

PubMed Central

2011-01-01

Background Despite the serious consequences of conflict for reproductive health, populations affected by conflict and its aftermath face tremendous barriers to accessing reproductive health services, due to insecurity, inadequate numbers of trained personnel and lack of supplies. Family planning is often particularly neglected. Methods In six conflict-affected areas in Sudan, northern Uganda and the Democratic Republic of Congo, household surveys of married or in-union women of reproductive age were conducted to determine baseline measures of family planning knowledge, attitudes and behaviors regarding contraception. Health facility assessments were carried out to assess baseline measures of family planning services availability. Data were double-entered into CSPro 3.2 and exported to SAS 9.2, which was used to calculate descriptive statistics. The studies' purposes were to guide program activities and to serve as a baseline against which program accomplishments could be measured. Results Knowledge of modern contraceptive methods was low relative to other sub-Saharan African countries, and use of modern methods was under 4% in four sites; in two sites with prior family planning services it was 12% and 16.2%. From 30% to 40% of women reported they did not want a child within two years, however, and an additional 12% to 35% wanted no additional children, suggesting a clear need for family planning services. The health facilities assessment showed that at most only one-third of the facilities mandated to provide family planning had the necessary staff, equipment and supplies to do so adequately; in some areas, none of the facilities were prepared to offer such services. Conclusions Family planning services are desired by women living in crisis situations when offered in a manner appropriate to their needs, yet services are rarely adequate to meet these needs. Refugee and internally displaced women must be included in national and donors' plans to improve family planning in Africa. PMID:21752241

Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib.

PubMed

Rothstein, Brooke; Joshipura, Deep; Saraiya, Ami; Abdat, Rana; Ashkar, Huda; Turkowski, Yana; Sheth, Vaneeta; Huang, Victor; Au, Shiu Chung; Kachuk, Courtney; Dumont, Nicole; Gottlieb, Alice B; Rosmarin, David

2017-06-01

Existing therapies for vitiligo are limited in efficacy and can be associated with undesirable side effects. Topical Janus kinase inhibitors may offer a new therapeutic option for vitiligo. We sought to assess the role of topical ruxolitinib 1.5% cream, a Janus kinase inhibitor, in vitiligo treatment. This 20-week, open-label, proof-of-concept trial of twice-daily topical ruxolitinib 1.5% cream was conducted in 12 patients with a minimum of 1% affected body surface area of vitiligo. The primary outcome was percent improvement in Vitiligo Area Scoring Index from baseline to week 20. Of 12 patients screened, 11 were enrolled and 9 completed the study (54.5% men; mean age, 52 years). Four patients with significant facial involvement at baseline had a 76% improvement in facial Vitiligo Area Scoring Index scores at week 20 (95% confidence interval, 53-99%; P = .001). A 23% improvement in overall Vitiligo Area Scoring Index scores was observed in all enrolled patients at week 20 (95% confidence interval, 4-43%; P = .02). Three of 8 patients responded on body surfaces and 1 of 8 patients responded on acral surfaces. Adverse events were minor, including erythema, hyperpigmentation, and transient acne. Limitations of the study include the small sample size and open-label study design. Topical ruxolitinib 1.5% cream provided significant repigmentation in facial vitiligo and may offer a valuable new treatment for vitiligo. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

The impact of cannabis use on patients enrolled in opioid agonist therapy in Ontario, Canada.

PubMed

Franklyn, Alexandra M; Eibl, Joseph K; Gauthier, Graham J; Marsh, David C

2017-01-01

With the Canadian government legalizing cannabis in the year 2018, the potential harms to certain populations-including those with opioid use disorder-must be investigated. Cannabis is one of the most commonly used substances by patients who are engaged in medication-assisted treatment for opioid use disorder, the effects of which are largely unknown. In this study, we examine the impact of baseline and ongoing cannabis use, and whether these are impacted differentially by gender. We conducted a retrospective cohort study using anonymized electronic medical records from 58 clinics offering opioid agonist therapy in Ontario, Canada. One-year treatment retention was the primary outcome of interest and was measured for patients who did and did not have a cannabis positive urine sample in their first month of treatment, and as a function of the proportion of cannabis-positive urine samples throughout treatment. Our cohort consisted of 644 patients, 328 of which were considered baseline cannabis users and 256 considered heavy users. Patients with baseline cannabis use and heavy cannabis use were at increased risk of dropout (38.9% and 48.1%, respectively). When evaluating these trends by gender, only female baseline users and male heavy users are at increased risk of premature dropout. Both baseline and heavy cannabis use are predictive of decreased treatment retention, and differences do exist between genders. With cannabis being legalized in the near future, physicians should closely monitor cannabis-using patients and provide education surrounding the potential harms of using cannabis while receiving treatment for opioid use disorder.

The impact of cannabis use on patients enrolled in opioid agonist therapy in Ontario, Canada

PubMed Central

Franklyn, Alexandra M.; Eibl, Joseph K.; Gauthier, Graham J.

2017-01-01

Background With the Canadian government legalizing cannabis in the year 2018, the potential harms to certain populations—including those with opioid use disorder—must be investigated. Cannabis is one of the most commonly used substances by patients who are engaged in medication-assisted treatment for opioid use disorder, the effects of which are largely unknown. In this study, we examine the impact of baseline and ongoing cannabis use, and whether these are impacted differentially by gender. Methods We conducted a retrospective cohort study using anonymized electronic medical records from 58 clinics offering opioid agonist therapy in Ontario, Canada. One-year treatment retention was the primary outcome of interest and was measured for patients who did and did not have a cannabis positive urine sample in their first month of treatment, and as a function of the proportion of cannabis-positive urine samples throughout treatment. Results Our cohort consisted of 644 patients, 328 of which were considered baseline cannabis users and 256 considered heavy users. Patients with baseline cannabis use and heavy cannabis use were at increased risk of dropout (38.9% and 48.1%, respectively). When evaluating these trends by gender, only female baseline users and male heavy users are at increased risk of premature dropout. Interpretation Both baseline and heavy cannabis use are predictive of decreased treatment retention, and differences do exist between genders. With cannabis being legalized in the near future, physicians should closely monitor cannabis-using patients and provide education surrounding the potential harms of using cannabis while receiving treatment for opioid use disorder. PMID:29117267

Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services

PubMed Central

Romero, Lisa M.; Middleton, Dawn; Mueller, Trisha; Avellino, Lia; Hallum-Montes, Rachel

2015-01-01

Purpose The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. Methods Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. Results Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. Conclusions The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities. PMID:26381918

Targeting the taqueria: implementing healthy food options at Mexican American restaurants.

PubMed

Hanni, Krista D; Garcia, Elan; Ellemberg, Cheryl; Winkleby, Marilyn

2009-04-01

As part of a 5-year community-based intervention in Salinas, California, the Steps to a Healthier Salinas team developed a taqueria intervention addressing obesity and diabetes among Mexican Americans. The authors present: (a) a comparison of service/entrée options for Salinas taquerias (n = 35) and fast-food restaurants ( n = 38) at baseline, (b) a case study of one taqueria, (c) a description of a healthy nutrition tool kit tailored to taquerias, and (d) an evaluation of the intervention at Year 3. It was found that traditional Mexican American-style menu offerings at taquerias tended to be healthier than American-style fast-food restaurant offerings. In addition, the initial response to the intervention has shown positive changes, which include the taqueria owners promoting available healthy menu items and modifying other menu offerings to reduce fats and increase fruit and vegetable availability. This, in turn, has led to a transition of the owners' perceptions of themselves as gatekeepers for a healthy community.

Gut microbiota composition and relapse risk in pediatric MS: A pilot study.

PubMed

Tremlett, Helen; Fadrosh, Douglas W; Faruqi, Ali A; Hart, Janace; Roalstad, Shelly; Graves, Jennifer; Lynch, Susan; Waubant, Emmanuelle

2016-04-15

We explored the association between baseline gut microbiota (16S rRNA biomarker sequencing of stool samples) in 17 relapsing-remitting pediatric MS cases and risk of relapse over a mean 19.8 months follow-up. From the Kaplan-Meier curve, 25% relapsed within an estimated 166 days from baseline. A shorter time to relapse was associated with Fusobacteria depletion (p=0.001 log-rank test), expansion of the Firmicutes (p=0.003), and presence of the Archaea Euryarchaeota (p=0.037). After covariate adjustments for age and immunomodulatory drug exposure, only absence (vs. presence) of Fusobacteria was associated with relapse risk (hazard ratio=3.2 (95% CI: 1.2-9.0), p=0.024). Further investigation is warranted. Findings could offer new targets to alter the MS disease course. Copyright © 2016 Elsevier B.V. All rights reserved.

Interpreting incremental value of markers added to risk prediction models.

PubMed

Pencina, Michael J; D'Agostino, Ralph B; Pencina, Karol M; Janssens, A Cecile J W; Greenland, Philip

2012-09-15

The discrimination of a risk prediction model measures that model's ability to distinguish between subjects with and without events. The area under the receiver operating characteristic curve (AUC) is a popular measure of discrimination. However, the AUC has recently been criticized for its insensitivity in model comparisons in which the baseline model has performed well. Thus, 2 other measures have been proposed to capture improvement in discrimination for nested models: the integrated discrimination improvement and the continuous net reclassification improvement. In the present study, the authors use mathematical relations and numerical simulations to quantify the improvement in discrimination offered by candidate markers of different strengths as measured by their effect sizes. They demonstrate that the increase in the AUC depends on the strength of the baseline model, which is true to a lesser degree for the integrated discrimination improvement. On the other hand, the continuous net reclassification improvement depends only on the effect size of the candidate variable and its correlation with other predictors. These measures are illustrated using the Framingham model for incident atrial fibrillation. The authors conclude that the increase in the AUC, integrated discrimination improvement, and net reclassification improvement offer complementary information and thus recommend reporting all 3 alongside measures characterizing the performance of the final model.

Core compressor exit stage study. Volume 3: Data and performance report for screening test configurations

NASA Technical Reports Server (NTRS)

Wisler, D. C.

1980-01-01

Rear stage blading designs that have lower losses in their endwall boundary layer regions were developed. Test data and performance results for rotor B, stator B, and stator C - blading designs that offer promise of reducing endwall losses relative to the baseline are given. A low speed research compressor was the principal investigative tool. The tests were conducted using four identical stages of blading so that the test data would be obtained in a true multistage environment.

Advanced solar receiver conceptual design study

NASA Technical Reports Server (NTRS)

Kesseli, J. B.; Lacy, D. E.

1987-01-01

High temperature solar dynamic Brayton and Stirling receivers are investigated as candidate electrical power generating systems for future LEO missions. These receivers are smaller and more efficient than conventional receivers, and they offer less structural complexity and fewer thermal stress problems. Use of the advanced Direct Absorption Storage Receiver allows many of the problems associated with working with high-volumetric-change phase-change materials to be avoided. A specific mass reduction of about 1/3 with respect to the baseline receiver has been realized.

Design and baseline characteristics of the 10 Small Steps Study: a randomised controlled trial of an intervention to promote healthy behaviour using a lifestyle score and personalised feedback.

PubMed

Parekh, Sanjoti; Vandelanotte, Corneel; King, David; Boyle, Frances M

2012-03-12

Non-communicable diseases (NCDs) are the leading causes of death globally and are associated with a limited set of common, modifiable health behaviours: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. General practice offers an ideal avenue for addressing such health behaviours on a population-wide basis. This paper describes the protocol of a multiple health behaviour change intervention designed for implementation in general practice and summarises the baseline characteristics of its participants. The 10 Small Steps (10SS) study, a randomised controlled trial, involved 4,678 adult general practice patients in Queensland, Australia. Self-reported data were collected to establish the proportion of participants meeting recommended guidelines for ten health behaviours: physical activity, body mass index, alcohol, smoking and six dietary behaviours. Participants were randomised to four groups: contact at baseline only ('single intervention' and corresponding control group) and contact at baseline and 3 months ('dual intervention' and corresponding control group). At each contact the participants received a computer-tailored feedback and one page information sheet according to their allocation to intervention or control groups. Change in the intervention group compared to the control group was assessed at 3 and12 months after baseline data collection.Responses were summed to calculate an individual lifestyle score (the Prudence Score), which ranged from 0 to 10. The baseline response was 56.5% (4678 of 8343 invited participants) and the study sample was primarily female (68.7%) with an average age of 47 years. The mean Prudence Score was 5.8 (95%CI 5.75-5.85). Baseline data from the 10SS study show that nearly all participants engage in some health behaviours but relatively few adhere simultaneously to a core set of dietary and lifestyle behaviours associated with risk of NCDs. Ample scope exists to improve health behaviour to reduce NCDs in the general practice setting and the 10SS study trial will provide data on the extent to which a minimal computer-tailored intervention can meet this objective. The protocol developed for the 10SS study has potential for translation into routine general practice as it has minimal impact on practice routine whilst contributing to primary prevention objectives. The Australian New Zealand Clinical Trials Registry ACTRN12611001213932.

Pretreatment data is highly predictive of liver chemistry signals in clinical trials

PubMed Central

Cai, Zhaohui; Bresell, Anders; Steinberg, Mark H; Silberg, Debra G; Furlong, Stephen T

2012-01-01

Purpose The goal of this retrospective analysis was to assess how well predictive models could determine which patients would develop liver chemistry signals during clinical trials based on their pretreatment (baseline) information. Patients and methods Based on data from 24 late-stage clinical trials, classification models were developed to predict liver chemistry outcomes using baseline information, which included demographics, medical history, concomitant medications, and baseline laboratory results. Results Predictive models using baseline data predicted which patients would develop liver signals during the trials with average validation accuracy around 80%. Baseline levels of individual liver chemistry tests were most important for predicting their own elevations during the trials. High bilirubin levels at baseline were not uncommon and were associated with a high risk of developing biochemical Hy’s law cases. Baseline γ-glutamyltransferase (GGT) level appeared to have some predictive value, but did not increase predictability beyond using established liver chemistry tests. Conclusion It is possible to predict which patients are at a higher risk of developing liver chemistry signals using pretreatment (baseline) data. Derived knowledge from such predictions may allow proactive and targeted risk management, and the type of analysis described here could help determine whether new biomarkers offer improved performance over established ones. PMID:23226004

The Advanced Glaucoma Intervention Study (AGIS): 12. Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma.

PubMed

2002-10-01

To examine the relationships between baseline risk factors and sustained decrease of visual field (SDVF) and sustained decrease of visual acuity (SDVA). Cohort study of participants in the Advanced Glaucoma Intervention Study (AGIS). This multicenter study enrolled patients between 1988 and 1992 and followed them until 2001; 789 eyes of 591 patients with advanced glaucoma were randomly assigned to one of two surgical sequences, argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) or trabeculectomy-ALT-trabeculectomy (TAT). This report is based on data from 747 eyes. Eyes were offered the next intervention in the sequence upon failure of the previous intervention. Failure was based on recurrent intraocular pressure elevation, visual field defect, and disk rim criteria. Study visits occurred every 6 months; potential follow-up ranged from 8 to 13 years. For each intervention sequence, Cox multiple regression analyses were used to examine the baseline characteristics for association with two vision outcomes: SDVF and SDVA. The magnitude of the association is measured by the hazard ratio (HR), where HR for binary variables is the relative change in the hazard (or risk) of the outcome in eyes with the factor divided by the hazard in eyes without the factor, and HR for continuous variables is the relative change in the hazard (or risk) of the outcome in eyes with a unit increase in the factor. Characteristics associated with increased SDVF risk in the ATT sequence are: less baseline visual field defect (hazard ratio [HR] = 0.86, P <.001, 95% CI = 0.82-0.90), male gender (HR = 2.23, P <.001, 1.54-3.23), and worse baseline visual acuity (HR = 0.96, P =.001, 0.94-0.98); in the TAT sequence: less baseline visual field defect (HR = 0.93, P =.001, 0.89-0.97) and diabetes (HR = 1.87, P =.007, 1.18-2.97). Characteristics associated with increased SDVA risk in both treatment sequences are better baseline acuity (ATT: HR = 1.05, P <.001, 1.02-1.09; TAT: HR = 1.06, P <.001, 1.03-1.08), older age (ATT: HR = 1.05, P =.001, 1.02-1.08; TAT: HR = 1.04, P =.002, 1.01-1.06), and less formal education (ATT: HR = 1.92, P =.001, 1.29-2.88; TAT: HR = 1.77, P =.002, 1.22-2.54). For SDVF, risk factors were better baseline visual field in both treatment sequences, male gender, and worse baseline visual acuity in the ATT sequence, and diabetes in the TAT sequence. For SDVA, risk factors in both treatment sequences were better baseline visual acuity, older age, and less formal education.

The pediatric resident training on tobacco project: baseline findings from the Parent/Guardian Tobacco Survey.

PubMed

Hymowitz, Norman; Schwab, Joseph; Haddock, Christopher keith; Pyle, Sara; Moore, Glenisha; Meshberg, Sarah

2005-07-01

Pediatricians have an important and unique role to play in the anti-tobacco arena. They may prevent relapse to smoking in women who stopped smoking during pregnancy, encourage parents to protect infants and young children from environmental tobacco smoke (ETS), prevent the onset of smoking in children and adolescents, and help patients and parents who smoke or use other forms of tobacco to quit. Unfortunately, few pediatricians intervene on tobacco use or ETS, and few pediatric residency training programs prepare residents to address tobacco. The Pediatric Residency Training on Tobacco Project is a 4-year randomized prospective study of the effectiveness of training pediatric residents to intervene on tobacco in patients and parents. In this paper, we present findings from the Baseline Parent/Guardian Tobacco Survey. Fifteen pediatric residency training programs participated in the Pediatric Residency Training on Tobacco Project, and they were assigned randomly to special and standard training conditions. The Baseline Parent/Guardian Tobacco Survey was administered to 1770 participants, a minimum of 100 from each site. The Parent/Guardian Survey was designed to describe the population under study. It addressed demographic information, family tobacco use, rules concerning smoking in the home and elsewhere, smoking behavior and beliefs, and parent/guardian reports of resident intervention on tobacco. Data analyses described the population served by Continuity Clinics associated with the pediatric residency training programs and determined the degree to which residents addressed tobacco in parents/guardians. The parents/guardians were primarily low-income African American and Hispanic females. Approximately 20% reported that they smoked cigarettes, and about 60% prohibited smoking in their home. Seventy percent of the parents reported that the resident asked about cigarette smoking, and about half indicated that the resident talked with them about ETS. However, only about 10% of the smokers stated that the doctor offered to help them stop smoking, and just 25% of all parents/guardians indicated that the doctor offered to help them stop exposing their children to ETS in the home or elsewhere. Parents of children brought to Continuity Clinic may benefit from advice and assistance on quitting cigarette smoking and protecting their children from ETS. While pediatric residents offer advice and encouragement, few provide the assistance parents require. These findings underscore the importance of training pediatric residents to address tobacco with the parents/guardians of the patients they serve.

Understanding How Postnatal Depression Screening and Early Intervention Work in the Real World - A Singaporean Perspective.

PubMed

Lee, Theresa My; Bautista, Dianne; Chen, Helen Y

2016-10-01

Postnatal depression is a major public health problem with clearly established adverse effects in child outcomes. This study examines the 4-year outcomes of a screening and early intervention programme, in relation to improvement in symptoms, functioning and health quality of life. Women were prospectively recruited up to 6 months postdelivery, using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. High-scorers (EPDS >13), were offered psychiatric consultation, and those with borderline scores (EPDS 10-12) were provided counselling, and offered follow-up phone counselling by the assigned case manager. Outcome measures were obtained at baseline, and at 6 months or discharge if earlier, for levels of symptoms, functioning, and health quality of life. From 2008 to 2012, 5245 women were screened, with 307 (5.9%) women with EPDS >13 receiving intervention. Of these, 70.0% had depression, 4.6% anxiety and 3.4% psychosis. In the depression subgroup, the net change was improvement of 93.4% EPDS symptom scores, 92.2% Global Assessment of Functioning (GAF) scores, and 88.3% visual analogue scale (EQ VAS) health quality of life scores. Outcome scores across diagnostic categories demonstrated median changes of 10 points on EPDS, 20 points on GAF, and 25 points on EQ VAS, reflecting 73.9%, 36.4% and 41.7% change from baseline scores. Women with psychosis showed the biggest (80.0%) relative change in GAF functioning scores from baseline to discharge but had the lowest median change in EPDS symptom scores. A screening and intervention programme rightly-sited within an obstetric setting can improve clinical outcomes because of early detection and intervention.

[A novel school-based strategy for the prevention of HIV/AIDS, sexually transmitted disease (STDs), and teen pregnancies].

PubMed

Torres, Pilar; Walker, Dilys M; Gutiérez, Juan Pablo; Bertozzi, Stefano M

2006-01-01

To introduce the study design of an HIV/AIDS and unplanned pregnancy prevention program targeting high school students, and to present the results from the baseline survey. A school curriculum was developed to inform adolescent students about HIV/AIDS/STD prevention, which included information on emergency contraception (EC) for adolescent students. A randomized controlled study was conducted to simultaneously evaluate the effect of this intervention. The baseline survey collected data on contraception knowledge and attitudes regarding sexual behaviors. A total of 11,117 students from 40 schools participated in the baseline (52% female, the mean age of both males and females was 15.5). A total of 10% of the females and 24% of the men surveyed were sexually active at baseline, but only 39% of those sexually active reported using a condom at the time of their first sexual intercourse. Among the sexually active students surveyed, a third of the males and a fifth of the females reported at least one condom slip or breakage. Most of the students were aware of EC. The low proportion of students that report using condoms accompanied by their incorrect use points to the need for HIV/AIDS and unplanned pregnancy prevention efforts. This novel approach offers adolescents EC, a backup method to the condom. The approach is feasible as students know what EC is and furthermore it appears that they are willing to use this method.

Eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder in a child and an adolescent with mild to borderline intellectual disability: A multiple baseline across subjects study.

PubMed

Mevissen, Liesbeth; Didden, Robert; Korzilius, Hubert; de Jongh, Ad

2017-12-01

This study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design. One child and one adolescent with MBID, who met diagnostic criteria for PTSD according to a PTSD clinical interview (i.e., ADIS-C PTSD section), adapted and validated for this target group, were offered four sessions of EMDR. PTSD symptoms were measured before, during and after EMDR, and at six weeks follow-up. For both participants, number of PTSD symptoms decreased in response to treatment and both no longer met PTSD criteria at post-treatment. This result was maintained at 6-week follow-up. The results of this study add further support to the notion that EMDR can be an effective treatment for PTSD in children and adolescents with MBID. Replication of this study in larger samples and using a randomized controlled design is warranted. © 2017 John Wiley & Sons Ltd.

Additive hazards regression and partial likelihood estimation for ecological monitoring data across space.

PubMed

Lin, Feng-Chang; Zhu, Jun

2012-01-01

We develop continuous-time models for the analysis of environmental or ecological monitoring data such that subjects are observed at multiple monitoring time points across space. Of particular interest are additive hazards regression models where the baseline hazard function can take on flexible forms. We consider time-varying covariates and take into account spatial dependence via autoregression in space and time. We develop statistical inference for the regression coefficients via partial likelihood. Asymptotic properties, including consistency and asymptotic normality, are established for parameter estimates under suitable regularity conditions. Feasible algorithms utilizing existing statistical software packages are developed for computation. We also consider a simpler additive hazards model with homogeneous baseline hazard and develop hypothesis testing for homogeneity. A simulation study demonstrates that the statistical inference using partial likelihood has sound finite-sample properties and offers a viable alternative to maximum likelihood estimation. For illustration, we analyze data from an ecological study that monitors bark beetle colonization of red pines in a plantation of Wisconsin.

Unprotected sex among African-American adolescents: a three-year study.

PubMed Central

Li, Xiaoming; Stanton, Bonita; Feigelman, Susan; Galbraith, Jennifer

2002-01-01

This study examined the cumulative change of unprotected sex over a period of three years among 383 African American youth ages 9 to 15 at baseline who participated in a trial of a Human Immunodeficiency Virus (HIV) risk reduction intervention. Cumulative scores of sexual intercourse and failure to use condoms were compared between intervention and control groups. The results indicate that cumulatively over the three-year period, intervention youth reported significantly lower rates of failure to use a condom. The findings indicate that face-to-face interventions may offer significant cumulative protection from unprotected sex over the long-term. PMID:12392042

E-care: a telecommunications technology intervention for family caregivers of dementia patients.

PubMed

Finkel, Sanford; Czaja, Sara J; Schulz, Richard; Martinovich, Zoran; Harris, Carol; Pezzuto, Donna

2007-05-01

This study evaluated the effectiveness of a technology-based psychoeducational intervention for family caregivers of dementia patients. An additional objective was to determine if the intervention could be implemented by a community-based social service agency. Forty-six caregivers were randomly assigned to either a technology-based intervention or an information-only control condition. Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidenced high depression at baseline experienced a significant decline in depression. This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers.

Notebook Computers Increase Communication.

ERIC Educational Resources Information Center

Carey, Doris M.; Sale, Paul

1994-01-01

Project FIT (Full Inclusion through Technology) provides notebook computers for children with severe disabilities. The computers offer many input and output options. Assessing the students' equipment needs is a complex process, requiring determination of communication goals and baseline abilities, and consideration of equipment features such as…

A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD.

PubMed

Zemore, Sarah E; Lui, Camillia; Mericle, Amy; Hemberg, Jordana; Kaskutas, Lee Ann

2018-05-01

Despite the effectiveness of 12-step groups, most people reporting a prior alcohol use disorder (AUD) do not sustain involvement in such groups at beneficial levels. This highlights the need for research on other mutual help groups that address alcohol problems and may attract those who avoid 12-step groups. The current study addresses this need, offering outcome data from the first longitudinal, comparative study of 12-step groups and their alternatives: The Peer ALlternatives for Addiction (PAL) Study. Adults with a lifetime AUD were surveyed at baseline (N=647), 6months (81% response rate) and 12months (83% response rate). Members of the largest known secular mutual help alternatives, namely Women for Sobriety (WFS), LifeRing, and SMART, were recruited in collaboration with group directors; current 12-step attendees were recruited from an online meeting hub. Online surveys assessed demographic and clinical variables; mutual help involvement; and alcohol and drug use and severity. Analyses involved multivariate logistic GEEs separately modelling alcohol abstinence, alcohol problems, and total abstinence across 6 and 12months. Key predictors were baseline primary group affiliation (PGA); primary group involvement (PGI) at both baseline and 6months; and the interaction between baseline PGA and 6-month PGI. The critical effects of interest were the interactions, expressing whether associations between changes in PGI from baseline to 6months and substance use outcomes differed by primary group. None of the interactions between baseline PGA and 6-month PGI were significant, suggesting no differences in the efficacy of WFS, LifeRing, or SMART, vs. 12-step groups. Nevertheless, some PGA main effects emerged. Compared to 12-step members, those identifying SMART as their primary group at baseline fared worse across outcomes, and those affiliating with LifeRing showed lower odds of total abstinence. Still, these effects became nonsignificant when controlling for baseline alcohol recovery goal, suggesting that any group differences may be explained by selection of those with weaker abstinence motivation into LifeRing and (especially) SMART. This study makes a valuable contribution in view of the extremely limited evidence on mutual help alternatives. Results tentatively suggest that WFS, LifeRing, and SMART are as effective as 12-step groups for those with AUDs, and that this population has the best odds of success when committing to lifetime total abstinence. An optimal care plan may thus involve facilitating involvement in a broad array of mutual help groups and supporting abstinence motivation. Copyright © 2018 Elsevier Inc. All rights reserved.

Cravings as a mediator and moderator of drinking outcomes in the COMBINE study.

PubMed

Subbaraman, Meenakshi Sabina; Lendle, Samuel; van der Laan, Mark; Kaskutas, Lee Ann; Ahern, Jennifer

2013-10-01

Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator. Secondary mediation and moderation analyses of COMBINE study data. Eleven United States academic sites. A total of 863 patients randomized to one of four treatment groups: naltrexone (100 mg/day; n = 209), the combined behavioral intervention (CBI, n = 236), naltrexone and CBI combined (n = 213) and placebo naltrexone (n = 205). Percentage of days abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, were measured at baseline, weeks 4 and 12 using the Obsessive-Compulsive Drinking Scale. Compared with placebo, naltrexone, CBI and the combination all increased PDA by an additional 6-10 percentage points for those with high cravings (P < 0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were mediated at least partially by cravings; craving reduction explained 48-53% of treatment effects (P < 0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks. The Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) naltrexone + CBI combination may not be more beneficial than either monotherapy because craving reduction is a common mechanism of both. © 2013 Society for the Study of Addiction.

Work factors and psychological distress in nurses' aides: a prospective cohort study

PubMed Central

Eriksen, Willy; Tambs, Kristian; Knardahl, Stein

2006-01-01

Background Nurses' aides (assistant nurses), the main providers of practical patient care in many countries, are doing both emotional and heavy physical work, and are exposed to frequent social encounters in their job. There is scarce knowledge, though, of how working conditions are related to psychological distress in this occupational group. The aim of this study was to identify work factors that predict the level of psychological distress in nurses' aides. Methods The sample of this prospective study comprised 5076 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4076 (80.3 %) completed a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were measured at baseline. Psychological distress (anxiety and depression) was assessed at baseline and follow-up by the SCL-5, a short version of Hopkins Symptom Checklist-25. Results In a linear regression model of the level of psychological distress at follow-up, with baseline level of psychological distress, work factors, and background factors as independent variables, work factors explained 2 % and baseline psychological distress explained 34 % of the variance. Exposures to role conflicts, exposures to threats and violence, working in apartment units for the aged, and changes in the work situation between baseline and follow-up that were reported to result in less support and encouragement were positively associated with the level of psychological distress. Working in psychiatric departments, and changes in the work situation between baseline and follow-up that gave lower work pace were negatively associated with psychological distress. Conclusion The study suggests that work factors explain only a modest part of the psychological distress in nurses' aides. Exposures to role conflicts and threats and violence at work may contribute to psychological distress in nurses' aides. It is important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy. It is also important that health service organisations focus on reducing role conflicts, and that leaders listen to and consider the views of the staff. PMID:17132172

Effectiveness of a group opt-in session on uptake and graduation rates for pulmonary rehabilitation.

PubMed

Graves, J; Sandrey, V; Graves, T; Smith, D L

2010-08-01

Pulmonary rehabilitation (PR) is an effective intervention in the treatment of patients with chronic obstructive pulmonary disease (COPD). Unfortunately some patients offered this treatment either fail to take up the offer or fail to complete the course. Studies have indicated a number of factors influencing uptake and completion rates. We describe the introduction of an intervention, the group opt-in session (GOIS), prior to individualised baseline assessment and entry to the PR course, with the intention being to improve uptake and completion rates. A 1.5-hour-long GOIS was offered as the first face-to-face contact to all patients referred for PR. Drop-out rates at all stages of the pathway from referral to graduation were collected on 200 patients prior to the introduction of the GOIS (non-GOIS group) and compared to the first 400 patients following introduction (the GOIS group). Possible independent predictors of course uptake and completion were examined in the GOIS group. The proportion of referred patients taking up the offer of individualised baseline assessment or a GOIS was similar (75% vs. 72.2%, p value not significant [ns]). However, since in the GOIS group the opt-in session preceded the individualised baseline assessment and some patients opted-out, a smaller proportion of referred patients underwent this assessment than in the non-GOIS group (58.7% vs. 75%, p < 0.001). In addition, dropouts following individualised baseline assessments were also reduced (7% vs. 22%, p < 0.001). Both of these factors reduced 'wasted' assessments. Similar proportions of patients referred began the PR course in both groups (53% vs. 51.7%, ns), but a higher proportion of patients graduated in the GOIS group (87.9% vs. 76.4%, p < 0.05). Drop-out rates due to illness were similar in both groups (8.5% pre vs. 6.8% post, ns). However, drop-out rates not due to illness were much higher in the non-GOIS group (15.1% vs. 5.3%, p < 0.001). In the GOIS group, patients who did not attend the GOIS were, on average, younger (64.6 years vs. 69.7 years, p < 0.001) and had a higher mean percent predicted Forced Expiratory Volume (50.6% vs. 43.8%, p < 0.05) than those that did attend. A greater proportion of patients who opted in to the GOIS and attended the PR course lived less than 25 minutes from the PR centre than either those who did not attend the GOIS or who attended and then opted out (77.4% vs. 63%, p<0.005). The GOIS improved the graduation rates at The North Bristol Lung Centre PR Course and reduced wasted assessments. There was no effect on initial uptake. Analysis of the behaviour of patients invited to a GOIS suggested that age, lung function and travel distance were important factors influencing patient choice.

Impact of Receiving Secondary Results from Genomic Research: A 12-Month Longitudinal Study.

PubMed

Wynn, Julia; Martinez, Josue; Bulafka, Jessica; Duong, Jimmy; Zhang, Yuan; Chiuzan, Codruta; Preti, Jain; Cremona, Maria L; Jobanputra, Vaidehi; Fyer, Abby J; Klitzman, Robert L; Appelbaum, Paul S; Chung, Wendy K

2018-06-01

The impact of returning secondary results from exome sequencing (ES) on patients/participants is important to understand as ES is increasingly utilized in clinical care and research. Participants were recruited from studies using ES and were separated into two arms: 107 who had ES and were offered the choice to learn secondary results (ES group) and 85 who had not yet had ES (No ES group). Questionnaires were administered at baseline and 1 and 12 months, following results disclosure (ES group) or enrollment (No ES group). While the majority (65%) elected to learn all results following pre-test counseling, it was reduced from the 76% who indicated a desire for all results at baseline. Thirty-seven percent received results associated with an increased personal disease risk. There were no differences in changes in any of the psychological and social measures from baseline to post-results disclosure between the ES and No ES groups. Receiving a wide range of secondary findings appeared to have little measurable impact on most participants. The experience of learning secondary results may be related to participants' previous experiences with genetics, as well as the genetic counseling provided. Future research with a more diverse, genetically naïve group, as well as scalable methods of delivery, is needed.

Impacts of Child Development Accounts on maternal depressive symptoms: evidence from a randomized statewide policy experiment.

PubMed

Huang, Jin; Sherraden, Michael; Purnell, Jason Q

2014-07-01

This study examines the impact of Child Development Accounts (CDAs)-asset-building accounts created for children at birth-on the depressive symptoms of mothers in a statewide randomized experiment conducted in the United States. The experiment identified the primary caregivers of children born in Oklahoma during 2007, and 2704 of the caregivers completed a baseline interview before random assignment to the treatment (n = 1358) or the control group (n = 1346). To treatment participants, the experiment offered CDAs built on the existing Oklahoma 529 College Savings Plan. The baseline and follow-up surveys measured the participants' depressive symptoms with a shortened version of the Center for Epidemiologic Studies Depression Scale (CES-D). In models that control for baseline CES-D scores, the mean follow-up score of treatment mothers is .17 lower than that of control mothers (p < .05). Findings suggest that CDAs have a greater impact among subsamples that reported lower income or lower education. Although designed as an economic intervention for children, CDAs may improve parents' psychological well-being. Findings also suggest that CDAs' impacts on maternal depressive symptoms may be partially mediated through children's social-emotional development. Copyright © 2014 Elsevier Ltd. All rights reserved.

Psychomotor retardation and vulnerability to interferon alpha induced major depressive disorder: Prospective study of a chronic hepatitis C cohort.

PubMed

Whale, Richard; Fialho, Renata; Rolt, Michael; Eccles, Jessica; Pereira, Marco; Keller, Majella; File, Alexandra; Haq, Inam; Tibble, Jeremy

2015-12-01

Major depressive disorder (MDD) is a common consequence of interferon alpha (IFNα) treatment and important supporting evidence of a role of inflammation in the aetiology of depression. This study aimed to expand the knowledge of baseline clinical vulnerability characteristics to IFNα induced MDD, particularly exploring sub-threshold depressive symptoms. A prospective cohort of chronic HCV patients undergoing treatment with pegylated-IFNα and ribavirin was studied. MDD was assessed using the Structured Clinical Interview for DSM-IV (SCID-I). Depressive symptoms and severity were assessed at baseline and monthly with the Hamilton Depression Rating Scale (HAMD). Subjects with MDD or taking antidepressant treatment at baseline were excluded. 278 patients were assessed for this cohort with a final study sample of 190. 94.2% had contracted HCV through intravenous drug use. During six months IFNα treatment, 53.2% of patients transitioned to DSM-IV threshold MDD. In the multivariate logistic analysis, independent factors significantly associated with development of MDD were younger age (OR 0.96, 95% CI 0.93-1.00, p=0.028), past history of MDD (OR 3.82, 95% CI 1.63-8.92, p=0.002), baseline HAMD items psychomotor retardation (OR 15.21, 95% CI 1.33-173.41, p=0.032) and somatic symptoms (general) (OR 2.96, 95% CI 1.44-6.08, p=0.003), and HCV genotype 2 (OR 2.27, 95% CI 1.07-4.78, p=0.032). During IFNα treatment, the rate of transition to MDD was high in this cohort. Psychomotor retardation and somatic symptoms may represent a greater inflamed state pre-treatment. This iatrogenic model of MDD may offer important insights into wider depression aetiology. Copyright © 2015 Elsevier Inc. All rights reserved.

A Worksite Occupational Health Clinic-Based Diabetes Mellitus Management Program.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Erickson, Denise; McCluskey, Maureen; Schultz, Alyssa

2015-12-01

This study is an analysis of a workplace diabetes management program offered to employees of a Fortune 100 financial services corporation located in the United States. The 12-month worksite-based educational program was for employees who were at risk for diabetes, had prediabetes, or were diagnosed with diabetes. This employed population, with health benefits, generally had acceptable control of their diabetes at the start of the program. They statistically improved most self-efficacy measures, but improvement in biometric tests at 6 and 12 months were not significantly different from baseline. Mean hemoglobin A1c at baseline, 6 months, and 12 months was 7.2%, 7.2%, and 7.3%, respectively. At 12 months, about 40% of preprogram survey participants completed all screenings and the post-program questionnaire. Disease management programs at the workplace can be an important component in helping employees enhance their knowledge of diabetes and maintain and improve their health.

Ovarian Cancer: Deaf and Hearing Women’s Knowledge Before and After an Educational Video

PubMed Central

Jensen, Lindsay G.; Nakaji, Melanie; Harry, Kadie M.; Gallegos, Nick; Malcarne, Vanessa L.; Sadler, Georgia Robins

2013-01-01

Members of the Deaf community report language and cultural barriers to accessing health information and care. This study evaluated whether an ovarian cancer education video in American Sign Language with English captioning and voiceover could close the anticipated knowledge gap between Deaf and hearing women’s cancer knowledge. Consented Deaf (n = 55) and hearing (n = 52) women’s General, Ovarian, and Total Cancer Knowledge were assessed before and after viewing the video. At baseline, hearing women demonstrated significantly higher General, Ovarian, and Total Cancer Knowledge scores than Deaf women. By the post-test, all of Deaf women’s knowledge scores had increased, closing the baseline gap. However, hearing women’s post-video knowledge had also increased, thereby creating a new knowledge gap. The ovarian cancer education video offers an effective method to increase ovarian and general cancer knowledge for Deaf and hearing women. PMID:23975658

Flash fire and slow burn: women's cardiovascular reactivity and recovery following hostile and benevolent sexism.

PubMed

Salomon, Kristen; Burgess, Kaleena D; Bosson, Jennifer K

2015-04-01

Women's cardiovascular responses to sexist treatment are documented, but researchers have yet to consider these responses separately as a function of sexism type (hostile vs. benevolent). This study demonstrates distinct effects of hostile and benevolent sexism for women's cardiovascular responses that indicate increased risk for cardiovascular disease. Female participants performed a demanding insight task after exposure to a male researcher who offered them a hostilely sexist, benevolently sexist, or nonsexist comment. Women displayed heightened cardiovascular reactivity (increases from baseline) during the task following hostile sexism, and they displayed impaired cardiovascular recovery (return to baseline after the task) following benevolent sexism. The effects seen in the hostile condition were mediated by self-reported anger. These findings indicate that women's affective responses to hostile and benevolent sexism differ but that exposure to both forms of sexism may have negative cardiovascular consequences. (c) 2015 APA, all rights reserved).

The Alzheimer's Disease Mitochondrial Cascade Hypothesis: Progress and Perspectives

PubMed Central

Swerdlow, Russell H.; Burns, Jeffrey M.; Khan, Shaharyar M.

2013-01-01

Ten years ago we first proposed the Alzheimer's disease (AD) mitochondrial cascade hypothesis. This hypothesis maintains gene inheritance defines an individual's baseline mitochondrial function; inherited and environmental factors determine rates at which mitochondrial function changes over time; and baseline mitochondrial function and mitochondrial change rates influence AD chronology. Our hypothesis unequivocally states in sporadic, late-onset AD, mitochondrial function affects amyloid precursor protein (APP) expression, APP processing, or beta amyloid (Aβ) accumulation and argues if an amyloid cascade truly exists, mitochondrial function triggers it. We now review the state of the mitochondrial cascade hypothesis, and discuss it in the context of recent AD biomarker studies, diagnostic criteria, and clinical trials. Our hypothesis predicts biomarker changes reflect brain aging, new AD definitions clinically stage brain aging, and removing brain Aβ at any point will marginally impact cognitive trajectories. Our hypothesis, therefore, offers unique perspective into what sporadic, late-onset AD is and how to best treat it. PMID:24071439

Effect of tidal cycle and food intake on the baseline plasma corticosterone rhythm in intertidally foraging marine iguanas.

PubMed

Woodley, Sarah K; Painter, Danika L; Moore, Michael C; Wikelski, Martin; Romero, L Michael

2003-06-15

In most species, plasma levels of baseline glucocorticoids such as corticosterone (B) have a circadian rhythm. This rhythm can be entrained by both photoperiod and food intake and is related to aspects of energy intake and metabolism. Marine iguanas (Amblyrhynchus cristatus) offer a unique opportunity to better understand the relative importance of the light:dark cycle versus food intake in influencing the rhythm in baseline B in a natural system. Compared to other species, food intake is not as strictly determined by the phase of the light:dark cycle. Animals feed in the intertidal zone so feeding activity is heavily influenced by the tidal cycle. We measured baseline plasma B levels in free-living iguanas over several 24-h periods that varied in the timing of low tide/foraging activity. We found that baseline B levels were higher during the day relative to night. However, when low tide occurred during the day, baseline B levels dropped coincident with the timing of low tide. Whether the baseline B rhythm (including the drop during foraging) is an endogenous rhythm with a circatidal component, or is simply a result of feeding and associated physiological changes needs to be tested. Together, these data suggest that the baseline B rhythm in marine iguanas is influenced by the tidal cycle/food intake as well as the light:dark cycle.

Exploring the success of an integrated primary care partnership: a longitudinal study of collaboration processes.

PubMed

Valentijn, Pim P; Vrijhoef, Hubertus J M; Ruwaard, Dirk; de Bont, Antoinette; Arends, Rosa Y; Bruijnzeels, Marc A

2015-01-22

Forming partnerships is a prominent strategy used to promote integrated service delivery across health and social service systems. Evidence about the collaboration process upon which partnerships evolve has rarely been addressed in an integrated-care setting. This study explores the longitudinal relationship of the collaboration process and the influence on the final perceived success of a partnership in such a setting. The collaboration process through which partnerships evolve is based on a conceptual framework which identifies five themes: shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management. Fifty-nine out of 69 partnerships from a national programme in the Netherlands participated in this survey study. At baseline, 338 steering committee members responded, and they returned 320 questionnaires at follow-up. Multiple-regression-analyses were conducted to explore the relationship between the baseline as well as the change in the collaboration process and the final success of the partnerships. Mutual gains and process management were the most significant baseline predictors for the final success of the partnership. A positive change in the relationship dynamics had a significant effect on the final success of a partnership. Insight into the collaboration process of integrated primary care partnerships offers a potentially powerful way of predicting their success. Our findings underscore the importance of monitoring the collaboration process during the development of the partnerships in order to achieve their full collaborative advantage.

Beyond Metrics? The Role of Hydrologic Baseline Archetypes in Environmental Water Management.

PubMed

Lane, Belize A; Sandoval-Solis, Samuel; Stein, Eric D; Yarnell, Sarah M; Pasternack, Gregory B; Dahlke, Helen E

2018-06-22

Balancing ecological and human water needs often requires characterizing key aspects of the natural flow regime and then predicting ecological response to flow alterations. Flow metrics are generally relied upon to characterize long-term average statistical properties of the natural flow regime (hydrologic baseline conditions). However, some key aspects of hydrologic baseline conditions may be better understood through more complete consideration of continuous patterns of daily, seasonal, and inter-annual variability than through summary metrics. Here we propose the additional use of high-resolution dimensionless archetypes of regional stream classes to improve understanding of baseline hydrologic conditions and inform regional environmental flows assessments. In an application to California, we describe the development and analysis of hydrologic baseline archetypes to characterize patterns of flow variability within and between stream classes. We then assess the utility of archetypes to provide context for common flow metrics and improve understanding of linkages between aquatic patterns and processes and their hydrologic controls. Results indicate that these archetypes may offer a distinct and complementary tool for researching mechanistic flow-ecology relationships, assessing regional patterns for streamflow management, or understanding impacts of changing climate.

Geodesy by radio interferometry: Water vapor radiometry for estimation of the wet delay

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

Elgered, G.; Davis, J.L.; Herring, T.A.

1991-04-10

An important source of error in very-long-baseline interferometry (VLBI) estimates of baseline length is unmodeled variations of the refractivity of the neutral atmosphere along the propagation path of the radio signals. The authors present and discuss the method of using data from a water vapor readiometer (WVR) to correct for the propagation delay caused by atmospheric water vapor, the major cause of these variations. Data from different WVRs are compared with estimated propagation delays obtained by Kalman filtering of the VLBI data themselves. The consequences of using either WVR data of Kalman filtering to correct for atmospheric propagation delay atmore » the Onsala VLBI site are investigated by studying the repeatability of estimated baseline lengths from Onsala to several other sites. The lengths of the baselines range from 919 to 7,941 km. The repeatability obtained for baseline length estimates shows that the methods of water vapor radiometry and Kalman filtering offer comparable accuracies when applied to VLBI observations obtained in the climate of the Swedish west coast. The use of WVR data yielded a 13% smaller weighted-root-mean-square (WRMS) scatter of the baseline length estimates compared to the use of a Kalman filter. It is also clear that the best minimum elevation angle for VLBI observations depends on the accuracy of the determinations of the total propagation delay to be used, since the error in this delay increases with increasing air mass. For use of WVR data along with accurate determinations of total surface pressure, the best minimum is about 20{degrees}; for use of a model for the wet delay based on the humidity and temperature at the ground, the best minimum is about 35{degrees}.« less

Low supply of social support as risk factor for mortality in the older adults.

PubMed

de Brito, Tábatta Renata Pereira; Nunes, Daniella Pires; Corona, Ligiana Pires; da Silva Alexandre, Tiago; de Oliveira Duarte, Yeda Aparecida

2017-11-01

To determine the relationship between social support and mortality in older adults, independent of other health conditions. This was a longitudinal study using the database of the 2006 SABE Study (Heath, Well-being and Aging), composed of 1413 individuals aged 60 years and over, living in São Paulo/Brazil. The present study used a questionnaire constructed for the SABE Study, which was reviewed by experts of Latin America and the Caribbean. The social network was evaluated using the variables: social support received; social support offered; number of members in the social network. The covariates included were age, gender, living arrangements, marital status, income, education, comorbidity, depressive symptoms, cognition and functional difficulties. Death as an outcome was evaluated after four years of follow-up. From a total of 1413 older adults at baseline, 268 died in a mean follow-up period of 3,9 years (SE=0,03). In the model adjusted offering social support and having networks composed of 9 or more members reduced the risk of death in the older adults. This study suggest that older adult who are offered support can benefit from mutual exchanges since reciprocity in relationships improves psychological well-being and is indicative of the quality of relationships. Thus, the older adults are part of a group of people whose role is not only to receive, but also to provide help to others, and the support offered seems to be as important as that received. Copyright © 2017 Elsevier B.V. All rights reserved.

Low-Resolution Electromagnetic Tomography (LORETA) of changed Brain Function Provoked by Pro-Dopamine Regulator (KB220z) in one Adult ADHD case.

PubMed

Steinberg, Bruce; Blum, Kenneth; McLaughlin, Thomas; Lubar, Joel; Febo, Marcelo; Braverman, Eric R; Badgaiyan, Rajendra D

Attention Deficit-Hyperactivity Disorder (ADHD) often continues into adulthood. Recent neuroimaging studies found lowered baseline dopamine tone in the brains of affected individuals that may place them at risk for Substance Use Disorder (SUD). This is an observational case study of the potential for novel management of Adult ADHD with a non-addictive glutaminergic-dopaminergic optimization complex KB200z. Low-resolution electromagnetic tomography (LORETA) was used to evaluate the effects of KB220z on a 72-year-old male with ADHD, at baseline and one hour following administration. The resultant z-scores, averaged across Eyes Closed, Eyes Open and Working Memory conditions, increased for each frequency band, in the anterior, dorsal and posterior cingulate regions, as well as the right dorsolateral prefrontal cortex during Working Memory, with KB220z. These scores are consistent with other human and animal neuroimaging studies that demonstrated increased connectivity volumes in reward circuitry and may offer a new approach to ADHD treatment. However, larger randomized trials to confirm these results are required.

Aerodynamic characteristics of two rotorcraft airfoils designed for application to the inboard region of a main rotor blade

NASA Technical Reports Server (NTRS)

Noonan, Kevin W.

1990-01-01

A wind tunnel investigation was conducted to determine the 2-D aerodynamic characteristics of two new rotorcraft airfoils designed especially for application to the inboard region of a helicopter main rotor blade. The two new airfoils, the RC(4)-10 and RC(5)-10, and a baseline airfoil, the VR-7, were all studied in the Langley Transonic Tunnel at Mach nos. from about 0.34 to 0.84 and at Reynolds nos. from about 4.7 to 9.3 x 10 (exp 6). The VR-7 airfoil had a trailing edge tab which is deflected upwards 4.6 degs. In addition, the RC(4)-10 airfoil was studied in the Langley Low Turbulence Pressure Tunnel at Mach nos. from 0.10 to 0.44 and at Reynolds nos. from 1.4 to 5.4 x 10 (exp 6) respectively. Some comparisons were made of the experimental data for the new airfoils and the predictions of two different theories. The results of this study indicates that both of the new airfoils offer advantages over the baseline airfoil. These advantages are discussed.

An environmental intervention to increase fruit and salad purchases in a cafeteria.

PubMed

Jeffery, R W; French, S A; Raether, C; Baxter, J E

1994-11-01

This study explored the hypothesis that consumption of fruit and salad in a cafeteria setting would increase if the variety of offerings was increased and their price reduced. Food purchases in a cafeteria setting were observed during 3 weeks of baseline observation, 3 weeks of intervention, and 3 weeks of return to baseline conditions. Intervention consisted of doubling the number of fruit choices, increasing salad ingredient selections by three, and reducing the price of both fruit and salad by 50%. The primary outcome measures in the study were daily sales of fruit and salad as assessed by cash register receipts. Fruit and salad purchases increased threefold in the intervention period compared to those in the nonintervention periods. Women and those trying to control their weight were most likely to make these nutritious food choices. Results of this study support the argument that increasing the number of nutritious food choices and making them more attractive economically may be important to changing food choice behavior. Further exploration of the practical application of the concept is recommended.

Low-Resolution Electromagnetic Tomography (LORETA) of changed Brain Function Provoked by Pro-Dopamine Regulator (KB220z) in one Adult ADHD case

PubMed Central

Steinberg, Bruce; Blum, Kenneth; McLaughlin, Thomas; Lubar, Joel; Febo, Marcelo; Braverman, Eric R.; Badgaiyan, Rajendra D

2016-01-01

Attention Deficit-Hyperactivity Disorder (ADHD) often continues into adulthood. Recent neuroimaging studies found lowered baseline dopamine tone in the brains of affected individuals that may place them at risk for Substance Use Disorder (SUD). This is an observational case study of the potential for novel management of Adult ADHD with a non-addictive glutaminergic-dopaminergic optimization complex KB200z. Low-resolution electromagnetic tomography (LORETA) was used to evaluate the effects of KB220z on a 72-year-old male with ADHD, at baseline and one hour following administration. The resultant z-scores, averaged across Eyes Closed, Eyes Open and Working Memory conditions, increased for each frequency band, in the anterior, dorsal and posterior cingulate regions, as well as the right dorsolateral prefrontal cortex during Working Memory, with KB220z. These scores are consistent with other human and animal neuroimaging studies that demonstrated increased connectivity volumes in reward circuitry and may offer a new approach to ADHD treatment. However, larger randomized trials to confirm these results are required. PMID:27610420

Transcranial magnetic stimulation for tinnitus: using the Tinnitus Functional Index to predict benefit in a randomized controlled trial.

PubMed

Theodoroff, Sarah M; Griest, Susan E; Folmer, Robert L

2017-02-09

Identifying characteristics associated with transcranial magnetic stimulation (TMS) benefit would offer insight as to why some individuals experience tinnitus relief following TMS treatment, whereas others do not. The purpose of this study was to use the Tinnitus Functional Index (TFI) and its subscales to identify specific factors associated with TMS treatment responsiveness. Individuals with bothersome tinnitus underwent 2000 pulses of 1-Hz TMS for 10 consecutive business days. The primary outcome measure was the TFI which yields a total score and eight individual subscale scores. Analyses were performed on baseline data from the active arm (n = 35) of a prospective, double-blind, randomized placebo-controlled clinical trial of TMS for tinnitus. Baseline total TFI score and three of the eight TFI subscales were useful in differentiating between responders and nonresponders to TMS intervention for tinnitus. These findings are not definitive, but suggest potential factors that contribute to perceived benefit following TMS. Overall, the main factor associated with TMS benefit was a higher tinnitus severity score for responders at baseline. The TFI subscales helped to clarify the factors that contributed to a higher severity score at baseline. Large-scale prospective research using systematic approaches is needed to identify and describe additional factors associated with tinnitus benefit following TMS. ClinicalTrials.gov, ID: NCT01104207 . Registered on 13 April 2010.

Which sexually active female students get themselves tested for Chlamydia trachomatis? A cohort study.

PubMed

Kerry, Sarah R; Nightingale, Claire M; Hay, Phillip; Oakeshott, Pippa

2016-06-01

Using data from the Prevention of Pelvic Infection (POPI) chlamydia screening trial, we compared the characteristics of female students who did or did not get tested for chlamydia outside the trial during 12 months' follow-up. Of the 2529 women in the trial, we excluded 68 chlamydia positives in the intervention group who were referred for treatment at baseline. Of the remaining 2461 women, 1980 (80%) answered the question about testing during follow-up on their 12 months' questionnaire and were included in the cohort. Of 1980 respondents, 529 (27%) reported having an independent chlamydia test, including 30 (48%) of 63 women with undiagnosed chlamydia at baseline. Predictors of testing included having undiagnosed chlamydia at baseline (adjusted odds ratio 2.44; 95% confidence interval 1.39-4.28), ≥2 sexual partners in the year prior to baseline (OR 1.99; 95% CI 1.60-2.48), history of sexually transmitted infection (1.63: 1.20-2.22); symptoms of pelvic discomfort, dyspareunia, abnormal vaginal discharge or inter-menstrual bleeding (1.38; 1.09-1.73); and black ethnicity (1.37, 1.06-1.76). Although more women with risk factors got tested, half of women with undiagnosed chlamydia did not get tested. To optimise detection of chlamydia, testing should be offered routinely. © The Author(s) 2015.

Managing the Facilities Portfolio: New Book Addresses Elimination of $60 Billion Problem.

ERIC Educational Resources Information Center

Rush, Sean; And Others

1991-01-01

This excerpt from "Managing the Facilities Portfolio: A Practical Approach to Institutional Renewal and Deferred Maintenance" offers higher education business officers a conceptual framework comprising four steps: (1) establish baseline; (2) estimate needs; (3) compare model alternatives; and (4) report to management. (DB)

76 FR 36583 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

... Docket No. CP2010-36 serve as the baseline contract for future functional equivalence analyses of the... commitments, do not alter the contract's functional equivalency. Id. at 4. The Postal Service asserts that... offered or the fundamental structure of the contract. Therefore, it requests that the instant contract be...

Impact of trained champions of comprehensive school physical activity programs on school physical activity offerings, youth physical activity and sedentary behaviors.

PubMed

Carson, Russell L; Castelli, Darla M; Pulling Kuhn, Ann C; Moore, Justin B; Beets, Michael W; Beighle, Aaron; Aija, Rahma; Calvert, Hannah G; Glowacki, Elizabeth M

2014-12-01

A quasi-experimental cluster-controlled design was used to test the impact of comprehensive school physical activity program (CSPAP) professional development on changes in school physical activity (PA) offerings, moderate-to-vigorous physical activity (MVPA) and sedentary behaviors of 9-14 year-old children during school. Two groups of Louisiana elementary and middle school physical education teachers (N=129) attended a CSPAP summer workshop (95 in 2012=intervention, 34 in 2013=control) and were assessed on school PA offerings (teacher-reported; pre, mid, and post). During the 2012-2013 school year, intervention teachers received CSPAP support while implementing new school PA programs. MVPA and sedentary behaviors were assessed (accelerometry; baseline and post) on a sample of 231 intervention, 120 control students from 16 different schools. Multivariate analysis of covariance indicated that intervention teachers reported significantly more PA offerings during school (3.35 vs. 2.37) and that involve staff (1.43 vs. 0.90). Three-level, mixed model regressions (stratified by sex) indicated that students overall spent less time in MVPA and more time being sedentary during school, but the effects were significantly blunted among intervention students, especially boys. This study provides preliminary evidence for CSPAP professional development programs to influence school-level PA offerings and offset student-level declines in MVPA and increases in sedentary behavior. Published by Elsevier Inc.

Yik Yak: a social media sensor

NASA Astrophysics Data System (ADS)

Leskovich, W. Robert

2015-05-01

This is the first academic paper which focuses specifically on the new social media application Yik Yak. To provide a solid foundation, a brief overview of a few anonymous social media platforms is provided. A social media sensor framework is then presented which utilizes a three-layered approach to addressing the use of analytic tools. Specifically the use of keyword, geolocation, sentiment, and network analysis is explored through the perspective of social media as a sensor. Challenges and criticisms are exposed in addition to some possible solutions. A theoretical case study is then offered which outlines a potential use of social media as a senor for emergency managers. The paper culminates with a data collection for the development of a lexicon for Yik Yak. This data collection focuses on an 18 day study which collects Yik Yak posts and Twitter tweets simultaneously. The top 100 keywords for each platform are collected for every 24 hour period and placed through a relative change comparison. Overall, Yik Yak offers a more stable baseline as compared to Twitter.

Lean management in academic surgery.

PubMed

Collar, Ryan M; Shuman, Andrew G; Feiner, Sandra; McGonegal, Amy K; Heidel, Natalie; Duck, Mary; McLean, Scott A; Billi, John E; Healy, David W; Bradford, Carol R

2012-06-01

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

Effect of neighbourhood deprivation and social cohesion on mental health inequality: a multilevel population-based longitudinal study.

PubMed

Fone, D; White, J; Farewell, D; Kelly, M; John, G; Lloyd, K; Williams, G; Dunstan, F

2014-08-01

The common mental disorders (CMDs) of anxiety and depression are the most common form of poor mental health in the general population. Evidence from the small number of previous cohort studies on the role of neighbourhood factors in mental health is inconclusive. We tested the hypothesis that high levels of neighbourhood social cohesion modify an adverse association between change in individual mental health and neighbourhood deprivation. We carried out a longitudinal multilevel analysis using data from the Caerphilly Health and Social Needs Cohort Study with a 7-year follow-up (n = 4426; age range 18-74 years at baseline). Neighbourhood deprivation and neighbourhood social cohesion were assessed at baseline and change in mental health between follow-up and baseline was assessed using the five-item Mental Health Inventory (MHI-5). Residence in the most deprived neighbourhoods was negatively associated with change in mental health, after adjusting for baseline individual socio-economic risk factors and transitions in life events. This negative effect was significantly reduced in high social cohesion neighbourhoods. The predicted change in mental health score was calculated for the 10th and 90th centiles of the household low-income distribution. The difference between them was -2.8 in the low social cohesion group and 1.1 in the high cohesion group. The difference between the groups was 3.9 [95% confidence interval (CI) 0.2-7.6]. The public health burden of poor mental health and mental health inequality could potentially be reduced by strengthening social cohesion in deprived neighbourhoods. This offers a mechanism to address the adverse effect of neighbourhood deprivation on population mental health.

Improving the driving practices of pizza deliverers: Response generalization and moderating effects of driving history

PubMed Central

Ludwig, Timothy D.; Geller, E. Scott

1991-01-01

A practical intervention program, targeting the safety belt use of pizza deliverers at two stores, increased significantly the use of both safety belts (143% above baseline) and turn signals (25% above baseline). Control subjects (i.e., pizza deliverers at a third no-intervention store and patrons driving to the pizza stores) showed no changes in belt or turn signal use over the course of 7-month study. The intervention program was staggered across two pizza stores and consisted of a group meeting wherein employees discussed the value of safety belts, received feedback regarding their low safety belt use, offered suggestions for increasing their belt use, and made a personal commitment to buckle up by signing buckle-up promise cards. Subsequently, employee-designed buckle-up reminder signs were placed in the pizza stores. By linking license plate numbers to individual driving records, we examined certain aspects of driving history as moderators of pre- and postintervention belt use. Although baseline belt use was significantly lower for drivers with one or more driving demerits or accidents in the previous 5 years, after the intervention these risk groups increased their belt use significantly and at the same rate as drivers with no demerits or accidents. Whereas baseline belt use was similar for younger (under 25) and older (25 or older) drivers, younger drivers were markedly more influenced by the intervention than were older drivers. Individual variation in belt use during baseline, intervention, and follow-up phases indicated that some drivers require more effective and costly intervention programs to motivate their safe driving practices. PMID:16795743

Client demands for unsafe sex: the socioeconomic risk environment for HIV among street and off-street sex workers.

PubMed

Deering, Kathleen N; Lyons, Tara; Feng, Cindy X; Nosyk, Bohdan; Strathdee, Steffanie A; Montaner, Julio S G; Shannon, Kate

2013-08-01

Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural, and client-related factors associated with being offered and accepting more money after clients' demand for sex without a condom. Cross-sectional study using baseline (February 2010 to October 2011) data from a longitudinal cohort of 510 SWs. A 2-part multivariable regression model was used to identify factors associated with 2 separate outcomes: (1) being offered more money for sex without a condom in the last 6 months; and (2) accepting more money, among those who had been offered more money. The sample included 490 SWs. In multivariable analysis, being offered more money for sex without a condom was more likely for SWs who used speedballs, had higher average numbers of clients per week, had difficulty accessing condoms, and had clients who visited other SWs. Accepting more money for sex without a condom was more likely for SWs self-reporting as a sexual minority and who had experienced client violence and used crystal methamphetamine less than daily (versus none) and less likely for SWs who solicited mainly indoors for clients (versus outdoor/public places). These results highlight the high demand for sex without a condom by clients of SWs. HIV prevention efforts should shift responsibility toward clients to reduce offers of more money for unsafe sex. Programs that mitigate the social and economic risk environments of SWs alongside the removal of criminal sanctions on sex work to enable condom use within safer indoor workspaces are urgently required.

A Predictive Model of Navy Second-Term Retention,

DTIC Science & Technology

1996-04-01

occupational choice in the Navy, and the consequences of pregnancy . These factors sug- gest that women are less likely to retain than men, However, it is...compare the baseline outcome to the hypothetical case in which no one was offered the bonus. This excercise implies that the program reduced retention by

ENVIRONMENTAL TESTS COMPARING KRESS INDIRECT DRY COOLING WITH CONVENTIONAL COKE OVEN PUSHING AND QUENCHING

EPA Science Inventory

The paper describes the Kress Indirect Dry Cooling (KIDC) process and gives results of an evaluation through baseline and demonstration emission testing. he KIDC process offers a technology that has the potential to reduce emissions from coke pushing and quenching at existing cok...

75 FR 21630 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... participate in the second phase. Quantitative surveys will be administered by computers and personal... administer a survey, conduct interviews and offer HIV rapid testing in Black Men who have sex with Men (BMSM...-minute eligibility screening interview. The baseline computer-based survey will take 45 minutes. The...

Globalisation and Education: The Case of North Korea.

ERIC Educational Resources Information Center

Reed, Gay Garland

1997-01-01

Looks at North Korean education in terms of the tension that exists between globalization and educational sovereignty. Offers a brief historical background to North Korean education and provides a baseline for developing three possible scenarios for its future. Illustrates the impact of domestic and international forces on North Korean education.…

NREL: Renewable Resource Data Center - Solar Resource Related Links

Science.gov Websites

the world. Baseline Surface Radiation Network (BSRN) Measures solar and atmospheric radiation at change. EnergyPlus Weather Data Offers weather data, arranged by World Meteorological Organization region and country, for more than 1,300 locations throughout the world. NASA Langley Distributed Active

Parenting programs during adolescence: Outcomes from universal and targeted interventions offered in real-world settings.

PubMed

Alfredsson, Elin K; Thorvaldsson, Valgeir; Axberg, Ulf; Broberg, Anders G

2018-04-26

The aim of this naturalistic study was to explore short and long-term outcomes of five different group-based parenting programs offered to parents of 10 to 17-year-olds. Three hundred and fifteen parents (277 mothers and 38 fathers) who had enrolled in a parenting program (universal: Active Parenting, COPE; Connect; targeted: COMET; Leadership training for parents of teenagers [LFT]) answered questionnaires at three measurement waves (baseline, post-measurement, and one-year follow-up). The questions concerned parenting style, parental mental health, family climate and adolescent mental health. Results revealed small to moderate changes in almost all outcome variables and in all parenting programs. Overall, parents in COMET reported the largest short and long-term changes. No substantial differences in change were seen between the other programs. The results support the general effectiveness of parenting programs for parents of adolescents. © 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

GPS and GIS-Based Data Collection and Image Mapping in the Antarctic Peninsula

USGS Publications Warehouse

Sanchez, Richard D.

1999-01-01

High-resolution satellite images combined with the rapidly evolving global positioning system (GPS) and geographic information system (GIS) technology may offer a quick and effective way to gather information in Antarctica. GPS- and GIS-based data collection systems are used in this project to determine their applicability for gathering ground truthing data in the Antarctic Peninsula. These baseline data will be used in a later study to examine changes in penguin habitats resulting in part from regional climate warming. The research application in this study yields important information on the usefulness and limits of data capture and high-resolution images for mapping in the Antarctic Peninsula.

Differential impact of immediate total deregulation of wellhead prices of natural gas on minority and low-income homeowners: a general review and a case study in the Washington, DC area

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

Green, R.D.; Gilbert, H.R.

1983-01-01

In this study, the authors evaluate the impact of total deregulation of wellhead prices of natural gas on various strata of the residential consuming population, and compare it to the baseline impact of a continuation of the Natural Gas Policy Act of 1978. They found that minority and poverty homeowners will suffer greater relative welfare losses than their white and non-poverty counterparts. They developed quantitative estimates of the extent of these differentials, and offered some policy proposals suggested by these findings. 54 refs., 8 figs., 68 tabs.

Brief coping strategy enhancement for distressing voices: Predictors of engagement and outcome in routine clinical practice.

PubMed

Paulik, Georgie; Jones, Anna-Marie; Hayward, Mark

2018-05-24

Cognitive behaviour therapy is recommended internationally as a treatment for psychosis (targeting symptoms such as auditory hallucinations, or "voices"). Yet mental health services are commonly unable to offer such resource-intensive psychological interventions. Brief, symptom-specific and less resource-intensive therapies are being developed as one initiative to increase access. However, as access increases, so might the risk of offering therapy to clients who are not optimally disposed to engage with and benefit from therapy. Thus, it is important to identify who is most/least likely to engage with and benefit from therapy, and when. In the current study, 225 clients were assessed for suitability for a brief, 4-session, manualized, cognitive behaviour therapy-based intervention for voices (named coping strategy enhancement therapy) and 144 commenced therapy, at a transdiagnostic voices clinic based in Sussex, UK. This article reports on the value of depression, anxiety, stress, insight into the origin of voices, length of voice hearing, and demographics in the prediction of engagement and outcomes. The study found that higher levels of baseline depression, anxiety, and stress were significantly associated with poorer outcomes, especially if clients also had high levels of voice-related distress. The engagement analyses showed that levels of voice-related distress at baseline predicted dropout. These findings highlight the importance of assessing negative affect and voice-related distress prior to commencing therapy for distressing voices, to help determine if the client is suitable or ready for brief-coping strategy enhancement. Copyright © 2018 John Wiley & Sons, Ltd.

An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial).

PubMed

Laws, Rachel A; Chan, Bibiana C; Williams, Anna M; Davies, Gawaine Powell; Jayasinghe, Upali W; Fanaian, Mahnaz; Harris, Mark F

2010-02-23

Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention. The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy. ACTRN12609001081202.

Vehicle integration effects on hypersonic waveriders. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Cockrell, Charles Edward, Jr.

1994-01-01

The integration of a class of hypersonic high-lift configurations known as waveriders into hypersonic cruise vehicles was evaluated. Waveriders offer advantages in aerodynamic performance and propulsion/airframe integration (PAI) characteristics over conventional hypersonic shapes. A wind-tunnel model was developed which integrates realistic vehicle components with two waverider shapes, referred to as the 'straight-wing' and 'cranked-wing' shapes. Both shapes were conical-flow-derived waveriders at a design Mach number of 4.0. The cranked-wing shape was designed to provide advantages in subsonic performance and directional stability over conventional waveriders. Experimental data and limited computational fluid dynamics (CFD) predictions were obtained over a Mach number range of 2.3 to 4.63 at a Reynolds number of 2.0x10(exp 6) per foot. The CFD predictions and flow visualization data confirmed the shock attachment characteristics of the baseline waverider shapes and illustrated the waverider flow-field properties. Both CFD predictions and experimental data showed that no significant performance degradations occur at off-design Mach numbers for the waverider shapes and the integrated configurations. The experimental data showed that the effects of adding a realistic canopy were minimal. The effects of adding engine components were to increase the drag and thus degrade the aerodynamic performance of the configuration. A significant degradation in aerodynamic performance was observed when 0 degree control surfaces were added to close the blunt base of the waverider to a sharp trailing edge. A comparison of the fully-integrated waverider models to the baseline shapes showed that the performance was significantly degraded when all of the components were added to the waveriders. The fully-integrated configurations studied here do not offer significant performance advantages over conventional hypersonic vehicles, but still offer advantages in air-breathing propulsion integration. Additionally, areas are identified in this study where improvements could be made to enhance the performance. Both fully-integrated configurations are longitudinally unstable over the Mach number range studied for unpowered conditions. The cranked-wing fully-integrated configuration provided significantly better lateral-directional stability characteristics than the straight-wing configuration.

Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees.

PubMed

Zivin, Kara; Sen, Ananda; Plegue, Melissa A; Maciejewski, Matthew L; Segar, Michelle L; AuYoung, Mona; Miller, Erin M; Janney, Carol A; Zulman, Donna M; Richardson, Caroline R

2017-03-01

Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-$1,055.39 vs -$577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-$1,037.60 vs -$388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

Illness beliefs predict self-care behaviours in patients with diabetic foot ulcers: a prospective study.

PubMed

Vedhara, Kavita; Dawe, Karen; Wetherell, Mark A; Miles, Jeremy N V; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona

2014-10-01

Patients' illness beliefs are known to be influential determinants of self-care behaviours in many chronic conditions. In a prospective observational study we examined their role in predicting foot self-care behaviours in patients with diabetic foot ulcers. Patients (n=169) were recruited from outpatient podiatry clinics. Clinical and demographic factors, illness beliefs and foot self-care behaviours were assessed as baseline (week 0). Foot self-care behaviours were assessed again 6, 12 and 24 weeks later. Linear regressions examined the contribution of beliefs at baseline to subsequent foot self-care behaviours, controlling for past behaviour (i.e., foot self-care at baseline) and clinical and demographic factors that may affect foot self-care (i.e., age and ulcer size). Our models accounted for between 42 and 58% of the variance in foot self-care behaviours. Even after controlling for past foot-care behaviours, age and ulcer size; patients' beliefs regarding the symptoms associated with ulceration, their understanding of ulceration and their perceived personal control over ulceration emerged as independent determinants of foot self-care. Patients' beliefs are important determinants of foot-care practices. They may, therefore, also be influential in determining ulcer outcomes. Interventions aimed at modifying illness beliefs may offer a means for promoting self-care and improving ulcer outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Novel soy germ pasta enriched in isoflavones ameliorates gastroparesis in type 2 diabetes: a pilot study.

PubMed

Setchell, Kenneth D R; Nardi, Elisabetta; Battezzati, Pier-Maria; Asciutti, Stefania; Castellani, Danilo; Perriello, Gabriele; Clerici, Carlo

2013-11-01

To determine the effect of soy germ pasta enriched in biologically active isoflavone aglycons on gastric emptying in type 2 diabetic patients with gastroparesis. This randomized double-blind, placebo-controlled study compared soy germ pasta with conventional pasta for effects on gastric emptying. Patients (n = 10) with delayed gastric emptying consumed one serving per day of each pasta for 8 weeks, with a 4-week washout. Gastric emptying time (t1/2) was measured using the [(13)C]octanoic acid breath test at baseline and after each period, and blood glucose and insulin concentrations were determined after oral glucose load. Soy germ pasta significantly accelerated the t1/2 in these patients (161.2 ± 17.5 min at baseline vs. 112.6 ± 11.2 min after treatment, P = 0.009). Such change differed significantly (P = 0.009) from that for conventional pasta (153.6 ± 24.2 vs. 156.2 ± 27.4 min), without affecting glucose or insulin concentrations. These findings suggest that soy germ pasta may offer a simple dietary approach to managing diabetic gastropathy.

Vitamin D in patients with intellectual and developmental disability in secure in-patient services in the North of England, UK.

PubMed

McKinnon, Iain; Lewis, Thomas; Mehta, Naomi; Imrit, Shahed; Thorp, Julie; Ince, Chris

2018-02-01

Aims and method To assess the benefits of the introduction of routine vitamin D serum sampling for all patients admitted to a secure in-patient hospital in the North of England providing medium security, low security and rehabilitation services for offenders with intellectual and developmental disability. The vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after 1 year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications. Eighty-three per cent of patients had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among established patients and new admissions. Regression analysis of baseline vitamin D levels revealed no differences for levels of security, seasonality, whether patients were taking antipsychotic or anticonvulsant medication, or length of stay. Patients with deficiency or insufficiency were all offered supplementation. Those who opted in had significantly higher vitamin D levels at follow-up, compared with those who declined treatment. Clinical implications Established and newly admitted patients in our secure mental health services had substantial levels of vitamin D insufficiency. In the light of the morbidities that are associated with deficient vitamin D levels, routine screening and the offer of supplementation is advisable. Declaration of interest None.

Quantification of [11C]GB67 binding to cardiac alpha1-adrenoceptors with positron emission tomography: validation in pigs.

PubMed

Park-Holohan, So-Jin; Asselin, Marie-Claude; Turton, David R; Williams, Sharron L; Hume, Susan P; Camici, Paolo G; Rimoldi, Ornella E

2008-09-01

An increase in human cardiac alpha(1)-adrenoceptor (alpha(1)-AR) density is associated with various diseases such as myocardial ischemia, congestive heart failure, hypertrophic cardiomyopathy and hypertension. Positron emission tomography (PET) with an appropriate radioligand offers the possibility of imaging receptor function in the normal and diseased heart. [(11)C]GB67, an analogue of prazosin, has been shown in rats to have potential as a PET ligand with high selectivity to alpha(1)-AR. However, alpha(1)-AR density is up to ten times higher in rat heart compared to that in man. The aim of the present preclinical study was to extend the previous evaluation to a large mammal heart, where the alpha(1)-AR density is comparable to man, and to validate a method for quantification before PET studies in man. Seven [(11)C]GB67 PET studies, with weight-adjusted target dose of either 5.29 MBq kg(-1) (pilot, test-retest and baseline-predose studies) or 8.22 MBq kg(-1) (baseline-displacement studies), were performed in four anaesthetised pigs (39.5 +/- 3.9 kg). Total myocardial volume of distribution (V (T)) was estimated under different pharmacological conditions using compartmental analysis with a radiolabelled metabolite-corrected arterial plasma input function. A maximum possible blocking dose of 0.12 mumol kg(-1) of unlabeled GB67 was given 20 min before [(11)C]GB67 administration in the predose study and 45 min after administration of [(11)C]GB67 in the displacement study. In addition, [(15)O]CO (3,000 MBq) and [(15)O]H(2)O, with weight adjusted target dose of 10.57 MBq kg(-1), were also administered for estimation of blood volume recovery (RC) of the left ventricular cavity and myocardial perfusion (MBF), respectively. [(11)C]GB67 V (T) values (in ml cm(-3)) were estimated to be 24.2 +/- 5.5 (range, 17.3-31.3), 10.1 (predose) and 11.6 (displacement). MBF did not differ within each pig, including between baseline and predose conditions. Predose and displacement studies showed that specific binding of [(11)C]GB67 to myocardial alpha(1)-ARs accounts for approximately 50% of V (T). The present study offers a methodology for using [(11)C]GB67 as a radioligand to quantify human myocardial alpha(1)-ARs in clinical PET studies.

The South Australia Health Chronic Disease Self-Management Internet Trial

ERIC Educational Resources Information Center

Lorig, Kate; Ritter, Philip L.; Plant, Kathryn; Laurent, Diana D.; Kelly, Pauline; Rowe, Sally

2013-01-01

Objectives: To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method: Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures,…

500 Million Americans by 2050? Alternative Projections of the U.S. Population.

ERIC Educational Resources Information Center

Ahlburg, Dennis; Vaupel, James W.

1993-01-01

Offers an alternative to the U.S. Bureau of the Consensus population projection for 2050. Discusses alternative mortality, fertility, and immigration assumptions and projection methods that use a baseline scenario of no further gains against mortality. Description of the U.S. population under alternative scenarios include changes in structure and…

Applying Statistical Process Control to Clinical Data: An Illustration.

ERIC Educational Resources Information Center

Pfadt, Al; And Others

1992-01-01

Principles of statistical process control are applied to a clinical setting through the use of control charts to detect changes, as part of treatment planning and clinical decision-making processes. The logic of control chart analysis is derived from principles of statistical inference. Sample charts offer examples of evaluating baselines and…

Blade pitch optimization methods for vertical-axis wind turbines

NASA Astrophysics Data System (ADS)

Kozak, Peter

Vertical-axis wind turbines (VAWTs) offer an inherently simpler design than horizontal-axis machines, while their lower blade speed mitigates safety and noise concerns, potentially allowing for installation closer to populated and ecologically sensitive areas. While VAWTs do offer significant operational advantages, development has been hampered by the difficulty of modeling the aerodynamics involved, further complicated by their rotating geometry. This thesis presents results from a simulation of a baseline VAWT computed using Star-CCM+, a commercial finite-volume (FVM) code. VAWT aerodynamics are shown to be dominated at low tip-speed ratios by dynamic stall phenomena and at high tip-speed ratios by wake-blade interactions. Several optimization techniques have been developed for the adjustment of blade pitch based on finite-volume simulations and streamtube models. The effectiveness of the optimization procedure is evaluated and the basic architecture for a feedback control system is proposed. Implementation of variable blade pitch is shown to increase a baseline turbine's power output between 40%-100%, depending on the optimization technique, improving the turbine's competitiveness when compared with a commercially-available horizontal-axis turbine.

Improving low-wage, midsized employers' health promotion practices: a randomized controlled trial.

PubMed

Hannon, Peggy A; Harris, Jeffrey R; Sopher, Carrie J; Kuniyuki, Alan; Ghosh, Donetta L; Henderson, Shelly; Martin, Diane P; Weaver, Marcia R; Williams, Barbara; Albano, Denise L; Meischke, Hendrika; Diehr, Paula; Lichiello, Patricia; Hammerback, Kristen E; Parks, Malcolm R; Forehand, Mark

2012-08-01

The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. To test the effectiveness of WPS for midsized employers in low-wage industries. Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Forty-eight midsized employers (100-999 workers) in King County WA. WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011. Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328). WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers. This study is registered at clinicaltrials.gov NCT00452816. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies.

PubMed

Saad, F; Yassin, A; Doros, G; Haider, A

2016-01-01

Long-term testosterone replacement therapy (TRT) up to 5 years has been shown to produce progressive and sustainable weight loss (WL) in hypogonadal men. This study investigated effects of long-term TRT up to 8 years in hypogonadal men with different obesity classes. From two independent observational registries we identified a total of 411 obese, hypogonadal men receiving TRT in urological clinics. The effects of TRT on anthropometric as well as metabolic parameters were studied for a maximum duration of 8 years, mean follow-up: 6 years. All men received long-acting injections of testosterone undecanoate in 3-monthly intervals. In all three classes of obesity, T therapy produced significant WL, decrease in waist circumference (WC) and body mass index (BMI). In patients with class I obesity, mean weight decreased from 102.6±6.4 to 84.1±4.9 kg, change from baseline: -17.4±0.5 kg and -16.8±0.4%. WC in this group of patients decreased from 106.8±7.4 to 95.1±5.3 cm, change from baseline: -10.6±0.3 cm. BMI decreased from 32.69±1.4 to 27.07±1.57, change from baseline: -5.52±0.15 kg m(-2). In patients with class II obesity, weight decreased from 116.8±6.9 to 91.3±6.3 kg, change from baseline: -25.3±0.5 kg and -21.5±0.4%. WC decreased from 113.5±7.5 to 100.0±5.4 cm, change from baseline: -13.9±0.4 cm. BMI decreased from 37.32±1.45 to 29.49±1.71, change from baseline: -8.15±0.17 kg m(-2). In patients with class III obesity, weight decreased from 129.0±5.6 to 98.9±4.8 kg, change from baseline: -30.5±0.7 kg and -23.6±0.5%. WC decreased from 118.5±5.6 to 103.8±4.9 cm, change from baseline: -14.3±0.4 cm. BMI decreased from 41.93±1.48 to 32.46±1.59, change from baseline -9.96±0.29 kg m(-2). Testosterone therapy appears to be an effective approach to achieve sustained WL in obese hypogonadal men irrespective of severity of obesity. Based on these findings we suggest that T therapy offers safe and effective treatment strategy of obesity in hypogonadal men.

Heat pipe thermal conditioning panel

NASA Technical Reports Server (NTRS)

Saaski, E. W.; Loose, J. D.; Mccoy, K. E.

1974-01-01

Thermal control of electronic hardware and experiments on future space vehicles is critical to proper functioning and long life. Thermal conditioning panels (cold plates) are a baseline control technique in current conceptual studies. Heat generating components mounted on the panels are typically cooled by fluid flowing through integral channels within the panel. However, replacing the pumped fluid coolant loop within the panel with heat pipes offers attractive advantages in weight, reliability, and installation. This report describes the development and fabrication of two large 0.76 x 0.76 m heat pipe thermal conditioning panels to verify performance and establish the design concept.

HPTN 068: A Randomized Control Trial of a Conditional Cash Transfer to Reduce HIV Infection in Young Women in South Africa-Study Design and Baseline Results.

PubMed

Pettifor, Audrey; MacPhail, Catherine; Selin, Amanda; Gómez-Olivé, F Xavier; Rosenberg, Molly; Wagner, Ryan G; Mabuza, Wonderful; Hughes, James P; Suchindran, Chirayath; Piwowar-Manning, Estelle; Wang, Jing; Twine, Rhian; Daniel, Tamu; Andrew, Philip; Laeyendecker, Oliver; Agyei, Yaw; Tollman, Stephen; Kahn, Kathleen

2016-09-01

Young women in South Africa are at high risk for HIV infection. Cash transfers offer promise to reduce HIV risk. We present the design and baseline results from HPTN 068, a phase III, individually randomized trial to assess the effect of a conditional cash transfer on HIV acquisition among South African young women. A total of 2533 young women were randomized to receive a monthly cash transfer conditional on school attendance or to a control group. A number of individual-, partner-, household- and school-level factors were associated with HIV and HSV-2 infection. After adjusting for age, all levels were associated with an increased odds of HIV infection with partner-level factors conveying the strongest association (aOR 3.05 95 % CI 1.84-5.06). Interventions like cash transfers that address structural factors such as schooling and poverty have the potential to reduce HIV risk in young women in South Africa.

[The impact on costs and care of two approaches to reduce employees' dental plan expenses in a private company].

PubMed

Costa Filho, Luiz Cesar da; Duncan, Bruce Bartholow; Polanczyk, Carisi Anne; Sória, Marina Lara; Habekost, Ana Paula; Costa, Carolina Covolo da

2008-05-01

The present study evaluated the dental care plan offered to 4,000 employees of a private hospital and their respective families. The analysis covered three stages: (1) baseline (control), when dental care was provided by an outsourced company with a network of dentists paid for services, (2) a renegotiation of costs with the original dental care provider, and (3) provision of dental care by the hospital itself, through directly hired dentists on regular salaries. Monthly economic and clinical data were collected for this research. The dental plan renegotiation reduced costs by 37% in relation to baseline, and the hospital's own dental service reduced costs by 50%. Renegotiation led to a 31% reduction in clinical procedures, without altering the dental care profile; the hospital's own dental service did not reduce the total number of clinical procedures, but modified the profile of dental care, since procedures related to the causes of diseases increased and surgical/restorative procedures decreased.

Gasoline conservation: a procedure for measuring and reducing the driving of college students

PubMed Central

Foxx, R. M.; Hake, D. F.

1977-01-01

The study sought to motivate college students to reduce the number of miles they drove each day and thus save gasoline. Students in two psychology classes were divided by class into two groups. The experimental group was offered various combinations of prizes such as cash, a tour of a mental-health facility, car servicing, and a university parking sticker for reducing driving. The value of the prize received was scaled in terms of per cent reduction in driving. The contrast group received no inducements. The condition in which the experimental group's mileage reduction was reinforced was counterbalanced by two baseline conditions. Several special recording procedures were used to reduce and detect the possibility of subjects altering their odometers, the source of the driving data. Experimental subjects reduced their average daily mileage by 20% relative to the initial baseline; the contrast group did not change. During the one-month reinforcement condition, the 12 experimental subjects saved some 170 gallons (worth $102) of gasoline. PMID:16795548

Interplanetary Electric Propulsion Uranus Mission Trades Supporting the Decadal Survey

NASA Technical Reports Server (NTRS)

Dankanich, John W.; McAdams, James

2011-01-01

The Decadal Survey Committee was tasked to develop a comprehensive science and mission strategy for planetary science that updates and extends the National Academies Space Studies Board s current solar system exploration decadal survey. A Uranus orbiter mission has been evaluated as a part of this 2013-2022 Planetary Science Decadal Survey. A comprehensive Uranus orbiter mission design was completed, including a broad search of interplanetary electric propulsion transfer options. The scope of interplanetary trades was limited to electric propulsion concepts, both solar and radioisotope powered. Solar electric propulsion offers significant payloads to Uranus. Inserted mass into the initial science orbit due is highly sensitive to transfer time due to arrival velocities. The recommended baseline trajectory is a 13 year transfer with an Atlas 551, a 1+1 NEXT stage with 15 kW of power using an EEJU trajectory and a 1,000km EGA flyby altitude constraint. This baseline delivers over 2,000kg into the initial science orbit. Interplanetary trajectory trades and sensitivity analyses are presented herein.

Dynamic performance of an aero-assist spacecraft - AFE

NASA Technical Reports Server (NTRS)

Chang, Ho-Pen; French, Raymond A.

1992-01-01

Dynamic performance of the Aero-assist Flight Experiment (AFE) spacecraft was investigated using a high-fidelity 6-DOF simulation model. Baseline guidance logic, control logic, and a strapdown navigation system to be used on the AFE spacecraft are also modeled in the 6-DOF simulation. During the AFE mission, uncertainties in the environment and the spacecraft are described by an error space which includes both correlated and uncorrelated error sources. The principal error sources modeled in this study include navigation errors, initial state vector errors, atmospheric variations, aerodynamic uncertainties, center-of-gravity off-sets, and weight uncertainties. The impact of the perturbations on the spacecraft performance is investigated using Monte Carlo repetitive statistical techniques. During the Solid Rocket Motor (SRM) deorbit phase, a target flight path angle of -4.76 deg at entry interface (EI) offers very high probability of avoiding SRM casing skip-out from the atmosphere. Generally speaking, the baseline designs of the guidance, navigation, and control systems satisfy most of the science and mission requirements.

Conservation of forest birds: evidence of a shifting baseline in community structure.

PubMed

Rittenhouse, Chadwick D; Pidgeon, Anna M; Albright, Thomas P; Culbert, Patrick D; Clayton, Murray K; Flather, Curtis H; Huang, Chengquan; Masek, Jeffrey G; Stewart, Susan I; Radeloff, Volker C

2010-08-02

Quantifying changes in forest bird diversity is an essential task for developing effective conservation actions. When subtle changes in diversity accumulate over time, annual comparisons may offer an incomplete perspective of changes in diversity. In this case, progressive change, the comparison of changes in diversity from a baseline condition, may offer greater insight because changes in diversity are assessed over longer periods of times. Our objectives were to determine how forest bird diversity has changed over time and whether those changes were associated with forest disturbance. We used North American Breeding Bird Survey data, a time series of Landsat images classified with respect to land cover change, and mixed-effects models to associate changes in forest bird community structure with forest disturbance, latitude, and longitude in the conterminous United States for the years 1985 to 2006. We document a significant divergence from the baseline structure for all birds of similar migratory habit and nest location, and all forest birds as a group from 1985 to 2006. Unexpectedly, decreases in progressive similarity resulted from small changes in richness (<1 species per route for the 22-year study period) and modest losses in abundance (-28.7 - -10.2 individuals per route) that varied by migratory habit and nest location. Forest disturbance increased progressive similarity for Neotropical migrants, permanent residents, ground nesting, and cavity nesting species. We also documented highest progressive similarity in the eastern United States. Contemporary forest bird community structure is changing rapidly over a relatively short period of time (e.g., approximately 22 years). Forest disturbance and forest regeneration are primary factors associated with contemporary forest bird community structure, longitude and latitude are secondary factors, and forest loss is a tertiary factor. Importantly, these findings suggest some regions of the United States may already fall below the habitat amount threshold where fragmentation effects become important predictors of forest bird community structure.

Attitude towards gender roles and violence against women and girls (VAWG): baseline findings from an RCT of 1752 youths in Pakistan.

PubMed

Saeed Ali, Tazeen; Karmaliani, Rozina; Mcfarlane, Judith; Khuwaja, Hussain M A; Somani, Yasmeen; Chirwa, Esnat D; Jewkes, Rachel

2017-01-01

Violence against women is driven by gender norms that normalize and justify gender inequality and violence. Gender norms are substantially shaped during adolescence. Programs offered through schools offer an opportunity to influence gender attitudes toward gender equity if we understand these to be partly shaped by peers and the school environment. We present an analysis of the baseline research conducted for a randomized controlled trial with 1752 grade 6 boys and girls and their attitudes toward gender roles, VAWG, and associated factors. We used baseline data from a  cluster randomised control study. Interviews were conducted in 40 public schools in Hyderabad, with 25-65 children per school. Questions were asked about attitudes toward gender roles, peer-to-peer perpetration, and victimization experiences, and family life, including father- or in-law-to- mother violence and food security. Multiple regression models were built of factors associated with gender attitudes for boys and girls. Our result have shown youth attitudes endorsing patriarchal gender beliefs were higher for boys, compared to girls. The multiple regression model showed that for boys, patriarchal gender attitudes were positively associated with hunger, depression, being promised already in marriage, and being a victim and/or perpetrator of peer violence. For girls gender attitudes were associated with hunger, experiencing corporal punishment at home, and being a perpetrator (for some, and victim) of peer violence. Youth patriarchal attitudes are closely related to their experience of violence at school and for girl's physical punishment, at home and for boys being promised in early marriage. We suggest that these variables are indicators of gender norms among peers and in the family. The significance of peer norms is that it provides the possibility that school-based interventions which work with school peers have the potential to positively impact youth patriarchal gender attitudes and foster attitudes of gender equality and respect, and potentially to decrease youth victimization and perpetration.

Treatment of word-finding deficits in fluent aphasia through the manipulation of spatial attention: Preliminary findings

PubMed Central

Dotson, Vonetta M.; Singletary, Floris; Fuller, Renee; Koehler, Shirley; Moore, Anna Bacon; Gonzalez Rothi, Leslie J.; Crosson, Bruce

2010-01-01

Background Attention, the processing of one source of information to the exclusion of others, is important for most cognitive processes, including language. Evidence suggests not only that dysfunctional attention mechanisms contribute to language deficits after stroke, but also that orienting attention to a patient's ipsilesional hemispace recruits attention mechanisms in the intact hemisphere and improves language functions in some persons with aphasia. Aims The aim of the current research was to offer proof of concept for the strategy of improving picture-naming performance in fluent aphasia by moving stimuli into the left hemispace. It was hypothesised that repeated orientation of attention to the ipsilesional hemispace during picture naming would lead to improved naming accuracy for participants with fluent aphasia. Methods & Procedures Three participants with stable fluent aphasia received daily treatment sessions that consisted of naming simple line drawings presented 45 degrees to the left of body midline on a computer monitor. Naming probes were administered before initiation of the treatment protocol to establish a baseline, and before each treatment session to measure change during treatment. The C statistic was used to establish the stability of baseline performance and to determine whether the slope of the treatment phases differed significantly from the slope of the baseline. Outcomes & Results Two of the three participants showed significant improvement over baseline performance in the percent correct of naming probes. One participant showed no improvement over baseline accuracy. Conclusions Results suggest that engaging right-hemisphere attention mechanisms may improve naming accuracy in some people with fluent aphasia. Findings justify further investigation of this treatment in a larger controlled study. PMID:22131638

Agricultural Baseline (BL0) scenario

DOE Data Explorer

Davis, Maggie R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000181319328); Hellwinckel, Chad M [University of Tennessee] (ORCID:0000000173085058); Eaton, Laurence [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000312709626); Turhollow, Anthony [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000228159350); Brandt, Craig [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000214707379); Langholtz, Matthew H. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000281537154)

2016-07-13

Scientific reason for data generation: to serve as the reference case for the BT16 volume 1 agricultural scenarios. The agricultural baseline runs from 2015 through 2040; a starting year of 2014 is used. Date the data set was last modified: 02/12/2016 How each parameter was produced (methods), format, and relationship to other data in the data set: simulation was developed without offering a farmgate price to energy crops or residues (i.e., building on both the USDA 2015 baseline and the agricultural census data (USDA NASS 2014). Data generated are .txt output files by year, simulation identifier, county code (1-3109). Instruments used: POLYSYS (version POLYS2015_V10_alt_JAN22B) supplied by the University of Tennessee APAC The quality assurance and quality control that have been applied: • Check for negative planted area, harvested area, production, yield and cost values. • Check if harvested area exceeds planted area for annuals. • Check FIPS codes.

Wind-tunnel evaluation of an advanced main-rotor blade design for a utility-class helicopter

NASA Technical Reports Server (NTRS)

Yeager, William T., Jr.; Mantay, Wayne R.; Wilbur, Matthew L.; Cramer, Robert G., Jr.; Singleton, Jeffrey D.

1987-01-01

An investigation was conducted in the Langley Transonic Dynamics Tunnel to evaluate differences between an existing utility-class main-rotor blade and an advanced-design main-rotor blade. The two rotor blade designs were compared with regard to rotor performance oscillatory pitch-link loads, and 4-per-rev vertical fixed-system loads. Tests were conducted in hover and over a range of simulated full-scale gross weights and density altitude conditions at advance ratios from 0.15 to 0.40. Results indicate that the advanced blade design offers performance improvements over the baseline blade in both hover and forward flight. Pitch-link oscillatory loads for the baseline rotor were more sensitive to the test conditions than those of the advanced rotor. The 4-per-rev vertical fixed-system load produced by the advanced blade was larger than that produced by the baseline blade at all test conditions.

Performance and Vibratory Loads Data From a Wind-Tunnel Test of a Model Helicopter Main-Rotor Blade With a Paddle-Type Tip

NASA Technical Reports Server (NTRS)

Yeager, William T., Jr.; Noonan, Kevin W.; Singleton, Jeffrey D.; Wilbur, Matthew L.; Mirick, Paul H.

1997-01-01

An investigation was conducted in the Langley Transonic Dynamics Tunnel to obtain data to permit evaluation of paddle-type tip technology for possible use in future U.S. advanced rotor designs. Data was obtained for both a baseline main-rotor blade and a main-rotor blade with a paddle-type tip. The baseline and paddle-type tip blades were compared with regard to rotor performance, oscillatory pitch-link loads, and 4-per-rev vertical fixed-system loads. Data was obtained in hover and forward flight over a nominal range of advance ratios from 0.15 to 0.425. Results indicate that the paddle-type tip offers no performance improvements in either hover or forward flight. Pitch-link oscillatory loads for the paddle-type tip are higher than for the baseline blade, whereas 4-per-rev vertical fixed-system loads are generally lower.

Client demands for unsafe sex: the socio-economic risk environment for HIV among street and off-street sex workers

PubMed Central

DEERING, Kathleen N; LYONS, Tara; FENG, Cindy X; NOSYK, Bohdan; STRATHDEE, Steffanie A; MONTANER, Julio SG; SHANNON, Kate

2013-01-01

Objective Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural and client-related factors associated with being offered and accepting more money after clients' demand for sex without a condom. Design Cross-sectional study using baseline (February/10-October/11) data from a longitudinal cohort of 510 SWs. Methods A two-part multivariable regression model was used to identify factors associated with two separate outcomes: (1) being offered and (2) accepting more money for sex without a condom in the last six months, among those who had been offered more money. Results The sample included 490 SWs. In multivariable analysis, being offered more money for sex without a condom was more likely for SWs who used speedballs, had higher average numbers of clients per week, had difficulty accessing condoms and had clients who visited other SWs. Accepting more money for sex without a condom was more likely for SWs self-reporting as a sexual minority and who had experienced client violence and used crystal methamphetamine use less than daily (vs. none), and less likely for SWs who solicited for clients mainly indoors (vs. outdoor/public places). Conclusions These results highlight the high demand for sex without a condom by clients of SWs. HIV prevention efforts should shift responsibility toward clients to reduce offers of more money for unsafe sex. Programs that mitigate the social and economic risk environments of SWs alongside the removal of criminal sanctions on sex work to enable condom use within safer indoor work spaces are urgently required. PMID:23614990

Impaired Sleep Predicts Cognitive Decline in Old People: Findings from the Prospective KORA Age Study.

PubMed

Johar, Hamimatunnisa; Kawan, Rasmila; Emeny, Rebecca Thwing; Ladwig, Karl-Heinz

2016-01-01

To investigate the association between sleep-related characteristics and cognitive change over 3 years of follow up in an aged population. Sleep characteristics and covariates were assessed at baseline in a standardized interview and clinical examination of the population-based KORA Age Study (n = 740, mean age = 75 years). Cognitive score (determined by telephone interview for cognitive status, TICS-m) was recorded at baseline and 3 years later. At baseline, 82.83% (n = 613) of participants had normal cognitive status, 13.51% (n = 100) were classified with mild cognitive impairment (MCI), and 3.64% (n = 27) with probable dementia. The effect of three distinct patterns of poor sleep (difficulties initiating [DIS] or maintaining sleep [DMS], daytime sleepiness [DS] or sleep duration) were considered on a change in cognitive score with adjustments for potential confounders in generalized linear regression models. Cognitive decline was more pronounced in individuals with DMS compared to those with no DMS (β = 1.33, 95% CI = 0.41-2.24, P < 0.001). However, the predictive power of DMS was only significant in individuals with normal cognition and not impaired subjects at baseline. Prolonged sleep duration increased the risk for cognitive decline in cognitively impaired elderly (β = 1.86, 95% CI = 0.15-3.57, P = 0.03). Other sleep characteristics (DIS and DS) were not significantly associated with cognitive decline. DMS and long sleep duration were associated with cognitive decline in normal and cognitively impaired elderly, respectively. The identification of impaired sleep quality may offer intervention strategies to deter cognitive decline in the elderly with normal cognitive function. © 2016 Associated Professional Sleep Societies, LLC.

Nasal budesonide offers superior symptom relief in perennial allergic rhinitis in comparison to nasal azelastine.

PubMed

Stern, M A; Wade, A G; Ridout, S M; Cambell, L M

1998-10-01

Allergic rhinitis is usually treated with oral antihistamines or nasal steroids. Topically active nasal antihistamine is a new treatment modality for allergic rhinitis. The efficacy in comparison to well established topical treatment alternatives is not fully known. To compare the efficacy of intranasally administered azelastine to budesonide, at their respectively recommended dosage, on the symptoms of perennial rhinitis patients. A placebo-controlled, randomized, parallel group study was conducted to compare the efficacy and tolerability of intranasal budesonide aqueous suspension (256 microg once daily) with azelastine hydrochloride nasal spray (280 microg twice daily (560 microg/day)) and with placebo in the treatment of perennial allergic rhinitis. The 195 patients (with at least a 2-year history of perennial allergic rhinitis) recorded individual nasal symptom scores, the degree of symptom control achieved and any adverse events experienced over a 2-week baseline period and a 6-week treatment period. Following treatment, the reductions in mean combined and individual nasal symptom scores from baseline values were significantly greater in the budesonide group compared with the placebo group (P < .0001 for all variables except runny nose P = .01). In patients treated with budesonide, there were also significantly larger reductions from baseline values in combined nasal symptom scores (P < .01) and in scores for all individual nasal symptoms (P < or = .05) compared with those treated with azelastine. The reductions from baseline in both combined and individual nasal symptom scores did not differ between azelastine and placebo. The study medications were well tolerated, producing no unexpected or serious treatment-related adverse events. A once-daily dose of 256 microg of intranasal budesonide aqueous suspension is significantly more effective at relieving the symptoms of perennial allergic rhinitis compared with a twice daily dose of 280 microg of azelastine nasal spray.

Baseline peripheral blood leukocytosis: Biological marker predicts outcome in oropharyngeal cancer, regardless of HPV-status.

PubMed

Gouw, Zeno A R; Paul de Boer, Jan; Navran, Arash; van den Brekel, Michiel W M; Sonke, Jan-Jakob; Al-Mamgani, Abrahim

2018-03-01

To study the prognostic value of abnormalities in baseline complete blood count in patients with oropharyngeal cancer (OPC) treated with (chemo) radiation. The prognostic value of baseline complete blood count on outcome in 234 patients with OPC treated between 2010 and 2015 was examined in multivariate analysis together with other conventional prognostic variables including HPV-status, tumor stage, tumor and nodal size. The 3-year overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant control (DC) of the whole group were 74%, 64%, 79%, and 88%, respectively. Leukocytosis and HPV-status were the only significant prognosticators for OS and DFS at the multivariate analysis. Patients without leukocytosis had a significantly better DC compared to those with leukocytosis (92% and 70%, respectively, p < 0.001). Patients with HPV-negative OPC had significantly worse LRC compared to HPV-positive patients (67% and 90%, respectively, p < 0.001). The 3-year OS in HPV-positive group with leukocytosis compared to those without leukocytosis were 69% and 95%, respectively (p < 0.001). The figures for HPV-negative patients were 41% vs. 61%, respectively (p = 0.010). This is the first study to date reporting the independent impact of leukocytosis and HPV-status on outcome of patients with OPC. The poor outcome of patients with leukocytosis is mainly caused by the worse DC. The significant impact of leukocytosis on outcome was even more pronounced in HPV-positive patients. These biomarkers could help identifying patients with poor prognosis at baseline requiring intensification of local and/or systemic treatment while treatment de-intensification might be offered to the low-risk group. Copyright © 2018 Elsevier Ltd. All rights reserved.

[The effects of simvastatin combined with different antioxidant vitamin regimens on serum lipid profile in patients with low HDL cholesterol levels].

PubMed

Pirat, Bahar; Korkmaz, Mehmet Emin; Eroğlu, Serpil; Tayfun, Egemen; Yildirir, Aylin; Uluçam, Melek; Ozin, Bülent; Müderrisoğlu, Haldun

2004-12-01

This study was designed to compare the effects of simvastatin versus a combination of simvastatin with vitamin C or E on serum lipid profile, particularly, high-density lipoprotein (HDL)-cholesterol (C) level, in patients with a low HDL-C level. Fifty-nine women and 49 men, who had a baseline HDL-C level equal to or lower than 40 mg/dl were randomized to one of the following study treatment groups: Group S (n=39) simvastatin 20 mg/day, Group S+C (n=33) simvastatin 20 mg/day + vitamin C 500 mg/day, and Group S+E (n=36) simvastatin 20 mg/day + vitamin E 400 IU/day. The groups' lipid profiles were obtained at baseline, 3rd and 6th months. Comparing with baseline values, total-C and low-density cholesterol (LDL-C) values significantly reduced (p<0.001) and HDL-C values significantly increased (Group S--33.9+/-3.9 mg/dl vs. 39.8+/-6.9 mg/dl, Group S+C--34.2+/-3.5 mg/dl vs. 38.1+/-6.1 mg/dl, Group S+E--33.1+/-3.6 mg/dl vs. 34.8+/-5.9 mg/dl, p<0.001) on therapy within the groups; however, there were no significant differences among the groups with regards to these parameters. The HDL-C levels increased from baseline by 14.0%, 11.7% and 10.2% in Group S, S+C, and S+E, respectively (p>0.05). A combination of simvastatin with antioxidant vitamins does not offer any beneficial effect over simvastatin alone. Particularly vitamin E seems to blunt the simvastatin induced HDL-C increase.

Analysis of Subjects' Vulnerability in a Touch Screen Game Using Behavioral Metrics.

PubMed

Parsinejad, Payam; Sipahi, Rifat

2017-12-01

In this article, we report results on an experimental study conducted with volunteer subjects playing a touch-screen game with two unique difficulty levels. Subjects have knowledge about the rules of both game levels, but only sufficient playing experience with the easy level of the game, making them vulnerable with the difficult level. Several behavioral metrics associated with subjects' playing the game are studied in order to assess subjects' mental-workload changes induced by their vulnerability. Specifically, these metrics are calculated based on subjects' finger kinematics and decision making times, which are then compared with baseline metrics, namely, performance metrics pertaining to how well the game is played and a physiological metric called pnn50 extracted from heart rate measurements. In balanced experiments and supported by comparisons with baseline metrics, it is found that some of the studied behavioral metrics have the potential to be used to infer subjects' mental workload changes through different levels of the game. These metrics, which are decoupled from task specifics, relate to subjects' ability to develop strategies to play the game, and hence have the advantage of offering insight into subjects' task-load and vulnerability assessment across various experimental settings.

Randomized trial of an uncertainty self-management telephone intervention for patients awaiting liver transplant.

PubMed

Bailey, Donald E; Hendrix, Cristina C; Steinhauser, Karen E; Stechuchak, Karen M; Porter, Laura S; Hudson, Julie; Olsen, Maren K; Muir, Andrew; Lowman, Sarah; DiMartini, Andrea; Salonen, Laurel Williams; Tulsky, James A

2017-03-01

We tested an uncertainty self-management telephone intervention (SMI) with patients awaiting liver transplant and their caregivers. Participants were recruited from four transplant centers and completed questionnaires at baseline, 10, and 12 weeks from baseline (generally two and four weeks after intervention delivery, respectively). Dyads were randomized to either SMI (n=56) or liver disease education (LDE; n=59), both of which involved six weekly telephone sessions. SMI participants were taught coping skills and uncertainty management strategies while LDE participants learned about liver function and how to stay healthy. Outcomes included illness uncertainty, uncertainty management, depression, anxiety, self-efficacy, and quality of life. General linear models were used to test for group differences. No differences were found between the SMI and LDE groups for study outcomes. This trial offers insight regarding design for future interventions that may allow greater flexibility in length of delivery beyond our study's 12-week timeframe. Our study was designed for the time constraints of today's clinical practice setting. This trial is a beginning point to address the unmet needs of these patients and their caregivers as they wait for transplants that could save their lives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The optimal frequency of aquatic physiotherapy for individuals with chronic musculoskeletal pain: a randomised controlled trial.

PubMed

Cuesta-Vargas, Antonio I; White, Melanie; González-Sánchez, Manuel; Kuisma, Raija

2015-01-01

To establish whether there was a difference in health-related quality of life (HRQoL) in people with chronic musculoskeletal disorders (PwCMSKD) after participating in a multimodal physiotherapy program (MPP) either two or three sessions a week. Total of 114 PwCMSKD participated in this prospective randomised controlled trial. An individualised MPP, consisting of exercises for mobility, motor-control, muscle strengthening, cardiovascular training, and health education, was implemented either twice a week (G2: n = 58) or three times a week) (G3: n = 56) for 1 year. HRQoL physical and mental health state (PHS/MHS), Roland Morris disability Questionnaire (RMQ), Neck-Disability-Index (NDI) and Western Ontario and McMaster Universities' Arthritis Index (WOMAC) were used to measure outcomes of MPP for people with chronic low back pain, chronic neck pain and osteoarthritis, respectively. Measures were taken at baseline, 8 weeks (8 w), 6 months (6 m), and 1 year (1 y) after starting the programme. No statistically significant differences were found between the two groups (G2 and G3), except in NDI at 8 w (-3.34, (CI 95%: -6.94/0.84, p = 0.025 (scale 0-50)). All variables showed improvement reaching the following values (from baseline to 1 y) G2: PHS: 57.72 (baseline: 41.17; (improvement: 16.55%), MHS: 74.51 (baseline: 47.46, 27.05%), HRQoL 0.90 (baseline: 0.72, 18%)), HRQoL-VAS 84.29 (baseline: 58.04, 26.25%), RMQ 4.15 (baseline: 7.85, 15.42%), NDI 3.96 (baseline: 21.87, 35.82%), WOMAC 7.17 (baseline: 25.51, 19.10%). G3: PHS: 58.64 (baseline: 39.75, 18.89%), MHS: 75.50 (baseline: 45.45, (30.05%), HRQoL 0.67 (baseline: 0.88, 21%), HRQoL-VAS 86.91 (baseline: 52.64, 34.27%), RMQ 4.83 (baseline: 8.93, 17.08%), NDI 4.91 (baseline: 23.82, 37.82%), WOMAC 6.35 (baseline: 15.30, 9.32%). No significant differences between the two groups were found in the outcomes of a MPP except in the NDI at 8 weeks, but both groups improved in all variables during the course of 1 year under study. Implications for Rehabilitation A multimodal physiotherapy program (MPP) improves quality of life, overall health, and function in people with chronic musculoskeletal disease after an intervention of short, medium and long term. This implies that twice a week MPP for people with chronic musculoskeletal pain has comparable results to three times a week provision and therefore may have implications in saving resources and cost for patients and service providers without compromising the outcomes of treatment. These results can be considered not only for therapists, but also for managers who offer the services to optimise the balance cost-effectiveness of the proposed interventions.

[Acceptance of preventive home visits among frail elderly persons : Participants an non-participants in a Follow-up after 2 and 4 years within the LUCAS longitudinal study].

PubMed

Pröfener, F; Anders, J; Dapp, U; Minder, C E; Golgert, S; von Renteln-Kruse, W

2016-10-01

The objective of preventive home visits (PHV) is to support independent living of elderly people. The target group is a matter of discussion and acceptance so far seems to have been low. The target group favored in studies were persons with functional impairments living independently; therefore, acceptance of this offer by frail persons and characteristics of participants and non-participants were studied. All participants classified as frail in the longitudinal urban cohort ageing study (LUCAS; BMBF Fkz 01ET0708-13/01, ET1002A-D/01EL1407) were randomized (RCT) in 2007/2008 into an intervention group (174 persons) and a control group (379 persons). Participants in the intervention group were offered the option of a PHV. Sociodemographic and health-related characteristics were compared between the participants with a PHV, non-participants and controls at baseline and after 2 and 4 years. Non-participants who refused the offer of the PHV were asked about their reasons. There were 64 persons (36.8 %) in the intervention group classified as frail who accepted the offer of a PHV. Of these, significantly more lived alone, tended to be female with a higher educational level and with less need of care. After 2 years significantly more persons in the group without PHV had died and after 4 years more participants with PHV reported a depressive mood. There were no other significant differences between the groups. Half of the reasons not to accept the PHV that were reported by the non-participants were because of health-related or psychological problems and one third because of lack of interest or need for PHV. The offer of PHV to frail elderly persons with an unlimited age was associated with a relatively high acceptance. The high number of refusals by non-participants with functional impairments is remarkable and needs further investigation.

Innovation versus complexity: what is too much of a good thing?

PubMed

Gottfredson, Mark; Aspinall, Keith

2005-11-01

What's the number of product or service offerings that would optimize both your revenues and your profits? For most firms, it's considerably lower than the number they offer today. The fact is, companies have strong incentives to be overly innovative in new product development. But continual launches of new products and line extensions add complexity throughout a company's operations, and as the costs of managing that complexity multiply, margins shrink. To maximize profit potential, a company needs to identify its innovation fulcrum, the point at which an additional offering destroys more value than it creates. The usual antidotes to complexity miss their mark because they treat the problem on the factory floor rather than at its source: in the product line. Mark Gottfredson and Keith Aspinall of Bain & Company present an approach that goes beyond the typical Six Sigma or lean-operations program to root out complexity hidden in the value chain. The first step is to ask, What would our company look like if it made and sold only a single product or service? In other words, you identify your company's equivalent of Henry Ford's one-size-fits-all Model T-for Starbucks, it might be a medium-size cup of coffee; for a bank, a simple checking account-and then determine the cost of producing that baseline offering. Next, you add variety back into the business system, product by product, and carefully forecast the resulting impact on sales as well as the cost implications across the value chain. When the analysis shows the costs beginning to overwhelm the added revenues, you've found your innovation fulcrum. By deconstructing their companies to a zero-complexity baseline, managers can break through organizational resistance and deeply entrenched ways of thinking to find the right balance between innovation and complexity.

Item response theory analysis of the mechanics baseline test

NASA Astrophysics Data System (ADS)

Cardamone, Caroline N.; Abbott, Jonathan E.; Rayyan, Saif; Seaton, Daniel T.; Pawl, Andrew; Pritchard, David E.

2012-02-01

Item response theory is useful in both the development and evaluation of assessments and in computing standardized measures of student performance. In item response theory, individual parameters (difficulty, discrimination) for each item or question are fit by item response models. These parameters provide a means for evaluating a test and offer a better measure of student skill than a raw test score, because each skill calculation considers not only the number of questions answered correctly, but the individual properties of all questions answered. Here, we present the results from an analysis of the Mechanics Baseline Test given at MIT during 2005-2010. Using the item parameters, we identify questions on the Mechanics Baseline Test that are not effective in discriminating between MIT students of different abilities. We show that a limited subset of the highest quality questions on the Mechanics Baseline Test returns accurate measures of student skill. We compare student skills as determined by item response theory to the more traditional measurement of the raw score and show that a comparable measure of learning gain can be computed.

Aspirin and incident depressive symptoms: A longitudinal cohort study over 8 years.

PubMed

Veronese, Nicola; Koyanagi, Ai; Stubbs, Brendon; Solmi, Marco; Fornaro, Michele; Fernandes, Brisa S; Muller, Christoph; Thompson, Trevor; Carvalho, André F; Maggi, Stefania

2018-02-01

Aspirin exhibits anti-atherosclerotic and anti-inflammatory properties-two potential risk factors for depression. The relationship between aspirin use and depression, however, remains unclear. We investigated whether the aspirin use is associated with a decreased incidence of depressive symptoms in a large North American cohort. Data from the Osteoarthritis Initiative dataset, a multicenter, longitudinal study on community-dwelling adults was analyzed. Aspirin use was defined through self-report in the past 30 days and confirmed by a trained interviewer. Incident depressive symptoms were defined as a score of ≥16 in the 20-item Center for Epidemiologic Studies-Depression scale. A total of 137 participants (mean age 65 y, 55.5% female) were using aspirin at baseline. Compared with 4003 participants not taking aspirin, no differences in Center for Epidemiologic Studies-Depression at baseline were evident (P = .65). After a median follow-up time of 8 years, the incidence of depressive symptoms was similar in those taking aspirin at baseline (43; 95% CI, 3-60) and in aspirin nonusers (38; 95% CI, 36-41) per 1000 y; log-rank test = 0.63). Based on Cox's regression analysis adjusted for 11 potential confounders, aspirin use was not significantly associated with the development of depressive symptoms (hazard ratio = 1.12; 95% CI, 0.78-1.62; P = .54). Adjustment for propensity scores or the use of propensity score matching did not alter the results. Our study found that prescription of aspirin offered no significant protection against incident depressive symptoms. Whether aspirin is beneficial in a subgroup of depression with high levels of inflammation remains to be investigated in future studies. Copyright © 2017 John Wiley & Sons, Ltd.

Ka-band study: 1988

NASA Technical Reports Server (NTRS)

Layland, J. W.; Horttor, R. L.; Clauss, R. C.; Wilcher, J. H.; Wallace, R. J.; Mudgway, D. J.

1989-01-01

The Ka-band study team was chartered in late 1987 to bring together all the planning elements for establishing 32 GHz (Ka-band) as the primary downlink frequency for deep-space operation, and to provide a stable baseline from which to pursue that development. This article summarizes the results of that study at its conclusion in mid-1988, and corresponds to material presented to NASA's Office of Space Operations on July 14, 1988. For a variety of reasons, Ka-band is the right next major step in deep-space communications. It offers improved radio metric accuracy through reduced plasma sensitivity and increased bandwidth. Because of these improvements, it offers the opportunity to reduce costs in the flight radio system or in the DSN by allocating part of the overall benefits of Ka-band to this cost reduction. A mission scenario is being planned that can drive at least two and possibly all three of the DSN subnets to provide a Ka-band downlink capability by the turn of the century. The implementation scenario devised by the study team is believed to be feasible within reasonable resource expectations, and capable of providing the needed upgrade as a natural follow-on to the technology development which is already underway.

Understanding the transformative aspects of the Wilderness and Protected Lands experience upon human health

Treesearch

Alan Ewert; Jillisa Overholt; Alison Voight; Chun Chieh Wang

2011-01-01

Wilderness and Protected Landscapes (WPLs) have long been considered special areas for a variety of reasons including baseline data, impact analyses, protected zones, and other tangible and intangible values. Another salient, and some would argue, a more important value offered through WPLs is that of human transformation. Accordingly, three theories have provided the...

The State of Connecticut's Youth, 2003: Data, Outcomes and Indicators.

ERIC Educational Resources Information Center

Canny, Priscilla F.; Cooke, Michelle Beaulieu

This report presents an overview of the most current data on the overall well-being of Connecticut's youth, offered to promote a shared sense of accountability in the state, to guide current funding and programmatic decisions, and to set a baseline against which to measure the impact of those decisions. This statistical portrait is based on widely…

SEDLP Research Brief No. 1: Key Findings from the Baseline Survey of Participants. The Sectoral Employment Development Learning Project.

ERIC Educational Resources Information Center

Zandniapour, Lily

Sectoral employment training programs attempt to provide disadvantaged people with good jobs that pay living wages and offer opportunities for advancement, using innovative approaches to employment training and interacting with industries to create systemic change in labor markets. The Sectoral Employment Development Learning Project (SEDLP) is a…

Improving Middle School Quality in Poor Countries: Evidence from the Honduran "Sistema De Aprendizaje Tutorial"

ERIC Educational Resources Information Center

McEwan, Patrick J.; Murphy-Graham, Erin; Torres Irribarra, David; Aguilar, Claudia; Rápalo, Renán

2015-01-01

This article evaluates the impact and cost-effectiveness of offering an innovative middle school model--the Sistema de Aprendizaje Tutorial (SAT)--to Honduran villages instead of traditional middle schools. We identified a matched sample of villages with either type of school and collected baseline data among primary school graduates eligible to…

An emergency department registration kiosk can increase HIV screening in high risk patients.

PubMed

Hsieh, Yu-Hsiang; Gauvey-Kern, Megan; Peterson, Stephen; Woodfield, Alonzo; Deruggiero, Katherine; Gaydos, Charlotte A; Rothman, Richard E

2014-12-01

We evaluated the feasibility and the patient acceptability of integrating a kiosk into routine emergency department (ED) practice for offering HIV testing. The work was conducted in four phases: phase 1 was a baseline, in which external testing staff offered testing at the bedside; phase 2 was a pilot assessment of a prototype kiosk; phase 3 was a pilot implementation and phase 4 was the full implementation with automated login. Feasibility was assessed by the proportion of offering HIV tests, acceptance, completion and result reporting. During the study period, the number of ED patients and eligible patients for screening were similar in the three main phases. However, the number and proportion of patients offered testing of those eligible for screening increased significantly from phase 1 (32%) to phase 3 (37%) and phase 4 (40%). There were slightly higher prevalences of newly diagnosed HIV with kiosk versus bedside testing (phase 1, 0%; phase 3, 0.2%; phase 4, 0.5%). Compared to patients tested at the bedside, patients tested via the kiosk were significantly younger, more likely to be female, to be black, and to report high risk behaviours. ED-based HIV screening via a registration-based kiosk was feasible, yielded similar proportions of testing, and increased the proportion of engagement of higher-risk patients in testing. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Evaluation of a hospital-based youth violence intervention.

PubMed

De Vos, E; Stone, D A; Goetz, M A; Dahlberg, L L

1996-01-01

To decrease adolescent morbidity and mortality and improve the quality of life, a violence-prevention consultation is offered to hospitalized victims of nondomestic violence. The context is a violence-prevention team approach to patient assessment, treatment, and follow-up. Psychoeducational counseling emphasizes the individual through a cognitive behavioral approach and also recognizes the individual in the proximal social setting through referrals to community resources. The in-hospital component draws on the health beliefs model, self-efficacy, the theory of reasoned action and their synergy with cognitive mediation theory as expressed in developmental psychology. The target group for the intervention is adolescents (12-17 years of age) who have been victims of violent assaults severe enough to warrant treatment at a Level One trauma center. The six steps in the intervention are to (1) review and assess the incident, (2) review the patient's conflict-resolution strategies and introduce nonviolent alternatives, (3) provide information on the prevalence of violence/homicide and determine the patient's risk status, (4) explore the patient's coping skills and support system, (5) develop a plan to stay safe, and (6) refer patient to services for follow-up activities. Approximately 15 study participants are identified each month, half of whom are randomly assigned to receive the intervention. Over the 12-month recruitment interval, approximately 180 adolescent patients will be identified. Baseline data are collected through hospital intake procedures and chart reviews. A battery of standardized measures supplemented by a brief structured, closed-ended interview is collected four months after the youths leave the hospital. Preliminary baseline data for 39 youths are reported. The "typical" youth is a 16-year-old African-American male. Even though nearly one third of victims had been shot, the typical patient was injured in a fight during which he was kicked, bitten, or beaten with or without a blunt instrument. The majority of incidents involved only one attacker who was known to the victim. Nearly half the injuries were precipitated by an argument or fight. No statistically significant differences between intervention subjects and nonintervention controls in terms of baseline variables have been observed. For inner-city adolescent victims of violent assaults, a hospital-based intervention offers a unique opportunity for reduction of the incidence of reinjury. We describe the elements of the intervention, including the theoretical basis and implementation; detail the overall evaluation design including modifications; and present preliminary analyses of baseline data.

A Rapid, Flexible Approach to Conceptual Space Mission Tradespace Definition and Exploration

NASA Technical Reports Server (NTRS)

Girerd, Andre R.

2005-01-01

This paper provides an overview of the Mission Tradespace Tool (MTT), a methodology and software framework developed to improve JPL's early design process by offering a rapid, structured, and inexpensive way to identify feasible design architectures from a wide array of candidate architectures. There has been a growing consensus at JPL that to improve the quality of service offered to design customers it is desirable to explore a wide tradespace of candidate architectures prior to forming a conceptual design baseline. This paper describes the rationale behind the MTT's approach to meet this need. Notable features of the framework are introduced and explained.

Declines in Employer-Sponsored Insurance between 2000 and 2008: Examining the Components of Coverage by Firm Size

PubMed Central

Vistnes, Jessica; Zawacki, Alice; Simon, Kosali; Taylor, Amy

2012-01-01

Objective To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law. Data Sources Private sector employer data from the 2000, 2001, and 2008 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC). Study Design We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size. Data Collection The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans. Principal Findings We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and take-up rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms. PMID:22250730

Primary Prevention of Lead Exposure: The Philadelphia Lead Safe Homes Study

PubMed Central

Campbell, Carla; Tran, Mary; Gracely, Edward; Starkey, Naomi; Kersten, Hans; Palermo, Peter; Rothman, Nancy; Line, Laura; Hansen-Turton, Tine

2011-01-01

Objective Lead exposure in children can lead to neuropsychological impairment. This study tested whether primary prevention interventions in the newborn period prevent elevated blood lead levels (BLLs). Methods The Philadelphia Lead Safe Homes (LSH) Study offered parental education, home evaluation, and lead remediation to the families of urban newborns. Households were randomized to a standard lead education group or maintenance education group. We conducted home visits at baseline, six months, and 12 months. To compare BLLs, we identified a matched comparison group. Results We enrolled and randomized 314 newborns in the intervention component; 110 completed the study. There were few significant differences between the randomized groups. In the combined intervention groups, positive results on visual inspection declined from baseline to 12 months (97.0% to 90.6%, p=0.007). At baseline, 36.9% of homes were above the U.S. Environmental Protection Agency's lead dust standard, compared with 26.9% at 12 months (p=0.032), mainly due to a drop in windowsill dust levels. Both groups showed a significant increase in parental scores on a lead education test. Children in the intervention and matched control groups had similar geometric mean initial BLLs (2.6 vs. 2.7, p=0.477), but a significantly higher percentage of children in the intervention group had an initial blood lead screening compared with those in the matched group (88.9% vs. 84.4%, p=0.032). Conclusions A study of primary prevention of lead exposure showed a higher blood lead screening rate for the combined intervention groups and mean BLLs at one year of age not statistically different from the comparison group. Most homes had lead hazards. Lead education significantly increased knowledge. PMID:21563715

Usefulness of morning home blood pressure measurements in patients with type 2 diabetes mellitus: results of a 10-year, prospective, longitudinal study.

PubMed

Kamoi, Kyuzi

2015-01-01

Previous cross-sectional studies and 6-year longitudinal study have demonstrated that home blood pressure (HBP) measurements upon awakening have a stronger predictive power for death, micro- and macrovascular complications than clinic blood pressure (CBP) measurements in patients with type 2 diabetes (T2DM). This study investigated which of these measurements offers stronger predictive power for outcomes over 10 years. At baseline, 400 Japanese patients with T2DM were classified as having hypertension (HT) or normotension (NT) based on HBP and CBP. The mean survey duration was 95 months. Primary and secondary end-points were death and new or worsened micro- and macrovascular complications, respectively. Differences in outcomes for each end-point between HT and NT patients were analyzed using Kaplan-Meier survival curves and log-rank testing. Associated risk factors were assessed using Cox proportional hazards analysis. Based on HBP, death and micro- and macrovascular complications were significantly higher in patients with HT than with NT at baseline and end-point. Based on CBP, there were no significant differences in incidence of death, micro- or macrovascular complications between patients with HT and NT at baseline and end-point, although a significant difference in incidence of death was observed between the HT and NT groups at end-point. However, the significance was significantly lower in CBP than in HBP. One risk factor associated with micro- and macrovascular complications in patients with HBP was therapy for HT. This 10-year longitudinal study of patients with T2DM demonstrated that elevated HBP upon awakening is predictive of death, and micro- and macrovascular complications.

Primary prevention of lead exposure: the Philadelphia lead safe homes study.

PubMed

Campbell, Carla; Tran, Mary; Gracely, Edward; Starkey, Naomi; Kersten, Hans; Palermo, Peter; Rothman, Nancy; Line, Laura; Hansen-Turton, Tine

2011-01-01

Lead exposure in children can lead to neuropsychological impairment. This study tested whether primary prevention interventions in the newborn period prevent elevated blood lead levels (BLLs). The Philadelphia Lead Safe Homes (LSH) Study offered parental education, home evaluation, and lead remediation to the families of urban newborns. Households were randomized to a standard lead education group or maintenance education group. We conducted home visits at baseline, six months, and 12 months. To compare BLLs, we identified a matched comparison group. We enrolled and randomized 314 newborns in the intervention component; 110 completed the study. There were few significant differences between the randomized groups. In the combined intervention groups, positive results on visual inspection declined from baseline to 12 months (97.0% to 90.6%, p = 0.007). At baseline, 36.9% of homes were above the U.S. Environmental Protection Agency's lead dust standard, compared with 26.9% at 12 months (p = 0.032), mainly due to a drop in windowsill dust levels. Both groups showed a significant increase in parental scores on a lead education test. Children in the intervention and matched control groups had similar geometric mean initial BLLs (2.6 vs. 2.7, p = 0.477), but a significantly higher percentage of children in the intervention group had an initial blood lead screening compared with those in the matched group (88.9% vs. 84.4%, p = 0.032). A study of primary prevention of lead exposure showed a higher blood lead screening rate for the combined intervention groups and mean BLLs at one year of age not statistically different from the comparison group. Most homes had lead hazards. Lead education significantly increased knowledge.

Immunogenicity of Fractional-Dose Vaccine during a Yellow Fever Outbreak - Preliminary Report.

PubMed

Ahuka-Mundeke, Steve; Casey, Rebecca M; Harris, Jennifer B; Dixon, Meredith G; Nsele, Pierre M; Kizito, Gabriel M; Umutesi, Grace; Laven, Janeen; Paluku, Gilson; Gueye, Abdou S; Hyde, Terri B; Sheria, Guylain K M; Muyembe-Tanfum, Jean-Jacques; Staples, J Erin

2018-02-14

Background In 2016, the response to a yellow fever outbreak in Angola and the Democratic Republic of Congo led to a global shortage of yellow fever vaccine. As a result, a fractional dose of the 17DD yellow fever vaccine (containing one fifth [0.1 ml] of the standard dose) was offered to 7.6 million children 2 years of age or older and nonpregnant adults in a preemptive campaign in Kinshasa. The goal of this study was to assess the immune response to the fractional dose in a large-scale campaign. Methods We recruited participants in four age strata at six vaccination sites. We assessed neutralizing antibody titers against yellow fever virus in blood samples obtained before vaccination and 28 to 35 days after vaccination, using a plaque reduction neutralization test with a 50% cutoff (PRNT 50 ). Participants with a PRNT 50 titer of 10 or higher at baseline were considered to be seropositive. Those with a baseline titer of less than 10 who became seropositive at follow-up were classified as having undergone seroconversion. Participants who were seropositive at baseline and who had an increase in the titer by a factor of 4 or more at follow-up were classified as having an immune response. Results Among 716 participants who completed follow-up, 705 (98%; 95% confidence interval [CI], 97 to 99) were seropositive after vaccination. Among 493 participants who were seronegative at baseline, 482 (98%; 95% CI, 96 to 99) underwent seroconversion. Among 223 participants who were seropositive at baseline, 148 (66%; 95% CI, 60 to 72) had an immune response. Lower baseline titers were associated with a higher probability of having an immune response (P<0.001). Conclusions A fractional dose of the 17DD yellow fever vaccine was effective at inducing seroconversion in most of the participants who were seronegative at baseline. These findings support the use of fractional-dose vaccination for outbreak control. (Funded by the U.S. Agency for International Development and the Centers for Disease Control and Prevention.).

Psychometric analysis in support of shortening the Scale for the Assessment of Negative Symptoms.

PubMed

Levine, Stephen Z; Leucht, Stefan

2013-09-01

Despite recent emphasis on the measurement and treatment of negative symptoms, studies of the Scale for the Assessment of Negative Symptoms (SANS) identify different symptom clusters, offer mixed support for its psychometric properties and suggest that it is shortened. The current study objective is to examine the psychometric properties of the SANS and the feasibility of a short research version of the SANS. Data were re-analyzed from three clinical trials that compared placebo and amisulpride to 60 days. Participants had chronic schizophrenia and predominantly negative symptoms (n=487). Baseline data were examined with exploratory factor analysis and Item Response Theory (IRT) to identify a short SANS. The short and original SANS were compared: with confirmatory factor analysis at endpoint; and on symptom response with mixed modeling to compare. Results showed that at baseline the SANS consisted of three factors labeled Affective-flattening, Asociality and Alogia-inattentiveness. IRT suggested a short SANS with 11 items and 3 response options. Comparisons of the original and short SANS showed: the short version was a better fit to the data based on confirmatory factor analysis at endpoint; similar significant (p<.001) correlations between the baseline and subsequent scores; similar reliability; and similar significance (p<.05) on response based on mixed modeling. It is concluded that a short SANS is feasible to assess predominantly negative symptoms in chronic schizophrenia in research settings. Copyright © 2012 Elsevier B.V. and ECNP. All rights reserved.

Neurocognitive training in patients with high-grade glioma: a pilot study.

PubMed

Hassler, Marco Ronald; Elandt, Katarzyna; Preusser, Matthias; Lehrner, Johann; Binder, Petra; Dieckmann, Karin; Rottenfusser, Andrea; Marosi, Christine

2010-03-01

Although their neurocognitive performance is one of the major concerns of patients with high-grade gliomas (HGG) and although neurocognitive deficits have been described to be associated with negative outcome, neurocognitive rehabilitation is usually not integrated into the routine care of patients with malignant gliomas. In this pilot trial, a weekly group training session for attention, verbal, and memory skills was offered to patients with HGG with pre and post-training evaluation. Eleven patients, six with glioblastoma multiforme and five with WHO grade III gliomas, median age 50 years, with a Karnofsky performance score of 80-100 participated in ten group training sessions of 90 min. For evaluation at baseline and after the training by a neuropsychologist not involved in care or training of the patients, Trail Making Tests A and B (TMTA and TMTB), Hopkins Verbal Learning Test (HVLT), and the Controlled Oral Word Association Test (COWA) were used. Comparison of mean group differences between baseline and at post-training evaluation after 12 weeks revealed improvement across all neurocognitive variables. The patients showed a great diversity in their performances, with worsening, improvement, and stabilization. However, a significant group difference was detected only for the HVLT (score 19.6 +/- 8.9 at baseline, 23.6 +/- 8.8 after 12 weeks, P = 0.04). This pilot study shows that neurocognitive training in patients with HGG is feasible as group training with weekly sessions and might be able to induce improvements in attention and memory skills.

Effect of Initial Conditions on Reproducibility of Scientific Research

PubMed Central

Djulbegovic, Benjamin; Hozo, Iztok

2014-01-01

Background: It is estimated that about half of currently published research cannot be reproduced. Many reasons have been offered as explanations for failure to reproduce scientific research findings- from fraud to the issues related to design, conduct, analysis, or publishing scientific research. We also postulate a sensitive dependency on initial conditions by which small changes can result in the large differences in the research findings when attempted to be reproduced at later times. Methods: We employed a simple logistic regression equation to model the effect of covariates on the initial study findings. We then fed the input from the logistic equation into a logistic map function to model stability of the results in repeated experiments over time. We illustrate the approach by modeling effects of different factors on the choice of correct treatment. Results: We found that reproducibility of the study findings depended both on the initial values of all independent variables and the rate of change in the baseline conditions, the latter being more important. When the changes in the baseline conditions vary by about 3.5 to about 4 in between experiments, no research findings could be reproduced. However, when the rate of change between the experiments is ≤2.5 the results become highly predictable between the experiments. Conclusions: Many results cannot be reproduced because of the changes in the initial conditions between the experiments. Better control of the baseline conditions in-between the experiments may help improve reproducibility of scientific findings. PMID:25132705

Effect of initial conditions on reproducibility of scientific research.

PubMed

Djulbegovic, Benjamin; Hozo, Iztok

2014-06-01

It is estimated that about half of currently published research cannot be reproduced. Many reasons have been offered as explanations for failure to reproduce scientific research findings- from fraud to the issues related to design, conduct, analysis, or publishing scientific research. We also postulate a sensitive dependency on initial conditions by which small changes can result in the large differences in the research findings when attempted to be reproduced at later times. We employed a simple logistic regression equation to model the effect of covariates on the initial study findings. We then fed the input from the logistic equation into a logistic map function to model stability of the results in repeated experiments over time. We illustrate the approach by modeling effects of different factors on the choice of correct treatment. We found that reproducibility of the study findings depended both on the initial values of all independent variables and the rate of change in the baseline conditions, the latter being more important. When the changes in the baseline conditions vary by about 3.5 to about 4 in between experiments, no research findings could be reproduced. However, when the rate of change between the experiments is ≤2.5 the results become highly predictable between the experiments. Many results cannot be reproduced because of the changes in the initial conditions between the experiments. Better control of the baseline conditions in-between the experiments may help improve reproducibility of scientific findings.

School-based obesity prevention programs: an evidence-based review.

PubMed

Kropski, Jonathan A; Keckley, Paul H; Jensen, Gordon L

2008-05-01

This review seeks to examine the effectiveness of school-based programs for reducing childhood overweight or obesity. A systematic review of the research literature published since 1990 was conducted to identify experimental or quasi-experimental school-based curricular or environmental preventive interventions, with evaluation>or=6 months after baseline, which reported outcomes in terms of a measure of overweight. Fourteen studies were identified, including one involving a nutrition-only program, two physical activity promotion interventions and eleven studies combining nutrition and physical activity components. Most studies (n=10) offered weak (grade 2) quality evidence. One study offered strong (grade 4) evidence reducing the odds ratio for overweight in girls only, while four grade 2 studies reported significant improvements in BMI or at-risk-for overweight or overweight prevalence in boys, girls, or both. Twelve studies reported significant improvement in at least one measure of dietary intake, physical activity, and/or sedentary behavior. Our ability to draw strong conclusions as to the efficacy of school-based obesity prevention programs is limited by the small number of published studies and by methodological concerns. Qualitative analysis suggests programs grounded in social learning may be more appropriate for girls, while structural and environmental interventions enabling physical activity may be more effective for boys. High-quality evaluation protocols should be considered essential components of future programs.

Offering Annual Fecal Occult Blood Tests at Annual Flu Shot Clinics Increases Colorectal Cancer Screening Rates

PubMed Central

Potter, Michael B.; Phengrasamy, La; Hudes, Esther S.; McPhee, Stephen J.; Walsh, Judith M.E.

2009-01-01

PURPOSE We wanted to determine whether providing home fecal occult blood test (FOBT) kits to eligible patients during influenza inoculation (flu shot) clinics can contribute to higher colorectal cancer screening (CRCS) rates. METHODS The study was time randomized. On 8 dates of an annual flu shot clinic at the San Francisco General Hospital, patients were offered flu shots as usual (control group) and on 9 other dates, patients were offered both flu shots and FOBT kits (intervention group). RESULTS The study included 514 patients aged 50 to 79 years, with 246 in the control group and 268 in the intervention group. At the conclusion of flu season, FOBT screening rates increased by 4.4 percentage points from 52.9% at baseline to 57.3% (P = .07) in the control group, and increased by 29.8 percentage points from 54.5% to 84.3% (P <.001) in the intervention group, with the change among intervention participants 25.4 percentage points greater than among control participants (P value for change difference <.001). Among patients initially due for CRCS, 20.7% in the control group and 68.0% in the intervention group were up-to-date at the conclusion of the study (P <.001). In multivariate analyses, the odds ratio for becoming up-to-date with screening in the intervention group (vs the control group) was 11.3 (95% CI, 5.8–22.0). CONCLUSIONS Offering FOBT kits during flu shot clinics dramatically increased the CRCS rate for flu shot clinic attendees. Pairing home FOBT kits with annual flu shots may be a useful strategy to improve CRCS rates in other primary care or public health settings. PMID:19139445

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

PubMed

Bancroft, Elizabeth K; Saya, Sibel; Page, Elizabeth C; Myhill, Kathryn; Thomas, Sarah; Pope, Jennifer; Chamberlain, Anthony; Hart, Rachel; Glover, Wayne; Cook, Jackie; Rosario, Derek J; Helfand, Brian T; Hutten Selkirk, Christina; Davidson, Rosemarie; Longmuir, Mark; Eccles, Diana M; Gadea, Neus; Brewer, Carole; Barwell, Julian; Salinas, Monica; Greenhalgh, Lynn; Tischkowitz, Marc; Henderson, Alex; Evans, David Gareth; Buys, Saundra S; Eeles, Rosalind A; Aaronson, Neil K

2018-05-26

To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening. © 2018 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.

Changing sex risk behaviors, gender norms, and relationship dynamics among couples in Cape Town, South Africa: Efficacy of an intervention on the dyad.

PubMed

Speizer, Ilene S; Zule, William A; Carney, Tara; Browne, Felicia A; Ndirangu, Jacqueline; Wechsberg, Wendee M

2018-05-18

South Africa continues to experience new HIV infections, with the highest risk among Black Africans living in poor communities. Most HIV prevention interventions target women or men separately and only a small number target couples jointly. This study examines varying strategies to engage women and men around HIV prevention and improved couple interactions. The study comprises three arms: (1) a couple-based intervention delivered to women and men jointly; (2) women and men both offered a gender-focused intervention that is delivered to them separately; and (3) an intervention offered to women only and their male partners receive standard HIV testing and counseling (comparison arm). Between June 2010 and April 2012, men were identified in and around drinking establishments in a large disadvantaged community in Cape Town and asked to participate in the study if they drink regularly, had recent unprotected sex with their partner, and have a female partner who was willing to participate in the study. A total of 299 couples completed the baseline assessment and 276 were included in the analysis of sexual risk, partner communication, conflict resolution, and gender norm outcomes at baseline and six-month follow-up. Couples that participated in the couple-level intervention and couples where both partners received the intervention separately had better couple-level gender norms than couples in the comparison arm (women only receive intervention). Further, couples in the couple-level intervention and the both partners exposed separately arms were more likely to have the man only report consistent condom use than neither partner report consistent condom use than couples in the comparison arm. Community-based HIV prevention intervention programs need to consider strategies to engage women and men and, if feasible, reach both partners jointly. Couple-level interventions are promising to improve gender norms and subsequently improve health outcomes, including reduced HIV risk among women, men, and couples. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cravings as a mediator and moderator of drinking outcomes in the COMBINE Study

PubMed Central

Lendle, Samuel; van der Laan, Mark; Kaskutas, Lee Ann; Ahern, Jennifer

2014-01-01

Aims Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) Study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator. Design Secondary mediation and moderation analyses of COMBINE study data. Setting Eleven United States academic sites. Participants 863 patients randomized to one of four treatment groups: naltrexone (100mg/d; n=209), the Combined Behavioral Intervention (CBI, n=236), naltrexone and CBI combined (n=213), and placebo naltrexone (n=205). Measurements Percent Days Abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, was measured at baseline, week 4 and week 12 using the Obsessive-Compulsive Drinking Scale. Findings Compared to placebo, naltrexone, CBI, and the combination all increased PDA by an additional 6–10 percentage points for those with high cravings (p<0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were at least partially mediated by cravings; craving reduction explained 48–53% of treatment effects (p<0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks. Conclusions Naltrexone and the behavioral intervention both improved abstinence by reducing cravings and were no longer effective once cravings were low. Furthermore, naltrexone reduced cravings by 4 weeks, while the behavioral intervention took longer to affect cravings. The COMBINE naltrexone + CBI combination may not have been more beneficial than either monotherapy because craving reduction was a common mechanism of both, and neither worked when cravings were low. PMID:23668624

PREDICTING ADHERENCE TO TREATMENT FOR METHAMPHETAMINE DEPENDENCE FROM NEUROPSYCHOLOGICAL AND DRUG USE VARIABLES*

PubMed Central

Dean, Andy C.; London, Edythe D.; Sugar, Catherine A.; Kitchen, Christina M. R.; Swanson, Aimee-Noelle; Heinzerling, Keith G.; Kalechstein, Ari D.; Shoptaw, Steven

2009-01-01

Although some individuals who abuse methamphetamine have considerable cognitive deficits, no prior studies have examined whether neurocognitive functioning is associated with outcome of treatment for methamphetamine dependence. In an outpatient clinical trial of bupropion combined with cognitive behavioral therapy and contingency management (Shoptaw et al., 2008), 60 methamphetamine-dependent adults completed three tests of reaction time and working memory at baseline. Other variables that were collected at baseline included measures of drug use, mood/psychiatric functioning, employment, social context, legal status, and medical status. We evaluated the relative predictive value of all baseline measures for treatment outcome using Classification and Regression Trees (CART; Breiman, 1984), a nonparametric statistical technique that produces easily interpretable decision rules for classifying subjects that are particularly useful in clinical settings. Outcome measures were whether or not a participant completed the trial and whether or not most urine tests showed abstinence from methamphetamine abuse. Urine-verified methamphetamine abuse at the beginning of the study was the strongest predictor of treatment outcome; two psychosocial measures (e.g., nicotine dependence and Global Assessment of Functioning) also offered some predictive value. A few reaction time and working memory variables were related to treatment outcome, but these cognitive measures did not significantly aid prediction after adjusting for methamphetamine usage at the beginning of the study. On the basis of these findings, we recommend that research groups seeking to identify new predictors of treatment outcome compare the predictors to methamphetamine usage variables to assure that unique predictive power is attained. PMID:19608354

High-Intensity Interval Training for Overweight Adolescents: Program Acceptance of a Media Supported Intervention and Changes in Body Composition.

PubMed

Herget, Sabine; Reichardt, Sandra; Grimm, Andrea; Petroff, David; Käpplinger, Jakob; Haase, Michael; Markert, Jana; Blüher, Susann

2016-11-08

High-intensity interval training (HIIT) consists of short intervals of exercise at high intensity intermitted by intervals of lower intensity and is associated with improvement of body composition and metabolic health in adults. Studies in overweight adolescents are scarce. We conducted a randomized controlled trial in overweight adolescents to compare acceptance and attendance of HIIT with or without weekly motivational encouragement through text messages and access to a study website. HIIT was offered for six months (including summer vacation) twice a week (60 min/session). Participation rates were continuously assessed and acceptance was measured. Clinical parameters were assessed at baseline and after six months. Twenty-eight adolescents participated in this study (age 15.5 ± 1.4; 54% female). The standard deviation score for body mass index over all participants was 2.33 at baseline and decreased by 0.026 (95% CI -0.048 to 0.10) units, p = 0.49. Waist to height ratio was 0.596 at baseline and decreased by 0.013 (95% CI 0.0025 to 0.024), p = 0.023. Participation within the first two months ranged from 65% to 75%, but fell to 15% within the last three months. Attendance in the intervention group was 14% (95% CI -8 to 37), p = 0.18, higher than the control group. Overall program content was rated as "good" by participants, although high drop-out rates were observed. Summer months constitute a serious problem regarding attendance. The use of media support has to be assessed further in appropriately powered trials.

High-Intensity Interval Training for Overweight Adolescents: Program Acceptance of a Media Supported Intervention and Changes in Body Composition

PubMed Central

Herget, Sabine; Reichardt, Sandra; Grimm, Andrea; Petroff, David; Käpplinger, Jakob; Haase, Michael; Markert, Jana; Blüher, Susann

2016-01-01

High-intensity interval training (HIIT) consists of short intervals of exercise at high intensity intermitted by intervals of lower intensity and is associated with improvement of body composition and metabolic health in adults. Studies in overweight adolescents are scarce. We conducted a randomized controlled trial in overweight adolescents to compare acceptance and attendance of HIIT with or without weekly motivational encouragement through text messages and access to a study website. HIIT was offered for six months (including summer vacation) twice a week (60 min/session). Participation rates were continuously assessed and acceptance was measured. Clinical parameters were assessed at baseline and after six months. Twenty-eight adolescents participated in this study (age 15.5 ± 1.4; 54% female). The standard deviation score for body mass index over all participants was 2.33 at baseline and decreased by 0.026 (95% CI −0.048 to 0.10) units, p = 0.49. Waist to height ratio was 0.596 at baseline and decreased by 0.013 (95% CI 0.0025 to 0.024), p = 0.023. Participation within the first two months ranged from 65% to 75%, but fell to 15% within the last three months. Attendance in the intervention group was 14% (95% CI −8 to 37), p = 0.18, higher than the control group. Overall program content was rated as “good” by participants, although high drop-out rates were observed. Summer months constitute a serious problem regarding attendance. The use of media support has to be assessed further in appropriately powered trials. PMID:27834812

Adiponectin as a Protective Factor Against the Progression Toward Type 2 Diabetes Mellitus in Postmenopausal Women.

PubMed

Darabi, Hossein; Raeisi, Alireza; Kalantarhormozi, Mohammad Reza; Ostovar, Afshin; Assadi, Majid; Asadipooya, Kamyar; Vahdat, Katayoun; Dobaradaran, Sina; Nabipour, Iraj

2015-08-01

Serum adiponectin levels have been suggested to be predictors of type 2 diabetes mellitus in diverse populations. However, the relationship between circulating adiponectin levels and the risk of development of type 2 diabetes in postmenopausal women has not been investigated.A total of 382 healthy postmenopausal women who participated in a prospective cohort study were followed for 5.8 years. Type 2 diabetes mellitus was defined according to the criteria set out by the American Diabetes Association. Adiponectin, osteoprotegerin (OPG), and high-sensitivity C-reactive protein (hs-CRP) levels were measured using ELISA.Of 195 women who did not have diabetes at baseline and who were reexamined in the second phase of the study for diabetic status, 35 subjects (17.9%) developed type 2 diabetes mellitus during the 5.8 years follow-up period. The women with type 2 diabetes had lower adiponectin levels than the healthy postmenopausal women. Multiple regression analysis showed that, after adjustments were made for age, cardiovascular risk factors, OPG, and hs-CRP levels, higher baseline adiponectin levels were associated with a lower relative risk (RR) of having type 2 (RR = 0.07, confidence interval [CI]: 0.01-0.66, P = 0.021).Higher baseline adiponectin levels functioned as a predictor of a lower risk of developing type 2 diabetes mellitus among postmenopausal women during a 5.8 years follow-up study. Therefore, it is suggested that elevated adiponectin levels may offer protection against the development of type 2 diabetes mellitus after the menopause.

Effect of 25-Hydroxyvitamin D Status on Serological Response to Influenza Vaccine in Prostate Cancer Patients

PubMed Central

Chadha, Manpreet K.; Fakih, Marwan; Muindi, Josephia; Tian, Lili; Mashtare, Terry; Johnson, Candace S.; Trump, Donald

2015-01-01

BACKGROUND Epidemiologic data suggest that there is an association between vitamin D deficiency and influenza infection. We conducted a prospective influenza vaccination study to determine the influence of vitamin D status on serological response to influenza vaccine in prostate cancer (CaP) patients. METHODS During the 2006–2007 influenza season, CaP patients treated at Roswell Park Cancer Institute were offered vaccination with the trivalent influenza vaccine (Fluzone®, 2006–2007) and sera collected for hemagglutination inhibition (HI) assay titers before and 3 months after vaccination. Response to vaccination was defined as ≥1:40 titer ratio or a fourfold increase in titer at 3 months, against any of the three strains. Serum 25-hydroxyvitamin D (25-D3) levels were measured using DiaSorin 125I radioimmunoassay kits. RESULTS Thirty-five patients with CaP participated in the study. Median baseline 25-D3 level was 44.88 ng/ml (range: 9.16–71.98 ng/ml) Serological response against any of the three strains was noted in 80%. There was a significant effect of baseline 25-D3 level when tested as a continuous variable in relation to serological response (P = 0.0446). All patients in the upper quartile of 25-D3 level responded by mounting a serological response (P = 0.0344). None of the other baseline variables (age, race, chemotherapy status, or white cell count) had an effect on serological response. CONCLUSIONS In this study in CaP patients, a replete vitamin D status was associated with more frequent serological response to influenza vaccine. PMID:20812224

Yoga-based intervention in patients with somatoform disorders: an open label trial.

PubMed

Sutar, Roshan; Desai, Geetha; Varambally, Shivarama; Gangadhar, B N

2016-06-01

Somatoform disorders are common mental disorders associated with impaired functioning and increased utilization of health resources. Yoga-based interventions have been used successfully for anxiety, depression, and chronic pain conditions. However, literature on the use of yoga in treatment of somatoform disorders is minimal. The current study assessed the effect of a specific yoga-based intervention in patients with somatoform disorders. Consenting patients meeting ICD-10 criteria for somatoform disorders were offered a specific yoga module (1 h per day) as a treatment. Assessments including Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), and others were carried out at baseline and after 2, 6, and 12 weeks. Sixty-four subjects were included in the study and 34 completed 12 weeks follow-up. Significant improvement was noted in pain severity from baseline to 12 weeks after regular yoga sessions. The mean VAS score dropped from 7.24 to 2.88. Worst and average pain score in the last 24 h on BPI dropped from 7.71 to 3.26 and from 6.12 to 2.0,7 respectively. Results of the study suggest that yoga-based intervention can be one of the non-pharmacological treatment options in somatoform disorders. These preliminary findings need replication in larger controlled studies.

Is insulin the preferred treatment for HbA1c >9%?

PubMed

Bloomgarden, Zachary

2017-09-01

The algorithms and guidelines of the American Association of Clinical Endocrinologists and the American Diabetes Association recommend that insulin administration be strongly considered for people with type 2 diabetes (T2D) with HbA1c levels exceeding 9.0% and 10%, respectively. Although the caveat is given in both sets of recommendations that this is particularly appropriate when patients are "symptomatic," referring to urinary frequency with increased thirst and appetite, weight loss, and ketosis, the clinical definition of such presentations may be ill-defined, and it is noteworthy that both documents consider insulin to offer particular benefit under such circumstances. However, with multiple options for glycemic treatment, it is of interest to reconsider this argument for insulin use. It should be recalled that in the UK Prospective Diabetes Study, diet alone was associated with a reduction in HbA1c from 9% to 7%. Drug-naïve people with T2D do often show surprisingly strong reductions in HbA1c with metformin-based dual-agent oral treatment approaches; a recent report showed that even with baseline HbA1c >11%, the combination of metformin with a sulfonylurea, pioglitazone, or sitagliptin was associated with reduction in HbA1c from 11.6% to 6.0%. A 32-week study of the combination of rosiglitazone with metformin in patients with mean baseline HbA1c 8.9% showed a mean HbA1c reduction of 2.3%, and an open-label cohort with baseline HbA1c 11.8% had a reduction in HbA1c to 7.8%. With metformin plus sitagliptin, a mean placebo-adjusted HbA1c reduction of 2.1% from a baseline of 8.8% was reported, with those patients with baseline HbA1c >9% having a 2.6% reduction in HbA1c, and an open-label cohort with baseline HbA1c 11.2% having a 2.9% reduction in HbA1c. Similar 2% HbA1c reductions from baseline levels of 9.1% were seen with metformin in initial combination with the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin. Although such dual oral agent approaches are more effective than monotherapy, with a combination regimen the HbA1c reduction will not be directly additive, because the expected reduction decreases at lower baseline HbA1c levels. As an example of this, administration of canagliflozin 300 mg daily to patients with baseline HbA1c >9% reduced levels from 9.6% by 1.8%, whereas at a baseline HbA1c of 10% either canagliflozin 300 mg or metformin 2 g/day reduced HbA1c by 2%; the addition of both agents led to an HbA1c reduction by somewhat less than 3%, which appears concordant with a reduction by the second agent from approximately 8% (10% to 2%). Similar less-than-additive effects of the addition of exenatide QW to dapagliflozin have been reported, with HbA1c reduction from a baseline of 10.0%-10.1% of 1.9% and 1.6% with the individual agents, respectively, and a reduction of 2.2% with their combination. However, one may consider these approaches inferior to the expected HbA1c reduction with insulin, suggesting that insulin should, indeed, be the preferred treatment for people with T2D and HbA1c >9%. Rather, studies comparing basal insulin directly with glucagon-like peptide-1 (GLP-1) receptor agonists (RA) suggest that the latter agents may offer superior benefit. The Diabetes Therapy Utilization: Researching Changes in HBA1C, Weight, and Other Factors Through Intervention with Exenatide Once Weekly (DURATION)-3 and Liraglutide Effect and Action in Diabetes (LEAD)-5 studies compared exenatide QW and liraglutide, respectively, with insulin glargine. Those study participants in the highest quartile of baseline HbA1c had levels ≥9.0% and ≥8.9%, with the GLP-1RA leading to 0.3% and 0.2% greater reductions in HbA1c, respectively, than insulin glargine. Another study comparing T2D patients receiving oral agents given liraglutide with those given insulin glargine showed that those in the highest baseline HbA1c quartile (mean 10.6%) had an HbA1c reduction of 3.1% with either agent. In the exenatide QW study, the reduction in HbA1c with this agent exceeded that with insulin glargine for those groups of study participants with HbA1c 9.0%-9.4%, 9.5%-9.9%, 10.0%-10.4%, 10.5%-10.9%, and even ≥11.0%. Similar superiority of the HbA1c-lowering effect of exenatide QW compared with that of insulin glargine was reported in a study with baseline HbA1c 8.5%. An individual-patient meta-analysis of six studies of another weekly GLP-1RA, namely dulaglutide, showed that at a baseline HbA1c of 10% the expected HbA1c reduction would be nearly 2.5%, and a study directly comparing dulaglutide with insulin glargine also showed a superior HbA1c-lowering effect of the former. Another advantage of the GLP-1RAs is their association with weight loss, rather than the weight gain associated with insulin treatment. An interesting potential combination is that of a GLP-1RA with a thiazolidinedione. In a study comparing the addition of exenatide QW and pioglitazone with the addition of basal-bolus insulin in 101 people receiving sulfonylureas and metformin with baseline HbA1c >10%, HbA1c fell from >11% by >4% compared with <4%, respectively, and the GLP-1RA plus thiazolidinedione treatment was associated with less weight gain and hypoglycemia. What can we conclude? Should HbA1c 11% be the new "use insulin" point? Insulin is an important part of our armamentarium for T2D, and is certainly needed for many patients, but with current therapeutic approaches including metformin, incretin-based treatments, SGLT2 inhibitors, and, possibly, thiazolidinediones, we can reconsider its use in many instances. Although there is no doubt that insulin is necessary for truly uncontrolled diabetes, we may wish to better define its correct indications. © 2017 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Assessment of menstrual blood loss in Belgian users of a new T-shaped levonorgestrel-releasing intrauterine system.

PubMed

Wildemeersch, Dirk; Rowe, Patrick J

2005-06-01

This study was conducted to evaluate the effect of a T-shaped levonorgestrel-releasing intrauterine system (Femilis, LNG IUS) on the amount of menstrual blood loss (MBL) in women with and without menorrhagia. The daily release of the LNG IUS was approximately 20 mug. In 60 Belgian women, less than 48 years of age at study enrollment, using the Femilis LNG IUS for 4 to more than 30 months, MBL was assessed with the visual assessment technique. Twenty-eight women had normal menstrual periods at baseline (menstrual score <185) and 32 women had idiopathic menorrhagia (menstrual score > or =185). Menstrual blood loss scores dropped significantly during the observation period in all women except one. The median menstrual score at baseline in women with normal menstrual bleeding was 140 (range 80-160) and dropped to a median score of 5 (range 0-150) at follow-up, a decrease of 96%. In the 32 women with menorrhagic bleeding at baseline, menstrual flow dropped from a median score of 232 (range 185-450) at baseline to a median score of 3 (range 0-50) at follow-up, a decrease of 99%. Twenty women developed amenorrhea (33%): 10 in the group of women with normal menstruation and 10 in those women with menorrhagia. Most of the remaining women had oligomenorrhea requiring the use of a few panty-liners only. In one woman, MBL did not decrease, thus requiring further evaluation. The impact on MBL of this new 20 mug/day LNG-releasing IUS confirms other studies with devices releasing the same or lower amounts of LNG. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The strong effect on MBL of this contraceptive method offers an important health benefit and improvement in quality of life, particularly in women with heavy bleeding and anemia, as other treatment modalities are less effective, more costly, more invasive or not readily available.

Transforming Parent-Child Interaction in Family Routines: Longitudinal Analysis with Families of Children with Developmental Disabilities.

PubMed

Lucyshyn, Joseph M; Fossett, Brenda; Bakeman, Roger; Cheremshynski, Christy; Miller, Lynn; Lohrmann, Sharon; Binnendyk, Lauren; Khan, Sophia; Chinn, Stephen; Kwon, Samantha; Irvin, Larry K

2015-12-01

The efficacy and consequential validity of an ecological approach to behavioral intervention with families of children with developmental disabilities was examined. The approach aimed to transform coercive into constructive parent-child interaction in family routines. Ten families participated, including 10 mothers and fathers and 10 children 3-8 years old with developmental disabilities. Thirty-six family routines were selected (2 to 4 per family). Dependent measures included child problem behavior, routine steps completed, and coercive and constructive parent-child interaction. For each family, a single case, multiple baseline design was employed with three phases: baseline, intervention, and follow-up. Visual analysis evaluated the functional relation between intervention and improvements in child behavior and routine participation. Nonparametric tests across families evaluated the statistical significance of these improvements. Sequential analyses within families and univariate analyses across families examined changes from baseline to intervention in the percentage and odds ratio of coercive and constructive parent-child interaction. Multiple baseline results documented functional or basic effects for 8 of 10 families. Nonparametric tests showed these changes to be significant. Follow-up showed durability at 11 to 24 months postintervention. Sequential analyses documented the transformation of coercive into constructive processes for 9 of 10 families. Univariate analyses across families showed significant improvements in 2- and 4-step coercive and constructive processes but not in odds ratio. Results offer evidence of the efficacy of the approach and consequential validity of the ecological unit of analysis, parent-child interaction in family routines. Future studies should improve efficiency, and outcomes for families experiencing family systems challenges.

Detecting reliable cognitive change in individual patients with the MATRICS Consensus Cognitive Battery.

PubMed

Gray, Bradley E; McMahon, Robert P; Green, Michael F; Seidman, Larry J; Mesholam-Gately, Raquelle I; Kern, Robert S; Nuechterlein, Keith H; Keefe, Richard S; Gold, James M

2014-10-01

Clinicians often need to evaluate the treatment response of an individual person and to know that observed change is true improvement or worsening beyond usual week-to-week changes. This paper gives clinicians tools to evaluate individual changes on the MATRICS Consensus Cognitive Battery (MCCB). We compare three different approaches: a descriptive analysis of MCCB test-retest performance with no intervention, a reliable change index (RCI) approach controlling for average practice effects, and a regression approach. Data were gathered as part of the MATRICS PASS study (Nuechterlein et al., 2008). A total of 159 people with schizophrenia completed the MCCB at baseline and 4weeks later. Data were analyzed using an RCI and a regression formula establishing confidence intervals. The RCI and regression approaches agree within one point when baseline values are close to the sample mean. However, the regression approach offers more accurate limits for expected change at the tails of the distribution of baseline scores. Although both approaches have their merits, the regression approach provides the most accurate measure of significant change across the full range of scores. As the RCI does not account for regression to the mean and has confidence limits that remain constant across baseline scores, the RCI approach effectively gives narrower confidence limits around an inaccurately predicted average change value. Further, despite the high test-retest reliability of the MCCB, a change in an individual's score must be relatively large to be confident that it is beyond normal month-to-month variation. Copyright © 2014 Elsevier B.V. All rights reserved.

Effectiveness of Oncologist-Referred Exercise and Healthy Eating Programming as a Part of Supportive Adjuvant Care for Early Breast Cancer.

PubMed

Kirkham, Amy A; Van Patten, Cheri L; Gelmon, Karen A; McKenzie, Donald C; Bonsignore, Alis; Bland, Kelcey A; Campbell, Kristin L

2018-01-01

Randomized trials have established efficacy of supervised exercise training during chemotherapy for breast cancer for numerous health outcomes. The purpose of this study was to assess reach, effectiveness, maintenance, and implementation of an evidence-based exercise and healthy eating program offered within an adjuvant care setting. Women receiving adjuvant chemotherapy for breast cancer were given a prescription by their oncologist to participate in the Nutrition and Exercise during Adjuvant Treatment (NExT) program. The NExT program consisted of supervised, moderate-intensity, aerobic and resistance exercise three times a week during adjuvant therapy, followed by a step-down in supervised sessions per week for 20 additional weeks, plus one group-based healthy eating session. Usual moderate-to-vigorous physical activity (MVPA) and health-related quality of life (HRQoL) were assessed by questionnaire at baseline, program completion, and one year later, along with measures of satisfaction and safety. Program reach encompassed referral of 53% of eligible patients, 78% uptake ( n  = 73 enrolled), and 78% retention for the 45.0 ± 8.3-week program. During the program, MVPA increased (116 ± 14 to 154 ± 14 minutes per week, p  = .014) and HRQoL did not change. One year later, MVPA (171 ± 24 minutes per week, p  = .014) and HRQoL (44 ± 1 to 49 ± 1, p  < .001) were significantly higher than baseline. Exercise adherence was 60% ± 26% to three sessions per week during treatment. No major adverse events occurred and injury prevalence did not change relative to baseline. Participants were highly satisfied. This oncologist-referred exercise and healthy eating supportive-care program for breast cancer patients receiving chemotherapy was safe, successful in reaching oncologists and patients, and effective for improving MVPA and maintaining HRQoL. Despite evidence that exercise is both safe and efficacious at improving physical fitness, quality of life, and treatment side effects for individuals with cancer, lifestyle programming is not offered as standard of cancer care. This study describes an oncologist-referred, evidence-based exercise and healthy eating program offered in collaboration with a university as supportive care to women with breast cancer receiving chemotherapy. The program was well received by oncologists and patients, safe, and relatively inexpensive to operate. Importantly, there was a significant positive impact on physical activity levels and health-related quality of life lasting for 2 years after initiation of therapy. © AlphaMed Press 2017.

Quarterly Update: July-September 1990

DTIC Science & Technology

1990-09-01

drafted a report that defines the process and the products of a feature oriented domain analysis ( FODA ) and provides a sample do- main analysis . This...receive ............... training to offer assessment services commercially. This section provides NASA adopted the rate monotonic scheduling analysis ...that the rate monotonic scheduling analysis approach will be the JulySeptember 1990 baseline methodology for its hard real-time operating system

Utilizing Telehealth to deliver family-based treatment for adolescent anorexia nervosa.

PubMed

Anderson, Kristen E; Byrne, Catherine E; Crosby, Ross D; Le Grange, Daniel

2017-10-01

The purpose of this study was to test the feasibility and preliminary effect size on the main outcome measure (weight gain) of family-based treatment (FBT) for adolescents with anorexia nervosa (AN) and their families delivered via a Telehealth platform (i.e., an HIPAA compliant videoconferencing format). Ten adolescents, mean age of 16.08 years (SD = 1.99), meeting DSM-5 criteria for AN or atypical AN, were enrolled in the study and offered FBT via a Telehealth platform. Feasibility and acceptability were evaluated by rates of recruitment and retention. Treatment outcome was determined utilizing percent median body mass index (%mBMI), the eating disorder examination (EDE), and measures for depression and self-esteem. Recruitment target was achieved within allotted time, and all participants were retained for the course of treatment. Percent mBMI improved significantly from baseline to the end-of-treatment (p = .013) and from baseline to the 6-month follow-up (p = .032). Similar results were achieved for the EDE Global Score (p = .002 and .001, respectively). These findings provide preliminary evidence that it is feasible to deliver FBT via Telehealth and that satisfactory clinical outcomes are achievable. © 2017 Wiley Periodicals, Inc.

Predictors of short-term treatment outcomes among California's Proposition 36 participants.

PubMed

Hser, Yih-Ing; Evans, Elizabeth; Teruya, Cheryl; Huang, David; Anglin, M Douglas

2007-05-01

California's voter-initiated Proposition 36 offers non-violent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. This article reports short-term treatment outcomes subsequent to this major shift in drug policy. Data are from 1104 individuals randomly selected from all Proposition 36 participants assessed for treatment in five California counties during 2004. The overall study sample was 30% female, 51% white, 18% Black, 24% Hispanic, and 7% other racial/ethnic groups. The mean+/-SD age was 37+/-10 years. Counties varied considerably in participant characteristics, treatment service intensity, treatment duration, urine testing, and employment and recidivism outcomes, but not in drug use at 3-month follow-up. Controlling for county, logistic regression analysis showed that drug abstinence was predicted by gender (female), employment at baseline (full or part-time), residential (vs. outpatient) stay, low psychiatric severity, frequent urine testing by treatment facility, and more days in treatment. Recidivism was predicted only by shorter treatment duration. Employment predictors included age (younger), gender (male), baseline employment, and lower psychiatric severity. The study findings support drug testing to monitor abstinence and highlight the need to address employment and psychiatric problems among Proposition 36 participants.

Relationships between the family environment and school-based obesity prevention efforts: can school programs help adolescents who are most in need?

PubMed Central

Bauer, K. W.; Neumark-Sztainer, D.; Hannan, P. J.; Fulkerson, J. A.; Story, M.

2011-01-01

Identifying factors that contribute to students' behavior and weight improvements during school-based obesity prevention interventions is critical for the development of effective programs. The current study aims to determine whether the support and resources that adolescent girls received from their families were associated with improvements in physical activity (PA), television use, dietary intake, body mass index (BMI) and body composition during participation in New Moves, a school-based intervention to prevent obesity and other weight-related problems. Adolescent girls in the intervention condition of New Moves (n = 135), and one parent of each girl, were included in the current analysis. At baseline, parents completed surveys assessing the family environment. At baseline and follow-up, 9–12 months later, girls' behaviors were self-reported, height and weight were measured by study staff and body fat was assessed using dual-energy X-ray absorptiometry. Results showed few associations between family environment factors and girls' likelihood of improving behavior, BMI or body composition. These findings suggest that in general, school-based interventions offer similar opportunities for adolescent girls to improve their PA, dietary intake, and weight, regardless of family support. PMID:21536714

Personal Control and Service Connection as Paths to Improved Mental Health and Exiting Homelessness among Severely Marginalized Homeless Youth.

PubMed

Slesnick, Natasha; Zhang, Jing; Brakenhoff, Brittany

2017-02-01

Non-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes. Seventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline. Personal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health. This study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.

Classroom attention in children with type 1 diabetes mellitus: the effect of stabilizing serum glucose.

PubMed

Daley, Kelly B; Wodrich, David L; Hasan, Khalid

2006-02-01

To determine whether stabilizing serum glucose, via introduction of an insulin pump, improves classroom attention among children with type-1 diabetes mellitus. Four boys having type-1 diabetes mellitus with unstable serum glucose were observed in their classroom for 10 baseline days. An insulin pump was placed and serum glucose stabilized, and they were then observed again for 10 days. A modified multiple baseline design was used to determine if improved on-task and off-task behavior was associated with better glycemic control. Rating scales and a laboratory measure of attention, measures of secondary interest, were also administered before and after pump introduction, and potential improvement in individuals' scores was evaluated. All boys had apparent improvement in on-task and off-task behavior as observed in their classrooms. Improvements were substantial, averaging 20% in on-task behavior and 34% in off-task behavior. However, no changes were detected on rating scales or laboratory measures. This study offers preliminary evidence that stabilizing serum glucose improves classroom attention, although the effect was detected only by observation of classroom behavior using highly structured techniques. Consequently, use of direct observation techniques may be important in studying the effects of chronic illness on classroom functioning.

Feasibility, acceptability and findings from a pilot randomized controlled intervention study on the impact of a book designed to inform patients about cancer clinical trials.

PubMed

Carney, Patricia A; Tucker, Erin K; Newby, Timothy A; Beer, Tomasz M

2014-03-01

This study was conducted to assess the feasibility, acceptability, and changes in knowledge among cancer patients assigned to receive a 160-page book on experimental cancer therapies and clinical trials. We enrolled 20 patients with cancer who had never participated in a clinical trial and randomly assigned them to receive the book either during week 1 or week 4 of the study. We collected baseline patient demographic and cancer-related information as well as knowledge about cancer clinical trials at week 0. Follow-up surveys were administered at weeks 3 and 6 for both study groups. Comparisons were made within and between groups randomized to receive the book early (at week 1) to those who received it later (at week 4). One hundred percent of data were captured in both groups at baseline, which decreased to 77.8% by week 6. The vast majority of participants found the book moderately or very useful (89% in the Early Group at week 3 and 95.5% in the Late Group at week 6). Within group pairwise comparisons found significant difference between baseline and week 6 in content-specific knowledge scores among participants in the Late Group [79% versus 92.1%, p = 0.01). Global knowledge scores increased significantly for variables reflecting knowledge that promotes decisions to participate in clinical trials. Providing published reading material to patients with cancer is both feasible and acceptable. Offering information to patients about cancer clinical trials, using a book designed for patients with cancer may influence knowledge related to decision to participate in clinical trials.

STAR 3 randomized controlled trial to compare sensor-augmented insulin pump therapy with multiple daily injections in the treatment of type 1 diabetes: research design, methods, and baseline characteristics of enrolled subjects.

PubMed

Davis, Stephen N; Horton, Edward S; Battelino, Tadej; Rubin, Richard R; Schulman, Kevin A; Tamborlane, William V

2010-04-01

Sensor-augmented pump therapy (SAPT) integrates real-time continuous glucose monitoring (RT-CGM) with continuous subcutaneous insulin infusion (CSII) and offers an alternative to multiple daily injections (MDI). Previous studies provide evidence that SAPT may improve clinical outcomes among people with type 1 diabetes. Sensor-Augmented Pump Therapy for A1c Reduction (STAR) 3 is a multicenter randomized controlled trial comparing the efficacy of SAPT to that of MDI in subjects with type 1 diabetes. Subjects were randomized to either continue with MDI or transition to SAPT for 1 year. Subjects in the MDI cohort were allowed to transition to SAPT for 6 months after completion of the study. SAPT subjects who completed the study were also allowed to continue for 6 months. The primary end point was the difference between treatment groups in change in hemoglobin A1c (HbA1c) percentage from baseline to 1 year of treatment. Secondary end points included percentage of subjects with HbA1c < or =7% and without severe hypoglycemia, as well as area under the curve of time spent in normal glycemic ranges. Tertiary end points include percentage of subjects with HbA1c < or =7%, key safety end points, user satisfaction, and responses on standardized assessments. A total of 495 subjects were enrolled, and the baseline characteristics similar between the SAPT and MDI groups. Study completion is anticipated in June 2010. Results of this randomized controlled trial should help establish whether an integrated RT-CGM and CSII system benefits patients with type 1 diabetes more than MDI.

Impact of an intervention on the availability and consumption of fruits and vegetables in the workplace.

PubMed

Bandoni, Daniel Henrique; Sarno, Flávio; Jaime, Patricia Constante

2011-06-01

To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias. This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre. Companies of São Paulo, Brazil. Twenty-nine companies and 2510 workers. After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers' consumption of fruits and vegetables (about 11 g) in the meals offered by the companies. Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.

Jog Your Mind: methodology and challenges of conducting evaluative research in partnership with community organizations.

PubMed

Bier, Nathalie; Lorthios-Guilledroit, Agathe; Nour, Kareen; Parisien, Manon; Ellemberg, Dave; Laforest, Sophie

2015-01-01

Jog Your Mind is a community-based program aiming at empowering elderly people to maintain their cognitive abilities using a multi-strategic approach including cognitively stimulating activities, mnemonic strategies, and strategies to promote healthy behaviors. It is offered to elderly individuals without known or diagnosed cognitive impairment by volunteers or community practitioners over ten weekly sessions. This paper describes the protocol of a quasi-experimental study designed to evaluate Jog Your Mind. Community responsible to recruit participants were either assigned to the experimental group (participating in the Jog Your Mind program) or to the control group (one-year waiting list). All participants were interviewed at baseline (T1), after the program (T2), and 12 months after the baseline (T3). Primary outcomes were the use of everyday memory strategies and aids and subjective memory functioning in daily life. Secondary outcomes included attitudes, knowledge, and behaviors related to cognitive vitality and cognitive abilities (memory and executive functions). Program delivery, organizational and environmental variables were recorded to document the implementation process. Twenty-three community organizations recruited 294 community-dwelling elderly individuals in total at T1. Between T1 and T3, an attrition rate of 15.2% was obtained. Jog Your Mind is one of the only programs targeting cognition among older adults being offered in community settings by community practitioners. The protocol described was designed with a focus on maximizing broad generalizations of the results while achieving scientific rigor. It can serve as an example to guide future research aiming to evaluate health interventions under natural conditions.

Assessing the food environment of a rural community: baseline findings from the heart of New Ulm project, Minnesota, 2010-2011.

PubMed

Pereira, Raquel F; Sidebottom, Abbey C; Boucher, Jackie L; Lindberg, Rebecca; Werner, Rebecca

2014-03-06

Changes in the food environment in the United States during the past few decades have contributed to increased rates of obesity, diabetes, and heart disease. Improving the food environment may be an effective primary prevention strategy to address these rising disease rates. The purpose of this study was to assess the consumer food environment of a rural community with high rates of obesity and low levels of fruit and vegetable consumption. Findings were used to identify food environment intervention strategies to be implemented as part of a larger community-based heart disease prevention program. We used the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and Stores (NEMS-S) to assess 34 restaurants, 3 grocery stores, and 5 convenience stores in New Ulm, Minnesota. At least half of the restaurants offered nonfried vegetables and 100% fruit juice. Only 32% had at least 1 entrée or 1 main dish salad that met standards for "healthy." Fewer than half (41%) had fruit available and under one-third offered reduced-size portions (29%) or whole-grain bread (26%). Grocery stores had more healthful items available, but findings were mixed on whether these items were made available at a lower price than less healthful items. Convenience stores were less likely to have fruits and vegetables and less likely to carry more healthful products (except milk) than grocery stores. Baseline findings indicated opportunities to improve availability, quality, and price of foods to support more healthful eating. A community-wide food environment assessment can be used to strategically plan targeted interventions.

The impact of befriending and peer support on family carers of people living with dementia: A mixed methods study.

PubMed

Smith, Raymond; Drennan, Vari; Mackenzie, Ann; Greenwood, Nan

Volunteer led befriending and peer support is provided to a wide range of people with varying needs. Despite large numbers of such schemes for carers of people with dementia, there is little evidence for any benefits they may offer. The aim of this research was to investigate the impact of befriending and peer support on carers of people with dementia and to explore their experiences of receiving the interventions using a mixed methods approach. Nineteen carers of people with dementia were recruited from befriending and peer support services. Carers completed the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Scale of Perceived Social Support (MSPSS) and UCLA Loneliness Scale at baseline, three months and six months. Of the 16 carers who completed the quantitative phase, eight took part in depth semi-structured interviews. A statistically significant increase in perceived social support from a significant other between baseline and three months was found (Z = 2.487, p = 0.013). Qualitative findings showed befriending and peer support to be important sources of emotional and social support for carers, which was facilitated by the volunteers' experiential similarity. Volunteer led befriending and peer support offers carers of people with dementia emotional and social support which enables them to cope better with challenges and continue caring. This has important implications for potentially reducing breakdowns in carer mental and physical health. Future research should explore whether these finding are replicable in other locations and in more diverse populations. Copyright © 2018 Elsevier B.V. All rights reserved.

The effect of split sleep schedules (6h-on/6h-off) on neurobehavioural performance, sleep and sleepiness.

PubMed

Short, Michelle A; Centofanti, Stephanie; Hilditch, Cassie; Banks, Siobhan; Lushington, Kurt; Dorrian, Jillian

2016-05-01

Shorter, more frequent rosters, such as 6h-on/6h-off split shifts, may offer promise to sleep, subjective sleepiness and performance by limiting shift length and by offering opportunities for all workers to obtain some sleep across the biological night. However, there exists a paucity of studies that have examined these shifts using objective measures of sleep and performance. The present study examined neurobehavioural performance, sleepiness and sleep during 6h-on/6h-off split sleep schedules. Sixteen healthy adults (6 males, 26.13 y ± 4.46) participated in a 9-day laboratory study that included two baseline nights (BL, 10h time in bed (TIB), 2200 h-0800 h), 4 days on one of two types of 6h-on/6h-off split sleep schedules with 5h TIB during each 'off' period (6h early: TIB 0300 h-0800 h and 1500 h-20000 h, or 6-h late: TIB 0900 h-1400 h and 2100 h-0200 h), and two recovery nights (10h TIB per night, 2200 h-0800 h). Participants received 10h TIB per 24h in total across both shift schedules. A neurobehavioural test bout was completed every 2 h during wake, which included the Psychomotor Vigilance Task (PVT) and the Karolinska Sleepiness Scale (KSS). Linear mixed effects models were used to assess the effect of day (BL, shift days 1-4), schedule (6h early, 6h late) and trial (numbers 1-6) on PVT lapses (operationalised as the number of reaction times >500 ms), PVT total lapse time, PVT fastest 10% of reaction times and KSS. Analyses were also conducted examining the effect of day and schedule on sleep variables. Overall, PVT lapses and total lapse time did not differ significantly between baseline and shift days, however, peak response speeds were significantly slower on the first shift day when compared to baseline, but only for those in the 6h-late condition. Circadian variations were apparent in performance outcomes, with individuals in the 6h-late condition demonstrated significantly more and longer lapses and slower peak reaction times at the end of their night shift (0730 h) than at any other time during their shifts. In the 6h-early condition, only response speed significantly differed across trials, with slower response speeds occurring at trial 1 (0930 h) than in trials 3 (1330 h) or 4 (2130 h). While subjective sleepiness was higher on shift days than at baseline, sleepiness did not accumulate across days. Total sleep was reduced across split sleep schedules compared to baseline. Overall, these results show that while there was not a cumulative cost to performance across days of splitting sleep, participants obtained less sleep and reported lowered alertness on shift days. Tests near the circadian nadir showed higher sleepiness and increased performance deficits. While this schedule did not produce cumulative impairment, the performance deficits witnessed during the biological night are still of operational concern for industry and workers alike. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study

PubMed Central

Paik, Kenneth E; Hei Tam, Hok; Fahed, Zeina; Winkler, Eric; Kontunen, Kaisa; Mkanna, Abdalla; Burnham, Gilbert

2017-01-01

Background Given the protracted nature of the crisis in Syria, the large noncommunicable disease (NCD) caseload of Syrian refugees and host Lebanese, and the high costs of providing NCD care, the implications for Lebanon’s health system are vast. Objective The aim of this study was to evaluate the effectiveness of treatment guidelines and a mobile health (mHealth) app on quality of care and health outcomes in primary care settings in Lebanon. Methods A longitudinal cohort study was implemented from January 2015 to August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth app on quality of care and health outcomes for Syrian and Lebanese patients in Lebanese primary health care (PHC) facilities. Results Compared with baseline record extraction, recording of blood pressure (BP) readings (−11.4%, P<.001) and blood sugar measurements (−6.9%, P=.03) significantly decreased following the implementation of treatment guidelines. Recording of BP readings also decreased after the mHealth phase as compared with baseline (−8.4%, P=.001); however, recording of body mass index (BMI) reporting increased at the end of the mHealth phase from baseline (8.1%, P<.001) and the guidelines phase (7.7%, P<.001). There were a great proportion of patients for whom blood sugar, BP, weight, height, and BMI were recorded using the tablet compared with in paper records; however, only differences in BMI were statistically significant (31.6% higher in app data as compared with paper records; P<.001). Data extracted from the mHealth app showed that a higher proportion of providers offered lifestyle counseling compared with the counseling reported in patients’ paper records (health diet counseling; 77.3% in app data vs 8.8% in paper records, P<.001 and physical activity counseling and 59.7% in app vs 7.1% in paper records, P<.001). There were statistically significant increases in all four measures of patient-provider interaction across study phases. Provider inquiry of medical history increased by 16.6% from baseline following guideline implementation and by 28.2% from baseline to mHealth implementation (P<.001). From baseline, patient report of provider inquiry regarding medication complications increased in the guidelines and mHealth phases by 12.9% and 59.6%, respectively, (P<.001). The proportion of patients reporting that providers asked other questions relevant to their illness increased from baseline through guidelines implementation by 27.8% and to mHealth implementation by 66.3% (P<.001). Follow-up scheduling increased from baseline to the guidelines phase by 20.6% and the mHealth phase by 39.8% (P<.001). Conclusions Results from this study of an mHealth app in 10 PHC facilities in Lebanon indicate that the app has potential to improve adherence to guidelines and quality of care. Further studies are necessary to determine the effects of patient-controlled health record apps on provider adherence to treatment guidelines, as well as patients’ long-term medication and treatment adherence and disease control. PMID:29046266

Space Station Mission Planning System (MPS) development study. Volume 2

NASA Technical Reports Server (NTRS)

Klus, W. J.

1987-01-01

The process and existing software used for Spacelab payload mission planning were studied. A complete baseline definition of the Spacelab payload mission planning process was established, along with a definition of existing software capabilities for potential extrapolation to the Space Station. This information was used as a basis for defining system requirements to support Space Station mission planning. The Space Station mission planning concept was reviewed for the purpose of identifying areas where artificial intelligence concepts might offer substantially improved capability. Three specific artificial intelligence concepts were to be investigated for applicability: natural language interfaces; expert systems; and automatic programming. The advantages and disadvantages of interfacing an artificial intelligence language with existing FORTRAN programs or of converting totally to a new programming language were identified.

Follow-On Technology Requirement Study for Advanced Subsonic Transport

NASA Technical Reports Server (NTRS)

Wendus, Bruce E.; Stark, Donald F.; Holler, Richard P.; Funkhouser, Merle E.

2003-01-01

A study was conducted to define and assess the critical or enabling technologies required for a year 2005 entry into service (EIS) engine for subsonic commercial aircraft, with NASA Advanced Subsonic Transport goals used as benchmarks. The year 2005 EIS advanced technology engine is an Advanced Ducted Propulsor (ADP) engine. Performance analysis showed that the ADP design offered many advantages compared to a baseline turbofan engine. An airplane/ engine simulation study using a long range quad aircraft quantified the effects of the ADP engine on the economics of typical airline operation. Results of the economic analysis show the ADP propulsion system provides a 6% reduction in direct operating cost plus interest, with half the reduction resulting from reduced fuel consumption. Critical and enabling technologies for the year 2005 EIS ADP were identified and prioritized.

Agricultural Baseline (BL0) scenario of the 2016 Billion-Ton Report

DOE Data Explorer

Davis, Maggie R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000181319328); Hellwinkel, Chad [University of Tennessee, APAC] (ORCID:0000000173085058); Eaton, Laurence [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000312709626); Langholtz, Matthew H [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000281537154); Turhollow, Anthony [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000228159350); Brandt, Craig [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000214707379); Myers, Aaron [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)] (ORCID:0000000320373827)

2016-07-13

Scientific reason for data generation: to serve as the reference case for the BT16 volume 1 agricultural scenarios. The agricultural baseline runs from 2015 through 2040; a starting year of 2014 is used. Date the data set was last modified: 02/12/2016 How each parameter was produced (methods), format, and relationship to other data in the data set: simulation was developed without offering a farmgate price to energy crops or residues (i.e., building on both the USDA 2015 baseline and the agricultural census data (USDA NASS 2014). Data generated are .txt output files by year, simulation identifier, county code (1-3109). Instruments used: POLYSYS (version POLYS2015_V10_alt_JAN22B) supplied by the University of Tennessee APAC The quality assurance and quality control that have been applied: • Check for negative planted area, harvested area, production, yield and cost values. • Check if harvested area exceeds planted area for annuals. • Check FIPS codes.

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

Lave, Matthew Samuel; Stein, Joshua; Burnham, Laurie

This report provides performance data and analysis for two Stion copper indium gallium selenide (CIGS) module types, one framed, the other frameless, and installed at the New Mexico, Florida and Vermont RTCs. Sandia looked at data from both module types and compared the latter with data from an adjacent monocrystalline baseline array at each RTC. The results indicate that the Stion modules are slightly outperforming their rated power, with efficiency values above 100% of rated power, at 25degC cell temperatures. In addition, Sandia sees no significant performance differences between module types, which is expected because the modules differ only inmore » their framing. In contrast to the baseline systems, the Stion strings showed increasing efficiency with increasing irradiance, with the greatest increase between zero and 400 Wm -2 but still noticeable increases at 1000 Wm -2 . Although baseline data availability in Vermont was spotty and therefore comparative trends are difficult to discern, the Stion modules there may offer snow- shedding advantages over monocrystalline-silicon modules but these findings are preliminary.« less

Phytoplankton diversity in Adriatic ports: Lessons from the port baseline survey for the management of harmful algal species.

PubMed

Mozetič, Patricija; Cangini, Monica; Francé, Janja; Bastianini, Mauro; Bernardi Aubry, Fabrizio; Bužančić, Mia; Cabrini, Marina; Cerino, Federica; Čalić, Marijeta; D'Adamo, Raffaele; Drakulović, Dragana; Finotto, Stefania; Fornasaro, Daniela; Grilli, Federica; Kraus, Romina; Kužat, Nataša; Marić Pfannkuchen, Daniela; Ninčević Gladan, Živana; Pompei, Marinella; Rotter, Ana; Servadei, Irene; Skejić, Sanda

2017-12-30

An inventory of phytoplankton diversity in 12 Adriatic ports was performed with the port baseline survey. Particular emphasis was put on the detection of harmful aquatic organisms and pathogens (HAOP) because of their negative impact on ecosystem, human health, and the economy. Phytoplanktonic HAOP are identified as species, either native or non-indigenous (NIS), which can trigger harmful algal blooms (HAB). A list of 691 taxa was prepared, and among them 52 were classified as HAB and five as NIS. Records of toxigenic NIS (Pseudo-nitzschia multistriata, Ostreopsis species including O. cf. ovata) indicate that the intrusion of non-native invasive phytoplankton species has already occurred in some Adriatic ports. The seasonal occurrence and abundance of HAOP offers a solid baseline for a monitoring design in ports in order to prevent ballast water uptake and possible expansion of HAOP outside their native region. Copyright © 2017 Elsevier Ltd. All rights reserved.

Quantifying electric vehicle battery degradation from driving vs. vehicle-to-grid services

NASA Astrophysics Data System (ADS)

Wang, Dai; Coignard, Jonathan; Zeng, Teng; Zhang, Cong; Saxena, Samveg

2016-11-01

The risk of accelerated electric vehicle battery degradation is commonly cited as a concern inhibiting the implementation of vehicle-to-grid (V2G) technology. However, little quantitative evidence exists in prior literature to refute or substantiate these concerns for different grid services that vehicles may offer. In this paper, a methodology is proposed to quantify electric vehicle (EV) battery degradation from driving only vs. driving and several vehicle-grid services, based on a semi-empirical lithium-ion battery capacity fade model. A detailed EV battery pack thermal model and EV powertrain model are utilized to capture the time-varying battery temperature and working parameters including current, internal resistance and state-of-charge (SOC), while an EV is driving and offering various grid services. We use the proposed method to simulate the battery degradation impacts from multiple vehicle-grid services including peak load shaving, frequency regulation and net load shaping. The degradation impact of these grid services is compared against baseline cases for driving and uncontrolled charging only, for several different cases of vehicle itineraries, driving distances, and climate conditions. Over the lifetime of a vehicle, our results show that battery wear is indeed increased when vehicles offer V2G grid services. However, the increased wear from V2G is inconsequential compared with naturally occurring battery wear (i.e. from driving and calendar ageing) when V2G services are offered only on days of the greatest grid need (20 days/year in our study). In the case of frequency regulation and peak load shaving V2G grid services offered 2 hours each day, battery wear remains minimal even if this grid service is offered every day over the vehicle lifetime. Our results suggest that an attractive tradeoff exists where vehicles can offer grid services on the highest value days for the grid with minimal impact on vehicle battery life.

Cohort profile: LIFEWORK, a prospective cohort study on occupational and environmental risk factors and health in the Netherlands

PubMed Central

Peeters, Petra H; Korevaar, Joke C; Bueno-de-Mesquita, Bas; Verschuren, W M Monique; Verheij, Robert A; Pieterson, Inka; van Leeuwen, Flora E

2018-01-01

Purpose LIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we describe the study design, ongoing data collection, baseline characteristics of participants and the repeatability of key questionnaire items. Participants 88 466 participants were enrolled in three cohort studies in 2011–2012. Exposure information was collected by a harmonised core questionnaire, or modelled based on occupational and residential histories; domains include air pollution (eg, nitrogen dioxide (NO2), particulate matter with diameter ≤2.5 µm (PM2.5)), noise, electromagnetic fields (EMF), mobile phone use, shift work and occupational chemical exposures. Chronic and subacute health outcomes are assessed by self-report and through linkage with health registries. Findings to date Participants had a median age of 51 years at baseline (range 19–87), and the majority are female (90%), with nurses being over-represented. Median exposure levels of NO2, PM2.5, EMF from base stations and noise at the participants’ home addresses at baseline were 22.9 µg/m3, 16.6 µg/m3, 0.003 mWm2 and 53.1 dB, respectively. Twenty-two per cent of participants reported to have started using a mobile phone more than 10 years prior to baseline. Repeatability for self-reported exposures was moderate to high (weighted kappa range: 0.69–1) for a subset of participants (n=237) who completed the questionnaire twice. Future plans We are actively and passively observing participants; we plan to administer a follow-up questionnaire every 4–5 years—the first follow-up will be completed in 2018—and linkage to cause-of-death and cancer registries occurs on a (bi)annual basis. This prospective cohort offers a unique, large and rich resource for research on contemporary occupational and environmental health risks and will contribute to the large international COSMOS study on mobile phone use and health. PMID:29431129

Does experiencing homelessness affect women's motivation to change alcohol or drug use?

PubMed

Upshur, Carole C; Weinreb, Linda; Cheng, Debbie M; Kim, Theresa W; Samet, Jeffrey H; Saitz, Richard

2014-01-01

Homeless women are at high risk of drug and alcohol dependence and may receive less opportunity for treatment. Our objective was to examine the association between experiencing homelessness and motivation to change drug or alcohol use. Women (n = 154) participants in a study of substance dependence at an urban medical center (69 with some homeless days in the last 90 days; 85 continuously housed at baseline) completed six items rating motivation to change alcohol or drug use (ie, importance, readiness, and confidence) at baseline and in 3-, 6-, and 12-month follow-up interviews. Unadjusted and longitudinal analyses controlling for covariates (eg, demographics, insurance status, substance use consequences, mental health status, and participation in treatment) were conducted. There were no significant differences between women experiencing homeless days versus continuously housed women in the odds of reporting high motivation to change alcohol or drug use, either in unadjusted baseline analyses or longitudinal analyses adjusted for covariates. Covariates that were significantly associated with high importance, readiness or confidence to change behavior were higher life time consequences of substance use, and participation in 12-step programs. The findings suggest that clinicians should not make assumptions that homeless women have low motivation to change their substance use. The same opportunities for addiction treatment should be offered to homeless as to housed women. © American Academy of Addiction Psychiatry.

Adapted shared reading at school for minimally verbal students with autism.

PubMed

Mucchetti, Charlotte A

2013-05-01

Almost nothing is known about the capacity of minimally verbal students with autism to develop literacy skills. Shared reading is a regular practice in early education settings and is widely thought to encourage language and literacy development. There is some evidence that children with severe disabilities can be engaged in adapted shared reading activities. The current study examines the impact of teacher-led adapted shared reading activities on engagement and story comprehension in minimally verbal 5-6-year-old children with autism using a multiple baseline/alternating treatment design. Four students and three teachers participated. Teachers conducted adapted shared reading activities with modified books (visual supports, three-dimensional objects, simplified text) and used specific strategies for increasing student engagement. Student performance during adapted activities was compared to performance during standard shared reading sessions. All four students showed increased story comprehension and engagement during adapted shared reading. Average percentage of session engaged was 87%-100% during adapted sessions, compared with 41%-52% during baseline. Average number of correct responses to story comprehension questions was 4.2-4.8 out of 6 during adapted sessions compared with 1.2-2 during baseline. Visual supports, tactile objects, and specific teaching strategies offer ways for minimally verbal students to meaningfully participate in literacy activities. Future research should investigate adapted shared reading activities implemented classroom-wide as well as joint engagement, language, and literacy outcomes after using such activities over time.

Fundamentals of Laparoscopic Surgery: A Surgical Skills Assessment Tool in Gynecology

PubMed Central

Arden, Deborah; Dodge, Laura E.; Zheng, Bin; Ricciotti, Hope A.

2011-01-01

Objective: To describe our experience with the Fundamentals of Laparoscopic Surgery (FLS) program as a teaching and assessment tool for basic laparoscopic competency among gynecology residents. Methods: A prospective observational study was conducted at a single academic institution. Before the FLS program was introduced, baseline FLS testing was offered to residents and gynecology division directors. Test scores were analyzed by training level and self-reported surgical experience. After implementing a minimally invasive gynecologic surgical curriculum, third-year residents were retested. Results: The pass rates for baseline FLS skills testing were 0% for first-year residents, 50% for second-year residents, and 75% for third- and fourth-year residents. The pass rates for baseline cognitive testing were 60% for first- and second-year residents, 67% for third-year residents, and 40% for fourth-year residents. When comparing junior and senior residents, there was a significant difference in pass rates for the skills test (P=.007) but not the cognitive test (P=.068). Self-reported surgical experience strongly correlated with skills scores (r-value=0.97, P=.0048), but not cognitive scores (r-value=0.20, P=.6265). After implementing a curriculum, 100% of the third-year residents passed the skills test, and 92% passed the cognitive examination. Conclusions: The FLS skills test may be a valuable assessment tool for gynecology residents. The cognitive test may need further adaptation for applicability to gynecologists. PMID:21902937

Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention.

PubMed

Phillips, R; Schneider, J; Molosankwe, I; Leese, M; Foroushani, P Sarrami; Grime, P; McCrone, P; Morriss, R; Thornicroft, G

2014-03-01

Depression and anxiety are major causes of absence from work and underperformance in the workplace. Cognitive behavioural therapy (CBT) can be effective in treating such problems and online versions offer many practical advantages. The aim of the study was to investigate the effectiveness of a computerized CBT intervention (MoodGYM) in a workplace context. The study was a phase III two-arm, parallel randomized controlled trial whose main outcome was total score on the Work and Social Adjustment Scale (WSAS). Depression, anxiety, psychological functioning, costs and acceptability of the online process were also measured. Most data were collected online for 637 participants at baseline, 359 at 6 weeks marking the end of the intervention and 251 participants at 12 weeks post-baseline. In both experimental and control groups depression scores improved over 6 weeks but attrition was high. There was no evidence for a difference in the average treatment effect of MoodGYM on the WSAS, nor for a difference in any of the secondary outcomes. This study found no evidence that MoodGYM was superior to informational websites in terms of psychological outcomes or service use, although improvement to subthreshold levels of depression was seen in nearly half the patients in both groups.

Energy reconstruction in the long-baseline neutrino experiment.

PubMed

Mosel, U; Lalakulich, O; Gallmeister, K

2014-04-18

The Long-Baseline Neutrino Experiment aims at measuring fundamental physical parameters to high precision and exploring physics beyond the standard model. Nuclear targets introduce complications towards that aim. We investigate the uncertainties in the energy reconstruction, based on quasielastic scattering relations, due to nuclear effects. The reconstructed event distributions as a function of energy tend to be smeared out and shifted by several 100 MeV in their oscillatory structure if standard event selection is used. We show that a more restrictive experimental event selection offers the possibility to reach the accuracy needed for a determination of the mass ordering and the CP-violating phase. Quasielastic-based energy reconstruction could thus be a viable alternative to the calorimetric reconstruction also at higher energies.

2540 km: Bimagic Baseline for Neutrino Oscillation Parameters

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

Dighe, Amol; Goswami, Srubabati; Ray, Shamayita

2010-12-31

We show that a source-to-detector distance of 2540 km, motivated recently [S. K. Raut, R. S. Singh, and S. U. Sankar, arXiv:0908.3741] for a narrow band superbeam, offers multiple advantages for a low energy neutrino factory with a detector that can identify muon charge. At this baseline, for any neutrino hierarchy, the wrong-sign muon signal is almost independent of CP violation and {theta}{sub 13} in certain energy ranges. This allows the identification of the hierarchy in a clean way. In addition, part of the muon spectrum is also sensitive to the CP violating phase and {theta}{sub 13}, so that themore » same setup can be used to probe these parameters as well.« less

Peas, please! Food familiarization through picture books helps parents introduce vegetables into preschoolers' diets.

PubMed

Owen, Laura H; Kennedy, Orla B; Hill, Claire; Houston-Price, Carmel

2018-05-26

Repeated taste exposure is an established means of increasing children's liking and intake of fruit and vegetables. However, parents find it difficult to offer children disliked foods repeatedly, often giving up after a few attempts. Studies show that familiarizing children to fruit and vegetables through picture books can increase their interest in tasting targeted foods. This study explored whether looking at picture books before providing foods to taste improved the outcomes of a home-delivered taste exposure regime. Parents of 127 toddlers (aged 21-24 months) identified two 'target' foods they wanted their child to eat (1 fruit, 1 vegetable). Families were randomly assigned to one of three groups. Parents and children in two experimental groups looked at books about either the target fruit or vegetable every day for two weeks; the control group did not receive a book. Parents in all three groups were then asked to offer their child both target foods every day during a 2-week taste-exposure phase. Parental ratings of children's liking and consumption of the foods were collected at baseline, immediately following taste-exposure (post-intervention), and 3 months later (follow-up). In all groups, liking of both foods increased following taste exposure and remained above baseline at follow-up (all ps < .001). In addition, compared to the control group who experienced only taste exposure, looking at vegetable books enhanced children's liking of their target vegetable post-intervention (p < .001) and at follow-up (p < .05), and increased consumption of the vegetable at follow-up (p < .01). Exposure to vegetable books was also associated with smaller increases in neophobia and food fussiness over the period of the study compared to controls (ps < .01), suggesting that picture books may have positive, long-term impacts on children's attitudes towards new foods. Copyright © 2018 Elsevier Ltd. All rights reserved.

Shared medical appointments: promoting weight loss in a clinical setting.

PubMed

Palaniappan, Latha P; Muzaffar, Amy L; Wang, Elsie J; Wong, Eric C; Orchard, Trevor J

2011-01-01

Shared medical appointments (SMAs) are 90-minute group appointments for patients with similar medical complaints. SMAs include components of a traditional office visit but provide further emphasis on health education. The effectiveness of SMAs on weight-loss in an outpatient setting has not been studied. Weight-loss SMAs were offered by one physician at the Palo Alto Medical Foundation. Teaching content included Diabetes Prevention Program materials. This analysis includes patients who attended at least one SMA (n = 74) compared with patients in the same physician's practice who had at least one office visit and a body mass index ≥ 25 kg/m(2) (n = 356). The SMA group had a higher proportion of women than the comparison group (76% vs 64%) and were older (mean, 52.4 years; SD, 13.1 years vs mean, 47.0 years; SD, 13.3 years). SMA patients on average lost 1.0% of their baseline weight. Patients in the comparison group on average gained 0.8% of their baseline weight. SMAs may be a viable option for physicians to promote weight loss in the clinical setting.

Cognitive Training through mHealth for Individuals with Substance Use Disorder.

PubMed

Gamito, Pedro; Oliveira, Jorge; Lopes, Paulo; Brito, Rodrigo; Morais, Diogo; Caçoete, Cristina; Leandro, André; Almeida, Teresa; Oliveira, Hugo

2017-03-23

Heroin addiction has a negative impact on cognitive functions, and even recovering addicts suffer from cognitive impairment. Recent approaches to cognitive intervention have been taking advantage of what new technologies have to offer. We report a study testing the efficacy of a serious games approach using tablets to stimulate and rehabilitate cognitive functions in recovering addicts. A small-scale cognitive training program with serious games was run with a sample of 14 male heroin addicts undergoing a rehabilitation program. We found consistent improvements in cognitive functioning between baseline and follow-up assessments for frontal lobe functions, verbal memory and sustained attention, as well as in some aspects of cognitive flexibility, decision-making and in depression levels. More than two thirds of patients in cognitive training had positive outcomes related to indicators of verbal memory cognitive flexibility, which contrasts to patients not in training, in which only one patient improved between baseline and follow-up. The results are promising but still require randomized control trials to determine the efficiency of this approach to cognitive rehabilitation programs for the cognitive recovery of heroin addicts.

Sleep and wakefulness in aircrew before and after transoceanic flights

NASA Technical Reports Server (NTRS)

Dement, William C.; Seidel, Wesley F.; Cohen, Suzanne A.; Carskadon, Mary A.; Bliwise, Nancy G.

1986-01-01

The effects of rapid transmeridian flight on sleep and wakefulness were studied in aircrew members before and after flying one of two routes: San Francisco (SFO) to London (LHR) or SFO to Tokyo. After an adaptation night, sleep and daytime sleepiness were measured objectively in SFO and during the first layover (L/O) of the target trip, using the 'core measures' described by Graeber et al. (1986) and respiration parameters, and the Multiple Sleep Latency Test (MSLT) described by Carscadon (1982); postsleep questionnaires provided subjective assessments. It was found that baseline sleep is not an ideal basis for subsequent comparison; nevertheless, there was an indication that L/O sleep periods tended to provide either less total sleep or less efficient sleep. During baseline, there was significant midday sleepiness tendency as measured by the MSLT; this tendency occurred at almost the same time on the second L/O day in LHR. Recommendations are offered for the adjustment of flight times and for scheduling times of permitted napping as accommodations for the periods of sleepiness tendency.

Action Centered Contextual Bandits.

PubMed

Greenewald, Kristjan; Tewari, Ambuj; Klasnja, Predrag; Murphy, Susan

2017-12-01

Contextual bandits have become popular as they offer a middle ground between very simple approaches based on multi-armed bandits and very complex approaches using the full power of reinforcement learning. They have demonstrated success in web applications and have a rich body of associated theoretical guarantees. Linear models are well understood theoretically and preferred by practitioners because they are not only easily interpretable but also simple to implement and debug. Furthermore, if the linear model is true, we get very strong performance guarantees. Unfortunately, in emerging applications in mobile health, the time-invariant linear model assumption is untenable. We provide an extension of the linear model for contextual bandits that has two parts: baseline reward and treatment effect. We allow the former to be complex but keep the latter simple. We argue that this model is plausible for mobile health applications. At the same time, it leads to algorithms with strong performance guarantees as in the linear model setting, while still allowing for complex nonlinear baseline modeling. Our theory is supported by experiments on data gathered in a recently concluded mobile health study.

Application of advanced material systems to composite frame elements

NASA Technical Reports Server (NTRS)

Llorente, Steven; Minguet, Pierre; Fay, Russell; Medwin, Steven

1992-01-01

A three phase program has been conducted to investigate DuPont's Long Discontinuous Fiber (LDF) composites. Additional tests were conducted to compare LDF composites against toughened thermosets and a baseline thermoset system. Results have shown that the LDF AS4/PEKK offers improved interlaminar (flange bending) strength with little reduction in mechanical properties due to the discontinuous nature of the fibers. In the third phase, a series of AS4/PEKK LDF C-section curved frames (representing a typical rotorcraft light frame) were designed, manufactured and tested. Specimen reconsolidation after 'stretch forming' and frame thickness were found to be key factors in this light frame's performance. A finite element model was constructed to correlate frame test results with expected strain levels determined from material property tests. Adequately reconsolidated frames performed well and failed at strain levels at or above baseline thermoset material test strains. Finally a cost study was conducted which has shown that the use of LDF for this frame would result in a significant cost savings, for moderate to large lot sizes compared with the hand lay-up of a thermoset frame.

Threshold regression to accommodate a censored covariate.

PubMed

Qian, Jing; Chiou, Sy Han; Maye, Jacqueline E; Atem, Folefac; Johnson, Keith A; Betensky, Rebecca A

2018-06-22

In several common study designs, regression modeling is complicated by the presence of censored covariates. Examples of such covariates include maternal age of onset of dementia that may be right censored in an Alzheimer's amyloid imaging study of healthy subjects, metabolite measurements that are subject to limit of detection censoring in a case-control study of cardiovascular disease, and progressive biomarkers whose baseline values are of interest, but are measured post-baseline in longitudinal neuropsychological studies of Alzheimer's disease. We propose threshold regression approaches for linear regression models with a covariate that is subject to random censoring. Threshold regression methods allow for immediate testing of the significance of the effect of a censored covariate. In addition, they provide for unbiased estimation of the regression coefficient of the censored covariate. We derive the asymptotic properties of the resulting estimators under mild regularity conditions. Simulations demonstrate that the proposed estimators have good finite-sample performance, and often offer improved efficiency over existing methods. We also derive a principled method for selection of the threshold. We illustrate the approach in application to an Alzheimer's disease study that investigated brain amyloid levels in older individuals, as measured through positron emission tomography scans, as a function of maternal age of dementia onset, with adjustment for other covariates. We have developed an R package, censCov, for implementation of our method, available at CRAN. © 2018, The International Biometric Society.

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life

PubMed Central

Prigerson, Holly G.; Bao, Yuhua; Shah, Manish A.; Paulk, M. Elizabeth; LeBlanc, Thomas W.; Schneider, Bryan J.; Garrido, Melissa M.; Reid, M. Carrington; Berlin, David A.; Adelson, Kerin B.; Neugut, Alfred I.; Maciejewski, Paul K.

2016-01-01

IMPORTANCE Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status. OBJECTIVE To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients’ performance status. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States. MAIN OUTCOMES AND MEASURES Patient QOD was determined using validated caregiver ratings of patients’ physical and mental distress in their final week. RESULTS Chemotherapy use was not associated with patient survival controlling for clinical setting and patients’ performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59). CONCLUSIONS AND RELEVANCE Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status. PMID:26203912

Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers.

PubMed

Danan, Elisheva R; Joseph, Anne M; Sherman, Scott E; Burgess, Diana J; Noorbaloochi, Siamak; Clothier, Barbara; Japuntich, Sandra J; Taylor, Brent C; Fu, Steven S

2016-08-01

Current guidelines advise providers to assess smokers' readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit. We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers' level of motivation to quit. Secondary analysis of a multicenter randomized controlled trial. A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers. Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines. Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year. At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care. Mostly male participants limits generalizability. Randomization was not stratified by SOC. Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.

Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients.

PubMed

Aboumatar, H; Naqibuddin, M; Chung, S; Adebowale, H; Bone, L; Brown, T; Cooper, L A; Gurses, A P; Knowlton, A; Kurtz, D; Piet, L; Putcha, N; Rand, C; Roter, D; Shattuck, E; Sylvester, C; Urteaga-Fuentes, A; Wise, R; Wolff, J L; Yang, T; Hibbard, J; Howell, E; Myers, M; Shea, K; Sullivan, J; Syron, L; Wang, Nae-Yuh; Pronovost, P

2017-11-01

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations. Copyright © 2017 Elsevier Inc. All rights reserved.

Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention.

PubMed

Wee, Liang En; Koh, Gerald Choon-Huat; Chin, Run Ting; Yeo, Wei Xin; Seow, Branden; Chua, Darren

2012-07-01

Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention. The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention. Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032). Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies. Copyright © 2012 Elsevier Inc. All rights reserved.

Motivation to change as a mediator for the longitudinal relationships of gender and alcohol severity with one-year drinking outcome.

PubMed

Small, Jeon; Ounpraseuth, Songthip; Curran, Geoffrey M; Booth, Brenda M

2012-05-01

We examined whether motivation to change mediated the relationships between gender and baseline alcohol severity with drinking outcome at 12-month follow-up in a longitudinal community sample. Data were from baseline and 12-month interviews from the Rural Alcohol Study, a probability sample of rural and urban at-risk drinkers (N = 733) from six southern states. At-risk drinkers were identified through a telephone-screening interview. Measures of motivation (problem recognition and taking action) were the resultant two factors derived from the Stages of Change Readiness and Treatment Eagerness Scale. Items on social consequences of drinking measured alcohol severity. Structural equation models examined relationships between baseline alcohol severity and motivation with drinks per drinking day at 12 months. We identified significant, direct paths between drinking at 12 months and alcohol severity and taking action with an unstandardized estimate of 0.116 (p < .05), alcohol severity and problem recognition (0.423, p < .01), and each of the two "motivation" latent constructs-problem recognition (1.846, p < .01) and taking action (-0.660, p < .01). Finally, the combined direct and negative effect of gender on alcohol consumption at 12-month follow-up was statistically significant, with an unstandardized estimate of -0.970 (p < .01). The current study offers evidence for motivation to change as a viable mechanism through which alcohol severity is associated with subsequent drinking outcomes. More research is needed to further explore the persistence of motivation to change on drinking outcomes over time.

Loss of ability to work and ability to live independently in Parkinson's disease.

PubMed

Jasinska-Myga, Barbara; Heckman, Michael G; Wider, Christian; Putzke, John D; Wszolek, Zbigniew K; Uitti, Ryan J

2012-02-01

Ability to work and live independently is of particular concern for patients with Parkinson's disease (PD). We studied a series of PD patients able to work or live independently at baseline, and evaluated potential risk factors for two separate outcomes: loss of ability to work and loss of ability to live independently. The series comprised 495 PD patients followed prospectively. Ability to work and ability to live independently were based on clinical interview and examination. Cox regression models adjusted for age and disease duration were used to evaluate associations of baseline characteristics with loss of ability to work and loss of ability to live independently. Higher UPDRS dyskinesia score, UPDRS instability score, UPDRS total score, Hoehn and Yahr stage, and presence of intellectual impairment at baseline were all associated with increased risk of future loss of ability to work and loss of ability to live independently (P ≤ 0.0033). Five years after initial visit, for patients ≤70 years of age with a disease duration ≤4 years at initial visit, 88% were still able to work and 90% to live independently. These estimates worsened as age and disease duration at initial visit increased; for patients >70 years of age with a disease duration >4 years, estimates at 5 years were 43% able to work and 57% able to live independently. The information provided in this study can offer useful information for PD patients in preparing for future ability to perform activities of daily living. Copyright © 2011 Elsevier Ltd. All rights reserved.

Suggestibility as a predictor of response to antidepressants: A preliminary prospective trial.

PubMed

Nitzan, Uri; Chalamish, Yossi; Krieger, Israel; Erez, Hany Burstein; Braw, Yoram; Lichtenberg, Pesach

2015-10-01

The growing awareness that so many do not respond adequately to antidepressant (AD) pharmacotherapy has sparked research seeking to characterize those who do. While the pharmacological mechanisms of AD treatment have been extensively evaluated, much remains unknown about the placebo component of the response to medication. This study examined the association between suggestibility levels and response to ADs amongst depressed patients. Twenty unipolar depression outpatients, recruited before starting AD monotherapy, received clear, standardized instructions that the therapeutic effects of AD, though not side effects, would require 2-4 weeks. At baseline (T1), 1 week (T2), and 1 month (T3), participants were evaluated for depressive symptoms, using the Hamilton Rating Scale for Depression-17 items (HAM-D); for anxiety by the Hamilton Rating Scale for Anxiety (HAM-A); for side effects by the Antidepressant Side Effect Checklist (ASEC); and for suggestibility, using the Multidimensional Iowa Suggestibility Scale (MISS). High levels of baseline suggestibility were associated with less improvement in depression level and more side-effects during the first week. In accordance with our hypothesis the more suggestible patients improved more between T2 and T3. No significant correlations were found between baseline suggestibility levels and change in anxiety. Small sample size and a self-report questionnaire assessing suggestibility were limitations. This study offers a potentially new and clinically useful approach to understanding and predicting who will respond to AD treatment. Suggestibility seems to play a role, presumably by shaping expectation, in response to AD treatment. We hope that this avenue will be further explored. Copyright © 2015 Elsevier B.V. All rights reserved.

Project Baseline: An unprecedented resource to study plant evolution across space and time.

PubMed

Etterson, Julie R; Franks, Steven J; Mazer, Susan J; Shaw, Ruth G; Gorden, Nicole L Soper; Schneider, Heather E; Weber, Jennifer J; Winkler, Katharine J; Weis, Arthur E

2016-01-01

Project Baseline is a seed bank that offers an unprecedented opportunity to examine spatial and temporal dimensions of microevolution during an era of rapid environmental change. Over the upcoming 50 years, biologists will withdraw genetically representative samples of past populations from this time capsule of seeds and grow them contemporaneously with modern samples to detect any phenotypic and molecular evolution that has occurred during the intervening time. We carefully developed this living genome bank using protocols to enhance its experimental value by collecting from multiple populations and species across a broad geographical range in sites that are likely to be preserved into the future. Seeds are accessioned with site and population data and are stored by maternal line under conditions that maximize seed longevity. This open-access resource will be available to researchers at regular intervals to evaluate contemporary evolution. To date, the Project Baseline collection includes 100-200 maternal lines of each of 61 species collected from over 831 populations on sites that are likely to be preserved into the future across the United States (∼78,000 maternal lines). Our strategically designed collection circumvents some problems that can cloud the results of "resurrection" studies involving naturally preserved or existing seed collections that are available fortuitously. The resurrection approach can be coupled with long-established and newer techniques over the next five decades to elucidate genetic change and thereby vastly improve our understanding of temporal and spatial changes in phenotype and the evolutionary processes underlying it. © 2016 Botanical Society of America.

Microdose transdermal estrogen therapy for relief of vulvovaginal symptoms in postmenopausal women.

PubMed

Bachmann, Gloria A; Schaefers, Matthias; Uddin, Alkaz; Utian, Wulf H

2009-01-01

The aim of this study was to investigate the effectiveness of microdose transdermal 17beta-estradiol (E2) therapy in postmenopausal women with moderate to severe vulvovaginal symptoms. This report is based on a subset of 121 women who reported most bothersome moderate or severe vulvovaginal symptoms at baseline, from a previous randomized, double-blind, placebo-controlled, multicenter study of 425 healthy, symptomatic, postmenopausal women. Recruits had experienced at least 7 moderate or severe hot flushes daily for at least 1 week or at least 50 moderate or severe hot flushes per week for at least 1 week. Effects on coprimary efficacy variables have been reported previously. Participants received low-dose transdermal E2 plus levonorgestrel (n = 43; nominal delivery 0.023 mg/d E2/0.0075 mg/d levonorgestrel), microdose E2 (n = 42; nominal delivery 0.014 mg/d), or placebo (n = 36) for 12 weeks. Secondary efficacy variables reported herein include mean change from baseline in vaginal pH and vaginal maturation index, the proportion of women with symptoms of vulvar and vaginal atrophy at baseline and week 12, and the proportion of women with moderate-to-severe symptoms of vulvar and vaginal atrophy. Microdose transdermal E2 treatment was associated with a consistent benefit versus placebo in women with vulvovaginal atrophy. There was a statistically significant difference between both E2 versus placebo for changes in vaginal pH and vaginal maturation index. Microdose transdermal E2 offers a useful addition to the therapeutic armamentarium for postmenopausal women in whom vulvovaginal symptoms are particularly troublesome.

Dietary Carbohydrate and Nocturnal Sleep Duration in Relation to Children's BMI: Findings from the IDEFICS Study in Eight European Countries.

PubMed

Hunsberger, Monica; Mehlig, Kirsten; Börnhorst, Claudia; Hebestreit, Antje; Moreno, Luis; Veidebaum, Toomas; Kourides, Yiannis; Siani, Alfonso; Molnar, Dénes; Sioen, Isabelle; Lissner, Lauren

2015-12-08

Previous research has found an association between being overweight and short sleep duration. We hypothesized that this association could be modified by a high carbohydrate (HC) diet and that the timing and type (starch or sugar) of intake may be an important factor in this context. Participants in the prospective, eight-country European study IDEFICS were recruited from September 2007 to June 2008, when they were aged two to nine years. Data on lifestyle, dietary intake and anthropometry were collected on two occasions. This study included 5944 children at baseline and 4301 at two-year follow-up. For each meal occasion (morning, midday, and evening), starch in grams and sugar in grams were divided by total energy intake (EI), and quartiles calculated. HC-starch and HC-sugar intake categories were defined as the highest quartile for each meal occasion. In a mutually adjusted linear regression model, short sleep duration as well as HC-starch in the morning were positively associated with body mass index (BMI) z-scores at baseline. HC-starch at midday was positively associated with body mass index (BMI) z-scores in children with short sleep duration, and negatively associated with BMI z-scores in those with normal sleep. After adjustment for baseline BMI z-scores, associations between total HC from starch or sugar and high BMI z-scores at two-year follow-up did not persist. Our observations offer a perspective on optimal timing for macronutrient consumption, which is known to be influenced by circadian rhythms. Reduced carbohydrate intake, especially during morning and midday meals, and following nocturnal sleep duration recommendations are two modifiable factors that may protect children from being overweight in the future.

Feasibility, Acceptability and Findings from a Pilot Randomized Controlled Intervention Study on the Impact of a Book Designed to Inform Patients about Cancer Clinical Trials

PubMed Central

Carney, Patricia A.; Tucker, Erin K.; Newby, Timothy A.; Beer, Tomasz M.

2014-01-01

Objective To assess the feasibility, acceptability and changes in knowledge among cancer patients assigned to receive a 160 page book on experimental cancer therapies and clinical trials. Methods We enrolled 20 patients with cancer who had never participated in a clinical trial, and randomly assigned them to receive the book either during Week 1or Week 4 of the study. We collected baseline patient demographic and cancer related information as well as knowledge about cancer clinical trials at Week 0. Follow-up surveys were administered at Weeks 3 and 6 for both study groups. Comparisons were made within and between groups randomized to receive the book Early (at Week 1) to those who received it Later (at Week 4). Results One hundred percent of data were captured in both groups at baseline, which decreased to 77.8% by Week 6. The vast majority of participants found the book moderately or very useful (89% in the Early Group at Week 3 and 95.5% in the Late Group at Week 6). Within group pair-wise comparisons found significant difference between baseline and Week 6 in content-specific knowledge scores among participants in the Late Group (79% vs. 92.1%, p=0.01). Global knowledge scores increased significantly for variables reflecting knowledge that promotes decisions to participate in clinical trials. Conclusions Providing published reading material to patients with cancer is both feasible and acceptable. Offering information to patients about cancer clinical trials, using a book designed for patients with cancer may influence knowledge related to decision to participate in clinical trials. PMID:24127249

Addendum to "Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial".

PubMed

Prinz, Ronald J; Sanders, Matthew R; Shapiro, Cheri J; Whitaker, Daniel J; Lutzker, John R

2016-04-01

A previous article published several years ago (Prinz et al. Prevention Science, 10, 1-12, 2009) described the main results of a place-randomized-design study focused on the prevention of child-maltreatment-related outcomes at a population level through the implementation of a multilevel system of parenting and family support (the Triple P-Positive Parenting Program). The current report, prepared at the encouragement of the journal, provides additional details about procedures, measures, and design-related decisions, presents an additional analysis of the main outcome variables, and poses questions about the study and its implications. We also offer guidance about how the field can move forward to build on this line of research. From the outset, the three designated primary child maltreatment outcomes were county-wide rates for substantiated child maltreatment cases, out-of-home placements, and hospital-treated child maltreatment injuries, derived from independent data sources available through administrative archival records. Baseline equivalence between the two intervention conditions was reaffirmed. The additional analysis, which made use of a 5-year baseline (replacing a 1-year baseline) and ANCOVA, yielded large effect sizes for all three outcomes that converged with those from the original analyses. Overall, the study underscored the potential for community-wide parenting and family support to produce population-level preventive impact on child maltreatment. Issues addressed included (1) the need for replication of population-oriented maltreatment prevention strategies like the one tested in this randomized experiment, (2) the need to demonstrate that a parenting-based population approach to maltreatment prevention can also impact children's adjustment apart from child abuse, and (3) the role of implementation science for achieving greater population reach and maintenance over time.

Patient, Treatment, and Health Care Utilization Variables Associated with Adherence to Metabolic Monitoring Practices in Children and Adolescents Taking Second-Generation Antipsychotics.

PubMed

Coughlin, Mary; Goldie, Catherine Lindsay; Tranmer, Joan; Khalid-Khan, Sarosh; Tregunno, Deborah

2018-04-01

Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines. A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest. Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring. Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.

Attitude towards gender roles and violence against women and girls (VAWG): baseline findings from an RCT of 1752 youths in Pakistan

PubMed Central

Saeed Ali, Tazeen; Karmaliani, Rozina; Mcfarlane, Judith; Khuwaja, Hussain M. A.; Somani, Yasmeen; Chirwa, Esnat D.; Jewkes, Rachel

2017-01-01

ABSTRACT Background: Violence against women is driven by gender norms that normalize and justify gender inequality and violence. Gender norms are substantially shaped during adolescence. Programs offered through schools offer an opportunity to influence gender attitudes toward gender equity if we understand these to be partly shaped by peers and the school environment. Objective: We present an analysis of the baseline research conducted for a randomized controlled trial with 1752 grade 6 boys and girls and their attitudes toward gender roles, VAWG, and associated factors. Methods: We used baseline data from a  cluster randomised control study. Interviews were conducted in 40 public schools in Hyderabad, with 25–65 children per school. Questions were asked about attitudes toward gender roles, peer-to-peer perpetration, and victimization experiences, and family life, including father- or in-law-to- mother violence and food security. Multiple regression models were built of factors associated with gender attitudes for boys and girls. Results: Our result have shown youth attitudes endorsing patriarchal gender beliefs were higher for boys, compared to girls. The multiple regression model showed that for boys, patriarchal gender attitudes were positively associated with hunger, depression, being promised already in marriage, and being a victim and/or perpetrator of peer violence. For girls gender attitudes were associated with hunger, experiencing corporal punishment at home, and being a perpetrator (for some, and victim) of peer violence. Conclusion: Youth patriarchal attitudes are closely related to their experience of violence at school and for girl’s physical punishment, at home and for boys being promised in early marriage. We suggest that these variables are indicators of gender norms among peers and in the family. The significance of peer norms is that it provides the possibility that school-based interventions which work with school peers have the potential to positively impact youth patriarchal gender attitudes and foster attitudes of gender equality and respect, and potentially to decrease youth victimization and perpetration. PMID:28758882

Atrial fibrillation among African Americans, Hispanics and Caucasians: clinical features and outcomes from the AFFIRM trial.

PubMed

Bush, David; Martin, Lisa W; Leman, Robert; Chandler, Mary; Haywood, L Julian

2006-03-01

The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study concluded that rate control with anticoagulation was equivalent overall to rhythm control with cardioversion for long-term survival and that anticoagulation reduced the risk of stroke. We compared baseline and follow-up data for three ethnic groups: Caucasians (n=3,599), African Americans (n=265) and Hispanics (n=132). Caucasians were older and more likely male, African Americans were more likely female and hypertensive, and Hispanics had higher prevalence of cardiomyopathy. Survival was better for rate control than rhythm control in Caucasians, equivalent in African Americans and better for rhythm control in Hispanics. Outcomes may be influenced by differential baseline characteristics, but low numbers of African Americans and Hispanics warrant caution in data interpretation. The AFFIRM study compared a rate-control strategy to a rhythm-control strategy for the treatment of atrial fibrillation (AF) in patients at high risk for stroke or death. It concluded that the rhythm-control strategy offered no survival advantage, and it also confirmed the value of anticoagulation to prevent complications of AF. Data have not previously been available for specific racial ethnic populations. We compared baseline and follow-up data for the patients randomized to rate-control versus rhythm-control in three population groups-Caucasian, African-American and Hispanic. Among 4,060 total patients, 3,599 were Caucasian, 265 were African-American and 132 were Hispanic. At baseline, Caucasians were older and had a higher percentage of males, normal ejection fractions, AF as their only cardiac diagnosis, a prior antiarrhythmic drug failure and less congestive heart failure. African Americans were more likely to be female, had more hypertension and qualified for the study with a first episode of AF, compared to Caucasians. Hispanics had more cardiomyopathy at baseline than Caucasians. Overall survival in Caucasians at five years for the rate-control and rhythm-control groups was 78.9% vs. 76.4%, respectively (p=0.04); for African Americans, 79.0% vs. 69.4% (p=0.22); and for Hispanics, 66.5% vs. 83.9% (p=0.01). Overall, survival was not different between the three populations. However, lower rates of event-free survival were recorded for Hispanics and for African Americans (p=0.0182). Different survival rates were found for rate-control versus rhythm-control in African-American and Hispanic patients, compared to Caucasian. These findings may be influenced by differences in baseline characteristics, but must be interpreted with caution because of the small sample sizes for African-American and Hispanic participants.

Clinical Benefits Over Time Associated with Use of V-Go Wearable Insulin Delivery Device in Adult Patients with Diabetes: A Retrospective Analysis.

PubMed

Sutton, David; Higdon, Charissa D; Nikkel, Carla; Hilsinger, Karrie A

2018-05-10

Advances in insulin delivery have improved outcomes in patients with diabetes. This study evaluated the impact of V-Go ® Wearable Insulin Delivery device on glycated hemoglobin (A1C) and insulin total daily dose (TDD) in patients with diabetes not achieving glycemic targets. Electronic medical record data was obtained for adult patients with A1C > 7% treated at a multicenter endocrine practice who initiated V-Go between August 2012 and August 2015. Data were collected at baseline and for up to four follow-up visits, and were analyzed overall, stratified by insulin use at baseline, and for patients prescribed a basal-bolus insulin regimen delivered by multiple daily injections (MDI) at baseline. Economic evaluations were conducted in patients previously prescribed MDI regimens. Patients (N = 103) were evaluated after a mean of 2, 6, 10, and 14 months of V-Go use. Baseline glycemic control was poor (A1C > 9%) in 59% of patients. Significant, sustained reductions in A1C compared with baseline were observed at every visit (p < 0.0001), with mean ± SE decrease of 1.67 ± 0.24% after 14 months. For patients prescribed insulin at baseline (n = 80), TDD was significantly reduced at all visits (p < 0.0001), with mean ± SE reduction of 17 ± 4.5 units/day at 14 months. Patients previously prescribed MDI therapy (n = 58) benefited from 1.53 ± 0.31% (p < 0.001) A1C reduction and TDD decrease of 30 ± 5 units/day after 14 months. Direct pharmacy wholesale acquisition costs for diabetes therapeutics were reduced by $25.00/patient/month. Use of V-Go was associated with improved glycemic control and decreased TDD. For patients previously prescribed basal-bolus MDI therapy, switching to insulin therapy with V-Go resulted in pharmacy cost savings based on wholesale acquisition costs. V-Go offers an efficacious method of insulin delivery that improves outcomes in patients and can reduce costs. Valeritas, Inc.

A Controlled Evaluation of Family Behavior Therapy in Concurrent Child Neglect and Drug Abuse

PubMed Central

Donohue, Brad; Azrin, Nathan H.; Bradshaw, Kelsey; Van Hasselt, Vincent B.; Cross, Chad L.; Urgelles, Jessica; Romero, Valerie; Hill, Heather H.; Allen, Daniel N.

2015-01-01

Objective Approximately 50% of Child Protective Service (CPS) referrals abuse drugs; yet, existing treatment studies in this population have been limited to case examinations. Therefore, a family-based behavioral therapy was evaluated in mothers referred from CPS for child neglect and drug abuse utilizing a controlled experimental design. Method 72 mothers evidencing drug abuse or dependence and child neglect were randomly assigned to Family Behavior Therapy (FBT) or Treatment as Usual (TAU). Participants were assessed at baseline, 6- month-, and 10-month post-randomization. Results As hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month post-randomization assessments when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6- and 10-month post-randomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug exposed children and FBT mothers of drug exposed children at 6- and 10-month post-randomization. Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6- and 10-month post-randomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6-month post-randomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6-month post-randomization relative to TAU mothers. Conclusion Family-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children. However, continued intervention development in this population is very much needed. PMID:24841866

A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse.

PubMed

Donohue, Brad; Azrin, Nathan H; Bradshaw, Kelsey; Van Hasselt, Vincent B; Cross, Chad L; Urgelles, Jessica; Romero, Valerie; Hill, Heather H; Allen, Daniel N

2014-08-01

Approximately 50% of child protective service (CPS) referrals abuse drugs; yet, existing treatment studies in this population have been limited to case examinations. Therefore, a family-based behavioral therapy was evaluated in mothers referred from CPS for child neglect and drug abuse utilizing a controlled experimental design. Seventy-two mothers evidencing drug abuse or dependence and child neglect were randomly assigned to family behavior therapy (FBT) or treatment as usual (TAU). Participants were assessed at baseline, 6 months, and 10 months postrandomization. As hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month postrandomization assessments when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6 and 10 months postrandomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug-exposed children and FBT mothers of drug-exposed children at 6 and 10 months postrandomization. Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6 and 10 months postrandomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6 months postrandomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6 months postrandomization relative to TAU mothers. Family-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children. However, continued intervention development in this population is very much needed. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Cluster-randomized controlled trial of the effects of free glasses on purchase of children's glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) study.

PubMed

Wang, Xiuqin; Congdon, Nathan; Ma, Yue; Hu, Min; Zhou, Yuan; Liao, Weiqi; Jin, Ling; Xiao, Baixiang; Wu, Xiaoyi; Ni, Ming; Yi, Hongmei; Huang, Yiwen; Varga, Beatrice; Zhang, Hong; Cun, Yongkang; Li, Xianshun; Yang, Luhua; Liang, Chaoguang; Huang, Wan; Rozelle, Scott; Ma, Xiaochen

2017-01-01

Offering free glasses can be important to increase children's wear. We sought to assess whether "Upgrade glasses" could avoid reduced glasses sales when offering free glasses to children in China. In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56-1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. ClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014.

Cognitive remediation versus active computer control in bipolar disorder with psychosis: study protocol for a randomized controlled trial.

PubMed

Lewandowski, Kathryn Eve; Sperry, Sarah H; Ongur, Dost; Cohen, Bruce M; Norris, Lesley A; Keshavan, Matcheri S

2016-03-12

Cognitive dysfunction is a major feature of bipolar disorder with psychosis and is strongly associated with functional outcomes. Computer-based cognitive remediation has shown promise in improving cognition in patients with schizophrenia. However, despite similar neurocognitive deficits between patients with schizophrenia and bipolar disorder, few studies have extended neuroscience-based cognitive remediation programs to this population. The Treatment to Enhance Cognition in Bipolar Disorder study is an investigator-initiated, parallel group, randomized, blinded clinical trial of an Internet-based cognitive remediation protocol for patients with bipolar disorder I with psychosis (n = 100). We also describe the development of our dose-matched active control paradigm. Both conditions involve 70 sessions of computer-based activities over 24 weeks. The control intervention was developed to mirror the treatment condition in dose and format but without the neuroplasticity-based task design and structure. All participants undergo neuropsychological and clinical assessment at baseline, after approximately 25 hours of study activities, post treatment, and after 6 months of no study contact to assess durability. Neuroimaging at baseline and post treatment are offered in an "opt-in" format. The primary outcomes are scores on the MATRICS battery; secondary and exploratory outcomes include measures of clinical symptoms, community functioning, and neuroimaging changes. Associations between change in cognitive measures and change in community functioning will be assessed. Baseline predictors of treatment response will be examined. The present study is the first we are aware of to implement an Internet-based cognitive remediation program in patients with bipolar disorder with psychosis and to develop a comparable web-based control paradigm. The mixed online and study-site format allows accessible treatment while providing weekly staff contact and bridging. Based on user-provided feedback, participant blinding is feasible. ClinicalTrials.gov NCT01470781 ; 11 July 2011.

Structural normalization of the lymphoid tissue in asymptomatic HIV-infected patients after 48 weeks of potent antiretroviral therapy.

PubMed

Macías, J; Japón, M A; Leal, M; Sáez, C; Pineda, J A; Segura, D I; Ortega, J; Lissen, E

2001-12-07

The hallmark of HIV infection is the involution and destruction of lymphoid tissue. However, very little information exists on the effect of highly active antiretroviral therapy (HAART) on lymphoid tissue structure. To evaluate the effect of a HAART regimen after 48 weeks on the architecture and cell regeneration of tonsil lymphoid tissue in HIV-infected patients with CD4 T cell counts > or = 500/microl. From June 1997 to February 1998 all asymptomatic HIV-infected patients with CD4 T cell counts > or = 500/microl seen at our unit were offered quadruple antiretroviral therapy. Tonsil biopsies were obtained at baseline and at 48 weeks. Tonsil tissue sections were examined to evaluate structural and immunohistochemical changes by two blinded and independent pathologists. Cell numbers were counted for selected markers in T-dependent zones. Eleven patients were evaluable, six were excluded because of insufficient or inadequate sampling in at least one of the biopsies. Cellular depletion, plasma cell accumulation and prominent vessels were observed in all cases; three excluded patients with evaluable baseline biopsies showed similar tissue lesions. Follow-up biopsies demonstrated some degree of improvement in all patients. Germinal centres appeared in seven cases that were not seen at baseline. CD4 cell counts increased and CD8 cell counts decreased significantly in lymphoid tissue. An increase in CD45RA+ cells was observed; however, the proportion of CD45+Ki67+ cells did not differ between baseline and 48 weeks. This study shows an unexpected range of moderate to severe lymphoid tissue lesions in mildly immunosuppressed HIV-infected patients, which was partly restored after 48 weeks of HAART.

Disruption to radiation therapy sessions due to anxiety among patients receiving radiation therapy to the head and neck area can be predicted using patient self-report measures.

PubMed

Clover, Kerrie; Oultram, Sharon; Adams, Catherine; Cross, Laraine; Findlay, Naomi; Ponman, Leah

2011-12-01

This analysis sought to determine whether patient self-report measures were associated with disruption to radiation therapy sessions due to anxiety among cancer patients undergoing radiation therapy to the head and neck region. A cohort of patients undergoing radiation therapy to the head and neck region at a major regional radiation oncology treatment centre (ROTC) in Australia completed self-report measures of anxiety, history of panic and fears relevant to use of an immobilising mask. The treating Radiation Therapist (RT) rated the level of session disruption due to patient anxiety during the Computerised Tomography/Simulation (CT/Sim) (baseline) session and first treatment session. Complete data were obtained for 90 patients. RTs rated 11 and 24% of patients as having some level of session disruption session due to anxiety at baseline and Treatment 1, respectively. Five factors were significantly associated with session disruption at baseline in bivariate analyses: currently taking psycho-active medication (p=0.008); fear of enclosed spaces (p=0.006); fear of face being covered up (p=0.006); fear of movement restriction (p=0.041) and ever had an anxiety attack (p=0.034). Sensitivity ranged from 0.57 to 0.75 and specificity ranged from 0.68 to 0.90. Only session disruption at baseline predicted disruption at Treatment 1 (p<0.01). This study offers some preliminary insights into the prevalence of patient anxiety severe enough to cause session disruption and patient self-report measures which might be used to flag patients for prophylactic treatment. Further development and replication in a larger sample is warranted before introduction of these measures into routine practice. Copyright © 2010 John Wiley & Sons, Ltd.

Posttraumatic Stress Disorder in U.S. Military Primary Care: Trajectories and Predictors of One-Year Prognosis.

PubMed

Bray, Robert M; Engel, Charles C; Williams, Jason; Jaycox, Lisa H; Lane, Marian E; Morgan, Jessica K; Unützer, Jürgen

2016-08-01

We examined the longitudinal course of primary care patients in the active duty Army with posttraumatic stress disorder (PTSD) and identified prognostic indicators of PTSD severity. Data were drawn from a 6-site randomized trial of collaborative primary care for PTSD and dpression in the military. Subjects were 474 soldiers with PTSD (scores ≥ 50 on the PTSD Checklist -Civilian Version). Four assessments were completed at U.S. Army installations: baseline, and follow-ups at 3 months (92.8% response rate [RR]), 6 months (90.1% RR), and 12 months (87.1% RR). Combat exposure and 7 validated indicators of baseline clinical status (alcohol misuse, depression, pain, somatic symptoms, low mental health functioning, low physical health functioning, mild traumatic brain injury) were used to predict PTSD symptom severity on the Posttraumatic Diagnostic Scale (Cronbach's α = .87, .92, .95, .95, at assessments 1-4, respectively). Growth mixture modeling identified 2 PTSD symptom trajectories: subjects reporting persistent symptoms (Persisters, 81.9%, n = 388), and subjects reporting improved symptoms (Improvers 18.1%, n = 86). Logistic regression modeling examined baseline predictors of symptom trajectories, adjusting for demographics, installation, and treatment condition. Subjects who reported moderate combat exposure, adjusted odds ratio (OR) = 0.44, 95% CI [0.20, 0.98], or who reported high exposure, OR = 0.39, 95% CI [0.17, 0.87], were less likely to be Improvers. Other baseline clinical problems were not related to symptom trajectories. Findings suggested that most military primary care patients with PTSD experience persistent symptoms, highlighting the importance of improving the effectiveness of their care. Most indicators of clinical status offered little prognostic information beyond the brief assessment of combat exposure. Copyright © 2016 International Society for Traumatic Stress Studies.

The COPE healthy lifestyles TEEN randomized controlled trial with culturally diverse high school adolescents: baseline characteristics and methods.

PubMed

Melnyk, Bernadette Mazurek; Kelly, Stephanie; Jacobson, Diana; Belyea, Michael; Shaibi, Gabriel; Small, Leigh; O'Haver, Judith; Marsiglia, Flavio Francisco

2013-09-01

Obesity and mental health disorders remain significant public health problems in adolescents. Substantial health disparities exist with minority youth experiencing higher rates of these problems. Schools are an outstanding venue to provide teens with skills needed to improve their physical and mental health, and academic performance. In this paper, the authors describe the design, intervention, methods and baseline data for a randomized controlled trial with 779 culturally diverse high-school adolescents in the southwest United States. Aims for this prevention study include testing the efficacy of the COPE TEEN program versus an attention control program on the adolescents' healthy lifestyle behaviors, Body Mass Index (BMI) and BMI%, mental health, social skills and academic performance immediately following the intervention programs, and at six and 12 months post interventions. Baseline findings indicate that greater than 40% of the sample is either overweight (n = 148, 19.00%) or obese (n = 182, 23.36%). The predominant ethnicity represented is Hispanic (n = 526, 67.52%). At baseline, 15.79% (n = 123) of the students had above average scores on the Beck Youth Inventory Depression subscale indicating mildly (n = 52, 6.68%), moderately (n = 47, 6.03%), or extremely (n = 24, 3.08%) elevated scores (see Table 1). Anxiety scores were slightly higher with 21.56% (n = 168) reporting responses suggesting mildly (n = 81, 10.40%), moderately (n = 58, 7.45%) or extremely (n = 29, 3.72%) elevated scores. If the efficacy of the COPE TEEN program is supported, it will offer schools a curriculum that can be easily incorporated into high school health courses to improve adolescent healthy lifestyle behaviors, psychosocial outcomes and academic performance. Copyright © 2013 Elsevier Inc. All rights reserved.

The COPE healthy lifestyles TEEN randomized controlled trial with culturally diverse high school adolescents: Baseline characteristics and methods

PubMed Central

Melnyk, Bernadette Mazurek; Kelly, Stephanie; Jacobson, Diana; Belyea, Michael; Shaibi, Gabriel; Small, Leigh; O’Haver, Judith; Marsiglia, Flavio Francisco

2014-01-01

Obesity and mental health disorders remain significant public health problems in adolescents. Substantial health disparities exist with minority youth experiencing higher rates of these problems. Schools are an outstanding venue to provide teens with skills needed to improve their physical and mental health, and academic performance. In this paper, the authors describe the design, intervention, methods and baseline data for a randomized controlled trial with 779 culturally diverse high-school adolescents in the southwest United States. Aims for this prevention study include testing the efficacy of the COPE TEEN program versus an attention control program on the adolescents’ healthy lifestyle behaviors, Body Mass Index (BMI) and BMI%, mental health, social skills and academic performance immediately following the intervention programs, and at six and 12 months post interventions. Baseline findings indicate that greater than 40% of the sample is either overweight (n = 148, 19.00%) or obese (n = 182, 23.36%). The predominant ethnicity represented is Hispanic (n = 526, 67.52%). At baseline, 15.79%(n = 123) of the students had above average scores on the Beck Youth Inventory Depression subscale indicating mildly (n = 52, 6.68%), moderately (n = 47, 6.03%), or extremely (n = 24, 3.08%) elevated scores (see 1). Anxiety scores were slightly higher with 21.56% (n = 168) reporting responses suggesting mildly (n = 81, 10.40%), moderately (n = 58, 7.45%) or extremely (n = 29, 3.72%) elevated scores. If the efficacy of the COPE TEEN program is supported, it will offer schools a curriculum that can be easily incorporated into high school health courses to improve adolescent healthy lifestyle behaviors, psychosocial outcomes and academic performance. PMID:23748156

Psychosocial intervention for children with narcolepsy: Parents' expectations and perceived support.

PubMed

Kippola-Pääkkönen, Anu; Härkäpää, Kristiina; Valkonen, Jukka; Tuulio-Henriksson, Annamari; Autti-Rämö, Ilona

2016-04-18

The study focuses on the parents of children who were affected by narcolepsy after a pandemic influenza and vaccination campaign in Finland. The main aim of the study was to clarify parents' expectations and perceived support from the intervention and to assess their need for additional support. The data were gathered using questionnaires. Fifty-eight parents answered the baseline questionnaire and 40 parents the final questionnaire. Parents' expectations of and perceived support from the intervention mainly related to peer support. The intervention offered an arena for sharing information and experiences and provided encouragement for coping in everyday life. Many expectations were not met, especially those concerning information about needed services, financial benefits and availability of local support. The results highlight that for persons with rare disorders and their families, an inpatient psychosocial intervention can offer an important arena to receive both informal and professionally led peer support. Comprehensive psychosocial and other support services are also needed in the community. Listening to parents' perspectives on the intervention and perceived support can help to establish multiform family-centred support for families with children affected by a rare chronic disabling condition. © The Author(s) 2016.

A break-even analysis for dementia care collaboration: Partners in Dementia Care.

PubMed

Morgan, Robert O; Bass, David M; Judge, Katherine S; Liu, C F; Wilson, Nancy; Snow, A Lynn; Pirraglia, Paul; Garcia-Maldonado, Maurilio; Raia, Paul; Fouladi, N N; Kunik, Mark E

2015-06-01

Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the "Partners in Dementia Care" (PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. Study subjects were veterans (N = 434) 50 years of age and older with dementia and their caregivers at two intervention (N = 269) and three comparison sites (N = 165). PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p ≤ 0.001), baseline cognitive impairment (p ≤ 0.05), number of personal care dependencies (p ≤ 0.01), and VA service priority (p ≤ 0.01) all predicted change in log total cost. These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination.

Identifying optimal threshold statistics for elimination of hookworm using a stochastic simulation model.

PubMed

Truscott, James E; Werkman, Marleen; Wright, James E; Farrell, Sam H; Sarkar, Rajiv; Ásbjörnsdóttir, Kristjana; Anderson, Roy M

2017-06-30

There is an increased focus on whether mass drug administration (MDA) programmes alone can interrupt the transmission of soil-transmitted helminths (STH). Mathematical models can be used to model these interventions and are increasingly being implemented to inform investigators about expected trial outcome and the choice of optimum study design. One key factor is the choice of threshold for detecting elimination. However, there are currently no thresholds defined for STH regarding breaking transmission. We develop a simulation of an elimination study, based on the DeWorm3 project, using an individual-based stochastic disease transmission model in conjunction with models of MDA, sampling, diagnostics and the construction of study clusters. The simulation is then used to analyse the relationship between the study end-point elimination threshold and whether elimination is achieved in the long term within the model. We analyse the quality of a range of statistics in terms of the positive predictive values (PPV) and how they depend on a range of covariates, including threshold values, baseline prevalence, measurement time point and how clusters are constructed. End-point infection prevalence performs well in discriminating between villages that achieve interruption of transmission and those that do not, although the quality of the threshold is sensitive to baseline prevalence and threshold value. Optimal post-treatment prevalence threshold value for determining elimination is in the range 2% or less when the baseline prevalence range is broad. For multiple clusters of communities, both the probability of elimination and the ability of thresholds to detect it are strongly dependent on the size of the cluster and the size distribution of the constituent communities. Number of communities in a cluster is a key indicator of probability of elimination and PPV. Extending the time, post-study endpoint, at which the threshold statistic is measured improves PPV value in discriminating between eliminating clusters and those that bounce back. The probability of elimination and PPV are very sensitive to baseline prevalence for individual communities. However, most studies and programmes are constructed on the basis of clusters. Since elimination occurs within smaller population sub-units, the construction of clusters introduces new sensitivities for elimination threshold values to cluster size and the underlying population structure. Study simulation offers an opportunity to investigate key sources of sensitivity for elimination studies and programme designs in advance and to tailor interventions to prevailing local or national conditions.

Randomised controlled trial of informal team sports for cardiorespiratory fitness and health benefit in Pacific adults.

PubMed

Biddle, Mark G; Vincent, Grace; McCambridge, Alana; Britton, Gabrielle; Dewes, Ofa; Elley, C Raina; Moyes, Simon A; Edge, Johann

2011-12-01

Rates of obesity, Type 2 diabetes and cardiovascular disease are high among Pacific people in New Zealand. Physical activity is recommended in the prevention and management of these conditions. Community-based, 'small-sided game' group activities may be an effective and culturally appropriate way to promote physical activity within Pacific communities. To assess the effectiveness of small-sided games-based exercise on fitness and health parameters among Pacific adults over four weeks. Twenty untrained (13 female) Pacific adults were randomised to intervention or control. Intervention participants were offered 45 minutes of small-sided games three times per week for four weeks. Control participants were offered one-month gym membership after the trial. Primary outcomes included cardiorespiratory fitness (VO₂peak) and leg strength (maximal concentric force of quadriceps at 60°/second) measured at baseline and four weeks. Secondary outcomes included glycaemia, lipid profile, blood pressure (BP), and inflammatory markers. Multivariable regression models were used to assess differences between groups, adjusting for baseline values, age and gender. At baseline, mean age was 34.8 years (SD 12.6), BMI 36.3 (6.7), systolic BP 127.7 mmHg (12.1), HbA1c 6.1% (1.9), VO₂peak 2.5 L/min (0.6) and leg strength 170.0 N.m (57.4). Sixteen participants completed the trial. Change in outcomes were greater in intervention than control participants in absolute VO₂peak (0.9 L/min (p=0.003)), leg strength (17.8 N.m (p=0.04)) and HDL (0.12 mmol/L (p=0.02)). There were no other significant differences. Small-sided games appear to be a promising means for improving the health and cardiorespiratory fitness and reducing the risk of diabetes and cardiovascular disease in Pacific adults.

Knowledge of Deaths in Hotel Rooms Diminishes Perceived Value and Elicits Guest Aversion.

PubMed

Bering, Jesse M; Curtin, Emma R; Jong, Jonathan

2017-01-01

Guest deaths are an inevitable aspect of the hospitality industry. In Study 1, participants read a vignette in which the previous guest died of natural causes, suicide, or homicide. Those who learned of a death (a) saw the room as less valuable, (b) opted to stay in a more basic room in which no death occurred, despite both rooms being offered for free, and (c) anticipated feeling uneasy when imagining an overnight stay. In Study 2, we investigated the persistence of this bias. Perceived room value and anticipatory well-being can be expected to return to baseline levels only many years after the death event. Similar to "stigmatized properties" in real estate, these data confirm an irrational and recalcitrant cognitive bias surrounding consumers' views of death-affected hotel rooms.

A system definition study for the Advanced Meteorological Temperature Sounder (AMTS)

NASA Technical Reports Server (NTRS)

1977-01-01

The functional requirements of Exhibit A (11) were used as the baseline for the conceptual design of a fixed grating out of plane multidetector spectrometer for the Space Shuttle application. Because the grating instrument would be large and the 28 element detector array would be difficult to cool radiatively from a free flying spacecraft and because increasing the spectral resolution of the grating instrument would be difficult in an instrument of reasonable size, a parallel study of a Nichelson interferometer spectrometer was undertaken. This type of instrument offers compact size, fewer detectors to cool, and the possibility of increased spectral resolution. The design and performance parameters of both the grating and interferometer approaches are described. The tradeoffs involved in comparing the two systems for sounding applications are discussed.

Review of alternate automotive engine fuel economy. Final report January-October 78

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

Cole, D.; Bolt, J.A.; Huber, P.

This study assessed the potential of alternate automotive engines to meet the fuel economy goals and emission levels of the 1980-1990 period. As part of NHTSA's continuing research in support of the Department of Transportation fuel economy activities, this study reviewed those developments offering viable substitutes for the current spark ignition engine systems. Categories assessed included stratified charge, diesels, turbo charging, rotary/Wankel engines, and the developmental gas turbine and Stirling cycle engines. Results of past and on-going research through 1978 were reviewed along with the development and production status of various alternate engine technologies proposed for automobiles and light trucksmore » through the 1980s. Assessment was then made of the potential fuel economy improvement as a percentage of 1978 baseline data.« less

Change Detection Algorithms for Information Assurance of Computer Networks

DTIC Science & Technology

2002-01-01

original document contains color images. 14. ABSTRACT see report 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18...number of computer attacks increases steadily per year. At the time of this writing the Internet Security Systems’ baseline assessment is that a new...across a network by exploiting security flaws in widely-used services offered by vulnerable computers. In order to locate the vulnerable computers, the

Bootstrapping a Multilingual Part-of-speech Tagger in One Person-day

DTIC Science & Technology

2002-01-01

dictionary , (2) a basic library reference grammar, and (3) access to an existing monolingual text corpus in the language. The al- gorithm begins by...inducing initial lexical POS dis- tributions from English translations in a bilingual dictionary without POS tags. It handles irregular, regular and semi...many booksellers and websites offer a foundation of linguistic wisdom in reference grammars and dictionaries . Thus starting from this baseline, what

Google Calendar Enhances Prospective Memory in Alzheimer's Disease: A Case Report.

PubMed

El Haj, Mohamad; Gallouj, Karim; Antoine, Pascal

2017-01-01

We investigated whether an external memory aid (i.e., Google Calendar) would alleviate prospective memory compromise in a patient with mild Alzheimer's disease. The patient was asked in the baseline phase to perform three prospective targeted events (e.g., attending her weekly bridge game at the community club) and three prospective control events (e.g., buying her weekly magazine). The same six prospective events were assessed in the intervention phase but the targeted-events were cued by Google Calendar while the control-events were not. Results showed less omission of the targeted events in the training phase than in the baseline phase, suggesting a positive effect of Google Calendar. This case report offers a unique view into how smartphone calendars may alleviate prospective memory compromise in patients with mild Alzheimer's disease.

Cognitive remediation for adolescents with 22q11 deletion syndrome (22q11DS): a preliminary study examining effectiveness, feasibility, and fidelity of a hybrid strategy, remote and computer-based intervention.

PubMed

Mariano, Margaret A; Tang, Kerri; Kurtz, Matthew; Kates, Wendy R

2015-08-01

22q11DS is a multiple anomaly syndrome involving intellectual and behavioral deficits, and increased risk for schizophrenia. As cognitive remediation (CR) has recently been found to improve cognition in younger patients with schizophrenia, we investigated the efficacy, feasibility, and fidelity of a remote, hybrid strategy, computerized CR program in youth with 22q11DS. A longitudinal design was implemented in which 21 participants served as their own controls. Following an eight month baseline period in which no interventions were provided, cognitive coaches met with participants remotely for CR via video conferencing three times a week over a targeted 8month timeframe and facilitated their progress through the intervention, offering task-specific strategies. A subset of strategies were examined for fidelity. Outcomes were evaluated using a neurocognitive test battery at baseline, pre-treatment and post-treatment. All participants adhered to the intervention. The mean length of the treatment phase was 7.96months. A moderately high correlation (intraclass correlation coefficient, 0.73) was found for amount and type of strategies offered by coaches. Participants exhibited significant improvements (ES=.36-.55, p≤.009) in working memory, shifting attention and cognitive flexibility. All significant models were driven by improvements in pre to post-treatment scores. Based on our preliminary investigation, a remote, hybrid strategy, computerized CR program can be implemented with 22q11DS youth despite geographic location, health, and cognitive deficits. It appears effective in enhancing cognitive skills during the developmental period of adolescence, making this type of CR delivery useful for youth with 22q11DS transitioning into post-school environments. Copyright © 2015 Elsevier B.V. All rights reserved.

Worksite-based cardiovascular risk screening and management: a feasibility study.

PubMed

Padwal, Raj; Rashead, Mohammad; Snider, Jonathan; Morrin, Louise; Lehman, Agnes; Campbell, Norm Rc

2017-01-01

Established cardiovascular risk factors are highly prevalent and contribute substantially to cardiovascular morbidity and mortality because they remain uncontrolled in many Canadians. Worksite-based cardiovascular risk factor screening and management represent a largely untapped strategy for optimizing risk factor control. In a 2-phase collaborative demonstration project between Alberta Health Services (AHS) and the Alberta Newsprint Company (ANC), ANC employees were offered cardiovascular risk factor screening and management. Screening was performed at the worksite by AHS nurses, who collected baseline history, performed automated blood pressure measurement and point-of-care testing for lipids and A1c, and calculated 10-year Framingham risk. Employees with a Framingham risk score of ≥10% and uncontrolled blood pressure, dyslipidemia, or smoking were offered 6 months of pharmacist case management to optimize their risk factor control. In total, 87 of 190 (46%) employees volunteered to undergo cardiovascular risk factor screening. Mean age was 44.5±11.9 years, 73 (83.9%) were male, 14 (16.1%) had hypertension, 4 (4.6%) had diabetes, 12 (13.8%) were current smokers, and 9 (10%) had dyslipidemia. Of 36 employees with an estimated Framingham risk score of ≥10%, 21 (58%) agreed to receive case management and 15 (42%) attended baseline and 6-month follow-up case management visits. Statistically significant reductions in left arm systolic blood pressure (-8.0±12.4 mmHg; p =0.03) and triglyceride levels (-0.8±1.4 mmol/L; p =0.04) occurred following case management. These findings demonstrate the feasibility and usefulness of collaborative, worksite-based cardiovascular risk factor screening and management. Expansion of this type of partnership in a cost-effective manner is warranted.

Assessing the Food Environment of a Rural Community: Baseline Findings From the Heart of New Ulm Project, Minnesota, 2010–2011

PubMed Central

Sidebottom, Abbey C.; Boucher, Jackie L.; Lindberg, Rebecca; Werner, Rebecca

2014-01-01

Introduction Changes in the food environment in the United States during the past few decades have contributed to increased rates of obesity, diabetes, and heart disease. Improving the food environment may be an effective primary prevention strategy to address these rising disease rates. The purpose of this study was to assess the consumer food environment of a rural community with high rates of obesity and low levels of fruit and vegetable consumption. Findings were used to identify food environment intervention strategies to be implemented as part of a larger community-based heart disease prevention program. Methods We used the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and Stores (NEMS-S) to assess 34 restaurants, 3 grocery stores, and 5 convenience stores in New Ulm, Minnesota. Results At least half of the restaurants offered nonfried vegetables and 100% fruit juice. Only 32% had at least 1 entrée or 1 main dish salad that met standards for “healthy.” Fewer than half (41%) had fruit available and under one-third offered reduced-size portions (29%) or whole-grain bread (26%). Grocery stores had more healthful items available, but findings were mixed on whether these items were made available at a lower price than less healthful items. Convenience stores were less likely to have fruits and vegetables and less likely to carry more healthful products (except milk) than grocery stores. Conclusion Baseline findings indicated opportunities to improve availability, quality, and price of foods to support more healthful eating. A community-wide food environment assessment can be used to strategically plan targeted interventions. PMID:24602590

Can Arthroplasty Stem INfluence Outcome? (CASINO): a randomized controlled equivalence trial of 125 mm versus 150 mm Exeter V40 stems in total hip arthroplasty.

PubMed

Hamilton, David F; Ohly, Nicholas E; Gaston, Paul

2018-04-16

The use of shorter length femoral stems during total hip arthroplasty has been suggested to accommodate wider patient femoral geometry and offer maximal bone preservation. However, cemented short-stem designs may increase the risk of varus stem malalignment and influence patient outcomes. CASINO is a multi-centre randomised equivalence trial that will recruit 220 patients undergoing total hip arthroplasty for osteoarthritis at two NHS hospitals in Scotland. Patients will be aged 45-80, undergoing unilateral primary hip arthroplasty, with no plan for contralateral procedure within the study timeframe, and able to comply with the protocol. Participants will be randomised to receive either a short (125 mm) or a standard (150 mm) Exeter V40 stem. The Contemporary acetabular component will be used in all cases. All implants will be cemented. Patient pain, function and satisfaction will be assessed using change from baseline measurement in Oxford Hip Score, Forgotten Joint Score, EQ-5D, pain numerical rating scores, and patient satisfaction questionnaire at baseline and at 1 and 2 years following surgery. Radiographic assessment will evaluate stem position and will be appraised by independent reviewers. Patients will be blind to implant allocation. Stem length may be associated with outcome; however, we can find no randomised trial in which researchers investigated the effect of stem length on patient outcome following cemented total hip arthroplasty. The aim of this trial is to determine if the use of short cemented stems offers equivalent patient outcomes to those achieved following surgery with standard length stems. International Standard Randomised Controlled Trial Number, ISRCTN13154542 , Registered on 30 June 2017.

Use of a training program to enhance NICU nurses' cognitive abilities for assessing preterm infant behaviors and offering supportive interventions.

PubMed

Liaw, Jen-Jiuan

2003-06-01

This study tested the use of a developmentally supportive care (DSC) training program in the form of videotaped and personalized instruction to increase nurses' cognitive abilities for assessing preterm infant behavioral signals and offering supportive care. The study used a two-group pre-test post-test quasi-experimental repeated measures design. The participants were 25 NICU nurses, 13 in the intervention group, and 12 in the control group. An instrument developed for the purpose of the study was a video test that measured the effectiveness of the DSC training. The video test questionnaires were administered to the participants twice with an interval of four weeks. ANCOVA controlling the baseline scores was used for data analysis. In general, the results support the hypothesis that nurses' cognitive abilities were enhanced after the DSC training. The increase in nurses' cognitive abilities is the prerequisite for behavioral change, based on the assumptions of Bandura's Social Cognitive Learning Theory (Bandura, 1986). As nurses' cognitive abilities increased, it would be possible that nurse behaviors in taking care of these preterm infants might change. Therefore, the author recommends that in order to improve NICU care quality and the outcomes of preterm infants, the concepts of developmentally supportive care be incorporated into NICU caregiving practice by educating nurses.

Hands-on Activities Designed to Familiarize Users with Data from ABI on GOES-R and AHI on Himawari-8

NASA Astrophysics Data System (ADS)

Lindstrom, S. S.; Schmit, T.; Gerth, J.; Gunshor, M. M.; Mooney, M. E.; Whittaker, T. M.

2016-12-01

Recent and ongoing launches of next-generation geostationary satellites offer a challenge to familiarize National Weather Service (and other) forecasters with the new capabilities of different spectral channels sensed by the Advanced Baseline Imager (ABI) on GOES-R and the Advanced Himawari Imager (AHI) on Himawari-8. Hands on HTML5-based applets developed at the Cooperative Institute for Meteorological Satellite Studies allow for quick comparisons of reflectance in the visible (0.4 to 0.7 um) and near-infrared channels (0.86 to 2.2 um) and brightness temperatures in the infrared (3.9 to 13.3 um). The web apps to explore the different channels on ABI and AHI are at http://cimss.ssec.wisc.edu/goes/webapps/bandapp/; those that offer guidance on how to produce Red/Green/Blue composites are at http://cimss.ssec.wisc.edu/goes/webapps/satrgb/overview.html. This talk will briefly discuss highlights from both websites, and suggest ways the applications can be used to educate forecasters and the general public.

Process evaluation results from the HEALTHY nutrition intervention to modify the total school food environment

PubMed Central

Volpe, S. L.; Hall, W. J.; Steckler, A.; Schneider, M.; Thompson, D.; Mobley, C.; Pham, T.; El ghormli, L.

2013-01-01

The process evaluation of HEALTHY, a large multi-center trial to decrease type 2 diabetes mellitus in middle school children, monitored the implementation of the intervention to ascertain the extent that components were delivered and received as intended. The purpose of this article is to report the process evaluation findings concerning the extent to which the HEALTHY nutrition intervention was implemented during the HEALTHY trial. Overall, the observed fidelity of implementing nutrition strategies improved from baseline to the end of the study. By the last semester, all but two nutrition process evaluation goals were met. The most challenging goal to implement was serving high fiber foods, including grain-based foods and legumes. The easiest goals to implement were lowering the fat content of foods offered and offering healthier beverages. The most challenging barriers experienced by research dietitians and food service staff were costs, availability of foods and student acceptance. Forming strong relationships between the research dietitians and food service staff was identified as a key strategy to meet HEALTHY nutrition goals. PMID:24107856

Evaluation of a community-based participatory farmworker eye health intervention in the "black dirt" region of New York state.

PubMed

Earle-Richardson, Giulia; Wyckoff, Lynae; Carrasquillo, Marilyn; Scribani, Melissa; Jenkins, Paul; May, John

2014-09-01

Eye irritation is a constant hazard for migrant and seasonal farmworkers, but there are few studies of the problem or how to address it. Researchers evaluated the effect of a community-based participatory eye health intervention on farmworker eye symptoms in the Hudson Valley, NY. A randomized pre-post intervention with 2, 4-week follow-up periods was implemented with a sample of 97 farmworkers. Five eye symptoms were measured, along with utilization of protective eyewear and eye drops. Leading baseline eye symptoms were redness (49%), blurred vision (43%), itching (43%), and eye pain (29%). Significant reductions in eye pain (P = 0.009), and non-significant reductions in redness were observed for the intervention group while controls experienced increases in both. The intervention was effective in significantly reducing eye pain, and to a lesser extent, redness. Future eyewear promotion programs should offer a range of eye wear, tailor offerings to local climate and tasks, evaluate eyewear durability, and include eye drops. © 2014 Wiley Periodicals, Inc.

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

PubMed Central

Robitaille, Yvonne; Laforest, Sophie; Fournier, Michel; Gauvin, Lise; Parisien, Manon; Corriveau, Hélène; Trickey, Francine; Damestoy, Nicole

2005-01-01

Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls. PMID:16195514

Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus.

PubMed

Yadav, Raman; Kothari, S Y; Borah, Diganta

2015-07-01

Lateral epicondylitis or Tennis Elbow is one of the most common causes of upper extremity pain with various treatment options. Platelet-rich plasma (PRP) offers a new option for the treatment of lateral epicondylitis. This study was conducted with an aim to compare the efficacy of PRP versus methyl-prednisolone local injection in patients with lateral epicondylitis. Sixty five patients with lateral epicondylitis were included in the study and randomized into two groups. Group A was treated with single injection of 1ml PRP with absolute platelet count of at least 1 million platelets/ mm(3). Group B was treated with single injection of 1ml (40mg) methyl-prednisolone. Pain, grip strength and functional improvements were assessed using visual analogue scale, dynamometer and quick Disabilities of the Arm, Shoulder and Hand scale respectively at baseline, 15 days, 1 month and 3 months. Sixty patients completed the follow up. All assessment parameters improved significantly in both the Groups at each follow up compared to baseline. At the end of three months group A showed significantly better improvement as compared to Group B. PRP and methyl-prenisolone both are effective in the treatment of lateral epicondylitis. However, PRP is a superior treatment option for longer duration efficacy.

Evaluation of a Multicomponent Psychosocial Skill Training Program for Junior Physicians in Their First Year at Work: A Pilot Study.

PubMed

Mache, Stefanie; Vitzthum, Karin; Klapp, Burghard F; Groneberg, David A

2015-10-01

The present study was designed to gather preliminary information regarding the feasibility of implementing a psychosocial resilience program and to assess if the program would potentially promote protective factors (such as resiliency, self-efficacy) and job satisfaction as well as decreasing perceived stress among a sample of German junior physicians. Eighty-two junior physicians in their first year after graduation took part in the project and were randomized in a controlled trial to either an intervention or a control group for 3 months. The intervention group was offered resilience training combined with cognitive behavioral and solution-focused counseling. Primary outcome measures included scales of the PSQ, BRCS, SWOPE, and COPSOQ. Two post-intervention follow-up measurements proved the effectiveness of the intervention. There was a significant improvement between baseline and follow-up intervention scores on measures of resilience, self-efficacy, optimism, and perceived stress observed in the intervention group compared to the control group. Job satisfaction did not significantly differ between baseline and follow-ups. These results indicate that the program to enhance resilience and decrease stress among physicians is feasible to implement as a group training program in a workplace setting. Further, the intervention provides statistically significant improvement in perceptions of distress and strengthens protective factors (such as resiliency).

Attitudes towards people with depression and schizophrenia among social service workers in Denmark.

PubMed

Jensen, Kamilla Bjørkøe; Vendsborg, Per; Hjorthøj, Carsten; Nordentoft, Merete

2017-04-01

Mental health-related stigma is a major public health issue, and is an obstacle to the possibility for successful treatment, recovery, and reintegration. To examine attitudes towards mental illness among employees in the social services. The study design was part of a large randomized trial, and data presented in this study are baseline data from this trial. Respondents completed a baseline questionnaire to assess the respondents' attitudes. A significant difference was found between employees' personal attitudes towards depression and schizophrenia. The same significant difference was found in the employees' perceived attitudes. Furthermore, a significant difference was found between the employees' personal and perceived attitudes. A significant difference was found between the respondents wish for social distance towards depression and schizophrenia in all cases, except regarding the willingness to provide a job at one's own workplace. Employees in the social services are comparable to the general public concerning attitudes towards mental illness. The results indicate that the employees in social services could have great use of gaining more knowledge about mental illness and ways in which to recognize a mental illness, in order to be able to offer the right kind of help and reduce the treatment gap concerning people suffering from mental illness.

Importance of change appraisal for employee well-being during organizational restructuring: findings from the Finnish paper industry's extensive transition.

PubMed

Pahkin, Krista; Nielsen, Karina; Väänänen, Ari; Mattila-Holappa, Pauliina; Leppänen, Anneli; Koskinen, Aki

2014-01-01

The global recession has forced the Finnish forest industry to carry out major restructuring activities. Employees have faced different kinds of restructuring, mainly aimed at reducing staff and production. Many studies have shown the negative consequences of restructuring on employee well-being by using negative, ill-health indicators. Our aim is to examine the extent to which change appraisal influences both the negative and positive aspects of work-related well-being among employees who continue working in the organization after the restructuring process. We also examine the role of different actors (top management, immediate supervisor, employees themselves) in how the change is appraised. The study investigated blue-collar employees working in the Finnish forest industry during a period of extensive transition (2008-2009). All six participating factories underwent restructuring between baseline and the follow-up survey (n=369). After adjustment for gender, age and baseline well-being, negative change appraisal increased the risk of experiencing more stress and less work enjoyment. Negative change appraisals thus also damaged the positive, motivational aspects of employee well-being. The results showed the importance of offering employees the opportunity to participate in the planning of changes related to their work as regards positive change appraisal.

Importance of Change Appraisal for Employee Well-being during Organizational Restructuring: Findings from the Finnish Paper Industry’s Extensive Transition

PubMed Central

PAHKIN, Krista; NIELSEN, Karina; VÄÄNÄNEN, Ari; MATTILA-HOLAPPA, Pauliina; LEPPÄNEN, Anneli; KOSKINEN, Aki

2014-01-01

The global recession has forced the Finnish forest industry to carry out major restructuring activities. Employees have faced different kinds of restructuring, mainly aimed at reducing staff and production. Many studies have shown the negative consequences of restructuring on employee well-being by using negative, ill-health indicators. Our aim is to examine the extent to which change appraisal influences both the negative and positive aspects of work-related well-being among employees who continue working in the organization after the restructuring process. We also examine the role of different actors (top management, immediate supervisor, employees themselves) in how the change is appraised. The study investigated blue-collar employees working in the Finnish forest industry during a period of extensive transition (2008–2009). All six participating factories underwent restructuring between baseline and the follow-up survey (n=369). After adjustment for gender, age and baseline well-being, negative change appraisal increased the risk of experiencing more stress and less work enjoyment. Negative change appraisals thus also damaged the positive, motivational aspects of employee well-being. The results showed the importance of offering employees the opportunity to participate in the planning of changes related to their work as regards positive change appraisal. PMID:24975107

PSR B0329+54: substructure in the scatter-broadened image discovered with RadioAstron on baselines up to 330 000 km

NASA Astrophysics Data System (ADS)

Popov, Mikhail V.; Bartel, Norbert; Gwinn, Carl R.; Johnson, Michael D.; Andrianov, Andrey; Fadeev, Evgeny; Joshi, Bhal Chandra; Kardashev, Nikolay; Karuppusamy, Ramesh; Kovalev, Yuri Y.; Kramer, Michael; Rudnitskiy, Alexey; Shishov, Vladimir; Smirnova, Tatiana; Soglasnov, Vladimir A.; Zensus, J. Anton

2017-02-01

We have resolved the scatter-broadened image of PSR B0329+54 and detected a substructure within it. These results are not influenced by any extended structure of a source but instead are directly attributed to the interstellar medium. We obtained these results at 324 MHz with the ground-space interferometer RadioAstron, which included the Space Radio Telescope, ground-based Westerbork Synthesis Radio Telescope and 64-m Kalyazin Radio Telescope on baseline projections up to 330 000 km in 2013 November 22 and 2014 January 1 to 2. At short 15 000 to 35 000 km ground-space baseline projections, the visibility amplitude decreases with baseline length, providing a direct measurement of the size of the scattering disc of 4.8 ± 0.8 mas. At longer baselines, no visibility detections from the scattering disc would be expected. However, significant detections were obtained with visibility amplitudes of 3 to 5 per cent of the maximum scattered around a mean and approximately constant up to 330 000 km. These visibilities reflect a substructure from scattering in the interstellar medium and offer a new probe of ionized interstellar material. The size of the diffraction spot near Earth is 17 000 ± 3 000 km. With the assumption of turbulent irregularities in the plasma of the interstellar medium, we estimate that the effective scattering screen is located 0.6 ± 0.1 of the distance from the Earth towards the pulsar.

Changes in School Food Preparation Methods Result in Healthier Cafeteria Lunches in Elementary Schools.

PubMed

Behrens, Timothy K; Liebert, Mina L; Peterson, Hannah J; Howard Smith, Jennifer; Sutliffe, Jay T; Day, Aubrey; Mack, Jodi

2018-05-01

The purpose of this study is to examine the impact of a districtwide food best practices and preparation changes in elementary schools lunches, implemented as part of the LiveWell@School childhood obesity program, funded by LiveWell Colorado/Kaiser Permanente Community Health Initiative. Longitudinal study examining how school changes in best practices for food preparation impacted the types of side items offered from 2009 to 2015 in elementary school cafeterias in a high-need school district in southern Colorado. Specifically, this study examined changes in side items (fruits, vegetables, potatoes, breads, and desserts). In Phase 1 (2009-2010), baseline data were collected. During Phase 2 (2010-2011), breaded and processed foods (e.g., frozen nuggets, pre-packaged pizza) were removed and school chefs were trained on scratch cooking methods. Phase 3 (2011-2012) saw an increased use of fresh/frozen fruits and vegetables after a new commodity order. During Phase 4 (2013-2015), chef consulting and training took place. The frequency of side offerings was tracked across phases. Analyses were completed in Fall 2016. Because of limited sample sizes, data from Phases 2 to 4 (intervention phases) were combined for potatoes and desserts. Descriptive statistics were calculated. After adjusting for length of time for each phase, Pearson chi-square tests were conducted to examine changes in offerings of side items by phase. Fresh fruit offerings increased and canned fruit decreased in Phases 1-4 (p=0.001). A significant difference was observed for vegetables (p=0.001), with raw and steamed vegetables increasing and canned vegetables decreasing from Phase 1 to 4. Fresh potatoes (low in sodium) increased and fried potatoes (high in sodium) decreased from Phase 1 to Phases 2-4 (p=0.001). Breads were eliminated entirely in Phase 2, and dessert changes were not significant (p=0.927). This approach to promoting healthier lunch sides is a promising paradigm for improving elementary cafeteria food offerings. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The ABCs of diabetes: diabetes self-management education program for African Americans affects A1C, lipid-lowering agent prescriptions, and emergency department visits.

PubMed

Magee, Michelle; Bowling, Andrea; Copeland, James; Fokar, Ali; Pasquale, Patricia; Youssef, Gretchen

2011-01-01

The purpose of the study was to examine the feasibility and impact of a concise community-based program on diabetes self-management education (DSME), according to frequency of emergency department visits and knowledge of, prescriptions for, and control of A1C, blood pressure, and low-density lipoprotein (LDL) cholesterol. A free community-based DSME program was placed in a public library. Adults with diabetes (N, 360) consented to participate in this prospective nonrandomized cohort study with preintervention-postintervention design. The small-group interactive DSME (two 2.5-hour classes) focused on improving cardiovascular disease risk factors and facilitating communication with the primary care physician. An increase in knowledge of American Diabetes Association-recommended targets for A1C, blood pressure, and LDL cholesterol from baseline to postintervention was seen among participants. Significant clinical outcomes included reduction in self-reported emergency department visits and reduction in mean A1C. However, despite an increase in prescriptions written for lipid-lowering drugs, blood pressure and LDL cholesterol did not change. Participants who started on insulin were more likely to achieve or maintain A1C < 7% compared to those who either did not take or stopped taking insulin during the study. Offering DSME classes for African Americans at a public library was feasible and significantly affected 6-month clinical outcomes, including a reduction in A1C, an increased likelihood of attaining a target A1C of < 7% if insulin was started during the study period, and a two-thirds reduction in emergency department visits for uncontrolled diabetes. Observed results suggest that partnering with community-based organizations such as public libraries offers an accessible and well-received location for offering DSME programs.

Integrating Routine HIV Screening in the New York City Community Health Center Collaborative.

PubMed

Rodriguez, Vanessa; Lester, Deborah; Connelly-Flores, Alison; Barsanti, Franco A; Hernandez, Paloma

2016-01-01

One in seven of the 1.1 million people living in the United States infected with HIV are not aware of their HIV status. At the same time, many clinical settings have not adopted routine HIV screening, which promotes linkage to specialist medical care. We sought to improve HIV screening in a large community health center network by using a data-driven, collaborative learning approach and system-wide modifications, where counselor-based HIV screening and testing were replaced by health-care providers and medical assistants. Urban Health Plan, Inc., a network of federally qualified health centers in the boroughs of the Bronx and Queens in New York City, provided HIV screening training for its health-care providers. In January 2011, it modified its electronic medical record system to incorporate HIV test offering. This study compared the 2010 baseline year with the three-year implementation follow-up period (January 2011 through December 2013) to determine the number of eligible individuals for HIV testing, HIV tests offered and performed, HIV-positive individuals, and HIV cases linked to specialty care. A total of 26,853 individuals at baseline and 100,369 individuals in the implementation period were eligible for HIV testing. HIV testing was performed on 2,079 (8%) of 26,853 eligible individuals in 2010 and 49,646 (50%) of 100,369 eligible individuals from 2011 through 2013. HIV-positive status was determined in 19 (0.9%) of 2,079 tested individuals in 2010 and 166 (0.3%) of 49,646 tested individuals from 2011 through 2013. Linkage to care was observed in all 19 eligible individuals and 127 (77%) of 166 eligible individuals who tested HIV positive in 2010 and 2011-2013, respectively. This study enabled routine HIV implementation testing at a community health center network, which resulted in enhanced HIV testing, an increased number of HIV-positive cases identified, and a rise in the number of patients linked to HIV specialist care.

A multicentre randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injections

PubMed Central

Deyle, Gail D; Gill, Norman W; Rhon, Daniel I; Allen, Chris S; Allison, Stephen C; Hando, Ben R; Petersen, Evan J; Dusenberry, Douglas I; Bellamy, Nicholas

2016-01-01

Introduction Corticosteroid injections (CSIs) are commonly used as an initial or a primary intervention for knee osteoarthritis (OA). Consistent evidence indicates CSIs offer symptom relief with conflicting reports regarding long-term efficacy. Physical therapy (PT) offers a non-invasive alternative. There is moderate evidence suggesting short-term and long-term symptom relief and functional improvement with PT interventions. Patients with knee OA are more commonly prescribed CSI than PT prior to total joint replacement. UnitedHealthcare and Military Health System data show substantially more total knee replacement patients receive preoperative CSI than PT. There are no studies comparing CSI to a PT approach in individuals with knee OA. The primary objective of this study is to compare the effectiveness of CSI to PT in individuals with knee OA at 1, 2 and 12 months. Methods and analysis We plan to recruit 156 participants meeting established knee OA criteria. Following informed consent, participants will be randomised to receive either CSI or PT. All participants will receive instruction on recommended exercise and weight control strategies plus usual medical care. The CSI intervention consisting of 3 injections and the PT intervention consisting of 8–12 sessions will be spaced over 12 months. Measures of the dependent variables (DVs) will occur at baseline, 4 weeks, 8 weeks, 6 months and 12 months post enrolment. This pragmatic, randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (CSI and PT) and time with five levels from baseline to 1 year. The primary DV is the Western Ontario & McMaster Universities Arthritis Index (WOMAC). We will also compare healthcare utilisation between the 2 groups. Ethics and Dissemination The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The authors intend to publish the results in a peer-reviewed source. Trial Registration Number NCT01427153. PMID:27033961

Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy.

PubMed

Knackstedt, Christian; Arndt, Marlies; Mischke, Karl; Marx, Nikolaus; Nieman, Fred; Kunert, Hanns Jürgen; Schauerte, Patrick; Norra, Christine

2014-05-01

Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.

Azithromycin buccal patch in treatment of chronic periodontitis.

PubMed

Latif, Sajith Abdul; Vandana, K L; Thimmashetty, J; Dalvi, Priyanka Jairaj

2016-01-01

This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90(th) day, and clinical parameter was assessed at the end of 90(th) day. SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90(th) day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients.

Azithromycin buccal patch in treatment of chronic periodontitis

PubMed Central

Latif, Sajith Abdul; Vandana, K. L.; Thimmashetty, J.; Dalvi, Priyanka Jairaj

2016-01-01

Aim: This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. Materials and Methods: A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90th day, and clinical parameter was assessed at the end of 90th day. Results: SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90th day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. Conclusion: The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients. PMID:27127325

An International Evaluation of Cognitive Reserve and Memory Changes in Early Old Age in 10 European Countries.

PubMed

Cadar, Dorina; Robitaille, Annie; Clouston, Sean; Hofer, Scott M; Piccinin, Andrea M; Muniz-Terrera, Graciela

2017-01-01

Cognitive reserve was postulated to explain individual differences in susceptibility to ageing, offering apparent protection to those with higher education. We investigated the association between education and change in memory in early old age. Immediate and delayed memory scores from over 10,000 individuals aged 65 years and older, from 10 countries of the Survey of Health, Ageing and Retirement in Europe, were modeled as a function of time in the study over an 8-year period, fitting independent latent growth models. Education was used as a marker of cognitive reserve and evaluated in association with memory performance and rate of change, while accounting for income, general health, smoking, body mass index, gender, and baseline age. In most countries, more educated individuals performed better on both memory tests at baseline, compared to those less educated. However, education was not protective against faster decline, except for in Spain for both immediate and delayed recall (0.007 [SE = 0.003] and 0.006 [SE = 0.002]), and Switzerland for immediate recall (0.006 [SE = 0.003]). Interestingly, highly educated Italian respondents had slightly faster declines in immediate recall (-0.006 [SE = 0.003]). We found weak evidence of a protective effect of education on memory change in most European samples, although there was a positive association with memory performance at individuals' baseline assessment. © 2017 The Author(s) Published by S. Karger AG, Basel.

Does experiencing homelessness affect women’s motivation to change alcohol or drug use??

PubMed Central

Upshur, Carole C.; Weinreb, Linda; Cheng, Debbie M.; Kim, Theresa W.; Samet, Jeffrey H.; Saitz, Richard

2013-01-01

Background and Objectives Homeless women are at high risk of drug and alcohol dependence and may receive less opportunity for treatment. Our objective was to examine the association between experiencing homelessness and motivation to change drug or alcohol use. Methods Women (n=154) participants in a study of substance dependence at an urban medical center (69 with some homeless days in the last 90 days; 85 continuously housed at baseline) completed 6 items rating motivation to change alcohol or drug use (i.e., importance, readiness, and confidence) at baseline and in 3, 6, and 12-month follow up interviews. Unadjusted, and longitudinal analyses controlling for covariates (e.g., demographics, insurance status, substance use consequences, mental health status, and participation in treatment), were conducted. Results There were no significant differences between women experiencing homeless days versus continuously housed women in the odds of reporting high motivation to change alcohol or drug use, either in unadjusted baseline analyses or longitudinal analyses adjusted for covariates. Covariates that were significantly associated with high importance, readiness or confidence to change behavior were higher life time consequences of substance use, and participation in 12-step programs. Discussion and Conclusions The findings suggest that clinicians should not make assumptions that homeless women have low motivation to change their substance use. Scientific Significance and Future Directions The same opportunities for addiction treatment should be offered to homeless as to housed women. PMID:24313245

Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh.

PubMed

Kuper, Hannah; Polack, Sarah; Mathenge, Wanjiku; Eusebio, Cristina; Wadud, Zakia; Rashid, Mamunur; Foster, Allen

2010-11-09

Poverty and blindness are believed to be intimately linked, but empirical data supporting this purported relationship are sparse. The objective of this study is to assess whether there is a reduction in poverty after cataract surgery among visually impaired cases. A multi-centre intervention study was conducted in three countries (Kenya, Philippines, Bangladesh). Poverty data (household per capita expenditure--PCE, asset ownership and self-rated wealth) were collected from cases aged ≥50 years who were visually impaired due to cataract (visual acuity<6/24 in the better eye) and age-sex matched controls with normal vision. Cases were offered free/subsidised cataract surgery. Approximately one year later participants were re-interviewed about poverty. 466 cases and 436 controls were examined at both baseline and follow-up (Follow up rate: 78% for cases, 81% for controls), of which 263 cases had undergone cataract surgery ("operated cases"). At baseline, operated cases were poorer compared to controls in terms of PCE (Kenya: $22 versus £35 p = 0.02, Bangladesh: $16 vs $24 p = 0.004, Philippines: $24 vs 32 p = 0.0007), assets and self-rated wealth. By follow-up PCE had increased significantly among operated cases in each of the three settings to the level of controls (Kenya: $30 versus £36 p = 0.49, Bangladesh: $23 vs $23 p = 0.20, Philippines: $45 vs $36 p = 0.68). There were smaller increases in self-rated wealth and no changes in assets. Changes in PCE were apparent in different socio-demographic and ocular groups. The largest PCE increases were apparent among the cases that were poorest at baseline. This study showed that cataract surgery can contribute to poverty alleviation, particularly among the most vulnerable members of society. This study highlights the need for increased provision of cataract surgery to poor people and shows that a focus on blindness may help to alleviate poverty and achieve the Millennium Development Goals.

The effect of timing of incentive payments on response rates for cohort study telephone interviews in primary care setting with cost-minimization analysis, a randomized controlled trial.

PubMed

Chin, Weng-Yee; Choi, Edmond P H; Lam, Cindy L K

2015-10-06

The effect of timing of incentive payments on the response rate of telephone surveys is unknown. This study examined whether up-front or delayed incentive payments were associated with higher response rates for participation in a telephone interview administered longitudinal cohort study amongst primary care patients with lower urinary tract symptoms, and to compare the costs between the two timing methods. This study was conducted as part of a naturalistic observation study on the health-related quality of life and health outcomes of Chinese primary care patients with lower urinary tract symptoms. The incentive payment was in the form of a supermarket gift voucher to the value of HD$50 (US$6.50) and could be used in lieu of cash at a major supermarket chain.720 subjects with lower urinary tract symptoms were randomly assigned into two groups. One group was offered an incentive of supermarket cash voucher at time of recruitment ('up-front' payment). The other group was told that the voucher would be sent to them after the complete of their 1-year follow-up telephone interview ('delayed' payment). Primary outcomes were the baseline and 1-year follow-up telephone survey response rates. There was no statistical difference in response rates at baseline (p-value = 0.938) or at the 1-year follow-up (p-value = 0.751) between groups. Cost per completed subject interviews for the up-front payment method was USD16.64, whilst cost for the delayed payment was USD 13.85. It appears the timing of incentive payments does not affect response rates for telephone interview surveys conducted on primary care patients in Hong Kong at baseline or at 1-year follow-up. Delayed incentive payments can reduce the overall cost per successful case. ClinicalTrials.gov Identifier: NCT02307929 Registered 28 August 2013.

A demonstration of real-time connected element interferometry for spacecraft navigation

NASA Technical Reports Server (NTRS)

Edwards, C.; Rogstad, D.; Fort, D.; White, L.; Iijima, B.

1992-01-01

Connected element interferometry is a technique of observing a celestial radio source at two spatially separated antennas, and then interfering the received signals to extract the relative phase of the signal at the two antennas. The high precision of the resulting phase delay data type can provide an accurate determination of the angular position of the radio source relative to the baseline vector between the two stations. A connected element interferometer on a 21-km baseline between two antennas at the Deep Space Network's Goldstone, CA tracking complex is developed. Fiber optic links are used to transmit the data at 112 Mbit/sec to a common site for processing. A real-time correlator to process these data in real-time is implemented. The architecture of the system is described, and observational data is presented to characterize the potential performance of such a system. The real-time processing capability offers potential advantages in terms of increased reliability and improved delivery of navigational data for time-critical operations. Angular accuracies of 50-100 nrad are achievable on this baseline.

The goldstone real-time connected element interferometer

NASA Technical Reports Server (NTRS)

Edwards, C., Jr.; Rogstad, D.; Fort, D.; White, L.; Iijima, B.

1992-01-01

Connected element interferometry (CEI) is a technique of observing a celestial radio source at two spatially separated antennas and then interfering the received signals to extract the relative phase of the signal at the two antennas. The high precision of the resulting phase delay data type can provide an accurate determination of the angular position of the radio source relative to the baseline vector between the two stations. This article describes a recently developed connected element interferometer on a 21-km baseline between two antennas at the Deep Space Network's Goldstone, California, tracking complex. Fiber-optic links are used to transmit the data to a common site for processing. The system incorporates a real-time correlator to process these data in real time. The architecture of the system is described, and observational data are presented to characterize the potential performance of such a system. The real-time processing capability offers potential advantages in terms of increased reliability and improved delivery of navigational data for time-critical operations. Angular accuracies of 50-100 nrad are achievable on this baseline.

Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations.

PubMed

Blaine, Rachel E; Fisher, Jennifer Orlet; Taveras, Elsie M; Geller, Alan C; Rimm, Eric B; Land, Thomas; Perkins, Meghan; Davison, Kirsten K

2015-07-21

Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012-2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2-12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2-5 years) more snacks to reward behavior (1.9 vs. 1.1, p < 0.001), keep quiet (1.0 vs. 0.5, p < 0.001), and celebrate achievements (1.7 vs. 1.0, p < 0.001) than parents of older children (6-12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70-0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52-0.99), or achievements (OR = 0.82; 95% CI 0.68-0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts.

Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation.

PubMed

Abu Hazeem, Anas A; Gillespie, Matthew J; Thun, Haley; Munson, David; Schwartz, Matthew C; Dori, Yoav; Rome, Jonathan J; Glatz, Andrew C

2013-10-01

To describe our experience with percutaneous closure of patent ductus arteriosus (PDA) in small infants and compare outcomes to matched surgical patients. Ligation via thoracotomy has been used to close PDAs in small infants, but has been associated with respiratory and hemodynamic compromise. We hypothesized that percutaneous closure would offer faster recovery of respiratory function. Patients <4 kg requiring positive pressure ventilation who underwent percutaneous PDA closure between January 2000 and April 2012 were reviewed and matched to contemporary surgical patients on gestational age (GA), birth weight (BW), procedure weight (WT), and ventilation mode. Patients returned to baseline respiratory status when the product of mean airway pressure and FiO2 returned to pre-procedural levels. Eight matched pairs were included. Median BW, GA, and WT were 1.43 kg (0.52-2.97), 29.8 weeks (24-39), and 2.8 kg (2.2-3.9) for catheter patients and 1.55 kg (0.48-3.04), 29 weeks (23-37), and 2.75 kg (2.3-4.2) for surgical patients. Complete PDA closure occurred in all. The median time to return to baseline respiratory status was significantly shorter in the percutaneous group (17 hr (range 0-113) vs. 53 hr (range 13-219), P < 0.05). In the percutaneous group, two patients developed mild aortic coarctation, one mild left pulmonary artery stenosis, and four femoral vascular thromboses which all resolved with medical therapy. Surgical complications included significant respiratory and cardiac compromise, rib fractures and urinary retention. Percutaneous closure of PDA in small infants on respiratory support is equivalent in safety and efficacy and may offer shorter recovery time than surgical ligation. Copyright © 2013 Wiley Periodicals, Inc.

Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India.

PubMed

Sachdeva, Kuldeep Singh; Raizada, Neeraj; Sreenivas, Achuthan; Van't Hoog, Anna H; van den Hof, Susan; Dewan, Puneet K; Thakur, Rahul; Gupta, R S; Kulsange, Shubhangi; Vadera, Bhavin; Babre, Ameet; Gray, Christen; Parmar, Malik; Ghedia, Mayank; Ramachandran, Ranjani; Alavadi, Umesh; Arinaminpathy, Nimalan; Denkinger, Claudia; Boehme, Catharina; Paramasivan, C N

2015-01-01

Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in high-burden settings. This study assessed the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis (PTB) and rifampicin-resistant PTB (DR-TB) cases in India. This demonstration study was implemented in 18 sub-district level TB programme units (TUs) in India in diverse geographic and demographic settings covering a population of 8.8 million. A baseline phase in 14 TUs captured programmatic baseline data, and an intervention phase in 18 TUs had Xpert MTB/RIF offered to all presumptive TB patients. We estimated changes in detection of TB and DR-TB, the former using binomial regression models to adjust for clustering and covariates. In the 14 study TUs, which participated in both phases, 10,675 and 70,556 presumptive TB patients were enrolled in the baseline and intervention phase, respectively, and 1,532 (14.4%) and 14,299 (20.3%) bacteriologically confirmed PTB cases were detected. The implementation of Xpert MTB/RIF was associated with increases in both notification rates of bacteriologically confirmed TB cases (adjusted incidence rate ratio [aIRR] 1.39; CI 1.18-1.64), and proportion of bacteriological confirmed TB cases among presumptive TB cases (adjusted risk ratio (aRR) 1.33; CI 1.6-1.52). Compared with the baseline strategy of selective drug-susceptibility testing only for PTB cases at high risk of drug-resistant TB, Xpert MTB/RIF implementation increased rifampicin resistant TB case detection by over fivefold. Among, 2765 rifampicin resistance cases detected, 1055 were retested with conventional drug susceptibility testing (DST). Positive predictive value (PPV) of rifampicin resistance detected by Xpert MTB/RIF was 94.7% (CI 91.3-98.1), in comparison to conventional DST. Introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case-notification rates of all bacteriologically confirmed TB by 39% and rifampicin-resistant TB case notification by fivefold.

Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India

PubMed Central

Sachdeva, Kuldeep Singh; Raizada, Neeraj; Sreenivas, Achuthan; van't Hoog, Anna H.; van den Hof, Susan; Dewan, Puneet K.; Thakur, Rahul; Gupta, R. S.; Kulsange, Shubhangi; Vadera, Bhavin; Babre, Ameet; Gray, Christen; Parmar, Malik; Ghedia, Mayank; Ramachandran, Ranjani; Alavadi, Umesh; Arinaminpathy, Nimalan; Denkinger, Claudia; Boehme, Catharina; Paramasivan, C. N.

2015-01-01

Background Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in high-burden settings. This study assessed the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis (PTB) and rifampicin-resistant PTB (DR-TB) cases in India. Methods This demonstration study was implemented in 18 sub-district level TB programme units (TUs) in India in diverse geographic and demographic settings covering a population of 8.8 million. A baseline phase in 14 TUs captured programmatic baseline data, and an intervention phase in 18 TUs had Xpert MTB/RIF offered to all presumptive TB patients. We estimated changes in detection of TB and DR-TB, the former using binomial regression models to adjust for clustering and covariates. Results In the 14 study TUs, which participated in both phases, 10,675 and 70,556 presumptive TB patients were enrolled in the baseline and intervention phase, respectively, and 1,532 (14.4%) and 14,299 (20.3%) bacteriologically confirmed PTB cases were detected. The implementation of Xpert MTB/RIF was associated with increases in both notification rates of bacteriologically confirmed TB cases (adjusted incidence rate ratio [aIRR] 1.39; CI 1.18-1.64), and proportion of bacteriological confirmed TB cases among presumptive TB cases (adjusted risk ratio (aRR) 1.33; CI 1.6-1.52). Compared with the baseline strategy of selective drug-susceptibility testing only for PTB cases at high risk of drug-resistant TB, Xpert MTB/RIF implementation increased rifampicin resistant TB case detection by over fivefold. Among, 2765 rifampicin resistance cases detected, 1055 were retested with conventional drug susceptibility testing (DST). Positive predictive value (PPV) of rifampicin resistance detected by Xpert MTB/RIF was 94.7% (CI 91.3-98.1), in comparison to conventional DST. Conclusion Introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case-notification rates of all bacteriologically confirmed TB by 39% and rifampicin-resistant TB case notification by fivefold. PMID:25996389

Efficacy and Safety of Sarecycline, a Novel, Once-Daily, Narrow Spectrum Antibiotic for the Treatment of Moderate to Severe Facial Acne Vulgaris: Results of a Phase 2, Dose-Ranging Study.

PubMed

Leyden, James J; Sniukiene, Vilma; Berk, David R; Kaoukhov, Alexandre

2018-03-01

There is a need for new oral antibiotics for acne with improved safety profiles and targeted antibacterial spectra. Sarecycline is a novel, tetracycline-class antibiotic specifically designed for acne, offering a narrow spectrum of activity compared with currently available tetracyclines, including less activity against enteric Gram-negative bacteria. This phase 2 study evaluated the efficacy and safety of three doses of sarecycline for moderate to severe facial acne vulgaris. In this multicenter, double-blind, placebo-controlled study, patients aged 12 to 45 years were randomized to once-daily sarecycline 0.75 mg/kg, 1.5 mg/kg, 3.0 mg/kg, or placebo. Efficacy analyses included change from baseline in inflammatory and noninflammatory lesion counts at week 12, with between-group comparisons using analysis of covariance. Safety assessments included adverse events (AEs), clinical laboratories, vital signs, electrocardiograms, and physical examinations. Overall, 285 randomized patients received at least one dose of study drug. At week 12, sarecycline 1.5 mg/kg and 3.0 mg/kg groups demonstrated significantly reduced inflammatory lesions from baseline (52.7% and 51.8%, respectively) versus placebo (38.3%; P=0.02 and P=0.03, respectively). Sarecycline was safe and well tolerated, with similar gastrointestinal AE rates in sarecycline and placebo groups. Vertigo and photosensitivity AEs occurred in less than 1% of patients when pooling sarecycline groups; no vulvovaginal candidiasis AEs occurred. Discontinuation rates due to AEs were low. No serious AEs occurred. Once-daily sarecycline 1.5 mg/kg significantly reduced inflammatory lesions versus placebo and was safe and well tolerated with low rates of AEs, including gastrointestinal AEs. Sarecycline 3.0 mg/kg did not result in additional efficacy versus 1.5 mg/kg. Sarecycline may represent a novel, once-daily treatment for patients with moderate to severe acne. It offers a narrow antibacterial spectrum relative to other tetracycline options, which may lead to less selective pressure on enteric Gram-negative bacteria, resulting in less disruption of commensal organisms and less potential for antibiotic resistance.

J Drugs Dermatol. 2018;17(3):333-338.

Environmental variation and macrofauna response in a coastal area influenced by land runoff

NASA Astrophysics Data System (ADS)

Akoumianaki, Ioanna; Papaspyrou, Sokratis; Kormas, Konstantinos Ar.; Nicolaidou, Artemis

2013-11-01

Macrofauna community interactions with environmental variables in the water column (salinity, temperature, turbidity, transparency, suspended particulate matter, particulate organic matter, choloroplastic pigments) and in the sediment (granulometric variables, organic carbon and pigments) were investigated in a coastal area with high land runoff due to riverine and temporary stream discharges (Greece, Aegean Sea, Maliakos Gulf). Samples were taken along a distance-depositional gradient from the river mouth to the open sea at eight stations, at times of different precipitation regime from August 2000 to May 2001. The physical variables, such as transparency and median grain size, generally increased seawards, and parallelled the depositional gradient as opposed to measures of food inputs and hydrodynamic regime. High environmental heterogeneity was observed during peak precipitation. The total number of species increased seawards and from August (122 species) to May (170 species). Maximum abundance also increased from August (4953 m-2) to May (10,220 individuals m-2), irrespective of distance from river mouth. Species belonging to different functional groups, as to recolonization, feeding, motility and substrate preferences, coexisted at all times indicating high functional diversity. Non-parametric multivariate regression showed that at times of low, rising and falling precipitation 78-81% of community variation was explained by environmental variables, indicating that macrofauna distribution and species composition respond to food inputs and sediment characteristics. During peak land runoff the community-environment relationship weakened (57% of the variability explained). The diversity of functional traits of the most abundant species indicates that the macrofauna community can absorb the impact of increased turbidity, sedimentation and current-driven dispersion. The study offers baseline information for the integrated coastal zone management in microtidal areas with high land runoff under Mediterranean-type climate conditions. During peak land runoff the community-environment relationship weakened (57% of the variability explained) whilst species distribution ranges increased. The study shows that the functional diversity in the study area prior to high discharge period enable macrofauna community to absorb the impact of increased turbidity, sedimentation and current-driven dispersion. The study offers baseline information for the impact of high land runoff in microtidal areas under Mediterranean-type climate conditions.

Maintenance of a smoking cessation program in public health clinics beyond the experimental evaluation period.

PubMed Central

Manfredi, C.; Crittenden, K.; Cho, Y. I.; Engler, J.; Warnecke, R.

2001-01-01

OBJECTIVES: As phase 3 of a study to evaluate a smoking cessation program in public health practice, the authors assess the maintenance and impact of the It's Time smoking cessation program in seven public maternal and child health clinics in Chicago. METHODS: The authors interviewed 404 clinic patients in the study's baseline phase (prior to introduction of the It's Time intervention program), and 610 in the program maintenance phase (in the year after experimental evaluation had ended) to assess exposure to smoking cessation interventions offered at the clinic, and smoking cessation outcomes (quit, actions toward quitting, scores on action, motivation, readiness, and confidence scales). The authors controlled for clustering of smokers within clinics, smokers' characteristics prior to clinic visit, and type of clinic service. They compared outcomes by study group (control or intervention) to which each clinic had been assigned in the earlier experimental phase. RESULTS: Compared to baseline, smokers in the maintenance phase had greater exposure to posters, provider advice and booklet, and better outcomes on seven of eight smoking cessation measures, including quitting. These improvements were larger for clinics with prior experience implementing It's Time. CONCLUSION: Participation in the experimental evaluation of the It's Time program prepared and possibly motivated the clinics to continue the program. Continuing the program resulted in greater delivery of interventions and improved smoking cessation outcomes for smokers in the clinics. PMID:11889280

Treatment of verb anomia in aphasia: efficacy of self-administered therapy using a smart tablet.

PubMed

Lavoie, Monica; Routhier, Sonia; Légaré, Annie; Macoir, Joël

2016-01-01

Aphasia is a chronic condition that usually requires long-term rehabilitation. However, even if many effective treatments can be offered to patients and families, speech therapy services for individuals with aphasia often remain limited because of logistical and financial considerations, especially more than 6 months after stroke. Therefore, the need to develop tools to maximize rehabilitation potential is unquestionable. The aim of this study was to test the efficacy of a self-administered treatment delivered with a smart tablet to improve written verb naming skills in CP, a 63-year-old woman with chronic aphasia. An ABA multiple baseline design was used to compare CP's performance in verb naming on three equivalent lists of stimuli trained with a hierarchy of cues, trained with no cues, and not trained. Results suggest that graphemic cueing therapy, done four times a week for 3 weeks, led to better written verb naming compared to baseline and to the untrained list. Moreover, generalization of the effects of treatment was observed in verb production, assessed with a noun-to-verb production task. Results of this study suggest that self-administered training with a smart tablet is effective in improving naming skills in chronic aphasia. Future studies are needed to confirm the effectiveness of new technologies in self-administered treatment of acquired language deficits.

Azelaic acid 15% gel once daily versus twice daily in papulopustular rosacea.

PubMed

Thiboutot, Diane M; Fleischer, Alan B; Del Rosso, James Q; Graupe, Klaus

2008-06-01

Twice-daily azelaic acid (AzA) is the conventional regimen for papulopustular rosacea, but once-daily AzA may be equally effective, with greater convenience and dosing flexibility. In order to test this hypothesis, an exploratory study was conducted. The evaluable efficacy population of this 12-week double-blind, parallel-group study included 72 patients and the population that was used to report safety results included 92 patients. Baseline characteristics were comparable between the once-daily and twice-daily study groups. Evaluations were performed at baseline and at weeks 4, 8, and 12. No significant difference was found between the once-daily and twice-daily groups at the end of study therapy in mean investigator global assessment (IGA) scores, treatment success, or treatment response. The mean number of inflammatory lesions, the intensity of erythema intensity, and the intensity of telangiectasia at treatment end were likewise not significantly different (P>.205 for all). More than 90% of subjects in each group rated cosmetic acceptability of this AzA gel as satisfactory or better. Based on these findings and those of prior studies, once-daily AzA 15% gel can therefore be utilized as a safe, effective, and economical dosing option for the treatment of mild-to-moderate papulopustular rosacea. Once-daily dosing of AzA 15% gel was well accepted by patients and can offer considerable dosing flexibility and convenience for the patient as well as for the dermatologist.

Yoga and Physical Rehabilitation Medicine: A Research Partnership in Integrative Care

PubMed Central

Middleton, KR; Acevedo, AT; Dietz, L; Brandon, Z; Andrade, R; Wallen, GR

2014-01-01

Mind-body interventions, such as yoga, that teach stress management with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. In order to be considered as viable care options integrative studies need to offer a comprehensive design and include clinicians familiar with the disease process of the study populations. A review of the literature reveals a dearth of information related to the collaboration between yoga and physical rehabilitation medicine. This article discusses the collaboration with physical rehabilitation medicine to collect relevant pre- and post-intervention measures for an on-going pilot acceptability/feasibility yoga study for minority patients with osteoarthritis or rheumatoid arthritis. An interdisciplinary clinical research team selected psychosocial and physical measures for a community sample of bilingual minority patients, not typically identified as practicing yoga. Sixteen female adults aged 40–63 years (mean =51) completed baseline physical assessments using single leg stance, functional reach test, time up and go test, timed up from the floor test and the Disabilities of the Arm, Shoulder and Hand measures. Baseline values show an average level of functional ability prior to beginning the intervention. Preliminary results indicate some improvement; however, selected measures may not have the sensitivity and specificity needed to identify significant change. In this study, combining interdisciplinary perspectives enhanced the quality of the research study design. The experience of this interdisciplinary clinical research team opens the discussion for future collaborations. PMID:24765541

The Most Compact Bright Radio-loud AGNs. II. VLBA Observations of 10 Sources at 43 and 86 GHz

NASA Astrophysics Data System (ADS)

Cheng, X.-P.; An, T.; Hong, X.-Y.; Yang, J.; Mohan, P.; Kellermann, K. I.; Lister, M. L.; Frey, S.; Zhao, W.; Zhang, Z.-L.; Wu, X.-C.; Li, X.-F.; Zhang, Y.-K.

2018-01-01

Radio-loud active galactic nuclei (AGNs), hosting powerful relativistic jet outflows, provide an excellent laboratory for studying jet physics. Very long baseline interferometry (VLBI) enables high-resolution imaging on milli-arcsecond (mas) and sub-mas scales, making it a powerful tool to explore the inner jet structure, shedding light on the formation, acceleration, and collimation of AGN jets. In this paper, we present Very Long Baseline Array observations of 10 radio-loud AGNs at 43 and 86 GHz that were selected from the Planck catalog of compact sources and are among the brightest in published VLBI images at and below 15 GHz. The image noise levels in our observations are typically 0.3 and 1.5 mJy beam‑1 at 43 and 86 GHz, respectively. Compared with the VLBI data observed at lower frequencies from the literature, our observations with higher resolutions (with the highest resolution being up to 0.07 mas at 86 GHz and 0.18 mas at 43 GHz) and at higher frequencies detected new jet components at sub-parsec scales, offering valuable data for studies of the physical properties of the innermost jets. These include the compactness factor of the radio structure (the ratio of core flux density to total flux density), and core brightness temperature ({T}{{b}}). In all these sources, the compact core accounts for a significant fraction (> 60 % ) of the total flux density. Their correlated flux density at the longest baselines is higher than 0.16 Jy. The compactness of these sources make them good phase calibrators of millimeter-wavelength ground-based and space VLBI.

The Effectiveness of a Peer Coaching Education on Control and Management of Type 2 Diabetes in Women: A Protocol for a Randomized Controlled Trial.

PubMed

Aalaa, Maryam; Sanjari, Mahnaz; Aghaei Meybodi, Hamid Reza; Amini, Mohammad Reza; Qorbani, Mostafa; Adibi, Hossien; Mehrdad, Neda

2017-04-01

Diabetes Education by Peer Coaching is a strategy which helps the patients with diabetes in the field of behavioral and emotional problems. However, the results of studies in this field in other countries could not be generalized in our context. So, the current study aimed to examine the effectiveness of Diabetes Education by Peer Coaching on Diabetes Management. Outcome variables for patients and peer coaches are measured at baseline and in3,6 and 12 months. The primary outcome consisted of Fasting Blood Sugar (FBS) and HbA1c. Secondary outcomes included Blood Pressure (BP), Body Mass Index (BMI,) Waist-Hip Ratio (WHR), Lipid Profile, diabetes self-care activities, diabetes-related quality of life, depression, and Social Capital levels.Initial analyses compared the frequency of baseline levels of outcome and other variables using a simple Chi-square test, t-test and the Mann-Whitney- U test. Sequential measurements in each group were evaluated by two-way analysis of variance. If significant differences in baseline characteristics were found, analyses were repeated adjusting for these differences using ANOVA and logistic regression for multivariate analyses. Additional analyses were conducted to look for the evidence of effect modification by pre-specified subgroups. The fact is that self-control and self-efficacy in diabetes management and treatment of diabetes could be important components. It seems that this research in this special setting with cultural differences would provide more evidence about peer-coaching model. It seems that if the peer-coaching model improves learning situations between patients with diabetes by offering one-on-one Diabetes Self Management Education, it could be an interactive approach to diabetic education. Trial Registration Number: IRCT201501128175N3.

Methods and baseline characteristics of a randomized trial treating early childhood obesity: the Positive Lifestyles for Active Youngsters (Team PLAY) trial.

PubMed

Hare, Marion E; Coday, Mace; Williams, Natalie A; Richey, Phyllis A; Tylavsky, Frances A; Bush, Andrew J

2012-05-01

There are few effective obesity interventions directed towards younger children, particularly young minority children. This paper describes the design, intervention, recruitment methods, and baseline data of the ongoing Positive Lifestyles for Active Youngsters (Team PLAY) study. This randomized controlled trial is designed to test the efficacy of a 6-month, moderately intense, primary care feasible, family-based behavioral intervention, targeting both young children and their parent, in promoting healthy weight change. Participants are 270 overweight and obese children (ages 4 to 7 years) and their parents, who were recruited from a primarily African American urban population. Parents and children were instructed in proven cognitive behavioral techniques (e.g. goal setting, self-talk, stimulus control and reinforcement) designed to encourage healthier food choices (more whole grains, fruits and vegetables, and less concentrated fats and sugar), reduce portion sizes, decrease sweetened beverages and increase moderate to vigorous physical activity engagement. The main outcome of this study is change in BMI at two year post enrollment. Recruitment using reactive methods (mailings, TV ads, pamphlets) was found to be more successful than using only a proactive approach (referral through physicians). At baseline, most children were very obese with an average BMI z-score of 2.6. Reported intake of fruits and vegetables and minutes of moderate to vigorous physical activity engagement did not meet national recommendations. If efficacious, Team PLAY would offer a model for obesity treatment directed at families with young children that could be tested and translated to both community and primary care settings. Copyright © 2012 Elsevier Inc. All rights reserved.

The Role of Social Support in Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder.

PubMed

Shnaider, Philippe; Sijercic, Iris; Wanklyn, Sonya G; Suvak, Michael K; Monson, Candice M

2017-05-01

The current study examined the effect of total, as well as different sources (i.e., family, friends, significant other) of, pretreatment/baseline social support on posttraumatic stress disorder (PTSD) severity and treatment response to cognitive-behavioral conjoint therapy (CBCT) for PTSD. Thirty-six patients were randomized to receive treatment immediately or to a waitlist condition. Those in the treatment condition were offered CBCT for PTSD, a couple-based therapy aimed at reducing PTSD symptoms and improving relationship functioning. PTSD symptoms were assessed at pre-/baseline, mid-/4 weeks of waiting, and posttreatment/12 weeks of waiting using the Clinician-Administered PTSD Scale, and patients self-reported on their levels of pretreatment/baseline social support using the Multidimensional Scale of Perceived Social Support. Total support, as well as social support from family and friends, was not associated with initial PTSD severity or treatment response. However, there was a significant positive association between social support from a significant other and initial PTSD severity (g = .92). Additionally, significant other social support moderated treatment outcomes, such that higher initial significant other support was associated with larger decreases in PTSD severity for those in the treatment condition (g = -1.14) but not the waitlist condition (g = -.04). Social support from a significant other may influence PTSD treatment outcomes within couple therapy for PTSD. The inclusion of intimate partners and other family members may be a fruitful avenue for improving PTSD treatment outcomes; however, future studies are needed to examine whether support can be increased with treatment and whether those improvements lead to greater PTSD symptom response. Copyright © 2016. Published by Elsevier Ltd.

Use of Self-Matching to Control for Stable Patient Characteristics While Addressing Time-Varying Confounding on Treatment Effect: A Case Study of Older Intensive Care Patients.

PubMed

Han, Ling; Pisani, M A; Araujo, K L B; Allore, Heather G

Exposure-crossover design offers a non-experimental option to control for stable baseline confounding through self-matching while examining causal effect of an exposure on an acute outcome. This study extends this approach to longitudinal data with repeated measures of exposure and outcome using data from a cohort of 340 older medical patients in an intensive care unit (ICU). The analytic sample included 92 patients who received ≥1 dose of haloperidol, an antipsychotic medication often used for patients with delirium. Exposure-crossover design was implemented by sampling the 3-day time segments prior ( Induction) and posterior ( Subsequent) to each treatment episode of receiving haloperidol. In the full cohort, there was a trend of increasing delirium severity scores (Mean±SD: 4.4±1.7) over the course of the ICU stay. After exposure-crossover sampling, the delirium severity score decreased from the Induction (4.9) to the Subsequent (4.1) intervals, with the treatment episode falling in-between (4.5). Based on a GEE Poisson model accounting for self-matching and within-subject correlation, the unadjusted mean delirium severity scores was -0.55 (95% CI: -1.10, -0.01) points lower for the Subsequent than the Induction intervals. The association diminished by 32% (-0.38, 95%CI: -0.99, 0.24) after adjusting only for ICU confounding, while being slightly increased by 7% (-0.60, 95%CI: -1.15, -0.04) when adjusting only for baseline characteristics. These results suggest that longitudinal exposure-crossover design is feasible and capable of partially removing stable baseline confounding through self-matching. Loss of power due to eliminating treatment-irrelevant person-time and uncertainty around allocating person-time to comparison intervals remain methodological challenges.

Increase in slow-wave vasomotion by hypoxia and ischemia in lowlanders and highlanders.

PubMed

Salvi, Paolo; Faini, Andrea; Castiglioni, Paolo; Brunacci, Fausto; Montaguti, Luca; Severi, Francesca; Gautier, Sylvie; Pretolani, Enzo; Benetos, Athanase; Parati, Gianfranco

2018-06-21

The physiological relevance of slow-wave vasomotion is still unclear, even it has been hypothesized it could be a compensatory mechanism enhancing tissue oxygenation in conditions of reduced oxygen supply. Aim of our study was to explore the effects of hypoxia and ischemia on slow-wave vasomotion in microcirculation. Peripheral oxygen saturation and forearm microcirculation flow (laser-Doppler flowmetry) were recorded at baseline and during post-occlusive reactive hyperemia in the Himalaya region from 8 European lowlanders (6 males; aged 29-39yrs) at 1350, 3400 and 5050m, and from 10 Nepalese male highlanders (aged 21-39yrs) at 3400 and 5050m of altitude. The same measurements were also performed at sea level in 16 healthy volunteers (aged 23-61yrs) during a short-term exposure to normobaric hypoxia. In lowlanders, exposure to progressively higher altitude under baseline flow conditions progressively increased 0.06-0.15Hz vasomotion amplitude [power spectral density % expressed as geometric means (geometric standard deviation) =14.0(3.6) at 1350m; 87.0(2.3) at 3400m and 249.8(3.6) at 5050m, p=0.006 and p<0.001 vs 1350m, respectively]. In highlanders, low frequency vasomotion amplitude was similarly enhanced at different altitudes [power spectral density % =183.4(4.1) at 3400m vs 236.0(3.0) at 5050m, p=0.139]. In both groups at altitude it was further increased after ischemic stimulus (p<0.001). At baseline, acute short lasting normobaric hypoxia did not induce low frequency vasomotion, which was conversely induced by ischemia even under normal oxygenation and barometric pressure. This study offers the demonstration of a significant increase in slow-wave vasomotion under prolonged hypobaric-hypoxia exposure at high altitude, with a further enhancement after ischemia induction.

Overdentures in the edentulous mandible supported by implants and retained by a Dolder bar: a 5-year prospective study.

PubMed

Heschl, Alexander; Payer, Michael; Clar, Volker; Stopper, Marlene; Wegscheider, Walther; Lorenzoni, Martin

2013-08-01

This prospective study was performed to evaluate the outcomes of XiVE® S plus implants (Dentsply Friadent, Mannheim, Germany) following conventional restoration with bar structures and overdentures in the edentulous mandible. A total of 39 patients were treated with four interforaminal implants (n = 156) splinted by a Dolder bar. Overdentures were attached to the bars after 3 months of healing. As primary outcome measures, clinical and radiological parameters were evaluated at the time of implant placement (baseline) and once a year (1, 2, 3, 4, 5 years) after functional loading. Secondary outcome measures included (i) primary stability and surgical complications, as well as (ii) Periotest® (Medizintechnik Gulden, Modautal, Germany) values, implant survival, and prosthetic complications at baseline and follow-up. A total of 156 implants were placed. The vast majority (n = 149) were tightened to >30 Ncm, while torques in the range of 20-30 Ncm were obtained in the remaining cases (n = 7). Mean crestal bone levels around the implants were 0.41 mm at baseline and 1.04/1.20/1.34/1.45/1.44 mm after 1/2/3/4/5 years respectively. The mean values of the plaque, calculus, bleeding, and mucosal indices remained low throughout this period. The reported follow-up periods involved one implant loss after 3 months (survival rate: 99.4%) and one implant failure after 4 years (success rate: 98.4%). Prosthetic complications included factures of bars (n = 3) and denture teeth (n = 7). Prosthetic survival was 100%. Dolder bars to restore oral implants in the edentulous mandible appear to offer a high rate of implant survival, good stability of the peri-implant tissue, and a low rate of prosthetic complications. © 2011 Wiley Periodicals, Inc.

Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: the RAPID Study.

PubMed

Ackermann, Ronald T; Finch, Emily A; Schmidt, Karen K; Hoen, Helena M; Hays, Laura M; Marrero, David G; Saha, Chandan

2014-01-01

Reaching Out and Preventing Increases in Diabetes (RAPID) is a community-based randomized trial evaluating the comparative costs and effectiveness of a group-based adaption of the DPP lifestyle intervention developed and implemented in partnership with the YMCA. RAPID enrolled adult primary care patients, with BMI 24 kg/m(2) or higher and abnormal glucose metabolism (HbA1c 5.7-6.9% or fasting plasma glucose 100-125 mg/dL). 509 participants were enrolled and randomized to one of two groups: standard clinical advice plus free-of-charge access to a group-based adaption of the DPP offered by the Y, versus standard clinical advice alone. Key outcomes for future analysis will include differences in body weight and other cardiovascular risk factors over a 24-month intervention period. At baseline, RAPID participants had a mean (SD) age of 51 ± 12.1 years, weight of 225.1 ± 56.2 lbs, and BMI of 36.9 ± 8.6 kg/m(2). 70.7% were women, 57.2% were African American, 35.4% were non-Hispanic White, and 3.2% were Hispanic. Mean HbA1c was 6.05 ± 0.34%. Additionally, 55.4% of participants had a baseline systolic blood pressure of ≥130 mmHg, 33.1% had a total blood cholesterol exceeding 200mg/dL, and 74% reported a household income of <$25,000. The RAPID Study successfully randomized a large cohort of participants with a wide distribution of age, body weight, and race who are at high risk for developing type 2 diabetes. © 2013.

Predictors of needle exchange program utilization during its implementation and expansion in Tijuana, Mexico.

PubMed

Smith, Danielle M; Werb, Dan; Abramovitz, Daniela; Magis-Rodriguez, Carlos; Vera, Alicia; Patterson, Thomas L; Strathdee, Steffanie A

2016-03-01

Until the early 2000s, there was only one needle exchange program (NEP) offered in Mexico. In 2004, the second Mexican NEP opened in Tijuana, but its utilization has not been studied. We studied predictors of initiating NEP during its early expansion in Tijuana, Mexico. From April 2006 to April 2007, people who inject drugs (PWID) residing in Tijuana who had injected within the last month were recruited using respondent-driven sampling. Weighted Poisson regression incorporating generalized estimating equations was used to identify predictors of initiating NEP, while accounting for correlation between recruiter and recruits. NEP uptake increased from 20% at baseline to 59% after 6 months. Among a subsample of PWID not accessing NEP at baseline (n = 480), 83% were male and median age was 37 years (Interquartile Range: 32-43). At baseline, 4.4% were HIV-infected and 5.9% had syphilis titers >1:8. In multivariate models, factors associated with NEP initiation (p < .05) were attending shooting galleries (Adjusted Relative Risk [ARR]: 1.54); arrest for track-marks (ARR: 1.38); having a family member that ever used drugs (ARR: 1.37); and having a larger PWID network (ARR: 1.01 per 10 persons). NEP initiation was inversely associated with obtaining syringes at pharmacies (ARR: .56); earning >2500 pesos/month (ARR: .66); and reporting needle sharing (ARR: .71). Uptake of NEP expansion in Tijuana was vigorous among PWID. We identified a range of factors that influenced the likelihood of NEP initiation, including police interaction. These findings have important implications for the scale-up of NEP in Mexico. © American Academy of Addiction Psychiatry.

Unexpected high vulnerability of functions in wilderness areas: evidence from coral reef fishes.

PubMed

D'agata, Stéphanie; Vigliola, Laurent; Graham, Nicholas A J; Wantiez, Laurent; Parravicini, Valeriano; Villéger, Sébastien; Mou-Tham, Gerard; Frolla, Philippe; Friedlander, Alan M; Kulbicki, Michel; Mouillot, David

2016-12-14

High species richness is thought to support the delivery of multiple ecosystem functions and services under changing environments. Yet, some species might perform unique functional roles while others are redundant. Thus, the benefits of high species richness in maintaining ecosystem functioning are uncertain if functions have little redundancy, potentially leading to high vulnerability of functions. We studied the natural propensity of assemblages to be functionally buffered against loss prior to fishing activities, using functional trait combinations, in coral reef fish assemblages across unfished wilderness areas of the Indo-Pacific: Chagos Archipelago, New Caledonia and French Polynesia. Fish functional diversity in these wilderness areas is highly vulnerable to fishing, explained by species- and abundance-based redundancy packed into a small combination of traits, leaving most other trait combinations (60%) sensitive to fishing, with no redundancy. Functional vulnerability peaks for mobile and sedentary top predators, and large species in general. Functional vulnerability decreases for certain functional entities in New Caledonia, where overall functional redundancy was higher. Uncovering these baseline patterns of functional vulnerability can offer early warning signals of the damaging effects from fishing, and may serve as baselines to guide precautionary and even proactive conservation actions. © 2016 The Author(s).

Unexpected high vulnerability of functions in wilderness areas: evidence from coral reef fishes

PubMed Central

Vigliola, Laurent; Graham, Nicholas A. J.; Wantiez, Laurent; Parravicini, Valeriano; Villéger, Sébastien; Mou-Tham, Gerard; Frolla, Philippe; Friedlander, Alan M.; Kulbicki, Michel; Mouillot, David

2016-01-01

High species richness is thought to support the delivery of multiple ecosystem functions and services under changing environments. Yet, some species might perform unique functional roles while others are redundant. Thus, the benefits of high species richness in maintaining ecosystem functioning are uncertain if functions have little redundancy, potentially leading to high vulnerability of functions. We studied the natural propensity of assemblages to be functionally buffered against loss prior to fishing activities, using functional trait combinations, in coral reef fish assemblages across unfished wilderness areas of the Indo-Pacific: Chagos Archipelago, New Caledonia and French Polynesia. Fish functional diversity in these wilderness areas is highly vulnerable to fishing, explained by species- and abundance-based redundancy packed into a small combination of traits, leaving most other trait combinations (60%) sensitive to fishing, with no redundancy. Functional vulnerability peaks for mobile and sedentary top predators, and large species in general. Functional vulnerability decreases for certain functional entities in New Caledonia, where overall functional redundancy was higher. Uncovering these baseline patterns of functional vulnerability can offer early warning signals of the damaging effects from fishing, and may serve as baselines to guide precautionary and even proactive conservation actions. PMID:27928042

Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

PubMed Central

Swanson, Jeffrey W.; Appelbaum, Paul S.; Swartz, Marvin S.; Ferron, Joelle; Van Dorn, Richard A.; Wagner, H. Ryan

2013-01-01

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N = 469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid. PMID:17294136

Vertebral column resection for the treatment of severe spinal deformity.

PubMed

Lenke, Lawrence G; Sides, Brenda A; Koester, Linda A; Hensley, Marsha; Blanke, Kathy M

2010-03-01

The ability to treat severe pediatric and adult spinal deformities through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in primary and revision surgery, but there is limited literature evaluating this new approach. Our purpose was therefore to provide further support of this technique. We reviewed 43 patients who underwent a posterior-only VCR using pedicle screws, anteriorly positioned cages, and intraoperative spinal cord monitoring between 2002 and 2006. Diagnoses included severe scoliosis, global kyphosis, angular kyphosis, or kyphoscoliosis. Forty (93%) procedures were performed at L1 or cephalad in the spinal cord (SC) territory. Seven patients (18%) lost intraoperative neurogenic monitoring evoked potentials (NMEPs) data during correction with data returning to baseline after prompt surgical intervention. All patients after surgery were at their baseline or showed improved SC function, whereas no one worsened. Two patients had nerve root palsies postoperatively, which resolved spontaneously at 6 months and 2 weeks. Spinal cord monitoring (specifically NMEP) is mandatory to prevent neurologic complications. Although technically challenging, a single-stage approach offers dramatic correction in both primary and revision surgery of severe spinal deformities. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Novel Soy Germ Pasta Enriched in Isoflavones Ameliorates Gastroparesis in Type 2 Diabetes

PubMed Central

Setchell, Kenneth D.R.; Nardi, Elisabetta; Battezzati, Pier-Maria; Asciutti, Stefania; Castellani, Danilo; Perriello, Gabriele; Clerici, Carlo

2013-01-01

OBJECTIVE To determine the effect of soy germ pasta enriched in biologically active isoflavone aglycons on gastric emptying in type 2 diabetic patients with gastroparesis. RESEARCH DESIGN AND METHODS This randomized double-blind, placebo-controlled study compared soy germ pasta with conventional pasta for effects on gastric emptying. Patients (n = 10) with delayed gastric emptying consumed one serving per day of each pasta for 8 weeks, with a 4-week washout. Gastric emptying time (t1/2) was measured using the [13C]octanoic acid breath test at baseline and after each period, and blood glucose and insulin concentrations were determined after oral glucose load. RESULTS Soy germ pasta significantly accelerated the t1/2 in these patients (161.2 ± 17.5 min at baseline vs. 112.6 ± 11.2 min after treatment, P = 0.009). Such change differed significantly (P = 0.009) from that for conventional pasta (153.6 ± 24.2 vs. 156.2 ± 27.4 min), without affecting glucose or insulin concentrations. CONCLUSIONS These findings suggest that soy germ pasta may offer a simple dietary approach to managing diabetic gastropathy. PMID:23835688

Using social network analysis to examine collaborative relationships among PhD and DNP students and faculty in a research-intensive university school of nursing.

PubMed

Merrill, Jacqueline A; Yoon, Sunmoo; Larson, Elaine; Honig, Judy; Reame, Nancy

2013-01-01

The nursing profession has seen a dramatic rise in the number of schools offering both DNP and PhD nursing programs. Information is limited on the impact of this parallel approach in doctoral education on the quality and scope of scholarly interactions or institutional culture.The authors studied collaboration characteristics across the DNP and PhD programs of a research-intensive university school of nursing, before and after programmatic enhancements. An IRB-approved online survey was delivered to faculty and students of both programs at baseline and one year after curricular changes. Response rates were 70% and 74%, respectively. The responses were analyzed by using social network analysis and descriptive statistics to characterize the number and strength of connections between and within student groups, and between students and faculty. At baseline, the flow of communication was centralized primarily through faculty. At Time 2, density of links between students increased and network centralization decreased, suggesting more distributed communication. This nonlinear quantitative approach may be a useful addition to the evaluation strategies for doctoral education initiatives. Copyright © 2013 Elsevier Inc. All rights reserved.

Return to work predictors of stroke survivors and their spousal caregivers.

PubMed

Schulz, Celia H; Godwin, Kyler M; Hersch, Gayle I; Hyde, Leslie K; Irabor, Jocelyn J; Ostwald, Sharon K

2017-01-01

Return to work is an issue of concern for stroke survivors and their spouses. Ramifications may include loss of income and self-efficacy. This study describes the return to work patterns of stroke survivors and their spousal caregivers post stroke. One hundred fifty-nine dyads were examined for their return to work patterns at baseline (post hospital discharge) and then at 3 month intervals for one year. Relationships were determined between work and gender, age, ethnicity, education, type of insurance, type of stroke, location of stroke, motor and cognitive functional status, depression, mutuality, and life satisfaction. Low levels of return to work by stroke survivors (7.5%) and a small decrease in the amount of working caregivers (from 45.3% to 40.35%) were found one year post baseline. Variables that predicted return to work changed over the five data points except for younger age for the caregiver, which was consistently significant across all data points. Three case scenarios representative of working patterns are offered. Further research is needed regarding the return to work needs of stroke survivors and their spousal caregivers, particularly what role the occupational therapist may play in facilitating that process.

Cohort profile: LIFEWORK, a prospective cohort study on occupational and environmental risk factors and health in the Netherlands.

PubMed

Reedijk, Marije; Lenters, Virissa; Slottje, Pauline; Pijpe, Anouk; Peeters, Petra H; Korevaar, Joke C; Bueno-de-Mesquita, Bas; Verschuren, W M Monique; Verheij, Robert A; Pieterson, Inka; van Leeuwen, Flora E; Rookus, Matti A; Kromhout, Hans; Vermeulen, Roel C H

2018-02-03

LIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we describe the study design, ongoing data collection, baseline characteristics of participants and the repeatability of key questionnaire items. 88 466 participants were enrolled in three cohort studies in 2011-2012. Exposure information was collected by a harmonised core questionnaire, or modelled based on occupational and residential histories; domains include air pollution (eg, nitrogen dioxide (NO 2 ), particulate matter with diameter ≤2.5 µm (PM 2.5 )), noise, electromagnetic fields (EMF), mobile phone use, shift work and occupational chemical exposures. Chronic and subacute health outcomes are assessed by self-report and through linkage with health registries. Participants had a median age of 51 years at baseline (range 19-87), and the majority are female (90%), with nurses being over-represented. Median exposure levels of NO 2 , PM 2.5 , EMF from base stations and noise at the participants' home addresses at baseline were 22.9 µg/m 3 , 16.6 µg/m 3 , 0.003 mWm 2 and 53.1 dB, respectively. Twenty-two per cent of participants reported to have started using a mobile phone more than 10 years prior to baseline. Repeatability for self-reported exposures was moderate to high (weighted kappa range: 0.69-1) for a subset of participants (n=237) who completed the questionnaire twice. We are actively and passively observing participants; we plan to administer a follow-up questionnaire every 4-5 years-the first follow-up will be completed in 2018-and linkage to cause-of-death and cancer registries occurs on a (bi)annual basis. This prospective cohort offers a unique, large and rich resource for research on contemporary occupational and environmental health risks and will contribute to the large international COSMOS study on mobile phone use and health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Eye contact as an antecedent to compliant behavior

PubMed Central

Hamlet, Carolynn C.; Axelrod, Saul; Kuerschner, Steven

1984-01-01

Many experimenters and practitioners regard eye contact between instructor and learner as a facilitator, if not a prerequisite, to the effective instruction of sighted people. Without scientifically supporting the practice of demanding eye contact, experimenters, nonetheless, advocate its use and offer a variety of procedures to promote its acquisition. To justify the widespread use of demanded eye contact and to explain its role functionally, one experiment and data from six replications with nine subjects are presented. The primary experiment provides an empirical base for the training of eye contact prior to instruction. In a multiple-baseline design across two students demanded eye contact resulted in levels of compliance that were double and triple those of baseline. A tentative functional analysis of demanded eye contact is presented, followed by a discussion of the relationship of eye contact to attending. PMID:16795682

Optimization of a Small Scale Linear Reluctance Accelerator

NASA Astrophysics Data System (ADS)

Barrera, Thor; Beard, Robby

2011-11-01

Reluctance accelerators are extremely promising future methods of transportation. Several problems still plague these devices, most prominently low efficiency. Variables to overcoming efficiency problems are many and difficult to correlate how they affect our accelerator. The study examined several differing variables that present potential challenges in optimizing the efficiency of reluctance accelerators. These include coil and projectile design, power supplies, switching, and the elusive gradient inductance problem. Extensive research in these areas has been performed from computational and theoretical to experimental. Findings show that these parameters share significant similarity to transformer design elements, thus general findings show current optimized parameters the research suggests as a baseline for further research and design. Demonstration of these current findings will be offered at the time of presentation.

Incentive compatibility and conflict resolution in international river basins: A case study of the Nile Basin

NASA Astrophysics Data System (ADS)

Wu, Xun; Whittington, Dale

2006-02-01

Nation-states rarely go to war over water, but it is equally rare that water conflicts in an international river basin are resolved through cooperation among the riparian countries that use the shared resources. Gains from cooperation will mean little to individual riparians unless the required cooperative behaviors are incentive compatible. Cooperative game theory offers useful insights for assessing cooperative solutions for water conflicts in international river basins. Applying cooperative game theory concepts such as core, nucleolus, and Shapley value to Nile water conflicts, we examine the incentive structure of both cooperative and noncooperative strategies for different riparian countries and establish some baseline conditions for incentive-compatible cooperation in the Nile basin.

Patient-tailored self-management intervention for older adults with hypertension in a nursing home.

PubMed

Park, Yeon-Hwan; Chang, HeeKyung; Kim, JinShil; Kwak, Jin Sang

2013-03-01

This study was to evaluate the effects of a patient-tailored self-management intervention on (1) blood pressure control and (2) self-care behaviour, exercise self-efficacy and medication adherence among Korean older hypertensive patients in a nursing home.   Little is known about whether a patient-tailored self-management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. A non-equivalent comparison group design. Forty-seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight-week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self-management. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8-week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self-care behaviour and exercise self-efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Patient-tailored self-management intervention was a practical approach for decreasing blood pressure and increasing self-care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long-term follow-up. A patient-tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to nursing home staffs, expanding their professional competence in clinical practice. © 2012 Blackwell Publishing Ltd.

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study.

PubMed

Hetherington, Sharon; Henwood, Tim; Swinton, Paul; Keogh, Justin; Gardiner, Paul; Tuckett, Anthony; Rouse, Kevin

2018-04-05

To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. Intervention study. Community-based older adult-specific exercise clinic. Older adults (N=245) with complex care needs who were receiving government-funded aged care support. Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=-.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A Diabetes Self-Management Program: 12-Month Outcome Sustainability From a Nonreinforced Pragmatic Trial.

PubMed

Lorig, Kate; Ritter, Philip L; Turner, Ralph M; English, Kathleen; Laurent, Diana D; Greenberg, Jay

2016-12-15

Diabetes self-management education has been shown to be effective in controlled trials. The 6-week Better Choices, Better Health-Diabetes (BCBH-D) self-management program was also associated with an improvement in health outcomes in a 6-month translation study. The objective of this study was to determine whether a national translation of the BCBH-D self-management program, offered both Web-based and face-to-face, was associated with improvements in health outcomes (including HbA1c) and health behaviors (including recommended medical tests) 1 year after intervention. Web-based programs were administered nationally, whereas face-to-face workshops took place in Atlanta, Indianapolis, and St Louis. Self-report questionnaires were either Web-based or administered by mail, at baseline and 1 year, and collected health and health-behavior measures. HbA1c blood samples were collected via mailed kits. A previous 6-month study found statistically significant improvements in 13 of 14 outcome measures, including HbA1c. For this study, paired t test compared baseline with 1-year outcomes. Subgroup analyses determined whether participants with specific conditions improved (high HbA1c, depression, hypoglycemia, nonadherence to medication, no aerobic exercise). The percentage of participants with improvements in effect size of at least 0.4 in at least 1 of the 5 measures was calculated. A total of 857 participants with 1-year data (69.7% of baseline participants) demonstrated statistically significant 1-year improvements in 13 of 15 outcome measures; 79.9% (685/857) of participants showed improvements in effect size of 0.4 or greater in at least 1 of the 5 criterial measures. Participants had small but significant benefits in multiple measures. Improvements previously noted at 6 months were maintained or amplified at 1 year. ©Kate Lorig, Philip L Ritter, Ralph M Turner, Kathleen English, Diana D Laurent, Jay Greenberg. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.12.2016.

The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines.

PubMed

Danquah, Lisa; Kuper, Hannah; Eusebio, Cristina; Rashid, Mamunur Akm; Bowen, Liza; Foster, Allen; Polack, Sarah

2014-01-01

Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. This was a longitudinal study. At baseline people aged ≥50 years with visual impairment due to cataract ('cases') and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (p<0.05). One year after surgery there were significant increases in HRQoL, participation and time spent in productive activities and per capita expenditure and reduction in assistance with activities so that the operated cases were similar to controls. These increases were still evident after six years with the exception that time spent on productive activities decreased among both cases and controls. Cataract causing visual loss is associated with reduced HRQoL and economic poverty among older adults in low-income countries. Cataract surgery improves the HRQoL of the individual and economy of the household. The findings of this study suggest these benefits are sustained in the long term.

Advanced stratified charge rotary aircraft engine design study

NASA Technical Reports Server (NTRS)

Badgley, P.; Berkowitz, M.; Jones, C.; Myers, D.; Norwood, E.; Pratt, W. B.; Ellis, D. R.; Huggins, G.; Mueller, A.; Hembrey, J. H.

1982-01-01

A technology base of new developments which offered potential benefits to a general aviation engine was compiled and ranked. Using design approaches selected from the ranked list, conceptual design studies were performed of an advanced and a highly advanced engine sized to provide 186/250 shaft Kw/HP under cruise conditions at 7620/25,000 m/ft altitude. These are turbocharged, direct-injected stratified charge engines intended for commercial introduction in the early 1990's. The engine descriptive data includes tables, curves, and drawings depicting configuration, performance, weights and sizes, heat rejection, ignition and fuel injection system descriptions, maintenance requirements, and scaling data for varying power. An engine-airframe integration study of the resulting engines in advanced airframes was performed on a comparative basis with current production type engines. The results show airplane performance, costs, noise & installation factors. The rotary-engined airplanes display substantial improvements over the baseline, including 30 to 35% lower fuel usage.

Five features of value-based insurance design plans were associated with higher rates of medication adherence.

PubMed

Choudhry, Niteesh K; Fischer, Michael A; Smith, Benjamin F; Brill, Gregory; Girdish, Charmaine; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H

2014-03-01

Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007-10. We found that after we adjusted for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features. The effects were as large as 4-5 percentage points. These findings can provide guidance for the structure of future VBID plans.

Engaging homeless persons in end of life preparations.

PubMed

Song, John; Wall, Melanie M; Ratner, Edward R; Bartels, Dianne M; Ulvestad, Nancy; Gelberg, Lillian

2008-12-01

There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population. To determine whether homeless persons will complete an advance directive (AD). Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG). Fifty-nine homeless persons recruited from a drop-in center. Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors. The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05). This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population.

Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: an assessment of clinical potential

PubMed Central

Sköld, K; Gorlia, T; Pellettieri, L; Giusti, V; H-Stenstam, B; Hopewell, J W

2010-01-01

The purpose of this study was to assess the potential of boron neutron capture therapy (BNCT), with a 6-h infusion of the boron carrier l-boronophenylalanine as a fructose preparation (BPA-f), as first-line radiotherapy for newly diagnosed glioblastoma multiforme (GBM). Patient survival data from a Phase II study using BNCT were compared with retrospective data from the two arms of a Phase III study using conventional radiotherapy (RT) in the reference arm and using RT plus concomitant and adjuvant medication with temozolomide (TMZ) in the experimental arm, and were also compared with small subgroups of these patients for whom the methylation status of the MGMT (O6-methylguanine–DNA methyltransferase) DNA repair gene was known. Differences in the baseline characteristics, salvage therapy after recurrence and levels of severe adverse events were also considered. The results indicate that BNCT offers a treatment that is at least as effective as conventional RT alone. For patients with an unmethylated MGMT DNA repair gene, a possible clinical advantage of BNCT over RT/TMZ was suggested. BNCT is a single-day treatment, which is of convenience to patients, with mild side effects, which would offer an initial 6 weeks of good-quality life during the time when patients would otherwise be undergoing daily treatments with RT and TMZ. It is suggested that the use of BNCT with a 6-h infusion of BPA-f should be explored in a stratified randomised Phase II trial in which patients with the unmethylated MGMT DNA repair gene are offered BNCT in the experimental arm and RT plus TMZ in the reference arm. PMID:20603410

A Peer-Support and Mindfulness Program to Improve the Mental Health of Medical Students.

PubMed

Moir, Fiona; Henning, Marcus; Hassed, Craig; Moyes, Simon A; Elley, C Raina

2016-01-01

There is evidence that peer-support programs can improve mental health indices and help-seeking behavior among students in some secondary school and university settings and that mindfulness can improve mental health in medical students. Peer-led programs have not been formally assessed in a medical student population, where psychological issues exist and where it has been shown that students approach peers for help in preference to staff members or professional services. Medical students elected peer leaders who underwent training and then provided the intervention. The peer leaders provided support to students in the intervention group, as well as offering teaching in mindfulness meditation. An exploratory study was conducted with 2nd- and 3rd-year medical students at 1 medical school in New Zealand randomized into 2 groups. In addition to existing mental health resources, intervention participants received a program including peer support and peer-taught mindfulness practice. Study participants not offered the intervention participants could use existing mental health resources. Primary measures included depression (PHQ-9) and anxiety (GAD-7) scores. Secondary measures were quality of life, resilience (15-item resilience scale), academic self-concept, and motivation to learn, assessed at baseline and 6 months. Of the 402 students eligible, 275 (68%) participated and 232 (58%) completed the study. At baseline, 53% were female and mean age was 21 years (SD = 3)-PHQ-9 score (M = 5.2, SD = 3.7) and GAD-7 score (M = 4.5, SD = 3.4). Twelve peer leaders were elected. There was good participation in the intervention. One fourth of intervention students used the face-to-face peer support and more than 50% attended a peer social event and/or participated in the mindfulness program. Although improvements in mental health were seen in the intervention group, the difference between the intervention and nonintervention groups did not reach statistical significance. Although evidence exists for effectiveness of peer support and mindfulness in other contexts, this exploratory study was not able to show a statistically significant effect. Future studies could consider using a longer training period for the peer leaders, as well as targeting the study population to those most likely to benefit such as those with poorer mental health, or using a more intensive intervention or larger sample size. A cluster randomized study design would also reduce the risk of contamination.

Effectiveness of offering healthy labelled meals in improving the nutritional quality of lunch meals eaten in a worksite canteen.

PubMed

Lassen, A D; Beck, A; Leedo, E; Andersen, E W; Christensen, T; Mejborn, H; Thorsen, A V; Tetens, I

2014-04-01

Healthier meal selections at restaurants and canteens are often limited and not actively promoted. In this Danish study the effectiveness of a healthy labelling certification program in improving dietary intake and influencing edible plate waste was evaluated in a quasi-experimental study design. Employees from an intervention worksite canteen and a matched control canteen were included in the study at baseline (February 2012), after completing the certification process (end-point) and six month from end-point (follow-up) (total n=270). In order to estimate nutrient composition of the consumed lunch meals and plate waste a validated digital photographic method was used combining estimation of food intake with food nutrient composition data. Food satisfaction was rated by participants using a questionnaire. Several significant positive nutritional effects were observed at the intervention canteen including a mean decrease in energy density in the consumed meals from 561kJ/100g at baseline to 368 and 407kJ/100g at end-point and follow-up, respectively (P<0.001). No significant changes were seen with regard to food satisfaction and plate waste. In the control canteen no positive nutritional effects were observed. The results of the study highlight the potential of using healthy labelling certification programs as a possible driver for increasing both the availability and awareness of healthy meal choices, thereby improving dietary intake when eating out. Copyright © 2013 Elsevier Ltd. All rights reserved.

Study of correlation between maternal fatigue and uterine contraction pattern in the active phase of labour.

PubMed

Ebrahimzadeh, Samira; Golmakani, Nahid; Kabirian, Maryam; Shakeri, Mohhamad T

2012-06-01

To evaluate the correlation between maternal fatigue and uterine contraction pattern at the beginning of the active phase of labour. Fatigue is one of the most common complaints in pregnant women that often continues until delivery. Maternal fatigue prolongs the labour process and increases the rate of cesarian section. Studies on the pattern of uterine contractions have shown that the length of the fall time is longer in prolonged labours than in normal deliveries. A cross-sectional study. This study was conducted on 100 primiparous women who were referred to Ommolbanin Hospital (Mashhad, Iran) in 2011. Maternal fatigue was assessed at the beginning of the active phase of labour. Then, the pattern of uterine contractions was monitored for 30 minutes by an external tocodynamometer. The F/R ratio was determined by measuring the time for a contraction to return to its baseline from its peak and the time for a contraction to rise to its peak. The data were analysed by chi-square and anova tests. The results showed that there was a significant relationship between maternal fatigue and uterine contraction pattern. The F/R ratio was increased with increase in fatigue severity. Fatigue causes changes in the pattern of uterine contractions. The return time of a contraction from its peak to its baseline (fall) is increased with increase in fatigue severity. Offering strategies to prevent tiredness and reduce the related fatigue complications. © 2012 Blackwell Publishing Ltd.

The national alcohol helpline in Sweden: an evaluation of its first year

PubMed Central

2014-01-01

Background Telephone helplines are easily available and can offer anonymity. Alcohol helplines may be a potential gateway to a more advanced support protocol, and they may function as a primary support option for some. However, although telephone helplines (quitlines) make up an established evidence-based support arena for smoking cessation, few studies have described such telephone-based alcohol counseling. Methods This study describes the basic characteristics of callers (n = 480) to the Swedish Alcohol Helpline during its first year of operation, and assesses aspects of change in alcohol behavior in a selected cohort of clients (n = 40) willing to abstain from anonymity and enter a proactive support protocol. Results During the study period, 50% of callers called for consultation regarding their own alcohol use (clients), a third called about relatives with alcohol problems, and the others called for information. The clients’ average age was 49 years, and half were females. The clients’ average AUDIT score at baseline was 21 (std. dev. =7.2). Approximately a quarter had scores indicating hazardous alcohol use at baseline, while the others had higher scores. In a follow-up pilot study, the average AUDIT score had decreased from 21 to 14. While clients reporting more severe alcohol use showed a significant decrease at follow-up, hazardous users exhibited no change during the study period. Conclusion The study indicates that telephone helplines addressing the general public can be a primary-care option to reduce risky alcohol use. A randomized controlled study is needed to control for the effect of spontaneous recovery. PMID:25015403

Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage-Protocol of a Swiss Nationwide Observational Study (MoCA-DCI Study).

PubMed

Stienen, Martin N; Fung, Christian; Bijlenga, Philippe; Zumofen, Daniel W; Maduri, Rodolfo; Robert, Thomas; Seule, Martin A; Marbacher, Serge; Geisseler, Olivia; Brugger, Peter; Gutbrod, Klemens; Chicherio, Christian; Monsch, Andreas U; Beaud, Valérie; Rossi, Stefania; Früh, Severin; Schmid, Nicole; Smoll, Nicolas R; Keller, Emanuela; Regli, Luca

2018-05-11

The exact relationship between delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) and neuropsychological impairment remains unknown, as previous studies lacked a baseline examination after aneurysm occlusion but before the DCI-period. Neuropsychological evaluation of acutely ill patients is often applied in a busy intensive care unit (ICU), where distraction represents a bias to the obtained results. To evaluate the relationship between DCI and neuropsychological outcome after aSAH by comparing the Montreal Cognitive Assessment (MoCA) results in aSAH patients with and without DCI at 3 mo with a baseline examination before the DCI-period (part 1). To determine the reliability of the MoCA, when applied in an ICU setting (part 2). Prospective, multicenter, and observational study performed at all Swiss neurovascular centers. For part 1, n = 240 consecutive aSAH patients and for part 2, n = 50 patients with acute brain injury are recruited. Part 1: Effect size of the relationship between DCI and neuropsychological outcome (MoCA). Part 2: Reliability measures for the MoCA. The institutional review boards approved this study on July 4, 2017 under case number BASEC 2017-00103. After completion, the results will be offered to an international scientific journal for peer-reviewed publication. This study determines the exact impact of DCI on the neuropsychological outcome after aSAH, unbiased by confounding factors such as early brain injury or patient-specific characteristics. The study provides unique insights in the neuropsychological state of patients in the early period after aSAH.

Evaluation of renal quantitative T2* changes on MRI following administration of ferumoxytol as a T2* contrast agent.

PubMed

Hedgire, Sandeep S; McDermott, Shaunagh; Wojtkiewicz, Gregory R; Abtahi, Seyed Mahdi; Harisinghani, Mukesh; Gaglia, Jason L

2014-01-01

To evaluate the time-dependent changes in regional quantitative T2* maps of the kidney following intravenous administration of ferumoxytol. Twenty-four individuals with normal kidney function underwent T2*-weighted MRI of the kidney before, immediately after, and 48 hours after intravenous administration of ferumoxytol at a dose of 4 mg/kg (group A, n=12) or 6 mg/kg (group B, n=12). T2* values were statistically analyzed using two-tailed paired t-tests. In group A, the percentage changes from baseline to immediate post and baseline to 48 hours were 85.3% and 64.2% for the cortex and 90.8% and 64.6% for the medulla, respectively. In group B, the percentage changes from baseline to immediate post and baseline to 48 hours were 85.2% and 73.4% for the cortex and 94.5% and 74% for the medulla, respectively. This difference was significant for both groups (P<0.0001). There is significant and differential uptake of ferumoxytol in the cortex and medulla of physiologically normal kidneys. This differential uptake may offer the ability to interrogate renal cortex and medulla with possible clinical applications in medical renal disease and transplant organ assessment. We propose an organ of interest based dose titration of ferumoxytol to better differentiate circulating from intracellular ferumoxytol particles.

Political Theory, Values and Public Health

PubMed Central

Latham, Stephen R.

2016-01-01

This article offers some general criticisms of the idea that any political theory can legitimate public health interventions, and then some particular criticisms of Civic Republicanism as a political theory for public health. Civic Republicanism, I argue, legitimizes liberty-infringing public health interventions by demanding high levels of civic engagement in framing and reviewing them; to demand such engagement in pursuit of such a baseline value as health will leave insufficient civic energy for the pursuit of higher values. PMID:27551295

FY 2002 Economic Outlook, Highlights from FY 1994 to FY 2001, FY 2002 Baseline Projections

DTIC Science & Technology

2001-01-01

have experienced four straight years of surplus, a stretch of prosperity last seen following World War I. For three years in a row, we have actually... safer . My Administration’s initiatives to reduce crime contributed to the lowest annual serious crime count since 1985. • Giving Americans confidence...Medicare trust funds and offered the hope of paying down the debt with prudent budget policies. The past eight years have also seen remarkable

An Analysis Of The Benefits And Application Of Earned Value Management (EVM) Project Management Techniques For Dod Programs That Do Not Meet Dod Policy Thresholds

DTIC Science & Technology

2017-12-01

carefully to ensure only minimum information needed for effective management control is requested.  Requires cost-benefit analysis and PM...baseline offers metrics that highlights performance treads and program variances. This information provides Program Managers and higher levels of...The existing training philosophy is effective only if the managers using the information have well trained and experienced personnel that can

Metal Matrix Composite LOX Turbopump Housing via Novel Tool-less Net-Shape Pressure Infiltration Casting Technology

NASA Technical Reports Server (NTRS)

Shah, Sandeep; Lee, Jonathan; Bhat, Biliyar; Wells, Doug; Gregg, Wayne; Marsh, Matthew; Genge, Gary; Forbes, John; Salvi, Alex; Cornie, James A.

2003-01-01

Metal matrix composites for propulsion components offer high performance and affordability, resulting in low weight and cost. The following sections in this viewgraph presentation describe the pressure infiltration casting of a metal matrix composite LOX turbopump housing: 1) Baseline Pump Design and Stress Analysis; 2) Tool-less Advanced Pressure Infiltration Casting Process; 3) Preform Splicing and Joining for Large Components such as Pump Housing; 4) Fullscale Pump Housing Redesign.

Vision & Needs for Distributed Controls: Customers for Control Systems and What Do They Value (Postprint)

DTIC Science & Technology

2009-08-01

in engine technology 7 VS. • Military demand is growing for FADEC & control systems with expert system embedded in the S/W for fault tolerance...leverage commercial FADECs & control systems S/W & H/W. •Modular / Universal/Distributed design can reduce development time and cost. S/W could offer...baseline for military-qualified FADECs . •To promote dual use, the services must recognize the similarities between commercial applications & military

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

PubMed Central

2013-01-01

Background Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. Methods/design A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. Discussion This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000889853 The trial is now in progress with 12 villages already have been randomised. PMID:23675705

Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation.

PubMed

Goheen, M M; Wegmüller, R; Bah, A; Darboe, B; Danso, E; Affara, M; Gardner, D; Patel, J C; Prentice, A M; Cerami, C

2016-12-01

Iron deficiency causes long-term adverse consequences for children and is the most common nutritional deficiency worldwide. Observational studies suggest that iron deficiency anemia protects against Plasmodium falciparum malaria and several intervention trials have indicated that iron supplementation increases malaria risk through unknown mechanism(s). This poses a major challenge for health policy. We investigated how anemia inhibits blood stage malaria infection and how iron supplementation abrogates this protection. This observational cohort study occurred in a malaria-endemic region where sickle-cell trait is also common. We studied fresh RBCs from anemic children (135 children; age 6-24months; hemoglobin <11g/dl) participating in an iron supplementation trial (ISRCTN registry, number ISRCTN07210906) in which they received iron (12mg/day) as part of a micronutrient powder for 84days. Children donated RBCs at baseline, Day 49, and Day 84 for use in flow cytometry-based in vitro growth and invasion assays with P. falciparum laboratory and field strains. In vitro parasite growth in subject RBCs was the primary endpoint. Anemia substantially reduced the invasion and growth of both laboratory and field strains of P. falciparum in vitro (~10% growth reduction per standard deviation shift in hemoglobin). The population level impact against erythrocytic stage malaria was 15.9% from anemia compared to 3.5% for sickle-cell trait. Parasite growth was 2.4 fold higher after 49days of iron supplementation relative to baseline (p<0.001), paralleling increases in erythropoiesis. These results confirm and quantify a plausible mechanism by which anemia protects African children against falciparum malaria, an effect that is substantially greater than the protection offered by sickle-cell trait. Iron supplementation completely reversed the observed protection and hence should be accompanied by malaria prophylaxis. Lower hemoglobin levels typically seen in populations of African descent may reflect past genetic selection by malaria. National Institute of Child Health and Development, Bill and Melinda Gates Foundation, UK Medical Research Council (MRC) and Department for International Development (DFID) under the MRC/DFID Concordat. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Being prepared to work in Gynecology Medicine: evaluation of an intervention to promote junior gynecologists professionalism, mental health and job satisfaction.

PubMed

Mache, Stefanie; Baresi, Lisa; Bernburg, Monika; Vitzthum, Karin; Groneberg, David

2017-01-01

Dealing with work-related stress is highly prevalent for employees in Gynecology Medicine. Junior physicians, in particular, have to face high working demands and challenges while starting their medical career after graduation. Job resources (i.e., social support) and personal resources (coping skills) might reduce job strain. The evidence for supportive and effective mental health interventions for clinicians is limited. Offering psychosocial skill training for entrants in Gynecology Medicine is expected to be highly beneficial. Following this, the present pilot study focused on strengthening physicians' psychosocial skills and analyzed the effects of innovative training for junior gynecologists working in German hospitals. Coping skills training for junior gynecologists was offered as group training for 12 weekly sessions over a time period of 3 months. Physicians were randomized to either an intervention group (IG) receiving the training (n = 38) or a control group (CG; n = 40). Training content involved developing and learning coping skills as well as solution-focused and cognitive behavioral counselling for junior gynecologists. Study outcomes were (1) perceived occupational stress, (2) emotional exhaustion, (3) resilience coping behavior, (4) emotion regulation skills and (5) job satisfaction. Surveys were distributed at baseline (T0), after the training (T1), after 3 (T2) and 6 months (T3). Junior gynecologists (IG) reported a significant decrease in perceived job stress and emotional exhaustion from baseline to all follow-ups, whereas the control group did not show any comparable results. A clear positive value of the mental health promotion program was also noticeable with regard to job satisfaction and increased coping skills (i.e., emotion regulation). Overall satisfaction with the skill training was high: gynecologists reported high scores for training design, content, received outcome and overall satisfaction with the training. In this pilot study, participating in a psychosocial skills training course adapted for gynecology clinicians was associated with reductions in perceived job stress, exhaustion and improvements in coping skills and satisfaction. Modified psychosocial skills training may be a time-efficient tool to support gynecologists in their performance and well-being, which may have positive implications for patient care.

Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the Primary School Free Breakfast Initiative in Wales [ISRCTN18336527

PubMed Central

Moore, Laurence; Moore, Graham F; Tapper, Katy; Lynch, Rebecca; Desousa, Carol; Hale, Janine; Roberts, Chris; Murphy, Simon

2007-01-01

Background School-based breakfast provision is increasingly being seen as a means of improving educational performance and dietary behaviour amongst children. Furthermore, recognition is growing that breakfast provision offers potential as a means of addressing social inequalities in these outcomes. At present however, the evidence base on the effectiveness of breakfast provision in bringing about these improvements is limited. Methods/Design This paper describes the research design of a large scale evaluation of the effectiveness of the Welsh Assembly Government's Primary School Free Breakfast Initiative. A cluster randomised trial, with school as the unit of randomisation was used for the outcome evaluation, with a nested qualitative process evaluation. Quantitative outcome measures included dietary habits, attitudes, cognitive function, classroom behaviour, and school attendance. The study recruited 111 primary schools in Wales, of which 56 were randomly assigned to control condition and 55 to intervention. Participants were Year 5 and 6 students (aged 9–11 years) in these schools. Data were collected for all 111 schools at each of three time points: baseline, 4 month and 12 month follow-up. This was achieved through a repeated cross-sectional survey of approximately 4350 students on each of these occasions. Of those students in Year 5 at baseline, 1975 provided data at one or both of the follow-ups, forming a nested cohort. The evaluation also included a nested process evaluation, using questionnaires, semi-structured interviews and case studies with students, school staff, and local authority scheme coordinators as key informants. Discussion An overview of the methods used for the evaluation is presented, providing an example of the feasibility of conducting robust evaluations of policy initiatives using a randomised trial design with nested process evaluation. Details are provided of response rates and the flow of participants. Reflection is offered on methodological issues encountered at various stages through the course of the study, focusing upon issues associated with conducting a randomised trial of a government policy initiative, and with conducting research in school settings. Trial registration Current Controlled Trials ISRCTN18336527 PMID:17888158

Effectiveness of a tinnitus management programme: a 2-year follow-up study

PubMed Central

Gudex, Claire; Skellgaard, Preben H; West, Torben; Sørensen, Jan

2009-01-01

Background Tinnitus impairs the possibility of leading a normal life in 0.5–1% of the population. While neither medical nor surgical treatment appears effective, counselling may offer some relief. An intervention combining counselling and hearing devices is offered to clients referred to the Centre for Help Aids and Communication (CHC) in southern Denmark. The aims of this exploratory study were to examine i) the characteristics of CHC's clients and their tinnitus, ii) the effectiveness of the treatment, and iii) whether particular client groups benefit more than others. Methods One hundred new clients presenting with tinnitus completed the Tinnitus Handicap Inventory (THI) three times – before their first consultation, after one month and after 1–2 years. The scores were tested for significant differences over time using tests for paired data. Logistic regression was used to examine factors associated with a clinically important difference (i.e. THI score improvement of at least 20 points). Results At final follow-up, total THI score was significantly lower than baseline, i.e. 29.8 (CI 25.5–34.2) vs. 37.2 (CI 33.1–37.2), p < 0.01. The programme achieved a clinically important difference for 27% and 24% of the clients one month and 1–2 years after the first consultation, respectively. It appeared that greater improvement in THI score was related to higher baseline THI score and possibly also to treatment by a particular CHC therapist. The absolute reduction in mean THI score after 1–2 years for clients with moderate and severe handicap was 14 and 20 points, respectively, i.e. similar to that previously reported for TRT (14–28 points). The cost of the current programme was approximately 200 EUR per client. Conclusion The tinnitus management programme appeared to provide significant benefit to many clients at a relatively low cost. It would be useful to conduct a randomised controlled study comparing the current programme with alternative forms of combination counselling/sound therapy approaches. PMID:19558680

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial.

PubMed

Merom, Dafna; Cumming, Robert; Mathieu, Erin; Anstey, Kaarin J; Rissel, Chris; Simpson, Judy M; Morton, Rachael L; Cerin, Ester; Sherrington, Catherine; Lord, Stephen R

2013-05-15

Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the 'holistic' approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Australian New Zealand Clinical Trials Registry ACTRN12612000889853The trial is now in progress with 12 villages already have been randomised.

Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the Primary School Free Breakfast Initiative in Wales [ISRCTN18336527].

PubMed

Moore, Laurence; Moore, Graham F; Tapper, Katy; Lynch, Rebecca; Desousa, Carol; Hale, Janine; Roberts, Chris; Murphy, Simon

2007-09-21

School-based breakfast provision is increasingly being seen as a means of improving educational performance and dietary behaviour amongst children. Furthermore, recognition is growing that breakfast provision offers potential as a means of addressing social inequalities in these outcomes. At present however, the evidence base on the effectiveness of breakfast provision in bringing about these improvements is limited. This paper describes the research design of a large scale evaluation of the effectiveness of the Welsh Assembly Government's Primary School Free Breakfast Initiative. A cluster randomised trial, with school as the unit of randomisation was used for the outcome evaluation, with a nested qualitative process evaluation. Quantitative outcome measures included dietary habits, attitudes, cognitive function, classroom behaviour, and school attendance. The study recruited 111 primary schools in Wales, of which 56 were randomly assigned to control condition and 55 to intervention. Participants were Year 5 and 6 students (aged 9-11 years) in these schools. Data were collected for all 111 schools at each of three time points: baseline, 4 month and 12 month follow-up. This was achieved through a repeated cross-sectional survey of approximately 4350 students on each of these occasions. Of those students in Year 5 at baseline, 1975 provided data at one or both of the follow-ups, forming a nested cohort. The evaluation also included a nested process evaluation, using questionnaires, semi-structured interviews and case studies with students, school staff, and local authority scheme coordinators as key informants. An overview of the methods used for the evaluation is presented, providing an example of the feasibility of conducting robust evaluations of policy initiatives using a randomised trial design with nested process evaluation. Details are provided of response rates and the flow of participants. Reflection is offered on methodological issues encountered at various stages through the course of the study, focusing upon issues associated with conducting a randomised trial of a government policy initiative, and with conducting research in school settings.

Early body composition, but not body mass, is associated with future accelerated decline in muscle quality

PubMed Central

Chiles Shaffer, Nancy; Gonzalez‐Freire, Marta; Shardell, Michelle D.; Zoli, Marco; Studenski, Stephanie A.; Ferrucci, Luigi

2017-01-01

Abstract Background Muscle quality (MQ) or strength‐to‐mass ratio declines with aging, but the rate of MQ change with aging is highly heterogeneous across individuals. The identification of risk factors for accelerated MQ decline may offer clues to identity the underpinning physiological mechanisms and indicate targets for prevention and treatment. Using data from the Baltimore Longitudinal Study of Aging, we tested whether measures of body mass and body composition are associated with differential rates of changes in MQ with aging. Methods Participants included 511 men and women, aged 50 years or older, followed for an average of 4 years (range: 1–8). MQ was operationalized as ratio between knee‐extension isokinetic strength and CT‐thigh muscle cross‐sectional area. Predictors included body mass and body composition measures: weight (kg), body mass index (BMI, kg/m2), dual‐energy x‐ray absorptiometry‐measured total body fat mass (TFM, kg) and lean mass (TLM, kg), and body fatness (TFM/weight). Covariates were baseline age, sex, race, and body height. Results Muscle quality showed a significant linear decline over the time of the follow up (average rate of decline 0.02 Nm/cm2 per year, P < .001). Independent of covariates, neither baseline body weight (P = .756) nor BMI (P = .777) was predictive of longitudinal rate of decline in MQ. Instead, higher TFM and lower TLM at baseline predicted steeper longitudinal decline in MQ (P = .036 and P < .001, respectively). In particular, participants with both high TFM and low TLM at baseline experienced the most dramatic decline compared with those with low TFM and high TLM (about 3% per year vs. 0.5% per year, respectively). Participants in the higher tertile of baseline body fatness presented a significantly faster decline of MQ than the rest of the population (P = .021). Similar results were observed when body mass, TFM, and TLM were modeled as time‐dependent predictors. Conclusions Body composition, but not weight nor BMI, is associated with future MQ decline, suggesting that preventive strategies aimed at maintaining good MQ with aging should specifically target body composition features. PMID:28198113

COMPLETE - a school-based intervention project to increase completion of upper secondary school in Norway: study protocol for a cluster randomized controlled trial.

PubMed

Larsen, T; Urke, H B; Holsen, I; Anvik, C H; Olsen, T; Waldahl, R H; Antonsen, K M; Johnson, R; Tobro, M; Brastad, B; Hansen, T B

2018-03-09

Drop out from upper secondary school represents a risk for the future health and wellbeing of young people. Strengthening of psychosocial aspects of the learning environment may be an effective strategy to promote completion of upper secondary school. This paper is a study protocol of a school based cluster randomized controlled trial (RCT) evaluating two school-based interventions, namely the Dream School Program (DSP) and the Mental Health Support Team (MHST). The interventions aim to improve psychosocial learning environments and subsequently school achievements and decrease drop-out and absence. The COMPLETE RCT is aimed at youth in upper secondary school, grade 1 (age 15-16 years), and examines the effect of the combination of the DSP and the MHST; and the DSP only, compared with a comparison group on the following primary outcomes: student completion, presence, average grade, and self-reported mental health. Seventeen upper secondary schools from four counties in Norway were randomized to one of the three arms: 1) DSP and MHST; 2) DSP; and 3) comparison (offered DSP intervention in 2018/2019). The study will evaluate the interventions based on information from two cohorts of students (cohort 1 (C1) and cohort 2 (C2)). For C1, data was collected at baseline (August 2016), and at first follow-up seven months later. Second follow-up will be collected 19 months after baseline. For C2, data was collected at baseline (August 2017), and first and second follow-up will be collected similarly to that of C2 seven and 19 months respectively after baseline. Process evaluations based on focus groups, interviews and observation will be conducted twice (first completed spring 2017). The COMPLETE trial is a large study that can provide useful knowledge about what interventions might effectively improve completion of upper secondary school. Its thorough process evaluation will provide critical information about barriers and points of improvement for optimizing intervention implementation. Findings can guide school development in the perspective of improving psychosocial learning environments and subsequent completion of upper secondary schooling. The trial was retrospectively registered in the ClinicalTrials.gov register on December 22.2017: NCT03382080 .

The practice of antenatal care: comparing four study sites in different parts of the world participating in the WHO Antenatal Care Randomised Controlled Trial.

PubMed

Piaggio, G; Ba'aqeel, H; Bergsjø, P; Carroli, G; Farnot, U; Lumbiganon, P; Pinol, A; Villar, J

1998-10-01

In the preparation of a randomised controlled trial to evaluate a new programme of antenatal care (ANC) in different parts of the world, we conducted a baseline survey of the ANC procedures in all 53 clinics participating in the trial. There were two components of this survey: (1) description of clinic characteristics and services offered: the staff of each clinic was interviewed and direct observation was made by field supervisors, and (2) the actual use of services by pregnant women attending these clinics: we reviewed a random sample of 2913 clinical histories. The clinical units surveyed were offering most of the activities, screening, laboratory tests and interventions recommended as effective according to the Cochrane Pregnancy and Childbirth Database (PCD), although some of these were not available in some sites. On the other hand, some tests and interventions that are considered not effective according to these criteria are reportedly offered. There was a difference across sites in the availability and offer to low-risk women of vaginal examination, evaluation of pelvic size, dental examination, external version for breech presentation and formal risk score classification, and a notable difference in the type of principal provider of ANC. There was a large variation in the actual use of screening and laboratory tests and interventions that should be offered to all women according to Cochrane PCD criteria: some of these are simply not available in a site; others are available, but only a fraction of women attending the clinics are receiving them. The participating sites all purport to follow the traditional 'Western' schedule for ANC, but in three sites we found that a high percentage of women initiate their ANC after the first trimester, and therefore do not have either the recommended minimum number of visits during pregnancy or the minimum first trimester evaluation. It is concluded that the variability and heterogeneity of ANC services provided in the four study sites are disturbing to the profession and cast doubts on the rationale of routine ANC.

A survey of degree completion programs in dental hygiene education.

PubMed

Portillo, Karen M; Rogo, Ellen J; Calley, Kristin H; Cellucci, Leigh W

2013-05-01

The purpose of this descriptive study was to identify specific information related to U.S. dental hygiene baccalaureate degree completion programs. Learning experiences, assessment methods, and baccalaureate institutional partnerships were assessed. Of the sixty dental hygiene programs that offer a degree completion program, the forty-two that met the inclusion criteria (including having operated for at least three years) were invited to participate in a thirty-eight item online survey. A 62 percent (n=26) response rate was obtained. Learning experiences in responding programs included core dental hygiene courses, general education courses, and elective dental hygiene courses. Emphasis areas offered by various programs were in the specialty areas of education, public or community health, and research. Respondents reported that their graduates were employed in multiple settings (65 percent; n=17), with 19 percent (n=5) reporting employment in the combined grouping of private practice, education, and public health. Institutional partnerships included articulation agreements (88 percent; n=21), community college baccalaureate (8 percent; n=2), and university extension (4 percent; n=1) models. The findings of this study provide a baseline for assessing the educational composition and design of U.S. dental hygiene degree completion programs. However, results of this study showed inconsistencies among learning experiences that might raise concerns when considering students' level of preparation for graduate education and future leadership roles in the profession.

Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations

PubMed Central

Blaine, Rachel E.; Fisher, Jennifer Orlet; Taveras, Elsie M.; Geller, Alan C.; Rimm, Eric B.; Land, Thomas; Perkins, Meghan; Davison, Kirsten K.

2015-01-01

Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012–2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2–12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2–5 years) more snacks to reward behavior (1.9 vs. 1.1, p < 0.001), keep quiet (1.0 vs. 0.5, p < 0.001), and celebrate achievements (1.7 vs. 1.0, p < 0.001) than parents of older children (6–12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70–0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52–0.99), or achievements (OR = 0.82; 95% CI 0.68–0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts. PMID:26197335

The effect of financial incentives on adherence to antipsychotic depot medication: does it change over time?

PubMed

Pavlickova, Hana; Bremner, Stephen A; Priebe, Stefan

2015-08-01

A recent cluster-randomized controlled trial found that offering financial incentives improves adherence to long-acting injectable antipsychotics (LAIs). The present study investigates whether the impact of incentives diminishes over time and whether the improvement in adherence is linked to the amount of incentives offered. Seventy-three teams with 141 patients with psychotic disorders (using ICD-10) were randomized to the intervention or control group. Over 1 year, patients in the intervention group received £15 (US $23) for each LAI, while control patients received treatment as usual. Adherence levels, ie, the percentage of prescribed LAIs that were received, were calculated for quarterly intervals. The amount of incentives offered was calculated from the treatment cycle at baseline. Multilevel models were used to examine the time course of the effect of incentives and the effect of the amount of incentives offered on adherence. Adherence increased in both the intervention and the control group over time by an average of 4.2% per quarterly interval (95% CI, 2.8%-5.6%; P < .001). Despite this general increase, adherence in the intervention group remained improved compared to the control group by between 11% and 14% per quarterly interval. There was no interaction effect between time and treatment group. Further, a higher total amount of incentives was associated with poorer adherence (βbootstrapped = -0.11; 95% CIbootstrapped, -0.20 to -0.01; P = .023). A substantial effect of financial incentives on adherence to LAIs occurs within the first 3 months of the intervention and is sustained over 1 year. A higher total amount of incentives does not increase the effect. ISRCTN.com identifier: ISRCTN77769281 and UKCRN.org identifier: 7033. © Copyright 2015 Physicians Postgraduate Press, Inc.

Posting point-of-purchase nutrition information in university canteens does not influence meal choice and nutrient intake.

PubMed

Hoefkens, Christine; Lachat, Carl; Kolsteren, Patrick; Van Camp, John; Verbeke, Wim

2011-08-01

Growing concern over the relation between out-of-home eating and overweight has triggered the use of point-of-purchase (POP) nutrition information when eating out of the home. In canteens that offer various unhealthy choices, the posting of POP nutrition information has the potential to improve meal choices and dietary intakes. The objective of this study was to increase the proportion of consumed meals that comply with recommendations for energy, saturated fat, sodium, and vegetable content by 5%. A one-group pretest-posttest design was used. A total of 224 customers of 2 university canteens completed a questionnaire used for consumer profiling and 3-d food records to assess their meal choices and nutrient intakes. The 12 best meal combinations received star ratings and descriptors for nutrients or food groups that did not comply. Reported meal choices in canteens and nutrient intakes did not improve after the intervention (P > 0.05). The nutritional profile of the meal choice, obtained from a qualitative and quantitative nutritional assessment of meals, mirrored the nutritional profile of all meals offered (P > 0.05) and not that of the recommended meals offered (P < 0.001). Meal choices were not compensated for later in the day (P > 0.05). The healthiest choices were made by participants with greater objective nutrition knowledge, stronger health and weight-control motives, and a greater openness to change meal choices at baseline (P < 0.05). The posting of nutrition information in university canteens did not effectively change meal choices and nutrient intakes. Despite the intervention, meal choices were largely determined by meals offered. Therefore, nutrition-information interventions in canteens may be more effective with a healthier meal supply. This trial was registered at clinicaltrials.gov as NCT01249508.

A randomized, double-blind, placebo-controlled, crossover trial evaluating the effect of intranasal insulin on cognition and mood in individuals with treatment-resistant major depressive disorder.

PubMed

Cha, Danielle S; Best, Michael W; Bowie, Christopher R; Gallaugher, Laura Ashley; Woldeyohannes, Hanna O; Soczynska, Joanna K; Lewis, Gary; MacQueen, Glenda; Sahakian, Barbara J; Kennedy, Sidney H; Lui, Jane P; Mansur, Rodrigo B; McIntyre, Roger S

2017-03-01

Cognitive dysfunction in major depressive disorder (MDD) is identified as a primary therapeutic target; no current treatment is approved for the treatment of cognitive dysfunction in MDD. We examined whether intranasal insulin offered a beneficial effect across measures of cognitive function in adults with MDD. Thirty-five adults (18-65 years of age: 47.09±9.89) meeting criteria for a major depressive episode as per the Diagnostic and Statistical Manual (DSM)-IV-Treatment Revised were included in this randomized, double blind, placebo-controlled, crossover design study. Subjects were not stratified based on baseline cognitive deficit. Subjects were randomized to 4 weeks of either intranasal insulin 40 International Units (IU) taken four times a day (i.e., morning, afternoon, evening, and before bed) (QID) (n=19) or placebo (n=16). No between group differences were observed in change from baseline on total Montgomery Åsberg Depression Rating Scale (MADRS) score (25.98±2.81), in either of the Positive or Negative subscales of the Positive and Negative Affect Schedule (PANAS), or on a global index of neurocognition. The possibility of practice and/or carry over effect could not be excluded. Methodological refinement (e.g., stratification of subjects based on baseline cognitive deficit) may have augmented assay sensitivity. Intranasal insulin did not demonstrate statistically significant improvements on overall mood, aspects of emotional processing, neurocognitive function, or self-reported quality of life patient reported outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

Diagnoses, Intervention Strategies, and Rates of Functional Improvement in Integrated Behavioral Health Care Patients

PubMed Central

Bridges, Ana J.; Gregus, Samantha J.; Rodriguez, Juventino Hernandez; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.

2016-01-01

Objective Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. Method Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. Results The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. Conclusion Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components. PMID:25774786

Validation of Community Models: 2. Development of a Baseline, Using the Wang-Sheeley-Arge Model

NASA Technical Reports Server (NTRS)

MacNeice, Peter

2009-01-01

This paper is the second in a series providing independent validation of community models of the outer corona and inner heliosphere. Here I present a comprehensive validation of the Wang-Sheeley-Arge (WSA) model. These results will serve as a baseline against which to compare the next generation of comparable forecasting models. The WSA model is used by a number of agencies to predict Solar wind conditions at Earth up to 4 days into the future. Given its importance to both the research and forecasting communities, it is essential that its performance be measured systematically and independently. I offer just such an independent and systematic validation. I report skill scores for the model's predictions of wind speed and interplanetary magnetic field (IMF) polarity for a large set of Carrington rotations. The model was run in all its routinely used configurations. It ingests synoptic line of sight magnetograms. For this study I generated model results for monthly magnetograms from multiple observatories, spanning the Carrington rotation range from 1650 to 2074. I compare the influence of the different magnetogram sources and performance at quiet and active times. I also consider the ability of the WSA model to forecast both sharp transitions in wind speed from slow to fast wind and reversals in the polarity of the radial component of the IMF. These results will serve as a baseline against which to compare future versions of the model as well as the current and future generation of magnetohydrodynamic models under development for forecasting use.

A randomized controlled trial of brief interventions for problem gambling in substance abuse treatment patients

PubMed Central

Petry, Nancy M.; Rash, Carla J.; Alessi, Sheila M.

2016-01-01

Objective This study evaluated the efficacy of brief gambling treatments in patients attending substance abuse treatment clinics. Methods Substance abuse treatment patients with gambling problems (N = 217) were randomly assigned to: a 10–15 minute Brief Psychoeducation intervention about gambling; a 10–15 minute Brief Advice intervention addressing gambling norms, risk factors, and methods to prevent additional problems; or four 50-min sessions consisting of motivational enhancement therapy plus cognitive-behavioral therapy for reducing gambling (MET+CBT). Gambling and related problems were assessed at baseline and throughout 24 months. Results In the sample as a whole, days and dollars wagered as well as gambling problems decreased markedly from baseline through month 5; thereafter, reductions in dollars wagered and gambling problems continued to decrease modestly but significantly, while days gambled remained constant. Brief Advice significantly reduced days gambled between baseline and month 5 relative to Brief Psychoeducation. The MET+CBT condition engendered no benefit beyond Brief Advice in terms of days gambled, but it did lead to more precipitous reductions in dollars gambled and problems experienced in the initial five months, and it engendered greater clinically significant improvements in gambling in both the short and long term. MET+CBT also resulted in initial decreases in self-reported alcohol use and problems, but it did not differentially impact self-reported illicit drug use problems or submission of positive samples. Conclusions Gambling problems tend to dissipate over time regardless of the intervention applied, but offering MET+CBT was more efficacious in decreasing gambling than providing a brief single session intervention. PMID:27398781

Workplace policies and prevalence of knee osteoarthritis: the Johnston County Osteoarthritis Project

PubMed Central

Chen, J-C; Linnan, L; Callahan, L F; Yelin, E H; Renner, J B

2007-01-01

Objective Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organisational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in the USA. Methods The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits policies (paid sick leave; disability payment) with KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analysed in participants (n = 1639) aged <65 years old and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favourable policies and adjust for this potential bias accordingly. Results Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering job-switch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paid sick leave (adjusted OR 0.58, 95% CI 0.37 to 0.91) and disability payment policies (adjusted OR 0.54, 95% CI 0.35 to 0.85). Even among those without overt knee-related symptoms, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment. Conclusion The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies. PMID:17567725

Workplace policies and prevalence of knee osteoarthritis: the Johnston County Osteoarthritis Project.

PubMed

Chen, J-C; Linnan, L; Callahan, L F; Yelin, E H; Renner, J B

2007-12-01

Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organisational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in the USA. The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits policies (paid sick leave; disability payment) with KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analysed in participants (n = 1639) aged <65 years old and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favourable policies and adjust for this potential bias accordingly. Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering job-switch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paid sick leave (adjusted OR 0.58, 95% CI 0.37 to 0.91) and disability payment policies (adjusted OR 0.54, 95% CI 0.35 to 0.85). Even among those without overt knee-related symptoms, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment. The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies.

Online access to doctors' notes: patient concerns about privacy.

PubMed

Vodicka, Elisabeth; Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-09-26

Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors' notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. To identify patients' attitudes toward privacy when given electronic access to their medical records, including visit notes. The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded "don't know") reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded "don't know") reported less concern. When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients' perceived risks to privacy.

[The efficacy and safety of budesonide inhalation suspension via transnasal nebulization compared with oral corticosteroids in chronic rhinosinusitis with nasal polyps].

PubMed

Lou, Hongfei; Wang, Chengshuo; Zhang, Luo

2015-05-01

To evaluate the efficacy and safety of a short course of nebulized budesonide via transnasal inhalation in chronic rhinosinusitis with nasal polyps. Fifty patients with severe eosinophilic nasal polyps were randomized devided into study group (n = 25) and control group (n = 25). The study group received budesonide inhalation suspension (1 mg twice daily) via transnasal nebulization for one week and the control group received oral prednisone (24 mg QD). Visual analogue scales (VAS) of nasal symptoms, endoscopic polyp scores (kennedy scores) and morning serum cortisol concentrations were assessed in both groups pre- and post-treatment. Operation time and surgical field bleeding were evaluated. Four subjects dropped out in control group. Budesonide transnasal nebulization caused a significant improvement in all nasal symptoms especially nasal obstruction (baseline: 8.25 ± 0.53; after treatment: 4.97 ± 0.97, P < 0.01) and reduced polyp size significantly (baseline: 4.64 ± 0.63; after treatment: 3.40 ± 0.76, P < 0.01) compared to pre-treatment. The patients treated with oral prednisone, however, showed more obvious improvement in nasal symptoms and polyp size, shorter operation time and better surgical field than budesonide group. Additionally, the morning serum cortisol concentration was mildly decreased after one week treatment in budesonide group [baseline (17.18 ± 2.83) μg/dl, after treatment (16.24 ± 2.93) μg/dl, P > 0.05], but all values were still located in normal range (normal range: 5-25 μg/dl). Conversely, the morning serum cortisol concentration in oral prednisone group was lower than normal limit [baseline (18.19 ± 2.81) μg/dl, after treatment (2.26 ± 0.70) μg/dl, P < 0.01]. Twice daily budesonide transnasal nebulization is an effective and safe treatment as evidenced by significant improvements in nasal symptoms and reduction in polyp size, coupled with an absence of hypothalamic-pituitary-adrenal axis suppression, which is safer than the systemic corticosteroids. Budesonide transnasal nebulization offers a viable treatment option for CRSwNP before operation.

A 2-Year Holistic Health and Stress Intervention: Results of an RCT in Clergy.

PubMed

Proeschold-Bell, Rae Jean; Turner, Elizabeth L; Bennett, Gary G; Yao, Jia; Li, Xiang-Fang; Eagle, David E; Meyer, Rachel A; Williams, Redford B; Swift, Robin Y; Moore, H Edgar; Kolkin, Melanie A; Weisner, Carl C; Rugani, Katherine M; Hough, Holly J; Williams, Virginia P; Toole, David C

2017-09-01

This study sought to determine the effect of a 2-year, multicomponent health intervention (Spirited Life) targeting metabolic syndrome and stress simultaneously. An RCT using a three-cohort multiple baseline design was conducted in 2010-2014. Participants were United Methodist clergy in North Carolina, U.S., in 2010, invited based on occupational status. Of invited 1,745 clergy, 1,114 consented, provided baseline data, and were randomly assigned to immediate intervention (n=395), 1-year waitlist (n=283), or 2-year waitlist (n=436) cohorts for a 48-month trial duration. The 2-year intervention consisted of personal goal setting and encouragement to engage in monthly health coaching, an online weight loss intervention, a small grant, and three workshops delivering stress management and theological content supporting healthy behaviors. Participants were not blinded to intervention. Trial outcomes were metabolic syndrome (primary) and self-reported stress and depressive symptoms (secondary). Intervention effects were estimated in 2016 in an intention-to-treat framework using generalized estimating equations with adjustment for baseline level of the outcome and follow-up time points. Log-link Poisson generalized estimating equations with robust SEs was used to estimate prevalence ratios (PRs) for binary outcomes; mean differences were used for continuous/score outcomes. Baseline prevalence of metabolic syndrome was 50.9% and depression was 11.4%. The 12-month intervention effect showed a benefit for metabolic syndrome (PR=0.86, 95% CI=0.79, 0.94, p<0.001). This benefit was sustained at 24 months of intervention (PR=0.88; 95% CI=0.78, 1.00, p=0.04). There was no significant effect on depression or stress scores. The Spirited Life intervention improved metabolic syndrome prevalence in a population of U.S. Christian clergy and sustained improvements during 24 months of intervention. These findings offer support for long-duration behavior change interventions and population-level interventions that allow participants to set their own health goals. This study is registered at www.clinicaltrials.gov NCT01564719. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Online Access to Doctors' Notes: Patient Concerns About Privacy

PubMed Central

Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-01-01

Background Offering patients online access to medical records, including doctors’ visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors’ notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. Objective To identify patients’ attitudes toward privacy when given electronic access to their medical records, including visit notes. Methods The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. Results 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded “don’t know”) reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded “don’t know”) reported less concern. Conclusions When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients’ perceived risks to privacy. PMID:24072335

Population-based estimates of survival and cost for metastatic melanoma.

PubMed

McCarron, C E; Ernst, S; Cao, J Q; Zaric, G S

2015-10-01

Fewer than half of all patients with metastatic melanoma survive more than 1 year. Standard treatments have had little success, but recent therapeutic advances offer the potential for an improved prognosis. In the present study, we used population-based administrative data to establish real-world baseline estimates of survival outcomes and costs against which new treatments can be compared. Data from administrative databases and patient registries were used to find a cohort of patients with metastatic melanoma in Ontario. To identify individuals most likely to receive new treatments, we focused on patients eligible for second-line treatment. The identified cohort had two characteristics: no surgical resection beyond primary skin excision, and receipt of first-line systemic therapy. Patient characteristics, Kaplan-Meier survival curves, and mean costs are reported. Of the 33,585 patients diagnosed with melanoma in Ontario from 1 January 1991 to 31 December 2010, 278 met the study inclusion criteria. Average age was 63 years, and 62% of the patients were men. Overall survival was estimated to be 19%, 12%, and 6% at 12, 24, and 60 months respectively. Mean survival time was 11.5 months, and mean cost was $30,685. Our baseline estimates indicate that survival outcomes are poor and costs are high for patients receiving standard treatment. Understanding the relative improvement accruing from any new treatment requires a comparison with the existing standard of care.

Effects of the Nurse Athlete Program on the Healthy Lifestyle Behaviors, Physical Health, and Mental Well-being of New Graduate Nurses.

PubMed

Hrabe, David P; Melnyk, Bernadette Mazurek; Buck, Jacalyn; Sinnott, Loraine T

Recognizing that transition from nursing student to point-of-care nurse can be a stressful time period in one's career. A pilot study at a large Midwestern medical center tested the preliminary effects of a health-oriented workshop, the Nurse Athlete, on new graduate nurses' healthy lifestyle beliefs, healthy lifestyle behaviors, depressive and anxiety symptoms, as well as health outcomes. The Nurse Athlete workshop, provided in partnership with Johnson & Johnson's Human Performance Institute (HPI), used materials from HPI's Corporate Athlete program. The 2-day workshop focuses on energy management through a comprehensive examination of goals and values in relation to one's spiritual, mental, emotional, and physical development and provides practical strategies to improve self-care. Eighty-eight new graduate nurses hired at the university's medical center were offered the opportunity to participate in the Nurse Athlete program and associated study. Sixty-nine percent of these new graduate nurses (n = 61) consented and participated in the program. There was a statistically significant decrease in the participants' weight and body mass index from baseline to the 6-month follow-up assessment, which resulted in small to medium positive effects for the Nurse Athlete program. There was also a significant decrease in body fat percentage across time, resulting in a large positive intervention effect. Statistically significant reductions in depressive symptoms were measured between baseline and 6 months.

A pilot study of a combined group and individual functional remediation program for patients with bipolar I disorder.

PubMed

Zyto, Susan; Jabben, Nienke; Schulte, Peter F J; Regeer, Barbara J; Kupka, Ralph W

2016-04-01

Bipolar disorder has been associated with a decrease in cognitive functioning affecting the functional outcome of patients independent of mood states. However, there have only been few attempts to investigate the effects of functional remediation for patients with bipolar disorder. The current study investigates the feasibility and effectiveness of a combined group and individual functional remediation program for bipolar disorder, including both patients and their caregivers. Twelve participants diagnosed with bipolar I disorder, and their caregivers, were treated with a combined group and individual functional remediation program. The feasibility of the program was evaluated by dropout rates and participants' evaluations of the program. The effectiveness of the program was explored through the assessment of functional outcome at baseline, immediately post-treatment, and follow-up three months later. The results indicate a high degree of satisfaction and a low dropout rate with the current program. Assessment of outcomes suggests improved functioning in the areas of autonomy and occupational functioning, evolving from baseline to follow-up. Due to a small sample size and the lack of a control group the results are preliminary. This relatively brief intervention offers a more tailor-made approach to functional remediation and shows good feasibility, acceptability and improvement of functioning in patients with bipolar I disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

Cluster-randomized controlled trial of the effects of free glasses on purchase of children's glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) study

PubMed Central

Wang, Xiuqin; Ma, Yue; Hu, Min; Zhou, Yuan; Liao, Weiqi; Jin, Ling; Xiao, Baixiang; Wu, Xiaoyi; Ni, Ming; Yi, Hongmei; Huang, Yiwen; Varga, Beatrice; Zhang, Hong; Cun, Yongkang; Li, Xianshun; Yang, Luhua; Liang, Chaoguang; Huang, Wan; Rozelle, Scott; Ma, Xiaochen

2017-01-01

Background Offering free glasses can be important to increase children’s wear. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China. Methods In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. Results Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56–1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. Conclusions Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. Trial registration ClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014. PMID:29161286

Offering a Treatment Choice in the Irradiation of Prostate Cancer Leads to Better Informed and More Active Patients, Without Harm to Well-Being

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

Tol-Geerdink, Julia J. van; Leer, Jan Willem; Lin, Emile N. J. Th. van

2008-02-01

Purpose: To examine, in prostate cancer patients, the effect of (1) being offered a choice between radiation doses in three-dimensional conformal radiotherapy, and of (2) accepting or declining the possibility to choose. Methods and Materials: A total of 150 patients with localized prostate cancer (T1-3N0M0) were offered a choice with a decision aid between two radiation doses (70 and 74 Gy). A control group of 144 patients received a fixed radiation dose without being offered a choice. Data were collected at baseline (before choice), before treatment (after choice), and 2 weeks and 6 months after treatment completion. Results: Compared withmore » the control group, the involvement group, receiving the decision aid, showed increased participation in decision making (p < 0.001), increased knowledge (p < 0.001), and improved risk perception (p < 0.001); they were more satisfied with the quality of information (p = 0.002) and considered their treatment a more appropriate treatment (p = 0.01). No group differences were found in well-being (e.g., general health, European Organization for Research and Treatment of Cancer quality of life, anxiety). Within the involvement group, accepting or declining the option to choose did not affect well-being either. Conclusions: Offering a choice of radiation dose, with a decision aid, increased involvement in decision making and led to a better-informed patient. In contrast to earlier suggestions, a strong increase in involvement did not result in improved well-being; and in contrast to clinical concerns, well-being was not negatively affected either, not even in those patients who preferred to leave the decision to their physician. This study shows that older patients, such as prostate cancer patients, can be informed and involved in decision making.« less

NASA TSRV essential flight control system requirements via object oriented analysis

NASA Technical Reports Server (NTRS)

Duffy, Keith S.; Hoza, Bradley J.

1992-01-01

The objective was to analyze the baseline flight control system of the Transport Systems Research Vehicle (TSRV) and to develop a system specification that offers high visibility of the essential system requirements in order to facilitate the future development of alternate, more advanced software architectures. The flight control system is defined to be the baseline software for the TSRV research flight deck, including all navigation, guidance, and control functions, and primary pilot displays. The Object Oriented Analysis (OOA) methodology developed is used to develop a system requirement definition. The scope of the requirements definition contained herein is limited to a portion of the Flight Management/Flight Control computer functionality. The development of a partial system requirements definition is documented, and includes a discussion of the tasks required to increase the scope of the requirements definition and recommendations for follow-on research.

Primary nerve grafting: A study of revascularization.

PubMed

Chalfoun, Charbel; Scholz, Thomas; Cole, Matthew D; Steward, Earl; Vanderkam, Victoria; Evans, Gregory R D

2003-01-01

It was the purpose of this study to evaluate the revascularization of primary nerve repair and grafts using orthogonal polarization spectral (OPS) (Cytometrix, Inc.) imaging, a novel method for real-time evaluation of microcirculatory blood flow. Twenty male Sprague Dawley rats (250 g) were anesthetized with vaporized halothane and surgically prepared for common peroneal nerve resection. Group I animals (n = 10) underwent primary neurorraphy following transection, utilizing a microsurgical technique with 10-0 nylon suture. Group II (n = 10) animals had a 7-mm segment of nerve excised, reversed, and subsequently replaced as a nerve graft under similar techniques. All animals were evaluated using the OPS imaging system on three portions (proximal, transection site/graft, and distal) of the nerve following repair or grafting. Reevaluation of 5 animals randomly selected from each group using the OPS imaging system was again performed on days 14 and 28 following microsurgical repair/grafting. Values were determined by percent change in vascularity of the common peroneal nerve at 0 hr following surgery. Real-time evaluation of blood flow was utilized as an additional objective criterion. Percent vascularity in group I and II animals increased from baseline in all segments at day 14. By day 28, vascularity in nerves of group I rats decreased in all segments to values below baseline, with the exception of the transection site, which remained at a higher value than obtained directly after surgical repair. In group II animals, vascularity remained above baseline in all segments except the distal segment, which returned to vascularity levels similar to those at 0 hr. Further, occlusion of the vessels demonstrated in the graft and distal segments following initial transection appeared to be corrected. This study suggests that revascularization may occur via bidirectional inosculation with favored proximal vascular growth advancement. The use of real-time imaging offers a unique evaluation of tissues through emerging technologies. Copyright 2003 Wiley-Liss, Inc.

Plantar Fascia Thickness is Longitudinally Associated with Retinopathy and Renal Dysfunction: A Prospective Study from Adolescence to Adulthood

PubMed Central

Benitez-Aguirre, Paul Z.; Craig, Maria E.; Jenkins, Alicia J.; Gallego, Patricia H.; Cusumano, Janine; Duffin, Anthony C.; Hing, Stephen; Donaghue, Kim C.

2012-01-01

Aim The aim was to study the longitudinal relationship between plantar fascia thickness (PFT) as a measure of tissue glycation and microvascular (MV) complications in young persons with type 1 diabetes (T1DM). Methods We conducted a prospective longitudinal cohort study of 152 (69 male) adolescents with T1DM who underwent repeated MV complications assessments and ultrasound measurements of PFT from baseline (1997–2002) until 2008. Retinopathy was assessed by 7-field stereoscopic fundal photography and nephropathy by albumin excretion rate (AER) from three timed overnight urine specimens. Longitudinal analysis was performed using generalized estimating equations (GEE). Results Median (interquartile range) age at baseline was 15.1 (13.4–16.8) years, and median follow-up was 8.3 (7.0–9.5) years, with 4 (3–6) visits per patient. Glycemic control improved from baseline to final visit [glycated hemoglobin (HbA1c) 8.5% to 8.0%, respectively; p = .004]. Prevalence of retinopathy increased from 20% to 51% (p < .001) and early elevation of AER (>7.5 µg/min) increased from 26% to 29% (p = .2). A greater increase in PFT (mm/year) was associated with retinopathy at the final assessment (ΔPFT 1st vs. 2nd–4th quartiles, χ2 = 9.87, p = .02). In multivariate GEE, greater PFT was longitudinally associated with retinopathy [odds ratio (OR) 4.6, 95% confidence interval (CI) 2.0–10.3] and early renal dysfunction (OR 3.2, CI 1.3–8.0) after adjusting for gender, blood pressure standard deviation scores, HbA1c, and total cholesterol. Conclusions In young people with T1DM, PFT was longitudinally associated with retinopathy and early renal dysfunction, highlighting the importance of early glycemic control and supporting the role of metabolic memory in MV complications. Measurement of PFT by ultrasound offers a noninvasive estimate of glycemic burden and tissue glycation. PMID:22538146

Plantar fascia thickness is longitudinally associated with retinopathy and renal dysfunction: a prospective study from adolescence to adulthood.

PubMed

Benitez-Aguirre, Paul Z; Craig, Maria E; Jenkins, Alicia J; Gallego, Patricia H; Cusumano, Janine; Duffin, Anthony C; Hing, Stephen; Donaghue, Kim C

2012-03-01

The aim was to study the longitudinal relationship between plantar fascia thickness (PFT) as a measure of tissue glycation and microvascular (MV) complications in young persons with type 1 diabetes (T1DM). We conducted a prospective longitudinal cohort study of 152 (69 male) adolescents with T1DM who underwent repeated MV complications assessments and ultrasound measurements of PFT from baseline (1997-2002) until 2008. Retinopathy was assessed by 7-field stereoscopic fundal photography and nephropathy by albumin excretion rate (AER) from three timed overnight urine specimens. Longitudinal analysis was performed using generalized estimating equations (GEE). Median (interquartile range) age at baseline was 15.1 (13.4-16.8) years, and median follow-up was 8.3 (7.0-9.5) years, with 4 (3-6) visits per patient. Glycemic control improved from baseline to final visit [glycated hemoglobin (HbA1c) 8.5% to 8.0%, respectively; p = .004]. Prevalence of retinopathy increased from 20% to 51% (p < .001) and early elevation of AER (>7.5 μg/min) increased from 26% to 29% (p = .2). A greater increase in PFT (mm/year) was associated with retinopathy at the final assessment (ΔPFT 1st vs. 2nd-4th quartiles, χ(2) = 9.87, p = .02). In multivariate GEE, greater PFT was longitudinally associated with retinopathy [odds ratio (OR) 4.6, 95% confidence interval (CI) 2.0-10.3] and early renal dysfunction (OR 3.2, CI 1.3-8.0) after adjusting for gender, blood pressure standard deviation scores, HbA1c, and total cholesterol. In young people with T1DM, PFT was longitudinally associated with retinopathy and early renal dysfunction, highlighting the importance of early glycemic control and supporting the role of metabolic memory in MV complications. Measurement of PFT by ultrasound offers a noninvasive estimate of glycemic burden and tissue glycation. © 2012 Diabetes Technology Society.

Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.

PubMed

Chen, Chien P; Braunstein, Steve; Mourad, Michelle; Hsu, I-Chow J; Haas-Kogan, Daphne; Roach, Mack; Fogh, Shannon E

2015-01-01

Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding. We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers. Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention). Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming. Copyright © 2015. Published by Elsevier Inc.

Creation of the Naturalistic Engagement in Secondary Tasks (NEST) distracted driving dataset.

PubMed

Owens, Justin M; Angell, Linda; Hankey, Jonathan M; Foley, James; Ebe, Kazutoshi

2015-09-01

Distracted driving has become a topic of critical importance to driving safety research over the past several decades. Naturalistic driving data offer a unique opportunity to study how drivers engage with secondary tasks in real-world driving; however, the complexities involved with identifying and coding relevant epochs of naturalistic data have limited its accessibility to the general research community. This project was developed to help address this problem by creating an accessible dataset of driver behavior and situational factors observed during distraction-related safety-critical events and baseline driving epochs, using the Strategic Highway Research Program 2 (SHRP2) naturalistic dataset. The new NEST (Naturalistic Engagement in Secondary Tasks) dataset was created using crashes and near-crashes from the SHRP2 dataset that were identified as including secondary task engagement as a potential contributing factor. Data coding included frame-by-frame video analysis of secondary task and hands-on-wheel activity, as well as summary event information. In addition, information about each secondary task engagement within the trip prior to the crash/near-crash was coded at a higher level. Data were also coded for four baseline epochs and trips per safety-critical event. 1,180 events and baseline epochs were coded, and a dataset was constructed. The project team is currently working to determine the most useful way to allow broad public access to the dataset. We anticipate that the NEST dataset will be extraordinarily useful in allowing qualified researchers access to timely, real-world data concerning how drivers interact with secondary tasks during safety-critical events and baseline driving. The coded dataset developed for this project will allow future researchers to have access to detailed data on driver secondary task engagement in the real world. It will be useful for standalone research, as well as for integration with additional SHRP2 data to enable the conduct of more complex research. Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.

Complex adaptive systems: A new approach for understanding health practices.

PubMed

Gomersall, Tim

2018-06-22

This article explores the potential of complex adaptive systems theory to inform behaviour change research. A complex adaptive system describes a collection of heterogeneous agents interacting within a particular context, adapting to each other's actions. In practical terms, this implies that behaviour change is 1) socially and culturally situated; 2) highly sensitive to small baseline differences in individuals, groups, and intervention components; and 3) determined by multiple components interacting "chaotically". Two approaches to studying complex adaptive systems are briefly reviewed. Agent-based modelling is a computer simulation technique that allows researchers to investigate "what if" questions in a virtual environment. Applied qualitative research techniques, on the other hand, offer a way to examine what happens when an intervention is pursued in real-time, and to identify the sorts of rules and assumptions governing social action. Although these represent very different approaches to complexity, there may be scope for mixing these methods - for example, by grounding models in insights derived from qualitative fieldwork. Finally, I will argue that the concept of complex adaptive systems offers one opportunity to gain a deepened understanding of health-related practices, and to examine the social psychological processes that produce health-promoting or damaging actions.

Titian: Data Provenance Support in Spark

PubMed Central

Interlandi, Matteo; Shah, Kshitij; Tetali, Sai Deep; Gulzar, Muhammad Ali; Yoo, Seunghyun; Kim, Miryung; Millstein, Todd; Condie, Tyson

2015-01-01

Debugging data processing logic in Data-Intensive Scalable Computing (DISC) systems is a difficult and time consuming effort. Today’s DISC systems offer very little tooling for debugging programs, and as a result programmers spend countless hours collecting evidence (e.g., from log files) and performing trial and error debugging. To aid this effort, we built Titian, a library that enables data provenance—tracking data through transformations—in Apache Spark. Data scientists using the Titian Spark extension will be able to quickly identify the input data at the root cause of a potential bug or outlier result. Titian is built directly into the Spark platform and offers data provenance support at interactive speeds—orders-of-magnitude faster than alternative solutions—while minimally impacting Spark job performance; observed overheads for capturing data lineage rarely exceed 30% above the baseline job execution time. PMID:26726305

Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam.

PubMed

Hoornenborg, Elske; Achterbergh, Roel Ca; van der Loeff, Maarten F Schim; Davidovich, Udi; van der Helm, Jannie J; Hogewoning, Arjan; van Duijnhoven, Yvonne Thp; Sonder, Gerard Jb; de Vries, Henry Jc; Prins, Maria

2018-03-01

The Amsterdam PrEP project is a prospective, open-label demonstration study at a large sexually transmitted infection (STI) clinic. We examined the uptake of PrEP; the baseline characteristics of men who have sex with men (MSM) and transgender persons initiating PrEP; their choices of daily versus event-driven PrEP and the determinants of these choices. From August 2015 through May 2016, enrolment took place at the STI clinic of the Public Health Service of Amsterdam, the Netherlands. MSM or transgender persons were eligible if they had at least one risk factor for HIV infection within the preceding six months. Participants were offered a choice between daily or event-driven use of tenofovir/emtricitabine. Baseline data were analysed using descriptive statistics and multivariable analysis was employed to determine variables associated with daily versus event-driven PrEP. Online applications were submitted by 870 persons, of whom 587 were invited for a screening visit. Of them, 415 were screened for eligibility and 376 initiated PrEP. One quarter (103/376, 27%) chose event-driven PrEP. Prevalence of bacterial STI was 19.0% and mean condomless anal sex (CAS) episodes in the preceding three months were 11. In multivariable analysis, older age (≥45 vs. ≤34, aOR 2.1, 95% CI 1.2 to 3.9), being involved in a steady relationship (aOR 1.7, 95% CI 1.0 to 2.7), no other daily medication use (aOR 0.6, 95% CI 0.3 to 0.9), and fewer episodes of CAS (per log increase aOR 0.7, 95% CI 0.6 to 0.9) were determinants for choosing event-driven PrEP. PrEP programmes are becoming one of the more important intervention strategies with the goal of reducing incident HIV-infection and we were unable to accommodate many of the persons applying for this study. Offering a choice of dosing regimen to PrEP users may enable further personalization of HIV prevention strategies and enhance up-take, adherence and cost-effectiveness. The majority of participants preferred daily versus event-driven use. Within this majority, a high number of CAS episodes before PrEP initiation was reported and we observed a high prevalence of STI. Determinants of choosing event-driven PrEP were older age, fewer CAS episodes, no other daily medication use, and involved in a steady relationship. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Potential Astrophysics Science Missions Enabled by NASA's Planned Ares V

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Thronson, Harley; Langhoff, Stepheni; Postman, Marc; Lester, Daniel; Lillie, Chuck

2009-01-01

NASA s planned Ares V cargo vehicle with its 10 meter diameter fairing and 60,000 kg payload mass to L2 offers the potential to launch entirely new classes of space science missions such as 8-meter monolithic aperture telescopes, 12- meter aperture x-ray telescopes, 16 to 24 meter segmented telescopes and highly capable outer planet missions. The paper will summarize the current Ares V baseline performance capabilities and review potential mission concepts enabled by these capabilities.

Engineered Polymer Composites Through Electrospun Nanofiber Coating of Fiber Tows

NASA Technical Reports Server (NTRS)

Kohlman, Lee W.; Bakis, Charles; Williams, Tiffany S.; Johnston, James C.; Kuczmarski, Maria A.; Roberts, Gary D.

2014-01-01

Composite materials offer significant weight savings in many aerospace applications. The toughness of the interface of fibers crossing at different angles often determines failure of composite components. A method for toughening the interface in fabric and filament wound components using directly electrospun thermoplastic nanofiber on carbon fiber tow is presented. The method was first demonstrated with limited trials, and then was scaled up to a continuous lab scale process. Filament wound tubes were fabricated and tested using unmodified baseline towpreg material and nanofiber coated towpreg.

First Results on a Transatlantic Time and Frequency Transfer by GPS Carrier Phase

DTIC Science & Technology

1998-12-01

Washington (USNO). Besides the longer baseline the choice of these two sites offers aho the possibility to compare frequently GeTT and TWSTFT . The paper...INTRODUCTION The GPS Common View (CV) and thc Two Way Satellite Time and Frequency Transfer ( TWSTFT ) are up to now the most used methods for precise tirnc... TWSTFT technique allows comparisons with a shorter trme but at the prize of heavy sending and receiving equipment on each site An interesting

In their own words: describing Canadian physician leadership.

PubMed

Snell, Anita J; Dickson, Graham; Wirtzfeld, Debrah; Van Aerde, John

2016-07-04

Purpose This is the first study to compile statistical data to describe the functions and responsibilities of physicians in formal and informal leadership roles in the Canadian health system. This mixed-methods research study offers baseline data relative to this purpose, and also describes physician leaders' views on fundamental aspects of their leadership responsibility. Design/methodology/approach A survey with both quantitative and qualitative fields yielded 689 valid responses from physician leaders. Data from the survey were utilized in the development of a semi-structured interview guide; 15 physician leaders were interviewed. Findings A profile of Canadian physician leadership has been compiled, including demographics; an outline of roles, responsibilities, time commitments and related compensation; and personal factors that support, engage and deter physicians when considering taking on leadership roles. The role of health-care organizations in encouraging and supporting physician leadership is explicated. Practical implications The baseline data on Canadian physician leaders create the opportunity to determine potential steps for improving the state of physician leadership in Canada; and health-care organizations are provided with a wealth of information on how to encourage and support physician leaders. Using the data as a benchmark, comparisons can also be made with physician leadership as practiced in other nations. Originality/value There are no other research studies available that provide the depth and breadth of detail on Canadian physician leadership, and the embedded recommendations to health-care organizations are informed by this in-depth knowledge.

Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study.

PubMed

Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

2017-02-01

Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery. Male patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p < 0.001). In females, there was no difference between the two groups in any of the components of urological or sexual function. However, composite female urological function score change from baseline was better in the robotic group (p = 0.003). Robotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.

Influence of Anti-TNF and Disease Modifying Antirheumatic Drugs Therapy on Pulmonary Forced Vital Capacity Associated to Ankylosing Spondylitis: A 2-Year Follow-Up Observational Study

PubMed Central

Rocha-Muñoz, Alberto Daniel; Brambila-Tapia, Aniel Jessica Leticia; Zavala-Cerna, María Guadalupe; Vásquez-Jiménez, José Clemente; De la Cerda-Trujillo, Liliana Faviola; Vázquez-Del Mercado, Mónica; Rodriguez-Jimenez, Norma Alejandra; Díaz-Rizo, Valeria; Díaz-González, Viviana; Cardona-Muñoz, Ernesto German; Dávalos-Rodríguez, Ingrid Patricia; Salazar-Paramo, Mario; Gamez-Nava, Jorge Ivan; Nava-Zavala, Arnulfo Hernan; Gonzalez-Lopez, Laura

2015-01-01

Objective. To evaluate the effect of anti-TNF agents plus synthetic disease modifying antirheumatic drugs (DMARDs) versus DMARDs alone for ankylosing spondylitis (AS) with reduced pulmonary function vital capacity (FVC%). Methods. In an observational study, we included AS who had FVC% <80% at baseline. Twenty patients were taking DMARDs and 16 received anti-TNF + DMARDs. Outcome measures: changes in FVC%, BASDAI, BASFI, 6-minute walk test (6MWT), Borg scale after 6MWT, and St. George's Respiratory Questionnaire at 24 months. Results. Both DMARDs and anti-TNF + DMARDs groups had similar baseline values in FVC%. Significant improvement was achieved with anti-TNF + DMARDs in FVC%, at 24 months, when compared to DMARDs alone (P = 0.04). Similarly, patients in anti-TNF + DMARDs group had greater improvement in BASDAI, BASFI, Borg scale, and 6MWT when compared to DMARDs alone. After 2 years of follow-up, 14/16 (87.5%) in the anti-TNF + DMARDs group achieved the primary outcome: FVC% ≥80%, compared with 11/20 (55%) in the DMARDs group (P = 0.04). Conclusions. Patients with anti-TNF + DMARDs had a greater improvement in FVC% and cardiopulmonary scales at 24 months compared with DMARDs. This preliminary study supports the fact that anti-TNF agents may offer additional benefits compared to DMARDs in patients with AS who have reduced FVC%. PMID:26078986

Smartphone-based ecological momentary assessment and intervention in a coping-focused intervention for hearing voices (SAVVy): study protocol for a pilot randomised controlled trial.

PubMed

Bell, Imogen H; Fielding-Smith, Sarah F; Hayward, Mark; Rossell, Susan L; Lim, Michelle H; Farhall, John; Thomas, Neil

2018-05-02

Smartphone-based ecological momentary assessment and intervention (EMA/I) show promise for enhancing psychological treatments for psychosis. EMA has the potential to improve assessment and formulation of experiences which fluctuate day-to-day, and EMI may be used to prompt use of therapeutic strategies in daily life. The current study is an examination of these capabilities in the context of a brief, coping-focused intervention for distressing voice hearing experiences. This is a rater-blinded, pilot randomised controlled trial comparing a four-session intervention in conjunction with use of smartphone EMA/I between sessions, versus treatment-as-usual. The recruitment target is 34 participants with persisting and distressing voice hearing experiences, recruited through a Voices Clinic based in Melbourne, Australia, and via wider advertising. Allocation will be made using minimisation procedure, balancing of the frequency of voices between groups. Assessments are completed at baseline and 8 weeks post-baseline. The primary outcomes of this trial will focus on feasibility and acceptability of the intervention and trial methodology, with secondary outcomes examining preliminary clinical effects related to overall voice severity, the emotional and functional impact of the voices, and emotional distress. This study offers a highly novel examination of specific smartphone capabilities and their integration with traditional psychological treatment for distressing voices. Such technology has potential to enhance psychological interventions and promote adaptation to distressing experiences. Australian New Zealand Clinical Trial Registry, ACTRN12617000348358 . Registered on 7 March 2017.

Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD).

PubMed

Janssen, Lotte; Kan, Cornelis C; Carpentier, Pieter J; Sizoo, Bram; Hepark, Sevket; Grutters, Janneke; Donders, Rogier; Buitelaar, Jan K; Speckens, Anne E M

2015-09-15

Adults with attention deficit hyperactivity disorder (ADHD) often present with a lifelong pattern of core symptoms that is associated with impairments of functioning in daily life. This has a substantial personal and economic impact. In clinical practice there is a high need for additional or alternative interventions for existing treatments, usually consisting of pharmacotherapy and/or psycho-education. Although previous studies show preliminary evidence for the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning, these studies have methodological limitations. This study will take account of these limitations and will examine the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) in further detail. A multi-centre, parallel-group, randomised controlled trial will be conducted in N = 120 adults with ADHD. Patients will be randomised to MBCT in addition to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline and at three, six and nine months after baseline. Primary outcome measure will be severity of ADHD symptoms rated by a blinded clinician. Secondary outcome measures will be self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. In addition, a cost-effectiveness analysis will be conducted. This trial will offer valuable information about the clinical and cost-effectiveness of MBCT in addition to TAU compared to TAU alone in adults swith ADHD. ClinicalTrials.gov NCT02463396. Registered 8 June 2015.

Design of Video Games for Children's Diet and Physical Activity Behavior Change.

PubMed

Baranowski, Tom; Thompson, Debbe; Buday, Richard; Lu, Amy Shirong; Baranowski, Janice

2010-01-01

Serious video games (VG) offer new opportunities for promoting health related diet and physical activity change among children. Games can be designed to use storylines, characters, and behavior change procedures, including modeling (e.g., engaging characters make changes themselves, and face and overcome challenges related to fruit and vegetable (FV) and physical activity (PA) goal attainment and/or consumption), skill development (e.g., asking behaviors; virtual recipe preparation), self regulatory behaviors (problem solving, goal setting, goal review, decision making), rewards (e.g., points and positive statements generated by the program), immediate feedback (e.g., through characters and/or statements that appear on the computer screen at critical decision points), and personalization (e.g., tailored choices offered at critical junctures, based on responses to baselines questions related to preferences, outcome expectancies, etc). We are in the earliest stages of learning how to optimally design effective behavior change procedures for use in VG, and yet they have been demonstrated to change behavior. As we learn, VG offer more and better opportunities for obesity prevention that can adjust to individual needs and preferences.

Design of Video Games for Children’s Diet and Physical Activity Behavior Change

PubMed Central

Baranowski, Tom; Thompson, Debbe; Buday, Richard; Lu, Amy Shirong; Baranowski, Janice

2012-01-01

Serious video games (VG) offer new opportunities for promoting health related diet and physical activity change among children. Games can be designed to use storylines, characters, and behavior change procedures, including modeling (e.g., engaging characters make changes themselves, and face and overcome challenges related to fruit and vegetable (FV) and physical activity (PA) goal attainment and/or consumption), skill development (e.g., asking behaviors; virtual recipe preparation), self regulatory behaviors (problem solving, goal setting, goal review, decision making), rewards (e.g., points and positive statements generated by the program), immediate feedback (e.g., through characters and/or statements that appear on the computer screen at critical decision points), and personalization (e.g., tailored choices offered at critical junctures, based on responses to baselines questions related to preferences, outcome expectancies, etc). We are in the earliest stages of learning how to optimally design effective behavior change procedures for use in VG, and yet they have been demonstrated to change behavior. As we learn, VG offer more and better opportunities for obesity prevention that can adjust to individual needs and preferences. PMID:25364331

LOW-ENGINE-FRICTION TECHNOLOGY FOR ADVANCED NATURAL-GAS RECIPROCATING ENGINES

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

Victor Wong; Tian Tian; Luke Moughon

This program aims at improving the efficiency of advanced natural-gas reciprocating engines (ANGRE) by reducing piston and piston ring assembly friction without major adverse effects on engine performance, such as increased oil consumption and wear. An iterative process of simulation, experimentation and analysis is being followed towards achieving the goal of demonstrating a complete optimized low-friction engine system. To date, a detailed set of piston and piston-ring dynamic and friction models have been developed and applied that illustrate the fundamental relationships among mechanical, surface/material and lubricant design parameters and friction losses. Demonstration of low-friction ring-pack designs in the Waukesha VGFmore » 18GL engine confirmed total engine FEMP (friction mean effective pressure) reduction of 7-10% from the baseline configuration without significantly increasing oil consumption or blow-by flow. This represents a substantial (30-40%) reduction of the ringpack friction alone. The measured FMEP reductions were in good agreement with the model predictions. Further improvements via piston, lubricant, and surface designs offer additional opportunities. Tests of low-friction lubricants are in progress and preliminary results are very promising. The combined analysis of lubricant and surface design indicates that low-viscosity lubricants can be very effective in reducing friction, subject to component wear for extremely thin oils, which can be mitigated with further lubricant formulation and/or engineered surfaces. Hence a combined approach of lubricant design and appropriate wear reduction offers improved potential for minimum engine friction loss. Piston friction studies indicate that a flatter piston with a more flexible skirt, together with optimizing the waviness and film thickness on the piston skirt offer significant friction reduction. Combined with low-friction ring-pack, material and lubricant parameters, a total power cylinder friction reduction of 30-50% is expected, translating to an engine efficiency increase of two percentage points from its current baseline towards the goal of 50% ARES engine efficiency. The design strategies developed in this study have promising potential for application in all modern reciprocating engines as they represent simple, low-cost methods to extract significant fuel savings. The current program has possible spinoffs and applications in other industries as well, including transportation, CHP, and diesel power generation. The progress made in this program has wide engine efficiency implications, and potential deployment of low-friction engine components or lubricants in the near term is possible as current investigations continue.« less

Developing and validating risk prediction models in an individual participant data meta-analysis

PubMed Central

2014-01-01

Background Risk prediction models estimate the risk of developing future outcomes for individuals based on one or more underlying characteristics (predictors). We review how researchers develop and validate risk prediction models within an individual participant data (IPD) meta-analysis, in order to assess the feasibility and conduct of the approach. Methods A qualitative review of the aims, methodology, and reporting in 15 articles that developed a risk prediction model using IPD from multiple studies. Results The IPD approach offers many opportunities but methodological challenges exist, including: unavailability of requested IPD, missing patient data and predictors, and between-study heterogeneity in methods of measurement, outcome definitions and predictor effects. Most articles develop their model using IPD from all available studies and perform only an internal validation (on the same set of data). Ten of the 15 articles did not allow for any study differences in baseline risk (intercepts), potentially limiting their model’s applicability and performance in some populations. Only two articles used external validation (on different data), including a novel method which develops the model on all but one of the IPD studies, tests performance in the excluded study, and repeats by rotating the omitted study. Conclusions An IPD meta-analysis offers unique opportunities for risk prediction research. Researchers can make more of this by allowing separate model intercept terms for each study (population) to improve generalisability, and by using ‘internal-external cross-validation’ to simultaneously develop and validate their model. Methodological challenges can be reduced by prospectively planned collaborations that share IPD for risk prediction. PMID:24397587

Teaching social-communication skills to preschoolers with autism: efficacy of video versus in vivo modeling in the classroom.

PubMed

Wilson, Kaitlyn P

2013-08-01

Video modeling is a time- and cost-efficient intervention that has been proven effective for children with autism spectrum disorder (ASD); however, the comparative efficacy of this intervention has not been examined in the classroom setting. The present study examines the relative efficacy of video modeling as compared to the more widely-used strategy of in vivo modeling using an alternating treatments design with baseline and replication across four preschool-aged students with ASD. Results offer insight into the heterogeneous treatment response of students with ASD. Additional data reflecting visual attention and social validity were captured to further describe participants' learning preferences and processes, as well as educators' perceptions of the acceptability of each intervention's procedures in the classroom setting.

Impact of resilience enhancing programs on youth surviving the Beslan school siege

PubMed Central

2010-01-01

The objective of this study was to evaluate a resilience-enhancing program for youth (mean age = 13.32 years) from Beslan, North Ossetia, in the Russian Federation. The program, offered in the summer of 2006, combined recreation, sport, and psychosocial rehabilitation activities for 94 participants, 46 of who were taken hostage in the 2004 school tragedy and experienced those events first hand. Self-reported resilience, as measured by the CD-RISC, was compared within subjects at the study baseline and at two follow-up assessments: immediately after the program and 6 months later. We also compared changes in resilience levels across groups that differed in their traumatic experiences. The results indicate a significant intra-participant mean increase in resilience at both follow-up assessments, and greater self-reported improvements in resilience processes for participants who experienced more trauma events. PMID:20412559

Effectiveness of a psychosocial weight management program for individuals with schizophrenia.

PubMed

Niv, Noosha; Cohen, Amy N; Hamilton, Alison; Reist, Christopher; Young, Alexander S

2014-07-01

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and Body Mass Index (BMI) were assessed at baseline, 1 year later, and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds, and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.

Implementation and Effectiveness of a Psychosocial Weight Management Program for Individuals with Schizophrenia

PubMed Central

Niv, Noosha; Cohen, Amy N.; Hamilton, Alison; Reist, Christopher; Young, Alexander S.

2013-01-01

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and BMI were assessed at baseline, 1 year later and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed. PMID:22430566

A therapeutic skating intervention for children with autism spectrum disorder.

PubMed

Casey, Amanda Faith; Quenneville-Himbeault, Gabriel; Normore, Alexa; Davis, Hanna; Martell, Stephen G

2015-01-01

The purpose of this study was to evaluate the effects of a highly structured therapeutic skating intervention on motor outcomes and functional capacity in 2 boys with autism spectrum disorder aged 7 and 10 years. This multiple-baseline, single-subject study assigned participants to three 1-hour skating sessions per week for 12 weeks focusing on skill and motor development. Multiple data points assessed (a) fidelity to the intervention and (b) outcomes measures including the Pediatric Balance Scale, Timed Up and Go, floor to stand, Six-Minute Walk Test, goal attainment, and weekly on-ice testing. Improvements were found in balance, motor behavior, and functional capacity by posttest with gains remaining above pretest levels at follow-up. Therapeutic skating may produce physical benefits for children with autism spectrum disorder and offer a viable, inexpensive community-based alternative to other forms of physical activity.

White Ethnic Residential Segregation in Historical Perspective: U.S. Cities in 1880

PubMed Central

Logan, John R.; Zhang, Weiwei

2013-01-01

Investigating immigrant residential patterns in 1880 offers a baseline for understanding residential assimilation trajectories in subsequent eras. This study uses 100% count information from the 1880 Census to estimate a multilevel model of ethnic isolation and exposure to native whites in 67 cities for individual Irish, German and British residents. At the individual level, the key predictors are drawn from assimilation theory: nativity, occupation, and marital status. The multilevel model makes it possible to control for these predictors and to study independent sources of variation in segregation across cities. There is considerable variation at the city level, especially due to differences in the relative sizes of groups. Other significant city-level predictors of people’s neighborhood composition include the share of group members who are foreign-born, the disparity in occupational standing between group members and native whites, and the degree of occupational segregation between them. PMID:23017933

Steps to Health employee weight management randomized control trial: short-term follow-up results.

PubMed

Østbye, Truls; Stroo, Marissa; Brouwer, Rebecca J N; Peterson, Bercedis L; Eisenstein, Eric L; Fuemmeler, Bernard F; Joyner, Julie; Gulley, Libby; Dement, John M

2015-02-01

To present the short-term follow-up findings of the Steps to Health study, a randomized trial to evaluate the effectiveness of two employee weight management programs offered within Duke University and the Health System. A total of 550 obese (body mass index, ≥30 kg/m2) employees were randomized 1:1 between January 2011 and June 2012 to the education-based Weight Management (WM) or the WM+ arm, which focused on behavior modification. Employees were contacted to complete a follow-up visit approximately 14 months after baseline. There were no clinically, or statistically, meaningful differences between arms, but there were modest reductions in body mass index, and positive, meaningful changes in diet and physical activity for both arms. The modest positive effects observed in this study may suggest that to achieve weight loss through the workplace more intensive interventions may be required.

Proteome studies of filamentous fungi.

PubMed

Baker, Scott E; Panisko, Ellen A

2011-01-01

The continued fast pace of fungal genome sequence generation has enabled proteomic analysis of a wide variety of organisms that span the breadth of the Kingdom Fungi. There is some phylogenetic bias to the current catalog of fungi with reasonable DNA sequence databases (genomic or EST) that could be analyzed at a global proteomic level. However, the rapid development of next generation sequencing platforms has lowered the cost of genome sequencing such that in the near future, having a genome sequence will no longer be a time or cost bottleneck for downstream proteomic (and transcriptomic) analyses. High throughput, nongel-based proteomics offers a snapshot of proteins present in a given sample at a single point in time. There are a number of variations on the general methods and technologies for identifying peptides in a given sample. We present a method that can serve as a "baseline" for proteomic studies of fungi.

A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain

PubMed Central

Waelde, Lynn C.; Feinstein, Amanda B.; Bhandari, Rashmi; Griffin, Anya; Yoon, Isabel A.; Golianu, Brenda

2017-01-01

Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13–17 years. Measures of pain intensity, functional disability, depression and parent worry about their child’s pain were obtained at baseline and post-treatment. Results indicated no significant changes in pain or depression, however functional disability and frequency of pain functioning complaints improved with small effect sizes. Parents’ worry about child’s pain significantly decreased with a large effect size. Participants rated intervention components positively and most teens suggested that the number of sessions be increased. Three case examples illustrate mindfulness meditation effects and precautions. Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy. PMID:28445406

Managing multiple-casualty incidents: a rural medical preparedness training assessment.

PubMed

Glow, Steven D; Colucci, Vincent J; Allington, Douglas R; Noonan, Curtis W; Hall, Earl C

2013-08-01

The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. Participants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities. A total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage. Mass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals' roles and responsibilities, allocate resources, triage patients, and assign transport priorities. After emergency department notification and in advance of arrival, emergency department personnel must assess available physical resources and availability and type of manpower, all while managing patients already under their care. Mass-casualty incident trainings should strengthen the key, individual elements essential to well-coordinated response such as communications, incident management system and triage. The practice scenarios should be matched to the specific resources of the community. The authors also believe that these trainings should be provided with all disciplines represented to eliminate training "silos," to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.

Factors Associated with Adherence to the HEDIS Quality Measure in Medicaid Patients with Schizophrenia

PubMed Central

Lafeuille, Marie-Hélène; Frois, Christian; Cloutier, Michel; Duh, Mei Sheng; Lefebvre, Patrick; Pesa, Jacqueline; Clancy, Zoe; Fastenau, John; Durkin, Mike

2016-01-01

Background Treatment continuity is a major challenge in the long-term management of patients with schizophrenia; poor patient adherence to antipsychotic drugs has been associated with negative clinical outcomes. Long-acting injectable therapies may improve adherence and lessen the risk for psychiatric-related relapse, often leading to rehospitalization and higher healthcare costs. Therefore, understanding the determinants of adherence to antipsychotics is critical in the management of patients with schizophrenia. Objective To assess the impact of baseline patient characteristics on adherence as measured by the Healthcare Effectiveness Data and Information Set (HEDIS) measure of continuity of antipsychotic medications among patients with Medicaid coverage. Methods Medicaid healthcare claims data between 2008 and 2011 from 5 states were used to identify patients who were diagnosed with schizophrenia (aged 25–64 years) and received ≥1 antipsychotic prescriptions in baseline year 2010 and in measurement year 2011. The HEDIS continuity of antipsychotic medications (ie, adherence) measure was defined as the proportion of days covered with any antipsychotic medication ≥80% during the measurement year. The 2 cohorts compared paliperidone palmitate with any other antipsychotics, including quetiapine, risperidone, and haloperidol. The baseline-year characteristics were evaluated as potential predictive factors of adherence in the measurement year using multivariate logistic regressions. The regression models incorporated the inverse probability of treatment weights to control for differences in baseline characteristics between the paliperidone palmitate and the other antipsychotics cohort. Results Among the 12,990 patients who received an antipsychotic during the study period, 48.6% successfully achieved the continuity criteria in the measurement year. After controlling for other covariates, the odds of adherence were improved by adherence at baseline (odds ratio [OR], 9.42; 95% confidence interval [CI], 8.55–10.39). The use of paliperidone palmitate was associated with a 26% increase in the odds of achieving adherence compared with the use of the other antipsychotics studied (OR, 1.26; 95% CI, 1.14–1.39). In addition, female sex (OR, 1.11; 95% CI, 1.01–1.22), age 55 to 64 years (OR, 1.26; 95% CI, 1.09–1.46) versus age 25 to 34 years, Hispanic race (OR, 1.37; 95% CI, 1.05–1.81) versus white race, and an increase of $10,000 in baseline inpatient costs (OR, 1.11; 95% CI, 1.08–1.15) were associated with greater odds of treatment continuity. Conclusions In addition to sex, age, and race, the baseline characteristics that were associated with achieving the HEDIS continuity of antipsychotic medication measure included previous-year adherence, inpatient costs, and the use of paliperidone palmitate. These findings offer insight to healthcare plans that cover Medicaid populations on the effects that patient characteristics and treatment types may have on adherence among patients with schizophrenia. PMID:27994714

The role of cognitive reserve on terminal decline: a cross-cohort analysis from two European studies: OCTO-Twin, Sweden, and Newcastle 85+, UK.

PubMed

Cadar, Dorina; Stephan, Blossom C M; Jagger, Carol; Johansson, Boo; Hofer, Scott M; Piccinin, Andrea M; Muniz-Terrera, Graciela

2016-06-01

Cognitive performance shows a marked deterioration in close proximity to death, as postulated by the terminal decline hypothesis. The effect of education on the rate of terminal decline in the oldest people (i.e. persons 85+ years) has been controversial and not entirely understood. In the current study, we investigated the rate of decline prior to death with a special focus on the role of education and socioeconomic position, in two European longitudinal studies of ageing: the Origins of Variance in the Old-Old: Octogenarian Twins (OCTO-Twin) and the Newcastle 85+ study. A process-based approach was used in which individuals' cognitive scores were aligned according to distance to death. In a coordinated analysis, multilevel models were employed to examine associations between different markers of cognitive reserve (education and socioeconomic position) and terminal decline using the mini-mental state examination (MMSE), controlling for age at baseline, sex, dementia incidence and time to death from the study entry to the time of death within each cohort. The current findings suggest that education was positively associated with higher MMSE scores prior to death in the OCTO-Twin, but not in the Newcastle 85+ study, independent of socioeconomic position and other factors such as baseline age, sex and time to death from the study entry. However, education was not associated with the rate of terminal decline in both of these studies. Our results offer only partial support to the cognitive reserve hypothesis and cognitive performance prior to death. © 2015 The Authors International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

Grade III ischemia on presentation with acute myocardial infarction predicts rapid progression of necrosis and less myocardial salvage with thrombolysis.

PubMed

Birnbaum, Yochai; Mahaffey, Kenneth W; Criger, Douglas A; Gates, Kathy B; Barbash, Gabriel I; Barbagelata, Alejandro; Clemmensen, Peter; Sgarbossa, Elena B; Gibbons, Raymond J; Rahman, M Atiar; Califf, Robert M; Granger, Chistopher B; Wagner, Galen S

2002-01-01

We assessed the relation between baseline electrocardiographic ischemia grades and initial myocardial area at risk (AR) and final infarct size (IS) in 49 patients who had undergone (99m)Tc sestamibi single-photon emission computed tomography before and 6 +/- 1 days after thrombolysis. Patients were classed as having grade III ischemia (ST segment elevation with terminal QRS distortion, n = 19) or grade II ischemia (ST elevation but no terminal QRS distortion, n = 30). We compared AR and IS by baseline ischemia grade and treatment (adenosine vs. placebo) and assessed relations of infarction index (IS/AR ratio x100) to time to thrombolysis, baseline ischemia grade, and adenosine therapy. Time to thrombolysis was similar for grade II and grade III. For placebo- treated patients, the median AR did not differ significantly between grade II (38%) and grade III patients (46%, p = 0.47), nor did median IS (16 vs. 40%, p = 0.096), but the median infarction index was 66 vs. 90% (p = 0.006). For adenosine-treated patients, median AR (21 vs. 26%, p = 0.44), median IS (5 vs. 17%, p = 0.15), and their ratio (31 vs. 67%, p = 0.23) did not differ significantly between grade II and grade III patients. The infarction index independently related to grade III ischemia (p = 0.0121) and adenosine therapy (p = 0.045). Infarct size related to baseline ischemia grade and was reduced by adenosine treatment. Necrosis progressed slowlier with baseline grade II versus III ischemia, which could offer more time for myocardial salvage with reperfusion. Copyright 2002 S. Karger AG, Basel

Impact of severity of personality disorder on the outcome of depression.

PubMed

Kelly, Brendan D; Nur, Ula A; Tyrer, Peter; Casey, Patricia

2009-06-01

The influence of severity of personality disorder on outcome of depression is unclear. Four hundred and ten patients with depression in 9 urban and rural communities in Finland, Ireland, Norway, Spain and the United Kingdom, were randomised to individual problem-solving treatment (n=121), group sessions on depression prevention (n=106) or treatment as usual (n=183). Depressive symptoms were recorded at baseline, 6 and 12 months. Personality assessment was performed using the Personality Assessment Schedule and analysed by severity (no personality disorder, personality difficulty, simple personality disorder, complex personality disorder). Complete personality assessments were performed on 301 individuals of whom 49.8% had no personality disorder; 19.3% had personality difficulties; 13.0% had simple personality disorder; and 17.9% had complex personality disorder. Severity of personality disorder was correlated with Beck Depression Inventory (BDI) scores at baseline (Spearman's r=0.21; p<0.001), 6 months (r=0.14; p=0.02) and 12 months (r=0.21; p=0.001). On multi-variable analysis, BDI at baseline (p<0.001) and type of treatment offered (individual therapy, group therapy, treatment as usual) (p=0.01) were significant independent predictors of BDI at 6 months. BDI at baseline was the sole significant independent predictor of BDI at 12 months (p<0.001). There was no interaction between personality disorder and treatment type for depression. While multi-variable analyses indicate that depressive symptoms at baseline are the strongest predictor of depressive symptoms at 6 and 12 months, the strong correlations between severity of personality disorder and depressive symptoms make it difficult to establish the independent effect of personality disorder on outcome of depression.

A Pilot Study of Naltrexone and BASICS for Heavy Drinking Young Adults

PubMed Central

Leeman, Robert F.; Palmer, Rebekka S.; Corbin, William R.; Romano, Denise M.; Meandzija, Boris; O’Malley, Stephanie S.

2008-01-01

Heavy drinking young adults often have limited motivation to change their drinking behavior. Adding pharmacotherapy to brief counseling is a novel approach to treating this population. A small open-label pilot study was conducted to assess the feasibility of offering eight weeks of daily and targeted (i.e., taken as needed in anticipation of drinking) naltrexone with BASICS (brief motivational) counseling to heavy drinking young adults; to assess the tolerability of the medication in this population and to obtain preliminary efficacy data. The sample (N = 14) showed strong adherence to study appointments and medication taking, supporting the feasibility of this approach. Overall, the medication was well-tolerated. Significant reductions from baseline were observed in drinks per drinking day and in percent heavy drinking days and these gains were maintained one month after treatment ended. A significant decrease in alcohol-related consequences was also observed. Findings from this small pilot study suggest that naltrexone in combination with BASICS represents a promising strategy to reduce heavy drinking among young adults. PMID:18502591

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study.

PubMed

Shahsavari, Hooman; Nasrabadi, Alireza Nikbakht; Almasian, Mohammad; Heydari, Heshmatolah; Hazini, Abdolrahim

2018-01-01

Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. The purpose of this study was to explore the administrative aspects of the delivery of home health care services. This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

Effectiveness of an online SUpport PRogramme (SUPR) for older hearing aid users: study protocol for a cluster randomised controlled trial

PubMed Central

Meijerink, Janine FJ; Pronk, Marieke; Paulissen, Bernadette; Witte, Birgit I; van der Wouden, Bregje; Jansen, Vera; Kramer, Sophia E

2017-01-01

Background An educational SUpport PRogramme called SUPR has been developed for hearing aid users (HAUs) and their communication partners (CPs) offering care beyond hearing aid fitting. SUPR teaches its users communication strategies, hearing aid handling skills and personal adjustment to hearing impairment. Methods/design Using a cluster randomised controlled trial design, 70 Dutch hearing aid dispenser practices were randomised into hearing aid fitting (care as usual, 34 practices) and hearing aid fitting including SUPR (36 practices). The aim was to recruit a total of 569 older (aged 50+ years) first-time (n=258) and experienced (n=311) HAUs and their CPs. SUPR consists of a Practical Support Booklet and online material offered via email over a period of 6–7 months. The booklet provides practical information on hearing aids, advice on communication strategies and home exercises. The online material consists of educational videos on hearing aid functionality and usage, communication strategies and peer testimonials. Finally, noncommittal email contact with the dispenser is offered. Every HAU is asked to assign a CP who is advised to be involved intensively. Effect measurements for HAUs and their CPs will occur at baseline and at 6, 12 and 18 months follow-up via online questionnaires. The primary outcomes for HAUs will be the use of communication strategies as measured by the subscales of the Communication Profile for the Hearing Impaired. A process evaluation will be performed. Ethics and dissemination The study was approved by the Dutch Institutional Review Board of the VU Medical University Center Amsterdam. This intervention could contribute to lowering the hearing impairment burden in our ageing society. The results will be disseminated through peer-reviewed publications and scientific conferences. Trial registration number ISRCTN77340339; Pre-results. PMID:28634259

The Role of Helminth Infection and Environment in the Development of Allergy: A Prospective Study of Newly-Arrived Ethiopian Immigrants in Israel.

PubMed

Stein, Miguel; Greenberg, Zalman; Boaz, Mona; Handzel, Zeev T; Meshesha, Mesfin K; Bentwich, Zvi

2016-01-01

Helminth infection may be protective against allergy and account for the low prevalence of allergy in developing countries. We studied prospectively the prevalence of allergy in Ethiopian immigrants with heavy helminth infection on arrival in Israel, and again after a year of adjustment to an urban industrialized setting, to explore the roles of helminth infection, changed environment and background immunity on the manifestations of allergy. 126 newly arrived Ethiopian immigrants were studied at baseline and 115 after a year of follow up in Israel. Allergic symptoms, Skin prick tests (SPT), Tuberculin (PPD) skin tests, stool and blood samples were obtained for determining parasites, blood IgE and eosinophil levels, respectively. Anti-helminthic therapy was offered to the entire infected individuals, but only 50/108 (46.3%) took the medication. At baseline, there was a significant negative association between helminth infection and allergy, 4/18 (22.2%) of uninfected participants were allergic compared to 7/108 (6.5%) of helminth-infected participants (p = 0.028), as well as between helminth infection and SPT reactivity, 12/18 (66.6%) of uninfected participants compared to 43/108 (39.8%) of helminth-infected participants (p = 0.033). After one year, a significant general increase in allergy and SPT was observed. While only 11/126 (8.7%) were allergic at baseline, 30/115 (26.1%) became allergic at follow-up (p<0.0001), and while 55/126 (43.7%) were SPT+ at baseline, 79/115 (68.7%) became SPT+ at follow-up (p<0.001). A twofold increase in allergen sensitization was also observed after one year in Israel, particularly for dust mites, grasses and olive tree (p<0.001). These results show that: a) Helminth infection is significantly associated with low allergy and low SPT reactivity; b) One year after immigration to Israel, allergy and SPT reactivity increased significantly in all immigrants; c) Higher increases in positive SPT and allergy were observed after a year in the group that remained infected with helminths, even though they had a lowered helminth load; d) The reasons for the increased allergy one year after immigration needs further investigation but probably reflects the combined influence of the decreased helminth load and novel environmental factors.

The Role of Helminth Infection and Environment in the Development of Allergy: A Prospective Study of Newly-Arrived Ethiopian Immigrants in Israel

PubMed Central

Stein, Miguel; Greenberg, Zalman; Boaz, Mona; Handzel, Zeev T.; Meshesha, Mesfin K.; Bentwich, Zvi

2016-01-01

Helminth infection may be protective against allergy and account for the low prevalence of allergy in developing countries. We studied prospectively the prevalence of allergy in Ethiopian immigrants with heavy helminth infection on arrival in Israel, and again after a year of adjustment to an urban industrialized setting, to explore the roles of helminth infection, changed environment and background immunity on the manifestations of allergy. 126 newly arrived Ethiopian immigrants were studied at baseline and 115 after a year of follow up in Israel. Allergic symptoms, Skin prick tests (SPT), Tuberculin (PPD) skin tests, stool and blood samples were obtained for determining parasites, blood IgE and eosinophil levels, respectively. Anti-helminthic therapy was offered to the entire infected individuals, but only 50/108 (46.3%) took the medication. At baseline, there was a significant negative association between helminth infection and allergy, 4/18 (22.2%) of uninfected participants were allergic compared to 7/108 (6.5%) of helminth-infected participants (p = 0.028), as well as between helminth infection and SPT reactivity, 12/18 (66.6%) of uninfected participants compared to 43/108 (39.8%) of helminth-infected participants (p = 0.033). After one year, a significant general increase in allergy and SPT was observed. While only 11/126 (8.7%) were allergic at baseline, 30/115 (26.1%) became allergic at follow-up (p<0.0001), and while 55/126 (43.7%) were SPT+ at baseline, 79/115 (68.7%) became SPT+ at follow-up (p<0.001). A twofold increase in allergen sensitization was also observed after one year in Israel, particularly for dust mites, grasses and olive tree (p<0.001). These results show that: a) Helminth infection is significantly associated with low allergy and low SPT reactivity; b) One year after immigration to Israel, allergy and SPT reactivity increased significantly in all immigrants; c) Higher increases in positive SPT and allergy were observed after a year in the group that remained infected with helminths, even though they had a lowered helminth load; d) The reasons for the increased allergy one year after immigration needs further investigation but probably reflects the combined influence of the decreased helminth load and novel environmental factors. PMID:26752538

Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study.

PubMed

Manuskiatti, W; Wachirakaphan, C; Lektrakul, N; Varothai, S

2009-07-01

A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome. Objective To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction. Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded. Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen (P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted. Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance.

Motivations, concerns and preferences of personal genome sequencing research participants: Baseline findings from the HealthSeq project

PubMed Central

Sanderson, Saskia C; Linderman, Michael D; Suckiel, Sabrina A; Diaz, George A; Zinberg, Randi E; Ferryman, Kadija; Wasserstein, Melissa; Kasarskis, Andrew; Schadt, Eric E

2016-01-01

Whole exome/genome sequencing (WES/WGS) is increasingly offered to ostensibly healthy individuals. Understanding the motivations and concerns of research participants seeking out personal WGS and their preferences regarding return-of-results and data sharing will help optimize protocols for WES/WGS. Baseline interviews including both qualitative and quantitative components were conducted with research participants (n=35) in the HealthSeq project, a longitudinal cohort study of individuals receiving personal WGS results. Data sharing preferences were recorded during informed consent. In the qualitative interview component, the dominant motivations that emerged were obtaining personal disease risk information, satisfying curiosity, contributing to research, self-exploration and interest in ancestry, and the dominant concern was the potential psychological impact of the results. In the quantitative component, 57% endorsed concerns about privacy. Most wanted to receive all personal WGS results (94%) and their raw data (89%); a third (37%) consented to having their data shared to the Database of Genotypes and Phenotypes (dbGaP). Early adopters of personal WGS in the HealthSeq project express a variety of health- and non-health-related motivations. Almost all want all available findings, while also expressing concerns about the psychological impact and privacy of their results. PMID:26036856

Does exercise aid smoking cessation through reductions in anxiety sensitivity and dysphoria?

PubMed

Zvolensky, Michael J; Rosenfield, David; Garey, Lorra; Kauffman, Brooke Y; Langdon, Kirsten J; Powers, Mark B; Otto, Michael W; Davis, Michelle L; Marcus, Bess H; Church, Timothy S; Frierson, Georita M; Hopkins, Lindsey B; Paulus, Daniel J; Baird, Scarlett O; Smits, Jasper A J

2018-07-01

Research shows that high anxiety sensitivity (AS) and dysphoria are related to poor smoking cessation outcomes. Engaging in exercise may contribute to improvement in smoking cessation outcomes through reductions in AS and dysphoria. In the current study, we examined whether exercise can aid smoking cessation through reductions in AS and dysphoria. Participants were sedentary and low activity adult daily smokers (N = 136) with elevated AS who participated in a randomized controlled trial comparing smoking cessation treatment (ST) plus an exercise intervention (ST + EX) to ST plus wellness education (ST + CTRL). Self-reported smoking status was assessed in-person weekly from baseline through week 16 (end of-treatment; EOT), at week 22 (4 months postquit day), and at week 30 (6 months postquit day), and verified biochemically. Results indicated that both AS and dysphoria at 6-month follow-up were significantly lower in the ST + EX group compared to the ST + CTRL group (controlling for baseline levels). Moreover, reductions in AS and dysphoria emerged as independent mechanisms of action explaining success in quitting. These novel findings offer clinically significant evidence suggesting that vigorous-intensity exercise can effectively engage affective constructs in the context of smoking cessation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Recruitment and retention of palliative cancer patients and their partners participating in a longitudinal evaluation of a psychosocial retreat program.

PubMed

Garland, Sheila N; Carlson, Linda E; Marr, Hubert; Simpson, Steve

2009-03-01

The negative impact of a palliative cancer diagnosis on the quality of life of patients and their partners is well documented. Unfortunately, research on interventions to improve psychological and spiritual well-being of these couples has been considered impractical because of the deleterious influence of disease progression on participation. This study evaluated the feasibility of offering the Tapestry Retreat, an intensive psychosocial intervention for palliative care patients and their partners. Participants in the Tapestry Retreat included 15 patients with advanced breast, prostate, or colon cancer and their partners (n = 30). Also included was a natural history group consisting of 20 patients and their partners (n = 40). All couples completed questionnaires related to quality of life, distress, marital satisfaction, and existential concerns at baseline, after the retreat or 1 month after baseline, and then again at 3, 6, 9, and 12 months. Patients in the Tapestry group were significantly more likely to be women who had received prior psychological support and were less comfortable with their finances. Partners attending the Tapestry retreat were also more likely to have received prior psychological support. Despite issues with recruitment and retention, retreat participation was considered feasible. Recommendations for future research are discussed.

Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia.

PubMed

Hansen, Mette Vinther; Hjorth, Peter; Kristiansen, Christina Blanner; Vandborg, Kirsten; Gustafsson, Lea Nørgaard; Munk-Jørgensen, Povl

2016-06-01

Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose and lipids and information on smoking and alcohol were obtained. On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care. © The Author(s) 2016.

Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia.

PubMed

Hansen, Mette Vinther; Hjorth, Peter; Kristiansen, Christina Blanner; Vandborg, Kirsten; Gustafsson, Lea Nørgaard; Munk-Jørgensen, Povl

2016-06-01

Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose, serum lipids, and information on smoking and alcohol were obtained. On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care. © The Author(s) 2016.

Traditional Chinese medicine diagnoses in a sample of women with fibromyalgia

PubMed Central

Mist, Scott D; Wright, Cheryl L; Jones, Kim Dupree; Carson, James W

2012-01-01

Background Traditional Chinese medicine (TCM) offers various treatment modalities guided by TCM diagnoses. In the United States, acupuncture is a commonly employed TCM method for treating a variety of chronic illnesses. Three systematic reviews have been reported recently, reaching differing conclusions about the efficacy of acupuncture for the treatment of fibromyalgia (FM). Among the FM acupuncture studies considered in these reviews, none used TCM diagnosis as an inclusion/exclusion criterion or adjusted treatment based on TCM diagnosis. Overlooking TCM diagnosis may be a reason for such disparate results. Primary study objective To obtain TCM diagnoses in a sample of women meeting 1990 American College of Rheumatology criteria for FM who were recruited for a yoga study and to investigate whether there is significant variability. Methods/design Two TCM practitioners conducted baseline TCM diagnostic examinations on 56 women with FM. A consensus diagnosis was reached based on standardised history, palpation and examination. Canonical discriminate analysis identified two baseline items which predicted TCM diagnosis. Setting School of Nursing, Oregon Health & Science University. Participants Women, ages 23–75, with FM recruited to a yoga intervention study Results Three primary TCM diagnoses were found in the population: Qi and Blood Deficiency (46.4%, CI 33.0% to 60.36%), Qi and Blood Stagnation (26.8%, CI 15.8% to 40.3%), and Liver Qi Stagnation (19.6%, CI 10.2% to 32.4%). Conclusion It is likely that previous studies of FM were treating a heterogeneous study population where variable results might be expected. Future acupuncture studies should either control for TCM diagnosis or consider its usefulness as an inclusion/exclusion criterion. PMID:22026964

MiDAS ENCORE: Randomized Controlled Study Design and Protocol.

PubMed

Benyamin, Ramsin M; Staats, Peter S

2015-01-01

Epidural steroid injections (ESIs) are commonly used for treatment of symptomatic lumbar spinal stenosis (LSS). ESIs are generally administered after failure of conservative therapy. For LSS patients suffering from neurogenic claudication, the mild® procedure provides an alternative to ESIs via minimally invasive lumbar decompression. Both ESIs and mild offer interventional pain treatment options for LSS patients experiencing neurogenic claudication refractory to more conservative therapies. Prospective, multi-center, randomized controlled, clinical study. Twenty-six interventional pain management centers throughout the United States. To compare patient outcomes following treatment with either mild or ESIs in LSS patients with neurogenic claudication and having verified ligamentum flavum hypertrophy. Study participants include Medicare beneficiaries who meet study inclusion/exclusion criteria. Eligible patients will be randomized in a 1:1 ratio to one of 2 treatment arms, mild (treatment group) or ESI (control group). Each study group will include approximately 150 patients who have experienced neurogenic claudication symptoms for ≥ 3 months duration who have failed to respond to physical therapy, home exercise programs, and oral analgesics. Those randomized to mild are prohibited from receiving lumbar ESIs during the study period, while those randomized to ESI may receive ESIs up to 4 times per year. Patient assessments will occur at baseline, 6 months, and one year. An additional assessment will be conducted for the mild patient group at 2 years. The primary efficacy outcome measure is the proportion of Oswestry Disability Index (ODI) responders from baseline to one year follow-up in the treatment group (mild) versus the control group (ESI). ODI responders are defined as those patients achieving the validated Minimal Important Change (MIC) of ≥ 10 point improvement in ODI from baseline to follow-up as a clinically significant efficacy threshold. Secondary efficacy outcome measures include the proportion of Zurich Claudication Questionnaire (ZCQ) and Numeric Pain Rating Scale (NPRS) responders from baseline to follow-up using validated MIC thresholds. Improvement in ZCQ domains of ≥ 0.5 is considered significant, and a Patient Satisfaction score of at least 2.5 represents a satisfied patient. A reduction of ≥ 2 points in NPRS is considered significant pain relief. The primary safety outcome measure is the incidence of device- and/or procedure-related adverse events. Descriptive summaries will be presented by randomized group for all outcome measures at baseline and follow-up time points. Inferential statistical analysis will be conducted to determine significant differences related to functional improvement, pain relief, and safety outcomes. Primary study results will be presented based on one-year follow-up data, with an interim analysis report when 6-month follow-up data become available. Patients are not blinded due to significant differences in treatment protocols between study groups. Also, since neither study arm is focused on treatment of radicular pain, there may be a higher non-responder rate for both groups versus standard of care due to study restrictions on adjunctive pain therapies. This prospective, multi-center, randomized controlled study will provide Level I evidence of the safety and effectiveness of mild versus ESIs in managing neurogenic claudication symptoms in LSS patients.

Community-Based Mindfulness Program for Disease Prevention and Health Promotion: Targeting Stress Reduction.

PubMed

Galla, Brian M; O'Reilly, Gillian A; Kitil, M Jennifer; Smalley, Susan L; Black, David S

2015-01-01

Poorly managed stress leads to detrimental physical and psychological consequences that have implications for individual and community health. Evidence indicates that U.S. adults predominantly use unhealthy strategies for stress management. This study examines the impact of a community-based mindfulness training program on stress reduction. This study used a one-group pretest-posttest design. The study took place at the UCLA Mindful Awareness Research Center in urban Los Angeles. A sample of N = 127 community residents (84% Caucasian, 74% female) were included in the study. Participants received mindfulness training through the Mindful Awareness Practices (MAPs) for Daily Living I. Mindfulness, self-compassion, and perceived stress were measured at baseline and postintervention. Paired-sample t-tests were used to test for changes in outcome measures from baseline to postintervention. Hierarchical regression analysis was fit to examine whether change in self-reported mindfulness and self-compassion predicted postintervention perceived stress scores. There were statistically significant improvements in self-reported mindfulness (t = -10.67, p < .001, d = .90), self-compassion (t = -8.50, p < .001, d = .62), and perceived stress (t = 9.28, p < .001, d = -.78) at postintervention. Change in self-compassion predicted postintervention perceived stress (β = -.44, t = -5.06, p < .001), but change in mindfulness did not predict postintervention perceived stress (β = -.04, t = -.41, p = .68). These results indicate that a community-based mindfulness training program can lead to reduced levels of psychological stress. Mindfulness training programs such as MAPs may offer a promising approach for general public health promotion through improving stress management in the urban community.

Impact of Bromocriptine-QR Therapy on Glycemic Control and Daily Insulin Requirement in Type 2 Diabetes Mellitus Subjects Whose Dysglycemia Is Poorly Controlled on High-Dose Insulin: A Pilot Study.

PubMed

Roe, Erin D; Chamarthi, Bindu; Raskin, Philip

2015-01-01

The concurrent use of a postprandial insulin sensitizing agent, such as bromocriptine-QR, a quick release formulation of bromocriptine, a dopamine D2 receptor agonist, may offer a strategy to improve glycemic control and limit/reduce insulin requirement in type 2 diabetes (T2DM) patients on high-dose insulin. This open label pilot study evaluated this potential utility of bromocriptine-QR. Ten T2DM subjects on metformin (1-2 gm/day) and high-dose (TDID ≥ 65 U/day) basal-bolus insulin were enrolled to receive once daily (morning) bromocriptine-QR (1.6-4.8 mg/day) for 24 weeks. Subjects with at least one postbaseline HbA1c measurement (N = 8) were analyzed for change from baseline HbA(1c), TDID, and postprandial glucose area under the curve of a four-hour mixed meal tolerance test (MMTT). Compared to the baseline, average HbA1c decreased 1.76% (9.74 ± 0.56 to 7.98 ± 0.36, P = 0.01), average TDID decreased 27% (199 ± 33 to 147 ± 31, P = 0.009), and MMTT AUC(60-240) decreased 32% (P = 0.04) over the treatment period. The decline in HbA(1c) and TDID was observed at 8 weeks and sustained over the remaining 16-week study duration. In this study, bromocriptine-QR therapy improved glycemic control and meal tolerance while reducing insulin requirement in T2DM subjects poorly controlled on high-dose insulin therapy.

A multicenter, double-blind, safety study of QR-333 for the treatment of symptomatic diabetic peripheral neuropathy. A preliminary report.

PubMed

Valensi, Paul; Le Devehat, Claude; Richard, Jean-Louis; Farez, Cherifo; Khodabandehlou, Taraneh; Rosenbloom, Richard A; LeFante, Carolyn

2005-01-01

QR-333, a topical compound that contains quercetin, a flavonoid with aldose reductase inhibitor effects, ascorbyl palmitate, and vitamin D(3), was formulated to decrease the oxidative stress that contributes to peripheral diabetic neuropathy and thus alleviate its symptoms. This proof-of-principle study assessed the efficacy and safety of QR-333 against placebo in a small cohort of patients with diabetic neuropathy. This randomized, placebo-controlled, double-blind trial included 34 men and women (21-71 years of age) with Type 1 or 2 diabetes and diabetic neuropathy who applied QR-333 or placebo (2:1 ratio), three times daily for 4 weeks, to each foot where symptoms were experienced. Five-point scales were used to determine changes from baseline to endpoint in symptoms and quality of life (efficacy). Safety was assessed through concomitant medications, adverse events, laboratory evaluations, and physical examinations. QR-333 reduced the severity of numbness, jolting pain, and irritation from baseline values. Improvements were also seen in overall and specific quality-of-life measures. QR-333 was well tolerated. Eleven patients in the QR-333 group reported 23 adverse events (all mild or moderate); 4 in the placebo group reported 5 events (all moderate). One patient who applied QR-333 noted a pricking sensation twice, the only adverse event considered possibly related to study treatment. From this preliminary safety study, it appears that QR-333 may safely offer relief of symptoms of diabetic neuropathy and improve quality of life. These findings warrant further investigation of this topical compound.

A Passive Cavity Concept for Improving the Off-Design Performance of Fixed-Geometry Exhaust Nozzles

NASA Technical Reports Server (NTRS)

Asbury, Scott C.; Gunther, Christopher L.; Hunter, Craig A.

1996-01-01

An investigation was conducted in the model preparation area of the Langley 16-Foot Transonic Tunnel to study a passive cavity concept for improving the off-design performance of fixed-geometry exhaust nozzles. Passive cavity ventilation (through a porous surface) was applied to divergent flap surfaces and tested at static conditions in a sub-scale, nonaxisymmetric, convergent-divergent nozzle. As part of a comprehensive investigation, force, moment and pressure measurements were taken and focusing schlieren flow visualization was obtained for a baseline configuration and D passive cavity configurations. All tests were conducted with no external flow and high-pressure air was used to simulate jet-exhaust flow at nozzle pressure ratios from 1.25 to approximately 9.50. Results indicate that baseline nozzle performance was dominated by unstable shock-induced boundary-layer separation at off-design conditions, which came about through the natural tendency of overexpanded exhaust flow to satisfy conservation requirements by detaching from the nozzle divergent flaps. Passive cavity ventilation added the ability to control off-design separation in the nozzle by either alleviating separation or encouraging stable separation of the exhaust flow. Separation alleviation offers potential for installed nozzle performance benefits by reducing drag at forward flight speeds, even though it may reduce off-design static thrust efficiency as much as 3.2 percent. Encouraging stable separation of the exhaust flow offers significant performance improvements at static, low NPR and low Mach number flight conditions by improving off-design static thrust efficiency as much as 2.8 percent. By designing a fixed-geometry nozzle with fully porous divergent flaps, where both cavity location and percent open porosity of the flaps could be varied, passive flow control would make it possible to improve off-design nozzle performance across a wide operating range. In addition, the ability to encourage separation on one flap while alleviating it on the other makes it possible to generate thrust vectoring in the nozzle through passive flow control.

The Effectiveness of Individualized Acupuncture Protocols in the Treatment of Gulf War Illness: A Pragmatic Randomized Clinical Trial.

PubMed

Conboy, Lisa; Gerke, Travis; Hsu, Kai-Yin; St John, Meredith; Goldstein, Marc; Schnyer, Rosa

2016-01-01

Gulf War Illness is a Complex Medical Illness characterized by multiple symptoms, including fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain affecting veterans of the first Gulf War. No standard of care treatment exists. This pragmatic Randomized Clinical Trial tested the effects of individualized acupuncture treatments offered in extant acupuncture practices in the community; practitioners had at least 5 years of experience plus additional training provided by the study. Veterans with diagnosed symptoms of Gulf War Illness were randomized to either six months of biweekly acupuncture treatments (group 1, n = 52) or 2 months of waitlist followed by weekly acupuncture treatments (group 2, n = 52). Measurements were taken at baseline, 2, 4 and 6 months. The primary outcome is the SF-36 physical component scale score (SF-36P) and the secondary outcome is the McGill Pain scale. Of the 104 subjects who underwent randomization, 85 completed the protocol (82%). A clinically and statistically significant average improvement of 9.4 points (p = 0.03) in the SF-36P was observed for group 1 at month 6 compared to group 2, adjusting for baseline pain. The secondary outcome of McGill pain index produced similar results; at 6 months, group 1 was estimated to experience a reduction of approximately 3.6 points (p = 0.04) compared to group 2. Individualized acupuncture treatment of sufficient dose appears to offer significant relief of physical disability and pain for veterans with Gulf War Illness. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Gulf War Illness Research Program under Award No. W81XWH-09-2-0064. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. ClinicalTrials.gov NCT01305811.

Initial Findings from a Novel School-Based Program, EMPATHY, Which May Help Reduce Depression and Suicidality in Youth.

PubMed

Silverstone, Peter H; Bercov, Marni; Suen, Victoria Y M; Allen, Andrea; Cribben, Ivor; Goodrick, Jodi; Henry, Stu; Pryce, Catherine; Langstraat, Pieter; Rittenbach, Katherine; Chakraborty, Samprita; Engels, Rutger C; McCabe, Christopher

2015-01-01

We describe initial pilot findings from a novel school-based approach to reduce youth depression and suicidality, the Empowering a Multimodal Pathway Towards Healthy Youth (EMPATHY) program. Here we present the findings from the pilot cohort of 3,244 youth aged 11-18 (Grades 6-12). They were screened for depression, suicidality, anxiety, use of drugs, alcohol, or tobacco (DAT), quality-of-life, and self-esteem. Additionally, all students in Grades 7 and 8 (mean ages 12.3 and 13.3 respectively) also received an 8-session cognitive-behavioural therapy (CBT) based program designed to increase resiliency to depression. Following screening there were rapid interventions for the 125 students (3.9%) who were identified as being actively suicidal, as well as for another 378 students (11.7%) who were felt to be at higher-risk of self-harm based on a combination of scores from all the scales. The intervention consisted of an interview with the student and their family followed by offering a guided internet-based CBT program. Results from the 2,790 students who completed scales at both baseline and 12-week follow-up showed significant decreases in depression and suicidality. Importantly, there was a marked decrease in the number of students who were actively suicidal (from n=125 at baseline to n=30 at 12-weeks). Of the 503 students offered the CBT program 163 (32%) took part, and this group had significantly lower depression scores compared to those who didn't take part. There were no improvements in self-esteem, quality-of-life, or the number of students using DAT. Only 60 students (2% of total screened) required external referral during the 24-weeks following study initiation. These results suggest that a multimodal school-based program may provide an effective and pragmatic approach to help reduce youth depression and suicidality. Further research is required to determine longer-term efficacy, reproducibility, and key program elements. ClinicalTrials.gov NCT02169960.

Metabolic and Psychological Impact of a Pragmatic Exercise Intervention Program in Adolescent and Young Adult Survivors of Pediatric Cancer-Related Cerebral Insult.

PubMed

Rath, Shoshana R; Long, Treya M; Bear, Natasha L; Miles, Gordon C P; Bullock, Andrew M; Gottardo, Nicholas G; Cole, Catherine H; Naylor, Louise H; Choong, Catherine S Y

2018-06-01

To assess metabolic function among adolescent and young adult (AYA) survivors of childhood cancer-related brain surgery or cranial irradiation (CRT) and to determine feasibility, safety, and metabolic as well as psychological impact of a 6-month exercise program in this cohort. Twenty AYAs aged 15-23 years were recruited. All had completed cancer treatment by age 15.5 and were more than 1 year after end of treatment. Metabolic function was assessed at baseline (T1), after a 6-month non-intervention period (T2), and after the 6-month intervention (T3). Psychological assessments were performed at T1 and T3. Eight to 12 months after the program (T4), its lasting impact was assessed by questionnaire. The 6-month intervention consisted of small group-based, tailored, supervised exercise sessions combining resistance and aerobic exercise. Sessions were offered up to thrice per week and adherence defined as participation in ≥24 sessions. Flexibility was built into the design with an alternative home-based program offered to those who could not attend the gymnasium. Thirteen of the 20 recruited participants were adherent to the program. There was one fall during exercise, but no injury was sustained. Higher rates of metabolic impairment than would be expected in a healthy cohort were found at baseline both among brain tumor survivors and survivors of total body irradiation. Central adiposity reduced post-intervention (p = 0.014) and improvements in adaptive function were seen. Participants enjoyed the program, but work and study commitments limited attendance. AYA survivors of childhood brain tumors and CRT should be screened for metabolic and psychological well-being. Small group-based exercise is safe, feasible, and enjoyable for this cohort and may benefit them both metabolically and psychologically. ACTRN12614000796684. Retrospectively registered July 28, 2014.

Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction

PubMed Central

Marsch, Lisa A; Brunette, Mary F; Dallery, Jesse

2017-01-01

Background Social media technologies offer a novel opportunity for scalable health interventions that can facilitate user engagement and social support, which in turn may reinforce positive processes for behavior change. Objective By using principles from health communication and social support literature, we implemented a Facebook group–based intervention that targeted smoking reduction and cessation. This study hypothesized that participants’ engagement with and perceived social support from our Facebook group intervention would predict smoking reduction. Methods We recruited 16 regular smokers who live in the United States and who were motivated in quitting smoking at screening. We promoted message exposure as well as engagement and social support systems throughout the intervention. For message exposure, we posted prevalidated, antismoking messages (such as national antismoking campaigns) on our smoking reduction and cessation Facebook group. For engagement and social support systems, we delivered a high degree of engagement and social support systems during the second and third week of the intervention and a low degree of engagement and social support systems during the first and fourth week. A total of six surveys were conducted via Amazon Mechanical Turk (MTurk) at baseline on a weekly basis and at a 2-week follow-up. Results Of the total 16 participants, most were female (n=13, 81%), white (n=15, 94%), and between 25 and 50 years of age (mean 34.75, SD 8.15). There was no study attrition throughout the 6-time-point baseline, weekly, and follow-up surveys. We generated Facebook engagement and social support composite scores (mean 19.19, SD 24.35) by combining the number of likes each participant received and the number of comments or wall posts each participant posted on our smoking reduction and cessation Facebook group during the intervention period. The primary outcome was smoking reduction in the past 7 days measured at baseline and at the two-week follow-up. Compared with the baseline, participants reported smoking an average of 60.56 fewer cigarettes per week (SD 38.83) at the follow-up, and 4 participants out of 16 (25%) reported 7-day point prevalence smoking abstinence at the follow-up. Adjusted linear regression models revealed that a one-unit increase in the Facebook engagement and social support composite scores predicted a 0.56-unit decrease in cigarettes smoked per week (standard error =.24, P=.04, 95% CI 0.024-1.09) when baseline readiness to quit, gender, and baseline smoking status were controlled (F4, 11=8.85, P=.002). Conclusions This study is the first Facebook group–based intervention that systemically implemented health communication strategies and engagement and social support systems to promote smoking reduction and cessation. Our findings imply that receiving one like or posting on the Facebook-based intervention platform predicted smoking approximately one less cigarette in the past 7 days, and that interventions should facilitate user interactions to foster user engagement and social support. PMID:28536096

Multi-layer service function chaining scheduling based on auxiliary graph in IP over optical network

NASA Astrophysics Data System (ADS)

Li, Yixuan; Li, Hui; Liu, Yuze; Ji, Yuefeng

2017-10-01

Software Defined Optical Network (SDON) can be considered as extension of Software Defined Network (SDN) in optical networks. SDON offers a unified control plane and makes optical network an intelligent transport network with dynamic flexibility and service adaptability. For this reason, a comprehensive optical transmission service, able to achieve service differentiation all the way down to the optical transport layer, can be provided to service function chaining (SFC). IP over optical network, as a promising networking architecture to interconnect data centers, is the most widely used scenarios of SFC. In this paper, we offer a flexible and dynamic resource allocation method for diverse SFC service requests in the IP over optical network. To do so, we firstly propose the concept of optical service function (OSF) and a multi-layer SFC model. OSF represents the comprehensive optical transmission service (e.g., multicast, low latency, quality of service, etc.), which can be achieved in multi-layer SFC model. OSF can also be considered as a special SF. Secondly, we design a resource allocation algorithm, which we call OSF-oriented optical service scheduling algorithm. It is able to address multi-layer SFC optical service scheduling and provide comprehensive optical transmission service, while meeting multiple optical transmission requirements (e.g., bandwidth, latency, availability). Moreover, the algorithm exploits the concept of Auxiliary Graph. Finally, we compare our algorithm with the Baseline algorithm in simulation. And simulation results show that our algorithm achieves superior performance than Baseline algorithm in low traffic load condition.

Downhole monitoring of biogenic gas production at the Maguelone shallow injection experimental site (Languedoc coastline, France).

NASA Astrophysics Data System (ADS)

Abdelghafour, H.; Brondolo, F.; Denchik, N.; Pezard, P. A.

2014-12-01

The controllability of CO2 geological storage can ensure the integrity of storage operations, requiring a precise monitoring of reservoir fluids and properties during injection and over time. In this context, deep saline aquifers offer a large capacity of storing CO2, but the accessibility to long term behavior studies remains limited until now. The Maguelone shallow experimental site located near Montpellier (Languedoc, France) provides such an opportunity for the understanding and accuracy of hydrogeophysical monitoring methods. The geology, petrophysic and hydrology of this site have been studied in details in previous studies, revealing the presence of a thin saline aquifer at 13-16 m depth surrounded by clay-rich materials. The site as a whole provides a natural laboratory to study CO2 injection at field scale, shallow depth, hence reasonable costs. The monitoring setup is composed of a series of hydrogeophysical and geochemical methods offering measurements of fluid pore pressure, electrical resistivity, acoustic velocities as well as pH and fluid properties and chemistry. To assess the response of the reservoir during CO2 injection, all measurements need to be compared to a representative baseline. Long after a series of gas injection experiments at Maguelone, fluctuations overtime of reservoir fluids and properties (such as pore fluid pH) were discovered at steady state, demonstrating the natural variability of the site in terms of biogenic gas (H2S, CH4, CO2) production and transfer. For this, a new resistivity baseline had to be constructed for all observatories. From this, the downhole gas saturation was determined versus depth and time from time-lapse resistivity logs analysed on the basis of other logs and laboratory measurements. The Waxman and Smits model (1968) for electrical properties of sand-clay formations was modified to estimate the gas saturation in 4D, to account for surface conductivity and pore connectivity. High frequency logging and monitoring of electrical properties both, with several measurements per hour and a dm-scale resolution, provide and insight into subsurface dynamics in terms of gas flow and storage, with biogenic gas saturations ranging from 0.1 to 5.0 %. This natural contribution has to be taken into account for upcoming experiments.

Indirect-response modeling of desmopressin at different levels of hydration.

PubMed

Callréus, T; Odeberg, J; Lundin, S; Höglund, P

1999-10-01

The objective of the present study was to investigate the pharmacokinetics (PK) and pharmacodynamics (PD) of desmopressin in healthy male subjects at different levels of overhydration. Also, we examined if an indirect-response model could be related to renal physiology and the pharmacological action of desmopressin. Eight healthy male subjects participated in this open, randomized crossover study with three periods. Each subject was orally water loaded (0 to 20 ml.kg-1 body weight) on 3 study days in order to achieve three different levels of hydration. After the initial water load, urine was voided every 15 min and the volumes were measured. To ensure continuous overhydration the subjects replaced their fluid loss with drinking-water. When a steady-state diuresis was achieved after approximately 2 hr, 0.396 microgram of desmopressin was administered intravenously as a bolus injection. Blood was sampled and urine was collected at intervals throughout the study day (10 hr). An indirect-response model, where desmopressin was assumed to inhibit the elimination of response, was fit to the urine osmolarity data. There were no statistically significant effects of different levels of hydration, as expressed by urine flow rate at baseline, on the estimates of the PK and PD model parameters. The calculated terminal half-lives of elimination (t1/2 beta) ranged between 2.76 and 8.37 hr with an overall mean of 4.36 hr. The overall means of plasma clearance and the volumes of distribution of the central compartment (Vc) and at steady state (Vss) were estimated to be 1.34 (SD 0.35) ml.min-1.kg-1, 151 (SD28) ml.kg-1, and 386 (SD 63) ml.kg-1, respectively. High urine flow rate, indicating overhydration, produced a diluted urine and thus a low osmolarity at baseline (R0). The effect of the urine flow rate on the urine osmolarity at baseline was highly significant (p < 0.0001). The mean values for IC50 and the sigmodicity factor (gamma) were 3.7 (SD 1.2) pg ml-1 and 13.0 (SD 3.5), respectively. In most cases when there was a high urine flow rate at baseline, the model and the estimated PD parameters could be related to the pharmacological action of desmopressin and renal physiology. Thus, the indirect-response model used in this study offers a mechanistic approach of modeling the effect of desmopressin in overhydrated subjects.

Systematic evaluation of a time-domain Monte Carlo fitting routine to estimate the adult brain optical properties

NASA Astrophysics Data System (ADS)

Selb, Juliette; Ogden, Tyler M.; Dubb, Jay; Fang, Qianqian; Boas, David A.

2013-03-01

Time-domain near-infrared spectroscopy (TD-NIRS) offers the ability to measure the absolute baseline optical properties of a tissue. Specifically, for brain imaging, the robust assessment of cerebral blood volume and oxygenation based on measurement of cerebral hemoglobin concentrations is essential for reliable cross-sectional and longitudinal studies. In adult heads, these baseline measurements are complicated by the presence of thick extra-cerebral tissue (scalp, skull, CSF). A simple semi-infinite homogeneous model of the head has proven to have limited use because of the large errors it introduces in the recovered brain absorption. Analytical solutions for layered media have shown improved performance on Monte-Carlo simulated data and layered phantom experiments, but their validity on real adult head data has never been demonstrated. With the advance of fast Monte Carlo approaches based on GPU computation, numerical methods to solve the radiative transfer equation become viable alternatives to analytical solutions of the diffusion equation. Monte Carlo approaches provide the additional advantage to be adaptable to any geometry, in particular more realistic head models. The goals of the present study were twofold: (1) to implement a fast and flexible Monte Carlo-based fitting routine to retrieve the brain optical properties; (2) to characterize the performances of this fitting method on realistic adult head data. We generated time-resolved data at various locations over the head, and fitted them with different models of light propagation: the homogeneous analytical model, and Monte Carlo simulations for three head models: a two-layer slab, the true subject's anatomy, and that of a generic atlas head. We found that the homogeneous model introduced a median 20 to 25% error on the recovered brain absorption, with large variations over the range of true optical properties. The two-layer slab model only improved moderately the results over the homogeneous one. On the other hand, using a generic atlas head registered to the subject's head surface decreased the error by a factor of 2. When the information is available, using the true subject anatomy offers the best performance.

A multicenter randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injection on pain and function related to knee osteoarthritis (PTA Trial)

PubMed

Deyle, Gail D; Gill, Norman W; Rhon, Daniel I; Allen, Chris S; Allison, Stephen C; Hando, Ben R; Petersen, Evan J; Dusenberry, Douglas I; Bellamy, Nicholas

2016-03-31

Corticosteroid injections (CSIs) are commonly used as an initial or a primary intervention for knee osteoarthritis (OA). Consistent evidence indicates CSIs offer symptom relief with conflicting reports regarding long-term efficacy. Physical therapy (PT) offers a non-invasive alternative. There is moderate evidence suggesting short-term and long-term symptom relief and functional improvement with PT interventions. Patients with knee OA are more commonly prescribed CSI than PT prior to total joint replacement. UnitedHealthcare and Military Health System data show substantially more total knee replacement patients receive preoperative CSI than PT. There are no studies comparing CSI to a PT approach in individuals with knee OA. The primary objective of this study is to compare the effectiveness of CSI to PT in individuals with knee OA at 1, 2 and 12 months. We plan to recruit 156 participants meeting established knee OA criteria. Following informed consent, participants will be randomised to receive either CSI or PT. All participants will receive instruction on recommended exercise and weight control strategies plus usual medical care. The CSI intervention consisting of 3 injections and the PT intervention consisting of 8-12 sessions will be spaced over 12 months. Measures of the dependent variables (DVs) will occur at baseline, 4 weeks, 8 weeks, 6 months and 12 months post enrolment. This pragmatic, randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (CSI and PT) and time with five levels from baseline to 1 year. The primary DV is the Western Ontario & McMaster Universities Arthritis Index (WOMAC). We will also compare healthcare utilisation between the 2 groups. The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The authors intend to publish the results in a peer-reviewed source. NCT01427153. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

First look at the physics case of TLEP

NASA Astrophysics Data System (ADS)

Bicer, M.; Duran Yildiz, H.; Yildiz, I.; Coignet, G.; Delmastro, M.; Alexopoulos, T.; Grojean, C.; Antusch, S.; Sen, T.; He, H.-J.; Potamianos, K.; Haug, S.; Moreno, A.; Heister, A.; Sanz, V.; Gomez-Ceballos, G.; Klute, M.; Zanetti, M.; Wang, L.-T.; Dam, M.; Boehm, C.; Glover, N.; Krauss, F.; Lenz, A.; Syphers, M.; Leonidopoulos, C.; Ciulli, V.; Lenzi, P.; Sguazzoni, G.; Antonelli, M.; Boscolo, M.; Dosselli, U.; Frasciello, O.; Milardi, C.; Venanzoni, G.; Zobov, M.; van der Bij, J.; de Gruttola, M.; Kim, D.-W.; Bachtis, M.; Butterworth, A.; Bernet, C.; Botta, C.; Carminati, F.; David, A.; Deniau, L.; d'Enterria, D.; Ganis, G.; Goddard, B.; Giudice, G.; Janot, P.; Jowett, J. M.; Lourenço, C.; Malgeri, L.; Meschi, E.; Moortgat, F.; Musella, P.; Osborne, J. A.; Perrozzi, L.; Pierini, M.; Rinolfi, L.; de Roeck, A.; Rojo, J.; Roy, G.; Sciabà, A.; Valassi, A.; Waaijer, C. S.; Wenninger, J.; Woehri, H.; Zimmermann, F.; Blondel, A.; Koratzinos, M.; Mermod, P.; Onel, Y.; Talman, R.; Castaneda Miranda, E.; Bulyak, E.; Porsuk, D.; Kovalskyi, D.; Padhi, S.; Faccioli, P.; Ellis, J. R.; Campanelli, M.; Bai, Y.; Chamizo, M.; Appleby, R. B.; Owen, H.; Cuna, H. Maury; Gracios, C.; Munoz-Hernandez, G. A.; Trentadue, L.; Torrente-Lujan, E.; Wang, S.; Bertsche, D.; Gramolin, A.; Telnov, V.; Kado, M.; Petroff, P.; Azzi, P.; Nicrosini, O.; Piccinini, F.; Montagna, G.; Kapusta, F.; Laplace, S.; da Silva, W.; Gizani, N.; Craig, N.; Han, T.; Luci, C.; Mele, B.; Silvestrini, L.; Ciuchini, M.; Cakir, R.; Aleksan, R.; Couderc, F.; Ganjour, S.; Lançon, E.; Locci, E.; Schwemling, P.; Spiro, M.; Tanguy, C.; Zinn-Justin, J.; Moretti, S.; Kikuchi, M.; Koiso, H.; Ohmi, K.; Oide, K.; Pauletta, G.; Ruiz de Austri, R.; Gouzevitch, M.; Chattopadhyay, S.

2014-01-01

The discovery by the ATLAS and CMS experiments of a new boson with mass around 125 GeV and with measured properties compatible with those of a Standard-Model Higgs boson, coupled with the absence of discoveries of phenomena beyond the Standard Model at the TeV scale, has triggered interest in ideas for future Higgs factories. A new circular e+e- collider hosted in a 80 to 100 km tunnel, TLEP, is among the most attractive solutions proposed so far. It has a clean experimental environment, produces high luminosity for top-quark, Higgs boson, W and Z studies, accommodates multiple detectors, and can reach energies up to the threshold and beyond. It will enable measurements of the Higgs boson properties and of Electroweak Symmetry-Breaking (EWSB) parameters with unequalled precision, offering exploration of physics beyond the Standard Model in the multi-TeV range. Moreover, being the natural precursor of the VHE-LHC, a 100 TeV hadron machine in the same tunnel, it builds up a long-term vision for particle physics. Altogether, the combination of TLEP and the VHE-LHC offers, for a great cost effectiveness, the best precision and the best search reach of all options presently on the market. This paper presents a first appraisal of the salient features of the TLEP physics potential, to serve as a baseline for a more extensive design study. [Figure not available: see fulltext.

Lifetime testing UV LEDs for use in the LISA charge management system

NASA Astrophysics Data System (ADS)

Hollington, D.; Baird, J. T.; Sumner, T. J.; Wass, P. J.

2017-10-01

As a future charge management light source, UV light-emitting diodes (UV LEDs) offer far superior performance in a range of metrics compared to the mercury lamps used in the past. As part of a qualification program a number of short wavelength UV LEDs have been subjected to a series of lifetime tests for potential use on the laser interferometer space antenna (LISA) mission. These tests were performed at realistic output levels for both fast and continuous discharging in either a DC or pulsed mode of operation and included a DC fast discharge test spanning 50 days, a temperature dependent pulsed fast discharge test spanning 21 days and a pulsed continuous discharge test spanning 507 days. Two types of UV LED have demonstrated lifetimes equivalent to over 25 years of realistic mission usage with one type providing a baseline for LISA and the other offering a backup solution.

Association between organizational climate and perceptions and use of an innovation in Swedish primary health care: a prospective study of an implementation.

PubMed

Carlfjord, Siw; Festin, Karin

2015-09-10

There is a need for new knowledge regarding determinants of a successful implementation of new methods in health care. The role of a receptive context for change to support effective diffusion has been underlined, and could be studied by assessing the organizational climate. The aim of this study was to assess the association between organizational climate when a computer-based lifestyle intervention tool (CLT) was introduced in primary health care (PHC) and the implementation outcome in terms of how the tool was perceived and used after 2 years. The CLT was offered to 32 PHC units in Sweden, of which 22 units agreed to participate in the study. Before the introduction of the CLT, the creative climate at each participating unit was assessed. After 24 months, a follow-up questionnaire was distributed to the staff to assess how the CLT was perceived and how it was used. A question on the perceived need for the CLT was also included. The units were divided into three groups according to the creative climate: high, medium and low. The main finding was that the units identified as having a positive creative climate demonstrated more frequent use and more positive perceptions regarding the new tool than those with the least positive creative climate. More positive perceptions were seen at both individual and unit levels. According to the results from this study there is an association between organizational climate at baseline and implementation outcome after 2 years when a tool for lifestyle intervention is introduced in PHC in Sweden. Further studies are needed before measurement of organizational climate at baseline can be recommended in order to predict implementation outcome.

The Building Wealth and Health Network: methods and baseline characteristics from a randomized controlled trial for families with young children participating in temporary assistance for needy families (TANF).

PubMed

Sun, Jing; Patel, Falguni; Kirzner, Rachel; Newton-Famous, Nijah; Owens, Constance; Welles, Seth L; Chilton, Mariana

2016-07-16

Families with children under age six participating in the Temporary Assistance for Needy Families Program (TANF) must participate in work-related activities for 20 h per week. However, due to financial hardship, poor health, and exposure to violence and adversity, families may experience great difficulty in reaching self-sufficiency. The purpose of this report is to describe study design and baseline findings of a trauma-informed financial empowerment and peer support intervention meant to mitigate these hardships. We conducted a randomized controlled trial of a 28-week intervention called Building Wealth and Health Network to improve financial security and maternal and child health among caregivers participating in TANF. Participants, recruited from County Assistance offices in Philadelphia, PA, were randomized into two intervention groups (partial and full) and one control group. Participants completed questionnaires at baseline to assess career readiness, economic hardship, health and wellbeing, exposure to adversity and violence, and interaction with criminal justice systems. Baseline characteristics demonstrate that among 103 participants, there were no significant differences by group. Mean age of participants was 25 years, and youngest child was 30 months. The majority of participants were women (94.2 %), never married (83.5 %), unemployed (94.2 %), and without a bank account (66.0 %). Many reported economic hardship (32.0 % very low household food secure, 65.0 % housing insecure, and 31.1 % severe energy insecure), and depression (57.3 %). Exposure to adversity was prevalent, where 38.8 % reported four or more Adverse Childhood Experiences including abuse, neglect and household dysfunction. In terms of community violence, 64.7 % saw a seriously wounded person after an incident of violence, and 27.2 % had seen someone killed. Finally, 14.6 % spent time in an adult correctional institution, and 48.5 % of the fathers of the youngest child spent time in prison. Baseline findings demonstrate that caregivers participating in TANF have suffered significant childhood adversity, adult violence exposure, and poverty-related stressors that can limit workforce success. High prevalence of housing and food insecurity, exposure to adversity, violence and criminal justice systems demands comprehensive programming to support families. Trauma-informed approaches to career readiness such as the Building Wealth and Health Network offer opportunities for potential success in the workforce. This study is retrospectively registered with ClinicalTrials.gov. The Identifier is: NCT02577705 The Registration date is October 13, 2015.

Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes.

PubMed

Bjornstad, Petter; Pyle, Laura; Nguyen, Nhung; Snell-Bergeon, Janet K; Bishop, Franziska K; Wadwa, R Paul; Maahs, David M

2015-02-01

Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for hemoglobin A1c (HbA1c), blood pressure (BP), lipids, and body mass index (BMI). We hypothesized that ISPAD/ADA goal achievement at baseline would be associated with cardiorenal risk factors at baseline and 2 yr follow-up in adolescents with type 1 diabetes. We assessed the cross-sectional and longitudinal relationships between ISPAD/ADA goal achievement at baseline and cardiorenal health at baseline and 2-yr follow-up (n = 297; 15.4 ± 2.1 yr at baseline) in adolescents with type 1 diabetes. Goal achievement was defined as HbA1c < 7.5%, BP < 90th percentile for age, sex, and height, low density lipoprotein-cholesterol (LDL-C) <100 mg/dL, high density lipoprotein-cholesterol (HDL-C) >35 mg/dL, triglycerides (TG) <150 mg/dL and BMI <85th percentile for age and sex. Cardiorenal outcomes included pulse-wave velocity (PWV), brachial distensibility (BrachD), augmentation index (AIx), and epidermal growth factor receptor (eGFR) continuously and categorically as hyperfiltration (eGFR ≥ 135 mL/min/1.73 m(2)). Adolescents with type 1 diabetes who met 1-3 goals, had significantly greater (P < 0.05) baseline PWV (5.1 ± 0.1 vs. 5.4 ± 0.1 m/s), follow-up PWV (5.5 ± 0.1 vs. 5.7 ± 0.1 m/s), greater follow-up eGFR (104 ± 2 vs. 116 ± 3 mL/min/1.73 m(2)), and greater odds of renal hyperfiltration at follow-up (odds ratio (OR): 20.0, 95% confidence interval (CI): 3.8-105.2) compared to those who met 4-6 goals after adjusting for Tanner stage, sex, age, and diabetes duration. No statistically significant differences in the cardiorenal outcomes were observed between adolescents with type 1 diabetes who met 4-6 goals and non-diabetic controls (n = 96). In adolescents with type 1 diabetes, baseline ADA/ISPAD goal achievement was associated with cardiorenal protection at baseline and 2-yr follow-up. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

PubMed Central

2012-01-01

Background Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. Methods/design A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline. Discussion Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Trial registration Netherlands Trial Register NTR2233 PMID:22937959

"Go! to Sleep": A Web-Based Therapy for Insomnia.

PubMed

Bernstein, Adam M; Allexandre, Didier; Bena, James; Doyle, Jonathan; Gendy, Gina; Wang, Lu; Fay, Susan; Mehra, Reena; Moul, Douglas; Foldvary-Schaefer, Nancy; Roizen, Michael F; Drerup, Michelle

2017-07-01

Insomnia is a common complaint of individuals presenting to healthcare providers and is associated with decreased quality of life and higher healthcare utilization. In-person cognitive behavioral therapy (CBT) is an effective treatment for insomnia but is hindered by cost and limited access to treatment. Initial research suggests that Web-based CBT may mitigate these obstacles. This study tests the effectiveness of a Web-based program for insomnia based on principles of CBT and stress management. We conducted a randomized trial with wait-list controls among adults with primary insomnia (n = 88). Two hundred sixty-three adults with comorbid insomnia were also included and analyzed separately. The intervention was a 6-week online program, and effectiveness was measured via the Insomnia Severity Index (ISI). Baseline ISI score for the intervention group (n = 43) was 17.0; 16.6 for the control group (n = 45). At first follow-up, the intervention group (n = 25) had a mean change from baseline of -7.3 (95% CI: -9.0, -5.6), sustained through second follow-up, while the control group (n = 35) had a change of -1.3 (-2.7, 0.1). The between-group difference was statistically significant (p < 0.001). Participants in the comorbid insomnia group had a baseline ISI score of 16.7 with improvement similar to the primary insomnia group (-6.9; -7.6, -6.2). We observed clinically meaningful improvements in insomnia severity in adults with primary or comorbid insomnia. Sustained improvement over 4 months underscores the effectiveness of a well-constructed online CBT for insomnia program. Go! to Sleep © offers a potentially effective treatment option for adults with insomnia by eliminating geographical barriers to care.

Double-blind, randomized crossover study of intravenous infusion of magnesium sulfate versus 5% dextrose on depressive symptoms in adults with treatment-resistant depression.

PubMed

Mehdi, Syed M A; Atlas, Steven E; Qadir, Sidra; Musselman, Dominique; Goldberg, Sharon; Woolger, Judi M; Corredor, Raul; Abbas, Muhammad H; Arosemena, Leopoldo; Caccamo, Simone; Campbell, Carmen S G; Farooqi, Ashar; Gao, Jinrun; Konefal, Janet; Lages, Lucas C; Lantigua, Laura; Lopez, Johanna; Padilla, Vanessa; Rasul, Ammar; Ray, Anna M; Simões, Herbert G; Tiozzo, Eduard; Lewis, John E

2017-03-01

Treatment-resistant depression patients are more likely to suffer from comorbid physical and mental disorders, experience marked and protracted functional impairment, and incur higher health-care costs than non-affected individuals. Magnesium sulfate is a treatment option that may offer great potential for patients with treatment-resistant depression based on prior work in animals and humans. Twelve subjects with mild or moderate treatment-resistant depression were randomized into a double-blind crossover trial to receive an infusion of 4 g of magnesium sulfate in 5% dextrose or placebo infusion of 5% dextrose with a 5-day washout in between the 8-day intervention period. Subjects were assessed before and after the intervention for serum and urine magnesium, lipid panel, the Hamilton Rating Scale for Depression, and the Patient Health Questionnaire-9. We found a difference in serum magnesium from day 2 to 8 (pre-infusion) (P < 0.002) and from baseline to day 8 (P < 0.02). No changes were noted on the Hamilton Rating Scale for Depression or the Patient Health Questionnaire-9 24 h post-treatment, but as serum magnesium increased from baseline to day 7, the Patient Health Questionnaire-9 decreased from baseline to day 7 (P = 0.02). Magnesium sulfate did not significantly affect depression 24 h post-infusion, but other results were consistent with the literature. The association between changes in serum magnesium and the Patient Health Questionnaire-9 supports the idea that magnesium sulfate may be used to address treatment-resistant depression, an ongoing medical challenge. © 2016 The Authors Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study.

PubMed

Tuleasca, Constantin; Witjas, Tatiana; Van de Ville, Dimitri; Najdenovska, Elena; Verger, Antoine; Girard, Nadine; Champoudry, Jerome; Thiran, Jean-Philippe; Cuadra, Meritxell Bach; Levivier, Marc; Guedj, Eric; Régis, Jean

2018-03-01

Drug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS. Fifty-two patients (30 male, 22 female; mean age 71.6 years, range 49-82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model. The only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size K c  = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman's rank correlation coefficient = 0.002). Routine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.

Intermediate outcomes of a chronic disease self-management program for Spanish-speaking older adults in South Florida, 2008-2010.

PubMed

Melchior, Michael A; Seff, Laura R; Bastida, Elena; Albatineh, Ahmed N; Page, Timothy F; Palmer, Richard C

2013-08-29

The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Spanish-speaking older adults, Tomando Control de su Salud (TCDS). Through the Healthy Aging Regional Collaborative, 8 area agencies delivered 82 workshops in 62 locations throughout South Florida. Spanish-speaking participants who attended workshops from October 1, 2008, through December 31, 2010, were aged 55 years or older, had at least 1 chronic condition, and completed baseline and post-test surveys were included in analysis (N=682). Workshops consisted of six, 2.5-hour sessions offered once per week for 6 weeks. A self-report survey was administered at baseline and again at the end of program instruction. To assess differences in outcomes, a repeated measures general linear model was used, controlling for agency and baseline general health. All outcomes showed improvement at 6 weeks. Outcomes that improved significantly were self-efficacy to manage disease, perceived social and role activities limitations, time spent walking, and time spent performing other aerobic activities. Implementation of TCDS significantly improved 4 of 8 health promotion skills and behaviors of Spanish-speaking older adults in South Florida. A community-based implementation of TCDS has the potential to improve health outcomes for a diverse, Spanish-speaking, older adult population.

Outcome Evaluation of the You Can Do It Initiative to Promote Exclusive Breastfeeding Among Women Enrolled in the New York State WIC Program by Race/Ethnicity.

PubMed

Edmunds, Lynn S; Lee, Furrina F; Eldridge, Johanna D; Sekhobo, Jackson P

To evaluate the effectiveness of You Can Do It at improving exclusive breastfeeding (BF) among New York State women enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Quasi-experimental study, September, 2013 through February, 2016. Multicomponent intervention paired with a yearlong learning community in 12 clinics. Women who were enrolled in WIC during the first trimester, intended to breastfeed or were undecided, and continued in WIC after delivery, comprised 1 baseline cohort (n = 688) and 2 intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (consented, n = 362) and non-BAPT (declined, n = 408). The BAPT was offered to all eligible women in the intervention enrollment period. Consenting women received multiple counseling sessions tailored to individual BAPT results throughout pregnancy and were contacted promptly after delivery. Prevalence of exclusive BF at 7, 30, and 60 days. Multivariate logistic regression, stratified by race/ethnicity. Statistical significance set at P < .05. Prevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts. The initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Effect of Preexercise Ingestion of Modified Amylomaize Starch on Glycemic Response While Cycling.

PubMed

Parks, Rachel B; Angus, Hector F; King, Douglas S; Sharp, Rick L

2018-01-01

Amylomaize-7 is classified as a resistant corn starch and is 68% digestible. When modified by partial hydrolysis in ethanol and hydrochloric acid its digestibility is 92%, yet retains its low glycemic and insulinemic properties. The purpose of this study was to characterize the metabolic response when modified amylomaize-7 or dextrose is consumed in the hour before exercise, and to compare the effect on performance of a brief high-intensity cycling trial. Ten male, trained cyclists were given 1 g/kg body mass of dextrose (DEX) or modified amylomaize-7 (AMY-7) or a flavored water placebo (PL) 45 min prior to exercise on a cycle ergometer. A 15-min ride at 60% W max was immediately followed by a self-paced time trial (TT) equivalent to 15 min at 80% W max . When cyclists consumed DEX, mean serum glucose concentration increased by 3.3 ± 2.1 mmol/L before exercise, compared to stable serum glucose observed for AMY-7 or PL. Glucose concentrations returned to baseline by pre-TT in all treatments. However, the mean post-TT glucose concentration of the DEX group was significantly lower than baseline, AMY-7, or PL. Serum insulin concentration increased nine-fold from baseline to preexercise in the DEX trial, whereas PL or AMY-7 remained unchanged. Time required to complete the performance trial was not significantly different between DEX, AMY-7 or PL. Preexercise ingestion of modified amylomaize-7 compared to dextrose resulted in a more stable serum glucose concentration, but did not offer a performance advantage in this high-intensity cycling trial.

A cluster-randomized trial of a college health center-based alcohol and sexual violence intervention (GIFTSS): Design, rationale, and baseline sample.

PubMed

Abebe, Kaleab Z; Jones, Kelley A; Rofey, Dana; McCauley, Heather L; Clark, Duncan B; Dick, Rebecca; Gmelin, Theresa; Talis, Janine; Anderson, Jocelyn; Chugani, Carla; Algarroba, Gabriela; Antonio, Ashley; Bee, Courtney; Edwards, Clare; Lethihet, Nadia; Macak, Justin; Paley, Joshua; Torres, Irving; Van Dusen, Courtney; Miller, Elizabeth

2018-02-01

Sexual violence (SV) on college campuses is common, especially alcohol-related SV. This is a 2-arm cluster randomized controlled trial to test a brief intervention to reduce risk for alcohol-related sexual violence (SV) among students receiving care from college health centers (CHCs). Intervention CHC staff are trained to deliver universal SV education to all students seeking care, to facilitate patient and provider comfort in discussing SV and related abusive experiences (including the role of alcohol). Control sites provide participants with information about drinking responsibly. Across 28 participating campuses (12 randomized to intervention and 16 to control), 2292 students seeking care at CHCs complete surveys prior to their appointment (baseline), immediately after (exit), 4months later (T2) and one year later (T3). The primary outcome is change in recognition of SV and sexual risk. Among those reporting SV exposure at baseline, changes in SV victimization, disclosure, and use of SV services are additional outcomes. Intervention effects will be assessed using generalized linear mixed models that account for clustering of repeated observations both within CHCs and within students. Slightly more than half of the participating colleges have undergraduate enrollment of ≥3000 students; two-thirds are public and almost half are urban. Among participants there were relatively more Asian (10 v 1%) and Black/African American (13 v 7%) and fewer White (58 v 74%) participants in the intervention compared to control. This study will offer the first formal assessment for SV prevention in the CHC setting. Clinical Trials #: NCT02355470. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Evaluation of the Accuracy and Related Factors of the Mechanical Torque-Limiting Device for Dental Implants

PubMed Central

Kazemi, Mahmood; Rohanian, Ahmad; Monzavi, Abbas; Nazari, Mohammad Sadegh

2013-01-01

Objective: Accurate delivery of torque to implant screws is critical to generate ideal preload in the screw joint and to offer protection against screw loosening. Mechanical torque-limiting devices (MTLDs) are available for this reason. In this study, the accuracy of one type of friction-style and two types of spring-style MTLDs at baseline, following fatigue conditions and sterilization processes were determined. Materials and Methods: Five unused MTLDs were selected from each of Straumann (ITI), Astra TECH and CWM systems. To measure the output of each MTLD, a digital torque gauge with a 3-jaw chuck was used to hold the driver. Force was applied to the MTLDs until either the friction styles released at a pre-calibrated torque value or the spring styles flexed to a pre-calibrated limit (target torque value). The peak torque value was recorded and the procedure was repeated 5 times for each MTLD. Then MTLDs were subjected to fatigue conditions at 500 and 1000 times and steam sterilization processes at 50 and 100 times and the peak torque value was recorded again at each stage. Results: Adjusted difference between measured torque values and target torque values differed significantly between stages for all 3 systems. Adjusted difference did not differ significantly between systems at all stages, but differed significantly between two different styles at baseline and 500 times fatigue stages. Conclusion: Straumann (ITI) devices differed minimally from target torque values at all stages. MTLDs with Spring-style were significantly more accurate than Friction-style device in achieving their target torque values at baseline and 500 times fatigue. PMID:23724209

Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial.

PubMed

Kok, Robin N; van Straten, Annemieke; Beekman, Aartjan; Bosmans, Judith; de Neef, Manja; Cuijpers, Pim

2012-08-31

Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline. Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Netherlands Trial Register NTR2233.

Short-term n-3 fatty acid supplementation but not aspirin increases plasma proresolving mediators of inflammation.

PubMed

Barden, Anne; Mas, Emilie; Croft, Kevin D; Phillips, Michael; Mori, Trevor A

2014-11-01

Resolution of inflammation is an active process involving specialized proresolving mediators (SPM) formed from the n-3 fatty acids. This study examined the effect of n-3 fatty acid supplementation and aspirin on plasma SPMs in healthy humans. Healthy volunteers (n = 21) were supplemented with n-3 fatty acids (2.4g/day) for 7 days with random assignment to take aspirin (300 mg/day) or placebo from day 5 to day 7. Blood was collected at baseline (day 0), day 5, and day 7. Plasma 18R/S-HEPE, E-series resolvins, 17R/S-HDHA, D-series resolvins, 14R/S-HDHA, and MaR-1 were measured by LC/MS/MS. At baseline concentrations of E- and D- series resolvins and the upstream precursors 18R/S-HEPE, 17R/S-HDHA ranged from 0.1nM to 0.2nM. 14R/S-HDHA was 3-fold higher than the other SPMs at baseline but MaR-1 was below the limit of detection. Supplementation with n-3 fatty acids significantly increased RvE1, 18R/S-HEPE, 17R/S-HDHA, and 14R/S-HDHA but not other SPMs. The addition of aspirin after 5 days of n-3 fatty acids did not affect concentrations of any SPM. N-3 fatty acid supplementation for 5 days results in concentrations of SPMs that are biologically active in healthy humans. Aspirin administered after n-3 fatty acids did not offer any additional benefit in elevating the levels of SPMs. Copyright © 2014 by the American Society for Biochemistry and Molecular Biology, Inc.

The dynamics of the oesophageal squamous epithelium 'normalisation' process in patients with gastro-oesophageal reflux disease treated with long-term acid suppression or anti-reflux surgery.

PubMed

Mastracci, L; Fiocca, R; Engström, C; Attwood, S; Ell, C; Galmiche, J P; Hatlebakk, J G; Långström, G; Eklund, S; Lind, T; Lundell, L

2017-05-01

Proton pump inhibitors and laparoscopic anti-reflux surgery (LARS) offer long-term symptom control to patients with gastro-oesophageal reflux disease (GERD). To evaluate the process of 'normalisation' of the squamous epithelium morphology of the distal oesophagus on these therapies. In the LOTUS trial, 554 patients with chronic GERD were randomised to receive either esomeprazole (20-40 mg daily) or LARS. After 5 years, 372 patients remained in the study (esomeprazole, 192; LARS, 180). Biopsies were taken at the Z-line and 2 cm above, at baseline, 1, 3 and 5 years. A severity score was calculated based on: papillae elongation, basal cell hyperplasia, intercellular space dilatations and eosinophilic infiltration. The epithelial proliferative activity was assessed by Ki-67 immunohistochemistry. A gradual improvement in all variables over 5 years was noted in both groups, at both the Z-line and 2 cm above. The severity score decreased from baseline at each subsequent time point in both groups (P < 0.001, all comparisons), attaining a normal level by 5 years. Corresponding decreases in Ki-67 expression were observed (P < 0.001, all comparisons). No significant differences were found between esomeprazole treatment and LARS. Neither baseline severity score nor Ki-67 expression predicted the risk of treatment failure. Five years of treatment is generally required before squamous epithelial cell morphology and proliferation are 'normalised' in patients with chronic GERD, despite endoscopic and symptomatic disease control. Control of the acid component of the refluxate seems to play the predominant role in restoring tissue morphology. © 2017 John Wiley & Sons Ltd.

Improvement in critical thinking dispositions of undergraduate nursing students through problem-based learning: a crossover-experimental study.

PubMed

Yu, Dehong; Zhang, Yaqing; Xu, Yun; Wu, Juemin; Wang, Caifeng

2013-10-01

Critical thinking (CT) is important to nursing education and practice. Although there is evidence that active learning approaches, such as problem-based learning (PBL), are effective in developing CT dispositions, the findings are inconclusive. This study examines the effect of PBL on the development of CT dispositions in nursing students using a crossover-experimental study in a course offered to nursing students in China. All students were randomly assigned to two parallel groups, with one group receiving PBL and the other receiving lecture-based learning (LBL) as a control. The CT Dispositions Inventory-Chinese Version was administered before and after the semester-long course. Data were collected at three time points. No significant differences between groups were noted in overall and sub-scale scores at baseline; however, pronounced differences in overall posttest scores existed between the PBL and LBL groups. Thus, PBL learning significantly enhanced the CT dispositions of nursing students enrolled in Medical-Surgical Nursing II. Copyright 2013, SLACK Incorporated.

A virtual patient educational activity to improve interprofessional competencies: A randomized trial.

PubMed

Shoemaker, Michael J; de Voest, Margaret; Booth, Andrew; Meny, Lisa; Victor, Justin

2015-01-01

The purpose of the present study was to determine whether an interprofessional virtual patient educational activity improved interprofessional competencies in pharmacy, physician assistant, and physical therapy graduate students. Seventy-two fifth semester pharmacy (n = 33), fourth semester physician assistant (n = 27) and fourth semester physical therapy (n = 12) graduate students participated in the study. Participants were stratified by discipline and randomized into control (n = 38) and experimental groups (n = 34). At baseline and at study completion, all participants completed an original, investigator-developed survey that measured improvement in selected Interprofessional Education Collaborative (IPEC) competencies and the Readiness for Interprofessional Learning Scale (RIPLS). The experimental group had statistically significantly greater odds of improving on a variety of IPEC competencies and RIPLS items. The use of a single, interprofessional educational activity resulted in having a greater awareness of other professions' scopes of practice, what other professions have to offer a given patient and how different professions can collaborate in patient care.

Analysis of an Interplanetary Coronal Mass Ejection by a Spacecraft Radio Signal: A Case Study

NASA Astrophysics Data System (ADS)

Molera Calvés, G.; Kallio, E.; Cimo, G.; Quick, J.; Duev, D. A.; Bocanegra Bahamón, T.; Nickola, M.; Kharinov, M. A.; Mikhailov, A. G.

2017-11-01

Tracking radio communication signals from planetary spacecraft with ground-based telescopes offers the possibility to study the electron density and the interplanetary scintillation of the solar wind. Observations of the telemetry link of planetary spacecraft have been conducted regularly with ground antennae from the European Very Long Baseline Interferometry Network, aiming to study the propagation of radio signals in the solar wind at different solar elongations and distances from the Sun. We have analyzed the Mars Express spacecraft radio signal phase fluctuations while, based on a 3-D heliosphere plasma simulation, an interplanetary coronal mass ejection (ICME) crossed the radio path during one of our observations on 6 April 2015. Our measurements showed that the phase scintillation indices increased by a factor of 4 during the passage of the ICME. The method presented here confirms that the phase scintillation technique based on spacecraft signals provides information of the properties and propagation of the ICMEs in the heliosphere.

A Mobile Phone HIV Medication Adherence Intervention: Acceptability and Feasibility Study.

PubMed

Martin, C Andrew; Upvall, Michele J

We present the findings of a qualitative pilot study designed to describe the experience of HIV medication adherence using a mobile phone application. Nine semi-structured focus group discussions were conducted over a 3-month period at an AIDS Services Organization in Central Texas. The data were analyzed following the principles of thematic analysis. During analysis, four themes were identified, and relations between these themes were delineated to reflect the experiences of the 23 participants. The mobile phone application, Care4Today™ Mobile Health Manager, was the intervention tool. Collection of focus group discussion outcomes over a 3-month period with baseline versus end-of-study data determined the feasibility and acceptability of this medication adherence intervention. The findings suggest that when individuals are offered the necessary resources, such as a mobile phone medication reminder application, they may have greater success in performing the behavior. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Implementation of a Complex Intervention to Support Leadership Development in Nursing Homes: A Multimethod Participatory Study.

PubMed

Dewar, Belinda; Barrie, Karen; Sharp, Cathy; Meyer, Julienne

2017-04-01

Leadership is key to quality improvement in nursing homes. This article reports on the initial analysis of the transformational My Home Life Leadership Support program for nursing home managers being implemented in Scotland. It analyses learning from a multimethod participatory descriptive study. Contribution analysis theory informed the evaluation. Evidence-Based Practice, Relationship-Centered Care, Appreciative Inquiry, and Caring Conversations informed the intervention to develop transformational leadership. Data generation methods included baseline and postintervention questionnaires to describe culture change within the study population, together with more in-depth qualitative data generated from group discussions throughout the leadership support program. Qualitative data analysis was an iterative collaborative process with participants to generate themes about the impact of the program on themselves and their practice. Data showed positive changes in managers' perceptions of their self-awareness, leadership communication and relationship skills, and development of positive cultures. This model offers lessons for those interested in ways to approach the emotional, educational, and cultural dynamics of change in other human service contexts.

Personality traits measured at baseline can predict academic performance in upper secondary school three years late.

PubMed

Rosander, Pia; Bäckström, Martin

2014-12-01

The aim of the present study was to explore the ability of personality to predict academic performance in a longitudinal study of a Swedish upper secondary school sample. Academic performance was assessed throughout a three-year period via final grades from the compulsory school and upper secondary school. The Big Five personality factors (Costa & McCrae, ) - particularly Conscientiousness and Neuroticism - were found to predict overall academic performance, after controlling for general intelligence. Results suggest that Conscientiousness, as measured at the age of 16, can explain change in academic performance at the age of 19. The effect of Neuroticism on Conscientiousness indicates that, as regarding getting good grades, it is better to be a bit neurotic than to be stable. The study extends previous work by assessing the relationship between the Big Five and academic performance over a three-year period. The results offer educators avenues for improving educational achievement. © 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study: Description and Baseline Characteristics of Participants.

PubMed

Paskett, Electra D; Caan, Bette J; Johnson, Lisa; Bernardo, Brittany M; Young, Gregory S; Pennell, Michael L; Ray, Roberta M; Kroenke, Candyce H; Porter, Peggy L; Anderson, Garnet L

2018-02-01

Background: The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study offers an important opportunity to advance cancer research by extending the original WHI studies to examine survivorship in women diagnosed with cancer during their participation in WHI. Methods: The goals of LILAC are to (i) obtain cancer treatment information and long-term cancer outcomes for women diagnosed with one of eight selected cancers (breast, endometrial, ovarian, lung, and colorectal cancers, and melanoma, lymphoma, and leukemia); (ii) augment the existing WHI biorepository with fixed tumor tissue from the solid tumor sites for cancers diagnosed since 2002; and (iii) develop, refine, and validate methods to use administrative data to capture treatment and recurrence data. Methods for accomplishing these goals are described, as are results from the initial LILAC participant survey. Results: A total of 9,934 WHI participants living with cancer were eligible for LILAC participation, of which 78% ( N = 7,760) agreed to participate. Among the three most prevalent cancer types, 54% are breast cancer survivors, 11% are melanoma survivors, and 10% are survivors of colorectal cancer. Conclusions: In addition to describing this resource, we present pertinent lessons that may assist other investigators interested in embedding survivorship research into existing large epidemiologic cohorts. Impact: The LILAC resource offers a valuable opportunity for researchers to study cancer survivorship and issues pertinent to cancer survivors in future studies. Cancer Epidemiol Biomarkers Prev; 27(2); 125-37. ©2017 AACR . ©2017 American Association for Cancer Research.

The PiGeOn project: protocol of a longitudinal study examining psychosocial and ethical issues and outcomes in germline genomic sequencing for cancer.

PubMed

Best, Megan; Newson, Ainsley J; Meiser, Bettina; Juraskova, Ilona; Goldstein, David; Tucker, Kathy; Ballinger, Mandy L; Hess, Dominique; Schlub, Timothy E; Biesecker, Barbara; Vines, Richard; Vines, Kate; Thomas, David; Young, Mary-Anne; Savard, Jacqueline; Jacobs, Chris; Butow, Phyllis

2018-04-23

Advances in genomics offer promise for earlier detection or prevention of cancer, by personalisation of medical care tailored to an individual's genomic risk status. However genome sequencing can generate an unprecedented volume of results for the patient to process with potential implications for their families and reproductive choices. This paper describes a protocol for a study (PiGeOn) that aims to explore how patients and their blood relatives experience germline genomic sequencing, to help guide the appropriate future implementation of genome sequencing into routine clinical practice. We have designed a mixed-methods, prospective, cohort sub-study of a germline genomic sequencing study that targets adults with cancer suggestive of a genetic aetiology. One thousand probands and 2000 of their blood relatives will undergo germline genomic sequencing as part of the parent study in Sydney, Australia between 2016 and 2020. Test results are expected within12-15 months of recruitment. For the PiGeOn sub-study, participants will be invited to complete surveys at baseline, three months and twelve months after baseline using self-administered questionnaires, to assess the experience of long waits for results (despite being informed that results may not be returned) and expectations of receiving them. Subsets of both probands and blood relatives will be purposively sampled and invited to participate in three semi-structured qualitative interviews (at baseline and each follow-up) to triangulate the data. Ethical themes identified in the data will be used to inform critical revisions of normative ethical concepts or frameworks. This will be one of the first studies internationally to follow the psychosocial impact on probands and their blood relatives who undergo germline genome sequencing, over time. Study results will inform ongoing ethical debates on issues such as informed consent for genomic sequencing, and informing participants and their relatives of specific results. The study will also provide important outcome data concerning the psychological impact of prolonged waiting for germline genomic sequencing. These data are needed to ensure that when germline genomic sequencing is introduced into standard clinical settings, ethical concepts are embedded, and patients and their relatives are adequately prepared and supported during and after the testing process.

Brain Functional Changes before, during, and after Clinical Pain.

PubMed

Hu, X; Racek, A J; Bellile, E; Nascimento, T D; Bender, M C; Toback, R L; Burnett, D; Khatib, L; McMahan, R; Kovelman, I; Ellwood, R P; DaSilva, A F

2018-05-01

This study used an emerging brain imaging technique, functional near-infrared spectroscopy (fNIRS), to investigate functional brain activation and connectivity that modulates sometimes traumatic pain experience in a clinical setting. Hemodynamic responses were recorded at bilateral somatosensory (S1) and prefrontal cortices (PFCs) from 12 patients with dentin hypersensitivity in a dental chair before, during, and after clinical pain. Clinical dental pain was triggered with 20 consecutive descending cold stimulations (32° to 0°C) to the affected teeth. We used a partial least squares path modeling framework to link patients' clinical pain experience with recorded hemodynamic responses at sequential stages and baseline resting-state functional connectivity (RSFC). Hemodynamic responses at PFC/S1 were sequentially elicited by expectation, cold detection, and pain perception at a high-level coefficient (coefficients: 0.92, 0.98, and 0.99, P < 0.05). We found that the pain ratings were positively affected only at a moderate level of coefficients by such sequence of functional activation (coefficient: 0.52, P < 0.05) and the baseline PFC-S1 RSFC (coefficient: 0.59, P < 0.05). Furthermore, when the dental pain had finally subsided, the PFC increased its functional connection with the affected S1 orofacial region contralateral to the pain stimulus and, in contrast, decreased with the ipsilateral homuncular S1 regions ( P < 0.05). Our study indicated for the first time that patients' clinical pain experience in the dental chair can be predicted concomitantly by their baseline functional connectivity between S1 and PFC, as well as their sequence of ongoing hemodynamic responses. In addition, this linked cascade of events had immediate after-effects on the patients' brain connectivity, even when clinical pain had already ceased. Our findings offer a better understating of the ongoing impact of affective and sensory experience in the brain before, during, and after clinical dental pain.

miR-21 expression and clinical outcome in locally advanced pancreatic cancer: exploratory analysis of the pancreatic cancer Erbitux, radiotherapy and UFT (PERU) trial

PubMed Central

Khan, Khurum; Cunningham, David; Peckitt, Clare; Barton, Sarah; Tait, Diana; Hawkins, Maria; Watkins, David; Starling, Naureen; Rao, Sheela; Begum, Ruwaida; Thomas, Janet; Oates, Jacqui; Guzzardo, Vincenza; Fassan, Matteo; Braconi, Chiara; Chau, Ian

2016-01-01

Background Locally advanced pancreatic cancer (LAPC) is associated with high mortality, and biomarker-driven treatment approach is currently lacking. This study evaluated safety and efficacy of a combination approach of chemotherapy followed by chemo-radiotherapy (CRT) +/− cetuximab, and the prognostic role of miR-21 in patients with LAPC treated with a multimodality approach. Patients and Methods This was a randomised phase II trial in which patients with inoperable LAPC were offered gemcitabine and capecitabine (GEM-CAP) for 16 weeks. Patients with stable disease or response after GEM-CAP were randomised to capecitabine or UFT plus radiotherapy (RT) (A), or capecitabine or UFT plus cetuximab plus RT (B). The primary outcome of the study was overall survival (OS). Clinical outcome was compared according to baseline circulating miR-21 levels. Results 17 patients were enrolled and treated with GEM-CAP, with 13 patients achieving disease control and being randomised to arms A (n:7) and B (n:6). After a median follow-up of 61.2 months, median progression free survival (PFS) was 10.4 months and 12.7 months, median OS was 15.8 months and 22.0 months in arms A and B respectively (p > 0.05). Patients with high baseline plasma miR-21 had worse PFS (3.5 vs. 12.7 months; p:0.032) and OS (5.1 vs 15.3 months; p:0.5) compared to patients with low miR-21. Circulating miR-21 levels reflected miR-21 expression within the tissues. Conclusions Addition of Cetuximab to CRT following induction chemotherapy did not improve survival. High miR-21 baseline plasma expression was associated with poor clinical outcome in LAPC patients treated with induction chemotherapy followed by chemo-radiotherapy. PMID:26862857

Reduced Exposure to Harmful and Potentially Harmful Smoke Constituents With the Tobacco Heating System 2.1

PubMed Central

Baker, Gizelle; Magnette, John; Picavet, Patrick; Weitkunat, Rolf

2017-01-01

Introduction: Heating rather than burning tobacco reduces levels of harmful and potentially harmful constituents, and consumer products using this approach aim to reduce exposure to tobacco toxicants. The Tobacco Heating System (THS) version 2.1 has been enhanced from earlier prototypes with an improved heat control and sensorial experience and thereby user acceptance. Exposure measurements are required to determine whether it may be possible to reduce the individual health risk compared to smoking combustible cigarettes (CCs). Methods: This controlled clinical study randomly assigned 40 smokers to either a group continuing to use of their own CC brand (n = 20) or a group switching to THS 2.1 (n = 20) for 5 days. Biomarkers of exposure were measured at baseline and on day 1 through day 5. Product consumption, Human Puffing Topography, the occurrence of adverse events, and an assessment of subjective effects, such as smoking satisfaction and enjoyment of respiratory tract sensations, were also determined. Results: The group of smokers who switched to THS 2.1 adapted their puffing behavior initially through longer puff duration and more puffs. During the duration of the study, total puff volume returned to baseline levels and the mean daily product consumption increased but with similar nicotine exposure compared to baseline CC use. Biomarkers of exposure to tobacco smoke toxicants which inform product risk assessment were significantly reduced with THS use compared to the CC group. THS 2.1 users experienced less reinforcing effects with THS 2.1 than with their own cigarette brand. Conclusions: THS 2.1 is a promising alternative to smoking CCs. Notwithstanding possible use adaption through consumption or puffing behavior, the exposure to harmful smoke constituents was markedly reduced with the new heated tobacco platform. Implications: Exposure markers to harmful and potentially harmful smoke constituents were lowered with the THS 2.1. Heating tobacco instead of burning can offer a potentially lower risk of delivering nicotine compared to CCs. PMID:27613951

Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study.

PubMed

Maiolino, Giuseppe; Rossitto, Giacomo; Bisogni, Valeria; Cesari, Maurizio; Seccia, Teresa Maria; Plebani, Mario; Rossi, Gian Paolo

2017-05-21

Current guidelines recommend use of the aldosterone-renin ratio (ARR) for the case detection of primary aldosteronism followed by confirmatory tests to exclude false-positive results from further diagnostic workup. We investigated the hypothesis that this could be unnecessary in patients with a high ARR value if the quantitative information carried by the ARR is taken into due consideration. We interrogated 2 large data sets of prospectively collected patients studied with the same predefined protocol, which included the captopril challenge test. We used an unambiguous diagnosis of aldosterone-producing adenoma as reference index. We also assessed whether the post-captopril ARR and plasma aldosterone concentration fall furnished a diagnostic gain over baseline ARR values. We found that the false-positive rate fell exponentially, and, conversely, the specificity increased with rising ARR values. At receiver operating characteristics curves and diagnostic odds ratio analysis, the high baseline ARR values implied very high positive likelihood ratio and diagnostic odds ratio values. The baseline and post-captopril ARR showed similar diagnostic accuracy (area under the receiver operating characteristics curve) in both the exploratory and validation cohorts, indicating lack of diagnostic gain with this confirmatory test (between-area under the curve difference, 0.005; 95% CI, -0.031 to 0.040; P =0.7 for comparison, and 0.05; 95% CI, -0.061 to 0.064; P =0.051 for comparison, respectively). These results indicate that the ARR conveys key quantitative information that, if properly used, can simplify the diagnostic workup, resulting in saving of money and resources. This can offer the chance of diagnosis and ensuing adrenalectomy to a larger number of hypertensive patients, ultimately resulting in better control of blood pressure. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Patiromer Lowers Serum Potassium When Taken without Food: Comparison to Dosing with Food from an Open-Label, Randomized, Parallel Group Hyperkalemia Study.

PubMed

Pergola, Pablo E; Spiegel, David M; Warren, Suzette; Yuan, Jinwei; Weir, Matthew R

2017-01-01

Patiromer is a sodium-free, nonabsorbed, potassium binder approved for treatment of hyperkalemia. This open-label study compares the efficacy and safety of patiromer administered without food versus with food. Adults with hyperkalemia (potassium ≥5.0 mEq/L) were randomized (1:1) to receive patiromer once daily without food or with food for 4 weeks. The dosage was adjusted (maximum: 25.2 g/day) using a prespecified titration schedule to achieve and maintain potassium within a target range (3.8-5.0 mEq/L). The primary efficacy endpoint was the proportion of patients with serum potassium in the target range at either week 3 or week 4. Safety was assessed by adverse events (AEs) and laboratory testing. Efficacy was evaluated in 112 patients; 65.2% were ≥65 years of age, 75.9% had chronic kidney disease, and 82.1% had diabetes. Baseline mean serum potassium was similar in the without-food (5.44 mEq/L) and with-food (5.34 mEq/L) groups. The primary endpoint was achieved by 87.3% (95% CI 75.5-94.7) and 82.5% (95% CI 70.1-91.3) of patients in the with-food and without-food groups, respectively; least squares mean changes in serum potassium from baseline to week 4 were -0.65 and -0.62 mEq/L, respectively (p < 0.0001). The most common AEs were diarrhea and constipation. Serum K+ remained ≥3.5 mEq/L in all patients; 5 patients developed serum magnesium <1.4 mg/dL, including 4 whose baseline magnesium was below the lower limit of normal. Patiromer is equally effective and well tolerated when taken without food or with food, thereby offering the potential for dosing flexibility. © 2017 The Author(s) Published by S. Karger AG, Basel.

The Study of HIV and Antenatal Care Integration in Pregnancy in Kenya: Design, Methods, and Baseline Results of a Cluster-Randomized Controlled Trial

PubMed Central

Turan, Janet M.; Steinfeld, Rachel L.; Onono, Maricianah; Bukusi, Elizabeth A.; Woods, Meghan; Shade, Starley B.; Washington, Sierra; Marima, Reson; Penner, Jeremy; Ackers, Marta L.; Mbori-Ngacha, Dorothy; Cohen, Craig R.

2012-01-01

Background Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma. Methodology/Principal Findings A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC clinics at government health facilities in rural Kenya. Twelve facilities were randomized to provide either fully integrated services (ANC, PMTCT, and HIV treatment services all delivered in the ANC clinic) or non-integrated services (ANC clinics provided ANC and basic PMTCT services and referred clients to a separate HIV clinic for HIV treatment). During June 2009– March 2011, 1,172 HIV-positive pregnant women were enrolled in the study. The main study outcomes are rates of maternal enrollment in HIV care and treatment, infant HIV testing uptake, and HIV-free infant survival. Baseline results revealed that the intervention and control cohorts were similar with respect to socio-demographics, male partner HIV testing, sero-discordance of the couple, obstetric history, baseline CD4 count, and WHO Stage. Challenges faced while conducting this trial at low-resource rural health facilities included frequent staff turnover, stock-outs of essential supplies, transportation challenges, and changes in national guidelines. Conclusions/Significance This is the first randomized trial of ANC and HIV service integration to be conducted in rural Africa. It is expected that the study will provide critical evidence regarding the implementation and effectiveness of this service delivery strategy, with important implications for programs striving to eliminate vertical transmission of HIV and improve maternal health. Trial Registration ClinicalTrials.gov NCT00931216 NCT00931216. PMID:22970177

Sensor Technology Baseline Study for Enabling Condition Based Maintenance Plus in Army Ground Vehicles

DTIC Science & Technology

2012-03-01

for enabling condition based maintenance plus in Army ground vehicles. The sensor study was driven from Failure Mode Effects Analysis ( FMEA ...of Tables Table 1. Sensor technology baseline study based on engine FMEA report. ...................................5 Table 2. Sensor technology...baseline study based on transmission FMEA report. .........................8 Table 3. Sensor technology baseline study based on alternator FMEA report

An Exploration of Smoking Among People Attending Residential Substance Abuse Treatment: Prevalence and Outcomes at Three Months Post-Discharge.

PubMed

Ingram, Isabella; Kelly, Peter J; Deane, Frank P; Baker, Amanda L; Lyons, Geoff; Blackman, Russell

2017-01-01

Smoking continues to be a major health concern for people with a history of alcohol or other substance use problems. The current research is aimed to (1) describe the prevalence of smoking in residential addictions treatment services and (2) compare characteristics of people who had or had not quit smoking. Participants were attending residential substance abuse treatment provided by the Australian Salvation Army. These programs are up to 10 months in length and offer a range of low-intensity smoking cessation supports. Measures of smoking, substance use, and clinical characteristics were collected from 2008 to 2015 at baseline and three months post-discharge from treatment (N = 702). At baseline, 86% of people were smokers (n = 606). At follow-up, only 48 participants who were smokers at baseline (7%) had quit smoking. Participants who had quit smoking at follow-up also reported higher rates of abstinence from alcohol or other substances at follow-up (72%) than people who had not quit smoking (46%; OR = 2.95, 95% CI [1.52, 5.74]). There is potential for smoking cessation to be better addressed as part of routine care in substance abuse treatment settings. Future research should evaluate the provision of more systematic smoking cessation interventions within these settings.

Effects of Convoluted Divergent Flap Contouring on the Performance of a Fixed-Geometry Nonaxisymmetric Exhaust Nozzle

NASA Technical Reports Server (NTRS)

Asbury, Scott C.; Hunter, Craig A.

1999-01-01

An investigation was conducted in the model preparation area of the Langley 16-Foot Transonic Tunnel to determine the effects of convoluted divergent-flap contouring on the internal performance of a fixed-geometry, nonaxisymmetric, convergent-divergent exhaust nozzle. Testing was conducted at static conditions using a sub-scale nozzle model with one baseline and four convoluted configurations. All tests were conducted with no external flow at nozzle pressure ratios from 1.25 to approximately 9.50. Results indicate that baseline nozzle performance was dominated by unstable, shock-induced, boundary-layer separation at overexpanded conditions. Convoluted configurations were found to significantly reduce, and in some cases totally alleviate separation at overexpanded conditions. This result was attributed to the ability of convoluted contouring to energize and improve the condition of the nozzle boundary layer. Separation alleviation offers potential for installed nozzle aeropropulsive (thrust-minus-drag) performance benefits by reducing drag at forward flight speeds, even though this may reduce nozzle thrust ratio as much as 6.4% at off-design conditions. At on-design conditions, nozzle thrust ratio for the convoluted configurations ranged from 1% to 2.9% below the baseline configuration; this was a result of increased skin friction and oblique shock losses inside the nozzle.

Empathy toward strangers triggers oxytocin release and subsequent generosity.

PubMed

Barraza, Jorge A; Zak, Paul J

2009-06-01

Empathy is related to a variety of prosocial behaviors, but the brain mechanisms producing the experience of empathy have not been fully characterized. This study investigated whether the experience of empathy raises oxytocin levels and affects subsequent generosity toward strangers. Short video clips of an emotional scene and an unemotional scene were used as stimuli. Participants rated the emotions they experienced and then played a $40 ultimatum game to gauge their generosity. We found that empathy was associated with a 47% increase in oxytocin from baseline. We also found the empathy-oxytocin response was stronger in women than in men. Higher levels of empathy were also associated with more generous monetary offers toward strangers in the ultimatum game. Our findings provide the first evidence that oxytocin is a physiologic signature for empathy and that empathy mediates generosity.

Sensitivity to neutrino decay with atmospheric neutrinos at the INO-ICAL detector

NASA Astrophysics Data System (ADS)

Choubey, Sandhya; Goswami, Srubabati; Gupta, Chandan; Lakshmi, S. M.; Thakore, Tarak

2018-02-01

Sensitivity of the magnetized Iron Calorimeter (ICAL) detector at the proposed India-based Neutrino Observatory (INO) to invisible decay of the mass eigenstate ν3 using atmospheric neutrinos is explored. A full three-generation analysis including Earth matter effects is performed in a framework with both decay and oscillations. The wide energy range and baselines offered by atmospheric neutrinos are shown to be excellent for constraining the ν3 lifetime. We find that with an exposure of 500 kton -yr the ICAL atmospheric experiment could constrain the ν3 lifetime to τ3/m3>1.51 ×10-10 s /eV at the 90% C.L. This is 2 orders of magnitude tighter than the bound from MINOS. The effect of invisible decay on the precision measurement of θ23 and |Δ m322| is also studied.

The Science and Design of the AGIS Observatory

NASA Astrophysics Data System (ADS)

Schroedter, Martin

2010-02-01

The AGIS observatory is a next-generation array of imaging atmospheric Cherenkov telescopes (IACTs) for gamma-ray astronomy between 100 GeV and 100 TeV. The AGIS observatory is the next logical step in high energy gamma-ray astronomy, offering improved angular resolution and sensitivity compared to FERMI, and overlapping the high energy end of FERMI's sensitivity band. The baseline AGIS observatory will employ an array of 36 Schwarzschild-Couder IACTs in combination with a highly pixelated (0.05^o diameter) camera. The instrument is designed to provide millicrab sensitivity over a wide (8^o diameter) field of view, allowing both deep studies of faint point sources as well as efficient mapping of the Galactic plane and extended sources. I will describe science drivers behind the AGIS observatory and the design and status of the project. )

The Science and Design of the AGIS Observatory

NASA Astrophysics Data System (ADS)

Falcone, Abraham; Aliu, E.; Arlen, T.; Benbow, W.; Buckley, J.; Bugaev, S.; Byrum, K.; Ciupik, L.; Coppi, P.; Digel, S.; Drake, G.; Finley, J.; Fortson, L.; Franco, J.; Funk, S.; Guarino, V.; Gyuk, G.; Hanna, D.; Hiriart, D.; Humensky, B.; Holder, J.; Kaaret, P.; Karlsson, N.; Kieda, D.; Konopelko, A.; Krawczynski, H.; Krennrich, F.; LeBohec, S.; Maier, G.; Mukherjee, R.; Ong, R.; Otte, N.; Pareschi, G.; Pohl, M.; Quinn, J.; Ramsey, B.; Romani, R.; Rovero, A. C.; Schroedter, M.; Sinnis, C.; Slane, P.; Smith, A.; Swordy, S.; Tajima, H.; Vassiliev, V.; Wagner, R.; Wakely, S. P.; Weekes, T. C.; Weinstein, A.; Williams, D.

2010-01-01

The AGIS observatory is a next-generation array of imaging atmospheric Cherenkov telescopes (IACTs) for gamma-ray astronomy between 100GeV and 100 TeV. The AGIS observatory is the next logical step in high energy gamma-ray astronomy, offering improved angular resolution and sensitivity compared to FERMI, and overlapping the high energy end of FERMI's sensitivity band. The baseline AGIS observatory will employ an array of 36 Schwarzschild-Couder IACTs in combination with a highly pixelated (0.05 degree/pixel) camera. The instrument is designed to provide millicrab sensitivity over a wide (8 degree diameter) field of view, allowing both deep studies of faint point sources as well as efficient mapping of the Galactic plane and extended sources. This presentation will include a description of science drivers behind the AGIS observatory and the design and status of the project.

In-Space Chemical Propulsion System Model

NASA Technical Reports Server (NTRS)

Byers, David C.; Woodcock, Gordon; Benfield, Michael P. J.

2004-01-01

Multiple, new technologies for chemical systems are becoming available and include high temperature rockets, very light propellant tanks and structures, new bipropellant and monopropellant options, lower mass propellant control components, and zero boil off subsystems. Such technologies offer promise of increasing the performance of in-space chemical propulsion for energetic space missions. A mass model for pressure-fed, Earth and space-storable, advanced chemical propulsion systems (ACPS) was developed in support of the NASA MSFC In-Space Propulsion Program. Data from flight systems and studies defined baseline system architectures and subsystems and analyses were formulated for parametric scaling relationships for all ACPS subsystem. The paper will first provide summary descriptions of the approaches used for the systems and the subsystems and then present selected analyses to illustrate use of the model for missions with characteristics of current interest.

In-Space Chemical Propulsion System Model

NASA Technical Reports Server (NTRS)

Byers, David C.; Woodcock, Gordon; Benfield, M. P. J.

2004-01-01

Multiple, new technologies for chemical systems are becoming available and include high temperature rockets, very light propellant tanks and structures, new bipropellant and monopropellant options, lower mass propellant control components, and zero boil off subsystems. Such technologies offer promise of increasing the performance of in-space chemical propulsion for energetic space missions. A mass model for pressure-fed, Earth and space-storable, advanced chemical propulsion systems (ACPS) was developed in support of the NASA MSFC In-Space Propulsion Program. Data from flight systems and studies defined baseline system architectures and subsystems and analyses were formulated for parametric scaling relationships for all ACPS subsystems. The paper will first provide summary descriptions of the approaches used for the systems and the subsystems and then present selected analyses to illustrate use of the model for missions with characteristics of current interest.

Low-Cost Simulation to Teach Anesthetists' Non-Technical Skills in Rwanda.

PubMed

Skelton, Teresa; Nshimyumuremyi, Isaac; Mukwesi, Christian; Whynot, Sara; Zolpys, Lauren; Livingston, Patricia

2016-08-01

Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS)-task management, team working, situation awareness, and decision making-are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in sub-Saharan Africa. This pilot study investigates whether a low-cost simulation model, with good psychological fidelity, can be used effectively to teach ANTS during cesarean delivery in Rwanda. Study participants were anesthesia providers working in a tertiary referral hospital in Rwanda. Baseline observations were conducted for 20 anesthesia providers during cesarean delivery using the established ANTS framework. After the first observation set was complete, participants were randomly assigned to either simulation intervention or control groups. The simulation intervention group underwent ANTS training using low-cost high psychological fidelity simulation with debriefing. No training was offered to the control group. Postintervention observations were then conducted in the same manner as the baseline observations. The primary outcome was the overall ANTS score (maximum, 16). The median (range) ANTS score of the simulation group was 13.5 (11-16). The ANTS score of the control group was 8 (8-9), with a statistically significant difference (P = .002). Simulation participants showed statistically significant improvement in subcategories and in the overall ANTS score compared with ANTS score before simulation exposure. Rwandan anesthesia providers show improvement in ANTS practice during cesarean delivery after 1 teaching session using a low-cost high psychological fidelity simulation model with debriefing.

Spacelab life sciences 2 post mission report

NASA Technical Reports Server (NTRS)

Buckey, Jay C.

1994-01-01

Jay C. Buckey, M.D., Assistant Professor of Medicine at The University of Texas Southwestern Medical Center at Dallas served as an alternate payload specialist astronaut for the Spacelab Life Sciences 2 Space Shuttle Mission from January 1992 through December 1993. This report summarizes his opinions on the mission and offers suggestions in the areas of selection, training, simulations, baseline data collection and mission operations. The report recognizes the contributions of the commander, payload commander and mission management team to the success of the mission. Dr. Buckey's main accomplishments during the mission are listed.

The Ideal Strategy for Cervical Cancer Screening in Japan: Result from the Fukui Cervical Cancer Screening Study.

PubMed

Kurokawa, T; Onuma, T; Shinagawa, A; Chino, Y; Kobayashi, M; Yoshida, Y

2018-05-16

The aims of the Fukui Cervical Cancer Screening (FCCS) study are to determine the frequency of women with high-risk HPV (hrHPV), whether HPV16 or HPV18 (HPV16/18), in the Japanese cancer screening population for the first time and to identify the best strategy for cervical cancer screening in Japan. This study enrolled 7,584 women ≥25 years of age who were undergoing routine screening. All women underwent liquid-based cytology and cobas HPV tests. Women with abnormal cytology, whether hrHPV positive or negative; women with hrHPV positivity with either normal or abnormal cytology; and women randomly selected from women with normal cytology and negative hrHPV negative were referred for colposcopy. The prevalences of hrHPV positivity and HPV16/18 positivity were 6.8% and 1.7%, respectively. The baseline data from the FCCS study showed that the combination of HPV tests and cytology was more sensitive than cytology with respect to the detection of intraepithelial neoplasia grade 2 or worse. However, the specificity (94.1%) of the co-testing strategy that required all women with abnormal cytology or hrHPV positivity to be referred for colposcopy was much lower than that (97.8%) of cytology. The sensitivity and specificity of the co-testing strategy that required only women with abnormal cytology or HPV16/18 positivity to undergo colposcopy were 85.5% and 97.0%, respectively. The baseline data from the FCCS study suggest that a cervical cancer screening strategy in which only women with abnormal cytology or HPV16/18 positivity undergo colposcopy offers a more balanced sensitivity and specificity than other strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Predicting Successful Treatment Outcome of Web-Based Self-help for Problem Drinkers: Secondary Analysis From a Randomized Controlled Trial

PubMed Central

Kramer, Jeannet; Keuken, Max; Smit, Filip; Schippers, Gerard; Cuijpers, Pim

2008-01-01

Background Web-based self-help interventions for problem drinking are coming of age. They have shown promising results in terms of cost-effectiveness, and they offer opportunities to reach out on a broad scale to problem drinkers. The question now is whether certain groups of problem drinkers benefit more from such Web-based interventions than others. Objective We sought to identify baseline, client-related predictors of the effectiveness of Drinking Less, a 24/7, free-access, interactive, Web-based self-help intervention without therapist guidance for problem drinkers who want to reduce their alcohol consumption. The intervention is based on cognitive-behavioral and self-control principles. Methods We conducted secondary analysis of data from a pragmatic randomized trial with follow-up at 6 and 12 months. Participants (N = 261) were adult problem drinkers in the Dutch general population with a weekly alcohol consumption above 210 g of ethanol for men or 140 g for women, or consumption of at least 60 g (men) or 40 g (women) one or more days a week over the past 3 months. Six baseline participant characteristics were designated as putative predictors of treatment response: (1) gender, (2) education, (3) Internet use competence (sociodemographics), (4) mean weekly alcohol consumption, (5) prior professional help for alcohol problems (level of problem drinking), and (6) participants’ expectancies of Web-based interventions for problem drinking. Intention-to-treat (ITT) analyses, using last-observation-carried-forward (LOCF) data, and regression imputation (RI) were performed to deal with loss to follow-up. Statistical tests for interaction terms were conducted and linear regression analysis was performed to investigate whether the participants’ characteristics as measured at baseline predicted positive treatment responses at 6- and 12-month follow-ups. Results At 6 months, prior help for alcohol problems predicted a small, marginally significant positive treatment outcome in the RI model only (beta = .18, P = .05, R2 = .11). At 12 months, females displayed modest predictive power in both imputation models (LOCF: beta = .22, P = .045, R2 = .02; regression: beta = .27, P = .01, R2 = .03). Those with higher levels of education exhibited modest predictive power in the LOCF model only (beta = .33, P = .01, R2 = .03). Conclusions Although female and more highly educated users appeared slightly more likely to derive benefit from the Drinking Less intervention, none of the baseline characteristics we studied persuasively predicted a favorable treatment outcome. The Web-based intervention therefore seems well suited for a heterogeneous group of problem drinkers and could hence be offered as a first-step treatment in a stepped-care approach directed at problem drinkers in the general population. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 47285230; http://www.controlled-trials.com/isrctn47285230 (Archived by WebCite at http://www.webcitation.org/5cSR2sMkp). PMID:19033150

Predicting successful treatment outcome of web-based self-help for problem drinkers: secondary analysis from a randomized controlled trial.

PubMed

Riper, Heleen; Kramer, Jeannet; Keuken, Max; Smit, Filip; Schippers, Gerard; Cuijpers, Pim

2008-11-22

Web-based self-help interventions for problem drinking are coming of age. They have shown promising results in terms of cost-effectiveness, and they offer opportunities to reach out on a broad scale to problem drinkers. The question now is whether certain groups of problem drinkers benefit more from such Web-based interventions than others. We sought to identify baseline, client-related predictors of the effectiveness of Drinking Less, a 24/7, free-access, interactive, Web-based self-help intervention without therapist guidance for problem drinkers who want to reduce their alcohol consumption. The intervention is based on cognitive-behavioral and self-control principles. We conducted secondary analysis of data from a pragmatic randomized trial with follow-up at 6 and 12 months. Participants (N = 261) were adult problem drinkers in the Dutch general population with a weekly alcohol consumption above 210 g of ethanol for men or 140 g for women, or consumption of at least 60 g (men) or 40 g (women) one or more days a week over the past 3 months. Six baseline participant characteristics were designated as putative predictors of treatment response: (1) gender, (2) education, (3) Internet use competence (sociodemographics), (4) mean weekly alcohol consumption, (5) prior professional help for alcohol problems (level of problem drinking), and (6) participants' expectancies of Web-based interventions for problem drinking. Intention-to-treat (ITT) analyses, using last-observation-carried-forward (LOCF) data, and regression imputation (RI) were performed to deal with loss to follow-up. Statistical tests for interaction terms were conducted and linear regression analysis was performed to investigate whether the participants' characteristics as measured at baseline predicted positive treatment responses at 6- and 12-month follow-ups. At 6 months, prior help for alcohol problems predicted a small, marginally significant positive treatment outcome in the RI model only (beta = .18, P = .05, R(2) = .11). At 12 months, females displayed modest predictive power in both imputation models (LOCF: beta = .22, P = .045, R(2) = .02; regression: beta = .27, P = .01, R(2) = .03). Those with higher levels of education exhibited modest predictive power in the LOCF model only (beta = .33, P = .01, R(2) = .03). Although female and more highly educated users appeared slightly more likely to derive benefit from the Drinking Less intervention, none of the baseline characteristics we studied persuasively predicted a favorable treatment outcome. The Web-based intervention therefore seems well suited for a heterogeneous group of problem drinkers and could hence be offered as a first-step treatment in a stepped-care approach directed at problem drinkers in the general population. International Standard Randomized Controlled Trial Number (ISRCTN): 47285230; http://www.controlled-trials.com/isrctn47285230 (Archived by WebCite at http://www.webcitation.org/5cSR2sMkp).

Lipid-based nutrient supplements containing vitamins and minerals attenuate renal electrolyte loss in HIV/AIDS patients starting antiretroviral therapy: A randomized controlled trial in Zambia.

PubMed

Munkombwe, D; Muungo, T L; Michelo, C; Kelly, P; Chirwa, S; Filteau, S

2016-06-01

Advanced HIV infection combined with undernutrition and antiretroviral therapy (ART) places HIV/AIDS patients at high risk of electrolyte abnormalities and increased morbidity and mortality. Here, in a sub-study of a large published randomized trial, we evaluated if nutritional supplements will help curtail renal electrolyte loss in HIV/AIDS patients starting ART. 130 malnourished HIV-positive patients referred for ART received lipid-based nutrient supplements alone (LNS, n = 63) or together with vitamins and minerals (LNS-VM, n = 67). Serum and spot urine samples were collected and assayed for creatinine, potassium, magnesium and phosphate concentrations at baseline and after 12 weeks of ART, and fractional excretion and reabsorption were calculated using standard equations. Eighteen (28.6%) patients from the LNS and 16 (23.9%) from LNS-VM groups died, most during the referral interval before starting ART. Phosphate excretion at baseline, was high in both LNS (mean ± SD: 1.2 ± 0.6 mg/mg creatinine) and LNS-VM (1.1 ± 0.8 mg/mg creatinine) groups relative to normal physiological ranges. Phosphate excretion remained high in the LNS group (1.1 ± 0.41 mg/mg creatinine) but significantly decreased in the LNS-VM group (0.6 ± 0.28 mg/mg creatinine; p < 0.001) after 12 weeks of ART. This difference is probably explained by increased renal tubular reabsorption of phosphate in the LNS-VM group (88.3 ± 5.7%) compared to the LNS group (76.6 ± 8.9%). The fractional excretion of potassium (FEK) was not significantly different at baseline between the two groups (p = 0.69) but the values were above normal physiological ranges (i.e. >6.4%) reflecting renal potassium wasting. However, FEK was significantly lowered in the LNS-VM group (6.2 ± 3.4%) but not in the LNS group (12.8 ± 4.7%) after 12 weeks of ART (p < 0.001). Finally, the fractional excretion of magnesium was not significantly different between the two groups at baseline (p = 0.68) and remained unchanged within normal physiological ranges at 12 weeks of ART (p = 0.82) in both groups. The LNS-VM regimen appeared to offer protection against phosphate and potassium loss during HIV/AIDS treatment. This offers potential opportunities to improve care and support of poorly nourished HIV-infected patients in resource-limited settings. www.pactr.org ID number: PACTR201106000300631. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Effectiveness of preventive support groups for children of mentally ill or addicted parents: a randomized controlled trial.

PubMed

van Santvoort, Floor; Hosman, Clemens M H; van Doesum, Karin T M; Janssens, Jan M A M

2014-06-01

In various countries preventive support groups are offered to children of mentally ill and/or addicted parents to reduce the risk that they will develop problems themselves. This study assessed the effectiveness of Dutch support groups for children aged 8-12 years old in terms of reducing negative cognitions; improving social support, competence, and parent-child interaction (direct intervention goals); and reducing emotional and behavioural problems (ultimate intervention aim). Children from 254 families were randomly assigned to the intervention or a control condition. Parents and children completed questionnaires at baseline and 3 and 6 months later. Emotional and behavioural problems of intervention group children were also assessed 1 year after the start. Univariate analyses of variance showed that children in the intervention group experienced a greater decrease in negative cognitions and sought more social support, immediately after participation and 3 months later, as compared to control group children. They also remained stable in their feelings of social acceptance (competence aspect) immediately after the intervention, whereas these feelings declined in control group children. The intervention and control groups both improved over time in terms of cognitions, competence, parent-child interaction and emotional and behavioural problem scores. Additional improvement in terms of problem scores was found in the intervention group 1 year after baseline. Further enhancement of effectiveness requires re-consideration of the support group goals; it should be studied whether the goals reflect the most important and influential risk and protective factors for this specific population. Besides, effects should be studied over a longer period.

Single-item measure for assessing quality of life in children with drug-resistant epilepsy.

PubMed

Conway, Lauryn; Widjaja, Elysa; Smith, Mary Lou

2018-03-01

The current study investigated the psychometric properties of a single-item quality of life (QOL) measure, the Global Quality of Life in Childhood Epilepsy question (G-QOLCE), in children with drug-resistant epilepsy. Data came from the Impact of Pediatric Epilepsy Surgery on Health-Related Quality of Life Study (PESQOL), a multicenter prospective cohort study (n = 118) with observations collected at baseline and at 6 months of follow-up on children aged 4-18 years. QOL was measured with the QOLCE-76 and KIDSCREEN-27. The G-QOLCE was an overall QOL question derived from the QOLCE-76. Construct validity and reliability were assessed with Spearman's correlation and intraclass correlation coefficient (ICC). Responsiveness was examined through distribution-based and anchor-based methods. The G-QOLCE showed moderate (r ≥ 0.30) to strong (r ≥ 0.50) correlations with composite scores, and most subscales of the QOLCE-76 and KIDSCREEN-27 at baseline and 6-month follow-up. The G-QOLCE had moderate test-retest reliability (ICC range: 0.49-0.72) and was able to detect clinically important change in patients' QOL (standardized response mean: 0.38; probability of change: 0.65; Guyatt's responsiveness statistics: 0.62 and 0.78). Caregiver anxiety and family functioning contributed most strongly to G-QOLCE scores over time. Results offer promising preliminary evidence regarding the validity, reliability, and responsiveness of the proposed single-item QOL measure. The G-QOLCE is a potentially useful tool that can be feasibly administered in a busy clinical setting to evaluate clinical status and impact of treatment outcomes in pediatric epilepsy.

Adherence to Mediterranean Diet Offers an Additive Protection Over the Use of Statin Therapy: Results from the ATTICA Study (2002-2012).

PubMed

Panagiotakos, Demosthenes B; Georgousopoulou, Ekavi N; Georgiopoulos, Georgios A; Pitsavos, Christos; Chrysohoou, Christina; Skoumas, Ioannis; Ntertimani, Maria; Laskaris, Alexandros; Papadimitriou, Lampros; Tousoulis, Dimitrios; Stefanadis, Christodoulos

2015-01-01

The protective role of Mediterranean diet on cardiovascular disease (CVD) risk has been extensively discussed in the literature, but its incremental effect over the use of CVD risk reducing agents (such as hypolipidemic treatment) has rarely been evaluated. The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89 years). Adherence to Mediterranean diet was assessed using the MedDietScore (range 0-55) and statin use was recorded for all subjects. During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the ATTICA study (15% lost-to-follow-up) and CVD development was recorded. Adherence to Mediterranean diet (highest tertile) decreased CVD risk by 29.3% (Hazard Ratio (HR): 0.707, 95% Confidence Intervals (CI): 0.537-0.831) as compared with the lowest tertile, independently of statin use. Patients with hyperlipidemia on a statin that adopted unhealthy dietary habits (lowest tertile) had 75% increased CVD risk than normolipidemic subjects with healthy dietary habits (HR=1.75, 95%CI: 1.33-2.29). The addition of Mediterranean diet tertiles in the multivariable model reclassified 46.7% of the participants to CVD risk categories. Adherence to Mediterranean diet confers a considerable reduction in CVD risk, independently of gender, age, family history of CVD, diabetes mellitus, smoking status, hypertension and physical activity status. Therefore, CVD prevention strategies should involve the implementation of a Mediterranean diet in both the general population and patients on a statin.

Combining community participatory research with a randomized clinical trial: the Protecting the Hood Against Tobacco (PHAT) smoking cessation study.

PubMed

Froelicher, Erika Sivarajan; Doolan, Daniel; Yerger, Valerie B; McGruder, Carol O; Malone, Ruth E

2010-01-01

This article describes the process and results of a smoking cessation intervention randomized clinical trial (RCT) that was conducted as a community-based participatory research project. This RCT tested whether outcomes are improved by adding social justice and tobacco industry targeting messages to a smoking cessation program conducted among African American adults within a low-income community in San Francisco, California. This study provides lessons for future similar research projects that focus on urban low-income populations. Participants were randomly allocated to receive a smoking-cessation program (control group [CG]) or CG care plus tobacco industry and media (IAM) messages. Primary interventions were behavioral. At intake, participants reporting severe withdrawal or smoking > or = 25 cigarettes daily were offered free nicotine replacement therapy. Baseline data were from an in-person interview. Outcome measures included self-reported smoking status; validation of quitting was by salivary cotinine assays. Of 87 participants providing baseline data, 31% (27) did not join the RCT. Proportions quitting in the CG and IAM group were 11.5% and 13.6% at 6 months and 5.3% and 15.8% at 12 months, respectively. African Americans in underserved inner-city neighborhoods can be recruited into RCTs with community participatory approaches. Differences between the CG and IAM in proportions who quit were 2.1% and 10.5% at 6 and 12 months, respectively. More than 3 years with adequate funding, high staffing ratios, and intense outreach and follow-up schedules are needed to achieve recruitment and study goals. 2010 Elsevier Inc. All rights reserved.

Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases

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

Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl; Graeff, Alexander de; Monninkhof, Evelyn M.

Purpose: To study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response. Patients and Methods: The prospectively collected data of 956 patients with breast, prostate, and lung cancer within the Dutch Bone Metastasis Study were used. These patients, irradiated for painful bone metastases, rated pain, QoL, and overall health at baseline and weekly afterward for 12 weeks. Using generalized estimating equations analysis, the course of QoL was studied, adjusted for primary tumor. To identify predictive variables, proportional hazard analyses were performed, taking into account death asmore » a competing risk, and C-statistics were calculated for discriminative value. Results: In total, 722 patients (76%) responded to radiation therapy. During follow-up, responders had a better QoL in all domains compared with nonresponders. Patients with breast or prostate cancer had a better QoL than patients with lung cancer. In multivariate analysis, baseline predictors for a pain response were breast or prostate cancer as primary tumor, younger age, good performance status, absence of visceral metastases, and using opioids. The discriminative ability of the model was low (C-statistic: 0.56). Conclusions: Responding patients show a better QoL after radiation therapy for painful bone metastases than nonresponders. Our model did not have enough discriminative power to predict which patients are likely to respond to radiation therapy. Therefore, radiation therapy should be offered to all patients with painful bone metastases, aiming to decrease pain and improve QoL.« less

Charting ELSI's future course: lessons from the recent past

PubMed Central

Walker, Rebecca L.; Morrissey, Clair

2018-01-01

Purpose We sought to examine the ethical, legal, and social implications (ELSI) literature research and scholarship types, topics, and contributing community fields of training as a first step to charting the broader ELSI community’s future priorities and goals. Methods We categorized 642 articles and book chapters meeting inclusion criteria for content in both human genetics or genomics and ethics or ELSI during a 5-year period (2003–2008) according to research and scholarship types, topics, and the area of advanced training of the first-listed author. Research and scholarship type categories were developed and characterized through in-depth review of 95 randomly sampled publications from the larger group. Results There is a single dominant approach to ELSI, which focuses on ethical and other social issues “downstream” of advances in genomics, the contributors to which predominately have advanced training in medicine or science fields other than social science. A comparatively low percentage of publications primarily offer policy recommendations, and these are much more likely to be written by those with advanced training in law than is the case for the literature as a whole. Social science studies predominately employ qualitative methods and vary significantly with respect to the extent and types of recommendations offered. Two further types of ELSI research and scholarship offer alternative models for so-called “normative” work in this field. Conclusion Considering topics, training, and types of ELSI research and scholarship from the most recent past allows for a baseline perspective that is sorely needed in charting this field’s future course. PMID:22261758

Computerized physical activity training for persons with severe mental illness - experiences from a communal supported housing project.

PubMed

Gyllensten, Amanda Lundvik; Forsberg, Karl-Anton

2017-11-01

To study the effectiveness of Exergames in communal psychiatry for persons with severe mental illness, a randomized cluster study was performed. The hypothesis was to increase physical activity habits to improve somatic health. To identify factors promoting or impeding the use of the Exergames. Assessments of BMI, blood pressure, physical fitness, SF36, GAF and social interactions were studied at baseline and 10 months. An integrated methods design using content analysis of focus group interviews was integrated with a statistical analysis. Forty-three persons were randomized to the intervention and 30 to the control group. The qualitative interviews included 18 users, 11 staffs and one technical assistant. There were no significant between-group changes in physical activity behaviours or somatic health parameters after 10 months. Only 5% of the intervention group made systematic use of the intervention. Technological difficulties and staff attitudes were found to be barriers. The Exergames were perceived as technically complicated. The staff did not see playing TV games as important and negative attitudes were found. Exergames was not a successful intervention to increase physical activity behaviours in persons with severe mental illness in the community. Exergames and motivation for physical activity in this group is problematic. Implications for rehabilitation There are difficulties to change passive physical activity habits for persons with severe mental illness, living in sheltered housing conditions in the community due to negative symptoms with depression, low motivation and bad self -confidence. An exergame intervention was not successful in this group of persons. No somatic health benefits were found. Simple physical activities and offering different choices meeting different user needs should be offered. Ensuring user and staff engagement, good technical knowledge and good monitoring is a need for a successful intervention, if Exergames are offered as an alternative physical activity.

The effects of adding group-based lifestyle counselling to individual counselling on changes in plasma glucose levels in a randomized controlled trial: the Inter99 study.

PubMed

Lau, C; Vistisen, D; Toft, U; Tetens, I; Glümer, C; Pedersen, O; Jørgensen, T; Borch-Johnsen, K

2011-12-01

This study aimed to assess whether group-based lifestyle counselling offered to a high-risk population subgroup had any effect beyond individual multifactorial interventions on fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) changes. In a population-based study of 6784 participants, 4053 were determined to be at high risk based on a risk estimate of ischaemic heart disease or the presence of risk factors (smoking, hypertension, hypercholesterolaemia, obesity, impaired glucose tolerance). Of these subjects, 90% were randomized to high-intensity intervention (group A) and 10% to low-intensity intervention (group B). All participants went through health examinations, risk assessments and individual lifestyle counselling. Participants in group A were further offered group-based lifestyle counselling. The intervention was repeated after 1 and 3 years. A total of 2738 participants free of diabetes at baseline (1999-2001) and with at least one FPG and/or 2hPG measurement during 5 years of follow-up were included in the analyses. Differences in changes of plasma glucose between groups A and B were analyzed using multilevel linear regression. For FPG, crude 5-year changes were significantly different between the two groups (group A: -0.003 mmol/L vs group B: -0.079 mmol/L; P=0.0427). After adjusting for relevant confounders, no differences in FPG changes were observed (P=0.116). Also, no significant differences in the 5-year changes in 2hPG between the two groups were observed (group A: - 0.127 mmol/L vs group B: -0.201 mmol/L; P=0.546). Offering additional group-based intervention to a high-risk population subgroup had no clinical effects on changes in plasma glucose beyond those of individualized multifactorial interventions. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence.

PubMed

Mellgren, Anders; Wexner, Steven D; Coller, John A; Devroede, Ghislain; Lerew, Darin R; Madoff, Robert D; Hull, Tracy

2011-09-01

Sacral nerve stimulation is effective in the treatment of urinary incontinence and is currently under Food and Drug Administration review in the United States for fecal incontinence. Previous reports have focused primarily on short-term results of sacral nerve stimulation for fecal incontinence. The present study reports the long-term effectiveness and safety of sacral nerve stimulation for fecal incontinence in a large prospective multicenter study. Patients with fecal incontinent episodes more than twice per week were offered participation in this multicentered prospective trial. Patients showing ≥ 50% improvement during test stimulation were offered chronic implantation of the InterStim Therapy system (Medtronic; Minneapolis, MN). The aims of the current report were to provide 3-year follow-up data on patients from that study who underwent sacral nerve stimulation and were monitored under the rigors of an Food and Drug Administration-approved investigational protocol. One hundred thirty-three patients underwent test stimulation with a 90% success rate, of whom 120 (110 females) with a mean age of 60.5 years and a mean duration of fecal incontinence of 7 years received chronic implantation. Mean length of follow-up was 3.1 (range, 0.2-6.1) years, with 83 patients completing all or part of the 3-year follow-up assessment. At 3 years follow-up, 86% of patients (P < .0001) reported ≥ 50% reduction in the number of incontinent episodes per week compared with baseline and the number of incontinent episodes per week decreased from a mean of 9.4 at baseline to 1.7. Perfect continence was achieved in 40% of subjects. The therapy also improved the fecal incontinence severity index. Sacral nerve stimulation had a positive impact on the quality of life, as evidenced by significant improvements in all 4 scales of the Fecal Incontinence Quality of Life instrument at 12, 24, and 36 months of follow-up. The most common device- or therapy-related adverse events through the mean 36 months of follow-up included implant site pain (28%), paresthesia (15%), change in the sensation of stimulation (12%), and infection (10%). There were no reported unanticipated adverse device effects associated with sacral nerve stimulation therapy. Sacral nerve stimulation using InterStim Therapy is a safe and effective treatment for patients with fecal incontinence. These data support long-term safety and effectiveness to 36 months.

The effectiveness of a telephone-based tobacco cessation program offered as part of a worksite health promotion program.

PubMed

Terry, Paul E; Seaverson, Erin Ld; Staufacker, Michael J; Tanaka, Akiko

2011-06-01

Extensive research on tobacco cessation affirms the effectiveness of interventions, although the literature is more limited concerning the impact of programs designed specifically for the workplace. The present study examines the effectiveness of a telephone-based health coaching tobacco cessation program that was provided as part of worksite health promotion programs by 10 large employers. The participants were recruited based on their health risks as identified by health assessments, and the program was personalized to meet their individual needs and stages of change. The results indicate that at 12 months, health coaching program participants achieved a 32% quit rate, compared to 18% for nonparticipants. The quit rate was highest (44%) among program completers who were ready to change at baseline. These results suggest that a tobacco cessation program offered as part of a worksite health promotion program can be highly effective, especially for those who are ready to change. However, the relatively low annual participation rate may indicate that tobacco users remain among the most difficult to engage and to support in their efforts to complete programs. Therefore, implementing a variety of engagement strategies, such as policy changes, as well as social and financial incentives and penalties will most likely have a positive effect at the population level.

Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake

PubMed Central

Leone, Lucia A.; Haynes-Maslow, Lindsey; Ammerman, Alice S.

2016-01-01

We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2–3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of −1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P = .01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users. PMID:28529669

Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake.

PubMed

Leone, Lucia A; Haynes-Maslow, Lindsey; Ammerman, Alice S

2017-01-01

We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2-3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of -1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P = .01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users.

Living Emotions, Avoiding Emotions: Behavioral Investigation of the Regulation of Socially Driven Emotions

PubMed Central

Grecucci, Alessandro; Giorgetta, Cinzia; Bonini, Nicolao; Sanfey, Alan G.

2013-01-01

Emotion regulation is important for psychological well-being. Although it is known that alternative regulation strategies may have different emotional consequences, the effectiveness of such strategies for socially driven emotions remains unclear. In this study we investigated the efficacy of different forms of reappraisal on responses to the selfish and altruistic behavior of others in the Dictator Game. In Experiment 1, subjects mentalized the intentions of the other player in one condition, and took distance from the situation in the other. Emotion ratings were recorded after each offer. Compared with a baseline condition, mentalizing led subjects to experience their emotions more positively when receiving both selfish and altruistic proposals, whereas distancing decreased the valence when receiving altruistic offers, but did not affect the perception of selfish behavior. In Experiment 2, subjects played with both computer and human partners while reappraising the meaning of the player’s intentions (with a human partner) or the meaning of the situation (with a computer partner). Results showed that both contexts were effectively modulated by reappraisal, however a stronger effect was observed when the donor was a human partner, as compared to a computer partner. Taken together, these results demonstrate that socially driven emotions can be successfully modulated by reappraisal strategies that focus on the reinterpretation of others’ intentions. PMID:23349645

Instant detection and identification of concealed explosive-related compounds: Induced Stokes Raman versus infrared.

PubMed

Elbasuney, Sherif; El-Sherif, Ashraf F

2017-01-01

The instant detection of explosives and explosive-related compounds has become an urgent priority in recent years for homeland security and counter-terrorism applications. Modern techniques should offer enhancement in selectivity, sensitivity, and standoff distances. Miniaturisation, portability, and field-ruggedisation are crucial requirements. This study reports on instant and standoff identification of concealed explosive-related compounds using customized Raman technique. Stokes Raman spectra of common explosive-related compounds were generated and spectrally resolved to create characteristic finger print spectra. The scattered Raman emissions over the band 400:2000cm -1 were compared to infrared absorption using FTIR. It has been demonstrated that the two vibrational spectroscopic techniques were opposite and completing each other. Molecular vibrations with strong absorption in infrared (those involve strong change in dipole moments) induced weak signals in Raman and vice versa. The tailored Raman offered instant detection, high sensitivity, and standoff detection capabilities. Raman demonstrated characteristic fingerprint spectra with stable baseline and sharp intense peaks. Complete correlations of absorption/scattered signals to certain molecular vibrations were conducted to generate an entire spectroscopic profile of explosive-related compounds. This manuscript shades the light on Raman as one of the prevailing technologies for instantaneous detection of explosive-related compounds. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Smoking prevalence, determinants, knowledge, attitudes and habits among Buddhist monks in Lao PDR.

PubMed

Vanphanom, Sychareun; Phengsavanh, Alongkon; Hansana, Visanou; Menorath, Sing; Tomson, Tanja

2009-06-08

This cross-sectional study, the first of its kind, uses baseline data on smoking prevalence among Buddhist monks in Northern and Central provinces of Lao PDR. Between March and September 2006, 390 monks were interviewed, using questionnaires, to assess smoking prevalence including determinants, knowledge and attitudes. Data entry was performed with Epi-Info (version 6.04) and data analysis with SPSS version 11. Descriptive analysis was employed for all independent and dependent variables. Chi-square or Fisher's exact test were used for categorical variables to compare smoking status, knowledge, attitudes and province. Logistic regression was applied to identify determinants of smoking. Daily current smoking was 11.8%. Controlling for confounding variables, age at start of monkhood and the length of religious education were significant determinants of smoking. The majority of the monks 67.9% were in favor of the idea that offerings of cigarettes should be prohibited and that they should refuse the cigarettes offered to them (30.3%) but, in fact, 34.8% of the monks who were current smokers accepted cigarettes from the public. Some monks were smokers, whilst they, in fact, should be used as non-smoking role models. There was no anti-smoking policy in temples. This needs to be addressed when setting up smoke-free policies at temples.

Selectivity optimization in green chromatography by gradient stationary phase optimized selectivity liquid chromatography.

PubMed

Chen, Kai; Lynen, Frédéric; De Beer, Maarten; Hitzel, Laure; Ferguson, Paul; Hanna-Brown, Melissa; Sandra, Pat

2010-11-12

Stationary phase optimized selectivity liquid chromatography (SOSLC) is a promising technique to optimize the selectivity of a given separation by using a combination of different stationary phases. Previous work has shown that SOSLC offers excellent possibilities for method development, especially after the recent modification towards linear gradient SOSLC. The present work is aimed at developing and extending the SOSLC approach towards selectivity optimization and method development for green chromatography. Contrary to current LC practices, a green mobile phase (water/ethanol/formic acid) is hereby preselected and the composition of the stationary phase is optimized under a given gradient profile to obtain baseline resolution of all target solutes in the shortest possible analysis time. With the algorithm adapted to the high viscosity property of ethanol, the principle is illustrated with a fast, full baseline resolution for a randomly selected mixture composed of sulphonamides, xanthine alkaloids and steroids. Copyright © 2010 Elsevier B.V. All rights reserved.

Safety and efficacy of intravitreal bevacizumab followed by pegaptanib maintenance as a treatment regimen for age-related macular degeneration.

PubMed

Hughes, Mark S; Sang, Delia N

2006-01-01

Vascular endothelial growth factor (VEGF)-A, both necessary and sufficient in promoting ocular neovascularization, is an attractive therapeutic target. Combining nonselective and selective VEGF blockade may provide clinical benefit with minimal risks in the treatment of neovascular age-related macular degeneration (AMD). Twenty patients with all subtypes of neovascular AMD and a broad range of baseline vision were treated with intravitreal bevacizumab followed by pegaptanib sodium for 54 weeks. Visual acuity measurements, biomicroscopy, funduscopy, fluorescein angiography, optical coherence tomography, and adverse event assessments were performed. Mean visual acuity improved from approximately 20/200 at baseline to 20/80. All patients experienced an improvement in retinal thickness, ranging from -47 to -297 microns. Adverse events were limited to transient irritation or redness. No significant elevation in intraocular pressure occurred following either bevacizumab or pegaptanib injections. Nonselective VEGF blockade with bevacizumab induction and selective VEGF165 blockade with pegaptanib as maintenance therapies may offer clinically meaningful outcomes with acceptable safety profiles in patients with AMD.

Capabilities and prospects of the East Asia Very Long Baseline Interferometry Network

NASA Astrophysics Data System (ADS)

An, T.; Sohn, B. W.; Imai, H.

2018-02-01

The very long baseline interferometry (VLBI) technique offers angular resolutions superior to any other instruments at other wavelengths, enabling unique science applications of high-resolution imaging of radio sources and high-precision astrometry. The East Asia VLBI Network (EAVN) is a collaborative effort in the East Asian region. The EAVN currently consists of 21 telescopes with diverse equipment configurations and frequency setups, allowing flexible subarrays for specific science projects. The EAVN provides the highest resolution of 0.5 mas at 22 GHz, allowing the fine imaging of jets in active galactic nuclei, high-accuracy astrometry of masers and pulsars, and precise spacecraft positioning. The soon-to-be-operational Five-hundred-meter Aperture Spherical radio Telescope (FAST) will open a new era for the EAVN. This state-of-the-art VLBI array also provides easy access to and crucial training for the burgeoning Asian astronomical community. This Perspective summarizes the status, capabilities and prospects of the EAVN.

The effect of stress induction on working memory in patients with psychogenic nonepileptic seizures.

PubMed

Bakvis, Patricia; Spinhoven, Philip; Putman, Peter; Zitman, Frans G; Roelofs, Karin

2010-11-01

Although psychogenic nonepileptic seizures (PNES) are considered a stress-induced paroxysmal disintegration of cognitive functions, it remains unknown whether stress indeed impairs cognitive integrative functions, such as working memory (WM), in patients with PNES. An N-back task with emotional distracters (angry, happy, and neutral faces) was administered at baseline and after stress induction (Cold Pressor Test) to 19 patients with PNES and 20 matched healthy controls. At baseline, patients displayed increased WM interference for the facial distracters. After stress induction, group differences generalized to the no-distracter condition. Within patients, high cortisol stress responses were associated with larger stress-induced WM impairments in the no-distracter condition. These findings demonstrate that patients' cognitive integrative functions are impaired by social distracters and stress induction. Moreover, the stress- and cortisol-related generalization of the relative WM impairments offers a promising experimental model for the characteristic paroxysmal disintegration of attentional and mnemonic functions in patients with PNES associated with stress. Copyright © 2010 Elsevier Inc. All rights reserved.

Segmented beryllium target for a 2 MW super beam facility

DOE PAGES

Davenne, T.; Caretta, O.; Densham, C.; ...

2015-09-14

The Long Baseline Neutrino Facility (LBNF, formerly the Long Baseline Neutrino Experiment) is under design as a next generation neutrino oscillation experiment, with primary objectives to search for CP violation in the leptonic sector, to determine the neutrino mass hierarchy and to provide a precise measurement of θ 23. The facility will generate a neutrino beam at Fermilab by the interaction of a proton beam with a target material. At the ultimate anticipated proton beam power of 2.3 MW the target material must dissipate a heat load of between 10 and 25 kW depending on the target size. This paper presents amore » target concept based on an array of spheres and compares it to a cylindrical monolithic target such as that which currently operates at the T2K facility. Thus simulation results show that the proposed technology offers efficient cooling and lower stresses whilst delivering a neutrino production comparable with that of a conventional solid cylindrical target.« less

Innovation in weight loss programs: a 3-dimensional virtual-world approach.

PubMed

Johnston, Jeanne D; Massey, Anne P; Devaneaux, Celeste A

2012-09-20

The rising trend in obesity calls for innovative weight loss programs. While behavioral-based face-to-face programs have proven to be the most effective, they are expensive and often inaccessible. Internet or Web-based weight loss programs have expanded reach but may lack qualities critical to weight loss and maintenance such as human interaction, social support, and engagement. In contrast to Web technologies, virtual reality technologies offer unique affordances as a behavioral intervention by directly supporting engagement and active learning. To explore the effectiveness of a virtual-world weight loss program relative to weight loss and behavior change. We collected data from overweight people (N = 54) participating in a face-to-face or a virtual-world weight loss program. Weight, body mass index (BMI), percentage weight change, and health behaviors (ie, weight loss self-efficacy, physical activity self-efficacy, self-reported physical activity, and fruit and vegetable consumption) were assessed before and after the 12-week program. Repeated measures analysis was used to detect differences between groups and across time. A total of 54 participants with a BMI of 32 (SD 6.05) kg/m(2)enrolled in the study, with a 13% dropout rate for each group (virtual world group: 5/38; face-to-face group: 3/24). Both groups lost a significant amount of weight (virtual world: 3.9 kg, P < .001; face-to-face: 2.8 kg, P = .002); however, no significant differences between groups were detected (P = .29). Compared with baseline, the virtual-world group lost an average of 4.2%, with 33% (11/33) of the participants losing a clinically significant (≥5%) amount of baseline weight. The face-to-face group lost an average of 3.0% of their baseline weight, with 29% (6/21) losing a clinically significant amount. We detected a significant group × time interaction for moderate (P = .006) and vigorous physical activity (P = .008), physical activity self-efficacy (P = .04), fruit and vegetable consumption (P = .007), and weight loss self-efficacy (P < .001). Post hoc paired t tests indicated significant improvements across all of the variables for the virtual-world group. Overall, these results offer positive early evidence that a virtual-world-based weight loss program can be as effective as a face-to-face one relative to biometric changes. In addition, our results suggest that a virtual world may be a more effective platform to influence meaningful behavioral changes and improve self-efficacy.

Innovation in Weight Loss Programs: A 3-Dimensional Virtual-World Approach

PubMed Central

Massey, Anne P; DeVaneaux, Celeste A

2012-01-01

Background The rising trend in obesity calls for innovative weight loss programs. While behavioral-based face-to-face programs have proven to be the most effective, they are expensive and often inaccessible. Internet or Web-based weight loss programs have expanded reach but may lack qualities critical to weight loss and maintenance such as human interaction, social support, and engagement. In contrast to Web technologies, virtual reality technologies offer unique affordances as a behavioral intervention by directly supporting engagement and active learning. Objective To explore the effectiveness of a virtual-world weight loss program relative to weight loss and behavior change. Methods We collected data from overweight people (N = 54) participating in a face-to-face or a virtual-world weight loss program. Weight, body mass index (BMI), percentage weight change, and health behaviors (ie, weight loss self-efficacy, physical activity self-efficacy, self-reported physical activity, and fruit and vegetable consumption) were assessed before and after the 12-week program. Repeated measures analysis was used to detect differences between groups and across time. Results A total of 54 participants with a BMI of 32 (SD 6.05) kg/m2 enrolled in the study, with a 13% dropout rate for each group (virtual world group: 5/38; face-to-face group: 3/24). Both groups lost a significant amount of weight (virtual world: 3.9 kg, P < .001; face-to-face: 2.8 kg, P = .002); however, no significant differences between groups were detected (P = .29). Compared with baseline, the virtual-world group lost an average of 4.2%, with 33% (11/33) of the participants losing a clinically significant (≥5%) amount of baseline weight. The face-to-face group lost an average of 3.0% of their baseline weight, with 29% (6/21) losing a clinically significant amount. We detected a significant group × time interaction for moderate (P = .006) and vigorous physical activity (P = .008), physical activity self-efficacy (P = .04), fruit and vegetable consumption (P = .007), and weight loss self-efficacy (P < .001). Post hoc paired t tests indicated significant improvements across all of the variables for the virtual-world group. Conclusions Overall, these results offer positive early evidence that a virtual-world-based weight loss program can be as effective as a face-to-face one relative to biometric changes. In addition, our results suggest that a virtual world may be a more effective platform to influence meaningful behavioral changes and improve self-efficacy. PMID:22995535

The effects of alcohol on the nonhuman primate brain: a network science approach to neuroimaging.

PubMed

Telesford, Qawi K; Laurienti, Paul J; Friedman, David P; Kraft, Robert A; Daunais, James B

2013-11-01

Animal studies have long been an important tool for basic research as they offer a degree of control often lacking in clinical studies. Of particular value is the use of nonhuman primates (NHPs) for neuroimaging studies. Currently, studies have been published using functional magnetic resonance imaging (fMRI) to understand the default-mode network in the NHP brain. Network science provides an alternative approach to neuroimaging allowing for evaluation of whole-brain connectivity. In this study, we used network science to build NHP brain networks from fMRI data to understand the basic functional organization of the NHP brain. We also explored how the brain network is affected following an acute ethanol (EtOH) pharmacological challenge. Baseline resting-state fMRI was acquired in an adult male rhesus macaque (n = 1) and a cohort of vervet monkeys (n = 10). A follow-up scan was conducted in the rhesus macaque to assess network variability and to assess the effects of an acute EtOH challenge on the brain network. The most connected regions in the resting-state networks were similar across species and matched regions identified as the default-mode network in previous NHP fMRI studies. Under an acute EtOH challenge, the functional organization of the brain was significantly impacted. Network science offers a great opportunity to understand the brain as a complex system and how pharmacological conditions can affect the system globally. These models are sensitive to changes in the brain and may prove to be a valuable tool in long-term studies on alcohol exposure. Copyright © 2013 by the Research Society on Alcoholism.

A cohort study examining headaches among veterans of Iraq and Afghanistan wars: Associations with traumatic brain injury, PTSD, and depression.

PubMed

Jaramillo, Carlos A; Eapen, Blessen C; McGeary, Cindy A; McGeary, Donald D; Robinson, Jedediah; Amuan, Megan; Pugh, Mary Jo

2016-03-01

To describe the prevalence and persistence of headache and associated conditions in an inception cohort of U.S. veterans of Iraq and Afghanistan wars. Iraq and Afghanistan war veterans (IAV) suffer from persistent and difficult-to-treat headaches that have been found to co-occur with traumatic brain injury (TBI) and other deployment related comorbidities. This longitudinal retrospective cohort study used data from the national Veterans Health Administration (VA) data repository for IAV who first received VA care in 2008 (baseline) and also received care each year in 2009, 2010, and 2011. We used ICD-9-CM codes, to identify those treated for headache each year (2008-2011). Individuals with headache diagnosed each year were classified as having persistent headache. We also identified comorbidities that may be associated with baseline headache using algorithms validated for use with ICD-9-CM codes. Comorbidities included TBI, posttraumatic stress disorder (PTSD), depression, and conditions associated with these diagnoses (anxiety, memory/attention/cognition, neck pain, tinnitus/hyperacusis, photosensitivity/photo blurring, insomnia, malaise/fatigue, and vertigo/dizziness). Multivariable logistic regression analysis was used to determine characteristics associated with baseline headache as well as those associated with persistent headache. Among all IAV, 38,426 received their first year of VA care in 2008 and had care each year 2009-2011: 13.7% of these were diagnosed with headache in 2008. Veterans diagnosed with headache in 2008 were more likely than those without a headache diagnosis to also have a diagnosis of TBI alone (adjusted odds ratios [AOR] 6.75; 95% CI 5.79-7.86), TBI + depression (AOR 7.09; 95% CI 5.23-9.66), TBI + PTSD (AOR 10.16; 95% CI 8.96-11.53), TBI + PTSD + depression (AOR 9.40; 95% CI 8.12-10.09), and neck pain (AOR 2.44; 95% CI 2.14-2.77). Among those with headache diagnosis in 2008, 24.3% had a headache diagnosis each of the subsequent years of care (persistent headache). While diagnoses of TBI, PTSD, and/or depression at baseline were not associated with headache persistence, persistence was more likely for individuals with baseline tinnitus/hyperacusis (AOR 1.21; 95% CI 1.02-1.45), insomnia (AOR 1.19; 95% CI 1.02-1.39), and vertigo/dizziness (AOR 1.83; 95% CI 1.30-2.57). Our results indicate that TBI alone is a strong predictor of headache in the first year of VA care among IAV and that comorbid psychiatric comorbidities increase the likelihood of headache among individuals with TBI. However, among those with baseline headache, only tinnitus, insomnia, and vertigo were baseline clinical predictors of headache persistence. These results suggest that attention to other symptoms and conditions early in the diagnosis and treatment of headaches may be important for understanding prognosis. These comorbidities offer potential targets for intervention strategies that may help address postdeployment headaches. © 2015 American Headache Society.

Should Studies of Diabetes Treatment Stratification Correct for Baseline HbA1c?

PubMed Central

Jones, Angus G.; Lonergan, Mike; Henley, William E.; Pearson, Ewan R.; Hattersley, Andrew T.; Shields, Beverley M.

2016-01-01

Aims Baseline HbA1c is a major predictor of response to glucose lowering therapy and therefore a potential confounder in studies aiming to identify other predictors. However, baseline adjustment may introduce error if the association between baseline HbA1c and response is substantially due to measurement error and regression to the mean. We aimed to determine whether studies of predictors of response should adjust for baseline HbA1c. Methods We assessed the relationship between baseline HbA1c and glycaemic response in 257 participants treated with GLP-1R agonists and assessed whether it reflected measurement error and regression to the mean using duplicate ‘pre-baseline’ HbA1c measurements not included in the response variable. In this cohort and an additional 2659 participants treated with sulfonylureas we assessed the relationship between covariates associated with baseline HbA1c and treatment response with and without baseline adjustment, and with a bias correction using pre-baseline HbA1c to adjust for the effects of error in baseline HbA1c. Results Baseline HbA1c was a major predictor of response (R2 = 0.19,β = -0.44,p<0.001).The association between pre-baseline and response was similar suggesting the greater response at higher baseline HbA1cs is not mainly due to measurement error and subsequent regression to the mean. In unadjusted analysis in both cohorts, factors associated with baseline HbA1c were associated with response, however these associations were weak or absent after adjustment for baseline HbA1c. Bias correction did not substantially alter associations. Conclusions Adjustment for the baseline HbA1c measurement is a simple and effective way to reduce bias in studies of predictors of response to glucose lowering therapy. PMID:27050911