Disability and health outcomes - from a cohort of people on long-term anti-retroviral therapy.

PubMed

Myezwa, Hellen; Hanass-Hancock, Jill; Ajidahun, Adedayo Tunde; Carpenter, Bradley

2018-12-01

Human-immunodeficiency virus (HIV)/Acquired immunodeficiency Syndrome (AIDS) remains a major health problem in South Africa - even after two decades since the introduction of antiretroviral therapy (ART). Long-term survival with HIV is associated with new health-related issues and a risk of functional limitation/disability. The aim of this study was to assess functional limitation associated with HIV/AIDS among people living with HIV (PLHIV) in South Africa. This study is a cross-sectional survey using a cohort in an urban area in Gauteng province, South Africa. Data were collected using questionnaires through an interview process. The information collected included aspects such as demographics, livelihood, the state of mental and physical health, adherence and disability. A total of 1044 participants with an average age of 42 ± 12 years were included in the study, with 51.9% of the participants reporting functional limitations (WHODAS ≥ 2). These were reported mainly in the domains of participation (40.2%) and mobility (38.7%). In addition, adherence to ART, symptoms of poor physical health and depression were strongly associated with their functional limitations/disability. HIV as a chronic disease is associated with functional limitations that are not adequately addressed and pose a risk of long-term disability and negative adherence outcomes. Therefore, wellness for PLHIV/AIDS needs to include interventions that can prevent and manage disability.

Readability of medicinal package leaflets: a systematic review

PubMed Central

Pires, Carla; Vigário, Marina; Cavaco, Afonso

2015-01-01

OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords “Readability and Package Leaflet” and “Readability and Package Insert” in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results. PMID:25741660

Readability of medicinal package leaflets: a systematic review.

PubMed

Pires, Carla; Vigário, Marina; Cavaco, Afonso

2015-01-01

OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords "Readability and Package Leaflet" and "Readability and Package Insert" in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results.

Health literacy and patient outcomes in chronic kidney disease: a systematic review.

PubMed

Taylor, Dominic M; Fraser, Simon; Dudley, Chris; Oniscu, Gabriel C; Tomson, Charles; Ravanan, Rommel; Roderick, Paul

2017-11-20

Limited health literacy affects 25% of people with chronic kidney disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity. We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD. A total of 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. In all, 18 300 patients were studied: 4367 non-dialysis CKD; 13 202 dialysis; 390 transplant; 341 unspecified. Median study size was 127 [interquartile range (IQR) 92-238)], but 480 (IQR 260-2392) for cohort studies. Median proportion of non-white participants was 48% (IQR 17-70%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical/laboratory parameters and 'hard' clinical outcomes. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts. There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of poor outcomes in CKD. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Methods to Limit Attrition in Longitudinal Comparative Effectiveness Trials: Lessons from the Lithium Use for Bipolar Disorder (LiTMUS) Study

PubMed Central

Sylvia, Louisa G.; Reilly-Harrington, Noreen A.; Leon, Andrew C.; Kansky, Christine I.; Ketter, Terence A.; Calabrese, Joseph R.; Thase, Michael E.; Bowden, Charles L.; Friedman, Edward S.; Ostacher, Michael J.; Iosifescu, Dan V.; Severe, Joanne; Nierenberg, Andrew A.

2013-01-01

Background High attrition rates which occur frequently in longitudinal clinical trials of interventions for bipolar disorder limit the interpretation of results. Purpose The aim of this article is to present design approaches that limited attrition in the Lithium Use for Bipolar Disorder (LiTMUS) Study. Methods LiTMUS was a 6-month randomized, longitudinal multi-site comparative effectiveness trial that examined bipolar participants who were at least mildly ill. Participants were randomized to either low to moderate doses of lithium or no lithium, in addition to other treatments needed for mood stabilization administered in a guideline-informed, empirically supported, and personalized fashion (N=283). Results Components of the study design that may have contributed to the low attrition rate of the study included use of: (1) an intent-to-treat design; (2) a randomized adjunctive single-blind design; (3) participant reimbursement; (4) intent-to-attend the next study visit (includes a discussion of attendance obstacles when intention is low); (5) quality care with limited participant burden; and (6) target windows for study visits. Limitations Site differences and the effectiveness and tolerability data have not been analyzed yet. Conclusions These components of the LiTMUS study design may have reduced the probability of attrition which would inform the design of future randomized clinical effectiveness trials. PMID:22076437

Stopping power of dense plasmas: The collisional method and limitations of the dielectric formalism.

PubMed

Clauser, C F; Arista, N R

2018-02-01

We present a study of the stopping power of plasmas using two main approaches: the collisional (scattering theory) and the dielectric formalisms. In the former case, we use a semiclassical method based on quantum scattering theory. In the latter case, we use the full description given by the extension of the Lindhard dielectric function for plasmas of all degeneracies. We compare these two theories and show that the dielectric formalism has limitations when it is used for slow heavy ions or atoms in dense plasmas. We present a study of these limitations and show the regimes where the dielectric formalism can be used, with appropriate corrections to include the usual quantum and classical limits. On the other hand, the semiclassical method shows the correct behavior for all plasma conditions and projectile velocity and charge. We consider different models for the ion charge distributions, including bare and dressed ions as well as neutral atoms.

Public understanding of chemistry research in print news

NASA Astrophysics Data System (ADS)

Hands, Michael D., Jr.

Despite numerous calls for improving scientific literacy, many American adults show a lack of understanding of experiments, scientific study, and scientific inquiry. News media is one important avenue for science learning, but previous research investigating health and/or environmental science news has shown that it is inconsistent in the presentation of scientific research limitations, potentially impacting reader understanding. In the first phase of this dissertation, seventeen news articles reporting on a single chemistry research article, along with associated press releases and research articles, were analyzed using move analysis to determine the structure of each type of text. It was found that the overall structure of each text genre was similar, with the main difference being that research articles start by presenting background information, while the others lead with highlighting overall research outcomes. Analysis of the steps revealed that, as seen for health and environmental science news articles, descriptions of the study limitations and methods were generally omitted in the news articles. Using these findings, a pilot study was conducted where study limitations were added to a chemistry research news article and the effect of its presence on staff members employed at a large Midwestern university (n=12) and science faculty employed at the same institution (n=6) was explored. Interviews with the participants revealed that including limitations enhanced readers' ability to identify conclusions and evaluate claims, but decreased their trust in the information. In the final part of this study, the trends seen in the previous phase were explored to determine their generalizability. Members of the public (n=232) and science faculty (n=191) read a randomly assigned news article either presenting or omitting the study limitations and research methods. Participants reading articles presenting limitations were able to evaluate the reasonableness of claims based on the article better than those who read the article omitting limitations when accounting for their views on the tentativeness of science (ToS). Presenting limitations was important in identifying unreasonable claims for both public and science faculty, while ToS views predicted ability to identify reasonable claims for the public. Including limitations also decreased readers' trust in the conclusions of the research. However, it did not impact their ability to determine the conclusions of the research and including methods did not have any effect on the measured outcomes.

Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.

PubMed

Bassuk, Ellen L; Hanson, Justine; Greene, R Neil; Richard, Molly; Laudet, Alexandre

2016-04-01

This systematic review identifies, appraises, and summarizes the evidence on the effectiveness of peer-delivered recovery support services for people in recovery from alcohol and drug addiction. Nine studies met criteria for inclusion in the review. They were assessed for quality and outcomes including substance use and recovery-related factors. Despite significant methodological limitations found in the included studies, the body of evidence suggests salutary effects on participants. Current limitations and recommendations for future research are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

77 FR 11128 - Medicare Program; Public Meetings in Calendar Year 2012 for All New Public Requests for Revisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

... 10- page limit for relevant studies published between the application deadline and the public meeting... include but are not limited to, alcoholic beverages, illegal narcotics, explosives, firearms or other...

Torque limit of PM motors for field-weakening region operation

DOEpatents

Royak, Semyon [Beachwood, OH; Harbaugh, Mark M [Richfield, OH

2012-02-14

The invention includes a motor controller and technique for controlling a permanent magnet motor. In accordance with one aspect of the present technique, a permanent magnet motor is controlled by receiving a torque command, determining a physical torque limit based on a stator frequency, determining a theoretical torque limit based on a maximum available voltage and motor inductance ratio, and limiting the torque command to the smaller of the physical torque limit and the theoretical torque limit. Receiving the torque command may include normalizing the torque command to obtain a normalized torque command, determining the physical torque limit may include determining a normalized physical torque limit, determining a theoretical torque limit may include determining a normalized theoretical torque limit, and limiting the torque command may include limiting the normalized torque command to the smaller of the normalized physical torque limit and the normalized theoretical torque limit.

Exercise and well-being: a review of mental and physical health benefits associated with physical activity.

PubMed

Penedo, Frank J; Dahn, Jason R

2005-03-01

This review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, including obesity, cancer, cardiovascular disease and sexual dysfunction. Furthermore, studies relating physical activity to depression and other mood states are reviewed. The studies include diverse ethnic populations, including men and women, as well as several age groups (e.g. adolescents, middle-aged and older adults). Results of the studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes. Generally, participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions. Similarly, participants in randomized clinical trials of physical-activity interventions show better health outcomes, including better general and health-related quality of life, better functional capacity and better mood states. The studies have several implications for clinical practice and research. Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes. Therefore, assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several populations. Several limitations were noted, particularly in research involving randomized clinical trials. These trials tend to involve limited sample sizes with short follow-up periods, thus limiting the clinical implications of the benefits associated with physical activity.

Reexamining Ground SOF Command and Control: Does One Size Fit All

DTIC Science & Technology

2016-12-01

Case studies covering varying methods of employment of special operations forces in limited contingencies will be utilized. The case studies focus on ...operating environment, much like an open organization. This research examines three case studies including operation JUST CAUSE in Panama, RESTORE HOPE in... case studies , the HQ elements formed around existing homogenous commands and not a Theater Special Operations Command (TSOC) staff with limited

A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy.

PubMed

Herrera, Samantha; Enuameh, Yeetey; Adjei, George; Ae-Ngibise, Kenneth Ayuurebobi; Asante, Kwaku Poku; Sankoh, Osman; Owusu-Agyei, Seth; Yé, Yazoume

2017-10-23

Lack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review. The authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites' websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix. The authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a 'true' gold standard to assess accuracy of VA malaria mortality. Existing VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization's Global Technical Strategy for Malaria 2016-2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries' vital registration systems for more robust and timely cause of death data.

Effects of work hour reduction on residents' lives: a systematic review.

PubMed

Fletcher, Kathlyn E; Underwood, Willie; Davis, Steven Q; Mangrulkar, Rajesh S; McMahon, Laurence F; Saint, Sanjay

2005-09-07

The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents. To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life. We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings. Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States. For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form. Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct. Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.

43 CFR 24.6 - Cooperative agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... continued and encouraged. Appropriate topics for such cooperative agreements include but are not limited to... reintroduction and propagation; (3) Research and other field study programs including those involving the taking...

43 CFR 24.6 - Cooperative agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... continued and encouraged. Appropriate topics for such cooperative agreements include but are not limited to... reintroduction and propagation; (3) Research and other field study programs including those involving the taking...

Self-Reported versus Professionally Assessed Functional Limitations in Community-Dwelling Very Old Individuals

ERIC Educational Resources Information Center

Carlsson, Gunilla; Haak, Maria; Nygren, Carita; Iwarsson, Susanne

2012-01-01

The objective of this study was to examine the relationship between self-reported and professionally assessed functional limitations in community-dwelling very old individuals. In total, 306 single-living adults aged 81-90 years were included in this cross-sectional study. The main outcome measure was the presence and absence of self-reported and…

Scientific Study of Malnutrition as a Limiting Factor in the Development of Education.

ERIC Educational Resources Information Center

Picasso de Oyague, Alfredo

This study on malnutrition as a limiting factor in the development of education (and, hence, in socioeconomic development generally) was presented to the UNESCO Seminar on Education, Nutrition, Agriculture and Man. The paper reports on recent research showing that the development of the central nervous system in very young children (including the…

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries.

PubMed

Liu, Liang Qin; Moody, Julie; Traynor, Michael; Dyson, Sue; Gall, Angela

2014-11-01

Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited. To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI. Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments. Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant). The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries

PubMed Central

Liu, Liang Qin; Moody, Julie; Traynor, Michael; Dyson, Sue; Gall, Angela

2014-01-01

Context Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited. Objectives To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI. Method Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments. Results Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant). Conclusion The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials. PMID:24969965

Promise and Limitations of Big Data Research in Plastic Surgery.

PubMed

Zhu, Victor Zhang; Tuggle, Charles Thompson; Au, Alexander Francis

2016-04-01

The use of "Big Data" in plastic surgery outcomes research has increased dramatically in the last 5 years. This article addresses some of the benefits and limitations of such research. This is a narrative review of large database studies in plastic surgery. There are several benefits to database research as compared with traditional forms of research, such as randomized controlled studies and cohort studies. These include the ease in patient recruitment, reduction in selection bias, and increased generalizability. As such, the types of outcomes research that are particularly suited for database studies include determination of geographic variations in practice, volume outcome analysis, evaluation of how sociodemographic factors affect access to health care, and trend analyses over time. The limitations of database research include data which are limited only to what was captured in the database, high power which can cause clinically insignificant differences to achieve statistical significance, and fishing which can lead to increased type I errors. The National Surgical Quality Improvement Project is an important general surgery database that may be useful for plastic surgeons because it is validated and has a large number of patients after over a decade of collecting data. The Tracking Operations and Outcomes for Plastic Surgeons Program is a newer database specific to plastic surgery. Databases are a powerful tool for plastic surgery outcomes research. It is critically important to understand their benefits and limitations when designing research projects or interpreting studies whose data have been drawn from them. For plastic surgeons, National Surgical Quality Improvement Project has a greater number of publications, but Tracking Operations and Outcomes for Plastic Surgeons Program is the most applicable database for plastic surgery research.

Applying Definitions of “Asbestos” to Environmental and “Low-Dose” Exposure Levels and Health Effects, Particularly Malignant Mesothelioma

PubMed Central

Case, B. W.; Abraham, J. L.; Meeker, G.; Pooley, F. D.; Pinkerton, K. E.

2011-01-01

Although asbestos research has been ongoing for decades, this increased knowledge has not led to consensus in many areas of the field. Two such areas of controversy include the specific definitions of asbestos, and limitations in understanding exposure-response relationships for various asbestos types and exposure levels and disease. This document reviews the current regulatory and mineralogical definitions and how variability in these definitions has led to difficulties in the discussion and comparison of both experimental laboratory and human epidemiological studies for asbestos. This review also examines the issues of exposure measurement in both animal and human studies, and discusses the impact of these issues on determination of cause for asbestos-related diseases. Limitations include the lack of detailed characterization and limited quantification of the fibers in most studies. Associated data gaps and research needs are also enumerated in this review. PMID:21534084

Applying definitions of “asbestos” to environmental and “low-dose” exposure Levels and health effects, particularly malignant mesothelioma

USGS Publications Warehouse

Case, B.W.; Abraham, J.L.; Meeker, G.; Pooley, F.D.; Pinkerton, K.E.

2011-01-01

Although asbestos research has been ongoing for decades, this increased knowledge has not led to consensus in many areas of the field. Two such areas of controversy include the specific definitions of asbestos, and limitations in understanding exposure-response relationships for various asbestos types and exposure levels and disease. This document reviews the current regulatory and mineralogical definitions and how variability in these definitions has led to difficulties in the discussion and comparison of both experimental laboratory and human epidemiological studies for asbestos. This review also examines the issues of exposure measurement in both animal and human studies, and discusses the impact of these issues on determination of cause for asbestos-related diseases. Limitations include the lack of detailed characterization and limited quantification of the fibers in most studies. Associated data gaps and research needs are also enumerated in this review.

[Who exactly are these "persons with limitations in daily living skills"? : Survey of insured persons based on health insurance data].

PubMed

Runte, Rebecca; Müller, Rolf

2016-12-01

In recent years German long-term care insurance coverage has gradually been extended to include services for people with limitations in daily living skills. Until now, however, it was unclear who exactly people with limited daily living skills are. The study aimed to characterize people with limited daily living skills who use additional support services as defined by § 45b of the Social Services Code XI (SGB XI). This study was based on a survey of 1284 people with limited daily living skills who used additional support services (§ 45b SGB XI). The data were analyzed descriptively. The average recipient was 81 years old, mainly in care level I and the majority of them were exclusively cared for by relatives. Of these recipients 61 % were diagnosed with dementia, 73.4 % had medium cognitive impairments while more than half could no longer carry out the instrumental activities of daily living (IADL). Statistics on people with limited daily living skills should be included in publications and reports so that the need for care and assistance can be estimated more precisely.

Factors associated with physical activity promotion by allied and other non-medical health professionals: A systematic review.

PubMed

Crisford, Paul; Winzenberg, Tania; Venn, Alison; Schultz, Martin; Aitken, Dawn; Cleland, Verity

2018-05-21

To identify factors associated with non-medical health professionals' engagement in physical activity (PA) promotion. Five electronic databases were searched for studies including practising health professionals (excluding medical doctors), a PA promotion practice measure, a test of association between potential influencing factors and PA promotion practice, and written in English. Two researchers independently screened studies and extracted data. Extracted data were synthesized in a tabular format with a narrative summary (thematic analysis). Thirty studies involving 7734 non-medical health professionals were included. Self-efficacy in PA promotion, positive beliefs in the benefits of PA, assessing patients' PA, and PA promotion training were the main factors associated with engaging in PA promotion. Lack of remuneration was not associated. Common study limitations included a lack of information on non-responders, data collection by survey only and limited reliability or validity testing of measurements. There are common factors influencing PA promotion, but the absence of studies from some health professions, limitations related to study measures, and the lack of randomised controlled intervention trials highlights the need for further research. The factors identified may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by health professionals. Copyright © 2018 Elsevier B.V. All rights reserved.

Evaluation of Options for Interpreting Environmental ...

EPA Pesticide Factsheets

Report Secondary data from the BioResponse Operational Testing and Evaluation project were used to study six options for interpreting culture-based/microbial count data sets that include left censored data, or measurements that are less than established quantification limits and/or detection limits.

Impaired voluntary neuromuscular activation limits muscle power in mobility-limited older adults

USDA-ARS?s Scientific Manuscript database

Background. Age-related alterations of neuromuscular activation may contribute to deficits in muscle power and mobility function. This study assesses whether impaired activation of the agonist quadriceps and antagonist hamstrings, including amplitude- and velocity-dependent characteristics of activa...

76 FR 42712 - Advisory Committee on Head Start Research and Evaluation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... Research and Evaluation will provide feedback on the published final report for the Head Start Impact Study... recommendations on follow-up research, including additional analysis of the Head Start Impact Study data. The... research agenda, including--but not limited to--how the Head Start Impact Study fits within this agenda...

Lattice QCD phase diagram in and away from the strong coupling limit.

PubMed

de Forcrand, Ph; Langelage, J; Philipsen, O; Unger, W

2014-10-10

We study lattice QCD with four flavors of staggered quarks. In the limit of infinite gauge coupling, "dual" variables can be introduced, which render the finite-density sign problem mild and allow a full determination of the μ-T phase diagram by Monte Carlo simulations, also in the chiral limit. However, the continuum limit coincides with the weak coupling limit. We propose a strong-coupling expansion approach towards the continuum limit. We show first results, including the phase diagram and its chiral critical point, from this expansion truncated at next-to-leading order.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions.

PubMed

Sultan-Taïeb, Hélène; Parent-Lamarche, Annick; Gaillard, Aurélie; Stock, Susan; Nicolakakis, Nektaria; Hong, Quan Nha; Vezina, Michel; Coulibaly, Youssouph; Vézina, Nicole; Berthelette, Diane

2017-12-08

Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation. Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers' needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

Expiratory Flow Limitation as a Risk Factor for Pulmonary Complications After Major Abdominal Surgery.

PubMed

Spadaro, Savino; Caramori, Gaetano; Rizzuto, Chiara; Mojoli, Francesco; Zani, Gianluca; Ragazzi, Riccardo; Valpiani, Giorgia; Dalla Corte, Francesca; Marangoni, Elisabetta; Volta, Carlo Alberto

2017-02-01

Postoperative pulmonary complications are major causes of postoperative morbidity and mortality. Although several risk factors have been associated with postoperative pulmonary complications, they are not consistent between studies and, even in those studies in which these factors were identified, the predictive power is low. We hypothesized that postoperative pulmonary complications would correlate with the presence of intraoperative expiratory flow limitation. Candidates for this prospective observational study were patients undergoing general anesthesia for major abdominal surgery. Preoperative data collection included age, body mass index, American Society of Anesthesiologists class, smoking and dyspnea history, and room air PO2. Expiratory flow limitation was assessed intraoperatively using the positive end-expiratory pressure test. Postoperative data collection included the incidence of postoperative pulmonary complications. Of the 330 patients we enrolled, 31% exhibited expiratory flow limitation. On univariate analysis, patients with expiratory flow limitation were more likely to have postoperative pneumonia (5% vs 0%, P < .001) and acute respiratory failure (11% vs 1%, P < .001) and a longer length of hospital stay (7 vs 9 days, P < .01). Multivariate analysis identified that expiratory flow limitation increased the risk of developing postoperative pulmonary complications by >50% (risk ratio, 2.7; 95% confidence interval, 1.7-4.2). Age and Medical Research Council dyspnea score were also significant multivariate risk factors for pulmonary complications. Our results show that intraoperative expiratory flow limitation correlates with that of postoperative pulmonary complication after major abdominal surgery. Further work is needed to better understand the relevance of expiratory flow limitation on postoperative pulmonary outcomes.

32 CFR 203.10 - Eligible activities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... reports include, but are not limited to: (i) Installation restoration program site studies, engineering documents, such as site inspections, remedial investigations, feasibility studies, engineering evaluation...

33 CFR 273.14 - Planning procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., D.C. 20314 will be followed by further investigations. Normally, a detailed State design memorandum... information. Field surveys and office studies should be limited to minimum essentials for further detailed... include, but not be limited to, the information contained in Appendix B. (b) State design memorandum. When...

33 CFR 273.14 - Planning procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., D.C. 20314 will be followed by further investigations. Normally, a detailed State design memorandum... information. Field surveys and office studies should be limited to minimum essentials for further detailed... include, but not be limited to, the information contained in Appendix B. (b) State design memorandum. When...

33 CFR 273.14 - Planning procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., D.C. 20314 will be followed by further investigations. Normally, a detailed State design memorandum... information. Field surveys and office studies should be limited to minimum essentials for further detailed... include, but not be limited to, the information contained in Appendix B. (b) State design memorandum. When...

33 CFR 273.14 - Planning procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., D.C. 20314 will be followed by further investigations. Normally, a detailed State design memorandum... information. Field surveys and office studies should be limited to minimum essentials for further detailed... include, but not be limited to, the information contained in Appendix B. (b) State design memorandum. When...

Teacher Fear of Litigation for Disciplinary Actions

ERIC Educational Resources Information Center

Holben, Diane M.; Zirkel, Perry A.; Caskie, Grace I. L.

2009-01-01

The present study determined the extent to which teachers' fear of litigation limits their disciplinary actions, including any significant differences by period, demographic factors, and item type. Teachers' perceptions of limitations placed on their disciplinary actions do not substantiate the "paralyzing fear" of litigation that…

33 CFR 273.14 - Planning procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., D.C. 20314 will be followed by further investigations. Normally, a detailed State design memorandum... information. Field surveys and office studies should be limited to minimum essentials for further detailed... include, but not be limited to, the information contained in appendix B. (b) State design memorandum. When...

Handgrip Strength Cutoff Points to Identify Mobility Limitation in Community-dwelling Older People and Associated Factors.

PubMed

Vasconcelos, K S de Souza; Dias, J M Domingues; Bastone, A de Carvalho; Vieira, R Alvarenga; Andrade, A C de Souza; Perracini, M Rodrigues; Guerra, R Oliveira; Dias, R Corrêa

2016-03-01

Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass and strength. The specific threshold of muscle weakness that leads to mobility limitations has not been identified. To determine the best cutoff point of handgrip strength for identifying mobility limitation and to investigate the factors associated with muscle weakness and mobility limitation in community-dwelling older people. Transversal study. Cities of Belo Horizonte, Barueri and Santa Cruz in Brazil. 1374 community-dwelling older people from the Frailty study in Brazilian older people (FIBRA Study). Outcomes included muscle weakness determined according to gender-specific handgrip strength cutoff points generated by Receiver Operating Characteristic curves, mobility limitation defined as a gait speed ≤ 0.8 m/s; and a combination of both muscle weakness and mobility limitation. Associated factors included socio-demographic variables, lifestyle, anthropometrics, health conditions, use of health services and disability. The cutoff points of handgrip strength with the best balancing between sensitivity and specificity for mobility limitation were 25.8 kgf for men (sensitivity 69%, specificity 73%) and 17.4 kgf (sensitivity 60%, specificity 66%) for women. Age and disability in instrumental activities of daily living were associated with all outcomes. Women had greater odds of mobility limitation than men. Physical inactivity, body fat, diabetes, depression, sleeping disturbances, number of medications and occurrence of falls remained as significant associated factors in the final model. Handgrip strength can be a useful tool to identify mobility limitation in clinical practice. Interventions to prevent or minimize impacts of sarcopenia should stimulate physical activity and improvement of body composition in addition to the management of chronic diseases and disabilities.

Employment and Disability: Evidence From the 1996 Medical Expenditures Panel Survey

PubMed Central

Findley, Patricia A.; Sambamoorthi, Usha

2007-01-01

The relationship between employment and disability has gained national attention, as the ability to maintain employment is inconsistent among those with limitations. This cross-sectional study of employment among individuals (N = 1691, age 21–62 years) with self-reported limitations in the 1996 Medical Expenditures Panel Survey seeks to identify predictors of employment despite physical and/or cognitive limitations. Two predictive models of employment including 10 variables are explored; 1 included insurance (χ2 = 3856.85, p ≤ 0.00) and the other removed the insurance variable (χ2 = 280.21, p ≤ 0.00). Individuals with limitations who are employed are more likely to have a college-level education, have better physical and mental health perceptions and have private insurance. This analysis demonstrates that people do work despite reported activity, functional or sensory limitations and that socioeconomic factors are crucial in why someone is able to attain employment. PMID:15055500

Assessing the effects of noise abatement measures on health risks: A case study in Istanbul

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

Ongel, Aybike, E-mail: aybike.ongel@eng.bahcesehir.edu.tr; Sezgin, Fatih, E-mail: fatih.sezgin@ibb.gov.tr

In recent decades, noise pollution caused by industrialization and increased motorization has become a major concern around the world because of its adverse effects on human well-being. Therefore, transportation agencies have been implementing noise abatement measures in order to reduce road traffic noise. However, limited attention is given to noise in environmental assessment of road transportation systems. This paper presents a framework for a health impact assessment model for road transportation noise emissions. The model allows noise impacts to be addressed with the health effects of air pollutant and greenhouse gas emissions from road transportation. The health damages assessed inmore » the model include annoyance, sleep disturbance, and cardiovascular disease in terms of acute myocardial infarction. The model was applied in a case study in Istanbul in order to evaluate the change in health risks from the implementation of noise abatement strategies. The noise abatement strategies evaluated include altering pavement surfaces in order to absorb noise and introducing speed limits. It was shown that significant improvements in health risks can be achieved using open graded pavement surfaces and introducing speed limits on highways. - Highlights: • Transportation noise has a significant effect on health. • Noise should be included in the environmental assessment of transportation systems. • Traffic noise abatement measures include noise reducing pavements and speed limits. • Noise abatement measures help reduce the health risks of transportation noise. • Speed limit reduction on uncongested roads is an effective way to reduce health risks.« less

Limitations of self-care in reducing the risk of lymphedema: supportive-educative systems.

PubMed

Armer, Jane M; Brooks, Constance W; Stewart, Bob R

2011-01-01

The purpose of this study was to examine patient perceptions of limitations related to self-care measures to reduce lymphedema risk following breast cancer surgery. Secondary analysis of survey data from a companion study to a study piloting a behavioral-educational intervention was conducted to examine the specific limitations in performing lymphedema risk-reduction self-care measures. Findings suggest a more comprehensive approach is needed if patients are to engage in self-care actions to reduce lymphedema risk. Understanding the concepts of self-care and personal support interventions that include motivational interviewing can help nurses design supportive-educative care systems that assist patients in overcoming limitations in the estimative, transitional, and productive phases of self-care necessary to reduce lymphedema risk.

Consulting by Business College Academics: Lessons for Business Communication Courses

ERIC Educational Resources Information Center

Dave, Anish

2009-01-01

Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies.

PubMed

Larivée, N; Suissa, S; Khosrow-Khavar, F; Tagalakis, V; Filion, K B

2017-09-01

The effects of fourth-generation drospirenone-containing combined oral contraceptives (COCs) on the risk of venous thromboembolism (VTE) are controversial. To assess the methodological strengths and limitations of the evidence on the VTE risk of these COCs. We searched CINAHL, the Cochrane Library, EMBASE, HealthStar, Medline, and the Science Citation Index. Studies were included if they were cohort and case-control studies, reported a venous thrombotic outcome, had a comparator group, reported an effect measure of the association of interest, and were published in English or French. We assessed study quality using the ROBINS-I tool and assessed the presence of four common sources of bias: prevalent user bias, inappropriate choice of comparator, VTE misclassification, and confounding. Our systematic review included 17 studies. The relative risks of VTE associated with drospirenone- versus second-generation levonorgestrel-containing COCs ranged from 1.0 to 3.3. Based on ROBINS-I, three studies had a moderate risk, ten had a serious risk, and four had a critical risk. Nine studies included prevalent users, four included inappropriate comparators, four had VTE misclassification, and five did not account for two or more important confounding factors. The three highest quality studies had relative risks ranging from 1.0 to 1.57. As a result of the methodological limitations of the individual studies, the VTE risk of drospirenone-containing COCs remains unknown. The highest quality studies suggest there are no or slightly increased harmful effects, but their confidence limits do not rule out an almost doubling of the risk. Systematic review of drospirenone: best studies show no or slightly increased VTE risk (versus levonorgestrel). © 2017 Royal College of Obstetricians and Gynaecologists.

Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting

PubMed Central

Khatun, Selina; Ahmed, Mujaddeed; Kache, Saraswati; Chisti, Mohammod Jobayer; Sarker, Shafiqul Alam; Maples, Stace D.; Pieri, Dane; Vardhan Korrapati, Teja; Sarnquist, Clea; Federspiel, Nancy; Rahman, Muhammad Waliur; Andrews, Jason R.; Rahman, Mahmudur; Nelson, Eric Jorge

2017-01-01

The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both p < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (p < 0.001 district; p = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/ antibiotic selection. These findings demonstrate that a smartphone-based tool can improve guideline adherence. This study should serve as a catalyst for a randomized controlled trial to expand on the findings and address limitations. PMID:28103233

Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting.

PubMed

Haque, Farhana; Ball, Robyn L; Khatun, Selina; Ahmed, Mujaddeed; Kache, Saraswati; Chisti, Mohammod Jobayer; Sarker, Shafiqul Alam; Maples, Stace D; Pieri, Dane; Vardhan Korrapati, Teja; Sarnquist, Clea; Federspiel, Nancy; Rahman, Muhammad Waliur; Andrews, Jason R; Rahman, Mahmudur; Nelson, Eric Jorge

2017-01-01

The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both p < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (p < 0.001 district; p = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/ antibiotic selection. These findings demonstrate that a smartphone-based tool can improve guideline adherence. This study should serve as a catalyst for a randomized controlled trial to expand on the findings and address limitations.

Study on Market Stability and Price Limit of Chinese Stock Index Futures Market: An Agent-Based Modeling Perspective.

PubMed

Xiong, Xiong; Nan, Ding; Yang, Yang; Yongjie, Zhang

2015-01-01

This paper explores a method of managing the risk of the stock index futures market and the cross-market through analyzing the effectiveness of price limits on the Chinese Stock Index 300 futures market. We adopt a cross-market artificial financial market (include the stock market and the stock index futures market) as a platform on which to simulate the operation of the CSI 300 futures market by changing the settings of price limits. After comparing the market stability under different price limits by appropriate liquidity and volatility indicators, we find that enhancing price limits or removing price limits both play a negative impact on market stability. In contrast, a positive impact exists on market stability if the existing price limit is maintained (increase of limit by10%, down by 10%) or it is broadened to a proper extent. Our study provides reasonable advice for a price limit setting and risk management for CSI 300 futures.

Study on Market Stability and Price Limit of Chinese Stock Index Futures Market: An Agent-Based Modeling Perspective

PubMed Central

2015-01-01

This paper explores a method of managing the risk of the stock index futures market and the cross-market through analyzing the effectiveness of price limits on the Chinese Stock Index 300 futures market. We adopt a cross-market artificial financial market (include the stock market and the stock index futures market) as a platform on which to simulate the operation of the CSI 300 futures market by changing the settings of price limits. After comparing the market stability under different price limits by appropriate liquidity and volatility indicators, we find that enhancing price limits or removing price limits both play a negative impact on market stability. In contrast, a positive impact exists on market stability if the existing price limit is maintained (increase of limit by10%, down by 10%) or it is broadened to a proper extent. Our study provides reasonable advice for a price limit setting and risk management for CSI 300 futures. PMID:26571135

On the limits of numerical astronomical solutions used in paleoclimate studies

NASA Astrophysics Data System (ADS)

Zeebe, Richard E.

2017-04-01

Numerical solutions of the equations of the Solar System estimate Earth's orbital parameters in the past and represent the backbone of cyclostratigraphy and astrochronology, now widely applied in geology and paleoclimatology. Given one numerical realization of a Solar System model (i.e., obtained using one code or integrator package), various parameters determine the properties of the solution and usually limit its validity to a certain time period. Such limitations are denoted here as "internal" and include limitations due to (i) the underlying physics/physical model and (ii) numerics. The physics include initial coordinates and velocities of Solar System bodies, treatment of the Moon and asteroids, the Sun's quadrupole moment, and the intrinsic dynamics of the Solar System itself, i.e., its chaotic nature. Numerical issues include solver algorithm, numerical accuracy (e.g., time step), and round-off errors. At present, internal limitations seem to restrict the validity of astronomical solutions to perhaps the past 50 or 60 myr. However, little is currently known about "external" limitations, that is, how do different numerical realizations compare, say, between different investigators using different codes and integrators? Hitherto only two solutions for Earth's eccentricity appear to be used in paleoclimate studies, provided by two different groups that integrated the full Solar System equations over the past >100 myr (Laskar and coworkers and Varadi et al. 2003). In this contribution, I will present results from new Solar System integrations for Earth's eccentricity obtained using the integrator package HNBody (Rauch and Hamilton 2002). I will discuss the various internal limitations listed above within the framework of the present simulations. I will also compare the results to the existing solutions, the details of which are still being sorted out as several simulations are still running at the time of writing.

A systematic review of the efficacy of venlafaxine for the treatment of fibromyalgia.

PubMed

VanderWeide, L A; Smith, S M; Trinkley, K E

2015-02-01

Fibromyalgia is a painful disease affecting 1-2% of the United States population. Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and milnacipran, are well studied and frequently used for treating this disorder. However, efficacy data are limited for the SNRI venlafaxine despite its use in nearly a quarter of patients with fibromyalgia. Accordingly, we systematically reviewed the efficacy of venlafaxine for treatment of fibromyalgia. PubMed, Web of Science and the Cochrane Database were searched using the terms 'venlafaxine' and 'fibromyalgia'. Results were classified as primary studies or review articles based on abstract review. References of review articles were evaluated to ensure no primary studies evaluating venlafaxine were overlooked. All clinical studies that investigated venlafaxine for the treatment of fibromyalgia were included and graded on strength of evidence. Five studies met the inclusion criteria, including 4 open-label cohort studies and 1 randomized, controlled trial. Study durations ranged from 6 weeks to 6 months, and study sizes ranged from 11 to 102 participants. Four of the five published studies reported improvement in at least one outcome. Generally consistent improvements were observed in pain-related outcome measures, including the Fibromyalgia Impact Questionnaire (range, 26-29% reduction; n = 2 studies), Visual Analog Scale (range, 36-45% reduction; n = 2 studies), McGill Pain Questionnaire (48% reduction; n = 1 study) and Clinical Global Impression scale (51% had significant score change; n = 1 study). However, the few studies identified were limited by small sample size, inconsistent use of outcomes and methodological concerns. Studies assessing the efficacy of venlafaxine in the treatment of fibromyalgia to date have been limited by small sample size, inconsistent venlafaxine dosing, lack of placebo control and lack of blinding. In the context of these limitations, venlafaxine appears to be at least modestly effective in treating fibromyalgia. Larger randomized controlled trials are needed to further elucidate the full benefit of venlafaxine. © 2014 John Wiley & Sons Ltd.

Multiple environmental stressors elicit complex interactive effects in the western fence lizard (Sceloporus occidentalis).

PubMed

McFarland, Craig A; Talent, Larry G; Quinn, Michael J; Bazar, Matthew A; Wilbanks, Mitchell S; Nisanian, Mandana; Gogal, Robert M; Johnson, Mark S; Perkins, Edward J; Gust, Kurt A

2012-11-01

Evaluation of multiple-stressor effects stemming from habitat degradation, climate change, and exposure to chemical contaminants is crucial for addressing challenges to ecological and environmental health. To assess the effects of multiple stressors in an understudied taxon, the western fence lizard (Sceloporus occidentalis) was used to characterize the individual and combined effects of food limitation, exposure to the munitions constituent 2,4,6-trinitrotoluene (TNT), and Plasmodium mexicanum (lizard malaria) infection. Three experimental assays were conducted including: Experiment I--TNT × Food Limitation, Experiment II--Food Limitation × Malaria Infection, and Experiment III--TNT × Malaria Infection. All experiments had a 30 day duration, the malaria treatment included infected and non infected control lizards, food limitation treatments included an ad libitum control and at least one reduced food ration and TNT exposures consisting of daily oral doses of corn oil control or a corn oil-TNT suspension at 5, 10, 20, 40 mg/kg/day. The individual stressors caused a variety of effects including: reduced feeding, reduced testes mass, anemia, increased white blood cell (WBC) concentrations and increased mass of liver, kidney and spleen in TNT exposures; reduced cholesterol, WBC concentrations and whole body, testes and inguinal fat weights given food limitation; and increased WBC concentrations and spleen weights as well as decreased cholesterol and testes mass in malaria infected lizards. Additive and interactive effects were found among certain stressor combinations including elimination of TNT-induced hormesis for growth under food limitation. Ultimately, our study indicates the potential for effects modulation when environmental stressors are combined.

The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

PubMed

Gilheaney, Órla; Zgaga, Lina; Harpur, Isolde; Sheaf, Greg; Kiefer, Liss; Béchet, Sibylle; Walshe, Margaret

2017-10-01

Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.

Electronic cigarettes: abuse liability, topography and subjective effects.

PubMed

Evans, Sarah E; Hoffman, Allison C

2014-05-01

To review the available evidence evaluating the abuse liability, topography, subjective effects, craving and withdrawal suppression associated with e-cigarette use in order to identify information gaps and provide recommendations for future research. Literature searches were conducted between October 2012 and January 2014 using five electronic databases. Studies were included in this review if they were peer-reviewed scientific journal articles evaluating clinical laboratory studies, national surveys or content analyses. A total of 15 peer-reviewed articles regarding behavioural use and effects of e-cigarettes published between 2010 and 2014 were included in this review. Abuse liability studies are limited in their generalisability. Topography (consumption behaviour) studies found that, compared with traditional cigarettes, e-cigarette average puff duration was significantly longer, and e-cigarette use required stronger suction. Data on e-cigarette subjective effects (such as anxiety, restlessness, concentration, alertness and satisfaction) and withdrawal suppression are limited and inconsistent. In general, study data should be interpreted with caution, given limitations associated with comparisons of novel and usual products, as well as the possible effects associated with subjects' previous experience/inexperience with e-cigarettes. Currently, very limited information is available on abuse liability, topography and subjective effects of e-cigarettes. Opportunities to examine extended e-cigarette use in a variety of settings with experienced e-cigarette users would help to more fully assess topography as well as behavioural and subjective outcomes. In addition, assessment of 'real-world' use, including amount and timing of use and responses to use, would clarify behavioural profiles and potential adverse health effects.

Digital multishaker modal testing

NASA Technical Reports Server (NTRS)

Blair, M.; Craig, R. R., Jr.

1983-01-01

A review of several modal testing techniques is made, along with brief discussions of their advantages and limitations. A new technique is presented which overcomes many of the previous limitations. Several simulated experiments are included to verify the validity and accuracy of the new method. Conclusions are drawn from the simulation studies and recommendations for further work are presented. The complete computer code configured for the simulation study is presented.

Effectiveness of a Time-Limited Incentive on Participation by Hard-to-Reach Respondents in a Panel Study

ERIC Educational Resources Information Center

Fomby, Paula; Sastry, Narayan; McGonagle, Katherine A.

2017-01-01

We describe an experiment to provide a time-limited incentive among a random sample of 594 hard-to-reach respondents, 200 of whom were offered the incentive to complete all survey components of a study during a three-week winter holiday period. Sample members were primary caregivers of children included in the 2014 Child Development Supplement to…

Opioids, Chronic Pain, and Addiction in Primary Care

PubMed Central

Barry, Declan T.; Irwin, Kevin S.; Jones, Emlyn S.; Becker, William C.; Tetrault, Jeanette M.; Sullivan, Lynn E.; Hansen, Helena; O’Connor, Patrick G.; Schottenfeld, Richard S.; Fiellin, David A.

2010-01-01

Research has largely ignored the systematic examination of physicians’ attitudes towards providing care for patients with chronic non-cancer pain. The objective of this study was to identify barriers and facilitators to opioid treatment of chronic non-cancer pain patients by office-based medical providers. We used a qualitative study design using individual and group interviews. Participants were twenty-three office-based physicians in New England. Interviews were audiotaped, transcribed, and systematically coded by a multidisciplinary team using the constant comparative method. Physician barriers included lack of expertise in the treatment of chronic pain and co-existing disorders, including addiction; lack of interest in pain management; patients’ aberrant behaviors; and physicians’ attitudes toward prescribing opioid analgesics. Physician facilitators included promoting continuity of patient care and the use of opioid agreements. Physicians’ perceptions of patient-related barriers included lack of physician responsiveness to patients’ pain reports, negative attitudes toward opioid analgesics, concerns about cost, and patients’ low motivation for pain treatment. Perceived logistical barriers included lack of appropriate pain management and addiction referral options, limited information regarding diagnostic workup, limited insurance coverage for pain management services, limited ancillary support for physicians, and insufficient time. Addressing these barriers to pain treatment will be crucial to improving pain management service delivery. PMID:20627817

The Effect of Music on the Test Scores of the Students in Limits and Derivatives Subject in the Mathematics Exams Done with Music

ERIC Educational Resources Information Center

Kesan, Cenk; Ozkalkan, Zuhal; Iric, Hamdullah; Kaya, Deniz

2012-01-01

In the exams based on limits and derivatives, in this study, it was tried to determine that if there was any difference in students' test scores according to the type of music listened to and environment without music. For this purpose, the achievement test including limits and derivatives and whose reliability coefficient of Cronbach Alpha is…

Abatement of synthetic landfill gas including limonene by biotrickling filter and membrane biofiltration.

PubMed

Hosoglu, Fatih; Fitch, Mark W

2012-01-01

In this study, a single silicone rubber membrane biofilter was compared to a lava rock biotrickling filter to examine the aerobic biofiltration of synthetic landfill gas including odorous limonene. The membrane bioreactor and biotrickling filter showed, respectively, maximum elimination capacities of 17 g m(-3) h(-1) and 31.3 g m(-3) h(-1) for limonene and removal efficiencies of 11 % and 18 % for methane. The membrane bioreactor was apparently mass transfer-limited and the biotrickling filter was reaction-limited.

Social Competence in Late Elementary School: Relationships to Parenting and Neighborhood Context

ERIC Educational Resources Information Center

Caughy, Margaret O'Brien; Franzini, Luisa; Windle, Michael; Dittus, Patricia; Cuccaro, Paula; Elliott, Marc N.; Schuster, Mark A.

2012-01-01

Despite evidence that neighborhoods confer both risk and resilience for youth development, the existing neighborhood research has a number of methodological limitations including lack of diversity in neighborhoods sampled and neighborhood characteristics assessed. The purpose of this study was to address these methodological limitations of…

Modifying patterns of movement in people with low back pain -does it help? A systematic review.

PubMed

Laird, Robert A; Kent, Peter; Keating, Jennifer L

2012-09-07

Physiotherapy for people with low back pain frequently includes assessment and modification of lumbo-pelvic movement. Interventions commonly aim to restore normal movement and thereby reduce pain and improve activity limitation. The objective of this systematic review was to investigate: (i) the effect of movement-based interventions on movement patterns (muscle activation, lumbo-pelvic kinematics or postural patterns) of people with low back pain (LBP), and (ii) the relationship between changes in movement patterns and subsequent changes in pain and activity limitation. MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2012. Randomised controlled trials or controlled clinical trials of people with LBP were eligible for inclusion. The intervention must have been designed to influence (i) muscle activity patterns, (ii) lumbo-pelvic kinematic patterns or (iii) postural patterns, and included measurement of such deficits before and after treatment, to allow determination of the success of the intervention on the lumbo-pelvic movement. Twelve trials (25% of retrieved studies) met the inclusion criteria. Two reviewers independently identified, assessed and extracted data. The PEDro scale was used to assess method quality. Intervention effects were described using standardised differences between group means and 95% confidence intervals. The included trials showed inconsistent, mostly small to moderate intervention effects on targeted movement patterns. There was considerable heterogeneity in trial design, intervention type and outcome measures. A relationship between changes to movement patterns and improvements in pain or activity limitation was observed in one of six studies on muscle activation patterns, one of four studies that examined the flexion relaxation response pattern and in two of three studies that assessed lumbo-pelvic kinematics or postural characteristics. Movement-based interventions were infrequently effective for changing observable movement patterns. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed. No independent studies confirm any observed relationships. Challenges for future research include defining best methods for measuring (i) movement aberrations, (ii) improvements in movements, and (iii) the relationship between changes in how people move and associated changes in other health indicators such as activity limitation.

40 CFR 1611.3 - Scope of permissible testimony.

Code of Federal Regulations, 2010 CFR

2010-07-01

... other types of CSB documents, including but not limited to safety recommendations, safety studies, safety proposals, safety accomplishments, reports labeled studies, and analysis reports, as they contain...

Absenteeism due to Functional Limitations Caused by Seven Common Chronic Diseases in US Workers.

PubMed

Vuong, Tam D; Wei, Feifei; Beverly, Claudia J

2015-07-01

The study examined the relationship between functional limitation due to chronic diseases and absenteeism among full-time workers. The studied chronic diseases include arthritis/rheumatism, cancer, diabetes, heart disease, hypertension, lung disease, and stroke. We analyzed data from the 2011 to 2013 National Health Interview Survey. Economic impact was determined by workdays lost and lost income. Increase in absenteeism was observed for each studied condition. Employees with multiple conditions also saw increase absenteeism. Employers lose 28.2 million workdays annually ($4.95 billion in lost income) due to functional limitation caused by chronic diseases. The results show a burden on society due to functional limitation caused by studied chronic diseases. Employers should look into implementing intervention/prevention programs, such as the Chronic Disease Self-Management Programs, to help reduce the cost associated with absenteeism.

Clinical and Prognostic Features of Erionite-Induced Malignant Mesothelioma

PubMed Central

Demirer, Ersin; Ghattas, Christian F.; Radwan, Mohamed O.

2015-01-01

This review analytically examines the published data for erionite-related malignant pleural mesothelioma (E-MPM) and any data to support a genetically predisposed mechanism to erionite fiber carcinogenesis. Adult patients of age ≥18 years with erionite-related pleural diseases and genetically predisposed mechanisms to erionite carcinogenesis were included, while exclusion criteria included asbestos- or tremolite-related pleural diseases. The search was limited to human studies though not limited to a specific timeframe. A total of 33 studies (31042 patients) including 22 retrospective studies, 6 prospective studies, and 5 case reports were reviewed. E-MPM developed in some subjects with high exposures to erionite, though not all. Chest CT was more reliable in detecting various pleural changes in E-MPM than chest X-ray, and pleural effusion was the most common finding in E-MPM cases, by both tests. Bronchoalveolar lavage remains a reliable and relatively less invasive technique. Chemotherapy with cisplatin and mitomycin can be administered either alone or following surgery. Erionite has been the culprit of numerous malignant mesothelioma cases in Europe and even in North America. Erionite has a higher degree of carcinogenicity with possible genetic transmission of erionite susceptibility in an autosomal dominant fashion. Therapeutic management for E-MPM remains very limited, and cure of the disease is extremely rare. PMID:25683976

Clinical relevance of diagnosing COPD by fixed ratio or lower limit of normal: a systematic review.

PubMed

van Dijk, Wouter D; Gupta, Nisha; Tan, Wan C; Bourbeau, Jean

2014-02-01

Different spirometric criteria in diagnosing COPD have been advocated by different groups, debilitating adequate diagnosis and treatment of COPD. We reviewed the clinical relevance of fixed ratio and lower limit of normal (LLN) in diagnosing COPD and explored if modifying factors may affect their clinical relevance. Two reviewers independently searched PubMed and Embase for papers that compared both criteria on any clinically relevant outcome, published before June 1st, 2012, without any language restriction. Two reviewers independently extracted the study characteristics, including study design, population characteristics and diagnostic criteria used, and summarized the results of clinical relevance. Study quality was assessed by scoring forms for bias and level of evidence. Of 394 studies retrieved, 11 studies were included, with a median of 1,258 participants. Although both criteria appeared related with various clinically relevant outcomes, we were unable to prefer one criterion over the other, with various performances of the criteria for different outcomes. Should the criteria disagree on diagnosis, an alternative diagnosis should be suspected, in particular in those (elderly) with less severe airflow limitation for whom the LLN appears a better criterion. The fixed ratio appears to perform better in subjects with more severe airflow limitation. In diagnosing COPD, severity of airflow limitation appears an important factor for choosing whether the fixed ratio or LLN. Disagreement between the criteria is suggestive for an alternative diagnosis. Future studies on clinical relevance should further reveal the criterion of choice, in order to improve adequate diagnosis and consequent treatments.

Identifying and assessing strategies for evaluating the impact of mobile eye health units on health outcomes.

PubMed

Fu, Shiwan; Turner, Angus; Tan, Irene; Muir, Josephine

2017-12-01

To identify and assess strategies for evaluating the impact of mobile eye health units on health outcomes. Systematic literature review. Worldwide. Peer-reviewed journal articles that included the use of a mobile eye health unit. Journal articles were included if outcome measures reflected an assessment of the impact of a mobile eye health unit on health outcomes. Six studies were identified with mobile services offering diabetic retinopathy screening (three studies), optometric services (two studies) and orthoptic services (one study). This review identified and assessed strategies in existing literature used to evaluate the impact of mobile eye health units on health outcomes. Studies included in this review used patient outcomes (i.e. disease detection, vision impairment, treatment compliance) and/or service delivery outcomes (i.e. cost per attendance, hospital transport use, inappropriate referrals, time from diabetic retinopathy photography to treatment) to evaluate the impact of mobile eye health units. Limitations include difficulty proving causation of specific outcome measures and the overall shortage of impact evaluation studies. Variation in geographical location, service population and nature of eye care providers limits broad application. © 2017 National Rural Health Alliance Inc.

Proteome analysis to assess physiological changes in Escherichia coli grown under glucose-limited fed-batch conditions.

PubMed

Raman, Babu; Nandakumar, M P; Muthuvijayan, Vignesh; Marten, Mark R

2005-11-05

Proteome analysis was used to compare global protein expression changes in Escherichia coli fermentation between exponential and glucose-limited fed-batch phase. Two-dimensional gel electrophoresis and MALDI-TOF mass spectrometry were used to separate and identify 49 proteins showing >2-fold difference in expression. Proteins upregulated during exponential phase include ribonucleotide biosynthesis enzymes and ribosomal recycling factor. Proteins upregulated during fed-batch phase include those involved in high-affinity glucose uptake, transport and degradation of alternate carbon sources and TCA cycle, suggesting an enhanced role of the cycle under glucose- and energy-limited conditions. We report the upregulation of several putative proteins (ytfQ, ygiS, ynaF, yggX, yfeX), not identified in any previous study under carbon-limited conditions. Copyright (c) 2005 Wiley Periodicals, Inc.

FUNCTIONAL LIMITATION AND DEPRESSIVE SYMPTOMATOLOGY: CONSIDERING PERCEIVED STIGMA AND DISCRIMINATION WITHIN A STRESS AND COPING FRAMEWORK

PubMed Central

Brown, Robyn Lewis

2016-01-01

This study examines whether perceived stigma and discrimination moderate the associations between functional limitation, psychosocial coping resources, and depressive symptoms among people with physical disabilities. Using two waves of data from a large community study including a representative sample of persons with physical disabilities (N=417), an SEM-based moderated mediation analysis was performed. Mediation tests demonstrate that mastery significantly mediates the association between functional limitation and depressive symptoms over the study period. Moderated mediation tests reveal that the linkage between functional limitation and mastery varies as a function of perceived stigma and experiences of major discrimination and day-to-day discrimination, however. The implications of these findings are discussed in the context of the stress and coping literature. PMID:28497112

Plastid proteomics for elucidating iron limited remodeling of plastid physiology in diatoms

NASA Astrophysics Data System (ADS)

Gomes, K. M.; Nunn, B. L.; Jenkins, B. D.

2016-02-01

Diatoms are important primary producers in the world's oceans and their growth is constrained in large regions by low iron availability. This low iron-induced limitation of primary production is due to the requirement for iron in components of essential metabolic pathways including key chloroplast functions such as photosynthesis and nitrate assimilation. Diatoms can bloom and accumulate high biomass during introduction of iron into low iron waters, indicating adaptations allowing for their survival in iron-limited waters and rapid growth when iron becomes more abundant. Prior studies have shown that under iron limited stress, diatoms alter plastid-specific processes including components of electron transport, size of light harvesting capacity and chlorophyll content, suggesting plastid-specific protein regulation. Due to their complex evolutionary history, resulting from a secondary endosymbiosis, knowledge regarding the complement of plastid localized proteins remains limited in comparison to other model photosynthetic organisms. While in-silico prediction of diatom protein localization provides putative candidates for plastid-localization, these analyses can be limited as most plastid prediction models were developed using plants, primary endosymbionts. In order to characterize proteins enriched in diatom chloroplast and to understand how the plastid proteome is remodeled in response to iron limitation, we used mass spectrometry based proteomics to compare plastid- enriched protein fractions from Thalassiosira pseudonana, grown in iron replete and limited conditions. These analyses show that iron stress alters regulation of major metabolic pathways in the plastid including the Calvin cycle and fatty acid synthesis. These components provide promising targets to further characterize the plastid specific response to iron limitation.

Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer - a systematic review.

PubMed

Roe, Justin W G; Carding, Paul N; Dwivedi, Raghav C; Kazi, Rehan A; Rhys-Evans, Peter H; Harrington, Kevin J; Nutting, Christopher M

2010-10-01

A systematic review to establish what evidence is available for swallowing outcomes following IMRT for head and neck cancer. Online electronic databases were searched to identify papers published in English from January 1998 to December 2009. Papers were independently appraised by two reviewers for methodological quality, method of swallowing evaluation and categorized according to the World Health Organisation's International Classification of Health Functions. The impact of radiation dose to dysphagia aspiration risk structures (DARS) was also evaluated. Sixteen papers met the inclusion criteria. The literature suggests that limiting the radiation dose to certain structures may result in favourable swallowing outcomes. Methodological limitations included variable assessment methods and outcome measures and heterogeneity of patients. There are only limited prospective data, especially where pre-treatment measures have been taken and compared to serial post-treatment assessment. Few studies have investigated the impact of IMRT on swallow function and the impact on everyday life. Initial studies have reported potential benefits but are limited in terms of study design and outcome data. Further well designed, prospective, longitudinal swallowing studies including multidimensional evaluation methods are required to enable a more comprehensive understanding of dysphagia complications and inform pre-treatment counselling and rehabilitation planning. Copyright © 2010 Elsevier Ltd. All rights reserved.

Osteoarthritis year in review: rehabilitation and outcomes.

PubMed

Davis, A M

2012-03-01

This review highlights seminal publications of rehabilitation interventions and outcomes in osteoarthritis (OA) of the hip or knee. Medline, CINAHL, and Embase databases from September 2010 through August 2011 were searched using the key words 'osteoarthritis', rehabilitation, physical therapy, exercise, and outcome(s), limited to human and English. Rehabilitation intervention studies were included if they were randomized trials (RCT), systematic reviews or meta-analyses. Studies of surgical interventions were excluded unless they included evaluation of a rehabilitation intervention. Outcome studies were included if they contributed methodologically to advancing outcome measurement. Reviews of measurement properties of outcomes were excluded. Eight publications were selected and reviewed that relate to interventions evaluating manual therapy in hip or knee OA, tele-rehabilitation and performance and participation measures as outcomes. One systematic review of hip and knee OA, one meta-analysis of knee OA provide limited support for the benefit of manual therapy with exercise for improving pain and function to a lesser extent in the short-term (3 months). Study quality overall was low. One high quality RCT in knee replacement of usual outpatient physiotherapy vs internet-based tele-rehabilitation based on a non-inferiority analysis demonstrated comparable outcomes on Western Ontario McMaster Universities' Osteoarthritis questionnaire (WOMAC) pain and function and performance measures. Three studies demonstrated that observed performance measures such as timed walk tests and stair-climbing and timed-up-and-go measure concepts differ from self-report of difficulty with physical function. Additionally, two studies showed differential times of recovery following total knee replacement (TKR). Two studies evaluated participation. One demonstrated the conceptual distinction of activity limitations and participation and a second re-analyzed trial data from knee OA studies. In one study, there were larger effects in combined activity/participation than for activity alone for arthroscopic lavage compared to intraarticular steroid and, in a second study, the effect was larger for activity with an advanced pharmacy intervention whereas the physiotherapy intervention demonstrated a larger effect for activity/participation. Interventions of manual therapy for hip and knee OA provided limited evidence of effectiveness. These studies are of limited quality due to lack of blinding and disclosure of co-intervention. Tele-rehabilitation may be a viable option to improve access to rehabilitation post joint replacement for those in rural and remote areas. Data continue to support the need to include performance measures as well as patient-reported outcomes in evaluating outcomes in OA. Additionally, measures of participation should be considered as core outcomes. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Performance evaluation capabilities for the design of physical systems

NASA Technical Reports Server (NTRS)

Pilkey, W. D.; Wang, B. P.

1972-01-01

The results are presented of a study aimed at developing and formulating a capability for the limiting performance of large steady state systems. The accomplishments reported include: (1) development of a theory of limiting performance of large systems subject to steady state inputs; (2) application and modification of PERFORM, the computational capability for the limiting performance of systems with transient inputs; and (3) demonstration that use of an inherently smooth control force for a limiting performance calculation improves the system identification phase of the design process for physical systems subjected to transient loading.

Correlates and Predictors of Mobility Limitation in Community-Dwelling Hispanic Older Adults in the United States: A Systematic Review.

PubMed

Chung, Jane; Flores-Montoya, Angelina

2018-06-01

This article presents a systematic review of the literature on correlates/predictors of mobility limitation among community-dwelling U.S. Hispanic older adults. A search of scientific databases (PubMed, CINAHL, and PsycINFO) was conducted. After abstract and full text review, 20 epidemiologic studies that met all eligibility criteria were included. The theoretical framework of mobility was used to categorize factors related to mobility limitation. The majority of the studies reviewed (n = 17) examined some aspect of physical factors in relation to mobility limitation. Several factors emerged as important influences on mobility outcomes: diabetes mellitus, stroke, obesity, arthritis, and depression. None examined the influence of built environment. This review suggests that multilevel factors can impact both mobility limitations and disability among U.S. Hispanic older adults. However, the study findings were inconsistent, with some studies showing significant relationships or effects and others demonstrating no associations or mixed findings.

Design and Analysis of Precise Pointing Systems

NASA Technical Reports Server (NTRS)

Kim, Young K.

2000-01-01

The mathematical models of Glovebox Integrated Microgravity Isolation Technology (g- LIMIT) dynamics/control system, which include six degrees of freedom (DOF) equations of motion, mathematical models of position sensors, accelerometers and actuators, and acceleration and position controller, were developed using MATLAB and TREETOPS simulations. Optimal control parameters of G-LIMIT control system were determined through sensitivity studies and its performance were evaluated with the TREETOPS model of G-LIMIT dynamics and control system. The functional operation and performance of the Tektronix DTM920 digital thermometer were studied and the inputs to the crew procedures and training of the DTM920 were documented.

Functional Magnetic Resonance Imaging and Functional Near-Infrared Spectroscopy: Insights from Combined Recording Studies

PubMed Central

Scarapicchia, Vanessa; Brown, Cassandra; Mayo, Chantel; Gawryluk, Jodie R.

2017-01-01

Although blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) is a widely available, non-invasive technique that offers excellent spatial resolution, it remains limited by practical constraints imposed by the scanner environment. More recently, functional near infrared spectroscopy (fNIRS) has emerged as an alternative hemodynamic-based approach that possesses a number of strengths where fMRI is limited, most notably in portability and higher tolerance for motion. To date, fNIRS has shown promise in its ability to shed light on the functioning of the human brain in populations and contexts previously inaccessible to fMRI. Notable contributions include infant neuroimaging studies and studies examining full-body behaviors, such as exercise. However, much like fMRI, fNIRS has technical constraints that have limited its application to clinical settings, including a lower spatial resolution and limited depth of recording. Thus, by combining fMRI and fNIRS in such a way that the two methods complement each other, a multimodal imaging approach may allow for more complex research paradigms than is feasible with either technique alone. In light of these issues, the purpose of the current review is to: (1) provide an overview of fMRI and fNIRS and their associated strengths and limitations; (2) review existing combined fMRI-fNIRS recording studies; and (3) discuss how their combined use in future research practices may aid in advancing modern investigations of human brain function. PMID:28867998

Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

PubMed Central

Scanlon, Michael L; Vreeman, Rachel C

2013-01-01

The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency virus (HIV)-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a compelling case for more data to guide strategies to improve access and adherence to treatment in resource-limited settings. PMID:23326204

Attention to Attributes and Objects in Working Memory

ERIC Educational Resources Information Center

Cowan, Nelson; Blume, Christopher L.; Saults, J. Scott

2013-01-01

It has been debated on the basis of change-detection procedures whether visual working memory is limited by the number of objects, task-relevant attributes within those objects, or bindings between attributes. This debate, however, has been hampered by several limitations, including the use of conditions that vary between studies and the absence…

Agents of Change in Promoting Reflective Abstraction: A Quasi-Experimental, Study on Limits in College Calculus

ERIC Educational Resources Information Center

Cappetta, Robert W.; Zollman, Alan

2013-01-01

We measured student performance on the concept of limit by promoting reflection through four agents of change: instructor, peer, curriculum and individual. It is based on Piaget's four constructs of reflective abstraction: interiorization, coordination, encapsulation, and generalization, and includes the notion of reversal, as refined into a…

The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review

PubMed Central

Hudson, Briony F; Oostendorp, Linda JM; Candy, Bridget; Vickerstaff, Victoria; Jones, Louise; Lakhanpaul, Monica; Bluebond-Langner, Myra; Stone, Paddy

2016-01-01

Background: Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. Aim: To explore how children and young people (aged 0–25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. Design: Systematic review. Data sources: MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. Results: A total of 215 studies – 152 qualitative, 54 quantitative and 9 mixed methods – were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants’ perceptions of potential burdens. Conclusion: All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment. PMID:27609607

Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review.

PubMed

Long, Kristin A; Lehmann, Vicky; Gerhardt, Cynthia A; Carpenter, Aubrey L; Marsland, Anna L; Alderfer, Melissa A

2018-06-01

Siblings' psychosocial adjustment to childhood cancer is poorly understood. This systematic review summarizes findings and limitations of the sibling literature since 2008, provides clinical recommendations, and offers future research directions. MEDLINE/Pubmed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched for articles related to siblings, psychosocial functioning, and pediatric cancer. After systematic screening, studies meeting inclusion criteria were rated for scientific merit, and findings were extracted and synthesized. In total, 102 studies were included (63 quantitative, 35 qualitative, 4 mixed-methods). Methodological limitations are common. Mean levels of anxiety, depression, and general adjustment are similar across siblings and comparisons, but symptoms of cancer-related posttraumatic stress are prevalent. School-aged siblings display poorer academic functioning and more absenteeism but similar peer relationships as peers. Quality of life findings are mixed. Adult siblings engage in higher levels of risky health behaviors and may have poorer health outcomes than comparisons. Risk factors for poor sibling adjustment include lower social support, poorer family functioning, lower income, non-White race, and shorter time since diagnosis, but findings are inconsistent. Qualitative themes include siblings' maturity, compassion, and autonomy, but also strong negative emotions, uncertainty, family disruptions, limited parental support, school problems, altered friendships, and unmet needs. Despite methodological limitations, research indicates a strong need for sibling support. Clinical recommendations include identifying at-risk siblings and developing interventions to facilitate family communication and increase siblings' social support, cancer-related knowledge, and treatment involvement. Future longitudinal studies focusing on mechanisms and moderators of siblings' adjustment would inform timing and targets of psychosocial care. Copyright © 2018 John Wiley & Sons, Ltd.

Three-Dimensional Upward Flame Spreading in Partial-Gravity Buoyant Flows

NASA Technical Reports Server (NTRS)

Sacksteder, Kurt R.; Feier, Ioan I.; Shih, Hsin-Yi; T'ien, James S.

2001-01-01

Reduced-gravity environments have been used to establish low-speed, purely forced flows for both opposed- and concurrent-flow flame spread studies. Altenkirch's group obtained spacebased experimental results and developed unsteady, two-dimensional numerical simulations of opposed-flow flame spread including gas-phase radiation, primarily away from the flammability limit for thin fuels, but including observations of thick fuel quenching in quiescent environments. T'ien's group contributed some early flame spreading results for thin fuels both in opposed flow and concurrent flow regimes, with more focus on near-limit conditions. T'ien's group also developed two- and three-dimensional numerical simulations of concurrent-flow flame spread incorporating gas-phase radiative models, including predictions of a radiatively-induced quenching limit reached in very low-speed air flows. Radiative quenching has been subsequently observed in other studies of combustion in very low-speed flows including other flame spread investigations, droplet combustion and homogeneous diffusion flames, and is the subject of several contemporary studies reported in this workshop. Using NASA aircraft flying partial-gravity "parabolic" trajectories, flame spreading in purely buoyant, opposed-flow (downward burning) has been studied. These results indicated increases in flame spread rates and enhanced flammability (lower limiting atmospheric oxygen content) as gravity levels were reduced from normal Earth gravity, and were consistent with earlier data obtained by Altenkirch using a centrifuge. In this work, experimental results and a three-dimensional numerical simulation of upward flame spreading in variable partial-gravity environments were obtained including some effects of reduced pressure and variable sample width. The simulation provides physical insight for interpreting the experimental results and shows the intrinsic 3-D nature of buoyant, upward flame spreading. This study is intended to link the evolving understanding of flame spreading in purely-forced flows to the purely-buoyant flow environment, particularly in the concurrent flow regime; provide additional insight into the existence of steady flame spread in concurrent flows; and stimulate direct comparisons between opposed- and concurrent-flow flame spread. Additionally, this effort is intended to provide direct practical understanding applicable to fire protection planning for the habitable facilities in partial gravity environments of anticipated Lunar and Martian explorations.

Using High-Resolution, Regional-Scale Data to Characterize Floating Aquatic Nuisance Vegetation in Coastal Louisiana Navigation Channels

DTIC Science & Technology

2014-01-01

Comparison of footprints from various image sensors used in this study . Landsat (blue) is in the upper left panel, SPOT (yellow) is in the upper right...the higher resolution sensors evaluated as part of this study are limited to four spectral bands. Moderate resolution processing. ArcGIS ...moderate, effective useful coverage may be much more limited for a scene that includes significant amounts of water. Throughout the study period, SPOT 4

Effects of Physical Limitations on Daily Activities Among Adults With Mental Health Disorders: Opportunities for Nursing and Occupational Therapy Interventions.

PubMed

Gardner, Jennifer; Swarbrick, Margaret; Ackerman, Ariane; Church, Theodora; Rios, Vanessa; Valente, Laura; Rutledge, John

2017-10-01

Individuals living with mental health disorders served by the public mental health system often face comorbid medical conditions that affect their quality of life and lifespan. The effect of physical limitations on the engagement in daily activities among individuals living with mental health disorders has not been extensively researched. Adults attending community wellness centers (N = 53) in a northeastern United State were included in a descriptive study exploring the impact of physical limitations on daily activities. The activities most frequently affected were: walking or moving around, sleeping, and finding a job. The physical limitations affecting these three activities were lack of energy and pain. Health care professionals, including mental health nurses and occupational therapy practitioners, are in an ideal position to collaborate by evaluating and offering treatment interventions that address physical limitations to positively affect occupational functioning and recovery. [Journal of Psychosocial Nursing and Mental Health Services, 55(10), 45-51.]. Copyright 2017, SLACK Incorporated.

Plasma rich in growth factors had limited effect on early bone formation in extraction sockets: Response to "Anitua, E., Alkhraisat, M.H. & Orive, G. (2013) Letter to the Editor: Rigorous methodology is the school of coherent conclusions in science. European Journal of Oral Implantology 6: 9-11.".

PubMed

Farina, Roberto; Bressan, Eriberto; Taut, Andrei; Cucchi, Alessandro; Trombelli, Leonardo

2014-10-01

To address the criticisms raised by Anitua et al. (European Journal of Oral Implantology, 6, 2013, 9-11) to the article "Plasma Rich in Growth Factors (PRGF) in Human Post-Extraction Sockets: an Histological and Histomorphometric Study.", recently published by Farina and colleagues (Clinical Oral Implants Research 2012; doi: 10.1111/clr.12033). All the methodological aspects criticized in the letter by Anitua et al. were thoroughly reconsidered and discussed in a structured short communication. When indicated, pertinent, additional material was included to reinforce our considerations. As most clinical studies in implant dentistry, including previous studies evaluating the efficacy/effectiveness of PRGF, the study by Farina et al. has some limitations. However, it is currently the only published controlled trial using quantitative parameters related to PRGF-induced early bone formation. Despite all limitations, the results of the study by Farina et al., which were based on different quantitative parameters (micro-CT scan, immunohistochemical markers of wound healing and bone deposition), indicated a limited effect of PRGF on early bone formation in extraction sockets. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Algorithms for Data Sharing, Coordination, and Communication in Dynamic Network Settings

DTIC Science & Technology

2007-12-03

problems in dynamic networks, focusing on mobile networks with wireless communication. Problems studied include data management, time synchronization ...The discovery of a fundamental limitation in capabilities for time synchronization in large networks. (2) The identification and development of the...Problems studied include data management, time synchronization , communication problems (broadcast, geocast, and point-to-point routing), distributed

A Case Study of Tack Tiles[R] Literacy Instruction for a Student with Multiple Disabilities Including Congenital Blindness

ERIC Educational Resources Information Center

Klenk, Jessicia A.; Pufpaff, Lisa A.

2011-01-01

Research on literacy instruction for students with multiple disabilities is limited. Empirical research on braille instruction for students with multiple disabilities that include congenital blindness is virtually nonexistent. This case study offers initial insight into possible methods of early braille literacy instruction for a student with…

40 CFR 60.2958 - What must I include in the deviation report?

Code of Federal Regulations, 2010 CFR

2010-07-01

... limitations or operating limit requirements. (b) The averaged and recorded data for those dates. (c) Durations and causes of each deviation from the emission limitations or operating limits and your corrective... limitations or operating limits specified in this subpart, include the seven items described in paragraphs (a...

40 CFR 60.3053 - What must I include in the deviation report?

Code of Federal Regulations, 2010 CFR

2010-07-01

... limitations or operating limit requirements. (b) The averaged and recorded data for those dates. (c) Durations and causes of each deviation from the emission limitations or operating limits and your corrective... limitations or operating limits specified in this subpart, include the seven items described in paragraphs (a...

40 CFR 60.2780 - What must I include in the deviation report?

Code of Federal Regulations, 2010 CFR

2010-07-01

... from the emission limitations or operating limit requirements. (b) The averaged and recorded data for those dates. (c) Duration and causes of each deviation from the emission limitations or operating limits... deviated from the emission limitations or operating limits specified in this subpart, include the six items...

Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations.

PubMed

Long, Brit; Koyfman, Alex; Vivirito, Michael A

2017-12-01

Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. Capnography includes the noninvasive measurement of CO 2 , providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients. Since the 1990s, capnography has been utilized extensively for cardiac arrest and procedural sedation. Qualitative capnography includes a colorimetric device, changing color on the amount of CO 2 present. Quantitative capnography provides a numeric value (end-tidal CO 2 ), and capnography most commonly includes a waveform as a function of time. Conditions in which capnography is informative include cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Patients with seizure, trauma, and respiratory conditions, such as pulmonary embolism and obstructive airway disease, can benefit from capnography, but further study is needed. Limitations include use of capnography in conditions with mixed pathophysiology, patients with low tidal volumes, and equipment malfunction. Capnography should be used in conjunction with clinical assessment. Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment. Published by Elsevier Inc.

Surgery for limited-stage small-cell lung cancer.

PubMed

Barnes, Hayley; See, Katharine; Barnett, Stephen; Manser, Renée

2017-04-21

Current treatment guidelines for limited-stage small-cell lung cancer (SCLC) recommend concomitant platinum-based chemo-radiotherapy plus prophylactic cranial irradiation, based on the premise that SCLC disseminates early, and is chemosensitive. However, although there is usually a favourable initial response, relapse is common and the cure rate for limited-stage SCLC remains relatively poor. Some recent clinical practice guidelines have recommended surgery for stage 1 (limited) SCLC followed by adjuvant chemotherapy, but this recommendation is largely based on the findings of observational studies. To determine whether, in patients with limited-stage SCLC, surgical resection of cancer improves overall survival and treatment-related deaths compared with radiotherapy or chemotherapy, or a combination of radiotherapy and chemotherapy, or best supportive care. We performed searches on CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science up to 11 January 2017. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. We included randomised controlled trials (RCTs) with adults diagnosed with limited-stage SCLC, confirmed by cytology or histology, and radiological assessment, considered medically suitable for resection and radical radiotherapy, which randomised participants to surgery versus any other intervention. We imported studies identified by the search into a reference manager database. We retrieved the full-text version of relevant studies, and two review authors independently extracted data. The primary outcome measures were overall survival and treatment-related deaths; and secondary outcome measures included loco-regional progression, quality of life, and adverse events. We included three trials with 330 participants. We judged the quality of the evidence as very low for all the outcomes. The quality of the data was limited by the lack of complete outcome reporting, unclear risk of bias in the methods in which the studies were conducted, and the age of the studies (> 20 years). The methods of cancer staging and types of surgical procedures, which do not reflect current practice, reduced our confidence in the estimation of the effect.Two studies compared surgery to radiation therapy, and in one study chemotherapy was administered to both arms. One study administered initial chemotherapy, then responders were randomised to surgery versus control; following, both groups underwent chest and whole brain irradiation.Due to the clinical heterogeneity of the trials, we were unable to pool results for meta-analysis.All three studies reported overall survival. One study reported a mean overall survival of 199 days in the surgical arm, compared to 300 days in the radiotherapy arm (P = 0.04). One study reported overall survival as 4% in the surgical arm, compared to 10% in the radiotherapy arm at two years. Conversely, one study reported overall survival at two years as 52% in the surgical arm, compared to 18% in the radiotherapy arm. However this difference was not statistically significant (P = 0.12).One study reported early postoperative mortality as 7% for the surgical arm, compared to 0% mortality in the radiotherapy arm. One study reported the difference in mean degree of dyspnoea as -1.2 comparing surgical intervention to radiotherapy, indicating that participants undergoing radiotherapy are likely to experience more dyspnoea. This was measured using a non-validated scale. Evidence from currently available RCTs does not support a role for surgical resection in the management of limited-stage small-cell lung cancer; however our conclusions are limited by the quality of the available evidence and the lack of contemporary data. The results of the trials included in this review may not be generalisable to patients with clinical stage 1 small-cell lung cancer carefully staged using contemporary staging methods. Although some guidelines currently recommend surgical resection in clinical stage 1 small-cell lung cancer, prospective randomised controlled trials are needed to determine if there is any benefit in terms of short- and long-term mortality and quality of life compared with chemo-radiotherapy alone.

Attempting to be active: Self-efficacy and barrier limitation differentiate activity levels of working mothers.

PubMed

Gierc, Madelaine; Locke, Sean; Jung, Mary; Brawley, Lawrence

2016-07-01

Working mothers are less physically active than working women without children and mothers who do not work. The purpose of this study was to examine concurrent self-regulatory efficacy and barriers to physical activity in a sample of working mothers. Women completed a mixed-methods survey which included measures of physical activity, concurrent self-regulatory efficacy, and barriers. Sufficiently active women experienced significantly greater concurrent self-regulatory efficacy and significantly less barrier limitation and frequency. No significant group differences were found for age, domestic duties performed, and children's extracurricular activities. Thematic analysis of barriers revealed six themes of common and unique factors, including limited time and family activities. © The Author(s) 2014.

Orbital studies of lunar magnetism

NASA Technical Reports Server (NTRS)

Mcleod, M. G.; Coleman, P. J., Jr.

1982-01-01

Limitations of present lunar magnetic maps are considered. Optimal processing of satellite derived magnetic anomaly data is also considered. Studies of coastal and core geomagnetism are discussed. Lunar remanent and induced lunar magnetization are included.

Biogeochemistry of vertebrate decomposition in a forest ecosystem

USDA-ARS?s Scientific Manuscript database

Decomposing plants and animals provide critical nutrients for ecosystems, including forests. During vertebrate decay, the rapid release of limiting nutrients, including N, P, C, and S fundamentally transforms the soil environment by stimulating endogenous organisms. The goal of this study was t...

Measurement properties of instruments that assess participation in young people with autism spectrum disorder: a systematic review.

PubMed

Lami, Francesca; Egberts, Kristine; Ure, Alexandra; Conroy, Rowena; Williams, Katrina

2018-03-01

To systematically review the measurement properties of instruments assessing participation in young people with autism spectrum disorder (ASD). A search was performed in MEDLINE, PsycINFO, and PubMed combining three constructs ('ASD', 'test of participation', 'measurement properties'). Results were restricted to articles including people aged 6 to 29 years. The 2539 identified articles were independently screened by two reviewers. For the included articles, data were extracted using standard forms and their risk of bias was assessed. Nine studies (8 cross-sectional) met the inclusion criteria, providing information on seven different instruments. The total sample included 634 participants, with sex available for 600 (males=494; females=106) and age available for 570, with mean age for these participants 140.58 months (SD=9.11; range=36-624). Included instruments were the school function assessment, vocational index, children's assessment of participation and enjoyment/preferences for activities of children, experience sampling method, Pediatric Evaluation of Disability Inventory, Computer Adaptive Test, adolescent and young adult activity card sort, and Patient-Reported Outcomes Measurement Information System parent-proxy peer relationships. Seven studies assessed reliability and validity; good properties were reported for half of the instruments considered. Most studies (n=6) had high risk of bias. Overall the quality of the evidence for each tool was limited. Validation of these instruments, or others that comprehensively assess participation, is needed. Future studies should follow recommended methodological standards. Seven instruments have been used to assess participation in young people with autism. One instrument, with excellent measurement properties in one study, does not comprehensively assess participation. Studies of three instruments that incorporate a more comprehensive assessment of participation have methodological limitations. Overall, limited evidence exists regarding measurement properties of participation assessments for young people with autism. © 2017 Mac Keith Press.

Physical Performance Limitations in Adolescent and Adult Survivors of Childhood Cancer and Their Siblings

PubMed Central

Rueegg, Corina S.; Michel, Gisela; Wengenroth, Laura; von der Weid, Nicolas X.; Bergstraesser, Eva; Kuehni, Claudia E.; Ammann, R.; Angst, R.; Beck Popovic, M.; Bergstraesser, E.; Brazzola, P.; Caflisch, U.; Greiner, J.; Grotzer, M.; Hengartner, H.; Kühne, T.; Leibundgut, K.; Niggli, F.; Nobile Buetti, L.; Ozsahin, H.; Paulussen, M.; Rischewski, J.; von der Weid, N.

2012-01-01

Purpose This study investigates physical performance limitations for sports and daily activities in recently diagnosed childhood cancer survivors and siblings. Methods The Swiss Childhood Cancer Survivor Study sent a questionnaire to all survivors (≥16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976–2003 aged <16 years. Siblings received similar questionnaires. We assessed two types of physical performance limitations: 1) limitations in sports; 2) limitations in daily activities (using SF-36 physical function score). We compared results between survivors diagnosed before and after 1990 and determined predictors for both types of limitations by multivariable logistic regression. Results The sample included 1038 survivors and 534 siblings. Overall, 96 survivors (9.5%) and 7 siblings (1.1%) reported a limitation in sports (Odds ratio 5.5, 95%CI 2.9-10.4, p<0.001), mainly caused by musculoskeletal and neurological problems. Findings were even more pronounced for children diagnosed more recently (OR 4.8, CI 2.4–9.6 and 8.3, CI 3.7–18.8 for those diagnosed <1990 and ≥1990, respectively; p = 0.025). Mean physical function score for limitations in daily activities was 49.6 (CI 48.9–50.4) in survivors and 53.1 (CI 52.5–53.7) in siblings (p<0.001). Again, differences tended to be larger in children diagnosed more recently. Survivors of bone tumors, CNS tumors and retinoblastoma and children treated with radiotherapy were most strongly affected. Conclusion Survivors of childhood cancer, even those diagnosed recently and treated with modern protocols, remain at high risk for physical performance limitations. Treatment and follow-up care should include tailored interventions to mitigate these late effects in high-risk patients. PMID:23082232

The Promise and Perils of Population Research on Same-Sex Families.

PubMed

Reczek, Corinne; Spiker, Russell; Liu, Hui; Crosnoe, Robert

2017-12-01

As a follow-up to our 2016 study, this article presents new findings examining the relationship between same-sex family structure and child health using the 2008-2015 National Health Interview Survey (NHIS). After discussing NIHS data problems, we examine the relationship between family structure and a broad range of child well-being outcomes, including school days lost, behavior, parent-rated health, emotional difficulties, and activity limitations. We find both similarities (school days lost, behavior, parent-rated health) and differences (emotional difficulties and activity limitations) across our two studies using different survey years, but our overall conclusions are robust. We further discuss the implications of our findings for future research on this topic, including how to account for biological relatedness in a study on child health in same-sex families.

Underlying risk factors for prescribing errors in long-term aged care: a qualitative study.

PubMed

Tariq, Amina; Georgiou, Andrew; Raban, Magdalena; Baysari, Melissa Therese; Westbrook, Johanna

2016-09-01

To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing. 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/

What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles.

PubMed

Philibert, Ingrid

2016-12-01

Examining influential, highly cited articles can show the advancement of knowledge about the effect of resident physicians' long work hours, as well as the benefits and drawbacks of work hour limits. A narrative review of 30 articles, selected for their contribution to the literature, explored outcomes of interest in the research on work hours-including patient safety, learning, and resident well-being. Articles were selected from a comprehensive review. Citation volume, quality, and contribution to the evolving thinking on work hours and to the Accreditation Council for Graduate Medical Education standards were assessed. Duty hour limits are supported by the scientific literature, particularly limits on weekly hours and reducing the frequency of overnight call. The literature shows declining hours and call frequency over 4 decades of study, although the impact on patient safety, learning, and resident well-being is not clear. The review highlighted limitations of the scientific literature on resident hours, including small samples and reduced generalizability for intervention studies, and the inability to rule out confounders in large studies using administrative data. Key areas remain underinvestigated, and accepted methodology is challenged when assessing the impact of interventions on the multiple outcomes of interest. The influential literature, while showing the beneficial effect of work hour limits, does not answer all questions of interest in determining optimal limits on resident hours. Future research should use methods that permit a broader, collective examination of the multiple, often competing attributes of the learning environment that collectively promote patient safety and resident learning and well-being.

Wastewater Phosphorus Removal by Two Different Types of Andesitic Volcanic Tephra

ERIC Educational Resources Information Center

Liesch, Amanda M.

2010-01-01

Phosphorus (P) is the limiting nutrient controlling productivity in most inland freshwater systems. Several materials have been proposed for use to remove excess P from wastewater treatment, including volcanic lapilli and ash (tephra). There is limited data in using tephra as a P filter. There were two objectives of this study: (1) to determine…

An Examination of School Factors Which Support and Limit Efficiency in Rural Special Education Resource Room Teachers

ERIC Educational Resources Information Center

Fankhauser, Jeff

2010-01-01

This dissertation examines the school factors which support and limit efficacy in rural special education resource room teachers. To explore these factors, a qualitative case study involving interviews, observations, and data analysis was conducted during the spring of 2010. Data collection included interviews and observations of the teachers,…

Parent skills training for parents of children or adults with developmental disorders: systematic review and meta-analysis protocol.

PubMed

Reichow, Brian; Kogan, Cary; Barbui, Corrado; Smith, Isaac; Yasamy, M Taghi; Servili, Chiara

2014-08-27

Developmental disorders, including intellectual disability and autism spectrum disorders, may limit an individual's capacity to conduct daily activities. The emotional and economic burden on families caring for an individual with a developmental disorder is substantial, and quality of life may be limited by a lack of services. Therefore, finding effective treatments to help this population should be a priority. Recent work has shown parent skills training interventions improve developmental, behavioural and family outcomes. The purpose of this review protocol is to extend previous findings by systematically analysing randomised controlled trials of parent skills training programmes for parents of children with developmental disorders including intellectual disabilities and autism spectrum disorders and use meta-analytic techniques to identify programme components reliably associated with successful outcomes of parent skills training programmes. We will include all studies conducted using randomised control trials designs that compare a group of parents receiving a parent skills training programme to a group of parents in a no-treatment control, waitlist control or treatment as usual comparison group. To locate studies, we will conduct an extensive electronic database search and then use snowball methods, with no limits to publication year or language. We will present a narrative synthesis including visual displays of study effects on child and parental outcomes and conduct a quantitative synthesis of the effects of parent skills training programmes using meta-analytic techniques. No ethical issues are foreseen and ethical approval is not required given this is a protocol for a systematic review. The findings of this study will be disseminated through peer-reviewed publications and international conference presentations. Updates of the review will be conducted, as necessary, to inform and guide practice. PROSPERO (CRD42014006993). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Prevalence of driving with blood drug concentrations above proposed new legal limits in Norway: estimations based on drug concentrations in oral fluid.

PubMed

Gjerde, Hallvard; Normann, Per T; Christophersen, Asbjørg S; Mørland, Jørg

2011-07-15

To estimate the prevalence of driving with blood drug concentrations above the recently proposed Norwegian legal limits for drugged driving in random traffic. The results from a roadside survey of 10,816 drivers was used as basis for the estimation, and the most prevalent drugs were included. Three approaches were used to estimate the prevalence of drug concentrations above the proposed legal limits in blood based on drug concentrations in oral fluid: comparison with drug concentrations observed in oral fluid and blood in pharmacokinetic studies, estimating the prevalence of drug concentrations in blood by calculating the prevalence of drug concentrations in oral fluid that were larger than the limit in blood multiplied with mean oral fluid/blood ratios, and a mathematical simulation mimicking the relationship between drug concentration distributions in blood and oral fluid for populations of drug users. In total, alcohol or drugs were detected in 5.7% of the samples of oral fluid from drivers in normal traffic; 3.8% (n=410) were positive for the drugs that we included in the assessment. The estimation of drug concentrations in blood suggested that about 1.5% had concentrations above the proposed legal limits in blood for the studied drugs, which is about 40% of those who were positive for the drugs in oral fluid. The estimated prevalence of driving with concentrations of psychoactive drugs in blood above the proposed legal limits was for illegal drugs 0.4% and for medicinal drugs 1.1%. These may be regarded as minimum estimates as some drugs were not included in the assessment. These prevalences are higher than the prevalence of driving with blood alcohol concentrations above the legal limit of 0.2g/kg in Norway. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis in a very early arthritis cohort.

PubMed

Norli, Ellen Sauar; Brinkmann, Gina H; Kvien, Tore K; Bjørneboe, Olav; Haugen, Anne J; Nygaard, Halvor; Thunem, Cathrine; Lie, Elisabeth; Mjaavatten, Maria D

2016-12-01

To study occurrence of and factors associated with self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis (RA) (2010 RA criteria) in patients with ≤16 weeks׳ duration of joint swelling. We applied the 2010 RA criteria in 1118 patients included in a 2-year longitudinal cohort. In all, 256 patients fulfilled the 2010 RA criteria at baseline; outcome was defined as either "self-limiting arthritis" (no DMARD use during follow-up, no swollen joints at last assessment, and no final clinical diagnosis of RA) or "persistent disease." The associations between baseline characteristics, including the components of the 2010 RA criteria score, and outcomes were studied. In total, 36 of 256 patients (14.1%) classified as having RA had self-limiting arthritis. These patients differed from patients with persistent disease according to ACPA positivity (11.1% vs. 65.0%, p < 0.001), duration of joint swelling (median = 47.5 vs. 66.0 days, p = 0.002), 2010 RA criteria points (median = 6.0 vs. 7.0, p < 0.001), and ever smoking (52.8% vs. 74.5%, p = 0.01). Having no serology points and no duration points were independent predictors of self-limiting arthritis. The rate of self-limiting arthritis was 2.7% vs. 29.4% among ACPA positive vs. ACPA negative patients (p < 0.001), and 32.5% when duration of joint swelling was <4 weeks vs. 10.6% with longer duration (p < 0.001). Negative ACPA status, short duration of joint swelling and being a never smoker were factors associated with self-limiting arthritis in early arthritis patients classified as having RA at presentation. Our findings contribute to identify patients who potentially do not need DMARDs and who should not be included in early RA clinical drug trials. Copyright © 2016 Elsevier Inc. All rights reserved.

Moses Lake Fishery Restoration Project : FY 1999 Annual Report.

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

None given

2000-12-01

The Moses Lake Project consists of 3 phases. Phase 1 is the assessment of all currently available physical and biological information, the collection of baseline biological data, the formulation of testable hypotheses, and the development of a detailed study plan to test the hypotheses. Phase 2 is dedicated to the implementation of the study plan including data collection, hypotheses testing, and the formulation of a management plan. Phase 3 of the project is the implementation of the management plan, monitoring and evaluation of the implemented recommendations. The project intends to restore the failed recreational fishery for panfish species (black crappie,more » bluegill and yellow perch) in Moses Lake as off site mitigation for lost recreational fishing opportunities for anadromous species in the upper Columbia River. This report summarizes the results of Phase 1 investigations and presents the study plan directed at initiating Phase 2 of the project. Phase 1of the project culminates with the formulation of testable hypotheses directed at investigating possible limiting factors to the production of panfish in Moses Lake. The limiting factors to be investigated will include water quality, habitat quantity and quality, food limitations, competition, recruitment, predation, over harvest, environmental requirements, and the physical and chemical limitations of the system in relation to the fishes.« less

Periodontitis is related to lung volumes and airflow limitation: a cross-sectional study.

PubMed

Holtfreter, Birte; Richter, Stefanie; Kocher, Thomas; Dörr, Marcus; Völzke, Henry; Ittermann, Till; Obst, Anne; Schäper, Christoph; John, Ulrich; Meisel, Peter; Grotevendt, Anne; Felix, Stephan B; Ewert, Ralf; Gläser, Sven

2013-12-01

This study aimed to assess the potential association of periodontal diseases with lung volumes and airflow limitation in a general adult population. Based on a representative population sample of the Study of Health in Pomerania (SHIP), 1463 subjects aged 25-86 years were included. Periodontal status was assessed by clinical attachment loss (CAL), probing depth and number of missing teeth. Lung function was measured using spirometry, body plethysmography and diffusing capacity of the lung for carbon monoxide. Linear regression models using fractional polynomials were used to assess associations between periodontal disease and lung function. Fibrinogen and high-sensitivity C-reactive protein (hs-CRP) were evaluated as potential intermediate factors. After full adjustment for potential confounders mean CAL was significantly associated with variables of mobile dynamic and static lung volumes, airflow limitation and hyperinflation (p<0.05). Including fibrinogen and hs-CRP did not change coefficients of mean CAL; associations remained statistically significant. Mean CAL was not associated with total lung capacity and diffusing capacity of the lung for carbon monoxide. Associations were confirmed for mean probing depth, extent measures of CAL/probing depth and number of missing teeth. Periodontal disease was significantly associated with reduced lung volumes and airflow limitation in this general adult population sample. Systemic inflammation did not provide a mechanism linking both diseases.

Psychology Ethics in Introductory Psychology Textbooks

ERIC Educational Resources Information Center

Zucchero, Renee' A.

2011-01-01

Previous research revealed that introductory psychology textbooks included limited information about psychology ethics. This study reviewed 48 current introductory psychology textbooks for research and other APA ethics content. These textbooks included slightly more total ethics content and were more thorough in their review of research ethics…

76 FR 23825 - Study Methodologies for Diagnostics in the Postmarket Setting; Public Workshop

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... community on issues related to the studies and methodological approaches examining diagnostics in the... discuss a large number of methodological concerns at the workshop, including, but not limited to the...

An Evidence-Based Systematic Review of Amplitude Compression in Hearing Aids for School-Age Children With Hearing Loss

PubMed Central

McCreery, Ryan W.; Venediktov, Rebecca A.; Coleman, Jaumeiko J.; Leech, Hillary M.

2013-01-01

Purpose Two clinical questions were developed: one addressing the comparison of linear amplification with compression limiting to linear amplification with peak clipping, and the second comparing wide dynamic range compression with linear amplification for outcomes of audibility, speech recognition, speech and language, and self- or parent report in children with hearing loss. Method Twenty-six databases were systematically searched for studies addressing a clinical question and meeting all inclusion criteria. Studies were evaluated for methodological quality, and effect sizes were reported or calculated when possible. Results The literature search resulted in the inclusion of 8 studies. All 8 studies included comparisons of wide dynamic range compression to linear amplification, and 2 of the 8 studies provided comparisons of compression limiting versus peak clipping. Conclusions Moderate evidence from the included studies demonstrated that audibility was improved and speech recognition was either maintained or improved with wide dynamic range compression as compared with linear amplification. No significant differences were observed between compression limiting and peak clipping on outcomes (i.e., speech recognition and self-/parent report) reported across the 2 studies. Preference ratings appear to be influenced by participant characteristics and environmental factors. Further research is needed before conclusions can confidently be drawn. PMID:22858616

Accessible Home Environments for People with Functional Limitations: A Systematic Review.

PubMed

Cho, Hea Young; MacLachlan, Malcolm; Clarke, Michael; Mannan, Hasheem

2016-08-17

The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.

Numerical Studies of Fluid Leakage from a Geologic DisposalReservoir for CO2 Show Self-Limiting Feedback between Fluid Flow and HeatTransfer

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

Pruess, Karsten

2005-03-22

Leakage of CO2 from a hypothetical geologic storage reservoir along an idealized fault zone has been simulated, including transitions between supercritical, liquid, and gaseous CO2. We find strong non-isothermal effects due to boiling and Joule-Thomson cooling of expanding CO2. Leakage fluxes are limited by limitations in conductive heat transfer to the fault zone. The interplay between multiphase flow and heat transfer effects produces non-monotonic leakage behavior.

Thermal discharges from Paducah Gaseous Diffusion Plant outfalls: Impacts on stream temperatures and fauna of Little Bayou and Big Bayou Creeks

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

Roy, W.K.; Ryon, M.G.; Hinzman, R.L.

1996-03-01

The development of a biological monitoring plan for the receiving streams of the Paducah Gaseous Diffusion Plant (PGDP) began in the late 1980s, because of an Agreed Order (AO) issued in September 1987 by the Kentucky Division of Water (KDOW). Five years later, in September 1992, more stringent effluent limitations were imposed upon the PGDP operations when the KDOW reissued Kentucky Pollutant Discharge Elimination System permit No. KY 0004049. This action prompted the US Department of Energy (DOE) to request a stay of certain limits contained in the permit. An AO is being negotiated between KDOW, the US Enrichment Corporationmore » (USEC), and DOE that will require that several studies be conducted, including this stream temperature evaluation study, in an effort to establish permit limitations. All issues associated with this AO have been resolved, and the AO is currently being signed by all parties involved. The proposed effluent temperature limit is 89 F (31.7 C) as a mean monthly temperature. In the interim, temperatures are not to exceed 95 F (35 C) as a monthly mean or 100 F (37.8 C) as a daily maximum. This study includes detailed monitoring of instream temperatures, benthic macroinvertebrate communities, fish communities, and a laboratory study of thermal tolerances.« less

Thermal Discharges from Paducah Gaseous Diffusion Plant Outfalls: Impacts on Stream Temperatures and Fauna of Little Bayou and Big Bayou Creeks

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

Roy, W.K.

1999-01-01

The development of a biological monitoring plan for the receiving streams of the Paducah Gaseous Diffusion Plant (PGDP) began in the late 1980s, because of an Agreed Order (AO) issued in September 1987 by the Kentucky Division of Water (KDOW). Five years later, in September 1992, more stringent effluent limitations were imposed upon the PGDP operations when the KDOW reissued Kentucky Pollutant Discharge Elimination System permit No. KY 0004049. This action prompted the US Department of Energy (DOE) to request a stay of certain limits contained in the permit. An AO is being negotiated between KDOW, the United States Enrichmentmore » Corporation (USEC), and DOE that will require that several studies be conducted, including this stream temperature evaluation study, in an effort to establish permit limitations. All issues associated with this AO have been resolved, and the AO is currently being signed by all parties involved. The proposed effluent temperature limit is 89 F (31.7C) as a mean monthly temperature. In the interim, temperatures are not to exceed 95 F (35 C) as a monthly mean or 100 F (37.8 C) as a daily maximum. This study includes detailed monitoring of instream temperatures, benthic macroinvertebrate communities, fish communities, and a laboratory study of thermal tolerances.« less

7 CFR 4279.150 - Feasibility studies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Feasibility studies. 4279.150 Section 4279.150... § 4279.150 Feasibility studies. A feasibility study by a qualified independent consultant may be required... affect the borrower's operations. An acceptable feasibility study should include, but not be limited to...

7 CFR 4279.150 - Feasibility studies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Feasibility studies. 4279.150 Section 4279.150... § 4279.150 Feasibility studies. A feasibility study by a qualified independent consultant may be required... affect the borrower's operations. An acceptable feasibility study should include, but not be limited to...

Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review.

PubMed

Ottisova, L; Hemmings, S; Howard, L M; Zimmerman, C; Oram, S

2016-08-01

To update and expand on a 2012 systematic review of the prevalence and risk of violence and the prevalence and risk of physical, mental and sexual health problems among trafficked people. Systematic review and meta-analysis. Searches of 15 electronic databases of peer-reviewed articles and doctoral theses were supplemented by reference screening, citation tracking of included articles and expert recommendations. Studies were included if they reported on the prevalence or risk of violence while trafficked, or the prevalence or risk of physical, mental or sexual health outcomes among people who have been trafficked. Two reviewers independently screened papers for eligibility and appraised the quality of included studies. Thirty-seven papers reporting on 31 studies were identified. The majority of studies were conducted in low and middle-income countries with women and girls trafficked into the sex industry. There is limited but emerging evidence on the health of trafficked men and the health consequences of trafficking into different forms of exploitation. Studies indicate that trafficked women, men and children experience high levels of violence and report significant levels of physical health symptoms, including headaches, stomach pain and back pain. Most commonly reported mental health problems include depression, anxiety and post-traumatic stress disorder. Although serological data on sexually transmitted infections are limited, women and girls trafficked for sexual exploitation self-report symptoms suggestive of a high prevalence of infections. Limitations of the review include methodological weaknesses of primary studies and some differences in definition and operationalisation of trafficking, which hinder comparability and generalisability of the results. There is increasing evidence human trafficking is associated with high prevalence and increased risk of violence and a range of physical and mental health problems. Although more studies have emerged in recent years reporting on the health of trafficked men and people trafficked for forms of exploitation other than in the sex industry, further research is needed in this area. Appropriate interventions and support services to address the multiple and serious medical needs, especially mental health, of trafficked people are urgently needed.

40 CFR 62.14740 - What must I include in the deviation report?

Code of Federal Regulations, 2010 CFR

2010-07-01

... your unit deviated from the emission limitations or operating limit requirements. (b) The averaged and recorded data for those dates. (c) Duration and causes of each deviation from the emission limitations or... that deviated from the emission limitations or operating limits specified in this subpart, include the...

33 CFR 165.9 - Geographic application of limited and controlled access areas and regulated navigation areas.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., including the territorial sea to a seaward limit of 12 nautical miles from the baseline. (c) Security zones..., including the territorial sea to a seaward limit of 12 nautical miles from the baseline. (d) Naval vessel..., including the territorial sea to a seaward limit of 12 nautical miles from the baseline. [USCG-2001-9044, 68...

A systematic review of working conditions and occupational health among immigrants in Europe and Canada.

PubMed

Sterud, T; Tynes, T; Mehlum, I Sivesind; Veiersted, K B; Bergbom, B; Airila, A; Johansson, B; Brendler-Lindqvist, M; Hviid, K; Flyvholm, M-A

2018-06-20

A systematic attempt to summarize the literature that examines working conditions and occupational health among immigrant in Europe and Canada. We established inclusion criteria, searched systematically for articles included in the Medline, Embase and Social Sciences Citation Index databases in the period 2000-2016 and checked the reference lists of all included papers. Eighty-two studies were included in this review; 90% were cross-sectional and 80% were based on self-report. Work injuries were consistently found to be more prevalent among immigrants in studies from different countries and in studies with different designs. The prevalence of perceived discrimination or bullying was found to be consistently higher among immigrant workers than among natives. In general, however, we found that the evidence that immigrant workers are more likely to be exposed to physical or chemical hazards and poor psychosocial working conditions is very limited. A few Scandinavian studies support the idea that occupational factors may partly contribute to the higher risk of sick leave or disability pension observed among immigrants. However, the evidence for working conditions as a potential mediator of the associations between immigrant status and poor general health and mental distress was very limited. Some indicators suggest that immigrant workers in Europe and Canada experience poorer working conditions and occupational health than do native workers. However, the ability to draw conclusions is limited by the large gaps in the available data, heterogeneity of immigrant working populations, and the lack of prospectively designed cohort studies.

Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 3: how to assess methodological limitations.

PubMed

Munthe-Kaas, Heather; Bohren, Meghan A; Glenton, Claire; Lewin, Simon; Noyes, Jane; Tunçalp, Özge; Booth, Andrew; Garside, Ruth; Colvin, Christopher J; Wainwright, Megan; Rashidian, Arash; Flottorp, Signe; Carlsen, Benedicte

2018-01-25

The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual's methodological limitations component. We developed the methodological limitations component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual methodological limitations component within several qualitative evidence syntheses before agreeing on the current definition and principles for application. When applying CERQual, we define methodological limitations as the extent to which there are concerns about the design or conduct of the primary studies that contributed evidence to an individual review finding. In this paper, we describe the methodological limitations component and its rationale and offer guidance on how to assess methodological limitations of a review finding as part of the CERQual approach. This guidance outlines the information required to assess methodological limitations component, the steps that need to be taken to assess methodological limitations of data contributing to a review finding and examples of methodological limitation assessments. This paper provides guidance for review authors and others on undertaking an assessment of methodological limitations in the context of the CERQual approach. More work is needed to determine which criteria critical appraisal tools should include when assessing methodological limitations. We currently recommend that whichever tool is used, review authors provide a transparent description of their assessments of methodological limitations in a review finding. We expect the CERQual approach and its individual components to develop further as our experiences with the practical implementation of the approach increase.

Limitations to the study of man in space in the U.S. space program

NASA Technical Reports Server (NTRS)

Bishop, Phillip A.; Greenisen, Mike

1993-01-01

Research on humans conducted during spaceflight is fraught both with great opportunities and great obstacles. The purpose of this paper is to review some of the limitations to research in space in the United States with hope that an informed scientific community may lead to more rapid and efficient solution of these problems. Limitations arise because opportunities to study the same astronauts in well-controlled situations on repeated spaceflights are practically non-existent. Human research opportunities are further limited by the necessity of avoiding simultaneous mutually-interfering experiments. Environmental factors, including diet and other physiological perturbations concomitant with spaceflight, also complicate research design and interpretation. Technical limitations to research methods and opportunities further restrict the development of the knowledge base. Finally, Earth analogues of space travel all suffer from inadequacies. Though all of these obstacles will eventually be overcome, creativity, diligence, and persistence are required to further our knowledge of humans in space.

Limitations to the study of man in the United States space program

NASA Technical Reports Server (NTRS)

Bishop, Phillip A.; Greenisen, Mike

1992-01-01

Research on humans conducted during space flight is fraught both with great opportunities and great obstacles. The purpose of this paper is to review some of the limitations to United States research in space in the hope that an informed scientific community may lead to more rapid and efficient solution of these problems. Limitations arise because opportunities to study the same astronauts in well-controlled situations on repeated space flights are practically non-existent. Human research opportunities are further limited by the necessity of avoiding simultaneous mutually-interfereing experiments. Environmental factors including diet and other physiological perturbations concomitant with space flight also complicates research design and interpretation. Technical limitations to research methods and opportunities further restrict the development of the knowledge base. Finally, earth analogues of space travel all suffer from inadequacies. Though all of these obstacles will eventually be overcome; creativity, diligence, and persistence are required to further our knowledge of humans in space.

Limitations to the study of man in space in the U.S. space program.

PubMed

Bishop, P A; Greenisen, M

1993-03-01

Research on humans conducted during spaceflight is fraught both with great opportunities and great obstacles. The purpose of this paper is to review some of the limitations to research in space in the United States with hope that an informed scientific community may lead to more rapid and efficient solution of these problems. Limitations arise because opportunities to study the same astronauts in well-controlled situations on repeated spaceflights are practically non-existent. Human research opportunities are further limited by the necessity of avoiding simultaneous mutually-interfering experiments. Environmental factors, including diet and other physiological perturbations concomitant with spaceflight, also complicate research design and interpretation. Technical limitations to research methods and opportunities further restrict the development of the knowledge base. Finally, Earth analogues of space travel all suffer from inadequacies. Though all of these obstacles will eventually be overcome, creativity, diligence, and persistence are required to further our knowledge of humans in space.

76 FR 7098 - Dealer Floor Plan Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-09

... inventory, including but not limited to automobiles, motorcycles, boats (including boat trailers..., including but not limited to automobiles, motorcycles, boats (including boat trailers), recreational...

Fundamental constructs in food parenting practices: a content map to guide future research

PubMed Central

Ward, Dianne S.; Fisher, Jennifer O.; Faith, Myles S.; Hughes, Sheryl O.; Kremers, Stef P.J.; Musher-Eizenman, Dara R.; O’Connor, Teresia M.; Patrick, Heather; Power, Thomas G.

2016-01-01

Although research shows that “food parenting practices” can impact children’s diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs – coercive control, structure, and autonomy support – as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization. PMID:26724487

Economic Studies in Motor Neurone Disease: A Systematic Methodological Review.

PubMed

Moore, Alan; Young, Carolyn A; Hughes, Dyfrig A

2017-04-01

Motor neurone disease (MND) is a devastating condition which greatly diminishes patients' quality of life and limits life expectancy. Health technology appraisals of future interventions in MND need robust data on costs and utilities. Existing economic evaluations have been noted to be limited and fraught with challenges. The aim of this study was to identify and critique methodological aspects of all published economic evaluations, cost studies, and utility studies in MND. We systematically reviewed all relevant published studies in English from 1946 until January 2016, searching the databases of Medline, EMBASE, Econlit, NHS Economic Evaluation Database (NHS EED) and the Health Economics Evaluation Database (HEED). Key data were extracted and synthesised narratively. A total of 1830 articles were identified, of which 15 economic evaluations, 23 cost and 3 utility studies were included. Most economic studies focused on riluzole (n = 9). Six studies modelled the progressive decline in motor function using a Markov design but did not include mutually exclusive health states. Cost estimates for a number of evaluations were based on expert opinion and were hampered by high variability and location-specific characteristics. Few cost studies reported disease-stage-specific costs (n = 3) or fully captured indirect costs. Utilities in three studies of MND patients used the EuroQol EQ-5D questionnaire or standard gamble, but included potentially unrepresentative cohorts and did not consider any health impacts on caregivers. Economic evaluations in MND suffer from significant methodological issues such as a lack of data, uncertainty with the disease course and use of inappropriate modelling framework. Limitations may be addressed through the collection of detailed and representative data from large cohorts of patients.

Helicopter noise regulations: An industry perspective

NASA Technical Reports Server (NTRS)

Wagner, R. A.

1978-01-01

A review of helicopter noise measurement programs and noise reduction/economic studies of FAA is given along with a critique of a study which addresses the economic impact of noise reduction on helicopter noise. Modification of several helicopters to reduce noise and demonstrate the economic impact of the application of the current state-of-the-art technology is discussed. Specific helicopters described include Boeing Vertol 347 Helicopter, Hughes OH-6 Helicopter, and Hughes 269C Helicopter. Other topics covered include: (1) noise trends and possible noise limits; (2) accuracy of helicopter noise prediction techniques; (3) limited change possibilities of derivatives; and (4) rotor impulsive noise. The unique operational capabilities of helicopters and the implications relative to noise regulations and certification are discussed.

An impoverished machine: challenges to human learning and instructional technology.

PubMed

Taraban, Roman

2008-08-01

Many of the limitations to human learning and processing identified by cognitive psychologists over the last 50 years still hold true, including computational constraints, low learning rates, and unreliable processing. Instructional technology can be used in classrooms and in other learning contexts to address these limitations to learning. However, creating technological innovations is not enough. As part of psychological science, the development and assessment of instructional systems should be guided by theories and practices within the discipline. The technology we develop should become an object of research like other phenomena that are studied. In the present article, I present an informal account of my own work in assessing instructional technology for engineering thermodynamics to show not only the benefits, but also the limitations, in studying the technology we create. I conclude by considering several ways of advancing the development of instructional technology within the SCiP community, including interdisciplinary research and envisioning learning contexts that differ radically from traditional learning focused on lectures and testing.

Autism spectrum disorder and pet therapy.

PubMed

Siewertsen, Caitlin M; French, Emma D; Teramoto, Masaru

2015-01-01

Autism Spectrum Disorder (ASD) encompasses a wide range of social and mental afflictions that are difficult to treat. Due to a lack of established treatments for ASD, alternative therapies have been the primary form of intervention. One of these alternatives is pet therapy, a field that has experienced growing interest and has recently accumulated studies that investigate its efficacy. This article reviews and summarizes that effectiveness as well as the findings and limitations associated with pet therapy for ASD. The majority of research on ASD and pet therapy has examined children and has primarily used dogs and horses for therapy. Studies have shown positive effects for the therapy, including high satisfaction rates among the participants' families. Major limitations of studies in the current literature include the lack of control groups and small sample sizes. Future research should incorporate better study designs and large samples to validate pet therapy as an appropriate treatment for ASD.

Garlic and onions: Their cancer prevention properties

PubMed Central

Nicastro, Holly L.; Ross, Sharon A.; Milner, John A.

2015-01-01

The Allium genus includes garlic, onions, shallots, leeks, and chives. These vegetables are popular in cuisines worldwide and are valued for their potential medicinal properties. Epidemiological studies, while limited in their abilities to assess Allium consumption, indicate some associations of Allium vegetable consumption with decreased risk of cancer, particularly cancers of the gastrointestinal tract. Limited intervention studies have been conducted to support these associations. The majority of supportive evidence on Allium vegetables cancer preventive effects comes from mechanistic studies. These studies highlight potential mechanisms of individual sulfur-containing compounds and of various preparations and extracts of these vegetables, including decreased bioactivation of carcinogens, antimicrobial activities, and redox modification. Allium vegetables and their components have effects at each stage of carcinogenesis and affect many biological processes that modify cancer risk. This review discusses the cancer preventive effects of Allium vegetables, particularly garlic and onions, and their bioactive sulfur compounds and highlights research gaps. PMID:25586902

On the Small Mass Limit of Quantum Brownian Motion with Inhomogeneous Damping and Diffusion

NASA Astrophysics Data System (ADS)

Lim, Soon Hoe; Wehr, Jan; Lampo, Aniello; García-March, Miguel Ángel; Lewenstein, Maciej

2018-01-01

We study the small mass limit (or: the Smoluchowski-Kramers limit) of a class of quantum Brownian motions with inhomogeneous damping and diffusion. For Ohmic bath spectral density with a Lorentz-Drude cutoff, we derive the Heisenberg-Langevin equations for the particle's observables using a quantum stochastic calculus approach. We set the mass of the particle to equal m = m0 ɛ , the reduced Planck constant to equal \\hbar = ɛ and the cutoff frequency to equal Λ = E_{Λ}/ɛ , where m_0 and E_{Λ} are positive constants, so that the particle's de Broglie wavelength and the largest energy scale of the bath are fixed as ɛ → 0. We study the limit as ɛ → 0 of the rescaled model and derive a limiting equation for the (slow) particle's position variable. We find that the limiting equation contains several drift correction terms, the quantum noise-induced drifts, including terms of purely quantum nature, with no classical counterparts.

Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study.

PubMed

Colaris, Joost W; Allema, Jan Hein; Reijman, Max; de Vries, Mark R; Ulas Biter, L; Bloem, Rolf M; van de Ven, Cees P; Verhaar, Jan A N

2014-04-01

Both-bone forearm fractures in children frequently result in a limitation of pronation/supination, which hinders daily activities. The purpose of this prospective multicentre study was to investigate which clinical factors are related to the limitation of pronation/supination in children with a both-bone forearm fracture. In four Dutch hospitals, consecutive children (<16 years) who sustained a both-bone forearm fracture were included. Children were followed up for 6-9 months and data from questionnaires, physical examination and X-rays were collected. Univariate and multivariate logistic regression analyses were used to assess the relationship between limitation of pronation/supination (≥20°) and several clinical factors. A group of 410 children with both-bone forearm fractures were included, of which 10 children missed the final examination (follow-up rate of 97.6%). We found that a re-fracture (odds ratio (OR) 11.7, 95% confidence interval (CI) 1.2; 118.5), a fracture in the diaphysis (OR 3.3, 95% CI 1.4; 7.9) and less physiotherapy during follow-up (OR 0.90, 95% CI 0.82; 0.98) were independently associated with a limitation of pronation/supination of 20° or more. These findings imply that a re-fracture and a diaphyseal located fracture were associated independently of each other with a limitation of pronation/supination in children with a both-bone forearm fracture. Furthermore, in children with severe limitation extensive physiotherapy is associated with better functional outcome. Copyright © 2013 Elsevier Ltd. All rights reserved.

Discussing race-related limitations of genomic testing for colon cancer risk: implications for education and counseling.

PubMed

Butrick, Morgan N; Vanhusen, Lauren; Leventhal, Kara-Grace; Hooker, Gillian W; Nusbaum, Rachel; Peshkin, Beth N; Salehizadeh, Yasmin; Pavlick, Jessica; Schwartz, Marc D; Graves, Kristi D

2014-08-01

This study examines communication about limitations of genomic results interpretation for colon cancer risk during education and counseling of minority participants. As part of a larger study conducted from 2010 to 2012, participants recruited from a large primary care clinic were offered testing for a research panel of 3 genomic markers (single nucleotide polymorphisms or SNPs) for colorectal cancer risk. Genetic counselors conducted pre- and post-test sessions which included discussion of limitations of result interpretation due to the lack of racial/ethnic diversity in research populations from which risk data are derived. Sessions were audio-recorded, transcribed and thematically analyzed. Many participants did not respond directly to this limitation. Among the participants that responded directly to this race-related limitation, many responses were negative. However, a few participants connected the limited minority information about SNPs with the importance of their current research participation. Genetic counselor discussions of this limitation were biomedically focused with limited explanations for the lacking data. The communication process themes identified included: low immediacy (infrequent use of language directly involving a participant), verbal dominance (greater speaking ratio of the counselor to the patient) and wide variation in the degree of interactivity (or the amount of turn-taking during the discussion). Placed within the larger literature on patient-provider communication, these present results provide insight into the dynamics surrounding race-related educational content for genomic testing and other emerging technologies. Clinicians may be better able to engage patients in the use of new genomic technology by increasing their awareness of specific communication processes and patterns during education or counseling sessions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Anticipated significant work limitation in primary care consulters with osteoarthritis: a prospective cohort study

PubMed Central

Wilkie, Ross; Phillipson, Chris; Hay, Elaine M; Pransky, Glenn

2014-01-01

Objective To describe the prevalence of expected work limitations (EWL) prior to future retirement age in osteoarthritis consulters, and the associated health, sociodemographic and workplace factors. Design Population-based prospective cohort study. Setting General practices in Staffordshire, England. Participants 297 working adults aged 50–65, who had consulted primary care for osteoarthritis. Outcome EWL was defined using a single question, “Do you think joint pain will limit your ability to work before you reach 69 years old?” Results 51 (17.2%) indicated that joint pain would not limit their ability to work until 69, 79 (26.6%) indicated EWL and 167 (56.2%) did not know if joint pain would limit work before 69. In bivariate analysis, physical function (OR 0.93; 95% CI 0.91 to 0.96), depression (4.51; 1.81 to 11.3), cognitive symptom (3.84; 1.81 to 8.18), current smoker (2.75; 1.02 to 7.38), age (0.69; 0.58 to 0.82), physically demanding job (3.18; 1.50 to 6.72), no opportunities to retrain (3.01; 1.29 to 7.05) and work dissatisfaction (3.69; 1.43 to 9.49) were associated with EWL. The final multivariate model included physical function and age. Conclusions Only one in five osteoarthritis consulters expected that joint pain would not limit their work participation before 69 years of age. Given the expectation for people to work until they are older, the results highlight the increasing need for clinicians to include work participation in their consultation and implement strategies to address work loss/limitation. Targeting pain-related functional limitation and effective communication with employers to manage workplace issues could reduce EWL. PMID:25190616

Evaluation of methods for managing censored results when calculating the geometric mean.

PubMed

Mikkonen, Hannah G; Clarke, Bradley O; Dasika, Raghava; Wallis, Christian J; Reichman, Suzie M

2018-01-01

Currently, there are conflicting views on the best statistical methods for managing censored environmental data. The method commonly applied by environmental science researchers and professionals is to substitute half the limit of reporting for derivation of summary statistics. This approach has been criticised by some researchers, raising questions around the interpretation of historical scientific data. This study evaluated four complete soil datasets, at three levels of simulated censorship, to test the accuracy of a range of censored data management methods for calculation of the geometric mean. The methods assessed included removal of censored results, substitution of a fixed value (near zero, half the limit of reporting and the limit of reporting), substitution by nearest neighbour imputation, maximum likelihood estimation, regression on order substitution and Kaplan-Meier/survival analysis. This is the first time such a comprehensive range of censored data management methods have been applied to assess the accuracy of calculation of the geometric mean. The results of this study show that, for describing the geometric mean, the simple method of substitution of half the limit of reporting is comparable or more accurate than alternative censored data management methods, including nearest neighbour imputation methods. Copyright © 2017 Elsevier Ltd. All rights reserved.

Efficacy of photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review.

PubMed

Al-Maweri, Sadeq Ali; Ashraf, Sajna; Kalakonda, Butchibabu; Halboub, Esam; Petro, Waleed; AlAizari, Nader Ahmed

2018-04-01

The aim of this study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of symptomatic oral lichen planus (OLP). PubMed/MEDLINE, Scopus, and ISI Web of knowledge were searched until July 2017, using the following keywords: OLP, erosive lichen planus, lichen planus, and PDT. Five clinical studies were included. The risk of bias was considered high in 4 studies and moderate in 1 study. The efficacy of PDT was compared with topical corticosteroids in all included studies. Laser wavelengths, duration of irradiation, and power density ranged between 420-660 nm, 30 seconds to 10 minutes, and 10-500 mW/cm 2 , respectively. All studies reported PDT to be effective in the management of symptomatic OLP. Two studies reported PDT to be as effective as corticosteroids, 1 study reported a better efficacy of PDT compared to corticosteroids, whereas 2 studies found PDT to be inferior to corticosteroids. The limited available evidence suggests that PDT is an effective treatment option for the management of OLP. However, due to the limited number of studies included in this review and heterogeneity among these studies, more well-designed clinical trials with adequate sample sizes are highly warranted. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis.

PubMed

Clarke, Brydie; Swinburn, Boyd; Sacks, Gary

2016-10-13

Theories of the policy process are recommended as tools to help explain both policy stasis and change. A systematic review of the application of such theoretical frameworks within the field of obesity prevention policy was conducted. A meta-synthesis was also undertaken to identify the key influences on policy decision-making. The review identified 17 studies of obesity prevention policy underpinned by political science theories. The majority of included studies were conducted in the United States (US), with significant heterogeneity in terms of policy level (e.g., national, state) studied, areas of focus, and methodologies used. Many of the included studies were methodologically limited, in regard to rigour and trustworthiness. Prominent themes identified included the role of groups and networks, political institutions, and political system characteristics, issue framing, the use of evidence, personal values and beliefs, prevailing political ideology, and timing. The limited application of political science theories indicates a need for future theoretically based research into the complexity of policy-making and multiple influences on obesity prevention policy processes.

Impact of Cooking and Home Food Preparation Interventions Among Adults: A Systematic Review (2011-2016).

PubMed

Reicks, Marla; Kocher, Megan; Reeder, Julie

2018-02-01

To update a review of the impact of interventions for adults that included a cooking component on diet, health, and psychosocial outcomes. A total of 3,047 records were identified by searching MEDLINE, Agricola, Web of Science, and the Cochrane Central Register of Controlled Trials (January, 2011 to March, 2016). A total of 34 articles met inclusion and exclusion criteria for analysis. Study description and outcomes were extracted and synthesized to generate conclusions regarding impact. Less than half of the studies included a control group. The most common intended outcomes were improvements in fruit and/or vegetable intake and weight. The majority of studies showed positive dietary behavior changes and improvements in cooking confidence and knowledge. Limitations included the lack of a control group, no follow-up past after intervention, the use of nonvalidated assessment instruments, and small convenience samples. Findings were similar to a previous review regarding positive impact on dietary and cooking confidence outcomes. Clinical and weight outcomes were addressed in more studies included in the current review than in the previous 1; however, limitations were similar. Intervention design and assessment tools need to be strengthened in intervention studies with cooking components. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Thermal Skin fabrication technology

NASA Technical Reports Server (NTRS)

Milam, T. B.

1972-01-01

Advanced fabrication techniques applicable to Thermal Skin structures were investigated, including: (1) chemical machining; (2) braze bonding; (3) diffusion bonding; and (4) electron beam welding. Materials investigated were nickel and nickel alloys. Sample Thermal Skin panels were manufactured using the advanced fabrication techniques studied and were structurally tested. Results of the program included: (1) development of improved chemical machining processes for nickel and several nickel alloys; (2) identification of design geometry limits; (3) identification of diffusion bonding requirements; (4) development of a unique diffusion bonding tool; (5) identification of electron beam welding limits; and (6) identification of structural properties of Thermal Skin material.

Semiconductor Laser Low Frequency Noise Characterization

NASA Technical Reports Server (NTRS)

Maleki, Lute; Logan, Ronald T.

1996-01-01

This work summarizes the efforts in identifying the fundamental noise limit in semiconductor optical sources (lasers) to determine the source of 1/F noise and it's associated behavior. In addition, the study also addresses the effects of this 1/F noise on RF phased arrays. The study showed that the 1/F noise in semiconductor lasers has an ultimate physical limit based upon similar factors to fundamental noise generated in other semiconductor and solid state devices. The study also showed that both additive and multiplicative noise can be a significant detriment to the performance of RF phased arrays especially in regard to very low sidelobe performance and ultimate beam steering accuracy. The final result is that a noise power related term must be included in a complete analysis of the noise spectrum of any semiconductor device including semiconductor lasers.

An Integrative Review of Technology to Support Communication With Parents of Infants in the NICU

PubMed Central

Epstein, Elizabeth G.; Arechiga, Jaqueline; Dancy, Margaret; Simon, Jordan; Wilson, Daniel; Alhusen, Jeanne L.

2017-01-01

Objective To synthesize findings from the published literature on the use of technology in the NICU to improve communications and interactions among health care providers, parents, and infants. Data Sources Electronic databases including Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar were searched for related research published through May 2016. The reference lists of all studies were reviewed, and a hand search of key journals was also conducted to locate eligible studies. Study Selection Eleven studies (five quantitative, two qualitative, and four mixed methods) were identified that met the inclusion criteria. Only studies published in English were included. Data Extraction Whittemore and Knafl’s methodology for conducting integrative reviews was used to guide data extraction, analysis, and synthesis. Data were extracted and organized according to the following headings: author, year, and location; study purpose and design; sample size and demographics; technology used; study findings; and limitations. Data Synthesis Various technologies were used, including videoconferencing, videophone, and commercially available modalities such as Skype, FaceTime, AngelEye, and NICView Webcams. In the 11 studies, three main outcomes were evaluated: parents’ perception of technology use, health care providers’ perceptions of technology use, and objective outcomes, such as parental anxiety or stress or infant length of stay. Overall, parents and health care providers perceived the varied interventions quite favorably, although a few significant differences were found for the objective measures. Conclusion Several interventions have been tested to improve communications and promote interactions among NICU health care team members, parents, and infants. Although initial findings are positive, research in this area is quite limited, and the reviewed studies had several limitations. There is a significant need for further rigorous research to be conducted with diverse samples. PMID:28263727

Clear-water abutment and contraction scour in the Coastal Plain and Piedmont Provinces of South Carolina, 1996-99

USGS Publications Warehouse

Benedict, Stephen T.

2016-01-01

Data from this study have been compiled into a database that includes photographs, figures, observed scour depths, theoretical scour depths, limited basin characteristics, limited soil data, and theoretical hydraulic data. The database can be used to compare studied sites with unstudied sites to assess the potential for scour at the unstudied sites. In addition, the database can be used to assess the performance of various theoretical methods for predicting clear-water abutment and contraction scour.

Systematic review of stigma reducing interventions for African/Black diasporic women

PubMed Central

Loutfy, Mona; Tharao, Wangari; Logie, Carmen; Aden, Muna A; Chambers, Lori A; Wu, Wei; Abdelmaseh, Marym; Calzavara, Liviana

2015-01-01

Introduction Literature indicates that racism, sexism, homophobia and HIV-related stigma have adverse impacts on health, well-being, and quality of life among HIV-positive women of African descent (African/Black diaspora). However, limited evidence exists on the effectiveness of interventions aimed at reducing stigma tailored for these women. This study systematically reviewed randomized controlled trials (RCTs), non-randomized observational and quasi-experimental studies evaluating the effectiveness of interventions aimed at reducing stigma experienced by this population. Methods The Cochrane methodology was used to develop a search strategy in consultation with a librarian scientist. Databases searched included the Cochrane Library, Ovid EMBASE, PsycInfo, and 10 others. Two reviewers independently assessed the studies for potential relevance and conducted the Cochrane grading of RCTs to assess risk of bias and the Newcastle–Ottawa scale to assess the quality of non-randomized studies. Eligible papers were selected if they employed an intervention design with African/Black diasporic women living with HIV as the target population and had a primary outcome of stigma reduction. Results Of the five studies that met all of the eligibility criteria, four demonstrated the effectiveness of interventions in reducing HIV-related stigma. Only two of the five studies were designed specifically for HIV-positive African/Black diasporic women. Limitations included the absence of interventions addressing other forms of stigma and discrimination (e.g. gender discrimination, racism, heterosexism). Conclusions Our findings suggest that there are limited interventions designed to address multiple forms of stigma, including gender and racial discrimination, experienced by HIV-positive African/Black diasporic women. PMID:25862565

Systematic review of stigma reducing interventions for African/Black diasporic women.

PubMed

Loutfy, Mona; Tharao, Wangari; Logie, Carmen; Aden, Muna A; Chambers, Lori A; Wu, Wei; Abdelmaseh, Marym; Calzavara, Liviana

2015-01-01

Literature indicates that racism, sexism, homophobia and HIV-related stigma have adverse impacts on health, well-being, and quality of life among HIV-positive women of African descent (African/Black diaspora). However, limited evidence exists on the effectiveness of interventions aimed at reducing stigma tailored for these women. This study systematically reviewed randomized controlled trials (RCTs), non-randomized observational and quasi-experimental studies evaluating the effectiveness of interventions aimed at reducing stigma experienced by this population. The Cochrane methodology was used to develop a search strategy in consultation with a librarian scientist. Databases searched included the Cochrane Library, Ovid EMBASE, PsycInfo, and 10 others. Two reviewers independently assessed the studies for potential relevance and conducted the Cochrane grading of RCTs to assess risk of bias and the Newcastle-Ottawa scale to assess the quality of non-randomized studies. Eligible papers were selected if they employed an intervention design with African/Black diasporic women living with HIV as the target population and had a primary outcome of stigma reduction. Of the five studies that met all of the eligibility criteria, four demonstrated the effectiveness of interventions in reducing HIV-related stigma. Only two of the five studies were designed specifically for HIV-positive African/Black diasporic women. Limitations included the absence of interventions addressing other forms of stigma and discrimination (e.g. gender discrimination, racism, heterosexism). Our findings suggest that there are limited interventions designed to address multiple forms of stigma, including gender and racial discrimination, experienced by HIV-positive African/Black diasporic women.

Adolescent Literature about the Splendid Little War: Centennial Reading.

ERIC Educational Resources Information Center

Carroll, Wayne M.; Taylor, Gwen

1998-01-01

Provides an annotated bibliography of trade books that can be used in studying the Spanish-American war. Although aimed at adolescents, the selections include books for students with limited reading skills. Covers fiction and nonfiction including writings on the war from Stephen Crane and Mark Twain. (MJP)

10 CFR Appendix A to Subpart D of... - Categorical Exclusions Applicable to General Agency Actions

Code of Federal Regulations, 2010 CFR

2010-01-01

... research and development A1Routine actions necessary to support the normal conduct of agency business, such... (including, but not limited to, literature surveys, inventories, audits), data analysis (including computer modelling), document preparation (such as conceptual design or feasibility studies, analytical energy supply...

10 CFR Appendix A to Subpart D of... - Categorical Exclusions Applicable to General Agency Actions

Code of Federal Regulations, 2011 CFR

2011-01-01

... research and development A1Routine actions necessary to support the normal conduct of agency business, such... (including, but not limited to, literature surveys, inventories, audits), data analysis (including computer modelling), document preparation (such as conceptual design or feasibility studies, analytical energy supply...

A study of girder deflections during bridge deck construction : final report.

DOT National Transportation Integrated Search

1971-01-01

Problems involved in obtaining the desired thickness of bridge decks were investigated. The study, which was limited to decks which were longitudinally screeded during construction, included (1) field measurements of the girder deflections during con...

12 CFR 611.1211 - Special requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Institution Status § 611.1211 Special requirements. (a) Special assessments, analyses, studies, and rulings... assessments, analyses, or studies, or to request rulings, including, but not limited to: (1) Assessments of fair value; (2) Analyses and rulings on tax implications; and (3) Studies of the effect of your...

12 CFR 611.1211 - Special requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Institution Status § 611.1211 Special requirements. (a) Special assessments, analyses, studies, and rulings... assessments, analyses, or studies, or to request rulings, including, but not limited to: (1) Assessments of fair value; (2) Analyses and rulings on tax implications; and (3) Studies of the effect of your...

77 FR 33133 - Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... includes both quantitative and non-quantitative limits on benefits. Examples of quantitative limits include... duration of treatment. Examples of non-quantitative limits include prior authorization and step therapy... relevant issuers would submit data and descriptive information on the [[Page 33136

Early childhood neurodevelopment after intrauterine growth restriction: a systematic review.

PubMed

Levine, Terri A; Grunau, Ruth E; McAuliffe, Fionnuala M; Pinnamaneni, RagaMallika; Foran, Adrienne; Alderdice, Fiona A

2015-01-01

Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR. PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines. Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR. Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies. Copyright © 2015 by the American Academy of Pediatrics.

Systematic review of surveillance by social media platforms for illicit drug use.

PubMed

Kazemi, Donna M; Borsari, Brian; Levine, Maureen J; Dooley, Beau

2017-12-01

The use of social media (SM) as a surveillance tool of global illicit drug use is limited. To address this limitation, a systematic review of literature focused on the ability of SM to better recognize illicit drug use trends was addressed. A search was conducted in databases: PubMed, CINAHL via Ebsco, PsychINFO via Ebsco, Medline via Ebsco, ERIC, Cochrane Library, Science Direct, ABI/INFORM Complete and Communication and Mass Media Complete. Included studies were original research published in peer-reviewed journals between January 2005 and June 2015 that primarily focused on collecting data from SM platforms to track trends in illicit drug use. Excluded were studies focused on purchasing prescription drugs from illicit online pharmacies. Selected studies used a range of SM tools/applications, including message boards, Twitter and blog/forums/platform discussions. Limitations included relevance, a lack of standardized surveillance systems and a lack of efficient algorithms to isolate relevant items. Illicit drug use is a worldwide problem, and the rise of global social networking sites has led to the evolution of a readily accessible surveillance tool. Systematic approaches need to be developed to efficiently extract and analyze illicit drug content from social networks to supplement effective prevention programs. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Exploring the relation between positive emotions and the functional status of older adults living independently: a systematic review.

PubMed

Cabrita, Miriam; Lamers, Sanne M A; Trompetter, Hester R; Tabak, Monique; Vollenbroek-Hutten, Miriam M R

2017-11-01

Literature suggests that positive emotions positively influence physiological parameters but their relation to functioning in the daily life of older adults living independently remains unclear. The present work aims to investigate the relation between positive emotions and functional status in daily life of older people living independently. A systematic literature review was conducted using the PubMed, PsycINFO and Scopus electronic databases. Included works were peer-reviewed empirical studies that analysed the relation between positive emotions and ability to perform activities of daily living with older adults living independently. After removal of duplicates, 10 out of 963 papers met the inclusion criteria. Cross-sectional studies (n = 6) provided limited evidence about a relation between positive emotions and functioning in daily life. However, longitudinal studies (n = 4) provide significant evidence for an interaction between the two factors, suggesting that time influences this interaction. The variety on the design and samples of the studies included in this review does not allow a cohesive conclusion of the results. Nevertheless, limited evidence suggests that higher frequency in the experience of positive emotions might be associated with lower functional limitations. The issue of causality in emotions-functioning remains unclear from the review. Further observational studies are highly recommended, supported by innovative technologies.

The relationship between activity specialization and preferences for setting and route attributes of selected rock climbers

Treesearch

Kurt Merrill; Alan Graefe

1998-01-01

Many natural areas are now in the process of developing climbing management plans in order to control management factors associated with the growth of rock climbing. These factors may include limiting areas of use and limiting the type of climber utilizing the resource. The purpose of this study was to further develop and operationalize the concept of recreation...

Limits of Human Performance. Annual Meeting (56th, Eugene, Oregon, July 19-26, 1984). American Academy of Physical Education Papers, No. 18.

ERIC Educational Resources Information Center

Clarke, David H., Ed.; Eckert, Helen M., Ed.

The following papers are included in this collection: (1) "The Scientific Study of Athletes and Athletics" (Henry J. Montoye); (2) "The Limits of Human Performance" (David H. Clarke); (3) "Observations of Extraordinary Performances in an Extreme Environment and in a Training Environment" (E.R. Buskirk); (4) "Metabolic Requirements of Distance…

Financial Aid and Minority Participation in Graduate Education: A Research Agenda for Today. A Research Report of the Minority Graduate Education (MGE) Project.

ERIC Educational Resources Information Center

Nettles, Michael

A proposed agenda to study why minority participation in graduate education is so limited and so often unsuccessful is presented. Considerations to bear in mind include: what kind of financial returns minority students receive as a result of completing graduate school; the limited financial support available for graduate education; the lack of…

"What I Feel in My Heart": Literacy Practices of and for the Self among Adults with Limited or No Schooling

ERIC Educational Resources Information Center

Baumgartner, Lisa M.

2016-01-01

The purpose of this study was to understand the literacy practices of individuals in Africa and the Americas who had between one and seven years of schooling. The questions investigated included: "In what literacy practices do adults with limited or no schooling engage for personal fulfillment? and (2) What do these practices reveal about the…

Informative graphing of continuous safety variables relative to normal reference limits.

PubMed

Breder, Christopher D

2018-05-16

Interpreting graphs of continuous safety variables can be complicated because differences in age, gender, and testing site methodologies data may give rise to multiple reference limits. Furthermore, data below the lower limit of normal are compressed relative to those points above the upper limit of normal. The objective of this study is to develop a graphing technique that addresses these issues and is visually intuitive. A mock dataset with multiple reference ranges is initially used to develop the graphing technique. Formulas are developed for conditions where data are above the upper limit of normal, normal, below the lower limit of normal, and below the lower limit of normal when the data value equals zero. After the formulae are developed, an anonymized dataset from an actual set of trials for an approved drug is evaluated comparing the technique developed in this study to standard graphical methods. Formulas are derived for the novel graphing method based on multiples of the normal limits. The formula for values scaled between the upper and lower limits of normal is a novel application of a readily available scaling formula. The formula for the lower limit of normal is novel and addresses the issue of this value potentially being indeterminate when the result to be scaled as a multiple is zero. The formulae and graphing method described in this study provides a visually intuitive method to graph continuous safety data including laboratory values, vital sign data.

Cooperation in scale-free networks with limited associative capacities

NASA Astrophysics Data System (ADS)

Poncela, Julia; Gómez-Gardeñes, Jesús; Moreno, Yamir

2011-05-01

In this work we study the effect of limiting the number of interactions (the associative capacity) that a node can establish per round of a prisoner’s dilemma game. We focus on the way this limitation influences the level of cooperation sustained by scale-free networks. We show that when the game includes cooperation costs, limiting the associative capacity of nodes to a fixed quantity renders in some cases larger values of cooperation than in the unrestricted scenario. This allows one to define an optimum capacity for which cooperation is maximally enhanced. Finally, for the case without cooperation costs, we find that even a tight limitation of the associative capacity of nodes yields the same levels of cooperation as in the original network.

Use of health systems evidence by policymakers in eastern mediterranean countries: views, practices, and contextual influences

PubMed Central

2012-01-01

Background Health systems evidence can enhance policymaking and strengthen national health systems. In the Middle East, limited research exists on the use of evidence in the policymaking process. This multi-country study explored policymakers’ views and practices regarding the use of health systems evidence in health policymaking in 10 eastern Mediterranean countries, including factors that influence health policymaking and barriers and facilitators to the use of evidence. Methods This study utilized a survey adapted and customized from a similar tool developed in Canada. Health policymakers from 10 countries (Algeria, Bahrain, Jordan, Lebanon Oman, Pakistan, Palestine, Sudan, Tunisia, and Yemen) were surveyed. Descriptive and bi-variate analyses were performed for quantitative questions and thematic analysis was done for qualitative questions. Results A total of 237 policymakers completed the survey (56.3% response rate). Governing parties, limited funding for the health sector and donor organizations exerted a strong influence on policymaking processes. Most (88.5%) policymakers reported requesting evidence and 43.1% reported collaborating with researchers. Overall, 40.1% reported that research evidence is not delivered at the right time. Lack of an explicit budget for evidence-informed health policymaking (55.3%), lack of an administrative structure for supporting evidence-informed health policymaking processes (52.6%), and limited value given to research (35.9%) all limited the use of research evidence. Barriers to the use of evidence included lack of research targeting health policy, lack of funding and investments, and political forces. Facilitators included availability of health research and research institutions, qualified researchers, research funding, and easy access to information. Conclusions Health policymakers in several countries recognize the importance of using health systems evidence. Study findings are important in light of changes unfolding in some Arab countries and can help undertake an analysis of underlying transformations and their respective health policy implications including the way evidence will be used in policy decisions. PMID:22799440

40 CFR 792.185 - Reporting of study results.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Reporting of study results. 792.185... study results. (a) A final report shall be prepared for each study and shall include, but not necessarily be limited to, the following: (1) Name and address of the facility performing the study and the...

40 CFR 792.185 - Reporting of study results.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 32 2011-07-01 2011-07-01 false Reporting of study results. 792.185... study results. (a) A final report shall be prepared for each study and shall include, but not necessarily be limited to, the following: (1) Name and address of the facility performing the study and the...

Current situations and discussions in Japan in relation to the new occupational equivalent dose limit for the lens of the eye.

PubMed

Yokoyama, Sumi; Hamada, Nobuyuki; Hayashida, Toshiyuki; Tsujimura, Norio; Tatsuzaki, Hideo; Kurosawa, Tadahiro; Nabatame, Kuniaki; Ohguchi, Hiroyuki; Ohno, Kazuko; Yamauchi-Kawaura, Chiyo; Iimoto, Takeshi; Ichiji, Takeshi; Hotta, Yutaka; Iwai, Satoshi; Akahane, Keiichi

2017-09-25

Since the International Commission on Radiological Protection recommended reducing the occupational equivalent dose limit for the lens of the eye in 2011, there have been extensive discussions in various countries. This paper reviews the current situation in radiation protection of the ocular lens and the discussions on the potential impact of the new lens dose limit in Japan. Topics include historical changes to the lens dose limit, the current situation with occupational lens exposures (e.g., in medical workers, nuclear workers, and Fukushima nuclear power plant workers) and measurements, and the current status of biological studies and epidemiological studies on radiation cataracts. Our focus is on the situation in Japan, but we believe such information sharing will be useful in many other countries.

Systematic Review of Integrative Health Care Research: Randomized Control Trials, Clinical Controlled Trials, and Meta-Analysis

PubMed Central

Khorsan, Raheleh; Coulter, Ian D.; Crawford, Cindy; Hsiao, An-Fu

2011-01-01

A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50). Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe. PMID:20953383

National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations.

PubMed

Karhade, Aditya V; Larsen, Alexandra M G; Cote, David J; Dubois, Heloise M; Smith, Timothy R

2017-08-05

Quality improvement, value-based care delivery, and personalized patient care depend on robust clinical, financial, and demographic data streams of neurosurgical outcomes. The neurosurgical literature lacks a comprehensive review of large national databases. To assess the strengths and limitations of various resources for outcomes research in neurosurgery. A review of the literature was conducted to identify surgical outcomes studies using national data sets. The databases were assessed for the availability of patient demographics and clinical variables, longitudinal follow-up of patients, strengths, and limitations. The number of unique patients contained within each data set ranged from thousands (Quality Outcomes Database [QOD]) to hundreds of millions (MarketScan). Databases with both clinical and financial data included PearlDiver, Premier Healthcare Database, Vizient Clinical Data Base and Resource Manager, and the National Inpatient Sample. Outcomes collected by databases included patient-reported outcomes (QOD); 30-day morbidity, readmissions, and reoperations (National Surgical Quality Improvement Program); and disease incidence and disease-specific survival (Surveillance, Epidemiology, and End Results-Medicare). The strengths of large databases included large numbers of rare pathologies and multi-institutional nationally representative sampling; the limitations of these databases included variable data veracity, variable data completeness, and missing disease-specific variables. The improvement of existing large national databases and the establishment of new registries will be crucial to the future of neurosurgical outcomes research. Copyright © 2017 by the Congress of Neurological Surgeons

Technical activities report: Heat, water, and mechanical studies

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

Alexander, W.K.

1951-10-04

Topics in the heat studies section include: front and rear face reflector shields at the C-pile; process tube channel thermocouples; water temperature limits for horizontal rods; slug temperature and thermal conductivity calculations; maximum slug-end cap temperature; boiling consideration studies; scram time limit for Panellit alarm; heat transfer test; slug stresses; thermal insulation of bottom tube row at C-pile; flow tests; present pile enrichment; electric analog; and measurement of thermal contact resistance. Topics in the water studies section include: 100-D flow laboratory; process water studies; fundamental studies on film formation; coatings on tip-offs; can difference tests; slug jacket abrasion at highmore » flow rates; corrosion studies; front tube dummy slugs; metallographic examination of tubes from H-pile; fifty-tube mock-up; induction heating facility; operational procedures and standards; vertical safety rod dropping time tests; recirculation; and power recovery. Mechanical development studies include: effect of Sphincter seal and lubricant VSR drop time; slug damage; slug bubble tester; P-13 removal; chemical slug stripper; effect of process tube rib spacing and width; ink facility installation; charging and discharging machines; process tube creep; flapper nozzle assembly test; test of single gun barrel assembly; pigtail fixture test; horizontal rod gland seal test; function test of C-pile; and intermediate test of Ball 3-X and VSR systems.« less

Wide brick tunnel randomization - an unequal allocation procedure that limits the imbalance in treatment totals.

PubMed

Kuznetsova, Olga M; Tymofyeyev, Yevgen

2014-04-30

In open-label studies, partial predictability of permuted block randomization provides potential for selection bias. To lessen the selection bias in two-arm studies with equal allocation, a number of allocation procedures that limit the imbalance in treatment totals at a pre-specified level but do not require the exact balance at the ends of the blocks were developed. In studies with unequal allocation, however, the task of designing a randomization procedure that sets a pre-specified limit on imbalance in group totals is not resolved. Existing allocation procedures either do not preserve the allocation ratio at every allocation or do not include all allocation sequences that comply with the pre-specified imbalance threshold. Kuznetsova and Tymofyeyev described the brick tunnel randomization for studies with unequal allocation that preserves the allocation ratio at every step and, in the two-arm case, includes all sequences that satisfy the smallest possible imbalance threshold. This article introduces wide brick tunnel randomization for studies with unequal allocation that allows all allocation sequences with imbalance not exceeding any pre-specified threshold while preserving the allocation ratio at every step. In open-label studies, allowing a larger imbalance in treatment totals lowers selection bias because of the predictability of treatment assignments. The applications of the technique in two-arm and multi-arm open-label studies with unequal allocation are described. Copyright © 2013 John Wiley & Sons, Ltd.

The evolution of structured illumination microscopy in studies of HIV.

PubMed

Marno, Kelly; Al'Zoubi, Lara; Pearson, Matthew; Posch, Markus; McKnight, Áine; Wheeler, Ann P

2015-10-15

The resolution limit of conventional light microscopy has proven to be limiting for many biological structures such as viruses including Human immunodeficiency virus (HIV). Individual HIV virions are impossible to study using confocal microscopy as they are well below the 200 nm resolution limit of conventional light microscopes. Structured illumination microscopy (SIM) allows a twofold enhancement in image resolution compared to standard widefield illumination and so provides an excellent tool for study of HIV. Viral capsids (CAs) vary between 110 and 146 nm so this study challenges the performance of SIM microscopes. SIM microscopy was first developed in 2000, commercialised in 2007 and rapidly developed. Here we present the changes in capabilities of the SIM microscopes for study of HIV localisation as the instrumentation for structured illumination microscopy has evolved over the past 8 years. Copyright © 2015. Published by Elsevier Inc.

Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in nonspecific low back pain? A systematic review.

PubMed

Wong, Arnold Y L; Parent, Eric C; Funabashi, Martha; Stanton, Tasha R; Kawchuk, Gregory N

2013-12-01

Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Prenatal risk factors for Tourette Syndrome: a systematic review.

PubMed

Chao, Ting-Kuang; Hu, Jing; Pringsheim, Tamara

2014-01-30

Tourette Syndrome (TS) appears to be an inherited disorder, although genetic abnormalities have been identified in less than 1% of patients, and the mode of inheritance is uncertain. Many studies have investigated environmental factors that might contribute to the onset and severity of tics and associated comorbidities such as obsessive compulsive disorder (OCD) and attention deficit hyperactive disorder (ADHD). A systematic review and qualitative analysis were performed to provide a broad view of the association between pre- and perinatal factors and TS. The Medline, Embase and PsycINFO databases were searched using terms specific to Tourette's syndrome and keywords such as "pregnancy", "prenatal", "perinatal", "birth" and "neonatal". Studies were limited to studies on human subjects published in English or French through October 2012. 22 studies were included. Studies were of limited methodological quality, with most samples derived from specialty clinics, and most exposures ascertained retrospectively. The majority of the results for demographic factors of parents, including age, education, socioeconomic status, and marital status, revealed no significant association with the onset of TS, or the presence of comorbidity. Many factors were reported to be significantly associated with the onset of TS, the presence of comorbidity and symptom severity, but the most consistently reported factors were maternal smoking and low birth weight. There are few studies evaluating the relationship between pre and perinatal events and TS, and existing studies have major limitations, including the use of clinic rather than epidemiologically derived samples, retrospective data collection on pre and perinatal events and multiple hypothesis testing without appropriate statistical correction. The mechanism by which prenatal and perinatal adversities could lead to TS onset or symptom severity is unknown, but may be related to changes in the dopaminergic system as a result of early brain injury.

The Scientific Basis of Uncertainty Factors Used in Setting Occupational Exposure Limits.

PubMed

Dankovic, D A; Naumann, B D; Maier, A; Dourson, M L; Levy, L S

2015-01-01

The uncertainty factor concept is integrated into health risk assessments for all aspects of public health practice, including by most organizations that derive occupational exposure limits. The use of uncertainty factors is predicated on the assumption that a sufficient reduction in exposure from those at the boundary for the onset of adverse effects will yield a safe exposure level for at least the great majority of the exposed population, including vulnerable subgroups. There are differences in the application of the uncertainty factor approach among groups that conduct occupational assessments; however, there are common areas of uncertainty which are considered by all or nearly all occupational exposure limit-setting organizations. Five key uncertainties that are often examined include interspecies variability in response when extrapolating from animal studies to humans, response variability in humans, uncertainty in estimating a no-effect level from a dose where effects were observed, extrapolation from shorter duration studies to a full life-time exposure, and other insufficiencies in the overall health effects database indicating that the most sensitive adverse effect may not have been evaluated. In addition, a modifying factor is used by some organizations to account for other remaining uncertainties-typically related to exposure scenarios or accounting for the interplay among the five areas noted above. Consideration of uncertainties in occupational exposure limit derivation is a systematic process whereby the factors applied are not arbitrary, although they are mathematically imprecise. As the scientific basis for uncertainty factor application has improved, default uncertainty factors are now used only in the absence of chemical-specific data, and the trend is to replace them with chemical-specific adjustment factors whenever possible. The increased application of scientific data in the development of uncertainty factors for individual chemicals also has the benefit of increasing the transparency of occupational exposure limit derivation. Improved characterization of the scientific basis for uncertainty factors has led to increasing rigor and transparency in their application as part of the overall occupational exposure limit derivation process.

75 FR 30277 - Airworthiness Directives; Empresa Brasileira de Aeronautica S.A. (EMBRAER) Model ERJ 190-100 STD...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... cracks resulted in modifications on the airplane Airworthiness Limitation Items (ALI), to include new... Limitation Items (ALI), to include new inspections tasks or modification of existing ones and its respective... modifications on the airplane Airworthiness Limitation Items (ALI), to include new inspections tasks or...

Driver speed selection on high-speed two-lane highways: Comparing speed profiles between uniform and differential speed limits.

PubMed

Russo, Brendan J; Savolainen, Peter T; Gates, Timothy J; Kay, Jonathan J; Frazier, Sterling

2017-07-04

Although a considerable amount of prior research has investigated the impacts of speed limits on traffic safety and operations, much of this research, and nearly all of the research related to differential speed limits, has been specific to limited access freeways. The unique safety and operational issues on highways without access control create difficulty relating the conclusions from prior freeway-related speed limit research to 2-lane highways, particularly research on differential limits due to passing limitations and subsequent queuing. Therefore, the objective of this study was to assess differences in driver speed selection with respect to the posted speed limit on rural 2-lane highways, with a particular emphasis on the differences between uniform and differential speed limits. Data were collected from nearly 59,000 vehicles across 320 sites in Montana and 4 neighboring states. Differences in mean speeds, 85th percentile speeds, and the standard deviation in speeds for free-flowing vehicles were examined across these sites using ordinary least squares regression models. Ultimately, the results of the analysis show that the mean speed, 85th percentile speed, and variability in travel speeds for free-flowing vehicles on 2-lane highways are generally lower at locations with uniform 65 mph speed limits, compared to locations with differential limits of 70 mph for cars and 60 mph for trucks. In addition to posted speed limits, several site characteristics were shown to influence speed selection including shoulder widths, frequency of horizontal curves, percentage of the segment that included no passing zones, and hourly volumes. Differences in vehicle speed characteristics were also observed between states, indicating that speed selection may also be influenced by local factors, such as driver population or enforcement.

Accessible Home Environments for People with Functional Limitations: A Systematic Review

PubMed Central

Cho, Hea Young; MacLachlan, Malcolm; Clarke, Michael; Mannan, Hasheem

2016-01-01

The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home. PMID:27548194

Multiple Transportable Carbohydrates During Exercise: Current Limitations and Directions for Future Research.

PubMed

Wilson, Patrick B

2015-07-01

The concept of multiple transportable carbohydrates (MTC) refers to a combination of saccharides that rely on distinct transporters for intestinal absorption. Ingestion of MTC during prolonged exercise has been purported to increase carbohydrate absorption efficiency, increase exogenous carbohydrate oxidation, reduce gastrointestinal (GI) distress, and improve athletic performance when carbohydrate intake is high (>50-60 g·h⁻¹). Although reviews of MTC research have been published previously, a comprehensive literature evaluation underscoring methodological limitations has not been conducted to guide future work. Accordingly, this review outlined the plausible mechanisms of MTC and subsequently evaluated MTC research based on several factors, including participant characteristics, exercise modality, exercise task, treatment formulation, treatment blinding, and pre-exercise nutrition status. A total of 27 articles examining MTC during exercise were identified and reviewed. Overall, ingestion of MTC led to increased exogenous carbohydrate oxidation, reduced GI distress, and improved performance during cycling lasting ≥2.5 hours, particularly when carbohydrate was ingested at ≥1.2 g·min⁻¹. Despite the apparent benefits, several limitations in the literature were apparent, including that only 3 studies used running, only 2 studies were conducted in the field, most participants were fasted, and women and adolescents were underrepresented. In addition, the majority of the studies fed carbohydrate at ≥1.2 g·min⁻¹, which may have inflated levels of GI distress and exaggerated performance decrements with single-saccharide feedings. Based on these limitations, future MTC investigations should consider focusing on running, examining team-based sports, including women and adolescents, conducting experiments under field conditions, examining the modifying effects of pre-exercise nutrition, and using modest feeding protocols (1.0-1.2 g·min⁻¹).

Suicidal ideation and its determinants in Korean adults: The role of physical activity and functional limitations.

PubMed

Park, S M

2015-01-01

The recognition of suicide as a major public health problem has suggested the need to identify risk factors that have implications for preventive intervention. In the suicidal process, suicidal ideation is a key stage in the pathway leading to eventual suicide. This study investigated the influence of physical activity and functional limitations on suicidal ideation among young and middle-aged adults in a high suicidal society. Data for the current study were obtained from the Fourth Korea National Health and Nutrition Examination Survey 2007-2009 (KNHANES), a cross-sectional study conducted by the Korea Centers for Disease Control and Prevention. The survey conducted face-to-face interviews with young adults (n = 2326) and middle-aged adults (n = 3396). Using multivariate logistic regression analysis, the relationship of physical activity and functional limitations with suicidal ideation in young and middle-aged adults was assessed. A notable outcome was that the absence of a regular walking was correlated with increased suicidal ideation in middle-aged women. The other major finding was that young women and middle-aged adults with functional limitations had a high rate of suicidal thoughts. Multiple intervention approaches, including informational, social and behavioural approaches, are needed to promote regular walking in middle-aged women. For instance, mass media campaigns, community walking groups and individually adapted health behaviour modification may provide opportunities for positive intervention. Additionally, another important public health implication from these findings is the need for a suicide-intervention support system that includes screening for suicide risk in healthcare settings, especially among young women with physical limitations.

Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies.

PubMed

Shardell, Michelle; Harris, Anthony D; El-Kamary, Samer S; Furuno, Jon P; Miller, Ram R; Perencevich, Eli N

2007-10-01

Quasi-experimental study designs are frequently used to assess interventions that aim to limit the emergence of antimicrobial-resistant pathogens. However, previous studies using these designs have often used suboptimal statistical methods, which may result in researchers making spurious conclusions. Methods used to analyze quasi-experimental data include 2-group tests, regression analysis, and time-series analysis, and they all have specific assumptions, data requirements, strengths, and limitations. An example of a hospital-based intervention to reduce methicillin-resistant Staphylococcus aureus infection rates and reduce overall length of stay is used to explore these methods.

Defining sarcopenia in terms of risk of physical limitations: a 5-year follow-up study of 3,153 chinese men and women.

PubMed

Woo, Jean; Leung, Jason; Sham, Aprille; Kwok, Timothy

2009-12-01

To examine the definition of sarcopenia in Chinese subjects by relating the value of appendicular skeletal muscle mass (ASM) divided by height squared to physical functional outcomes after 4 years. Four-year prospective study. A Chinese community in Hong Kong SAR China. Three thousand one hundred fifty-three community-living men and women aged 65 and older. Information collected by questionnaire included demographics, health limitation on activities of daily living (ADLs), self-care, physical activity level, dietary intake, and psychosocial functioning. Measurements included height, weight, grip strength, step length in a 6-minute walk, and body composition. Four-year outcomes for those with ASM in kg per height in meters squared (ASM/ht(2)) less than 2 standard deviations (SDs) and 2 SDs or more below the young adult mean value were compared using analysis of variance and logistic regression, adjusting for potential confounding factors such as age, fat mass, presence or absence of malnutrition, dietary protein and vitamin D intake, comorbidity, and cognitive impairment. Participants with ASM/ht(2) 2 SDs or more below the young adult mean had lower grip strength and greater limitation in climbing stairs and general ADLs after adjusting for confounding factors. A U-shaped relationship was observed between physical limitation and ASM/ht(2), with increasing physical limitation below or above a range of 7.25 to 6.75 kg/m(2) in men and 6.00 to 6.25 kg/m(2) in women. Values of 5.25 to 6.74 kg/m(2) in women were associated with approximately 30% less risk of functional limitation after 5 years. No clear cutoff was found in men. Sarcopenia may be defined in terms of a range of values for ASM/ht(2) associated with the lowest risk of future physical limitations. The importance of establishing a quantitative value for the definition of sarcopenia may facilitate future interventional studies using pharmacological or nonpharmacological strategies.

Sources of Variability in Physical Activity Among Inactive People with Multiple Sclerosis.

PubMed

Uszynski, Marcin K; Herring, Matthew P; Casey, Blathin; Hayes, Sara; Gallagher, Stephen; Motl, Robert W; Coote, Susan

2018-04-01

Evidence supports that physical activity (PA) improves symptoms of multiple sclerosis (MS). Although application of principles from Social Cognitive Theory (SCT) may facilitate positive changes in PA behaviour among people with multiple sclerosis (pwMS), the constructs often explain limited variance in PA. This study investigated the extent to which MS symptoms, including fatigue, depression, and walking limitations combined with the SCT constructs, explained more variance in PA than SCT constructs alone among pwMS. Baseline data, including objectively assessed PA, exercise self-efficacy, goal setting, outcome expectations, 6-min walk test, fatigue and depression, from 65 participants of the Step It Up randomized controlled trial completed in Ireland (2016), were included. Multiple regression models quantified variance explained in PA and independent associations of (1) SCT constructs, (2) symptoms and (3) SCT constructs and symptoms. Model 1 included exercise self-efficacy, exercise goal setting and multidimensional outcomes expectations for exercise and explained ~14% of the variance in PA (R 2 =0.144, p < 0.05). Model 2 included walking limitations, fatigue and depression and explained 20% of the variance in PA (R 2 =0.196, p < 0.01). Model 3 combined models 1 and 2 and explained variance increased to ~29% (R 2 =0.288; p<0.01). In Model 3, exercise self-efficacy (β=0.30, p < 0.05), walking limitations (β=0.32, p < 0.01), fatigue (β = -0.41, p < 0.01) and depression (β = 0.34, p < 0.05) were significantly and independently associated with PA. Findings suggest that relevant MS symptoms improved by PA, including fatigue, depression and walking limitations, and SCT constructs together explained more variance in PA than SCT constructs alone, providing support for targeting both SCT constructs and these symptoms in the multifactorial promotion of PA among pwMS.

Challenges of Obtaining Evidence-Based Information Regarding Medications and Male Fertility.

PubMed

Drobnis, Erma Z; Nangia, Ajay K

2017-01-01

In the clinic, the existing literature is insufficient to counsel our infertile men on medication use. Most studies have flaws that limit their application to evidence-based practice. In this chapter, we discuss the limitations of the current literature and the challenges to designing more useful studies. Among the most important weaknesses of existing studies is lack of power; that is, too few men are included to draw conclusions about the existence and size of medication effects. Adequate power is particularly important when confirming an absence of medication effect. Bias is also a problem in most studies. Early studies were rarely randomized, placebo-controlled, or blinded; a common example is patients receiving different medication regimes based on the severity of their symptoms-making it impossible to attribute differences between treated and untreated men to the medications. Additional bias is introduced by failing to include other factors that influence the outcome in the experimental design. A uniform population amenable to randomization and placebo-control are experimental species, and useful information has been gained from these models. However, application to humans is limited by differences from other species in route of drug administration, absorption of the drug, concentration in the male genital tract tissues, and genital tract physiology. To a lesser degree, there is variation among individual men in their response to drugs. In addition, drugs in the same class may have different effects, limiting the applicability of data across drugs of a single class. Complicating matters further, a toxic medication may seem to improve fertility endpoints by improving a disease condition that diminishes fertility. Finally, drug interactions have not been studied, and actual fertility data (pregnancy/fecundity) in humans are rare. A healthy dose of skepticism is warranted when evaluating studies of medications and male reproductive health.

Association between pediatric asthma care quality and morbidity and English language proficiency in Ohio.

PubMed

Montgomery, Martha P; Allen, Elizabeth D; Thomas, Olivia; Robinson, Byron F; Clark, Donnie; Connelly, Ann; Mott, Joshua A; Conrey, Elizabeth

2018-05-08

Limited English proficiency can be a barrier to asthma care and is associated with poor outcomes. This study examines whether pediatric patients in Ohio with limited English proficiency experience lower asthma care quality or higher morbidity. We used electronic health records for asthma patients aged 2-17 years from a regional, urban, children's hospital in Ohio during 2011-2015. Community-level demographics were included from U.S. Census data. By using chi-square and t-tests, patients with limited English proficiency and bilingual English-speaking patients were compared with English-only patients. Five asthma outcomes-two quality and three morbidity measures-were modeled using generalized estimating equations. The study included 15 352 (84%) English-only patients, 1744 (10%) patients with limited English proficiency, and 1147 (6%) bilingual patients. Pulmonary function testing (quality measure) and multiple exacerbation visits (morbidity measure) did not differ by language group. Compared with English-only patients, bilingual patients had higher odds of ever having an exacerbation visit (morbidity measure) (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.2-1.6) but lower odds of admission to intensive care (morbidity measure) (aOR, 0.3; 95% CI, 0.2-0.7), while patients with limited English proficiency did not differ on either factor. Recommended follow-up after exacerbation (quality measure) was higher for limited English proficiency (aOR, 1.8; 95% CI, 1.4-2.3) and bilingual (aOR, 1.6; 95% CI, 1.3-2.1), compared with English-only patients. In this urban, pediatric population with reliable interpreter services, limited English proficiency was not associated with worse asthma care quality or morbidity.

Family Therapist as Consultant in Foster Care: Expanding the Parameters of Practice.

ERIC Educational Resources Information Center

Morrissette, Patrick J.

1996-01-01

Traditionally, the role of the family therapist working in foster care has been limited to the areas of evaluation and treatment. This paper proposes that the family therapist can extend conventional boundaries to include the practice of systemic consultation. Case studies are included to exemplify family therapist microlevel consultation with…

A qualitative case study to identify possible barriers that limit effective elementary science education

NASA Astrophysics Data System (ADS)

Foster, Donald Carey

The purpose of this case study was to identify barriers that limit the effectiveness of elementary teachers in the teaching of science. It is of the utmost urgency that barriers be first identified, so that possible solutions can be explored to bring about the improvement of elementary science education. This urgency has been imposed by the scheduled national testing of students in science by 2007, as mandated by the No Child Left Behind Act of 2001. Using qualitative case study methods, the researcher conducted interviews with 8 elementary teachers from two schools within one school district who taught 3rd, 4th, and 5th grade. These interviews were designed to gain insight into barriers these elementary teachers perceived as factors limiting their effectiveness in teaching science and preparing students for high-stakes testing. Barriers in the areas of teacher background, typical teaching day, curriculum, inservices, and legislative influences were explored. This study concluded that the barriers explored do have a substantial negative affect on the teaching and learning of science in the elementary grades. Specifically, the barriers revealed in this study include the limited science background of elementary teachers, inadequate class time devoted to science, non-comprehensive curriculum, ineffective or lack of inservice training, and pressures from legislated mandates. But it is also clear that these barriers are so intertwined that one cannot remove these barriers one at a time. It will take a collective effort from all involved, including legislators, administrators, teachers, parents, and students, to alleviate these barriers and discover effective solutions to improve elementary science education.

Loratadine and Pregnancy

MedlinePlus

... with several limitations suggested a small risk for hypospadias (a condition where the opening of the penis ... risk of any type of birth defect, including hypospadias. Also, studies involving infants with hypospadias did not ...

Chemical and biological warfare: General studies. (Latest citations from the NTIS bibliographic database). NewSearch

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

Not Available

1994-10-01

The bibliography contains citations concerning federally sponsored and conducted studies into chemical and biological warfare operations and planning. These studies cover areas not addressed in other parts of this series. The topics include production and storage of agents, delivery techniques, training, military and civil defense, general planning studies, psychological reactions to chemical warfare, evaluations of materials exposed to chemical agents, and studies on banning or limiting chemical warfare. Other published searches in this series on chemical warfare cover detection and warning, defoliants, protection, and biological studies, including chemistry and toxicology. (Contains 250 citations and includes a subject term index andmore » title list.)« less

Chemical and biological warfare: General studies. (Latest citations from the NTIS bibliographic database). Published Search

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

NONE

1997-11-01

The bibliography contains citations concerning federally sponsored and conducted studies into chemical and biological warfare operations and planning. These studies cover areas not addressed in other parts of this series. The topics include production and storage of agents, delivery techniques, training, military and civil defense, general planning studies, psychological reactions to chemical warfare, evaluations of materials exposed to chemical agents, and studies on banning or limiting chemical warfare. Other published searches in this series on chemical warfare cover detection and warning, defoliants, protection, and biological studies, including chemistry and toxicology.(Contains 50-250 citations and includes a subject term index and titlemore » list.) (Copyright NERAC, Inc. 1995)« less

Chemical and biological warfare: General studies. (Latest citations from the NTIS bibliographic database). Published Search

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

NONE

1996-10-01

The bibliography contains citations concerning federally sponsored and conducted studies into chemical and biological warfare operations and planning. These studies cover areas not addressed in other parts of this series. The topics include production and storage of agents, delivery techniques, training, military and civil defense, general planning studies, psychological reactions to chemical warfare, evaluations of materials exposed to chemical agents, and studies on banning or limiting chemical warfare. Other published searches in this series on chemical warfare cover detection and warning, defoliants, protection, and biological studies, including chemistry and toxicology. (Contains 50-250 citations and includes a subject term index andmore » title list.) (Copyright NERAC, Inc. 1995)« less

Chemical and biological warfare: General studies. (Latest citations from the NTIS bibliographic database). Published Search

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

NONE

1995-09-01

The bibliography contains citations concerning federally sponsored and conducted studies into chemical and biological warfare operations and planning. These studies cover areas not addressed in other parts of this series. The topics include production and storage of agents, delivery techniques, training, military and civil defense, general planning studies, psychological reactions to chemical warfare, evaluations of materials exposed to chemical agents, and studies on banning or limiting chemical warfare. Other published searches in this series on chemical warfare cover detection and warning, defoliants, protection, and biological studies, including chemistry and toxicology.(Contains 50-250 citations and includes a subject term index and titlemore » list.) (Copyright NERAC, Inc. 1995)« less

Cognitive Limitations at Work Among Employed Breast Cancer Survivors in China.

PubMed

Zeng, Yingchun; Cheng, Andy S K; Feuerstein, Michael

This study aimed to determine whether levels of distress (anxiety and depression) and cognitive symptoms at work are related to work productivity and quality of life (QOL) in Chinese breast cancer survivors (BCS), compared to a group of Chinese women without cancer but with different musculoskeletal pain related to work. This study used a cross-sectional study design. Working BCS were recruited in a tumor hospital's outpatient department, and women with no history of cancer (noncancer comparison [NCC] group) were recruited from a rehabilitation center. A total of 412 participants were included. Multiple regression analyses indicated that higher anxiety was associated with work limitations (B = .005, p = .014) and QOL (B = 2.417, p = .004) in the BCS group only. Cognitive limitations at work were associated with work limitations (B = .002, p = .001) and QOL (B = 1.022, p = .003) in the BCS group only. Depressive symptoms (B = .028, p = .017) were significantly associated with work limitations in the NCC group. Breast cancer survivors reported higher levels of cognitive limitations at work and anxiety, lower levels of work productivity, and QOL. When remaining at work is a viable option for the cancer survivor with cognitive limitations at work, the rehabilitation nurse should consider approaches to best accommodate the specific cognitive limitations and work tasks, as well as help the patient manage associated anxiety when present.

Economic evaluations of eHealth technologies: A systematic review.

PubMed

Sanyal, Chiranjeev; Stolee, Paul; Juzwishin, Don; Husereau, Don

2018-01-01

Innovations in eHealth technologies have the potential to help older adults live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults. We systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Eleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studies demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors. This review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.

Use of synchrotron tomography to image naturalistic anatomy in insects

NASA Astrophysics Data System (ADS)

Socha, John J.; De Carlo, Francesco

2008-08-01

Understanding the morphology of anatomical structures is a cornerstone of biology. For small animals, classical methods such as histology have provided a wealth of data, but such techniques can be problematic due to destruction of the sample. More importantly, fixation and physical slicing can cause deformation of anatomy, a critical limitation when precise three-dimensional data are required. Modern techniques such as confocal microscopy, MRI, and tabletop x-ray microCT provide effective non-invasive methods, but each of these tools each has limitations including sample size constraints, resolution limits, and difficulty visualizing soft tissue. Our research group at the Advanced Photon Source (Argonne National Laboratory) studies physiological processes in insects, focusing on the dynamics of breathing and feeding. To determine the size, shape, and relative location of internal anatomy in insects, we use synchrotron microtomography at the beamline 2-BM to image structures including tracheal tubes, muscles, and gut. Because obtaining naturalistic, undeformed anatomical information is a key component of our studies, we have developed methods to image fresh and non-fixed whole animals and tissues. Although motion artifacts remain a problem, we have successfully imaged multiple species including beetles, ants, fruit flies, and butterflies. Here we discuss advances in biological imaging and highlight key findings in insect morphology.

Creating Rural Allied Health Leadership Structures Using District Advisors: An Action Research Project Using Program Logic.

PubMed

Schmidt, David; Kurtz, Megan; Davidson, Stuart

2017-01-01

District advisors in five allied health disciplines were introduced in a local health district in rural Australia in 2013. These strategic leadership roles provide support to clinicians and managers. As there is little research exploring allied health leadership models from a strategic and operational perspective, the coordinated commencement of these roles provided opportunity to study the creation of this leadership structure. Four advisors participated in this action research study which used focus groups and program logic processes to explore the inputs, outputs, barriers, outcomes to date, and preferred future outcomes of the leadership model. A purpose-built questionnaire was sent to 134 allied health clinicians or managers with questionnaire responses used by advisors to visualise the leadership model. Advisors prioritised policy development, representing the profession outside the organisation, and supporting department managers, whilst clinicians prioritised communication and connection-building within the organisation. Outcomes of the leadership model included connection, coordination, and advocacy for clinicians. Future preferred outcomes included increased strategic and workforce planning. Barriers included limited time, a widespread workforce and limited resourcing. Instituting a leadership model improved communication, cohesion, and coordination within the organisation. Future increases in workforce planning and coordination are limited by advisor capacity and competing workloads.

Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis

PubMed Central

2012-01-01

Background Traditionally, hyperbaric oxygen treatment (HBOT) has been used to treat a limited repertoire of disease, including decompression sickness and healing of problem wounds. However, some investigators have used HBOT to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Methods Comprehensive searches were conducted in 8 scientific databases through 2011 to identify publications using HBOT in IBD. Human studies and animal models were collated separately. Results Thirteen studies of HBOT in Crohn's disease and 6 studies in ulcerative colitis were identified. In all studies, participants had severe disease refractory to standard medical treatments, including corticosteroids, immunomodulators and anti-inflammatory medications. In patients with Crohn's disease, 31/40 (78%) had clinical improvements with HBOT, while all 39 patients with ulcerative colitis improved. One study in Crohn's disease reported a significant decrease in proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) and one study in ulcerative colitis reported a decrease in IL-6 with HBOT. Adverse events were minimal. Twelve publications reported using HBOT in animal models of experimentally-induced IBD, including several studies reporting decreased markers of inflammation or immune dysregulation, including TNF-alpha (3 studies), IL-1beta (2 studies), neopterin (1 study) and myeloperoxidase activity (5 studies). HBOT also decreased oxidative stress markers including malondialdehyde (3 studies) and plasma carbonyl content (2 studies), except for one study that reported increased plasma carbonyl content. Several studies reported HBOT lowered nitric oxide (3 studies) and nitric oxide synthase (3 studies) and one study reported a decrease in prostaglandin E2 levels. Four animal studies reported decreased edema or colonic tissue weight with HBOT, and 8 studies reported microscopic improvements on histopathological examination. Although most publications reported improvements with HBOT, some studies suffered from limitations, including possible publication and referral biases, the lack of a control group, the retrospective nature and a small number of participants. Conclusions HBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD. PMID:22417628

Auditory Processing of Older Adults with Probable Mild Cognitive Impairment

ERIC Educational Resources Information Center

Edwards, Jerri D.; Lister, Jennifer J.; Elias, Maya N.; Tetlow, Amber M.; Sardina, Angela L.; Sadeq, Nasreen A.; Brandino, Amanda D.; Bush, Aryn L. Harrison

2017-01-01

Purpose: Studies suggest that deficits in auditory processing predict cognitive decline and dementia, but those studies included limited measures of auditory processing. The purpose of this study was to compare older adults with and without probable mild cognitive impairment (MCI) across two domains of auditory processing (auditory performance in…

Age, Gender and Social Class in ELT Coursebooks: A Critical Study

ERIC Educational Resources Information Center

Arikan, Arda

2004-01-01

Recent trends in English Language Teaching (ELT) research necessitates the study of course books and instructional materials from various perspectives including but not limited to their cultural, social, and psychological qualities and effects (Kramsch 2000). Age, social class, and gender, as represented in course books are studied because…

An Extensive Analysis of Preservice Elementary Teachers' Knowledge of Fractions

ERIC Educational Resources Information Center

Newton, Kristie Jones

2008-01-01

The study of preservice elementary teachers' knowledge of fractions is important because fractions are notoriously difficult to learn and teach. Unfortunately, studies of preservice teachers' fraction knowledge are limited and have focused primarily on division. The present study included all four operations to provide a more comprehensive…

Age, Gender and Social Class in ELT Coursebooks: A Critical Study

ERIC Educational Resources Information Center

Arikan, Arda

2005-01-01

Recent trends in English Language Teaching (ELT) research necessitates the study of coursebooks and instructional materials from various perspectives including but not limited to their cultural, social, and psychological qualities and effects (Kramsch 2000). Age, social class, and gender, as represented in coursebooks are studied because teachers…

Classwide Functional Analysis and Treatment of Preschoolers' Disruptive Behavior

ERIC Educational Resources Information Center

Poole, Veena Y.; Dufrene, Brad A.; Sterling, Heather E.; Tingstrom, Daniel H.; Hardy, Christina M.

2012-01-01

Relatively few functional assessment and intervention studies have been conducted in preschool classrooms with children of typical development who engage in high incidence problem behaviors. Moreover, limited studies have used functional assessment procedures with the class as the unit of analysis. This study included functional analyses and a…

I was never recruited: challenges in cross-Canada nurse mobility.

PubMed

Hall, Linda McGillis; Peterson, Jessica; Sheri, Sheri; Andrews, Gavin; Lalonde, Michelle; Harris, Alexandra; MacDonald-Rencz, Sandra

2013-01-01

The internal migration of nurses within Canada has had limited study. This paper reports the results of a survey of registered nurses and licensed practical nurses who had migrated between the provinces and territories in Canada. Factors contributing to internal nurse mobility included seeking full-time work, opportunities for career advancement and flexible scheduling options. Few nurses received incentives to move between the provinces/territories to work. A number of challenges with internal migration are identified, including complexities related to licensing and limitations in available job information. Implications for nursing health human resources policy related to nurse retention in Canada are identified and discussed.

Determinants of knowledge and attitudes about sugar and the association of knowledge and attitudes with sugar intake among adults: A systematic review.

PubMed

Gupta, Adyya; Smithers, Lisa G; Harford, Jane; Merlin, Tracy; Braunack-Mayer, Annette

2018-07-01

Efforts to reduce sugar intake levels have been primarily limited to increasing knowledge and changing attitudes. We conducted a systematic review to (1) identify factors influencing adults' knowledge and attitudes about sugar, and (2) determine if there is an association between knowledge and attitudes about sugar and sugar intake. We searched 15 electronic databases from inception to December 2016 for English language publications including adults with relevant exposure and outcome measures. Findings were summarised meta-narratively. Of 3287 studies, 22 studies (14 for objective one and 8 for objective two) were included. Individual (liking of sugary food), interpersonal (attitudes of peers) and environmental factors (media, health professionals and food labelling) influenced adults' knowledge and attitudes about sugar, at least to some extent. Overall, quality of the studies included in our review was weak, and evidence for the application of the Knowledge-Attitude-Behavior model for understanding sugar intake is limited. Protocol registered in the PROSPERO International prospective register of systematic reviews (registration number CRD42015027540). Copyright © 2018 Elsevier Ltd. All rights reserved.

Team learning and innovation in nursing, a review of the literature.

PubMed

Timmermans, Olaf; Van Linge, Roland; Van Petegem, Peter; Van Rompaey, Bart; Denekens, Joke

2012-01-01

The capability to learn and innovate has been recognized as a key-factor for nursing teams to deliver high quality performance. Researchers suggest there is a relation between team-learning activities and changes in nursing teams throughout the implementation of novelties. A review of the literature was conducted in regard to the relation between team learning and implementation of innovations in nursing teams and to explore factors that contribute or hinder team learning. The search was limited to studies that were published in English or Dutch between 1998 and 2010. Eight studies were included in the review. The results of this review revealed that research on team learning and innovation in nursing is limited. The included studies showed moderate methodological quality and low levels of evidence. Team learning included processes to gather, process, and store information from different innovations within the nursing team and the prevalence of team-learning activities was contributed or hindered by individual and contextual factors. Further research is needed on the relation between team learning and implementation of innovations in nursing. Copyright © 2011 Elsevier Ltd. All rights reserved.

40 CFR 160.185 - Reporting of study results.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Reporting of study results. 160.185... GOOD LABORATORY PRACTICE STANDARDS Records and Reports § 160.185 Reporting of study results. (a) A final report shall be prepared for each study and shall include, but not necessarily be limited to, the...

40 CFR 160.185 - Reporting of study results.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Reporting of study results. 160.185... GOOD LABORATORY PRACTICE STANDARDS Records and Reports § 160.185 Reporting of study results. (a) A final report shall be prepared for each study and shall include, but not necessarily be limited to, the...

Open Platform for Limit Protection with Carefree Maneuver Applications

NASA Technical Reports Server (NTRS)

Jeram, Geoffrey J.

2004-01-01

This Open Platform for Limit Protection guides the open design of maneuver limit protection systems in general, and manned, rotorcraft, aerospace applications in particular. The platform uses three stages of limit protection modules: limit cue creation, limit cue arbitration, and control system interface. A common set of limit cue modules provides commands that can include constraints, alerts, transfer functions, and friction. An arbitration module selects the "best" limit protection cues and distributes them to the most appropriate control path interface. This platform adopts a holistic approach to limit protection whereby it considers all potential interface points, including the pilot's visual, aural, and tactile displays; and automatic command restraint shaping for autonomous limit protection. For each functional module, this thesis guides the control system designer through the design choices and information interfaces among the modules. Limit cue module design choices include type of prediction, prediction mechanism, method of critical control calculation, and type of limit cue. Special consideration is given to the nature of the limit, particularly the level of knowledge about it, and the ramifications for limit protection design, especially with respect to intelligent control methods such as fuzzy inference systems and neural networks.

Work limitations, workplace concerns, and job satisfaction of persons with chronic disease.

PubMed

Siu, Andrew M H; Hung, Anchor; Lam, Ada Y L; Cheng, Andy

2013-01-01

This study investigates the workplace experiences of people with chronic diseases, including their work limitations, emotional health, concerns about discrimination, and support from colleagues and employer. This study identifies the factors that contribute to work adjustment (job tenure and job satisfaction). A purposive sample of 136 persons aged 18 to 60 with chronic diseases who had been employed in the past 6 months completed a survey about their workplace experience. The questionnaire included several standardized instruments: the Perceived Health and Self-efficacy in Managing Chronic Disease Scale, Work Limitations Questionnaire, Overall Job Satisfaction Scale, and the Depression Anxiety Stress Scale-21. The researchers also designed original items to measure concerns about discriminatory practices, workplace support, and self-stigma. Persons with chronic diseases were fairly satisfied with their jobs and had extended stays in those jobs. They reported a minor productivity loss and physical limitations. Most participants let co-workers, employers, and supervisors know they had chronic disease, but they were concerned about the support those people provide. Participants were more likely to be highly satisfied with their jobs if they had high self-efficacy in managing their disease, perceived more workplace support, and had less work limitations (especially output demands). Job tenure is associated age, education, and monthly income, but not clinical indicators. Persons with chronic disease who were able to maintain good work adjustment tended to be "fit" with few work limitations and little emotional distress. The key factors affecting work adjustment were efficacy in managing their disease, workplace support, and output demands.

40 CFR Appendix A to Part 419 - Processes Included in the Determination of BAT Effluent Limitations for Total Chromium...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 29 2011-07-01 2009-07-01 true Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium, and Phenolic Compounds (4AAP) A...—Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium...

40 CFR Appendix A to Part 419 - Processes Included in the Determination of BAT Effluent Limitations for Total Chromium...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium, and Phenolic Compounds (4AAP) A...—Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium...

40 CFR Appendix A to Part 419 - Processes Included in the Determination of BAT Effluent Limitations for Total Chromium...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 29 2014-07-01 2012-07-01 true Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium, and Phenolic Compounds (4AAP) A...—Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium...

40 CFR Appendix A to Part 419 - Processes Included in the Determination of BAT Effluent Limitations for Total Chromium...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 30 2012-07-01 2012-07-01 false Processes Included in the Determination of BAT Effluent Limitations for Total Chromium, Hexavalent Chromium, and Phenolic Compounds (4AAP... Part 419—Processes Included in the Determination of BAT Effluent Limitations for Total Chromium...

13 CFR 107.240 - Limitations on including non-cash capital contributions in Private Capital.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Licensee from its parent Licensee, valued at the lower of cost or fair value. (e) Other non-cash assets... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Limitations on including non-cash... Sbic § 107.240 Limitations on including non-cash capital contributions in Private Capital. Non-cash...

Myelin Associated Inhibitors: A Link Between Injury-Induced and Experience-Dependent Plasticity

PubMed Central

Akbik, Feras; Cafferty, William B. J.; Strittmatter, Stephen M.

2011-01-01

SUMMARY In the adult, both neurologic recovery and anatomical growth after a CNS injury are limited. Two classes of growth inhibitors, myelin associated inhibitors (MAIs) and extracellular matrix associated inhibitors, limit both functional recovery and anatomical rearrangements in animal models of spinal cord injury. Here we focus on how MAIs limit a wide spectrum of growth that includes regeneration, sprouting, and plasticity in both the intact and lesioned CNS. Three classic myelin associated inhibitors, Nogo-A, MAG, and OMgp, signal through their common receptors, Nogo-66 Receptor-1 (NgR1) and Paired-Immunoglobulin-like-Receptor-1 (PirB), to regulate cytoskeletal dynamics and inhibit growth. Initially described as inhibitors of axonal regeneration, subsequent work has demonstrated that MAIs also limit activity and experience-dependent plasticity in the intact, adult CNS. MAIs therefore represent a point of convergence for plasticity that limits anatomical rearrangements regardless of the inciting stimulus, blurring the distinction between injury studies and more “basic” plasticity studies. PMID:21699896

Adjusting for car occupant injury liability in relation to age, speed limit, and gender-specific driver crash involvement risk.

PubMed

Keall, Michael; Frith, William

2004-12-01

It is well established that older drivers' fragility is an important factor associated with higher levels of fatal crash involvement for older drivers. There has been less research on age-related fragility with respect to the sort of minor injuries that are more common in injury crashes. This study estimates a quantity that is related to injury fragility: the probability that a driver or a passenger of that driver will be injured in crashes involving two cars. The effects of other factors apart from drivers' fragility are included in this measure, including the fragility of the passengers, the crashworthiness of cars driven, seatbelt use by the occupants, and characteristics of crashes (including configuration and impact speed). The car occupant injury liability estimates appropriately includes these factors to adjust risk curves by age, gender, and speed limit accounting for overrepresentation in crashes associated with fragility and these other factors.

Building physician resilience.

PubMed

Jensen, Phyllis Marie; Trollope-Kumar, Karen; Waters, Heather; Everson, Jennifer

2008-05-01

To explore the dimensions of family physician resilience. Qualitative study using in-depth interviews with family physician peers. Hamilton, Ont. Purposive sample of 17 family physicians. An iterative process of face-to-face, in-depth interviews that were audiotaped and transcribed. The research team independently reviewed each interview for emergent themes with consensus reached through discussion and comparison. Themes were grouped into conceptual categories. Four main aspects of physician resilience were identified: 1) attitudes and perspectives, which include valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations; 2) balance and prioritization, which include setting limits, taking effective approaches to continuing professional development, and honouring the self;3) practice management style, which includes sound business management, having good staff, and using effective practice arrangements; and 4) supportive relations, which include positive personal relationships, effective professional relationships, and good communication. Resilience is a dynamic, evolving process of positive attitudes and effective strategies.

The effects of integrated care: a systematic review of UK and international evidence.

PubMed

Baxter, Susan; Johnson, Maxine; Chambers, Duncan; Sutton, Anthea; Goyder, Elizabeth; Booth, Andrew

2018-05-10

Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. Prospero registration number: 42016037725 .

Characteristics of Qualitative Descriptive Studies: A Systematic Review

PubMed Central

Kim, Hyejin; Sefcik, Justine S.; Bradway, Christine

2016-01-01

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, despite inconsistencies, most articles included characteristics consistent with limited, available QD definitions and descriptions. Next, flexibility or variability of methods was common and desirable for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD study so that readers can determine whether the methods used were reasonable and effective in producing useful findings. PMID:27686751

Twelfth International Symposium on Methodologies for Intelligent Systems (ISMIS󈧄) Held in Charlotte, North Carolina on October 11-14, 2000

DTIC Science & Technology

2000-10-14

without any knowledge of the problem area. Therefore, Darwinian-type evolutionary computation has found a very wide range of applications, including many ...the author examined many biomedical studies that included literature searches. The Science Citation Index (SCL) Abstracts of these studies...yield many records that are non-relevant to the main technical themes of the study. In summary, these types of simple limited queries can result in two

Advanced EVA system design requirements study

NASA Technical Reports Server (NTRS)

Woods, T. G.

1988-01-01

The results are presented of a study to identify specific criteria regarding space station extravehicular activity system (EVAS) hardware requirements. Key EVA design issues include maintainability, technology readiness, LSS volume vs. EVA time available, suit pressure/cabin pressure relationship and productivity effects, crew autonomy, integration of EVA as a program resource, and standardization of task interfaces. A variety of DOD EVA systems issues were taken into consideration. Recommendations include: (1) crew limitations, not hardware limitations; (2) capability to perform all of 15 generic missions; (3) 90 days on-orbit maintainability with 50 percent duty cycle as minimum; and (4) use by payload sponsors of JSC document 10615A plus a Generic Tool Kit and Specialized Tool Kit description. EVA baseline design requirements and criteria, including requirements of various subsystems, are outlined. Space station/EVA system interface requirements and EVA accommodations are discussed in the areas of atmosphere composition and pressure, communications, data management, logistics, safe haven, SS exterior and interior requirements, and SS airlock.

What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review.

PubMed

Yuan, Beibei; Målqvist, Mats; Trygg, Nadja; Qian, Xu; Ng, Nawi; Thomsen, Sarah

2014-06-21

The deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities. We searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis. 22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups. Studies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side.

Reflection on Mobile Applications for Blood Pressure Management: A Systematic Review on Potential Effects and Initiatives.

PubMed

Mohammadi, Reyhaneh; Ayatolahi Tafti, Movahhedeh; Hoveidamanesh, Soodabeh; Ghanavati, Reza; Pournik, Omid

2018-01-01

Ischemic heart disease and stroke have been considered as the first global leading cause of death in last decades [1]. Blood pressure (BP) management is one of the easiest ways suggested for preventing and controlling cardiovascular diseases before the patient develops complications and death-following outcomes. Appearance of technology advancements in the health system has motivated researchers and health providers to study its different aspects and applications in order to improve disease prevention and management. Following these efforts, mobile health (mHealth) technologies were presented to provide people with fast and easier-to-use services. Although there are some unsolved challenges, these technologies have become popular among many people. As an important part of mHealth, mobile applications (apps) have been the focused subject of many studies in the last decade. The objective of this systematic review is to assess the potential effects of mobile apps designed for BP management by scrutinizing the related studies. Search methods: We searched the following electronic databases in December 2016: Medline (PubMed), National Center for Biotechnology Information (NCBI), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center(ERIC), Web of Science, ProQuest, and Google Scholar. No language restriction and start point limitation were imposed. We included studies that evaluated and assessed mobile apps for BP management and related clinical trials that considered mobile app as the only difference between intervention and control groups. Two review authors applied the eligibility criteria, extracted data and assessed the quality of included studies. Literature search resulted in 13 included studies and 27 reviews. 12 records of 13 included studies identified as interventional studies. The review showed that the mobile apps may improve individual's BP condition and medication adherence. Most of the studies had emphasized positive effects of mobile apps in BP management. However, there is a necessity for performing further investigations due to the identified issues in this study such as low number of participants and limited intervention period in randomized controlled trials, and interventions limited to only hypertensive or high-risked individual.

Computer-Based Cognitive Training for Executive Functions after Stroke: A Systematic Review

PubMed Central

van de Ven, Renate M.; Murre, Jaap M. J.; Veltman, Dick J.; Schmand, Ben A.

2016-01-01

Background: Stroke commonly results in cognitive impairments in working memory, attention, and executive function, which may be restored with appropriate training programs. Our aim was to systematically review the evidence for computer-based cognitive training of executive dysfunctions. Methods: Studies were included if they concerned adults who had suffered stroke or other types of acquired brain injury, if the intervention was computer training of executive functions, and if the outcome was related to executive functioning. We searched in MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Study quality was evaluated based on the CONSORT Statement. Treatment effect was evaluated based on differences compared to pre-treatment and/or to a control group. Results: Twenty studies were included. Two were randomized controlled trials that used an active control group. The other studies included multiple baselines, a passive control group, or were uncontrolled. Improvements were observed in tasks similar to the training (near transfer) and in tasks dissimilar to the training (far transfer). However, these effects were not larger in trained than in active control groups. Two studies evaluated neural effects and found changes in both functional and structural connectivity. Most studies suffered from methodological limitations (e.g., lack of an active control group and no adjustment for multiple testing) hampering differentiation of training effects from spontaneous recovery, retest effects, and placebo effects. Conclusions: The positive findings of most studies, including neural changes, warrant continuation of research in this field, but only if its methodological limitations are addressed. PMID:27148007

Natural Divertor Spherical Tokamak Plasmas with bean shape and ergodic limiter

NASA Astrophysics Data System (ADS)

Ribeiro, Celso; Herrera, Julio; Chavez, Esteban; Tritz, Kevin

2013-10-01

The former spherical tokamak (ST) MEDUSA (Madison EDUcation Small Aspect.ratio tokamak, R < 0.14 m, a < 0.10 m, BT < 0.5T, Ip < 40 kA, 3 ms pulse) is being recommissioned in Costa Rica Institute of Technology. The main objectives of the MEDUSA-CR project are training and to clarify several issues in relevant physics for conventional and mainly STs, including beta studies in bean-shaped ST plasmas, transport, heating and current drive via Alfvén wave, and natural divertor STs with ergodic magnetic limiter. We report here improvements in the self-consistency of these equilibrium comparisons and a preliminary study of their MHD stability beta limits. VIE-ITCR, IAEA-CRP contract 17592, National Instruments of Costa Rica.

Poststroke Seizures and Epilepsy: Clinical Studies and Animal Models

PubMed Central

Kelly, Kevin M.

2002-01-01

Poststroke seizures and epilepsy have been described in numerous clinical studies for many years. Most studies are retrospective in design, include relatively small numbers of patients, have limited periods of follow-up, and report a diversity of findings. Well-designed clinical trials and population studies in the recent past addressed several critical clinical issues and generated important findings regarding the occurrence of poststroke seizures and epilepsy. In contrast, the pathophysiologic events of injured brain that establish poststroke epileptogenesis are not well understood, and animal modeling has had limited development. Reviews of several important clinical studies and animal models that hold promise for a better understanding of poststroke epileptogenesis are presented. PMID:15309107

Aerodynamic Limits on Large Civil Tiltrotor Sizing and Efficiency

NASA Technical Reports Server (NTRS)

Acree, C W., Jr.

2014-01-01

The NASA Large Civil Tiltrotor (2nd generation, or LCTR2) has been the reference design for avariety of NASA studies of design optimization, engine and gearbox technology, handling qualities, andother areas, with contributions from NASA Ames, Glenn and Langley Centers, plus academic and industrystudies. Ongoing work includes airfoil design, 3D blade optimization, engine technology studies, andwingrotor aerodynamic interference. The proposed paper will bring the design up to date with the latestresults of such studies, then explore the limits of what aerodynamic improvements might hope toaccomplish. The purpose is two-fold: 1) determine where future technology studies might have the greatestpayoff, and 2) establish a stronger basis of comparison for studies of other vehicle configurations andmissions.

Differences in the Nature of Body Image Disturbances between Female Obese Individuals with versus without a Comorbid Binge Eating Disorder: An Exploratory Study Including Static and Dynamic Aspects of Body Image

ERIC Educational Resources Information Center

Legenbauer, Tanja; Vocks, Silja; Betz, Sabrina; Puigcerver, Maria Jose Baguena; Benecke, Andrea; Troje, Nikolaus F.; Ruddel, Heinz

2011-01-01

Various components of body image were measured to assess body image disturbances in patients with obesity. To overcome limitations of previous studies, a photo distortion technique and a biological motion distortion device were included to assess static and dynamic aspects of body image. Questionnaires assessed cognitive-affective aspects, bodily…

40 CFR 158.33 - Confidential data.

Code of Federal Regulations, 2012 CFR

2012-07-01

... organism or the behavior of such pesticide in the environment, including, but not limited to, data on safety to fish and wildlife, humans and other mammals, plants, animals, and soil, and studies on...

40 CFR 158.33 - Confidential data.

Code of Federal Regulations, 2014 CFR

2014-07-01

... organism or the behavior of such pesticide in the environment, including, but not limited to, data on safety to fish and wildlife, humans and other mammals, plants, animals, and soil, and studies on...

Adult Coping with Childhood Sexual Abuse: A Theoretical and Empirical Review

PubMed Central

Walsh, Kate; Fortier, Michelle A.; DiLillo, David

2009-01-01

Coping has been suggested as an important element in understanding the long-term functioning of individuals with a history of child sexual abuse (CSA). The present review synthesizes the literature on coping with CSA, first by examining theories of coping with trauma, and, second by examining how these theories have been applied to studies of coping in samples of CSA victims. Thirty-nine studies were reviewed, including eleven descriptive studies of the coping strategies employed by individuals with a history of CSA, eighteen correlational studies of the relationship between coping strategies and long-term functioning of CSA victims, and ten investigations in which coping was examined as a mediational factor in relation to long-term outcomes. These studies provide initial information regarding early sexual abuse and subsequent coping processes. However, this literature is limited by several theoretical and methodological issues, including a failure to specify the process of coping as it occurs, a disparity between theory and research, and limited applicability to clinical practice. Future directions of research are discussed and include the need to understand coping as a process, identification of coping in relation to adaptive outcomes, and considerations of more complex mediational and moderational processes in the study of coping with CSA. PMID:20161502

How Low Can You Go? The Importance of Quantifying Minimum Generation Levels for Renewable Integration

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

Denholm, Paul L; Brinkman, Gregory L; Mai, Trieu T

One of the significant limitations of solar and wind deployment is declining value caused by the limited correlation of renewable energy supply and electricity demand as well as limited flexibility of the power system. Limited flexibility can result from thermal and hydro plants that cannot turn off or reduce output due to technical or economic limits. These limits include the operating range of conventional thermal power plants, the need for process heat from combined heat and power plants, and restrictions on hydro unit operation. To appropriately analyze regional and national energy policies related to renewable deployment, these limits must bemore » accurately captured in grid planning models. In this work, we summarize data sources and methods for U.S. power plants that can be used to capture minimum generation levels in grid planning tools, such as production cost models. We also provide case studies for two locations in the U.S. (California and Texas) that demonstrate the sensitivity of variable generation (VG) curtailment to grid flexibility assumptions which shows the importance of analyzing (and documenting) minimum generation levels in studies of increased VG penetration.« less

Remembering Complex Objects in Visual Working Memory: Do Capacity Limits Restrict Objects or Features?

PubMed Central

Hardman, Kyle; Cowan, Nelson

2014-01-01

Visual working memory stores stimuli from our environment as representations that can be accessed by high-level control processes. This study addresses a longstanding debate in the literature about whether storage limits in visual working memory include a limit to the complexity of discrete items. We examined the issue with a number of change-detection experiments that used complex stimuli which possessed multiple features per stimulus item. We manipulated the number of relevant features of the stimulus objects in order to vary feature load. In all of our experiments, we found that increased feature load led to a reduction in change-detection accuracy. However, we found that feature load alone could not account for the results, but that a consideration of the number of relevant objects was also required. This study supports capacity limits for both feature and object storage in visual working memory. PMID:25089739

Recent molecular genetic studies and methodological issues in suicide research.

PubMed

Tsai, Shih-Jen; Hong, Chen-Jee; Liou, Ying-Jay

2011-06-01

Suicide behavior (SB) spans a spectrum ranging from suicidal ideation to suicide attempts and completed suicide. Strong evidence suggests a genetic susceptibility to SB, including familial heritability and common occurrence in twins. This review addresses recent molecular genetic studies in SB that include case-control association, genome gene-expression microarray, and genome-wide association (GWA). This work also reviews epigenetics in SB and pharmacogenetic studies of antidepressant-induced suicide. SB fulfills criteria for a complex genetic phenotype in which environmental factors interact with multiple genes to influence susceptibility. So far, case-control association approaches are still the mainstream in SB genetic studies, although whole genome gene-expression microarray and GWA studies have begun to emerge in recent years. Genetic association studies have suggested several genes (e.g., serotonin transporter, tryptophan hydroxylase 2, and brain-derived neurotrophic factor) related to SB, but not all reports support these findings. The case-control approach while useful is limited by present knowledge of disease pathophysiology. Genome-wide studies of gene expression and genetic variation are not constrained by our limited knowledge. However, the explanatory power and path to clinical translation of risk estimates for common variants reported in genome-wide association studies remain unclear because of the presence of rare and structural genetic variation. As whole genome sequencing becomes increasingly widespread, available genomic information will no longer be the limiting factor in applying genetics to clinical medicine. These approaches provide exciting new avenues to identify new candidate genes for SB genetic studies. The other limitation of genetic association is the lack of a consistent definition of the SB phenotype among studies, an inconsistency that hampers the comparability of the studies and data pooling. In summary, SB involves multiple genes interacting with non-genetic factors. A better understanding of the SB genes by combining whole genome approaches with case-control association studies, may potentially lead to developing effective screening, prevention, and management of SB. Copyright © 2010 Elsevier Inc. All rights reserved.

Seasonal patterns of estuarine acidification in seagrass beds of the Snohomish Estuary, WA

EPA Science Inventory

Recent studies have begun to explore physical and biogeochemical mechanisms of carbonate chemistry variability in a variety of coastal habitats, including coral reefs, upwelling margins, and inland seas. To our knowledge, there have been limited mechanistic studies of annual car...

Psychometric viability of measures of functional performance commonly used for people with dementia: a systematic review of measurement properties.

PubMed

Fox, Benjamin; Henwood, Timothy; Keogh, Justin; Neville, Christine

2016-08-01

Confidence in findings can only be drawn from measurement tools that have sound psychometric properties for the population with which they are used. Within a dementia specific population, measures of physical function have been poorly justified in exercise intervention studies, with justification of measures based on validity or reliability studies from dissimilar clinical populations, such as people with bronchitis or healthy older adults without dementia. To review the reliability and validity of quantitative measures of pre-identified physical function, as commonly used within exercise intervention literature for adults with dementia. Participants were adults, aged 65 years and older, with a confirmed medical diagnosis of dementia. n/a Desired studies were observational and cross-sectional and that assessed measures from a pre-identified list of measures of physical function. Studies that assessed the psychometric constructs of reliability and validity were targeted. COSMIN taxology was used to define reliability and validity. This included, but were not limited to, Intra-Class Correlations, Kappa, Cronbach's Alpha, Chi Squared, Standard Error of Measurement, Minimal Detectable Change and Limits of Agreement. Published material was sourced from the following four databases: MEDLINE, EMBASE, CINAHL and ISI Web of Science. Grey literature was searched for using ALOIS, Google Scholar and ProQuest. The COSMIN checklist was used to assess methodological quality of included studies. Assessment was completed by two reviewers independently. Reliability and validity data was extracted from included studies using standardized Joanna Briggs Institute data collection forms. Extraction was completed by two reviewers. A narrative synthesis of measurement properties of the tools used to measure physical function was performed. Quantitative meta-analysis was conducted for Intra-Class Correlation Coefficients only. With respect to relative reliability, studies reporting assessed measures had intraclass correlation coefficients greater than 0.71, indicating their suitability for use at a group level. However, a consistent finding among studies that included assessment of absolute reliability was that intra individual variation was too large for meaningful measurement of individuals. This was indicated by large Minimal Detectable Change (MDC) scores. Walk Speed has the smallest reported Mimimal Detectable Change score at 0.11m/s. This represented a change of 35% before statistical variation could be eliminated as the cause for this change. All measures had large MDC values. Walk Speed had the smallest MDC values at 0.11m/s, which represented a necessary change of 35%. Only a limited number of studies assessed the validity of measures. This supports the use of these measures in a very narrow selection of circumstances (see Summary of Findings). In summary, measures have shown appropriate levels of relative reliability. This supports their use at the group level. However, large levels of intra-individual variation undermine their applicability at the individual level. Limited studies of validity were available to this review, which limits a conclusion on whether measures are valid for people with dementia.

The use of medication in selective mutism: a systematic review.

PubMed

Manassis, Katharina; Oerbeck, Beate; Overgaard, Kristin Romvig

2016-06-01

Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.

The health impacts of semiconductor production: an epidemiologic review

PubMed Central

Kim, Myoung-Hee; Kim, Hyunjoo; Paek, Domyung

2014-01-01

Background: Despite concerns over the harmful health effects of semiconductor production, epidemiological studies have shown mixed results. Objectives: We aim to critically appraise epidemiologic studies to date, and to suggest future research and actions to protect workers in semiconductor industry. Methods: Epidemiologic studies were identified through electronic database searches, review of reference lists of relevant published works, and expert consultations, and were narratively reviewed. Results: Most evidence suggests reproductive risks from fabrication jobs, including spontaneous abortion (SAB), congenital malformation, and reduced fertility. Although chemicals have been suspected as causal agents, knowledge of the likely contribution(s) from specific exposures is still limited. Evidence of cancer risk seems to be equivocal. However, the available studies had serious limitations including healthy worker effects (HWEs), information bias, and insufficient power, all of which are associated with underestimation. Nevertheless, excess risks for non-Hodgkin's lymphoma (NHL), leukemia, brain tumor, and breast cancer were observed. Conclusions: Monitoring and innovative research based on international collaboration with a focus on sentinel events are required. PMID:24999845

The health impacts of semiconductor production: an epidemiologic review.

PubMed

Kim, Myoung-Hee; Kim, Hyunjoo; Paek, Domyung

2014-01-01

Despite concerns over the harmful health effects of semiconductor production, epidemiological studies have shown mixed results. We aim to critically appraise epidemiologic studies to date, and to suggest future research and actions to protect workers in semiconductor industry. Epidemiologic studies were identified through electronic database searches, review of reference lists of relevant published works, and expert consultations, and were narratively reviewed. Most evidence suggests reproductive risks from fabrication jobs, including spontaneous abortion (SAB), congenital malformation, and reduced fertility. Although chemicals have been suspected as causal agents, knowledge of the likely contribution(s) from specific exposures is still limited. Evidence of cancer risk seems to be equivocal. However, the available studies had serious limitations including healthy worker effects (HWEs), information bias, and insufficient power, all of which are associated with underestimation. Nevertheless, excess risks for non-Hodgkin's lymphoma (NHL), leukemia, brain tumor, and breast cancer were observed. Monitoring and innovative research based on international collaboration with a focus on sentinel events are required.

Survey of aflatoxin M1 in raw milk in the five provinces of China.

PubMed

Zheng, Nan; Wang, Jia-Qi; Han, Rong-Wei; Zhen, Yun-Peng; Xu, Xiao-Min; Sun, Peng

2013-01-01

Aflatoxin M1 (AFM1) is the only mycotoxin that has a legal limit in milk all over the world. In the present study, 360 raw milk samples were collected from Beijing, Hebei, Shanxi, Shanghai and Guangdong provinces in China in September 2010, and their AFM1 levels were determined by using enzyme-linked immunosorbent assay (ELISA). More than three-fourths (78.1%) of the 360 raw milk samples contained AFM1 at concentrations of 5-123 ng L⁻¹. AFM1 contents in all positive samples were far below the Chinese and US legal limit of 500 ng L⁻¹, but 10% of the raw milk samples exceeded the EU legal limit of 50 ng L⁻¹. Moreover, both incidence and content of AFM1 in milk collected from the southern provinces, including Shanghai and Guangdong, were higher than those collected from the northern provinces, including Beijing, Hebei and Shanxi.

Smart-device environmental control systems: experiences of people with cervical spinal cord injuries.

PubMed

Hooper, Bethany; Verdonck, Michele; Amsters, Delena; Myburg, Michelle; Allan, Emily

2017-09-06

Environmental control systems (ECS) are devices that enable people with severe physical limitations to independently control household appliances. Recent advancements in the area of environmental control technology have led to the development of ECS that can be controlled through mainstream smart-devices. There is limited research on ECS within Australia and no known research addressing smart-device ECS. The current study sought to explore users' experiences with smart-device ECS within Australia. The study followed a single embedded case study method. Participants (n = 5) were existing ECS users with a cervical spinal cord injury. Data were collected through semi-structured interviews with participants, reflexive journals and field notes. An inductive approach was used to analyze the data thematically. The experience of using a smart-device ECS presented both opportunities and costs to users. The opportunities included: independent control, choice, peace of mind, connection, effective resource use, and control over smart-phone functions and applications. The associated costs included: financial, time, frustration, and technical limitations. While findings are similar to previous research into traditional ECS this study indicates that smart-device ECS also offered a new opportunity for users to access mainstream smart-device functions and applications. Future research should investigate methods and resources that practitioners could utilize to better support new users of smart-device ECS. Implications for Rehabilitation As with traditional environmental control systems, users of smart environmental control systems report increased independence, choice and control. Smart-device environmental control systems provide users with access to mainstream smart-device functions and applications, which facilitate connection to family and the outside world. The costs to the user of smart-device environmental control systems include monetary and time investment, dealing with technical limitations and resulting frustration. Prescribers and installers must consider ways to mitigate these costs experienced by users.

Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors?

PubMed Central

Ölveczky, Daniele D.; Kiely, Dan K.; LaRose, Sharon I.; Jette, Alan M.

2011-01-01

Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically. Objective The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care. Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise. Methods A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy. Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R2), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores. Limitations This study included older adults with mobility limitations and may not generalize to other populations. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was associated with age and physiologic factors, whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors. PMID:22003163

A review of ecologic studies of lung cancer and indoor radon.

PubMed

Stidley, C A; Samet, J M

1993-09-01

Although radon exposure is an established cause of lung cancer among underground miners, the lung cancer risk to the general population from indoor radon remains controversial. This controversy stems in part from the contradictory results of published studies of indoor radon and lung cancer, including 15 ecologic studies, seven of which found a positive association, six no association, and two a negative association. To address the misunderstanding of the indoor radon risk that has resulted from these ecologic studies, the authors discuss the general methodologic problems and limitations of ecologic studies, and the particular limitations of these 15 studies. The authors conclude that the shortcomings of the ecologic studies render them uninformative on the lung cancer risk associated with indoor radon.

HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings.

PubMed

Finkelstein, Julia L; Gala, Pooja; Rochford, Rosemary; Glesby, Marshall J; Mehta, Saurabh

2015-01-01

Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n = 799), 90 studies were included in this review. Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.

Assessment of Histological Remission in Ulcerative Colitis: Discrepancies Between Daily Practice and Expert Opinion.

PubMed

Römkens, Tessa E H; Kranenburg, Pim; Tilburg, Arjan van; Bronkhorst, Carolien; Nagtegaal, Iris D; Drenth, Joost P H; Hoentjen, Frank

2018-03-28

Histological remission [HR] is a potential treatment target in ulcerative colitis [UC]. Limited 'real world' data are available on the reliability of histological scoring when assessing minimal histological inflammation. The aim of this study was to investigate the reliability of UC histological scores in colonic biopsies showing mucosal healing [MH] and limited histological inflammation, and to compare the 'daily practice' histological assessment with expert reviews by gastrointestinal [GI] pathologists. We performed a retrospective single-centre study. Colonic biopsies from UC patients with MH [Mayo score ≤ 1] were included. All biopsies assessed in daily practice were reassessed by three blinded GI pathologists using three histological scores (Geboes score [GS], Riley score [RS], Harpaz [Gupta] Index [HGI]) and a global visual scale [GVS]. We evaluated inter- and intra-observer variation between GI pathologists and correlations between scores including the initial histological assessment using Cronbach's alpha and Spearman rho analysis. In total, 270 biopsies from 39 UC patients were included. The inter-observer concordance for all histological indexes was substantial to almost perfect [GS 0.84; HGI 0.61; GVS 0.74, RS 0.91]. Correlation between the RS and GS was almost perfect [R = 0.86], but we found no correlation between the primary histological assessment and reassessment by GI pathologists. Current UC histological scores reliably assess limited histological inflammation in UC patients. The discrepancy between the initial histological assessment and the reassessment by dedicated GI pathologists suggests a gap between daily practice and academic expertise. This issue may limit the implementation of HR as a treatment target for UC in daily practice.

The Feasibility and Impact of Routine Combined Limited Transthoracic Echocardiography and Lung Ultrasound on Diagnosis and Management of Patients Admitted to ICU: A Prospective Observational Study.

PubMed

Haji, Kavi; Haji, Darsim; Canty, David J; Royse, Alistair G; Tharmaraj, Dhaksha; Azraee, Meor; Hopkins, Lynda; Royse, Collin F

2018-02-01

Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. Prospective observational study. Tertiary ICU. Ninety-three critically ill participants within 24 hours of admission to ICU. A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound. Ultrasound was performed by an independent intensivist and checked for accuracy offline by a second reviewer. Ultrasound images were interpretable in 99%, with good interobserver agreement. The hemodynamic diagnosis was altered in 66% of participants, including new (14%) or altered (25%) abnormal states or exclusion of clinically diagnosed abnormal state (27%). Valve pathology of at least moderate severity was diagnosed for mitral regurgitation (7%), aortic stenosis (1%), aortic stenosis and mitral regurgitation (1%), tricuspid regurgitation (3%), and 1 case of mitral regurgitation was excluded. Lung pathology diagnosis was changed in 58% of participants including consolidation (13%), interstitial syndrome (4%), and pleural effusion (23%), and exclusion of clinically diagnosed consolidation (6%), interstitial syndrome (3%), and pleural effusion (9%). Management changed in 65% of participants including increased (12%) or decreased (23%) fluid therapy, initiation (10%), changing (6%) or cessation (9%) of inotropic, vasoactive or diuretic drugs, non-invasive ventilation (3%), and pleural drainage (2%). Routine screening of patients with combined limited TTE and lung ultrasound on admission to ICU is feasible and frequently alters diagnosis and management. Copyright © 2018 Elsevier Inc. All rights reserved.

Risk factors for persistent airflow limitation: Analysis of 306 patients with asthma.

PubMed

Wang, Lingcheng; Gao, Shuncui; Zhu, Wei; Su, Jun

2014-01-01

Objectives : To determine the risk factors associated with persistent airflow limitation in patients with asthma. Method s: This study was designed and carried out in the department of respiratory medicine, fourth People's Hospital of Jinan City, Shandong province, China between Jan 2012 and Dec 2012. Three hundred and six asthma patients participating in the study were divided into persistent airflow limitation group (PAFL) and no persistent airflow limitation group (NPAFL). The patients participated in pulmonary function tests and sputum induction examination. The clinical data including age, gender, onset age, disease course, smoking history, family history, regular corticosteroid inhalation, hospitalization history and presence of atopy were collected. Results : In 306 patients, 128 (40.5%) were included in PAFL group and 178(59.5%) in NPAFL group. Multivariate analysis demonstrated smoking (≥10 pack-years; OR, 7.1; 95% CI, 1.8 to 31.2), longer asthma duration (≥ 20years) (OR, 6.3; 95% CI, 1.7 to 28.5), absence of regular corticosteroid inhalation (OR, 3.5; 95% CI, 1.1 to 14.5) and neutrophil in induced sputum≥65% (OR, 1.8; 95% CI, 1.0 to 2.8) were independent risk factors for PAFL. Conclusions : Smoking, longer asthma duration and increased neutrophil in induced sputum are risk factors for PAFL, while regular corticosteroid inhalation is protective factor. Smoking cessation and regular corticosteroid inhalation may play an important role in preventing the occurrence of persistent airflow limitation group (PAFL).

Neurophysiological effects of acute oxytocin administration: systematic review and meta-analysis of placebo-controlled imaging studies

PubMed Central

Wigton, Rebekah; Radua, Jocham; Allen, Paul; Averbeck, Bruno; Meyer-Lindenberg, Andreas; McGuire, Philip; Shergill, Sukhi S.; Fusar-Poli, Paolo

2015-01-01

Background Oxytocin (OXT) plays a prominent role in social cognition and may have clinical applications for disorders such as autism, schizophrenia and social anxiety. The neural basis of its mechanism of action remains unclear. Methods We conducted a systematic literature review of placebo-controlled imaging studies using OXT as a pharmacological manipulator of brain activity. Results We identified a total of 21 studies for inclusion in our review, and after applying additional selection criteria, 11 of them were included in our fMRI voxel-based meta-analysis. The results demonstrate consistent alterations in activation of brain regions, including the temporal lobes and insula, during the processing of social stimuli, with some variation dependent on sex and task. The meta-analysis revealed significant left insular hyperactivation after OXT administration, suggesting a potential modulation of neural circuits underlying emotional processing. Limitations This quantitative review included only a limited number of studies, thus the conclusions of our analysis should be interpreted cautiously. This limited sample size precluded a more detailed exploration of potential confounding factors, such as sex or other demographic factors, that may have affected our meta-analysis. Conclusion Oxytocin has a wide range of effects over neural activity in response to social and emotional processing, which is further modulated by sex and task specificity. The magnitude of this neural activation is largest in the temporal lobes, and a meta-analysis across all tasks and both sexes showed that the left insula demonstrated the most robust activation to OXT administration. PMID:25520163

Sex-Dependent Effects of Developmental Lead Exposure on the Brain.

PubMed

Singh, Garima; Singh, Vikrant; Sobolewski, Marissa; Cory-Slechta, Deborah A; Schneider, Jay S

2018-01-01

The role of sex as an effect modifier of developmental lead (Pb) exposure has until recently received little attention. Lead exposure in early life can affect brain development with persisting influences on cognitive and behavioral functioning, as well as, elevated risks for developing a variety of diseases and disorders in later life. Although both sexes are affected by Pb exposure, the incidence, manifestation, and severity of outcomes appears to differ in males and females. Results from epidemiologic and animal studies indicate significant effect modification by sex, however, the results are not consistent across studies. Unfortunately, only a limited number of human epidemiological studies have included both sexes in independent outcome analyses limiting our ability to draw definitive conclusions regarding sex-differentiated outcomes. Additionally, due to various methodological differences across studies, there is still not a good mechanistic understanding of the molecular effects of lead on the brain and the factors that influence differential responses to Pb based on sex. In this review, focused on prenatal and postnatal Pb exposures in humans and animal models, we discuss current literature supporting sex differences in outcomes in response to Pb exposure and explore some of the ideas regarding potential molecular mechanisms that may contribute to sex-related differences in outcomes from developmental Pb exposure. The sex-dependent variability in outcomes from developmental Pb exposure may arise from a combination of complex factors, including, but not limited to, intrinsic sex-specific molecular/genetic mechanisms and external risk factors including sex-specific responses to environmental stressors which may act through shared epigenetic pathways to influence the genome and behavioral output.

Sex-Dependent Effects of Developmental Lead Exposure on the Brain

PubMed Central

Singh, Garima; Singh, Vikrant; Sobolewski, Marissa; Cory-Slechta, Deborah A.; Schneider, Jay S.

2018-01-01

The role of sex as an effect modifier of developmental lead (Pb) exposure has until recently received little attention. Lead exposure in early life can affect brain development with persisting influences on cognitive and behavioral functioning, as well as, elevated risks for developing a variety of diseases and disorders in later life. Although both sexes are affected by Pb exposure, the incidence, manifestation, and severity of outcomes appears to differ in males and females. Results from epidemiologic and animal studies indicate significant effect modification by sex, however, the results are not consistent across studies. Unfortunately, only a limited number of human epidemiological studies have included both sexes in independent outcome analyses limiting our ability to draw definitive conclusions regarding sex-differentiated outcomes. Additionally, due to various methodological differences across studies, there is still not a good mechanistic understanding of the molecular effects of lead on the brain and the factors that influence differential responses to Pb based on sex. In this review, focused on prenatal and postnatal Pb exposures in humans and animal models, we discuss current literature supporting sex differences in outcomes in response to Pb exposure and explore some of the ideas regarding potential molecular mechanisms that may contribute to sex-related differences in outcomes from developmental Pb exposure. The sex-dependent variability in outcomes from developmental Pb exposure may arise from a combination of complex factors, including, but not limited to, intrinsic sex-specific molecular/genetic mechanisms and external risk factors including sex-specific responses to environmental stressors which may act through shared epigenetic pathways to influence the genome and behavioral output. PMID:29662502

Studies in matter antimatter separation and in the origin of lunar magnetism

NASA Technical Reports Server (NTRS)

Barker, W. A.; Greeley, R.; Parkin, C.; Aggarwal, H.

1974-01-01

Antimatter experiments of the University of Santa Clara are investigated. Topics reported include: (1) planetary geology, (2) lunar Apollo magnetometer experiments, and (3) Roche limit of a solid body.

14 CFR 380.17 - Charters conducted by educational institutions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (AVIATION PROCEEDINGS) SPECIAL REGULATIONS PUBLIC CHARTERS Conditions and Limitations § 380.17 Charters... study abroad which is of at least 4 weeks duration. The charter group may also include a student...

The Chinese Number Naming System and Its Impact on the Arithmetic Performance of Pre-Schoolers in Hong Kong

ERIC Educational Resources Information Center

Ng, Sharon Sui Ngan

2012-01-01

Asian children, including Chinese children, perform better than their English-speaking peers in cross-national mathematics studies. This superior Asian performance is attributed to several factors including cultural beliefs, educational systems and practices, and the Chinese number naming system. Given the limited empirical evidence on pre-school…

Immune Interference After Sequential Alphavirus Vaccine Vaccinations

DTIC Science & Technology

2009-01-01

education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or...western equine encephalitis (EEE and WEE) vaccines before live attenuated Venezuelan (VEE) vaccine had significantly lower rates of antibody response than...Venezuelan equine encephalitis virus, VEE, vaccines, alphavirus, antibody responses, human studies 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF

The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review.

PubMed

Harper, Sarah K; Webb, Thomas L; Rayner, Kelly

2013-05-01

A number of studies have used mindfulness-based interventions to influence the behavior of people with intellectual disabilities, to improve their quality of life, and to reduce challenging behavior. The present review critically evaluates 18 studies and assesses the clinical and academic impact of their findings. Strengths identified included replicable methodological approaches, use of multiple baseline designs, strong construct and criterion validity, and consideration of the mechanisms by which mindfulness influences behavior change. Limitations included a lack of randomized controlled trials, inclusion of qualitative data without structured analysis, limited use of statistical analyses, and problems with sampling leading to difficulties generalizing findings. There was also a paucity of research investigating the impact of "Dialectical Behavior Therapy" and "Acceptance and Commitment Therapy" and the role of mindfulness within these approaches. Further research is warranted in this regard.

Prevention of metabolic diseases: fruits (including fruit sugars) vs. vegetables.

PubMed

Kuzma, Jessica N; Schmidt, Kelsey A; Kratz, Mario

2017-07-01

To discuss recent evidence from observational and intervention studies on the relationship between fruit and vegetable (F&V) consumption and metabolic disease. Observational studies have consistently demonstrated a modest inverse association between the intake of fruit and leafy green vegetables, but not total vegetables, and biomarkers of metabolic disease as well as incident type 2 diabetes mellitus. This is in contrast to limited evidence from recently published randomized controlled dietary intervention trials, which - in sum - suggests little to no impact of increased F&V consumption on biomarkers of metabolic disease. Evidence from observational studies that fruit and leafy green vegetable intake is associated with lower type 2 diabetes risk and better metabolic health could not be confirmed by dietary intervention trials. It is unclear whether this discrepancy is because of limitations inherent in observational studies (e.g., subjective dietary assessment methods, residual confounding) or due to limitations in the few available intervention studies (e.g., short duration of follow-up, interventions combining whole fruit and fruit juice, or lack of compliance). Future studies that attempt to address these limitations are needed to provide more conclusive insight into the impact of F&V consumption on metabolic health.

Epidural steroid injections: update on efficacy, safety, and newer medications for injection.

PubMed

Kozlov, N; Benzon, H T; Malik, K

2015-08-01

The best evidence for epidural injection appears to be in the setting of radicular pain with epidural steroid and non-steroid injections more efficacious than non-epidural injections. Studies showed the efficacy of non-particulate steroid to approach the efficacy of particulate steroid and very limited comparisons demonstrated no significant difference between epidural steroid and epidural non-steroid (local anesthetic) injection. Preliminary studies evaluating epidural injection of disease modifying anti-rheumatic drugs such etanercept and tocilizumab showed conflicting results and had significant limitations. Randomized studies support better efficacy of transforaminal injection due to greater incidence of ventral epidural spread of injectate when compared to interlaminar injection. Thus, the transforaminal approach is recommended when unilateral radicular pain is limited to one nerve root. However, the transforaminal approach is associated with greater incidence of central nervous system injury, including paraplegia, attributed to embolization of the particulate steroid. Recent studies showed that non-particulate steroids potentially last as long as particulate steroids. Therefore non-particulate steroid should be used in initial transforaminal epidural injection. Future studies should look into the role of adjunct diagnostic aids, including digital subtraction angiography, in detecting intravascular injection and the ideal site of needle placement, whether it is the safe triangle or the triangle of Kambin. Finally, the role of epidural disease -modifying antirheumatic drugs in the management of back pain needs to be better elucidated.

Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

PubMed Central

Akande, Tokunbo; Shankar, Anita V.; McIntire, Katherine N.; Gounder, Celine R.; Gupta, Amita; Yang, Wei-Teng

2014-01-01

Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services. PMID:24900921

A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication.

PubMed

Moorhead, S Anne; Hazlett, Diane E; Harrison, Laura; Carroll, Jennifer K; Irwin, Anthea; Hoving, Ciska

2013-04-23

There is currently a lack of information about the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals from primary research. To review the current published literature to identify the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals, and identify current gaps in the literature to provide recommendations for future health communication research. This paper is a review using a systematic approach. A systematic search of the literature was conducted using nine electronic databases and manual searches to locate peer-reviewed studies published between January 2002 and February 2012. The search identified 98 original research studies that included the uses, benefits, and/or limitations of social media for health communication among the general public, patients, and health professionals. The methodological quality of the studies assessed using the Downs and Black instrument was low; this was mainly due to the fact that the vast majority of the studies in this review included limited methodologies and was mainly exploratory and descriptive in nature. Seven main uses of social media for health communication were identified, including focusing on increasing interactions with others, and facilitating, sharing, and obtaining health messages. The six key overarching benefits were identified as (1) increased interactions with others, (2) more available, shared, and tailored information, (3) increased accessibility and widening access to health information, (4) peer/social/emotional support, (5) public health surveillance, and (6) potential to influence health policy. Twelve limitations were identified, primarily consisting of quality concerns and lack of reliability, confidentiality, and privacy. Social media brings a new dimension to health care as it offers a medium to be used by the public, patients, and health professionals to communicate about health issues with the possibility of potentially improving health outcomes. Social media is a powerful tool, which offers collaboration between users and is a social interaction mechanism for a range of individuals. Although there are several benefits to the use of social media for health communication, the information exchanged needs to be monitored for quality and reliability, and the users' confidentiality and privacy need to be maintained. Eight gaps in the literature and key recommendations for future health communication research were provided. Examples of these recommendations include the need to determine the relative effectiveness of different types of social media for health communication using randomized control trials and to explore potential mechanisms for monitoring and enhancing the quality and reliability of health communication using social media. Further robust and comprehensive evaluation and review, using a range of methodologies, are required to establish whether social media improves health communication practice both in the short and long terms.

The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review.

PubMed

Vivera, Manuel Joseph; Gomersall, Judith Streak

2016-04-01

Ardita (facial paralysis) is a medical condition that disfigures or distorts the facial appearance of the sufferer causing facial asymmetry and malfunction. Ardita patients may benefit from considering alternative treatments such as Ayurveda, including Taila Nasya (nasal instillation of medicated oil). To synthesize the best available evidence on the effectiveness of different Nasya oils in the treatment of Ardita. Studies conducted on adult sufferers (18-70 years) of Ardita (chronic or acute) in any setting were considered. Studies including participants who were pregnant or suffered allergic rhinitis, fever, intracranial tumor/hemorrhage and bilateral facial palsy were excluded. Standalone treatment of Nasya (at all dosages and frequencies) compared to Nasya in combination with other Ayurvedic treatments was considered. Comparisons between different interventions including Taila Nasya alone, Taila Nasya in combination with other Ayurvedic interventions and Ayurvedic interventions that did not include Taila Nasya were also considered. Changes in Ardita symptoms, including facial distortion, speech disorders and facial pain, were measured. All quantitative study designs (experimental, quasi-experimental and observational) were considered. Relevant studies were identified following a comprehensive literature search. References provided within these key studies identified additional resources. Indian universities were also contacted for results of Ardita studies undertaken in their institutions.A three-step search strategy aimed to find studies of published and unpublished studies was undertaken. Studies published in the English language were considered for inclusion, irrespective of publication date/year. Following an initial limited search of MEDLINE and CINAHL, the text words contained in the title and abstract, and of the index terms used to describe each articles were analyzed. From the identified keywords and index terms, searches were undertaken across all relevant databases such as PubMed, CINHAL, Cochrane (CENTRAL), Scopus, Centre for Review and Dissemination databases, Turning Research into Practice (TRIP), EMBASE, EBM Reviews, DHARA, Google Scholar, MedNar and ProQuest Dissertations. Finally, reference lists of identified theses and articles were searched for additional studies. Universities and website operators related to Ayurvedic research in India were contacted, including the National Institute of Ayurveda for relevant studies. Besides this, the University of Adelaide librarian was contacted to retrieve those studies identified in the reference lists of theses and articles. Studies were critically assessed by the review author and a secondary reviewer prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute. Data was extracted by the primary reviewer using the standardized data extraction tool from the Joanna Briggs Institute. Different interventions and comparators across studies precluded meta-analysis. Narrative synthesis was performed. Only two pseudo randomized studies with a small number of participants met inclusion criteria and were included in the review. One study with 20 participants, divided equally into two groups compared the effectiveness of two nasal instillations in alleviating four Ardita symptoms. The second study of 15 participants each in two groups compared the effectiveness of nasal instillation with placement of medicated oil on the head on seven Ardita symptoms. Observational measurements of Ardita symptoms were graded as Mild, Moderate or Marked at baseline and after one month. The study conducted on 30 participants using Nasya intervention showed participants had better relief from the symptoms of facial pain, speech disorder and earache within the range of 78.2% to 90.9%, graded as Marked. Along with statistical data available in the studies, this review found low levels of evidence favoring Taila Nasya intervention. The review did not include any studies examining effectiveness of Nasya compared to conventional treatment for Ardita. This review presents extremely limited evidence from only two small experimental studies that administration of Nasya oil alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids/upward eye rolling and dribbling of saliva in adult patients. No strong conclusions may be drawn from the evidence included in the review due to the limited number of studies, limited number of participants and poor quality of studies. Practitioners should advice Ardita patients that there is extremely limited evidence suggesting the potential effectiveness of Nasya oils alone or Nasya in conjunction with other Ayurvedic treatments in managing symptoms. However, given the absence of a strong evidence base, practitioners should be guided by clinical wisdom and patient preference. Well controlled clinical trials comparing standalone Nasya therapy to other Ayurvedic treatments and/or conventional medicine for Ardita symptoms need to be conducted to examine the relative effectiveness of different Nasya oils in treating Ardita.

Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review.

PubMed

Oram, Siân; Stöckl, Heidi; Busza, Joanna; Howard, Louise M; Zimmerman, Cathy

2012-01-01

There is very limited evidence on the health consequences of human trafficking. This systematic review reports on studies investigating the prevalence and risk of violence while trafficked and the prevalence and risk of physical, mental, and sexual health problems, including HIV, among trafficked people. We conducted a systematic review comprising a search of Medline, PubMed, PsycINFO, EMBASE, and Web of Science, hand searches of reference lists of included articles, citation tracking, and expert recommendations. We included peer-reviewed papers reporting on the prevalence or risk of violence while trafficked and/or on the prevalence or risk of any measure of physical, mental, or sexual health among trafficked people. Two reviewers independently screened papers for eligibility and appraised the quality of included studies. The search identified 19 eligible studies, all of which reported on trafficked women and girls only and focused primarily on trafficking for sexual exploitation. The review suggests a high prevalence of violence and of mental distress among women and girls trafficked for sexual exploitation. The random effects pooled prevalence of diagnosed HIV was 31.9% (95% CI 21.3%-42.4%) in studies of women accessing post-trafficking support in India and Nepal, but the estimate was associated with high heterogeneity (I² = 83.7%). Infection prevalence may be related as much to prevalence rates in women's areas of origin or exploitation as to the characteristics of their experience. Findings are limited by the methodological weaknesses of primary studies and their poor comparability and generalisability. Although limited, existing evidence suggests that trafficking for sexual exploitation is associated with violence and a range of serious health problems. Further research is needed on the health of trafficked men, individuals trafficked for other forms of exploitation, and effective health intervention approaches.

Prevalence and Risk of Violence and the Physical, Mental, and Sexual Health Problems Associated with Human Trafficking: Systematic Review

PubMed Central

Oram, Siân; Stöckl, Heidi; Busza, Joanna; Howard, Louise M.; Zimmerman, Cathy

2012-01-01

Background There is very limited evidence on the health consequences of human trafficking. This systematic review reports on studies investigating the prevalence and risk of violence while trafficked and the prevalence and risk of physical, mental, and sexual health problems, including HIV, among trafficked people. Methods and Findings We conducted a systematic review comprising a search of Medline, PubMed, PsycINFO, EMBASE, and Web of Science, hand searches of reference lists of included articles, citation tracking, and expert recommendations. We included peer-reviewed papers reporting on the prevalence or risk of violence while trafficked and/or on the prevalence or risk of any measure of physical, mental, or sexual health among trafficked people. Two reviewers independently screened papers for eligibility and appraised the quality of included studies. The search identified 19 eligible studies, all of which reported on trafficked women and girls only and focused primarily on trafficking for sexual exploitation. The review suggests a high prevalence of violence and of mental distress among women and girls trafficked for sexual exploitation. The random effects pooled prevalence of diagnosed HIV was 31.9% (95% CI 21.3%–42.4%) in studies of women accessing post-trafficking support in India and Nepal, but the estimate was associated with high heterogeneity (I 2 = 83.7%). Infection prevalence may be related as much to prevalence rates in women's areas of origin or exploitation as to the characteristics of their experience. Findings are limited by the methodological weaknesses of primary studies and their poor comparability and generalisability. Conclusions Although limited, existing evidence suggests that trafficking for sexual exploitation is associated with violence and a range of serious health problems. Further research is needed on the health of trafficked men, individuals trafficked for other forms of exploitation, and effective health intervention approaches. Please see later in the article for the Editors' Summary PMID:22666182

Community environmental factors are associated with disability in older adults with functional limitations: the MOST study.

PubMed

Keysor, Julie J; Jette, Alan M; LaValley, Michael P; Lewis, Cora E; Torner, James C; Nevitt, Michael C; Felson, Dave T

2010-04-01

There is limited evidence supporting the hypothesized environment-disability link. The objectives of this study were to (a) identify the prevalence of community mobility barriers and transportation facilitators and (b) examine whether barriers and facilitators were associated with disability among older adults with functional limitations. Four hundred and thirty-five participants aged 65+ years old with functional limitations were recruited from the Multicenter Osteoarthritis Study, a prospective study of community-dwelling adults with or at risk of developing symptomatic knee osteoarthritis. Presence of community barriers and facilitators was ascertained by the Home and Community Environment survey. Two domains of disability, (a) daily activity limitation (DAL) and (b) daily activity frequency (DAF), were assessed with the Late-Life Disability Instrument. Covariates included age, gender, education, race, comorbidity, body mass index, knee pain, and functional limitation. Multivariable logistic regression was used to examine adjusted associations of community factors with presence of DAL and DAF. Approximately one third of the participants lived in a community with high mobility barriers and low transportation facilitators. High mobility barriers was associated with greater odds of DAL (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2-3.1) after adjusting for covariates, and high transportation facilitators was associated with lower odds of DAL (OR = 0.5, 95% CI 0.3-0.8) but not with DAF in adjusted models. People with functional limitations who live in communities that were more restrictive felt more limited in doing daily activities but did not perform these daily activities any less frequently.

Seed Rain and Seed Bank Reveal that Seed Limitation Strongly Influences Plant Community Assembly in Grasslands

PubMed Central

Marteinsdóttir, Bryndís

2014-01-01

Dispersal is an important factor in plant community assembly, but assembly studies seldom include information on actual dispersal into communities, i.e. the local propagule pool. The aim of this study was to determine which factors influence plant community assembly by focusing on two phases of the assembly process: the dispersal phase and the establishment phase. At 12 study sites in grazed ex-arable fields in Sweden the local plant community was determined and in a 100-m radius around the centre of each site, the regional species pool was measured. The local seed bank and the seed rain was explored to estimate the local propagule pool. Trait-based models were then applied to investigate if species traits (height, seed mass, clonal abilities, specific leaf area and dispersal method) and regional abundance influenced which species from the regional species pool, dispersed to the local community (dispersal phase) and which established (establishment phase). Filtering of species during the dispersal phase indicates the effect of seed limitation while filtering during the establishment phase indicates microsite limitation. On average 36% of the regional species pool dispersed to the local sites and of those 78% did establish. Species with enhanced dispersal abilities, e.g. higher regional abundance, smaller seeds and dispersed by cattle, were more likely to disperse to the sites than other species. At half the sites, dispersal was influenced by species height. Species establishment was however mainly unlinked to the traits included in this study. This study underlines the importance of seed limitation in local plant community assembly. It also suggests that without information on species dispersal into a site, it is difficult to distinguish between the influence of dispersal and establishment abilities, and thus seed and microsite limitation, as both can be linked to the same trait. PMID:25057815

Job Satisfaction: The Comparison between School-Leavers and College Graduates

ERIC Educational Resources Information Center

Kamarulzaman, Wirawani; Nordin, Mohamad Sahari

2012-01-01

The purpose of this study is to address the gaps in the literature and compare the job satisfaction between school leavers and college graduates. Specifically, the proposed study sought to expand the existing, yet limited research exploring job satisfaction between school-leavers and college graduates. In this study, the comparison includes these…

A Simulation Study of Missing Data with Multiple Missing X's

ERIC Educational Resources Information Center

Rubright, Jonathan D.; Nandakumar, Ratna; Glutting, Joseph J.

2014-01-01

When exploring missing data techniques in a realistic scenario, the current literature is limited: most studies only consider consequences with data missing on a single variable. This simulation study compares the relative bias of two commonly used missing data techniques when data are missing on more than one variable. Factors varied include type…

Effective Management of High-Use/High-Demand Space Using Restaurant-Style Pagers

ERIC Educational Resources Information Center

Gonzalez, Adriana

2012-01-01

The library landscape is changing at a fast pace, with an increase in the demand for study space including quiet, individualized study space; open group study space; and as enclosed group study space. In large academic libraries, managing limited high-demand resources is crucial and is partially being driven by the greater emphasis on group…

Comparative Sensitivities of Gravitational Wave Detectors Based on Atom Interferometers and Light Interferometers

NASA Technical Reports Server (NTRS)

Baker, John G.; Thorpe, J. I.

2012-01-01

We consider a class of proposed gravitational wave detectors based on multiple atomic interferometers separated by large baselines and referenced by common laser systems. We compute the sensitivity limits of these detectors due to intrinsic phase noise of the light sources, non-inertial motion of the light sources, and atomic shot noise and compare them to sensitivity limits for traditional light interferometers. We find that atom interferometers and light interferometers are limited in a nearly identical way by intrinsic phase noise and that both require similar mitigation strategies (e.g. multiple arm instruments) to reach interesting sensitivities. The sensitivity limit from motion of the light sources is slightly different and favors the atom interferometers in the low-frequency limit, although the limit in both cases is severe. Whether this potential advantage outweighs the additional complexity associated with including atom interferometers will require further study.

Laboratory evaluation of a field-portable sealed source X-ray fluorescence spectrometer for determination of metals in air filter samples.

PubMed

Lawryk, Nicholas J; Feng, H Amy; Chen, Bean T

2009-07-01

Recent advances in field-portable X-ray fluorescence (FP XRF) spectrometer technology have made it a potentially valuable screening tool for the industrial hygienist to estimate worker exposures to airborne metals. Although recent studies have shown that FP XRF technology may be better suited for qualitative or semiquantitative analysis of airborne lead in the workplace, these studies have not extensively addressed its ability to measure other elements. This study involved a laboratory-based evaluation of a representative model FP XRF spectrometer to measure elements commonly encountered in workplace settings that may be collected on air sample filter media, including chromium, copper, iron, manganese, nickel, lead, and zinc. The evaluation included assessments of (1) response intensity with respect to location on the probe window, (2) limits of detection for five different filter media, (3) limits of detection as a function of analysis time, and (4) bias, precision, and accuracy estimates. Teflon, polyvinyl chloride, polypropylene, and mixed cellulose ester filter media all had similarly low limits of detection for the set of elements examined. Limits of detection, bias, and precision generally improved with increasing analysis time. Bias, precision, and accuracy estimates generally improved with increasing element concentration. Accuracy estimates met the National Institute for Occupational Safety and Health criterion for nearly all the element and concentration combinations. Based on these results, FP XRF spectrometry shows potential to be useful in the assessment of worker inhalation exposures to other metals in addition to lead.

A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals.

PubMed

Pollock, Alex; Campbell, Pauline; Deery, Ruth; Fleming, Mick; Rankin, Jean; Sloan, Graham; Cheyne, Helen

2017-08-01

The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives. © 2017 John Wiley & Sons Ltd.

Anti-tobacco mass media and socially disadvantaged groups: a systematic and methodological review.

PubMed

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Chris

2012-07-01

Only a limited amount of research has been conducted to explore whether there are socioeconomic status differences in responses to mass media. However, the methodological quality of this evidence has not been assessed, limiting confidence in conclusions that can be drawn regarding study outcomes. A systematic review of the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged groups was conducted, and the methodological quality of included studies was assessed. Medline, The Cochrane Library, PsycInfo, Embase and Web of Science were searched using MeSH and keywords for quantitative studies conducted in Western countries prior to March 2012. A methodological quality assessment and narrative analysis of included studies was undertaken. Seventeen relevant studies (reported in 18 papers) were identified; however, weak study designs and selection bias were common characteristics, limiting strong conclusions about effectiveness. Using predominantly non-cessation related outcome measures reviewed papers indicated mixed results for mass media tobacco control campaign effectiveness among various social groups. Most studies assessed mass media impact on low socioeconomic status groups rather than highly socially disadvantaged groups. Methodological rigour of evaluations in this field must be improved to aid understanding regarding the effectiveness of mass media campaigns in driving cessation among disadvantaged groups. The results of this review indicate a gap in methodologically rigorous research into the effectiveness of mass media campaigns among socially disadvantaged groups, particularly the highly disadvantaged. © 2012 Australasian Professional Society on Alcohol and other Drugs.

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2014 CFR

2014-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

21 CFR 201.322 - Over-the-counter drug products containing internal analgesic/antipyretic active ingredients...

Code of Federal Regulations, 2010 CFR

2010-04-01

... not limited to, acetaminophen, aspirin, carbaspirin calcium, choline salicylate, ibuprofen, ketoprofen... anti-inflammatory analgesic/antipyretic active ingredients—including but not limited to aspirin...—including but not limited to aspirin, carbaspirin calcium, choline salicylate, ibuprofen, ketoprofen...

Patient-reported outcome instruments that evaluate adherence behaviours in adults with asthma: A systematic review of measurement properties.

PubMed

Gagné, Myriam; Boulet, Louis-Philippe; Pérez, Norma; Moisan, Jocelyne

2018-04-30

To systematically identify the measurement properties of patient-reported outcome instruments (PROs) that evaluate adherence to inhaled maintenance medication in adults with asthma. We conducted a systematic review of six databases. Two reviewers independently included studies on the measurement properties of PROs that evaluated adherence in asthmatic participants aged ≥18 years. Based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), the reviewers (1) extracted data on internal consistency, reliability, measurement error, content validity, structural validity, hypotheses testing, cross-cultural validity, criterion validity, and responsiveness; (2) assessed the methodological quality of the included studies; (3) assessed the quality of the measurement properties (positive or negative); and (4) summarised the level of evidence (limited, moderate, or strong). We screened 6,068 records and included 15 studies (14 PROs). No studies evaluated measurement error or responsiveness. Based on methodological and measurement property quality assessments, we found limited positive evidence of: (a) internal consistency of the Adherence Questionnaire, Refined Medication Adherence Reason Scale (MAR-Scale), Medication Adherence Report Scale for Asthma (MARS-A), and Test of the Adherence to Inhalers (TAI); (b) reliability of the TAI; and (c) structural validity of the Adherence Questionnaire, MAR-Scale, MARS-A, and TAI. We also found limited negative evidence of: (d) hypotheses testing of Adherence Questionnaire; (e) reliability of the MARS-A; and (f) criterion validity of the MARS-A and TAI. Our results highlighted the need to conduct further high-quality studies that will positively evaluate the reliability, validity, and responsiveness of the available PROs. This article is protected by copyright. All rights reserved.

Exceeding the speed limit: prevalence and determinants in Iran.

PubMed

Moradi, Ali; Motevalian, Seyed Abbas; Mirkoohi, Maryam; McKay, Mary Pat; Rahimi-Movaghar, Vafa

2013-01-01

Speeding is one of the most common risk behaviours associated with crashes causing signficant injury. The objective of this study is to explore the prevalence and determinants of speeding on a road between Tehran and Hamadan, Iran. In a cross-sectional study in 2009, stretches of the road were studied including three groups of posted speed limits: < 50 km/h, 50-100 km/h and > 100 km/h. Each stretch was evaluated both in daylight and dark. Randomly identified driver's speed was checked by a handheld speed camera and then the driver was invited to participate in a survey. Statistical analysis was performed using Chi-Square, crude and adjusted odds ratio, 95% confidence interval and multiple logistic regression models. Overall, 52.8% of the drivers were travelling more than 10 km/h above the posted limit. Where limits were < 50 km/h, 74.6% of drivers were speeding. This declined to 46.9% for sections with limits between 50 and 100 km/h and to 36.9% for sections posted more than 100 km/h. Finally, more than half the drivers were observed to be speeding. Driving more than the posted limit was far more likely on the areas with the lowest posted speed limits, personal passenger vehicles, modern vehicles not using seat belts, and male drivers.

Regional rainfall thresholds for landslide occurrence using a centenary database

NASA Astrophysics Data System (ADS)

Vaz, Teresa; Luís Zêzere, José; Pereira, Susana; Cruz Oliveira, Sérgio; Quaresma, Ivânia

2017-04-01

Rainfall is one of the most important triggering factors for landslides occurrence worldwide. The relation between rainfall and landslide occurrence is complex and some approaches have been focus on the rainfall thresholds identification, i.e., rainfall critical values that when exceeded can initiate landslide activity. In line with these approaches, this work proposes and validates rainfall thresholds for the Lisbon region (Portugal), using a centenary landslide database associated with a centenary daily rainfall database. The main objectives of the work are the following: i) to compute antecedent rainfall thresholds using linear and potential regression; ii) to define lower limit and upper limit rainfall thresholds; iii) to estimate the probability of critical rainfall conditions associated with landslide events; and iv) to assess the thresholds performance using receiver operating characteristic (ROC) metrics. In this study we consider the DISASTER database, which lists landslides that caused fatalities, injuries, missing people, evacuated and homeless people occurred in Portugal from 1865 to 2010. The DISASTER database was carried out exploring several Portuguese daily and weekly newspapers. Using the same newspaper sources, the DISASTER database was recently updated to include also the landslides that did not caused any human damage, which were also considered for this study. The daily rainfall data were collected at the Lisboa-Geofísico meteorological station. This station was selected considering the quality and completeness of the rainfall data, with records that started in 1864. The methodology adopted included the computation, for each landslide event, of the cumulative antecedent rainfall for different durations (1 to 90 consecutive days). In a second step, for each combination of rainfall quantity-duration, the return period was estimated using the Gumbel probability distribution. The pair (quantity-duration) with the highest return period was considered as the critical rainfall combination responsible for triggering the landslide event. Only events whose critical rainfall combinations have a return period above 3 years were included. This criterion reduces the likelihood of been included events whose triggering factor was other than rainfall. The rainfall quantity-duration threshold for the Lisbon region was firstly defined using the linear and potential regression. Considering that this threshold allow the existence of false negatives (i.e. events below the threshold) it was also identified the lower limit and upper limit rainfall thresholds. These limits were defined empirically by establishing the quantity-durations combinations bellow which no landslides were recorded (lower limit) and the quantity-durations combinations above which only landslides were recorded without any false positive occurrence (upper limit). The zone between the lower limit and upper limit rainfall thresholds was analysed using a probabilistic approach, defining the uncertainties of each rainfall critical conditions in the triggering of landslides. Finally, the performances of the thresholds obtained in this study were assessed using ROC metrics. This work was supported by the project FORLAND - Hydrogeomorphologic risk in Portugal: driving forces and application for land use planning [grant number PTDC/ATPGEO/1660/2014] funded by the Portuguese Foundation for Science and Technology (FCT), Portugal. Sérgio Cruz Oliveira is a post-doc fellow of the FCT [grant number SFRH/BPD/85827/2012].

Occupational-Technical Curriculum Development TV Study.

ERIC Educational Resources Information Center

McClure, Lyndon

Section I of this report provides a brief review of various experiments and studies conducted in the United States and abroad on the effectiveness of televised occupational-technical courses. Issues discussed include the packaging of televised instruction; the need for preproduction testing; the limitations of television teaching; teacher and…

Study Skills in Anatomy and Physiology: Is There a Difference?

ERIC Educational Resources Information Center

Husmann, Polly R.; Barger, J. Bradley; Schutte, Audra F.

2016-01-01

Many factors influence the way individual students study, including but not limited to: previous coursework, attitudes toward the class (motivation, intimidation, risk, etc.), metacognition, and work schedules. However, little of this research has involved medical students. The present article asks the question, "Do individual medical…

Gonadotrophin-releasing hormone agonist treatment for sexual offenders: A systematic review.

PubMed

Lewis, Alexandra; Grubin, Don; Ross, Callum C; Das, Mrigendra

2017-10-01

Sexual offending is a significant international issue causing long-term consequences for victims, perpetrators and society. The purpose of this study was to review the existing research data assessing the efficacy of gonadotrophin-releasing hormone agonists for treating adult, male, sexual offenders. The method of this review involved the examination of studies involving participants prescribed at least one month of a gonadotrophin-releasing hormone agonist for the purposes of reducing sexual drive related to offending. The primary outcome measures were recidivism rates and sexual functioning. Secondary outcome measures included assessment of side effects and effects on interpersonal/psychiatric functioning. Studies in the English language that were dated 1969-2015 were included. Twelve eligible studies (323 participants) were identified. A reduction in a variety of measures of sexual functioning and/or risk was found in all studies. Robust recidivism data was limited. Medication was rarely described as ineffectual. All studies reported side effects. Reduction in bone density and potential long-term reduction in fertility in some subjects were issues of concern. Whilst identified studies showed promising results with respect to sexual functioning, challenges in performing randomised control trials in this subject group meant that included studies were methodologically limited. This review recommends that future research must be performed before the effectiveness and tolerability of gonadotrophin-releasing hormone agonists in this population can be confirmed.

The impact of community-based arts and health interventions on cognition in people with dementia: a systematic literature review.

PubMed

Young, Rhea; Camic, Paul M; Tischler, Victoria

2016-01-01

Dementia is a progressive condition, affecting increasing numbers of people, characterised by cognitive decline. The current systematic review aimed to evaluate research pertaining to the impact of arts and health interventions on cognition in people with dementia. A literature search was conducted utilising PsychInfo, Cochrane Reviews, Web of Science, Medline and British Humanities Index databases. Seventeen studies were included in the review, including those related to literary, performing and visual arts. The review highlighted this as an emerging area of research with the literature consisting largely of small-scale studies with methodological limitations including lack of control groups and often poorly defined samples. All the studies suggested, however, that arts-based activities had a positive impact on cognitive processes, in particular on attention, stimulation of memories, enhanced communication and engagement with creative activities. The existent literature suggests that arts activities are helpful interventions within dementia care. A consensus has yet to emerge, however, about the direction for future research including the challenge of measurement and the importance of methodological flexibility. It is suggested that further research address some of these limitations by examining whether the impact of interventions vary depending on cognitive ability and to continue to assess how arts interventions can be of use across the stages of dementia.

Epidemiologic Evaluation of Measurement Data in the Presence of Detection Limits

PubMed Central

Lubin, Jay H.; Colt, Joanne S.; Camann, David; Davis, Scott; Cerhan, James R.; Severson, Richard K.; Bernstein, Leslie; Hartge, Patricia

2004-01-01

Quantitative measurements of environmental factors greatly improve the quality of epidemiologic studies but can pose challenges because of the presence of upper or lower detection limits or interfering compounds, which do not allow for precise measured values. We consider the regression of an environmental measurement (dependent variable) on several covariates (independent variables). Various strategies are commonly employed to impute values for interval-measured data, including assignment of one-half the detection limit to nondetected values or of “fill-in” values randomly selected from an appropriate distribution. On the basis of a limited simulation study, we found that the former approach can be biased unless the percentage of measurements below detection limits is small (5–10%). The fill-in approach generally produces unbiased parameter estimates but may produce biased variance estimates and thereby distort inference when 30% or more of the data are below detection limits. Truncated data methods (e.g., Tobit regression) and multiple imputation offer two unbiased approaches for analyzing measurement data with detection limits. If interest resides solely on regression parameters, then Tobit regression can be used. If individualized values for measurements below detection limits are needed for additional analysis, such as relative risk regression or graphical display, then multiple imputation produces unbiased estimates and nominal confidence intervals unless the proportion of missing data is extreme. We illustrate various approaches using measurements of pesticide residues in carpet dust in control subjects from a case–control study of non-Hodgkin lymphoma. PMID:15579415

BORDERLINE RESECTABLE PANCREATIC CANCER: Need for Standardization and Methods for Optimal Clinical Trial Design

PubMed Central

Katz, Matthew HG; Marsh, Robert; Herman, Joseph M.; Shi, Qian; Collison, Eric; Venook, Alan; Kindler, Hedy; Alberts, Steven; Philip, Philip; Lowy, Andrew M.; Pisters, Peter; Posner, Mitchell; Berlin, Jordan; Ahmad, Syed A.

2017-01-01

Methodological limitations of prior studies have prevented progress in the treatment of patients with borderline resectable pancreatic adenocarcinoma. Shortcomings have included the absence of staging and treatment standards and pre-existing biases with regard to the use of neoadjuvant therapy and the role of vascular resection at pancreatectomy. In this manuscript, we will review limitations of studies of borderline resectable PDAC reported to date, highlight important controversies related to this disease stage, emphasize the research infrastructure necessary for its future study, and present a recently-approved Intergroup pilot study (Alliance A0201101) that will provide a foundation upon which subsequent well-designed clinical trials can be performed. PMID:23435609

Long-Term Effects of Habitual Barefoot Running and Walking: A Systematic Review.

PubMed

Hollander, Karsten; Heidt, Christoph; VAN DER Zwaard, Babette C; Braumann, Klaus-Michael; Zech, Astrid

2017-04-01

Barefoot locomotion is widely believed to be beneficial for motor development and biomechanics but are implied to be responsible for foot pathologies and running-related injuries. Although most of available studies focused on acute effects of barefoot running and walking little is known regarding the effects of long-term barefoot versus shod locomotion. The purpose of this study was to systematically review the literature to evaluate current evidence of habitual barefoot (HB) versus habitual shod locomotion on foot anthropometrics, biomechanics, motor performance, and pathologies. Four electronic databases were searched using terms related to habitually barefoot locomotion. Relevant studies were identified based on title, abstract, and full text, and a forward (citation tracking) and backward (references) search was performed. Risk of bias was assessed, data pooling, and meta-analysis (random effects model) performed and finally levels of evidence determined. Fifteen studies with 8399 participants were included. Limited evidence was found for a reduced ankle dorsiflexion at footstrike (pooled effect size, -3.47; 95% confidence interval [CI], -5.18 to -1.76) and a lower pedobarographically measured hallux angle (-1.16; 95% CI, -1.64 to -0.68). HB populations had wider (0.55; 95% CI, 0.06-1.05) but no shorter (-0.22; 95% CI, -0.51 to 0.08) feet compared with habitual shod populations. No differences in relative injury rates were found, with limited evidence for a different body part distribution of musculoskeletal injuries and more foot pathologies and less foot deformities and defects in HB runners. Only limited or very limited evidence is found for long-term effects of HB locomotion regarding biomechanics or health-related outcomes. Moreover, no evidence exists for motor performance. Future research should include prospective study designs.

Internet-based interventions for the prevention and treatment of depression in people living in developing countries: A systematic review.

PubMed

Martínez, Pablo; Rojas, Graciela; Martínez, Vania; Lara, María Asunción; Pérez, J Carola

2018-07-01

Internet-based interventions for depression may be a valuable resource to reduce the treatment gap for those living in developing countries. However, evidence comes mainly from developed countries. This systematic review summarized the evidence on preventive or therapeutic Internet-based interventions for depression for people who reside in developing countries. CINAHL, EMBASE, PubMed, SciELO Citation Indexes, the Journal of Medical Internet Research, and the Telemedicine and e-Health journal, were searched up to June 2017, to identify feasibility or effectiveness studies of preventive or therapeutic Internet-based interventions for depression, with or without human support. Studies included subjects residing in developing countries, and were published in English or Spanish. Study protocols were included. Risk of bias and/or quality of the reporting of the studies included was assessed. Five feasibility studies, aimed at the prevention of depression, and a study protocol were included in this systematic review. Reports came mostly from the Americas (n = 4). Internet-based interventions aimed at the prevention of depression presented low levels of human support, were useful and acceptable to their users, and require further design refinements to improve their use and retention. No gray literature was searched or included in this systematic review. Searches were limited to English and Spanish languages. Internet-based interventions aimed at the prevention of depression in people who reside in developing countries are in an early phase of development, limiting the generalizability of the results. Future studies must employ persuasive designs to improve user retention, incorporating larger samples and a control group to conclusively determine feasibility. Copyright © 2018 Elsevier B.V. All rights reserved.

48 CFR 1552.209-74 - Limitation of future contracting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... preclude START contractors from performing construction management services under other EPA contracts. (3... Contracting Officer. Examples of such contracts include, but are not limited to, Superfund Management and... Contracting Officer. Examples of such contracts include, but are not limited to, Superfund Management and...

48 CFR 1552.209-74 - Limitation of future contracting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... preclude START contractors from performing construction management services under other EPA contracts. (3... Contracting Officer. Examples of such contracts include, but are not limited to, Superfund Management and... Contracting Officer. Examples of such contracts include, but are not limited to, Superfund Management and...

Congressional Report Waffles on Merit Pay.

ERIC Educational Resources Information Center

American School Board Journal, 1983

1983-01-01

A skeptical review of recent congressional task force recommendations for public school teachers, which include only a limited endorsement of merit pay and strong encouragement for sabbatical leave for teachers to study and travel abroad. (JBM)

Internet driver education study.

DOT National Transportation Integrated Search

2010-05-01

Incorporating technology through online courses, including drivers education (DE), is the wave of the future for : learning. While many states allow online DE as an accepted method of learning, Wisconsin currently only allows it on a : limited bas...

A Systematic Scoping Review of Yoga Intervention Components and Study Quality

PubMed Central

Elwy, A. Rani; Groessl, Erik J.; Eisen, Susan V.; Riley, Kristen; Maiya, Meghan; Lee, Jennifer P.; Sarkin, Andrew; Park, Crystal L.

2014-01-01

Context The scientific study of yoga requires rigorous methodology. This review aimed to systematically assess all studies of yoga interventions to: (1) determine yoga intervention characteristics; (2) examine methodologic quality of the subset of RCTs; and (3) explore how well these interventions are reported. Evidence acquisition Searches were conducted through April 2012 in PubMed, PsycInfo, Ageline, and Ovid’s Alternative and Complementary Medicine database using the text term yoga, and through handsearching five journals. Original studies were included if the intervention: (1) consisted of at least one yoga session with some type of health assessment; (2) targeted adults age ≥18 years; (3) was published in an English language peer–reviewed journal; and (4) was available for review. Evidence synthesis Of 3,062 studies identified, 465 studies in 30 countries were included. Analyses were conducted through 2013. Most interventions took place in India (n=228) or the U.S. (n=124), with intensity ranging from a single yoga session up to two sessions per day. Intervention lengths ranged from one session to 2 years. Asanas (poses) were mentioned as yoga components in 369 (79%) interventions, but were either minimally or not at all described in 200 (54%) of these. Most interventions (74%, n=336) did not include home practice. Of the included studies, 151 were RCTs. RCT quality was rated as poor. Conclusions This review highlights the inadequate reporting and methodologic limitations of current yoga intervention research, which limits study interpretation and comparability. Recommendations for future methodology and reporting are discussed. PMID:24996759

Measurement properties of tools measuring mental health knowledge: a systematic review.

PubMed

Wei, Yifeng; McGrath, Patrick J; Hayden, Jill; Kutcher, Stan

2016-08-23

Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties. We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of the overall quality of each measurement property across studies as "strong", "moderate", "limited", "conflicting", or "unknown". We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from "poor" to "excellent" including 6 studies addressing the content validity, internal consistency or structural validity demonstrating "excellent" quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools. Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist.

Trajectories of Limitations in Activities of Daily Living among Older Adults in Mexico, 2001–2012

PubMed Central

Wong, Rebeca

2016-01-01

Background Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited. Objectives This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories. Methods The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012. Results The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education. Conclusions Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help inform public health policies to better serve the population. PMID:26993585

Trajectories of limitations in activities of daily living among older adults in Mexico, 2001-2012.

PubMed

Díaz-Venegas, Carlos; Wong, Rebeca

2016-07-01

Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited. This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories. The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012. The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education. Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help public health policies to better serve the population. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between Breast Feeding and Paediatric Sleep Disordered Breathing: a Systematic Review.

PubMed

Ponce-Garcia, Cecilia; Hernandez, Ivonne Angelica; Major, Paul; Flores-Mir, Carlos

2017-07-01

Breast feeding has been suggested as a potential protective factor against childhood snoring and sleep disordered breathing (SDB). SDB can have major health consequences. The objective of this systematic review is to synthesise the available literature concerning any potential association between infant feeding methods and SDB in young children. Five electronic databases were searched. All searches were inclusive until August 5, 2016. Two authors independently reviewed potentially relevant articles for eligibility. Any prospective or retrospective study, case-control study, cohort study, clinical trial, and cross-sectional study that evaluated the association between infant feeding methods and SDB were included. Data on study design, aim of study, sample size, study population, assessment tool, infant feeding methods, and outcome measures were extracted. Nine studies fulfilled the criteria to be finally included in this review, only cohorts and cross-sectional studies were identified. While seven of the selected studies reported a statistically significant association between breast feeding and reduced risk of SDB, the remaining two studies did not report any association. The main methodological limitation was high heterogeneity in the diagnostic criteria and assessment tools to identify SDB and limited data collection on infant feeding methods. The current evidence may point to a protective association, however, as uncertainty is moderate, any suggestion that breast feeding may or may not decrease the risk of SDB is currently unwarranted. More research on the topic is required to resolve some of the contradictions between included studies. © 2017 John Wiley & Sons Ltd.

Elemental economy: microbial strategies for optimizing growth in the face of nutrient limitation.

PubMed

Merchant, Sabeeha S; Helmann, John D

2012-01-01

Microorganisms play a dominant role in the biogeochemical cycling of nutrients. They are rightly praised for their facility for fixing both carbon and nitrogen into organic matter, and microbial driven processes have tangibly altered the chemical composition of the biosphere and its surrounding atmosphere. Despite their prodigious capacity for molecular transformations, microorganisms are powerless in the face of the immutability of the elements. Limitations for specific elements, either fleeting or persisting over eons, have left an indelible trace on microbial genomes, physiology, and their very atomic composition. We here review the impact of elemental limitation on microbes, with a focus on selected genetic model systems and representative microbes from the ocean ecosystem. Evolutionary adaptations that enhance growth in the face of persistent or recurrent elemental limitations are evident from genome and proteome analyses. These range from the extreme (such as dispensing with a requirement for a hard to obtain element) to the extremely subtle (changes in protein amino acid sequences that slightly, but significantly, reduce cellular carbon, nitrogen, or sulfur demand). One near-universal adaptation is the development of sophisticated acclimation programs by which cells adjust their chemical composition in response to a changing environment. When specific elements become limiting, acclimation typically begins with an increased commitment to acquisition and a concomitant mobilization of stored resources. If elemental limitation persists, the cell implements austerity measures including elemental sparing and elemental recycling. Insights into these fundamental cellular properties have emerged from studies at many different levels, including ecology, biological oceanography, biogeochemistry, molecular genetics, genomics, and microbial physiology. Here, we present a synthesis of these diverse studies and attempt to discern some overarching themes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Elemental Economy: microbial strategies for optimizing growth in the face of nutrient limitation

PubMed Central

Merchant, Sabeeha S.; Helmann, John D.

2014-01-01

Microorganisms play a dominant role in the biogeochemical cycling of nutrients. They are rightly praised for their facility at fixing both carbon and nitrogen into organic matter, and microbial driven processes have tangibly altered the chemical composition of the biosphere and its surrounding atmosphere. Despite their prodigious capacity for molecular transformations, microorganisms are powerless in the face of the immutability of the elements. Limitations for specific elements, either fleeting or persisting over eons, have left an indelible trace on microbial genomes, physiology, and their very atomic composition. We here review the impact of elemental limitation on microbes, with a focus on selected genetic model systems and representative microbes from the ocean ecosystem. Evolutionary adaptations that enhance growth in the face of persistent or recurrent elemental limitations are evident from genome and proteome analyses. These range from the extreme (such as dispensing with a requirement for a hard to obtain element) to the extremely subtle (changes in protein amino acid sequences that slightly, but significantly, reduce cellular carbon, nitrogen, or sulfur demand). One near universal adaptation is the development of sophisticated acclimation programs by which cells adjust their chemical composition in response to a changing environment. When specific elements become limiting, acclimation typically begins with an increased commitment to acquisition and a concomitant mobilization of stored resources. If elemental limitation persists, the cell implements austerity measures including elemental-sparing and elemental-recycling. Insights into these fundamental cellular properties have emerged from studies at many different levels; including ecology, biological oceanography, biogeochemistry, molecular genetics, genomics, and microbial physiology. Here, we present a synthesis of these diverse studies and attempt to discern some overarching themes. PMID:22633059

Administration of resveratrol: What formulation solutions to bioavailability limitations?

PubMed

Amri, A; Chaumeil, J C; Sfar, S; Charrueau, C

2012-03-10

Resveratrol (3,5,4'-trihydroxystilbene), a naturally occurring polyphenol, has attracted considerable interest for its beneficial potentials for human health, which include anti-oxidant, anti-inflammatory, cardioprotective and anti-tumor activities. However, the in vivo biological effects of resveratrol appear strongly limited by its low bioavailability, which is a barrier to the development of therapeutic applications. In this context, an increasing number of recent studies have aimed at designing novel resveratrol formulations to overcome its poor solubility, limited stability, high metabolization and weak bioavailability. This review outlines physicochemical and pharmacokinetic limitations to resveratrol bioavailability, describes formulations tested for resveratrol administration, controlled release and targeting, and identifies future opportunities for resveratrol delivery. Copyright © 2011 Elsevier B.V. All rights reserved.

Childhood obesity: a review of increased risk for physical and psychological comorbidities.

PubMed

Pulgarón, Elizabeth R

2013-01-01

Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities. The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally. PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities. The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems. The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

Systematic Review of the Literature on Pain in Patients with Polytrauma Including Traumatic Brain Injury

PubMed Central

Dobscha, Steven K.; Clark, Michael E.; Morasco, Benjamin J.; Freeman, Michele; Campbell, Rose; Helfand, Mark

2010-01-01

Objective To review the literature addressing the assessment and management of pain in patients with polytraumatic injuries including traumatic brain injury (TBI) and blast-related headache, and to identify patient, clinician and systems factors associated with pain-related outcomes. Design Systematic review. Methods We conducted searches in MEDLINE of literature published from 1950 through July 2008. Due to a limited number of studies using controls or comparators, we included observational and rigorous qualitative studies. We systematically rated the quality of systematic reviews, cohort, and case-control design studies. Results One systematic review, 93 observational studies, and one qualitative research study met inclusion criteria. The literature search yielded no published studies that assessed measures of pain intensity or pain-related functional interference among patients with cognitive deficits due to TBI, that compared patients with blast-related headache with patients with other types of headache, or that assessed treatments for blast-related headache pain. Studies on the association between TBI severity and pain reported mixed findings. There was limited evidence that the following factors are associated with pain among TBI patients: severity, location, and multiplicity of injuries; insomnia; fatigue; depression; and post-traumatic stress disorder. Conclusions Very little evidence is currently available to guide pain assessment and treatment approaches in patients with polytrauma. Further research employing systematic observational as well as controlled intervention designs is clearly indicated. PMID:19818031

Prediction of forming limit in hydro-mechanical deep drawing of steel sheets using ductile fracture criterion

NASA Astrophysics Data System (ADS)

Oh, S.-T.; Chang, H.-J.; Oh, K. H.; Han, H. N.

2006-04-01

It has been observed that the forming limit curve at fracture (FLCF) of steel sheets, with a relatively higher ductility limit have linear shapes, similar to those of a bulk forming process. In contrast, the FLCF of sheets with a relatively lower ductility limit have rather complex shapes approaching the forming limit curve at neck (FLCN) towards the equi-biaxial strain paths. In this study, the FLCFs of steel sheets were measured and compared with the fracture strains predicted from specific ductile fracture criteria, including a criterion suggested by the authors, which can accurately describe FLCFs with both linear and complex shapes. To predict the forming limit for hydro-mechanical deep drawing of steel sheets, the ductile fracture criteria were integrated into a finite element simulation. The simulation, results based on the criterion suggested by authors accurately predicted the experimetal, fracture limits of steel sheets for the hydro-mechanical deep drawing process.

Interventions in sports settings to reduce risky alcohol consumption and alcohol-related harm: a systematic review.

PubMed

Kingsland, Melanie; Wiggers, John H; Vashum, Khanrin P; Hodder, Rebecca K; Wolfenden, Luke

2016-01-21

Elevated levels of risky alcohol consumption and alcohol-related harm have been reported for sportspeople and supporters compared to non-sporting populations. Limited systematic reviews have been conducted to assess the effect of interventions targeting such behaviours. A review was undertaken to determine if interventions implemented in sports settings decreased alcohol consumption and related harms. Studies were included that implemented interventions within sports settings; measured alcohol consumption or alcohol-related injury or violence and were either randomised controlled trials, staggered enrollment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials or natural experiments. Studies without a parallel comparison group were excluded. Studies from both published and grey literature were included. Two authors independently screened potential studies against the eligibility criteria, and two authors independently extracted data from included studies and assessed risk of bias. The results of included studies were synthesised narratively. The title and abstract of 6382 papers and the full text of 45 of these papers were screened for eligibility. Three studies met the inclusion criteria for the review. One of the included studies was a randomised controlled trial (RCT) of a cognitive-behavioural intervention with athletes within an Olympic training facility in the USA. The study reported a significant change in alcohol use between pre-test and follow-up between intervention and control groups. The other two studies were RCTs in community sports clubs in Ireland and Australia. The Australian study found a significant intervention effect for both risky alcohol consumption at sports clubs and overall risk of alcohol-related harm. The Irish study found no significant intervention effect. A limited number of studies have been conducted to assess the effect of interventions implemented in sports settings on alcohol consumption and related harms. While two of the three studies found significant intervention effects, it is difficult to determine the extent to which such effects are generalisable. Further controlled trials are required in this setting. PROSPERO CRD42014001739.

Attrition from Student Affairs: Perspectives from Those Who Exited the Profession

ERIC Educational Resources Information Center

Marshall, Sarah M.; Gardner, Megan Moore; Hughes, Carole; Lowery, Ute

2016-01-01

Attrition of student affairs professionals is an issue of concern for the profession. This mixed methods study highlights reasons why participants left their student affairs careers. Seven general themes emerged from the study, including burnout, salary issues, career alternatives, work/family conflict, limited advancement, supervisor issues and…

ASSESSING EXPOSURE IN EPIDEMIOLOGIC STUDIES TO DISINFECTION BY-PRODUCTS IN DRINKING WATER: REPORT FROM AN INTERNATIONAL WORKSHOP

EPA Science Inventory

The inability to accurately assess exposure has been one of the major shortcomings of epidemiologic studies of disinfection by-products (DBPs) in drinking water. A number of contributing factors include: (1) limited information on the identity, occurrence, toxicity and pharmacok...

Trends in Financial Satisfaction: Does Poverty Make a Difference?

ERIC Educational Resources Information Center

Hsieh, Chang-Ming

2002-01-01

Gerontological studies on financial satisfaction have been limited by the dearth of longitudinal research and the lack of research that includes the concept of poverty. In order to bridge these gaps, this longitudinal study examines and compares the intracohort and intercohort effects on financial satisfaction trends by poverty status among…

24 CFR 570.415 - Community Development Work Study Program.

Code of Federal Regulations, 2013 CFR

2013-04-01

... assistance, including, but not limited to, students who are Black, American Indian/Alaskan Native, Hispanic... disabilities means a student who meets the definition of “person with disabilities” in the Americans with... students who participate in a work study program while enrolled in full-time graduate programs in community...

24 CFR 570.415 - Community Development Work Study Program.

Code of Federal Regulations, 2014 CFR

2014-04-01

... assistance, including, but not limited to, students who are Black, American Indian/Alaskan Native, Hispanic... disabilities means a student who meets the definition of “person with disabilities” in the Americans with... students who participate in a work study program while enrolled in full-time graduate programs in community...

24 CFR 570.415 - Community Development Work Study Program.

Code of Federal Regulations, 2012 CFR

2012-04-01

... assistance, including, but not limited to, students who are Black, American Indian/Alaskan Native, Hispanic... disabilities means a student who meets the definition of “person with disabilities” in the Americans with... students who participate in a work study program while enrolled in full-time graduate programs in community...

An evaluation of U.S. strawberry producers trait prioritization—evidence from audience clicker surveys

USDA-ARS?s Scientific Manuscript database

Studies evaluating the relative importance of strawberry traits to U.S. strawberry producers are limited. The strawberry traits included in this study were fruit skin color, fruit size, fruit flavor, fruit firmness, shelf life at retail, open plant canopy, productivity, extended harvest season, roo...

21 CFR 814.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... agency, which may include (but are not limited to) data derived from new clinical studies, reports of adverse events, or new analyses of previously submitted data (e.g., meta-analyses) if the studies, events... criteria in § 1271.10(a) and that is also regulated as a device. (q) Unique device identifier (UDI) means...

Homeless Adolescents' Perceptions of Positive Development: A Comparative Study

ERIC Educational Resources Information Center

Nott, Brooke Dolenc; Vuchinich, Samuel

2016-01-01

Background: While some recent research has addressed homeless youth from a strengths-based approach, comparative studies of homeless and non-homeless youth from a strengths perspective are few; research that includes youth's views on positive youth development are also limited. Objective: Addressing these gaps and using an inductive approach,…

Testing Alternative Explanations for the Associations between Parenting and Adolescent Suicidal Problems

ERIC Educational Resources Information Center

Boeninger, Daria K.; Masyn, Katherine E.; Conger, Rand D.

2013-01-01

Although studies have established associations between parenting characteristics and adolescent suicidality, the strength of the evidence for these links remains unclear, largely because of methodological limitations, including lack of accounting for possible child effects on parenting. This study addresses these issues by using autoregressive…

Homogenization limit for a multiband effective mass model in heterostructures

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

Morandi, O., E-mail: morandi@ipcms.unistra.fr

We study the homogenization limit of a multiband model that describes the quantum mechanical motion of an electron in a quasi-periodic crystal. In this approach, the distance among the atoms that constitute the material (lattice parameter) is considered a small quantity. Our model include the description of materials with variable chemical composition, intergrowth compounds, and heterostructures. We derive the effective multiband evolution system in the framework of the kp approach. We study the well posedness of the mathematical problem. We compare the effective mass model with the standard kp models for uniform and non-uniforms crystals. We show that in themore » limit of vanishing lattice parameter, the particle density obtained by the effective mass model, converges to the exact probability density of the particle.« less

[Exercising sexual and reproductive rights: a qualitative study of heterosexual people with HIV in Mexico].

PubMed

Campero, Lourdes; Kendall, Tamil; Caballero, Marta; Mena, Ana Lorena; Herrera, Cristina

2010-01-01

To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights. Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States. Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies. To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

Con: Meta-analysis: some key limitations and potential solutions.

PubMed

Esterhuizen, Tonya M; Thabane, Lehana

2016-06-01

Meta-analysis, a statistical combination of results of several trials to produce a summary effect, has been subject to criticism in the past, mainly for the reasons of poor quality of included studies, heterogeneity between studies meta-analyzed and failing to address publication bias. These limitations can cause the results to be misleading, which is important if policy and practice decisions are based on systematic reviews and meta-analyses. We elaborate on these limitations and illustrate them with examples from the nephrology literature. Finally, we present some potential solutions, notably, education in meta-analysis for evidence producers and consumers as well as the use of individual patient data for meta-analyses. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems: a qualitative study

PubMed Central

May, Stephen; Withers, Sarah; Reeve, Sarah; Greasley, Alison

2010-01-01

The aim of this study was to explore the clinical reasoning process used by novice physical therapists in specific patient problems. Nine physical therapists in the UK with limited experience of managing musculoskeletal problems were included. Semi-structured interviews were conducted on how novice physical therapists would assess and manage a patient with a shoulder problem; interviews were transcribed and analyzed using framework analysis. To be included as a final theme at least 50% of participants had to mention that theme. A large number of items (n = 93) were excluded as fewer than 50% of participants referred to each item. Included items related to seven main themes: history (16), physical exam (13), investigations (1), diagnostic reasoning (1), clinical reasoning process (diagnostic pathway) (3), clinical reasoning process (management pathway) (5) and treatment options (1). Items mostly related to information gathering, although there was some use of hypothetico-deductive clinical reasoning there appeared to be limited understanding of the clinical implications of data gathered, and clinical reasoning through use of pattern recognition was minimal. Major weaknesses were apparent in the clinical reasoning skills of these novice therapists compared to previous reports of expert clinical reasoning, indicating areas for development in the education of student and junior physical therapists. PMID:21655390

Brain training: hype or hope?

PubMed

van Heugten, Caroline M; Ponds, Rudolf W H M; Kessels, Roy P C

2016-10-01

Brain training is topical yet controversial. Effects are often limited to trained tasks; and near and far effects to untrained tasks or everyday life measures are often small or lacking altogether. More recent approaches use evidence from cognitive neuroscience on neuroplasticity, resulting in novel cognitive interventions. This special issue encompasses the state of the art of these interventions. Two systematic reviews and nine experimental studies in a variety of patient groups or healthy participants are included, the results of which mostly confirm earlier findings: effects on trained tasks are consistently reported, but generalisation in terms of functional outcome is limited and little evidence is found of long-term effects. In general, the studies show promising, yet challenging training effects on cognition in healthy persons and patients with cognitive deficits. As such, they may be seen as positive "proof of principle" studies, highlighting that cognitive enhancement is possible. The field of brain training, however, is in urgent need of larger and more thoroughly designed studies. These future studies should also include outcome measures on daily functioning, self-efficacy and quality of life in addition to neuropsychological tests or tasks related to cognitive functioning.

Are Natural Ingredients Effective in the Management of Hyperpigmentation? A Systematic Review

PubMed Central

Angra, Kunal; Halder, Rebat M.

2018-01-01

BACKGROUND: Hyperpigmentation disorders are commonly encountered in dermatology clinics. Botanical and natural ingredients have gained popularity as alternative depigmenting products. OBJECTIVE: We sought to review clinical studies evaluating the use of different natural products in treating hyperpigmentation so clinicians are better equipped to educate their patients. Specific ingredients reviewed include azelaic acid, aloesin, mulberry, licorice extracts, lignin peroxidase, kojic acid, niacinamide, ellagic acid, arbutin, green tea, turmeric, soy, and ascorbic acid. METHODS: Systematic searches of PubMed and SCOPUS databases were performed in March 2016 using the various ingredient names, “melasma”and “hyperpigmentation.” Two reviewers independently screened titles, leading to the selection of 30 clinical studies. RESULTS: Review of the literature revealed few clinical trials that evaluated the treatment of hyperpigmentation with natural ingredients. Despite the limited evidence-based research, several natural ingredients did show efficacy as depigmenting agents, including azelaic acid, soy, lignin peroxidase, ascorbic acid iontophoresis, arbutin, ellagic acid, licorice extracts, niacinamide, and mulberry. CONCLUSION: The aforementioned ingredients show promise as natural treatments for patients with hyperpigmentation disorders. These agents might also provide clinicians and researchers with a way to further characterize the pathogenesis of dyschromia. However, the paucity of clinical studies is certainly a limitation. Additionally, many of the in-vivo studies are limited by the short length of the trials, and questions remain about the long-term efficacy and safety of the ingredients used in these studies. Lastly, we suggest a standardized objective scoring system be implemented in any further comparative studies. PMID:29552273

Experimentally Observed Electrical Durability of 4H-SiC JFET ICs Operating from 500 C to 700 C

NASA Technical Reports Server (NTRS)

Neudeck, Philip G.; Spry, David J.; Chen, Liangyu; Lukco, Dorothy; Chang, Carl W.; Beheim, Glenn M.

2016-01-01

Prolonged 500 degrees Celsius to 700 degrees Celsius electrical testing data from 4H-SiC junction field effect transistor (JFET) integrated circuits (ICs) are combined with post-testing microscopic studies in order to gain more comprehensive understanding of the durability limits of the present version of NASA Glenn's extreme temperature microelectronics technology. The results of this study support the hypothesis that T = 500 degrees Celsius durability-limiting IC failure initiates with thermal-stress-related crack formation where dielectric passivation layers overcoat micron-scale vertical features including patterned metal traces.

Comparative study of minutiae selection algorithms for ISO fingerprint templates

NASA Astrophysics Data System (ADS)

Vibert, B.; Charrier, C.; Le Bars, J.-M.; Rosenberger, C.

2015-03-01

We address the selection of fingerprint minutiae given a fingerprint ISO template. Minutiae selection plays a very important role when a secure element (i.e. a smart-card) is used. Because of the limited capability of computation and memory, the number of minutiae of a stored reference in the secure element is limited. We propose in this paper a comparative study of 6 minutiae selection methods including 2 methods from the literature and 1 like reference (No Selection). Experimental results on 3 fingerprint databases from the Fingerprint Verification Competition show their relative efficiency in terms of performance and computation time.

Work related injury among aging women.

PubMed

Harrison, Tracie; Legarde, Brittany; Kim, Sunhun; Walker, Janiece; Blozis, Shelley; Umberson, Debra

2013-02-01

This article reports the experiences of women aged 55 to 75 with mobility impairments who attributed aspects of their limitations to workplace injuries and provides insight into worker's compensation policies. The study sample includes Mexican American (MA) and non-Hispanic White (NHW) women aged 55 to 75 who participated in a 4-year ethnographic study of disablement. Ninety-two of the 122 participants in the study attributed aspects of their functional limitations to employment, and their experiences were analyzed using data from 354 meetings. Using Lipscomb and colleagues' conceptual model of work and health disparities, the women's experiences were grouped into three categories according to type of injury, assistance gained, and the consequences of a workplace injury; the results have broad implications for policies that influence aging outcomes. Workplace injuries causing permanent functional limitations compound the effects of age and gender on employment outcomes. Policies addressing health disparities should consider work related influences.

Work Related Injury among Aging Women

PubMed Central

LeGarde, Brittany; Kim, SungHun; Walker, Janiece; Blozis, Shelley; Umberson, Debra

2013-01-01

This article reports the experiences of women age 55 to 75 with mobility impairments who attributed aspects of their limitations to workplace injuries and provides insight into worker’s compensation policies. The study sample includes Mexican American and non-Hispanic White women ages 55–75 who participated in a 4-year ethnographic study of disablement. Ninety-two of the 122 participants in the study attributed aspects of their functional limitations to employment, and their experiences were analyzed using data from 354 meetings. Using Lipscomb and colleagues’ conceptual model of work and health disparities, the women’s experiences were grouped into three categories according to type of injury, assistance gained, and the consequences of a workplace injury; the results have broad implications for policies that influence aging outcomes. Workplace injuries causing permanent functional limitations compound the effects of age and gender on employment outcomes. Policies addressing health disparities should consider work related influences. PMID:23528432

Total Arsenic, Cadmium, and Lead Determination in Brazilian Rice Samples Using ICP-MS

PubMed Central

Buzzo, Márcia Liane; de Arauz, Luciana Juncioni; Carvalho, Maria de Fátima Henriques; Arakaki, Edna Emy Kumagai; Matsuzaki, Richard; Tiglea, Paulo

2016-01-01

This study is aimed at investigating a suitable method for rice sample preparation as well as validating and applying the method for monitoring the concentration of total arsenic, cadmium, and lead in rice by using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Various rice sample preparation procedures were evaluated. The analytical method was validated by measuring several parameters including limit of detection (LOD), limit of quantification (LOQ), linearity, relative bias, and repeatability. Regarding the sample preparation, recoveries of spiked samples were within the acceptable range from 89.3 to 98.2% for muffle furnace, 94.2 to 103.3% for heating block, 81.0 to 115.0% for hot plate, and 92.8 to 108.2% for microwave. Validation parameters showed that the method fits for its purpose, being the total arsenic, cadmium, and lead within the Brazilian Legislation limits. The method was applied for analyzing 37 rice samples (including polished, brown, and parboiled), consumed by the Brazilian population. The total arsenic, cadmium, and lead contents were lower than the established legislative values, except for total arsenic in one brown rice sample. This study indicated the need to establish monitoring programs for emphasizing the study on this type of cereal, aiming at promoting the Public Health. PMID:27766178

Assistive technology for communication of older adults: a systematic review.

PubMed

Pedrozo Campos Antunes, Thaiany; Souza Bulle de Oliveira, Acary; Hudec, Robert; Brusque Crocetta, Tania; Ferreira de Lima Antão, Jennifer Yohanna; de Almeida Barbosa, Renata Thais; Guarnieri, Regiani; Massetti, Thais; Garner, David M; de Abreu, Luiz Carlos

2018-02-16

Describe the use of assistive technology to enhance communication opportunities for older adults. A systematic review was conducted in two databases, PubMed and Web of Science, by using two different searches in each. The search was limited to original articles, in English language, including people aged 60 years and older that used any type of assistive technology for communication. The articles found in the initial search were filtered by title, abstracts and the remaining articles were fully read. Eighteen studies were included in this review after the reading of full-texts. Most of the studies included apparently healthy participants with communication limitations due to aging related changes and the others included people with some pathology that prevent them from normal communication. Four categories of assistive technology were identified: assistive technology for people with speech problems; robot or videoconferencing systems; Information and Communication Technologies and, other types of assistive technology for communication, such as hearing aids and scrapbooks. Assistive technology for communication of older adults is not only used by people with disabilities that prevent them from usual communication. They are mostly for older adults without a pathological communication problem.

Clinical and surgical applications of smart glasses.

PubMed

Mitrasinovic, Stefan; Camacho, Elvis; Trivedi, Nirali; Logan, Julia; Campbell, Colson; Zilinyi, Robert; Lieber, Bryan; Bruce, Eliza; Taylor, Blake; Martineau, David; Dumont, Emmanuel L P; Appelboom, Geoff; Connolly, E Sander

2015-01-01

With the increased efforts to adopt health information technology in the healthcare field, many innovative devices have emerged to improve patient care, increase efficiency, and decrease healthcare costs. A recent addition is smart glasses: web-connected glasses that can present data onto the lenses and record images or videos through a front-facing camera. In this article, we review the most salient uses of smart glasses in healthcare, while also denoting their limitations including practical capabilities and patient confidentiality. Using keywords including, but not limited to, ``smart glasses'', ``healthcare'', ``evaluation'', ``privacy'', and ``development'', we conducted a search on Ovid-MEDLINE, PubMed, and Google Scholar. A total of 71 studies were included in this review. Smart glasses have been adopted into the healthcare setting with several useful applications including, hands-free photo and video documentation, telemedicine, Electronic Health Record retrieval and input, rapid diagnostic test analysis, education, and live broadcasting. In order for the device to gain acceptance by medical professionals, smart glasses will need to be tailored to fit the needs of medical and surgical sub-specialties. Future studies will need to qualitatively assess the benefits of smart glasses as an adjunct to the current health information technology infrastructure.

JOURNAL CLUB: Quantification of Fetal Dose Reduction if Abdominal CT Is Limited to the Top of the Iliac Crests in Pregnant Patients With Trauma.

PubMed

Corwin, Michael T; Seibert, J Anthony; Fananapazir, Ghaneh; Lamba, Ramit; Boone, John M

2016-04-01

The purposes of this study were to correlate fetal z-axis location within the maternal abdomen on CT with gestational age and estimate fetal dose reduction of a study limited to the abdomen only, with its lower aspect at the top of the iliac crests, compared with full abdominopelvic CT in pregnant trauma patients. We performed a study of pregnant patients who underwent CT of the abdomen and pelvis for trauma at a single institution over a 10-year period. The inferior aspect of maternal liver, spleen, gallbladder, pancreas, adrenals, and kidneys was recorded as above or below the iliac crests. The distance from the iliac crest to the top of the fetus or gestational sac was determined. The CT images of the limited and full scanning studies were independently reviewed by two blinded radiologists to identify traumatic injuries. Fetal dose profiles, including both scatter and primary radiation, were computed analytically along the central axis of the patient to estimate fetal dose reduction. Linear regression analysis was performed between gestational age and distance of the fetus to the iliac crests. Thirty-five patients were included (mean age, 26.2 years). Gestational age ranged from 5 to 38 weeks, with 5, 19, and 11 gestations in the first, second, and third trimesters, respectively. All solid organs were above the iliac crests in all patients. In three of six patients, traumatic findings in the pelvis would have been missed with the limited study. There was high correlation between gestational age and distance of the fetus to the iliac crests (R(2) = 0.84). The mean gestational age at which the top of the fetus was at the iliac crest was 17.3 weeks. Using the limited scanning study, fetuses at 5, 20, and 40 weeks of gestation would receive an estimated 4.3%, 26.2%, and 59.9% of the dose, respectively, compared with the dose for the full scanning study. In pregnant patients in our series with a history of trauma, CT of the abdomen only was an effective technique to reduce fetal radiation exposure compared with full abdomen and pelvis CT.

Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials.

PubMed

Henriksen, Marius; Creaby, Mark W; Lund, Hans; Juhl, Carsten; Christensen, Robin

2014-07-15

We performed a systematic review, meta-analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis (OA) progression. Systematic review, meta-analysis and application of Bradford Hill's considerations on causation. We searched MEDLINE, Scopus, AMED, CINAHL and SportsDiscus for prospective cohort studies and randomised controlled trials (RCTs) from 1950 through October 2013. We selected cohort studies and RCTs in which estimates of knee joint loading during walking were used to predict structural knee OA progression assessed by X-ray or MRI. Meta-analysis was performed to estimate the combined OR for structural disease progression with higher baseline loading. The likelihood of a causal link between knee joint loading and OA progression was assessed from cohort studies using the Bradford Hill guidelines to derive a 0-4 causation score based on four criteria and examined for confirmation in RCTs. Of the 1078 potentially eligible articles, 5 prospective cohort studies were included. The studies included a total of 452 patients relating joint loading to disease progression over 12-72 months. There were very serious limitations associated with the methodological quality of the included studies. The combined OR for disease progression was 1.90 (95% CI 0.85 to 4.25; I(2)=77%) for each one-unit increment in baseline knee loading. The combined causation score was 0, indicating no causal association between knee loading and knee OA progression. No RCTs were found to confirm or refute the findings from the cohort studies. There is very limited and low-quality evidence to support for a causal link between knee joint loading during walking and structural progression of knee OA. CRD42012003253. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

PubMed Central

Williamson, Lisa M; Parkes, Alison; Wight, Daniel; Petticrew, Mark; Hart, Graham J

2009-01-01

Background Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative research to examine the limits to modern contraceptive use identified by young women in developing countries. Focusing on qualitative research allows the assessment of complex processes often missed in quantitative analyses. Methods Literature searches of 23 databases, including Medline, Embase and POPLINE®, were conducted. Literature from 1970–2006 concerning the 11–24 years age group was included. Studies were critically appraised and meta-ethnography was used to synthesise the data. Results Of the 12 studies which met the inclusion criteria, seven met the quality criteria and are included in the synthesis (six from sub-Saharan Africa; one from South-East Asia). Sample sizes ranged from 16 to 149 young women (age range 13–19 years). Four of the studies were urban based, one was rural, one semi-rural, and one mixed (predominantly rural). Use of hormonal methods was limited by lack of knowledge, obstacles to access and concern over side effects, especially fear of infertility. Although often more accessible, and sometimes more attractive than hormonal methods, condom use was limited by association with disease and promiscuity, together with greater male control. As a result young women often relied on traditional methods or abortion. Although the review was limited to five countries and conditions are not homogenous for all young women in all developing countries, the overarching themes were common across different settings and contexts, supporting the potential transferability of interventions to improve reproductive health. Conclusion Increasing modern contraceptive method use requires community-wide, multifaceted interventions and the combined provision of information, life skills, support and access to youth-friendly services. Interventions should aim to counter negative perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention should be exploited, despite the challenges involved. PMID:19228420

Fundamental constructs in food parenting practices: a content map to guide future research.

PubMed

Vaughn, Amber E; Ward, Dianne S; Fisher, Jennifer O; Faith, Myles S; Hughes, Sheryl O; Kremers, Stef P J; Musher-Eizenman, Dara R; O'Connor, Teresia M; Patrick, Heather; Power, Thomas G

2016-02-01

Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Cross-cultural adaptation and measurement properties of generic and cancer-related patient-reported outcome measures (PROMs) for use with cancer patients in Brazil: a systematic review.

PubMed

Albach, Carlos Augusto; Wagland, Richard; Hunt, Katherine J

2018-04-01

This systematic review (1) identifies the current generic and cancer-related patient-reported outcome measures (PROMs) that have been cross-culturally adapted to Brazilian Portuguese and applied to cancer patients and (2) critically evaluates their cross-cultural adaptation (CCA) and measurement properties. Seven databases were searched for articles regarding the translation and evaluation of measurement properties of generic and cancer-related PROMs cross-culturally adapted to Brazilian Portuguese that are applied in adult (≥18 years old) cancer patients. The methodological quality of included studies was assessed using the COSMIN checklist. The bibliographic search retrieved 1674 hits, of which seven studies analysing eight instruments were included in this review. Data on the interpretability of scores were poorly reported. Overall, the quality of the CCA process was inconsistent throughout the studies. None of the included studies performed a cross-cultural validation. The evidence concerning the quality of measurement properties is limited by poor or fair methodological quality. Moreover, limited information regarding measurement properties was provided within the included papers. This review aids the selection process of Brazilian Portuguese PROMs for use in cancer patients. After acknowledging the methodological caveats and strengths of each tool, our opinion is that for quality of life and symptoms assessment the adapted FACT-G version and the ESAS could be recommended, respectively. Future research should rely on the already accepted standards of CCA and validation studies.

Developmental toxicity study in rats exposed dermally to clarified slurry oil for a limited period of gestation

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

Feuston, M.H.; Mackerer, C.R.

1996-10-11

Clarified slurry oil (CSO, CAS number 64741-62-4), a refinery stream produced by processing crude oil, is a developmental toxicant when administered dermally throughout gestation to pregnant rats. The manifestations of developmental toxicity observed included embryolethlity and growth retardation; evidence of teratogenicity was limited, and not conclusive. The present study was undertaken to further explore the teratogenic potential of CSO. In an attempt to limit emnbryolethality and thereby promote detection of terata, CSO was administered once daily for a limited period of gestation i[gestation days (GD) 9-12], via dermal application, to pregnant Sprague-Dawley rats at doses of 0, 10, 100, andmore » 1000 mg/kg. All animals were sacrificed on GD 20. Detailed examination of the dams was performed. Due to the screening nature of this investigation, fetal evaluations were limited to body weight measurements, external examinations, and evaluation of select visceral endpoints. In the dams exposed to CSO, significant decreases in body weight [absolute and gain (GD 9-13, GD 0-20)] and in the amount of food consumed were observed at 100 and 1000 mg/kg. Additional evidence of maternal toxicity observed at 1000 mg/kg included decreased absolute and relative thymus weights, increased absolute and relative liver weights, and aberrant serum chemistry. Ingestion of the test material was evident at the high dose. Developmental toxicity was observed at 1000 mg/kg and included increased embryolethality, decreased body weight, and anomalous development (cleft palate, brachydactyly, edema). Although a low incidence of abnormal fetal development was observed at 100 mg/kg, it was not conclusive that the alterations were due to CSO exposure. It is likely that three- to seven-ring polycyclic aromatic compounds present in CSO were responsible for the toxic effects observed. 33 refs., 5 tabs.« less

Nucleic Acid Aptamers: An Emerging Tool for Biotechnology and Biomedical Sensing

PubMed Central

Ku, Ti-Hsuan; Zhang, Tiantian; Luo, Hua; Yen, Tony M.; Chen, Ping-Wei; Han, Yuanyuan; Lo, Yu-Hwa

2015-01-01

Detection of small molecules or proteins of living cells provides an exceptional opportunity to study genetic variations and functions, cellular behaviors, and various diseases including cancer and microbial infections. Our aim in this review is to give an overview of selected research activities related to nucleic acid-based aptamer techniques that have been reported in the past two decades. Limitations of aptamers and possible approaches to overcome these limitations are also discussed. PMID:26153774

The Impact of Nitrogen Limitation and Mycorrhizal Symbiosis on Aspen Tree Growth and Development

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

Tran, Bich Thi Ngoc

Nitrogen deficiency is the most common and widespread nutritional deficiency affecting plants worldwide. Ectromycorrhizal symbiosis involves the beneficial interaction of plants with soil fungi and plays a critical role in nutrient cycling, including the uptake of nitrogen from the environment. The main goal of this study is to understand how limiting nitrogen in the presence or absence of an ectomycorrhizal fungi, Laccaria bicolor, affects the health of aspen trees, Populus temuloides.

Flood-plain delineation for Accotink Creek Basin, Fairfax County, Virginia

USGS Publications Warehouse

Soule, Pat L.

1977-01-01

Water-surface profiles of the 25-year and 100-year floods maps on which the 25-, 50-, and 100-year flood limits are delineated for streams in the Accotink Creek basin are presented in this report. Excluded are segments of Accotink Creek within the Fort Belvoir Military Reservation. The techniques used in the computation of the flood profiles and delineation of flood limits are presented, and specific hydraulic problems encountered within the study area are also included.

PILOT PEAT-BED TREATMENT SYSTEM FOR NPDES OUTFALL H-12

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

Halverson, N; Ralph Nichols, R; Topher Berry, T

2007-10-22

A National Pollutant Discharge Elimination System (NPDES) Permit was issued to the Savannah River Site (SRS) by the South Carolina Department of Health and Environmental Control (SCDHEC) and became effective on December 1, 2003. The new permit contained revised limits for copper and zinc derived by adjusting the South Carolina aquatic life water quality standards in accordance with dissolved metals criteria. The new copper and zinc limits are very low and may not be met consistently at Outfall H-12. The outfall has periodically exceeded the new 6 {micro}g/l (0.006 mg/L) monthly average limit and the 8 {micro}g/l (0.008 mg/L) maximummore » limit for copper and recently has begun exceeding the 100 {micro}g/l (0.100 mg/L) limit for zinc. The compliance date for Outfall H-12 is November 1, 2008. A study was conducted on this outfall and other outfalls to evaluate possible alternatives for meeting the new permit limits (Shipman and Bugher 2004). The study team recommended construction of a peat bed for treatment of the Outfall H-12 effluent. This recommendation was repeated by a second alternatives study team in 2007 (WSRC 2007). A bench-scale laboratory study demonstrated the feasibility of peat-bed treatment for Outfall H-12 effluent, with the peat demonstrating excellent removal of copper (Nelson and Specht 2005). An additional study was performed in 2006 and early 2007 using vertical-flow peat columns to investigate the influence of water retention time (contact time) on the removal of copper and zinc from the water (Nelson 2007c). Analytical results indicated that copper removal was very high at each of the three retention times tested, ranging from 99.6% removal at five and three hours to 98.8% removal at one hour. Effluent copper levels from these studies were much lower than the new compliance limit for the outfall. Most divalent metals, including zinc, were removed to below their normal reporting detection limit. The H-Area Material Disposition organization requested a larger-scale study to investigate key design and operation parameters/issues, such as the possibility of rapid plugging of the piping or clogging of the peat bed, the effectiveness of the treatment, hydraulic conductivity, etc. The resulting pilot-scale facility was constructed adjacent to Outfall H-12 with SCDHEC approval (Mullinax 2007). The pilot-scale study was performed by the Savannah River National Laboratory's (SRNL) Environmental Science and Biotechnology Directorate personnel. Since the construction and operation of the pilot-scale peat bed facility, however, a new strategy for achieving compliance of Outfall H-12 effluent with the new permit limits has been selected. This new strategy incorporates a variety of efforts including source reduction, recalculation of limits using an aquatic species that is indigenous to the area instead of a standard species, and dissolved organic carbon addition to reduce copper toxicity. This report documents the construction and operation of the pilot-scale treatment system, the results obtained, and recommendations on the usefulness of this technology for Outfall H-12 or other outfalls at SRS.« less

Characteristics of Qualitative Descriptive Studies: A Systematic Review.

PubMed

Kim, Hyejin; Sefcik, Justine S; Bradway, Christine

2017-02-01

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, although there were some inconsistencies, most articles included characteristics consistent with the limited available QD definitions and descriptions. Next, flexibility or variability of methods was common and effective for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD studies so that readers can determine whether the methods used were reasonable and effective in producing useful findings. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Boosting Educational Attainment and Adult Earnings: Does School Spending Matter after All?

ERIC Educational Resources Information Center

Jackson, C. Kirabo; Johnson, Rucker C.; Persico, Claudia

2015-01-01

This study addresses limitations in a study conducted by James Coleman in 1966, which analyzed aspects of educational equality in the United States--including the relationship between school spending and student outcomes--as well as other studies covering the same topic that stemmed from Coleman's Report. Coleman found that variation in school…

An Overview of Vocational Education and Training in Malta.

ERIC Educational Resources Information Center

European Training Foundation, Turin (Italy).

Data for studies of vocational education and training systems in Malta and five other countries in the region were gathered through an analysis of existing studies and visits to the main stakeholders in the countries. Some of the main conclusions reached by the study of Malta include the following: (1) since the island has limited natural…

Substituting whole grains for refined grains in a 6-wk randomized trial has a modest effect on gut microbiota and immune and inflammatory markers of healthy adults

USDA-ARS?s Scientific Manuscript database

Background: Observational studies suggest an inverse association between whole-grain (WG) consumption and inflammation. However, evidence from interventional studies is limited, and few studies have included measurements of cell-mediated immunity. Objective: We assessed the effects of diets rich in ...

A spin rotator model for Heisenberg helimagnet

NASA Astrophysics Data System (ADS)

Felcy, A. Ludvin; Latha, M. M.

2018-02-01

We study the dynamics of a helimagnetic spin system by proposing a spin rotator model taking into account bilinear, twist interplane and anisotropic interactions in the continuum limit. The dynamical equations of motion are obtained and studied numerically. The influence of different types of inhomogeneities is also analysed. Similar studies are carried out for the system including biquadratic type interactions.

Caribbean Regional Communications Service Study. Report.

ERIC Educational Resources Information Center

Lalor, Gerald C.

A follow-up to a limited experiment with the use of satellites in education and public service conducted by the University of the West Indies (UWI) in 1978, this study explores the feasibility of providing a number of services, which would include an extension system based on the use of the UWI telecommunications network. The study was designed to…

75 FR 70738 - Gulf Oil Limited Partnership; Supplemental Notice That Initial Market-Based Rate Filing Includes...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-18

... Limited Partnership; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for... proceeding of Gulf Oil Limited Partnership's application for market-based rate authority, with an... CFR Part 34, of future issuances of securities and assumptions of liability. Any person desiring to...

Impact of access management practices to pedestrian safety.

DOT National Transportation Integrated Search

2017-03-31

This study focused on the impact of access management practices to the safety of pedestrians. Some : of the access management practices considered to impact pedestrian safety included limiting direct : access to and from major streets, locating signa...

FLUORESCENT IN SITU HYBRIDIZATION AND MICROAUTORADIOGRAPHY APPLIED TO ECOPHYSIOLOGY IN SOIL

EPA Science Inventory

Soil microbial communities perform many important processes, including nutrient cycling, plant-microorganism interactions, and degradation of xenobiotics. The study of microbial communities, however, has been limited by cultural methods, which may greatly underestimate diversity....

Age-related functional limitations, countermeasures, and crash risks : traffic tech.

DOT National Transportation Integrated Search

2012-03-01

This study updates and extends our understanding of how : age-related functional deficits, including changes in vision, : cognition, strength, and flexibility can increase older drivers : crash risks. The report discusses the potential of a variet...

Yoga in the schools: a systematic review of the literature.

PubMed

Serwacki, Michelle L; Cook-Cottone, Catherine

2012-01-01

The objective of this research was to examine the evidence for delivering yoga-based interventions in schools. An electronic literature search was conducted to identify peer-reviewed, published studies in which yoga and a meditative component (breathing practices or meditation) were taught to youths in a school setting. Pilot studies, single cohort, quasi-experimental, and randomized clinical trials were considered. quality was evaluated and summarized. Twelve published studies were identified. Samples for which yoga was implemented as an intervention included youths with autism, intellectual disability, learning disability, and emotional disturbance, as well as typically developing youths. Although effects of participating in school-based yoga programs appeared to be beneficial for the most part, methodological limitations, including lack of randomization, small samples, limited detail regarding the intervention, and statistical ambiguities curtailed the ability to provide definitive conclusions or recommendations. Findings speak to the need for greater methodological rigor and an increased understanding of the mechanisms of success for school-based yoga interventions.

Telerheumatology: A Systematic Review.

PubMed

McDougall, John A; Ferucci, Elizabeth D; Glover, Janis; Fraenkel, Liana

2017-10-01

To identify and summarize the published and gray literature on the use of telemedicine for the diagnosis and management of inflammatory and/or autoimmune rheumatic disease. We performed a registered systematic search (CRD42015025382) for studies using MEDLINE (1946 to July 2015), Embase (1974 to July 2015), Web of Science (1900 to July 2015), and Scopus (1946 to July 2015) databases. We included studies that demonstrated the use of telemedicine for diagnosis and/or management of inflammatory/autoimmune rheumatic disease. Following data extraction, we performed a descriptive analysis. Our literature search identified 1,468 potentially eligible studies. Of these studies, 20 were ultimately included in this review. Studies varied significantly in publication type, quality of evidence, and the reporting of methods. Most demonstrated a high risk of bias. Rheumatoid arthritis was the most commonly studied rheumatic disease (42% of patients). Studies demonstrated conflicting results regarding the effectiveness of telemedicine (18 found it effective, 1 found it effective but possibly harmful, and 1 found it ineffective). A limited number of studies included some component of a cost analysis (n = 6; 16% of patients); all of these found telemedicine to be cost-effective. Studies identified by this systematic review generally found telemedicine to be effective for the diagnosis and management of autoimmune/inflammatory rheumatic disease; however, there is limited evidence to support this conclusion. Further studies are needed to determine the best uses of telemedicine for the diagnosis and management of these conditions. © 2016, American College of Rheumatology.

Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.

PubMed

Houston, Kirsty Anne; George, Elizabeth C; Maitland, Kathryn

2018-05-04

Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty. We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings. We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%). The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group of children to the harm of fluid-bolus therapy.

Barriers to health care for undocumented immigrants: a literature review

PubMed Central

Hacker, Karen; Anies, Maria; Folb, Barbara L; Zallman, Leah

2015-01-01

With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care. PMID:26586971

The diagnostic accuracy of Clinical Dehydration Scale in identifying dehydration in children with acute gastroenteritis: a systematic review.

PubMed

Falszewska, Anna; Dziechciarz, Piotr; Szajewska, Hania

2014-10-01

To systematically update diagnostic accuracy of the Clinical Dehydration Scale (CDS) in clinical recognition of dehydration in children with acute gastroenteritis. Six databases were searched for diagnostic accuracy studies in which population were children aged 1 to 36 months with acute gastroenteritis; index test was the CDS; and reference test was post-illness weight gain. Three studies involving 360 children were included. Limited evidence showed that in high-income countries the CDS provides strong diagnostic accuracy for ruling in moderate and severe (>6%) dehydration (positive likelihood ratio 5.2-6.6), but has limited value for ruling it out (negative likelihood ratio 0.4-0.55). In low-income countries, the CDS has limited value either for ruling moderate or severe dehydration in or out. In both settings, the CDS had limited value for ruling in or out dehydration <3% or dehydration 3% to 6%. The CDS can help assess moderate to severe dehydration in high-income settings. Given the limited data, the evidence should be viewed with caution. © The Author(s) 2014.

42 CFR 73.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (including, but not limited to, bacteria, viruses, fungi, rickettsiae, or protozoa), or infectious substance... product of plants, animals, microorganisms (including, but not limited to, bacteria, viruses, fungi...

42 CFR 73.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (including, but not limited to, bacteria, viruses, fungi, rickettsiae, or protozoa), or infectious substance... product of plants, animals, microorganisms (including, but not limited to, bacteria, viruses, fungi...

42 CFR 73.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (including, but not limited to, bacteria, viruses, fungi, rickettsiae, or protozoa), or infectious substance... product of plants, animals, microorganisms (including, but not limited to, bacteria, viruses, fungi...

Evaluating psycho-educational interventions for informal carers of patients receiving cancer care or palliative care: strengths and limitations of different study designs.

PubMed

Schildmann, Eva K; Higginson, Irene J

2011-06-01

Despite evidence of negative psychological sequelae and unmet needs, there are few evaluated interventions for informal caregivers in cancer and palliative care. The aim of this article is to debate the strengths and limitations of randomized controlled trials (RCTs) and other designs that can be used to evaluate the effectiveness of these interventions. Psycho-educational interventions are used as example for this debate article, as a number of studies of various designs evaluating this type of intervention have been published. Systematic searching in Medline and the bibliography of a relevant systematic review identified five RCTs, one pre-test/post-test study with a control group and six one-group pre-test/post-test studies of psycho-educational interventions for caregivers. The methodological strengths and weaknesses were assessed. RCTs are seen as the gold standard, but can have important limitations in the context of carer intervention research, including biased recruitment and low generalizability, problems with blinding and attrition. Pre-test/post-test studies with a control group may be more feasible and more generalizable. Their crucial limitation is selection bias. Before-after studies are compromised by additional specific biases and therefore are the weakest of all discussed designs. After analysing the strengths and weaknesses of the mentioned study designs, this paper presents strategies to address the limitations of RCTs evaluating psycho-educational interventions for carers in cancer or palliative care. © The Author(s) 2011

Oxygen-limited thermal tolerance is seen in a plastron-breathing insect and can be induced in a bimodal gas exchanger.

PubMed

Verberk, Wilco C E P; Bilton, David T

2015-07-01

Thermal tolerance has been hypothesized to result from a mismatch between oxygen supply and demand. However, the generality of this hypothesis has been challenged by studies on various animal groups, including air-breathing adult insects. Recently, comparisons across taxa have suggested that differences in gas exchange mechanisms could reconcile the discrepancies found in previous studies. Here, we test this suggestion by comparing the behaviour of related insect taxa with different gas exchange mechanisms, with and without access to air. We demonstrate oxygen-limited thermal tolerance in air-breathing adults of the plastron-exchanging water bug Aphelocheirus aestivalis. Ilyocoris cimicoides, a related, bimodal gas exchanger, did not exhibit such oxygen-limited thermal tolerance and relied increasingly on aerial gas exchange with warming. Intriguingly, however, when denied access to air, oxygen-limited thermal tolerance could also be induced in this species. Patterns in oxygen-limited thermal tolerance were found to be consistent across life-history stages in these insects, with nymphs employing the same gas exchange mechanisms as adults. These results advance our understanding of oxygen limitation at high temperatures; differences in the degree of respiratory control appear to modulate the importance of oxygen in setting tolerance limits. © 2015. Published by The Company of Biologists Ltd.

Oxygen-limited thermal tolerance is seen in a plastron-breathing insect and can be induced in a bimodal gas exchanger

PubMed Central

Verberk, Wilco C. E. P.; Bilton, David T.

2015-01-01

ABSTRACT Thermal tolerance has been hypothesized to result from a mismatch between oxygen supply and demand. However, the generality of this hypothesis has been challenged by studies on various animal groups, including air-breathing adult insects. Recently, comparisons across taxa have suggested that differences in gas exchange mechanisms could reconcile the discrepancies found in previous studies. Here, we test this suggestion by comparing the behaviour of related insect taxa with different gas exchange mechanisms, with and without access to air. We demonstrate oxygen-limited thermal tolerance in air-breathing adults of the plastron-exchanging water bug Aphelocheirus aestivalis. Ilyocoris cimicoides, a related, bimodal gas exchanger, did not exhibit such oxygen-limited thermal tolerance and relied increasingly on aerial gas exchange with warming. Intriguingly, however, when denied access to air, oxygen-limited thermal tolerance could also be induced in this species. Patterns in oxygen-limited thermal tolerance were found to be consistent across life-history stages in these insects, with nymphs employing the same gas exchange mechanisms as adults. These results advance our understanding of oxygen limitation at high temperatures; differences in the degree of respiratory control appear to modulate the importance of oxygen in setting tolerance limits. PMID:25964420

Sensitivity to Change and Responsiveness of Four Balance Measures for Community-Dwelling Older Adults

PubMed Central

Latham, Nancy K.; Jette, Alan M.; Wagenaar, Robert C.; Ni, Pengsheng; Slavin, Mary D.; Bean, Jonathan F.

2012-01-01

Background Impaired balance has a significant negative impact on mobility, functional independence, and fall risk in older adults. Although several, well-respected balance measures are currently in use, there is limited evidence regarding the most appropriate measure to assess change in community-dwelling older adults. Objective The aim of this study was to compare floor and ceiling effects, sensitivity to change, and responsiveness across the following balance measures in community-dwelling elderly people with functional limitations: Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment total scale (POMA-T), POMA balance subscale (POMA-B), and Dynamic Gait Index (DGI). Design Retrospective data from a 16-week exercise trial were used. Secondary analyses were conducted on the total sample and by subgroups of baseline functional limitation or baseline balance scores. Methods Participants were 111 community-dwelling older adults 65 years of age or older, with functional limitations. Sensitivity to change was assessed using effect size, standardized response mean, and paired t tests. Responsiveness was assessed using minimally important difference (MID) estimates. Results No floor effects were noted. Ceiling effects were observed on all measures, including in people with moderate to severe functional limitations. The POMA-T, POMA-B, and DGI showed significantly larger ceiling effects compared with the BBS. All measures had low sensitivity to change in total sample analyses. Subgroup analyses revealed significantly better sensitivity to change in people with lower compared with higher baseline balance scores. Although both the total sample and lower baseline balance subgroups showed statistically significant improvement from baseline to 16 weeks on all measures, only the lower balance subgroup showed change scores that consistently exceeded corresponding MID estimates. Limitations This study was limited to comparing 4 measures of balance, and anchor-based methods for assessing MID could not be reported. Conclusions Important limitations, including ceiling effects and relatively low sensitivity to change and responsiveness, were noted across all balance measures, highlighting their limited utility across the full spectrum of the community-dwelling elderly population. New, more challenging measures are needed for better discrimination of balance ability in community-dwelling elderly people at higher functional levels. PMID:22114200

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies.

PubMed

Chao, Tiffany E; Mandigo, Morgan; Opoku-Anane, Jessica; Maine, Rebecca

2016-01-01

Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.

Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

PubMed

Cerqueira, Raphael O; Frey, Benicio N; Leclerc, Emilie; Brietzke, Elisa

2017-12-01

The objective of this study was to evaluate whether Vitex agnus castus is a safe and effective treatment for PMS and premenstrual dysphoric disorder (PMDD) and to discuss the implications of these findings for clinical practice. A systematic review of literature was conducted using PubMed and Scielo databases. The inclusion criteria were randomized controlled trials (RCT) using V. agnus castus in individuals with PMS or PMDD that compared this intervention with placebo or an active comparator and included a description of blinding and dropouts/withdrawals. The search was conducted by two independent investigators who reached consensus on the included trials. A total of eight RCTs were included in this study. Most studies focused on PMS, and the diagnostic criteria of PMS and PMDD changed over the years. Three different preparations of V. agnus castus (VAC) were tested, and there was significant variability in the measurement of treatment outcomes between the studies. Nevertheless, all eight studies were positive for VAC in the treatment of PMS or PMDD and VAC was overall well tolerated. Main limitations were differences in definition of diagnostic criteria, the instruments used as main outcome measures, and different preparations of VAC extracts limit the comparison of results between studies. In conclusion, the RCTs using VAC for treatment of PMS/PMDD suggested that the VAC extract is a safe and efficacious alternative to be considered for the treatment of PMS/PMDD symptoms.

Australia's Unprecedented Future Temperature Extremes Under Paris Limits to Warming

NASA Astrophysics Data System (ADS)

Lewis, Sophie C.; King, Andrew D.; Mitchell, Daniel M.

2017-10-01

Record-breaking temperatures can detrimentally impact ecosystems, infrastructure, and human health. Previous studies show that climate change has influenced some observed extremes, which are expected to become more frequent under enhanced future warming. Understanding the magnitude, as a well as frequency, of such future extremes is critical for limiting detrimental impacts. We focus on temperature changes in Australian regions, including over a major coral reef-building area, and assess the potential magnitude of future extreme temperatures under Paris Agreement global warming targets (1.5°C and 2°C). Under these limits to global mean warming, we determine a set of projected high-magnitude unprecedented Australian temperature extremes. These include extremes unexpected based on observational temperatures, including current record-breaking events. For example, while the difference in global-average warming during the hottest Australian summer and the 2°C Paris target is 1.1°C, extremes of 2.4°C above the observed summer record are simulated. This example represents a more than doubling of the magnitude of extremes, compared with global mean change, and such temperatures are unexpected based on the observed record alone. Projected extremes do not necessarily scale linearly with mean global warming, and this effect demonstrates the significant potential benefits of limiting warming to 1.5°C, compared to 2°C or warmer.

CHAT: development and validation of a computer-delivered, self-report, substance use assessment for adolescents.

PubMed

Lord, Sarah E; Trudeau, Kimberlee J; Black, Ryan A; Lorin, Lucy; Cooney, Elizabeth; Villapiano, Albert; Butler, Stephen F

2011-01-01

The current study was conducted to construct and validate a computer-delivered, multimedia, substance use self-assessment for adolescents. Reliability and validity of six problem dimensions were evaluated in two studies, conducted from 2003 to 2008. Study 1 included 192 adolescents from five treatment settings throughout the United States (N = 142) and two high schools from Greater Boston, Massachusetts (N = 50). Study 2 included 356 adolescents (treatment: N = 260; school: N = 94). The final version of Comprehensive Health Assessment for Teens (CHAT) demonstrated relatively strong psychometric properties. The limitations and implications of this study are noted. This study was supported by an SBIR grant.

Interventions targeted at women to encourage the uptake of cervical screening

PubMed Central

Everett, Thomas; Bryant, Andrew; Griffin, Michelle F; Martin-Hirsch, Pierre PL; Forbes, Carol A; Jepson, Ruth G

2014-01-01

Background World-wide, cervical cancer is the second most common cancer in women. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection. Objectives To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical cancer screening. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical cancer screening. Data collection and analysis Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis. Main results Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. Secondary outcomes including cost data were incompletely documented so evidence was limited. Most trials were at moderate risk of bias. Informed uptake of cervical screening was not reported in any trials. Authors’ conclusions There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear. PMID:21563135

Extending the boundaries of the Declaration of Helsinki: a case study of an unethical experiment in a non-medical setting

PubMed Central

Richter, E.; Barach, P.; Berman, T.; Ben-David, G; Weinberger, Z.

2001-01-01

To examine the ethical issues involved in governmental decisions with potential health risks, we review the history of the decision to raise the interurban speed limit in Israel in light of its impact on road death and injury. In 1993, the Israeli Ministry of Transportation initiated an "experiment" to raise the interurban speed limit from 90 to 100 kph. The "experiment" did not include a protocol and did not specify cut-off points for early termination in the case of adverse results. After the raise in the speed limit, the death toll on interurban roads rose as a result of a sudden increase in speeds and case fatality rates. The committee's decision is a case study in unfettered human experimentation and public health risks when the setting is non-medical and lacks a defined ethical framework. The case study states the case for extending Helsinki type safeguards to experimentation in non-medical settings. Key Words: Declaration of Helsinki • human experimentation • speed limit PMID:11314157

7 CFR 331.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... microorganism (including, but not limited to, bacteria, viruses, fungi, rickettsiae, or protozoa), or infectious... material or product of plants, animals, microorganisms (including, but not limited to, bacteria, viruses...

Study protocol for a randomized controlled trial of telephone-delivered cognitive behavior therapy compared with befriending for treating depression and anxiety in older adults with COPD.

PubMed

Doyle, Colleen; Dunt, David; Ames, David; Fearn, Marcia; You, Emily Chuanmei; Bhar, Sunil

2016-01-01

COPD is an umbrella term to describe chronic lung diseases that cause limitations in lung airflow, including emphysema and chronic bronchitis. The prevalence of depression and anxiety in people with COPD is high, although these comorbidities are often undiagnosed, untreated, or undertreated. There is a need to identify efficacious treatments for depression and anxiety in people with COPD. Cognitive behavior therapy (CBT) for the treatment of anxiety and depression has a strong evidence base. There has been some success delivering this treatment over the telephone in limited studies. The aim of this study is to evaluate the efficacy of both telephone-administered CBT and befriending on outcomes for patients with diagnosed COPD who have at least mild levels of depression and/or anxiety. The protocol described in this paper is of a pragmatic randomized controlled trial comparing eight sessions of telephone CBT to an active social control, referred to as befriending. Primary outcome measures will include depression and anxiety symptoms, and secondary outcome measures will include quality of life, self-efficacy, and COPD symptom severity. Participants' satisfaction with the intervention and therapeutic alliance will also be assessed. Measures will be taken pre- and postdelivery of the intervention and again at 8 weeks following the intervention. People with COPD often have limitations to their mobility because of their breathlessness. They are often already attending many medical appointments and could be reluctant to attend for face-to-face psychological treatment. The results of this study should identify the relative efficacy of CBT delivered over the telephone to this population, which, if successful, may be a cost-effective and more palatable alternative to face-to-face treatment of depression or anxiety for this population.

Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia.

PubMed

Porter, Joanne E; Miller, Nareeda; Giannis, Anita; Coombs, Nicole

2017-07-01

Family Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. One rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. Seventeen adult presentations (Metro n=9, Rural n=8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. During 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effect of visceral osteopathic manual therapy applications on pain, quality of life and function in patients with chronic nonspecific low back pain.

PubMed

Tamer, Seval; Öz, Müzeyyen; Ülger, Özlem

2017-01-01

The efficacy of osteopathic manual therapy (OMT) applications on chronic nonspecific low back pain (LBP) has been demonstrated. However, visceral applications, which are an important part of OMT techniques, have not been included in those studies. The study's objective was to determine the effect of OMT including visceral applications on the function and quality of life (QoL) in patients with chronic nonspecific LBP. The study was designed with a simple method of block randomization. Thirty-nine patients with chronic nonspecific LBP were included in the study. OMT group consisted of 19 patients to whom OMT and exercise methods were applied. The visceral osteopathic manual therapy (vOMT) group consisted of 20 patients to whom visceral applications were applied in addition to the applications carried out in the other group. Ten sessions were performed over a two-week period. Pain (VAS), function (Oswestry Index) and QoL (SF-36) assessments were carried out before the treatment and on the sixth week of treatment. Both of the treatments were found to be effective on pain and function, physical function, pain, general health, social function of the QoL sub-parameter. vOMT was effective on all sub-QoL parameters (p<0.05). Comparing the groups, it was determined that the energy and physical limitations of the QoL scores in vOMT were higher (p< 0.05). Visceral applications on patients with non-specific LBP gave positive results together with OMT and exercise methods. We believe that visceral fascial limitations, which we think cause limitations and pain in the lumbar segment, should be taken into consideration.

The application of system dynamics modelling to environmental health decision-making and policy - a scoping review.

PubMed

Currie, Danielle J; Smith, Carl; Jagals, Paul

2018-03-27

Policy and decision-making processes are routinely challenged by the complex and dynamic nature of environmental health problems. System dynamics modelling has demonstrated considerable value across a number of different fields to help decision-makers understand and predict the dynamic behaviour of complex systems in support the development of effective policy actions. In this scoping review we investigate if, and in what contexts, system dynamics modelling is being used to inform policy or decision-making processes related to environmental health. Four electronic databases and the grey literature were systematically searched to identify studies that intersect the areas environmental health, system dynamics modelling, and decision-making. Studies identified in the initial screening were further screened for their contextual, methodological and application-related relevancy. Studies deemed 'relevant' or 'highly relevant' according to all three criteria were included in this review. Key themes related to the rationale, impact and limitation of using system dynamics in the context of environmental health decision-making and policy were analysed. We identified a limited number of relevant studies (n = 15), two-thirds of which were conducted between 2011 and 2016. The majority of applications occurred in non-health related sectors (n = 9) including transportation, public utilities, water, housing, food, agriculture, and urban and regional planning. Applications were primarily targeted at micro-level (local, community or grassroots) decision-making processes (n = 9), with macro-level (national or international) decision-making to a lesser degree. There was significant heterogeneity in the stated rationales for using system dynamics and the intended impact of the system dynamics model on decision-making processes. A series of user-related, technical and application-related limitations and challenges were identified. None of the reported limitations or challenges appeared unique to the application of system dynamics within the context of environmental health problems, but rather to the use of system dynamics in general. This review reveals that while system dynamics modelling is increasingly being used to inform decision-making related to environmental health, applications are currently limited. Greater application of system dynamics within this context is needed before its benefits and limitations can be fully understood.

Systematic Review of Integrated Medical and Psychiatric Self-Management Interventions for Adults with Serious Mental Illness

PubMed Central

Whiteman, Karen L.; Naslund, John A.; DiNapoli, Elizabeth A.; Bruce, Martha L.; Bartels, Stephen J.

2016-01-01

Objective Adults with serious mental illness are disproportionately affected by medical comorbidity, earlier onset of disease, and premature mortality. Integrated self-management interventions have been developed to address both medical and psychiatric illnesses. This systematic review aimed to: review the evidence of the effect of self-management interventions targeting both medical and psychiatric illnesses and evaluate the potential for implementation. Methods Databases including CINAHL, Cochrane Central, Ovid Medline, PsycINFO, and Web of Science were searched for articles published between 1946 and July 2015. Studies evaluating integrated medical and psychiatric self-management interventions for adults with schizophrenia spectrum or mood disorders and medical comorbidity were included. Results Fifteen studies reported on nine interventions (i.e., nine randomized control trials, six pre/post designs). Most studies demonstrated feasibility, acceptability, and preliminary effectiveness; however, clinical effectiveness could not be established in most of the studies due to methodological limitations. Factors identified that may deter implementation included operating costs, impractical length of the intervention, and the workforce needs of these interventions. Conclusions Integrated medical and psychiatric illness self-management interventions appear feasible and acceptable, with high potential for clinical effectiveness. However, implementation considerations were rarely considered in intervention development, contributing to limited uptake and reach in real-world settings. PMID:27301767

Use of active video gaming in children with neuromotor dysfunction: a systematic review.

PubMed

Hickman, Robbin; Popescu, Lisa; Manzanares, Robert; Morris, Brendan; Lee, Szu-Ping; Dufek, Janet S

2017-09-01

To examine current evidence on use of active video gaming (AVG) to improve motor function in children with movement disorders including cerebral palsy, developmental coordination disorder, and Down syndrome. Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL were searched. Included papers studied the use of AVG for improving movement-related outcomes in these populations. Parameters studied included health condition, strength of evidence, AVG delivery methods, capacity for individualizing play, outcomes addressed, effectiveness for achieving outcomes, and challenges/limitations. The 20 extracted articles varied in quality. Studies involved children with six different conditions using AVG in clinical, home, or school settings for 49 different motor outcomes. Dosage varied in frequency and duration. Choice of games played and difficulty level were therapist determined (n=6) or child controlled (n=14). The most common study limitations were small sample sizes and difficulty individualizing treatment. All articles showed improvement in outcomes with AVG, although differences were not consistently significant compared with conventional therapy. Heterogeneity of measurement tools and target outcomes prevented meta-analysis or development of formal recommendations. However, AVG is feasible and shows potential for improving outcomes in this population. Additional investigations of dosing variables, utility as a home supplement to clinical care, and outcomes with larger sample sizes are merited. © 2017 Mac Keith Press.

Reporting Multiple Individual Injuries in Studies of Team Ball Sports: A Systematic Review of Current Practice.

PubMed

Fortington, Lauren V; van der Worp, Henk; van den Akker-Scheek, Inge; Finch, Caroline F

2017-06-01

To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies. The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports. A systematic search of three online databases for articles published before 2016. Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was >1 consecutive calendar year/season; and (3) individuals were the unit of analysis. Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries. Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete. Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions.

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis

PubMed Central

Ragab, Ehab Mohamed

2009-01-01

Background Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. Patients and methods This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. Results In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. Conclusion Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF. PMID:20033696

Prenatal risk factors for Tourette Syndrome: a systematic review

PubMed Central

2014-01-01

Background Tourette Syndrome (TS) appears to be an inherited disorder, although genetic abnormalities have been identified in less than 1% of patients, and the mode of inheritance is uncertain. Many studies have investigated environmental factors that might contribute to the onset and severity of tics and associated comorbidities such as obsessive compulsive disorder (OCD) and attention deficit hyperactive disorder (ADHD). A systematic review and qualitative analysis were performed to provide a broad view of the association between pre- and perinatal factors and TS. Methods The Medline, Embase and PsycINFO databases were searched using terms specific to Tourette’s syndrome and keywords such as “pregnancy”, “prenatal”, “perinatal”, “birth” and “neonatal”. Studies were limited to studies on human subjects published in English or French through October 2012. Results 22 studies were included. Studies were of limited methodological quality, with most samples derived from specialty clinics, and most exposures ascertained retrospectively. The majority of the results for demographic factors of parents, including age, education, socioeconomic status, and marital status, revealed no significant association with the onset of TS, or the presence of comorbidity. Many factors were reported to be significantly associated with the onset of TS, the presence of comorbidity and symptom severity, but the most consistently reported factors were maternal smoking and low birth weight. Conclusions There are few studies evaluating the relationship between pre and perinatal events and TS, and existing studies have major limitations, including the use of clinic rather than epidemiologically derived samples, retrospective data collection on pre and perinatal events and multiple hypothesis testing without appropriate statistical correction. The mechanism by which prenatal and perinatal adversities could lead to TS onset or symptom severity is unknown, but may be related to changes in the dopaminergic system as a result of early brain injury. PMID:24479407

Cycle O(CY1991) NLS trade studies and analyses report. Book 2, part 2: Propulsion

NASA Technical Reports Server (NTRS)

Cronin, R.; Werner, M.; Bonson, S.; Spring, R.; Houston, R.

1992-01-01

This report documents the propulsion system tasks performed in support of the National Launch System (NLS) Cycle O preliminary design activities. The report includes trades and analyses covering the following subjects: (1) Maximum Tank Stretch Study; (2) No LOX Bleed Performance Analysis; (3) LOX Bleed Trade Study; (4) LO2 Tank Pressure Limits; (5) LOX Tank Pressurization System Using Helium; (6) Space Transportation Main Engine (STME) Heat Exchanger Performance; (7) LH2 Passive Recirculation Performance Analysis; (8) LH2 Bleed/Recirculation Study; (9) LH2 Tank Pressure Limits; and (10) LH2 Pressurization System. For each trade study an executive summary and a detailed trade study are provided. For the convenience of the reader, a separate section containing a compilation of only the executive summaries is also provided.

A review of traffic-related air pollution exposure assessment studies in the developing world.

PubMed

Han, Xianglu; Naeher, Luke P

2006-01-01

Exposure assessment studies in the developing world are important. Although recent years have seen an increasing number of traffic-related pollution exposure studies, exposure assessment data on this topic are still limited. Differences among measuring methods and a lack of strict quality control in carrying out exposure assessment make it difficult to generalize and compare findings between studies. In this article, exposure assessment studies carried out in the developing world on several traffic-related air pollutants are reviewed. These pollutants include particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO(2)), volatile organic compounds (VOCs), and polycyclic aromatic hydrocarbons (PAHs). In addition, it discusses advantages and disadvantages of various monitoring methods (ambient fixed-site monitoring, microenvironment monitoring, and personal exposure assessment using portable samplers) for these pollutants in exposure assessment studies. Also included in this paper is a brief introduction of standards for these pollutants in ambient air or in occupational settings established by the United States Environmental Protection Agency (USEPA), the United States Occupational Safety and Health Administration (OSHA) and the World Health Organization (WHO). The review ends with a summary of the limitations and gaps in recent studies and suggestions for future research in the developing world.

The Tanzanian trauma patients' prehospital experience: a qualitative interview-based study.

PubMed

Kuzma, Kristin; Lim, Andrew George; Kepha, Bernard; Nalitolela, Neema Evelyne; Reynolds, Teri A

2015-04-27

We sought to characterise the prehospital experience of Tanzanian trauma patients, and identify barriers and facilitators to implement community-based emergency medical systems (EMS). Our study was conducted in the emergency department of an urban national referral hospital in Tanzania. A convenience sample of 34 adult trauma patients, or surrogate family members, presenting or referred to an urban referral emergency department in Tanzania for treatment of injury, participated in the study. Participation in semistructured, iteratively developed interviews until saturation of responses was reached. A grounded theory-based approach to qualitative analysis was used to identify recurrent themes. We characterised numerous deficiencies within the existing clinic-to-hospital referral network, including missed/delayed diagnoses, limited management capabilities at pre-referral facilities and interfacility transfer delays. Potential barriers to EMS implementation include patient financial limitations and lack of insurance, limited public infrastructure and resources, and the credibility of potential first aid responders. Potential facilitators of EMS include communities' tendency to pool resources, individuals' trust of other community members to be first aid responders, and faith in community leaders to organise EMS response. Participants expressed a strong desire to learn first aid. The composite themes generated by the data suggest that there are myriad structural, financial, institutional and cultural barriers to the implementation of a formal prehospital system. However, our analysis also revealed potential facilitators to a first-responder system that takes advantage of close-knit local communities and the trust of recognised leaders in society. The results suggest favourable acceptability for community-based response by trained lay people. There is significant opportunity for care improvements with short trainings and low-cost supply planning. Further research looking at the effects of delay on outcomes in this population is needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

40 CFR 423.11 - Specialized definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... not included. (c) The term chemical metal cleaning waste means any wastewater resulting from the cleaning of any metal process equipment with chemical compounds, including, but not limited to, boiler tube... chemical cleaning compounds] any metal process equipment including, but not limited to, boiler tube...

40 CFR 423.11 - Specialized definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... not included. (c) The term chemical metal cleaning waste means any wastewater resulting from the cleaning of any metal process equipment with chemical compounds, including, but not limited to, boiler tube... chemical cleaning compounds] any metal process equipment including, but not limited to, boiler tube...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2012 CFR

2012-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2014 CFR

2014-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis.

PubMed

Yuan, Jing; Zhang, Ling-Lin; Lu, Yu-Jie; Han, Meng-Yao; Yu, Ai-Hua; Cai, Xiao-Jun

2017-11-28

To evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular hole-induced retinal detachment (MHRD). Pubmed, Cochrane Library, and Embase were systematically searched for studies that compared ILM peeling with inverted ILM flap technique for macular hole-induced retinal detachment. The primary outcomes are the rate of retinal reattachment and the rate of macular hole closure 6 months later after initial surgery, the secondary outcome is the postoperative best-corrected visual acuity (BCVA) 6 months later after initial surgery. Four studies that included 98 eyes were selected. All the included studies were retrospective comparative studies. The preoperative best-corrected visual acuity was equal between ILM peeling and inverted ILM flap technique groups. It was indicated that the rate of retinal reattachment (odds ratio (OR) = 0.14, 95% confidence interval (CI):0.03 to 0.69; P = 0.02) and macular hole closure (OR = 0.06, 95% CI:0.02 to 0.19; P < 0.00001) after initial surgery was higher in the group of vitrectomy with inverted ILM flap technique than that in the group of vitrectomy with ILM peeling. However, there was no statistically significant difference in postoperative best-corrected visual acuity (mean difference (MD) 0.18 logarithm of the minimum angle of resolution; 95% CI -0.06 to 0.43 ; P = 0.14) between the two surgery groups. Compared with ILM peeling, vitrectomy with inverted ILM flap technique resulted significantly higher of the rate of retinal reattachment and macular hole closure, but seemed does not improve postoperative best-corrected visual acuity.

[Limiting a Medline/PubMed query to the "best" articles using the JCR relative impact factor].

PubMed

Avillach, P; Kerdelhué, G; Devos, P; Maisonneuve, H; Darmoni, S J

2014-12-01

Medline/PubMed is the most frequently used medical bibliographic research database. The aim of this study was to propose a new generic method to limit any Medline/PubMed query based on the relative impact factor and the A & B categories of the SIGAPS score. The entire PubMed corpus was used for the feasibility study, then ten frequent diseases in terms of PubMed indexing and the citations of four Nobel prize winners. The relative impact factor (RIF) was calculated by medical specialty defined in Journal Citation Reports. The two queries, which included all the journals in category A (or A OR B), were added to any Medline/PubMed query as a central point of the feasibility study. Limitation using the SIGAPS category A was larger than the when using the Core Clinical Journals (CCJ): 15.65% of PubMed corpus vs 8.64% for CCJ. The response time of this limit applied to the entire PubMed corpus was less than two seconds. For five diseases out of ten, limiting the citations with the RIF was more effective than with the CCJ. For the four Nobel prize winners, limiting the citations with the RIF was more effective than the CCJ. The feasibility study to apply a new filter based on the relative impact factor on any Medline/PubMed query was positive. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Central nervous system medication use and incident mobility limitation in community elders: the Health, Aging, and Body Composition study.

PubMed

Boudreau, Robert M; Hanlon, Joseph T; Roumani, Yazan F; Studenski, Stephanie A; Ruby, Christine M; Wright, Rollin M; Hilmer, Sarah N; Shorr, Ronald I; Bauer, Douglas C; Simonsick, Eleanor M; Newman, Anne B

2009-10-01

To evaluate whether CNS medication use in older adults was associated with a higher risk of future incident mobility limitation. This 5-year longitudinal cohort study included 3055 participants from the health, aging and body composition (Health ABC) study who were well-functioning at baseline. CNS medication use (benzodiazepine and opioid receptor agonists, antipsychotics, and antidepressants) was determined yearly (except year 4) during in-home or in-clinic interviews. Summated standardized daily doses (low, medium, and high) and duration of CNS drug use were computed. Incident mobility limitation was operationalized as two consecutive self-reports of having any difficulty walking 1/4 mile or climbing 10 steps without resting every 6 months after baseline. Multivariable Cox proportional hazard analyses were conducted adjusting for demographics, health behaviors, health status, and common indications for CNS medications. Each year at least 13.9% of participants used a CNS medication. By year 6, overall 49% had developed incident mobility limitation. In multivariable models, CNS medication users compared to never users showed a higher risk for incident mobility limitation (adjusted hazard ratio (Adj. HR) 1.28; 95% confidence interval (CI) 1.12-1.47). Similar findings of increased risk were seen in analyses examining dose- and duration-response relationships. CNS medication use is independently associated with an increased risk of future incident mobility limitation in community dwelling elderly. Further studies are needed to determine the impact of reducing CNS medication exposure on mobility problems. 2009 John Wiley & Sons, Ltd.

Hypothesised mechanisms of swimming-related death: a systematic review.

PubMed

Asplund, Chad A; Creswell, Lawrence L

2016-11-01

Recent reports from triathlon and competitive open-water swimming indicate that these events have higher rates of death compared with other forms of endurance sport. The potential causal mechanism for swimming-related death is unclear. To examine available studies on the hypothesised mechanisms of swimming-related death to determine the most likely aetiologies. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (1950 to present) were searched, yielding 1950 potential results, which after title and citation reviews were reduced to 83 possible reports. Studies included discussed mechanisms of death during swimming in humans, and were Level 4 evidence or higher. A total of 17 studies (366 total swimmers) were included for further analysis: 5 investigating hyperthermia/hypothermia, 7 examining cardiac mechanisms and responses, and 5 determining the presence of pulmonary edema. The studies provide inconsistent and limited-quality or disease-oriented evidence that make definitive conclusions difficult. The available evidence is limited but may suggest that cardiac arrhythmias are the most likely aetiology of swimming-related death. While symptoms of pulmonary edema may occur during swimming, current evidence does not support swimming-induced pulmonary edema as a frequent cause of swimming-related death, nor is there evidence to link hypothermia or hyperthermia as a causal mechanism. Further higher level studies are needed. 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/.

Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand

PubMed Central

Murray, Jordan K.; DiStefano, Anthony S.; Yang, Joshua S.; Wood, Michele M.

2016-01-01

Migrant populations face increased HIV vulnerabilities, including limited access to antiretroviral therapy (ART). Civil conflict in Myanmar has displaced thousands of people from the minority Shan ethnic group into northern Thailand, where they bear a disproportionate HIV burden. To identify barriers and facilitators of ART use in this population, we conducted a rapid ethnographic assessment and case study with a clinical sample of Shan migrants receiving treatment for HIV in a district hospital in Chiang Mai, Thailand, Thai nurses providing their care, and health care administrators (n = 23). Barriers included fears of arrest and deportation, communication difficulties, perceived social marginalization, limited HIV knowledge, and lack of finances. Facilitating factors included hospital-based migrant registration services and community outreach efforts involving support group mobilization, referral practices, and radio broadcasts. These findings provided a contextualized account to inform policies, community interventions, and nursing practice to increase treatment access for minority migrant groups. PMID:27188762

Predation of Ladybird Beetles (Coleoptera: Coccinellidae) by Amphibians

PubMed Central

Sloggett, John J.

2012-01-01

Studies of predation of ladybird beetles (Coccinellidae) have focused on a limited number of predator taxa, such as birds and ants, while other potential predators have received limited attention. I here consider amphibians as predators of ladybirds. Published amphibian gut analyses show that ladybirds are quite often eaten by frogs and toads (Anura), with recorded frequencies reaching up to 15% of dietary items. Salamanders (Caudata) eat ladybirds less frequently, probably as their habits less often bring them into contact with the beetles. Amphibians do not appear to be deleteriously affected by the potentially toxic alkaloids that ladybirds possess. Amphibians, especially frogs and toads, use primarily prey movement as a release cue to attack their food; it is thus likely that their ability to discriminate against ladybirds and other chemically defended prey is limited. Because of this poor discriminatory power, amphibians have apparently evolved non-specific resistance to prey defensive chemicals, including ladybird alkaloids. Although amphibian-related ladybird mortality is limited, in certain habitats it could outweigh mortality from more frequently studied predators, notably birds. The gut analyses from the herpetological literature used in this study, suggest that in studying predation of insects, entomologists should consider specialized literature on other animal groups. PMID:26466621

Predation of Ladybird Beetles (Coleoptera: Coccinellidae) by Amphibians.

PubMed

Sloggett, John J

2012-07-18

Studies of predation of ladybird beetles (Coccinellidae) have focused on a limited number of predator taxa, such as birds and ants, while other potential predators have received limited attention. I here consider amphibians as predators of ladybirds. Published amphibian gut analyses show that ladybirds are quite often eaten by frogs and toads (Anura), with recorded frequencies reaching up to 15% of dietary items. Salamanders (Caudata) eat ladybirds less frequently, probably as their habits less often bring them into contact with the beetles. Amphibians do not appear to be deleteriously affected by the potentially toxic alkaloids that ladybirds possess. Amphibians, especially frogs and toads, use primarily prey movement as a release cue to attack their food; it is thus likely that their ability to discriminate against ladybirds and other chemically defended prey is limited. Because of this poor discriminatory power, amphibians have apparently evolved non-specific resistance to prey defensive chemicals, including ladybird alkaloids. Although amphibian-related ladybird mortality is limited, in certain habitats it could outweigh mortality from more frequently studied predators, notably birds. The gut analyses from the herpetological literature used in this study, suggest that in studying predation of insects, entomologists should consider specialized literature on other animal groups.

Health and social care professionals' attitudes to interprofessional working and interprofessional education: A literature review.

PubMed

O'Carroll, Veronica; McSwiggan, Linda; Campbell, Martin

2016-01-01

The healthcare setting is a rich learning environment for students to experience interprofessional working (IPW) and interprofessional education (IPE). However, opportunities for IPE are limited, and student experiences of effective IPW are varied. This raises the question of how IPW and IPE are valued by health or social care professionals. A search of the literature was carried out to identify studies of health and social care staff attitudes to IPW and IPE. This review provides a summary of the main factors found to influence attitudes and the strengths and limitations of these studies. Professional background and prior IPE experience were identified as the influencing factors for which there is most evidence. The main limitations of the studies accessed included a focus on the value of IPE for staff, as opposed to students, and a limited number of studies considering the relationship between attitudes to IPW and the value placed on IPE. It is important that health and social care professionals lead by example by working collaboratively and providing students with opportunities for IPE. Identifying the variables influencing attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for students learning in the healthcare setting.

Vibration safety limits for magnetic resonance elastography.

PubMed

Ehman, E C; Rossman, P J; Kruse, S A; Sahakian, A V; Glaser, K J

2008-02-21

Magnetic resonance elastography (MRE) has been demonstrated to have potential as a clinical tool for assessing the stiffness of tissue in vivo. An essential step in MRE is the generation of acoustic mechanical waves within a tissue via a coupled mechanical driver. Motivated by an increasing volume of human imaging trials using MRE, the objectives of this study were to audit the vibration amplitude of exposure for our IRB-approved human MRE studies, to compare these values to a conservative regulatory standard for vibrational exposure and to evaluate the applicability and implications of this standard for MRE. MRE displacement data were examined from 29 MRE exams, including the liver, brain, kidney, breast and skeletal muscle. Vibrational acceleration limits from a European Union directive limiting occupational exposure to whole-body and extremity vibrations (EU 2002/44/EC) were adjusted for time and frequency of exposure, converted to maximum displacement values and compared to the measured in vivo displacements. The results indicate that the vibrational amplitudes used in MRE studies are below the EU whole-body vibration limit, and the EU guidelines represent a useful standard that could be readily accepted by Institutional Review Boards to define standards for vibrational exposures for MRE studies in humans.

Vibration safety limits for magnetic resonance elastography

PubMed Central

Ehman, E C; Rossman, P J; Kruse, S A; Sahakian, A V; Glaser, K J

2010-01-01

Magnetic resonance elastography (MRE) has been demonstrated to have potential as a clinical tool for assessing the stiffness of tissue in vivo. An essential step in MRE is the generation of acoustic mechanical waves within tissue via a coupled mechanical driver. Motivated by an increasing volume of human imaging trials using MRE, the objectives of this study were to audit the vibration amplitude of exposure for our IRB-approved human MRE studies, to compare these values to a conservative regulatory standard for vibrational exposure, and to evaluate the applicability and implications of this standard for MRE. MRE displacement data were examined from 29 MRE exams, including the liver, brain, kidney, breast, and skeletal muscle. Vibrational acceleration limits from a European Union directive limiting occupational exposure to whole-body and extremity vibrations (EU 2002/44/EC) were adjusted for time and frequency of exposure, converted to maximum displacement values, and compared to the measured in vivo displacements. The results indicate that the vibrational amplitudes used in MRE studies are below the EU whole-body vibration limit and the EU guidelines represent a useful standard that could be readily accepted by Institutional Review Boards to define standards for vibrational exposures for MRE studies in humans. PMID:18263949

Real-time teleophthalmology versus face-to-face consultation: A systematic review.

PubMed

Tan, Irene J; Dobson, Lucy P; Bartnik, Stephen; Muir, Josephine; Turner, Angus W

2017-08-01

Introduction Advances in imaging capabilities and the evolution of real-time teleophthalmology have the potential to provide increased coverage to areas with limited ophthalmology services. However, there is limited research assessing the diagnostic accuracy of face-to-face teleophthalmology consultation. This systematic review aims to determine if real-time teleophthalmology provides comparable accuracy to face-to-face consultation for the diagnosis of common eye health conditions. Methods A search of PubMed, Embase, Medline and Cochrane databases and manual citation review was conducted on 6 February and 7 April 2016. Included studies involved real-time telemedicine in the field of ophthalmology or optometry, and assessed diagnostic accuracy against gold-standard face-to-face consultation. The revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool assessed risk of bias. Results Twelve studies were included, with participants ranging from four to 89 years old. A broad number of conditions were assessed and include corneal and retinal pathologies, strabismus, oculoplastics and post-operative review. Quality assessment identified a high or unclear risk of bias in patient selection (75%) due to an undisclosed recruitment processes. The index test showed high risk of bias in the included studies, due to the varied interpretation and conduct of real-time teleophthalmology methods. Reference standard risk was overall low (75%), as was the risk due to flow and timing (75%). Conclusion In terms of diagnostic accuracy, real-time teleophthalmology was considered superior to face-to-face consultation in one study and comparable in six studies. Store-and-forward image transmission coupled with real-time videoconferencing is a suitable alternative to overcome poor internet transmission speeds.

A systematic review of the anti-obesity and weight lowering effect of ginger (Zingiber officinale Roscoe) and its mechanisms of action.

PubMed

Ebrahimzadeh Attari, Vahideh; Malek Mahdavi, Aida; Javadivala, Zeinab; Mahluji, Sepideh; Zununi Vahed, Sepideh; Ostadrahimi, Alireza

2018-04-01

Recently, the beneficial effects of ginger on obesity is taken into consideration. Albeit, it seems that the anti-obesity effect of ginger and its mechanism of action has not yet been reviewed. Therefore, the aim of this study was to systematically review the effect of Zingiber officinale Roscoe on obesity management. Databases including PubMed, Scopus, Google scholar, and Science Direct were searched from 1995 until May 2017 using the definitive keywords. Searching was limited to articles with English language. All of the relevant human and animal studies and also in vitro studies were included. Review articles, abstract in congress, and also other varieties of ginger were excluded. Eligibility of included articles were evaluated by 3 reviewers, which also extracted data. Articles were critically assessed individually for possible risk of bias. Twenty-seven articles (6 in vitro, 17 animal, and 4 human studies) were reviewed. Most of the experimental studies supported the weight lowering effect of ginger extract or powder in obese animal models, whereas the results of the available limited clinical studies showed no changes or slight changes of anthropometric measurements and body composition in subjects with obesity. Ginger could modulate obesity through various potential mechanisms including increasing thermogenesis, increasing lipolysis, suppression of lipogenesis, inhibition of intestinal fat absorption, and controlling appetite. This review article provides some convincing evidence to support the efficacy of ginger in obesity management and demonstrates the importance of future clinical trials. Copyright © 2017 John Wiley & Sons, Ltd.

Litter decomposition, N2-fixer abundance, and microbial dynamics govern tropical dry forest recovery to land use change

NASA Astrophysics Data System (ADS)

Trierweiler, A.; Powers, J. S.; Xu, X.; Gei, M. G.; Medvigy, D.

2017-12-01

As one of the most threatened tropical biomes, Seasonal Dry Tropical Forests (TDF) have undergone extensive land-use change. However, some areas are undergoing recovery into secondary forests. Despite their broad distribution (42% of tropical forests), they are under-studied compared to wet tropical forests and our understanding of their biogeochemical cycling and belowground processes are limited. Here, we use models along with field measurements to improve our understanding of nutrient cycling and limitation in secondary TDFs. We ask (1) Is there modeling evidence that tropical dry forests can become nutrient limited? (2) What are the most important mechanisms employed to avoid nutrient limitation? (3) How might climate change alter biogeochemical cycling and nutrient limitation in recovering TDF? We use a new version of the Ecosystem Demography (ED2) model that has been recently parameterized for TDFs and incorporates a range of plant functional groups (including deciduousness and N2-fixation) and multiple resource constraints (carbon, nitrogen, phosphorus, and water). In the model, plants then can dynamically adjust their carbon allocation and nutrient acquisition strategies using N2-fixing bacteria and mycorrhizal fungi according to the nutrient limitation status. We ran the model for a nutrient gradient of field sites in Costa Rica and explored the sensitivity of nutrient limitation to key mechanisms including litter respiration, N resorption, N2-fixation, and overflow respiration. Future runs will evaluate how CO2 and climate change affect recovering TDFs. We found increasing nutrient limitation across the nutrient gradient of sites. Nitrogen limitation dominated the nutrient limitation signal. In the model, forest litter accumulation was negatively correlated with site fertility in Costa Rican forests. Our sensitivity analyses indicate that N2-fixer abundance, decomposition rates, and adding more explicit microbial dynamics are key factors in overcoming this limitation. These insights improve our understanding of how TDFs function and are especially relevant to the management of recovering secondary TDFs by highlighting potential bottlenecks in the recovery process.

WETLAND PARTNERS: CITIZEN MONITORING SHADOW STUDY

EPA Science Inventory

The products include: 1) Collect vegetation, macroinvertebrate and water quality data at "essential" habitat sites. 2) Evaluate the capacity of citizen monitors to gather valid and viable data. 3) Understand the limitations of volunteer-gathered data. 4) Assess the the effective...

The impact of Nanocomposites across their Lifecycle

EPA Science Inventory

There are limited systematic comprehensive studies on the aging of different composites, release of nanoparticles, and identifying their different forms. The polymer type, the aging conditions including UV dose and moisture affect the amount of the release of nanofillers (nanopar...

Impacts of allowing exceptions to spring load restrictions.

DOT National Transportation Integrated Search

2011-03-01

This literature search includes citations from Minnesota on the costs and benefits of enforcing or removing spring : load limits, as well as one study from Norway on the same topic. Several provinces in Canada have taken a : different approachredu...

Challenges and opportunities for minority owned trucking firms under affirmative actions : a case study.

DOT National Transportation Integrated Search

2012-01-01

Despite the steady growth and the introduction of "set-aside" programs/Affirmative Actions, minority owned firms often faced stiff business challenges. These challenges include a lack of business networking opportunities, limited financial resources,...

Overeating styles and adiposity among multiethnic youth

USDA-ARS?s Scientific Manuscript database

Reasons for inconsistent associations between overeating styles and adiposity among youth may include differences in effects by age, gender, or ethnicity; failure to control for social desirability of response; or adiposity measurement limitations. This study examined the relationship between overea...

An evaluation of bituminized fiber pipe culverts.

DOT National Transportation Integrated Search

1970-01-01

This report describes the results to date in a limited study, including laboratory tests and field evaluations, of the suitability of bituminized fiber pipe for use as highway culverts. Crushing strength data obtained from three-edge bearing tests in...

Understanding plant response to nitrogen limitation for the improvement of crop nitrogen use efficiency.

PubMed

Kant, Surya; Bi, Yong-Mei; Rothstein, Steven J

2011-02-01

Development of genetic varieties with improved nitrogen use efficiency (NUE) is essential for sustainable agriculture. Generally, NUE can be divided into two parts. First, assimilation efficiency involves nitrogen (N) uptake and assimilation and second utilization efficiency involves N remobilization. Understanding the mechanisms regulating these processes is crucial for the improvement of NUE in crop plants. One important approach is to develop an understanding of the plant response to different N regimes, especially to N limitation, using various methods including transcription profiling, analysing mutants defective in their normal response to N limitation, and studying plants that show better growth under N-limiting conditions. One can then attempt to improve NUE in crop plants using the knowledge gained from these studies. There are several potential genetic and molecular approaches for the improvement of crop NUE discussed in this review. Increased knowledge of how plants respond to different N levels as well as to other environmental conditions is required to achieve this.

Remembering complex objects in visual working memory: do capacity limits restrict objects or features?

PubMed

Hardman, Kyle O; Cowan, Nelson

2015-03-01

Visual working memory stores stimuli from our environment as representations that can be accessed by high-level control processes. This study addresses a longstanding debate in the literature about whether storage limits in visual working memory include a limit to the complexity of discrete items. We examined the issue with a number of change-detection experiments that used complex stimuli that possessed multiple features per stimulus item. We manipulated the number of relevant features of the stimulus objects in order to vary feature load. In all of our experiments, we found that increased feature load led to a reduction in change-detection accuracy. However, we found that feature load alone could not account for the results but that a consideration of the number of relevant objects was also required. This study supports capacity limits for both feature and object storage in visual working memory. PsycINFO Database Record (c) 2015 APA, all rights reserved.

Assessing the 16 hour intern shift limit: Results of a multi-center, mixed-methods study of residents and faculty in general surgery.

PubMed

Coverdill, James E; Alseidi, Adnan; Borgstrom, David C; Dent, Daniel L; Dumire, Russell; Fryer, Jonathan; Hartranft, Thomas H; Holsten, Steven B; Nelson, M Timothy; Shabahang, Mohsen M; Sherman, Stanley R; Termuhlen, Paula M; Woods, Randy J; Mellinger, John D

2018-02-01

The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts. Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items. Semi-structured interviews conducted with 39 residents and 43 faculty were analyzed for main themes. Few view the intern shift limit as a positive change. Views differ (P < 0.01) for residents and faculty on 12 of 15 item means and across PGY levels on all 15 items. Interviews indicate concerns about losses with respect to education and professional development, difficulties when interns transition to their second year, and how intern shifts may be more fatiguing than expected. The 16-h limit on intern shifts has remained a source of concern and an educational challenge for residents and faculty. Copyright © 2017 Elsevier Inc. All rights reserved.

Limited-preparation CT colonography in frail elderly patients: a feasibility study.

PubMed

Keeling, Aoife N; Slattery, Michael M; Leong, Sum; McCarthy, Eoghan; Susanto, Maja; Lee, Michael J; Morrin, Martina M

2010-05-01

Full colonic preparation can be onerous and may be poorly tolerated in frail elderly patients. The purpose of this study was to prospectively assess the image quality and diagnostic yield of limited-preparation CT colonography (CTC) in elderly patients with suspected colorectal cancer who were deemed medically unfit or unsuitable for colonoscopy. A prospective study was performed of 67 elderly patients with reduced functional status referred for CTC. Participants were prescribed a limited bowel preparation consisting of a low-residue diet for 3 days, 1 L of 2% oral diatrizoate meglumine (Gastrografin) 24 hours before CTC, and 1 L of 2% oral Gastrografin over the 2 hours immediately before CTC. No cathartic preparation was administered. All colonic segments were graded from 1 to 5 for image quality (1, unreadable; 2, poor; 3, equivocal; 4, good; 5, excellent) and reader confidence. Clinical and conventional colonoscopy follow-up findings were documented, and all colonic and extracolonic pathologic findings were documented. Overall image quality and reader confidence in the evaluation of the colon was rated good or excellent in 84% of the colonic segments. Colonic abnormalities were identified in 12 patients (18%), including four colonic tumors, two polyps, and seven colonic strictures. Incidental extraintestinal findings were detected in 43 patients (64%), including nine patients with lesions radiologically consistent with malignancy. Limited-preparation low-dose CTC is a feasible and useful minimally invasive technique with which to evaluate the colon and exclude gross pathology (mass lesions and polyps > 1 cm) in elderly patients with diminished performance status, yielding good to excellent image quality.

An update of the appraisal of the accuracy and utility of cervical discography in chronic neck pain.

PubMed

Onyewu, Obi; Manchikanti, Laxmaiah; Falco, Frank J E; Singh, Vijay; Geffert, Stephanie; Helm, Standiford; Cohen, Steven P; Hirsch, Joshua A

2012-01-01

Chronic neck pain represents a significant public health problem. Despite high prevalence rates, there is a lack of consensus regarding the causes or treatments for this condition. Based on controlled evaluations, the cervical intervertebral discs, facet joints, and atlantoaxial joints have all been implicated as pain generators. Cervical provocation discography, which includes disc stimulation and morphological evaluation, is occasionally used to distinguish a painful disc from other potential sources of pain. Yet in the absence of validation and controlled outcome studies, the procedure remains mired in controversy. A systematic review of the diagnostic accuracy of cervical discography. To systematically evaluate and update the diagnostic accuracy of cervical discography. The available literature on cervical discography was reviewed. Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. However, studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. A total of 41 manuscripts were considered for accuracy and utility of cervical discography in chronic neck pain. There were 23 studies evaluating accuracy of discography. There were 3 studies meeting inclusion criteria for assessing the accuracy and prevalence of discography, with a prevalence of 16% to 53%. Based on modified Agency for Healthcare Research and Quality (AHRQ) accuracy evaluation and United States Preventive Services Task Force (USPSTF) level of evidence criteria, this systematic review indicates the strength of evidence is limited for the diagnostic accuracy of cervical discography. Limitations include a paucity of literature, poor methodological quality, and very few studies performed utilizing International Association for the Study of Pain (IASP) criteria. There is limited evidence for the diagnostic accuracy of cervical discography. Nevertheless, in the absence of any other means to establish a relationship between pathology and symptoms, cervical provocation discography may be an important evaluation tool in certain contexts to identify a subset of patients with chronic neck pain secondary to intervertebral disc disorders. Based on the current systematic review, cervical provocation discography performed according to the IASP criteria with control disc(s), and a minimum provoked pain intensity of 7 of 10, or at least 70% reproduction of worst pain (i.e. worst spontaneous pain of 7 = 7 x 70% = 5), may be a useful tool for evaluating chronic pain and cervical disc abnormalities in a small proportion of patients.

Groundstory vegetation response to different thinning intensities in a minor stream bottom in Mississippi: a preliminary analysis

Treesearch

Brent R. Frey; Ellen M. Boerger

2015-01-01

Groundstory vegetation typically accounts for the greatest proportion of plant diversity in temperate forests, representing a critical structural component and mediating numerous ecosystem processes, including tree regeneration. The effects of thinning on groundstory vegetation have received limited study in bottomland hardwood stands. This study investigated...

Examining Factors Influencing Attrition at a Small, Private, Selective Liberal Arts College

ERIC Educational Resources Information Center

Gansemer-Topf, Ann M.; Zhang, Yi; Beatty, Cameron C.; Paja, Scott

2014-01-01

Despite a diverse body of literature on college student retention, studies focusing on small, private, selective liberal arts colleges are limited. This study utilized a mixed methodology beginning with logistic regression analyses and followed with a qualitative inquiry that included interviews with students who had not persisted. While variables…

A DIRECTORY OF COMMUNITY WAGE SURVEYS, 1948-JUNE 1965.

ERIC Educational Resources Information Center

Bureau of Labor Statistics (DOL), Washington, DC.

IN 1948 THE BUREAU OF LABOR STATISTICS INSTITUTED A PROGRAM OF SURVEYS IN WHICH OCCUPATIONS COMMON TO A VARIETY OF MANUFACTURING AND NONMANUFACTURING INDUSTRIES WERE STUDIED ON A COMMUNITYWIDE BASIS. THE EARLIER STUDIES WERE LIMITED TO OFFICE WORKERS BUT WERE EXPANDED BY 1951 TO INCLUDE PROFESSIONAL AND TECHNICAL, MAINTENANCE AND POWER PLANT, AND…

The Three Domains of Disgust Scale: Factor Structure, Psychometric Properties, and Conceptual Limitations

ERIC Educational Resources Information Center

Olatunji, Bunmi O.; Adams, Thomas; Ciesielski, Bethany; David, Bieke; Sarawgi, Shivali; Broman-Fulks, Joshua

2012-01-01

This investigation examined the measurement properties of the Three Domains of Disgust Scale (TDDS). Principal components analysis in Study 1 (n = 206) revealed three factors of Pathogen, Sexual, and Moral Disgust that demonstrated excellent reliability, including test-retest over 12 weeks. Confirmatory factor analyses in Study 2 (n = 406)…

Multidimensional Social Control Variables as Predictors of Drunkenness among French Adolescents

ERIC Educational Resources Information Center

Begue, Laurent; Roche, Sebastian

2009-01-01

Background: Previous studies of the determinants of drunkenness among youth investigated the contribution of a limited range of variables measuring social control. For the first time in France, this study including 1295 participants aged 14-19 years aimed at assessing the relative contribution of a broad range of multidimensional variables…

Preliminary Analysis of Interteaching's Frequent Examinations Component in the Community College Classroom

ERIC Educational Resources Information Center

Felderman, Theresa A.

2014-01-01

Interteaching has shown to be an effective alternative to traditional lecture in a number of studies, but thorough analyses of its components, including frequent exams, is limited. Research suggests that increasing the frequency of exams may improve student learning. This study assessed the effectiveness of interteaching's frequent exams component…

Toward exploratory analysis of diversity unified across fields of study: an information visualization approach

Treesearch

Tuan Pham; Julia Jones; Ronald Metoyer; Frederick Colwell

2014-01-01

The study of the diversity of multivariate objects shares common characteristics and goals across disciplines, including ecology and organizational management. Nevertheless, subject-matter experts have adopted somewhat separate diversity concepts and analysis techniques, limiting the potential for sharing and comparing across disciplines. Moreover, while large and...

Young Adult Books: Helping to Prepare Teachers for Augmentative Alternative Communication

ERIC Educational Resources Information Center

Donne, Vicki

2016-01-01

Many educators have reported limited education in their training or preparation programs on assistive technology and communication devices. The present study reported on action research conducted in this area using book study groups. Participants included graduate students enrolled in a face-to-face course required within their special education…

Sounds Affecting the Moments of Stuttering in Multilingualism: A Case Study

ERIC Educational Resources Information Center

Morrish, Taryn; Nesbitt, Amy; le Roux, Mia; Zsilavecz, Ursula; van der Linde, Jeannie

2017-01-01

Research involving stuttering in multilingual individuals is limited. Speech-language therapists face the challenge of treating a diverse client base, which includes multilingual individuals. The aim of this study was to examine the stuttering moments across English, Afrikaans, and German in a multilingual speaker. A single multilingual adult with…

Narrative synthesis of equine-assisted psychotherapy literature: Current knowledge and future research directions.

PubMed

Lee, Ping-Tzu; Dakin, Emily; McLure, Merinda

2016-05-01

Equine-assisted psychotherapy (EAP) is an innovative emerging approach to mental health treatment. This narrative synthesis explores the current state of knowledge and areas for future research in EAP. Specifically reviewed are qualitative and quantitative empirical studies, including both articles published in peer-reviewed journals and research presented in theses and dissertations. We selected 24 studies for final inclusion in this study, dating between 2005 and 2013, and including the first EAP empirical research completed in 2005. Four of these studies are peer-reviewed journal articles, while 20 are master's theses or doctoral dissertations. The reviewed qualitative research provides initial evidence for the value of EAP for enhancing adolescents' communication and relationship skills. The reviewed experimental and quasi-experimental research provides initial evidence for the value of EAP for enhancing children's and adolescents' emotional, social and behavioural functioning. Yet, conclusions about the effectiveness of EAP must still be considered preliminary due to various methodological limitations in the reviewed research. The narrative review describes these methodological limitations and concludes with recommendations for future research. © 2015 John Wiley & Sons Ltd.

Defense Acquisition Research Journal. Volume 23, Number 4, Issue 79, October 2016

DTIC Science & Technology

2016-10-01

the final word on ship design decisions, including critical operational requirements and costs. Kuehn provides a captivating description of how the...requires using material from primary sources, including program documents, policy papers, memoranda, surveys , interviews, etc. Articles are...instrument, • describe the limitations of the research, • ensure results are quantitative and qualitative, • determine if the study can be replicated, and

Electroweak results from the tevatron

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

Wood, D.

1997-01-01

Electroweak results are presented from the CDF and DO experiments based on data collected in recent runs of the Fermilab Tevatron Collider. The measurements include the mass and width of the W boson, the production cross sections of the W and Z bosons, and the W charge asymmetry. Additional results come from studies of events with pairs of electroweak gauge bosons and include limits on anomalous couplings.

Music therapy in an integrated pediatric palliative care program.

PubMed

Knapp, Caprice; Madden, Vanessa; Wang, Hua; Curtis, Charlotte; Sloyer, Phyllis; Shenkman, Elizabeth

National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida's Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents' experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.

Questionnaires Measuring Patients’ Spiritual Needs: A Narrative Literature Review

PubMed Central

Seddigh, Ruohollah; Keshavarz-Akhlaghi, Amir-Abbas; Azarnik, Somayeh

2016-01-01

Context The objective of the present review was to collect published spiritual needs questionnaires and to present a clear image of the research condition of this domain. Evidence Acquisition First, an electronic search was conducted with no limits on time span (until June 2015) or language in the following databases: PubMed, Scopus, Ovid, ProQuest and Google Scholar. All derivations of the keywords religion and spiritual alongside need and its synonyms were included in the search. Researches that introduced new tools was then selected and included in the study. Due to the limited quantity of questionnaires in this domain and with no consideration given to the existence or lack of exact standardization information, all of the questionnaires were included in the final report. Results Eight questionnaires were found: patients spiritual needs assessment scale (PSNAS), spiritual needs inventory (SNI), spiritual interests related to illness tool (SpIRIT), spiritual needs questionnaire (SpNQ), spiritual needs assessment for patients (SNAP), spiritual needs scale (SNS), spiritual care needs inventory (SCNI), and spiritual needs questionnaire for palliative care. Conclusions These questionnaires have been designed from a limited medical perspective and often involve cultural concepts which complicate their cross-cultural applicability. PMID:27284281

A Scoping Review of Social Media Use in Social Work Practice.

PubMed

Chan, Chitat

2016-01-01

The trend of using social media in social work is increasing, but research which systematically reviews and evaluates their uses in actual practice is limited. This article reviews the social work literature to identify the uses, benefits, and limitations of social media in social work practice, and identifies current gaps in the literature to provide recommendations for future social work research. Articles in 64 social work journals published between 2000 and 2014 were screened and analyzed. The included articles (n = 20) were analyzed with particular reference to their level of evidence and ways of social media use. The methodological quality of the studies in this review was low, and this was consistent with the findings of recent systematic reviews of social media use in medical healthcare. The findings initially suggested that social media can potentially contribute to various social work processes, including: service user engagement, need assessment, intervention, and program evaluation. Limitations include lack of quality control, reliability, confidentiality, and privacy. In social work, the dominant research concern in social media is more about professional ethics than their application in intervention. Implications for research and practice are discussed.

Piloted Simulation Assessment of a High-Speed Civil Transport Configuration. [conducted with the Langley six-degree-of-freedom Visual Motion Simulator

NASA Technical Reports Server (NTRS)

Jackson, E. Bruce; Raney, David L.; Glaab, Louis J.; Derry, Stephen D.

2002-01-01

An assessment of a proposed configuration of a high-speed civil transport was conducted by using NASA and industry research pilots. The assessment was conducted to evaluate operational aspects of the configuration from a pilot's perspective, with the primary goal being to identify potential deficiencies in the configuration. The configuration was evaluated within and at the limits of the design operating envelope to determine the suitability of the configuration to maneuver in a typical mission as well as in emergency or envelope-limit conditions. The Cooper-Harper rating scale was used to evaluate the flying qualities of the configuration. A summary flying qualities metric was also calculated. The assessment was performed in the Langley six-degree-of-freedom Visual Motion Simulator. The effect of a restricted cockpit field-of-view due to obstruction by the vehicle nose was not included in this study. Tasks include landings, takeoffs, climbs, descents, overspeeds, coordinated turns, and recoveries from envelope limit excursions. Emergencies included engine failures, loss of stability augmentation, engine inlet unstarts, and emergency descents. Minimum control speeds and takeoff decision, rotation, and safety speeds were also determined.

A framework for the meta-analysis of Bland-Altman studies based on a limits of agreement approach.

PubMed

Tipton, Elizabeth; Shuster, Jonathan

2017-10-15

Bland-Altman method comparison studies are common in the medical sciences and are used to compare a new measure to a gold-standard (often costlier or more invasive) measure. The distribution of these differences is summarized by two statistics, the 'bias' and standard deviation, and these measures are combined to provide estimates of the limits of agreement (LoA). When these LoA are within the bounds of clinically insignificant differences, the new non-invasive measure is preferred. Very often, multiple Bland-Altman studies have been conducted comparing the same two measures, and random-effects meta-analysis provides a means to pool these estimates. We provide a framework for the meta-analysis of Bland-Altman studies, including methods for estimating the LoA and measures of uncertainty (i.e., confidence intervals). Importantly, these LoA are likely to be wider than those typically reported in Bland-Altman meta-analyses. Frequently, Bland-Altman studies report results based on repeated measures designs but do not properly adjust for this design in the analysis. Meta-analyses of Bland-Altman studies frequently exclude these studies for this reason. We provide a meta-analytic approach that allows inclusion of estimates from these studies. This includes adjustments to the estimate of the standard deviation and a method for pooling the estimates based upon robust variance estimation. An example is included based on a previously published meta-analysis. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

77 FR 54927 - Notice of Affirmative Determination Regarding Application for Reconsideration

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... WIPRO LIMITED, WIPRO TECHNOLOGIES, ALLIANCE MANAGERS, INCLUDING WORKERS WORKING REMOTELY IN NEW JERSEY, EAST BRUNSWICK, NEW JERSEY TA-W-81,575A WIPRO LIMITED, WIPRO TECHNOLOGIES, ALLIANCE MANAGERS, INCLUDING... TECHNOLOGIES, ALLIANCE MANAGERS, INCLUDING WORKERS WORKING REMOTELY IN CALIFORNIA, MOUNTAIN VIEW, CALIFORNIA TA...

Nanoparticle accumulation and transcytosis in brain endothelial cell layers

NASA Astrophysics Data System (ADS)

Ye, Dong; Raghnaill, Michelle Nic; Bramini, Mattia; Mahon, Eugene; Åberg, Christoffer; Salvati, Anna; Dawson, Kenneth A.

2013-10-01

The blood-brain barrier (BBB) is a selective barrier, which controls and limits access to the central nervous system (CNS). The selectivity of the BBB relies on specialized characteristics of the endothelial cells that line the microvasculature, including the expression of intercellular tight junctions, which limit paracellular permeability. Several reports suggest that nanoparticles have a unique capacity to cross the BBB. However, direct evidence of nanoparticle transcytosis is difficult to obtain, and we found that typical transport studies present several limitations when applied to nanoparticles. In order to investigate the capacity of nanoparticles to access and transport across the BBB, several different nanomaterials, including silica, titania and albumin- or transferrin-conjugated gold nanoparticles of different sizes, were exposed to a human in vitro BBB model of endothelial hCMEC/D3 cells. Extensive transmission electron microscopy imaging was applied in order to describe nanoparticle endocytosis and typical intracellular localisation, as well as to look for evidence of eventual transcytosis. Our results show that all of the nanoparticles were internalised, to different extents, by the BBB model and accumulated along the endo-lysosomal pathway. Rare events suggestive of nanoparticle transcytosis were also observed for several of the tested materials.The blood-brain barrier (BBB) is a selective barrier, which controls and limits access to the central nervous system (CNS). The selectivity of the BBB relies on specialized characteristics of the endothelial cells that line the microvasculature, including the expression of intercellular tight junctions, which limit paracellular permeability. Several reports suggest that nanoparticles have a unique capacity to cross the BBB. However, direct evidence of nanoparticle transcytosis is difficult to obtain, and we found that typical transport studies present several limitations when applied to nanoparticles. In order to investigate the capacity of nanoparticles to access and transport across the BBB, several different nanomaterials, including silica, titania and albumin- or transferrin-conjugated gold nanoparticles of different sizes, were exposed to a human in vitro BBB model of endothelial hCMEC/D3 cells. Extensive transmission electron microscopy imaging was applied in order to describe nanoparticle endocytosis and typical intracellular localisation, as well as to look for evidence of eventual transcytosis. Our results show that all of the nanoparticles were internalised, to different extents, by the BBB model and accumulated along the endo-lysosomal pathway. Rare events suggestive of nanoparticle transcytosis were also observed for several of the tested materials. Electronic supplementary information (ESI) available: Nanoparticle characterization in relevant media by Dynamic Light Scattering and SDS-PAGE. Transport study for silica nanoparticles across the BBB layer. Additional Electron Microscopy images of cells treated with the different nanoparticles investigated and details of the filters of the transwell systems. See DOI: 10.1039/c3nr02905k

Education and disability trends of older Americans, 2000-2014.

PubMed

Tsai, Yuping

2017-09-01

Trends in disability among older Americans has declined since the 1980s. The study examines whether the trend continues to decline and whether educational disparities exist in the prevalence of functional limitations. I used the 2000-2014 National Health Interview Survey and included adults aged ≥65 years. Functional limitations was measured by three outcomes: the need for help with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) and physical function limitations. I used a set of logistic models to estimate the average annual change rate of functional limitations. I examined whether the annual rate of change differed by education, age group and sex. During 2000-2014, the annual increase rate of ADL limitations was 1.7% (P < 0.001) and was 2.0% (P < 0.001) for physical function limitations; IADL limitation did not change significantly. All subgroups experienced an increase in ADL and physical function limitations except for adults with a more than high school education. The lower-educated group had a higher proportion and a higher annual rate of increase in all outcomes. Increasing trends in chronic conditions may contribute to the increasing trend in functional limitations. The study highlighted a large educational disparity in late-life disability among older Americans. Published by Oxford University Press on behalf of Faculty of Public Health 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Physical limitations in sensors for a drag-free deep space probe

NASA Technical Reports Server (NTRS)

Juillerat, R.

1971-01-01

The inner perturbing forces acting on sensors were analyzed, taking into account the technological limitations imposed on the proof mass position pickup and proof mass acquisition system. The resulting perturbing accelerations are evaluated as a function of the drag-free sensor parameters. Perturbations included gravitational attraction, electrical action, magnetic action, pressure effects, radiation effects, and action of the position pickup. These data can be used to study the laws of guidance, providing an optimization of the space probe as a whole.

A Worked Example of an Application of the Saint Simulation Program.

DTIC Science & Technology

1987-09-01

tApprove foX pu bldc L-- -’ -:,=* J Approved for public release. This work is copyright. Apart from any fair dealing for the purpose of study, research...this network are 1. there are three types of incoming messages, 2. the rate of message generation is varied between two limits and is controlled by the...SAINT controlling program, and 3. the whole scenario is run for a fixed period of time itim limit). These features were included on the basis of

Nuclear physics from lattice QCD at strong coupling.

PubMed

de Forcrand, Ph; Fromm, M

2010-03-19

We study numerically the strong coupling limit of lattice QCD with one flavor of massless staggered quarks. We determine the complete phase diagram as a function of temperature and chemical potential, including a tricritical point. We clarify the nature of the low temperature dense phase, which is strongly bound "nuclear" matter. This strong binding is explained by the nuclear potential, which we measure. Finally, we determine, from this first-principles limiting case of QCD, the masses of "atomic nuclei" up to A=12 "carbon".

Sex between men in the context of HIV: The AIDS 2008 Jonathan Mann Memorial Lecture in health and human rights

PubMed Central

2008-01-01

Gay, bisexual, and other men who have sex with men (MSM) have been among the most affected populations by HIV since the AIDS pandemic was first identified in the 1980s. Evidence from a wide range of studies show that these men remain at the highest risk for HIV acquisition in both developed and developing countries, and that despite three decades of evidence of their vulnerability to HIV, they remain under-served and under-studied. Prevention strategies targeted to MSM are markedly under-funded in most countries, leading to limited access to health services including prevention, treatment, and care. We explore the global epidemic among MSM in 2008, the limited funding available globally to respond to these epidemics, and the human rights contexts and factors which drive HIV spread and limit HIV responses for these men. What do we mean by the term MSM? MSM is a construct from the 1990s that tries to capture behavior and not identity. It was crafted to avoid stigmatizing and culturally laden terms such as gay or bisexual, which do not capture the wide diversity of orientations, sexual practices, cultures, and contextual settings in which male same-sex behaviors occur, and where HIV transmission and acquisition risks are centered. MSM includes both gay and non-gay identified men, bisexual men, and MSM who identify themselves as heterosexuals. It also includes men engaging in "situational" sex between men, such as can occur in prisons, schools, militaries or other environments; and it includes male sex workers who may be of any orientation but are often at very high risk for HIV. MSM may include some biologically male transgender persons, though some do not identify as male. And MSM includes a wide array of traditional and local terms worldwide–with enormous cultural diversity in Asia, Africa, Latin America and elsewhere. We use the term MSM here at its most inclusive. PMID:19108725

A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication

PubMed Central

Hazlett, Diane E; Harrison, Laura; Carroll, Jennifer K; Irwin, Anthea; Hoving, Ciska

2013-01-01

Background There is currently a lack of information about the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals from primary research. Objective To review the current published literature to identify the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals, and identify current gaps in the literature to provide recommendations for future health communication research. Methods This paper is a review using a systematic approach. A systematic search of the literature was conducted using nine electronic databases and manual searches to locate peer-reviewed studies published between January 2002 and February 2012. Results The search identified 98 original research studies that included the uses, benefits, and/or limitations of social media for health communication among the general public, patients, and health professionals. The methodological quality of the studies assessed using the Downs and Black instrument was low; this was mainly due to the fact that the vast majority of the studies in this review included limited methodologies and was mainly exploratory and descriptive in nature. Seven main uses of social media for health communication were identified, including focusing on increasing interactions with others, and facilitating, sharing, and obtaining health messages. The six key overarching benefits were identified as (1) increased interactions with others, (2) more available, shared, and tailored information, (3) increased accessibility and widening access to health information, (4) peer/social/emotional support, (5) public health surveillance, and (6) potential to influence health policy. Twelve limitations were identified, primarily consisting of quality concerns and lack of reliability, confidentiality, and privacy. Conclusions Social media brings a new dimension to health care as it offers a medium to be used by the public, patients, and health professionals to communicate about health issues with the possibility of potentially improving health outcomes. Social media is a powerful tool, which offers collaboration between users and is a social interaction mechanism for a range of individuals. Although there are several benefits to the use of social media for health communication, the information exchanged needs to be monitored for quality and reliability, and the users’ confidentiality and privacy need to be maintained. Eight gaps in the literature and key recommendations for future health communication research were provided. Examples of these recommendations include the need to determine the relative effectiveness of different types of social media for health communication using randomized control trials and to explore potential mechanisms for monitoring and enhancing the quality and reliability of health communication using social media. Further robust and comprehensive evaluation and review, using a range of methodologies, are required to establish whether social media improves health communication practice both in the short and long terms. PMID:23615206

Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults.

PubMed

Steinman, Bernard A; Allen, Susan M; Chen, Jie; Pynoos, Jon

2015-02-01

To test whether limitations in mobility and large-muscle functioning mediate self-reported vision status to increase fall risk among respondents age 65 and above. This study used two waves from the Health and Retirement Study. We conducted binary logistic and negative binomial regression analyses to test indirect paths leading from self-reported vision status to falls, via indices of mobility and large-muscle functioning. Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status. Implications of these findings are discussed including the need for prioritizing improved muscle strength of older men and women with poor vision as a preventive measure against falls. © The Author(s) 2014.

Store owners as potential agents of change: energy drinks in the interior of Alaska.

PubMed

Wojcicki, Janet M; de Schweinitz, Peter

2017-01-01

Childhood obesity disproportionately impacts disadvantaged communities, including Alaska Native children. In part, lack of access to fresh fruits and vegetables and over consumption of sugar sweetened beverages including energy drinks contribute to excessive weight gain in Alaska Native youth. This commentary reports the possibility of storeowners and workers partnering with community members to limit sales of nutrient-poor energy drinks through point-of-sale counselling in rural communities in the interior of Alaska. This model of intervention may be useful to implement in areas where there are limited health workers or others that can serve as health educators. This study reports preliminary evidence from rural Alaska and from other Arctic communities that store workers may effectively improve community health status by limiting or promoting specific products. Storeowners or workers may be helpful partners in the fight against childhood obesity as they are present at the point of sale of high-risk beverages to Alaska Native youth.

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review.

PubMed

Mosnaim, Giselle S; Pappalardo, Andrea A; Resnick, Scott E; Codispoti, Christopher D; Bandi, Sindhura; Nackers, Lisa; Malik, Rabia N; Vijayaraghavan, Vimala; Lynch, Elizabeth B; Powell, Lynda H

2016-01-01

Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Drug delivery systems for ovarian cancer treatment: a systematic review and meta-analysis of animal studies

PubMed Central

Raavé, René; de Vries, Rob B.M.; Massuger, Leon F.; van Kuppevelt, Toin H.

2015-01-01

Current ovarian cancer treatment involves chemotherapy that has serious limitations, such as rapid clearance, unfavorable biodistribution and severe side effects. To overcome these limitations, drug delivery systems (DDS) have been developed to encapsulate chemotherapeutics for delivery to tumor cells. However, no systematic assessment of the efficacy of chemotherapy by DDS compared to free chemotherapy (not in a DDS) has been performed for animal studies. Here, we assess the efficacy of chemotherapy in DDS on survival and tumor growth inhibition in animal studies. We searched PubMed and EMBASE (via OvidSP) to systematically identify studies evaluating chemotherapeutics encapsulated in DDS for ovarian cancer treatment in animal studies. Studies were assessed for quality and risk of bias. Study characteristics were collected and outcome data (survival/hazard ratio or tumor growth inhibition) were extracted and used for meta-analyses. Meta-analysis was performed to identify and explore which characteristics of DDS influenced treatment efficacy. A total of 44 studies were included after thorough literature screening (2,735 studies found after initial search). The risk of bias was difficult to assess, mainly because of incomplete reporting. A total of 17 studies (377 animals) and 16 studies (259 animals) could be included in the meta-analysis for survival and tumor growth inhibition, respectively. In the majority of the included studies chemotherapeutics entrapped in a DDS significantly improved efficacy over free chemotherapeutics regarding both survival and tumor growth inhibition. Subgroup analyses, however, revealed that cisplatin entrapped in a DDS did not result in additional tumor growth inhibition compared to free cisplatin, although it did result in improved survival. Micelles did not show a significant tumor growth inhibition compared to free chemotherapeutics, which indicates that micelles may not be a suitable DDS for ovarian cancer treatment. Other subgroup analyses, such as targeted versus non-targeted DDS or IV versus IP administration route, did not identify specific characteristics of DDS that affected treatment efficacy. This systematic review shows the potential, but also the limitations of chemotherapy by drug delivery systems for ovarian cancer treatment. For future animal research, we emphasize that data need to be reported with ample attention to detailed reporting. PMID:26713240

Childhood Sexual Violence in Indonesia: A Systematic Review.

PubMed

Rumble, Lauren; Febrianto, Ryan Fajar; Larasati, Melania Niken; Hamilton, Carolyn; Mathews, Ben; Dunne, Michael P

2018-01-01

There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.

'A band of brothers'-an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study.

PubMed

Bernthal, Elizabeth M; Draper, H J A; Henning, J; Kelly, J C

2017-06-01

To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments. A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs. Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1. This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand. 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 Effects of Implementing an Online Professional Learning Community for Teachers of Gifted and Talented Courses: An Action Research Study

ERIC Educational Resources Information Center

Mintz, Chelsey A.

2017-01-01

The purpose of this action research study was to examine the effects of implementing an online professional learning community (PLC) designed explicitly for teachers of gifted and talented (GT) English language arts (ELA) courses. The present action research (AR) is a limited mixed design study, including quantitative and qualitative elements, to…

Anterior ischemic optic neuropathy and hematologic malignancy: a systematic review of case reports and case series.

PubMed

Sousa, David Cordeiro; Rodrigues, Filipe Brogueira; Duarte, Gonçalo; Campos, Fátima; Pinto, Filomena; Vaz-Carneiro, A

2016-12-01

Demographic and clinical characteristics associated with nonarteritic anterior ischemic optic neuropathy (NAION) are well described. Patients with hematologic neoplasms may share some of these characteristics, and it may be useful clinically to better understand this set of patients. Our objective is to review systematically the characteristics of patients with both hematologic malignancies and NAION. Systematic review. Patients with NAION diagnosis related in time to a hematologic neoplasm. Data sources for the study included MEDLINE, Web of Science, LILACS, SciELO, and OpenGrey. The study eligibility criteria included case reports and case series. We found 261 records, with 15 studies included plus our case report. A total of 19 patients (8 female) with mean age of 54.6 years (range, 12-87) were analyzed: 37% (7) non-Hodgkin lymphoma; 26% (5) myeloproliferative neoplasms; 21% (4) myelodysplasia; 16% (3) leukemias. The limitations included verification bias, inability to test statistical association between NAION and hematologic neoplasms, the small number of cases, and confounding factors related to medical history and specific interventions in each case limited the robustness of our conclusions. Our results identified the characteristics of patients with NAION and hematologic neoplasms related in time. Additional observational studies may enlighten the importance of looking for evidence of an occult neoplastic disorder in patients presenting with NAION. A prompt diagnosis would be of invaluable significance for the best management, in terms of follow-up and therapeutics. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Auditory Outcomes with Hearing Rehabilitation in Children with Unilateral Hearing Loss: A Systematic Review.

PubMed

Appachi, Swathi; Specht, Jessica L; Raol, Nikhila; Lieu, Judith E C; Cohen, Michael S; Dedhia, Kavita; Anne, Samantha

2017-10-01

Objective Options for management of unilateral hearing loss (UHL) in children include conventional hearing aids, bone-conduction hearing devices, contralateral routing of signal (CROS) aids, and frequency-modulating (FM) systems. The objective of this study was to systematically review the current literature to characterize auditory outcomes of hearing rehabilitation options in UHL. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to January 2016. Manual searches of bibliographies were also performed. Review Methods Studies analyzing auditory outcomes of hearing amplification in children with UHL were included. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Results Of the 249 articles identified, 12 met inclusion criteria. Seven articles solely focused on outcomes with bone-conduction hearing devices. Outcomes favored improved pure-tone averages, speech recognition thresholds, and sound localization in implanted patients. Five studies focused on FM systems, conventional hearing aids, or CROS hearing aids. Limited data are available but suggest a trend toward improvement in speech perception with hearing aids. FM systems were shown to have the most benefit for speech recognition in noise. Studies evaluating CROS hearing aids demonstrated variable outcomes. Conclusions Data evaluating functional and objective auditory measures following hearing amplification in children with UHL are limited. Most studies do suggest improvement in speech perception, speech recognition in noise, and sound localization with a hearing rehabilitation device.

The effectiveness and cost-effectiveness of diversion and aftercare programmes for offenders using class A drugs: a systematic review and economic evaluation.

PubMed

Hayhurst, Karen P; Leitner, Maria; Davies, Linda; Flentje, Rachel; Millar, Tim; Jones, Andrew; King, Carlene; Donmall, Michael; Farrell, Michael; Fazel, Seena; Harris, Rochelle; Hickman, Matthew; Lennox, Charlotte; Mayet, Soraya; Senior, Jane; Shaw, Jennifer

2015-01-01

The societal costs of problematic class A drug use in England and Wales exceed £15B; drug-related crime accounts for almost 90% of costs. Diversion plus treatment and/or aftercare programmes may reduce drug-related crime and costs. To assess the effectiveness and cost-effectiveness of diversion and aftercare for class A drug-using offenders, compared with no diversion. Adult class A drug-using offenders diverted to treatment or an aftercare programme for their drug use. Programmes to identify and divert problematic drug users to treatment (voluntary, court mandated or monitored services) at any point within the criminal justice system (CJS). Aftercare follows diversion and treatment, excluding care following prison or non-diversionary drug treatment. Thirty-three electronic databases and government online resources were searched for studies published between January 1985 and January 2012, including MEDLINE, PsycINFO and ISI Web of Science. Bibliographies of identified studies were screened. The UK Drug Data Warehouse, the UK Drug Treatment Outcomes Research Study and published statistics and reports provided data for the economic evaluation. Included studies evaluated diversion in adult class A drug-using offenders, in contact with the CJS. The main outcomes were drug use and offending behaviour, and these were pooled using meta-analysis. The economic review included full economic evaluations for adult opiate and/or crack, or powder, cocaine users. An economic decision analytic model, estimated incremental costs per unit of outcome gained by diversion and aftercare, over a 12-month time horizon. The perspectives included the CJS, NHS, social care providers and offenders. Probabilistic sensitivity analysis and one-way sensitivity analysis explored variance in parameter estimates, longer time horizons and structural uncertainty. Sixteen studies met the effectiveness review inclusion criteria, characterised by poor methodological quality, with modest sample sizes, high attrition rates, retrospective data collection, limited follow-up, no random allocation and publication bias. Most study samples comprised US methamphetamine users. Limited meta-analysis was possible, indicating a potential small impact of diversion interventions on reducing drug use [odds ratio (OR) 1.68, 95% confidence interval (CI) 1.12 to 2.53 for reduced primary drug use, and OR 2.60, 95% CI 1.70 to 3.98 for reduced use of other drugs]. The cost-effectiveness review did not identify any relevant studies. The economic evaluation indicated high uncertainty because of variance in data estimates and limitations in the model design. The primary analysis was unclear whether or not diversion was cost-effective. The sensitivity analyses indicated some scenarios where diversion may be cost-effective. Nearly all participants (99.6%) in the effectiveness review were American (Californian) methamphetamine users, limiting transfer of conclusions to the UK. Data and methodological limitations mean it is unclear whether or not diversion is effective or cost-effective. High-quality evidence for the effectiveness and cost-effectiveness of diversion schemes is sparse and does not relate to the UK. Importantly this research identified a range of methodological limitations in existing evidence. These highlight the need for research to conceptualise, define and develop models of diversion programmes and identify a core outcome set. A programme of feasibility, pilot and definitive trials, combined with process evaluation and qualitative research is recommended to assess the effectiveness and cost-effectiveness of diversionary interventions in class A drug-using offenders. The National Institute for Health Research Health Technology Assessment programme.

Electronic Reserve--A Staff Development Opportunity.

ERIC Educational Resources Information Center

Smith, Robyn

1997-01-01

The Queensland University of Technology (QUT) Library's experience in developing an electronic reserve service is offered as a case study. Discussion includes the limited access service, technical components, academic community support, lending staff training, usage, copyright, and future scenarios and solutions. (AEF)

7 CFR 400.701 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., unique policy provisions or endorsements, the delivery process of the submission, and the process of... information is based, such data may include, but is not limited to, focus group results, market research studies, qualitative market estimates, effects upon the delivery system or ancillary participants...

7 CFR 400.701 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., unique policy provisions or endorsements, the delivery process of the submission, and the process of... information is based, such data may include, but is not limited to, focus group results, market research studies, qualitative market estimates, effects upon the delivery system or ancillary participants...

7 CFR 400.701 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., unique policy provisions or endorsements, the delivery process of the submission, and the process of... information is based, such data may include, but is not limited to, focus group results, market research studies, qualitative market estimates, effects upon the delivery system or ancillary participants...

7 CFR 400.701 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., unique policy provisions or endorsements, the delivery process of the submission, and the process of... information is based, such data may include, but is not limited to, focus group results, market research studies, qualitative market estimates, effects upon the delivery system or ancillary participants...

Removal of cyanobacteria and cyanotoxins through drinking water treatment-full-scale studies?

EPA Science Inventory

This presentation covers the control of intact cyanobacterial cells through particulate removal processes such as coagulation, sedimentation and filtration. The control of cyanobacterial toxins through oxidation and adsorption processes including, but not limited to, chlorine, oz...

Economic Evaluation of Hospital and Community Pharmacy Services.

PubMed

Gammie, Todd; Vogler, Sabine; Babar, Zaheer-Ud-Din

2017-01-01

To review the international body of literature from 2010 to 2015 concerning methods of economic evaluations used in hospital- and community-based studies of pharmacy services in publicly funded health systems worldwide, their clinical outcomes, and economic effectiveness. The literature search was undertaken between May 2, 2015, and September 4, 2015. Keywords included "health economics" and "evaluation" "assessment" or "appraisal," "methods," "hospital" or "community" or "residential care," "pharmacy" or "pharmacy services" and "cost minimisation analysis" or "cost utility analysis" or "cost effectiveness analysis" or "cost benefit analysis." The databases searched included MEDLINE, PubMed, Google Scholar, Science Direct, Springer Links, and Scopus, and journals searched included PLoS One, PLoS Medicine, Nature, Health Policy, Pharmacoeconomics, The European Journal of Health Economics, Expert Review of Pharmacoeconomics and Outcomes Research, and Journal of Health Economics. Studies were selected on the basis of study inclusion criteria. These criteria included full-text original research articles undertaking an economic evaluation of hospital- or community-based pharmacy services in peer-reviewed scientific journals and in English, in countries with a publicly funded health system published between 2010 and 2015. 14 articles were included in this review. Cost-utility analysis (CUA) was the most utilized measure. Cost-minimization analysis (CMA) was not used by any studies. The limited use of cost-benefit analyses (CBAs) is likely a result of technical challenges in quantifying the cost of clinical benefits, risks, and outcomes. Hospital pharmacy services provided clinical benefits including improvements in patient health outcomes and reductions in adverse medication use, and all studies were considered cost-effective due to meeting a cost-utility (per quality-adjusted life year) threshold or were cost saving. Community pharmacy services were considered cost-effective in 8 of 10 studies. Economic evaluations of hospital and community pharmacy services are becoming increasingly commonplace to enable an understanding of which health care services provide value for money and to inform policy makers as to which services will be cost-effective in light of limited health care resources.

Black hole thermodynamics under the microscope

NASA Astrophysics Data System (ADS)

Falls, Kevin; Litim, Daniel F.

2014-04-01

A coarse-grained version of the effective action is used to study the thermodynamics of black holes, interpolating from largest to smallest masses. The physical parameters of the black hole are linked to the running couplings by thermodynamics, and the corresponding equation of state includes quantum corrections for temperature, specific heat, and entropy. If quantum gravity becomes asymptotically safe, the state function predicts conformal scaling in the limit of small horizon area and bounds on black hole mass and temperature. A metric-based derivation for the equation of state and quantum corrections to the thermodynamical, statistical, and phenomenological definition of entropy are also given. Further implications and limitations of our study are discussed.

Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.

PubMed

de Jongh, Thyra E; Gurol-Urganci, Ipek; Allen, Elizabeth; Zhu, Nina Jiayue; Atun, Rifat

2016-06-01

Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively. 12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis.

PubMed

Asker, Martin; Brooke, Hannah L; Waldén, Markus; Tranaeus, Ulrika; Johansson, Fredrik; Skillgate, Eva; Holm, Lena W

2018-03-26

To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports. Systematic review with best-evidence synthesis. Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017. Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria. Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power. All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports. CRD42015026850. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Barriers and Facilitators to Initiating and Completing Time-Limited Trials in Critical Care.

PubMed

Bruce, Courtenay R; Liang, Cecilia; Blumenthal-Barby, Jennifer S; Zimmerman, Janice; Downey, Andrea; Pham, Linda; Theriot, Lisette; Delgado, Estevan D; White, Douglas

2015-12-01

A time-limited trial is an agreement between clinicians and patients or surrogate decision makers to use medical therapies over a defined period of time to see if the patient improves or deteriorates according to agreed-upon clinical milestones. Although time-limited trials are broadly advocated, there is little empirical evidence of the benefits and risks of time-limited trials, when they are initiated, when and why they succeed or fail, and what facilitates completion of them. Our study objectives were to 1) identify the purposes for which clinicians use time-limited trials and 2) identify barriers and facilitators to initiating and completing time-limited trials. Semistructured interviews: We analyzed interviews using qualitative description with constant comparative techniques. Nine hundred-bed, academic, tertiary hospital in Houston, Texas. Interviewees were from open medical, surgical, neurosurgical, and cardiovascular ICUs. Thirty healthcare professionals were interviewed (nine surgeons, 16 intensivists, three nurse practitioners, and two "other" clinicians). None. Interviewees reported initiating time-limited trials for three different purposes: to prepare surrogates and clinicians for discussion and possible shifts toward comfort-care only therapies, build consensus, and refine prognostic information. The main barriers to initiating time-limited trials involve clinicians' or surrogate decision makers' disagreement on setting a time limit. Barriers to completing time-limited trials include 1) requesting more time; 2) communication breakdowns because of rotating call schedules; and 3) changes in clinical course. Finally, facilitators to completing time-limited trials include 1) having defined goals about what could be achieved during an ICU stay, either framed in narrow, numeric terms or broad goals focusing on achievable activities of daily living; 2) applying time-limited trials in certain types of cases; and 3) taking ownership to ensure completion of the trial. An understanding of barriers and facilitators to initiating and completing time-limited trials is an essential first step toward appropriate utilization of time-limited trials in the ICUs, as well as developing educational or communication interventions with clinicians to facilitate time-limited trial use. We provide practical suggestions on patient populations in whom time-limited trials may be successful, the setting, and clinicians likely to benefit from educational interventions, allowing clinicians to have a fuller sense of when and how to use time-limited trials.

Interventions to build resilience in family caregivers of people living with dementia: a comprehensive systematic review.

PubMed

Petriwskyj, Andrea; Parker, Deborah; O'Dwyer, Siobhan; Moyle, Wendy; Nucifora, Nikki

2016-06-01

Recent studies have indicated that family caregivers of people with dementia have higher rates of depression, anxiety and hopelessness, as well as higher levels of burden, stress and distress. Not all caregivers, however, succumb to the negative effects of caring. Caregivers who are able to recover from, resist or adapt to the physical and psychological demands of caring can be considered "resilient". The objective of this review was to examine the existing evidence regarding interventions for building resilience in family caregivers of people living with dementia. This review considered studies that included family caregivers of people with dementia. Studies investigating interventions to build resilience in family caregivers were considered by the review. For qualitative studies, the phenomena of interest were family caregivers' experiences of the interventions including factors affecting implementation and their subjective experience of outcomes. Studies conducted in any cultural or geographical context and any settings including participants' homes in the community, residential aged care or hospital, medical or allied health practice were considered for inclusion. Quantitative studies incorporating experimental and descriptive study designs and qualitative studies, including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research were considered for inclusion. Quantitative studies were included that contained either objective or subjective outcome measures (or a combination of both). In cases in which proxy measures of resilience were used, only those papers that explicitly related the aims of the intervention and the measurement of outcomes to resilience itself were considered for inclusion. Proxies could include, but were not limited to, self-efficacy, locus of control, perceived burden, psychological wellbeing, strength, coping, positive adjustment and resourcefulness. Qualitative studies were similarly considered for inclusion if they explicitly related the aims of the intervention to resilience. Eleven electronic databases were searched for research studies published in English in or after 1990. Quantitative and qualitative studies selected for retrieval were assessed by two independent reviewers for methodological validity using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Quantitative and qualitative data were extracted from publications included in the review using the standardized data extraction tools from JBI-MAStARI and JBI-QARI. It was not possible to pool quantitative findings for statistical meta-analysis using JBI-MAStARI. Qualitative research findings were too limited to be pooled using the JBI-QARI. The findings are presented in narrative form. The review included three publications reporting one quantitative intervention study and one mixed-method intervention study. There was a lack of available studies and, of the two intervention studies that were identified, neither found any statistically significant change in quantitative measures of resilience. Qualitative data suggested positive impacts of a poetry writing intervention and a positive experience of the intervention. The studies differed in both the nature of the intervention and the way resilience was conceptualized and operationalized. Consequently, it was not possible to offer any recommendations for practice. Implications for research relate to the development of a more comprehensive theory of resilience in family caregivers that can be used to develop and rigorously evaluate reliable and valid measures of resilience in line with that theory. Further, well-designed, sufficiently powered intervention studies informed by theory are needed.

The Association Between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours.

PubMed

Ngai, Ka Ming; Grudzen, Corita R; Lee, Roy; Tong, Vicky Y; Richardson, Lynne D; Fernandez, Alicia

2016-08-01

Language barriers are known to negatively affect many health outcomes among limited English proficiency patient populations, but little is known about the quality of care such patients receive in the emergency department (ED). This study seeks to determine whether limited English proficiency patients experience different quality of care than English-speaking patients in the ED, using unplanned revisit within 72 hours as a surrogate quality indicator. We conducted a retrospective cohort study in an urban adult ED in 2012, with a total of 41,772 patients and 56,821 ED visits. We compared 2,943 limited English proficiency patients with 38,829 English-speaking patients presenting to the ED after excluding patients with psychiatric complaints, altered mental status, and nonverbal states, and those with more than 4 ED visits in 12 months. Two main outcomes-the risk of inpatient admission from the ED and risk of unplanned ED revisit within 72 hours-were measured with odds ratios from generalized estimating equation multivariate models. Limited English proficiency patients were more likely than English speakers to be admitted (32.0% versus 27.2%; odds ratio [OR]=1.20; 95% confidence interval [CI] 1.11 to 1.30). This association became nonsignificant after adjustments (OR=1.04; 95% CI 0.95 to 1.15). Included in the analysis of ED revisit within 72 hours were 32,857 patients with 45,546 ED visits; 4.2% of all patients (n=1,380) had at least 1 unplanned revisit. Limited English proficiency patients were more likely than English speakers to have an unplanned revisit (5.0% versus 4.1%; OR=1.19; 95% CI 1.02 to 1.45). This association persisted (OR=1.24; 95% CI 1.02 to 1.53) after adjustment for potential confounders, including insurance status. We found no difference in hospital admission rates between limited English proficiency patients and English-speaking patients. Yet limited English proficiency patients were 24% more likely to have an unplanned ED revisit within 72 hours, with an absolute difference of 0.9%, suggesting challenges in ED quality of care. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The safety of St John's wort (Hypericum perforatum) in pregnancy and lactation: A systematic review of rodent studies.

PubMed

Avila, Catharine; Whitten, Dawn; Evans, Sue

2018-04-30

Herbal products are popular among women during the perinatal period. St John's wort (SJW), Hypericum perforatum, is a common remedy for mild depression, a problem prevalent in this population. Although the safety of herbal products must be investigated, ethical issues constrain intervention studies in humans. Hence, animal studies often inform clinical decisions. The objective of this study is to systematically review rodent studies assessing the safety of SJW during the perinatal period. A literature search to November 10, 2017, identified 10 rodent studies that met a priori inclusion criteria. Study quality was evaluated according to both the Systematic Review Centre for Laboratory animal Experimentation tool for assessing bias and recommendations for appropriate reporting of herbal medicine research. Significant methodological limitations were found in each of the studies reviewed. These limitations include the lack of botanical verification and omission of extract characterization, inadequate explanation of dosage rationale, and absence of bias limiting protocols. Critical appraisal with contemporary tools indicates that each of the reviewed studies lacks appropriate rigour, rendering the results unreliable. Despite this, these papers are used in the rationale for recommending or contraindicating SJW during pregnancy and lactation. Copyright © 2018 John Wiley & Sons, Ltd.

[Collagen-polyvinylpyrrolidone: a new therapeutic option for treatment of sequelae after radical mastectomy in women with breast cancer. Preliminary study].

PubMed

Ruiz-Eng, Rafael; Montiel-Jarquín, Alvaro; de la Rosa-Pérez, Raúl; López-Colombo, Aurelio; Gómez-Conde, Eduardo; Zamudio-Huerta, Leticia

2010-01-01

Approximately 30% of women who undergo mastectomy without reconstructive treatment due to breast cancer present sequelae. These include paresthesias, keloid healing, hypoesthesia, lymphedema and limitation of the function of the ipsilateral upper extremity. We undertook this study to present the results using collagen-polyvinylpyrrolidone (Clg- Pvp) as treatment for posmastectomy sequelae in women with breast cancer. We conducted a unicentric, longitudinal and prospective clinical trial between August 1, 2007 and July 31, 2008. Included variables were age, lymphedema, limitation of the function of the ipsilateral upper extremity, collapse of the wound, keloid healing, paresthesias, and appearance of the surgical area. The appearance of the surgical area (aesthetic aspect) was evaluated before and 6 months after treatment was initiated. Clg-Pvp was administered weekly for a 6-month period. Seven women were included with a median age of 49 years (range: 40-72 years). One patient (14.28%) presented lymphedema, two patients (28.57%) presented collapse of the wound, two patients (28.57%) had keloid healing, three patients (42.85%) experienced paresthesias, five patients (71.4%) reported pain, and five patients (71.4%) reported limitation of the function of the ipsilateral upper extremity. At the completion of the treatment, aesthetic improvement was statistically significant (p = 0.0020, Mann-Whitney U test). Clinical and aesthetic results are good after application of Clg-Pvp for treating sequelae in women with breast cancer who underwent mastectomy without reconstructive surgery.

Sexual orientation and treatment-seeking for depression in a multilingual worldwide sample

PubMed Central

Rutter, Tara M.; Flentje, Annesa; Dilley, James W.; Barakat, Suzanne; Liu, Nancy H.; Gross, Margaret S.; Muñoz, Ricardo F.; Leykin, Yan

2016-01-01

Background Prior research has found higher rates of mental health problems among sexual minority individuals. We examine treatment-seeking for depression, as well as its relationship with sexual orientation, in a large, multilingual, international sample. Method Participants in an automated, quintilingual internet-based depression screening tool were screened for depression, and completed several background measures, including sexual orientation (with an option to decline to state) and past and current depression treatment seeking. Results 3,695 participants screened positive for current or past depression and responded to the sexual orientation question. Those who declined to state their sexual orientation were far less likely to seek any treatment than individuals endorsing any orientation; they were especially unlikely to seek psychotherapy. Individuals identifying as bisexual sought both psychotherapy and alternative treatments at a higher rate than other groups. An interaction was observed between sexual orientation and gender, such that lesbian women were especially likely to have used psychotherapy. Other variables that emerged as significant predictors of treatment-seeking for depression included age and participant's language. Limitations Limitations include possible misinterpretation of translated terms due to regional differences, and possible limits to generalizability due to this study being conducted on the internet. Conclusions Our results suggest that individuals who decline to state their sexual orientation may be more likely to forgo effective treatments for depression. Further studies of depression service utilization should focus on developing treatment modalities that could better engage sexual minority individuals, especially those who are reluctant to disclose their orientation. PMID:27466746

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other expenditures which are incurred by or allocated to a business unit as a whole. These include, but are not...

Peer review of health research funding proposals: A systematic map and systematic review of innovations for effectiveness and efficiency.

PubMed

Shepherd, Jonathan; Frampton, Geoff K; Pickett, Karen; Wyatt, Jeremy C

2018-01-01

To investigate methods and processes for timely, efficient and good quality peer review of research funding proposals in health. A two-stage evidence synthesis: (1) a systematic map to describe the key characteristics of the evidence base, followed by (2) a systematic review of the studies stakeholders prioritised as relevant from the map on the effectiveness and efficiency of peer review 'innovations'. Standard processes included literature searching, duplicate inclusion criteria screening, study keyword coding, data extraction, critical appraisal and study synthesis. A total of 83 studies from 15 countries were included in the systematic map. The evidence base is diverse, investigating many aspects of the systems for, and processes of, peer review. The systematic review included eight studies from Australia, Canada, and the USA, evaluating a broad range of peer review innovations. These studies showed that simplifying the process by shortening proposal forms, using smaller reviewer panels, or expediting processes can speed up the review process and reduce costs, but this might come at the expense of peer review quality, a key aspect that has not been assessed. Virtual peer review using videoconferencing or teleconferencing appears promising for reducing costs by avoiding the need for reviewers to travel, but again any consequences for quality have not been adequately assessed. There is increasing international research activity into the peer review of health research funding. The studies reviewed had methodological limitations and variable generalisability to research funders. Given these limitations it is not currently possible to recommend immediate implementation of these innovations. However, many appear promising based on existing evidence, and could be adapted as necessary by funders and evaluated. Where feasible, experimental evaluation, including randomised controlled trials, should be conducted, evaluating impact on effectiveness, efficiency and quality.

Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review

PubMed Central

van Mourik, Maaike S M; van Duijn, Pleun Joppe; Moons, Karel G M; Bonten, Marc J M; Lee, Grace M

2015-01-01

Objective Measuring the incidence of healthcare-associated infections (HAI) is of increasing importance in current healthcare delivery systems. Administrative data algorithms, including (combinations of) diagnosis codes, are commonly used to determine the occurrence of HAI, either to support within-hospital surveillance programmes or as free-standing quality indicators. We conducted a systematic review evaluating the diagnostic accuracy of administrative data for the detection of HAI. Methods Systematic search of Medline, Embase, CINAHL and Cochrane for relevant studies (1995–2013). Methodological quality assessment was performed using QUADAS-2 criteria; diagnostic accuracy estimates were stratified by HAI type and key study characteristics. Results 57 studies were included, the majority aiming to detect surgical site or bloodstream infections. Study designs were very diverse regarding the specification of their administrative data algorithm (code selections, follow-up) and definitions of HAI presence. One-third of studies had important methodological limitations including differential or incomplete HAI ascertainment or lack of blinding of assessors. Observed sensitivity and positive predictive values of administrative data algorithms for HAI detection were very heterogeneous and generally modest at best, both for within-hospital algorithms and for formal quality indicators; accuracy was particularly poor for the identification of device-associated HAI such as central line associated bloodstream infections. The large heterogeneity in study designs across the included studies precluded formal calculation of summary diagnostic accuracy estimates in most instances. Conclusions Administrative data had limited and highly variable accuracy for the detection of HAI, and their judicious use for internal surveillance efforts and external quality assessment is recommended. If hospitals and policymakers choose to rely on administrative data for HAI surveillance, continued improvements to existing algorithms and their robust validation are imperative. PMID:26316651

Health information exchanges--Unfulfilled promise as a data source for clinical research.

PubMed

Parker, Carol; Weiner, Michael; Reeves, Mathew

2016-03-01

To determine the use of health information exchange organizations (HIEs) to support and conduct clinical research. This scoping review included US-based studies published between January 2003 and March 2014 that used data from an HIE to address at least one of three categories of research: clinical or epidemiological research, financial evaluation, or utilization of health services. Eligibility was not restricted to research on HIEs. Studies with research questions outside of the evaluation of HIEs themselves were sought. Eighteen articles met final study inclusion criteria from an initial list of 847 hits. Fifteen studies addressed a clinical or epidemiological research question, 6 addressed a financial consideration, and 8 addressed a utilization issue. Considerable overlap was found among the research categories: 13 articles addressed more than one category. Of the eighteen included studies, only two used HIE data to answer a research objective that was NOT specific to HIE use. Research designs were varied and ranged from observational studies, such as cohort and cross-sectional studies, to randomized trials. The 18 articles represent the involvement of a small number of HIEs; 7 of the studies were from a single HIE. This review demonstrates that HIE-provided information is available and used to answer clinical or epidemiological, financial, or utilization-based research questions; however, the majority of the studies using HIE data are done with the primary goal of evaluating the use and impact of HIEs on health care delivery and outcomes. As HIEs mature and become integrated parts of the health care industry, the authors anticipate that fewer studies will be published that describe or validate the role of HIEs, and more will use HIEs as multi-institutional data sources for conducting clinical research and improving health services and clinical outcomes. Articles identified in this review indicate the limited extent that HIE data are being used for clinical research outside of the evaluation of HIEs themselves, as well as the limited number of specific HIEs that are involved in generating published research. Significant barriers exist that prevent HIEs from developing into an invaluable resource for clinical research including technological infrastructure limitations, business processes limiting secondary use of data, and lack of participating provider support. Research to better understand challenges to developing the necessary infrastructure and policies to foster HIE engagement in research would be valuable as HIEs represent an opportunity to engage non-traditional health care provider research partners. Copyright © 2015. Published by Elsevier Ireland Ltd.

Energy savings opportunity survey. FY85 Energy Engineering Analysis Program. Various locations, Eighth US Army, Korea. Final report

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

NONE

1987-03-01

This study was prepared as part of the Engineering Energy Analysis Program (EEAP). The EEAP is a Department of Defense (DOD) program which was initiated in the late 1970`s in response to a Presidential Order. The program`s primary goal is to reduce energy consumption within the DOD thereby curbing dependence on foreign non-renewable energy sources, notably oil. The Energy Engineering Analysis Program (EEAP) is administrated by the U.S. Army Corps of Engineers through the Huntsville Division located in Huntsville, Alabama. The EEAP program effort in Korea has consisted of two major studies. The first study occured in 1981 and consistedmore » of basewide energy studies. The scope for these studies included looking at entire camps. The second effort under the EEAP program in Korea is this study. The scope of work for this study includes a total of 63 buildings located at 19 different camps throughout Korea from Taegu to the DMZ (see Figure 1). This study is properly known as an Energy Savings Opportunity Survey (ESOS). Since an ESOS is limited to examining individual buildings, energy savings projects are limited to the scale and complexity of the buildings within the study.« less

Public reporting in health care: how do consumers use quality-of-care information? A systematic review.

PubMed

Faber, Marjan; Bosch, Marije; Wollersheim, Hub; Leatherman, Sheila; Grol, Richard

2009-01-01

One of the underlying goals of public reporting is to encourage the consumer to select health care providers or health plans that offer comparatively better quality-of-care. To review the weight consumers give to quality-of-care information in the process of choice, to summarize the effect of presentation formats, and to examine the impact of quality information on consumers' choice behavior. The evidence is organized in a theoretical consumer choice model. English language literature was searched in PubMed, the Cochrane Clinical Trial, and the EPOC Databases (January 1990-January 2008). Study selection was limited to randomized controlled trails, controlled before-after trials or interrupted time series. Included interventions focused on choice behavior of consumers in health care settings. Outcome measures referred to one of the steps in a consumer choice model. The quality of the study design was rated, and studies with low quality ratings were excluded. All 14 included studies examine quality information, usually CAHPS, with respect to its impact on the consumer's choice of health plans. Easy-to-read presentation formats and explanatory messages improve knowledge about and attitude towards the use of quality information; however, the weight given to quality information depends on other features, including free provider choice and costs. In real-world settings, having seen quality information is a strong determinant for choosing higher quality-rated health plans. This review contributes to an understanding of consumer choice behavior in health care settings. The small number of included studies limits the strength of our conclusions.

Neuropsychological impairments in panic disorder: a systematic review.

PubMed

O'Sullivan, Kate; Newman, Emily F

2014-01-01

There is a growing body of literature investigating the neuropsychological profile of panic disorder (PD), some of which suggests potential cognitive dysfunction. This paper systematically reviews the existing literature on neuropsychological performance in PD. PsycINFO, EMBASE, MEDLINE and PsycARTICLES databases were searched to identify articles reporting on neuropsychological function in PD published in English during the time period 1980 to March 2012. 14 studies were identified. There was limited support for impairment in short term memory among individuals with PD, although this was not found across all studies. Overall, the reviewed studies did not support the presence of impairment in other areas of cognitive functioning, including executive function, long term memory, visuospatial or perceptual abilities and working memory. Studies with samples of fewer than 15 participants per group were excluded from this review. A limited amount of research has been published on this topic and small sample sizes (under 25 per group) have been used by many studies. Therefore, the current review is based on a small number of studies with limited power. There is limited evidence of specific neuropsychological impairments in participants with PD. Impairments in short term memory warrant further investigation to establish their relevance to clinical practice. Larger sample sizes and appropriate statistical adjustment for multiple comparisons in future studies is highly recommended. Copyright © 2014 Elsevier B.V. All rights reserved.

Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study.

PubMed

Kulmala, Jenni; Hinrichs, Timo; Törmäkangas, Timo; von Bonsdorff, Mikaela B; von Bonsdorff, Monika E; Nygård, Clas-Håkan; Klockars, Matti; Seitsamo, Jorma; Ilmarinen, Juhani; Rantanen, Taina

2014-01-01

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.

A scoping review of rapid review methods.

PubMed

Tricco, Andrea C; Antony, Jesmin; Zarin, Wasifa; Strifler, Lisa; Ghassemi, Marco; Ivory, John; Perrier, Laure; Hutton, Brian; Moher, David; Straus, Sharon E

2015-09-16

Rapid reviews are a form of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a timely manner. Although numerous centers are conducting rapid reviews internationally, few studies have examined the methodological characteristics of rapid reviews. We aimed to examine articles, books, and reports that evaluated, compared, used or described rapid reviews or methods through a scoping review. MEDLINE, EMBASE, the Cochrane Library, internet websites of rapid review producers, and reference lists were searched to identify articles for inclusion. Two reviewers independently screened literature search results and abstracted data from included studies. Descriptive analysis was conducted. We included 100 articles plus one companion report that were published between 1997 and 2013. The studies were categorized as 84 application papers, seven development papers, six impact papers, and four comparison papers (one was included in two categories). The rapid reviews were conducted between 1 and 12 months, predominantly in Europe (58 %) and North America (20 %). The included studies failed to report 6 % to 73 % of the specific systematic review steps examined. Fifty unique rapid review methods were identified; 16 methods occurred more than once. Streamlined methods that were used in the 82 rapid reviews included limiting the literature search to published literature (24 %) or one database (2 %), limiting inclusion criteria by date (68 %) or language (49 %), having one person screen and another verify or screen excluded studies (6 %), having one person abstract data and another verify (23 %), not conducting risk of bias/quality appraisal (7 %) or having only one reviewer conduct the quality appraisal (7 %), and presenting results as a narrative summary (78 %). Four case studies were identified that compared the results of rapid reviews to systematic reviews. Three studies found that the conclusions between rapid reviews and systematic reviews were congruent. Numerous rapid review approaches were identified and few were used consistently in the literature. Poor quality of reporting was observed. A prospective study comparing the results from rapid reviews to those obtained through systematic reviews is warranted.

Interventions to combat or prevent drug counterfeiting: a systematic review.

PubMed

El-Jardali, Fadi; Akl, Elie A; Fadlallah, Racha; Oliver, Sandy; Saleh, Nadine; El-Bawab, Lamya; Rizk, Rana; Farha, Aida; Hamra, Rasha

2015-03-18

Drug counterfeiting has serious public health and safety implications. The objective of this study was to systematically review the evidence on the effectiveness of interventions to combat or prevent drug counterfeiting. We searched multiple electronic databases and the grey literature up to March 2014. Two reviewers completed, in duplicate and independently, the study selection, data abstraction and risk of bias assessment. We included randomised trials, non-randomised studies, and case studies examining any intervention at the health system-level to combat or prevent drug counterfeiting. Outcomes of interest included changes in failure rates of tested drugs and changes in prevalence of counterfeit medicines. We excluded studies that focused exclusively on substandard, degraded or expired drugs, or that focused on medication errors. We assessed the risk of bias in each included study. We reported the results narratively and, where applicable, we conducted meta-analyses. We included 21 studies representing 25 units of analysis. Overall, we found low quality evidence suggesting positive effects of drug registration (OR=0.23; 95% CI 0.08 to 0.67), and WHO-prequalification of drugs (OR=0.06; 95% CI 0.01 to 0.35) in reducing the prevalence of counterfeit and substandard drugs. Low quality evidence suggests that licensing of drug outlets is probably ineffective (OR=0.66; 95% CI 0.41 to 1.05). For multifaceted interventions (including a mix of regulations, training of inspectors, public-private collaborations and legal actions), low quality evidence suggest they may be effective. The single RCT provided moderate quality evidence of no effect of 'two extra inspections' in improving drug quality. Policymakers and stakeholders would benefit from registration and WHO-prequalification of drugs and may also consider multifaceted interventions. Future effectiveness studies should address the methodological limitations of the available evidence. PROSPERO CRD42014009269. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A qualitative evidence synthesis on the management of male obesity.

PubMed

Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Stewart, Fiona; Robertson, Clare; Boyers, Dwayne; Avenell, Alison

2015-10-12

To investigate what weight management interventions work for men, with which men, and under what circumstances. Realist synthesis of qualitative studies. Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches. Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings. 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design. Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Geosynchronous platform definition study. Volume 4, Part 1: Traffic analysis and system requirements for the baseline traffic model

NASA Technical Reports Server (NTRS)

1973-01-01

The traffic analyses and system requirements data generated in the study resulted in the development of two traffic models; the baseline traffic model and the new traffic model. The baseline traffic model provides traceability between the numbers and types of geosynchronous missions considered in the study and the entire spectrum of missions foreseen in the total national space program. The information presented pertaining to the baseline traffic model includes: (1) definition of the baseline traffic model, including identification of specific geosynchronous missions and their payload delivery schedules through 1990; (2) Satellite location criteria, including the resulting distribution of the satellite population; (3) Geosynchronous orbit saturation analyses, including the effects of satellite physical proximity and potential electromagnetic interference; and (4) Platform system requirements analyses, including satellite and mission equipment descriptions, the options and limitations in grouping satellites, and on-orbit servicing criteria (both remotely controlled and man-attended).

Experimental Limiting Oxygen Concentrations for Nine Organic Solvents at Temperatures and Pressures Relevant to Aerobic Oxidations in the Pharmaceutical Industry

PubMed Central

2015-01-01

Applications of aerobic oxidation methods in pharmaceutical manufacturing are limited in part because mixtures of oxygen gas and organic solvents often create the potential for a flammable atmosphere. To address this issue, limiting oxygen concentration (LOC) values, which define the minimum partial pressure of oxygen that supports a combustible mixture, have been measured for nine commonly used organic solvents at elevated temperatures and pressures. The solvents include acetic acid, N-methylpyrrolidone, dimethyl sulfoxide, tert-amyl alcohol, ethyl acetate, 2-methyltetrahydrofuran, methanol, acetonitrile, and toluene. The data obtained from these studies help define safe operating conditions for the use of oxygen with organic solvents. PMID:26622165

Physical Activity and Sarcopenia in the Geriatric Population: A Systematic Review.

PubMed

Lee, Szu-Ying; Tung, Heng-Hsin; Liu, Chieh-Yu; Chen, Liang-Kung

2018-05-01

Sarcopenia is an aging-related health problem in the geriatric population. Sarcopenia reduces muscle mass, muscle strength, and physical performance. Although physical activity is protective against sarcopenia for older adults, there are limited studies in this area. The purpose of this study was to integrate and analyze research on physical activity and sarcopenia in the geriatric population. Studies that assess sarcopenia were searched across electronic databases that included Medline, PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Studies that implemented physical activity-related intervention or research were included. A critical appraisal skills program was used for quality assessment of the selected articles. Study selection and data extraction were counted by 2 independent reviewers. Of the 149 references identified through the database search, 10 studies were included in this systematic review. Seven studies were randomized controlled trials, and 3 were cross-sectional or longitudinal. The results of 8 studies indicated significant improvement in muscle mass, muscle strength, and physical performance through exercise intervention, as determined by long-term observation. Physical activity is an effective protective strategy for sarcopenia. Most studies of older adults exercise intervention indicated that the participants achieved positive results, but maintenance of muscle strength appeared to depend on continuous implementation of certain types of physical activities. A limitation of these 10 reviewed studies was that there was no consistency in the measurement of sarcopenia. Therefore, sarcopenia measurement needs further investigation. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Assessing medical professionalism: A systematic review of instruments and their measurement properties.

PubMed

Li, Honghe; Ding, Ning; Zhang, Yuanyuan; Liu, Yang; Wen, Deliang

2017-01-01

Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments' measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations. A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990-2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument's usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee's criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments. After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar's instrument for nursing students, Nurse Practitioners' Roles and Competencies Scale, and Perceived Faculty Competency Inventory. Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.

Laboratory Reconstructions of Real World Frontal Crash Configurations using the Hybrid III and THOR Dummies and PMHS.

PubMed

Petitjean, Audrey; Lebarbe, Matthieu; Potier, Pascal; Trosseille, Xavier; Lassau, Jean-Pierre

2002-11-01

Load-limiting belt restraints have been present in French cars since 1995. An accident study showed the greater effectiveness in thorax injury prevention using a 4 kN load limiter belt with an airbag than using a 6 kN load limiter belt without airbag. The criteria for thoracic tolerance used in regulatory testing is the sternal deflection for all restraint types, belt and/or airbag restraint. This criterion does not assess the effectiveness of the restraint 4 kN load limiter belt with airbag observed in accidentology. To improve the understanding of thoracic tolerance, frontal sled crashes were performed using the Hybrid III and THOR dummies and PMHS. The sled configuration and the deceleration law correspond to those observed in the accident study. Restraint conditions evaluated are the 6 kN load-limiting belt and the 4 kN load-limiting belt with an airbag. Loads between the occupant and the sled environment were recorded. Various measurements (including thoracic deflections and head, thorax and pelvis accelerations and angular velocities on the dummies) characterize the dummy and PMHS behavior. PMHS anthropometry and injuries were noted. This study presents the test methodology and the results used to evaluate dummy ability to discriminate both restraint types and dummy measurement ability to be representative of thoracic injury risk for all restraint types. The injury results of the PMHS tests showed the same tendency as the accident study. Some of the criteria proposed in the literature did not show a better protection of the 4 kN load limiter belt with airbag restraint, in particular thoracic deflection maxima for both dummies. The four thoracic deflections measured on the THOR and Hybrid III dummies may allow more accurate analysis of the loading pattern and therefore of injury risk.

Low abundance of long-tongued pollinators leads to pollen limitation in four specialized hawkmoth-pollinated plants in the Atlantic Rain forest, Brazil

NASA Astrophysics Data System (ADS)

Amorim, Felipe W.; Wyatt, Graham E.; Sazima, Marlies

2014-11-01

Long-tubed hawkmoth-pollinated species present some of the most remarkable examples of floral specialization depending exclusively on long-tongued hawkmoths for sexual reproduction. Nonetheless, long-tongued hawkmoths do not rely exclusively on specialized plants as nectar sources, which may limit sexual reproduction through pollen limitation. However, very few studies have quantified the level of pollen limitation in plants with highly specialized floral traits in tropical regions. In this context, we studied four sympatric hawkmoth-pollinated species in a highland Atlantic Rain forest and assessed pollen limitation and their dependence on pollinators by analyzing the floral biology, breeding system, pollination mechanisms, and abundance of long-tongued pollinators. We showed that the four species are self-compatible, but are completely dependent on long-tongued hawkmoths to set fruits, and that flower visitation was infrequent in all plant species. Pollen limitation indices ranged from 0.53 to 0.96 showing that fruit set is highly limited by pollen receipt. Long-tongued moths are much less abundant and comprise only one sixth of the hawkmoth fauna. Pollen analyses of 578 sampled moths revealed that hawkmoths visited ca. 80 plant species in the community, but only two of the four species studied. Visited plants included a long-tubed hawkmoth-pollinated species endemic to the lowland forest ca. 15-20 km away from the study site. Specialization index ( H 2 ' = 0.20) showed that community-level interactions between hawkmoths and plants are generalized. We suggest that sexual reproduction of these highly specialized hawkmoth-pollinated species is impaired by competition among plants for pollinators, in conjunction with the low abundance and diversity of long-tongued pollinators.

Design study for a 16x zoom lens system for visible surveillance camera

NASA Astrophysics Data System (ADS)

Vella, Anthony; Li, Heng; Zhao, Yang; Trumper, Isaac; Gandara-Montano, Gustavo A.; Xu, Di; Nikolov, Daniel K.; Chen, Changchen; Brown, Nicolas S.; Guevara-Torres, Andres; Jung, Hae Won; Reimers, Jacob; Bentley, Julie

2015-09-01

*avella@ur.rochester.edu Design study for a 16x zoom lens system for visible surveillance camera Anthony Vella*, Heng Li, Yang Zhao, Isaac Trumper, Gustavo A. Gandara-Montano, Di Xu, Daniel K. Nikolov, Changchen Chen, Nicolas S. Brown, Andres Guevara-Torres, Hae Won Jung, Jacob Reimers, Julie Bentley The Institute of Optics, University of Rochester, Wilmot Building, 275 Hutchison Rd, Rochester, NY, USA 14627-0186 ABSTRACT High zoom ratio zoom lenses have extensive applications in broadcasting, cinema, and surveillance. Here, we present a design study on a 16x zoom lens with 4 groups (including two internal moving groups), designed for, but not limited to, a visible spectrum surveillance camera. Fifteen different solutions were discovered with nearly diffraction limited performance, using PNPX or PNNP design forms with the stop located in either the third or fourth group. Some interesting patterns and trends in the summarized results include the following: (a) in designs with such a large zoom ratio, the potential of locating the aperture stop in the front half of the system is limited, with ray height variations through zoom necessitating a very large lens diameter; (b) in many cases, the lens zoom motion has significant freedom to vary due to near zero total power in the middle two groups; and (c) we discuss the trade-offs between zoom configuration, stop location, packaging factors, and zoom group aberration sensitivity.

Postpartum smoking relapse and becoming a mother.

PubMed

Gaffney, Kathleen F

2006-01-01

To propose an innovative, theoretically-derived conceptual framework for studies of postpartum smoking relapse including concepts of smoking abstinence self-efficacy and becoming a mother. Presentation of an existing research paradigm followed by evidence from intervention research and studies of factors associated with postpartum smoking behavior, leading to a new approach to postpartum smoking relapse. Effectiveness of current interventions to prevent relapse is limited. Variables associated with becoming a mother are missing from studies of postpartum smoking relapse. Context-specific variables that influence a woman's progression through the stages of becoming a mother might include protective or risk factors that should be incorporated into the design of postpartum smoking relapse studies.

Systematic Review of Correlates and Determinants of Physical Activity in Persons With Multiple Sclerosis.

PubMed

Streber, René; Peters, Stefan; Pfeifer, Klaus

2016-04-01

To review the current evidence regarding correlates and determinants of physical activity (PA) in persons with multiple sclerosis (pwMS). PubMed and Scopus (1980 to January 2015) and reference lists of eligible studies. Eligible studies include adults with multiple sclerosis; have a cross-sectional or prospective observational design; or examine the effect of a theory-based intervention trial on PA, including a mediation analysis. Eligible studies also apply a quantitative assessment of PA and correlates or proposed mediators and are published in English or German language. Two reviewers independently evaluated the risk of bias, extracted data, and categorized variables according to the International Classification of Functioning, Disability and Health. Consistency and the direction of associations were evaluated with a semiquantitative approach. Fifty-six publications with data from observational studies and 2 interventional studies provided evidence for 86 different variables. Consistent correlates of PA were the disability level, walking limitations in particular, PA-related self-efficacy, self-regulation constructs, employment status, and educational level. One interventional study provided evidence for a causal relation between self-regulation and PA. However, 59 of the 86 investigated variables in observational studies are based on 1 or 2 study findings, and most results stem from cross-sectional designs. Beside the importance of the general disability level and walking limitations, the results highlight the importance of personal factors (eg, PA-related self-efficacy, self-regulatory constructs, sociodemographic factors). Limitations and implications of the current review are discussed. Research that is more rigorous is needed to better understand what affects PA in pwMS. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Impact of L/D on 90 Degree Sharp-Edge Orifice Flow with Manifold Passage Cross Flow (Preprint)

DTIC Science & Technology

2007-04-30

that are observed by measurement as the flow transitions from non-cavitation to cavitation (turbulent flow), supercavitation , and finally separation in...include inception of cavitation, supercavitation , and separation. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...cavitation to cavitation (turbulent flow), supercavitation , and finally separation in sharp-edge 90 degree orifices. This study includes orifice L/D from

Optimal plateau pressure for patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-analysis with meta-regression.

PubMed

Yasuda, Hideto; Nishimura, Tetsuro; Kamo, Tetsuro; Sanui, Masamitsu; Nango, Eishu; Abe, Takayuki; Takebayashi, Toru; Lefor, Alan Kawarai; Hashimoto, Satoru

2017-05-29

Lower tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS) is a strategy to reduce the plateau pressure and driving pressure to limit ventilator-induced lung injury (VILI). Several randomised controlled trials (RCTs) and meta-analyses showed that limiting both the plateau pressure and the tidal volume decreased mortality, but the optimal plateau pressure to demonstrate a benefit is uncertain. The aim of this systematic review is to investigate the optimal upper limit of plateau pressure in patients with ARDS to prevent VILI and improve clinical outcomes using meta-analysis with and without meta-regression. RCTs comparing two mechanical ventilation strategies will be included, with lower plateau pressure and with higher plateau pressure, among patients with ARDS and acute lung injury. Data sources include MEDLINE via the NCBI Entrez system, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Ichushi, a database of papers in Japanese. Two of three physicians will independently screen trials obtained by search for eligibility, and extract data from included studies onto standardised data recording forms. For each included trial, the risk of bias and the quality of evidence will be evaluated using the Grading of Recommendation Assessment Development and Evaluation system. This study does not require ethical approval. The results of this systematic review and meta-analysis with and without meta-regression will be disseminated through conference presentation and publication in a peer-reviewed journal. CRD42016041924. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementation of mental health parity: lessons from california.

PubMed

Rosenbach, Margo L; Lake, Timothy K; Williams, Susan R; Buck, Jeffrey A

2009-12-01

This article reports the experiences of health plans, providers, and consumers with California's mental health parity law and discusses implications for implementation of the 2008 federal parity law. This study used a multimodal data collection approach to assess the first five years of California's parity implementation (from 2000 to 2005). Telephone interviews were conducted with 68 state-level stakeholders, and in-person interviews were conducted with 77 community-based stakeholders. Six focus groups included 52 providers, and six included 32 consumers. A semistructured interview protocol was used. Interview notes and transcripts were coded to facilitate analysis. Health plans eliminated differential benefit limits and cost-sharing requirements for certain mental disorders to comply with the law, and they used managed care to control costs. In response to concerns about access to and quality of care, the state expanded oversight of health plans, issuing access-to-care regulations and conducting focused studies. California's parity law applied to a limited list of psychiatric diagnoses. Health plan executives said they spent considerable resources clarifying which diagnoses were covered at parity levels and concluded that the limited diagnosis list was unnecessary with managed care. Providers indicated that the diagnosis list had unintended consequences, including incentives to assign a more severe diagnosis that would be covered at parity levels, rather than a less severe diagnosis that would not be covered at such levels. The lack of consumer knowledge about parity was widely acknowledged, and consumers in the focus groups requested additional information about parity. Experiences in California suggest that implementation of the 2008 federal parity law should include monitoring health plan performance related to access and quality, in addition to monitoring coverage and costs; examining the breadth of diagnoses covered by health plans; and mounting a campaign to educate consumers about their insurance benefits.

The clinical effects of Kinesio® Tex taping: A systematic review.

PubMed

Morris, D; Jones, D; Ryan, H; Ryan, C G

2013-05-01

Kinesio(®) Tex tape (KTT) is used in a variety of clinical settings. The purpose of this study was to investigate the effect of KTT from randomized controlled trials (RCTs) in the management of clinical conditions. A systematic literature search of CINAHL; MEDLINE; OVID; AMED; SCIENCE DIRECT; PEDRO; www.internurse.com; SPORT DISCUS; BRITISH NURSING INDEX; www.kinesiotaping.co.uk; www.kinesiotaping.com; COCHRANE CENTRAL REGISTER OF CLINICAL TRIALS; and PROQUEST was performed up to April 2012. The risk of bias and quality of evidence grading was performed using the Cochrane collaboration methodology. Eight RCTs met the full inclusion/exclusion criteria. Six of these included patients with musculoskeletal conditions; one included patients with breast-cancer-related lymphedema; and one included stroke patients with muscle spasticity. Six studies included a sham or usual care tape/bandage group. There was limited to moderate evidence that KTT is no more clinically effective than sham or usual care tape/bandage. There was limited evidence from one moderate quality RCT that KTT in conjunction with physiotherapy was clinically beneficial for plantar fasciitis related pain in the short term; however, there are serious questions around the internal validity of this RCT. There currently exists insufficient evidence to support the use of KTT over other modalities in clinical practice.

Teaching caring and competence: Student transformation during an older adult focused service-learning course.

PubMed

Brown, Karen M; Bright, Leslie M

2017-11-01

Innovative teaching strategies develop nurses' knowledge, skills, and attitudes while simultaneously integrating the art of caring and transforming attitudes toward adults over age 65. The study's purpose was to explore students' experiences and attitudes toward older adults with cognitive and/or physical limitations as well as the effects on students' knowledge and skills during a baccalaureate nursing, course which included a service-learning experience. Service-learning synthesizes meaningful community service, academic instruction, and reflection. Participants included baccalaureate students enrolled in a service-learning nursing course focused on older adults. This retrospective, qualitative, phenomenological study used reflective journals and an online survey to explore baccalaureate nursing students' experiences toward older adults with cognitive and/or physical limitations. Themes included initial attitudes of anticipation, apprehension, anxiety, and ageist stereotypes. Final attitudes included a "completely changed perspective" of caring, compassion, and respect indicative of a rewarding, "life-changing" experience. Participants cited enhanced learning, especially in the areas of patient-centered care, collaboration, communication, advocacy, empathy, assessment skills, and evidence-based practice. This innovative teaching strategy led to transformed attitudes toward older adults, reduced fear of older adult populations, an increased desire to work with older adults, and the ability to form a transpersonal, caring relationship while enhancing nursing knowledge and skills. Copyright © 2017 Elsevier Ltd. All rights reserved.

Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants.

PubMed

Morse, Diane S; Silverstein, Jennifer; Thomas, Katherine; Bedel, Precious; Cerulli, Catherine

2015-12-01

Therapeutic diversion courts seek to address justice-involved participants' underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives. Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff ( n = 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health. Numerous systemic factors impacted women's access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options. By understanding the social determinant of health for women in drug treatment court and stakeholder's perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.