Advanced Computer Image Generation Techniques Exploiting Perceptual Characteristics. Final Report.

ERIC Educational Resources Information Center

Stenger, Anthony J.; And Others

This study suggests and identifies computer image generation (CIG) algorithms for visual simulation that improve the training effectiveness of CIG simulators and identifies areas of basic research in visual perception that are significant for improving CIG technology. The first phase of the project entailed observing three existing CIG simulators.…

Fracture of fiber-reinforced composites analyzed via acoustic emission.

PubMed

Ereifej, Nadia S; Oweis, Yara G; Altarawneh, Sandra K

2015-01-01

This study investigated the fracture resistance of composite resins using a three-point bending test and acoustic emission (AE) analysis. Three groups of specimens (n=15) were prepared: non-reinforced BelleGlass HP composite (NRC), unidirectional (UFRC) and multidirectional (MFRC) fiber-reinforced groups which respectively incorporated unidirectional Stick and multidirectional StickNet fibers. Specimens were loaded to failure in a universal testing machine while an AE system was used to detect audible signals. Initial fracture strengths and AE amplitudes were significantly lower than those at final fracture in all groups (p<0.05). Initial fracture strength of UFRC (170.0 MPa) was significantly higher than MFRC (124.6 MPa) and NRC (87.9 MPa). Final fracture strength of UFRC (198.1 MPa) was also significantly higher than MFRC (151.0 MPa) and NRC (109.2 MPa). Initial and final fracture strengths were significantly correlated (r=0.971). It was concluded that fiber reinforcement improved the fracture resistance of composite resin materials and the monitoring of acoustic signals revealed significant information regarding the fracture process.

Vertical integration of basic science in final year of medical education.

PubMed

Rajan, Sudha Jasmine; Jacob, Tripti Meriel; Sathyendra, Sowmya

2016-01-01

Development of health professionals with ability to integrate, synthesize, and apply knowledge gained through medical college is greatly hampered by the system of delivery that is compartmentalized and piecemeal. There is a need to integrate basic sciences with clinical teaching to enable application in clinical care. To study the benefit and acceptance of vertical integration of basic science in final year MBBS undergraduate curriculum. After Institutional Ethics Clearance, neuroanatomy refresher classes with clinical application to neurological diseases were held as part of the final year posting in two medical units. Feedback was collected. Pre- and post-tests which tested application and synthesis were conducted. Summative assessment was compared with the control group of students who had standard teaching in other two medical units. In-depth interview was conducted on 2 willing participants and 2 teachers who did neurology bedside teaching. Majority (>80%) found the classes useful and interesting. There was statistically significant improvement in the post-test scores. There was a statistically significant difference between the intervention and control groups' scores during summative assessment (76.2 vs. 61.8 P < 0.01). Students felt that it reinforced, motivated self-directed learning, enabled correlations, improved understanding, put things in perspective, gave confidence, aided application, and enabled them to follow discussions during clinical teaching. Vertical integration of basic science in final year was beneficial and resulted in knowledge gain and improved summative scores. The classes were found to be useful, interesting and thought to help in clinical care and application by majority of students.

SURGICAL OUTCOMES IN PATIENTS WITH MACULAR PUCKER AND GOOD PREOPERATIVE VISUAL ACUITY AFTER VITRECTOMY WITH MEMBRANE PEELING.

PubMed

Reilly, Gayatri; Melamud, Alexander; Lipscomb, Peter; Toussaint, Brian

2015-09-01

To evaluate whether patients with macular pucker (epiretinal membrane [ERM]) and good preoperative visual acuity (20/50 or better) benefit from small-gauge pars plana vitrectomy with membrane peeling. Retrospective chart review of eyes undergoing small-gauge pars plana vitrectomy for ERM. Inclusion criterion was impaired visual acuity (20/50 or better) due to ERM. Exclusion criteria were preoperative visual acuity of 20/60 or worse, previous surgery (other than uncomplicated cataract surgery), and any documented evidence of macular or corneal disease that would limit visual potential. The main outcome measure was final visual acuity. Secondary outcomes included the role of internal limiting membrane peeling, and the effect of preoperative cystoid macular edema and internal limiting membrane peeling on visual acuity. One hundred and forty eyes met inclusion criteria of which 94% underwent 25-gauge vitrectomy (remainder had 23-gauge). There was a statistically significant improvement in final vision with the mean preoperative visual acuity of 0.305 logMAR (20/40) and 1-year visual acuity of 0.250 logMAR (20/35) (P = 0.0167). Cataract formation in phakic patients had a significant effect on the final visual outcome. Fifty-six of 63 patients (89%) in the phakic cohort developed a visually significant cataract by study end. The mean time to recommendation of cataract surgery was 8.4 months. Thirty-eight eyes (27%) had preoperative cystoid macular edema. Fifty-nine eyes (42%) underwent internal limiting membrane peeling. Neither one of these secondary outcome measures had a significant effect on the final visual outcome. Pars plana vitrectomy is both efficacious and safe an option for patients with ERMs and good preoperative vision. Eyes with an ERM and vision 20/50 or better had a statistically significant improvement in the final visual outcome after small-gauge pars plana vitrectomy surgery. As with large-gauge vitrectomy, cataract formation occurred in most phakic eyes within the first year after surgery.

Long-term results after limited macular translocation surgery for wet age-related macular degeneration.

PubMed

Oshima, Hisaaki; Iwase, Takeshi; Ishikawa, Kohei; Yamamoto, Kentaro; Terasaki, Hiroko

2017-01-01

To evaluate the long-term results of limited macular translocation (LMT) surgery with radial chorioscleral outfolding in patients with wet age-related macular degeneration (AMD) and subfoveal choroidal neovascularization (CNV). In addition, to identify the factors associated with the final best-corrected visual acuity (BCVA). The medical records of 20 eyes of 20 consecutive patients (65.2±9.8 years) who had undergone LMT for the treatment of wet AMD and were followed for at least 5 years, were reviewed. The surgical outcomes including the BCVA, degree of foveal displacement, and complications were recorded. The mean foveal displacement was 1332 ± 393 μm after the LMT. The CNV was removed in 16 eyes and photocoagulated in 4 eyes. The mean preoperative VA was 0.83 ± 0.33 logMAR units which significantly improved to 0.59 ± 0.37 logMAR units at 1 year after the surgery (P = 0.015). This BCVA was maintained at 0.59 ± 0.41 logMAR units on the final examination. The final BCVA was significantly correlated with that at 1 year after the surgery (r = 0.83, P<0.001). Multiple linear regression analysis showed that the final BCVA was significantly correlated with the BCVA at 1 year after the surgery (P<0.001), a recurrence of a CNV (P = 0.001), and the age (P = 0.022). LMT improves the BCVA significantly at 1 year, and the improved BCVA lasted for at least 5 years. These results indicate that the impaired function of the sensory retina at the fovea can recover on the new RPE after the displacement for at least 5 years. The ability to maintain good retinal function on the new RPE for a long period is important for future treatments of CNVs such as the transplantation of RPE cells and stem cells.

Effects of asymmetric rolling process on ridging resistance of ultra-purified 17%Cr ferritic stainless steel

NASA Astrophysics Data System (ADS)

Lu, Cheng-zhuang; Li, Jing-yuan; Fang, Zhi

2018-02-01

In ferritic stainless steels, a significant non-uniform recrystallization orientation and a substantial texture gradient usually occur, which can degrade the ridging resistance of the final sheets. To improve the homogeneity of the recrystallization orientation and reduce the texture gradient in ultra-purified 17%Cr ferritic stainless steel, in this work, we performed conventional and asymmetric rolling processes and conducted macro and micro-texture analyses to investigate texture evolution under different cold-rolling conditions. In the conventional rolling specimens, we observed that the deformation was not uniform in the thickness direction, whereas there was homogeneous shear deformation in the asymmetric rolling specimens as well as the formation of uniform recrystallized grains and random orientation grains in the final annealing sheets. As such, the ridging resistance of the final sheets was significantly improved by employing the asymmetric rolling process. This result indicates with certainty that the texture gradient and orientation inhomogeneity can be attributed to non-uniform deformation, whereas the uniform orientation gradient in the thickness direction is explained by the increased number of shear bands obtained in the asymmetric rolling process.

Measuring Technological and Content Knowledge of Undergraduate Primary Teachers in Mathematics

NASA Astrophysics Data System (ADS)

Doukakis, Spyros; Chionidou-Moskofoglou, Maria; Mangina-Phelan, Eleni; Roussos, Petros

Twenty-five final-year undergraduate students of primary education who were attending a course on mathematics education participated in a research project during the 2009 spring semester. A repeated measures experimental design was used. Quantitative data on students' computer attitudes, self-efficacy in ICT, attitudes toward educational software, and self-efficacy in maths were collected. Data analysis showed a statistically non-significant improvement on participants' computer attitudes and self-efficacy in ICT and ES, but a significant improvement of self-efficacy in mathematics.

Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students.

PubMed

Camargo, Lucila Basto; Raggio, Daniela Prócida; Bonacina, Carlos Felipe; Wen, Chao Lung; Mendes, Fausto Medeiros; Bönecker, Marcelo José Strazzeri; Haddad, Ana Estela

2014-07-17

The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants-38 dental students and 38 pediatric dentistry students-in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975-0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001). The e-learning strategy has the potential of improving students' knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.

Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears: Preoperative Factors Associated With Outcome Deterioration Over 2 Years.

PubMed

Shon, Min Soo; Koh, Kyoung Hwan; Lim, Tae Kang; Kim, Won Ju; Kim, Kyung Cheon; Yoo, Jae Chul

2015-08-01

Arthroscopic partial repair is a treatment option in irreparable large-to-massive rotator cuff tears without arthritic changes. However, there are indications that arthroscopic partial repair does not yield satisfactory outcomes. To report the clinical and radiographic results of arthroscopic partial repairs in patients with irreparable large-to-massive cuff tears. In addition, an analysis was performed regarding preoperative factors that may influence patient outcomes and patient-rated satisfaction over time. Case series; Level of evidence, 4. From 2005 to 2011, a total of 31 patients who underwent arthroscopic partial repair for irreparable large-to-massive cuff tears were retrospectively evaluated. Partial repair was defined as posterior cuff tissue repair with or without subscapularis tendon repair to restore the transverse force couple of the cuff. Pain visual analog scale (PVAS), questionnaire results (American Shoulder and Elbow Surgeons [ASES] and Simple Shoulder Test [SST]), and radiographic changes (acromiohumeral distance and degenerative change) were assessed preoperatively, at first follow-up (roughly 1 year postoperatively), and at final follow-up (>2 years postoperatively). Patients rated their satisfaction level at each postoperative follow-up as well. Preoperative factors that might influence outcomes, such as patient demographics, tear size, and fatty infiltration, were investigated. The preoperative, first follow-up, and final follow-up results for mean PVAS (5.13, 2.13, and 3.16, respectively) and questionnaires (ASES: 41.97, 76.37, and 73.78; SST: 3.61, 6.33, and 6.07, respectively) improved significantly (all P < .05). Radiographic evaluation showed no difference compared with preoperative status. Nevertheless, patient-rated satisfaction at final evaluation was inferior: 16 good responses ("very satisfied" and "satisfied") and 15 poor responses ("rather the same" and "dissatisfied"). Despite initial improvements in both groups (P < .05), patients with poor satisfaction demonstrated statistically significant deterioration in mean PVAS (from 2.07 to 4.67), questionnaire scores (ASES: from 74.56 to 59.80; SST: from 5.11 to 3.81), and acromiohumeral distance (from 7.19 to 5.06 mm) between the first and final follow-up (all P < .05). Patients with good satisfaction showed no significant difference or they improved (P > .05) from the first to the final follow-up. Among preoperative factors, fatty infiltration of the teres minor was identified as the only statistically significant factor affecting patient-rated satisfaction (P = .007). This study showed that arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year follow-up. However, about half of the patients in the study were not satisfied with their outcomes, which had deteriorated over time. Preoperative fatty infiltration of the teres minor was the only factor that correlated with worse final outcomes and poor satisfaction after arthroscopic partial repair. © 2015 The Author(s).

Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application.

PubMed

Bianchi, Bernardo; Ferri, Andrea; Ferrari, Silvano; Copelli, Chiara; Sesenna, Enrico

2011-04-01

The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed. From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant. No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467). Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Vehicle-to-vehicle communications in mixed passenger-freight convoys : [final report].

DOT National Transportation Integrated Search

2016-09-01

Vehicle convoys (platoons) hold a promise for significant efficiency improvements of freight and : passenger transportation through better system integration. Through the use of advanced driver : assistance, vehicles in a convoy can keep shorter dist...

Vertical integration of basic science in final year of medical education

PubMed Central

Rajan, Sudha Jasmine; Jacob, Tripti Meriel; Sathyendra, Sowmya

2016-01-01

Background: Development of health professionals with ability to integrate, synthesize, and apply knowledge gained through medical college is greatly hampered by the system of delivery that is compartmentalized and piecemeal. There is a need to integrate basic sciences with clinical teaching to enable application in clinical care. Aim: To study the benefit and acceptance of vertical integration of basic science in final year MBBS undergraduate curriculum. Materials and Methods: After Institutional Ethics Clearance, neuroanatomy refresher classes with clinical application to neurological diseases were held as part of the final year posting in two medical units. Feedback was collected. Pre- and post-tests which tested application and synthesis were conducted. Summative assessment was compared with the control group of students who had standard teaching in other two medical units. In-depth interview was conducted on 2 willing participants and 2 teachers who did neurology bedside teaching. Results: Majority (>80%) found the classes useful and interesting. There was statistically significant improvement in the post-test scores. There was a statistically significant difference between the intervention and control groups' scores during summative assessment (76.2 vs. 61.8 P < 0.01). Students felt that it reinforced, motivated self-directed learning, enabled correlations, improved understanding, put things in perspective, gave confidence, aided application, and enabled them to follow discussions during clinical teaching. Conclusion: Vertical integration of basic science in final year was beneficial and resulted in knowledge gain and improved summative scores. The classes were found to be useful, interesting and thought to help in clinical care and application by majority of students. PMID:27563584

Medical students in their final six months of training: progress in self-perceived clinical competence, and relationship between experience and confidence in practical skills.

PubMed

Lai, N M; Sivalingam, N; Ramesh, J C

2007-11-01

We evaluated the progress in the self-perceived competence of medical students in a range of common clinical, practical and personal skills, in their final six months of training. The study was conducted on 65 final-year medical students undertaking their senior clerkship training at International Medical University, Malaysia. Questionnaire surveys were conducted at the beginning and the end of the six-month period, with 44 items covering clinical, practical, personal skills and readiness to work. Correlations were performed for experience and self-perceived competence, with the respective skills. 64 students returned the first survey and 63 returned the second survey. When the two survey results were compared, significant increases were found in self-perceived competence for the majority of the skills examined. The items with no significant improvement were divided into those which the students were already proficient in before senior clerkship, and those in which experience and confidence remained poor at the end of training. There were significant, but moderate, correlations between the experience and confidence of all common practical skills (correlation coefficients: 0.348-0.522, p-value is less than 0.001 for all items). At the end of training, students were, in general, more prepared to work as house officers (mean rating in the first survey: 3.05, second survey: 3.97, p-value is less than 0.001). Significant progresses in clinical experience and confidence can be observed in the final stages of medical training. The findings of inadequate improvements in some skills call for dedicated training sessions and strengthening of on-site supervision.

Factoring local sequence composition in motif significance analysis.

PubMed

Ng, Patrick; Keich, Uri

2008-01-01

We recently introduced a biologically realistic and reliable significance analysis of the output of a popular class of motif finders. In this paper we further improve our significance analysis by incorporating local base composition information. Relying on realistic biological data simulation, as well as on FDR analysis applied to real data, we show that our method is significantly better than the increasingly popular practice of using the normal approximation to estimate the significance of a finder's output. Finally we turn to leveraging our reliable significance analysis to improve the actual motif finding task. Specifically, endowing a variant of the Gibbs Sampler with our improved significance analysis we demonstrate that de novo finders can perform better than has been perceived. Significantly, our new variant outperforms all the finders reviewed in a recently published comprehensive analysis of the Harbison genome-wide binding location data. Interestingly, many of these finders incorporate additional information such as nucleosome positioning and the significance of binding data.

Randomised trial of LHRH analogue treatment on final height in girls with onset of puberty aged 7.5-8.5 years

PubMed Central

Cassio, A.; Cacciari, E.; Balsamo, A.; Bal, M.; Tassinari, D.

1999-01-01

OBJECTIVE—To study the effectiveness of luteinising hormone releasing hormone (LHRH) analogues in improving final height in girls affected by early puberty.
PATIENTS—Forty six consecutive girls with onset of puberty aged 7.5-8.5 years randomly divided into two groups: one treated with 3.75 mg triptorelin intramuscularly every four weeks (group 1); and the other with no treatment (group 2).
RESULTS—Mean (SD) chronological age at onset of menarche was significantly higher in group 1 than in group 2 (11.9 (1.0) v 10.8 (0.7) years). However, mean (SD) height at menarche (152.7 (7.2) v 152.5(5.7) cm) and mean (SD) growth after menarche (4.9 (3.0) v 5.4(2.2) cm) were similar in both groups. The mean (SD) final height was similar in the two groups (group 1, 158.1 (6.2) cm; group 2, 158.6 (6.0) cm) and not significantly different from target height. Fourteen of 20 patients in group 1 and 12 of 18 patients in group 2 showed final height equal to or higher than target height. Final heights of girls with poor initial height prognosis were significantly lower than those of girls with good prognosis, but in patients with the same initial height prognosis, both groups showed final heights similar and not significantly different from their target heights.
CONCLUSIONS—LHRH analogue has no apparent effect on final height in subjects with onset of puberty between 7.5 and 8.5years.

 PMID:10490438

Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve.

PubMed

Sudo, Hideki; Abe, Yuichiro; Abumi, Kuniyoshi; Iwasaki, Norimasa; Ito, Manabu

2016-02-01

There is limited consensus on the optimal surgical strategy for double thoracic adolescent idiopathic scoliosis (AIS). Recent studies have reported that pedicle screw constructs to maximize scoliosis correction cause further thoracic spine lordosis. The objective of this study was to apply a new surgical technique for double thoracic AIS with rigid proximal thoracic (PT) curves and assess its clinical outcomes. Twenty one consecutive patients with Lenke 2 AIS and a rigid PT curve (Cobb angle ≥30º on side-bending radiographs, flexibility ≤30 %) treated with the simultaneous double-rod rotation technique (SDRRT) were included. In this technique, a temporary rod is placed at the concave side of the PT curve. Then, distraction force is applied to correct the PT curve, which reforms a sigmoid double thoracic curve into an approximate single thoracic curve. As a result, the PT curve is typically converted from an apex left to an apex right curve before applying the correction rod for PT and main thoracic curve. All patients were followed for at least 2 years (average 2.7 years). The average main thoracic and PT Cobb angle correction rate at the final follow-up was 74.7 and 58.0 %, respectively. The average preoperative T5-T12 thoracic kyphosis was 9.3°, which improved significantly to 19.0° (p < 0.0001) at the final follow-up. Although 71 % patients had preoperative level shoulders or a positive radiographic shoulder height, all patients had mildly imbalanced or balanced shoulders at the final follow-up. The average preoperative main thoracic apical vertebral rotation angle of 20.7° improved significantly after surgery to 16.4° (p = 0.0046), while the average preoperative total SRS questionnaire score of 3.7 improved significantly to 4.4 (p = 0.0012) at the final follow-up. Radiographic findings and patient outcomes were satisfactory. Thoracic kyphosis can be maintained or improved, while coronal and axial deformities can be corrected using SDRRT for Lenke 2 AIS with a rigid PT curve.

The Effects of an Oral Supplement Enriched With Fish Oil, Prebiotics, and Antioxidants on Nutrition Status in Crohn’s Disease Patients

PubMed Central

Wiese, Dawn M.; Lashner, Bret A.; Lerner, Edith; DeMichele, Stephen J.; Seidner, Douglas L.

2015-01-01

Background Research in the treatment of Crohn’s disease (CD) supports anti-inflammatory benefits of n-3 fatty acids from fish oil, prebiotics, and antioxidants. A nutritionally balanced inflammatory bowel disease nutrition formula (IBDNF) enriched with these compounds has the potential to improve nutrition status and disease activity in CD. Methods This is an open-label pilot study investigating the effects of IBDNF on nutrition status in CD patients. Twenty-eight patients with active CD on stable medication were asked to consume 16 oz of IBDNF/d for 4 months. Nutrition status was assessed with dual-energy X-ray absorptiometry scans and serum micronutrient levels. Disease activity and quality of life were measured using the Crohn’s Disease Activity Index (CDAI) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results Twenty patients completed the final visit. After 4 months, there was a significant decrease in plasma phospholipid levels of arachidonic acid with increases in eicosapentaenoic acid (EPA) and docosahexaenoic acid. Ten patients had a final EPA concentration of >2%. There was improvement in fat-free and fat mass in patients with final EPA >2% (P = .014 and P = .05). Vitamin D (25-OH) levels improved in all patients (18.5–25.9 ng/mL, P < .001). Those with EPA >2% had significantly lower CDAI (116 ± 94.5 vs 261.8 ± 86.5; P = .005) and higher IBDQ (179.1 ± 26.6 vs 114.6 ± 35.9, P < .001) compared to those with EPA <2%. Conclusions IBDNF has the potential to deposit fat-free and fat mass, improve vitamin D status, and improve quality of life in CD patients. PMID:21775642

Application of a theoretical model to evaluate COPD disease management.

PubMed

Lemmens, Karin M M; Nieboer, Anna P; Rutten-Van Mölken, Maureen P M H; van Schayck, Constant P; Asin, Javier D; Dirven, Jos A M; Huijsman, Robbert

2010-03-26

Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care.

Application of a theoretical model to evaluate COPD disease management

PubMed Central

2010-01-01

Background Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. Methods A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. Results Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. Conclusions The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care. PMID:20346135

Mechanical suppression: Modern technology applied to an old art. [MK 12 motors

NASA Technical Reports Server (NTRS)

Crockford, W. H.; Durney, T. E.; Scott, D. E.; Condon, J. A.

1980-01-01

Various suppressor configurations were analyzed and evaluated in an effort to reduce combustion instability and improved ballistic reproducibility of the MK 12 motor. A static firing test series of eight field return boosters featured two baseline motor firings with the existing suppressor in each motor, followed by two tests each of two different prototype suppressor designs. Results were analyzed and used to generate the design for the final two firings. Acoustic pressure pulsers were utilized to measure the damping effectiveness of the final design. The reduction in motor vibration and acoustic pressure levels between the baseline tests and the final two improved lightweight tests was significant. The average acceleration level of the motors equipped with flightweight rods was reduced to only 5% of the level in the unmodified motors; the average acoustic pressure level was reduced to 20%; maximum values were reduced to 6% for acceleration and 23% for pressure.

Soft tissue balancing in total knee arthroplasty using sensor-guided assessment: is there a learning curve?

PubMed

Gharaibeh, Monther A; Chen, Darren B; MacDessi, Samuel J

2018-05-01

Sensor-guided assessment for soft tissue balance in total knee arthroplasty (TKA) has been reported to improve patient satisfaction and self-reported outcome scores. As more surgeons adopt this technology in TKA, we performed this study to identify if there is a learning curve with its use. Analysis of a total of 90 consecutive cases was performed in this study. Initial and final intercompartmental pressure differences were recorded before and after knee ligament balancing. The first 45 patients (group 1) were compared to the last 45 patients (group 2) in terms of operative time and the final state of knee balance. A balanced knee was defined as pressure difference between medial and lateral compartments of ≤15 pounds. Group 1 had 10 unbalanced knees in the final pressure difference assessment, while all cases in group 2 were balanced (P < 0.001). There was no statistically significant difference in mean operative time between the two groups. A scatter plot of intercompartmental pressure difference identified that after 30 cases, the capacity to achieve knee ligament balance improved. This study suggests that there is a learning curve with the use of sensor-guided assessment in TKA in achieving knee balance; however, the differences noted between initial and final groups were small and may not be of clinical significance. © 2018 Royal Australasian College of Surgeons.

Improving striping operations through system optimization - phase 2 : final report.

DOT National Transportation Integrated Search

2016-07-01

Striping operations generate a significant workload for MoDOT maintenance operations. The requirement for each striping crew : to replenish its stock of paint and other consumable items from a bulk storage facility, along with the necessity to make s...

Increasing URM Undergraduate Student Success through Assessment-Driven Interventions: A Multiyear Study Using Freshman-Level General Biology as a Model System.

PubMed

Carmichael, Mary C; St Clair, Candace; Edwards, Andrea M; Barrett, Peter; McFerrin, Harris; Davenport, Ian; Awad, Mohamed; Kundu, Anup; Ireland, Shubha Kale

2016-01-01

Xavier University of Louisiana leads the nation in awarding BS degrees in the biological sciences to African-American students. In this multiyear study with ∼5500 participants, data-driven interventions were adopted to improve student academic performance in a freshman-level general biology course. The three hour-long exams were common and administered concurrently to all students. New exam questions were developed using Bloom's taxonomy, and exam results were analyzed statistically with validated assessment tools. All but the comprehensive final exam were returned to students for self-evaluation and remediation. Among other approaches, course rigor was monitored by using an identical set of 60 questions on the final exam across 10 semesters. Analysis of the identical sets of 60 final exam questions revealed that overall averages increased from 72.9% (2010) to 83.5% (2015). Regression analysis demonstrated a statistically significant correlation between high-risk students and their averages on the 60 questions. Additional analysis demonstrated statistically significant improvements for at least one letter grade from midterm to final and a 20% increase in the course pass rates over time, also for the high-risk population. These results support the hypothesis that our data-driven interventions and assessment techniques are successful in improving student retention, particularly for our academically at-risk students. © 2016 M. C. Carmichael et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Effects of vitamin D-fortified low fat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women: A randomised controlled clinical trial.

PubMed

Jafari, Tina; Faghihimani, Elham; Feizi, Awat; Iraj, Bijan; Javanmard, Shaghayegh Haghjooy; Esmaillzadeh, Ahmad; Fallah, Aziz A; Askari, Gholamreza

2016-02-01

Low levels of serum 25-hydroxy vitamin D (25(OH)D) are common in type 2 diabetic patients and cause several complications particularly, in postmenopausal women due to their senile and physiological conditions. This study aimed to assess the effects of vitamin D-fortified low fat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women. In a randomized, placebo-controlled, double-blind parallel-group clinical trial, 59 postmenopausal women with type 2 diabetes received fortified yogurt (FY; 2000 IU vitamin D in 100 g/day) or plain yogurt (PY) for 12 weeks. Glycemic markers, anthropometric indexes, inflammatory, and bone turnover markers were assessed at baseline and after 12 weeks. After intervention, in FY group (vs PY group), were observed: significant increase in serum 25(OH)D and decrease of PTH (stable values in PY); significant improvement in serum fasting insulin, HOMA-IR, HOMA-B, QUICKI, and no changes in serum fasting glucose and HbA1c (significant worsening of all indexes in PY); significant improvement in WC, WHR, FM, and no change in weight and BMI (stable values in PY); significant increase of omentin (stable in PY) and decrease of sNTX (significant increase in PY). Final values of glycemic markers (except HbA1c), omentin, and bone turnover markers significantly improved in FY group compared to PY group. Regarding final values of serum 25(OH)D in FY group, subjects were classified in insufficient and sufficient categories. Glycemic status improved more significantly in the insufficient rather than sufficient category; whereas the other parameters had more amelioration in the sufficient category. Daily consumption of 2000 IU vitamin D-fortified yogurt for 12 weeks improved glycemic markers (except HbA1c), anthropometric indexes, inflammation, and bone turnover markers in postmenopausal women with type 2 diabetes. www.irct.ir (IRCT2013110515294N1). Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Improvement of Base and Soil Construction Quality by Using Intelligent Compaction Technology : Final Report.

DOT National Transportation Integrated Search

2017-08-01

Intelligent Compaction (IC) technique is a fast-developing technology for base and soil compaction quality control. Proof-rolling subgrades and bases using IC rollers upon completion of compaction can identify the less stiff spots and significantly i...

Influence parameters of impact grinding mills

NASA Technical Reports Server (NTRS)

Hoeffl, K.; Husemann, K.; Goldacker, H.

1984-01-01

Significant parameters for impact grinding mills were investigated. Final particle size was used to evaluate grinding results. Adjustment of the parameters toward increased charge load results in improved efficiency; however, it was not possible to define a single, unified set to optimum grinding conditions.

Demonstration of Three Corrosion-Resistant Sustainable Roofing Systems

DTIC Science & Technology

2013-06-01

will significantly im- prove upon the performance of the original roofing systems . Improvement of energy efficiency, drainage , and other attributes...Sustainable Roofing Systems Final Report on Project F08-AR02 Co ns tr uc tio n En gi ne er in g R es ea rc h La bo ra to ry David M. Bailey...CERL TR-13-7 June 2013 Demonstration of Three Corrosion-Resistant Sustainable Roofing Systems Final Report on Project F08-AR02 David M. Bailey

Major Upgrades to the AIRS Version-6 Water Vapor Profile Methodology

NASA Technical Reports Server (NTRS)

Susskind, Joel; Blaisdell, John; Iredell, Lena

2015-01-01

This research is a continuation of part of what was shown at the last AIRS Science Team Meeting and the AIRS 2015 NetMeeting. AIRS Version 6 was finalized in late 2012 and is now operational. Version 6 contained many significant improvements in retrieval methodology compared to Version 5. Version 6 retrieval methodology used for the water vapor profile q(p) and ozone profile O3(p) retrievals is basically unchanged from Version 5, or even from Version 4. Subsequent research has made significant improvements in both water vapor and O3 profiles compared to Version 6.

Swimming performance changes during the final 3 weeks of training leading to the Sydney 2000 Olympic Games.

PubMed

Mujika, I; Padilla, S; Pyne, D

2002-11-01

The purpose of this study was to determine the magnitude of the swimming performance change during the final 3 weeks of training (F3T) leading to the Sydney 2000 Olympic Games. Olympic swimmers who took part in the same event or events at the Telstra 2000 Grand Prix Series in Melbourne, Australia, (26 - 27 August 2000), and 21 - 28 d later at the Sydney 2000 Olympic Games (16 - 23 September 2000) were included in this analysis. A total of 99 performances (50 male, 49 female) were analysed. The overall performance improvement between pre- and post-F3T conditions for all swimmers was 2.18 +/- 1.50 % (p < 0.0001), (range - 1.14 % to 6.02 %). A total of 91 of the 99 analysed performances were faster after the F3T and only 8 were slower. The percentage improvement with F3T was significantly higher (P < 0.01) in males (2.57 +/- 1.45 %) than in females (1.78 +/- 1.45 %). In conclusion, the pre-Olympic F3T elicited a significant performance improvement of 2.57 % for male and 1.78 % for female swimmers at the Sydney 2000 Olympic Games. The magnitude was similar for all competition events, and was achieved by swimmers from different countries and performance levels. These data provide a quantitative framework for coaches and swimmers to set realistic performance goals based on individual performance levels before the final training phase leading to important competitions.

Development of active traffic management strategies for Minnesota freeway corridors : final report.

DOT National Transportation Integrated Search

2015-06-01

In this study, the effectiveness of the I-35W variable advisory speed limit system on the improvement of the traffic : flow was evaluated with the real traffic data. The analysis results indicate there was significant reduction in the : average maxim...

Experimental and modeling approaches for food waste composting: a review.

PubMed

Li, Zhentong; Lu, Hongwei; Ren, Lixia; He, Li

2013-10-01

Composting has been used as a method to dispose food waste (FW) and recycle organic matter to improve soil structure and fertility. Considering the significance of composting in FW treatment, many researchers have paid their attention on how to improve FW composting efficiency, reduce operating cost, and mitigate the associated environmental damage. This review focuses on the overall studies of FW composting, not only various parameters significantly affecting the processes and final results, but also a number of simulation approaches that are greatly instrumental in well understanding the process mechanism and/or results prediction. Implications of many key ingredients on FW composting performance are also discussed. Perspects of effective laboratory experiments and computer-based simulation are finally investigated, demonstrating many demanding areas for enhanced research efforts, which include the screening of multi-functional additives, volatile organiccompound emission control, necessity of modeling and post-modeling analysis, and usefulness of developing more conjunctive AI-based process control techniques. Copyright © 2013 Elsevier Ltd. All rights reserved.

Visual Acuity Outcomes of the Boston Keratoprosthesis Type 1: Multicenter Study Results.

PubMed

Rudnisky, Christopher J; Belin, Michael W; Guo, Rong; Ciolino, Joseph B

2016-02-01

To report logarithm of the minimal angle of resolution (logMAR) visual outcomes of the Boston keratoprosthesis type 1. Prospective cohort study. Preoperative, intraoperative, and postoperative parameters of 300 eyes of 300 patients who underwent implantation of a Boston keratoprosthesis type 1 device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers were collected. After an average of 17.1 ± 14.8 months, visual acuity improved significantly (P < .0001) to a mean final value of 0.89 ± 0.64 (20/150). There were also significantly fewer eyes with light perception (6.7%; n = 19; P < .0001), although 3.1% (n = 9) progressed to no light perception. There was no association between age (P = .08), sex (P = .959), operative side (P = .167), or failure (P = .494) and final visual acuity. The median time to achieve 20/200 visual acuity was 1 month (95% confidence interval 1.0-6.0) and it was retained for an average of 47.8 months. Multivariate analysis, controlling for preoperative visual acuity, demonstrated 2 factors associated with final visual outcome: chemical injury was associated with better final vision (P = .007), whereas age-related macular degeneration was associated with poorer vision (P < .0001). The Boston keratoprosthesis type 1 is an effective device for rehabilitation in advanced ocular surface disease, resulting in a significant improvement in visual acuity. Eyes achieved a mean value of 20/150 (0.89 ± 0.64 logMAR units) after 6 months and this was relatively stable thereafter. The best visual prognosis is observed in chemical injury eyes, whereas the worst prognosis is in aniridia, although the latter has limited visual potential. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of corticosteroids on hyposmia in persistent allergic rhinitis.

PubMed

Catana, Iuliu V; Chirila, Magdalena; Negoias, Simona; Bologa, Ramona; Cosgarea, Marcel

2013-01-01

To asses the effects of two topical nasal corticosteroids sprays on hyposmia in patients with persistent allergic rhinitis. The study was a prospective clinical trial and it included twenty four patients with persistent allergic rhinitis (PER) and hyposmia (H). The patients were divided into two groups depending on the type of corticosteroid topical nasal spray treatment: group A, 200 micrograms dose of mometasone furoate (MF) and group B, 110 micrograms dose of fluticasone furoate (FF) both administered in the morning for 4 weeks. The olfactory function of the patients was evaluated with the extended Test battery "Sniffin' Sticks". The visual analogue scale (VAS) was used for the assessment of hyposmia, nasal discharge. The level of the nasal obstruction, before and after the treatment, was evaluated through the anterior rhinomanometry. The comparisons between the two types of topical corticosteroids showed a significant improvement separately between scores of the odor threshold (OT), odor discrimination (OD) and odor identification (OI) and also on the final olfactory score (SDI) before and after 4 weeks of the treatment. The comparisons of the VAS scores pre and post treatment showed a significant improvement in hyposmia and nasal obstruction. The nasal airflow and the nasal discharge scores were improved, but the differences were not statistically significant between the groups. The final statistical analysis found no significant differences between the two patients groups. The study concludes that fluticasone furoate and mometasone furoate have quite the same effects on hyposmia and on the classical symptoms from PER.

Introduction of e-learning in dental radiology reveals significantly improved results in final examination.

PubMed

Meckfessel, Sandra; Stühmer, Constantin; Bormann, Kai-Hendrik; Kupka, Thomas; Behrends, Marianne; Matthies, Herbert; Vaske, Bernhard; Stiesch, Meike; Gellrich, Nils-Claudius; Rücker, Martin

2011-01-01

Because a traditionally instructed dental radiology lecture course is very time-consuming and labour-intensive, online courseware, including an interactive-learning module, was implemented to support the lectures. The purpose of this study was to evaluate the perceptions of students who have worked with web-based courseware as well as the effect on their results in final examinations. Users (n(3+4)=138) had access to the e-program from any networked computer at any time. Two groups (n(3)=71, n(4)=67) had to pass a final exam after using the e-course. Results were compared with two groups (n(1)=42, n(2)=48) who had studied the same content by attending traditional lectures. In addition a survey of the students was statistically evaluated. Most of the respondents reported a positive attitude towards e-learning and would have appreciated more access to computer-assisted instruction. Two years after initiating the e-course the failure rate in the final examination dropped significantly, from 40% to less than 2%. The very positive response to the e-program and improved test scores demonstrated the effectiveness of our e-course as a learning aid. Interactive modules in step with clinical practice provided learning that is not achieved by traditional teaching methods alone. To what extent staff savings are possible is part of a further study. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Improvement of Diurnal Blood Pressure Variation by Azilsartan.

PubMed

Okamura, Keisuke; Shirai, Kazuyuki; Okuda, Tetsu; Urata, Hidenori

2018-01-01

Azilsartan is an angiotensin II receptor blocker with a potent antihypertensive effect. In a multicenter, prospective, open-label study, 265 patients with poor blood pressure control despite treatment with other angiotensin II receptor blockers were switched to 20 mg/day of azilsartan (patients on standard dosages) or 40 mg/day of azilsartan (patients on high dosages). Blood pressure was 149/83 mm Hg before switching and was significantly reduced from 1 month after switching until final assessment (132/76 mm Hg, P < 0.001). The pulse rate was 72/min before switching and increased significantly from 3 months after switching until final assessment (74/min, P < 0.005). A significant decrease of home morning systolic and diastolic pressure was observed from 1 and 3 months, respectively. Home morning blood pressure was 143/82 mm Hg before switching and 130/76 mm Hg at final assessment (P < 0.01). The morning-evening difference of systolic blood pressure decreased from 14.6 to 6.6 mm Hg after switching (P = 0.09). The estimated glomerular filtration rate was significantly decreased at 3, 6, and 12 months after switching, and serum uric acid was significantly increased at 12 months. No serious adverse events occurred. Azilsartan significantly reduced the blood pressure and decreased diurnal variation in patients responding poorly to other angiotensin II receptor blockers.

Major Upgrades to the AIRS Version-6 Ozone Profile Methodology

NASA Technical Reports Server (NTRS)

Susskind, Joel; Blaisdell, John; Iredell, Lena

2015-01-01

This research is a continuation of part of what was shown at the last AIRS Science Team Meeting in the talk Improved Water Vapor and Ozone Profiles in SRT AIRS Version-6.X and the AIRS February 11, 2015 NetMeeting Further improvements in water vapor and ozone profiles compared to Version-6.AIRS Version-6 was finalized in late 2012 and is now operational. Version-6 contained many significant improvements in retrieval methodology compared to Version-5. However, Version-6 retrieval methodology used for the water vapor profile q(p) and ozone profile O3(p) retrievals is basically unchanged from Version-5, or even from Version-4. Subsequent research has made significant improvements in both water vapor and O3 profiles compared to Version-6. This talk will concentrate on O3 profile retrievals. Improvements in water vapor profile retrievals are given in a separate presentation.

The promising effect of linagliptin and/or indole-3-carbinol on experimentally-induced polycystic ovarian syndrome.

PubMed

Kabel, Ahmed M; Al-Shehri, Aisha H; Al-Talhi, Rehab A; Abd Elmaaboud, Maaly A

2017-08-01

Polycystic ovarian syndrome (PCOS) is one of the most common medical conditions that lead to female infertility worldwide. The aim of this study was to assess the effect of linagliptin and/or indole-3-carbinol (I3C) on PCOS in female rats. Fifty female Wistar rats were randomly allocated into five equal groups: Control group; Letrozole-induced PCOS group; Letrozole + Linagliptin group; Letrozole + I3C group and Letrozole + Linagliptin + I3C group. Body weight, body mass index, Lee index and ovarian indices were determined. Plasma levels of luteinizing hormone (LH), free testosterone, estradiol, progesterone, prolactin, fasting blood glucose (FBG) and fasting plasma insulin were measured. Quantitative Insulin Sensitivity Check Index (QUICKI) was calculated. Tissue antioxidant status, transforming growth factor beta 1 (TGF-β1), tumor necrosis factor alpha (TNF-α), interleukin 10 (IL-10) and Nrf2/HO-1 content were assessed. Histopathological and immunohistochemical examination of the ovaries were done. Linagliptin and/or I3C induced significant decrease in tissue TGF-β1, TNF-α, IL-10, plasma free testosterone, luteinizing hormone, progesterone, estradiol, FBG and insulin levels associated with significant improvement of insulin resistance whereas tissue Nrf2/HO-1 content and antioxidant enzymes were significantly increased compared to PCOS group. In addition, final body weight, final body mass and Lee indices were significantly decreased compared to PCOS group. Also, there was significant improvement of the ovarian morphology compared to PCOS group. This improvement was significant with linagliptin/I3C combination compared to the use of each of these drugs alone. In conclusion, linagliptin/I3C combination might represent a beneficial therapeutic modality for amelioration of PCOS. Copyright © 2017 Elsevier B.V. All rights reserved.

C3–6 Laminoplasty for Cervical Spondylotic Myelopathy Maintains Satisfactory Long-Term Surgical Outcomes

PubMed Central

Sakaura, Hironobu; Hosono, Noboru; Mukai, Yoshihiro; Iwasaki, Motoki; Yoshikawa, Hideki

2014-01-01

Study Design Prospective cohort study. Objective To clarify long-term surgical outcomes of C3–6 laminoplasty preserving muscles attached to the C2 and C7 spinous processes in patients with cervical spondylotic myelopathy (CSM). Methods Twenty patients who underwent C3–6 open-door laminoplasty for CSM and who were followed for 8 to 10 years were included in this study. Myelopathic symptoms were assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate, or mild. C2–7 angle was measured using lateral radiographs of the cervical spine before surgery and at final follow-up. Results Mean JOA score before surgery (11.7) was significantly improved to 15.2 at the time of maximum recovery (1 year after surgery), declining slightly to 14.9 by the latest follow-up. Late deterioration of JOA score developed in eight patients, but was unrelated to the cervical spine lesions in each case. No patient suffered from prolonged postoperative axial neck pain at final follow-up. The mean C2–7 angle before surgery (13.8 degrees) significantly increased to 19.2 degrees at final follow-up. Conclusions C3–6 laminoplasty preserving muscles attached to the C2 and C7 spinous processes in patients with CSM maintained satisfactory long-term neurologic improvement with significantly reduced frequencies of prolonged postoperative axial neck pain and loss of C2–7 angle after surgery. PMID:25083358

C3-6 laminoplasty for cervical spondylotic myelopathy maintains satisfactory long-term surgical outcomes.

PubMed

Sakaura, Hironobu; Hosono, Noboru; Mukai, Yoshihiro; Iwasaki, Motoki; Yoshikawa, Hideki

2014-08-01

Study Design Prospective cohort study. Objective To clarify long-term surgical outcomes of C3-6 laminoplasty preserving muscles attached to the C2 and C7 spinous processes in patients with cervical spondylotic myelopathy (CSM). Methods Twenty patients who underwent C3-6 open-door laminoplasty for CSM and who were followed for 8 to 10 years were included in this study. Myelopathic symptoms were assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate, or mild. C2-7 angle was measured using lateral radiographs of the cervical spine before surgery and at final follow-up. Results Mean JOA score before surgery (11.7) was significantly improved to 15.2 at the time of maximum recovery (1 year after surgery), declining slightly to 14.9 by the latest follow-up. Late deterioration of JOA score developed in eight patients, but was unrelated to the cervical spine lesions in each case. No patient suffered from prolonged postoperative axial neck pain at final follow-up. The mean C2-7 angle before surgery (13.8 degrees) significantly increased to 19.2 degrees at final follow-up. Conclusions C3-6 laminoplasty preserving muscles attached to the C2 and C7 spinous processes in patients with CSM maintained satisfactory long-term neurologic improvement with significantly reduced frequencies of prolonged postoperative axial neck pain and loss of C2-7 angle after surgery.

Multicenter Clinical Trial of the Nucleus® Hybrid™ S8 Cochlear Implant: Final Outcomes

PubMed Central

Gantz, Bruce J; Dunn, Camille; Oleson, Jacob; Hansen, Marlan; Parkinson, Aaron; Turner, Christopher

2015-01-01

Objective The concept expanding electrical speech processing to those with more residual acoustic hearing with a less invasive shorter cochlear implant has been ongoing since 1999. A multi-center study of the Nucleus Hybrid S8 CI took place between 2002–11. This report describes the final outcomes of this clinical trial. Study Design Multi-Center longitudinal single subject design Methods Eighty-seven subjects received a Nucleus® Hybrid™ S8 implant in their poorer ear. Speech perception in quiet (CNC words) and in noise (BKB-SIN) was collected pre- and post-operatively at 3, 6, and 12 months. Subjective questionnaire data using the APHAB was also collected. Results Some level of hearing preservation was accomplished in 98% subjects with 90% maintaining a functional low-frequency pure-tone average (LFPTA) at initial activation. By 12 months, 5 subjects had total hearing loss and 80% of subjects maintained functional hearing. CNC words demonstrated that 82.5% and 87.5% of subjects had significant improvements in the Hybrid and Combined conditions. The majority of had improvements with BKB-SIN. Results also indicated that as long as subjects maintained at least a severe LFPTA, there was significant improvement in speech understanding. Furthermore, all subjects reported positive improvements in hearing in three of the 4 subscales of the APHAB. Conclusion The concept of hybrid speech processing has significant advantages for subjects with residual low-frequency hearing. In this study, the Nucleus® Hybrid™ S8 provided improved word understanding in quiet and noise. Additionally, there appears to be stability of the residual hearing after initial activation of the device. Level of evidence 2c PMID:26756395

Improving titer while maintaining quality of final formulated drug substance via optimization of CHO cell culture conditions in low-iron chemically defined media.

PubMed

Xu, Jianlin; Rehmann, Matthew S; Xu, Xuankuo; Huang, Chao; Tian, Jun; Qian, Nan-Xin; Li, Zheng Jian

2018-04-01

During biopharmaceutical process development, it is important to improve titer to reduce drug manufacturing costs and to deliver comparable quality attributes of therapeutic proteins, which helps to ensure patient safety and efficacy. We previously reported that relative high-iron concentrations in media increased titer, but caused unacceptable coloration of a fusion protein during early-phase process development. Ultimately, the fusion protein with acceptable color was manufactured using low-iron media, but the titer decreased significantly in the low-iron process. Here, long-term passaging in low-iron media is shown to significantly improve titer while maintaining acceptable coloration during late-phase process development. However, the long-term passaging also caused a change in the protein charge variant profile by significantly increasing basic variants. Thus, we systematically studied the effect of media components, seed culture conditions, and downstream processing on productivity and quality attributes. We found that removing β-glycerol phosphate (BGP) from basal media reduced basic variants without affecting titer. Our goals for late-phase process development, improving titer and matching quality attributes to the early-phase process, were thus achieved by prolonging seed culture age and removing BGP. This process was also successfully scaled up in 500-L bioreactors. In addition, we demonstrated that higher concentrations of reactive oxygen species were present in the high-iron Chinese hamster ovary cell cultures compared to that in the low-iron cultures, suggesting a possible mechanism for the drug substance coloration caused by high-iron media. Finally, hypotheses for the mechanisms of titer improvement by both high-iron and long-term culture are discussed.

SOIL moisture data intercomparison

NASA Astrophysics Data System (ADS)

Kerr, Yann; Rodriguez-Frenandez, Nemesio; Al-Yaari, Amen; Parens, Marie; Molero, Beatriz; Mahmoodi, Ali; Mialon, Arnaud; Richaume, Philippe; Bindlish, Rajat; Mecklenburg, Susanne; Wigneron, Jean-Pierre

2016-04-01

The Soil Moisture and Ocean Salinity satellite (SMOS) was launched in November 2009 and started delivering data in January 2010. Subsequently, the satellite has been in operation for over 6 years while the retrieval algorithms from Level 1 to Level 2 underwent significant evolutions as knowledge improved. Other approaches for retrieval at Level 2 over land were also investigated while Level 3 and 4 were initiated. In this présentation these improvements are assessed by inter-comparisons of the current Level 2 (V620) against the previous version (V551) and new products either using neural networks or Level 3. In addition a global evaluation of different SMOS soil moisture (SM) products is performed comparing products with those of model simulations and other satellites (AMSR E/ AMSR2 and ASCAT). Finally, all products were evaluated against in situ measurements of soil moisture (SM). The study demonstrated that the V620 shows a significant improvement (including those at level1 improving level2)) with respect to the earlier version V551. Results also show that neural network based approaches can yield excellent results over areas where other products are poor. Finally, global comparison indicates that SMOS behaves very well when compared to other sensors/approaches and gives consistent results over all surfaces from very dry (African Sahel, Arizona), to wet (tropical rain forests). RFI (Radio Frequency Interference) is still an issue even though detection has been greatly improved while RFI sources in several areas of the world are significantly reduced. When compared to other satellite products, the analysis shows that SMOS achieves its expected goals and is globally consistent over different eco climate regions from low to high latitudes and throughout the seasons.

78 FR 40496 - Notice of availability of the Final Environmental Impact Statement for the Proposed Hollister...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-05

... silver mining operation. Most of the infrastructure to support a mining operation was authorized and.... The Proposed Action consists of underground mining, constructing a new production shaft, improving.... Public comments resulted in the addition of clarifying text, but did not significantly change the...

Beyond "Job-Embedded": Ensuring That Good Professional Development Gets Results

ERIC Educational Resources Information Center

National Institute for Excellence in Teaching, 2012

2012-01-01

Two recent studies by Biancarosa et al. and by Saunders et al. have finally demonstrated that "job-embedded, sustained professional development" can significantly improve student achievement. But there's a catch. In both studies, effective professional development (PD) strategies were successful only under certain circumstances or only in some…

Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer: a prospective study.

PubMed

Paleri, Vinidh; Carding, Paul; Chatterjee, Sanjoy; Kelly, Charles; Wilson, Janet Ann; Welch, Andrew; Drinnan, Michael

2012-12-01

The voice impact of treatment for nonlaryngeal head and neck primary sites remains unknown. We conducted a prospective study of a consecutive sample of patients undergoing chemoradiation for nonlaryngeal head and neck cancer. The Voice Symptom Scale (VoiSS) was completed, and voice recordings were made at 3 time-points. Of 42 recruited patients, 34 completed the measures before and in the early posttreatment phase (mean 16.5 weeks), while 21 patients were assessed at the final time-point (mean, 20.4 months). VoiSS scores showed statistically significant progressive deterioration in the total score (p = .02) and impairment subscale (p < .0001) through to the final assessment. Acoustic measures and perceptual ratings deteriorated significantly (p < .001) in the early posttreatment weeks and improved at the final assessment, but not to the baseline. Interrater agreement was excellent for expert measures. To the best of our knowledge, this is the first prospective study to show that chemoradiation therapy for nonlaryngeal head and neck cancer has a significant effect on the patients' self-reported voice quality, even in the long term. Copyright © 2012 Wiley Periodicals, Inc.

Efficacy and Safety of Doxepin 1 mg, 3 mg, and 6 mg in Adults with Primary Insomnia

PubMed Central

Roth, Thomas; Rogowski, Roberta; Hull, Steven; Schwartz, Howard; Koshorek, Gail; Corser, Bruce; Seiden, David; Lankford, Alan

2007-01-01

Study Objectives: To evaluate the efficacy and safety of doxepin 1, 3, and 6 mg in insomnia patients. Design: Adults (18-64 y) with chronic primary insomnia (DSM-IV) were randomly assigned to one of four sequences of 1 mg, 3 mg, and 6 mg of doxepin, and placebo in a crossover study. Treatment periods consisted of 2 polysomnographic assessment nights with a 5-day or 12-day drug-free interval between periods. Efficacy was assessed using polysomnography (PSG) and patient-reported measures. Safety analyses included measures of residual sedation and adverse events. Measurements and Results: Sixty-seven patients were randomized. Wake time during sleep, the a priori defined primary endpoint, was statistically significantly improved at the doxepin 3 mg and 6 mg doses versus placebo. All three doses had statistically significant improvements versus placebo for PSG-defined wake after sleep onset, total sleep time, and overall sleep efficiency (SE). SE in the final third-of-the-night also demonstrated statistically significant improvement at all doses. The doxepin 6 mg dose significantly reduced subjective latency to sleep onset. All three doxepin doses had a safety profile comparable to placebo. There were no statistically significant differences in next-day residual sedation, and sleep architecture was generally clinically preserved. Conclusions: In adults with primary insomnia, doxepin 1 mg, 3 mg, and 6 mg was well-tolerated and produced improvement in objective and subjective sleep maintenance and duration endpoints that persisted into the final hour of the night. The side-effect profile was comparable to placebo, with no reported anticholinergic effects, no memory impairment, and no significant hangover/next-day residual effects. These data demonstrate that doxepin 1 mg, 3 mg, and 6 mg is efficacious in improving the sleep of patients with chronic primary insomnia. Citation: Roth T; Rogowski R; Hull S; Schwartz H; Koshorek G; Corser B; Seiden D. Efficacy and safety of doxepin 1 mg, 3 mg, and 6 mg in adults with primary insomnia. SLEEP 2007;30(11):1555-1561. PMID:18041488

Relationship between Learning Style and Academic Status of Babol Dental Students

PubMed Central

Nasiri, Zahra; Gharekhani, Samane; Ghasempour, Maryam

2016-01-01

Introduction Identifying and employing students’ learning styles could play an important role in selecting appropriate teaching methods in order to improve education. The aim of this study was to determine the relationship between the students’ final exam scores and the learning style preferences of dental students at Babol University of Medical Sciences. Methods This cross-sectional study was conducted on 88 dental students studying in their fourth, fifth, and sixth years using the visual–aural–reading/writing–kinesthetic (VARK) learning styles’ questionnaire. The data were analyzed with IBM SPSS, version 21, using the chi-squared test and the t-test. Results Of the 88 participants who responded to the questionnaire, 87 preferred multimodal learning styles. There was no significant difference between the mean of the final exam scores in students who did and did not prefer the aural learning style (p = 0.86), the reading/writing learning style (p = 0.20), and the kinesthetic learning style (p = 0.32). In addition, there was no significant difference between the scores on the final clinical course among the students who had different preferences for learning style. However, there was a significant difference between the mean of the final exam scores in students with and without visual learning style preference (p = 0.03), with the former having higher mean scores. There was no significant relationship between preferred learning styles and gender (p > 0.05). Conclusion The majority of dental students preferred multimodal learning styles, and there was a significant difference between the mean of the final exam scores for students with and without a preference for the visual learning style. In addition, there were no differences in the preferred learning styles between male and female students. PMID:27382442

Arthroscopic lysis of adhesions for the stiff total knee: results after failed manipulation.

PubMed

Tjoumakaris, Fotios Paul; Tucker, Bradfords Chofield; Post, Zachary; Pepe, Matthew David; Orozco, Fabio; Ong, Alvin C

2014-05-01

Arthrofibrosis after total knee arthroplasty (TKA) is a potentially devastating complication, resulting in loss of motion and function and residual pain. For patients in whom aggressive physical therapy and manipulation under anesthesia fail, lysis of adhesions may be the only option to rescue the stiff TKA. The purpose of this study is to report the results of arthroscopic lysis of adhesions after failed manipulation for a stiff, cruciate-substituting TKA. This retrospective study evaluated patients who had undergone arthroscopic lysis of adhesions for arthrofibrosis after TKA between 2007 and 2011. Minimum follow-up was 12 months (average, 31 months). Average total range of motion of patients in this series was 62.3°. Average preoperative flexion contracture was 16° and average flexion was 78.6°. Statistical analysis was performed using Student's t test. Pre- to postoperative increase in range of motion was significant (P<.001) (average, 62° preoperatively to 98° postoperatively). Average preoperative extension deficit was 16°, which was reduced to 4° at final follow-up. This value was also found to be statistically significant (P<.0001). With regard to ultimate flexion attained, average preoperative flexion was 79°, which was improved to 103° at final follow-up. This improvement in flexion was statistically significant (P<.0001). Patients can reliably expect an improvement after arthroscopic lysis of adhesions for a stiff TKA using a standardized arthroscopic approach; however, patients achieved approximately half of the improvement that was obtained at the time of surgery. Copyright 2014, SLACK Incorporated.

Integrated Application of Active Controls (IAAC) technology to an advanced subsonic transport project: Wing planform study and final configuration selection

NASA Technical Reports Server (NTRS)

1981-01-01

The Wing Planform Study and Final Configuration Selection Task of the Integrated Application of Active Controls (IAAC) Technology Project within the Energy Efficient Transport Program is documented. Application of Active Controls Technology (ACT) in combination with increased wing span resulted in significant improvements over the Conventional Baseline Configuration (Baseline) and the Initial ACT Configuration previously established. The configurations use the same levels of technology, takeoff gross weight, and payload as the Baseline. The Final ACT Configuration (Model 768-107) incorporates pitch-augmented stability (which enabled an approximately 10% aft shift in cruise center of gravity and a 44% reduction in horizontal tail size), lateral/directional-augmented stability, an angle-of-attack limiter, and wing-load alleviation. Flutter-mode control was not beneficial for this configuration. This resulted in an 890 kg (1960 lb) reduction in airplane takeoff gross weight and a 9.8% improvement in cruise lift/drag. At the Baseline mission range (3589 km 1938 nmi), this amounts to 10% block-fuel reduction. Results of this task strongly indicate that the IAAC Project should proceed with the Final ACT evaluation, and begin the required control system development and test.

Volume change and energy exchange: How they affect symmetry in the Noh problem

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

Vachal, Pavel; Wendroff, Burton

The edge viscosity of Caramana, Shashkov and Whalen is known to fail on the Noh problem in an initially rectangular grid. In this paper, we present a simple change that significantly improves the behavior in that case. We also show that added energy exchange between cells improves the symmetry of both edge viscosity and the tensor viscosity of Campbell and Shashkov. Finally, as suggested by Noh, this addition also reduces the wall heating effect.

Volume change and energy exchange: How they affect symmetry in the Noh problem

DOE PAGES

Vachal, Pavel; Wendroff, Burton

2018-03-14

The edge viscosity of Caramana, Shashkov and Whalen is known to fail on the Noh problem in an initially rectangular grid. In this paper, we present a simple change that significantly improves the behavior in that case. We also show that added energy exchange between cells improves the symmetry of both edge viscosity and the tensor viscosity of Campbell and Shashkov. Finally, as suggested by Noh, this addition also reduces the wall heating effect.

Polypropylene mesh augmentation for complete quadriceps rupture after total knee arthroplasty.

PubMed

Nodzo, Scott R; Rachala, Sridhar R

2016-01-01

Polypropylene mesh has previously been shown to be an effective treatment for failed patellar tendon repairs after total knee arthroplasty (TKA), but there have been few reports of this synthetic mesh used in complete quadriceps rupture after TKA. We retrospectively reviewed seven consecutive cases in six patients with complete quadriceps tears after TKA who had their quadriceps tendon repaired with suture and polypropylene mesh augmentation. All but two patients had previously failed primary suture repair. Patient outcomes were evaluated using the Knee Society Score. Standardized anterior-posterior (AP), lateral and merchant radiographs were evaluated preoperatively and at final follow-up. Seven knees in six patients were evaluated with a mean follow-up of 34±10 (range 24 to 49months) months. There were only four clinical successes defined as an extensor lag less than 30°. Of the functioning knees at final follow-up (n=5) the overall extensor lag in this group did significantly improve from 50±13° to 20±15° (range 5 to 40°) (p=.01). Mean postoperative flexion at final follow-up was 115±8°. Mean Knee Society Score for function improved from 20±30 to 45±54 (p=.03) as did the mean Knee Society Score for pain (44±18 vs. 74±78, p=.02). Polypropylene mesh offered limited postoperative functional results when used as an augment to the multiply operated knee that sustains a complete quadriceps rupture after TKA, but did allow for significant improvement in postoperative pain outcomes. IV. Copyright © 2015 Elsevier B.V. All rights reserved.

Coding tools investigation for next generation video coding based on HEVC

NASA Astrophysics Data System (ADS)

Chen, Jianle; Chen, Ying; Karczewicz, Marta; Li, Xiang; Liu, Hongbin; Zhang, Li; Zhao, Xin

2015-09-01

The new state-of-the-art video coding standard, H.265/HEVC, has been finalized in 2013 and it achieves roughly 50% bit rate saving compared to its predecessor, H.264/MPEG-4 AVC. This paper provides the evidence that there is still potential for further coding efficiency improvements. A brief overview of HEVC is firstly given in the paper. Then, our improvements on each main module of HEVC are presented. For instance, the recursive quadtree block structure is extended to support larger coding unit and transform unit. The motion information prediction scheme is improved by advanced temporal motion vector prediction, which inherits the motion information of each small block within a large block from a temporal reference picture. Cross component prediction with linear prediction model improves intra prediction and overlapped block motion compensation improves the efficiency of inter prediction. Furthermore, coding of both intra and inter prediction residual is improved by adaptive multiple transform technique. Finally, in addition to deblocking filter and SAO, adaptive loop filter is applied to further enhance the reconstructed picture quality. This paper describes above-mentioned techniques in detail and evaluates their coding performance benefits based on the common test condition during HEVC development. The simulation results show that significant performance improvement over HEVC standard can be achieved, especially for the high resolution video materials.

Hip Arthroscopy for Femoral-Acetabular Impingement: Do Active Claims Affect Outcomes?

PubMed

Gigi, Roy; Rath, Ehud; Sharfman, Zachary T; Shimonovich, Shachar; Ronen, Itai; Amar, Eyal

2016-04-01

To compare outcomes of 3 patient groups undergoing hip arthroscopy. This study included 138 consecutive hip arthroscopies (106 analyzed) for femoral-acetabular impingement (FAI) with or without labral tear in patients with a minimum 1-year follow-up. Inclusion criteria included patients older than 18 with clinical or radiologic manifestation of FAI with or without labral tear. Exclusion criteria included previous hip surgery and various hip pathologies. Patients were classified into 3 study groups. Group 1 included work-related injuries with active claims ACs (n = 33); mean age, 32 (range, 19 to 63); group 2 included sports injuries with no ACs (n = 35); mean age, 32 (range, 18 to 69); and group 3 included non-sports-related injuries without pending ACs (NAS; n = 38); mean age, 45 (range, 20 to 68). Outcomes were assessed using modified Harris hip scores (mHHS) and hip outcome scores (HOS) preoperatively and during the final evaluation. Baseline score for all groups did not significantly differ (P = .210 for mHHS, P = .176 for HOS). All groups significantly improved from preoperative to final evaluation (group 1: mHHS P = .42, HOS P = .001; group 2: mHHS P < .001, HOS P < .001; group 3 NAS: mHHS P = .001, HOS P = .007). AC patients had the lowest final evaluation scores, while the sports group had the highest. The NAS group did not differ from either group at final evaluation. Preoperative and final evaluation scores inversely correlated with age (r range, -24 to -28; P < .05). This study has shown that patients may benefit from arthroscopic repair of FAI and labral tears regardless of ACs. The level of improvement, however, is not constant across patients with different characteristics. Moreover, it appears that age may impact perceived improvement after hip arthroscopy. Hip arthroscopy as an intervention in patients with ACs provided positive outcomes, corroborating that an AC is not a contraindication for this procedure. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effects of corticosteroids on hyposmia in persistent allergic rhinitis

PubMed Central

CATANA, IULIU V.; CHIRILA, MAGDALENA; NEGOIAS, SIMONA; BOLOGA, RAMONA; COSGAREA, MARCEL

2013-01-01

Objective To asses the effects of two topical nasal corticosteroids sprays on hyposmia in patients with persistent allergic rhinitis. Material and Methods The study was a prospective clinical trial and it included twenty four patients with persistent allergic rhinitis (PER) and hyposmia (H). The patients were divided into two groups depending on the type of corticosteroid topical nasal spray treatment: group A, 200 micrograms dose of mometasone furoate (MF) and group B, 110 micrograms dose of fluticasone furoate (FF) both administered in the morning for 4 weeks. The olfactory function of the patients was evaluated with the extended Test battery „Sniffin’ Sticks”. The visual analogue scale (VAS) was used for the assessment of hyposmia, nasal discharge. The level of the nasal obstruction, before and after the treatment, was evaluated through the anterior rhinomanometry. Results The comparisons between the two types of topical corticosteroids showed a significant improvement separately between scores of the odor threshold (OT), odor discrimination (OD) and odor identification (OI) and also on the final olfactory score (SDI) before and after 4 weeks of the treatment. The comparisons of the VAS scores pre and post treatment showed a significant improvement in hyposmia and nasal obstruction. The nasal airflow and the nasal discharge scores were improved, but the differences were not statistically significant between the groups. The final statistical analysis found no significant differences between the two patients groups. Conclusion The study concludes that fluticasone furoate and mometasone furoate have quite the same effects on hyposmia and on the classical symptoms from PER. PMID:26527931

Music therapy for children and adolescents with behavioural and emotional problems: a randomised controlled trial.

PubMed

Porter, Sam; McConnell, Tracey; McLaughlin, Katrina; Lynn, Fiona; Cardwell, Christopher; Braiden, Hannah-Jane; Boylan, Jackie; Holmes, Valerie

2017-05-01

Although music therapy (MT) is considered an effective intervention for young people with mental health needs, its efficacy in clinical settings is unclear. We therefore examined the efficacy of MT in clinical practice. Two hundred and fifty-one child (8-16 years, with social, emotional, behavioural and developmental difficulties) and parent dyads from six Child and Adolescent Mental Health Service community care facilities in Northern Ireland were randomised to 12 weekly sessions of MT plus usual care [n = 123; 76 in final analyses] or usual care alone [n = 128; 105 in final analyses]. Follow-up occurred at 13 weeks and 26 weeks postrandomisation. Primary outcome was improvement in communication (Social Skills Improvement System Rating Scales) (SSIS) at 13 weeks. Secondary outcomes included social functioning, self-esteem, depression and family functioning. There was no significant difference for the child SSIS at week 13 (adjusted difference in mean 2.4; 95% CI -1.2 to 6.1; p = .19) or for the guardian SSIS (0.5; 95% CI -2.9 to 3.8; p = .78). However, for participants aged 13 and over in the intervention group, the child SSIS communication was significantly improved (6.1, 95% CI 1.6 to 10.5; p = .007) but not the guardian SSIS (1.1; 95% CI -2.9 to 5.2; p = .59). Overall, self-esteem was significantly improved and depression scores were significantly lower at week 13. There was no significant difference in family or social functioning at week 13. While the findings provide some evidence for the integration of music therapy into clinical practice, differences relating to subgroups and secondary outcomes indicate the need for further study. ISRCTN Register; ISRCTN96352204. © 2016 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

Automatic video shot boundary detection using k-means clustering and improved adaptive dual threshold comparison

NASA Astrophysics Data System (ADS)

Sa, Qila; Wang, Zhihui

2018-03-01

At present, content-based video retrieval (CBVR) is the most mainstream video retrieval method, using the video features of its own to perform automatic identification and retrieval. This method involves a key technology, i.e. shot segmentation. In this paper, the method of automatic video shot boundary detection with K-means clustering and improved adaptive dual threshold comparison is proposed. First, extract the visual features of every frame and divide them into two categories using K-means clustering algorithm, namely, one with significant change and one with no significant change. Then, as to the classification results, utilize the improved adaptive dual threshold comparison method to determine the abrupt as well as gradual shot boundaries.Finally, achieve automatic video shot boundary detection system.

Improvement of Diurnal Blood Pressure Variation by Azilsartan

PubMed Central

Okamura, Keisuke; Shirai, Kazuyuki; Okuda, Tetsu; Urata, Hidenori

2018-01-01

Background Azilsartan is an angiotensin II receptor blocker with a potent antihypertensive effect. Methods In a multicenter, prospective, open-label study, 265 patients with poor blood pressure control despite treatment with other angiotensin II receptor blockers were switched to 20 mg/day of azilsartan (patients on standard dosages) or 40 mg/day of azilsartan (patients on high dosages). Results Blood pressure was 149/83 mm Hg before switching and was significantly reduced from 1 month after switching until final assessment (132/76 mm Hg, P < 0.001). The pulse rate was 72/min before switching and increased significantly from 3 months after switching until final assessment (74/min, P < 0.005). A significant decrease of home morning systolic and diastolic pressure was observed from 1 and 3 months, respectively. Home morning blood pressure was 143/82 mm Hg before switching and 130/76 mm Hg at final assessment (P < 0.01). The morning-evening difference of systolic blood pressure decreased from 14.6 to 6.6 mm Hg after switching (P = 0.09). The estimated glomerular filtration rate was significantly decreased at 3, 6, and 12 months after switching, and serum uric acid was significantly increased at 12 months. No serious adverse events occurred. Conclusion Azilsartan significantly reduced the blood pressure and decreased diurnal variation in patients responding poorly to other angiotensin II receptor blockers. PMID:29238433

The implementation and validation of improved landsurface hydrology in an atmospheric general circulation model

NASA Technical Reports Server (NTRS)

Johnson, Kevin D.; Entekhabi, Dara; Eagleson, Peter S.

1991-01-01

Landsurface hydrological parameterizations are implemented in the NASA Goddard Institute for Space Studies (GISS) General Circulation Model (GCM). These parameterizations are: (1) runoff and evapotranspiration functions that include the effects of subgrid scale spatial variability and use physically based equations of hydrologic flux at the soil surface, and (2) a realistic soil moisture diffusion scheme for the movement of water in the soil column. A one dimensional climate model with a complete hydrologic cycle is used to screen the basic sensitivities of the hydrological parameterizations before implementation into the full three dimensional GCM. Results of the final simulation with the GISS GCM and the new landsurface hydrology indicate that the runoff rate, especially in the tropics is significantly improved. As a result, the remaining components of the heat and moisture balance show comparable improvements when compared to observations. The validation of model results is carried from the large global (ocean and landsurface) scale, to the zonal, continental, and finally the finer river basin scales.

An improved segmentation method for defects inspection on steel roller surface

NASA Astrophysics Data System (ADS)

Xu, Jirui; Li, Xuekun; Cao, Yuzhong; Shi, Depeng; Yang, Jun; Jiang, Sheng; Rong, Yiming

2018-05-01

In the field of metal rolling, the quality of the steel roller's surface is significant for the final rolling products, e.g. metal sheets or foils. Besides the dimensional accuracy and surface roughness, the optical uniformity of the roller surface is also required for high quality rolling application. The typical optical defects of rollers after finish grinding include speckles, chatter marks, feed traces, and combination of all above. Unlike surface roughness, the optical defects can hardly be characterized by the topography or scanning electrical microscope measurement. Only the inspection by bared eyes of experienced engineers appears to be the effective manner for surface optical defects examination for large steel rollers. In this paper, an on-site machine vision system is designed to add on to the roller grinding machine to capture the surface image, and then an improved optical defects segmentation algorithm is developed based on the active contour model. Finally, experiments are carried out to verify the efficacy of the improved model.

Spatial Cognition and Map Interpretation

DTIC Science & Technology

1987-09-01

Terrain association Spatial cognition Map reading Videogames aa mldm II naeaaaaiy and Hontlty by block numbor) Spatial memory span Orientation...ability. Finally, field and classroom performance was compared to wayfinding in a simulated ( videogame ) environment in which position coordinates were...a simulated ( videogame ) environment. Findings: MITAC instruction significantly improved the experimental group’s ability to perform terrain

Knowledge, Attitudes and Preventive Efforts of Malaysian Medical Students Regarding Exposure to Environmental Tobacco and Cigarette Smoking.

ERIC Educational Resources Information Center

Frisch, Ann Stirling; Kurtz, Margot; Shamsuddin, Khadijah

1999-01-01

Study examines changes in knowledge, attitudes, and preventive efforts of Malaysian students concerning cigarette smoking and environmental exposure to tobacco smoke from their first pre-clinical year in medical school until their final clinical year. Although there were significant improvements in knowledge about smoking and environmental…

Evaluating the Effects of Flexible Learning about Aseptic Compounding on First-year Students in a Pharmacy Skills Laboratory.

PubMed

Neville, Michael W; Palmer, Russ; Elder, Deborah; Fulford, Michael; Morris, Steve; Sappington, Kellie

2015-08-25

To evaluate how flexible learning via online video review affects the ability and confidence of first-year (P1) pharmacy students to accurately compound aseptic preparations. Customary instructions and assignments for aseptic compounding were provided to students, who were given unlimited access to 5 short review videos in addition to customary instruction. Student self-confidence was assessed online, and faculty members evaluated students' aseptic technique at the conclusion of the semester. No significant difference on final assessment scores was observed between those who viewed videos and those who did not. Student self-confidence scores increased significantly from baseline, but were not significantly higher for those who viewed videos than for those who did not. First-year students performed well on final aseptic compounding assessments, and those who viewed videos had a slight advantage. Student self-confidence improved over the semester regardless of whether or not students accessed review videos.

Concepts first: A course with improved educational outcomes and parity for underrepresented minority groups

NASA Astrophysics Data System (ADS)

Webb, D. J.

2017-08-01

Two active learning physics courses were taught and compared. The "concepts first" course was organized to teach only concepts in the first part of the class, the ultimate goal being to increase students' problem-solving abilities much later in the class. The other course was taught in the same quarter by the same instructor using the same curricular materials, but covered material in the standard (chapter-by-chapter) order. After accounting for incoming student characteristics, students from the concepts-first course scored significantly better in two outcome measures: their grade on the final exam and the grade received in their subsequent physics course. Moreover, in the concepts-first class course, students from groups underrepresented in physics had final exam scores and class grades that were indistinguishable from other students. Finally, students who took at least one concepts-first course in introductory physics were found to have significantly higher rates of graduation with a STEM major than students from this cohort who did not.

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.

Role-playing is an effective instructional strategy for genetic counseling training: an investigation and comparative study.

PubMed

Xu, Xiao-Feng; Wang, Yan; Wang, Yan-Yan; Song, Ming; Xiao, Wen-Gang; Bai, Yun

2016-09-02

Genetic diseases represent a significant public health challenge in China that will need to be addressed by a correspondingly large number of professional genetic counselors. However, neither an official training program for genetic counseling, nor formal board certification, was available in China before 2015. In 2009, a genetic counseling training program based on role-playing was implemented as a pilot study at the Third Military Medical University to train third-year medical students. Questionnaires on participant attitudes to the program and role-playing were randomly administered to 324 students after they had finished their training. Pre- and post-training instructional tests, focusing on 42 key components of genetic counseling, were administered randomly to 200 participants to assess mastery of each component. Finally, scores in final examinations of 578 participants from 2009 to 2011 were compared to scores obtained by 614 non-participating students from 2006 to 2008 to further assess program efficacy. Both the training program and the instructional strategy of role-playing were accepted by most participants. Students believed that role-playing improved their practice of genetic counseling and medical genetics, enhanced their communication skills, and would likely contribute to future professional performance. The average understanding of 40 of the key points in genetic counseling was significantly improved, and most students approached excellent levels of mastery. Scores in final examinations and the percentages of students scoring above 90 were also significantly elevated. Role-playing is a feasible and effective instructional strategy for training genetic counselors in China as well as in other developing countries.

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course.

PubMed

Hwang, Jee-In; Yoon, Tai-Young; Jin, Hyeon-Jeong; Park, Yikyun; Park, Ju-Young; Lee, Beom-Joon

2016-11-01

As final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students' safety competence.

Development, implementation, and evaluation of a community pharmacy-based asthma care model.

PubMed

Saini, Bandana; Krass, Ines; Armour, Carol

2004-11-01

Pharmacists are uniquely placed in the healthcare system to address critical issues in asthma management in the community. Various programs have shown the benefits of a pharmacist-led asthma care program; however, no such programs have previously been evaluated in Australia. To measure the impact of a specialized asthma service provided through community pharmacies in terms of objective patient clinical, humanistic, and economic outcomes. A parallel controlled design, where 52 intervention patients and 50 control patients with asthma were recruited in 2 distinct locations, was used. In the intervention area, pharmacists were trained and delivered an asthma care model, with 3 follow-up visits over 6 months. This model was evaluated based on clinical, humanistic, and economic outcomes compared between and within groups. There was a significant reduction in asthma severity in the intervention group, 2.6 +/- 0.5 to 1.6 +/- 0.7 (mean +/- SD; p < 0.001) versus the control group, 2.3 +/- 0.7 to 2.4 +/- 0.5. In the intervention group, peak flow indices improved from 82.7% +/- 8.2% at baseline to 87.4% +/- 8.9% (p < 0.001) at the final visit, and there was a significant reduction in the defined daily dose of albuterol used by patients, from 374.8 +/- 314.8 microg at baseline to 198.4 +/- 196.9 microg at the final visit (p < 0.015). There was also a statistically significant improvement in perceived control of asthma and asthma-related knowledge scores in the intervention group compared with the control group between baseline and the final visit. Annual savings of $132.84(AU) in medication costs per patient and $100,801.20 for the whole group, based on overall severity reduction, were demonstrated. Based on the results of this study, it appears that a specialized asthma care model offers community pharmacists an opportunity to contribute toward improving asthma management in the Australian community.

Teaching Health versus Treating Illness: The Efficacy of Three Principles Correctional Counseling with People in an English Prison.

PubMed

Kelley, Thomas M; Hollows, Jacqueline; Lambert, Eric G; Savard, Dennis M; Pransky, Jack

2018-07-01

Three principles correctional counseling (3PCC) posits that people in prison have inner mental health they have obscured to varying degrees with their own thinking. 3PCC further posits that people in prison can rekindle and sustain this inner health via understanding how three psychospiritual principles-Universal Mind, consciousness, and thought-coalesce to form people's psychological experience. We review the three principles and explain how exposure to these principles can lead to improved mental health and improved behavior. Then, we describe 3PCC and distinguish it from prevailing correctional counseling methods. Finally, we present a preliminary study that examines the efficacy of 3PCC for improving the mental health and behavior of people in an English prison. Our findings show that participants exposed to 3PCC showed a significant improvement in mental well-being and purpose in life, significant reductions in anxiety and anger, and improved behavior in the prison community.

Search for new phenomena in monophoton final states in proton–proton collisions at s = 8  TeV

DOE PAGES

Khachatryan, V.

2016-02-01

In this paper, results are presented from a search for new physics in final states containing a photon and missing transverse momentum. The data correspond to an integrated luminosity of 19.6 fb -1 collected in proton–proton collisions at √s = 8 TeV with the CMS experiment at the LHC. No deviation from the standard model predictions is observed for these final states. New, improved limits are set on dark matter production and on parameters of models with large extra dimensions. In particular, the first limits from the LHC on branon production are found and significantly extend previous limits from LEPmore » and the Tevatron. Finally, an upper limit of 14.0 fb on the cross section is set at the 95% confidence level for events with a monophoton final state with photon transverse momentum greater than 145 GeV and missing transverse momentum greater than 140 GeV.« less

Perceptual, durational and tongue displacement measures following articulation therapy for rhotic sound errors.

PubMed

Bressmann, Tim; Harper, Susan; Zhylich, Irina; Kulkarni, Gajanan V

2016-01-01

Outcomes of articulation therapy for rhotic errors are usually assessed perceptually. However, our understanding of associated changes of tongue movement is limited. This study described perceptual, durational and tongue displacement changes over 10 sessions of articulation therapy for /ɹ/ in six children. Four of the participants also received ultrasound biofeedback of their tongue shape. Speech and tongue movement were recorded pre-therapy, after 5 sessions, in the final session and at a one month follow-up. Perceptually, listeners perceived improvement and classified more productions as /ɹ/ in the final and follow-up assessments. The durations of VɹV syllables at the midway point of the therapy were longer. Cumulative tongue displacement increased in the final session. The average standard deviation was significantly higher in the middle and final assessments. The duration and tongue displacement measures illustrated how articulation therapy affected tongue movement and may be useful for outcomes research about articulation therapy.

Search for new phenomena in monophoton final states in proton-proton collisions at √{ s} = 8 TeV

NASA Astrophysics Data System (ADS)

Khachatryan, V.; Sirunyan, A. M.; Tumasyan, A.; Adam, W.; Bergauer, T.; Dragicevic, M.; Erö, J.; Friedl, M.; Frühwirth, R.; Ghete, V. M.; Hartl, C.; Hörmann, N.; Hrubec, J.; Jeitler, M.; Kiesenhofer, W.; Knünz, V.; Krammer, M.; Krätschmer, I.; Liko, D.; Mikulec, I.; Rabady, D.; Rahbaran, B.; Rohringer, H.; Schöfbeck, R.; Strauss, J.; Treberer-Treberspurg, W.; Waltenberger, W.; Wulz, C.-E.; Mossolov, V.; Shumeiko, N.; Suarez Gonzalez, J.; Alderweireldt, S.; Bansal, M.; Bansal, S.; Cornelis, T.; De Wolf, E. A.; Janssen, X.; Knutsson, A.; Lauwers, J.; Luyckx, S.; Ochesanu, S.; Rougny, R.; Van De Klundert, M.; Van Haevermaet, H.; Van Mechelen, P.; Van Remortel, N.; Van Spilbeeck, A.; Blekman, F.; Blyweert, S.; D'Hondt, J.; Daci, N.; Heracleous, N.; Keaveney, J.; Lowette, S.; Maes, M.; Olbrechts, A.; Python, Q.; Strom, D.; Tavernier, S.; Van Doninck, W.; Van Mulders, P.; Van Onsem, G. P.; Villella, I.; Caillol, C.; Clerbaux, B.; De Lentdecker, G.; Dobur, D.; Favart, L.; Gay, A. P. R.; Grebenyuk, A.; Léonard, A.; Mohammadi, A.; Perniè, L.; Reis, T.; Seva, T.; Thomas, L.; Vander Velde, C.; Vanlaer, P.; Wang, J.; Zenoni, F.; Adler, V.; Beernaert, K.; Benucci, L.; Cimmino, A.; Costantini, S.; Crucy, S.; Dildick, S.; Fagot, A.; Garcia, G.; Mccartin, J.; Ocampo Rios, A. A.; Ryckbosch, D.; Salva Diblen, S.; Sigamani, M.; Strobbe, N.; Thyssen, F.; Tytgat, M.; Yazgan, E.; Zaganidis, N.; Basegmez, S.; Beluffi, C.; Bruno, G.; Castello, R.; Caudron, A.; Ceard, L.; Da Silveira, G. G.; Delaere, C.; du Pree, T.; Favart, D.; Forthomme, L.; Giammanco, A.; Hollar, J.; Jafari, A.; Jez, P.; Komm, M.; Lemaitre, V.; Nuttens, C.; Pagano, D.; Perrini, L.; Pin, A.; Piotrzkowski, K.; Popov, A.; Quertenmont, L.; Selvaggi, M.; Vidal Marono, M.; Vizan Garcia, J. M.; Beliy, N.; Caebergs, T.; Daubie, E.; Hammad, G. H.; Aldá Júnior, W. L.; Alves, G. A.; Brito, L.; Correa Martins Junior, M.; Dos Reis Martins, T.; Mora Herrera, C.; Pol, M. E.; Carvalho, W.; Chinellato, J.; Custódio, A.; Da Costa, E. M.; De Jesus Damiao, D.; De Oliveira Martins, C.; Fonseca De Souza, S.; Malbouisson, H.; Matos Figueiredo, D.; Mundim, L.; Nogima, H.; Prado Da Silva, W. L.; Santaolalla, J.; Santoro, A.; Sznajder, A.; Tonelli Manganote, E. J.; Vilela Pereira, A.; Bernardes, C. A.; Dogra, S.; Fernandez Perez Tomei, T. R.; Gregores, E. M.; Mercadante, P. G.; Novaes, S. F.; Padula, Sandra S.; Aleksandrov, A.; Genchev, V.; Iaydjiev, P.; Marinov, A.; Piperov, S.; Rodozov, M.; Sultanov, G.; Vutova, M.; Dimitrov, A.; Glushkov, I.; Hadjiiska, R.; Litov, L.; Pavlov, B.; Petkov, P.; Bian, J. G.; Chen, G. M.; Chen, H. S.; Chen, M.; Cheng, T.; Du, R.; Jiang, C. H.; Plestina, R.; Romeo, F.; Tao, J.; Wang, Z.; Asawatangtrakuldee, C.; Ban, Y.; Li, Q.; Liu, S.; Mao, Y.; Qian, S. J.; Wang, D.; Zou, W.; Avila, C.; Chaparro Sierra, L. F.; Florez, C.; Gomez, J. P.; Gomez Moreno, B.; Sanabria, J. C.; Godinovic, N.; Lelas, D.; Polic, D.; Puljak, I.; Antunovic, Z.; Kovac, M.; Brigljevic, V.; Kadija, K.; Luetic, J.; Mekterovic, D.; Sudic, L.; Attikis, A.; Mavromanolakis, G.; Mousa, J.; Nicolaou, C.; Ptochos, F.; Razis, P. A.; Bodlak, M.; Finger, M.; Finger, M.; Assran, Y.; Elgammal, S.; Mahmoud, M. A.; Radi, A.; Kadastik, M.; Murumaa, M.; Raidal, M.; Tiko, A.; Eerola, P.; Fedi, G.; Voutilainen, M.; Härkönen, J.; Karimäki, V.; Kinnunen, R.; Kortelainen, M. J.; Lampén, T.; Lassila-Perini, K.; Lehti, S.; Lindén, T.; Luukka, P.; Mäenpää, T.; Peltola, T.; Tuominen, E.; Tuominiemi, J.; Tuovinen, E.; Wendland, L.; Talvitie, J.; Tuuva, T.; Besancon, M.; Couderc, F.; Dejardin, M.; Denegri, D.; Fabbro, B.; Faure, J. L.; Favaro, C.; Ferri, F.; Ganjour, S.; Givernaud, A.; Gras, P.; Hamel de Monchenault, G.; Jarry, P.; Locci, E.; Malcles, J.; Neveu, J.; Rander, J.; Rosowsky, A.; Titov, M.; Baffioni, S.; Beaudette, F.; Busson, P.; Charlot, C.; Dahms, T.; Dalchenko, M.; Dobrzynski, L.; Filipovic, N.; Florent, A.; Granier de Cassagnac, R.; Mastrolorenzo, L.; Miné, P.; Mironov, C.; Naranjo, I. N.; Nguyen, M.; Ochando, C.; Paganini, P.; Regnard, S.; Salerno, R.; Sauvan, J. B.; Sirois, Y.; Veelken, C.; Yilmaz, Y.; Zabi, A.; Agram, J.-L.; Andrea, J.; Aubin, A.; Bloch, D.; Brom, J.-M.; Chabert, E. C.; Collard, C.; Conte, E.; Fontaine, J.-C.; Gelé, D.; Goerlach, U.; Goetzmann, C.; Le Bihan, A.-C.; Van Hove, P.; Gadrat, S.; Beauceron, S.; Beaupere, N.; Boudoul, G.; Bouvier, E.; Brochet, S.; Carrillo Montoya, C. A.; Chasserat, J.; Chierici, R.; Contardo, D.; Depasse, P.; El Mamouni, H.; Fan, J.; Fay, J.; Gascon, S.; Gouzevitch, M.; Ille, B.; Kurca, T.; Lethuillier, M.; Mirabito, L.; Perries, S.; Ruiz Alvarez, J. D.; Sabes, D.; Sgandurra, L.; Sordini, V.; Vander Donckt, M.; Verdier, P.; Viret, S.; Xiao, H.; Rurua, L.; Autermann, C.; Beranek, S.; Bontenackels, M.; Edelhoff, M.; Feld, L.; Heister, A.; Hindrichs, O.; Klein, K.; Ostapchuk, A.; Raupach, F.; Sammet, J.; Schael, S.; Weber, H.; Wittmer, B.; Zhukov, V.; Ata, M.; Brodski, M.; Dietz-Laursonn, E.; Duchardt, D.; Erdmann, M.; Fischer, R.; Güth, A.; Hebbeker, T.; Heidemann, C.; Hoepfner, K.; Klingebiel, D.; Knutzen, S.; Kreuzer, P.; Merschmeyer, M.; Meyer, A.; Millet, P.; Olschewski, M.; Padeken, K.; Papacz, P.; Reithler, H.; Schmitz, S. A.; Sonnenschein, L.; Teyssier, D.; Thüer, S.; Weber, M.; Cherepanov, V.; Erdogan, Y.; Flügge, G.; Geenen, H.; Geisler, M.; Haj Ahmad, W.; Hoehle, F.; Kargoll, B.; Kress, T.; Kuessel, Y.; Künsken, A.; Lingemann, J.; Nowack, A.; Nugent, I. M.; Perchalla, L.; Pooth, O.; Stahl, A.; Asin, I.; Bartosik, N.; Behr, J.; Behrenhoff, W.; Behrens, U.; Bell, A. J.; Bergholz, M.; Bethani, A.; Borras, K.; Burgmeier, A.; Cakir, A.; Calligaris, L.; Campbell, A.; Choudhury, S.; Costanza, F.; Diez Pardos, C.; Dolinska, G.; Dooling, S.; Dorland, T.; Eckerlin, G.; Eckstein, D.; Eichhorn, T.; Flucke, G.; Garay Garcia, J.; Geiser, A.; Gunnellini, P.; Hauk, J.; Hempel, M.; Horton, D.; Jung, H.; Kalogeropoulos, A.; Kasemann, M.; Katsas, P.; Kieseler, J.; Kleinwort, C.; Korol, I.; Krücker, D.; Lange, W.; Leonard, J.; Lipka, K.; Lobanov, A.; Lohmann, W.; Lutz, B.; Mankel, R.; Marfin, I.; Melzer-Pellmann, I.-A.; Meyer, A. B.; Mittag, G.; Mnich, J.; Mussgiller, A.; Naumann-Emme, S.; Nayak, A.; Novgorodova, O.; Ntomari, E.; Perrey, H.; Pitzl, D.; Placakyte, R.; Raspereza, A.; Ribeiro Cipriano, P. M.; Roland, B.; Ron, E.; Sahin, M. Ö.; Salfeld-Nebgen, J.; Saxena, P.; Schmidt, R.; Schoerner-Sadenius, T.; Schröder, M.; Seitz, C.; Spannagel, S.; Vargas Trevino, A. D. R.; Walsh, R.; Wissing, C.; Aldaya Martin, M.; Blobel, V.; Centis Vignali, M.; Draeger, A. R.; Erfle, J.; Garutti, E.; Goebel, K.; Görner, M.; Haller, J.; Hoffmann, M.; Höing, R. S.; Kirschenmann, H.; Klanner, R.; Kogler, R.; Lange, J.; Lapsien, T.; Lenz, T.; Marchesini, I.; Ott, J.; Peiffer, T.; Perieanu, A.; Pietsch, N.; Poehlsen, J.; Poehlsen, T.; Rathjens, D.; Sander, C.; Schettler, H.; Schleper, P.; Schlieckau, E.; Schmidt, A.; Seidel, M.; Sola, V.; Stadie, H.; Steinbrück, G.; Troendle, D.; Usai, E.; Vanelderen, L.; Vanhoefer, A.; Barth, C.; Baus, C.; Berger, J.; Böser, C.; Butz, E.; Chwalek, T.; De Boer, W.; Descroix, A.; Dierlamm, A.; Feindt, M.; Frensch, F.; Giffels, M.; Gilbert, A.; Hartmann, F.; Hauth, T.; Husemann, U.; Katkov, I.; Kornmayer, A.; Kuznetsova, E.; Lobelle Pardo, P.; Mozer, M. U.; Müller, Th.; Nürnberg, A.; Quast, G.; Rabbertz, K.; Röcker, S.; Simonis, H. J.; Stober, F. M.; Ulrich, R.; Wagner-Kuhr, J.; Wayand, S.; Weiler, T.; Wolf, R.; Anagnostou, G.; Daskalakis, G.; Geralis, T.; Giakoumopoulou, V. A.; Kyriakis, A.; Loukas, D.; Markou, A.; Markou, C.; Psallidas, A.; Topsis-Giotis, I.; Agapitos, A.; Kesisoglou, S.; Panagiotou, A.; Saoulidou, N.; Stiliaris, E.; Aslanoglou, X.; Evangelou, I.; Flouris, G.; Foudas, C.; Kokkas, P.; Manthos, N.; Papadopoulos, I.; Paradas, E.; Strologas, J.; Bencze, G.; Hajdu, C.; Hidas, P.; Horvath, D.; Sikler, F.; Veszpremi, V.; Vesztergombi, G.; Zsigmond, A. J.; Beni, N.; Czellar, S.; Karancsi, J.; Molnar, J.; Palinkas, J.; Szillasi, Z.; Makovec, A.; Raics, P.; Trocsanyi, Z. L.; Ujvari, B.; Swain, S. K.; Beri, S. B.; Bhatnagar, V.; Gupta, R.; Bhawandeep, U.; Kalsi, A. K.; Kaur, M.; Kumar, R.; Mittal, M.; Nishu, N.; Singh, J. B.; Kumar, Ashok; Kumar, Arun; Ahuja, S.; Bhardwaj, A.; Choudhary, B. C.; Kumar, A.; Malhotra, S.; Naimuddin, M.; Ranjan, K.; Sharma, V.; Banerjee, S.; Bhattacharya, S.; Chatterjee, K.; Dutta, S.; Gomber, B.; Jain, Sa.; Jain, Sh.; Khurana, R.; Modak, A.; Mukherjee, S.; Roy, D.; Sarkar, S.; Sharan, M.; Abdulsalam, A.; Dutta, D.; Kailas, S.; Kumar, V.; Mohanty, A. K.; Pant, L. M.; Shukla, P.; Topkar, A.; Aziz, T.; Banerjee, S.; Bhowmik, S.; Chatterjee, R. M.; Dewanjee, R. K.; Dugad, S.; Ganguly, S.; Ghosh, S.; Guchait, M.; Gurtu, A.; Kole, G.; Kumar, S.; Maity, M.; Majumder, G.; Mazumdar, K.; Mohanty, G. B.; Parida, B.; Sudhakar, K.; Wickramage, N.; Bakhshiansohi, H.; Behnamian, H.; Etesami, S. M.; Fahim, A.; Goldouzian, R.; Khakzad, M.; Mohammadi Najafabadi, M.; Naseri, M.; Paktinat Mehdiabadi, S.; Rezaei Hosseinabadi, F.; Safarzadeh, B.; Zeinali, M.; Felcini, M.; Grunewald, M.; Abbrescia, M.; Calabria, C.; Chhibra, S. S.; Colaleo, A.; Creanza, D.; De Filippis, N.; De Palma, M.; Fiore, L.; Iaselli, G.; Maggi, G.; Maggi, M.; My, S.; Nuzzo, S.; Pompili, A.; Pugliese, G.; Radogna, R.; Selvaggi, G.; Sharma, A.; Silvestris, L.; Venditti, R.; Abbiendi, G.; Benvenuti, A. C.; Bonacorsi, D.; Braibant-Giacomelli, S.; Brigliadori, L.; Campanini, R.; Capiluppi, P.; Castro, A.; Cavallo, F. R.; Codispoti, G.; Cuffiani, M.; Dallavalle, G. M.; Fabbri, F.; Fanfani, A.; Fasanella, D.; Giacomelli, P.; Grandi, C.; Guiducci, L.; Marcellini, S.; Masetti, G.; Montanari, A.; Navarria, F. L.; Perrotta, A.; Primavera, F.; Rossi, A. M.; Rovelli, T.; Siroli, G. P.; Tosi, N.; Travaglini, R.; Albergo, S.; Cappello, G.; Chiorboli, M.; Costa, S.; Giordano, F.; Potenza, R.; Tricomi, A.; Tuve, C.; Barbagli, G.; Ciulli, V.; Civinini, C.; D'Alessandro, R.; Focardi, E.; Gallo, E.; Gonzi, S.; Gori, V.; Lenzi, P.; Meschini, M.; Paoletti, S.; Sguazzoni, G.; Tropiano, A.; Benussi, L.; Bianco, S.; Fabbri, F.; Piccolo, D.; Ferretti, R.; Ferro, F.; Lo Vetere, M.; Robutti, E.; Tosi, S.; Dinardo, M. E.; Fiorendi, S.; Gennai, S.; Gerosa, R.; Ghezzi, A.; Govoni, P.; Lucchini, M. T.; Malvezzi, S.; Manzoni, R. A.; Martelli, A.; Marzocchi, B.; Menasce, D.; Moroni, L.; Paganoni, M.; Pedrini, D.; Ragazzi, S.; Redaelli, N.; Tabarelli de Fatis, T.; Buontempo, S.; Cavallo, N.; Di Guida, S.; Fabozzi, F.; Iorio, A. O. M.; Lista, L.; Meola, S.; Merola, M.; Paolucci, P.; Azzi, P.; Bacchetta, N.; Bisello, D.; Branca, A.; Carlin, R.; Checchia, P.; Dall'Osso, M.; Dorigo, T.; Galanti, M.; Gasparini, U.; Giubilato, P.; Gozzelino, A.; Kanishchev, K.; Lacaprara, S.; Margoni, M.; Meneguzzo, A. T.; Pazzini, J.; Pozzobon, N.; Ronchese, P.; Simonetto, F.; Torassa, E.; Tosi, M.; Vanini, S.; Ventura, S.; Zotto, P.; Zucchetta, A.; Zumerle, G.; Gabusi, M.; Ratti, S. P.; Re, V.; Riccardi, C.; Salvini, P.; Vitulo, P.; Biasini, M.; Bilei, G. M.; Ciangottini, D.; Fanò, L.; Lariccia, P.; Mantovani, G.; Menichelli, M.; Saha, A.; Santocchia, A.; Spiezia, A.; Androsov, K.; Azzurri, P.; Bagliesi, G.; Bernardini, J.; Boccali, T.; Broccolo, G.; Castaldi, R.; Ciocci, M. A.; Dell'Orso, R.; Donato, S.; Fiori, F.; Foà, L.; Giassi, A.; Grippo, M. T.; Ligabue, F.; Lomtadze, T.; Martini, L.; Messineo, A.; Moon, C. S.; Palla, F.; Rizzi, A.; Savoy-Navarro, A.; Serban, A. T.; Spagnolo, P.; Squillacioti, P.; Tenchini, R.; Tonelli, G.; Venturi, A.; Verdini, P. G.; Vernieri, C.; Barone, L.; Cavallari, F.; D'imperio, G.; Del Re, D.; Diemoz, M.; Jorda, C.; Longo, E.; Margaroli, F.; Meridiani, P.; Micheli, F.; Nourbakhsh, S.; Organtini, G.; Paramatti, R.; Rahatlou, S.; Rovelli, C.; Santanastasio, F.; Soffi, L.; Traczyk, P.; Amapane, N.; Arcidiacono, R.; Argiro, S.; Arneodo, M.; Bellan, R.; Biino, C.; Cartiglia, N.; Casasso, S.; Costa, M.; Degano, A.; Demaria, N.; Finco, L.; Mariotti, C.; Maselli, S.; Migliore, E.; Monaco, V.; Musich, M.; Obertino, M. M.; Ortona, G.; Pacher, L.; Pastrone, N.; Pelliccioni, M.; Pinna Angioni, G. L.; Potenza, A.; Romero, A.; Ruspa, M.; Sacchi, R.; Solano, A.; Staiano, A.; Tamponi, U.; Belforte, S.; Candelise, V.; Casarsa, M.; Cossutti, F.; Della Ricca, G.; Gobbo, B.; La Licata, C.; Marone, M.; Schizzi, A.; Umer, T.; Zanetti, A.; Chang, S.; Kropivnitskaya, A.; Nam, S. K.; Kim, D. H.; Kim, G. N.; Kim, M. S.; Kong, D. J.; Lee, S.; Oh, Y. D.; Park, H.; Sakharov, A.; Son, D. C.; Kim, T. J.; Kim, J. Y.; Song, S.; Choi, S.; Gyun, D.; Hong, B.; Jo, M.; Kim, H.; Kim, Y.; Lee, B.; Lee, K. S.; Park, S. K.; Roh, Y.; Choi, M.; Kim, J. H.; Park, I. C.; Ryu, G.; Ryu, M. S.; Choi, Y.; Choi, Y. K.; Goh, J.; Kim, D.; Kwon, E.; Lee, J.; Seo, H.; Yu, I.; Juodagalvis, A.; Komaragiri, J. R.; Md Ali, M. A. B.; Casimiro Linares, E.; Castilla-Valdez, H.; De La Cruz-Burelo, E.; Heredia-de La Cruz, I.; Hernandez-Almada, A.; Lopez-Fernandez, R.; Sanchez-Hernandez, A.; Carrillo Moreno, S.; Vazquez Valencia, F.; Pedraza, I.; Salazar Ibarguen, H. A.; Morelos Pineda, A.; Krofcheck, D.; Butler, P. H.; Reucroft, S.; Ahmad, A.; Ahmad, M.; Hassan, Q.; Hoorani, H. R.; Khan, W. A.; Khurshid, T.; Shoaib, M.; Bialkowska, H.; Bluj, M.; Boimska, B.; Frueboes, T.; Górski, M.; Kazana, M.; Nawrocki, K.; Romanowska-Rybinska, K.; Szleper, M.; Zalewski, P.; Brona, G.; Bunkowski, K.; Cwiok, M.; Dominik, W.; Doroba, K.; Kalinowski, A.; Konecki, M.; Krolikowski, J.; Misiura, M.; Olszewski, M.; Wolszczak, W.; Bargassa, P.; Beirão Da Cruz E Silva, C.; Faccioli, P.; Ferreira Parracho, P. G.; Gallinaro, M.; Lloret Iglesias, L.; Nguyen, F.; Rodrigues Antunes, J.; Seixas, J.; Varela, J.; Vischia, P.; Afanasiev, S.; Bunin, P.; Golutvin, I.; Karjavin, V.; Konoplyanikov, V.; Kozlov, G.; Lanev, A.; Malakhov, A.; Matveev, V.; Moisenz, P.; Palichik, V.; Perelygin, V.; Savina, M.; Shmatov, S.; Shulha, S.; Skatchkov, N.; Smirnov, V.; Zarubin, A.; Golovtsov, V.; Ivanov, Y.; Kim, V.; Levchenko, P.; Murzin, V.; Oreshkin, V.; Smirnov, I.; Sulimov, V.; Uvarov, L.; Vavilov, S.; Vorobyev, A.; Vorobyev, An.; Andreev, Yu.; Dermenev, A.; Gninenko, S.; Golubev, N.; Kirsanov, M.; Krasnikov, N.; Pashenkov, A.; Tlisov, D.; Toropin, A.; Epshteyn, V.; Gavrilov, V.; Lychkovskaya, N.; Popov, V.; Pozdnyakov, I.; Safronov, G.; Semenov, S.; Spiridonov, A.; Stolin, V.; Vlasov, E.; Zhokin, A.; Andreev, V.; Azarkin, M.; Dremin, I.; Kirakosyan, M.; Leonidov, A.; Mesyats, G.; Rusakov, S. V.; Vinogradov, A.; Belyaev, A.; Boos, E.; Bunichev, V.; Dubinin, M.; Dudko, L.; Ershov, A.; Gribushin, A.; Klyukhin, V.; Kodolova, O.; Lokhtin, I.; Obraztsov, S.; Savrin, V.; Snigirev, A.; Azhgirey, I.; Bayshev, I.; Bitioukov, S.; Kachanov, V.; Kalinin, A.; Konstantinov, D.; Krychkine, V.; Petrov, V.; Ryutin, R.; Sobol, A.; Tourtchanovitch, L.; Troshin, S.; Tyurin, N.; Uzunian, A.; Volkov, A.; Adzic, P.; Ekmedzic, M.; Milosevic, J.; Rekovic, V.; Alcaraz Maestre, J.; Battilana, C.; Calvo, E.; Cerrada, M.; Chamizo Llatas, M.; Colino, N.; De La Cruz, B.; Delgado Peris, A.; Domínguez Vázquez, D.; Escalante Del Valle, A.; Fernandez Bedoya, C.; Fernández Ramos, J. P.; Flix, J.; Fouz, M. C.; Garcia-Abia, P.; Gonzalez Lopez, O.; Goy Lopez, S.; Hernandez, J. M.; Josa, M. I.; Navarro De Martino, E.; Pérez-Calero Yzquierdo, A.; Puerta Pelayo, J.; Quintario Olmeda, A.; Redondo, I.; Romero, L.; Soares, M. S.; Albajar, C.; de Trocóniz, J. F.; Missiroli, M.; Moran, D.; Brun, H.; Cuevas, J.; Fernandez Menendez, J.; Folgueras, S.; Gonzalez Caballero, I.; Brochero Cifuentes, J. A.; Cabrillo, I. J.; Calderon, A.; Duarte Campderros, J.; Fernandez, M.; Gomez, G.; Graziano, A.; Lopez Virto, A.; Marco, J.; Marco, R.; Martinez Rivero, C.; Matorras, F.; Munoz Sanchez, F. J.; Piedra Gomez, J.; Rodrigo, T.; Rodríguez-Marrero, A. Y.; Ruiz-Jimeno, A.; Scodellaro, L.; Vila, I.; Vilar Cortabitarte, R.; Abbaneo, D.; Auffray, E.; Auzinger, G.; Bachtis, M.; Baillon, P.; Ball, A. H.; Barney, D.; Benaglia, A.; Bendavid, J.; Benhabib, L.; Benitez, J. F.; Bernet, C.; Bloch, P.; Bocci, A.; Bonato, A.; Bondu, O.; Botta, C.; Breuker, H.; Camporesi, T.; Cerminara, G.; Colafranceschi, S.; D'Alfonso, M.; d'Enterria, D.; Dabrowski, A.; David, A.; De Guio, F.; De Roeck, A.; De Visscher, S.; Di Marco, E.; Dobson, M.; Dordevic, M.; Dupont-Sagorin, N.; Elliott-Peisert, A.; Eugster, J.; Franzoni, G.; Funk, W.; Gigi, D.; Gill, K.; Giordano, D.; Girone, M.; Glege, F.; Guida, R.; Gundacker, S.; Guthoff, M.; Hammer, J.; Hansen, M.; Harris, P.; Hegeman, J.; Innocente, V.; Janot, P.; Kousouris, K.; Krajczar, K.; Lecoq, P.; Lourenço, C.; Magini, N.; Malgeri, L.; Mannelli, M.; Marrouche, J.; Masetti, L.; Meijers, F.; Mersi, S.; Meschi, E.; Moortgat, F.; Morovic, S.; Mulders, M.; Musella, P.; Orsini, L.; Pape, L.; Perez, E.; Perrozzi, L.; Petrilli, A.; Petrucciani, G.; Pfeiffer, A.; Pierini, M.; Pimiä, M.; Piparo, D.; Plagge, M.; Racz, A.; Rolandi, G.; Rovere, M.; Sakulin, H.; Schäfer, C.; Schwick, C.; Sharma, A.; Siegrist, P.; Silva, P.; Simon, M.; Sphicas, P.; Spiga, D.; Steggemann, J.; Stieger, B.; Stoye, M.; Takahashi, Y.; Treille, D.; Tsirou, A.; Veres, G. I.; Wardle, N.; Wöhri, H. K.; Wollny, H.; Zeuner, W. D.; Bertl, W.; Deiters, K.; Erdmann, W.; Horisberger, R.; Ingram, Q.; Kaestli, H. C.; Kotlinski, D.; Langenegger, U.; Renker, D.; Rohe, T.; Bachmair, F.; Bäni, L.; Bianchini, L.; Buchmann, M. A.; Casal, B.; Chanon, N.; Dissertori, G.; Dittmar, M.; Donegà, M.; Dünser, M.; Eller, P.; Grab, C.; Hits, D.; Hoss, J.; Lustermann, W.; Mangano, B.; Marini, A. C.; Martinez Ruiz del Arbol, P.; Masciovecchio, M.; Meister, D.; Mohr, N.; Nägeli, C.; Nessi-Tedaldi, F.; Pandolfi, F.; Pauss, F.; Peruzzi, M.; Quittnat, M.; Rebane, L.; Rossini, M.; Starodumov, A.; Takahashi, M.; Theofilatos, K.; Wallny, R.; Weber, H. A.; Amsler, C.; Canelli, M. F.; Chiochia, V.; De Cosa, A.; Hinzmann, A.; Hreus, T.; Kilminster, B.; Lange, C.; Millan Mejias, B.; Ngadiuba, J.; Robmann, P.; Ronga, F. J.; Taroni, S.; Verzetti, M.; Yang, Y.; Cardaci, M.; Chen, K. H.; Ferro, C.; Kuo, C. M.; Lin, W.; Lu, Y. J.; Volpe, R.; Yu, S. S.; Chang, P.; Chang, Y. H.; Chang, Y. W.; Chao, Y.; Chen, K. F.; Chen, P. H.; Dietz, C.; Grundler, U.; Hou, W.-S.; Kao, K. Y.; Liu, Y. F.; Lu, R.-S.; Majumder, D.; Petrakou, E.; Tzeng, Y. M.; Wilken, R.; Asavapibhop, B.; Singh, G.; Srimanobhas, N.; Suwonjandee, N.; Adiguzel, A.; Bakirci, M. N.; Cerci, S.; Dozen, C.; Dumanoglu, I.; Eskut, E.; Girgis, S.; Gokbulut, G.; Gurpinar, E.; Hos, I.; Kangal, E. E.; Kayis Topaksu, A.; Onengut, G.; Ozdemir, K.; Ozturk, S.; Polatoz, A.; Sunar Cerci, D.; Tali, B.; Topakli, H.; Vergili, M.; Akin, I. V.; Bilin, B.; Bilmis, S.; Gamsizkan, H.; Isildak, B.; Karapinar, G.; Ocalan, K.; Sekmen, S.; Surat, U. E.; Yalvac, M.; Zeyrek, M.; Albayrak, E. A.; Gülmez, E.; Kaya, M.; Kaya, O.; Yetkin, T.; Cankocak, K.; Vardarlı, F. I.; Levchuk, L.; Sorokin, P.; Brooke, J. J.; Clement, E.; Cussans, D.; Flacher, H.; Goldstein, J.; Grimes, M.; Heath, G. P.; Heath, H. F.; Jacob, J.; Kreczko, L.; Lucas, C.; Meng, Z.; Newbold, D. M.; Paramesvaran, S.; Poll, A.; Sakuma, T.; Senkin, S.; Smith, V. J.; Williams, T.; Bell, K. W.; Belyaev, A.; Brew, C.; Brown, R. M.; Cockerill, D. J. A.; Coughlan, J. A.; Harder, K.; Harper, S.; Olaiya, E.; Petyt, D.; Shepherd-Themistocleous, C. H.; Thea, A.; Tomalin, I. R.; Womersley, W. J.; Worm, S. D.; Baber, M.; Bainbridge, R.; Buchmuller, O.; Burton, D.; Colling, D.; Cripps, N.; Cutajar, M.; Dauncey, P.; Davies, G.; Della Negra, M.; Dunne, P.; Ferguson, W.; Fulcher, J.; Futyan, D.; Hall, G.; Iles, G.; Jarvis, M.; Karapostoli, G.; Kenzie, M.; Lane, R.; Lucas, R.; Lyons, L.; Magnan, A.-M.; Malik, S.; Mathias, B.; Nash, J.; Nikitenko, A.; Pela, J.; Pesaresi, M.; Petridis, K.; Raymond, D. M.; Rogerson, S.; Rose, A.; Seez, C.; Sharp, P.; Tapper, A.; Vazquez Acosta, M.; Virdee, T.; Zenz, S. C.; Cole, J. E.; Hobson, P. R.; Khan, A.; Kyberd, P.; Leggat, D.; Leslie, D.; Martin, W.; Reid, I. D.; Symonds, P.; Teodorescu, L.; Turner, M.; Dittmann, J.; Hatakeyama, K.; Kasmi, A.; Liu, H.; Scarborough, T.; Charaf, O.; Cooper, S. I.; Henderson, C.; Rumerio, P.; Avetisyan, A.; Bose, T.; Fantasia, C.; Lawson, P.; Richardson, C.; Rohlf, J.; St. John, J.; Sulak, L.; Alimena, J.; Berry, E.; Bhattacharya, S.; Christopher, G.; Cutts, D.; Demiragli, Z.; Dhingra, N.; Ferapontov, A.; Garabedian, A.; Heintz, U.; Kukartsev, G.; Laird, E.; Landsberg, G.; Luk, M.; Narain, M.; Segala, M.; Sinthuprasith, T.; Speer, T.; Swanson, J.; Breedon, R.; Breto, G.; Calderon De La Barca Sanchez, M.; Chauhan, S.; Chertok, M.; Conway, J.; Conway, R.; Cox, P. T.; Erbacher, R.; Gardner, M.; Ko, W.; Lander, R.; Miceli, T.; Mulhearn, M.; Pellett, D.; Pilot, J.; Ricci-Tam, F.; Searle, M.; Shalhout, S.; Smith, J.; Squires, M.; Stolp, D.; Tripathi, M.; Wilbur, S.; Yohay, R.; Cousins, R.; Everaerts, P.; Farrell, C.; Hauser, J.; Ignatenko, M.; Rakness, G.; Takasugi, E.; Valuev, V.; Weber, M.; Burt, K.; Clare, R.; Ellison, J.; Gary, J. W.; Hanson, G.; Heilman, J.; Ivova Rikova, M.; Jandir, P.; Kennedy, E.; Lacroix, F.; Long, O. R.; Luthra, A.; Malberti, M.; Olmedo Negrete, M.; Shrinivas, A.; Sumowidagdo, S.; Wimpenny, S.; Branson, J. G.; Cerati, G. B.; Cittolin, S.; D'Agnolo, R. T.; Holzner, A.; Kelley, R.; Klein, D.; Letts, J.; Macneill, I.; Olivito, D.; Padhi, S.; Palmer, C.; Pieri, M.; Sani, M.; Sharma, V.; Simon, S.; Sudano, E.; Tadel, M.; Tu, Y.; Vartak, A.; Welke, C.; Würthwein, F.; Yagil, A.; Barge, D.; Bradmiller-Feld, J.; Campagnari, C.; Danielson, T.; Dishaw, A.; Dutta, V.; Flowers, K.; Franco Sevilla, M.; Geffert, P.; George, C.; Golf, F.; Gouskos, L.; Incandela, J.; Justus, C.; Mccoll, N.; Richman, J.; Stuart, D.; To, W.; West, C.; Yoo, J.; Apresyan, A.; Bornheim, A.; Bunn, J.; Chen, Y.; Duarte, J.; Mott, A.; Newman, H. B.; Pena, C.; Rogan, C.; Spiropulu, M.; Timciuc, V.; Vlimant, J. R.; Wilkinson, R.; Xie, S.; Zhu, R. Y.; Azzolini, V.; Calamba, A.; Carlson, B.; Ferguson, T.; Iiyama, Y.; Paulini, M.; Russ, J.; Vogel, H.; Vorobiev, I.; Cumalat, J. P.; Ford, W. T.; Gaz, A.; Krohn, M.; Luiggi Lopez, E.; Nauenberg, U.; Smith, J. G.; Stenson, K.; Ulmer, K. A.; Wagner, S. R.; Alexander, J.; Chatterjee, A.; Chaves, J.; Chu, J.; Dittmer, S.; Eggert, N.; Mirman, N.; Nicolas Kaufman, G.; Patterson, J. R.; Ryd, A.; Salvati, E.; Skinnari, L.; Sun, W.; Teo, W. D.; Thom, J.; Thompson, J.; Tucker, J.; Weng, Y.; Winstrom, L.; Wittich, P.; Winn, D.; Abdullin, S.; Albrow, M.; Anderson, J.; Apollinari, G.; Bauerdick, L. A. T.; Beretvas, A.; Berryhill, J.; Bhat, P. C.; Bolla, G.; Burkett, K.; Butler, J. N.; Cheung, H. W. K.; Chlebana, F.; Cihangir, S.; Elvira, V. D.; Fisk, I.; Freeman, J.; Gao, Y.; Gottschalk, E.; Gray, L.; Green, D.; Grünendahl, S.; Gutsche, O.; Hanlon, J.; Hare, D.; Harris, R. M.; Hirschauer, J.; Hooberman, B.; Jindariani, S.; Johnson, M.; Joshi, U.; Kaadze, K.; Klima, B.; Kreis, B.; Kwan, S.; Linacre, J.; Lincoln, D.; Lipton, R.; Liu, T.; Lykken, J.; Maeshima, K.; Marraffino, J. M.; Martinez Outschoorn, V. I.; Maruyama, S.; Mason, D.; McBride, P.; Merkel, P.; Mishra, K.; Mrenna, S.; Musienko, Y.; Nahn, S.; Newman-Holmes, C.; O'Dell, V.; Prokofyev, O.; Sexton-Kennedy, E.; Sharma, S.; Soha, A.; Spalding, W. J.; Spiegel, L.; Taylor, L.; Tkaczyk, S.; Tran, N. V.; Uplegger, L.; Vaandering, E. W.; Vidal, R.; Whitbeck, A.; Whitmore, J.; Yang, F.; Acosta, D.; Avery, P.; Bortignon, P.; Bourilkov, D.; Carver, M.; Curry, D.; Das, S.; De Gruttola, M.; Di Giovanni, G. P.; Field, R. D.; Fisher, M.; Furic, I. K.; Hugon, J.; Konigsberg, J.; Korytov, A.; Kypreos, T.; Low, J. F.; Matchev, K.; Milenovic, P.; Mitselmakher, G.; Muniz, L.; Rinkevicius, A.; Shchutska, L.; Snowball, M.; Sperka, D.; Yelton, J.; Zakaria, M.; Hewamanage, S.; Linn, S.; Markowitz, P.; Martinez, G.; Rodriguez, J. L.; Adams, T.; Askew, A.; Bochenek, J.; Diamond, B.; Haas, J.; Hagopian, S.; Hagopian, V.; Johnson, K. F.; Prosper, H.; Veeraraghavan, V.; Weinberg, M.; Baarmand, M. M.; Hohlmann, M.; Kalakhety, H.; Yumiceva, F.; Adams, M. R.; Apanasevich, L.; Bazterra, V. E.; Berry, D.; Betts, R. R.; Bucinskaite, I.; Cavanaugh, R.; Evdokimov, O.; Gauthier, L.; Gerber, C. E.; Hofman, D. J.; Khalatyan, S.; Kurt, P.; Moon, D. H.; O'Brien, C.; Silkworth, C.; Turner, P.; Varelas, N.; Bilki, B.; Clarida, W.; Dilsiz, K.; Duru, F.; Haytmyradov, M.; Merlo, J.-P.; Mermerkaya, H.; Mestvirishvili, A.; Moeller, A.; Nachtman, J.; Ogul, H.; Onel, Y.; Ozok, F.; Penzo, A.; Rahmat, R.; Sen, S.; Tan, P.; Tiras, E.; Wetzel, J.; Yi, K.; Barnett, B. A.; Blumenfeld, B.; Bolognesi, S.; Fehling, D.; Gritsan, A. V.; Maksimovic, P.; Martin, C.; Swartz, M.; Baringer, P.; Bean, A.; Benelli, G.; Bruner, C.; Kenny, R. P., III; Malek, M.; Murray, M.; Noonan, D.; Sanders, S.; Sekaric, J.; Stringer, R.; Wang, Q.; Wood, J. S.; Chakaberia, I.; Ivanov, A.; Khalil, S.; Makouski, M.; Maravin, Y.; Saini, L. K.; Shrestha, S.; Skhirtladze, N.; Svintradze, I.; Gronberg, J.; Lange, D.; Rebassoo, F.; Wright, D.; Baden, A.; Belloni, A.; Calvert, B.; Eno, S. C.; Gomez, J. A.; Hadley, N. J.; Kellogg, R. G.; Kolberg, T.; Lu, Y.; Marionneau, M.; Mignerey, A. C.; Pedro, K.; Skuja, A.; Tonjes, M. B.; Tonwar, S. C.; Apyan, A.; Barbieri, R.; Bauer, G.; Busza, W.; Cali, I. A.; Chan, M.; Di Matteo, L.; Gomez Ceballos, G.; Goncharov, M.; Gulhan, D.; Klute, M.; Lai, Y. S.; Lee, Y.-J.; Levin, A.; Luckey, P. D.; Ma, T.; Paus, C.; Ralph, D.; Roland, C.; Roland, G.; Stephans, G. S. F.; Stöckli, F.; Sumorok, K.; Velicanu, D.; Veverka, J.; Wyslouch, B.; Yang, M.; Zanetti, M.; Zhukova, V.; Dahmes, B.; Gude, A.; Kao, S. C.; Klapoetke, K.; Kubota, Y.; Mans, J.; Pastika, N.; Rusack, R.; Singovsky, A.; Tambe, N.; Turkewitz, J.; Acosta, J. G.; Oliveros, S.; Avdeeva, E.; Bloom, K.; Bose, S.; Claes, D. R.; Dominguez, A.; Gonzalez Suarez, R.; Keller, J.; Knowlton, D.; Kravchenko, I.; Lazo-Flores, J.; Malik, S.; Meier, F.; Ratnikov, F.; Snow, G. R.; Zvada, M.; Dolen, J.; Godshalk, A.; Iashvili, I.; Kharchilava, A.; Kumar, A.; Rappoccio, S.; Alverson, G.; Barberis, E.; Baumgartel, D.; Chasco, M.; Haley, J.; Massironi, A.; Morse, D. M.; Nash, D.; Orimoto, T.; Trocino, D.; Wang, R.-J.; Wood, D.; Zhang, J.; Hahn, K. A.; Kubik, A.; Mucia, N.; Odell, N.; Pollack, B.; Pozdnyakov, A.; Schmitt, M.; Stoynev, S.; Sung, K.; Velasco, M.; Won, S.; Brinkerhoff, A.; Chan, K. M.; Drozdetskiy, A.; Hildreth, M.; Jessop, C.; Karmgard, D. J.; Kellams, N.; Lannon, K.; Luo, W.; Lynch, S.; Marinelli, N.; Pearson, T.; Planer, M.; Ruchti, R.; Valls, N.; Wayne, M.; Wolf, M.; Woodard, A.; Antonelli, L.; Brinson, J.; Bylsma, B.; Durkin, L. S.; Flowers, S.; Hart, A.; Hill, C.; Hughes, R.; Kotov, K.; Ling, T. Y.; Puigh, D.; Rodenburg, M.; Smith, G.; Winer, B. L.; Wolfe, H.; Wulsin, H. W.; Driga, O.; Elmer, P.; Hardenbrook, J.; Hebda, P.; Hunt, A.; Koay, S. A.; Lujan, P.; Marlow, D.; Medvedeva, T.; Mooney, M.; Olsen, J.; Piroué, P.; Quan, X.; Saka, H.; Stickland, D.; Tully, C.; Werner, J. S.; Zuranski, A.; Brownson, E.; Mendez, H.; Ramirez Vargas, J. E.; Barnes, V. E.; Benedetti, D.; Bortoletto, D.; De Mattia, M.; Gutay, L.; Hu, Z.; Jha, M. K.; Jones, M.; Jung, K.; Kress, M.; Leonardo, N.; Lopes Pegna, D.; Maroussov, V.; Miller, D. H.; Neumeister, N.; Radburn-Smith, B. C.; Shi, X.; Shipsey, I.; Silvers, D.; Svyatkovskiy, A.; Wang, F.; Xie, W.; Xu, L.; Yoo, H. D.; Zablocki, J.; Zheng, Y.; Parashar, N.; Stupak, J.; Adair, A.; Akgun, B.; Ecklund, K. M.; Geurts, F. J. M.; Li, W.; Michlin, B.; Padley, B. P.; Redjimi, R.; Roberts, J.; Zabel, J.; Betchart, B.; Bodek, A.; Covarelli, R.; de Barbaro, P.; Demina, R.; Eshaq, Y.; Ferbel, T.; Garcia-Bellido, A.; Goldenzweig, P.; Han, J.; Harel, A.; Khukhunaishvili, A.; Korjenevski, S.; Petrillo, G.; Vishnevskiy, D.; Ciesielski, R.; Demortier, L.; Goulianos, K.; Lungu, G.; Mesropian, C.; Arora, S.; Barker, A.; Chou, J. P.; Contreras-Campana, C.; Contreras-Campana, E.; Duggan, D.; Ferencek, D.; Gershtein, Y.; Gray, R.; Halkiadakis, E.; Hidas, D.; Kaplan, S.; Lath, A.; Panwalkar, S.; Park, M.; Patel, R.; Salur, S.; Schnetzer, S.; Somalwar, S.; Stone, R.; Thomas, S.; Thomassen, P.; Walker, M.; Rose, K.; Spanier, S.; York, A.; Bouhali, O.; Castaneda Hernandez, A.; Eusebi, R.; Flanagan, W.; Gilmore, J.; Kamon, T.; Khotilovich, V.; Krutelyov, V.; Montalvo, R.; Osipenkov, I.; Pakhotin, Y.; Perloff, A.; Roe, J.; Rose, A.; Safonov, A.; Suarez, I.; Tatarinov, A.; Akchurin, N.; Cowden, C.; Damgov, J.; Dragoiu, C.; Dudero, P. R.; Faulkner, J.; Kovitanggoon, K.; Kunori, S.; Lee, S. W.; Libeiro, T.; Volobouev, I.; Appelt, E.; Delannoy, A. G.; Greene, S.; Gurrola, A.; Johns, W.; Maguire, C.; Mao, Y.; Melo, A.; Sharma, M.; Sheldon, P.; Snook, B.; Tuo, S.; Velkovska, J.; Arenton, M. W.; Boutle, S.; Cox, B.; Francis, B.; Goodell, J.; Hirosky, R.; Ledovskoy, A.; Li, H.; Lin, C.; Neu, C.; Wood, J.; Clarke, C.; Harr, R.; Karchin, P. E.; Kottachchi Kankanamge Don, C.; Lamichhane, P.; Sturdy, J.; Belknap, D. A.; Carlsmith, D.; Cepeda, M.; Dasu, S.; Dodd, L.; Duric, S.; Friis, E.; Hall-Wilton, R.; Herndon, M.; Hervé, A.; Klabbers, P.; Lanaro, A.; Lazaridis, C.; Levine, A.; Loveless, R.; Mohapatra, A.; Ojalvo, I.; Perry, T.; Pierro, G. A.; Polese, G.; Ross, I.; Sarangi, T.; Savin, A.; Smith, W. H.; Taylor, D.; Verwilligen, P.; Vuosalo, C.; Woods, N.; CMS Collaboration

2016-04-01

Results are presented from a search for new physics in final states containing a photon and missing transverse momentum. The data correspond to an integrated luminosity of 19.6 fb-1 collected in proton-proton collisions at √{ s} = 8 TeV with the CMS experiment at the LHC. No deviation from the standard model predictions is observed for these final states. New, improved limits are set on dark matter production and on parameters of models with large extra dimensions. In particular, the first limits from the LHC on branon production are found and significantly extend previous limits from LEP and the Tevatron. An upper limit of 14.0 fb on the cross section is set at the 95% confidence level for events with a monophoton final state with photon transverse momentum greater than 145 GeV and missing transverse momentum greater than 140 GeV.

Dual triggering with GnRH agonist plus hCG versus triggering with hCG alone for IVF/ICSI outcome in GnRH antagonist cycles: a systematic review and meta-analysis.

PubMed

Chen, Chi-Huang; Tzeng, Chii-Ruey; Wang, Peng-Hui; Liu, Wei-Min; Chang, Heng-Yu; Chen, Huang-Hui; Chen, Ching-Hui

2018-03-29

To summarize available evidence from randomized-controlled trials which have evaluated triggering of final oocyte maturation with concomitant GnRH agonists and hCG in patients undergoing IVF, and to analyze whether dual triggering is as efficacious as hCG triggering in terms of oocyte and pregnancy outcomes. A comprehensive literature search was performed to identify randomized-controlled trials comparing IVF outcomes between women receiving combined administration of hCG with GnRH agonists and those receiving hCG alone for triggering of final oocyte maturation. Four studies including 527 patients eligible for inclusion in meta-analysis were identified. No significant difference in the number of mature oocytes or fertilized oocytes retrieved was found between groups. Clinical pregnancy rate with dual triggering was significantly higher as compared with hCG-alone triggering (pooled OR = 0.48, 95% CI 0.31-0.77, P = 0.002), but there was no significant difference in the ongoing pregnancy rate between groups. Results of meta-analysis indicate comparable or significantly improved outcomes with the use of GnRH agonists plus hCG as compared with hCG alone for triggering of final oocyte maturation.

[Improvement of Psychosomatic Rehabilitation after Prestationary Intervention].

PubMed

Sander, K; Winkler, G; Hofer, N; Hunatschek, S; Doerr, R

2016-12-01

Aim of the study: Improvement of psychosomatic rehabilitation efforts with prestationary intervention. Method: The study is designed as a prospective and randomisized interventon study including 317 in patients. Result: Most of the patients were women (69.4 %), the mean age was 50.2 years. As measured with the BDI-II patients with prestationary intervention improved more than patients without intervention. The motivation has not been changed significantly in both treatment arms. Various independent cofactors like long duration of unemployment, disablement and patients who apply to pension were identified. Conclusion: Finally a prestationary telephon interview improves the results of psychosomatic rehabilitation measured with BDI. © Georg Thieme Verlag KG Stuttgart · New York.

Outcome of endoscopic trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy in children.

PubMed

Yu, Bo; Chen, Yingbai; Ma, Yingjie; Tu, Yunhai; Wu, Wencan

2018-06-26

To evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON). From July 1st, 2008 to July 1st, 2015, 62 children diagnosed with ITON who underwent ETOCD were reviewed. Main outcome measure was improvement in visual acuity after treatment. Altogether 62 children (62 eyes) with a mean age of 11.26 ± 4.14 years were included. Thirty-three (53.2%) of them had residual vision before surgery while 29 (46.8%) had no light perception (NLP). The overall visual acuity improvement rate after surgery was 54.84%. The improvement rate of patients with residual vision (69.70%) was significant higher than that of patients with no light perception (NLP) (37.9%) (P = 0.012). However, no significant difference was shown among patients with different residual vision (P = 0.630). Presence of orbital and/ or optic canal fracture and hemorrhage within the post-ethmoid and/or sphenoid sinus resulted in poor postoperative visual acuity, duration of presenting complaints did not affect final visual acuity or did not effect outcomes. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome. Three patients developed cerebrospinal fluid rhinorrhea and one encountered cavernous sinus hemorrhage during surgery. No other severe complications were observed. Children with residual vision had better postoperative visual prognosis and benefited more from ETOCD than children with NLP. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome, however, this needs to be reassessed in children presenting long after the injury.Treatment should still be recommended even for cases of delayed presentation to hospital.

Integrated Application of Active Controls (IAAC) technology to an advanced subsonic transport project: Wing planform study and final configuration selection

NASA Technical Reports Server (NTRS)

1981-01-01

This report summarizes the Wing Planform Study Task and Final Configuration Selection of the Integrated Application of Active Controls (IAAC) Technology Project within the Energy Efficient Transport Program. Application of Active Controls Technology (ACT) in combination with increased wing span resulted in significant improvements over the Conventional Baseline Configuration (Baseline) and the Initial ACT Configuration previously established. The configurations use the same levels of technology (except for ACT), takeoff gross weight, and payload as the Baseline. The Final ACT Configuration (Model 768-107) incorporates pitch-augmented stability (which enabled an approximately 10% aft shift in cruise center of gravity and a 45% reduction in horizontal tail sizes), lateral/directional-augmented stability, an angle-of-attack limiter, and wing-load alleviation. Flutter-mode control was not beneficial for this configuration. This resulted in an 890 kg (1960 lb) reduction in airplane takeoff gross weight and a 9.8% improvement in cruise lift/drag. At the Baseline mission range (3590 km) (1938 nmi), this amounts to 10% block fuel reduction. Good takeoff performance at high-altitude airports on a hot day was also achieved. Results of this task strongly indicate that the IAAC Project should proceed with the Final ACT evaluation and begin the required control system development and testing.

What works with worked examples: Extending self-explanation and analogical comparison to synthesis problems

NASA Astrophysics Data System (ADS)

Badeau, Ryan; White, Daniel R.; Ibrahim, Bashirah; Ding, Lin; Heckler, Andrew F.

2017-12-01

The ability to solve physics problems that require multiple concepts from across the physics curriculum—"synthesis" problems—is often a goal of physics instruction. Three experiments were designed to evaluate the effectiveness of two instructional methods employing worked examples on student performance with synthesis problems; these instructional techniques, analogical comparison and self-explanation, have previously been studied primarily in the context of single-concept problems. Across three experiments with students from introductory calculus-based physics courses, both self-explanation and certain kinds of analogical comparison of worked examples significantly improved student performance on a target synthesis problem, with distinct improvements in recognition of the relevant concepts. More specifically, analogical comparison significantly improved student performance when the comparisons were invoked between worked synthesis examples. In contrast, similar comparisons between corresponding pairs of worked single-concept examples did not significantly improve performance. On a more complicated synthesis problem, self-explanation was significantly more effective than analogical comparison, potentially due to differences in how successfully students encoded the full structure of the worked examples. Finally, we find that the two techniques can be combined for additional benefit, with the trade-off of slightly more time on task.

The Effectiveness of the Use of Programed Analyses of Musical Works on Students' Perception of Form. Final Report.

ERIC Educational Resources Information Center

Nelson, Carl B.

Linearly programed materials used with musical references on magnetic tapes were compared to conventional listening materials used outside the classroom and to assignments for a college music course. The point of the comparison was to ascertain whether or not the programed materials significantly improved students' aural perception of the…

Location of Shared Services, Part Three, Final Report for Phase I, Rural Shared Services.

ERIC Educational Resources Information Center

Northern Montana Coll., Havre.

Part Three of a four-part report, designed to identify, evaluate, and synthesize shared services research and development efforts conducted throughout the nation, identifies 215 sites in 48 states which exhibit potentially significant attempts to improve rural education through some method of sharing services. A brief resume of each of the…

What Works Clearinghouse Quick Review: "KIPP Middle Schools: Impacts on Achievement and Other Outcomes, Final Report"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2013

2013-01-01

This study examined whether attending a Knowledge is Power Program (KIPP) middle school improved students' reading, math, social studies, and science achievement for up to 4 years following enrollment. The study reported that students attending KIPP middle schools scored statistically significantly higher than matched students on all of the state…

The impact of a disease management programme for type 2 diabetes on health-related quality of life: multilevel analysis of a cluster-randomised controlled trial.

PubMed

Panisch, Sigrid; Johansson, Tim; Flamm, Maria; Winkler, Henrike; Weitgasser, Raimund; Sönnichsen, Andreas C

2018-01-01

Type 2 diabetes is a chronic disease associated with poorer health outcomes and decreased health related quality of life (HRQoL). The aim of this analysis was to explore the impact of a disease management programme (DMP) in type 2 diabetes on HRQoL. A multilevel model was used to explain the variation in EQ-VAS. A cluster-randomized controlled trial-analysis of the secondary endpoint HRQoL. Our study population were general practitioners and patients in the province of Salzburg. The DMP "Therapie-Aktiv" was implemented in the intervention group, and controls received usual care. Outcome measure was a change in EQ-VAS after 12 months. For comparison of rates, we used Fisher's Exact test; for continuous variables the independent T test or Welch test were used. In the multilevel modeling, we examined various models, continuously adding variables to explain the variation in the dependent variable, starting with an empty model, including only the random intercept. We analysed random effects parameters in order to disentangle variation of the final EQ-VAS. The EQ-VAS significantly increased within the intervention group (mean difference 2.19, p = 0.005). There was no significant difference in EQ-VAS between groups (mean difference 1.00, p = 0.339). In the intervention group the improvement was more distinct in women (2.46, p = 0.036) compared to men (1.92, p = 0.063). In multilevel modeling, sex, age, family and work circumstances, any macrovascular diabetic complication, duration of diabetes, baseline body mass index and baseline EQ-VAS significantly influence final EQ-VAS, while DMP does not. The final model explains 28.9% (EQ-VAS) of the total variance. Most of the unexplained variance was found on patient-level (95%) and less on GP-level (5%). DMP "Therapie-Aktiv" has no significant impact on final EQ-VAS. The impact of DMPs in type 2 diabetes on HRQoL is still unclear and future programmes should focus on patient specific needs and predictors in order to improve HRQoL. Trial registration Current Controlled trials Ltd., ISRCTN27414162.

External exercise information provides no immediate additional performance benefit to untrained individuals in time trial cycling.

PubMed

Williams, C A; Bailey, S D; Mauger, A R

2012-01-01

To determine the importance of the provision of external exercise information to the setting of the pacing strategy, in subjects unfamiliar with a cycling task. Twenty-two healthy, untrained cyclists (VO(2max), 50 ± 9 mL-(1)·kg-(1)·min-(1)) were randomly assigned to a control (CON) group or an experimental (EXP) group and two successive 4 km time trials (TT) were performed, separated by a 17 min recovery. The CON group received distance knowledge and distance feedback; the EXP group received neither, but knew that each TT was to be of the same distance. No significant difference in completion time (p>0.05) was observed between the groups for either time to complete TT one (TT1) (CON=443 ± 33 s versus EXP=471 ± 63 s) or time to complete TT two (time trial 2) (CON=461 ± 37 s versus EXP=501 ± 94 s). No significant difference in the final RPE was observed between groups. However, a significant interaction for RPE (rating of perceived exertion)×TT in the CON was observed (F7,70=5.32, p<0.05), with significantly higher RPE values in the final kilometre of TT2 (p<0.05). The lack of any performance improvement in either group, despite the differences in exercise information received, indicates both a reliance on the afferent feedback for setting a pacing strategy and slow learning effect from practice in subjects unfamiliar with the task. The modification in RPE profile observed in the CON, despite no performance improvement, suggests exercise perception based changes may pre-empt work rate based changes and thus not immediately translate to improved performance.

Pars plana vitrectomy with juxtapapillary laser photocoagulation versus vitrectomy without juxtapapillary laser photocoagulation for the treatment of optic disc pit maculopathy: the results of the KKESH International Collaborative Retina Study Group.

PubMed

Abouammoh, Marwan A; Alsulaiman, Sulaiman M; Gupta, Vishali S; Mousa, Ahmed; Hirakata, Akito; Berrocal, Maria H; Chenworth, Megan; Chhablani, Jay; Oshima, Yusuke; AlZamil, Waseem M; Casella, Antonio Marcelo; Papa-Oliva, Gabriela; Banker, Alay S; Arevalo, J Fernando

2016-04-01

To compare the functional and anatomic outcomes of pars plana vitrectomy (PPV) with juxtapapillary laser photocoagulation (JLP) versus vitrectomy without JLP in optic disc pit maculopathy. This was a multicentre, retrospective study of 46 consecutive patients with optic disc pit maculopathy presenting at tertiary eye centres between 1992 and 2012. Indications for surgery included distorted or decreased vision. Surgical intervention included PPV, posterior vitreous detachment, with or without gas tamponade. Twenty-four patients received laser photocoagulation at the temporal edge of the optic disc pit (group A) and 22 patients had no laser (group B). Postoperative best-corrected visual acuity (BCVA) and optical coherence tomography findings were the main outcome measures. Mean follow-up was 44 months (range 12-98 months). BCVA in group A improved significantly from 0.7 logMAR (20/100) preoperatively to 0.5 logMAR (20/60) postoperatively (p=0.017). In group B, BCVA improved from 0.7 logMAR (20/100) preoperatively to 0.4 logMAR (20/40) postoperatively (p=0.014). The difference in final BCVA between groups was not statistically significant (p=0.693). The mean central macular thickness (CMT) in group A improved significantly from 750 μm preoperatively to 309 μm at last follow-up (p<0.0001). The mean CMT in group B improved from 616 μm preoperatively to 291 μm at last follow-up (p=0.028). The difference in final CMT between groups was not statistically significant (p=0.747). PPV with JLP for optic disc pit maculopathy had similar functional and anatomic outcomes compared with vitrectomy without JLP. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Administrative review process for adjudicating initial disability claims. Final rule.

PubMed

2006-03-31

The Social Security Administration is committed to providing the high quality of service the American people expect and deserve. In light of the significant growth in the number of disability claims and the increased complexity of those claims, the need to make substantial changes in our disability determination process has become urgent. We are publishing a final rule that amends our administrative review process for applications for benefits that are based on whether you are disabled under title II of the Social Security Act (the Act), or applications for supplemental security income (SSI) payments that are based on whether you are disabled or blind under title XVI of the Act. We expect that this final rule will improve the accuracy, consistency, and timeliness of decision-making throughout the disability determination process.

Atomic Layer Deposition Al2O3 Coatings Significantly Improve Thermal, Chemical, and Mechanical Stability of Anodic TiO2 Nanotube Layers

PubMed Central

2017-01-01

We report on a very significant enhancement of the thermal, chemical, and mechanical stability of self-organized TiO2 nanotubes layers, provided by thin Al2O3 coatings of different thicknesses prepared by atomic layer deposition (ALD). TiO2 nanotube layers coated with Al2O3 coatings exhibit significantly improved thermal stability as illustrated by the preservation of the nanotubular structure upon annealing treatment at high temperatures (870 °C). In addition, a high anatase content is preserved in the nanotube layers against expectation of the total rutile conversion at such a high temperature. Hardness of the resulting nanotube layers is investigated by nanoindentation measurements and shows strongly improved values compared to uncoated counterparts. Finally, it is demonstrated that Al2O3 coatings guarantee unprecedented chemical stability of TiO2 nanotube layers in harsh environments of concentrated H3PO4 solutions. PMID:28291942

Emotional intelligence and academic performance in first and final year medical students: a cross-sectional study.

PubMed

Chew, Boon How; Zain, Azhar Md; Hassan, Faezah

2013-03-27

Research on emotional intelligence (EI) suggests that it is associated with more pro-social behavior, better academic performance and improved empathy towards patients. In medical education and clinical practice, EI has been related to higher academic achievement and improved doctor-patient relationships. This study examined the effect of EI on academic performance in first- and final-year medical students in Malaysia. This was a cross-sectional study using an objectively-scored measure of EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Academic performance of medical school students was measured using continuous assessment (CA) and final examination (FE) results. The first- and final-year students were invited to participate during their second semester. Students answered a paper-based demographic questionnaire and completed the online MSCEIT on their own. Relationships between the total MSCEIT score to academic performance were examined using multivariate analyses. A total of 163 (84 year one and 79 year five) medical students participated (response rate of 66.0%). The gender and ethnic distribution were representative of the student population. The total EI score was a predictor of good overall CA (OR 1.01), a negative predictor of poor result in overall CA (OR 0.97), a predictor of the good overall FE result (OR 1.07) and was significantly related to the final-year FE marks (adjusted R(2) = 0.43). Medical students who were more emotionally intelligent performed better in both the continuous assessments and the final professional examination. Therefore, it is possible that emotional skill development may enhance medical students' academic performance.

Multi-objective optimization in quantum parameter estimation

NASA Astrophysics Data System (ADS)

Gong, BeiLi; Cui, Wei

2018-04-01

We investigate quantum parameter estimation based on linear and Kerr-type nonlinear controls in an open quantum system, and consider the dissipation rate as an unknown parameter. We show that while the precision of parameter estimation is improved, it usually introduces a significant deformation to the system state. Moreover, we propose a multi-objective model to optimize the two conflicting objectives: (1) maximizing the Fisher information, improving the parameter estimation precision, and (2) minimizing the deformation of the system state, which maintains its fidelity. Finally, simulations of a simplified ɛ-constrained model demonstrate the feasibility of the Hamiltonian control in improving the precision of the quantum parameter estimation.

Nanosensors and nanomaterials for monitoring glucose in diabetes

PubMed Central

Cash, Kevin J.; Clark, Heather A.

2010-01-01

Worldwide, diabetes is a rapidly growing problem that is managed at the individual level by monitoring and controlling blood glucose levels to minimize the negative effects of the disease. Because of limitations in diagnostic methods, significant research efforts are focused on developing improved methods to measure glucose. Nanotechnology has impacted these efforts by increasing the surface area of sensors, improving the catalytic properties of electrodes and providing nanoscale sensors. Herein, we discuss developments in the past several years on both nanosensors that directly measure glucose as well as nanomaterials that improve glucose sensor function. Finally, we discuss challenges that must be overcome to apply these developments in the clinic. PMID:20869318

The impact of instituting Process-Oriented Guided-Inquiry Learning (POGIL) in a fundamental nursing course.

PubMed

Roller, Maureen C; Zori, Susan

2017-03-01

POGIL, using small groups of students, who assume the roles of leader, manager, recorder, and reflector to complete problem based activities in science courses, has demonstrated significant improvement in students' grades and course satisfaction in science courses and a nursing Fundamentals course. Using POGIL with nursing students in fundamentals nursing courses could help to improve final grades and course satisfaction while promoting active learning, critical thinking, and teamwork. To examine differences in final course grades, Assessment Technologies Institute, LLC (ATi) scores and course satisfaction in 2 groups of fundamentals nursing students where one group experienced Process Oriented Guided Inquiry Learning (POGIL) as a teaching strategy and one group did not. Satisfaction with performing in the varied roles used during POGIL was also examined. This quantitative descriptive study used a comparative design, with one group of students who experienced POGIL while analyzing case scenarios in class and a control group who did not experience POGIL. A t-test was used to compare final grades, ATi scores, and satisfaction survey results. A mid-size, private university in the northeastern United States was the setting. A convenience sample of pre-licensure baccalaureate nursing students taking Fundamental in Nursing Courses during the junior semester. The experimental group (N=63) had higher final course grades (p=0.046), better understanding of the course material (p=0.005), and greater satisfaction with grades (p=0.008) than the control group (N=75). The results of this study revealed that Fundamental nursing students who experienced POGIL had significantly higher final grades and course satisfaction compared with students who did not experience POGIL. The active learning and teamwork experienced during POGIL, may be beneficial to students as they transition to practicing nurses. Additional research using POGIL with a variety of nursing courses could be beneficial in educating undergraduate nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of answer-until-correct and full-credit assessments in a team-based learning course.

PubMed

Farland, Michelle Z; Barlow, Patrick B; Levi Lancaster, T; Franks, Andrea S

2015-03-25

To assess the impact of awarding partial credit to team assessments on team performance and on quality of team interactions using an answer-until-correct method compared to traditional methods of grading (multiple-choice, full-credit). Subjects were students from 3 different offerings of an ambulatory care elective course, taught using team-based learning. The control group (full-credit) consisted of those enrolled in the course when traditional methods of assessment were used (2 course offerings). The intervention group consisted of those enrolled in the course when answer-until-correct method was used for team assessments (1 course offering). Study outcomes included student performance on individual and team readiness assurance tests (iRATs and tRATs), individual and team final examinations, and student assessment of quality of team interactions using the Team Performance Scale. Eighty-four students enrolled in the courses were included in the analysis (full-credit, n=54; answer-until-correct, n=30). Students who used traditional methods of assessment performed better on iRATs (full-credit mean 88.7 (5.9), answer-until-correct mean 82.8 (10.7), p<0.001). Students who used answer-until-correct method of assessment performed better on the team final examination (full-credit mean 45.8 (1.5), answer-until-correct 47.8 (1.4), p<0.001). There was no significant difference in performance on tRATs and the individual final examination. Students who used the answer-until-correct method had higher quality of team interaction ratings (full-credit 97.1 (9.1), answer-until-correct 103.0 (7.8), p=0.004). Answer-until-correct assessment method compared to traditional, full-credit methods resulted in significantly lower scores for iRATs, similar scores on tRATs and individual final examinations, improved scores on team final examinations, and improved perceptions of the quality of team interactions.

A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up.

PubMed

Tigchelaar, S; van Sambeeck, J; Koeter, S; van Kampen, A

2018-04-01

Trochlear osteotomy is a rarely performed procedure, only indicated in selected cases. Due to its nature, it can potentially lead to cartilage damage and subsequent early osteoarthritis. Satisfactory short-term results from lateral condyle-elevating osteotomy have previously been reported. The long-term effects of this procedure on clinical outcomes, patellar stability and radiological osteoarthritis are reported here. Sixteen patients (19 knees) with patellar instability due to trochlear dysplasia were included. An isolated lateral condyle-elevating trochlear osteotomy was performed between 1995 and 2002. All patients were re-examined at a minimum of 12-year follow-up. Three patients were lost to follow-up, and one patient underwent a patellofemoral arthroplasty 3 years post-operatively due to progressive osteoarthritis. Complete follow-up was therefore available in 12 patients (15 knees). Recurrent instability, VAS pain, WOMAC, Lysholm and Kujala scores were used as outcome measures. Radiological osteoarthritis was recorded using the Iwano and the Kellgren-Lawrence classifications. A repeated-measures ANOVA was used to test for repeated measures (pre-operative, 2-year and final follow-up), and Spearman's correlation coefficient for relationships between osteoarthritis and functional scores. At final follow-up, VAS pain showed a non-significant improvement from 52 to 25, and the median Kujala score was 78. Median Lysholm (54-71, p = 0.021) and WOMAC (78-96, p = 0.021) scores improved from the pre-operative assessment to final follow-up. There was no significant difference observed between clinical scores at the 2-year and final follow-up. Residual patellar instability was reported in four out of 15 knees. Three knees showed no patellofemoral osteoarthritis, eight knees had grade 1 and four knees grade 2. No correlation between VAS pain, Lysholm, WOMAC or Kujala scores and osteoarthritis could be identified (n.s.). A stand-alone lateral condyle-elevating trochleoplasty results in the significant improvement of most clinical scores; however, when performed as a stand-alone procedure, it leads to a high percentage of residual instability. In contrast to general belief, the development of patellofemoral osteoarthritis at 12-year follow-up did not exceed the findings from other trochleoplasty case series. Case series with no comparison group, Level IV.

Surgical Outcome of Intermittent Exotropia With Improvement in Control Grade Subsequent to Part-time Preoperative Occlusion Therapy.

PubMed

Bang, Seung Pil; Lee, Dong Cheol; Lee, Se Youp

2018-01-01

To evaluate the effect of improvement in the control grade of intermittent exotropia using part-time occlusion therapy on the final postoperative outcome. Control of intermittent exotropia was graded as good, fair, or poor in 89 consecutive patients with intermittent exotropia during their first visit. The patients were reevaluated after part-time preoperative occlusion therapy and divided into two groups (improvement and no improvement) according to whether they showed improvement in control grade. The surgical success rate was compared retrospectively between the two groups. The mean angle of deviation on the first visit was 27.61 ± 5.40 prism diopters (PD) at distance and 29.82 ± 5.28 PD at near. There were significant improvements in the angles of deviation for distance (26.17 ± 5.09 PD) and near (27.26 ± 5.56 PD) after part-time occlusion (both P < .001). The 49 patients who had a significantly improved control grade had a significantly better surgical success rate (77.6%) than the 40 patients who did not (50%; P = .007). Part-time occlusion therapy improves the control grade of intermittent exotropia, leading to a better likelihood of successful surgery and a reduction of the angles of deviation for distance and near. [J Pediatr Ophthalmol Strabismus. 2018;55(1):59-64.]. Copyright 2017, SLACK Incorporated.

The effect of ubiquinone and combined antioxidant therapy on oxidative stress markers in non-proliferative diabetic retinopathy: A phase IIa, randomized, double-blind, and placebo-controlled study.

PubMed

Rodríguez-Carrizalez, Adolfo Daniel; Castellanos-González, José Alberto; Martínez-Romero, Esaú César; Miller-Arrevillaga, Guillermo; Pacheco-Moisés, Fermín Paul; Román-Pintos, Luis Miguel; Miranda-Díaz, Alejandra Guillermina

2016-07-01

Objective To evaluate the effect of ubiquinone (Coenzyme Q10) and combined antioxidant therapy (CAT) on oxidative stress markers in non-proliferative diabetic retinopathy (NPDR) under clinical management. Study design In a randomized, double-blind, phase IIa, placebo-controlled, clinical trial, three study groups were formed and administered medications as follows: Group 1, Coenzyme Q10; Group 2, CAT; and Group 3, placebo. Methods Serum levels of the products of lipid peroxidation (LPO) and nitrites/nitrates, as markers of oxidative/nitrosative stress, were measured. As antioxidants, the total antioxidant capacity (TAC), catalase activity, and glutathione peroxidase (GPx) activity were measured. Results Baseline serum levels of LPO and nitrites/nitrates were significantly elevated in the three groups vs. healthy group (P < 0.0001), while final levels in the Coenzyme Q10 and CAT groups were decreased vs. normal levels (P < 0.0001). The baseline TAC was consumed in the three groups (P < 0.0001), while final results in the Coenzyme Q10 and CAT groups improved (P < 0.0001). Baseline catalase activity was increased in all groups vs. normal values (P < 0.001), while final levels in the Coenzyme Q10 (P < 0.001) and CAT groups (P < 0.0001) were decreased. GPx behaved similarly to catalase and improved in the final results (P < 0.0001). Discussion Adjunctive antioxidant treatment for 6 months was effective and safe for improving the oxidative stress in NPDR.

Project Loon based augmentation for global ionospheric modeling over Southern Hemisphere

NASA Astrophysics Data System (ADS)

Wang, Cheng; Shi, Chuang; Zhang, Hongping

2017-04-01

Global ionospheric products of vertical total electron content (VTEC) derived from GNSS measurements may have low accuracy over oceans and southern latitudes where there are not rich observations. Project Loon provides a great opportunity to enhance the measurements over those areas. In this contribution, a simulation of Project Loon based augmentation for global ionospheric modeling is performed by using the international reference ionosphere (IRI) which could simulate VTEC measurements for the balloons. The performance of the enhanced method based on simulation of Project Loon is investigated by comparing with VTEC maps from Ionosphere Associate Analysis Centers (IAACs) as well as IGS final GIMs. The comparison indicates that there is a better consistency between the VTEC maps by the enhanced method and IGS final GIMs. Also, obvious improvements of RMS maps in GIMs for the middle latitudes and southern latitudes are enabled by the augmentation of Project Loon. Additionally, JASON data are used to validate the specific improvement of the VTEC maps. The results show that the performance of VTEC maps is improved slightly, especially in southern latitudes. It is possible that the VTEC maps could be improved significantly by using real GPS measurements from balloons of Project Loon in the near future.

Project Loon based augmentation for global ionospheric modeling over Southern Hemisphere.

PubMed

Wang, Cheng; Shi, Chuang; Zhang, Hongping

2017-04-06

Global ionospheric products of vertical total electron content (VTEC) derived from GNSS measurements may have low accuracy over oceans and southern latitudes where there are not rich observations. Project Loon provides a great opportunity to enhance the measurements over those areas. In this contribution, a simulation of Project Loon based augmentation for global ionospheric modeling is performed by using the international reference ionosphere (IRI) which could simulate VTEC measurements for the balloons. The performance of the enhanced method based on simulation of Project Loon is investigated by comparing with VTEC maps from Ionosphere Associate Analysis Centers (IAACs) as well as IGS final GIMs. The comparison indicates that there is a better consistency between the VTEC maps by the enhanced method and IGS final GIMs. Also, obvious improvements of RMS maps in GIMs for the middle latitudes and southern latitudes are enabled by the augmentation of Project Loon. Additionally, JASON data are used to validate the specific improvement of the VTEC maps. The results show that the performance of VTEC maps is improved slightly, especially in southern latitudes. It is possible that the VTEC maps could be improved significantly by using real GPS measurements from balloons of Project Loon in the near future.

Project Loon based augmentation for global ionospheric modeling over Southern Hemisphere

PubMed Central

Wang, Cheng; Shi, Chuang; Zhang, Hongping

2017-01-01

Global ionospheric products of vertical total electron content (VTEC) derived from GNSS measurements may have low accuracy over oceans and southern latitudes where there are not rich observations. Project Loon provides a great opportunity to enhance the measurements over those areas. In this contribution, a simulation of Project Loon based augmentation for global ionospheric modeling is performed by using the international reference ionosphere (IRI) which could simulate VTEC measurements for the balloons. The performance of the enhanced method based on simulation of Project Loon is investigated by comparing with VTEC maps from Ionosphere Associate Analysis Centers (IAACs) as well as IGS final GIMs. The comparison indicates that there is a better consistency between the VTEC maps by the enhanced method and IGS final GIMs. Also, obvious improvements of RMS maps in GIMs for the middle latitudes and southern latitudes are enabled by the augmentation of Project Loon. Additionally, JASON data are used to validate the specific improvement of the VTEC maps. The results show that the performance of VTEC maps is improved slightly, especially in southern latitudes. It is possible that the VTEC maps could be improved significantly by using real GPS measurements from balloons of Project Loon in the near future. PMID:28383058

A Comprehensive Peer Network Intervention to Improve Social Communication of Children with Autism Spectrum Disorders: A Randomized Trial in Kindergarten and First Grade

PubMed Central

Kamps, Debra; Thiemann-Bourque, Kathy; Heitzman-Powell, Linda; Schwartz, Ilene; Rosenberg, Nancy; Mason, Rose; Cox, Suzanne

2015-01-01

The purpose of this randomized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First-grade children with Autism Spectrum Disorders (ASD). Trained school staff members provided direct instruction for 56 children in the intervention group, and 39 children participated in a comparison group. Results showed children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment social probes and generalization probes. Treatment session data showed significant growth for total communications over baseline levels. Children in treatment also showed more growth in language and adaptive communication. Finally, teachers’ ratings of prosocial skills revealed significantly greater improvements for the intervention group. PMID:25510450

Injection of Mesenchymal Stem Cells as a Supplementary Strategy of Marrow Stimulation Improves Cartilage Regeneration After Lateral Sliding Calcaneal Osteotomy for Varus Ankle Osteoarthritis: Clinical and Second-Look Arthroscopic Results.

PubMed

Kim, Yong Sang; Koh, Yong Gon

2016-05-01

To compare the clinical and second-look arthroscopic outcomes in patients undergoing arthroscopic marrow stimulation combined with lateral sliding calcaneal osteotomy for varus ankle osteoarthritis, with or without adipose-derived mesenchymal stem cell (MSC) injection. In this retrospective comparative study, 49 patients with varus ankle osteoarthritis underwent second-look arthroscopy after arthroscopic marrow stimulation combined with lateral sliding calcaneal osteotomy between January 2010 and November 2012; 23 ankles underwent marrow stimulation alone (group 1), and 26 underwent marrow stimulation with MSC injection (group 2). The decision whether to receive the MSC injection, which was free of charge, was solely up to the patients. Second-look arthroscopies were performed at a mean of 12.5 months and 12.4 months postoperatively in group 1 and group 2, respectively. Clinical outcome measures included a visual analog scale (VAS) score for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) score. The radiologic outcome variable was the talar tilt angle. On second-look arthroscopy, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade. The mean VAS score improved significantly from 7.3 ± 0.9 to 3.9 ± 1.2 in group 1 and from 7.4 ± 0.8 to 3.1 ± 1.5 in group 2 at final follow-up (P < .001 for both groups). The mean AOFAS score also improved significantly from 64.4 ± 4.1 to 79.6 ± 7.7 in group 1 and from 63.5 ± 4.2 to 84.2 ± 7.9 in group 2 at final follow-up (P < .001 for both groups). The VAS and AOFAS scores were significantly better in group 2 than in group 1 (P = .040 and P = .047, respectively). ICRS grades were significantly correlated with clinical outcomes in both groups (all P < .05), and there were significant differences in ICRS grades between the groups (P < .05). The mean talar tilt angle improved significantly after lateral sliding calcaneal osteotomy in both groups and was significantly correlated with clinical outcomes and ICRS grade (all P < .05). In patients with varus ankle osteoarthritis who underwent lateral sliding calcaneal osteotomy, significant improvements in VAS and AOFAS scores, as well as better ICRS grades, were achieved at short-term follow-up after marrow stimulation with additional MSC injection compared with after marrow stimulation alone. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Environmental Assessment and Final Finding of No Significant Impact for Lantirn Village & Camera I Site Upgrades Fort Wainwright Yukon Training Area Fort Wainwright, Alaska

DTIC Science & Technology

2009-08-01

improved road access and overhead power. The site contains a WISS shelter, five (5) 40’ connex containers, UMTE pedestal, shelter, and a weather ...monitoring station (Figure 3- 1 ). 3.1.8.3 Camera I site consists of a roughly l acre site with semi-improved road access and overhead power. The site...characteristics such as microclimate , soil temperature, and moisture regimes. which in turn influence the type of vegetation that will be found there

Functional change in the pattern of swallowing through the performance of orofacial exercises.

PubMed

Alves, Irina Claudia Fernandes; Andrade, Claudia Regina Furquim de

2017-05-22

The objective was to determine if there was functional improvement of swallowing pattern in subjects identified with risk of oropharyngeal dysphagia after four weeks of specific oropharyngeal exercises. These exercises have pre-determined intensity and duration. It is a longitudinal study of functional effect, determined by initial and final comparative measures. Participants were adults and elderly, selected in a period of 24 months. A total of 68 participants were included. All subjects had a clinical evaluation of swallowing, and an initial measure in a functional scale. The individuals were split into two groups, according to the initial levelling of ASHA NOMS scale. In Group 1 (G1) - ASHA NOMS, initial of levels 1 and 2; Group 2 (G2) - ASHA NOMS, initial of levels 3, 4 and 5. All subjects executed an exercise protocol performed for four weeks. The protocol includes sessions with a speech therapist, and continuity of activities in home environment. Finally, new measurement of swallowing performance was held. For G2 group there was statistically significant improvement. For G1, the relation was insignificant, despite the intense change in ASHA NOMS scale, however, in this group there was a reduced number of individuals due to the profile severity. The program was effective because after four exercise sessions, there was significant improvement in swallowing pattern, demonstrated by functional scale.

Acute stent recoil and optimal balloon inflation strategy: an experimental study using real-time optical coherence tomography.

PubMed

Kitahara, Hideki; Waseda, Katsuhisa; Yamada, Ryotaro; Otagiri, Kyuhachi; Tanaka, Shigemitsu; Kobayashi, Yuhei; Okada, Kozo; Kume, Teruyoshi; Nakagawa, Kaori; Teramoto, Tomohiko; Ikeno, Fumiaki; Yock, Paul G; Fitzgerald, Peter J; Honda, Yasuhiro

2016-06-12

Our aim was to evaluate stent expansion and acute recoil at deployment and post-dilatation, and the impact of post-dilatation strategies on final stent dimensions. Optical coherence tomography (OCT) was performed on eight bare metal platforms of drug-eluting stents (3.0 mm diameter, n=6 for each) during and after balloon inflation in a silicone mock vessel. After nominal-pressure deployment, a single long (30 sec) vs. multiple short (10 sec x3) post-dilatations were performed using a non-compliant balloon (3.25 mm, 20 atm). Stent areas during deployment with original delivery systems were smaller in stainless steel stents than in cobalt-chromium and platinum-chromium stents (p<0.001), whereas subsequent acute recoil was comparable among the three materials. At post-dilatation, acute recoil was greater in cobalt-chromium and platinum-chromium stents than in stainless steel stents (p<0.001), resulting in smaller final stent areas in cobalt-chromium and platinum-chromium stents than in stainless steel stents (p<0.001). In comparison between conventional and latest-generation cobalt-chromium stents, stent areas were not significantly different after both deployment and post-dilatation. With multiple short post-dilatations, acute recoil was significantly improved from first to third short inflation (p<0.001), achieving larger final area than a single long inflation, despite stent materials/designs (p<0.001). Real-time OCT revealed significant acute recoil in all stent types. Both stent materials/designs and post-dilatation strategies showed a significant impact on final stent expansion.

Health impact assessment as an agent of policy change: improving the health impacts of the mayor of London's draft transport strategy.

PubMed

Mindell, J; Sheridan, L; Joffe, M; Samson-Barry, H; Atkinson, S

2004-03-01

To increase the positive and mitigate the negative health impacts of the mayor's draft transport strategy for London. A rapid prospective health impact assessment (HIA) of the penultimate draft of the strategy, using a review commissioned by the regional director of public health; an appraisal of congestion charging; and a participatory workshop. Two audits of changes were performed to assess the impact on policy of the HIA process. Regional government policy development. Recommendations from the rapid HIA were fed back into the drafting process. Changes (a) between the penultimate draft and the draft for public consultation and (b) between that and the final mayoral strategy. The draft transport strategy published for consultation differed in a number of respects from the previous version. Almost all the recommendations from the HIA were incorporated into the final strategy. Significant changes included promoting sustainable travel plans for workplaces and schools; giving priority to infrastructure and services that benefit London's deprived communities; increased emphasis on promoting walking and cycling and reducing reliance on private cars; and a commitment to track the health impacts of the final strategy and its implementation. Specific additions included re-allocating road space. HIA was successful in influencing the transport strategy for London, resulting in several improvements from a health viewpoint. HIA is an effective method both for bringing about significant change in policy proposals and in increasing policy makers' understanding of determinants of health and hence in changing attitudes of policy makers.

Stable reconstruction using halo vest for unstable upper cervical spine and occipitocervical instability.

PubMed

Ogihara, Nobuhide; Takahashi, Jun; Hirabayashi, Hiroki; Hashidate, Hiroyuki; Mukaiyama, Keijiro; Kato, Hiroyuki

2012-02-01

Upper cervical or occipitocervical disorders such as rheumatoid arthritis present as atlantoaxial subluxation, vertical subluxation of the axis, and subaxial subluxation, which produce myelopathy and severe pain. In such cases, occipitocervical reconstruction surgery may be indicated, and several reports have described reduction of subluxation by fixing the halo vest before this surgery. The purpose of this study was to evaluate the efficacy of using the halo vest before the surgery for unstable upper cervical spine and for occipitocervical instability. Twenty-eight patients (9 men and 19 women; mean age, 61.8 years at surgery) who presented with atlantoaxial or occipitocervical fusion were studied. In all cases, the halo vest was fixed in the conscious condition, and subluxation was reduced before the surgery. The mean follow-up period was 45 months. Roentgenologic measurement and clinical evaluation were performed before the surgery and at the final follow-up. Using the halo vest resulted in significant reductions in the atlantodental interval, the space available for the spinal cord, and the Ranawat value (p < 0.05), and these were maintained until the final follow-up. The mean Japanese Orthopedic Association score significantly improved from 9.5 before surgery to 12.2 at the final follow-up (p = 0.01). Nineteen cases (68%) improved by more than 1 grade by Ranawat's classification after surgery and 16 cases (57%) maintained the same at the follow-up visit. Conscious preoperative reduction using the halo vest for occipitocervical disorders is a useful and safe technique.

The influence of situation awareness training on nurses' confidence about patient safety skills: A prospective cohort study.

PubMed

Stomski, Norman; Gluyas, Heather; Andrus, Prue; Williams, Anne; Hopkins, Martin; Walters, Jennifer; Sandy, Martinique; Morrison, Paul

2018-04-01

Several studies report that patient safety skills, especially non-technical skills, receive scant attention in nursing curricula. Hence, there is a compelling reason to incorporate material that enhances non-technical skills, such as situation awareness, in nursing curricula in order to assist in the reduction of healthcare related adverse events. The objectives of this study were to: 1) understand final year nursing students' confidence in their patient safety skills; and 2) examine the impact of situation awareness training on final year nursing students' confidence in their patient safety skills. Participants were enrolled from a convenience sample comprising final year nursing students at a Western Australia university. Self-reported confidence in patient safety skills was assessed with the Health Professional in Patient Safety Survey before and after the delivery of a situation awareness educational intervention. Pre/post educational intervention differences were examined by repeated measures ANOVA. No significant differences in confidence about patient safety skills were identified within settings (class/clinical). However, confidence in patient safety skills significantly decreased between settings i.e. nursing students lost confidence after clinical placements. The educational intervention delivered in this study did not seem to improve confidence in patient safety skills, but substantial ceiling effects may have confounded the identification of such improvement. Further studies are required to establish whether the findings of this study can be generalised to other university nursing cohorts. Copyright © 2018 Elsevier Ltd. All rights reserved.

Free range users and one hit wonders: community users of an Internet-based cognitive behaviour therapy program.

PubMed

Christensen, Helen; Griffiths, Kathy; Groves, Chloe; Korten, Ailsa

2006-01-01

Little is known about the predictors of symptom change or the methods that might increase user 'compliance' on websites designed to improve mental health outcomes. The present paper: (i) examines predictors of expected final depression and anxiety scores on the MoodGYM website as a function of user characteristics; and (ii) compares the compliance rates of the original site with the new public version of the site (MoodGYM Mark II). The latter site requires compulsory completion of 'core' online assessments and may increase completion of site questionnaires. MoodGYM Mark I participants were 19,607 visitors (public registrants) between April 2001 and September 2003 plus 182 participants who had been randomly assigned to MoodGYM in an earlier trial (The BlueMood Trial). MoodGYM Mark II participants were 38,791 public registrants of the MoodGYM Mark II site collected between September 2003 and October 2004. Symptom assessments are repeated within the website intervention to allow the examination of change in symptoms. Outcome variables were gender, initial depression severity scores, number of assessments completed and final anxiety and depression scores. Men are predicted to be 0.19 units (SE=0.095) higher than women on depression, controlling for the initial depression level and number of modules completed. For initial depression scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. For initial anxiety scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. Mark II registrants were more likely than to Mark I registrants to complete onsite assessments. Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.

Resilient Braided Rope Seal

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M. (Inventor); Kren, Lawrence A. (Inventor)

1996-01-01

A resilient braided rope seal for use in high temperature applications. The resilient braided rope seal includes a center core of fibers, a resilient 5 member overbraided by at least one layer of braided sheath fibers tightly packed together. The resilient member adds significant stiffness to the seal while maintaining resiliency. Furthermore, the seal permanent set and hysteresis are greatly reduced. Finally, improved load capabilities are provided.

Native Hawaiian Hearing and Speech Project. Counteracting the Negative Educational Effects of Otitis Media in Native Hawaiian Preschoolers. Final Report.

ERIC Educational Resources Information Center

Kamehameha Schools/Bernice Pauahi Bishop Estate, Honolulu, HI.

This study aimed to produce a significant improvement in the educational achievement of Hawaiian preschool children in 2 years, through implementation of a communication program in five preschool classes serving approximately 100 children. The six components of the program were: (1) an enhanced hearing loss and middle-ear disorder and speech…

Comparison of bone tunnel and suture anchor techniques in the modified Broström procedure for chronic lateral ankle instability.

PubMed

Hu, Chang-Yong; Lee, Keun-Bae; Song, Eun-Kyoo; Kim, Myung-Sun; Park, Kyung-Soon

2013-08-01

The modified Broström procedure is frequently used to treat chronic lateral ankle instability. There are 2 common methods of the modified Broström procedure, which are the bone tunnel and suture anchor techniques. To compare the clinical outcomes of the modified Broström procedure using the bone tunnel and suture anchor techniques. Cohort study; Level of evidence, 2. Eighty-one patients (81 ankles) treated with the modified Broström procedure for chronic lateral ankle instability constituted the study cohort. The 81 ankles were divided into 2 groups, namely, a bone tunnel technique (BT group; 40 ankles) and a suture anchor technique (SA group; 41 ankles). The Karlsson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, anterior talar translation, and talar tilt angle were used to evaluate clinical and radiographic outcomes. The BT group consisted of 32 men and 8 women with a mean age of 34.8 years at surgery and a mean follow-up duration of 34.2 months. The SA group consisted of 33 men and 8 women with a mean age of 33.3 years at surgery and a mean follow-up duration of 32.8 months. Mean Karlsson scores improved significantly from 57.0 points preoperatively to 94.9 points at final follow-up in the BT group and from 59.9 points preoperatively to 96.4 points at final follow-up in the SA group. Mean AOFAS scores also improved from 64.2 points preoperatively to 97.8 points at final follow-up in the BT group and from 70.3 points preoperatively to 97.4 points at final follow-up in the SA group. Mean anterior talar translations in the BT group and SA group improved from 9.0 mm and 9.2 mm preoperatively to 6.5 mm and 6.8 mm at final follow-up, respectively. Mean talar tilt angles were 12.0° in the BT group and 12.5° in the SA group preoperatively and 8.8° at final follow-up for both groups. No significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, anterior talar translation, and talar tilt angle. The bone tunnel and suture anchor techniques of the modified Broström procedure showed similar good functional and radiographic outcomes. Both techniques appear to be effective and reliable methods for the treatment of chronic lateral ankle instability.

Improvements in the order, isotropy and electron density of glypican-1 crystals by controlled dehydration

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

Awad, Wael; Cairo University, Cairo; Svensson Birkedal, Gabriel

The anisotropy of crystals of glypican-1 was significantly reduced by controlled dehydration using the HC1 device, allowing the building of previously disordered parts of the structure. The use of controlled dehydration for improvement of protein crystal diffraction quality is increasing in popularity, although there are still relatively few documented examples of success. A study has been carried out to establish whether controlled dehydration could be used to improve the anisotropy of crystals of the core protein of the human proteoglycan glypican-1. Crystals were subjected to controlled dehydration using the HC1 device. The optimal protocol for dehydration was developed by carefulmore » investigation of the following parameters: dehydration rate, final relative humidity and total incubation time T{sub inc}. Of these, the most important was shown to be T{sub inc}. After dehydration using the optimal protocol the crystals showed significantly reduced anisotropy and improved electron density, allowing the building of previously disordered parts of the structure.« less

Auditing an Online Self-reported Interventional Radiology Adverse Event Database for Compliance and Accuracy.

PubMed

Burch, Ezra A; Shyn, Paul B; Chick, Jeffrey F; Chauhan, Nikunj R

2017-04-01

The purpose of this study was to determine whether auditing an online self-reported interventional radiology quality assurance database improves compliance with record entry or improves the accuracy of adverse event (AE) reporting and grading. Physicians were trained in using the database before the study began. An audit of all database entries for the first 3 months, or the first quarter, was performed, at which point physicians were informed of the audit process; entries for the subsequent 3 months, or the second quarter, were again audited. Results between quarters were compared. Compliance with record entry improved from the first to second quarter, but reminders were necessary to ensure 100% compliance with record entry. Knowledge of the audit process did not significantly improve self-reporting of AE or accuracy of AE grading. However, auditing significantly changed the final AE reporting rates and grades. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Peer video review and feedback improve performance in basic surgical skills.

PubMed

Vaughn, Carolyn J; Kim, Edward; O'Sullivan, Patricia; Huang, Emily; Lin, Matthew Y C; Wyles, Susannah; Palmer, Barnard J A; Pierce, Jonathan L; Chern, Hueylan

2016-02-01

Incorporation of home-video assessments allows flexibility in feedback but requires faculty time. Peer feedback (PF) may provide additional benefits while avoiding these constraints. Twenty-four surgical interns completed a 12-week skills curriculum with home-video assignments focused on knot tying and suturing. Interns were randomized into 2 groups: PF or faculty feedback (FF). Peers and faculty provided feedback on home videos with checklists, global rating, and comments. Learners' skills were assessed at baseline, during, and at the conclusion of the curriculum. Performance of the 2 groups as rated by experts was compared. FF and PF were compared. Both groups improved from baseline, and the highest rated scores were seen on their home-video assessments. The PF group performed better at the final assessment than the FF group (effect size, .84). When using a checklist, there was no significant difference between scores given by peers and faculty. The PF group performed better at the final assessment, suggesting reviewing and analyzing another's performance may improve one's own performance. With checklists as guidance, peers can serve as raters comparable to faculty. Copyright © 2016 Elsevier Inc. All rights reserved.

The implementation and validation of improved land-surface hydrology in an atmospheric general circulation model

NASA Technical Reports Server (NTRS)

Johnson, Kevin D.; Entekhabi, Dara; Eagleson, Peter S.

1993-01-01

New land-surface hydrologic parameterizations are implemented into the NASA Goddard Institute for Space Studies (GISS) General Circulation Model (GCM). These parameterizations are: 1) runoff and evapotranspiration functions that include the effects of subgrid-scale spatial variability and use physically based equations of hydrologic flux at the soil surface and 2) a realistic soil moisture diffusion scheme for the movement of water and root sink in the soil column. A one-dimensional climate model with a complete hydrologic cycle is used to screen the basic sensitivities of the hydrological parameterizations before implementation into the full three-dimensional GCM. Results of the final simulation with the GISS GCM and the new land-surface hydrology indicate that the runoff rate, especially in the tropics, is significantly improved. As a result, the remaining components of the heat and moisture balance show similar improvements when compared to observations. The validation of model results is carried from the large global (ocean and land-surface) scale to the zonal, continental, and finally the regional river basin scales.

Computer assisted diagnostic system in tumor radiography.

PubMed

Faisal, Ahmed; Parveen, Sharmin; Badsha, Shahriar; Sarwar, Hasan; Reza, Ahmed Wasif

2013-06-01

An improved and efficient method is presented in this paper to achieve a better trade-off between noise removal and edge preservation, thereby detecting the tumor region of MRI brain images automatically. Compass operator has been used in the fourth order Partial Differential Equation (PDE) based denoising technique to preserve the anatomically significant information at the edges. A new morphological technique is also introduced for stripping skull region from the brain images, which consequently leading to the process of detecting tumor accurately. Finally, automatic seeded region growing segmentation based on an improved single seed point selection algorithm is applied to detect the tumor. The method is tested on publicly available MRI brain images and it gives an average PSNR (Peak Signal to Noise Ratio) of 36.49. The obtained results also show detection accuracy of 99.46%, which is a significant improvement than that of the existing results.

Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes.

PubMed

Kelly, Robert E; Mellins, Robert B; Shamberger, Robert C; Mitchell, Karen K; Lawson, M Louise; Oldham, Keith T; Azizkhan, Richard G; Hebra, Andre V; Nuss, Donald; Goretsky, Michael J; Sharp, Ronald J; Holcomb, George W; Shim, Walton K T; Megison, Stephen M; Moss, R Lawrence; Fecteau, Annie H; Colombani, Paul M; Cooper, Dan; Bagley, Traci; Quinn, Amy; Moskowitz, Alan B; Paulson, James F

2013-12-01

A multicenter study of pectus excavatum was described previously. This report presents our final results. Patients treated surgically at 11 centers were followed prospectively. Each underwent a preoperative evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, complications, and perioperative pain. One year after treatment, patients underwent repeat chest CT scan, pulmonary function tests, and body image survey. A subset of 50 underwent exercise pulmonary function testing. Of 327 patients, 284 underwent Nuss procedure and 43 underwent open procedure without mortality. Of 182 patients with complete follow-up (56%), 18% had late complications, similarly distributed, including substernal bar displacement in 7% and wound infection in 2%. Mean initial CT scan index of 4.4 improved to 3.0 post operation (severe >3.2, normal = 2.5). Computed tomography index improved at the deepest point (xiphoid) and also upper and middle sternum. Pulmonary function tests improved (forced vital capacity from 88% to 93%, forced expiratory volume in 1 second from 87% to 90%, and total lung capacity from 94% to 100% of predicted (p < 0.001 for each). VO2 max during peak exercise increased by 10.1% (p = 0.015) and O2 pulse by 19% (p = 0.007) in 20 subjects who completed both pre- and postoperative exercise tests. There is significant improvement in lung function at rest and in VO2 max and O2 pulse after surgical correction of pectus excavatum, with CT index >3.2. Operative correction significantly reduces CT index and markedly improves the shape of the entire chest, and can be performed safely in a variety of centers. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluating the Effects of Flexible Learning about Aseptic Compounding on First-year Students in a Pharmacy Skills Laboratory

PubMed Central

Palmer, Russ; Elder, Deborah; Fulford, Michael; Morris, Steve; Sappington, Kellie

2015-01-01

Objective. To evaluate how flexible learning via online video review affects the ability and confidence of first-year (P1) pharmacy students to accurately compound aseptic preparations. Design. Customary instructions and assignments for aseptic compounding were provided to students, who were given unlimited access to 5 short review videos in addition to customary instruction. Student self-confidence was assessed online, and faculty members evaluated students’ aseptic technique at the conclusion of the semester. Assessment. No significant difference on final assessment scores was observed between those who viewed videos and those who did not. Student self-confidence scores increased significantly from baseline, but were not significantly higher for those who viewed videos than for those who did not. Conclusion. First-year students performed well on final aseptic compounding assessments, and those who viewed videos had a slight advantage. Student self-confidence improved over the semester regardless of whether or not students accessed review videos. PMID:26430278

Effect of virtual reality in Parkinson's disease: a prospective observational study.

PubMed

Severiano, Maria Izabel Rodrigues; Zeigelboim, Bianca Simone; Teive, Hélio Afonso Ghizoni; Santos, Geslaine Janaína Barbosa; Fonseca, Vinícius Ribas

2018-02-01

To assess the effectiveness of balance exercises by means of virtual reality games in Parkinson's disease. Sixteen patients were submitted to anamnesis, otorhinolaryngological and vestibular examinations, as well as the Dizziness Handicap Inventory, Berg Balance Scale, SF-36 questionnaire, and the SRT, applied before and after rehabilitation with virtual reality games. Final scoring for the Dizziness Handicap Inventory and Berg Balance Scale was better after rehabilitation. The SRT showed a significant result after rehabilitation. The SF-36 showed a significant change in the functional capacity for the Tightrope Walk and Ski Slalom virtual reality games (p < 0.05), as well as in the mental health aspect of the Ski Slalom game (p < 0.05). The Dizziness Handicap Inventory and Berg Balance Scale showed significant changes in the Ski Slalom game (p < 0.05). There was evidence of clinical improvement in patients in the final assessment after virtual rehabilitation. The Tightrope Walk and Ski Slalom virtual games were shown to be the most effective for this population.

CaMKII activity is essential for improvement of memory-related behaviors by chronic rivastigmine treatment.

PubMed

Moriguchi, Shigeki; Tagashira, Hideaki; Sasaki, Yuzuru; Yeh, Jay Z; Sakagami, Hiroyuki; Narahashi, Toshio; Fukunaga, Kohji

2014-03-01

Because the cholinergic system is down-regulated in the brain of Alzheimer's disease patients, cognitive deficits in Alzheimer's disease patients are significantly improved by rivastigmine treatment. To address the mechanism underlying rivastigmine-induced memory improvements, we chronically treated olfactory bulbectomized (OBX) mice with rivastigmine. The chronic rivastigmine treatments for 12-13 days starting at 10 days after OBX operation significantly improved memory-related behaviors assessed by Y-maze task, novel object recognition task, passive avoidance task, and Barnes maze task, whereas the single rivastigmine treatment failed to improve the memory. Consistent with the improved memory-related behaviors, long-term potentiation in the hippocampal CA1 region was markedly restored by rivastigmine treatments. In immunoblotting analyses, the reductions of calcium/calmodulin-dependent protein kinase II (CaMKII) autophosphorylation and calcium/calmodulin-dependent protein kinase IV (CaMKIV) phosphorylation in the CA1 region in OBX mice were significantly restored by rivastigmine treatments. In addition, phosphorylation of AMPAR subunit glutamate receptor 1 (GluA1) (Ser-831) and cAMP-responsive element-binding protein (Ser-133) as downstream targets of CaMKII and CaMKIV, respectively, in the CA1 region was also significantly restored by chronic rivastigmine treatments. Finally, we confirmed that rivastigmine-induced improvements of memory-related behaviors and long-term potentiation were not obtained in CaMKIIα(+/-) mice. On the other hand, CaMKIV(-/-) mice did not exhibit the cognitive impairments. Taken together, the stimulation of CaMKII activity in the hippocampus is essential for rivastigmine-induced memory improvement in OBX mice. © 2013 International Society for Neurochemistry.

Nurses' knowledge and perception of delirium screening and assessment in the intensive care unit: Long-term effectiveness of an education-based knowledge translation intervention.

PubMed

Hickin, Sharon L; White, Sandra; Knopp-Sihota, Jennifer

2017-08-01

To determine the impact of education on nurses' knowledge of delirium, knowledge and perception of a validated screening tool, and delirium screening in the ICU. A quasi-experimental single group pretest-post-test design. A 16 bed ICU in a Canadian urban tertiary care centre. Nursing knowledge and perception were measured at baseline, 3-month and 18-month periods. Delirium screening was then assessed over 24-months. During the study period, 197 surveys were returned; 84 at baseline, 53 at 3-months post education, and 60 at the final assessment period 18-months post intervention. The significant improvements in mean knowledge scores at 3-months post intervention (7.2, SD 1.3) were not maintained at 18-months (5.3, SD 1.1). Screening tool perception scores remained unchanged. Improvements in the perception of utility were significant at both time periods (p=0.03, 0.02 respectively). Physician value significantly improved at 18-months (p=0.01). Delirium screening frequency improved after education (p<0.001) demonstrating a positive correlation over time (p<0.01). Multifaceted education is effective in improving delirium knowledge and screening; however, without sustained effort, progress is transient. Education improved perceived tool utility and over time utility perception and physician value improved. Copyright © 2017 Elsevier Ltd. All rights reserved.

Long-term surgical outcomes of retinal detachment in patients with Stickler syndrome

PubMed Central

Reddy, Devasis N; Yonekawa, Yoshihiro; Thomas, Benjamin J; Nudleman, Eric D; Williams, George A

2016-01-01

Purpose The aim of the study was to present the long-term anatomical and visual outcomes of retinal detachment repair in patients with Stickler syndrome. Patients and methods This study is a retrospective, interventional, consecutive case series of patients with Stickler syndrome undergoing retinal reattachment surgery from 2009 to 2014 at the Associated Retinal Consultants, William Beaumont Hospital. Results Sixteen eyes from 13 patients were identified. Patients underwent a mean of 3.1 surgical interventions (range: 1–13) with a mean postoperative follow-up of 94 months (range: 5–313 months). Twelve eyes (75%) developed proliferative vitreoretinopathy. Retinal reattachment was achieved in 100% of eyes, with ten eyes (63%) requiring silicone oil tamponade at final follow-up. Mean preoperative visual acuity (VA) was 20/914, which improved to 20/796 at final follow-up (P=0.81). There was a significant correlation between presenting and final VA (P<0.001), and patients with poorer presenting VA were more likely to require silicone oil tamponade at final follow-up (P=0.04). Conclusion Repair of retinal detachment in patients with Stickler syndrome often requires multiple surgeries, and visual outcomes are variable. Presenting VA is significantly predictive of long-term VA outcomes. PMID:27574392

Assessing the learning curve for the acquisition of laparoscopic skills on a virtual reality simulator.

PubMed

Sherman, V; Feldman, L S; Stanbridge, D; Kazmi, R; Fried, G M

2005-05-01

The aim of this study was to develop summary metrics and assess the construct validity for a virtual reality laparoscopic simulator (LapSim) by comparing the learning curves of three groups with different levels of laparoscopic expertise. Three groups of subjects ('expert', 'junior', and 'naïve') underwent repeated trials on three LapSim tasks. Formulas were developed to calculate scores for efficiency ('time-error') and economy of 'motion' ('motion') using metrics generated by the software after each drill. Data (mean +/- SD) were evaluated by analysis of variance (ANOVA). Significance was set at p < 0.05. All three groups improved significantly from baseline to final for both 'time-error' and 'motion' scores. There were significant differences between groups in time error performances at baseline and final, due to higher scores in the 'expert' group. A significant difference in 'motion' scores was seen only at baseline. We have developed summary metrics for the LapSim that differentiate among levels of laparoscopic experience. This study also provides evidence of construct validity for the LapSim.

Effects of hard mask etch on final topography of advanced phase shift masks

NASA Astrophysics Data System (ADS)

Hortenbach, Olga; Rolff, Haiko; Lajn, Alexander; Baessler, Martin

2017-07-01

Continuous shrinking of the semiconductor device dimensions demands steady improvements of the lithographic resolution on wafer level. These requirements challenge the photomask industry to further improve the mask quality in all relevant printing characteristics. In this paper topography of the Phase Shift Masks (PSM) was investigated. Effects of hard mask etch on phase shift uniformity and mask absorber profile were studied. Design of experiments method (DoE) was used for the process optimization, whereas gas composition, bias power of the hard mask main etch and bias power of the over-etch were varied. In addition, influence of the over-etch time was examined at the end of the experiment. Absorber depth uniformity, sidewall angle (SWA), reactive ion etch lag (RIE lag) and through pitch (TP) dependence were analyzed. Measurements were performed by means of Atomic-force microscopy (AFM) using critical dimension (CD) mode with a boot-shaped tip. Scanning electron microscope (SEM) cross-section images were prepared to verify the profile quality. Finally CD analysis was performed to confirm the optimal etch conditions. Significant dependence of the absorber SWA on hard mask (HM) etch conditions was observed revealing an improvement potential for the mask absorber profile. It was found that hard mask etch can leave a depth footprint in the absorber layer. Thus, the etch depth uniformity of hard mask etch is crucial for achieving a uniform phase shift over the active mask area. The optimized hard mask etch process results in significantly improved mask topography without deterioration of tight CD specifications.

Lactose-free frozen yogurt: production and characteristics.

PubMed

Skryplonek, Katarzyna; Gomes, David; Viegas, Jorge; Pereira, Carlos; Henriques, Marta

2017-01-01

Nowadays, consumer demand is driving better and more nutritious dairy products. Changing from traditional to new lactose-free products poses technological challenges for the food industry in order to maintain or improve their food characteristics and consumer preferences. This study investigates the production of lactose-free frozen yogurt by enzymati- cally hydrolysis of lactose, and its influence on the final product characteristics. In the case of lactose-free products, commercial Ha-lactase® was used for hydrolysis, and the reaction occurred simultaneously with fermentation. The effect of lactose hydrolysis on the physicochemical properties, texture, viscosity, overrun and sensory attributes in the final product was investigated. After yogurt maturation, the acidity of the lactose-free product was significantly higher than in the control, suggesting that breaking down lactose enhances the fermentation process. Lactose-free frozen yogurt had significantly lower hardness and stickiness and higher viscosity than control frozen yogurt. Moreover, lactose hydrolysis promoted a smooth and creamy consistency, whereas in the case of conventional prod- ucts a coarse structure, due to the presence of large ice crystals, was identified. Hydrolysis of lactose also improved the sweetness and brightness of frozen yogurt. The improved textural properties of lactose-free product results from the fact that monosaccharides produced during lactose hydrolysis depress the freezing point of the mix, which enables product with softer structure and bigger resistance to ice recrystallization to be obtained. The study showed that lactose-free frozen yogurt may be used successfully for production of novel lactose-free frozen desserts. Lactose hydrolysis improves the texture and viscosity of the product,     as well as enhancing its sensory quality.

Early versus delayed rehabilitation following arthroscopic rotator cuff repair: A systematic review.

PubMed

Gallagher, Brian P; Bishop, Meghan E; Tjoumakaris, Fotios P; Freedman, Kevin B

2015-05-01

Early passive range of motion (ROM) following arthroscopic cuff repair is thought to decrease postoperative stiffness and improve functionality. However, early aggressive rehabilitation may compromise repair integrity. Our purpose was to perform a systematic review to determine if there are differences between early and delayed rehabilitation after arthroscopic rotator cuff repair in terms of clinical outcomes and healing. We performed a literature search with the terms 'arthroscopic rotator cuff', 'immobilization', 'early', 'delayed', 'late', and 'rehabilitation' using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Selection criteria included: level I/II evidence ≤ 6 months in duration, comparing early versus delayed rehabilitation following arthroscopic repair. Data regarding demographics, sample sizes, duration, cuff pathology, surgery, rehabilitation, functional outcomes, pain, ROM and anatomic assessment of healing were analyzed. PRIMSA criteria were followed. We identified six articles matching our criteria. Three reported significantly increased functional scores within the first 3-6 months with early rehabilitation compared to the delayed group, only one of which continued to observe a difference at a final follow-up of 15 months. Four articles showed improved ROM in the first 3-6 months post-operatively with early rehabilitation. One noted transient differences in pain scores. Only one study noted significant differences in ROM at final follow-up. No study reported any significant difference in rates of rotator cuff re-tear. However, two studies noted a trend towards increased re-tear with early rehabilitation that did not reach significance. This was more pronounced in studies including medium-large tears. Early rehabilitation after arthroscopic cuff repair is associated with some initial improvements in ROM and function. Ultimately, similar clinical and anatomical outcomes between groups existed at 1 year. While there was no significant difference between groups in anatomic failure of the repaired cuff, there may be a trend towards increased re-tear with larger tears.

Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis.

PubMed

Cheng, Xiaofei; Zhang, Kai; Sun, Xiaojiang; Zhao, Changqing; Li, Hua; Ni, Bin; Zhao, Jie

2017-08-01

Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures. This study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis. This is a prospective cohort study. This study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF. Visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score. The clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168). There were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group. When compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery. Copyright © 2017 Elsevier Inc. All rights reserved.

Improving crystal size distribution by internal seeding combined cooling/antisolvent crystallization with a cooling/heating cycle

NASA Astrophysics Data System (ADS)

Lenka, Maheswata; Sarkar, Debasis

2018-03-01

This work investigates the effect of internal seeding and an initial cooling/heating cycle on the final crystal size distribution (CSD) during a combined cooling/antisolvent crystallization of L-asparagine monohydrate from it's aqueous solution using isopropyl-alcohol as antisolvent. Internal seeds were generated by one-pot addition of various amounts of antisolvent to the crystallizer. It was then followed by a cooling/heating cycle to dissolve the fines produced and thus obtain a suitable initial seed. A combined cooling/antisolvent crystallization was then followed by employing a linear cooling profile with simultaneous addition of antisolvent with a constant mass flow rate to promote the growth of the internally generated seeds. The amount of initial antisolvent influences the characteristics of the internal seeds generated and the effect of initial amount of antisolvent on the final CSD is investigated. It was found that the introduction of a single cooling/heating cycle significantly improves the reproducibility of final CSD as well as the mean size. Overall, the study indicates that the application of internal seeding with a single cooling/heating cycle for fines dissolution is an effective technique to tailor crystal size distribution.

The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types.

PubMed

Vanaman Wilson, Monique J; Jones, Isabela T; Bolton, Joanna; Larsen, Lisa; Fabi, Sabrina Guillen

2018-04-13

The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery. To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III-V. Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment. Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator-assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted. The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III-V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ.

Rotigotine Objectively Improves Sleep in Parkinson's Disease: An Open-Label Pilot Study with Actigraphic Recording.

PubMed

Calandra-Buonaura, Giovanna; Guaraldi, Pietro; Doria, Andrea; Zanigni, Stefano; Nassetti, Stefania; Favoni, Valentina; Cevoli, Sabina; Provini, Federica; Cortelli, Pietro

2016-01-01

Sleep disturbances represent important predictors of poor quality of life (QoL) in Parkinson's disease (PD). This open-label pilot study aimed to objectively assess, by means of actigraphic recording, effect of rotigotine on sleep in PD patients with self-reported sleep complaints. 15 PD patients underwent one-week actigraphic recording before (T0) and during (T1) rotigotine treatment, which was titrated to the dose subjectively improving motor symptoms (4-8 mg/24 h). Sleep disturbances, daytime sleepiness, cognitive performance, QoL, and depression were also evaluated with questionnaires. Actigraphic recordings showed a significant reduction in nocturnal motor activity and mean duration of wake episodes after sleep onset during rotigotine treatment compared to baseline. In 10 patients presenting objective evidence of poor sleep quality at T0 (sleep efficiency ≤ 85%), rotigotine also significantly improved other sleep parameters and further reduced nocturnal motor activity and mean duration of wake episodes. A significant decrease in number and duration of daytime sleep episodes was also observed at T1. Finally we confirmed that rotigotine significantly improves perceived sleep quality and QoL. Our study showed for the first time that rotigotine is associated with an objective improvement of nocturnal and diurnal sleep disturbances in PD patients with self-reported sleep complaints. This study is registered with AIFA-observational study registry number 12021.

One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits

PubMed Central

Ito, Manabu; Abumi, Kuniyoshi; Kotani, Yoshihisa; Takahata, Masahiko; Hojo, Yoshihiro; Minami, Akio

2010-01-01

The number of reports describing osteoporotic vertebral fracture has increased as the number of elderly people has grown. Anterior decompression and fusion alone for the treatment of vertebral collapse is not easy for patients with comorbid medical problems and severe bone fragility. The purpose of the present study was to evaluate the efficacy of one-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. A consecutive series of 21 patients who sustained osteoporotic vertebral collapse with neurological deficits were managed with posterior decompression and short-segmental pedicle screw instrumentation augmented with ultra-high molecular weight polyethylene (UHMWP) cables with or without vertebroplasty using calcium phosphate cement. The mean follow-up was 42 months. All patients showed neurologic recovery. Segmental kyphotic angle at the instrumented level was significantly improved from an average preoperative kyphosis of 22.8–14.7 at a final follow-up. Spinal canal occupation was significantly reduced from an average before surgery of 40.4–19.1% at the final follow-up. Two patients experienced loosening of pedicle screws and three patients developed subsequent vertebral compression fractures within adjacent segments. However, these patients were effectively treated in a conservative fashion without any additional surgery. Our results indicated that one-stage posterior instrumentation surgery augmented with UHMWP cables could provide significant neurological improvement in the treatment of osteoporotic vertebral collapse. PMID:20157741

One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits.

PubMed

Sudo, Hideki; Ito, Manabu; Abumi, Kuniyoshi; Kotani, Yoshihisa; Takahata, Masahiko; Hojo, Yoshihiro; Minami, Akio

2010-06-01

The number of reports describing osteoporotic vertebral fracture has increased as the number of elderly people has grown. Anterior decompression and fusion alone for the treatment of vertebral collapse is not easy for patients with comorbid medical problems and severe bone fragility. The purpose of the present study was to evaluate the efficacy of one-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. A consecutive series of 21 patients who sustained osteoporotic vertebral collapse with neurological deficits were managed with posterior decompression and short-segmental pedicle screw instrumentation augmented with ultra-high molecular weight polyethylene (UHMWP) cables with or without vertebroplasty using calcium phosphate cement. The mean follow-up was 42 months. All patients showed neurologic recovery. Segmental kyphotic angle at the instrumented level was significantly improved from an average preoperative kyphosis of 22.8-14.7 at a final follow-up. Spinal canal occupation was significantly reduced from an average before surgery of 40.4-19.1% at the final follow-up. Two patients experienced loosening of pedicle screws and three patients developed subsequent vertebral compression fractures within adjacent segments. However, these patients were effectively treated in a conservative fashion without any additional surgery. Our results indicated that one-stage posterior instrumentation surgery augmented with UHMWP cables could provide significant neurological improvement in the treatment of osteoporotic vertebral collapse.

Impact of an in-house emergency radiologist on report turnaround time.

PubMed

Lamb, Leslie; Kashani, Paria; Ryan, John; Hebert, Guy; Sheikh, Adnan; Thornhill, Rebecca; Fasih, Najla

2015-01-01

One of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow. The purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time. Preliminary and final report turnaround times, provided by the radiology resident and staff, respectively, for patients undergoing computed tomography or ultrasonography of their abdomen/pelvis in 2008 (before the implementation of emergency radiology in-house staff service) were compared to those performed during the same time frame in 2009 and 2010 (after staffing protocols were changed). A total of 1,624 reports were reviewed. Overall, there was no statistically significant decrease in the preliminary report turnaround times between 2008 and 2009 (p = 0.1102), 2009 and 2010 (p = 0.6232), or 2008 and 2010 (p = 0.0890), although times consistently decreased from a median of 2.40 hours to 2.08 hours to 2.05 hours (2008 to 2009 to 2010). There was a statistically significant decrease in final report turnaround times between 2008 and 2009 (p < 0.0001), 2009 and 2010 (p < 0.0011), and 2008 and 2010 (p < 0.0001). Median final report times decreased from 5.00 hours to 3.08 hours to 2.75 hours in 2008, 2009, and 2010, respectively. There was also a significant decrease in the time interval between preliminary and final reports between 2008 and 2009 (p < 0.0001) and 2008 and 2010 (p < 0.0001) but no significant change between 2009 and 2010 (p = 0.4144). Our results indicate that the presence of a dedicated ED radiologist significantly reduces final report turnaround time and thus may positively impact the time to ED patient disposition. Patient care is improved when attending radiologists are immediately available to read complex films, both in terms of health care outcomes and regarding the need for repeat testing. Providing emergency physicians with accurate imaging findings as rapidly as possible facilitates effective and timely management and thus optimizes patient care.

Spherical primary optical telescope (SPOT) segments

NASA Astrophysics Data System (ADS)

Hall, Christopher; Hagopian, John; DeMarco, Michael

2012-09-01

The spherical primary optical telescope (SPOT) project is an internal research and development program at NASA Goddard Space Flight Center. The goals of the program are to develop a robust and cost effective way to manufacture spherical mirror segments and demonstrate a new wavefront sensing approach for continuous phasing across the segmented primary. This paper focuses on the fabrication of the mirror segments. Significant cost savings were achieved through the design, since it allowed the mirror segments to be cast rather than machined from a glass blank. Casting was followed by conventional figuring at Goddard Space Flight Center. After polishing, the mirror segments were mounted to their composite assemblies. QED Technologies used magnetorheological finishing (MRF®) for the final figuring. The MRF process polished the mirrors while they were mounted to their composite assemblies. Each assembly included several magnetic invar plugs that extended to within an inch of the face of the mirror. As part of this project, the interaction between the MRF magnetic field and invar plugs was evaluated. By properly selecting the polishing conditions, MRF was able to significantly improve the figure of the mounted segments. The final MRF figuring demonstrates that mirrors, in the mounted configuration, can be polished and tested to specification. There are significant process capability advantes due to polishing and testing the optics in their final, end-use assembled state.

Emotional intelligence and academic performance in first and final year medical students: a cross-sectional study

PubMed Central

2013-01-01

Background Research on emotional intelligence (EI) suggests that it is associated with more pro-social behavior, better academic performance and improved empathy towards patients. In medical education and clinical practice, EI has been related to higher academic achievement and improved doctor-patient relationships. This study examined the effect of EI on academic performance in first- and final-year medical students in Malaysia. Methods This was a cross-sectional study using an objectively-scored measure of EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Academic performance of medical school students was measured using continuous assessment (CA) and final examination (FE) results. The first- and final-year students were invited to participate during their second semester. Students answered a paper-based demographic questionnaire and completed the online MSCEIT on their own. Relationships between the total MSCEIT score to academic performance were examined using multivariate analyses. Results A total of 163 (84 year one and 79 year five) medical students participated (response rate of 66.0%). The gender and ethnic distribution were representative of the student population. The total EI score was a predictor of good overall CA (OR 1.01), a negative predictor of poor result in overall CA (OR 0.97), a predictor of the good overall FE result (OR 1.07) and was significantly related to the final-year FE marks (adjusted R2 = 0.43). Conclusions Medical students who were more emotionally intelligent performed better in both the continuous assessments and the final professional examination. Therefore, it is possible that emotional skill development may enhance medical students’ academic performance. PMID:23537129

Development and Processing Improvement of Aerospace Aluminum Alloys

NASA Technical Reports Server (NTRS)

Lisagor, W. Barry; Bales, Thomas T.

2007-01-01

This final report, in multiple presentation format, describes a comprehensive multi-tasked contract study to improve the overall property response of selected aerospace alloys, explore further a newly-developed and registered alloy, and correlate the processing, metallurgical structure, and subsequent properties achieved with particular emphasis on the crystallographic orientation texture developed. Modifications to plate processing, specifically hot rolling practices, were evaluated for Al-Li alloys 2195 and 2297, for the recently registered Al-Cu-Ag alloy, 2139, and for the Al-Zn-Mg-Cu alloy, 7050. For all of the alloys evaluated, the processing modifications resulted in significant improvements in mechanical properties. Analyses also resulted in an enhanced understanding of the correlation of processing, crystallographic texture, and mechanical properties.

Nanosensors and nanomaterials for monitoring glucose in diabetes.

PubMed

Cash, Kevin J; Clark, Heather A

2010-12-01

Worldwide, diabetes is a rapidly growing problem that is managed at the individual level by monitoring and controlling blood glucose levels to minimize the negative effects of the disease. Because of limitations in diagnostic methods, significant research efforts are focused on developing improved methods to measure glucose. Nanotechnology has impacted these efforts by increasing the surface area of sensors, improving the catalytic properties of electrodes and providing nanoscale sensors. Here, we discuss developments in the past several years on both nanosensors that directly measure glucose and nanomaterials that improve glucose sensor function. Finally, we discuss challenges that must be overcome to apply these developments in the clinic. Copyright © 2010 Elsevier Ltd. All rights reserved.

Adverse Drug Events in Children: How Big is the Problem?

PubMed

Zed, Peter J

2015-01-01

Adverse drug events in children is an under appreciated but significant cause of health care contact resulting in ED visits and hospital admissions with associated resource utilization. In recent years we have started to better understand the impact of ADEs in children but there remains significant questions that must be addressed to further improve our understanding of the etiology of these ADEs and strategies for prevention and management. This paper will describe what is known regarding the frequency, severity, preventability and classification of ADEs in children. It will also describe some of the challenges and unanswered questions regarding patient, drug and system factors, which contribute to ADEs in children. Finally, areas of future research will be identified to further improve our understanding of ADEs in children to inform prevention strategies as well as early recognition and management approaches to minimize the significant ADEs can have on children, families and our health care system.

Open Scenario Study, Phase I. Volume 1. Assessment Overview and Results

DTIC Science & Technology

2008-03-01

review of resources and requirements necessary to implement the response and improving civil military relations. Money Laudering Presents local...or money ? C. PHASE ONE APPROACH To systematically address these kinds of questions, IDA pursued a three-part approach that included reviewing the...their organizations a significant amount of time or money ? B. INTERVIEW QUESTIONS The final sponsor-approved version of the interview questions

Final Technical Report: Advanced Measurement and Analysis of PV Derate Factors.

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

King, Bruce Hardison; Burton, Patrick D.; Hansen, Clifford

2015-12-01

The Advanced Measurement and Analysis of PV Derate Factors project focuses on improving the accuracy and reducing the uncertainty of PV performance model predictions by addressing a common element of all PV performance models referred to as “derates”. Widespread use of “rules of thumb”, combined with significant uncertainty regarding appropriate values for these factors contribute to uncertainty in projected energy production.

Next Generation Solar Collectors for CSP

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

Molnar, Attila; Charles, Ruth

The intent of “Next Generation Solar Collectors for CSP” program was to develop key technology elements for collectors in Phase 1 (Budget Period 1), design these elements in Phase 2 (Budget Period 2) and to deploy and test the final collector in Phase 3 (Budget Period 3). 3M and DOE mutually agreed to terminate the program at the end of Budget Period 1, primarily due to timeline issues. However, significant advancements were achieved in developing a next generation reflective material and panel that has the potential to significantly improve the efficiency of CSP systems.

Cat-scratch disease: ocular manifestations and treatment outcome.

PubMed

Habot-Wilner, Zohar; Trivizki, Omer; Goldstein, Michaella; Kesler, Anat; Shulman, Shiri; Horowitz, Josepha; Amer, Radgonde; David, Ran; Ben-Arie-Weintrob, Yael; Bakshi, Erez; Almog, Yehoshua; Sartani, Gil; Vishnevskia-Dai, Vicktoria; Kramer, Michal; Bar, Asaf; Kehat, Rinat; Ephros, Moshe; Giladi, Michael

2018-03-05

To characterize cat-scratch disease (CSD) ocular manifestations and visual outcome and evaluate the effect of systemic antibiotics and corticosteroids on final visual acuity (VA). Multicentre retrospective cohort study. Medical records of 86 patients with ocular disease (107 eyes) of 3222 patients identified in a national CSD surveillance study were reviewed. Mean age was 35.1 ± 14.2 years. Median follow-up was 20 weeks (range 1-806 weeks). Of 94/107 (88%) eyes with swollen disc, 60 (64%) had neuroretinitis at presentation, 14 (15%) developed neuroretinitis during follow-up, and 20 (21%) were diagnosed with inflammatory disc oedema. Optic nerve head lesion, uveitis, optic neuropathy and retinal vessel occlusion were found in 43 (40%), 38 (36%), 34 (33%) and 8 (7%) eyes, respectively. Good VA (better than 20/40), moderate vision loss (20/40-20/200) and severe vision loss (worse than 20/200) were found in 26/79 (33%), 35/79 (44%) and 18/79 (23%) eyes at baseline and in 63/79 (80%), 11/79 (14%) and 5/79 (6%) eyes at final follow-up, respectively (p < 0.001). Significant VA improvement (defined as improvement of ≥3 Snellen lines at final follow-up compared to baseline) occurred in 12/24 (50%) eyes treated with antibiotics compared with 14/16 (88%) eyes treated with antibiotics and corticosteroids (p = 0.02). Multivariate logistic regression was suggestive of the same association (odds ratio 7.0; 95% CI 1.3-37.7; p = 0.024). Optic nerve head lesion is a common and unique manifestation of ocular CSD. Most patients improved and had final good VA. Combined antibiotics and corticosteroid treatment was associated with a better visual outcome. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Initial Outcomes from a Multicenter Study Utilizing the Indego Powered Exoskeleton in Spinal Cord Injury.

PubMed

Tefertiller, Candy; Hays, Kaitlin; Jones, Janell; Jayaraman, Arun; Hartigan, Clare; Bushnik, Tamara; Forrest, Gail F

2018-01-01

Objective: To assess safety and mobility outcomes utilizing the Indego powered exoskeleton in indoor and outdoor walking conditions with individuals previously diagnosed with a spinal cord injury (SCI). Methods: We conducted a multicenter prospective observational cohort study in outpatient clinics associated with 5 rehabilitation hospitals. A convenience sample of nonambulatory individuals with SCI ( N = 32) completed an 8-week training protocol consisting of walking training 3 times per week utilizing the Indego powered exoskeleton in indoor and outdoor conditions. Participants were also trained in donning/doffing the exoskeleton during each session. Safety measures such as adverse events (AEs) were monitored and reported. Time and independence with donning/doffing the exoskeleton as well as walking outcomes to include the 10-meter walk test (10MWT), 6-minute walk test (6MWT), Timed Up & Go test (TUG), and 600-meter walk test were evaluated from midpoint to final evaluations. Results: All 32 participants completed the training protocol with limited device-related AEs, which resulted in no interruption in training. The majority of participants in this trial were able to don and doff the Indego independently. Final walking speed ranged from 0.19 to 0.55 m/s. Final average indoor and outdoor walking speeds among all participants were 0.37 m/s ( SD = 0.08, 0.09, respectively), after 8 weeks of training. Significant ( p < .05) improvements were noted between midpoint and final gait speeds in both indoor and outdoor conditions. Average walking endurance also improved among participants after training. Conclusion: The Indego was shown to be safe for providing upright mobility to 32 individuals with SCIs who were nonambulatory. Improvements in speed and independence were noted with walking in indoor and outdoor conditions as well as with donning/doffing the exoskeleton.

Participation in asynchronous online discussion forums does improve student learning of gross anatomy.

PubMed

Green, Rodney A; Farchione, Davide; Hughes, Diane L; Chan, Siew-Pang

2014-01-01

Asynchronous online discussion forums are common in blended learning models and are popular with students. A previous report has suggested that participation in these forums may assist student learning in a gross anatomy subject but it was unclear as to whether more academically able students post more often or whether participation led to improved learning outcomes. This study used a path model to analyze the contribution of forum participation, previous academic ability, and student campus of enrolment to final marks in a multicampus gross anatomy course for physiotherapy students. The course has a substantial online learning management system (LMS) that incorporates asynchronous forums as a learning tool, particularly to answer learning objectives. Students were encouraged to post new threads and answer queries in threads started by others. The forums were moderated weekly by staff. Discussion forums were the most used feature of the LMS site with 31,920 hits. Forty-eight percent of the students posted at least once with 186 threads initiated by students and a total of 608 posts. The total number of posts made a significant direct contribution to final mark (P = 0.008) as did previous academic ability (P = 0.002). Although campus did not contribute to final mark, there was a trend for students at the campus where the course coordinator was situated to post more often than those at the other campus (P = 0.073). These results indicate that asynchronous online discussion forums can be an effective tool for improving student learning outcomes as evidenced by final marks in gross anatomy teaching. Copyright © 2013 American Association of Anatomists.

Voluntary wheel running improves recovery from a moderate spinal cord injury.

PubMed

Engesser-Cesar, Christie; Anderson, Aileen J; Basso, D Michele; Edgerton, V R; Cotman, Carl W

2005-01-01

Recently, locomotor training has been shown to improve overground locomotion in patients with spinal cord injury (SCI). This has triggered renewed interest in the role of exercise in rehabilitation after SCI. However, there are no mouse models for voluntary exercise and recovery of function following SCI. Here, we report voluntary wheel running improves recovery from a SCI in mice. C57Bl/10 female mice received a 60-kdyne T9 contusion injury with an IH impactor after 3 weeks of voluntary wheel running or 3 weeks of standard single housing conditions. Following a 7-day recovery period, running mice were returned to their running wheels. Weekly open-field behavior measured locomotor recovery using the Basso, Beattie and Bresnahan (BBB) locomotor rating scale and the Basso Mouse Scale (BMS) locomotor rating scale, a scale recently developed specifically for mice. Initial experiments using standard rung wheels show that wheel running impaired recovery, but subsequent experiments using a modified flat-surface wheel show improved recovery with exercise. By 14 days post SCI, the modified flat-surface running group had significantly higher BBB and BMS scores than the sedentary group. A repeated measures ANOVA shows locomotor recovery of modified flat-surface running mice was significantly improved compared to sedentary animals (p < 0.05). Locomotor assessment using a ladder beam task also shows a significant improvement in the modified flat-surface runners (p < 0.05). Finally, fibronectin staining shows no significant difference in lesion size between the two groups. These data represent the first mouse model showing voluntary exercise improves recovery after SCI.

Anodal transcranial direct current stimulation of the left dorsolateral prefrontal cortex enhances emotion recognition in depressed patients and controls.

PubMed

Brennan, Sean; McLoughlin, Declan M; O'Connell, Redmond; Bogue, John; O'Connor, Stephanie; McHugh, Caroline; Glennon, Mark

2017-05-01

Transcranial direct current stimulation (tDCS) can enhance a range of neuropsychological functions but its efficacy in addressing clinically significant emotion recognition deficits associated with depression is largely untested. A randomized crossover placebo controlled study was used to investigate the effects of tDCS over the left dorsolateral prefrontal cortex (L-DLPFC) on a range of neuropsychological variables associated with depression as well as neural activity in the associated brain region. A series of computerized tests was administered to clinical (n = 17) and control groups (n = 20) during sham and anodal (1.5 mA) stimulation. Anodal tDCS led to a significant main effect for overall emotion recognition (p = .02), with a significant improvement in the control group (p = .04). Recognition of disgust was significantly greater in the clinical group (p = .01). Recognition of anger was significantly improved for the clinical group (p = .04) during anodal stimulation. Differences between groups for each of the six emotions at varying levels of expression found that at 40% during anodal stimulation, happy recognition significantly improved for the clinical group (p = .01). Anger recognition at 80% during anodal stimulation significantly improved for the clinical group (p = .02). These improvements were observed in the absence of any change in psychomotor speed or trail making ability during anodal stimulation. Working memory significantly improved during anodal stimulation for the clinical group but not for controls (p = .03). The tentative findings of this study indicate that tDCS can have a neuromodulatory effect on a range of neuropsychological variables. However, it is clear that there was a wide variation in responses to tDCS and that individual difference and different approaches to testing and stimulation have a significant impact on final outcomes. Nonetheless, tDCS remains a promising tool for future neuropsychological research.

Factors associated with the improvement of vocal fold movement: an analysis of LEMG and laryngeal CT parameters.

PubMed

Mengsteab, Paulos Y; Kwon, Jeong-Yi; Han, Tai Ryoon; Kwon, Tack Kyun; Kim, Deok-Ho; Kim, Sang Jun

2015-02-01

The aim of this study is to elucidate the relationship of laryngeal electromyography (LEMG) and computed tomographic (CT) parameters to improve the prognosis of recurrent laryngeal nerve injury. 22 patients clinically suspected of having recurrent laryngeal nerve injury were examined with LEMG and CT studies. Bilateral thyroarytenoid (TA) muscles were examined and findings were interpreted by a single blind technique. Laryngeal CT image analysis of the ventricle dilation symmetry determined TA muscle atrophy. Finally, a follow-up laryngoscopic examination determined improvement of vocal fold movement. Ventricle dilation symmetry and the dichotomized TA muscle atrophy parameter significantly relate to the improvement of vocal fold movement (χ(2)=4.029, P=0.039, and χ(2)=3.912, P=0.048, respectively). When the severity of vocal fold impairment was classified as severe TA muscle atrophy or none/discrete MUAP recruitment, it was found to significantly relate with the improvement of vocal fold movement (χ(2)=6.712, P=.010). From this study, image analysis of the ventricle dilation symmetry to determine the severity of TA muscle atrophy shows promise for the improved prognosis of vocal fold immobility. Copyright © 2014 Elsevier Ltd. All rights reserved.

Does cramming work? Impact of National Web-Based Thoracic Surgery Curriculum login frequency on thoracic surgery in-training exam performance.

PubMed

Luc, Jessica G Y; Verrier, Edward D; Allen, Mark S; Aloia, Lauren; Baker, Craig; Fann, James I; Iannettoni, Mark D; Yang, Stephen C; Vaporciyan, Ara A; Antonoff, Mara B

2018-04-18

Web-based curricula provide login data that can be advantageously used to characterize and analyze study habits. We sought to compare thoracic surgical trainee In-Training Examination percentiles with regard to their study habits (ie, cramming), as characterized by curriculum login frequency to the national Web-based Thoracic Surgery Curriculum. Furthermore, we then aimed to characterize the curriculum login frequency of trainees as stratified by their performance on the In-Training Examination and their improvement on the In-Training Examination over subsequent years. We performed a retrospective review of trainees who accessed the curriculum before the 2014 In-Training Examination, with curriculum login data collected from site analytics. Scores were compared between trainees who crammed (≥30% increase in logins in the month before the In-Training Examination) and those who did not. Trainees were stratified on the basis of 2014 In-Training Examination percentile and improvement in percentile from 2013 to 2014 into high, medium, and low scorers and improvers. Of 256 trainees who took the 2014 In-Training Examination, 63 (25%) met criteria as crammers. Crammers increased total study sessions immediately before the In-Training Examination (P < .001), but without impact on 2014 In-Training Examination percentile (P = .995) or year-to-year improvement (P = .234). Stratification by In-Training Examination percentile demonstrated that highest scoring trainees used the curriculum more frequently in the final month than medium-range scorers (P = .039). When stratified by extent of year-to-year improvement, those who improved the most accessed the curriculum significantly more often in the last month compared with baseline (P = .040). Moreover, those with greatest improvement logged in more in the final month than those with least improvement (P = .006). Increasing the frequency of study periods on the national Web-based thoracic surgery curriculum before the In-Training Examination may have a unique benefit to trainees who initially score low to allow them to significantly improve their subsequent year In-Training Examination performance. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

[Application of target restoration space quantity and quantitative relation in precise esthetic prosthodontics].

PubMed

Haiyang, Yu; Tian, Luo

2016-06-01

Target restoration space (TRS) is the most precise space required for designing optimal prosthesis. TRS consists of an internal or external tooth space to confirm the esthetics and function of the final restoration. Therefore, assisted with quantitive analysis transfer, TRS quantitative analysis is a significant improvement for minimum tooth preparation. This article presents TRS quantity-related measurement, analysis, transfer, and internal relevance of three TR. classifications. Results reveal the close bond between precision and minimally invasive treatment. This study can be used to improve the comprehension and execution of precise esthetic prosthodontics.

Improvements in the order, isotropy and electron density of glypican-1 crystals by controlled dehydration.

PubMed

Awad, Wael; Svensson Birkedal, Gabriel; Thunnissen, Marjolein M G M; Mani, Katrin; Logan, Derek T

2013-12-01

The use of controlled dehydration for improvement of protein crystal diffraction quality is increasing in popularity, although there are still relatively few documented examples of success. A study has been carried out to establish whether controlled dehydration could be used to improve the anisotropy of crystals of the core protein of the human proteoglycan glypican-1. Crystals were subjected to controlled dehydration using the HC1 device. The optimal protocol for dehydration was developed by careful investigation of the following parameters: dehydration rate, final relative humidity and total incubation time Tinc. Of these, the most important was shown to be Tinc. After dehydration using the optimal protocol the crystals showed significantly reduced anisotropy and improved electron density, allowing the building of previously disordered parts of the structure.

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients.

PubMed

Ribeiro, Camila Ferrari; Souza, Fernanda Homem de Mello de; Jordão, Juliana Merheb; Haendchen, Letícia Cortes; Mesquita, Lismary; Schmitt, Juliano Vilaverde; Faucz, Luciana Lisboa

2012-01-01

Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. To assess the efficacy of a therapy and its cosmetic results. In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

[Educative strategy evaluation to improve critical reading skills on clinical research texts in second year gyneco-obstetrics residents].

PubMed

Carranza Lira, Sebastián; Arce Herrera, Rosa María; González González, Patricia

2007-11-01

The educative models and strategies to achieve a significant learning have a wide variety. The development of clinical aptitude for clinical research papers lecture has an important place to maintain the physician actualized and for resident formation. To evaluate the degree of development of the aptitude for the reading of clinical research articles in 2nd grade residents of the gynecology and obstetrics speciality alter an educative strategy. In 16 2nd year gynecology and obstetrics residents, a previously validated instrument was applied for the evaluation of critical lecture of clinical research articles in general medicine previous and after and educative strategy. Statistical analysis was with Kruskal-Wallis analysis of variance. Also Wilcoxon test was used to assess the differences between baseline and final results. The median of age was 27 (24-31) years, gender 56.3% women and 43.8% men. A statistically significant increase in global score was observed after the educative strategy. After it only there was a significant increase in the indicator to interpret. After evaluating the domain degrees according to the indicator to interpret, in baseline evaluation it predominated the very low level and at the final evaluation the very low and low levels. In the indicator to judge at baseline the majority were in the very low level, and at the end in very low and low levels. According to the indicator to propose at baseline all were in the level expected by hazard, and at the end a minimal proportion was at very low level. These results traduce a discrete improvement in critical lecture process, which makes to consider the educative strategy that was used, since the objective to improve critical lecture capacity was not achieved.

Prediction of Tissue Outcome and Assessment of Treatment Effect in Acute Ischemic Stroke Using Deep Learning.

PubMed

Nielsen, Anne; Hansen, Mikkel Bo; Tietze, Anna; Mouridsen, Kim

2018-06-01

Treatment options for patients with acute ischemic stroke depend on the volume of salvageable tissue. This volume assessment is currently based on fixed thresholds and single imagine modalities, limiting accuracy. We wish to develop and validate a predictive model capable of automatically identifying and combining acute imaging features to accurately predict final lesion volume. Using acute magnetic resonance imaging, we developed and trained a deep convolutional neural network (CNN deep ) to predict final imaging outcome. A total of 222 patients were included, of which 187 were treated with rtPA (recombinant tissue-type plasminogen activator). The performance of CNN deep was compared with a shallow CNN based on the perfusion-weighted imaging biomarker Tmax (CNN Tmax ), a shallow CNN based on a combination of 9 different biomarkers (CNN shallow ), a generalized linear model, and thresholding of the diffusion-weighted imaging biomarker apparent diffusion coefficient (ADC) at 600×10 -6 mm 2 /s (ADC thres ). To assess whether CNN deep is capable of differentiating outcomes of ±intravenous rtPA, patients not receiving intravenous rtPA were included to train CNN deep, -rtpa to access a treatment effect. The networks' performances were evaluated using visual inspection, area under the receiver operating characteristic curve (AUC), and contrast. CNN deep yields significantly better performance in predicting final outcome (AUC=0.88±0.12) than generalized linear model (AUC=0.78±0.12; P =0.005), CNN Tmax (AUC=0.72±0.14; P <0.003), and ADC thres (AUC=0.66±0.13; P <0.0001) and a substantially better performance than CNN shallow (AUC=0.85±0.11; P =0.063). Measured by contrast, CNN deep improves the predictions significantly, showing superiority to all other methods ( P ≤0.003). CNN deep also seems to be able to differentiate outcomes based on treatment strategy with the volume of final infarct being significantly different ( P =0.048). The considerable prediction improvement accuracy over current state of the art increases the potential for automated decision support in providing recommendations for personalized treatment plans. © 2018 American Heart Association, Inc.

Improvement of quality of life in patients with benign goiter after surgical treatment.

PubMed

Bukvic, Branka R; Zivaljevic, Vladan R; Sipetic, Sandra B; Diklic, Aleksandar D; Tausanovic, Katarina M; Paunovic, Ivan R

2014-08-01

A quality of life (QoL) assessment is considered an important outcome measure in the treatment of benign thyroid diseases. The aims of this study were to analyze the impact of different surgical treatments on QoL in patients with benign thyroid diseases and to evaluate factors correlating with the QoL outcomes. A prospective longitudinal study was conducted. One hundred thirty-two patients met the inclusion/exclusion criteria and completed the disease-specific questionnaire, thyroid patient-reported outcome (ThyPRO), before surgery and after 6 months. Preoperative and postoperative QoL outcomes were compared and correlating factors were analyzed. Indication for surgery was euthyroid goiter, toxic goiter, and suspicious malignant thyroid disease in 58.3, 29.5, and 12.1 % of the patients, respectively. None of the patients had overtly toxic goiter. There were 65.2 % of the patients who underwent total thyroidectomy, while 34.8 % underwent hemithyroidectomy. The total postoperative complication rate was 5.3 %. QoL improved significantly after surgical treatment, independent of the extent of performed surgery. The most affected domain, pre- and postoperative, was for tiredness. QoL improvement was significant for women in all domains, while for men, it was significant in only three domains (goiter symptoms, emotional susceptibility, and cosmetic complaints) and in overall QoL. Younger patients had significantly better cognitive functioning and daily life, while elderly patients had significantly less cosmetic complaints. The factors that significantly correlated with improvement of QoL in different domains were lower education level, duration of disease, and microcarcinoma at final histology. QoL in patients with benign thyroid diseases improves significantly after operative treatment, independent of the extent of the operation.

Final Requirements--School Improvement Grants--Title I of the Elementary and Secondary Education Act of 1965. Final Rule. Federal Register, Part IV, Department of Education, 34 CFR Chapter II

ERIC Educational Resources Information Center

National Archives and Records Administration, 2015

2015-01-01

The Assistant Secretary for Elementary and Secondary Education adopts final requirements for the School Improvement Grants (SIG) program, authorized under section 1003(g) of title I of the Elementary and Secondary Education Act of 1965, as amended (ESEA). These final requirements make changes to the current SIG program requirements and implement…

From dV-Trainer to Real Robotic Console: The Limitations of Robotic Skill Training.

PubMed

Yang, Kun; Zhen, Hang; Hubert, Nicolas; Perez, Manuela; Wang, Xing Huan; Hubert, Jacques

To investigate operators' performance quality, mental stress, and ergonomic habits through a training curriculum on robotic simulators. Forty volunteers without robotic surgery experience were recruited to practice 2 exercises on a dV-Trainer (dVT) for 14 hours. The simulator software (M-score a ) provided an automatic evaluation of the overall score for the surgeons' performance. Each participant provided a subjective difficulty score (validity to be proven) for each exercise. Their ergonomic habits were evaluated based on the workspace range and armrest load-validated criteria for evaluating the proficiency of using the armrest. They then repeated the same tasks on a da Vinci Surgical Skill Simulator for a final-level test. Their final scores were compared with their initial scores and the scores of 5 experts on the da Vinci Surgical Skill Simulator. A total of 14 hours of training on the dVT significantly improved the surgeons' performance scores to the expert level with a significantly reduced workload, but their ergonomic score was still far from the expert level. Sufficient training on the dVT improves novices' performance, reduces psychological stress, and inculcates better ergonomic habits. Among the evaluated criteria, novices had the most difficulty in achieving expert levels of ergonomic skills. The training benefits of robotic surgery simulators should be determined with quantified variables. The detection of the limitations during robotic training curricula could guide the targeted training and improve the training effect. Copyright © 2017. Published by Elsevier Inc.

Evaluating the short-term effects of a communication skills program for preclinical medical students.

PubMed

Lee, Young-Mee; Lee, Young Hee

2014-09-01

Regardless of the growing importance of communication skills as a core clinical competence, few studies have determined the effects of communication skills courses in undergraduate medical curricula in Asian medical schools. The purpose of this study was to examine the effectiveness of a communication skills program for preclinical medical students. A communication skills course was provided to 111 second-year medical students in a medical college in Korea. Students' self-assessed competency of communication skills was evaluated by a questionnaire survey. To examine the improvement in observed communication skills, the students' encounters with standardized patients (SPs) were assessed at the first session and at the final course assessment. A structured checklist, consisting of 25 communication skills items, was used for the assessment. Students' self-assessed competency of communication skills increased significantly after completion of the course (p<0.001). The observed communication skills scores also improved significantly at the end of the course; the mean scores of the first SPs encounters was 49.6 (standard deviation [SD], 11.1), and those of cases A and B at the final assessment were 61.5 (SD, 8.4) and 69.6 (SD, 7.8), respectively (F₆₁=269.54, p<0.001). Even a short period of medical communication skills course was beneficial in developing and improving communication skills competency in preclinical medical students. Further studies should be followed to examine whether the acquisition of communication skills during preclinical studies can be sustained into clerkship and actual practice.

Mixed-method tutoring support improves learning outcomes of veterinary students in basic subjects.

PubMed

García-Iglesias, María J; Pérez-Martínez, Claudia; Gutiérrez-Martín, César B; Díez-Laiz, Raquel; Sahagún-Prieto, Ana M

2018-02-01

Tutoring is a useful tool in the university teaching-learning binomial, although its development is impaired in large classes. Recent improvements in information and communication technologies have made tutoring possible via the Internet. The aim of this study was to evaluate the efficacy of mixed-method academic tutoring in two basic subjects in Veterinary Science studies at the University of León (Spain) to optimize the usefulness of tutoring support in the college environment. This quasi-experimental study was firstly carried out as a pilot study in a small group of tutored students of "Cytology and Histology" (CH) (47/186; 25.3%) and "Veterinary Pharmacology" (VP) (33/141; 23.4%) subjects, and was implemented in a large class of CH the next academic year (150 students) while comparing the results with those obtained in a previous tutorless course (162 students). Tutored students were given access to online questionnaires with electronic feedback on each subject. In addition to traditional tutoring carried out in both tutored and tutorless students, the pilot study included three sessions of face-to-face tutoring in order to monitor the progress of students. Its efficacy was assessed by monitoring students' examination scores and attendance as well as a satisfaction survey. Although the examination attendance rate in the pilot study was not significantly different between tutored and tutorless groups in both subjects, an increase for numerical scores in tutored groups was observed, with a significant higher final score in VP (p = 0.001) and in the CH practice exams (first term, p = 0.009; final, p = 0.023). Good and merit scores were also better in tutored students with significant differences in VP (p = 0.005). Students felt comfortable with the tutoring service (100% in CH; 91.7% in VP). Implementation of this additional support in CH also resulted in a significant increase of attendance at the final exam in tutored courses (87.3% versus 77.2%; p = 0.026), scaled (p = 0.001) and numerical scores (final score, p = 0.001). Online tutoring support, together with conventional teaching methods, may be a useful method to incorporate student-centered learning in basic subjects in Veterinary Science.

Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations.

PubMed

Orozco-Beltran, D; Pan, C; Svendsen, A L; Faerch, L; Caputo, S

2016-03-01

To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters. Study of Once-Daily Levemir (SOLVE(™) ) is an international, 24-week, observational study of insulin initiation in people with type 2 diabetes. A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) -1.2 ± 1.4% (-13.1 ± 15.3 mmol/mol) and -1.3 ± 1.6% (-14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [-0.04%, 95% confidence interval (CI) -0.09 to -0.01 (-0.4 mmol/mol, 95% CI -1.0-0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06-0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64-0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001). Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation. © 2016 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Shoulder and Elbow Recovery at 2 and 11 Years Following Brachial Plexus Reconstruction.

PubMed

Wang, Jung-Pan; Rancy, Schneider K; Lee, Steve K; Feinberg, Joseph H; Wolfe, Scott W

2016-02-01

To report short-term and long-term outcomes on a single patient cohort observed longitudinally after nerve reconstruction for adult brachial plexus injury. Eleven male patients who underwent plexus reconstruction by the same surgeon at 2 institutions presented for clinical examination 7.5 or more years after surgery (average, 11.4 years; range, 7.5-22 years). Average age at the time of operation was 35 years (range, 17-73 years). Mean delay until surgery was 5 months (range, 2-11 months). Two patients had C5 paralysis, 2 had C5-C6 paralysis, 2 had C5-C7 paralysis, and 5 had complete 5-level injuries. Outcome parameters included active range of motion (ROM) in degrees, a modified British Medical Research Council (mBMRC) scale for muscle strength, and electromyographic motor unit configuration and recruitment pattern. Differences in ROM and mBMRC between 2-year and long-term follow-up were assessed with paired-sample t tests using an alpha value of .05. Average shoulder abduction and mBMRC at final follow-up were both significantly improved compared with the 2-year follow-up results (P < .05). Average elbow flexion and mBMRC increased significantly between 2 years and final follow-up (P < .05). Electromyographic results for 6 patients at final follow-up showed improved motor unit configuration in 10 of 15 muscles and improved recruitment in 3 of 15 muscles compared with 2-year electromyographic results. Patients continued to gain ROM and strength in the shoulder and elbow well after 2 to 3 years after surgery, contrary to previous reports. Although the precise mechanism is unknown, we speculate that a number of factors may be involved, including terminal collateral sprouting, maturation of motor units, improvements in motor unit recruitment, additional muscle fiber hypertrophy, or an as-yet undescribed mechanism. We recommend that patients be encouraged to continue strengthening exercises well after the initial recovery period and that more comparative long-term data be collected to expand on these observations. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Career choices of today's medical students: where does surgery rank?

PubMed

Boyle, E; Healy, D; Hill, A D K; O'Connell, P R; Kerin, M; McHugh, S; Coyle, P; Kelly, J; Walsh, S R; Coffey, J C

2013-09-01

The national junior doctor recruitment crisis prompts an appraisal of medical student attitudes to different career pathways. The purpose of this study was to perform a national review of surgical career intentions of Irish final year medical students. Ethical and institutional approval was obtained at each study location. A questionnaire was designed and distributed to final year students. Domains assessed included demographics, career plans and reasons associated. Anonymised responses were collated and evaluated. Categorical data were compared with Fisher's exact test. Responses were obtained from 342 students in four medical schools of whom 78.6% were undergraduates. Over half (53%) were Irish, with Malaysia, Canada and the USA the next most common countries of origin. Only 18% of students intended to pursue surgery, with 60% stating they did not plan to, and 22% undecided. Of those who plan not to pursue surgery, 28% were unsure about a speciality but the most common choices were medicine (39%), general practice (16%) and paediatrics (8%). Reasons for not picking a career in surgery included long hours and the unstructured career path. Suggestions to improve uptake included earlier and more practical exposure to surgery, improved teaching/training and reduction in working hours. In this study 18% of final year medical students identified surgery as their chosen career pathway. Although lifestyle factors are significant in many students' decision, perceived quality and duration of surgical training were also relevant and are modifiable factors which, if improved could increase interest in surgery as a career.

An integrated fuzzy approach for strategic alliance partner selection in third-party logistics.

PubMed

Erkayman, Burak; Gundogar, Emin; Yilmaz, Aysegul

2012-01-01

Outsourcing some of the logistic activities is a useful strategy for companies in recent years. This makes it possible for firms to concentrate on their main issues and processes and presents facility to improve logistics performance, to reduce costs, and to improve quality. Therefore provider selection and evaluation in third-party logistics become important activities for companies. Making a strategic decision like this is significantly hard and crucial. In this study we proposed a fuzzy multicriteria decision making (MCDM) approach to effectively select the most appropriate provider. First we identify the provider selection criteria and build the hierarchical structure of decision model. After building the hierarchical structure we determined the selection criteria weights by using fuzzy analytical hierarchy process (AHP) technique. Then we applied fuzzy technique for order preference by similarity to ideal solution (TOPSIS) to obtain final rankings for providers. And finally an illustrative example is also given to demonstrate the effectiveness of the proposed model.

An Integrated Fuzzy Approach for Strategic Alliance Partner Selection in Third-Party Logistics

PubMed Central

Gundogar, Emin; Yılmaz, Aysegul

2012-01-01

Outsourcing some of the logistic activities is a useful strategy for companies in recent years. This makes it possible for firms to concentrate on their main issues and processes and presents facility to improve logistics performance, to reduce costs, and to improve quality. Therefore provider selection and evaluation in third-party logistics become important activities for companies. Making a strategic decision like this is significantly hard and crucial. In this study we proposed a fuzzy multicriteria decision making (MCDM) approach to effectively select the most appropriate provider. First we identify the provider selection criteria and build the hierarchical structure of decision model. After building the hierarchical structure we determined the selection criteria weights by using fuzzy analytical hierarchy process (AHP) technique. Then we applied fuzzy technique for order preference by similarity to ideal solution (TOPSIS) to obtain final rankings for providers. And finally an illustrative example is also given to demonstrate the effectiveness of the proposed model. PMID:23365520

A Fractional Bipolar Radiofrequency Device Combined with a Bipolar Radiofrequency and Infrared Light Treatment for Improvement in Facial Wrinkles and Overall Skin Tone and Texture.

PubMed

Gold, Alan H; Pozner, Jason; Weiss, Robert

2016-10-01

A variety of techniques and energy-based technologies are currently utilized for the treatment of facial wrinkles. Fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light have both been reported to be safe and effective for the non-invasive treatment of wrinkles and overall facial rejuvenation. A multicenter, prospective clinical trial evaluated a protocol of treatment with a device incorporating bipolar radiofrequency and infrared light followed by treatment with a fractional bipolar radiofrequency device for facial wrinkle reduction and improvement in the overall appearance of aged facial skin. Fifty-six patients with mild to moderate facial wrinkles received three full-face treatments (forehead, nose, cheeks, periorbital, and perioral areas) at 4 to 6 week intervals and were evaluated at 12 and 24 weeks after the last treatment. Clinical photographs at baseline and follow-ups were assessed by both the investigators and patients using the Global Aesthetic Improvement scale. Treatment safety was evaluated. Study participants also completed a satisfaction and improvement questionnaire. Fitzpatrick Wrinkling and Elastosis Score was decreased significantly at three months (P < .01; paired t test) and at six months (P < .001; paired t test) after the final treatment. Investigators' assessments of overall improvement in facial appearance, demonstrated 88% improvement at 12 weeks and 82% at 24 weeks after the final treatment. Subject evaluations were similar, consistently reporting improvement in wrinkles and overall facial skin appearance throughout the study, and high a degree of satisfaction with their final results. Subjects tolerated the procedures well, with only transient mild to moderate erythema and edema occurring in most patients, and without complications. A combined protocol of bipolar radiofrequency and infrared light treatment followed by fractionated bipolar radiofrequency treatment results in safe, well tolerated, and effective improvement in overall skin tone and texture and reduction of facial wrinkles. 4 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

An 8-year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration.

PubMed

Berg, Karina; Roald, Anca B; Navaratnam, Jesintha; Bragadóttir, Ragnheiður

2017-12-01

To investigate long-term visual results of treatment with anti-vascular endothelial growth factor (VEGF) agents for neovascular age-related macular degeneration (nAMD) following a treat-and-extend regimen. Retrospective review of 155 patients who initiated treatment with bevacizumab for nAMD in one eye. At the final 8-year visit, 40 patients (26%) remained for follow-up. Mean change in best-corrected visual acuity (BCVA) was calculated compared to baseline values. Mean BCVA improved significantly from baseline during the first year of treatment, with -0.11 logMAR units equivalent to 6.1 approximate Early Treatment Diabetic Retinopathy Study (approxETDRS) letters (p = <0.001). Mean BCVA was still significantly improved after 4 years of treatment for the entire group of patients and after 6 years of treatment for the subgroup of 40 patients who remained at the final 8-year visit. Thereafter, BCVA gradually declined and at 8 years, there was a mean change of 0.05 logMAR units equivalent to 2.1 approxETDRS letters below baseline (p = 0.530). Mean number of injections during the first year was 6.1 ± 2.8 and during year 8 was 5.4 ± 3.5. At 5 years, fundus autofluorescence showed some degree of macular atrophy in all eyes. At the final 8-year visit, 87.5% of the eyes had stable neovascular lesions with no fluid on optical coherence tomography (OCT). In an everyday clinical setting, treatment of nAMD patients with a treat-and-extend modality provided improvement and stability of vision for several years. After 8 years of follow-up, there was a decline in visual acuity (VA) that could be explained by macular atrophic development. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Repeated recall as an intervention to improve memory performance in heart failure patients.

PubMed

Viveiros, Jennifer; Sethares, Kristen; Shapiro, Amy

2017-12-01

Up to 50% of heart failure patients demonstrate aspects of cognitive impairment, including memory deficit. Novel interventions are needed to address memory deficit among heart failure patients. The goal of this study was to evaluate the testing effect as an intervention to improve memory performance in heart failure patients. This was a randomized controlled clinical trial ( N=84) comparing the memory performance of heart failure patients with and without mild cognitive impairment after a repeated testing intervention. Memory performance was measured by verbal word pair associates recall scores, between attention control and experimental subjects. Patients had a mean age of 71.7 ± 13.3 years and similar baseline memory (immediate p=.79 and delayed p=.47). Overall, there were no significant differences in memory between experimental and control subjects, respectively (67.2±18.87 vs. 61.9±22.3, verbal word pair associates, t = -1.179, p=.24). In the final hierarchical regression model, age ( p=.018) and education ( p=.006) were significant predictors of memory performance, with the intervention approaching significance ( p=.079). Although not statistically significant, the intervention group reported better memory. Age and education continue to be significant contributors to memory performance in the heart failure population. Continued development of interventions to improve memory performance in heart failure patients is indicated.

Low-FODMAP formula improves diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multicenter, double-blind clinical trial.

PubMed

Yoon, So Ra; Lee, Jong Hwa; Lee, Jae Hyang; Na, Ga Yoon; Lee, Kyun-Hee; Lee, Yoon-Bok; Jung, Gu-Hun; Kim, Oh Yoen

2015-11-03

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates that play an important role in inducing functional gut symptoms. A low-FODMAP diet improves abdominal symptoms in patients with inflammatory bowel disease and irritable bowel syndrome. However, there were no study for the effect of FODMAP content on gastrointestinal intolerance and nutritional status in patients receiving enteral nutrition (EN). In this randomized, multicenter, double-blind, 14-day clinical trial, eligible hospitalized patients receiving EN (n = 100) were randomly assigned to three groups; 84 patients completed the trial (low-FODMAP EN, n = 30; moderate-FODMAP EN, n = 28; high-FODMAP EN, n = 26). Anthropometric and biochemical parameters were measured; stool assessment was performed using the King's Stool Chart and clinical definition. Baseline values were not significantly different among the three groups. After the 14-day intervention, diarrhea significantly improved in the low-FODMAP group than in the moderate- and high-FODMAP groups (P < 0.05). King's Stool scores in diarrhea subjects were significantly and steadily reduced in the low-FODMAP group compared with the other two groups (P for time and EN type interaction <0.05). BMI increased significantly in the low- and high-FODMAP groups during the intervention (P < 0.05 for both), and showed a trend toward increasing in the moderate-FODMAP group (P < 0.10). Serum prealbumin increased significantly in all groups by 14-day; by 3-day, it had increased to the levels at 14-day in the low-FODMAP group. At 14-day, serum transferrin had increased significantly in the moderate-FODMAP group. In addition, subjects were classified by final condition (unimproved, normal maintenance, diarrhea only improved, constipation only improved, and recurrent diarrhea/constipation improved). Seventy-five percent of the diarrhea improved group consumed the low-FODMAP EN formula. 38.5 and 46.2% of recurrent diarrhea/constipation improved group consumed the low- and moderate-FODMAP EN respectively. BMI significantly increased in all groups except the unimproved. Prealbumin levels significantly increased in the diarrhea-improved and recurrent diarrhea/constipation groups at 3-day and continued by 14-day, and in the constipation-improved group at 14-day. Transferrin levels significantly increased in the diarrhea-improved and recurrent diarrhea/constipation groups at 14-day. Low-FODMAP EN may improve diarrhea, leading to improved nutritional status and facilitating prompt recovery from illness.

A Randomized Controlled Trial to Assess the Effects of Competition on the Development of Laparoscopic Surgical Skills

PubMed Central

Hashimoto, Daniel A.; Gomez, Ernest D.; Beyer-Berjot, Laura; Khajuria, Ankur; Williams, Noel N.; Darzi, Ara; Aggarwal, Rajesh

2015-01-01

Background Serious games have demonstrated efficacy in improving participation in surgical training activities, but studies have not yet demonstrated the effect of serious gaming on performance. This study investigated whether competitive training affects laparoscopic surgical performance. Methods Twenty novices were recruited, and 18 (2 drop-outs) were randomized into control or competitive (CT) groups to perform 10 virtual reality (VR) laparoscopic cholecystectomies (LC). Competitiveness of each participant was assessed. The CT group was informed they were competing to outperform one another for a prize; performance ranking was shown prior to each session. The control group did not compete. Performance was assessed on time, movements, and instrument path length. Quality of performance was assessed with a global rating score (GRS). Results There were no significant intergroup differences in baseline skill or measured competitiveness. Time and GRS, at final LC, were not significantly different between groups; however, the CT group was significantly more dexterous than control and had significantly lower variance in number of movements and instrument path length at the final LC (p=0.019). Contentiousness was inversely related to time in the CT group. Conclusion This was the first randomized controlled trial to investigate if competitive training can enhance performance in laparoscopic surgery. Competitive training may lead to improved dexterity in laparoscopic surgery but yields otherwise similar performance to standard training in novices. Competition may have different effects on novices versus experienced surgeons, and subsequent research should investigate competitive training in experienced surgeons as well. PMID:26169566

A Randomized Controlled Trial to Assess the Effects of Competition on the Development of Laparoscopic Surgical Skills.

PubMed

Hashimoto, Daniel A; Gomez, Ernest D; Beyer-Berjot, Laura; Khajuria, Ankur; Williams, Noel N; Darzi, Ara; Aggarwal, Rajesh

2015-01-01

Serious games have demonstrated efficacy in improving participation in surgical training activities, but studies have not yet demonstrated the effect of serious gaming on performance. This study investigated whether competitive training (CT) affects laparoscopic surgical performance. A total of 20 novices were recruited, and 18 (2 dropouts) were randomized into control or CT groups to perform 10 virtual reality laparoscopic cholecystectomies (LCs). Competitiveness of each participant was assessed. The CT group members were informed they were competing to outperform one another for a prize; performance ranking was shown before each session. The control group did not compete. Performance was assessed on time, movements, and instrument path length. Quality of performance was assessed with a global rating scale score. There were no significant intergroup differences in baseline skill or measured competitiveness. Time and global rating scale score, at final LC, were not significantly different between groups; however, the CT group was significantly more dexterous than control and had significantly lower variance in number of movements and instrument path length at the final LC (p = 0.019). Contentiousness was inversely related to time in the CT group. This was the first randomized controlled trial to investigate if CT can enhance performance in laparoscopic surgery. CT may lead to improved dexterity in laparoscopic surgery but yields otherwise similar performance to that of standard training in novices. Competition may have different effects on novices vs experienced surgeons, and subsequent research should investigate CT in experienced surgeons as well. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Weight management practices and their relationship to knowledge, perception and health status of Saudi females attending diet clinics in Riyadh city.

PubMed

Albassam, Reem Suliman; Abdel Gawwad, Ensaf S; Khanam, Latifa

2007-01-01

The objective of the study was to identify weight management (WM) practices among women attending diet clinics in Riyadh city, assess their impact on knowledge, perceptions, nutritional and health status and define some predictors for weight reduction among these women. The pretest-posttest research design was used. All female clients attending 8 diet clinics for the first visit within 8 months period and fulfilling the study inclusion criteria (212 out of 263) were included. The results show that out of 170 females who had previously tried to lose weight, only 32.4% reported success in reducing weight, meanwhile 61.7% reported weight regain. The mean total score of dietary practices, physical activity score, self efficacy and satisfaction of self-body image were improved significantly at posttest. Analysis of 24 h. dietary recall revealed that total energy and nutrients intake were significantly reduced at posttest. Dieting related problems increased significantly at posttest. Nutritional knowledge was at moderately fair level at both pretest and posttest; however it showed a significant improvement in the posttest. Perceived severity, perceived barriers and negative modeling effect were significantly decreased at the posttest. Over expectation for weight reduction was clearly evident as posttest body mass index (BMI) revealed a wide discrepancy between the expected and final weights. However, as compared to initial and final BMI, there was an increase in women who attained normal weight and a decrease in the percentage of obese and morbid obese women. All anthropometric indices, blood pressure, biochemical investigation showed significant improvement at posttest. Among the five WM modalities studied, moderate hypo-calorie plan diet modality was the longest (chi = 5.6 month) with the least weight loss (7.8%) and the minimum side effects. Both groups under very low calorie diet and protein diet had the highest weight reduction (13.2% &12.3%), at the same time both diets exhibited the highest number of side effects. The study recommends use of the primary approach for achieving weight loss through therapeutic life style change with banning those modalities accompanied with serious health complications.

Iran: Politics, Gulf Security, and U.S. Policy

DTIC Science & Technology

2016-03-30

to produce the added benefit of improving U.S.-Iran relations. However, since the deal was finalized, Iran, Iran has tested ballistic missiles and...political and social freedoms and reducing Iran’s international isolation, continues to back state intervention in the economy to benefit workers and lower...is able to generate profits from its business affiliates, which enjoy vast tax and regulatory benefits , and can spend significant amounts of

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

Chambers, Mark S.; Posner, Marshall; Jones, Christopher Uwe

Purpose: To study the efficacy and safety of cevimeline in two double-blind trials (Studies 003 and 004) enrolling patients with head and neck cancer in whom xerostomia developed after radiotherapy. Methods and Materials: Subjects were randomly assigned to receive cevimeline, 30 mg three times daily, or placebo for 12 weeks, with the possibility of dose escalation to 45 mg three times daily at 6 weeks. The primary efficacy endpoint was the patient's final global evaluation of oral dryness; change in unstimulated salivary flow was a secondary endpoint. Results: Five hundred seventy subjects (284 in Study 003 and 286 in Studymore » 004) were randomized. Significantly more cevimeline-treated subjects than placebo recipients (47.4% vs. 33.3%, p = 0.0162) in Study 003 reported improvement in dry mouth in the final global evaluation of oral dryness. No significant difference between groups in the final global evaluation was seen in Study 004, in which a high placebo response rate of 47.6% was observed. In both studies, cevimeline-treated subjects had significantly greater increases in the objective measure of unstimulated salivary flow than placebo recipients (p 0.0093 [Study 003] and p = 0.0215 [Study 004]), whereas no significant differences in stimulated salivary flow were observed. The most frequent adverse event was increased sweating. Conclusion: Cevimeline was well tolerated by patients with xerostomia after radiotherapy for head and neck cancer, and oral administration of 30-45 mg of cevimeline three times daily increased unstimulated salivary flow.« less

Cevimeline for the treatment of postirradiation xerostomia in patients with head and neck cancer.

PubMed

Chambers, Mark S; Posner, Marshall; Jones, Christopher Uwe; Biel, Merrill A; Hodge, Kenneth M; Vitti, Robert; Armstrong, Ingrid; Yen, Cindy; Weber, Randal S

2007-07-15

To study the efficacy and safety of cevimeline in two double-blind trials (Studies 003 and 004) enrolling patients with head and neck cancer in whom xerostomia developed after radiotherapy. Subjects were randomly assigned to receive cevimeline, 30 mg three times daily, or placebo for 12 weeks, with the possibility of dose escalation to 45 mg three times daily at 6 weeks. The primary efficacy endpoint was the patient's final global evaluation of oral dryness; change in unstimulated salivary flow was a secondary endpoint. Five hundred seventy subjects (284 in Study 003 and 286 in Study 004) were randomized. Significantly more cevimeline-treated subjects than placebo recipients (47.4% vs. 33.3%, p = 0.0162) in Study 003 reported improvement in dry mouth in the final global evaluation of oral dryness. No significant difference between groups in the final global evaluation was seen in Study 004, in which a high placebo response rate of 47.6% was observed. In both studies, cevimeline-treated subjects had significantly greater increases in the objective measure of unstimulated salivary flow than placebo recipients (p = 0.0093 [Study 003] and p = 0.0215 [Study 004]), whereas no significant differences in stimulated salivary flow were observed. The most frequent adverse event was increased sweating. Cevimeline was well tolerated by patients with xerostomia after radiotherapy for head and neck cancer, and oral administration of 30-45 mg of cevimeline three times daily increased unstimulated salivary flow.

Important learning factors in high- and low-achieving students in undergraduate biomechanics.

PubMed

Hsieh, ChengTu; Knudson, Duane

2017-07-21

The purpose of the present study was to document crucial factors associated with students' learning of biomechanical concepts, particularly between high- and-low achieving students. Students (N = 113) from three introductory biomechanics classes at two public universities volunteered for the study. Two measures of students' learning were obtained, final course grade and improvement on the Biomechanics Concept Inventory version 3 administered before and after the course. Participants also completed a 15-item questionnaire documenting student learning characteristics, effort, and confidence. Partial correlations controlling for all other variables in the study, confirmed previous studies that students' grade point average (p < 0.01), interest in biomechanics, (p < 0.05), and physics credits passed (p < 0.05) are factors uniquely associated with learning biomechanics concepts. Students' confidence when encountering difficult biomechanics concepts was also significantly (p < 0.05) associated with final grade. There were significant differences between top 15% and bottom 15% achievers on these variables (p < 0.05), as well as on readings completed, work to pay for college per week, and learning epistemology. Consequently, instructors should consider strategies to promote students' interest in biomechanics and confidence in solving relevant professional problems in order to improve learning for both low- and high-ability students.

Obesity Has Minimal Impact on Short-Term Functional Scores After Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy.

PubMed

Morris, Brent J; Haigler, Richard E; Cochran, John M; Laughlin, Mitzi S; Elkousy, Hussein A; Gartsman, Gary M; Edwards, T Bradley

2016-01-01

The potential adverse effect of body mass index (BMI) on shoulder function scores after reverse shoulder arthroplasty (RSA) has not been investigated. We conducted a study to examine outcomes of RSA performed for rotator cuff tear arthropathy (RCTA) across BMI categories (normal weight, overweight, obese). We hypothesized that, compared with normal-weight patients, obese patients would have worse shoulder function scores, worse mobility, and more complications. Using a prospective shoulder arthroplasty registry, we identified 77 primary RSAs performed for RCTA with minimum 2-year follow-up. Thirty-four patients had normal weight (BMI <25 kg/m2), 21 were overweight (BMI 25-30 kg/m2), and 22 were obese (BMI >30 kg/m2). Shoulder function scores, mobility, and satisfaction were evaluated before surgery and at final follow-up. The 3 BMI groups were not significantly different on demographic factors, preoperative shoulder function scores, or preoperative mobility (P > .05). For each group, shoulder function scores and mobility significantly improved between the preoperative and final follow-up assessments (P < .001). Patient satisfaction was similar between groups (P = .967). Improved shoulder function scores, mobility, and patient satisfaction can be expected after RSA for RCTA in patients regardless of BMI.

Effects of oxygenated or hydrogenated water on growth performance, blood parameters, and antioxidant enzyme activity of broiler chickens.

PubMed

Shin, D; Cho, E S R; Bang, H-T; Shim, K S

2016-11-01

This study was conducted to investigate the effects of providing oxygenated and hydrogenated water on the growth performance, blood biochemical parameters, and immunoglobulin concentrations and antioxidant enzyme activity of broiler chickens. In our investigation, 144 Ross × Ross broiler chicks were randomly allotted to three different treatment groups with four replicates (treatment × replicate × bird = 3 × 4 × 12). All chicks were given one of the following types of water for five weeks: tap water (CON), hydrogenated water (HNW), and oxygenated water (ONW). ONW supplementation increased the final body weight and weight gain and also improved both feed intake and feed conversion of broiler chickens as compared to those of CON broiler chickens (P < 0.05). The abdominal fat and its ratio to the final body weight showed that fat accumulation in the broiler chicken abdomen was reduced when broiler chickens drank only ONW for five weeks (P < 0.05). ONW supplementation improved blood parameters, including triacylglyceride, total cholesterol, and low-density lipoprotein-cholesterol. Additionally, in accordance with a globulin increase in broiler chickens, both IgG and IgM generation were significantly enhanced when ONW was supplied to broiler chickens (P < 0.05) but only a numerical advance was observed in the HNW group (P > 0.05). Both oxygenated and hydrogenated water supplementation significantly improved the antioxidant effects (P < 0.05), and it seems that superoxide dismutase refinement was completed due to oxygen and/or hydrogen enhancement of drinking water. These results indicate that oxygen enhancement of drinking water may be recommended to improve growth performance by increasing immunoglobulins mainly IgG and IgM. © Crown copyright 2016.

Does restoration of focal lumbar lordosis for single level degenerative spondylolisthesis result in better patient-reported clinical outcomes? A systematic literature review.

PubMed

Rhee, Chanseok; Visintini, Sarah; Dunning, Cynthia E; Oxner, William M; Glennie, R Andrew

2017-10-01

It is controversial whether the surgical restoration of sagittal balance and spinopelvic angulation in a single level lumbar degenerative spondylolisthesis results in clinical improvements. The purpose of this study to systematically review the available literature to determine whether the surgical correction of malalignment in lumbar degenerative spondylolisthesis correlates with improvements in patient-reported clinical outcomes. Literature searches were performed via Ovid Medline, Embase, CENTRAL and Web of Science using search terms "lumbar," "degenerative/spondylolisthesis" and "surgery/surgical/surgeries/fusion". This resulted in 844 articles and after reviewing the abstracts and full-texts, 13 articles were included for summary and final analysis. There were two Level II articles, four Level III articles and five Level IV articles. Most commonly used patient-reported outcome measures (PROMs) were Oswestery disability index (ODI) and visual analogue scale (VAS). Four articles were included for the final statistical analysis. There was no statistically significant difference between the patient groups who achieved successful surgical correction of malalignment and those who did not for either ODI (mean difference -0.94, CI -8.89-7.00) or VAS (mean difference 1.57, CI -3.16-6.30). Two studies assessed the efficacy of manual reduction of lumbar degenerative spondylolisthesis and their clinical outcomes after the operation, and there was no statistically significant improvement. Overall, the restoration of focal lumbar lordosis and restoration of sagittal balance for single-level lumbar degenerative spondylolisthesis does not seem to yield clinical improvements but well-powered studies on this specific topic is lacking in the current literature. Future well-powered studies are needed for a more definitive conclusion. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lumbar multifidus and erector spinae electromyograms during back bridge exercise in time and frequency domains.

PubMed

Mello, Roger Gomes Tavares; Carriço, Igor Rodrigues; da Matta, Thiago Torres; Nadal, Jurandir; Oliveira, Liliam Fernandes

2016-01-01

Muscle activity is studied during trunk stabilization exercises using electromyograms (EMG) in time domain. However, the frequency domain analysis provides information that would be important to understand fatigue process. To assess EMG of lumbar multifidus (LM) and erector spinae (ES) muscles, in time and frequency domains, during back bridge exercise. Nineteen healthy young men performed the exercise for one minute and EMG was monitored by surface electromyography. Normalized root mean square (RMS) value and spectral median frequency (MF) were compared between beginning and final epochs of test. The dynamics of the MF during whole test was also obtained by short-time Fourier transform. RMS values were about 30% of maximum voluntary contraction, and LM muscle showed greater MF than ES, which did not decrease at the final of exercise. However, the slope of MF was significant mainly for LM. Muscle activation of 30% is sufficient to keep lumbar stability and is suitable to improve muscular endurance. The significance of MF slope without decreasing at the final of exercise indicates challenging muscular endurance without imply on high fatigability. Due to lower muscular demand, this exercise might be recommended for trunk stabilizing for low back pain patients.

Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation.

PubMed

Harkema, Susan J; Schmidt-Read, Mary; Lorenz, Douglas J; Edgerton, V Reggie; Behrman, Andrea L

2012-09-01

To evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI. Prospective observational cohort. Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Patients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN. Intensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration. Berg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test. Outcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement. Significant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Comparison of glycaemic control and cardiovascular risk profile in patients with type 2 diabetes during treatment with either repaglinide or metformin.

PubMed

Derosa, Giuseppe; Mugellini, Amedeo; Ciccarelli, Leonardina; Crescenzi, Giuseppe; Fogari, Roberto

2003-06-01

To compare glycaemic control and cardiovascular risk profile in patients with type 2 diabetes following 12 months' treatment with either repaglinide or metformin. This was an open uncontrolled randomised study in n=112 patients with inadequately controlled type 2 diabetes not previously treated with oral hypoglycaemic agents. Patients beginning treatment with either repaglinide or metformin entered an 8-week titration period (to optimise dosage: repaglinide, 2-4 mg/day; metformin, 1500-2500 mg/day) followed by a 12-month treatment period. Glycaemic control and cardiovascular risk factors were determined at baseline and at the end of the treatment period. Mean (S.D.) final drug doses were 3 (+/-1) mg/day in the repaglinide group and 2000 (+/-500) mg/day in the metformin group. Significant improvements in glycaemic control [glycated haemoglobin, fasting and 2-h postprandial plasma glucose (PPG)] were demonstrated in both treatment groups. The decrease in PPG was significantly greater in the repaglinide group (P<0.05). During the treatment period, fasting plasma insulin (FPI) decreased significantly in both groups, more so with metformin (P<0.05). Two-hour postprandial plasma insulin (PPI) levels decreased only in the metformin group (P<0.05). Significant improvements between baseline and final visit were demonstrated in one or both groups in the following cardiovascular risk factors: total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, plasminogen activator inhibitor, lipoprotein(a) and homocysteine. No changes were observed in high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I, apolipoprotein B, fibrinogen, body mass index (BMI) or blood pressure. The use of repaglinide or metformin in drug therapy-nai;ve patients with type 2 diabetes over a 12-month period is associated with improvements in both glycaemic control and cardiovascular risk profile. The latter cannot necessarily be attributed to the pharmacotherapy per se, but provides reassurance in the context of initiating oral hypoglycaemic drug therapy with these agents.

Six months methylphenidate treatment improves emotion dysregulation in adolescents with attention deficit/hyperactivity disorder: a prospective study.

PubMed

Suzer Gamli, Ipek; Tahiroglu, Aysegul Yolga

2018-01-01

Individuals with attention deficit/hyperactivity disorder (ADHD) may suffer from emotional dysregulation (ED), although this symptom is not listed among the diagnostic criteria. Methylphenidate (MPH) is useful in reducing emotional symptoms in ADHD. The aim of the present study was to determine both psychosocial risk factors and presence of ED in adolescents with ADHD before and after MPH treatment. Eighty-two patients aged 12-18 years with ADHD were included as participants. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime, the Difficulties in Emotion Regulation Scale (DERS), sociodemographic form, and the Inventory of Statements About Self-Injury were administered. Results were compared before and after 6 months MPH treatment. A significant improvement was detected on DERS for impulsivity (15.9±6.8 initial vs 14.2±6.5 final test, p <0.01) and total score (88.4±23.3 initial vs 82.4±2.7 final test, p <0.05) across all patients taking MPH regardless of subtype and sex. Despite treatment, a significant difference remained for impulsivity, strategies, and total score in patients with comorbid oppositional defiant disorder (ODD) compared with those without ODD, but no difference was detected for conduct disorder comorbidity. In patients who self-harm, scores for goals, impulsivity, strategies, clarity, and total score were higher before treatment: furthermore, impulsivity and total score remained high after treatment. In maltreated patients, goals, impulsivity, strategies, and total scores were significantly higher before treatment; however, their symptoms were ameliorated after treatment with MPH. Individuals with severe ED may "self-medicate" by smoking and/or self-harming. MPH led to significant improvements in ED possibly owing, in part, to a decrease in impulsivity, so that individuals felt more able to supervise their emotions and engage in goal-directed behaviors. ED should be considered particularly in patients with additional psychosocial factors and ODD comorbidity, and included in the treatment plan.

Tuning in to teens: Improving parental responses to anger and reducing youth externalizing behavior problems.

PubMed

Havighurst, Sophie S; Kehoe, Christiane E; Harley, Ann E

2015-07-01

Parent emotion socialization plays an important role in shaping emotional and behavioral development during adolescence. The Tuning in to Teens (TINT) program aims to improve parents' responses to young people's emotions with a focus on teaching emotion coaching. This study examined the efficacy of the TINT program in improving emotion socialization practices in parents and whether this reduced family conflict and youth externalizing difficulties. Schools were randomized into intervention and control conditions and 225 primary caregiving parents and 224 youth took part in the study. Self-report data was collected from parents and youth during the young person's final year of elementary school and again in their first year of secondary school. Multilevel analyses showed significant improvements in parent's impulse control difficulties and emotion socialization, as well as significant reductions in family conflict and youth externalizing difficulties. This study provides support for the TINT program in reducing youth externalizing behavior problems. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Effect of Peracetic Acid as A Final Rinse on Push Out Bond Strength of Root Canal Sealers to Root Dentin.

PubMed

Gaddala, Naresh; Veeramachineni, Chandrasekhar; Tummala, Muralidhar

2015-05-01

Smear layer which was formed during the instrumentation of root canals hinders the penetration of root canal sealers to root dentin and affect the bond strength of root canal sealers to root dentin. Final irrigant such as demineralizing agents are used to remove the inorganic portion of the smear layer. In the present study, peracetic acid used as a final rinse, to effect the bond strength of root canal sealers to root dentin. The purpose of the present study was to evaluate the efficacy of peracetic acid as a final irrigant on bond strength of root canal sealers to root dentin. Sixty six freshly extracted human single rooted mandibular premolars were used for this study. After decoronation the samples were instrumented with Protaper upto F3 and irrigated with 5.25% NaOcl. The teeth were then divided into three groups based on final irrigant used: Group-1(control group) Canals were irrigated with distilled water. Group-2: Canals were irrigated with peracetic acid. Group-3: Canals were irrigated with smear clear. Each group was further divided into three subgroups (n=30) based on the sealer used to obturate the canals. Subgroup-1: kerr, Subgroup-2: Apexit plus, Subgroup-3: AH PLUS. Each sealer was mixed and coated to master cone and placed in the canal. The bonding between sealer and dentin surface was evaluated using push out bond strength by universal testing machine. The mean bond strength values of each group were statistically evaluated using Two-way ANOVA followed by Tukey post-hoc test. Significant difference was found among the bond strength of the sealers. But, there is no statistically significant difference between the groups irrigated with peracetic acid and smear clear compared to control group. AH Plus showed highest bond strength irrespective of the final irrigant used. Peracetic acid when employed as final irrigant improved the bond strength of root canal sealers compared to control group but not statistically significant than smear clear.

Effect of Peracetic Acid as A Final Rinse on Push Out Bond Strength of Root Canal Sealers to Root Dentin

PubMed Central

Gaddala, Naresh; Veeramachineni, Chandrasekhar

2015-01-01

Background Smear layer which was formed during the instrumentation of root canals hinders the penetration of root canal sealers to root dentin and affect the bond strength of root canal sealers to root dentin. Final irrigant such as demineralizing agents are used to remove the inorganic portion of the smear layer. In the present study, peracetic acid used as a final rinse, to effect the bond strength of root canal sealers to root dentin. Aim The purpose of the present study was to evaluate the efficacy of peracetic acid as a final irrigant on bond strength of root canal sealers to root dentin. Materials and Methods Sixty six freshly extracted human single rooted mandibular premolars were used for this study. After decoronation the samples were instrumented with Protaper upto F3 and irrigated with 5.25% NaOcl. The teeth were then divided into three groups based on final irrigant used: Group-1(control group) Canals were irrigated with distilled water. Group-2: Canals were irrigated with peracetic acid. Group-3: Canals were irrigated with smear clear. Each group was further divided into three subgroups (n=30) based on the sealer used to obturate the canals. Subgroup-1: kerr, Subgroup-2: Apexit plus, Subgroup-3: AH PLUS. Each sealer was mixed and coated to master cone and placed in the canal. The bonding between sealer and dentin surface was evaluated using push out bond strength by universal testing machine. The mean bond strength values of each group were statistically evaluated using Two-way ANOVA followed by Tukey post-hoc test. Results Significant difference was found among the bond strength of the sealers. But, there is no statistically significant difference between the groups irrigated with peracetic acid and smear clear compared to control group. AH Plus showed highest bond strength irrespective of the final irrigant used. Conclusion Peracetic acid when employed as final irrigant improved the bond strength of root canal sealers compared to control group but not statistically significant than smear clear. PMID:26155568

Primary Effects of Intravitreal Bevacizumab in Patients with Diabetic Macular Edema

PubMed Central

Tareen, Iftikhar-ul-Haq; Rahman, Azizur; Mahar, P.S; Memon, Muhammad Saleh

2013-01-01

Objective: To evaluate the efficacy of primary intra vitreal bevacizumab (IVB) injection on macular edema in diabetic patients with improvement in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT). Methods: This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study (ETDRS) charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography (FFA) and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month. Results: The mean BCVA at base line was 0.42±0.14 Log Mar units. This improved to 0.34±0.13, 0.25±0.12, 0.17±0.12 and 0.16±0.14 Log Mar units at 1 month after 1st, 2nd 3rd injections and at final visit at 6 months respectively, a difference that was statistically significant (P>0.0001) from base line. The mean 1mm CMT measurement was 452.9 ± 143.1 µm at base line, improving to 279.8 ± 65.2 µm (P<0.0001) on final visit. No serious complications were observed. Conclusions: Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME. PMID:24353679

Treatment effect, postoperative complications, and their reasons in juvenile thoracic and lumbar spinal tuberculosis surgery.

PubMed

He, Qing-Yi; Xu, Jian-Zhong; Zhou, Qiang; Luo, Fei; Hou, Tianyong; Zhang, Zehua

2015-10-01

Fifty-four juvenile cases under 18 years of age with thoracic and lumbar spinal tuberculosis underwent focus debridement, deformity correction, bone graft fusion, and internal fixation. The treatment effects, complications, and reasons were analyzed retrospectively. There were 54 juvenile cases under 18 years of age with thoracolumbar spinal tuberculosis. The average age was 9.2 years old, and the sample comprised 38 males and 16 females. The disease types included 28 thoracic cases, 17 thoracolumbar cases, and 9 lumbar cases. Nerve function was evaluated with the Frankel classification. Thirty-six cases were performed with focus debridement and deformity correction and were supported with allograft or autograft in mesh and fixed with pedicle screws from a posterior approach. Eight cases underwent a combined anterior and posterior surgical approach. Nine cases underwent osteotomy and deformity correction, and one case received focus debridement. The treatment effects, complications, and bone fusions were tracked for an average of 52 months. According to the Frankel classification, paralysis was improved from 3 cases of B, 8 cases of C, 18 cases of D, and 25 cases of E preoperatively. This improvement was found in 3 cases of C, 6 cases of D, and 45 cases of E at a final follow-up postoperatively. No nerve dysfunction was aggravated. VAS was improved from 7.8 ± 1.7 preoperatively to 3.2 ± 2.1 at final follow-up postoperatively. ODI was improved from 77.5 ± 17.3 preoperatively to 28.4 ± 15.9 at final follow-up postoperatively. Kyphosis Cobb angle improved from 62.2° ± 3.7° preoperatively to 37° ± 2.4° at final follow-up postoperatively. Both of these are significant improvements, and all bone grafts were fused. Complications related to the operation occurred in 31.5% (17/54) of cases. Six cases suffered postoperative aggravated kyphosis deformity, eight cases suffered proximal kyphosis deformity, one case suffered pedicle penetration, one case suffered failure of internal devices, and one case suffered recurrence of tuberculosis. As long as the treatment plan is fully prepared, the surgical option can achieve a satisfactory curative effect in treating juvenile spinal tuberculosis despite some complications.

Tapentadol extended release for the management of chronic neck pain

PubMed Central

Billeci, Domenico; Coluzzi, Flaminia

2017-01-01

Background The role of opioids in the management of chronic neck pain is still poorly investigated. No data are available on tapentadol extended release (ER). In this article, we present 54 patients with moderate-to-severe chronic neck pain treated with tapentadol ER. Patients and methods Patients received tapentadol ER 100 mg/day; dosage was then adjusted according to clinical needs. The following parameters were recorded: pain; Douleur Neuropathique 4 score; Neck Disability Index score; range of motion; pain-associated sleep interference; quality of life (Short Form [36] Health Survey); Patient Global Impression of Change (PGIC); Clinician GIC; opioid-related adverse effects; and need for other analgesics. Results A total of 44 of 54 patients completed the 12-week observation. Tapentadol ER daily doses increased from 100 mg/day to a mean (standard deviation) dosage of 204.5 (102.8) mg/day at the final evaluation. Mean pain intensity at movement significantly decreased from baseline (8.1 [1.1]) to all time points (P<0.01). At baseline, 70% of patients presented a positive neuropathic component. This percentage dropped to 23% after 12 weeks. Tapentadol improved Neck Disability Index scores from 55.6 (18.6) at baseline to 19.7 (20.9) at the final evaluation (P<0.01). Tapentadol significantly improved neck range of motion in all three planes of motion, particularly in lateral flexion. Quality of life significantly improved in all Short Form (36) Health Survey subscales (P<0.01) and in both physical and mental status (P<0.01). Based on PGIC results, approximately 90% of patients rated their overall condition as much/very much improved. Tapentadol was well tolerated: no patients discontinued due to side effects. The use of other analgesics was reduced during the observed period. Conclusion Our results suggest that tapentadol ER, started at 100 mg/day, is effective and well tolerated in patients with moderate-to-severe chronic neck pain, including opioid-naïve subjects. Patients can expect a decrease in pain, an improvement in neck function, and a decrease in neuropathic symptoms. PMID:28280384

Futility Disputes: A Review of the Literature and Proposed Model for Dispute Navigation Through Trust Building.

PubMed

Leland, Brian D; Torke, Alexia M; Wocial, Lucia D; Helft, Paul R

2017-10-01

Futility disputes in the intensive care unit setting have received significant attention in the literature over the past several years. Although the idea of improving communication in an attempt to resolve these challenging situations has been regularly discussed, the concept and role of trust building as the means by which communication improves and disputes are best navigated is largely absent. We take this opportunity to review the current literature on futility disputes and argue the important role of broken trust in these encounters, highlighting current evidence establishing the necessity and utility of trust in both medical decision-making and effective communication. Finally, we propose a futility dispute navigation model built upon improved communication through trust building.

Use of international foundations of medicine clinical sciences examination to evaluate students' performance in the local examination at the University of Sharjah, United Arab Emirates.

PubMed

Dash, Nihar Ranjan; Abdalla, Mohamed Elhassan; Hussein, Amal

2017-01-01

Several medical schools around the world are moving away from isolated, locally developed in-house assessments to the introduction of external examinations into their curriculum. Although the objective varies, it is typically done to evaluate, audit, and compare students' performance to international standards. Similarly, the International Foundations of Medicine-Clinical Sciences Examination (IFOM-CSE) was introduced in the College of Medicine at the University of Sharjah as an external assessment criterion in addition to the existing in-house assessments. The aim of this study was to compare the student performance in this newly introduced IFOM-CSE examination and the existing in-house final examination in the college. The scores of three consecutive final-year undergraduate medical student batches (2013-2015) who took both the IFOM-CSE and the existing in-house final examination were analyzed. Pearson correlation and one-way analysis of variance test were conducted using SPSS 22. The students' scores in the IFOM-CSE and in the final examination prepared locally were highly correlated with Pearson correlation coefficients of 0.787 for batch 2013, 0.827 for batch 2014, and 0.830 for batch 2015 (P < 0.0005). Interestingly, while the mean scores of the IFOM-CSE among the three batches in the years 2013, 2014, and 2015 (475, 492, and 513, respectively) showed improvement with borderline significance (F[2226] = 2.73, P = 0.067), local examination scores showed a significant improvement during the study period (F[2277] = 52.87, P < 0.0005). The findings of this study showed that students' scores in the local examination were consistently correlated with their scores in the IFOM-CSE over all the three batches. Thus, introduction of external examination can be an important evaluation tool to a comprehensive internal assessment system providing evidence of external validity.

A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part II: Effects on function.

PubMed

Reznik, J E; Biros, E; Sacher, Y; Kibrik, O; Milanese, S; Gordon, S; Galea, M P

2017-01-01

Neurogenic heterotopic ossification (NHO) occurs as a complication of traumatic brain injury (TBI). Management of clinically significant NHO remains variable. Complications of mature NHO include limitation of mobility. The effect of the extracorporeal shock wave therapy (ESWT) on range of motion at hip and knee, and function in patients with TBI with chronic NHO was investigated. A series of single-case studies applying ESWT to chronic NHO at the hip or knee of 11 patients with TBI were undertaken at a rehabilitation hospital. Participants received four applications of high-energy EWST delivered to the affected hip or knee over a period of 8 weeks. Two-weekly follow- up assessments were carried out; final assessments were made 3 and 6 months post-intervention. Range of motion (ROM) and Functional Reach (FR) or Modified Functional Reach (MFR) were measured. Application of high-energy ESWT was associated with significant improvement in ROM (flexion) of the NHO-affected knee (Tau = 0.833, 95% CI 0.391-1.276, p = 0.002) and significant improvement of FR (Overall Tau 0.486, 95% CI 0.141-0.832, p = 0.006); no significant improvement in hip ROM or MFR. ESWT may improve mobility and balance of patients with TBI who have chronic NHO.

Adaptive Fading Memory H∞ Filter Design for Compensation of Delayed Components in Self Powered Flux Detectors

NASA Astrophysics Data System (ADS)

Tamboli, Prakash Kumar; Duttagupta, Siddhartha P.; Roy, Kallol

2015-08-01

The paper deals with dynamic compensation of delayed Self Powered Flux Detectors (SPFDs) using discrete time H∞ filtering method for improving the response of SPFDs with significant delayed components such as Platinum and Vanadium SPFD. We also present a comparative study between the Linear Matrix Inequality (LMI) based H∞ filtering and Algebraic Riccati Equation (ARE) based Kalman filtering methods with respect to their delay compensation capabilities. Finally an improved recursive H∞ filter based on the adaptive fading memory technique is proposed which provides an improved performance over existing methods. The existing delay compensation algorithms do not account for the rate of change in the signal for determining the filter gain and therefore add significant noise during the delay compensation process. The proposed adaptive fading memory H∞ filter minimizes the overall noise very effectively at the same time keeps the response time at minimum values. The recursive algorithm is easy to implement in real time as compared to the LMI (or ARE) based solutions.

Optical performance of segmented aperture windows for solar tower receivers

NASA Astrophysics Data System (ADS)

Buck, Reiner

2017-06-01

Segmented quartz windows are a concept to build larger windows for receivers that require a closed aperture. Reflection losses are a significant loss factor for such solar receivers. Without any additional measures, the reflection loss can reach about 12%. One important measure to improve transmission is the application of anti-reflective coatings, which is beneficial in any case. Another option is modifying the window geometry, especially the edge surfaces of the glass segments. A certain fraction of the reflection losses are caused by a light-guide effect in the glass body, for rays entering through the front surface. Changing the cut surfaces in a way reducing the light-guide effect can significantly improve transmission of a segmented window. Several possible configurations are evaluated and discussed. The results of ray-tracing simulations verify the improvement. The final selection of the window configuration depends on the optical properties and on mechanical strength, manufacturing and cost considerations. This has to be evaluated for any specific receiver design.

Patients' Body Image Improves After Mohs Micrographic Surgery for Nonmelanoma Head and Neck Skin Cancer.

PubMed

Beal, Brandon T; White, Emily K; Behera, Anit K; Zavell, Amy E; McGuinness, Ashley E; Blangger, Holly; Armbrecht, Eric S; Maher, Ian A

2018-05-24

Most skin cancers occur on the head and neck, areas of the body that are significant to an individual's body image (BI) perception. Poor BI is a robust risk factor for depression and decreased quality of life. Thus, patients with nonmelanoma head and neck skin cancer (NMHNSC) may be more vulnerable to BI disturbance and the negative sequelae of poor BI. Describe the nature of BI concerns in patients diagnosed with NMHNSC and assess how BI changes with treatment. Patients undergoing Mohs micrographic surgery (MMS) for NMHNSC completed assessments of BI and well-being before (N = 239) and 6 months after (N = 80) treatment with MMS. Demographic and tumor data were gathered through retrospective chart review. Body image improved significantly 6 months after MMS, and the magnitude of this change was large (η = 0.18). Repair length (length of final scar irrespective of repair type) >4 cm predicted poorer BI at 6-month follow-up. Patients' BI improves after treatment with MMS for NMHNSC.

Eigenvector decomposition of full-spectrum x-ray computed tomography.

PubMed

Gonzales, Brian J; Lalush, David S

2012-03-07

Energy-discriminated x-ray computed tomography (CT) data were projected onto a set of basis functions to suppress the noise in filtered back-projection (FBP) reconstructions. The x-ray CT data were acquired using a novel x-ray system which incorporated a single-pixel photon-counting x-ray detector to measure the x-ray spectrum for each projection ray. A matrix of the spectral response of different materials was decomposed using eigenvalue decomposition to form the basis functions. Projection of FBP onto basis functions created a de facto image segmentation of multiple contrast agents. Final reconstructions showed significant noise suppression while preserving important energy-axis data. The noise suppression was demonstrated by a marked improvement in the signal-to-noise ratio (SNR) along the energy axis for multiple regions of interest in the reconstructed images. Basis functions used on a more coarsely sampled energy axis still showed an improved SNR. We conclude that the noise-resolution trade off along the energy axis was significantly improved using the eigenvalue decomposition basis functions.

Weather Information Communication (WINCOMM) VDL-3 and 1090ES Final Test Requirements, Test Plans, and Test Results

NASA Technical Reports Server (NTRS)

Griner, James H.; Jirberg, Russ; Frantz, Brian; Kachmar, Brian A.

2006-01-01

NASA s Aviation Safety Program was created for the purpose of making a significant reduction in the incidents of weather related aviation accidents by improving situational awareness. The objectives of that program are being met in part through advances in weather sensor technology, and in part through advances in the communications technology that are developed for use in the National Airspace System. It is this latter element, i.e., the improvements in aviation communication technologies, that is the focus of the Weather Information Communications project. This report describes the final flight test results completed under the WINCOMM project at the NASA Glenn Research Center of the 1090 Extended Squitter (1090ES) and VDL Mode 3 (VDL-3) data links as a medium for weather data exchange. It presents the use of 1090ES to meet the program objectives of sending broadcast turbulence information and the use of VDL-3 to send graphical weather images. This report provides the test requirements and test plans, which led to flight tests, as well as final results from flight testing. The reports define the changes made to both avionics and ground-based receivers as well as the ground infrastructure to support implementation of the recommended architecture, with a focus on the issues associated with these changes.

Educational interventions to improve inhaler techniques and their impact on asthma and COPD control: a pilot effectiveness-implementation trial.

PubMed

Maricoto, Tiago; Madanelo, Sofia; Rodrigues, Luís; Teixeira, Gilberto; Valente, Carla; Andrade, Lília; Saraiva, Alcina

2016-01-01

To assess the impact that educational interventions to improve inhaler techniques have on the clinical and functional control of asthma and COPD, we evaluated 44 participants before and after such an intervention. There was a significant decrease in the number of errors, and 20 patients (46%) significantly improved their technique regarding prior exhalation and breath hold. In the asthma group, there were significant improvements in the mean FEV1, FVC, and PEF (of 6.4%, 8.6%, and 8.3% respectively). Those improvements were accompanied by improvements in Control of Allergic Rhinitis and Asthma Test scores but not in Asthma Control Test scores. In the COPD group, there were no significant variations. In asthma patients, educational interventions appear to improve inhaler technique, clinical control, and functional control. RESUMO Para avaliar o impacto do ensino da técnica inalatória no controle clínico e funcional de pacientes com asma ou DPOC, incluíram-se 44 participantes antes e após essa intervenção. Houve uma diminuição significativa no número de erros cometidos, sendo que 20 pacientes (46%) melhoraram significativamente sua técnica na expiração prévia e apneia final. No grupo asma, houve significativa melhora nas médias de FEV1 (6,4%), CVF (8,6%) e PFE (8,3%), e essa melhora correlacionou-se com os resultados no Control of Allergic Rhinitis and Asthma Test, mas não com os do Asthma Control Test. No grupo DPOC, não houve variações significativas. O ensino da técnica inalatória parece melhorar seu desempenho e os controles clínico e funcional em pacientes com asma.

Engagement Assessment Using EEG Signals

NASA Technical Reports Server (NTRS)

Li, Feng; Li, Jiang; McKenzie, Frederic; Zhang, Guangfan; Wang, Wei; Pepe, Aaron; Xu, Roger; Schnell, Thomas; Anderson, Nick; Heitkamp, Dean

2012-01-01

In this paper, we present methods to analyze and improve an EEG-based engagement assessment approach, consisting of data preprocessing, feature extraction and engagement state classification. During data preprocessing, spikes, baseline drift and saturation caused by recording devices in EEG signals are identified and eliminated, and a wavelet based method is utilized to remove ocular and muscular artifacts in the EEG recordings. In feature extraction, power spectrum densities with 1 Hz bin are calculated as features, and these features are analyzed using the Fisher score and the one way ANOVA method. In the classification step, a committee classifier is trained based on the extracted features to assess engagement status. Finally, experiment results showed that there exist significant differences in the extracted features among different subjects, and we have implemented a feature normalization procedure to mitigate the differences and significantly improved the engagement assessment performance.

Using Web-Based Key Character and Classification Instruction for Teaching Undergraduate Students Insect Identification

NASA Astrophysics Data System (ADS)

Golick, Douglas A.; Heng-Moss, Tiffany M.; Steckelberg, Allen L.; Brooks, David. W.; Higley, Leon G.; Fowler, David

2013-08-01

The purpose of the study was to determine whether undergraduate students receiving web-based instruction based on traditional, key character, or classification instruction differed in their performance of insect identification tasks. All groups showed a significant improvement in insect identifications on pre- and post-two-dimensional picture specimen quizzes. The study also determined student performance on insect identification tasks was not as good as for family-level identification as compared to broader insect orders and arthropod classification identification tasks. Finally, students erred significantly more by misidentification than misspelling specimen names on prepared specimen quizzes. Results of this study support that short web-based insect identification exercises can improve insect identification performance. Also included is a discussion of how these results can be used in teaching and future research on biological identification.

The combined use of virtual reality exposure in the treatment of agoraphobia.

PubMed

Pitti, Carmen T; Peñate, Wenceslao; de la Fuente, Juan; Bethencourt, Juan M; Roca-Sánchez, María J; Acosta, Leopoldo; Villaverde, María L; Gracia, Ramón

2015-01-01

This study compares the differential efficacy of three groups of treatments for agoraphobia: paroxetine combined with cognitive-behavioral therapy, paroxetine combined with cognitive-behavioral therapy and virtual reality exposure, and a group with only paroxetine. 99 patients with agoraphobia were finally selected. Both combined treatment groups received 11 sessions of cognitive-behavioral therapy, and one of the groups was also exposed to 4 sessions of virtual reality treatment. Treatments were applied in individual sessions once a week for 3 months. The three treatment groups showed statistically significant improvements. In some measures, combined treatment groups showed greater improvements. The virtual reality exposure group showed greater improvement confronting phobic stimuli. Treatments combining psychopharmacological and psychological therapy showed greater efficacy. Although the use of new technologies led to greater improvement, treatment adherence problems still remain.

Ocular vascular occlusive disorders: Natural history of visual outcome☆

PubMed Central

Hayreh, Sohan Singh

2014-01-01

Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO – much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen within 7 days of onset, central VF defect improved in 47% and peripheral VF in 52%, and in transient BRAO central and peripheral VFs were normal at follow-up. My studies showed that AION, CRVO, BRVO, CRAO and BRAO, each consist of multiple distinct clinical sub-categories with different visual outcome. Contrary to the prevalent impression, these studies on the natural history of visual outcome have shown that there is a statistically significant spontaneous visual improvement in each category. The factors which influence the visual outcome in various ocular vascular occlusive disorders are discussed. PMID:24769221

Revision anatomical reconstruction of the lateral ligaments of the ankle augmented with suture tape for patients with a failed Broström procedure.

PubMed

Cho, B K; Kim, Y M; Choi, S M; Park, H W; SooHoo, N F

2017-09-01

The aim of this prospective study was to evaluate the intermediate-term outcomes after revision anatomical ankle ligament reconstruction augmented with suture tape for a failed modified Broström procedure. A total of 30 patients with persistent instability of the ankle after a Broström procedure underwent revision augmented with suture tape. Of these, 24 patients who were followed up for more than two years were included in the study. There were 13 men and 11 women. Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5 months (24 to 56) The clinical outcome was assessed using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) score. The stability of the ankle was assessed using stress radiographs. The mean FAOS and FAAM scores improved significantly to 87.5 (73 to 94) and 85.1 (70 to 95) points at final follow-up, respectively (p < 0.001). The mean angle of talar tilt and anterior talar translation improved significantly to 2.8° (0° to 6°) and 4.1 mm (2 to 7) at final follow-up, respectively (p < 0.001). Side to side comparison in stress radiographs at final follow-up showed no significant difference. The revision failed in one patient who underwent a further revision using allograft tendon. The revision modified Broström procedure augmented with suture tape is an effective form of treatment for recurrent instability of the ankle following a failed Broström procedure. This technique provides reliable stability and satisfactory clinical outcomes at intermediate-term follow-up. Cite this article: Bone Joint J 2017;99-B:1183-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Climate influence on Baltic cod, sprat, and herring stock-recruitment relationships

NASA Astrophysics Data System (ADS)

Margonski, Piotr; Hansson, Sture; Tomczak, Maciej T.; Grzebielec, Ryszard

2010-10-01

A wide range of possible recruitment drivers were tested for key exploited fish species in the Baltic Sea Regional Advisory Council (RAC) area: Eastern Baltic Cod, Central Baltic Herring, Gulf of Riga Herring, and sprat. For each of the stocks, two hypotheses were tested: (i) recruitment is significantly related to spawning stock biomass, climatic forcing, and feeding conditions and (ii) by acknowledging these drivers, management decisions can be improved. Climate impact expressed by climatic indices or changes in water temperature was included in all the final models. Recruitment of the herring stock appeared to be influenced by different factors: the spawning stock biomass, winter Baltic Sea Index prior to spawning, and potentially the November-December sea surface temperature during the winter after spawning were important to Gulf of Riga Herring, while the final models for Central Baltic Herring included spawning stock biomass and August sea surface temperature. Recruitment of sprat appeared to be influenced by July-August temperature, but was independent of the spawning biomass when SSB > 200,000 tons. Recruitment of Eastern Baltic Cod was significantly related to spawning stock biomass, the winter North Atlantic Oscillation index, and the reproductive volume in the Gotland Basin in May. All the models including extrinsic factors significantly improved prediction ability as compared to traditional models, which account for impacts of the spawning stock biomass alone. Based on the final models the minimum spawning stock biomass to derive the associated minimum recruitment under average environmental conditions was calculated for each stock. Using uncertainty analyses, the spawning stock biomass required to produce associated minimum recruitment was presented with different probabilities considering the influence of the extrinsic drivers. This tool allows for recruitment to be predicted with a required probability, that is, higher than the average 50% estimated from the models. Further, this approach considers unfavorable environmental conditions which mean that a higher spawning stock biomass is needed to maintain recruitment at a required level.

Spontaneous Resolution of Long-Standing Macular Detachment due to Optic Disc Pit with Significant Visual Improvement.

PubMed

Parikakis, Efstratios A; Chatziralli, Irini P; Peponis, Vasileios G; Karagiannis, Dimitrios; Stratos, Aimilianos; Tsiotra, Vasileia A; Mitropoulos, Panagiotis G

2014-01-01

To report a case of spontaneous resolution of a long-standing serous macular detachment associated with an optic disc pit, leading to significant visual improvement. A 63-year-old female presented with a 6-month history of blurred vision and micropsia in her left eye. Her best-corrected visual acuity was 6/24 in the left eye, and fundoscopy revealed serous macular detachment associated with optic disc pit, which was confirmed by optical coherence tomography (OCT). The patient was offered vitrectomy as a treatment alternative, but she preferred to be reviewed conservatively. Three years after initial presentation, neither macular detachment nor subretinal fluid was evident in OCT, while the inner segment/outer segment (IS/OS) junction line was intact. Her visual acuity was improved from 6/24 to 6/12 in her left eye, remaining stable at the 6-month follow-up after resolution. We present a case of spontaneous resolution of a long-standing macular detachment associated with an optic disc pit with significant visual improvement, postulating that the integrity of the IS/OS junction line may be a prognostic factor for final visual acuity and suggesting OCT as an indicator of visual prognosis and the probable necessity of a surgical management.

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

PubMed

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

The Patient Safety Leadership Academy at the University of Pennsylvania: the first cohort's learning experience.

PubMed

Wurster, Angela B; Pearson, Kathy; Sonnad, Seema S; Mullen, James L; Kaiser, Larry R

2007-01-01

We based the Patient Safety Leadership Academy (PSLA) on the premise that improving management skills could improve patient safety and employee satisfaction. Fellows completed baseline surveys on leadership skills knowledge, patient safety knowledge, and program goals. They completed the same surveys 7 months later at the final PSLA session. The fellows also completed a survey assessing how PSLA improved expertise and comparing PSLA to other patient safety learning opportunities. Matched pairs t tests were used to compare baseline and postprogram results. Baseline scores indicated appropriateness of focusing on leadership, with average leadership knowledge (2.48) significantly lower than patient safety knowledge (3.22). For patient safety, postprogram results were significant for 8 of 10 questions. All results were significant for leadership. Fellows also rated skills covered by the curriculum on a scale of 1 to 10. For all areas, the median score for knowledge gained was 7. When compared with other patient safety learning experiences, participants rated PSLA as 4 or 5, where 1 indicated the other experience much more valuable and 5 much more valuable. PSLA demonstrates that leadership skills are perceived as important by physicians and managers in surgical areas. This study demonstrated that a leadership skills approach to patient safety training could improve knowledge in specific leadership areas and general patient safety.

Botulinum toxin a can positively impact first impression.

PubMed

Dayan, Steven H; Lieberman, Elliot D; Thakkar, Nirav N; Larimer, Karen A; Anstead, Amy

2008-06-01

BACKGROUND First impression is influenced by facial appearance and improved by cosmetic surgery. OBJECTIVE We wanted to determine if treatment with botulinum toxin A (BTxnA) would improve first impression. MATERIALS AND METHODS Women received BTxnA in the forehead. Photos were taken prior to, and 1 week after, final BTxnA injection in smiling and relaxed poses. Photos were divided into books with each subject represented only once. Evaluators completed a survey rating first impression on various measures of success for each photo. RESULTS No differences were seen for social skills, financial, or relationship success scales. A significant decrease in first impression scores between treatment photos was seen for academic performance and occupational success. However, analysis of between-subject effects found that "smile/relax" accounted for the decreased score in both scales. Significant increases in first impression scores were seen for dating success, attractiveness, and athletic success scales where smile/relax and BTxnA contributed significantly to the improved scores. CONCLUSIONS BTxnA improved first impression scores for dating success, attractiveness, and athletic success scales. Academic performance and occupational success scores were not affected by BTxnA when the smile/relax variable was included. The smile/relax variable was a more important predictor for academic performance and occupational success scores.

Rowing performance, body composition, and bone mineral density outcomes in college-level rowers after a season of concurrent training.

PubMed

Young, Kaelin C; Kendall, Kristina L; Patterson, Kaitlyn M; Pandya, Priyanka D; Fairman, Ciaran M; Smith, Samuel W

2014-11-01

To assess changes in body composition, lumbar-spine bone mineral density (BMD), and rowing performance in college-level rowers over a competition season. Eleven Division I college rowers (mean ± SD 21.4 ± 3.7 y) completed 6 testing sessions throughout the course of their competition season. Testing included measurements of fat mass, bone-free lean mass (BFLM), body fat (%BF), lumbar-spine BMD, and 2000-m time-trial performance. After preseason testing, rowers participated in a periodized training program, with the addition of resistance training to the traditional aerobic-training program. Significant (P < .05) improvements in %BF, total mass, and BFLM were observed at midseason and postseason compared with preseason. Neither lumbar-spine BMD nor BMC significantly changed over the competitive season (P > .05). Finally, rowing performance (as measured by 2000-m time and average watts achieved) significantly improved at midseason and postseason compared with preseason. Our results highlight the efficacy of a seasonal concurrent training program serving to improve body composition and rowing performance, as measured by 2000-m times and average watts, among college-level rowers. Our findings offer practical applications for coaches and athletes looking to design a concurrent strength and aerobic training program to improve rowing performance across a season.

Nasal symptoms following endoscopic transsphenoidal pituitary surgery: assessment using the General Nasal Patient Inventory.

PubMed

Wang, Yi Yuen; Srirathan, Vinothan; Tirr, Erica; Kearney, Tara; Gnanalingham, Kanna K

2011-04-01

The endoscopic approach for pituitary tumors is a recent innovation and is said to reduce the nasal trauma associated with transnasal transsphenoidal surgery. The authors assessed the temporal changes in the rhinological symptoms following endoscopic transsphenoidal surgery for pituitary lesions, using the General Nasal Patient Inventory (GNPI). The GNPI was administered to 88 consecutive patients undergoing endoscopic transsphenoidal surgery at 3 time points (presurgery, 3-6 months postsurgery, and at final follow-up). The total GNPI score and the scores for the individual GNPI questions were calculated and differences between groups were assessed once before surgery, several months after surgery, and at final follow-up. Of a maximum possible score of 135, the mean GNPI score at 3-6 months postsurgery was only 12.9 ± 12 and was not significantly different from the preoperative score (10.4 ± 13) or final follow-up score (10.3 ± 10). Patients with functioning tumors had higher GNPI scores than those with nonfunctioning tumors for each of these time points (p < 0.05). Individually, a mild increase in symptom severity was seen for symptoms attributable to the nasal trauma of surgery, with partial recovery (nasal sores and bleeding) or complete recovery (nasal blockage, painful sinuses, and unpleasant nasal smell) by final follow-up (p < 0.05). Progressive improvements in symptom severity were seen for symptoms more attributable to tumor mass preoperatively (for example, headaches and painkiller use [p < 0.05]). In total, by final follow-up 8 patients (9%) required further treatment or advice for ongoing nasal symptoms. Endoscopic transsphenoidal surgery is a well-tolerated minimally invasive procedure for pituitary fossa lesions. Overall patient-assessed nasal symptoms do not change, but some individual symptoms may show a mild worsening or overall improvement.

Growth performance and carcass characteristics of broiler chickens fed diets supplemented with graded levels of charcoal from maize cob or seed of Canarium schweinfurthii Engl.

PubMed

Kana, Jean Raphael; Teguia, Alexis; Mungfu, Berrian Musa; Tchoumboue, Joseph

2011-01-01

Growth performances and carcass characteristics of broiler chickens fed diets supplemented with graded levels of Canarium schweinfurthii Engl seed (charcoal A) or maize cob (charcoal B) were studied using a total of 110 3-week-old male chicks. 11 experimental diets including a control and other containing either 0.2, 0.4, 0.6, 0.8 or 1% charcoal from C. schweinfurthii Engl seed (A(0.2), A(0.4), A(0.6), A(0.8), and A(1%), respectively) or from maize cob (B(0.2), B(0.4), B(0.6), B(0.8), and B(1%), respectively) supplements were used. Each of the diets was fed to ten individually birds caged in a completely randomized design. Results indicated that birds fed 0.2, 0.4, and 0.6% of either charcoal A or B had significantly (P < 0.05) higher final body weights as compared to control birds, while, above 0.6% slightly depressed average final body weights and weight gain. The best growth performance was achieved with 0.2% inclusion of charcoals. There was no significant (P > 0.05) influence of charcoal B on the overall feed intake. Only the B(0.6) feed significantly (P < 0.05) improved feed conversion ratio as compared with the control. Dressing percentage, liver weight and abdominal fat were not significantly (P > 0.05) affected by charcoal. However, there was a significant (P < 0.05) reduction in gizzard weight with charcoal B. Charcoal had no significant (P > 0.05) influence on intestine length and weight. More than 0.6% of charcoal A significantly (P < 0.05) depressed intestine density. It was concluded that under the conditions of this study, charcoal from maize cob or Canarium seeds could be used to improve growth performances and some carcass traits in broiler chickens.

Predictive value of spectral-domain optical coherence tomography features in assessment of visual prognosis in eyes with acute welding arc maculopathy.

PubMed

Zhang, Chunxia; Dang, Guangfu; Zhao, Tianmei; Wang, DongLin; Su, Yan; Qu, Yi

2018-04-12

To observe spectral-domain optical coherence tomography (SD-OCT) features and to determine whether baseline OCT features can be used as predictors of visual acuity outcome in eyes with acute welding arc maculopathy. This retrospective study enrolled twenty-two eyes of eleven subjects with acute welding arc maculopathy. All subjects were evaluated by SD-OCT at baseline and final visit. The involved parameters included best-corrected visual acuity (BCVA), central macular thickness (CMT), the length of ellipsoid zone (EZ) defects, the greatest linear dimension (GLD) of outer retinal lesions, EZ reflectivity and relative EZ reflectivity (defined as the ratio of EZ reflectivity to retinal pigment epithelium reflectivity on OCT). Acute welding arc maculopathy was presented as abnormal hyperreflectivity, hyporeflectivity and defects of outer retinal layer in fovea on OCT. Compared with baseline, BCVA improved significantly accompanied by decreased GLD of outer retinal lesions and the length of EZ defects at final visit (P = 0.0004, P < 0.0001 and P < 0.0001, respectively). No significant changes were shown on CMT (P = 0.248). In multivariate regression analysis, final BCVA was associated with baseline BCVA and the length of EZ defects (P = 0.012 and P = 0.045, respectively). However, EZ reflectivity and relative EZ reflectivity were not associated with final BCVA (P > 0.05). In conclusion, SD-OCT images clearly reveal morphological changes in outer retinal layer in acute welding arc maculopathy. The baseline BCVA and length of EZ defects are the strongest predictors of final BCVA.

Astrometric Calibrations of HST Images in the Era of Gaia.

NASA Astrophysics Data System (ADS)

Kozhurina-Platais, Vera; Grogin, Norman A.; Sabbi, Elena

2018-06-01

It is well-known that HST images, taken with ACS/WFC and WFC3/UVIS, have substantial geometric distortion. Over the years our knowledge about this distortion has been vastly improved. Nevertheless, in certain applications it may not be good enough. Preliminary results of comparison state-of-the-art HST astrometric standards and the Gaia DR1 indicate significant scale difference, global rotation, and edge effects in the HST data. However, in terms of positional precision the HST standards are not surpassed yet. The next release of Gaia data DR2 were used to finalize and improve the HST astrometric calibrations down to 0.5 mas or better.

A Study of Work Based Learning For Construction Building Workers

NASA Astrophysics Data System (ADS)

Siregar, Syafiatun

2018-03-01

Work-based learning (WBL) is designed to improve the competence of participants. This study aims to apply the WBL and to develop attitudes, knowledge, skills, behaviors, and habits, which in turn can improve the competence of construction workers in the field to be sampled. This research was conducted on building construction workers in Medan City with 30 research subjects. The results showed that the evaluation of learning increased in phase I obtained the difference of the average score of 20.9 (the meeting I) and 25.50 (meeting II). The final result shows that the level of activity and competence increased significantly after WBL

Transplantation of autologous bone marrow-derived mesenchymal stem cells for traumatic brain injury☆

PubMed Central

Jiang, Jindou; Bu, Xingyao; Liu, Meng; Cheng, Peixun

2012-01-01

Results from the present study demonstrated that transplantation of autologous bone marrow-derived mesenchymal stem cells into the lesion site in rat brain significantly ameliorated brain tissue pathological changes and brain edema, attenuated glial cell proliferation, and increased brain-derived neurotrophic factor expression. In addition, the number of cells double-labeled for 5-bromodeoxyuridine/glial fibrillary acidic protein and cells expressing nestin increased. Finally, blood vessels were newly generated, and the rats exhibited improved motor and cognitive functions. These results suggested that transplantation of autologous bone marrow-derived mesenchymal stem cells promoted brain remodeling and improved neurological functions following traumatic brain injury. PMID:25806058

Low-Speed Pressure Sensitive Paint Studies

NASA Technical Reports Server (NTRS)

Owen, Brown; Mehta, Rabindra; Nixon, David (Technical Monitor)

1998-01-01

A series of low speed (M less than 0.2) experiments using University of Washington Fib-07 Pressure Sensitive Paint (PSP) have been conducted at NASA Ames on a NACA 0012 airfoil. Significant improvements in results have been shown: PSP calibration errors of the improved data (with pressure taps as a reference) now agree with theoretical error limits. Additional measurements on the 0012 airfoil using Temperature Sensitive Paint have been made. These TSP measurements now fully quantify the impact of temporal temperature changes on model surfaces on PSP measurements. Finally, simultaneous PSP - TSP measurements have been performed, allowing in-situ temperature correction of PSP data with good results.

75 FR 19670 - Notice of Availability of the Record of Decision for the I-65 to US 31W Access Improvement Final...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-15

...)] Notice of Availability of the Record of Decision for the I-65 to US 31W Access Improvement Final... implement the I-65 to US 31W Access Improvement project in Warren County, Kentucky. The Division... US 31W Access Improvement project can be viewed and downloaded from the project Web site at http...

Solving of the coefficient inverse problems for a nonlinear singularly perturbed reaction-diffusion-advection equation with the final time data

NASA Astrophysics Data System (ADS)

Lukyanenko, D. V.; Shishlenin, M. A.; Volkov, V. T.

2018-01-01

We propose the numerical method for solving coefficient inverse problem for a nonlinear singularly perturbed reaction-diffusion-advection equation with the final time observation data based on the asymptotic analysis and the gradient method. Asymptotic analysis allows us to extract a priory information about interior layer (moving front), which appears in the direct problem, and boundary layers, which appear in the conjugate problem. We describe and implement the method of constructing a dynamically adapted mesh based on this a priory information. The dynamically adapted mesh significantly reduces the complexity of the numerical calculations and improve the numerical stability in comparison with the usual approaches. Numerical example shows the effectiveness of the proposed method.

Rostral anterior cingulate cortex activity and early symptom improvement during treatment for major depressive disorder

PubMed Central

Korb, Alexander S.; Hunter, Aimee M.; Cook, Ian A.; Leuchter, Andrew F.

2011-01-01

In treatment trials for Major Depressive Disorder (MDD), early symptom improvement is predictive of eventual clinical response. Clinical response may also be predicted by elevated pretreatment theta (4-7 Hz) current density in the rostral anterior cingulate (rACC) and medial orbitofrontal cortex (mOFC). We investigated the relationship between pretreatment EEG and early improvement in predicting clinical outcome in 72 MDD subjects across three placebo-controlled treatment trials. Subjects were randomized to receive fluoxetine, venlafaxine, or placebo. Theta current density in the rACC and mOFC was computed with Low-Resolution Brain Electromagnetic Tomography (LORETA). An ANCOVA, examining week 8 Hamilton Depression Rating Scale (HamD) percent change, showed a significant effect of week-2-HamD-percent-change, and a significant three-way interaction of week-2-HamD-percent-change × Treatment × rACC. Medication subjects with robust early improvement showed almost no relationship between rACC theta current density and final clinical outcome. However, in subjects with little early improvement, rACC activity showed a strong relationship with clinical outcome. The model examining mOFC showed a trend in the three-way interaction. A combination of pretreatment rACC activity and early symptom improvement may be useful for predicting treatment response. PMID:21546222

Magnetic Field Applications in Semiconductor Crystal Growth and Metallurgy

NASA Technical Reports Server (NTRS)

Mazuruk, Konstantin; Ramachandran, Narayanan; Grugel, Richard; Curreri, Peter A. (Technical Monitor)

2002-01-01

The Traveling Magnetic Field (TMF) technique, recently proposed to control meridional flow in electrically conducting melts, is reviewed. In particular, the natural convection damping capability of this technique has been numerically demonstrated with the implication of significantly improving crystal quality. Advantages of the traveling magnetic field, in comparison to the more mature rotating magnetic field method, are discussed. Finally, results of experiments with mixing metallic alloys in long ampoules using TMF is presented

U.S.-Mexico Policy Coordination: An Assessment of the Twenty-First Century Border Policy Coordination Effort

DTIC Science & Technology

2011-10-28

FINAL 3. DATES COVERED (From - To) September 2011 – October 2011 4. TITLE AND SUBTITLE U.S. – MEXICO POLICY COORDINATION AN...national levels of both governments leading to significant inefficiency on issues related to the border. In 2010, the United States and Mexico ...effort to improve United States border policy coordination with Mexico . This paper assesses the effectiveness of the Twenty-First Century Border policy

Materials Research of Perovskite Thin Films for Uncooled Infrared (IR) Detectors

DTIC Science & Technology

2011-07-01

Today April 2010, 5 (2), 99–105. 4. Livingston, F. E.; Helvajian , H . Laser Processing Architecture for Improved Material Processing. in Laser...crystalline final perovskite (BaTiO3) in only 3 h , representing a significantly increased throughput compared to previous results using vapor...Plane Arrays; ARL-TR-5389; U.S. Army Research Laboratory: Adelphi, MD, November 2010. 5. Wemple, S. H . Phys. Rev. B 1970, 2, 2679. 6. Xu, J

Military Base Realignments and Closures: DOD Has Improved Environmental Cleanup Reporting but Should Obtain and Share More Information

DTIC Science & Technology

2017-01-01

the property, put final cleanup remedies in place before the property is transferred. However, under some circumstances the services may conduct an...early transfer before cleanup has been completed. When remedies are in place for addressing the contamination of a former installation or the...cleanup at BRAC installations will significantly increase due to the high cost of remediating emerging contaminants, primarily perfluorooctane

Outcome of modified Kidner procedure with subtalar arthroereisis for painful accessory navicular associated with planovalgus deformity.

PubMed

Garras, David N; Hansen, Patricia L; Miller, Adam G; Raikin, Steven Mark

2012-11-01

Type II accessory naviculars are frequently associated with planovalgus deformity. Operative treatment for patients recalcitrant to nonoperative treatment involves resection, with or without takedown, and reattachment of the tibialis posterior tendon as described by Kidner. This does not address the planovalgus deformity. The authors hypothesized that adding a subtalar arthroereisis to the Kidner procedure would lead to improvement of pain and function and correction of the deformity. Institutional Review Board-approved, prospectively collected data were reviewed for 20 patients (23 feet), who underwent a combined modified Kidner and subtalar arthroereisis for painful type II accessory navicular with planovalgus deformity recalcitrant to nonoperative treatment. The average age at the time of surgery was 18 years. Patients were evaluated preoperatively and at final follow-up clinically, radiographically, and via the visual analog pain scale (VAPS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and a satisfaction rating. Mean follow-up was 53.9 months. The mean AOFAS scores improved from 53 preoperatively to 95 at final follow-up and the mean VAPS score decreased from 7.4 preoperatively to 1.7 at final follow-up. Radiographically, the average Meary's angle improved from 18.5° apex plantar preoperatively to 3° apex plantar on weight-bearing lateral radiographs, and the average talar head uncoverage percentage on weight-bearing anteroposterior radiographs improved from 24% preoperatively to 3%. Nineteen of 20 patients reported good or excellent results. Three patients required implant removal because of pain; no recurrence of planovalgus deformity occurred after implant removal. No patients developed subtalar arthritis. The modified Kidner procedure combined with a subtalar arthroereisis resulted in significant pain and functional improvement. The deformity correction obtained at surgery was maintained even if the arthroereisis plug was removed. The extra-articular plug did not lead to subtalar arthritis.

Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study.

PubMed

Godeau, Emmanuelle; Vignes, Céline; Sentenac, Mariane; Ehlinger, Virginie; Navarro, Félix; Grandjean, Hélène; Arnaud, Catherine

2010-10-01

although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students' attitudes towards their disabled peers. the participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12-13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke-McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children's attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. seven hundred and eighty-four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), p<0.001; baseline 25.2 (5.4), final 26.0 (5.7), p<0.009) with no significant difference between the intervention and control groups. Individual score changes over time were associated with baseline score (p<0.001 for total and all sub-scores). Lower improvement in attitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (p<0.001), and behavioural (p=0.001) scores, while higher improvement existed for the cognitive domain (p=0.029). although we found no effect of our intervention, we found an improvement in attitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.

The effect of intensive speech rate and intonation therapy on intelligibility in Parkinson's disease.

PubMed

Martens, Heidi; Van Nuffelen, Gwen; Dekens, Tomas; Hernández-Díaz Huici, Maria; Kairuz Hernández-Díaz, Hector Arturo; De Letter, Miet; De Bodt, Marc

2015-01-01

Most studies on treatment of prosody in individuals with dysarthria due to Parkinson's disease are based on intensive treatment of loudness. The present study investigates the effect of intensive treatment of speech rate and intonation on the intelligibility of individuals with dysarthria due to Parkinson's disease. A one group pretest-posttest design was used to compare intelligibility, speech rate, and intonation before and after treatment. Participants included eleven Dutch-speaking individuals with predominantly moderate dysarthria due to Parkinson's disease, who received five one-hour treatment sessions per week during three weeks. Treatment focused on lowering speech rate and magnifying the phrase final intonation contrast between statements and questions. Intelligibility was perceptually assessed using a standardized sentence intelligibility test. Speech rate was automatically assessed during the sentence intelligibility test as well as during a passage reading task and a storytelling task. Intonation was perceptually assessed using a sentence reading task and a sentence repetition task, and also acoustically analyzed in terms of maximum fundamental frequency. After treatment, there was a significant improvement of sentence intelligibility (effect size .83), a significant increase of pause frequency during the passage reading task, a significant improvement of correct listener identification of statements and questions, and a significant increase of the maximum fundamental frequency in the final syllable of questions during both intonation tasks. The findings suggest that participants were more intelligible and more able to manipulate pause frequency and statement-question intonation after treatment. However, the relationship between the change in intelligibility on the one hand and the changes in speech rate and intonation on the other hand is not yet fully understood. Results are nuanced in the light of the operated research design. The reader will be able to: (1) describe the effect of intensive speech rate and intonation treatment on intelligibility of speakers with dysarthria due to PD, (2) describe the effect of intensive speech rate treatment on rate manipulation by speakers with dysarthria due to PD, and (3) describe the effect of intensive intonation treatment on manipulation of the phrase final intonation contrast between statements and questions by speakers with dysarthria due to PD. Copyright © 2015 Elsevier Inc. All rights reserved.

Improvement of the stability of hydroxyapatite through glass ceramic reinforcement.

PubMed

Ha, Na Ra; Yang, Zheng Xun; Hwang, Kyu Hong; Kim, Tae Suk; Lee, Jong Kook

2010-05-01

Hydroxyapatite has achieved significant application in orthopedic and dental implants due to its excellent biocompatibility. Sintered hydroxyapatites showed significant dissolution, however, after their immersion in water or simulated body fluid (SBF). This grain boundary dissolution, even in pure hydroxyapatites, resulted in grain separation at the surfaces, and finally, in fracture. In this study, hydroxyapatite ceramics containing apatite-wollastonite (AW) or calcium silicate (SG) glass ceramics as additives were prepared to prevent the dissolution. AW and SG glass ceramics were added at 0-7 wt% and powder-compacted uniaxially followed by firing at moisture conditions. The glass phase was incorporated into the hydroxyapatite to act as a sintering aid, followed by crystallization, to improve the mechanical properties without reducing the biocompatibility. As seen in the results of the dissolution test, a significant amount of damage was reduced even after more than 14 days. TEM and SEM showed no decomposition of HA to the secondary phase, and the fracture toughness increased, becoming even higher than that of the commercial hydroxyapatite.

Negative Emotions and Suicidal Ideation During Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment

PubMed Central

Kiosses, Dimitris N.; Gross, James J.; Banerjee, Samprit; Duberstein, Paul R.; Putrino, David; Alexopoulos, George S.

2017-01-01

Objectives To examine the relationship of negative emotions with suicidal ideation during 12-weeks of Problem Adaptation Therapy (PATH) vs. Supportive Therapy of Cognitively Impaired Older Adults (ST-CI). We hypothesize that: a) improved negative emotions are associated with reduced suicidal ideation; b) PATH improves negative emotions more than ST-CI; and c) improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation. Design RCT of two home-delivered psychosocial interventions. Setting Weill-Cornell Institute of Geriatric Psychiatry; interventions and assessments were conducted at participants’ home. Participants 74 older participants (65–95 years old) with MDD and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions PATH focuses on improving emotion regulation whereas ST-CI focuses on non-specific therapeutic factors, such as understanding and empathy. Measurements Improved negative emotions are measured as improvement in Montgomery Asberg’s Depression Rating Scales’ (MADRS) observer-ratings of sadness, anxiety, guilt, hopelessness and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item. Results MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F[1, 165]=12.73, p=0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F[1,63.2]=7.02, p=0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F[1, 96]=9.95, p=0.0022). Conclusions Our findings that improvement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation. PMID:28223082

Ponte osteotomies to treat major thoracic adolescent idiopathic scoliosis curves allow more effective corrective maneuvers.

PubMed

Pizones, Javier; Sánchez-Mariscal, Felisa; Zúñiga, Lorenzo; Izquierdo, Enrique

2015-07-01

There is controversy regarding the effect of the Ponte osteotomies in the improvement of coronal correction, its maintenance during follow-up, and the restoration of thoracic kyphosis in adolescent idiopathic scoliosis (AIS). Seventy-three AIS patients with Lenke type 1-4 curves were included. A prospective description of 43 consecutive patients who underwent apical Ponte osteotomies and sublaminar wires with hybrid instrumentation was retrospectively compared to a historical cohort of 30 patients without "Ponte osteotomies". The surgical details and complications were recorded. We evaluated the radiological measurements and SRS-22 Questionnaire scores over a 2-year follow-up. The Ponte group achieved better postoperative (70 vs 57 %) and final (62 vs 50 %) main curve correction P < 0.001, with no significant loss of correction (4.2° vs 2.5°) P = 0.2 at the final follow-up (48 vs 106 months). We did not find a difference in thoracic (T5-T12) postoperative (22° vs 24°) and final (25° vs 26°) mean kyphosis angle. However, the "Ponte osteotomies" helped to achieve a normal sagittal profile, increasing preoperative hypokyphotic curves (<10°) from 6° to 17° (control: 9°-12°; P = 0.01); and preoperative hyperkyphotic curves (>40°) from 52° to 26° (control: 46°-39°; P = 0.01). The length of surgery was similar (4.3 vs 4.6 h), as were the SRS-22 scores. No major complications were found. Ponte osteotomies in major thoracic AIS curves treated by sublaminar wires allowed more effective corrective maneuvers, which improved coronal correction without a significant loss during follow-up. The sagittal profile appears to be determined by other variables; however, "Ponte osteotomies" facilitate the contouring of the desired kyphosis.

Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma.

PubMed

Facon, Thierry; Dimopoulos, Meletios A; Dispenzieri, Angela; Catalano, John V; Belch, Andrew; Cavo, Michele; Pinto, Antonello; Weisel, Katja; Ludwig, Heinz; Bahlis, Nizar J; Banos, Anne; Tiab, Mourad; Delforge, Michel; Cavenagh, Jamie D; Geraldes, Catarina; Lee, Je-Jung; Chen, Christine; Oriol, Albert; De La Rubia, Javier; White, Darrell; Binder, Daniel; Lu, Jin; Anderson, Kenneth C; Moreau, Philippe; Attal, Michel; Perrot, Aurore; Arnulf, Bertrand; Qiu, Lugui; Roussel, Murielle; Boyle, Eileen; Manier, Salomon; Mohty, Mohamad; Avet-Loiseau, Herve; Leleu, Xavier; Ervin-Haynes, Annette; Chen, Guang; Houck, Vanessa; Benboubker, Lotfi; Hulin, Cyrille

2018-01-18

This FIRST trial final analysis examined survival outcomes in patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) treated with lenalidomide and low-dose dexamethasone until disease progression (Rd continuous), Rd for 72 weeks (18 cycles; Rd18), or melphalan, prednisone, and thalidomide (MPT; 72 weeks). The primary endpoint was progression-free survival (PFS; primary comparison: Rd continuous vs MPT). Overall survival (OS) was a key secondary endpoint (final analysis prespecified ≥60 months' follow-up). Patients were randomized to Rd continuous (n = 535), Rd18 (n = 541), or MPT (n = 547). At a median follow-up of 67 months, PFS was significantly longer with Rd continuous vs MPT (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.59-0.79; P < .00001) and was similarly extended vs Rd18. Median OS was 10 months longer with Rd continuous vs MPT (59.1 vs 49.1 months; HR, 0.78; 95% CI, 0.67-0.92; P = .0023), and similar with Rd18 (62.3 months). In patients achieving complete or very good partial responses, Rd continuous had an ≈30-month longer median time to next treatment vs Rd18 (69.5 vs 39.9 months). Over half of all patients who received second-line treatment were given a bortezomib-based therapy. Second-line outcomes were improved in patients receiving bortezomib after Rd continuous and Rd18 vs after MPT. No new safety concerns, including risk for secondary malignancies, were observed. Treatment with Rd continuous significantly improved survival outcomes vs MPT, supporting Rd continuous as a standard of care for patients with transplant-ineligible NDMM. This trial was registered at www.clinicaltrials.gov as #NCT00689936 and EudraCT as 2007-004823-39. © 2018 by The American Society of Hematology.

Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma

PubMed Central

Dimopoulos, Meletios A.; Dispenzieri, Angela; Catalano, John V.; Belch, Andrew; Cavo, Michele; Pinto, Antonello; Weisel, Katja; Ludwig, Heinz; Bahlis, Nizar J.; Banos, Anne; Tiab, Mourad; Delforge, Michel; Cavenagh, Jamie D.; Geraldes, Catarina; Lee, Je-Jung; Chen, Christine; Oriol, Albert; De La Rubia, Javier; White, Darrell; Binder, Daniel; Lu, Jin; Anderson, Kenneth C.; Moreau, Philippe; Attal, Michel; Perrot, Aurore; Arnulf, Bertrand; Qiu, Lugui; Roussel, Murielle; Boyle, Eileen; Manier, Salomon; Mohty, Mohamad; Avet-Loiseau, Herve; Leleu, Xavier; Ervin-Haynes, Annette; Chen, Guang; Houck, Vanessa; Benboubker, Lotfi; Hulin, Cyrille

2018-01-01

This FIRST trial final analysis examined survival outcomes in patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) treated with lenalidomide and low-dose dexamethasone until disease progression (Rd continuous), Rd for 72 weeks (18 cycles; Rd18), or melphalan, prednisone, and thalidomide (MPT; 72 weeks). The primary endpoint was progression-free survival (PFS; primary comparison: Rd continuous vs MPT). Overall survival (OS) was a key secondary endpoint (final analysis prespecified ≥60 months’ follow-up). Patients were randomized to Rd continuous (n = 535), Rd18 (n = 541), or MPT (n = 547). At a median follow-up of 67 months, PFS was significantly longer with Rd continuous vs MPT (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.59-0.79; P < .00001) and was similarly extended vs Rd18. Median OS was 10 months longer with Rd continuous vs MPT (59.1 vs 49.1 months; HR, 0.78; 95% CI, 0.67-0.92; P = .0023), and similar with Rd18 (62.3 months). In patients achieving complete or very good partial responses, Rd continuous had an ≈30-month longer median time to next treatment vs Rd18 (69.5 vs 39.9 months). Over half of all patients who received second-line treatment were given a bortezomib-based therapy. Second-line outcomes were improved in patients receiving bortezomib after Rd continuous and Rd18 vs after MPT. No new safety concerns, including risk for secondary malignancies, were observed. Treatment with Rd continuous significantly improved survival outcomes vs MPT, supporting Rd continuous as a standard of care for patients with transplant-ineligible NDMM. This trial was registered at www.clinicaltrials.gov as #NCT00689936 and EudraCT as 2007-004823-39. PMID:29150421

The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial.

PubMed

Andersen, Steven Arild Wuyts; Mikkelsen, Peter Trier; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten

2016-01-01

Cognitive overload can inhibit learning, and cognitive load theory-based instructional design principles can be used to optimize learning situations. This study aims to investigate the effect of implementing cognitive load theory-based design principles in virtual reality simulation training of mastoidectomy. Eighteen novice medical students received 1 h of self-directed virtual reality simulation training of the mastoidectomy procedure randomized for standard instructions (control) or cognitive load theory-based instructions with a worked example followed by a problem completion exercise (intervention). Participants then completed two post-training virtual procedures for assessment and comparison. Cognitive load during the post-training procedures was estimated by reaction time testing on an integrated secondary task. Final-product analysis by two blinded expert raters was used to assess the virtual mastoidectomy performances. Participants in the intervention group had a significantly increased cognitive load during the post-training procedures compared with the control group (52 vs. 41 %, p  = 0.02). This was also reflected in the final-product performance: the intervention group had a significantly lower final-product score than the control group (13.0 vs. 15.4, p  < 0.005). Initial instruction using worked examples followed by a problem completion exercise did not reduce the cognitive load or improve the performance of the following procedures in novices. Increased cognitive load when part tasks needed to be integrated in the post-training procedures could be a possible explanation for this. Other instructional designs and methods are needed to lower the cognitive load and improve the performance in virtual reality surgical simulation training of novices.

PconsFold: improved contact predictions improve protein models.

PubMed

Michel, Mirco; Hayat, Sikander; Skwark, Marcin J; Sander, Chris; Marks, Debora S; Elofsson, Arne

2014-09-01

Recently it has been shown that the quality of protein contact prediction from evolutionary information can be improved significantly if direct and indirect information is separated. Given sufficiently large protein families, the contact predictions contain sufficient information to predict the structure of many protein families. However, since the first studies contact prediction methods have improved. Here, we ask how much the final models are improved if improved contact predictions are used. In a small benchmark of 15 proteins, we show that the TM-scores of top-ranked models are improved by on average 33% using PconsFold compared with the original version of EVfold. In a larger benchmark, we find that the quality is improved with 15-30% when using PconsC in comparison with earlier contact prediction methods. Further, using Rosetta instead of CNS does not significantly improve global model accuracy, but the chemistry of models generated with Rosetta is improved. PconsFold is a fully automated pipeline for ab initio protein structure prediction based on evolutionary information. PconsFold is based on PconsC contact prediction and uses the Rosetta folding protocol. Due to its modularity, the contact prediction tool can be easily exchanged. The source code of PconsFold is available on GitHub at https://www.github.com/ElofssonLab/pcons-fold under the MIT license. PconsC is available from http://c.pcons.net/. Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press.

Assessment of global precipitation measurement satellite products over Saudi Arabia

NASA Astrophysics Data System (ADS)

Mahmoud, Mohammed T.; Al-Zahrani, Muhammad A.; Sharif, Hatim O.

2018-04-01

Most hydrological analysis and modeling studies require reliable and accurate precipitation data for successful simulations. However, precipitation measurements should be more representative of the true precipitation distribution. Many approaches and techniques are used to collect precipitation data. Recently, hydrometeorological and climatological applications of satellite precipitation products have experienced a significant improvement with the emergence of the latest satellite products, namely, the Integrated Multi-satellitE Retrievals for Global Precipitation Measurement (GPM) mission (IMERG) products, which can be utilized to estimate and analyze precipitation data. This study focuses on the validation of the IMERG early, late and final run rainfall products using ground-based rain gauge observations throughout Saudi Arabia for the period from October 2015 to April 2016. The accuracy of each IMERG product is assessed using six statistical performance measures to conduct three main evaluations, namely, regional, event-based and station-based evaluations. The results indicate that the early run product performed well in the middle and eastern parts as well as some of the western parts of the country; meanwhile, the satellite estimates for the other parts fluctuated between an overestimation and an underestimation. The late run product showed an improved accuracy over the southern and western parts; however, over the northern and middle parts, it showed relatively high errors. The final run product revealed significantly improved precipitation estimations and successfully obtained higher accuracies over most parts of the country. This study provides an early assessment of the performance of the GPM satellite products over the Middle East. The study findings can be used as a beneficial reference for the future development of the IMERG algorithms.

Operations research methods improve chemotherapy patient appointment scheduling.

PubMed

Santibáñez, Pablo; Aristizabal, Ruben; Puterman, Martin L; Chow, Vincent S; Huang, Wenhai; Kollmannsberger, Christian; Nordin, Travis; Runzer, Nancy; Tyldesley, Scott

2012-12-01

Clinical complexity, scheduling restrictions, and outdated manual booking processes resulted in frequent clerical rework, long waitlists for treatment, and late appointment notification for patients at a chemotherapy clinic in a large cancer center in British Columbia, Canada. A 17-month study was conducted to address booking, scheduling and workload issues and to develop, implement, and evaluate solutions. A review of scheduling practices included process observation and mapping, analysis of historical appointment data, creation of a new performance metric (final appointment notification lead time), and a baseline patient satisfaction survey. Process improvement involved discrete event simulation to evaluate alternative booking practice scenarios, development of an optimization-based scheduling tool to improve scheduling efficiency, and change management for implementation of process changes. Results were evaluated through analysis of appointment data, a follow-up patient survey, and staff surveys. Process review revealed a two-stage scheduling process. Long waitlists and late notification resulted from an inflexible first-stage process. The second-stage process was time consuming and tedious. After a revised, more flexible first-stage process and an automated second-stage process were implemented, the median percentage of appointments exceeding the final appointment notification lead time target of one week was reduced by 57% and median waitlist size decreased by 83%. Patient surveys confirmed increased satisfaction while staff feedback reported reduced stress levels. Significant operational improvements can be achieved through process redesign combined with operations research methods.

Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone.

PubMed

Maddocks, I; Somogyi, A; Abbott, F; Hayball, P; Parker, D

1996-09-01

We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. Thirteen patients completed the study. Statistically significant improvements in mental state and nausea and vomiting occurred following a change from morphine to oxycodone. Pain scores improved but did not reach a level of statistical significance. The phenotype status of the patients was tested to establish their capacity to metabolize oxycodone. One patient who did not achieve adequate pain control proved to be a poor metabolizer. These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days. A small proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.

Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial.

PubMed

Doi, Marcelo Yugi; Tano, Simone Sayomi; Schultz, Adriane Rocha; Borges, Ricardo; Marchiori, Luciana Lozza de Moraes

2016-01-01

Tinnitus is a subjective sensation of hearing a sound in the absence of an external stimulus, which significantly worsens the quality of life in 15-25% of affected individuals. To assess the effectiveness of acupuncture therapy for tinnitus. Randomized clinical trial ( 2T9T7Q) with 50 participants with tinnitus, divided into two groups: 25 participants in the acupuncture group and 25 participants in the control group. The acupuncture group received acupuncture treatment and the control group received no treatment. After a period of 5 weeks, they were called to perform the final evaluation and the control group received acupuncture treatment for ethical reasons. A statistically significant result was found for the primary outcome, reducing the intensity of tinnitus, with p=0.0001 and the secondary endpoint, showing improvement in quality of life, with p=0.0001. Chinese scalp acupuncture associated with bilateral electroacupuncture demonstrated, in the short term, a statistically significant improvement by reducing the level of tinnitus intensity, as well as improving the quality of life of individuals with tinnitus. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Low Vision Rehabilitation for Adult African Americans in Two Settings.

PubMed

Draper, Erin M; Feng, Rui; Appel, Sarah D; Graboyes, Marcy; Engle, Erin; Ciner, Elise B; Ellenberg, Jonas H; Stambolian, Dwight

2016-07-01

The Vision Rehabilitation for African Americans with Central Vision Impairment (VISRAC) study is a demonstration project evaluating how modifications in vision rehabilitation can improve the use of functional vision. Fifty-five African Americans 40 years of age and older with central vision impairment were randomly assigned to receive either clinic-based (CB) or home-based (HB) low vision rehabilitation services. Forty-eight subjects completed the study. The primary outcome was the change in functional vision in activities of daily living, as assessed with the Veteran's Administration Low-Vision Visual Function Questionnaire (VFQ-48). This included scores for overall visual ability and visual ability domains (reading, mobility, visual information processing, and visual motor skills). Each score was normalized into logit estimates by Rasch analysis. Linear regression models were used to compare the difference in the total score and each domain score between the two intervention groups. The significance level for each comparison was set at 0.05. Both CB and HB groups showed significant improvement in overall visual ability at the final visit compared with baseline. The CB group showed greater improvement than the HB group (mean of 1.28 vs. 0.87 logits change), though the group difference is not significant (p = 0.057). The CB group visual motor skills score showed significant improvement over the HB group score (mean of 3.30 vs. 1.34 logits change, p = 0.044). The differences in improvement of the reading and visual information processing scores were not significant (p = 0.054 and p = 0.509) between groups. Neither group had significant improvement in the mobility score, which was not part of the rehabilitation program. Vision rehabilitation is effective for this study population regardless of location. Possible reasons why the CB group performed better than the HB group include a number of psychosocial factors as well as the more standardized distraction-free work environment within the clinic setting.

Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial.

PubMed

Raman, Renukanth Patabi Cheta; Taiyeb-Ali, Tara Bai; Chan, Siew Pheng; Chinna, Karuthan; Vaithilingam, Rathna Devi

2014-06-25

40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. 15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012). NSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels. ClinicalTrials.gov: NCT01951547.

Improved nurse job satisfaction and job retention with the transition from a "mandatory consultation" model to a "semiclosed" surgical intensive care unit: a 1-year prospective evaluation.

PubMed

Haut, Elliott R; Sicoutris, Corinna P; Meredith, Denise M; Sonnad, Seema S; Reilly, Patrick M; Schwab, C William; Hanson, C William; Gracias, Vicente H

2006-02-01

The change from a "mandatory consultation" to a "semiclosed" surgical intensive care unit (SICU) model will impact nurses considerably. We hypothesize that nurse job satisfaction, job turnover rates, and hospital costs for temporary agency nurses will improve and these improvements will be more dramatic in SICU sections with greater involvement of a dedicated surgical critical care service (SCCS). Prospective longitudinal survey. Tertiary-care university hospital. SICU staff nurses. Change from mandatory consultation to semiclosed SICU. We surveyed SICU nurses during the year-long transition to a semiclosed SICU service (five time points, 3-month intervals). The first four surveys included ten questions on nurse job satisfaction. The final survey included two additional questions. All questions were on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Nurse job turnover rates and money spent on agency nurses were compared over time; 503 of a possible 914 surveys were completed (55% overall return rate). Nurse job satisfaction scores significantly improved over time for all questions (p < .05). Hospital spending on agency nurses decreased significantly (p = .0098). The yearly nurse job turnover rate dropped from 25% to 16% (p = .15). The scores for both year-end statements ("I am more satisfied with my job now than 1 year ago" and "The SCCS management of all orders has improved my job satisfaction") were significantly higher in sections with greater SCCS involvement (p = .0070 and p < .0001). Nurse job satisfaction improved significantly with the transition to a semiclosed SICU. This higher satisfaction was associated with a significant decrease in spending on temporary agency nurses and a trend toward increased staff nurse job retention. SICU sections with greater SCCS involvement had more dramatic improvements. This semiclosed SICU model may help retain SICU nurses in a competitive job market in which experienced nurses are in short supply.

Improving balance skills in patients who had stroke through virtual reality treadmill training.

PubMed

Yang, Saiwei; Hwang, Wei-Hsung; Tsai, Yi-Ching; Liu, Fu-Kang; Hsieh, Lin-Fen; Chern, Jen-Suh

2011-12-01

The aim of this study was to evaluate the effects of virtual reality (VR) treadmill training on the balance skills of patients who have had a stroke. A total of 14 patients with strokes were recruited and randomly assigned to receive VR treadmill or traditional treadmill training. The outcome measures that were included for the study were center of pressure (COP) sway excursion, COP maximum sway in anterior-posterior direction, COP maximum sway in medial-lateral direction, COP sway area, bilateral limb-loading symmetric index, the sway excursion values for the paretic foot (sway excursion/P), paretic limb stance time (stance time/P), number of steps of the paretic limb (number of steps/P), and contact area of the paretic foot (contact A/P) during quiet stance, sit-to-stand transfer, and level walking. There were no significant improvements in COP-related measures and symmetric index during the quiet stance, either in the VR treadmill or traditional treadmill training group (P > 0.05). However, the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant (P = 0.038). Traditional treadmill training failed to improve sit-to-stand performance, whereas VR treadmill training improved symmetric index (P = 0.028) and sway excursion (P = 0.046) significantly during sit-to-stand transfer. The changes of symmetric index between groups were markedly different (P = 0.045). Finally, both groups improved significantly in stance time/P, but only VR treadmill training increased contact A/P (P = 0.034) after training during level walking. The difference between groups during level walking was not significant. Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance, but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did. VR treadmill training also improved balance skill during sit-to-stand transfers and the involvement of paretic limb in level walking more than the traditional one did.

Color management of porcelain veneers: influence of dentin and resin cement colors.

PubMed

Dozic, Alma; Tsagkari, Maria; Khashayar, Ghazal; Aboushelib, Moustafa

2010-01-01

Porcelain veneers have become an interesting treatment option to correct the shape and color of anterior teeth. Because of their limited thickness and high translucency, achieving a good color match is influenced by several variables. The aim of this work was to investigate the influence of natural dentin and resin cement colors on final color match of porcelain veneers. A preselected shade tab (A1) was chosen as the target color for a maxillary central incisor, and its color parameters (L*a*b*) were measured using a digital spectrophotometer (SpectroShade, MHT). Nine natural dentin colors (Natural Die Material, Ivoclar Vivadent) representing a wide range of tooth colors were used to prepare resin replicas of the maxillary central incisor with a standard preparation for porcelain veneers. The prepared porcelain veneers (IPS Empress Esthetic, A1, 0.6 mm thick, Ivoclar Vivadent) were cemented on the resin dies (nine groups of natural dentin colors) using seven shades of resin cement (Variolink Veneers, Ivoclar Vivadent). The L*a*b* values of the cemented veneers were measured, and DE values were calculated against the preselected target color (A1). DE greater than 3.3 was considered as a significant color mismatch detectable by the human eye. The seven shades of resin cement had no significant influence on the final color of the veneers, as the measured DE values were almost identical for every test group. On the other hand, the color of natural dentin was a significant factor that influenced final color match. None of the 63 tested combinations (nine natural dentin colors and seven resin cement colors) produced an acceptable color match. Thin porcelain veneers cannot mask underlying tooth color even when different shades of resin cement are used. Incorporation of opaque porcelain (high chroma) may improve final color match.

Clinical Effects of Posterior Limited Long-Segment Pedicle Instrumentation for the Treatment of Thoracolumbar Fractures.

PubMed

Liang, Chengmin; Liu, Bin; Zhang, Wei; Yu, Haiyang; Cao, Jie; Yin, Wen

2018-06-01

The purpose of this study was to assess the clinical effects of treating thoracolumbar fractures with posterior limited long-segment pedicle instrumentation (LLSPI). A total of 58 thoracolumbar fracture patients were retrospectively analyzed, including 31 cases that were fixed by skipping the fractured vertebra with 6 screws using LLSPI and 27 cases that were fixed by skipping the fractured vertebra with 4 screws using short-segment pedicle instrumentation (SSPI). Surgery time, blood loss, hospital stay, Oswestry disability index (ODI), neurological function, sagittal kyphotic Cobb angle (SKA), percentage of anterior vertebral height (PAVH), instrumentation failure, and the loss of SKA and PAVH were recorded before and after surgery. No significant differences were observed in either the surgery time or hospital stay (P < 0.05), while there were significant differences in blood loss between the two groups. At the final follow-up, both the ODI and the neurological status were notably improved compared to those at the preoperative state (P < 0.05), but the difference between the two groups was relatively small. Furthermore, the SKA and PAVH were notably improved at the final follow-up compared to postoperative values (P < 0.05), but no significant difference was observed between the two groups. During long-term follow-up, the loss of SKA and PAVH in the LLSPI group was significantly less than that in the SSPI group (P < 0.05). Based on strict criteria for data collection and analysis, the clinical effects of LLSPI for the treatment of thoracolumbar fractures were satisfactory, especially for maintaining the height of the fractured vertebra and reducing the loss of SKA and instrumentation failure rates.

A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study.

PubMed

Petersen, I; Hanass Hancock, J; Bhana, A; Govender, K

2014-04-01

Co-morbid depression in HIV-positive patients on anti-retroviral (ART) treatment poses a public health threat. It compromises treatment adherence and accelerates disease progression. This study aimed to assess the feasibility of a group-based counselling intervention for depressed HIV-positive patients in primary health care (PHC) in South Africa using a task shifting approach. Using a randomized control design, 76 HIV-positive patients with co-morbid depression were initially recruited. This reduced to 34 in the final cohort. Participants were assessed using the Patient Health Questionnaire (PHQ9), Hopkins Symptom Checklist (HSCL-25) and Multidimensional Scale of Perceived Social Support (MSPSS) at baseline and 3-month follow-up. The intervention was adapted from a local group-based Interpersonal Therapy (IPT) intervention. Process evaluation interviews were held with the HIV counsellors who delivered the intervention and a sub-sample of participants. Repeated measures ANOVA analysis showed significantly greater improvement on depression scores on the PHQ9 in the intervention group compared to the control group. A significant decline in the mean scores on the HSCL-25 was found for both groups although this was more pronounced for the intervention group. There was no significant improvement in the MSPSS scores. The small sample size of the final cohort affected the power of the study to detect significant differences between the intervention and control groups on the MSPSS. Longer term impact of the intervention is unknown. These preliminary findings suggest that group-based counselling for depression in HIV-positive patients can potentially be effectively delivered by appropriately trained and supported lay HIV counsellors. The need for a larger trial is indicated. Copyright © 2014 Elsevier B.V. All rights reserved.

VIDEO BLOGGING AND ENGLISH PRESENTATION PERFORMANCE: A PILOT STUDY.

PubMed

Alan Hung, Shao-Ting; Danny Huang, Heng-Tsung

2015-10-01

This study investigated the utility of video blogs in improving EFL students' performance in giving oral presentations and, further, examined the students' perceptions toward video blogging. Thirty-six English-major juniors participated in a semester-long video blog project for which they uploaded their 3-min. virtual presentation clips over 18 weeks. Their virtual presentation clips were rated by three raters using a scale for speaking performance that contained 14 presentation skills. Data sources included presentation clips, reflections, and interviews. The results indicated that the students' overall presentation performance improved significantly. In particular, among the 14 presentation skills projection, intonation, posture, introduction, conclusion, and purpose saw the most substantial improvement. Finally, the qualitative data revealed that learners perceived that the video blog project facilitated learning but increased anxiety.

[Repeated body position change training can improve human head-down tilt tolerance].

PubMed

Wu, Bin; Wu, Ping; Xue, Yue-Ying; Liu, Xing-Hua; Wang, Yan-Lei; Jiang, Shi-Zhong

2008-02-01

To verify the hypothesis that repeated body position change training can improve human head-down tilt (HDT) tolerance. Six young healthy subjects were trained with repeated position change for 9 times and 11 days according to protocol of alternative head-down and head-up tilts, each time of training lasted for about 35 min. Their HDT tolerance (- 30 degrees/30 min) were determined before and after training. (1) Compared with the data before training, subjects' symptom scores during HDT test after training decreased significantly (6.00 +/- 3.79 vs 1.00 +/- 0.63, P < 0.05), magnitude of the decreased heart rate increased significantly (-0.6 +/- 2.5 vs -4.4 +/- 3.6, P < 0.01). (2) Before training, blood flow volume of internal jugular vein (IJV) during HDT decreased significantly and that of internal carotid artery (ICA) increased significantly at the beginning period of HDT compared with pre-HDT (P < 0.01), while blood flow volume of the common carotid artery (CCA) presented increasing trend. After training, there was no significant difference in blood flow volume of IJV between during HDT and pre-HDT, that of ICA and CCA presented decreasing trend in the final period of HDT compared with Pre-HDT. Repeated body position change training can improve human head-down tilt tolerance. And its main causation is that headward shift of blood volume is restrained to some extend during HDT after training.

A Final Approach Trajectory Model for Current Operations

NASA Technical Reports Server (NTRS)

Gong, Chester; Sadovsky, Alexander

2010-01-01

Predicting accurate trajectories with limited intent information is a challenge faced by air traffic management decision support tools in operation today. One such tool is the FAA's Terminal Proximity Alert system which is intended to assist controllers in maintaining safe separation of arrival aircraft during final approach. In an effort to improve the performance of such tools, two final approach trajectory models are proposed; one based on polynomial interpolation, the other on the Fourier transform. These models were tested against actual traffic data and used to study effects of the key final approach trajectory modeling parameters of wind, aircraft type, and weight class, on trajectory prediction accuracy. Using only the limited intent data available to today's ATM system, both the polynomial interpolation and Fourier transform models showed improved trajectory prediction accuracy over a baseline dead reckoning model. Analysis of actual arrival traffic showed that this improved trajectory prediction accuracy leads to improved inter-arrival separation prediction accuracy for longer look ahead times. The difference in mean inter-arrival separation prediction error between the Fourier transform and dead reckoning models was 0.2 nmi for a look ahead time of 120 sec, a 33 percent improvement, with a corresponding 32 percent improvement in standard deviation.

Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain.

PubMed

Mata-Cases, M; Roura-Olmeda, P; Berengué-Iglesias, M; Birulés-Pons, M; Mundet-Tuduri, X; Franch-Nadal, J; Benito-Badorrey, B; Cano-Pérez, J F

2012-03-01

To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia. Sequential cross-sectional studies were performed during 1993-2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals. Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA(1c) (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA(1c) ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed. Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia. © 2012 Blackwell Publishing Ltd.

Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain

PubMed Central

Mata-Cases, M; Roura-Olmeda, P; Berengué-Iglesias, M; Birulés-Pons, M; Mundet-Tuduri, X; Franch-Nadal, J; Benito-Badorrey, B; Cano-Pérez, J F

2012-01-01

Aims To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia. Methods Sequential cross-sectional studies were performed during 1993–2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals. Results Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA1c (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA1c ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed. Conclusions Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia. PMID:22340449

A randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of the extended-release tramadol hydrochloride/acetaminophen fixed-dose combination tablet for the treatment of chronic low back pain.

PubMed

Lee, Jae Hyup; Lee, Chong-Suh

2013-11-01

Chronic low back pain is a common condition that is often difficult to treat. The combination of tramadol hydrochloride and acetaminophen in an extended-release formulation has been shown to provide rapid and long-lasting analgesic effects resulting from the synergistic activity of these 2 active ingredients. The goal of this study was to evaluate the efficacy and safety of extended-release tramadol hydrochloride 75-mg/acetaminophen 650-mg fixed-dose combination tablets (TA-ER) for the treatment of chronic low back pain. This Phase III, double-blind, placebo-controlled, parallel-group study enrolled 245 patients with moderate to severe (≥4 cm on a 10-cm visual analog scale) chronic (≥3 months') low back pain insufficiently controlled by previous NSAIDs or cyclooxygenase-2-selective inhibitors and randomly assigned them to receive 4 weeks of either TA-ER or placebo. The primary efficacy end point was the percentage of patients with a pain intensity change rate ≥30% from baseline to final evaluation. Secondary end points included quality of life (Korean Short Form-36), functionality (Korean Oswestry Disability Index), and adverse events. The percentage of patients with a pain intensity change rate ≥30% was significantly higher (P < 0.05) in the TA-ER group than in the placebo group for both the full analysis set and the per-protocol population. Pain relief success rate from baseline was significantly higher with TA-ER versus placebo at days 8 and 15 but not at the final visit. Patients in the TA-ER group had significant improvements versus placebo in role-physical, general health, and reported health transition domains of the Korean Short Form-36 and significantly higher functional improvements in the personal care section of the Korean Oswestry Disability Index. Patient assessment of overall pain control as "very good" was also significantly higher with TA-ER than with placebo. Adverse events were reported more frequently with TA-ER than with placebo; the most common adverse events reported were nausea, dizziness, constipation, and vomiting. TA-ER was significantly more effective than placebo in providing pain relief, functional improvements, and improved quality of life. It exhibited a predictable safety profile in patients with chronic low back pain. ClinicalTrials.gov identifier: NCT01112267. © 2013 The Authors. Published by Elsevier HS Journals, Inc. All rights reserved.

Using Mind Maps to Improve Medical Student Performance in a Pharmacology Course at Kunming Medical University.

PubMed

Ying, Guo; Jianping, Xie; Haiyun, Luo; Xia, Li; Jianyu, Yang; Qun, Xuan; Jianyun, Yu

2017-07-01

To determine whether students using mind maps would improve their performance in a final examination at the end of lecture-based pharmacology course. Aquasi-experimental study. Kunming Medical University, from September 2014 to January 2015. One hundred and twenty-two (122) third year undergraduate medical students, starting a 48-hour lecturebased pharmacology course, volunteered to use mind maps as one of their study strategies (intervention group), while the remaining 100 students in the class continued to use their usual study strategies (control group) over the duration of the course. The performance of both groups in the final course examination was compared. Students in the intervention group also completed a questionnaire on the usefulness of mind maps during the course and in preparation for the final examination. The students' performance of intervention group was superior to performance of the control group in all parts of a multi-modal final examination. For the multiple choice questions and comprehensive scores, average marks of 45.97 ±7.22 and 68.07 ±12.77, respectively were acquired by the control group, and 51.77 ±4.95 (p<0.01) and 80.05 ±7.54 (p<0.01), respectively by the intervention group. The median IQR scores for "filling in the blanks" questions, short answers questions and case analyses, were 6.00 (6.00), 8.00 (3.50), 8.75 (5.88), respectively for the control group, and were all significantly higher at 8.00 (4.00) (p=0.024), 10.00 (2.00) (p<0.001), and 11.00 (3.25) (p=0.002), respectively for the interventiongroup. Questionnaire responses showed that 95.45% thought that mind maps helped them to prepare more efficiently for the final exam; 90.91% believed that mind maps helped them to better understand all of pharmacology. Ninety-one percent also thought that mind maps would help them to better understand other disciplines, and 86.36% students would like the lecturers to utilize mind mapping as an alternative to conventional teaching formats, such as the use of Power Point. The addition of mind maps to students' study of pharmacology at Kunming Medical University improved their performance in all aspects of a multi-modal final examination.

Rolling scheduling of electric power system with wind power based on improved NNIA algorithm

NASA Astrophysics Data System (ADS)

Xu, Q. S.; Luo, C. J.; Yang, D. J.; Fan, Y. H.; Sang, Z. X.; Lei, H.

2017-11-01

This paper puts forth a rolling modification strategy for day-ahead scheduling of electric power system with wind power, which takes the operation cost increment of unit and curtailed wind power of power grid as double modification functions. Additionally, an improved Nondominated Neighbor Immune Algorithm (NNIA) is proposed for solution. The proposed rolling scheduling model has further improved the operation cost of system in the intra-day generation process, enhanced the system’s accommodation capacity of wind power, and modified the key transmission section power flow in a rolling manner to satisfy the security constraint of power grid. The improved NNIA algorithm has defined an antibody preference relation model based on equal incremental rate, regulation deviation constraints and maximum & minimum technical outputs of units. The model can noticeably guide the direction of antibody evolution, and significantly speed up the process of algorithm convergence to final solution, and enhance the local search capability.

Development of an improved GTA (gas tungsten arc) weld temperature monitor fixture

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

Hollar, D.L.

1990-05-01

An initial design weld temperature control fixture was implemented into final closure of an electronic assembly in November 1986. Use of this fixture indicated several areas that could be improved. Review of these areas with the process engineer and the weld operator provided the ideas to be incorporated into the new design Phase 2 fixture. Some primary areas of change and improvement included fixture mobility to provide better accessibility to the weld joint area, automatic timed blow cooling of the weld joint, and a feature to assure proper thermocouple placement. The resulting Phase 2 fixture design provided all of themore » essential weld temperature monitoring features in addition to several significant improvements. Technology developed during this project will pave the way to similar process monitoring of other manual gas tungsten arc (GTA) welding applications. 9 figs.« less

Extracellular space preservation aids the connectomic analysis of neural circuits.

PubMed

Pallotto, Marta; Watkins, Paul V; Fubara, Boma; Singer, Joshua H; Briggman, Kevin L

2015-12-09

Dense connectomic mapping of neuronal circuits is limited by the time and effort required to analyze 3D electron microscopy (EM) datasets. Algorithms designed to automate image segmentation suffer from substantial error rates and require significant manual error correction. Any improvement in segmentation error rates would therefore directly reduce the time required to analyze 3D EM data. We explored preserving extracellular space (ECS) during chemical tissue fixation to improve the ability to segment neurites and to identify synaptic contacts. ECS preserved tissue is easier to segment using machine learning algorithms, leading to significantly reduced error rates. In addition, we observed that electrical synapses are readily identified in ECS preserved tissue. Finally, we determined that antibodies penetrate deep into ECS preserved tissue with only minimal permeabilization, thereby enabling correlated light microscopy (LM) and EM studies. We conclude that preservation of ECS benefits multiple aspects of the connectomic analysis of neural circuits.

Performance of structured lipids incorporating selected phenolic and ascorbic acids.

PubMed

Gruczynska, Eliza; Przybylski, Roman; Aladedunye, Felix

2015-04-15

Conditions applied during frying require antioxidant which is stable at these conditions and provides protection for frying oil and fried food. Novel structured lipids containing nutraceuticals and antioxidants were formed by enzymatic transesterification, exploring canola oil and naturally occurring antioxidants such as ascorbic and selected phenolic acids as substrates. Lipozyme RM IM lipase from Rhizomucor miehei was used as biocatalyst. Frying performance and oxidative stability of the final transesterification products were evaluated. The novel lipids showed significantly improved frying performance compared to canola oil. Oxidative stability assessment of the structured lipids showed significant improvement in resistance to oxidative deterioration compared to original canola oil. Interestingly, the presence of ascorbic acid in an acylglycerol structure protected α-tocopherol against thermal degradation, which was not observed for the phenolic acids. Developed structured lipids containing nutraceuticals and antioxidants may directly affect nutritional properties of lipids also offering nutraceutical ingredients for food formulation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review

PubMed Central

Bliddal, H; Leeds, A R; Christensen, R

2014-01-01

Obesity is widely acknowledged as a risk factor for both the incidence and progression of osteoarthritis, and has a negative influence on outcomes. Loss of at least 10& of body weight, coupled with exercise, is recognized as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health-related quality of life. However, questions still remain surrounding optimal management. Given the significant health, social and economic burden of osteoarthritis, especially in obese patients, it is imperative to advance our knowledge of osteoarthritis and obesity, and apply this to improving care and outcomes. This paper overviews what is already known about osteoarthritis and obesity, discusses current key challenges and ongoing hypotheses arising from research in these areas, and finally, postulates what the future may hold in terms of new horizons for obese patients with osteoarthritis. PMID:24751192

Improving the radiation hardness of graphene field effect transistors

DOE PAGES

Alexandrou, Konstantinos; Masurkar, Amrita; Edrees, Hassan; ...

2016-10-11

Ionizing radiation poses a significant challenge to the operation and reliability of conventional silicon-based devices. In this paper, we report the effects of gamma radiation on graphene field-effect transistors (GFETs), along with a method to mitigate those effects by developing a radiation-hardened version of our back-gated GFETs. We demonstrate that activated atmospheric oxygen from the gamma ray interaction with air damages the semiconductor device, and damage to the substrate contributes additional threshold voltage instability. Our radiation-hardened devices, which have protection against these two effects, exhibit minimal performance degradation, improved stability, and significantly reduced hysteresis after prolonged gamma radiation exposure. Finally,more » we believe this work provides an insight into graphene's interactions with ionizing radiation that could enable future graphene-based electronic devices to be used for space, military, and other radiation-sensitive applications.« less

Advanced control of dissolved oxygen concentration in fed batch cultures during recombinant protein production.

PubMed

Kuprijanov, A; Gnoth, S; Simutis, R; Lübbert, A

2009-02-01

Design and experimental validation of advanced pO(2) controllers for fermentation processes operated in the fed-batch mode are described. In most situations, the presented controllers are able to keep the pO(2) in fermentations for recombinant protein productions exactly on the desired value. The controllers are based on the gain-scheduling approach to parameter-adaptive proportional-integral controllers. In order to cope with the most often appearing distortions, the basic gain-scheduling feedback controller was complemented with a feedforward control component. This feedforward/feedback controller significantly improved pO(2) control. By means of numerical simulations, the controller behavior was tested and its parameters were determined. Validation runs were performed with three Escherichia coli strains producing different recombinant proteins. It is finally shown that the new controller leads to significant improvements in the signal-to-noise ratio of other key process variables and, thus, to a higher process quality.

Improving the radiation hardness of graphene field effect transistors

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

Alexandrou, Konstantinos; Masurkar, Amrita; Edrees, Hassan

Ionizing radiation poses a significant challenge to the operation and reliability of conventional silicon-based devices. In this paper, we report the effects of gamma radiation on graphene field-effect transistors (GFETs), along with a method to mitigate those effects by developing a radiation-hardened version of our back-gated GFETs. We demonstrate that activated atmospheric oxygen from the gamma ray interaction with air damages the semiconductor device, and damage to the substrate contributes additional threshold voltage instability. Our radiation-hardened devices, which have protection against these two effects, exhibit minimal performance degradation, improved stability, and significantly reduced hysteresis after prolonged gamma radiation exposure. Finally,more » we believe this work provides an insight into graphene's interactions with ionizing radiation that could enable future graphene-based electronic devices to be used for space, military, and other radiation-sensitive applications.« less

Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment.

PubMed

Kiosses, Dimitris N; Gross, James J; Banerjee, Samprit; Duberstein, Paul R; Putrino, David; Alexopoulos, George S

2017-06-01

To examine the relationship of negative emotions with suicidal ideation during 12 weeks of Problem Adaptation Therapy (PATH) versus Supportive Therapy of Cognitively Impaired Older Adults (ST-CI), hypothesizing that improved negative emotions are associated with reduced suicidal ideation, PATH improves negative emotions more than ST-CI, and improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation. In a randomized controlled trial of two home-delivered psychosocial interventions, 74 older participants (65-95 years old) with major depressive disorder and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions and assessments were conducted in participants' homes. PATH focuses on improving emotion regulation, whereas ST-CI focuses on nonspecific therapeutic factors, such as understanding and empathy. Improved negative emotions were measured as improvement in Montgomery Asberg's Depression Rating Scales' (MADRS) observer ratings of sadness, anxiety, guilt, hopelessness, and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item. MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F [1,165]  = 12.73, p = 0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F [1,63.2]  = 7.02, p = 0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F [1, 96]  = 9.95, p = 0.0022). Findings thatimprovement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation (clinicaltrials.gov; NCT00368940). Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery.

PubMed

Fang, Xiao-Ling; Tong, Yao; Zhou, Ya-Li; Zhao, Pei-Quan; Wang, Zhao-Yang

2017-11-01

To determine whether internal limiting membrane (ILM) peeling improves anatomical and functional outcomes in idiopathic macular pucker (IMP)/epiretinal membrane (ERM) surgery in this systematic review and meta-analysis. We searched the PubMed, Medline, Web of Science, Cochrane, Ovid MEDLINE, ClinicalTrials.gov and CNKI databases for studies published before 15 September 2016. The eligibility criteria included studies comparing ILM peeling versus no-peeling for IMP surgery. Thirteen articles (10 retrospective cohort studies, 1 prospective cohort study and 2 randomised controlled trials (RCTs)) were included in the review. Primary outcomes: no differences were observed in the best-corrected visual acuity (BCVA) or central macular thickness (CMT) at 12 months; however, lower ERM recurrence (OR, 0.13; 95% CI 0.04 to 0.41; p=0.0004) and reoperation rates (OR, 0.10; 95% CI 0.02 to 0.49; p=0.004) that favoured ILM peeling were observed at the final follow-up. no difference was observed in BCVA at 3, 6 months, the final follow-up or in CMT at 3, 6 months, the final follow-up. Significantly increased CMT, which favoured ILM peeling, was observed at the final follow-up (p=0.002) in the RCTs. ILM peeling yielded greater anatomical success, but no improvement in functional outcomes as the treatment of choice for patients undergoing IMP surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The impact of peer review on paediatric forensic reports.

PubMed

Kariyawasam, Uditha

2016-10-01

To retrospectively evaluate the common grammar and spelling errors of the medico-legal reports written by the doctors at the Victorian Forensic Paediatric Medical Service (VFPMS) in both Royal Children's Hospital (RCH) and Monash Medical Centre. The reports were evaluated at two points in time; before and after peer review. The aim of the study was to ascertain whether peer review improved the grammar and spelling in VFPMS medico-legal reports. Draft VFPMS reports are sent to the VFPMS medical director for peer review. The current study sampled 50 reports that were sent consecutively to Dr. Anne Smith from 1st of May 2015. The 50 corresponding final reports were then retrieved from the VFPMS database. The 50 pairs of draft and final reports were scored using a 50-point scoring system. The scores of the draft reports were compared to the scores of the final report to assess if there was a change in quality as measured using an explicit criteria audit of report structure, simple grammar, jargon use and spelling. The audit did not include evaluation of the validity of forensic opinions. The overall scores were statistically analysed using descriptive statistics and a paired T-test. The scores of the reports improved by 2.24% when the final reports were compared to the draft reports (p < 0.001). The peer-review process resulted in a significantly higher quality of medico-legal reports. The report writing and peer-review process could be assisted by an abbreviated version of the checklist used for the audit. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

[The relationship between MMR vaccination level and the number of new cases of autism in children].

PubMed

Mrozek-Budzyn, Dorota; Kiełtyka, Agnieszka

2008-01-01

The MMR vaccination coverage in Malopolskie voivodeship improved rapidly and finally reached a high level during last years. The number of new cases of autism spectrum disorders in children during that time revealed a slightly rising but not significant trend, while the number of childhood autism were stable. Ecological study showed no correlation between MMR vaccination and an increased risk of childhood autism and autism spectrum disorders in children.

Final Report: Rational Design of Anode Surface Chemistry in Microbial Fuel Cells for Improved Exoelectrogen Attachment and Electron Transfer

DTIC Science & Technology

2015-12-21

SECURITY CLASSIFICATION OF: The overall goal of this project is to determine how electrode surface chemistry can be rationally designed to decrease...2015 Approved for Public Release; Distribution Unlimited Final Report: Rational Design of Anode Surface Chemistry in Microbial Fuel Cells for...ABSTRACT Final Report: Rational Design of Anode Surface Chemistry in Microbial Fuel Cells for Improved Exoelectrogen Attachment and Electron Transfer

Functional outcomes in Duchenne muscular dystrophy scoliosis: comparison of the differences between surgical and nonsurgical treatment.

PubMed

Suk, Kyung Soo; Lee, Byung Ho; Lee, Hwan Mo; Moon, Seong Hwan; Choi, Young Chul; Shin, Dong Eun; Ha, Jung Won; Song, Kwang Min; Kim, Hak Sun

2014-03-05

While most studies of Duchenne muscular dystrophy scoliosis focus on technical and radiographic indices, functional status is a more important factor to consider in the management of Duchenne muscular dystrophy. The objectives of the current study were to compare the pulmonary function, radiographic outcome, and functional recovery, with use of validated questionnaires, in surgically and nonsurgically treated patients with Duchenne muscular dystrophy who have scoliosis. Sixty-six patients (forty treated surgically and twenty-six treated nonsurgically) with a minimum follow-up of two years were included in this study. Forced vital capacity, radiographic parameters (the Cobb angle, lordosis, and pelvic obliquity), and functional status, according to the modified Rancho scale and manual muscle test, were measured preoperatively and at the time of the final follow-up. The Muscular Dystrophy Spine Questionnaire (MDSQ) was completed at the final follow-up evaluation. Pulmonary function, functional scores (manual muscle test and modified Rancho scale), and radiographic measurements, except for lordosis, were similar for both groups at the time of the initial consultation (p > 0.05). At the time of the final follow-up, all radiographic parameters were significantly improved in the surgical group compared with the nonsurgical group. The mean score (and standard deviation) on the manual muscle test was not significantly different between the surgical and nonsurgical groups (23.2 ± 8.3 versus 22.8 ± 6.3; p = 0.828). The mean score on the modified Rancho scale also showed similar results in the groups (3.9 ± 0.3 and 4.04 ± 0.3, respectively; p = 0.088). The surgical group had higher mean MDSQ scores than the nonsurgical group (35.1 ± 14.7 and 26.9 ± 9.9, respectively; p = 0.008). Both groups showed a decrease in forced vital capacity at the time of the final follow-up, but the deterioration of forced vital capacity was significantly slower (p = 0.035) in the surgical group (268 ± 361 mL) than in the nonsurgical group (536 ± 323 mL). Surgery in patients who had Duchenne muscular dystrophy with scoliosis improved function and decreased the rate of deterioration of forced vital capacity compared with patients treated conservatively. However, the muscle power and forced vital capacity decreased in both groups.

Combined robotic-aided gait training and physical therapy improve functional abilities and hip kinematics during gait in children and adolescents with acquired brain injury.

PubMed

Beretta, Elena; Romei, Marianna; Molteni, Erika; Avantaggiato, Paolo; Strazzer, Sandra

2015-01-01

To evaluate the combined effect of robotic-aided gait training (RAGT) and physical therapy (PT) on functional abilities and gait pattern in children and adolescents exiting acquired brain injury (ABI), through functional clinical scales and 3D-Gait Analysis (GA). A group of 23 patients with ABI underwent 20 sessions of RAGT in addition to traditional manual PT. All the patients were evaluated before and after the training by using the Gross Motor Function Measures (GMFM) and the Functional Assessment Questionnaire. Ambulant children were also evaluated through the 6 Minutes Walk Test (6MinWT) and GA. Finally, results were compared with those obtained from a control group of ABI children who underwent PT only. After the training, the GMFM showed significant improvement in both dimensions 'D' (standing) and 'E' (walking). In ambulant patients the 6MinWT showed significant improvement after training and GA highlighted a significant increase in cadence, velocity and stride length. Moreover, hip kinematics on the sagittal plane revealed a statistically significant increase in range of motion (ROM) during the whole gait cycle, increased hip extension during terminal stance and increased ROM during the swing phase. The data suggest that the combined programme RAGT + PT induces improvements in functional activities and gait pattern in children and adolescents with ABI and demonstrated it to be an elective tool for the maintenance of the patients' full compliance throughout the rehabilitative programme.

Xanthan production on polyurethane foam and its enhancement by air pressure pulsation.

PubMed

Zhang, Zhi-guo; Chen, Hong-zhang

2010-12-01

In this study, we evaluated the feasibility of solid-state fermentation (SSF) on polyurethane foam (PUF) for xanthan production. The effects of air pressure pulsation (APP) on biomass accumulation and final xanthan concentration were also studied. Under suitable conditions (15% inoculum, 0.5-cm (side length) PUF cubes, 15 mL medium per gram cubes and 4.5 cm bed depth), the broth was dispersed on the PUF as a film. When the initial glucose concentration in the media was low (20 and 40 g L⁻¹), there was no significant difference between the final xanthan concentration in static SSF and submerged fermentation (SMF). When high initial glucose concentrations (60 and 80 g L⁻¹) were used, the final gum concentrations in SSF were much higher than those in SMF. When the APP technique was applied in xanthan production with a medium containing a high glucose concentration (80 g L⁻¹), the oxygen consumption rate of Xanthomonas campestris was significantly enhanced at the later stages of fermentation, and both the biomass and xanthan concentration were improved. The results indicated that SSF on PUF is suitable for xanthan preparation, especially when the initial glucose concentration ranged from 60 to 80 g L⁻¹. Those results also demonstrated that APP technology can be used to enhance xanthan yields.

A Two-Stream Deep Fusion Framework for High-Resolution Aerial Scene Classification

PubMed Central

Liu, Fuxian

2018-01-01

One of the challenging problems in understanding high-resolution remote sensing images is aerial scene classification. A well-designed feature representation method and classifier can improve classification accuracy. In this paper, we construct a new two-stream deep architecture for aerial scene classification. First, we use two pretrained convolutional neural networks (CNNs) as feature extractor to learn deep features from the original aerial image and the processed aerial image through saliency detection, respectively. Second, two feature fusion strategies are adopted to fuse the two different types of deep convolutional features extracted by the original RGB stream and the saliency stream. Finally, we use the extreme learning machine (ELM) classifier for final classification with the fused features. The effectiveness of the proposed architecture is tested on four challenging datasets: UC-Merced dataset with 21 scene categories, WHU-RS dataset with 19 scene categories, AID dataset with 30 scene categories, and NWPU-RESISC45 dataset with 45 challenging scene categories. The experimental results demonstrate that our architecture gets a significant classification accuracy improvement over all state-of-the-art references. PMID:29581722

A Two-Stream Deep Fusion Framework for High-Resolution Aerial Scene Classification.

PubMed

Yu, Yunlong; Liu, Fuxian

2018-01-01

One of the challenging problems in understanding high-resolution remote sensing images is aerial scene classification. A well-designed feature representation method and classifier can improve classification accuracy. In this paper, we construct a new two-stream deep architecture for aerial scene classification. First, we use two pretrained convolutional neural networks (CNNs) as feature extractor to learn deep features from the original aerial image and the processed aerial image through saliency detection, respectively. Second, two feature fusion strategies are adopted to fuse the two different types of deep convolutional features extracted by the original RGB stream and the saliency stream. Finally, we use the extreme learning machine (ELM) classifier for final classification with the fused features. The effectiveness of the proposed architecture is tested on four challenging datasets: UC-Merced dataset with 21 scene categories, WHU-RS dataset with 19 scene categories, AID dataset with 30 scene categories, and NWPU-RESISC45 dataset with 45 challenging scene categories. The experimental results demonstrate that our architecture gets a significant classification accuracy improvement over all state-of-the-art references.

Influence of age on the outcome of single stage reconstructive surgery for congenital dislocation of the hip joint.

PubMed

Bhatti, Anisuddin; Jamali, A R; Mehboob, Ghulam

2009-01-01

This study was conducted to assess the effect of age on the ultimate outcome measures following single stage surgical procedure of soft tissue release, relocation, capsulorrhaphy, femoral shortening with varus/derotation osteotomy and pelvic osteotomy. A case series. The study with two groups of pretest-posttest design was conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from 1993 to January 2008. Patients included were having neglected, congenital dislocation of the hip joint, aged over 3 years. Patients with failed previous surgery, paralytic, teratological, traumatic or septic dislocations and patients with less than 5 years follow-up were excluded from the study. The patients were divided into two groups, 3-7 years (37 hip joints) and over 7 years (13 hip joints). The single stage surgical procedure of open relocation, femoral shortening/derotation/ varus osteotomy and pelvic osteotomy was the dependent variable; whereas, the final clinico-radiological results based upon Tonnis grading, Severin's clinical/radiological grading, Klisic's overall rating and acetabular index were the independent variables of the study. Pre- and postoperative data was assessed for overall improvement and the difference in outcome measures between the two age groups. Significant overall improvement on all parameters was achieved after surgery. When results were compared between two age groups, there was no significant difference in the final outcome as per Tonnis grading and Severin's clinical typing as modified by Gibson (97.3% versus 84.4% normal hip joints or Tonnis grade 1 and 78.37% versus 53.85% Severin's type 1) but the results based upon Severin's radiological grading (62.16% versus 15.38%) and Klisic's overall rating (62.16% versus 15.38%) were significantly better in 3-7 years as compared to those over 7 years. There was no significant difference between the two age groups when compared for improvement in acetabular index. On further analysis, a progressive deterioration of results with increasing age was observed, yet the results in those aged over 7 years were reasonably justified surgical correction of congenital dislocation of the hip joint. Majority of the complications were seen in children operated at the age of 4-5 years. There were 7 cases (14%) of redislocation/subluxation and 6 were in 3-7 years age group. There were 4 cases (8%) of the avascular necrosis of the femoral head. Three patients had residual coxa vara and 2 had significant limb shortening. Limb lengthening was done in these 2 cases. The final results displayed progressive deterioration of clinical, radiological and functional outcome measures with aging after single stage reconstructive surgery for the congenital dislocation of hip joint. However, despite this, the results in children over 7 years were also good/excellent in most of the cases justifying surgery.

REM desensitization as a new therapeutic method for post-traumatic stress disorder: a randomized controlled trial.

PubMed

Ahmadi, Khodabakhsh; Hazrati, Majid; Ahmadizadeh, Mohammadjavad; Noohi, Sima

2015-04-01

to evaluate potential efficacy of a new therapeutic approach in posttraumatic stress disorder in comparison with eye movement desensitization and reprocessing (EMDR), a standard treatment approach and controls. the study was designed using a randomized controlled trial methodology. Participants were recruited from military servicemen aged between 25 to 50 years who were admitting hospitals of Bushehr, Iran, with the final diagnosis of PTSD. Finally 33 male patients were devided into three subgroups: G1: EMDR; G2: REM Desensitization; and group 3: controls who received no therapy. Mississippi Scale for Posttraumatic Stress Disorder, Pittsburgh Sleep Quality Index (PSQI) and a 37 item death anxiety questionnaire were used for measures. multiple comparisons showed that intrusive thoughts were significantly more likely to improve with REM Desensitization versus EMDR (P=0.03), while depression was more responsive to EMDR (p=0.03). Among the Pittsburgh scale for the quality of sleep items, sleep quality (p=0.02), sleep duration (p=0.001), and total sleep quality score (p=0.002) were significantly more likely to improve in the REM Desensitization group. Change in the absolute death anxiety scores was not different between subgroups excepting EMDR versus control group (p=0.05). REM, desensitization, the new therapeutic approach to PTSD is a highly effective strategy, even more than EMDR, the standard treatment, in most of the evaluated subjects, with special emphasis on sleep symptoms, and also in the management of intrusive thoughts. Depression is the only factor in which, REM Desensitization was significantly less likely to represent a superior therapeutic effect than EMDR.

Efficiency, error and yield in light-directed maskless synthesis of DNA microarrays

PubMed Central

2011-01-01

Background Light-directed in situ synthesis of DNA microarrays using computer-controlled projection from a digital micromirror device--maskless array synthesis (MAS)--has proved to be successful at both commercial and laboratory scales. The chemical synthetic cycle in MAS is quite similar to that of conventional solid-phase synthesis of oligonucleotides, but the complexity of microarrays and unique synthesis kinetics on the glass substrate require a careful tuning of parameters and unique modifications to the synthesis cycle to obtain optimal deprotection and phosphoramidite coupling. In addition, unintended deprotection due to scattering and diffraction introduce insertion errors that contribute significantly to the overall error rate. Results Stepwise phosphoramidite coupling yields have been greatly improved and are now comparable to those obtained in solid phase synthesis of oligonucleotides. Extended chemical exposure in the synthesis of complex, long oligonucleotide arrays result in lower--but still high--final average yields which approach 99%. The new synthesis chemistry includes elimination of the standard oxidation until the final step, and improved coupling and light deprotection. Coupling Insertions due to stray light are the limiting factor in sequence quality for oligonucleotide synthesis for gene assembly. Diffraction and local flare are by far the largest contributors to loss of optical contrast. Conclusions Maskless array synthesis is an efficient and versatile method for synthesizing high density arrays of long oligonucleotides for hybridization- and other molecular binding-based experiments. For applications requiring high sequence purity, such as gene assembly, diffraction and flare remain significant obstacles, but can be significantly reduced with straightforward experimental strategies. PMID:22152062

Shoulder arthroscopy simulator training improves shoulder arthroscopy performance in a cadaveric model.

PubMed

Henn, R Frank; Shah, Neel; Warner, Jon J P; Gomoll, Andreas H

2013-06-01

The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaveric model of shoulder arthroscopy. Seventeen first-year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and 9 of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The 2 groups were compared by use of Student t tests, and change over time within groups was analyzed with paired t tests. There were no observed differences between the 2 groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (P < .05). Time to completion was significantly faster in the simulator group compared with controls at the final evaluation (P < .05). No difference was observed between the groups on the subjective scores at the final evaluation (P = .98). Shoulder arthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaveric model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. There may be a role for simulator training in shoulder arthroscopy education. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Shoulder Arthroscopy Simulator Training Improves Shoulder Arthroscopy Performance in a Cadaver Model

PubMed Central

Henn, R. Frank; Shah, Neel; Warner, Jon J.P.; Gomoll, Andreas H.

2013-01-01

Purpose The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaver model of shoulder arthroscopy. Methods Seventeen first year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and nine of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The two groups were compared with students t-tests, and change over time within groups was analyzed with paired t-tests. Results There were no observed differences between the two groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (p<0.05). Time to completion was significantly faster in the simulator group compared to controls at final evaluation (p<0.05). No difference was observed between the groups on the subjective scores at final evaluation (p=0.98). Conclusions Shoulder arthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaver model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. Clinical Relevance There may be a role for simulator training in shoulder arthroscopy education. PMID:23591380

Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion?

PubMed Central

Kim, Hyeun Sung; Ju, Chang Il; Wang, Hui Sun; Lee, Sung Myung; Kim, Dong Min

2014-01-01

Objective The purpose of this study was to evaluate the efficacy of implant removal of percutaneous short segment fixation after vertebral fracture consolidation in terms of motion preservation. Methods Between May 2007 and January 2011, 44 patients underwent percutaneous short segment screw fixation due to a thoracolumbar burst fracture. Sixteen of these patients, who underwent implant removal 12 months after screw fixation, were enrolled in this study. Motor power was intact in all patients, despite significant vertebral height loss and canal compromise. The patients were divided into two groups by degree of osteoporosis : Group A (n=8), the non-osteoporotic group, and Group B (n=8), the osteoporotic group. Imaging and clinical findings including vertebral height loss, kyphotic angle, range of motion (ROM), and complications were analyzed. Results Significant pain relief was achieved in both groups at final follow-up versus preoperative values. In terms of vertebral height loss, both groups showed significant improvement at 12 months after screw fixation and restored vertebral height was maintained to final follow-up in spite of some correction loss. ROM (measured using Cobb's method) in flexion and extension in Group A was 10.5° (19.5/9.0°) at last follow-up, and in Group B was 10.2° (18.8/8.6°) at last follow-up. Both groups showed marked improvement in ROM as compared with the screw fixation state, which was considered motionless. Conclusion Removal of percutaneous implants after vertebral fracture consolidation can be an effective treatment to preserve motion regardless of osteoporosis for thoracolumbar burst fractures. PMID:24653799

Simulation Training for Residents Focused on Mechanical Ventilation: A Randomized Trial Using Mannequin-Based Versus Computer-Based Simulation.

PubMed

Spadaro, Savino; Karbing, Dan Stieper; Fogagnolo, Alberto; Ragazzi, Riccardo; Mojoli, Francesco; Astolfi, Luca; Gioia, Antonio; Marangoni, Elisabetta; Rees, Stephen Edward; Volta, Carlo Alberto

2017-12-01

Advances in knowledge regarding mechanical ventilation (MV), in particular lung-protective ventilation strategies, have been shown to reduce mortality. However, the translation of these advances in knowledge into better therapeutic performance in real-life clinical settings continues to lag. High-fidelity simulation with a mannequin allows students to interact in lifelike situations; this may be a valuable addition to traditional didactic teaching. The purpose of this study is to compare computer-based and mannequin-based approaches for training residents on MV. This prospective randomized single-blind trial involved 50 residents. All participants attended the same didactic lecture on respiratory pathophysiology and were subsequently randomized into two groups: the mannequin group (n = 25) and the computer screen-based simulator group (n = 25). One week later, each underwent a training assessment using five different scenarios of acute respiratory failure of different etiologies. Later, both groups underwent further testing of patient management, using in situ high-fidelity simulation of a patient with acute respiratory distress syndrome. Baseline knowledge was not significantly different between the two groups (P = 0.72). Regarding the training assessment, no significant differences were detected between the groups. In the final assessment, the scores of only the mannequin group significantly improved between the training and final session in terms of either global rating score [3.0 (2.5-4.0) vs. 2.0 (2.0-3.0), P = 0.005] or percentage of key score (82% vs. 71%, P = 0.001). Mannequin-based simulation has the potential to improve skills in managing MV.

Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

PubMed

Kuunders, Theo J M; Jacobs, Monique A M; Goor, Ien A M van de; Bon-Martens, Marja J H van; Oers, Hans A M van; Paulussen, Theo G W M

2017-08-15

Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals. A web survey was send to 304 RHS health professionals. The questionnaire was based on a theory- and research-based framework of determinants of public health innovations. Main outcomes were guideline use and completeness of use, defined as the number of health topics and checklists used. Associations between determinants and (completeness of) guideline use were explored by multivariate regression models. The survey was started by 120 professionals (39%). Finally, results from 73 respondents (24%) were eligible for analyses. All 28 Dutch RHS organizations were represented in the final dataset. About half of the respondents (48%) used the guideline. The average score for completeness of use (potential range 1-10) was 2.37 (sd = 1.78; range 1-7). Knowledge, perceived task responsibility and usability were significantly related to guideline use in univariate analyses. Only usability remained significant in the multivariate model on guideline use. Only self-efficacy accounted for significant proportions of variance in completeness of use. The results imply that strategies to improve guideline use by RHSs should primarily target perceived usability. Self-efficacy appeared the primary target for improving completeness of guideline use. Methods for targeting these determinants in RHSs are discussed.

Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies.

PubMed

Lee, Moses; Walsh, James; Smith, Margaret M; Ling, Jeff; Wines, Andrew; Lam, Peter

2017-08-01

Minimally invasive surgery is being used increasingly, including for hallux valgus surgery. Despite the growing interest in minimally invasive procedures, there have been few publications on percutaneous chevron/akin (PECA) procedures, and no studies have been published comparing PECA to open scarf/akin osteotomies (SA). This was a prospective, randomized study of 50 patients undergoing operative correction of hallux valgus using one of 2 techniques (PECA vs open SA). Data were collected preoperatively and on 1 day, 2 weeks, 6 weeks, and 6 months postoperatively. Outcome measures include the American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal (AOFAS-HMI) Score, visual analog pain score, hallux valgus angle (HVA), and 1-2 intermetatarsal angle (IMA). Twenty-five patients underwent PECA procedures and 25 patients received SA procedures. Both groups showed significantly improved AOFAS-HMI scores after surgery (PECA group: 61.8 to 88.9, SA group: 57.3 to 84.1, P = .560) with comparable final scores. HVA and IMA also presented similar outcomes at final follow-up ( P = .520 and P = .270, respectively). However, the PECA group showed significantly lower pain level (VAS) in the early postoperative phase (postoperative day 1 to postoperative week 6, P < .001 and P = .004, respectively). No serious complications were observed in either group. Both groups showed comparable good to excellent clinical and radiologic outcomes at final follow-up. However, the PECA group had significantly less pain in the first 6 weeks following surgery. Level of Evidence Level II, prospective comparative study.

Limited distal clavicle excision of acromioclavicular joint osteoarthritis.

PubMed

Gokkus, K; Saylik, M; Atmaca, H; Sagtas, E; Aydin, A T

2016-05-01

Resection of the distal aspect of clavicle has a well-documented treatment modality in case of acromioclavicular joint osteoarthritis resistant to conservative treatment. Limited (mean ∼0.5cm distal end of clavicle resection) distal clavicle excision of A-C joint arthritis in cases resistant to conservative treatment may reduce the pain and improve the shoulder function. In this study, we retrospectively evaluated the results of limited distal clavicle excision of acromioclavicular joint osteoarthritis resistant to conservative treatment. All patients were evaluated by using the Visual Analogue Scale (VAS) and UCLA shoulder rating scale (University of California Los Angeles), either before surgery or final follow-up period for pain and functional results, respectively. A total of 110 patients (48 male, 62 female) with AC joint arthritis, treated between the years of 2008-2012, were retrospectively analyzed. A total of 30 patients (12 male, 18 female) who failed to show improvement with conservative treatment underwent limited surgical open excision of distal clavicle. The mean age of the study population was 52.5±1.2 years. The mean follow-up period was 27±1.3 months. The mean preoperative VAS score was 83.6±5.58 (range, 70-90) while mean VAS was 26.6±9.3 (range, 10-50) at the final follow-up. There was a statistically significant difference between pre- and postoperative VAS scores in patients who had treated by surgical approach (P<0.001). The mean UCLA score of the patients increased postoperatively from 11.5 (range, 9-14) to 29.2 (range, 27-32) at the final follow-up. There was a statistically significant difference between the two time periods with respect to UCLA scores (P<0.001). In patients with AC osteoarthritis resistant to conservative therapy, the hypothesized limited clavicle excision (mean ∼0.5cm distal end of clavicle resection with preserving coracoclavicular ligaments and inferior capsule) reduced the pain and improved the shoulder function. Our midterm follow-up (mean 27 months) results showed that limited distal clavicle excision of patients with AC joint osteoarthritis resistant to conservative treatment (0.5cm distal end of clavicle resection with preserving inferior capsule, and coracoclavicular ligaments) reduced the pain and improved the shoulder function. IV (Retrospective study). Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A clinical study on the usefulness of autologous plasma filler in the treatment of nasolabial fold wrinkles.

PubMed

Choi, Young-Jun; Kim, Han-Saem; Min, Joon Hong; Nam, Jae-Hui; Lee, Ga-Young; Kim, Won-Serk

2017-06-01

Recently, the efficacy of autologous plasma filler for the reduction of facial wrinkles has been demonstrated. The aim of our study is to validate the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles. Twenty Korean patients with moderate-to-severe nasolabial fold wrinkles were enrolled. The patients were treated with one session of autologous plasma filler. The wrinkle improvement effects were evaluated at 1-week, 4-week, 8-week, and 12-week after the treatment. Three assessment methods were applied. First, two independent dermatologists assessed cosmetic results using a 5-point wrinkle assessment scale. Second, global aesthetic improvement score was used for assessment of the final cosmetic results. Third, patient satisfaction was surveyed. Also, the adverse effects associated to treatment were observed. Mean age of the patients was 44.5 years. The average 5-point wrinkle assessment scale score was significantly improved at 1, 4, 8, and 12 weeks after treatment, comparing to before treatment (p < 0.01). The patients' average global aesthetic improvement score also indicated better cosmetic outcomes. The clinical improvement with sufficient patients' satisfaction and no significant adverse events demonstrated that novel autologous plasma filler could be considered as efficient and safety treatment option for nasolabial fold wrinkles.

Caregiver education in Parkinson's disease: formative evaluation of a standardized program in seven European countries.

PubMed

A'Campo, L E I; Spliethoff-Kamminga, N G A; Macht, M; Roos, R A C

2010-02-01

The formative evaluation of a standardized psychosocial education program for patients with Parkinson's disease (PD) and their caregivers. The results of the participation of the caregivers are presented next to the data of the patients. Caregivers (n = 137) and patients with PD (n = 151) participated in the 8-week program in separate groups. Measurements were performed on psychosocial problems (BELA-P/A-k), health state (EQ-5D VAS), quality of life (PDQ-39) and depression (SDS) 1 week before and 1 week after the program. Participants rated their mood on a visual analogue scale before and after each session, and they filled in an evaluation questionnaire after the last session. Scores on the BELA-P/A-k improved significantly on the 'bothered by scale' as well as the 'need for help scale'. No improvements were found on EQ-5D VAS, PDQ-39 and SDS. Mood ratings improved significantly after each session. Most participants evaluated the program as positive. Feedback led to improvements in the program, which are incorporated in a final manual. The program was feasible to run in the different countries. This exploratory study led to improvements in the program and recommendations for further research. A study on the effectiveness of the program is the next step.

Modeling Clinical Outcomes in Prostate Cancer: Application and Validation of the Discrete Event Simulation Approach.

PubMed

Pan, Feng; Reifsnider, Odette; Zheng, Ying; Proskorovsky, Irina; Li, Tracy; He, Jianming; Sorensen, Sonja V

2018-04-01

Treatment landscape in prostate cancer has changed dramatically with the emergence of new medicines in the past few years. The traditional survival partition model (SPM) cannot accurately predict long-term clinical outcomes because it is limited by its ability to capture the key consequences associated with this changing treatment paradigm. The objective of this study was to introduce and validate a discrete-event simulation (DES) model for prostate cancer. A DES model was developed to simulate overall survival (OS) and other clinical outcomes based on patient characteristics, treatment received, and disease progression history. We tested and validated this model with clinical trial data from the abiraterone acetate phase III trial (COU-AA-302). The model was constructed with interim data (55% death) and validated with the final data (96% death). Predicted OS values were also compared with those from the SPM. The DES model's predicted time to chemotherapy and OS are highly consistent with the final observed data. The model accurately predicts the OS hazard ratio from the final data cut (predicted: 0.74; 95% confidence interval [CI] 0.64-0.85 and final actual: 0.74; 95% CI 0.6-0.88). The log-rank test to compare the observed and predicted OS curves indicated no statistically significant difference between observed and predicted curves. However, the predictions from the SPM based on interim data deviated significantly from the final data. Our study showed that a DES model with properly developed risk equations presents considerable improvements to the more traditional SPM in flexibility and predictive accuracy of long-term outcomes. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy : Evaluation by a multidisciplinary/multigender committee.

PubMed

Soror, Tamer; Kovács, György; Seibold, Nina; Melchert, Corinna; Baumann, Kristin; Wenzel, Eike; Stojanovic-Rundic, Suzana

2017-05-01

Patients with early-stage breast cancer can benefit from adjuvant accelerated partial breast irradiation (APBI) following breast-conserving surgery (BCS). This work reports on cosmetic results following APBI using multicatheter high-dose-rate interstitial brachytherapy (HDR-IBT). Between 2006 and 2014, 114 patients received adjuvant APBI using multicatheter HDR-IBT. For each patient, two photographs were analyzed: the first was taken after surgery (baseline image) and the second at the last follow-up visit. Cosmesis was assessed by a multigender multidisciplinary team using the Harvard Breast Cosmesis Scale. Dose-volume histogram (DVH) parameters and the observed cosmetic results were investigated for potential correlations. The median follow-up period was 3.5 years (range 0.6-8.5 years). The final cosmetic scores were 30% excellent, 52% good, 14.5% fair, and 3.5% poor. Comparing the baseline and follow-up photographs, 59.6% of patients had the same score, 36% had a better final score, and 4.4% had a worse final score. Only lower target dose nonuniformity ratio (DNR) values (0.3 vs. 0.26; p = 0.009) were significantly associated with improved cosmetic outcome vs. same/worse cosmesis. APBI using multicatheter HDR-IBT adjuvant to BCS results in favorable final cosmesis. Deterioration in breast cosmesis occurs in less than 5% of patients. The final breast cosmetic outcome in patients treated with BCS and APBI using multicatheter HDR-IBT is influenced primarily by the cosmetic result of the surgery. A lower DNR value is significantly associated with a better cosmetic outcome.

Prognostic factors in Acanthamoeba keratitis.

PubMed

Kaiserman, Igor; Bahar, Irit; McAllum, Penny; Srinivasan, Sathish; Elbaz, Uri; Slomovic, Allan R; Rootman, David S

2012-06-01

To assess the prognostic factors influencing visual prognosis and length of treatment after acanthamoeba keratitis (AK). Forty-two AK eyes of 41 patients treated between 1999 and 2006 were included. A diagnosis of AK was made on the basis of culture results with a corresponding clinical presentation. We calculated the prognostic effect of the various factors on final visual acuity and the length of treatment. Multivariate regression analysis was used to adjust for the simultaneous effects of the various prognostic factors. Mean follow-up was 19.7 ± 21.0 months. Sixty-four percent of cases had > 1 identified risk factor for AK, the most common risk factor being contact lens wear (92.9% of eyes). At presentation, median best spectacle corrected visual acuity (BCVA) was 20/200 (20/30 to Hand Motion [HM]) that improved after treatment to 20/50 (20/20 to Counting Fingers [CF]). Infection acquired by swimming or related to contact lenses had significantly better final BCVA (p = 0.03 and p = 0.007, respectively). Neuritis and pseudodendrites were also associated with better final BCVA (p = 0.04 and p = 0.05, respectively). Having had an epithelial defect on presentation and having been treated with topical steroid were associated with worse final best spectacle corrected visual acuity (BSCVA) (p = 0.0006 and p = 0.04). Multivariate regression analysis found a good initial visual acuity (p = 0.002), infections related to swimming (p = 0.01), the absence of an epithelial defect (p = 0.03), having been treated with chlorhexidine (p = 0.05), and not having receive steroids (p = 0.003) to significantly forecast a good final BCVA. We identified several prognostic factors that can help clinicians evaluate the expected visual damage of the AK infection and thus tailor treatment accordingly. Copyright © 2012 Canadian Ophthalmological Society. All rights reserved.

Murine models of osteosarcoma: A piece of the translational puzzle.

PubMed

Walia, Mannu K; Castillo-Tandazo, Wilson; Mutsaers, Anthony J; Martin, Thomas John; Walkley, Carl R

2018-06-01

Osteosarcoma (OS) is the most common cancer of bone in children and young adults. Despite extensive research efforts, there has been no significant improvement in patient outcome for many years. An improved understanding of the biology of this cancer and how genes frequently mutated contribute to OS may help improve outcomes for patients. While our knowledge of the mutational burden of OS is approaching saturation, our understanding of how these mutations contribute to OS initiation and maintenance is less clear. Murine models of OS have now been demonstrated to be highly valid recapitulations of human OS. These models were originally based on the frequent disruption of p53 and Rb in familial OS syndromes, which are also common mutations in sporadic OS. They have been applied to significantly improve our understanding about the functions of recurrently mutated genes in disease. The murine models can be used as a platform for preclinical testing and identifying new therapeutic targets, in addition to testing the role of additional mutations in vivo. Most recently these models have begun to be used for discovery based approaches and screens, which hold significant promise in furthering our understanding of the genetic and therapeutic sensitivities of OS. In this review, we discuss the mouse models of OS that have been reported in the last 3-5 years and newly identified pathways from these studies. Finally, we discuss the preclinical utilization of the mouse models of OS for identifying and validating actionable targets to improve patient outcome. © 2017 Wiley Periodicals, Inc.

Growth status of Korean orphans raised in the affluent West: anthropometric trend, multivariate determinants, and descriptive comparison with their North and South Korean peers.

PubMed

Schwekendiek, Daniel J

2017-04-01

This paper investigates the trend in height among adult Korean orphans who were adopted in early life into affluent Western nations. Final heights of 148 females were analyzed based on a Korean government survey conducted in 2008. Height of the orphans was descriptively compared against final heights of South and North Koreans. Furthermore, statistical determinants of orphan height were investigated in multivariate regressions. Mean height of Korean orphans was 160.44 cm (SD 5.89), which was higher than that of South Koreans at 158.83 cm (SD 5.01). Both Korean orphans and South Koreans were taller than North Koreans at 155.30 cm (SD 4.94). However, height of Korean orphans stagnated at around 160-161 cm while those of North and South Koreans improved over time. In the regression analysis, the socioeconomic status of the adoptive family was statistically significant in all models, while dummies for the adoptive nations and age at adoption were insignificant. This study shows that the mean final height of women experiencing extreme environmental improvements in early-life is capped at 160-161 cm, tentatively suggesting that social stress factors in the host nation or early-life factors in the birth nation might have offset some of the environmental enrichment effects achieved through intercountry adoption.

Post-Flight EDL Entry Guidance Performance of the 2011 Mars Science Laboratory Mission

NASA Technical Reports Server (NTRS)

Mendeck, Gavin F.; McGrew, Lynn Craig

2013-01-01

The 2011 Mars Science Laboratory was the first Mars guided entry which safely delivered the rover to a landing within a touchdown ellipse of 19.1 km x 6.9 km. The Entry Terminal Point Controller guidance algorithm is derived from the final phase Apollo Command Module guidance and, like Apollo, modulates the bank angle to control the range flown. The guided entry performed as designed without any significant exceptions. The Curiosity rover was delivered about 2.2 km from the expected touchdown. This miss distance is attributed to little time to correct the downrange drift from the final bank reversal and a suspected tailwind during heading alignment. The successful guided entry for the Mars Science Laboratory lays the foundation for future Mars missions to improve upon.

Recent enhancements to the GRIDGEN structured grid generation system

NASA Technical Reports Server (NTRS)

Steinbrenner, John P.; Chawner, John R.

1992-01-01

Significant enhancements are being implemented into the GRIDGEN3D, multiple block, structured grid generation software. Automatic, point-to-point, interblock connectivity will be possible through the addition of the domain entity to GRIDBLOCK's block construction process. Also, the unification of GRIDGEN2D and GRIDBLOCK has begun with the addition of edge grid point distribution capability to GRIDBLOCK. The geometric accuracy of surface grids and the ease with which databases may be obtained is being improved by adding support for standard computer-aided design formats (e.g., PATRAN Neutral and IGES files). Finally, volume grid quality was improved through addition of new SOR algorithm features and the new hybrid control function type to GRIDGEN3D.

Evaluation of some technical factors affecting surgical outcome in photorefractive keratectomy with the VISX 2020 excimer laser

NASA Astrophysics Data System (ADS)

Maguen, Ezra I.; Salz, James J.; Papaioannou, Thanassis; Nesburn, Anthony B.

1995-05-01

Some technical factors relating to the use of the VISX model 20/20 excimer laser for photorefractive keratectomy will be discussed and the way they affect the final optical correction will be demonstrated, as follows: (1) Discontinuation of nitrogen flow: improved corneal haze but induced a mean undercorrection of 0.8 D, 18 months postoperatively. (2) Discontinuation of the use of the fixation ring did not affect centration in a statistically significant fashion. (3) Enlargement of the optical from 5.0 mm to 6.0 mm zone did not affect the refractive outcome. Visual acuity was improved in eyes which had PRK done with a 6.0 mm optical zone.

Improving ethical knowledge and sensemaking from cases through elaborative interrogation and outcome valence.

PubMed

Johnson, James F; Bagdasarov, Zhanna; MacDougall, Alexandra E; Steele, Logan; Connelly, Shane; Devenport, Lynn D; Mumford, Michael D

2014-01-01

The case-based approach to learning is popular among many applied fields. However, results of case-based education vary widely on case content and case presentation. This study examined two aspects of case-based education-outcome valence and case elaboration methods-in a two-day case-based Responsible Conduct of Research (RCR) ethics education program. Results suggest that outcome information is an integral part of a quality case. Furthermore, valence consistent outcomes may have certain advantages over mixed valence outcome information. Finally, students enjoy and excel working with case material, and the use of elaborative interrogation techniques can significantly improve internally-focused ethical sensemaking strategies associated with personal biases, constraints, and emotions.

Recognition of digital characteristics based new improved genetic algorithm

NASA Astrophysics Data System (ADS)

Wang, Meng; Xu, Guoqiang; Lin, Zihao

2017-08-01

In the field of digital signal processing, Estimating the characteristics of signal modulation parameters is an significant research direction. The paper determines the set of eigenvalue which can show the difference of the digital signal modulation based on the deep research of the new improved genetic algorithm. Firstly take them as the best gene pool; secondly, The best gene pool will be changed in the genetic evolvement by selecting, overlapping and eliminating each other; Finally, Adapting the strategy of futher enhance competition and punishment to more optimizer the gene pool and ensure each generation are of high quality gene. The simulation results show that this method not only has the global convergence, stability and faster convergence speed.

[Clinical observation of 5 cases of diabetes insipidus complicated with skeletal fluorosis].

PubMed

Wang, Shuan-Chi; Tao, Xiao-Bing; Wang, Fang-Fang; Zhang, Nan

2017-07-25

To investigate the mechanism of diabetes insipidus complicated with skeletal fluorosis and the surgical treatment of spinal canal stenosis caused by skeletal fluorosis. From January 2000 to November 2011, 5 patients with diabetes insipidus complicated with skeletal fluorosis were treated with drug and cervical or thoracic posterior decompression including 2 males and 3 females with age of 35, 45, 47, 49, 55 years old respectively. The symptoms was mainly limb motor sensory disturbance accompanied by polyuria and polyuria. Imaging showed that cervical and thoracic multi-segmental continuous spinal stenosis. It was diagnosed with diabetes insipidus according to the symptoms and laboratory tests. According to the symptoms, the vertebral with problems were located and treated by posterior laminectomy decompression or the expansive open-door laminectomy. The recovery of neurological symptoms were recorded and the operation result were evaluate by JOA score improvement rate. The wound healed well in 5 cases, and 1 case of cervical axial pain was improved after symptomatic treatment. Five patients were followed up for 2 to 6 years with an average of 4 years. Numbness of limb and weakness symptoms of follow-up patients were significantly improved, muscle strength and acupuncture hypothyroidism were significantly improved compared with preoperative, the JOA score was significantly improved. At the final follow-up, the improvement rate got excellent results in 2 cases, good in 2 and fair in 1. Long-term high intake of fluoride can cause skeletal fluorosis in patients with diabetes insipidus. The posterior decompression is effective for the majority of spinal canal stenosis caused by skeletal fluorosis.

Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3-yr longitudinal study.

PubMed

Sañudo, Borja; Carrasco, Luis; de Hoyo, Moisés; McVeigh, Joseph G

2012-07-01

This study aimed to evaluate the immediate effects of a 6-mo combined exercise program on quality-of-life, physical function, depression, and aerobic capacity in women with fibromyalgia syndrome and to determine the impact of repeated delivery of the intervention. Forty-one women with fibromyalgia were randomly assigned to a training group (EG; n = 21) and a control group (CG; n = 20). Quality-of-life and physical function were assessed using the 36-item Short-Form Health Survey (SF-36) and the Fibromyalgia Impact Questionnaire, and depression was measured using the Beck Depression Inventory. Physical fitness was measured using the 6-min Walk Test. Outcomes were assessed at baseline and after each 6-mo intervention, which was delivered over 30 mos (6 mos of training and 6 mos of detraining). After a 6-mo combined exercise program, there was a significant improvement in the Fibromyalgia Impact Questionnaire (P < 0.0005) for the training group over the control group. Repeated-measures analysis of variance across all time points demonstrated significant main effects for time for the Fibromyalgia Impact Questionnaire, SF-36, Beck Depression Inventory and the 6-min Walk Test, but there were no between-group interaction effects. For the EG, there were significant within-group changes in the Fibromyalgia Impact Questionnaire, SF-36, and Beck Depression Inventory at the final time point; however, there were no within-group changes for the control group. Improvement achieved for the training group were maintained during the detraining period. A long-term exercise program can produce immediate improvements in key health domains in women with fibromyalgia. The benefits achieved with regular training can be maintained for 30 mos. The lack of difference between groups over time may be caused by attrition and consequent lack of power at the final time point.

GA-Responsive Dwarfing Gene Rht12 Affects the Developmental and Agronomic Traits in Common Bread Wheat

PubMed Central

Chen, Liang; Phillips, Andrew L.; Condon, Anthony G.; Parry, Martin A. J.; Hu, Yin-Gang

2013-01-01

Opportunities exist for replacing reduced height (Rht) genes Rht-B1b and Rht-D1b with alternative dwarfing genes, such as the gibberellin-responsive gene Rht12, for bread wheat improvement. However, a comprehensive understanding of the effects and mode of action of Rht12 is lacking. In the present study, the effects of Rht12 were characterized by analyzing its effects on seeding vigour, seedling roots, leaf and stem morphology, spike development and carbohydrate assimilation and distribution. This was carried out in the four genotypes of F2:3 lines derived from a cross between Ningchun45 and Karcagi (12) in two experiments of autumn sowing and spring sowing. Rht12 significantly decreased stem length (43%∼48% for peduncle) and leaf length (25%∼30% for flag leaf) while the thickness of the internode walls and width of the leaves were increased. Though the final plant stature was shortened (40%) by Rht12, the seedling vigour, especially coleoptile length and root traits at the seedling stage, were not affected adversely. Rht12 elongated the duration of the spike development phase, improved the proportion of spike dry weight at anthesis and significantly increased floret fertility (14%) in the autumn sowing experiment. However, Rht12 delayed anthesis date by around 5 days and even the dominant Vrn-B1 allele could not compensate this negative effect. Additionally, grain size was reduced with the ability to support spike development after anthesis decreased in Rht12 lines. Finally, grain yield was similar between the dwarf and tall lines in the autumn sowing experiment. Thus, Rht12 could substantially reduce plant height without altering seeding vigour and significantly increase spikelet fertility in the favourable autumn sowing environment. The successful utilization of Rht12 in breeding programs will require careful selection since it might delay ear emergence. Nonetheless, the potential exists for wheat improvement by using Rht12. PMID:23658622

IMPACT OF FLUORIDE ON DENTAL HEALTH QUALITY.

PubMed

Medjedovic, Eida; Medjedovic, Senad; Deljo, Dervis; Sukalo, Aziz

2015-12-01

Fluoride is natural element that strengthens teeth and prevents their decay. Experts believe that the best way to prevent cavities is the use of fluoride from multiple sources. Studies even show that in some cases, fluoride can stop already started damage of the teeth. In children younger than 6 years fluoride is incorporated into the enamel of permanent teeth, making the teeth more resistant to the action of bacterial and acids in food. The aim of this study is to determine the effects of improving the health status of teeth after six months treatment with the use of topical fluoridation 0.5% NaF, and the level and quality of the impact of treatment with chemical 0.5% NaF on the dental health of children at age from 8 to 15 years, in relation to gender and chronological age. This study included school children aged 8 to 15 years who visited health and dental services dependent in Mostar. It is obvious that after the implementation of treatment with 5% NaF by the method of topical fluoridation, health status of subjects from the experimental group significantly improved, so that at the final review 89.71% or 61 subjects of the experimental group had healthy (cured teeth), tooth with dental caries only 5.88% or 4 respondents tooth with dental caries and filling 4.41% or 3 respondents, extracted baby tooth 14.71% or 10 respondents, while for 13.24% of respondents was identified state with still unerupted teeth. Our findings are indirectly confirmed that the six-month treatment of fluoridation with 5% NaF, contributed to statistically significant improvement in overall oral health of the experimental group compared to the control group which was not treated by any dental treatment. It can be concluded that there is a statistically significant difference in the evaluated parameters of oral health of children in the control group compared to the studied parameters of oral health the experimental group of children at the final dental examination.

Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea.

PubMed

Neikrug, Ariel B; Liu, Lianqi; Avanzino, Julie A; Maglione, Jeanne E; Natarajan, Loki; Bradley, Lenette; Maugeri, Alex; Corey-Bloom, Jody; Palmer, Barton W; Loredo, Jose S; Ancoli-Israel, Sonia

2014-01-01

Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. Sleep laboratory. Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). Continuous positive airway pressure. PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.

Management of functional, hepatic damage after chemotherapy with Liverubin (pharma-standard silymarin).

PubMed

Pellegrini, L; Belcaro, G; Dugall, M; Hu, S; Gizzi, G; Corsi, M; Hosoi, M; Luzzi, R; Feragalli, B; Cotellese, R

2015-10-22

Mild, temporary hepatic failure (MTHF) after chemotherapy is a common clinical problem; in case of repeated episodes MTHF may cause chronic impairment. This registry has evaluated post- chemotherapy (PC)-MTHF in subjects using Liverubin (standardized Silymarin) for 8 weeks (3 capsules/day). PC-MTHF was evaluated in a registry study. Hepatitis markers were negative at inclusion and at end-registry. In the final registry there were results concerning 18 Liverubin-supplemented patients and 19 controls completing the 8-week period. Signs/symptoms. The distribution of the most common symptoms and signs with ultrasound scans were comparable. Symptoms were mostly minimal or subclinical. Most symptoms observed at inclusion were completely disappeared or greatly attenuated after 8 weeks. The improvement produced by Liverubin induced a better and faster disappearance of symptoms. The results of the blood tests (at inclusion and at 8 weeks showed the increase in albumin, significantly (P<0.05) faster with the final values higher in the supplement group. Total bilirubin was reduced with the supplement better than in controls (P<0.05). Direct bilirubin values improved more in the supplement (P<0.05) group. The decrease in SGPT and AST-ASAT was more evident with the supplement (P<0.05). Improvement in controls was more limited. Alkaline phosphatase was significantly lower (than in controls) with Liverubin at 8 weeks (p<0.05). Gamma GT also decreased more and faster with the supplement. The ESR (erythrocytes sedimentation rate) was decreased in both groups, more in the Liverubin group (P<0.05). There was a more limited decrease in controls with persisting higher values at 8 weeks. The white cell count was also better at 3 months (with a larger decrease with the supplement; P<0.05). Oxidative stress. Plasma free radicals (PFR) were elevated in both groups at inclusion. A more significant decrease in the supplement group was observed at 8 weeks. Persisting elevation in values was seen in controls (P<0.05). Platelets values improved better with Liverubin (P<0.05). Safety and tolerability were optimal (no side effect was registered). In conclusion, results from this pilot registry indicate a significant activity of Liverubin associated with a very good safety profile, in patients with post-chemotherapy hepatic failure. The recovery of hepatic function is faster and more effective with Liverubin in comparison with the best "standard" management.

76 FR 54525 - Notice of Availability of a Final Environmental Assessment (Final EA) and a Finding of No...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-01

... Environmental Assessment (Final EA) and a Finding of No Significant Impact (FONSI)/Record of Decision (ROD) for... Environmental Assessment (Final EA) and Finding of No Significant Impact (FONSI)/Record of Decision (ROD) for a...)/Record of Decision (ROD) based on the Final Environmental Assessment (Final EA) for a Proposed Airport...

Engineering xylose metabolism for production of polyhydroxybutyrate in the non-model bacterium Burkholderia sacchari.

PubMed

Guamán, Linda P; Barba-Ostria, Carlos; Zhang, Fuzhong; Oliveira-Filho, Edmar R; Gomez, José Gregório C; Silva, Luiziana F

2018-05-15

Despite its ability to grow and produce high-value molecules using renewable carbon sources, two main factors must be improved to use Burkholderia sacchari as a chassis for bioproduction at an industrial scale: first, the lack of molecular tools to engineer this organism and second, the inherently slow growth rate and poly-3-hydroxybutyrate [P(3HB)] production using xylose. In this work, we have addressed both factors. First, we adapted a set of BglBrick plasmids and showed tunable expression in B. sacchari. Finally, we assessed growth rate and P(3HB) production through overexpression of xylose transporters, catabolic or regulatory genes. Overexpression of xylR significantly improved growth rate (55.5% improvement), polymer yield (77.27% improvement), and resulted in 71% of cell dry weight as P(3HB). These values are unprecedented for P(3HB) accumulation using xylose as a sole carbon source and highlight the importance of precise expression control for improving utilization of hemicellulosic sugars in B. sacchari.

A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

PubMed

Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

2013-01-01

There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

Fermentation process improvement of a Chinese traditional food: soybean residue cake.

PubMed

Yao, Yingzheng; Pan, Siyi; Wang, Kexing; Xu, Xiaoyun

2010-09-01

Fermentation process improvement of soybean residue cake, a Chinese traditional fermented food, and its physicochemical analysis during fermentation were studied. One of the dominant strains in the fermentation was isolated and identified as Mucor racemosus Fresenius. The fermentation process was improved by subsection fermentation. The crude protein content decreased from 19.95 ± 0.03% in the raw soybean residue to 16.85 ± 0.10% in the fermented products, and the formaldehyde nitrogen content increased from 0.068 ± 0.004% to 0.461 ± 0.022% in final fermented cakes. Hardness of samples significantly (P < 0.05) increased whereas springiness, cohesiveness, and resilience significantly (P < 0.05) decreased with increasing fermentation time, respectively. Microstructure observations showed obvious change of the surface of cake samples during the fermentation process. During the soybean processing, it will produce plenty of by-products, and the most part of them is soybean residue. The discarded soybean residue causes economic loss. Fortunately, we can obtain nutritious and delicious fermented soybean residue cakes by fermenting soybean residue as raw material.

N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction.

PubMed

Haaf, Philip; Balmelli, Cathrin; Reichlin, Tobias; Twerenbold, Raphael; Reiter, Miriam; Meissner, Julia; Schaub, Nora; Stelzig, Claudia; Freese, Michael; Paniz, Patricia; Meune, Christophe; Drexler, Beatrice; Freidank, Heike; Winkler, Katrin; Hochholzer, Willibald; Mueller, Christian

2011-08-01

Myocardial ischemia is a strong trigger of N-terminal pro-B-type natriuretic peptide (NT-proBNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that NT-proBNP might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction. In a prospective multicenter study, NT-proBNP was measured at presentation in 658 consecutive patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality. Acute myocardial infarction was the adjudicated final diagnosis in 117 patients (18%). NT-proBNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other final diagnoses (median 886 pg/mL vs 135 pg/mL, P <.001). The diagnostic accuracy of NT-proBNP for acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval [CI], 0.75-0.83). When added to cardiac troponin T, NT-proBNP significantly increased the AUC from 0.89 (95% CI, 0.84-0.93) to 0.91 (95% CI, 0.88-0.94; P=.033). Cumulative 24-month mortality rates were 0% in the first, 1.3% in the second, 8.3% in the third, and 23.3% in the fourth quartile of NT-proBNP (P <.001). NT-proBNP (AUC 0.85, 95% CI, 0.81-0.89) predicted all-cause mortality independently of and more accurately than both cardiac troponin T (AUC 0.66, 95% CI, 0.58-0.74; P <.001) and the Thrombolysis in Myocardial Infarction risk score (AUC 0.79, 95% CI, 0.74-0.84; P <.001). Net reclassification improvement (Thrombolysis in Myocardial Infarction vs additionally NT-proBNP) was 0.188 (P <.009), and integrated discrimination improvement was 0.100 (P <.001). Use of NT-proBNP improves the early diagnosis and risk stratification of patients with suspected acute myocardial infarction. Copyright © 2011 Elsevier Inc. All rights reserved.

Four Weeks of β-alanine Supplementation Improves High-Intensity Game Activities in Water Polo.

PubMed

Brisola, Gabriel Motta Pinheiro; de Souza Malta, Elvis; Santiago, Paulo Roberto Pereira; Vieira, Luiz Henrique Palucci; Zagatto, Alessandro Moura

2018-04-13

The present study aimed to investigate whether four weeks of β-alanine supplementation improves total distance covered, distance covered and time spent in different speed zones, and sprint numbers during a simulated water polo game. The study design was double-blind, parallel and placebo controlled. Eleven male water polo players participated in the study, divided randomly into two homogeneous groups (placebo and β-alanine groups). The participants performed a simulated water polo game before and after the supplementation period (4 weeks). Participants received 4.8g∙day -1 of dextrose or β-alanine on the first ten days and 6.4g∙day -1 on the final 18 days. Only the β-alanine group presented a significant improvement in total sprint numbers compared to the pre-supplementation moment (PRE=7.8±5.2a.u.; POST=20.2±7.8a.u.; p=.002). Furthermore, β-alanine supplementation presented a likely beneficial effect on improving total distance covered (83%) and total time spent (81%) in zone 4 of speed (i.e., speed≥1.8m∙s -1 ). There was no significant interaction effect (group×time) for any variable. To conclude, four weeks of β-alanine supplementation can slightly improve sprint numbers and had a likely beneficial effect on improving distance covered and time spent in zone 4 of speed in a water polo simulated game.

On the combinatorics of sparsification.

PubMed

Huang, Fenix Wd; Reidys, Christian M

2012-10-22

We study the sparsification of dynamic programming based on folding algorithms of RNA structures. Sparsification is a method that improves significantly the computation of minimum free energy (mfe) RNA structures. We provide a quantitative analysis of the sparsification of a particular decomposition rule, Λ∗. This rule splits an interval of RNA secondary and pseudoknot structures of fixed topological genus. Key for quantifying sparsifications is the size of the so called candidate sets. Here we assume mfe-structures to be specifically distributed (see Assumption 1) within arbitrary and irreducible RNA secondary and pseudoknot structures of fixed topological genus. We then present a combinatorial framework which allows by means of probabilities of irreducible sub-structures to obtain the expectation of the Λ∗-candidate set w.r.t. a uniformly random input sequence. We compute these expectations for arc-based energy models via energy-filtered generating functions (GF) in case of RNA secondary structures as well as RNA pseudoknot structures. Furthermore, for RNA secondary structures we also analyze a simplified loop-based energy model. Our combinatorial analysis is then compared to the expected number of Λ∗-candidates obtained from the folding mfe-structures. In case of the mfe-folding of RNA secondary structures with a simplified loop-based energy model our results imply that sparsification provides a significant, constant improvement of 91% (theory) to be compared to an 96% (experimental, simplified arc-based model) reduction. However, we do not observe a linear factor improvement. Finally, in case of the "full" loop-energy model we can report a reduction of 98% (experiment). Sparsification was initially attributed a linear factor improvement. This conclusion was based on the so called polymer-zeta property, which stems from interpreting polymer chains as self-avoiding walks. Subsequent findings however reveal that the O(n) improvement is not correct. The combinatorial analysis presented here shows that, assuming a specific distribution (see Assumption 1), of mfe-structures within irreducible and arbitrary structures, the expected number of Λ∗-candidates is Θ(n2). However, the constant reduction is quite significant, being in the range of 96%. We furthermore show an analogous result for the sparsification of the Λ∗-decomposition rule for RNA pseudoknotted structures of genus one. Finally we observe that the effect of sparsification is sensitive to the employed energy model.

77 FR 14473 - Final Guidance on Improving the Process for Preparing Efficient and Timely Environmental Reviews...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

... COUNCIL ON ENVIRONMENTAL QUALITY 40 CFR Parts 1500, 1501, 1502, 1503, 1505, 1506, 1507, and 1508 Final Guidance on Improving the Process for Preparing Efficient and Timely Environmental Reviews Under the National Environmental Policy Act AGENCY: Council on Environmental Quality. ACTION: Notice of...

The role of social media use in improving cancer survivors' emotional well-being: a moderated mediation study.

PubMed

Jiang, Shaohai

2017-06-01

In the USA, levels of emotional well-being among cancer survivors remain low. Social media is recognized as important to improve their emotional well-being. However, little is known about social mechanisms that underlie the impact of health-related social media in cancer care. This study proposed a moderated mediation model to signify a pathway linking social media use to emotional well-being. Four-hundred and fifty-nine cancer survivors identified through the 2013 US-based Health Information National Trends Survey were included for data analysis. First, structural equation modeling was conducted to examine the path from social media use to emotional well-being, mediated by patient activation. Second, hierarchical regression was performed to test the moderation effect of emotion management. Last, a normal theory-based approach was used to explore the final moderated mediation model. The effect of health-related social media use on emotional well-being was completely mediated by patient activation. Also, emotion management positively moderated the effect of patient activation on emotional well-being. Last, emotion management positively moderated the mediation pathway from health-related social media use to patient activation, and finally, to emotional well-being. Health-related social media, by itself, is not sufficient to bring about improvement in cancer survivors' emotional well-being. Patient activation and emotion management play a significant role. In future interventions designed to improve cancer survivors' emotional health, health practitioners should not only encourage cancer survivors to use social media for health purposes, but also activate them in the course of care, and improve their emotion self-management skills.

A review and prospects for Nb3Sn superconductor development

NASA Astrophysics Data System (ADS)

Xu, Xingchen

2017-09-01

Nb3Sn superconductors have significant applications in constructing high-field (>10 T) magnets. This article briefly reviews development of Nb3Sn superconductor and proposes prospects for further improvement. It is shown that significant improvement of critical current density (J c) is needed for future accelerator magnets. After a brief review of the development of Nb3Sn superconductors, the factors controlling J c are summarized and correlated with their microstructure and chemistry. The non-matrix J c of Nb3Sn conductors is mainly determined by three factors: the fraction of current-carrying Nb3Sn phase in the non-matrix area, the upper critical field B c2, and the flux line pinning capacity. Then prospects to improve the three factors are discussed respectively. An analytic model was developed to show how the ratios of precursors determine the phase fractions after heat treatment, based on which it is predicted that the limit of current-carrying Nb3Sn fraction in subelements is ∼65%. Then, since B c2 is largely determined by the Nb3Sn stoichiometry, a thermodynamic/kinetic theory is presented to show what essentially determines the Sn content of Nb3Sn conductors. This theory explains the influences of Sn sources and Ti addition on stoichiometry and growth rate of Nb3Sn layers. Next, to improve flux pinning, previous efforts in this community to introduce additional pinning centers to Nb3Sn wires are reviewed, and an internal oxidation technique is described. Finally, prospects for further improvement of non-matrix J c of Nb3Sn conductors are discussed, and it is seen that the only opportunity for further significantly improving J c lies in improving flux pinning.

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

PubMed

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

Hawthorn Fruit Extract Elevates Expression of Nrf2/HO-1 and Improves Lipid Profiles in Ovariectomized Rats

PubMed Central

Yoo, Jeong-Hyun; Liu, Yanan; Kim, Hyun-Sook

2016-01-01

The purpose of this study was to investigate the effects of hawthorn (Crataegus pinnatifida Bunge) extract on the lipid profiles and antioxidant properties in ovariectomized (OVX) rats. After ovariectomy, the rats were randomly divided into four groups: the non-OVX control (Sham), the OVX-control (OVX), the OVX + 100 mg/kg b.w. of hawthorn extract (OL), and the OVX + 200 mg/kg b.w. of hawthorn extract (OH). The final body weights of the OVX group were significantly increased, but the increment was significantly decreased in hawthorn groups (p < 0.05). The serum total and low-density lipoprotein (LDL) cholesterol levels were significantly elevated in the OVX group, whereas the hawthorn groups showed a significant decrease in these levels (p < 0.05). The hepatic triglyceride (TG) and malondialdehyde (MDA) levels were significantly reduced in the hawthorn groups compared with the OVX group (p < 0.05). The mRNA expression of nuclear factor erythroid 2–related factor (Nrf2), heme oxygenase-1 (HO-1), and glutathione peroxidase (GPx) were significantly decreased in the OVX group, whereas the hawthorn groups exhibited a significant increase in expression (p < 0.05). The protein expressions of Nrf2, HO-1, and GPx were lower in the OVX group than the Sham group (p < 0.05). The oral administration of hawthorn extract reversed the suppression of protein levels. These results suggest that hawthorn extract could have protective effects in OVX rats by improving lipid profiles, decreasing oxidative stress, and improving the antioxidant defense system. PMID:27187458

Hawthorn Fruit Extract Elevates Expression of Nrf2/HO-1 and Improves Lipid Profiles in Ovariectomized Rats.

PubMed

Yoo, Jeong-Hyun; Liu, Yanan; Kim, Hyun-Sook

2016-05-13

The purpose of this study was to investigate the effects of hawthorn (Crataegus pinnatifida Bunge) extract on the lipid profiles and antioxidant properties in ovariectomized (OVX) rats. After ovariectomy, the rats were randomly divided into four groups: the non-OVX control (Sham), the OVX-control (OVX), the OVX + 100 mg/kg b.w. of hawthorn extract (OL), and the OVX + 200 mg/kg b.w. of hawthorn extract (OH). The final body weights of the OVX group were significantly increased, but the increment was significantly decreased in hawthorn groups (p < 0.05). The serum total and low-density lipoprotein (LDL) cholesterol levels were significantly elevated in the OVX group, whereas the hawthorn groups showed a significant decrease in these levels (p < 0.05). The hepatic triglyceride (TG) and malondialdehyde (MDA) levels were significantly reduced in the hawthorn groups compared with the OVX group (p < 0.05). The mRNA expression of nuclear factor erythroid 2-related factor (Nrf2), heme oxygenase-1 (HO-1), and glutathione peroxidase (GPx) were significantly decreased in the OVX group, whereas the hawthorn groups exhibited a significant increase in expression (p < 0.05). The protein expressions of Nrf2, HO-1, and GPx were lower in the OVX group than the Sham group (p < 0.05). The oral administration of hawthorn extract reversed the suppression of protein levels. These results suggest that hawthorn extract could have protective effects in OVX rats by improving lipid profiles, decreasing oxidative stress, and improving the antioxidant defense system.

Evaluation of a Low Energy, Low Density, Non-Ablative Fractional 1927 nm Wavelength Laser for Facial Skin Resurfacing.

PubMed

Brauer, Jeremy A; Alabdulrazzaq, Hamad; Bae, Yoon-Soo Cindy; Geronemus, Roy G

2015-11-01

We investigated the safety, tolerability and efficacy of a low energy low density, non-ablative fractional 1,927-nm laser in the treatment of facial photodamage, melasma, and post inflammatory hyperpigmentation. Prospective non-randomized trial. Single center, private practice with a dedicated research department. Subjects with clinically diagnosed facial photodamage, melasma, or post inflammatory hyperpigmentation. Subjects received four to six treatments at 14-day intervals (+/- 3 days) with a low energy low density non-ablative fractional 1,927-nm laser (Solta Hayward, CA) with an energy level of 5 mJ, and density coverage of either 5%, 7.5%, or 10%, with a total of up to 8 passes. Blinded assessment of clinical photos for overall improvement at one and three months post final treatment. Investigator improvement scores, and subject pain and satisfaction scores for overall improvement were recorded as well. We enrolled 23 subjects, average age 45.0 years (range, 25-64 years), 22 with Fitzpatrick Skin Types I-IV and 1 with Type VI, with facial photodamage, melasma, or post inflammatory hyperpigmentation. Approximately 55% of subjects reported marked to very significant improvement at one and three months post final treatment. Blinded assessment of photography of 20 subjects revealed an average of moderate improvement at one-month follow up and mild to moderate improvement at three months. Average subject pain score was 3.4/10 during treatment. Favorable outcomes were demonstrated using the low energy low density, non-ablative fractional 1,927-nm laser in facial resurfacing for photodamage, melasma, and post inflammatory hyperpigmentation. Results were maintained at the 3-month follow up, as demonstrated by investigator and subject assessments, as well as blinded evaluations by three independent dermatologists utilizing photographs obtained from a standardized facial imaging device.

A Novel Adjustment Method for Shearer Traction Speed through Integration of T-S Cloud Inference Network and Improved PSO

PubMed Central

Si, Lei; Wang, Zhongbin; Yang, Yinwei

2014-01-01

In order to efficiently and accurately adjust the shearer traction speed, a novel approach based on Takagi-Sugeno (T-S) cloud inference network (CIN) and improved particle swarm optimization (IPSO) is proposed. The T-S CIN is built through the combination of cloud model and T-S fuzzy neural network. Moreover, the IPSO algorithm employs parameter automation adjustment strategy and velocity resetting to significantly improve the performance of basic PSO algorithm in global search and fine-tuning of the solutions, and the flowchart of proposed approach is designed. Furthermore, some simulation examples are carried out and comparison results indicate that the proposed method is feasible, efficient, and is outperforming others. Finally, an industrial application example of coal mining face is demonstrated to specify the effect of proposed system. PMID:25506358

Organically Modified Nanoclay-Reinforced Rigid Polyurethane Films

NASA Astrophysics Data System (ADS)

Park, Yong Tae; Qian, Yuqiang; Lindsay, Chris; Stein, Andreas; Macosko, Christopher

2012-02-01

The nanodispersion of vermiculite in polyurethanes was investigated to produce organoclay-reinforced rigid gas barrier films. Reducing gas transport can improve the insulation performance of closed cell polyurethane foam. In a previous study, the dispersion of vermiculite in polyurethanes without organic modification was not sufficient due to the non-uniform dispersion morphology. When vermiculite was modified by cation exchange with long-chain quaternary ammonium cations, the dispersion in methylene diphenyl diisocyanate (MDI) was significantly improved. Dispersion was improved by combining high intensity dispersive mixing with efficient distributive mixing. Polymerization conditions were also optimized in order to provide a high state of nanodispersion in the polyurethane nanocomposite. The dispersions were characterized using rheological, microscopic and scattering/diffraction techniques. The final nanocomposites showed enhancement of mechanical properties and reduction in permeability to carbon dioxide at low clay concentration (around 2 wt percent).

MOOSE IPL Extensions (Control Logic)

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

Permann, Cody

In FY-2015, the development of MOOSE was driven by the needs of the NEAMS MOOSE-based applications, BISON, MARMOT, and RELAP-7. An emphasis was placed on the continued upkeep and improvement MOOSE in support of the product line integration goals. New unified documentation tools have been developed, several improvements to regression testing have been enforced and overall better software quality practices have been implemented. In addition the Multiapps and Transfers systems have seen significant refactoring and robustness improvements, as has the “Restart and Recover” system in support of Multiapp simulations. Finally, a completely new “Control Logic” system has been engineered tomore » replace the prototype system currently in use in the RELAP-7 code. The development of this system continues and is expected to handle existing needs as well as support future enhancements.« less

Simulation of thin slot spirals and dual circular patch antennas using the finite element method with mixed elements

NASA Technical Reports Server (NTRS)

Gong, Jian; Volakis, John L.; Nurnberger, Michael W.

1995-01-01

This semi-annual report describes progress up to mid-January 1995. The report contains five sections all dealing with the modeling of spiral and patch antennas recessed in metallic platforms. Of significance is the development of decomposition schemes which separate the different regions of the antenna volume. Substantial effort was devoted to improving the feed model in the context of the finite element method (FEM). Finally, an innovative scheme for truncating finite element meshes is presented.

Final Environmental Assessment for the Boles Wells Field Perimeter Security Improvement Project Otero County, New Mexico

DTIC Science & Technology

2005-10-03

barbed wire boundary fence was built in 1957. The 1957 fence was considered adequate until1989, when it was replaced by new barbed wire on metal T ... inclusion on the NRHP; however~ it will not be affected by the Proposed Action and no further work is warranted. Four other sites in the project area...in significant effects, it is also reasonable to expect that the inclusion of smaller additional projects would result in no major change to the

Final Environmental Assessment and Finding of No Significant Impact (EA/FONSI) for 2012-14 Capital Improvements Program (CIP) at Davis-Monthan Air Force Base, Tucson, Arizona

DTIC Science & Technology

2012-03-01

3553 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) US Air Force, Davis-Monthan AFB 355 CES/CEAO...would be insignificant. Operational impacts, including the use of groundwater for water supply, would be similar to current conditions. Biological...expected in the vicinity of the hush house. Land Use and Visual Resources. Construction and demolition activities would create temporary land use

A Multi-scale, Multi-Model, Machine-Learning Solar Forecasting Technology

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

Hamann, Hendrik F.

The goal of the project was the development and demonstration of a significantly improved solar forecasting technology (short: Watt-sun), which leverages new big data processing technologies and machine-learnt blending between different models and forecast systems. The technology aimed demonstrating major advances in accuracy as measured by existing and new metrics which themselves were developed as part of this project. Finally, the team worked with Independent System Operators (ISOs) and utilities to integrate the forecasts into their operations.

Evaluation of Foaming Performance of Bitumen Modified with the Addition of Surface Active Agent

NASA Astrophysics Data System (ADS)

Chomicz-Kowalska, Anna; Mrugała, Justyna; Maciejewski, Krzysztof

2017-10-01

The article presents the analysis of the performance of foamed bitumen modified using surface active agents. Although, bitumen foaming permits production of asphalt concrete and other asphalt mix types without using chemical additives in significantly reduced temperatures, the decrease in processing temperatures still impacts the adhesion performance and bitumen coating of aggregates in final mixes. Therefore, in some cases it may be feasible to incorporate adhesion promoters and surface active agents into warm and half-warm mixes with foamed bitumen to increase their service life and resilience. Because of the various nature of the available surface active agents, varying bitumen compatibility and their possible impact on the rheological properties of bitumen, the introduction of surface active agents may significantly alter the bitumen foaming performance. The tests included basic performance tests of bitumen before and after foaming. The two tested bitumen were designated as 35/50 and 50/70 penetration grade binders, which were modified with a surface active agent widely used for improving mixture workability, compactibility and adhesion in a wide range of asphalt mixes and techniques, specifically Warm Mix Asphalt. Alongside to the reference unmodified bitumen, binders with 0.2%, 0.4% and 0.6% surface active agent concentration were tested. The analysis has shown a positive influence of the modifier on the foaming performance of both of the base bitumen increasing their maximum expansion ratio and bitumen foam halflife. In the investigations, it was found that the improvement was dependent on the bitumen type and modifier content. The improved expansion ratio and foam half-life has a positive impact on the aggregate coating and adhesion, which together with the adhesion promoting action of the modifier will have a combined positive effect on the quality of produced final asphalt mixes.

Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

PubMed

Mahindra, Pankaj; Yamin, Mohammad; Selhi, Harpal S; Singla, Sonia; Soni, Ashwani

2016-01-01

Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis. Copyright 2016, SLACK Incorporated.

Patient-Reported Outcomes of Aesthetics and Satisfaction in Immediate Breast Reconstruction After Nipple-Sparing Mastectomy With Implants and Fat Grafting.

PubMed

Qureshi, Ali A; Odom, Elizabeth B; Parikh, Rajiv P; Myckatyn, Terence M; Tenenbaum, Marissa M

2017-10-01

Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM. 3. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Effects of hemoadsorption on cytokine removal and short-term survival in septic rats

PubMed Central

Peng, Zhi-Yong; Carter, Melinda J.; Kellum, John A.

2012-01-01

Objective A broad-spectrum immune-regulating therapy could be beneficial in the treatment of sepsis. Our previous studies have shown that a hemoadsorption device (CytoSorb) removes both pro- and anti-inflammatory cytokines and improves survival in experimental endotoxemia. We sought to determine whether hemoadsorption can also be effective in the treatment of sepsis. Design Randomized controlled laboratory experiment. Setting University laboratory. Interventions Rats were subjected to cecal ligation and puncture (CLP) and 20 hrs later were randomized to receive either hemoadsorption or sham treatment using an arterial-venous circuit. Hemoadsorption was accomplished using a cartridge containing Cytosorb beads. Blood was drawn for cytokine measurements and mean arterial pressure (MAP) was continuously monitored. Cytokines were measured via multiplex bead immunoassays. Survival time was observed for 9 hours after the intervention and assessed by Kaplan–Meier statistics. The overall survival in each group was compared using Fisher’s exact test. Finally, we used a Cox proportional-hazards model to examine the effects of cytokine removal on survival time. Measurements and Main Results Baseline plasma cytokine concentrations and MAP were similar between hemoadsorption and sham-treated groups. However, the concentrations of tumor necrosis factor, interleukin (IL)-1β, IL-6, and IL-10 were significantly lower after hemoadsorption compared to the sham group. Six hours after treatment ended, IL-6 and IL-10 concentrations were still lower in hemoadsorption group. MAP was significantly better in hemoadsorption compared to sham-treated animals (p < .05). Finally, mean survival time was significantly longer (720 vs. 381 min, p < .05, Mann–Whitney test), and overall survival was significantly better (11/17 vs. 2/16, p < .01) with hemoadsorption compared to sham. Combined reduction in both IL-6 and IL-10 was associated with a significantly decreased risk of death (hazard ratio, .11, p = .005). Conclusion Hemoadsorption reduced circulating cytokines, improved MAP, and resulted in better short-term survival in CLP-induced septic rats. PMID:18434884

Effects of hemoadsorption on cytokine removal and short-term survival in septic rats.

PubMed

Peng, Zhi-Yong; Carter, Melinda J; Kellum, John A

2008-05-01

A broad-spectrum immune-regulating therapy could be beneficial in the treatment of sepsis. Our previous studies have shown that a hemoadsorption device (CytoSorb) removes both pro- and anti-inflammatory cytokines and improves survival in experimental endotoxemia. We sought to determine whether hemoadsorption can also be effective in the treatment of sepsis. Randomized controlled laboratory experiment. University laboratory. Rats were subjected to cecal ligation and puncture (CLP) and 20 hrs later were randomized to receive either hemoadsorption or sham treatment using an arterial-venous circuit. Hemoadsorption was accomplished using a cartridge containing Cytosorb beads. Blood was drawn for cytokine measurements and mean arterial pressure (MAP) was continuously monitored. Cytokines were measured via multiplex bead immunoassays. Survival time was observed for 9 hours after the intervention and assessed by Kaplan-Meier statistics. The overall survival in each group was compared using Fisher's exact test. Finally, we used a Cox proportional-hazards model to examine the effects of cytokine removal on survival time. Baseline plasma cytokine concentrations and MAP were similar between hemoadsorption and sham-treated groups. However, the concentrations of tumor necrosis factor, interleukin (IL)-1beta, IL-6, and IL-10 were significantly lower after hemoadsorption compared to the sham group. Six hours after treatment ended, IL-6 and IL-10 concentrations were still lower in hemoadsorption group. MAP was significantly better in hemoadsorption compared to sham-treated animals (p < .05). Finally, mean survival time was significantly longer (720 vs. 381 min, p < .05, Mann-Whitney test), and overall survival was significantly better (11/17 vs. 2/16, p < .01) with hemoadsorption compared to sham. Combined reduction in both IL-6 and IL-10 was associated with a significantly decreased risk of death (hazard ratio, .11, p = .005). Hemoadsorption reduced circulating cytokines, improved MAP, and resulted in better short-term survival in CLP-induced septic rats.

Single-row, double-row, and transosseous equivalent techniques for isolated supraspinatus tendon tears with minimal atrophy: A retrospective comparative outcome and radiographic analysis at minimum 2-year followup

PubMed Central

McCormick, Frank; Gupta, Anil; Bruce, Ben; Harris, Josh; Abrams, Geoff; Wilson, Hillary; Hussey, Kristen; Cole, Brian J.

2014-01-01

Purpose: The purpose of this study was to measure and compare the subjective, objective, and radiographic healing outcomes of single-row (SR), double-row (DR), and transosseous equivalent (TOE) suture techniques for arthroscopic rotator cuff repair. Materials and Methods: A retrospective comparative analysis of arthroscopic rotator cuff repairs by one surgeon from 2004 to 2010 at minimum 2-year followup was performed. Cohorts were matched for age, sex, and tear size. Subjective outcome variables included ASES, Constant, SST, UCLA, and SF-12 scores. Objective outcome variables included strength, active range of motion (ROM). Radiographic healing was assessed by magnetic resonance imaging (MRI). Statistical analysis was performed using analysis of variance (ANOVA), Mann — Whitney and Kruskal — Wallis tests with significance, and the Fisher exact probability test <0.05. Results: Sixty-three patients completed the study requirements (20 SR, 21 DR, 22 TOE). There was a clinically and statistically significant improvement in outcomes with all repair techniques (ASES mean improvement P = <0.0001). The mean final ASES scores were: SR 83; (SD 21.4); DR 87 (SD 18.2); TOE 87 (SD 13.2); (P = 0.73). There was a statistically significant improvement in strength for each repair technique (P < 0.001). There was no significant difference between techniques across all secondary outcome assessments: ASES improvement, Constant, SST, UCLA, SF-12, ROM, Strength, and MRI re-tear rates. There was a decrease in re-tear rates from single row (22%) to double-row (18%) to transosseous equivalent (11%); however, this difference was not statistically significant (P = 0.6). Conclusions: Compared to preoperatively, arthroscopic rotator cuff repair, using SR, DR, or TOE techniques, yielded a clinically and statistically significant improvement in subjective and objective outcomes at a minimum 2-year follow-up. Level of Evidence: Therapeutic level 3. PMID:24926159

Assessing the outcome of Strengthening Laboratory Management Towards Accreditation (SLMTA) on laboratory quality management system in city government of Addis Ababa, Ethiopia

PubMed Central

Sisay, Abay; Mindaye, Tedla; Tesfaye, Abrham; Abera, Eyob; Desale, Adino

2015-01-01

Introduction Strengthening Laboratory Management Toward Accreditation (SLMTA) is a competency-based management training programme designed to bring about immediate and measurable laboratory improvement. The aim of this study is to assess the outcome of SLMTA on laboratory quality management system in Addis Ababa, Ethiopia. Methods The study used an Institutional based cross sectional study design that employed a secondary and primary data collection approach on the participated institution of medical laboratory in SLMTA. The study was conducted in Addis Ababa city government and the data was collected from February ‘April 2014 and data was entered in to EPI-data version 3.1 and was analyzed by SPSS version 20. Results The assessment finding indicate that there was a significant improvement in average scores (141.4; range of 65-196, 95%CI =86.275-115.5, p = 0.000) at final with 3 laboratories become 3 star, 6 laboratories were at 2 star, 11 were 1 star. Laboratory facilities respondents which thought getting adequate and timely manner mentorship were found 2.5 times more likely to get good success in the final score(AOR= 2.501, 95% CI= 1.109-4.602) than which did not get it. Conclusion At the end of SLMTA implementation,3 laboratories score 3 star, 6 laboratories were at 2 star, 11 were at 1 star. The most important contributing factor for not scoring star in the final outcome of SLMTA were not conducting their customer satisfaction survey, poor staff motivation, and lack of regular equipment service maintenance. Mentorship, onsite and offsite coaching and training activities had shown a great improvement on laboratory quality management system in most laboratories. PMID:26175805

Assessing the outcome of Strengthening Laboratory Management Towards Accreditation (SLMTA) on laboratory quality management system in city government of Addis Ababa, Ethiopia.

PubMed

Sisay, Abay; Mindaye, Tedla; Tesfaye, Abrham; Abera, Eyob; Desale, Adino

2015-01-01

Strengthening Laboratory Management Toward Accreditation (SLMTA) is a competency-based management training programme designed to bring about immediate and measurable laboratory improvement. The aim of this study is to assess the outcome of SLMTA on laboratory quality management system in Addis Ababa, Ethiopia. The study used an Institutional based cross sectional study design that employed a secondary and primary data collection approach on the participated institution of medical laboratory in SLMTA. The study was conducted in Addis Ababa city government and the data was collected from February 'April 2014 and data was entered in to EPI-data version 3.1 and was analyzed by SPSS version 20. The assessment finding indicate that there was a significant improvement in average scores (141.4; range of 65-196, 95%CI=86.275-115.5, p=0.000) at final with 3 laboratories become 3 star, 6 laboratories were at 2 star, 11 were 1 star. Laboratory facilities respondents which thought getting adequate and timely manner mentorship were found 2.5 times more likely to get good success in the final score(AOR=2.501, 95% CI=1.109-4.602) than which did not get it. At the end of SLMTA implementation,3 laboratories score 3 star, 6 laboratories were at 2 star, 11 were at 1 star. The most important contributing factor for not scoring star in the final outcome of SLMTA were not conducting their customer satisfaction survey, poor staff motivation, and lack of regular equipment service maintenance. Mentorship, onsite and offsite coaching and training activities had shown a great improvement on laboratory quality management system in most laboratories.

Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

PubMed

Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

2015-12-01

Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

C-A4-01: Computerized Clinical Decision Support During Drug Ordering for Long-term Care Residents With Renal Insufficiency

PubMed Central

Field, Terry S; Rochon, Paula; Lee, Monica; Gavendo, Linda; Baril, Joann L; Gurwitz, Jerry H

2010-01-01

Objective: To determine whether a computerized clinical decision support system (CDSS) providing patient specific recommendations in real- time improves the quality of prescribing for long-term care residents with renal insufficiency. Design: A randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units. Measurement: The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: recommended medication doses; recommended administration frequencies; recommendations to avoid the drug; 4) warnings of missing information. Results: The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 1.1). For the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often than a relative risk 1.2 (1.0, 1.4). By tracking personnel time and expenditures, we estimated the cost of developing the CDSS as $48,668.57. Drug costs saved during the 12 months of the trial are estimated at $2,137. Conclusion: Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions. However, patient well-being and quality of care rather than the business case related to cost savings are likely to be the key drivers for adoption of this HIT application.

Bladder augmentation and artificial sphincter implantation: urodynamic behavior and effects on continence.

PubMed

Rodó, Juan S; Cáceres, Freud A; Lerena, Javier R; Rossy, Enrica

2008-02-01

To quantify changes in bladder capacity, pressure and compliance after isolated bladder augmentation or augmentation associated with implantation of an artificial sphincter, and to compare the various types of augmentation. Preoperative and postoperative urodynamic studies were performed in a group of 38 patients (18 males and 20 females; age range 2-19 years), who underwent a type of bladder augmentation. The bladder improved in capacity in all patients (mean values: initial 137 ml, final 336 ml, individual increase 229 ml; 434%) except two, in which the augmentation was done with ureter. The mean pressure improved (initial 32 cm of H(2)O, final 14, decrease per patient 18 cm of H2O; 49%). The curve of compliance, progressively increasing typical of hyperreflexia and poor compliance, present in 70% of the cases preoperatively, improved in 78% cases postoperatively, although there were several different patterns. Urodynamic behavior was analyzed with regard to the tissue used for augmentation (ileum, ureter or sigmoid colon). In the sigmoid colon group, there were no significant differences in the urodynamic behavior of the bladder neo-reservoir in relation to the configuration used. With bladder augmentation comes an increase in bladder capacity, a reduction in pressure, and an improvement in compliance and continence. The level of change in capacity, pressure and compliance varies with the tissue used and the length and caliber of the insert. When the procedure is carried out using sigmoid colon tissue, there are no noteworthy differences among the various possible configurations.

TiO2 nanocrystals decorated Z-schemed core-shell CdS-CdO nanorod arrays as high efficiency anodes for photoelectrochemical hydrogen generation.

PubMed

Li, Chia-Hsun; Hsu, Chan-Wei; Lu, Shih-Yuan

2018-07-01

TiO 2 nanocrystals decorated core-shell CdS-CdO nanorod arrays, TiO 2 @CdO/CdS NR, were fabricated as high efficiency anodes for photoelctrochemical hydrogen generation. The novel sandwich heterostructure was constructed from first growth of CdS nanorod arrays on a fluorine doped tin oxide (FTO) substrate with a hydrothermal process, followed by in situ generation of CdO thin films of single digit nanometers from the CdS nanorod surfaces through thermal oxidation, and final decoration of TiO 2 nanocrystals of 10-20 nm via a successive ionic layer absorption and reaction process. The core-shell CdS-CdO heterostructure possesses a Z-scheme band structure to enhance interfacial charge transfer, facilitating effective charge separation to suppress electron-hole recombination within CdS for much improved current density generation. The final decoration of TiO 2 nanocrystals passivates surface defects and trap states of CdO, further suppressing surface charge recombination for even higher photovoltaic conversion efficiencies. The photoelectrochemical performances of the plain CdS nanorod array were significantly improved with the formation of the sandwich heterostructure, achieving a photo current density of 3.2 mA/cm 2 at 1.23 V (vs. RHE), a 141% improvement over the plain CdS nanorod array and a 32% improvement over the CdO/CdS nanorod array. Copyright © 2018 Elsevier Inc. All rights reserved.

Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus.

PubMed

Choi, Jun-Ik; Lee, Keun-Bae

2016-07-01

The objectives of this study were to compare the clinical outcomes of the two common bone marrow stimulation techniques such as subchondral drilling and microfracture for symptomatic osteochondral lesions of the talus and to evaluate prognostic factors affecting the outcomes. Ninety patients (90 ankles) who underwent arthroscopic bone marrow stimulation for small- to mid-sized osteochondral lesions of the talus constituted the study cohort. The 90 ankles were divided into two groups: a drilling group (40 ankles) and a microfracture group (50 ankles). Each group was matched for age and gender, and both groups had characteristics similar to those obtained from pre-operative demographic data. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the ankle activity score (AAS) were used to compare clinical outcomes, during a mean follow-up period of 43 months. The median AOFAS scores were 66.0 points (51-80) in drilling group and 66.5 points (45-81) in microfracture group pre-operatively, and these improved to 89.4 points (77-100) and 90.1 points (69-100) at the final follow-up, respectively. The median VAS scores improved at the final follow-up compared with the pre-operative condition. The median AAS for the drilling group improved from 4.5 (1-6) pre-operatively to 6.0 (1-8) at the final follow-up, while those for the microfracture group improved from 3.0 (2-8) to 6.0 (3-9). No significant differences were observed between the two groups in terms of the AOFAS scores, VAS, and AAS. The arthroscopic subchondral drilling and microfracture techniques that were used to stimulate bone marrow showed similar clinical outcomes. The results of this study suggest that both techniques are effective and reliable in treating small- to mid-sized osteochondral lesions of the talus, regardless of which of the two techniques is used. Level III, retrospective comparative study.

Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering.

PubMed

Huang, Jing-Hui; Yang, Wei-Zhou; Shen, Chao; Chang, Michael S; Li, Huan; Luo, Zhuo-Jing; Tao, Hui-Ren

2015-10-15

Retrospective case series. To investigate the safety and efficacy of spine-shortening osteotomy for congenital scoliosis with tethered cord. Conventional surgery for congenital scoliosis associated with tethered cord risks the complications of detethering. Spine-shortening osteotomy holds the potential to correct scoliosis and decrease spinal cord tension simultaneously without an extra detethering procedure, but no data on this issue is available. 21 patients (14 females and 7 males, average age 15.4 yr) underwent spine-shortening osteotomy without detethering. All of the patients had tethered cord. Patients with main curve more than 90° underwent vertebral column resection (VCR), whereas the others had pedicle subtraction osteotomy (PSO) performed. The average postoperative follow-up period was 45.2 months. The mean operation time was 544.5 min with average blood loss of 2769.1 ml. The deformity correction was 61.3% in the coronal plane and 43.9° in the sagittal plane. 10 patients had neurological deficits preoperatively. At the final follow-up, the deficits in 8 (80%) patients were significantly improved, whereas 2 (20%) remained unchanged. At final follow-up, 71.4% (5/7) patients reported improvement in motor function, 100% (3/3) had improved pain scores, and 75% (3/4) reported better sensory function after the spine-shortening osteotomy. Urinary dysfunction and bowel incontinence present preoperatively in 3 patients all recovered by final follow-up. 5 (23.8%) patients incurred complications including temporary neurological deterioration in 1 patient, urinary tract infection in 2 patients, cerebrospinal fluid leakage in 1 patient, and blood loss more than 5000 ml in 1 patient. Spine-shortening osteotomy is a safe and effective procedure for congenital scoliosis associated with tethered cord. Spine-shortening osteotomy at the thoracic apical vertebrae level not only corrects the spine deformity but also simultaneously releases the tension of the tethered cord, resulting in improved neurologic function.

[Comparison of clinical effects between anterior cervical Zero-incision fusion system and traditional nail plate system in the treatment of cervical spondylotic myelopathy].

PubMed

Chang, Bu-Qing; Feng, Hu; Yu, Chao-Jiang; Huang, Kai; Gao, Xiao; Tang, Hao; Jiang, Yun-Chang

2017-05-25

To compare the short-term efficacy of anterior cervical discectomy and fusion(ACDF) with traditional nail plate system and Zero-profile device in the treatment of cervical spondylotic myelopathy(CSM). The clinical data of 45 patients with CSM treated from July 2014 to August 2015 was retrospectively analyzed. There were 23 males and 22 females with an average age of 53.7 years old(range, 32 to 71 years old). The course of disease was 5 months to 2 years. All the patients were treated with ACDF with 24 cases by traditional nail plate system fixation(group A) and 21 cases by Zero-P system fixation(group B). Operation time and intraoperative bleeding were compared between two groups. Neurological function and cervical pain were evaluated by Japanese Orthopaedic Association scores (JOA) and visual analogue scale (VAS), respectively. Cervical curvature(Cobb angle) change and intervertebral fusion were evaluated by X-rays and CT. And associated complications were analyzed in two groups. All the patients were followed up for 12 to 16 months with an average of 14 months. Operation time of group A and B was(87.6±23.2) min and (62.7±17.3) min respectively, and the difference was significant between two groups; and intraoperative bleeding was (80.2±36.8) ml and (78.4±29.6) ml respectively, and the difference was not significant. At final follow-up, JOA and VAS of all patients were obvious improved, but there was no significant difference between two groups. Preoperative Cobb angle in group A and B was (8.7±4.3) ° and (8.6±4.2) ° respectively, and the difference was significant. The Cobb angle at final follow-up was (14.5±6.4) ° and (17.4±8.6) ° respectively, and the difference between two groups was significant. The incidence of dysphagia in group A and B were 29.17% and 9.52% respectively, and there was significant difference between two groups. All intervertebral spaces got fusion at final follow-up. No tracheo-asophageal injury and recurrent laryngeal nerve damage or other complications were found. No fusional migration, subsidence, loosening, breakage, etc. were found. The clinical comparison of Zero-P interbody fixation system and cervical plate internal fixation for the treatment of cervical spondylosis was quite fair, but Zero-P showed a better therapeutic effect with improvement of life quality.

Steroids versus No Steroids in Nonarteritic Anterior Ischemic Optic Neuropathy: A Randomized Controlled Trial.

PubMed

Saxena, Rohit; Singh, Digvijay; Sharma, Medha; James, Mathew; Sharma, Pradeep; Menon, Vimla

2018-04-25

To examine the role of oral steroid therapy in the treatment of nondiabetic cases of acute nonarteritic anterior ischemic optic neuropathy (NAAION). Randomized double-blind clinical trial. Thirty-eight patients with acute nondiabetic NAAION divided into 2 arms of 19 patients each. One arm constituted the cases and the other constituted the controls. Cases received oral steroid therapy and were designated the steroid group, whereas controls received placebo and were designated the nonsteroid group. Best-corrected visual acuity (BCVA), visual evoked response (VER), and OCT were performed at baseline, 1 month, 3 months, and 6 months after recruitment into the trial. Best-corrected visual acuity, VER, and retinal nerve fiber layer changes on OCT. Both groups showed significant improvement in BCVA, VER latency, and resolution of disc edema on OCT parameters over 6 months. Final outcome showed no statistically significant difference with regard to visual acuity, although VER was better in the steroid group (P = 0.011). Best-corrected visual acuity, VER amplitude, and VER latency (P = 0.02, P = 0.02, and P = 0.04, respectively) showed a greater percentage improvement in the steroid group, which also saw a faster resolution of disc edema on OCT (1-month follow-up). Oral steroids in acute NAAION did not improve the visual acuity significantly at 6 months. However, they improved resolution of disc edema significantly and enabled a greater improvement in VER parameters. This subtle benefit of oral steroids in NAAION is clinically unimportant and does not provide support for its use. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Simulation-Based Training Platforms for Arthroscopy: A Randomized Comparison of Virtual Reality Learning to Benchtop Learning.

PubMed

Middleton, Robert M; Alvand, Abtin; Garfjeld Roberts, Patrick; Hargrove, Caroline; Kirby, Georgina; Rees, Jonathan L

2017-05-01

To determine whether a virtual reality (VR) arthroscopy simulator or benchtop (BT) arthroscopy simulator showed superiority as a training tool. Arthroscopic novices were randomized to a training program on a BT or a VR knee arthroscopy simulator. The VR simulator provided user performance feedback. Individuals performed a diagnostic arthroscopy on both simulators before and after the training program. Performance was assessed using wireless objective motion analysis and a global rating scale. The groups (8 in the VR group, 9 in the BT group) were well matched at baseline across all parameters (P > .05). Training on each simulator resulted in significant performance improvements across all parameters (P < .05). BT training conferred a significant improvement in all parameters when trainees were reassessed on the VR simulator (P < .05). In contrast, VR training did not confer improvement in performance when trainees were reassessed on the BT simulator (P > .05). BT-trained subjects outperformed VR-trained subjects in all parameters during final assessments on the BT simulator (P < .05). There was no difference in objective performance between VR-trained and BT-trained subjects on final VR simulator wireless objective motion analysis assessment (P > .05). Both simulators delivered improvements in arthroscopic skills. BT training led to skills that readily transferred to the VR simulator. Skills acquired after VR training did not transfer as readily to the BT simulator. Despite trainees receiving automated metric feedback from the VR simulator, the results suggest a greater gain in psychomotor skills for BT training. Further work is required to determine if this finding persists in the operating room. This study suggests that there are differences in skills acquired on different simulators and skills learnt on some simulators may be more transferable. Further work in identifying user feedback metrics that enhance learning is also required. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

An open treatment trial of duloxetine in elderly patients with dysthymic disorder.

PubMed

Kerner, Nancy; D'Antonio, Kristina; Pelton, Gregory H; Salcedo, Elianny; Ferrar, Jennifer; Roose, Steven P; Devanand, Dp

2014-05-08

We evaluated the efficacy and side effects of the selective serotonin and norepinephrine reuptake inhibitor antidepressant duloxetine in older adults with dysthymic disorder. Patients ≥ 60 years old with dysthymic disorder received flexible dose duloxetine 20-120 mg daily in an open-label 12-week trial. The main outcomes were change from baseline to 12 weeks in 24-item Hamilton Depression Rating Scale scores and Treatment Emergent Symptoms Scale scores. Response required ≥ 50% decline in Hamilton Depression Rating Scale scores with a Clinical Global Impression of much improved or better, and remission required final Hamilton Depression Rating Scale ≤ 6. Intent-to-treat analyses were conducted with the last observation carried forward. In 30 patients, the mean age was 70.7 (standard deviation (SD) = 7.6) years and 56.7% were female. In intent-to-treat analyses, there were 16 responders (53.3%) and 10 remitters (33.3%). Of these, 19 patients completed the trial. The mean maximum dose was 76.3 mg (SD = 38.5) in the total sample and 101 mg (SD = 17.9) in completers. In the total sample, the mean final dose was 51 mg (SD = 27.2) and correlated significantly with decline in Hamilton Depression Rating Scale ( p < .03); decline in Hamilton Depression Rating Scale correlated significantly with decline in Treatment Emergent Symptoms Scale ( p < .001). Daily doses above 60 mg were associated with greater improvement and well tolerated. This result was partly confounded by early dropouts having received low doses. Demographic and medical comorbidities, including cardiac disease and hypertension, were not related to response. Somatic side effects were common prior to duloxetine treatment and improved rather than worsened with duloxetine. There were no serious adverse events. Duloxetine at relatively high doses showed moderate efficacy in elderly patients with dysthymic disorder and was well tolerated in successful completers. Reduced somatic symptoms were associated with improvement in depressive symptoms. A systematic placebo-controlled trial of duloxetine in older patients with dysthymic disorder may be warranted.

Early-Onset Bipolar Disorder: Characteristics and Outcomes in the Clinic.

PubMed

Connor, Daniel F; Ford, Julian D; Pearson, Geraldine S; Scranton, Victoria L; Dusad, Asha

2017-12-01

To assess patient characteristics and clinician-rated outcomes for children diagnosed with early-onset bipolar disorder in comparison to a depressive disorders cohort from a single clinic site. To assess predictors of bipolar treatment response. Medical records from 714 consecutive pediatric patients evaluated and treated at an academic tertiary child and adolescent psychiatry clinic between 2006 and 2012 were reviewed. Charts of bipolar children (n = 49) and children with depressive disorders (n = 58) meeting study inclusion/exclusion criteria were compared on variables assessing clinical characteristics, treatments, and outcomes. Outcomes were assessed by using pre- and post-Clinical Global Impressions (CGI)-Severity and Children's Global Assessment Scale (CGAS) scores, and a CGI-Improvement score ≤2 at final visit determined responder status. Bipolar outcome predictors were assessed by using multiple linear regression. Clinic prevalence rates were 6.9% for early-onset bipolar disorder and 1.5% for very early-onset bipolar disorder. High rates of comorbid diagnoses, symptom severity, parental stress, and child high-risk behaviors were found in both groups. The bipolar cohort had higher rates of aggression and higher lifetime systems of care utilization. The final CGI and CGAS outcomes for unipolar depression patients differed statistically significantly from those for the bipolar cohort, reflecting better clinical status and more improvement at outcome for the depression patients. Both parent-reported Child Behavior Checklist total T-score at clinic admission and the number of lifetime systems-of-care for the child were significantly and inversely associated with improvement for the bipolar cohort. Early-onset bipolar disorder is a complex and heterogeneous psychiatric disorder. Evidence-based treatment should emphasize psychopharmacology with adjunctive family and individual psychotherapy. Strategies to improve engagement in treatment may be especially important. Given high rates of high-risk behaviors in these youth, regular mental health follow-up to assess safety is important. Additional evidence-based treatments for pediatric bipolar disorder are needed.

The application of a new type of titanium mesh cage in hybrid anterior decompression and fusion technique for the treatment of continuously three-level cervical spondylotic myelopathy.

PubMed

Liu, Xiaowei; Chen, Yu; Yang, Haisong; Li, Tiefeng; Xu, Haidong; Xu, Bin; Chen, Deyu

2017-01-01

To evaluate the efficacy and safety of a new type of titanium mesh cage (NTMC) in hybrid anterior decompression and fusion method (HDF) in treating continuously three-level cervical spondylotic myelopathy (TCSM). Ninety-four cases who had TCSM and accepted the HDF from Jan 2007 to Jan 2010 were included. Clinical and radiological outcomes were compared between cases who had the NTMC (Group A, n = 45) and traditional titanium mesh cage (TTMC, Group B, n = 49) after corpectomies. Each case accepted one polyetheretherketone cage (PEEK) after discectomy. Mean follow-up were 74.4 and 77.3 months in Group A and B, respectively (p > 0.05). Differences in cervical lordosis (CL), segmental lordosis (SL), anterior segmental height (ASH) and posterior segmental height (PSH) between two groups were not significant preoperatively, 3-days postoperatively or at final visit. However, losses of the CL, SL, ASH and PSH were all significantly larger in Group B at the final visit, so did incidences of segmental subsidence and severe subsidence. Difference in preoperative Japanese Orthopedic Association (JOA), visual analog scale (VAS), neck disability index (NDI) or SF-36 between two groups was not significant. At the final visit, fusion rate, JOA, and SF-36 were all comparable between two groups, but the VAS and NDI were both significantly greater in Group B. For cases with TCSM, HDF with the NTMC and TTMC can provide comparable radiological and clinical improvements. But application of the NTMC in HDF is of advantages in decreasing the subsidence incidence, losses of lordosis correction, VAS and NDI.

Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness.

PubMed

Cooper, Simon; Kinsman, Leigh; Buykx, Penny; McConnell-Henry, Tracy; Endacott, Ruth; Scholes, Julie

2010-08-01

To examine, in a simulated environment, the ability of final-year nursing students to assess, identify and respond to patients either deteriorating or at risk of deterioration. The early identification and management of patient deterioration has a major impact on patient outcomes. 'Failure to rescue' is of international concern, with significant concerns over nurses' ability to detect deterioration, the reasons for which are unknown. Mixed methods incorporating quantitative measures of performance (knowledge, skill and situation awareness) and, to be reported at a later date, a qualitative reflective review of decision processes. Fifty-one final-year, final-semester student nurses attended a simulation laboratory. Students completed a knowledge questionnaire and two video-recorded simulated scenarios (mannequin based) to assess skill performance. The scenarios simulated deteriorating patients with hypovolaemic and septic shock. Situation awareness was measured by randomly stopping each scenario and asking a series of questions relating to the situation. The mean knowledge score was 74% (range 46-100%) and the mean skill performance score across both scenarios was 60% (range 30-78%). Skill performance improved significantly (p < 0.01) by the second scenario. However, skill performance declined significantly in both scenarios as the patient's condition deteriorated (hypovolaemia scenario: p = 0.012, septic scenario: p = 0.000). The mean situation awareness score across both scenarios was 59% (range 38-82%). Participants tended to identify physiological indicators of deterioration (77%) but had low comprehension scores (44%). Knowledge scores suggest, on average, a satisfactory academic preparation, but this study identified significant deficits in students' ability to manage patient deterioration. This study suggests that student nurses, at the point of qualification, may be inadequately prepared to identify and manage deteriorating patients in the clinical setting.

Does hydroxyapatite coating enhance ingrowth and improve longevity of a Zweymuller type stem? A double-blinded randomised RSA trial.

PubMed

Hoornenborg, Daniel; Sierevelt, Inger N; Spuijbroek, Joost A; Cheung, John; van der Vis, Harm M; Beimers, Lijkele; Haverkamp, Daniel

2017-09-11

An ongoing discussion is whether using a hydroxyapatite coating enhances the ingrowth and longevity of a femoral stem in total hip arthroplasty. The best way to predict speed of ingrowth and long-term outcome is by evaluating micromotion by radiostereometric analysis. To study the effect of hydroxyapatite (HA) coating on the migration of the SL-PLUS hip stem, we performed a prospective double blind randomised controlled trial comparing the early migration of the hydroxyapatite (HA)-coated SL-PLUS stem compared to the Standard (non-coated) SL-PLUS stem. 51 patients were randomly assigned to receive either an uncoated or a HA-coated femoral component during total hip replacement. RSA images were obtained direct postoperatively and at 6 weeks, 12 weeks, 6 months, 12 months and 24 months. HOOS scores were obtained preoperative and at final follow-up. RSA evaluation demonstrated significant migration up to 3 months postoperatively in both groups. After initial setting no significant migration was observed. There was no significant difference in migration between the HA-coated group and the uncoated group.Both Harris Hip Score (HHS) and HOOS domain scores (pain and ADL) significantly improved compared to baseline at 24 months after surgery in both treatment groups (p<0.001 for all comparisons). Improvement did not differ significantly between the 2 groups. At 2 years follow-up, the HA-coated and uncoated Zweymuller type, distal fitting stem do not show different migration patterns.

Effectiveness of Ivabradine in Treating Stable Angina Pectoris.

PubMed

Ye, Liwen; Ke, Dazhi; Chen, Qingwei; Li, Guiqiong; Deng, Wei; Wu, Zhiqin

2016-04-01

Many studies show that ivabradine is effective for stable angina.This meta-analysis was performed to determine the effect of treatment duration and control group type on ivabradine efficacy in stable angina pectoris.Relevant articles in the English language in the PUBMED and EMBASE databases and related websites were identified by using the search terms "ivabradine," "angina," "randomized controlled trials," and "Iva." The final search date was November 2, 2015.Articles were included if they were published randomized controlled trials that related to ivabradine treatment of stable angina pectoris.Patients with stable angina pectoris were included.The patients were classified according to treatment duration (<3 vs ≥3 months) or type of control group (placebo vs beta-receptor blocker). Angina outcomes were heart rate at rest or peak, exercise duration, and time to angina onset.Seven articles were selected. There were 3747 patients: 2100 and 1647 were in the ivabradine and control groups, respectively. The ivabradine group had significantly longer exercise duration when they had been treated for at least 3 months, but not when treatment time was less than 3 months. Ivabradine significantly improved time to angina onset regardless of treatment duration. Control group type did not influence the effect of exercise duration (significant) or time to angina onset (significant).Compared with beta-blocker and placebo, ivabradine improved exercise duration and time to onset of angina in patients with stable angina. However, its ability to improve exercise duration only became significant after at least 3 months of treatment.

Improving global CD uniformity by optimizing post-exposure bake and develop sequences

NASA Astrophysics Data System (ADS)

Osborne, Stephen P.; Mueller, Mark; Lem, Homer; Reyland, David; Baik, KiHo

2003-12-01

Improvements in the final uniformity of masks can be shrouded by error contributions from many sources. The final Global CD Uniformity (GCDU) of a mask is degraded by individual contributions of the writing tool, the Post Applied Bake (PAB), the Post Exposure Bake (PEB), the Develop sequence and the Etch step. Final global uniformity will improve by isolating and minimizing the variability of the PEB and Develop. We achieved this de-coupling of the PEB and Develop process from the whole process stream by using "dark loss" which is the loss of unexposed resist during the develop process. We confirmed a correspondence between Angstroms of dark loss and nanometer sized deviations in the chrome CD. A plate with a distinctive dark loss pattern was related to a nearly identical pattern in the chrome CD. This pattern was verified to have originated during the PEB process and displayed a [Δ(Final CD)/Δ(Dark Loss)] ratio of 6 for TOK REAP200 resist. Previous papers have reported a sensitive linkage between Angstroms of dark loss and nanometers in the final uniformity of the written plate. These initial studies reported using this method to improve the PAB of resists for greater uniformity of sensitivity and contrast. Similarly, this paper demonstrates an outstanding optimization of PEB and Develop processes.

Insulin protects against hepatic damage postburn.

PubMed

Jeschke, Marc G; Kraft, Robert; Song, Juquan; Gauglitz, Gerd G; Cox, Robert A; Brooks, Natasha C; Finnerty, Celeste C; Kulp, Gabriela A; Herndon, David N; Boehning, Darren

2011-01-01

Burn injury causes hepatic dysfunction associated with endoplasmic reticulum (ER) stress and induction of the unfolded protein response (UPR). ER stress/UPR leads to hepatic apoptosis and activation of the Jun-N-terminal kinase (JNK) signaling pathway, leading to vast metabolic alterations. Insulin has been shown to attenuate hepatic damage and to improve liver function. We therefore hypothesized that insulin administration exerts its effects by attenuating postburn hepatic ER stress and subsequent apoptosis. Male Sprague Dawley rats received a 60% total body surface area (TBSA) burn injury. Animals were randomized to receive saline (controls) or insulin (2.5 IU/kg q. 24 h) and euthanized at 24 and 48 h postburn. Burn injury induced dramatic changes in liver structure and function, including induction of the ER stress response, mitochondrial dysfunction, hepatocyte apoptosis, and up-regulation of inflammatory mediators. Insulin decreased hepatocyte caspase-3 activation and apoptosis significantly at 24 and 48 h postburn. Furthermore, insulin administration decreased ER stress significantly and reversed structural and functional changes in hepatocyte mitochondria. Finally, insulin attenuated the expression of inflammatory mediators IL-6, MCP-1, and CINC-1. Insulin alleviates burn-induced ER stress, hepatocyte apoptosis, mitochondrial abnormalities, and inflammation leading to improved hepatic structure and function significantly. These results support the use of insulin therapy after traumatic injury to improve patient outcomes.

Insulin Protects against Hepatic Damage Postburn

PubMed Central

Jeschke, Marc G; Kraft, Robert; Song, Juquan; Gauglitz, Gerd G; Cox, Robert A; Brooks, Natasha C; Finnerty, Celeste C; Kulp, Gabriela A; Herndon, David N; Boehning, Darren

2011-01-01

Burn injury causes hepatic dysfunction associated with endoplasmic reticulum (ER) stress and induction of the unfolded protein response (UPR). ER stress/UPR leads to hepatic apoptosis and activation of the Jun-N-terminal kinase (JNK) signaling pathway, leading to vast metabolic alterations. Insulin has been shown to attenuate hepatic damage and to improve liver function. We therefore hypothesized that insulin administration exerts its effects by attenuating postburn hepatic ER stress and subsequent apoptosis. Male Sprague Dawley rats received a 60% total body surface area (TBSA) burn injury. Animals were randomized to receive saline (controls) or insulin (2.5 IU/kg q. 24 h) and euthanized at 24 and 48 h postburn. Burn injury induced dramatic changes in liver structure and function, including induction of the ER stress response, mitochondrial dysfunction, hepatocyte apoptosis, and up-regulation of inflammatory mediators. Insulin decreased hepatocyte caspase-3 activation and apoptosis significantly at 24 and 48 h postburn. Furthermore, insulin administration decreased ER stress significantly and reversed structural and functional changes in hepatocyte mitochondria. Finally, insulin attenuated the expression of inflammatory mediators IL-6, MCP-1, and CINC-1. Insulin alleviates burn-induced ER stress, hepatocyte apoptosis, mitochondrial abnormalities, and inflammation leading to improved hepatic structure and function significantly. These results support the use of insulin therapy after traumatic injury to improve patient outcomes. PMID:21267509

Interactive large-group teaching in a dermatology course.

PubMed

Ochsendorf, F R; Boehncke, W-H; Sommerlad, M; Kaufmann, R

2006-12-01

This is a prospective study to find out whether an interactive large-group case-based teaching approach combined with small-group bedside teaching improves student satisfaction and learning outcome in a practical dermatology course. During two consecutive terms a rotating system of large-group interactive case-study-method teaching with two tutors (one content expert, one process facilitator) and bedside teaching with randomly appointed tutors was evaluated with a nine-item questionnaire and multiple-choice test performed at the beginning and the end of the course (n = 204/231 students evaluable). The results of three different didactic approaches utilized over the prior year served as a control. The interactive course was rated significantly better (p < 0.0001) than the standard course with regard to all items. The aggregate mark given by the students for the whole course was 1.58-0.61 (mean +/- SD, range 1 (good)-5 (poor)). This was significantly better than the standard course (p < 0.0001) and not different from small-group teaching approaches. The mean test results in the final examination improved significantly (p < 0.01). The combination of large-group interactive teaching and small-group bedside teaching was well accepted, improved the learning outcome, was rated as good as a small-group didactic approach and needed fewer resources in terms of personnel.

Use of planar array electrophysiology for the development of robust ion channel cell lines.

PubMed

Clare, Jeffrey J; Chen, Mao Xiang; Downie, David L; Trezise, Derek J; Powell, Andrew J

2009-01-01

The tractability of ion channels as drug targets has been significantly improved by the advent of planar array electrophysiology platforms which have dramatically increased the capacity for electrophysiological profiling of lead series compounds. However, the data quality and through-put obtained with these platforms is critically dependent on the robustness of the expression reagent being used. The generation of high quality, recombinant cell lines is therefore a key step in the early phase of ion channel drug discovery and this can present significant challenges due to the diversity and organisational complexity of many channel types. This article focuses on several complex and difficult to express ion channels and illustrates how improved stable cell lines can be obtained by integration of planar array electrophysiology systems into the cell line generation process per se. By embedding this approach at multiple stages (e.g., during development of the expression strategy, during screening and validation of clonal lines, and during characterisation of the final cell line), the cycle time and success rate in obtaining robust expression of complex multi-subunit channels can be significantly improved. We also review how recent advances in this technology (e.g., population patch clamp) have further widened the versatility and applicability of this approach.

Shoe midsole longitudinal bending stiffness and running economy, joint energy, and EMG.

PubMed

Roy, Jean-Pierre R; Stefanyshyn, Darren J

2006-03-01

It has been shown that mechanical energy is dissipated at the metatarsophalangeal (MTP) joint during running and jumping. Furthermore, increasing the longitudinal bending stiffness of the midsole significantly reduced the energy dissipated at the MTP joint and increased jump performance. It was hypothesized that increasing midsole longitudinal bending stiffness would also lead to improvements in running economy. This study investigated the influence of midsole longitudinal bending stiffness on running economy (performance variable) and evaluated the local effects on joint energetics and muscular activity. Carbon fiber plates were inserted into running shoe midsoles and running economy, joint energy, and electromyographic (EMG) data were collected on 13 subjects. Approximately a 1% metabolic energy savings was observed when subjects ran in a stiff midsole relative to the control midsole. Subjects with a greater body mass had a greater decrease in oxygen consumption rates in the stiff midsole relative to the control midsole condition. The stiffer midsoles showed no significant differences in energy absorption at the MTP joint compared with the control shoe. Finally, no significant changes were observed in muscular activation. Increasing midsole longitudinal bending stiffness led to improvements in running economy, yet the underlying mechanisms that can be attributed to this improvement are still not fully understood.

Effect of using an audience response system on learning environment, motivation and long-term retention, during case-discussions in a large group of undergraduate veterinary clinical pharmacology students.

PubMed

Doucet, Michèle; Vrins, André; Harvey, Denis

2009-12-01

Teaching methods that provide an opportunity for individual engagement and focussed feedback are required to create an active learning environment for case-based teaching in large groups. A prospective observational controlled study was conducted to evaluate whether the use of an audience response system (ARS) would promote an active learning environment during case-based discussions in large groups, have an impact on student motivation and improve long-term retention. Group A (N = 83) participated in large group case discussions where student participation was voluntary, while for group B (N = 86) an ARS was used. Data collection methods included student and teacher surveys, student focus group interviews, independent observations and 1-year post-course testing. Results indicated that the use of an ARS provided an active learning environment during case-based discussions in large groups by favouring engagement, observation and critical reflection and by increasing student and teacher motivation. Although final exam results were significantly improved in group B, long-term retention was not significantly different between groups. It was concluded that ARS use significantly improved the learning experience associated with case-based discussions in a large group of undergraduate students.

Quality improvement of a rice-substituted fried noodle by utilizing the protein-polyphenol interaction between a pea protein isolate and green tea (Camellia sinensis) extract.

PubMed

Song, Youngwoon; Yoo, Sang-Ho

2017-11-15

The quality of rice-substituted fried noodles was improved by applying interaction between pea protein isolate (PPI) and green tea extract (GTE). Radical-scavenging activities of GTE were stably maintained when exposed to acidic pH, UV light, and fluorescent light, but decreased by approximately 65% when exposed to 80°C for 168h. The RVA profiles of noodle dough showed that peak viscosity and breakdown increased significantly but that setback and final viscosity remained unchanged with 20% rice flour replacement. PPI significantly decreased the viscosity parameters of rice-supplemented dough, and the addition of GTE recovered these values significantly. The cooking loss and viscoelasticity (R max ) of cooked rice-supplemented noodles were fully restored by combined treatment of PPI and GTE. GTE decreased the peroxide value of fried noodles by 14% after storage at 63°C for 16days. Therefore, PPI+GTE treatment has great potential for use in fried noodles owing to the reinforced network and antioxidant activity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Anticipatory guidance through DVD.

PubMed

Franz, Sandra; McMahon, Pamela M; Calongne, Laurinda; Steele-Moses, Susan K

2014-03-01

The major purpose of the study was to determine if a 5-minute DVD is an effective method for communicating anticipatory guidance to parents at their child's 4-month well-child visit. A total of 84 caregivers were randomly assigned to receive anticipatory guidance through standard care (written anticipatory guidance handout and free talk) or DVD (DVD format + standard care). Participants completed a brief questionnaire immediately before and after their visit. As anticipated, knowledge scores improved significantly from pre-test to post-test. There was also a significant interaction between format used for anticipatory guidance and time. Specifically, there was greater improvement in knowledge over time for parents in the DVD group as compared with the standard care group. Additionally, the mean knowledge level of those in the DVD group as compared with those in the standard care group trended toward significance. Finally, visit length was shortened by nearly 3 minutes in the DVD group, and close to 100% of all respondents, regardless of anticipatory guidance format, indicated that they were very satisfied with their visit and amount of information learned.

Short-term sensorimotor-based intervention for handwriting performance in elementary school children.

PubMed

Alhusaini, Adel A; Melam, Ganeswara Rao; Buragadda, Syamala

2016-11-01

Handwriting problems in childhood can have lifelong repercussions, affecting learning and career. Sensorimotor intervention therefore helps to alleviate these problems. Thirty-one students (16 boys, 15 girls) underwent Minnesota Handwriting Assessment (MHA) to assess legibility, form, alignment, size, and spacing (the primary variables in this subject) as well as rate. Finally, 10 students (seven boys, three girls) aged 6-8 years (mean age, 77.1 ± 1.45 months) participated in an intervention program. Baseline MHA, Handwriting Proficiency Screening Questionnaire (HPSQ), and grip strength were measured. The same group of students acted as their own controls and were analyzed before the interventions and later after completion of the protocol. There was a significant improvement in MHA scores for legibility, form, alignment, size and spacing (P < 0.05), with the exception of rate. There were also significant changes in legibility, time performance and physical and emotional wellbeing domains in the HPSQ, and grip strength (P < 0.05, paired t-test). Short-term sensorimotor-based intervention produced significant improvements in the handwriting performance of elementary school children. © 2016 Japan Pediatric Society.

Exceptional oxygen reduction reaction activity and durability of platinum–nickel nanowires through synthesis and post-treatment optimization

DOE PAGES

Alia, Shaun M.; Ngo, Chilan; Shulda, Sarah; ...

2017-04-11

For the first time, extended nanostructured catalysts are demonstrated with both high specific activity (>6000 μA cm Pt –2 at 0.9 V) and high surface areas (>90 m 2 g Pt –1). Platinum–nickel (Pt—Ni) nanowires, synthesized by galvanic displacement, have previously produced surface areas in excess of 90 m 2 g Pt –1, a significant breakthrough in and of itself for extended surface catalysts. Unfortunately, these materials were limited in terms of their specific activity and durability upon exposure to relevant electrochemical test conditions. Through a series of optimized postsynthesis steps, significant improvements were made to the activity (3-fold increasemore » in specific activity), durability (21% mass activity loss reduced to 3%), and Ni leaching (reduced from 7 to 0.3%) of the Pt—Ni nanowires. Finally, these materials show more than a 10-fold improvement in mass activity compared to that of traditional carbon-supported Pt nanoparticle catalysts and offer significant promise as a new class of electrocatalysts in fuel cell applications.« less

Exceptional oxygen reduction reaction activity and durability of platinum–nickel nanowires through synthesis and post-treatment optimization

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

Alia, Shaun M.; Ngo, Chilan; Shulda, Sarah

For the first time, extended nanostructured catalysts are demonstrated with both high specific activity (>6000 μA cm Pt –2 at 0.9 V) and high surface areas (>90 m 2 g Pt –1). Platinum–nickel (Pt—Ni) nanowires, synthesized by galvanic displacement, have previously produced surface areas in excess of 90 m 2 g Pt –1, a significant breakthrough in and of itself for extended surface catalysts. Unfortunately, these materials were limited in terms of their specific activity and durability upon exposure to relevant electrochemical test conditions. Through a series of optimized postsynthesis steps, significant improvements were made to the activity (3-fold increasemore » in specific activity), durability (21% mass activity loss reduced to 3%), and Ni leaching (reduced from 7 to 0.3%) of the Pt—Ni nanowires. Finally, these materials show more than a 10-fold improvement in mass activity compared to that of traditional carbon-supported Pt nanoparticle catalysts and offer significant promise as a new class of electrocatalysts in fuel cell applications.« less

A double-blind placebo-controlled study into the efficacy of a homeopathic remedy for fear of firework noises in the dog (Canis familiaris).

PubMed

Cracknell, Nina R; Mills, Daniel S

2008-07-01

Seventy-five dogs that showed a fear response to fireworks participated in a double-blinded, placebo-controlled clinical trial to assess the efficacy of a homeopathic remedy for the alleviation of their behavioural signs. Dogs were randomly assigned to one of two treatments; the homeopathic treatment or the placebo treatment. At the baseline assessments the owners identified the behavioural signs of fear that their dogs normally displayed in response to fireworks, rated their frequency and intensity, and assessed the global severity of their dog's responses. These measures were repeated at the final assessment and owners also completed weekly diaries for the length of the trial. There were significant improvements in the owners' rating of 14/15 behavioural signs of fear in the placebo treatment group and all 15 behavioural signs in the homeopathic treatment group. Both treatment groups also showed significant improvement in the owners' rating of the global severity of their dog's responses. However, there was no significant difference in the response seen between the two treatment groups.

The impact of specially designed digital games-based learning in undergraduate pathology and medical education.

PubMed

Kanthan, Rani; Senger, Jenna-Lynn

2011-01-01

The rapid advances of computer technologies have created a new e-learner generation of "Homo-zappien" students that think and learn differently. Digital gaming is an effective, fun, active, and encouraging way of learning, providing immediate feedback and measurable process. Within the context of ongoing reforms in medical education, specially designed digital games, a form of active learning, are effective, complementary e-teaching/learning resources. To examine the effectiveness of the use of specially designed digital games for student satisfaction and for measurable academic improvement. One hundred fourteen students registered in first-year pathology Medicine 102 had 8 of 16 lecture sessions reviewed in specially designed content-relevant digital games. Performance scores to relevant content sessions were analyzed at midterm and final examinations. Seventy-one students who registered in second-year pathology Medicine 202 were exposed to the games only during the final examination, with the midterm examination serving as an internal matched-control group. Outcome measures included performance at midterm and final examinations. Paired 2-tailed t test statistics compared means. A satisfaction survey questionnaire of yes or no responses analyzed student engagement and their perceptions to digital game-based learning. Questions relevant to the game-play sessions had the highest success rate in both examinations among 114 first-year students. In the 71 second-year students, the examination scores at the end of the final examination were significantly higher than the scores on the midterm examination. Positive satisfaction survey noted increased student engagement, enhanced personal learning, and reduced student stress. Specially constructed digital games-based learning in undergraduate pathology courses showed improved academic performance as measured by examination test scores with increased student satisfaction and engagement.

Relationship between push phase and final race time in skeleton performance.

PubMed

Zanoletti, Costanza; La Torre, Antonio; Merati, Giampiero; Rampinini, Ermanno; Impellizzeri, Franco M

2006-08-01

The aim of this study was to examine the relationship between push-time and final race time in skeleton participants during a series of major international competitions to determine the importance of the push phase in skeleton performance. Correlations were computed from the first and second heat split data measured during 24 men and 24 women skeleton competitions. Body mass, height, age, and years of experience of the first 30 men and women athletes of the skeleton, bobsleigh and luge 2003-2004 World Cup ranking were used for the comparison between sliding sports. Moderate but significant correlations (p < 0.05) were found between push-time and final race time in men (r(mean) = 0.48) and women (r(mean) = 0.63). No correlations were found between changes in the individual push-time between the first and second heat with the corresponding changes in final race time. The bobsleigh sliders are heavier than the athletes of the other sliding disciplines. Luge athletes have more experience and are younger than bobsleigh and skeleton sliders. The results of this study suggest that a fast push phase is a prerequisite to success in competition and confirms that the selection of skeleton athletes based on the ability to accelerate to a maximum speed quickly could be valid. However, a good or improved push-time does not ensure a placement in the top finishing positions. On the basis of these results, we suggest that strength and power training is necessary to maintain a short push-time but additional physical training aimed to enhance the push phase might not reflect performance improvements. The recruitment of younger athletes and an increase of youthful competitive activity may be another effective way to reach international competitive results.

Reconstruction for chronic Achilles tendinopathy: comparison of flexor hallucis longus (FHL) transfer versus V-Y advancement.

PubMed

Staggers, Jackson R; Smith, Kenneth; de C Netto, Cesar; Naranje, Sameer; Prasad, Krishna; Shah, Ashish

2018-04-01

Several operative techniques exist for Achilles tendinopathy. The purpose of our study was to compare the clinical and functional outcomes of flexor hallucis longus (FHL) transfer and V-Y advancement for the treatment of chronic insertional Achilles tendinopathy. Retrospective chart review from 2010 to 2016 of patients that underwent FHL transfer or V-Y advancement for chronic insertional Achilles tendinopathy. Outcome measures were compared for these two procedures. In total, 46 patients (49 ankles) with a mean age of 55.0 (range 33-73) years. Mean follow-up time 44.7 +/- 25.5 months. FHL group had 21 patients (21 ankles) with 89% satisfaction, 14% complication rate, final VAS of 0.4, final VISA-A of 89.1, subjective strength improvement following surgery of 78%, and 94% would recommend the procedure. V-Y group had 25 patients (28 ankles) with 74% subjective satisfaction, 21% complication rate, final VAS of 1.4, final VISA-A of 78.4, subjective strength improvement following surgery of 67%, and 84% would recommend the procedure. There was no significant difference in any of the results rates between the two groups (p > .05). V-Y advancement is comparable to FHL transfer for the operative management of insertional Achilles tendinopathy. Though our results trend towards less satisfactory results following V-Y advancement, we found high satisfaction rates with similar functional outcomes and complication rates in both operative groups. We suggest considering V-Y advancement as a viable option for the primary treatment of chronic insertional Achilles tendinopathy in patients who may not be an ideal candidate for FHL transfer.

From access to success in science: An academic-student affairs intervention for undergraduate freshmen biology students

NASA Astrophysics Data System (ADS)

Aldridge, Jacqueline Nouvelle

The first year experience is known to present an array of challenges for traditional college students. In particular, freshmen who major in a STEM discipline have their own unique set of challenges when they transition from high school science and math to college science and math; especially chemistry. As a result, students may encounter negative experiences which lower academic and social confidence. This project was designed as a pilot study intervention for a small group of freshmen biology students who were considered academically at-risk due their math SAT scores. The study occurred during the fall semester involving an enhanced active learning component based on the Peer-led Team Learning (PLTL) general chemistry supplemental pedagogy model, and a biology-focused First Year Experience (FYE). PLTL workshops took place in freshmen residence halls, creating a live-n-learn community environment. Mid-term and final chemistry grades and final math grades were collected to measure academic progress. Self-reporting surveys and journals were used to encourage participants to reconstruct their experiences and perceptions of the study. Descriptive analysis was performed to measure statistical significance between midterm and final grade performance, and a general inductive qualitative method was used to determine academic and social confidence as well as experiences and perceptions of the project. Findings of this project revealed a statistically significant improvement between chemistry midterm and final grades of the sample participants. Although academic confidence did not increase, results reveal that social confidence progressed as the majority of students developed a value for studying in groups.

Gated Auditory Speech Perception in Elderly Hearing Aid Users and Elderly Normal-Hearing Individuals: Effects of Hearing Impairment and Cognitive Capacity

PubMed Central

Lidestam, Björn; Hällgren, Mathias; Rönnberg, Jerker

2014-01-01

This study compared elderly hearing aid (EHA) users and elderly normal-hearing (ENH) individuals on identification of auditory speech stimuli (consonants, words, and final word in sentences) that were different when considering their linguistic properties. We measured the accuracy with which the target speech stimuli were identified, as well as the isolation points (IPs: the shortest duration, from onset, required to correctly identify the speech target). The relationships between working memory capacity, the IPs, and speech accuracy were also measured. Twenty-four EHA users (with mild to moderate hearing impairment) and 24 ENH individuals participated in the present study. Despite the use of their regular hearing aids, the EHA users had delayed IPs and were less accurate in identifying consonants and words compared with the ENH individuals. The EHA users also had delayed IPs for final word identification in sentences with lower predictability; however, no significant between-group difference in accuracy was observed. Finally, there were no significant between-group differences in terms of IPs or accuracy for final word identification in highly predictable sentences. Our results also showed that, among EHA users, greater working memory capacity was associated with earlier IPs and improved accuracy in consonant and word identification. Together, our findings demonstrate that the gated speech perception ability of EHA users was not at the level of ENH individuals, in terms of IPs and accuracy. In addition, gated speech perception was more cognitively demanding for EHA users than for ENH individuals in the absence of semantic context. PMID:25085610

Improvement of foaming ability of egg white product by irradiation and its application

NASA Astrophysics Data System (ADS)

Song, Hyun-Pa; Kim, Binna; Choe, Jun-Ho; Jung, Samooel; Kim, Kyong-Su; Kim, Dong-Ho; Jo, Cheorun

2009-03-01

To investigate the enhancement of foaming abilities of liquid egg white (LEW) and egg white powder (EWP) by irradiation and its application for bakery product, LEW and EWP were irradiated at 0, 1, 2, and 5 kGy by Co-60 gamma ray. There was no pH change found among treatments in both LEW and EWP. The viscosity of LEW decreased significantly by irradiation ( P<0.05), whereas that of EWP was not affected by irradiation. The foaming ability of LEW and EWP was significantly increased by irradiation as a dose-dependent manner ( P<0.05). The volume and the height of angel cake baked with irradiated LEW were significantly higher than those of unirradiated control ( P<0.05). For EWP, the volume and the height of angel cake were greater at 2 kGy only than those of control. A significant decrease in hardness, chewiness, and gumminess values and an increase in Hunter L* value were observed in the angel cakes prepared from irradiated egg white products ( P<0.05). Results indicated that irradiation of egg white could offer advantages in increasing foaming ability and improving quality of final bakery products.

Minimum dV for Targeted Spacecraft Disposal

NASA Technical Reports Server (NTRS)

Bacon, John

2017-01-01

The density scale height of the Earth's atmosphere undergoes significant reduction in the final phases of a natural decay. It can be shown that for most realistic ballistic numbers, it is possible to exploit this effect to amplify available spacecraft dV by using it at the penultimate perigee to penetrate into higher drag regions at final apogee. The drag at this lower pass can more effectively propel a spacecraft towards the final target region than applying the same dV direct Hohmann transfer at that final apogee. This study analyzes the potential use of this effect-- in combination with small phasing burns--to calculate the absolute minimum delta-V that would be required to reliably guide a spacecraft to any specified safe unoccupied ocean region as a function of ballistic number, orbit inclination, and initial eccentricity. This calculation is made for controllable spacecraft in several orbit inclinations and eccentricities with arbitrary initial LAN and ArgP one week before final entry, under three-sigma atmospheric perturbations. The study analyzes the dV required under varying levels of final controllable altitude at which dV may be imparted, and various definitions of the length and location of a "safe" disposal area. The goal of such research is to improve public safety by creating assured safe disposal strategies for low-dV and/or low-thrust spacecraft that under more traditional strategies would need to be abandoned to a fully random decay.

Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair

PubMed Central

Flanagin, Brody A.; Garofalo, Raffaele; Lo, Eddie Y.; Feher, LeeAnne; Castagna, Alessandro; Qin, Huanying; Krishnan, Sumant G.

2016-01-01

Purpose: Arthroscopic transosseous (TO) rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless) rotator cuff repair technique. Materials and Methods: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless) rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM) was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student's t-test to compare the effect of other clinical characteristics on final outcome. Results: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001). Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES) score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%), good in 8 (7.3%), fair in 3 (2.8%), and poor in 3 (2.8%). There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy) compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of injury preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. Conclusions: Arthroscopic TO rotator cuff repair technique leads to statistically significant midterm improvement in ROM and satisfactory midterm subjective outcome scores with low complication/failure rates in patients with average medium-sized rotator cuff tears with minimal fatty infiltration. Further work is required to evaluate radiographic healing rates with this technique and to compare outcomes following suture anchor repair. Level of Evidence: Level IV PMID:26980983

Percutaneous internal fixation of proximal fifth metatarsal jones fractures (Zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes.

PubMed

Murawski, Christopher D; Kennedy, John G

2011-06-01

Internal fixation is a popular first-line treatment method for proximal fifth metatarsal Jones fractures in athletes; however, nonunions and screw breakage can occur, in part because of nonspecific fixation hardware and poor blood supply. To report the results from 26 patients who underwent percutaneous internal fixation with a specialized screw system of a proximal fifth metatarsal Jones fracture (zones II and III) and bone marrow aspirate concentrate. Case series; Level of evidence, 4. Percutaneous internal fixation for a proximal fifth metatarsal Jones fracture (zones II and III) was performed on 26 athletic patients (mean age, 27.47 years; range, 18-47). All patients were competing at some level of sport and were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score and SF-12 outcome scores. The mean follow-up time was 20.62 months (range, 12-28). Of the 26 fractures, 17 were traditional zone II Jones fractures, and the remaining 9 were zone III proximal diaphyseal fractures. The mean Foot and Ankle Outcome Score significantly increased, from 51.15 points preoperatively (range, 14-69) to 90.91 at final follow-up (range, 71-100; P < .01). The mean physical component of the SF-12 score significantly improved, from 25.69 points preoperatively (range, 6-39) to 54.62 at final follow-up (range, 32-62; P < .01). The mean mental component of the SF-12 score also significantly improved, from 28.20 points preoperatively (range, 14-45) to 58.41 at final follow-up (range, 36-67; P < .01). The mean time to fracture healing on standard radiographs was 5 weeks after surgery (range, 4-24). Two patients did not return to their previous levels of sporting activity. One patient experienced a delayed union, and 1 healed but later refractured. Percutaneous internal fixation of proximal fifth metatarsal Jones fractures, with a Charlotte Carolina screw and bone marrow aspirate concentrate, provides more predictable results while permitting athletes a return to sport at their previous levels of competition, with few complications.

Evaluation of primary and secondary stability of titanium implants using different surgical techniques.

PubMed

Tabassum, Afsheen; Meijer, Gert J; Walboomers, X Frank; Jansen, John A

2014-04-01

To investigate the influence of different surgical techniques on the primary and secondary implant stability using trabecular bone of goats as an implantation model. In the iliac crest of eight goats, 48 cylindrical-screw-type implants with a diameter of 4.2 mm (Dyna(®) ; Bergen op Zoom, the Netherlands) were installed, using three different surgical techniques: (i) 5% undersized, using a final drill diameter of 4 mm; (ii) 15% undersized, using a final drill diameter of 3.6 mm; and (iii) 25% undersized, using a final drill diameter of 3.2 mm. Peak insertion torque values were measured by a Digital(®) (MARK-10 Corporation, New York, NY, USA) torque gauge instrument during placement. At 3 weeks after implantation, removal torque was measured. Histomorphometrically, the peri-implant bone volume was measured in three zones; the inner zone (0-500 μm), the middle zone (500-1000 μm) and the outer zone (1000-1500 μm). Evaluation of the obtained data demonstrated no statistically significant difference between different surgical techniques regarding removal torque values. With respect to the percentage peri-implant bone volume (%BV), also no significant difference could be observed between all three applied surgical techniques for both the inner, middle and outer zone. However, irrespective of the surgical technique, it was noticed that the %BV was significantly higher for the inner zone as compared to middle and outer zone (P < 0.05) around the implant. At 3 weeks after implant installation, independent of the used undersized surgical technique, the %BV in the inner zone (0-500 μm) peri-implant area was improved due to both condensation of the surrounding bone as also the translocation of host bone particles along the implant surface. Surprisingly, no mechanical beneficial effect of the 25% undersized surgical technique could be observed as compared to the 5% or 15% undersized surgical technique to improve primary or secondary implant stability. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of Dose of Behavioral Treatment for Obesity on Binge Eating Severity

PubMed Central

Ariel, Aviva H.; Perri, Michael G.

2016-01-01

Objectives We evaluated the effects of three doses of a behavioral intervention for obesity (High dose = 24 sessions, Moderate = 16 sessions, Low = 8 sessions) compared with a nutrition education control group (Control) on binge eating. We also examined whether participants with clinically significant improvements in binge eating had better treatment adherence and weight-loss outcomes than those who did not experience clinically significant improvements in binge eating. Finally, we examined the relation of pretreatment binge eating severity to changes at six months. Methods Participants included 572 adults (female = 78.7%; baseline mean ±SD: age = 52.7 ±11.2 years, BMI = 36.4 ±3.9 kg/m2) who provided binge eating data at baseline. We evaluated binge eating severity (assessed via the Binge Eating Scale) and weight status at baseline and six months, as well as treatment adherence over six months. Results At six months, participants in the Moderate and High treatment conditions reported greater reductions in binge eating severity than participants in the Low and Control conditions, ps < .02. Participants who demonstrated improvements in binge eating severity reported greater dietary self-monitoring adherence and attained larger weight losses than those who did not experience clinically significant reductions, ps < .001. Pretreatment binge eating severity predicted less improvement in binge eating severity over six months and fewer days with dietary self-monitoring records completed, ps ≤ .002. Conclusion A moderate or high dose of behavioral weight-loss treatment may be required to produce clinically significant reductions in binge eating severity in adults with obesity. PMID:27086049

HYPOPHOSPHATEMIC RICKETS: CASE REPORT.

PubMed

Maia, Marta Liliane de Almeida; Abreu, Ana Lucia Santos; Nogueira, Paulo Cesar Koch; Val, Maria Luiza Dautro Moreira do; Carvalhaes, João Tomas de Abreu; Andrade, Maria Cristina de

2018-03-29

Early diagnosis and immediate treatment of hypophosphatemic rickets is of utmost importance as it may prevent subsequent sequelae. This report aims at warning pediatricians to consider the presence of the disease. Description of the metabolic profile, creatinine clearance, nutritional status, weight and body structure of a patient who presented the clinical-laboratorial characteristics of hypophosphatemic rickets and was followed in an outpatient clinic for tubulopathies over the period of 12 months. The patient had been bedridden for some time, was dependent on mechanical ventilation and presented an altered metabolic bone condition. Treatment was phosphate (initial: 65 mg/kg/day and final: 24,2 mg/kg/day), calcium (initial: 127 mg/kg/day, final: 48,4 mg/kg/day) and calcitriol (initial: 0.06 mcg/kg/day, final: 0.03 mcg/kg/day). The patient improved, evolving into spontaneous breathing and walking unaided. Laboratory results: calcium (mg/dL) initial 7.1, final 10.1; phosphate (mg/dL) initial 1.7 final 3.2; magnesium (mg/dL) initial 1.5 final 2.1, parathyroid hormone (pg/l) initial 85.8, final 52.7, alkaline phosphatase (UI/l) initial 12660, final 938; there was also improvement in weight/structural development (Z score: H/A initial: -6.05, final -3.64; W/A: initial -2.92, final -1.57) with presence of transitory gallstones. Creatinine clearance (mL/min/1.73m2bsa) was constant. The medication improved his laboratory results and nutritional status, but the patient did not return for two years for follow-up and, during this period, his condition has noticeably deteriorated. Early diagnosis and follow-up are essential in dealing with this pathology.

Effect of chemical admixtures on properties of high-calcium fly ash geopolymer

NASA Astrophysics Data System (ADS)

Rattanasak, Ubolluk; Pankhet, Kanokwan; Chindaprasirt, Prinya

2011-06-01

Owing to the high viscosity of sodium silicate solution, fly ash geopolymer has the problems of low workability and rapid setting time. Therefore, the effect of chemical admixtures on the properties of fly ash geopolymer was studied to overcome the rapid set of the geopolymer in this paper. High-calcium fly ash and alkaline solution were used as starting materials to synthesize the geopolymer. Calcium chloride, calcium sulfate, sodium sulfate, and sucrose at dosages of 1wt% and 2wt% of fly ash were selected as admixtures based on concrete knowledge to improve the properties of the geopolymer. The setting time, compressive strength, and degree of reaction were recorded, and the microstructure was examined. The results show that calcium chloride significantly shortens both the initial and final setting times of the geopolymer paste. In addition, sucrose also delays the final setting time significantly. The degrees of reaction of fly ash in the geopolymer paste with the admixtures are all higher than those of the control paste. This contributes to the obvious increases in compressive strength.

Quantifying The Food And Drug Administration's rulemaking delays highlights the need for transparency.

PubMed

Hwang, Thomas J; Avorn, Jerry; Carpenter, Daniel; Kesselheim, Aaron S

2014-02-01

The Food and Drug Administration (FDA) frequently uses its rulemaking process to establish or modify the way it regulates drugs, medical devices, and other medical products. The federal agency's rulemaking is controversial because of its perceived complexity, lack of transparency, and lengthy duration. To shed light on the FDA's rulemaking process, we examined the evolution of significant rules that the agency published during 2000-12 for drugs, devices, and other medical products. We found that the rules' median time to finalization was 7.3 years, with the pre-rule phase and postreview deliberation within the FDA accounting for the majority of that time. Rules that involved mandatory cost-benefit analyses were associated with an additional delay of approximately two years. We also found that longer review times were significantly associated with a reduction in the stringency of final rules, compared to the originally proposed versions. We recommend improving FDA's rulemaking by allocating additional resources to increase efficiency and by embarking on initiatives to promote transparency by the FDA and other parts of the executive branch.

Shaft-Condylar Angle for surgical correction in neglected and displaced lateral humeral condyle fracture in children.

PubMed

Mulpruek, Pornchai; Angsanuntsukh, Chanika; Woratanarat, Patarawan; Sa-Ngasoongsong, Paphon; Tawonsawatruk, Tulyapruek; Chanplakorn, Pongsthorn

2015-09-01

To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA<30°, >50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

Effect of skill laboratory training on academic performance of medical students.

PubMed

Khan, Muhammad Alamgir; Shabbir, Faizania; Qamar, Khadija; Rajput, Tausif Ahmed

2017-05-01

To observe the effect of skill lab training on academic performance of final year medical students in terms of marks obtained in long case, short case, objective structured clinical examination and viva. The cross-sectional comparative study was conducted at Army Medical College, Rawalpindi from February to April 2015. Two batches of final year MBBS were recruited for the study. Batch 1 received conventional training, and Batch 2 received skill lab training. The performance of students was assessed by comparing the marks obtained in long case, short case, objective structured clinical examination and viva. Data was analysed using SPSS 23. Of the 335 subjects, 168(50.1%) were male and 167(49.9%) were female students with a mean age of 21.79±1.02 years. Batch 1 had 151(45%) students and Batch 2 had 184(55%). Batch 2 got significantly higher marks in long case, short case and objective structured clinical examination (p<0.05 each). Viva result was not found to be related to training (p>0.05). Acquisition of clinical skills significantly improved when medial students were trained in skill laboratories.

An enriched multimedia eBook application to facilitate learning of anatomy.

PubMed

Stirling, Allan; Birt, James

2014-01-01

This pilot study compared the use of an enriched multimedia eBook with traditional methods for teaching the gross anatomy of the heart and great vessels. Seventy-one first-year students from an Australian medical school participated in the study. Students' abilities were examined by pretest, intervention, and post-test measurements. Perceptions and attitudes toward eBook technology were examined by survey questions. Results indicated a strongly positive user experience coupled with increased marks; however, there were no statistically significant results for the eBook method of delivery alone outperforming the traditional anatomy practical session. Results did show a statistically significant difference in the final marks achieved based on the sequencing of the learning modalities. With initial interaction with the multimedia content followed by active experimentation in the anatomy lab, students' performance was improved in the final test. Obtained data support the role of eBook technology in modern anatomy curriculum being a useful adjunct to traditional methods. Further study is needed to investigate the importance of sequencing of teaching interventions. © 2013 American Association of Anatomists.

Clipping in neurocontrol by adaptive dynamic programming.

PubMed

Fairbank, Michael; Prokhorov, Danil; Alonso, Eduardo

2014-10-01

In adaptive dynamic programming, neurocontrol, and reinforcement learning, the objective is for an agent to learn to choose actions so as to minimize a total cost function. In this paper, we show that when discretized time is used to model the motion of the agent, it can be very important to do clipping on the motion of the agent in the final time step of the trajectory. By clipping, we mean that the final time step of the trajectory is to be truncated such that the agent stops exactly at the first terminal state reached, and no distance further. We demonstrate that when clipping is omitted, learning performance can fail to reach the optimum, and when clipping is done properly, learning performance can improve significantly. The clipping problem we describe affects algorithms that use explicit derivatives of the model functions of the environment to calculate a learning gradient. These include backpropagation through time for control and methods based on dual heuristic programming. However, the clipping problem does not significantly affect methods based on heuristic dynamic programming, temporal differences learning, or policy-gradient learning algorithms.

Investigation and Application of Nb Microalloying Technology in Seamless Steel Tube with High Performance

NASA Astrophysics Data System (ADS)

Zhang, Chuanyou; Wang, Qian; Sun, Yu; Wang, Huibin; Zhang, Wei; Wang, Qingfeng; Guo, Aimin; Sun, Kaiming

Extensive investigations of metallurgical roles played by Nb microalloying in advanced products of seamless steel tube have been carried out. The results show that with Nb microalloyed , the recrystallized austenite grain (RAG) and final ferrite grain of tubular steel are evidently refined even experiencing a piercing and a continuous rolling at very high temperature, and a certain quantity of (Nb,V)(C,N) and (Ti,Nb,V)(C,N) particles form on air cooling. Moreover, for quenching (Q) & tempering (T) treated tubular steels, the nanoscale particles of (Nb,V) (C,N) further precipitate on heating stage of Q at 900-1000°C, leading to a significant refinement of prior austenite grain (PAG) and final martensitic or bainitic packet/block structures, and during subsequent T at 600-700°C, producing an improved resistance to softening.

Force-free electrodynamics in dynamical curved spacetimes

NASA Astrophysics Data System (ADS)

McWilliams, Sean

2015-04-01

We present results on our study of force-free electrodynamics in curved spacetimes. Specifically, we present several improvements to what has become the established set of evolution equations, and we apply these to study the nonlinear stability of analytically known force-free solutions for the first time. We implement our method in a new pseudo-spectral code built on top of the SpEC code for evolving dynamic spacetimes. Finally, we revisit these known solutions and attempt to clarify some interesting properties that render them analytically tractable. Finally, we preview some new work that similarly revisits the established approach to solving another problem in numerical relativity: the post-merger recoil from asymmetric gravitational-wave emission. These new results may have significant implications for the parameter dependence of recoils, and consequently on the statistical expectations for recoil velocities of merged systems.

The development of a model to predict BW gain of growing cattle fed grass silage-based diets.

PubMed

Huuskonen, A; Huhtanen, P

2015-08-01

The objective of this meta-analysis was to develop and validate empirical equations predicting BW gain (BWG) and carcass traits of growing cattle from intake and diet composition variables. The modelling was based on treatment mean data from feeding trials in growing cattle, in which the nutrient supply was manipulated by wide ranges of forage and concentrate factors. The final dataset comprised 527 diets in 116 studies. The diets were mainly based on grass silage or grass silage partly or completely replaced by whole-crop silages, hay or straw. The concentrate feeds consisted of cereal grains, fibrous by-products and protein supplements. Mixed model regression analysis with a random study effect was used to develop prediction equations for BWG and carcass traits. The best-fit models included linear and quadratic effects of metabolisable energy (ME) intake per metabolic BW (BW0.75), linear effects of BW0.75, and dietary concentrations of NDF, fat and feed metabolisable protein (MP) as significant variables. Although diet variables had significant effects on BWG, their contribution to improve the model predictions compared with ME intake models was small. Feed MP rather than total MP was included in the final model, since it is less correlated to dietary ME concentration than total MP. None of the quadratic terms of feed variables was significant (P>0.10) when included in the final models. Further, additional feed variables (e.g. silage fermentation products, forage digestibility) did not have significant effects on BWG. For carcass traits, increased ME intake (ME/BW0.75) improved both dressing proportion (P0.10) effect on dressing proportion or carcass conformation score, but it increased (P<0.01) carcass fat score. The current study demonstrated that ME intake per BW0.75 was clearly the most important variable explaining the BWG response in growing cattle. The effect of increased ME supply displayed diminishing responses that could be associated with increased energy concentration of BWG, reduced diet metabolisability (proportion of ME of gross energy) and/or decreased efficiency of ME utilisation for growth with increased intake. Negative effects of increased dietary NDF concentration on BWG were smaller compared to responses that energy evaluation systems predict for energy retention. The present results showed only marginal effects of protein supply on BWG in growing cattle.

Visualization Improves Supraclavicular Access to the Subclavian Vein in a Mixed Reality Simulator.

PubMed

Sappenfield, Joshua Warren; Smith, William Brit; Cooper, Lou Ann; Lizdas, David; Gonsalves, Drew B; Gravenstein, Nikolaus; Lampotang, Samsun; Robinson, Albert R

2018-07-01

We investigated whether visual augmentation (3D, real-time, color visualization) of a procedural simulator improved performance during training in the supraclavicular approach to the subclavian vein, not as widely known or used as its infraclavicular counterpart. To train anesthesiology residents to access a central vein, a mixed reality simulator with emulated ultrasound imaging was created using an anatomically authentic, 3D-printed, physical mannequin based on a computed tomographic scan of an actual human. The simulator has a corresponding 3D virtual model of the neck and upper chest anatomy. Hand-held instruments such as a needle, an ultrasound probe, and a virtual camera controller are directly manipulated by the trainee and tracked and recorded with submillimeter resolution via miniature, 6 degrees of freedom magnetic sensors. After Institutional Review Board approval, 69 anesthesiology residents and faculty were enrolled and received scripted instructions on how to perform subclavian venous access using the supraclavicular approach based on anatomic landmarks. The volunteers were randomized into 2 cohorts. The first used real-time 3D visualization concurrently with trial 1, but not during trial 2. The second did not use real-time 3D visualization concurrently with trial 1 or 2. However, after trial 2, they observed a 3D visualization playback of trial 2 before performing trial 3 without visualization. An automated scoring system based on time, success, and errors/complications generated objective performance scores. Nonparametric statistical methods were used to compare the scores between subsequent trials, differences between groups (real-time visualization versus no visualization versus delayed visualization), and improvement in scores between trials within groups. Although the real-time visualization group demonstrated significantly better performance than the delayed visualization group on trial 1 (P = .01), there was no difference in gain scores, between performance on the first trial and performance on the final trial, that were dependent on group (P = .13). In the delayed visualization group, the difference in performance between trial 1 and trial 2 was not significant (P = .09); reviewing performance on trial 2 before trial 3 resulted in improved performance when compared to trial 1 (P < .0001). There was no significant difference in median scores (P = .13) between the real-time visualization and delayed visualization groups for the last trial after both groups had received visualization. Participants reported a significant improvement in confidence in performing supraclavicular access to the subclavian vein. Standard deviations of scores, a measure of performance variability, decreased in the delayed visualization group after viewing the visualization. Real-time visual augmentation (3D visualization) in the mixed reality simulator improved performance during supraclavicular access to the subclavian vein. No difference was seen in the final trial of the group that received real-time visualization compared to the group that had delayed visualization playback of their prior attempt. Training with the mixed reality simulator improved participant confidence in performing an unfamiliar technique.

Practicing more retrieval routes leads to greater memory retention.

PubMed

Zheng, Jun; Zhang, Wei; Li, Tongtong; Liu, Zhaomin; Luo, Liang

2016-09-01

A wealth of research has shown that retrieval practice plays a significant role in improving memory retention. The current study focused on one simple yet rarely examined question: would repeated retrieval using two different retrieval routes or using the same retrieval route twice lead to greater long-term memory retention? Participants elaborately learned 22 Japanese-Chinese translation word pairs using two different mediators. Half an hour after the initial study phase, the participants completed two retrieval sessions using either one mediator (Tm1Tm1) or two different mediators (Tm1Tm2). On the final test, which was performed 1week after the retrieval practice phase, the participants received only the cue with a request to report the mediator (M1 or M2) followed by the target (Experiment 1) or only the mediator (M1 or M2) with a request to report the target (Experiment 2). The results of Experiment 1 indicated that the participants who practiced under the Tm1Tm2 condition exhibited greater target retention than those who practiced under the Tm1Tm1 condition. This difference in performance was due to the significant disadvantage in mediator retrieval and decoding of the unpracticed mediator under the Tm1Tm1 condition. Although mediators were provided to participants on the final test in Experiment 2, decoding of the unpracticed mediators remained less effective than decoding of the practiced mediators. We conclude that practicing multiple retrieval routes leads to greater memory retention than focusing on a single retrieval route. Thus, increasing retrieval variability during repeated retrieval practice indeed significantly improves long-term retention in a delay test. Copyright © 2016 Elsevier B.V. All rights reserved.

Development and Evaluation of a Mandatory Course in Geriatric Medicine for Fourth Year Medical Students.

PubMed

Freter, Susan; Gordon, Janet; Mallery, Laurie

2006-12-01

As the population ages, older adults will make up an increasing proportion of the practices of most physicians. Because of this, education of medical students in Geriatric Medicine is essential, yet there is considerable variability in the amount, timing within the curriculum, and content of geriatric training in Medical Schools. Our goal was to develop and evaluate an integrated, mandatory 3-week geriatric medicine course for fourth year medical students with emphasis on knowledge acquisition. All fourth year medical students at Dalhousie Medical School underwent 2 ½ days of didactic teaching on core geriatric topics and a 2-week clinical rotation. Pre-rotation knowledge testing occurred on the first day of the rotation. On the final examination, students were retested on the 15 pre-rotation questions, as well as 5 additional questions that they had not encountered previously. There was a statistically significant improvement in examination performance from 46.9% on the pretest to 78.6% on the final examination (t=24.7, p˂.001). It is unlikely that the significant improvement in scores is simply a result of repeat testing, as students tended to score better on the five additional questions that they had not seen before. We developed a geriatric medicine course for fourth year medical students, in one integrated 3-week block, using a combination of didactic teaching and clinical encounters. We used students as their own controls, using the same questions pre- and post-rotation, and demonstrated significant knowledge acquisition on a variety of topics pertaining to geriatric medicine and care of the older patient. Future research should address the issue of translating acquired knowledge in geriatric medicine into demonstrated clinical skills when caring for the elderly.

Link prediction boosted psychiatry disorder classification for functional connectivity network

NASA Astrophysics Data System (ADS)

Li, Weiwei; Mei, Xue; Wang, Hao; Zhou, Yu; Huang, Jiashuang

2017-02-01

Functional connectivity network (FCN) is an effective tool in psychiatry disorders classification, and represents cross-correlation of the regional blood oxygenation level dependent signal. However, FCN is often incomplete for suffering from missing and spurious edges. To accurate classify psychiatry disorders and health control with the incomplete FCN, we first `repair' the FCN with link prediction, and then exact the clustering coefficients as features to build a weak classifier for every FCN. Finally, we apply a boosting algorithm to combine these weak classifiers for improving classification accuracy. Our method tested by three datasets of psychiatry disorder, including Alzheimer's Disease, Schizophrenia and Attention Deficit Hyperactivity Disorder. The experimental results show our method not only significantly improves the classification accuracy, but also efficiently reconstructs the incomplete FCN.

Impact and promise of NASA aeropropulsion technology

NASA Technical Reports Server (NTRS)

Saunders, Neal T.; Bowditch, David N.

1987-01-01

The aeropropulsion industry in the United States has established an enviable record of leading the world in aeropropulsion for commercial and military aircraft. The NASA aeropropulsion propulsion program (primarily conducted through the Lewis Research Center) has significantly contributed to that success through research and technology advances and technology demonstrations such as the Refan, Engine Component Improvement, and the Energy Efficient Engine Programs. Some past NASA contributions to engines in current aircraft are reviewed, and technologies emerging from current research programs for the aircraft of the 1990's are described. Finally, current program thrusts toward improving propulsion systems in the 2000's for subsonic commercial aircraft and higher speed aircraft such as the High-Speed Civil Transport and the National Aerospace Plane (NASP) are discussed.

Advanced Rotorcraft Transmission (ART) program-Boeing helicopters status report

NASA Technical Reports Server (NTRS)

Lenski, Joseph W., Jr.; Valco, Mark J.

1991-01-01

The Advanced Rotorcraft Transmission (ART) program is structured to incorporate key emerging material and component technologies into an advanced rotorcraft transmission with the intention of making significant improvements in the state of the art (SOA). Specific objectives of ART are: (1) Reduce transmission weight by 25 pct.; (2) Reduce transmission noise by 10 dB; and (3) Improve transmission life and reliability, while extending Mean Time Between Removal to 5000 hr. Boeing selected a transmission sized for the Tactical Tilt Rotor (TTR) aircraft which meets the Future Air Attack Vehicle (FAVV) requirements. Component development testing will be conducted to evaluate the high risk concepts prior to finalizing the advanced transmission configuration. The results of tradeoff studies and development test which were completed are summarized.

Improving basic surgical skills for final year medical students: the value of a rural weekend.

PubMed

House, A K; House, J

2000-05-01

Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques. The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety-five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process. The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty-five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant. The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the classroom. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.

Improvement of succinate production by release of end-product inhibition in Corynebacterium glutamicum.

PubMed

Chung, Soon-Chun; Park, Joon-Song; Yun, Jiae; Park, Jin Hwan

2017-03-01

Succinate is a renewable-based platform chemical that may be used to produce a wide range of chemicals including 1,4-butanediol, tetrahydrofurane, and γ-butyrolactone. However, industrial fermentation of organic acids is often subject to end-product inhibition, which significantly retards cell growth and limits metabolic activities and final productivity. In this study, we report the development of metabolically engineered Corynebacterium glutamicum for high production of succinate by release of end-product inhibition coupled with an increase of key metabolic flux. It was found that the rates of glucose consumption and succinate production were significantly reduced by extracellular succinate in an engineered strain, S003. To understand the mechanism underlying the inhibition by succinate, comparative transcriptome analysis was performed. Among the downregulated genes, overexpression of the NCgl0275 gene was found to suppress the inhibition of glucose consumption and succinate production, resulting in a 37.7% increase in succinate production up to 55.4g/L in fed-batch fermentation. Further improvement was achieved by increasing the metabolic flux from PEP to OAA. The final engineered strain was able to produce 152.2g/L succinate, the highest production reported to date, with a yield of 1.1g/g glucose under anaerobic condition. These results suggest that the release of end-product inhibition coupled with an increase in key metabolic flux is a promising strategy for enhancing production of succinate. Copyright © 2017. Published by Elsevier Inc.

Surface charge modification increases firefly luciferase rigidity without alteration in bioluminescence spectra.

PubMed

Mortazavi, Mojtaba; Hosseinkhani, Saman

2017-01-01

Protein engineering can provide useful approaches for loop anchoring and mutation of surface-exposed loop residues to Arg for the design of thermostable proteins. In this context and due to the high proportion of surface loops, some of the solvent-exposed residues in the Lampyris turkestanicus luciferase were mutated to Arg. Using the red-emitter mutant luciferase (E354R/Arg356), the single (-Q35R, -I182R, -I232R and -L300R), double (-Q35R/I232R) and triple (-Q35R/I232R/I182R) mutant luciferases were introduced. The relative remaining activity of -I232R, double and triple mutants increased significantly compared to the wild-type at 40°C. The optimal temperature of these mutants increased up to 40°C which were 15°C more than wild-type luciferase. It is anticipated that these mutations increased the local interactions that finally improved the thermostability and optimum temperature of luciferase. It should be noted that Arg substitution at amino acid positions 35, 182 and 232 had no effect on the bioluminescence emission spectra. Furthermore, these mutations have not significantly changed the specific activities of firefly luciferases. Finally, with the use of the homology modeling and molecular docking, the effects of these substitutions were evaluated. In conclusion, this study provides beneficial insights on how the thermal stability of luciferase can be improved by protein engineering for biological applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Using paper presentation breaks during didactic lectures improves learning of physiology in undergraduate students.

PubMed

Ghorbani, Ahmad; Ghazvini, Kiarash

2016-03-01

Many studies have emphasized the incorporation of active learning into classrooms to reinforce didactic lectures for physiology courses. This work aimed to determine if presenting classic papers during didactic lectures improves the learning of physiology among undergraduate students. Twenty-two students of health information technology were randomly divided into the following two groups: 1) didactic lecture only (control group) and 2) didactic lecture plus paper presentation breaks (DLPP group). In the control group, main topics of gastrointestinal and endocrine physiology were taught using only the didactic lecture technique. In the DLPP group, some topics were presented by the didactic lecture method (similar to the control group) and some topics were taught by the DLPP technique (first, concepts were covered briefly in a didactic format and then reinforced with presentation of a related classic paper). The combination of didactic lecture and paper breaks significantly improved learning so that students in the DLPP group showed higher scores on related topics compared with those in the control group (P < 0.001). Comparison of the scores of topics taught by only the didactic lecture and those using both the didactic lecture and paper breaks showed significant improvement only in the DLPP group (P < 0.001). Data obtained from the final exam showed that in the DLPP group, the mean score of the topics taught by the combination of didactic lecture and paper breaks was significantly higher than those taught by only didactic lecture (P < 0.05). In conclusion, the combination of paper presentation breaks and didactic lectures improves the learning of physiology. Copyright © 2016 The American Physiological Society.

Multidimensional improvements induced by an intensive obesity inpatients rehabilitation programme.

PubMed

Giordano, Francesca; Berteotti, Michela; Budui, Simona; Calgaro, Nicole; Franceschini, Laura; Gilli, Federica; Masiero, Marina; Raschellà, Guido; Salvetti, Sabrina; Taddei, Micol; Schena, Federico; Busetto, Luca

2017-06-01

To analyse the short-term effectiveness of an intensive multidimensional inpatient programme specifically developed for patients with severe obesity. A multidisciplinary team managed a 3-week residential programme characterised by the integration of nutritional and physical rehabilitation with psychological and educational intervention. All patients consecutively admitted in 10 months were analysed at admission and discharge for changes in the following domains: anthropometry (weight, body mass index (BMI), waist and neck circumferences), cardiovascular risk factors (glycaemia, HbA1c, lipid profile, blood pressure), quality of life, eating behaviour, and physical performance (VO 2peak by incremental cycle ergometer test, 6-min walking test (6MWT), chair stands test). 136 subjects (61% females, median age 52.7 years) with obesity (mean BMI 43.2 kg/m 2 ) and multiple comorbidities were analysed. A 3.9% BMI reduction and a reduction in waist (-3.8%) and neck (-3.3%) circumferences were observed. Glycaemic control was achieved in 68% of patients with uncontrolled diabetes at admission. Blood pressure control was achieved in all patients with uncontrolled hypertension at admission. Total cholesterol (-16%), LDL-cholesterol (-19%) and triglycerides (-9%) were significantly reduced. Psychometric assessment showed improvements in quality of life perception and binge eating disorder. Finally, a significant improvement in physical performance (+4.7% improvement in VO 2peak , with longer distances in 6MWT and a higher number of standings) was observed. Our preliminary data prove that a 3-week programme determined a clinically significant multi-dimensional improvement in patients with severe obesity. Long-term follow-up data are needed to confirm the efficacy of our rehabilitation setting.

Virtual reality-based simulation training for ventriculostomy: an evidence-based approach.

PubMed

Schirmer, Clemens M; Elder, J Bradley; Roitberg, Ben; Lobel, Darlene A

2013-10-01

Virtual reality (VR) simulation-based technologies play an important role in neurosurgical resident training. The Congress of Neurological Surgeons (CNS) Simulation Committee developed a simulation-based curriculum incorporating VR simulators to train residents in the management of common neurosurgical disorders. To enhance neurosurgical resident training for ventriculostomy placement using simulation-based training. A course-based neurosurgical simulation curriculum was introduced at the Neurosurgical Simulation Symposium at the 2011 and 2012 CNS annual meetings. A trauma module was developed to teach ventriculostomy placement as one of the neurosurgical procedures commonly performed in the management of traumatic brain injury. The course offered both didactic and simulator-based instruction, incorporating written and practical pretests and posttests and questionnaires to assess improvement in skill level and to validate the simulators as teaching tools. Fourteen trainees participated in the didactic component of the trauma module. Written scores improved significantly from pretest (75%) to posttest (87.5%; P < .05). Seven participants completed the ventriculostomy simulation. Significant improvements were observed in anatomy (P < .04), burr hole placement (P < .03), final location of the catheter (P = .05), and procedure completion time (P < .004). Senior residents planned a significantly better trajectory (P < .01); junior participants improved most in terms of identifying the relevant anatomy (P < .03) and the time required to complete the procedure (P < .04). VR ventriculostomy placement as part of the CNS simulation trauma module complements standard training techniques for residents in the management of neurosurgical trauma. Improvement in didactic and hands-on knowledge by course participants demonstrates the usefulness of the VR simulator as a training tool.

Improving Forecast Skill by Assimilation of Quality Controlled AIRS Version 5 Temperature Soundings

NASA Technical Reports Server (NTRS)

Susskind, Joel; Reale, Oreste

2009-01-01

The AIRS Science Team Version 5 retrieval algorithm has been finalized and is now operational at the Goddard DAAC in the processing (and reprocessing) of all AIRS data. The AIRS Science Team Version 5 retrieval algorithm contains two significant improvements over Version 4: 1) Improved physics allows for use of AIRS observations in the entire 4.3 micron CO2 absorption band in the retrieval of temperature profile T(p) during both day and night. Tropospheric sounding 15 micron CO2 observations are now used primarily in the generation of cloud cleared radiances R(sub i). This approach allows for the generation of accurate values of R(sub i) and T(p) under most cloud conditions. 2) Another very significant improvement in Version 5 is the ability to generate accurate case-by-case, level-by-level error estimates for the atmospheric temperature profile, as well as for channel-by-channel error estimates for R(sub i). These error estimates are used for Quality Control of the retrieved products. We have conducted forecast impact experiments assimilating AIRS temperature profiles with different levels of Quality Control using the NASA GEOS-5 data assimilation system. Assimilation of Quality Controlled T(p) resulted in significantly improved forecast skill compared to that obtained from analyses obtained when all data used operationally by NCEP, except for AIRS data, is assimilated. We also conducted an experiment assimilating AIRS radiances uncontaminated by clouds, as done operationally by ECMWF and NCEP. Forecast resulting from assimilated AIRS radiances were of poorer quality than those obtained assimilating AIRS temperatures.

Effect of final evaluation on job motivation from the perspective of nurses in Ahvaz Hospitals in 2012

PubMed Central

Faraji Khiavi, F; Amiri, E; Ghobadian, S; Roshankar, R

2015-01-01

Background: Increasing nurses’ motivation is among the most important and complex nursing duties. Performance evaluation system could be used as a means to improve the quantity and quality of the human resources. Therefore, current research objected to evaluate the effect of final evaluation on job motivation from the perspective of nurses in Ahvaz hospitals according to Herzberg scheme. Methods: This investigation conducted in 2012. Research population included nurses in Ahvaz educational hospitals. The sample size was calculated 120 and sampling was performed based on classification and random sampling. Research instrument was a self-made questionnaire with confirmed validity through content analysis and Cronbach’s alpha calculated at 0.94. Data examined utilizing ANOVA, T-Test, and descriptive statistics. Results: The nurses considered the final evaluation on management policy (3.2 ± 1.11) and monitoring (3.15 ± 1.15) among health items and responsibility (3.15 ± 1.15) and progress (3.06 ± 1.24) among motivational factors relatively effective. There was a significant association between scores of nurses' views in different age and sex groups (P = 0.01), but there was no significant association among respondents in educational level and marital status. Conclusion: Experienced nurses believed that evaluation has little effect on job motivation. If annual assessment of the various job aspects are considered, managers could use it as an efficient tool to motivate nurses. PMID:28316733

Effect of final evaluation on job motivation from the perspective of nurses in Ahvaz Hospitals in 2012.

PubMed

Faraji Khiavi, F; Amiri, E; Ghobadian, S; Roshankar, R

2015-01-01

Background: Increasing nurses' motivation is among the most important and complex nursing duties. Performance evaluation system could be used as a means to improve the quantity and quality of the human resources. Therefore, current research objected to evaluate the effect of final evaluation on job motivation from the perspective of nurses in Ahvaz hospitals according to Herzberg scheme. Methods: This investigation conducted in 2012. Research population included nurses in Ahvaz educational hospitals. The sample size was calculated 120 and sampling was performed based on classification and random sampling. Research instrument was a self-made questionnaire with confirmed validity through content analysis and Cronbach's alpha calculated at 0.94. Data examined utilizing ANOVA, T-Test, and descriptive statistics. Results: The nurses considered the final evaluation on management policy (3.2 ± 1.11) and monitoring (3.15 ± 1.15) among health items and responsibility (3.15 ± 1.15) and progress (3.06 ± 1.24) among motivational factors relatively effective. There was a significant association between scores of nurses' views in different age and sex groups (P = 0.01), but there was no significant association among respondents in educational level and marital status. Conclusion: Experienced nurses believed that evaluation has little effect on job motivation. If annual assessment of the various job aspects are considered, managers could use it as an efficient tool to motivate nurses.

Search for WH Associated Production in the l upsilon b-bbar Final State Using the DØ Detector at the Tevatron

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

Brown, Jonathan

2011-09-15

The Standard Model is the framework which allows to describe interactions between particles and their dynamics. The Higgs mechanism is a solution to naturally introduce a mass term in the theoretical description of this model. After electroweak spontaneous symmetry breaking, a new massive scalar particle is introduced, the Higgs boson. Since it hasn’t been discovered yet, the search for the Higgs boson is carried at the Tevatron, which is a pmore » $$\\bar{p}$$ collider at a center-of-mass of 1.96 TeV. For M H <115 GeV, the dominant decay mode is H → b$$\\bar{b}$$ . The analysis presented in this document is focused on the 100< M H <150 GeV mass range, in the channel where the Higgs boson is produced in assocation with a W boson which decays either to an electron or muon and a neutrino. The study of this final state relies on informations collected from all parts of the DØ detector. A result based on 5.3 fb -1 of RunII Tevatron collisions is presented here. In order to increase the sensitivity to the signal, the analysis is separated in different sub-channels according to the lepton flavour, number of jets in the final state, number of jets identified as originated from b quarks and data taking periods. After selecting events, a multivariate analysis technique is used to separate signal-like events from the expected physics and instrumental backgrounds. A good agreement between data and simulation is observed. As no signal excess is observed in data, an observed (expected) upper limit of 4.5 (4.8) for M H = 115 GeV is set on the ratio of the WH cross section multiplied by the H → b$$\\bar{b}$$ branching fraction to its standard model prediction, at 95% confidence level. Since the final Tevatron dataset is soon to be analyzed, an effort is brought to achieve the maximum sensitivity. A preliminary analysis updated in Summer 2011 is presented as well as future improvements to be considered in the final publication for the search in the WH → ℓνb$$\\bar{b}$$ channel. Since the dijet invariant mass is the most discriminant single variable, a correction based on jet shapes is derived to improve the mass resolution, hence the analysis sensitivity. Moreover, a different usage of b-jets identification tools and optimization studies on the final discriminant yields a significant improvement. This result is part of the Tevatron Higgs combination.« less

Effective therapy of transected quadriceps muscle in rat: Gastric pentadecapeptide BPC 157.

PubMed

Staresinic, Mario; Petrovic, Igor; Novinscak, Tomislav; Jukic, Ivana; Pevec, Damira; Suknaic, Slaven; Kokic, Neven; Batelja, Lovorka; Brcic, Luka; Boban-Blagaic, Alenka; Zoric, Zdenka; Ivanovic, Domagoj; Ajduk, Marko; Sebecic, Bozidar; Patrlj, Leonardo; Sosa, Tomislav; Buljat, Gojko; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

2006-05-01

We report complete transection of major muscle and the systemic peptide treatment that induces healing of quadriceps muscle promptly and then maintains the healing with functional restoration. Initially, stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419, PL-10, PLD-116, PL 14736 Pliva, Croatia; in trials for inflammatory bowel disease; wound treatment; no toxicity reported; effective alone without carrier) also superiorly accelerates the healing of transected Achilles tendon. Regularly, quadriceps muscle completely transected transversely 1.0 cm proximal to patella presents a definitive defect that cannot be compensated in rat. BPC 157 (10 microg, 10 ng, 10 pg/kg) is given intraperitoneally, once daily; the first application 30 min posttransection, the final 24 h before sacrifice. It consistently improves muscle healing throughout the whole 72-day period. Improved are: (i) biomechanic (load of failure increased); (ii) function (walking recovery and extensor postural thrust/motor function index returned toward normal healthy values); (iii) microscopy/immunochemistry [i.e., mostly muscle fibers connect muscle segments; absent gap; significant desmin positivity for ongoing regeneration of muscle; larger myofibril diameters on both sides, distal and proximal (normal healthy rat-values reached)]; (iv) macroscopic presentation (stumps connected; subsequently, atrophy markedly attenuated; finally, presentation close to normal noninjured muscle, no postsurgery leg contracture). Thus, posttransection healing-consistently improved-may suggest this peptide therapeutic application in muscle disorders. Copyright 2006 Orthopaedic Research Society.

Decision making in a multidisciplinary cancer team: does team discussion result in better quality decisions?

PubMed

Kee, Frank; Owen, Tracy; Leathem, Ruth

2004-01-01

To establish whether treatment recommendations made by clinicians concur with the best outcomes predicted from their prognostic estimates and whether team discussion improves the quality or outcome of their decision making, the authors studied real-time decision making by a lung cancer team. Clinicians completed pre- and postdiscussion questionnaires for 50 newly diagnosed patients. For each patient/doctor pairing, a decision model determined the expected patient outcomes from the clinician's prognostic estimates. The difference between the expected utility of the recommended treatment and the maximum utility derived from the clinician's predictions of the outcomes (the net utility loss) following all potential treatment modalities was calculated as an indicator of quality of the decision. The proportion of treatment decisions changed by the multidisciplinary team discussion was also calculated. Insofar as the change in net utility loss brought about by multidisciplinary team discussion was not significantly different from zero, team discussion did not improve the quality of decision making overall. However, given the modest power of the study, these findings must be interpreted with caution. In only 23 of 87 instances (26%) in which an individual specialist's initial treatment preference differed from the final group judgment did the specialist finally concur with the group treatment choice after discussion. This study does not support the theory that team discussion improves decision making by closing a knowledge gap.

Comparison of the Modified Broström Procedure for Chronic Lateral Ankle Instability With and Without Subfibular Ossicle.

PubMed

Ahn, Hyeon-Wook; Lee, Keun-Bae

2016-12-01

Subfibular ossicles are frequently found in patients with chronic lateral ankle instability (CLAI). However, there is a lack of consensus about the optimal surgical treatment for CLAI with subfibular ossicle. To evaluate the clinical and radiographic outcomes of the modified Broström procedure with subfibular ossicle excision compared with the same procedure for CLAI without subfibular ossicle. Cohort study; Level of evidence, 3. Ninety-six patients (96 ankles) treated with the modified Broström procedure using bone tunnel and suture anchor techniques for CLAI constituted the study cohort. The 96 ankles were divided into 2 groups with and without subfibular ossicles. The ossicle group (42 ankles) and nonossicle group (54 ankles) consisted of patients with a mean age of 26.6 and 30.3 years, respectively, at the time of surgery with a mean follow-up duration of 63.7 and 62.1 months, respectively. Subfibular ossicles were excised in the ossicle group. Mean Karlsson scores improved from 55.2 to 95.3 in the ossicle group and from 56.4 to 94.8 in the nonossicle group at final follow-up. Mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores also improved from 63.3 to 95.9 in the ossicle group and from 62.8 to 95.1 in the nonossicle group at final follow-up. Mean talar tilt angles were 14.0° in the ossicle group and 12.2° in the nonossicle group preoperatively and 7.6° and 6.8° at the final follow-up, respectively. Mean anterior talar translations in the ossicle group and nonossicle groups improved from 9.3 and 9.4 mm preoperatively to 5.8 and 5.7 mm at final follow-up, respectively. No significant differences were found between the 2 groups in terms of Karlsson score, AOFAS score, talar tilt angle, and anterior talar translation at final follow-up (P > .05). The modified Broström procedure with subfibular ossicle excision provided similarly good clinical and radiographic outcomes compared with the same procedure without subfibular ossicle excision. Accordingly, the study results suggest that these procedures appear to be effective and reliable method for the treatment of CLAI with subfibular ossicle. © 2016 The Author(s).

Re-annotation, improved large-scale assembly and establishment of a catalogue of noncoding loci for the genome of the model brown alga Ectocarpus.

PubMed

Cormier, Alexandre; Avia, Komlan; Sterck, Lieven; Derrien, Thomas; Wucher, Valentin; Andres, Gwendoline; Monsoor, Misharl; Godfroy, Olivier; Lipinska, Agnieszka; Perrineau, Marie-Mathilde; Van De Peer, Yves; Hitte, Christophe; Corre, Erwan; Coelho, Susana M; Cock, J Mark

2017-04-01

The genome of the filamentous brown alga Ectocarpus was the first to be completely sequenced from within the brown algal group and has served as a key reference genome both for this lineage and for the stramenopiles. We present a complete structural and functional reannotation of the Ectocarpus genome. The large-scale assembly of the Ectocarpus genome was significantly improved and genome-wide gene re-annotation using extensive RNA-seq data improved the structure of 11 108 existing protein-coding genes and added 2030 new loci. A genome-wide analysis of splicing isoforms identified an average of 1.6 transcripts per locus. A large number of previously undescribed noncoding genes were identified and annotated, including 717 loci that produce long noncoding RNAs. Conservation of lncRNAs between Ectocarpus and another brown alga, the kelp Saccharina japonica, suggests that at least a proportion of these loci serve a function. Finally, a large collection of single nucleotide polymorphism-based markers was developed for genetic analyses. These resources are available through an updated and improved genome database. This study significantly improves the utility of the Ectocarpus genome as a high-quality reference for the study of many important aspects of brown algal biology and as a reference for genomic analyses across the stramenopiles. © 2016 The Authors. New Phytologist © 2016 New Phytologist Trust.

Constraining primordial non-Gaussianity with bispectrum and power spectrum from upcoming optical and radio surveys

NASA Astrophysics Data System (ADS)

Karagiannis, Dionysios; Lazanu, Andrei; Liguori, Michele; Raccanelli, Alvise; Bartolo, Nicola; Verde, Licia

2018-07-01

We forecast constraints on primordial non-Gaussianity (PNG) and bias parameters from measurements of galaxy power spectrum and bispectrum in future radio continuum and optical surveys. In the galaxy bispectrum, we consider a comprehensive list of effects, including the bias expansion for non-Gaussian initial conditions up to second order, redshift space distortions, redshift uncertainties and theoretical errors. These effects are all combined in a single PNG forecast for the first time. Moreover, we improve the bispectrum modelling over previous forecasts, by accounting for trispectrum contributions. All effects have an impact on final predicted bounds, which varies with the type of survey. We find that the bispectrum can lead to improvements up to a factor ˜5 over bounds based on the power spectrum alone, leading to significantly better constraints for local-type PNG, with respect to current limits from Planck. Future radio and photometric surveys could obtain a measurement error of σ (f_{NL}^{loc}) ≈ 0.2. In the case of equilateral PNG, galaxy bispectrum can improve upon present bounds only if significant improvements in the redshift determinations of future, large volume, photometric or radio surveys could be achieved. For orthogonal non-Gaussianity, expected constraints are generally comparable to current ones.

Constraining Primordial non-Gaussianity with Bispectrum and Power Spectum from Upcoming Optical and Radio Surveys

NASA Astrophysics Data System (ADS)

Karagiannis, Dionysios; Lazanu, Andrei; Liguori, Michele; Raccanelli, Alvise; Bartolo, Nicola; Verde, Licia

2018-04-01

We forecast constraints on primordial non-Gaussianity (PNG) and bias parameters from measurements of galaxy power spectrum and bispectrum in future radio continuum and optical surveys. In the galaxy bispectrum, we consider a comprehensive list of effects, including the bias expansion for non-Gaussian initial conditions up to second order, redshift space distortions, redshift uncertainties and theoretical errors. These effects are all combined in a single PNG forecast for the first time. Moreover, we improve the bispectrum modelling over previous forecasts, by accounting for trispectrum contributions. All effects have an impact on final predicted bounds, which varies with the type of survey. We find that the bispectrum can lead to improvements up to a factor ˜5 over bounds based on the power spectrum alone, leading to significantly better constraints for local-type PNG, with respect to current limits from Planck. Future radio and photometric surveys could obtain a measurement error of σ (f_{NL}^{loc}) ≈ 0.2. In the case of equilateral PNG, galaxy bispectrum can improve upon present bounds only if significant improvements in the redshift determinations of future, large volume, photometric or radio surveys could be achieved. For orthogonal non-Gaussianity, expected constraints are generally comparable to current ones.

Designing a Pediatric Severe Sepsis Screening Tool

PubMed Central

Sepanski, Robert J.; Godambe, Sandip A.; Mangum, Christopher D.; Bovat, Christine S.; Zaritsky, Arno L.; Shah, Samir H.

2014-01-01

We sought to create a screening tool with improved predictive value for pediatric severe sepsis (SS) and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric emergency department (ED). “Gold standard” SS cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over 2 months. The tool’s identification of SS was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS) parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating characteristics (ROC). Age-specific normal and abnormal values for heart rate (HR) and respiratory rate (RR) were empirically derived from 143,603 children seen in a second pediatric ED over 3 years. Univariate analyses were performed for each measure in the tool to assess its association with SS and to characterize it as an “early” or “late” indicator of SS. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly threefold improvement over the original ICCPS tool. False positive systemic inflammatory response syndrome identifications were nearly sixfold lower. PMID:24982852

AUI&GIV: Recommendation with Asymmetric User Influence and Global Importance Value.

PubMed

Zhao, Zhi-Lin; Wang, Chang-Dong; Lai, Jian-Huang

2016-01-01

The user-based collaborative filtering (CF) algorithm is one of the most popular approaches for making recommendation. Despite its success, the traditional user-based CF algorithm suffers one serious problem that it only measures the influence between two users based on their symmetric similarities calculated by their consumption histories. It means that, for a pair of users, the influences on each other are the same, which however may not be true. Intuitively, an expert may have an impact on a novice user but a novice user may not affect an expert at all. Besides, each user may possess a global importance factor that affects his/her influence to the remaining users. To this end, in this paper, we propose an asymmetric user influence model to measure the directed influence between two users and adopt the PageRank algorithm to calculate the global importance value of each user. And then the directed influence values and the global importance values are integrated to deduce the final influence values between two users. Finally, we use the final influence values to improve the performance of the traditional user-based CF algorithm. Extensive experiments have been conducted, the results of which have confirmed that both the asymmetric user influence model and global importance value play key roles in improving recommendation accuracy, and hence the proposed method significantly outperforms the existing recommendation algorithms, in particular the user-based CF algorithm on the datasets of high rating density.

AUI&GIV: Recommendation with Asymmetric User Influence and Global Importance Value

PubMed Central

Zhao, Zhi-Lin; Wang, Chang-Dong; Lai, Jian-Huang

2016-01-01

The user-based collaborative filtering (CF) algorithm is one of the most popular approaches for making recommendation. Despite its success, the traditional user-based CF algorithm suffers one serious problem that it only measures the influence between two users based on their symmetric similarities calculated by their consumption histories. It means that, for a pair of users, the influences on each other are the same, which however may not be true. Intuitively, an expert may have an impact on a novice user but a novice user may not affect an expert at all. Besides, each user may possess a global importance factor that affects his/her influence to the remaining users. To this end, in this paper, we propose an asymmetric user influence model to measure the directed influence between two users and adopt the PageRank algorithm to calculate the global importance value of each user. And then the directed influence values and the global importance values are integrated to deduce the final influence values between two users. Finally, we use the final influence values to improve the performance of the traditional user-based CF algorithm. Extensive experiments have been conducted, the results of which have confirmed that both the asymmetric user influence model and global importance value play key roles in improving recommendation accuracy, and hence the proposed method significantly outperforms the existing recommendation algorithms, in particular the user-based CF algorithm on the datasets of high rating density. PMID:26828803

Impact of initial surface parameters on the final quality of laser micro-polished surfaces

NASA Astrophysics Data System (ADS)

Chow, Michael; Bordatchev, Evgueni V.; Knopf, George K.

2012-03-01

Laser micro-polishing (LμP) is a new laser-based microfabrication technology for improving surface quality during a finishing operation and for producing parts and surfaces with near-optical surface quality. The LμP process uses low power laser energy to melt a thin layer of material on the previously machined surface. The polishing effect is achieved as the molten material in the laser-material interaction zone flows from the elevated regions to the local minimum due to surface tension. This flow of molten material then forms a thin ultra-smooth layer on the top surface. The LμP is a complex thermo-dynamic process where the melting, flow and redistribution of molten material is significantly influenced by a variety of process parameters related to the laser, the travel motions and the material. The goal of this study is to analyze the impact of initial surface parameters on the final surface quality. Ball-end micromilling was used for preparing initial surface of samples from H13 tool steel that were polished using a Q-switched Nd:YAG laser. The height and width of micromilled scallops (waviness) were identified as dominant parameter affecting the quality of the LμPed surface. By adjusting process parameters, the Ra value of a surface, having a waviness period of 33 μm and a peak-to-valley value of 5.9 μm, was reduced from 499 nm to 301 nm, improving the final surface quality by 39.7%.

Design improvement of a pump wear ring labyrinth seal

NASA Technical Reports Server (NTRS)

Rhode, David L.; Morrison, G. L.; Ko, S. H.; Waughtal, S. P.

1987-01-01

The investigation was successful in obtaining two improved designs for the impeller wear ring seal of the liquid hydrogen turbopump of interest. A finite difference computer code was extensively used in a parametric computational study in determining a cavity configuration with high flow resistance due to turbulence dissipation. These two designs, along with that currently used, were fabricated and tested. The improved designs were denoted Type O and Type S. The measurements showed that Type O and Type S given 67 and 30 percent reduction in leakage over the current design, respectively. It was found that the number of cavities, the step height and the presence of a small stator groove are quite important design features. Also, the tooth thickness is of some significance. Finally, the tooth height and an additional large cavity cut out from the stator (upstream of the step) are of negligible importance.

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

Sun, Rongyu; Zhao, Changyin; Zhang, Xiaoxiang, E-mail: cyzhao@pmo.ac.cn

The data reduction method for optical space debris observations has many similarities with the one adopted for surveying near-Earth objects; however, due to several specific issues, the image degradation is particularly critical, which makes it difficult to obtain precise astrometry. An automatic image reconstruction method was developed to improve the astrometry precision for space debris, based on the mathematical morphology operator. Variable structural elements along multiple directions are adopted for image transformation, and then all the resultant images are stacked to obtain a final result. To investigate its efficiency, trial observations are made with Global Positioning System satellites and themore » astrometry accuracy improvement is obtained by comparison with the reference positions. The results of our experiments indicate that the influence of degradation in astrometric CCD images is reduced, and the position accuracy of both objects and stellar stars is improved distinctly. Our technique will contribute significantly to optical data reduction and high-order precision astrometry for space debris.« less

Test Activities in the Langley Transonic Dynamics Tunnel and a Summary of Recent Facility Improvements

NASA Technical Reports Server (NTRS)

Cole, Stanley R.; Johnson, R. Keith; Piatak, David J.; Florance, Jennifer P.; Rivera, Jose A., Jr.

2003-01-01

The Langley Transonic Dynamics Tunnel (TDT) has provided a unique capability for aeroelastic testing for over forty years. The facility has a rich history of significant contributions to the design of many United States commercial transports, military aircraft, launch vehicles, and spacecraft. The facility has many features that contribute to its uniqueness for aeroelasticity testing, perhaps the most important feature being the use of a heavy gas test medium to achieve higher test densities compared to testing in air. Higher test medium densities substantially improve model-building requirements and therefore simplify the fabrication process for building aeroelastically scaled wind tunnel models. This paper describes TDT capabilities that make it particularly suited for aeroelasticity testing. The paper also discusses the nature of recent test activities in the TDT, including summaries of several specific tests. Finally, the paper documents recent facility improvement projects and the continuous statistical quality assessment effort for the TDT.

Ignition improvement by injector arrangement in a multi-fuel combustor for micro gas turbine

NASA Astrophysics Data System (ADS)

Antoshkiv, O.; Poojitganont, T.; Jeansirisomboon, S.; Berg, H. P.

2018-01-01

The novel combustor design also has an impact on the ignitor arrangement. The conventional ignitor system cannot guarantee optimal ignition performance in the usual radial position. The difficult ignitability of gaseous fuels was the main challenge for the ignitor system improvement. One way to improve the ignition performance significantly is a torch ignitor system in which the gaseous fuel is directly mixed with a large amount of the combustor air. To reach this goal, the ignition process was investigated in detail. The micro gas turbine (MGT) ignition was optimised considering three main procedures: torch ignitor operation, burner ignition and flame propagation between the neighbour injectors. A successful final result of the chain of ignition procedures depends on multiple aspects of the combustor design. Performed development work shows an important step towards designing modern high-efficiency low-emission combustors.

Upgrades to the NOAA/NESDIS automated Cloud-Motion Vector system

NASA Technical Reports Server (NTRS)

Nieman, Steve; Menzel, W. Paul; Hayden, Christopher M.; Wanzong, Steve; Velden, Christopher S.

1993-01-01

The latest version of the automated cloud motion vector software has yielded significant improvements in the quality of the GOES cloud-drift winds produced operationally by NESDIS. Cloud motion vectors resulting from the automated system are now equal or superior in quality to those which had the benefit of manual quality control a few years ago. The single most important factor in this improvement has been the upgraded auto-editor. Improved tracer selection procedures eliminate targets in difficult regions and allow a higher target density and therefore enhanced coverage in areas of interest. The incorporation of the H2O-intercept height assignment method allows an adequate representation of the heights of semi-transparent clouds in the absence of a CO2-absorption channel. Finally, GOES-8 water-vapor motion winds resulting from the automated system are superior to any done previously by NESDIS and should now be considered as an operational product.

Retention of drug administration skills after intensive teaching.

PubMed

Wheeler, D W; Degnan, B A; Murray, L J; Dunling, C P; Whittlestone, K D; Wood, D F; Smith, H L; Gupta, A K

2008-04-01

We have identified deficiencies in medical students' drug administration skills, and we attempted to address them with interactive online teaching modules and simulated critical incident scenarios. Short-term improvements have been evident with this intensive effort, but medium-term retention of skills has not been measured. A drug administration lecture, an online module and a simulated emergency scenario were offered to final year clinical students. None of the teaching was compulsory but participation was recorded, along with students' simulator performances and marks in an objective structured practical examination 9 months later. A poor simulator score predicted a poor performance in the later examination. Participation in the simulated scenario only significantly improved examination scores when supplemented by online teaching (p = 0.002). Intensive drug administration teaching using an online module and high fidelity simulation improves drug administration skills in the medium term. Students found simulation much more engaging than online teaching.

Enhancing the Relationship Adjustment of South Asian Canadian Couples Using a Systemic-Constructivist Approach to Couple Therapy.

PubMed

Ahmad, Saunia; Reid, David W

2016-10-01

The effectiveness of systemic-constructivist couple therapy (SCCT) in improving the relationship adjustment of South Asian Canadian couples in ways that attend to their culture was evaluated. The SCCT interventions engage partners in reflexive processing of both their own and their partner's ways of construing, and the reciprocity between these two. A core change mechanism of SCCT, couple identity ("we-ness"), that connotes the ability for thinking and experiencing relationally, was coded from verbatim transcripts of partners' within-session dialogue. As predicted, South Asian partners' relationship adjustment improved significantly from the first to final session of SCCT, and concurrent increases in each partner's couple identity mediated such improvements. The implications for considering culture and couple identity in couple therapy are discussed. Video Abstract is found in the online version of the article. © 2016 American Association for Marriage and Family Therapy.

Improvement on Timing Accuracy of LIDAR for Remote Sensing

NASA Astrophysics Data System (ADS)

Zhou, G.; Huang, W.; Zhou, X.; Huang, Y.; He, C.; Li, X.; Zhang, L.

2018-05-01

The traditional timing discrimination technique for laser rangefinding in remote sensing, which is lower in measurement performance and also has a larger error, has been unable to meet the high precision measurement and high definition lidar image. To solve this problem, an improvement of timing accuracy based on the improved leading-edge timing discrimination (LED) is proposed. Firstly, the method enables the corresponding timing point of the same threshold to move forward with the multiple amplifying of the received signal. Then, timing information is sampled, and fitted the timing points through algorithms in MATLAB software. Finally, the minimum timing error is calculated by the fitting function. Thereby, the timing error of the received signal from the lidar is compressed and the lidar data quality is improved. Experiments show that timing error can be significantly reduced by the multiple amplifying of the received signal and the algorithm of fitting the parameters, and a timing accuracy of 4.63 ps is achieved.

Labor-Management Cooperation in Illinois: How a Joint Union Company Team Is Improving Facility Safety.

PubMed

Mahan, Bruce; Maclin, Reggie; Ruttenberg, Ruth; Mundy, Keith; Frazee, Tom; Schwartzkopf, Randy; Morawetz, John

2018-01-01

This study of Afton Chemical Corporation's Sauget facility and its International Chemical Workers Union Council (ICWUC) Local 871C demonstrates how significant safety improvements can be made when committed leadership from both management and union work together, build trust, train the entire work force in U.S. Occupational Safety and Health Administration 10-hour classes, and communicate with their work force, both salaried and hourly. A key finding is that listening to the workers closest to production can lead to solutions, many of them more cost-efficient than top-down decision-making. Another is that making safety and health an authentic value is hard work, requiring time, money, and commitment. Third, union and management must both have leadership willing to take chances and learn to trust one another. Fourth, training must be for everyone and ongoing. Finally, health and safety improvements require dedicated funding. The result was resolution of more than one hundred safety concerns and an ongoing institutionalized process for continuing improvement.

Identification of synergistic impacts during anaerobic co-digestion of organic wastes.

PubMed

Astals, S; Batstone, D J; Mata-Alvarez, J; Jensen, P D

2014-10-01

Anaerobic co-digestion has been widely investigated, but there is limited analysis of interaction between substrates. The objective of this work was to assess the role of carbohydrates, protein and lipids in co-digestion behaviour separately, and together. Two sets of batch tests were done, each set consisting of the mono-digestion of three substrates, and the co-digestion of seven mixtures. The first was done with pure substrates--cellulose, casein and olive oil--while in the second slaughterhouse waste--paunch, blood and fat--were used as carbohydrate, protein and lipid sources, respectively. Synergistic effects were mainly improvement of process kinetics without a significant change in biodegradability. Kinetics improvement was linked to the mitigation of inhibitory compounds, particularly fats dilution. The exception was co-digestion of paunch with lipids, which resulted in an improved final yield with model based analysis indicating the presence of paunch improved degradability of the fatty feed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Relationship Between the Remaining Years of Healthy Life Expectancy in Older Age and National Income Level, Educational Attainment, and Improved Water Quality.

PubMed

Kim, Jong In; Kim, Gukbin

2016-10-01

The remaining years of healthy life expectancy (RYH) at age 65 years can be calculated as RYH (65) = healthy life expectancy-aged 65 years. This study confirms the associations between socioeconomic indicators and the RYH (65) in 148 countries. The RYH data were obtained from the World Health Organization. Significant positive correlations between RYH (65) in men and women and the socioeconomic indicators national income, education level, and improved drinking water were found. Finally, the predictors of RYH (65) in men and women were used to build a model of the RYH using higher socioeconomic indicators (R(2 )= 0.744, p < .001). Overall country-level educational attainment, national income level, and improved water quality influenced the RYH at 65 years. Therefore, policymaking to improve these country-level socioeconomic factors is expected to have latent effects on RYH in older age. © The Author(s) 2016.

A Novel Strategy of Ambiguity Correction for the Improved Faraday Rotation Estimator in Linearly Full-Polarimetric SAR Data.

PubMed

Li, Jinhui; Ji, Yifei; Zhang, Yongsheng; Zhang, Qilei; Huang, Haifeng; Dong, Zhen

2018-04-10

Spaceborne synthetic aperture radar (SAR) missions operating at low frequencies, such as L-band or P-band, are significantly influenced by the ionosphere. As one of the serious ionosphere effects, Faraday rotation (FR) is a remarkable distortion source for the polarimetric SAR (PolSAR) application. Various published FR estimators along with an improved one have been introduced to solve this issue, all of which are implemented by processing a set of PolSAR real data. The improved estimator exhibits optimal robustness based on performance analysis, especially in term of the system noise. However, all published estimators, including the improved estimator, suffer from a potential FR angle (FRA) ambiguity. A novel strategy of the ambiguity correction for those FR estimators is proposed and shown as a flow process, which is divided into pixel-level and image-level correction. The former is not yet recognized and thus is considered in particular. Finally, the validation experiments show a prominent performance of the proposed strategy.

The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.

PubMed

Scarcella, P; Buonomo, E; Zimba, I; Doro Altan, A M; Germano, P; Palombi, L; Marazzi, M C

2011-01-01

DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 p< 0.024) . In the cohort in HAART, both the mean of BMI value (initial value: 20.7 ± 3.9; final value: 21.9 ± 3.3 p< 0.001) and of haemoglobin (initial value: 9.9 ± 2.2; final value: 10.8 ± 1.7 p< 0.001) showed a higher significant increase. The increase in BMI was statistically associated with the DDS in HAART patients. In conclusion nutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and HAART on the nutritional status of African AIDS patients and also highlights the complementary role of an adequate and diversified diet in persons living with HIV/AIDS in resources limited settings.

Islet product characteristics and factors related to successful human islet transplantation from the Collaborative Islet Transplant Registry (CITR) 1999-2010.

PubMed

Balamurugan, A N; Naziruddin, B; Lockridge, A; Tiwari, M; Loganathan, G; Takita, M; Matsumoto, S; Papas, K; Trieger, M; Rainis, H; Kin, T; Kay, T W; Wease, S; Messinger, S; Ricordi, C; Alejandro, R; Markmann, J; Kerr-Conti, J; Rickels, M R; Liu, C; Zhang, X; Witkowski, P; Posselt, A; Maffi, P; Secchi, A; Berney, T; O'Connell, P J; Hering, B J; Barton, F B

2014-11-01

The Collaborative Islet Transplant Registry (CITR) collects data on clinical islet isolations and transplants. This retrospective report analyzed 1017 islet isolation procedures performed for 537 recipients of allogeneic clinical islet transplantation in 1999-2010. This study describes changes in donor and islet isolation variables by era and factors associated with quantity and quality of final islet products. Donor body weight and BMI increased significantly over the period (p<0.001). Islet yield measures have improved with time including islet equivalent (IEQ)/particle ratio and IEQs infused. The average dose of islets infused significantly increased in the era of 2007-2010 when compared to 1999-2002 (445.4±156.8 vs. 421.3±155.4×0(3) IEQ; p<0.05). Islet purity and total number of β cells significantly improved over the study period (p<0.01 and <0.05, respectively). Otherwise, the quality of clinical islets has remained consistently very high through this period, and differs substantially from nonclinical islets. In multivariate analysis of all recipient, donor and islet factors, and medical management factors, the only islet product characteristic that correlated with clinical outcomes was total IEQs infused. This analysis shows improvements in both quantity and some quality criteria of clinical islets produced over 1999-2010, and these parallel improvements in clinical outcomes over the same period. © 2014 The Authors. American Journal of Transplantation Published by Wiley Periodicals, Inc. on behalf of American Society of Transplant Surgeons.

Data Assimilation Experiments using Quality Controlled AIRS Version 5 Temperature Soundings

NASA Technical Reports Server (NTRS)

SUsskind, Joel

2008-01-01

The AIRS Science Team Version 5 retrieval algorithm has been finalized and is now operational at the Goddard DAAC in the processing (and reprocessing) of all AIRS data. The AIRS Science Team Version 5 retrieval algorithm contains two significant improvements over Version 4: 1) Improved physics allows for use of AIRS observations in the entire 4.3 pm C02 absorption band in the retrieval of temperature profile T(p) during both day and night. Tropospheric sounding 15 pm C02 observations are now used primarily in the generation of cloud cleared radiances Ri. This approach allows for the generation of accurate values of Ri and T(p) under most cloud conditions. 2) Another very significant improvement in Version 5 is the ability to generate accurate case-by-case, level-by-level error estimates for the atmospheric temperature profile, as well as for channel-by- channel error estimates for Ri. These error estimates are used for quality control of the retrieved products. We have conducted forecast impact experiments assimilating AIRS temperature profiles with different levels of quality control using the NASA GEOS-5 data assimilation system. Assimilation of quality controlled T(p) resulted in significantly improved forecast skill compared to that obtained from analyses obtained when all data used operationally by NCEP, except for AIRS data, is assimilated. We also conducted an experiment assimilating AIRS radiances uncontaminated by clouds, as done Operationally by ECMWF and NCEP. Forecasts resulting from assimilated AIRS radiances were of poorer quality than those obtained assimilating AIRS temperatures.

Islet Product Characteristics and Factors Related to Successful Human Islet Transplantation From the Collaborative Islet Transplant Registry (CITR) 1999–2010

PubMed Central

Balamurugan, A N; Naziruddin, B; Lockridge, A; Tiwari, M; Loganathan, G; Takita, M; Matsumoto, S; Papas, K; Trieger, M; Rainis, H; Kin, T; Kay, T W; Wease, S; Messinger, S; Ricordi, C; Alejandro, R; Markmann, J; Kerr-Conti, J; Rickels, M R; Liu, C; Zhang, X; Witkowski, P; Posselt, A; Maffi, P; Secchi, A; Berney, T; O’Connell, P J; Hering, B J; Barton, F B

2014-01-01

The Collaborative Islet Transplant Registry (CITR) collects data on clinical islet isolations and transplants. This retrospective report analyzed 1017 islet isolation procedures performed for 537 recipients of allogeneic clinical islet transplantation in 1999–2010. This study describes changes in donor and islet isolation variables by era and factors associated with quantity and quality of final islet products. Donor body weight and BMI increased significantly over the period (p < 0.001). Islet yield measures have improved with time including islet equivalent (IEQ)/particle ratio and IEQs infused. The average dose of islets infused significantly increased in the era of 2007–2010 when compared to 1999–2002 (445.4 ± 156.8 vs. 421.3 ± 155.4 ×103 IEQ; p < 0.05). Islet purity and total number of β cells significantly improved over the study period (p < 0.01 and <0.05, respectively). Otherwise, the quality of clinical islets has remained consistently very high through this period, and differs substantially from nonclinical islets. In multivariate analysis of all recipient, donor and islet factors, and medical management factors, the only islet product characteristic that correlated with clinical outcomes was total IEQs infused. This analysis shows improvements in both quantity and some quality criteria of clinical islets produced over 1999–2010, and these parallel improvements in clinical outcomes over the same period. PMID:25278159

Tomosynthesis in the Diagnostic Setting: Changing Rates of BI-RADS Final Assessment over Time.

PubMed

Raghu, Madhavi; Durand, Melissa A; Andrejeva, Liva; Goehler, Alexander; Michalski, Mark H; Geisel, Jaime L; Hooley, Regina J; Horvath, Laura J; Butler, Reni; Forman, Howard P; Philpotts, Liane E

2016-10-01

Purpose To evaluate the effect of tomosynthesis in diagnostic mammography on the Breast Imaging Reporting and Data System (BI-RADS) final assessment categories over time. Materials and Methods This retrospective study was approved by the institutional review board. The authors reviewed all diagnostic mammograms obtained during a 12-month interval before (two-dimensional [2D] mammography [June 2, 2010, to June 1, 2011]) and for 3 consecutive years after (tomosynthesis year 1 [2012], tomosynthesis year 2 [2013], and tomosynthesis year 3 [2014]) the implementation of tomosynthesis. The requirement to obtain informed consent was waived. The rates of BI-RADS final assessment categories 1-5 were compared between the 2D and tomosynthesis groups. The positive predictive values after biopsy (PPV3) for BI-RADS category 4 and 5 cases were compared. The mammographic features (masses, architectural distortions, calcifications, focal asymmetries) of lesions categorized as probably benign (BI-RADS category 3) and those for which biopsy was recommended (BI-RADS category 4 or 5) were reviewed. The χ(2) test was used to compare the rates of BI-RADS final assessment categories 1-5 between the two groups, and multivariate logistic regression analysis was performed to compare all diagnostic studies categorized as BI-RADS 3-5. Results There was an increase in the percentage of cases reported as negative or benign (BI-RADS category 1 or 2) with tomosynthesis (58.7% with 2D mammography vs 75.8% with tomosynthesis at year 3, P < .0001). A reduction in the percentage of probably benign (BI-RADS category 3) final assessments also occurred (33.3% with 2D mammography vs 16.4% with tomosynthesis at year 3, P < .0001). Although the rates of BI-RADS 4 or 5 assessments did not change significantly with tomosynthesis (8.0% with 2D mammography vs 7.8% with tomosynthesis at year 3, P = .2), there was a significant increase in the PPV3 (29.6% vs 50%, respectively; P < .0001). These trends increased during the 3 years of tomosynthesis use. Conclusion Tomosynthesis in the diagnostic setting resulted in progressive shifts in the BI-RADS final assessment categories over time, with a significant increase in the proportion of studies classified as normal, a continued decrease in the rate of studies categorized as probably benign, and improved diagnostic confidence in biopsy recommendations. (©) RSNA, 2016.

78 FR 11632 - Notice of Availability for the Draft Finding of No Significant Impact and Final Programmatic...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-19

... Significant Impact and Final Programmatic Environmental Assessment for Army 2020 Force Structure Realignment... Significant Impact (FNSI) and final Programmatic Environmental Assessment (PEA) for Army 2020 force structure realignments that may occur from Fiscal Years (FYs) 2013-2020. The Army published the Notice of Availability of...

Evidence for associated production of a Higgs boson with a top quark pair in final states with electrons, muons, and hadronically decaying $$\\tau$$ leptons at $$\\sqrt{s} =$$ 13 TeV

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

Sirunyan, Albert M; et al.

Results of a search for the standard model Higgs boson produced in association with a top quark pair (more » $$\\mathrm{t\\overline{t}}$$H) in final states with electrons, muons, and hadronically decaying $$\\tau$$ leptons are presented. The analyzed data set corresponds to an integrated luminosity of 35.9 fb$$^{-1}$$ recorded in proton-proton collisions at $$\\sqrt{s} =$$ 13 TeV by the CMS experiment in 2016. The sensitivity of the search is improved by using matrix element and machine learning methods to separate the signal from backgrounds. The measured signal rate amounts to 1.23$$^{+0.45}_{-0.43}$$ times the production rate expected in the standard model, with an observed (expected) significance of 3.2$$\\sigma$$ (2.8$$\\sigma$$), which represents evidence for $$\\mathrm{t\\overline{t}}$$H production in those final states. An upper limit on the signal rate of 2.1 times the standard model production rate is set at 95% confidence level.« less

Factor Analysis of Linear Type Traits and Their Relation with Longevity in Brazilian Holstein Cattle

PubMed Central

Kern, Elisandra Lurdes; Cobuci, Jaime Araújo; Costa, Cláudio Napolis; Pimentel, Concepta Margaret McManus

2014-01-01

In this study we aimed to evaluate the reduction in dimensionality of 20 linear type traits and more final score in 14,943 Holstein cows in Brazil using factor analysis, and indicate their relationship with longevity and 305 d first lactation milk production. Low partial correlations (−0.19 to 0.38), the medium to high Kaiser sampling mean (0.79) and the significance of the Bartlett sphericity test (p<0.001), indicated correlations between type traits and the suitability of these data for a factor analysis, after the elimination of seven traits. Two factors had autovalues greater than one. The first included width and height of posterior udder, udder texture, udder cleft, loin strength, bone quality and final score. The second included stature, top line, chest width, body depth, fore udder attachment, angularity and final score. The linear regression of the factors on several measures of longevity and 305 d milk production showed that selection considering only the first factor should lead to improvements in longevity and 305 milk production. PMID:25050015

Combining microwave resonance technology to multivariate data analysis as a novel PAT tool to improve process understanding in fluid bed granulation.

PubMed

Lourenço, Vera; Herdling, Thorsten; Reich, Gabriele; Menezes, José C; Lochmann, Dirk

2011-08-01

A set of 192 fluid bed granulation batches at industrial scale were in-line monitored using microwave resonance technology (MRT) to determine moisture, temperature and density of the granules. Multivariate data analysis techniques such as multiway partial least squares (PLS), multiway principal component analysis (PCA) and multivariate batch control charts were applied onto collected batch data sets. The combination of all these techniques, along with off-line particle size measurements, led to significantly increased process understanding. A seasonality effect could be put into evidence that impacted further processing through its influence on the final granule size. Moreover, it was demonstrated by means of a PLS that a relation between the particle size and the MRT measurements can be quantitatively defined, highlighting a potential ability of the MRT sensor to predict information about the final granule size. This study has contributed to improve a fluid bed granulation process, and the process knowledge obtained shows that the product quality can be built in process design, following Quality by Design (QbD) and Process Analytical Technology (PAT) principles. Copyright © 2011. Published by Elsevier B.V.

Elective course in acute care using online learning and patient simulation.

PubMed

Seybert, Amy L; Kane-Gill, Sandra L

2011-04-11

To enhance students' knowledge of and critical-thinking skills in the management of acutely ill patients using online independent learning partnered with high-fidelity patient simulation sessions. Students enrolled in the Acute Care Simulation watched 10 weekly Web-based video presentations on various critical care and advanced cardiovascular pharmacotherapy topics. After completing each online module, all students participated in groups in patient-care simulation exercises in which they prepared a pharmacotherapeutic plan for the patient, recommended this plan to the patient's physician, and completed a debriefing session with the facilitator. Students completed a pretest and posttest before and after each simulation exercise, as well as midterm and final evaluations and a satisfaction survey. Pharmacy students significantly improved their scores on 9 of the 10 tests (p ≤ 0.05). Students' performance on the final evaluation improved compared with performance on the midterm evaluation. Overall, students were satisfied with the unique dual approach to learning and enjoyed the realistic patient-care environment that the simulation laboratory provided. Participation in an elective course that combined self-directed Web-based learning and hands-on patient simulation exercises increased pharmacy students' knowledge and critical-thinking skills in acute care.

Watching Subtitled Films Can Help Learning Foreign Languages.

PubMed

Birulés-Muntané, J; Soto-Faraco, S

2016-01-01

Watching English-spoken films with subtitles is becoming increasingly popular throughout the world. One reason for this trend is the assumption that perceptual learning of the sounds of a foreign language, English, will improve perception skills in non-English speakers. Yet, solid proof for this is scarce. In order to test the potential learning effects derived from watching subtitled media, a group of intermediate Spanish students of English as a foreign language watched a 1h-long episode of a TV drama in its original English version, with English, Spanish or no subtitles overlaid. Before and after the viewing, participants took a listening and vocabulary test to evaluate their speech perception and vocabulary acquisition in English, plus a final plot comprehension test. The results of the listening skills tests revealed that after watching the English subtitled version, participants improved these skills significantly more than after watching the Spanish subtitled or no-subtitles versions. The vocabulary test showed no reliable differences between subtitled conditions. Finally, as one could expect, plot comprehension was best under native, Spanish subtitles. These learning effects with just 1 hour exposure might have major implications with longer exposure times.

VITRECTOMY FOR MACULAR RETINOSCHISIS WITHOUT A DETECTABLE OPTIC DISK PIT.

PubMed

Haruta, Masatoshi; Yamakawa, Ryoji

2017-05-01

To evaluate the efficacy of vitrectomy in the treatment of macular retinoschisis without a detectable optic disk pit. This retrospective interventional case series included eight patients with acquired, unilateral macular retinoschisis with or without foveal detachment. Patients with an optic disk pit, vitreomacular traction, or high myopia were excluded. Six of the eight patients underwent vitrectomy with internal limiting membrane peeling and fluid-air exchange. The surgical outcome was evaluated in terms of the improvement in the macular anatomy and the best-corrected visual acuity. During vitrectomy, all the six eyes were confirmed to have preexisting posterior vitreous detachment. Macular retinoschisis was resolved or reduced in all the six eyes after vitrectomy. The mean central foveal thickness showed significant improvement at the time of the patient's final visit after vitrectomy. The mean best-corrected visual acuity was 20/52 before surgery and 20/31 at the final visit. Vitrectomy might be effective for the treatment of macular retinoschisis without an optic disk pit. Although clinically similar to optic pit maculopathy except for the absence of pit, our intraoperative observations of the posterior hyaloid membrane suggest that maculopathy without optic disk pit has a distinct pathogenesis.

Watching Subtitled Films Can Help Learning Foreign Languages

PubMed Central

Birulés-Muntané, J.; Soto-Faraco, S.

2016-01-01

Watching English-spoken films with subtitles is becoming increasingly popular throughout the world. One reason for this trend is the assumption that perceptual learning of the sounds of a foreign language, English, will improve perception skills in non-English speakers. Yet, solid proof for this is scarce. In order to test the potential learning effects derived from watching subtitled media, a group of intermediate Spanish students of English as a foreign language watched a 1h-long episode of a TV drama in its original English version, with English, Spanish or no subtitles overlaid. Before and after the viewing, participants took a listening and vocabulary test to evaluate their speech perception and vocabulary acquisition in English, plus a final plot comprehension test. The results of the listening skills tests revealed that after watching the English subtitled version, participants improved these skills significantly more than after watching the Spanish subtitled or no-subtitles versions. The vocabulary test showed no reliable differences between subtitled conditions. Finally, as one could expect, plot comprehension was best under native, Spanish subtitles. These learning effects with just 1 hour exposure might have major implications with longer exposure times. PMID:27355343

Chemical Durability Improvement and Static Fatigue of Glasses.

DTIC Science & Technology

1982-08-01

Afl-Alla 837 RENSSELAER POLYIECmfJ!C INST TRtOY NY DEPT OF MATERIAL--ETC F/6 ii/ CHEMICAL DURABILITY IMPROVEMENT AND STATIC FATIGUE OF GLASSESW AUC2...82 M TOMOZAWA NOGGIN 7A-C-0315 UNC LASS IF IED N ENEEEEEE FINAL TECHNICAL REPORT For the period April 1, 1978 "u March 31, 198200 CHEMICAL DURABILITY...REPORT A PERIOD COVERED Chemical Durability Improvement and Static Final Technical Report Fatiue o GlasesApril 1, 1978"’,March 31, 1982 S. PERFORMING ORG

Olive fruits and vacuum impregnation, an interesting combination for dietetic iron enrichment.

PubMed

Zunin, Paola; Turrini, Federica; Leardi, Riccardo; Boggia, Raffaella

2017-02-01

In this study vacuum impregnation (VI) was employed for the iron enrichment of olive fruits, which are very interesting as food vehicle for VI mineral supplementation for the porosity of their pulp. NaFeEDTA was chosen for olives fortification since it prevents iron from binding with compounds that could hinder it from being efficiently absorbed and since it causes few organoleptic problems. In order to improve the efficiency of the VI process, several parameters of the whole process were studied by design of experiment techniques. First of all D-optimal design was employed for a preliminary screening of the most significant process variables and showed that the concentration of VI solution was by far the most significant process variable, though its time in contact with olives was also significant. A factorial design was then applied to the remaining variables and it showed that the speed of the addition of VI solution was also significant. Finally, the application of a face centered composite design to the three selected variables allowed to detect processing conditions leading to final iron contents of 1.5-3 mg/g, corresponding to an introduction of 10-15 mg Fe with four or five fortified olive fruits. No effect on olive taste was observed at these concentrations. The results showed that olive fruits were the most interesting vehicles for the supplementation of both iron and other minerals.

Solution-Based Approaches to Fabrication of YBa2Cu3O7-δ (YBCO): Precursors of Tri-Fluoroacetate (TFA) and Nanoparticle Colloids

NASA Astrophysics Data System (ADS)

Mukhopadhyay, S. M.; Su, J.; Chintamaneni, V.

2007-10-01

Detailed investigation of superconducting films of YBa2Cu3O7-δ (YBCO) prepared from solution-based precursors have been performed. Two precursors have been compared in this study: the presently used trifluoroacetate (TFA) solution and a recently developed colloidal suspension containing nanoparticles of mixed oxide. Detailed analyses of the evolution of microstructure and chemistry of the films have been performed, and process parameters have been correlated with final superconducting properties. Both films need two heating steps: a low temperature calcination and a higher temperature crystallization step. For TFA films, it was seen that the heating rate during calcination needs to be carefully optimized and is expected to be slow. For the alternate process using a nanoparticle precursor, a significantly faster calcination rate is possible. In the TFA process, the Ba ion remains as fluoride and the Y remains as oxyfluoride after calcination. This implies that, during the final crystallization stage to form YBCO, fluorine-containing gases will evolve, resulting in residual porosity. On the other hand, the film from the nanoparticle process is almost fully oxidized after calcination. Therefore, no gases evolve at the final firing (crystallization) stage, and the film has much lower porosity. The superconducting properties of both types of films are adequate, but the nanoparticle films appear to have persistently higher J c values. Moreover, they show improved flux pinning in higher magnetic fields, probably due to nanoscale precipitates of a Cu-rich phase. In addition, the nanocolloid films seem to show additionally enhanced flux pinning when doped with minute amounts of second phase precipitates. It therefore appears that, whereas the TFA process is already quite successful, the newly developed nanoparticle process has significant scope for additional improvement. It can be scaled-up with ease, and can be easily adapted to incorporate nanoscale flux pinning defects for in-field performance.

Extracellular space preservation aids the connectomic analysis of neural circuits

PubMed Central

Pallotto, Marta; Watkins, Paul V; Fubara, Boma; Singer, Joshua H; Briggman, Kevin L

2015-01-01

Dense connectomic mapping of neuronal circuits is limited by the time and effort required to analyze 3D electron microscopy (EM) datasets. Algorithms designed to automate image segmentation suffer from substantial error rates and require significant manual error correction. Any improvement in segmentation error rates would therefore directly reduce the time required to analyze 3D EM data. We explored preserving extracellular space (ECS) during chemical tissue fixation to improve the ability to segment neurites and to identify synaptic contacts. ECS preserved tissue is easier to segment using machine learning algorithms, leading to significantly reduced error rates. In addition, we observed that electrical synapses are readily identified in ECS preserved tissue. Finally, we determined that antibodies penetrate deep into ECS preserved tissue with only minimal permeabilization, thereby enabling correlated light microscopy (LM) and EM studies. We conclude that preservation of ECS benefits multiple aspects of the connectomic analysis of neural circuits. DOI: http://dx.doi.org/10.7554/eLife.08206.001 PMID:26650352

Model Studies on the Effectiveness of MBBR Reactors for the Restoration of Small Water Reservoirs

NASA Astrophysics Data System (ADS)

Nowak, Agata; Mazur, Robert; Panek, Ewa; Chmist, Joanna

2018-02-01

The authors present the Moving Bed Biofilm Reactor (MBBR) model with a quasi-continuous flow for small water reservoir restoration, characterized by high concentrations of organic pollutants. To determine the efficiency of wastewater treatment the laboratory analysis of physic-chemical parameters were conducted for the model on a semi-technical scale of 1:3. Wastewater treatment process was carried out in 24 h for 1 m3 for raw sewage. The startup period was 2 weeks for all biofilters (biological beds). Approximately 50% reduction in COD and BOD5 was obtained on average for the studied bioreactors. Significant improvements were achieved in theclarity of the treated wastewater, with the reduction of suspension by 60%. The oxygen profile has improved significantly in 7 to 9 hours of the process, and a diametric reduction in the oxidative reduction potential was recorded. A preliminary model of biological treatment effectiveness was determined based on the conducted studies. In final stages, the operation mode was set in real conditions of polluted water reservoirs.

Optimizing Dynamical Network Structure for Pinning Control

NASA Astrophysics Data System (ADS)

Orouskhani, Yasin; Jalili, Mahdi; Yu, Xinghuo

2016-04-01

Controlling dynamics of a network from any initial state to a final desired state has many applications in different disciplines from engineering to biology and social sciences. In this work, we optimize the network structure for pinning control. The problem is formulated as four optimization tasks: i) optimizing the locations of driver nodes, ii) optimizing the feedback gains, iii) optimizing simultaneously the locations of driver nodes and feedback gains, and iv) optimizing the connection weights. A newly developed population-based optimization technique (cat swarm optimization) is used as the optimization method. In order to verify the methods, we use both real-world networks, and model scale-free and small-world networks. Extensive simulation results show that the optimal placement of driver nodes significantly outperforms heuristic methods including placing drivers based on various centrality measures (degree, betweenness, closeness and clustering coefficient). The pinning controllability is further improved by optimizing the feedback gains. We also show that one can significantly improve the controllability by optimizing the connection weights.

Joint Development of a Fourth Generation Single Crystal Superalloy

NASA Technical Reports Server (NTRS)

Walston, S.; Cetel, A.; MacKay, R.; OHara, K.; Duhl, D.; Dreshfield, R.

2004-01-01

A new, fourth generation, single crystal superalloy has been jointly developed by GE Aircraft Engines, Pratt & Whitney, and NASA. The focus of the effort was to develop a turbine airfoil alloy with long-term durability for use in the High Speed Civil Transport. In order to achieve adequate long-time strength improvements at moderate temperatures and retain good microstructural stability, it was necessary to make significant composition changes from 2nd and 3rd generation single crystal superalloys. These included lower chromium levels, higher cobalt and rhenium levels and the inclusion of a new alloying element, ruthenium. It was found that higher Co levels were beneficial to reducing both TCP precipitation and SRZ formation. Ruthenium caused the refractory elements to partition more strongly to the ' phase, which resulted in better overall alloy stability. The final alloy, EPM 102, had significant creep rupture and fatigue improvements over the baseline production alloys and had acceptable microstructural stability. The alloy is currently being engine tested and evaluated for advanced engine applications.

Pelvic Floor Muscle Exercise for Paediatric Functional Constipation.

PubMed

Farahmand, Fatemeh; Abedi, Aidin; Esmaeili-Dooki, Mohammad Reza; Jalilian, Rozita; Tabari, Sanaz Mehrabani

2015-06-01

Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. In this study which was conducted in Children's Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC.

Effect of Terminal Modification on the Molecular Assembly and Mechanical Properties of Protein-Based Block Copolymers.

PubMed

Jacobsen, Matthew M; Tokareva, Olena S; Ebrahimi, Davoud; Huang, Wenwen; Ling, Shengjie; Dinjaski, Nina; Li, David; Simon, Marc; Staii, Cristian; Buehler, Markus J; Kaplan, David L; Wong, Joyce Y

2017-09-01

Accurate prediction and validation of the assembly of bioinspired peptide sequences into fibers with defined mechanical characteristics would aid significantly in designing and creating materials with desired properties. This process may also be utilized to provide insight into how the molecular architecture of many natural protein fibers is assembled. In this work, computational modeling and experimentation are used in tandem to determine how peptide terminal modification affects a fiber-forming core domain. Modeling shows that increased terminal molecular weight and hydrophilicity improve peptide chain alignment under shearing conditions and promote consolidation of semicrystalline domains. Mechanical analysis shows acute improvements to strength and elasticity, but significantly reduced extensibility and overall toughness. These results highlight an important entropic function that terminal domains of fiber-forming peptides exhibit as chain alignment promoters, which ultimately has notable consequences on the mechanical behavior of the final fiber products. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Intra-articular treatment of rheumatoid knee-joint effusion with triamcinolone hexacetonide versus sodium morrhuate. A prospective study.

PubMed

Menninger, H; Reinhardt, S; Söndgen, W

1994-01-01

Thirty-one patients with knee effusions associated with rheumatoid arthritis (RA) have been treated with two intraarticular (i.a.) injections of each 330 mg sodium morrhuate (SM) used for synoviorthesis versus a single injection of 20 mg triamcinolone hexacetonide (TA). During an observation period of one year, five articular parameters as well as patient's and doctor's global assessments were evaluated. TA showed an earlier onset and a longer duration of therapeutic effects with high statistical significance. The maximum improvement was significantly more pronounced with TA than with SM. Finally after one year improvement measured by a remission index was observed in 81% versus 33% resp. of all joints injected. Due to ineffectiveness of the primary treatment nine patients (60%) out of the SM group, but not patient out of the TA group had to be crossed over to the other treatment. SM usually caused a reactive effusion within hours after injection requiring arthrocentesis. In conclusion efficacy and tolerability are clearly better for TA than for SM.

The Mechanism of Ultrasonic Vibration on Grain Refining and Degassing in GTA Spot Welding of Copper Joints.

PubMed

Al-Ezzi, Salih; Quan, Gaofeng; Elrayah, Adil

2018-05-07

This paper examines the effect of ultrasonic vibration (USV) on grain size and interrupted porosity in Gas Tungsten Arc (GTA) spot-welded copper. Grain size was refined by perpendicularly attaching a transducer to the welded sheet and applying USV to the weld pool for a short time (0, 2, 4, and 6 s) in addition improvements to the degassing process. Results illustrate a significant reduction of grain size (57%). Notably, USV provided interaction between reformations (fragmentation) and provided nucleation points (detaching particles from the fusion line) for grains in the nugget zone and the elimination of porosity in the nugget zone. The GTA spot welding process, in conjunction with USV, demonstrated an improvement in the corrosion potential for a copper spot-welded joint in comparison to the joint welded without assistance of USV. Finally, welding of copper by GTA spot welding in conjunction with ultrasound for 2 s presented significant mechanical properties.

The Mechanism of Ultrasonic Vibration on Grain Refining and Degassing in GTA Spot Welding of Copper Joints

PubMed Central

Quan, Gaofeng

2018-01-01

This paper examines the effect of ultrasonic vibration (USV) on grain size and interrupted porosity in Gas Tungsten Arc (GTA) spot-welded copper. Grain size was refined by perpendicularly attaching a transducer to the welded sheet and applying USV to the weld pool for a short time (0, 2, 4, and 6 s) in addition improvements to the degassing process. Results illustrate a significant reduction of grain size (57%). Notably, USV provided interaction between reformations (fragmentation) and provided nucleation points (detaching particles from the fusion line) for grains in the nugget zone and the elimination of porosity in the nugget zone. The GTA spot welding process, in conjunction with USV, demonstrated an improvement in the corrosion potential for a copper spot-welded joint in comparison to the joint welded without assistance of USV. Finally, welding of copper by GTA spot welding in conjunction with ultrasound for 2 s presented significant mechanical properties. PMID:29735894

ENERGY EFFICIENCY UPGRADES FOR SANITATION FACILITIES IN SELAWIK, AK FINAL REPORT

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

POLLIS, REBECCA

2014-10-17

The Native Village of Selawik is a federally recognized Alaskan tribe, located at the mouth of the Selawik River, about 90 miles east of Kotzebue in northwest Alaska. Due to the community’s rural location and cold climate, it is common for electric rates to be four times higher than the cost urban residents pay. These high energy costs were the driving factor for Selawik pursuing funding from the Department of Energy in order to achieve significant energy cost savings. The main objective of the project was to improve the overall energy efficiency of the water treatment/distribution and sewer collection systemsmore » in Selawik by implementing the retrofit measures identified in a previously conducted utility energy audit. One purpose for the proposed improvements was to enable the community to realize significant savings associated with the cost of energy. Another purpose of the upgrades was to repair the vacuum sewer system on the west side of Selawik to prevent future freeze-up problems during winter months.« less

Long-term effects of user preference-oriented recommendation method on the evolution of online system

NASA Astrophysics Data System (ADS)

Shi, Xiaoyu; Shang, Ming-Sheng; Luo, Xin; Khushnood, Abbas; Li, Jian

2017-02-01

As the explosion growth of Internet economy, recommender system has become an important technology to solve the problem of information overload. However, recommenders are not one-size-fits-all, different recommenders have different virtues, making them be suitable for different users. In this paper, we propose a novel personalized recommender based on user preferences, which allows multiple recommenders to exist in E-commerce system simultaneously. We find that output of a recommender to each user is quite different when using different recommenders, the recommendation accuracy can be significantly improved if each user is assigned with his/her optimal personalized recommender. Furthermore, different from previous works focusing on short-term effects on recommender, we also evaluate the long-term effect of the proposed method by modeling the evolution of mutual feedback between user and online system. Finally, compared with single recommender running on the online system, the proposed method can improve the accuracy of recommendation significantly and get better trade-offs between short- and long-term performances of recommendation.

Maintenance of improved lipid levels following attendance at a cardiovascular risk reduction clinic: a 10-year experience

PubMed Central

Pearson, Glen J; Olson, Kari L; Panich, Nicole E; Majumdar, Sumit R; Tsuyuki, Ross T; Gilchrist, Dawna M; Damani, Ali; Francis, Gordon A

2008-01-01

Background: Specialty cardiovascular risk reduction clinics (CRRC) increase the proportion of patients attaining recommended lipid targets; however, it is not known if the benefits are sustained after discharge. We evaluated the impact of a CRRC on lipid levels and assessed the long-term effect of a CRRC in maintaining improved lipid levels following discharge. Methods: The medical records of consecutive dyslipidemic patients discharged ×6 months from a tertiary hospital CRRC from January 1991 to January 2001 were retrospectively reviewed. The primary outcome was the change in patients’ lipid levels between the final CRRC visit and the most recent primary care follow-up. A worst-case analysis was conducted to evaluate the potential impact of the patients in whom the follow-up lipid profiles post-discharge from the CRRC were not obtained. Results: Within the CRRC (median follow-up = 1.28 years in 1064 patients), we observed statistically significant improvements in all lipid parameters. In the 411 patients for whom post-discharge lipid profiles were available (median follow-up = 2.41 years), there were no significant differences observed in low-density lipoprotein-cholesterol, total cholesterol (TC), or triglycerides since CRRC discharge; however, there were small improvements in high-density lipoprotein-cholesterol (HDL-C) and TC:HDL ratio (p < 0.05 for both). The unadjusted worst-case analysis (653 patients with no follow-up lipid profiles) demonstrated statistically significant worsening of all lipid parameters between CRRC discharge and the most recent follow-up. However, when the change in lipid parameters between the baseline and the most recent follow-up was assessed in this analysis, the changes in all lipid parameters were significantly improved (p < 0.05). Conclusions: This study demonstrates that a CRRC can improve lipid levels and suggests that these benefits are sustained once patients are returned to the care of their primary physician. PMID:19183763

Parentally-adjusted deficit of height as a prognostic factor of the effectiveness of growth hormone (GH) therapy in children with GH deficiency.

PubMed

Hilczer, Maciej; Smyczyńska, Joanna; Lewiński, Andrzej

2006-01-01

Parental height is the most important identifiable factor influencing final height (FH) of children with growth hormone (GH) deficiency (GHD), treated with GH. Assessment of FH of patients with GHD--classified into familial short stature (FSS) and non-familial short stature (non-FSS) according to parentally adjusted deficit of height. The analysis comprised 101 patients (76 boys) with childhood-onset GHD. Final height was compared with patients' height before GH therapy, predicted adult height (PAH) and target height (TH). Both GH peak in stimulating tests and height standard deviation score (SDS) before the therapy were significantly lower in non-FSS than in FSS. Target height was significantly lower in FSS than in non-FSS. Parentally-adjusted deficit of height was significantly more profound in non-FSS than in FSS. The prognosis of adult height was very similar in both groups of patients, being significantly worse in non-FSS than in FSS while corrected by TH. The absolute FH was similar in FSS and non-FSS, being, however, significantly lower in non-FSS than in FSS while corrected by TH. Improvement of height was significantly better in non-FSS than in FSS. In both groups, FH SDS was significantly better than height SDS before the therapy (H0SDS). In FSS group, PAH was similar to TH, moreover, FH corresponded to both PAH and TH. In non-FSS group FH was significantly higher than PAH, but both FH and PAH were significantly lower than TH. 1) Growth hormone therapy was more effective in the patients with non-FSS than in those with FSS. 2) Parentally-adjusted deficit of height is an important prognostic factor of GH therapy effectiveness.

Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: a confocal microscopic study.

PubMed

Akcay, Merve; Arslan, Hakan; Mese, Merve; Durmus, Nazlı; Capar, Ismail Davut

2017-09-01

The aim of this in vitro study was to evaluate the efficacy of different irrigation techniques including laser-activated irrigation using an erbium:yttrium-aluminum-garnet (Er:YAG) laser with a novel tip design (photon-induced photoacoustic streaming (PIPS)), Er:YAG laser with Preciso tip, sonic activation, and passive ultrasonic activation on the final irrigation solution penetration into dentinal tubules by using a laser scanning confocal microscope. In this study, 65 extracted single-rooted human mandibular premolars were instrumented up to size 40 and randomly divided into 5 groups (n = 13) based on the activation technique of the final irrigation solution as follows: conventional irrigation (control group), sonic activation, passive ultrasonic activation, Er:YAG-PIPS tip activation, and Er:YAG-Preciso tip activation. In each group, 5 mL of 5% NaOCl labeled with fluorescent dye was used during the activation as the final irrigation solution. Specimens were sectioned at 2.5 and 8 mm from the apex and then examined under a confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc tests (P = 0.05). Both Er:YAG laser (Preciso/PIPS) activations exhibited a significantly higher penetration area than the other groups (P < 0.05). Additionally, passive ultrasonic activation had significantly higher penetration than the sonic activation group and the control group. Statistically significant differences were also found between each root canal third (coronal > middle > apical) (P < 0.001). The results from the present study support the use of Er:YAG laser activation (Preciso/PIPS) to improve the effectiveness of the final irrigation procedure by increasing the irrigant penetration area into the dentinal tubules. The activation of the irrigant and the creation of the streaming with the Er:YAG laser have a positive effect on the irrigant penetration.

Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon.

PubMed

Kengne, Andre Pascal; Fezeu, Leopold; Sobngwi, Eugene; Awah, Paschal Kum; Aspray, Terence J; Unwin, Nigel C; Mbanya, Jean-Claude

2009-08-01

To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon. We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits. The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight. Nurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.

The Wind Forecast Improvement Project (WFIP): A Public/Private Partnership for Improving Short Term Wind Energy Forecasts and Quantifying the Benefits of Utility Operations. The Southern Study Area, Final Report

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

Freedman, Jeffrey M.; Manobianco, John; Schroeder, John

This Final Report presents a comprehensive description, findings, and conclusions for the Wind Forecast Improvement Project (WFIP) -- Southern Study Area (SSA) work led by AWS Truepower (AWST). This multi-year effort, sponsored by the Department of Energy (DOE) and National Oceanographic and Atmospheric Administration (NOAA), focused on improving short-term (15-minute - 6 hour) wind power production forecasts through the deployment of an enhanced observation network of surface and remote sensing instrumentation and the use of a state-of-the-art forecast modeling system. Key findings from the SSA modeling and forecast effort include: 1. The AWST WFIP modeling system produced an overall 10more » - 20% improvement in wind power production forecasts over the existing Baseline system, especially during the first three forecast hours; 2. Improvements in ramp forecast skill, particularly for larger up and down ramps; 3. The AWST WFIP data denial experiments showed mixed results in the forecasts incorporating the experimental network instrumentation; however, ramp forecasts showed significant benefit from the additional observations, indicating that the enhanced observations were key to the model systems’ ability to capture phenomena responsible for producing large short-term excursions in power production; 4. The OU CAPS ARPS simulations showed that the additional WFIP instrument data had a small impact on their 3-km forecasts that lasted for the first 5-6 hours, and increasing the vertical model resolution in the boundary layer had a greater impact, also in the first 5 hours; and 5. The TTU simulations were inconclusive as to which assimilation scheme (3DVAR versus EnKF) provided better forecasts, and the additional observations resulted in some improvement to the forecasts in the first 1 - 3 hours.« less

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation.

PubMed

Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

2014-08-01

The Kabeho Mwana project (2006-2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.

Functional Outcomes Following Anterior Transfer of the Tibialis Posterior Tendon for Foot Drop Secondary to Peroneal Nerve Palsy.

PubMed

Cho, Byung-Ki; Park, Kyoung-Jin; Choi, Seung-Myung; Im, Se-Hyuk; SooHoo, Nelson F

2017-06-01

This retrospective comparative study reports the practical function in daily and sports activities after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Seventeen patients were followed for a minimum of 3 years after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Matched controls were used to evaluate the level of functional restoration. Functional evaluations included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) scores, and isokinetic muscle strength test. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, hindfoot alignment angle, and navicular height. Mean AOFAS, FAOS, and FAAM scores significantly improved from 65.1 to 86.2, 55.6 to 87.8, and 45.7 to 84.4 points at final follow-up, respectively. However, all functional evaluation scores were significantly lower as compared to the control group ( P < .001). Mean peak torque (60 degrees/sec) of ankle dorsiflexors, plantarflexors, invertors, and evertors at final follow-up were 7.1 (deficit ratio of 65.4%), 39.2, 9.8, and 7.3 Nm, respectively. These muscle strengths were significantly lower compared to the control group ( P < .001). No significant differences in radiographic measurements were found, and no patients presented with a postoperative flat foot deformity. One patient (5.9%) needed an ankle-foot orthosis for occupational activity. Anterior transfer of the tibialis posterior tendon appears to be an effective surgical option for paralytic foot drop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of the normal ankle, function in daily activities and gait ability were satisfactorily improved. In addition, tibialis posterior tendon transfer demonstrated no definitive radiographic or clinical progression to postoperative flat foot deformity at intermediate-term follow-up. Level IV, retrospective case series.

Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis.

PubMed

Diniz, Juliete M; Botelho, Ricardo V

2017-11-01

OBJECTIVE Thoracolumbar fractures account for 90% of spinal fractures, with the burst subtype corresponding to 20% of this total. Controversy regarding the best treatment for this condition remains. The traditional surgical approach, when indicated, involves spinal fixation and arthrodesis. Newer studies have brought the need for fusion associated with internal fixation into question. Not performing arthrodesis could reduce surgical time and intraoperative bleeding without affecting clinical and radiological outcomes. With this study, the authors aimed to assess the effect of fusion, adjuvant to internal fixation, on surgically treated thoracolumbar burst fractures. METHODS A search of the Medline and Cochrane Central Register of Controlled Trials databases was performed to identify randomized trials that compared the use and nonuse of arthrodesis in association with internal fixation for the treatment of thoracolumbar burst fractures. The search encompassed all data in these databases up to February 28, 2016. RESULTS Five randomized/quasi-randomized trials, which involved a total of 220 patients and an average follow-up time of 69.1 months, were included in this review. No significant difference between groups in the final scores of the visual analog pain scale or Low Back Outcome Scale was detected. Surgical time and blood loss were significantly lower in the group of patients who did not undergo fusion (p < 0.05). Among the evaluated radiological outcomes, greater mobility in the affected segment was found in the group of those who did not undergo fusion. No significant difference between groups in the degree of kyphosis correction, loss of kyphosis correction, or final angle of kyphosis was observed. CONCLUSIONS The data reviewed in this study suggest that the use of arthrodesis did not improve clinical outcomes, but it was associated with increased surgical time and higher intraoperative bleeding and did not promote significant improvement in radiological parameters.

Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

PubMed

Lee, Sung Hyun; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Se Jin; Park, Jin Sung

2017-07-01

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p < 0.05 for all scores). The retear rate of small-to-medium tears was similar in the modified tension band and suture bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

Light-duty vehicle greenhouse gas emission standards and corporate average fuel economy standards : final rule

DOT National Transportation Integrated Search

2010-05-07

Final Rule to establish a National Program consisting of new standards for light-duty vehicles that will reduce greenhouse gas emissions and improve fuel economy. This joint : Final Rule is consistent with the National Fuel Efficiency Policy announce...

Final priority; technical assistance to improve state data capacity--National Technical Assistance Center to improve state capacity to accurately collect and report IDEA data. Final priority.

PubMed

2013-05-20

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Technical Assistance to Improve State Data Capacity program. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2013 and later years. We take this action to focus attention on an identified national need to provide technical assistance (TA) to States to improve their capacity to meet the data collection and reporting requirements of the Individuals with Disabilities Education Act (IDEA). We intend this priority to establish a TA center to improve State capacity to accurately collect and report IDEA data (Data Center).

Training driving ability in a traumatic brain-injured individual using a driving simulator: a case report.

PubMed

Imhoff, Sarah; Lavallière, Martin; Germain-Robitaille, Mathieu; Teasdale, Normand; Fait, Philippe

2017-01-01

Traumatic brain injury (TBI) causes functional deficits that may significantly interfere with numerous activities of daily living such as driving. We report the case of a 20-year-old woman having lost her driver's license after sustaining a moderate TBI. We aimed to evaluate the effectiveness of an in-simulator training program with automated feedback on driving performance in a TBI individual. The participant underwent an initial and a final in-simulator driving assessment and 11 in-simulator training sessions with driving-specific automated feedbacks. Driving performance (simulation duration, speed regulation and lateral positioning) was measured in the driving simulator. Speeding duration decreased during training sessions from 1.50 ± 0.80 min (4.16 ± 2.22%) to 0.45 ± 0.15 min (0.44 ± 0.42%) but returned to initial duration after removal of feedbacks for the final assessment. Proper lateral positioning improved with training and was maintained at the final assessment. Time spent in an incorrect lateral position decreased from 18.85 min (53.61%) in the initial assessment to 1.51 min (4.64%) on the final assessment. Driving simulators represent an interesting therapeutic avenue. Considerable research efforts are needed to confirm the effectiveness of this method for driving rehabilitation of individuals who have sustained a TBI.

Clinical Comparison of Two Methods of Graft Preparation in Descemet Membrane Endothelial Keratoplasty.

PubMed

Rickmann, Annekatrin; Opitz, Natalia; Szurman, Peter; Boden, Karl Thomas; Jung, Sascha; Wahl, Silke; Haus, Arno; Damm, Lara-Jil; Januschowski, Kai

2018-01-01

Descemet membrane endothelial keratoplasty (DMEK) has been improved over the last decade. The aim of this study was to compare the clinical outcome of the recently introduced liquid bubble method compared to the standard manual preparation. This retrospective study evaluated the outcome of 200 patients after DMEK surgery using two different graft preparation techniques. Ninety-six DMEK were prepared by manual dissection and 104 by the novel liquid bubble technique. The mean follow-up time was 13.7 months (SD ± 8, range 6-36 months). Best corrected mean visual acuity (BCVA) increased for all patients statistically significant from baseline 0.85 logMAR (SD ± 0.5) to 0.26 logMAR (SD ± 0.27) at the final follow-up (Wilcoxon, p = 0.001). Subgroup analyses of BCVA at the final follow-up between manual dissection and liquid bubble preparation showed no statistically significant difference (Mann-Whitney U Test, p = 0.64). The mean central corneal thickness was not statistically different (manual dissection: 539 µm, SD ± 68 µm and liquid bubble technique: 534 µm, SD ± 52 µm,) between the two groups (Mann-Whitney U Test, p = 0.64). At the final follow-up, mean endothelial cell count of donor grafts was statistically not significant different at the final follow-up with 1761 cells/mm 2 (-30.7%, SD ± 352) for manual dissection compared to liquid bubble technique with 1749 cells/mm 2 (-29.9%, SD ± 501) (Mann-Whitney U-Test, p = 0.73). The re-DMEK rate was comparable for manual dissection with 8 cases (8.3%) and 7 cases (6.7%) for liquid bubble dissection (p = 0.69, Chi-Square Test). Regarding the clinical outcome, we did not find a statistical significant difference between manual dissection and liquid bubble graft preparation. Both preparation techniques lead to an equivalent clinical outcome after DMEK surgery.

An Informed Approach to Improving Quantitative Literacy and Mitigating Math Anxiety in Undergraduates Through Introductory Science Courses

NASA Astrophysics Data System (ADS)

Follette, K.; McCarthy, D.

2012-08-01

Current trends in the teaching of high school and college science avoid numerical engagement because nearly all students lack basic arithmetic skills and experience anxiety when encountering numbers. Nevertheless, such skills are essential to science and vital to becoming savvy consumers, citizens capable of recognizing pseudoscience, and discerning interpreters of statistics in ever-present polls, studies, and surveys in which our society is awash. Can a general-education collegiate course motivate students to value numeracy and to improve their quantitative skills in what may well be their final opportunity in formal education? We present a tool to assess whether skills in numeracy/quantitative literacy can be fostered and improved in college students through the vehicle of non-major introductory courses in astronomy. Initial classroom applications define the magnitude of this problem and indicate that significant improvements are possible. Based on these initial results we offer this tool online and hope to collaborate with other educators, both formal and informal, to develop effective mechanisms for encouraging all students to value and improve their skills in basic numeracy.

Efficiency improvements of offline metrology job creation

NASA Astrophysics Data System (ADS)

Zuniga, Victor J.; Carlson, Alan; Podlesny, John C.; Knutrud, Paul C.

1999-06-01

Progress of the first lot of a new design through the production line is watched very closely. All performance metrics, cycle-time, in-line measurement results and final electrical performance are critical. Rapid movement of this lot through the line has serious time-to-market implications. Having this material waiting at a metrology operation for an engineer to create a measurement job plan wastes valuable turnaround time. Further, efficient use of a metrology system is compromised by the time required to create and maintain these measurement job plans. Thus, having a method to develop metrology job plans prior to the actual running of the material through the manufacture area can significantly improve both cycle time and overall equipment efficiency. Motorola and Schlumberger have worked together to develop and test such a system. The Remote Job Generator (RJG) created job plans for new device sin a manufacturing process from an NT host or workstation, offline. This increases available system tim effort making production measurements, decreases turnaround time on job plan creation and editing, and improves consistency across job plans. Most importantly this allows job plans for new devices to be available before the first wafers of the device arrive at the tool for measurement. The software also includes a database manager which allows updates of existing job plans to incorporate measurement changes required by process changes or measurement optimization. This paper will review the result of productivity enhancements through the increased metrology utilization and decreased cycle time associated with the use of RJG. Finally, improvements in process control through better control of Job Plans across different devices and layers will be discussed.

Improving the treatment planning and delivery process of Xoft electronic skin brachytherapy.

PubMed

Manger, Ryan; Rahn, Douglas; Hoisak, Jeremy; Dragojević, Irena

2018-05-14

To develop an improved Xoft electronic skin brachytherapy process and identify areas of further improvement. A multidisciplinary team conducted a failure modes and effects analysis (FMEA) by developing a process map and a corresponding list of failure modes. The failure modes were scored for their occurrence, severity, and detectability, and a risk priority number (RPN) was calculated for each failure mode as the product of occurrence, severity, and detectability. Corrective actions were implemented to address the higher risk failure modes, and a revised process was generated. The RPNs of the failure modes were compared between the initial process and final process to assess the perceived benefits of the corrective actions. The final treatment process consists of 100 steps and 114 failure modes. The FMEA took approximately 20 person-hours (one physician, three physicists, and two therapists) to complete. The 10 most dangerous failure modes had RPNs ranging from 336 to 630. Corrective actions were effective at addressing most failure modes (10 riskiest RPNs ranging from 189 to 310), yet the RPNs were higher than those published for alternative systems. Many of these high-risk failure modes remained due to hardware design limitations. FMEA helps guide process improvement efforts by emphasizing the riskiest steps. Significant risks are apparent when using a Xoft treatment unit for skin brachytherapy due to hardware limitations such as the lack of several interlocks, a short source lifespan, and variability in source output. The process presented in this article is expected to reduce but not eliminate these risks. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Polydatin administration improves serum biochemical parameters and oxidative stress markers during chronic alcoholism: a pilot study.

PubMed

Pace, Maria Caterina; Passavanti, Maria Beatrice; Aurilio, Caterina; Sansone, Pasquale; Aurilio, Rossella; DE Maria, Salvatore; Lama, Stefania; Federico, Alessandro; Ravagnan, Gianpietro; Caraglia, Michele; Stiuso, Paola

2015-01-01

Polydatin, a hydroxystilbene derived from the rhizome of Polygonum cuspidatum, elicits hepatoprotective and neuroprotective effects through its anti-oxidant properties. The present study aimed to determine the effects of oral administration of polydatin in alcoholic patients in order to improve liver biochemical parameters, serum oxidative stress and mental state. We enrolled 20 chronic alcoholic patients hospitalized for rehabilitative therapy. The patients were divided into two groups receiving the following treatment regimes for two weeks: administration of an anti-oxidant nutritional supplement containing glutathione and vitamin C (group 1), or glutathione, vitamin C and polydatin (group 2). The results of the present study show that elevated plasma aspartate aminotransferase and alanine aminotransferase levels in patients after two weeks of alcohol withdrawal were significantly reduced by polydatin (group 2), when compared to group 1. Polydatin also significantly reduced lipid peroxidation levels. Finally, our preliminary data resulting from the analysis of the Mini-Mental Status suggest that polydatin improves cognitive performance. Daily dietary administration of polydatin should be considered for prevention and treatment of liver disease and cognitive impairment in alcoholic patients. Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Engineering of Neuron Growth and Enhancing Cell-Chip Communication via Mixed SAMs.

PubMed

Markov, Aleksandr; Maybeck, Vanessa; Wolf, Nikolaus; Mayer, Dirk; Offenhäusser, Andreas; Wördenweber, Roger

2018-06-06

The interface between cells and inorganic surfaces represents one of the key elements for bioelectronics experiments and applications ranging from cell cultures and bioelectronics devices to medical implants. In the present paper, we describe a way to tailor the biocompatibility of substrates in terms of cell growth and to significantly improve cell-chip communication, and we also demonstrate the reusability of the substrates for cell experiments. All these improvements are achieved by coating the substrates or chips with a self-assembled monolayer (SAM) consisting of a mixture of organic molecules, (3-aminopropyl)-triethoxysilane and (3-glycidyloxypropyl)-trimethoxysilane. By varying the ratio of these molecules, we are able to tune the cell density and live/dead ratios of rat cortical neurons cultured directly on the mixed SAM as well as neurons cultured on protein-coated SAMs. Furthermore, the use of the SAM leads to a significant improvement in cell-chip communications. Action potential signals of up to 9.4 ± 0.6 mV (signal-to-noise ratio up to 47) are obtained for HL-1 cells on microelectrode arrays. Finally, we demonstrate that the SAMs facilitate a reusability of the samples for all cell experiments with little re-processing.

Manipulation of follicle development to ensure optimal oocyte quality and conception rates in cattle.

PubMed

Baruselli, P S; Sá Filho, M F; Ferreira, R M; Sales, J N S; Gimenes, L U; Vieira, L M; Mendanha, M F; Bó, G A

2012-08-01

Over the last several decades, a number of therapies have been developed that manipulate ovarian follicle growth to improve oocyte quality and conception rates in cattle. Various strategies have been proposed to improve the responses to reproductive biotechnologies following timed artificial insemination (TAI), superovulation (SOV) or ovum pickup (OPU) programmes. During TAI protocols, final follicular growth and size of the ovulatory follicle are key factors that may significantly influence oocyte quality, ovulation, the uterine environment and consequently pregnancy outcomes. Progesterone concentrations during SOV protocols influence follicular growth, oocyte quality and embryo quality; therefore, several adjustments to SOV protocols have been proposed depending on the animal category and breed. In addition, the success of in vitro embryo production is directly related to the number and quality of cumulus oocyte complexes harvested by OPU. Control of follicle development has a significant impact on the OPU outcome. This article discusses a number of key points related to the manipulation of ovarian follicular growth to maximize oocyte quality and improve conception rates following TAI and embryo transfer of in vivo- and in vitro-derived embryos in cattle. © 2012 Blackwell Verlag GmbH.

Evaluation of cage designs and feeding regimes for honey bee (Hymenoptera: Apidae) laboratory experiments.

PubMed

Huang, Shao Kang; Csaki, Tamas; Doublet, Vincent; Dussaubat, Claudia; Evans, Jay D; Gajda, Anna M; Gregorc, Alex; Hamilton, Michele C; Kamler, Martin; Lecocq, Antoine; Muz, Mustafa N; Neumann, Peter; Ozkirim, Asli; Schiesser, Aygün; Sohr, Alex R; Tanner, Gina; Tozkar, Cansu Ozge; Williams, Geoffrey R; Wu, Lyman; Zheng, Huoqing; Chen, Yan Ping

2014-02-01

The aim of this study was to improve cage systems for maintaining adult honey bee (Apis mellifera L.) workers under in vitro laboratory conditions. To achieve this goal, we experimentally evaluated the impact of different cages, developed by scientists of the international research network COLOSS (Prevention of honey bee COlony LOSSes), on the physiology and survival of honey bees. We identified three cages that promoted good survival of honey bees. The bees from cages that exhibited greater survival had relatively lower titers of deformed wing virus, suggesting that deformed wing virus is a significant marker reflecting stress level and health status of the host. We also determined that a leak- and drip-proof feeder was an integral part of a cage system and a feeder modified from a 20-ml plastic syringe displayed the best result in providing steady food supply to bees. Finally, we also demonstrated that the addition of protein to the bees' diet could significantly increase the level ofvitellogenin gene expression and improve bees' survival. This international collaborative study represents a critical step toward improvement of cage designs and feeding regimes for honey bee laboratory experiments.

Employing overlayers to improve the performance of Cu 2BaSnS 4 thin film based photoelectrochemical water reduction devices

DOE PAGES

Ge, Jie; Roland, Paul J.; Koirala, Prakash; ...

2017-01-19

Earth-abundant copper-barium-thiostannate Cu 2BaSnS 4 (CBTS)-based thin films have recently been reported to exhibit the optoelectronic and defect properties suitable as absorbers for photoelectrochemical (PEC) water splitting and the top cell of tandem photovoltaic solar cells. However, the photocurrents of CBTS-based PEC devices are still much lower than the theoretical value, partially due to ineffective charge collection at CBTS/water interface and instability of CBTS in electrolytes. Here, we report on overcoming these issues by employing overlayer engineering. We find that CdS/ZnO/TiO 2 overlayers can significant-ly improve the PEC performance, achieving saturated cathodic photocurrents up to 7.8 mA cm -2 atmore » the potential of -0.10 V versus reversible hydrogen electrode (RHE) in a neutral electrolyte solution, which is much higher than the best bare CBTS film attaining a photocurrent of 4.8 mA cm -2 at the potential of -0.2 V versus RHE. Finally, our results suggest a viable approach for improving the performance of CBTS-based PEC cells.« less

Waste-Activated Sludge Fermentation for Polyacrylamide Biodegradation Improved by Anaerobic Hydrolysis and Key Microorganisms Involved in Biological Polyacrylamide Removal.

PubMed

Dai, Xiaohu; Luo, Fan; Zhang, Dong; Dai, Lingling; Chen, Yinguang; Dong, Bin

2015-07-06

During the anaerobic digestion of dewatered sludge, polyacrylamide (PAM), a chemical conditioner, can usually be consumed as a carbon and nitrogen source along with other organic matter (e.g., proteins and carbohydrates in the sludge). However, a significant accumulation of acrylamide monomers (AMs) was observed during the PAM biodegradation process. To improve the anaerobic hydrolysis of PAM, especially the amide hydrolysis process, and to avoid the generation of the intermediate product AM, a new strategy is reported herein that uses an initial pH of 9, 200 mg COD/L of PAM and a fermentation time of 17 d. First, response surface methodology (RSM) was applied to optimize PAM removal in the anaerobic digestion of the sludge. The biological hydrolysis of PAM reached 86.64% under the optimal conditions obtained from the RSM. Then, the mechanisms for the optimized parameters that significantly improved the biological hydrolysis of PAM were investigated by the synergistic effect of the main organic compounds in the sludge, the floc size distribution, and the enzymatic activities. Finally, semi-continuous-flow experiments for a microbial community study were investigated based on the determination of key microorganisms involved in the biological hydrolysis of PAM.

Lignin Sulfonation and SO2 Addition Enhance the Hydrolyzability of Deacetylated and Then Steam-Pretreated Poplar with Reduced Inhibitor Formation.

PubMed

Tang, Yong; Dou, Xiaoli; Hu, Jinguang; Jiang, Jianxin; Saddler, Jack N

2018-01-01

The merit of deacetylation of corn stover prior to pretreatment is decreasing the formation of inhibitors and improving enzyme hydrolysis, proved in dilute acid pretreatment. However, few studies are done on how deacetylation would affect bioconversion process containing steam explosion. In this study, the effect of deacetylation on steam explosion was conducted using poplar as substrate. About 57 to 90% of acetyl group in poplar, depending on alkaline types and concentration, was removed by dilute alkaline deacetylation in 6 h. Deacetylation eliminated over 85% of inhibitor formation during downstream steam explosion. However, deacetylation prior to steam explosion decreased the dissolution of hemicellulose, thus reducing the cellulose accessibility of pretreated poplar, finally resulting in 5-20% decrease in glucose yield and 20-35% decrease in xylose yield. The addition of 5% SO 2 during steam explosion significantly improved the hydrolysis of deacetylated and pretreated poplar without significantly increasing the concentration of inhibitors. Incorporating 45 mmol/kg sulfoacid group in lignin fraction of deacetylated and then pretreated poplar dramatically improved the xylose yield to about 100% and increased the glucose yield by 30%.

Study of water recovery and solid waste processing for aerospace and domestic applications. Volume 1: Final report summary

NASA Technical Reports Server (NTRS)

Guarneri, C. A.; Reed, A.; Renman, R. E.

1972-01-01

This study of water reclamation and waste disposal is directed toward a more efficient utilization of natural resources. From an ecological standpoint improved methods of land use, water processing equipment, and ideal population profiles are investigated. Methods are described whereby significant reduction in water usage can be achieved by the adoption of presently available and practically applied technological concepts. Allowances are made for social, natural, and economic contingencies which are likely to occur up to the year 2000.

Rapid determination of global moment-tensor solutions

USGS Publications Warehouse

Sipkin, S.A.

1994-01-01

In an effort to improve data services, the National Earthquake Information Center has begun a program, in cooperation with the Incorporated Research Institutions for Seismology Data Management Center (IRIS DMC), to produce rapid estimates of the seismic moment tensor for most earthquakes with a bodywave magnitude of 5.8 or greater. An estimate of the moment tensor can usually be produced within 20 minutes of the arrival of the broadband P-waveform data from the IRIS DMC. The solutions do not vary significantly from the final solutions determined using the entire network. -from Author

Neural network-based run-to-run controller using exposure and resist thickness adjustment

NASA Astrophysics Data System (ADS)

Geary, Shane; Barry, Ronan

2003-06-01

This paper describes the development of a run-to-run control algorithm using a feedforward neural network, trained using the backpropagation training method. The algorithm is used to predict the critical dimension of the next lot using previous lot information. It is compared to a common prediction algorithm - the exponentially weighted moving average (EWMA) and is shown to give superior prediction performance in simulations. The manufacturing implementation of the final neural network showed significantly improved process capability when compared to the case where no run-to-run control was utilised.

The effectiveness of a physical activity and nutrition education program in the prevention of overweight in schoolchildren in Criciúma, Brazil.

PubMed

da Silva, L S M; Fisberg, M; de Souza Pires, M M; Nassar, S M; Sottovia, C B

2013-11-01

The objectives of this study were to evaluate nutritional status, aptitude and physical activity at the beginning and end of the nutrition education and physical activity intervention program as compared with a control group. We conducted a 28-week quasi-experimental study involving 238 students (108 in the intervention group (IG) and 130 in the control group (CG)). The IG participated in curricular and extracurricular activities for nutrition education (50 min once a week) and physical activity (50 min twice a week), and the CG participated only in curricular activities. Nutritional status was determined using body mass index, according to the WHO 2007 curve. The effect of the intervention program was evaluated using a model of generalized estimating equations. Among overweight students, a greater reduction in percentile of BMI was observed in the IG (64.6%) compared with CG (36.4%), P=0.001. Improvement in nutritional status occurred in 26.2% of IG versus 10.4% of CG (P=0.014). The IG showed a significant increase in the amount of moderate or vigorous physical activity (P=0.012), whereas in the control group the increase was not significant (P=0.810). In three physical fitness tests, the IG showed significant improvements in performance (P<0.001), whereas the control group's performance was worse in the final evaluation. The intervention program had a positive effect on overweight, with significant improvements in nutritional status and physical fitness.

76 FR 21940 - Notice of Final Federal Agency Actions on Proposed Highway in Indiana

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-19

... improvements, guard-rail, cul-de-sacs, and a potential levee) made necessary based on final design that were... necessary based on final design that were not analyzed in the Tier 2 Section 1 ROD or FEIS (approved... easements, and revised right-of-way to even station and offset) made necessary based on final design that...

78 FR 57685 - Guidance Regarding Deduction and Capitalization of Expenditures Related to Tangible Property

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

...This document contains final regulations that provide guidance on the application of sections 162(a) and 263(a) of the Internal Revenue Code (Code) to amounts paid to acquire, produce, or improve tangible property. The final regulations clarify and expand the standards in the current regulations under sections 162(a) and 263(a). These final regulations replace and remove temporary regulations under sections 162(a) and 263(a) and withdraw proposed regulations that cross referenced the text of those temporary regulations. This document also contains final regulations under section 167 regarding accounting for and retirement of depreciable property and final regulations under section 168 regarding accounting for property under the Modified Accelerated Cost Recovery System (MACRS) other than general asset accounts. The final regulations will affect all taxpayers that acquire, produce, or improve tangible property. These final regulations do not finalize or remove the 2011 temporary regulations under section 168 regarding general asset accounts and disposition of property subject to section 168, which are addressed in the notice of proposed rulemaking on this subject in the Proposed Rules section in this issue of the Federal Register.

Effectiveness of Ivabradine in Treating Stable Angina Pectoris

PubMed Central

Ye, Liwen; Ke, Dazhi; Chen, Qingwei; Li, Guiqiong; Deng, Wei; Wu, Zhiqin

2016-01-01

Abstract Many studies show that ivabradine is effective for stable angina. This meta-analysis was performed to determine the effect of treatment duration and control group type on ivabradine efficacy in stable angina pectoris. Relevant articles in the English language in the PUBMED and EMBASE databases and related websites were identified by using the search terms “ivabradine,” “angina,” “randomized controlled trials,” and “Iva.” The final search date was November 2, 2015. Articles were included if they were published randomized controlled trials that related to ivabradine treatment of stable angina pectoris. Patients with stable angina pectoris were included. The patients were classified according to treatment duration (<3 vs ≥3 months) or type of control group (placebo vs beta-receptor blocker). Angina outcomes were heart rate at rest or peak, exercise duration, and time to angina onset. Seven articles were selected. There were 3747 patients: 2100 and 1647 were in the ivabradine and control groups, respectively. The ivabradine group had significantly longer exercise duration when they had been treated for at least 3 months, but not when treatment time was less than 3 months. Ivabradine significantly improved time to angina onset regardless of treatment duration. Control group type did not influence the effect of exercise duration (significant) or time to angina onset (significant). Compared with beta-blocker and placebo, ivabradine improved exercise duration and time to onset of angina in patients with stable angina. However, its ability to improve exercise duration only became significant after at least 3 months of treatment. PMID:27057864

Responsiveness of the Countermovement Jump and Handgrip Strength to an Incremental Running Test in Endurance Athletes: Influence of Sex

PubMed Central

García-Pinillos, Felipe; Delgado-Floody, Pedro; Martínez-Salazar, Cristian; Latorre-Román, Pedro Á.

2018-01-01

Abstract The present study analyzed the acute effects of an incremental running test on countermovement jump (CMJ) and handgrip strength performance in endurance athletes, considering the effect of post-exercise recovery time and sex. Thirty-three recreationally trained long-distance runners, 20 men and 13 women, participated voluntarily in this study. The participants performed the Léger test, moreover, the CMJ and handgrip strength tests were carried out before and after the running test and during different stages of recovery (at the 1st min of recovery (posttest1), 5th min of recovery (posttest2), and 10th min of recovery (posttest3)). Two-way analysis of variance revealed a significant improvement in the CMJ (pre-posttest1, p = 0.001) and handgrip strength (pre-posttest2, p = 0.017) during recovery time. The Pearson’s Chi-2 test showed no significant relationship (p ≥ 0.05) between sex and post-activation potentiation (PAP). A linear regression analysis pointed to heart rate recovery as a predictive factor of CMJ improvement (PAP). In conclusion, despite significant fatigue reached during the Léger test, the long-distance runners did not experience an impaired CMJ and handgrip strength performance, either men or women, achieving an improvement (PAP) in posttest conditions. The results obtained showed no significant relationship between sex and PAP. Moreover, significant effect of recovery after running at high intensity on CMJ performance and handgrip strength was found. Finally, the data suggest that PAP condition can be predicted by heart rate recovery in endurance runners. PMID:29599872

Caprylic Triglyceride as a Novel Therapeutic Approach to Effectively Improve the Performance and Attenuate the Symptoms Due to the Motor Neuron Loss in ALS Disease

PubMed Central

Zhao, Wei; Varghese, Merina; Vempati, Prashant; Dzhun, Anastasiya; Cheng, Alice; Wang, Jun; Lange, Dale; Bilski, Amanda; Faravelli, Irene; Pasinetti, Giulio Maria

2012-01-01

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of motor neurons causing progressive muscle weakness, paralysis, and finally death. ALS patients suffer from asthenia and their progressive weakness negatively impacts quality of life, limiting their daily activities. They have impaired energy balance linked to lower activity of mitochondrial electron transport chain enzymes in ALS spinal cord, suggesting that improving mitochondrial function may present a therapeutic approach for ALS. When fed a ketogenic diet, the G93A ALS mouse shows a significant increase in serum ketones as well as a significantly slower progression of weakness and lower mortality rate. In this study, we treated SOD1-G93A mice with caprylic triglyceride, a medium chain triglyceride that is metabolized into ketone bodies and can serve as an alternate energy substrate for neuronal metabolism. Treatment with caprylic triglyceride attenuated progression of weakness and protected spinal cord motor neuron loss in SOD1-G93A transgenic animals, significantly improving their performance even though there was no significant benefit regarding the survival of the ALS transgenic animals. We found that caprylic triglyceride significantly promoted the mitochondrial oxygen consumption rate in vivo. Our results demonstrated that caprylic triglyceride alleviates ALS-type motor impairment through restoration of energy metabolism in SOD1-G93A ALS mice, especially during the overt stage of the disease. These data indicate the feasibility of using caprylic acid as an easily administered treatment with a high impact on the quality of life of ALS patients. PMID:23145119

Caprylic triglyceride as a novel therapeutic approach to effectively improve the performance and attenuate the symptoms due to the motor neuron loss in ALS disease.

PubMed

Zhao, Wei; Varghese, Merina; Vempati, Prashant; Dzhun, Anastasiya; Cheng, Alice; Wang, Jun; Lange, Dale; Bilski, Amanda; Faravelli, Irene; Pasinetti, Giulio Maria

2012-01-01

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of motor neurons causing progressive muscle weakness, paralysis, and finally death. ALS patients suffer from asthenia and their progressive weakness negatively impacts quality of life, limiting their daily activities. They have impaired energy balance linked to lower activity of mitochondrial electron transport chain enzymes in ALS spinal cord, suggesting that improving mitochondrial function may present a therapeutic approach for ALS. When fed a ketogenic diet, the G93A ALS mouse shows a significant increase in serum ketones as well as a significantly slower progression of weakness and lower mortality rate. In this study, we treated SOD1-G93A mice with caprylic triglyceride, a medium chain triglyceride that is metabolized into ketone bodies and can serve as an alternate energy substrate for neuronal metabolism. Treatment with caprylic triglyceride attenuated progression of weakness and protected spinal cord motor neuron loss in SOD1-G93A transgenic animals, significantly improving their performance even though there was no significant benefit regarding the survival of the ALS transgenic animals. We found that caprylic triglyceride significantly promoted the mitochondrial oxygen consumption rate in vivo. Our results demonstrated that caprylic triglyceride alleviates ALS-type motor impairment through restoration of energy metabolism in SOD1-G93A ALS mice, especially during the overt stage of the disease. These data indicate the feasibility of using caprylic acid as an easily administered treatment with a high impact on the quality of life of ALS patients.

ACTH has beneficial effects on stuttering in ADHD and ASD patients with ESES: A retrospective study.

PubMed

Altunel, Attila; Sever, Ali; Altunel, Emine Özlem

2017-02-01

Etiology of stuttering remains unknown and no pharmacologic intervention has been approved for treatment. We aimed to evaluate EEG parameters and the effect of adrenocorticotropic hormone (ACTH) therapy in stuttering. In this retrospective study, 25 patients with attention deficit and hyperactivity (ADHD) or autism spectrum disorder (ASD), and comorbid stuttering were followed and treated with ACTH for electrical status epilepticus in sleep (ESES). Sleep EEGs were recorded at referral and follow-up visits and short courses of ACTH were administered when spike-wave index (SWI) was ⩾15%. The assessment of treatment effectiveness was based on reduction in SWI, and the clinician-reported improvement in stuttering, and ADHD or ASD. Statistical analyses were conducted in order to investigate the relationship between the clinical and EEG parameters. Following treatment with ACTH, a reduction in SWI in all the patients was accompanied by a 72% improvement in ADHD or ASD, and 83.8% improvement in stuttering. Twelve of the 25 patients with stuttering showed complete treatment response. Linear regressions established that SWI at final visit significantly predicted improvement in ADHD or ASD, and in stuttering. If symptoms had recurred, improvement was once again achieved with repeated ACTH therapies. Stuttering always improved prior to, and recurred following ADHD or ASD. The underlying etiology leading to ESES may play a significant role in the pathophysiology of stuttering and connect stuttering to other developmental disorders. ACTH therapy has beneficial effects on stuttering and improves EEG parameters. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis.

PubMed

Thoma, Daniel S; Naenni, Nadja; Figuero, Elena; Hämmerle, Christoph H F; Schwarz, Frank; Jung, Ronald E; Sanz-Sánchez, Ignacio

2018-03-01

To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri-implant health or disease in partially and fully edentulous patients. A MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri-implant mucosa. Studies reporting on the peri-implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full-text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta-analyses were applied whenever possible. Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) [n = 2; WMD = 0.863; 95% CI (0.658; 1.067); p < .001]. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention [with or without residual keratinized tissue]) [n = 4; WMD = -0.175 mm; 95% CI: (-0.313; -0.037); p = .013]. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time [WMD = 0.110; 95% CI: 0.067; 0.154; p < .001] and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting. Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri-implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss. © 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.

Using crowdsourcing to prioritize bicycle network improvements : final report.

DOT National Transportation Integrated Search

2016-04-01

Effort to improve the bicycle route network using crowdsourced data is a powerful means : of incorporating citizens in infrastructure improvement decisions, which will improve : livability by maximizing the benefit of the bicycle infrastructure fundi...

Production, characterization, and mechanical behavior of cementitious materials incorporating carbon nanofibers

NASA Astrophysics Data System (ADS)

Yazdanbakhsh, Ardavan

Carbon nanotubes (CNTs) and carbon nanofirbers (CNFs) have excellent properties (mechanical, electrical, magnetic, etc.), which can make them effective nanoreinforcements for improving the properties of materials. The incorporation of CNT/Fs in a wide variety of materials has been researched extensively in the past decade. However, the past study on the reinforcement of cementitious materials with these nanofilaments has been limited. The findings from those studies indicate that CNT/Fs did not significantly improve the mechanical properties of cementitious materials. Two major parameters influence the effectiveness of any discrete inclusion in composite material: The dispersion quality of the inclusions and the interfacial bond between the inclusions and matrix. The main focus of this dissertation is on the dispersion factor, and consists of three main tasks: First a novel thermodynamic-based method for dispersion quantification was developed. Second, a new method, incorporating the utilization of silica fume, was devised to improve and stabilize the dispersion of CNFs in cement paste. And third, the dispersion quantification method and mechanical testing were employed to measure, compare, and correlate the dispersion and mechanical properties of CNF-incorporated cement paste produced with the conventional and new methods. Finally, the main benefits, including the increase in strength and resistance to shrinkage cracking, obtained from the utilization of CNFs in cement paste will be presented. The investigations and the corresponding results show that the novel dispersion quantification method can be implemented easily to perform a wide variety of tasks ranging from measuring dispersion of nanofilaments in composites using their optical/SEM micrographs as input, to measuring the effect of cement particle/clump size on the dispersion of nano inclusions in cement paste. It was found that cement particles do not affect the dispersion of nano inclusions in cement paste significantly while the dispersion of nano inclusions can notably degenerates if the cement particles are agglomerated. The novel dispersion quantification method shows that, the dispersion of CNFs in cement paste significantly improves by utilizing silica fume. However, it was found that the dispersion of silica fume particles is an important parameter and poorly dispersed silica fume cannot enhance the overall dispersion of nano inclusions in cementitious materials. Finally, the mechanical testing and experimentations showed that CNFs, in absence of moist curing, even if poorly dispersed, can provide important benefits in terms of strength and crack resistance.

Breathe Easier Online: Evaluation of a Randomized Controlled Pilot Trial of an Internet-Based Intervention to Improve Well-being in Children and Adolescents With a Chronic Respiratory Condition

PubMed Central

Dunn, Tamara L; Casey, Leanne M; Sheffield, Jeanie K; Petsky, Helen; Anderson-James, Sophie; Chang, Anne B

2012-01-01

Background Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. Objective To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. Methods We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). Results The two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. Conclusions Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033; http://www.anzctr.org.au/trial_view.aspx?ID=308074 (Archived by WebCite at http://www.webcitation.org/63BL55mXH) PMID:22356732

Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD.

PubMed

Waizel, Maria; Todorova, Margarita G; Masyk, Michael; Wolf, Katharina; Rickmann, Annekatrin; Helaiwa, Khaled; Blanke, Björn R; Szurman, Peter

2017-05-23

To evaluate changes in central macular thickness (CMT) and visual outcome in patients with neovascular age-related macular degeneration (AMD) treated initially with bevacizumab and subsequently switched to either aflibercept or ranibizumab. Observational clinical study was performed. We measured the structural outcome (CMT on SD-OCT; μm) and the visual outcome (best corrected visual acuity (BCVA); logMAR), as follows: before treatment (at baseline), following bevacizumab treatment (switch follow-up) and after switching from bevacizumab to aflibercept- or ranibizumab treatment (final follow-up, AG/, RG). From a total of 96 eyes treated with intravitreal injections of bevacizumab (10.5 ± 7.6 (mean ± SD)), 58 eyes switched to aflibercept (6.5 ± 3.9; AG) and 38 eyes switched to ranibizumab (7.1 ± 5.3; RG) (≥ 3 injections, each). In addition, these eyes were compared to 37 eyes under bevacizumab monotherapy. In the AG, the CMT decreased slightly from 430 ± 220 μm at baseline to 419 ± 212 μm at switch follow-up (p = 0.86), but decreased significantly to 318 ± 159 μm at final follow-up, AG (p < 0.0001). In the ranibizumab group (RG), the CMT increased from 396 ± 174 μm at baseline to 499 ± 333 μm at switch follow-up (p = 0.012), but decreased significantly to 394 ± 202 μm at final follow-up, RG (p = 0.007). Secondary outcome: In the AG, the mean BCVA worsened from logMAR 0.57 ± 0.33 at baseline to 0.63 ± 0.30 at switch follow-up and improved slightly to 0.53 ± 0.71 at final follow-up, AG (p = 0.46). In the RG, mean BCVA worsened from 0.57 ± 0.28 at baseline to 0.64 ± 0.31 at switch follow-up and improved slightly to 0.60 ± 0.36 at final follow-up, RG (p = 0.64). Switching from bevacizumab to either aflibercept, or ranibizumab, has a strong anatomical effect in eyes with neovascular AMD. Nevertheless, even if the switch to aflibercept shows a minimal functional benefit over that to ranibizumab, visual prognosis remains limited.

Learning-oriented assessment increases performance and written skills in a second year metabolic biochemistry course.

PubMed

Vanderlelie, Jessica J; Alexander, Heather G

2016-07-08

Assessment plays a critical role in learning and teaching and its power to enhance engagement and student outcomes is still underestimated in tertiary education. The current project considers the impact of a staged redesign of an assessment strategy that emphasized relevance of learning, formative assessment, student engagement, and feedback on student performance, failure rates and overall engagement in the course. Significant improvements in final grades (p < 0.0001) and written performance (p < 0.0001) in the final examination were noted that coincided with increased lecture attendance and overall engagement in the course. This study reinforces the importance of an integrated approach to assessment that includes well developed formative tasks and a continuous summative assessment strategy. © 2016 by The International Union of Biochemistry and Molecular Biology, 44(4):412-420, 2016. © 2016 The International Union of Biochemistry and Molecular Biology.

Stigma towards mental illness among medical students in Australia and Ghana.

PubMed

Lyons, Zaza; Laugharne, Jonathan; Laugharne, Richard; Appiah-Poku, John

2015-06-01

Stigma towards mental illness has been found to impact adversely on medical students' attitudes towards psychiatry. This study aimed to assess the impact of stigma among final year students at the University of Science and Technology in Kumasi, Ghana, and the University of Western Australia. A 28-item "Attitudes and stigma towards mental health" questionnaire was distributed to final year students at both universities. There was a significant difference in questionnaire scores, with Australian students showing more positive attitudes towards mental illness and lower levels of stigma compared with Ghanaian students. Stigmatization was expressed by Australian and Ghanaian students. A combination of medical school experiences and wider societal and cultural beliefs could be responsible for students' attitudes towards mental illness. Educators can develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students' attitudes towards psychiatry as a discipline and mental illness in general.

High temperature process steam application at the Southern Union Refining Company, Hobbs, New Mexico. Solar energy in the oil patch. Final report, Phase III: operation, maintenance, and performance

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

Wilson, L.E.; McGuire, D.R.

1984-05-01

This final report summarizes the technical reports for Phase III of this project. The third phase included the operation, maintenance, upgrade and performance reporting of a 10,080 square foot Solar Industrial Process Heat System installed at the Famariss Energy Refinery of Southern Union Refining Company near Hobbs, New Mexico. This report contains a description of the upgraded system, and a summary of the overall operation, maintenance and performance of the installed system. The results of the upgrade activities can be seen in the last two months of operational data. Steam production was significantly greater in peak flow and monthly totalmore » than at any previous time. Also monthly total cost savings was greatly improved even though natural gas costs remain much lower than originally anticipated.« less

A third-order approximation method for three-dimensional wheel-rail contact

NASA Astrophysics Data System (ADS)

Negretti, Daniele

2012-03-01

Multibody train analysis is used increasingly by railway operators whenever a reliable and time-efficient method to evaluate the contact between wheel and rail is needed; particularly, the wheel-rail contact is one of the most important aspects that affects a reliable and time-efficient vehicle dynamics computation. The focus of the approach proposed here is to carry out such tasks by means of online wheel-rail elastic contact detection. In order to improve efficiency and save time, a main analytical approach is used for the definition of wheel and rail surfaces as well as for contact detection, then a final numerical evaluation is used to locate contact. The final numerical procedure consists in finding the zeros of a nonlinear function in a single variable. The overall method is based on the approximation of the wheel surface, which does not influence the contact location significantly, as shown in the paper.

Computer-aided implant design for the restoration of cranial defects.

PubMed

Chen, Xiaojun; Xu, Lu; Li, Xing; Egger, Jan

2017-06-23

Patient-specific cranial implants are important and necessary in the surgery of cranial defect restoration. However, traditional methods of manual design of cranial implants are complicated and time-consuming. Our purpose is to develop a novel software named EasyCrania to design the cranial implants conveniently and efficiently. The process can be divided into five steps, which are mirroring model, clipping surface, surface fitting, the generation of the initial implant and the generation of the final implant. The main concept of our method is to use the geometry information of the mirrored model as the base to generate the final implant. The comparative studies demonstrated that the EasyCrania can improve the efficiency of cranial implant design significantly. And, the intra- and inter-rater reliability of the software were stable, which were 87.07 ± 1.6% and 87.73 ± 1.4% respectively.

Observer efficiency in discrimination tasks simulating malignant and benign breast lesions imaged with ultrasound

PubMed Central

Abbey, Craig K.; Zemp, Roger J.; Liu, Jie; Lindfors, Karen K.; Insana, Michael F.

2009-01-01

We investigate and extend the ideal observer methodology developed by Smith and Wagner to detection and discrimination tasks related to breast sonography. We provide a numerical approach for evaluating the ideal observer acting on radio-frequency (RF) frame data, which involves inversion of large nonstationary covariance matrices, and we describe a power-series approach to computing this inverse. Considering a truncated power series suggests that the RF data be Wiener-filtered before forming the final envelope image. We have compared human performance for Wiener-filtered and conventional B-mode envelope images using psychophysical studies for 5 tasks related to breast cancer classification. We find significant improvements in visual detection and discrimination efficiency in four of these five tasks. We also use the Smith-Wagner approach to distinguish between human and processing inefficiencies, and find that generally the principle limitation comes from the information lost in computing the final envelope image. PMID:16468454