Cushing's syndrome: Stepwise approach to diagnosis

PubMed Central

Lila, Anurag R.; Sarathi, Vijaya; Jagtap, Varsha S.; Bandgar, Tushar; Menon, Padmavathy; Shah, Nalini S.

2011-01-01

The projected prevalence of Cushing's syndrome (CS) inclusive of subclinical cases in the adult population ranges from 0.2–2% and it may no longer be considered as an orphan disease (2–3 cases/million/year). The recognition of CS by physicians is important for early diagnosis and treatment. Late-night salivary cortisol, dexamethasone suppressiontesti, or 24-h urine free cortisol are good screening tests. Positively screened cases need stepwise evaluation by an endocrinologist. This paper discusses the importance of screening for CS and suggests a stepwise diagnostic approach to a case of suspected hypercortisolism. PMID:22145134

Adolescent substance involvement use and abuse.

PubMed

Monasterio, Erica B

2014-09-01

Substance use in adolescence is common, but not all use indicates a substance use disorder. The primary care provider has an essential role in screening for substance involvement, assessing the level of substance use and its impact on function, and engaging in a brief intervention to encourage and support behavioral change related to substance use. This article summarizes the literature on adolescent vulnerability to substance use disorders and their impact on adolescent health and well-being. Practical concrete suggestions for approaches to screening, brief interventions, and referral to treatment provide a stepwise approach to adolescent substance use assessment and intervention. Copyright © 2014 Elsevier Inc. All rights reserved.

Discrimination of Geographical Origin of Asian Garlic Using Isotopic and Chemical Datasets under Stepwise Principal Component Analysis.

PubMed

Liu, Tsang-Sen; Lin, Jhen-Nan; Peng, Tsung-Ren

2018-01-16

Isotopic compositions of δ 2 H, δ 18 O, δ 13 C, and δ 15 N and concentrations of 22 trace elements from garlic samples were analyzed and processed with stepwise principal component analysis (PCA) to discriminate garlic's country of origin among Asian regions including South Korea, Vietnam, Taiwan, and China. Results indicate that there is no single trace-element concentration or isotopic composition that can accomplish the study's purpose and the stepwise PCA approach proposed does allow for discrimination between countries on a regional basis. Sequentially, Step-1 PCA distinguishes garlic's country of origin among Taiwanese, South Korean, and Vietnamese samples; Step-2 PCA discriminates Chinese garlic from South Korean garlic; and Step-3 and Step-4 PCA, Chinese garlic from Vietnamese garlic. In model tests, countries of origin of all audit samples were correctly discriminated by stepwise PCA. Consequently, this study demonstrates that stepwise PCA as applied is a simple and effective approach to discriminating country of origin among Asian garlics. © 2018 American Academy of Forensic Sciences.

Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces.

PubMed

Pantanowitz, Liron; Labranche, Wayne; Lareau, William

2010-05-26

Clinical laboratory outreach business is changing as more physician practices adopt an electronic medical record (EMR). Physician connectivity with the laboratory information system (LIS) is consequently becoming more important. However, there are no reports available to assist the informatician with establishing and maintaining outreach LIS-EMR connectivity. A four-stage scheme is presented that was successfully employed to establish unidirectional and bidirectional interfaces with multiple physician EMRs. This approach involves planning (step 1), followed by interface building (step 2) with subsequent testing (step 3), and finally ongoing maintenance (step 4). The role of organized project management, software as a service (SAAS), and alternate solutions for outreach connectivity are discussed.

Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces

PubMed Central

Pantanowitz, Liron; LaBranche, Wayne; Lareau, William

2010-01-01

Clinical laboratory outreach business is changing as more physician practices adopt an electronic medical record (EMR). Physician connectivity with the laboratory information system (LIS) is consequently becoming more important. However, there are no reports available to assist the informatician with establishing and maintaining outreach LIS–EMR connectivity. A four-stage scheme is presented that was successfully employed to establish unidirectional and bidirectional interfaces with multiple physician EMRs. This approach involves planning (step 1), followed by interface building (step 2) with subsequent testing (step 3), and finally ongoing maintenance (step 4). The role of organized project management, software as a service (SAAS), and alternate solutions for outreach connectivity are discussed. PMID:20805958

Dealing with office emergencies. Stepwise approach for family physicians.

PubMed Central

Sempowski, Ian P.; Brison, Robert J.

2002-01-01

OBJECTIVE: To develop a simple stepwise approach to initial management of emergencies in family physicians' offices; to review how to prepare health care teams and equipment; and to illustrate a general approach to three of the most common office emergencies. QUALITY OF EVIDENCE: MEDLINE was searched from January 1980 to December 2001. Articles were selected based on their clinical relevance, quality of evidence, and date of publication. We reviewed American family medicine, pediatric, dental, and dermatologic articles, but found that the area has not been well studied from a Canadian family medicine perspective. Consensus statements by specialty professional groups were used to identify accepted emergency medical treatments. MAIN MESSAGE: Family medicine offices are frequently poorly equipped and inadequately prepared to deal with emergencies. Straightforward emergency response plans can be designed and tailored to an office's risk profile. A systematic team approach and effective use of skills, support staff, and equipment is important. The general approach can be modified for specific patients or conditions. CONCLUSION: Family physicians can plan ahead and use a team approach to develop a simple stepwise response to emergency situations in the office. PMID:12371305

A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention.

PubMed

Sacks, G; Swinburn, B; Kraak, V; Downs, S; Walker, C; Barquera, S; Friel, S; Hawkes, C; Kelly, B; Kumanyika, S; L'Abbé, M; Lee, A; Lobstein, T; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Neal, B; Rayner, M; Sanders, D; Snowdon, W; Vandevijvere, S

2013-10-01

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third ('optimal') step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Epilepsy and psychosis: a practical approach.

PubMed

Maguire, Melissa; Singh, Jasvinder; Marson, Anthony

2018-04-01

The psychoses of epilepsy can be classified according to their temporal relationship with seizures, namely as ictal, postictal and interictal psychosis. Interictal psychosis is the most common and may resemble schizophrenia. They can be challenging to diagnose and to manage, especially given the perception that some antipsychotic drugs may exacerbate seizures, while some antiepileptic medications may worsen psychosis. The current uncertainty around their best management means that some patients may not receive appropriate care. We propose a practical stepwise approach to managing psychosis in patients with epilepsy, summarising the key clinical features. We provide a framework for diagnosis, investigation and management of psychosis in the acute and long term. We also summarise the available evidence on the risk of psychosis with current antiepileptic drugs and the risk of seizures with antipsychotic drugs. © 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.

Cost-effectiveness modelling in diagnostic imaging: a stepwise approach.

PubMed

Sailer, Anna M; van Zwam, Wim H; Wildberger, Joachim E; Grutters, Janneke P C

2015-12-01

Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this article we provide a comprehensive framework of direct and indirect effects that should be considered for CEA in DI, suitable for all imaging modalities. We describe and explain the methodology of decision analytic modelling in six steps aiming to transfer theory of CEA to clinical research by demonstrating key principles of CEA in a practical approach. We thereby provide radiologists with an introduction to the tools necessary to perform and interpret CEA as part of their research and clinical practice. • DI influences medical decision making, affecting both costs and health outcome. • This article provides a comprehensive framework for CEA in DI. • A six-step methodology for conducting and interpreting cost-effectiveness modelling is proposed.

Practical Guide for Ascidian Microinjection: Phallusia mammillata.

PubMed

Yasuo, Hitoyoshi; McDougall, Alex

2018-01-01

Phallusia mammillata has recently emerged as a new ascidian model. Its unique characteristics, including the optical transparency of eggs and embryos and efficient translation of exogenously introduced mRNA in eggs, make the Phallusia system suitable for fluorescent protein (FP)-based imaging approaches. In addition, genomic and transcriptomic resources are readily available for this ascidian species, facilitating functional gene studies. Microinjection is probably the most versatile technique for introducing exogenous molecules such as plasmids, mRNAs, and proteins into ascidian eggs/embryos. However, it is not practiced widely within the community; presumably, because the system is rather laborious to set up and it requires practice. Here, we describe in as much detail as possible two microinjection methods that we use daily in the laboratory: one based on an inverted microscope and the other on a stereomicroscope. Along the stepwise description of system setup and injection procedure, we provide practical tips in the hope that this chapter might be a useful guide for introducing or improving a microinjection setup.

Stepwise detection of recombination breakpoints in sequence alignments.

PubMed

Graham, Jinko; McNeney, Brad; Seillier-Moiseiwitsch, Françoise

2005-03-01

We propose a stepwise approach to identify recombination breakpoints in a sequence alignment. The approach can be applied to any recombination detection method that uses a permutation test and provides estimates of breakpoints. We illustrate the approach by analyses of a simulated dataset and alignments of real data from HIV-1 and human chromosome 7. The presented simulation results compare the statistical properties of one-step and two-step procedures. More breakpoints are found with a two-step procedure than with a single application of a given method, particularly for higher recombination rates. At higher recombination rates, the additional breakpoints were located at the cost of only a slight increase in the number of falsely declared breakpoints. However, a large proportion of breakpoints still go undetected. A makefile and C source code for phylogenetic profiling and the maximum chi2 method, tested with the gcc compiler on Linux and WindowsXP, are available at http://stat-db.stat.sfu.ca/stepwise/ jgraham@stat.sfu.ca.

Improving prediction of metal uptake by Chinese cabbage (Brassica pekinensis L.) based on a soil-plant stepwise analysis.

PubMed

Zhang, Sha; Song, Jing; Gao, Hui; Zhang, Qiang; Lv, Ming-Chao; Wang, Shuang; Liu, Gan; Pan, Yun-Yu; Christie, Peter; Sun, Wenjie

2016-11-01

It is crucial to develop predictive soil-plant transfer (SPT) models to derive the threshold values of toxic metals in contaminated arable soils. The present study was designed to examine the heavy metal uptake pattern and to improve the prediction of metal uptake by Chinese cabbage grown in agricultural soils with multiple contamination by Cd, Cu, Ni, Pb, and Zn. Pot experiments were performed with 25 historically contaminated soils to determine metal accumulation in different parts of Chinese cabbage. Different soil bioavailable metal fractions were determined using different extractants (0.43M HNO3, 0.01M CaCl2, 0.005M DTPA, and 0.01M LWMOAs), soil moisture samplers, and diffusive gradients in thin films (DGT), and the fractions were compared with shoot metal uptake using both direct and stepwise multiple regression analysis. The stepwise approach significantly improved the prediction of metal uptake by cabbage over the direct approach. Strongly pH dependent or nonlinear relationships were found for the adsorption of root surfaces and in root-shoot uptake processes. Metals were linearly translocated from the root surface to the root. Therefore, the nonlinearity of uptake pattern is an important explanation for the inadequacy of the direct approach in some cases. The stepwise approach offers an alternative and robust method to study the pattern of metal uptake by Chinese cabbage (Brassica pekinensis L.). Copyright © 2016. Published by Elsevier B.V.

Improving meat quality of organic pork through post mortem handling of carcasses: an innovative approach.

PubMed

Therkildsen, Margrethe; Kristensen, Lars; Kyed, Sybille; Oksbjerg, Niels

2012-06-01

This study was conducted to examine the best combination of post mortem chilling, suspension and ageing in order to optimize tenderness of organic pork at slaughter, which may be tougher than conventionally produced pork, because of lower daily gain. Combinations of stepwise chilling with a holding period of 6h at 10°C or traditional blast tunnel chilling, suspension in the pelvic bone or Achilles Tendon and ageing 2 or 4 days post mortem were tested. Stepwise chilling and ageing improved tenderness of the loin, and the effects were additive, whereas pelvic suspension was less effective in texture improvements, and non-additive to stepwise chilling. Stepwise chilling improved tenderness to a similar degree as can be obtained within 2-4 days of extended ageing, however, the minimum temperature during the holding period seems to be crucial in order to obtain a positive effect of stepwise chilling, and it should be above 7.5°C. Copyright © 2011 Elsevier Ltd. All rights reserved.

When to Use Methadone for pain: A Case-Based Approach.

PubMed

Palat, Gayatri; Vallath, Nandini; Chary, Srini; Broderick, Ann

2018-01-01

The case studies are written in this article to illustrate how methadone might be used for pain in the Indian context. These cases might be used for discussion in a multidisciplinary team, or for individual study. It is important to understand that pain requires a multidisciplinary approach as opioids will assist only with physical, i.e. neuropathic and nociceptive pain, but not emotional, spiritual, or relational pain or the pain of immobility. The social determinants of pain were included to demonstrate how emotional, relational, and psychological dimensions of pain amplify the physical aspects of pain. The case studies follow a practical step-wise approach to pain while undergoing cancer treatment, pain toward the end-of-life and needing longer acting opioid. Methadone in children, and methadone in conditions of opioid toxicity or where there is a need for absorption in the proximal intestine cases are included.

Neuropsychological assessment in collaborative Parkinson’s disease research

PubMed Central

Watson, G. Stennis; Cholerton, Brenna A.; Gross, Rachel G.; Weintraub, Daniel; Zabetian, Cyrus P.; Trojanowski, John Q.; Montine, Thomas J.; Siderowf, Andrew; Leverenz, James B.

2012-01-01

Cognitive impairment (CI) and behavioral disturbances can be the earliest symptoms of Parkinson’s disease (PD), ultimately afflict the vast majority of PD patients, and increase caregiver burden. Our two Morris K. Udall Centers of Excellence for Parkinson’s Disease Research were supported by the National Institute of Neurological Disorders and Stroke (NINDS) to recommend a comprehensive yet practical approach to cognitive and behavioral assessment to fuel collaborative research. We recommend a step-wise approach with two levels of standardized evaluation to establish a common battery, as well as an alternative testing recommendation for severely impaired subjects, and review supplemental tests that may be useful in specific research settings. Our flexible approach may be applied to studies with varying emphasis on cognition and behavior, does not place undue burden on participants or resources, and has a high degree of compatibility with existing test batteries to promote collaboration. PMID:23164549

What to do When Scalar Invariance Fails: The Extended Alignment Method for Multi-Group Factor Analysis Comparison of Latent Means Across Many Groups.

PubMed

Marsh, Herbert W; Guo, Jiesi; Parker, Philip D; Nagengast, Benjamin; Asparouhov, Tihomir; Muthén, Bengt; Dicke, Theresa

2017-01-12

Scalar invariance is an unachievable ideal that in practice can only be approximated; often using potentially questionable approaches such as partial invariance based on a stepwise selection of parameter estimates with large modification indices. Study 1 demonstrates an extension of the power and flexibility of the alignment approach for comparing latent factor means in large-scale studies (30 OECD countries, 8 factors, 44 items, N = 249,840), for which scalar invariance is typically not supported in the traditional confirmatory factor analysis approach to measurement invariance (CFA-MI). Importantly, we introduce an alignment-within-CFA (AwC) approach, transforming alignment from a largely exploratory tool into a confirmatory tool, and enabling analyses that previously have not been possible with alignment (testing the invariance of uniquenesses and factor variances/covariances; multiple-group MIMIC models; contrasts on latent means) and structural equation models more generally. Specifically, it also allowed a comparison of gender differences in a 30-country MIMIC AwC (i.e., a SEM with gender as a covariate) and a 60-group AwC CFA (i.e., 30 countries × 2 genders) analysis. Study 2, a simulation study following up issues raised in Study 1, showed that latent means were more accurately estimated with alignment than with the scalar CFA-MI, and particularly with partial invariance scalar models based on the heavily criticized stepwise selection strategy. In summary, alignment augmented by AwC provides applied researchers from diverse disciplines considerable flexibility to address substantively important issues when the traditional CFA-MI scalar model does not fit the data. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Towards a Best Practice Approach in PBPK Modeling: Case Example of Developing a Unified Efavirenz Model Accounting for Induction of CYPs 3A4 and 2B6

PubMed Central

Ke, A; Barter, Z; Rowland‐Yeo, K

2016-01-01

In this study, we present efavirenz physiologically based pharmacokinetic (PBPK) model development as an example of our best practice approach that uses a stepwise approach to verify the different components of the model. First, a PBPK model for efavirenz incorporating in vitro and clinical pharmacokinetic (PK) data was developed to predict exposure following multiple dosing (600 mg q.d.). Alfentanil i.v. and p.o. drug‐drug interaction (DDI) studies were utilized to evaluate and refine the CYP3A4 induction component in the liver and gut. Next, independent DDI studies with substrates of CYP3A4 (maraviroc, atazanavir, and clarithromycin) and CYP2B6 (bupropion) verified the induction components of the model (area under the curve [AUC] ratios within 1.0–1.7‐fold of observed). Finally, the model was refined to incorporate the fractional contribution of enzymes, including CYP2B6, propagating autoinduction into the model (Racc 1.7 vs. 1.7 observed). This validated mechanistic model can now be applied in clinical pharmacology studies to prospectively assess both the victim and perpetrator DDI potential of efavirenz. PMID:27435752

Development and Climate Change: A Mainstreaming Approach for Assessing Economic, Social, and Environmental Impacts of Adaptation Measures

NASA Astrophysics Data System (ADS)

Halsnæs, Kirsten; Trærup, Sara

2009-05-01

The paper introduces the so-called climate change mainstreaming approach, where vulnerability and adaptation measures are assessed in the context of general development policy objectives. The approach is based on the application of a limited set of indicators. These indicators are selected as representatives of focal development policy objectives, and a stepwise approach for addressing climate change impacts, development linkages, and the economic, social and environmental dimensions related to vulnerability and adaptation are introduced. Within this context it is illustrated using three case studies how development policy indicators in practice can be used to assess climate change impacts and adaptation measures based on three case studies, namely a road project in flood prone areas of Mozambique, rainwater harvesting in the agricultural sector in Tanzania and malaria protection in Tanzania. The conclusions of the paper confirm that climate risks can be reduced at relatively low costs, but the uncertainty is still remaining about some of the wider development impacts of implementing climate change adaptation measures.

Development and climate change: a mainstreaming approach for assessing economic, social, and environmental impacts of adaptation measures.

PubMed

Halsnaes, Kirsten; Traerup, Sara

2009-05-01

The paper introduces the so-called climate change mainstreaming approach, where vulnerability and adaptation measures are assessed in the context of general development policy objectives. The approach is based on the application of a limited set of indicators. These indicators are selected as representatives of focal development policy objectives, and a stepwise approach for addressing climate change impacts, development linkages, and the economic, social and environmental dimensions related to vulnerability and adaptation are introduced. Within this context it is illustrated using three case studies how development policy indicators in practice can be used to assess climate change impacts and adaptation measures based on three case studies, namely a road project in flood prone areas of Mozambique, rainwater harvesting in the agricultural sector in Tanzania and malaria protection in Tanzania. The conclusions of the paper confirm that climate risks can be reduced at relatively low costs, but the uncertainty is still remaining about some of the wider development impacts of implementing climate change adaptation measures.

Validation of multisource electronic health record data: an application to blood transfusion data.

PubMed

Hoeven, Loan R van; Bruijne, Martine C de; Kemper, Peter F; Koopman, Maria M W; Rondeel, Jan M M; Leyte, Anja; Koffijberg, Hendrik; Janssen, Mart P; Roes, Kit C B

2017-07-14

Although data from electronic health records (EHR) are often used for research purposes, systematic validation of these data prior to their use is not standard practice. Existing validation frameworks discuss validity concepts without translating these into practical implementation steps or addressing the potential influence of linking multiple sources. Therefore we developed a practical approach for validating routinely collected data from multiple sources and to apply it to a blood transfusion data warehouse to evaluate the usability in practice. The approach consists of identifying existing validation frameworks for EHR data or linked data, selecting validity concepts from these frameworks and establishing quantifiable validity outcomes for each concept. The approach distinguishes external validation concepts (e.g. concordance with external reports, previous literature and expert feedback) and internal consistency concepts which use expected associations within the dataset itself (e.g. completeness, uniformity and plausibility). In an example case, the selected concepts were applied to a transfusion dataset and specified in more detail. Application of the approach to a transfusion dataset resulted in a structured overview of data validity aspects. This allowed improvement of these aspects through further processing of the data and in some cases adjustment of the data extraction. For example, the proportion of transfused products that could not be linked to the corresponding issued products initially was 2.2% but could be improved by adjusting data extraction criteria to 0.17%. This stepwise approach for validating linked multisource data provides a basis for evaluating data quality and enhancing interpretation. When the process of data validation is adopted more broadly, this contributes to increased transparency and greater reliability of research based on routinely collected electronic health records.

Approaches to the simulation of unconfined flow and perched groundwater flow in MODFLOW

USGS Publications Warehouse

Bedekar, Vivek; Niswonger, Richard G.; Kipp, Kenneth; Panday, Sorab; Tonkin, Matthew

2012-01-01

Various approaches have been proposed to manage the nonlinearities associated with the unconfined flow equation and to simulate perched groundwater conditions using the MODFLOW family of codes. The approaches comprise a variety of numerical techniques to prevent dry cells from becoming inactive and to achieve a stable solution focused on formulations of the unconfined, partially-saturated, groundwater flow equation. Keeping dry cells active avoids a discontinuous head solution which in turn improves the effectiveness of parameter estimation software that relies on continuous derivatives. Most approaches implement an upstream weighting of intercell conductance and Newton-Raphson linearization to obtain robust convergence. In this study, several published approaches were implemented in a stepwise manner into MODFLOW for comparative analysis. First, a comparative analysis of the methods is presented using synthetic examples that create convergence issues or difficulty in handling perched conditions with the more common dry-cell simulation capabilities of MODFLOW. Next, a field-scale three-dimensional simulation is presented to examine the stability and performance of the discussed approaches in larger, practical, simulation settings.

Assimilating Traditional Healing Into Preventive Medicine Residency Curriculum.

PubMed

Kesler, Denece O; Hopkins, L Olivia; Torres, Eliseo; Prasad, Arti

2015-11-01

Comprehensive cultural competency includes knowledge and awareness of culturally based healing and wellness practices. Healthcare providers should be aware of the individual patient's beliefs, culture, and use of culturally based health practices because patients may adopt such practices for general wellness or as adjunct therapies without the benefit of discussion with their healthcare provider. This article describes the culturally based traditional healing curriculum that has been implemented in the University of New Mexico Public Health and General Preventive Medicine Residency Program in order to fulfill this knowledge necessity. Curricular elements were added in a stepwise manner starting in 2011, with the full content as described implemented starting in 2013. Data were collected annually with evaluation of the full curriculum occurring in 2015. New Mexico has a diverse population base that includes predominantly Hispanic and Native American cultures, making the inclusion of curriculum regarding traditional healing practices very pertinent. Residents at the University of New Mexico were educated through several curricular components about topics such as Curanderismo, the art of Mexican Folk Healing. An innovative approach was used, with a compendium of training methods that included learning directly from traditional healers and participation in healing practices. The incorporation of this residency curriculum resulted in a means to produce physicians well trained in approaching patient care and population health with knowledge of culturally based health practices in order to facilitate healthy patients and communities. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations.

PubMed

van der Poel, Marcel J; Huisman, Floor; Busch, Olivier R; Abu Hilal, Mohammad; van Gulik, Thomas M; Tanis, Pieter J; Besselink, Marc G

2017-10-01

Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction. A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared. A total of 135 laparoscopic resections were performed. Overall conversion rate was 4% (n = 5), clinically relevant complication rate 13% (n = 18) and mortality 0.7% (n = 1). A significant increase in patients with major LLS, multiple liver resections, previous abdominal surgery, malignancies and lesions located in posterior segments was observed after the fellowship as well as a decrease in the use of hand-assistance. Increasing complexity in the post fellowship period was reflected by an increase in operating times, but without comprising other surgical outcomes. A stepwise introduction of LLS combined with structured training reduced the clinical impact of the learning curve, thereby confirming guideline recommendations. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Collaborative field research and training in occupational health and ergonomics.

PubMed

Kogi, K

1998-01-01

Networking collaborative research and training in Asian developing countries includes three types of joint activities: field studies of workplace potentials for better safety and health, intensive action training for improvement of working conditions in small enterprises, and action-oriented workshops on low-cost improvements for managers, workers, and farmers. These activities were aimed at identifying workable strategies for making locally adjusted improvements in occupational health and ergonomics. Many improvements have resulted as direct outcomes. Most these improvements were multifaceted, low-cost, and practicable using local skills. Three common features of these interactive processes seem important in facilitating realistic improvements: 1) voluntary approaches building on local achievements; 2) the use of practical methods for identifying multiple improvements; and 3) participatory steps for achieving low-cost results first. The effective use of group work tools is crucial. Stepwise training packages have thus proven useful for promoting local problem-solving interventions based on voluntary initiatives.

Concussion evaluation and management in pediatrics.

PubMed

Rivera, Robin G; Roberson, Susan P; Whelan, Margaret; Rohan, Annie

2015-01-01

Concussions are among the most complex injuries to assess and manage in sports medicine and primary care. Sports concussion in youth has received much attention in recent years because research shows that improperly managed concussion can lead to long-term cognitive deficits and mental health problems. There are several notable risk factors affecting the incidence and severity of concussion in school-age children and adolescents, including a history of a previous concussion. A more conservative approach for return to activities following concussion has been proposed for children and adolescents. Programs of individualized, stepwise increases in physical activity have largely replaced use of algorithms for assigning a grade and activity expectations to concussions. Although validity and reliability testing is ongoing to support use of concussion assessment instruments in pediatric patients, it is practical and appropriate that clinicians incorporate symptom checklists, sideline and balance assessment tools, and neurocognitive assessment instruments into their practice in accordance with evidence-based guidelines.

Application of stepwise multiple regression techniques to inversion of Nimbus 'IRIS' observations.

NASA Technical Reports Server (NTRS)

Ohring, G.

1972-01-01

Exploratory studies with Nimbus-3 infrared interferometer-spectrometer (IRIS) data indicate that, in addition to temperature, such meteorological parameters as geopotential heights of pressure surfaces, tropopause pressure, and tropopause temperature can be inferred from the observed spectra with the use of simple regression equations. The technique of screening the IRIS spectral data by means of stepwise regression to obtain the best radiation predictors of meteorological parameters is validated. The simplicity of application of the technique and the simplicity of the derived linear regression equations - which contain only a few terms - suggest usefulness for this approach. Based upon the results obtained, suggestions are made for further development and exploitation of the stepwise regression analysis technique.

The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

PubMed

Hughes, Roger; Margetts, Barrie

2012-11-01

The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

An investigation of correlation between pilot scanning behavior and workload using stepwise regression analysis

NASA Technical Reports Server (NTRS)

Waller, M. C.

1976-01-01

An electro-optical device called an oculometer which tracks a subject's lookpoint as a time function has been used to collect data in a real-time simulation study of instrument landing system (ILS) approaches. The data describing the scanning behavior of a pilot during the instrument approaches have been analyzed by use of a stepwise regression analysis technique. A statistically significant correlation between pilot workload, as indicated by pilot ratings, and scanning behavior has been established. In addition, it was demonstrated that parameters derived from the scanning behavior data can be combined in a mathematical equation to provide a good representation of pilot workload.

Community pharmacist-delivered Medicare Annual Wellness Visits within a family medicine practice.

PubMed

Evans, Taylor A; Fabel, Patricia H; Ziegler, Bryan

To identify the steps to implement a community pharmacist into a family medicine practice to deliver Medicare Annual Wellness Visits (AWVs). Medicine Mart Pharmacy is a locally owned and operated pharmacy that has served the West Columbia, SC, area for over 30 years. The services offered by the pharmacy have expanded over the past 3 years through the addition of a community pharmacy resident. A stepwise approach was developed for a community pharmacist to identify, market, and establish an AWV service through a collaborative practice agreement with a local family medicine practice. The pharmacy team contacted each office and obtained information about the physician practices and their willingness to participate in the program. Two financial models were created and evaluated to determine budget implications. Many patients were seen at the physician offices; they were eligible for AWV, but had not received them. Meetings were scheduled with 3 of the 6 offices; however, none of the offices moved forward with the proposed program. Integrating a pharmacist into the AWV role may be profitable to both the pharmacy and the medical office with persistence and time to have a successful collaboration. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Innovative integrative bedside teaching model improves tutors’ self-assessments of teaching skills and attitudes

PubMed Central

Gat, Itai; Pessach-Gelblum, Liat; Givati, Gili; Haim, Nadav; Paluch-Shimon, Shani; Unterman, Avraham; Bar-Shavit, Yochay; Grabler, Galit; Sagi, Doron; Achiron, Anat; Ziv, Amitai

2016-01-01

Introduction Patient bedside is the ideal setting for teaching physical examination, medical interviewing, and interpersonal skills. Herein we describe a novel model for bedside teaching (BST) practiced during tutor training workshop and its resulting effect on practitioners’ self assessment of teaching skills and perceptions. Methods One-day tutor training workshop included theoretical knowledge supplementation regarding tutors’ roles as well as implementing practical tools for clinical education, mainly BST model. The model, which emphasizes simultaneous clinical and communication teaching in a stepwise approach, was practiced by consecutive simulations with a gradual escalation of difficulty and adjusted instruction approaches. Pre- and post-workshop-adjusted questionnaires using a Likert scale of 1 to 4 were completed by participants and compared. Results Analysis was based on 25 out of 48 participants who completed both questionnaires. Significantly improved teaching skills were demonstrated upon workshop completion (mean 3.3, SD 0.5) compared with pre-training (mean 2.6, SD 0.6; p<0.001) with significant increase in most examined parameters. Significantly improved tutor's roles internalization was demonstrated after training completion (mean 3.7, SD 0.3) compared with pre-workshop (mean 3.5 SD 0.5; p=0.002). Discussion Successful BST involves combination of clinical and communication skills. BST model practiced during the workshop may contribute to improved teaching skills in this challenging environment. PMID:26894587

Treatment Algorithm for Chronic Idiopathic Constipation and Constipation-Predominant Irritable Bowel Syndrome Derived from a Canadian National Survey and Needs Assessment on Choices of Therapeutic Agents.

PubMed

Tse, Yvonne; Armstrong, David; Andrews, Christopher N; Bitton, Alain; Bressler, Brian; Marshall, John; Liu, Louis W C

2017-01-01

Background . Chronic idiopathic constipation (CIC) and constipation-predominant irritable bowel syndrome (IBS-C) are common functional lower gastrointestinal disorders that impair patients' quality of life. In a national survey, we aimed to evaluate (1) Canadian physician practice patterns in the utilization of therapeutic agents listed in the new ACG and AGA guidelines; (2) physicians satisfaction with these agents for their CIC and IBS-C patients; and (3) the usefulness of these new guidelines in their clinical practice. Methods . A 9-item questionnaire was sent to 350 Canadian specialists to evaluate their clinical practice for the management of CIC and IBS-C. Results . The response rate to the survey was 16% ( n = 55). Almost all (96%) respondents followed a standard, stepwise approach for management while they believed that only 24% of referring physicians followed the same approach. Respondents found guanylyl cyclase C (GCC) agonist most satisfying when treating their patients. Among the 69% of respondents who were aware of published guidelines, only 50% found them helpful in prioritizing treatment choices and 69% of respondents indicated that a treatment algorithm, applicable to Canadian practice, would be valuable. Conclusion . Based on this needs assessment, a treatment algorithm was developed to provide clinical guidance in the management of IBS-C and CIC in Canada.

Methodological approach to moving nutritional science evidence into practice.

PubMed

Crawford, Cindy; Teo, Lynn; Elfenbaum, Pamela; Enslein, Viviane; Deuster, Patricia A; Berry, Kevin

2017-06-01

The Metabolically Optimized Brain study explored nutritional science believed to be ready to place into practice to help improve US service members' cognitive performance and, thereby, optimize mission-readiness. A transparent, step-wise, research approach was used for informing evidence-based decisions among and for various, diverse stakeholders. A steering committee and subject-matter experts convened to devise the protocol and independent systematic reviews were performed to determine the quality of the evidence for nutritional science in 4 areas relevant to military populations: (1) caffeinated foods and beverages; (2) omega-3 polyunsaturated fatty acids; (3) plant-based foods and beverages or their phytochemical constituents; and (4) whole dietary patterns. A research expert panel was asked to then recommend future research directions and solutions likely to benefit warfighters. An implementation expert panel further considered how to apply sound nutritional science in a cost-effective manner. This article summarizes the methodological processes, high-level results, global research recommendations, and priorities for implementation. Specific results of the individual dietary interventions, as well as recommendations for moving this field of research and practice forward, are detailed throughout the current supplement. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Recommendations for a step-wise comparative approach to the evaluation of new screening tests for colorectal cancer.

PubMed

Young, Graeme P; Senore, Carlo; Mandel, Jack S; Allison, James E; Atkin, Wendy S; Benamouzig, Robert; Bossuyt, Patrick M M; Silva, Mahinda De; Guittet, Lydia; Halloran, Stephen P; Haug, Ulrike; Hoff, Geir; Itzkowitz, Steven H; Leja, Marcis; Levin, Bernard; Meijer, Gerrit A; O'Morain, Colm A; Parry, Susan; Rabeneck, Linda; Rozen, Paul; Saito, Hiroshi; Schoen, Robert E; Seaman, Helen E; Steele, Robert J C; Sung, Joseph J Y; Winawer, Sidney J

2016-03-15

New screening tests for colorectal cancer continue to emerge, but the evidence needed to justify their adoption in screening programs remains uncertain. A review of the literature and a consensus approach by experts was undertaken to provide practical guidance on how to compare new screening tests with proven screening tests. Findings and recommendations from the review included the following: Adoption of a new screening test requires evidence of effectiveness relative to a proven comparator test. Clinical accuracy supported by programmatic population evaluation in the screening context on an intention-to-screen basis, including acceptability, is essential. Cancer-specific mortality is not essential as an endpoint provided that the mortality benefit of the comparator has been demonstrated and that the biologic basis of detection is similar. Effectiveness of the guaiac-based fecal occult blood test provides the minimum standard to be achieved by a new test. A 4-phase evaluation is recommended. An initial retrospective evaluation in cancer cases and controls (Phase 1) is followed by a prospective evaluation of performance across the continuum of neoplastic lesions (Phase 2). Phase 3 follows the demonstration of adequate accuracy in these 2 prescreening phases and addresses programmatic outcomes at 1 screening round on an intention-to-screen basis. Phase 4 involves more comprehensive evaluation of ongoing screening over multiple rounds. Key information is provided from the following parameters: the test positivity rate in a screening population, the true-positive and false-positive rates, and the number needed to colonoscope to detect a target lesion. New screening tests can be evaluated efficiently by this stepwise comparative approach. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Classifying the auditory P300 using mobile EEG recordings without calibration phase.

PubMed

Zink, R; Hunyádi, B; Van Huffel, S; De Vos, M

2015-08-01

One of the major drawbacks in mobile EEG Brain Computer Interfaces (BCI) is the need for subject specific training data to train a classifier. By removing the need for supervised classification and calibration phase, new users could start immediate interaction with a BCI. We propose a solution to exploit the structural difference by means of canonical polyadic decomposition (CPD) for three-class auditory oddball data without the need for subject-specific information. We achieve this by adding average event-related-potential (ERP) templates to the CPD model. This constitutes a novel similarity measure between single-trial pairs and known-templates, which results in a fast and interpretable classifier. These results have similar accuracy to those of the supervised and cross-validated stepwise LDA approach but without the need for having subject-dependent data. Therefore the described CPD method has a significant practical advantage over the traditional and widely used approach.

Stepwise Advice Negotiation in Writing Center Peer Tutoring

ERIC Educational Resources Information Center

Park, Innhwa

2014-01-01

While the delivery and reception of advice is a practice integral to a wide range of settings, little attention has been given to the detailed practices of advice resistance and how it leads to advice negotiation. Based on 7 hours of videotaped tutoring interactions among 6 tutors and 11 tutees, this conversation analytic study examines the…

Stepwise sequential redox potential modulation possible on a single platform.

PubMed

Pepiol, Ariadna; Teixidor, Francesc; Sillanpää, Reijo; Lupu, Marius; Viñas, Clara

2011-12-23

Step by step: The cluster [3,3'-Co(1,2-C(2)B(9)H(11))(2)](-) is an excellent platform for making a stepwise tunable redox potential system by dehydroiodination. With the addition of up to eight iodine substituents (purple; see picture), there is a fall in the E(1/2)(Co(III)/Co(II)) value from -1.80 V to -0.68 V (vs. Fc(+)/Fc; Fc = ferrocene). A practical application of this tunability has been observed in the growth of polypyrrole. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Development and implementation of the Caribbean Laboratory Quality Management Systems Stepwise Improvement Process (LQMS-SIP) Towards Accreditation.

PubMed

Alemnji, George; Edghill, Lisa; Guevara, Giselle; Wallace-Sankarsingh, Sacha; Albalak, Rachel; Cognat, Sebastien; Nkengasong, John; Gabastou, Jean-Marc

2017-01-01

Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. We report the development of a stepwise process for quality systems improvement in the Caribbean Region. The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called 'Laboratory Quality Management System - Stepwise Improvement Process (LQMS-SIP) Towards Accreditation' to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement.

The Virtual Mission - A step-wise approach to large space missions

NASA Technical Reports Server (NTRS)

Hansen, Elaine; Jones, Morgan; Hooke, Adrian; Pomphrey, Richard

1992-01-01

Attention is given to the Virtual Mission (VM) concept, wherein multiple scientific instruments will be on different platforms, in different orbits, operated from different control centers, at different institutions, and reporting to different user groups. The VM concept enables NASA's science and application users to accomplish their broad science goals with a fleet made up of smaller, more focused spacecraft and to alleviate the difficulties involved with single, large, complex spacecraft. The concept makes possible the stepwise 'go-as-you-pay' extensible approach recommended by Augustine (1990). It enables scientists to mix and match the use of many smaller satellites in novel ways to respond to new scientific ideas and needs.

Advancing a Model-Validated Statistical Method for Decomposing the Key Oceanic Drivers of Regional Climate: Focus on Northern and Tropical African Climate Variability in the Community Earth System Model (CESM)

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

Wang, Fuyao; Yu, Yan; Notaro, Michael

This study advances the practicality and stability of the traditional multivariate statistical method, generalized equilibrium feedback assessment (GEFA), for decomposing the key oceanic drivers of regional atmospheric variability, especially when available data records are short. An advanced stepwise GEFA methodology is introduced, in which unimportant forcings within the forcing matrix are eliminated through stepwise selection. Method validation of stepwise GEFA is performed using the CESM, with a focused application to northern and tropical Africa (NTA). First, a statistical assessment of the atmospheric response to each primary oceanic forcing is carried out by applying stepwise GEFA to a fully coupled controlmore » run. Then, a dynamical assessment of the atmospheric response to individual oceanic forcings is performed through ensemble experiments by imposing sea surface temperature anomalies over focal ocean basins. Finally, to quantify the reliability of stepwise GEFA, the statistical assessment is evaluated against the dynamical assessment in terms of four metrics: the percentage of grid cells with consistent response sign, the spatial correlation of atmospheric response patterns, the area-averaged seasonal cycle of response magnitude, and consistency in associated mechanisms between assessments. In CESM, tropical modes, namely El Niño–Southern Oscillation and the tropical Indian Ocean Basin, tropical Indian Ocean dipole, and tropical Atlantic Niño modes, are the dominant oceanic controls of NTA climate. In complementary studies, stepwise GEFA is validated in terms of isolating terrestrial forcings on the atmosphere, and observed oceanic and terrestrial drivers of NTA climate are extracted to establish an observational benchmark for subsequent coupled model evaluation and development of process-based weights for regional climate projections.« less

Advancing a Model-Validated Statistical Method for Decomposing the Key Oceanic Drivers of Regional Climate: Focus on Northern and Tropical African Climate Variability in the Community Earth System Model (CESM)

DOE PAGES

Wang, Fuyao; Yu, Yan; Notaro, Michael; ...

2017-09-27

This study advances the practicality and stability of the traditional multivariate statistical method, generalized equilibrium feedback assessment (GEFA), for decomposing the key oceanic drivers of regional atmospheric variability, especially when available data records are short. An advanced stepwise GEFA methodology is introduced, in which unimportant forcings within the forcing matrix are eliminated through stepwise selection. Method validation of stepwise GEFA is performed using the CESM, with a focused application to northern and tropical Africa (NTA). First, a statistical assessment of the atmospheric response to each primary oceanic forcing is carried out by applying stepwise GEFA to a fully coupled controlmore » run. Then, a dynamical assessment of the atmospheric response to individual oceanic forcings is performed through ensemble experiments by imposing sea surface temperature anomalies over focal ocean basins. Finally, to quantify the reliability of stepwise GEFA, the statistical assessment is evaluated against the dynamical assessment in terms of four metrics: the percentage of grid cells with consistent response sign, the spatial correlation of atmospheric response patterns, the area-averaged seasonal cycle of response magnitude, and consistency in associated mechanisms between assessments. In CESM, tropical modes, namely El Niño–Southern Oscillation and the tropical Indian Ocean Basin, tropical Indian Ocean dipole, and tropical Atlantic Niño modes, are the dominant oceanic controls of NTA climate. In complementary studies, stepwise GEFA is validated in terms of isolating terrestrial forcings on the atmosphere, and observed oceanic and terrestrial drivers of NTA climate are extracted to establish an observational benchmark for subsequent coupled model evaluation and development of process-based weights for regional climate projections.« less

Implementing Competency-Based Medical Education in a Postgraduate Family Medicine Residency Training Program: A Stepwise Approach, Facilitating Factors, and Processes or Steps That Would Have Been Helpful.

PubMed

Schultz, Karen; Griffiths, Jane

2016-05-01

In 2009-2010, the postgraduate residency training program at the Department of Family Medicine, Queen's University, wrestled with the practicalities of competency-based medical education (CBME) implementation when its accrediting body, the College of Family Physicians of Canada, introduced the competency-based Triple C curriculum. The authors used a stepwise approach to implement CMBE; the steps were to (1) identify objectives, (2) identify competencies, (3) map objectives and competencies to learning experiences and assessment processes, (4) plan learning experiences, (5) develop an assessment system, (6) collect and interpret data, (7) adjust individual residents' training programs, and (8) distribute decisions to stakeholders. The authors also note overarching processes, costs, and facil itating factors and processes or steps that would have been helpful for CBME implementation. Early outcomes are encouraging. Residents are being directly observed more often with increased documented feedback about performance based on explicit competency standards (24,000 data points for 150 residents from 2013 to 2015). These multiple observations are being collated in a way that is allowing the identification of patterns of performance, red flags, and competency development trajectory. Outliers are being identified earlier, resulting in earlier individualized modification of their residency training program. The authors will continue to provide and refine faculty development, are developing an entrustable professional activity field note app for handheld devices, and are undertaking research to explore what facilitates learners' competency development, what increases assessors' confidence in making competence decisions, and whether residents are better trained as a result of CBME implementation.

Illustration of Step-Wise Latent Class Modeling With Covariates and Taxometric Analysis in Research Probing Children's Mental Models in Learning Sciences

PubMed Central

Stamovlasis, Dimitrios; Papageorgiou, George; Tsitsipis, Georgios; Tsikalas, Themistoklis; Vaiopoulou, Julie

2018-01-01

This paper illustrates two psychometric methods, latent class analysis (LCA) and taxometric analysis (TA) using empirical data from research probing children's mental representation in science learning. LCA is used to obtain a typology based on observed variables and to further investigate how the encountered classes might be related to external variables, where the effectiveness of classification process and the unbiased estimations of parameters become the main concern. In the step-wise LCA, the class membership is assigned and subsequently its relationship with covariates is established. This leading-edge modeling approach suffers from severe downward-biased estimations. The illustration of LCA is focused on alternative bias correction approaches and demonstrates the effect of modal and proportional class-membership assignment along with BCH and ML correction procedures. The illustration of LCA is presented with three covariates, which are psychometric variables operationalizing formal reasoning, divergent thinking and field dependence-independence, respectively. Moreover, taxometric analysis, a method designed to detect the type of the latent structural model, categorical or dimensional, is introduced, along with the relevant basic concepts and tools. TA was applied complementarily in the same data sets to answer the fundamental hypothesis about children's naïve knowledge on the matters under study and it comprises an additional asset in building theory which is fundamental for educational practices. Taxometric analysis provided results that were ambiguous as far as the type of the latent structure. This finding initiates further discussion and sets a problematization within this framework rethinking fundamental assumptions and epistemological issues. PMID:29713300

Cardiometabolic prevention consultation in the Netherlands: screening uptake and detection of cardiometabolic risk factors and diseases--a pilot study.

PubMed

Van der Meer, Victor; Nielen, Markus M J; Drenthen, Anton J M; Van Vliet, Mieke; Assendelft, Willem J J; Schellevis, Francois G

2013-02-26

Until now, cardiometabolic risk assessment in Dutch primary health care was directed at case-finding, and structured, programmatic prevention is lacking. Therefore, the Prevention Consultation cardiometabolic risk (PC CMR), a stepwise approach to identify and manage patients with cardiometabolic risk factors, was developed. The aim of this study was 1) to evaluate uptake rates of the two steps of the PC CMR, 2) to assess the rates of newly diagnosed hypertension, hypercholesterolemia, diabetes mellitus and chronic kidney disease and 3) to explore reasons for non-participation. Sixteen general practices throughout the Netherlands were recruited to implement the PC CMR during 6 months. In eight practices eligible patients aged between 45 and 70 years without a cardiometabolic disease were actively invited by a personal letter ('active approach') and in eight other practices eligible patients were informed about the PC CMR only by posters and leaflets in the practice ('passive approach'). Participating patients completed an online risk estimation (first step). Patients estimated as having a high risk according to the online risk estimation were advised to visit their general practice to complete the risk profile with blood pressure measurements and blood tests for cholesterol and glucose and to receive recommendations about risk lowering interventions (second step). The online risk estimation was completed by 521 (33%) and 96 (1%) of patients in the practices with an active and passive approach, respectively. Of these patients 392 (64%) were estimated to have a high risk and were referred to the practice; 142 of 392 (36%) consulted the GP. A total of 31 (22%) newly diagnosed patients were identified. Hypertension, hypercholesterolemia, diabetes and chronic kidney disease were diagnosed in 13%, 11%, 1% and 0%, respectively. Privacy risks were the most frequently mentioned reason not to participate. One third of the patients responded to an active invitation to complete an online risk estimation. A passive invitation resulted in only a small number of participating patients. Two third of the participants of the online risk estimation had a high risk, but only one third of them attended the GP office. One in five visiting patients had a diagnosed cardiometabolic risk factor or disease.

Development and implementation of the Caribbean Laboratory Quality Management Systems Stepwise Improvement Process (LQMS-SIP) Towards Accreditation

PubMed Central

Alemnji, George; Edghill, Lisa; Wallace-Sankarsingh, Sacha; Albalak, Rachel; Cognat, Sebastien; Nkengasong, John; Gabastou, Jean-Marc

2017-01-01

Background Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. Objectives We report the development of a stepwise process for quality systems improvement in the Caribbean Region. Methods The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called ‘Laboratory Quality Management System – Stepwise Improvement Process (LQMS-SIP) Towards Accreditation’ to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. Results This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. Conclusion This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement. PMID:28879149

Factors affecting Korean nursing student empowerment in clinical practice.

PubMed

Ahn, Yang-Heui; Choi, Jihea

2015-12-01

Understanding the phenomenon of nursing student empowerment in clinical practice is important. Investigating the cognition of empowerment and identifying predictors are necessary to enhance nursing student empowerment in clinical practice. To identify empowerment predictors for Korean nursing students in clinical practice based on studies by Bradbury-Jones et al. and Spreitzer. A cross-sectional design was used for this study. This study was performed in three nursing colleges in Korea, all of which had similar baccalaureate nursing curricula. Three hundred seven junior or senior nursing students completed a survey designed to measure factors that were hypothesized to influence nursing student empowerment in clinical practice. Data were collected from November to December 2011. Study variables included self-esteem, clinical decision making, being valued as a learner, satisfaction regarding practice with a team member, perception on professor/instructor/clinical preceptor attitude, and total number of clinical practice fields. Data were analyzed using stepwise multiple regression analyses. All of the hypothesized study variables were significantly correlated to nursing student empowerment. Stepwise multiple regression analysis revealed that clinical decision making in nursing (t=7.59, p<0.001), being valued as a learner (t=6.24, p<0.001), self-esteem (t=3.62, p<0.001), and total number of clinical practice fields (t=2.06, p=0.040). The explanatory power of these predictors was 35% (F=40.71, p<0.001). Enhancing nursing student empowerment in clinical practice will be possible by using educational strategies to improve nursing student clinical decision making. Simultaneously, attitudes of nurse educators are also important to ensure that nursing students are treated as valued learners and to increase student self-esteem in clinical practice. Finally, diverse clinical practice field environments should be considered to enhance experience. Copyright © 2015 Elsevier Ltd. All rights reserved.

Paediatric gastrostomy stoma complications and treatments: A rapid scoping review.

PubMed

Townley, Ashleigh; Wincentak, Joanne; Krog, Kim; Schippke, Julia; Kingsnorth, Shauna

2018-04-01

To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use. Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice. A scoping review using a rapid review approach. Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18 years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data. Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections. The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted. Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for nutrition support. © 2017 John Wiley & Sons Ltd.

AN AUDITING FRAMEWORK TO SUBSTANTIATE ELECTRONIC RECORDKEEPING PRACTICES

EPA Science Inventory

Quality assurance audits of computer systems help to ensure that the end data meet the needs of the user. Increasingly complex systems require the stepwise procedures outlined below.

The areas reviewed in this paper include both technical and evidentiary criteria. I...

Intensification of insulin therapy in patients with type 2 diabetes mellitus: An algorithm for basal-bolus therapy

PubMed Central

2012-01-01

The incidence of diabetes mellitus is projected to continue to increase worldwide over the next 20 years leading to increased costs in the management of the disease and its associated co-morbidities. Insulin replacement is one of many treatment options that can help to bring about near normoglycemia in the patient with type 2 diabetes mellitus (T2DM). Glycemic control as close to normoglycemia as possible can help to reduce the risk of microvascular and macrovascular complications, yet less than one-half of patients with T2DM achieve glycemic targets as recommended by practice guidelines. The purpose of this review is to provide guidance to primary care physicians for the initiation and intensification of basal-bolus insulin therapy in patients with T2DM. Two treatment algorithms that can be both patient- and physician-driven are proposed: a stepwise approach and a multiple daily injections approach. Evidence shaping the two approaches will be discussed alongside management issues that surround the patient treated with insulin: hypoglycemia, weight gain, patient education, and quality of life. PMID:22822902

A unified approach for EIT imaging of regional overdistension and atelectasis in acute lung injury.

PubMed

Gómez-Laberge, Camille; Arnold, John H; Wolf, Gerhard K

2012-03-01

Patients with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) are vulnerable to ventilator-induced lung injury. Although this syndrome affects the lung heterogeneously, mechanical ventilation is not guided by regional indicators of potential lung injury. We used electrical impedance tomography (EIT) to estimate the extent of regional lung overdistension and atelectasis during mechanical ventilation. Techniques for tidal breath detection, lung identification, and regional compliance estimation were combined with the Graz consensus on EIT lung imaging (GREIT) algorithm. Nine ALI/ARDS patients were monitored during stepwise increases and decreases in airway pressure. Our method detected individual breaths with 96.0% sensitivity and 97.6% specificity. The duration and volume of tidal breaths erred on average by 0.2 s and 5%, respectively. Respiratory system compliance from EIT and ventilator measurements had a correlation coefficient of 0.80. Stepwise increases in pressure could reverse atelectasis in 17% of the lung. At the highest pressures, 73% of the lung became overdistended. During stepwise decreases in pressure, previously-atelectatic regions remained open at sub-baseline pressures. We recommend that the proposed approach be used in collaborative research of EIT-guided ventilation strategies for ALI/ARDS.

Dispersion of speckle suppression efficiency for binary DOE structures: spectral domain and coherent matrix approaches.

PubMed

Lapchuk, Anatoliy; Prygun, Olexandr; Fu, Minglei; Le, Zichun; Xiong, Qiyuan; Kryuchyn, Andriy

2017-06-26

We present the first general theoretical description of speckle suppression efficiency based on an active diffractive optical element (DOE). The approach is based on spectral analysis of diffracted beams and a coherent matrix. Analytical formulae are obtained for the dispersion of speckle suppression efficiency using different DOE structures and different DOE activation methods. We show that a one-sided 2D DOE structure has smaller speckle suppression range than a two-sided 1D DOE structure. Both DOE structures have sufficient speckle suppression range to suppress low-order speckles in the entire visible range, but only the two-sided 1D DOE can suppress higher-order speckles. We also show that a linear shift 2D DOE in a laser projector with a large numerical aperture has higher effective speckle suppression efficiency than the method using switching or step-wise shift DOE structures. The generalized theoretical models elucidate the mechanism and practical realization of speckle suppression.

Context-Sensitive Ethics in School Psychology

ERIC Educational Resources Information Center

Lasser, Jon; Klose, Laurie McGarry; Robillard, Rachel

2013-01-01

Ethical codes and licensing rules provide foundational guidance for practicing school psychologists, but these sources fall short in their capacity to facilitate effective decision-making. When faced with ethical dilemmas, school psychologists can turn to decision-making models, but step-wise decision trees frequently lack the situation…

Simple models for estimating local removals of timber in the northeast

Treesearch

David N. Larsen; David A. Gansner

1975-01-01

Provides a practical method of estimating subregional removals of timber and demonstrates its application to a typical problem. Stepwise multiple regression analysis is used to develop equations for estimating removals of softwood, hardwood, and all timber from selected characteristics of socioeconomic structure.

Thermodynamics--A Practical Subject.

ERIC Educational Resources Information Center

Jones, Hugh G.

1984-01-01

Provides a simplified, synoptic overview of the area of thermodynamics, enumerating and explaining the four basic laws, and introducing the mathematics involved in a stepwise fashion. Discusses such basic tools of thermodynamics as enthalpy, entropy, Helmholtz free energy, and Gibbs free energy, and their uses in problem solving. (JM)

An Approach to Coping with Anxiety about AIDS.

ERIC Educational Resources Information Center

Krieger, Irwin

1988-01-01

Describes a stepwise counseling approach for assisting persons with heightened anxiety about Acquired Immune Deficiency Syndrome (AIDS) and ways to handle fears about the sexual transmission of AIDS. Five steps discussed include getting accurate information, assessing fear prior to exposure, learning to protect oneself and others, gathering peer…

A Guided Discovery Approach for Learning Glycolysis.

ERIC Educational Resources Information Center

Schultz, Emeric

1997-01-01

Argues that more attention should be given to teaching students how to learn the rudiments of specific metabolic pathways. This approach describes a unique way of learning the glycolytic pathway in stepwise fashion. The pedagogy involves clear rote components that are connected to a set of generalizations that develop and enhance important…

An integrative top-down and bottom-up qualitative model construction framework for exploration of biochemical systems.

PubMed

Wu, Zujian; Pang, Wei; Coghill, George M

Computational modelling of biochemical systems based on top-down and bottom-up approaches has been well studied over the last decade. In this research, after illustrating how to generate atomic components by a set of given reactants and two user pre-defined component patterns, we propose an integrative top-down and bottom-up modelling approach for stepwise qualitative exploration of interactions among reactants in biochemical systems. Evolution strategy is applied to the top-down modelling approach to compose models, and simulated annealing is employed in the bottom-up modelling approach to explore potential interactions based on models constructed from the top-down modelling process. Both the top-down and bottom-up approaches support stepwise modular addition or subtraction for the model evolution. Experimental results indicate that our modelling approach is feasible to learn the relationships among biochemical reactants qualitatively. In addition, hidden reactants of the target biochemical system can be obtained by generating complex reactants in corresponding composed models. Moreover, qualitatively learned models with inferred reactants and alternative topologies can be used for further web-lab experimental investigations by biologists of interest, which may result in a better understanding of the system.

Stepwise Bay Annulation of Indigo for the Synthesis of Desymmetrized Electron Acceptors and Donor–Acceptor Constructs

DOE PAGES

Kolaczkowski, Matthew A.; He, Bo; Liu, Yi

2016-10-10

In this work, a selective stepwise annulation of indigo has been demonstrated as a means of providing both monoannulated and differentially double-annulated indigo derivatives. Disparate substitution of the electron accepting bay-annulated indigo system allows for fine control over both the electronic properties as well as donor-acceptor structural architectures. Optical and electronic properties were characterized computationally as well as through UV-vis absorption spectroscopy and cyclic voltammetry. Finally, this straightforward method provides a modular approach for the design of indigo-based materials with tailored optoelectronic properties.

Development and Application of a Stepwise Assessment Process for Rational Redesign of Sequential Skills-Based Courses.

PubMed

Gallimore, Casey E; Porter, Andrea L; Barnett, Susanne G

2016-10-25

Objective. To develop and apply a stepwise process to assess achievement of course learning objectives related to advanced pharmacy practice experiences (APPEs) preparedness and inform redesign of sequential skills-based courses. Design. Four steps comprised the assessment and redesign process: (1) identify skills critical for APPE preparedness; (2) utilize focus groups and course evaluations to determine student competence in skill performance; (3) apply course mapping to identify course deficits contributing to suboptimal skill performance; and (4) initiate course redesign to target exposed deficits. Assessment. Focus group participants perceived students were least prepared for skills within the Accreditation Council for Pharmacy Education's pre-APPE core domains of Identification and Assessment of Drug-related Problems and General Communication Abilities. Course mapping identified gaps in instruction, performance, and assessment of skills within aforementioned domains. Conclusions. A stepwise process that identified strengths and weaknesses of a course, was used to facilitate structured course redesign. Strengths of the process included input and corroboration from both preceptors and students. Limitations included feedback from a small number of pharmacy preceptors and increased workload on course coordinators.

Stepwise Approach to Writing Journal-Style Lab Reports in the Organic Chemistry Course Sequence

ERIC Educational Resources Information Center

Wackerly, Jay Wm.

2018-01-01

An approach is described that gradually transitions second-year organic chemistry students to writing full "The Journal of Organic Chemistry" ("JOC") style lab reports. The primary goal was to introduce students to and build rhetorical skills in scientific and technical writing. This was accomplished by focusing on four main…

Stepwise approach to myopathy in systemic disease.

PubMed

Chawla, Jasvinder

2011-01-01

Muscle diseases can constitute a large variety of both acquired and hereditary disorders. Myopathies in systemic disease results from several different disease processes including endocrine, inflammatory, paraneoplastic, infectious, drug- and toxin-induced, critical illness myopathy, metabolic, and myopathies with other systemic disorders. Patients with systemic myopathies often present acutely or sub acutely. On the other hand, familial myopathies or dystrophies generally present in a chronic fashion with exceptions of metabolic myopathies where symptoms on occasion can be precipitated acutely. Most of the inflammatory myopathies can have a chance association with malignant lesions; the incidence appears to be specifically increased only in patients with dermatomyositis. In dealing with myopathies associated with systemic illnesses, the focus will be on the acquired causes. Management is beyond the scope of this chapter. Prognosis is based upon the underlying cause and, most of the time, carries a good prognosis. In order to approach a patient with suspected myopathy from systemic disease, a stepwise approach is utilized.

Porphyrin-sensitized solar cells: systematic molecular optimization, coadsorption and cosensitization.

PubMed

Song, Heli; Liu, Qingyun; Xie, Yongshu

2018-02-15

As a promising low-cost solar energy conversion technique, dye-sensitized solar cells have undergone spectacular development since 1991. For practical applications, improvement of power conversion efficiency has always been one of the major research topics. Porphyrins are outstanding sensitizers endowed with strong sunlight harvesting ability in the visible region and multiple reaction sites available for functionalization. However, judicious molecular design in consideration of light-harvest, energy levels, operational dynamics, adsorption geometry and suppression of back reactions is specifically required for achieving excellent photovoltaic performance. This feature article highlights some of the recently developed porphyrin sensitizers, especially focusing on the systematic dye structure optimization approach in combination with coadsorption and cosensitization methods in pursuing higher efficiencies. Herein, we expect to provide more insights into the structure-performance correlation and molecular engineering strategies in a stepwise manner.

Design and implementation of a novel mechanical testing system for cellular solids.

PubMed

Nazarian, Ara; Stauber, Martin; Müller, Ralph

2005-05-01

Cellular solids constitute an important class of engineering materials encompassing both man-made and natural constructs. Materials such as wood, cork, coral, and cancellous bone are examples of cellular solids. The structural analysis of cellular solid failure has been limited to 2D sections to illustrate global fracture patterns. Due to the inherent destructiveness of 2D methods, dynamic assessment of fracture progression has not been possible. Image-guided failure assessment (IGFA), a noninvasive technique to analyze 3D progressive bone failure, has been developed utilizing stepwise microcompression in combination with time-lapsed microcomputed tomographic imaging (microCT). This method allows for the assessment of fracture progression in the plastic region, where much of the structural deformation/energy absorption is encountered in a cellular solid. Therefore, the goal of this project was to design and fabricate a novel micromechanical testing system to validate the effectiveness of the stepwise IGFA technique compared to classical continuous mechanical testing, using a variety of engineered and natural cellular solids. In our analysis, we found stepwise compression to be a valid approach for IGFA with high precision and accuracy comparable to classical continuous testing. Therefore, this approach complements the conventional mechanical testing methods by providing visual insight into the failure propagation mechanisms of cellular solids. (c) 2005 Wiley Periodicals, Inc.

Scientific Evaluation and Review of Claims in Health Care (SEaRCH): A Streamlined, Systematic, Phased Approach for Determining "What Works" in Healthcare.

PubMed

Jonas, Wayne B; Crawford, Cindy; Hilton, Lara; Elfenbaum, Pamela

2017-01-01

Answering the question of "what works" in healthcare can be complex and requires the careful design and sequential application of systematic methodologies. Over the last decade, the Samueli Institute has, along with multiple partners, developed a streamlined, systematic, phased approach to this process called the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™). The SEaRCH process provides an approach for rigorously, efficiently, and transparently making evidence-based decisions about healthcare claims in research and practice with minimal bias. SEaRCH uses three methods combined in a coordinated fashion to help determine what works in healthcare. The first, the Claims Assessment Profile (CAP), seeks to clarify the healthcare claim and question, and its ability to be evaluated in the context of its delivery. The second method, the Rapid Evidence Assessment of the Literature (REAL © ), is a streamlined, systematic review process conducted to determine the quantity, quality, and strength of evidence and risk/benefit for the treatment. The third method involves the structured use of expert panels (EPs). There are several types of EPs, depending on the purpose and need. Together, these three methods-CAP, REAL, and EP-can be integrated into a strategic approach to help answer the question "what works in healthcare?" and what it means in a comprehensive way. SEaRCH is a systematic, rigorous approach for evaluating healthcare claims of therapies, practices, programs, or products in an efficient and stepwise fashion. It provides an iterative, protocol-driven process that is customized to the intervention, consumer, and context. Multiple communities, including those involved in health service and policy, can benefit from this organized framework, assuring that evidence-based principles determine which healthcare practices with the greatest promise are used for improving the public's health and wellness.

Focusing light through random photonic layers by four-element division algorithm

NASA Astrophysics Data System (ADS)

Fang, Longjie; Zhang, Xicheng; Zuo, Haoyi; Pang, Lin

2018-02-01

The propagation of waves in turbid media is a fundamental problem of optics with vast applications. Optical phase optimization approaches for focusing light through turbid media using phase control algorithm have been widely studied in recent years due to the rapid development of spatial light modulator. The existing approaches include element-based algorithms - stepwise sequential algorithm, continuous sequential algorithm and whole element optimization approaches - partitioning algorithm, transmission matrix approach and genetic algorithm. The advantage of element-based approaches is that the phase contribution of each element is very clear; however, because the intensity contribution of each element to the focal point is small especially for the case of large number of elements, the determination of the optimal phase for a single element would be difficult. In other words, the signal to noise ratio of the measurement is weak, leading to possibly local maximal during the optimization. As for whole element optimization approaches, all elements are employed for the optimization. Of course, signal to noise ratio during the optimization is improved. However, because more random processings are introduced into the processing, optimizations take more time to converge than the single element based approaches. Based on the advantages of both single element based approaches and whole element optimization approaches, we propose FEDA approach. Comparisons with the existing approaches show that FEDA only takes one third of measurement time to reach the optimization, which means that FEDA is promising in practical application such as for deep tissue imaging.

Design Exception In-Service Monitoring Program Development

DOT National Transportation Integrated Search

2017-05-01

This study evaluates various possible program designs for in-service monitoring of design exceptions (DEs) for the Georgia Department of Transportation. The study recommends a multitier stepwise approach to the evaluation of DEs. Specifically, the pr...

A step-wise approach for analysis of the mouse embryonic heart using 17.6 Tesla MRI

PubMed Central

Gabbay-Benziv, Rinat; Reece, E. Albert; Wang, Fang; Bar-Shir, Amnon; Harman, Chris; Turan, Ozhan M.; Yang, Peixin; Turan, Sifa

2018-01-01

Background The mouse embryo is ideal for studying human cardiac development. However, laboratory discoveries do not easily translate into clinical findings partially because of histological diagnostic techniques that induce artifacts and lack standardization. Aim To present a step-wise approach using 17.6 T MRI, for evaluation of mice embryonic heart and accurate identification of congenital heart defects. Subjects 17.5-embryonic days embryos from low-risk (non-diabetic) and high-risk (diabetic) model dams. Study design Embryos were imaged using 17.6 Tesla MRI. Three-dimensional volumes were analyzed using ImageJ software. Outcome measures Embryonic hearts were evaluated utilizing anatomic landmarks to locate the four-chamber view, the left- and right-outflow tracts, and the arrangement of the great arteries. Inter- and intra-observer agreement were calculated using kappa scores by comparing two researchers’ evaluations independently analyzing all hearts, blinded to the model, on three different, timed occasions. Each evaluated 16 imaging volumes of 16 embryos: 4 embryos from normal dams, and 12 embryos from diabetic dams. Results Inter-observer agreement and reproducibility were 0.779 (95% CI 0.653–0.905) and 0.763 (95% CI 0.605–0.921), respectively. Embryonic hearts were structurally normal in 4/4 and 7/12 embryos from normal and diabetic dams, respectively. Five embryos from diabetic dams had defects: ventricular septal defects (n = 2), transposition of great arteries (n = 2) and Tetralogy of Fallot (n = 1). Both researchers identified all cardiac lesions. Conclusion A step-wise approach for analysis of MRI-derived 3D imaging provides reproducible detailed cardiac evaluation of normal and abnormal mice embryonic hearts. This approach can accurately reveal cardiac structure and, thus, increases the yield of animal model in congenital heart defect research. PMID:27569369

Teaching Simulation and Computer-Aided Separation Optimization in Liquid Chromatography by Means of Illustrative Microsoft Excel Spreadsheets

ERIC Educational Resources Information Center

Fasoula, S.; Nikitas, P.; Pappa-Louisi, A.

2017-01-01

A series of Microsoft Excel spreadsheets were developed to simulate the process of separation optimization under isocratic and simple gradient conditions. The optimization procedure is performed in a stepwise fashion using simple macros for an automatic application of this approach. The proposed optimization approach involves modeling of the peak…

Word Problems: A "Meme" for Our Times.

ERIC Educational Resources Information Center

Leamnson, Robert N.

1996-01-01

Discusses a novel approach to word problems that involves linear relationships between variables. Argues that working stepwise through intermediates is the way our minds actually work and therefore this should be used in solving word problems. (JRH)

BOOK REVIEW: WETLAND DESIGN, PRINCIPLES AND PRACTICES FOR LANDSCAPE ARCHITECTS AND LAND-USE PLANNERS

EPA Science Inventory

The book is organized in such a way that it provides a stepwise guide that begins with a basic historical and aesthetic overview of wetland design. The book then summarizes the key concepts involved in cumultive impacts from a landscape ecology persepetive, and then delves furth...

Stepwise and stagewise approaches for spatial cluster detection

PubMed Central

Xu, Jiale

2016-01-01

Spatial cluster detection is an important tool in many areas such as sociology, botany and public health. Previous work has mostly taken either hypothesis testing framework or Bayesian framework. In this paper, we propose a few approaches under a frequentist variable selection framework for spatial cluster detection. The forward stepwise methods search for multiple clusters by iteratively adding currently most likely cluster while adjusting for the effects of previously identified clusters. The stagewise methods also consist of a series of steps, but with tiny step size in each iteration. We study the features and performances of our proposed methods using simulations on idealized grids or real geographic area. From the simulations, we compare the performance of the proposed methods in terms of estimation accuracy and power of detections. These methods are applied to the the well-known New York leukemia data as well as Indiana poverty data. PMID:27246273

Stepwise and stagewise approaches for spatial cluster detection.

PubMed

Xu, Jiale; Gangnon, Ronald E

2016-05-01

Spatial cluster detection is an important tool in many areas such as sociology, botany and public health. Previous work has mostly taken either a hypothesis testing framework or a Bayesian framework. In this paper, we propose a few approaches under a frequentist variable selection framework for spatial cluster detection. The forward stepwise methods search for multiple clusters by iteratively adding currently most likely cluster while adjusting for the effects of previously identified clusters. The stagewise methods also consist of a series of steps, but with a tiny step size in each iteration. We study the features and performances of our proposed methods using simulations on idealized grids or real geographic areas. From the simulations, we compare the performance of the proposed methods in terms of estimation accuracy and power. These methods are applied to the the well-known New York leukemia data as well as Indiana poverty data. Copyright © 2016 Elsevier Ltd. All rights reserved.

A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease.

PubMed

Casteleijn, Niek F; Visser, Folkert W; Drenth, Joost P H; Gevers, Tom J G; Groen, Gerbrand J; Hogan, Marie C; Gansevoort, Ron T

2014-09-01

Chronic pain, defined as pain existing for >4-6 weeks, affects >60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe, impacting physical activity and social relationships, and frequently difficult to manage. This review provides an overview of pathophysiological mechanisms that can lead to pain and discusses the sensory innervation of the kidneys and the upper abdominal organs, including the liver. In addition, the results of a systematic literature search of ADPKD-specific treatment options are presented. Based on pathophysiological knowledge and evidence derived from the literature an argumentative stepwise approach for effective management of chronic pain in ADPKD is proposed. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

A Stepwise Approach: Decreasing Infection in Deep Brain Stimulation for Childhood Dystonic Cerebral Palsy.

PubMed

Johans, Stephen J; Swong, Kevin N; Hofler, Ryan C; Anderson, Douglas E

2017-09-01

Dystonia is a movement disorder characterized by involuntary muscle contractions, which cause twisting movements or abnormal postures. Deep brain stimulation has been used to improve the quality of life for secondary dystonia caused by cerebral palsy. Despite being a viable treatment option for childhood dystonic cerebral palsy, deep brain stimulation is associated with a high rate of infection in children. The authors present a small series of patients with dystonic cerebral palsy who underwent a stepwise approach for bilateral globus pallidus interna deep brain stimulation placement in order to decrease the rate of infection. Four children with dystonic cerebral palsy who underwent a total of 13 surgical procedures (electrode and battery placement) were identified via a retrospective review. There were zero postoperative infections. Using a multistaged surgical plan for pediatric patients with dystonic cerebral palsy undergoing deep brain stimulation may help to reduce the risk of infection.

Stepwise Assembly and Characterization of DNA Linked Two-Color Quantum Dot Clusters.

PubMed

Coopersmith, Kaitlin; Han, Hyunjoo; Maye, Mathew M

2015-07-14

The DNA-mediated self-assembly of multicolor quantum dot (QD) clusters via a stepwise approach is described. The CdSe/ZnS QDs were synthesized and functionalized with an amphiphilic copolymer, followed by ssDNA conjugation. At each functionalization step, the QDs were purified via gradient ultracentrifugation, which was found to remove excess polymer and QD aggregates, allowing for improved conjugation yields and assembly reactivity. The QDs were then assembled and disassembled in a stepwise manner at a ssDNA functionalized magnetic colloid, which provided a convenient way to remove unreacted QDs and ssDNA impurities. After assembly/disassembly, the clusters' optical characteristics were studied by fluorescence spectroscopy and the assembly morphology and stoichiometry was imaged via electron microscopy. The results indicate that a significant amount of QD-to-QD energy transfer occurred in the clusters, which was studied as a function of increasing acceptor-to-donor ratios, resulting in increased QD acceptor emission intensities compared to controls.

[After ACC/AHA and ESC Guidelines: Pre-operative cardiological evaluation in non-cardiac surgery: certainties, controversial areas and opportunities for a team approach].

PubMed

Urbinati, Stefano; Faggiano, Pompilio; Colivicchi, Furio; Riccio, Carmine; Abrignani, Maurizio Giuseppe; Genovesi-Ebert, Alberto; Fattirolli, Francesco; De Feo, Stefania; Gambetti, Simona; Uguccioni, Massimo

2011-09-01

A standardized and evidence-based approach to the cardiological management of patients undergoing noncardiac surgery has been recently defined by Task Forces of the American Heart Association (AHA), American College of Cardiology (ACC) and the European Society of Cardiology (ESC) that published their guidelines in 2007 and 2009, respectively. Both the recommendations moved from risk indices to a practical, stepwise approach of the patient, which integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure. In the present paper the main topics of the guidelines are discussed, and moreover, emphasis is placed on four controversial issues such as the use of prophylactic coronary revascularization in patients with myocardial ischemia, the perioperative management of patients with congestive heart failure, the routine use of betablockers and statins, and, finally, the management of antiplatelet therapies in patients with coronary stents. In addition to promoting an improvement of immediate perioperative care, the preoperative cardiological evaluation should be a challenge for identifying subjects with enhanced risk of cardiovascular events, who should be treated and monitored during a long-term follow-up.

A stepwise approach to stroke surveillance in Brazil: the EMMA (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral) study.

PubMed

Goulart, Alessandra C; Bustos, Iara R; Abe, Ivana M; Pereira, Alexandre C; Fedeli, Ligia M; Benseñor, Isabela M; Lotufo, Paulo A

2010-08-01

Stroke mortality rates in Brazil are the highest in the Americas. Deaths from cerebrovascular disease surpass coronary heart disease. To verify stroke mortality rates and morbidity in an area of São Paulo, Brazil, using the World Health Organization Stepwise Approach to Stroke Surveillance. We used the World Health Organization Stepwise Approach to Stroke Surveillance structure of stroke surveillance. The hospital-based data comprised fatal and nonfatal stroke (Step 1). We gathered stroke-related mortality data in the community using World Health Organization questionnaires (Step 2). The questionnaire determining stroke prevalence was activated door to door in a family-health-programme neighbourhood (Step 3). A total of 682 patients 18 years and above, including 472 incident cases, presented with cerebrovascular disease and were enrolled in Step 1 during April-May 2009. Cerebral infarction (84.3%) and first-ever stroke (85.2%) were the most frequent. In Step 2, 256 deaths from stroke were identified during 2006-2007. Forty-four per cent of deaths were classified as unspecified stroke, 1/3 as ischaemic stroke, and 1/4 due to haemorrhagic subtype. In Step 3, 577 subjects over 35 years old were evaluated at home, and 244 cases of stroke survival were diagnosed via a questionnaire, validated by a board-certified neurologist. The population demographic characteristics were similar in the three steps, except in terms of age and gender. By including data from all settings, World Health Organization stroke surveillance can provide data to help plan future resources that meet the needs of the public-health system.

The role of multicollinearity in landslide susceptibility assessment by means of Binary Logistic Regression: comparison between VIF and AIC stepwise selection

NASA Astrophysics Data System (ADS)

Cama, Mariaelena; Cristi Nicu, Ionut; Conoscenti, Christian; Quénéhervé, Geraldine; Maerker, Michael

2016-04-01

Landslide susceptibility can be defined as the likelihood of a landslide occurring in a given area on the basis of local terrain conditions. In the last decades many research focused on its evaluation by means of stochastic approaches under the assumption that 'the past is the key to the future' which means that if a model is able to reproduce a known landslide spatial distribution, it will be able to predict the future locations of new (i.e. unknown) slope failures. Among the various stochastic approaches, Binary Logistic Regression (BLR) is one of the most used because it calculates the susceptibility in probabilistic terms and its results are easily interpretable from a geomorphological point of view. However, very often not much importance is given to multicollinearity assessment whose effect is that the coefficient estimates are unstable, with opposite sign and therefore difficult to interpret. Therefore, it should be evaluated every time in order to make a model whose results are geomorphologically correct. In this study the effects of multicollinearity in the predictive performance and robustness of landslide susceptibility models are analyzed. In particular, the multicollinearity is estimated by means of Variation Inflation Index (VIF) which is also used as selection criterion for the independent variables (VIF Stepwise Selection) and compared to the more commonly used AIC Stepwise Selection. The robustness of the results is evaluated through 100 replicates of the dataset. The study area selected to perform this analysis is the Moldavian Plateau where landslides are among the most frequent geomorphological processes. This area has an increasing trend of urbanization and a very high potential regarding the cultural heritage, being the place of discovery of the largest settlement belonging to the Cucuteni Culture from Eastern Europe (that led to the development of the great complex Cucuteni-Tripyllia). Therefore, identifying the areas susceptible to landslides may lead to a better understanding and mitigation for government, local authorities and stakeholders to plan the economic activities, minimize the damages costs, environmental and cultural heritage protection. The results show that although the VIF Stepwise selection allows a more stable selection of the controlling factors, the AIC Stepwise selection produces better predictive performance. Moreover, when working with replicates the effect of multicollinearity are statistically reduced by the application of the AIC stepwise selection and the results are easily interpretable in geomorphologic terms.

Adolescents' perspectives and food choice behaviors in terms of the environmental impacts of food production practices: application of a psychosocial model.

PubMed

Bissonnette, M M; Contento, I R

2001-01-01

The objective of this study was to investigate adolescents' perspectives about the environmental impacts of food production practices and whether these perspectives are related to their food choice. Food choice was operationalized as consumption and purchase of organic foods and locally grown foods. A survey questionnaire was administered to a convenience sample of adolescents and analyzed for descriptive information and relationships among variables. Subjects were 651 ethnically diverse, urban and suburban high school senior students in a major metropolitan area. Variables of an Expanded Theory of Planned Behavior were measured including beliefs, attitudes, perceived social influences, motivation to comply, perceived behavioral control, self-identity, perceived responsibility, behavioral intention, and behavior. Descriptive statistics, Pearson correlation coefficients, and stepwise multiple regression analyses were used. Surveyed adolescents did not have strong or consistent beliefs or attitudes about the environmental impact of food production practices. Cognitive-motivational processes were at work, however, since their perspectives were significantly correlated with behavioral intentions and food choice behaviors. Behavioral intention was best accounted for by attitudes and perceived social influences (and perceived responsibility for organic food), and behavior was best accounted for by behavioral intentions, beliefs, and perceived social influences (and self-identity for local food). There is a need to make salient to adolescents the environmental impact of food production practices through both cognitive and experiential approaches.

Stepwise approach to curative surgery using percutaneous transhepatic cholangiodrainage and portal vein embolization for severe bile duct injury during laparoscopic cholecystectomy: a case report.

PubMed

Honmyo, Naruhiko; Kuroda, Shintaro; Kobayashi, Tsuyoshi; Ishiyama, Kohei; Ide, Kentaro; Tahara, Hiroyuki; Ohira, Masahiro; Ohdan, Hideki

2016-12-01

Laparoscopic cholecystectomy (LC) has been recently adapted to acute cholecystitis. Major bile duct injury during LC, especially Strasberg-Bismuth classification type E, can be a critical problem sometimes requiring hepatectomy. Safety and definitive treatment without further morbidities, such as posthepatectomy liver failure, is required. Here, we report a case of severe bile duct injury treated with a stepwise approach using (99m)Tc-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging to accurately estimate liver function.A 52-year-old woman diagnosed with acute cholecystitis underwent LC at another hospital and was transferred to our university hospital for persistent bile leakage on postoperative day 20. She had no jaundice or infection, although an intraperitoneal drainage tube discharged approximately 500 ml of bile per day. Recorded operation procedure showed removal of the gallbladder with a part of the common bile duct due to its misidentification, and each of the hepatic ducts and right hepatic artery was injured. Abdominal enhanced CT revealed obstructive jaundice of the left liver and arterial shunt through the hilar plate to the right liver. Magnetic resonance cholangiopancreatography revealed type E4 or more advanced bile duct injury according to the Bismuth-Strasberg classification. We planned a stepwise approach using percutaneous transhepatic cholangiodrainage (PTCD) and portal vein embolization (PVE) for secure right hemihepatectomy and biliary-jejunum reconstruction and employed (99m)Tc-GSA SPECT/CT fusion imaging to estimate future remnant liver function. The left liver function rate had changed from 26.2 % on admission to 26.3 % after PTCD and 54.5 % after PVE, while the left liver volume rate was 33.8, 33.3, and 49.6 %, respectively. The increase of liver function was higher than that of volume (28.3 vs. 15.8 %). On postoperative day 63, the curative operation, right hemihepatectomy and biliary-jejunum reconstruction, was performed, and posthepatectomy liver failure could be avoided.Careful consideration of treatment strategy for each case is necessary for severe bile duct injury with arterial injury requiring hepatectomy. The stepwise approach using PTCD and PVE could enable hemihepatectomy, and (99m)Tc-GSA SPECT/CT fusion imaging was useful to estimate heterogeneous liver function.

Who attends a UK diabetes screening programme? Findings from the ADDITION-Cambridge study.

PubMed

Sargeant, L A; Simmons, R K; Barling, R S; Butler, R; Williams, K M; Prevost, A T; Kinmonth, A L; Wareham, N J; Griffin, S J

2010-09-01

One of the factors influencing the cost-effectiveness of population screening for Type 2 diabetes may be uptake. We examined attendance and practice- and individual-level factors influencing uptake at each stage of a diabetes screening programme in general practice. A stepwise screening programme was undertaken among 135, 825 people aged 40-69 years without known diabetes in 49 general practices in East England. The programme included a score based on routinely available data (age, sex, body mass index and prescribed medication) to identify those at high risk, who were offered random capillary blood glucose (RBG) and glycosylated haemoglobin tests. Those screening positive were offered fasting capillary blood glucose (FBG) and confirmatory oral glucose tolerance tests (OGTT). There were 33 539 high-risk individuals invited for a RBG screening test; 24 654 (74%) attended. Ninety-four per cent attended the follow-up FBG test and 82% the diagnostic OGTT. Seventy per cent of individuals completed the screening programme. Practices with higher general practitioner staff complements and those located in more deprived areas had lower uptake for RBG and FBG tests. Male sex and a higher body mass index were associated with lower attendance for RBG testing. Older age, prescription of antihypertensive medication and a higher risk score were associated with higher attendance for FBG and RBG tests. High attendance rates can be achieved by targeted stepwise screening of individuals assessed as high risk by data routinely available in general practice. Different strategies may be required to increase initial attendance, ensure completion of the screening programme, and reduce the risk that screening increases health inequalities.

Experiences of support in working toward personal recovery goals: a collaborative, qualitative study.

PubMed

Biringer, Eva; Davidson, Larry; Sundfør, Bengt; Ruud, Torleif; Borg, Marit

2016-11-25

Recovery can be understood as a subjective process guided by personal expectations, goals and hopes. The aim of the study was to explore how persons using a Community Mental Health Centre (CMHC) experienced that their expectations for treatment, and goals and hopes for recovery were supported by the health professionals during treatment. Employing a hermeneutic-phenomenological approach, eight service users were interviewed about their expectations for treatment and their goals and hopes for recovery at the start of their contact with health professionals at a CMHC. Two years later, they were re-interviewed about their experiences of treatment and support from the health professionals in their work towards these goals and hopes. A collaborative approach was adopted. A co-researcher with lived experience took part in all stages of the study. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Five themes reflecting how participants experienced support from health professionals at the CMHC in their work towards their recovery goals were elicited, as follows: developing an understanding of oneself and one's mental health problems; learning how to change feelings and behaviours; being 'pushed' into social arenas; finding helpful medication; and counselling in family, practical and financial issues. The participants' expectations about counselling with regard to longer-term family, practical, and financial challenges were insufficiently met by the CMHC. In the experience of the service users, recovery occurred within the context of their everyday life with or without the support of their professional helpers. To facilitate recovery, health professionals should acknowledge the service user's personal goals and hopes and take a more comprehensive and longer-term approach to his or her needs and desires. Acknowledging and facilitating recovery goals by offering counselling with regard to family, practical and financial issues seems particularly important.

Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness

PubMed Central

Dettinger, Julia; Calkins, Kimberly; Kibore, Minnie; Gachuno, Onesmus; Walker, Dilys

2018-01-01

Background Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. Objective-method We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. Findings Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. Significance Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted. PMID:29474397

Handling Missing Data: Analysis of a Challenging Data Set Using Multiple Imputation

ERIC Educational Resources Information Center

Pampaka, Maria; Hutcheson, Graeme; Williams, Julian

2016-01-01

Missing data is endemic in much educational research. However, practices such as step-wise regression common in the educational research literature have been shown to be dangerous when significant data are missing, and multiple imputation (MI) is generally recommended by statisticians. In this paper, we provide a review of these advances and their…

A stepwise composite echocardiographic score predicts severe pulmonary hypertension in patients with interstitial lung disease.

PubMed

Bax, Simon; Bredy, Charlene; Kempny, Aleksander; Dimopoulos, Konstantinos; Devaraj, Anand; Walsh, Simon; Jacob, Joseph; Nair, Arjun; Kokosi, Maria; Keir, Gregory; Kouranos, Vasileios; George, Peter M; McCabe, Colm; Wilde, Michael; Wells, Athol; Li, Wei; Wort, Stephen John; Price, Laura C

2018-04-01

European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using the tricuspid regurgitant velocity and right atrial pressure (right ventricular systolic pressure (RVSP)) and additional echocardiographic signs. Consecutive ILD patients with suspected PH underwent RHC between 2005 and 2015. Receiver operating curve analysis tested the ability of components of the score to predict mPAP ≥35 mmHg, and a score devised using a stepwise approach. The score was tested in a contemporaneous validation cohort. The score used "additional PH signs" where RVSP was unavailable, using a bootstrapping technique. Within the derivation cohort (n=210), a score ≥7 predicted severe PH with 89% sensitivity, 71% specificity, positive predictive value 68% and negative predictive value 90%, with similar performance in the validation cohort (n=61) (area under the curve (AUC) 84.8% versus 83.1%, p=0.8). Although RVSP could be estimated in 92% of studies, reducing this to 60% maintained a fair accuracy (AUC 74.4%). This simple stepwise echocardiographic PH score can predict severe PH in patients with ILD.

A stepwise composite echocardiographic score predicts severe pulmonary hypertension in patients with interstitial lung disease

PubMed Central

Bax, Simon; Bredy, Charlene; Kempny, Aleksander; Dimopoulos, Konstantinos; Devaraj, Anand; Walsh, Simon; Jacob, Joseph; Nair, Arjun; Kokosi, Maria; Keir, Gregory; Kouranos, Vasileios; George, Peter M.; McCabe, Colm; Wilde, Michael; Wells, Athol; Li, Wei; Wort, Stephen John; Price, Laura C.

2018-01-01

European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using the tricuspid regurgitant velocity and right atrial pressure (right ventricular systolic pressure (RVSP)) and additional echocardiographic signs. Consecutive ILD patients with suspected PH underwent RHC between 2005 and 2015. Receiver operating curve analysis tested the ability of components of the score to predict mPAP ≥35 mmHg, and a score devised using a stepwise approach. The score was tested in a contemporaneous validation cohort. The score used “additional PH signs” where RVSP was unavailable, using a bootstrapping technique. Within the derivation cohort (n=210), a score ≥7 predicted severe PH with 89% sensitivity, 71% specificity, positive predictive value 68% and negative predictive value 90%, with similar performance in the validation cohort (n=61) (area under the curve (AUC) 84.8% versus 83.1%, p=0.8). Although RVSP could be estimated in 92% of studies, reducing this to 60% maintained a fair accuracy (AUC 74.4%). This simple stepwise echocardiographic PH score can predict severe PH in patients with ILD. PMID:29750141

Joint effect of unlinked genotypes: application to type 2 diabetes in the EPIC-Potsdam case-cohort study.

PubMed

Knüppel, Sven; Meidtner, Karina; Arregui, Maria; Holzhütter, Hermann-Georg; Boeing, Heiner

2015-07-01

Analyzing multiple single nucleotide polymorphisms (SNPs) is a promising approach to finding genetic effects beyond single-locus associations. We proposed the use of multilocus stepwise regression (MSR) to screen for allele combinations as a method to model joint effects, and compared the results with the often used genetic risk score (GRS), conventional stepwise selection, and the shrinkage method LASSO. In contrast to MSR, the GRS, conventional stepwise selection, and LASSO model each genotype by the risk allele doses. We reanalyzed 20 unlinked SNPs related to type 2 diabetes (T2D) in the EPIC-Potsdam case-cohort study (760 cases, 2193 noncases). No SNP-SNP interactions and no nonlinear effects were found. Two SNP combinations selected by MSR (Nagelkerke's R² = 0.050 and 0.048) included eight SNPs with mean allele combination frequency of 2%. GRS and stepwise selection selected nearly the same SNP combinations consisting of 12 and 13 SNPs (Nagelkerke's R² ranged from 0.020 to 0.029). LASSO showed similar results. The MSR method showed the best model fit measured by Nagelkerke's R² suggesting that further improvement may render this method a useful tool in genetic research. However, our comparison suggests that the GRS is a simple way to model genetic effects since it does not consider linkage, SNP-SNP interactions, and no non-linear effects. © 2015 John Wiley & Sons Ltd/University College London.

Order Selection for General Expression of Nonlinear Autoregressive Model Based on Multivariate Stepwise Regression

NASA Astrophysics Data System (ADS)

Shi, Jinfei; Zhu, Songqing; Chen, Ruwen

2017-12-01

An order selection method based on multiple stepwise regressions is proposed for General Expression of Nonlinear Autoregressive model which converts the model order problem into the variable selection of multiple linear regression equation. The partial autocorrelation function is adopted to define the linear term in GNAR model. The result is set as the initial model, and then the nonlinear terms are introduced gradually. Statistics are chosen to study the improvements of both the new introduced and originally existed variables for the model characteristics, which are adopted to determine the model variables to retain or eliminate. So the optimal model is obtained through data fitting effect measurement or significance test. The simulation and classic time-series data experiment results show that the method proposed is simple, reliable and can be applied to practical engineering.

EPA MODELING TOOLS FOR CAPTURE ZONE DELINEATION

EPA Science Inventory

The EPA Office of Research and Development supports a step-wise modeling approach for design of wellhead protection areas for water supply wells. A web-based WellHEDSS (wellhead decision support system) is under development for determining when simple capture zones (e.g., centri...

A survey of variable selection methods in two Chinese epidemiology journals

PubMed Central

2010-01-01

Background Although much has been written on developing better procedures for variable selection, there is little research on how it is practiced in actual studies. This review surveys the variable selection methods reported in two high-ranking Chinese epidemiology journals. Methods Articles published in 2004, 2006, and 2008 in the Chinese Journal of Epidemiology and the Chinese Journal of Preventive Medicine were reviewed. Five categories of methods were identified whereby variables were selected using: A - bivariate analyses; B - multivariable analysis; e.g. stepwise or individual significance testing of model coefficients; C - first bivariate analyses, followed by multivariable analysis; D - bivariate analyses or multivariable analysis; and E - other criteria like prior knowledge or personal judgment. Results Among the 287 articles that reported using variable selection methods, 6%, 26%, 30%, 21%, and 17% were in categories A through E, respectively. One hundred sixty-three studies selected variables using bivariate analyses, 80% (130/163) via multiple significance testing at the 5% alpha-level. Of the 219 multivariable analyses, 97 (44%) used stepwise procedures, 89 (41%) tested individual regression coefficients, but 33 (15%) did not mention how variables were selected. Sixty percent (58/97) of the stepwise routines also did not specify the algorithm and/or significance levels. Conclusions The variable selection methods reported in the two journals were limited in variety, and details were often missing. Many studies still relied on problematic techniques like stepwise procedures and/or multiple testing of bivariate associations at the 0.05 alpha-level. These deficiencies should be rectified to safeguard the scientific validity of articles published in Chinese epidemiology journals. PMID:20920252

Orthostatic Hypotension: A Practical Approach to Investigation and Management.

PubMed

Arnold, Amy C; Raj, Satish R

2017-12-01

The maintenance of blood pressure upon the assumption of upright posture depends on rapid cardiovascular adaptations driven primarily by the autonomic nervous system. Failure of these compensatory mechanisms can result in orthostatic hypotension (OH), defined as sustained reduction in systolic blood pressure > 20 mm Hg or diastolic blood pressure > 10 mm Hg within 3 minutes of standing or > 60° head-up tilt. OH is a common finding, particularly in elderly populations, associated with cardiovascular and cerebrovascular morbidity and mortality. Therefore, it is important to identify OH in the clinical setting. The detection of OH requires blood pressure measurements in the supine and standing positions. A more practical approach in clinics might be measurement of seated and standing blood pressure, but this can produce smaller depressor responses because of reduced gravitational stress. Heart rate responses to standing should be concomitantly measured to assess integrity of baroreflex function. Patients with OH can present with symptoms of cerebral hypoperfusion on standing predisposing to syncope and falls; however, many patients are asymptomatic. When the diagnosis of OH is established, it is important to document potentially deleterious medications and comorbidities and to assess for neurogenic autonomic impairment to establish underlying causes. Treatment should be initiated in a structured and stepwise approach starting with nonpharmacological interventions (eg, lifestyle modifications and physical countermanoeuvres), and adding pharmacological interventions as needed in patients with severe OH (eg, midodrine, droxidopa, fludrocortisone). The treatment goal in OH should be to improve symptoms and functional status, and not to target arbitrary blood pressure values. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

ISECG Global Exploration Roadmap: A Stepwise Approach to Deep Space Exploration

NASA Technical Reports Server (NTRS)

Martinez, Roland; Goodliff, Kandyce; Whitley, Ryan

2013-01-01

In 2011, ISECG released the Global Exploration Roadmap (GER), advancing the "Global Exploration Strategy: The Framework for Coordination" by articulating the perspectives of participating agencies on exploration goals and objectives, mission scenarios, and coordination of exploration preparatory activities. The GER featured a stepwise development and demonstration of capabilities ultimately required for human exploration of Mars. In 2013 the GER was updated to reflect the ongoing evolution of agency's exploration policies and plans, informed by individual agency and coordinated analysis activities that are relevant to various elements of the GER framework as well as coordinated stakeholder engagement activities. For this release of version 2 of the GER in the mid 2013 timeframe, a modified mission scenario is presented, more firmly reflecting the importance of a stepwise evolution of critical capabilities provided by multiple partners necessary for executing increasingly complex missions to multiple destinations and leading to human exploration of Mars. This paper will describe the updated mission scenario, the changes since the release of version 1, the mission themes incorporated into the scenario, and risk reduction for Mars missions provided by exploration at various destinations.

The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities

PubMed Central

Guthold, Regina; Cowan, Melanie; Savin, Stefan; Bhatti, Lubna; Armstrong, Timothy; Bonita, Ruth

2016-01-01

Objectives. We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance. Methods. STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants. Results. To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys. Conclusions. STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS’ capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide. PMID:26696288

The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities.

PubMed

Riley, Leanne; Guthold, Regina; Cowan, Melanie; Savin, Stefan; Bhatti, Lubna; Armstrong, Timothy; Bonita, Ruth

2016-01-01

We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance. STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants. To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys. STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS' capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide.

Ethanol dehydration in HZSM-5 studied by density functional theory: evidence for a concerted process.

PubMed

Kim, Seonah; Robichaud, David J; Beckham, Gregg T; Paton, Robert S; Nimlos, Mark R

2015-04-16

Dehydration over acidic zeolites is an important reaction class for the upgrading of biomass pyrolysis vapors to hydrocarbon fuels or to precursors for myriad chemical products. Here, we examine the dehydration of ethanol at a Brønsted acid site, T12, found in HZSM-5 using density functional theory (DFT). The geometries of both cluster and mixed quantum mechanics/molecular mechanics (QM:MM) models are prepared from the ZSM-5 crystal structure. Comparisons between these models and different DFT methods are conducted to show similar results among the models and methods used. Inclusion of the full catalyst cavity through a QM:MM approach is found to be important, since activation barriers are computed on average as 7 kcal mol(-1) lower than those obtained with a smaller cluster model. Two different pathways, concerted and stepwise, have been considered when examining dehydration and deprotonation steps. The current study shows that a concerted dehydration process is possible with a lower (4-5 kcal mol(-1)) activation barrier while previous literature studies have focused on a stepwise mechanism. Overall, this work demonstrates that fairly high activation energies (∼50 kcal mol(-1)) are required for ethanol dehydration. A concerted mechanism is favored over a stepwise mechanism because charge separation in the transition state is minimized. QM:MM approaches appear to provide superior results to cluster calculations due to a more accurate representation of charges on framework oxygen atoms.

Comparison of the diabetes guidelines from the ADA/EASD and the AACE/ACE.

PubMed

Cornell, Susan

To compare recent diabetes guideline updates from the American Diabetes Association-European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists-American College of Endocrinology (AACE/ACE). The ADA/EASD guideline continues to advocate a stepwise approach to glycemic control that initiates with metformin and intensifies treatment incrementally to dual and triple therapy at 3-month intervals until the patient is at their individualized goal. The AACE/ACE guideline provides a broader choice of first-line medications, with a suggested hierarchy of use, and it encourages initial dual and triple therapy if the glycated hemoglobin (A1C) level is high enough at diagnosis (7.5%-9.0% and >9.0%, respectively). Target A1C levels are higher in the ADA/EASD guideline (≤7.0%) compared with the AACE/ACE guideline (≤6.5%), although both statements indicate that targets should be adjusted to specific clinical scenarios based on safety. Both guidelines now include the new sodium-glucose cotransporter-2 inhibitors among their choices of acceptable glucose-lowering medications and endorse the overall cardiovascular and pancreatic safety of incretin therapies, and the safety of pioglitazone vis-a-vis bladder cancer. In practice, the ADA/EASD guidelines tend to be more user-friendly for general practitioners because of the simple stepwise intensification regimen, whereas the AACE/ACE guidelines are more commonly followed by specialists (endocrinologists) because of the more aggressive A1C targets. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

“Brevity is the Soul of Wit”: Use of a Stepwise Project to Teach Concise Scientific Writing

PubMed Central

Cyr, Nicole E.

2017-01-01

Skillful writing is essential for professionals in science and medicine. Consequently, many undergraduate institutions have adjusted their curriculum to include in-depth instruction and practice in writing for students majoring in the sciences. In neuroscience, students are often asked to write a laboratory report in the style of a primary scientific article or a term paper structured like a review article. Typically, students write section by section and build up to the final draft of a complete paper. In this way, students learn how to write a scientific paper. While learning to write such a paper is important, this is not the only type of written communication relevant to scientific careers. Here, I describe a stepwise writing project aimed to improve editing, succinctness, and the ability to synthesize the literature. Furthermore, I provide feedback from the students, and discuss the advantages and challenges of this project. PMID:29371841

Diagnosis of Chronic Kidney Disease Based on Support Vector Machine by Feature Selection Methods.

PubMed

Polat, Huseyin; Danaei Mehr, Homay; Cetin, Aydin

2017-04-01

As Chronic Kidney Disease progresses slowly, early detection and effective treatment are the only cure to reduce the mortality rate. Machine learning techniques are gaining significance in medical diagnosis because of their classification ability with high accuracy rates. The accuracy of classification algorithms depend on the use of correct feature selection algorithms to reduce the dimension of datasets. In this study, Support Vector Machine classification algorithm was used to diagnose Chronic Kidney Disease. To diagnose the Chronic Kidney Disease, two essential types of feature selection methods namely, wrapper and filter approaches were chosen to reduce the dimension of Chronic Kidney Disease dataset. In wrapper approach, classifier subset evaluator with greedy stepwise search engine and wrapper subset evaluator with the Best First search engine were used. In filter approach, correlation feature selection subset evaluator with greedy stepwise search engine and filtered subset evaluator with the Best First search engine were used. The results showed that the Support Vector Machine classifier by using filtered subset evaluator with the Best First search engine feature selection method has higher accuracy rate (98.5%) in the diagnosis of Chronic Kidney Disease compared to other selected methods.

A Graph Oriented Approach for Network Forensic Analysis

ERIC Educational Resources Information Center

Wang, Wei

2010-01-01

Network forensic analysis is a process that analyzes intrusion evidence captured from networked environment to identify suspicious entities and stepwise actions in an attack scenario. Unfortunately, the overwhelming amount and low quality of output from security sensors make it difficult for analysts to obtain a succinct high-level view of complex…

Working with Evaluation Stakeholders: A Rationale, Step-Wise Approach and Toolkit

ERIC Educational Resources Information Center

Bryson, John M.; Patton, Michael Quinn; Bowman, Ruth A.

2011-01-01

In the broad field of evaluation, the importance of stakeholders is often acknowledged and different categories of stakeholders are identified. Far less frequent is careful attention to analysis of stakeholders' interests, needs, concerns, power, priorities, and perspectives and subsequent application of that knowledge to the design of…

Photoprecursor approach as an effective means for preparing multilayer organic semiconducting thin films by solution processes

PubMed Central

Yamaguchi, Yuji; Suzuki, Mitsuharu; Motoyama, Takao; Sugii, Shuhei; Katagiri, Chiho; Takahira, Katsuya; Ikeda, Shinya; Yamada, Hiroko; Nakayama, Ken-ichi

2014-01-01

The vertical composition profile of active layer has a major effect on the performance of organic photovoltaic devices (OPVs). While stepwise deposition of different materials is a conceptually straightforward method for controlled preparation of multi-component active layers, it is practically challenging for solution processes because of dissolution of the lower layer. Herein, we overcome this difficulty by employing the photoprecursor approach, in which a soluble photoprecursor is solution-deposited then photoconverted in situ to a poorly soluble organic semiconductor. This approach enables solution-processing of the p-i-n triple-layer architecture that has been suggested to be effective in obtaining efficient OPVs. We show that, when 2,6-dithienylanthracene and a fullerene derivative PC71BM are used as donor and acceptor, respectively, the best p-i-n OPV affords a higher photovoltaic efficiency than the corresponding p-n device by 24% and bulk-heterojunction device by 67%. The photoprecursor approach is also applied to preparation of three-component p-i-n films containing another donor 2,6-bis(5′-(2-ethylhexyl)-(2,2′-bithiophen)-5-yl)anthracene in the i-layer to provide a nearly doubled efficiency as compared to the original two-component p-i-n system. These results indicate that the present approach can serve as an effective means for controlled preparation of well-performing multi-component active layers in OPVs and related organic electronic devices. PMID:25413952

Implementing and Assessing Inquiry-Based Learning through the CAREER Award

NASA Astrophysics Data System (ADS)

Brudzinski, M. R.

2011-12-01

In order to fully attain the benefits of inquiry-based learning, instructors who typically employ the traditional lecture format need to make many adjustments to their approach. This change in styles can be intimidating and logistically difficult to overcome, both for instructors and students, such that a stepwise approach to this transformation is likely to be more manageable. In this session, I will describe a series of tools to promote inquiry-based learning that I am helping to implement and assess in classroom courses and student research projects. I will demonstrate the importance of integrating with existing institutional initiatives as well as recognizing how student development plays a key role in student engagement. Some of the features I will highlight include: defining both student learning outcomes and student development outcomes, converting content training to be self-directed and asynchronous, utilizing conceptests to help students practice thinking like scientists, and employing both objective pre/post assessment and student self-reflective assessment. Lastly, I will reflect on how the well-defined goal of teaching and research integration in the CAREER award solicitation resonated with me even as an undergraduate and helped inspire my early career.

Advancing alternatives analysis: The role of predictive toxicology in selecting safer chemical products and processes.

PubMed

Malloy, Timothy; Zaunbrecher, Virginia; Beryt, Elizabeth; Judson, Richard; Tice, Raymond; Allard, Patrick; Blake, Ann; Cote, Ila; Godwin, Hilary; Heine, Lauren; Kerzic, Patrick; Kostal, Jakub; Marchant, Gary; McPartland, Jennifer; Moran, Kelly; Nel, Andre; Ogunseitan, Oladele; Rossi, Mark; Thayer, Kristina; Tickner, Joel; Whittaker, Margaret; Zarker, Ken

2017-09-01

Alternatives analysis (AA) is a method used in regulation and product design to identify, assess, and evaluate the safety and viability of potential substitutes for hazardous chemicals. It requires toxicological data for the existing chemical and potential alternatives. Predictive toxicology uses in silico and in vitro approaches, computational models, and other tools to expedite toxicological data generation in a more cost-effective manner than traditional approaches. The present article briefly reviews the challenges associated with using predictive toxicology in regulatory AA, then presents 4 recommendations for its advancement. It recommends using case studies to advance the integration of predictive toxicology into AA, adopting a stepwise process to employing predictive toxicology in AA beginning with prioritization of chemicals of concern, leveraging existing resources to advance the integration of predictive toxicology into the practice of AA, and supporting transdisciplinary efforts. The further incorporation of predictive toxicology into AA would advance the ability of companies and regulators to select alternatives to harmful ingredients, and potentially increase the use of predictive toxicology in regulation more broadly. Integr Environ Assess Manag 2017;13:915-925. © 2017 SETAC. © 2017 SETAC.

Studies of Transgenic Mosquitoes in Disease-Endemic Countries: Preparation of Containment Facilities

PubMed Central

Mutunga, James Mutuku; Diabaté, Abdoulaye; Namountougou, Moussa; Coulibaly, Mamadou B.; Sylla, Lakamy; Kayondo, Jonathan; Balyesima, Victor; Clark, Lorna; Benedict, Mark Q.; Raymond, Peter

2018-01-01

Abstract Novel approaches to area-wide control of vector species offer promise as additional tools in the fight against vectored diseases. Evaluation of transgenic insect strains aimed at field population control in disease-endemic countries may involve international partnerships and should be done in a stepwise approach, starting with studies in containment facilities. The preparations of both new-build and renovated facilities are described, including working with local and national regulations regarding land use, construction, and biosafety requirements, as well as international guidance to fill any gaps in regulation. The examples given are for containment categorization at Arthropod Containment Level 2 for initial facility design, classification of wastes, and precautions during shipping. Specific lessons were derived from preparations to evaluate transgenic (non-gene drive) mosquitoes in West and East African countries. Documented procedures and the use of a non-transgenic training strain for trial shipments and culturing were used to develop competence and confidence among the African facility staff, and along the chain of custody for transport. This practical description is offered to support other research consortia or institutions preparing containment facilities and operating procedures in conditions where research on transgenic insects is at an early stage. PMID:29337662

Studies of Transgenic Mosquitoes in Disease-Endemic Countries: Preparation of Containment Facilities.

PubMed

Quinlan, M Megan; Mutunga, James Mutuku; Diabaté, Abdoulaye; Namountougou, Moussa; Coulibaly, Mamadou B; Sylla, Lakamy; Kayondo, Jonathan; Balyesima, Victor; Clark, Lorna; Benedict, Mark Q; Raymond, Peter

2018-01-01

Novel approaches to area-wide control of vector species offer promise as additional tools in the fight against vectored diseases. Evaluation of transgenic insect strains aimed at field population control in disease-endemic countries may involve international partnerships and should be done in a stepwise approach, starting with studies in containment facilities. The preparations of both new-build and renovated facilities are described, including working with local and national regulations regarding land use, construction, and biosafety requirements, as well as international guidance to fill any gaps in regulation. The examples given are for containment categorization at Arthropod Containment Level 2 for initial facility design, classification of wastes, and precautions during shipping. Specific lessons were derived from preparations to evaluate transgenic (non-gene drive) mosquitoes in West and East African countries. Documented procedures and the use of a non-transgenic training strain for trial shipments and culturing were used to develop competence and confidence among the African facility staff, and along the chain of custody for transport. This practical description is offered to support other research consortia or institutions preparing containment facilities and operating procedures in conditions where research on transgenic insects is at an early stage.

Impact of automation on mass spectrometry.

PubMed

Zhang, Yan Victoria; Rockwood, Alan

2015-10-23

Mass spectrometry coupled to liquid chromatography (LC-MS and LC-MS/MS) is an analytical technique that has rapidly grown in popularity in clinical practice. In contrast to traditional technology, mass spectrometry is superior in many respects including resolution, specificity, multiplex capability and has the ability to measure analytes in various matrices. Despite these advantages, LC-MS/MS remains high cost, labor intensive and has limited throughput. This specialized technology requires highly trained personnel and therefore has largely been limited to large institutions, academic organizations and reference laboratories. Advances in automation will be paramount to break through this bottleneck and increase its appeal for routine use. This article reviews these challenges, shares perspectives on essential features for LC-MS/MS total automation and proposes a step-wise and incremental approach to achieve total automation through reducing human intervention, increasing throughput and eventually integrating the LC-MS/MS system into the automated clinical laboratory operations. Copyright © 2015 Elsevier B.V. All rights reserved.

Medications and breast-feeding: Current concepts.

PubMed

Nice, Frank J; Luo, Amy C

2012-01-01

To describe the various factors that come into play when a breast-feeding mother is taking medications, including use of prescription drugs, over-the-counter medications, recreational drugs, galactogogues, and herbal remedies and to provide a framework used for counseling breast-feeding women. Community and hospital pharmacy and health care settings. Consultative services provided to breast-feeding mothers who had been prescribed or were using medications. Use of pharmacokinetic factors, maternal and child factors, a list of questions to ask breast-feeding mothers, and a stepwise approach to counsel breast-feeding mothers on the compatibility of using medications while breast-feeding. By positive intervention of pharmacists and health care providers, up to 1 million breast-feeding mothers, who must use medications, can continue to breast-feed while taking medications. Objectively weighing the benefits of drugs and breast-feeding versus the risks of drugs and not breast-feeding, in most cases, allows for pharmacists to give current and practical advice to mothers and other health professionals who counsel mothers.

American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines.

PubMed

Conwell, Darwin L; Lee, Linda S; Yadav, Dhiraj; Longnecker, Daniel S; Miller, Frank H; Mortele, Koenraad J; Levy, Michael J; Kwon, Richard; Lieb, John G; Stevens, Tyler; Toskes, Phillip P; Gardner, Timothy B; Gelrud, Andres; Wu, Bechien U; Forsmark, Christopher E; Vege, Santhi S

2014-11-01

The diagnosis of chronic pancreatitis remains challenging in early stages of the disease. This report defines the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. All current diagnostic procedures are reviewed, and evidence-based statements are provided about their utility and limitations. Diagnostic criteria for chronic pancreatitis are classified as definitive, probable, or insufficient evidence. A diagnostic (STEP-wise; survey, tomography, endoscopy, and pancreas function testing) algorithm is proposed that proceeds from a noninvasive to a more invasive approach. This algorithm maximizes specificity (low false-positive rate) in subjects with chronic abdominal pain and equivocal imaging changes. Furthermore, a nomenclature is suggested to further characterize patients with established chronic pancreatitis based on TIGAR-O (toxic, idiopathic, genetic, autoimmune, recurrent, and obstructive) etiology, gland morphology (Cambridge criteria), and physiologic state (exocrine, endocrine function) for uniformity across future multicenter research collaborations. This guideline will serve as a baseline manuscript that will be modified as new evidence becomes available and our knowledge of chronic pancreatitis improves.

Developing and marketing a community pharmacy-based asthma management program.

PubMed

Rupp, M T; McCallian, D J; Sheth, K K

1997-01-01

To develop a community pharmacy-based asthma management program and successfully market the program to a managed care organization. Community-based ambulatory care. Independent community pharmacy. Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.

Integrating uniform design and response surface methodology to optimize thiacloprid suspension

PubMed Central

Li, Bei-xing; Wang, Wei-chang; Zhang, Xian-peng; Zhang, Da-xia; Mu, Wei; Liu, Feng

2017-01-01

A model 25% suspension concentrate (SC) of thiacloprid was adopted to evaluate an integrative approach of uniform design and response surface methodology. Tersperse2700, PE1601, xanthan gum and veegum were the four experimental factors, and the aqueous separation ratio and viscosity were the two dependent variables. Linear and quadratic polynomial models of stepwise regression and partial least squares were adopted to test the fit of the experimental data. Verification tests revealed satisfactory agreement between the experimental and predicted data. The measured values for the aqueous separation ratio and viscosity were 3.45% and 278.8 mPa·s, respectively, and the relative errors of the predicted values were 9.57% and 2.65%, respectively (prepared under the proposed conditions). Comprehensive benefits could also be obtained by appropriately adjusting the amount of certain adjuvants based on practical requirements. Integrating uniform design and response surface methodology is an effective strategy for optimizing SC formulas. PMID:28383036

Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus.

PubMed

Bou, Rosa; Adán, Alfredo; Borrás, Fátima; Bravo, Beatriz; Calvo, Inmaculada; De Inocencio, Jaime; Díaz, Jesús; Escudero, Julia; Fonollosa, Alex; de Vicuña, Carmen García; Hernández, Victoria; Merino, Rosa; Peralta, Jesús; Rúa, María-Jesús; Tejada, Pilar; Antón, Jordi

2015-05-01

Uveitis associated with juvenile idiopathic arthritis (JIA) typically involves the anterior chamber segment, follows an indolent chronic course, and presents a high rate of uveitic complications and a worse outcome as compared to other aetiologies of uveitis. Disease assessment, treatment, and outcome measures have not been standardized. Collaboration between pediatric rheumatologists and ophthalmologists is critical for effective management and prevention of morbidity, impaired vision, and irreparable visual loss. Although the Standardization of Uveitis Nomenclature Working Group recommendations have been a great advance to help clinicians to improve consistency in grading and reporting data, difficulties arise at the time of deciding the best treatment approach in the individual patient in routine daily practice. For this reason, recommendations for a systematized control and treatment strategies according to clinical characteristics and disease severity in children with JIA-related uveitis were developed by a panel of experts with special interest in uveitis associated with JIA. A clinical management algorithm organized in a stepwise regimen is here presented.

[A Multimedia Tutorial to Train Ultrasonography of the Thyroid for Medical Students].

PubMed

Ritter, Julia; Wolfram, Maximilian; Schuler, Stefan; Guntinas-Lichius, Orlando

2017-11-01

Physicians in education often have poor experience in practice and assessment of ultrasonography on entering their profession, due to a deficiency of training offers during their study of medicine. Hence, a multimedia device for stepwise learning and training ultrasonography of the thyroid was developed. A software for a portable ultrasonography system was used to design a multimedia device for ultrasonography of the thyroid. It allows the user to illustrate texts and pictorial material simultaneously with ultrasound examination in order to compare own findings with examples from a database. The device was evaluated by 8 medical students and compared to a tutor-guided training. A structured, stepwise manual for ultrasonography of the thyroid with a large content of examples in different sectional images was designed for simultaneous reconstruction with the ultrasonography device. The informative content of the device and the replicability of the examination procedure were evaluated positively. Assessment respecting clarity, eligibility for users without experience and learning success was varying. The tutorial to learn and train ultrasonography of the thyroid is an instrument for self-learning and improving practical education in ultrasonography in medical education. In the next version, the manual for the examination will be structured in greater detail. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of job satisfaction and working atmosphere of dental nurses in Germany.

PubMed

Goetz, Katja; Hasse, Philipp; Campbell, Stephen M; Berger, Sarah; Dörfer, Christof E; Hahn, Karolin; Szecsenyi, Joachim

2016-02-01

The purpose of the study was to assess the level of job satisfaction of dental nurses in ambulatory care and to explore the impact of aspects of working atmosphere on and their association with job satisfaction. This cross-sectional study was based on a job satisfaction survey. Data were collected from 612 dental nurses working in 106 dental care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Working atmosphere was measured with five items. Linear regression analyses were performed in which each item of the job satisfaction scale was handled as dependent variables. A stepwise linear regression analysis was performed with overall job satisfaction and the five items of working atmosphere, job satisfaction, and individual characteristics. The response rate was 88.3%. Dental nurses were satisfied with 'colleagues' and least satisfied with 'income.' Different aspects of job satisfaction were mostly associated with the following working atmosphere issues: 'responsibilities within the practice team are clear,' 'suggestions for improvement are taken seriously,' 'working atmosphere in the practice team is good,' and 'made easier to admit own mistakes.' Within the stepwise linear regression analysis, the aspect 'physical working condition' (β = 0.304) showed the highest association with overall job satisfaction. The total explained variance of the 14 associated variables was 0.722 with overall job satisfaction. Working atmosphere within this discrete sample of dental care practice seemed to be an important influence on reported working condition and job satisfaction for dental nurses. Because of the high association of job satisfaction with physical working condition, the importance of paying more attention to an ergonomic working position for dental nurses to ensure optimal quality of care is highlighted. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Krypton and xenon in lunar fines

NASA Technical Reports Server (NTRS)

Basford, J. R.; Dragon, J. C.; Pepin, R. O.; Coscio, M. R., Jr.; Murthy, V. R.

1973-01-01

Data from grain-size separates, stepwise-heated fractions, and bulk analyses of 20 samples of fines and breccias from five lunar sites are used to define three-isotope and ordinate intercept correlations in an attempt to resolve the lunar heavy rare gas system in a statistically valid approach. Tables of concentrations and isotope compositions are given.

Estimating raw material equivalents on a macro-level: comparison of multi-regional input-output analysis and hybrid LCI-IO.

PubMed

Schoer, Karl; Wood, Richard; Arto, Iñaki; Weinzettel, Jan

2013-12-17

The mass of material consumed by a population has become a useful proxy for measuring environmental pressure. The "raw material equivalents" (RME) metric of material consumption addresses the issue of including the full supply chain (including imports) when calculating national or product level material impacts. The RME calculation suffers from data availability, however, as quantitative data on production practices along the full supply chain (in different regions) is required. Hence, the RME is currently being estimated by three main approaches: (1) assuming domestic technology in foreign economies, (2) utilizing region-specific life-cycle inventories (in a hybrid framework), and (3) utilizing multi-regional input-output (MRIO) analysis to explicitly cover all regions of the supply chain. While the first approach has been shown to give inaccurate results, this paper focuses on the benefits and costs of the latter two approaches. We analyze results from two key (MRIO and hybrid) projects modeling raw material equivalents, adjusting the models in a stepwise manner in order to quantify the effects of individual conceptual elements. We attempt to isolate the MRIO gap, which denotes the quantitative impact of calculating the RME of imports by an MRIO approach instead of the hybrid model, focusing on the RME of EU external trade imports. While, the models give quantitatively similar results, differences become more pronounced when tracking more detailed material flows. We assess the advantages and disadvantages of the two approaches and look forward to ways to further harmonize data and approaches.

Quantitative laser-induced breakdown spectroscopy data using peak area step-wise regression analysis: an alternative method for interpretation of Mars science laboratory results

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

Clegg, Samuel M; Barefield, James E; Wiens, Roger C

2008-01-01

The ChemCam instrument on the Mars Science Laboratory (MSL) will include a laser-induced breakdown spectrometer (LIBS) to quantify major and minor elemental compositions. The traditional analytical chemistry approach to calibration curves for these data regresses a single diagnostic peak area against concentration for each element. This approach contrasts with a new multivariate method in which elemental concentrations are predicted by step-wise multiple regression analysis based on areas of a specific set of diagnostic peaks for each element. The method is tested on LIBS data from igneous and metamorphosed rocks. Between 4 and 13 partial regression coefficients are needed to describemore » each elemental abundance accurately (i.e., with a regression line of R{sup 2} > 0.9995 for the relationship between predicted and measured elemental concentration) for all major and minor elements studied. Validation plots suggest that the method is limited at present by the small data set, and will work best for prediction of concentration when a wide variety of compositions and rock types has been analyzed.« less

Size-Induced Segregation in the Stepwise Microhydration of Hydantoin and Its Role in Proton-Induced Charge Transfer

NASA Astrophysics Data System (ADS)

Calvo, Florent; Bacchus-Montabonel, Marie-Christine

2018-01-01

Recent photochemistry experiments provided evidence for the formation of hydantoin by irradiation of interstellar ice analogues. The significance of these results and the importance of hydantoin in prebiotic chemistry and polypeptide synthesis motivate the present theoretical investigation, in which we analyzed the effects of stepwise hydration on the electronic and thermodynamical properties of the structure of microhydrated hydantoin using a variety of computational approaches. We generally find microhydration to proceed around the hydantoin heterocycle until 5 water molecules are reached, at which stage hydration becomes segregated with a water cluster forming aside the heterocycle. The reactivity of microhydrated hydantoin caused by an impinging proton was evaluated through charge transfer collision cross sections for microhydrated compounds but also for hydantoin on icy grains modeled using a cluster approach mimicking the true hexagonal ice surface. The effects of hydration on charge transfer efficiency are mostly significant when few water molecules are present, and they progressively weaken and stabilize in larger clusters. On the ice substrate, charge transfer essentially contributes to a global increase in the cross sections.

Optimizing separate phase light hydrocarbon recovery from contaminated unconfined aquifers

NASA Astrophysics Data System (ADS)

Cooper, Grant S.; Peralta, Richard C.; Kaluarachchi, Jagath J.

A modeling approach is presented that optimizes separate phase recovery of light non-aqueous phase liquids (LNAPL) for a single dual-extraction well in a homogeneous, isotropic unconfined aquifer. A simulation/regression/optimization (S/R/O) model is developed to predict, analyze, and optimize the oil recovery process. The approach combines detailed simulation, nonlinear regression, and optimization. The S/R/O model utilizes nonlinear regression equations describing system response to time-varying water pumping and oil skimming. Regression equations are developed for residual oil volume and free oil volume. The S/R/O model determines optimized time-varying (stepwise) pumping rates which minimize residual oil volume and maximize free oil recovery while causing free oil volume to decrease a specified amount. This S/R/O modeling approach implicitly immobilizes the free product plume by reversing the water table gradient while achieving containment. Application to a simple representative problem illustrates the S/R/O model utility for problem analysis and remediation design. When compared with the best steady pumping strategies, the optimal stepwise pumping strategy improves free oil recovery by 11.5% and reduces the amount of residual oil left in the system due to pumping by 15%. The S/R/O model approach offers promise for enhancing the design of free phase LNAPL recovery systems and to help in making cost-effective operation and management decisions for hydrogeologists, engineers, and regulators.

Application of the modified chi-square ratio statistic in a stepwise procedure for cascade impactor equivalence testing.

PubMed

Weber, Benjamin; Lee, Sau L; Delvadia, Renishkumar; Lionberger, Robert; Li, Bing V; Tsong, Yi; Hochhaus, Guenther

2015-03-01

Equivalence testing of aerodynamic particle size distribution (APSD) through multi-stage cascade impactors (CIs) is important for establishing bioequivalence of orally inhaled drug products. Recent work demonstrated that the median of the modified chi-square ratio statistic (MmCSRS) is a promising metric for APSD equivalence testing of test (T) and reference (R) products as it can be applied to a reduced number of CI sites that are more relevant for lung deposition. This metric is also less sensitive to the increased variability often observed for low-deposition sites. A method to establish critical values for the MmCSRS is described here. This method considers the variability of the R product by employing a reference variance scaling approach that allows definition of critical values as a function of the observed variability of the R product. A stepwise CI equivalence test is proposed that integrates the MmCSRS as a method for comparing the relative shapes of CI profiles and incorporates statistical tests for assessing equivalence of single actuation content and impactor sized mass. This stepwise CI equivalence test was applied to 55 published CI profile scenarios, which were classified as equivalent or inequivalent by members of the Product Quality Research Institute working group (PQRI WG). The results of the stepwise CI equivalence test using a 25% difference in MmCSRS as an acceptance criterion provided the best matching with those of the PQRI WG as decisions of both methods agreed in 75% of the 55 CI profile scenarios.

In preparation of the nationwide dissemination of the school-based obesity prevention program DOiT: stepwise development applying the intervention mapping protocol.

PubMed

van Nassau, Femke; Singh, Amika S; van Mechelen, Willem; Brug, Johannes; Chin A Paw, Mai J M

2014-08-01

The school-based Dutch Obesity Intervention in Teenagers (DOiT) program is an evidence-based obesity prevention program. In preparation for dissemination throughout the Netherlands, this study aimed to adapt the initial program and to develop an implementation strategy and materials. We revisited the Intervention Mapping (IM) protocol, using results of the previous process evaluation and additional focus groups and interviews with students, parents, teachers, and professionals. The adapted 2-year DOiT program consists of a classroom, an environmental and a parental component. The year 1 lessons aim to increase awareness and knowledge of healthy behaviors. The lessons in year 2 focus on the influence of the (obesogenic) environment. The stepwise development of the implementation strategy resulted in objectives that support teachers' implementation. We developed a 7-step implementation strategy and supporting materials by translating the objectives into essential elements and practical strategies. This study illustrates how revisiting the IM protocol resulted in an adapted program and tailored implementation strategy based on previous evaluations as well as input from different stakeholders. The stepwise development of DOiT can serve as an example for other evidence-based programs in preparation for wider dissemination. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

QSPR models for half-wave reduction potential of steroids: a comparative study between feature selection and feature extraction from subsets of or entire set of descriptors.

PubMed

Hemmateenejad, Bahram; Yazdani, Mahdieh

2009-02-16

Steroids are widely distributed in nature and are found in plants, animals, and fungi in abundance. A data set consists of a diverse set of steroids have been used to develop quantitative structure-electrochemistry relationship (QSER) models for their half-wave reduction potential. Modeling was established by means of multiple linear regression (MLR) and principle component regression (PCR) analyses. In MLR analysis, the QSPR models were constructed by first grouping descriptors and then stepwise selection of variables from each group (MLR1) and stepwise selection of predictor variables from the pool of all calculated descriptors (MLR2). Similar procedure was used in PCR analysis so that the principal components (or features) were extracted from different group of descriptors (PCR1) and from entire set of descriptors (PCR2). The resulted models were evaluated using cross-validation, chance correlation, application to prediction reduction potential of some test samples and accessing applicability domain. Both MLR approaches represented accurate results however the QSPR model found by MLR1 was statistically more significant. PCR1 approach produced a model as accurate as MLR approaches whereas less accurate results were obtained by PCR2 approach. In overall, the correlation coefficients of cross-validation and prediction of the QSPR models resulted from MLR1, MLR2 and PCR1 approaches were higher than 90%, which show the high ability of the models to predict reduction potential of the studied steroids.

Embracing value co-creation in primary care services research: a framework for success.

PubMed

Janamian, Tina; Crossland, Lisa; Jackson, Claire L

2016-04-18

Value co-creation redresses a key criticism of researcher-driven approaches to research - that researchers may lack insight into the end users' needs and values across the research journey. Value co-creation creates, in a step-wise way, value with, and for, multiple stakeholders through regular, ongoing interactions leading to innovation, increased productivity and co-created outcomes of value to all parties - thus creating a "win more-win more" environment. The Centre of Research Excellence (CRE) in Building Primary Care Quality, Performance and Sustainability has co-created outcomes of value that have included robust and enduring partnerships, research findings that have value to end users (such as the Primary Care Practice Improvement Tool and the best-practice governance framework), an International Implementation Research Network in Primary Care and the International Primary Health Reform Conference. Key lessons learned in applying the strategies of value co-creation have included the recognition that partnership development requires an investment of time and effort to ensure meaningful interactions and enriched end user experiences, that research management systems including governance, leadership and communication also need to be "co-creative", and that openness and understanding is needed to work across different sectors and cultures with flexibility, fairness and transparency being essential to the value co-creation process.

Characterization of complex systems using the design of experiments approach: transient protein expression in tobacco as a case study.

PubMed

Buyel, Johannes Felix; Fischer, Rainer

2014-01-31

Plants provide multiple benefits for the production of biopharmaceuticals including low costs, scalability, and safety. Transient expression offers the additional advantage of short development and production times, but expression levels can vary significantly between batches thus giving rise to regulatory concerns in the context of good manufacturing practice. We used a design of experiments (DoE) approach to determine the impact of major factors such as regulatory elements in the expression construct, plant growth and development parameters, and the incubation conditions during expression, on the variability of expression between batches. We tested plants expressing a model anti-HIV monoclonal antibody (2G12) and a fluorescent marker protein (DsRed). We discuss the rationale for selecting certain properties of the model and identify its potential limitations. The general approach can easily be transferred to other problems because the principles of the model are broadly applicable: knowledge-based parameter selection, complexity reduction by splitting the initial problem into smaller modules, software-guided setup of optimal experiment combinations and step-wise design augmentation. Therefore, the methodology is not only useful for characterizing protein expression in plants but also for the investigation of other complex systems lacking a mechanistic description. The predictive equations describing the interconnectivity between parameters can be used to establish mechanistic models for other complex systems.

Neuropsychology 3.0: Evidence-Based Science and Practice

PubMed Central

Bilder, Robert M.

2011-01-01

Neuropsychology is poised for transformations of its concepts and methods, leveraging advances in neuroimaging, the human genome project, psychometric theory, and information technologies. It is argued that a paradigm shift towards evidence-based science and practice can be enabled by innovations, including: (1) formal definition of neuropsychological concepts and tasks in cognitive ontologies; (2) creation of collaborative neuropsychological knowledgebases; and (3) design of web-based assessment methods that permit free development, large-sample implementation, and dynamic refinement of neuropsychological tests and the constructs these aim to assess. This article considers these opportunities, highlights selected obstacles, and offers suggestions for stepwise progress towards these goals. PMID:21092355

Brucine diol-copper-catalyzed asymmetric synthesis of endo-pyrrolidines: the mechanistic dichotomy of imino esters.

PubMed

Li, Jian-Yuan; Kim, Hun Young; Oh, Kyungsoo

2015-03-06

Enantio- and diastereodivergent approaches to pyrrolidines are described by using catalyst- and substrate-controlled reaction pathways. A concerted endo-selective [3 + 2]-cycloaddition pathway is developed for the reaction of methyl imino ester, whereas endo-pyrrolidines with an opposite absolute stereochemical outcome are prepared by using the stepwise reaction pathway of tert-butyl imino ester. The development of catalyst- and substrate-controlled stereodivergent approaches highlights the inherent substrate-catalyst interactions in the [3 + 2]-cycloaddition reactions of metalated azomethine ylides.

Service users' expectations of treatment and support at the Community Mental Health Centre in their recovery.

PubMed

Biringer, Eva; Davidson, Larry; Sundfør, Bengt; Ruud, Torleif; Borg, Marit

2017-09-01

Focus on service users' needs, coping and empowerment, user involvement, and comprehensiveness are supposed to be key elements of the Community Mental Health Centres in Norway. Taking a user-oriented approach means acknowledging the individual's own expectations, aims and hopes. However, studies that have investigated service users' expectations of treatment and support at Community Mental Health Centres are hard to find. The aim of the study was therefore to explore service users' expectations at the start of treatment at a Community Mental Health Centre. Within a collaborative framework, taking a hermeneutic-phenomenological approach, ten service users participated in in-depth interviews about their expectations, hopes and aims for treatment and recovery. The participants sought help due to various mental health issues that had interfered with their lives and created disability and suffering. A data-driven stepwise approach in line with thematic analysis was used. The study was approved by the Norwegian Social Science Data Services. The following four main themes representing participants' expectations at the start of treatment were elicited: hope for recovery, developing understanding, finding tools for coping and receiving counselling and practical assistance. Participants' expectations about treatment were tightly interwoven with their personal aims and hopes for their future life, and expectations were often related to practical and financial problems, the solution of which being deemed necessary to gain a safe basis for recovery in the long run. The transferability of the results may be limited by the small number of participants. The study emphasises how important it is that service users' personal aims and expectations guide the collaborative treatment process. In addition to providing treatment aimed at improving symptoms, Community Mental Health Centres should take a more comprehensive approach than today by providing more support with family issues, social life, education, work and financial issues. © 2016 Nordic College of Caring Science.

A practical and systematic approach to organisational capacity strengthening for research in the health sector in Africa.

PubMed

Bates, Imelda; Boyd, Alan; Smith, Helen; Cole, Donald C

2014-03-03

Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. Our objective here was to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. We used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. Our paper describes three contrasting case studies of organisational research capacity strengthening to illustrate how our five-step approach works in practice. Our five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. Our pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed. Our five-step approach is flexible enough to generate and utilise ongoing learning. We have tested and critiqued our approach in a variety of organisational settings in the health sector in sub-Saharan Africa, but it needs to be applied and evaluated in other sectors and continents to determine the extent of transferability.

Better Care Teams: A Stepwise Skill Reinforcement Model.

PubMed

Christopher, Beth-Anne; Grantner, Mary; Coke, Lola A; Wideman, Marilyn; Kwakwa, Francis

2016-06-01

The Building Healthy Urban Communities initiative presents a path for organizations partnering to improve patient outcomes with continuing education (CE) as a key component. Components of the CE initiative included traditional CE delivery formats with an essential element of adaptability and new methods, with rigorous evaluation over time that included evaluation prior to the course, immediately following the CE session, 6 to 8 weeks after the CE session, and then subsequent monthly "testlets." Outcome measures were designed to allow for ongoing adaptation of content, reinforcement of key learning objectives, and use of innovative concordant testing and retrieval practice techniques. The results after 1 year of programming suggest the stepwise skill reinforcement model is effective for learning and is an efficient use of financial and human resources. More important, its design is one that could be adopted at low cost by organizations willing to work in close partnership. J Contin Educ Nurs. 2016;47(6):283-288. Copyright 2016, SLACK Incorporated.

Consensus on the guidelines for the dietary management of classical galactosemia.

PubMed

Kerckhove, Kristel Vande; Diels, Marianne; Vanhaesebrouck, Sigrid; Luyten, Karin; Pyck, Nancy; De Meyer, An; Van Driessche, Marleen; Robert, Martine; Corthouts, Karen; Caris, Ariane; Duchateau, Emilie; Dassy, Martine; Bihet, Genevieve

2015-02-01

Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable. Copyright © 2014 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Practical aspects of the control of cardiovascular risk in type 2 diabetes mellitus and the metabolic syndrome

PubMed Central

Cerghizan, Anca; Bala, Cornelia; Nita, Cristina; Hancu, Nicolae

2007-01-01

Cardiovascular disease is unanimously recognized as the major burden in type 2 diabetes, in terms of both mortality and morbidity. There is an extensive evidence coming from epidemiological studies that supports this statement. The presence of the metabolic syndrome confers a higher risk of long-term death, and dysglycemia appears to be responsible for the most of the excess risk. The metabolic syndrome also has an essential role in the modern concept of cardiovascular prevention. Global cardiovascular risk represents the action and consequences of all risk factors that simultaneously or sequentially act on the body, leading to atherogenesis/atherosclerosis. In daily practice, a stepwise approach to control cardiovascular risk in people with type 2 diabetes has been proposed. This algorithm comprises three steps: identification of cardiovascular risk factors, interpretation of global cardiovascular risk, and intervention for all identified risk factors and diseases. In the past decades, the whole concept of diabetes and the metabolic syndrome care has undergone a radical change. From here the concept of modern management of those diseases emerged: early, multi-factorial and intensive control. This concept emphasized early and aggressive interventions for all cardiovascular risk factors in the long-term management. The model of multiple cardiovascular risk factor intervention ought to be implemented in daily practice as much as possible. This offers a unique opportunity to reduce the devastating cardiovascular morbidity and mortality in people with type 2 diabetes and the metabolic syndrome. PMID:18650987

Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

PubMed Central

2012-01-01

Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five phases therapists have to go through. The guidance includes criteria and conditions that motivate therapists, and make it possible for them, to actually use technology in their daily clinical practice. Conclusions The reported requirements are important as guidance for people involved in the development of rehabilitation technology for arm-hand therapy of stroke patients. The stepwise guide provides a tool for facilitating successful implementation of technology in clinical practice, thus meeting future therapy demand. PMID:22856548

Development and Evaluation of an Implementation Strategy for Collecting Data in a National Registry and the Use of Patient-Reported Outcome Measures in Physical Therapist Practices: Quality Improvement Study.

PubMed

Meerhoff, Guus A; van Dulmen, Simone A; Maas, Marjo J M; Heijblom, Karin; Nijhuis-van der Sanden, Maria W G; Van der Wees, Philip J

2017-08-01

In 2013, the Royal Dutch Society for Physical Therapy launched the program "Quality in Motion." This program aims to collect data from electronic health record systems in a registry that is fed back to physical therapists, facilitating quality improvement. The purpose of this study was to describe the development of an implementation strategy for the program and to evaluate the feasibility of building a registry and implementing patient-reported outcome measures (PROMs) in physical therapist practices. A stepwise approach using mixed methods was established in 3 consecutive pilots with 355 physical therapists from 66 practices. Interim results were evaluated using quantitative data from a self-assessment questionnaire and the registry and qualitative data from 21 semistructured interviews with physical therapists. Descriptive statistics and McNemar's symmetry chi-squared test were used to summarize the feasibility of implementing PROMs. PROMs were selected for the 5 most prevalent musculoskeletal conditions in Dutch physical therapist practices. A core component of the implementation strategy was the introduction of knowledge brokers to support physical therapists in establishing the routine use of PROMs in clinical practice and to assist in executing peer assessment workshops. In February 2013, 30.3% of the physical therapist practices delivered 4.4 completed treatment episodes per physical therapist to the registry; this increased to 92.4% in November 2014, delivering 54.1 completed patient episodes per physical therapist. Pre- and posttreatment PROM use increased from 12.2% to 39.5%. It is unclear if the participating physical therapists reflect a representative sample of Dutch therapists. Building a registry and implementing PROMs in physical therapist practices are feasible. The routine use of PROMs needs to increase to ensure valid feedback of outcomes. Using knowledge brokers is promising for implementing the program via peer assessment workshops. © 2017 American Physical Therapy Association

Patterns and Variations in Microvascular Decompression for Trigeminal Neuralgia

PubMed Central

TODA, Hiroki; GOTO, Masanori; IWASAKI, Koichi

2015-01-01

Microvascular decompression (MVD) is a highly effective surgical treatment for trigeminal neuralgia (TN). Although there is little prospective clinical evidence, accumulated observational studies have demonstrated the benefits of MVD for refractory TN. In the current surgical practice of MVD for TN, there have been recognized patterns and variations in surgical anatomy and various decompression techniques. Here we provide a stepwise description of surgical procedures and relevant anatomical characteristics, as well as procedural options. PMID:25925756

Post-graduate education for medical specialists focused on patients with medically unexplained physical symptoms; development of a communication skills training programme.

PubMed

Weiland, Anne; Blankenstein, Annette H; Willems, Mariëtte H A; Van Saase, Jan L C M; Van der Molen, Henk T; Van Dulmen, Alexandra M; Arends, Lidia R

2013-09-01

Stepwise description of the development of a post-graduate communication skills training programme for medical specialists focused on patients with medically unexplained physical symptoms (MUPS) to improve specialist interaction with MUPS patients. Using the 'intervention mapping approach' we accomplished a needs assessment (literature study and pilot) to formulate intervention objectives and identify methods and techniques for a MUPS-focused communication skills training programme for medical specialists. A 14-h training programme which consists of experiential learning, role-play and feedback. Using skills from Cognitive Behavioural Therapy, medical specialists are stimulated to explore interrelating factors that reinforce symptoms, to reassure patients effectively and to provide plausible and understandable explanations for MUPS. Dealing with complex referrals and informing GPs properly are also practiced. By applying the 'intervention mapping approach' we were able to create a feasible and promising intervention to improve specialist interaction with MUPS patients. Intervention effects are currently being assessed in a randomized controlled trial. If the RCT demonstrates sufficient effectiveness and efficiency of the MUPS focused communication skills training programme for medical specialists the intervention could be embedded in post-graduate education of medical specialists and residents. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Restoring Forest Landscapes: Important Lessons Learnt

NASA Astrophysics Data System (ADS)

Mansourian, Stephanie; Vallauri, Daniel

2014-02-01

Forest restoration at large scales, or landscapes, is an approach that is increasingly relevant to the practice of environmental conservation. However, implementation remains a challenge; poor monitoring and lesson learning lead to similar mistakes being repeated. The World Wildlife Fund (WWF), the global conservation organization, recently took stock of its 10 years of implementation of forest landscape restoration. A significant body of knowledge has emerged from the work of the WWF and its partners in the different countries, which can be of use to the wider conservation community, but for this to happen, lessons need to be systematically collected and disseminated in a coherent manner to the broader conservation and development communities and, importantly, to policy makers. We use this review of the WWF's experiences and compare and contrast it with other relevant and recent literature to highlight 11 important lessons for future large-scale forest restoration interventions. These lessons are presented using a stepwise approach to the restoration of forested landscapes. We identify the need for long-term commitment and funding, and a concerted and collaborative effort for successful forest landscape restoration. Our review highlights that monitoring impact within landscape-scale forest restoration remains inadequate. We conclude that forest restoration within landscapes is a challenging yet important proposition that has a real but undervalued place in environmental conservation in the twenty-first century.

Are we ready for Taenia solium cysticercosis elimination in sub-Saharan Africa?

PubMed

Johansen, Maria Vang; Trevisan, Chiara; Gabriël, Sarah; Magnussen, Pascal; Braae, Uffe Christian

2017-01-01

The World Health Organization announced in November 2014 at the fourth international meeting on 'the control of neglected zoonotic diseases - from advocacy to action', that intervention tools for eliminating Taenia solium taeniosis/cysticercosis (TSTC) are in place. The aim of this work was to elucidate theoretical outcomes of various control options suggested for TSTC elimination in sub-Saharan Africa (SSA) over a 4-year period. Our current knowledge regarding T. solium epidemiology and control primarily builds on studies from Latin America. A simple transmission model - built on data from Latin America - has been used to predict the effect of various interventions such as mass treatment of humans, vaccination and treatment of pigs, and health education of communities, potentially leading to change in bad practices and reducing transmission risks. Based on simulations of the transmission model, even a 4-year integrated One Health approach fails to eliminate TSTC from a small community and in all simulations, the prevalence of human taeniosis and porcine cysticercosis start to rise as soon as the programmes end. Our current knowledge regarding transmission and burden of TSTC in SSA is scarce and while claiming to be tool ready, the selection of diagnostic and surveillance tools, as well as the algorithms and stepwise approaches for control and elimination of TSTC remain major challenges.

Influence of rainfall and catchment characteristics on urban stormwater quality.

PubMed

Liu, An; Egodawatta, Prasanna; Guan, Yuntao; Goonetilleke, Ashantha

2013-02-01

The accuracy and reliability of urban stormwater quality modelling outcomes are important for stormwater management decision making. The commonly adopted approach where only a limited number of factors are used to predict urban stormwater quality may not adequately represent the complexity of the quality response to a rainfall event or site-to-site differences to support efficient treatment design. This paper discusses an investigation into the influence of rainfall and catchment characteristics on urban stormwater quality in order to investigate the potential areas for errors in current stormwater quality modelling practices. It was found that the influence of rainfall characteristics on pollutant wash-off is step-wise based on specific thresholds. This means that a modelling approach where the wash-off process is predicted as a continuous function of rainfall intensity and duration is not appropriate. Additionally, other than conventional catchment characteristics, namely, land use and impervious surface fraction, other catchment characteristics such as impervious area layout, urban form and site specific characteristics have an important influence on both, pollutant build-up and wash-off processes. Finally, the use of solids as a surrogate to estimate other pollutant species was found to be inappropriate. Individually considering build-up and wash-off processes for each pollutant species should be the preferred option. Copyright © 2012 Elsevier B.V. All rights reserved.

Monitoring the price and affordability of foods and diets globally.

PubMed

Lee, A; Mhurchu, C N; Sacks, G; Swinburn, B; Snowdon, W; Vandevijvere, S; Hawkes, C; L'abbé, M; Rayner, M; Sanders, D; Barquera, S; Friel, S; Kelly, B; Kumanyika, S; Lobstein, T; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Neal, B; Walker, C

2013-10-01

Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Pulse width modulation-based temperature tracking for feedback control of a shape memory alloy actuator.

PubMed

Ayvali, Elif; Desai, Jaydev P

2014-04-01

This work presents a temperature-feedback approach to control the radius of curvature of an arc-shaped shape memory alloy (SMA) wire. The nonlinear properties of the SMA such as phase transformation and its dependence on temperature and stress make SMA actuators difficult to control. Tracking a desired trajectory is more challenging than controlling just the position of the SMA actuator since the desired path is continuously changing. Consequently, tracking the desired strain directly or tracking the parameters such as temperature and electrical resistance that are related to strain with a model is a challenging task. Temperature-feedback is an attractive approach when direct measurement of strain is not practical. Pulse width modulation (PWM) is an effective method for SMA actuation and it can be used along with a compensator to control the temperature of the SMA. Using the constitutive model of the SMA, the desired temperature profile can be obtained for a given strain trajectory. A PWM-based nonlinear PID controller with a feed-forward heat transfer model is proposed to use temperature-feedback for tracking a desired temperature trajectory. The proposed controller is used during the heating phase of the SMA actuator. The controller proves to be effective in tracking step-wise and continuous trajectories.

Associations between parental feeding practices and child vegetable consumption. Mediation by child cognitions?

PubMed

Melbye, Elisabeth L; Øgaard, Torvald; Øverby, Nina C

2013-10-01

The present study aimed to explore the process in which parental food-related behaviors might influence preadolescent children's vegetable consumption, addressing potential mediating effects of child cognitions. Cross-sectional surveys were performed among 10-12-year-olds and their parents. The child questionnaire included measures of vegetable consumption and child cognitions related to vegetable consumption (i.e. attitudes, social influence, self-efficacy and intention). The parent questionnaire included measures of parental feeding practices adapted from the Comprehensive Feeding Practices Questionnaire. Stepwise regressions were performed to reveal potential mediating effects of child cognitions on the associations between parental feeding practices and child vegetable consumption. Our results suggested a mediating effect of child self-efficacy on the association between parental restrictive behavior and child vegetable consumption. Other potential mediating effects were not supported in this study. Copyright © 2013 Elsevier Ltd. All rights reserved.

An efficient approach for surveillance of childhood diabetes by type derived from electronic health record data: the SEARCH for Diabetes in Youth Study

PubMed Central

Zhong, Victor W; Obeid, Jihad S; Craig, Jean B; Pfaff, Emily R; Thomas, Joan; Jaacks, Lindsay M; Beavers, Daniel P; Carey, Timothy S; Lawrence, Jean M; Dabelea, Dana; Hamman, Richard F; Bowlby, Deborah A; Pihoker, Catherine; Saydah, Sharon H

2016-01-01

Objective To develop an efficient surveillance approach for childhood diabetes by type across 2 large US health care systems, using phenotyping algorithms derived from electronic health record (EHR) data. Materials and Methods Presumptive diabetes cases <20 years of age from 2 large independent health care systems were identified as those having ≥1 of the 5 indicators in the past 3.5 years, including elevated HbA1c, elevated blood glucose, diabetes-related billing codes, patient problem list, and outpatient anti-diabetic medications. EHRs of all the presumptive cases were manually reviewed, and true diabetes status and diabetes type were determined. Algorithms for identifying diabetes cases overall and classifying diabetes type were either prespecified or derived from classification and regression tree analysis. Surveillance approach was developed based on the best algorithms identified. Results We developed a stepwise surveillance approach using billing code–based prespecified algorithms and targeted manual EHR review, which efficiently and accurately ascertained and classified diabetes cases by type, in both health care systems. The sensitivity and positive predictive values in both systems were approximately ≥90% for ascertaining diabetes cases overall and classifying cases with type 1 or type 2 diabetes. About 80% of the cases with “other” type were also correctly classified. This stepwise surveillance approach resulted in a >70% reduction in the number of cases requiring manual validation compared to traditional surveillance methods. Conclusion EHR data may be used to establish an efficient approach for large-scale surveillance for childhood diabetes by type, although some manual effort is still needed. PMID:27107449

Fine tuning of transmission features in nanoporous anodic alumina distributed Bragg reflectors

NASA Astrophysics Data System (ADS)

Lim, Siew Yee; Law, Cheryl Suwen; Santos, Abel

2018-01-01

This study introduces an innovative apodisation strategy to tune the filtering features of distributed Bragg reflectors based on nanoporous anodic alumina (NAA-DBRs). The effective medium of NAA-DBRs, which is modulated in a stepwise fashion by a pulse-like anodisation approach, is apodised following a logarithmic negative function to engineer the transmission features of NAA-DBRs. We investigate the effect of various apodisation parameters such as apodisation amplitude difference, anodisation period, current density offset and pore widening time, to tune and optimise the optical properties of NAA-DBRs in terms of central wavelength position, full width at half maximum and quality of photonic stop band. The transmission features of NAA-DBRs are shown to be fully controllable with precision across the spectral regions by means of the apodisation parameters. Our study demonstrates that an apodisation strategy can significantly narrow the width and enhance the quality of the characteristic photonic stop band of NAA-DBRs. This rationally designed anodisation approach based on the combination of apodisation and stepwise pulse anodisation enables the development of optical filters with tuneable filtering features to be integrated into optical technologies acting as essential photonic elements in devices such as optical sensors and biosensors.

Transforming paper-based assessment forms to a digital format: Exemplified by the Housing Enabler prototype app.

PubMed

Svarre, Tanja; Lunn, Tine Bieber Kirkegaard; Helle, Tina

2017-11-01

The aim of this paper is to provide the reader with an overall impression of the stepwise user-centred design approach including the specific methods used and lessons learned when transforming paper-based assessment forms into a prototype app, taking the Housing Enabler as an example. Four design iterations were performed, building on a domain study, workshops, expert evaluation and controlled and realistic usability tests. The user-centred design process involved purposefully selected participants with different Housing Enabler knowledge and housing adaptation experience. The design iterations resulted in the development of a Housing Enabler prototype app. The prototype app has several features and options that are new compared with the original paper-based Housing Enabler assessment form. These new features include a user friendly overview of the assessment form; easy navigation by swiping back and forth between items; onsite data analysis; and ranking of the accessibility score, photo documentation and a data export facility. Based on the presented stepwise approach, a high-fidelity Housing Enabler prototype app was successfully developed. The development process has emphasized the importance of combining design participants' knowledge and experiences, and has shown that methods should seem relevant to participants to increase their engagement.

Promoting chlamydia screening with posters and leaflets in general practice--a qualitative study.

PubMed

Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

2009-10-12

General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.

Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

PubMed Central

Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

2009-01-01

Background General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice. PMID:19821964

Mapping wildfire vulnerability in Mediterranean Europe. Testing a stepwise approach for operational purposes.

PubMed

Oliveira, Sandra; Félix, Fernando; Nunes, Adélia; Lourenço, Luciano; Laneve, Giovanni; Sebastián-López, Ana

2018-01-15

Vulnerability assessment is a vital component of wildfire management. This research focused on the development of a framework to measure and map vulnerability levels in several areas within Mediterranean Europe, where wildfires are a major concern. The framework followed a stepwise approach to evaluate its main components, expressed by exposure, sensitivity and coping capacity. Data on population density, fuel types, protected areas location, roads infrastructure and surveillance activities, among others, were integrated to create composite indices, representing each component and articulated in multiple dimensions. Maps were created for several test areas, in northwest Portugal, southwest Sardinia in Italy and northeast Corsica in France, with the contribution of local participants from civil protection institutions and forest services. Results showed the influence of fuel sensitivity levels, population distribution and protected areas coverage for the overall vulnerability classes. Reasonable levels of accuracy were found on the maps provided through the validation procedure, with an overall match above 72% for the several sites. The systematic and flexible approach applied allowed for adjustments to local circumstances with regards to data availability and fire management procedures, without compromising its consistency and with substantial operational capabilities. The results obtained and the positive feedback of end-users encourage its further application, as a means to improve wildfire management strategies at multiple levels with the latest scientific outputs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site

PubMed Central

Vaidya, Abhinav; Aryal, Umesh Raj; Krettek, Alexandra

2013-01-01

Objectives This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal. Design To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveillance and other resources, scoring all responses. We also recorded blood pressure and took anthropometric measurements. Setting Our study was conducted as part of the Heart-Health-Associated Research and Dissemination in the Community project in the Jhaukhel-Duwakot Health Demographic Surveillance Site in two urbanising villages near Kathmandu. Participants The study population included 777 respondents from six randomly selected clusters in both villages. Results Seventy per cent of all participants were women and 26.9% lacked formal education. The burden of cardiovascular risk factors was high; 20.1% were current smokers, 43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as causative. Around 60% of respondents did not know any heart attack symptoms compared with 20% who knew 2–4 symptoms. Median percentage scores for knowledge, attitude and practice/behaviour were 79.3, 74.3 and 48, respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Among those with highly satisfactory knowledge, only 14.7% had a highly satisfactory attitude and 19.5% and 13.9% had satisfactory and highly satisfactory practices, respectively. Conclusions Our study demonstrates a gap between cardiovascular health knowledge, attitude and practice/behaviour in a semiurban community in a low-income nation, even among those already affected by cardiovascular disease. PMID:24157816

American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: Evidence-Based Report on Diagnostic Guidelines

PubMed Central

Conwell, Darwin L.; Lee, Linda S.; Yadav, Dhiraj; Longnecker, Daniel S.; Miller, Frank H.; Mortele, Koenraad J.; Levy, Michael J.; Kwon, Richard; Lieb, John G.; Stevens, Tyler; Toskes, Philip P.; Gardner, Timothy B.; Gelrud, Andres; Wu, Bechien U.; Forsmark, Christopher E.; Vege, Santhi S.

2016-01-01

The diagnosis of chronic pancreatitis remains challenging in early stages of the disease. This report defines the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. All current diagnostic procedures are reviewed and evidence based statements are provided about their utility and limitations. Diagnostic criteria for chronic pancreatitis are classified as definitive, probable or insufficient evidence. A diagnostic (STEP-wise; S-survey, T-tomography, E-endoscopy and P-pancreas function testing) algorithm is proposed that proceeds from a non-invasive to a more invasive approach. This algorithm maximizes specificity (low false positive rate) in subjects with chronic abdominal pain and equivocal imaging changes. Futhermore, a nomenclature is suggested to further characterize patients with established chronic pancreatitis based on TIGAR-O (T-toxic, I-idiopathic, G-genetic, A- autoimmune, R-recurrent and O-obstructive) etiology, gland morphology (Cambridge criteria) and physiologic state (exocrine, endocrine function) for uniformity across future multi-center research collaborations. This guideline will serve as a baseline manuscript that will be modified as new evidence becomes available and our knowledge of chronic pancreatitis improves. PMID:25333398

A novel minimum cost maximum power algorithm for future smart home energy management.

PubMed

Singaravelan, A; Kowsalya, M

2017-11-01

With the latest development of smart grid technology, the energy management system can be efficiently implemented at consumer premises. In this paper, an energy management system with wireless communication and smart meter are designed for scheduling the electric home appliances efficiently with an aim of reducing the cost and peak demand. For an efficient scheduling scheme, the appliances are classified into two types: uninterruptible and interruptible appliances. The problem formulation was constructed based on the practical constraints that make the proposed algorithm cope up with the real-time situation. The formulated problem was identified as Mixed Integer Linear Programming (MILP) problem, so this problem was solved by a step-wise approach. This paper proposes a novel Minimum Cost Maximum Power (MCMP) algorithm to solve the formulated problem. The proposed algorithm was simulated with input data available in the existing method. For validating the proposed MCMP algorithm, results were compared with the existing method. The compared results prove that the proposed algorithm efficiently reduces the consumer electricity consumption cost and peak demand to optimum level with 100% task completion without sacrificing the consumer comfort.

Evaluation of a New Molecular Entity as a Victim of Metabolic Drug-Drug Interactions-an Industry Perspective.

PubMed

Bohnert, Tonika; Patel, Aarti; Templeton, Ian; Chen, Yuan; Lu, Chuang; Lai, George; Leung, Louis; Tse, Susanna; Einolf, Heidi J; Wang, Ying-Hong; Sinz, Michael; Stearns, Ralph; Walsky, Robert; Geng, Wanping; Sudsakorn, Sirimas; Moore, David; He, Ling; Wahlstrom, Jan; Keirns, Jim; Narayanan, Rangaraj; Lang, Dieter; Yang, Xiaoqing

2016-08-01

Under the guidance of the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ), scientists from 20 pharmaceutical companies formed a Victim Drug-Drug Interactions Working Group. This working group has conducted a review of the literature and the practices of each company on the approaches to clearance pathway identification (fCL), estimation of fractional contribution of metabolizing enzyme toward metabolism (fm), along with modeling and simulation-aided strategy in predicting the victim drug-drug interaction (DDI) liability due to modulation of drug metabolizing enzymes. Presented in this perspective are the recommendations from this working group on: 1) strategic and experimental approaches to identify fCL and fm, 2) whether those assessments may be quantitative for certain enzymes (e.g., cytochrome P450, P450, and limited uridine diphosphoglucuronosyltransferase, UGT enzymes) or qualitative (for most of other drug metabolism enzymes), and the impact due to the lack of quantitative information on the latter. Multiple decision trees are presented with stepwise approaches to identify specific enzymes that are involved in the metabolism of a given drug and to aid the prediction and risk assessment of drug as a victim in DDI. Modeling and simulation approaches are also discussed to better predict DDI risk in humans. Variability and parameter sensitivity analysis were emphasized when applying modeling and simulation to capture the differences within the population used and to characterize the parameters that have the most influence on the prediction outcome. Copyright © 2016 by The American Society for Pharmacology and Experimental Therapeutics.

Step-wise refolding of recombinant proteins.

PubMed

Tsumoto, Kouhei; Arakawa, Tsutomu; Chen, Linda

2010-04-01

Protein refolding is still on trial-and-error basis. Here we describe step-wise dialysis refolding, in which denaturant concentration is altered in step-wise fashion. This technology controls the folding pathway by adjusting the concentrations of the denaturant and other solvent additives to induce sequential folding or disulfide formation.

A Step-Wise Approach to Elicit Triangular Distributions

NASA Technical Reports Server (NTRS)

Greenberg, Marc W.

2013-01-01

Adapt/combine known methods to demonstrate an expert judgment elicitation process that: 1.Models expert's inputs as a triangular distribution, 2.Incorporates techniques to account for expert bias and 3.Is structured in a way to help justify expert's inputs. This paper will show one way of "extracting" expert opinion for estimating purposes. Nevertheless, as with most subjective methods, there are many ways to do this.

Synthesis of 5-acyl-6-[2-hydroxy-3-(amino)propylamino]-1,3-dialkyl-1H-pyrimidine-2,4-diones.

PubMed

Singh, Palwinder; Paul, Kamaldeep; Holzer, Wolfgang

2005-11-07

A stepwise synthetic approach involving substitution of 6-chloro-1,3-dialkyluracils (5 and 6) with 3-(tert-amino)-2-hydroxypropylamines and subsequent acylation at C5 of uracil has been used to synthesize pyrimidinediones 27-33 in 61-89% overall yield. The conformational aspects of the new molecules based upon NMR data have been discussed.

Dizziness and vertigo.

PubMed

Wipperman, Jennifer

2014-03-01

Dizziness is a common and challenging condition seen in the primary care office. Because dizziness is a vague term that can include a wide array of medical disorders, it is important to use a stepwise approach to differentiate between causes. This article focuses on vertigo and its four most common causes: benign paroxysmal peripheral vertigo, vestibular neuritis, vestibular migraine, and Meniere's disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Estimating extent of mortality associated with the Douglas-fir beetle in the Central and Northern Rockies

Treesearch

Jose F. Negron; Willis C. Schaupp; Kenneth E. Gibson; John Anhold; Dawn Hansen; Ralph Thier; Phil Mocettini

1999-01-01

Data collected from Douglas-fir stands infected by the Douglas-fir beetle in Wyoming, Montana, Idaho, and Utah, were used to develop models to estimate amount of mortality in terms of basal area killed. Models were built using stepwise linear regression and regression tree approaches. Linear regression models using initial Douglas-fir basal area were built for all...

Stepwise group sparse regression (SGSR): gene-set-based pharmacogenomic predictive models with stepwise selection of functional priors.

PubMed

Jang, In Sock; Dienstmann, Rodrigo; Margolin, Adam A; Guinney, Justin

2015-01-01

Complex mechanisms involving genomic aberrations in numerous proteins and pathways are believed to be a key cause of many diseases such as cancer. With recent advances in genomics, elucidating the molecular basis of cancer at a patient level is now feasible, and has led to personalized treatment strategies whereby a patient is treated according to his or her genomic profile. However, there is growing recognition that existing treatment modalities are overly simplistic, and do not fully account for the deep genomic complexity associated with sensitivity or resistance to cancer therapies. To overcome these limitations, large-scale pharmacogenomic screens of cancer cell lines--in conjunction with modern statistical learning approaches--have been used to explore the genetic underpinnings of drug response. While these analyses have demonstrated the ability to infer genetic predictors of compound sensitivity, to date most modeling approaches have been data-driven, i.e. they do not explicitly incorporate domain-specific knowledge (priors) in the process of learning a model. While a purely data-driven approach offers an unbiased perspective of the data--and may yield unexpected or novel insights--this strategy introduces challenges for both model interpretability and accuracy. In this study, we propose a novel prior-incorporated sparse regression model in which the choice of informative predictor sets is carried out by knowledge-driven priors (gene sets) in a stepwise fashion. Under regularization in a linear regression model, our algorithm is able to incorporate prior biological knowledge across the predictive variables thereby improving the interpretability of the final model with no loss--and often an improvement--in predictive performance. We evaluate the performance of our algorithm compared to well-known regularization methods such as LASSO, Ridge and Elastic net regression in the Cancer Cell Line Encyclopedia (CCLE) and Genomics of Drug Sensitivity in Cancer (Sanger) pharmacogenomics datasets, demonstrating that incorporation of the biological priors selected by our model confers improved predictability and interpretability, despite much fewer predictors, over existing state-of-the-art methods.

Anthropometric correlations between parts of the upper and lower limb: models for personal identification in a Sudanese population.

PubMed

Ahmed, Altayeb Abdalla

2016-09-01

Identification of a deceased individual is an essential component of medicolegal practice. However, personal identification based on commingled limbs or parts of limbs, necessary in investigations of mass disasters or some crimes, is a difficult task. Limb measurements have been utilized in the development of biological parameters for personal identification, but the possibility to estimate the dimensions of parts of limbs other than hands and feet has not been assessed. The present study proposes an approach to estimate the dimensions of various parts of limbs based on other limb measurements. The study included 320 Sudanese adults, with equal representation of men and women. Nine limb dimensions were measured (five based on the upper limb, four based on the lower limb), and extensive statistical analysis of the distribution of values was performed. The results showed that all of the measured dimensions were sexually dimorphic and that there was a significant positive correlation between the dimensions of various parts of limbs. Regression models (direct and stepwise) were developed to estimate the dimensions of parts of limbs based on measurements pertaining to one or more other parts of limbs. The study revealed that the dimensions of parts of the upper and lower limb can be estimated from one another. These findings can be used in medicolegal practice and extended to constructive surgery, orthopedics, and prosthesis design for lost limbs.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.

PubMed

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-09-01

The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

A Population Biology Perspective on the Stepwise Infection Process of the Bacterial Pathogen Pasteuria ramosa in Daphnia.

PubMed

Ebert, Dieter; Duneau, David; Hall, Matthew D; Luijckx, Pepijn; Andras, Jason P; Du Pasquier, Louis; Ben-Ami, Frida

2016-01-01

The infection process of many diseases can be divided into series of steps, each one required to successfully complete the parasite's life and transmission cycle. This approach often reveals that the complex phenomenon of infection is composed of a series of more simple mechanisms. Here we demonstrate that a population biology approach, which takes into consideration the natural genetic and environmental variation at each step, can greatly aid our understanding of the evolutionary processes shaping disease traits. We focus in this review on the biology of the bacterial parasite Pasteuria ramosa and its aquatic crustacean host Daphnia, a model system for the evolutionary ecology of infectious disease. Our analysis reveals tremendous differences in the degree to which the environment, host genetics, parasite genetics and their interactions contribute to the expression of disease traits at each of seven different steps. This allows us to predict which steps may respond most readily to selection and which steps are evolutionarily constrained by an absence of variation. We show that the ability of Pasteuria to attach to the host's cuticle (attachment step) stands out as being strongly influenced by the interaction of host and parasite genotypes, but not by environmental factors, making it the prime candidate for coevolutionary interactions. Furthermore, the stepwise approach helps us understanding the evolution of resistance, virulence and host ranges. The population biological approach introduced here is a versatile tool that can be easily transferred to other systems of infectious disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

Developing a customised approach for strengthening tuberculosis laboratory quality management systems toward accreditation

PubMed Central

Trollip, Andre; Erni, Donatelle; Kao, Kekeletso

2017-01-01

Background Quality-assured tuberculosis laboratory services are critical to achieve global and national goals for tuberculosis prevention and care. Implementation of a quality management system (QMS) in laboratories leads to improved quality of diagnostic tests and better patient care. The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has led to measurable improvements in the QMS of clinical laboratories. However, progress in tuberculosis laboratories has been slower, which may be attributed to the need for a structured tuberculosis-specific approach to implementing QMS. We describe the development and early implementation of the Strengthening Tuberculosis Laboratory Management Toward Accreditation (TB SLMTA) programme. Development The TB SLMTA curriculum was developed by customizing the SLMTA curriculum to include specific tools, job aids and supplementary materials specific to the tuberculosis laboratory. The TB SLMTA Harmonized Checklist was developed from the World Health Organisation Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist, and incorporated tuberculosis-specific requirements from the Global Laboratory Initiative Stepwise Process Towards Tuberculosis Laboratory Accreditation online tool. Implementation Four regional training-of-trainers workshops have been conducted since 2013. The TB SLMTA programme has been rolled out in 37 tuberculosis laboratories in 10 countries using the Workshop approach in 32 laboratories in five countries and the Facility-based approach in five tuberculosis laboratories in five countries. Conclusion Lessons learnt from early implementation of TB SLMTA suggest that a structured training and mentoring programme can build a foundation towards further quality improvement in tuberculosis laboratories. Structured mentoring, and institutionalisation of QMS into country programmes, is needed to support tuberculosis laboratories to achieve accreditation. PMID:28879165

What did first-year students experience during their interprofessional education? A qualitative analysis of e-portfolios.

PubMed

Imafuku, Rintaro; Kataoka, Ryuta; Ogura, Hiroshi; Suzuki, Hisayoshi; Enokida, Megumi; Osakabe, Keitaro

2018-05-01

Interprofessional collaboration is an essential approach to comprehensive patient care. As previous studies have argued, interprofessional education (IPE) must be integrated in a stepwise, systematic manner in undergraduate health profession education programmes. Given this perspective, first-year IPE is a critical opportunity for building the foundation of interprofessional collaborative practice. This study aims to explore the first-year students' learning processes and the longitudinal changes in their perceptions of learning in a year-long IPE programme. Data were collected at a Japanese medical university, in which different pedagogical approaches are adopted in the IPE programme. Some of these approaches include interprofessional problem-based learning, early exposure, and interactive lecture-based teaching. The students are required to submit written reflections as a formative assessment. This study conducted an inductive thematic analysis of 104 written reflections from a series of e-portfolios of 26 first-year students. The themes related to learning outcomes from student perspectives included communication (e.g., active listening and intelligible explanation), teams and teamwork (e.g., mutual engagement and leadership), roles/responsibilities as a group member (e.g., self-directed learning and information literacy), and roles/responsibilities as a health professional (e.g., understanding of the student's own professional and mutual respect in an interprofessional team). The study also indicated three perspectives of students' learning process at different stages of the IPE, i.e., processes by which students became active and responsible learners, emphasised the enhancement of teamwork, and developed their own interprofessional identities. This study revealed the first-year students' learning processes in the year-long IPE programme and clarified the role of the first-year IPE programme within the overall curriculum. The findings suggest that the students' active participation in the IPE programme facilitated their fundamental understanding of communication/teamwork and identity formation as a health professional in interprofessional collaborative practice.

The relationship between organizational policies and practices and work limitations among hospital patient care workers.

PubMed

Sparer, Emily H; Boden, Leslie I; Sorensen, Glorian; Dennerlein, Jack T; Stoddard, Anne; Wagner, Gregory R; Nagler, Eve M; Hashimoto, Dean M; Hopcia, Karen; Sabbath, Erika L

2018-05-29

We examined relationships between organizational policies and practices (OPPs) (safety practices, ergonomic practices, and people-oriented culture) and work limitations in a sample of hospital workers. We used the 6-item Work Limitations Questionnaire (WLQ) to assess workers' perceptions of health-related work limitations. Self-reported OPPs and the WLQ were collected from workers in Boston, Massachusetts (n = 1277). We conducted random-intercept multi-level logistic regression models for each OPP using stepwise selection of covariates. As the unit-average ergonomic practice score increased by one, the odds of a worker reporting work limitations decreased by approximately 39% (P-value = 0.018), adjusted for job title, age, and body mass index. A similar relationship existed for people-oriented culture (P-value = 0.038). The association between safety practices and work limitations was similar, but not statistically significant. This study demonstrated the importance of workplace OPPs. OPPs that promote positive and supportive environments and that foster improvements in ergonomics may help reduce work limitations. © 2018 Wiley Periodicals, Inc.

Diels–Alder Reactions of Allene with Benzene and Butadiene: Concerted, Stepwise, and Ambimodal Transition States

PubMed Central

2015-01-01

Multiconfigurational complete active space methods (CASSCF and CASPT2) have been used to investigate the (4 + 2) cycloadditions of allene with butadiene and with benzene. Both concerted and stepwise radical pathways were examined to determine the mechanism of the Diels–Alder reactions with an allene dienophile. Reaction with butadiene occurs via a single ambimodal transition state that can lead to either the concerted or stepwise trajectories along the potential energy surface, while reaction with benzene involves two separate transition states and favors the concerted mechanism relative to the stepwise mechanism via a diradical intermediate. PMID:25216056

Stepwise Analysis of Differential Item Functioning Based on Multiple-Group Partial Credit Model.

ERIC Educational Resources Information Center

Muraki, Eiji

1999-01-01

Extended an Item Response Theory (IRT) method for detection of differential item functioning to the partial credit model and applied the method to simulated data using a stepwise procedure. Then applied the stepwise DIF analysis based on the multiple-group partial credit model to writing trend data from the National Assessment of Educational…

Two-generation analysis of pollen flow across a landscape. V. A stepwise approach for extracting factors contributing to pollen structure.

Treesearch

R. J. Dyer; R. D. Westfall; V. L. Sork; P. E. Smouse

2004-01-01

Patterns of pollen dispersal are central to both the ecology and evolution of plant populations. However, the mechanisms controlling either the dispersal process itself or our estimation of that process may be influenced by site-specific factors such as local forest structure and nonuniform adult genetic structure. Here, we present an extension of the AMOVA model...

Assessment of the integrity of concrete bridge structures by acoustic emission technique

NASA Astrophysics Data System (ADS)

Yoon, Dong-Jin; Park, Philip; Jung, Juong-Chae; Lee, Seung-Seok

2002-06-01

This study was aimed at developing a new method for assessing the integrity of concrete structures. Especially acoustic emission technique was used in carrying out both laboratory experiment and field application. From the previous laboratory study, we confirmed that AE analysis provided a promising approach for estimating the level of damage and distress in concrete structures. The Felicity ratio, one of the key parameter for assessing damage, exhibits a favorable correlation with the overall damage level. The total number of AE events under stepwise cyclic loading also showed a good agreement with the damage level. In this study, a new suggested technique was applied to several concrete bridges in Korea in order to verify the applicability in field. The AE response was analyzed to obtain key parameters such as the total number and rate of AE events, AE parameter analysis for each event, and the characteristic features of the waveform as well as Felicity ratio analysis. Stepwise loading-unloading procedure for AE generation was introduced in field test by using each different weight of vehicle. According to the condition of bridge, for instance new or old bridge, AE event rate and AE generation behavior indicated many different aspects. The results showed that the suggested analyzing method would be a promising approach for assessing the integrity of concrete structures.

Predicting Retention Times of Naturally Occurring Phenolic Compounds in Reversed-Phase Liquid Chromatography: A Quantitative Structure-Retention Relationship (QSRR) Approach

PubMed Central

Akbar, Jamshed; Iqbal, Shahid; Batool, Fozia; Karim, Abdul; Chan, Kim Wei

2012-01-01

Quantitative structure-retention relationships (QSRRs) have successfully been developed for naturally occurring phenolic compounds in a reversed-phase liquid chromatographic (RPLC) system. A total of 1519 descriptors were calculated from the optimized structures of the molecules using MOPAC2009 and DRAGON softwares. The data set of 39 molecules was divided into training and external validation sets. For feature selection and mapping we used step-wise multiple linear regression (SMLR), unsupervised forward selection followed by step-wise multiple linear regression (UFS-SMLR) and artificial neural networks (ANN). Stable and robust models with significant predictive abilities in terms of validation statistics were obtained with negation of any chance correlation. ANN models were found better than remaining two approaches. HNar, IDM, Mp, GATS2v, DISP and 3D-MoRSE (signals 22, 28 and 32) descriptors based on van der Waals volume, electronegativity, mass and polarizability, at atomic level, were found to have significant effects on the retention times. The possible implications of these descriptors in RPLC have been discussed. All the models are proven to be quite able to predict the retention times of phenolic compounds and have shown remarkable validation, robustness, stability and predictive performance. PMID:23203132

Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches.

PubMed

Miyachi, Hayato; Furuya, Hiroyuki; Umezawa, Kazuo; Itoh, Yumiko; Ohshima, Toshio; Miyamoto, Motoaki; Asai, Satomi

2007-03-01

Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful. The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design. Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations. The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.

Alcohol-related problems: emergency physicians' current practice and attitudes.

PubMed

O'Rourke, Maria; Richardson, Lynne D; Wilets, Ilene; D'Onofrio, Gail

2006-04-01

To determine whether emergency physicians' (EPs) attitudes affect their support and practice of brief intervention in the Emergency Department (ED), EPs completed an anonymous survey. EPs were asked about their attitudes toward patients with alcohol problems, current ED screening, use of brief intervention, and barriers to use of brief intervention. Chi-square analysis was used and a step-wise regression model was constructed. Respondents reported a high prevalence of patients with alcohol-related problems: 18% in a typical shift. Eighty-one percent said it is important to advise patients to change behavior; half said using a brief intervention is important. Attending physicians had significantly less alcohol education than residents, but were significantly more likely to support the use of brief intervention. Support was not associated with gender, race, census, hours of education, or personal experience. EPs who felt that brief intervention was an integral part of their job were more likely to use it in their daily practice.

Nursing philosophy: A review of current pre registration curricula in the UK.

PubMed

Mackintosh-Franklin, Carolyn

2016-02-01

Nursing in the UK has been subject to criticism for failing to provide care and compassion in practice, with a series of reports highlighting inadequacies in care. This scrutiny provides nursing with an ideal opportunity to evaluate the underpinning philosophy of nursing practice, and for nurse educators to use this philosophy as the basis for programmes which can inculcate neophyte student nurses with a fundamental understanding of the profession, whilst providing other health care professionals and service users with a clear representation of professional nursing practice. The key word philosophy was used in a systematic stepwise descriptive content analysis of the programme specifications of 33 current undergraduate programme documents, leading to an undergraduate award and professional registration as a nurse. The word philosophy featured minimally in programme specification documents, with 12 (36%) documents including it. Its use was superficial in 3 documents and focused on educational philosophy in a further 3 documents. 2 programme specifications identified their philosophy as the NMC (2010) standards for pre-registration nurse education. 2 programme specifications articulated a philosophy specific to that programme and HEI, focusing on caring, and 2 made reference to underpinning philosophies present in nursing literature; the Relationship Centred Care Approach, and The Humanising Care Philosophy. The philosophy of nursing practice is not clearly articulated in pre-registration curricula. This failure to identify the fundamental nature of nursing is detrimental to the development of the profession, and given this lack of direction it is not surprising that some commentators feel nursing has lost its way. Nurse educators must review their current curricula to ensure that there is clear articulation of nursing's professional philosophical stance, and use this as the framework for pre-registration curricula to support the development of neophyte nursing students towards a clear and focused understanding of what nursing practice is. Copyright © 2015 Elsevier Ltd. All rights reserved.

International STakeholder NETwork (ISTNET): Creating a ...

EPA Pesticide Factsheets

A major problem in developmental neurotoxicity (DNT) risk assessment is the lack of toxicological hazard information for most compounds. Therefore, new approaches are being considered to provide adequate experimental data that allow regulatory decisions. This process requires a matching of regulatory needs on the one hand and the opportunities provided by new test sys-tems and methods on the other hand. Alignment of academically and industrially-driven assay development with regulatory needs in the field of DNT is a core mission of the International STakeholder NETwork (ISNET) in DNT testing. The first meeting of ISTNET was held in Zur-ich on 23-24 January 2014 in order to explore the concept of adverse outcome pathway (AOP) to practical DNT testing. AOPs were considered promising tools to promote test systems develop-ment according to regulatory needs. Moreover, the AOP concept was identified as an important guiding principle to assemble predictive integrated testing strategies (ITSs) for DNT. The recommendations on a roadmap towards AOP-based DNT testing is considered a stepwise approach, operating initially with incomplete AOPs for compound grouping, and focussing on key events of neurodevelopment. Next steps to be considered in follow-up activities are the use of case studies to further apply the AOP concept in regulatory DNT testing, making use of AOP intersections (common key events) for economic development of screening assays, and address-ing the transit

Practicability of patient self-testing of oral anticoagulant therapy by the international normalized ratio (INR) using a portable whole blood monitor. A pilot investigation.

PubMed

Hasenkam, J M; Knudsen, L; Kimose, H H; Grønnesby, H; Attermann, J; Andersen, N T; Pilegaard, H K

1997-01-01

The prophylactic efficacy of long-term oral anticoagulant treatment (OAT) has been demonstrated in a number of clinical conditions with increased tendency to thromboembolism, and the number of individuals subjected to OAT in the industrialised world has increased substantially in recent years. Since this therapy requires considerable resources from both the health care system and the patients, the feasibility of patients' self-monitoring and self-management of OAT has been investigated (1,2,3). The anticipated advantages of this approach include improved convenience and compliance for the patient, who may increase his apprehension for managing the treatment. In addition, self-testing allows for more frequent control compared to the conventional out-patient approach. Importantly, a prerequisite for conceiving a safe and operational concept for patient self-management (PSM) is the availability of a portable INR monitoring system with an accuracy, precision, reproducibility, and long-term reliability comparable to standard coagulometric equipment. The purpose of the present study was to evaluate the feasibility of a commercially available INR-monitor. CoaguChek, for patient self-testing, through a step-wise investigation of the performance characteristics of the equipment in the laboratory, in command of the patient, and during self-testing and self-adjustment of treatment at home. Laboratory INR values were used as reference.

Adjunctive Strategies in the Management of Resistant, ‘Undilatable’ Coronary Lesions After Successfully Crossing a CTO with a Guidewire

PubMed Central

Fairley, Sara L.; Spratt, James C.; Rana, Omar; Talwar, Suneel; Hanratty, Colm; Walsh, Simon

2014-01-01

Successful revascularisation of chronic total occlusions (CTOs) remains one of the greatest challenges in the era of contemporary percutaneous coronary intervention (PCI). Such lesions are encountered with increasing frequency in current clinical practice. A predictable increase in the future burden of CTO management can be anticipated given the ageing population, increased rates of renal failure, graft failure and diabetes mellitus. Given recent advances and developments in CTO PCI management, successful recanalisation can be anticipated in the majority of procedures undertaken at high-volume centres when performed by expert operators. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful CTO intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons and high speed rotational atherectomy (HSRA). Novel approaches have proven to be safe and technically feasible where standard approaches have failed. A step-wise progression of strategies is demonstrated, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. These methods will be described in the setting of clinical examples and include use of very high-pressure non-compliant balloon dilation, intentional balloon rupture with vessel dissection or balloon assisted micro-dissection (BAM), excimer coronary laser atherectomy (ECLA) and use of HSRA in various ‘offlabel’ settings. PMID:24694106

Preparative isolation and purification of macrolactin antibiotics from marine bacterium Bacillus amyloliquefaciens using high-speed counter-current chromatography in stepwise elution mode.

PubMed

He, Shan; Wang, Hongqiang; Yan, Xiaojun; Zhu, Peng; Chen, Juanjuan; Yang, Rui

2013-01-11

Preparative high-speed counter-current chromatography (HSCCC) was successfully applied to the isolation and purification of two macrolactin antibiotics from marine bacterium Bacillus amyloliquefaciens for the first time using stepwise elution with a pair of two-phase solvent systems composed of n-hexane-ethyl acetate-methanol-water at (1:4:1:4, v/v) and (3:4:3:4, v/v). The preparative HSCCC separation was performed on 300 mg of crude sample yielding macrolactin B (22.7 mg) and macrolactin A (40.4 mg) in a one-step separation, with purities over 95% as determined by HPLC. The structures of these compounds were identified by MS, (1)H NMR and (13)C NMR. Our results demonstrated that HSCCC was an efficient technique to separate marine antibiotics, which provide an approach to solve the problem of their sample availability for drug development. Copyright © 2012 Elsevier B.V. All rights reserved.

Experimental and theoretical evidence for bilayer-by-bilayer surface melting of crystalline ice

PubMed Central

Sánchez, M. Alejandra; Kling, Tanja; Ishiyama, Tatsuya; van Zadel, Marc-Jan; Mezger, Markus; Jochum, Mara N.; Cyran, Jenée D.; Smit, Wilbert J.; Bakker, Huib J.; Shultz, Mary Jane; Morita, Akihiro; Donadio, Davide; Nagata, Yuki; Bonn, Mischa; Backus, Ellen H. G.

2017-01-01

On the surface of water ice, a quasi-liquid layer (QLL) has been extensively reported at temperatures below its bulk melting point at 273 K. Approaching the bulk melting temperature from below, the thickness of the QLL is known to increase. To elucidate the precise temperature variation of the QLL, and its nature, we investigate the surface melting of hexagonal ice by combining noncontact, surface-specific vibrational sum frequency generation (SFG) spectroscopy and spectra calculated from molecular dynamics simulations. Using SFG, we probe the outermost water layers of distinct single crystalline ice faces at different temperatures. For the basal face, a stepwise, sudden weakening of the hydrogen-bonded structure of the outermost water layers occurs at 257 K. The spectral calculations from the molecular dynamics simulations reproduce the experimental findings; this allows us to interpret our experimental findings in terms of a stepwise change from one to two molten bilayers at the transition temperature. PMID:27956637

Combining PCR with Microscopy to Reduce Costs of Laboratory Diagnosis of Buruli Ulcer

PubMed Central

Yeboah-Manu, Dorothy; Asante-Poku, Adwoa; Asan-Ampah, Kobina; Ampadu, Emelia Danso Edwin; Pluschke, Gerd

2011-01-01

The introduction of antibiotic therapy as first-line treatment of Buruli ulcer underlines the importance of laboratory confirmation of clinical diagnosis. Because smear microscopy has very limited sensitivity, the technically demanding and more expensive IS2404 diagnostic polymerase chain reaction (PCR) has become the main method for confirmation. By optimization of the release of mycobacteria from swab specimen and concentration of bacterial suspensions before smearing, we were able to improve the detection rate of acid-fast bacilli by microscopy after Ziehl–Neelsen staining. Compared with IS2404 PCR, which is the gold standard diagnostic method, the sensitivity and specificity of microscopy with 100 concentrated specimens were 58.4% and 95.7%, respectively. We subsequently evaluated a stepwise laboratory confirmation algorithm with detection of AFB as first-line method and IS2404 PCR performed only with those samples that were negative in microscopic analysis. This stepwise approach reduced unit cost by more than 50% to $5.41, and the total costs were reduced from $917 to $433. PMID:22049046

Is there a step-wise migration in Nigeria? A case study of the migrational histories of migrants in Lagos.

PubMed

Afolayan, A A

1985-09-01

"The paper sets out to test whether or not the movement pattern of people in Nigeria is step-wise. It examines the spatial order in the country and the movement pattern of people. It then analyzes the survey data and tests for the validity of step-wise migration in the country. The findings show that step-wise migration cannot adequately describe all the patterns observed." The presence of large-scale circulatory migration between rural and urban areas is noted. Ways to decrease the pressure on Lagos by developing intermediate urban areas are considered. excerpt

A practical and systematic approach to organisational capacity strengthening for research in the health sector in Africa

PubMed Central

2014-01-01

Background Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. Our objective here was to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. Methods We used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. Our paper describes three contrasting case studies of organisational research capacity strengthening to illustrate how our five-step approach works in practice. Results Our five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. Our pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed. Conclusions Our five-step approach is flexible enough to generate and utilise ongoing learning. We have tested and critiqued our approach in a variety of organisational settings in the health sector in sub-Saharan Africa, but it needs to be applied and evaluated in other sectors and continents to determine the extent of transferability. PMID:24581148

[An automatic system controlled by microcontroller for carotid sinus perfusion].

PubMed

Yi, X L; Wang, M Y; Fan, Z Z; He, R R

2001-08-01

To establish a new method for controlling automatically the carotid perfusion pressure. A cheap practical automatic perfusion unit based on AT89C2051 micro controller was designed. The unit, LDB-M perfusion pump and the carotid sinus of an animal constituted an automatic perfusion system. This system was able to provide ramp and stepwise updown perfusion pattern and has been used in the research of baroreflex. It can insure the precision and reproducibility of perfusion pressure curve, and improve the technical level in corresponding medical field.

Multiple isotope effects with alternative dinucleotide substrates as a probe of the malic enzyme reaction

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

Weiss, P.M.; Urbauer, J.L.; Cleland, W.W.

1991-06-11

Deuterium isotope effects and {sup 13}C isotope effects with deuterium- and protium-labeled malate have been obtained for both NAD- and NADP-malic enzymes by using a variety of alternative dinucleotide substrates. With nicotinamide-containing dinucleotides as the oxidizing substrate, the {sup 13}C effect decreases when deuterated malate is the substrate compared to the value obtained with protium-labeled malate. These data are consistent with a stepwise chemical mechanism in which hydride transfer precedes decarboxylation of the oxalacetate intermediate as previously proposed. When dinucleotide substrates such as thio-NAD, 3-nicotinamide rings are used, the {sup 13}C effect increases when deuterated malate is the substrate comparedmore » to the value obtained with protium-labeled malate. These data, at face value, are consistent with a change in mechanism from stepwise to concerted for the oxidative decarboxylation portion of the mechanism. However, the increase in the deuterium isotope effect from 1.5 to 3 with a concomitant decrease in the {sup 13}C isotope effect from 1.034 to 1.003 as the dinucleotide substrate is changed suggests that the reaction may still be stepwise with the non-nicotinamide dinucleotides. A more likely explanation is that a {beta}-secondary {sup 13}C isotope effect accompanies hydride transfer as a result of hyperconjugation of the {beta}-carboxyl of malate as the transition state for the hydride transfer step is approached.« less

Random Survival Forest in practice: a method for modelling complex metabolomics data in time to event analysis.

PubMed

Dietrich, Stefan; Floegel, Anna; Troll, Martina; Kühn, Tilman; Rathmann, Wolfgang; Peters, Anette; Sookthai, Disorn; von Bergen, Martin; Kaaks, Rudolf; Adamski, Jerzy; Prehn, Cornelia; Boeing, Heiner; Schulze, Matthias B; Illig, Thomas; Pischon, Tobias; Knüppel, Sven; Wang-Sattler, Rui; Drogan, Dagmar

2016-10-01

The application of metabolomics in prospective cohort studies is statistically challenging. Given the importance of appropriate statistical methods for selection of disease-associated metabolites in highly correlated complex data, we combined random survival forest (RSF) with an automated backward elimination procedure that addresses such issues. Our RSF approach was illustrated with data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study, with concentrations of 127 serum metabolites as exposure variables and time to development of type 2 diabetes mellitus (T2D) as outcome variable. Out of this data set, Cox regression with a stepwise selection method was recently published. Replication of methodical comparison (RSF and Cox regression) was conducted in two independent cohorts. Finally, the R-code for implementing the metabolite selection procedure into the RSF-syntax is provided. The application of the RSF approach in EPIC-Potsdam resulted in the identification of 16 incident T2D-associated metabolites which slightly improved prediction of T2D when used in addition to traditional T2D risk factors and also when used together with classical biomarkers. The identified metabolites partly agreed with previous findings using Cox regression, though RSF selected a higher number of highly correlated metabolites. The RSF method appeared to be a promising approach for identification of disease-associated variables in complex data with time to event as outcome. The demonstrated RSF approach provides comparable findings as the generally used Cox regression, but also addresses the problem of multicollinearity and is suitable for high-dimensional data. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Interrogating concepts of care in the HIV care continuum: ethnographic insights from the implementation of a "Universal Test and Treat" approach in South Africa.

PubMed

Wademan, Dillon T; Reynolds, Lindsey J

2016-01-01

South Africa currently sustains the largest antiretroviral treatment (ART) programme in the world. The number of people on ART is set to grow even more in the coming years as incidence remains stable, people on ART stay healthy, and guidelines for initiation become increasingly inclusive. The South African public health sector has increasingly relied on community- and home-based lay and professional "carers" to carry out the everyday tasks of rolling out the ART programme. Drawing on ethnographic research in one locality in the Western Cape, the paper explores the care practices of two such groups of carers implementing a 'Universal Test and Treat' (UTT) approach. The UTT approach being evlauated in this place is based on one model of the HIV treatment cascade, or care continuum, which focuses on the steps necessary to identify and link HIV-positive individuals to care and retain them in lifelong HIV treatment. In this context, community-based care workers are responsible for carrying out several discrete steps in the HIV care continuum, including testing people for HIV, linking HIV-positive individuals to care, and supporting adherence. In order to retain clients within the continuum, however, carers also perform other forms of labour that stretch their care work beyond more bounded notions of a stepwise progression of care. These broader forms of care, which can be material, emotional, social or physical in nature, appear alongside the more structured technical and biomedical tasks formally expected of carers. We argue that understanding the dynamics of these more distributed and relational forms of care is essential for the effective implementation of the care continuum, and of the UTT approach, in diverse contexts.

Englisch Klasse 7: 1. Bericht Uber die audio-linguale Konzeption, 2. The Nature of the Curriculum for the Eighties and Onwards (Grade 7 English: 1. A Report on the Audiolingual Concept).

ERIC Educational Resources Information Center

Freudenstein, Reinhold; Habel, Hans-Gunther

This report consists of two papers devoted to the learning of English in the comprehensive high schools of Hessia, West Germany. The first paper discusses a study which suggests replacement of traditional methods by an audiolingual approach. A catalog of learning goals supplants outdated curriculums, thereby ensuring a stepwise progression of…

Coping with Academic Stressors: A Pilot Study

DTIC Science & Technology

1976-12-20

Sarason anid James H./Johnso K! N,0𔃺’ -75-90 V 9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT, PROJECT, TASK AREA A WORK UNIT...coping skills in the personnel of functioning organizations , it seemed desirable to approach this task in a stepwise fashion. An impoDrtant first step...research in a complex organization such as a police department. (Research with a police department is currently underway.) Because it was felt

The effect of thermal history on crystalline structure and mechanical properties of β-nucleated isotactic polypropylene

NASA Astrophysics Data System (ADS)

Tian, Yefei; Zhou, Jian; Feng, Jiachun

2018-04-01

The effect of thermal history on β-nucleated iPP was systematically investigated by comparing the variance of crystalline microstructures and mechanical property of stepwise crystallized sample and annealed sample, which experienced different thermal history. The mechanical property tests exhibit that that the toughness of stepwise crystallized sample and annealed sample were both decreased compared to control sample, while the tensile strength of the stepwise crystallized sample increased slightly. Structure investigation showed that the α-relaxation peak, which is related to the assignment of chains in rigid amorphous phase, moved to the high temperature region for stepwise crystallized sample, while it moved to the low temperature region for annealed sample. The results indicated the weakening in rigid amorphous fraction (RAF) and the increase in lamellar thickness of β-iPP after stepwise crystallization treatment. For annealed sample, the RAF strengthened and lamellar thickness decreased slightly after thermal treatment. A mechanism of crystalline microstructures evolution of restricted area between the main lamellar under different treatments was proposed.

Risk Factors Predicting Infectious Lactational Mastitis: Decision Tree Approach versus Logistic Regression Analysis.

PubMed

Fernández, Leónides; Mediano, Pilar; García, Ricardo; Rodríguez, Juan M; Marín, María

2016-09-01

Objectives Lactational mastitis frequently leads to a premature abandonment of breastfeeding; its development has been associated with several risk factors. This study aims to use a decision tree (DT) approach to establish the main risk factors involved in mastitis and to compare its performance for predicting this condition with a stepwise logistic regression (LR) model. Methods Data from 368 cases (breastfeeding women with mastitis) and 148 controls were collected by a questionnaire about risk factors related to medical history of mother and infant, pregnancy, delivery, postpartum, and breastfeeding practices. The performance of the DT and LR analyses was compared using the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity and accuracy of both models were calculated. Results Cracked nipples, antibiotics and antifungal drugs during breastfeeding, infant age, breast pumps, familial history of mastitis and throat infection were significant risk factors associated with mastitis in both analyses. Bottle-feeding and milk supply were related to mastitis for certain subgroups in the DT model. The areas under the ROC curves were similar for LR and DT models (0.870 and 0.835, respectively). The LR model had better classification accuracy and sensitivity than the DT model, but the last one presented better specificity at the optimal threshold of each curve. Conclusions The DT and LR models constitute useful and complementary analytical tools to assess the risk of lactational infectious mastitis. The DT approach identifies high-risk subpopulations that need specific mastitis prevention programs and, therefore, it could be used to make the most of public health resources.

Factors associated with resident satisfaction with their continuity experience.

PubMed

Serwint, Janet R; Feigelman, Susan; Dumont-Driscoll, Marilyn; Collins, Rebecca; Zhan, Min; Kittredge, Diane

2004-01-01

To identify factors associated with resident satisfaction concerning residents' continuity experience. Continuity directors distributed questionnaires to residents at their respective institutions. Resident satisfaction was defined as satisfied or very satisfied on a Likert scale. The independent variables included 60 characteristics of the continuity experience from 7 domains: 1) patient attributes, 2) continuity and longitudinal issues, 3) responsibility as primary care provider, 4) preceptor characteristics, 5) educational opportunities, 6) exposure to practice management, and 7) interaction with other clinic and practice staff. A stepwise logistic regression model and the Generalized Estimating Equations approach were used. Thirty-six programs participated. Of 1155 residents (71%) who provided complete data, 67% (n = 775) stated satisfaction with their continuity experience. The following characteristics (adjusted odds ratio [OR] and 95% confidence interval [CI]) were found to be most significant: preceptor as good role model, OR = 7.28 ( CI = 4.2, 12.5); appropriate amount of teaching, OR = 3.25 (CI = 2.1, 5.1); involvement during hospitalization, OR = 2.61 (CI = 1.3, 5.2); exposure to practice management, OR = 2.39 (CI = 1.5, 3.8); good balance of general pediatric patients, OR = 2.34 (CI = 1.5, 3.6); resident as patient advocate, OR = 1.74 (CI = 1.2, 2.4); and appropriate amount of nursing support, OR = 1.65 (CI = 1.1, 2.6). Future career choice, type of continuity site, and level of training were not found to be statistically significant. Pediatric resident satisfaction was significantly associated with 7 variables, the most important of which were the ability of the preceptor to serve as a role model and teacher. The type of continuity site was not significant. Residency programs may use these data to develop interventions to enhance resident satisfaction, which may lead to enhanced work performance and patient satisfaction.

Toward a new information infrastructure in health technology assessment: communication, design, process, and results.

PubMed

Neikter, Susanna Allgurin; Rehnqvist, Nina; Rosén, Måns; Dahlgren, Helena

2009-12-01

The aim of this study was to facilitate effective internal and external communication of an international network and to explore how to support communication and work processes in health technology assessment (HTA). STRUCTURE AND METHODS: European network for Health Technology Assessment (EUnetHTA) connected sixty-four HTA Partner organizations from thirty-three countries. User needs in the different steps of the HTA process were the starting point for developing an information system. A step-wise, interdisciplinary, creative approach was used in developing practical tools. An Information Platform facilitated the exchange of scientific information between Partners and with external target groups. More than 200 virtual meetings were set up during the project using an e-meeting tool. A Clearinghouse prototype was developed with the intent to offering a single point of access to HTA relevant information. This evolved into a next step not planned from the outset: Developing a running HTA Information System including several Web-based tools to support communication and daily HTA processes. A communication strategy guided the communication effort, focusing on practical tools, creating added value, involving stakeholders, and avoiding duplication of effort. Modern technology enables a new information infrastructure for HTA. The potential of information and communication technology was used as a strategic tool. Several target groups were represented among the Partners, which supported collaboration and made it easier to identify user needs. A distinctive visual identity made it easier to gain and maintain visibility on a limited budget.

Day case hernia repair: weak evidence or practice gap?

PubMed

Scarfe, Anje; Duncan, Joanna; Ma, Ning; Cameron, Alun; Rankin, David; Karatassas, Alex; Fletcher, David; Watters, David; Maddern, Guy

2018-06-01

Analysis of a private insurer's administrative data set revealed significant variation in the length of hospital stay following hernia surgery. This review examined factors influencing the performance of day surgery for inguinal, femoral and umbilical hernia repair in adults. A systematic literature search was conducted in the PubMed, Embase and Cochrane Library databases to identify studies and clinical practice guidelines (CPGs) comparing same day hernia surgery to surgery followed by an overnight stay. Screening of studies by abstract and full text was completed by a single researcher and checked by a second. Studies were selected for inclusion based on a step-wise approach across three phases. Limited evidence from one systematic review, and three case series studies including 3213 patients found that same day hernia surgery was as safe and effective as an overnight stay. All identified CPGs recommended a same day procedure for most patients. Two case series studies reported that 3-8% of patients were ineligible for day procedures due to medical reasons; however, the characteristics of patients, in general, which are not suitable, have not been adequately investigated. Day surgery for groin hernia repair is safe and effective for most patients. However, evidence-based support is only one of many factors that may contribute to the uptake of day surgery in Australia. There is an opportunity for key stakeholders across the private healthcare system to deliver an equally effective but more sustainable and affordable hernia care by increasing the day surgery rates. © 2018 Royal Australasian College of Surgeons.

Geriatric Hip Fracture Care: Fixing a Fragmented System.

PubMed

Anderson, Mary E; Mcdevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. To describe a stepwise approach to systems redesign for this patient population. We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Hospital length of stay. We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.

Job satisfaction of primary care physicians in Switzerland: an observational study.

PubMed

Goetz, Katja; Jossen, Marianne; Szecsenyi, Joachim; Rosemann, Thomas; Hahn, Karolin; Hess, Sigrid

2016-10-01

Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were rated higher by female physicians than male physicians. Within the stepwise regression analysis, the aspect 'opportunity to use abilities' (β = 0.644) showed the highest association to overall job satisfaction for male physicians while for female physicians it was income (β = 0.733). The presented results contribute to an understanding of factors that influence levels of satisfaction of female and male physicians. Therefore, research and intervention about job satisfaction should consider gender as well as the stereotypes that come along with these social roles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

β-Thalassemia intermedia: a comprehensive overview and novel approaches.

PubMed

Asadov, Chingiz; Alimirzoeva, Zohra; Mammadova, Tahira; Aliyeva, Gunay; Gafarova, Shahla; Mammadov, Jeyhun

2018-01-29

β-Thalassemia intermedia is a clinical condition of intermediate gravity between β-thalassemia minor, the asymptomatic carrier, and β-thalassemia major, the transfusion-dependent severe anemia. It is characterized by a significant clinical polymorphism, which is attributable to its genetic heterogeneity. Ineffective erythropoiesis, chronic anemia, and iron overload contribute to the clinical complications of thalassemia intermedia through stepwise pathophysiological mechanisms. These complications, including splenomegaly, extramedullary erythropoiesis, iron accumulation, leg ulcers, thrombophilia, and bone abnormalities can be managed via fetal hemoglobin induction, occasional transfusions, chelation, and in some cases, stem cell transplantation. Given its clinical diversity, thalassemia intermedia patients require tailored approaches to therapy. Here we present an overview and novel approaches to the genetic basis, pathophysiological mechanisms, clinical complications, and optimal management of thalassemia intermedia.

Environmental influences on alcohol consumption practices of alcoholic beverage servers.

PubMed

Nusbaumer, Michael R; Reiling, Denise M

2002-11-01

Public drinking establishments have long been associated with heavy drinking among both their patrons and servers. Whether these environments represent locations where heavy drinking is learned (learning hypothesis) or simply places where already-heavy drinkers gather in a supportive environment (selection hypothesis) remains an important question. A sample of licensed alcoholic beverage servers in the state of Indiana, USA, was surveyed to better understand the drinking behaviors of servers within the alcohol service industry. Responses (N = 938) to a mailed questionnaire were analyzed to assess the relative influence of environmental and demographic factors on the drinking behavior of servers. Stepwise regression revealed "drinking on the job" as the most influential environmental factor on heavy drinking behaviors, followed by age and gender as influential demographic factors. Support was found for the selection hypothesis, but not for the learning hypothesis. Policy implications are discussed. factors on the drinking behavior of servers. Stepwise regression revealed "drinking on the job" as the most influential environmental factor on heavy drinking behaviors, followed by age and gender as influential demographic factors. Support was found for the selection hypothesis, but not for the learning hypothesis. Policy implications are discussed.

Satisfaction among early and mid-career dentists in a metropolitan dental hospital in China

PubMed Central

Cui, Xiaoxi; Dunning, David G; An, Na

2017-01-01

A growing body of research has examined career satisfaction among dentists using a standardized instrument, dentist satisfaction survey (DSS). This project examined career satisfaction of early to mid-career dentists in China, a population whose career satisfaction, heretofore, has not been studied. This is an especially critical time to examine career satisfaction because of health care reform measures being implemented in China. A culturally sensitive Chinese-language version of the DSS (CDSS) was developed and electronically administered to 367 early and mid-career dentists in a tertiary dental hospital in Beijing, China. One hundred and seventy respondents completed the survey. The average total career score was 123, with a range of 82–157. Data analysis showed some significant differences in total career score and several subscales based on gender, working hours per week, and years in practice. A stepwise regression model revealed that two variables predicted total career score: working hours per week and gender. Stepwise regression also demonstrated that four subscales significantly predicted the overall professional satisfaction subscale score: respect, delivery of care, income and patient relations. Implications of these results are discussed in light of the health care delivery system and dentist career paths in China. PMID:29355243

Satisfaction among early and mid-career dentists in a metropolitan dental hospital in China.

PubMed

Cui, Xiaoxi; Dunning, David G; An, Na

2017-01-01

A growing body of research has examined career satisfaction among dentists using a standardized instrument, dentist satisfaction survey (DSS). This project examined career satisfaction of early to mid-career dentists in China, a population whose career satisfaction, heretofore, has not been studied. This is an especially critical time to examine career satisfaction because of health care reform measures being implemented in China. A culturally sensitive Chinese-language version of the DSS (CDSS) was developed and electronically administered to 367 early and mid-career dentists in a tertiary dental hospital in Beijing, China. One hundred and seventy respondents completed the survey. The average total career score was 123, with a range of 82-157. Data analysis showed some significant differences in total career score and several subscales based on gender, working hours per week, and years in practice. A stepwise regression model revealed that two variables predicted total career score: working hours per week and gender. Stepwise regression also demonstrated that four subscales significantly predicted the overall professional satisfaction subscale score: respect, delivery of care, income and patient relations. Implications of these results are discussed in light of the health care delivery system and dentist career paths in China.

Super-resolution fluorescence microscopy by stepwise optical saturation

PubMed Central

Zhang, Yide; Nallathamby, Prakash D.; Vigil, Genevieve D.; Khan, Aamir A.; Mason, Devon E.; Boerckel, Joel D.; Roeder, Ryan K.; Howard, Scott S.

2018-01-01

Super-resolution fluorescence microscopy is an important tool in biomedical research for its ability to discern features smaller than the diffraction limit. However, due to its difficult implementation and high cost, the super-resolution microscopy is not feasible in many applications. In this paper, we propose and demonstrate a saturation-based super-resolution fluorescence microscopy technique that can be easily implemented and requires neither additional hardware nor complex post-processing. The method is based on the principle of stepwise optical saturation (SOS), where M steps of raw fluorescence images are linearly combined to generate an image with a M-fold increase in resolution compared with conventional diffraction-limited images. For example, linearly combining (scaling and subtracting) two images obtained at regular powers extends the resolution by a factor of 1.4 beyond the diffraction limit. The resolution improvement in SOS microscopy is theoretically infinite but practically is limited by the signal-to-noise ratio. We perform simulations and experimentally demonstrate super-resolution microscopy with both one-photon (confocal) and multiphoton excitation fluorescence. We show that with the multiphoton modality, the SOS microscopy can provide super-resolution imaging deep in scattering samples. PMID:29675306

A Preoperative Planning Tool: Aggregate Anterior Approach to the Humerus With Quantitative Comparisons.

PubMed

Phelps, Kevin D; Harmer, Luke S; Crickard, Colin V; Hamid, Nady; Sample, Katherine M; Andrews, Erica B; Seymour, Rachel B; Hsu, Joseph R

2018-06-01

Extensile approaches to the humerus are often needed when treating complex proximal or distal fractures that have extension into the humeral shaft or in those fractures that occur around implants. The 2 most commonly used approaches for more complex fractures include the modified lateral paratricipital approach and the deltopectoral approach with distal anterior extension. Although the former is well described and quantified, the latter is often associated with variable nomenclature with technical descriptions that can be confusing. Furthermore, a method to expose the entire humerus through an anterior extensile approach has not been described. Here, we illustrate and quantify a technique for connecting anterior humeral approaches in a stepwise fashion to form an aggregate anterior approach (AAA). We also describe a method for further distal extension to expose 100% of the length of the humerus and compare this approach with both the AAA and the lateral paratricipital in terms of access to critical bony landmarks, as well as the length and area of bone exposed.

Stepwise magnetic-geochemical approach for efficient assessment of heavy metal polluted sites

NASA Astrophysics Data System (ADS)

Appel, E.; Rösler, W.; Ojha, G.

2012-04-01

Previous studies have shown that magnetometry can outline the distribution of fly ash deposition in the surroundings of coal-burning power plants and steel industries. Especially the easy-to-measure magnetic susceptibility (MS) is capable to act as a proxy for heavy metal (HM) pollution caused by such kind of point source pollution. Here we present a demonstration project around the coal-burning power plant complex "Schwarze Pumpe" in eastern Germany. Before reunification of West and East Germany huge amounts of HM pollutants were emitted from the "Schwarze Pumpe" into the environment by both fly ash emission and dumped clinker. The project has been conducted as part of the TASK Centre of Competence which aims at bringing new innovative techniques closer to the market. Our project combines in situ and laboratory MS measurements and HM analyses in order to demonstrate the efficiency of a stepwise approach for site assessment of HM pollution around point sources of fly-ash emission and deposition into soil. The following scenario is played through: We assume that the "true" spatial distribution of HM pollution (given by the pollution load index PLI comprising Fe, Zn, Pb, and Cu) is represented by our entire set of 85 measured samples (XRF analyses) from forest sites around the "Schwarze Pumpe". Surface MS data (collected with a Bartington MS2D) and in situ vertical MS sections (logged by an SM400 instrument) are used to determine a qualitative overview of potentially higher and lower polluted areas. A suite of spatial HM distribution maps obtained by random selections of 30 out of the 85 analysed sites is compared to the HM map obtained from a targeted 30-sites-selection based on pre-information from the MS results. The PLI distribution map obtained from the targeted 30-sites-selection shows all essential details of the "true" pollution map, while the different random 30-sites-selections miss important features. This comparison shows that, for the same cost investment, a stepwise combined magnetic-geochemical site assessment leads to a clearly more significant characterization of soil pollution than by a common approach with exclusively random sampling for geochemical analysis, or alternatively to an equal quality result for lower costs.

Melanin fluorescence spectra by step-wise three photon excitation

NASA Astrophysics Data System (ADS)

Lai, Zhenhua; Kerimo, Josef; DiMarzio, Charles A.

2012-03-01

Melanin is the characteristic chromophore of human skin with various potential biological functions. Kerimo discovered enhanced melanin fluorescence by stepwise three-photon excitation in 2011. In this article, step-wise three-photon excited fluorescence (STPEF) spectrum between 450 nm -700 nm of melanin is reported. The melanin STPEF spectrum exhibited an exponential increase with wavelength. However, there was a probability of about 33% that another kind of step-wise multi-photon excited fluorescence (SMPEF) that peaks at 525 nm, shown by previous research, could also be generated using the same process. Using an excitation source at 920 nm as opposed to 830 nm increased the potential for generating SMPEF peaks at 525 nm. The SMPEF spectrum peaks at 525 nm photo-bleached faster than STPEF spectrum.

A diagnostic approach to hemochromatosis

PubMed Central

Tavill, Anthony S; Adams, Paul C

2006-01-01

In the present clinical review, a diagnostic approach to hemochromatosis is discussed from the perspective of two clinicians with extensive experience in this area. The introduction of genetic testing and large-scale population screening studies have broadened our understanding of the clinical expression of disease and the utility of biochemical iron tests for the detection of disease and for the assessment of disease severity. Liver biopsy has become more of a prognostic test than a diagnostic test. The authors offer a stepwise, diagnostic algorithm based on current evidence-based data, that they regard as most cost-effective. An early diagnosis can lead to phlebotomy therapy to prevent the development of cirrhosis. PMID:16955151

Unified nonlinear approach to both weak and strong-interaction problems. [heat transfer in hypersonic flow

NASA Technical Reports Server (NTRS)

Gupta, R. N.; Rodkiewicz, C. M.

1975-01-01

The numerical results are obtained for heat transfer, skin-friction, and viscous interaction induced pressure for a step-wise accelerated flat plate in hypersonic flow. In the unified approach here the results are presented for both weak and strong-interaction problems without employing any linearization scheme. With the help of the numerical method used in this work an accurate prediction of wall shear can be made for the problems with plate velocity changes of 1% or larger. The obtained results indicate that the transient contribution to the induced pressure for helium is greater than that for air.

The remarkable environmental rebound effect of electric cars: a microeconomic approach.

PubMed

Font Vivanco, David; Freire-González, Jaume; Kemp, René; van der Voet, Ester

2014-10-21

This article presents a stepwise, refined, and practical analytical framework to model the microeconomic environmental rebound effect (ERE) stemming from cost differences of electric cars in terms of changes in multiple life cycle environmental indicators. The analytical framework is based on marginal consumption analysis and hybrid life cycle assessment (LCA). The article makes a novel contribution through a reinterpretation of the traditional rebound effect and methodological refinements. It also provides novel empirical results about the ERE for plug-in hybrid electric (PHE), full-battery electric (FBE), and hydrogen fuel cell (HFC) cars for Europe. The ERE is found to have a remarkable impact on product-level environmental scores. For the PHE car, the ERE causes a marginal increase in demand and environmental pressures due to a small decrease in the cost of using this technology. For FBE and HFC cars, the high capital costs cause a noteworthy decrease in environmental pressures for some indicators (negative rebound effect). The results corroborate the concern over the high influence of cost differences for environmental assessment, and they prompt sustainable consumption policies to consider markets and prices as tools rather than as an immutable background.

Rational Selection, Criticality Assessment, and Tiering of Quality Attributes and Test Methods for Analytical Similarity Evaluation of Biosimilars.

PubMed

Vandekerckhove, Kristof; Seidl, Andreas; Gutka, Hiten; Kumar, Manish; Gratzl, Gyöngyi; Keire, David; Coffey, Todd; Kuehne, Henriette

2018-05-10

Leading regulatory agencies recommend biosimilar assessment to proceed in a stepwise fashion, starting with a detailed analytical comparison of the structural and functional properties of the proposed biosimilar and reference product. The degree of analytical similarity determines the degree of residual uncertainty that must be addressed through downstream in vivo studies. Substantive evidence of similarity from comprehensive analytical testing may justify a targeted clinical development plan, and thus enable a shorter path to licensing. The importance of a careful design of the analytical similarity study program therefore should not be underestimated. Designing a state-of-the-art analytical similarity study meeting current regulatory requirements in regions such as the USA and EU requires a methodical approach, consisting of specific steps that far precede the work on the actual analytical study protocol. This white paper discusses scientific and methodological considerations on the process of attribute and test method selection, criticality assessment, and subsequent assignment of analytical measures to US FDA's three tiers of analytical similarity assessment. Case examples of selection of critical quality attributes and analytical methods for similarity exercises are provided to illustrate the practical implementation of the principles discussed.

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

Tang, Kunkun, E-mail: ktg@illinois.edu; Inria Bordeaux – Sud-Ouest, Team Cardamom, 200 avenue de la Vieille Tour, 33405 Talence; Congedo, Pietro M.

The Polynomial Dimensional Decomposition (PDD) is employed in this work for the global sensitivity analysis and uncertainty quantification (UQ) of stochastic systems subject to a moderate to large number of input random variables. Due to the intimate connection between the PDD and the Analysis of Variance (ANOVA) approaches, PDD is able to provide a simpler and more direct evaluation of the Sobol' sensitivity indices, when compared to the Polynomial Chaos expansion (PC). Unfortunately, the number of PDD terms grows exponentially with respect to the size of the input random vector, which makes the computational cost of standard methods unaffordable formore » real engineering applications. In order to address the problem of the curse of dimensionality, this work proposes essentially variance-based adaptive strategies aiming to build a cheap meta-model (i.e. surrogate model) by employing the sparse PDD approach with its coefficients computed by regression. Three levels of adaptivity are carried out in this paper: 1) the truncated dimensionality for ANOVA component functions, 2) the active dimension technique especially for second- and higher-order parameter interactions, and 3) the stepwise regression approach designed to retain only the most influential polynomials in the PDD expansion. During this adaptive procedure featuring stepwise regressions, the surrogate model representation keeps containing few terms, so that the cost to resolve repeatedly the linear systems of the least-squares regression problem is negligible. The size of the finally obtained sparse PDD representation is much smaller than the one of the full expansion, since only significant terms are eventually retained. Consequently, a much smaller number of calls to the deterministic model is required to compute the final PDD coefficients.« less

Remote Sensing as a Landscape Epidemiologic Tool to Identify Villages at High Risk for Malaria Transmission

NASA Technical Reports Server (NTRS)

Beck, Louisa R.; Rodriquez, Mario H.; Dister, Sheri W.; Rodriquez, Americo D.; Rejmankova, Eliska; Ulloa, Armando; Meza, Rosa A.; Roberts, Donald R.; Paris, Jack F.; Spanner, Michael A.;

Medical Simulations for Exploration Medicine

NASA Technical Reports Server (NTRS)

Reyes, David; Suresh, Rahul; Pavela, James; Urbina, Michelle; Mindock, Jennifer; Antonsen, Erik

2018-01-01

Medical simulation is a useful tool that can be used to train personnel, develop medical processes, and assist cross-disciplinary communication. Medical simulations have been used in the past at NASA for these purposes, however they are usually created ad hoc. A stepwise approach to scenario development has not previously been used. The NASA Exploration Medical Capability (ExMC) created a medical scenario development tool to test medical procedures, technologies, concepts of operation and for use in systems engineering (SE) processes.

Mapping land cover from satellite images: A basic, low cost approach

NASA Technical Reports Server (NTRS)

Elifrits, C. D.; Barney, T. W.; Barr, D. J.; Johannsen, C. J.

1978-01-01

Simple, inexpensive methodologies developed for mapping general land cover and land use categories from LANDSAT images are reported. One methodology, a stepwise, interpretive, direct tracing technique was developed through working with university students from different disciplines with no previous experience in satellite image interpretation. The technique results in maps that are very accurate in relation to actual land cover and relative to the small investment in skill, time, and money needed to produce the products.

Modelling of volunteer satisfaction and intention to remain in community service: A stepwise approach

NASA Astrophysics Data System (ADS)

Hasan, Hazlin; Wahid, Sharifah Norhuda Syed; Jais, Mohammad; Ridzuan, Arifi

2017-05-01

The purpose of this study is to obtain the most significant model of volunteer satisfaction and intention to remain in community service by using a stepwise approach. Currently, Malaysians, young and old are showing more interests in involving themselves in community service projects, either locally or internationally. This positive movement of serving the needy is somehow being halted by the lack of human and financial resources. Therefore, the trend today sees organizers of such projects depend heavily on voluntary supports as they enable project managers to add and to expand the quantity and diversity of services offered without exhausting the minimal budget available. Volunteers are considered a valuable commodity as the available pool of volunteers may be declining due to various reasons which include the volunteer satisfaction. In tandem with the existing situation, a selected sample of 215 diploma students from one of the public universities in Malaysia, who have been involved in at least one community service project, agreed that everybody should have a volunteering intention in helping others. The findings revealed that the most significant model obtained contains two factors that contributed towards intention to remain in community service; work assignment and organizational support, with work assignment becoming the most significant factor. Further research on the differences of intention to remain in community service between students' stream and gender would be conducted to contribute to the body of knowledge.

Supported Silver Nanoparticle and Near-Interface Solution Dynamics in a Deep Eutectic Solvent

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

Hammons, Joshua A.; Ustarroz, Jon; Muselle, Thibault

2016-01-28

Type III deep eutectic solvents (DES) have attracted significant interest as both environmentally friendly and functional solvents that are, in some ways, advantageous to traditional aqueous systems. While these solvents continue to produce remarkable thin films and nanoparticle assemblies, their interactions with metallic surfaces are complex and difficult to manipulate. In this study, the near-surface region (2–600 nm) of a carbon surface is investigated immediately following silver nanoparticle nucleation and growth. This is accomplished, in situ, using a novel grazing transmission small-angle X-ray scattering approach with simultaneous voltammetry and electrochemical impedance spectroscopy. With this physical and electrochemical approach, the timemore » evolution of three distinct surface interaction phenomena is observed: aggregation and coalescence of Ag nanoparticles, multilayer perturbations induced by nonaggregated Ag nanoparticles, and a stepwise transport of dissolved Ag species from the carbon surface. The multilayer perturbations contain charge-separated regions of positively charged choline-ethylene and negatively charged Ag and Cl species. Both aggregation-coalescence and the stepwise decrease in Ag precursor near the surface are observed to be very slow (~2 h) processes, as both ion and particle transport are significantly impeded in a DES as compared to aqueous electrolytes. Finally, altogether, this study shows how the unique chemistry of the DES changes near the surface and in the presence of nanoparticles that adsorb the constituent species.« less

Stepwise hydrolysis to improve carbon releasing efficiency from sludge.

PubMed

Liu, Hongbo; Wang, Yuanyuan; Wang, Ling; Yu, Tiantian; Fu, Bo; Liu, He

2017-08-01

Based on thermal alkaline hydrolysis (TAH), a novel strategy of stepwise hydrolysis was developed to improve carbon releasing efficiency from waste activated sludge (WAS). By stepwise increasing hydrolysis intensity, conventional sludge hydrolysis (the control) was divided into four stages for separately recovering sludge carbon sources with different bonding strengths, namely stage 1 (60 °C, pH 6.0-8.0), stage 2 (80 °C, pH 6.0-8.0), stage 3 (80 °C, pH 10.0) and stage 4 (90 °C, pH 12.0). Results indicate stepwise hydrolysis could enhance the amount of released soluble chemical oxygen demand (SCOD) for almost 2 times, from 7200 to 14,693 mg/L, and the released carbon presented better biodegradability, with BOD/COD of 0.47 and volatile fatty acids (VFAs) yield of 0.37 g VFAs/g SCOD via anaerobic fermentation. Moreover, stepwise hydrolysis also improved the dewaterability of hydrolyzed sludge, capillary suction time (CST) reducing from 2500 to 1600 s. Economic assessment indicates stepwise hydrolysis shows less alkali demand and lower thermal energy consumption than those of the control. Furthermore, results of this study help support the concepts of improving carbon recovery in wastewater by manipulating WAS composition and the idea of classifiably recovering the nutrients in WAS. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Fast optimization of stepwise gradient conditions for ternary mobile phase in reversed-phase high performance liquid chromatography].

PubMed

Shan, Yi-chu; Zhang, Yu-kui; Zhao, Rui-huan

2002-07-01

In high performance liquid chromatography, it is necessary to apply multi-composition gradient elution for the separation of complex samples such as environmental and biological samples. Multivariate stepwise gradient elution is one of the most efficient elution modes, because it combines the high selectivity of multi-composition mobile phase and shorter analysis time of gradient elution. In practical separations, the separation selectivity of samples can be effectively adjusted by using ternary mobile phase. For the optimization of these parameters, the retention equation of samples must be obtained at first. Traditionally, several isocratic experiments are used to get the retention equation of solute. However, it is time consuming especially for the separation of complex samples with a wide range of polarity. A new method for the fast optimization of ternary stepwise gradient elution was proposed based on the migration rule of solute in column. First, the coefficients of retention equation of solute are obtained by running several linear gradient experiments, then the optimal separation conditions are searched according to the hierarchical chromatography response function which acts as the optimization criterion. For each kind of organic modifier, two initial linear gradient experiments are used to obtain the primary coefficients of retention equation of each solute. For ternary mobile phase, only four linear gradient runs are needed to get the coefficients of retention equation. Then the retention times of solutes under arbitrary mobile phase composition can be predicted. The initial optimal mobile phase composition is obtained by resolution mapping for all of the solutes. A hierarchical chromatography response function is used to evaluate the separation efficiencies and search the optimal elution conditions. In subsequent optimization, the migrating distance of solute in the column is considered to decide the mobile phase composition and sustaining time of the latter steps until all the solutes are eluted out. Thus the first stepwise gradient elution conditions are predicted. If the resolution of samples under the predicted optimal separation conditions is satisfactory, the optimization procedure is stopped; otherwise, the coefficients of retention equation are adjusted according to the experimental results under the previously predicted elution conditions. Then the new stepwise gradient elution conditions are predicted repeatedly until satisfactory resolution is obtained. Normally, the satisfactory separation conditions can be found only after six experiments by using the proposed method. In comparison with the traditional optimization method, the time needed to finish the optimization procedure can be greatly reduced. The method has been validated by its application to the separation of several samples such as amino acid derivatives, aromatic amines, in which satisfactory separations were obtained with predicted resolution.

Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study.

PubMed

Asensio, J A; Petrone, P; García-Núñez, L; Kimbrell, B; Kuncir, E

2007-01-01

Complex hepatic injuries grades IV-V are highly lethal. The objective of this study is to assess the multidisciplinary approach for their management and to evaluate if survival could be improved with this approach. Prospective 54-month study of all patients sustaining hepatic injuries grades IV-V managed operatively at a Level I Trauma Center. survival. univariate and stepwise logistic regression. Seventy-five patients sustained penetrating (47/63%) and blunt (28/37%) injuries. Seven (9%) patients underwent emergency department thoracotomy with a mortality of 100%. Out of the 75 patients, 52 (69%) sustained grade IV, and 23 (31%) grade V. The estimated blood loss was 3,539+/-3,040 ml. The overall survival was 69%, adjusted survival excluding patients requiring emergency department thoracotomy was 76%. Survival stratified to injury grade: grade IV 42/52-81%, grade V 10/23-43%. Mortality grade IV versus V injuries (p < 0.002; RR 2.94; 95% CI 1.52-5.70). Risk factors for mortality: packed red blood cells transfused in operating room (p=0.024), estimated blood loss (p < 0.001), dysryhthmia (p < 0.0001), acidosis (p = 0.051), hypothermia (p = 0.04). The benefit of angiography and angioembolization indicated: 12% mortality (2/17) among those that received it versus a 36% mortality (21/58) among those that did not (p = 0.074; RR 0.32; 95% CI 0.08-1.25). Stepwise logistic regression identified as significant independent predictors of outcome: estimated blood loss (p= 0.0017; RR 1.24; 95% CI 1.08-1.41) and number of packed red blood cells transfused in the operating room (p = 0.0358; RR 1.16; 95% CI 1.01-1.34). The multidisciplinary approach to the management of these severe grades of injuries appears to improve survival in these highly lethal injuries. A prospective multi-institutional study is needed to validate this approach.

Stepwise intervention including 1-on-1 counseling is highly effective in increasing influenza vaccination among health care workers.

PubMed

Jung, Younghee; Kwon, Mihye; Song, Jeongmi

2017-06-01

The influenza vaccination rate among health care workers (HCWs) remains suboptimal. We attempted to increase vaccine uptake in HCWs by nonmandatory measures, including 1-on-1 counseling. In 2015 we used a stepwise approach including (1) text messaging on the last day of the vaccination period, (2) extending the vaccination period by 3 days, (3) education for the low uptake group, and (4) 1-on-1 counseling for unvaccinated HCWs after the 3 interventions. There were 1,433 HCWs included. By the end of the initial 3 days, the uptake rate was 80.0% (1,146/1,433). During an extension for a further 3 days, 33 additional HCWs received the vaccine. One month after starting the vaccination, 90.1% (1,291/1,433) of the HCWs were vaccinated, but this included only 76.1% (210/276) of the doctors (lowest among HCWs). After 3 educational presentations targeted at the unvaccinated doctors, no additional individuals were vaccinated in the following 2 weeks. After 1-on-1 counseling for unvaccinated HCWs, the overall vaccination rate increased to 94.7% (1,357/1,433) in 2015, higher than in the previous year (82.5%, P < .001). Of the unvaccinated doctors, 63.2% (43/68) were vaccinated, therefore achieving 92.4% (255/276) compliance, higher than the 56.5% in the previous year (152/269, P < .001). Stepwise intervention including 1-on-1 counseling is effective in increasing influenza vaccination rates among HCWs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The use of machine learning for the identification of peripheral artery disease and future mortality risk.

PubMed

Ross, Elsie Gyang; Shah, Nigam H; Dalman, Ronald L; Nead, Kevin T; Cooke, John P; Leeper, Nicholas J

2016-11-01

A key aspect of the precision medicine effort is the development of informatics tools that can analyze and interpret "big data" sets in an automated and adaptive fashion while providing accurate and actionable clinical information. The aims of this study were to develop machine learning algorithms for the identification of disease and the prognostication of mortality risk and to determine whether such models perform better than classical statistical analyses. Focusing on peripheral artery disease (PAD), patient data were derived from a prospective, observational study of 1755 patients who presented for elective coronary angiography. We employed multiple supervised machine learning algorithms and used diverse clinical, demographic, imaging, and genomic information in a hypothesis-free manner to build models that could identify patients with PAD and predict future mortality. Comparison was made to standard stepwise linear regression models. Our machine-learned models outperformed stepwise logistic regression models both for the identification of patients with PAD (area under the curve, 0.87 vs 0.76, respectively; P = .03) and for the prediction of future mortality (area under the curve, 0.76 vs 0.65, respectively; P = .10). Both machine-learned models were markedly better calibrated than the stepwise logistic regression models, thus providing more accurate disease and mortality risk estimates. Machine learning approaches can produce more accurate disease classification and prediction models. These tools may prove clinically useful for the automated identification of patients with highly morbid diseases for which aggressive risk factor management can improve outcomes. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Integrating practical, regulatory and ethical strategies for enhancing farm animal welfare.

PubMed

Mellor, D J; Stafford, K J

2001-11-01

To provide an integrated view of relationships between assessment of animal welfare. societal expectations regarding animal welfare standards, the need for regulation, and two ethical strategies for promoting animal welfare, emphasising farm animals. Ideas in relevant papers and key insights were outlined and illustrated, where appropriate, by New Zealand experience with different facets of the welfare management of farm animals. An animal's welfare is good when its nutritional, environmental, health, behavioural and mental needs are met. Compromise may occur in one or more of these areas and is assessed by scientifically-informed best judgement using parameters validated by directed research and objective analysis in clinical and practical settings. There is a wide range of perceptions of what constitutes good and bad welfare in society, so that animal welfare standards cannot be left to individual preferences to determine. Rather, the promotion of animal welfare is seen as requiring central regulation, but managed in a way that allows for adjustments based on new scientific knowledge of animals' needs and changing societal perceptions of what is acceptable and unacceptable treatment of animals. Concepts of 'minimal welfare', representing the threshold of cruelty, and 'acceptable welfare', representing higher, more acceptable standards than those that merely avoid cruelty, are outlined. They are relevant to economic analyses, which deal with determinants of animal welfare standards based on financial costs and the desire of the public to feel broadly comfortable about the treatment of the animals that are used to serve their needs. Ethical strategies for promoting animal welfare can be divided broadly into the 'gold standard' approach and the 'incremental improvement' approach. The first defines the ideal that is to be required in a particular situation and will accept nothing less than that ideal, whereas the second aims to improve welfare in a step-wise fashion by setting a series of achievable goals, seeing each small advance as worthwhile progress towards the same ideal. 'Incremental improvement' is preferred. This also has application in veterinary practice where the professional commitment to maintain good welfare standards may at times conflict with financial constraints experienced by clients.

Thermal properties of alkali-activated aluminosilicates

NASA Astrophysics Data System (ADS)

Florian, Pavel; Valentova, Katerina; Fiala, Lukas; Zmeskal, Oldrich

2017-07-01

The paper is focused on measurements and evaluation of thermal properties of alkali-activated aluminosilicates (AAA) with various carbon admixtures. Such composites consisting of blast-furnace slag, quartz sand, water glass as alkali activator and small amount of electrically conductive carbon admixture exhibit better electric and thermal properties than the reference material. Such enhancement opens up new practical applications, such as designing of snow-melting, de-icing or self-sensing systems that do not need any external sensors to detect current condition of building material. Thermal properties of the studied materials were measured by the step-wise transient method and mutually compared.

The ADDITION-Cambridge trial protocol: a cluster -- randomised controlled trial of screening for type 2 diabetes and intensive treatment for screen-detected patients.

PubMed

Echouffo-Tcheugui, Justin B; Simmons, Rebecca K; Williams, Kate M; Barling, Roslyn S; Prevost, A Toby; Kinmonth, Ann Louise; Wareham, Nicholas J; Griffin, Simon J

2009-05-12

The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, the benefits of such a strategy remain uncertain. The ADDITION-Cambridge study aims to evaluate the effectiveness and cost-effectiveness of (i) a stepwise screening strategy for type 2 diabetes; and (ii) intensive multifactorial treatment for people with screen-detected diabetes in primary care. 63 practices in the East Anglia region participated. Three undertook the pilot study, 33 were allocated to three groups: no screening (control), screening followed by intensive treatment (IT) and screening plus routine care (RC) in an unbalanced (1:3:3) randomisation. The remaining 27 practices were randomly allocated to IT and RC. A risk score incorporating routine practice data was used to identify people aged 40-69 years at high-risk of undiagnosed diabetes. In the screening practices, high-risk individuals were invited to take part in a stepwise screening programme. In the IT group, diabetes treatment is optimised through guidelines, target-led multifactorial treatment, audit, feedback, and academic detailing for practice teams, alongside provision of educational materials for newly diagnosed participants. Primary endpoints are modelled cardiovascular risk at one year, and cardiovascular mortality and morbidity at five years after diagnosis of diabetes. Secondary endpoints include all-cause mortality, development of renal and visual impairment, peripheral neuropathy, health service costs, self-reported quality of life, functional status and health utility. Impact of the screening programme at the population level is also assessed through measures of mortality, cardiovascular morbidity, health status and health service use among high-risk individuals. ADDITION-Cambridge is conducted in a defined high-risk group accessible through primary care. It addresses the feasibility of population-based screening for diabetes, as well as the benefits and costs of screening and intensive multifactorial treatment early in the disease trajectory. The intensive treatment algorithm is based on evidence from studies including individuals with clinically diagnosed diabetes and the education materials are informed by psychological theory. ADDITION-Cambridge will provide timely evidence concerning the benefits of early intensive treatment and will inform policy decisions concerning screening for type 2 diabetes. Current Controlled trials ISRCTN86769081.

The ADDITION-Cambridge trial protocol: a cluster – randomised controlled trial of screening for type 2 diabetes and intensive treatment for screen-detected patients

PubMed Central

Echouffo-Tcheugui, Justin B; Simmons, Rebecca K; Williams, Kate M; Barling, Roslyn S; Prevost, A Toby; Kinmonth, Ann Louise; Wareham, Nicholas J; Griffin, Simon J

2009-01-01

Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, the benefits of such a strategy remain uncertain. Methods and design The ADDITION-Cambridge study aims to evaluate the effectiveness and cost-effectiveness of (i) a stepwise screening strategy for type 2 diabetes; and (ii) intensive multifactorial treatment for people with screen-detected diabetes in primary care. 63 practices in the East Anglia region participated. Three undertook the pilot study, 33 were allocated to three groups: no screening (control), screening followed by intensive treatment (IT) and screening plus routine care (RC) in an unbalanced (1:3:3) randomisation. The remaining 27 practices were randomly allocated to IT and RC. A risk score incorporating routine practice data was used to identify people aged 40–69 years at high-risk of undiagnosed diabetes. In the screening practices, high-risk individuals were invited to take part in a stepwise screening programme. In the IT group, diabetes treatment is optimised through guidelines, target-led multifactorial treatment, audit, feedback, and academic detailing for practice teams, alongside provision of educational materials for newly diagnosed participants. Primary endpoints are modelled cardiovascular risk at one year, and cardiovascular mortality and morbidity at five years after diagnosis of diabetes. Secondary endpoints include all-cause mortality, development of renal and visual impairment, peripheral neuropathy, health service costs, self-reported quality of life, functional status and health utility. Impact of the screening programme at the population level is also assessed through measures of mortality, cardiovascular morbidity, health status and health service use among high-risk individuals. Discussion ADDITION-Cambridge is conducted in a defined high-risk group accessible through primary care. It addresses the feasibility of population-based screening for diabetes, as well as the benefits and costs of screening and intensive multifactorial treatment early in the disease trajectory. The intensive treatment algorithm is based on evidence from studies including individuals with clinically diagnosed diabetes and the education materials are informed by psychological theory. ADDITION-Cambridge will provide timely evidence concerning the benefits of early intensive treatment and will inform policy decisions concerning screening for type 2 diabetes. Trial registration Current Controlled trials ISRCTN86769081 PMID:19435491

An Official American Thoracic Society Workshop Report. A Framework for Addressing Multimorbidity in Clinical Practice Guidelines for Pulmonary Disease, Critical Illness, and Sleep Disorders.

PubMed

Wilson, Kevin C; Gould, Michael K; Krishnan, Jerry A; Boyd, Cynthia M; Brozek, Jan L; Cooke, Colin R; Douglas, Ivor S; Goodman, Richard A; Joo, Min J; Lareau, Suzanne; Mularski, Richard A; Patel, Minal R; Rosenfeld, Richard M; Shanawani, Hasan; Slatore, Christopher; Sockrider, Marianna; Sufian, Beth; Thomson, Carey C; Wiener, Renda Soylemez

2016-03-01

Coexistence of multiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework.

Stepwise nanoassembly of a single hairpin probe and its biosensing.

PubMed

Xu, Jianguo; Zheng, Tingting; Le, Jingqing; Jia, Lee

2018-09-01

Herein, we describe a novel trigger-induced DNA nanoassembly method using only one loop-stem shaped hairpin probe (HP) that consists of three different functional regions as a single building unit. The Region I is designed complementary to the trigger, while the Region II and Region III are projected to complementary with each other. When hybridized with the trigger, a toehold mediated strand displacement (TMSD) occurred on the strand of Region I, leading to the release of Region III for further hybridization with the Region II on another HP molecule and in turn inducing a stepwise growth of HP with the aid of polymerase. Unlike the conventional assembly approaches that rely on the sophisticated sequence design and complex operation, the single-HP nanoassembly is easy and fast. Moreover, because many HPs are opened during the assembly process, we exemplified the nanoassembly strategy by re-designing a new labeled hairpin probe to analyze the Kras oncogene with a high sensitivity and specificity. The present study demonstrated a novel promising DNA nanoassembly strategy for biological applications. Copyright © 2018 Elsevier B.V. All rights reserved.

Blind prediction of noncanonical RNA structure at atomic accuracy.

PubMed

Watkins, Andrew M; Geniesse, Caleb; Kladwang, Wipapat; Zakrevsky, Paul; Jaeger, Luc; Das, Rhiju

2018-05-01

Prediction of RNA structure from nucleotide sequence remains an unsolved grand challenge of biochemistry and requires distinct concepts from protein structure prediction. Despite extensive algorithmic development in recent years, modeling of noncanonical base pairs of new RNA structural motifs has not been achieved in blind challenges. We report a stepwise Monte Carlo (SWM) method with a unique add-and-delete move set that enables predictions of noncanonical base pairs of complex RNA structures. A benchmark of 82 diverse motifs establishes the method's general ability to recover noncanonical pairs ab initio, including multistrand motifs that have been refractory to prior approaches. In a blind challenge, SWM models predicted nucleotide-resolution chemical mapping and compensatory mutagenesis experiments for three in vitro selected tetraloop/receptors with previously unsolved structures (C7.2, C7.10, and R1). As a final test, SWM blindly and correctly predicted all noncanonical pairs of a Zika virus double pseudoknot during a recent community-wide RNA-Puzzle. Stepwise structure formation, as encoded in the SWM method, enables modeling of noncanonical RNA structure in a variety of previously intractable problems.

Automation of peak-tracking analysis of stepwise perturbed NMR spectra.

PubMed

Banelli, Tommaso; Vuano, Marco; Fogolari, Federico; Fusiello, Andrea; Esposito, Gennaro; Corazza, Alessandra

2017-02-01

We describe a new algorithmic approach able to automatically pick and track the NMR resonances of a large number of 2D NMR spectra acquired during a stepwise variation of a physical parameter. The method has been named Trace in Track (TINT), referring to the idea that a gaussian decomposition traces peaks within the tracks recognised through 3D mathematical morphology. It is capable of determining the evolution of the chemical shifts, intensity and linewidths of each tracked peak.The performances obtained in term of track reconstruction and correct assignment on realistic synthetic spectra were high above 90% when a noise level similar to that of experimental data were considered. TINT was applied successfully to several protein systems during a temperature ramp in isotope exchange experiments. A comparison with a state-of-the-art algorithm showed promising results for great numbers of spectra and low signal to noise ratios, when the graduality of the perturbation is appropriate. TINT can be applied to different kinds of high throughput chemical shift mapping experiments, with quasi-continuous variations, in which a quantitative automated recognition is crucial.

Insulin degludec/insulin aspart once daily in Type 2 diabetes: a comparison of simple or stepwise titration algorithms (BOOST® : SIMPLE USE).

PubMed

Park, S W; Bebakar, W M W; Hernandez, P G; Macura, S; Hersløv, M L; de la Rosa, R

2017-02-01

To compare the efficacy and safety of two titration algorithms for insulin degludec/insulin aspart (IDegAsp) administered once daily with metformin in participants with insulin-naïve Type 2 diabetes mellitus. This open-label, parallel-group, 26-week, multicentre, treat-to-target trial, randomly allocated participants (1:1) to two titration arms. The Simple algorithm titrated IDegAsp twice weekly based on a single pre-breakfast self-monitored plasma glucose (SMPG) measurement. The Stepwise algorithm titrated IDegAsp once weekly based on the lowest of three consecutive pre-breakfast SMPG measurements. In both groups, IDegAsp once daily was titrated to pre-breakfast plasma glucose values of 4.0-5.0 mmol/l. Primary endpoint was change from baseline in HbA 1c (%) after 26 weeks. Change in HbA 1c at Week 26 was IDegAsp Simple -14.6 mmol/mol (-1.3%) (to 52.4 mmol/mol; 6.9%) and IDegAsp Stepwise -11.9 mmol/mol (-1.1%) (to 54.7 mmol/mol; 7.2%). The estimated between-group treatment difference was -1.97 mmol/mol [95% confidence interval (CI) -4.1, 0.2] (-0.2%, 95% CI -0.4, 0.02), confirming the non-inferiority of IDegAsp Simple to IDegAsp Stepwise (non-inferiority limit of ≤ 0.4%). Mean reduction in fasting plasma glucose and 8-point SMPG profiles were similar between groups. Rates of confirmed hypoglycaemia were lower for IDegAsp Stepwise [2.1 per patient years of exposure (PYE)] vs. IDegAsp Simple (3.3 PYE) (estimated rate ratio IDegAsp Simple /IDegAsp Stepwise 1.8; 95% CI 1.1, 2.9). Nocturnal hypoglycaemia rates were similar between groups. No severe hypoglycaemic events were reported. In participants with insulin-naïve Type 2 diabetes mellitus, the IDegAsp Simple titration algorithm improved HbA 1c levels as effectively as a Stepwise titration algorithm. Hypoglycaemia rates were lower in the Stepwise arm. © 2016 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Evidence and consensus recommendations for the pharmacological management of pain in India

PubMed Central

Dureja, Gur Prasad; Iyer, Rajagopalan N; Das, Gautam; Ahdal, Jaishid; Narang, Prashant

2017-01-01

Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events – particularly with opioids and surgical methods of analgesia – are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case–control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making. PMID:28435313

Virus Identification in Unknown Tropical Febrile Illness Cases Using Deep Sequencing

PubMed Central

Balmaseda, Angel; Harris, Eva; DeRisi, Joseph L.

2012-01-01

Dengue virus is an emerging infectious agent that infects an estimated 50–100 million people annually worldwide, yet current diagnostic practices cannot detect an etiologic pathogen in ∼40% of dengue-like illnesses. Metagenomic approaches to pathogen detection, such as viral microarrays and deep sequencing, are promising tools to address emerging and non-diagnosable disease challenges. In this study, we used the Virochip microarray and deep sequencing to characterize the spectrum of viruses present in human sera from 123 Nicaraguan patients presenting with dengue-like symptoms but testing negative for dengue virus. We utilized a barcoding strategy to simultaneously deep sequence multiple serum specimens, generating on average over 1 million reads per sample. We then implemented a stepwise bioinformatic filtering pipeline to remove the majority of human and low-quality sequences to improve the speed and accuracy of subsequent unbiased database searches. By deep sequencing, we were able to detect virus sequence in 37% (45/123) of previously negative cases. These included 13 cases with Human Herpesvirus 6 sequences. Other samples contained sequences with similarity to sequences from viruses in the Herpesviridae, Flaviviridae, Circoviridae, Anelloviridae, Asfarviridae, and Parvoviridae families. In some cases, the putative viral sequences were virtually identical to known viruses, and in others they diverged, suggesting that they may derive from novel viruses. These results demonstrate the utility of unbiased metagenomic approaches in the detection of known and divergent viruses in the study of tropical febrile illness. PMID:22347512

Testing inferences in developmental evolution: the forensic evidence principle.

PubMed

Larsson, Hans C E; Wagner, Günter P

2012-09-01

Developmental evolution (DE) examines the influence of developmental mechanisms on biological evolution. Here we consider the question: "what is the evidence that allows us to decide whether a certain developmental scenario for an evolutionary change is in fact "correct" or at least falsifiable?" We argue that the comparative method linked with what we call the "forensic evidence principle" (FEP) is sufficient to conduct rigorous tests of DE scenarios. The FEP states that different genetically mediated developmental causes of an evolutionary transformation will leave different signatures in the development of the derived character. Although similar inference rules have been used in practically every empirical science, we expand this approach here in two ways: (1) we justify the validity of this principle with reference to a well-known result from mathematical physics, known as the symmetry principle, and (2) propose a specific form of the FEP for DE: given two or more developmental explanations for a certain evolutionary event, say an evolutionary novelty, then the evidence discriminating between these hypotheses will be found in the most proximal internal drivers of the derived character. Hence, a detailed description of the ancestral and derived states, and their most proximal developmental drivers are necessary to discriminate between various evolutionary developmental hypotheses. We discuss how this stepwise order of testing is necessary, establishes a formal test, and how skipping this order of examination may violate a more accurate examination of DE. We illustrate the approach with an example from avian digit evolution. © 2012 Wiley Periodicals, Inc.

International STakeholder NETwork (ISTNET): creating a developmental neurotoxicity (DNT) testing road map for regulatory purposes.

PubMed

Bal-Price, Anna; Crofton, Kevin M; Leist, Marcel; Allen, Sandra; Arand, Michael; Buetler, Timo; Delrue, Nathalie; FitzGerald, Rex E; Hartung, Thomas; Heinonen, Tuula; Hogberg, Helena; Bennekou, Susanne Hougaard; Lichtensteiger, Walter; Oggier, Daniela; Paparella, Martin; Axelstad, Marta; Piersma, Aldert; Rached, Eva; Schilter, Benoît; Schmuck, Gabriele; Stoppini, Luc; Tongiorgi, Enrico; Tiramani, Manuela; Monnet-Tschudi, Florianne; Wilks, Martin F; Ylikomi, Timo; Fritsche, Ellen

2015-02-01

A major problem in developmental neurotoxicity (DNT) risk assessment is the lack of toxicological hazard information for most compounds. Therefore, new approaches are being considered to provide adequate experimental data that allow regulatory decisions. This process requires a matching of regulatory needs on the one hand and the opportunities provided by new test systems and methods on the other hand. Alignment of academically and industrially driven assay development with regulatory needs in the field of DNT is a core mission of the International STakeholder NETwork (ISTNET) in DNT testing. The first meeting of ISTNET was held in Zurich on 23-24 January 2014 in order to explore the concept of adverse outcome pathway (AOP) to practical DNT testing. AOPs were considered promising tools to promote test systems development according to regulatory needs. Moreover, the AOP concept was identified as an important guiding principle to assemble predictive integrated testing strategies (ITSs) for DNT. The recommendations on a road map towards AOP-based DNT testing is considered a stepwise approach, operating initially with incomplete AOPs for compound grouping, and focussing on key events of neurodevelopment. Next steps to be considered in follow-up activities are the use of case studies to further apply the AOP concept in regulatory DNT testing, making use of AOP intersections (common key events) for economic development of screening assays, and addressing the transition from qualitative descriptions to quantitative network modelling.

Evidence and consensus recommendations for the pharmacological management of pain in India.

PubMed

Dureja, Gur Prasad; Iyer, Rajagopalan N; Das, Gautam; Ahdal, Jaishid; Narang, Prashant

2017-01-01

Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events - particularly with opioids and surgical methods of analgesia - are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case-control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.

Quantitative analysis of the thermal requirements for stepwise physical dormancy-break in seeds of the winter annual Geranium carolinianum (Geraniaceae)

PubMed Central

Gama-Arachchige, N. S.; Baskin, J. M.; Geneve, R. L.; Baskin, C. C.

2013-01-01

Background and Aims Physical dormancy (PY)-break in some annual plant species is a two-step process controlled by two different temperature and/or moisture regimes. The thermal time model has been used to quantify PY-break in several species of Fabaceae, but not to describe stepwise PY-break. The primary aims of this study were to quantify the thermal requirement for sensitivity induction by developing a thermal time model and to propose a mechanism for stepwise PY-breaking in the winter annual Geranium carolinianum. Methods Seeds of G. carolinianum were stored under dry conditions at different constant and alternating temperatures to induce sensitivity (step I). Sensitivity induction was analysed based on the thermal time approach using the Gompertz function. The effect of temperature on step II was studied by incubating sensitive seeds at low temperatures. Scanning electron microscopy, penetrometer techniques, and different humidity levels and temperatures were used to explain the mechanism of stepwise PY-break. Key Results The base temperature (Tb) for sensitivity induction was 17·2 °C and constant for all seed fractions of the population. Thermal time for sensitivity induction during step I in the PY-breaking process agreed with the three-parameter Gompertz model. Step II (PY-break) did not agree with the thermal time concept. Q10 values for the rate of sensitivity induction and PY-break were between 2·0 and 3·5 and between 0·02 and 0·1, respectively. The force required to separate the water gap palisade layer from the sub-palisade layer was significantly reduced after sensitivity induction. Conclusions Step I and step II in PY-breaking of G. carolinianum are controlled by chemical and physical processes, respectively. This study indicates the feasibility of applying the developed thermal time model to predict or manipulate sensitivity induction in seeds with two-step PY-breaking processes. The model is the first and most detailed one yet developed for sensitivity induction in PY-break. PMID:23456728

Extending the 3ω method: thermal conductivity characterization of thin films.

PubMed

Bodenschatz, Nico; Liemert, André; Schnurr, Sebastian; Wiedwald, Ulf; Ziemann, Paul

2013-08-01

A lock-in technique for measurement of thermal conductivity and volumetric heat capacity of thin films is presented. The technique is based on the 3ω approach using electrical generation and detection of oscillatory heat along a thin metal strip. Thin films are deposited onto the backside of commercial silicon nitride membranes, forming a bilayer geometry with distinct thermal parameters. Stepwise comparison to an adapted heat diffusion model delivers these parameters for both layers. Highest sensitivity is found for metallic thin films.

Discriminating between Graduates and Failure in the USAF Medical Laboratory Specialist School: An Explorative Approach.

DTIC Science & Technology

1981-12-01

occurred on the Introversion Scale of the NMPI. 20 A review of the use of psychological tests on MT’s was accomplished by Driver and Feeley [1974...programs, Gondek [1981] has recommended that the best pro- cedure for variable inclusion when using a stepwise procedure is to use the threshold default...values supplied by the package, since no simple rules exist for determining entry or removal thresholds for partial F’s, tolerance statistics, or any of

Climate Risk Informed Decision Analysis (CRIDA): A novel practical guidance for Climate Resilient Investments and Planning

NASA Astrophysics Data System (ADS)

Jeuken, Ad; Mendoza, Guillermo; Matthews, John; Ray, Patrick; Haasnoot, Marjolijn; Gilroy, Kristin; Olsen, Rolf; Kucharski, John; Stakhiv, Gene; Cushing, Janet; Brown, Casey

2016-04-01

Engineers and water managers have always incorporated uncertainty in water resources operations, design and planning. In recent years, concern has been growing concern that many of the fundamental principles to address uncertainty in planning and design are insufficient for coping with unprecedented shifts in climate, especially given the long lifetimes of water investments - spanning decades, even centuries. Can we design and operate new flood risk management, energy, water supply and sanitation, and agricultural projects that are robust to shifts over 20, 50, or more years? Since about 2009, better approaches to planning and designing under climate uncertainty have been gaining ground worldwide. The main challenge is to operationalize these approaches and bring them from science to practice, embed them within the existing decision-making processes of particular institutions, and shift from highly specialized "boutique" applications to methods that result in consistent, replicable outcomes accessible to water managers worldwide. With CRIDA a serious step is taken to achieve these goals. CRIDA is built on two innovative but complementary approaches that have developed in isolation across the Atlantic over the past seven years: diagnosing and assessing risk (decision scaling), and developing sequential decision steps to compensate for uncertainty within regulatory / performance standards (adaptation pathways). First, the decision scaling or "bottom up" framework to climate change adaptation was first conceptualized during the US/Canada Great Lakes regulation study and has recently been placed in a decision-making context for water-related investments published by the World Bank Second, the adaptation pathways approach was developed in the Netherlands to cope with the level of climate uncertainty we now face. Adaptation pathways is a tool for maintaining options and flexibility while meeting operational goals by envisioning how sequences of decisions can be navigated over time. They are part of the Dutch adaptive planning approach Adaptive Delta Management, executed and develop by the Dutch Delta program. Both decision scaling and adaptation pathways have been piloted in studies worldwide. The objective of CRIDA is to mainstream effective climate adaptation for professional water managers. The CRIDA publication, due in april 2016, follows the generic water design planning design cycle. At each step, CRIDA describes stepwise guidance for incorporating climate robustness: problem definition, stress test, alternatives formulation and recommendation, evaluation and selection. In the presentation the origin, goal, steps and practical tools available at each step of CRIDA will be explained. In two other abstracts ("Climate Risk Informed Decision Analysis: A Hypothetical Application to the Waas Region" by Gilroy et al., "The Application of Climate Risk Informed Decision Analysis to the Ioland Water Treatment Plant in Lusaka, Zambia, by Kucharski et al.), the application of CRIDA to cases is explained

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach.

PubMed

Cupisti, Adamasco; D'Alessandro, Claudia; Di Iorio, Biagio; Bottai, Anna; Zullo, Claudia; Giannese, Domenico; Barsotti, Massimiliano; Egidi, Maria Francesca

2016-09-06

Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG). In the NTG patients the dietary interventions were assigned in order to prevent or correct abnormalities and to maintain a good nutritional status. They included manipulation of sodium, phosphate, energy and protein dietary intakes while paying special attention to each patient's dietary habits. Phosphate and BUN levels were lower in the NTG than in the CG, especially in stage 4 and 5. The prevalence of hyperphosphatemia was lower in the NTG than in CG in stage 5 (13.3 % vs 53.3 %, p < 001, respectively), in stage 4 (4.1 % vs 18.3 % vs, p < 0.001) and stage 3b (2.8 % vs 9.5 % p < 0.05). Serum albumin was higher in NTG than in CG especially in stage 5 . The use of calcium-free intestinal phosphate binders was significantly lower in NTG than in CG (11 % vs 19 % p < 0.01), as well as that of Erythropoiesis stimulating agents (11 % vs 19 %, p < 0.01), and active Vitamin D preparations (13 % vs 21 %, p < 0.01). This case-control study shows the usefulness of a nutritional support in addition to the pharmacological good practice in CKD patients on tertiary care. Lower phosphate and BUN levels are obtained together with maintenance of serum albumin levels. In addition, a lower need of erythropoiesis stimulating agents, phosphate binders and active Vitamin D preparations was detected in NTG. This study suggests that a nutritional support may be useful in the management of the world-wide growing CKD burden.

Space transportation propulsion application - A development challenge

NASA Astrophysics Data System (ADS)

Beichel, Rudi; O'Brien, Charles J.; Taylor, James P.

1989-10-01

This paper presents an approach to achieving a cost-effective vertical takeoff, horizontal landing earth-to-orbit vehicle. The key propulsion system problems are addressed. The approach leads to a near-term rocket-powered single-stage-to-orbit system. A flying test-bed vehicle development program is described which allows the orderly development of vital advanced propulsion system and vehicle structural technology within a reasonable cost. The experimental (X-n) vehicle approach also allows the development of operational procedures that result in airline-type costs to space, and permits concepts, such as heavy-lift flight configurations, to be tested in a stepwise manner. Thrust modulation, instead of gimballed engines, allows a significant weight reduction in the propulsion system. Air-breathing airturborocket engines are used for loiter and landing to ensure safe return to earth.

Personalized assessment and management of women at risk for breast cancer in North America.

PubMed

Pruthi, Sandhya; Heisey, Ruth; Bevers, Therese

2015-03-01

Many women at increased risk for breast cancer would benefit from referral for genetic testing, enhanced screening, preventive therapy or risk-reducing surgery. We present a visual model and a step-wise approach to assist with a personalized risk stratification and management of these women. We present current recommendations with respect to lifestyle behaviors and mammographic screening, and we review the current evidence regarding enhanced screening and risk-reducing therapies. We discuss the usefulness of three risk-assessment tools in determining whether a woman qualifies for genetic testing, enhanced screening or preventive therapy and present four cases to demonstrate the usefulness of this approach in the clinical setting.

Stepwise Construction of Heterobimetallic Cages by an Extended Molecular Library Approach.

PubMed

Hardy, Matthias; Struch, Niklas; Topić, Filip; Schnakenburg, Gregor; Rissanen, Kari; Lützen, Arne

2018-04-02

Two novel heterobimetallic complexes, a trigonal-bipyramidal and a cubic one, have been synthesized and characterized using the same C 3 -symmetric metalloligand, prepared by a simple subcomponent self-assembly strategy. Adopting the molecular library approach, we chose a mononuclear, preorganized iron(II) complex as the metalloligand capable of self-assembly into a trigonal-bipyramidal or a cubic aggregate upon coordination to cis-protected C 2 -symmetric palladium(II) or unprotected tetravalent palladium(II) ions, respectively. The trigonal-bipyramidal complex was characterized by NMR and UV-vis spectroscopy, electrospray ionization mass spectrometry (ESI-MS), and single-crystal X-ray diffraction. The cubic structure was characterized by NMR and UV-vis spectroscopy and ESI-MS.

Ovulation induction in women with polycystic ovary syndrome.

PubMed

Perales-Puchalt, Alfredo; Legro, Richard S

2013-08-01

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. There are multiple ways to induce ovulation in PCOS patients, which will eventually provide a successful live birth. Each of these treatments varies in aggressiveness and effectiveness. Ranging from lifestyle modifications, through insulin-sensitizing agents, selective estrogen receptor modulators, aromatase inhibitors, gonadotropins, to laparoscopic ovarian drilling and assisted reproductive techniques, each method achieves ovulation induction through different mechanisms of action. This review provides a description and specific characteristics of the different methods used for ovulation induction which can help to design a personalized approach to each PCOS patient, and a general stepwise approach to ovulation induction in these patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Modelling road accidents: An approach using structural time series

NASA Astrophysics Data System (ADS)

Junus, Noor Wahida Md; Ismail, Mohd Tahir

2014-09-01

In this paper, the trend of road accidents in Malaysia for the years 2001 until 2012 was modelled using a structural time series approach. The structural time series model was identified using a stepwise method, and the residuals for each model were tested. The best-fitted model was chosen based on the smallest Akaike Information Criterion (AIC) and prediction error variance. In order to check the quality of the model, a data validation procedure was performed by predicting the monthly number of road accidents for the year 2012. Results indicate that the best specification of the structural time series model to represent road accidents is the local level with a seasonal model.

Effects of stepwise dry/wet-aging and freezing on meat quality of beef loins.

PubMed

Kim, Yuan H Brad; Meyers, Brandon; Kim, Hyun-Wook; Liceaga, Andrea M; Lemenager, Ronald P

2017-01-01

The objective of this study was to evaluate the effects of stepwise dry/wet-aging and freezing method on quality attributes of beef loins. Paired loins (M. Longissimus lumborum) from eight carcasses were assigned to either stepwise dry/wet-aging (carcass dry-aging for 10days then further wet-aging for 7days in vacuum bags) or carcass dry-aging only for 17days. Then, each loin was divided into three sections for freezing (never-frozen, blast or cryogenic freezing). Stepwise dry/wet-aged loin had lower purge/drip loss and shear force than conventionally dry-aged loin (P<0.05), but similar color and sensory characteristics (P>0.05). The cryogenic freezing resulted in a significant decrease in shear force values and a significant improvement in water-holding capacity (WHC). These findings indicate that the stepwise dry/wet-aging coupled with cryogenic freezing could provide beneficial impacts to the local meat industry by providing equivalent quality attributes as conventional dry-aging and improving WHC of frozen/thawed meat, while reducing the time needed for dry-aging. Copyright © 2016 Elsevier Ltd. All rights reserved.

Competency-based teacher training: A systematic revision of a proven programme in medical didactics.

PubMed

Griewatz, Jan; Simon, Melanie; Lammerding-Koeppel, Maria

2017-01-01

Objectives: Competency-based medical education (CBME) requires factual knowledge to be practically applied together with skills and attitudes. With the National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) representing a strong official demand for competence-orientation, it is generally important to explicitly outline its characteristics and review its realisation in teacher trainings. Further requirements are given by the core competencies for medical teachers (KLM). As an example the MQ programme ("Medizindidaktische Qualifikation") in Baden-Wuerttemberg, a long established and well-accepted training, has been critically revised on this basis, concerning its suitability for the demands of CBME, its needs for adjustment and the efforts to be undertaken for its implementation. Methods: In a systematic quality management process the MQ curriculum and its organisational framing were analysed and further developed in a step-wise comprehensive approach, using the six-step cycle by Kern. The procedures included a thorough needs assessment (e.g. literature research, programme mapping), strategic decisions on structure and content, piloting and evaluation. During the process essential elements of project and change management were considered. Results: The experiences of the MQ example revealed helpful information for key factors to be considered in the pending change process any training provider will be confronted with. Guiding questions were developed related to the process phases. Our analyses showed persistent key points of proven value as stable foundation for change, as well as components needing special consideration to foster competence-oriented aims and transfer into practice: reflection, feedback, application-oriented methods and transparent competence development. These aspects have to be consciously perceived and experienced by participants. Taking this into account, we re-designed the course evidence-based. Besides visualising competencies and their progress, the occasions for reflection and feedback as well as the number of typical, practice-oriented tasks were extended to facilitate self-directed learning, critical self-reflection and individualised solutions. It is shown at what point, in what form and with which purpose these aspects were integrated in the MQ programme. Piloting showed good acceptance by participants, trainers. Preliminary assessment of the outcome is promising. Conclusion: Respecting the high workload, most likely medical teachers will not put CBME concepts into practice without impulses and support. Therefore, in didactical trainings, medical teachers should practice in a competency-based teaching setting and reflect themselves in different professional roles to be able to transfer the experiences to their own educational approach. Trainers and training can serve as models for CBME realisation.

Competency-based teacher training: A systematic revision of a proven programme in medical didactics

PubMed Central

Griewatz, Jan; Simon, Melanie; Lammerding-Koeppel, Maria

2017-01-01

Objectives: Competency-based medical education (CBME) requires factual knowledge to be practically applied together with skills and attitudes. With the National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) representing a strong official demand for competence-orientation, it is generally important to explicitly outline its characteristics and review its realisation in teacher trainings. Further requirements are given by the core competencies for medical teachers (KLM). As an example the MQ programme (“Medizindidaktische Qualifikation”) in Baden-Wuerttemberg, a long established and well-accepted training, has been critically revised on this basis, concerning its suitability for the demands of CBME, its needs for adjustment and the efforts to be undertaken for its implementation. Methods: In a systematic quality management process the MQ curriculum and its organisational framing were analysed and further developed in a step-wise comprehensive approach, using the six-step cycle by Kern. The procedures included a thorough needs assessment (e.g. literature research, programme mapping), strategic decisions on structure and content, piloting and evaluation. During the process essential elements of project and change management were considered. Results: The experiences of the MQ example revealed helpful information for key factors to be considered in the pending change process any training provider will be confronted with. Guiding questions were developed related to the process phases. Our analyses showed persistent key points of proven value as stable foundation for change, as well as components needing special consideration to foster competence-oriented aims and transfer into practice: reflection, feedback, application-oriented methods and transparent competence development. These aspects have to be consciously perceived and experienced by participants. Taking this into account, we re-designed the course evidence-based. Besides visualising competencies and their progress, the occasions for reflection and feedback as well as the number of typical, practice-oriented tasks were extended to facilitate self-directed learning, critical self-reflection and individualised solutions. It is shown at what point, in what form and with which purpose these aspects were integrated in the MQ programme. Piloting showed good acceptance by participants, trainers. Preliminary assessment of the outcome is promising. Conclusion: Respecting the high workload, most likely medical teachers will not put CBME concepts into practice without impulses and support. Therefore, in didactical trainings, medical teachers should practice in a competency-based teaching setting and reflect themselves in different professional roles to be able to transfer the experiences to their own educational approach. Trainers and training can serve as models for CBME realisation. PMID:29085888

Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

PubMed

Goldie, Sue J; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

2010-04-20

Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately prevent four of five maternal deaths; this approach coupled stepwise improvements in family planning and safe abortion with consecutively implemented strategies that incrementally increased skilled attendants, improved antenatal/postpartum care, shifted births away from home, and improved recognition of referral need, transport, and availability/quality of EmOC. The strategies in this approach ranged from being cost-saving to having incremental cost-effectiveness ratios less than US$500 per year of life saved (YLS), well below India's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Early intensive efforts to improve family planning and control of fertility choices and to provide safe abortion, accompanied by a paced systematic and stepwise effort to scale up capacity for integrated maternal health services over several years, is as cost-effective as childhood immunization or treatment of malaria, tuberculosis, or HIV. In just 5 y, more than 150,000 maternal deaths would be averted through increasing contraception rates to meet women's needs for spacing and limiting births; nearly US$1.5 billion would be saved by coupling safe abortion to aggressive family planning efforts; and with stepwise investments to improve access to pregnancy-related health services and to high-quality facility-based intrapartum care, more than 75% of maternal deaths could be prevented. If accomplished over the next decade, the lives of more than one million women would be saved.

A new stepwise carbon cycle data assimilation system using multiple data streams to constrain the simulated land surface carbon cycle

DOE PAGES

Peylin, Philippe; Bacour, Cédric; MacBean, Natasha; ...

2016-09-20

Here, large uncertainties in land surface models (LSMs) simulations still arise from inaccurate forcing, poor description of land surface heterogeneity (soil and vegetation properties), incorrect model parameter values and incomplete representation of biogeochemical processes. The recent increase in the number and type of carbon cycle-related observations, including both in situ and remote sensing measurements, has opened a new road to optimize model parameters via robust statistical model–data integration techniques, in order to reduce the uncertainties of simulated carbon fluxes and stocks. In this study we present a carbon cycle data assimilation system that assimilates three major data streams, namely themore » Moderate Resolution Imaging Spectroradiometer (MODIS)-Normalized Difference Vegetation Index (NDVI) observations of vegetation activity, net ecosystem exchange (NEE) and latent heat (LE) flux measurements at more than 70 sites (FLUXNET), as well as atmospheric CO 2 concentrations at 53 surface stations, in order to optimize the main parameters (around 180 parameters in total) of the Organizing Carbon and Hydrology in Dynamics Ecosystems (ORCHIDEE) LSM (version 1.9.5 used for the Coupled Model Intercomparison Project Phase 5 (CMIP5) simulations). The system relies on a stepwise approach that assimilates each data stream in turn, propagating the information gained on the parameters from one step to the next. Overall, the ORCHIDEE model is able to achieve a consistent fit to all three data streams, which suggests that current LSMs have reached the level of development to assimilate these observations. The assimilation of MODIS-NDVI (step 1) reduced the growing season length in ORCHIDEE for temperate and boreal ecosystems, thus decreasing the global mean annual gross primary production (GPP). Using FLUXNET data (step 2) led to large improvements in the seasonal cycle of the NEE and LE fluxes for all ecosystems (i.e., increased amplitude for temperate ecosystems). The assimilation of atmospheric CO 2, using the general circulation model (GCM) of the Laboratoire de Météorologie Dynamique (LMDz; step 3), provides an overall constraint (i.e., constraint on large-scale net CO 2 fluxes), resulting in an improvement of the fit to the observed atmospheric CO 2 growth rate. Thus, the optimized model predicts a land C (carbon) sink of around 2.2 PgC yr -1 (for the 2000–2009 period), which is more compatible with current estimates from the Global Carbon Project (GCP) than the prior value. The consistency of the stepwise approach is evaluated with back-compatibility checks. The final optimized model (after step 3) does not significantly degrade the fit to MODIS-NDVI and FLUXNET data that were assimilated in the first two steps, suggesting that a stepwise approach can be used instead of the more “challenging” implementation of a simultaneous optimization in which all data streams are assimilated together. Most parameters, including the scalar of the initial soil carbon pool size, changed during the optimization with a large error reduction. This work opens new perspectives for better predictions of the land carbon budgets.« less

A new stepwise carbon cycle data assimilation system using multiple data streams to constrain the simulated land surface carbon cycle

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

Peylin, Philippe; Bacour, Cédric; MacBean, Natasha

Here, large uncertainties in land surface models (LSMs) simulations still arise from inaccurate forcing, poor description of land surface heterogeneity (soil and vegetation properties), incorrect model parameter values and incomplete representation of biogeochemical processes. The recent increase in the number and type of carbon cycle-related observations, including both in situ and remote sensing measurements, has opened a new road to optimize model parameters via robust statistical model–data integration techniques, in order to reduce the uncertainties of simulated carbon fluxes and stocks. In this study we present a carbon cycle data assimilation system that assimilates three major data streams, namely themore » Moderate Resolution Imaging Spectroradiometer (MODIS)-Normalized Difference Vegetation Index (NDVI) observations of vegetation activity, net ecosystem exchange (NEE) and latent heat (LE) flux measurements at more than 70 sites (FLUXNET), as well as atmospheric CO 2 concentrations at 53 surface stations, in order to optimize the main parameters (around 180 parameters in total) of the Organizing Carbon and Hydrology in Dynamics Ecosystems (ORCHIDEE) LSM (version 1.9.5 used for the Coupled Model Intercomparison Project Phase 5 (CMIP5) simulations). The system relies on a stepwise approach that assimilates each data stream in turn, propagating the information gained on the parameters from one step to the next. Overall, the ORCHIDEE model is able to achieve a consistent fit to all three data streams, which suggests that current LSMs have reached the level of development to assimilate these observations. The assimilation of MODIS-NDVI (step 1) reduced the growing season length in ORCHIDEE for temperate and boreal ecosystems, thus decreasing the global mean annual gross primary production (GPP). Using FLUXNET data (step 2) led to large improvements in the seasonal cycle of the NEE and LE fluxes for all ecosystems (i.e., increased amplitude for temperate ecosystems). The assimilation of atmospheric CO 2, using the general circulation model (GCM) of the Laboratoire de Météorologie Dynamique (LMDz; step 3), provides an overall constraint (i.e., constraint on large-scale net CO 2 fluxes), resulting in an improvement of the fit to the observed atmospheric CO 2 growth rate. Thus, the optimized model predicts a land C (carbon) sink of around 2.2 PgC yr -1 (for the 2000–2009 period), which is more compatible with current estimates from the Global Carbon Project (GCP) than the prior value. The consistency of the stepwise approach is evaluated with back-compatibility checks. The final optimized model (after step 3) does not significantly degrade the fit to MODIS-NDVI and FLUXNET data that were assimilated in the first two steps, suggesting that a stepwise approach can be used instead of the more “challenging” implementation of a simultaneous optimization in which all data streams are assimilated together. Most parameters, including the scalar of the initial soil carbon pool size, changed during the optimization with a large error reduction. This work opens new perspectives for better predictions of the land carbon budgets.« less

How are patients influenced when counseled for minimally invasive lumbar spine surgeries? A stepwise model assessing pivotal information for decision-making.

PubMed

Hey, Hwee Weng Dennis; Kumar, Nishant; Teo, Alex Quok An; Tan, Kimberly-Anne; Kumar, Naresh; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-08-01

Although minimally invasive surgery (MIS)-transforaminal lumbar interbody fusion (TLIF) has many evidence-based short-term benefits over open TLIF, both procedures have similar long-term outcomes. Patients' preference for MIS over open TLIF may be confounded by a lack of understanding of what each approach entails. The study aimed to identify the various factors influencing patients' choice between MIS and open TLIF. This is a cross-sectional study conducted at a tertiary health-care institution. Patients, for whom TLIF procedures were indicated, were recruited over a 3-month period from specialist outpatient clinics. The outcome measure was patients' choice of surgical approach (MIS or open). All patients were subjected to a stepwise interviewing process and were asked to select between open and MIS approaches at each step. Further subgroup analysis stratifying subjects based on stages of decision-making was performed to identify key predictors of selection changes. No sources of funding were required for this study and there are no conflicts of interests. Fifty-four patients with a mean age of 55.8 years participated in the study. Thirteen (24.1%) consistently selected a single approach, whereas 31 (57.4%) changed their selection more than once during the interviewing process. Overall, 12 patients (22.2%) had a final decision different from their initial choice, and 15 patients (27.8%) were unable to decide. A large proportion of patients (65.0%) initially favored the open approach's midline incision. This proportion dropped to 16.7% (p<.001) upon mention of the term MIS. The proportion of patients favoring MIS dropped significantly following discussion on the pros and cons (p=.002) of each approach, as well as conversion or revision surgery (p=.017). Radiation and cosmesis were identified as the two most important factors influencing patients' final decisions. The longer midline incision of the open approach is cosmetically more appealing to patients than the paramedian stab wounds of MIS. The advantages of the MIS approach may not be as valued by patients as they are by surgeons. Given the equivalent long-term outcomes of both approaches, it is crucial that patients are adequately informed during preoperative counseling to achieve the best consensus decision. Copyright © 2017 Elsevier Inc. All rights reserved.

Recommendations for a step‐wise comparative approach to the evaluation of new screening tests for colorectal cancer

PubMed Central

Senore, Carlo; Mandel, Jack S.; Allison, James E.; Atkin, Wendy S.; Benamouzig, Robert; Bossuyt, Patrick M. M.; Silva, Mahinda De; Guittet, Lydia; Halloran, Stephen P.; Haug, Ulrike; Hoff, Geir; Itzkowitz, Steven H.; Leja, Marcis; Levin, Bernard; Meijer, Gerrit A.; O'Morain, Colm A.; Parry, Susan; Rabeneck, Linda; Rozen, Paul; Saito, Hiroshi; Schoen, Robert E.; Seaman, Helen E.; Steele, Robert J. C.; Sung, Joseph J. Y.; Winawer, Sidney J.

2016-01-01

BACKGROUND New screening tests for colorectal cancer continue to emerge, but the evidence needed to justify their adoption in screening programs remains uncertain. METHODS A review of the literature and a consensus approach by experts was undertaken to provide practical guidance on how to compare new screening tests with proven screening tests. RESULTS Findings and recommendations from the review included the following: Adoption of a new screening test requires evidence of effectiveness relative to a proven comparator test. Clinical accuracy supported by programmatic population evaluation in the screening context on an intention‐to‐screen basis, including acceptability, is essential. Cancer‐specific mortality is not essential as an endpoint provided that the mortality benefit of the comparator has been demonstrated and that the biologic basis of detection is similar. Effectiveness of the guaiac‐based fecal occult blood test provides the minimum standard to be achieved by a new test. A 4‐phase evaluation is recommended. An initial retrospective evaluation in cancer cases and controls (Phase 1) is followed by a prospective evaluation of performance across the continuum of neoplastic lesions (Phase 2). Phase 3 follows the demonstration of adequate accuracy in these 2 prescreening phases and addresses programmatic outcomes at 1 screening round on an intention‐to‐screen basis. Phase 4 involves more comprehensive evaluation of ongoing screening over multiple rounds. Key information is provided from the following parameters: the test positivity rate in a screening population, the true‐positive and false‐positive rates, and the number needed to colonoscope to detect a target lesion. CONCLUSIONS New screening tests can be evaluated efficiently by this stepwise comparative approach. Cancer 2016;122:826–39. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. PMID:26828588

Adaptive surrogate modeling by ANOVA and sparse polynomial dimensional decomposition for global sensitivity analysis in fluid simulation

NASA Astrophysics Data System (ADS)

Tang, Kunkun; Congedo, Pietro M.; Abgrall, Rémi

2016-06-01

The Polynomial Dimensional Decomposition (PDD) is employed in this work for the global sensitivity analysis and uncertainty quantification (UQ) of stochastic systems subject to a moderate to large number of input random variables. Due to the intimate connection between the PDD and the Analysis of Variance (ANOVA) approaches, PDD is able to provide a simpler and more direct evaluation of the Sobol' sensitivity indices, when compared to the Polynomial Chaos expansion (PC). Unfortunately, the number of PDD terms grows exponentially with respect to the size of the input random vector, which makes the computational cost of standard methods unaffordable for real engineering applications. In order to address the problem of the curse of dimensionality, this work proposes essentially variance-based adaptive strategies aiming to build a cheap meta-model (i.e. surrogate model) by employing the sparse PDD approach with its coefficients computed by regression. Three levels of adaptivity are carried out in this paper: 1) the truncated dimensionality for ANOVA component functions, 2) the active dimension technique especially for second- and higher-order parameter interactions, and 3) the stepwise regression approach designed to retain only the most influential polynomials in the PDD expansion. During this adaptive procedure featuring stepwise regressions, the surrogate model representation keeps containing few terms, so that the cost to resolve repeatedly the linear systems of the least-squares regression problem is negligible. The size of the finally obtained sparse PDD representation is much smaller than the one of the full expansion, since only significant terms are eventually retained. Consequently, a much smaller number of calls to the deterministic model is required to compute the final PDD coefficients.

Approaches to modelling uranium (VI) adsorption on natural mineral assemblages

USGS Publications Warehouse

Waite, T.D.; Davis, J.A.; Fenton, B.R.; Payne, T.E.

2000-01-01

Component additivity (CA) and generalised composite (GC) approaches to deriving a suitable surface complexation model for description of U(VI) adsorption to natural mineral assemblages are pursued in this paper with good success. A single, ferrihydrite-like component is found to reasonably describe uranyl uptake to a number of kaolinitic iron-rich natural substrates at pH > 4 in the CA approach with previously published information on nature of surface complexes, acid-base properties of surface sites and electrostatic effects used in the model. The GC approach, in which little pre-knowledge about generic surface sites is assumed, gives even better fits and would appear to be a method of particular strength for application in areas such as performance assessment provided the model is developed in a careful, stepwise manner with simplicity and goodness of fit as the major criteria for acceptance.

A Multi-Faceted Approach to Inquiry-Based Learning

NASA Astrophysics Data System (ADS)

Brudzinski, M. R.; Sikorski, J.

2009-12-01

In order to fully attain the benefits of inquiry-based learning, instructors who typically employ the traditional lecture format need to make several adjustments to their approach. This change in styles can be intimidating and logistically difficult to overcome. A stepwise approach to this transformation is likely to be more manageable for individual faculty or departments. In this session, we will describe several features that we are implementing in our introductory geology course with the ultimate goal of converting to an entirely inquiry-based approach. Our project is part of the Miami University initiative in the top 25 enrolled courses to move towards the “student as scholar” model for engaged learning. Some of the features we developed for our course include: student learning outcomes, student development outcomes, out-of-class content quizzes, in-class conceptests, pre-/post-course assessment, reflective knowledge surveys, and daily group activities.

Uncovering of melanin fluorescence in human skin tissue

NASA Astrophysics Data System (ADS)

Scholz, Matthias; Stankovic, Goran; Seewald, Gunter; Leupold, Dieter

2007-07-01

Due to its extremely low fluorescence quantum yield, in the conventionally (one-photon) excited autofluorescence of skin tissue, melanin fluorescence is masked by several other endogenous and possibly also exogenous fluorophores (e.g. NADH, FAD, Porphyrins). A first step to enhance the melanin contribution had been realized by two-photon fs-pulse excitation in the red/near IR, based on the fact that melanin can be excited by stepwise two-photon absorption, whereas all other fluorophores in this spectral region allow only simultaneous two-photon excitation. Now, the next and decisive step has been realized: Using an extremely sensitive detection system, for the first time twophoton fluorescence of skin tissue excited with pulses in the ns-range could be measured. The motivation for this step was based on the fact that the population density of the fluorescent level resulting from a stepwise excitation has a different dependence of the pulse duration than that from a simultaneous excitation (Δt2 vs. Δt). Due to this strong discrimination between the fluorophores, practically pure melanin fluorescence can be obtained. Examples for in-vivo, ex-vivo as well as paraffin embedded skin tissue will be shown. The content of information with respect to early diagnosis of skin deseases will be discussed.

Multifaceted Modularity: A Key for Stepwise Building of Hierarchical Complexity in Actinide Metal–Organic Frameworks

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

Dolgopolova, Ekaterina A.; Ejegbavwo, Otega A.; Martin, Corey R.

Growing necessity for efficient nuclear waste management is a driving force for development of alternative architectures towards fundamental understanding of mechanisms involved in actinide integration inside extended structures. In this manuscript, metal-organic frameworks (MOFs) were investigated as a model system for engineering radionuclide containing materials through utilization of unprecedented MOF modularity, which cannot be replicated in any other type of materials. Through the implementation of recent synthetic advances in the MOF field, hierarchical complexity of An-materials were built stepwise, which was only feasible due to preparation of the first examples of actinide-based frameworks with “unsaturated” metal nodes. The first successfulmore » attempts of solid-state metathesis and metal node extension in An-MOFs are reported, and the results of the former approach revealed drastic differences in chemical behavior of extended structures versus molecular species. Successful utilization of MOF modularity also allowed us to structurally characterize the first example of bimetallic An-An nodes. To the best of our knowledge, through combination of solid-state metathesis, guest incorporation, and capping linker installation, we were able to achieve the highest Th wt% in mono- and bi-actinide frameworks with minimal structural density. Overall, combination of a multistep synthetic approach with homogeneous actinide distribution and moderate solvothermal conditions could make MOFs an exceptionally powerful tool to address fundamental questions responsible for chemical behavior of An-based extended structures, and therefore, shed light on possible optimization of nuclear waste administration.« less

Multifaceted Modularity: A Key for Stepwise Building of Hierarchical Complexity in Actinide Metal-Organic Frameworks.

PubMed

Dolgopolova, Ekaterina A; Ejegbavwo, Otega A; Martin, Corey R; Smith, Mark D; Setyawan, Wahyu; Karakalos, Stavros G; Henager, Charles H; Zur Loye, Hans-Conrad; Shustova, Natalia B

2017-11-22

Growing necessity for efficient nuclear waste management is a driving force for development of alternative architectures toward fundamental understanding of mechanisms involved in actinide (An) integration inside extended structures. In this manuscript, metal-organic frameworks (MOFs) were investigated as a model system for engineering radionuclide containing materials through utilization of unprecedented MOF modularity, which cannot be replicated in any other type of materials. Through the implementation of recent synthetic advances in the MOF field, hierarchical complexity of An-materials was built stepwise, which was only feasible due to preparation of the first examples of actinide-based frameworks with "unsaturated" metal nodes. The first successful attempts of solid-state metathesis and metal node extension in An-MOFs are reported, and the results of the former approach revealed drastic differences in chemical behavior of extended structures versus molecular species. Successful utilization of MOF modularity also allowed us to structurally characterize the first example of bimetallic An-An nodes. To the best of our knowledge, through combination of solid-state metathesis, guest incorporation, and capping linker installation, we were able to achieve the highest Th wt % in mono- and biactinide frameworks with minimal structural density. Overall, the combination of a multistep synthetic approach with homogeneous actinide distribution and moderate solvothermal conditions could make MOFs an exceptionally powerful tool to address fundamental questions responsible for chemical behavior of An-based extended structures and, therefore, shed light on possible optimization of nuclear waste administration.

Analyzing urban ecosystem variation in the City of Dongguan: A stepwise cluster modeling approach.

PubMed

Sun, J; Li, Y P; Gao, P P; Suo, C; Xia, B C

2018-06-13

In this study, a stepwise cluster modeling approach (SCMA) is developed for analyzing urban ecosystem variation via Normalized Difference Vegetation Index (NDVI). NDVI is an indicator of vegetation growth and coverage and useful in reflecting urban ecosystem. SCMA is established on a cluster tree that can characterize the complex relationship between independent and dependent variables. SCMA is applied to the City of Dongguan for simulating the urban NDVI and identifying associated drivers of human activity, topography and meteorology without specific functions. Results show that SCMA performances better than conventional statistical methods, illustrating the ability of SCMA in capturing the complex and nonlinear features of urban ecosystem. Results disclose that human activities play negative effects on NDVI due to the destruction of green space for pursuing more space for buildings. NDVI reduces gradually from the south part to the north part of Dongguan due to increased gross domestic product and population density, indicating that the ecosystem in Dongguan is better in the south part. NDVI in the northeast part (dominated by agriculture) is sensitive to the growth of economy and population. More attention should be paid to this part for sustainable development, such as increasing afforestation, planting grass and constructing parks. Precipitation has a positive effect on NDVI due to the promotion of soil moisture that is beneficial to plants' growth. Awareness of these complexities is helpful for sustainable development of urban ecosystem. Copyright © 2018 Elsevier Inc. All rights reserved.

Case Study: Using Contemporary Behaviour Change Science to Design and Implement an Effective Nutritional Intervention within Professional Rugby League.

PubMed

Costello, Nessan; McKenna, Jim; Sutton, Louise; Deighton, Kevin; Jones, Ben

2018-01-18

Designing and implementing successful dietary intervention is integral to the role of sport nutrition professionals as they attempt to positively change the dietary behaviour of athletes. High-performance sport is a time-pressured environment where immediate results can often supersede pursuit of the most effective evidence-based practice. However, efficacious dietary intervention necessitates comprehensive, systematic and theoretical behavioural design and implementation if the habitual dietary behaviours of athletes are to be positively changed. Therefore, this case study demonstrates how the Behaviour Change Wheel was used to design and implement an effective nutritional intervention within professional rugby league. The eight-step intervention targeted athlete consumption of a high quality dietary intake of 25.1 MJ each day, to achieve an overall body mass increase of 5 kg across a twelve-week intervention period. The Capability, Opportunity, Motivation-Behaviour model and APEASE criteria were used to identify population-specific intervention functions, policy categories, behaviour change techniques and modes of intervention delivery. The resulting intervention was successful, increasing the average daily energy intake of the athlete to 24.5 MJ, which corresponded in a 6.2 kg body mass gain. Despite consuming 0.6 MJ less per day than targeted, secondary outcome measures of diet quality, strength, body composition and immune function all substantially improved, supporting a sufficient energy intake and the overall efficacy of a behavioural approach. Ultimately, the Behaviour Change Wheel provides sport nutrition professionals with an effective and practical step-wise method via which to design and implement effective nutritional interventions for use within high-performance sport.

Becoming a health literate organization: Formative research results from healthcare organizations providing care for undeserved communities.

PubMed

Adsul, Prajakta; Wray, Ricardo; Gautam, Kanak; Jupka, Keri; Weaver, Nancy; Wilson, Kristin

2017-11-01

Background Integrating health literacy into primary care institutional policy and practice is critical to effective, patient centered health care. While attributes of health literate organizations have been proposed, approaches for strengthening them in healthcare systems with limited resources have not been fully detailed. Methods We conducted key informant interviews with individuals from 11 low resourced health care organizations serving uninsured, underinsured, and government-insured patients across Missouri. The qualitative inquiry explored concepts of impetus to transform, leadership commitment, engaging staff, alignment to organization wide goals, and integration of health literacy with current practices. Findings Several health care organizations reported carrying out health literacy related activities including implementing patient portals, selecting easy to read patient materials, offering community education and outreach programs, and improving discharge and medication distribution processes. The need for change presented itself through data or anecdotal staff experience. For any change to be undertaken, administrators and medical directors had to be supportive; most often a champion facilitated these changes in the organization. Staff and providers were often resistant to change and worried they would be saddled with additional work. Lack of time and funding were the most common barriers reported for integration and sustainability. To overcome these barriers, managers supported changes by working one on one with staff, seeking external funding, utilizing existing resources, planning for stepwise implementation, including members from all staff levels and clear communication. Conclusion Even though barriers exist, resource scarce clinical settings can successfully plan, implement, and sustain organizational changes to support health literacy.

Geriatric Hip Fracture Care: Fixing a Fragmented System

PubMed Central

Anderson, Mary E; McDevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Context Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. Objective To describe a stepwise approach to systems redesign for this patient population. Design We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Main Outcome Measures Hospital length of stay. Results We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Conclusion Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system. PMID:28488991

Impact of chemical oxidation on indigenous bacteria and mobilization of nutrients and subsequent bioremediation of crude oil-contaminated soil.

PubMed

Xu, Jinlan; Deng, Xin; Cui, Yiwei; Kong, Fanxing

2016-12-15

Fenton pre-oxidation provides nutrients to promote bioremediation. However, the effects of the indigenous bacteria that remain following Fenton oxidation on nutrient mobilization and subsequent bioremediation remain unclear. Experiments were performed with inoculation with native bacteria and foreign bacteria or without inoculation after four regimens of stepwise pre-oxidations. The effects of the indigenous bacteria remaining after stepwise oxidation on nutrient mobilization and subsequent bioremediation over 80 days were investigated. After stepwise Fenton pre-oxidation at a low H 2 O 2 concentration (225×4), the remaining indigenous bacterial populations reached their peak (4.8±0.17×10 6 CFU/g), the nutrients were mobilized rapidly, and the subsequent bioremediation of crude oil was improved (biodegradation efficiency of 35%). However, after stepwise Fenton pre-oxidation at a high H 2 O 2 concentration (450×4), only 3.6±0.16×10 3 CFU/g of indigenous bacteria remained, and the indigenous bacteria that degrade C 15 -C 30 alkanes were inhibited. The nutrient mobilization was then highly limited, and only 19% of total petroleum hydrocarbon was degraded. Furthermore, the recovery period after the low H 2 O 2 concentration stepwise Fenton pre-oxidation (225×4) was less than 20 days, which was 20-30 days shorter than with the other pre-oxidation treatments. Therefore, stepwise Fenton pre-oxidation at a low H 2 O 2 concentration protects indigenous bacterial populations and improves the nutrient mobilization and subsequent bioremediation. Copyright © 2016 Elsevier B.V. All rights reserved.

Development, validation and operating room-transfer of a six-step laparoscopic training program for the vesicourethral anastomosis.

PubMed

Klein, Jan; Teber, Dogu; Frede, Tom; Stock, Christian; Hruza, Marcel; Gözen, Ali; Seemann, Othmar; Schulze, Michael; Rassweiler, Jens

2013-03-01

Development and full validation of a laparoscopic training program for stepwise learning of a reproducible application of a standardized laparoscopic anastomosis technique and integration into the clinical course. The training of vesicourethral anastomosis (VUA) was divided into six simple standardized steps. To fix the objective criteria, four experienced surgeons performed the stepwise training protocol. Thirty-eight participants with no previous laparoscopic experience were investigated in their training performance. The times needed to manage each training step and the total training time were recorded. The integration into the clinical course was investigated. The training results and the corresponding steps during laparoscopic radical prostatectomy (LRP) were analyzed. Data analysis of corresponding operating room (OR) sections of 793 LRP was performed. Based on the validity, criteria were determined. In the laboratory section, a significant reduction of OR time for every step was seen in all participants. Coordination: 62%; longitudinal incision: 52%; inverted U-shape incision: 43%; plexus: 47%. Anastomosis catheter model: 38%. VUA: 38%. The laboratory section required a total time of 29 hours (minimum: 16 hours; maximum: 42 hours). All participants had shorter execution times in the laboratory than under real conditions. The best match was found within the VUA model. To perform an anastomosis under real conditions, 25% more time was needed. By using the training protocol, the performance of the VUA is comparable to that of an surgeon with experience of about 50 laparoscopic VUA. Data analysis proved content, construct, and prognostic validity. The use of stepwise training approaches enables a surgeon to learn and reproduce complex reconstructive surgical tasks: eg, the VUA in a safe environment. The validity of the designed system is given at all levels and should be used as a standard in the clinical surgical training in laparoscopic reconstructive urology.

Nurse stress at two different organizational settings in Alexandria.

PubMed

Zaghloul, Ashraf Az; Abou El Enein, Nagwa Y

2009-04-15

The objective of the study was to explore the difference in stress levels among nurses working at two different health care organizations and the determinants of nurse stress within each organization. Job stress is defined as the harmful emotional and physical reactions resulting from the interactions between the worker and her/his work environment where the demands of the job exceed the worker's capabilities and resources. A convenient sample of nurses in two hospitals in Alexandria; Shark Al Madina (n = 120) and Karmouz (n = 170) hospitals. All nurses present at the time of the study were approached to be included in the study. The response rate for Shark Al Madina hospital was 94% and for Karmouz hospital, 71%. Data collection took place using a nurse stress questionnaire previously developed and tested for validity and reliability to measure stress in clinical nursing practice. The 5% level of significance was used throughout the statistical analysis for all relevant tests. The highest mean stress scores were the same for both hospitals. The dimension of coping with new situations was 2.7 ± 0.6 at Shark Al Madina hospital and was 2.5 ± 0.7 at Karmouz hospital while the dimension of job security was 2.7 ± 0.6 and 2.5 ± 0.7 at Shark Al Madina and Karmouz hospitals, respectively. Stepwise multiple regression for Shark Al Madina hospital model revealed workload (β = 1.38), security (β = 5.04), and shortage of support staff (β = 3.39). For the Karmouz hospital model, stepwise multiple regression revealed security (β = 4.78) and shortage of resources (β = 3.66). Stressors among nurses appear to be the same despite the differences in organizational or hierarchical structure where they work or the type of consumer they serve. It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent nurse burnout. This could be achieved with job redesign, modification of shift work systems, and by offering occupational health education as well as assurance regarding job security especially during the global financial crisis.

Nurse stress at two different organizational settings in Alexandria

PubMed Central

Zaghloul, Ashraf AZ; Abou El Enein, Nagwa Y

2009-01-01

Objective: The objective of the study was to explore the difference in stress levels among nurses working at two different health care organizations and the determinants of nurse stress within each organization. Job stress is defined as the harmful emotional and physical reactions resulting from the interactions between the worker and her/his work environment where the demands of the job exceed the worker’s capabilities and resources. Methodology: A convenient sample of nurses in two hospitals in Alexandria; Shark Al Madina (n = 120) and Karmouz (n = 170) hospitals. All nurses present at the time of the study were approached to be included in the study. The response rate for Shark Al Madina hospital was 94% and for Karmouz hospital, 71%. Data collection took place using a nurse stress questionnaire previously developed and tested for validity and reliability to measure stress in clinical nursing practice. The 5% level of significance was used throughout the statistical analysis for all relevant tests. Results: The highest mean stress scores were the same for both hospitals. The dimension of coping with new situations was 2.7 ± 0.6 at Shark Al Madina hospital and was 2.5 ± 0.7 at Karmouz hospital while the dimension of job security was 2.7 ± 0.6 and 2.5 ± 0.7 at Shark Al Madina and Karmouz hospitals, respectively. Stepwise multiple regression for Shark Al Madina hospital model revealed workload (β = 1.38), security (β = 5.04), and shortage of support staff (β = 3.39). For the Karmouz hospital model, stepwise multiple regression revealed security (β = 4.78) and shortage of resources (β = 3.66). Conclusion: Stressors among nurses appear to be the same despite the differences in organizational or hierarchical structure where they work or the type of consumer they serve. It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent nurse burnout. This could be achieved with job redesign, modification of shift work systems, and by offering occupational health education as well as assurance regarding job security especially during the global financial crisis. PMID:21197346

Predicting Use of Outdoor Fall Prevention Strategies: Considerations for Prevention Practices.

PubMed

Chippendale, Tracy

2018-01-01

Outdoor falls are just as common as indoor falls, but have received less attention in research and practice. Behavioral strategies play an important role in outdoor fall prevention. The purpose of this study was to examine predictors of strategy use. Backward stepwise regression was used to study factors associated with use of outdoor fall prevention strategies among a random sample ( N = 120) of community-dwelling seniors. Significant negative predictors of strategy use included higher education levels ( p < .01) and living in an urban versus a suburban environment ( p < .01). Concern about falls and number of identified risks were positive predictors ( ps < .05). Differences were found between outdoor fallers and nonfallers in the use of three different types of strategies ( ps < .05). There are some differences in the profiles of people who use and do not use outdoor fall prevention strategies. Further study of additional factors is warranted.

An Official American Thoracic Society Workshop Report

PubMed Central

Wilson, Kevin C.; Gould, Michael K.; Krishnan, Jerry A.; Boyd, Cynthia M.; Brozek, Jan L.; Cooke, Colin R.; Douglas, Ivor S.; Goodman, Richard A.; Joo, Min J.; Lareau, Suzanne; Mularski, Richard A.; Patel, Minal R.; Rosenfeld, Richard M.; Shanawani, Hasan; Slatore, Christopher; Sockrider, Marianna; Sufian, Beth; Thomson, Carey C.; Wiener, Renda Soylemez

2018-01-01

Coexistence of multiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework. PMID:26963362

International Instrumentation Symposium, 38th, Las Vegas, NV, Apr. 26-30, 1992, Proceedings

NASA Astrophysics Data System (ADS)

The present volume on aerospace instrumentation discusses computer applications, blast and shock, implementation of the Clean Air Act amendments, and thermal systems. Attention is given to measurement uncertainty/flow measurement, data acquisition and processing, force/acceleration/motion measurements, and hypersonics/reentry vehicle systems. Topics addressed include wind tunnels, real time systems, and pressure effects. Also discussed are a distributed data and control system for space simulation and thermal testing a stepwise shockwave velocity determinator, computer tracking and decision making, the use of silicon diodes for detecting the liquid-vapor interface in hydrogen, and practical methods for analysis of uncertainty propagation.

On Organization of Information: Approach and Early Work

NASA Technical Reports Server (NTRS)

Degani, Asaf; Jorgensen, Charles C.; Iverson, David; Shafto, Michael; Olson, Leonard

2009-01-01

In this report we describe an approach for organizing information for presentation and display. "e approach stems from the observation that there is a stepwise progression in the way signals (from the environment and the system under consideration) are extracted and transformed into data, and then analyzed and abstracted to form representations (e.g., indications and icons) on the user interface. In physical environments such as aerospace and process control, many system components and their corresponding data and information are interrelated (e.g., an increase in a chamber s temperature results in an increase in its pressure). "ese interrelationships, when presented clearly, allow users to understand linkages among system components and how they may affect one another. Organization of these interrelationships by means of an orderly structure provides for the so-called "big picture" that pilots, astronauts, and operators strive for.

Stepwise pH-responsive nanoparticles for enhanced cellular uptake and on-demand intracellular release of doxorubicin.

PubMed

Chen, Wei-Liang; Li, Fang; Tang, Yan; Yang, Shu-di; Li, Ji-Zhao; Yuan, Zhi-Qiang; Liu, Yang; Zhou, Xiao-Feng; Liu, Chun; Zhang, Xue-Nong

2017-01-01

Physicochemical properties, including particle size, zeta potential, and drug release behavior, affect targeting efficiency, cellular uptake, and antitumor effect of nanocarriers in a formulated drug-delivery system. In this study, a novel stepwise pH-responsive nanodrug delivery system was developed to efficiently deliver and significantly promote the therapeutic effect of doxorubicin (DOX). The system comprised dimethylmaleic acid-chitosan-urocanic acid and elicited stepwise responses to extracellular and intracellular pH. The nanoparticles (NPs), which possessed negative surface charge under physiological conditions and an appropriate nanosize, exhibited advantageous stability during blood circulation and enhanced accumulation in tumor sites via enhanced permeability and retention effect. The tumor cellular uptake of DOX-loaded NPs was significantly promoted by the first-step pH response, wherein surface charge reversion of NPs from negative to positive was triggered by the slightly acidic tumor extracellular environment. After internalization into tumor cells, the second-step pH response in endo/lysosome acidic environment elicited the on-demand intracellular release of DOX from NPs, thereby increasing cytotoxicity against tumor cells. Furthermore, stepwise pH-responsive NPs showed enhanced antiproliferation effect and reduced systemic side effect in vivo. Hence, the stepwise pH-responsive NPs provide a promising strategy for efficient delivery of antitumor agents.

Stepwise pH-responsive nanoparticles for enhanced cellular uptake and on-demand intracellular release of doxorubicin

PubMed Central

Chen, Wei-liang; Li, Fang; Tang, Yan; Yang, Shu-di; Li, Ji-zhao; Yuan, Zhi-qiang; Liu, Yang; Zhou, Xiao-feng; Liu, Chun; Zhang, Xue-nong

2017-01-01

Physicochemical properties, including particle size, zeta potential, and drug release behavior, affect targeting efficiency, cellular uptake, and antitumor effect of nanocarriers in a formulated drug-delivery system. In this study, a novel stepwise pH-responsive nanodrug delivery system was developed to efficiently deliver and significantly promote the therapeutic effect of doxorubicin (DOX). The system comprised dimethylmaleic acid-chitosan-urocanic acid and elicited stepwise responses to extracellular and intracellular pH. The nanoparticles (NPs), which possessed negative surface charge under physiological conditions and an appropriate nanosize, exhibited advantageous stability during blood circulation and enhanced accumulation in tumor sites via enhanced permeability and retention effect. The tumor cellular uptake of DOX-loaded NPs was significantly promoted by the first-step pH response, wherein surface charge reversion of NPs from negative to positive was triggered by the slightly acidic tumor extracellular environment. After internalization into tumor cells, the second-step pH response in endo/lysosome acidic environment elicited the on-demand intracellular release of DOX from NPs, thereby increasing cytotoxicity against tumor cells. Furthermore, stepwise pH-responsive NPs showed enhanced antiproliferation effect and reduced systemic side effect in vivo. Hence, the stepwise pH-responsive NPs provide a promising strategy for efficient delivery of antitumor agents. PMID:28652730

Direct 40Ar/39Ar age determination of fluid inclusions using in-vacuo¬ stepwise crushing - Example of garnet from the Cycladic Blueschist Unit on Syros

NASA Astrophysics Data System (ADS)

Uunk, Bertram; Postma, Onno; Wijbrans, Jan; Brouwer, Fraukje

2017-04-01

Metamorphic minerals and veins commonly trap attending hydrous fluids in fluid inclusions, which yield a wealth of information on the history of the hosting metamorphic system. When these fluids are sufficiently saline, the KCl in the inclusions can be used as a K/Ar geochronologic system, potentially dating inclusion incorporation. Whilst primary fluid inclusions (PFIs) can date fluid incorporation during mineral or vein growth, secondary fluid inclusion trails (SFIs) can provide age constraints on later fluid flow events. At VU Amsterdam, a new in-vacuo crushing apparatus has been designed to extract fluid inclusions from minerals for 40Ar/39Ar analysis. Separates are crushed inside a crusher tube connected to a purification line and a quadrupole mass spectrometer. In-vacuo crushing is achieved by lifting and dropping a steel pestle using an externally controlled magnetic field. As the gas can be analyzed between different crushing steps, the setup permits stepwise crushing experiments. Additionally, crushed powder can be heated by inserting the crusher tube in an externally controlled furnace. Dating by 40Ar/39Ar stepwise crushing has the added advantage that, during neutron irradiation to produce 39Ar from 39K, 38Ar and 37Ar are also produced from 38Cl and 40Ca, respectively. Simultaneous analysis of these argon isotopes permits constraining the chemistry of the argon source sampled during the experiment. This allows a distinction between different fluid or crystal lattice sources. Garnet from three samples of the HP metamorphic Cycladic Blueschist Unit on Syros, Greece was stepwise crushed to obtain fluid inclusion ages. Initial steps for all three experiments yield significant components of excess argon, which are interpreted to originate from grain boundary fluids and secondary fluid inclusions trails. During subsequent steps, age results stabilize to a plateau age. One garnet from North Syros yields an unusually old 80 Ma plateau age. However, isochrons indicate the presence of excess argon in the PFIs and isochron ages overlap with other isotopic constraints on the age of garnet growth during eclogite metamorphism (55-50 Ma) in the underlying metabasite. Garnet from two samples from the center of Syros yields younger ages overlapping with greenschist overprinting (25-30 Ma). Further studies will indicate whether these younger ages reflect a young garnet growth age or a young fluid flow event affecting older garnet crystals. The stepwise crushing and heating approach shows to be effective in dating fluid inclusions in natural mineral systems. As many metamorphic processes occur under influence or in the presence of fluids, this method should greatly expand our possibilities to date crustal processes.

The systematic development of ROsafe: an intervention to promote STI testing among vocational school students.

PubMed

Wolfers, Mireille; de Zwart, Onno; Kok, Gerjo

2012-05-01

This article describes the development of ROsafe, an intervention to promote sexually transmitted infection (STI) testing at vocational schools in the Netherlands. Using the planning model of intervention mapping (IM), an educational intervention was designed that consisted of two lessons, an Internet site, and sexual health services at the school sites. IM is a stepwise approach for theory- and evidence-based development and implementation of interventions. It includes six steps: needs assessment, specification of the objectives in matrices, selection of theoretical methods and practical strategies, program design, implementation planning, and evaluation. The processes and outcomes that are performed during Steps 1 to 4 of IM are presented, that is, literature review and qualitative and quantitative research in needs assessment, leading to the definition of the desired behavioral outcomes and objectives. The matrix of change objectives for STI-testing behavior is presented, and then the development of theory into program is described, using examples from the program. Finally, the planning for implementation and evaluation is discussed. The educational intervention used methods that were derived from the social cognitive theory, the elaboration likelihood model, the persuasive communication matrix, and theories about risk communication. Strategies included short movies, discussion, knowledge quiz, and an interactive behavioral self-test through the Internet.

Dapagliflozin and saxagliptin tablets for adults with type 2 diabetes.

PubMed

Scheen, André J

2017-12-01

Saxagliptin (a dipeptidyl peptidase-4 inhibitor, DPP-4i) and dapagliflozin (a sodium-glucose cotransporter type 2 inhibitor, SGLT2i) improve glucose control in type 2 diabetes (T2D) through different potentially complementary mechanisms, thus offering the opportunity for a combined therapy. Area covered: The characteristics of the saxagliptin/dapagliflozin combination are analysed, focusing on: 1) pharmacokinetic and pharmacodynamic properties; 2) efficacy and safety in phase III trials with concurrent and sequential add-on therapy; and 3) potential use in clinical practice, including in special populations (cardiovascular disease, heart failure, chronic kidney disease, elderly). Expert commentary: Conclusions drawn from clinical trials investigating combination with the separate drugs are considered to apply to the fixed-dose combination (FDC) that demonstrates bioequivalence. Dual saxagliptin/dapagliflozin therapy is more potent than either monotherapy and can be used as an initial combination or a stepwise sequential approach. Dual therapy is generally well tolerated and may be used in special populations, with some limitations because of the presence of dapagliflozin. However, the latter may offer some advantages because of multiple effects attributed to SGLT2i. The best place of this dual combination for the management of T2D and the profile of patients who will make the most of this combined therapy remains to be defined.

The effects of magnetic fields exposure on relative permittivity of saline solutions measured by a high resolution SPR system

PubMed Central

Jiang, Li; Zhao, Xinyuan; Fei, Yue; Yu, Dongdong; Qian, Jun; Tong, Jinguang; Chen, Guangdi; He, Sailing

2016-01-01

A measurement system for the relative permittivity of a physiological solution under 50 Hz magnetic fields (MF) is presented. It is based on a phase-sensitive surface plasmon resonance (SPR) system. Relative permittivity was analyzed for different solute concentrations of sodium chloride under various MF exposure parameters. We found that MF exposure at 0.2–4.0 mT step-wise decreased significantly the SPR phase signal of a 0.9% sodium chloride solution while 0.1 mT of MF exposure did not. The decreases in the SPR phase signal depended on the duration of MF exposure, and the signal reached a plateau after 15 min of exposure. Interestingly, the decreased SPR phase signal showed a gradual increase and approached the background level when the exposure was drawn off. In addition, we found that the response of the sodium chloride solution to MF also depended on its concentration. In brief, the relative permittivity of sodium chloride in solutions appears to be practically affected by 50 Hz MF exposure. Our data indicates that the relative permittivity of the saline solution influenced by MF exposure should be considered when investigating the biological effects of MF exposure on organisms in experimental study. PMID:27121618

Knowledge of skull base anatomy and surgical implications of human sacrifice among pre-Columbian Mesoamerican cultures.

PubMed

Lopez-Serna, Raul; Gomez-Amador, Juan Luis; Barges-Coll, Juan; Arriada-Mendicoa, Nicasio; Romero-Vargas, Samuel; Ramos-Peek, Miguel; Celis-Lopez, Miguel Angel; Revuelta-Gutierrez, Rogelio; Portocarrero-Ortiz, Lesly

2012-08-01

Human sacrifice became a common cultural trait during the advanced phases of Mesoamerican civilizations. This phenomenon, influenced by complex religious beliefs, included several practices such as decapitation, cranial deformation, and the use of human cranial bones for skull mask manufacturing. Archaeological evidence suggests that all of these practices required specialized knowledge of skull base and upper cervical anatomy. The authors conducted a systematic search for information on skull base anatomical and surgical knowledge among Mesoamerican civilizations. A detailed exposition of these results is presented, along with some interesting information extracted from historical documents and pictorial codices to provide a better understanding of skull base surgical practices among these cultures. Paleoforensic evidence from the Great Temple of Tenochtitlan indicates that Aztec priests used a specialized decapitation technique, based on a deep anatomical knowledge. Trophy skulls were submitted through a stepwise technique for skull mask fabrication, based on skull base anatomical landmarks. Understanding pre-Columbian Mesoamerican religions can only be realized by considering them in their own time and according to their own perspective. Several contributions to medical practice might have arisen from anatomical knowledge emerging from human sacrifice and decapitation techniques.

Impact of a health education program for secondary school Saudi girls about menstruation at Riyadh city.

PubMed

Fetohy, Ebtisam M

2007-01-01

An experimental study was conducted to assess the impact and suitability of menstrual education program (MEP) for 1st and 2nd graders at a girls' secondary school in Riyadh city. The MEP was conducted on 5 classes, through one session and one assessment. The results revealed that the mean scores of knowledge, attitude and practice of the intervention classes (1st and 2nd graders) were significantly higher than that of the control classes. Stepwise linear regression models show that the age of menarche and grade were the predictors of students' knowledge among the control group and explained 7.8% of the variation of the knowledge score. Knowledge was a predictor of students' attitude of both groups (control and intervention) (beta = 0.359, 0.300 respectively). Knowledge was also a predictor of students' menstrual practice among control group (beta = -2.12). Attitude was a predictor of students' menstrual practice for both groups (beta = 0.360, 0.252 respectively). The study recommended the replication of the same program among elementary, preparatory, and other secondary schools for improvement of students' menstrual knowledge, attitudes and practice.

The variability of practice in minimally invasive thoracic surgery for pulmonary resections.

PubMed

Rocco, Gaetano; Internullo, Eveline; Cassivi, Stephen D; Van Raemdonck, Dirk; Ferguson, Mark K

2008-08-01

Thoracic surgeons participating in this survey seemed to have clearly indicated their perception of VATS major lung resections, in particular VATS lobectomy. 1. The acronym VATS as a short form of "video-assisted thoracic surgery" was the preferred terminology. 2. According to the respondents, the need or use of rib spreading served as the defining characteristic of "open" thoracic surgery. 3. It was most commonly suggested that VATS lobectomy is performed by means of two or three port incisions with the addition of a minithoracotomy or access incision. 4. Rib spreading (shearing) was not deemed acceptable as part of a strictly defined VATS procedure. 5. Although there was no general consensus, respondents suggested that the preferred approach for visualization in a VATS procedure was only through the video monitor. 6. Although minimally invasive procedures for lung resection are still mainly being used for diagnostic and minor therapeutic purposes, young surgeons seemed to be more likely to recommend VATS lung surgery for major pulmonary resections than their more senior colleagues. 7. The survey confirmed that the use of the standard posterolateral thoracotomy is still widespread. Almost 40% of the surgeons claimed to use the standard posterolateral thoracotomy for more than 50% of their cases and less than 30% use it for less than 5% of cases. 8. The major reasons to perform VATS lobectomy were perceived to be reduced pain and decreased hospitalization. 9. Approximately 60% of the surgeons claimed to perform VATS lobectomy in less than 5% of their lobectomy cases. Younger consultants reported using VATS lobectomy in up to 50% of their lobectomy cases. There was the suggestion that lack of resources could justify the minor impact of VATS lobectomy in the thoracic surgical practice in middle- to low-income countries. 10. The currently available scientific evidence on safety and effectiveness, and technologic advancements were emphasized as the two factors having a major impact on the development of minimally invasive thoracic surgical practice. 11. Any lack of popularity of VATS lobectomy was presumed to be caused by several equally important factors. Resistance to change by more senior surgeons ranked highly among younger surgeons, however, as an explanation for the slow adoption of this technique. Senior surgeons. however, seemed to focus their attention on the steep learning curve of VATS lobectomy. In addition, surgeons from middle- to low-income countries recognized certain financial and logistic difficulties as major determinants of the lack of popularity of VATS lobectomy. 12. Most surgeons thought that robotic thoracic surgery represented an evolution of VATS. Nevertheless, almost 30% did not think current robotic methods meet the criteria for minimally invasive surgery. More than 90% of the participants stated that they did not perform robotic thoracic surgery. This was reportedly because of costs. but also because of the fact that robotic approaches have not yet demonstrated a distinct advantage over nonrobotic VATS procedures. 13. It was suggested that in every unit or department there should be at least one surgeon with a specific interest and capability in VATS lobectomy. The younger surgeons. however, seemed to envisage more widespread competency being optimal. 14. Most suggested that training in VATS lobectomy be done in a stepwise fashion starting from the classical open technique. Older surgeons wanted to see this as an extracurricular activity following completion of the current training curriculum rather than included in the traditional training program. In the opinion of the thoracic surgeons taking part in this survey, pulmonary resections not performed according to these standards could not be called VATS procedures but should be included within the MITS category at large, along with other diagnostic and therapeutic interventions. In addition, the survey confirmed that the time-honored muscle-dividing thoracotomy is still widely used. The opportunity for a progressive move toward the routine use of less invasive approaches for major pulmonary resections, however, is already well within sight. Given the results of the ESTS survey supporting a stepwise teaching process leading to VATS lobectomy, hybrid and minimally invasive open lung resections (discussed elsewhere in this issue) collectively defined as MITS may serve as starting point in this process to expand the appropriate use of VATS lobectomy in the modern thoracic surgical practice.

Synthesis of Acetone-Derived C6 , C9 , and C12 Carbon Scaffolds for Chemical and Fuel Applications.

PubMed

Moore, Cameron M; Jenkins, Rhodri W; Janicke, Michael T; Kubic, William L; Polikarpov, Evgueni; Semelsberger, Troy A; Sutton, Andrew D

2016-12-20

A simple, inexpensive catalyst system (Amberlyst 15 and Ni/SiO 2 -Al 2 O 3 ) is described for the upgrading of acetone to a range of chemicals and potential fuels. Stepwise hydrodeoxygenation of the produced ketones can yield branched alcohols, alkenes, and alkanes. An analysis of these products is provided, which demonstrates that this approach can provide a product profile of valuable bioproducts and potential biofuels. © 2016 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

The spinal cord: a review of functional neuroanatomy.

PubMed

Bican, Orhan; Minagar, Alireza; Pruitt, Amy A

2013-02-01

The spinal cord controls the voluntary muscles of the trunk and limbs and receives sensory input from these areas. It extends from the medulla oblongata to the lower border of the first lumbar vertebra. A basic knowledge of spinal cord anatomy is essential for interpretation of clinical signs and symptoms and for understanding of pathologic processes involving the spinal cord. In this article, anatomic structures are correlated with relevant clinical signs and symptoms and a step-wise approach to spinal cord diagnosis is outlined. Copyright © 2013 Elsevier Inc. All rights reserved.

Cloud field classification based upon high spatial resolution textural features. I - Gray level co-occurrence matrix approach

NASA Technical Reports Server (NTRS)

Welch, R. M.; Sengupta, S. K.; Chen, D. W.

1988-01-01

Stratocumulus, cumulus, and cirrus clouds were identified on the basis of cloud textural features which were derived from a single high-resolution Landsat MSS NIR channel using a stepwise linear discriminant analysis. It is shown that, using this method, it is possible to distinguish high cirrus clouds from low clouds with high accuracy on the basis of spatial brightness patterns. The largest probability of misclassification is associated with confusion between the stratocumulus breakup regions and the fair-weather cumulus.

Evaluation of Indoor Air Quality Screening Strategies: A Step-Wise Approach for IAQ Screening.

PubMed

Wong, Ling-Tim; Mui, Kwok-Wai; Tsang, Tsz-Wun

2016-12-14

Conducting a full indoor air quality (IAQ) assessment in air-conditioned offices requires large-scale material and manpower resources. However, an IAQ index can be adopted as a handy screening tool to identify any premises (with poor IAQ) that need more comprehensive IAQ assessments to prioritize IAQ improvements. This study proposes a step-wise IAQ screening protocol to facilitate its cost-effective management among building owners and managers. The effectiveness of three IAQ indices, namely θ₁ (with one parameter: CO₂), θ₂ (with two parameters: CO₂ and respirable suspended particulates, RSP) and θ₃ (with three parameters: CO₂, RSP, and total volatile organic compounds, TVOC) are evaluated. Compared in a pairwise manner with respect to the minimum satisfaction levels as stated in the IAQ Certification Scheme by the Hong Kong Environmental Protection Department, the results show that a screening test with more surrogate IAQ parameters is good at identifying both lower and higher risk groups for unsatisfactory IAQ, and thus offers higher resolution. Through the sensitivity and specificity for identifying IAQ problems, the effectiveness of alternative IAQ screening methods with different monitoring parameters is also reported.

Assessment of plant species diversity based on hyperspectral indices at a fine scale.

PubMed

Peng, Yu; Fan, Min; Song, Jingyi; Cui, Tiantian; Li, Rui

2018-03-19

Fast and nondestructive approaches of measuring plant species diversity have been a subject of excessive scientific curiosity and disquiet to environmentalists and field ecologists worldwide. In this study, we measured the hyperspectral reflectances and plant species diversity indices at a fine scale (0.8 meter) in central Hunshandak Sandland of Inner Mongolia, China. The first-order derivative value (FD) at each waveband and 37 hyperspectral indices were used to assess plant species diversity. Results demonstrated that the stepwise linear regression of FD can accurately estimate the Simpson (R 2  = 0.83), Pielou (R 2  = 0.87) and Shannon-Wiener index (R 2  = 0.88). Stepwise linear regression of FD (R 2  = 0.81, R 2  = 0.82) and spectral vegetation indices (R 2  = 0.51, R 2  = 0.58) significantly predicted the Margalef and Gleason index. It was proposed that the Simpson, Pielou and Shannon-Wiener indices, which are widely used as plant species diversity indicators, can be precisely estimated through hyperspectral indices at a fine scale. This research promotes the development of methods for assessment of plant diversity using hyperspectral data.

Mechanistic studies on the transformation of ethanol into ethene over Fe-ZSM-5 zeolite.

PubMed

Maihom, Thana; Khongpracha, Pipat; Sirijaraensre, Jakkapan; Limtrakul, Jumras

2013-01-14

Ethanol, through the utilization of bioethanol as a chemical resource, has received considerable industrial attention as it provides an alternative route to produce more valuable hydrocarbons. Using a density functional theory approach incorporating the M06-L functional, which includes dispersion interactions, a large 34T nanocluster model of Fe-ZSM-5 zeolite in which T is a Si or Al atom is employed to examine both the stepwise and concerted mechanisms of the transformation of ethanol into ethene. For the stepwise mechanism, ethanol dehydration commences from the first hydrogen abstraction of the ethanol OH group to form the ethoxide-hydroxide intermediate with a low activation energy of 17.7 kcal mol(-1). Consequently, the ethoxide-hydroxide intermediate is decomposed into ethene through hydrogen abstraction from the ethoxide methyl carbon to either the OH group of hydroxide or the oxygen of the ethoxide group with high activation energies of 64.8 and 63.5 kcal mol(-1), respectively. For the concerted mechanism, ethanol transformation into the ethene product occurs in a single step without intermediate formation, with an activation energy of 32.9 kcal mol(-1). Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Comparison of bioavailable vanadium in alfalfa rhizosphere soil extracted by an improved BCR procedure and EDTA, HCl, and NaNO₃ single extractions in a pot experiment with V-Cd treatments.

PubMed

Yang, Jie; Teng, Yanguo; Zuo, Rui; Song, Liuting

2015-06-01

The BCR sequential extraction procedure was compared with EDTA, HCl, and NaNO3 single extractions for evaluating vanadium bioavailability in alfalfa rhizosphere soil. The amounts of vanadium extracted by these methods were in the following order: BCR (bioavailable V) > EDTA ≈ HCl > NaNO3. Both correlation analysis and stepwise regression were adopted to illustrate the extractable vanadium between different reagents. The correlation coefficients between extracted vanadium and the vanadium contents in alfalfa roots were R NaNO3 = 0.948, R HCl = 0.902, R EDTA = 0.816, and R bioavailable V = 0.819. The stepwise multiple regression equation of the NaNO3 extraction was the most significant at a 95 % confidence interval. The influence of pH, total organic carbon, and cadmium content of soil to vanadium bioavailability were not definite. In summary, both the BCR sequential extraction and the single extraction methods were valid approaches for predicting vanadium bioavailability in alfalfa rhizosphere soil, especially the single extractions.

Handheld Tissue Hardness Meters for Assessing the Mechanical Properties of Skeletal Muscle: A Feasibility Study.

PubMed

Chino, Kentaro; Takahashi, Hideyuki

2016-09-01

The purpose of this study was to examine the feasibility of using handheld tissue hardness meters to assess the mechanical properties of skeletal muscle. This observational study included 33 healthy men (age, 22.4 ± 4.4 years) and 33 healthy women (age, 23.7 ± 4.2 years). Participants were placed in a supine position, and tissue hardness overlying the rectus femoris and the shear modulus of the muscle were measured on the right side of the body at 50% thigh length. In the same position, subcutaneous adipose tissue thickness and muscle thickness were measured using B-mode ultrasonography. To examine the associations of subcutaneous adipose tissue thickness, muscle thickness, and muscle shear modulus with tissue hardness, linear regression using a stepwise bidirectional elimination approach was performed. Stepwise linear regression revealed that subcutaneous adipose tissue thickness (r = -0.38, P = .002) and muscle shear modulus (r = 0.27, P = .03) were significantly associated with tissue hardness. Significant associations among adipose tissue thickness, muscle shear modulus, and tissue hardness show the limitations and feasibility of handheld tissue hardness meters for assessing the mechanical properties of skeletal muscles. Copyright © 2016. Published by Elsevier Inc.

Evaluation of Indoor Air Quality Screening Strategies: A Step-Wise Approach for IAQ Screening

PubMed Central

Wong, Ling-tim; Mui, Kwok-wai; Tsang, Tsz-wun

2016-01-01

Conducting a full indoor air quality (IAQ) assessment in air-conditioned offices requires large-scale material and manpower resources. However, an IAQ index can be adopted as a handy screening tool to identify any premises (with poor IAQ) that need more comprehensive IAQ assessments to prioritize IAQ improvements. This study proposes a step-wise IAQ screening protocol to facilitate its cost-effective management among building owners and managers. The effectiveness of three IAQ indices, namely θ1 (with one parameter: CO2), θ2 (with two parameters: CO2 and respirable suspended particulates, RSP) and θ3 (with three parameters: CO2, RSP, and total volatile organic compounds, TVOC) are evaluated. Compared in a pairwise manner with respect to the minimum satisfaction levels as stated in the IAQ Certification Scheme by the Hong Kong Environmental Protection Department, the results show that a screening test with more surrogate IAQ parameters is good at identifying both lower and higher risk groups for unsatisfactory IAQ, and thus offers higher resolution. Through the sensitivity and specificity for identifying IAQ problems, the effectiveness of alternative IAQ screening methods with different monitoring parameters is also reported. PMID:27983667

Retro-regression--another important multivariate regression improvement.

PubMed

Randić, M

2001-01-01

We review the serious problem associated with instabilities of the coefficients of regression equations, referred to as the MRA (multivariate regression analysis) "nightmare of the first kind". This is manifested when in a stepwise regression a descriptor is included or excluded from a regression. The consequence is an unpredictable change of the coefficients of the descriptors that remain in the regression equation. We follow with consideration of an even more serious problem, referred to as the MRA "nightmare of the second kind", arising when optimal descriptors are selected from a large pool of descriptors. This process typically causes at different steps of the stepwise regression a replacement of several previously used descriptors by new ones. We describe a procedure that resolves these difficulties. The approach is illustrated on boiling points of nonanes which are considered (1) by using an ordered connectivity basis; (2) by using an ordering resulting from application of greedy algorithm; and (3) by using an ordering derived from an exhaustive search for optimal descriptors. A novel variant of multiple regression analysis, called retro-regression (RR), is outlined showing how it resolves the ambiguities associated with both "nightmares" of the first and the second kind of MRA.

Classification of lung cancer patients and controls by chromatography of modified nucleosides in serum

USGS Publications Warehouse

McEntire, John E.; Kuo, Kenneth C.; Smith, Mark E.; Stalling, David L.; Richens, Jack W.; Zumwalt, Robert W.; Gehrke, Charles W.; Papermaster, Ben W.

1989-01-01

A wide spectrum of modified nucleosides has been quantified by high-performance liquid chromatography in serum of 49 male lung cancer patients, 35 patients with other cancers, and 48 patients hospitalized for nonneoplastic diseases. Data for 29 modified nucleoside peaks were normalized to an internal standard and analyzed by discriminant analysis and stepwise discriminant analysis. A model based on peaks selected by a stepwise discriminant procedure correctly classified 79% of the cancer and 75% of the noncancer subjects. It also demonstrated 84% sensitivity and 79% specificity when comparing lung cancer to noncancer subjects, and 80% sensitivity and 55% specificity in comparing lung cancer to other cancers. The nucleoside peaks having the greatest influence on the models varied dependent on the subgroups compared, confirming the importance of quantifying a wide array of nucleosides. These data support and expand previous studies which reported the utility of measuring modified nucleoside levels in serum and show that precise measurement of an array of 29 modified nucleosides in serum by high-performance liquid chromatography with UV scanning with subsequent data modeling may provide a clinically useful approach to patient classification in diagnosis and subsequent therapeutic monitoring.

Impact of statistical learning methods on the predictive power of multivariate normal tissue complication probability models.

PubMed

Xu, Cheng-Jian; van der Schaaf, Arjen; Schilstra, Cornelis; Langendijk, Johannes A; van't Veld, Aart A

2012-03-15

To study the impact of different statistical learning methods on the prediction performance of multivariate normal tissue complication probability (NTCP) models. In this study, three learning methods, stepwise selection, least absolute shrinkage and selection operator (LASSO), and Bayesian model averaging (BMA), were used to build NTCP models of xerostomia following radiotherapy treatment for head and neck cancer. Performance of each learning method was evaluated by a repeated cross-validation scheme in order to obtain a fair comparison among methods. It was found that the LASSO and BMA methods produced models with significantly better predictive power than that of the stepwise selection method. Furthermore, the LASSO method yields an easily interpretable model as the stepwise method does, in contrast to the less intuitive BMA method. The commonly used stepwise selection method, which is simple to execute, may be insufficient for NTCP modeling. The LASSO method is recommended. Copyright © 2012 Elsevier Inc. All rights reserved.

Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation: The Randomized Alster-Lost-AF Trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation).

PubMed

Fink, Thomas; Schlüter, Michael; Heeger, Christian-Hendrik; Lemes, Christine; Maurer, Tilman; Reissmann, Bruno; Riedl, Johannes; Rottner, Laura; Santoro, Francesco; Schmidt, Boris; Wohlmuth, Peter; Mathew, Shibu; Sohns, Christian; Ouyang, Feifan; Metzner, Andreas; Kuck, Karl-Heinz

2017-07-01

Pulmonary vein isolation (PVI) for persistent atrial fibrillation is associated with limited success rates and often requires multiple procedures to maintain stable sinus rhythm. In the prospective and randomized Alster-Lost-AF trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation), we sought to assess, in patients with symptomatic persistent or long-standing persistent atrial fibrillation, the outcomes of initial ablative strategies comprising either stand-alone PVI (PVI-only approach) or a stepwise approach of PVI followed by complex fractionated atrial electrogram ablation and linear ablation (Substrate-modification approach). Patients were randomized 1:1 to stand-alone PVI or PVI plus substrate modification. The primary study end point was freedom from recurrence of any atrial tachyarrhythmia, outside a 90-day blanking period, at 12 months. A total of 124 patients were enrolled, with 118 patients included in the analysis (61 in the PVI-only group, 57 in the Substrate-modification group). Atrial tachyarrhythmias recurred in 28 PVI-only group patients and 24 Substrate-modification group patients, for 1-year freedom from tachyarrhythmia recurrence after a single ablation procedure of 54% (95% confidence interval, 43%-68%) in the PVI-only and 57% (95% confidence interval, 46%-72%) in the Substrate-modification group ( P =0.86). Twenty-four patients in the PVI-only group (39%) and 18 in the Substrate-modification group (32%) were without arrhythmia recurrence and off antiarrhythmic drug therapy at the end of the 12-month follow-up. In patients with persistent and long-standing persistent atrial fibrillation, no significant difference was observed in 12-month freedom from atrial tachyarrhythmias between an index ablative approach of stand-alone PVI and a stepwise approach of PVI plus complex fractionated atrial electrogram and linear ablation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00820625. © 2017 American Heart Association, Inc.

Health Beliefs and Breast Self-Examination among Undergraduate Female Students in Public Universities in Klang Valley, Malaysia.

PubMed

Akhtari-Zavare, Mehrnoosh; Juni, Muhamad Hanafiah; Ismail, Irmi Zarina; Said, Salmiah Md; Latiff, Latiffah A

2015-01-01

Breast cancer is the most frequently occurring cancer in women and the most common cause of cancer death worldwide. A cross-sectional study was carried out among 792 female undergraduate students in public universities in Klang Valley, Malaysia, from January to April 2011. Data were collected using a validated questionnaire developed for this study. The mean age of respondents was 21.7±1.2 years. Most of them were single (96.8%), Malay (91.9%) and 150 (19.6%) claimed they had practiced BSE. There was a significant differences between performers and non-performers correlated to age, marital status, check breast by doctor, and being trained about BSE. Performers had lower mean scores for perceived barriers and susceptibility and higher mean score for confidence. Stepwise logistic regression analysis yielded four significant predictor variables. Overall our findings indicate that the practice of BSE while perceived as being important is not frequently practiced among female in Malaysia. Targeted education should be implemented to improve early detection of breast cancer.

[Poverty and Health: The Living Standard Approach as a Supplementary Concept to Measure Relative Poverty. Results from the German Socio-Economic Panel (GSOEP 2011)].

PubMed

Pförtner, T-K

2016-06-01

A common indicator of the measurement of relative poverty is the disposable income of a household. Current research introduces the living standard approach as an alternative concept for describing and measuring relative poverty. This study compares both approaches with regard to subjective health status of the German population, and provides theoretical implications for the utilisation of the income and living standard approach in health research. Analyses are based on the German Socio-Economic Panel (GSOEP) from the year 2011 that includes 12 290 private households and 21106 survey members. Self-rated health was based on a subjective assessment of general health status. Income poverty is based on the equalised disposable income and is applied to a threshold of 60% of the median-based average income. A person will be denoted as deprived (inadequate living standard) if 3 or more out of 11 living standard items are lacking due to financial reasons. To calculate the discriminate power of both poverty indicators, descriptive analyses and stepwise logistic regression models were applied separately for men and women adjusted for age, residence, nationality, educational level, occupational status and marital status. The results of the stepwise regression revealed a stronger poverty-health relationship for the living standard indicator. After adjusting for all control variables and the respective poverty indicator, income poverty was statistically not significantly associated with a poor subjective health status among men (OR Men: 1.33; 95% CI: 1.00-1.77) and women (OR Women: 0.98; 95% CI: 0.78-1.22). In contrast, the association between deprivation and subjective health status was statistically significant for men (OR Men: 2.00; 95% CI: 1.57-2.52) and women (OR Women: 2.11; 95% CI: 1.76-2.64). The results of the present study indicate that the income and standard of living approach measure different dimensions of poverty. In comparison to the income approach, the living standard approach measures stronger shortages of wealth and is relatively robust towards gender differences. This study expands the current debate about complementary research on the association between poverty and health. © Georg Thieme Verlag KG Stuttgart · New York.

Patient safety culture in China: a case study in an outpatient setting in Beijing

PubMed Central

Liu, Chaojie; Liu, Weiwei; Wang, Yuanyuan; Zhang, Zhihong; Wang, Peng

2014-01-01

Objectives To investigate the patient safety culture in an outpatient setting in Beijing and explore the meaning and implications of the safety culture from the perspective of health workers and patients. Methods A mixed methods approach involving a questionnaire survey and in-depth interviews was adopted. Among the 410 invited staff members, 318 completed the Hospital Survey of Patient Safety Culture (HSOPC). Patient safety culture was described using 12 subscale scores. Inter-subscale correlation analysis, ANOVA and stepwise multivariate regression analyses were performed to identify the determinants of the patient safety culture scores. Interviewees included 22 patients selected through opportunity sampling and 27 staff members selected through purposive sampling. The interview data were analysed thematically. Results The survey respondents perceived high levels of unsafe care but had personally reported few events. Lack of ‘communication openness’ was identified as a major safety culture problem, and a perception of ‘penalty’ was the greatest barrier to the encouragement of error reporting. Cohesive ‘teamwork within units’, while found to be an area of strength, conversely served as a protective and defensive mechanism for medical practice. Low levels of trust between providers and consumers and lack of management support constituted an obstacle to building a positive patient safety culture. Conclusions This study in China demonstrates that a punitive approach to error is still widespread despite increasing awareness of unsafe care, and managers have been slow in acknowledging the importance of building a positive patient safety culture. Strong ‘teamwork within units’, a common area of strength, could fuel the concealment of errors. PMID:24351971

Optimum load distribution between heat sources based on the Cournot model

NASA Astrophysics Data System (ADS)

Penkovskii, A. V.; Stennikov, V. A.; Khamisov, O. V.

2015-08-01

One of the widespread models of the heat supply of consumers, which is represented in the "Single buyer" format, is considered. The methodological base proposed for its description and investigation presents the use of principles of the theory of games, basic propositions of microeconomics, and models and methods of the theory of hydraulic circuits. The original mathematical model of the heat supply system operating under conditions of the "Single buyer" organizational structure provides the derivation of a solution satisfying the market Nash equilibrium. The distinctive feature of the developed mathematical model is that, along with problems solved traditionally within the bounds of bilateral relations of heat energy sources-heat consumer, it considers a network component with its inherent physicotechnical properties of the heat network and business factors connected with costs of the production and transportation of heat energy. This approach gives the possibility to determine optimum levels of load of heat energy sources. These levels provide the given heat energy demand of consumers subject to the maximum profit earning of heat energy sources and the fulfillment of conditions for formation of minimum heat network costs for a specified time. The practical realization of the search of market equilibrium is considered by the example of a heat supply system with two heat energy sources operating on integrated heat networks. The mathematical approach to the solution search is represented in the graphical form and illustrates computations based on the stepwise iteration procedure for optimization of levels of loading of heat energy sources (groping procedure by Cournot) with the corresponding computation of the heat energy price for consumers.

An improved pseudotargeted metabolomics approach using multiple ion monitoring with time-staggered ion lists based on ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometry.

PubMed

Wang, Yang; Liu, Fang; Li, Peng; He, Chengwei; Wang, Ruibing; Su, Huanxing; Wan, Jian-Bo

2016-07-13

Pseudotargeted metabolomics is a novel strategy integrating the advantages of both untargeted and targeted methods. The conventional pseudotargeted metabolomics required two MS instruments, i.e., ultra-high performance liquid chromatography/quadrupole-time- of-flight mass spectrometry (UHPLC/Q-TOF MS) and UHPLC/triple quadrupole mass spectrometry (UHPLC/QQQ-MS), which makes method transformation inevitable. Furthermore, the picking of ion pairs from thousands of candidates and the swapping of the data between two instruments are the most labor-intensive steps, which greatly limit its application in metabolomic analysis. In the present study, we proposed an improved pseudotargeted metabolomics method that could be achieved on an UHPLC/Q-TOF/MS instrument operated in the multiple ion monitoring (MIM) mode with time-staggered ion lists (tsMIM). Full scan-based untargeted analysis was applied to extract the target ions. After peak alignment and ion fusion, a stepwise ion picking procedure was used to generate the ion lists for subsequent single MIM and tsMIM. The UHPLC/Q-TOF tsMIM MS-based pseudotargeted approach exhibited better repeatability and a wider linear range than the UHPLC/Q-TOF MS-based untargeted metabolomics method. Compared to the single MIM mode, the tsMIM significantly increased the coverage of the metabolites detected. The newly developed method was successfully applied to discover plasma biomarkers for alcohol-induced liver injury in mice, which indicated its practicability and great potential in future metabolomics studies. Copyright © 2016 Elsevier B.V. All rights reserved.

Periodic Application of Stochastic Cost Optimization Methodology to Achieve Remediation Objectives with Minimized Life Cycle Cost

NASA Astrophysics Data System (ADS)

Kim, U.; Parker, J.

2016-12-01

Many dense non-aqueous phase liquid (DNAPL) contaminated sites in the U.S. are reported as "remediation in progress" (RIP). However, the cost to complete (CTC) remediation at these sites is highly uncertain and in many cases, the current remediation plan may need to be modified or replaced to achieve remediation objectives. This study evaluates the effectiveness of iterative stochastic cost optimization that incorporates new field data for periodic parameter recalibration to incrementally reduce prediction uncertainty and implement remediation design modifications as needed to minimize the life cycle cost (i.e., CTC). This systematic approach, using the Stochastic Cost Optimization Toolkit (SCOToolkit), enables early identification and correction of problems to stay on track for completion while minimizing the expected (i.e., probability-weighted average) CTC. This study considers a hypothetical site involving multiple DNAPL sources in an unconfined aquifer using thermal treatment for source reduction and electron donor injection for dissolved plume control. The initial design is based on stochastic optimization using model parameters and their joint uncertainty based on calibration to site characterization data. The model is periodically recalibrated using new monitoring data and performance data for the operating remediation systems. Projected future performance using the current remediation plan is assessed and reoptimization of operational variables for the current system or consideration of alternative designs are considered depending on the assessment results. We compare remediation duration and cost for the stepwise re-optimization approach with single stage optimization as well as with a non-optimized design based on typical engineering practice.

Non-invasive prenatal diagnosis for fetal sex determination: benefits and disadvantages from the service users' perspective.

PubMed

Lewis, Celine; Hill, Melissa; Skirton, Heather; Chitty, Lyn S

2012-11-01

Prenatal fetal sex determination is clinically indicated for women who are at risk of having a child with a serious genetic disorder affecting a particular sex. Ultrasound has been the traditional method used, but early fetal sex determination using non-invasive prenatal diagnosis (NIPD) can now be performed using cell-free fetal DNA in maternal plasma. The study aim was to assess the views and experiences of service users who had used NIPD for fetal sex determination. In this paper, we report on the perceived benefits and disadvantages. A qualitative approach using semi-structured interviews was used. A total of 44 participants (38 women and 6 partners of participating women) were recruited. Participants' views and experiences of NIPD were overwhelmingly positive. Concerning benefits over traditional methods, three themes emerged: (1) technical aspects of technology; (2) timing; and (3) enhanced decision-making. Practical advantages of NIPD included avoiding miscarriage, and there were a number of psychological advantages associated with timing such as perceived control, early re-engagement, normalization of pregnancy and peace of mind. Participants also valued NIPD as it enabled a stepwise approach to decision-making. A number of disadvantages were discussed including concerns about social sexing and increased bonding at a time in pregnancy when miscarriage risk is high. However, participants felt these were fairly minor in comparison with the advantages of NIPD. Until definitive genetic diagnosis using NIPD is available, NIPD for fetal sex determination is perceived as a good interim measure with a number of notable advantages over traditional methods.

Non-invasive prenatal diagnosis for fetal sex determination: benefits and disadvantages from the service users' perspective

PubMed Central

Lewis, Celine; Hill, Melissa; Skirton, Heather; Chitty, Lyn S

2012-01-01

Prenatal fetal sex determination is clinically indicated for women who are at risk of having a child with a serious genetic disorder affecting a particular sex. Ultrasound has been the traditional method used, but early fetal sex determination using non-invasive prenatal diagnosis (NIPD) can now be performed using cell-free fetal DNA in maternal plasma. The study aim was to assess the views and experiences of service users who had used NIPD for fetal sex determination. In this paper, we report on the perceived benefits and disadvantages. A qualitative approach using semi-structured interviews was used. A total of 44 participants (38 women and 6 partners of participating women) were recruited. Participants' views and experiences of NIPD were overwhelmingly positive. Concerning benefits over traditional methods, three themes emerged: (1) technical aspects of technology; (2) timing; and (3) enhanced decision-making. Practical advantages of NIPD included avoiding miscarriage, and there were a number of psychological advantages associated with timing such as perceived control, early re-engagement, normalization of pregnancy and peace of mind. Participants also valued NIPD as it enabled a stepwise approach to decision-making. A number of disadvantages were discussed including concerns about social sexing and increased bonding at a time in pregnancy when miscarriage risk is high. However, participants felt these were fairly minor in comparison with the advantages of NIPD. Until definitive genetic diagnosis using NIPD is available, NIPD for fetal sex determination is perceived as a good interim measure with a number of notable advantages over traditional methods. PMID:22453293

What Factors Influence Community Oral and Maxillofacial Surgeons' Choice to Use Capnography in the Office-Based Ambulatory Anesthesia Setting?

PubMed

Matin, Mehdi B; Gonzalez, Martin L; Dodson, Thomas B

2015-08-01

The American Association of Oral and Maxillofacial Surgeons Board of Trustees mandated monitoring using capnography during moderate sedation (MS) and deep sedation or general anesthesia (DS/GA) delivered in the office setting effective January 1, 2014. The purpose of this study was to estimate the frequency of capnography use and to identify variables associated with a clinician's choice to use capnography before the mandate. To address the research purpose, the authors designed a prospective cohort study and enrolled 2 samples: 1) American private practicing oral and maxillofacial surgeons (OMSs) and 2) all eligible patients for whom these OMSs delivered MS or DS/GA. The predictor variables were categorized as surgeon or patient demographics, anesthesia risk factors, procedure-related variables, and anesthetic medications. The outcome variable was capnography use during MS or DS/GA. Descriptive, bivariate, and forward stepwise multiple logistic regression statistics were computed to evaluate the association between the predictor variables and capnography use, with statistical significance set at a P value less than or equal to .05. The surgeon sample was composed of 95 OMSs and 13.7% reported using capnography. The patient sample included 3,495 patients with a mean age of 30.6 years (standard deviation, 17.8 yr), 43.5% were men, and 5.6% were monitored using capnography. Based on bivariate analyses, 17 variables were associated with capnography use. Forward stepwise regression modeling identified 9 variables statistically associated with capnography use. These variables were patient's age, Mallampati airway score, alcohol consumption, board certification, sevoflurane use, number of monitoring methods, electrocardiogram use, precordial stethoscope use, and number of personnel in operating suite. Although this study might be of historical interest at this time, the results offer insight into OMSs' practice patterns before the mandatory requirement to use capnography. As more OMSs comply with the capnography mandate, their practice patterns involving variables found to statistically correlate with capnography use might become more similar to those of early adopters of this technology. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

MULGRES: a computer program for stepwise multiple regression analysis

Treesearch

A. Jeff Martin

1971-01-01

MULGRES is a computer program source deck that is designed for multiple regression analysis employing the technique of stepwise deletion in the search for most significant variables. The features of the program, along with inputs and outputs, are briefly described, with a note on machine compatibility.

Caregiver Input to Optimize the Design of a Pediatric Care Planning Guide for Rehabilitation: Descriptive Study

PubMed Central

Lim, Heather K; Corden, Marya E

2017-01-01

Background Caregiver input has informed the design of a valid electronic patient-reported outcome (PRO) measure for use in pediatric rehabilitation. This proxy assessment may be further developed to expedite and enhance patient-centered care planning processes, but user input is first needed to finalize the core requirements that will guide its design. Objective The objective of this study was to examine the feasibility of a stepwise process for building on a baseline assessment of young children's participation in activities to develop a care plan relevant to pediatric rehabilitation. Methods A cross-sectional descriptive study design was employed using qualitative methods. Data were collected via Web-based technology and by telephone. Twenty-five caregivers of young children (9 with developmental delays, 16 without delays) and between 1 and 7 years were recruited from a subsample of parents who had previously enrolled in a Web-based validation of a PRO on children’s participation and provided consent for future contact. Each caregiver completed a demographic questionnaire and Young Children’s Participation and Environment Measure (YC-PEM) online, followed by a 20- to 60-min semistructured and audiotaped phone interview to review and build upon PRO results as summarized in an electronic report. Interview data were content coded to the interview guide and reviewed by multiple research staff to estimate feasibility according to stepwise completion rates, perceptions of difficulty in step completion, and perceptions of overall utility. Results Half of the participants in the final study sample (N=25) fully completed a stepwise process of building on their baseline PRO assessment to develop an initial care plan for their child. In most cases, similar stepwise completion rates and trends in the approaches taken for step completion were found regardless of the child’s disability status. However, more parents of children with disabilities reported difficulties in rank ordering their priorities for change and identified child-focused strategies for goal attainment. Nearly 77% (19/25) of users were willing to use the process to develop and communicate intervention priorities and strategies with professionals, family, and friends. Conclusions Results informed revisions to the care planning guide before usability and feasibility testing of an initial Web-based prototype that is now underway. PMID:29066421

Finite cohesion due to chain entanglement in polymer melts.

PubMed

Cheng, Shiwang; Lu, Yuyuan; Liu, Gengxin; Wang, Shi-Qing

2016-04-14

Three different types of experiments, quiescent stress relaxation, delayed rate-switching during stress relaxation, and elastic recovery after step strain, are carried out in this work to elucidate the existence of a finite cohesion barrier against free chain retraction in entangled polymers. Our experiments show that there is little hastened stress relaxation from step-wise shear up to γ = 0.7 and step-wise extension up to the stretching ratio λ = 1.5 at any time before or after the Rouse time. In contrast, a noticeable stress drop stemming from the built-in barrier-free chain retraction is predicted using the GLaMM model. In other words, the experiment reveals a threshold magnitude of step-wise deformation below which the stress relaxation follows identical dynamics whereas the GLaMM or Doi-Edwards model indicates a monotonic acceleration of the stress relaxation dynamics as a function of the magnitude of the step-wise deformation. Furthermore, a sudden application of startup extension during different stages of stress relaxation after a step-wise extension, i.e. the delayed rate-switching experiment, shows that the geometric condensation of entanglement strands in the cross-sectional area survives beyond the reptation time τd that is over 100 times the Rouse time τR. Our results point to the existence of a cohesion barrier that can prevent free chain retraction upon moderate deformation in well-entangled polymer melts.

Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

PubMed Central

Goldie, Sue J.; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

2010-01-01

Background Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Methods and Findings Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold (∼23%–35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately prevent four of five maternal deaths; this approach coupled stepwise improvements in family planning and safe abortion with consecutively implemented strategies that incrementally increased skilled attendants, improved antenatal/postpartum care, shifted births away from home, and improved recognition of referral need, transport, and availability/quality of EmOC. The strategies in this approach ranged from being cost-saving to having incremental cost-effectiveness ratios less than US$500 per year of life saved (YLS), well below India's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Conclusions Early intensive efforts to improve family planning and control of fertility choices and to provide safe abortion, accompanied by a paced systematic and stepwise effort to scale up capacity for integrated maternal health services over several years, is as cost-effective as childhood immunization or treatment of malaria, tuberculosis, or HIV. In just 5 y, more than 150,000 maternal deaths would be averted through increasing contraception rates to meet women's needs for spacing and limiting births; nearly US$1.5 billion would be saved by coupling safe abortion to aggressive family planning efforts; and with stepwise investments to improve access to pregnancy-related health services and to high-quality facility-based intrapartum care, more than 75% of maternal deaths could be prevented. If accomplished over the next decade, the lives of more than one million women would be saved. Please see later in the article for the Editors' Summary PMID:20421922

Rational engineering of nanoporous anodic alumina optical bandpass filters

NASA Astrophysics Data System (ADS)

Santos, Abel; Pereira, Taj; Law, Cheryl Suwen; Losic, Dusan

2016-08-01

Herein, we present a rationally designed advanced nanofabrication approach aiming at producing a new type of optical bandpass filters based on nanoporous anodic alumina photonic crystals. The photonic stop band of nanoporous anodic alumina (NAA) is engineered in depth by means of a pseudo-stepwise pulse anodisation (PSPA) approach consisting of pseudo-stepwise asymmetric current density pulses. This nanofabrication method makes it possible to tune the transmission bands of NAA at specific wavelengths and bandwidths, which can be broadly modified across the UV-visible-NIR spectrum through the anodisation period (i.e. time between consecutive pulses). First, we establish the effect of the anodisation period as a means of tuning the position and width of the transmission bands of NAA across the UV-visible-NIR spectrum. To this end, a set of nanoporous anodic alumina bandpass filters (NAA-BPFs) are produced with different anodisation periods, ranging from 500 to 1200 s, and their optical properties (i.e. characteristic transmission bands and interferometric colours) are systematically assessed. Then, we demonstrate that the rational combination of stacked NAA-BPFs consisting of layers of NAA produced with different PSPA periods can be readily used to create a set of unique and highly selective optical bandpass filters with characteristic transmission bands, the position, width and number of which can be precisely engineered by this rational anodisation approach. Finally, as a proof-of-concept, we demonstrate that the superposition of stacked NAA-BPFs produced with slight modifications of the anodisation period enables the fabrication of NAA-BPFs with unprecedented broad transmission bands across the UV-visible-NIR spectrum. The results obtained from our study constitute the first comprehensive rationale towards advanced NAA-BPFs with fully controllable photonic properties. These photonic crystal structures could become a promising alternative to traditional optical bandpass filters based on glass and plastic.Herein, we present a rationally designed advanced nanofabrication approach aiming at producing a new type of optical bandpass filters based on nanoporous anodic alumina photonic crystals. The photonic stop band of nanoporous anodic alumina (NAA) is engineered in depth by means of a pseudo-stepwise pulse anodisation (PSPA) approach consisting of pseudo-stepwise asymmetric current density pulses. This nanofabrication method makes it possible to tune the transmission bands of NAA at specific wavelengths and bandwidths, which can be broadly modified across the UV-visible-NIR spectrum through the anodisation period (i.e. time between consecutive pulses). First, we establish the effect of the anodisation period as a means of tuning the position and width of the transmission bands of NAA across the UV-visible-NIR spectrum. To this end, a set of nanoporous anodic alumina bandpass filters (NAA-BPFs) are produced with different anodisation periods, ranging from 500 to 1200 s, and their optical properties (i.e. characteristic transmission bands and interferometric colours) are systematically assessed. Then, we demonstrate that the rational combination of stacked NAA-BPFs consisting of layers of NAA produced with different PSPA periods can be readily used to create a set of unique and highly selective optical bandpass filters with characteristic transmission bands, the position, width and number of which can be precisely engineered by this rational anodisation approach. Finally, as a proof-of-concept, we demonstrate that the superposition of stacked NAA-BPFs produced with slight modifications of the anodisation period enables the fabrication of NAA-BPFs with unprecedented broad transmission bands across the UV-visible-NIR spectrum. The results obtained from our study constitute the first comprehensive rationale towards advanced NAA-BPFs with fully controllable photonic properties. These photonic crystal structures could become a promising alternative to traditional optical bandpass filters based on glass and plastic. Electronic supplementary information (ESI) available: An example demonstrating the effect of pore widening on the position and width of the transmission band of a NAA-BPF and a comprehensive table summarising the position and FWHM of the different bands of the NAA-BPFs produced in this study. See DOI: 10.1039/c6nr03490j

Experience, Reflect, Critique: The End of the "Learning Cycles" Era

ERIC Educational Resources Information Center

Seaman, Jayson

2008-01-01

According to prevailing models, experiential learning is by definition a stepwise process beginning with direct experience, followed by reflection, followed by learning. It has been argued, however, that stepwise models inadequately explain the holistic learning processes that are central to learning from experience, and that they lack scientific…

A Latent-Variable Causal Model of Faculty Reputational Ratings.

ERIC Educational Resources Information Center

King, Suzanne; Wolfle, Lee M.

A reanalysis was conducted of Saunier's research (1985) on sources of variation in the National Research Council (NRC) reputational ratings of university faculty. Saunier conducted a stepwise regression analysis using 12 predictor variables. Due to problems with multicollinearity and because of the atheoretical nature of stepwise regression,…

Regulatory challenges and approaches to characterize nanomedicines and their follow-on similars.

PubMed

Mühlebach, Stefan; Borchard, Gerrit; Yildiz, Selcan

2015-03-01

Nanomedicines are highly complex products and are the result of difficult to control manufacturing processes. Nonbiological complex drugs and their biological counterparts can comprise nanoparticles and therefore show nanomedicine characteristics. They consist of not fully known nonhomomolecular structures, and can therefore not be characterized by physicochemical means only. Also, intended copies of nanomedicines (follow-on similars) may have clinically meaningful differences, creating the regulatory challenge of how to grant a high degree of assurance for patients' benefit and safety. As an example, the current regulatory approach for marketing authorization of intended copies of nonbiological complex drugs appears inappropriate; also, a valid strategy incorporating the complexity of such systems is undefined. To demonstrate sufficient similarity and comparability, a stepwise quality, nonclinical and clinical approach is necessary to obtain market authorization for follow-on products as therapeutic alternatives, substitution and/or interchangeable products. To fill the regulatory gap, harmonized and science-based standards are needed.

A neural network approach to cloud classification

NASA Technical Reports Server (NTRS)

Lee, Jonathan; Weger, Ronald C.; Sengupta, Sailes K.; Welch, Ronald M.

1990-01-01

It is shown that, using high-spatial-resolution data, very high cloud classification accuracies can be obtained with a neural network approach. A texture-based neural network classifier using only single-channel visible Landsat MSS imagery achieves an overall cloud identification accuracy of 93 percent. Cirrus can be distinguished from boundary layer cloudiness with an accuracy of 96 percent, without the use of an infrared channel. Stratocumulus is retrieved with an accuracy of 92 percent, cumulus at 90 percent. The use of the neural network does not improve cirrus classification accuracy. Rather, its main effect is in the improved separation between stratocumulus and cumulus cloudiness. While most cloud classification algorithms rely on linear parametric schemes, the present study is based on a nonlinear, nonparametric four-layer neural network approach. A three-layer neural network architecture, the nonparametric K-nearest neighbor approach, and the linear stepwise discriminant analysis procedure are compared. A significant finding is that significantly higher accuracies are attained with the nonparametric approaches using only 20 percent of the database as training data, compared to 67 percent of the database in the linear approach.

ColoSeq provides comprehensive lynch and polyposis syndrome mutational analysis using massively parallel sequencing.

PubMed

Pritchard, Colin C; Smith, Christina; Salipante, Stephen J; Lee, Ming K; Thornton, Anne M; Nord, Alex S; Gulden, Cassandra; Kupfer, Sonia S; Swisher, Elizabeth M; Bennett, Robin L; Novetsky, Akiva P; Jarvik, Gail P; Olopade, Olufunmilayo I; Goodfellow, Paul J; King, Mary-Claire; Tait, Jonathan F; Walsh, Tom

2012-07-01

Lynch syndrome (hereditary nonpolyposis colon cancer) and adenomatous polyposis syndromes frequently have overlapping clinical features. Current approaches for molecular genetic testing are often stepwise, taking a best-candidate gene approach with testing of additional genes if initial results are negative. We report a comprehensive assay called ColoSeq that detects all classes of mutations in Lynch and polyposis syndrome genes using targeted capture and massively parallel next-generation sequencing on the Illumina HiSeq2000 instrument. In blinded specimens and colon cancer cell lines with defined mutations, ColoSeq correctly identified 28/28 (100%) pathogenic mutations in MLH1, MSH2, MSH6, PMS2, EPCAM, APC, and MUTYH, including single nucleotide variants (SNVs), small insertions and deletions, and large copy number variants. There was 100% reproducibility of detection mutation between independent runs. The assay correctly identified 222 of 224 heterozygous SNVs (99.4%) in HapMap samples, demonstrating high sensitivity of calling all variants across each captured gene. Average coverage was greater than 320 reads per base pair when the maximum of 96 index samples with barcodes were pooled. In a specificity study of 19 control patients without cancer from different ethnic backgrounds, we did not find any pathogenic mutations but detected two variants of uncertain significance. ColoSeq offers a powerful, cost-effective means of genetic testing for Lynch and polyposis syndromes that eliminates the need for stepwise testing and multiple follow-up clinical visits. Copyright © 2012 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

Epileptic Encephalopathy in Childhood: A Stepwise Approach for Identification of Underlying Genetic Causes.

PubMed

Patel, Jaina; Mercimek-Mahmutoglu, Saadet

2016-10-01

Epilepsy is one of the most common neurological disorders in childhood. Epilepsy associated with global developmental delay and cognitive dysfunction is defined as epileptic encephalopathy. Certain inherited metabolic disorders presenting with epileptic encephalopathy can be treated with disease specific diet, vitamin, amino acid or cofactor supplementations. In those disorders, disease specific therapy is successful to achieve good seizure control and improve long-term neurodevelopmental outcome. For this reason, intractable epilepsy with global developmental delay or history of developmental regression warrants detailed metabolic investigations for the possibility of an underlying treatable inherited metabolic disorder, which should be undertaken as first line investigations. An underlying genetic etiology in epileptic encephalopathy has been supported by recent studies such as array comparative genomic hybridization, targeted next generation sequencing panels, whole exome and whole genome sequencing. These studies report a diagnostic yield up to 70%, depending on the applied genetic testing as well as number of patients enrolled. In patients with epileptic encephalopathy, a stepwise approach for diagnostic work-up will help to diagnose treatable inherited metabolic disorders quickly. Application of detailed genetic investigations such as targeted next generation sequencing as second line and whole exome sequencing as third line testing will diagnose underlying genetic disease which will help for genetic counseling as well as guide for prenatal diagnosis. Knowledge of underlying genetic cause will provide novel insights into the pathogenesis of epileptic encephalopathy and pave the ground towards the development of targeted neuroprotective treatment strategies to improve the health outcome of children with epileptic encephalopathy.

The SARE tool for rabies control: Current experience in Ethiopia.

PubMed

Coetzer, A; Kidane, A H; Bekele, M; Hundera, A D; Pieracci, E G; Shiferaw, M L; Wallace, R; Nel, L H

2016-11-01

The Stepwise Approach towards Rabies Elimination (SARE) tool was developed through a joint effort of the Food and Agriculture Organization (FAO) of the United Nations and the Global Alliance for Rabies Control (GARC), to provide a standard mechanism for countries to assess their rabies situation and measure progress in eliminating the disease. Because the African continent has the highest per capita death rate from rabies, and Ethiopia is estimated to have the second largest number of rabies deaths of all African countries, Ethiopia undertook a self-assessment by means of the Stepwise Approach towards Rabies Elimination (SARE) tool. In February 2016, the Ethiopian government hosted an intersectoral consultative meeting in an effort to assess the progress that has been made towards the control and elimination of canine rabies. The SARE assessment identified a number of critical gaps, including poor inter-sectoral collaboration and limited availability and access to dog vaccine, while the existence of a surveillance system for rabies and legislation for outbreak declaration and response were among the strengths identified. The SARE tool enabled key criteria to be prioritized, thereby accelerating the National Strategy and ensuring that Ethiopia will progress rapidly in line with the goals set by the global community for the elimination of human rabies deaths by 2030. Although the analysis showed that Ethiopia is still in the early stages of rabies control (Stage 0.5/5), the country shows great promise in terms of developing a SARE-guided National Rabies Prevention and Control Strategy. Copyright © 2016 Elsevier B.V. All rights reserved.

Cationic gemini surfactant-assisted synthesis of hollow Au nanostructures by stepwise reductions.

PubMed

Wang, Wentao; Han, Yuchun; Tian, Maozhang; Fan, Yaxun; Tang, Yongqiang; Gao, Mingyuan; Wang, Yilin

2013-06-26

A novel synthetic approach was developed for creating versatile hollow Au nanostructures by stepwise reductions of Au(III) upon the use of cationic gemini surfactant hexamethylene-1,6-bis(dodecyl dimethylammonium bromide) (C12C6C12Br2) as a template agent. It was observed that the Au(I) ions obtained from the reduction of Au(III) by ascorbic acid can assist the gemini surfactant to form vesicles, capsule-like, and tube-like aggregates that subsequently act as soft templates for hollow Au nanostructures upon further reduction of Au(I) to Au(0) by NaBH4. It was demonstrated that the combination of C12C6C12Br2 and Au(I) plays a key role in regulating the structure of the hollow precursors not only because C12C6C12Br2 has a stronger aggregation ability in comparison with its single chain counterpart but also because the electrostatic repulsion between head groups of C12C6C12Br2 is greatly weakened after Au(III) is converted to Au(I), which is in favor of the construction of vesicles, capsule-like, and tube-like aggregates. Compared with solid Au nanospheres, the resultant hollow nanostructures exhibit enhanced electrocatalytic activities in methanol oxidation, following the order of elongated nanocapsule > nanocapsule > nanosphere. Benefiting from balanced interactions between the gemini surfactant and Au(I), this soft-template method may present a facile and versatile approach for the controlled synthesis of Au nanostructures potentially useful for fuel cells and other Au nanodevices.

A stepwise procedure for science communication in the field

NASA Astrophysics Data System (ADS)

Nisancioglu, Kerim; Paasche, Øyvind

2017-04-01

Communicating and disseminating earth science to laypersons, high-school students and their teachers are becoming increasingly important considering the overwhelming impact human civilization have on the planet. One of the main challenges with this type of dissemination arises from the cross-disciplinary nature of the Earth system as it encompasses anything from cloud physics to the geological evidence of ice ages being played out on millennial time scales. During the last four years we have tested and developed an approach referred to as «Turspor» which can be translated to 'Trail Tracks'. The ambition with "Turspor" is to inspire participants to seek in-depth knowledge relating to observations of features made in the field (glacial moraines, active permafrost, clouds, winds and so forth) as we have come to learn that observations made in the field enhances students capability to grasp the bare essentials related to the phenomena in question. By engaging master and PhD students in the process we create a platform where students can improve their teaching and communicative skills through a stepwise procedure. The initial concept was tested on 35 high school students during the summer of 2012 in the mountainous area of Snøheim on Dovre, Southern Norway. Before the arrival of the high school students, the university students prepared one page written summaries describing relevant geological or meteorological features and trained on how to best disseminate a basic scientific understanding of these. Specific examples were patterned ground caused by permafrost, glacier flour, katabatic winds, and equilibrium line altitude of glaciers. Based on the success of the program over the past 4 years with field trips together with local schools, we are in the process of developing the concept to be offered as a course at the master and PhD level, including a week of training in didactics applied to topics in the geosciences as well as practical training in the field. The university students who complete the course will be in charge of guiding local high school students in the field (mostly at university field stations in the mountains of Norway), as well as follow up on the topics discussed in collaboration with the high-school teachers during a subsequent visit to the classroom. By participating in the program, high-school students will experience inquiry-based learning, adding to their understanding of the scientific process. Sites developed through this program so far have been documented with a GPS tag, detailed description, background and pictures and hosted by the Norwegian Trekking Association website: ut.no as well as an associated app. The stepwise procedure of this concept has been developed through continous interaction with teachers, students and the general public. As a consequence, our capability to address and explain many earth science features of large societal relevance such as glacier retreat, thawing permafrost, flooding, snow avalanches, vegetation dynamics and climate change in general has been greatly improved. For examples see https://www.ut.no/gruppe/8.1819/

Teaching ethics to engineers: ethical decision making parallels the engineering design process.

PubMed

Bero, Bridget; Kuhlman, Alana

2011-09-01

In order to fulfill ABET requirements, Northern Arizona University's Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to "grey" or multiple possible solution technical problems. To identify and solve these problems, the engineering design process is used. Ethical problems are also "grey" problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue.

Improved separation and size characterization of gold nanoparticles through a novel capillary zone electrophoresis method using poly(sodium4-styrenesulfonate) as stabiliser and a stepwise field strength gradient.

PubMed

Ciriello, Rosanna; Iallorenzi, Pina Teresa; Laurita, Alessandro; Guerrieri, Antonio

2017-03-01

A novel capillary zone electrophoresis (CZE) method was developed for an improved separation and size characterization of pristine gold nanoparticles (AuNP) using uncoated fused-silica capillaries with UV-Vis detection at 520 nm. To avoid colloid aggregation and/or adsorption during runs, poly(sodium 4-styrenesulfonate) (PSS) was added (1%, w/v) in the running buffer (CAPS 10 mM, pH 11). This polyelectrolyte conferred an enhanced stabilization to AuNP, both steric and electrostatic, exalting at the same time their differences in electrophoretic mobility. Resolution was further and successfully improved through a stepwise field strength gradient by the application of 25 kV for the first 5 min and then 10 kV. Migration times varied linearly with particles diameters showing relative standard deviations better than 1% for daily experiments and 3% for interday experiments. A comparison with the size distribution obtained by transmission electron microscopy (TEM) allowed assessing that the electrophoretic profile can reasonably be considered as representative of the effective size heterogeneity of each colloid. Finally, the practical utility of the proposed method was demonstrated by measuring the core diameter of a gold colloid sample produced by chemical synthesis which was in good agreement with the value obtained by TEM measurements. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Comparison of three portable instruments to measure compression pressure.

PubMed

Partsch, H; Mosti, G

2010-10-01

Measurement of interface pressure between the skin and a compression device has gained practical importance not only for characterizing the efficacy of different compression products in physiological and clinical studies but also for the training of medical staff. A newly developed portable pneumatic pressure transducer (Picopress®) was compared with two established systems (Kikuhime® and SIGaT tester®) measuring linearity, variability and accuracy on a cylindrical model using a stepwise inflated sphygmomanometer as the reference. In addition the variation coefficients were measured by applying the transducers repeatedly under a blood pressure cuff on the distal lower leg of a healthy human subject with stepwise inflation. In the pressure range between 10 and 80 mmHg all three devices showed a linear association compared with the sphygmomanometer values (Pearson r>0.99). The best reproducibility (variation coefficients between 1.05-7.4%) and the highest degree of accuracy demonstrated by Bland-Altman plots was achieved with the Picopress® transducer. Repeated measurements of pressure in a human leg revealed average variation coefficients for the three devices of 4.17% (Kikuhime®), 8.52% (SIGaT®) and 2.79% (Picopress®). The results suggest that the Picopress® transducer, which also allows dynamic pressure tracing in connection with a software program and which may be left under a bandage for several days, is a reliable instrument for measuring the pressure under a compression device.

A feasible strategy to balance the crystallinity and specific surface area of metal oxide nanocrystals

NASA Astrophysics Data System (ADS)

Zhang, Q. P.; Xu, X. N.; Liu, Y. T.; Xu, M.; Deng, S. H.; Chen, Y.; Yuan, H.; Yu, F.; Huang, Y.; Zhao, K.; Xu, S.; Xiong, G.

2017-04-01

Practical, efficient synthesis of metal oxide nanocrystals with good crystallinity and high specific surface area by a modified polymer-network gel method is demonstrated, taking ZnO nanocrystals as an example. A novel stepwise heat treatment yields significant improvement in crystal quality. Such nanophase materials can effectively degrade common organic dyes under solar radiation and can perform very well in photo-assisted detection of NO2 gas. Other typical metal oxide nanocrystals with good crystallinity and high specific surface area were also synthesized successfully under similar conditions. This work provides a general strategy for the synthesis of metal oxide nanocrystals, balancing the crystallinity and specific surface area.

Infrared laser driven double proton transfer. An optimal control theory study

NASA Astrophysics Data System (ADS)

Abdel-Latif, Mahmoud K.; Kühn, Oliver

2010-02-01

Laser control of ultrafast double proton transfer is investigated for a two-dimensional model system describing stepwise and concerted transfer pathways. The pulse design has been done by employing optimal control theory in combination with the multiconfiguration time-dependent Hartree wave packet propagation. The obtained laser fields correspond to multiple pump-dump pulse sequences. Special emphasis is paid to the relative importance of stepwise and concerted transfer pathways for the driven wave packet and its dependence on the parameters of the model Hamiltonian as well as on the propagation time. While stepwise transfer is dominating in all cases considered, for high barrier systems concerted transfer proceeding via tunneling can make a contribution.

Response time of mitochondrial oxygen consumption following stepwise changes in cardiac energy demand.

PubMed

van Beek, J H; Westerhof, N

1990-01-01

We determined the speed with which mitochondrial oxygen consumption and therefore the mitochondrial ATP-synthesis adapted to changes in metabolic demand in the rabbit heart. This was done by measuring the oxygen uptake of the whole heart during a stepwise change in heart rate and correcting for the time taken by diffusion and by convective transport in the blood vessels. Data for the correction for transport time were obtained from the response of venous oxygen concentration to a stepwise change of arterial oxygen concentration. The time constant of the response of mitochondrial oxygen consumption to a step change in heart rate was found to be 4-8 s.

Impact of euthanasia rates, euthanasia practices, and human resource practices on employee turnover in animal shelters.

PubMed

Rogelberg, Steven G; Reeve, Charlie L; Spitzmüller, Christiane; DiGiacomo, Natalie; Clark, Olga L; Teeter, Lisa; Walker, Alan G; Starling, Paula G; Carter, Nathan T

2007-03-01

To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. Cross-sectional original study. 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations.

SPIRIT: Systematic Planning of Intelligent Reuse of Integrated Clinical Routine Data. A Conceptual Best-practice Framework and Procedure Model.

PubMed

Hackl, W O; Ammenwerth, E

2016-01-01

Secondary use of clinical routine data is receiving an increasing amount of attention in biomedicine and healthcare. However, building and analysing integrated clinical routine data repositories are nontrivial, challenging tasks. As in most evolving fields, recognized standards, well-proven methodological frameworks, or accurately described best-practice approaches for the systematic planning of solutions for secondary use of routine medical record data are missing. We propose a conceptual best-practice framework and procedure model for the systematic planning of intelligent reuse of integrated clinical routine data (SPIRIT). SPIRIT was developed based on a broad literature overview and further refined in two case studies with different kinds of clinical routine data, including process-oriented nursing data from a large hospital group and high-volume multimodal clinical data from a neurologic intensive care unit. SPIRIT aims at tailoring secondary use solutions to specific needs of single departments without losing sight of the institution as a whole. It provides a general conceptual best-practice framework consisting of three parts: First, a secondary use strategy for the whole organization is determined. Second, comprehensive analyses are conducted from two different viewpoints to define the requirements regarding a clinical routine data reuse solution at the system level from the data perspective (BOTTOM UP) and at the strategic level from the future users perspective (TOP DOWN). An obligatory clinical context analysis (IN BETWEEN) facilitates refinement, combination, and integration of the different requirements. The third part of SPIRIT is dedicated to implementation, which comprises design and realization of clinical data integration and management as well as data analysis solutions. The SPIRIT framework is intended to be used to systematically plan the intelligent reuse of clinical routine data for multiple purposes, which often was not intended when the primary clinical documentation systems were implemented. SPIRIT helps to overcome this gap. It can be applied in healthcare institutions of any size or specialization and allows a stepwise setup and evolution of holistic clinical routine data reuse solutions.

An Efficient Microarray-Based Genotyping Platform for the Identification of Drug-Resistance Mutations in Majority and Minority Subpopulations of HIV-1 Quasispecies.

PubMed

Martín, Verónica; Perales, Celia; Fernández-Algar, María; Dos Santos, Helena G; Garrido, Patricia; Pernas, María; Parro, Víctor; Moreno, Miguel; García-Pérez, Javier; Alcamí, José; Torán, José Luis; Abia, David; Domingo, Esteban; Briones, Carlos

2016-01-01

The response of human immunodeficiency virus type 1 (HIV-1) quasispecies to antiretroviral therapy is influenced by the ensemble of mutants that composes the evolving population. Low-abundance subpopulations within HIV-1 quasispecies may determine the viral response to the administered drug combinations. However, routine sequencing assays available to clinical laboratories do not recognize HIV-1 minority variants representing less than 25% of the population. Although several alternative and more sensitive genotyping techniques have been developed, including next-generation sequencing (NGS) methods, they are usually very time consuming, expensive and require highly trained personnel, thus becoming unrealistic approaches in daily clinical practice. Here we describe the development and testing of a HIV-1 genotyping DNA microarray that detects and quantifies, in majority and minority viral subpopulations, relevant mutations and amino acid insertions in 42 codons of the pol gene associated with drug- and multidrug-resistance to protease (PR) and reverse transcriptase (RT) inhibitors. A customized bioinformatics protocol has been implemented to analyze the microarray hybridization data by including a new normalization procedure and a stepwise filtering algorithm, which resulted in the highly accurate (96.33%) detection of positive/negative signals. This microarray has been tested with 57 subtype B HIV-1 clinical samples extracted from multi-treated patients, showing an overall identification of 95.53% and 89.24% of the queried PR and RT codons, respectively, and enough sensitivity to detect minority subpopulations representing as low as 5-10% of the total quasispecies. The developed genotyping platform represents an efficient diagnostic and prognostic tool useful to personalize antiviral treatments in clinical practice.

Learning science with ICT - Developing a pedagogy of successful practice

NASA Astrophysics Data System (ADS)

Rogers, Laurence Trevelyan

The oeuvre which I present spans a period of time during which the use of ICT in science education has been transformed from a technical teaching aid into a major genre of activity on a national and international scale. My contribution to this change has been as a researcher, teacher trainer, software author and electronics designer. Such a combination of roles has made my approach multidisciplinary, creating a unique partnership between research, pedagogy and technical development. The fruits of my work have influenced practice directly in science departments in secondary schools through the publication of articles, chapters and a book, and especially through the dissemination of original curriculum materials, hardware tools and the Insight suite of software. Embedded in these tools are my understandings of the new context for learning science, rooted in constructivism and derived from professional experience, classroom research studies and research literature. My aim throughout has been to promote ideas which will help the science education community gain a vision of the full potential of ICT. It will be shown that my activities in each of three strands, research, literature study and curriculum development, have been interconnected at many stages such that advances in one strand have prompted progress in another in a stepwise fashion. Thus, my curriculum developments have provided the tools for study, my evaluative field research has provided insights for refining the tools and of new opportunities for their use, research literature has deepened my understanding of the issues and has identified criteria for the design of the curriculum tools and for research methodology. In total, this process itself has exemplified a constructivist development and is reflected in the portfolio items which begin with practitioner articles and graduate to papers linking research findings to theoretical arguments.

Reactivity of Household Oxygen Bleaches: A Stepwise Laboratory Exercise in High School Chemistry Course

ERIC Educational Resources Information Center

Nakano, Masayoshi; Ogasawara, Haruka; Wada, Takeshi; Koga, Nobuyoshi

2016-01-01

This paper reports on a learning program designed for high school chemistry classes that involves laboratory exercises using household oxygen bleaches. In this program, students are taught the chemistry of oxygen bleaches through a stepwise inquiry using laboratory exercises organized with different pedagogical intents. Through comparative…

The concern of emergence of multi-station reaction pathways that might make stepwise the mechanism of the 1,3-dipolar cycloadditions of azides and alkynes

NASA Astrophysics Data System (ADS)

Mohtat, Bita; Siadati, Seyyed Amir; Khalilzadeh, Mohammad Ali; Zareyee, Daryoush

2018-03-01

After hot debates on the concerted or stepwise nature of the mechanism of the catalyst-free 1,3-dipolar cycloadditions (DC)s, nowadays, it is being believed that for the reaction of each dipole and dipolarophile, there is a possibility that the reaction mechanism becomes stepwise, intermediates emerge, and the reaction becomes non-stereospecific. Yield of even minimal amounts of unwanted side products or stereoisomers as impurities could bring many troubles like difficult purification steps. In this project, we have made attempts to study all probable reaction channels of the azide cycloadditions with two functionalized alkynes, in order to answer this question: "is there any possibility that intermediates evolve in the catalyst-free click 1,3-DC reaction of azide-alkynes?". During the calculations, several multi-station reaction pathways supporting the stepwise and concerted mechanisms were detected. Also, the born-oppenheimer molecular dynamic (BOMD) simulation was used to find trustable geometries which could be emerged during the reaction coordinate.

A national EHR strategy preparedness characterisation model and its application in the South-East European region.

PubMed

Orfanidis, Leonidas; Bamidis, Panagiotis; Eaglestone, Barry

2006-01-01

This paper is concerned with modelling national approaches towards electronic health record systems (NEHRS) development. A model framework is stepwise produced, that allows for the characterisation of the preparedness and the readiness of a country to develop an NEHRS. Secondary data of published reports are considered for the creation of the model. Such sources are identified to mostly originate from within a sample of five developed countries. Factors arising from these sources are identified, coded and scaled, so as to allow for a quantitative application of the model. Instantiation of the latter for the case of the five developed countries is contrasted with the set of countries from South East Europe (SEE). The likely importance and validity of this modelling approach is discussed, using the Delphi method.

Theoretical study on the reaction mechanism of hydrogenation of furfural to furfuryl alcohol on Lewis acidic BEA zeolites: effects of defect structure and tetravalent metals substitution.

PubMed

Injongkol, Yuwanda; Maihom, Thana; Treesukul, Piti; Sirijaraensre, Jakkapan; Boekfa, Bundet; Limtrakul, Jumras

2017-09-13

Furfural acquired from agricultural sources is receiving extensive attention in the petrochemical industry as it offers an alternative route to generate more valuable hydrocarbon compounds. Herein, we investigate the furfural hydrogenation to furfuryl alcohol catalyzed by Lewis acidic BEA zeolites at the molecular level by means of the M06-L density functional theory. The mechanistic pictures in the catalytic procedure are revealed. The possible reaction pathways are considered to proceed via either concerted or stepwise mechanisms. With the contribution of zeolite oxygen bridging for the H-H splitting, the rate determining step activation barrier for the stepwise mechanism is 14.7 kcal mol -1 lower than that for the concerted mechanism. The stepwise reaction therefore seems to be favored compared to the concerted one. The catalytic effect of the defect zeolite framework on the stepwise mechanism is also investigated. The activation energy for the stepwise rate-determining step over this site is significantly lower than the corresponding step over the perfect one by 14.1 kcal mol -1 . Finally, the catalytic activity of tetravalent metal centers (Sn, Ge, Zr and Hf) substituted in BEA is also preliminarily compared and it is found to follow the order of Hf > Zr > Sn > Ge based on activation energies and the reaction rate. The difference in the activation energy can be traced back to the difference in the charge transfer from the catalytic site to the adsorbed molecules.

Controlled breathing protocols probe human autonomic cardiovascular rhythms

NASA Technical Reports Server (NTRS)

Cooke, W. H.; Cox, J. F.; Diedrich, A. M.; Taylor, J. A.; Beightol, L. A.; Ames, J. E. 4th; Hoag, J. B.; Seidel, H.; Eckberg, D. L.

1998-01-01

The purpose of this study was to determine how breathing protocols requiring varying degrees of control affect cardiovascular dynamics. We measured inspiratory volume, end-tidal CO2, R-R interval, and arterial pressure spectral power in 10 volunteers who followed the following 5 breathing protocols: 1) uncontrolled breathing for 5 min; 2) stepwise frequency breathing (at 0.3, 0.25, 0.2, 0.15, 0.1, and 0.05 Hz for 2 min each); 3) stepwise frequency breathing as above, but with prescribed tidal volumes; 4) random-frequency breathing (approximately 0.5-0.05 Hz) for 6 min; and 5) fixed-frequency breathing (0.25 Hz) for 5 min. During stepwise breathing, R-R interval and arterial pressure spectral power increased as breathing frequency decreased. Control of inspired volume reduced R-R interval spectral power during 0.1 Hz breathing (P < 0.05). Stepwise and random-breathing protocols yielded comparable coherence and transfer functions between respiration and R-R intervals and systolic pressure and R-R intervals. Random- and fixed-frequency breathing reduced end-tidal CO2 modestly (P < 0.05). Our data suggest that stringent tidal volume control attenuates low-frequency R-R interval oscillations and that fixed- and random-rate breathing may decrease CO2 chemoreceptor stimulation. We conclude that autonomic rhythms measured during different breathing protocols have much in common but that a stepwise protocol without stringent control of inspired volume may allow for the most efficient assessment of short-term respiratory-mediated autonomic oscillations.

Parenting practices are associated with fruit and vegetable consumption in pre-school children

PubMed Central

O’Connor, Teresia M; Hughes, Sheryl O; Watson, Kathy B; Baranowski, Tom; Nicklas, Theresa A; Fisher, Jennie O; Beltran, Alicia; Baranowski, Janice C; Qu, Haiyan; Shewchuk, Richard M

2009-01-01

Objective Parents may influence children’s fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children. Design An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004–5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children’s consumption of F&V, after controlling for potential confounding factors. Results A three-cluster solution provided the best fit (R2 = 0 62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments’ practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized β = 0·09, P < 0·1; final model R2 = 0·17) after controlling for confounders, including parental feeding styles. Conclusions Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children’s F&V intake. PMID:19490734

A stepwise protocol for the treatment of refractory gastroesophageal reflux-induced chronic cough

PubMed Central

Xu, Xianghuai; Lv, Hanjing; Yu, Li; Chen, Qiang; Liang, Siwei

2016-01-01

Background Refractory gastroesophageal reflux-induced chronic cough (GERC) is difficult to manage. The purpose of the study is to evaluate the efficacy of a novel stepwise protocol for treating this condition. Methods A total of 103 consecutive patients with suspected refractory reflux-induced chronic cough failing to a standard anti-reflux therapy were treated with a stepwise therapy. Treatment commences with high-dose omeprazole and, if necessary, is escalated to subsequent sequential treatment with ranitidine and finally baclofen. The primary end-point was overall cough resolution, and the secondary end-point was cough resolution after each treatment step. Results High-dose omeprazole eliminated or improved cough in 28.1% of patients (n=29). Further stepwise of treatment with the addition of ranitide yielded a favorable response in an additional 12.6% (n=13) of patients, and subsequent escalation to baclofen provoked response in another 36.9% (n=38) of patients. Overall, this stepwise protocol was successful in 77.6% (n=80) of patients. The diurnal cough symptom score fell from 3 [1] to 1 [0] (Z=6.316, P=0.000), and the nocturnal cough symptom score decreased from 1 [1] to 0 [1] (Z=–4.511, P=0.000), with a corresponding reduction in the Gastroesophageal Reflux Diagnostic Questionnaire score from 8.6±1.7 to 6.8±0.7 (t=3.612, P=0.000). Conversely, the cough threshold C2 to capsaicin was increased from 0.49 (0.49) µmol/L to 1.95 (2.92) µmol/L (Z=–5.892, P=0.000), and the cough threshold C5 was increased from 1.95 (2.92) µmol/L to 7.8 (5.85) µmol/L (Z=–5.171, P=0.000). Conclusions Sequential stepwise anti-reflux therapy is a useful therapeutic strategy for refractory reflux-induced chronic cough. PMID:26904227

Do 360-degree feedback survey results relate to patient satisfaction measures?

PubMed

Hageman, Michiel G J S; Ring, David C; Gregory, Paul J; Rubash, Harry E; Harmon, Larry

2015-05-01

There is evidence that feedback from 360-degree surveys-combined with coaching-can improve physician team performance and quality of patient care. The Physicians Universal Leadership-Teamwork Skills Education (PULSE) 360 is one such survey tool that is used to assess work colleagues' and coworkers' perceptions of a physician's leadership, teamwork, and clinical practice style. The Clinician & Group-Consumer Assessment of Healthcare Providers and System (CG-CAHPS), developed by the US Department of Health and Human Services to serve as the benchmark for quality health care, is a survey tool for patients to provide feedback that is based on their recent experiences with staff and clinicians and soon will be tied to Medicare-based compensation of participating physicians. Prior research has indicated that patients and coworkers often agree in their assessment of physicians' behavioral patterns. The goal of the current study was to determine whether 360-degree, also called multisource, feedback provided by coworkers could predict patient satisfaction/experience ratings. A significant relationship between these two forms of feedback could enable physicians to take a more proactive approach to reinforce their strengths and identify any improvement opportunities in their patient interactions by reviewing feedback from team members. An automated 360-degree software process may be a faster, simpler, and less resource-intensive approach than telephoning and interviewing patients for survey responses, and it potentially could facilitate a more rapid credentialing or quality improvement process leading to greater fiscal and professional development gains for physicians. Our primary research question was to determine if PULSE 360 coworkers' ratings correlate with CG-CAHPS patients' ratings of overall satisfaction, recommendation of the physician, surgeon respect, and clarity of the surgeon's explanation. Our secondary research questions were to determine whether CG-CAHPS scores correlate with additional composite scores from the Quality PULSE 360 (eg, insight impact score, focus concerns score, leadership-teamwork index score, etc). We retrospectively analyzed existing quality improvement data from CG-CAHPS patient surveys as well as from a department quality improvement initiative using 360-degree survey feedback questionnaires (Quality PULSE 360 with coworkers). Bivariate analyses were conducted to identify significant relationships for inclusion of research variables in multivariate linear analyses (eg, stepwise regression to determine the best fitting predictive model for CG-CAHPS ratings). In all higher order analyses, CG-CAHPS ratings were treated as the dependent variables, whereas PULSE 360 scores served as independent variables. This approach led to the identification of the most predictive linear model for each CG-CAHPS' performance rating (eg, [1] overall satisfaction; [2] recommendation of the physician; [3] surgeon respect; and [4] clarity of the surgeon's explanation) regressed on all PULSE scores with which there was a significant bivariate relationship. Backward stepwise regression was then used to remove unnecessary predictors from the linear model based on changes in the variance explained by the model with or without inclusion of the predictor. The Quality PULSE 360 insight impact score correlated with patient satisfaction (0.50, p = 0.01), patient recommendation (0.58, p = 0.002), patient rating of surgeon respect (0.74, p < 0.001), and patient impression of clarity of the physician explanation (0.69, p < 0.001). Additionally, leadership-teamwork index also correlated with patient rating of surgeon respect (0.46, p = 0.019) and patient impression of clarity of the surgeon's explanation (0.39, p = 0.05). Multivariate analyses supported retention of insight impact as a predictor of patient overall satisfaction, patient recommendation of the surgeon, and patient rating of surgeon respect. Both insight impact and leadership-teamwork index were retained as predictors of patient impression of explanation. Several other PULSE 360 variables were correlated with CG-CAHPS ratings, but none were retained in the linear models post stepwise regression. The relationship between Quality PULSE 360 feedback scores and measures of patient satisfaction reaffirm that feedback from work team members may provide helpful information into how patients may be perceiving their physicians' behavior and vice versa. Furthermore, the findings provide tentative support for the use of team-based feedback to improve the quality of relationships with both coworkers and patients. The 360-degree survey process may offer an effective tool for physicians to obtain feedback about behavior that could directly impact practice reimbursement and reputation or potentially be used for bonuses to incentivize better team professionalism and patient satisfaction, ie, "pay-for-professionalism." Further research is needed to expand on this line of inquiry, determine which interventions can improve 360-degree and patient satisfaction scores, and explain the shared variance in physician performance that is captured in the perceptions of patients and coworkers.

[Rapid analysis of biocompatibility with graded test samples exemplified by Ni-NiTi-Ti].

PubMed

Bogdanski, D; Köller, M; Bram, M; Stöver, D; Buchkremer, H P; Choi, J; Epple, M; Muhr, G

2002-01-01

The biocompatibility of nickel-titanium alloys was investigated by single-culture experiments on functionally graded samples with a stepwise change in composition from nickel to titanium, including NiTi shape memory alloy of a 50:50 mixture. This approach permitted a considerable decrease of experimental resources by simultaneously studying a full variation of composition. The results indicate a good biocompatibility for a nickel content up to about 50%. The cells used in the biocompatibility studies comprised human osteoblast-like osteosarcoma cells (SAOS-2, MG-63), primary human osteoblasts (HOB), and murine fibroblasts (3T3).

InGaP/GaAs Inverted Dual Junction Solar Cells For CPV Applications Using Metal-Backed Epitaxial Lift-Off

NASA Astrophysics Data System (ADS)

Bauhuis, Gerard J.; Mulder, Peter; Haverkamp, Erik J.; Schermer, John J.; Nash, Lee J.; Fulgoni, Dominic J. F.; Ballard, Ian M.; Duggan, Geoffrey

2010-10-01

The epitaxial lift-off (ELO) technique has been combined with inverted III-V PV cell epitaxial growth with the aim of employing thin film PV cells in HCPV systems. In a stepwise approach to the realization of an inverted triple junction on a MELO platform we have first grown a GaAs single junction PV cell to establish the basic layer release process and cell processing steps followed by the growth, fabrication and test of an inverted InGaP/GaAs dual junction structure.

Gynecomastia: pathophysiology, evaluation, and management.

PubMed

Johnson, Ruth E; Murad, M Hassan

2009-11-01

Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Although a fairly common presentation in the primary care setting and mostly of benign etiology, it can cause patients considerable anxiety. The initial step is to rule out pseudogynecomastia by careful history taking and physical examination. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies may facilitate cost-effective diagnosis. If results of all studies are normal, idiopathic gynecomastia is diagnosed. The evidence in this area is mainly of observational nature and lower quality.

National Institutes of Health addresses the science of diversity

PubMed Central

Valantine, Hannah A.; Collins, Francis S.

2015-01-01

The US biomedical research workforce does not currently mirror the nation’s population demographically, despite numerous attempts to increase diversity. This imbalance is limiting the promise of our biomedical enterprise for building knowledge and improving the nation’s health. Beyond ensuring fairness in scientific workforce representation, recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation. The complexity inherent in diversifying the research workforce underscores the need for a rigorous scientific approach, consistent with the ways we address the challenges of science discovery and translation to human health. Herein, we identify four cross-cutting diversity challenges ripe for scientific exploration and opportunity: research evidence for diversity’s impact on the quality and outputs of science; evidence-based approaches to recruitment and training; individual and institutional barriers to workforce diversity; and a national strategy for eliminating barriers to career transition, with scientifically based approaches for scaling and dissemination. Evidence-based data for each of these challenges should provide an integrated, stepwise approach to programs that enhance diversity rapidly within the biomedical research workforce. PMID:26392553

National Institutes of Health addresses the science of diversity.

PubMed

Valantine, Hannah A; Collins, Francis S

2015-10-06

The US biomedical research workforce does not currently mirror the nation's population demographically, despite numerous attempts to increase diversity. This imbalance is limiting the promise of our biomedical enterprise for building knowledge and improving the nation's health. Beyond ensuring fairness in scientific workforce representation, recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation. The complexity inherent in diversifying the research workforce underscores the need for a rigorous scientific approach, consistent with the ways we address the challenges of science discovery and translation to human health. Herein, we identify four cross-cutting diversity challenges ripe for scientific exploration and opportunity: research evidence for diversity's impact on the quality and outputs of science; evidence-based approaches to recruitment and training; individual and institutional barriers to workforce diversity; and a national strategy for eliminating barriers to career transition, with scientifically based approaches for scaling and dissemination. Evidence-based data for each of these challenges should provide an integrated, stepwise approach to programs that enhance diversity rapidly within the biomedical research workforce.

Registered Dietitian Nutritionists' Perspectives on Integrating Food and Water System Issues into Professional Practice.

PubMed

Heidelberger, Lindsay; Smith, Chery; Robinson-O'Brien, Ramona; Earthman, Carrie; Robien, Kim

2017-02-01

Sustainable agriculture encompasses economic, environmental, and social aspects of the food system. Members of the Academy of Nutrition and Dietetics (Academy) play an important role in promoting sustainable agriculture because they work in areas where they can influence the food purchasing decisions of foodservice operations and the public. To investigate behavior of registered dietitian nutritionists (RDNs) toward incorporating sustainable agriculture principles into professional practice using the Theory of Planned Behavior. This cross-sectional study surveyed RDNs nationwide about their perspectives on incorporating sustainable agriculture issues into practice. The survey questions were based on a survey originally administered to Minnesota RDNs during 2002. The sample (N=626) was drawn from a randomly selected, national sample of Academy members. Data were analyzed using descriptive statistics, independent t tests, Pearson correlations, and stepwise regression. The sample was mostly white, female, and the average age was 45.4±12.2 years. Almost half of Academy RDNs (47%) reported incorporating environmental issues into their practice. All four Theory of Planned Behavior variables (intention, attitude, perceived behavior control, and subjective norm) were predictive of behavior to include sustainable agriculture issues into practice. Barriers to incorporating this topic into practice included lack of knowledge, ability, time, and employer support. This study found that most of the RDN respondents had heard of sustainable agriculture and nearly half reported including this topic in their professional practice. To integrate this topic into practice more consistently, RDNs need more knowledge, time, and employer support. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Targeting factors for change: contraceptive counselling and care of female adolescents.

PubMed

Bitzer, Johannes; Abalos, Virginia; Apter, Dan; Martin, Ricardo; Black, Amanda

2016-12-01

Sexual and reproductive health care should empower and enable all individuals to have a sex life that is as safe and pleasurable as possible. Achievement of this goal for adolescents is often impeded by regional and sociocultural barriers. To review global barriers to provision of effective counselling and care of adolescents seeking advice on contraception and sexual and reproductive health and identify elements of best practice that can be adapted to meet their needs at regional level. Experts with clinical experience and a scholarly background in the provision of contraceptive services to adolescents participated in a stepwise process of literature review and discussion according to the agreed objectives. The Global CARE (Contraception: Access, Resources, Education) group identified barriers to the access, availability and acceptance of contraception by adolescents, not only at the political and sociocultural level but also within health care practice. The group collected and summarized successful local strategies and tools suitable for adaptation in other regions. Elements of best practice for providing contraception regardless of setting or regional constraints, including required skills, knowledge, and attitudes, were also proposed. Sharing of evidence-based best practice in delivering contraceptive services, improvements in health care provider education, and sharing of experience between countries will hopefully help to overcome the barriers to appropriate and effective counselling and care of adolescents.

Some Considerations on the Partial Credit Model

ERIC Educational Resources Information Center

Verhelst, N. D.; Verstralen, H. H. F. M.

2008-01-01

The Partial Credit Model (PCM) is sometimes interpreted as a model for stepwise solution of polytomously scored items, where the item parameters are interpreted as difficulties of the steps. It is argued that this interpretation is not justified. A model for stepwise solution is discussed. It is shown that the PCM is suited to model sums of binary…

Stepwise Inquiry into Hard Water in a High School Chemistry Laboratory

ERIC Educational Resources Information Center

Kakisako, Mami; Nishikawa, Kazuyuki; Nakano, Masayoshi; Harada, Kana S.; Tatsuoka, Tomoyuki; Koga, Nobuyoshi

2016-01-01

This study focuses on the design of a learning program to introduce complexometric titration as a method for determining water hardness in a high school chemistry laboratory. Students are introduced to the different properties and reactions of hard water in a stepwise manner so that they gain the necessary chemical knowledge and conceptual…

A few of our favorite unconfirmed ideas

PubMed Central

2015-01-01

Medical practice is rooted in our dependence on the best available evidence from incremental scientific experimentation and rigorous clinical trials. Progress toward determining the true worth of ongoing practice or suggested innovations can be glacially slow when we insist on following the stepwise scientific pathway, and a prevailing but imperfect paradigm often proves difficult to challenge. Yet most experienced clinicians and clinical scientists harbor strong thoughts about how care could or should be improved, even if the existing evidence base is thin or lacking. One of our Future of Critical Care Medicine conference sessions encouraged sharing of novel ideas, each presented with what the speaker considers a defensible rationale. Our intent was to stimulate insightful thinking and free interchange, and perhaps to point in new directions toward lines of innovative theory and improved care of the critically ill. In what follows, a brief background outlines the rationale for each novel and deliberately provocative unconfirmed idea endorsed by the presenter. PMID:26728101

Production of Biodiesel from Acid Oil via a Two-Step Enzymatic Transesterification.

PubMed

Choi, Nakyung; Lee, Jeom-Sig; Kwak, Jieun; Lee, Junsoo; Kim, In-Hwan

2016-11-01

A two-step enzymatic transesterification process in a solvent-free system has been developed as a novel approach to the production of biodiesel using acid oil from rice bran oil soapstock. The acid oil consisted of 53.7 wt% fatty acids, 2.4 wt% monoacylglycerols, 9.1 wt% diacylglycerols, 28.8 wt% triacylglycerols, and 6.0 wt% others. Three immobilized lipases were evaluated as potential biocatalysts, including Novozym 435 from Candida antarctica, Lipozyme RM IM from Rhizomucor miehei, and Lipozyme TL IM from Thermomyces lanuginosus. The effects of molar ratio of acid oil to ethanol, temperature, and enzyme loading were investigated to determine the optimum conditions for the transesterification with the three immobilized lipases. The optimum conditions of the three immobilized lipases were a molar ratio of 1:5 (acid oil to ethanol), the temperature range of 30-40°C, and the enzyme loading range of 5-10%. The two-step transesterification was then conducted under the optimum conditions of each lipase. The stepwise use of Novozym 435 and Lipozyme TL IM or Lipozyme RM IM and Lipozyme TL IM resulted in similar or higher levels of yield to the individual lipases. The maximum yields obtained in both stepwise uses were ca. 92%.

Multielement fingerprinting as a tool in origin authentication of PGI food products: Tropea red onion.

PubMed

Furia, Emilia; Naccarato, Attilio; Sindona, Giovanni; Stabile, Gaetano; Tagarelli, Antonio

2011-08-10

Tropea red onion ( Allium cepa L. var. Tropea) is among the most highly appreciated Italian products. It is cultivated in specific areas of Calabria and, due to its characteristics, was recently awarded with the protected geographical indications (PGI) certification from the European Union. A reliable classification of onion samples in groups corresponding to "Tropea" and "non-Tropea" categories is now available to the producers. This important goal has been achieved through the evaluation of three supervised chemometric approaches. Onion samples with PGI brand (120) and onion samples not cultivated following the production regulations (80) were digested by a closed-vessel microwave oven system. ICP-MS equipped with a dynamic reaction cell was used to determine the concentrations of 25 elements (Al, Ba, Ca, Cd, Ce, Cr, Dy, Eu, Fe, Ga, Gd, Ho, La, Mg, Mn, Na, Nd, Ni, Pr, Rb, Sm, Sr, Tl, Y, and Zn). The multielement fingerprint was processed using linear discriminant analysis (LDA) (standard and stepwise), soft independent modeling of class analogy (SIMCA), and back-propagation artificial neural network (BP-ANN). The cross-validation procedure has shown good results in terms of the prediction ability for all of the chemometric models: standard LDA, 94.0%; stepwise LDA, 94.5%; SIMCA, 95.5%; and BP-ANN, 91.5%.

Stepwise Guided Photorefractive Keratectomy in Treatment of Irregular Astigmatism After Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty.

PubMed

Sorkin, Nir; Einan-Lifshitz, Adi; Abelson, Sagi; Boutin, Tanguy; Showail, Mahmood; Borovik, Armand; Ashkenazy, Zach; Chan, Clara C; Rootman, David S

2017-11-01

To report the outcome of stepwise ablation using topography-guided photorefractive keratectomy to treat irregular astigmatism after either penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK). This is a retrospective, interventional analysis including patients with irregular astigmatism after either PKP or DALK, who underwent topography-guided photorefractive keratectomy. The entire cohort was analyzed, as well as the PKP and DALK groups separately. Analysis of factors associated with a better outcome was also performed. Thirty-four eyes of 34 patients (20 PKP patients and 14 DALK patients) aged 47.4 ± 15.9 years were included. Twenty-one patients underwent more than 1 ablation. Refractive stability and a minimal period of 5 months were required before repeat ablation. The average follow-up duration was 17.0 ± 6.0 months. Corrected distance visual acuity (CDVA) improved significantly from 0.22 ± 0.14 logarithm of the minimum angle of resolution (logMAR) to 0.14 ± 0.12 logMAR at final follow-up (P = 0.035). Uncorrected distance visual acuity (UDVA) improved significantly from 0.90 ± 0.54 logMAR to 0.57 ± 0.40 logMAR at final follow-up (P = 0.004). CDVA and UDVA improved by ≥1 Snellen lines in 54.2% and 70.8% of the eyes, respectively, and by ≥3 Snellen lines in 16.7% and 54.2% of the eyes, respectively. Statistically significant improvement was seen in optical aberrometry indices (total root mean square, higher-order aberration root mean square, defocus, coma, trefoil, and spherical aberration). The difference between PKP and DALK in either CDVA (P = 0.562) or UDVA (P = 0.384) improvement was nonsignificant. The stepwise topography-guided photorefractive keratectomy approach in cases of irregular astigmatism after PKP or DALK can help improve visual acuity outcomes. Patients should be appropriately counseled that more than 1 treatment will likely be needed.

Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.

PubMed

Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet; Rubin, Susan; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, Payal; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M

2017-01-01

Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy. We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort. We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology.

PubMed

Braden, Abby; Rhee, Kyung; Peterson, Carol B; Rydell, Sarah A; Zucker, Nancy; Boutelle, Kerri

2014-09-01

Emotional eating is the tendency to eat in response to negative emotions. Prior research has identified a relationship between parenting style and child emotional eating, but this has not been examined in clinical samples. Furthermore, the relationship between specific parenting practices (e.g., parent feeding practices) and child emotional eating has not yet been investigated. The current study examined relationships between child emotional eating and both general and specific parenting constructs as well as maternal symptoms of depression and binge eating among a treatment-seeking sample of overweight children. Participants included 106 mother-child dyads who attended a baseline assessment for enrollment in a behavioral intervention for overeating. Ages of children ranged from 8 to 12  years old. Mothers completed self-report measures of their child's emotional eating behavior, their own feeding practices, and symptoms of depression and binge eating. Children completed a self-report measure of their mothers' general parenting style. A stepwise regression analysis was conducted to identify the parent variable that was most strongly related to child emotional eating, controlling for child age and gender. Emotional feeding behavior (i.e., a tendency to offer food to soothe a child's negative emotions) was the parent factor most significantly related to child emotional eating. Findings suggest that emotional feeding practices in parents may be related to emotional eating in children. Treatment with overweight children who engage in emotional eating may be improved by targeting parent feeding practices. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessment of genotoxicity of herbal medicinal products: application of the "bracketing and matrixing" concept using the example of Valerianae radix (valerian root).

PubMed

Kelber, Olaf; Wegener, Tankred; Steinhoff, Barbara; Staiger, Christiane; Wiesner, Jacqueline; Knöss, Werner; Kraft, Karin

2014-01-01

An assessment of genotoxicity is a precondition for marketing authorization respectively registration of herbal medicinal products (HMPs), as well as for inclusion into the 'Community list of herbal substances, preparations and combinations thereof for use in traditional herbal medicinal products' established by the European Commission in accordance with Directive 2001/83/EC as amended, and based on proposals from the Committee on Herbal Medicinal Products (HMPC). In the 'Guideline on the assessment of genotoxicity of herbal substances/preparations' (EMEA/HMPC/107079/2007) HMPC has described a stepwise approach for genotoxicity testing, according to which the Ames test is a sufficient base for the assessment of genotoxicity in case of an unequivocally negative result. For reducing efforts for testing of individual herbal substances/preparations, HMPC has also developed the 'guideline on selection of test materials for genotoxicity testing for traditional herbal medicinal products/herbal medicinal products' (EMEA/HMPC/67644/2009) with the aim to allow testing of a standard range of test materials which could be considered representative of the commonly used preparations from a specific herbal drug according to a 'bracketing/matrixing' approach. The purpose of this paper is to provide data on the practical application of this bracketing and matrixing concept using the example of Valerianae radix, with the intention of facilitating its inclusion in the "Community list". Five extraction solvents, representing the extremes of the polarity range and including also mid-range extraction solvents, were used, covering the entire spectrum of phytochemical constituents of Valerianae radix, thereby including polar and non-polar constituents. Extracts were tested in the Ames test according to all relevant guidelines. Results were unequivocally negative for all extracts. A review of the literature showed that this result is in accordance with the available data, thus demonstrating the lack of a genotoxic potential. In conclusion the two guidelines on genotoxicity provide a practically applicable concept. Valerianae radix has no genotoxic potential, supporting its use in HMPs and its inclusion in the Community list. Copyright © 2014 The Authors. Published by Elsevier GmbH.. All rights reserved.

Field trials of a novel toolkit for evaluating 'intangible' values-related dimensions of projects.

PubMed

Burford, Gemma; Velasco, Ismael; Janoušková, Svatava; Zahradnik, Martin; Hak, Tomas; Podger, Dimity; Piggot, Georgia; Harder, Marie K

2013-02-01

A novel toolkit has been developed, using an original approach to develop its components, for the purpose of evaluating 'soft' outcomes and processes that have previously been generally considered 'intangible': those which are specifically values based. This represents a step-wise, significant, change in provision for the assessment of values-based achievements that are of absolutely key importance to most civil society organisations (CSOs) and values-based businesses, and fills a known gap in evaluation practice. In this paper, we demonstrate the significance and rigour of the toolkit by presenting an evaluation of it in three diverse scenarios where different CSOs use it to co-evaluate locally relevant outcomes and processes to obtain results which are both meaningful to them and potentially comparable across organisations. A key strength of the toolkit is its original use of a prior generated, peer-elicited 'menu' of values-based indicators which provides a framework for user CSOs to localise. Principles of participatory, process-based and utilisation-focused evaluation are embedded in this toolkit and shown to be critical to its success, achieving high face-validity and wide applicability. The emerging contribution of this next-generation evaluation tool to other fields, such as environmental values, development and environmental sustainable development, shared values, business, education and organisational change is outlined. Copyright © 2012 Elsevier Ltd. All rights reserved.

Estimating the Mechanical Behavior of the Knee Joint during Crouch Gait: Implications for Real-Time Motor Control of Robotic Knee Orthoses

PubMed Central

Damiano, Diane L.; Bulea, Thomas C.

2016-01-01

Individuals with cerebral palsy frequently exhibit crouch gait, a pathological walking pattern characterized by excessive knee flexion. Knowledge of the knee joint moment during crouch gait is necessary for the design and control of assistive devices used for treatment. Our goal was to 1) develop statistical models to estimate knee joint moment extrema and dynamic stiffness during crouch gait, and 2) use the models to estimate the instantaneous joint moment during weight-acceptance. We retrospectively computed knee moments from 10 children with crouch gait and used stepwise linear regression to develop statistical models describing the knee moment features. The models explained at least 90% of the response value variability: peak moment in early (99%) and late (90%) stance, and dynamic stiffness of weight-acceptance flexion (94%) and extension (98%). We estimated knee extensor moment profiles from the predicted dynamic stiffness and instantaneous knee angle. This approach captured the timing and shape of the computed moment (root-mean-squared error: 2.64 Nm); including the predicted early-stance peak moment as a correction factor improved model performance (root-mean-squared error: 1.37 Nm). Our strategy provides a practical, accurate method to estimate the knee moment during crouch gait, and could be used for real-time, adaptive control of robotic orthoses. PMID:27101612

[Ligament-controlled positioning of the knee prosthesis components].

PubMed

Widmer, K-H; Zich, A

2015-04-01

There are at least two predominant goals in total knee replacement: first, the surgeon aims to achieve an optimal postoperative kinematic motion close to the patient's physiological range, and second, he aims for concurrent high ligament stability to establish pain-free movement for the entire range of motion. A number of prosthetic designs and surgical techniques have been developed in recent years to achieve both of these targets. This study presents another modified surgical procedure for total knee implantation. As in common practice the osteotomies are planned preoperatively, referencing well-defined bony landmarks, but their placement and orientation are also controlled intraoperatively in a stepwise sequence via ligamentous linkages. This method is open to all surgical approaches and can be applied for PCL-conserving or -sacrificing techniques. The anterior femoral osteotomy is carried out first, followed by the distal femoral osteotomy. Then, the extension gap is finalized by tensioning the ligaments and "top-down" referencing at the level of the tibial osteotomy, followed by finishing the flexion gap in the same way, except that the osteotomy of the posterior condyles is referenced in a "bottom-up" fashion. Hence, this technique relies on both bony and ligament-controlled procedures. Thus, it respects the modified ligamentous framework and drives the prosthetic components into the new ligamentous envelope. Further improvement may be achieved by additional control of the kinematics during surgery by applying modern computer navigation technology.

Assessment of Tooth Wear Among Glass Factory Workers: WHO 2013 Oral Health Survey.

PubMed

Chaturvedi, Pulkit; Bhat, Nagesh; Asawa, Kailash; Tak, Mridula; Bapat, Salil; Gupta, Vivek Vardhan

2015-08-01

Glass factory workers are often exposed to the hazardous environment that leads to deleterious oral health and subsequently, general health. We planned to determine the effects of the particulates present in the milieu on the tooth wear among workers. To assess tooth wear among glass factory workers in Jaipur, Rajasthan, India. A descriptive cross-sectional survey was conducted among 936 glass workers in Jaipur, Rajasthan, India from January-June 2014. A survey proforma was designed for tooth wear evaluation with the help of WHO Oral Health Assessment form 2013 (for adults). Information regarding oral health practices, adverse habits and dietary habits, demographic details was gathered and clinical parameters were recorded. The Chi-square test, t-test, One-way Analysis of Variance and a Stepwise multiple linear regression analysis. The most prevalent form of erosion was enamel erosion (589, 62.93%) with few subjects of deeper dentinal erosion and the difference was statistically significant (p=0.001). Dental erosion was found to be higher among males compared to females. Years of experience and educational status were identified as best predictors for dental erosion. It was concluded that there was considerable evidence of dental erosion found among the factory workers. Due to ignorance on social, cultural and health aspects, professional approach with regular dental care services for detection of early symptoms and planning of preventive strategies is warranted.

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

PubMed Central

Scalco, Renata S; Snoeck, Marc; Quinlivan, Ros; Treves, Susan; Laforét, Pascal; Jungbluth, Heinz; Voermans, Nicol C

2016-01-01

Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed. PMID:27900193

Culturally Adaptive Walking Intervention for Korean-Chinese Female Migrant Workers.

PubMed

Cho, Sunghye; Lee, Hyeonkyeong; Kim, Jung Hee; Lee, Meenhye; Lee, Young-Me

2017-05-01

Although the literature has commonly cited that development of culturally adaptive interventions is key to improving the health outcomes of culturally and linguistically diverse populations, there have been limited culturally adaptive walking interventions specific to Korean-Chinese (KC) migrants. The objective of this study is to describe the process in development of culturally adaptive walking interventions for KC female migrant workers, using the intervention mapping (IM) method. The culturally adaptive walking intervention was developed using the IM method, which is a stepwise theory and evidence-based approach for planning interventions. The IM method process has six steps, including needs assessment, formulation of change objectives, selection of theory-based methods and practical strategies, development of an intervention program, development of an adoption and implementation plan, and development of an evaluation design. The determinants of walking behavior, including knowledge, self-efficacy, social support, and acculturation, were identified through an extensive literature review, community leader interviews, and a survey of female KC migrant workers. Appropriate intervention methods and strategies were identified based on relevant theories. Acculturation was a determinant of exercise behavior, and various methods to improve cultural adaptation were identified in the context of the lifestyles and working environments of the target population. The IM method provided a foundation for creating a health intervention for KC female migrant workers. This method could easily be useful for health care providers working with other groups.

The effects of pure potassium channel blocker nifekalant and sodium channel blocker mexiletine on malignant ventricular tachyarrhythmias.

PubMed

Otuki, Sou; Hasegawa, Kanae; Watanabe, Hiroshi; Katsuumi, Goro; Yagihara, Nobue; Iijima, Kenichi; Sato, Akinori; Izumi, Daisuke; Furushima, Hiroshi; Chinushi, Masaomi; Aizawa, Yoshifusa; Minamino, Tohru

Patients with repetitive ventricular tachyarrhythmias - so-called electrical storm - frequently require antiarrhythmic drugs. Amiodarone is widely used for the treatment of electrical storm but is ineffective in some patients. Therefore, we investigated the efficacy of stepwise administration of nifekalant, a pure potassium channel blocker, and mexiletine for electrical storm. This study included 44 patients with repetitive ventricular tachyarrhythmias who received stepwise therapy with nifekalant and mexiletine for electrical storm. Nifekalant was initially administered, and mexiletine was subsequently added if nifekalant failed to control ventricular tachyarrhythmias. Nifekalant completely suppressed recurrences of ventricular arrhythmias in 28 patients (64%), including 6 patients in whom oral amiodarone failed to control arrhythmias. In 9 of 16 patients in whom nifekalant was partially effective but failed to suppress ventricular arrhythmias, mexiletine was added. The addition of mexiletine prevented recurrences of ventricular tachyarrhythmias in 5 of these 9 patients (56%). There was no death associated with electrical storm. In total, the stepwise treatment with nifekalant and mexiletine was effective in preventing ventricular tachyarrhythmias in 33 of 44 patients (75%). There was no difference in cycle length of the ventricular tachycardia, QRS interval, QT interval, or left ventricular ejection fraction between patients who responded to antiarrhythmic drugs and those who did not. During follow-up, 8 patients had repetitive ventricular tachyarrhythmia recurrences, and the stepwise treatment was effective in 6 of these 8 patients (75%). The stepwise treatment with nifekalant and mexiletine was highly effective in the suppression of electrical storm. Copyright © 2016. Published by Elsevier Inc.

Dairy operation management practices and herd milk production.

PubMed

Losinger, W C; Heinrichs, A J

1996-03-01

A national US survey collected data on herd milk production and management of Holstein herds. Step-wise selection identified management practices that were related to herd milk production using only operations that calculated herd milk production as well as using data from all operations. Results were similar. Milk production was highest in the West. Operations with < 100 dairy cows had lower production than did larger operations. Operations with > 25% registered cattle had higher production than operations with no registered cattle. Dairy operations that reported a mean BW > 545 kg at first calving had higher mean milk production than operations with a mean BW < or = 545 kg at first calving. Operations that reported mean age at first calving < 27 mo had higher mean milk production than operations with a mean age > or = 27 mo at first calving. In addition, use of the following management practices was associated with higher rolling herd average milk production: calves born in individual areas in buildings, calves hand-fed first colostrum, starter grain fed to preweaned calves, ionophores fed to heifers from birth to first calving, DHIA record-keeping system used, computerized records, and no new cattle introduced in the previous 12 mo.

The role of personality traits and barriers to mental health treatment seeking among college students.

PubMed

Jennings, Kristen S; Goguen, Kandice N; Britt, Thomas W; Jeffirs, Stephanie M; Wilkes, Jack R; Brady, Ashley R; Pittman, Rebecca A; DiMuzio, Danielle J

2017-11-01

Many college students experience a mental health problem yet do not seek treatment from a mental health professional. In the present study, we examined how perceived barriers (stigma perceptions, negative attitudes about treatment, and perceptions of practical barriers), as well as the Big Five personality traits, relate to treatment seeking among college students reporting a current mental health problem. The sample consisted of 261 college students, 115 of which reported experiencing a current problem. Results of a series of logistic regressions revealed that perceived stigma from others (OR = .32), self-stigma (OR = .29), negative attitudes about treatment (OR = .27), and practical barriers (OR = .34) were all associated with a lower likelihood of having sought treatment among students experiencing a problem. Of the five-factor model personality traits, only Neuroticism was associated with a higher likelihood of having sought treatment when experiencing a mental health problem (OR = 2.71). When we considered all significant predictors in a final stepwise conditional model, only self-stigma, practical barriers, and Neuroticism remained significant unique predictors. Implications for addressing barriers to treatment and encouraging treatment seeking among college students are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Monotonous and stepwise character of deformation accumulation as a hierarchically organized process under high-temperature deformation of aluminum-magnesium alloy

NASA Astrophysics Data System (ADS)

Makarov, S. V.; Plotnikov, V. A.; Lysikov, M. V.

2017-12-01

Stepwise kinetics of deformation accumulation and monotonous and pulsed acoustic emission bear witness to the active role of acoustic emission in deformation processes. A standing acoustic wave in the region of deformation localization determines the effect of self-organization of dislocations on macroscopic scales around the natural resonator of the system.

Patient safety culture in China: a case study in an outpatient setting in Beijing.

PubMed

Liu, Chaojie; Liu, Weiwei; Wang, Yuanyuan; Zhang, Zhihong; Wang, Peng

2014-07-01

To investigate the patient safety culture in an outpatient setting in Beijing and explore the meaning and implications of the safety culture from the perspective of health workers and patients. A mixed methods approach involving a questionnaire survey and in-depth interviews was adopted. Among the 410 invited staff members, 318 completed the Hospital Survey of Patient Safety Culture (HSOPC). Patient safety culture was described using 12 subscale scores. Inter-subscale correlation analysis, ANOVA and stepwise multivariate regression analyses were performed to identify the determinants of the patient safety culture scores. Interviewees included 22 patients selected through opportunity sampling and 27 staff members selected through purposive sampling. The interview data were analysed thematically. The survey respondents perceived high levels of unsafe care but had personally reported few events. Lack of 'communication openness' was identified as a major safety culture problem, and a perception of 'penalty' was the greatest barrier to the encouragement of error reporting. Cohesive 'teamwork within units', while found to be an area of strength, conversely served as a protective and defensive mechanism for medical practice. Low levels of trust between providers and consumers and lack of management support constituted an obstacle to building a positive patient safety culture. This study in China demonstrates that a punitive approach to error is still widespread despite increasing awareness of unsafe care, and managers have been slow in acknowledging the importance of building a positive patient safety culture. Strong 'teamwork within units', a common area of strength, could fuel the concealment of errors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Structure-based thresholds of toxicological concern-guidance for application to substances present at low levels in the diet

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

Renwick, A.G.

Health-based guidance values, such as the ADI, use chemical-specific data to determine the highest intake that would be without significant adverse health effects. A threshold of toxicological concern (TTC) is a level of intake predicted to be without adverse effects based on the toxicity of structurally related compounds. The main advantage of the use of TTCs is that the risk of low exposures can be evaluated without the need for chemical-specific animal toxicity data. TTCs have been used for many years for screening the safety of packaging migrants by the FDA in the USA, and of flavoring substances, by themore » JECFA. A recent reassessment of the use of TTCs, organized by ILSI Europe, has developed a decision tree which allows a systematic approach to the evaluation of low levels of diverse chemicals in food. The decision tree incorporates a series of increasing TTC values into a step-wise approach. Potentially genotoxic carcinogens are considered first, based on the presence of known structural alerts. Aflatoxin-like, azoxy- and nitroso-compounds are removed from consideration because they are the most potent, and a practical TTC could not be established. Other compounds with structural alerts for genotoxicity are allocated a TTC of 0.15 {mu}g/person per day. Compounds without structural alerts for genotoxicity are evaluated based on chemical structure and intake using a series of TTC values derived by the application of a 100-fold uncertainty factor to the 5th percentile of the distribution of NOAELs from chronic studies on compounds sharing similar structural characteristics.« less

Use of evidence-based management in healthcare administration decision-making.

PubMed

Guo, Ruiling; Berkshire, Steven D; Fulton, Lawrence V; Hermanson, Patrick M

2017-07-03

Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( r s = 0.217, n = 152, p < 0.01), attitude towards EBMgt ( r s = 0.517, n = 152, p < 0.01), and the number of organization employees ( r s = 0.195, n = 152, p = 0.016). Originality/value This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.

Deprescribing Benzodiazepines in Older Patients: Impact of Interventions Targeting Physicians, Pharmacists, and Patients.

PubMed

Ng, Brendan J; Le Couteur, David G; Hilmer, Sarah N

2018-04-28

Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome. Multiple studies have trialled interventions to deprescribe BZDs in older people and are discussed in this narrative review. Reported success rates of deprescribing BZD interventions range between 27 and 80%, and this variability can be attributed to heterogeneity of methodological approaches and limited generalisability to cognitively impaired patients. Interventions targeting the patient and/or carer include raising awareness (direct-to-consumer education, minimal interventions, and 'one-off' geriatrician counselling) and resourcing the patient (gradual dose reduction [GDR] with or without cognitive behavioural therapy, teaching relaxation techniques, and sleep hygiene). These are effective if the patient is motivated to cease and is not significantly cognitively impaired. Interventions targeted to physicians include prescribing interventions by audit, algorithm or medication review, and providing supervised GDR in combination with medication substitution. Pharmacists have less frequently been the targets for studies, but have key roles in several multifaceted interventions. Interventions are evaluated according to the Behaviour Change Wheel. Research supports trialling a stepwise approach in the cognitively intact older person, but having a low threshold to use less-consultative methods in patients with dementia. Several resources are available to support deprescribing of BZDs in clinical practice, including online protocols.

Pedagogical principles underpinning undergraduate Nurse Education in the UK: A review.

PubMed

Mackintosh-Franklin, Carolyn

2016-05-01

This review provides a contextual report of the current use of pedagogy in undergraduate nursing programmes run by Higher Education Institutes (HEIs) in the United Kingdom (UK). Pedagogy provides the framework for educators to add shape and structure to the educational process, and to support student learning and programme development. Traditionally nurse education has used a behaviourist approach focusing on learning outcomes and competency based education, although there is also increasing support for the cognitive/student learning focused pedagogic approach. The keywords andragogy, pedagogy and student centred learning were used in a systematic stepwise descriptive content analysis of the programme specifications and programme handbooks of 40 current undergraduate programme documents, leading to an undergraduate award and professional registration as a nurse. 42% (17) of documents contained reference to the words, pedagogy and student centred learning, whilst no documents used the word andragogy. Where identified, pedagogy was used in a superficial manner, with only three documents identifying a specific pedagogical philosophy: one HEI citing a value based curriculum and two HEIs referencing social constructionism. Nine HEIs made reference to student centred learning but with no additional pedagogic information. A review of teaching, learning and assessment strategies indicated no difference between the documented strategies used by HEIs when comparing those with an espoused pedagogy and those without. Although educational literature supports the use of pedagogic principles in curriculum design, this is not explicit in undergraduate nursing programme documentation, and suggests that nurse educators do not view pedagogy as important to their programmes. Instead programmes appear to be developed based on operational and functional requirements with a focus on acquisition of knowledge and skills, and the fitness to practice of graduates entering the nursing workforce. Copyright © 2016 Elsevier Ltd. All rights reserved.

A stepwise model to predict monthly streamflow

NASA Astrophysics Data System (ADS)

Mahmood Al-Juboori, Anas; Guven, Aytac

2016-12-01

In this study, a stepwise model empowered with genetic programming is developed to predict the monthly flows of Hurman River in Turkey and Diyalah and Lesser Zab Rivers in Iraq. The model divides the monthly flow data to twelve intervals representing the number of months in a year. The flow of a month, t is considered as a function of the antecedent month's flow (t - 1) and it is predicted by multiplying the antecedent monthly flow by a constant value called K. The optimum value of K is obtained by a stepwise procedure which employs Gene Expression Programming (GEP) and Nonlinear Generalized Reduced Gradient Optimization (NGRGO) as alternative to traditional nonlinear regression technique. The degree of determination and root mean squared error are used to evaluate the performance of the proposed models. The results of the proposed model are compared with the conventional Markovian and Auto Regressive Integrated Moving Average (ARIMA) models based on observed monthly flow data. The comparison results based on five different statistic measures show that the proposed stepwise model performed better than Markovian model and ARIMA model. The R2 values of the proposed model range between 0.81 and 0.92 for the three rivers in this study.

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

PubMed Central

Mannoji, Chikato; Murakami, Masazumi; Kinoshita, Tomoaki; Hirayama, Jiro; Miyashita, Tomohiro; Eguchi, Yawara; Yamazaki, Masashi; Suzuki, Takane; Aramomi, Masaaki; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Furuya, Takeo

2016-01-01

Study Design Retrospective case-control study. Purpose To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Overview of Literature Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. Methods The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Results Stepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. Conclusions When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure. PMID:27994785

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures.

PubMed

Koda, Masao; Mannoji, Chikato; Murakami, Masazumi; Kinoshita, Tomoaki; Hirayama, Jiro; Miyashita, Tomohiro; Eguchi, Yawara; Yamazaki, Masashi; Suzuki, Takane; Aramomi, Masaaki; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Furuya, Takeo

2016-12-01

Retrospective case-control study. To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Stepwise logistic regression revealed kissing spine ( p =0.024; odds ratio, 3.80) and foraminal stenosis ( p <0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

Induction of ovulation in clomiphene-resistant polycystic ovary syndrome with pulsatile GnRH.

PubMed

Tan, S L; Farhi, J; Homburg, R; Jacobs, H S

1996-08-01

To determine the efficacy of pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins in a stepwise approach for inducing ovulation in women with clomiphene-resistant polycystic ovary syndrome (PCOS). Eighty women with clomiphene-resistant anovulatory infertility and PCOS were given subcutaneous pulsatile GnRH (15 micrograms every 90 minutes) using a portable infusion pump. If no follicular development was seen, clomiphene citrate (100 mg/day for 5 days) was given concurrently with the hormone in the next cycle of treatment. Those who still failed to ovulate regularly were treated with combined pulsatile GnRH with intramuscular gonadotropins (one ampule per day for 5-7 days). RESULTS. Sixty-six of 131 (50%) pulsatile GnRH cycles, 94 of 142 (66%) pulsatile GnRH with clomiphene cycles, and 48 of 69 (70%) pulsatile GnRH with gonadotropin cycles were ovulatory. Monofollicular response (one follicle at least 14 mm on the day of ovulation) occurred in 80.6, 83.9, and 53.6% of cycles, and multifollicular response occurred in 4.8, 3.1, and 21.6% of cycles in the three groups, respectively. Mild ovarian hyperstimulation occurred in one of the 342 cycles. The cumulative conception rate was 30% after three cycles, 60% after six cycles, and 73% after nine cycles. The miscarriage rate was 22% (ten of 45 pregnancies), and 35 women (78%) had live births (33 singletons and two sets of twins). The use of subcutaneous pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins for induction of ovulation in clomiphene-resistant PCOS in a stepwise approach produces a high cumulative conception rate associated with a low rate of multiple pregnancy and ovarian hyperstimulation syndrome.

High drug loading self-microemulsifying/micelle formulation: design by high-throughput formulation screening system and in vivo evaluation.

PubMed

Sakai, Kenichi; Obata, Kouki; Yoshikawa, Mayumi; Takano, Ryusuke; Shibata, Masaki; Maeda, Hiroyuki; Mizutani, Akihiko; Terada, Katsuhide

2012-10-01

To design a high drug loading formulation of self-microemulsifying/micelle system. A poorly-soluble model drug (CH5137291), 8 hydrophilic surfactants (HS), 10 lipophilic surfactants (LS), 5 oils, and PEG400 were used. A high loading formulation was designed by a following stepwise approach using a high-throughput formulation screening (HTFS) system: (1) an oil/solvent was selected by solubility of the drug; (2) a suitable HS for highly loading was selected by the screenings of emulsion/micelle size and phase stability in binary systems (HS, oil/solvent) with increasing loading levels; (3) a LS that formed a broad SMEDDS/micelle area on a phase diagram containing the HS and oil/solvent was selected by the same screenings; (4) an optimized formulation was selected by evaluating the loading capacity of the crystalline drug. Aqueous solubility behavior and oral absorption (Beagle dog) of the optimized formulation were compared with conventional formulations (jet-milled, PEG400). As an optimized formulation, d-α-tocopheryl polyoxyethylene 1000 succinic ester: PEG400 = 8:2 was selected, and achieved the target loading level (200 mg/mL). The formulation formed fine emulsion/micelle (49.1 nm), and generated and maintained a supersaturated state at a higher level compared with the conventional formulations. In the oral absorption test, the area under the plasma concentration-time curve of the optimized formulation was 16.5-fold higher than that of the jet-milled formulation. The high loading formulation designed by the stepwise approach using the HTFS system improved the oral absorption of the poorly-soluble model drug.

Effectiveness of treat-to-target strategy for LDL-cholesterol control in type 2 diabetes: post-hoc analysis of data from the MIND.IT study.

PubMed

Ardigò, Diego; Vaccaro, Olga; Cavalot, Franco; Rivellese, Albarosa Angela; Franzini, Laura; Miccoli, Roberto; Patti, Lidia; Boemi, Massimo; Trovati, Mariella; Zavaroni, Ivana

2014-04-01

The paper presents a post-hoc analysis of the intensity of dyslipidaemia care operated in the first 2 years of Multiple-Intervention-in-type-2-Diabetes.ITaly (MIND.IT) study. MIND.IT is a multicentric, randomized, two-parallel arm trial involving 1461 type 2 diabetic patients at high cardiovascular (CV) risk. The study compares the usual care (UC) of CV prevention with a multifactorial intensive care (IC) approach aiming at achieving target values for the main CV risk factors according to a step-wise treat-to-target approach. Proportion of patients on target for low-density lipoprotein cholesterol (LDL-C) was about 10% at baseline and increased significantly more with IC than UC (43 vs. 27%; p < 0.001). However, the majority (57%) of patients, in this intended intensively treated cohort, failed to achieve the proposed target. Average LDL-C decreased from 144 ± 35 to 108 ± 31 mg/dl with IC and from 142 ± 28 to 118 ± 32 with UC (p-for-interaction <0.0001). IC was associated with a significantly greater increase in statin prescription and lower withdrawal from treatment than UC (43 vs. 11% and 28 vs. 61%, respectively; both p < 0.001). However, the new treatments were characterized in both groups by the use of low starting doses (≤ 10 mg of atorvastatin, equivalent dose in more than 90% of patients) without increase in case of missed target. The application of a multifactorial treat-to-target intervention is associated with a significant improvement in LDL-C beyond usual practice. However, the change in LDL-C appears to be more related to an increased number of treated patients and a decreased treatment withdrawal than to a true treat-to-target approach.

Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial.

PubMed

Simmons, Rebecca K; Echouffo-Tcheugui, Justin B; Sharp, Stephen J; Sargeant, Lincoln A; Williams, Kate M; Prevost, A Toby; Kinmonth, Ann Louise; Wareham, Nicholas J; Griffin, Simon J

2012-11-17

The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20,184 individuals aged 40-69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA(1c)) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Of 16,047 high-risk individuals in screening practices, 15,089 (94%) were invited for screening during 2001-06, 11,737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184,057 person-years of follow up (median duration 9·6 years [IQR 8·9-9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90-1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75-1·38), cancer (1·08, 0·90-1·30), or diabetes-related mortality (1·26, 0·75-2·10) associated with invitation to screening. In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad. Copyright © 2012 Elsevier Ltd. All rights reserved.

Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial

PubMed Central

Simmons, Rebecca K; Echouffo-Tcheugui, Justin B; Sharp, Stephen J; Sargeant, Lincoln A; Williams, Kate M; Prevost, A Toby; Kinmonth, Ann Louise; Wareham, Nicholas J; Griffin, Simon J

2012-01-01

Summary Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40–69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA1c) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001–06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9·6 years [IQR 8·9–9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90–1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75–1·38), cancer (1·08, 0·90–1·30), or diabetes-related mortality (1·26, 0·75–2·10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. Funding Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad. PMID:23040422

A stepwise regression tree for nonlinear approximation: applications to estimating subpixel land cover

USGS Publications Warehouse

Huang, C.; Townshend, J.R.G.

2003-01-01

A stepwise regression tree (SRT) algorithm was developed for approximating complex nonlinear relationships. Based on the regression tree of Breiman et al . (BRT) and a stepwise linear regression (SLR) method, this algorithm represents an improvement over SLR in that it can approximate nonlinear relationships and over BRT in that it gives more realistic predictions. The applicability of this method to estimating subpixel forest was demonstrated using three test data sets, on all of which it gave more accurate predictions than SLR and BRT. SRT also generated more compact trees and performed better than or at least as well as BRT at all 10 equal forest proportion interval ranging from 0 to 100%. This method is appealing to estimating subpixel land cover over large areas.

A method for the selection of a functional form for a thermodynamic equation of state using weighted linear least squares stepwise regression

NASA Technical Reports Server (NTRS)

Jacobsen, R. T.; Stewart, R. B.; Crain, R. W., Jr.; Rose, G. L.; Myers, A. F.

1976-01-01

A method was developed for establishing a rational choice of the terms to be included in an equation of state with a large number of adjustable coefficients. The methods presented were developed for use in the determination of an equation of state for oxygen and nitrogen. However, a general application of the methods is possible in studies involving the determination of an optimum polynomial equation for fitting a large number of data points. The data considered in the least squares problem are experimental thermodynamic pressure-density-temperature data. Attention is given to a description of stepwise multiple regression and the use of stepwise regression in the determination of an equation of state for oxygen and nitrogen.

Practical Unitary Simulator for Non-Markovian Complex Processes

NASA Astrophysics Data System (ADS)

Binder, Felix C.; Thompson, Jayne; Gu, Mile

2018-06-01

Stochastic processes are as ubiquitous throughout the quantitative sciences as they are notorious for being difficult to simulate and predict. In this Letter, we propose a unitary quantum simulator for discrete-time stochastic processes which requires less internal memory than any classical analogue throughout the simulation. The simulator's internal memory requirements equal those of the best previous quantum models. However, in contrast to previous models, it only requires a (small) finite-dimensional Hilbert space. Moreover, since the simulator operates unitarily throughout, it avoids any unnecessary information loss. We provide a stepwise construction for simulators for a large class of stochastic processes hence directly opening the possibility for experimental implementations with current platforms for quantum computation. The results are illustrated for an example process.

Memory for self-generated narration in the elderly.

PubMed

Drevenstedt, J; Bellezza, F S

1993-06-01

The story mnemonic technique, an effective encoding and retrieval strategy for young adults, was used as a procedure to study encoding and recall in elderly women. Experiment 1 (15 undergraduate and 14 elderly women) showed the technique to be reliable over 3 weeks and without practice effects in both age groups. In Experiment 2, 67 elderly women (mean age = 72 years) were found to make up 3 distinctive subgroupings in patterns of narration cohesiveness and recall accuracy, consistent with pilot data on the technique. A stepwise multiple regression equation found narration cohesiveness, an adaptation of the Daneman-Carpenter (1980) working-memory measure and vocabulary to predict word recall. Results suggested that a general memory factor differentiated the 3 elderly subgroups.

Innovation in dental education: The "On-the-Fly" approach to simultaneous development, implementation and evidence collection.

PubMed

de Boer, I R; Bakker, D R; Serrano, C M; Koopman, P; Wesselink, P R; Vervoorn, J M

2018-03-01

This study outlines an approach for education innovation and addresses the ambivalence between evidence-based and non-evidence-based conditions. The "on-the-fly" approach was described as involving implementation during the development of an innovation for dental education. The process of designing and implementing cutting-edge technology of the MOOG Simodont Dental Trainer (DT) whilst systematically collecting evidence illustrates the "on-the-fly" approach. Using the "on-the-fly" approach for developing, implementing and collecting evidence simultaneously in an academic environment appears feasible in serving both the professionals, users and developers and system designers. During the implementation of the new technology, growing evidence stepwise strengthened its position; therefore, showing stakeholders that evidence was used to improve the technology seemed to support and increase acceptance of the new technology. When pioneering an innovative technology in a specialty field, the development stage often precedes evidence for its effectiveness. Consciously choosing the "on-the-fly" approach clarifies to stakeholders in advance about the lack of evidence in an innovation and the need of their support to collect such evidence for improvement and in order to facilitate implementation. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Marker-Based Hierarchical Segmentation and Classification Approach for Hyperspectral Imagery

NASA Technical Reports Server (NTRS)

Tarabalka, Yuliya; Tilton, James C.; Benediktsson, Jon Atli; Chanussot, Jocelyn

2011-01-01

The Hierarchical SEGmentation (HSEG) algorithm, which is a combination of hierarchical step-wise optimization and spectral clustering, has given good performances for hyperspectral image analysis. This technique produces at its output a hierarchical set of image segmentations. The automated selection of a single segmentation level is often necessary. We propose and investigate the use of automatically selected markers for this purpose. In this paper, a novel Marker-based HSEG (M-HSEG) method for spectral-spatial classification of hyperspectral images is proposed. First, pixelwise classification is performed and the most reliably classified pixels are selected as markers, with the corresponding class labels. Then, a novel constrained marker-based HSEG algorithm is applied, resulting in a spectral-spatial classification map. The experimental results show that the proposed approach yields accurate segmentation and classification maps, and thus is attractive for hyperspectral image analysis.

A coarse-grained Monte Carlo approach to diffusion processes in metallic nanoparticles

NASA Astrophysics Data System (ADS)

Hauser, Andreas W.; Schnedlitz, Martin; Ernst, Wolfgang E.

2017-06-01

A kinetic Monte Carlo approach on a coarse-grained lattice is developed for the simulation of surface diffusion processes of Ni, Pd and Au structures with diameters in the range of a few nanometers. Intensity information obtained via standard two-dimensional transmission electron microscopy imaging techniques is used to create three-dimensional structure models as input for a cellular automaton. A series of update rules based on reaction kinetics is defined to allow for a stepwise evolution in time with the aim to simulate surface diffusion phenomena such as Rayleigh breakup and surface wetting. The material flow, in our case represented by the hopping of discrete portions of metal on a given grid, is driven by the attempt to minimize the surface energy, which can be achieved by maximizing the number of filled neighbor cells.

Association between red blood cell distribution width (RDW) and carotid artery atherosclerosis (CAS) in patients with primary ischemic stroke.

PubMed

Jia, He; Li, Huimian; Zhang, Yan; Li, Che; Hu, Yingyun; Xia, Chunfang

2015-01-01

The present study aimed to explore the association between RDW and CAS in patients with ischemic stroke, expecting to find a new and significant diagnosis index for clinical practice. This cross-sectional study involves 432 consecutive patients with primary ischemic stroke (within 72 h). All subjects were confirmed by magnetic resonance imaging, and underwent physical examination, laboratory tests and carotid ultrasonography check. Finally, 392 patients were included according to the exclusion criteria. The odds ratios of independent variables were calculated using stepwise multiple logistic regression. Carotid intimal-medial thickness (IMT) and RDW are both significantly different between CAS group and control group. Univariate analyses show that high-sensitive C-reactive protein (Hs-CRP) and RDW (r=0.436) are both in significantly positive association with IMT. Stepwise multiple logistic regression shows that RDW is an independent protective factor of CAS in patients with ischemic stroke. Compared with the lowest quartile, the second to fourth quartiles are 1.13 (95% CI: 1.13-3.05), 2.02 (95% CI: 1.66-4.67), and 3.10 (95% CI: 2.46-7.65), respectively. The present study suggested that RDW level were higher than non-CAS in patients with primary ischemic stroke. Our results facilitated a bridge to connect RDW with ischemic stroke and further confirmed the role of RDW in the progression of the ischemic stroke. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

How to value protection from natural hazards - a step-by-step discrete choice approach

NASA Astrophysics Data System (ADS)

Olschewski, R.

2013-04-01

In mountainous regions, forests play a crucial role in protecting the local population from natural hazards. In cases where existing forests are destroyed, e.g. by wind throws or diseases, the protection function has to be restored through technical measures. To determine the willingness to pay (WTP) for protection against avalanches, a choice experiment has been conducted and different experiment specifications have been tested to determine possible impacts on the results. The present study contributes to a comprehensive assessment of protection measures, and helps to identify efficient solutions based on the judgement of the people potentially endangered by natural hazards. The stepwise approach has the advantage to gradually check data fit, thereby didactically showing an operational way of dealing with different model specifications. The detailed case study can serve as a manual for conducting choice experiments with a similar focus and demonstrates the suitability and caveats of this approach to value protection from natural hazards in general.

[Artificial intelligence in sleep analysis (ARTISANA)--modelling visual processes in sleep classification].

PubMed

Schwaibold, M; Schöller, B; Penzel, T; Bolz, A

2001-05-01

We describe a novel approach to the problem of automated sleep stage recognition. The ARTISANA algorithm mimics the behaviour of a human expert visually scoring sleep stages (Rechtschaffen and Kales classification). It comprises a number of interacting components that imitate the stepwise approach of the human expert, and artificial intelligence components. On the basis of parameters extracted at 1-s intervals from the signal curves, artificial neural networks recognize the incidence of typical patterns, e.g. delta activity or K complexes. This is followed by a rule interpretation stage that identifies the sleep stage with the aid of a neuro-fuzzy system while taking account of the context. Validation studies based on the records of 8 patients with obstructive sleep apnoea have confirmed the potential of this approach. Further features of the system include the transparency of the decision-taking process, and the flexibility of the option for expanding the system to cover new patterns and criteria.

A systems approach to physiologic evolution: From micelles to consciousness.

PubMed

Torday, John S; Miller, William B

2018-01-01

A systems approach to evolutionary biology offers the promise of an improved understanding of the fundamental principles of life through the effective integration of many biologic disciplines. It is presented that any critical integrative approach to evolutionary development involves a paradigmatic shift in perspective, more than just the engagement of a large number of disciplines. Critical to this differing viewpoint is the recognition that all biological processes originate from the unicellular state and remain permanently anchored to that phase throughout evolutionary development despite their macroscopic appearances. Multicellular eukaryotic development can, therefore, be viewed as a series of connected responses to epiphenomena that proceeds from that base in continuous iterative maintenance of collective cellular homeostatic equipoise juxtaposed against an ever-changing and challenging environment. By following this trajectory of multicellular eukaryotic evolution from within unicellular First Principles of Physiology forward, the mechanistic nature of complex physiology can be identified through a step-wise analysis of a continuous arc of vertebrate evolution based upon serial exaptations. © 2017 Wiley Periodicals, Inc.

Selecting predictors for discriminant analysis of species performance: an example from an amphibious softwater plant.

PubMed

Vanderhaeghe, F; Smolders, A J P; Roelofs, J G M; Hoffmann, M

2012-03-01

Selecting an appropriate variable subset in linear multivariate methods is an important methodological issue for ecologists. Interest often exists in obtaining general predictive capacity or in finding causal inferences from predictor variables. Because of a lack of solid knowledge on a studied phenomenon, scientists explore predictor variables in order to find the most meaningful (i.e. discriminating) ones. As an example, we modelled the response of the amphibious softwater plant Eleocharis multicaulis using canonical discriminant function analysis. We asked how variables can be selected through comparison of several methods: univariate Pearson chi-square screening, principal components analysis (PCA) and step-wise analysis, as well as combinations of some methods. We expected PCA to perform best. The selected methods were evaluated through fit and stability of the resulting discriminant functions and through correlations between these functions and the predictor variables. The chi-square subset, at P < 0.05, followed by a step-wise sub-selection, gave the best results. In contrast to expectations, PCA performed poorly, as so did step-wise analysis. The different chi-square subset methods all yielded ecologically meaningful variables, while probable noise variables were also selected by PCA and step-wise analysis. We advise against the simple use of PCA or step-wise discriminant analysis to obtain an ecologically meaningful variable subset; the former because it does not take into account the response variable, the latter because noise variables are likely to be selected. We suggest that univariate screening techniques are a worthwhile alternative for variable selection in ecology. © 2011 German Botanical Society and The Royal Botanical Society of the Netherlands.

Porous media fracturing dynamics: stepwise crack advancement and fluid pressure oscillations

NASA Astrophysics Data System (ADS)

Cao, Toan D.; Hussain, Fazle; Schrefler, Bernhard A.

2018-02-01

We present new results explaining why fracturing in saturated porous media is not smooth and continuous but is a distinct stepwise process concomitant with fluid pressure oscillations. All exact solutions and almost all numerical models yield smooth fracture advancement and fluid pressure evolution, while recent experimental results, mainly from the oil industry, observation from geophysics and a very few numerical results for the quasi-static case indeed reveal the stepwise phenomenon. We summarize first these new experiments and these few numerical solutions for the quasi-static case. Both mechanical loading and pressure driven fractures are considered because their behaviours differ in the direction of the pressure jumps. Then we explore stepwise crack tip advancement and pressure fluctuations in dynamic fracturing with a hydro-mechanical model of porous media based on the Hybrid Mixture Theory. Full dynamic analyses of examples dealing with both hydraulic fracturing and mechanical loading are presented. The stepwise fracture advancement is confirmed in the dynamic setting as well as in the pressure fluctuations, but there are substantial differences in the frequency contents of the pressure waves in the two loading cases. Comparison between the quasi-static and fully dynamic solutions reveals that the dynamic response gives much more information such as the type of pressure oscillations and related frequencies and should be applied whenever there is a doubt about inertia forces playing a role - the case in most fracturing events. In the absence of direct relevant dynamic tests on saturated media some experimental results on dynamic fracture in dry materials, a fast hydraulic fracturing test and observations from geophysics confirm qualitatively the obtained results such as the type of pressure oscillations and the substantial difference in the behaviour under the two loading cases.

Novel Investigation on Nanostructured Multilayer and Functionally Graded Ni-P Electroless Coatings on Stainless Steel

NASA Astrophysics Data System (ADS)

Anvari, S. R.; Monirvaghefi, S. M.; Enayati, M. H.

2015-06-01

In this study, step-wise multilayer and functionally graded Ni-P coatings were deposited with electroless in which the content of phosphorus and nickel would be changed gradually and step-wise through the thickness of the coatings, respectively. To compare the properties of these coatings with Ni-P single-layer coatings, three types of coatings with different phosphorus contents were deposited. Heat treatment of coatings was performed at 400 °C for 1 h. The microstructure and phase transformation of coatings were characterized by SEM/EDS, TEM, and XRD. The mechanical properties of coatings were studied by nanoindentation test. According to the results of the single-layer coatings, low P coating had the maximum hardness and also the ratio of hardness ( H) to elasticity modulus ( E) for the mentioned coating was maximum. In addition, low and medium P coatings had crystalline and semi-crystalline structure, respectively. The mentioned coatings had <111> texture and after heat treatment their texture didn't change. While high P coating had amorphous structure, after heat treatment it changed to crystalline structure with <100> texture for nickel grains. Furthermore, the results showed that functionally graded and step-wise multilayer coatings were deposited successfully by using the same initial bath and changing the temperature and pH during deposition. Nanoindentation test results showed that the hardness of the mentioned coatings changed from 670 Hv near the substrate to 860 Hv near the top surface of coatings. For functionally graded coating the hardness profile had gradual changes, while step-wise multilayer coating had step-wise hardness profile. After heat treatment trend of hardness profiles was changed, so that near the substrate, hardness was measured 1400 Hv and changed to 1090 Hv at the top coat.

An effective approach to quantitative analysis of ternary amino acids in foxtail millet substrate based on terahertz spectroscopy.

PubMed

Lu, Shao Hua; Li, Bao Qiong; Zhai, Hong Lin; Zhang, Xin; Zhang, Zhuo Yong

2018-04-25

Terahertz time-domain spectroscopy has been applied to many fields, however, it still encounters drawbacks in multicomponent mixtures analysis due to serious spectral overlapping. Here, an effective approach to quantitative analysis was proposed, and applied on the determination of the ternary amino acids in foxtail millet substrate. Utilizing three parameters derived from the THz-TDS, the images were constructed and the Tchebichef image moments were used to extract the information of target components. Then the quantitative models were obtained by stepwise regression. The correlation coefficients of leave-one-out cross-validation (R loo-cv 2 ) were more than 0.9595. As for external test set, the predictive correlation coefficients (R p 2 ) were more than 0.8026 and the root mean square error of prediction (RMSE p ) were less than 1.2601. Compared with the traditional methods (PLS and N-PLS methods), our approach is more accurate, robust and reliable, and can be a potential excellent approach to quantify multicomponent with THz-TDS spectroscopy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Designing of a fluoride selective receptor through molecular orbital engineering

NASA Astrophysics Data System (ADS)

Mishra, Rakesh K.; Kumar, Virendra; Diwan, Uzra; Upadhyay, K. K.; Roy Chowdhury, P. K.

2012-11-01

The stepwise substitution of appropriate groups over the 3-[(2,4-dinitro-phenyl)-hydrazono]-butyric acid ethyl ester (R3) lead receptor R1 which showed selectivity towards fluoride in DMSO. The UV-vis and 1H NMR titration studies revealed the details of the binding between receptor R1 and fluoride. The receptor R1 also recognized fluoride in a toothpaste solution to as low as 50 ppm. The theoretical simulations of recognition event at Density Functional Theory (DFT) level using B3LYP/6-31G** basis set and polarizable continuum model (PCM) approach lead a semi-quantitative match with the experimental results.

Risk factors of major noncommunicable diseases in Bahrain. The need for a surveillance system.

PubMed

Hamadeh, Randah R

2004-09-01

Noncommunicable diseases NCDs are the major cause of morbidity and mortality in Bahrain. The review examines the prevalence of risk factors of major NCDs from the available literature and determines the impact of the rapid socio economic changes on their burden. It further recommends ways of improving their reporting and monitoring. Smoking, obesity, diabetes, hypertension, hyperlipidemia, physical activity and nutrition are considered. The review points out that data on some of the factors is available but deficient for others. The call for the establishment of an integrated surveillance system using the World Health Organization STEPwise approach is stressed.

Pediatric Major Head Injury: Not a Minor Problem.

PubMed

Leetch, Aaron N; Wilson, Bryan

2018-05-01

Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly. Reduction of intracranial pressure through hyperosmolar therapy, decompressive craniotomy, and seizure prophylaxis may be considered after stabilization. Nonaccidental trauma should be considered when evaluating pediatric trauma patients. Copyright © 2017 Elsevier Inc. All rights reserved.

The economics of transboundary air pollution in Europe.

PubMed

Van Ierland, E C

1991-01-01

Acid rain is causing substantial damage in all Eastern and Western European countries. This article presents a stepwise linear optimisation model, that places transboundary air pollution by SO2 and NOx in a game theoretical framework. The national authorities of 28 countries are perceived as players in a game in which they can choose optimal strategies. It is illustrated that optimal national abatement programmes may be far from optimal if considered from an international point of view. Several scenarios are discussed, including a reference case, full cooperation, Pareto optimality and a critical loads approach. The need for international cooperation and regional differentiation of abatement programmes is emphasised.

Polar cloud and surface classification using AVHRR imagery - An intercomparison of methods

NASA Technical Reports Server (NTRS)

Welch, R. M.; Sengupta, S. K.; Goroch, A. K.; Rabindra, P.; Rangaraj, N.; Navar, M. S.

1992-01-01

Six Advanced Very High-Resolution Radiometer local area coverage (AVHRR LAC) arctic scenes are classified into ten classes. Three different classifiers are examined: (1) the traditional stepwise discriminant analysis (SDA) method; (2) the feed-forward back-propagation (FFBP) neural network; and (3) the probabilistic neural network (PNN). More than 200 spectral and textural measures are computed. These are reduced to 20 features using sequential forward selection. Theoretical accuracy of the classifiers is determined using the bootstrap approach. Overall accuracy is 85.6 percent, 87.6 percent, and 87.0 percent for the SDA, FFBP, and PNN classifiers, respectively, with standard deviations of approximately 1 percent.

Gynecomastia: Pathophysiology, Evaluation, and Management

PubMed Central

Johnson, Ruth E.; Murad, M. Hassan

2009-01-01

Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Although a fairly common presentation in the primary care setting and mostly of benign etiology, it can cause patients considerable anxiety. The initial step is to rule out pseudogynecomastia by careful history taking and physical examination. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies may facilitate cost-effective diagnosis. If results of all studies are normal, idiopathic gynecomastia is diagnosed. The evidence in this area is mainly of observational nature and lower quality. PMID:19880691

Targeted drug delivery to the brain using magnetic nanoparticles.

PubMed

Thomsen, Louiza Bohn; Thomsen, Maj Schneider; Moos, Torben

2015-01-01

Brain capillary endothelial cells denote the blood-brain barrier (BBB), and conjugation of nanoparticles with antibodies that target molecules expressed by these endothelial cells may facilitate their uptake and transport into the brain. Magnetic nanoparticles can be encapsulated in liposomes and carry large molecules with therapeutic potential, for example, siRNA, cDNA and polypeptides. An additional approach to enhance the transport of magnetic nanoparticles across the BBB is the application of extracranially applied magnetic force. Stepwise targeting of magnetic nanoparticles to brain capillary endothelial cells followed by transport through the BBB using magnetic force may prove a novel mechanism for targeted therapy of macromolecules to the brain.

A new proposal for randomized start design to investigate disease-modifying therapies for Alzheimer disease.

PubMed

Zhang, Richard Y; Leon, Andrew C; Chuang-Stein, Christy; Romano, Steven J

2011-02-01

The increasing prevalence of Alzheimer disease (AD) and lack of effective agents to attenuate progression have accelerated research and development of disease modifying (DM) therapies. The traditional parallel group design and single time point analysis used in the support of past AD drug approvals address symptomatic benefit over relatively short treatment durations. More recent trials investigating disease modification are by necessity longer in duration and require larger sample sizes. Nevertheless, trial design and analysis remain mostly unchanged and may not be adequate to meet the objective of demonstrating disease modification. Randomized start design (RSD) has been proposed as an option to study DM effects, but its application in AD trials may have been hampered by certain methodological challenges. To address the methodological issues that have impeded more extensive use of RSD in AD trial and to encourage other researchers to develop novel design and analysis methodologies to better ascertain DM effects for the next generation of AD therapies, we propose a stepwise testing procedure to evaluate potential DM effects of novel AD therapies. Alzheimer Disease Assessment Scale-Cognitive Subscale (ADAS-cog) is used for illustration. We propose to test three hypotheses in a stepwise sequence. The three tests pertain to treatment difference at two separate time points and a difference in the rate of change. Estimation is facilitated by the Mixed-effects Model for Repeated Measures approach. The required sample size is estimated using Monte Carlo simulations and by modeling ADAS-cog data from prior longitudinal AD studies. The greatest advantage of the RSD proposed in this article is its ability to critically address the question on a DM effect. The AD trial using the new approach would be longer (12-month placebo period plus 12-month delay-start period; total 24-month duration) and require more subjects (about 1000 subjects per arm for the non-inferiority margin chosen in the illustration). It would also require additional evaluations to estimate the rate of ADAS-cog change toward the end of the trial. A regulatory claim of disease modification for any compound will likely require additional verification of a drug's effect on a validated biomarker of Alzheimer's pathology. Incorporation of the RSD in AD trials is feasible. With proper trial setup and statistical procedures, this design could support the detection of a disease-modifying effect. In our opinion, a two-phase RSD with a stepwise hypothesis testing procedure could be a reasonable option for future studies.

An inter-networking mechanism with stepwise synchronization for wireless sensor networks.

PubMed

Yamamoto, Hiroshi; Wakamiya, Naoki; Murata, Masayuki

2011-01-01

To realize the ambient information society, multiple wireless networks deployed in the region and devices carried by users are required to cooperate with each other. Since duty cycles and operational frequencies are different among networks, we need a mechanism to allow networks to efficiently exchange messages. For this purpose, we propose a novel inter-networking mechanism where two networks are synchronized with each other in a moderate manner, which we call stepwise synchronization. With our proposal, to bridge the gap between intrinsic operational frequencies, nodes near the border of networks adjust their operational frequencies in a stepwise fashion based on the pulse-coupled oscillator model as a fundamental theory of synchronization. Through simulation experiments, we show that the communication delay and the energy consumption of border nodes are reduced, which enables wireless sensor networks to communicate longer with each other.

Renewable platform chemicals from directional microwave-assisted liquefaction coupling stepwise extraction of waste biomass

Treesearch

Junfeng Feng; Chungyun Hse; Zhongzhi Yang; Kui Wang; Jianchun Jiang; Junming Xu

2017-01-01

Directional microwave-assisted liquefaction and stepwise extraction are introduced for producing platform chemicals: aromatics and monosaccharides. When sulfuric acid was used as a catalyst, a 45% monosaccharides yield and a 29% aromatics yield were obtained from bamboo with 0.3 g catalyst per 18 g methanol and 2 g bamboo at 160 °C with 10 min. Approximately 78–86 wt%...

Application of the stepwise focusing method to optimize the cost-effectiveness of genome-wide association studies with limited research budgets for genotyping and phenotyping.

PubMed

Ohashi, J; Clark, A G

2005-05-01

The recent cataloguing of a large number of SNPs enables us to perform genome-wide association studies for detecting common genetic variants associated with disease. Such studies, however, generally have limited research budgets for genotyping and phenotyping. It is therefore necessary to optimize the study design by determining the most cost-effective numbers of SNPs and individuals to analyze. In this report we applied the stepwise focusing method, with two-stage design, developed by Satagopan et al. (2002) and Saito & Kamatani (2002), to optimize the cost-effectiveness of a genome-wide direct association study using a transmission/disequilibrium test (TDT). The stepwise focusing method consists of two steps: a large number of SNPs are examined in the first focusing step, and then all the SNPs showing a significant P-value are tested again using a larger set of individuals in the second focusing step. In the framework of optimization, the numbers of SNPs and families and the significance levels in the first and second steps were regarded as variables to be considered. Our results showed that the stepwise focusing method achieves a distinct gain of power compared to a conventional method with the same research budget.

Multi-layered nanoparticles for penetrating the endosome and nuclear membrane via a step-wise membrane fusion process.

PubMed

Akita, Hidetaka; Kudo, Asako; Minoura, Arisa; Yamaguti, Masaya; Khalil, Ikramy A; Moriguchi, Rumiko; Masuda, Tomoya; Danev, Radostin; Nagayama, Kuniaki; Kogure, Kentaro; Harashima, Hideyoshi

2009-05-01

Efficient targeting of DNA to the nucleus is a prerequisite for effective gene therapy. The gene-delivery vehicle must penetrate through the plasma membrane, and the DNA-impermeable double-membraned nuclear envelope, and deposit its DNA cargo in a form ready for transcription. Here we introduce a concept for overcoming intracellular membrane barriers that involves step-wise membrane fusion. To achieve this, a nanotechnology was developed that creates a multi-layered nanoparticle, which we refer to as a Tetra-lamellar Multi-functional Envelope-type Nano Device (T-MEND). The critical structural elements of the T-MEND are a DNA-polycation condensed core coated with two nuclear membrane-fusogenic inner envelopes and two endosome-fusogenic outer envelopes, which are shed in stepwise fashion. A double-lamellar membrane structure is required for nuclear delivery via the stepwise fusion of double layered nuclear membrane structure. Intracellular membrane fusions to endosomes and nuclear membranes were verified by spectral imaging of fluorescence resonance energy transfer (FRET) between donor and acceptor fluorophores that had been dually labeled on the liposome surface. Coating the core with the minimum number of nucleus-fusogenic lipid envelopes (i.e., 2) is essential to facilitate transcription. As a result, the T-MEND achieves dramatic levels of transgene expression in non-dividing cells.

Stepwise crystallization and the layered distribution in crystallization kinetics of ultra-thin poly(ethylene terephthalate) film

NASA Astrophysics Data System (ADS)

Zuo, Biao; Xu, Jianquan; Sun, Shuzheng; Liu, Yue; Yang, Juping; Zhang, Li; Wang, Xinping

2016-06-01

Crystallization is an important property of polymeric materials. In conventional viewpoint, the transformation of disordered chains into crystals is usually a spatially homogeneous process (i.e., it occurs simultaneously throughout the sample), that is, the crystallization rate at each local position within the sample is almost the same. Here, we show that crystallization of ultra-thin poly(ethylene terephthalate) (PET) films can occur in the heterogeneous way, exhibiting a stepwise crystallization process. We found that the layered distribution of glass transition dynamics of thin film modifies the corresponding crystallization behavior, giving rise to the layered distribution of the crystallization kinetics of PET films, with an 11-nm-thick surface layer having faster crystallization rate and the underlying layer showing bulk-like behavior. The layered distribution in crystallization kinetics results in a particular stepwise crystallization behavior during heating the sample, with the two cold-crystallization temperatures separated by up to 20 K. Meanwhile, interfacial interaction is crucial for the occurrence of the heterogeneous crystallization, as the thin film crystallizes simultaneously if the interfacial interaction is relatively strong. We anticipate that this mechanism of stepwise crystallization of thin polymeric films will allow new insight into the chain organization in confined environments and permit independent manipulation of localized properties of nanomaterials.

Stepwise crystallization and the layered distribution in crystallization kinetics of ultra-thin poly(ethylene terephthalate) film

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

Zuo, Biao, E-mail: chemizuo@zstu.edu.cn, E-mail: wxinping@yahoo.com; Xu, Jianquan; Sun, Shuzheng

2016-06-21

Crystallization is an important property of polymeric materials. In conventional viewpoint, the transformation of disordered chains into crystals is usually a spatially homogeneous process (i.e., it occurs simultaneously throughout the sample), that is, the crystallization rate at each local position within the sample is almost the same. Here, we show that crystallization of ultra-thin poly(ethylene terephthalate) (PET) films can occur in the heterogeneous way, exhibiting a stepwise crystallization process. We found that the layered distribution of glass transition dynamics of thin film modifies the corresponding crystallization behavior, giving rise to the layered distribution of the crystallization kinetics of PET films,more » with an 11-nm-thick surface layer having faster crystallization rate and the underlying layer showing bulk-like behavior. The layered distribution in crystallization kinetics results in a particular stepwise crystallization behavior during heating the sample, with the two cold-crystallization temperatures separated by up to 20 K. Meanwhile, interfacial interaction is crucial for the occurrence of the heterogeneous crystallization, as the thin film crystallizes simultaneously if the interfacial interaction is relatively strong. We anticipate that this mechanism of stepwise crystallization of thin polymeric films will allow new insight into the chain organization in confined environments and permit independent manipulation of localized properties of nanomaterials.« less

The Architecture of the Golfer's Brain

PubMed Central

Jäncke, Lutz; Koeneke, Susan; Hoppe, Ariana; Rominger, Christina; Hänggi, Jürgen

2009-01-01

Background Several recent studies have shown practice-dependent structural alterations in humans. Cross-sectional studies of intensive practice of specific tasks suggest associated long-term structural adaptations. Playing golf at a high level of performance is one of the most demanding sporting activities. In this study, we report the relationship between a particular level of proficiency in playing golf (indicated by golf handicap level) and specific neuroanatomical features. Principal Findings Using voxel-based morphometry (VBM) of grey (GM) and white matter (WM) volumes and fractional anisotropy (FA) measures of the fibre tracts, we identified differences between skilled (professional golfers and golfers with an handicap from 1–14) and less-skilled golfers (golfers with an handicap from 15–36 and non-golfer). Larger GM volumes were found in skilled golfers in a fronto-parietal network including premotor and parietal areas. Skilled golfers revealed smaller WM volume and FA values in the vicinity of the corticospinal tract at the level of the internal and external capsule and in the parietal operculum. However, there was no structural difference within the skilled and less-skilled golfer group. Conclusion There is no linear relationship between the anatomical findings and handicap level, amount of practice, and practice hours per year. There was however a strong difference between highly-practiced golfers (at least 800–3,000 hours) and those who have practised less or non-golfers without any golfing practise, thus indicating a step-wise structural and not a linear change. PMID:19277116

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders.

PubMed

Bharucha, Adil E; Rao, Satish S C; Shin, Andrea S

2017-12-01

The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best Practice Advice 1: A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first. Best Practice Advice 2: Pelvic floor retraining with biofeedback therapy is recommended for patients with FI who do not respond to the conservative measures indicated above. Best Practice Advice 3: Perianal bulking agents such as intra-anal injection of dextranomer may be considered when conservative measures and biofeedback therapy fail. Best Practice Advice 4: Sacral nerve stimulation should be considered for patients with moderate or severe FI in whom symptoms have not responded after a 3-month or longer trial of conservative measures and biofeedback therapy and who do not have contraindications to these procedures. Best Practice Advice 5: Until further evidence is available, percutaneous tibial nerve stimulation should not be used for managing FI in clinical practice. Best Practice Advice 6: Barrier devices should be offered to patients who have failed conservative or surgical therapy, or in those who have failed conservative therapy who do not want or are not eligible for more invasive interventions. Best Practice Advice 7: Anal sphincter repair (sphincteroplasty) should be considered in postpartum women with FI and in patients with recent sphincter injuries. In patients who present later with symptoms of FI unresponsive to conservative and biofeedback therapy and evidence of sphincter damage, sphincteroplasty may be considered when perianal bulking injection and sacral nerve stimulation are not available or have proven unsuccessful. Best Practice Advice 8: The artificial anal sphincter, dynamic graciloplasty, may be considered for patients with medically refractory severe FI who have failed treatment or are not candidates for barrier devices, sacral nerve stimulation, perianal bulking injection, sphincteroplasty and a colostomy. Best Practice Advice 9: Major anatomic defects (eg, rectovaginal fistula, full-thickness rectal prolapse, fistula in ano, or cloaca-like deformity) should be rectified with surgery. Best Practice Advice 10: A colostomy should be considered in patients with severe FI who have failed conservative treatment and have failed or are not candidates for barrier devices, minimally invasive surgical interventions, and sphincteroplasty. Best Practice Advice 11: A magnetic anal sphincter device may be considered for patients with medically refractory severe FI who have failed or are not candidates for barrier devices, perianal bulking injection, sacral nerve stimulation, sphincteroplasty, or a colostomy. Data regarding efficacy are limited and 40% of patients had moderate or severe complications. Best Practice Advice 12: For defecatory disorders, biofeedback therapy is the treatment of choice. Best Practice Advice 13: Based on limited evidence, sacral nerve stimulation should not be used for managing defecatory disorders in clinical practice. Best Practice Advice 14: Anterograde colonic enemas are not effective in the long term for management of defecatory disorders. Best Practice Advice 15: The stapled transanal rectal resection and related procedures should not be routinely performed for correction of structural abnormalities in patients with defecatory disorders. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Dietary recommendations for infants and toddlers among pediatric dentists in North Carolina.

PubMed

Sim, Chien J; Iida, Hiroko; Vann, William F; Quinonez, Rocio B; Steiner, Michael J

2014-01-01

The purposes of this study were to: describe practice patterns, knowledge, and attitudes of pediatric dentists in North Carolina (N.C.) in delivering dietary recommendations to the parents/caregivers of infants and toddlers; and identify barriers that limit the implementation of related recommendations. Our survey instrument included 30 questions covering eight domains of barriers to guideline adherence. Surveys were mailed to 150 practicing pediatric dentists in N.C. Descriptive and bivariate analyses were performed. Exploratory factor analysis was used to identify subscales and inform the multivariable model. The response rate was 57 percent (86/150), 80 percent of whom reported providing infant and toddler feeding recommendations routinely. Knowledge of and agreement with the recommendation regarding breast-feeding duration was lower than that for bottle-feeding recommendations. Stepwise logistic regression analysis indicated that survey respondents were less likely to provide dietary recommendations regularly to the parents/caregivers of infants and toddlers when they have practice constraints and the respondents disagree with American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) recommendations on bottle and juice consumption. Most respondents routinely provide dietary recommendations to the parents/caregivers of infants and toddlers. Disagreement with AAP and AAPD recommendations on bottle, and juice consumption as well as practice constraints impedes practitioners from providing dietary recommendations regularly to the parents/caregivers of infants and toddlers.

Prayer at Midlife is Associated with Reduced Risk of Cognitive Decline in Arabic Women

PubMed Central

Inzelberg, Rivka; Afgin, Anne E; Massarwa, Magda; Schechtman, Edna; Israeli-Korn, Simon D.; Strugatsky, Rosa; Abuful, Amin; Kravitz, Efrat; Farrer, Lindsay A.; Friedland, Robert P.

2013-01-01

Midlife habits may be important for the later development of Alzheimer's disease (AD). We estimated the contribution of midlife prayer to the development of cognitive decline. In a door-to-door survey, residents aged ≥65 years were systematically evaluated in Arabic including medical history, neurological, cognitive examination, and a midlife leisure-activities questionnaire. Praying was assessed by the number of monthly praying hours at midlife. Stepwise logistic regression models were used to evaluate the effect of prayer on the odds of mild cognitive impairment (MCI) and AD versus cognitively normal individuals. Of 935 individuals that were approached, 778 [normal controls (n=448), AD (n=92) and MCI (n=238)] were evaluated. A higher proportion of cognitively normal individuals engaged in prayer at midlife [(87%) versus MCI (71%) or AD (69%) (p<0.0001)]. Since 94% of males engaged in prayer, the effect on cognitive decline could not be assessed in men. Among women, stepwise logistic regression adjusted for age and education, showed that prayer was significantly associated with reduced risk of MCI (p=0.027, OR=0.55, 95% CI 0.33-0.94), but not AD. Among individuals endorsing prayer activity, the amount of prayer was not associated with MCI or AD in either gender. Praying at midlife is associated with lower risk of mild cognitive impairment in women. PMID:23116476

Strategy for design NIR calibration sets based on process spectrum and model space: An innovative approach for process analytical technology.

PubMed

Cárdenas, V; Cordobés, M; Blanco, M; Alcalà, M

2015-10-10

The pharmaceutical industry is under stringent regulations on quality control of their products because is critical for both, productive process and consumer safety. According to the framework of "process analytical technology" (PAT), a complete understanding of the process and a stepwise monitoring of manufacturing are required. Near infrared spectroscopy (NIRS) combined with chemometrics have lately performed efficient, useful and robust for pharmaceutical analysis. One crucial step in developing effective NIRS-based methodologies is selecting an appropriate calibration set to construct models affording accurate predictions. In this work, we developed calibration models for a pharmaceutical formulation during its three manufacturing stages: blending, compaction and coating. A novel methodology is proposed for selecting the calibration set -"process spectrum"-, into which physical changes in the samples at each stage are algebraically incorporated. Also, we established a "model space" defined by Hotelling's T(2) and Q-residuals statistics for outlier identification - inside/outside the defined space - in order to select objectively the factors to be used in calibration set construction. The results obtained confirm the efficacy of the proposed methodology for stepwise pharmaceutical quality control, and the relevance of the study as a guideline for the implementation of this easy and fast methodology in the pharma industry. Copyright © 2015 Elsevier B.V. All rights reserved.

Medication safety and knowledge-based functions: a stepwise approach against information overload.

PubMed

Patapovas, Andrius; Dormann, Harald; Sedlmayr, Brita; Kirchner, Melanie; Sonst, Anja; Müller, Fabian; Pfistermeister, Barbara; Plank-Kiegele, Bettina; Vogler, Renate; Maas, Renke; Criegee-Rieck, Manfred; Prokosch, Hans-Ulrich; Bürkle, Thomas

2013-09-01

The aim was to improve medication safety in an emergency department (ED) by enhancing the integration and presentation of safety information for drug therapy. Based on an evaluation of safety of drug therapy issues in the ED and a review of computer-assisted intervention technologies we redesigned an electronic case sheet and implemented computer-assisted interventions into the routine work flow. We devised a four step system of alerts, and facilitated access to different levels of drug information. System use was analyzed over a period of 6 months. In addition, physicians answered a survey based on the technology acceptance model TAM2. The new application was implemented in an informal manner to avoid work flow disruption. Log files demonstrated that step I, 'valid indication' was utilized for 3% of the recorded drugs and step II 'tooltip for well-known drug risks' for 48% of the drugs. In the questionnaire, the computer-assisted interventions were rated better than previous paper based measures (checklists, posters) with regard to usefulness, support of work and information quality. A stepwise assisting intervention received positive user acceptance. Some intervention steps have been seldom used, others quite often. We think that we were able to avoid over-alerting and work flow intrusion in a critical ED environment. © 2013 The Authors. British Journal of Clinical Pharmacology © 2013 The British Pharmacological Society.

Development of an in vitro culture method for stepwise differentiation of mouse embryonic stem cells and induced pluripotent stem cells into mature osteoclasts.

PubMed

Nishikawa, Keizo; Iwamoto, Yoriko; Ishii, Masaru

2014-05-01

The development of methods for differentiation of embryonic stem cells (ESCs) and induced pluripotent stem cell (iPSCs) into functional cells have helped to analyze the mechanism regulating cellular processes and to explore cell-based assays for drug discovery. Although several reports have demonstrated methods for differentiation of mouse ESCs into osteoclast-like cells, it remains unclear whether these methods are applicable for differentiation of iPSCs to osteoclasts. In this study, we developed a simple method for stepwise differentiation of mouse ESCs and iPSCs into bone-resorbing osteoclasts based upon a monoculture approach consisting of three steps. First, based on conventional hanging-drop methods, embryoid bodies (EBs) were produced from mouse ESCs or iPSCs. Second, EBs were cultured in medium supplemented with macrophage colony-stimulating factor (M-CSF), and differentiated to osteoclast precursors, which expressed CD11b. Finally, ESC- or iPSC-derived osteoclast precursors stimulated with receptor activator of nuclear factor-B ligand (RANKL) and M-CSF formed large multinucleated osteoclast-like cells that expressed tartrate-resistant acid phosphatase and were capable of bone resorption. Molecular analysis showed that the expression of osteoclast marker genes such as Nfatc1, Ctsk, and Acp5 are increased in a RANKL-dependent manner. Thus, our procedure is simple and easy and would be helpful for stem cell-based bone research.

Prayer at midlife is associated with reduced risk of cognitive decline in Arabic women.

PubMed

Inzelberg, Rivka; Afgin, Anne E; Massarwa, Magda; Schechtman, Edna; Israeli-Korn, Simon D; Strugatsky, Rosa; Abuful, Amin; Kravitz, Efrat; Farrer, Lindsay A; Friedland, Robert P

2013-03-01

Midlife habits may be important for the later development of Alzheimer's disease (AD). We estimated the contribution of midlife prayer to the development of cognitive decline. In a door-to-door survey, residents aged ≥65 years were systematically evaluated in Arabic including medical history, neurological, cognitive examination, and a midlife leisure-activities questionnaire. Praying was assessed by the number of monthly praying hours at midlife. Stepwise logistic regression models were used to evaluate the effect of prayer on the odds of mild cognitive impairment (MCI) and AD versus cognitively normal individuals. Of 935 individuals that were approached, 778 [normal controls (n=448), AD (n=92) and MCI (n=238)] were evaluated. A higher proportion of cognitively normal individuals engaged in prayer at midlife [(87%) versus MCI (71%) or AD (69%) (p<0.0001)]. Since 94% of males engaged in prayer, the effect on cognitive decline could not be assessed in men. Among women, stepwise logistic regression adjusted for age and education, showed that prayer was significantly associated with reduced risk of MCI (p=0.027, OR=0.55, 95% CI 0.33-0.94), but not AD. Among individuals endorsing prayer activity, the amount of prayer was not associated with MCI or AD in either gender. Praying at midlife is associated with lower risk of mild cognitive impairment in women.

Photoswitchable Dihydroazulene Macrocycles for Solar Energy Storage: The Effects of Ring Strain.

PubMed

Vlasceanu, Alexandru; Frandsen, Benjamin N; Skov, Anders B; Hansen, Anne Schou; Rasmussen, Mads Georg; Kjaergaard, Henrik G; Mikkelsen, Kurt V; Nielsen, Mogens Brøndsted

2017-10-06

Efficient energy storage and release are two major challenges of solar energy harvesting technologies. The development of molecular solar thermal systems presents one approach to address these issues by tuning the isomerization reactions of photo/thermoswitches. Here we show that the incorporation of photoswitches into macrocyclic structures is a particularly attractive solution for increasing the storage time. We present the synthesis and properties of a series of macrocycles incorporating two dihydroazulene (DHA) photoswitching subunits, bridged by linkers of varying chain length. Independent of ring size, all macrocycles exhibit stepwise, light-induced, ring-opening reactions (DHA-DHA to DHA-VHF to VHF-VHF; VHF = vinylheptafulvene) with the first DHA undergoing isomerization with a similar efficiency as the uncyclized parent system while the second (DHA-VHF to VHF-VHF) is significantly slower. The energy-releasing, VHF-to-DHA, ring closures also occur in a stepwise manner and are systematically found to proceed slower in the more strained (smaller) cycles, but in all cases with a remarkably slow conversion of the second VHF to DHA. We managed to increase the half-life of the second VHF-to-DHA conversion from 65 to 202 h at room temperature by simply decreasing the ring size. A computational study reveals the smallest macrocycle to have the most energetic VHF-VHF state and hence highest energy density.

A New Combined Stepwise-Based High-Order Decoupled Direct and Reduced-Form Method To Improve Uncertainty Analysis in PM2.5 Simulations.

PubMed

Huang, Zhijiong; Hu, Yongtao; Zheng, Junyu; Yuan, Zibing; Russell, Armistead G; Ou, Jiamin; Zhong, Zhuangmin

2017-04-04

The traditional reduced-form model (RFM) based on the high-order decoupled direct method (HDDM), is an efficient uncertainty analysis approach for air quality models, but it has large biases in uncertainty propagation due to the limitation of the HDDM in predicting nonlinear responses to large perturbations of model inputs. To overcome the limitation, a new stepwise-based RFM method that combines several sets of local sensitive coefficients under different conditions is proposed. Evaluations reveal that the new RFM improves the prediction of nonlinear responses. The new method is applied to quantify uncertainties in simulated PM 2.5 concentrations in the Pearl River Delta (PRD) region of China as a case study. Results show that the average uncertainty range of hourly PM 2.5 concentrations is -28% to 57%, which can cover approximately 70% of the observed PM 2.5 concentrations, while the traditional RFM underestimates the upper bound of the uncertainty range by 1-6%. Using a variance-based method, the PM 2.5 boundary conditions and primary PM 2.5 emissions are found to be the two major uncertainty sources in PM 2.5 simulations. The new RFM better quantifies the uncertainty range in model simulations and can be applied to improve applications that rely on uncertainty information.

Tandem catalysis for the preparation of cylindrical polypeptide brushes.

PubMed

Rhodes, Allison J; Deming, Timothy J

2012-11-28

Here, we report a method for synthesis of cylindrical copolypeptide brushes via N-carboxyanhydride (NCA) polymerization utilizing a new tandem catalysis approach that allows preparation of brushes with controlled segment lengths in a straightforward, one-pot procedure requiring no intermediate isolation or purification steps. To obtain high-density brush copolypeptides, we used a "grafting from" approach where alloc-α-aminoamide groups were installed onto the side chains of NCAs to serve as masked initiators. These groups were inert during cobalt-initiated NCA polymerization and gave allyloxycarbonyl-α-aminoamide-substituted polypeptide main chains. The alloc-α-aminoamide groups were then activated in situ using nickel to generate initiators for growth of side-chain brush segments. This use of stepwise tandem cobalt and nickel catalysis was found to be an efficient method for preparation of high-chain-density, cylindrical copolypeptide brushes, where both the main chains and side chains can be prepared with controlled segment lengths.

The active analog approach applied to the pharmacophore identification of benzodiazepine receptor ligands

NASA Astrophysics Data System (ADS)

Tebib, Souhail; Bourguignon, Jean-Jacques; Wermuth, Camille-Georges

1987-07-01

Applied to seven potent benzodiazepine-receptor ligands belonging to chemically different classes, the active analog approach allowed the stepwise identification of the pharmacophoric pattern associated with the recognition by the benzodiazepine receptor. A unique pharmacophore model was derived which involves six critical zones: (a) a π-electron rich aromatic (PAR) zone; (b) two electron-rich zones δ1 and δ2 placed at 5.0 and 4.5 Å respectively from the reference centroid in the PAR zone; (c) a freely rotating aromatic ring (FRA) region; (d) an out-of-plane region (OPR), strongly associated with agonist properties; and (e) an additional hydrophobic region (AHR). The model accommodates all presently known ligands of the benzodiazepine receptor, identifies sensitivity to steric hindrance close to the δ1 zone, accounts for R and S differential affinities and distinguishes requirements for agonist versus non-agonist activity profiles.

Resolving writer's block.

PubMed Central

Huston, P.

1998-01-01

PROBLEM BEING ADDRESSED: Writer's block, or a distinctly uncomfortable inability to write, can interfere with professional productivity. OBJECTIVE OF PROGRAM: To identify writer's block and to outline suggestions for its early diagnosis, treatment, and prevention. MAIN COMPONENTS OF PROGRAM: Once the diagnosis has been established, a stepwise approach to care is recommended. Mild blockage can be resolved by evaluating and revising expectations, conducting a task analysis, and giving oneself positive feedback. Moderate blockage can be addressed by creative exercises, such as brainstorming and role-playing. Recalcitrant blockage can be resolved with therapy. Writer's block can be prevented by taking opportunities to write at the beginning of projects, working with a supportive group of people, and cultivating an ongoing interest in writing. CONCLUSIONS: Writer's block is a highly treatable condition. A systematic approach can help to alleviate anxiety, build confidence, and give people the information they need to work productively. PMID:9481467

Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya

PubMed Central

Binanay, Cynthia A.; Akwanalo, Constantine O.; Aruasa, Wilson; Barasa, Felix A.; Corey, G. Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C.; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E.; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J.; Bloomfield, Gerald S.

2015-01-01

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource limited setting. Our experiences may guide the development of similar collaborations in other settings. PMID:26653630

The Sherlock Holmes approach to diagnosing fetal syndromes by ultrasound.

PubMed

Benacerraf, Beryl B

2012-03-01

Prenatal detection of fetal anomalies is one of the major goals of obstetrical ultrasound. The primary reason is the options that are often offered to the family and caregivers from therapy in selected cases to special care at delivery to termination of the pregnancy. An important aspect of the diagnosis is to determine whether the anomaly is expected to be lethal or associated with severe physical or mental impediments. This goal is often difficult to accomplish without a clear diagnosis. A systematic approach is essential when an abnormality is first identified sonographically to help the practitioner discover certain patterns of associated defects. The use of this logical and stepwise strategy facilitates arriving at the correct diagnosis of specific syndrome by taking all anatomic findings into account. This process focuses on first pinpointing a key or sentinel feature specific to each syndrome and which can anchor the diagnosis.

Remote sensing-aided systems for snow qualification, evapotranspiration estimation, and their application in hydrologic models

NASA Technical Reports Server (NTRS)

Korram, S.

1977-01-01

The design of general remote sensing-aided methodologies was studied to provide the estimates of several important inputs to water yield forecast models. These input parameters are snow area extent, snow water content, and evapotranspiration. The study area is Feather River Watershed (780,000 hectares), Northern California. The general approach involved a stepwise sequence of identification of the required information, sample design, measurement/estimation, and evaluation of results. All the relevent and available information types needed in the estimation process are being defined. These include Landsat, meteorological satellite, and aircraft imagery, topographic and geologic data, ground truth data, and climatic data from ground stations. A cost-effective multistage sampling approach was employed in quantification of all the required parameters. The physical and statistical models for both snow quantification and evapotranspiration estimation was developed. These models use the information obtained by aerial and ground data through appropriate statistical sampling design.

Monitoring the health-related labelling of foods and non-alcoholic beverages in retail settings.

PubMed

Rayner, M; Wood, A; Lawrence, M; Mhurchu, C N; Albert, J; Barquera, S; Friel, S; Hawkes, C; Kelly, B; Kumanyika, S; L'abbé, M; Lee, A; Lobstein, T; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Neal, B; Sacks, G; Sanders, D; Snowdon, W; Swinburn, B; Vandevijvere, S; Walker, C

2013-10-01

Food labelling on food packaging has the potential to have both positive and negative effects on diets. Monitoring different aspects of food labelling would help to identify priority policy options to help people make healthier food choices. A taxonomy of the elements of health-related food labelling is proposed. A systematic review of studies that assessed the nature and extent of health-related food labelling has been conducted to identify approaches to monitoring food labelling. A step-wise approach has been developed for independently assessing the nature and extent of health-related food labelling in different countries and over time. Procedures for sampling the food supply, and collecting and analysing data are proposed, as well as quantifiable measurement indicators and benchmarks for health-related food labelling. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Vacuum FTIR observation on hygroscopic properties and phase transition of malonic acid aerosols

NASA Astrophysics Data System (ADS)

Shao, Xu; Zhang, Yun; Pang, Shu-Feng; Zhang, Yun-Hong

2017-02-01

A novel approach based on a combination of a pulse relative humidity (RH) controlling system and a rapid scan vacuum FTIR spectrometer was utilized to investigate the hygroscopic property and phase transition of malonic acid (MA) aerosols. By using this approach, both water vapor amount around the aerosols and water content within aerosols with sub-second time resolution were obtained. Based on the features of FTIR absorbing bands, it can be known that the evolution of hydrogen-bonding structures of malonic acid aerosols took place from (H2O)n-MA to MA-MA accompanying with phase transition in the dehumidifying process. And in present paper, the stepwise efflorescence of MA aerosols and nucleation rates at different RHs are first reported. Our observation has shown that the efflorescence of MA started at ∼17% RH and the nucleation rates increased with decreasing RH.

Method of selective reduction of polyhalosilanes with alkyltin hydrides

DOEpatents

Sharp, Kenneth G.; D'Errico, John J.

1989-01-01

The invention relates to the selective and stepwise reduction of polyhalosilanes by reacting at room temperature or below with alkyltin hydrides without the use of free radical intermediates. Alkyltin hydrides selectively and stepwise reduce the Si--Br, Si--Cl, or Si--I bonds while leaving intact any Si--F bonds. When two or more different halogens are present on the polyhalosilane, the halogen with the highest atomic weight is preferentially reduced.

An Inter-Networking Mechanism with Stepwise Synchronization for Wireless Sensor Networks

PubMed Central

Yamamoto, Hiroshi; Wakamiya, Naoki; Murata, Masayuki

2011-01-01

To realize the ambient information society, multiple wireless networks deployed in the region and devices carried by users are required to cooperate with each other. Since duty cycles and operational frequencies are different among networks, we need a mechanism to allow networks to efficiently exchange messages. For this purpose, we propose a novel inter-networking mechanism where two networks are synchronized with each other in a moderate manner, which we call stepwise synchronization. With our proposal, to bridge the gap between intrinsic operational frequencies, nodes near the border of networks adjust their operational frequencies in a stepwise fashion based on the pulse-coupled oscillator model as a fundamental theory of synchronization. Through simulation experiments, we show that the communication delay and the energy consumption of border nodes are reduced, which enables wireless sensor networks to communicate longer with each other. PMID:22164073

Efficient red organic electroluminescent devices by doping platinum(II) Schiff base emitter into two host materials with stepwise energy levels.

PubMed

Zhou, Liang; Kwok, Chi-Chung; Cheng, Gang; Zhang, Hongjie; Che, Chi-Ming

2013-07-15

In this work, organic electroluminescent (EL) devices with double light-emitting layers (EMLs) having stepwise energy levels were designed to improve the EL performance of a red-light-emitting platinum(II) Schiff base complex. A series of devices with single or double EML(s) were fabricated and characterized. Compared with single-EML devices, double-EML devices showed improved EL efficiency and brightness, attributed to better balance in carriers. In addition, the stepwise distribution in energy levels of host materials is instrumental in broadening the recombination zone, thus delaying the roll-off of EL efficiency. The highest EL current efficiency and power efficiency of 17.36 cd/A and 14.73 lm/W, respectively, were achieved with the optimized double-EML devices. At high brightness of 1000 cd/m², EL efficiency as high as 8.89 cd/A was retained.

Stepwise photochromism of bisnaphthopyrans exhibiting an excitation intensity-dependent color change.

PubMed

Inagaki, Yuki; Mutoh, Katsuya; Abe, Jiro

2018-06-07

Non-linear photoresponses against excitation light intensity are important for the development of attractive photofunctional materials exhibiting high spatial selective photoswitching that is not affected by weak background light. Biphotochromic systems composed of two fast photochromic units have the potential to show a stepwise two-photon absorption process in which the optical properties can be non-linearly controlled by changing the excitation light conditions. Herein, we designed and synthesized novel bisnaphthopyran derivatives containing fast photoswitchable naphthopyran units. The bisnaphthopyran derivatives show a stepwise two-photon-induced photochromic reaction upon UV light irradiation accompanied by a drastic color change due to a large change in the molecular structure between the one-photon product and the two-photon product. Consequently, the color of the bisnaphthopyran derivatives can be non-linearly controlled by changing the excitation intensity. This characteristic photochromic property of the biphotochromic system provides important insight into advanced photoresponsive materials.

CORRELATION PURSUIT: FORWARD STEPWISE VARIABLE SELECTION FOR INDEX MODELS

PubMed Central

Zhong, Wenxuan; Zhang, Tingting; Zhu, Yu; Liu, Jun S.

2012-01-01

In this article, a stepwise procedure, correlation pursuit (COP), is developed for variable selection under the sufficient dimension reduction framework, in which the response variable Y is influenced by the predictors X1, X2, …, Xp through an unknown function of a few linear combinations of them. Unlike linear stepwise regression, COP does not impose a special form of relationship (such as linear) between the response variable and the predictor variables. The COP procedure selects variables that attain the maximum correlation between the transformed response and the linear combination of the variables. Various asymptotic properties of the COP procedure are established, and in particular, its variable selection performance under diverging number of predictors and sample size has been investigated. The excellent empirical performance of the COP procedure in comparison with existing methods are demonstrated by both extensive simulation studies and a real example in functional genomics. PMID:23243388

Working conditions, work style, and job satisfaction among Albanian teachers

NASA Astrophysics Data System (ADS)

Kloep, Marion; Tarifa, Fatos

1994-03-01

For the first time in Albania, a large-scale study investigating teachers' working conditions was conducted. 349 teachers from many parts of the country and from all school levels answered an extensive questionnaire, providing a comprehensive description of their working situation. As data for parts of the study exist from the USA, Germany, Singapore, England, and Poland, results could be discussed in comparison to the conditions in these countries, showing that self-reported job satisfaction and engagement in effective classroom practices is relatively high among Albanian teachers, while the economic and physical conditions are bad. Stepwise regression analyses reveal that the items measuring professional autonomy account for a considerable part of the variance of the job satisfaction measure; while work efficiency is mainly predicted by items measuring social support and, again, professional autonomy.

Developing and validating a predictive model for stroke progression.

PubMed

Craig, L E; Wu, O; Gilmour, H; Barber, M; Langhorne, P

2011-01-01

Progression is believed to be a common and important complication in acute stroke, and has been associated with increased mortality and morbidity. Reliable identification of predictors of early neurological deterioration could potentially benefit routine clinical care. The aim of this study was to identify predictors of early stroke progression using two independent patient cohorts. Two patient cohorts were used for this study - the first cohort formed the training data set, which included consecutive patients admitted to an urban teaching hospital between 2000 and 2002, and the second cohort formed the test data set, which included patients admitted to the same hospital between 2003 and 2004. A standard definition of stroke progression was used. The first cohort (n = 863) was used to develop the model. Variables that were statistically significant (p < 0.1) on univariate analysis were included in the multivariate model. Logistic regression was the technique employed using backward stepwise regression to drop the least significant variables (p > 0.1) in turn. The second cohort (n = 216) was used to test the performance of the model. The performance of the predictive model was assessed in terms of both calibration and discrimination. Multiple imputation methods were used for dealing with the missing values. Variables shown to be significant predictors of stroke progression were conscious level, history of coronary heart disease, presence of hyperosmolarity, CT lesion, living alone on admission, Oxfordshire Community Stroke Project classification, presence of pyrexia and smoking status. The model appears to have reasonable discriminative properties [the median receiver-operating characteristic curve value was 0.72 (range 0.72-0.73)] and to fit well with the observed data, which is indicated by the high goodness-of-fit p value [the median p value from the Hosmer-Lemeshow test was 0.90 (range 0.50-0.92)]. The predictive model developed in this study contains variables that can be easily collected in practice therefore increasing its usability in clinical practice. Using this analysis approach, the discrimination and calibration of the predictive model appear sufficiently high to provide accurate predictions. This study also offers some discussion around the validation of predictive models for wider use in clinical practice.

Explaining outputs of primary health care: population and practice factors.

PubMed Central

Baker, D; Klein, R

1991-01-01

OBJECTIVE--To examine whether variations in the activities of general practice among family health service authorities can be explained by the populations characteristics and the organisation and resourcing of general practice. DESIGN--The family health services authorities were treated as discrete primary health care systems. Nineteen performance indicators reflecting the size, distribution, and characteristics of the population served; the organisation of general practice (inputs); and the activities generated by general practitioners and their staff (output) were analysed by stepwise regression. SETTING--90 family health services authorities in England. MAIN OUTCOME MEASURES--Rates of cervical smear testing, immunisation, prescribing, and night visiting. RESULTS--53% of the variation in uptake of cervical cytology was accounted for by Jarman score (t = -3.3), list inflation (-0.41), the proportion of practitioners over 65 (-0.64), the number of ancillary staff per practitioner (2.5), and 70% of the variation in immunisation rates by standardised mortality ratios (-6.6), the proportion of practitioners aged over 65 (-4.8), and the number of practice nurses per practitioner (3.5). Standardised mortality ratios (8.4), the number of practitioners (2.3), and the proportion over 65 (2.2), and the number of ancillary staff per practitioner (-3.1) accounted for 69% of variation in prescribing rates. 54% of the variation in night visiting was explained by standardised mortality ratios (7.1), the proportion of practitioners with lists sizes below 1000 (-2.2), the proportion aged over 65 (-0.4), and the number of practice nurses per practitioner (-2.5). CONCLUSIONS--Family health services authorities are appropriate systems for studying output of general practice. Their performance indicators need to be refined and to be linked to other relevant factors, notably the performance of hospital, community, and social services. PMID:1653065

Aptitude of psychiatric nurses: conceptual considerations and measurement difficulties.

PubMed

Haspeslagh, M; Delesie, L; Igodt, P

2008-06-01

Patient allocation is common practice in psychiatric nursing. This study investigates nurse aptitude, a sub-concept of competence, to validate and refine patient allocation. The focus is on operationalizing aptitude for daily management purposes. Aptitude varies in function of the tasks to be performed and the therapeutic relationship of each psychiatric nurse with her individual patients. Time, job context, socio-cultural context and semantic frame of reference have also to be taken into account when operationalizing aptitude. Self and peer opinions are a basis for aptitude measurement as patient care and its management are shared among a small team of nurses. A meticulous idio-graphic analysis is necessary. These constraints generate several measurement difficulties that are to be dealt with without too many unrealistic assumptions. The research design enabled reliable aggregation of peer 'on' and 'from' opinions. These allowed confrontation of opinions and identification of bias in these. Stepwise explorative experimentation led to gauging and calibrating a specific aptitude questionnaire to the context of psychiatric nursing. The final version is now being applied in practice in 14 wards of 11 hospitals in Flanders.

Understanding emerging treatment paradigms in rheumatoid arthritis

PubMed Central

2011-01-01

Treatment strategies for rheumatoid arthritis (RA) will continue to evolve as new drugs are developed, as new data become available, and as our potential to achieve greater and more consistent outcomes becomes more routine. Many patients will find both symptom relief and modest control of their disease with disease-modifying antirheumatic drugs (DMARDs), yet this course of therapy is clearly not effective in all patients. In fact, despite strong evidence that intensive treatment in the early stages of RA can slow or stop disease progression and may prevent disability, many patients continue to be managed in a stepwise manner and are treated with an ongoing monotherapy regimen with DMARDs. There is now a large body of evidence demonstrating the success of treating RA patients with anti-TNF therapy, usually in combination with methotrexate. As a result of the increased use of anti-TNF therapy, treatment paradigms have changed – and our practice is beginning to reflect this change. In the present review, we summarize the salient points of several recently proposed and emerging treatment paradigms with an emphasis on how these strategies may impact future practice. PMID:21624182

Understanding emerging treatment paradigms in rheumatoid arthritis.

PubMed

Breedveld, Ferdinand C; Combe, Bernard

2011-05-25

Treatment strategies for rheumatoid arthritis (RA) will continue to evolve as new drugs are developed, as new data become available, and as our potential to achieve greater and more consistent outcomes becomes more routine. Many patients will find both symptom relief and modest control of their disease with disease-modifying antirheumatic drugs (DMARDs), yet this course of therapy is clearly not effective in all patients. In fact, despite strong evidence that intensive treatment in the early stages of RA can slow or stop disease progression and may prevent disability, many patients continue to be managed in a stepwise manner and are treated with an ongoing monotherapy regimen with DMARDs. There is now a large body of evidence demonstrating the success of treating RA patients with anti-TNF therapy, usually in combination with methotrexate. As a result of the increased use of anti-TNF therapy, treatment paradigms have changed - and our practice is beginning to reflect this change. In the present review, we summarize the salient points of several recently proposed and emerging treatment paradigms with an emphasis on how these strategies may impact future practice.

Adaptive evolution of Escherichia coli to Ciprofloxacin in controlled stress environments: emergence of resistance in continuous and step-wise gradients

NASA Astrophysics Data System (ADS)

Deng, J.; Zhou, L.; Dong, Y.; Sanford, R. A.; Shechtman, L. A.; Alcalde, R.; Werth, C. J.; Fouke, B. W.

2017-12-01

Microorganisms in nature have evolved in response to a variety of environmental stresses, including gradients in pH, flow and chemistry. While environmental stresses are generally considered to be the driving force of adaptive evolution, the impact and extent of any specific stress needed to drive such changes has not been well characterized. In this study, a microfluidic diffusion chamber (MDC) and a batch culturing system were used to systematically study the effects of continuous versus step-wise stress increments on adaptation of E. coli to the antibiotic ciprofloxacin. In the MDC, a diffusion gradient of ciprofloxacin was established across a microfluidic well array to microscopically observe changes in Escherichia coli strain 307 replication and migration patterns that would indicate emergence of resistance due to genetic mutations. Cells recovered from the MDC only had resistance of 50-times the original minimum inhibition concentration (MICoriginal) of ciprofloxacin, although minimum exposure concentrations were over 80 × MICoriginal by the end of the experiment. In complementary batch experiments, E. coli 307 were exposed to step-wise daily increases of ciprofloxacin at rates equivalent to 0.1×, 0.2×, 0.4× or 0.8× times MICoriginal/day. Over a period of 18 days, E. coli cells were able to acquire resistance of up to 225 × MICoriginal, with exposure to ciprofloxacin concentration up to only 14.9 × MIC­original. The different levels of acquired resistance in the continuous MDC versus step-wise batch increment experiments suggests that the intrinsic rate of E. coli adaptation was exceeded in the MDC, while the step-wise experiments favor adaptation to the highest ciprofloxacin experiments. Genomic analyses of E. coli DNA extracted from the microfluidic cell and batch cultures indicated four single nucleotide polymorphism (SNP) mutations of amino acid 82, 83 and 87 in the gyrA gene. The progression of adaptation in the step-wise increments of ciprofloxacin indicate that the Ser83-Leu mutation gradually becomes dominant over other gyrA mutations with increased antibiotic resistance. Co-existence of the Ser83-Leu and Asp87—Gly mutations appear to provide the greatest level of resistance (i.e., 85 × to 225 × MICoriginal), and only emerged after the whole community acquired the Ser83—Leu mutation.

Association between sexual role and HIV status among Peruvian men who have sex with men seeking an HIV test: a cross-sectional analysis.

PubMed

McLean, Sarah A; Galea, Jerome T; Prudden, Holly J; Calvo, Gino; Sánchez, Hugo; Brown, Brandon

2016-08-01

In Latin America, sexual role, sexual identity and sexual practices are intricately related; the roles activo, pasivo and moderno often encompass sexual identity and sexual practices. We aimed to understand the association between sexual role and HIV status in Peruvian men who have sex with men. HIV-testing services at Epicentro Salud, a Peruvian gay men's health centre, were paired with clinic data on demographics and sexual behaviour. Bidirectional stepwise logistic regression was conducted to determine associations between sexual role and HIV status. Of 366 clients who underwent HIV testing, 86 (23.5%) tested positive. There was a strong association between sexual role ('activo' or typically insertive, 'pasivo' or typically receptive, 'moderno' or typically versatile) and a positive HIV test (p = 0.002). Compared to clients with an activo role, those who reported a pasivo (OR = 6.14) and moderno (OR = 6.26) role were more likely to test positive for HIV. Sexual role was associated with sexual identity (gay, straight and bisexual) and gender of partners in the past six months. Self-reported pasivo and moderno sexual roles were strongly associated with a positive HIV test result. Further research should examine differences in sexual practices between sexual role groups. © The Author(s) 2016.

Surgical management of coracoid fractures: technical tricks and clinical experience.

PubMed

Hill, Brian W; Jacobson, Aaron R; Anavian, Jack; Cole, Peter A

2014-05-01

The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures; surgical management may be warranted to avoid functional compromise or impingement. A direct approach through Langer's lines allows for easy exposure and direct visualization for an anatomic reduction of simple fractures through the shaft or base of the coracoid. An anterior approach for fractures that extend into the superior glenoid fossa allows for direct exposure to obtain an anatomic articular reduction and indirect reduction of the coracoid fracture. In cases where a complex glenoid or scapula neck/body fracture is being addressed simultaneously either a posterior Judet approach can be used with an indirect reduction method or a separate anterior approach must be combined to address it if not in continuity with the superior scapular segment. Implant selection, primarily interfragmentary screws or a buttress plate, should be based on the size of the fragment, the degree of comminution, and the degree of articular involvement to ensure adequate stabilization. The purpose of this manuscript was to describe a stepwise approach to the surgical management of displaced coracoid fractures, describe surgical tips and techniques, and to present the clinical outcomes in 22 patients after surgical treatment with this approach.

Stepwise synthesis and characterization of germa[4], [5], [8], and [10]pericyclynes.

PubMed

Tanimoto, Hiroki; Nagao, Tomohiko; Fujiwara, Taro; Nishiyama, Yasuhiro; Morimoto, Tsumoru; Suzuka, Toshimasa; Tsutsumi, Ken; Kakiuchi, Kiyomi

2015-07-14

The stepwise syntheses of germa[N]pericyclynes, including [5]pericyclynes, and their characterization are described. The yields of germa[4] and [8]pericyclynes were improved significantly compared to those obtained in previous studies. The routes reported herein afforded the novel germa[5] and [10]pericyclynes, which were characterized by X-ray crystallography, UV-Vis spectroscopy, and fluorescence emission spectroscopy. A unique fluorescence emission was observed for the large germa[10]pericyclyne ring.

Tape transport mechanism

DOEpatents

Groh, Edward F.; McDowell, William; Modjeski, Norbert S.; Keefe, Donald J.; Groer, Peter

1979-01-01

A device is provided for transporting, in a stepwise manner, tape between a feed reel and takeup reel. An indexer moves across the normal path of the tape displacing it while the tape on the takeup reel side of the indexer is braked. After displacement, the takeup reel takes up the displaced tape while the tape on the feed reel side of the indexer is braked, providing stepwise tape transport in precise intervals determined by the amount of displacement caused by the indexer.

Localized, stepwise template growth of functional nanowires from an amino acid-supported framework in a microfluidic chip.

PubMed

Puigmartí-Luis, Josep; Rubio-Martínez, Marta; Imaz, Inhar; Cvetković, Benjamin Z; Abad, Llibertat; Pérez Del Pino, Angel; Maspoch, Daniel; Amabilino, David B

2014-01-28

A spatially controlled synthesis of nanowire bundles of the functional crystalline coordination polymer (CP) Ag(I)TCNQ (tetracyanoquinodimethane) from previously fabricated and trapped monovalent silver CP (Ag(I)Cys (cysteine)) using a room-temperature microfluidic-assisted templated growth method is demonstrated. The incorporation of microengineered pneumatic clamps in a two-layer polydimethylsiloxane-based (PDMS) microfluidic platform was used. Apart from guiding the formation of the Ag(I)Cys coordination polymer, this microfluidic approach enables a local trapping of the in situ synthesized structures with a simple pneumatic clamp actuation. This method not only enables continuous and multiple chemical events to be conducted upon the trapped structures, but the excellent fluid handling ensures a precise chemical activation of the amino acid-supported framework in a position controlled by interface and clamp location that leads to a site-specific growth of Ag(I)TCNQ nanowire bundles. The synthesis is conducted stepwise starting with Ag(I)Cys CPs, going through silver metal, and back to a functional CP (Ag(I)TCNQ); that is, a novel microfluidic controlled ligand exchange (CP → NP → CP) is presented. Additionally, the pneumatic clamps can be employed further to integrate the conductive Ag(I)TCNQ nanowire bundles onto electrode arrays located on a surface, hence facilitating the construction of the final functional interfaced systems from solution specifically with no need for postassembly manipulation. This localized self-supported growth of functional matter from an amino acid-based CP shows how sequential localized chemistry in a fluid cell can be used to integrate molecular systems onto device platforms using a chip incorporating microengineered pneumatic tools. The control of clamp pressure and in parallel the variation of relative flow rates of source solutions permit deposition of materials at different locations on a chip that could be useful for device array preparation. The in situ reaction and washing procedures make this approach a powerful one for the fabrication of multicomponent complex nanomaterials using a soft bottom-up approach.

Evaluation of alternative model selection criteria in the analysis of unimodal response curves using CART

USGS Publications Warehouse

Ribic, C.A.; Miller, T.W.

1998-01-01

We investigated CART performance with a unimodal response curve for one continuous response and four continuous explanatory variables, where two variables were important (ie directly related to the response) and the other two were not. We explored performance under three relationship strengths and two explanatory variable conditions: equal importance and one variable four times as important as the other. We compared CART variable selection performance using three tree-selection rules ('minimum risk', 'minimum risk complexity', 'one standard error') to stepwise polynomial ordinary least squares (OLS) under four sample size conditions. The one-standard-error and minimum-risk-complexity methods performed about as well as stepwise OLS with large sample sizes when the relationship was strong. With weaker relationships, equally important explanatory variables and larger sample sizes, the one-standard-error and minimum-risk-complexity rules performed better than stepwise OLS. With weaker relationships and explanatory variables of unequal importance, tree-structured methods did not perform as well as stepwise OLS. Comparing performance within tree-structured methods, with a strong relationship and equally important explanatory variables, the one-standard-error-rule was more likely to choose the correct model than were the other tree-selection rules 1) with weaker relationships and equally important explanatory variables; and 2) under all relationship strengths when explanatory variables were of unequal importance and sample sizes were lower.

Improved model of the retardance in citric acid coated ferrofluids using stepwise regression

NASA Astrophysics Data System (ADS)

Lin, J. F.; Qiu, X. R.

2017-06-01

Citric acid (CA) coated Fe3O4 ferrofluids (FFs) have been conducted for biomedical application. The magneto-optical retardance of CA coated FFs was measured by a Stokes polarimeter. Optimization and multiple regression of retardance in FFs were executed by Taguchi method and Microsoft Excel previously, and the F value of regression model was large enough. However, the model executed by Excel was not systematic. Instead we adopted the stepwise regression to model the retardance of CA coated FFs. From the results of stepwise regression by MATLAB, the developed model had highly predictable ability owing to F of 2.55897e+7 and correlation coefficient of one. The average absolute error of predicted retardances to measured retardances was just 0.0044%. Using the genetic algorithm (GA) in MATLAB, the optimized parametric combination was determined as [4.709 0.12 39.998 70.006] corresponding to the pH of suspension, molar ratio of CA to Fe3O4, CA volume, and coating temperature. The maximum retardance was found as 31.712°, close to that obtained by evolutionary solver in Excel and a relative error of -0.013%. Above all, the stepwise regression method was successfully used to model the retardance of CA coated FFs, and the maximum global retardance was determined by the use of GA.

Impacts of different climate change regimes and extreme climatic events on an alpine meadow community

PubMed Central

Alatalo, Juha M.; Jägerbrand, Annika K.; Molau, Ulf

2016-01-01

Climate variability is expected to increase in future but there exist very few experimental studies that apply different warming regimes on plant communities over several years. We studied an alpine meadow community under three warming regimes over three years. Treatments consisted of (a) a constant level of warming with open-top chambers (ca. 1.9 °C above ambient), (b) yearly stepwise increases in warming (increases of ca. 1.0, 1.9 and 3.5 °C), and (c) pulse warming, a single first-year pulse event of warming (increase of ca. 3.5 °C). Pulse warming and stepwise warming was hypothesised to cause distinct first-year and third-year effects, respectively. We found support for both hypotheses; however, the responses varied among measurement levels (whole community, canopy, bottom layer, and plant functional groups), treatments, and time. Our study revealed complex responses of the alpine plant community to the different experimentally imposed climate warming regimes. Plant cover, height and biomass frequently responded distinctly to the constant level of warming, the stepwise increase in warming and the extreme pulse-warming event. Notably, we found that stepwise warming had an accumulating effect on biomass, the responses to the different warming regimes varied among functional groups, and the short-term perturbations had negative effect on species richness and diversity PMID:26888225

Sexual dimorphism of the mandible in a contemporary Chinese Han population.

PubMed

Dong, Hongmei; Deng, Mohong; Wang, WenPeng; Zhang, Ji; Mu, Jiao; Zhu, Guanghui

2015-10-01

A present limitation of forensic anthropology practice in China is the lack of population-specific criteria on contemporary human skeletons. In this study, a sample of 203 maxillofacial Cone beam computed tomography (CBCT) images, including 96 male and 107 female cases (20-65 years old), was analyzed to explore mandible sexual dimorphism in a population of contemporary adult Han Chinese to investigate the potential use of the mandible as sex indicator. A three-dimensional image from mandible CBCT scans was reconstructed using the SimPlant Pro 11.40 software. Nine linear and two angular parameters were measured. Discriminant function analysis (DFA) and logistic regression analysis (LRA) were used to develop the mathematics models for sex determination. All of the linear measurements studied and one angular measurement were found to be sexually dimorphic, with the maximum mandibular length and bi-condylar breadth being the most dimorphic by univariate DFA and LRA respectively. The cross-validated sex allocation accuracies on multivariate were ranged from 84.2% (direct DFA), 83.5% (direct LRA), 83.3% (stepwise DFA) to 80.5% (stepwise LRA). In general, multivariate DFA yielded a higher accuracy and LRA obtained a lower sex bias, and therefore both DFA and LRA had their own advantages for sex determination by the mandible in this sample. These results suggest that the mandible expresses sexual dimorphism in the contemporary adult Han Chinese population, indicating an excellent sexual discriminatory ability. Cone beam computed tomography scanning can be used as alternative source for contemporary osteometric techniques. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Periprosthetic joint infections: a clinical practice algorithm.

PubMed

Volpe, Luigi; Indelli, Pier Francesco; Latella, Leonardo; Poli, Paolo; Yakupoglu, Jale; Marcucci, Massimiliano

2014-01-01

periprosthetic joint infection (PJI) accounts for 25% of failed total knee arthroplasties (TKAs) and 15% of failed total hip arthroplasties (THAs). The purpose of the present study was to design a multidisciplinary diagnostic algorithm to detect a PJI as cause of a painful TKA or THA. from April 2010 to October 2012, 111 patients with suspected PJI were evaluated. The study group comprised 75 females and 36 males with an average age of 71 years (range, 48 to 94 years). Eighty-four patients had a painful THA, while 27 reported a painful TKA. The stepwise diagnostic algorithm, applied in all the patients, included: measurement of serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels; imaging studies, including standard radiological examination, standard technetium-99m-methylene diphosphonate (MDP) bone scan (if positive, confirmation by LeukoScan was obtained); and joint aspiration with analysis of synovial fluid. following application of the stepwise diagnostic algorithm, 24 out of our 111 screened patients were classified as having a suspected PJI (21.7%). CRP and ESR levels were negative in 84 and positive in 17 cases; 93.7% of the patients had a positive technetium-labeled bone scan, and 23% a positive LeukoScan. Preoperative synovial fluid analysis was positive in 13.5%; analysis of synovial fluid obtained by preoperative aspiration showed a leucocyte count of > 3000 cells μ/l in 52% of the patients. the present study showed that the diagnosis of PJI requires the application of a multimodal diagnostic protocol in order to avoid complications related to surgical revision of a misdiagnosed "silent" PJI. Level IV, therapeutic case series.

Prostate intensity-modulated radiotherapy planning in seven mouse clicks: Development of a class solution for cancer.

PubMed

Wood, Maree; Fonseca, Amara; Sampson, David; Kovendy, Andrew; Westhuyzen, Justin; Shakespeare, Thomas; Turnbull, Kirsty

2016-01-01

The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA). Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner. Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit ( n  = 20); Stage 3, template review ( n  = 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients. The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency. It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.

Quantitative and Mechanistic Assessment of Model Lipophilic Drugs in Micellar Solutions in the Transport Kinetics Across MDR1-MDCK Cell Monolayers.

PubMed

Ho, Norman F H; Nielsen, James; Peterson, Michelle; Burton, Philip S

2016-02-01

An approach to characterizing P-glycoprotein (Pgp) interaction potential for sparingly water-soluble compounds was developed using bidirectional transport kinetics in MDR1-MDCK cell monolayers. Paclitaxel, solubilized in a dilute polysorbate 80 (PS80) micellar solution, was used as a practical example. Although the passage of paclitaxel across the cell monolayer was initially governed by the thermodynamic activity of the micelle-solubilized drug solution, Pgp inhibition was sustained by the thermodynamic activity (i.e., critical micelle concentration) of the PS80 micellar solution bathing the apical (ap) membrane. The mechanistic understanding of the experimental strategies and treatment of data was supported by a biophysical model expressed in the form of transport events occurring at the ap and basolateral (bl) membranes in series whereas the vectorial directions of the transcellular kinetics were accommodated. The derived equations permitted the stepwise quantitative delineation of the Pgp efflux activity (inhibited and uninhibited by PS80) and the passive permeability coefficient of the ap membrane, the passive permeability at the bl membrane and, finally, the distinct coupling of these with efflux pump activity to identify the rate-determining steps and mechanisms. The Jmax/KM(∗) for paclitaxel was in the order of 10(-4) cm/s and the ap- and bl-membrane passive permeability coefficients were asymmetric, with bl-membrane permeability significantly greater than ap. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Lost in translation: assessing effectiveness of focus group questioning techniques to develop improved translation of terminology used in HIV prevention clinical trials.

PubMed

Mack, Natasha; Ramirez, Catalina B; Friedland, Barbara; Nnko, Soori

2013-01-01

Achieving participant comprehension has proven to be one of the most difficult, practical, and ethical challenges of HIV prevention clinical trials. It becomes even more challenging when local languages do not have equivalent scientific and technical vocabularies, rendering communication of scientific concepts in translated documents extremely difficult. Even when bilingual lexicons are developed, there is no guarantee that participants understand the terminology as translated. We conducted twelve focus groups with women of reproductive age in Mwanza, Tanzania to explore the effectiveness of four questioning techniques for: (1) assessing participants' familiarity with existing technical terms and concepts, (2) generating a list of acceptable technical and non-technical terms, (3) testing our definitions of technical terms, and (4) verifying participants' preferences for terms. Focus groups were transcribed, translated, and qualitatively analyzed. A translation process that uses all four questioning techniques in a step-wise approach is an effective way to establish a baseline understanding of participants' familiarity with research terms, to develop and test translatable definitions, and to identify participants' preferred terminology for international HIV clinical research. This may help to ensure that important concepts are not "lost in translation." The results emphasize the importance of using a variety of techniques depending on the level of participant familiarity with research concepts, the existence of colloquial or technical terms in the target language, and the inherent complexity of the terms.

A robust and efficient stepwise regression method for building sparse polynomial chaos expansions

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

Abraham, Simon, E-mail: Simon.Abraham@ulb.ac.be; Raisee, Mehrdad; Ghorbaniasl, Ghader

2017-03-01

Polynomial Chaos (PC) expansions are widely used in various engineering fields for quantifying uncertainties arising from uncertain parameters. The computational cost of classical PC solution schemes is unaffordable as the number of deterministic simulations to be calculated grows dramatically with the number of stochastic dimension. This considerably restricts the practical use of PC at the industrial level. A common approach to address such problems is to make use of sparse PC expansions. This paper presents a non-intrusive regression-based method for building sparse PC expansions. The most important PC contributions are detected sequentially through an automatic search procedure. The variable selectionmore » criterion is based on efficient tools relevant to probabilistic method. Two benchmark analytical functions are used to validate the proposed algorithm. The computational efficiency of the method is then illustrated by a more realistic CFD application, consisting of the non-deterministic flow around a transonic airfoil subject to geometrical uncertainties. To assess the performance of the developed methodology, a detailed comparison is made with the well established LAR-based selection technique. The results show that the developed sparse regression technique is able to identify the most significant PC contributions describing the problem. Moreover, the most important stochastic features are captured at a reduced computational cost compared to the LAR method. The results also demonstrate the superior robustness of the method by repeating the analyses using random experimental designs.« less

Assessment of Tooth Wear Among Glass Factory Workers: WHO 2013 Oral Health Survey

PubMed Central

Bhat, Nagesh; Asawa, Kailash; Tak, Mridula; Bapat, Salil; Gupta, Vivek Vardhan

2015-01-01

Background Glass factory workers are often exposed to the hazardous environment that leads to deleterious oral health and subsequently, general health. We planned to determine the effects of the particulates present in the milieu on the tooth wear among workers. Aim To assess tooth wear among glass factory workers in Jaipur, Rajasthan, India. Settings and Design A descriptive cross-sectional survey was conducted among 936 glass workers in Jaipur, Rajasthan, India from January-June 2014. Materials and Methods A survey proforma was designed for tooth wear evaluation with the help of WHO Oral Health Assessment form 2013 (for adults). Information regarding oral health practices, adverse habits and dietary habits, demographic details was gathered and clinical parameters were recorded. Statistical Analysis The Chi–square test, t–test, One-way Analysis of Variance and a Stepwise multiple linear regression analysis. Results The most prevalent form of erosion was enamel erosion (589, 62.93%) with few subjects of deeper dentinal erosion and the difference was statistically significant (p=0.001). Dental erosion was found to be higher among males compared to females. Years of experience and educational status were identified as best predictors for dental erosion. Conclusion It was concluded that there was considerable evidence of dental erosion found among the factory workers. Due to ignorance on social, cultural and health aspects, professional approach with regular dental care services for detection of early symptoms and planning of preventive strategies is warranted. PMID:26436050

Lost in Translation: Assessing Effectiveness of Focus Group Questioning Techniques to Develop Improved Translation of Terminology Used in HIV Prevention Clinical Trials

PubMed Central

Mack, Natasha; Ramirez, Catalina B.; Friedland, Barbara; Nnko, Soori

2013-01-01

Introduction Achieving participant comprehension has proven to be one of the most difficult, practical, and ethical challenges of HIV prevention clinical trials. It becomes even more challenging when local languages do not have equivalent scientific and technical vocabularies, rendering communication of scientific concepts in translated documents extremely difficult. Even when bilingual lexicons are developed, there is no guarantee that participants understand the terminology as translated. Methods We conducted twelve focus groups with women of reproductive age in Mwanza, Tanzania to explore the effectiveness of four questioning techniques for: (1) assessing participants' familiarity with existing technical terms and concepts, (2) generating a list of acceptable technical and non-technical terms, (3) testing our definitions of technical terms, and (4) verifying participants' preferences for terms. Focus groups were transcribed, translated, and qualitatively analyzed. Results and Discussion A translation process that uses all four questioning techniques in a step-wise approach is an effective way to establish a baseline understanding of participants' familiarity with research terms, to develop and test translatable definitions, and to identify participants' preferred terminology for international HIV clinical research. This may help to ensure that important concepts are not “lost in translation.” The results emphasize the importance of using a variety of techniques depending on the level of participant familiarity with research concepts, the existence of colloquial or technical terms in the target language, and the inherent complexity of the terms. PMID:24040075

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients.

PubMed

Sutcliffe, Robert P; Hollyman, Marianne; Hodson, James; Bonney, Glenn; Vohra, Ravi S; Griffiths, Ewen A

2016-11-01

Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Using a gamified monitoring app to change adolescents' snack intake: the development of the REWARD app and evaluation design.

PubMed

Van Lippevelde, W; Vangeel, J; De Cock, N; Lachat, C; Goossens, L; Beullens, K; Vervoort, L; Braet, C; Maes, L; Eggermont, S; Deforche, B; Van Camp, J

2016-08-05

As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds. The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents. When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs). NCT02622165 registrated November 15, 2015 on clinicaltrials.gov.

Update on perioperative care of the cardiac patient for noncardiac surgery.

PubMed

Ghadimi, Kamrouz; Thompson, Annemarie

2015-06-01

The current review will address key topics and recommendations of the recent 2014 update of the American College of Cardiology and American Heart Association clinical practice guideline for the perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. The completely rewritten guideline provides a stepwise approach for the identification and management of patients at highest risk for major adverse cardiac events and discusses new or updated recommendations. For example, β-blockers should be continued perioperatively but treatment should not be initiated within 24 h of noncardiac surgery. Angiotensin-converting enzyme inhibitors should be continued, but if held, may be restarted as soon as feasible. Routine aspirin therapy is not recommended without previous coronary stent implantation or risk assessment for myocardial ischemia. Elective noncardiac surgery should not be performed within 30 days of bare metal stent or 12 months of drug-eluting stent implantation because of in-stent thrombosis as well as bleeding risk from dual antiplatelet therapy during surgery. Noncardiac surgery may be considered, however, in patients on antiplatelet agents 180 days after drug-eluting stent placement if risk of surgical delay exceeds risk of stent thrombosis from cessation of antiplatelet therapy. In conclusion, this review will discuss the important topics from the 2014 American College of Cardiology/American Heart Association guideline in order to provide the perioperative physician with the most recent evidence necessary to minimize major adverse cardiac events in patients undergoing noncardiac surgery.

Complete biodegradation of chlorpyrifos by engineered Pseudomonas putida cells expressing surface-immobilized laccases.

PubMed

Liu, Jin; Tan, Luming; Wang, Jing; Wang, Zhiyong; Ni, Hong; Li, Lin

2016-08-01

The long-term abuse use of chlorpyrifos-like pesticides in agriculture and horticulture has resulted in significant soil or water contamination and a worldwide ecosystem threat. In this study, the ability of a solvent-tolerant bacterium, Pseudomonas putida MB285, with surface-displayed bacterial laccase, to biodegrade chlorpyrifos was investigated. The results of compositional analyses of the degraded products demonstrate that the engineered MB285 was capable of completely eliminating chlorpyrifos via direct biodegradation, as determined by high-performance liquid chromatography and gas chromatography-mass spectrometry assays. Two intermediate metabolites, namely 3,5,6-trichloro-2-pyridinol (TCP) and diethyl phosphate, were temporarily detectable, verifying the joint and stepwise degradation of chlorpyrifos by surface laccases and certain cellular enzymes, whereas the purified free laccase incompletely degraded chlorpyrifos into TCP. The degradation reaction can be conducted over a wide range of pH values (2-7) and temperatures (5-55 °C) without the need for Cu(2+). Bioassays using Caenorhabditis elegans as an indicator organism demonstrated that the medium was completely detoxified of chlorpyrifos by degradation. Moreover, the engineered cells exhibited a high capacity of repeated degradation and good performance in continuous degradation cycles, as well as a high capacity to degrade real effluents containing chlorpyrifos. Therefore, the developed system exhibited a high degradation capacity and performance and constitutes an improved approach to address chlorpyrifos contamination in chlorpyrifos-remediation practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Stepwise sequential analysis of stable multiradicals formation in polyphenolic myricetin active OH groups throughout the antioxidant process to scavenge free radicals

NASA Astrophysics Data System (ADS)

Barzegar, Abolfazl; Rezaei-Sadabady, Rogaie

2017-10-01

Five galvinoxyl radicals (Grad) reduction by one polyphenolic myricetin (Myc, 3,3‧,4‧,5,5‧,7-Hexahydroxyflavone) molecule-using EPR method-demonstrated that each Myc should donate at least five H atoms resulted in multiradicals Myc5rad (5 Grad + 1Myc → 5 GH + 1 Myc5rad). The process that five H atoms donation occurs from different OH sites of Myc lead to appearing of five unpaired valence electrons of Myc5rad via two possible different mechanisms. First; concerted five H atoms donation from five different OH groups that directly results in Myc5rad radicals (Myc → Myc5rad). Second; the step-wise radical formation in five different OH groups of Myc (Myc → Mycrad → Myc2rad → Myc3rad → Myc4rad → Myc5rad). Computational DFT method was used to analyze all the six different OH groups of Myc which involved in free radical reactions for the purposes of clarification the stable multiradicals Myc5rad formation mechanism. The fast semi-empirical combined quantum method, AM1/DFT, as well as full DFT geometry optimization approaches of B3LYP functional DFT/DFT with different basis sets of 6-31G (d), 6-311 + G (d,p) and 6-311 + G (2d,2p) confirmed the stepwise H atom abstraction trend on the main three hydroxyl sites as 4‧-Orad → 4‧-Orad3-Orad → 4‧-Orad3-Orad-7Orad both in the gas and water phase. Spin delocalization over the entire Myc, adding the co-planarity, contributed to the stabilization of respective radical species. The excellent stability of Myc radicals should give an effective chain-breaking antioxidant activity for Myc in biological environment which is expected to have far fewer side effects. These findings may be useful to elucidate the radical scavenging mechanism of other flavonoids regarding to design novel antioxidants.

Easy assessment of the biocompatibility of Ni-Ti alloys by in vitro cell culture experiments on a functionally graded Ni-NiTi-Ti material.

PubMed

Bogdanski, Denise; Köller, Manfred; Müller, Dietmar; Muhr, Gert; Bram, Martin; Buchkremer, Hans Peter; Stöver, Detlev; Choi, Jongsik; Epple, Matthias

2002-12-01

The biocompatibility of nickel-titanium alloys was investigated by single-culture experiments on functionally graded samples with a stepwise change in composition from pure nickel to pure titanium, including an Ni-Ti shape memory alloy for a 50:50 mixture. This approach permitted a considerable decrease of experimental resources by simultaneously studying a full variation of composition. The results indicate a good biocompatibility for a nickel content up to about 50%. The cells used in the biocompatibility studies comprised osteoblast-like osteosarcoma cells (SAOS-2, MG-63), primary human osteoblasts (HOB), and murine fibroblasts (3T3).

[Role of cytology in hematopathological diagnostics].

PubMed

Bode, B; Tinguely, M

2012-07-01

The role of cytology has so far been underrecognized in the diagnostic process of hematopathological questions. This article presents an algorithm which allows a stepwise work-up of cytology specimens obtained by minimally invasive ultrasound-guided fine needle aspiration in patients with unexplained lymph node swelling. Moreover, it is shown how the selective separation of cytology specimens allows the application of immunophenotypic analysis including flow cytometry and immunohistochemistry as well as molecular analyses, such as fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) strategies. With the integrative procedure presented, cytology offers an excellent cost-effective tool for the diagnostic approach of patients with suspected hematopathological malignancies allowing a high diagnostic accuracy, ideal for initial diagnosis or follow-up.

Endoglycosidase and glycoamidase release of N-linked oligosaccharides.

PubMed

Freeze, H H

2001-05-01

Carbohydrate chain modifications are often used to monitor glycoprotein movement through the secretory pathway. This is because stepwise sugar-chain processing is unidirectional and generally corresponds to the forward or anterograde movement of proteins. This unit offers a group of techniques that will help analyze the general structure of carbohydrate chains on a protein and, therefore, oligosaccharide processing mileposts. The sugar chains themselves are not analyzed, but their presence and structure are inferred from gel mobility differences after one or more enzymatic digestions. This approach is most often used in combination with [35S]Met pulse-chase metabolic labeling protocols, but they can be applied to any suitably labeled protein (e.g., biotinylated or 125I-labeled).

"I write to know what I think": a four-year writing curriculum.

PubMed

Lister, Elena; Kravis, Nathan; Sandberg, Larry; Halpern, Jeffrey K; Cabaniss, Deborah L; Singer, Meriamne B

2008-12-01

The four-year writing curriculum of the Columbia Center for Psychoanalytic Training and Research has as its main objective to teach candidates to learn about analysis through writing. Learning to write about analyses ultimately entails learning to clarify and then express how one thinks and functions as an analyst. Since its inception ten years ago, the program has evolved into its current structure, a stepwise approach through the years of candidate training based on a didactic method called "layering." For each level of the course, candidates' typical writing difficulties are examined, and examples given of write-ups and how they were used in teaching. The essential role of the faculty experience is also described.

Integrated Mecical Model (IMM) 4.0 Verification and Validation (VV) Testing (HRP IWS 2016)

NASA Technical Reports Server (NTRS)

Walton, M; Kerstman, E.; Arellano, J.; Boley, L.; Reyes, D.; Young, M.; Garcia, Y.; Saile, L.; Myers, J.

2016-01-01

Timeline, partial treatment, and alternate medications were added to the IMM to improve the fidelity of this model to enhance decision support capabilities. Using standard design reference missions, IMM VV testing compared outputs from the current operational IMM (v3) with those from the model with added functionalities (v4). These new capabilities were examined in a comparative, stepwise approach as follows: a) comparison of the current operational IMM v3 with the enhanced functionality of timeline alone (IMM 4.T), b) comparison of IMM 4.T with the timeline and partial treatment (IMM 4.TPT), and c) comparison of IMM 4.TPT with timeline, partial treatment and alternative medication (IMM 4.0).

Concussion management in collegiate student-athletes: return-to-academics recommendations.

PubMed

Hall, Eric E; Ketcham, Caroline J; Crenshaw, Cayce R; Baker, Martin H; McConnell, Jodi M; Patel, Kirtida

2015-05-01

Concussions in collegiate athletics can affect student-athletes both on the field and in the classroom. As policies are made to outline return-to-play decisions and timelines, this article will make the case that return-to-academics should also be included and follow a step-wise protocol. Complete cognitive rest is a cornerstone of concussion recovery and slow reintroduction to academics should precede return-to-play. The college structure allows for student-athletes to begin small doses of cognitive activity after the recommended complete cognitive rest. It is recommended that return-to-academics involves a team approach to help the student-athlete navigate the responsibilities of course work while healing from a brain injury.

Critically Underdeveloped Left Heart Morphology Associated with Prematurity and Low Birth Weight: Conditional Staged Rehabilitation Towards Biventricular Repair and Time-Related Growth of Left Heart Structures.

PubMed

Ahmad, Fareed; Mangano, Robert; Shore, Shirah; Polimenakos, Anastasios

2017-10-01

This is a case report of premature low birth weight infant with hypoplasia of left heart structures and a large malaligned VSD who underwent successful staged approach of biventricular repair. We obtained qualitative and quantitative echocardiographic, MRI, and conventional catheterization data to support stepwise strategy towards LV rehabilitation to sustain adequate cardiac output. A thorough and intense follow-up has shown significant growth of left heart structures and favorable clinical status following staged biventricular repair. Our data indicate usefulness of qualitative and quantitative advanced complimentary multi-imaging modalities in predicting the postnatal growth potential of critically underdeveloped left heart structures.

Management of Infrapopliteal Arterial Disease: Critical Limb Ischemia.

PubMed

Mustapha, Jihad A; Diaz-Sandoval, Larry J

2014-10-01

According to the TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease, "there is increasing evidence to support a recommendation for angioplasty in patients with critical limb ischemia and infrapopliteal artery occlusion." Management of infrapopliteal artery disease starts with diagnosis using modern preprocedural noninvasive and invasive imaging. Interventionalists need to learn the role of chronic total occlusion cap analysis and collateral zone recognition in angiosome-directed interventions for management of critical limb ischemia and be familiar with equipment and device selection and a stepwise approach for endovascular interventions. Interventionalists need to know which crossing tools to use to successfully cross-complex chronic total occlusion caps. Copyright © 2014 Elsevier Inc. All rights reserved.

Status Epilepticus

PubMed Central

Manno, Edward M.

2011-01-01

Status epilepticus is a neurological emergency that is commonly encountered by the neurohospitalist. Successful treatment depends upon the recognition of prolonged seizure activity and the acute mobilization of available resources. Pharmacologic treatment regimens have been shown to decrease the time needed for successful control of seizures and have provided for the rapid administration of anticonvulsant medications. Treatment strategies have evolved so that clinicians can administer effective doses of medication by whatever routes of administration are immediately available. Traditional algorithms for the treatment of status epilepticus have used a stepwise approach to the administration of first-, second-, and third-order medications. More recent options have included aggressive anesthetic doses of medications while second-line medications are being titrated. PMID:23983834

Generation of glucose-responsive, insulin-producing cells from human umbilical cord blood-derived mesenchymal stem cells.

PubMed

Prabakar, Kamalaveni R; Domínguez-Bendala, Juan; Molano, R Damaris; Pileggi, Antonello; Villate, Susana; Ricordi, Camillo; Inverardi, Luca

2012-01-01

We sought to assess the potential of human cord blood-derived mesenchymal stem cells (CB-MSCs) to derive insulin-producing, glucose-responsive cells. We show here that differentiation protocols based on stepwise culture conditions initially described for human embryonic stem cells (hESCs) lead to differentiation of cord blood-derived precursors towards a pancreatic endocrine phenotype, as assessed by marker expression and in vitro glucose-regulated insulin secretion. Transplantation of these cells in immune-deficient animals shows human C-peptide production in response to a glucose challenge. These data suggest that human cord blood may be a promising source for regenerative medicine approaches for the treatment of diabetes mellitus.

Assessment of factors that predict physical activity among Oklahoma clergy: a theory of planned behavior approach.

PubMed

Gwin, Shannon; Taylor, E Laurette; Branscum, Paul; Hofford, Craig

2013-01-01

The purpose of this study was to examine predictors of physical activity among clergy members in Oklahoma, using the theory of planned behavior. A 51-item valid and reliable instrument, measuring theory of planned behavior constructs and physical activity, was developed and administered to 141 clergy members. Results indicated that the majority of those surveyed were white (93%), college educated (97%), and overweight or obese (84%). Stepwise multiple regression analysis found that intentions accounted for 13.8% of the variance of physical activity whereas attitudes, subjective norms, and perceived behavioral control accounted for 54.8% of the variance of intention. Implications for intervention development are discussed.

Voltage-Clamp Studies on Uterine Smooth Muscle

PubMed Central

Anderson, Nels C.

1969-01-01

These studies have developed and tested an experimental approach to the study of membrane ionic conductance mechanisms in strips of uterine smooth muscle. The experimental and theoretical basis for applying the double sucrose-gap technique is described along with the limitations of this system. Nonpropagating membrane action potentials were produced in response to depolarizing current pulses under current-clamp conditions. The stepwise change of membrane potential under voltage-clamp conditions resulted in a family of ionic currents with voltage- and time-dependent characteristics. In sodium-free solution the peak transient current decreased and its equilibrium potential shifted along the voltage axis toward a more negative internal potential. These studies indicate a sodium-dependent, regenerative excitation mechanism. PMID:5796366

The impact of intrinsic and extrinsic factors on the job satisfaction of dentists.

PubMed

Goetz, K; Campbell, S M; Broge, B; Dörfer, C E; Brodowski, M; Szecsenyi, J

2012-10-01

The Two-Factor Theory of job satisfaction distinguishes between intrinsic-motivation (i.e. recognition, responsibility) and extrinsic-hygiene (i.e. job security, salary, working conditions) factors. The presence of intrinsic-motivation facilitates higher satisfaction and performance, whereas the absences of extrinsic factors help mitigate against dissatisfaction. The consideration of these factors and their impact on dentists' job satisfaction is essential for the recruitment and retention of dentists. The objective of the study is to assess the level of job satisfaction of German dentists and the factors that are associated with it. This cross-sectional study was based on a job satisfaction survey. Data were collected from 147 dentists working in 106 dental practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Organizational characteristics were measured with two items. Linear regression analyses were performed in which each of the nine items of the job satisfaction scale (excluding overall satisfaction) were handled as dependent variables. A stepwise linear regression analysis was performed with overall job satisfaction as the dependent outcome variable, the nine items of job satisfaction and the two items of organizational characteristics controlled for age and gender as predictors. The response rate was 95.0%. Dentists were satisfied with 'freedom of working method' and mostly dissatisfied with their 'income'. Both variables are extrinsic factors. The regression analyses identified five items that were significantly associated with each item of the job satisfaction scale: 'age', 'mean weekly working time', 'period in the practice', 'number of dentist's assistant' and 'working atmosphere'. Within the stepwise linear regression analysis the intrinsic factor 'opportunity to use abilities' (β = 0.687) showed the highest score of explained variance (R(2) = 0.468) regarding overall job satisfaction. With respect to the Two-Factor Theory of job satisfaction both components, intrinsic and extrinsic, are essential for dentists but the presence of intrinsic motivating factors like the opportunity to use abilities has most positive impact on job satisfaction. The findings of this study will be helpful for further activities to improve the working conditions of dentists and to ensure quality of care. © 2012 John Wiley & Sons A/S.

Prediction of Carcass Composition Using Carcass Grading Traits in Hanwoo Steers.

PubMed

Lee, Jooyoung; Won, Seunggun; Lee, Jeongkoo; Kim, Jongbok

2016-09-01

The prediction of carcass composition in Hanwoo steers is very important for value-based marketing, and the improvement of prediction accuracy and precision can be achieved through the analyses of independent variables using a prediction equation with a sufficient dataset. The present study was conducted to develop a prediction equation for Hanwoo carcass composition for which data was collected from 7,907 Hanwoo steers raised at a private farm in Gangwon Province, South Korea, and slaughtered in the period between January 2009 and September 2014. Carcass traits such as carcass weight (CWT), back fat thickness (BFT), eye-muscle area (EMA), and marbling score (MAR) were used as independent variables for the development of a prediction equation for carcass composition, such as retail cut weight and percentage (RC, and %RC, respectively), trimmed fat weight and percentage (FAT, and %FAT, respectively), and separated bone weight and percentage (BONE, and %BONE), and its feasibility for practical use was evaluated using the estimated retail yield percentage (ELP) currently used in Korea. The equations were functions of all the variables, and the significance was estimated via stepwise regression analyses. Further, the model equations were verified by means of the residual standard deviation and the coefficient of determination (R(2)) between the predicted and observed values. As the results of stepwise analyses, CWT was the most important single variable in the equation for RC and FAT, and BFT was the most important variable for the equation of %RC and %FAT. The precision and accuracy of three variable equation consisting CWT, BFT, and EMA were very similar to those of four variable equation that included all for independent variables (CWT, BFT, EMA, and MAR) in RC and FAT, while the three variable equations provided a more accurate prediction for %RC. Consequently, the three-variable equation might be more appropriate for practical use than the four-variable equation based on its easy and cost-effective measurement. However, a relatively high average difference for the ELP in absolute value implies a revision of the official equation may be required, although the current official equation for predicting RC with three variables is still valid.

Needlestick Injuries in Interventional Radiology Are Common and Underreported.

PubMed

Deipolyi, Amy R; Prabhakar, Anand M; Naidu, Sailendra; Oklu, Rahmi

2017-12-01

Purpose To determine the prevalence of and risk factors for needlesticks in interventional radiology physicians, as well as the attitudes, behaviors, and conditions that promote or interfere with reporting of these injuries. Materials and Methods A total of 3889 interventional radiologists from academic and private practice in the United States were surveyed by emailing all interventional radiologist members of the Society of Interventional Radiology, including attending-level physicians and trainees (April-August 2016). The institutional review board waived the need for consent. Questions inquired about the nature, frequency, and type of needlestick and sharps injuries and whether and to whom these incidents were reported. Stepwise regression was used to determine variables predicting whether injuries were reported. Results In total, 908 (23%) interventional radiologists completed at least a portion of the survey. Eight hundred fourteen (91%) of 895 respondents reported a prior needlestick injury, 583 (35%) of 895 reported at least one injury while treating an HIV-positive patient, and 626 (71%) of 884 reported prior training regarding needlestick injury. There was, on average, one needlestick for every 5 years of practice. Most needlestick or sharps injuries were self inflicted (711 [87%] of 817) and involved a hollow-bore device (464 [56%] of 824). Only 566 (66%) of 850 injuries were reported. The most common reasons for not reporting included perceived lack of utility of reporting (79 [28%] of 282), perceived low risk for injury (56 [20%] of 282), noncontaminated needle (53 [19%] of 282), too-lengthy reporting process (37 [13%] of 282), and associated stigma (23 [8%] of 282). Only 156 (25%) of 624 respondents informed their significant other. Stepwise regression assessing variables affecting the likelihood of reporting showed that male sex (P = .009), low-risk patient (P < .0001), self injury (P = .010), trainee status (P < .0001), and the total number of prior injuries (P = .019) were independent predictors of not reporting. Conclusion Needlestick injuries are ubiquitous among interventional radiologists and are often not reported. © RSNA, 2017 Online supplemental material is available for this article.

Tobacco smoking in Mongolia: findings of a national knowledge, attitudes and practices study.

PubMed

Demaio, Alessandro R; Nehme, Jessica; Otgontuya, Dugee; Meyrowitsch, Dan Wolf; Enkhtuya, Palam

2014-02-28

In 2009, 48% of males aged 15 or over in Mongolia consumed tobacco, placing Mongolia among the countries with the highest prevalence of male smokers in the world. Importantly, tobacco use is one of the four major risk factors contributing to the global burden of non-communicable diseases (NCDs) - the leading cause of mortality in Mongolia. However, the knowledge, attitudes and practices of the Mongolian population with regards to smoking are largely unmeasured. In this context, a national NCDs knowledge, attitudes and practices survey focusing, among other things, on NCD risk factors was implemented in Mongolia in late 2010 to complement the previous WHO STEPwise approach to Surveillance Survey (STEPS) findings from 2009. This publication explores the smoking-related findings of the Knowledge, Attitudes and Practices Survey (KAPS). A nationally representative sample size was calculated using methodologies aligned with the WHO STEPS surveys. As a result, 3450 people from across Mongolia were selected using a multi-stage, random cluster sampling method from permanent residents aged between 15 and 64 years. The KAP survey questionnaire was interviewer-administered on a door-to-door basis. In Mongolia at 2010, 46.3% of males and 6.8% of females were smokers. This practice was especially dominant among males and urban dwellers (MOR 2.2), and more so among the middle-aged (45-54) (MOR 2.1) while still displaying a high prevalence among Mongolian youth (15.5%). The probability of smoking was independent of the level of education. Although the level of awareness of the health hazards related to tobacco smoking was generally very high in the population, this was influenced by the level of education as more people with a primary and secondary level of education believed that smoking at least one pack of cigarette per day was required to harm one's health (MOR 5.8 for primary education and 2.5 for secondary). Finally, this knowledge did not necessarily translate into a behavioural outcome as 15.5% of the population did not object to people smoking in their house, and especially so among males (MOR 4.1). The findings of this KAP survey corroborate the 2009 WHO STEPS Survey findings with regards to the prevalence of tobacco smoking in Mongolia. It identifies males, urban dwellers and Mongolian youth as groups that should be targeted by public health measures on tobacco consumption, while keeping in mind that higher levels of awareness of the harms caused by tobacco smoking do not necessarily translate into behavioural changes.

Developing a spatial-statistical model and map of historical malaria prevalence in Botswana using a staged variable selection procedure

PubMed Central

Craig, Marlies H; Sharp, Brian L; Mabaso, Musawenkosi LH; Kleinschmidt, Immo

2007-01-01

Background Several malaria risk maps have been developed in recent years, many from the prevalence of infection data collated by the MARA (Mapping Malaria Risk in Africa) project, and using various environmental data sets as predictors. Variable selection is a major obstacle due to analytical problems caused by over-fitting, confounding and non-independence in the data. Testing and comparing every combination of explanatory variables in a Bayesian spatial framework remains unfeasible for most researchers. The aim of this study was to develop a malaria risk map using a systematic and practicable variable selection process for spatial analysis and mapping of historical malaria risk in Botswana. Results Of 50 potential explanatory variables from eight environmental data themes, 42 were significantly associated with malaria prevalence in univariate logistic regression and were ranked by the Akaike Information Criterion. Those correlated with higher-ranking relatives of the same environmental theme, were temporarily excluded. The remaining 14 candidates were ranked by selection frequency after running automated step-wise selection procedures on 1000 bootstrap samples drawn from the data. A non-spatial multiple-variable model was developed through step-wise inclusion in order of selection frequency. Previously excluded variables were then re-evaluated for inclusion, using further step-wise bootstrap procedures, resulting in the exclusion of another variable. Finally a Bayesian geo-statistical model using Markov Chain Monte Carlo simulation was fitted to the data, resulting in a final model of three predictor variables, namely summer rainfall, mean annual temperature and altitude. Each was independently and significantly associated with malaria prevalence after allowing for spatial correlation. This model was used to predict malaria prevalence at unobserved locations, producing a smooth risk map for the whole country. Conclusion We have produced a highly plausible and parsimonious model of historical malaria risk for Botswana from point-referenced data from a 1961/2 prevalence survey of malaria infection in 1–14 year old children. After starting with a list of 50 potential variables we ended with three highly plausible predictors, by applying a systematic and repeatable staged variable selection procedure that included a spatial analysis, which has application for other environmentally determined infectious diseases. All this was accomplished using general-purpose statistical software. PMID:17892584

Multiple-Objective Stepwise Calibration Using Luca

USGS Publications Warehouse

Hay, Lauren E.; Umemoto, Makiko

2007-01-01

This report documents Luca (Let us calibrate), a multiple-objective, stepwise, automated procedure for hydrologic model calibration and the associated graphical user interface (GUI). Luca is a wizard-style user-friendly GUI that provides an easy systematic way of building and executing a calibration procedure. The calibration procedure uses the Shuffled Complex Evolution global search algorithm to calibrate any model compiled with the U.S. Geological Survey's Modular Modeling System. This process assures that intermediate and final states of the model are simulated consistently with measured values.

Density estimation in tiger populations: combining information for strong inference

USGS Publications Warehouse

Gopalaswamy, Arjun M.; Royle, J. Andrew; Delampady, Mohan; Nichols, James D.; Karanth, K. Ullas; Macdonald, David W.

2012-01-01

A productive way forward in studies of animal populations is to efficiently make use of all the information available, either as raw data or as published sources, on critical parameters of interest. In this study, we demonstrate two approaches to the use of multiple sources of information on a parameter of fundamental interest to ecologists: animal density. The first approach produces estimates simultaneously from two different sources of data. The second approach was developed for situations in which initial data collection and analysis are followed up by subsequent data collection and prior knowledge is updated with new data using a stepwise process. Both approaches are used to estimate density of a rare and elusive predator, the tiger, by combining photographic and fecal DNA spatial capture–recapture data. The model, which combined information, provided the most precise estimate of density (8.5 ± 1.95 tigers/100 km2 [posterior mean ± SD]) relative to a model that utilized only one data source (photographic, 12.02 ± 3.02 tigers/100 km2 and fecal DNA, 6.65 ± 2.37 tigers/100 km2). Our study demonstrates that, by accounting for multiple sources of available information, estimates of animal density can be significantly improved.

Scope & Limitations of Fmoc Chemistry SPPS-Based Approaches to the Total Synthesis of Insulin Lispro via Ester Insulin

PubMed Central

Dhayalan, Balamurugan; Mandal, Kalyaneswar; Rege, Nischay; Weiss, Michael A.; Eitel, Simon H.; Meier, Thomas; Schoenleber, Ralph O.; Kent, Stephen B.H.

2017-01-01

We have systematically explored three approaches based on Fmoc chemistry SPPS for the total chemical synthesis of the key depsipeptide intermediate for the efficient total chemical synthesis of insulin. The approaches used were: stepwise Fmoc chemistry SPPS; the ‘hybrid method’, in which maximally-protected peptide segments made by Fmoc chemistry SPPS are condensed in solution; and, native chemical ligation using peptide-thioester segments generated by Fmoc chemistry SPPS. A key building block in all three approaches was a Glu[Oβ(Thr)] ester-linked dipeptide equipped with a set of orthogonal protecting groups compatible with Fmoc chemistry SPPS. The most effective method for the preparation of the 51 residue ester-linked polypeptide chain of ester insulin was the use of unprotected peptide-thioester segments, prepared from peptide-hydrazides synthesized by Fmoc chemistry SPPS, and condensed by native chemical ligation. High resolution X-ray crystallography confirmed the disulfide pairings and three-dimensional structure of synthetic insulin lispro prepared from ester insulin lispro by this route. Further optimization of these pilot studies should yield an effective total chemical synthesis of insulin lispro (Humalog) based on peptide synthesis by Fmoc chemistry SPPS. PMID:27905149

Density estimation in tiger populations: combining information for strong inference.

PubMed

Gopalaswamy, Arjun M; Royle, J Andrew; Delampady, Mohan; Nichols, James D; Karanth, K Ullas; Macdonald, David W

2012-07-01

A productive way forward in studies of animal populations is to efficiently make use of all the information available, either as raw data or as published sources, on critical parameters of interest. In this study, we demonstrate two approaches to the use of multiple sources of information on a parameter of fundamental interest to ecologists: animal density. The first approach produces estimates simultaneously from two different sources of data. The second approach was developed for situations in which initial data collection and analysis are followed up by subsequent data collection and prior knowledge is updated with new data using a stepwise process. Both approaches are used to estimate density of a rare and elusive predator, the tiger, by combining photographic and fecal DNA spatial capture-recapture data. The model, which combined information, provided the most precise estimate of density (8.5 +/- 1.95 tigers/100 km2 [posterior mean +/- SD]) relative to a model that utilized only one data source (photographic, 12.02 +/- 3.02 tigers/100 km2 and fecal DNA, 6.65 +/- 2.37 tigers/100 km2). Our study demonstrates that, by accounting for multiple sources of available information, estimates of animal density can be significantly improved.

Dispersion of Nanomaterials in Aqueous Media: Towards Protocol Optimization.

PubMed

Kaur, Inder; Ellis, Laura-Jayne; Romer, Isabella; Tantra, Ratna; Carriere, Marie; Allard, Soline; Mayne-L'Hermite, Martine; Minelli, Caterina; Unger, Wolfgang; Potthoff, Annegret; Rades, Steffi; Valsami-Jones, Eugenia

2017-12-25

The sonication process is commonly used for de-agglomerating and dispersing nanomaterials in aqueous based media, necessary to improve homogeneity and stability of the suspension. In this study, a systematic step-wise approach is carried out to identify optimal sonication conditions in order to achieve a stable dispersion. This approach has been adopted and shown to be suitable for several nanomaterials (cerium oxide, zinc oxide, and carbon nanotubes) dispersed in deionized (DI) water. However, with any change in either the nanomaterial type or dispersing medium, there needs to be optimization of the basic protocol by adjusting various factors such as sonication time, power, and sonicator type as well as temperature rise during the process. The approach records the dispersion process in detail. This is necessary to identify the time points as well as other above-mentioned conditions during the sonication process in which there may be undesirable changes, such as damage to the particle surface thus affecting surface properties. Our goal is to offer a harmonized approach that can control the quality of the final, produced dispersion. Such a guideline is instrumental in ensuring dispersion quality repeatability in the nanoscience community, particularly in the field of nanotoxicology.

Dispersion of Nanomaterials in Aqueous Media: Towards Protocol Optimization

PubMed Central

Kaur, Inder; Ellis, Laura-Jayne; Romer, Isabella; Tantra, Ratna; Carriere, Marie; Allard, Soline; Mayne-L'Hermite, Martine; Minelli, Caterina; Unger, Wolfgang; Potthoff, Annegret; Rades, Steffi; Valsami-Jones, Eugenia

2017-01-01

The sonication process is commonly used for de-agglomerating and dispersing nanomaterials in aqueous based media, necessary to improve homogeneity and stability of the suspension. In this study, a systematic step-wise approach is carried out to identify optimal sonication conditions in order to achieve a stable dispersion. This approach has been adopted and shown to be suitable for several nanomaterials (cerium oxide, zinc oxide, and carbon nanotubes) dispersed in deionized (DI) water. However, with any change in either the nanomaterial type or dispersing medium, there needs to be optimization of the basic protocol by adjusting various factors such as sonication time, power, and sonicator type as well as temperature rise during the process. The approach records the dispersion process in detail. This is necessary to identify the time points as well as other above-mentioned conditions during the sonication process in which there may be undesirable changes, such as damage to the particle surface thus affecting surface properties. Our goal is to offer a harmonized approach that can control the quality of the final, produced dispersion. Such a guideline is instrumental in ensuring dispersion quality repeatability in the nanoscience community, particularly in the field of nanotoxicology. PMID:29364209

A Combined Photochemical and Multicomponent Reaction Approach to Precision Oligomers.

PubMed

Konrad, Waldemar; Bloesser, Fabian R; Wetzel, Katharina S; Boukis, Andreas C; Meier, Michael A R; Barner-Kowollik, Christopher

2018-03-07

We introduce the convergent synthesis of linear monodisperse sequence-defined oligomers through a unique approach, combining the Passerini three-component reaction (P-3CR) and a Diels-Alder (DA) reaction based on photocaged dienes. A set of oligomers is prepared resting on a Passerini linker unit carrying an isocyano group for chain extension by P-3CR and a maleimide moiety for photoenol conjugation enabling a modular approach for chain growth. Monodisperse oligomers are accessible in a stepwise fashion by switching between both reaction types. Employing sebacic acid as a core unit allows the synthesis of a library of symmetric sequence-defined oligomers. The oligomers consist of alternating P-3CR and photoblocks with molecular weights up to 3532.16 g mol -1 , demonstrating the successful switching from P-3CR to photoenol conjugation. In-depth characterization was carried out including size-exclusion chromatography (SEC), high-resolution electrospray ionization mass spectrometry (ESI-MS) and NMR spectroscopy, evidencing the monodisperse nature of the precision oligomers. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Modeling Sustainable Food Systems.

PubMed

Allen, Thomas; Prosperi, Paolo

2016-05-01

The processes underlying environmental, economic, and social unsustainability derive in part from the food system. Building sustainable food systems has become a predominating endeavor aiming to redirect our food systems and policies towards better-adjusted goals and improved societal welfare. Food systems are complex social-ecological systems involving multiple interactions between human and natural components. Policy needs to encourage public perception of humanity and nature as interdependent and interacting. The systemic nature of these interdependencies and interactions calls for systems approaches and integrated assessment tools. Identifying and modeling the intrinsic properties of the food system that will ensure its essential outcomes are maintained or enhanced over time and across generations, will help organizations and governmental institutions to track progress towards sustainability, and set policies that encourage positive transformations. This paper proposes a conceptual model that articulates crucial vulnerability and resilience factors to global environmental and socio-economic changes, postulating specific food and nutrition security issues as priority outcomes of food systems. By acknowledging the systemic nature of sustainability, this approach allows consideration of causal factor dynamics. In a stepwise approach, a logical application is schematized for three Mediterranean countries, namely Spain, France, and Italy.

Modeling Sustainable Food Systems

NASA Astrophysics Data System (ADS)

Allen, Thomas; Prosperi, Paolo

2016-05-01

The processes underlying environmental, economic, and social unsustainability derive in part from the food system. Building sustainable food systems has become a predominating endeavor aiming to redirect our food systems and policies towards better-adjusted goals and improved societal welfare. Food systems are complex social-ecological systems involving multiple interactions between human and natural components. Policy needs to encourage public perception of humanity and nature as interdependent and interacting. The systemic nature of these interdependencies and interactions calls for systems approaches and integrated assessment tools. Identifying and modeling the intrinsic properties of the food system that will ensure its essential outcomes are maintained or enhanced over time and across generations, will help organizations and governmental institutions to track progress towards sustainability, and set policies that encourage positive transformations. This paper proposes a conceptual model that articulates crucial vulnerability and resilience factors to global environmental and socio-economic changes, postulating specific food and nutrition security issues as priority outcomes of food systems. By acknowledging the systemic nature of sustainability, this approach allows consideration of causal factor dynamics. In a stepwise approach, a logical application is schematized for three Mediterranean countries, namely Spain, France, and Italy.

Verification of performance specifications of a molecular test: cystic fibrosis carrier testing using the Luminex liquid bead array.

PubMed

Lacbawan, Felicitas L; Weck, Karen E; Kant, Jeffrey A; Feldman, Gerald L; Schrijver, Iris

2012-01-01

The number of clinical laboratories introducing various molecular tests to their existing test menu is continuously increasing. Prior to offering a US Food and Drug Administration-approved test, it is necessary that performance characteristics of the test, as claimed by the company, are verified before the assay is implemented in a clinical laboratory. To provide an example of the verification of a specific qualitative in vitro diagnostic test: cystic fibrosis carrier testing using the Luminex liquid bead array (Luminex Molecular Diagnostics, Inc, Toronto, Ontario). The approach used by an individual laboratory for verification of a US Food and Drug Administration-approved assay is described. Specific verification data are provided to highlight the stepwise verification approach undertaken by a clinical diagnostic laboratory. Protocols for verification of in vitro diagnostic assays may vary between laboratories. However, all laboratories must verify several specific performance specifications prior to implementation of such assays for clinical use. We provide an example of an approach used for verifying performance of an assay for cystic fibrosis carrier screening.

A simple approach to quantitative analysis using three-dimensional spectra based on selected Zernike moments.

PubMed

Zhai, Hong Lin; Zhai, Yue Yuan; Li, Pei Zhen; Tian, Yue Li

2013-01-21

A very simple approach to quantitative analysis is proposed based on the technology of digital image processing using three-dimensional (3D) spectra obtained by high-performance liquid chromatography coupled with a diode array detector (HPLC-DAD). As the region-based shape features of a grayscale image, Zernike moments with inherently invariance property were employed to establish the linear quantitative models. This approach was applied to the quantitative analysis of three compounds in mixed samples using 3D HPLC-DAD spectra, and three linear models were obtained, respectively. The correlation coefficients (R(2)) for training and test sets were more than 0.999, and the statistical parameters and strict validation supported the reliability of established models. The analytical results suggest that the Zernike moment selected by stepwise regression can be used in the quantitative analysis of target compounds. Our study provides a new idea for quantitative analysis using 3D spectra, which can be extended to the analysis of other 3D spectra obtained by different methods or instruments.

Stepwise management of asthma.

PubMed

Khalid, Ayesha N

2015-09-01

Stepwise management of asthma remains an area of evolving research. Asthma is one of the most expensive chronic diseases in the United States; stepwise management is an important area of focus, with several recent guidelines recommending management. This is a review of published English language literature, focusing on management guidelines for asthma in adult and pediatric patients. Asthma is a chronic disease whose assessment of severity allows for therapeutic goals to match the impairment noted. Good evidence exists to aid risk reduction, leading to decreased emergency room visits, preventing loss of lung function in adults and lung growth in children, and optimizing pharmacotherapy with reduced side effects profile. Recent asthma management guidelines incorporate 4 components of asthma care including: monitoring of severity, patient education, controlling external triggers, and medications, including recent attention to medication adherence. Asthma is an expensive chronic disease with preventive measures leading to reduced healthcare costs. Future targeted cytokine therapy to decrease serum and blood eosinophils may become an integral part of asthma management. © 2015 ARS-AAOA, LLC.

Response kinetics of tethered bacteria to stepwise changes in nutrient concentration.

PubMed

Chernova, Anna A; Armitage, Judith P; Packer, Helen L; Maini, Philip K

2003-09-01

We examined the changes in swimming behaviour of the bacterium Rhodobacter sphaeroides in response to stepwise changes in a nutrient (propionate), following the pre-stimulus motion, the initial response and the adaptation to the sustained concentration of the chemical. This was carried out by tethering motile cells by their flagella to glass slides and following the rotational behaviour of their cell bodies in response to the nutrient change. Computerised motion analysis was used to analyse the behaviour. Distributions of run and stop times were obtained from rotation data for tethered cells. Exponential and Weibull fits for these distributions, and variability in individual responses are discussed. In terms of parameters derived from the run and stop time distributions, we compare the responses to stepwise changes in the nutrient concentration and the long-term behaviour of 84 cells under 12 propionate concentration levels from 1 nM to 25 mM. We discuss traditional assumptions for the random walk approximation to bacterial swimming and compare them with the observed R. sphaeroides motile behaviour.

Stepwise Iterative Fourier Transform: The SIFT

NASA Technical Reports Server (NTRS)

Benignus, V. A.; Benignus, G.

1975-01-01

A program, designed specifically to study the respective effects of some common data problems on results obtained through stepwise iterative Fourier transformation of synthetic data with known waveform composition, was outlined. Included in this group were the problems of gaps in the data, different time-series lengths, periodic but nonsinusoidal waveforms, and noisy (low signal-to-noise) data. Results on sinusoidal data were also compared with results obtained on narrow band noise with similar characteristics. The findings showed that the analytic procedure under study can reliably reduce data in the nature of (1) sinusoids in noise, (2) asymmetric but periodic waves in noise, and (3) sinusoids in noise with substantial gaps in the data. The program was also able to analyze narrow-band noise well, but with increased interpretational problems. The procedure was shown to be a powerful technique for analysis of periodicities, in comparison with classical spectrum analysis techniques. However, informed use of the stepwise procedure nevertheless requires some background of knowledge concerning characteristics of the biological processes under study.

Improved efficiency in blue phosphorescent organic light-emitting diodes by the stepwise doping structure

NASA Astrophysics Data System (ADS)

Yang, Liping; Wang, Xiaoping; Kou, Zhiqi; Ji, Changyan

2017-04-01

The electro-optical properties of the blue phosphorescent organic light-emitting diodes (PHOLEDs) can be affected by the stepwise doping structure in the emitting layer (EML). A series of multi-EML devices with different doping concentration of blue dopant (FIrpic) are fabricated. The effect of the stepwise doping structure close to the electron transport layer is more obvious than that close to the hole transport layer. When the doping concentration increases gradually from the hole injection side to the electron injection side, the maximum values of the luminance, current and power efficiency can reach to 9745 cd/m2 (at 9 V), 32.0 cd/A and 25.1 lm/W in the device with the asymmetric tri-EML structure, which is improved by about 10% compared with that in the bi-EML device. When the number of the EML is four, the performance of the device becomes worse because of the interface effect resulting from different concentration of dopant.

Effect of Stepwise Doping on Lifetime and Efficiency of Blue and White Phosphorescent Organic Light Emitting Diodes.

PubMed

Lee, Song Eun; Lee, Ho Won; Lee, Seok Jae; Koo, Ja-ryong; Lee, Dong Hyung; Yang, Hyung Jin; Kim, Hye Jeong; Yoon, Seung Soo; Kim, Young Kwan

2015-02-01

We investigated a light emission mechanism of blue phosphorescent organic light emitting diodes (PHOLEDs), using a stepwise doping profile of 2, 8, and 14 wt.% within the emitting layer (EML). We fabricated several blue PHOLEDs with phosphorescent blue emitter iridium(III) bis[(4,6-difluorophenyl)-pyridinato-N,C2]picolinate doped in N,N'-dicarbazolyl-3,5-benzene as a p-type host material. A blue PHOLED with the highest doping concentration as part of the EML close to an electron transporting layer showed a maximum luminous efficiency of 20.74 cd/A, and a maximum external quantum efficiency of 10.52%. This can be explained by effective electron injection through a highly doped EML side. Additionally, a white OLED based on the doping profile was fabricated with two thin red EMLs within a blue EML maintaining a thickness of 30 nm for the entire EML. Keywords: Blue Phosphorescent Organic Light Emitting Diodes, Stepwise Doping Structure, Charge Trapping Effect.

Novel stepwise pH control strategy to improve short chain fatty acid production from sludge anaerobic fermentation.

PubMed

Zhao, Jianwei; Wang, Dongbo; Liu, Yiwen; Ngo, Huu Hao; Guo, Wenshan; Yang, Qi; Li, Xiaoming

2018-02-01

This study reports an innovative strategy known as stepwise pH fermentation, developed to enhance the production of short chain volatile fatty acids (SCFA) from waste activated sludge (WAS) anaerobic fermentation. Experimental results confirmed the optimal pH for WAS disruption and acidification was 11 and 9, respectively, and corresponding optimal time was, respectively, 5 d and 2 d. In this scenario, the optimal SCFA yield was 2356 mg chemical oxygen demand (COD)/L, which was much higher than that derived from alkaline fermentation system. Investigation of the mechanism indicated that pH 11 could accelerate the disruption of WAS and inhibit the activities of methanogens; furthermore, pH 9 was beneficial to the activity of acid-producing bacteria, resulting in more SCFA production. Stepwise pH fermentation integrated with sodium chloride (NaCl) present in WAS had synergistic impacts on WAS anaerobic fermentation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Stepwise self-assembly of C60 mediated by atomic scale moiré magnifiers

NASA Astrophysics Data System (ADS)

Gruznev, D. V.; Matetskiy, A. V.; Bondarenko, L. V.; Utas, O. A.; Zotov, A. V.; Saranin, A. A.; Chou, J. P.; Wei, C. M.; Lai, M. Y.; Wang, Y. L.

2013-04-01

Self-assembly of atoms or molecules on a crystal surface is considered one of the most promising methods to create molecular devices. Here we report a stepwise self-assembly of C60 molecules into islands with unusual shapes and preferred sizes on a gold-indium-covered Si(111) surface. Specifically, 19-mer islands prefer a non-compact boomerang shape, whereas hexagonal 37-mer islands exhibit extraordinarily enhanced stability and abundance. The stepwise self-assembly is mediated by the moiré interference between an island with its underlying lattice, which essentially maps out the adsorption-energy landscape of a C60 on different positions of the surface with a lateral magnification factor and dictates the probability for the subsequent attachment of C60 to an island’s periphery. Our discovery suggests a new method for exploiting the moiré interference to dynamically assist the self-assembly of particles and provides an unexplored tactic of engineering atomic scale moiré magnifiers to facilitate the growth of monodispersed mesoscopic structures.