Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Bu, Stella; Charles, Cathy; Gafni, Amiram; Fisher, Alana; Juraskova, Ilona

2016-07-01

Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Involving Patients and Families in the Analysis of Suicides, Suicide Attempts, and Other Sentinel Events in Mental Healthcare: A Qualitative Study in The Netherlands.

PubMed

Bouwman, Renée; de Graaff, Bert; de Beurs, Derek; van de Bovenkamp, Hester; Leistikow, Ian; Friele, Roland

2018-05-29

Involving patients and families in mental healthcare is becoming more commonplace, but little is known about how they are involved in the aftermath of serious adverse events related to quality of care (sentinel events, including suicides). This study explores the role patients and families have in formal processes after sentinel events in Dutch mental healthcare. We analyzed the existing policies of 15 healthcare organizations and spoke with 35 stakeholders including patients, families, their counselors, the national regulator, and professionals. Respondents argue that involving patients and families is valuable to help deal with the event emotionally, provide additional information, and prevent escalation. Results indicate that involving patients and families is only described in sentinel event policies to a limited extent. In practice, involvement consists mostly of providing aftercare and sharing information about the event by providers. Complexities such as privacy concerns and involuntary admissions are said to hinder involvement. Respondents also emphasize that involvement should not be obligatory and stress the need for patients and families to be involved throughout the process of treatment. There is no one-size-fits-all strategy for involving patients and families after sentinel events. The first step seems to be early involvement during treatment process itself.

The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

PubMed

Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

2010-01-01

Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

Parental Involvement and Child and Adolescent Eating Disorders: Perspectives from Residents in Psychiatry, Pediatrics, and Family Medicine

PubMed Central

Marcon, Tamara Davidson; Girz, Laura; Stillar, Amanda; Tessier, Carole; Lafrance, Adele

2017-01-01

Objectives Best practice guidelines encourage the involvement of parents in the assessment and treatment of child/adolescent eating disorders (ED). This study investigated medical residents’ perspectives regarding parental involvement as well as their expectations for future practice in the assessment and treatment of ED. Method Five hundred and eighty-four medical residents from 17 Canadian residency programs specializing in family medicine, pediatrics, and psychiatry completed a web-based survey. Questions pertained to assessment and treatment practices for child/adolescent ED. Analyses included ANOVAs, paired t-tests, and, for residents who endorsed family involvement (N = 444), qualitative content analysis. Results Overall, residents reported that they “mostly” agreed with the involvement of family in the assessment and treatment of ED. Residents’ endorsement of family involvement in both domains increased according to the extent of ED training received. Four major themes emerged from the content analysis of family involvement and included recommendations in line with evidence-based models and unspecified, passive involvement in the assessment and recovery process. Conclusions Many residents endorse family involvement in both assessment and treatment; however, understanding of the nature of such involvement is often vague. Training in evidence-based protocols is necessary for residents planning to engage in multi-disciplinary assessment, referral, and/or treatment in their future practice. PMID:28747930

A Guide for Developing Standard Operating Job Procedures for the Primary Sedimentation Process Wastewater Treatment Facility. SOJP No. 4.

ERIC Educational Resources Information Center

Charles County Community Coll., La Plata, MD.

This guide describes standard operating job procedures for the primary sedimentation process of wastewater treatment plants. The primary sedimentation process involves removing settleable and suspended solids, in part, from wastewater by gravitational forces, and scum and other floatable solids from wastewater by mechanical means. Step-by-step…

The multidisciplinary treatment plan: a format for enhancing activity therapy department involvement.

PubMed

Lang, E; Mattson, M

1985-01-01

A structured, goal-oriented format for enhancing the involvement of activity therapy disciplines in the multidisciplinary treatment planning process has been developed in a large private psychiatric teaching hospital. The format, an adaptation of the problem-oriented record, encompasses formal procedures for identifying and recording relevant problems, goals, methods, and objectives for activity therapy treatment. The benefits of this approach include the development of specific, measurable, attainable functional goals; increased accountability in treatment planning and delivery; less time spent in documentation; and education of other staff about the role and function of activities therapy. Patients have a better understanding of their goals and the steps needed to achieve them and show increased participation in the therapy process.

Failure mode and effects analysis as a performance improvement tool in trauma.

PubMed

Day, Suzanne; Dalto, Joseph; Fox, Jolene; Turpin, Melinda

2006-01-01

Performance improvement (PI) in the multiple systems injured patient frequently highlights areas for improvement in overall hospital care processes. Failure mode effects analysis (FMEA) is an effective tool to assess and prioritize areas of risk in clinical practice. Failure mode effects analysis is often initiated by a "near-miss" or concern for risk as opposed to a root cause analysis that is initiated solely after a sentinel event. In contrast to a root cause analysis, the FMEA looks more broadly at processes involved in the delivery of care. The purpose of this abstract was to demonstrate the usefulness of FMEA as a PI tool by describing an event and following the event through the healthcare delivery PI processes involved. During routine chart abstraction, a trauma registrar found that an elderly trauma patient admitted with a subdural hematoma inadvertently received heparin during the course of a dialysis treatment. Although heparin use was contraindicated in this patient, there were no sequelae as a result of the error. This case was reviewed by the trauma service PI committee and the quality improvement team, which initiated FMEA. An FMEA of inpatient dialysis process was conducted following this incident. The process included physician, nursing, and allied health representatives involved in dialysis. As part of the process, observations of dialysis treatments and staff interviews were conducted. Observation revealed that nurses generally left the patient's room and did not involve themselves in the dialysis process. A formal patient "pass-off" report was not done. Nurses did not review dialysis orders or reevaluate the treatment plan before treatment. We found that several areas of our current practice placed our patients at risk. 1. The nephrology consult/dialysis communication process was inconsistent. 2. Scheduling of treatments for chronic dialysis patients could occur without a formal consult or order. 3. RNs were not consistently involved in dialysis scheduling, setup, or treatment. 4. Dialysis technicians may exceed scope of practice (taking telephone orders) when scheduling of treatment occurred before consult and written orders. Near-miss events may be overlooked as opportunities for improvement in cases where no harm has come to the patient. As a result of our FMEA investigation, the following recommendations were made to improve hospital care delivery in those trauma patients who require inpatient dialysis: 1. Education of RNs about the dialysis process. 2. Implementation of a formal reporting process between the RN and the dialysis technician before the procedure is initiated. 3. RN supervision of dialysis treatments. 4. Use of a preprinted inpatient dialysis form. 5. Education of dialysis technicians regarding their scope of practice. 6. Improve notification process for scheduling dialysis procedures between units and dialysis coordinator (similar to x-ray scheduling). Our performance improvement focus has broadened to include all reported "near-miss" events in order to improve our healthcare delivery process before an event with sequelae occurs. We have found that using FMEA has greatly increased our ability to facilitate change across all services and departments within the hospital.

Leading processes of patient care and treatment in hierarchical healthcare organizations in Sweden--process managers' experiences.

PubMed

Nilsson, Kerstin; Sandoff, Mette

2015-01-01

The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers' experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization. This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style. The process managers' experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager's responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager. Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings. This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers' experiences, a subject that has not been investigated earlier.

'The bloke can be a bit hazy about what's going on': men and cross-border reproductive treatment.

PubMed

Hudson, Nicky; Culley, Lorraine

2013-09-01

While social science research has begun to demonstrate the significant impact of infertility and involuntary childlessness for men, far fewer studies have specifically explored the male experience of, or men's involvement in, infertility treatment-seeking and there are few published studies which specifically describe men's experiences with cross-border reproduction. This paper presents data from the first UK study of transnational treatment-seeking and specifically explores men's involvement in this process. Data from interviews with 10 men and 34 women who were seeking treatment abroad are organized according to three themes: 'going along with it'; 'being a rock'; and 'doing their bit'. The paper argues that gender is an important aspect of the cross-border treatment experience and that both traditional and emergent gender identities are expressed in the process of treatment-seeking. Healthcare providers need to actively explore men's perspectives of the treatment process in all locations, to improve quality of care by reducing men's feelings of marginalization and enhancing their experience of treatment, especially but not exclusively, around the issue of semen collection. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Decision-making processes for the uptake and implementation of family-based therapy by eating disorder treatment teams: a qualitative study.

PubMed

Kimber, Melissa; Couturier, Jennifer; Jack, Susan; Niccols, Alison; Van Blyderveen, Sherry; McVey, Gail

2014-01-01

To explore the decision-making processes involved in the uptake and implementation of evidence-based treatments (EBTs), namely, family-based treatment (FBT), among therapists and their administrators within publically funded eating disorder treatment programs in Ontario, Canada. Fundamental qualitative description guided sampling, data collection, and analytic decisions. Forty therapists and 11 administrators belonging to a network of clinicians treating eating disorders completed an in-depth interview regarding the decision-making processes involved in EBT uptake and implementation within their organizations. Content analysis and the constant comparative technique were used to analyze interview transcripts, with 20% of the data independently double-coded by a second coder. Therapists and their administrators identified the importance of an inclusive change culture in evidence-based practice (EBP) decision-making. Each group indicated reluctance to make EBP decisions in isolation from the other. Additionally, participants identified seven stages of decision-making involved in EBT adoption, beginning with exposure to the EBT model and ending with evaluating the impact of the EBT on patient outcomes. Support for a stage-based decision-making process was in participants' indication that the stages were needed to demonstrate that they considered the costs and benefits of making a practice change. Participants indicated that EBTs endorsed by the Provincial Network for Eating Disorders or the Academy for Eating Disorders would more likely be adopted. Future work should focus on integrating the important decision-making processes identified in this study with known implementation models to increase the use of low-cost and effective treatments, such as FBT, within eating disorder treatment programs. Copyright © 2013 Wiley Periodicals, Inc.

LITERATURE REVIEWS TO SUPPORT ION EXCHANGE TECHNOLOGY SELECTION FOR MODULAR SALT PROCESSING

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

King, W

2007-11-30

This report summarizes the results of literature reviews conducted to support the selection of a cesium removal technology for application in a small column ion exchange (SCIX) unit supported within a high level waste tank. SCIX is being considered as a technology for the treatment of radioactive salt solutions in order to accelerate closure of waste tanks at the Savannah River Site (SRS) as part of the Modular Salt Processing (MSP) technology development program. Two ion exchange materials, spherical Resorcinol-Formaldehyde (RF) and engineered Crystalline Silicotitanate (CST), are being considered for use within the SCIX unit. Both ion exchange materials havemore » been studied extensively and are known to have high affinities for cesium ions in caustic tank waste supernates. RF is an elutable organic resin and CST is a non-elutable inorganic material. Waste treatment processes developed for the two technologies will differ with regard to solutions processed, secondary waste streams generated, optimum column size, and waste throughput. Pertinent references, anticipated processing sequences for utilization in waste treatment, gaps in the available data, and technical comparisons will be provided for the two ion exchange materials to assist in technology selection for SCIX. The engineered, granular form of CST (UOP IE-911) was the baseline ion exchange material used for the initial development and design of the SRS SCIX process (McCabe, 2005). To date, in-tank SCIX has not been implemented for treatment of radioactive waste solutions at SRS. Since initial development and consideration of SCIX for SRS waste treatment an alternative technology has been developed as part of the River Protection Project Waste Treatment Plant (RPP-WTP) Research and Technology program (Thorson, 2006). Spherical RF resin is the baseline media for cesium removal in the RPP-WTP, which was designed for the treatment of radioactive waste supernates and is currently under construction in Hanford, WA. Application of RF for cesium removal in the Hanford WTP does not involve in-riser columns but does utilize the resin in large scale column configurations in a waste treatment facility. The basic conceptual design for SCIX involves the dissolution of saltcake in SRS Tanks 1-3 to give approximately 6 M sodium solutions and the treatment of these solutions for cesium removal using one or two columns supported within a high level waste tank. Prior to ion exchange treatment, the solutions will be filtered for removal of entrained solids. In addition to Tanks 1-3, solutions in two other tanks (37 and 41) will require treatment for cesium removal in the SCIX unit. The previous SCIX design (McCabe, 2005) utilized CST for cesium removal with downflow supernate processing and included a CST grinder following cesium loading. Grinding of CST was necessary to make the cesium-loaded material suitable for vitrification in the SRS Defense Waste Processing Facility (DWPF). Because RF resin is elutable (and reusable) and processing requires conversion between sodium and hydrogen forms using caustic and acidic solutions more liquid processing steps are involved. The WTP baseline process involves a series of caustic and acidic solutions (downflow processing) with water washes between pH transitions across neutral. In addition, due to resin swelling during conversion from hydrogen to sodium form an upflow caustic regeneration step is required. Presumably, one of these basic processes (or some variation) will be utilized for MSP for the appropriate ion exchange technology selected. CST processing involves two primary waste products: loaded CST and decontaminated salt solution (DSS). RF processing involves three primary waste products: spent RF resin, DSS, and acidic cesium eluate, although the resin is reusable and typically does not require replacement until completion of multiple treatment cycles. CST processing requires grinding of the ion exchange media, handling of solids with high cesium loading, and handling of liquid wash and conditioning solutions. RF processing requires handling and evaporation of cesium eluates, disposal of spent organic resin, and handling of the various liquid wash and regenerate solutions used. In both cases, the DSS will be immobilized in a low activity waste form. It appears that both technologies are mature, well studied, and generally suitable for this application. Technology selection will likely be based on downstream impacts or preferences between the various processing options for the two materials rather than on some unacceptable performance property identified for one material. As a result, the following detailed technical review and summary of the two technologies should be useful to assist in technology selection for SCIX.« less

A comparison of the environmental impact of different AOPs: risk indexes.

PubMed

Giménez, Jaime; Bayarri, Bernardí; González, Óscar; Malato, Sixto; Peral, José; Esplugas, Santiago

2014-12-31

Today, environmental impact associated with pollution treatment is a matter of great concern. A method is proposed for evaluating environmental risk associated with Advanced Oxidation Processes (AOPs) applied to wastewater treatment. The method is based on the type of pollution (wastewater, solids, air or soil) and on materials and energy consumption. An Environmental Risk Index (E), constructed from numerical criteria provided, is presented for environmental comparison of processes and/or operations. The Operation Environmental Risk Index (EOi) for each of the unit operations involved in the process and the Aspects Environmental Risk Index (EAj) for process conditions were also estimated. Relative indexes were calculated to evaluate the risk of each operation (E/NOP) or aspect (E/NAS) involved in the process, and the percentage of the maximum achievable for each operation and aspect was found. A practical application of the method is presented for two AOPs: photo-Fenton and heterogeneous photocatalysis with suspended TiO2 in Solarbox. The results report the environmental risks associated with each process, so that AOPs tested and the operations involved with them can be compared.

Pharmacology of Ischemia-Reperfusion. Translational Research Considerations.

PubMed

Prieto-Moure, Beatriz; Lloris-Carsí, José M; Barrios-Pitarque, Carlos; Toledo-Pereyra, Luis-H; Lajara-Romance, José María; Berda-Antolí, M; Lloris-Cejalvo, J M; Cejalvo-Lapeña, Dolores

2016-08-01

Ischemia-reperfusion (IRI) is a complex physiopathological mechanism involving a large number of metabolic processes that can eventually lead to cell apoptosis and ultimately tissue necrosis. Treatment approaches intended to reduce or palliate the effects of IRI are varied, and are aimed basically at: inhibiting cell apoptosis and the complement system in the inflammatory process deriving from IRI, modulating calcium levels, maintaining mitochondrial membrane integrity, reducing the oxidative effects of IRI and levels of inflammatory cytokines, or minimizing the action of macrophages, neutrophils, and other cell types. This study involved an extensive, up-to-date review of the bibliography on the currently most widely used active products in the treatment and prevention of IRI, and their mechanisms of action, in an aim to obtain an overview of current and potential future treatments for this pathological process. The importance of IRI is clearly reflected by the large number of studies published year after year, and by the variety of pathophysiological processes involved in this major vascular problem. A quick study of the evolution of IRI-related publications in PubMed shows that in a single month in 2014, 263 articles were published, compared to 806 articles in the entire 1990.

The Psychotherapy Process with Adolescents: A First Pilot Study and Preliminary Comparisons between Different Therapeutic Modalities Using the "Adolescent Psychotherapy Q-Set"

ERIC Educational Resources Information Center

Bychkova, Tetyana; Hillman, Saul; Midgley, Nick; Schneider, Celeste

2011-01-01

An innovative methodology is presented for describing the therapeutic processes involved in five types of adolescent treatments: psychoanalysis, psychodynamic psychotherapy, cognitive-behavioural therapy, mentalisation-based treatment and interpersonal psychotherapy. Using the "Adolescent Psychotherapy Q-Set" (APQ), 18 experienced clinicians…

Changes in Pre-service Science Teachers' Understandings After Being Involved in Explicit Nature of Science and Socioscientific Argumentation Processes

NASA Astrophysics Data System (ADS)

Kutluca, A. Y.; Aydın, A.

2017-08-01

The study explored the changes in pre-service science teachers' understanding of the nature of science and their opinions about the nature of science, science teaching and argumentation after their participation in explicit nature of science (NOS) and socioscientific argumentation processes. The participants were 56 third-grade pre-service science teachers studying in a state university in Turkey. The treatment group comprised 27 participants, and there were 29 participants in the comparison group. The comparison group participants were involved in a student-centred science-teaching process, and the participants of the treatment group were involved in explicit NOS and socioscientific argumentation processes. In the study, which lasted a total of 11 weeks, a NOS-as-argumentation questionnaire was administered to all the participants to determine their understanding of NOS at the beginning and end of the data collection process, and six random participants of the treatment group participated in semi-structured interview questions in order to further understand their views regarding NOS, science teaching and argumentation. Qualitative and quantitative data analysis revealed that the explicit NOS and socioscientific argumentation processes had a significant effect on pre-service science teachers' NOS understandings. Furthermore, NOS, argumentation and science teaching views of the participants in the treatment group showed a positive change. The results of this study are discussed in light of the related literature, and suggestions are made within the context of contribution to science-teaching literature, improvement of education quality and education of pre-service teachers.

49 CFR 701.7 - Timing of responses to requests.

Code of Federal Regulations, 2011 CFR

2011-10-01

... needed to process a request or the number of pages involved. (2) In general, when requests are received... taken out of order and given expedited treatment whenever it is determined that they involve a...

49 CFR 701.7 - Timing of responses to requests.

Code of Federal Regulations, 2012 CFR

2012-10-01

... needed to process a request or the number of pages involved. (2) In general, when requests are received... taken out of order and given expedited treatment whenever it is determined that they involve a...

49 CFR 701.7 - Timing of responses to requests.

Code of Federal Regulations, 2013 CFR

2013-10-01

... needed to process a request or the number of pages involved. (2) In general, when requests are received... taken out of order and given expedited treatment whenever it is determined that they involve a...

Process for removing an organic compound from water

DOEpatents

Baker, Richard W.; Kaschemekat, Jurgen; Wijmans, Johannes G.; Kamaruddin, Henky D.

1993-12-28

A process for removing organic compounds from water is disclosed. The process involves gas stripping followed by membrane separation treatment of the stripping gas. The stripping step can be carried out using one or multiple gas strippers and using air or any other gas as stripping gas. The membrane separation step can be carried out using a single-stage membrane unit or a multistage unit. Apparatus for carrying out the process is also disclosed. The process is particularly suited for treatment of contaminated groundwater or industrial wastewater.

Atomic Oxygen Treatment as a Method of Recovering Smoke Damaged Paintings. Revised

NASA Technical Reports Server (NTRS)

Rutledge, Sharon K.; Banks, Bruce A.; Forkapa, Mark; Stueber, Thomas; Sechkar, Edward; Malinowski, Kevin

1999-01-01

A noncontact technique is described that uses atomic oxygen, generated under low pressure in the presence of nitrogen, to remove soot and charred varnish from the surface of a painting. The process, which involves surface oxidation, permits control of the amount of surface material removed. The effectiveness of the process was evaluated by reflectance measurements from selected areas made during the removal of soot from acrylic gesso, ink on paper, and varnished oil paint substrates. For the latter substrate, treatment also involved the removal of damaged varnish and paint binder from the surface.

Treatment of sentence comprehension and production in aphasia: is there cross-modal generalisation?

PubMed

Adelt, Anne; Hanne, Sandra; Stadie, Nicole

2016-09-09

Exploring generalisation following treatment of language deficits in aphasia can provide insights into the functional relation of the cognitive processing systems involved. In the present study, we first review treatment outcomes of interventions targeting sentence processing deficits and, second report a treatment study examining the occurrence of practice effects and generalisation in sentence comprehension and production. In order to explore the potential linkage between processing systems involved in comprehending and producing sentences, we investigated whether improvements generalise within (i.e., uni-modal generalisation in comprehension or in production) and/or across modalities (i.e., cross-modal generalisation from comprehension to production or vice versa). Two individuals with aphasia displaying co-occurring deficits in sentence comprehension and production were trained on complex, non-canonical sentences in both modalities. Two evidence-based treatment protocols were applied in a crossover intervention study with sequence of treatment phases being randomly allocated. Both participants benefited significantly from treatment, leading to uni-modal generalisation in both comprehension and production. However, cross-modal generalisation did not occur. The magnitude of uni-modal generalisation in sentence production was related to participants' sentence comprehension performance prior to treatment. These findings support the assumption of modality-specific sub-systems for sentence comprehension and production, being linked uni-directionally from comprehension to production.

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

ERIC Educational Resources Information Center

Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

2011-01-01

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

Interaction Structures between a Child and Two Therapists in the Psychodynamic Treatment of a Child with Asperger's Disorder

ERIC Educational Resources Information Center

Goodman, Geoff; Athey-Lloyd, Laura

2011-01-01

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures--repetitive patterns of interactions between patient and therapist over the course of…

18 CFR 1301.5 - Timing of responses to requests.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the estimated processing time, including a consideration of the number of pages involved. If TVA... processing. (1) Requests and appeals will be taken out of order and given expedited treatment whenever TVA...

15 CFR 4.6 - Time limits and expedited processing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... tracks by distinguishing between simple and more complex requests based on the number of pages involved...) Expedited processing. (1) Requests and appeals shall be taken out of order and given expedited treatment...

Patients' experiences of communication and involvement in decision-making about atrial fibrillation treatment in consultations with nurses and physicians.

PubMed

Siouta, Eleni; Hellström Muhli, Ulla; Hedberg, Berith; Broström, Anders; Fossum, Bjöörn; Karlgren, Klas

2016-09-01

Insights in consultations across patient interactions with physicians and nurses are of vital importance for strengthening the patients' involvement in the treatment decision-making process. The experience of involvement and communication in decision-making from the patients' perspective has been sparsely explored. To examine how patients describe involvement in and communication about decision-making regarding treatment in consultations with nurses and physicians. Twenty-two patients with atrial fibrillation (AF), aged 37-90 years, were interviewed directly after their consultations with nurses and physicians in outpatient AF clinics in six Swedish hospitals. In consultations with nurses, the patients felt involved when obtaining clarifications about AF as a disease and its treatment and when preparing for and building up confidence in decision-making. In consultations with physicians, the patients felt involved when they could cooperate in decision-making, when acquiring knowledge, and when they felt that they were being understood. One shared category was found in consultations with both nurses and physicians, and the patients felt involved when they had a sense of trust and felt secure during and between consultations. Patients with AF stated that they would need to acquire knowledge and build up confidence and ability in order to be effectively involved in the decision-making about treatment. Despite not being actively involved in decision-making, patients felt involved through experiencing supportive and confirming communication. Attention must be given to the relationship with the patient to create the conditions for patient involvement in the consultation. This can be achieved through supportive communication attempting to create a feeling of clarity and building confidence. This will support involvement in decision-making concerning AF treatment and feelings of being understood and of trust in physicians and/or nurses. © 2015 Nordic College of Caring Science.

49 CFR 7.32 - Final determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... amount of work and/or time needed to process the appeal, or on the number of pages involved. (2) A...) Expedited processing. (1) An appeal will be taken out of order and given expedited treatment whenever a...

49 CFR 7.31 - Initial determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the amount of work and/or time needed to process the request, or on the number of pages involved. (2...) Expedited processing. (1) Requests and appeals will be taken out of order and given expedited treatment...

The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy.

PubMed

Tremblay, Joël; Dufour, Magali; Bertrand, Karine; Blanchette-Martin, Nadine; Ferland, Francine; Savard, Annie-Claude; Saint-Jacques, Marianne; Côté, Mélissa

2017-01-01

Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants. Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple. Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG), couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners ( n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment) were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes. Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1) the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2) the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3) the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4) the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5) the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other. Discussion: Participants reported satisfaction with both treatment models, but their experience was more positive in couple treatment. Complementary benefits emerged from each form of treatment, which points to future treatments involving both types. Future research should explore both the couple processes associated with attempts to stop pathological gambling and the various ways of involving partners in the gamblers' treatment.

The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy

PubMed Central

Tremblay, Joël; Dufour, Magali; Bertrand, Karine; Blanchette-Martin, Nadine; Ferland, Francine; Savard, Annie-Claude; Saint-Jacques, Marianne; Côté, Mélissa

2018-01-01

Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants. Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple. Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG), couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners (n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment) were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes. Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1) the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2) the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3) the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4) the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5) the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other. Discussion: Participants reported satisfaction with both treatment models, but their experience was more positive in couple treatment. Complementary benefits emerged from each form of treatment, which points to future treatments involving both types. Future research should explore both the couple processes associated with attempts to stop pathological gambling and the various ways of involving partners in the gamblers' treatment. PMID:29416520

Selecting candidate structures for lithium treatment : what to provide the petrographer along with concrete specimens : tech brief.

DOT National Transportation Integrated Search

2006-02-01

The process of selecting candidate structures (and : appropriate components of structures) for lithium treatment : invariably involves sampling one or several components : of the structures for laboratory investigations, particularly : petrographic e...

WE-E-BRD-01: HDR Brachytherapy I: Overview of Clinical Application and QA

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

Libby, B; Showalter, T

2014-06-15

With the increased usage of high dose rate (HDR) brachytherapy and the introduction of dedicated image guided brachytherapy suites, it is necessary to review the processes and procedures associated with safely delivering these treatments in the expedited time scales that dedicated treatment suites afford. The speakers will present the clinical aspects of switching from LDR to HDR treatments, including guidelines for patient selection, and the clinical outcomes comparing LDR to HDR. The speakers will also discuss the HDR treatment process itself, because the shortened clinical timeline involved with a streamlined scan/plan/treat workflow can introduce other issues. Safety and QA aspectsmore » involved with the streamlined process, including increased personnel required for parallel tasks, and possible interfering tasks causing delays in patient treatments will also be discussed. Learning Objectives: To understand the clinical aspects of HDR Brachytherapy, including common clinical indications, patient selection, and the evolving evidence in support of this therapeutic modality To review the current prominent clinical trials for HDR brachytherapy To interpret the established guidelines for HDR brachytherapy quality assurance for implementation into practical clinical settings. To introduce the basic requirements for image guided brachytherapy.« less

Effects of industrial processing on folate content in green vegetables.

PubMed

Delchier, Nicolas; Ringling, Christiane; Le Grandois, Julie; Aoudé-Werner, Dalal; Galland, Rachel; Georgé, Stéphane; Rychlik, Michael; Renard, Catherine M G C

2013-08-15

Folates are described to be sensitive to different physical parameters such as heat, light, pH and leaching. Most studies on folates degradation during processing or cooking treatments were carried out on model solutions or vegetables only with thermal treatments. Our aim was to identify which steps were involved in folates loss in industrial processing chains, and which mechanisms were underlying these losses. For this, the folates contents were monitored along an industrial canning chain of green beans and along an industrial freezing chain of spinach. Folates contents decreased significantly by 25% during the washing step for spinach in the freezing process, and by 30% in the green beans canning process after sterilisation, with 20% of the initial amount being transferred into the covering liquid. The main mechanism involved in folate loss during both canning green beans and freezing spinach was leaching. Limiting the contact between vegetables and water or using steaming seems to be an adequate measure to limit folates losses during processing. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Parent participation in the treatment of dyslexic children - the results of a paper-pencil questionnaire].

PubMed

Multhauf, Bettina; Buschmann, Anke

2014-07-01

This study examined the degree and manner of involving parents in the treatment of dyslexic children. The study also identified therapeutic variables predicting the extent of parent involvement and the reasons for any instances of failed involvement. A sample of 53 out of 120 randomly selected German dyslexia therapists (response rate: 44 %) filled out a paper-pencil questionnaire assessing the degree and manner of parent involvement in the treatment of dyslexic children. Furthermore, therapists' attitudes toward parent involvement and their subjective competence when working with parents were assessed. The most common forms of parent involvement occurred during anamnesis and when drawing up recommendations for home exercises. The therapists' attitudes toward working with parents predicted the extent of parent involvement (β = .58). There was a significant correlation between working with parents and the subjective competence of the therapist (r = .28), which was mediated by therapists' attitudes toward parent involvement. Disinterest on the part of parents and therapists' lack of time proved to be reasons for less parent involvement. Despite declared positive attitudes toward working with parents, the involvement of parents in the therapeutic process by therapists was limited.

Identification of Key Factors Involved in the Biosorption of Patulin by Inactivated Lactic Acid Bacteria (LAB) Cells.

PubMed

Wang, Ling; Wang, Zhouli; Yuan, Yahong; Cai, Rui; Niu, Chen; Yue, Tianli

2015-01-01

The purpose of this study was to identify the key factors involved in patulin adsorption by heat-inactivated lactic acid bacteria (LAB) cells. For preventing bacterial contamination, a sterilization process was involved in the adsorption process. The effects of various physical, chemical, and enzymatic pre-treatments, simultaneous treatments, and post-treatments on the patulin adsorption performances of six LAB strains were evaluated. The pre-treated cells were characterized by scanning electron microscopy (SEM). Results showed that the removal of patulin by viable cells was mainly based on adsorption or degradation, depending on the specific strain. The adsorption abilities were widely increased by NaOH and esterification pre-treatments, and reduced by trypsin, lipase, iodate, and periodate pre-treatments. Additionally, the adsorption abilities were almost maintained at pH 2.2-4.0, and enhanced significantly at pH 4.0-6.0. The effects of sodium and magnesium ions on the adsorption abilities at pH 4 were slight and strain-specific. A lower proportion of patulin was released from the strain with higher adsorption ability. Analyses revealed that the physical structure of peptidoglycan was not a principal factor. Vicinal OH and carboxyl groups were not involved in patulin adsorption, while alkaline amino acids, thiol and ester compounds were important for patulin adsorption. Additionally, besides hydrophobic interaction, electrostatic interaction also participated in patulin adsorption, which was enhanced with the increase in pH (4.0-6.0).

Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian Locality of the International Triple Frontier.

PubMed

Silva-Sobrinho, Reinaldo Antonio; Wysocki, Anneliese Domingues; Scatena, Lúcia Marina; Pinto, Erika Simone Galvão; Beraldo, Aline Ale; Andrade, Rubia Laine Paula; Zilly, Adriana; Munhak da Silva, Rosane Meire; Gomes, Michela Prestes; Mayer, Paulo César Morales; Ruffino-Netto, Antonio; Villa, Tereza Cristina Scatena

2017-01-01

To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a triple international border municipality. The present study was an evaluative survey of cross-sectional and quantitative approach conducted with 225 PHC healthcare professionals. Data was collected through a structured and validated instrument, which provided five indicators of "structure" and four indicators of "process" classified as unsatisfactory, regular or satisfactory. The "structure" component was unsatisfactory for the indicator of professionals involved in TB care and training, and regular for the indicator of connection between the units and other levels of care. The "process" component was regular for the indicators of TB information, directly observed treatment and reference and counter reference on TB, and unsatisfactory for external actions on TB control. The "structure" and "process" components points out some weaknesses in terms of management and organization of human resources. Low frequency of training and the turnover influenced the involvement of professionals. Elements of "structure" and "process" show the need for investing in the PHC team and improving the clinical management of cases.

CONTAMINANT ADSORPTION AND OXIDATION VIA FENTON REACTION

EPA Science Inventory

A ground water treatment process is proposed involving two cgemical processes: adsorption and oxidation. Adsorption of an organic compound onto granulated activated carbon (GAC) containing iron conveniently results in immobilizing and concentrating contaminants from the ground w...

Prevention and harm reduction for chemical dependency: a process perspective.

PubMed

DiClemente, C C

1999-06-01

Clinical psychology is often on the periphery of treatment and prevention efforts to stop substance abuse and dependence. This article describes the current status of prevention research and practice, outlines a process perspective on the initiation and cessation of drug use and abuse, and offers some new ideas about how psychology can and should become involved in the prevention of chemical dependency. Psychologists are faced with the precursors and consequences of chemical dependency on a daily basis. With improved training and increased awareness, and aided by a process perspective, psychology and psychologists can play an important role in preventing the onset of chemical dependency, creating early interventions to stop the process of initiation, and becoming more involved in treatment and harm-reduction efforts. Psychologists have the basic training and the biopsychosocial orientation that could make them effective agents for primary, secondary, and tertiary prevention of chemical dependency.

Fenton-like initiation of a toluene transformation mechanism

EPA Science Inventory

In Fenton-driven oxidation treatment systems, reaction intermediates derived from parent compounds can play a significant role in the overall treatment process. Fenton-like reactions in the presence of toluene or benzene, involved a transformation mechanism that was highly effici...

Assessment of wastewater treatment alternatives for small communities: An analytic network process approach.

PubMed

Molinos-Senante, María; Gómez, Trinidad; Caballero, Rafael; Hernández-Sancho, Francesc; Sala-Garrido, Ramón

2015-11-01

The selection of the most appropriate wastewater treatment (WWT) technology is a complex problem since many alternatives are available and many criteria are involved in the decision-making process. To deal with this challenge, the analytic network process (ANP) is applied for the first time to rank a set of seven WWT technology set-ups for secondary treatment in small communities. A major advantage of ANP is that it incorporates interdependent relationships between elements. Results illustrated that extensive technologies, constructed wetlands and pond systems are the most preferred alternatives by WWT experts. The sensitivity analysis performed verified that the ranking of WWT alternatives is very stable since constructed wetlands are almost always placed in the first position. This paper showed that ANP analysis is suitable to deal with complex decision-making problems, such as the selection of the most appropriate WWT system contributing to better understand the multiple interdependences among elements involved in the assessment. Copyright © 2015 Elsevier B.V. All rights reserved.

2 Courts Put Limits on Research Involving the Mentally Ill.

ERIC Educational Resources Information Center

Burd, Stephen

1995-01-01

Courts in New York and Texas have imposed limits on psychiatric research involving involuntarily institutionalized patients as subjects, citing state and constitutional protection of privacy, due process, and equal protection. Some are concerned that mental health research and treatment will suffer. (MSE)

Prefrontal Cortex and Drug Abuse Vulnerability: Translation to Prevention and Treatment Interventions

PubMed Central

Perry, Jennifer L.; Joseph, Jane E.; Jiang, Yang; Zimmerman, Rick S.; Kelly, Thomas H.; Darna, Mahesh; Huettl, Peter; Dwoskin, Linda P.; Bardo, Michael T.

2010-01-01

Vulnerability to drug abuse is related to both reward seeking and impulsivity, two constructs thought to have a biological basis in the prefrontal cortex (PFC). This review addresses similarities and differences in neuroanatomy, neurochemistry and behavior associated with PFC function in rodents and primates. Emphasis is placed on monoamine and amino acid neurotransmitter systems located in anatomically distinct subregions: medial prefrontal cortex (mPFC); lateral prefrontal cortex (lPFC); anterior cingulate cortex (ACC); and orbitofrontal cortex (OFC). While there are complex interconnections and overlapping functions among these regions, each is thought to be involved in various functions related to health-related risk behaviors and drug abuse vulnerability. Among the various functions implicated, evidence suggests that mPFC is involved in reward processing, attention and drug reinstatement; lPFC is involved in decision-making, behavioral inhibition and attentional gating; ACC is involved in attention, emotional processing and self-monitoring; and OFC is involved in behavioral inhibition, signaling of expected outcomes and reward/punishment sensitivity. Individual differences factors (e.g., age and sex) influence functioning of these regions, which, in turn, impacts drug abuse vulnerability. Implications for the development of drug abuse prevention and treatment strategies aimed at engaging PFC inhibitory processes that may reduce risk-related behaviors are discussed, including the design of effective public service announcements, cognitive exercises, physical activity, direct current stimulation, feedback control training and pharmacotherapies. A major challenge in drug abuse prevention and treatment rests with improving intervention strategies aimed at strengthening PFC inhibitory systems among at-risk individuals. PMID:20837060

Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

PubMed

Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

2015-11-01

The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Predictors of Physical Altercation among Adolescents in Residential Substance Abuse Treatment

PubMed Central

Crawley, Rachel D.; Becan, Jennifer Edwards; Knight, Danica Kalling; Joe, George W.; Flynn, Patrick M.

2014-01-01

This study tested the hypothesis that basic social information-processing components represented by family conflict, peer aggression, and pro-aggression cognitive scripts are related to aggression and social problems among adolescents in substance abuse treatment. The sample consisted of 547 adolescents in two community-based residential facilities. Correlation results indicated that more peer aggression is related to more pro-aggression scripts; scripts, peer aggression, and family conflict are associated with social problems; and in-treatment physical altercation involvement is predicted by higher peer aggression. Findings suggest that social information-processing components are valuable for treatment research. PMID:26622072

Creativity, self creation, and the treatment of mental illness.

PubMed

Rothenberg, A

2006-06-01

This paper examines how an understanding of systematic findings about creative processes involved in art, literature, and science can be applied to the effective treatment of mental illness. These findings and applications are illustrated by particular reference to the work of the poet Sylvia Plath and the treatment of a patient who aspired to become a writer.

How do health care workers manage a patient with multiple care needs from both health and social care services? - A vignette study.

PubMed

Vehko, Tuulikki; Jolanki, Outi; Aalto, Anna-Mari; Sinervo, Timo

2018-06-01

To assess how health care professionals outline the management of care and explore which health or social care professionals were involved in the patient's treatment. A survey with a patient vignette for general practitioners (n = 31) and registered nurses (n = 31) working daily in Finnish health centres located in four cities. Respondents answered structural questions and explained in detail the care process that they tailored for the patient. The care process was examined using content analysis. A physician-nurse working pair was declared to be in charge of the care process by 27% of respondents, a registered nurse by 9% and a general practitioner by 11%. However, 53% reported that no single person or working pair was in charge of the care process (response rate 72%). The concluding result of the analyses of the presented process was that both treatment practices and the professionals participating in the patient's treatment varied. Collaboration with social services was occasional, and few care processes included referrals to social services. For the patient who needs both health and social care services, the management of care is a challenge. To improve the chances of patients being actively involved in making treatment plans at least three factors need to be addressed. Firstly, a written treatment plan should explicate the care process. Second, collaboration and interaction between health and social care services should be strengthened, and third, a contact person should be named to avoid care gaps in primary health care. Next-step data from patients need to be collected to get their views on care management and compare these with those from general practitioners and registered nurses.

Healthcare decisions: a review of children's involvement.

PubMed

Baston, Jenny

2008-04-01

Children's rights, their ability to consent to treatment and their involvement in healthcare decisions have received considerable attention in recent years. There is some evidence to suggest that when children are involved in the decision-making process, they retain a sense of control over their situation. However there are still unresolved issues related to a child's right to decide and nurses may be confused about the extent to which children can and should be involved in decision-making. A code of practice for involving children in decisions was first suggested in 2001 and there is still a need for a consistent, structured and robust method of ensuring that children are included in the decision-making process at all stages of their health care.

Becoming Therapeutic Agents: A Grounded Theory of Mothers' Process When Implementing Cognitive Behavioural Therapy at Home with an Anxious Child.

PubMed

Pishva, Rana

2017-05-01

The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home. A grounded theory goes beyond the description of a process, offering an explanatory theory that brings taken-for-granted meanings and processes to the surface. The theory that emerged from the analysis suggests that CBT implementation by mothers of anxious children is characterized by the evolution of mothers' perception of their child and mothers' perception of their role as well as a shift from reacting with emotion to responding pragmatically to the child. Changes occur as mothers recognize the crisis, make links between the treatment rationale, child's symptoms and their own parenting strategies, integrate tenets of CBT for anxiety and eventually focus on sustaining therapeutic gains through natural life transitions. The theory widens our understanding of mothers' role, therapeutic engagement, process, and decision-making. The theory also generates new hypotheses regarding parent involvement in the treatment of paediatric anxiety disorders and proposes novel research avenues that aim to maximize the benefits of parental involvement in the treatment of paediatric anxiety disorders. Copyright © 2016 John Wiley & Sons, Ltd. Mothers of anxious youth who take part in parent-centred programmes experience a shift in their perception of the child and of their role. Parental strategy after CBT implementation shifts from emotional empathy to cognitive empathy. Mothers experience significant challenges and require additional support in prevention of relapse and knowledge translation. Copyright © 2016 John Wiley & Sons, Ltd.

Allergenic properties and differential response of walnut subjected to processing treatments

USDA-ARS?s Scientific Manuscript database

Walnut is one of the most frequently involved foods in anaphylactic reactions. We investigated changes in walnut allergenicity after physical treatments by in vitro techniques and physiologically relevant assays. Changes in the allergenicity of walnut subjected to high pressure and thermal/pressur...

Assessment of in vitro cyto/genotoxicity of sequentially treated electroplating effluent on the human hepatocarcinoma HuH-7 cell line.

PubMed

Naik, Umesh Chandra; Das, Mihir Tanay; Sauran, Swati; Thakur, Indu Shekhar

2014-03-01

The present study compares in vitro toxicity of electroplating effluent after the batch treatment process with that obtained after the sequential treatment process. Activated charcoal prepared from sugarcane bagasse through chemical carbonization, and tolerant indigenous bacteria, Bacillus sp. strain IST105, were used individually and sequentially for the treatment of electroplating effluent. The sequential treatment involving activated charcoal followed by bacterial treatment removed 99% of Cr(VI) compared with the batch processes, which removed 40% (charcoal) and 75% (bacteria), respectively. Post-treatment in vitro cyto/genotoxicity was evaluated by the MTT test and the comet assay in human HuH-7 hepatocarcinoma cells. The sequentially treated sample showed an increase in LC50 value with a 6-fold decrease in comet-assay DNA migration compared with that of untreated samples. A significant decrease in DNA migration and an increase in LC50 value of treated effluent proved the higher effectiveness of the sequential treatment process over the individual batch processes. Copyright © 2014 Elsevier B.V. All rights reserved.

New biological agents in the treatment of multiple sclerosis.

PubMed

Buc, M

2018-01-01

Multiple sclerosis (MS) is an inflammatory disease induced by autoimmune processes. Their understanding has resulted in an introduction of biological agents to its treatment. Interferon beta and glatiramer acetate have been in clinical practice for more than 20 years. Nowadays, novel biologics, which target molecules involved in immunopathological processes more specifically have entered the scene. They are represented by monoclonal antibodies binding to molecules VLA4 (natalizumab), CD20 (ocrelizumab), CD52 (alemtuzumab) or alpha subunit of IL-2 receptor (daclizumab) or by small molecules such as those modulating the receptors involved in regulation of lymphocyte migration (fingolimod, ozanimod) or in induction of lymphopenia by apoptosis (dimethyl fumarate, cladribine). In the article, we shortly describe their efficacies, adverse reactions and perspectives of a future development in MS biologics. A treatment of neuromyelitis optica by monoclonal antibodies (rituximab, aquaporumab) is given too (Tab. 1, Fig. 2, Ref. 71).

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

Anameric, B.; Kawatra, S.K.

The pig iron nugget process is gaining in importance as an alternative to the traditional blast furnace. Throughout the process, self-reducing-fluxing dried greenballs composed of iron ore concentrate, reducing-carburizing agent (coal), flux (limestone) and binder (bentonite) are heat-treated. During the heat treatment, dried greenballs are first transformed into direct reduced iron (DRI), then to transition direct reduced iron (TDRI) and finally to pig iron nuggets. The furnace temperature and/or residence time and the corresponding levels of carburization, reduction and metallization dictate these transformations. This study involved the determination of threshold furnace temperatures and residence times for completion of all ofmore » the transformation reactions and pig iron nugget production. The experiments involved the heat treatment of self-reducing-fluxing dried greenballs at various furnace temperatures and residence times. The products of these heat treatments were identified by utilizing optical microscopy, apparent density and microhardness measurements.« less

Treatment decision-making among breast cancer patients in Malaysia.

PubMed

Nies, Yong Hui; Islahudin, Farida; Chong, Wei Wen; Abdullah, Norlia; Ismail, Fuad; Ahmad Bustamam, Ros Suzanna; Wong, Yoke Fui; Saladina, J J; Mohamed Shah, Noraida

2017-01-01

This study investigated breast cancer patients' involvement level in the treatment decision-making process and the concordance between patients' and physician's perspectives in decision-making. A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients' involvement in treatment decision-making, and patients' preference for behavioral involvement and information related to their disease. The majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient-physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3-5) and 2 (IQR =2-3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients' preferred role in the process of treatment decision-making and the patients' preference for information seeking ( p >0.05). However, only educational qualification ( p =0.004) was significantly associated with patients' preference for information seeking in multivariate analysis. Physicians failed to understand patients' perspectives and preferences in treatment decision-making. The concordance between physicians' perception and patients' perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.

Assessing attentional biases with stuttering.

PubMed

Lowe, Robyn; Menzies, Ross; Packman, Ann; O'Brian, Sue; Jones, Mark; Onslow, Mark

2016-01-01

Many adults who stutter presenting for speech treatment experience social anxiety disorder. The presence of mental health disorders in adults who stutter has been implicated in a failure to maintain speech treatment benefits. Contemporary theories of social anxiety disorder propose that the condition is maintained by negative cognitions and information processing biases. Consistent with cognitive theories, the probe detection task has shown that social anxiety is associated with an attentional bias to avoid social information. This information processing bias is suggested to be involved in maintaining anxiety. Evidence is emerging for information processing biases being involved with stuttering. This study investigated information processing in adults who stutter using the probe detection task. Information processing biases have been implicated in anxiety maintenance in social anxiety disorder and therefore may have implications for the assessment and treatment of stuttering. It was hypothesized that stuttering participants compared with control participants would display an attentional bias to avoid attending to social information. Twenty-three adults who stutter and 23 controls completed a probe detection task in which they were presented with pairs of photographs: a face displaying an emotional expression-positive, negative or neutral-and an everyday household object. All participants were subjected to a mild social threat induction being told they would speak to a small group of people on completion of the task. The stuttering group scored significantly higher than controls for trait anxiety, but did not differ from controls on measures of social anxiety. Non-socially anxious adults who stutter did not display an attentional bias to avoid looking at photographs of faces relative to everyday objects. Higher scores on trait anxiety were positively correlated with attention towards photographs of negative faces. Attentional biases as assessed by the probe detection task may not be a characteristic of non-socially anxious adults who stutter. A vigilance to attend to threat information with high trait anxiety is consistent with findings of studies using the emotional Stroop task in stuttering and social anxiety disorder. Future research should investigate attentional processing in people who stutter who are socially anxious. It will also be useful for future studies to employ research paradigms that involve speaking. Continued research is warranted to explore information processing and potential biases that could be involved in the maintenance of anxiety and failure to maintain the benefits of speech treatment outcomes. © 2015 Royal College of Speech and Language Therapists.

Involving Patients in Weighting Benefits and Harms of Treatment in Parkinson's Disease

PubMed Central

Weernink, Marieke G. M.; van Til, Janine A.; van Vugt, Jeroen P. P.; Movig, Kris L. L.; Groothuis-Oudshoorn, Catharina G. M.; IJzerman, Maarten J.

2016-01-01

Introduction Little is known about how patients weigh benefits and harms of available treatments for Parkinson’s Disease (oral medication, deep brain stimulation, infusion therapy). In this study we have (1) elicited patient preferences for benefits, side effects and process characteristics of treatments and (2) measured patients’ preferred and perceived involvement in decision-making about treatment. Methods Preferences were elicited using a best-worst scaling case 2 experiment. Attributes were selected based on 18 patient-interviews: treatment modality, tremor, slowness of movement, posture and balance problems, drowsiness, dizziness, and dyskinesia. Subsequently, a questionnaire was distributed in which patients were asked to indicate the most and least desirable attribute in nine possible treatment scenarios. Conditional logistic analysis and latent class analysis were used to estimate preference weights and identify subgroups. Patients also indicated their preferred and perceived degree of involvement in treatment decision-making (ranging from active to collaborative to passive). Results Two preference patterns were found in the patient sample (N = 192). One class of patients focused largely on optimising the process of care, while the other class focused more on controlling motor-symptoms. Patients who had experienced advanced treatments, had a shorter disease duration, or were still employed were more likely to belong to the latter class. For both classes, the benefits of treatment were more influential than the described side effects. Furthermore, many patients (45%) preferred to take the lead in treatment decisions, however 10.8% perceived a more passive or collaborative role instead. Discussion Patients weighted the benefits and side effects of treatment differently, indicating there is no “one-size-fits-all” approach to choosing treatments. Moreover, many patients preferred an active role in decision-making about treatment. Both results stress the need for physicians to know what is important to patients and to share treatment decisions to ensure that patients receive the treatment that aligns with their preferences. PMID:27575744

Beyond Depression: Towards a Process-Based Approach to Research, Diagnosis, and Treatment.

PubMed

Forgeard, Marie J C; Haigh, Emily A P; Beck, Aaron T; Davidson, Richard J; Henn, Fritz A; Maier, Steven F; Mayberg, Helen S; Seligman, Martin E P

2011-12-01

Despite decades of research on the etiology and treatment of depression, a significant proportion of the population is affected by the disorder, fails to respond to treatment and is plagued by relapse. Six prominent scientists, Aaron Beck, Richard Davidson, Fritz Henn, Steven Maier, Helen Mayberg, and Martin Seligman, gathered to discuss the current state of scientific knowledge on depression, and in particular on the basic neurobiological and psychopathological processes at play in the disorder. These general themes were addressed: 1) the relevance of learned helplessness as a basic process involved in the development of depression; 2) the limitations of our current taxonomy of psychological disorders; 3) the need to work towards a psychobiological process-based taxonomy; and 4) the clinical implications of implementing such a process-based taxonomy.

Beyond Depression: Towards a Process-Based Approach to Research, Diagnosis, and Treatment

PubMed Central

Forgeard, Marie J. C.; Haigh, Emily A. P.; Beck, Aaron T.; Davidson, Richard J.; Henn, Fritz A.; Maier, Steven F.; Mayberg, Helen S.; Seligman, Martin E. P.

2012-01-01

Despite decades of research on the etiology and treatment of depression, a significant proportion of the population is affected by the disorder, fails to respond to treatment and is plagued by relapse. Six prominent scientists, Aaron Beck, Richard Davidson, Fritz Henn, Steven Maier, Helen Mayberg, and Martin Seligman, gathered to discuss the current state of scientific knowledge on depression, and in particular on the basic neurobiological and psychopathological processes at play in the disorder. These general themes were addressed: 1) the relevance of learned helplessness as a basic process involved in the development of depression; 2) the limitations of our current taxonomy of psychological disorders; 3) the need to work towards a psychobiological process-based taxonomy; and 4) the clinical implications of implementing such a process-based taxonomy. PMID:22509072

Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce confounding in mediation investigations.

PubMed

Landau, Sabine; Emsley, Richard; Dunn, Graham

2018-06-01

Random allocation avoids confounding bias when estimating the average treatment effect. For continuous outcomes measured at post-treatment as well as prior to randomisation (baseline), analyses based on (A) post-treatment outcome alone, (B) change scores over the treatment phase or (C) conditioning on baseline values (analysis of covariance) provide unbiased estimators of the average treatment effect. The decision to include baseline values of the clinical outcome in the analysis is based on precision arguments, with analysis of covariance known to be most precise. Investigators increasingly carry out explanatory analyses to decompose total treatment effects into components that are mediated by an intermediate continuous outcome and a non-mediated part. Traditional mediation analysis might be performed based on (A) post-treatment values of the intermediate and clinical outcomes alone, (B) respective change scores or (C) conditioning on baseline measures of both intermediate and clinical outcomes. Using causal diagrams and Monte Carlo simulation, we investigated the performance of the three competing mediation approaches. We considered a data generating model that included three possible confounding processes involving baseline variables: The first two processes modelled baseline measures of the clinical variable or the intermediate variable as common causes of post-treatment measures of these two variables. The third process allowed the two baseline variables themselves to be correlated due to past common causes. We compared the analysis models implied by the competing mediation approaches with this data generating model to hypothesise likely biases in estimators, and tested these in a simulation study. We applied the methods to a randomised trial of pragmatic rehabilitation in patients with chronic fatigue syndrome, which examined the role of limiting activities as a mediator. Estimates of causal mediation effects derived by approach (A) will be biased if one of the three processes involving baseline measures of intermediate or clinical outcomes is operating. Necessary assumptions for the change score approach (B) to provide unbiased estimates under either process include the independence of baseline measures and change scores of the intermediate variable. Finally, estimates provided by the analysis of covariance approach (C) were found to be unbiased under all the three processes considered here. When applied to the example, there was evidence of mediation under all methods but the estimate of the indirect effect depended on the approach used with the proportion mediated varying from 57% to 86%. Trialists planning mediation analyses should measure baseline values of putative mediators as well as of continuous clinical outcomes. An analysis of covariance approach is recommended to avoid potential biases due to confounding processes involving baseline measures of intermediate or clinical outcomes, and not simply for increased precision.

Ammonium removal pathways and microbial community in GAC-sand dual media filter in drinking water treatment.

PubMed

Feng, Shuo; Xie, Shuguang; Zhang, Xiaojian; Yang, Zhiyu; Ding, Wei; Liao, Xiaobin; Liu, Yuanyuan; Chen, Chao

2012-01-01

A GAC-sand dual media filter (GSF) was devised as an alternative solution for drinking water treatment plant to tackle the raw water polluted by ammonium in place of expensive ozone-GAC processes or bio-pretreatments. The ammonium removal pathways and microbial community in the GSFs were investigated. The concentrations of ammonium, nitrite and nitrate nitrogen were monitored along the filter. Total inorganic nitrogen (TIN) loss occurred during the filtration. For 1 mg ammonium removal, the TIN loss was as high as 0.35 mg, DO consumption was 3.06 mg, and alkalinity consumption was 5.55 mg. It was assumed that both nitrification and denitrification processes occur in the filters to fit the TIN loss and low DO consumption. During the filtration, nitritation, nitrification and nitritation-anaerobic ammonium oxidation processes probably occur, while traditional nitrification and denitrification and simultaneous nitrification and denitrification processes may occur. In the GSFs, Nitrosomonas and Nitrospira are likely to be involved in nitrification processes, while Novosphingobium, Comamonadaceae and Oxalobacteraceae may be involved in denitrification processes.

What is a “good” treatment decision?: Decisional control, knowledge, treatment decision-making, and quality of life in men with clinically localized prostate cancer

PubMed Central

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J.; Homish, D. Lynn

2016-01-01

Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. PMID:26957566

What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer.

PubMed

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J; Homish, D Lynn

2016-08-01

We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. © The Author(s) 2016.

Improved mechanical properties of retorted carrots by ultrasonic pre-treatments.

PubMed

Day, Li; Xu, Mi; Øiseth, Sofia K; Mawson, Raymond

2012-05-01

The use of ultrasound pre-processing treatment, compared to blanching, to enhance mechanical properties of non-starchy cell wall materials was investigated using carrot as an example. The mechanical properties of carrot tissues were measured by compression and tensile testing after the pre-processing treatment prior to and after retorting. Carrot samples ultrasound treated for 10 min at 60 °C provided a higher mechanical strength (P<0.05) to the cell wall structure than blanching for the same time period. With the addition of 0.5% CaCl(2) in the pre-treatment solution, both blanching and ultrasound treatment showed synergistic effect on enhancing the mechanical properties of retorted carrot pieces. At a relatively short treatment time (10 min at 60 °C) with the use of 0.5% CaCl(2), ultrasound treatment achieved similar enhancement to the mechanical strength of retorted carrots to blanching for a much longer time period (i.e. 40 min). The mechanism involved appears to be related to the stress responses present in all living plant matter. However, there is a need to clarify the relative importance of the potential stress mechanisms in order to get a better understanding of the processing conditions likely to be most effective. The amount of ultrasound treatment required is likely to involve low treatment intensities and there are indications from the structural characterisation and mechanical property analyses that the plant cell wall tissues were more elastic than that accomplished using low temperature long time blanching. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian Locality of the International Triple Frontier

PubMed Central

Silva-Sobrinho, Reinaldo Antonio; Wysocki, Anneliese Domingues; Scatena, Lúcia Marina; Pinto, Erika Simone Galvão; Beraldo, Aline Ale; Andrade, Rubia Laine Paula; Zilly, Adriana; Munhak da Silva, Rosane Meire; Gomes, Michela Prestes; Mayer, Paulo César Morales; Ruffino-Netto, Antonio; Villa, Tereza Cristina Scatena

2017-01-01

Objective: To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a triple international border municipality. Methods: The present study was an evaluative survey of cross-sectional and quantitative approach conducted with 225 PHC healthcare professionals. Data was collected through a structured and validated instrument, which provided five indicators of "structure" and four indicators of "process" classified as unsatisfactory, regular or satisfactory. Results: The "structure" component was unsatisfactory for the indicator of professionals involved in TB care and training, and regular for the indicator of connection between the units and other levels of care. The "process" component was regular for the indicators of TB information, directly observed treatment and reference and counter reference on TB, and unsatisfactory for external actions on TB control. Conclusion: The "structure" and "process" components points out some weaknesses in terms of management and organization of human resources. Low frequency of training and the turnover influenced the involvement of professionals. Elements of "structure" and "process" show the need for investing in the PHC team and improving the clinical management of cases. PMID:29204229

Neuromodulatory treatments for chronic pain: efficacy and mechanisms

PubMed Central

Jensen, Mark P.; Day, Melissa A.; Miró, Jordi

2017-01-01

Chronic pain is common, and the available treatments do not provide adequate relief for most patients. Neuromodulatory interventions that modify brain processes underlying the experience of pain have the potential to provide substantial relief for some of these patients. The purpose of this Review is to summarize the state of knowledge regarding the efficacy and mechanisms of noninvasive neuromodulatory treatments for chronic pain. The findings provide support for the efficacy and positive side-effect profile of hypnosis, and limited evidence for the potential efficacy of meditation training, noninvasive electrical stimulation procedures, and neurofeedback procedures. Mechanisms research indicates that hypnosis influences multiple neurophysiological processes involved in the experience of pain. Evidence also indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain. Less is known about the mechanisms of other neuromodulatory treatments. On the basis of the data discussed in this Review, training in the use of self-hypnosis might be considered a viable ‘first-line’ approach to treat chronic pain. More-definitive research regarding the benefits and costs of meditation training, noninvasive brain stimulation and neurofeedback is needed before these treatments can be recommended for the treatment of chronic pain. PMID:24535464

Neuromodulatory treatments for chronic pain: efficacy and mechanisms.

PubMed

Jensen, Mark P; Day, Melissa A; Miró, Jordi

2014-03-01

Chronic pain is common, and the available treatments do not provide adequate relief for most patients. Neuromodulatory interventions that modify brain processes underlying the experience of pain have the potential to provide substantial relief for some of these patients. The purpose of this Review is to summarize the state of knowledge regarding the efficacy and mechanisms of noninvasive neuromodulatory treatments for chronic pain. The findings provide support for the efficacy and positive side-effect profile of hypnosis, and limited evidence for the potential efficacy of meditation training, noninvasive electrical stimulation procedures, and neurofeedback procedures. Mechanisms research indicates that hypnosis influences multiple neurophysiological processes involved in the experience of pain. Evidence also indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain. Less is known about the mechanisms of other neuromodulatory treatments. On the basis of the data discussed in this Review, training in the use of self-hypnosis might be considered a viable 'first-line' approach to treat chronic pain. More-definitive research regarding the benefits and costs of meditation training, noninvasive brain stimulation and neurofeedback is needed before these treatments can be recommended for the treatment of chronic pain.

Improving quality of care in substance abuse treatment using five key process improvement principles

PubMed Central

Hoffman, Kim A.; Green, Carla A.; Ford, James H.; Wisdom, Jennifer P.; Gustafson, David H.; McCarty, Dennis

2012-01-01

Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: 1) Understand and involve the customer; 2) Fix key problems; 3) Pick a powerful change leader; 4) Get ideas from outside the organization; and 5) Use rapid-cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate application of each principle. Results suggest that the most successful organizations integrate and apply most, if not all, of the five principles as they develop and test change strategies. PMID:22282129

Advanced Oxidation Processes: Process Mechanisms, Affecting Parameters and Landfill Leachate Treatment.

PubMed

Su-Huan, Kow; Fahmi, Muhammad Ridwan; Abidin, Che Zulzikrami Azner; Soon-An, Ong

2016-11-01

  Advanced oxidation processes (AOPs) are of special interest in treating landfill leachate as they are the most promising procedures to degrade recalcitrant compounds and improve the biodegradability of wastewater. This paper aims to refresh the information base of AOPs and to discover the research gaps of AOPs in landfill leachate treatment. A brief overview of mechanisms involving in AOPs including ozone-based AOPs, hydrogen peroxide-based AOPs and persulfate-based AOPs are presented, and the parameters affecting AOPs are elaborated. Particularly, the advancement of AOPs in landfill leachate treatment is compared and discussed. Landfill leachate characterization prior to method selection and method optimization prior to treatment are necessary, as the performance and practicability of AOPs are influenced by leachate matrixes and treatment cost. More studies concerning the scavenging effects of leachate matrixes towards AOPs, as well as the persulfate-based AOPs in landfill leachate treatment, are necessary in the future.

The Involvement of a Concerned Significant Other in Gambling Disorder Treatment Outcome.

PubMed

Jiménez-Murcia, Susana; Tremblay, Joël; Stinchfield, Randy; Granero, Roser; Fernández-Aranda, Fernando; Mestre-Bach, Gemma; Steward, Trevor; Del Pino-Gutiérrez, Amparo; Baño, Marta; Moragas, Laura; Aymamí, Neus; Gómez-Peña, Mónica; Tárrega, Salomé; Valenciano-Mendoza, Eduardo; Giroux, Isabelle; Sancho, Marta; Sánchez, Isabel; Mallorquí-Bagué, Núria; González, Vega; Martín-Romera, Virginia; Menchón, José M

2017-09-01

Interpersonal distress is a common feature in gambling disorder and adding a concerned significant other (CSO) to the recovery process could be an effective tool for improving treatment outcome. However, little empirical evidence is available regarding the effectiveness of including a CSO to interventions. We aimed to compare treatment outcomes (i.e. compliance with therapy guidelines, dropout from treatment, and relapse during treatment) in a CBT program involving a CSO to CBT treatment as usual (TAU) without a CSO. The sample comprised male gambling disorder patients (N = 675). The manualized CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. Patient CSOs attended a predetermined number of sessions with the patient and were provided with resources to acquire a better understanding of the disorder, to manage risk situations, and to aid patients in adhering to treatment guidelines. Patients with a CSO had significant higher treatment attendance and reduced dropout compared to patients receiving TAU. Moreover, patients whose spouse was involved in the treatment program were less likely to relapse and adhered to the treatment guidelines more than those with a non-spousal CSO. Our results suggest that incorporating interpersonal support to gambling disorder interventions could potentially improve treatment outcomes.

Pharmacological Treatment Effects on Eye Movement Control

ERIC Educational Resources Information Center

Reilly, James L.; Lencer, Rebekka; Bishop, Jeffrey R.; Keedy, Sarah; Sweeney, John A.

2008-01-01

The increasing use of eye movement paradigms to assess the functional integrity of brain systems involved in sensorimotor and cognitive processing in clinical disorders requires greater attention to effects of pharmacological treatments on these systems. This is needed to better differentiate disease and medication effects in clinical samples, to…

Recruiting patients to clinical trials: lessons from studies of growth hormone treatment in renal failure.

PubMed

Postlethwaite, R J; Reynolds, J M; Wood, A J; Evans, J H; Lewis, M A; Eminson, D M

1995-07-01

Issues raised by the recruitment of children to trials of growth hormone treatment for short stature in chronic renal failure are reported. Information needs of parents and children are discussed, the latter should take account of the children's developmental level and anticipated involvement in decision making. When the incidence of certain side effects is low and probably unquantifiable there are particular problems; failure to include these in information sheets may compromise informed consent but inclusion will, at least for some families, make an already difficult decision even more complicated. A process of recruitment is described which attempts to protect against bias and which balances the requirement to impart neutral information with appropriate clinical involvement in the decision to enter the study. Other functions of the recruitment process are identified. Analysis of understanding and decision making demonstrates that good understanding is neither necessary nor sufficient for ease of decision making. The recruitment process was time consuming and needs planning and funding in future studies. Many of these issues are of general importance for trials of treatment in children.

Multiple calmodulin-like proteins in Arabidopsis are induced by insect-derived (Spodoptera littoralis) oral secretion

PubMed Central

Vadassery, Jyothilakshmi; Scholz, Sandra S.; Mithöfer, Axel

2012-01-01

In plant cells, diverse environmental changes often induce transient elevation in the intracellular calcium concentrations, which are involved in signaling pathways leading to the respective cellular reactions. Therefore, these calcium elevations need to be deciphered into specific downstream responses. Calmodulin-like-proteins (CMLs) are calcium-sensing proteins present only in higher plants. They are involved in signaling processes induced by both abiotic as well as biotic stress factors. However, the role of CMLs in the interaction of plants with herbivorous insects is almost unknown. Here we show that in Arabidopsis thaliana a number of CMLs genes (CML9, 11,12,16,17 and 23) are upregulated due to treatments with oral secretion of larvae of the herbivorous insect Spodoptera littoralis. We identified that these genes belong to two groups that respond with different kinetics to the treatment with oral secretion. Our data indicate that signaling networks involving multiple CMLs very likely have important functions in plant defense against insect herbivores, in addition to their involvement in many other stress-induced processes in plants. PMID:22902684

Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions.

PubMed

Blevins, Claire E; Rawat, Nishi; Stein, Michael D

2018-05-07

The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increased demand for treatment, however, is not being met by a corresponding increase in access to or availability of treatment. This report focuses specifically on the treatment referral process, which we have identified as 1 of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (ie, referral source) and individuals who work in substance use disorder facilities (ie, referral recipient). Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n = 59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures. Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then proposed several solutions to address specific barriers. Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.

Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study.

PubMed

Puts, Martine T E; Sattar, Schroder; McWatters, Kara; Lee, Katherine; Kulik, Michael; MacDonald, Mary-Ellen; Jang, Raymond; Amir, Eitan; Krzyzanowska, Monika K; Leighl, Natasha; Fitch, Margaret; Joshua, Anthony M; Warde, Padraig; Tourangeau, Ann E; Alibhai, Shabbir M H

2017-03-01

Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70-79 and 80+). All interviews were analyzed using thematic analysis. There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists' opinion. "Trust in my oncologist" and "chemotherapy as the last resort to prolong life" were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved. This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the older adult's or their family members' decision.

Psychotherapy: The Humanistic (and Effective) Treatment

ERIC Educational Resources Information Center

Wampold, Bruce E.

2007-01-01

Although it is well established that psychotherapy is remarkably effective, the change process in psychotherapy is not well understood. Psychotherapy is compared with medicine and cultural healing practices to argue that critical aspects of psychotherapy involve human processes that are used in religious, spiritual, and cultural healing practices.…

Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders.

PubMed

Del Valle Del Valle, Gema; Carrió, Carmen; Belloch, Amparo

2017-10-09

Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking. A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed. The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables. The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

Lagochilascariasis leading to severe involvement of ocular globes, ears and meninges.

PubMed

Aquino, Renata T R; Magliari, Maria E R; Vital Filho, José; Silva, Maria A L G; Lima, Carlos A da Conceição; Rocha, Antonio J; Silva, Carlos J; Rewin, Jonathan A; Nahas, Tatiana R; Chieffi, Pedro Paulo

2008-01-01

A case report of a 31 year-old woman from Paraíba State (North-Eastern Brazil) that presented severe involvement of ocular globes, ears and meninges. Diagnosis was established after enucleation of her left eye, when adult worms were seen in the midst of a granulomatous inflammatory process. Her response to the initial treatment with levamisole and cambendazole was good, but there was a relapse after the fifth month of treatment even with maintenance doses of both medications. She later received ivermectin and albendazol and responded well.

Treating Substance Use Disorders in the Criminal Justice System

PubMed Central

Hiller, Matthew; Hamilton, Leah

2013-01-01

The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders. PMID:24132733

Process for guidance, containment, treatment, and imaging in a subsurface environment utilizing ferro-fluids

DOEpatents

Moridis, George J.; Oldenburg, Curtis M.

2001-01-01

Disclosed are processes for monitoring and control of underground contamination, which involve the application of ferrofluids. Two broad uses of ferrofluids are described: (1) to control liquid movement by the application of strong external magnetic fields; and (2) to image liquids by standard geophysical methods.

Strength enhancement process for prealloyed powder superalloys

NASA Technical Reports Server (NTRS)

Waters, W. J.; Freche, J. C.

1977-01-01

A technique involving superplastic processing and high pressure autoclaving was applied to a nickel base prealloyed powder alloy. Tensile strengths as high as 2865 MN/sq m at 480 C were obtained with as-superplastically deformed material. Appropriate treatments yielding materials with high temperature tensile and stress rupture strengths were also devised.

An ecological vegetation-activated sludge process (V-ASP) for decentralized wastewater treatment: system development, treatment performance, and mathematical modeling.

PubMed

Yuan, Jiajia; Dong, Wenyi; Sun, Feiyun; Li, Pu; Zhao, Ke

2016-05-01

An environment-friendly decentralized wastewater treatment process that is comprised of activated sludge process (ASP) and wetland vegetation, named as vegetation-activated sludge process (V-ASP), was developed for decentralized wastewater treatment. The long-term experimental results evidenced that the vegetation sequencing batch reactor (V-SBR) process had consistently stable higher removal efficiencies of organic substances and nutrients from domestic wastewater compared with traditional sequencing batch reactor (SBR). The vegetation allocated into V-SBR system could not only remove nutrients through its vegetation transpiration ratio but also provide great surface area for microorganism activity enhancement. This high vegetation transpiration ratio enhanced nutrients removal effectiveness from wastewater mainly by flux enhancement, oxygen and substrate transportation acceleration, and vegetation respiration stimulation. A mathematical model based on ASM2d was successfully established by involving the specific function of vegetation to simulate system performance. The simulation results on the influence of operational parameters on V-ASP treatment effectiveness demonstrated that V-SBR had a high resistance to seasonal temperature fluctuations and influent loading shocking.

A neuroimaging study of emotion-cognition interaction in schizophrenia: the effect of ziprasidone treatment.

PubMed

Stip, Emmanuel; Cherbal, Adel; Luck, David; Zhornitsky, Simon; Bentaleb, Lahcen Ait; Lungu, Ovidiu

2017-04-01

Functional and structural brain changes associated with the cognitive processing of emotional visual stimuli were assessed in schizophrenic patients after 16 weeks of antipsychotic treatment with ziprasidone. Forty-five adults aged 18 to 40 were recruited: 15 schizophrenia patients (DSM-IV criteria) treated with ziprasidone (mean daily dose = 120 mg), 15 patients treated with other antipsychotics, and 15 healthy controls who did not receive any medication. Functional and structural neuroimaging data were acquired at baseline and 16 weeks after treatment initiation. In each session, participants selected stimuli, taken from standardized sets, based on their emotional valence. After ziprasidone treatment, several prefrontal regions, typically involved in cognitive control (anterior cingulate and ventrolateral prefrontal cortices), were significantly activated in patients in response to positive versus negative stimuli. This effect was greater whenever they had to select negative compared to positive stimuli, indicating an asymmetric effect of cognitive treatment of emotionally laden information. No such changes were observed for patients under other antipsychotics. In addition, there was an increase in the brain volume commonly recruited by healthy controls and patients under ziprasidone, in response to cognitive processing of emotional information. The structural analysis showed no significant changes in the density of gray and white matter in ziprasidone-treated patients compared to patients receiving other antipsychotic treatments. Our results suggest that functional changes in brain activity after ziprasidone medication precede structural and clinical manifestations, as markers that the treatment is efficient in restoring the functionality of prefrontal circuits involved in processing emotionally laden information in schizophrenia.

Predictors of affect following treatment decision-making for prostate cancer: conversations, cognitive processing, and coping.

PubMed

Christie, Kysa M; Meyerowitz, Beth E; Giedzinska-Simons, Antoinette; Gross, Mitchell; Agus, David B

2009-05-01

Research suggests that cancer patients who are more involved in treatment decision-making (TDM) report better quality of life following treatment. This study examines the association and possible mechanisms between prostate cancer patient's discussions about TDM and affect following treatment. We predicted that the length of time patients spent discussing treatment options with social networks and physicians prior to treatment would predict emotional adjustment after treatment. We further predicted that cognitive processing, coping, and patient understanding of treatment options would mediate this association. Fifty-seven patients completed questionnaires prior to treatment and at 1 and 6 months following treatment completion. Findings from the present study suggest that discussing treatment options with others, prior to beginning treatment for prostate cancer, significantly contributed to improvements in affect 1 and 6 months following treatment. Residualized regression analyses indicated that discussing treatment options with patient's social networks predicted a decrease in negative affect 1 and 6 months following treatment, while discussions with physicians predicted an increase in positive affect 1 month following treatment. Patients who spent more time discussing treatment options with family and friends also reported greater pre-treatment social support and emotional expression. Mediation analyses indicated that these coping strategies facilitated cognitive processing (as measured by a decrease in intrusive thoughts) and that cognitive processing predicted improvement in affect. Greater time spent talking with family and friends about treatment options may provide opportunities for patients to cope with their cancer diagnosis and facilitate cognitive processing, which may improve patient distress over time. Copyright (c) 2008 John Wiley & Sons Ltd.

Aftercare Guidelines for Drug and Alcohol Program Advisors

DTIC Science & Technology

1991-10-21

recovery process . Aftercare is the most critical part of this process ensuring productivity and maximization of resources. OPNAV Instruction 5350G-4...Aftercare is not a stand-alone program, it is part of a process . This process includes: (1) the harmful involvement with alcohol or other drugs or...she should understand all of the process . Three Phases The first three years after initial treatment are considered the most critical. Three phases take

A Novel Nonelectrolytic Process for Chromium and Nickel Coating

DTIC Science & Technology

2015-06-01

thermal spraying and involves similar protocols for coating an object. The process proceeds after powder is injected into a plasma jet then superheated...HVOF) High velocity oxygen fuel coating is characteristic of a thermal spray coating process , enhancing anti-corrosion and anti-wear properties of...observations due to limited metal deposition on the surface during treatment. No powder particles were produced during this RES process . a. Optical

Substance use disorder patients who are mandated to treatment: characteristics, treatment process, and 1- and 5-year outcomes.

PubMed

Kelly, John F; Finney, John W; Moos, Rudolf

2005-04-01

A substantial number of patients with substance use disorders (SUDs) are mandated to treatment by the justice system. However, little is known about their characteristics and how they fare during treatment and in the longer term compared with nonmandated, justice-system-involved patients and patients not involved in the justice system. This prospective study (n=2,095) examined differences in pretreatment characteristics, treatment perceptions and satisfaction, during-treatment changes, and 1- and 5-year outcomes among these three types of patients and tested whether differences in pretreatment characteristics or during-treatment changes could help explain posttreatment outcome similarities or differences. Mandated patients had a less severe clinical profile at treatment intake, yet this did not account for their observed similar/better outcomes, which appeared because of the similar therapeutic gains made during treatment. Treatment perceptions and satisfaction were also comparable across groups. These findings appear to support the idea that judicial mandates can provide an opportunity for offenders with SUDs to access and benefit from needed treatment.

Psychological pain interventions and neurophysiology: implications for a mechanism-based approach.

PubMed

Flor, Herta

2014-01-01

This article provides an illustrative overview of neurophysiological changes related to acute and chronic pain involving structural and functional brain changes, which might be the targets of psychological interventions. A number of psychological pain treatments have been examined with respect to their effects on brain activity, ranging from cognitive- and operant behavioral interventions, meditation and hypnosis, to neuro- and biofeedback, discrimination training, imagery and mirror treatment, as well as virtual reality and placebo applications. These treatments affect both ascending and descending aspects of pain processing and act through brain mechanisms that involve sensorimotor areas as well as those involved in affective-motivational and cognitive-evaluative aspects. The analysis of neurophysiological changes related to effective psychological pain treatment can help to identify subgroups of patients with chronic pain who might profit from different interventions, can aid in predicting treatment outcome, and can assist in identifying responders and nonresponders, thus enhancing the efficacy and efficiency of psychological interventions. Moreover, new treatment targets can be developed and tested. Finally, the use of neurophysiological measures can also aid in motivating patients to participate in psychological interventions and can increase their acceptance in clinical practice. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Insights into the Molecular Events That Regulate Heat-Induced Chilling Tolerance in Citrus Fruits.

PubMed

Lafuente, María T; Establés-Ortíz, Beatriz; González-Candelas, Luis

2017-01-01

Low non-freezing temperature may cause chilling injury (CI), which is responsible for external quality deterioration in many chilling-sensitive horticultural crops. Exposure of chilling-sensitive citrus cultivars to non-lethal high-temperature conditioning may increase their chilling tolerance. Very little information is available about the molecular events involved in such tolerance. In this work, the molecular events associated with the low temperature tolerance induced by heating Fortune mandarin, which is very sensitive to chilling, for 3 days at 37°C prior to cold storage is presented. A transcriptomic analysis reveals that heat-conditioning has an important impact favoring the repression of genes in cold-stored fruit, and that long-term heat-induced chilling tolerance is an active process that requires activation of transcription factors involved in transcription initiation and of the WRKY family. The analysis also shows that chilling favors degradation processes, which affect lipids and proteins, and that the protective effect of the heat-conditioning treatment is more likely to be related to the repression of the genes involved in lipid degradation than to the modification of fatty acids unsaturation, which affects membrane permeability. Another major factor associated with the beneficial effect of the heat treatment on reducing CI is the regulation of stress-related proteins. Many of the genes that encoded such proteins are involved in secondary metabolism and in oxidative stress-related processes.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study

PubMed Central

Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-01-01

Objectives Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Design Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Setting Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Participants Purposeful sample of 10 patients with a diagnosis of cancer–dementia, informal caregivers (n=9) and oncology HCPs (n=12). Results Four themes were identified: (1) leading to the initial consultation—HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information—informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care—patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment—there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Conclusions Although patients with cancer–dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. PMID:29654025

Shallow processing of ambiguous pronouns: evidence for delay.

PubMed

Stewart, Andrew J; Holler, Judith; Kidd, Evan

2007-12-01

Two self-paced reading-time experiments examined how ambiguous pronouns are interpreted under conditions that encourage shallow processing. In Experiment 1 we show that sentences containing ambiguous pronouns are processed at the same speed as those containing unambiguous pronouns under shallow processing, but more slowly under deep processing. We outline three possible models to account for the shallow processing of ambiguous pronouns. Two involve an initial commitment followed by possible revision, and the other involves a delay in interpretation. In Experiment 2 we provide evidence that supports the delayed model of ambiguous pronoun resolution under shallow processing. We found no evidence to support a processing system that makes an initial commitment to an interpretation of the pronoun when it is encountered. We extend the account of pronoun resolution proposed by Rigalleau, Caplan, and Baudiffier (2004) to include the treatment of ambiguous pronouns under shallow processing.

Family involvement for breast cancer decision making among Chinese-American women.

PubMed

Lee, Shiuyu Katie C; Knobf, M Tish

2016-12-01

To describe family involvement in decision making for primary treatment in Chinese-American women with early-stage breast cancer. Qualitative data were collected in 2003 from semi-structured questions in interviews with a sample of Chinese-American (ChA) women with breast cancer, who were recruited from the metropolitan New York area. Responses to the questions were written in Chinese immediately during the interview and read back to the subject for accuracy and validation. Content analysis was used to inductively code and analyze the data to generate themes. The participants consisted of 123 ChA women with early stage breast cancer with a mean age of 48.7 years (±9.3) and who had lived in the United States a median of 13.6 years. Support and Caring was the major theme that described family involvement in the breast cancer decision-making process. Gathering Information, Being There, Navigating the Health Care System, Maintaining Family Life and Making the Decision described the aspects of family support in the process. The majority of women described the treatment decision making as a collaborative supportive process with the family, but limited English fluency, strong opinions, lack of a shared perspective, distant living proximity and competing work responsibilities of family members were stressful for the women and perceived as non-supportive. Family involvement in health care decision making is culturally embedded in Asian populations. Culturally sensitive patient and family consultation strategies are needed to assist informed treatment decision making in Chinese-American women diagnosed with breast cancer. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Constraints on Enhanced Extinction Resulting from Extinction Treatment in the Presence of an Added Excitor

ERIC Educational Resources Information Center

Urcelay, Gonzalo P.; Lipatova, Olga; Miller, Ralph R.

2009-01-01

Three Pavlovian fear conditioning experiments with rats as subjects explored the effect of extinction in the presence of a concurrent excitor. Our aim was to explore this particular treatment, documented in previous studies to deepen extinction, with novel control groups to shed light on the processes involved in extinction. Relative to subjects…

Parental Factors that Detract from the Effectiveness of Cognitive-Behavioral Treatment for Childhood Anxiety: Recommendations for Practitioners

ERIC Educational Resources Information Center

Walker, Jerry V., III

2012-01-01

This article reviews the recent empirical literature on the various parental factors that detract from the effectiveness of cognitive-behavioral treatment for children with anxiety. Interventions such as treating parental anxiety and increasing parental involvement in the therapeutic process may combat these factors. Newer strategies such as…

Oxidation of atrazine in aqueous media by solar- enhanced Fenton-like process involving persulfate and ferrous ion.

PubMed

Khandarkhaeva, Marina; Batoeva, Agniya; Aseev, Denis; Sizykh, Marina; Tsydenova, Oyuna

2017-03-01

The oxidation of s-triazines (using atrazine (ATZ) as a model compound) by a solar-enhanced Fenton-like process involving persulfate and ferrous ion was studied. A flow-through tubular photoreactor was employed for the experiments. The solar-enhanced oxidative system involving ferrous ion and persulfate (Solar/S 2 O 8 2- /Fe 2+ ) showed the highest ATZ degradation efficiency when compared with other treatments (unactivated S 2 O 8 2- , Solar - sunlight only, S 2 O 8 2- /Fe 2+ , Solar/S 2 O 8 2- ). Complete degradation of ATZ and 20% reduction in total organic carbon (TOC) content were observed after 30min of the treatment. The in situ generated • ОН and SO 4 -• radicals were shown to be involved in ATZ oxidation using the radical scavengers methanol and tert-butyl alcohol. Furthermore, iron compounds were shown to act not only as catalysts but also as photo-sensitizers, as the introduction of ferrous ion into the reaction mixture led to an increased absorbance of the solution and expansion of the absorption spectrum into the longer wavelength spectral region. Copyright © 2016 Elsevier Inc. All rights reserved.

The Use of Outcome Mapping in the Educational Context

ERIC Educational Resources Information Center

Lewis, Anna

2014-01-01

Outcome Mapping is intended to measure the process by which change occurs, it shifts away from the products of the program to focus on changes in behaviors, relationships, actions, and/or activities of the people involved in the treatment program. This process-oriented methodology, most often used in designing and evaluating community development…

Titration in the treatment of the more troubled patient.

PubMed

Winer, J A; Ornstein, E D

2001-01-01

This article defines and discusses a modification of technique recommended by the authors in the psychoanalytic treatment of more troubled patients--a modification they call titration. Titration is defined as a conscious decision by the analyst to increase or decrease assistance (or gratification) gradually, in order to facilitate the analytic process. The authors emphasize the complexity of decisions in treatment by focusing on the decision-making processes that titration requires. Guidelines and a case vignette are presented. The authors conclude by considering some of the politics involved in the introduction of technique modifications, the salience of the titration concept, and directions for further exploration.

Enhancing exposure therapy for anxiety disorders with glucocorticoids: from basic mechanisms of emotional learning to clinical applications.

PubMed

Bentz, Dorothée; Michael, Tanja; de Quervain, Dominique J-F; Wilhelm, Frank H

2010-03-01

Current neurophysiological and psychological accounts view exposure therapy as the clinical analog of extinction learning that results in persistent modifications of the fear memory involved in the pathogenesis, symptomatology, and maintenance of anxiety disorders. Evidence from studies in animals and humans indicate that glucocorticoids have the potential to facilitate the processes that underlie extinction learning during exposure therapy. Particularly, glucocorticoids can restrict retrieval of previous aversive learning episodes and enhance consolidation of memory traces relating to non-fearful responding in feared situations. Thus, glucocorticoid treatment especially in combination with exposure therapy might be a promising approach to optimize treatment of anxiety disorders. This review examines the processes involved in aversive conditioning, fear learning and fear extinction, and how glucocorticoids might enhance restructuring of fear memories during therapy. Copyright 2009 Elsevier Ltd. All rights reserved.

HANDBOOK ON ADVANCED PHOTOCHEMICAL OXIDATION ...

EPA Pesticide Factsheets

This handbook summarizes commercial-scale system performance and cost data for advanced photochemical oxidation (APO) treatment of contaminated water, air, and solids. Similar information from pilot- and bench-scale evaluations of APO processes is also included to supplement the commercial-scale data. Performance and cost data is summarized for various APO processes, including vacuum ultraviolet (VUV) photolysis, ultraviolet (UV)/oxidation, photo-Fenton, and dye- or semiconductor-sensitized APO processes. This handbook is intended to assist engineering practitioners in evaluating the applicability of APO processes and in selecting one or more such processes for site-specific evaluation.APO has been shown to be effective in treating contaminated water and air. Regarding contaminated water treatment, UV/oxidation has been evaluated for the most contaminants, while VUV photolysis has been evaluated for the fewest. Regarding contaminated air treatment, the sensitized APO processes have been evaluated for the most contaminants, while VUV photolysis has been evaluated for the fewest.APO processes for treating contaminated solids generally involve treatment of contaminated slurry or leachate generated using an extraction process such as soil washing. APO has been shown to be effective in treating contaminated solids, primarily at the bench-scale level. Information

Semi-solid processing of high-chromium tool steel to obtain microstructures without carbide network

NASA Astrophysics Data System (ADS)

Jirková, H.; Aišman, D.; Rubešová, K.; Opatová, K.; Mašek, B.

2017-02-01

Treatment of high-alloy tool steels that involves transition to the semi-solid state can transform the sharp-edged primary carbides which usually form during solidification. These carbides severely impair toughness and are virtually impossible to eliminate by conventional treatment routes. Upon classical semi-solid processing which dissolves these carbides, the resulting microstructure consists of polyhedral and super-saturated austenite embedded in lamellar austenite-carbide network. This type of microstructure reflects in the mechanical properties, predominantly in material behaviour under tensile loading. Such a network, however, can be removed by appropriate thermomechanical treatment. In the present experiment, various procedures involving heating to the semi-solid state were tested on X210Cr12 tool steel. The feedstock was heated to the temperature range of 1220 - 1280 °C. The heating was followed by procedures involving either water quenching to the forming temperature, room temperature or temperature from the range from 500 °C to 1000 °C followed by reheating to the forming temperature. It was found that the development of the lamellar network strongly depends on the temperature of heating to semi-solid state. Thermomechanical treatment produced microstructures in which the matrix consisted of a mixture of polyhedral austenite grains and the M-A constituent. In addition, the initial lamellar eutectic network was partially or even completely melted and substituted with a mixture of very fine recrystallized austenite grains and precipitates of chromium carbides. Some fine M7C3 carbides were present in the austenitic-martensitic matrix as well. When appropriate processing parameters were chosen, very good mechanical properties were obtained, among them a hardness of 860 HV10.

Conceptual change strategies in teaching genetics

NASA Astrophysics Data System (ADS)

Batzli, Laura Elizabeth

The purpose of this study was to evaluate the effectiveness of utilizing conceptual change strategies when teaching high school genetics. The study examined the effects of structuring instruction to provide students with cognitive situations which promote conceptual change, specifically instruction was structured to elicit students' prior knowledge. The goal of the study was that the students would not only be able to solve genetics problems and define basic terminology but they would also have constructed more scientific schemas of the actual processes involved in inheritance. This study is based on the constructivist theory of learning and conceptual change research which suggest that students are actively involved in the process of relating new information to prior knowledge as they construct new knowledge. Two sections of biology II classes received inquiry based instruction and participated in structured cooperative learning groups. However, the unique difference in the treatment group's instruction was the use of structured thought time and the resulting social interaction between the students. The treatment group students' instructional design allowed students to socially construct their cognitive knowledge after elicitation of their prior knowledge. In contrast, the instructional design for the control group students allowed them to socially construct their cognitive knowledge of genetics without the individually structured thought time. The results indicated that the conceptual change strategies with individually structured thought time improved the students' scientific mastery of genetics concepts and they maintained fewer post instructional alternative conceptions. Although all students gained the ability to correctly solve genetics problems, the treatment group students were able to explain the processes involved in terms of meiosis. The treatment group students were also able to better apply their knowledge to novel genetic situations. The implications for genetics instruction from these results were discussed.

Effects of dextromethorphan/quinidine on auditory event-related potentials in multiple sclerosis patients with pseudobulbar affect.

PubMed

Haiman, Guy; Pratt, Hillel; Miller, Ariel

2009-10-01

The purpose of this study was to characterize the brain activity and associated cortical structures involved in pseudobulbar affect (PBA), a condition characterized by uncontrollable episodes of laughing and/or crying in patients with multiple sclerosis before and after treatment with dextromethorphan/quinidine (DM/Q). Behavioral responses and event-related potentials (ERPs) in response to subjectively significant and neutral verbal stimuli were recorded from 2 groups: 6 multiple sclerosis patients with PBA before (PBA-preTx) and after (PBA-DM/Q) treatment with DM/Q and 6 healthy control (HC) subjects. Statistical nonparametric mapping comparisons of ERP source current density distributions between groups were conducted for subjectively significant and neutral stimuli separately before and after treatment with DM/Q. Treatment with DM/Q had a normalizing effect on the behavioral responses of PBA patients. Event-related potential waveform comparisons of PBA-preTx and PBA-DM/Q with HC, for both neutral and subjectively significant stimuli, revealed effects on early ERP components. Comparisons between PBA-preTx and HC, in response to subjectively significant stimuli, revealed both early and late effects. Source analysis comparisons between PBA-preTx and PBA-DM/Q indicated distinct activations in areas involved in emotional processing and high-level and associative visual processing in response to neutral stimuli and in areas involved in emotional, somatosensory, primary, and premotor processing in response to subjectively significant stimuli. In most cases, stimuli evoked higher current density in PBA-DM/Q compared with the other groups. In conclusion, differences in brain activity were observed before and after medication. Also, DM/Q administration resulted in normalization of behavioral and electrophysiological measures.

Quantitative Proteomic Analysis of Mosquito C6/36 Cells Reveals Host Proteins Involved in Zika Virus Infection.

PubMed

Xin, Qi-Lin; Deng, Cheng-Lin; Chen, Xi; Wang, Jun; Wang, Shao-Bo; Wang, Wei; Deng, Fei; Zhang, Bo; Xiao, Gengfu; Zhang, Lei-Ke

2017-06-15

Zika virus (ZIKV) is an emerging arbovirus belonging to the genus Flavivirus of the family Flaviviridae During replication processes, flavivirus manipulates host cell systems to facilitate its replication, while the host cells activate antiviral responses. Identification of host proteins involved in the flavivirus replication process may lead to the discovery of antiviral targets. The mosquitoes Aedes aegypti and Aedes albopictus are epidemiologically important vectors for ZIKV, and effective restrictions of ZIKV replication in mosquitoes will be vital in controlling the spread of virus. In this study, an iTRAQ-based quantitative proteomic analysis of ZIKV-infected Aedes albopictus C6/36 cells was performed to investigate host proteins involved in the ZIKV infection process. A total of 3,544 host proteins were quantified, with 200 being differentially regulated, among which CHCHD2 can be upregulated by ZIKV infection in both mosquito C6/36 and human HeLa cells. Our further study indicated that CHCHD2 can promote ZIKV replication and inhibit beta interferon (IFN-β) production in HeLa cells, suggesting that ZIKV infection may upregulate CHCHD2 to inhibit IFN-I production and thus promote virus replication. Bioinformatics analysis of regulated host proteins highlighted several ZIKV infection-regulated biological processes. Further study indicated that the ubiquitin proteasome system (UPS) plays roles in the ZIKV entry process and that an FDA-approved inhibitor of the 20S proteasome, bortezomib, can inhibit ZIKV infection in vivo Our study illustrated how host cells respond to ZIKV infection and also provided a candidate drug for the control of ZIKV infection in mosquitoes and treatment of ZIKV infection in patients. IMPORTANCE ZIKV infection poses great threats to human health, and there is no FDA-approved drug available for the treatment of ZIKV infection. During replication, ZIKV manipulates host cell systems to facilitate its replication, while host cells activate antiviral responses. Identification of host proteins involved in the ZIKV replication process may lead to the discovery of antiviral targets. In this study, the first quantitative proteomic analysis of ZIKV-infected cells was performed to investigate host proteins involved in the ZIKV replication process. Bioinformatics analysis highlighted several ZIKV infection-regulated biological processes. Further study indicated that the ubiquitin proteasome system (UPS) plays roles in the ZIKV entry process and that an FDA-approved inhibitor of the UPS, bortezomib, can inhibit ZIKV infection in vivo Our study not only illustrated how host cells respond to ZIKV infection but also provided a candidate drug for the control of ZIKV infection in mosquitoes and treatment of ZIKV infection in patients. Copyright © 2017 American Society for Microbiology.

Melasma update

PubMed Central

Sarkar, Rashmi; Arora, Pooja; Garg, Vijay Kumar; Sonthalia, Sidharth; Gokhale, Narendra

2014-01-01

Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms “melasma, pathogenesis, etiology, diagnosis, treatment” and have included data of the last few years. PMID:25396123

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy.

PubMed

Edlmann, Ellie; Giorgi-Coll, Susan; Whitfield, Peter C; Carpenter, Keri L H; Hutchinson, Peter J

2017-05-30

Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.

Evolution of Patient Decision-Making Regarding Medical Treatment of Rheumatoid Arthritis.

PubMed

Mathews, Alexandra L; Coleska, Adriana; Burns, Patricia B; Chung, Kevin C

2016-03-01

The migration of health care toward a consumer-driven system favors increased patient participation during the treatment decision-making process. Patient involvement in treatment decision discussions has been linked to increased treatment adherence and patient satisfaction. Previous studies have quantified decision-making styles of patients with rheumatoid arthritis (RA); however, none of them have considered the evolution of patient involvement after living with RA for many years. We conducted a qualitative study to determine the decision-making model used by long-term RA patients, and to describe the changes in their involvement over time. Twenty participants were recruited from the ongoing Silicone Arthroplasty in Rheumatoid Arthritis study. Semistructured interviews were conducted and data were analyzed using grounded theory methodology. Nineteen out of 20 participants recalled using the paternalistic decision-making (PDM) model immediately following their diagnosis. Fourteen of the 19 participants who initially used PDM evolved to shared decision-making (SDM). Participants attributed the change in involvement to the development of a trusting relationship with their physician, as well as to becoming educated about the disease. When initially diagnosed with RA, patients may let their physician decide on the best treatment course. However, over time patients may evolve to exercise a more collaborative role. Physicians should understand that even within SDM, each patient can demonstrate a varied amount of autonomy. It is up to the physician to have a discussion with each patient to determine his or her desired level of involvement. © 2016, American College of Rheumatology.

Global transcriptome analysis of eukaryotic genes affected by gromwell extract.

PubMed

Bang, Soohyun; Lee, Dohyun; Kim, Hanhe; Park, Jiyong; Bahn, Yong-Sun

2014-02-01

Gromwell is known to have diverse pharmacological, cosmetic and nutritional benefits for humans. Nevertheless, the biological influence of gromwell extract (GE) on the general physiology of eukaryotic cells remains unknown. In this study a global transcriptome analysis was performed to identify genes affected by the addition of GE with Cryptococcus neoformans as the model system. In response to GE treatment, genes involved in signal transduction were immediately regulated, and the evolutionarily conserved sets of genes involved in the core cellular functions, including DNA replication, RNA transcription/processing and protein translation/processing, were generally up-regulated. In contrast, a number of genes involved in carbohydrate metabolism and transport, inorganic ion transport and metabolism, post-translational modification/protein turnover/chaperone functions and signal transduction were down-regulated. Among the GE-responsive genes that are also evolutionarily conserved in the human genome, the expression patterns of YSA1, TPO2, CFO1 and PZF1 were confirmed by northern blot analysis. Based on the functional characterization of some GE-responsive genes, it was found that GE treatment may promote cellular tolerance against a variety of environmental stresses in eukaryotes. GE treatment affects the expression levels of a significant portion of the Cryptococcus genome, implying that GE significantly affects the general physiology of eukaryotic cells. © 2013 Society of Chemical Industry.

Removal of polycyclic aromatic hydrocarbons in aqueous environment by chemical treatments: a review.

PubMed

Rubio-Clemente, Ainhoa; Torres-Palma, Ricardo A; Peñuela, Gustavo A

2014-04-15

Due to their carcinogenic, mutagenic and teratogenic potential, the removal of polycyclic aromatic hydrocarbons (PAHs) from aqueous environment using physical, biological and chemical processes has been studied by several researchers. This paper reviews the current state of knowledge concerning PAHs including their physico-chemical properties, input sources, occurrence, adverse effects and conventional and alternative chemical processes applied for their removal from water. The mechanisms and reactions involved in each treatment method are reported, and the effects of various variables on the PAH degradation rate as well as the extent of degradation are also discussed. Extensive literature analysis has shown that an effective way to perform the conversion and mineralization of this type of substances is the application of advanced oxidation processes (AOPs). Furthermore, combined processes, particularly AOPs coupled with biological treatments, seem to be one of the best solutions for the treatment of effluents containing PAHs. Copyright © 2013 Elsevier B.V. All rights reserved.

Geothermal injection treatment: Process chemistry, field experiences, and design options

NASA Astrophysics Data System (ADS)

Kindle, C. H.; Mercer, B. W.; Elmore, R. P.; Blair, S. C.; Myers, D. A.

1984-09-01

The successful development of geothermal reservoirs to generate electric power will require the injection disposal of approximately 700,000 gal/h (2,600,000 1/h) of heat depleted brine for every 50,000 kW of generating capacity. To maintain injectability, the spent brine must be compatible with the receiving formation. The factors that influence this brine/formation compatibility and tests to quantify them are discussed. Some form of treatment will be necessary prior to injection for most situations; the process chemistry involved to avoid and/or accelerate the formation of precipitate particles is also discussed. The treatment processes, either avoidance or controlled precipitation approaches, are described in terms of their principles and demonstrated applications in the geothermal field and, when such experience is limited, in other industrial use. Monitoring techniques for tracking particulate growth, the effect of process parameters on corrosion, and well injectability are presented. Examples of brine injection, preinjection treatment, and recovery from injectivity loss are examined and related to the aspects listed above.

[A systemic risk analysis of hospital management processes by medical employees--an effective basis for improving patient safety].

PubMed

Sobottka, Stephan B; Eberlein-Gonska, Maria; Schackert, Gabriele; Töpfer, Armin

2009-01-01

Due to the knowledge gap that exists between patients and health care staff the quality of medical treatment usually cannot be assessed securely by patients. For an optimization of safety in treatment-related processes of medical care, the medical staff needs to be actively involved in preventive and proactive quality management. Using voluntary, confidential and non-punitive systematic employee surveys, vulnerable topics and areas in patient care revealing preventable risks can be identified at an early stage. Preventive measures to continuously optimize treatment quality can be defined by creating a risk portfolio and a priority list of vulnerable topics. Whereas critical incident reporting systems are suitable for continuous risk assessment by detecting safety-relevant single events, employee surveys permit to conduct a systematic risk analysis of all treatment-related processes of patient care at any given point in time.

Treatment decision-making processes in the systemic treatment of ovarian cancer: review of the scientific evidence.

PubMed

Luketina, Hrvoje; Fotopoulou, Christina; Luketina, Ruzica-Rosalia; Pilger, Adak; Sehouli, Jalid

2012-09-01

The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer. The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC. The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician's personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organisations also seem to play a significant role in the treatment decision-making process. This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.

Production and dose determination of the Infection and Treatment Method (ITM) Muguga cocktail vaccine used to control East Coast fever in cattle.

PubMed

Patel, Ekta; Mwaura, Stephen; Kiara, Henry; Morzaria, Subhash; Peters, Andrew; Toye, Philip

2016-03-01

The Infection and Treatment Method (ITM) of vaccination against the apicomplexan parasite Theileria parva has been used since the early 1970s and is still the only commercially available vaccine to combat the fatal bovine disease, East Coast fever (ECF). The disease is tick-transmitted and results in annual economic losses of at least $300 million per year. While this vaccine technology has been available for over 40 years, few attempts have been made to standardize the production process and characterize the vaccine. The latest batch was produced in early 2008 at the International Livestock Research Institute (ILRI). The vaccine production involves the use of cattle free from parasites routinely monitored throughout the production process, and a pathogen-free tick colony. This paper describes the protocol used in the recent production, and the process improvements, including improved quality control tools, that had not been employed in previous ITM productions. The paper also describes the processes involved in determining the appropriate field dose, which involved a three-step in vivo study with various dilutions of the vaccine stabilate. The vaccine was shown to be safe and viable after production, and a suitable field dose was identified as 1 ml of a 1:100 dilution. Copyright © 2015 Elsevier GmbH. All rights reserved.

Superacid Passivation of Crystalline Silicon Surfaces.

PubMed

Bullock, James; Kiriya, Daisuke; Grant, Nicholas; Azcatl, Angelica; Hettick, Mark; Kho, Teng; Phang, Pheng; Sio, Hang C; Yan, Di; Macdonald, Daniel; Quevedo-Lopez, Manuel A; Wallace, Robert M; Cuevas, Andres; Javey, Ali

2016-09-14

The reduction of parasitic recombination processes commonly occurring within the silicon crystal and at its surfaces is of primary importance in crystalline silicon devices, particularly in photovoltaics. Here we explore a simple, room temperature treatment, involving a nonaqueous solution of the superacid bis(trifluoromethane)sulfonimide, to temporarily deactivate recombination centers at the surface. We show that this treatment leads to a significant enhancement in optoelectronic properties of the silicon wafer, attaining a level of surface passivation in line with state-of-the-art dielectric passivation films. Finally, we demonstrate its advantage as a bulk lifetime and process cleanliness monitor, establishing its compatibility with large area photoluminescence imaging in the process.

Patients' preferences regarding shared decision-making in the treatment of inflammatory bowel disease: results from a patient-empowerment study.

PubMed

Baars, Judith E; Markus, Tineke; Kuipers, Ernst J; van der Woude, C Janneke

2010-01-01

Shared decision-making is gaining favor in clinical practice, although the extent to which patients want to be involved in choosing their treatment varies substantially. Because data are lacking on the preferences of patients with chronic diseases such as inflammatory bowel disease (IBD), we wanted to assess IBD patients' preferences about being involved in such decisions. Adult IBD patients were asked to anonymously complete an online survey on their preferences. Non-parametric tests (chi(2)) were used to determine the relationship between responses and respondents. The questionnaire was completed by 1,067 patients, 617 with Crohn's disease and 450 with ulcerative colitis. Patients' mean age was 43 (SD 13.7) years; the majority were female (66%). In total, 866 patients (81%) reported it as 'very important' to be actively involved in the decision-making process, and another 177 (17%) rated it as 'quite important'. When asked how their treatment could be improved, 537 patients (50%) wanted close, equitable collaboration with their physician. This preference was significantly associated with a disease duration of

Flame-resistant textiles

NASA Technical Reports Server (NTRS)

Fogg, L. C.; Stringham, R. S.; Toy, M. S.

1980-01-01

Flame resistance treatment for acid resistant polyamide fibers involving photoaddition of fluorocarbons to surface has been scaled up to treat 10 yards of commercial width (41 in.) fabric. Process may be applicable to other low cost polyamides, polyesters, and textiles.

Cancer treatment decision-making processes for older patients with complex needs: a qualitative study.

PubMed

Bridges, Jackie; Hughes, Jane; Farrington, Naomi; Richardson, Alison

2015-12-14

Although older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This study aimed to investigate how cancer treatment decisions are formulated for older people with complex health and social care needs and the factors that shape these processes. Qualitative study involving semistructured interviews and non-participant observations. Framework approach used for data analysis. Breast and colorectal cancer services in five English NHS hospital trusts. Interviews: purposive sample of 22 clinicians directly involved in a face-to-face clinical role with patients regarding cancer treatment and care, maximising variation across clinical roles, tumour types and trusts. purposive sample of five cancer multidisciplinary meetings, maximising variation across location, team size and tumour type. The initial stages of cancer treatment decision-making are team-based, medically dominated and focused on the cancer. For patients with complex health and social care needs that extend beyond cancer pathology, later and less visible stages in the decision-making process are more haphazard and may result in less effective and workable treatment plans, as individual clinicians struggle to devise and deliver these plans without breaching time-based targets. Service targets that focus resources solely on the presenting disease can disadvantage older patients with complex health and social care needs that extend beyond this primary diagnosis. Care should be taken to ensure time-based targets do not disincentivise thorough and timely assessment that can lead to the formulation of treatment plans tailored to individual needs and circumstances. 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/

Combined analysis of mRNA and miRNA identifies dehydration and salinity responsive key molecular players in citrus roots.

PubMed

Xie, Rangjin; Zhang, Jin; Ma, Yanyan; Pan, Xiaoting; Dong, Cuicui; Pang, Shaoping; He, Shaolan; Deng, Lie; Yi, Shilai; Zheng, Yongqiang; Lv, Qiang

2017-02-06

Citrus is one of the most economically important fruit crops around world. Drought and salinity stresses adversely affected its productivity and fruit quality. However, the genetic regulatory networks and signaling pathways involved in drought and salinity remain to be elucidated. With RNA-seq and sRNA-seq, an integrative analysis of miRNA and mRNA expression profiling and their regulatory networks were conducted using citrus roots subjected to dehydration and salt treatment. Differentially expressed (DE) mRNA and miRNA profiles were obtained according to fold change analysis and the relationships between miRNAs and target mRNAs were found to be coherent and incoherent in the regulatory networks. GO enrichment analysis revealed that some crucial biological processes related to signal transduction (e.g. 'MAPK cascade'), hormone-mediated signaling pathways (e.g. abscisic acid- activated signaling pathway'), reactive oxygen species (ROS) metabolic process (e.g. 'hydrogen peroxide catabolic process') and transcription factors (e.g., 'MYB, ZFP and bZIP') were involved in dehydration and/or salt treatment. The molecular players in response to dehydration and salt treatment were partially overlapping. Quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) analysis further confirmed the results from RNA-seq and sRNA-seq analysis. This study provides new insights into the molecular mechanisms how citrus roots respond to dehydration and salt treatment.

Treatment decision-making in chronic diseases: What are the family members' roles, needs and attitudes? A systematic review.

PubMed

Lamore, Kristopher; Montalescot, Lucile; Untas, Aurélie

2017-12-01

This systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making. A comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria. Out of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients' culture. FMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process. Physicians should include FMs in treatment decision-making when the patients and their FMs wish to be included. Copyright © 2017 Elsevier B.V. All rights reserved.

A typology of preferences for participation in healthcare decision making.

PubMed

Flynn, Kathryn E; Smith, Maureen A; Vanness, David

2006-09-01

Classifying patients as "active" or "passive" with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patients' desired roles is an essential step towards promoting care that respects and responds to individual patients' preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions ("autonomists"). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions ("delegators"). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments.

Theoretical treatment of the processes involving the dipole transitions to the lowest exciton states in hexagonal semiconductors

NASA Astrophysics Data System (ADS)

Semenova, L. E.

2018-04-01

The treatment of the two-photon transitions to the An=1 exciton level and the resonant Raman scattering of light by LO-phonons is given for the hexagonal semiconductors A2B6, taking into account the influence of the complex top valence band and anisotropy of the exciton effective mass.

Emotional Processing, Interaction Process, and Outcome in Clarification-Oriented Psychotherapy for Personality Disorders: A Process-Outcome Analysis.

PubMed

Kramer, Ueli; Pascual-Leone, Antonio; Rohde, Kristina B; Sachse, Rainer

2016-06-01

It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study.

PubMed

McWilliams, Lorna; Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-04-12

Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. © 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.

Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians.

PubMed

Cardoso, Teresa; Fonseca, Teresa; Pereira, Sofia; Lencastre, Luís

2003-12-01

The objective of the present study was to evaluate the opinion of Portuguese intensive care physicians regarding 'do-not-resuscitate' (DNR) orders and decisions to withhold/withdraw treatment. A questionnaire was sent to all physicians working on a full-time basis in all intensive care units (ICUs) registered with the Portuguese Intensive Care Society. A total of 266 questionnaires were sent and 175 (66%) were returned. Physicians from 79% of the ICUs participated. All participants stated that DNR orders are applied in their units, and 98.3% stated that decisions to withhold treatment and 95.4% stated that decisions to withdraw treatment are also applied. About three quarters indicated that only the medical group makes these decisions. Fewer than 15% of the responders stated that they involve nurses, 9% involve patients and fewer than 11% involve patients' relatives in end-of-life decisions. Physicians with more than 10 years of clinical experience more frequently indicated that they involve nurses in these decisions (P < 0.05), and agnostic/atheist doctors more frequently involve patients' relatives in decisions to withhold/withdraw treatment (P < 0.05). When asked about who they thought should be involved, more than 26% indicated nurses, more than 35% indicated the patient and more than 25% indicated patients' relatives. More experienced doctors more frequently felt that nurses should be involved (P < 0.05), and male doctors more frequently stated that patients' relatives should be involved in DNR orders (P < 0.05). When a decision to withdraw treatment is made, 76.8% of 151 respondents indicated that they would initiate palliative care; no respondent indicated that they would administer drugs to accelerate the expected outcome. The probability of survival from the acute episode and patients' wishes were the most important criteria influencing end-of-life decisions. These decisions are made only by the medical group in most of the responding ICUs, with little input from nursing staff, patients, or patients' relatives, although many respondents expressed a wish to involve them more in this process. Sex, experience and religious beliefs of the respondents influences the way in which these decisions are made.

Mechanical and Metallurgical Evolution of Stainless Steel 321 in a Multi-step Forming Process

NASA Astrophysics Data System (ADS)

Anderson, M.; Bridier, F.; Gholipour, J.; Jahazi, M.; Wanjara, P.; Bocher, P.; Savoie, J.

2016-04-01

This paper examines the metallurgical evolution of AISI Stainless Steel 321 (SS 321) during multi-step forming, a process that involves cycles of deformation with intermediate heat treatment steps. The multi-step forming process was simulated by implementing interrupted uniaxial tensile testing experiments. Evolution of the mechanical properties as well as the microstructural features, such as twins and textures of the austenite and martensite phases, was studied as a function of the multi-step forming process. The characteristics of the Strain-Induced Martensite (SIM) were also documented for each deformation step and intermediate stress relief heat treatment. The results indicated that the intermediate heat treatments considerably increased the formability of SS 321. Texture analysis showed that the effect of the intermediate heat treatment on the austenite was minor and led to partial recrystallization, while deformation was observed to reinforce the crystallographic texture of austenite. For the SIM, an Olson-Cohen equation type was identified to analytically predict its formation during the multi-step forming process. The generated SIM was textured and weakened with increasing deformation.

Transcriptional profile of sweet orange in response to chitosan and salicylic acid.

PubMed

Coqueiro, Danila Souza Oliveira; de Souza, Alessandra Alves; Takita, Marco Aurélio; Rodrigues, Carolina Munari; Kishi, Luciano Takeshi; Machado, Marcos Antonio

2015-04-12

Resistance inducers have been used in annual crops as an alternative for disease control. Wood perennial fruit trees, such as those of the citrus species, are candidates for treatment with resistance inducers, such as salicylic acid (SA) and chitosan (CHI). However, the involved mechanisms in resistance induced by elicitors in citrus are currently few known. In the present manuscript, we report information regarding the transcriptional changes observed in sweet orange in response to exogenous applications of SA and CHI using RNA-seq technology. More genes were induced by SA treatment than by CHI treatment. In total, 1,425 differentially expressed genes (DEGs) were identified following treatment with SA, including the important genes WRKY50, PR2, and PR9, which are known to participate in the salicylic acid signaling pathway, and genes involved in ethylene/Jasmonic acid biosynthesis (ACS12, AP2 domain-containing transcription factor, and OPR3). In addition, SA treatment promoted the induction of a subset of genes involved in several metabolic processes, such as redox states and secondary metabolism, which are associated with biotic stress. For CHI treatment, there were 640 DEGs, many of them involved in secondary metabolism. For both SA and CHI treatments, the auxin pathway genes were repressed, but SA treatment promoted induction in the ethylene and jasmonate acid pathway genes, in addition to repressing the abscisic acid pathway genes. Chitosan treatment altered some hormone metabolism pathways. The DEGs were validated by quantitative Real-Time PCR (qRT-PCR), and the results were consistent with the RNA-seq data, with a high correlation between the two analyses. We expanded the available information regarding induced defense by elicitors in a species of Citrus that is susceptible to various diseases and identified the molecular mechanisms by which this defense might be mediated.

Quint: An R package for the identification of subgroups of clients who differ in which treatment alternative is best for them.

PubMed

Dusseldorp, Elise; Doove, Lisa; Mechelen, Iven van

2016-06-01

In the analysis of randomized controlled trials (RCTs), treatment effect heterogeneity often occurs, implying differences across (subgroups of) clients in treatment efficacy. This phenomenon is typically referred to as treatment-subgroup interactions. The identification of subgroups of clients, defined in terms of pretreatment characteristics that are involved in a treatment-subgroup interaction, is a methodologically challenging task, especially when many characteristics are available that may interact with treatment and when no comprehensive a priori hypotheses on relevant subgroups are available. A special type of treatment-subgroup interaction occurs if the ranking of treatment alternatives in terms of efficacy differs across subgroups of clients (e.g., for one subgroup treatment A is better than B and for another subgroup treatment B is better than A). These are called qualitative treatment-subgroup interactions and are most important for optimal treatment assignment. The method QUINT (Qualitative INteraction Trees) was recently proposed to induce subgroups involved in such interactions from RCT data. The result of an analysis with QUINT is a binary tree from which treatment assignment criteria can be derived. The implementation of this method, the R package quint, is the topic of this paper. The analysis process is described step-by-step using data from the Breast Cancer Recovery Project, showing the reader all functions included in the package. The output is explained and given a substantive interpretation. Furthermore, an overview is given of the tuning parameters involved in the analysis, along with possible motivational concerns associated with choice alternatives that are available to the user.

SU-E-T-635: Process Mapping of Eye Plaque Brachytherapy

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

Huynh, J; Kim, Y

Purpose: To apply a risk-based assessment and analysis technique (AAPM TG 100) to eye plaque brachytherapy treatment of ocular melanoma. Methods: The role and responsibility of personnel involved in the eye plaque brachytherapy is defined for retinal specialist, radiation oncologist, nurse and medical physicist. The entire procedure was examined carefully. First, major processes were identified and then details for each major process were followed. Results: Seventy-one total potential modes were identified. Eight major processes (corresponding detailed number of modes) are patient consultation (2 modes), pretreatment tumor localization (11), treatment planning (13), seed ordering and calibration (10), eye plaque assembly (10),more » implantation (11), removal (11), and deconstruction (3), respectively. Half of the total modes (36 modes) are related to physicist while physicist is not involved in processes such as during the actual procedure of suturing and removing the plaque. Conclusion: Not only can failure modes arise from physicist-related procedures such as treatment planning and source activity calibration, but it can also exist in more clinical procedures by other medical staff. The improvement of the accurate communication for non-physicist-related clinical procedures could potentially be an approach to prevent human errors. More rigorous physics double check would reduce the error for physicist-related procedures. Eventually, based on this detailed process map, failure mode and effect analysis (FMEA) will identify top tiers of modes by ranking all possible modes with risk priority number (RPN). For those high risk modes, fault tree analysis (FTA) will provide possible preventive action plans.« less

Effect of novel food processing methods on packaging: structure, composition, and migration properties.

PubMed

Guillard, V; Mauricio-Iglesias, M; Gontard, N

2010-11-01

Classical stabilization techniques (thermal treatments) usually involve food to be packed after being processed. On the contrary and increasingly, novel food processing methods, such as high pressure or microwaves, imply that both packaging and foodstuff undergo the stabilization treatment. Moreover, novel treatments (UV light, irradiation, ozone, cold plasma) are specifically used for disinfection and sterilization of the packaging material itself. Therefore, in the last several years a number of papers have focused on the effects of these new treatments on food-packaging interactions with a special emphasis on chemical migration and safety concerns. New packaging materials merged on the market with specific interest regarding the environment (i.e. bio-sourced materials) or mechanical and barrier properties (i.e. nanocomposites packaging materials). It is time to evaluate the knowledge about how these in-package food technologies affect food/packaging interactions, and especially for novel biodegradable and/or active materials. This article presents the effect of high pressure treatment, microwave heating, irradiation, UV-light, ozone and, cold plasma treatment on food/packaging interactions.

Mercury removal from water streams through the ion exchange membrane bioreactor concept.

PubMed

Oehmen, Adrian; Vergel, Dario; Fradinho, Joana; Reis, Maria A M; Crespo, João G; Velizarov, Svetlozar

2014-01-15

Mercury is a highly toxic heavy metal that causes human health problems and environmental contamination. In this study, an ion exchange membrane bioreactor (IEMB) process was developed to achieve Hg(II) removal from drinking water and industrial effluents. Hg(II) transport through a cation exchange membrane was coupled with its bioreduction to Hg(0) in order to achieve Hg removal from concentrated streams, with minimal production of contaminated by-products observed. This study involves (1) membrane selection, (2) demonstration of process effectiveness for removing Hg from drinking water to below the 1ppb recommended limit, and (3) process application for treatment of concentrated water streams, where >98% of the Hg was removed, and the throughput of contaminated water was optimised through membrane pre-treatment. The IEMB process represents a novel mercury treatment technology with minimal generation of contaminated waste, thereby reducing the overall environmental impact of the process. Copyright © 2013 Elsevier B.V. All rights reserved.

Neurobiological and clinical relationship between psychiatric disorders and chronic pain.

PubMed

Bras, Marijana; Dordević, Veljko; Gregurek, Rudolf; Bulajić, Masa

2010-06-01

Pain is one of the most ubiquitous problems of today's world, its impact being far-reaching. Current conceptualizations of pain medicine adopt a bio-psycho-social perspective. In this model, pain is best described as an interactive, psycho-physiological behavioral pattern that cannot be divided into independent psycho-social and physical components. Neurophysiologic substrates of the pain experience can be broken down into the pain transmission elements emanating from peripheral, spinal, and supra-spinal processes. There are many complex mechanisms involved in pain processing within the central nervous system, being influenced by genetics, interaction of neurotransmitters and their receptors, and pain- augmenting and pain-inhibiting neural circuits. The patient's emotional experiences, beliefs and expectations may determine the outcome of treatment, and are fully emphasized in the focus of treatment interventions. There are several common psychiatric disorders accompanying and complicating the experience of pain that warrant clinical attention and that can be the focus of psychiatric treatment. These include depression, anxiety, sleep disorders, somatoform disorders, substance-related disorders and personality disorders. Complex and disabling pain conditions often require comprehensive pain treatment programs, involving interdisciplinary and multimodal treatment approaches. There are many roles that the psychiatrist can perform in the assessment and treatment of the patients with pain, individually tailored to meet the specific needs of the patient. Rational poly-pharmacy is of a high importance in the treatment of patients with chronic pain, with antidepressants and anticonvulsants contributing as the important adjuvant analgesic agents.

Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer.

PubMed

Faivre, J C; Adam, V; Block, V; Metzger, M; Salleron, J; Dauchy, S

2017-11-01

The study's purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer. The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer. We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making. The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.

Acrylic and Modacrylic Fibers Production: National Emission Standards for Hazardous Air Pollutants (NESHAP) for Area Sources

EPA Pesticide Factsheets

This NESHAP applies to facilities using pressure or thermal treatment processes involving wood preservatives containing chromium, arsenic, dioxins, or methylene chloride. Page includes rule summary, rule history and additional documents.

Flexible Polyurethane Foam Production and Fabrication: National Emission Standards for Hazardous Air Pollutants (NESHAP) for Area Sources

EPA Pesticide Factsheets

This NESHAP applies to facilities using pressure or thermal treatment processes involving wood preservatives containing chromium, arsenic, dioxins, or methylene chloride. Inlcudes federal register citations, rule history and additional resources.

Informed Consent to Treatment in Psychiatry

PubMed Central

Neilson, Grainne; Chaimowitz, Gary

2015-01-01

Summary Patients have a right to be informed and actively involved in their health care. Fundamental to a person’s dignity and autonomy is the right to make decisions about their psychiatric treatment, including their right to refuse unwanted treatments, providing that the refusal is a capable one. It is important that psychiatrists have an awareness of the ethical underpinnings of consent and the legislated requirements related to consent, including precedent cases. Consent may change over time and for different conditions and circumstances. Consent must be an ongoing process.

JPRS Report, Science & Technology, Japan

DTIC Science & Technology

1991-01-31

final test. Keywords: Spherical Pressure Hull, Titanium Alloy , Three-Dimensional Machining, Electron Beam Welding . 1. Introduction In bodies like... processed (the heat treatment involving high-temperature heating and rapid quenching in order to obtain finer grains of the titanium alloy ) and...given m Table 3. The test results were all satisfactory. Forged material of titanium alloy , manufactured by forging, beta processing , and billet

Fear extinction and memory reconsolidation as critical components in behavioral treatment for posttraumatic stress disorder and potential augmentation of these processes.

PubMed

Smith, Noelle B; Doran, Jennifer M; Sippel, Lauren M; Harpaz-Rotem, Ilan

2017-05-10

Posttraumatic stress disorder (PTSD) is associated with alterations in critical brain regions such as the amygdala, hippocampus, and prefrontal cortex. This brief review has two objectives: (1) to discuss research examining extinction and reconsolidation processes as mechanisms in PTSD psychotherapy, and (2) present possibilities for augmenting extinction and reconsolidation within treatment through alterations to therapeutic interventions and novel approaches. A key component of many effective PTSD therapies is exposure, which involves intentional confrontation and processing of the traumatic memory. Our review suggests that extinction and reconsolidation processes underlie effective exposure-based treatment, but the neurobiological mechanisms of these processes in behavioral treatments for PTSD remains unclear. We argue that enhancing extinction and/or disrupting reconsolidation of a feared memory may improve the efficacy of existing treatments (e.g., increased change for limited/non-responders, faster/greater changes for responders), which can be done through multiple channels. Potential avenues for augmentation of the processes of extinction and reconsolidation in PTSD psychotherapies are reviewed, including behavioral modifications, pharmacotherapy agents, and the use of devices during therapy. We further suggest that investigations towards understanding the extent to which extinction and reconsolidation processes are necessary in effective PTSD psychotherapy is an important future direction for enhancing clinical care among PTSD populations. Published by Elsevier B.V.

The assessment of depressive patients' involvement in decision making in audio-taped primary care consultations.

PubMed

Loh, Andreas; Simon, Daniela; Hennig, Katrin; Hennig, Benjamin; Härter, Martin; Elwyn, Glyn

2006-11-01

In primary care of depression treatment options such as antidepressants, counseling and psychotherapy are reasonable. Patient involvement could foster adherence and clinical outcome. However, there is a lack of empirical information about the extent to which general practitioners involve patients in decision making processes in this condition, and about the consultation time spent for distinct decision making tasks. Twenty general practice consultations with depressive patients prior to a treatment decision were audio-taped and transcribed. Patient involvement in decision making was assessed with the OPTION-scale and durations of decision making stages were measured. Mean duration of consultations was 16 min, 6s. The mean of the OPTION-items were between 0.0 and 26.9, in a scale range from 0 to 100. Overall, 78.6% of the consultation time was spent for the step "problem definition" (12 min, 42 s). Very low levels of patient involvement in medical decisions were observed in consultations about depression. Physicians used the majority of their time for the definition of the patient's medical problem. To improve treatment decision making in this condition, general practitioners should enhance their decision making competences and be more aware of the time spent in each decision making stage.

The safety of bone allografts used in dentistry: a review.

PubMed

Holtzclaw, Dan; Toscano, Nicholas; Eisenlohr, Lisa; Callan, Don

2008-09-01

Recent media reports concerning "stolen body parts" have shaken the public's trust in the safety of and the use of ethical practices involving human allografts. The authors provide a comprehensive review of the safety aspects of human bone allografts. The authors reviewed U.S. government regulations, industry standards, independent industry association guidelines, company guidelines and scientific articles related to the use of human bone allografts in the practice of dentistry published in the English language. The use of human bone allografts in the practice of dentistry involves the steps of procurement, processing, use and tracking. Rigorous donor screening and aseptic proprietary processing programs have rendered the use of human bone allografts safe and effective as a treatment option. When purchasing human bone allografts for the practice of dentistry, one should choose products accredited by the American Association of Tissue Banks for meeting uniformly high safety and quality control measures. Knowledge of human bone allograft procurement, processing, use and tracking procedures may allow dental clinicians to better educate their patients and address concerns about this valuable treatment option.

Case studies in medical futility.

PubMed

Mains, Douglas A; Coustasse, Alberto; Lurie, Sue G

2007-01-01

Technology has provided means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient. This study presents two case histories, compiled from historical patient charts, staff notes and observations, that illustrate the variety of ethical issues involved and the role culture plays in the decision making process related to possible futile medical treatment. Ethical and cultural issues related to the cases are discussed and processes are presented that can help hospitals to avoid, or decrease the level of, medically futile care, and improve the cultural appropriateness of medical care and relationships with patients.

Improved Heat Treatment Of Steel Alloy 4340

NASA Technical Reports Server (NTRS)

Cooper, Lawrence B.

1993-01-01

New process takes significantly less time than prior heat-treatment processes. Involves placing steel plate directly in furnace and heat-treating. Plate then quenched in slowly moving oil to reduce stresses. Any deflection then pressed out. Possible uses of 4340 steel include new and improved bulletproof vests for military and police personnel and armor for bulletproof automobiles for military, police, diplomatic, and private users. Also used in other military land vehicles as tanks and in both military and civilian aircraft. Lighter armorplate enables land vehicles and aircraft to attain greater speed and maneuverability, consume less fuel, and afford better protection from snipers or terrorists.

Chronic intestinal pseudo-obstruction.

PubMed

Gabbard, Scott L; Lacy, Brian E

2013-06-01

Chronic intestinal pseudo-obstruction (CIP) is a rare and serious disorder of the gastrointestinal (GI) tract characterized as a motility disorder with the primary defect of impaired peristalsis; symptoms are consistent with a bowel obstruction, although mechanical obstruction cannot be identified. CIP is classified as a neuropathy, myopathy, or mesenchymopathy; it is a neuropathic process in the majority of patients. The natural history of CIP is generally that of a progressive disorder, although occasional patients with secondary CIP note significant symptomatic improvement when the underlying disorder is identified and treated. Symptoms vary from patient to patient depending on the location of the luminal GI tract involved and the degree of involvement; however, the small intestine is nearly always involved. Common symptoms include dysphagia, gastroesophageal reflux, abdominal pain, nausea, vomiting, bloating, abdominal distension, constipation or diarrhea, and involuntary weight loss. Unfortunately, these symptoms are nonspecific, which can contribute to misdiagnosis or a delay in diagnosis and treatment. Since many of the symptoms and signs suggest a mechanical bowel obstruction, diagnostic tests typically focus on uncovering a mechanical obstruction, although routine tests do not identify an obstructive process. Nutrition supplementation is required for many patients with CIP due to symptoms of dysphagia, nausea, vomiting, and weight loss. This review discusses the epidemiology, etiology, pathogenesis, diagnosis, and treatment of patients with CIP, with an emphasis on nutrition assessment and treatment options for patients with nutrition compromise.

Lignin biodegradation by the ascomycete Chrysonilia sitophila.

PubMed

Rodríguez, J; Ferraz, A; Nogueira, R F; Ferrer, I; Esposito, E; Durán, N

1997-01-01

The lignin biodegradation process has an important role in the carbon cycle of the biosphere. The study of this natural process has developed mainly with the use of basidiomycetes in laboratory investigations. This has been a logical approach since most of the microorganisms involved in lignocellulosic degradation belong to this class of fungi. However, other microorganisms such as ascomycetes and also some bacteria, are involved in the lignin decaying process. This work focuses on lignin biodegradation by a microorganism belonging to the ascomycete class, Chrysonilia sitophila. Lignin peroxidase production and characterization, mechanisms of lignin degradation (lignin model compounds and lignin in wood matrix) and biosynthesis of veratryl alcohol are outstanding. Applications of C. sitophila for effluent treatment, wood biodegradation and single-cell protein production are also discussed.

Grafting of alginates on UF/NF ceramic membranes for wastewater treatment.

PubMed

Athanasekou, C P; Romanos, G E; Kordatos, K; Kasselouri-Rigopoulou, V; Kakizis, N K; Sapalidis, A A

2010-10-15

The mechanism of heavy metal ion removal in processes involving multi-layered tubular ultrafiltration and nanofiltration (UF/NF) membranes was investigated by conducting retention experiments in both flow-through and cross-flow modes. The prospect of the regeneration of the membranes through an acidic process was also examined and discussed. The UF/NF membranes were functionalised with alginates to develop hybrid inorganic/organic materials for continuous, single pass, wastewater treatment applications. The challenge laid in the induction of additional metal adsorption and improved regeneration capacity. This was accomplished by stabilizing alginates either into the pores or on the top-separating layer of the membrane. The preservation of efficient water fluxes at moderate trans-membrane pressures introduced an additional parameter that was pursued in parallel to the membrane modification process. The deposition and stabilization of alginates was carried out via physical (filtration/cross-linking) and chemical (grafting) procedures. The materials developed by means of the filtration process exhibited a 25-60% enhancement of their Cd(2+) binding capacity, depending on the amount of the filtered alginate solution. The grafting process led to the development of alginate layers with adequate stability under acidic regeneration conditions and metal retention enhancement of 25-180%, depending on the silane involved as grafting agent and the solvent of silanisation. 2010 Elsevier B.V. All rights reserved.

The meaning of suffering in drug addiction and recovery from the perspective of existentialism, Buddhism and the 12-Step program.

PubMed

Chen, Gila

2010-09-01

The aim of the current article was to examine the meaning of suffering in drug addiction and in the recovery process. Negative emotions may cause primary suffering that can drive an individual toward substance abuse. At the same time, drugs only provide temporary relief, and over time, the pathological effects of the addiction worsen causing secondary suffering, which is a motivation for treatment. The 12-Step program offers a practical way to cope with suffering through a process of surrender. The act of surrender sets in motion a conversion experience, which involves a self-change including reorganization of one's identity and meaning in life. This article is another step toward understanding one of the several factors that contribute to the addict's motivation for treatment. This knowledge may be helpful for tailoring treatment that addresses suffering as a factor that initiates treatment motivation and, in turn, treatment success.

Involving patients in a multidisciplinary European consensus process and in the development of a 'patient summary of the consensus document for colon and rectal cancer care'.

PubMed

Boelens, Petra G; Taylor, Claire; Henning, Geoffrey; Marang-van de Mheen, Perla J; Espin, Eloy; Wiggers, Theo; Gore-Booth, Jola; Moss, Barbara; Valentini, Vincenzo; van de Velde, Cornelis J H

2014-01-01

High-quality cancer care should be accessible for patients and healthcare professionals. Involvement of patients as partners in guideline formation and consensus processes is still rarely found. EURECCA, short for European Registration of Cancer Care, is the platform to improve outcomes of cancer care by reducing variation in the diagnostic and treatment process. EURECCA acknowledges the important role of patients in implementation of consensus information in clinical practice. The aim of this article is to describe the process of involving patients in the consensus process and in developing the patient summary of the consensus for colon and rectal cancer care. The Delphi method for achieving consensus was used. Three online voting rounds and one tele-voting round were offered to an expert panel of oncology professionals and patient representatives. At four different stages, patients and/or patient representatives were involved in the process: (1) during the consensus process, (2) lecturing about the role of the patient, (3) development of the patient summary, and (4) testing the patient summary. Representatives were invited to the voting and commenting rounds of this process and given an equal vote. Although patients were not consulted during the planning stages of this process, patient involvement increased following the panel's discussion of the implementation of the consensus among the patient population. After the consensus meeting, the patient summary was written by patient representatives, oncologists and nurses. A selection of proactive patients reviewed the draft patient summary; responses were positive and several patient-reported outcomes were added. Questionnaires to evaluate the use and implementation of the patient summary in daily practice are currently being developed and tested. Patient consultation will be needed in future planning for selection of topics. The present study may function as a model for future consensus processes to involve patients at different stages and to implement both patient and healthcare professional versions in daily practice.

Diagnostic Pathways as Social and Participatory Practices: The Case of Herpes Simplex Encephalitis

PubMed Central

Cooper, Jessie; Kierans, Ciara; Defres, Sylviane; Easton, Ava; Kneen, Rachel; Solomon, Tom

2016-01-01

Herpes simplex virus (HSV) encephalitis is a potentially devastating disease, with significant rates of mortality and co-morbidities. Although the prognosis for people with HSV encephalitis can be improved by prompt treatment with aciclovir, there are often delays involved in the diagnosis and treatment of the disease. In response, National Clinical Guidelines have been produced for the UK which make recommendations for improving the management of suspected viral encephalitis. However, little is currently known about the everyday experiences and processes involved in the diagnosis and care of HSV encephalitis. The reported study aimed to provide an account of the diagnosis and treatment of HSV encephalitis from the perspective of people who had been affected by the condition. Thirty narrative interviews were conducted with people who had been diagnosed with HSV encephalitis and their significant others. The narrative accounts reveal problems with gaining access to a diagnosis of encephalitis and shortfalls in care for the condition once in hospital. In response, individuals and their families work hard to obtain medical recognition for the problem and shape the processes of acute care. As a consequence, we argue that the diagnosis and management of HSV encephalitis needs to be considered as a participatory process, which is co-produced by health professionals, patients, and their families. The paper concludes by making recommendations for developing the current management guidelines by formalising the critical role of patients and their significant others in the identification, and treatment of, HSV encephalitis. PMID:26960197

Diagnostic Pathways as Social and Participatory Practices: The Case of Herpes Simplex Encephalitis.

PubMed

Cooper, Jessie; Kierans, Ciara; Defres, Sylviane; Easton, Ava; Kneen, Rachel; Solomon, Tom

2016-01-01

Herpes simplex virus (HSV) encephalitis is a potentially devastating disease, with significant rates of mortality and co-morbidities. Although the prognosis for people with HSV encephalitis can be improved by prompt treatment with aciclovir, there are often delays involved in the diagnosis and treatment of the disease. In response, National Clinical Guidelines have been produced for the UK which make recommendations for improving the management of suspected viral encephalitis. However, little is currently known about the everyday experiences and processes involved in the diagnosis and care of HSV encephalitis. The reported study aimed to provide an account of the diagnosis and treatment of HSV encephalitis from the perspective of people who had been affected by the condition. Thirty narrative interviews were conducted with people who had been diagnosed with HSV encephalitis and their significant others. The narrative accounts reveal problems with gaining access to a diagnosis of encephalitis and shortfalls in care for the condition once in hospital. In response, individuals and their families work hard to obtain medical recognition for the problem and shape the processes of acute care. As a consequence, we argue that the diagnosis and management of HSV encephalitis needs to be considered as a participatory process, which is co-produced by health professionals, patients, and their families. The paper concludes by making recommendations for developing the current management guidelines by formalising the critical role of patients and their significant others in the identification, and treatment of, HSV encephalitis.

Treatment of persistent organic pollutants in wastewater using hydrodynamic cavitation in synergy with advanced oxidation process.

PubMed

Badmus, Kassim Olasunkanmi; Tijani, Jimoh Oladejo; Massima, Emile; Petrik, Leslie

2018-03-01

Persistent organic pollutants (POPs) are very tenacious wastewater contaminants. The consequences of their existence have been acknowledged for negatively affecting the ecosystem with specific impact upon endocrine disruption and hormonal diseases in humans. Their recalcitrance and circumvention of nearly all the known wastewater treatment procedures are also well documented. The reported successes of POPs treatment using various advanced technologies are not without setbacks such as low degradation efficiency, generation of toxic intermediates, massive sludge production, and high energy expenditure and operational cost. However, advanced oxidation processes (AOPs) have recently recorded successes in the treatment of POPs in wastewater. AOPs are technologies which involve the generation of OH radicals for the purpose of oxidising recalcitrant organic contaminants to their inert end products. This review provides information on the existence of POPs and their effects on humans. Besides, the merits and demerits of various advanced treatment technologies as well as the synergistic efficiency of combined AOPs in the treatment of wastewater containing POPs was reported. A concise review of recently published studies on successful treatment of POPs in wastewater using hydrodynamic cavitation technology in combination with other advanced oxidation processes is presented with the highlight of direction for future research focus.

Network-Based Methods for Identifying Key Active Proteins in the Extracellular Electron Transfer Process in Shewanella oneidensis MR-1.

PubMed

Ding, Dewu; Sun, Xiao

2018-01-16

Shewanella oneidensis MR-1 can transfer electrons from the intracellular environment to the extracellular space of the cells to reduce the extracellular insoluble electron acceptors (Extracellular Electron Transfer, EET). Benefiting from this EET capability, Shewanella has been widely used in different areas, such as energy production, wastewater treatment, and bioremediation. Genome-wide proteomics data was used to determine the active proteins involved in activating the EET process. We identified 1012 proteins with decreased expression and 811 proteins with increased expression when the EET process changed from inactivation to activation. We then networked these proteins to construct the active protein networks, and identified the top 20 key active proteins by network centralization analysis, including metabolism- and energy-related proteins, signal and transcriptional regulatory proteins, translation-related proteins, and the EET-related proteins. We also constructed the integrated protein interaction and transcriptional regulatory networks for the active proteins, then found three exclusive active network motifs involved in activating the EET process-Bi-feedforward Loop, Regulatory Cascade with a Feedback, and Feedback with a Protein-Protein Interaction (PPI)-and identified the active proteins involved in these motifs. Both enrichment analysis and comparative analysis to the whole-genome data implicated the multiheme c -type cytochromes and multiple signal processing proteins involved in the process. Furthermore, the interactions of these motif-guided active proteins and the involved functional modules were discussed. Collectively, by using network-based methods, this work reported a proteome-wide search for the key active proteins that potentially activate the EET process.

MR imaging of spinal infection.

PubMed

Tins, Bernhard J; Cassar-Pullicino, Victor N

2004-09-01

Magnetic resonance (MR) imaging plays a pivotal role in the diagnosis and management of spinal infection, enjoying a high sensitivity and specificity. A thorough understanding of spinal anatomy and the physicochemical pathological processes associated with infection is a desirable prerequisite allowing accurate interpretation of the disease process. Apart from confirmation of the disease, MR imaging is also best suited to excluding multifocal spinal involvement and the detection/exclusion of complications. It plays an essential role in the decision-making process concerning conservative versus surgical treatment and is also the best imaging method to monitor the effect of treatment. The MR features of infection confidently exclude tumor, degeneration, and so forth as the underlying process; differentiate pyogenic from granulomatous infections in most cases; and can suggest the rarer specific infective organisms. Copyright 2004 Thieme Medical Publishers, Inc.

Untargeted analysis to monitor metabolic changes of garlic along heat treatment by LC-QTOF MS/MS.

PubMed

Molina-Calle, María; Sánchez de Medina, Verónica; Calderón-Santiago, Mónica; Priego-Capote, Feliciano; Luque de Castro, María D

2017-09-01

Black garlic is increasing its popularity in cuisine around the world; however, scant information exists on the composition of this processed product. In this study, polar compounds in fresh garlic and in samples taken at different times during the heat treatment process to obtain black garlic have been characterized by liquid chromatography coupled to tandem mass spectrometry in high resolution mode. Ninety-five compounds (mainly amino acids and metabolites, organosulfur compounds, and saccharides and derivatives) were tentatively identified in all the analysed samples and classified as a function of the family they belong to. Statistical analysis of the results allowed establishing that the major changes in garlic occur during the first days of treatment, and they mainly affect to the three representative families. The main pathways involved in the synthesis of the compounds affected by heat treatment, and their evolution during the process were studied. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Integration of membrane separation and Fenton processes for sanitary landfill leachate treatment.

PubMed

Santos, Amanda Vitória; Andrade, Laura Hamdan de; Amaral, Míriam Cristina Santos; Lange, Liséte Celina

2018-04-06

The appropriate treatment of sanitary landfill leachate is one of the greatest challenges nowadays due to the large volumes of solid waste generated. Thus, the aim of this study is to evaluate the performance of different routes involving the integration of advanced oxidation processes based on Fenton's reagents (AOP-Fenton) and microfiltration (MF) and nanofiltration (NF) membrane processes for the treatment of landfill leachate. MF module configuration (submerged or sidestream) and MF and NF recovery rate were evaluated. The combination of AOP-Fenton, MF and NF proved to be an effective treatment for landfill leachate. High removal efficiencies of chemical oxidation demand (94-96%) and colour (96-99%) were obtained. The configuration named route 3, composed of MF of raw landfill leachate (MF1), POA-Fenton-MF2 of the MF1 concentrate and NF of both MF1 and MF2 permeates, showed a higher global water recovery and was responsible for lower waste generation. It was considered the best one in terms of environmental, technical and economical aspects.

Process simulation and dynamic control for marine oily wastewater treatment using UV irradiation.

PubMed

Jing, Liang; Chen, Bing; Zhang, Baiyu; Li, Pu

2015-09-15

UV irradiation and advanced oxidation processes have been recently regarded as promising solutions in removing polycyclic aromatic hydrocarbons (PAHs) from marine oily wastewater. However, such treatment methods are generally not sufficiently understood in terms of reaction mechanisms, process simulation and process control. These deficiencies can drastically hinder their application in shipping and offshore petroleum industries which produce bilge/ballast water and produced water as the main streams of marine oily wastewater. In this study, the factorial design of experiment was carried out to investigate the degradation mechanism of a typical PAH, namely naphthalene, under UV irradiation in seawater. Based on the experimental results, a three-layer feed-forward artificial neural network simulation model was developed to simulate the treatment process and to forecast the removal performance. A simulation-based dynamic mixed integer nonlinear programming (SDMINP) approach was then proposed to intelligently control the treatment process by integrating the developed simulation model, genetic algorithm and multi-stage programming. The applicability and effectiveness of the developed approach were further tested though a case study. The experimental results showed that the influences of fluence rate and temperature on the removal of naphthalene were greater than those of salinity and initial concentration. The developed simulation model could well predict the UV-induced removal process under varying conditions. The case study suggested that the SDMINP approach, with the aid of the multi-stage control strategy, was able to significantly reduce treatment cost when comparing to the traditional single-stage process optimization. The developed approach and its concept/framework have high potential of applicability in other environmental fields where a treatment process is involved and experimentation and modeling are used for process simulation and control. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cork boiling wastewater treatment and reuse through combination of advanced oxidation technologies.

PubMed

Ponce-Robles, L; Miralles-Cuevas, S; Oller, I; Agüera, A; Trinidad-Lozano, M J; Yuste, F J; Malato, S

2017-03-01

Industrial preparation of cork consists of its immersion for approximately 1 hour in boiling water. The use of herbicides and pesticides in oak tree forests leads to absorption of these compounds by cork; thus, after boiling process, they are present in wastewater. Cork boiling wastewater shows low biodegradability and high acute toxicity involving partial inhibition of their biodegradation when conventional biological treatment is applied. In this work, a treatment line strategy based on the combination of advanced physicochemical technologies is proposed. The final objective is the reuse of wastewater in the cork boiling process; thus, reducing consumption of fresh water in the industrial process itself. Coagulation pre-treatment with 0.5 g/L of FeCl 3 attained the highest turbidity elimination (86 %) and 29 % of DOC elimination. Similar DOC removal was attained when using 1 g/L of ECOTAN BIO (selected for ozonation tests), accompanied of 64 % of turbidity removal. Ozonation treatments showed less efficiency in the complete oxidation of cork boiling wastewater, compared to solar photo-Fenton process, under the studied conditions. Nanofiltration system was successfully employed as a final purification step with the aim of obtaining a high-quality reusable permeate stream. Monitoring of unknown compounds by LC-QTOF-MS allowed the qualitative evaluation of the whole process. Acute and chronic toxicity as well as biodegradability assays were performed throughout the whole proposed treatment line.

Primary cicatricial alopecia: clinical features and management.

PubMed

Ross, Elizabeth K

2007-04-01

The primary cicatricial alopecias are an uncommon, complex group of disorders that result in permanent destruction of the hair follicle, usually involving scalp hair alone. Prompt diagnosis and treatment are needed to help thwart continued hair loss and the distress that often accompanies this hair loss. Nurses can facilitate the diagnostic and treatment process and, through educational and emotionally supportive measures, have a meaningful, positive impact on the patient's well being.

Investigating Catalytic Properties of Composite Nanoparticle Assemblies

DTIC Science & Technology

2001-11-01

electrode surfaces, were found to be catalytically active towards electrooxidation of CO and MeOH upon activation. The activation involved partial removal...to proceed under stirring at room temperature for 4 hours. producing a dark-brown solution of DT-encapsulated nanoparticles that was then cleaned in... ethanol or used in the heating treatment. Processing. Highly-monodispersed Au particles (5.3 ±0.3 nm) were prepared by thermally activated treatment of

Treatment decision-making in the medical encounter: comparing the attitudes of French surgeons and their patients in breast cancer care.

PubMed

Nguyen, Florence; Moumjid, Nora; Charles, Cathy; Gafni, Amiram; Whelan, Tim; Carrère, Marie-Odile

2014-02-01

To explore attitudes of French surgeons and their patients towards treatment decision-making (TDM) in the medical encounter. Surgeons involved in early stage breast cancer and their patients treated in a French cancer care network received a cross-sectional survey questionnaire containing examples of four different approaches to TDM: paternalistic, "some sharing", informed TDM and, shared TDM. Surgeons' interaction styles were clearly distributed among paternalistic, shared and mixed. The paternalistic approach seemed to be associated with private rather than public practice and with less professional experience. Patients reported a rather low level of participation in TDM, varying by socio-demographic characteristics. One third of patients were dissatisfied with the way their treatment decision had been made. Most surgeons reported adopting the "some sharing" approach. However, one patient out of three reported that they would have liked to participate more in the TDM process. Surgeons need to ask patients what their preferences for involvement in TDM are and then think about ways to accommodate both their own and patients' preferences regarding the TDM process to be used in each encounter. In addition, decision aids could be offered to surgeons to help them discuss treatment options with their patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A pivotal role of vacuolar H(+)-ATPase in regulation of lipid production in Phaeodactylum tricornutum.

PubMed

Zhang, Huiying; Zeng, Rensen; Chen, Daoyi; Liu, Jian

2016-08-08

Microalgal lipids have been considered as a promising source for biodiesel production. Alkaline pH can induce neutral lipid accumulation in microalgae cells. However, whether and how proton pumps, especially vacuolar H(+)-ATPase (V-ATPase), function in these processes is not well known. In this study, we treated Phaeodactylum tricornutum with V-ATPase specific inhibitor bafilomycin A1 (BFA1) to determine its role in lipid production. Firstly, V-ATPase activity was increased in the latter phase of microalgae growth. BFA1 treatment decreased the cell density and lipid contents. Further analysis showed that BFA1 treatment reduced the number and size of oil bodies. GC-MS analysis showed that lipid components were not affected by BFA1 treatment. Intracellular pH was decreased and nitrogen depletion was delayed after BFA1 treatment. RNA-Seq analysis showed that expression of genes involved in calcium signaling, sulfur metabolism, cell cycle, glycolysis, pentose phosphate pathway, porphyrin, chlorophyll metabolism and lipid catabolic metabolism were upregulated, while expression of genes involved in ion transmembrane transport, ubiquitin mediated proteolysis, SNARE interactions in vesicular transport, fatty acid biosynthesis were downregulated under BFA1 treatment. Our findings provided insights into the molecular mechanisms underlying lipid accumulation and the key genes involved in lipid metabolism in Phaeodactylum tricornutum in response to BFA1.

Identifying Cognitive Mechanisms Targeted for Treatment Development in Schizophrenia: An Overview of the First Meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) Initiative

PubMed Central

Carter, Cameron S.; Barch, Deanna M.; Buchanan, Robert W.; Bullmore, Ed; Krystal, John H.; Cohen, Jonathan; Geyer, Mark; Green, Michael; Nuechterlein, Keith H.; Robbins, Trevor; Silverstein, Steven; Smith, Edward E.; Strauss, Milton; Wykes, Til; Heinssen, Robert

2008-01-01

This overview describes the generation and development of the ideas that led to the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) initiative. It also describes the organization, process and products of the first meeting. The CNTRICS initiative involves a series of three conferences that will systematically address barriers to translating paradigms developed in the basic animal and human cognitive neuroscience fields for use in translational research aimed at developing novel treatments for cognitive impairments in schizophrenia. The articles in this special section report on the results of the first conference, which used a criterion based consensus-building process to develop a set of cognitive constructs to be targeted for translation efforts. PMID:18466880

Spectroscopic and antimicrobial studies of polystyrene films under air plasma and He-Ne laser treatment

NASA Astrophysics Data System (ADS)

Pawde, S. M.; Parab, Sanmesh S.

2008-05-01

Polystyrene (PS) films are used in packaging and biomedical applications because of their transparency and good environmental properties. The present investigation is centered on the antifungal and antibacterial activities involved in the film surface. Subsequently, microbial formations were immobilized on the modified PS films. Living microorganisms such as bacteria and yeast were used. Untreated PS films show very fast rate of growth of bacteria within few hours. The study involves developments of polymer surfaces with bacterial growth and further studies after giving antibacterial treatment such as plasma treatment. Major emphasis has been given to study the effect of various parameters which can affect the performance of the improved material. Films were prepared by two methods: plasma treatment under vacuum and under ongoing He-Ne laser source. The parameters such as (1) surface area by contact angle measurements, (2) quality of material before and after treatment by SEM and FTIR spectra and (3) material characterization by UV-vis spectra were studied. It was observed that plasma treatment of the PS material for different processing time improved the surface properties of PS films.

Multidimensional treatment foster care as a preventive intervention to promote resiliency among youth in the child welfare system.

PubMed

Leve, Leslie D; Fisher, Philip A; Chamberlain, Patricia

2009-12-01

Demographic trends indicate that a growing segment of families is exposed to adversity such as poverty, drug use problems, caregiver transitions, and domestic violence. Although these risk processes and the accompanying poor outcomes for children have been well studied, little is known about why some children develop resilience in the face of such adversity, particularly when it is severe enough to invoke child welfare involvement. This paper describes a program of research involving families in the child welfare system. Using a resiliency framework, evidence from 4 randomized clinical trials that included components of the Multidimensional Treatment Foster Care program is presented. Future directions and next steps are proposed.

The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Charles, Cathy; Gafni, Amiram; Entwistle, Vikki; Epstein, Ronald; Juraskova, Ilona

2017-11-01

Family caregivers are regularly involved in cancer consultations and treatment decision-making (DM). Yet there is limited conceptual description of caregiver influence/involvement in DM. To address this, an empirically-grounded conceptual framework of triadic DM (TRIO Framework) and corresponding graphical aid (TRIO Triangle) were developed. Jabareen's model for conceptual framework development informed multiple phases of development/validation, incorporation of empirical research and theory, and iterative revisions by an expert advisory group. Findings coalesced into six empirically-grounded conceptual insights: i) Caregiver influence over a decision is variable amongst different groups; ii) Caregiver influence is variable within the one triad over time; iii) Caregivers are involved in various ways in the wider DM process; iv) DM is not only amongst three, but can occur among wider social networks; v) Many factors may affect the form and extent of caregiver involvement in DM; vi) Caregiver influence over, and involvement in, DM is linked to their everyday involvement in illness care/management. The TRIO Framework/Triangle may serve as a useful guide for future empirical, ethical and/or theoretical work. This Framework can deepen clinicians's and researcher's understanding of the diverse and varying scope of caregiver involvement and influence in DM. Copyright © 2017 Elsevier B.V. All rights reserved.

Effective method of treatment of effluents from production of bitumens under basic pH conditions using hydrodynamic cavitation aided by external oxidants.

PubMed

Boczkaj, Grzegorz; Gągol, Michał; Klein, Marek; Przyjazny, Andrzej

2018-01-01

Utilization of cavitation in advanced oxidation processes (AOPs) is a promising trend in research on treatment of industrial effluents. The paper presents the results of investigations on the use of hydrodynamic cavitation aided by additional oxidation processes (O 3 /H 2 O 2 /Peroxone) to reduce the total pollution load in the effluent from the production of bitumens. A detailed analysis of changes in content of volatile organic compounds (VOCs) for all processes studied was also performed. The studies revealed that the most effective treatment process involves hydrodynamic cavitation aided by ozonation (40% COD reduction and 50% BOD reduction). The other processes investigated (hydrodynamic cavitation+H 2 O 2 , hydrodynamic cavitation+Peroxone and hydrodynamic cavitation alone) ensure reduction of COD by 20, 25 and 13% and reduction of BOD by 49, 32 and 18%, respectively. The results of this research revealed that most of the VOCs studied are effectively degraded. The formation of byproducts is one of the aspects that must be considered in evaluation of the AOPs studied. This work confirmed that furfural is one of the byproducts whose concentration increased during treatment by hydrodynamic cavitation alone as well as hydrodynamic cavitation aided by H 2 O 2 as an external oxidant and it should be controlled during treatment processes. Copyright © 2017 Elsevier B.V. All rights reserved.

FMEA of manual and automated methods for commissioning a radiotherapy treatment planning system.

PubMed

Wexler, Amy; Gu, Bruce; Goddu, Sreekrishna; Mutic, Maya; Yaddanapudi, Sridhar; Olsen, Lindsey; Harry, Taylor; Noel, Camille; Pawlicki, Todd; Mutic, Sasa; Cai, Bin

2017-09-01

To evaluate the level of risk involved in treatment planning system (TPS) commissioning using a manual test procedure, and to compare the associated process-based risk to that of an automated commissioning process (ACP) by performing an in-depth failure modes and effects analysis (FMEA). The authors collaborated to determine the potential failure modes of the TPS commissioning process using (a) approaches involving manual data measurement, modeling, and validation tests and (b) an automated process utilizing application programming interface (API) scripting, preloaded, and premodeled standard radiation beam data, digital heterogeneous phantom, and an automated commissioning test suite (ACTS). The severity (S), occurrence (O), and detectability (D) were scored for each failure mode and the risk priority numbers (RPN) were derived based on TG-100 scale. Failure modes were then analyzed and ranked based on RPN. The total number of failure modes, RPN scores and the top 10 failure modes with highest risk were described and cross-compared between the two approaches. RPN reduction analysis is also presented and used as another quantifiable metric to evaluate the proposed approach. The FMEA of a MTP resulted in 47 failure modes with an RPN ave of 161 and S ave of 6.7. The highest risk process of "Measurement Equipment Selection" resulted in an RPN max of 640. The FMEA of an ACP resulted in 36 failure modes with an RPN ave of 73 and S ave of 6.7. The highest risk process of "EPID Calibration" resulted in an RPN max of 576. An FMEA of treatment planning commissioning tests using automation and standardization via API scripting, preloaded, and pre-modeled standard beam data, and digital phantoms suggests that errors and risks may be reduced through the use of an ACP. © 2017 American Association of Physicists in Medicine.

Change in nomenclature for the immunologic synapse from Troxis Necrosis to trogocytosis.

PubMed

French, Samuel W

2017-10-01

The immunologic synapse mechanism of liver necrosis was termed Troxis Necrosis meaning "nibbling". (Wang MX et al. and French SW. Exp Mol Pathol 2001, 71: 137-146). This mechanism of liver injury was first named "Piecemeal Necrosis" by Hans Popper. It is involved in autoimmune hepatitis, HCV, HBV, primary biliary cirrhosis and steatohepatitis. This process involves the T cell receptor (TCR) which binds to the hepatocyte antigen presenting major histocompatibility complex (MHC) on the hepatocytic plasma membrane which quickly leads to the removal of the complex from the liver and uptake by the CD4 lymphocyte. This process is performed by the immunologic synapse now called trogocytosis meaning "gnaw" (Martinez-Martin N et al., Immunity 2011, 35: 208-222 and Dustin ML, Cancer Immunol Res 2014, 2: 1023-1033). The repeated episodes of uptake of the hepatocyte bite by bite causes the hepatocyte to slowly disappear like the Cheshire cat. This immunological synapse process is also involved in drug hepatitis, Hashimoto's thyroiditis, type I diabetes, autoimmune adrenalitis, autoimmune gastritis and cancer therapy. Treatment of Alzheimer's disease is also now being studied with PD-L1 antibody as used in the treatment of cancer allowing recruitment of disease modifying leukocytes to the sites of brain pathology (Schwartz M. Science 2017, 357: 254-255). Acknowledgement: Supported by a Grant from NIAAAUO1-021898. Copyright © 2017. Published by Elsevier Inc.

Sociocultural determinants of the help-seeking behavior of patients with mental illness.

PubMed

Lin, K M; Inui, T S; Kleinman, A M; Womack, W M

1982-02-01

This descriptive study employed semistructured interviewing and questionnaire administration to delineate the sociocultural determinants of the help-seeking process in 48 psychiatric patients. The help-seeking process is considered in two stages. The first stage starts from the recognition of initial symptoms and ends in the first contact with a mental health professional. The second stage is defined as that time between the first contact and actual participation in a planned treatment program. In both stages, patients typically go through phases of lay consultation, nonpsychiatric professional consultation, and referral. The multiple steps which are usually involved in help seeking often result in significant delay of both mental health contact and treatment. The help-seeking process was found to correlate strongly with ethnicity. Both Asians and Blacks showed more extended family involvement, and the involvement of key family members tended to be persistent and intensive in Asians. Ethnicity was also associated with the length of delay, with Asians showing the longest delay and Caucasians the least. These ethnic differences were also reflected in help-seeking pathway assignment using Lin's criteria. Although modernity and parochialism, as measured by the level of modernization and the cohesiveness of the social network system of the subjects, were also found to be correlated with delay, they appeared to exert an influence independent from that of ethnicity.

Therapeutic strategies for allergic diseases

NASA Astrophysics Data System (ADS)

Barnes, Peter J.

1999-11-01

Many drugs are now in development for the treatment of atopic diseases, including asthma, allergic rhinitis and atopic dermatitis. These treatments are based on improvements in existing therapies or on a better understanding of the cellular and molecular mechanisms involved in atopic diseases. Although most attention has been focused on asthma, treatments that inhibit the atopic disease process would have application to all atopic diseases, as they often coincide. Most of the many new therapies in development are aimed at inhibiting components of the allergic inflammatory response, but in the future there are real possibilities for the development of preventative and even curative treatments.

Pilot trial on separation conditions for diaper recycling.

PubMed

Kim, Kyung-Shin; Cho, Hee-Sun

2017-09-01

By utilizing laboratory-scale tests, the optimal separation conditions for diaper recycling were identified, and then, these conditions were validated by a pilot trial. In this research, we determined the mass balances derived during various processing steps and identified the most feasible procedures to use for separating each material in the output flow. The results showed that drum screening was not able to remove all the fiber and super absorbent particles (SAP) in the plastic-rich fraction and that cellulose enzyme treatment can be a good solution. To achieve better separation of fibers and SAP, slot screening followed by a cleaner is a potential option. A feasible diaper recycling process was recommended based on these results. This process involves screening and enzymatic treatment for the plastic fraction, and screening, cleaning, and thickening for the fiber fraction. Treatment procedures were also proposed for the SAP fraction and rejected materials. Copyright © 2017. Published by Elsevier Ltd.

Induction of Senescence and Identification of Differentially Expressed Genes in Tomato in Response to Monoterpene

PubMed Central

Kumar, Vinay; Kumar, Anil; Irfan, Mohammad; Chakraborty, Niranjan; Chakraborty, Subhra; Datta, Asis

2013-01-01

Monoterpenes, which are among the major components of plant essential oils, are known for their ecological roles as well for pharmaceutical properties. Geraniol, an acyclic monoterpene induces cell cycle arrest and apoptosis/senescence in various cancer cells and plants; however, the genes involved in the process and the underlying molecular mechanisms are not well understood. In this study, we demonstrate that treatment of tomato plants with geraniol results in induction of senescence due to a substantial alteration in transcriptome. We have identified several geraniol-responsive protein encoding genes in tomato using suppression subtractive hybridization (SSH) approach. These genes comprise of various components of signal transduction, cellular metabolism, reactive oxygen species (ROS), ethylene signalling, apoptosis and DNA damage response. Upregulation of NADPH oxidase and antioxidant genes, and increase in ROS level after geraniol treatment point towards the involvement of ROS in geraniol-mediated senescence. The delayed onset of seedling death and induced expression of geraniol-responsive genes in geraniol-treated ethylene receptor mutant (Nr) suggest that geraniol-mediated senescence involves both ethylene dependent and independent pathways. Moreover, expression analysis during tomato ripening revealed that geraniol-responsive genes are also associated with the natural organ senescence process. PMID:24098759

When a Patient Commits Suicide.

ERIC Educational Resources Information Center

Marshall, Karol A.

1980-01-01

Suicide is a tragic and upsetting event which sometimes occurs when a person is in some form of therapy. This paper advocates a process after a patient commits suicide which allows for a thorough and orderly working through of the event by involved treatment personnel. (Author)

As You Get Older

MedlinePlus

... that your parents will still be involved in the decision-making process. If you and your parents have been talking ... be considering more treatment, you can’t put the rest of your life on hold. You ... a college decision, because you think you have another surgery coming ...

PROCESS DESIGN MANUAL: LAND APPLICATION OF SEWAGE SLUDGE AND DOMESTIC SEPTAGE

EPA Science Inventory

Land application of sewage sludge generated by domestic sewage treatment is performed in an environmentally safe and cost–effective manner in many communities. Land application involves taking advantage of the fertilizing and soil conditioning properties of sewage sludge by sp...

Solid Waste: Resource Recovery and Reuse

ERIC Educational Resources Information Center

Bernardo, James V.

1973-01-01

Discusses some of the processes involved in resource recovery (recycling) from municipal solid wastes. Provides specific examples of recovery of valuable resources, and suggests that the environmental consequences and technology related to solid waste treatment should be included in high school science courses. (JR)

Complete physico-chemical treatment for coke plant effluents.

PubMed

Ghose, M K

2002-03-01

Naturally found coal is converted to coke which is suitable for metallurgical industries. Large quantities of liquid effluents produced contain a large amount of suspended solids, high COD, BOD, phenols, ammonia and other toxic substances which are causing serious pollution problem in the receiving water to which they are discharged. There are a large number of coke plants in the vicinity of Jharia Coal Field (JCF). Characteristics of the effluents have been evaluated. The present effluent treatment systems were found to be inadequate. Physico-chemical treatment has been considered as a suitable option for the treatment of coke plant effluents. Ammonia removal by synthetic zeolite, activated carbon for the removal of bacteria, viruses, refractory organics, etc. were utilized and the results are discussed. A scheme has been proposed for the complete physico-chemical treatment, which can be suitably adopted for the recycling, reuse and safe disposal of the treated effluent. Various unit process and unit operations involved in the treatment system have been discussed. The process may be useful on industrial scale at various sites.

Using Workflow Modeling to Identify Areas to Improve Genetic Test Processes in the University of Maryland Translational Pharmacogenomics Project.

PubMed

Cutting, Elizabeth M; Overby, Casey L; Banchero, Meghan; Pollin, Toni; Kelemen, Mark; Shuldiner, Alan R; Beitelshees, Amber L

Delivering genetic test results to clinicians is a complex process. It involves many actors and multiple steps, requiring all of these to work together in order to create an optimal course of treatment for the patient. We used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. We propose a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center, so that personalized medicine program implementers can identify areas to improve genetic testing processes. We found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. We demonstrate our use of BPMN to improve this important clinical process for CYP2C19 genetic testing in patients undergoing invasive treatment of coronary heart disease.

Using Workflow Modeling to Identify Areas to Improve Genetic Test Processes in the University of Maryland Translational Pharmacogenomics Project

PubMed Central

Cutting, Elizabeth M.; Overby, Casey L.; Banchero, Meghan; Pollin, Toni; Kelemen, Mark; Shuldiner, Alan R.; Beitelshees, Amber L.

2015-01-01

Delivering genetic test results to clinicians is a complex process. It involves many actors and multiple steps, requiring all of these to work together in order to create an optimal course of treatment for the patient. We used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. We propose a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center, so that personalized medicine program implementers can identify areas to improve genetic testing processes. We found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. We demonstrate our use of BPMN to improve this important clinical process for CYP2C19 genetic testing in patients undergoing invasive treatment of coronary heart disease. PMID:26958179

[Adherence to pharmacological treatment in adult patients undergoing hemodialysis].

PubMed

Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima

2012-06-01

Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patient's orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.

Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes.

PubMed

Gordon-Hollingsworth, Arlene T; Becker, Emily M; Ginsburg, Golda S; Keeton, Courtney; Compton, Scott N; Birmaher, Boris B; Sakolsky, Dara J; Piacentini, John; Albano, Anne M; Kendall, Philip C; Suveg, Cynthia M; March, John S

2015-10-01

This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7-17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement.

Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes

PubMed Central

Gordon-Hollingsworth, Arlene T.; Becker, Emily M.; Keeton, Courtney; Compton, Scott N.; Birmaher, Boris B.; Sakolsky, Dara J.; Piacentini, John; Albano, Anne M.; Kendall, Philip C.; Suveg, Cynthia M.; March, John S.

2014-01-01

This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7–17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement. PMID:25293650

Deubiquitinating enzymes in cancer stem cells: functions and targeted inhibition for cancer therapy.

PubMed

Kaushal, Kamini; Antao, Ainsley Mike; Kim, Kye-Seong; Ramakrishna, Suresh

2018-06-01

The ability of cancers to evade conventional treatments, such as chemotherapy and radiation therapy, has been attributed to a subpopulation of cancer stem cells (CSCs). CSCs are regulated by mechanisms similar to those that regulate normal stem cells (NSCs), including processes involving ubiquitination and deubiquitination enzymes (DUBs) that regulate the expression of various factors, such as Notch, Wnt, Sonic Hedgehog (Shh), and Hippo. In this review, we discuss the roles of various DUBs involved in the regulation of core stem cell transcription factors and CSC-related proteins that are implicated in the modulation of cellular processes and carcinogenesis. In addition, we discuss the various DUB inhibitors that have been designed to target processes relevant to cancer and CSC maintenance. Copyright © 2018 Elsevier Ltd. All rights reserved.

Problematics of Time and Timing in the Longitudinal Study of Human Development: Theoretical and Methodological Issues

PubMed Central

Lerner, Richard M.; Schwartz, Seth J; Phelps, Erin

2009-01-01

Studying human development involves describing, explaining, and optimizing intraindividual change and interindividual differences in such change and, as such, requires longitudinal research. The selection of the appropriate type of longitudinal design requires selecting the option that best addresses the theoretical questions asked about developmental process and the use of appropriate statistical procedures to best exploit data derived from theory-predicated longitudinal research. This paper focuses on several interrelated problematics involving the treatment of time and the timing of observations that developmental scientists face in creating theory-design fit and in charting in change-sensitive ways developmental processes across life. We discuss ways in which these problematics may be addressed to advance theory-predicated understanding of the role of time in processes of individual development. PMID:19554215

Cutaneous tuberculosis: diagnosis, histopathology and treatment - part II.

PubMed

Santos, Josemir Belo dos; Figueiredo, Ana Roberta; Ferraz, Cláudia Elise; Oliveira, Márcia Helena de; Silva, Perla Gomes da; Medeiros, Vanessa Lucília Sileira de

2014-01-01

The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent. At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009. This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs.

Finding agreement to limit life-sustaining treatment for children who are in state custody.

PubMed

Savage, T; Michalak, D R

2001-01-01

For children in state custody with extensive disabilities who reside in a skilled nursing facility, it is possible and, at times, desirable to limit treatment in the form of withholding resuscitation. With demonstration and documentation of the benefits and burdens of resuscitation for a particular child, the child protection agency will authorize a "Do Not Resuscitate" order. This article discusses the procedural as well as ethical issues involved in the process of finding agreement to limit life-sustaining treatment for children who are in state custody.

The Insula: A ‘Hub of Activity’ in Migraine

PubMed Central

Borsook, David; Veggeberg, Rosanna; Erpelding, Nathalie; Borra, Ronald; Linnman, Clas; Burstein, Rami; Becerra, Lino

2017-01-01

The insula, a ‘cortical hub’ buried within the lateral sulcus, is involved in a number of processes including goal-directed cognition, conscious awareness, autonomic regulation, interoception and somatosensation. While some of these processes are well known in the clinical presentation of migraine (i.e., autonomic and somatosensory alterations), other more complex behaviors in migraine, such as conscious awareness and error detection, are less well described. Since the insula processes and relays afferent inputs from brain areas involved in these functions to areas involved in higher cortical function such as frontal, temporal and parietal regions, it may be implicated as a brain region that translates the signals of altered internal milieu in migraine, along with other chronic pain conditions, through the insula into complex behaviors. Here we review how the insula function and structure is altered in migraine. As a brain region of a number of brain functions, it may serve as a model to study new potential clinical perspectives for migraine treatment. PMID:26290446

Emotional Modulation of Learning and Memory: Pharmacological Implications.

PubMed

LaLumiere, Ryan T; McGaugh, James L; McIntyre, Christa K

2017-07-01

Memory consolidation involves the process by which newly acquired information becomes stored in a long-lasting fashion. Evidence acquired over the past several decades, especially from studies using post-training drug administration, indicates that emotional arousal during the consolidation period influences and enhances the strength of the memory and that multiple different chemical signaling systems participate in this process. The mechanisms underlying the emotional influences on memory involve the release of stress hormones and activation of the basolateral amygdala, which work together to modulate memory consolidation. Moreover, work suggests that this amygdala-based memory modulation occurs with numerous types of learning and involves interactions with many different brain regions to alter consolidation. Additionally, studies suggest that emotional arousal and amygdala activity in particular influence synaptic plasticity and associated proteins in downstream brain regions. This review considers the historical understanding for memory modulation and cellular consolidation processes and examines several research areas currently using this foundational knowledge to develop therapeutic treatments. Copyright © 2017 by The American Society for Pharmacology and Experimental Therapeutics.

Redox Regulation in Amyotrophic Lateral Sclerosis

PubMed Central

Parakh, Sonam; Spencer, Damian M.; Halloran, Mark A.; Soo, Kai Y.; Atkin, Julie D.

2013-01-01

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that results from the death of upper and lower motor neurons. Due to a lack of effective treatment, it is imperative to understand the underlying mechanisms and processes involved in disease progression. Regulations in cellular reduction/oxidation (redox) processes are being increasingly implicated in disease. Here we discuss the possible involvement of redox dysregulation in the pathophysiology of ALS, either as a cause of cellular abnormalities or a consequence. We focus on its possible role in oxidative stress, protein misfolding, glutamate excitotoxicity, lipid peroxidation and cholesterol esterification, mitochondrial dysfunction, impaired axonal transport and neurofilament aggregation, autophagic stress, and endoplasmic reticulum (ER) stress. We also speculate that an ER chaperone protein disulphide isomerase (PDI) could play a key role in this dysregulation. PDI is essential for normal protein folding by oxidation and reduction of disulphide bonds, and hence any disruption to this process may have consequences for motor neurons. Addressing the mechanism underlying redox regulation and dysregulation may therefore help to unravel the molecular mechanism involved in ALS. PMID:23533690

Inhibition of Pseudomonas aeruginosa adhesion to fibronectin by PA-IL and monosaccharides: involvement of a lectin-like process.

PubMed

Rebiere-Huët, Julie; Di Martino, Patrick; Hulen, Christian

2004-05-01

Pseudomonas aeruginosa adherence to fibronectin has been shown to be important to bacterial colonization and infection. To better understand the mechanisms involved in this interaction, the role of the carbohydrate moiety of the fibronectin molecule in P. aeruginosa adhesion was studied. Strain NK 125 502 adhered to immobilized fibronectin with an adherence index of 4.8 x 10(5) CFU/ micro g. Periodic oxidation of fibronectin markedly reduced the adhesion of P. aeruginosa, while a neuraminidase treatment increased bacteria adhesion. N-Acetylgalactosamine, N-acetylglucosamine, sialic acid, and also lectin PA-IL worked as efficient inhibitors in adhesion assays: 59%, 70.7%, 100%, and 60% of inhibition, respectively. We have demonstrated here the involvement of a lectin-like process in the interaction of P. aeruginosa NK 125 502 with immobilized fibronectin.

The association of β-arrestin2 polymorphisms with response to antidepressant treatment in depressed patients.

PubMed

Petit, Anne-Cécile; El Asmar, Khalil; David, Denis J; Gardier, Alain M; Becquemont, Laurent; Fève, Bruno; Verstuyft, Céline; Corruble, Emmanuelle

2018-02-02

The study of genetic polymorphisms involved in antidepressants (AD) response is essential to provide a personalized medicine approach in the field of depression. β-arrestin 2 (ARRB2) is a candidate gene in the pharmacogenetics of AD as it is involved in the signaling cascade downstream of numerous neurotransmitter receptors. We investigated the association between five ARRB2 single nucleotide polymorphisms (SNPs): rs1045280, rs2036657, rs4790694, rs3786047 and rs452246, and response to AD treatment in a sample of 569 patients with a major depressive episode treated for 6months. We show that GG/GT patients for rs4522461 (n=534) and AA/AC patients for rs4790694 (n=244) have a lower response to AD than other genotype groups (HDRS score of 10.9 vs 8.0 after 6months, multivariate analysis: p=0.03; 12.2 vs 9.6, p=0.02, respectively). These data provide additional evidence that β-arrestin 2 is a regulator of intracellular signal transduction processes involved in AD treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing an Integrated, Brief Biobehavioral HIV Prevention Intervention for High-Risk Drug Users in Treatment: The Process and Outcome of Formative Research

PubMed Central

Shrestha, Roman; Altice, Frederick; Karki, Pramila; Copenhaver, Michael

2017-01-01

To date, HIV prevention efforts have largely relied on singular strategies (e.g., behavioral or biomedical approaches alone) with modest HIV risk-reduction outcomes for people who use drugs (PWUD), many of whom experience a wide range of neurocognitive impairments (NCI). We report on the process and outcome of our formative research aimed at developing an integrated biobehavioral approach that incorporates innovative strategies to address the HIV prevention and cognitive needs of high-risk PWUD in drug treatment. Our formative work involved first adapting an evidence-based behavioral intervention—guided by the Assessment–Decision–Administration–Production–Topical experts–Integration–Training–Testing model—and then combining the behavioral intervention with an evidence-based biomedical intervention for implementation among the target population. This process involved eliciting data through structured focus groups (FGs) with key stakeholders—members of the target population (n = 20) and treatment providers (n = 10). Analysis of FG data followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis and cross-case analysis. Based on all information, we integrated the adapted community-friendly health recovery program—a brief evidence-based HIV prevention behavioral intervention—with the evidence-based biomedical component [i.e., preexposure prophylaxis (PrEP)], an approach that incorporates innovative strategies to accommodate individuals with NCI. This combination approach—now called the biobehavioral community-friendly health recovery program—is designed to address HIV-related risk behaviors and PrEP uptake and adherence as experienced by many PWUD in treatment. This study provides a complete example of the process of selecting, adapting, and integrating the evidence-based interventions—taking into account both empirical evidence and input from target population members and target organization stakeholders. The resultant brief evidence-based biobehavioral approach could significantly advance primary prevention science by cost-effectively optimizing PrEP adherence and HIV risk reduction within common drug treatment settings. PMID:28553295

The prelude on novel receptor and ligand targets involved in the treatment of diabetes mellitus.

PubMed

Jonnalagadda, Venu Gopal; Ram Raju, Allam Venkata Sita; Pittala, Srinivas; Shaik, Afsar; Selkar, Nilakash Annaji

2014-01-01

Metabolic disorders are a group of disorders, due to the disruption of the normal metabolic process at a cellular level. Diabetes Mellitus and Tyrosinaemia are the majorly reported metabolic disorders. Among them, Diabetes Mellitus is a one of the leading metabolic syndrome, affecting 5 to 7 % of the population worldwide and mainly characterised by elevated levels of glucose and is associated with two types of physiological event disturbances such as impaired insulin secretion and insulin resistance. Up to now, various treatment strategies are like insulin, alphaglucosidase inhibitors, biguanides, incretins were being followed. Concurrently, various novel therapeutic strategies are required to advance the therapy of Diabetes mellitus. For the last few decades, there has been an extensive research in understanding the metabolic pathways involved in Diabetes Mellitus at the cellular level and having the profound knowledge on cell-growth, cell-cycle, and apoptosis at a molecular level provides new targets for the treatment of Diabetes Mellitus. Receptor signalling has been involved in these mechanisms, to translate the information coming from outside. To understand the various receptors involved in these pathways, we must have a sound knowledge on receptors and ligands involved in it. This review mainly summarises the receptors and ligands which are involved the Diabetes Mellitus. Finally, researchers have to develop the alternative chemical moieties that retain their affinity to receptors and efficacy. Diabetes Mellitus being a metabolic disorder due to the glucose surfeit, demands the need for regular exercise along with dietary changes.

[Involvement of the peripheral nervous system in systemic connective tissue diseases: report on clinical cases].

PubMed

Kujawska-Danecka, Hanna; Masiak, Anna; Smoleńska, Zaneta; Zdrojewski, Zbigniew

2011-01-01

The peripheral nervous system is usually involved in the majority of systemic connective tissue diseases, particularly in systemic lupus erythematosus, Sjögren's syndrome, vasculitis and systemic sclerosis. The pathogenesis of lesions in the peripheral nervous system associated with the autoimmune process is complex and it appears that two mechanisms, immunological and ischemic, are of greatest importance. Structures of the nervous system may be damaged by several autoantibodies (e.g. antineuronal, anti-nerve growth factor, anti-neurotrophins), by cytotoxic effects ofproinflammatory cytokines and by activated cells of the immune system. Local ischemia and hypoxia of neurons caused by inflammation of vasa nervosum represents the second significant mechanism leading to damage of nerve fibres in the peripheral nervous system. We present 3 cases with involvement of the peripheral nervous system as a dominant feature in the clinical picture of systemic connective tissue diseases. Clinical conditions in which the peripheral nervous system is involved include peripheral sensory and sensorimotor polyneuropathy, mononeuropathies, cranial neuropathies, acute inflammatory demyelinating polyneuropathy (Guillian-Barré syndrome), chronic inflammatory demyelinating polyneuropathy, plexopathy, myasthenia gravis, and dysfunctions of the autonomic nervous system. The diagnosis is based on clinical symptoms reported by the patient and disclosed during neurologic examination. The importance of electrophysiologic tests is advocated. Selection of treatment depends on the patient's clinical condition, as well as on the clinical form and type of disease. Treatment relies principally on glucocorticosteroids, intravenous immunoglobulins, cyclophosphamide, and other immunosuppressive drugs. Plasmapheresis and rituximab are administered in severe cases. Rehabilitation of the patient appears to be an important element of therapy. Cases with neurologic symptoms as the first and often the sole manifestation of systemic connective tissue disease are particularly problematic requiring a multidimensional approach; their process of diagnosis and treatment is usually long.

Myeloproliferative neoplasms and inflammation: whether to target the malignant clone or the inflammatory process or both.

PubMed

Koschmieder, S; Mughal, T I; Hasselbalch, H C; Barosi, G; Valent, P; Kiladjian, J-J; Jeryczynski, G; Gisslinger, H; Jutzi, J S; Pahl, H L; Hehlmann, R; Maria Vannucchi, A; Cervantes, F; Silver, R T; Barbui, T

2016-05-01

The Philadelphia-negative myeloproliferative neoplasms (MPNs) are clonal disorders involving hematopoietic stem and progenitor cells and are associated with myeloproliferation, splenomegaly and constitutional symptoms. Similar signs and symptoms can also be found in patients with chronic inflammatory diseases, and inflammatory processes have been found to play an important role in the pathogenesis and progression of MPNs. Signal transduction pathways involving JAK1, JAK2, STAT3 and STAT5 are causally involved in driving both the malignant cells and the inflammatory process. Moreover, anti-inflammatory and immune-modulating drugs have been used successfully in the treatment of MPNs. However, to date, many unresoved issues remain. These include the role of somatic mutations that are present in addition to JAK2V617F, CALR and MPL W515 mutations, the interdependency of malignant and nonmalignant cells and the means to eradicate MPN-initiating and -maintaining cells. It is imperative for successful therapeutic approaches to define whether the malignant clone or the inflammatory cells or both should be targeted. The present review will cover three aspects of the role of inflammation in MPNs: inflammatory states as important differential diagnoses in cases of suspected MPN (that is, in the absence of a clonal marker), the role of inflammation in MPN pathogenesis and progression and the use of anti-inflammatory drugs for MPNs. The findings emphasize the need to separate the inflammatory processes from the malignancy in order to improve our understanding of the pathogenesis, diagnosis and treatment of patients with Philadelphia-negative MPNs.

Sensory Processing Dysfunction in the Personal Experience and Neuronal Machinery of Schizophrenia

PubMed Central

Javitt, Daniel C.; Freedman, Robert

2015-01-01

Sensory processing deficits, first investigated by Kraeplin and Bleuler as possible pathophysiological mechanisms in schizophrenia, are now being re-characterized in the context of modern understanding of the involved molecular and neurobiological brain mechanisms. The National Institute of Mental Health Research Domain Criteria position these deficits as intermediaries between molecular and cellular mechanisms and clinical symptoms of schizophrenia such as hallucinations. The pre-pulse inhibition of startle responses by a weaker preceding tone, the inhibitory gating of response to paired sensory stimuli characterized using the auditory P50 evoked response, and the detection of slightly different stimuli that elicits the cortical Mismatch Negativity potential demonstrate deficits in early sensory processing mechanisms, whose molecular and neurobiological bases are increasingly well understood. Deficits in sensory processing underlie more complex cognitive dysfunction and, vice versa, are affected by higher-level cognitive difficulties. These deficits are now being used to identify genes involved in familial transmission of the illness and to monitor potentially therapeutic drug effects for both treatment and prevention. This research also provides a clinical reminder that patients’ sensory perception of the surrounding world, even during treatment sessions, may differ considerable from others’ perceptions. A person’s ability to understand and interact effectively with surrounding world ultimately depends upon an underlying sensory experience of it. PMID:25553496

Current biotechnological developments in Belgium.

PubMed

Masschelein, C A; Callegari, J P; Laurent, M; Simon, J P; Taeymans, D

1989-01-01

In recent years, actions have been undertaken by the Belgian government to promote process innovation and technical diversification. Research programs are initiated and coordinated by the study committee for biotechnology setup within the Institute for Scientific Research in Industry and Agriculture (IRSIA). As a result of this action, the main areas where biotechnological processes are developed or commercially exploited include plant genetics, protein engineering, hybridoma technology, biopesticides, production by genetic engineering of vaccines and drugs, monoclonal detection of human and animal deseases, process reactors for aerobic and anaerobic wastewater treatment, and genetic modification of yeast and bacteria as a base for biomass and energy. Development research also includes new fermentation technologies principally based on immobilization of microorganisms, reactor design, and optimization of unit operations involved in downstream processing. Food, pharmaceutical, and chemical industries are involved in genetic engineering and biotechnology and each of these sectors is overviewed in this paper.

Treatment of evaporator condensates by pervaporation

DOEpatents

Blume, Ingo; Baker, Richard W.

1990-01-01

A pervaporation process for separating organic contaminants from evaporator condensate streams is disclosed. The process employs a permselective membrane that is selectively permeable to an organic component of the condensate. The process involves contacting the feed side of the membrane with a liquid condensate stream, and withdrawing from the permeate side a vapor enriched in the organic component. The driving force for the process is the in vapor pressure across the membrane. This difference may be provided for instance by maintaining a vacuum on the permeate side, or by condensing the permeate. The process offers a simple, economic alternative to other separation techniques.

Physicians' participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study.

PubMed

Heisler, M; Tierney, E; Ackermann, R T; Tseng, C; Narayan, K M Venkat; Crosson, J; Waitzfelder, B; Safford, M M; Duru, K; Herman, W H; Kim, C

2009-09-01

In participatory decision-making (PDM), physicians actively engage patients in treatment and other care decisions. Patients who report that their physicians engage in PDM have better disease self-management and health outcomes. We examined whether physicians' diabetes-specific treatment PDM preferences as well as their self-reported practices are associated with the quality of diabetes care their patients receive. 2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n=4198) in 10 US health plans across the country and their physicians (n=1217). We characterized physicians' diabetes care PDM preferences and practices as 'no patient involvement,' 'physician-dominant,' 'shared,' or 'patient-dominant' and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients'satisfaction with physician communication; and (3) whether patients' A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control. Most physicians preferred 'shared' PDM (58%) rather than 'no patient involvement' (9%), 'physician-dominant' (28%) or 'patient dominant' PDM (5%). However, most reported practicing 'physician-dominant' PDM (43%) with most of their patients, rather than 'no patient involvement' (13%), 'shared' (37%) or 'patient-dominant' PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred 'shared' PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03-3.07] and patients of physicians who preferred 'patient-dominant' treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04-2.39] than those of providers who preferred 'no patient involvement' in treatment decision-making. There were no differences in patients' satisfaction with their doctor's communication or control of A1c, SBP or LDL depending on their physicians' PDM preferences. Physicians' self-reported PDM practices were not associated with any of the examined aspects of diabetes care in multivariate analyses. Patients whose physicians prefer more patient involvement in decision-making are more likely than patients whose physicians prefer more physician-directed styles to receive some recommended risk factor screening tests, an important first step toward improved diabetes outcomes. Involving patients in treatment decision-making alone, however, appears not to be sufficient to improve biomedical outcomes.

Sarcosine Up-Regulates Expression of Genes Involved in Cell Cycle Progression of Metastatic Models of Prostate Cancer

PubMed Central

Heger, Zbynek; Merlos Rodrigo, Miguel Angel; Michalek, Petr; Polanska, Hana; Masarik, Michal; Vit, Vitezslav; Plevova, Mariana; Pacik, Dalibor; Eckschlager, Tomas; Stiborova, Marie

2016-01-01

The effects of sarcosine on the processes driving prostate cancer (PCa) development remain still unclear. Herein, we show that a supplementation of metastatic PCa cells (androgen independent PC-3 and androgen dependent LNCaP) with sarcosine stimulates cells proliferation in vitro. Similar stimulatory effects were observed also in PCa murine xenografts, in which sarcosine treatment induced a tumor growth and significantly reduced weight of treated mice (p < 0.05). Determination of sarcosine metabolism-related amino acids and enzymes within tumor mass revealed significantly increased glycine, serine and sarcosine concentrations after treatment accompanied with the increased amount of sarcosine dehydrogenase. In both tumor types, dimethylglycine and glycine-N-methyltransferase were affected slightly, only. To identify the effects of sarcosine treatment on the expression of genes involved in any aspect of cancer development, we further investigated expression profiles of excised tumors using cDNA electrochemical microarray followed by validation using the semi-quantitative PCR. We found 25 differentially expressed genes in PC-3, 32 in LNCaP tumors and 18 overlapping genes. Bioinformatical processing revealed strong sarcosine-related induction of genes involved particularly in a cell cycle progression. Our exploratory study demonstrates that sarcosine stimulates PCa metastatic cells irrespectively of androgen dependence. Overall, the obtained data provides valuable information towards understanding the role of sarcosine in PCa progression and adds another piece of puzzle into a picture of sarcosine oncometabolic potential. PMID:27824899

Effect of treatment in a constructed wetland on toxicity of textile wastewater

USGS Publications Warehouse

Baughman, G.L.; Perkins, W.S.; Lasier, P.J.; Winger, P.V.

2003-01-01

Constructed wetlands for treating wastewater have proliferated in recent years and their characteristics have been studied extensively. In most cases, constructed wetlands have been used primarily for removal of nutrients and heavy metals. Extensive literature is available concerning construction and use of wetlands for treatment of wastewater. Even so, quantitative descriptions of wetland function and processes are highly empirical and difficult to extrapolate. The processes involved in removal of pollutants by wetlands are poorly understood, especially for waste streams as complex as textile effluents. The few studies conducted on treatment of textile wastewater in constructed wetlands were cited in earlier publications. Results of a two-year study of a full-scale wetland treating textile effluent are presented here. The paper describes the effects of the wetland on aquatic toxicity of the wastewater and draws conclusions about the utility and limitations of constructed wetlands for treatment of textile effluents.

Design of the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study (NC ProCESS).

PubMed

Chen, Ronald C; Carpenter, William R; Kim, Mimi; Hendrix, Laura H; Agans, Robert P; Meyer, Anne-Marie; Hoffmeyer, Anna; Reeve, Bryce B; Nielsen, Matthew E; Usinger, Deborah S; Strigo, Tara S; Jackman, Anne M; Anderson, Mary; Godley, Paul A

2015-01-01

The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) was designed in collaboration with stakeholders to compare the effectiveness of different treatment options for localized prostate cancer. Using the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry, 1,419 patients (57% of eligible) with newly-diagnosed localized prostate cancer were enrolled from January 2011 to June 2013, on average 5 weeks after diagnosis. All participants were enrolled prior to treatment and this population-based cohort is sociodemographically diverse. Prospective follow-up continues to collect data on treatments received, disease control, survival and patient-reported outcomes. This study highlights several important considerations regarding stakeholder involvement, study design and generalizability regarding comparative effectiveness research in prostate cancer.

Revegetation studies on Tosco II and USBM retorted oil shales

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

Kilkelly, M.K.; Harbert, H.P.; Berg, W.A.

1981-01-01

In 1973 studies on the revegetation of processed oil shales were initiated. The objectives of these studies were to investigate the vegetative stabilization of processed oil shales and to follow moisture and soluble salt movement in the retorted shale profile. Studies involving TOSCO II and USBM retorted shales were established at both a low-elevation (Anvil Points) and a high-elevation (Piceance Basin). Treatments included leaching and various depths of soil cover. After seven growing seasons a good vegetative cover remains with differences between treatments insignificant, with the exception of the TOSCO retorted shale south-aspect, which consistently supported less perennial vegetative covermore » than other treatments. With time, a shift from perennial grasses to dominance by shrubs was observed, especially on south-aspect slopes. 6 refs.« less

Fractionation and cellulase treatment for enhancing the properties of kraft-based dissolving pulp.

PubMed

Duan, Chao; Wang, Xinqi; Zhang, YanLing; Xu, Yongjian; Ni, Yonghao

2017-01-01

The aim of this study was to investigate a combined process involving pulp fractionation and cellulase treatment of each fraction for improving the molecular weight distribution (MWD) and reactivity of a kraft-based dissolving pulp. Three pulp fractions, namely long-fiber, mid-fiber and short-fiber fractions (LF, MF and SF, respectively), were used as the substrates. The results showed that the SF had the highest accessibility, lowest viscosity, and highest cellulase adsorption capacity, while the opposite was true for the LF. At a given viscosity, the combined process led to a lower polydispersity index (3.71 vs 4.98) and a higher Fock reactivity (85.6% vs 76.3%), in comparison to the conventional single-stage cellulase treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Transformation of pharmaceuticals during oxidation/disinfection processes in drinking water treatment.

PubMed

Postigo, Cristina; Richardson, Susan D

2014-08-30

Pharmaceuticals are emerging contaminants of concern and are widespread in the environment. While the levels of these substances in finished drinking waters are generally considered too low for human health concern, there are now concerns about their disinfection by-products (DBPs) that can form during drinking water treatment, which in some cases have been proven to be more toxic than the parent compounds. The present manuscript reviews the transformation products of pharmaceuticals generated in water during different disinfection processes, i.e. chlorination, ozonation, chloramination, chlorine dioxide, UV, and UV/hydrogen peroxide, and the main reaction pathways taking place. Most of the findings considered for this review come from controlled laboratory studies involving reactions of pharmaceuticals with these oxidants used in drinking water treatment. Copyright © 2014 Elsevier B.V. All rights reserved.

Management of Uveitis in Spondyloarthropathy: Current Trends

PubMed Central

Gupta, Nikhil; Agarwal, Aditi

2018-01-01

Spondyloarthritis is a chronic inflammatory disease predominantly affecting joints of the axial skeleton. However, as many as 50% of patients with this disease may have extra-articular manifestations, which include uveitis; psoriasis; inflammatory bowel disease such as Crohn disease or ulcerative colitis; cardiovascular manifestations in the form of conduction abnormalities, atherosclerosis, or valvular heart disease; pulmonary involvement; and rarely renal involvement. Uveitis occurs in 25% to 40% of patients with spondyloarthritis. Management of uveitis is crucial to prevent morbidity caused by vision loss and secondary complications. Treatment ranges from local therapies to systemic drugs and varies depending on the severity and response to treatment. Categories of medical treatment include nonsteroidal anti-inflammatory agents, corticosteroids, and steroid-sparing agents. Biologic therapies such as antitumor necrosis factor agents act early in the disease process and have revolutionized the field of rheumatology, including management of uveitis. This review will focus on the management of ophthalmic manifestations in spondyloarthropathies. PMID:29272246

Management and Treatment of Temporomandibular Disorders: A Clinical Perspective

PubMed Central

Wright, Edward F.; North, Sarah L.

2009-01-01

A temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime. TMD is often viewed as a repetitive motion disorder of the masticatory structures and has many similarities to musculoskeletal disorders of other parts of the body. Treatment often involves similar principles as other regions as well. However, patients with TMD and concurrent cervical pain exhibit a complex symptomatic behavior that is more challenging than isolated TMD symptoms. Although routinely managed by medical and dental practitioners, TMD may be more effectively cared for when physical therapists are involved in the treatment process. Hence, a listing of situations when practitioners should consider referring TMD patients to a physical therapist can be provided to the practitioners in each physical therapist's region. This paper should assist physical therapists with evaluating, treating, insurance billing, and obtaining referrals for TMD patients. PMID:20140156

Refusal of treatment, leading to death: towards optimization of informed consent.

PubMed

Trevor-Deutsch, B; Nelson, R F

1996-12-01

Few medical decisions create more anguish than ones involving cessation of treatment, resulting in the death of a patient. In this article, the ethical and legal aspects of the withdrawal of treatment are examined with respect to a case of a 67-year-old man who fell and sustained a fracture of his second cervical vertebra, rendering him paralysed and respirator-dependent. He immediately requested the withdrawal of treatment, but his family baulked. Ethics consultation recommended delaying the decision, to give the patient enough time to foster optimal comprehension and synthesis of information related to his condition and the consequences; we refer to this process as "optimization of informed consent." When the patient was informed of the delay and the reasons for it, he was assured (and subsequently repeatedly reassured) of his ultimate right to refuse treatment at a future date. On balance, optimization of informed consent promotes patients' autonomy, even though it involves suspending this autonomy for a time. It is also consistent with physicians' responsibility to promote life and avoid premature death.

Soldering and brazing safety guide: A handbook on space practice for those involved in soldering and brazing

NASA Astrophysics Data System (ADS)

This manual provides those involved in welding and brazing with effective safety procedures for use in performance of their jobs. Hazards exist in four types of general soldering and brazing processes: (1) cleaning; (2) application of flux; (3) application of heat and filler metal; and (4) residue cleaning. Most hazards during those operations can be avoided by using care, proper ventilation, protective clothing and equipment. Specific process hazards for various methods of brazing and soldering are treated. Methods to check ventilation are presented as well as a check of personal hygiene and good maintenance practices are stressed. Several emergency first aid treatments are described.

Value choices and considerations when limiting intensive care treatment: a qualitative study.

PubMed

Halvorsen, K; Førde, R; Nortvedt, P

2009-01-01

To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment. Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment. Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes. Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.

Treatment Attrition: Associations with Negative Affect Smoking Motives and Barriers to Quitting Among Treatment-Seeking Smokers

PubMed Central

Garey, Lorra; Kauffman, Brooke Y.; Neighbors, Clayton; Schmidt, Norman B.; Zvolensky, Michael J.

2016-01-01

Introduction Pre-treatment attrition and perceived barriers for quitting are clinically important processes involved in early phases of quitting smoking. However, less is known about the constructs that may contribute to these processes such as negative affect reduction smoking motives. Method The current study sought to evaluate the relation between negative affect reduction smoking motives with pre-treatment attrition and perceived barriers for quitting in a sample of 425 treatment-seeking smokers (48.5% female; Mage = 37.69; SD = 13.61) enrolled in a smoking cessation study examining the efficacy of a transdiagnostic panic-smoking cessation treatment relative to a standard smoking cessation treatment. Results Results indicated that greater negative affect reduction smoking motives was associated with an increased likelihood of treatment initiation (Odds Ratio = 1.49, CI: 1.09, 2.04). Additionally, negative affect reduction smoking motives was associated with greater perceived barriers for cessation among pre-treatment drop-outs and treatment initiators. Conclusions This initial investigation provides evidence for the possible clinical utility in addressing negative affect reduction smoking motives during early stages of quitting. Additionally, such findings could potentially inform the development of personalized, early stages of quitting interventions for smoking cessation. PMID:27518764

Inactivation of dinoflagellate Scripsiella trochoidea in synthetic ballast water by advanced oxidation processes.

PubMed

Yang, Zhishan; Jiang, Wenju; Zhang, Yi; Lim, T M

2015-01-01

Ship-borne ballast water contributes significantly to the transfer of non-indigenous species across aquatic environments. To reduce the risk of bio-invasion, ballast water should be treated before discharge. In this study, the efficiencies of several conventional and advanced oxidation processes were investigated for potential ballast water treatment, using a marine dinoflagellate species, Scripsiella trochoidea, as the indicator organism. A stable and consistent culture was obtained and treated by ultraviolet (UV) light, ozone (O3), hydrogen peroxide (H2O2), and their various combinations. UV apparently inactivated the cells after only 10 s of irradiation, but subsequently photo-reactivation of the cells was observed for all methods involving UV. O3 exhibited 100% inactivation efficiency after 5 min treatment, while H2O2 only achieved maximum 80% inactivation in the same duration. Combined methods, e.g. UV/O3 and UV/H2O2, were found to inhibit photo-reactivation and improve treatment efficiency to some degree, indicating the effectiveness of using combined treatment processes. The total residual oxidant (TRO) levels of the methods were determined, and the results indicated that UV and O3 generated the lowest and highest TRO, respectively. The synergic effect of combined processes on TRO generation was found to be insignificant, and thus UV/O3 was recommended as a potentially suitable treatment process for ballast water.

Complementarity of statistical treatments to reconstruct worldwide routes of invasion: The case of the Asian ladybird Harmonia axyridis

USDA-ARS?s Scientific Manuscript database

Technical Abstract. Molecular markers can provide clear insight into the introduction history of invasive species. However, inferences about recent introduction histories remain challenging, because of the stochastic demographic processes often involved. Approximate Bayesian computation (ABC) can he...

Influence of volumetric reduction factor during ozonation of nanofiltration concentrates for wastewater reuse.

PubMed

Azaïs, Antonin; Mendret, Julie; Petit, Eddy; Brosillon, Stephan

2016-12-01

Global population growth induces increased threat on drinking water resources. One way to address this environmental issue is to reuse water from wastewater treatment plant. The presence of pathogenic microorganisms and potentially toxic organic micropollutants does not allow a direct reuse of urban effluents. Membrane processes such reverse osmosis (RO) or nanofiltration (NF) can be considered to effectively eliminate these pollutants. The integration of membrane processes involves the production of concentrated retentates which require being disposed. To date, no treatment is set up to manage safely this pollution. This work focuses on the application of ozonation for the treatment of NF retentates in the framework of the wastewater reuse. Ozonation is a powerful oxidation process able to react and degrade a wide range of organic pollutants. Four pharmaceutical micropollutants were selected as target molecules: acetaminophen, carbamazepine, atenolol and diatrozic acid. This study highlighted that NF represents a viable alternative to the commonly used RO process ensuring high retention at much lower operating costs. Ozonation appears to be effective to degrade the most reactive pollutants toward molecular ozone but is limited for the reduction of refractory ozone pollutants due to the inhibition of the radical chain by the high content of organic matter in the retentates. The ozonation process appears to be a promising NF retentate treatment, but additional treatments after ozonation are required to lead to a zero liquid discharge treatment scheme. Copyright © 2016 Elsevier Ltd. All rights reserved.

Correction to hill (2005).

PubMed

Hill, Clara E

2006-01-01

Reports an error in "Therapist Techniques, Client Involvement, and the Therapeutic Relationship: Inextricably Intertwined in the Therapy Process" by Clara E. Hill (Psychotherapy: Theory, Research, Practice, Training, 2005 Win, Vol 42(4), 431-442). An author's name was incorrectly spelled in a reference. The correct reference is presented. (The following abstract of the original article appeared in record 2006-03309-003.) I propose that therapist techniques, client involvement, and the therapeutic relationship are inextricably intertwined and need to be considered together in any discussion of the therapy process. Furthermore, I present a pantheoretical model of how these three variables evolve over four stages of successful therapy: initial impression formation, beginning the therapy (involves the components of facilitating client exploration and developing case conceptualization and treatment strategies), the core work of therapy (involves the components of theory-relevant tasks and overcoming obstacles), and termination. Theoretical propositions as well as implications for training and research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Who needs collaborative care treatment? A qualitative study exploring attitudes towards and experiences with mental healthcare among general practitioners and care managers.

PubMed

Møller, Marlene Christina Rosengaard; Mygind, Anna; Bro, Flemming

2018-05-30

Collaborative care treatment is widely recognized as an effective approach to improve the quality of mental healthcare through enhanced and structured collaboration between general practice and specialized psychiatry. However, studies indicate that the complexity of collaborative care treatment interventions challenge the implementation in real-life general practice settings. Four Danish Collaborative Care Models were launched in 2014 for patients with mild/moderate anxiety and depression. These involved collaboration between general practitioners, care managers and consultant psychiatrists. Taking a multi-practice bottom-up approach, this paper aims to explore the perceived barriers and enablers related to collaborative care for patients with mental health problems and to investigate the actual experiences with a Danish collaborative care model in a single-case study in order to identify enablers and barriers for successful implementation. Combining interviews and observations of usual treatment practices, we conducted a multi-practice study among general practitioners who were not involved in the Danish collaborative care models to explore their perspectives on existing mental health treatment and to investigate (from a bottom-up approach) their perceptions of and need for collaborative care in mental health treatment. Additionally, by combining observations and qualitative interviews, we followed the implementation of a Danish collaborative care model in a single-case study to convey identified barriers and enablers of the collaborative care model. Experienced and perceived enablers of the Danish collaborative care model mainly consisted of a need for new treatment options to deal with mild/moderate anxiety and depression. The model was considered to meet the need for a free fast track to high-quality treatment. Experienced barriers included: poor adaptation of the model to the working conditions and needs in daily general practice, time consumption, unsustainable logistical set-up and unclear care manager role. General practitioners in the multi-practice study considered access to treatment and not collaboration with specialised psychiatry to be essential for this group of patients. The study calls for increased attention to implementation processes and better adaptation of collaborative care models to the clinical reality of general practice. Future interventions should address the treatment needs of specific patient populations and should involve relevant stakeholders in the design and implementation processes.

[Plastic surgery treatment techniques for interdisciplinary therapy of pressure sores].

PubMed

Müller, Karin; Becker, Frederic; Pfau, Matthias; Werdin, Frank

2017-06-01

Pressure sores in geriatric patients represent a challenge for all disciplines involved in the treatment process; however, the prerequisite for successful treatment is the elaboration of an interdisciplinary treatment concept. The treatment goals should be adapted to the individual needs of the patients including the life situation, general condition and local findings. In addition to general basic operative techniques, such as wound cleansing and conditioning, plastic and reconstructive surgery provides a wide range of highly specialized operative techniques for the treatment of these patients by which a definitive defect coverage can be achieved. The aim of this article is to raise awareness for these complex and highly specialized procedures for all disciplines participating in the treatment in order to improve the interdisciplinary cooperation and ultimately the quality of treatment.

Multidimensional Treatment Foster Care as a Preventive Intervention to Promote Resiliency Among Youth in the Child Welfare System

PubMed Central

Leve, Leslie D.; Fisher, Philip A.; Chamberlain, Patricia

2009-01-01

Demographic trends indicate that a growing segment of families is exposed to adversity such as poverty, drug use problems, caregiver transitions, and domestic violence. Although these risk processes and the accompanying poor outcomes for children have been well-studied, little is known about why some children develop resilience in the face of such adversity, particularly when it is severe enough to invoke child welfare involvement. This paper describes a program of research involving families in the child welfare system. Using a resiliency framework, evidence from four randomized clinical trials that included components of the Multidimensional Treatment Foster Care program is presented. Future directions and next steps are proposed. PMID:19807861

Are decisions under risk malleable?

PubMed

Fong, C; McCabe, K

1999-09-14

Human decision making under risk and uncertainty may depend on individual involvement in the outcome-generating process. Expected utility theory is silent on this issue. Prospect theory in its current form offers little, if any, prediction of how or why involvement in a process should matter, although it may offer ex post interpretations of empirical findings. Well-known findings in psychology demonstrate that when subjects exercise more involvement or choice in lottery procedures, they value their lottery tickets more highly. This often is interpreted as an "illusion of control," meaning that when subjects are more involved in a lottery, they may believe they are more likely to win, perhaps because they perceive that they have more control over the outcome. Our experimental design eliminates several possible alternative explanations for the results of previous studies in an experiment that varies the degree and type of involvement in lottery procedures. We find that in treatments with more involvement subjects on average place less rather than more value on their lottery tickets. One possible explanation for this is that involvement interacts with loss aversion by causing subjects to weigh losses more heavily than they would otherwise. One implication of our study is that involvement, either independently or in interaction with myopic loss aversion, may help explain the extreme risk aversion of bond investors.

What sex abusers say about their treatment: results from a qualitative study on pedophiles in treatment at a Canadian penitentiary clinic.

PubMed

Drapeau, Martin; Korner, Annett C; Granger, Luc; Brunet, Louis

2005-01-01

This exploratory study used qualitative methodology to examine what pedophiles think about treatment, as well as their daily experience of a treatment program. To this end, twenty-three offenders receiving treatment from the La Macaza federal penitentiary clinic were interviewed using non-directive semi-structured interviews. Comparative analysis was used to analyze the resulting material. The following themes are discussed based on the results of this analysis: (a) the participants' past experience of therapy; (b) motivations for choosing the La Macaza clinic for treatment; (c) the structure of the program; (d) the group dynamics; (e) the therapists; and (f) the hardships and difficulties of treatment. Results suggest that the therapists and the program may have a function of containment or holding. Although part of the therapeutic process involves a focus on identifying and reducing cognitive distortions, results also warn therapists against misusing this concept by applying it to legitimately different opinions. Findings are discussed in terms of possible program improvements. The authors conclude that greater attention must be given to process research.

Organics removal in oily bilgewater by electrocoagulation process.

PubMed

Asselin, Mélanie; Drogui, Patrick; Brar, Satinder Kaur; Benmoussa, Hamel; Blais, Jean-François

2008-03-01

This study investigated the treatment of oily bilgewater using an electrocoagulation technique. Electrocoagulation process was evaluated at laboratory scale (1.7 l electrolytic cell) and involved utilization of two kinds of electrodes (iron and aluminium) arranged either in bipolar (BP) or monopolar (MP) configuration. Results showed that the best performance was obtained using mild steel MP electrode system operated at a current intensity of 1.5A, through 60 or 90 min of treatment. Under these conditions, removal yields of 93.0+/-3.3% and 95.6+/-0.2% were measured for BOD and O&G, respectively, whereas CODs and CODt were removed by 61.3+/-3.6% and 78.1+/-0.1%, respectively. Likewise, 99.4+/-0.1% of n-C10 to n-C50 hydrocarbons was removed from oily bilgewater. Electrocoagulation was also efficient for clarification of OBW. Removal yields of 99.8+/-0.4% and 98.4+/-0.5% have been measured for TSS and turbidity, respectively. Electrocoagulation process operated under the optimal conditions involves a total cost of 0.46 US$ per cubic meter of treated OBW. This cost only includes energy and electrode consumptions, chemicals, and sludge disposal.

Treatment planning: A key milestone to prevent treatment dropout in adolescents with borderline personality disorder.

PubMed

Desrosiers, Lyne; Saint-Jean, Micheline; Breton, Jean-Jacques

2015-06-01

The aim of this study was to gain a broader appreciation of processes involved in treatment dropout in adolescents with borderline personality disorder (BPD). A constructivist grounded theory was chosen using a multiple-case research design with three embedded levels of analysis (adolescent, parent, and care setting). Theoretical sampling and the different stages of analysis specific to grounded theory were performed according to the iterative process of constant comparative analysis. Twelve cases were examined (nine dropouts among adolescents with BPD and for the purpose of falsification, one dropout of suicidal adolescent without BPD and two completed treatments among adolescents with BPD). To document the cases, three groups of informants were recruited (adolescents, parents, and therapists involved in the treatment) and 34 interviews were conducted. Psychological characteristics, perception of mental illness and mental health care, and help-seeking context were the specific treatment dropout vulnerabilities identified in adolescents with BPD and in their parents. However, their disengagement became an issue only when care-setting response--including mitigation of accessibility problems, adaptation of services to needs of adolescents with BPD, preparation for treatment, and concern for clinicians' disposition to treat--was ill-suited to these treatment dropout vulnerabilities. Treatment planning proves to be a key milestone to properly engage adolescents with BPD and their parent. Systematic assessment of treatment dropout vulnerabilities before the intervention plan is laid out could foster better-suited responses of the care setting thus decreasing the incidence of treatment discontinuation in adolescents with BPD. Treatment dropout vulnerabilities specific to adolescents with BPD and their parents can be detected before the beginning of treatment. Premature treatment termination may be prevented if the care setting considers these vulnerabilities at treatment planning. Fears and negative reaction to treatment can be attenuated if the reasons behind the therapeutic orientation are explained and if the adolescent understand how the treatment will affect his condition. Concerns for autonomy of the adolescent, parental help-seeking context as well as ensuring that the clinician has the skills, interest, and motivation to work with the family may have a positive effect on families' commitment to treatment. © 2014 The British Psychological Society.

WE-H-BRC-04: Implement Lean Methodology to Make Our Current Process of CT Simulation to Treatment More Efficient

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

Boddu, S; Morrow, A; Krishnamurthy, N

Purpose: Our goal is to implement lean methodology to make our current process of CT simulation to treatment more efficient. Methods: In this study, we implemented lean methodology and tools and employed flowchart in excel for process-mapping. We formed a group of physicians, physicists, dosimetrists, therapists and a clinical physics assistant and huddled bi-weekly to map current value streams. We performed GEMBA walks and observed current processes from scheduling patient CT Simulations to treatment plan approval. From this, the entire workflow was categorized into processes, sub-processes, and tasks. For each process we gathered data on touch time, first time quality,more » undesirable effects (UDEs), and wait-times from relevant members of each task. UDEs were binned per frequency of their occurrence. We huddled to map future state and to find solutions to high frequency UDEs. We implemented visual controls, hard stops, and documented issues found during chart checks prior to treatment plan approval. Results: We have identified approximately 64 UDEs in our current workflow that could cause delays, re-work, compromise the quality and safety of patient treatments, or cause wait times between 1 – 6 days. While some UDEs are unavoidable, such as re-planning due to patient weight loss, eliminating avoidable UDEs is our goal. In 2015, we found 399 issues with patient treatment plans, of which 261, 95 and 43 were low, medium and high severity, respectively. We also mapped patient-specific QA processes for IMRT/Rapid Arc and SRS/SBRT, involving 10 and 18 steps, respectively. From these, 13 UDEs were found and 5 were addressed that solved 20% of issues. Conclusion: We have successfully implemented lean methodology and tools. We are further mapping treatment site specific workflows to identify bottlenecks, potential breakdowns and personnel allocation and employ tools like failure mode effects analysis to mitigate risk factors to make this process efficient.« less

Parental decision making involvement and decisional conflict: a descriptive study.

PubMed

Boland, Laura; Kryworuchko, Jennifer; Saarimaki, Anton; Lawson, Margaret L

2017-06-13

Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child's health. However, little is known about parents' experience of decisional conflict. We explored parents' perceived decision making involvement and its association with parents' decisional conflict. We conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child. Four hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p < 0.001). Further, parents with options were more likely to: feel sure about the decision (RR 1.08, 95% CI 1.02-1.15); understand the information (RR 1.92, 95% CI 1.63-2.28); be clear about the risks and benefits (RR 1.12, 95% CI 1.05-1.20); and, have sufficient support and advice to make a choice (RR 1.07, 95% CI 1.03-1.11). Many parents in our sample experienced decisional conflict after their clinical consultation. Involving parents in the decision making process might reduce their risk of decisional conflict. Evidence based interventions that support parent decision making involvement, such as shared decision making, should be evaluated and implemented in pediatrics as a strategy to reduce parents' decisional conflict.

Early family-based intervention in the path to alcohol problems: rationale and relationship between treatment process characteristics and child and parenting outcomes.

PubMed

Nye, C L; Zucker, R A; Fitzgerald, H E

1999-03-01

Risk for subsequent development of alcohol problems is not uniform across the population of alcoholic families, but varies with parental comorbidity and family history. Recent studies have also identified disruptive child behavior problems in the preschool years as predictive of alcoholism in adulthood. Given the quality of risk structure in highest risk families, prevention programming is more appropriately family based rather than individual. A family-based intervention program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to change this potential mediating risk structure. A population-based recruitment strategy enrolled 52 alcoholic families in a 10-month intervention involving parent training and marital problem solving. The study examined the interplay between parent treatment investment and parent and therapist expectations and satisfaction in predicting change in child behavior and authoritative parenting style during the program, and for 6 months afterward among the 29 families whose sustained involvement allowed these effects to be evaluated. Parent expectations at pretreatment influenced their early investment in the program, which in turn predicted child and parenting outcomes. Parent and therapist satisfaction ratings during treatment were associated with one another and with expectations that the program would continue to promote changes in their child. Parent investment was a particularly salient influence on outcome, as higher investment throughout the program was associated with improvement in child behavior and authoritative parenting at termination. Findings indicate that treatment process characteristics mediate the influence of baseline parent functioning on treatment success and that treatment changes themselves predict later child outcomes.

Admission and capacity planning for the implementation of one-stop-shop in skin cancer treatment using simulation-based optimization.

PubMed

Romero, H L; Dellaert, N P; van der Geer, S; Frunt, M; Jansen-Vullers, M H; Krekels, G A M

2013-03-01

Hospitals and health care institutions are facing the challenge of improving the quality of their services while reducing their costs. The current study presents the application of operations management practices in a dermatology oncology outpatient clinic specialized in skin cancer treatment. An interesting alternative considered by the clinic is the implementation of a one-stop-shop concept for the treatment of new patients diagnosed with basal cell carcinoma. This alternative proposes a significant improvement in the average waiting time that a patient spends between the diagnosis and treatment. This study is focused on the identification of factors that influence the average throughput time of patients treated in the clinic from the logistic perspective. A two-phase approach was followed to achieve the goals stated in this study. The first phase included an integrated approach for the deterministic analysis of the capacity using a demand-supply model for the hospital processes, while the second phase involved the development of a simulation model to include variability to the activities involved in the process and to evaluate different scenarios. Results showed that by managing three factors: the admission rule, resources allocation and capacity planning in the dermato-oncology unit throughput times for treatments of new patients can be decreased with more than 90 %, even with the same resource level. Finally, a pilot study with 16 patients was also conducted to evaluate the impact of implementing the one stop shop concept from a clinical perspective. Patients turned out to be satisfied with the fast diagnosis and treatment.

Identifying the candidate genes involved in the calyx abscission process of 'Kuerlexiangli' (Pyrus sinkiangensis Yu) by digital transcript abundance measurements.

PubMed

Qi, Xiaoxiao; Wu, Jun; Wang, Lifen; Li, Leiting; Cao, Yufen; Tian, Luming; Dong, Xingguang; Zhang, Shaoling

2013-10-23

'Kuerlexiangli' (Pyrus sinkiangensis Yu), a native pear of Xinjiang, China, is an important agricultural fruit and primary export to the international market. However, fruit with persistent calyxes affect fruit shape and quality. Although several studies have looked into the physiological aspects of the calyx abscission process, the underlying molecular mechanisms remain unknown. In order to better understand the molecular basis of the process of calyx abscission, materials at three critical stages of regulation, with 6000 × Flusilazole plus 300 × PBO treatment (calyx abscising treatment) and 50 mg.L-1GA3 treatment (calyx persisting treatment), were collected and cDNA fragments were sequenced using digital transcript abundance measurements to identify candidate genes. Digital transcript abundance measurements was performed using high-throughput Illumina GAII sequencing on seven samples that were collected at three important stages of the calyx abscission process with chemical agent treatments promoting calyx abscission and persistence. Altogether more than 251,123,845 high quality reads were obtained with approximately 8.0 M raw data for each library. The values of 69.85%-71.90% of clean data in the digital transcript abundance measurements could be mapped to the pear genome database. There were 12,054 differentially expressed genes having Gene Ontology (GO) terms and associating with 251 Kyoto Encyclopedia of Genes and Genomes (KEGG) defined pathways. The differentially expressed genes correlated with calyx abscission were mainly involved in photosynthesis, plant hormone signal transduction, cell wall modification, transcriptional regulation, and carbohydrate metabolism. Furthermore, candidate calyx abscission-specific genes, e.g. Inflorescence deficient in abscission gene, were identified. Quantitative real-time PCR was used to confirm the digital transcript abundance measurements results. We identified candidate genes that showed highly dynamic changes in expression during the calyx abscission process. These genes are potential targets for future functional characterization and should be valuable for exploration of the mechanisms of calyx abscission, and eventually for developing methods based on small molecule application to induce calyx abscission in fruit production.

Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis.

PubMed

Pron, G

2015-01-01

Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. The objectives of the analysis were to evaluate patients' eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no randomized trials comparing MRgHIFU and other guidance methods, other minimally invasive treatments, or surgeries for symptomatic uterine fibroids. Limitations with MRgHIFU included restricted eligibility, requirement for a dedicated MR device to guide the treatment, lengthy procedure time, and loss of MR opportunity time. For women failing medical therapy and seeking alternatives to hysterectomy for symptomatic uterine fibroids, MRgHIFU provides a safe and effective, noninvasive, uterine-preserving treatment from which they rapidly recover. The treatment advantages of MRgHIFU are potentially offset by restrictive eligibility, lengthy procedure time, and dependence on availability of an MR device. The lack of comparative evidence between MRgHIFU and other, more established uterine-preserving treatments limits informed decision making among treatment options.

Magnetic Resonance–Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis

PubMed Central

Pron, G

2015-01-01

Background Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. Objectives The objectives of the analysis were to evaluate patients’ eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. Methods A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. Results The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no randomized trials comparing MRgHIFU and other guidance methods, other minimally invasive treatments, or surgeries for symptomatic uterine fibroids. Limitations with MRgHIFU included restricted eligibility, requirement for a dedicated MR device to guide the treatment, lengthy procedure time, and loss of MR opportunity time. Conclusions For women failing medical therapy and seeking alternatives to hysterectomy for symptomatic uterine fibroids, MRgHIFU provides a safe and effective, noninvasive, uterine-preserving treatment from which they rapidly recover. The treatment advantages of MRgHIFU are potentially offset by restrictive eligibility, lengthy procedure time, and dependence on availability of an MR device. The lack of comparative evidence between MRgHIFU and other, more established uterine-preserving treatments limits informed decision making among treatment options. PMID:26357530

Acne vulgaris.

PubMed

Moradi Tuchayi, Sara; Makrantonaki, Evgenia; Ganceviciene, Ruta; Dessinioti, Clio; Feldman, Steven R; Zouboulis, Christos C

2015-09-17

Acne vulgaris is a chronic inflammatory disease - rather than a natural part of the life cycle as colloquially viewed - of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. Some of the key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. Grading of acne involves lesion counting and photographic methods. However, there is a lack of consensus on the exact grading criteria, which hampers the conduction and comparison of randomized controlled clinical trials evaluating treatments. Prevention of acne relies on the successful management of modifiable risk factors, such as underlying systemic diseases and lifestyle factors. Several treatments are available, but guidelines suffer from a lack of data to make evidence-based recommendations. In addition, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Acne commonly causes scarring and reduces the quality of life of patients. New treatment options with a shift towards targeting the early processes involved in acne development instead of suppressing the effects of end products will enhance our ability to improve the outcomes for patients with acne.

Telemedicine utilization to support the management of the burns treatment involving patient pathways in both developed and developing countries: a case study.

PubMed

Syed-Abdul, Shabbir; Scholl, Jeremiah; Chen, Chiehfeng Cliff; Santos, Martinho D P S; Jian, Wen-Shan; Liou, Der-Ming; Li, Yu-Chuan

2012-01-01

This case study reports on the utilization of telemedicine to support the management of the burns treatment in the islands of Sao Tome and Principe by Taipei Medical University-affiliated hospital in Taiwan. The authors share experiences about usage of telemedicine to support treatment of the burn victims in a low-income country that receive reconstructive surgery in a developed country. Throughout the entire care process, telemedicine has been used not only to provide an expert advice from distance but also to help establish and maintain the doctor-patient relationship, to keep patients in contact with their families, and to help educate and consult the medical personal physically present in Sao Tome and Principe. This case study presents the details of how this process has been conducted to date, on what were learned from this process, and on issues that should be considered to improve this process in the future. The authors plan to create instructional videos and post them on YouTube to aid clinical workers providing similar treatment during the acute care and rehabilitation process and also to support eLearning in many situations where it otherwise is not possible to use videoconferencing to establish real-time contact between doctors at the local site and remote specialists.

Adherence Rating Scale for Cognitive Processing Therapy - Cognitive Only: Analysis of Psychometric Properties.

PubMed

Dittmann, Clara; Müller-Engelmann, Meike; Resick, Patricia A; Gutermann, Jana; Stangier, Ulrich; Priebe, Kathlen; Fydrich, Thomas; Ludäscher, Petra; Herzog, Julia; Steil, Regina

2017-11-01

The assessment of therapeutic adherence is essential for accurately interpreting treatment outcomes in psychotherapy research. However, such assessments are often neglected. To fill this gap, we aimed to develop and test a scale that assessed therapeutic adherence to Cognitive Processing Therapy - Cognitive Only (CPT), which was adapted for a treatment study targeting patients with post-traumatic stress disorder and co-occurring borderline personality symptoms. Two independent, trained raters assessed 30 randomly selected treatment sessions involving seven therapists and eight patients who were treated in a multicentre randomized controlled trial. The inter-rater reliability for all items and the total score yielded good to excellent results (intraclass correlation coefficient [ICC] = 0.70 to 1.00). Cronbach's α was .56 for the adherence scale. Regarding content validity, three experts confirmed the relevance and appropriateness of each item. The adherence rating scale for the adapted version of CPT is a reliable instrument that can be helpful for interpreting treatment effects, analysing possible relationships between therapeutic adherence and treatment outcomes and teaching therapeutic skills.

"Fabrication of arbitrarily shaped carbonate apatite foam based on the interlocking process of dicalcium hydrogen phosphate dihydrate".

PubMed

Sugiura, Yuki; Tsuru, Kanji; Ishikawa, Kunio

2017-08-01

Carbonate apatite (CO 3 Ap) foam with an interconnected porous structure is highly attractive as a scaffold for bone replacement. In this study, arbitrarily shaped CO 3 Ap foam was formed from α-tricalcium phosphate (α-TCP) foam granules via a two-step process involving treatment with acidic calcium phosphate solution followed by hydrothermal treatment with NaHCO 3 . The treatment with acidic calcium phosphate solution, which is key to fabricating arbitrarily shaped CO 3 Ap foam, enables dicalcium hydrogen phosphate dihydrate (DCPD) crystals to form on the α-TCP foam granules. The generated DCPD crystals cause the α-TCP granules to interlock with each other, inducing an α-TCP/DCPD foam. The interlocking structure containing DCPD crystals can survive hydrothermal treatment with NaHCO 3 . The arbitrarily shaped CO 3 Ap foam was fabricated from the α-TCP/DCPD foam via hydrothermal treatment at 200 °C for 24 h in the presence of a large amount of NaHCO 3 .

An integrated treatment model for dual diagnosis of psychosis and addiction.

PubMed

Minkoff, K

1989-10-01

A model that integrates the treatment of patients with a dual diagnosis of psychosis and addiction has been developed on a general hospital psychiatric unit. The model emphasizes the parallels between the standard biopsychosocial illness-and-rehabilitation model for treatment of serious psychiatric disorders and the 12-step disease-and-recovery model of Alcoholics Anonymous for treatment of addiction. Dual-diagnosis patients are viewed as having two primary, chronic, biologic mental illnesses, each requiring specific treatment to stabilize acute symptoms and engage the patient in a recovery process. An integrated treatment program is described, as are the steps taken to alleviate psychiatric clinicians' concerns about patient involvement in AA and addiction clinicians' discomfort with patients' use of medication.

Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery.

PubMed

Stea, Jonathan N; Yakovenko, Igor; Hodgins, David C

2015-09-01

The present study of recovery from cannabis use disorders was undertaken with 2 primary objectives that address gaps in the literature. The first objective was to provide an exploratory portrait of the recovery process from cannabis use disorders, comparing individuals who recovered naturally with those who were involved in treatment. The second objective was to explore systematically the similarities and differences between abstinence and moderation recoveries. Adults who have recovered from a cannabis use disorder were recruited in the community (N = 119). The abstinence and treatment-assisted participants exhibited higher levels of lifetime cannabis problem severity than the moderation and natural recovery participants, respectively. As well, cognitive factors were identified as the most useful strategies for recovery (e.g., thinking about benefits and negative consequences of cannabis), followed by behavioral factors (e.g., avoidance of triggers for use and high-risk situations). Findings lend further support to the effectiveness of cognitive, motivational, and behavioral strategies as helpful actions and maintenance factors involved in the recovery process. The findings also generally support the idea that cannabis use disorders lie on a continuum of problem severity, with moderation and natural recoveries more likely to occur at the lower end of the continuum and abstinence and treatment-assisted recoveries more likely to occur at the upper end. (c) 2015 APA, all rights reserved).

Combined analysis of mRNA and miRNA identifies dehydration and salinity responsive key molecular players in citrus roots

PubMed Central

Xie, Rangjin; Zhang, Jin; Ma, Yanyan; Pan, Xiaoting; Dong, Cuicui; Pang, Shaoping; He, Shaolan; Deng, Lie; Yi, Shilai; Zheng, Yongqiang; Lv, Qiang

2017-01-01

Citrus is one of the most economically important fruit crops around world. Drought and salinity stresses adversely affected its productivity and fruit quality. However, the genetic regulatory networks and signaling pathways involved in drought and salinity remain to be elucidated. With RNA-seq and sRNA-seq, an integrative analysis of miRNA and mRNA expression profiling and their regulatory networks were conducted using citrus roots subjected to dehydration and salt treatment. Differentially expressed (DE) mRNA and miRNA profiles were obtained according to fold change analysis and the relationships between miRNAs and target mRNAs were found to be coherent and incoherent in the regulatory networks. GO enrichment analysis revealed that some crucial biological processes related to signal transduction (e.g. ‘MAPK cascade’), hormone-mediated signaling pathways (e.g. abscisic acid- activated signaling pathway’), reactive oxygen species (ROS) metabolic process (e.g. ‘hydrogen peroxide catabolic process’) and transcription factors (e.g., ‘MYB, ZFP and bZIP’) were involved in dehydration and/or salt treatment. The molecular players in response to dehydration and salt treatment were partially overlapping. Quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) analysis further confirmed the results from RNA-seq and sRNA-seq analysis. This study provides new insights into the molecular mechanisms how citrus roots respond to dehydration and salt treatment. PMID:28165059

Comparative Analysis of Toxic Responses of Organic Extracts from Diesel and Selected Alternative Fuels Engine Emissions in Human Lung BEAS-2B Cells.

PubMed

Libalova, Helena; Rossner, Pavel; Vrbova, Kristyna; Brzicova, Tana; Sikorova, Jitka; Vojtisek-Lom, Michal; Beranek, Vit; Klema, Jiri; Ciganek, Miroslav; Neca, Jiri; Pencikova, Katerina; Machala, Miroslav; Topinka, Jan

2016-11-03

This study used toxicogenomics to identify the complex biological response of human lung BEAS-2B cells treated with organic components of particulate matter in the exhaust of a diesel engine. First, we characterized particles from standard diesel (B0), biodiesel (methylesters of rapeseed oil) in its neat form (B100) and 30% by volume blend with diesel fuel (B30), and neat hydrotreated vegetable oil (NEXBTL100). The concentration of polycyclic aromatic hydrocarbons (PAHs) and their derivatives in organic extracts was the lowest for NEXBTL100 and higher for biodiesel. We further analyzed global gene expression changes in BEAS-2B cells following 4 h and 24 h treatment with extracts. The concentrations of 50 µg extract/mL induced a similar molecular response. The common processes induced after 4 h treatment included antioxidant defense, metabolism of xenobiotics and lipids, suppression of pro-apoptotic stimuli, or induction of plasminogen activating cascade; 24 h treatment affected fewer processes, particularly those involved in detoxification of xenobiotics, including PAHs. The majority of distinctively deregulated genes detected after both 4 h and 24 h treatment were induced by NEXBTL100; the deregulated genes included, e.g., those involved in antioxidant defense and cell cycle regulation and proliferation. B100 extract, with the highest PAH concentrations, additionally affected several cell cycle regulatory genes and p38 signaling.

Effects of Treatment Type on Alcohol Consumption Partially Mediated by Alcoholics Anonymous Attendance.

PubMed

Karriker-Jaffe, Katherine J; Klinger, Jamie L; Witbrodt, Jane; Kaskutas, Lee Ann

2018-03-21

As insurance coverage, funding sources and venues for drug and alcohol treatment evolve in the United States, it is important to assess how the type of treatment received may impact long-term outcomes. The current study aims were to examine effects of treatment type on alcohol consumption in the year after treatment intake and to test mediators of effects of treatment type on later alcohol use. Longitudinal data from clients in inpatient and outpatient alcohol treatment programs in California (n = 560) were used in ordinary least squares path analysis adjusting for respondent characteristics typically associated with both treatment completion and alcohol use. The primary outcome was amount of alcohol consumed in the 12 months after treatment entry; hypothesized mediators were treatment duration and participation in Alcoholics Anonymous (AA). Despite higher baseline problem severity and a shorter treatment duration, inpatient clients consumed less alcohol after treatment than outpatient clients (B [95% CI] = -0.95 [-1.67, -0.23]). AA involvement was a significant mediator of the relationship between treatment type and alcohol consumption, with inpatient clients being more involved in AA and also drinking less after treatment than outpatient clients; the bias-corrected bootstrap 95% confidence interval for the indirect effect (B = -0.20) was entirely below zero (-0.43 to -0.05). Outpatient clients may benefit from customized posttreatment recommendations to identify additional resources to assist in the recovery process during the first year after treatment.

Modelling biofilm-induced formation damage and biocide treatment in subsurface geosystems

PubMed Central

Ezeuko, C C; Sen, A; Gates, I D

2013-01-01

Biofilm growth in subsurface porous media, and its treatment with biocides (antimicrobial agents), involves a complex interaction of biogeochemical processes which provide non-trivial mathematical modelling challenges. Although there are literature reports of mathematical models to evaluate biofilm tolerance to biocides, none of these models have investigated biocide treatment of biofilms growing in interconnected porous media with flow. In this paper, we present a numerical investigation using a pore network model of biofilm growth, formation damage and biocide treatment. The model includes three phases (aqueous, adsorbed biofilm, and solid matrix), a single growth-limiting nutrient and a single biocide dissolved in the water. Biofilm is assumed to contain a single species of microbe, in which each cell can be a viable persister, a viable non-persister, or non-viable (dead). Persisters describe small subpopulation of cells which are tolerant to biocide treatment. Biofilm tolerance to biocide treatment is regulated by persister cells and includes ‘innate’ and ‘biocide-induced’ factors. Simulations demonstrate that biofilm tolerance to biocides can increase with biofilm maturity, and that biocide treatment alone does not reverse biofilm-induced formation damage. Also, a successful application of biological permeability conformance treatment involving geologic layers with flow communication is more complicated than simply engineering the attachment of biofilm-forming cells at desired sites. PMID:23164434

The Masterson Approach with play therapy: a parallel process between mother and child.

PubMed

Mulherin, M A

2001-01-01

This paper discusses a case in which the Masterson Approach was used with play therapy to treat a child with a developing personality disorder. It describes the parallel progression of the child and mother in adjunct therapy throughout a six-year period. The unique value of the Masterson Approach is that it provides the therapist with a framework and tool to diagnose and treat a child during the dynamic process of play. The case describes the mother-child dyad throughout therapy. It traces their parallel processes that involve separation, individuation, rapprochement, and the recovery of real self-capacities. Each stage of treatment is described, including verbal interventions. The child's internal affective state and intrapsychic structure during the various stages of treatment are illustrated by representative pictures.

SERDP ER-1376 Enhancement of In Situ Bioremediation of Energetic Compounds by Coupled Abiotic/Biotic Processes:Final Report for 2004 - 2006

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

Szecsody, James E.; Comfort, Steve; Fredrickson, Herbert L.

2007-08-07

This project was initiated by SERDP to quantify processes and determine the effectiveness of abiotic/biotic mineralization of energetics (RDX, HMX, TNT) in aquifer sediments by combinations of biostimulation (carbon, trace nutrient additions) and chemical reduction of sediment to create a reducing environment. Initially it was hypothesized that a balance of chemical reduction of sediment and biostimulation would increase the RDX, HMX, and TNT mineralization rate significantly (by a combination of abiotic and biotic processes) so that this abiotic/biotic treatment may be a more efficient for remediation than biotic treatment alone in some cases. Because both abiotic and biotic processes aremore » involved in energetic mineralization in sediments, it was further hypothesized that consideration for both abiotic reduction and microbial growth was need to optimize the sediment system for the most rapid mineralization rate. Results show that there are separate optimal abiotic/biostimulation aquifer sediment treatments for RDX/HMX and for TNT. Optimal sediment treatment for RDX and HMX (which have chemical similarities and similar degradation pathways) is mainly chemical reduction of sediment, which increased the RDX/HMX mineralization rate 100 to150 times (relative to untreated sediment), with additional carbon or trace nutrient addition, which increased the RDX/HMX mineralization rate an additional 3 to 4 times. In contrast, the optimal aquifer sediment treatment for TNT involves mainly biostimulation (glucose addition), which stimulates a TNT/glucose cometabolic degradation pathway (6.8 times more rapid than untreated sediment), degrading TNT to amino-intermediates that irreversibly sorb (i.e., end product is not CO2). The TNT mass migration risk is minimized by these transformation reactions, as the triaminotoluene and 2,4- and 2,6-diaminonitrotoluene products that irreversibly sorb are no longer mobile in the subsurface environment. These transformation rates are increased 13 times further by chemical reduction of sediment. Dithionite reduction alone is not an effective treatment for TNT (intermediates that irreversibly sorb are not produced), even though the TNT degradation rate (to 2- or 4-aminodinitrotoluene) increases.« less

Processing and properties of carbon nanofibers reinforced epoxy powder composites

NASA Astrophysics Data System (ADS)

Palencia, C.; Mazo, M. A.; Nistal, A.; Rubio, F.; Rubio, J.; Oteo, J. L.

2011-11-01

Commercially available CNFs (diameter 30-300 nm) have been used to develop both bulk and coating epoxy nanocomposites by using a solvent-free epoxy matrix powder. Processing of both types of materials has been carried out by a double-step process consisting in an initial physical premix of all components followed by three consecutive extrusions. The extruded pellets were grinded into powder and sieved. Carbon nanofibers powder coatings were obtained by electrostatic painting of the extruded powder followed by a curing process based in a thermal treatment at 200 °C for 25 min. On the other hand, for obtaining bulk carbon nanofibers epoxy composites, a thermal curing process involving several steps was needed. Gloss and mechanical properties of both nanocomposite coatings and bulk nanocomposites were improved as a result of the processing process. FE-SEM fracture surface microphotographs corroborate these results. It has been assessed the key role played by the dispersion of CNFs in the matrix, and the highly important step that is the processing and curing of the nanocomposites. A processing stage consisted in three consecutive extrusions has reached to nanocomposites free of entanglements neither agglomerates. This process leads to nanocomposite coatings of enhanced properties, as it has been evidenced through gloss and mechanical properties. A dispersion limit of 1% has been determined for the studied system in which a given dispersion has been achieved, as the bending mechanical properties have been increased around 25% compared with the pristine epoxy resin. It has been also demonstrated the importance of the thickness in the nanocomposite, as it involves the curing stage. The complex curing treatment carried out in the case of bulk nanocomposites has reached to reagglomeration of CNFs.

Review on experiment-based two- and three-dimensional models for wound healing

PubMed Central

Gefen, Amit

2016-01-01

Traumatic and chronic wounds are a considerable medical challenge that affects many populations and their treatment is a monetary and time-consuming burden in an ageing society to the medical systems. Because wounds are very common and their treatment is so costly, approaches to reveal the responses of a specific wound type to different medical procedures and treatments could accelerate healing and reduce patient suffering. The effects of treatments can be forecast using mathematical modelling that has the predictive power to quantify the effects of induced changes to the wound-healing process. Wound healing involves a diverse and complex combination of biophysical and biomechanical processes. We review a wide variety of contemporary approaches of mathematical modelling of gap closure and wound-healing-related processes, such as angiogenesis. We provide examples of the understanding and insights that may be garnered using those models, and how those relate to experimental evidence. Mathematical modelling-based simulations can provide an important visualization tool that can be used for illustrational purposes for physicians, patients and researchers. PMID:27708762

A preliminary model of work during initial examination and treatment planning appointments.

PubMed

Irwin, J Y; Torres-Urquidy, M H; Schleyer, T; Monaco, V

2009-01-10

Objective This study's objective was to formally describe the work process for charting and treatment planning in general dental practice to inform the design of a new clinical computing environment.Methods Using a process called contextual inquiry, researchers observed 23 comprehensive examination and treatment planning sessions during 14 visits to 12 general US dental offices. For each visit, field notes were analysed and reformulated as formalised models. Subsequently, each model type was consolidated across all offices and visits. Interruptions to the workflow, called breakdowns, were identified.Results Clinical work during dental examination and treatment planning appointments is a highly collaborative activity involving dentists, hygienists and assistants. Personnel with multiple overlapping roles complete complex multi-step tasks supported by a large and varied collection of equipment, artifacts and technology. Most of the breakdowns were related to technology which interrupted the workflow, caused rework and increased the number of steps in work processes.Conclusion Current dental software could be significantly improved with regard to its support for communication and collaboration, workflow, information design and presentation, information content, and data entry.

Emanuel Miller Lecture: Early Onset Depressions--Meanings, Mechanisms and Processes

ERIC Educational Resources Information Center

Goodyer, Ian M.

2008-01-01

Background: Depressive syndromes in children and adolescents constitute a serious group of mental disorders with considerable risk for recurrence. A more precise understanding of aetiology is necessary to improve treatment and management. Methods: Three neuroactive agents are purported to be involved in the aetiology of these disorders: serotonin,…

APPLICATION OF PLANT AND EARTHWORM BIOASSAYS TO EVALUATE REMEDIATION OF A LEAD-CONTAMINATED SOIL

EPA Science Inventory

Earthworm acute toxicity, plant seed germination/root elongation (SG/RE) and plant genotoxicity bioassays were employed to evaluate the remediation of a lead-contaminated soil. The remediation involved removal of heavy metals by a soil washing/soil leaching treatment process. A p...

Measurement of Outcomes in Vision-Related Rehabilitation.

ERIC Educational Resources Information Center

Head, Daniel

1998-01-01

Comments on an earlier article by Lorraine Lidoff on health insurance coverage of vision-related rehabilitation services. Urges a standard model of services involving selection of measurable outcomes that reflect treatment processes, selection of the most appropriate time to measure outcomes, and selection of the best method for collecting outcome…

Marathon Group Counseling with Illicit Drug Users: Analysis of Content.

ERIC Educational Resources Information Center

Page, Richard C.; Wills, Judy

1983-01-01

Summarized a 16-hour marathon group for illicit drug users (N=12) in residential treatment. Content analysis showed the group spent more time on interpersonal relationships and relatively little time on group process. Drug users were able to successfully participate in therapeutic group discussions involving self-investment. (JAC)

40 CFR 440.132 - General definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... facility. (e) “In-situ leach methods” means the processes involving the purposeful introduction of suitable... mines, any area of land on or in which grading has been completed to return the earth to desired contour... equivalent regional rainfall and evaporation data. (c) “Appropriate treatment of the recycle water” in...

40 CFR 440.132 - General definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... facility. (e) “In-situ leach methods” means the processes involving the purposeful introduction of suitable... mines, any area of land on or in which grading has been completed to return the earth to desired contour... equivalent regional rainfall and evaporation data. (c) “Appropriate treatment of the recycle water” in...

40 CFR 440.132 - General definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... facility. (e) “In-situ leach methods” means the processes involving the purposeful introduction of suitable... mines, any area of land on or in which grading has been completed to return the earth to desired contour... equivalent regional rainfall and evaporation data. (c) “Appropriate treatment of the recycle water” in...

Manager`s views of public involvement

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

Branch, K.M.; Heerwagen, J.; Bradbury, J.

1995-12-01

Four issues commonly form the framework for debates about the acceptability of proposed projects or technologies--the substantive decision or technological choice; the treatment of the community by the proponent organization; the way the decision-making process has been structured and managed; and the status of institutional safeguards and protection. One of the clear messages of cultural theory is that differences in perspectives are a normal and inevitable part of society, and that attempts to resolve differences by persuasion are not likely to work. These findings are useful when considering the goals and possibilities of public involvement as a decision-making tool, andmore » when designing or evaluating public involvement training programs for managers. The research reported here examines the viewpoints and concerns of managers and decision-makers about the four issues identified above, with particular emphasis on their perspectives and concerns about opening decision-making processes to the public and about managers` roles and responsibilities for structuring and managing open decision-making processes. Implications of these findings for public involvement training for managers is also discussed. The data presented in this paper were obtained from face-to-face interviews with managers and decision-makers with experience managing a variety of hazardous waste management decision-making processes. We conducted these interviews in the course of four separate research projects: needs assessments to support the design and development of a public involvement training program for managers; a study of community residents` and managers` perspectives on the chemical stockpile disposal program; an evaluation of the effectiveness of public involvement training for managers in the Department of Energy; and a study to develop indicators of the benefits and costs of public involvement.« less

Decision making by patients with breast cancer: the role of information in treatment selection.

PubMed

Hughes, K K

1993-05-01

In recent years, patients have become more involved in the clinical decision-making process, yet the nature of this process, including the role of information, is poorly understood. The purpose of this exploratory study was to examine the relationship between information about breast cancer treatment alternatives and patients' choices of treatments. The target population was all patients with breast cancer in the process of deciding between breast conservation (lumpectomy plus irradiation) and more traditional management (modified radical mastectomy, with or without reconstruction). A convenience sample of 71 female patients with stage I or II breast cancer was drawn from a breast clinic affiliated with a 1,000-bed tertiary medical center. The amount of information provided to each subject and the nature of its presentation were recorded using an observer checklist. Recall of information and final treatment selection were ascertained during telephone interviews conducted six to eight weeks after surgery. The results indicate that subjects' choice of treatment was unrelated to the amount of information they received during the clinic visit. Manner of presentation also did not influence treatment selection. However, treatment selection was related to the amount of information subjects received prior to their clinic visit (p < 0.01). The results also indicate that patients' recall of information about treatments and associated risks is exceedingly poor. Clinical and legal implications are discussed and recommendations for further research are offered in this article.

Colorectal cancer patients' attitudes towards involvement in decision making.

PubMed

Beaver, Kinta; Campbell, Malcolm; Craven, Olive; Jones, David; Luker, Karen A; Susnerwala, Shabbir S

2009-03-01

To design and administer an attitude rating scale, exploring colorectal cancer patients' views of involvement in decision making. To examine the impact of socio-demographic and/or treatment-related factors on decision making. To conduct principal components analysis to determine if the scale could be simplified into a number of factors for future clinical utility. An attitude rating scale was constructed based on previous qualitative work and administered to colorectal cancer patients using a cross-sectional survey approach. 375 questionnaires were returned (81.7% response). For patients it was important to be informed and involved in the decision-making process. Information was not always used to make decisions as patients placed their trust in medical expertise. Women had more positive opinions on decision making and were more likely to want to make decisions. Written information was understood to a greater degree than verbal information. The scale could be simplified to a number of factors, indicating clinical utility. Few studies have explored the attitudes of colorectal cancer patients towards involvement in decision making. This study presents new insights into how patients view the concept of participation; important when considering current policy imperatives in the UK of involving service users in all aspects of care and treatment.

Further Investigation Into the Use of Laser Surface Preparation of Ti-6Al-4V Alloy for Adhesive Bonding

NASA Technical Reports Server (NTRS)

Palmieri, Frank L.; Crow, Allison; Zetterberg, Anna; Hopkins, John; Wohl, Christopher J.; Connell, John W.; Belcher, Tony; Blohowiak, Kay Y.

2014-01-01

Adhesive bonding offers many advantages over mechanical fastening, but requires robust materials and processing methodologies before it can be incorporated in primary structures for aerospace applications. Surface preparation is widely recognized as one of the key steps to producing robust and predictable bonds. This report documents an ongoing investigation of a surface preparation technique based on Nd:YAG laser ablation as a replacement for the chemical etch and/or abrasive processes currently applied to Ti-6Al-4V alloys. Laser ablation imparts both topographical and chemical changes to a surface that can lead to increased bond durability. A laser based process provides an alternative to chemical-immersion, manual abrasion, and grit blast process steps which are expensive, hazardous, environmentally unfriendly, and less precise. In addition, laser ablation is amenable to process automation, which can improve reproducibility to meet quality standards for surface preparation. An update on work involving adhesive property testing, surface characterization, surface stability, and the effect of laser surface treatment on fatigue behavior is presented. Based on the tests conducted, laser surface treatment is a viable replacement for the immersion chemical surface treatment processes. Testing also showed that the fatigue behavior of the Ti-6Al-4V alloy is comparable for surfaces treated with either laser ablation or chemical surface treatment.

A metabolic mechanism analysis of Fuzheng-Huayu formula for improving liver cirrhosis with traditional Chinese medicine syndromes.

PubMed

Song, Ya-Nan; Chen, Jian; Cai, Fei-Fei; Lu, Yi-Yu; Chen, Qi-Long; Zhang, Yong-Yu; Liu, Ping; Su, Shi-Bing

2018-06-01

Fuzheng-Huayu formula (FZHY), a Chinese herbal mixture prescription, has been proven effective in treating liver fibrosis and cirrhosis in both clinical trials and animal experiments. In this study we assessed the metabolic mechanisms of traditional Chinese medicine (TCM) syndrome-based FZHY treatment in liver cirrhosis (LC). A total of 113 participants, including 50 healthy controls and 63 LC patients, were recruited. According to the diagnosis and differentiation of the TCM syndromes, the LC patients were classified into 5 TCM syndrome groups including the liver stagnation syndrome (LSS), spleen deficiency and damp overabundance syndrome (SDDOS), damp-heat accumulation syndrome (DHAS), liver-kidney Yin deficiency syndrome (LKYDS), and blood stagnation syndrome (BSS), and administered FZHY for 6 months. FZHY treatment significantly decreased serum levels of hyaluronic acid (HA), a biochemical marker for LC, as well as TCM syndrome scores (the TCM syndrome scores were decreased in all the groups with significant decreases in the LSS and LKYDS groups). Furthermore, FZHY treatment gradually shifted the metabolic profiles of LC patients from a pathologic state to a healthy state, especially in LC patients with LSS and LKYDS. Twenty-two differently altered metabolites (DAMs) were identified, including carbohydrates, amino acids, fatty acids, etc with 9 DAMs in LSS patients, 9 in LKYDS patients, and 4 in other patients. The metabolic pathways involved in the conversion of amino acids and the body's detoxification process were regulated first, followed by the pathways involved in the body's energy supply process. In conclusion, the evaluation of the effect of TCM syndrome-based FZHY treatment show that FZHY has a better effect on LKYDS and LSS than on the other TCM syndromes, and the metabolic mechanisms might be involved in the increased detoxification function in LKYDS and the improvement of energy supply in LSS, which provides important evidence for the clinical application of TCM syndrome-based treatment.

Unfavourable outcomes in orthognathic surgery.

PubMed

Bonanthaya, Krishnamurthy; Anantanarayanan, P

2013-05-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Unfavourable outcomes in orthognathic surgery

PubMed Central

Bonanthaya, Krishnamurthy; Anantanarayanan, P.

2013-01-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution. PMID:24501454

Understanding Recovery Barriers: Youth Perceptions About Substance Use Relapse

PubMed Central

Gonzales, Rachel; Anglin, M. Douglas; Beattie, Rebecca; Ong, Chris Angelo; Glik, Deborah C.

2014-01-01

Objective To qualitatively explore how treatment-involved youth retrospectively contextualize relapse from substance use. Methods Fourteen focus groups were conducted with 118 youth (78.3% male; 66.1% Latino) enrolled in participating substance abuse treatment programs (4 young adult and 10 adolescent) throughout Los Angeles County. Transcripts were analyzed for relapse perception themes. Results Dominant relapse themes include emotional reasons (90%), life stressors (85%), cognitive factors (75%), socialization processes (65%), and environmental issues (55%). Conclusions Youth perceptions about relapse during treatment should be used to better inform clinical approaches and shape early-intervention recovery agendas for substance-abusing youth. PMID:22584088

Photodynamic treatment of herpes simplex virus during its replicative cycle.

PubMed Central

Khan, N C; Melnick, J L; Biswal, N

1977-01-01

Photodynamic treatment of herpes simplex virus type 1-infected hamster embryo fibroblasts (LSH strain) with a low concentration of proflavine (0.08 mug/10(5) cells per ml), a 3-9-diamine acridine dye, inhibited production not only of infectious progeny but also of virion particles. However, there was no appreciable inhibition of viral or cellular DNA synthesis, even when the infected cells were repeatedly exposed to this low concentration of dye and light during the replication cycle of the virus. It thus appears that photodynamic treatment of infected cells interferes with the processes involved in virus maturation. PMID:189063

Multiple Sclerosis: Epidemiologic, Clinical, and Therapeutic Aspects.

PubMed

Vidal-Jordana, Angela; Montalban, Xavier

2017-05-01

Multiple sclerosis (MS) is a chronic autoimmune and degenerative disease of the central nervous system that affects young people. MS develops in genetically susceptible individuals exposed to different unknown triggering factors. Different phenotypes are described. About 15% of patients present with a primary progressive course and 85% with a relapsing-remitting course. An increasing number of disease-modifying treatments has emerged. Although encouraging, the number of drugs challenges the neurologist because each treatment has its own risk-benefit profile. Patients should be involved in the decision-making process to ensure good treatment and safety monitoring adherence. Copyright © 2016 Elsevier Inc. All rights reserved.

Pathophysiology, Evaluation, and Treatment of Bloating

PubMed Central

Gabbard, Scott L.; Crowell, Michael D.

2011-01-01

Abdominal bloating is commonly reported by men and women of all ages. Bloating occurs in nearly all patients with irritable bowel syndrome, and it also occurs in patients with other functional and organic disorders. Bloating is frequently disturbing to patients and frustrating to clinicians, as effective treatments are limited and are not universally successful. Although the terms bloating and abdominal distention are often used interchangeably, these symptoms likely involve different pathophysiologic processes, both of which are still not completely understood. The goal of this paper is to review the pathophysiology, evaluation, and treatment of bloating and abdominal distention. PMID:22298969

Unifying the field: developing an integrative paradigm for behavior therapy.

PubMed

Eifert, G H; Forsyth, J P; Schauss, S L

1993-06-01

The limitations of early conditioning models and treatments have led many behavior therapists to abandon conditioning principles and replace them with loosely defined cognitive theories and treatments. Systematic theory extensions to human behavior, using new concepts and processes derived from and built upon the basic principles, could have prevented the divisive debates over whether psychological dysfunctions are the results of conditioning or cognition and whether they should be treated with conditioning or cognitive techniques. Behavior therapy could also benefit from recent advances in experimental cognitive psychology that provide objective behavioral methods of studying dysfunctional processes. We suggest a unifying paradigm for explaining abnormal behavior that links and integrates different fields of study and processes that are frequently believed to be incompatible or antithetical such as biological vulnerability variables, learned behavioral repertoires, and that also links historical and current antecedents of the problem. An integrative paradigmatic behavioral approach may serve a unifying function in behavior therapy (a) by promoting an understanding of the dysfunctional processes involved in different disorders and (b) by helping clinicians conduct functional analyses that lead to theory-based, individualized, and effective treatments.

Advances of Stem Cell Therapeutics in Cutaneous Wound Healing and Regeneration.

PubMed

Kanji, Suman; Das, Hiranmoy

2017-01-01

Cutaneous wound healing is a complex multiple phase process, which overlaps each other, where several growth factors, cytokines, chemokines, and various cells interact in a well-orchestrated manner. However, an imbalance in any of these phases and factors may lead to disruption in harmony of normal wound healing process, resulting in transformation towards chronic nonhealing wounds and abnormal scar formation. Although various therapeutic interventions are available to treat chronic wounds, current wound-care has met with limited success. Progenitor stem cells possess potential therapeutic ability to overcome limitations of the present treatments as it offers accelerated wound repair with tissue regeneration. A substantial number of stem cell therapies for cutaneous wounds are currently under development as a result of encouraging preliminary findings in both preclinical and clinical studies. However, the mechanisms by which these stem cells contribute to the healing process have yet to be elucidated. In this review, we emphasize on the major treatment modalities currently available for the treatment of the wound, role of various interstitial stem cells and exogenous adult stem cells in cutaneous wound healing, and possible mechanisms involved in the healing process.

Spatial memory and integration processes in congenital blindness.

PubMed

Vecchi, Tomaso; Tinti, Carla; Cornoldi, Cesare

2004-12-22

The paper tests the hypothesis that difficulties met by the blind in spatial processing are due to the simultaneous treatment of independent spatial representations. Results showed that lack of vision does not impede the ability to process and transform mental images; however, blind people are significantly poorer in the recall of more than a single spatial pattern at a time than in the recall of the corresponding material integrated into a single pattern. It is concluded that the simultaneous maintenance of different spatial information is affected by congenital blindness, while cognitive processes that may involve sequential manipulation are not.

Measurement of fracture toughness of metallic materials produced by additive manufacturing

NASA Astrophysics Data System (ADS)

Quénard, O.; Dorival, O.; Guy, Ph.; Votié, A.; Brethome, K.

2018-04-01

This study focuses on the microstructure and mechanical properties of metallic materials produced by additive layer manufacturing (ALM), especially the laser beam melting process. The influence of the specimen orientation during the ALM process and that of two post-build thermal treatments were investigated. The identified metal powder is Ti-6Al-4V (titanium base). Metallographic analysis shows their effects on the microstructure of the metals. Mechanical experiments involving tensile tests as well as toughness tests were performed according to ASTM (American Society for Testing and Materials) norms. The results show that the main influence is that of the thermal treatments; however the manufacturing stacking direction may lead to some anisotropy in the mechanical properties.

Power Ultrasound to Process Dairy Products

NASA Astrophysics Data System (ADS)

Bermúdez-Aguirre, Daniela; Barbosa-Cánovas, Gustavo V.

Conventional methods of pasteurizing milk involve the use of heat regardless of treatment (batch, high temperature short time - HTST or ultra high temperature - UHT sterilization), and the quality of the milk is affected because of the use of high temperatures. Consequences of thermal treatment are a decrease in nutritional properties through the destruction of vitamins or denaturation of proteins, and sometimes the flavor of milk is undesirably changed. These changes are produced at the same time that the goal of the pasteurization process is achieved, which is to have a microbiological safe product, free of pathogenic bacteria, and to reduce the load of deteriorative microorganisms and enzymes, resulting in a product with a longer storage life.

Management of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department.

PubMed

Suau, Salvador J; DeBlieux, Peter M C

2016-02-01

Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers. Copyright © 2016 Elsevier Inc. All rights reserved.

Targeting iron metabolism in drug discovery and delivery

PubMed Central

Crielaard, Bart J.; Lammers, Twan; Rivella, Stefano

2017-01-01

Iron fulfils a central role in many essential biochemical processes in human physiology, which makes proper processing of iron crucial. Although iron metabolism is subject to relatively strict physiological control, in recent years numerous disorders, such as cancer and neurodegenerative diseases, have been linked to deregulated iron homeostasis. Because of its involvement in the pathogenesis of these diseases, iron metabolism constitutes a promising and largely unexploited therapeutic target for the development of new pharmacological treatments. Several iron metabolism-targeted therapies are already under clinical evaluation for haematological disorders, and these and newly developed therapeutic agents will likely have substantial benefit in the clinical management of iron metabolism-associated diseases, for which few efficacious treatments are often available. PMID:28154410

[Modern view on etiology, pathogenesis and treatment of chronic pelvic pain syndrome].

PubMed

Vinarov, A Z

2017-04-01

The manuscript presents the analysis of scientific manuscripts written by Russian and foreign researchers devoted to chronic pelvic pain syndrome (CPPS) studies. In spite of widespread disease, there is no clear understanding on etiopathogenetic mechanisms of CPPS development and it is shown that besides infectious process cardiovascular, neuronal, locomotor, endocrine and immune systems are involved into pathological process of CPPS. Mentioned factors complicate the doctors task on effective therapy choice and stress the reasonability of complex approach to CPPS treatment. Combination drug containing affinity purified antibodies to endothelial NO-synthase and prostate-specific antigen in released-active form influences different pathogenetic mechanisms of CPPS and thereby reveals pronounced clinical efficacy.

Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways

PubMed Central

Sturgeon, John A.; Finan, Patrick H.; Zautra, Alex J.

2017-01-01

In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) show an increased prevalence of some mental health disorders, particularly those involving mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and psychological responses to the disease, and can also impair responses to treatment through disruption of therapeutic alliance and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed. PMID:27411910

Utilizing placebo mechanisms for dose reduction in pharmacotherapy.

PubMed

Doering, Bettina K; Rief, Winfried

2012-03-01

The knowledge and systematic application of the placebo effect remains limited, although its importance to the treatment of various medical conditions has increasingly been recognized. A possible application of the placebo effect to pharmacotherapy is seen in conditioning processes that aim at a placebo-controlled dose reduction of drugs while maintaining the efficacy of the medical treatment. The pairing of a placebo and a pharmacological agent may achieve satisfactory treatment outcomes in combination with a lower dose of medication. This procedure includes classic and instrumental conditioning processes that involve both conscious and non-conscious information processing. Although recent studies have gathered preliminary evidence for the efficacy of placebo-controlled dose reduction (e.g. in psoriasis and attention deficit hyperactivity disorder [ADHD]), they have also illustrated the difficulties that are inherent to this approach. We critically review previous approaches and discuss designs for clinical trials that seem appropriate to the investigation of conditioned placebo effects in pharmacotherapy. Copyright © 2011 Elsevier Ltd. All rights reserved.

State of the art of biological processes for coal gasification wastewater treatment.

PubMed

Zhao, Qian; Liu, Yu

2016-01-01

The treatment of coal gasification wastewater (CGW) poses a serious challenge on the sustainable development of the global coal industry. The CGW contains a broad spectrum of high-strength recalcitrant substances, including phenolic, monocyclic and polycyclic aromatic hydrocarbons, heterocyclic nitrogenous compounds and long chain aliphatic hydrocarbon. So far, biological treatment of CGW has been considered as an environment-friendly and cost-effective method compared to physiochemical approaches. Thus, this reviews aims to provide a comprehensive picture of state of the art of biological processes for treating CGW wastewater, while the possible biodegradation mechanisms of toxic and refractory organic substances were also elaborated together with microbial community involved. Discussion was further extended to advanced bioprocesses to tackle high-concentration ammonia and possible options towards in-plant zero liquid discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

Functional brain networks associated with cognitive control, cocaine dependence, and treatment outcome.

PubMed

Worhunsky, Patrick D; Stevens, Michael C; Carroll, Kathleen M; Rounsaville, Bruce J; Calhoun, Vince D; Pearlson, Godfrey D; Potenza, Marc N

2013-06-01

Individuals with cocaine dependence often evidence poor cognitive control. The purpose of this exploratory study was to investigate networks of functional connectivity underlying cognitive control in cocaine dependence and examine the relationship of the networks to the disorder and its treatment. Independent component analysis (ICA) was applied to fMRI data to investigate if regional activations underlying cognitive control processes operate in functional networks, and whether these networks relate to performance and treatment outcome measures in cocaine dependence. Twenty patients completed a Stroop task during fMRI prior to entering outpatient treatment and were compared to 20 control participants. ICA identified five distinct functional networks related to cognitive control interference events. Cocaine-dependent patients displayed differences in performance-related recruitment of three networks. Reduced involvement of a "top-down" fronto-cingular network contributing to conflict monitoring correlated with better treatment retention. Greater engagement of two "bottom-up" subcortical and ventral prefrontal networks related to cue-elicited motivational processing correlated with abstinence during treatment. The identification of subcortical networks linked to cocaine abstinence and cortical networks to treatment retention suggests that specific circuits may represent important, complementary targets in treatment development for cocaine dependence. 2013 APA, all rights reserved

Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions

PubMed Central

Harvey, Allison G.; Gumport, Nicole B.

2015-01-01

The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy. PMID:25768982

Basic concepts regarding fracture healing and the current options and future directions in managing bone fractures.

PubMed

Bigham-Sadegh, Amin; Oryan, Ahmad

2015-06-01

Fracture healing is a complex physiological process, which involves a well-orchestrated series of biological events. Repair of large bone defects resulting from trauma, tumours, osteitis, delayed unions, non-unions, osteotomies, arthrodesis and multifragmentary fractures is a current challenge of surgeons and investigators. Different therapeutic modalities have been developed to enhance the healing response and fill the bone defects. Different types of growth factors, stem cells, natural grafts (autografts, allografts or xenografts) and biologic- and synthetic-based tissue-engineered scaffolds are some of the examples. Nevertheless, these organic and synthetic materials and therapeutic agents have some significant limitations, and there are still no well-approved treatment modalities to meet all the expected requirements. Bone tissue engineering is a newer option than the traditional grafts and may overcome many limitations of the bone graft. To select an appropriate treatment strategy in achieving a successful and secure healing, more information concerning injuries of bones, their healing process and knowledge of the factors involved are required. The main goals of this work are to present different treatment modalities of the fractured bones and to explain how fractures normally heal and what factors interfere with fracture healing. This study provides an overview of the processes of fracture healing and discusses the current therapeutic strategies that have been claimed to be effective in accelerating fracture healing. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

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

Scrudato, R.J.; Chiarenzelli, J.R.

An electrochemical peroxidation (ECP) process has been developed and used to degrade polychlorinated biphenyls (PCB) and volatile organic compounds (VOC)-contaminated water, sludge, and sediments at a New York State Federal and State Superfund Site. The process involves passing an oscillating low-amperage (<10 amps) current through steel electrodes immersed in an acidified water or sediment slurry into which hydrogen peroxide (<1,000 ppm) is added. The generated free radicals attack organic compounds, including organo-metallic complexes and refractory compounds including PCBs. PCB degradation ranged from about 30% to 80% in experiments involving Federal Superfund Site sediments; total PCBs were reduced by {approximately}97% tomore » 68%, respectively, in water and slurry collected from a State Superfund subsurface storage tank. VOC bench-scale experiments involved chloroethane, 1,1-dichloroethane, dichloromethane, 1,1,1-trichloroethane, and acetone and after a 3-min ECP treatment, degradation ranged from >94% to about 99.9%. Results indicate the ECP is a viable process to degrade organic contaminants in water and sediment suspensions. Because the treated water suspensions are acidified, select trace metal sorbed to the particulates is solubilized and therefore can be segregated from the particulates, offering a process that simultaneously degrades organic contaminants and separates trace metals. 19 refs., 1 fig., 4 tabs.« less

Perceived involvement and preferences in shared decision-making among patients with hypertension.

PubMed

Mah, Hui Chin; Muthupalaniappen, Leelavathi; Chong, Wei Wen

2016-06-01

Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension. The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making. A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia. The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM. Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Theory of molecular rate processes in the presence of intense laser radiation

NASA Technical Reports Server (NTRS)

George, T. F.; Zimmerman, I. H.; Devries, P. L.; Yuan, J.-M.; Lam, K.-S.; Bellum, J. C.; Lee, H.-W.; Slutsky, M. S.; Lin, J.-T.

1979-01-01

The present paper deals with the influence of intense laser radiation on gas-phase molecular rate processes. Representations of the radiation field, the particle system, and the interaction involving these two entities are discussed from a general rather than abstract point of view. The theoretical methods applied are outlined, and the formalism employed is illustrated by application to a variety of specific processes. Quantum mechanical and semiclassical treatments of representative atom-atom and atom-diatom collision processes in the presence of a field are examined, and examples of bound-continuum processes and heterogeneous catalysis are discussed within the framework of both quantum-mechanical and semiclassical theories.

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

Improved inter-observer agreement of an expert review panel in an oncology treatment trial--Insights from a structured interventional process.

PubMed

Nestle, Ursula; Rischke, Hans Christian; Eschmann, Susanne Martina; Holl, Gabriele; Tosch, Marco; Miederer, Matthias; Plotkin, Michail; Essler, Markus; Puskas, Cornelia; Schimek-Jasch, Tanja; Duncker-Rohr, Viola; Rühl, Friederike; Leifert, Anja; Mix, Michael; Grosu, Anca-Ligia; König, Jochem; Vach, Werner

2015-11-01

Oncologic imaging is a key for successful cancer treatment. While the quality assurance (QA) of image acquisition protocols has already been focussed, QA of reading and reporting offers still room for improvement. The latter was addressed in the context of a prospective multicentre trial on fluoro-deoxyglucose (FDG)-positron-emission tomography (PET)/CT-based chemoradiotherapy for locally advanced non-small cell lung cancer (NSCLC). An expert panel was prospectively installed performing blinded reviews of mediastinal NSCLC involvement in FDG-PET/CT. Due to a high initial reporting inter-observer disagreement, the independent data monitoring committee (IDMC) triggered an interventional harmonisation process, which overall involved 11 experts uttering 6855 blinded diagnostic statements. After assessing the baseline inter-observer agreement (IOA) of a blinded re-review (phase 1), a discussion process led to improved reading criteria (phase 2). Those underwent a validation study (phase 3) and were then implemented into the study routine. After 2 months (phase 4) and 1 year (phase 5), the IOA was reassessed. The initial overall IOA was moderate (kappa 0.52 CT; 0.53 PET). After improvement of reading criteria, the kappa values improved substantially (kappa 0.61 CT; 0.66 PET), which was retained until the late reassessment (kappa 0.71 CT; 0.67 PET). Subjective uncertainty was highly predictive for low IOA. The IOA of an expert panel was significantly improved by a structured interventional harmonisation process which could be a model for future clinical trials. Furthermore, the low IOA in reporting nodal involvement in NSCLC may bear consequences for individual patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Therapists' perspectives on optimal treatment for pathological narcissism.

PubMed

Kealy, David; Goodman, Geoff; Rasmussen, Brian; Weideman, Rene; Ogrodniczuk, John S

2017-01-01

This study used Q methodology to explore clinicians' perspectives regarding optimal psychotherapy process in the treatment of pathological narcissism, a syndrome of impaired self-regulation. Participants were 34 psychotherapists of various disciplines and theoretical orientations who reviewed 3 clinical vignettes portraying hypothetical cases of grandiose narcissism, vulnerable narcissism, and panic disorder without pathological narcissism. Participants then used the Psychotherapy Process Q set, a 100-item Q-sort instrument, to indicate their views regarding optimal therapy process for each hypothetical case. By-person principal components analysis with varimax rotation was conducted on all 102 Q-sorts, revealing 4 components representing clinicians' perspectives on ideal therapy processes for narcissistic and non-narcissistic patients. These perspectives were then analyzed regarding their relationship to established therapy models. The first component represented an introspective, relationally oriented therapy process and was strongly correlated with established psychodynamic treatments. The second component, most frequently endorsed for the panic disorder vignette, consisted of a cognitive and alliance-building approach that correlated strongly with expert-rated cognitive-behavioral therapy. The third and fourth components involved therapy processes focused on the challenging interpersonal behaviors associated with narcissistic vulnerability and grandiosity, respectively. The perspectives on therapy processes that emerged in this study reflect different points of emphasis in the treatment of pathological narcissism, and may serve as prototypes of therapist-generated approaches to patients suffering from this issue. The findings suggest several areas for further empirical inquiry regarding psychotherapy with this population. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Proteomic investigation into betulinic acid-induced apoptosis of human cervical cancer HeLa cells.

PubMed

Xu, Tao; Pang, Qiuying; Zhou, Dong; Zhang, Aiqin; Luo, Shaman; Wang, Yang; Yan, Xiufeng

2014-01-01

Betulinic acid is a pentacyclic triterpenoid that exhibits anticancer functions in human cancer cells. This study provides evidence that betulinic acid is highly effective against the human cervical cancer cell line HeLa by inducing dose- and time-dependent apoptosis. The apoptotic process was further investigated using a proteomics approach to reveal protein expression changes in HeLa cells following betulinic acid treatment. Proteomic analysis revealed that there were six up- and thirty down-regulated proteins in betulinic acid-induced HeLa cells, and these proteins were then subjected to functional pathway analysis using multiple analysis software. UDP-glucose 6-dehydrogenase, 6-phosphogluconate dehydrogenase decarboxylating, chain A Horf6-a novel human peroxidase enzyme that involved in redox process, was found to be down-regulated during the apoptosis process of the oxidative stress response pathway. Consistent with our results at the protein level, an increase in intracellular reactive oxygen species was observed in betulinic acid-treated cells. The proteins glucose-regulated protein and cargo-selection protein TIP47, which are involved in the endoplasmic reticulum pathway, were up-regulated by betulinic acid treatment. Meanwhile, 14-3-3 family proteins, including 14-3-3β and 14-3-3ε, were down-regulated in response to betulinic acid treatment, which is consistent with the decrease in expression of the target genes 14-3-3β and 14-3-3ε. Furthermore, it was found that the antiapoptotic bcl-2 gene was down-regulated while the proapoptotic bax gene was up-regulated after betulinic acid treatment in HeLa cells. These results suggest that betulinic acid induces apoptosis of HeLa cells by triggering both the endoplasmic reticulum pathway and the ROS-mediated mitochondrial pathway.

MO-D-213-02: Quality Improvement Through a Failure Mode and Effects Analysis of Pediatric External Beam Radiotherapy

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

Gray, J; Lukose, R; Bronson, J

2015-06-15

Purpose: To conduct a failure mode and effects analysis (FMEA) as per AAPM Task Group 100 on clinical processes associated with teletherapy, and the development of mitigations for processes with identified high risk. Methods: A FMEA was conducted on clinical processes relating to teletherapy treatment plan development and delivery. Nine major processes were identified for analysis. These steps included CT simulation, data transfer, image registration and segmentation, treatment planning, plan approval and preparation, and initial and subsequent treatments. Process tree mapping was utilized to identify the steps contained within each process. Failure modes (FM) were identified and evaluated with amore » scale of 1–10 based upon three metrics: the severity of the effect, the probability of occurrence, and the detectability of the cause. The analyzed metrics were scored as follows: severity – no harm = 1, lethal = 10; probability – not likely = 1, certainty = 10; detectability – always detected = 1, undetectable = 10. The three metrics were combined multiplicatively to determine the risk priority number (RPN) which defined the overall score for each FM and the order in which process modifications should be deployed. Results: Eighty-nine procedural steps were identified with 186 FM accompanied by 193 failure effects with 213 potential causes. Eighty-one of the FM were scored with a RPN > 10, and mitigations were developed for FM with RPN values exceeding ten. The initial treatment had the most FM (16) requiring mitigation development followed closely by treatment planning, segmentation, and plan preparation with fourteen each. The maximum RPN was 400 and involved target delineation. Conclusion: The FMEA process proved extremely useful in identifying previously unforeseen risks. New methods were developed and implemented for risk mitigation and error prevention. Similar to findings reported for adult patients, the process leading to the initial treatment has an associated high risk.« less

Locally advanced and metastatic basal cell carcinoma: molecular pathways, treatment options and new targeted therapies.

PubMed

Ruiz Salas, Veronica; Alegre, Marta; Garcés, Joan Ramón; Puig, Lluis

2014-06-01

The hedgehog (Hh) signaling pathway has been identified as important to normal embryonic development in living organisms and it is implicated in processes including cell proliferation, differentiation and tissue patterning. Aberrant Hh pathway has been involved in the pathogenesis and chemotherapy resistance of different solid and hematologic malignancies. Basal cell carcinoma (BCC) and medulloblastoma are two well-recognized cancers with mutations in components of the Hh pathway. Vismodegib has recently approved as the first inhibitor of one of the components of the Hh pathway (smoothened). This review attempts to provide current data on the molecular pathways involved in the development of BCC and the therapeutic options available for the treatment of locally advanced and metastatic BCC, and the new targeted therapies in development.

[Metacognition in psychotic disorders: from concepts to intervention].

PubMed

de Jong, S; van Donkersgoed, R J M; Arends, J; Lysaker, P H; Wunderink, L; van der Gaag, M; Aleman, A; Pijnenborg, G H M

2016-01-01

Persons with a psychotic disorder commonly experience difficulties with what is considered to be metacognitive capacity. In this article we discuss several definitions of this concept, the measurement instruments involved and the clinical interventions that target this concept. To present a review of various frequently used definitions of metacognition and related concepts and to describe the measurement instruments involved and the treatment options available for improving the metacognitive capacity of persons with a psychotic disorder. We present an overview of several definitions of metacognition in psychotic disorders and we discuss frequently used measurement instruments and treatment options. The article focuses on recent developments in a model devised by Semerari et al. The measurement instrument involved (Metacognition Assessment Scale - A) is discussed in terms of it being an addition to existing methods. On the basis of the literature it appears that metacognition and related concepts are measurable constructs, although definitions and instruments vary considerably. The new conceptualisation of social information processing also leads to the development of a new form of psychotherapy that aims to help patients suffering from psychotic disorders to improve metacognitive capacity. There seems to be evidence that metacognitive abilities are a possible target for treatment, but further research is needed.

The miRacle in Pancreatic Cancer by miRNAs: Tiny Angels or Devils in Disease Progression

PubMed Central

Hawa, Zuhair; Haque, Inamul; Ghosh, Arnab; Banerjee, Snigdha; Harris, LaCoiya; Banerjee, Sushanta K.

2016-01-01

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with increasing incidence and high mortality. Surgical resection is the only potentially curative treatment of patients with PDAC. Because of the late presentation of the disease, about 20 percent of patients are candidates for this treatment. The average survival of resected patients is between 12 and 20 months, with a high probability of relapse. Standard chemo and radiation therapies do not offer significant improvement of the survival of these patients. Furthermore, novel treatment options aimed at targeting oncogenes or growth factors in pancreatic cancer have proved unsuccessful. Thereby, identifying new biomarkers that can detect early stages of this disease is of critical importance. Among these biomarkers, microRNAs (miRNAs) have supplied a profitable recourse and become an attractive focus of research in PDAC. MiRNAs regulate many genes involved in the development of PDAC through mRNA degradation or translation inhibition. The possibility of intervention in the molecular mechanisms of miRNAs regulation could begin a new generation of PDAC therapies. This review summarizes the reports describing miRNAs involvement in cellular processes involving pancreatic carcinogenesis and their utility in diagnosis, survival and therapeutic potential in pancreatic cancer. PMID:27240340

Information giving and involvement in treatment decisions: is more really better? Psychological effects and relation with adherence.

PubMed

Wroe, Abigail L; Salkovskis, Paul M; Rees, Margaret; Jack, Tim

2013-01-01

The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence. Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management. Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety. Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.

Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing

PubMed Central

Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

2015-01-01

Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called “threshold probability” at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today’s clinical practice. PMID:26244571

Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

PubMed

Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

2015-01-01

Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

Multiple Electrophysiological Markers of Visual-Attentional Processing in a Novel Task Directed toward Clinical Use

PubMed Central

Bolduc-Teasdale, Julie; Jolicoeur, Pierre; McKerral, Michelle

2012-01-01

Individuals who have sustained a mild brain injury (e.g., mild traumatic brain injury or mild cerebrovascular stroke) are at risk to show persistent cognitive symptoms (attention and memory) after the acute postinjury phase. Although studies have shown that those patients perform normally on neuropsychological tests, cognitive symptoms remain present, and there is a need for more precise diagnostic tools. The aim of this study was to develop precise and sensitive markers for the diagnosis of post brain injury deficits in visual and attentional functions which could be easily translated in a clinical setting. Using electrophysiology, we have developed a task that allows the tracking of the processes involved in the deployment of visual spatial attention from early stages of visual treatment (N1, P1, N2, and P2) to higher levels of cognitive processing (no-go N2, P3a, P3b, N2pc, SPCN). This study presents a description of this protocol and its validation in 19 normal participants. Results indicated the statistically significant presence of all ERPs aimed to be elicited by this novel task. This task could allow clinicians to track the recovery of the mechanisms involved in the deployment of visual-attentional processing, contributing to better diagnosis and treatment management for persons who suffer a brain injury. PMID:23227309

Binding mechanism of patulin to heat-treated yeast cell.

PubMed

Guo, C; Yuan, Y; Yue, T; Hatab, S; Wang, Z

2012-12-01

This study aims to assess the removal mechanism of patulin using heat-treated Saccharomyces cerevisiae cells and identify the role of different cell wall components in the binding process. In order to understand the binding mechanism, viable cells, heat-treated cells, cell wall and intracellular extract were performed to assess their ability to remove patulin. Additionally, the effects of chemical and enzymatic treatments of yeast on the binding ability were tested. The results showed that there was no significant difference between viable (53·28%) and heat-treated yeast cells (51·71%) in patulin binding. In addition, the cell wall fraction decreased patulin by 35·05%, and the cell extract nearly failed to bind patulin. Treatments with protease E, methanol, formaldehyde, periodate or urea significantly decreased (P < 0·05) the ability of heat-treated cells to remove patulin. Fourier transform infrared (FTIR) analysis indicated that more functional groups were involved in the binding process of heat-treated cells. Polysaccharides and protein are important components of yeast cell wall involved in patulin removal. In addition, hydrophobic interactions play a major role in binding processes. Heat-treated S. cerevisiae cells could be used to control patulin contamination in the apple juice industry. Also, our results proof that the patulin removal process is based mainly on the adsorption not degradation. © 2012 The Society for Applied Microbiology.

Development and kinetic analysis of cobalt gradient formation in WC-Co composites

NASA Astrophysics Data System (ADS)

Guo, Jun

2011-12-01

Functionally graded cemented tungsten carbide (FG WC-Co) is one of the main research directions in the field of WC-Co over decades. Although it has long been recognized that FG WC-Co could outperform conventional homogeneous WC-Co owing to its potentially superior combinations of mechanical properties, until recently there has been a lack of effective and economical methods to make such materials. The lack of the technology has prevented the manufacturing and industrial applications of FG WC-Co from becoming a reality. This dissertation is a comprehensive study of an innovative atmosphere heat treatment process for producing FG WC-Co with a surface cobalt compositional gradient. The process exploited a triple phase field in W-C-Co phase diagram among three phases (solid WC, solid Co, and liquid Co) and the dependence of the migration of liquid Co on temperature and carbon content. WC-Co with a graded surface cobalt composition can be achieved by controlling the diffusion of carbon transported from atmosphere during sintering or during postsintering heat treatment. The feasibility of the process was validated by the successful preparations of FG WC-Co via both carburization and decarburization process following conventional liquid phase sintering. A study of the carburization process was undertaken to further understand and quantitatively modeled this process. The effects of key processing parameters (including heat treating temperature, atmosphere, and time) and key materials variables (involving Co content, WC grain size, and addition of grain growth inhibitors) on the formation of Co gradients were examined. Moreover, a carbon-diffusion controlled kinetic model was developed for simulating the formation of the gradient during the process. The parameters involved in this model were determined by thermodynamic calculations and regression-fit of simulation results with experimental data. In summary, this research first demonstrated the principle of the approach. Second, a model was developed to predict the gradients produced by the carbon-controlled atmosphere heat treatment process, which is useful for manufacturing WC-Co with designed gradients. FG WC-Co materials produced using this method are expected to exhibit superior performance in many applications and to have a profound impact on the manufacturing industries that use tungsten carbide tools.

Engaging patients in health care decisions in the emergency department through shared decision-making: a systematic review.

PubMed

Flynn, Darren; Knoedler, Meghan A; Hess, Erik P; Murad, M Hassan; Erwin, Patricia J; Montori, Victor M; Thomson, Richard G

2012-08-01

Many decisions in the emergency department (ED) may benefit from patient involvement, even though this setting has been considered least conducive to shared decision-making (SDM). The objective was to conduct a systematic review to evaluate the approaches, methods, and tools used to engage patients or their surrogates in SDM in the ED. Five electronic databases were searched in conjunction with contacting content experts, reviewing selected bibliographies, and conducting citation searches using the Web of Knowledge database. Two reviewers independently selected eligible studies that addressed patient involvement and engagement in decision-making in the ED setting via the use of decision support interventions (DSIs), defined as decision aids or decision support designed to communicate probabilistic information on the risks and benefits of treatment options to patients as part of an SDM process. Eligible studies described and assessed at least one of the following outcomes: patient knowledge, experiences and perspectives on participating in treatment or management decisions, clinician or patient satisfaction, preference for involvement and/or degree of engagement in decision-making and treatment preferences, and clinical outcomes (e.g., rates of hospital admission/readmission, rates of medical or surgical interventions). Two reviewers extracted data on study characteristics, methodologic quality, and outcomes. The authors also assessed the extent to which SDM interventions adhered to good practice for the presentation of information on outcome probabilities (eight probability items from the International Patient Decision Aid Standards Instrument [IPDASi]) and had comprehensive development processes. Five studies met inclusion criteria and were synthesized using a narrative approach. Each study was of satisfactory methodologic quality and used a DSI to engage patients or their surrogates in decision-making in the ED across four domains: 1) management options for children with small lacerations; 2) options for rehydrating children presenting with vomiting or diarrhea or both; 3) risk of bacteremia (and associated complications), tests, and treatment options for febrile children; and 4) short-term risk of acute coronary syndrome (ACS) in adults with low-risk nontraumatic chest pain. Three studies had poor IPDASi probabilities and development process scores and lacked development informed by theory or involvement of clinicians and patients in development and usability testing. Overall, DSIs were associated with improvements in patients' knowledge and satisfaction with the explanation of their care, preferences for involvement, and engagement in decision-making and demonstrated utility for eliciting patients' preferences and values about management and treatment options. Two computerized DSIs (designed to predict risk of ACS in adults presenting to the ED with chest pain) were shown to reduce health care use without evidence of harm. None of the studies reported lack of feasibility of SDM in the ED. Early investigation of SDM in the ED suggests that patients may benefit from involvement in decision-making and offers no empirical evidence to suggest that SDM is not feasible. Future work is needed to develop and test additional SDM interventions in the ED and to identify contextual barriers and facilitators to implementation in practice. © 2012 by the Society for Academic Emergency Medicine.

Social policy and drug dependence: an historical case study.

PubMed

Smart, C

1985-11-01

A detailed examination is presented of the background to the reports and policy developments concerning drug dependence which emerged in Britain during the 1960s. Analysis of documents and interviews with policy makers, officials and doctors involved in the events of the period, reveal that explanatory models in terms of 'moral panic' or 'power struggle' tend to oversimplify the complex processes involved. The role in policy formation of the media, government departments and groups within the medical profession is considered. The patterns of conflict and convergence are seen to overlap simple lines of 'interest'--we find conflict within the medical profession, convergence between the Home Office (legal) and elements of the medical professions (medical). The resulting legal and institutional framework involved only loose guidelines from the centre about treatment, and the shape of policy was determined by individual doctors in the new hospital treatment centres. The apparent re-run of the 1960s being staged in the 1980s will require detailed research in the future in order to avoid superficial comparisons.

Treatment attrition: Associations with negative affect smoking motives and barriers to quitting among treatment-seeking smokers.

PubMed

Garey, Lorra; Kauffman, Brooke Y; Neighbors, Clayton; Schmidt, Norman B; Zvolensky, Michael J

2016-12-01

Pre-treatment attrition and perceived barriers for quitting are clinically important processes involved in early phases of quitting smoking. However, less is known about the constructs that may contribute to these processes such as negative affect reduction smoking motives. The current study sought to evaluate the relation between negative affect reduction smoking motives and pre-treatment attrition and perceived barriers for quitting in a sample of 425 treatment-seeking smokers (48.5% female; Mage=37.69 years; SD=13.61) enrolled in a smoking cessation study examining the efficacy of a transdiagnostic panic-smoking cessation treatment relative to a standard smoking cessation treatment. Results indicated that greater negative affect reduction smoking motives was associated with an increased likelihood of treatment initiation (odds ratio=1.49, CI: 1.09, 2.04). Additionally, negative affect reduction smoking motives was associated with greater perceived barriers for cessation among pre-treatment drop-outs and treatment initiators. This initial investigation provides evidence for the possible clinical utility in addressing negative affect reduction smoking motives during early stages of quitting. Additionally, such findings could potentially inform the development of personalized, early stages of quitting interventions for smoking cessation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Surface pre-treatment of aluminium by cleaning, chemical ething and conversion coating

NASA Astrophysics Data System (ADS)

Zaki, Mohammad Hafizudden Mohd; Mohd, Yusairie; Isa, Nik Norziehana Che

2017-12-01

Surface pre-treatment is one of the critical treatments for surface modification of aluminium (Al). In this study, pre-treatment of Al surface involved three stages; (1) cleaning (polishing and degreasing), (2) chemical etching (alkaline and acid) and (3) conversion coating (ie: zincate treatment). Cleaning process of Al was conducted by polishing and degreasing with acetone while etching process was done by immersion in 1.25 M NaOH solution (i.e: alkaline etching) followed with acid etching using 8 M HNO3 solution. The zincate treatment was conducted via electroless coating method by immersion of Al into a bath solution containing 0.5 M Zn(NO3)2, 0.1 M HNO3 and 0.2 M NaBH4 (reducing agent) for one hour. Different temperatures (ie: 25 °C, 50 °C, 75 °C, 90 °C) of bath solutions at pH 4 were used to investigate the effect of temperature on zincate treatment. Surface morphology and chemical composition of the pre-treated Al were characterized using Field Emission Scanning Electron Microscopy (FESEM) and Energy Dispersion X-ray analysis (EDX), respectively. The results showed that oxide layer on Al surface decreased after chemical etching process. Temperature of zincate solution has significantly affected the conversion coating process of aluminium. It was found that zinc oxide (ZnO) and zinc borate (ZnO.B2O3) were dominantly formed after zincate treatment at high temperature (ie:90 °C) with curved blade-like structure and composition of Zn, B and O with 13.70 wt.%, 3.52 wt.% and 54.39 wt.%, respectively. However, zincate treatment at low temperature (ie:<50 °C) has produced low metallic Zn.

Water recovery and solid waste processing for aerospace and domestic applications. Volume 2: Appendices

NASA Technical Reports Server (NTRS)

Murray, R. W.

1973-01-01

Water and sewage treatment systems are presented with concentration on the filtration of water. Equipment is described for organic removal, solids removal, nutrient removal, inorganic removal, and disinfection of the water. Such things as aseline hardware, additional piping connections, waste disposal, and costs involved are also reported.

Measuring the Impact of Data Mining on Churn Management.

ERIC Educational Resources Information Center

Lejeune, Miguel A. P. M.

2001-01-01

Churn management is a concern for businesses, particularly in the digital economy. A customer relationship framework is proposed to help deal with churn issues. The model integrates the electronic channel and involves four tools for enhancing data collection, data treatment, data analysis and data integration in the decision-making process.…

Subdural Hematoma

DTIC Science & Technology

2006-07-01

characterization of more subtle associated CNS injuries. Treatment of nonacute subdural hematoma may involve craniotomy -guided hematoma evacuation...nature of this process. Note the ventricular shunt (arrow) in place for drainage of hydrocephalus, caused by significant mass effect on the...collections may require craniotomy . Because SDH may be under high intracranial pressure resultant from associated injuries, patients with the acute form

Aversive Memory Reactivation Engages in the Amygdala Only Some Neurotransmitters Involved in Consolidation

ERIC Educational Resources Information Center

Bucherelli, Corrado; Baldi, Elisabetta; Mariottini, Chiara; Passani, Maria Beatrice; Blandina, Patrizio

2006-01-01

Consolidation refers to item stabilization in long-term memory. Retrieval renders a consolidated memory sensitive, and a "reconsolidation" process has been hypothesized to keep the original memory persistent. Some authors could not detect this phenomenon. Here we show that retrieved contextual fear memory is vulnerable to amnesic treatments and…

Identification and Management of Dysphagia in the Public Schools: Prologue.

ERIC Educational Resources Information Center

Logemann, Jeri A.; O'Toole, Thomas J.

2000-01-01

This introductory article describes following articles (EC 625 128-134) that address processes and issues related to offering care for children with swallowing disorders in the public school. Procedures for screening, assessing, and treatment, issues involved in establishing a dysphagia program in a school system, and legal and ethical issues are…

Electrochemical processing of solid waste

NASA Technical Reports Server (NTRS)

Bockris, John OM.

1987-01-01

An investigation of electrochemical waste treatment methods suitable for closed, or partially closed, life support systems for manned space exploration is discussed. The technique being investigated involves the electrolysis of solid waste where the aim is to upgrade waste material (mainly fecal waste) to generate gases that can be recycled in a space station or planetary space environment.

Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities

ERIC Educational Resources Information Center

Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.

2016-01-01

Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and…

[Low-energy wideband electromagnetic radiation and manual therapy in the treatment of neurological manifestations of spinal osteochondrosis].

PubMed

Afoshin, S A; Gerasimenko, M Iu

2006-01-01

It is shown that the advanced technique of low-energy wideband electromagnetic radiation improves vascular tonicity and peripheral circulation while a modified technique of manual therapy facilitates movements in the affected part of the spine and reduces tonicity of the muscles involved in the pathological process.

Behaviourally designed treatments that increase willingness to treatment from families with children suffering from autism spectrum disorder.

PubMed

Bogliacino, Francesco; Parra Forero, Israel Andrés

2015-10-01

Autism spectrum disorder is a lifelong disability that is not well known by the general population and tends to be associated with social stigma; also, because it involves children, it may get highly emotionally charged. These stylised facts engender a number of possible heuristics and biases at the moment of deciding on following a treatment or looking for a diagnosis, which should be considered in the presentation of information. Using insights from Behavioural Economics, three treatments are designed to present the information regarding possible therapies. Between-subjects design with one level of variation. Interviews were performed with a convenience sample of 154 households from the metropolitan area of Bogotá (Colombia). The treatments include: use of default option, use of professional interviewer to illustrate the therapy and emotionally charged presentation. Kruskal-Wallis test of the intention to be treated rejects the null hypothesis (χ(2)=22.14, p=0.00). The cognitive processing of the information is not a determinant, supporting the claim that genuine framing effects shape the choice. The strongest effect of the treatment with a professional suggests a key role for asymmetry of the information, which is confirmed indirectly through the postexperiment questionnaire. Bad healthcare decisions are not necessarily driven by lack of information. Asymmetric information (eg, delegating the decision to a professional) improves choices, especially when social stigma is involved. Cognitive processing of information seems to be less relevant than the framing effect. 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.

Clinical use of patient decision-making aids for stone patients.

PubMed

Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

2017-08-01

Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

Magnetic field effects on spectrally resolved lifetime of on-line oxygen monitoring using magneto-optic probes

NASA Astrophysics Data System (ADS)

Mermut, O.; Gallant, P.; Le Bouch, N.; Leclair, S.; Noiseux, I.; Vernon, M.; Morin, J.-F.; Diamond, K.; Patterson, M. S.; Samkoe, K.; Pogue, B.

2009-02-01

Multimodal agents that serve as both probes for contrast and light-activated effectors of cellular processes in diseased tissue were developed. These agents were introduced into multicellular tumor spheroids (3D tissue models) and in the chorioallantoic membrane (CAM) of a chicken embryo. The luminescence decay was examined using a novel technique involving a spectrally-resolved fluorescence lifetime apparatus integrated with a weak electromagnet. A spectrallyresolved lifetime setup was used to identify magneto-optic species sensitive to magnetic field effects and distinguish from background emissions. We demonstrate that the applied magnetic fields can alter reaction rates and product distribution of some dyes detected by time- and spectrally-resolved luminescence changes. We will discuss the use of exogenous magneto-optical probes taken up in tumors to both induce phototoxicity, a process that is governed by complex and dynamically evolving mechanisms involving reactive oxygen species, and monitor treatment progress. The magnetic field enhancement, measured over a range of weak fields (0-300 mT) is correlated to oxygenation and may be used to monitor dynamic changes occurring due to oxygen consumption over the course of photodynamic therapy. Such online measurements provide the possibility to derive real-time information about response to treatment via monitoring magnetic field enhancement/suppression of the time-resolved, spectrally-resolved luminescence of the probe at the site of the treatment directly. Magnetic perturbation of lifetime can serve as a status reporter, providing optical feedback of oxygen-mediated treatments in situ and allowing for real-time adjustment of a phototherapy treatment plan.

Differential gene expression between skin and cervix induced by the E7 oncoprotein in a transgenic mouse model

PubMed Central

Ibarra Sierra, E; Díaz Chávez, J; Cortés-Malagón, EM; Uribe-Figueroa, L; Hidalgo-Miranda, A; Lambert, PF; Gariglio, P

2013-01-01

HPV16 E7 oncoprotein expression in K14E7 transgenic mice induces cervical cancer after 6 months of treatment with the co-carcinogen 17β-estradiol. In untreated mice, E7 also induces skin tumors late in life albeit at low penetrance. These findings indicate that E7 alters cellular functions in cervix and skin so as to predispose these organs to tumorigenesis. Using microarrays, we determined the global genes expression profile in cervical and skin tissue of young adult K14E7 transgenic mice without estrogen treatment. In these tissues, the E7 oncoprotein altered the transcriptional pattern of genes involved in several biological processes including signal transduction, transport, metabolic process, cell adhesion, apoptosis, cell differentiation, immune response and inflammatory response. Among the E7-dysregulated genes were ones not previously known to be involved in cervical neoplasia including DMBT1, GLI1 and 17βHSD2 in cervix, as well as MMP2, 12, 14, 19 and 27 in skin. PMID:22980503

Differential gene expression between skin and cervix induced by the E7 oncoprotein in a transgenic mouse model.

PubMed

Ibarra Sierra, E; Díaz Chávez, J; Cortés-Malagón, E M; Uribe-Figueroa, L; Hidalgo-Miranda, A; Lambert, P F; Gariglio, P

2012-11-25

HPV16 E7 oncoprotein expression in K14E7 transgenic mice induces cervical cancer after 6 months of treatment with the co-carcinogen 17β-estradiol. In untreated mice, E7 also induces skin tumors late in life albeit at low penetrance. These findings indicate that E7 alters cellular functions in cervix and skin so as to predispose these organs to tumorigenesis. Using microarrays, we determined the global genes expression profile in cervical and skin tissue of young adult K14E7 transgenic mice without estrogen treatment. In these tissues, the E7 oncoprotein altered the transcriptional pattern of genes involved in several biological processes including signal transduction, transport, metabolic process, cell adhesion, apoptosis, cell differentiation, immune response and inflammatory response. Among the E7-dysregulated genes were ones not previously known to be involved in cervical neoplasia including DMBT1, GLI1 and 17βHSD2 in cervix, as well as MMP2, 12, 14, 19 and 27 in skin. Copyright © 2012 Elsevier Inc. All rights reserved.

Blood transfusion: patient identification and empowerment.

PubMed

Stout, Lynn; Joseph, Sundari

Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful.

Effect of MK-801 and Clozapine on the Proteome of Cultured Human Oligodendrocytes

PubMed Central

Cassoli, Juliana S.; Iwata, Keiko; Steiner, Johann; Guest, Paul C.; Turck, Christoph W.; Nascimento, Juliana M.; Martins-de-Souza, Daniel

2016-01-01

Separate lines of evidence have demonstrated the involvement of N-methyl-D-aspartate (NMDA) receptor and oligodendrocyte dysfunctions in schizophrenia. Here, we have carried out shotgun mass spectrometry proteome analysis of oligodendrocytes treated with the NMDA receptor antagonist MK-801 to gain potential insights into these effects at the molecular level. The MK-801 treatment led to alterations in the levels of 68 proteins, which are associated with seven distinct biological processes. Most of these proteins are involved in energy metabolism and many have been found to be dysregulated in previous proteomic studies of post-mortem brain tissues from schizophrenia patients. Finally, addition of the antipsychotic clozapine to MK-801-treated oligodendrocyte cultures resulted in changes in the levels of 45 proteins and treatment with clozapine alone altered 122 proteins and many of these showed opposite changes to the MK-801 effects. Therefore, these proteins and the associated energy metabolism pathways should be explored as potential biomarkers of antipsychotic efficacy. In conclusion, MK-801 treatment of oligodendrocytes may provide a useful model for testing the efficacy of novel treatment approaches. PMID:26973466

Prefrontal Reactivity to Social Signals of Threat as a Predictor of Treatment Response in Anxious Youth

PubMed Central

Kujawa, Autumn; Swain, James E; Hanna, Gregory L; Koschmann, Elizabeth; Simpson, David; Connolly, Sucheta; Fitzgerald, Kate D; Monk, Christopher S; Phan, K Luan

2016-01-01

Neuroimaging has shown promise as a tool to predict likelihood of treatment response in adult anxiety disorders, with potential implications for clinical decision-making. Despite the relatively high prevalence and emergence of anxiety disorders in youth, very little work has evaluated neural predictors of response to treatment. The goal of the current study was to examine brain function during emotional face processing as a predictor of response to treatment in children and adolescents (age 7–19 years; N=41) with generalized, social, and/or separation anxiety disorder. Prior to beginning treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline or cognitive behavior therapy (CBT), participants completed an emotional faces matching task during functional magnetic resonance imaging (fMRI). Whole brain responses to threatening (ie, angry and fearful) and happy faces were examined as predictors of change in anxiety severity following treatment. Greater activation in inferior and superior frontal gyri, including dorsolateral prefrontal cortex and ventrolateral prefrontal cortex, as well as precentral/postcentral gyri during processing of threatening faces predicted greater response to CBT and SSRI treatment. For processing of happy faces, activation in postcentral gyrus was a significant predictor of treatment response. Post-hoc analyses indicated that effects were not significantly moderated by type of treatment. Findings suggest that greater activation in prefrontal regions involved in appraising and regulating responses to social signals of threat predict better response to SSRI and CBT treatment in anxious youth and that neuroimaging may be a useful tool for predicting how youth will respond to treatment. PMID:26708107

Use of osmotic dehydration to improve fruits and vegetables quality during processing.

PubMed

Maftoonazad, Neda

2010-11-01

Osmotic treatment describes a preparation step to further processing of foods involving simultaneous transient moisture loss and solids gain when immersing in osmotic solutions, resulting in partial drying and improving the overall quality of food products. The different aspects of the osmotic dehydration (OD) technology namely the solutes employed, solutions characteristics used, process variables influence, as well as, the quality characteristics of the osmodehydrated products will be discussed in this review. As the process is carried out at mild temperatures and the moisture is removed by a liquid diffusion process, phase change that would be present in the other drying processes will be avoided, resulting in high quality products and may also lead to substantial energy savings. To optimize this process, modeling of the mass transfer phenomenon can improve high product quality. Several techniques such as microwave heating, vacuum, high pressure, pulsed electric field, etc. may be employed during or after osmotic treatment to enhance performance of the osmotic dehydration. Moreover new technologies used in osmotic dehydration will be discussed. Patents on osmotic dehydration of fruits and vegetables are also discussed in this article.

Gastro-oesophageal cancer: facts, myths and surgical folk lore.

PubMed

Park, K G M

2002-12-01

The prognosis of patients with gastric and oesophageal cancers remains poor but increased knowledge of the factors involved in carcinogenesis and a better understanding of the disease process has led to strategies to improve outcomes. These are discussed under the following headings: (1) Prevention of the disease, (2) early detection of tumours, (3) treatment selection and (4) treatment. The likely impact of developments in each of these areas is considered in relation to population-based data from the Scottish Audit of Gastro-Oesophageal Cancer (SAGOC). Although there are a number of novel developments in the management of gastric and oesophageal cancer it is only by the conduct of controlled trials that the value of these will be determined. More immediate improvements in patient care may be derived from rationalisation of existing resources to ensure that all patients benefit from early diagnosis, the appropriate selection and delivery of treatment. One model of care, which may ensure this is the development of managed clinical networks, would maintain the involvement of all units in the management and treatment of upper GI cancers to a level that is possible with the facilities available. At the same time the patients requiring more specialised treatment would benefit from established referral networks

Priority setting and evidence based purchasing.

PubMed

Frith, L

1999-01-01

The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements of value. However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements--a patient's own assessment of the value of the treatment--then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them.

Translating neurotrophic and cellular plasticity: from pathophysiology to improved therapeutics for bipolar disorder

PubMed Central

Soeiro-de-Souza, M. G.; Dias, V. V.; Figueira, M. L.; Forlenza, O. V.; Gattaz, W. F.; Zarate, C. A.; Machado-Vieira, R.

2014-01-01

Objective Bipolar disorder (BD) likely involves, at a molecular and cellular level, dysfunctions of critical neurotrophic, cellular plasticity and resilience pathways and neuroprotective processes. Therapeutic properties of mood stabilizers are presumed to result from a restoration of the function of these altered pathways and processes through a wide range of biochemical and molecular effects. We aimed to review the altered pathways and processes implicated in BD, such as neurotrophic factors, mitogen-activated protein kinases, Bcl-2, phosphoinositol signaling, intracellular calcium and glycogen synthase kinase-3. Methods We undertook a literature search of recent relevant journal articles, book chapter and reviews on neurodegeneration and neuroprotection in BD. Search words entered were ‘brain-derived neurotrophic factor,’ ‘Bcl-2,’ ‘mitogen-activated protein kinases,’ ‘neuroprotection,’ ‘calcium,’ ‘bipolar disorder,’ ‘mania,’ and ‘depression.’ Results The most consistent and replicated findings in the pathophysiology of BD may be classified as follows: i) calcium dysregulation, ii) mitochondrial/endoplasmic reticulum dysfunction, iii) glial and neuronal death/atrophy and iv) loss of neurotrophic/plasticity effects in brain areas critically involved in mood regulation. In addition, the evidence supports that treatment with mood stabilizers; in particular, lithium restores these pathophysiological changes. Conclusion Bipolar disorder is associated with impairments in neurotrophic, cellular plasticity and resilience pathways as well as in neuroprotective processes. The evidence supports that treatment with mood stabilizers, in particular lithium, restores these pathophysiological changes. Studies that attempt to prevent (intervene before the onset of the molecular and cellular changes), treat (minimize severity of these deficits over time), and rectify (reverse molecular and cellular deficits) are promising therapeutic strategies for developing improved treatments for bipolar disorder. PMID:22676371

Translating neurotrophic and cellular plasticity: from pathophysiology to improved therapeutics for bipolar disorder.

PubMed

Soeiro-de-Souza, M G; Dias, V V; Figueira, M L; Forlenza, O V; Gattaz, W F; Zarate, C A; Machado-Vieira, R

2012-11-01

Bipolar disorder (BD) likely involves, at a molecular and cellular level, dysfunctions of critical neurotrophic, cellular plasticity and resilience pathways and neuroprotective processes. Therapeutic properties of mood stabilizers are presumed to result from a restoration of the function of these altered pathways and processes through a wide range of biochemical and molecular effects. We aimed to review the altered pathways and processes implicated in BD, such as neurotrophic factors, mitogen-activated protein kinases, Bcl-2, phosphoinositol signaling, intracellular calcium and glycogen synthase kinase-3. We undertook a literature search of recent relevant journal articles, book chapter and reviews on neurodegeneration and neuroprotection in BD. Search words entered were 'brain-derived neurotrophic factor,''Bcl-2,''mitogen-activated protein kinases,''neuroprotection,''calcium,''bipolar disorder,''mania,' and 'depression.' The most consistent and replicated findings in the pathophysiology of BD may be classified as follows: i) calcium dysregulation, ii) mitochondrial/endoplasmic reticulum dysfunction, iii) glial and neuronal death/atrophy and iv) loss of neurotrophic/plasticity effects in brain areas critically involved in mood regulation. In addition, the evidence supports that treatment with mood stabilizers; in particular, lithium restores these pathophysiological changes. Bipolar disorder is associated with impairments in neurotrophic, cellular plasticity and resilience pathways as well as in neuroprotective processes. The evidence supports that treatment with mood stabilizers, in particular lithium, restores these pathophysiological changes. Studies that attempt to prevent (intervene before the onset of the molecular and cellular changes), treat (minimize severity of these deficits over time), and rectify (reverse molecular and cellular deficits) are promising therapeutic strategies for developing improved treatments for bipolar disorder. © 2012 John Wiley & Sons A/S.

Long-term consequences of chronic fluoxetine exposure on the expression of myelination-related genes in the rat hippocampus

PubMed Central

Kroeze, Y; Peeters, D; Boulle, F; van den Hove, D L A; van Bokhoven, H; Zhou, H; Homberg, J R

2015-01-01

The selective serotonin reuptake inhibitor (SSRI) fluoxetine is widely prescribed for the treatment of symptoms related to a variety of psychiatric disorders. After chronic SSRI treatment, some symptoms remediate on the long term, but the underlying mechanisms are not yet well understood. Here we studied the long-term consequences (40 days after treatment) of chronic fluoxetine exposure on genome-wide gene expression. During the treatment period, we measured body weight; and 1 week after treatment, cessation behavior in an SSRI-sensitive anxiety test was assessed. Gene expression was assessed in hippocampal tissue of adult rats using transcriptome analysis and several differentially expressed genes were validated in independent samples. Gene ontology analysis showed that upregulated genes induced by chronic fluoxetine exposure were significantly enriched for genes involved in myelination. We also investigated the expression of myelination-related genes in adult rats exposed to fluoxetine at early life and found two myelination-related genes (Transferrin (Tf) and Ciliary neurotrophic factor (Cntf)) that were downregulated by chronic fluoxetine exposure. Cntf, a neurotrophic factor involved in myelination, showed regulation in opposite direction in the adult versus neonatally fluoxetine-exposed groups. Expression of myelination-related genes correlated negatively with anxiety-like behavior in both adult and neonatally fluoxetine-exposed rats. In conclusion, our data reveal that chronic fluoxetine exposure causes on the long-term changes in expression of genes involved in myelination, a process that shapes brain connectivity and contributes to symptoms of psychiatric disorders. PMID:26393488

Using atmospheric pressure plasma treatment for treating grey cotton fabric.

PubMed

Kan, Chi-Wai; Lam, Chui-Fung; Chan, Chee-Kooi; Ng, Sun-Pui

2014-02-15

Conventional wet treatment, desizing, scouring and bleaching, for grey cotton fabric involves the use of high water, chemical and energy consumption which may not be considered as a clean process. This study aims to investigate the efficiency of the atmospheric pressure plasma (APP) treatment on treating grey cotton fabric when compared with the conventional wet treatment. Grey cotton fabrics were treated with different combinations of plasma parameters with helium and oxygen gases and also through conventional desizing, scouring and bleaching processes in order to obtain comparable results. The results obtained from wicking and water drop tests showed that wettability of grey cotton fabrics was greatly improved after plasma treatment and yielded better results than conventional desizing and scouring. The weight reduction of plasma treated grey cotton fabrics revealed that plasma treatment can help remove sizing materials and impurities. Chemical and morphological changes in plasma treated samples were analysed by FTIR and SEM, respectively. Finally, dyeability of the plasma treated and conventional wet treated grey cotton fabrics was compared and the results showed that similar dyeing results were obtained. This can prove that plasma treatment would be another choice for treating grey cotton fabrics. Copyright © 2013 Elsevier Ltd. All rights reserved.

Malachite green decolorization by the filamentous fungus Myrothecium roridum--Mechanistic study and process optimization.

PubMed

Jasińska, Anna; Paraszkiewicz, Katarzyna; Sip, Anna; Długoński, Jerzy

2015-10-01

The filamentous fungus Myrothecium roridum isolated from a dye-contaminated area was investigated in terms of its use for the treatment of Malachite green (MG). The mechanisms involved in this process were established. Peroxidases and cytochrome P-450 do not mediate MG elimination. The laccase of M. roridum IM 6482 was found to be responsible for the decolorization of 8-11% of MG. Thermostable low-molecular-weight factors (LMWF) resistant to sodium azide were found to be largely involved in dye decomposition. In addition, MG decolorization by M. roridum IM 6482 occurred in a non-toxic manner. Data from antimicrobial tests showed that MG toxicity decreased after decolorization. To optimize the MG decolorization process, the effects of operational parameters (such as the medium pH and composition, process temperature and culture agitation) were examined. The results demonstrate that M. roridum IM 6482 may be used effectively as an alternative to traditional decolorization agents. Copyright © 2015 Elsevier Ltd. All rights reserved.

Protocol evaluation for effective music therapy for persons with nonfluent aphasia.

PubMed

Kim, Mijin; Tomaino, Concetta M

2008-01-01

Although the notion of the language specificity of neural correlates has been widely accepted in the past (e.g., lefthemispheric dominance including Broca's and Wernike's area, N400 ERP component of semantic processing, and the P600 ERP component of syntactic processing, etc.), recent studies have shown that music and language share some important neurological aspects in their processing, both involving bilateral hemispheric activities. In line with this are the frequent behavioral clinical observations that persons with aphasia show improved articulation and prosody of speech in musically assisted phrases. Connecting recent neurological findings with clinical observations would not only inform clinical practice but would enhance understanding of the neurological mechanisms involved in the processing of speech/language and music. This article presents a music therapy treatment protocol study of 7 nonfluent patients with aphasia. The data and findings are discussed with regard to some of the recent focuses and issues addressed in the experimental studies using cognitive-behavioral, electrophysiological, and brain-imaging techniques.

Gift Exchange Theory: a critique in relation to organ transplantation.

PubMed

Sque, M; Payne, S A

1994-01-01

Organ transplantation is becoming more important as a viable method of treatment for certain severe medical conditions. It is a complex and demanding process for all involved. Nursing as a developing science must respond to cultural and economic changes. Therefore, a need exists to develop a body of empirically based knowledge to understand and support the process of organ transplantation. This paper will argue that as trading in organs is unacceptable to the moral standards of western society and outlawed in many countries, an alternative framework must be considered for understanding the mechanisms through which organs are donated and utilized. The donating and receiving of organs may be equated with gift-giving, as there is no barter of commodities involved. Therefore, a useful framework to explore this phenomenon will be one that underpins the process of giving and receiving of gifts. Gift Exchange Theory will be evaluated and critically examined in relation to organ transplantation and the role of nurses in this process.

Physical therapy for facial paralysis: a tailored treatment approach.

PubMed

Brach, J S; VanSwearingen, J M

1999-04-01

Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score= 17/100, final FGS score= 68/100) and no reported functional limitations. Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.

Effects of Cryogenic Treatment on the Strength Properties of Heat Resistant Stainless Steel (07X16H6)

NASA Astrophysics Data System (ADS)

Nadig, D. S.; Bhat, M. R.; Pavan, V. K.; Mahishi, Chandan

2017-09-01

Cryogenic treatment on metals is a well known technology where the materials are exposed to cryogenic temperature for prolonged time duration. The process involves three stages viz. slow cooling, holding at cryogenic temperature and warming to room temperature. During this process, hard and micro sized carbide particles are released within the steel material. In addition, soft and unconverted austenite of steel changes to strong martensite structure. These combined effects increase the strength and hardness of the cryotreated steel. In this experimental study, the effects of cryogenic treatment, austenitising and tempering on the mechanical properties of stainless steel (07X16H6) have been carried. After determining the strength properties of the original material, the specimens were cryotreated at 98K for 24 hours in a specially developed cryotreatment system. The effects of austenitising prior to cryogenic treatment and tempering post cryotreatment on the mechanical properties of steel samples have been experimentally determined and analysed.

Novel insights into the effect of nitrogen on storage protein biosynthesis and protein body development in wheat caryopsis.

PubMed

Yu, Xurun; Chen, Xinyu; Wang, Leilei; Yang, Yang; Zhu, Xiaowei; Shao, Shanshan; Cui, Wenxue; Xiong, Fei

2017-04-01

Molecular and cytological mechanisms concerning the effects of nitrogen on wheat (Triticum aestivum L.) storage protein biosynthesis and protein body development remain largely elusive. We used transcriptome sequencing, proteomics techniques, and light microscopy to investigate these issues. In total, 2585 differentially expressed genes (DEGs) and 57 differentially expressed proteins (DEPs) were found 7 days after anthesis (DAA), and 2456 DEGs and 64 DEPs were detected 18 DAA after nitrogen treatment. Gene ontology terms related to protein biosynthesis processes enriched these numbers by 678 and 582 DEGs at 7 and 18 DAA, respectively. Further, 25 Kyoto Encyclopedia of Genes and Genomes pathways were involved in protein biosynthesis at both 7 and 18 DAA. DEPs related to storage protein biosynthesis contained gliadin and glutenin subunits, most of which were up-regulated after nitrogen treatment. Quantitative real-time PCR analysis indicated that some gliadin and glutenin subunit encoding genes were differentially expressed at 18 DAA. Structural observation revealed that wheat endosperm accumulated more and larger protein bodies after nitrogen treatment. Collectively, our findings suggest that nitrogen treatment enhances storage protein content, endosperm protein body quantity, and partial processing quality by altering the expression levels of certain genes involved in protein biosynthesis pathways and storage protein expression at the proteomics level. © The Author 2017. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Comparative Analysis of Toxic Responses of Organic Extracts from Diesel and Selected Alternative Fuels Engine Emissions in Human Lung BEAS-2B Cells

PubMed Central

Libalova, Helena; Rossner,, Pavel; Vrbova, Kristyna; Brzicova, Tana; Sikorova, Jitka; Vojtisek-Lom, Michal; Beranek, Vit; Klema, Jiri; Ciganek, Miroslav; Neca, Jiri; Pencikova, Katerina; Machala, Miroslav; Topinka, Jan

2016-01-01

This study used toxicogenomics to identify the complex biological response of human lung BEAS-2B cells treated with organic components of particulate matter in the exhaust of a diesel engine. First, we characterized particles from standard diesel (B0), biodiesel (methylesters of rapeseed oil) in its neat form (B100) and 30% by volume blend with diesel fuel (B30), and neat hydrotreated vegetable oil (NEXBTL100). The concentration of polycyclic aromatic hydrocarbons (PAHs) and their derivatives in organic extracts was the lowest for NEXBTL100 and higher for biodiesel. We further analyzed global gene expression changes in BEAS-2B cells following 4 h and 24 h treatment with extracts. The concentrations of 50 µg extract/mL induced a similar molecular response. The common processes induced after 4 h treatment included antioxidant defense, metabolism of xenobiotics and lipids, suppression of pro-apoptotic stimuli, or induction of plasminogen activating cascade; 24 h treatment affected fewer processes, particularly those involved in detoxification of xenobiotics, including PAHs. The majority of distinctively deregulated genes detected after both 4 h and 24 h treatment were induced by NEXBTL100; the deregulated genes included, e.g., those involved in antioxidant defense and cell cycle regulation and proliferation. B100 extract, with the highest PAH concentrations, additionally affected several cell cycle regulatory genes and p38 signaling. PMID:27827897

Impact of a web-based prostate cancer treatment decision aid on patient-reported decision process parameters: results from the Prostate Cancer Patient Centered Care trial.

PubMed

Cuypers, Maarten; Lamers, Romy E D; Kil, Paul J M; van de Poll-Franse, Lonneke V; de Vries, Marieke

2018-05-12

To compare patients' evaluation of the treatment decision-making process in localized prostate cancer between counseling that included an online decision aid (DA) and standard counseling. Eighteen Dutch hospitals were randomized to DA counseling (n = 235) or the control group with standard counseling (n = 101) in a pragmatic, cluster randomized controlled trial. The DA was provided to patients at, or soon after diagnosis. Decisional conflict, involvement, knowledge, and satisfaction with information were assessed with a questionnaire after treatment decision-making. Anxiety and depression served as covariates. The levels of decision involvement and conflict were comparable between patients in both groups. Patients with a DA felt more knowledgeable but scored equally well on a knowledge test as patients without a DA. Small significant negative effects were found on satisfaction with information and preparation for decision-making. A preference for print over online and depression and anxiety symptoms was negatively associated with satisfaction and conflict scores in the DA group. The DA aimed to support shared decision-making, while outcomes for a majority of DA users were comparable to patients who received standard counseling. Patients, who are less comfortable with the online DA format or experience anxiety or depression symptoms, could require more guidance toward shared decision-making. To evaluate long-term DA effects, follow-up evaluation on treatment satisfaction and decisional regret will be done.

Anticipatory reward processing among cocaine-dependent individuals with and without concurrent methadone-maintenance treatment: Relationship to treatment response*

PubMed Central

Yip, Sarah W.; DeVito, Elise E.; Kober, Hedy; Worhunsky, Patrick D.; Carroll, Kathleen M.; Potenza, Marc N.

2016-01-01

Background Cocaine dependence among opioid-dependent methadone-maintained individuals is a significant public health problem and is particularly challenging to treat. The neurobiology of this clinically complex population has not been previously assessed using fMRI. Methods fMRI data from cocaine-dependent, methadone-maintained (CD-MM) patients (n=24), cocaine-dependent (CD) patients (n=20) and healthy comparison (HC; n=21) participants were acquired during monetary incentive delay task performance. All patients were scanned prior to treatment for cocaine dependence. Between-group differences in anticipatory reward and loss processing were assessed using whole-brain ANOVAs in SPM12 (pFWE<.05). Correlations between durations of abstinence during treatment and BOLD responses within the insula and caudate were also explored. Results Main effects of diagnostic group, primarily involving decreased BOLD responses among CD-MM patients in comparison to HCs, were observed during anticipatory reward and loss processing within regions of posterior cingulate cortex, precuneus, inferior frontal gyrus and dorsolateral prefrontal cortex. BOLD responses within the right caudate were negatively associated with percentage of cocaine-negative urines during treatment among CD-MM patients, but not among non-methadone-maintained CD patients. Conclusions These data suggest neurofunctional differences that may be related to treatment outcomes for behavioral therapies between cocaine-dependent individuals with and without methadone-maintenance treatment. These findings may relate to differences in treatment efficacies and to the elevated relapse rates observed in methadone-maintained populations. PMID:27430401

Multiscale Modelling of Cancer Progression and Treatment Control: The Role of Intracellular Heterogeneities in Chemotherapy Treatment

NASA Astrophysics Data System (ADS)

Chaplain, Mark A. J.; Powathil, Gibin G.

Cancer is a complex, multiscale process involving interactions at intracellular, intercellular and tissue scales that are in turn susceptible to microenvironmental changes. Each individual cancer cell within a cancer cell mass is unique, with its own internal cellular pathways and biochemical interactions. These interactions contribute to the functional changes at the cellular and tissue scale, creating a heterogenous cancer cell population. Anticancer drugs are effective in controlling cancer growth by inflicting damage to various target molecules and thereby triggering multiple cellular and intracellular pathways, leading to cell death or cell-cycle arrest. One of the major impediments in the chemotherapy treatment of cancer is drug resistance driven by multiple mechanisms, including multi-drug and cell-cycle mediated resistance to chemotherapy drugs. In this article, we discuss two hybrid multiscale modelling approaches, incorporating multiple interactions involved in the sub-cellular, cellular and microenvironmental levels to study the effects of cell-cycle, phase-specific chemotherapy on the growth and progression of cancer cells.

Multiscale Modelling of Cancer Progression and Treatment Control: The Role of Intracellular Heterogeneities in Chemotherapy Treatment

NASA Astrophysics Data System (ADS)

Chaplain, Mark A. J.; Powathil, Gibin G.

2015-04-01

Cancer is a complex, multiscale process involving interactions at intracellular, intercellular and tissue scales that are in turn susceptible to microenvironmental changes. Each individual cancer cell within a cancer cell mass is unique, with its own internal cellular pathways and biochemical interactions. These interactions contribute to the functional changes at the cellular and tissue scale, creating a heterogenous cancer cell population. Anticancer drugs are effective in controlling cancer growth by inflicting damage to various target molecules and thereby triggering multiple cellular and intracellular pathways, leading to cell death or cell-cycle arrest. One of the major impediments in the chemotherapy treatment of cancer is drug resistance driven by multiple mechanisms, including multi-drug and cell-cycle mediated resistance to chemotherapy drugs. In this article, we discuss two hybrid multiscale modelling approaches, incorporating multiple interactions involved in the sub-cellular, cellular and microenvironmental levels to study the effects of cell-cycle, phase-specific chemotherapy on the growth and progression of cancer cells.

Genome-wide analysis and characterization of Aux/IAA family genes related to fruit ripening in papaya (Carica papaya L.).

PubMed

Liu, Kaidong; Yuan, Changchun; Feng, Shaoxian; Zhong, Shuting; Li, Haili; Zhong, Jundi; Shen, Chenjia; Liu, Jinxiang

2017-05-05

Auxin/indole-3-acetic acid (Aux/IAA) family genes encode short-lived nuclear proteins that mediate the responses of auxin-related genes and are involved in several plant developmental and growth processes. However, how Aux/IAA genes function in the fruit development and ripening of papaya (Carica papaya L.) is largely unknown. In this study, a comprehensive identification and a distinctive expression analysis of 18 C. papaya Aux/IAA (CpIAA) genes were performed using newly updated papaya reference genome data. The Aux/IAA gene family in papaya is slightly smaller than that in Arabidopsis, but all of the phylogenetic subfamilies are represented. Most of the CpIAA genes are responsive to various phytohormones and expressed in a tissues-specific manner. To understand the putative biological functions of the CpIAA genes involved in fruit development and ripening, quantitative real-time PCR was used to test the expression profiling of CpIAA genes at different stages. Furthermore, an IAA treatment significantly delayed the ripening process in papaya fruit at the early stages. The expression changes of CpIAA genes in ACC and 1-MCP treatments suggested a crosstalk between auxin and ethylene during the fruit ripening process of papaya. Our study provided comprehensive information on the Aux/IAA family in papaya, including gene structures, phylogenetic relationships and expression profiles. The involvement of CpIAA gene expression changes in fruit development and ripening gives us an opportunity to understand the roles of auxin signaling in the maturation of papaya reproductive organs.

Temperature shock, injury and transient sensitivity to nisin in Gram negatives.

PubMed

Boziaris, I S; Adams, M R

2001-10-01

The effect of thermal stresses on survival, injury and nisin sensitivity was investigated in Salmonella Enteritidis PT4, PT7 and Pseudomonas aeruginosa. Heating at 55 degrees C, rapid chilling to 0.5 degrees C or freezing at -20 degrees C produced transient sensitivity to nisin. Cells were only sensitive if nisin was present during stress. Resistance recovered rapidly afterwards, though some cells displayed residual injury. Injury was assessed by SDS sensitivity, hydrophobicity changes, lipopolysaccharide release and NPN uptake. LPS release and hydrophobicity were not always associated with transient nisin sensitivity. Uptake of NPN correlated better but persisted longer after treatment. Thermal shocks produce transient injury to the outer membrane, allowing nisin access. After treatment, the permeability barrier is rapidly restored by a process apparently involving reorganization rather than biosynthetic repair. Inclusion of nisin during food treatments that impose sub-lethal stress on Gram negatives could increase process lethality, enhancing microbiological safety and stability.

Cerebral arterial gas embolism from attempted mechanical thrombectomy: recovery following hyperbaric oxygen therapy.

PubMed

Segan, Louise; Permezel, Fiona; Ch'ng, Wei; Millar, Ian; Brooks, Mark; Lee-Archer, Matt; Cloud, Geoffrey

2018-04-01

Cerebral arterial gas embolism is a recognised complication of endovascular intervention with an estimated incidence of 0.08%. Its diagnosis is predominantly clinical, supported by neuroimaging. The treatment relies on alleviating mechanical obstruction and reversing the proinflammatory processes that contribute to tissue ischaemia. Hyperbaric oxygen therapy is an effective treatment and has multiple mechanisms to reverse the pathological processes involved in cerebral arterial gas embolism. Symptomatic cerebral arterial gas embolism is a rare complication of endovascular intervention for acute ischaemic stroke. Although there are no previous descriptions of its successful treatment with hyperbaric oxygen therapy following mechanical thrombectomy, this is likely to become more common as mechanical thrombectomy is increasingly used worldwide to treat acute ischaemic stroke. © 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.

Toward Implementing Patient Flow in a Cancer Treatment Center to Reduce Patient Waiting Time and Improve Efficiency.

PubMed

Suss, Samuel; Bhuiyan, Nadia; Demirli, Kudret; Batist, Gerald

2017-06-01

Outpatient cancer treatment centers can be considered as complex systems in which several types of medical professionals and administrative staff must coordinate their work to achieve the overall goals of providing quality patient care within budgetary constraints. In this article, we use analytical methods that have been successfully employed for other complex systems to show how a clinic can simultaneously reduce patient waiting times and non-value added staff work in a process that has a series of steps, more than one of which involves a scarce resource. The article describes the system model and the key elements in the operation that lead to staff rework and patient queuing. We propose solutions to the problems and provide a framework to evaluate clinic performance. At the time of this report, the proposals are in the process of implementation at a cancer treatment clinic in a major metropolitan hospital in Montreal, Canada.

DNA end-processing enzyme polynucleotide kinase as a potential target in the treatment of cancer.

PubMed

Allinson, Sarah L

2010-06-01

Pharmacological inhibition of DNA-repair pathways as an approach for the potentiation of chemo- and radio-therapeutic cancer treatments has attracted increasing levels of interest in recent years. Inhibitors of several enzymes involved in the repair of DNA strand breaks are currently at various stages of the drug development process. Polynucleotide kinase (PNK), a bifunctional DNA-repair enzyme that possesses both 3'-phosphatase and 5'-kinase activities, plays an important role in the repair of both single strand and double strand breaks and as a result, RNAi-mediated knockdown of PNK sensitizes cells to a range of DNA-damaging agents. Recently, a small molecule inhibitor of PNK has been developed that is able to sensitize cells to ionizing radiation and the topoisomerase I poison, camptothecin. Although still in the early stages of development, PNK inhibition represents a promising means of enhancing the efficacy of existing cancer treatments.

Practical tips for sexual counseling and psychotherapy in premature ejaculation.

PubMed

Rowland, David; Cooper, Stewart

2011-10-01

A number of milestones in the treatment of premature ejaculation (PE) have occurred over the past five decades, including the development of various behavioral and cognitive techniques as well as pharmacotherapies that modify neurophysiological processes involved in ejaculation. Nevertheless, the notion that sexual responses such as PE are influenced by physiological, psychobehavioral, cultural, and relationship factors is as valid now as it was 50 years ago, and therefore, interventions should consider all such domains in the development of effective treatment strategies. Provide an overview of which patients with PE are suitable to receive psychosexual treatment and the psychological approaches for managing this disorder. Review of the literature. Psychosexual treatments that integrate behavioral, psychological, and relationship functioning. PE is typically a couple's problem and, therefore, psychotherapy is best when the partner is involved. Before embarking on psychotherapy, the clinician should obtain a medical history pertaining to sexual-, psychological-, and relationship-related factors, so that the treatment strategy can be tailored to the needs of the individual. General strategies underpinning integrative, "process-oriented" elements of psychotherapy most relevant to PE are: developing the therapist-patient relationship; expressing empathy, genuineness, and positive regard; motivational interviewing, i.e., developing motivation to change; developing discrepancy; working through resistance; identifying PE-related affect, cognitions, and behaviors (including interaction with partners); and supporting self-efficacy. The four main domains that encompass psychotherapy techniques specific to the treatment of PE are: behavioral; cognitive; affective; and relational. Sustained positive outcomes in PE may be obtained using a combination treatment strategy that addresses all elements of PE, including psychological and biological factors. Psychosexual treatments may help the patient with PE and his partner to address their sexual problems and improve their overall relationship. The effects of psychosexual therapy may be augmented by combining this intervention with pharmacotherapy. 2011 International Society for Sexual Medicine.

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS

PubMed Central

López, Mónica E.; Kaplan, Celia P.; Nápoles, Anna M.; Hwang, E. Shelly; Livaudais, Jennifer C.; Karliner, Leah S.

2013-01-01

Objective To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Methods Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women’s preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Results Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Conclusion Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Practice Implications Use of professional interpreters may address communication-related disparities for these women. PMID:24207116

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS.

PubMed

López, Mónica E; Kaplan, Celia P; Nápoles, Anna M; Hwang, E Shelley; Livaudais, Jennifer C; Karliner, Leah S

2014-01-01

To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women's preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<0.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Use of professional interpreters may address communication-related disparities for these women. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Restoration of the Occlusal Vertical Dimension with an Overlay Removable Partial Denture: A Clinical Report.

PubMed

Zanardi, Piero Rocha; Santos, Mayara Silva; Stegun, Roberto Chaib; Sesma, Newton; Costa, Bruno; Laganá, Dalva Cruz

2016-10-01

The process of tooth loss throughout life associated with severe occlusal wear may pose a challenge in the rehabilitation of partially edentulous arches. In these cases, many therapeutic procedures are necessary because each tooth must be restored to obtain the correct anatomical contour and recover the occlusal vertical dimension (OVD). A removable partial denture (RPD) with occlusal/incisal coverage, also known as an overlay RPD, is an alternative treatment option with fewer interventions, and, consequently, lower cost. This clinical report reviews the principles involved in the clinical indication for an overlay RPD, as well as the necessary planning and execution, to discuss the feasibility and clinical effectiveness of this treatment, identifying the indications, advantages, and disadvantages of this procedure through the presentation of a clinical case. The overlay RPD can be an alternative treatment for special situations involving partially edentulous arches in patients who need reestablishment of the OVD and/or realignment of the occlusal plane, and it can be used as a temporary or definitive treatment. The main advantages of this type of treatment are its simplicity, reversibility, and relatively low cost; however, further studies are needed to ensure the efficacy of this treatment option. © 2015 by the American College of Prosthodontists.

Kidney transplantation process in Brazil represented in business process modeling notation.

PubMed

Peres Penteado, A; Molina Cohrs, F; Diniz Hummel, A; Erbs, J; Maciel, R F; Feijó Ortolani, C L; de Aguiar Roza, B; Torres Pisa, I

2015-05-01

Kidney transplantation is considered to be the best treatment for people with chronic kidney failure, because it improves the patients' quality of life and increases their length of survival compared with patients undergoing dialysis. The kidney transplantation process in Brazil is defined through laws, decrees, ordinances, and resolutions, but there is no visual representation of this process. The aim of this study was to analyze official documents to construct a representation of the kidney transplantation process in Brazil with the use of business process modeling notation (BPMN). The methodology for this study was based on an exploratory observational study, document analysis, and construction of process diagrams with the use of BPMN. Two rounds of validations by specialists were conducted. The result includes the kidney transplantation process in Brazil representation with the use of BPMN. We analyzed 2 digital documents that resulted in 2 processes with 45 total of activities and events, 6 organizations involved, and 6 different stages of the process. The constructed representation makes it easier to understand the rules for the business of kidney transplantation and can be used by the health care professionals involved in the various activities within this process. Construction of a representation with language appropriate for the Brazilian lay public is underway. Copyright © 2015 Elsevier Inc. All rights reserved.

Charge-carrier relaxation in sonochemically fabricated dendronized CaSiO3-SiO2-Si nanoheterostructures

NASA Astrophysics Data System (ADS)

Savkina, Rada; Smirnov, Aleksey; Kirilova, Svitlana; Shmid, Volodymyr; Podolian, Artem; Nadtochiy, Andriy; Odarych, Volodymyr; Korotchenkov, Oleg

2018-04-01

We present systematic studies of charge-carrier relaxation processes in sonochemically nanostructured silicon wafers. Impedance spectroscopy and transient photovoltage techniques are employed. It is found that interface potential in Si wafers remarkably increases upon their exposure to sonochemical treatments in Ca-rich environments. In contrast, the density of fast interface electron states remains almost unchanged. It is found that the initial photovoltage decay, taken before ultrasonic treatments, exhibits the involvement of shorter- and longer time recombination and trapping centers. The decay speeds up remarkably due to cavitation treatments, which is accompanied by a substantial quenching of the photovoltage magnitude. It is also found that, before the treatments, the photovoltage magnitude is markedly non-uniform over the wafer surface, implying the existence of distributed sites affecting distribution of photoexcited carriers. The treatments cause an overall broadening of the photovoltage distribution. Furthermore, impedance measurements monitor the progress in surface structuring relevant to several relaxation processes. We believe that sonochemical nanostructuring of silicon wafers with dendronized CaSiO3 may enable new promising avenue towards low-cost solar energy efficiency multilayered solar cell device structures.

Drawing and interpreting data: Children's impressions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in four onchocerciasis endemic countries in Africa

PubMed Central

Amuyunzu-Nyamongo, Mary; Tchounkeu, Yolande Flore Longang; Oyugi, Rahel Akumu; Kabali, Asaph Turinde; Okeibunor, Joseph C.; Manianga, Cele; Amazigo, Uche V.

2011-01-01

Although the depiction of a child leading a blind man is the most enduring image of onchocerciasis in Africa, research activities have hardly involved children. This paper aims at giving voice to children through drawings and their interpretation. The study was conducted in 2009 in Cameroon, Democratic Republic of Congo (DRC), Nigeria and Uganda. Children aged 6–16 years were asked to draw their perceptions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in their communities. A total of 50 drawings were generated. The drawings depicted four main aspects of onchocerciasis: (1) the disease symptoms, (2) the negative consequences of onchocerciasis among children and in the community generally, (3) the ivermectin distribution process, and (4) the benefits or effects of taking ivermectin. Out of the 50 drawings, 30 were on symptoms, 7 on effects of the disease on children, 8 on distribution process, and 5 represented multiple perceptions on symptoms, drug distribution processes, benefits, and effects of treatment. The lack of clarity when treatment with ivermectin can be stopped in endemic areas requires working with children to ensure continued compliance with treatment into the future. Children's drawings should be incorporated into health education interventions. PMID:21637349

Process for preparing multilayer enzyme coating on a fiber

DOEpatents

Kim, Jungbae [Richland, WA; Kwak, Ja Hun [Richland, WA; Grate, Jay W [West Richland, WA

2009-11-03

A process for preparing high stability, high activity biocatalytic materials is disclosed and processes for using the same. The process involves coating of a material or fiber with enzymes and enzyme aggregate providing a material or fiber with high biocatalytic activity and stability useful in heterogeneous environments. In one illustrative approach, enzyme "seeds" are covalently attached to polymer nanofibers followed by treatment with a reagent that crosslinks additional enzyme molecules to the seed enzymes forming enzyme aggregates thereby improving biocatalytic activity due to increased enzyme loading and enzyme stability. This approach creates a useful new biocatalytic immobilized enzyme system with potential applications in bioconversion, bioremediation, biosensors, and biofuel cells.

Choosing a Control Group in Effectiveness Trials of Behavioral Drug Abuse Treatments

PubMed Central

Brigham, Gregory S.; Feaster, Daniel J.; Wakim, Paul G.; Dempsey, Catherine L.

2009-01-01

Effectiveness trials are an important step in the scientific process of developing and evaluating behavioral treatments. The focus on effectiveness research presents a different set of requirements on the research design when compared with efficacy studies. The choice of a control condition has many implications for a clinical trial's internal and external validity. The purpose of this manuscript is to provide a discussion of the issues involved in choosing a control group for effectiveness trials of behavioral interventions in substance abuse treatment. The authors provide a description of four trial designs and a discussion of the advantages and disadvantages of each. PMID:19553062

Anticancer Activity of Curcumin and Its Analogues: Preclinical and Clinical Studies.

PubMed

Allegra, Alessandro; Innao, Vanessa; Russo, Sabina; Gerace, Demetrio; Alonci, Andrea; Musolino, Caterina

2017-01-02

Curcumin has been shown to have a wide variety of therapeutic effects, ranging from anti-inflammatory, chemopreventive, anti-proliferative, and anti-metastatic. This review provides an overview of the recent research conducted to overcome the problems with the bioavailability of curcumin, and of the preclinical and clinical studies that have reported success in combinatorial strategies coupling curcumin with other treatments. Research on the signaling pathways that curcumin treatment targets shows that it potently acts on major intracellular components involved in key processes such as genomic modulations, cell invasion and cell death pathways. Curcumin is a promising molecule for the prevention and treatment of cancer.

Recent mouse and rat methods for the study of experimental oral candidiasis.

PubMed

Costa, Anna C B P; Pereira, Cristiane A; Junqueira, Juliana C; Jorge, Antonio O C

2013-07-01

The Candida genus expresses virulence factors that, when combined with immunosuppression and other risk factors, can cause different manifestations of oral candidiasis. The treatment of mucosal infections caused by Candida and the elucidation of the disease process have proven challenging. Therefore, the study of experimentally induced oral candidiasis in rats and mice is useful to clarify the etiopathology of this condition, improve diagnosis, and search for new therapeutic options because the disease process in these animals is similar to that of human candidiasis lesions. Here, we describe and discuss new studies involving rat and mouse models of oral candidiasis with respect to methods for inducing experimental infection, methods for evaluating the development of experimental candidiasis, and new treatment strategies for oral candidiasis.

Proceedings of the conference on energy conservation: Retrofit of Municipal Wastewater Treatment Facilities

NASA Astrophysics Data System (ADS)

1982-02-01

The concepts of the roles of heat and temperature, ventilation and water removal when organic material is assembled into a self insulating mass are summarized. The practical application of these concepts in static pile configuration or the Rutgers process are outlined. The concepts and means of application are relevant to all design approaches whether or not a reactor structure is involved, whether the process is batch or continuous, and whether the mass is agitated or static.

Bridging the Gap: Understanding Eye Movements and Attentional Mechanisms is Key to Improving Amblyopia Treatment

NASA Astrophysics Data System (ADS)

Gambacorta, Christina Grace

Amblyopia is a developmental visual disorder resulting in sensory, motor and attentional deficits, including delays in both saccadic and manual reaction time. It is unclear whether this delay is due to differences in sensory processing of the stimulus, or the processes required to dis-engage/shift/re-engage attention when moving the eye from fixation to a saccadic target. In the first experiment we compare asymptotic saccadic and manual reaction times between the two eyes, using equivalent stimulus strength to account for differences in sensory processing. In a follow-up study, we modulate RT by removing the fixation dot, which is thought to release spatial attention at the fovea, and reduces reaction time in normal observers. Finally, we discuss the implications for these findings on future amblyopic treatment, specifically dichoptic video game playing. Playing videogames may help engage the attentional network, leading to greater improvements than traditional treatment of patching the non- amblyopic eye. Further, when treatment involves both eyes, fixation stability may be improved during the therapeutic intervention, yielding a better outcome than just playing a video game with a patch over the non-amblyopic eye.

Attitudes Toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists.

PubMed

Shin, Dong Wook; Cho, Juhee; Roter, Debra L; Kim, So Young; Yang, Hyung Kook; Park, Keeho; Kim, Hyung Jin; Shin, Hee-Young; Kwon, Tae Gyun; Park, Jong Hyock

2017-06-01

To investigate how cancer patients, family caregiver, and their treating oncologist view the risks and benefits of family involvement in cancer treatment decision making (TDM) or the degree to which these perceptions may differ. A nationwide, multicenter survey was conducted with 134 oncologists and 725 of their patients and accompanying caregivers. Participant answered to modified Control Preferences Scale and investigator-developed questionnaire regarding family involvement in cancer TDM. Most participants (>90%) thought that family should be involved in cancer TDM. When asked if the oncologist should allow family involvement if the patient did not want them involved, most patients and caregivers (>85%) thought they should. However, under this circumstance, only 56.0% of oncologists supported family involvement. Patients were significantly more likely to skew their responses toward patient rather than family decisional control than were their caregivers (P < .003); oncologists were more likely to skew their responses toward patient rather than family decisional control than caregivers (P < .001). Most respondents thought that family involvement is helpful and neither hamper patient autonomy nor complicate cancer TDM process. Oncologists were largely positive, but less so in these ratings than either patients or caregivers (P < .002). Patients, family caregivers, and, to a lesser degree, oncologists expect and valued family involvement in cancer TDM. These findings support a reconsideration of traditional models focused on protection of patient autonomy to a more contextualized form of relational autonomy, whereby the patient and family caregivers can be seen as a unit for autonomous decision. Copyright © 2016 John Wiley & Sons, Ltd.

Photo-fenton degradation of diclofenac: identification of main intermediates and degradation pathway.

PubMed

Pérez-Estrada, Leónidas A; Malato, Sixto; Gernjak, Wolfgang; Agüera, Ana; Thurman, E Michael; Ferrer, Imma; Fernández-Alba, Amadeo R

2005-11-01

In recent years, the presence of pharmaceuticals in the aquatic environment has been of growing interest. These new contaminants are important because many of them are not degraded under the typical biological treatments applied in the wastewater treatment plants and represent a continuous input into the environment. Thus, compounds such as diclofenac are present in surface waters in all Europe and a crucial need for more enhanced technologies that can reduce its presence in the environment has become evident. In this sense, advanced oxidation processes (AOPs) represent a good choice for the treatment of hazardous nonbiodegradable pollutants. This work deals with the solar photodegradation of diclofenac, an antiinflammatory drug, in aqueous solutions by photo-Fenton reaction. A pilot-scale facility using a compound parabolic collector (CPC) reactor was used for this study. Results obtained show rapid and complete oxidation of diclofenac after 60 min, and total mineralization (disappearance of dissolved organic carbon, DOC) after 100 min of exposure to sunlight. Although diclofenac precipitates during the process at low pH, its degradation takes place in the homogeneous phase governed by a precipitation-redissolution-degradation process. Establishment of the reaction pathway was made possible by a thorough analysis of the reaction mixture identifying the main intermediate products generated. Gas chromatography-mass spectrometry (GC/ MS) and liquid chromatography coupled with time-of-flight mass spectrometry (LC/TOF-MS) were used to identify 18 intermediates, in two tentative degradation routes. The main one was based on the initial hydroxylation of the phenylacetic acid moiety in the C-4 position and subsequent formation of a quinone imine derivative that was the starting point for further multistep degradation involving hydroxylation, decarboxylation, and oxidation reactions. An alternative route was based on the transient preservation of the biphenyl amino moiety that underwent a similar oxidative process of C-N bond cleavage. The proposed degradation route differs from those previously reported involving alternative degradation processes (ozonization, UV/H2O2, or photolysis), indicating that diclofenac degradation follows different pathways, depending on the treatment applied.

Patients' perceptions of information and education for renal replacement therapy: an independent survey by the European Kidney Patients' Federation on information and support on renal replacement therapy.

PubMed

Van Biesen, Wim; van der Veer, Sabine N; Murphey, Mark; Loblova, Olga; Davies, Simon

2014-01-01

Selection of an appropriate renal replacement modality is of utmost importance for patients with end stage renal disease. Previous studies showed provision of information to and free modality choice by patients to be suboptimal. Therefore, the European Kidney Patients' Federation (CEAPIR) explored European patients' perceptions regarding information, education and involvement on the modality selection process. CEAPIR developed a survey, which was disseminated by the national kidney patient organisations in Europe. In total, 3867 patients from 36 countries completed the survey. Respondents were either on in-centre haemodialysis (53%) or had a functioning graft (38%) at the time of survey. The majority (78%) evaluated the general information about kidney disease and treatment as helpful, but 39% did not recall being told about alternative treatment options than their current one. Respondents were more often satisfied with information provided on in-centre haemodialysis (90%) and transplantation (87%) than with information provided on peritoneal dialysis (79%) or home haemodialysis (61%), and were more satisfied with information from health care professionals vs other sources such as social media. Most (75%) felt they had been involved in treatment selection, 29% perceived they had no free choice. Involvement in modality selection was associated with enhanced satisfaction with treatment (OR 3.13; 95% CI 2.72-3.60). Many respondents (64%) could not remember receiving education on how to manage their kidney disease in daily life. Perceptions on information seem to differ between countries. Kidney patients reported to be overall satisfied with the information they received on their disease and treatment, although information seemed mostly to have been focused on one modality. Patients involved in modality selection were more satisfied with their treatment. However, in the perception of the patients, the freedom to choose an alternative modality showed room for improvement.

Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making.

PubMed

Mokhles, S; Nuyttens, J J M E; de Mol, M; Aerts, J G J V; Maat, A P W M; Birim, Ö; Bogers, A J J C; Takkenberg, J J M

2018-01-15

The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.

The influence of propofol anesthesia exposure on nonaversive memory retrieval and expression of molecules involved in memory process in the dorsal hippocampus in peripubertal rats.

PubMed

Pavković, Željko; Milanović, Desanka; Ruždijić, Sabera; Kanazir, Selma; Pešić, Vesna

2018-06-01

The effects of anesthetic drugs on postoperative cognitive function in children are not well defined and have not been experimentally addressed. The present study aimed to examine the influence of propofol anesthesia exposure on nonaversive hippocampus-dependent learning and biochemical changes involved in memory process in the dorsal hippocampus, in peripubertal rats as the rodent model of periadolescence. The intersession spatial habituation and the novel object recognition tasks were used to assess spatial and nonspatial, nonaversive hippocampus-dependent learning. The exposure to anesthesia was performed after comparably long acquisition phases in both tasks. Behavioral testing lasted for 2 consecutive days (24-hour retention period). Changes in the expression of molecules involved in memory retrieval/reconsolidation were examined in the dorsal hippocampus by Western blot and immunohistochemistry, at the time of behavioral testing. Exposure to propofol anesthesia resulted in inappropriate assessment of spatial novelty at the beginning of the test session and affected continuation of acquisition in the spatial habituation test. The treatment did not affect recognition of the novel object at the beginning of the test session but it attenuated overall preference to novelty, reflecting retrieval of a weak memory. The expression of phosphorylated extracellular signal-regulated kinase 2 (involved in memory retrieval) was decreased while the level of phosphorylated Ca 2+ /calmodulin-dependent protein kinase IIα and early growth response protein 1 (involved in memory reconsolidation) was increased in the dorsal hippocampus. The level of Finkel-Biskis-Jinkins murine osteosarcoma viral oncogene homolog B (neuronal activity indicator) was increased in the dorsal dentate gyrus. Enhanced exploratory activity was still evident in the propofol anesthesia exposure (PAE) group 48 hour after the treatment in both tasks. In peripubertal rats, propofol anesthesia exposure affects memory retrieval and acquisition of new learning in the spatial and nonspatial, nonaversive learning tasks 24 hour after the treatment, along with the expression of molecules that participate in memory retrieval/reconsolidation in the dorsal hippocampus. These results may have clinical implications, favoring control of basic cognitive functions in older children after the propofol exposure. © 2018 John Wiley & Sons Ltd.

Subungual squamous cell carcinoma: A case study

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

Neill, Cory J., E-mail: coryjneill@gmail.com

The purpose of this case study is to describe a dosimetric delivery of radiation to a superficial disease process involving the skin and bone of the distal finger. A 76-year-old male patient presented with a subungual squamous cell carcinoma (SCC) of the left distal index finger with bony involvement. The patient refused conventional surgical treatment but agreed to external beam radiation therapy (EBRT). There is a gap in the current literature describing how to successfully immobilize fingers and which EBRT modality is dosimetrically advantageous in treating them. The construction of a simple immobilization method with the patient in a reproduciblemore » position is described. The use of photons and electrons were compared ultimately showing photons to be dosimetrically advantageous. Long-term efficacy of the treatment was not evaluated because of patient noncompliance.« less

Effect of hindlimb suspension and clenbuterol treatment on polyamine levels in skeletal muscle

NASA Technical Reports Server (NTRS)

Abukhalaf, Imad K.; von Deutsch, Daniel A.; Wineski, Lawrence E.; Silvestrov, Natalia A.; Abera, Saare A.; Sahlu, Sinafikish W.; Potter, David E.; Thierry-Palmer, M. (Principal Investigator)

2002-01-01

Polyamines are unbiquitous, naturally occurring small aliphatic, polycationic, endogenous compounds. They are involved in many cellular processes and may serve as secondary or tertiary messengers to hormonal regulation. The relationship of polyamines and skeletal muscle mass of adductor longus, extensor digitorum longus, and gastrocnemius under unloading (hindlimb suspension) conditions was investigated. Unloading significantly affected skeletal muscle polyamine levels in a fiber-type-specific fashion. Under loading conditions, clenbuterol treatment increased all polyamine levels, whereas under unloading conditions, only the spermidine levels were consistently increased. Unloading attenuated the anabolic effects of clenbuterol in predominately slow-twitch muscles (adductor longus), but had little impact on clenbuterol's action as a countermeasure in fast- twitch muscles such as the extensor digitorum longus. Spermidine appeared to be the primary polyamine involved in skeletal muscle atrophy/hypertrophy. Copyright 2002 S. Karger AG, Basel.

Development of Bruton's tyrosine kinase Inhibitors for Rheumatoid Arthritis.

PubMed

Jiahui, Lv; Jingde, Wu; Feng, He; Ying, Qu; Qiuqiong, Zhang; Chenggong, Yu

2018-03-16

Rheumatoid Arthritis (RA) is a chronic autoimmune disease and becomes one of the major causes of disability and work force loss. The presence of abnormal B cell and autoantibodies produced by most RA patients, primarily ACPA and RF, indicate that the function of B cell was involved in the development of RA disease. Accordingly, the drug targeting B cell has become a hot spot in the treatment of RA. Studies have shown that Bruton's tyrosine kinase (BTK) is involved in the regulation of B cell proliferation and activation process. Some small molecule BTK inhibitors have shown excellent inhibition in biological activity analysis and animal models. Therefore, this review will briefly introduce BTK and its role in cell signaling and overview recent progress of BTK inhibitors for RA treatment. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

The growth receptors and their role in wound healing.

PubMed

Rolfe, Kerstin J; Grobbelaar, Adriaan O

2010-11-01

Abnormal wound healing is a major problem in healthcare today, with both scarring and chronic wounds affecting large numbers of individuals worldwide. Wound healing is a complex process involving several variables, including growth factors and their receptors. Chronic wounds fail to complete the wound healing process, while scarring is considered to be an overzealous wound healing process. Growth factor receptors and their ligands are being investigated to assess their potential in the development of therapeutic strategies to improve wound healing. This review discusses potential therapeutics for manipulating growth factors and their corresponding receptors for the treatment of abnormal wound healing.

Anaerobic Digestion I. Sludge Treatment and Disposal Course #166. Instructor's Guide [and] Student Workbook.

ERIC Educational Resources Information Center

Arasmith, E. E.

This lesson is the first of a two-part series on anaerobic digestion. Topics discussed include the five basic functions of an anaerobic digester, basic theory of the biological processes involved, basic equipment necessary for digestion, and the products of digestion. The lesson includes an instructor's guide and student workbook. The instructor's…

Five Heads Are Better than One: Preliminary Results of Team-Based Learning in a Communication Disorders Graduate Course

ERIC Educational Resources Information Center

Epstein, Baila

2016-01-01

Background: Clinical problem-solving is fundamental to the role of the speech-language pathologist in both the diagnostic and treatment processes. The problem-solving often involves collaboration with clients and their families, supervisors, and other professionals. Considering the importance of cooperative problem-solving in the profession,…

Using Concept Mapping to Improve Parent Implementation of Positive Behavioral Interventions for Children with Challenging Behaviors

ERIC Educational Resources Information Center

Alkahtani, Keetam D. F.

2013-01-01

Children's challenging behaviors can be addressed with effective interventions that can meet children's emotional needs and support their families. Positive Behavioral Interventions and Supports (PBIS) value the family involvement in the process of their child treatment. The intention of this study was to use concept mapping as an adjunct to PBIS…

FT-IR and C-13 NMR analysis of soil humic fractions from a long term cropping systems study

USDA-ARS?s Scientific Manuscript database

Increased knowledge of humic fractions is important due to its involvement in many soil ecosystem processes. Soil humic acid (HA) and fulvic acid (FA) from a nine-year agroecosystem study with different tillage, cropping system, and N source treatments were characterized using FT-IR andsolid-state ...

Learner's Guide: Water Quality Monitoring. An Instructional Guide for the Two-Year Water Quality Monitoring Curriculum.

ERIC Educational Resources Information Center

Glazer, Richard B.; And Others

This learner's guide is designed to meet the training needs for technicians involved in monitoring activities related to the Federal Water Pollution Act and the Safe Drinking Water Act. In addition it will assist technicians in learning how to perform process control laboratory procedures for drinking water and wastewater treatment plant…

Patient Activities Planning and Progress Noting a Humanistic Integrated-Team Approach.

ERIC Educational Resources Information Center

Muilenburg, Ted

This document outlines a system for planning recreation therapy, documenting progress, and relating the entire process to a team approach which includes patient assessment and involvement. The recreation program is seen as therapeutic, closely related to the total medical treatment program. The model is designed so that it can be adapted to almost…

Reduction of verotoxigenic Escherichia coli in production of fermented sausages.

PubMed

Holck, Askild L; Axelsson, Lars; Rode, Tone Mari; Høy, Martin; Måge, Ingrid; Alvseike, Ole; L'abée-Lund, Trine M; Omer, Mohamed K; Granum, Per Einar; Heir, Even

2011-11-01

After a number of foodborne outbreaks of verotoxigenic Escherichia coli involving fermented sausages, some countries have imposed regulations on sausage production. For example, the US Food Safety and Inspection Service requires a 5 log(10) reduction of E. coli in fermented products. Such regulations have led to a number of studies on the inactivation of E. coli in fermented sausages by changing processing and post-processing conditions. Several factors influence the survival of E. coli such as pre-treatment of the meat, amount of NaCl, nitrite and lactic acid, water activity, pH, choice of starter cultures and addition of antimicrobial compounds. Also process variables like fermentation temperature and storage time play important roles. Though a large variety of different production processes of sausages exist, generally the reduction of E. coli caused by production is in the range 1-2 log(10). In many cases this may not be enough to ensure microbial food safety. By optimising ingredients and process parameters it is possible to increase E. coli reduction to some extent, but in some cases still other post process treatments may be required. Such treatments may be storage at ambient temperatures, specific heat treatments, high pressure processing or irradiation. HACCP analyses have identified the quality of the raw materials, low temperature in the batter when preparing the sausages and a rapid pH drop during fermentation as critical control points in sausage production. This review summarises the literature on the reduction verotoxigenic E. coli in production of fermented sausages. Copyright © 2011 Elsevier Ltd. All rights reserved.

Antigen recovery and preservation using the microwave irradiation of biological samples for transmission electron microscopy analysis.

PubMed

Aïoun, Josiane; Chat, Sophie; Bordat, Christian; Péchoux, Christine

2013-01-01

Most studies using microwave irradiation (MWI) for the preparation of tissue samples have reported an improvement in structural integrity. However, there have been few studies on the effect of microwave (MW) on antigen preservation during sample preparation prior to immunolocalization. This report documents our experience of specimen preparation using an automatic microwave apparatus to obtain antigen preservation and retrieval. We tested the effects of MW processing vs. conventional procedures on the morphology and antigenicity of two different tissues: the brain and mammary gland, whose chemical composition and anatomical organization are quite different. We chose to locate the transcription factor PPARβ/δ using immunocytochemistry on brain tissue sections from hamsters. Antigen retrieval protocols involving MWI were used to restore immunoreactivity. We also studied the efficiency of the ultrastructural immunolocalization of both PPARγ and caveolin-1 following MWI vs. conventional treatment, on mammary gland tissue from mice at 10 days of lactation. Our findings showed that the treatment of tissue samples with MWI, in the context of a process lasting just a few hours from fixation to immunolocalization, enabled similar, or even better, results than conventional protocols. The quantification of immunolabeling for cav-1 indicated an increase in density of up to three-fold in tissues processed in the microwave oven. Furthermore, MW treatment permitted the localization of PPARβ/δ in glutaraldehyde-fixed specimens, which was impossible in the absence of MWI. This study thus showed that techniques involving the use of microwaves could largely improve both ultrastructure and immunodetection. Copyright © 2013 Elsevier Ltd. All rights reserved.

Theory-Based Active Ingredients of Effective Treatments for Substance Use Disorders

PubMed Central

Moos, Rudolf H.

2007-01-01

This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients’ life contexts, and how much their influence varies depending upon clients’ demographic and personal characteristics. PMID:17129682

Theory-based active ingredients of effective treatments for substance use disorders.

PubMed

Moos, Rudolf H

2007-05-11

This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients' life contexts, and how much their influence varies depending upon clients' demographic and personal characteristics.

Advances of Stem Cell Therapeutics in Cutaneous Wound Healing and Regeneration

PubMed Central

Kanji, Suman

2017-01-01

Cutaneous wound healing is a complex multiple phase process, which overlaps each other, where several growth factors, cytokines, chemokines, and various cells interact in a well-orchestrated manner. However, an imbalance in any of these phases and factors may lead to disruption in harmony of normal wound healing process, resulting in transformation towards chronic nonhealing wounds and abnormal scar formation. Although various therapeutic interventions are available to treat chronic wounds, current wound-care has met with limited success. Progenitor stem cells possess potential therapeutic ability to overcome limitations of the present treatments as it offers accelerated wound repair with tissue regeneration. A substantial number of stem cell therapies for cutaneous wounds are currently under development as a result of encouraging preliminary findings in both preclinical and clinical studies. However, the mechanisms by which these stem cells contribute to the healing process have yet to be elucidated. In this review, we emphasize on the major treatment modalities currently available for the treatment of the wound, role of various interstitial stem cells and exogenous adult stem cells in cutaneous wound healing, and possible mechanisms involved in the healing process. PMID:29213192

A Process of Multidisciplinary Team Communication to Individualize Stroke Rehabilitation of an 84-Year-Old Stroke Patient.

PubMed

Hiragami, Fukumi; Hiragami, Shogo; Suzuki, Yasuo

Previously, we have used a multidisciplinary team (MDT) approach to individualize rehabilitation of very old stroke patients as a means to establish intervention points for addressing impaired activities of daily living (ADL). However, this previous study was limited because of a lack in describing the communication process over time. This case study characterized the MDT communication process in the rehabilitation of an 84-year-old patient over the course of 15 weeks. The MDT consisted of 3 nurses, 1 doctor, 6 therapists, and the patient/families. Meetings (15 minutes each) were held at 4, 6, 8, and 15 weeks following the patient's admission. To individualize the rehabilitation, the communication process involved gaining knowledge about ADL impairments, sharing assessments, providing treatment options, and reflecting on desired treatment outcomes-a process termed KATR. The knowledge, assessment, treatment, and reflection (KATR) process established intervention points focusing on specific ADL impairments. The team members focused the interventions on the impaired ADL identified in the KATR process, and individualized rehabilitation was generated from the MDT information-sharing knowledge. In the initial meeting (Week 4), intervention points derived from the KATR process focused on rehabilitation of self-care impairments. These impairments improved by Week 15. By the last meeting, the MDT intervention points focused on mobility impairments. Having an organized communication process (i.e., KATR) facilitates individualization of rehabilitation without lengthy and frequent MDT meetings and enhances the quality of rehabilitation after a stroke.

[Various pathways leading to the progression of chronic liver diseases].

PubMed

Egresi, Anna; Lengyel, Gabriella; Somogyi, Anikó; Blázovics, Anna; Hagymási, Krisztina

2016-02-21

As the result of various effects (viruses, metabolic diseases, nutritional factors, toxic agents, autoimmune processes) abnormal liver function, liver steatosis and connective tissue remodeling may develop. Progression of this process is complex including various pathways and a number of factors. The authors summarize the factors involved in the progression of chronic liver disease. They describe the role of cells and the produced inflammatory mediators and cytokines, as well as the relationship between the disease and the intestinal flora. They emphasize the role of oxidative stress, mitochondrial dysfunction and cell death in disease progression. Insulin resistance and micro-elements (iron, copper) in relation to liver damage are also discussed, and genetic and epigenetic aspects underlying disease progression are summarized. Discovery of novel treatment options, assessment of the effectiveness of treatment, as well as the success and proper timing of liver transplantation may depend on a better understanding of the process of disease progression.

Hurdles and delays in access to anti-cancer drugs in Europe

PubMed Central

Ades, F; Zardavas, D; Senterre, C; de Azambuja, E; Eniu, A; Popescu, R; Piccart, M; Parent, F

2014-01-01

Demographic changes in the world population will cause a significant increase in the number of new cases of cancer. To handle this challenge, societies will need to adapt how they approach cancer prevention and treatment, with changes to the development and uptake of innovative anticancer drugs playing an important role. However, there are obstacles to implementing innovative drugs in clinical practice. Prior to being incorporated into daily practice, the drug must obtain regulatory and reimbursement approval, succeed in changing the prescription habits of physicians, and ultimately gain the compliance of individual patients. Developing an anticancer drug and bringing it into clinical practice is, therefore, a lengthy and complex process involving multiple partners in several areas. To optimize patient treatment and increase the likelihood of implementing health innovation, it is essential to have an overview of the full process. This review aims to describe the process and discuss the hurdles arising at each step. PMID:25525460

Hurdles and delays in access to anti-cancer drugs in Europe.

PubMed

Ades, F; Zardavas, D; Senterre, C; de Azambuja, E; Eniu, A; Popescu, R; Piccart, M; Parent, F

2014-01-01

Demographic changes in the world population will cause a significant increase in the number of new cases of cancer. To handle this challenge, societies will need to adapt how they approach cancer prevention and treatment, with changes to the development and uptake of innovative anticancer drugs playing an important role. However, there are obstacles to implementing innovative drugs in clinical practice. Prior to being incorporated into daily practice, the drug must obtain regulatory and reimbursement approval, succeed in changing the prescription habits of physicians, and ultimately gain the compliance of individual patients. Developing an anticancer drug and bringing it into clinical practice is, therefore, a lengthy and complex process involving multiple partners in several areas. To optimize patient treatment and increase the likelihood of implementing health innovation, it is essential to have an overview of the full process. This review aims to describe the process and discuss the hurdles arising at each step.

Pharmacology of Vagal Afferent Influences on Disordered Breathing During Sleep

PubMed Central

Carley, David W; Radulovacki, Miodrag

2008-01-01

Sleep related breathing disorders (SRBD) are a significant public health concern, with a prevalence in the US general population of ∼2% of women and ∼4% of men. Although significant strides have been made in our understanding of these disorders with respect to epidemiology, risk factors, pathogenesis and consequences, work to understand these factors in terms of the underlying cellular, molecular and neuromodulatory processes remains in its infancy. Current primary treatments are surgical or mechanical, with no drug treatments available. Basic investigations into the neurochemistry and neuropharmacology of sleep-related changes in respiratory pattern generation and modulation will be essential to clarify the pathogenic processes underlying SRBD and to identify rational and specific pharmacotherapeutic opportunities. Here we summarize emerging work suggesting the importance of vagal afferent feedback systems in sleep related respiratory pattern disturbances and pointing toward a rich but complex array of neurochemical and neuromodulatory processes that may be involved. PMID:18694851

Mepiquat: A Process-Induced Byproduct in Roasted Cereal-Based Foodstuffs.

PubMed

Bessaire, Thomas; Tarres, Adrienne; Stadler, Richard H; Wermann, Silke; Hofmann, Jocelyne; Theurillat, Viviane; Combremont, Raphaël; Delatour, Thierry

2016-02-10

Mepiquat, a growth regulator widely used in agriculture, is also known as a process-induced byproduct formed in coffee from natural constituents during heat treatments such as roasting. This study examines mepiquat formation in cereal-based foodstuffs treated at sufficiently high temperature to trigger methyl transfer reactions that involve glycine betaine and choline naturally present in cereals. Color measurements of roasted barley grains revealed a correlation between thermal treatment and mepiquat content. Trials at industrial scale on instant beverages composed of roasted cereals demonstrated significant increases in mepiquat during the thermal process (in the range of 140-205 μg/kg in final products). A targeted survey of commercial products showed mepiquat in the range 69-381 μg/kg in powdered cereal instant drinks and 42-168 μg/kg in mugicha tea, a roasted barley infusion. These findings will not significantly affect the exposure of consumers to mepiquat due to the low amounts detected.

Fibroblast growth factor receptors in breast cancer: expression, downstream effects, and possible drug targets.

PubMed

Tenhagen, M; van Diest, P J; Ivanova, I A; van der Wall, E; van der Groep, P

2012-08-01

Cancer treatments are increasingly focusing on the molecular mechanisms underlying the oncogenic processes present in tumors of individual patients. Fibroblast growth factor receptors (FGFRs) are among the many molecules that are involved in oncogenesis and are currently under investigation for their potential as drug targets in breast cancer patients. These receptor tyrosine kinases play a role in several processes including proliferation, angiogenesis, and migration. Alterations in these basal processes can contribute to the development and progression of tumors. Among breast cancer patients, several subgroups have been shown to harbor genetic aberrations in FGFRs, including amplifications of FGFR1, FGFR2, and FGFR4 and mutations in FGFR2 and FGFR4. Here, we review in vitro and in vivo models that have partly elucidated the molecular implications of these different genetic aberrations, the resulting tumor characteristics, and the potential of FGFRs as therapeutic targets for breast cancer treatment.

THERP and HEART integrated methodology for human error assessment

NASA Astrophysics Data System (ADS)

Castiglia, Francesco; Giardina, Mariarosa; Tomarchio, Elio

2015-11-01

THERP and HEART integrated methodology is proposed to investigate accident scenarios that involve operator errors during high-dose-rate (HDR) treatments. The new approach has been modified on the basis of fuzzy set concept with the aim of prioritizing an exhaustive list of erroneous tasks that can lead to patient radiological overexposures. The results allow for the identification of human errors that are necessary to achieve a better understanding of health hazards in the radiotherapy treatment process, so that it can be properly monitored and appropriately managed.

Physiotherapy for functional motor disorders: a consensus recommendation

PubMed Central

Nielsen, Glenn; Stone, Jon; Matthews, Audrey; Brown, Melanie; Sparkes, Chris; Farmer, Ross; Masterton, Lindsay; Duncan, Linsey; Winters, Alisa; Daniell, Laura; Lumsden, Carrie; Carson, Alan; David, Anthony S; Edwards, Mark

2015-01-01

Background Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment. Methods A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience. Results We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms. Conclusions Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package. PMID:25433033

War zone veterans returning to treatment: effects of social functioning and psychopathology.

PubMed

Fontana, Alan; Rosenheck, Robert

2010-10-01

Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program. The results suggest that both initial severity and deterioration of status contribute to return to treatment and involve changes in both social functioning and psychopathology. Determination of the direction of effects between social functioning and psychopathology showed that psychopathology in the form of PTSD, other Axis I disorder or violent behavior generally affected subsequent social functioning, but not vice versa. Psychopathology in the form of alcohol or drug abuse/dependence, however, showed reciprocal effects with social functioning. These results point to the importance of emphasizing interventions that address social dysfunction and that address psychopathology, from the beginning of treatment as a way of maximizing the benefits and minimizing the need for recurrent care.

Aloesin from Aloe vera accelerates skin wound healing by modulating MAPK/Rho and Smad signaling pathways in vitro and in vivo.

PubMed

Wahedi, Hussain Mustatab; Jeong, Minsun; Chae, Jae Kyoung; Do, Seon Gil; Yoon, Hyeokjun; Kim, Sun Yeou

2017-05-15

Cutaneous wound healing is a complex process involving various regulatory factors at the molecular level. Aloe vera is widely used for cell rejuvenation, wound healing, and skin moisturizing. This study aimed to investigate the effects of aloesin from Aloe vera on cutaneous wound healing and mechanisms involved therein. This study consisted of both in vitro and in vivo experiments involving skin cell lines and mouse model to demonstrate the wound healing effects of aloesin by taking into account several parameters ranging from cultured cell migration to wound healing in mice. The activities of Smad signaling molecules (Smad2 and Smad3), MAPKs (ERK and JNK), and migration-related proteins (Cdc42, Rac1, and α-Pak) were assessed after aloesin treatment in cultured cells (1, 5 and 10µM) and mouse skin (0.1% and 0.5%). We also monitored macrophage recruitment, secretion of cytokines and growth factors, tissue development, and angiogenesis after aloesin treatment using IHC analysis and ELISAs. Aloesin increased cell migration via phosphorylation of Cdc42 and Rac1. Aloesin positively regulated the release of cytokines and growth factors (IL-1β, IL-6, TGF-β1 and TNF-α) from macrophages (RAW264.7) and enhanced angiogenesis in endothelial cells (HUVECs). Aloesin treatment accelerated wound closure rates in hairless mice by inducing angiogenesis, collagen deposition and granulation tissue formation. More importantly, aloesin treatment resulted in the activation of Smad and MAPK signaling proteins that are key players in cell migration, angiogenesis and tissue development. Aloesin ameliorates each phase of the wound healing process including inflammation, proliferation and remodeling through MAPK/Rho and Smad signaling pathways. These findings indicate that aloesin has the therapeutic potential for treating cutaneous wounds. Copyright © 2017 Elsevier GmbH. All rights reserved.

Effects of grain processing methods on the expression of genes involved in volatile fatty acid transport and pH regulation, and keratinization in rumen epithelium of beef cattle

PubMed Central

Del Bianco Benedeti, Pedro; Silva, Breno de Castro; Pacheco, Marcos Vinícius Carneiro; Carvalho Filho, Ivan; Lopes, Mariana Mescouto; Marcondes, Marcos Inácio; Mantovani, Hilário Cuquetto; Valadares Filho, Sebastião de Campos; Detmann, Edenio

2018-01-01

Two experiments were carried out to evaluate the effects of corn and sorghum with different processing methods on the expression of genes involved in volatile fatty acids transport and pH regulation, and ruminal keratinization in rumen epithelium of finishing bulls. For Exp. 1, five rumen cannulated Nellore bulls were used in a 5x5 Latin square arrangement, with 14 d for adaptation and 9 d for sample collection. Treatments were: dry ground corn, dry ground sorghum, reconstituted corn, reconstituted sorghum, and control (forage-based diet). Samples of rumen epithelium from ventral sac were excised, rinsed, snap-frozen and stored at -80°C until total RNA isolation and quantitative real-time PCR analysis. In the Exp. 2, 24 Nellore bulls were assigned to a completely randomized design lasting 168 d. Experimental treatments were similar to those at Exp. 1, but without the control treatment. After the experimental period, bulls were slaughtered and rumen epithelium samples were rapidly excised for further histological analysis. Rumen epithelial tissue from animals fed reconstituted corn had lower expression of downregulated-in-adenoma (P = 0.03) and Na+/H+ exchanger 2 (trend; P = 0.09). The expression of Na+/ H+ exchanger 1 (P = 0.10) and putative anion transporter (P = 0.06) tended to be lower in rumen epithelium of bulls fed reconstituted grains. Ruminal concentration of valerate was greater for animals fed reconstituted grain (P = 0.01). Likewise, animals fed reconstituted corn tended to have greater butyrate ruminal concentration (P = 0.08). Keratinized layer thickness did not differ among treatments (P > 0.10). Therefore, reconstituted grains (especially corn) decrease the mRNA expression of genes involved in volatile fatty acids transport and pH control in the rumen epithelium. PMID:29902237

The Advantages of Parental Involvement in Cognitive-Behavioral Treatment of Childhood Obsessive-Compulsive Disorder: A Single-Case Example.

PubMed

Oldham-Cooper, Rose; Glasman, David; Loades, Maria

2016-04-01

Interventions for the treatment of anxiety disorders in children have a growing evidence base. Cognitive-behavioral therapy for the treatment of specific anxiety disorders in children and adolescents, including obsessive-compulsive disorder, is now an established intervention. However, a question remains concerning the benefits of parental involvement in treatment. Some studies report limited or no benefit of including parents in treatment, whereas other studies have indicated additional advantages of parental involvement. The present case report describes the treatment of an 11-year-old girl with obsessive-compulsive disorder using cognitive-behavioral therapy derived largely from the treatment approaches outlined in Carr (2006), March and Mulle (1998), and Derisley, Heyman, Robinson, and Turner (2008). The child's mother attended all sessions and also a one-off parent-only session toward the end of treatment. The report considers the benefits of involving the child's mother in treatment and possible factors that could suggest parental involvement is indicated in future cases. Both child and mother, and the therapist, believed that parental involvement had been an important and useful element of treatment. Possible reasons for benefits of parental involvement were considered to be high parental anxiety at the outset of treatment, age of the client, and involvement of the parent in obsessions and compulsions. © 2016 Wiley Periodicals, Inc.

Setting up a clinical trial for a novel disease: a case study of the Doxycycline for the Treatment of Nodding Syndrome Trial – challenges, enablers and lessons learned

PubMed Central

Anguzu, Ronald; Akun, Pamela R; Ogwang, Rodney; Shour, Abdul Rahman; Sekibira, Rogers; Ningwa, Albert; Nakamya, Phellister; Abbo, Catherine; Mwaka, Amos D; Opar, Bernard; Idro, Richard

2018-01-01

ABSTRACT A large amount of preparation goes into setting up trials. Different challenges and lessons are experienced. Our trial, testing a treatment for nodding syndrome, an acquired neurological disorder of unknown cause affecting thousands of children in Eastern Africa, provides a unique case study. As part of a study to determine the aetiology, understand pathogenesis and develop specific treatment, we set up a clinical trial in a remote district hospital in Uganda. This paper describes our experiences and documents supportive structures (enablers), challenges faced and lessons learned during set-up of the trial. Protocol development started in September 2015 with phased recruitment of a critical study team. The team spent 12 months preparing trial documents, procurement and training on procedures. Potential recruitment sites were pre-visited, and district and local leaders met as key stakeholders. Key enablers were supportive local leadership and investment by the district and Ministry of Health. The main challenges were community fears about nodding syndrome, adverse experiences of the community during previous research and political involvement. Other challenges included the number and delays in protocol approvals and lengthy procurement processes. This hard-to-reach area has frequent power and Internet fluctuations, which may affect cold chains for study samples, communication and data management. These concerns decreased with a pilot community engagement programme. Experiences and lessons learnt can reduce the duration of processes involved in trial-site set-up. A programme of community engagement and local leader involvement may be key to the success of a trial and in reducing community opposition towards participation in research. PMID:29382251

Setting up a clinical trial for a novel disease: a case study of the Doxycycline for the Treatment of Nodding Syndrome Trial - challenges, enablers and lessons learned.

PubMed

Anguzu, Ronald; Akun, Pamela R; Ogwang, Rodney; Shour, Abdul Rahman; Sekibira, Rogers; Ningwa, Albert; Nakamya, Phellister; Abbo, Catherine; Mwaka, Amos D; Opar, Bernard; Idro, Richard

2018-01-01

A large amount of preparation goes into setting up trials. Different challenges and lessons are experienced. Our trial, testing a treatment for nodding syndrome, an acquired neurological disorder of unknown cause affecting thousands of children in Eastern Africa, provides a unique case study. As part of a study to determine the aetiology, understand pathogenesis and develop specific treatment, we set up a clinical trial in a remote district hospital in Uganda. This paper describes our experiences and documents supportive structures (enablers), challenges faced and lessons learned during set-up of the trial. Protocol development started in September 2015 with phased recruitment of a critical study team. The team spent 12 months preparing trial documents, procurement and training on procedures. Potential recruitment sites were pre-visited, and district and local leaders met as key stakeholders. Key enablers were supportive local leadership and investment by the district and Ministry of Health. The main challenges were community fears about nodding syndrome, adverse experiences of the community during previous research and political involvement. Other challenges included the number and delays in protocol approvals and lengthy procurement processes. This hard-to-reach area has frequent power and Internet fluctuations, which may affect cold chains for study samples, communication and data management. These concerns decreased with a pilot community engagement programme. Experiences and lessons learnt can reduce the duration of processes involved in trial-site set-up. A programme of community engagement and local leader involvement may be key to the success of a trial and in reducing community opposition towards participation in research.

Effect of stainless steel manual metal arc welding fume on free radical production, DNA damage, and apoptosis induction.

PubMed

Antonini, James M; Leonard, Stephen S; Roberts, Jenny R; Solano-Lopez, Claudia; Young, Shih-Houng; Shi, Xianglin; Taylor, Michael D

2005-11-01

Questions exist concerning the potential carcinogenic effects after welding fume exposure. Welding processes that use stainless steel (SS) materials can produce fumes that may contain metals (e.g., Cr, Ni) known to be carcinogenic to humans. The objective was to determine the effect of in vitro and in vivo welding fume treatment on free radical generation, DNA damage, cytotoxicity and apoptosis induction, all factors possibly involved with the pathogenesis of lung cancer. SS welding fume was collected during manual metal arc welding (MMA). Elemental analysis indicated that the MMA-SS sample was highly soluble in water, and a majority (87%) of the soluble metal was Cr. Using electron spin resonance (ESR), the SS welding fume had the ability to produce the biologically reactive hydroxyl radical (*OH), likely as a result of the reduction of Cr(VI) to Cr(V). In vitro treatment with the MMA-SS sample caused a concentration-dependent increase in DNA damage and lung macrophage death. In addition, a time-dependent increase in the number of apoptotic cells in lung tissue was observed after in vivo treatment with the welding fume. In summary, a soluble MMA-SS welding fume was found to generate reactive oxygen species and cause DNA damage, lung macrophage cytotoxicity and in vivo lung cell apoptosis. These responses have been shown to be involved in various toxicological and carcinogenic processes. The effects observed appear to be related to the soluble component of the MMA-SS sample that is predominately Cr. A more comprehensive in vivo animal study is ongoing in the laboratory that is continuing these experiments to try to elucidate the potential mechanisms that may be involved with welding fume-induced lung disease.

How Effective Is a Virtual Consultation Process in Facilitating Multidisciplinary Decision-Making for Malignant Epidural Spinal Cord Compression?

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

Fitzpatrick, David; St Luke's Hospital, Dublin; Grabarz, Daniel

Purpose: The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). Methods and Materials: A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. Results: After excluding 20 patients whomore » were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. Conclusion: The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes.« less

Energetic investigation of the adsorption process of CH4, C2H6 and N2 on activated carbon: Numerical and statistical physics treatment

NASA Astrophysics Data System (ADS)

Ben Torkia, Yosra; Ben Yahia, Manel; Khalfaoui, Mohamed; Al-Muhtaseb, Shaheen A.; Ben Lamine, Abdelmottaleb

2014-01-01

The adsorption energy distribution (AED) function of a commercial activated carbon (BDH-activated carbon) was investigated. For this purpose, the integral equation is derived by using a purely analytical statistical physics treatment. The description of the heterogeneity of the adsorbent is significantly clarified by defining the parameter N(E). This parameter represents the energetic density of the spatial density of the effectively occupied sites. To solve the integral equation, a numerical method was used based on an adequate algorithm. The Langmuir model was adopted as a local adsorption isotherm. This model is developed by using the grand canonical ensemble, which allows defining the physico-chemical parameters involved in the adsorption process. The AED function is estimated by a normal Gaussian function. This method is applied to the adsorption isotherms of nitrogen, methane and ethane at different temperatures. The development of the AED using a statistical physics treatment provides an explanation of the gas molecules behaviour during the adsorption process and gives new physical interpretations at microscopic levels.

Grand Junction projects office mixed-waste treatment program, VAC*TRAX mobile treatment unit process hazards analysis

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

Bloom, R.R.

1996-04-01

The objective of this report is to demonstrate that a thorough assessment of the risks associated with the operation of the Rust Geotech patented VAC*TRAX mobile treatment unit (MTU) has been performed and documented. The MTU was developed to treat mixed wastes at the US Department of Energy (DOE) Albuquerque Operations Office sites. The MTU uses an indirectly heated, batch vacuum dryer to thermally desorb organic compounds from mixed wastes. This process hazards analysis evaluated 102 potential hazards. The three significant hazards identified involved the inclusion of oxygen in a process that also included an ignition source and fuel. Changesmore » to the design of the MTU were made concurrent with the hazard identification and analysis; all hazards with initial risk rankings of 1 or 2 were reduced to acceptable risk rankings of 3 or 4. The overall risk to any population group from operation of the MTU was determined to be very low; the MTU is classified as a Radiological Facility with low hazards.« less

Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis.

PubMed

Hamel, Aimee V; Gaugler, Joseph E; Porta, Carolyn M; Hadidi, Niloufar Niakosari

Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making. The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process. MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes. Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process. Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.

Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care.

PubMed

Ishikura, Satoshi

2008-11-01

The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also.

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician's point of view.

PubMed

Kovshoff, Hanna; Williams, Sarah; Vrijens, May; Danckaerts, Marina; Thompson, Margaret; Yardley, Lucy; Hodgkins, Paul; Sonuga-Barke, Edmund J S

2012-02-01

Clinical decision making is influenced by a range of factors and constitutes an inherently complex task. Here we present results from the decisions regarding ADHD management (DRAMa) study in which we undertook a thematic analysis of clinicians' experiences and attitudes to assessment, diagnosis and treatment of ADHD. Fifty prescribing child psychiatrists and paediatricians from Belgium and the UK took part in semi-structured interviews about their decisions regarding the assessment, diagnosis and treatment of ADHD. Interviews were transcribed and processed using thematic analysis and the principles of grounded theory. Clinicians described the assessment and diagnostic process as inherently complicated and requiring time and experience to piece together the accounts of children made by multiple sources and through the use of varying information gathering techniques. Treatment decisions were viewed as a shared process between families, children, and the clinician. Published guidelines were viewed as vague, and few clinicians spoke about the use of symptom thresholds or specific impairment criteria. Furthermore, systematic or operationalised criteria to assess treatment outcomes were rarely used. Decision making in ADHD is regarded as a complicated, time consuming process which requires extensive use of clinical impression, and involves a partnership with parents. Clinicians want to separate biological from environmental causal factors to understand the level of impairment and the subsequent need for a diagnosis of ADHD. Clinical guidelines would benefit from revisions to take into account the real-world complexities of clinical decision making for ADHD.

Relevance of stroke code, stroke unit and stroke networks in organization of acute stroke care--the Madrid acute stroke care program.

PubMed

Alonso de Leciñana-Cases, María; Gil-Núñez, Antonio; Díez-Tejedor, Exuperio

2009-01-01

Stroke is a neurological emergency. The early administration of specific treatment improves the prognosis of the patients. Emergency care systems with early warning for the hospital regarding patients who are candidates for this treatment (stroke code) increases the number of patients treated. Currently, reperfusion via thrombolysis for ischemic stroke and attention in stroke units are the bases of treatment. Healthcare professionals and health provision authorities need to work together to organize systems that ensure continuous quality care for the patients during the whole process of their disease. To implement this, there needs to be an appropriate analysis of the requirements and resources with the objective of their adjustment for efficient use. It is necessary to provide adequate information and continuous training for all professionals who are involved in stroke care, including primary care physicians, extrahospital emergency teams and all physicians involved in the care of stroke patients within the hospital. The neurologist has the function of coordinating the protocols of intrahospital care. These organizational plans should also take into account the process beyond the acute phase, to ensure the appropriate application of measures of secondary prevention, rehabilitation, and chronic care of the patients that remain in a dependent state. We describe here the stroke care program in the Community of Madrid (Spain). (c) 2009 S. Karger AG, Basel.

The methodology for defining the European Standards for the certification of Haemophilia Centres in Europe

PubMed Central

Candura, Fabio; Menichini, Ivana; Calizzani, Gabriele; Giangrande, Paul; Mannucci, Pier Mannuccio; Makris, Michael

2014-01-01

Introduction Work Package 4 Development of the standardisation criteria of the European Haemophilia Network project has the main objective of implementing a common and shared European strategy for a certification system for two levels of Haemophilia Centres: European Haemophilia Treatment Centres and European Haemophilia Comprehensive Care Centres in the Member States of the European Union. Materials and methods An inclusive and participatory process for developing shared standards and criteria for the management of patients with inherited bleeding disorders has been carried out. The process has been implemented through four different consultation events involving the entire European community of stakeholders that significantly contributed in the drafting of the European Guidelines for the certification of Haemophilia Centres. Results The Guidelines set the standards for the designation of centres that provide specialised and multidisciplinary care (Haemophilia Comprehensive Care Centres) as well as local routine care (Haemophilia Treatment Centres). Standards cover several issues such as: general requirements; patient care; advisory services; laboratory; networking of clinical and specialised services. Conclusions The drafting of the European Guidelines for the certification of Haemophilia Centres was performed adopting a rigorous methodological approach. In order to build the widest possible consensus to the quality standards, the main institutional and scientific stakeholders have been involved. The resulting document will significantly contribute in promoting standardisation in the quality of diagnosis and treatment in European Haemophilia Centres. PMID:24922292

Chronic fluoxetine treatment directs energy metabolism towards the citric acid cycle and oxidative phosphorylation in rat hippocampal nonsynaptic mitochondria.

PubMed

Filipović, Dragana; Costina, Victor; Perić, Ivana; Stanisavljević, Andrijana; Findeisen, Peter

2017-03-15

Fluoxetine (Flx) is the principal treatment for depression; however, the precise mechanisms of its actions remain elusive. Our aim was to identify protein expression changes within rat hippocampus regulated by chronic Flx treatment versus vehicle-controls using proteomics. Fluoxetine-hydrohloride (15mg/kg) was administered daily to adult male Wistar rats for 3weeks, and cytosolic and nonsynaptic mitochondrial hippocampal proteomes were analyzed. All differentially expressed proteins were functionally annotated according to biological process and molecular function using Uniprot and Blast2GO. Our comparative study revealed that in cytosolic and nonsynaptic mitochondrial fractions, 60 and 3 proteins respectively, were down-regulated, and 23 and 60 proteins, respectively, were up-regulated. Proteins differentially regulated in cytosolic and nonsynaptic mitochondrial fractions were primarily related to cellular and metabolic processes. Of the identified proteins, the expressions of calretinin and parvalbumine were confirmed. The predominant molecular functions of differentially expressed proteins in both cell hippocampal fractions were binding and catalytic activity. Most differentially expressed proteins in nonsynaptic mitochondria were catalytic enzymes involved in the pyruvate metabolism, citric acid cycle, oxidative phosphorylation, ATP synthesis, ATP transduction and glutamate metabolism. Results indicate that chronic Flx treatment may influence proteins involved in calcium signaling, cytoskeletal structure, chaperone system and stimulates energy metabolism via the upregulation of GAPDH expression in cytoplasm, as well as directing energy metabolism toward the citric acid cycle and oxidative phosphorylation in nonsynaptic mitochondria. This approach provides new insight into the chronic effects of Flx treatment on protein expression in a key brain region associated with stress response and memory. Copyright © 2017 Elsevier B.V. All rights reserved.

American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

PubMed

Kampman, Kyle; Jarvis, Margaret

2015-01-01

The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This "Practice Guideline" was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) - a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.

[Treatment of substance dependence by a bio-cognitive model based on behavioral pharmacology].

PubMed

Hori, Toru; Komiyama, Tokutaro; Harada, Seiichi; Matsumoto, Takenori

2005-01-01

We have introduced cognitive behavior therapy (CBT) into the treatment of substance dependence patients, which involves disease education and focused group therapy to obtain insight into the taking behavior and to establish concrete countermeasures to prevent relapse. We have created a bio-cognitive model based on biological aspects to explain the pathology of substance dependence. 'Dependence' is a term in behavioral pharmacology defined as reinforced drug seeking and taking behavior. Changes in taking behavior are thought to occur due to the repetition of the reinforcement action of psychoactive substances in the reward system of the brain. Therefore, when intake desire is strong, it is hard for patients to control themselves, and there is a feature of difficulties considering the process of thinking in CBT. In other words, when craving becomes strong, a chain of behavior happens spontaneously, without schema, involving automatic thoughts. We think that the improvement of protracted withdrawal syndrome (PWS) and entire frontal lobe function are important in learning to discern distortion of cognition. When PWS is improved, a conflict is easy to bring about in the process of drug seeking and taking behavior. And, it is easy to execute avoidance plans (coping skills) which are established to cope with craving in advance. We think that a goal for treatment is to discern drug seeking and taking behavior with natural emotion. The recovery of PWS and frontal lobe dysfunction takes a long time with a serious dependence, so we must perform repetition of CBT. As the treatment introduction of involuntary admission cases is adequate or cases of 1 to 3 months of admission treatment based on voluntary admission are hard to treat, treatment to obtain insights into patients while carrying out repeated CBT using a bio-cognitive model and to improve PWS could be a possibility as one treatment for the pathology of diversified substance dependence.

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories.

PubMed

Matheson, Lauren; Boulton, Mary; Lavender, Verna; Protheroe, Andrew; Brand, Sue; Wanat, Marta; Watson, Eila

2016-02-01

Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men's experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors. In-depth qualitative interviews were conducted with testicular cancer survivors over two time points approximately 6 months apart in the year following treatment completion. Interviews were analysed using a grounded theory approach. The sample included 18 testicular cancer survivors between 22 and 44 years (mean age 34). A grounded theory was developed, which explained the process of positive adjustment over the first year following the treatment completion in terms of men's ability to dismantle the present and future threats of cancer, involving the key transitions of gaining a sense of perspective and striving to get on with life and restore normality. These were facilitated by six key processes. The processes that explained a negative adjustment trajectory are also presented. These findings contribute to the understanding of the psychosocial impact of testicular cancer on younger men's lives and have implications for the provision of support to testicular cancer survivors. Further investigation into the feasibility of one-on-one peer support interventions is warranted, as well as informal support that respects men's desire for independence. Understanding the processes involved in adjustment highlights ways in which health professionals can offer support to those struggling to adjust through challenging illness beliefs, encouraging emotional disclosure and facilitating peer mentoring.

Alterations of microRNA-124 expression in peripheral blood mononuclear cells in pre- and post-treatment patients with major depressive disorder.

PubMed

He, Shen; Liu, Xiaohua; Jiang, Kaida; Peng, Daihui; Hong, Wu; Fang, Yiru; Qian, Yiping; Yu, Shunying; Li, Huafang

2016-07-01

Recently, increasing evidence has indicated that dysfunction of microRNA-124 (miR-124) might be involved in the pathophysiology and treatment of major depressive disorder (MDD) in some animal models of depression. However, the role of miR-124 in MDD patients remains unclear. The objective of this study was to investigate whether the miR-124 expression levels in peripheral blood mononuclear cells (PBMCs) were associated with MDD and to evaluate the effects of antidepressant treatment on miR-124 levels. Quantitative real-time PCR was applied to detect miR-124 expression in 32 pre- and post-treatment MDD patients and 30 healthy controls. Our results showed that expression levels of miR-124 from PBMCs in MDD patients were significantly higher than those in healthy controls (p < 0.001), and that the area under the curve of miR-124 from ROC analysis was 0.762 with a sensitivity of 83.33% and specificity of 66.67% in distinguishing MDD patients from healthy controls. In addition, the expression levels of miR-124 were significantly down-regulated after eight weeks of treatment (p < 0.001). MiRNA target gene prediction and functional annotation analysis indicated that altered miR-124 was involved in affecting some important biological processes and pathways related to MDD. These results provide new information on miR-124 involvement in the biological alterations of MDD and in antidepressant effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Involvement in decisions about intravenous treatment for nursing home patients: nursing homes versus hospital wards.

PubMed

Klomstad, Kristin; Pedersen, Reidar; Førde, Reidun; Romøren, Maria

2018-05-08

Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient's best interest, assessment of capacity to consent, and on the patient's own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. The patients' capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units.

PubMed

Long-Sutehall, Tracy; Willis, Helen; Palmer, Rachel; Ugboma, Debra; Addington-Hall, Julia; Coombs, Maureen

2011-12-01

The process of withdrawal of treatment in critical care environments has created ethical and moral dilemmas in relation to end of life care in the UK and elsewhere. Common within this discourse is the differing demands made on health professionals as they strive to provide care for the dying patient and family members. Despite reports that withdrawal of treatment is a source of tension between those nurses and doctors involved in the process, the role of the nurse in facilitating withdrawal of treatment has received relatively little attention. To illustrate how differing dying trajectories impact on decision-making underpinning withdrawal of treatment processes, and what nurses do to shape withdrawal of treatment. Qualitative methods of enquiry using clinical vignettes and applying Charmaz's grounded theory method. Single audio-recorded qualitative interviews with thirteen critical care nurses from four intensive care specialities: cardiac; general; neurological and renal were carried out. Interviews were facilitated by an end-of-life vignette developed with clinical collaborators. Across critical care areas four key dying trajectories were identified. These trajectories were shaped by contested boundaries associated with delayed or stalled decision-making around how withdrawal of treatment should proceed. Nurses provided end of life care (including collaborative and action-oriented skills) to shape the dying trajectory of patients so as to satisfy the wishes of the patient and family, and their own professional aims. Differing views as to when withdrawal of treatment should commence and how it should be operationalised appeared to be underpinned by the requirements of the role that health professionals fulfil, with doctors focusing on making withdrawal of treatment decisions, and nurse's being tasked with operationalising the processes that constitute it. Multidisciplinary teams need a 'shared' understanding of each other's roles, responsibilities, aims, and motivations when planning and implementing the dying trajectory of withdrawal of treatment. 2011 Elsevier Ltd. All rights reserved.

ADVANCED SULFUR CONTROL CONCEPTS

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

Apostolos A. Nikolopoulos; Santosh K. Gangwal; William J. McMichael

Conventional sulfur removal in integrated gasification combined cycle (IGCC) power plants involves numerous steps: COS (carbonyl sulfide) hydrolysis, amine scrubbing/regeneration, Claus process, and tail-gas treatment. Advanced sulfur removal in IGCC systems involves typically the use of zinc oxide-based sorbents. The sulfides sorbent is regenerated using dilute air to produce a dilute SO{sub 2} (sulfur dioxide) tail gas. Under previous contracts the highly effective first generation Direct Sulfur Recovery Process (DSRP) for catalytic reduction of this SO{sub 2} tail gas to elemental sulfur was developed. This process is currently undergoing field-testing. In this project, advanced concepts were evaluated to reduce themore » number of unit operations in sulfur removal and recovery. Substantial effort was directed towards developing sorbents that could be directly regenerated to elemental sulfur in an Advanced Hot Gas Process (AHGP). Development of this process has been described in detail in Appendices A-F. RTI began the development of the Single-step Sulfur Recovery Process (SSRP) to eliminate the use of sorbents and multiple reactors in sulfur removal and recovery. This process showed promising preliminary results and thus further process development of AHGP was abandoned in favor of SSRP. The SSRP is a direct Claus process that consists of injecting SO{sub 2} directly into the quenched coal gas from a coal gasifier, and reacting the H{sub 2}S-SO{sub 2} mixture over a selective catalyst to both remove and recover sulfur in a single step. The process is conducted at gasifier pressure and 125 to 160 C. The proposed commercial embodiment of the SSRP involves a liquid phase of molten sulfur with dispersed catalyst in a slurry bubble-column reactor (SBCR).« less

An empowerment process: successful recovery from alcohol dependence.

PubMed

Yeh, Mei-Yu; Che, Hui-Lian; Lee, Li-Wei; Horng, Fen-Fang

2008-04-01

The purpose of this study was to explore the concepts and processes for successful abstinence from alcohol for Taiwanese Alcoholics Anonymous members. Attempting to identify the psychological and social influences upon alcohol consumption remission outside of alcoholism treatment could help professionals to engage in a broad array of community interventions in an informed fashion. Grounded theory method was utilized in this study. The study chose nine participants who had succeeded in abstinence, using theoretical sampling and conducted in-depth interviews by an open-ended questionnaire. The results of this study indicated that the core of the process during which alcoholic individuals succeeded in abstaining from further alcohol consumption was an empowerment process for the involved individual. Alcoholics felt that their family, interpersonal relationships, jobs and personal finances all had been at 'rock-bottom' level following a long period of alcohol dependence. This feeling caused the individual to experience an emotion of a loss of control and provoked the arousal of an alcoholic's inner consciousness levels, this then resulting in the generation of a driving force for abstinence from alcohol for these individuals. The expansion of an individual's internal awakening power helps the individual to obtain assistance and to resist the temptation of further alcohol consumption. Therefore, the power derived by individuals from the stages of repositioning, releasing, active sharing, resistance and assistance are the maintenance factors for an individual's empowerment process that help maintain the successful recovery from alcohol for the involved individual. A good comprehension of the recovery processes for alcoholics, we believe, will trigger clinical professionals to pay appropriate attention to the specific problems and needs of alcoholic individuals, to build an effective resource network for treatment and to help solve alcoholics' physical and psychosocial problems.

Qualitative exploration of stakeholders' perspectives of involuntary admission under the Mental Health Act 2001 in Ireland.

PubMed

Smyth, Siobhán; Casey, Dympna; Cooney, Adeline; Higgins, Agnes; McGuinness, David; Bainbridge, Emma; Keys, Mary; Georgieva, Irina; Brosnan, Liz; Beecher, Claire; Hallahan, Brian; McDonald, Colm; Murphy, Kathy

2017-12-01

There is international interest in, and continued concern about, the potential long-term impact of involuntary admission to psychiatric institutions, and the effect this coercive action has on a person's well-being and human rights. Involuntary detention in hospital remains a controversial process that involves stakeholders with competing concerns and who often describe negative experiences of the process, which can have long-lasting effects on the therapeutic relationship with service users. The aim of the present study was to explore the perspectives of key stakeholders involved in the involuntary admission and detention of people under the Mental Health Act 2001 in Ireland. Focus groups were used to collect data. Stakeholders interviewed were service users, relatives, general practitioners, psychiatrists, mental health nurses, solicitors, tribunal members, and police. Data were analysed using a general inductive approach. Three key categories emerged: (i) getting help; (ii) detention under the Act; and (iii) experiences of the tribunal process. This research highlights gaps in information and uncertainty about the involuntary admission process for stakeholders, but particularly for service users who are most affected by inadequate processes and supports. Mental health law has traditionally focussed on narrower areas of detention and treatment, but human rights law requires a greater refocussing on supporting service users to ensure a truly voluntary approach to care. The recent human rights treaty, the UN Convention on the Rights of Persons with Disabilities, is to guarantee a broad range of fundamental rights, such as liberty and integrity, which can be affected by coercive processes of involuntary admission and treatment. © 2016 Australian College of Mental Health Nurses Inc.

Sonochemistry in environmental remediation. 1. Combinative and hybrid sonophotochemical oxidation processes for the treatment of pollutants in water.

PubMed

Adewuyi, Yusuf G

2005-05-15

Sonoprocessing is the utilization of sonic and ultrasonic waves in chemical synthesis and processes. It is a new and rapidly growing research field with broad applications in environmental engineering, green chemical synthesis, and processing. The application of this environmentally benign technique in environmental remediation is currently under active research and development. Sonochemical oxidation is effective in treating toxic effluents and reducing toxicity. However, the ultrasonic treatment is highly energy intensive since sonication is relatively inefficient with respect to total input energy and is therefore not economically attractive or feasible alone. Hence, sonochemistry has not yet received much attention as an alternative for industrial and large-scale chemical and environmental processes. One of the most interesting topics in the recent advances in sonochemistry is the possibility of double or more excitations with ultrasound and other types of energy. The coupling of ultrasound with other free energy sources (i.e., UV) or chemical oxidation utilizing H2O2, O3, or ferrous ion presents interesting and attractive approaches. Therefore, many recent efforts have been devoted to improving the efficiency of sonochemical reactions by exploiting the advantages of combinative or hybrid processes involving the simultaneous or sequential use of ultrasonic irradiation and other advanced oxidation processes, electrochemical processes, and biological treatment. This paper provides a critical review of the applications of ultrasound in environmental remediation, focusing on recent developments and unifying analysis of combinative or hybrid systems, namely, sonophotochemical oxidation processes.

[Experiences of adolescents seropositive for HIV/AIDS: a qualitative study].

PubMed

Galano, Eliana; Turato, Egberto Ribeiro; Delmas, Philippe; Côté, José; Gouvea, Aida de Fátima Thomé Barbosa; Succi, Regina Célia de Menezes; Machado, Daisy Maria

2016-06-01

Explore the meanings attributed by young individuals about "living as an adolescent with HIV" in a group of patients that acquired the infection at birth and the elements involved with the adherence to antiretroviral treatment. Qualitative study, involving 20 subjects (aged 13-20 years), followed at services specialized in the treatment of pediatric Aids in São Paulo, Brazil. Semi-structured interviews were carried out of which script consisted of questions about their personal histories, experiences and difficulties they must face while living with HIV/Aids. Being "normal" and "different" were central issues voiced by the participants. However, a normal life situation is guaranteed by being responsible with one's health, the condition that the diagnosis be kept secret and concerns about HIV transmission and dissemination to a sexual partner. The answers about treatment show that adherence is a dynamic process and involves moments of greater or lesser interest in relation to care for one's health. The adolescents have plans and projects and although HIV is considered a stressor, positive perspectives for the future prevailed. To live as an adolescent with HIV involves subtle dimensions that need to be recognized and legitimized by professionals who follow the trajectory of these young individuals. It is necessary to allow a space in which the adolescents can reflect and find support regarding issues related to the construction of their sexuality and care of one's own body. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

A simple and inexpensive retainer for overdenture prosthesis

PubMed Central

Kumar, Lakshya; Rao, Jitendra; Yadav, Akanksha

2013-01-01

This article describes a clinical case report of a 65-year-old male patient in which an overdenture was fabricated by using a simple, logical and inexpensive means of retentive device. The described mandibular overdenture involves a simple modification in the coping design and a wire lock mechanism which was fabricated during denture processing. The problems associated with copings were overcome by putting the patient on a regimen wherein topical fluoride was applied every week on the abutment. The denture, fabricated involving a wire lock mechanism, was highly retentive and stable. Patient was highly satisfied with the outcome of the treatment. PMID:23861281

Involvement of Rabbinic and communal authorities in decision-making by haredi Jews in the UK with breast cancer: an interpretative phenomenological analysis.

PubMed

Coleman-Brueckheimer, Kate; Spitzer, Joseph; Koffman, Jonathan

2009-01-01

This paper examines how Rabbinic and communal authorities participated in treatment decisions made by a group of strictly orthodox haredi Jews with breast cancer living in London. Semi-structured interviews were conducted with five haredi breast cancer patients. The transcripts were analysed using interpretative phenomenological analysis. Demographic and personal data were collected using structured questionnaires. All participants sought Rabbinic involvement, with four seeking rulings concerning religious rituals and treatment options. Participants' motivations were to ensure their actions accorded with Jewish law and hence God's will. By delegating treatment decisions, decision-making became easier and participants could avoid guilt and blame. They could actively participate in the process by choosing which Rabbi to approach, by providing personal information and by stating their preferences. Attitudes towards Rabbinic involvement were occasionally conflicted. This was related to the understanding that Rabbinic rulings were binding, and occasional doubts that their situation would be correctly interpreted. Three participants consulted the community's 'culture broker' for medical referrals and non-binding advice concerning treatment. Those who consulted the culture broker had to transcend social norms restricting unnecessary contact between men and women. Hence, some participants described talking to him as uncomfortable. Other concerns related to confidentiality. By consulting Rabbinic authorities, haredi cancer patients participated in a socially sanctioned method of decision-making continuous with their religious values. Imposing meaning on their illness in this way may be associated with positive psychological adjustment. Rabbinic and communal figures may endorse therapeutic recommendations and make religious and cultural issues comprehensible to clinicians, and as such healthcare practitioners may benefit from this involvement.

Proteomes and Ubiquitylomes Analysis Reveals the Involvement of Ubiquitination in Protein Degradation in Petunias1

PubMed Central

Liu, Juanxu; Wei, Qian; Wang, Rongmin; Yang, Weiyuan; Ma, Yueyue; Chen, Guoju

2017-01-01

Petal senescence is a complex programmed process. It has been demonstrated previously that treatment with ethylene, a plant hormone involved in senescence, can extensively alter transcriptome and proteome profiles in plants. However, little is known regarding the impact of ethylene on posttranslational modification (PTM) or the association between PTM and the proteome. Protein degradation is one of the hallmarks of senescence, and ubiquitination, a major PTM in eukaryotes, plays important roles in protein degradation. In this study, we first obtained reference petunia (Petunia hybrida) transcriptome data via RNA sequencing. Next, we quantitatively investigated the petunia proteome and ubiquitylome and the association between them in petunia corollas following ethylene treatment. In total, 51,799 unigenes, 3,606 proteins, and 2,270 ubiquitination sites were quantified 16 h after ethylene treatment. Treatment with ethylene resulted in 14,448 down-regulated and 6,303 up-regulated unigenes (absolute log2 fold change > 1 and false discovery rate < 0.001), 284 down-regulated and 233 up-regulated proteins, and 320 up-regulated and 127 down-regulated ubiquitination sites using a 1.5-fold threshold (P < 0.05), indicating that global ubiquitination levels increase during ethylene-mediated corolla senescence in petunia. Several putative ubiquitin ligases were up-regulated at the protein and transcription levels. Our results showed that the global proteome and ubiquitylome were negatively correlated and that ubiquitination could be involved in the degradation of proteins during ethylene-mediated corolla senescence in petunia. Ethylene regulates hormone signaling transduction pathways at both the protein and ubiquitination levels in petunia corollas. In addition, our results revealed that ethylene increases the ubiquitination levels of proteins involved in endoplasmic reticulum-associated degradation. PMID:27810942

Bisphenol A stimulates human prostate cancer cell migration via remodelling of calcium signalling.

PubMed

Derouiche, Sandra; Warnier, Marine; Mariot, Pascal; Gosset, Pierre; Mauroy, Brigitte; Bonnal, Jean-Louis; Slomianny, Christian; Delcourt, Philippe; Prevarskaya, Natalia; Roudbaraki, Morad

2013-12-01

Bisphenol A (BPA), the principal constituent of reusable water bottles, metal cans, and plastic food containers, has been shown to be involved in human prostate cancer (PCa) cell proliferation. The aim of the present study was to explore the effect of BPA on PCa cell migration and the pathways involved in these processes. Using the transwell technique, we clearly show for the first time that the pre-treatment of the cells with BPA (1-10 nM) induces human PCa cell migration. Using a calcium imaging technique, we show that BPA pre-treatment induces an amplification of Store-Operated Calcium Entry (SOCE) in LNCaP cells. RT-PCR and Western blot experiments allowed the identification of the ion channel proteins which are up-regulated by BPA pre-treatments. These include the Orai1 protein, which is known as an important SOCE actor in various cell systems, including human PCa cells. Using a siRNA strategy, we observed that BPA-induced amplification of SOCE was Orai1-dependent. Interestingly, the BPA-induced PCa cell migration was suppressed when the calcium entry was impaired by the use of SOCE inhibitors (SKF96365, BTP2), or when the extracellular calcium was chelated. Taken together, the results presented here show that BPA induces PCa cells migration via a modulation of the ion channel protein expression involved in calcium entry and in cancer cell migration. The present data provide novel insights into the molecular mechanisms involved in the effects of an environmental factor on cancer cells and suggest both the necessity of preventive measures and the possibility of targeting ion channels in the treatment of PCa cell metastasis.

Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: Generalization to narrative discourse comprehension

PubMed Central

Blake, Margaret Lehman; Tompkins, Connie A.; Scharp, Victoria L.; Meigh, Kimberly M.; Wambaugh, Julie

2014-01-01

Coarse coding is the activation of broad semantic fields that can include multiple word meanings and a variety of features, including those peripheral to a word’s core meaning. It is a partially domain-general process related to general discourse comprehension and contributes to both literal and non-literal language processing. Adults with damage to the right cerebral hemisphere (RHD) and a coarse coding deficit are particularly slow to activate features of words that are relatively distant or peripheral. This manuscript reports a pre-efficacy study of Contextual Constraint Treatment (CCT), a novel, implicit treatment designed to increase the efficiency of coarse coding with the goal of improving narrative comprehension and other language performance that relies on coarse coding. Participants were four adults with RHD. The study used a single-subject controlled experimental design across subjects and behaviors. The treatment involves pre-stimulation, using a hierarchy of strong- and moderately-biased contexts, to prime the intended distantly-related features of critical stimulus words. Three of the four participants exhibited gains in auditory narrative discourse comprehension, the primary outcome measure. All participants exhibited generalization to untreated items. No strong generalization to processing nonliteral language was evident. The results indicate that CCT yields both improved efficiency of the coarse coding process and generalization to narrative comprehension. PMID:24983133

Integrating Fenton's process and ion exchange for olive mill wastewater treatment and iron recovery.

PubMed

Reis, Patrícia M; Martins, Pedro J M; Martins, Rui C; Gando-Ferreira, Licínio M; Quinta-Ferreira, Rosa M

2018-02-01

A novel integrated methodology involving Fenton's process followed by ion exchange (IE) was proposed for the treatment of olive mill wastewater. Fenton's process was optimized and it was able to remove up to 81% of chemical oxygen demand when pH 3.5, reaction time 1 h, [Fe 2+ ] = 50 mg L -1 and [Fe 2+ ]/[H 2 O 2 ] = 0.002 were applied. In spite of the potential of this treatment approach, final iron removal from the liquid typically entails pH increase and iron sludge production. The integration of an IE procedure using Lewatit TP 207 resin was found to be able to overcome this important environmental shortcoming. The resin showed higher affinity toward Fe 3+ than to Fe 2+ . However, the iron removal efficiency of an effluent coming from Fenton's was independent of the type of the initial iron used in the process. The presence of organic matter had no significant effect over the resin iron removal efficiency. Even if some efficiency decrease was observed when a high initial iron load was applied, the adsorbent mass quantity can be easily adapted to reach the desired iron removal. The use of IE is an interesting industrial approach able to surpass Fenton's peroxidation drawback and will surely boost its full-scale application in the treatment of bio-refractory effluents.

Proteomic characterization of hippocampus of chronically socially isolated rats treated with fluoxetine: Depression-like behaviour and fluoxetine mechanism of action.

PubMed

Perić, Ivana; Costina, Victor; Stanisavljević, Andrijana; Findeisen, Peter; Filipović, Dragana

2018-06-01

Due to the severity of depressive symptoms, there remains a necessity in defining the underlying mechanisms of depression and the precise actions of antidepressants in alleviating these symptoms. Proteomics is a powerful and promising tool for discovering novel pathways of cellular responses to disease and treatment. As chronic social isolation (CSIS) is a valuable animal model for studying depression, we performed a comparative subproteomic study of rat hippocampus to explore the effect of six weeks of CSIS and the therapeutic effect of chronic fluoxetine (Flx) treatment (last three weeks of CSIS; 15 mg/kg/day). Behaviorally, Flx treatment normalized the decreased sucrose preference and increased marble burying results resulting from CSIS, indicative of a FLX-induced attenuation of both anhedonia and anxiety. An analysis of cytosolic and nonsynaptic mitochondrial subproteome patterns revealed that CSIS resulted in down-regulation of proteins involved in mitochondrial transport and energy processes, primarily tricarboxylic acid (TCA) cycle and oxidative phosphorylation. Chronic Flx treatment resulted in an up-regulation of CSIS-altered proteins and additional expression of other transporter and energy-involved proteins. Immunohistochemical analysis revealed hippocampal subregion-specific effects of CSIS and/or Flx treatment on selective protein expressions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided "Intratissue Percutaneous Electrolysis" application.

PubMed

Mattiussi, Gabriele; Moreno, Carlos

2016-01-01

Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE) is a neuropathy caused by fibrosis interposed between the semimembranosus tendon and the sciatic nerve, at the level of the ischial tuberosity. Ultrasound-guided Intratissue Percutaneous Electrolysis (US-guided EPI) involves galvanic current transfer within the treatment target tissue (fibrosis) via a needle 0.30 to 0.33 mm in diameter. The galvanic current in a saline solution instantly develops the chemical process of electrolysis, which in turn induces electrochemical ablation of fibrosis. In this article, the interventional procedure is presented in detail, and both the strengths and limits of the technique are discussed. US-guided EPI eliminates the fibrotic accumulation that causes PHTrSNE, without the semimembranosus tendon or the sciatic nerve being directly involved during the procedure. The technique is however of limited use in cases of compression neuropathy. US-guided EPI is a technique that is quick to perform, minimally invasive and does not force the patient to suspend their activities (work or sports) to make the treatment effective. This, coupled to the fact that the technique is generally well-tolerated by patients, supports use of US-guided EPI in the treatment of PHTrSNE.

Neuronal Dysregulation in Stroke-Associated Pseudobulbar Affect (PBA): Diagnostic Scales and Current Treatment Options.

PubMed

Lapchak, Paul A

2015-10-01

Until recently there was little understanding of the exact pathophysiology and treatment choices for stroke patients with Pseudobulbar affect (PBA). PBA is typically characterized by outbursts or uncontrollable laughing or crying and in the majority of patients, the outbursts being involuntary and incompatible with the patients' emotional state. PBA is a behavioral syndrome reported to be displayed in 28-52% of stroke patients with first or multiple strokes, and incidence may be higher in patients who have had prior stroke events, and higher in females. There is typically involvement of glutaminergic, serotoninergic and dopaminergic neuronal circuits of the corticolimbic-subcorticothalamic-pontocerebellar network. PBA is now understood to be a disinhibition syndrome in which specific pathways involving serotonin and glutamate are disrupted or modulated causing reduced cortical inhibition of a cerebellar/brainstem-situated "emotional" laughing or crying focal center. Stroke-induced disruption of one or more neuronal pathway circuits may "disinhibit" voluntary laughing and crying making the process involuntary. With a "new" treatment currently being marketed to treat PBA patients, this article will delve into the neurological and physiological basis for PBA in stroke, and review progress with the diagnosis and treatment of PBA.

Neuronal Dysregulation in Stroke-Associated Pseudobulbar Affect (PBA): Diagnostic Scales and Current Treatment Options

PubMed Central

Lapchak, Paul A

2015-01-01

Until recently there was little understanding of the exact pathophysiology and treatment choices for stroke patients with Pseudobulbar affect (PBA). PBA is typically characterized by outbursts or uncontrollable laughing or crying and in the majority of patients, the outbursts being involuntary and incompatible with the patients’ emotional state. PBA is a behavioral syndrome reported to be displayed in 28–52% of stroke patients with first or multiple strokes, and incidence may be higher in patients who have had prior stroke events, and higher in females. There is typically involvement of glutaminergic, serotoninergic and dopaminergic neuronal circuits of the corticolimbic-subcorticothalamic-pontocerebellar network. PBA is now understood to be a disinhibition syndrome in which specific pathways involving serotonin and glutamate are disrupted or modulated causing reduced cortical inhibition of a cerebellar/brainstem-situated “emotional” laughing or crying focal center. Stroke-induced disruption of one or more neuronal pathway circuits may “disinhibit” voluntary laughing and crying making the process involuntary. With a “new” treatment currently being marketed to treat PBA patients, this article will delve into the neurological and physiological basis for PBA in stroke, and review progress with the diagnosis and treatment of PBA. PMID:26693049

The use of discrete-event simulation modelling to improve radiation therapy planning processes.

PubMed

Werker, Greg; Sauré, Antoine; French, John; Shechter, Steven

2009-07-01

The planning portion of the radiation therapy treatment process at the British Columbia Cancer Agency is efficient but nevertheless contains room for improvement. The purpose of this study is to show how a discrete-event simulation (DES) model can be used to represent this complex process and to suggest improvements that may reduce the planning time and ultimately reduce overall waiting times. A simulation model of the radiation therapy (RT) planning process was constructed using the Arena simulation software, representing the complexities of the system. Several types of inputs feed into the model; these inputs come from historical data, a staff survey, and interviews with planners. The simulation model was validated against historical data and then used to test various scenarios to identify and quantify potential improvements to the RT planning process. Simulation modelling is an attractive tool for describing complex systems, and can be used to identify improvements to the processes involved. It is possible to use this technique in the area of radiation therapy planning with the intent of reducing process times and subsequent delays for patient treatment. In this particular system, reducing the variability and length of oncologist-related delays contributes most to improving the planning time.

Dynamics of Lamin-A Processing Following Precursor Accumulation

PubMed Central

Liu, Qian; Kim, Dae In; Syme, Janet; LuValle, Phyllis; Burke, Brian; Roux, Kyle J.

2010-01-01

Lamin A (LaA) is a component of the nuclear lamina, an intermediate filament meshwork that underlies the inner nuclear membrane (INM) of the nuclear envelope (NE). Newly synthesized prelamin A (PreA) undergoes extensive processing involving C-terminal farnesylation followed by proteolysis yielding non-farnesylated mature lamin A. Different inhibitors of these processing events are currently used therapeutically. Hutchinson-Gilford Progeria Syndrome (HGPS) is most commonly caused by mutations leading to an accumulation of a farnesylated LaA isoform, prompting a clinical trial using farnesyltransferase inhibitors (FTI) to reduce this modification. At therapeutic levels, HIV protease inhibitors (PI) can unexpectedly inhibit the final processing step in PreA maturation. We have examined the dynamics of LaA processing and associated cellular effects during PI or FTI treatment and following inhibitor washout. While PI reversibility was rapid, with respect to both LaA maturation and associated cellular phenotype, recovery from FTI treatment was more gradual. FTI reversibility is influenced by both cell type and rate of proliferation. These results suggest a less static lamin network than has previously been observed. PMID:20526372

Experiencing cancer treatment decision-making in managed care.

PubMed

Wenzel, Jennifer; Shaha, Maya

2008-09-01

This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support.

Recent mouse and rat methods for the study of experimental oral candidiasis

PubMed Central

Costa, Anna CBP; Pereira, Cristiane A; Junqueira, Juliana C; Jorge, Antonio OC

2013-01-01

The Candida genus expresses virulence factors that, when combined with immunosuppression and other risk factors, can cause different manifestations of oral candidiasis. The treatment of mucosal infections caused by Candida and the elucidation of the disease process have proven challenging. Therefore, the study of experimentally induced oral candidiasis in rats and mice is useful to clarify the etiopathology of this condition, improve diagnosis, and search for new therapeutic options because the disease process in these animals is similar to that of human candidiasis lesions. Here, we describe and discuss new studies involving rat and mouse models of oral candidiasis with respect to methods for inducing experimental infection, methods for evaluating the development of experimental candidiasis, and new treatment strategies for oral candidiasis. PMID:23715031

Comparison of six methods for isolating mycobacteria from swine lymph nodes.

PubMed

Thoen, C O; Richards, W D; Jarnagin, J L

1974-03-01

Six laboratory methods were compared for isolating acid-fast bacteria. Tuberculous lymph nodes from each of 48 swine as identified by federal meat inspectors were processed by each of the methods. Treated tissue suspensions were inoculated onto each of eight media which were observed at 7-day intervals for 9 weeks. There were no statistically significant differences between the number of Mycobacterium avium complex bacteria isolated by each of the six methods. Rapid tissue preparation methods involving treatment with 2% sodium hydroxide or treatment with 0.2% zephiran required only one-third to one-fourth the processing time as a standard method. There were small differences in the amount of contamination among the six methods, but no detectable differences in the time of first appearance of M. avium complex colonies.

Emerging role of Twist1 in fibrotic diseases.

PubMed

Ning, Xiaoxuan; Zhang, Kun; Wu, Qingfeng; Liu, Minna; Sun, Shiren

2018-03-01

Epithelial-mesenchymal transition (EMT) is a pathological process that occurs in a variety of diseases, including organ fibrosis. Twist1, a basic helix-loop-helix transcription factor, is involved in EMT and plays significant roles in various fibrotic diseases. Suppression of the EMT process represents a promising approach for the treatment of fibrotic diseases. In this review, we discuss the roles and the underlying molecular mechanisms of Twist1 in fibrotic diseases, including those affecting kidney, lung, skin, oral submucosa and other tissues. We aim at providing new insight into the pathogenesis of various fibrotic diseases and facilitating the development of novel diagnostic and therapeutic methods for their treatment. © 2018 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

Providing support to family members.

PubMed

Davidhizar, Ruth; Dowd, Steven

2004-01-01

Providing recognition and simple information can be powerful and reassure a family member who is anxious and worried about an ill relative. While "answers" concerning the procedure are often not available, providing information that is available--the locations of the rest rooms and coffee shop; approximately how long the procedure will take; where to wait; and the process involved in the radiological procedure, reading and getting the results--can give some feeling of control, and thus reduce feelings of powerlessness. Most importantly, family members who are recognized and included with the patient in the treatment process will be reassured of the competency of the staff and gain hopefulness about the outcome of the diagnostic and treatment experience. And providing hope in the healthcare setting is a radiology professional's most important job.

Common Orbital Infections ~ State of the Art ~ Part I

PubMed Central

Hamed-Azzam, Shirin; AlHashash, Islam; Briscoe, Daniel; Rose, Geoffrey E; Verity, David H.

2018-01-01

Infections of the orbit and periorbita are relatively frequent, and can cause significant local and systemic morbidity. Loss of vision occurs in more than 10% of patients, and systemic sequelae can include meningitis, intracranial abscess, and death. Numerous organisms infect the orbit, but the most common are bacteria. There are many methods through which orbital infections occur, with infection from the neighboring ethmoid sinuses the most likely cause for all age groups. Prompt management is essential in suspected orbital cellulitis, and involves urgent intravenous antibiotics, rehydration, and treatment of any co-existent underlying systemic disease, e.g., diabetes, renal failure. This review summarizes the common infectious processes of the orbit in both pediatric and adult groups. We review pathophysiology, symptoms, signs, and treatment for infectious orbital processes. PMID:29719647

Vojta method in the treatment of developmental hip dysplasia – a case report

PubMed Central

Kiebzak, Wojciech; Żurawski, Arkadiusz; Dwornik, Michał

2016-01-01

Background Developmental dysplasia of the hip joint is one of the most common congenital defects and often results in functional and structural disorders. Such cases particularly demand optimizing therapeutic effects and maximally reducing the duration of therapy. Purpose The aim of this case report is to present the therapeutic process in a child with developmental hip dysplasia. Case report This is a case report of a female child with a birth weight of 2,800 g and an Apgar score of 9 points born to a gravida 3 para 3 mother at 37 weeks. The child was delivered by cesarean section, and the pregnancy was complicated by oligohydramnios. Subluxation of the left hip joint was diagnosed by an orthopedist in the third month of life. The treatment followed was the Vojta method (the first phase of reflex turning and reflex crawling). Results During the 6 weeks of the Vojta treatment, the left half of the femoral head was centralized, and the process of formation of the hip joint acetabulum was influenced effectively enough to change the acetabulum’s Graff type from the baseline D to IIb after 41 days of treatment. Conclusion The diagnostic work-up of congenital hip joint dysplasia should involve a physiotherapist who will investigate the child’s neuromuscular coordination, in addition to a neonatologist and a pediatrician. The therapy for a disorder of hip joint development of neuromotor origin should involve the application of global patterns according to Vojta. Children with congenital dysplasia of the hip joint should commence rehabilitation as early as possible. PMID:27578980

Pharmacology for the treatment of premature ejaculation.

PubMed

Giuliano, François; Clèment, Pierre

2012-07-01

Male sexual response comprises four phases: excitement, including erection; plateau; ejaculation, usually accompanied by orgasm; and resolution. Ejaculation is a complex sexual response involving a sequential process consisting of two phases: emission and expulsion. Ejaculation, which is basically a spinal reflex, requires a tight coordination between sympathetic, parasympathetic, and somatic efferent pathways originating from different segments and area in the spinal cord and innervating pelvi-perineal anatomical structures. A major relaying and synchronizing role is played by a group of lumbar neurons described as the spinal generator of ejaculation. Excitatory and inhibitory influences from sensory genital and cerebral stimuli are integrated and processed in the spinal cord. Premature ejaculation (PE) can be defined by ≤1-min ejaculatory latency, an inability to delay ejaculation, and negative personal consequences. Because there is no physiological impairment in PE, any pharmacological agent with central or peripheral mechanism of action that is delaying the ejaculation is a drug candidate for the treatment of PE. Ejaculation is centrally mediated by a variety of neurotransmitter systems, involving especially serotonin and serotonergic pathways but also dopaminergic and oxytocinergic systems. Pharmacological delay of ejaculation can be achieved either by inhibiting excitatory or reinforcing inhibitory pathways from the brain or the periphery to the spinal cord. PE can be treated with long-term use of selective serotonin-reuptake inhibitors (SSRIs) or tricyclic antidepressants. Dapoxetine, a short-acting SSRI, is the first treatment registered for the on-demand treatment of PE. Anesthetics applied on the glans penis have the ability to lengthen the time to ejaculation. Targeting oxytocinergic, neurokinin-1, dopaminergic, and opioid receptors represent future avenues to delaying ejaculation.

Predicting treatment noncompliance among criminal justice-mandated clients: a theoretical and empirical exploration.

PubMed

Sung, Hung-En; Belenko, Steven; Feng, Li; Tabachnick, Carrie

2004-01-01

Compliance with therapeutic regimens constitutes an important but infrequently studied precursor of treatment engagement and is a necessary condition of successful treatment. This study builds on recent treatment process research and provides a theory-driven analysis of treatment compliance. Five hypotheses are formulated to predict treatment noncompliance among criminal justice-mandated clients. These hypotheses tap different determinants of treatment progress, including physical prime, supportive social network, conventional social involvement, treatment motivation, and risk-taking propensity. Data from 150 addicted felons participating in a diversion program are analyzed to test the hypotheses. Predictors related to these hypotheses correctly identify 58% of the fully compliant clients and 55-88% of the noncompliant clients. Most hypotheses are at least partially corroborated and a few strong correlates emerge across analyses. Clients in their physical prime, those with poorer social support, and those lacking internal desires for change were found especially likely to violate treatment program rules. Clinical implications are discussed.

Therapeutic experience of severe and recurrent secondary hyperparathyroidism in a patient on hemodialysis for 18 years: A case report.

PubMed

Zhu, Mingwen; Zhang, Zongming; Lin, Fangcai; Miao, Jieping; Wang, Pei; Zhang, Chong; Yu, Hongwei; Deng, Hai; Liu, Zhuo; Liu, Limin; Wan, Baijiang; Yang, Haiyan; Song, Mengmeng; Zhao, Yue; Jiang, Nan; Zhang, Zichao; Zhang, Zhenya; Pan, Lijie

2018-05-01

For patients with refractory secondary hyperparathyroidism (SHPT), parathyroidectomy (PTX) has received increasing attention. However, evidence-based medicine shows that there is still controversy regarding surgical methods, efficacy, and safety. We retrospectively analyzed the process of diagnosis and treatment in one patient with severe SHPT and long-term chronic renal failure (CRF), so as to further improve the therapeutic effect. A 61-year-old female with SHPT and CRF manifested as no urine for 18 years, underwent PTX 4 times since September 2010, with satisfactory final recovery. The first operation involved resection of 3 parathyroid glands in the normal position; the second operation involved removal of an ectopic parathyroid gland, combined with parathyroid gland autotransplantation; the third operation was performed to resect suspected recurrent parathyroid gland; the fourth operation involved partial excision of the autotransplanted parathyroid glands. Accurate preoperative localized diagnosis and optimal surgical approach play key roles in the prevention and treatment of SHPT; postoperative recurrence of SHPT caused by ectopic or autotransplanted parathyroid gland should receive more attention.

New quality assurance program integrating "modern radiotherapy" within the German Hodgkin Study Group.

PubMed

Kriz, J; Baues, C; Engenhart-Cabillic, R; Haverkamp, U; Herfarth, K; Lukas, P; Schmidberger, H; Marnitz-Schulze, S; Fuchs, M; Engert, A; Eich, H T

2017-02-01

Field design changed substantially from extended-field RT (EF-RT) to involved-field RT (IF-RT) and now to involved-node RT (IN-RT) and involved-site RT (IS-RT) as well as treatment techniques in radiotherapy (RT) of Hodgkin's lymphoma (HL). The purpose of this article is to demonstrate the establishment of a quality assurance program (QAP) including modern RT techniques and field designs within the German Hodgkin Study Group (GHSG). In the era of modern conformal RT, this QAP had to be fundamentally adapted and a new evaluation process has been intensively discussed by the radiotherapeutic expert panel of the GHSG. The expert panel developed guidelines and criteria to analyse "modern" field designs and treatment techniques. This work is based on a dataset of 11 patients treated within the sixth study generation (HD16-17). To develop a QAP of "modern RT", the expert panel defined criteria for analysing current RT procedures. The consensus of a modified QAP in ongoing and future trials is presented. With this schedule, the QAP of the GHSG could serve as a model for other study groups.

The A-Framework: The Role of Access, Attributes, and Affordance in the Adoption of Distance Education Technology for Lifestyle Change

ERIC Educational Resources Information Center

Tierney, Patrick J.; Moisey, Susan

2014-01-01

This exploratory mixed methods case study examined the use of distance education technology for lifestyle change within the context of obesity treatment and weight management. In the quantitative phase of the study, 19 adults involved in an obesity-related lifestyle change program or change process completed a questionnaire that determined their…

Differential Effects of Emotion-Focused Therapy and Psychoeducation in Facilitating Forgiveness and Letting Go of Emotional Injuries

ERIC Educational Resources Information Center

Greenberg, Leslie J.; Warwar, Serine H.; Malcolm, Wanda M.

2008-01-01

This study compared the effectiveness of emotion-focused therapy (EFT) involving gestalt empty-chair dialogue in the treatment of individuals who were emotionally injured by a significant other with therapy in a psychoeducation group designed to deal with these injuries. In addition, this study examined aspects of the emotional process of…

Introducing Experimental Design by Evaluating Efficacy of Herbal Remedies (Do Herbal Remedies Really Work?)

ERIC Educational Resources Information Center

Smith, Robert A.; Pontiggia, Laura; Waterman, Carrie; Lichtenwalner, Meghan

2010-01-01

This paper is based upon experiments developed as part of a Directed Research course designed to provide undergraduate biology students experience in the principles and processes of the scientific method used in biological research. The project involved the evaluation of herbal remedies used in many parts of the world in the treatment of diseases…

Analysis of Camp Pendleton California Medical Treatment Facility Budget and Execution Process

DTIC Science & Technology

2008-12-01

for the formal internship, residency, fellowship and graduate training in medicine and dentistry . Graduate Medical Education involves costs of in...Conservation, medical aspects of ergonomics , reproductive hazards, ionizing and non- ionizing radiation safety, workplace assessments (afloat & ashore...care and services to authorized beneficiaries through the operation of hospital departments of dentistry and dental clinics and operation of

Detergent-Based Isolation of Yeast Membrane Rafts: An Inquiry-Based Laboratory Series for the Undergraduate Cell Biology or Biochemistry Lab

ERIC Educational Resources Information Center

Willhite, D. Grant; Wright, Stephen E.

2009-01-01

Lipid rafts have been implicated in numerous cellular processes including cell signaling, endocytosis, and even viral infection. Isolation of these lipid rafts often involves detergent treatment of the membrane to dissolve nonraft components followed by separation of raft regions in a density gradient. We present here an inquiry-based lab series…

Endoplasmic reticulum calcium release potentiates the ER stress and cell death caused by an oxidative stress in MCF-7 cells.

PubMed

Dejeans, Nicolas; Tajeddine, Nicolas; Beck, Raphaël; Verrax, Julien; Taper, Henryk; Gailly, Philippe; Calderon, Pedro Buc

2010-05-01

Increase in cytosolic calcium concentration ([Ca2+](c)), release of endoplasmic reticulum (ER) calcium ([Ca2+](er)) and ER stress have been proposed to be involved in oxidative toxicity. Nevertheless, their relative involvements in the processes leading to cell death are not well defined. In this study, we investigated whether oxidative stress generated during ascorbate-driven menadione redox cycling (Asc/Men) could trigger these three events, and, if so, whether they contributed to Asc/Men cytoxicity in MCF-7 cells. Using microspectrofluorimetry, we demonstrated that Asc/Men-generated oxidative stress was associated with a slow and moderate increase in [Ca2+](c), largely preceding permeation of propidium iodide, and thus cell death. Asc/Men treatment was shown to partially deplete ER calcium stores after 90 min (decrease by 45% compared to control). This event was associated with ER stress activation, as shown by analysis of eIF2 phosphorylation and expression of the molecular chaperone GRP94. Thapsigargin (TG) was then used to study the effect of complete [Ca2+](er) emptying during the oxidative stress generated by Asc/Men. Surprisingly, the combination of TG and Asc/Men increased ER stress to a level considerably higher than that observed for either treatment alone, suggesting that [Ca2+](er) release alone is not sufficient to explain ER stress activation during oxidative stress. Finally, TG-mediated [Ca2+](er) release largely potentiated ER stress, DNA fragmentation and cell death caused by Asc/Men, supporting a role of ER stress in the process of Asc/Men cytotoxicity. Taken together, our results highlight the involvement of ER stress and [Ca2+](er) decrease in the process of oxidative stress-induced cell death in MCF-7 cells. 2009 Elsevier Inc. All rights reserved.

An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

PubMed Central

2012-01-01

Background The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS) hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model. Discussion The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1) Working with an initial model 2) Unfolding the different treatment philosophies 3) Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme) 4) Phrasing the common assumptions for an integrative MS program theory 5) Developing the integrative MS program theory 6) Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment. Summary An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level. PMID:22524586

Hydrothermal Liquefaction Treatment Hazard Analysis Report

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

Lowry, Peter P.; Wagner, Katie A.

Hazard analyses were performed to evaluate the modular hydrothermal liquefaction treatment system. The hazard assessment process was performed in 2 stages. An initial assessment utilizing Hazard Identification and Preliminary Hazards Analysis (PHA) techniques identified areas with significant or unique hazards (process safety-related hazards) that fall outside of the normal operating envelope of PNNL and warranted additional analysis. The subsequent assessment was based on a qualitative What-If analysis. The analysis was augmented, as necessary, by additional quantitative analysis for scenarios involving a release of hazardous material or energy with the potential for affecting the public. The following selected hazardous scenarios receivedmore » increased attention: •Scenarios involving a release of hazardous material or energy, controls were identified in the What-If analysis table that prevent the occurrence or mitigate the effects of the release. •Scenarios with significant consequences that could impact personnel outside the immediate operations area, quantitative analyses were performed to determine the potential magnitude of the scenario. The set of “critical controls” were identified for these scenarios (see Section 4) which prevent the occurrence or mitigate the effects of the release of events with significant consequences.« less

Vascular Remodelling and Mesenchymal Transition in Systemic Sclerosis

PubMed Central

Nicolosi, Pier Andrea; Tombetti, Enrico; Maugeri, Norma; Rovere-Querini, Patrizia; Brunelli, Silvia; Manfredi, Angelo A.

2016-01-01

Fibrosis of the skin and of internal organs, autoimmunity, and vascular inflammation are hallmarks of Systemic Sclerosis (SSc). The injury and activation of endothelial cells, with hyperplasia of the intima and eventual obliteration of the vascular lumen, are early features of SSc. Reduced capillary blood flow coupled with deficient angiogenesis leads to chronic hypoxia and tissue ischemia, enforcing a positive feed-forward loop sustaining vascular remodelling, further exacerbated by extracellular matrix accumulation due to fibrosis. Despite numerous developments and a growing number of controlled clinical trials no treatment has been shown so far to alter SSc natural history, outlining the need of further investigation in the molecular pathways involved in the pathogenesis of the disease. We review some processes potentially involved in SSc vasculopathy, with attention to the possible effect of sustained vascular inflammation on the plasticity of vascular cells. Specifically we focus on mesenchymal transition, a key phenomenon in the cardiac and vascular development as well as in the remodelling of injured vessels. Recent work supports the role of transforming growth factor-beta, Wnt, and Notch signaling in these processes. Importantly, endothelial-mesenchymal transition may be reversible, possibly offering novel cues for treatment. PMID:27069480

Microwave oxidation treatment of sewage sludge.

PubMed

Lo, Kwang V; Srinivasan, Asha; Liao, Ping H; Bailey, Sam

2015-01-01

Microwave-oxidation treatment of sewage sludge using various oxidants was studied. Two treatment schemes with a combination of hydrogen peroxide and ozone were examined: hydrogen peroxide and ozone were introduced into the sludge simultaneously, followed by microwave heating. The other involved the ozonation first, and then the resulting solution was subjected to microwave and hydrogen peroxide treatment. The set with ozonation followed by hydrogen peroxide plus microwave heating yielded higher soluble materials than those of the set with hydrogen peroxide plus ozone first and then microwave treatment. No settling was observed for all treatments in the batch operation, except ozone/microwave plus hydrogen peroxide set at 120°C. The pilot-scale continuous-flow 915 MHz microwave study has demonstrated that microwave-oxidation process is feasible for real-time industrial application. It would help in providing key data for the design of a full-scale system for treating sewage sludge and the formulation of operational protocols.

Influences of post weld heat treatment on tensile strength and microstructure characteristics of friction stir welded butt joints of AA2014-T6 aluminum alloy

NASA Astrophysics Data System (ADS)

Rajendran, C.; Srinivasan, K.; Balasubramanian, V.; Balaji, H.; Selvaraj, P.

2016-08-01

Friction stir welded (FSWed) joints of aluminum alloys exhibited a hardness drop in both the advancing side (AS) and retreating side (RS) of the thermo-mechanically affected zone (TMAZ) due to the thermal cycle involved in the FSW process. In this investigation, an attempt has been made to overcome this problem by post weld heat treatment (PWHT) methods. FSW butt (FSWB) joints of Al-Cu (AA2014-T6) alloy were PWHT by two methods such as simple artificial aging (AA) and solution treatment followed by artificial aging (STA). Of these two treatments, STA was found to be more beneficial than the simple aging treatment to improve the tensile properties of the FSW joints of AA2014 aluminum alloy.

Development and evaluation of a decision aid for patients considering first‐line chemotherapy for metastatic breast cancer

PubMed Central

Chiew, Kimberly S.; Shepherd, Heather; Vardy, Janette; Tattersall, Martin H.N.; Butow, Phyllis N.; Leighl, Natasha B.

2007-01-01

Abstract Objective  Treatment decisions in advanced breast cancer are complex, with enhanced quality of life and survival among important treatment goals. Patients with metastatic breast cancer face the decision of whether or not to have chemotherapy, and many wish to be involved in this decision. We report the development and evaluation of a decision aid (DA) designed to assist patients facing this treatment decision. Design and sample  Women with metastatic breast cancer (n = 17) and medical oncologists in Australia and Canada (n = 7) were invited to evaluate the DA. Intervention  A DA was developed for patients with hormone‐resistant metastatic breast cancer considering chemotherapy. The DA presented options of supportive care, with or without chemotherapy. Potential benefits and side effects of different chemotherapy regimens, and evidence‐based prognostic estimates were described, and a values clarification exercise included. Main outcome measures  Patient questionnaires evaluating information and decision involvement preferences, attitudes toward the DA and oncologist feedback regarding attitudes toward the DA. Results  Seventeen patients participated; fifteen desired as much information about their illness as possible; sixteen wished to be actively involved in the decision‐making process. The majority rated the DA as highly acceptable, clear and informative, and would recommend it to others facing this treatment decision. Conclusion  This is the first DA for patients with advanced metastatic breast cancer considering chemotherapy. A randomized trial is underway to evaluate its role in clinical decision‐making. PMID:18297781

The role of evidence and the expert in contemporary processes of governance: the case of opioid substitution treatment policy in England.

PubMed

Duke, Karen; Thom, Betsy

2014-09-01

This paper is based on research examining stakeholder involvement in substitution treatment policy which was undertaken as part of the EU funded FP7 ALICE-RAP (Addictions and Lifestyles in Contemporary Europe - Reframing Addictions Project). In England, the research coincided with a policy shift towards a recovery orientated drug treatment framework and a heated debate surrounding the role of substitute prescribing. The study aimed to explore the various influences on the development of the new 'recovery' policy from the perspectives of the key stakeholders involved. The paper is based on documentary analyses and key informant interviews with a range of stakeholders, including representatives of user organisations, treatment providers, civil servants, and members of expert committees. Drawing on the theoretical insights offered by Backstrand's 'civic science' framework, the changing role of evidence and the position of experts in the processes of drugs policy governance are explored. 'Evidence' was used to problematise the issue of substitution treatment and employed to legitimise, justify and construct arguments around the possible directions of policy and practice. Conflicting beliefs about drug treatment and about motivation for policy change emerge in the argumentation, illustrating tensions in the governance of drug treatment and the power differentials separating different groups of stakeholders. Their role in the production of evidence also illustrates issues of power regarding the definition and development of 'usable knowledge'. There were various attempts at greater representation of different forms of evidence and participation by a wider group of stakeholders in the debates surrounding substitution treatment. However, key national and international experts and the appointment of specialist committees continued to play dominant roles in building consensus and translating scientific evidence into policy discourse. Substitution treatment policy has witnessed a challenge to the dominance of 'scientific evidence' within policy decision making, but in the absence of alternative evidence with an acceptable credibility and legitimacy base, traditional notions of what constitutes evidence based policy persist and there is a continuing lack of recognition of 'civic science'. Copyright © 2014 Elsevier B.V. All rights reserved.

Whole-body iron transport and metabolism: Mechanistic, multi-scale model to improve treatment of anemia in chronic kidney disease

PubMed Central

Sarkar, Joydeep

2018-01-01

Iron plays vital roles in the human body including enzymatic processes, oxygen-transport via hemoglobin and immune response. Iron metabolism is characterized by ~95% recycling and minor replenishment through diet. Anemia of chronic kidney disease (CKD) is characterized by a lack of synthesis of erythropoietin leading to reduced red blood cell (RBC) formation and aberrant iron recycling. Treatment of CKD anemia aims to normalize RBC count and serum hemoglobin. Clinically, the various fluxes of iron transport and accumulation are not measured so that changes during disease (e.g., CKD) and treatment are unknown. Unwanted iron accumulation in patients is known to lead to adverse effects. Current whole-body models lack the mechanistic details of iron transport related to RBC maturation, transferrin (Tf and TfR) dynamics and assume passive iron efflux from macrophages. Hence, they are not predictive of whole-body iron dynamics and cannot be used to design individualized patient treatment. For prediction, we developed a mechanistic, multi-scale computational model of whole-body iron metabolism incorporating four compartments containing major pools of iron and RBC generation process. The model accounts for multiple forms of iron in vivo, mechanisms involved in iron uptake and release and their regulation. Furthermore, the model is interfaced with drug pharmacokinetics to allow simulation of treatment dynamics. We calibrated our model with experimental and clinical data from peer-reviewed literature to reliably simulate CKD anemia and the effects of current treatment involving combination of epoietin-alpha and iron dextran. This in silico whole-body model of iron metabolism predicts that a year of treatment can potentially lead to 90% downregulation of ferroportin (FPN) levels, 15-fold increase in iron stores with only a 20% increase in iron flux from the reticulo-endothelial system (RES). Model simulations quantified unmeasured iron fluxes, previously unknown effects of treatment on FPN-level and iron stores in the RES. This mechanistic whole-body model can be the basis for future studies that incorporate iron metabolism together with related clinical experiments. Such an approach could pave the way for development of effective personalized treatment of CKD anemia. PMID:29659573

Intersubjectivity in schizophrenia: life story analysis of three cases

PubMed Central

Irarrázaval, Leonor; Sharim, Dariela

2014-01-01

The processes involved in schizophrenia are approached from a viewpoint of understanding, revealing those social elements susceptible to integration for psychotherapeutic purposes, as a complement to the predominant medical-psychiatric focus. Firstly, the paper describes the patients’ disturbances of self-experience and body alienations manifested in acute phases of schizophrenia. Secondly, the paper examines the patients’ personal biographical milestones and consequently the acute episode is contextualized within the intersubjective scenario in which it manifested itself in each case. Thirdly, the patients’ life stories are analyzed from a clinical psychological perspective, meaningfully connecting symptoms and life-world. Finally, it will be argued that the intersubjective dimension of the patients’ life stories shed light not only on the interpersonal processes involved in schizophrenia but also upon the psychotherapeutic treatment best suited to each individual case. PMID:24575073

A Simple and Useful Method to Apply Exogenous NO Gas to Plant Systems: Bell Pepper Fruits as a Model.

PubMed

Palma, José M; Ruiz, Carmelo; Corpas, Francisco J

2018-01-01

Nitric oxide (NO) is involved many physiological plant processes, including germination, growth and development of roots, flower setting and development, senescence, and fruit ripening. In the latter physiological process, NO has been reported to play an opposite role to ethylene. Thus, treatment of fruits with NO may lead to delay ripening independently of whether they are climacteric or nonclimacteric. In many cases different methods have been reported to apply NO to plant systems involving sodium nitroprusside, NONOates, DETANO, or GSNO to investigate physiological and molecular consequences. In this chapter a method to treat plant materials with NO is provided using bell pepper fruits as a model. This method is cheap, free of side effects, and easy to apply since it only requires common chemicals and tools available in any biology laboratory.

Gliotransmission and Brain Glucose Sensing

PubMed Central

Lanfray, Damien; Arthaud, Sébastien; Ouellet, Johanne; Compère, Vincent; Do Rego, Jean-Luc; Leprince, Jérôme; Lefranc, Benjamin; Castel, Hélène; Bouchard, Cynthia; Monge-Roffarello, Boris; Richard, Denis; Pelletier, Georges; Vaudry, Hubert; Tonon, Marie-Christine; Morin, Fabrice

2013-01-01

Hypothalamic glucose sensing is involved in the control of feeding behavior and peripheral glucose homeostasis, and glial cells are suggested to play an important role in this process. Diazepam-binding inhibitor (DBI) and its processing product the octadecaneuropeptide (ODN), collectively named endozepines, are secreted by astroglia, and ODN is a potent anorexigenic factor. Therefore, we investigated the involvement of endozepines in brain glucose sensing. First, we showed that intracerebroventricular administration of glucose in rats increases DBI expression in hypothalamic glial-like tanycytes. We then demonstrated that glucose stimulates endozepine secretion from hypothalamic explants. Feeding experiments indicate that the anorexigenic effect of central administration of glucose was blunted by coinjection of an ODN antagonist. Conversely, the hyperphagic response elicited by central glucoprivation was suppressed by an ODN agonist. The anorexigenic effects of centrally injected glucose or ODN agonist were suppressed by blockade of the melanocortin-3/4 receptors, suggesting that glucose sensing involves endozepinergic control of the melanocortin pathway. Finally, we found that brain endozepines modulate blood glucose levels, suggesting their involvement in a feedback loop controlling whole-body glucose homeostasis. Collectively, these data indicate that endozepines are a critical relay in brain glucose sensing and potentially new targets in treatment of metabolic disorders. PMID:23160530

Deciding treatment for miscarriage--experiences of women and healthcare professionals.

PubMed

Olesen, Mette Linnet; Graungaard, Anette H; Husted, Gitte R

2015-06-01

Women experiencing miscarriage are offered a choice of different treatments to terminate their wanted pregnancy at a time when they are often shocked and distressed. Women's and healthcare professionals' experiences of the decision-making process are not well described. We aimed to gain insight into this process and the circumstances that may affect it. A qualitative study using a grounded theory approach. Data were obtained through semi-structured interviews with six women who had chosen and completed either surgical, medical or expectant treatment for miscarriage and five healthcare professionals involved in the decision-making at an emergency gynaecological department in Denmark. An inductive explorative method was chosen due to limited knowledge about the decision-making process, and a theoretical perspective was not applied until the final analysis. Despite information and pretreatment counselling, choice of treatment was often determined by unspoken emotional considerations, including fear of seeing the foetus or fear of anaesthesia. These considerations were not discussed during the decision-making process, which was a time when the women were under time pressure and experienced emotional distress. Healthcare professionals did not explore women's considerations for choosing a particular treatment and prioritised information differently. We found theory about coping and decision-making in stressful situations useful in increasing our understanding of the women's reactions. In relation to theory about informed consent, our findings suggest that women need more understanding of the treatments before making a decision. This study is limited due to a small sample size, but it generates important findings that need to be examined in a larger sample. Frequently, women did not use information provided about treatment pros and cons in their decision-making process. Because of unspoken thoughts, and women's needs being unexplored by healthcare professionals, information did not target women's needs and their reasoning remained unapparent. © 2014 Nordic College of Caring Science.

[The ethical reflection approach in decision-making processes in health institutes].

PubMed

Gruat, Renaud

2015-12-01

Except in the specific case of end-of-life care, the law says nothing about the way in which health professionals must carry out ethical reflection regarding the treatment of their patients. A problem-solving methodology called the "ethical reflection approach" performed over several stages can be used. The decision-making process involves the whole team and draws on the ability of each caregiver to put forward a reasoned argument, in the interest of the patient. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The Biology of Bone and Ligament Healing.

PubMed

Cottrell, Jessica A; Turner, Jessica Cardenas; Arinzeh, Treena Livingston; O'Connor, J Patrick

2016-12-01

This review describes the normal healing process for bone, ligaments, and tendons, including primary and secondary healing as well as bone-to-bone fusion. It depicts the important mediators and cell types involved in the inflammatory, reparative, and remodeling stages of each healing process. It also describes the main challenges for clinicians when trying to repair bone, ligaments, and tendons with a specific emphasis on Charcot neuropathy, fifth metatarsal fractures, arthrodesis, and tendon sheath and adhesions. Current treatment options and research areas are also reviewed. Copyright © 2016 Elsevier Inc. All rights reserved.

Green PCB Remediation from Sediment Systems (GPRSS) Project

NASA Technical Reports Server (NTRS)

Falker, John; Thompson, Karen; Zeitlin, Nancy; Quinn, Jacqueline; Parrish, Lewis M.

2014-01-01

An ongoing problem facing the global environment community including NASA centers is the removal and remediation of polychlorinated biphenyls (PCBs). PCBs were commonly used in a variety of materials including paints, caulking, and adhesives due to the advantageous physical and chemical properties that PCBs imparted to these various materials. Unfortunately, these properties have made the treatment of sites contaminated with these chemicals extremely difficult to deal with, due to their inherent chemical stability. The remediation of sediments contaminated with PCBs is especially difficult, primarily due to the risk of releasing the contaminant into the environment during the treatment process. Traditional treatment options involve the use of dredging and incineration of the contaminated soils/sediments, in which the chance of releasing the contaminants is greatly increased. The purpose of this project is to develop cleanup technology capable of remediating contaminated sediments in-situ, with minimum intrusion. This allows for the minimization of any potential contaminant release during the treatment process, providing a safer method for cleanup operations (as opposed to dredging/incineration) and still treating the basic problem of PCB contamination (as opposed to capping).

Dynamic changes in methylome and transcriptome patterns in response to methyltransferase inhibitor 5-azacytidine treatment in citrus

PubMed Central

Xu, Jidi; Wang, Xia; Cao, Hongbo; Xu, Haidan; Xu, Qiang

2017-01-01

Abstract DNA methylation is known to play an important role in various developmental processes in plants. However, there is a general lack of understanding about the possible functions of DNA methylation in fruit trees. Using callus as a model, methylome, transcriptome and metabolite changes were assessed after treatment with the DNA methyltransferase inhibitor 5-azacytidine (5azaC). Genome-wide methylome analysis revealed the demethylation of a diverse of genes, including many genes encoding transcription factors (TFs), genes involved in biological processes, and the up-regulation of a wide range of transposable elements (TEs). Combined with the RNA-seq data, we observed no obvious genome-wide correlation between the changes in methylation status and expression levels. Furthermore, 5azaC treatment induced carotenoid degradation along with strong activation of carotenoid cleavage dioxygenases 1 (CpCCD1). Functional complementation analysis in bacterial system showed that CpCCD1 exhibited strong catalytic activities toward zeaxanthin, β-carotene and lycopene. In summary, 5azaC treatments induced carotenoid degradation by CpCCD1 activation and led to a genome-wide demethylation effect. PMID:28575160

Purification and Crystallization of Murine Myostatin: A Negative Regulator of Muscle Mass

NASA Technical Reports Server (NTRS)

Hong, Young S.; Adamek, Daniel; Bridge, Kristi; Malone, Christine C.; Young, Ronald B.; Miller, Teresa; Karr, Laurel

2004-01-01

Myostatin (MSTN) has been crystallized and its preliminary X-ray diffraction data were collected. MSTN is a negative regulator of muscle growt/differentiation and suppressor of fat accumulation. It is a member of TGF-b family of proteins. Like other members of this family, the regulation of MSTN is critically tied to its process of maturation. This process involves the formation of a homodimer followed by two proteolytic steps. The first proteolytic cleavage produces a species where the n-terminal portion of the dimer is covalently separated from, but remains non-covalently bound to, the c-terminal, functional, portion of the protein. The protein is activated upon removal of the n-terminal "pro-segment" by a second n-terminal proteolytic cut by BMP-1 in vivo, or by acid treatment in vitro. Understanding the structural nature and physical interactions involved in these regulatory processes is the objective of our studies. Murine MSTN was purified from culture media of genetically engineered Chinese Hamster Ovary cells by multicolumn purification process and crystallized using the vapor diffusion method.

The Study of Glioma by Xenotransplantation in Zebrafish Early Life Stages

PubMed Central

Motaln, Helena; Turnšek, Tamara Lah

2015-01-01

Zebrafish (Danio rerio) and their transparent embryos are becoming an increasingly popular tool for studying processes involved in tumor progression and in the search for novel tumor treatment approaches. The xenotransplantation of fluorescently labeled mammalian cancer cells into zebrafish embryos is an approach enabling relatively high-throughput in vivo analyses. The small size of the embryos as well as the relative simplicity of their manipulation and maintenance allow for large numbers of embryos to be processed efficiently in a short time and at low cost. Furthermore, the possibility of fluorescence microscopic imaging of tumor progression within zebrafish embryos and larvae holds unprecedented potential for the real-time visualization of these processes in vivo. This review presents the methodologies of xenotransplantation studies on zebrafish involving research on tumor invasion, proliferation, tumor-induced angiogenesis and screening for antitumor therapeutics. We further focus on the application of these zebrafish to the study of glioma; in particular, its most common and malignant form, glioblastoma. PMID:26109632

Evaluation of a Novel Approach for Reducing Emissions of Pharmaceuticals to the Environment

NASA Astrophysics Data System (ADS)

Bean, Thomas G.; Bergstrom, Ed; Thomas-Oates, Jane; Wolff, Amy; Bartl, Peter; Eaton, Bob; Boxall, Alistair B. A.

2016-10-01

Increased interest over the levels of pharmaceuticals detected in the environment has led to the need for new approaches to manage their emissions. Inappropriate disposal of unused and waste medicines and release from manufacturing plants are believed to be important pathways for pharmaceuticals entering the environment. In situ treatment technologies, which can be used on-site in pharmacies, hospitals, clinics, and at manufacturing plants, might provide a solution. In this study we explored the use of Pyropure, a microscale combined pyrolysis and gasification in situ treatment system for destroying pharmaceutical wastes. This involved selecting 17 pharmaceuticals, including 14 of the most thermally stable compounds currently in use and three of high environmental concern to determine the technology's success in waste destruction. Treatment simulation studies were done on three different waste types and liquid, solid, and gaseous emissions from the process were analyzed for parent pharmaceutical and known active transformation products. Gaseous emissions were also analyzed for NOx, particulates, dioxins, furans, and metals. Results suggest that Pyropure is an effective treatment process for pharmaceutical wastes: over 99 % of each study pharmaceutical was destroyed by the system without known active transformation products being formed during the treatment process. Emissions of the other gaseous air pollutants were within acceptable levels. Future uptake of the system, or similar in situ treatment approaches, by clinics, pharmacists, and manufacturers could help to reduce the levels of pharmaceuticals in the environment and reduce the economic and environmental costs of current waste management practices.

Recycling process for recovery of gallium from GaN an e-waste of LED industry through ball milling, annealing and leaching

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

Swain, Basudev, E-mail: swain@iae.re.kr; Mishra, Chinmayee; Kang, Leeseung

Waste dust generated during manufacturing of LED contains significant amounts of gallium and indium, needs suitable treatment and can be an important resource for recovery. The LED industry waste dust contains primarily gallium as GaN. Leaching followed by purification technology is the green and clean technology. To develop treatment and recycling technology of these GaN bearing e-waste, leaching is the primary stage. In our current investigation possible process for treatment and quantitative leaching of gallium and indium from the GaN bearing e-waste or waste of LED industry dust has been developed. To recycle the waste and quantitative leaching of gallium,more » two different process flow sheets have been proposed. In one, process first the GaN of the waste the LED industry dust was leached at the optimum condition. Subsequently, the leach residue was mixed with Na{sub 2}CO{sub 3}, ball milled followed by annealing, again leached to recover gallium. In the second process, the waste LED industry dust was mixed with Na{sub 2}CO{sub 3}, after ball milling and annealing, followed acidic leaching. Without pretreatment, the gallium leaching was only 4.91 w/w % using 4 M HCl, 100 °C and pulp density of 20 g/L. After mechano-chemical processing, both these processes achieved 73.68 w/w % of gallium leaching at their optimum condition. The developed process can treat and recycle any e-waste containing GaN through ball milling, annealing and leaching. - Highlights: • Simplest process for treatment of GaN an LED industry waste developed. • The process developed recovers gallium from waste LED waste dust. • Thermal analysis and phase properties of GaN to Ga{sub 2}O{sub 3} and GaN to NaGaO{sub 2} revealed. • Solid-state chemistry involved in this process reported. • Quantitative leaching of the GaN was achieved.« less

Regenerative endodontics.

PubMed

Simon, S; Smith, A J

2014-03-01

Significant advances in our understanding of the biological processes involved in tooth development and repair at the cellular and molecular levels have underpinned the newly emerging area of regenerative endodontics. Development of treatment protocols based on exploiting the natural wound healing properties of the dental pulp and applying tissue engineering principles has allowed reporting of case series showing preservation of tissue vitality and apexogenesis. To review current case series reporting regenerative endodontics. Current treatment approaches tend to stimulate more reparative than regenerative responses in respect of the new tissue generated, which often does not closely resemble the physiological structure of dentine-pulp. However, despite these biological limitations, such techniques appear to offer significant promise for improved treatment outcomes. Improved biological outcomes will likely emerge from the many experimental studies being reported and will further contribute to improvements in clinical treatment protocols.

Open Reduction in Pediatric Condylar Fracture.

PubMed

Barbosa, Alexandre Agostini; Mariano, Ronaldo Célio

2017-05-01

Facial fractures in children are rare. Lack of pneumatization, fat pockets, mixed dentition, contribute to the elasticity and bone stability. When mandibular fractures occur in children, most often involve the condyle by indirect trauma. Such fractures are the center of discussion on the form of treatment if this should be performed conservatively, or held the reduction and fixation of the fracture with surgical exposure of the fragments. In condylar fractures in children, in most patients, the proposed treatment is closed reduction. Treatment with open reduction and fixation has its specific indications. In this case, the authors report a patient cycling accident victim, with cut-contusion injury in ment with limited mouth opening and left condylar fracture with medial rotation. The treatment was the reduction and fixation of fragments by open process.

Effect of hybrid, maturity, and mechanical processing of corn silage on intake and digestibility by beef cattle.

PubMed

Andrae, J G; Hunt, C W; Pritchard, G T; Kennington, L R; Harrison, J H; Kezar, W; Mahanna, W

2001-09-01

A study involving a 2 x 2 x 2 factorial arrangement of treatments was conducted to evaluate effects of hybrid (Pioneer 3335 and 3489), maturity (half milkline and blacklayer), and mechanical processing (field chopper with and without on-board rollers engaged) on intake and digestibility of corn silage. Forty Angus steers (322 +/- 5.2 kg BW) were assigned to the eight silage treatments (five steers per treatment) and individually fed using electronic gates. Diets consisted of 60% corn silage and 40% chopped alfalfa hay (DM basis). Following a 5-d adaptation period, intake was measured for 7 d and subsequently fecal samples were collected for 5 d. Chromic oxide (5 g/d) was fed beginning 7 d before fecal sample collection and digestibility was determined by the ratio of Cr in the feed and feces. Steers were reallocated to treatments and these procedures were repeated, providing 10 observations per treatment. In addition, all silages were ruminally incubated in six mature cows for 0, 8, 16, 24, 48, and 96 h to determine extent and rate of DM, starch, NDF, and ADF disappearance. Processing increased DMI of hybrid 3489 but did not affect DMI of hybrid 3335 (hybrid x processing; P < 0.06). Total tract digestibility of DM, starch, NDF, and ADF decreased (P < 0.01) as plant maturity increased. Maturity tended to decrease starch digestibility more for hybrid 3489 than for hybrid 3335 (hybrid x maturity; P < 0.10). Processing increased (P < 0.01) starch digestibility but decreased (P < 0.01) NDF and ADF digestibility, resulting in no processing effect on DM digestibility. There was a numerical trend for processing to increase starch digestibility more for latethan for early-maturity corn silage (maturity x processing; P = 0.11). Processing increased in situ rates of DM and starch disappearance and maturity decreased in situ disappearance rates of starch and fiber. These data indicate that hybrid, maturity, and processing all affect corn silage digestibility. Mechanical processing of corn silage increased starch digestibility, which may have been associated with the observed decreased fiber digestibility.

Patients’ experiences of referral for colorectal cancer

PubMed Central

2013-01-01

Background Outcomes for colorectal cancer patients vary significantly. Compared to other countries, Australia has a good record with patient outcomes, yet there is little information available on the referral pathway. This paper explores the views of Australian patients and their experiences of referral for colorectal cancer treatment following diagnosis; the aim was to improve our understanding of the referral pathway and guide the development of future interventions. Methods A purposive sampling strategy was used, recruiting 29 patients representing urban and rural areas from 3 Australian states who participated in 4 focus groups. Seven patients provided individual interviews to supplement the data. Recordings were transcribed verbatim, data was coded with NVivo software and analysed thematically before deductive analysis. Results Four aspects of the referral process were identified by patients, namely detection/diagnosis, referral for initial treatment/specialist care, the roles of the GP/specialist, and the patient’s perceived involvement in the process. The referral process was characterised by a lack of patient involvement, with few examples of shared decision-making and few examples of limited choice. However, patients did not always feel they had the knowledge to make informed decisions. Information exchange was highly valued by patients when it occurred, and it increased their satisfaction with the process. Other factors mediating care included the use of the public versus private health system, the quality of information exchange (GP to specialist and GP to patient), continuity of care between GP and specialist, and the extent of information provision when patients moved between specialist and GP care. Conclusions Patients described poor GP continuity, ad hoc organisational systems and limited information exchange, at both interpersonal and inter-organisational levels, all leading to sub-optimal care. Implementation of a system of information feedback to GPs and engagement with them might improve information exchange for patients, enabling them to be more involved in improved referral outcomes. PMID:23972115

Pretreatment of coal during transport

DOEpatents

Johnson, Glenn E.; Neilson, Harry B.; Forney, Albert J.; Haynes, William P.

1977-04-19

Many available coals are "caking coals" which possess the undesirable characteristic of fusing into a solid mass when heated through their plastic temperature range (about 400.degree. C.) which temperature range is involved in many common treatment processes such as gasification, hydrogenation, carbonization and the like. Unless the caking properties are first destroyed, the coal cannot be satisfactorily used in such processes. A process is disclosed herein for decaking finely divided coal during its transport to the treating zone by propelling the coal entrained in an oyxgen-containing gas through a heated transport pipe whereby the separate transport and decaking steps of the prior art are combined into a single step.

Two new advanced forms of spectrometry for space and commercial applications

NASA Technical Reports Server (NTRS)

Schlager, Kenneth J.

1991-01-01

Reagentless ultraviolet absorption spectrometry (UVAS) and Liquid Atomic Emission Spectrometry (LAES) represent new forms of spectrometry with extensive potential in both space and commercial applications. Originally developed under KSC sponsorship for monitoring nutrient solutions for the Controlled Ecological Life Support System (CELSS), both UVAS and LAES have extensive analytical capabilities for both organic and inorganic chemical compounds. Both forms of instrumentation involve the use of remote fiber optic probes and real-time measurements for on-line process monitoring. Commercial applications exist primarily in environmental analysis and for process control in the chemical, pulp and paper, food processing, metal plating, and water/wastewater treatment industries.

Estrogen Effects on Wound Healing

PubMed Central

Horng, Huann-Cheng; Chang, Wen-Hsun; Yeh, Chang-Ching; Huang, Ben-Shian; Chang, Chia-Pei; Chen, Yi-Jen; Tsui, Kuan-Hao

2017-01-01

Wound healing is a physiological process, involving three successive and overlapping phases—hemostasis/inflammation, proliferation, and remodeling—to maintain the integrity of skin after trauma, either by accident or by procedure. Any disruption or unbalanced distribution of these processes might result in abnormal wound healing. Many molecular and clinical data support the effects of estrogen on normal skin homeostasis and wound healing. Estrogen deficiency, for example in postmenopausal women, is detrimental to wound healing processes, notably inflammation and re-granulation, while exogenous estrogen treatment may reverse these effects. Understanding the role of estrogen on skin might provide further opportunities to develop estrogen-related therapy for assistance in wound healing. PMID:29099810

Emerging usage of electrocoagulation technology for oil removal from wastewater: A review.

PubMed

An, Chunjiang; Huang, Gordon; Yao, Yao; Zhao, Shan

2017-02-01

Electrocoagulation is a simple and efficient treatment method involving the electrodissolution of sacrificial anodes and formation of hydroxo-metal products as coagulants, while the simultaneous production of hydrogen at the cathode facilitates the pollutant removal by flotation. Oil is one of the most important hydrocarbon products in the modern world. It can cause environmental pollution during various stages of production, transportation, refining and use. Electrocoagulation treatment is particularly effective for destabilization of oil-in-water emulsions by neutralizing charges and bonding oil pollutants to generated flocs and hydrogen bubbles. The development of electrocoagulation technologies provided a promising alternative for oil removal from wastewater. This paper presents a review of emerging electrochemical technologies used for treating oil-containing wastewater. It includes a brief description of the oily wastewater origin and characteristics. The treatment processes developed so far for oily wastewater and the electrocoagulation mechanisms are also introduced. This paper summarizes the current applications of electrocoagulation for oil removal from wastewater. The factors that influence the electrocoagulation treatment efficiencies as well as the process optimization and modeling studies are discussed. The state-of-the-art and development trends of electrocoagulation process for oil removal are further introduced. Copyright © 2016 Elsevier B.V. All rights reserved.

Professional roles in physiotherapy practice: Educating for self-management, relational matching, and coaching for everyday life.

PubMed

Solvang, Per Koren; Fougner, Marit

2016-11-01

The patient's active participation in treatment and rehabilitation represents a cultural change in clinical practice as well as a major change in physiotherapist and patient roles. This article presents findings from a study aimed at gaining a better understanding of how physiotherapists in actual practice understand their interactions with patients during the treatment process. This article reports on the findings from focus-group interviews with physiotherapists working in three different settings. Analyses of the interview data identified three modes of physiotherapy practice. In one, physiotherapists educate their patients to be self-managing in conducting exercise programs based on sound evidence. Educational films available on the Internet are included in these efforts to teach patients. In another, physiotherapists emphasize the importance of a close relationship to the patient. A good personal chemistry is believed to improve the treatment process. And finally, what physiotherapists learn about the living conditions and the biographies of their patients was shown to be very important. Understanding the importance of the life-world and taking this into consideration in the treatment process were factors considered to be central to good practice. The article concludes with a discussion linking these findings to those of other studies identifying those factors contributing to our knowledge of what is involved in biopsychosocial practice in physiotherapy.

Osteochondritis Dissecans Involving the Trochlear Groove Treated With Retrograde Drilling

PubMed Central

Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Yamamoto, Tetsuji

2015-01-01

Abstract Osteochondritis dissecans (OCD) occurs frequently in the humeral capitellum of the upper extremity, whereas OCD involving the trochlear groove (trochlear groove OCD) is rarely reported. A standard treatment for trochlear groove OCD has therefore not been determined, although several methods have been tried. The case of a 14-year-old male gymnast with bilateral trochlear groove OCD is presented. Retrograde drilling from the lateral condyle of the humerus was applied for the OCD lesion of the left elbow, since it was larger in size than that in the right elbow and was symptomatic. Conversely, since the right lesion was small and asymptomatic, it was managed conservatively. After treatment, consolidation of the OCD lesions was observed in both elbows. However, the time to healing was shorter in the left elbow treated surgically than in the right elbow managed conservatively. In conclusion, retrograde drilling is a very simple and minimally invasive treatment. This case suggests that retrograde drilling for trochlear groove OCD may be a useful procedure that may accelerate the healing process for OCD lesions. PMID:26356703

A systematic review of sensory-based treatments for children with disabilities.

PubMed

Barton, Erin E; Reichow, Brian; Schnitz, Alana; Smith, Isaac C; Sherlock, Daniel

2015-02-01

Sensory-based therapies are designed to address sensory processing difficulties by helping to organize and control the regulation of environmental sensory inputs. These treatments are increasingly popular, particularly with children with behavioral and developmental disabilities. However, empirical support for sensory-based treatments is limited. The purpose of this review was to conduct a comprehensive and methodologically sound evaluation of the efficacy of sensory-based treatments for children with disabilities. Methods for this review were registered with PROSPERO (CRD42012003243). Thirty studies involving 856 participants met our inclusion criteria and were included in this review. Considerable heterogeneity was noted across studies in implementation, measurement, and study rigor. The research on sensory-based treatments is limited due to insubstantial treatment outcomes, weak experimental designs, or high risk of bias. Although many people use and advocate for the use of sensory-based treatments and there is a substantial empirical literature on sensory-based treatments for children with disabilities, insufficient evidence exists to support their use. Copyright © 2014 Elsevier Ltd. All rights reserved.

From research to practice: how OPUS treatment was accepted and implemented throughout Denmark.

PubMed

Nordentoft, Merete; Melau, Marianne; Iversen, Tina; Petersen, Lone; Jeppesen, Pia; Thorup, Anne; Bertelsen, Mette; Hjorthøj, Carsten Rygaard; Hastrup, Lene Halling; Jørgensen, Per

2015-04-01

The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process. Modified assertive community treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial. To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, relatives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophrenia and higher user satisfaction. The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for implementing early intervention services; as a result, OPUS teams were disseminated throughout the country. The content of the treatment is now further developed, and new elements are being tried out - such as individual placement and support, lifestyle changes, cognitive remediation, specialized treatment for substance abuse and different kinds of user involvement. © 2013 Wiley Publishing Asia Pty Ltd.

Improvement of cognitive function in schizophrenia with N-acetylcysteine: A theoretical review.

PubMed

Yolland, Caitlin O B; Phillipou, Andrea; Castle, David J; Neill, Erica; Hughes, Matthew E; Galletly, Cherrie; Smith, Zoe M; Francis, Paul S; Dean, Olivia M; Sarris, Jerome; Siskind, Dan; Harris, Anthony W F; Rossell, Susan L

2018-05-30

Schizophrenia is a debilitating psychiatric illness associated with positive and negative symptoms as well as significant impairments in cognition. Current antipsychotic medications do not alleviate these cognitive deficits, and more effective therapeutic options are required. Increased oxidative stress and altered antioxidant levels, including glutathione (GSH) have been observed both in individuals with cognitive impairment and in people with schizophrenia. A GSH precursor, the antioxidant N-acetylcysteine (NAC) has been investigated as a novel treatment for the cognitive symptoms of schizophrenia, and recent research suggests that NAC may be a promising adjunctive treatment option. However, the current literature lacks integration as to why NAC may effectively improve cognition in schizophrenia. The present theoretical synthesis aimed to address this gap by examining the processes by which NAC may improve cognitive function in schizophrenia. The schizophrenia literature was reviewed in three key domains: cognitive impairment, the relationship between oxidative stress and cognition, and the efficacy of NAC as a novel treatment. This led to a theoretical analysis of the neurobiological processes by which NAC may improve cognition in schizophrenia. This theoretical review concluded that improved cognition may result from a combination of factors, including decreased oxidative stress, neuroprotection of cognitive networks and an increase in glutamatergic modulation of the N-methyl-d-aspartate receptor system. Whilst a number of mechanisms by which NAC may improve cognition and symptoms in schizophrenia have been proposed, there is still limited understanding of the specific metabolic pathways involved and how they interrelate and modify specific symptomology. Exploration of how NAC treatment may act to improve cognitive function could guide clinical trials by investigation of the specific neurotransmitter systems and processes involved, allowing for targeted neurological outcome measures. Future research would benefit from the investigation of both in vivo cortical GSH concentration and peripheral plasma GSH in a population of individuals with chronic schizophrenia.

When informed consent goes poorly: a descriptive study of medical negligence claims and patient complaints.

PubMed

Gogos, Andrew J; Clark, Richard B; Bismark, Marie M; Gruen, Russell L; Studdert, David M

2011-09-19

To describe the frequency, characteristics, and outcomes of medicolegal disputes over informed consent. Retrospective review and analysis of negligence claims against doctors insured by Avant Mutual Group Limited and complaints lodged with the Office of the Health Services Commissioner of Victoria that alleged failures in the informed consent process and were adjudicated between 1 January 2002 and 31 December 2008. Case frequency (by medical specialty), type of allegation, type of treatment. A total of 481 cases alleged deficiencies in the informed consent process (218 of 1898 conciliated complaints [11.5%]; 263 of 7846 negligence claims [3.4%]). 57% of these cases were against surgeons. Plastic surgeons experienced dispute rates that were more than twice those of any other specialty or subspecialty group. 92% of cases (442/481) involved surgical procedures and 16% (77/481) involved cosmetic procedures. The primary allegation in 71% of cases was that the clinician failed to mention or properly explain risks of complications. Five treatment types - procedures on reproductive organs (12% of cases), procedures on facial features excluding eyes (12%), prescription medications (8%), eye surgery (7%) and breast surgery (7%) - accounted for 46% of all cases. The typical dispute over informed consent involves an operation, often cosmetic, and allegations that a particular complication was not properly disclosed. With Australian courts now looking to patient preferences in setting legal standards of care for risk disclosure, medicolegal disputes provide valuable insights for targeting both quality improvement efforts and risk management activities.

Experiences of treatment decision making for young people diagnosed with depressive disorders: a qualitative study in primary care and specialist mental health settings

PubMed Central

2011-01-01

Background Clinical guidelines advocate for the inclusion of young people experiencing depression as well as their caregivers in making decisions about their treatment. Little is known, however, about the degree to which these groups are involved, and whether they want to be. This study sought to explore the experiences and desires of young people and their caregivers in relation to being involved in treatment decision making for depressive disorders. Methods Semi-structured interviews were carried out with ten young people and five caregivers from one primary care and one specialist mental health service about their experiences and beliefs about treatment decision making. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Experiences of involvement for clients varied and were influenced by clients themselves, clinicians and service settings. For caregivers, experiences of involvement were more homogenous. Desire for involvement varied across clients, and within clients over time; however, most clients wanted to be involved at least some of the time. Both clients and caregivers identified barriers to involvement. Conclusions This study supports clinical guidelines that advocate for young people diagnosed with depressive disorders to be involved in treatment decision making. In order to maximise engagement, involvement in treatment decision making should be offered to all clients. Involvement should be negotiated explicitly and repeatedly, as desire for involvement may change over time. Caregiver involvement should be negotiated on an individual basis; however, all caregivers should be supported with information about mental disorders and treatment options. PMID:22151735

DESTINY-S: attitudes of physicians toward disability and treatment in malignant MCA infarction.

PubMed

Neugebauer, Hermann; Creutzfeldt, Claire J; Hemphill, J Claude; Heuschmann, Peter U; Jüttler, Eric

2014-08-01

Decompressive hemicraniectomy (DHC) reduces mortality and improves outcome after malignant middle cerebral artery (MCA) infarction but leaves a high number of survivors severely disabled. Attitudes among physicians toward the degree of disability that is considered acceptable and the impact of aphasia may play a major role in treatment decisions. DESTINY-S is a multicenter, international, cross-sectional survey among 1,860 physicians potentially involved in the treatment of malignant MCA infarction. Questions concerned the grade of disability, the hemisphere of the stroke, and the preferred treatment for malignant MCA infarction. mRS scores of 3 or better were considered acceptable by the majority of respondents (79.3%). Only few considered a mRS score of 5 still acceptable (5.8%). A mRS score of 4 was considered acceptable by 38.0%. Involved hemisphere (dominant vs. non-dominant) was considered a major clinical symptom influencing treatment decisions in 47.7% of respondents, also reflected by significantly different rates for DHC as preferred treatment in dominant versus non-dominant hemispheric infarction (46.9 vs. 72.9%). Significant differences in acceptable disability and treatment decisions were found among geographic regions, medical specialties, and respondents with different work experiences. Little consensus exists among physicians regarding acceptable outcome and therapeutic management after malignant MCA infarction, and physician's recommendations do not correlate with available evidence. We advocate for a decision-making process that balances scientific evidence, patient preference, and clinical expertise.

Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis.

PubMed

Jastreboff, Pawel J; Jastreboff, Margaret M

2015-01-01

Definitions, potential mechanisms, and treatments for decreased sound tolerance, hyperacusis, misophonia, and diplacousis are presented with an emphasis on the associated physiologic and neurophysiological processes and principles. A distinction is made between subjects who experience these conditions versus patients who suffer from them. The role of the limbic and autonomic nervous systems and other brain systems involved in cases of bothersome decreased sound tolerance is stressed. The neurophysiological model of tinnitus is outlined with respect to how it may contribute to our understanding of these phenomena and their treatment. © 2015 Elsevier B.V. All rights reserved.

Combined laser and photodynamic treatment in extensive purulent wounds

NASA Astrophysics Data System (ADS)

Solovieva, A. B.; Tolstih, P. I.; Melik-Nubarov, N. S.; Zhientaev, T. M.; Kuleshov, I. G.; Glagolev, N. N.; Ivanov, A. V.; Karahanov, G. I.; Tolstih, M. P.; Timashev, P. S.

2010-05-01

Recently, photodynamic therapy (PDT) has been used for the treatment of festering wounds and trophic ulcers. An important advantage of PDT is its ability to affect bacterial cultures that are resistant to antibiotics. However the use of PDT alone does not usually guarantee a stable antiseptic effect and cannot prevent an external infection of wounds and burns. In this work attention is focused on the healing of the extensive soft tissues wounds with combined laser therapy (LT) and PDT treatment. At the first stage of this process festering tissues (for example spacious purulent wounds with area more than 100 cm2) were illuminated with high-energy laser beam (with power 20 W) in continues routine. The second stage involves “softer” PDT affect, which along with the completion stages of destruction pathological cells, stimulating the process of wound granulation and epithelization. Also, according to our previous results, photosensitizer (photoditazin) is introduced inside the wound with different amphiphilic polymers for increasing the PDT efficacy.

Microsecond-pulsed dielectric barrier discharge plasma stimulation of tissue macrophages for treatment of peripheral vascular disease

PubMed Central

Miller, V.; Lin, A.; Kako, F.; Gabunia, K.; Kelemen, S.; Brettschneider, J.; Fridman, G.; Fridman, A.; Autieri, M.

2015-01-01

Angiogenesis is the formation of new blood vessels from pre-existing vessels and normally occurs during the process of inflammatory reactions, wound healing, tissue repair, and restoration of blood flow after injury or insult. Stimulation of angiogenesis is a promising and an important step in the treatment of peripheral artery disease. Reactive oxygen species have been shown to be involved in stimulation of this process. For this reason, we have developed and validated a non-equilibrium atmospheric temperature and pressure short-pulsed dielectric barrier discharge plasma system, which can non-destructively generate reactive oxygen species and other active species at the surface of the tissue being treated. We show that this plasma treatment stimulates the production of vascular endothelial growth factor, matrix metalloproteinase-9, and CXCL 1 that in turn induces angiogenesis in mouse aortic rings in vitro. This effect may be mediated by the direct effect of plasma generated reactive oxygen species on tissue. PMID:26543345

Microsecond-pulsed dielectric barrier discharge plasma stimulation of tissue macrophages for treatment of peripheral vascular disease

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

Miller, V., E-mail: vmiller@coe.drexel.edu; Lin, A.; Brettschneider, J.

Angiogenesis is the formation of new blood vessels from pre-existing vessels and normally occurs during the process of inflammatory reactions, wound healing, tissue repair, and restoration of blood flow after injury or insult. Stimulation of angiogenesis is a promising and an important step in the treatment of peripheral artery disease. Reactive oxygen species have been shown to be involved in stimulation of this process. For this reason, we have developed and validated a non-equilibrium atmospheric temperature and pressure short-pulsed dielectric barrier discharge plasma system, which can non-destructively generate reactive oxygen species and other active species at the surface of themore » tissue being treated. We show that this plasma treatment stimulates the production of vascular endothelial growth factor, matrix metalloproteinase-9, and CXCL 1 that in turn induces angiogenesis in mouse aortic rings in vitro. This effect may be mediated by the direct effect of plasma generated reactive oxygen species on tissue.« less

Core communication components along the cancer care process: the perspective of breast cancer patients.

PubMed

Prades, Joan; Ferro, Tàrsila; Gil, Francisco; Borras, Josep M

2014-10-01

This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n = 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Poultry slaughterhouse wastewater treatment plant for high quality effluent.

PubMed

Del Nery, V; Damianovic, M H Z; Moura, R B; Pozzi, E; Pires, E C; Foresti, E

2016-01-01

This paper assesses a wastewater treatment plant (WWTP) regarding the technology used, as well as organic matter and nutrient removal efficiencies aiming to optimize the treatment processes involved and wastewater reclamation. The WWTP consists of a dissolved air flotation (DAF) system, an upflow anaerobic sludge blanket (UASB) reactor, an aerated-facultative pond (AFP) and a chemical-DAF system. The removal efficiencies of chemical oxygen demand (COD) (97.9 ± 1.0%), biochemical oxygen demand (BOD) (98.6 ± 1.0%) and oil and grease (O&G) (91.1 ± 5.2%) at the WWTP, the nitrogen concentration of 17 ± 11 mg N-NH3 and phosphorus concentration of 1.34 ± 0.93 mg PO4(-3)/L in the final effluent indicate that the processes used are suitable to comply with discharge standards in water bodies. Nitrification and denitrification tests conducted using biomass collected at three AFP points indicated that nitrification and denitrification could take place in the pond.

Integration of Treatment Innovation Planning and Implementation: Strategic Process Models and Organizational Challenges

PubMed Central

Lehman, Wayne E. K.; Simpson, D. Dwayne; Knight, Danica K.; Flynn, Patrick M.

2015-01-01

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A 2-phase procedural approach is therefore presented based on the integration of TCU models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. PMID:21443294

Removal of antibiotic cloxacillin by means of electrochemical oxidation, TiO2 photocatalysis, and photo-Fenton processes: analysis of degradation pathways and effect of the water matrix on the elimination of antimicrobial activity.

PubMed

Serna-Galvis, Efraim A; Giraldo-Aguirre, Ana L; Silva-Agredo, Javier; Flórez-Acosta, Oscar A; Torres-Palma, Ricardo A

2017-03-01

This study evaluates the treatment of the antibiotic cloxacillin (CLX) in water by means of electrochemical oxidation, TiO 2 photocatalysis, and the photo-Fenton system. The three treatments completely removed cloxacillin and eliminated the residual antimicrobial activity from synthetic pharmaceutical wastewater containing the antibiotic, commercial excipients, and inorganic ions. However, significant differences in the degradation routes were found. In the photo-Fenton process, the hydroxyl radical was involved in the antibiotic removal, while in the TiO 2 photocatalysis process, the action of both the holes and the adsorbed hydroxyl radicals degraded the pollutant. In the electrochemical treatment (using a Ti/IrO 2 anode in sodium chloride as supporting electrolyte), oxidation via HClO played the main role in the removal of CLX. The analysis of initial by-products showed five different mechanistic pathways: oxidation of the thioether group, opening of the central β-lactam ring, breakdown of the secondary amide, hydroxylation of the aromatic ring, and decarboxylation. All the oxidation processes exhibited the three first pathways. Moreover, the aromatic ring hydroxylation was found in both photochemical treatments, while the decarboxylation of the pollutant was only observed in the TiO 2 photocatalysis process. As a consequence of the degradation routes and mechanistic pathways, the elimination of organic carbon was different. After 480 and 240 min, the TiO 2 photocatalysis and photo-Fenton processes achieved ∼45 and ∼15 % of mineralization, respectively. During the electrochemical treatment, 100 % of the organic carbon remained even after the antibiotic was treated four times the time needed to degrade it. In contrast, in all processes, a natural matrix (mineral water) did not considerably inhibit pollutant elimination. However, the presence of glucose in the water significantly affected the degradation of CLX by means of TiO 2 photocatalysis.

Decision-making Processes among Prostate Cancer Survivors with Rising PSA Levels: Results from a Qualitative Analysis.

PubMed

Shen, Megan Johnson; Nelson, Christian J; Peters, Ellen; Slovin, Susan F; Hall, Simon J; Hall, Matt; Herrera, Phapichaya Chaoprang; Leventhal, Elaine A; Leventhal, Howard; Diefenbach, Michael A

2015-05-01

Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physicians and patients who experience a rising PSA after definitive treatment for prostate cancer. In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment. Compared with the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians' treatment recommendations. Prostate cancer survivors' decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians' recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels. © The Author(s) 2014.

The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news.

PubMed

Warnock, Clare; Buchanan, Jean; Tod, Angela Mary

2017-07-01

The aim of this study was to explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news. The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or participants. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. The study used a descriptive survey design involving self-reported written accounts and framework analysis. Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 and April 2014. Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarizes the factors that contribute to creating difficult experiences for staff when breaking bad news. The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice. © 2017 John Wiley & Sons Ltd.

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study.

PubMed

Lempp, H; Abayneh, S; Gurung, D; Kola, L; Abdulmalik, J; Evans-Lacko, S; Semrau, M; Alem, A; Thornicroft, G; Hanlon, C

2018-02-01

The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation. A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services. Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives. Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs.

An overview of advanced reduction processes for bromate removal from drinking water: Reducing agents, activation methods, applications and mechanisms.

PubMed

Xiao, Qian; Yu, Shuili; Li, Lei; Wang, Ting; Liao, Xinlei; Ye, Yubing

2017-02-15

Bromate (BrO 3 - ) is a possible human carcinogen regulated at a strict standard of 10μg/L in drinking water. Various techniques to eliminate BrO 3 - usually fall into three main categories: reducing bromide (Br - ) prior to formation of BrO 3 - , minimizing BrO 3 - formation during the ozonation process, and removing BrO 3 - from post-ozonation waters. However, the first two approaches exhibit low degradation efficiency and high treatment cost. The third workaround has obvious advantages, such as high reduction efficiency, more stable performance and easier combination with UV disinfection, and has therefore been widely implemented in water treatment. Recently, advanced reduction processes (ARPs), the photocatalysis of BrO 3 - , have attracted much attention due to improved performance. To increase the feasibility of photocatalytic systems, the focus of this work concerns new technological developments, followed by a summary of reducing agents, activation methods, operational parameters, and applications. The reaction mechanisms of two typical processes involving UV/sulfite homogeneous photocatalysis and UV/titanium dioxide heterogeneous photocatalysis are further summarized. The future research needs for ARPs to reach full-scale potential in drinking water treatment are suggested accordingly. Copyright © 2016. Published by Elsevier B.V.

The influence of expert opinions on the selection of wastewater treatment alternatives: a group decision-making approach.

PubMed

Kalbar, Pradip P; Karmakar, Subhankar; Asolekar, Shyam R

2013-10-15

The application of multiple-attribute decision-making (MADM) to real life decision problems suggests that avoiding the loss of information through scenario-based approaches and including expert opinions in the decision-making process are two major challenges that require more research efforts. Recently, a wastewater treatment technology selection effort has been made with a 'scenario-based' method of MADM. This paper focuses on a novel approach to incorporate expert opinions into the scenario-based decision-making process, as expert opinions play a major role in the selection of treatment technologies. The sets of criteria and the indicators that are used consist of both qualitative and quantitative criteria. The group decision-making (GDM) approach that is implemented for aggregating expert opinions is based on an analytical hierarchy process (AHP), which is the most widely used MADM method. The pairwise comparison matrices (PCMs) for qualitative criteria are formed based on expert opinions, whereas, a novel approach is proposed for generating PCMs for quantitative criteria. It has been determined that the experts largely prefer natural treatment systems because they are more sustainable in any scenario. However, PCMs based on expert opinions suggest that advanced technologies such as the sequencing batch reactor (SBR) can also be appropriate for a given decision scenario. The proposed GDM approach is a rationalized process that will be more appropriate in realistic scenarios where multiple stakeholders with local and regional societal priorities are involved in the selection of treatment technology. Copyright © 2013 Elsevier Ltd. All rights reserved.

Analysis of microstructure in electro-spark deposited IN718 superalloy

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

Anisimov, E.; Khan, A.K.; Ojo, O.A., E-mail: olanr

2016-09-15

The microstructure of electro-spark deposited (ESD) superalloy IN718 was studied by the use of scanning electron microscopy (SEM), electron backscatter diffraction (EBSD), transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS) techniques. In converse to general assumption, the extremely high cooling rate involved in the ESD process did not produce partitionless solidification that is devoid of second phase microconstituents in the material, nano-sized Laves phase and MC carbide particles were observed within the deposited layer. Notwithstanding the several thermal cycles involved in the process, the extremely low heat input of the process produced a deposited region that is free ofmore » the main strengthening phase of the alloy, γ″ phase precipitates, which is in contrast to what have been reported on laser deposition. Nevertheless, application of the standard full heat treatment of the alloy resulted in extensive formation of the γ″ phase precipitates and δ phase precipitates, the most stable secondary phase of the alloy, with nearly, if not complete, dissolution of the Laves phase particles. Furthermore, the XPS analysis done in the study revealed the formation of nano-oxides within the deposited layer, which increased the microhardness of the superalloy in the as-deposited condition and inhibited its grain growth during post-process heat treatment. The microstructure analysis done in this work is crucial to the understanding of properties of the superalloy processed by the ESD technique. - Highlights: •Electron microscopy analyses of electro-spark deposited IN 718 superalloy were performed. •Nano-sized secondary phase particles were observed within the deposited layer. •The study shows that the ESD did not produce partitionless solidification of the alloy.« less

Molecular Mechanisms of Metastatic Progression in Breast Cancer

DTIC Science & Technology

2005-07-31

preliminary, this data indicated a possible protective effect of clusterin on the SUM-159PT cells following TNF-alpha treatment. 5 Dr . Flanagan’s...hormone independence and invasion are linked genotypically, or whether they involve inde- pendent genetic or epigenetics processes, remains to be...Foundation for Breast Cancer Research. The authors would like to acknowledge Ken Jones for his excellent technical assistance, and Jeffrey Dawson