HIPAA and talking with family caregivers: what does the law really say?

PubMed

Levine, Carol

2006-08-01

The Health Insurance Portability and Accountability Act of 1996 (PL 104-191), known as HIPAA, has confused and unnecessarily alarmed many conscientious health care providers. Nurses in particular are likely to be on the front line of family caregivers' inquiries, because physicians are often difficult to reach and because family caregivers look to nurses as sources of reliable information. A major retraining of health care providers at all levels is needed to dampen the "HIPAA scare" and clarify what HIPAA does and does not say about communication with family caregivers.

Psychiatrists′ work with sickness certification: frequency, experiences and severity of the certification tasks in a national survey in Sweden

PubMed Central

2012-01-01

Background Many psychiatrists are involved in sickness certification of their patients; however, there is very limited knowledge about this aspect of their work. The objective of this study was to explore frequencies of problematic issues in the sickness certification tasks and experiences of severity regarding these problematic issues among psychiatrists. Methods A cross-sectional nationwide questionnaire study to all physicians in Sweden. The 579 specialists in psychiatry who answered the questionnaire, were under 65 years of age, worked mainly in psychiatric care, and had consultations involving sickness certification at least once a week were included. Results The frequency of problematic sickness certification consultations a few times per year or more often was considered by 87.3% of the psychiatrists; 11.7% handle such cases at least once a week. A majority (60.9%) reported ‘not having enough time with the patient’ at least once a week. The psychiatrists had access to several categories of professionals in their daily work. More than one third certified unnecessarily long sick-leave periods at least once a month due to waiting times for Social Insurance Office investigations or for treatments or investigations within health care. Conclusion The majority found it problematic to assess the level and duration of work incapacity, but also other types of problems like unnecessarily long sick-leave periods due to different types of waiting times. The findings have implications for different kinds of organisational and managerial support and training in sickness certification issues, like guidance to assess the level and duration of work incapacity. PMID:23075202

Necessity of creating digital tools to ensure efficiency of technical means

NASA Astrophysics Data System (ADS)

Rakov, V. I.; Zakharova, O. V.

2018-05-01

The authors estimated the problems of functioning of technical objects. The article notes that the increasing complexity of automation systems may lead to an increase of the redundant resource in proportion to the number of components and relationships in the system, and to the need of the redundant resource constant change that can make implementation of traditional structures with redundancy unnecessarily costly (Standby System, Fault Tolerance, High Availability). It proposes the idea of creating digital tools to ensure efficiency of technical facilities.

Infantile methemoglobinemia: reexamining the role of drinking water nitrates.

PubMed

Avery, A A

1999-07-01

Ingestion of nitrates in drinking water has long been thought to be a primary cause of acquired infantile methemoglobinemia, often called blue baby syndrome. However, recent research and a review of historical cases offer a more complex picture of the causes of infantile methemoglobinemia. Gastrointestinal infection and inflammation and the ensuing overproduction of nitric oxide may be the cause of many cases of infantile methemoglobinemia previously attributed to drinking water nitrates. If so, current limits on allowable levels of nitrates in drinking water, which are based solely on the health threat of infantile methemoglobinemia, may be unnecessarily strict.

Health Problems at School

MedlinePlus

... not have to pursue further evaluation of your youngster, which may disrupt her classroom work and unnecessarily concern her. If your child has an injury or illness that requires immobilization or limitations on ...

18 CFR 380.15 - Siting and maintenance requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... disposed of without undue delay. (7) Remaining trees and shrubs should not be unnecessarily damaged. (8... nearby residences or public areas, should be planted in trees and shrubs, or other appropriate...

Report: Review of Hotline Complaint 2010-282

EPA Pesticide Factsheets

Report #10-P-0165, July 15, 2010. We could not substantiate the allegation of fraud; however, the actions of the employee and his supervisor were contrary to existing travel policies and were unnecessarily costly.

Infantile methemoglobinemia: reexamining the role of drinking water nitrates.

PubMed Central

Avery, A A

1999-01-01

Ingestion of nitrates in drinking water has long been thought to be a primary cause of acquired infantile methemoglobinemia, often called blue baby syndrome. However, recent research and a review of historical cases offer a more complex picture of the causes of infantile methemoglobinemia. Gastrointestinal infection and inflammation and the ensuing overproduction of nitric oxide may be the cause of many cases of infantile methemoglobinemia previously attributed to drinking water nitrates. If so, current limits on allowable levels of nitrates in drinking water, which are based solely on the health threat of infantile methemoglobinemia, may be unnecessarily strict. Images Figure 1 Figure 2 PMID:10379005

GCK-MODY in the US National Monogenic Diabetes Registry: frequently misdiagnosed and unnecessarily treated.

PubMed

Carmody, David; Naylor, Rochelle N; Bell, Charles D; Berry, Shivani; Montgomery, Jazzmyne T; Tadie, Elizabeth C; Hwang, Jessica L; Greeley, Siri Atma W; Philipson, Louis H

2016-10-01

GCK-MODY leads to mildly elevated blood glucose typically not requiring therapy. It has been described in all ethnicities, but mainly in Caucasian Europeans. Here we describe our US cohort of GCK-MODY. We examined the rates of detection of heterozygous mutations in the GCK gene in individuals referred to the US Monogenic Diabetes Registry with a phenotype consistent with GCK-MODY. We also assessed referral patterns, treatment and demography, including ethnicity, of the cohort. Deleterious heterozygous GCK mutations were found in 54.7 % of Registry probands selected for GCK sequencing for this study. Forty-nine percent were previously unnecessarily treated with glucose-lowering agents, causing hypoglycemia and other adverse effects in some of the subjects. The proportion of probands found to have a GCK mutation through research-based testing was similar across each ethnic group. However, together African-American, Latino and Asian subjects represented only 20.5 % of screened probands and 17.2 % of those with GCK-MODY, despite higher overall diabetes prevalence in these groups. Our data show that a high detection rate of GCK-MODY is possible based on clinical phenotype and that prior to genetic diagnosis, a large percentage are inappropriately treated with glucose-lowering therapies. We also find low minority representation in our Registry, which may be due to disparities in diagnostic diabetes genetic testing and is an area needing further investigation.

The overprotection of Mars

NASA Astrophysics Data System (ADS)

Fairén, Alberto G.; Schulze-Makuch, Dirk

2013-07-01

Planetary protection policies aim to guard Solar System bodies from biological contamination from spacecraft. Costly efforts to sterilize Mars spacecraft need to be re-evaluated, as they are unnecessarily inhibiting a more ambitious agenda to search for extant life on Mars.

Plasmonic Films Can Easily Be Better: Rules and Recipes

PubMed Central

2015-01-01

High-quality materials are critical for advances in plasmonics, especially as researchers now investigate quantum effects at the limit of single surface plasmons or exploit ultraviolet- or CMOS-compatible metals such as aluminum or copper. Unfortunately, due to inexperience with deposition methods, many plasmonics researchers deposit metals under the wrong conditions, severely limiting performance unnecessarily. This is then compounded as others follow their published procedures. In this perspective, we describe simple rules collected from the surface-science literature that allow high-quality plasmonic films of aluminum, copper, gold, and silver to be easily deposited with commonly available equipment (a thermal evaporator). Recipes are also provided so that films with optimal optical properties can be routinely obtained. PMID:25950012

Antibiotics during childhood and inflammatory bowel disease?

PubMed

2014-10-01

Four epidemiological studies, including two large cohort studies in children aged 17 years or under, have studied the link between antibiotic therapy and inflammatory bowel disease. The risk of inflammatory bowel disease appeared to be twice as high in children exposed to an antibiotic as in unexposed children. The risk appeared higher following exposure during the first year of life, with beta-lactam antibiotics, and with repeated antibiotic courses. One postulated mechanism is through destruction of the anaerobic intestinal flora by antibiotics. In practice, these data provide yet another reason to avoid unnecessarily exposing children to antibiotics.

32 CFR 2700.14 - Challenges to classification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NEGOTIATIONS SECURITY INFORMATION REGULATIONS Original Classification § 2700.14 Challenges to classification. If holders of classified information believe the information is improperly or unnecessarily... the OMSN Information Security Oversight Committee, established pursuant to § 2700.51. Action on such...

Acquisition Cycle Time: Defining the Problem

DTIC Science & Technology

2016-04-01

oversight and prescribe a more laissez - faire approach to acquisition. Others diagnose unaffordable ambitions and unnecessarily demanding requirements, and...treated as a subsystem. Systems engineering organizations need to engineer the software/avionics system – a change in leadership technical background

Children, Sports, and Chronic Disease.

ERIC Educational Resources Information Center

Goldberg, Barry

1990-01-01

Discusses four chronic diseases (cystic fibrosis, congenital heart disease, rheumatoid arthritis, and asthma) that affect American children. Many have their physical activities unnecessarily restricted, though sports and exercise can actually alleviate symptoms and improve their psychosocial development. Physicians are encouraged to prescribe…

Cuff deflation: rehabilitation in critical care.

PubMed

Bach, John R; Gonçalves, Miguel R; Rodriguez, Pedro Landete; Saporito, Louis; Soares, Luisa

2014-08-01

This is a case series of rehabilitation failures that resulted in severe reactive depression from patients unnecessarily bereft of verbal communication by being left to breathe or be ventilated via tracheostomy tubes, with or without inflated cuffs, for months to years.

A Language for Specifying Compiler Optimizations for Generic Software

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

Willcock, Jeremiah J.

2007-01-01

Compiler optimization is important to software performance, and modern processor architectures make optimization even more critical. However, many modern software applications use libraries providing high levels of abstraction. Such libraries often hinder effective optimization — the libraries are difficult to analyze using current compiler technology. For example, high-level libraries often use dynamic memory allocation and indirectly expressed control structures, such as iteratorbased loops. Programs using these libraries often cannot achieve an optimal level of performance. On the other hand, software libraries have also been recognized as potentially aiding in program optimization. One proposed implementation of library-based optimization is to allowmore » the library author, or a library user, to define custom analyses and optimizations. Only limited systems have been created to take advantage of this potential, however. One problem in creating a framework for defining new optimizations and analyses is how users are to specify them: implementing them by hand inside a compiler is difficult and prone to errors. Thus, a domain-specific language for librarybased compiler optimizations would be beneficial. Many optimization specification languages have appeared in the literature, but they tend to be either limited in power or unnecessarily difficult to use. Therefore, I have designed, implemented, and evaluated the Pavilion language for specifying program analyses and optimizations, designed for library authors and users. These analyses and optimizations can be based on the implementation of a particular library, its use in a specific program, or on the properties of a broad range of types, expressed through concepts. The new system is intended to provide a high level of expressiveness, even though the intended users are unlikely to be compiler experts.« less

Organizing for Reporting.

ERIC Educational Resources Information Center

Wilton, Jennifer

1990-01-01

Reporting occupies a central place in institutional research but is ongoing and never completed. With automation and data management, the proportion of time spent on either routine or ad hoc reporting should decline. This function need not draw unnecessarily from resources for more interesting work. (MSE)

Viking dynamics experience with application to future payload design

NASA Technical Reports Server (NTRS)

Barrett, S.; Rader, W. P.; Payne, K. R.

1978-01-01

Analytical and test techniques are discussed. Areas in which hindsight indicated erroneous, redundant, or unnecessarily severe design and test specifications are identified. Recommendations are made for improvements in the dynamic design and criteria philosophy, aimed at reducing costs for payloads.

Tuberculosis: A Problem for Lifeguards?

ERIC Educational Resources Information Center

Skaros, Susan

1996-01-01

Lifeguards run the risk of workplace infection by tuberculosis-carrying swimmers. Even if they work in ventilated, sunlit areas (which reduces risk), they can contract tuberculosis when performing respiratory resuscitation. Without appropriate precautions, lifeguards may be unnecessarily exposed. A tuberculosis infection control plan is needed in…

Sharpen Your Skills: Mathematics and Science Braille.

ERIC Educational Resources Information Center

Eulert, Von E.; Cohn, Doris

1984-01-01

Three articles about mathematics and science braille are provided for braille transcribers and teachers of the visually handicapped. The first article discusses common problems such as setting braille writers incorrectly, duplicating transcribed materials unnecessarily, and incorrectly transcribing from typescript. The second article provides a…

3 CFR 13556 - Executive Order 13556 of November 4, 2010. Controlled Unclassified Information

Code of Federal Regulations, 2011 CFR

2011-01-01

.... Controlled Unclassified Information 13556 Order 13556 Presidential Documents Executive Orders Executive Order... information, such as information that involves privacy, security, proprietary business interests, and law... safeguarding of documents, led to unclear or unnecessarily restrictive dissemination policies, and created...

16 CFR 1700.3 - Establishment of standards for special packaging.

Code of Federal Regulations, 2011 CFR

2011-01-01

... standard; (2) Available scientific, medical, and engineering data concerning special packaging and... such standards, the Commission shall not prescribe specific packaging designs, product content, package... such substance in a package which the Commission determines is unnecessarily attractive to children. (e...

16 CFR 1700.3 - Establishment of standards for special packaging.

Code of Federal Regulations, 2010 CFR

2010-01-01

... standard; (2) Available scientific, medical, and engineering data concerning special packaging and... such standards, the Commission shall not prescribe specific packaging designs, product content, package... such substance in a package which the Commission determines is unnecessarily attractive to children. (e...

16 CFR 1700.3 - Establishment of standards for special packaging.

Code of Federal Regulations, 2012 CFR

2012-01-01

... standard; (2) Available scientific, medical, and engineering data concerning special packaging and... such standards, the Commission shall not prescribe specific packaging designs, product content, package... such substance in a package which the Commission determines is unnecessarily attractive to children. (e...

16 CFR 1700.3 - Establishment of standards for special packaging.

Code of Federal Regulations, 2014 CFR

2014-01-01

... standard; (2) Available scientific, medical, and engineering data concerning special packaging and... such standards, the Commission shall not prescribe specific packaging designs, product content, package... such substance in a package which the Commission determines is unnecessarily attractive to children. (e...

Iterative h-minima-based marker-controlled watershed for cell nucleus segmentation.

PubMed

Koyuncu, Can Fahrettin; Akhan, Ece; Ersahin, Tulin; Cetin-Atalay, Rengul; Gunduz-Demir, Cigdem

2016-04-01

Automated microscopy imaging systems facilitate high-throughput screening in molecular cellular biology research. The first step of these systems is cell nucleus segmentation, which has a great impact on the success of the overall system. The marker-controlled watershed is a technique commonly used by the previous studies for nucleus segmentation. These studies define their markers finding regional minima on the intensity/gradient and/or distance transform maps. They typically use the h-minima transform beforehand to suppress noise on these maps. The selection of the h value is critical; unnecessarily small values do not sufficiently suppress the noise, resulting in false and oversegmented markers, and unnecessarily large ones suppress too many pixels, causing missing and undersegmented markers. Because cell nuclei show different characteristics within an image, the same h value may not work to define correct markers for all the nuclei. To address this issue, in this work, we propose a new watershed algorithm that iteratively identifies its markers, considering a set of different h values. In each iteration, the proposed algorithm defines a set of candidates using a particular h value and selects the markers from those candidates provided that they fulfill the size requirement. Working with widefield fluorescence microscopy images, our experiments reveal that the use of multiple h values in our iterative algorithm leads to better segmentation results, compared to its counterparts. © 2016 International Society for Advancement of Cytometry. © 2016 International Society for Advancement of Cytometry.

Model selection with multiple regression on distance matrices leads to incorrect inferences.

PubMed

Franckowiak, Ryan P; Panasci, Michael; Jarvis, Karl J; Acuña-Rodriguez, Ian S; Landguth, Erin L; Fortin, Marie-Josée; Wagner, Helene H

2017-01-01

In landscape genetics, model selection procedures based on Information Theoretic and Bayesian principles have been used with multiple regression on distance matrices (MRM) to test the relationship between multiple vectors of pairwise genetic, geographic, and environmental distance. Using Monte Carlo simulations, we examined the ability of model selection criteria based on Akaike's information criterion (AIC), its small-sample correction (AICc), and the Bayesian information criterion (BIC) to reliably rank candidate models when applied with MRM while varying the sample size. The results showed a serious problem: all three criteria exhibit a systematic bias toward selecting unnecessarily complex models containing spurious random variables and erroneously suggest a high level of support for the incorrectly ranked best model. These problems effectively increased with increasing sample size. The failure of AIC, AICc, and BIC was likely driven by the inflated sample size and different sum-of-squares partitioned by MRM, and the resulting effect on delta values. Based on these findings, we strongly discourage the continued application of AIC, AICc, and BIC for model selection with MRM.

The Modularization of Women.

ERIC Educational Resources Information Center

Peterson, Yen; Brockmann, C. Thomas

The standard classification of women's roles into the traditional, dual career, and single parent constellations is unnecessarily restrictive and stereotyping. These categories reflect neither the myriad of role choices facing women today, nor the forces shaping the resulting contexts. This paper focuses upon modules, the component task or…

36 CFR 4.22 - Unsafe operation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... VEHICLES AND TRAFFIC SAFETY § 4.22 Unsafe operation. (a) The elements of this section constitute offenses... which is reasonable and prudent considering wildlife, traffic, weather, road and light conditions and road character. (2) Operating a motor vehicle in a manner which unnecessarily causes its tires to...

36 CFR 4.22 - Unsafe operation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... VEHICLES AND TRAFFIC SAFETY § 4.22 Unsafe operation. (a) The elements of this section constitute offenses... which is reasonable and prudent considering wildlife, traffic, weather, road and light conditions and road character. (2) Operating a motor vehicle in a manner which unnecessarily causes its tires to...

16 CFR § 1700.3 - Establishment of standards for special packaging.

Code of Federal Regulations, 2013 CFR

2013-01-01

... such standard; (2) Available scientific, medical, and engineering data concerning special packaging and... such standards, the Commission shall not prescribe specific packaging designs, product content, package... such substance in a package which the Commission determines is unnecessarily attractive to children. (e...

Is clinical cognition binary or continuous?

PubMed

Norman, Geoffrey; Monteiro, Sandra; Sherbino, Jonathan

2013-08-01

A dominant theory of clinical reasoning is the so-called "dual processing theory," in which the diagnostic process may proceed through a rapid, unconscious, intuitive process (System 1) or a slow, conceptual, analytical process (System 2). Diagnostic errors are thought to arise primarily from cognitive biases originating in System 1. In this issue, Custers points out that this model is unnecessarily restrictive and that it is more likely that diagnostic tasks may proceed through a variety of mental strategies ranging from "analytical" to "intuitive."The authors of this commentary agree that the notion that System 1 and System 2 processes are somehow in competition and will necessarily lead to different conclusions is unnecessarily restrictive. On the other hand, they argue that there is substantial evidence in support of a dual processing model, and that most objections to dual processing theory can be easily accommodated by simply presuming that both processes operate in concertand that solving any task may rely to varying degrees on both processes.

A nurse staffing analysis at the largest hospital in the Gulf region

NASA Astrophysics Data System (ADS)

Louly, M.; Gharbi, A.; Azaiez, M. N.; Bouras, A.

2014-12-01

The paper considers a staffing problem at a local hospital. The managers consider they are understaffed and try to overwhelm the staffing deficit problem through overtime, rather than hiring additional nurses. However, the huge amount of allocated budget for overtime becomes a concern and needs some assessment, analysis and justification. The current hospital estimates suggests that the shortage at the hospital level corresponds to 300 full time equivalent (FTE) nurses, but the deficit is not basedon deep scientific approach. This paper deals with staffing model that provides the required scientific evidence on the deficit level. It also gives the accurate information on the overtime components. As a results, the suggested staffing model shows that some nursing units are unnecessarily overstaffed. Moreover, the current study reveals that the real deficit is of only 215 FTE resulting in a potential saving of 28%.

Care for the chronically ill: Nursing home incentive payment experiment

PubMed Central

Weissert, William G.; Scanlon, William J.; Wan, Thomas T. H.; Skinner, Douglas E.

1983-01-01

Nursing home reinbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design. PMID:10310528

Untreated pain, narcotics regulation, and global health ideologies.

PubMed

King, Nicholas B; Fraser, Veronique

2013-01-01

Pain management is marginalized or ignored, with millions of people worldwide unnecessarily living with untreated pain. Reducing global inequalities in untreated pain requires a concerted global effort, say Veronique Fraser and colleagues, which must attend to the complexity of pain and promote multimodal, multidisciplinary pain management.

A Small, For-Profit College Unnerves Pittsburgh Academics.

ERIC Educational Resources Information Center

Borrego, Anne Marie

2001-01-01

Explores how Pittsburgh's traditional colleges did not fight the for-profit University of Phoenix when it arrived, but are now going after a tiny for-profit institution, Potomac College, that wants to expand into the area. The colleges claim the school unnecessarily duplicates offerings they provide. (EV)

Was Euclid an Unnecessarily Sophisticated Psychologist?

ERIC Educational Resources Information Center

Arabie, Phipps

1991-01-01

The current state of multidimensional scaling using the city-block metric is reviewed, with attention to (1) substantive and theoretical issues; (2) recent algorithmic developments and their implications for analysis; (3) isometries with other metrics; (4) links to graph-theoretic models; and (5) prospects for future development. (SLD)

Do Procrastination-Friendly Environments Make Students Delay Unnecessarily?

ERIC Educational Resources Information Center

Nordby, Kent; Klingsieck, Katrin; Svartdal, Frode

2017-01-01

Research on procrastination emphasizes trait explanations for unwanted delay, yet environmental factors are most probably significant contributors to the problem. In this paper, we review literature related to the influence of environmental factors on academic procrastination and investigate how such factors may be assessed in facilitating…

Simple and Practical Efficiency Lessons

ERIC Educational Resources Information Center

Kolpin, Van

2018-01-01

The derivation of conditions necessary for Pareto efficient production and exchange is a lesson frequently showcased in microeconomic theory textbooks. Traditional delivery of this lesson is, however, limited in its scope of application and can be unnecessarily convoluted. The author shows that the universe of application is greatly expanded and a…

Scenario Problem Solving: A Measure of the Quality of Gifted Students' Thinking

ERIC Educational Resources Information Center

Munro, John K.

2015-01-01

Teachers continue to face the challenge of identifying efficaciously gifted students' learning capacity in its multiple forms. While most educators acknowledge its multidimensional characteristics, the protocols used to identify it are frequently evaluated as unnecessarily restrictive. This study investigates an assessment tool that could…

Ongoing Activities to Facilitate Access to Supplementary Materials for Cartographic Education.

ERIC Educational Resources Information Center

Anderson, Paul S.

A wealth of unpublished or unstructured educational materials for all aspects of cartographic instruction are widely dispersed and unnecessarily difficult to obtain. The Cartography Assistance Brochures Project of the Cartography Specialty Group of the Association of American Geographers (AAG), the North American Cartographic Information Society,…

Restrictive Citizenship: Civic-Oriented Service-Learning Opportunities for All Students

ERIC Educational Resources Information Center

Mann, Jay A.; Dymond, Stacy K.; Bonati, Michelle L.; Neeper, Lance S.

2015-01-01

Citizenship education that uses service-learning continues to be implemented in a manner that may restrict many students from full, meaningful participation. The authors contend that much of the literature on civic-oriented service-learning unnecessarily positions successful projects at the extremes: (a) political socialization versus civic…

Viability of Welfare Technology in Mass Technical Literacy Programme

ERIC Educational Resources Information Center

Achintya; Prabha, Manish

2009-01-01

Each developing country should be encouraged to identify its own priorities and develop welfare technology mobilizing its own natural and human resources and should not unnecessarily imitate the stereotyped technologies from the developed countries. The existing curriculum has to be updated and strengthened to include the concept of welfare…

Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective

ERIC Educational Resources Information Center

Bransford, Cassandra L.

2011-01-01

The focus of this article is on illustrating how the differences between the paternalistic and empowerment approaches embedded within social work have unnecessarily evolved into competing approaches to practice. Tracing the historical evolution of both paternalistic and empowerment approaches, the article posits that social work is more amenable…

Developing educational resources for population genetics in R: An open and collaborative approach

USDA-ARS?s Scientific Manuscript database

The R computing and statistical language community has developed a myriad of resources for conducting populations genetic analyses. However, resources for learning how to carry out population genetic analyses in R are scattered and often incomplete, which can make acquiring this skill unnecessarily ...

48 CFR 26.203 - Transition of work.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Transition of work. 26.203... PROGRAMS OTHER SOCIOECONOMIC PROGRAMS Disaster or Emergency Assistance Activities 26.203 Transition of work... emergency response work to local firms (e.g., unnecessarily broad scopes of work or long periods of...

48 CFR 26.203 - Transition of work.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Transition of work. 26.203... PROGRAMS OTHER SOCIOECONOMIC PROGRAMS Disaster or Emergency Assistance Activities 26.203 Transition of work... emergency response work to local firms (e.g., unnecessarily broad scopes of work or long periods of...

The Inquisition: A Parody for Christian Student Evaluation

ERIC Educational Resources Information Center

Rovai, Alfred P.; Kohns, Jonathan W.; Kelly, Henry F.; Rhea, Nancy E.

2007-01-01

The present phenomenological case study examined the experiences of 21 faculty members at a Christian university regarding anonymous student evaluations that include destructive criticism that tear down rather than edify their professor and use unnecessarily harsh words. The study revealed that most student criticism of teaching is instructive in…

36 CFR 1004.22 - Unsafe operation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 1004.22 Parks, Forests, and Public Property PRESIDIO TRUST VEHICLES AND TRAFFIC SAFETY § 1004.22..., traffic, weather, road and light conditions and road character. (2) Operating a motor vehicle in a manner which unnecessarily causes its tires to squeal, skid or break free of the road surface. (3) Failing to...

Representations for Semantic Learning Webs: Semantic Web Technology in Learning Support

ERIC Educational Resources Information Center

Dzbor, M.; Stutt, A.; Motta, E.; Collins, T.

2007-01-01

Recent work on applying semantic technologies to learning has concentrated on providing novel means of accessing and making use of learning objects. However, this is unnecessarily limiting: semantic technologies will make it possible to develop a range of educational Semantic Web services, such as interpretation, structure-visualization, support…

40 CFR 156.212 - Personal protective equipment statements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... respirator with MSHA/NIOSH/ approval number prefix TC-21C; or (ii) Respirator with an organic-vapor-removing... unnecessarily. (ii) Gases applied outdoors. For products that are formulated or applied as a gas (space and soil... activities outdoors, use either a respirator with an organic-vapor-removing cartridge with a prefilter...

40 CFR 156.212 - Personal protective equipment statements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... respirator with MSHA/NIOSH/ approval number prefix TC-21C; or (ii) Respirator with an organic-vapor-removing... unnecessarily. (ii) Gases applied outdoors. For products that are formulated or applied as a gas (space and soil... activities outdoors, use either a respirator with an organic-vapor-removing cartridge with a prefilter...

40 CFR 156.212 - Personal protective equipment statements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... respirator with MSHA/NIOSH/ approval number prefix TC-21C; or (ii) Respirator with an organic-vapor-removing... unnecessarily. (ii) Gases applied outdoors. For products that are formulated or applied as a gas (space and soil... activities outdoors, use either a respirator with an organic-vapor-removing cartridge with a prefilter...

40 CFR 156.212 - Personal protective equipment statements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... respirator with MSHA/NIOSH/ approval number prefix TC-21C; or (ii) Respirator with an organic-vapor-removing... unnecessarily. (ii) Gases applied outdoors. For products that are formulated or applied as a gas (space and soil... activities outdoors, use either a respirator with an organic-vapor-removing cartridge with a prefilter...

40 CFR 156.212 - Personal protective equipment statements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... respirator with MSHA/NIOSH/ approval number prefix TC-21C; or (ii) Respirator with an organic-vapor-removing... unnecessarily. (ii) Gases applied outdoors. For products that are formulated or applied as a gas (space and soil... activities outdoors, use either a respirator with an organic-vapor-removing cartridge with a prefilter...

A Liberal Sexual Ethics for Adolescence? Jan Steutel's View as a Starting Point

ERIC Educational Resources Information Center

Tellings, A.

2009-01-01

In this article Jan Steutel's paper "Towards a sexual ethics for adolescence" is discussed. It is argued that his dichotomous conception of "child" versus "adult" unnecessarily limits his conception of "adolescence", with unfortunate consequences for the answers to his research questions. Steutel's treatment…

Twenty-Second Lunar and Planetary Science Conference

NASA Technical Reports Server (NTRS)

1991-01-01

The papers in this collection were written for general presentation, avoiding jargon and unnecessarily complex terms. Some of the topics covered include: planetary evolution, planetary satellites, planetary composition, planetary surfaces, planetary geology, volcanology, meteorite impacts and composition, and cosmic dust. Particular emphasis is placed on Mars and the Moon.

Advantages and disadvantages of unstructured cardiovascular risk factor screening for follow-up in primary care.

PubMed

de Boer, Anna W; de Mutsert, Renée; den Heijer, Martin; Rosendaal, Frits R; Jukema, Johan W; Blom, Jeanet W; Numans, Mattijs E

2016-07-01

In contrast to structured, integrated risk assessment in primary care, unstructured risk factor screening outside primary care and corresponding recommendations to consult a general practitioner (GP) are often based on one abnormal value of a single risk factor. This study investigates the advantages and disadvantages of unstructured screening of blood pressure and cholesterol outside primary care. After the baseline visit of the Netherlands Epidemiology of Obesity study (population-based prospective cohort study in persons aged 45-65 years, recruited 2008-2012) all participants received a letter with results of blood pressure and cholesterol, and a recommendation to consult a GP if results were abnormal. Four years after the start of the study, participants received a questionnaire about the follow-up of their results. The study population consisted of 6343 participants, 48% men, mean age 56 years, mean body mass index 30 kg/m(2). Of all participants 66% had an abnormal result and, of these, 49% had a treatment indication based on the risk estimation system SCORE-NL 2006. Of the 25% of the participants who did not consult a GP, 40% had a treatment indication. Of the participants with an abnormal result 19% were worried, of whom 60% had no treatment indication. In this population 51% of the participants with an abnormal result had unnecessarily received a recommendation to consult a GP, and 10% were unnecessarily worried. GPs should be informed about the complete risk assessment, and only participants at intermediate or high risk should receive a recommendation to consult a GP. © The European Society of Cardiology 2015.

Types of Mathematics-Language Reading Interactions that Unnecessarily Hinder Algebra Learning and Assessment

ERIC Educational Resources Information Center

Lager, Carl A.

2006-01-01

English language learners (ELLs)--one of the lowest-achieving and fastest growing middle-school subpopulations--are challenged in the classroom by language components which could potentially jumpstart real mathematical growth for these and, eventually, all other students as well. Going beyond traditional word problems, this study documented and…

Engaging in Vocabulary Learning in Science: The Promise of Multimodal Instruction

ERIC Educational Resources Information Center

Townsend, Dianna; Brock, Cynthia; Morrison, Jennifer D.

2018-01-01

To a science 'outsider', science language often appears unnecessarily technical and dense. However, scientific language is typically used with the goal of being concise and precise, which allows those who regularly participate in scientific discourse communities to learn from each other and build upon existing scientific knowledge. One essential…

Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg.

PubMed

Fleming, Geoffrey M; Remenapp, Robert T; Bartlett, Robert H; Annich, Gail M

2006-05-01

To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg. Retrospective cohort study of all neonatal and pediatric patients < 10 kg placed on ECLS from May 1998 to April 2001. Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit. Initiation of ECLS in infants < 10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.

High speed and adaptable error correction for megabit/s rate quantum key distribution.

PubMed

Dixon, A R; Sato, H

2014-12-02

Quantum Key Distribution is moving from its theoretical foundation of unconditional security to rapidly approaching real world installations. A significant part of this move is the orders of magnitude increases in the rate at which secure key bits are distributed. However, these advances have mostly been confined to the physical hardware stage of QKD, with software post-processing often being unable to support the high raw bit rates. In a complete implementation this leads to a bottleneck limiting the final secure key rate of the system unnecessarily. Here we report details of equally high rate error correction which is further adaptable to maximise the secure key rate under a range of different operating conditions. The error correction is implemented both in CPU and GPU using a bi-directional LDPC approach and can provide 90-94% of the ideal secure key rate over all fibre distances from 0-80 km.

High speed and adaptable error correction for megabit/s rate quantum key distribution

PubMed Central

Dixon, A. R.; Sato, H.

2014-01-01

Quantum Key Distribution is moving from its theoretical foundation of unconditional security to rapidly approaching real world installations. A significant part of this move is the orders of magnitude increases in the rate at which secure key bits are distributed. However, these advances have mostly been confined to the physical hardware stage of QKD, with software post-processing often being unable to support the high raw bit rates. In a complete implementation this leads to a bottleneck limiting the final secure key rate of the system unnecessarily. Here we report details of equally high rate error correction which is further adaptable to maximise the secure key rate under a range of different operating conditions. The error correction is implemented both in CPU and GPU using a bi-directional LDPC approach and can provide 90–94% of the ideal secure key rate over all fibre distances from 0–80 km. PMID:25450416

Health-risk based approach to setting drinking water standards for long-term space missions

NASA Technical Reports Server (NTRS)

Macler, Bruce A.; Dunsky, Elizabeth C.

1992-01-01

In order to develop plausible and appropriate drinking water contaminant standards for longer-term NASA space missions, such as those planned for the Space Exploration Initiative, a human health risk characterization was performed using toxicological and exposure values typical of space operations and crew. This risk characterization showed that the greatest acute waterborne health concern was from microbial infection leading to incapacitating gastrointestinal illness. Ingestion exposure pathways for toxic materials yielded de minimus acute health risks unlikely to affect SEI space missions. Risks of chronic health problems were within acceptable public health limits. Our analysis indicates that current Space Station Freedom maximum contamination levels may be unnecessarily strict. We propose alternative environmental contaminant values consistent with both acceptable short and long-term crew health safety.

Clinical practices in neonatal oxygenation: where have we failed? What can we do?

PubMed

Sola, A; Saldeño, Y P; Favareto, V

2008-05-01

Oxygen is among the most frequently used therapies in neonates worldwide. Nevertheless, many times it is used unnecessarily. Neonatal practices have changed over the last several years; treatments originally believed to be beneficial have been discarded. Oxygen utilized 'just in case' or 'prophylactically' can lead to great damage previously ignored and/or unseen by healthcare providers. It is imperative to improve education on neonatal oxygenation and saturation monitoring. It is also important not to depend on old assumptions, which were not based on evidences. The potential for unseen damage at the cellular and tissue levels cannot be ignored. Therapies that prove to be outdated or even dangerous must be eliminated while further research and confirmation of the best practices are determined. Freedom to choose can come at a price.

The cost of postabortion care and legal abortion in Colombia.

PubMed

Prada, Elena; Maddow-Zimet, Isaac; Juarez, Fatima

2013-09-01

Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

A preliminary, qualitative exploration of the influences associated with drop-out from cognitive-behavioural therapy for problem gambling: an Australian perspective.

PubMed

Dunn, Kirsten; Delfabbro, Paul; Harvey, Peter

2012-06-01

It has been estimated that 80% of Australians engage in some form of gambling, with approximately 115,000 Australians experiencing severe problems (Productivity Commission 2010). Very few people with problem gambling seek help and, of those who do, large numbers drop-out of therapy before completing their program. To gain insights into these problems, participants who had either completed or withdrawn prematurely from an individual CBT-based problem gambling treatment program were interviewed to examine factors predictive of premature withdrawal from therapy as well as people's 'readiness' for change. The results indicated that there might be some early indicators of risk for early withdrawal. These included: gambling for pleasure or social interaction; non-compliance with homework tasks; gambling as a strategy to avoid personal issues or dysphoric mood; high levels of guilt and shame; and a lack of readiness for change. The study further showed that application of the term 'drop-out' to some clients may be an unnecessarily negative label in that a number appear to have been able to reduce their gambling urges even after a short exposure to therapy.

Objective assessment of the effects of texting while driving: a simulator study.

PubMed

Bendak, Salaheddine

2015-01-01

Recent advances in electronic communication technology led to many drivers opting to send and receive text messages while driving. This, inevitably, has a potential to distract drivers, impair driving performance and lead to crashes. This study aims to assess the risk involved in texting while driving through assessing the distraction caused and determining the change in key driving performance indicators. Twenty-one paid young male volunteers were recruited to participate in this study. Each participant drove a driving simulator on four different scenarios involving driving while texting and without texting on highways and town roads. Results showed that texting while driving led, on average, to five times more crashes than driving without texting. Due to distraction also, participants unnecessarily crossed lane boundaries and road boundaries more often while texting as compared to driving without texting. Moreover, distraction due to texting led to participants deviating their eyes off the road while texting 15 times per session, on average, more than without texting. Results demonstrated a high-risk level of distraction and clear impairment in drivers' ability to drive safely due to texting. Based on the results, practical recommendations to combat this phenomenon are given.

New UK nickel-plated steel coins constitute an increased allergy and eczema risk.

PubMed

Julander, Anneli; Midander, Klara; Herting, Gunilla; Thyssen, Jacob P; White, Ian R; Odnevall Wallinder, Inger; Lidén, Carola

2013-06-01

Nickel-plated steel coins have recently been introduced in the United Kingdom. To compare the performance and allergy risk of the new nickel-plated coins (five and ten pence) with those of the cupro-nickel coins being replaced. Coin handling studies with assessment of skin exposure and metal release in artificial sweat were performed. Six volunteers participated. The amount of nickel deposited onto skin during the handling of nickel-plated coins for 1 hr was 7.5 µg/cm(2) , four times higher than that from cupro-nickel coins. The nickel content in the oxidized surface of nickel-plated coins was higher, explaining the higher skin dose. Initial nickel release rates were 10-27 times higher than 1-week rates, emphasizing that brief and repeated contact results in significant nickel exposure. Nickel-plated coins deposit higher levels of nickel onto skin than cupro-nickel coins, and hence pose an increased allergy risk. One-week release in artificial sweat is not suitable for determining the risk of handling items with high nickel release that come into short, repeated contact with the skin. The nickel skin dose is recommended for risk assessment. UK citizens are now, because of this change in coinage, unnecessarily exposed to higher levels of nickel on the skin. This is of public health concern. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Report on the Audit of DoD Immunity From State Taxation

DTIC Science & Technology

1991-02-15

This is our final report on the audit of DOD Immunity from State Taxation for your information and use. We made the audit from July to September 1990...The objective of the audit was to determine whether DoD was unnecessarily paying state sales taxes. We also determined if sales taxes were being

Rectifying an Honest Error in World University Rankings: A Solution to the Problem of Indicator Weight Discrepancies

ERIC Educational Resources Information Center

Soh, Kaycheng

2013-01-01

Discrepancies between the nominal and attained indicator weights misinform rank consumers as to the relative importance of the indicators. This may lead to unwarranted institutional judgements and misdirected actions, causing resources being wasted unnecessarily. As a follow-up to two earlier studies, data from the Academic Ranking of World…

Preventing Bandwidth Abuse at the Router through Sending Rate Estimate-based Active Queue Management

DTIC Science & Technology

2007-06-01

behavior is growing in the Internet. These non-responsive sources can monopolize network bandwidth and starve the “congestion friendly” flows. Without...unnecessarily complex because most of the flows in the Internet are short flows usually termed as “web mice ” [7]. Moreover, having a separate queue for each

Development Education: NGO Priorities for the Eighties. Development Education Paper No. 17.

ERIC Educational Resources Information Center

Vickers, Jeanne

Nongovernmental organizations (NGOs) have a central role to play in mobilizing the political will of governments to change the present imbalance in the distribution, consumption, and control of the world's resources. In a time of world economic crisis, millions die unnecessarily every year for lack of food, shelter, and medical care. Thirty…

Frequency of Unnecessarily Biopsies among Patients with Suspicion of Prostate Cancer in Syrian Men.

PubMed

Bachour, Dala-Maria; Chahin, Emil; Al-Fahoum, Sahar

2015-01-01

The prevalence of prostate cancer is considered high in many countries, and screening tests are very important in order to detect prostate cancer in its early stages; however false positivity with these screening tests means that a lot of patients undergo unnecessary biopsy, which is an invasive procedure, for the confirmatory test. The purpose of this study was to estimate the frequency of unnecessary biopsy cases in patients referred for prostate biopsy in one of the most important and overload cancer centers in Syria. Retrospective data for a period of four years between January 2009 and December 2012 were collected in Al- Bayrouni University Medical hospital in Damascus, Syria. The patients from whom data were collected were referred to our histopathological department because of elevated prostate specific antigen (PSA) serum or an abnormal digital rectal examination (DRE). All patients underwent prostatic TRUS-guided biopsies. Diagnosis of prostate cancer (PCa) or benign prostatic hyperplasia (BPH) was based on histopathological examination and prostate cancers cases were graded and scored according to the Gleason score system. For the 406 patients referred to biopsy, the mean±SD age was 58.4 ±23.3 years. The mean ± SD PSA level was 49.2±21.5 ng/ ml. Of the total we found 237 patients diagnosed with PCa (58. 4%), 166 patients with BPH (40.9%) and 3 cases were unable to be diagnosed (0.7%) because of biopsy collection errors. Our study shows that a high percentage of patients are undergoing unnecessary biopsy, which suggests that the performed screening tests had a high level of false positive and may need re-evaluation.

Surveillance or Self-Surveillance? Behavioral Cues Can Increase the Rate of Drivers’ Pro-Environmental Behavior at a Long Wait Stop

PubMed Central

Meleady, Rose; Abrams, Dominic; Van de Vyver, Julie; Hopthrow, Tim; Mahmood, Lynsey; Player, Abigail; Lamont, Ruth; Leite, Ana C.

2017-01-01

By leaving their engines idling for long periods, drivers contribute unnecessarily to air pollution, waste fuel, and produce noise and fumes that harm the environment. Railway level crossings are sites where many cars idle, many times a day. In this research, testing two psychological theories of influence, we examine the potential to encourage drivers to switch off their ignition while waiting at rail crossings. Two field studies presented different signs at a busy rail crossing site with a 2-min average wait. Inducing public self-focus (via a “Watching Eyes” stimulus) was not effective, even when accompanied by a written behavioral instruction. Instead, cueing a private-self focus (“think of yourself”) was more effective, doubling the level of behavioral compliance. These findings confirm the need to engage the self when trying to instigate self-regulatory action, but that cues evoking self-surveillance may sometimes be more effective than cues that imply external surveillance. PMID:29200472

The view from the tip of the iceberg.

PubMed

Josephs, L

1997-01-01

In recent years there has been a growing interest in refining the technique of ego defense analysis. All of these approaches share in common an attempt to work closely with the patient's free associations, to interpret at a level that is accessible to the patient's consciously observing ego, and to avoid bypassing the analysis of the patient's most surface-level resistances in an effort to understand unconscious conflict. These innovations reflect a commendable effort to work in a way that is rigorously empirical, that respects the patient's autonomy, and that minimizes the pressure of the analyst's transferential authority in the patient's acceptance of the analyst's interpretations. Despite the undeniable value of these technical innovations, such approaches to ego defense analysis may inadvertently result in certain overemphases in technique that may unnecessarily constrain the analytic process. They may result in a sort of obsessive tunnel vision that is overly focused on small details to the exclusion of the larger picture. An approach that counterbalances the microscopic and the macroscopic analysis of ego defense is recommended.

Changes in Serum Bicarbonate Levels Caused by Acetate-Containing Bicarbonate-Buffered Hemodialysis Solution: An Observational Prospective Cohort Study.

PubMed

Panesar, Mandip; Shah, Neal; Vaqar, Sarosh; Ivaturi, Kaushik; Gudleski, Gregory; Muscarella, Mary; Lambert, Judy; Su, Winnie; Murray, Brian

2017-04-01

Fresenius Medical Care's NaturaLyte dialysate has been associated with increased risk of sudden cardiac death by causing metabolic alkalosis from its acetate content based on retrospective data using pre-dialysis bicarbonate levels only. The study objective was to measure inter/intra-dialytic changes in serum bicarbonate and degree of alkalosis conferred by varying concentrations of NaturaLyte bicarbonate dialysate. Thirty-nine hemodialysis patients were divided into four groups based on prescribed bicarbonate dialysate concentrations; Group 1 (N = 9): 30-32 mEq/L, Group 2 (N = 5): 33-34 mEq/L, Group 3 (N = 10): 35-36 mEq/L, Group 4 (N = 15): 37-40 mEq/L. Serial (pre-dialysis, immediate post-dialysis, 2 h post-dialysis, and 68 h post-dialysis) bicarbonate levels were measured. Mean pre-dialysis serum bicarbonate levels (representing 44 h post-dialysis levels) in all four groups were not statistically different. Pre-dialysis and 68 h post-dialysis bicarbonate levels in each group were also not significantly different. However, immediate post-dialysis and 2 h post-dialysis bicarbonate levels were significantly increased in all four groups proportional to dialysate dose. There was statistically significant inter-group bicarbonate level difference (P < 0.05) except between the first and second (P = 0.43) and second and third (P = 0.07) groups in the immediate post-dialysis period. Similar results were obtained for the 2 h post-dialysis period. High bicarbonate dialysate causes large and rapid fluctuations in serum bicarbonate levels during the intra/inter-dialytic period, which returns to baseline within 44 to 68 h after dialysis. This refutes the necessity to correct pre-dialysis acidosis with high bicarbonate dialysate since rapid equilibration is likely to occur and unnecessarily exposes patients to large shifts in their acid base balance. © 2017 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

Absolute pitch memory: its prevalence among musicians and dependence on the testing context.

PubMed

Wong, Yetta Kwailing; Wong, Alan C-N

2014-04-01

Absolute pitch (AP) is widely believed to be a rare ability possessed by only a small group of gifted and special individuals (AP possessors). While AP has fascinated psychologists, neuroscientists, and musicians for more than a century, no theory can satisfactorily explain why this ability is so rare and difficult to learn. Here, we show that AP ability appears rare because of the methodological issues of the standard pitch-naming test. Specifically, the standard test unnecessarily poses a high decisional demand on AP judgments and uses a testing context that is highly inconsistent with one's musical training. These extra cognitive challenges are not central to AP memory per se and have thus led to consistent underestimation of AP ability in the population. Using the standard test, we replicated the typical findings that the accuracy for general violinists was low (12.38 %; chance level = 0 %). With identical stimuli, scoring criteria, and participants, violinists attained 25 % accuracy in a pitch verification test in which the decisional demand of AP judgment was reduced. When the testing context was increasingly similar to their musical experience, verification accuracy improved further and reached 39 %, three times higher than that for the standard test. Results were replicated with a separate group of pianists. Our findings challenge current theories about AP and suggest that the prevalence of AP among musicians has been highly underestimated in prior work. A multimodal framework is proposed to better explain AP memory.

The Beck Depression Inventory, Second Edition (BDI-II): A Cross-Sample Structural Analysis

ERIC Educational Resources Information Center

Strunk, Kamden K.; Lane, Forrest C.

2017-01-01

A common concern about the Beck Depression Inventory, Second edition (BDI-II) among researchers in the area of depression has long been the single-factor scoring scheme. Methods exist for making cross-sample comparisons of latent structure but tend to rely on estimation methods that can be imprecise and unnecessarily complex. This study presents a…

Consumer behavior: a quadrennium.

PubMed

Jacoby, J; Johar, G V; Morrin, M

1998-01-01

Consumer behavior continued to attract additional researchers and publication outlets from 1993 through 1996. Both general interest and domain-specific scholarly contributions are discussed, along with limitations and suggested areas for future research. A concluding section observes that the integrity of consumer research is unnecessarily compromised by the failure of the major scholarly association in the field to develop and adopt a code of researcher ethics.

A simplified Forest Inventory and Analysis database: FIADB-Lite

Treesearch

Patrick D. Miles

2008-01-01

This publication is a simplified version of the Forest Inventory and Analysis Data Base (FIADB) for users who do not need to compute sampling errors and may find the FIADB unnecessarily complex. Possible users include GIS specialists who may be interested only in identifying and retrieving geographic information and per acre values for the set of plots used in...

What Is Evidence-Based Practice? Research-to-Results Brief. Publication #2007-14

ERIC Educational Resources Information Center

Metz, Allison J. R.; Espiritu, Rachele; Moore, Kristin A.

2007-01-01

This brief represents part 1 in a series on fostering the adoption of evidence-based practices in out-of-school time programs. The lag between discovering effective practices and using them "on the ground" can be unnecessarily long, sometimes taking 15 to 20 years! The purpose of this brief is to provide practitioners with a better understanding…

A Time of Quiet Activism: Research, Practice, and Policy in American Women's Higher Education, 1945-1965

ERIC Educational Resources Information Center

Eisenmann, Linda

2005-01-01

This article reflects on three narratives that affected American women's participation in higher education during the first twenty years after World War II. In hindsight, the educators of the 1950s and early 1960s may seem gratuitously meek and self-effacing. In comparison to later efforts, their activism can appear unnecessarily limited and too…

Evaluating Hydrogen Evolution and Oxidation in Alkaline Media to Establish Baselines

DOE PAGES

Alia, Shaun M.; Pivovar, Bryan S.

2018-04-28

This paper fills a significant gap in the literature for alkaline hydrogen evolution (HER) and oxidation (HOR) baseline performance, while reviewing the different variables that influence observed properties. Although high-performing HER-HOR catalysts in acidic electrolytes are too active to measure kinetic in rotating disk electrode (RDE) half-cells, under alkaline conditions RDE kinetics evaluations are relevant and half-cell performances are comparable to hydrogen pump data. This paper focuses on best practices to ensure that half-cell tests don't unnecessarily lower platinum group metal (PGM) performance or improve non-PGM performance. Specific aspects examined include experiments on PGMs minimizing the impact of impurities (electrolyte,more » cell material) and experiments on non-PGMs minimizing the impact from test protocols (counter electrode).« less

Evaluating Hydrogen Evolution and Oxidation in Alkaline Media to Establish Baselines

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

Alia, Shaun M.; Pivovar, Bryan S.

This paper fills a significant gap in the literature for alkaline hydrogen evolution (HER) and oxidation (HOR) baseline performance, while reviewing the different variables that influence observed properties. Although high-performing HER-HOR catalysts in acidic electrolytes are too active to measure kinetic in rotating disk electrode (RDE) half-cells, under alkaline conditions RDE kinetics evaluations are relevant and half-cell performances are comparable to hydrogen pump data. This paper focuses on best practices to ensure that half-cell tests don't unnecessarily lower platinum group metal (PGM) performance or improve non-PGM performance. Specific aspects examined include experiments on PGMs minimizing the impact of impurities (electrolyte,more » cell material) and experiments on non-PGMs minimizing the impact from test protocols (counter electrode).« less

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice

PubMed Central

Rozel, John S.; Mulvey, Edward P.

2018-01-01

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk. PMID:28375722

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice.

PubMed

Rozel, John S; Mulvey, Edward P

2017-05-08

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk.

A Health Production Model with Endogenous Retirement

PubMed Central

Galama, Titus; Kapteyn, Arie; Fonseca, Raquel; Michaud, Pierre-Carl

2012-01-01

We formulate a stylized structural model of health, wealth accumulation and retirement decisions building on the human capital framework of health and derive analytic solutions for the time paths of consumption, health, health investment, savings and retirement. We argue that the literature has been unnecessarily restrictive in assuming that health is always at the “optimal” health level. Exploring the properties of corner solutions we find that advances in population health decrease the retirement age, while at the same time individuals retire when their health has deteriorated. This potentially explains why retirees point to deteriorating health as an important reason for early retirement, while retirement ages have continued to fall in the developed world, despite continued improvements in population health and mortality. In our model, workers with higher human capital invest more in health and because they stay healthier retire later than those with lower human capital whose health deteriorates faster. PMID:22888062

The Emperor's New Clothes II--time for regulators to wake up and take responsibility for unnecessary asthma morbidity: time for the second aerosol 'transition'.

PubMed

Everard, Mark L

2013-09-01

The rate of technological improvement continues to accelerate. Regulators in every field dealing with consumer products continue to set ever higher standards to protect consumers from adverse events and use 'recalls' to remove products that prove to be harmful from the market. In the field of medical products in general the issues of 'human factors' and 'usability' are now, quite rightly, a major issue at least among regulators in the USA. The elephant in the inhaled therapy room is of course the continued use of obsolete, portable inhalers which few patients can use effectively for the treatment of asthma. Countless studies have demonstrated that the inability of patients to use these devices effectively is a major factor in perpetuating unnecessarily high levels of morbidity. They fail to meet basic usability standards and do not incorporate the facility to provide feedback to patient and clinician. More than 20 years ago regulators deemed that pressurised metered dose inhalers containing chlorofluorocarbons should be removed from the market on environmental grounds even though their use accounted for less than 0.5% of chlorofluorocarbon use. Surely asthmatic patients require the same level of protection. Unfortunately regulators appear determined to fossilise the field in a 1950's time warp by ensuring that the failings of obsolete technology are perpetuated in any 'generic' device. The time has come for regulators to meet their obligations to 'protect the public health by assuring the safety, effectiveness, and security of drugs, vaccines and other biological products, medical devices….' and mandate the phasing out of these antiquated devices within the next decade in order to reduce the unacceptably high burden of preventable morbidity and death associated with their use.

Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing

PubMed Central

Cragun, Deborah; Kinney, Anita Y; Pal, Tuya

2017-01-01

Introduction DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert Commentary As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay. PMID:27910721

Image Dependent Relative Formation Navigation for Autonomous Aerial Refueling

DTIC Science & Technology

2011-03-01

and local variations of the Earth’s surface make a mathematical model difficult to create and use. The definition of an equipotential surface ...controlled with flight control surfaces attached to it. To refuel using this method, the receiver pilot flies the aircraft to within a defined refueling...I-frame would unnecessarily complicate aircraft navigation that, by definition, is limited to altitudes relatively close to the surface of the Earth

Hurricane Karl's Structure and Some Thoughts for 2014 Strategy

NASA Technical Reports Server (NTRS)

Cecil, Dan; Leppert, Ken, II

2014-01-01

Karl has interesting data, but far below the standards we should be able to achieve in HS3. We need to fly AV-1 over hurricanes in 2014. Most of the cold cloud shield in the inner core of hurricanes should be safe for AV-1 to fly. Significant convection occupies a small region, but we sometimes unnecessarily apply the 5000-ft separation rule to the entire cold cloud shield.

Science, bad science, and pseudoscience.

PubMed

Giuffre, M

1997-12-01

The American public is being overwhelmed with scientific sounding claims for products to be ingested and/or applied to the body that have no research support. To protect ourselves and our patients from potential harm or unnecessarily wasting their resources, we need to be aware of the problem. In addition we need to apply the standards we have learned for critiquing research to the claims made by the purveyors of these products.

Managing the Transformation: A Change Management Strategy for U.S. Marine Corps Expeditionary Energy Initiatives

DTIC Science & Technology

2017-12-01

themes into the change management narrative in preparation for the synthesis of all the information . C. SYNTHESIS With the narratives from both the...positive results. Relying on managers to synthesize and act on a large volume of information unnecessarily exposes the organization to risk, including...challenges and threats. 3. Information Flow and Intra-Organizational Relationships The management of information in the Marine Corps, specifically how it is

Improving Weather Research and Forecasting Model Initial Conditions via Surface Pressure Analysis

DTIC Science & Technology

2015-09-01

Obsgrid) that creates input data for the Advanced Research version of the Weather Research and Forecasting model ( WRF -ARW) is modified to perform a...surface pressure objective analysis to allow surface analyses of other fields to be more fully utilized in the WRF -ARW initial conditions. Nested 27-, 9...of surface pressure unnecessarily limits the application of other surface analyses into the WRF initial conditions and contributes to the creation of

Twenty-Third Lunar and Planetary Science Conference

NASA Technical Reports Server (NTRS)

1992-01-01

Presented here is a collection of papers from the Twenty-Third Lunar and Planetary Science Conference that were chosen for having the greatest potential interest for the general reading public. The presentations avoid jargon and unnecessarily complex terms. Topics covered include electron microscopy studies of a circumstellar rock, the fractal analysis of lava flows, volcanic activity on Venus, the isotopic signature of recent solar wind nitrogen, and the implications of impact crater distribution on Venus.

Nutritional disturbances in Crohn's disease.

PubMed Central

Harries, A. D.; Heatley, R. V.

1983-01-01

A wide range of nutritional disturbances may be found in patients with Crohn's disease. As more sophisticated tests become available to measure vitamin and trace element deficiencies, so these are being recognized as complications of Crohn's disease. It is important to recognize nutritional deficiencies at an early stage and initiate appropriate treatment. Otherwise many patients, experiencing what can be a chronic and debilitating illness, may suffer unnecessarily from the consequences of deprivation of vital nutrients. PMID:6359105

Development of high capacity, high rate lithium ion batteries utilizing metal fiber conductive additives

NASA Astrophysics Data System (ADS)

Ahn, Soonho; Kim, Youngduk; Kim, Kyung Joon; Kim, Tae Hyung; Lee, Hyungkeun; Kim, Myung H.

As lithium ion cells dominate the battery market, the performance improvement is an utmost concern among developers and researchers. Conductive additives are routinely employed to enhance electrode conductivity and capacity. Carbon particulates—graphite or carbon black powders—are conventional and popular choices as conductive fillers. However, percolation requirements of particles demand significant volumetric content of impalpable, and thereby high area conductive fillers. As might be expected, the electrode active surface area escalates unnecessarily, resulting in overall increase in reaction with electrolytes and organic solvents. The increased reactions usually manifest as an irreversible loss of anode capacity, gradual oxidation and consumption of electrolyte on the cathode—which causes capacity decline during cycling—and an increased threat to battery safety by gas evolution and exothermic solvent oxidation. In this work we have utilized high aspect ratio, flexible, micronic metal fibers as low active area and high conductivity additives. The metal fibers appear well dispersed within the electrode and to satisfy percolation requirements very efficiently at very low volumetric content compared to conventional carbon-based conductive additives. Results from 18650-type cells indicate significant enhancements in electrode capacity and high rate capability while the irreversible capacity loss is negligible.

Cleft lift procedure for pilonidal disease: technique and perioperative management.

PubMed

Favuzza, J; Brand, M; Francescatti, A; Orkin, B

2015-08-01

Pilonidal disease is a common condition affecting young patients. It is often disruptive to their lifestyle due to recurrent abscesses or chronic wound drainage. The most common surgical treatment, "cystectomy," removes useful tissue unnecessarily and does not address the etiology of the condition. Herein, we describe the etiology of pilonidal disease and our technique for definitive management of pilonidal disease using the cleft lift procedure. In this paper, we present our method of performing the cleft lift procedure for pilonidal disease including perioperative management and surgical technique. We have used the cleft lift procedure in nearly 200 patients with pilonidal disease, in both primary and salvage procedures settings. It has been equally successful in both settings with a high rate of success. It results in a closed wound with relatively minimal discomfort and straightforward wound care. We have described our current approach to recurrent and complex pilonidal disease using the cleft lift procedure. Once learned, the cleft lift procedure is a straightforward and highly successful solution to a chronic and challenging condition.

Impact of high-risk conjunctions on Active Debris Removal target selection

NASA Astrophysics Data System (ADS)

Lidtke, Aleksander A.; Lewis, Hugh G.; Armellin, Roberto

2015-10-01

Space debris simulations show that if current space launches continue unchanged, spacecraft operations might become difficult in the congested space environment. It has been suggested that Active Debris Removal (ADR) might be necessary in order to prevent such a situation. Selection of objects to be targeted by ADR is considered important because removal of non-relevant objects will unnecessarily increase the cost of ADR. One of the factors to be used in this ADR target selection is the collision probability accumulated by every object. This paper shows the impact of high-probability conjunctions on the collision probability accumulated by individual objects as well as the probability of any collision occurring in orbit. Such conjunctions cannot be predicted far in advance and, consequently, not all the objects that will be involved in such dangerous conjunctions can be removed through ADR. Therefore, a debris remediation method that would address such events at short notice, and thus help prevent likely collisions, is suggested.

Nightmares: from anxiety symptom to sleep disorder.

PubMed

Spoormaker, Victor I; Schredl, Michael; van den Bout, Jan

2006-02-01

The DSM-IV-TR definition of nightmares-extremely frightening dreams from which the person wakes up directly-is unnecessarily narrow. Other emotions (anger, grief) have also been reported in nightmares, and direct awakening from a bad dream seems to be unrelated to increased distress. In addition, assessment of nightmares is problematic. Polysomnographic recordings have an ameliorating effect on nightmare frequency, retrospective measurements tend to underestimate nightmare frequency, and persons with frequent nightmares may feel reluctant to fill out (daily) prospective measurements. For studying nightmares, it is necessary to distinguish idiopathic nightmares from posttraumatic nightmares, which are part of a posttraumatic stress reaction or disorder that may result from experiencing a traumatic event. Both types of nightmares have been associated with an elevated level of periodic limb movements, although only posttraumatic nightmares seem to be related to more and longer nocturnal awakenings. Nightmares have also been repeatedly associated with the general level of psychopathology, or the so-called personality factor neuroticism. Nightmare distress, the impact on daily functioning caused by nightmares, may function as a mediating variable. Several studies in the last decades have shown that nightmares can be treated with several cognitive-behavioral techniques. The cognitive-restructuring technique imagery rehearsal therapy is the treatment of choice for nightmares, although a randomized controlled trial with an attention control-group has not yet been carried out. Nightmares are more than a symptom of a larger (anxiety) syndrome and need to be viewed from a sleep medicine perspective: nightmares are a highly prevalent and separate sleep disorder that can and should receive specific treatment.

Mathematical programming for the efficient allocation of health care resources.

PubMed

Stinnett, A A; Paltiel, A D

1996-10-01

Previous discussions of methods for the efficient allocation of health care resources subject to a budget constraint have relied on unnecessarily restrictive assumptions. This paper makes use of established optimization techniques to demonstrate that a general mathematical programming framework can accommodate much more complex information regarding returns to scale, partial and complete indivisibility and program interdependence. Methods are also presented for incorporating ethical constraints into the resource allocation process, including explicit identification of the cost of equity.

Positive "alveolar" responses to antigen inhalation provocation tests: their validity and recognition.

PubMed Central

Hendrick, D J; Marshall, R; Faux, J A; Krall, J M

1980-01-01

The validity of inhalation tests in the investigation of extrinsic allergic alveolitis was assessed from the results of 144 antigen and control tests in 31 subjects. A definitive pattern of positive late responses was observed. Reactions to nebulised bird serum and droppings in subjects with bird fancier's lung were identical to reactions after "natural" exposures in aviaries or lofts, and to reactions after "occupational" challenges in subjects with farmer's lung and mushroom worker's lung. In general, positive tests were easily recognised subjectively from symptoms and signs appropriate to an influenza-like illness and undue respiratory effort on exercise. They were associated with significant changes in six readily available objective monitoring measurements--exercise minute ventilation (greater than or equal to +15%), body temperature (> 37.2 degrees C), circulating neutrophils (greater than or equal to +2500/mm3), exercise respiratory frequency (greater than or equal to +25%), circulating lymphocytes (greater than ore equal to -500/mm3 with lymphopenia), and forced vital capacity (greater than or equal to -15%). These confirmatory monitoring tests had specificities of approximately 95% and sensitivities of 85-48%. Measurement of diffusing capacity, lung volume subdivisions, or resting minute ventilation/respiratory frequency proved to be too insensitive to be useful, as did auscultation and chest radiography. We conclude that responses that do provoke significant changes in these less sensitive tests are unnecessarily distressing and, presumable, unnecessarily hazardous. PMID:7434297

Metabolomics Guides Rational Development of a Simplified Cell Culture Medium for Drug Screening against Trypanosoma brucei

PubMed Central

Creek, Darren J.; Nijagal, Brunda; Kim, Dong-Hyun; Rojas, Federico; Matthews, Keith R.

2013-01-01

In vitro culture methods underpin many experimental approaches to biology and drug discovery. The modification of established cell culture methods to make them more biologically relevant or to optimize growth is traditionally a laborious task. Emerging metabolomic technology enables the rapid evaluation of intra- and extracellular metabolites and can be applied to the rational development of cell culture media. In this study, untargeted semiquantitative and targeted quantitative metabolomic analyses of fresh and spent media revealed the major nutritional requirements for the growth of bloodstream form Trypanosoma brucei. The standard culture medium (HMI11) contained unnecessarily high concentrations of 32 nutrients that were subsequently removed to make the concentrations more closely resemble those normally found in blood. Our new medium, Creek's minimal medium (CMM), supports in vitro growth equivalent to that in HMI11 and causes no significant perturbation of metabolite levels for 94% of the detected metabolome (<3-fold change; α = 0.05). Importantly, improved sensitivity was observed for drug activity studies in whole-cell phenotypic screenings and in the metabolomic mode of action assays. Four-hundred-fold 50% inhibitory concentration decreases were observed for pentamidine and methotrexate, suggesting inhibition of activity by nutrients present in HMI11. CMM is suitable for routine cell culture and offers important advantages for metabolomic studies and drug activity screening. PMID:23571546

Performance comparison for Barnes model 12-1000, Exotech model 100, and Ideas Inc. Biometer Mark 2

NASA Technical Reports Server (NTRS)

Robinson, B. (Principal Investigator)

1981-01-01

Results of tests show that all channels of all instruments, except channel 3 of the Biometer Mark 2, were stable in response to input signals were linear, and were adequately stable in response to temperature changes. The Biometer Mark 2 is labelled with an inappropriate description of the units measured and the dynamic range is a inappropriate for field measurements causing unnecessarily high fractional errors. This instrument is, therefore, quantization limited. The dynamic range and noise performance of the Model 12-1000 are appropriate for remote sensing field research. The field of view and performance of the Model 100A and the Model 12-1000 are satisfactory. The Biometer Mark 2 has not, as yet, been satisfactorily equipped with an acceptable field of view determining device. Neither the widely used aperture plate nor the 24 deg cone are acceptable.

Autonomous spatially adaptive sampling in experiments based on curvature, statistical error and sample spacing with applications in LDA measurements

NASA Astrophysics Data System (ADS)

Theunissen, Raf; Kadosh, Jesse S.; Allen, Christian B.

2015-06-01

Spatially varying signals are typically sampled by collecting uniformly spaced samples irrespective of the signal content. For signals with inhomogeneous information content, this leads to unnecessarily dense sampling in regions of low interest or insufficient sample density at important features, or both. A new adaptive sampling technique is presented directing sample collection in proportion to local information content, capturing adequately the short-period features while sparsely sampling less dynamic regions. The proposed method incorporates a data-adapted sampling strategy on the basis of signal curvature, sample space-filling, variable experimental uncertainty and iterative improvement. Numerical assessment has indicated a reduction in the number of samples required to achieve a predefined uncertainty level overall while improving local accuracy for important features. The potential of the proposed method has been further demonstrated on the basis of Laser Doppler Anemometry experiments examining the wake behind a NACA0012 airfoil and the boundary layer characterisation of a flat plate.

The practice of nursing research: getting ready for 'ethics' and the matter of character.

PubMed

Sellman, Derek

2016-03-01

Few would argue with the idea that nursing research should be conducted ethically yet obtaining ethical approval is considered by many to have become unnecessarily burdensome. This brief article investigates the idea that there might be a relationship between the level of perceived burdensomeness of the research ethics application process on the one hand and the character of the nurse-researcher on the other. Given that nurses are required to be other-regarding, a nurse who undertakes research primarily for self-regarding reasons would seem to be acting in ways inconsistent with the aims of nursing as set out in nursing codes. It is suggested that the self-regarding nurse-researcher may find the ethics application process more burdensome than the other-regarding nurse-researcher who, it is further suggested, is engaged with nursing research as a practice in the technical sense in which that term has been developed by the philosopher Alasdair MacIntyre. © 2015 John Wiley & Sons Ltd.

Interpretations of quantum mechanics, joint measurement of incompatible observables, and counterfactual definiteness

NASA Astrophysics Data System (ADS)

de Muynck, W. M.; de Baere, W.; Martens, H.

1994-12-01

The validity of the conclusion to the nonlocality of quantum mechanics, accepted widely today as the only reasonable solution to the EPR and Bell issues, is questioned and criticized. Arguments are presented which remove the compelling character of this conclusion and make clear that it is not the most obvious solution. Alternative solutions are developed which are free of the contradictions related with the nonlocality conclusion. Firstly, the dependence on the adopted interpretation is shown, with the conclusion that the alleged nonlocality property of the quantum formalism may have been reached on the basis of an interpretation that is unnecessarily restrictive. Secondly, by extending the conventional quantum formalism along the lines of Ludwig and Davies it is shown that the Bell problem may be related to complementarity rather than to nonlocality. Finally, the dependence on counterfactual reasoning is critically examined. It appears that locality on the quantum level may still be retained provided one accepts a newly proposed principle of nonreproducibility at the individual quantum level as an alternative of quantum nonlocality. It is concluded that the locality principle can retain its general validity, in full conformity with all experimental data.

Population-reaction model and microbial experimental ecosystems for understanding hierarchical dynamics of ecosystems.

PubMed

Hosoda, Kazufumi; Tsuda, Soichiro; Kadowaki, Kohmei; Nakamura, Yutaka; Nakano, Tadashi; Ishii, Kojiro

2016-02-01

Understanding ecosystem dynamics is crucial as contemporary human societies face ecosystem degradation. One of the challenges that needs to be recognized is the complex hierarchical dynamics. Conventional dynamic models in ecology often represent only the population level and have yet to include the dynamics of the sub-organism level, which makes an ecosystem a complex adaptive system that shows characteristic behaviors such as resilience and regime shifts. The neglect of the sub-organism level in the conventional dynamic models would be because integrating multiple hierarchical levels makes the models unnecessarily complex unless supporting experimental data are present. Now that large amounts of molecular and ecological data are increasingly accessible in microbial experimental ecosystems, it is worthwhile to tackle the questions of their complex hierarchical dynamics. Here, we propose an approach that combines microbial experimental ecosystems and a hierarchical dynamic model named population-reaction model. We present a simple microbial experimental ecosystem as an example and show how the system can be analyzed by a population-reaction model. We also show that population-reaction models can be applied to various ecological concepts, such as predator-prey interactions, climate change, evolution, and stability of diversity. Our approach will reveal a path to the general understanding of various ecosystems and organisms. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Postpartum maternal separation anxiety, overprotective parenting, and children's social-emotional well-being: longitudinal evidence from an Australian cohort.

PubMed

Cooklin, Amanda R; Giallo, Rebecca; D'Esposito, Fabrizio; Crawford, Sharinne; Nicholson, Jan M

2013-08-01

Postpartum maternal separation anxiety refers to a mothers' experience of worry and concern about leaving her child for short-term separations. The long-term effects of high maternal separation anxiety on maternal parenting behaviors and child outcomes have been not been established empirically. The aim of this study was to ascertain the prospective relationships between maternal separation anxiety during the child's first year of life, and overprotective parenting and children's social and emotional functioning at age 2-3 years. Structural equation modeling with a large representative cohort of Australian mother-child dyads (N = 3,103) indicated that high maternal separation anxiety was associated with more overprotective parenting behaviors and poorer child socioemotional functioning at age 2-3 years. Findings suggest women with high postpartum maternal separation anxiety may sustain this vigilance across the first years following birth, promoting overprotective behaviors, and resulting in increased behavior problems in their children. Support for women around negotiating separation from their children early in parenthood may prevent the establishment of a repertoire of parenting behaviors that includes unnecessarily high vigilance, monitoring, and anxiety about separation. © 2013 American Psychological Association

Developing an Operational and Tactical Methodology for Incorporating Existing Technologies to Produce the Highest Probability of Detecting an Individual Wearing an IED

DTIC Science & Technology

2010-06-01

The public response to the tactical use of suicide bombing depends on how the tactic is used by the insurgent organizations, against whom, and...people from unnecessarily getting hurt. If the goal is to pull aside potential suspects and conduct further searches, then a less certain or...a significant question to security forces. How do you stop a suicide bomber on his way to the target? Individuals who carry improvised explosives

Supporting the Maritime Information Dominance: Optimizing Tactical Network for Biometric Data Sharing in Maritime Interdiction Operations

DTIC Science & Technology

2015-03-01

information dominance in the maritime domain by optimizing tactical mobile ad hoc network (MANET) systems for wireless sharing of biometric data in maritime interdiction operations (MIO). Current methods for sharing biometric data in MIO are unnecessarily slow and do not leverage wireless networks at the tactical edge to maximize information dominance . Field experiments allow students to test wireless MANETs at the tactical edge. Analysis is focused on determining optimal MANET design and implementation. It considers various implementations with

Do you know your business associates?

PubMed

Hinkley, Gerald M; Glitz, Rachel; Hirsch, W Reece

2003-01-01

HIPAA's business associate rules require covered entities to identify their business associates and enter into contracts with them to safeguard the privacy of individually identifiable health information. Covered entities need to determine who their business associates are and whether exceptions apply. Covered entities need to examine their business associate contracts to ensure that the contracts contain provisions required by HIPAA. Covered entities should not enter into business associate contracts unnecessarily. Existing business associate contracts are subject to a transition period for compliance with HIPAA.

Lowered reference limits for hCG improve follow-up of patients with hCG-producing tumors.

PubMed

Nome, Ragnhild V; Bjøro, Trine; Paus, Elisabeth; Bjerner, Johan; Fosså, Sophie D; Steen, Rita; Nustad, Kjell; Bolstad, Nils

2018-02-01

Human Chorionic Gonadotropin (hCG) is produced by germ cell tumors, but can also be elevated in benign conditions such as primary hypogonadism, where hCG is produced by the pituitary gland. In our experience, the reference limits for hCG (Elecsys hCG+β-assay, Roche Diagnostics), were unnecessarily high and did not reflect levels encountered in clinical practice. We wanted to establish new reference limits to increase the clinical utility of the hCG-assay. We analysed hCG in serum samples from a healthy adult population and in a cohort of testicular cancer survivors. The gonadotropins LH and FSH were measured in the cohort and in a selection of the reference population to assess gonadal function. We found low hCG levels for all men and women <45years (97.5 percentiles 0.1 and 0.2IU/L, respectively) from the healthy population (n=795) having normal FSH and LH. Due to assay limitations, we suggest a common reference limit of <0.3IU/L. For the age group ≥45, the 97.5 percentiles in the healthy population were 0.5IU/L for men and 6.0IU/L for women. In all subjects from both the reference population and the cohort (n=732), hCG levels exceeding the reference limit could be fully explained by reduced gonadal function indicated by elevated LH and FSH levels. The Elecsys hCG+β-assay should have lower reference limits than recommended by the manufacturer, with important implications for tumor follow-up. Elevated hCG is rare with intact gonadal function, both in a normal population and among survivors of testicular cancer, and should lead to further investigations when encountered in clinical practice. Copyright © 2017 Oslo University Hospital. Published by Elsevier Inc. All rights reserved.

Comparison of sampling methodologies for nutrient monitoring in streams: uncertainties, costs and implications for mitigation

NASA Astrophysics Data System (ADS)

Audet, J.; Martinsen, L.; Hasler, B.; de Jonge, H.; Karydi, E.; Ovesen, N. B.; Kronvang, B.

2014-07-01

Eutrophication of aquatic ecosystems caused by excess concentrations of nitrogen and phosphorus may have harmful consequences for biodiversity and poses a health risk to humans via the water supplies. Reduction of nitrogen and phosphorus losses to aquatic ecosystems involves implementation of costly measures, and reliable monitoring methods are therefore essential to select appropriate mitigation strategies and to evaluate their effects. Here, we compare the performances and costs of three methodologies for the monitoring of nutrients in rivers: grab sampling, time-proportional sampling and passive sampling using flow proportional samplers. Assuming time-proportional sampling to be the best estimate of the "true" nutrient load, our results showed that the risk of obtaining wrong total nutrient load estimates by passive samplers is high despite similar costs as the time-proportional sampling. Our conclusion is that for passive samplers to provide a reliable monitoring alternative, further development is needed. Grab sampling was the cheapest of the three methods and was more precise and accurate than passive sampling. We conclude that although monitoring employing time-proportional sampling is costly, its reliability precludes unnecessarily high implementation expenses.

Comparison of sampling methodologies for nutrient monitoring in streams: uncertainties, costs and implications for mitigation

NASA Astrophysics Data System (ADS)

Audet, J.; Martinsen, L.; Hasler, B.; de Jonge, H.; Karydi, E.; Ovesen, N. B.; Kronvang, B.

2014-11-01

Eutrophication of aquatic ecosystems caused by excess concentrations of nitrogen and phosphorus may have harmful consequences for biodiversity and poses a health risk to humans via water supplies. Reduction of nitrogen and phosphorus losses to aquatic ecosystems involves implementation of costly measures, and reliable monitoring methods are therefore essential to select appropriate mitigation strategies and to evaluate their effects. Here, we compare the performances and costs of three methodologies for the monitoring of nutrients in rivers: grab sampling; time-proportional sampling; and passive sampling using flow-proportional samplers. Assuming hourly time-proportional sampling to be the best estimate of the "true" nutrient load, our results showed that the risk of obtaining wrong total nutrient load estimates by passive samplers is high despite similar costs as the time-proportional sampling. Our conclusion is that for passive samplers to provide a reliable monitoring alternative, further development is needed. Grab sampling was the cheapest of the three methods and was more precise and accurate than passive sampling. We conclude that although monitoring employing time-proportional sampling is costly, its reliability precludes unnecessarily high implementation expenses.

Support vector machine incremental learning triggered by wrongly predicted samples

NASA Astrophysics Data System (ADS)

Tang, Ting-long; Guan, Qiu; Wu, Yi-rong

2018-05-01

According to the classic Karush-Kuhn-Tucker (KKT) theorem, at every step of incremental support vector machine (SVM) learning, the newly adding sample which violates the KKT conditions will be a new support vector (SV) and migrate the old samples between SV set and non-support vector (NSV) set, and at the same time the learning model should be updated based on the SVs. However, it is not exactly clear at this moment that which of the old samples would change between SVs and NSVs. Additionally, the learning model will be unnecessarily updated, which will not greatly increase its accuracy but decrease the training speed. Therefore, how to choose the new SVs from old sets during the incremental stages and when to process incremental steps will greatly influence the accuracy and efficiency of incremental SVM learning. In this work, a new algorithm is proposed to select candidate SVs and use the wrongly predicted sample to trigger the incremental processing simultaneously. Experimental results show that the proposed algorithm can achieve good performance with high efficiency, high speed and good accuracy.

Research Required for the Effective Implementation of the Framework Convention on Tobacco Control, Articles 9 and 10

PubMed Central

2013-01-01

This paper is part of a series of articles intended to set out the research questions that are relevant to the successful implementation of the various provisions of the Framework Convention on Tobacco Control (FCTC). This paper focuses on issues affecting Articles 9 and 10 of the FCTC. This paper focuses on the research that is most important for most countries, rather than on what is desirable in countries with high levels of research capacity. Articles 9 and 10 of the FCTC address the regulation of contents and emissions of tobacco products and regulation of tobacco product disclosure. Such regulation will be essential if the long-term objective of reducing the danger of tobacco products is to be achieved. There are many components of tobacco and tobacco smoke that are excessively toxic and dangerous to the user. Many of these components are carcinogenic and addictive and can be removed or reduced substantially with current known technology. The fact that these components remain in tobacco and tobacco smoke at levels that are unnecessarily dangerous is precisely the reason why the successful implementation of Articles 9 and 10 of the FCTC is important to tobacco control. This paper discusses the scientific challenges involved in successfully implementing Articles 9 and 10 of the FCTC, which focuses on regulating carcinogens and toxins in tobacco and tobacco smoke, the abuse liability of tobacco products, and the additives and engineering features in tobacco products that make tobacco products appealing to future consumers. The research issues we focus on are those required to support the early stages of regulation. As regulation proceeds, new and more sophisticated research questions will undoubtedly emerge. PMID:23024247

Cellular effects of acute exposure to high peak power microwave systems: Morphology and toxicology.

PubMed

Ibey, Bennett L; Roth, Caleb C; Ledwig, Patrick B; Payne, Jason A; Amato, Alayna L; Dalzell, Danielle R; Bernhard, Joshua A; Doroski, Michael W; Mylacraine, Kevin S; Seaman, Ronald L; Nelson, Gregory S; Woods, Clifford W

2016-03-15

Electric fields produced by advanced pulsed microwave transmitter technology now readily exceed the Institute of Electrical and Electronic Engineers (IEEE) C.95.1 peak E-field limit of 100 kV/m, highlighting a need for scientific validation of such a specific limit. Toward this goal, we exposed Jurkat Clone E-6 human lymphocyte preparations to 20 high peak power microwave (HPPM) pulses (120 ns duration) with a mean peak amplitude of 2.3 MV/m and standard deviation of 0.1 with the electric field at cells predicted to range from 0.46 to 2.7 MV/m, well in excess of current standard limit. We observed that membrane integrity and cell morphology remained unchanged 4 h after exposure and cell survival 24 h after exposure was not statistically different from sham exposure or control samples. Using flow cytometry to analyze membrane disruption and morphological changes per exposed cell, no changes were observed in HPPM-exposed samples. Current IEEE C95.1-2005 standards for pulsed radiofrequency exposure limits peak electric field to 100 kV/m for pulses shorter than 100 ms [IEEE (1995) PC95.1-Standard for Safety Levels with Respect to Human Exposure to Electric, Magnetic and Electromagnetic Fields, 0 Hz to 300 GHz, Institute of Electrical and Electronic Engineers: Piscataway, NJ, USA]. This may impose large exclusion zones that limit HPPM technology use. In this study, we offer evidence that maximum permissible exposure of 100 kV/m for peak electric field may be unnecessarily restrictive for HPPM devices. Bioelectromagnetics. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Community preparedness for lava flows from Mauna Loa and Hualālai volcanoes, Kona, Hawai'i

USGS Publications Warehouse

Gregg, Chris E.; Houghton, Bruce F.; Paton, Douglas; Swanson, Donald A.; Johnston, David M.

2004-01-01

Lava flows from Mauna Loa and Huala??lai volcanoes are a major volcanic hazard that could impact the western portion of the island of Hawai'i (e.g., Kona). The most recent eruptions of these two volcanoes to affect Kona occurred in A.D. 1950 and ca. 1800, respectively. In contrast, in eastern Hawai'i, eruptions of neighboring Ki??lauea volcano have occurred frequently since 1955, and therefore have been the focus for hazard mitigation. Official preparedness and response measures are therefore modeled on typical eruptions of Ki??lauea. The combinations of short-lived precursory activity (e.g., volcanic tremor) at Mauna Loa, the potential for fast-moving lava flows, and the proximity of Kona communities to potential vents represent significant emergency management concerns in Kona. Less is known about past eruptions of Huala??lai, but similar concerns exist. Future lava flows present an increased threat to personal safety because of the short times that may be available for responding. Mitigation must address not only the specific characteristics of volcanic hazards in Kona, but also the manner in which the hazards relate to the communities likely to be affected. This paper describes the first steps in developing effective mitigation plans: measuring the current state of people's knowledge of eruption parameters and the implications for their safety. We present results of a questionnaire survey administered to 462 high school students and adults in Kona. The rationale for this study was the long lapsed time since the last Kona eruption, and the high population growth and expansion of infrastructure over this time interval. Anticipated future growth in social and economic infrastructure in this area provides additional justification for this work. The residents of Kona have received little or no specific information about how to react to future volcanic eruptions or warnings, and short-term preparedness levels are low. Respondents appear uncertain about how to respond to threatening lava flows and overestimate the minimum time available to react, suggesting that personal risk levels are unnecessarily high. A successful volcanic warning plan in Kona must be tailored to meet the unique situation there. ?? Springer-Verlag 2004.

A systematic literature review of the economic implications of chemotherapy-induced diarrhea and its impact on quality of life.

PubMed

Tarricone, Rosanna; Abu Koush, Dana; Nyanzi-Wakholi, Barbara; Medina-Lara, Antonieta

2016-03-01

Chemotherapy-induced diarrhea (CID) diminishes physical performance, raises anxiety and depression levels, and increases healthcare resource utilization. To understand the impact that CID has on health-related quality of life (HRQoL) and on healthcare resource utilization. Systematic searches were conducted in MEDLINE, EMBASE, DARE, and the NHS EED databases. A total of 22 articles were retrieved for full review (n=17, HRQoL; n=5 healthcare resource utilization). Only 2 studies had assessed HRQoL in patients experiencing CID, while cost studies demonstrated that CID episodes are unnecessarily expensive and can be avoided if diagnosed and treated early. Better management of CID has the potential to reduce overall economic burden and improve patients' HRQoL. Available evidence also relays the need to conduct larger studies that assess HRQoL and consider cost beyond direct medical costs in order to understand the full impact of CID on HRQoL and healthcare resource utilization. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

All-fiber, single-frequency, and single-mode Er3+:Yb3+ fiber amplifier at 1556  nm core-pumped at 1018  nm.

PubMed

Varona, Omar de; Steinke, Michael; Neumann, Jörg; Kracht, Dietmar

2018-06-01

Emerging applications, such as gravitational wave astronomy, demand single-frequency lasers with diffraction-limited emission at 1.5 μm. Fiber amplifiers have greatly evolved to fulfill these requirements. Hundreds of watts are feasible using large-mode-area and specialty fibers. However, their application in a few watts to tens of watts in monolithic systems is unnecessarily complex due to the poor commercial availability of fiber components and standard integration procedures. In this Letter we propose and experimentally demonstrate a novel and simple method to amplify single-frequency signals at 1.5 μm up to tens of watts by core-pumping single-mode Er 3+ :Yb 3+ fiber amplifiers at 1018 nm. The proof-of-principle system is tested with different active fibers, lengths, and seed power levels. Over 11 W with an efficiency of more than 48% versus launched power is achieved. Additionally, performance degradation during operation was observed for which photodarkening due to P1 defects might be an explanation.

Saliency U-Net: A regional saliency map-driven hybrid deep learning network for anomaly segmentation

NASA Astrophysics Data System (ADS)

Karargyros, Alex; Syeda-Mahmood, Tanveer

2018-02-01

Deep learning networks are gaining popularity in many medical image analysis tasks due to their generalized ability to automatically extract relevant features from raw images. However, this can make the learning problem unnecessarily harder requiring network architectures of high complexity. In case of anomaly detection, in particular, there is often sufficient regional difference between the anomaly and the surrounding parenchyma that could be easily highlighted through bottom-up saliency operators. In this paper we propose a new hybrid deep learning network using a combination of raw image and such regional maps to more accurately learn the anomalies using simpler network architectures. Specifically, we modify a deep learning network called U-Net using both the raw and pre-segmented images as input to produce joint encoding (contraction) and expansion paths (decoding) in the U-Net. We present results of successfully delineating subdural and epidural hematomas in brain CT imaging and liver hemangioma in abdominal CT images using such network.

[Mountain biking : Breezy ups and traumatic downs].

PubMed

Schueller, G

2010-05-01

For more than two decades the popularity of mountain biking as a national pastime as well as a competitive sport has been undiminished. However, its related risks are not monitored as closely as those, for example, of skiing. The injuries caused by mountain biking are specific and cannot be compared with those caused by other cycling sports. This is due not only to the characteristics of the terrain but also to the readiness to assume a higher risk compared to cycle racing.The particular value of radiology is in the acute trauma setting. Most often musculoskeletal lesions must be examined and digital radiography and MRI are the most useful techniques. Severe trauma of the cranium, face, spine, thorax and abdomen are primarily evaluated with CT, particularly in dedicated trauma centers. Therefore, radiology can play a role in the rapid diagnosis and optimal treatment of the trauma-related injuries of mountain biking. Thus, the unnecessarily high economical damage associated with mountain biking can be avoided.

BARI+: A Biometric Based Distributed Key Management Approach for Wireless Body Area Networks

PubMed Central

Muhammad, Khaliq-ur-Rahman Raazi Syed; Lee, Heejo; Lee, Sungyoung; Lee, Young-Koo

2010-01-01

Wireless body area networks (WBAN) consist of resource constrained sensing devices just like other wireless sensor networks (WSN). However, they differ from WSN in topology, scale and security requirements. Due to these differences, key management schemes designed for WSN are inefficient and unnecessarily complex when applied to WBAN. Considering the key management issue, WBAN are also different from WPAN because WBAN can use random biometric measurements as keys. We highlight the differences between WSN and WBAN and propose an efficient key management scheme, which makes use of biometrics and is specifically designed for WBAN domain. PMID:22319333

Atopic and Contact Dermatitis of the Vulva.

PubMed

Pichardo-Geisinger, Rita

2017-09-01

Pruritus, or itch, is a common vulvar complaint that is often treated empirically as a yeast infection; however, yeast infections are just one of the many conditions that can cause vulvar itch. Ignoring other conditions can prolong pruritus unnecessarily. Atopic dermatitis, irritant contact dermatitis, and allergic contact dermatitis are extremely common noninfectious causes of vulvar itch that are often underdiagnosed by nondermatologists. Identifying these conditions and treating them appropriately can significantly improve a patient's quality of life and appropriately decrease health care expenditures by preventing unnecessary additional referrals or follow-up visits and decreasing pharmaceutical costs. Copyright © 2017 Elsevier Inc. All rights reserved.

The Swiss regulatory framework for paediatric health research.

PubMed

Junod, Valerie

2008-07-01

Medical research on minors entails both risks and benefits. Under Swiss law, clinical trials on children, including nontherapeutic drug trials, are permissible. However, ethics committees must systematically verify that all clinical studies have a favorable risk-benefit profile. Additional safeguards are designed to ensure that children are not unnecessarily involved in research and that proper consent is always obtained. Federal Swiss law is undergoing revision to extend these protections beyond clinical trials to a broad array of health research. The Swiss drug agency also seeks to improve the incentives for pharmaceutical firms to develop new paediatric drugs and relevant paediatric drug labels.

An overview of the major changes in the 2002 APA Ethics Code.

PubMed

Knapp, Samuel; VandeCreek, Leon

2003-06-01

This article summarizes the major changes that were made to the 2002 Ethical Principles and Code of Conduct of the American Psychological Association. The 2002 Ethics Code retains the general format of the 1992 Ethics Code and does not radically alter the obligations of psychologists. One goal of the Ethics Committee Task Force was to reduce the potential of the Ethics Code to be used to unnecessarily punish psychologists. In addition, the revised Ethics Code expresses greater sensitivity to the needs of cultural and linguistic minorities and students. Shortcomings of the 2002 Ethics Code are discussed.

Extending the P4P agenda, part 2: how Medicare can reduce waste and improve the care of the chronically ill.

PubMed

Wennberg, John E; Fisher, Elliott S; Skinner, Jonathan S; Bronner, Kristen K

2007-01-01

The care of Americans with severe chronic illnesses is disorganized, unnecessarily costly, and undisciplined by sound clinical science. The federal government should invest in a crash program to improve the scientific basis of managing chronic illness, and the Centers for Medicare and Medicaid Services (CMS) should extend its pay-for-performance (P4P) agenda to ensure that within ten years all Americans with severe chronic illnesses have access to accountable health care organizations providing evidence-based prospective care. This paper recommends a strategy for achieving this goal.

Smoking, vaping and public health: Time to be creative.

PubMed

Sweanor, David

2016-03-16

The development of policies on vaping in health care organizations (HCOs) needs to be based on a solid understanding of science and a recognition of individual rights. It should also be seen in the broader public health context of innovative alternative nicotine delivery systems playing a key role in ending the immense devastation of combustible cigarettes. Opposition to vaping based on inaccurate and incomplete information, or fear of unlikely and avoidable hypothetical unintended consequences, will invariably cause great harm to individuals, impede rather than assist the attainment of public health objectives, and unnecessarily prolong the epidemic of cigarette-caused diseases.

[Overdiagnosis in cancer screening].

PubMed

Cervera Deval, J; Sentís Crivillé, M; Zulueta, J J

2015-01-01

In screening programs, overdiagnosis is defined as the detection of a disease that would have gone undetected without screening when that disease would not have resulted in morbimortality and was treated unnecessarily. Overdiagnosis is a bias inherent in screening and an undesired effect of secondary prevention and improved sensitivity of diagnostic techniques. It is difficult to discriminate a priori between clinically relevant diagnoses and those in which treatment is unnecessary. To minimize the effects of overdiagnosis, screening should be done in patients at risk. Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

BARI+: a biometric based distributed key management approach for wireless body area networks.

PubMed

Muhammad, Khaliq-ur-Rahman Raazi Syed; Lee, Heejo; Lee, Sungyoung; Lee, Young-Koo

2010-01-01

Wireless body area networks (WBAN) consist of resource constrained sensing devices just like other wireless sensor networks (WSN). However, they differ from WSN in topology, scale and security requirements. Due to these differences, key management schemes designed for WSN are inefficient and unnecessarily complex when applied to WBAN. Considering the key management issue, WBAN are also different from WPAN because WBAN can use random biometric measurements as keys. We highlight the differences between WSN and WBAN and propose an efficient key management scheme, which makes use of biometrics and is specifically designed for WBAN domain.

An Energy Saving System for a Beam Pumping Unit

PubMed Central

Lv, Hongqiang; Liu, Jun; Han, Jiuqiang; Jiang, An

2016-01-01

Beam pumping units are widely used in the oil production industry, but the energy efficiency of this artificial lift machinery is generally low, especially for the low-production well and high-production well in the later stage. There are a number of ways for energy savings in pumping units, with the periodic adjustment of stroke speed and rectification of balance deviation being two important methods. In the paper, an energy saving system for a beam pumping unit (ESS-BPU) based on the Internet of Things (IoT) was proposed. A total of four types of sensors, including load sensor, angle sensor, voltage sensor, and current sensor, were used to detect the operating conditions of the pumping unit. Data from these sensors was fed into a controller installed in an oilfield to adjust the stroke speed automatically and estimate the degree of balance in real-time. Additionally, remote supervision could be fulfilled using a browser on a computer or smartphone. Furthermore, the data from a practical application was recorded and analyzed, and it can be seen that ESS-BPU is helpful in reducing energy loss caused by unnecessarily high stroke speed and a poor degree of balance. PMID:27187402

Anatomy of a decision III: Evaluation of national disposal at sea program action level efficacy considering 2 chemical action levels.

PubMed

Apitz, Sabine E; Vivian, Chris; Agius, Suzanne

2017-11-01

The potential performance (i.e., ability to separate nontoxic from toxic sediments) of a range of international Disposal at Sea (DaS) chemical Action Levels (ALs) was compared using a sediment chemical and toxicological database. The use of chemistry alone (without the use of further lines of evidence) did not perform well at reducing costs and protecting the environment. Although some approaches for interpreting AL1 results are very effective at filtering out the majority of acutely toxic sediments, without subsequent toxicological assessment, a large proportion of nontoxic sediments would be unnecessarily subjected to treatment and containment, and a number of sublethally toxic sediments would be missed. Even the best tiered systems that collect and evaluate information sequentially resulted in the failure to catch at least some sublethally or acutely toxic sediments. None of the AL2s examined were particularly effective in distinguishing between non-, sublethally, or acutely toxic sediments. Thus, this review did not support the use of chemical AL2s to predict the degree to which sediments will be toxic. Integr Environ Assess Manag 2017;13:1086-1099.© 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

WE-A-BRD-01: Innovation in Radiation Therapy Planning I: Knowledge Guided Treatment Planning

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

Wu, Q; Olsen, L

2014-06-15

Intensity modulated radiation therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) offer the capability of normal tissues and organs sparing. However, the exact amount of sparing is often unknown until the plan is complete. This lack of prior guidance has led to the iterative, trial and-error approach in current planning practice. Even with this effort the search for patient-specific optimal organ sparing is still strongly influenced by planner's experience. While experience generally helps in maximizing the dosimetric advantages of IMRT/VMAT, there have been several reports showing unnecessarily high degree of plan quality variability at individual institutions and amongst different institutions,more » even with a large amount of experience and the best available tools. Further, when physician and physicist evaluate a plan, the dosimetric quality of the plan is often compared with a standard protocol that ignores individual patient anatomy and tumor characteristic variations. In recent years, developments of knowledge models for clinical IMRT/VMAT planning guidance have shown promising clinical potentials. These knowledge models extract past expert clinical experience into mathematical models that predict dose sparing references at patient-specific level. For physicians and planners, these references provide objective values that reflect best achievable dosimetric constraints. For quality assurance, applying patient-specific dosimetry requirements will enable more quantitative and objective assessment of protocol compliance for complex IMRT planning. Learning Objectives: Modeling and representation of knowledge for knowledge-guided treatment planning. Demonstrations of knowledge-guided treatment planning with a few clinical caanatomical sites. Validation and evaluation of knowledge models for cost and quality effective standardization of plan optimization.« less

A case with unexplained bleeding from multiple sites: munchausen syndrome by proxy.

PubMed

Tüfekçi, Özlem; Gözmen, Salih; Yılmaz, Şebnem; Hilkay Karapınar, Tuba; Çetin, Benhur; Burak Dursun, Onur; Emiroğlu, Neslihan; Ören, Hale; Irken, Gülersu

2011-08-01

Munchausen syndrome by proxy (MBP) is an extreme form of child abuse where children were unnecessarily treated or investigated for medical conditions that were falsified by their caregivers. Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. Extensive investigation revealed no organic etiologies for bleeding. The diagnosis of MBP was put by a multidisciplinary team. The diagnosis of MBP must be kept in mind in conditions where there is no underlying organic pathology in a bleeding patient.

75 FR 13 - Alternate Fracture Toughness Requirements for Protection Against Pressurized Thermal Shock Events

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

...The Nuclear Regulatory Commission (NRC) is amending its regulations to provide alternate fracture toughness requirements for protection against pressurized thermal shock (PTS) events for pressurized water reactor (PWR) pressure vessels. This final rule provides alternate PTS requirements based on updated analysis methods. This action is desirable because the existing requirements are based on unnecessarily conservative probabilistic fracture mechanics analyses. This action reduces regulatory burden for those PWR licensees who expect to exceed the existing requirements before the expiration of their licenses, while maintaining adequate safety, and may choose to comply with the final rule as an alternative to complying with the existing requirements.

Action, Not Rhetoric, Needed to Reverse the Opioid Overdose Epidemic.

PubMed

Davis, Corey; Green, Traci; Beletsky, Leo

2017-03-01

Despite shifts in rhetoric and some positive movement, Americans with the disease of addiction are still often stigmatized, criminalized, and denied access to evidencebased care. Dramatically reducing the number of lives unnecessarily lost to overdose requires an evidence-based, equity-focused, well-funded, and coordinated response. We present in this brief article evidence-based and promising practices for improving and refocusing the response to this simmering public health crisis. Topics covered include improving clinical decision-making, improving access to non-judgmental evidence-based treatment, investing in comprehensive public health approaches to problematic drug use, and changing the way law enforcement actors interact with people who use drugs.

[Ethical challenges of genetic manipulation and research with animals].

PubMed

Rodríguez Yunta, Eduardo

2012-01-01

Research with animals presents ethical questions both for being used as models of human diseases and for being a prerequisite for trials in humans, as in the introduction of genetic modifications. Some of these questions refer to the fact that, as models, they do not fully represent the human condition; that conducting toxicity tests causes great harm to animals; that their nature is altered by genetic modifications and that introducing genetically modified organisms is a risk. The use of animals in research for the benefit of humans imposes the moral responsibility to respect them, not making them suffer unnecessarily, since they are living beings capable of feeling.

Press abstracts of the 21st Lunar and Planetary Science Conference

NASA Technical Reports Server (NTRS)

1990-01-01

The Program Committee for the Twenty-fisrt Lunar and Planetary Science Conference has chosen these contributions as having the greatest potential interest for the general public. The papers in this collection were written for general presentation, avoiding jargon and unnecessarily complex terms. More technical abstracts will be found in Lunar and Planetary Science XXI. Representative titles are: Ancient Ocean-Land-Atmosphere Interactions on Mars: Global Model and Geological Evidence; Oxygen Isotopic Compositions of Ordinary Chondrites and Their Chondrules; Exposure Ages and Collisional History of L-Chondrite Parent Bodies; Models of Solar-Powered Geysers on Triton; and Search for Life: A Science Rationale for a Permanent Base on Mars.

Four aspects to make science open "by design" and not as an after-thought.

PubMed

Halchenko, Yaroslav O; Hanke, Michael

2015-01-01

Unrestricted dissemination of methodological developments in neuroimaging became the propelling force in advancing our understanding of brain function. However, despite such a rich legacy, it remains not uncommon to encounter software and datasets that are distributed under unnecessarily restricted terms, or that violate terms of third-party products (software or data). With this brief correspondence we would like to recapitulate four important aspects of scientific research practice, which should be taken into consideration as early as possible in the course of any project. Keeping these in check will help neuroimaging to stay at the forefront of the open science movement.

Threshold-based queuing system for performance analysis of cloud computing system with dynamic scaling

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

Shorgin, Sergey Ya.; Pechinkin, Alexander V.; Samouylov, Konstantin E.

Cloud computing is promising technology to manage and improve utilization of computing center resources to deliver various computing and IT services. For the purpose of energy saving there is no need to unnecessarily operate many servers under light loads, and they are switched off. On the other hand, some servers should be switched on in heavy load cases to prevent very long delays. Thus, waiting times and system operating cost can be maintained on acceptable level by dynamically adding or removing servers. One more fact that should be taken into account is significant server setup costs and activation times. Formore » better energy efficiency, cloud computing system should not react on instantaneous increase or instantaneous decrease of load. That is the main motivation for using queuing systems with hysteresis for cloud computing system modelling. In the paper, we provide a model of cloud computing system in terms of multiple server threshold-based infinite capacity queuing system with hysteresis and noninstantanuous server activation. For proposed model, we develop a method for computing steady-state probabilities that allow to estimate a number of performance measures.« less

Summary and critique of the new NIH guidelines for recombinant DNA research.

PubMed

Szybalski, W

1979-03-01

New NIH Guidelines for research involving recombinant DNA (R-DNA) molecules were issued on December 15, 1978. These are composed of four main parts, the first defining R-DNA and specifying prohibitions and exemptions, the second describing physical and biological containment, the third assigning the containment levels for many R-DNA experiments, and the fourth detailing the roles and responsibilities of the investigator, research institutions and NIH. Although the new Guidelines reduce restrictions, principally on those R-DNA experiments that use Escherichia coli K-12 host-vector systems, and exempt from the Guidelines several classes of experiments on prokaryotes that naturally exchange their DNA, most of their provisions are unjustified by the present assessment of the absence of any practical risks; many totally innocuous experiments are unnecessarily restricted and even virtually prohibited mainly because no host-vector systems were officially certified. The term Guidelines is a misnomer since they are mandatory regulations, even without any statutory basis. They impose large but unnecessary bureaucratic burdens on scientists, research institutions, research committees and NIH, and represent unwarranted censorship of basic research, which is antithetical to the creativity of human thought, thus posing serious dangers to the traditional freedom of inquiry.

Appropriate use of red blood cell transfusion in emergency departments: a study in five emergency departments

PubMed Central

Díaz, Manuel Quintana; Borobia, Alberto M.; García Erce, José A.; Maroun-Eid, Charbel; Fabra, Sara; Carcas, Antonio; Frías, Jesus; Muñoz, Manuel

2017-01-01

Background Transfusion of blood components continues to be an important therapeutic resource into the 21st century. Between 5 and 58% of transfusions carried out are estimated to be unnecessary. According to several studies, at least 20% of packed red blood cell transfusions (RBCT) are administered in hospital emergency departments (ED), but few data are available about the appropriateness of RBCT in this setting. This multicentre, cross-sectional observational study aims to assess the appropriateness of RBCT indications and transfused volumes in patients who attend ED. Materials and methods The study cohort is made up of consecutive consenting adult patients (≥18 years old) who received RBCT in ED over a 3-month period and for whom relevant clinical data were collected and analysed. Results Data from 908 RBCT episodes (2±1 units per transfused patient) were analysed. RBCT was considered appropriate in 21.4% (n=195), with significant differences according to RBCT indication (p<0.001), hospital level (p<0.001) and prescribing physician (p=0.002). Pre-transfusion haemoglobin level (Hb) negatively correlated with RBCT appropriateness (r=–0.616; p<0.01). Only 72.4% of appropriate RBCT had a post-transfusion Hb assessment (n=516). Of these, 45% were considered to be over-transfused (n=232), with significant differences according to RBCT indication (p=0.012) and prescribing physician (p=0.047). Overall, 584/1,433 (41%) of evaluable RBC units were unnecessarily transfused. Discussion The appropriateness of RBCT in ED is similar to other hospital departments, but the rate of over-transfusion was high. These data support the need for a reassessment after transfusion of each RBC unit before further units are prescribed. In view of these results, we recommend that physicians should be made more aware of the need to prescribe RBCT appropriately in order to reduce over-transfusion. PMID:27416566

Do patients living with ulcerative colitis adhere to healthy eating guidelines? A cross-sectional study.

PubMed

Walton, Michelle; Alaunyte, Ieva

2014-11-28

Ulcerative colitis (UC) is an inflammatory bowel disease that causes gastrointestinal lesions, bleeding, diarrhoea and nutritional complications. Insufficient nutrient intake can additionally deteriorate nutritional status. The present cross-sectional study aimed to determine whether UC patients adhere to national dietary guidelines and to assess their dietary habits. An online questionnaire (n 93) was used to assess health-related conditions, current nutritional knowledge, professional dietary guidance and food avoidance. A 24 h dietary recall (n 81) was used to assess nutrient intakes, which were then compared with the national recommended intake values. The results showed that the nutritional knowledge of participants was limited with unofficial sources being used, including websites. Numerous food groups, predominantly fibre-rich foods and fruit and vegetables, were largely avoided by the participants. Almost half of the study population eliminated foods such as dairy products to alleviate symptoms, possibly unnecessarily. Energy intakes were significantly (P< 0·05) lower than the national recommended intake values in women aged 18-65 years and men aged 18-60 years. Fat intake exceeded the national recommended intake values (P< 0·0001), at the expense of carbohydrate and fibre intakes, which were significantly (P< 0·005) lower than the national recommended intake values. Protein intake was significantly high in women aged 19-50 years (P< 0·00) and men aged 19-50 years (P< 0·005). Vitamin C, vitamin B12 and Ca intake levels were overachieved by all participants (P< 0·001), while women aged 19-50 years did not achieve their dietary Fe reference nutrient intake levels (P< 0·001). Osteopaenia, osteoporosis and anaemia were reported by 12, 6 and 31 % of the participants, respectively. Findings indicate that food avoidance may contribute to nutrient deficiencies in UC patients. Low intakes of these food groups, especially during remission, are preventing patients from adhering to dietary guidelines.

Hair and bare skin discrimination for laser-assisted hair removal systems.

PubMed

Cayir, Sercan; Yetik, Imam Samil

2017-07-01

Laser-assisted hair removal devices aim to remove body hair permanently. In most cases, these devices irradiate the whole area of the skin with a homogenous power density. Thus, a significant portion of the skin, where hair is not present, is burnt unnecessarily causing health risks. Therefore, methods that can distinguish hair regions automatically would be very helpful avoiding these unnecessary applications of laser. This study proposes a new system of algorithms to detect hair regions with the help of a digital camera. Unlike previous limited number of studies, our methods are very fast allowing for real-time application. Proposed methods are based on certain features derived from histograms of hair and skin regions. We compare our algorithm with competing methods in terms of localization performance and computation time and show that a much faster real-time accurate localization of hair regions is possible with the proposed method. Our results show that the algorithm we have developed is extremely fast (around 45 milliseconds) allowing for real-time application with high accuracy hair localization ( 96.48 %).

An Inexpensive, Point-of-Care Urine Test for Bladder Cancer in Patients Undergoing Hematuria Evaluation.

PubMed

Acharya, Abhinav P; Theisen, Kathryn M; Correa, Andres; Meyyappan, Thiagarajan; Apfel, Abraham; Sun, Tao; Tarin, Tatum V; Little, Steven R

2017-11-01

Although hematuria (blood in urine) is the most common symptom of bladder cancer, 70-98% of hematuria cases are benign. These hematuria patients unnecessarily undergo costly, invasive, and expensive evaluation for bladder cancer. Therefore, there remains a need for noninvasive office-based tests that can rapidly and reliably rule out bladder cancer in patients undergoing hematuria evaluation. Herein, a clinical assay for matrix metalloproteinases ("Ammps") is presented, which generates a visual signal based on the collagenase activity (in urine of patients) on the Ammps substrates. Ammps substrates are generated by crosslinking gelatin with Fe(II) chelated alginate nanoparticles, which precipitate in urine samples. The cleavage of gelatin-conjugated alginate (Fe(II)) nanoparticles by collagenases generates free-floating alginate (Fe(II)) nanoparticles that participate in Fenton's reaction to generate a visual signal. In a pilot study of 88 patients, Ammps had 100% sensitivity, 85% specificity, and a negative predictive value (NPV) of 100% for diagnosing bladder cancer. This high NPV can be useful in ruling out bladder cancer in patients referred for hematuria evaluation. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Noninvasive Prenatal Diagnosis of Congenital Adrenal Hyperplasia.

PubMed

Khattab, Ahmed; Yuen, Tony; Sun, Li; Yau, Mabel; Barhan, Ariella; Zaidi, Mone; Lo, Y M Dennis; New, Maria I

2016-01-01

A major hallmark of classical congenital adrenal hyperplasia (CAH) is genital ambiguity noted at birth in affected females, which leads to psychological and psychosexual issues in adult life. Attempts to correct genital ambiguity through surgical intervention have been partially successful. Fetal hyperandrogenemia and genital ambiguity have been shown to be preventable by prenatal administration of low-dose dexamethasone initiated before the 9th week of gestation. In 7 of 8 at-risk pregnancies, the unaffected fetus is unnecessarily exposed to dexamethasone for weeks until the diagnosis of classical CAH is ruled out by invasive procedures. This therapeutic dilemma calls for early prenatal diagnosis so that dexamethasone treatment can be directed to affected female fetuses only. We describe the utilization of cell-free fetal DNA in mothers carrying at-risk fetuses as early as 6 gestational weeks by targeted massively parallel sequencing of the genomic region including and flanking the CYP21A2 gene. Our highly personalized and innovative approach should permit the diagnosis of CAH before genital development begins, therefore restricting the purposeful administration of dexamethasone to mothers carrying affected females. © 2016 S. Karger AG, Basel.

How "resistant" is artemisinin resistant malaria? - The risks of ambiguity using the term "resistant" malaria.

PubMed

Hanscheid, Thomas; Hardisty, David W

2018-04-30

In scientific discourse, few would consider the widely used term resistance as ambiguous. The definition and usage of the term antimicrobial resistance revolves around the concept that microorganisms change in ways that render antimicrobial medications clinically ineffective. Because artemisinins have become the cornerstone for antimalarial therapy, the widely used term artemisinin resistance in scientific literature is highly alarming. Naturally, many people will assume that artemisinin resistance must essentially be the same as antimicrobial resistance, which means it is clinically ineffective. However, this is incorrect, and the WHO defines artemisinin resistance differently to antimicrobial resistance as "partial/relative resistance". This means that parasite clearance times are increased but does not automatically mean that artemisinins have become clinically inefficacious. Is the ambiguous use of the term resistance justified and appropriate, although it might be misleading biomedical researchers, the media, policy makers and possibly attending physicians? Science is also about clear and unambiguous use of terminology, so that a message is accurately communicated and understood. Ambiguity can lead to misunderstandings, and misunderstandings can cause wrong actions; unnecessarily so. Copyright © 2018 Elsevier Ltd. All rights reserved.

Allergic-like reactions to asparaginase: Atypical allergies without asparaginase inactivation.

PubMed

Kloos, Robin Q H; Pieters, Rob; Escherich, Gabriele; van der Sluis, Inge M

2016-11-01

Asparaginase is an important component of pediatric acute lymphoblastic leukemia (ALL) therapy. Unfortunately, this treatment is hampered by hypersensitivity reactions. In general, allergies - regardless of severity - cause complete inactivation of the drug. However, we report atypical allergic reactions without inactivation of asparaginase, here called allergic-like reactions. Patients with an allergic-like reaction, who were treated according to the Dutch Childhood Oncology Group ALL-11 or the CoALL 08-09 protocol, were described. The reactions were identified by continual measurement of asparaginase activity levels. Characteristics, including timing of occurrence, symptoms, grade, and the presence of antiasparaginase antibodies, were compared to those of real allergies. Fourteen allergic-like reactions occurred in nine patients. Five reactions were to PEGasparaginase and nine to Erwinia asparaginase. Allergic-like reactions occurred relatively late after the start of infusion compared to real allergies. Antibodies were absent in all but one patient with an allergic-like reaction, while they were detected in all patients with a real allergy. Symptoms and grade did not differ between the groups. Asparaginase was continued with the same formulation in six patients of whom four finished treatment with adequate activity levels. In conclusion, allergic-like reactions occur relatively late after the start of infusion and without antibodies. Despite these clinical differences, allergic-like reactions can only be distinguished from real allergies by continually measuring asparaginase activity levels. If clinically tolerated, formulations should not be switched in case of allergic-like reactions. Moreover, failure to recognize these reactions may lead to a less favorable prognosis if asparaginase therapy is terminated unnecessarily. © 2016 Wiley Periodicals, Inc.

Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation.

PubMed

Das, Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

2015-01-12

Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patient-specific computational simulation to analyze how three different RMs act to improve physiological responses, and investigate how different levels of PEEP contribute to maintaining effective lung recruitment. We conducted experiments on five 'virtual' ARDS patients using a computational simulator that reproduces static and dynamic features of a multivariable clinical dataset on the responses of individual ARDS patients to a range of ventilator inputs. Three recruitment maneuvers (sustained inflation (SI), maximal recruitment strategy (MRS) followed by a titrated PEEP, and prolonged recruitment maneuver (PRM)) were implemented and evaluated for a range of different pressure settings. All maneuvers demonstrated improvements in gas exchange, but the extent and duration of improvement varied significantly, as did the observed mechanism of operation. Maintaining adequate post-RM levels of PEEP was seen to be crucial in avoiding cliff-edge type re-collapse of alveolar units for all maneuvers. For all five patients, the MRS exhibited the most prolonged improvement in oxygenation, and we found that a PEEP setting of 35 cm H2O with a fixed driving pressure of 15 cm H2O (above PEEP) was sufficient to achieve 95% recruitment. Subsequently, we found that PEEP titrated to a value of 16 cm H2O was able to maintain 95% recruitment in all five patients. There appears to be significant scope for reducing the peak levels of PEEP originally specified in the MRS and hence to avoid exposing the lung to unnecessarily high pressures. More generally, our study highlights the huge potential of computer simulation to assist in evaluating the efficacy of different recruitment maneuvers, in understanding their modes of operation, in optimizing RMs for individual patients, and in supporting clinicians in the rational design of improved treatment strategies.

Consequences of climate change, eutrophication, and other anthropogenic impacts to coastal salt marshes: multiple stressors reduce resiliency and sustainability

NASA Astrophysics Data System (ADS)

Watson, E. B.; Wigand, C.; Nelson, J.; Davey, E.; Van Dyke, E.; Wasson, K.

2011-12-01

Coastal salt marshes provide a wide variety of ecosystem services, including habitat for protected vertebrates and ecologically valuable invertebrate fauna, flood protection, and improvements in water quality for adjacent marine and estuarine environments. Here, we consider the impacts of future sea level rise combined with other anthropogenic stressors to salt marsh sustainability through the implementation of field and laboratory mesocosms, manipulative experiments, correlative studies, and predictive modeling conducted in central California and southern New England salt marshes. We report on measurements of soil respiration, decomposition, sediment accumulation, and marsh elevation, which considered jointly suggest an association between nitrate input and marsh elevation loss resulting from mineralization of soil organic matter. Furthermore, use of imaging techniques (CT scans) has shown differences in belowground root and rhizome structure associated with fertilization, resulting in a loss of sediment cohesion promoted by fine root structure. Additionally, field and greenhouse mesocosm experiments have provided insight into the specific biogeochemical processes responsible for plant mortality at high immersion or salinity levels. In conclusion, we have found that poor water quality (i.e. eutrophication) leads to enhanced respiration and decomposition of soil organic matter, which ultimately contributes to a loss of salt marsh sustainability. However, marsh deterioration studied at field sites (Jamaica Bay, NY and Elkhorn Slough, CA) is associated not only with enhanced nutrient loads, but also increased immersion due to tidal range increases resulting from dredging. To ensure the continuation of the ecosystem services provided by tidal wetlands and to develop sustainable management strategies that provide favorable outcomes under a variety of future sea level rise and land use scenarios, we need to develop a better understanding of the relative impacts of the various stressors leading to salt marsh loss. Without this understanding, costly remediation may unintentionally lead to continued marsh deterioration. More research is needed to carefully document the positive and negative aspects of nutrient loading to coastal marsh sustainability in order to ensure that coastal watersheds are managed in a way that minimizes detrimental impacts to adjacent coastal habitats, while not interfering unnecessarily with important and needed public interest activities such as agriculture and wastewater discharge.

Determinants of the number of mammography units in 31 countries with significant mammography screening

PubMed Central

Autier, P; Ouakrim, D A

2008-01-01

In the 2000s, most of the female population of industrialised countries had access to mammography breast cancer screening, but with variable modalities among the countries. We assessed the number of mammography units (MUs) in 31 European, North American and Asian countries where significant mammography activity has existed for over 10 years, collecting data on the number of such units and of radiologists by contacting institutions in each country likely to provide the relevant information. Around 2004, there were 32 324 MU in 31 countries, the number per million women ranging from less than 25 in Turkey, Denmark, the Netherlands, the United Kingdom, Norway, Poland and Hungary to more than 80 in Cyprus, Italy, France, the United States and Austria. In a multivariate analysis, the number of MUs was positively associated with the number of radiologists (P=0.0081), the number of women (P=0.0023) and somewhat with the country surface area (P=0.077). There is considerable variation in the density of MU across countries and the number of MUs in service are often well above what would be necessary according to local screening recommendations. High number of MUs in some countries may have undesirable consequences, such as unnecessarily high screening frequency and decreased age at which screening is started. PMID:18781176

The economic burden of pneumonia and meningitis among children less than five years old in Hanoi, Vietnam.

PubMed

Le, Phuc; Griffiths, Ulla K; Anh, Dang D; Franzini, Luisa; Chan, Wenyaw; Pham, Ha; Swint, John M

2014-11-01

To estimate the average treatment costs of pneumonia and meningitis among children under five years of age in a tertiary hospital in Hanoi, Vietnam from societal, health sector and household perspectives. We used a cost-of-illness approach to identify cost categories to be included for different perspectives. A prospective survey was conducted among eligible patients to get detailed personal costing items. From the perspective of the health sector, the mean costs for treating a case of pneumonia and meningitis were USD 180 and USD 300, respectively. From the household's perspective, the average treatment costs were USD 272 for pneumonia and USD 534 for meningitis. When also including indirect costs, the average total treatment costs from the societal perspective were USD 318 for pneumonia and USD 727 for meningitis. The study contributed to limited evidence on the high treatment costs of pneumonia and meningitis to the Vietnamese society, which is useful for a cost-effectiveness analysis of Haemophilus influenzae type b vaccine or other relevant disease preventions. It also indicated a need to re-evaluate the health insurance policy for children under 6 years old, so that the unnecessarily high out-of-pocket costs of these diseases are reduced. © 2014 John Wiley & Sons Ltd.

White Grape Juice Elicits a Lower Breath Hydrogen Response Compared with Apple Juice in Healthy Human Subjects: A Randomized Controlled Trial.

PubMed

Erickson, Jennifer; Wang, Qi; Slavin, Joanne

2017-06-01

Diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPS) are used to manage symptoms in individuals with irritable bowel syndrome. Although effective at reducing symptoms, the diet can be complex and restrictive. In addition, there are still large gaps in the literature and many foods with unclear effects in the gastrointestinal (GI) tract, like fruit juice. Although many fruits are allowable on a low-FODMAP diet, consumption of all fruit juice is generally cautioned due to the large fructose load contained in juice, regardless of the glucose concentration. Very little research exists regarding the importance of limiting fructose load during a low-FODMAP diet; therefore, individuals following a low-FODMAP diet may be unnecessarily restricting their diets. To determine whether there is a difference in GI tolerance between juice from a high-FODMAP fruit (apple juice) and juice from a low-FODMAP fruit (white grape juice) in healthy human subjects. The goal is to provide insight into the role of juice in a low-FODMAP diet. A double-blind, randomized, controlled crossover study was conducted with 40 healthy adults. Fasted subjects consumed 12 oz of either apple juice or white grape juice. Breath hydrogen measures were taken at baseline, 1, 2, and 3 hours. Subjective GI tolerance surveys were completed at the same time intervals and at 12 and 24 hours. Breath hydrogen and GI symptoms were assessed with area under the curve analysis. Significance was determined with a two-sided t test with a P value <0.05. Consumption of apple juice resulted in a greater mean breath hydrogen area under the curve at 23.3 ppm/hour (95% CI 13.0 to 33.6) compared with white grape juice at 5.8 ppm/hour (95% CI -4.6 to 16.1) (P<0.001). No differences in reported GI symptoms were seen between treatments. Both juices were well tolerated and neither produced any severe symptoms in healthy adults. White grape juice consumption resulted in only a small rise in breath hydrogen, which may suggest excluding foods only because of the high fructose load could be unnecessarily restrictive. The results of this study suggest that the fructose-to-glucose ratio is likely more important than the total fructose load of the food when considering the acceptability of a food on a low-FODMAP diet. More research is needed in individuals with irritable bowel syndrome to determine whether white grape juice and other juices from low-FODMAP fruits could be additional beverage options for individuals following a low-FODMAP diet. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

1KW Power Transmission Using Wireless Acoustic-Electric Feed-Through (WAEF)

NASA Technical Reports Server (NTRS)

Sherrit, S.; Bao, X.; Badescu, M.; Aldrich, J.; Bar-Cohen, Y.; Biederman, W.

2008-01-01

A variety of space applications require the delivery of power into sealed structures. Since the structural integrity can be degraded by holes for cabling we present an alternative method of delivering power and information using stress waves to the internal space of a sealed structure. One particular application of this technology is in sample return missions where it is critical to preserve the sample integrity and to prevent earth contamination. Therefore, the container has to be hermetically sealed and the integrity of the seal must be monitored in order to insure to a high degree of reliability the integrity of the sample return vessel. In this study we investigated the use of piezoelectric acoustic-electric power feed-through devices to transfer electric power wirelessly through a solid wall by using elastic or acoustic waves. The technology is applicable to a range of space and terrestrial applications where power is required by electronic equipment inside sealed containers, vacuum or pressure vessels, etc., where holes in the wall are prohibitive or may result in significant structural performance degradation or unnecessarily complex designs. To meet requirements of higher power applications, the feasibility to transfer kilowatts level power was investigated. Pre-stressed longitudinal piezoelectric feed-through devices were analyzed by finite element models and an equivalent circuit model was developed to predict the power transfer characteristics to different electric loads. Based on the results of the analysis a prototype device was designed, fabricated and a demonstration of the transmission of electric power up to 1.068-kW was successfully conducted. Efficiencies in the 80-90% range were also demonstrated and methods to increase the efficiency further are currently being considered.

What factors might have led to the emergence of Ebola in West Africa?

PubMed

Alexander, Kathleen A; Sanderson, Claire E; Marathe, Madav; Lewis, Bryan L; Rivers, Caitlin M; Shaman, Jeffrey; Drake, John M; Lofgren, Eric; Dato, Virginia M; Eisenberg, Marisa C; Eubank, Stephen

2015-01-01

An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa, and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent. The emergence of this deadly disease in West Africa invites many questions, foremost among these: why now, and why in West Africa? Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need. A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease. Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa. Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily. To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community.

What Factors Might Have Led to the Emergence of Ebola in West Africa?

PubMed Central

Alexander, Kathleen A.; Sanderson, Claire E.; Marathe, Madav; Lewis, Bryan L.; Rivers, Caitlin M.; Shaman, Jeffrey; Drake, John M.; Lofgren, Eric; Dato, Virginia M.; Eisenberg, Marisa C.; Eubank, Stephen

2015-01-01

An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa, and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent. The emergence of this deadly disease in West Africa invites many questions, foremost among these: why now, and why in West Africa? Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need. A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease. Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa. Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily. To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community. PMID:26042592

Study Calls for Improvements to U.S. Visa Process for Students, Scholars

NASA Astrophysics Data System (ADS)

Showstack, Randy

2004-03-01

U.S. federal agencies are implementing some measures to reduce delays in providing foreign scientists and students with non-immigrant visas, although additional steps could help to improve the cumbersome process, according to a government study released on 25 February by the U.S. General Accounting Office (GAO). The study, which was requested by the House of Representatives Science Committee, reviewed the issuance of F-1 and J-1 visas in light of national security measures put in place after September 11, 2001. The committee has expressed concerns about whether new security measures are detrimental to scientific research by unnecessarily delaying the issuance of visas to foreign students and scholars.

Unformed minds: juveniles, neuroscience, and the law.

PubMed

Harman, Oren

2013-09-01

Recently, the question of adolescent culpability has been brought before the Supreme Court of the United States for reconsideration. Neuroscience, adolescent advocates claim, is teaching us that young people cannot be found fully responsible for their actions. The reason: their brains are not fully formed. Here I consider the history of the use of scientific evidence in the courtroom, a number of adolescent murder cases, and the data now emerging from neuroscience, and argue that when it comes to brains, judges, just like the rest of us, are unnecessarily impressed. Ultimately, how we determine culpability should rest on normative and ethical considerations rather than on scientific ones. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Radiata and the evolutionary origins of the bilaterian body plan

NASA Technical Reports Server (NTRS)

Martindale, Mark Q.; Finnerty, John R.; Henry, Jonathan Q.

2002-01-01

The apparent conservation of cellular and molecular developmental mechanisms observed in a handful of bilaterian metazoans has spawned a "race" to reconstruct the bilaterian ancestor. Knowledge of this ancestor would permit us to reconstruct the evolutionary changes that have occurred along specific bilaterian lineages. However, comparisons among extant bilaterians provide an unnecessarily limited view of the ancestral bilaterian. Since the original bilaterians are believed by many to be derived from a radially symmetrical ancestor, additional evidence might be obtained by examining present-day radially symmetrical animals. We briefly review pertinent features of the body plans of the extant radial eumetazoan phyla, the Cnidaria, and Ctenophora, in the context of revealing potential evolutionary links to the bilaterians.

Spacecraft Water Exposure Guidelines (SWEGs)

NASA Technical Reports Server (NTRS)

James, John T.

2008-01-01

As the protection of crew health is a primary focus of the National Aeronautics and Space Administration, the Space and Life Sciences Directorate (SLSD) is vigilant in setting potable water limits for spaceflight that are health protective. Additional it is important that exposure limits not be set so stringently that water purification systems are unnecessarily over designed. With these considerations in mind, NASA has partnered with the National Research Council on Toxicology (NRCCOT) to develop spacecraft water exposure guidelines (SWEGs) for application in spaceflight systems. Based on documented guidance (NRC, 2000) NASA has established 28 SWEGs for chemical components that are particularly relevant to water systems on the International Space Station, the Shuttle and looking forward to Constellation.

"The evil virus cell": Students‘ knowledge and beliefs about viruses

PubMed Central

Enzinger, Sonja M.; Fink, Andreas

2017-01-01

Education about virus biology at school is of pivotal interest to raise public awareness concerning means of disease transmission and, thus, methods to prevent infection, and to reduce unnecessary antibiotic treatment due to patient pressure on physicians in case of viral diseases such as influenza. This study aimed at making visible the knowledge of Austrian high school and university students with respect to virus biology, virus structure and health-education issues. The data presented here stem from comprehensive questionnaire analyses, including the task to draw a virus, from a cross-sectional study with 133 grade 7 and 199 grade 10 high school students, and 133 first-year biology and 181 first-year non-biology university students. Analyses were performed both quantitatively and qualitatively. ANOVA revealed a highly significant group effect for total knowledge relating to virus biology and health issues (F(3, 642) = 44.17, p < 0.01, η2p = 0.17). Specific post-hoc tests by means of the Tukey test showed significant differences between all groups (p < .01) with the exception of 1st year non-biology students and grade 10 high school students. Students enrolled in university-level biology outperformed all other groups, even though they had not yet encountered this topic at their courses; part of this phenomenon might be due to their affinity for learning about biological topics. However, even many first-year biology students had a high number of severe misconceptions, e.g., defining a virus as a pro- or eukaryotic cell, or falsely naming malaria as a viral disease. Since there was no significant difference in virus-related knowledge between high schools, virus biology seems to have been taught similarly among the tested schools. However, the majority of participants stated that the virus-related knowledge they had acquired at school was not sufficient. Based on the results presented here we urgently suggest improving and intensifying teaching this topic at school, since virus-related knowledge was by far too fragmentary among many participants. Such lack of health-relevant knowledge may contribute to pressure on physicians by patients to unnecessarily prescribe antibiotics, and possibly lead to potentially dangerous neglect concerning vaccination. The effectiveness of newly developed virus-related teaching units and material could be tested with the instrument used here. PMID:28350815

"The evil virus cell": Students' knowledge and beliefs about viruses.

PubMed

Simon, Uwe K; Enzinger, Sonja M; Fink, Andreas

2017-01-01

Education about virus biology at school is of pivotal interest to raise public awareness concerning means of disease transmission and, thus, methods to prevent infection, and to reduce unnecessary antibiotic treatment due to patient pressure on physicians in case of viral diseases such as influenza. This study aimed at making visible the knowledge of Austrian high school and university students with respect to virus biology, virus structure and health-education issues. The data presented here stem from comprehensive questionnaire analyses, including the task to draw a virus, from a cross-sectional study with 133 grade 7 and 199 grade 10 high school students, and 133 first-year biology and 181 first-year non-biology university students. Analyses were performed both quantitatively and qualitatively. ANOVA revealed a highly significant group effect for total knowledge relating to virus biology and health issues (F(3, 642) = 44.17, p < 0.01, η2p = 0.17). Specific post-hoc tests by means of the Tukey test showed significant differences between all groups (p < .01) with the exception of 1st year non-biology students and grade 10 high school students. Students enrolled in university-level biology outperformed all other groups, even though they had not yet encountered this topic at their courses; part of this phenomenon might be due to their affinity for learning about biological topics. However, even many first-year biology students had a high number of severe misconceptions, e.g., defining a virus as a pro- or eukaryotic cell, or falsely naming malaria as a viral disease. Since there was no significant difference in virus-related knowledge between high schools, virus biology seems to have been taught similarly among the tested schools. However, the majority of participants stated that the virus-related knowledge they had acquired at school was not sufficient. Based on the results presented here we urgently suggest improving and intensifying teaching this topic at school, since virus-related knowledge was by far too fragmentary among many participants. Such lack of health-relevant knowledge may contribute to pressure on physicians by patients to unnecessarily prescribe antibiotics, and possibly lead to potentially dangerous neglect concerning vaccination. The effectiveness of newly developed virus-related teaching units and material could be tested with the instrument used here.

Inappropriate documentation of heparin allergy in the medical record because of misdiagnosis of heparin-induced thrombocytopenia: frequency and consequences.

PubMed

McMahon, C M; Tanhehco, Y C; Cuker, A

2017-02-01

Essentials Misdiagnosis of heparin-induced thrombocytopenia (HIT) may be associated with adverse outcomes. We conducted a study of patients with a heparin allergy in the chart due to misdiagnosis of HIT. 42% of patients with a heparin allergy due to suspected HIT were clearly HIT-negative. 68% were unnecessarily treated with an alternative anticoagulant, 66% of whom had major bleeding. Background It is recommended that heparin be added to the allergy list of patients with heparin-induced thrombocytopenia (HIT). Misdiagnosis of HIT could lead to inappropriate documentation of a heparin allergy and adverse outcomes. Objectives To determine the frequency and consequences of inappropriate documentation of a heparin allergy because of misdiagnosis of HIT. Methods We conducted a cohort study of patients with an inappropriate heparin allergy listed in the electronic medical record (EMR) because of misdiagnosis of HIT. We searched the EMR for patients with a new heparin allergy. Patients were eligible if the reason for allergy listing was suspected acute HIT and laboratory testing for HIT was performed within 60 days. Subjects were defined as 'HIT-negative' if they had a 4Ts score of ≤ 3 or negative laboratory test results. Results Of 239 subjects with a new heparin allergy documented because of concern regarding HIT, 100 (42%) met the prespecified definition of HIT-negative. Sixty-eight (68%) HIT-negative subjects unnecessarily received an alternative parenteral anticoagulant for a median duration of 10.5 days. Among these 68 patients, 45 (66%) met criteria for major bleeding. Sixty-eight (68%) of the 100 HIT-negative subjects had an inappropriate allergy to heparin documented that persisted in the EMR for > 3 years beyond the index hospitalization. Conclusions Inappropriate listing of heparin as an allergy in the EMR because of misdiagnosis of HIT is common, is associated with substantial rates of unnecessary alternative anticoagulant use and major bleeding, and tends to persist beyond the index admission. © 2016 International Society on Thrombosis and Haemostasis.

Tetrahedral and polyhedral mesh evaluation for cerebral hemodynamic simulation--a comparison.

PubMed

Spiegel, Martin; Redel, Thomas; Zhang, Y; Struffert, Tobias; Hornegger, Joachim; Grossman, Robert G; Doerfler, Arnd; Karmonik, Christof

2009-01-01

Computational fluid dynamic (CFD) based on patient-specific medical imaging data has found widespread use for visualizing and quantifying hemodynamics in cerebrovascular disease such as cerebral aneurysms or stenotic vessels. This paper focuses on optimizing mesh parameters for CFD simulation of cerebral aneurysms. Valid blood flow simulations strongly depend on the mesh quality. Meshes with a coarse spatial resolution may lead to an inaccurate flow pattern. Meshes with a large number of elements will result in unnecessarily high computation time which is undesirable should CFD be used for planning in the interventional setting. Most CFD simulations reported for these vascular pathologies have used tetrahedral meshes. We illustrate the use of polyhedral volume elements in comparison to tetrahedral meshing on two different geometries, a sidewall aneurysm of the internal carotid artery and a basilar bifurcation aneurysm. The spatial mesh resolution ranges between 5,119 and 228,118 volume elements. The evaluation of the different meshes was based on the wall shear stress previously identified as a one possible parameter for assessing aneurysm growth. Polyhedral meshes showed better accuracy, lower memory demand, shorter computational speed and faster convergence behavior (on average 369 iterations less).

Initial loss of productive days and income among women seeking induced abortion in Cambodia.

PubMed

Potdar, Rukmini; Fetters, Tamara; Phirun, Lam

2008-01-01

The study describes the loss of productive time and income related to abortion care and care-seeking among 110 women presenting at public and private sector abortion providers in Cambodia. Data were collected through women's exit interviews, and descriptive analysis was used to examine lost time and income against a number of explanatory variables, such as gestational age of pregnancy, type of abortion provider and facility, type of uterine evacuation procedure, number of health visits, and the woman's occupation. Results indicate that lost time and earnings increase with the number of visits to obtain the termination, gestational age, and selection of a private physician or non-governmental organization clinic. Lost time and earnings also vary by the woman's type of employment. The study underscores the need for safer, accessible, and more affordable abortion services in order to ensure that these services are available for all women. Even in the Cambodian context, where abortion is unrestricted during the first trimester of pregnancy, the study findings show that the process of searching for and obtaining high-quality abortion care was unnecessarily complicated and costly to women and their household members.

Asymptomatic bacteriuria: when the treatment is worse than the disease.

PubMed

Trautner, Barbara W

2011-12-06

Asymptomatic bacteriuria (ABU) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ABU must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. Interactions between the organism, the host, and the bladder environment determine whether bacteriuria leads to ABU or to UTI. ABU is a very common condition that is often treated unnecessarily with antibiotics-it should be detected and treated in pregnant women and patients undergoing urologic surgery, but in most other patient groups, treatment does not confer benefit and can be harmful. A change in prescribing behavior for ABU has been achieved through several fairly high-intensity interventions, such as interactive educational sessions for physicians, but whether these improvements persist beyond the study period is not known. Further research is needed to determine whether screening for and treatment of ABU is beneficial in patients with renal transplants, patients with orthotopic neobladders, patients undergoing prosthetic joint implantation, and patients with neutropenia. © 2012 Macmillan Publishers Limited. All rights reserved

Implications of path tolerance and path characteristics on critical vehicle manoeuvres

NASA Astrophysics Data System (ADS)

Lundahl, K.; Frisk, E.; Nielsen, L.

2017-12-01

Path planning and path following are core components in safe autonomous driving. Typically, a path planner provides a path with some tolerance on how tightly the path should be followed. Based on that, and other path characteristics, for example, sharpness of curves, a speed profile needs to be assigned so that the vehicle can stay within the given tolerance without going unnecessarily slow. Here, such trajectory planning is based on optimal control formulations where critical cases arise as on-the-limit solutions. The study focuses on heavy commercial vehicles, causing rollover to be of a major concern, due to the relatively high centre of gravity. Several results are obtained on required model complexity depending on path characteristics, for example, quantification of required path tolerance for a simple model to be sufficient, quantification of when yaw inertia needs to be considered in more detail, and how the curvature rate of change interplays with available friction. Overall, in situations where the vehicle is subject to a wide range of driving conditions, from good transport roads to more tricky avoidance manoeuvres, the requirements on the path following will vary. For this, the provided results form a basis for real-time path following.

PhyloTreePruner: A Phylogenetic Tree-Based Approach for Selection of Orthologous Sequences for Phylogenomics.

PubMed

Kocot, Kevin M; Citarella, Mathew R; Moroz, Leonid L; Halanych, Kenneth M

2013-01-01

Molecular phylogenetics relies on accurate identification of orthologous sequences among the taxa of interest. Most orthology inference programs available for use in phylogenomics rely on small sets of pre-defined orthologs from model organisms or phenetic approaches such as all-versus-all sequence comparisons followed by Markov graph-based clustering. Such approaches have high sensitivity but may erroneously include paralogous sequences. We developed PhyloTreePruner, a software utility that uses a phylogenetic approach to refine orthology inferences made using phenetic methods. PhyloTreePruner checks single-gene trees for evidence of paralogy and generates a new alignment for each group containing only sequences inferred to be orthologs. Importantly, PhyloTreePruner takes into account support values on the tree and avoids unnecessarily deleting sequences in cases where a weakly supported tree topology incorrectly indicates paralogy. A test of PhyloTreePruner on a dataset generated from 11 completely sequenced arthropod genomes identified 2,027 orthologous groups sampled for all taxa. Phylogenetic analysis of the concatenated supermatrix yielded a generally well-supported topology that was consistent with the current understanding of arthropod phylogeny. PhyloTreePruner is freely available from http://sourceforge.net/projects/phylotreepruner/.

Remote Sensing of Extraterrestrial life: Complexity as the key characteristicsof living systems

NASA Astrophysics Data System (ADS)

Wolf, Sebastian

2015-07-01

Motivated by the detection of planetary candidates around more than one thousand stars since 1995 and the beginning characterization of their major properties (orbit, mass, physical conditions and chemical composition of their atmosphere), the quest for understanding the origin and evolution of life from the broadest possible perspective comes into reach of scientific exploration. Due to the apparent lack of a better starting point, the search for life outside Earth is strongly influenced and guided by biological and biochemical studies of life on our planet so far. Furthermore, this search is built on the assumption that life - in the sense of animated matter - is qualitatively different from inanimate matter. However, the first constraint might unnecessarily limit our search, while the latter underlying assumption is not justified. In this study, a more general approach to search for life in the universe with astrophysical means is proposed, which is not based on the above constraint and assumption. More specifically, the property of living systems to possess a high degree of complexity in structure and its response to the environment is discussed in view of its potential to be used for remote sensing of extraterrestrial life.

Unfinished feticide: a legal commentary.

PubMed Central

Brazier, Margaret

1990-01-01

Jansen expresses concern as to the legal implications of both selective reduction of pregnancy and unsuccessful attempts at termination of pregnancy using mifepristone. This commentary examines the legality of both procedures and concludes that Jansen is over-optimistic in his belief that neither procedure is likely to fall foul of the criminal laws on induced abortion. By contrast his anxieties about civil liability arising from the subsequent live birth of a damaged infant are, it is suggested, unnecessarily pessimistic. Such an action is most unlikely to succeed if brought by the infant herself and any claim on the part of the mother will normally be dependent on proof of negligence. The commentary focusses on the law in England with relevant references to other common law jurisdictions. PMID:11642779

Nodular Fasciitis with Cortical Erosion of the Hand

PubMed Central

Park, Jin Sung; Lee, Jong-Sil; Na, Jae-Boem

2012-01-01

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present. PMID:22379562

Debridement and wound bed preparation.

PubMed

Falabella, Anna F

2006-01-01

Debridement can play a vital role in wound bed preparation and the removal of barriers that impair wound healing. In accordance with the TIME principles, debridement can help remove nonviable tissue, control inflammation or infection, decrease excess moisture, and stimulate a nonadvancing wound edge. There are many types of debridement, each with a set of advantages and disadvantages that must be clearly understood by the healthcare team. Failure to use the correct debridement method for a given type of wound may lead to further delays in healing, increase patient suffering, and unnecessarily increase the cost of care. This review article discusses the various methods of debridement, describes currently available debriding agents, evaluates the clinical data regarding their efficacy and safety, and describes strategies for the management of problematic nonhealing wounds.

Ethical issues, dilemmas and controversies in 'cosmetic' or aesthetic dentistry. A personal opinion.

PubMed

Kelleher, M

2012-04-27

Stephen Hancocks' elegant editorial of 11 December 2011 raises interesting questions which deserve discussion. Most experienced dentists would agree that the less that is done to teeth for cosmetic reasons, the lesser are the risks of disappointment, failure of expectation, or threat of litigation. Yet there is an increasing number of cases where aesthetics are the primary concern for dentists and patients alike and some patients are consenting to treatment without being properly informed of the destructive nature of the procedures to their sound tooth tissue and structures to achieve the desired 'cosmetic' outcome. This raises ethical issues, as much of this overtreatment is unnecessarily destructive and goes against the healing and caring principles of the dental profession.

Ergonomic risk factors associated with clinical dentistry.

PubMed

Rucker, Lance M; Sunell, Susanne

2002-02-01

Ergonomics has formed an integral aspect of dental education at the University of British Columbia since the early 1980s. However, studies continued to indicate that dentists are at risk for developing musculoskeletal problems. This provided the impetus for a study of the risk factors associated with these problems. The data analyzed from 421 survey respondents in British Columbia indicate that indeed dentists are experiencing musculoskeletal pain and discomfort. However, the data also suggest that dentists can recognize and identify their own postures, practicing positions, and the equipment usage patterns that are associated with increased risks of experiencing musculoskeletal pain and discomfort. Such recognition is the first critical step to avoiding or neutralizing ergonomic habits and work environment layouts that might otherwise unnecessarily shorten professional clinical careers.

Acute lymphoblastic leukemia of adulthood: progress or not?

PubMed

Wiernik, Peter H

2011-12-01

Much new information about ALL in adults has recently been learned from major clinical and laboratory studies. However, much of the recently reported improved management of this leukemia pertains only to younger patients. Elderly patients do not fair very well with modern therapy, including intensified treatment approaches. The question arises whether current treatment may be unnecessarily intensive, not only for elderly patients but for most patients. There are no prospective, randomized studies that clearly demonstrate that anthracyclines, cyclophosphamide or cytarabine are required for optimal results in this leukemia. Eliminating drugs of marginal value but with the potential for considerable toxicity may allow us to intensify treatment with drugs that are most effective at a cost of even less toxicity than usually expected.

Development of a Composite Delamination Fatigue Life Prediction Methodology

NASA Technical Reports Server (NTRS)

OBrien, Thomas K.

2009-01-01

Delamination is one of the most significant and unique failure modes in composite structures. Because of a lack of understanding of the consequences of delamination and the inability to predict delamination onset and growth, many composite parts are unnecessarily rejected upon inspection, both immediately after manufacture and while in service. NASA Langley is leading the efforts in the U.S. to develop a fatigue life prediction methodology for composite delamination using fracture mechanics. Research being performed to this end will be reviewed. Emphasis will be placed on the development of test standards for delamination characterization, incorporation of approaches for modeling delamination in commercial finite element codes, and efforts to mature the technology for use in design handbooks and certification documents.

Transforming Better Babies into Fitter Families: archival resources and the history of American eugenics movement, 1908-1930.

PubMed

Selden, Steven

2005-06-01

In the early 1920s, determinist conceptions of biology helped to transform Better Babies contest into Fitter Families competitions with a strong commitment to controlled human breeding. While the earlier competitions were concerned for physical and mental standards, the latter contests collected data on a broad range of presumed hereditary characters. The complex behaviors thought to be determined by one's heredity included being generous, jealous, and cruel. In today's context, the popular media often interpret advances in molecular genetics in a similarly reductive and determinist fashion. This paper argues that such a narrow interpretation of contemporary biology unnecessarily constrains the public in developing social policies concerning complex social behavior ranging from crime to intelligence.

Added value of interferon-gamma release assays in screening for tuberculous infection in the Netherlands.

PubMed

Erkens, C G M; Dinmohamed, A G; Kamphorst, M; Toumanian, S; van Nispen-Dobrescu, R; Alink, M; Oudshoorn, N; Mensen, M; van den Hof, S; Borgdorff, M; Verver, S

2014-04-01

Interferon-gamma release assays (IGRAs) are reported to be more specific for the diagnosis of latent tuberculous infection (LTBI) than the tuberculin skin test (TST). The two-step procedure, TST followed by an IGRA, is reported to be cost-effective in high-income countries, but it requires more financial resources. To assess the added value of IGRA compared to TST alone in the Netherlands. Test results and background data on persons tested with an IGRA were recorded by the Public Municipal Health Services in a web-based database. The number of persons diagnosed with LTBI using different screening algorithms was calculated. In those tested with an IGRA, at least 60% of persons who would have been diagnosed with LTBI based on TST alone had a negative IGRA. Among those with a TST reaction below the cut-off for the diagnosis of LTBI, 13% had a positive IGRA. For 41% of persons tested with an IGRA after TST, the IGRA influenced whether or not an LTBI diagnosis would be made. With the IGRA as reference standard, a high proportion of persons in low-prevalence settings are treated unnecessarily for LTBI if tested with TST alone, while a small proportion eligible for preventive treatment are missed. Incremental costs of the two-step strategy seem to be balanced by the improved targeting of preventive treatment.

Lessons from a national audit of acute pancreatitis: A summary of the NCEPOD report 'Treat the Cause'.

PubMed

O'Reilly, D A; McPherson, S J; Sinclair, M T; Smith, N

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is an independent organisation whose remit is to review the quality of medical and surgical care provided in the United Kingdom. We undertook a review into the care provided to patients treated for acute pancreatitis during a 6 month study period between 1st January and 30th June 2014. This included assessment of care at an organisational level, clinical level within hospitals and external peer review. From a random sample, 712 patients underwent hospital clinician review and 418 patients had external peer review. Overall, we found that there was room for improvement in care in over 50% of patients with acute pancreatitis. Case reviewers felt that efforts to prevent recurrent episodes due to gallstones and alcohol were inadequate as 21% of patients in the study had one or more previous episodes of acute pancreatitis. Aspects of general care where improvements could be made include better antibiotic stewardship; as 1/5 of patients were considered to have been given antibiotics unnecessarily. Overall management of the patients' nutrition was considered adequate by the case reviewers in only 85% of cases. The use of an early warning score was omitted in 31% of emergency department admissions. Recommendations include standardised early warning scoring systems to be used throughout the hospital and commenced in the emergency department. The development of better networking arrangements and regional pancreatitis units, with shared management guidelines, is also essential to improve the coordination of care. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Progesterone for Prevention of Preterm Birth: Shortcomings and Unintended Consequences of the Orphan Drug Act.

PubMed

Gee, Rebekah E; Kuy, SreyRam; Karas, Laura O

2017-12-01

Preterm birth is a problem of major public health significance that continues to plague our country despite the existence of a therapy, 17α-hydroxyprogesterone caproate, with known efficacy in reducing the risk of spontaneous preterm birth among high-risk women. Over the past several years, the Louisiana Department of Health has undertaken a robust, multifaceted initiative to improve access to 17α-hydroxyprogesterone caproate, which resulted in a 3.5-fold increase in the percentage of eligible high-risk pregnant women in the Medicaid program who received the therapy between 2013 and 2016. Yet despite Louisiana's progress, the vast majority of the eligible population still fails to receive 17α-hydroxyprogesterone caproate. In this Current Commentary, we argue that the high price of progesterone since U.S. Food and Drug Administration approval has unnecessarily complicated access, and our nation has potentially suffered nearly 60,000 avoidable premature births as a consequence. We present the history of the orphan drug approval and manufacturer-imposed price increase for injectable progesterone, the interplay between the drug's high price and the persistence of racial and ethnic disparities in preterm birth, which are particularly germane in Louisiana, and Louisiana's broad-reaching efforts to improve progesterone coverage. The story of 17α-hydroxyprogesterone caproate highlights the durable barriers that high prices place in the way of access and helps illuminate the shortcomings and unintended consequences of the Orphan Drug Act. This case, however, is not an outlier; it is the far-too-common product of monopoly pricing in the U.S. pharmaceutical market, inadvertently bolstered by existing law, at the expense of affordability and patient access.

New method to design stellarator coils without the winding surface

NASA Astrophysics Data System (ADS)

Zhu, Caoxiang; Hudson, Stuart R.; Song, Yuntao; Wan, Yuanxi

2018-01-01

Finding an easy-to-build coils set has been a critical issue for stellarator design for decades. Conventional approaches assume a toroidal ‘winding’ surface, but a poorly chosen winding surface can unnecessarily constrain the coil optimization algorithm, This article presents a new method to design coils for stellarators. Each discrete coil is represented as an arbitrary, closed, one-dimensional curve embedded in three-dimensional space. A target function to be minimized that includes both physical requirements and engineering constraints is constructed. The derivatives of the target function with respect to the parameters describing the coil geometries and currents are calculated analytically. A numerical code, named flexible optimized coils using space curves (FOCUS), has been developed. Applications to a simple stellarator configuration, W7-X and LHD vacuum fields are presented.

Is a description deeper than the quantum one possible?

NASA Astrophysics Data System (ADS)

Ghirardi, GianCarlo; Romano, Raffaele

2014-12-01

Recently, it has been argued that quantum mechanics is a complete theory, and that different quantum states do necessarily correspond to different elements of reality, under the assumptions that quantum mechanics is correct and that measurement settings can be freely chosen. In this work, we prove that this result is a consequence of an unnecessarily strong mathematical expression of the free choice assumption, which embodies more conditions than explicitly stated. The issues of the completeness of quantum mechanics, and of the interpretation of the state vector, are by no means resolved. Taking this perspective, we describe how the recently introduced class of crypto-nonlocal hidden variables theories can be used to characterize the maximal possible departure from quantum mechanics, when the system consists of a pair of qubits.

Clinical research with economically disadvantaged populations

PubMed Central

Denny, Colleen C; Grady, Christine

2007-01-01

Concerns about exploiting the poor or economically disadvantaged in clinical research are widespread in the bioethics community. For some, any research that involves economically disadvantaged individuals is de facto ethically problematic. The economically disadvantaged are thought of as “venerable” to exploitation, impaired decision making, or both, thus requiring either special protections or complete exclusion from research. A closer examination of the worries about vulnerabilities among the economically disadvantaged reveals that some of these worries are empirically or logically untenable, while others can be better resolved by improved study designs than by blanket exclusion of poorer individuals from research participation. The scientific objective to generate generalisable results and the ethical objective to fairly distribute both the risks and benefits of research oblige researchers not to unnecessarily bar economically disadvantaged subjects from clinical research participation. PMID:17601862

Managing a chest tube and drainage system.

PubMed

Durai, Rajaraman; Hoque, Happy; Davies, Tony W

2010-02-01

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes. Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Modeling Road Vulnerability to Snow Using Mixed Integer Optimization

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

Rodriguez, Tony K; Omitaomu, Olufemi A; Ostrowski, James A

As the number and severity of snowfall events continue to grow, the need to intelligently direct road maintenance during these snowfall events will also grow. In several locations, local governments lack the resources to completely treat all roadways during snow events. Furthermore, some governments utilize only traffic data to determine which roads should be treated. As a result, many schools, businesses, and government offices must be unnecessarily closed, which directly impacts the social, educational, and economic well-being of citizens and institutions. In this work, we propose a mixed integer programming formulation to optimally allocate resources to manage snowfall on roadsmore » using meteorological, geographical, and environmental parameters. Additionally, we evaluate the impacts of an increase in budget for winter road maintenance on snow control resources.« less

Modeling biological problems in computer science: a case study in genome assembly.

PubMed

Medvedev, Paul

2018-01-30

As computer scientists working in bioinformatics/computational biology, we often face the challenge of coming up with an algorithm to answer a biological question. This occurs in many areas, such as variant calling, alignment and assembly. In this tutorial, we use the example of the genome assembly problem to demonstrate how to go from a question in the biological realm to a solution in the computer science realm. We show the modeling process step-by-step, including all the intermediate failed attempts. Please note this is not an introduction to how genome assembly algorithms work and, if treated as such, would be incomplete and unnecessarily long-winded. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

LICRE: unsupervised feature correlation reduction for lipidomics.

PubMed

Wong, Gerard; Chan, Jeffrey; Kingwell, Bronwyn A; Leckie, Christopher; Meikle, Peter J

2014-10-01

Recent advances in high-throughput lipid profiling by liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) have made it possible to quantify hundreds of individual molecular lipid species (e.g. fatty acyls, glycerolipids, glycerophospholipids, sphingolipids) in a single experimental run for hundreds of samples. This enables the lipidome of large cohorts of subjects to be profiled to identify lipid biomarkers significantly associated with disease risk, progression and treatment response. Clinically, these lipid biomarkers can be used to construct classification models for the purpose of disease screening or diagnosis. However, the inclusion of a large number of highly correlated biomarkers within a model may reduce classification performance, unnecessarily inflate associated costs of a diagnosis or a screen and reduce the feasibility of clinical translation. An unsupervised feature reduction approach can reduce feature redundancy in lipidomic biomarkers by limiting the number of highly correlated lipids while retaining informative features to achieve good classification performance for various clinical outcomes. Good predictive models based on a reduced number of biomarkers are also more cost effective and feasible from a clinical translation perspective. The application of LICRE to various lipidomic datasets in diabetes and cardiovascular disease demonstrated superior discrimination in terms of the area under the receiver operator characteristic curve while using fewer lipid markers when predicting various clinical outcomes. The MATLAB implementation of LICRE is available from http://ww2.cs.mu.oz.au/∼gwong/LICRE © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Prostate-specific antigen levels in the United States: implications of various definitions for abnormal.

PubMed

Welch, H Gilbert; Schwartz, Lisa M; Woloshin, Steven

2005-08-03

The finding that some men with a normal prostate-specific antigen (PSA) level (i.e., less than 4 ng/mL) nonetheless have microscopic evidence of prostate cancer has led to some suggestions that the threshold defining abnormal should be lowered to 2.5 ng/mL. We examined the effect of this lower threshold on the number of American men who would be labeled abnormal by a single PSA test. We obtained PSA data on a nationally representative sample of American men 40 years of age and older with no history of prostate cancer and no current inflammation or infection of the prostate gland (n = 1308) from the 2001-2002 National Health and Nutrition Examination Survey. We obtained data on the 10-year risk of prostate cancer death in the pre-PSA era from DevCan, the National Cancer Institute's software to calculate the probability of dying of cancer. Based on NHANES data, approximately 1.5 million American men aged 40 to 69 years have a PSA level over 4.0 ng/mL. Lowering the threshold to 2.5 ng/mL would label an additional 1.8 million men as abnormal, if all men were screened. For men aged 70 years or older, the corresponding numbers are 1.5 and 1.2 million. The proportion of the population affected by different thresholds would vary with age. Among men in their 60s, for example, 17% have a PSA level over 2.5 ng/mL, 5.7% have a PSA level over 4.0 ng/mL, and 1.7% have a PSA level over 10.0 ng/mL. For context, only 0.9% of men in their 60s are expected to die from prostate cancer in the next 10 years. Lowering the PSA threshold to 2.5 ng/mL would double the number of men defined as abnormal, to up to 6 million. Until there is evidence that screening is effective, increasing the number of men recommended for prostate biopsy--and the number potentially diagnosed and treated unnecessarily--would be a mistake.

Optical microsystem for analyzing engine lubricants

NASA Astrophysics Data System (ADS)

Scott, Andrew J.; Mabesa, Jose R., Jr.; Gorsich, David; Rathgeb, Brian; Said, Ali A.; Dugan, Mark; Haddock, Tom F.; Bado, Philippe W.

2004-12-01

It is possible to dramatically improve the performance, reliability, and maintainability of vehicles and other similarly complex equipment if improved sensing and diagnostics systems are available. Each year military and commercial maintenance personnel unnecessarily replace, at scheduled intervals, significant amounts of lubricant fluids in vehicles, weapon systems, and supporting equipment. Personnel draw samples of fluids and send them to test labs for analysis to determine if replacement is necessary. Systematic use of either on-board (embedded) lubricant quality analysis capabilities will save millions of dollars each year in avoided fluid changes, saved labor, prevented damage to mechanical components while providing associated environmental benefits. This paper discusses the design, the manufacturing, and the evaluation of robust optical sensors designed to monitor the condition of industrial fluids. The sensors reported are manufactured from bulk fused silica substrates. They incorporate three-dimensional micro fluidic circuitry side-by-side with three-dimensional wave guided optical networks. The manufacturing of the optical waveguides are completed using a direct-write process based on the use of femtosecond laser pulses to locally alter the structure of the glass substrate at the nano-level. The microfluidic circuitry is produced using the same femtosecond laser based process, followed by an anisotropic wet chemical etching step. Data will be presented regarding the use of these sensors to monitor the quality of engine oil and possibly some other vehicle lubricants such as hydraulic oil.

Load Index Metrics for an Optimized Management of Web Services: A Systematic Evaluation

PubMed Central

Souza, Paulo S. L.; Santana, Regina H. C.; Santana, Marcos J.; Zaluska, Ed; Faical, Bruno S.; Estrella, Julio C.

2013-01-01

The lack of precision to predict service performance through load indices may lead to wrong decisions regarding the use of web services, compromising service performance and raising platform cost unnecessarily. This paper presents experimental studies to qualify the behaviour of load indices in the web service context. The experiments consider three services that generate controlled and significant server demands, four levels of workload for each service and six distinct execution scenarios. The evaluation considers three relevant perspectives: the capability for representing recent workloads, the capability for predicting near-future performance and finally stability. Eight different load indices were analysed, including the JMX Average Time index (proposed in this paper) specifically designed to address the limitations of the other indices. A systematic approach is applied to evaluate the different load indices, considering a multiple linear regression model based on the stepwise-AIC method. The results show that the load indices studied represent the workload to some extent; however, in contrast to expectations, most of them do not exhibit a coherent correlation with service performance and this can result in stability problems. The JMX Average Time index is an exception, showing a stable behaviour which is tightly-coupled to the service runtime for all executions. Load indices are used to predict the service runtime and therefore their inappropriate use can lead to decisions that will impact negatively on both service performance and execution cost. PMID:23874776

Improving the quality of health care: using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N)*

PubMed Central

Ollenschlager, G; Marshall, C; Qureshi, S; Rosenbrand, K; Burgers, J; Makela, M; Slutsky, J; t for

2004-01-01



 Clinical practice guidelines are regarded as powerful tools to achieve effective health care. Although many countries have built up experience in the development, appraisal, and implementation of guidelines, until recently there has been no established forum for collaboration at an international level. As a result, in different countries seeking similar goals and using similar strategies, efforts have been unnecessarily duplicated and opportunities for harmonisation lost because of the lack of a supporting organisational framework. This triggered a proposal in 2001 for an international guidelines network built on existing partnerships. A baseline survey confirmed a strong demand for such an entity. A multinational group of guideline experts initiated the development of a non-profit organisation aimed at promotion of systematic guideline development and implementation. The Guidelines International Network (G-I-N) was founded in November 2002. One year later the Network released the International Guideline Library, a searchable database which now contains more than 2000 guideline resources including published guidelines, guidelines under development, "guidelines for guidelines", training materials, and patient information tools. By June 2004, 52 organisations from 27 countries had joined the network including institutions from Oceania, North America, and Europe, and WHO. This paper describes the process that led to the foundation of the G-I-N, its characteristics, prime activities, and ideas on future projects and collaboration. PMID:15576708

Identifying Risk Factors Associated with Inappropriate Use of Acid Suppressive Therapy at a Community Hospital

PubMed Central

Bodukam, Vijay; Saigal, Kirit; Bahl, Jaya; Wang, Yvette; Hanlon, Alexandra; Lu, Yinghui; Davis, Michael

2016-01-01

Purpose. By examining the prescribing patterns and inappropriate use of acid suppressive therapy (AST) during hospitalization and at discharge we sought to identify the risk factors associated with such practices. Methods. In this retrospective observational study, inpatient records were reviewed from January 2011 to December 2013. Treatment with AST was considered appropriate if the patient had a known specific indication or met criteria for stress ulcer prophylaxis. Results. In 2011, out of 58 patients who were on AST on admission, 32 were newly started on it and 23 (72%) were inappropriate cases. In 2012, out of 97 patients on AST, 61 were newly started on it and 51 (84%) were inappropriate cases. In 2013, 99 patients were on AST, of which 48 were newly started on it and 36 (75%) were inappropriate cases. 19% of the patients inappropriately started on AST were discharged on it in three years. Younger age, female sex, and 1 or more handoffs between services were significantly associated with increased risk of inappropriate AST. Conclusion. Our findings reflect inappropriate prescription of AST which leads to increase in costs of care and unnecessarily puts the patient at risk for potential adverse events. The results of this study emphasize the importance of examining the patient's need for AST at each level of care especially when the identified risk factors are present. PMID:27818680

Path Complexity in Virtual Water Maze Navigation: Differential Associations with Age, Sex, and Regional Brain Volume.

PubMed

Daugherty, Ana M; Yuan, Peng; Dahle, Cheryl L; Bender, Andrew R; Yang, Yiqin; Raz, Naftali

2015-09-01

Studies of human navigation in virtual maze environments have consistently linked advanced age with greater distance traveled between the start and the goal and longer duration of the search. Observations of search path geometry suggest that routes taken by older adults may be unnecessarily complex and that excessive path complexity may be an indicator of cognitive difficulties experienced by older navigators. In a sample of healthy adults, we quantify search path complexity in a virtual Morris water maze with a novel method based on fractal dimensionality. In a two-level hierarchical linear model, we estimated improvement in navigation performance across trials by a decline in route length, shortening of search time, and reduction in fractal dimensionality of the path. While replicating commonly reported age and sex differences in time and distance indices, a reduction in fractal dimension of the path accounted for improvement across trials, independent of age or sex. The volumes of brain regions associated with the establishment of cognitive maps (parahippocampal gyrus and hippocampus) were related to path dimensionality, but not to the total distance and time. Thus, fractal dimensionality of a navigational path may present a useful complementary method of quantifying performance in navigation. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Surgical management of ulcerative colitis in the era of biologicals.

PubMed

Devaraj, Bikash; Kaiser, Andreas M

2015-01-01

Proctocolectomy has been a curative option for patients with severe ulcerative colitis. In recent years, there has been a growing use of medical salvage therapy in the management of patients with moderate to severe ulcerative colitis. We aimed at reviewing the role of surgical management in a time of intensified medical management on the basis of published trial data. The aim was to determine the efficacy of aggressive medical versus surgical management in achieving multifaceted treatment goals. A comprehensive search of Pubmed, Medline, the Cochrane database was performed. Abstracts were evaluated for relevance. Selected articles were then reviewed in detail, including references. Recommendations were then drafted based on evidence and conclusions in the selected articles. The majority of patients with UC will not need surgery. However, steroid-refractoriness and steroid-dependence signal a subset of patients with more challenging disease. Biological therapy has been shown to achieve short-term improvement and temporarily reduce the need for a colectomy. However, there is a substantial financial and medical price to pay because a high fraction of these salvaged patients will still need a curative colectomy but may be exposed to the negative impact of prolonged immunosuppression, chronic illness, and a higher probability to require 3 rather than 2 operations. Proctocolectomy with ileo-anal pouch anastomosis-performed in 1, 2, or 3 steps depending on the patient's condition-remains the surgical procedure of choice. Even though it has its share of possible complications, it has been associated with excellent long-term outcomes and high levels of satisfaction, such that in the majority of patients they become indistinguishable from unaffected normal individuals. The current data demonstrate that use of medical salvage therapy in the treatment of UC will likely continue to grow and evolve. Consensus is being developed to better define and predict failure of medical therapy and clarify the role of the different treatment modalities. For many patients, sacrificing the nonresponsive diseased colon is an underused or unnecessarily delayed chance to normalize their health and life. Biologicals in many instances may have to be considered the bridge to that end.

Cellulase retention and sugar removal by membrane ultrafiltration during lignocellulosic biomass hydrolysis.

PubMed

Knutsen, Jeffrey S; Davis, Robert H

2004-01-01

Technologies suitable for the separation and reuse of cellulase enzymes during the enzymatic saccharification of pretreated corn stover are investigated to examine the economic and technical viability of processes that promote cellulase reuse while removing inhibitory reaction products such as glucose and cellobiose. The simplest and most suitable separation is a filter with relatively large pores on the order of 20-25 mm that retains residual corn stover solids while passing reaction products such as glucose and cellobiose to form a sugar stream for a variety of end uses. Such a simple separation is effective because cellulase remains bound to the residual solids. Ultrafiltration using 50-kDa polyethersulfone membranes to recover cellulase enzymes in solution was shown not to enhance further the saccharification rate or overall conversion. Instead, it appears that the necessary cellulase enzymes, including beta-glucosidase, are tightly bound to the substrate; when fresh corn stover is contacted with highly washed residual solids, without the addition of fresh enzymes, glucose is generated at a high rate. When filtration was applied multiple times, the concentration of inhibitory reaction products such as glucose and cellobiose was reduced from 70 to 10 g/L. However, an enhanced saccharification performance was not observed, most likely because the concentration of the inhibitory products remained too high. Further reduction in the product concentration was not investigated, because it would make the reaction unnecessarily complex and result in a product stream that is much too dilute to be useful. Finally, an economic analysis shows that reuse of cellulase can reduce glucose production costs, especially when the enzyme price is high. The most economic performance is shown to occur when the cellulase enzyme is reused and a small amount of fresh enzyme is added after each separation step to replace lost or deactivated enzyme.

National Combustion Code Validated Against Lean Direct Injection Flow Field Data

NASA Technical Reports Server (NTRS)

Iannetti, Anthony C.

2003-01-01

Most combustion processes have, in some way or another, a recirculating flow field. This recirculation stabilizes the reaction zone, or flame, but an unnecessarily large recirculation zone can result in high nitrogen oxide (NOx) values for combustion systems. The size of this recirculation zone is crucial to the performance of state-of-the-art, low-emissions hardware. If this is a large-scale combustion process, the flow field will probably be turbulent and, therefore, three-dimensional. This research dealt primarily with flow fields resulting from lean direct injection (LDI) concepts, as described in Research & Technology 2001. LDI is a concept that depends heavily on the design of the swirler. The LDI concept has the potential to reduce NOx values from 50 to 70 percent of current values, with good flame stability characteristics. It is cost effective and (hopefully) beneficial to do most of the design work for an LDI swirler using computer-aided design (CAD) and computer-aided engineering (CAE) tools. Computational fluid dynamics (CFD) codes are CAE tools that can calculate three-dimensional flows in complex geometries. However, CFD codes are only beginning to correctly calculate the flow fields for complex devices, and the related combustion models usually remove a large portion of the flow physics.

Implementation of a chest pain management service improves patient care and reduces length of stay.

PubMed

Scott, Adam C; O'Dwyer, Kristina M; Cullen, Louise; Brown, Anthony; Denaro, Charles; Parsonage, William

2014-03-01

Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

A theoretical study of inertial cavitation from acoustic radiation force impulse (ARFI) imaging and implications for the mechanical index

PubMed Central

Church, Charles C.; Labuda, Cecille; Nightingale, Kathryn

2014-01-01

The mechanical index (MI) attempts to quantify the likelihood that exposure to diagnostic ultrasound will produce an adverse biological effect by a nonthermal mechanism. The current formulation of the MI implicitly assumes that the acoustic field is generated using the short pulse durations appropriate to B-mode imaging. However, acoustic radiation force impulse (ARFI) imaging employs high-intensity pulses up to several hundred acoustic periods long. The effect of increased pulse durations on the thresholds for inertial cavitation was studied computationally in water, urine, blood, cardiac and skeletal muscle, brain, kidney, liver and skin. The results show that while the effect of pulse duration on cavitation thresholds in the three liquids can be considerable, reducing them by, e.g., 6% – 24% at 1 MHz, the effect in tissue is minor. More importantly, the frequency dependence of the MI appears to be unnecessarily conservative, i.e., that the magnitude of the exponent on frequency could be increased to 0.75. Comparison of these theoretical results with experimental measurements suggests that some tissues do not contain the pre-existing, optimally sized bubbles assumed for the MI. This means that in these tissues the MI is not necessarily a strong predictor of the probability for an adverse biological effect. PMID:25592457

Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients.

PubMed

Patel, Anju K; Mildenhall, Nicholas R; Kim, William; Carroll, Thomas L

2014-04-01

To determine in true vocal fold (TVF) atrophy patients if symptoms of throat clearing and mucus sensation, attributed to laryngopharyngeal reflux (LPR), are due to glottic insufficiency. Is the TVF atrophy population being prescribed proton pump inhibitors unnecessarily? A retrospective review of patients with TVF atrophy but no other underlying laryngeal pathology seen at a tertiary voice center from July 2009 to May 2012 was conducted. Patient demographics, symptoms, LPR diagnosis, interventions, and pre-intervention and post-intervention Voice Handicap Index-10 (VHI) and Reflux Symptom Index (RSI) scores were recorded. Twenty-six patients met inclusion criteria, and 85% were treated for LPR. Throat clearing and mucus sensation (85%), dysphonia (54%), and globus sensation (46%) were recorded. Interventions included LPR medical management (65%), vocal fold augmentation (23%), and voice therapy (12%). Reflux Symptom Index scores improved in all groups. Voice Handicap Index-10 and RSI scores normalized in patients treated with augmentation. Globus was never present in patients who received augmentation. Throat clearing and mucus sensation may be due to underlying glottic insufficiency and changes of the aging larynx rather than LPR. High VHI and RSI scores normalized with TVF augmentation. Further work is needed to evaluate symptom presentation and risk versus benefit of treatment options, especially if it avoids unnecessary proton pump inhibitor trials.

Bureaucracy Versus Environment: The Environmental Costs of Bureaucratic Governance

NASA Astrophysics Data System (ADS)

Singer, S. Fred

The 15 contributors to this volume have an important message. They are convinced that both environmental and economic costs of bureaucratic management of natural resources are too high, and unnecessarily so. The main reason is an institutional one: Authority is given to those who do not bear responsibility for the consequences o f their actions.A classic case is the set of specific numerical emission standards for automobiles in the Clean Air Act Amendments of 1970. Congress arrived at these standards without a scientific basis, without technical analysis, and certainly without any consideration of costs and benefits. Only 3 years later did Senator Muskie ask the National Academy of Sciences to conduct a cost-benefit analysis. The NAS results were presented in a fashion that seemed to support the action of Congress; yet, the statutory emissions standards yielded marginal costs well beyond their marginal benefits. They had a major impact on Detroit during the 1970's, and very likely damaged, perhaps irreversibly, the competitive standing of the American automobile industry, a major segment of the U.S. economy. But the economic costs of these actions were never considered, least of all by the responsible bureaucrats. They were completely buffered from any consequences flowing from the exercise of their authority.

First responder and physician liability during an emergency.

PubMed

Eddy, Amanda

2013-01-01

First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

Using a point-of-dispensing clinic for prophylaxis of meningococcal disease.

PubMed

Ngo, Van P; Civen, Rachel H; Dassey, David E; Davenport, Deborah; Mascola, Laurene

2010-03-01

A point-of-dispensing clinic was held to distribute ciprofloxacin prophylaxis when 2 high school students were reported to the health department with invasive meningococcal disease. Of more than 3,100 school staff and students in attendance, 2,861 received prophylaxis. A survey was administered to students 2 weeks postclinic to better understand the motivations for clinic attendance and to quantify side effects of oral 500-mg ciprofloxacin prophylaxis. Data collected included reasons for attendance and perception of risk for acquiring meningococcal disease, rated on a 1-to-5 scale; type of contact with cases; and side effects. Of 2,888 students, 1,624 completed surveys; 1,390 took ciprofloxacin. The students rated parental influence and directives from the high school as reasons for attendance a mean of 3.97 and 3.34, respectively. The mean rating for risk of acquiring meningococcal disease was 1.49. Only 3% reported direct contact with case(s). Side effects, most commonly headache (17%) and stomachache (10%), were reported in 40% of students. Serious side effects such as rash and facial swelling were reported in <1%. In this adolescent population, few serious side effects and no joint disorders were reported after they ingested single-dose ciprofloxacin; however, many received the prophylaxis unnecessarily. Students were motivated by parents and school officials. Health departments should collaborate with schools to prepare and disseminate messages that balance the risks of unnecessary antibiotic use with those of exposure to disease.

Service innovation in glaucoma management: using a Web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.

PubMed

Wright, Heathcote R; Diamond, Jeremy P

2015-03-01

To assess the importance of specialist supervision in a new model of glaucoma service delivery. An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: 'normal', 'stable', 'low risk', 'unstable' and 'high risk'. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist. 24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists' interim decisions resulting in an overall reduction in review appointments by 2.4%. Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A traditionally administered short course failed to improve medical students' diagnostic performance. A quantitative evaluation of diagnostic thinking.

PubMed

Noguchi, Yoshinori; Matsui, Kunihiko; Imura, Hiroshi; Kiyota, Masatomo; Fukui, Tsuguya

2004-05-01

Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students. Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities. The students' estimates of test characteristics of exercise stress test, and pretest and posttest probability for each scenario were evaluated before and after the short course. The pretest probability estimates by the students, as well as their proficiency in applying Bayes's theorem, were improved in the high pretest probability scenario after the short course. However, estimates of pretest probability in the low pretest probability scenario, and their proficiency in applying Bayes's theorem in the intermediate and low pretest probability scenarios, showed essentially no improvement. A carefully designed, but traditionally administered, short course could not improve the students' abilities in estimating pretest probability in a low pretest probability setting, and subsequently students remained incompetent in ruling out disease. We need to develop educational methods that cultivate a well-balanced clinical sense to enable students to choose a suitable diagnostic strategy as needed in a clinical setting without being one-sided to the "rule-in conscious paradigm."

The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.

PubMed

Kunze-Szikszay, Nils; Krack, Lennart A; Wildenauer, Pauline; Wand, Saskia; Heyne, Tim; Walliser, Karoline; Spering, Christopher; Bauer, Martin; Quintel, Michael; Roessler, Markus

2016-10-10

Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).

Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory.

PubMed

Bamford, Claire; Heaven, Ben; May, Carl; Moynihan, Paula

2012-10-30

Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation. We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring). The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualizing barriers to implementation; robust links with behavior-change theories would further increase the practical utility of NPT.

Hot surface temperatures of domestic appliances.

PubMed

Bassett, Malcolm; Arild, Anne-Helene

2002-09-01

Domestic appliances are burning people. In the European Union, accidents requiring hospital treatment due to burns from hot objects account for between 0 and 1% of all such accidents. Young children are particularly at risk. These reported accidents requiring hospital treatment are also likely to be a small proportion of the total number of burns from hot objects. There is a lack of hard evidence about the level of accidents, typical consumer expectation and use, and on the state of the art of appliances. Results of technical laboratory tests carried out on products are used to demonstrate the state of the art and also show how consumer expectations could be changing. Results of a survey into accidents, based on a written questionnaire following telephone contact, provide information on non-hospital cases. Results of tests on products show that there are significant differences in the temperatures of touchable surfaces, even in products of the same type. Typically, these differences are due to variations in design and/or materials of construction. Some products are hot enough to burn skin. Accident research indicates that non-hospital medical practices are treating burn injuries, which are therefore not being included into the current accident statistics. For products with the same function, some types of design or materials of construction are safer, with lower surface temperatures. Many product standards have no or unnecessarily high limits on surface temperatures. Many standards do not address the realities of who is using their products, for what purpose or where they are located. Some standards use unreasonable general limitations and exclusions that allow products with higher surface temperatures than they should have. Many standards rely on the experience factor for avoiding injury that is no longer valid, with the increased availability of safer products of the same type. A major field of work ahead is to carry out more surveys and in-depth studies of non-fatal accidents and injuries.

Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory

PubMed Central

2012-01-01

Background Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation. Methods We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Results Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring). Conclusions The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualizing barriers to implementation; robust links with behavior-change theories would further increase the practical utility of NPT. PMID:23110857

Evaluation of knowledge resources for public health reporting logic: Implications for knowledge authoring and management

PubMed Central

Staes, Catherine J; Altamore, Rita; Han, EunGyoung; Mottice, Susan; Rajeev, Deepthi; Bradshaw, Richard

2011-01-01

To control disease, laboratories and providers are required to report conditions to public health authorities. Reporting logic is defined in a variety of resources, but there is no single resource available for reporters to access the list of reportable events and computable reporting logic for any jurisdiction. In order to develop evidence-based requirements for authoring such knowledge, we evaluated reporting logic in the Council of State and Territorial Epidemiologist (CSTE) position statements to assess its readiness for automated systems and identify features that should be considered when designing an authoring interface; we evaluated codes in the Reportable Condition Mapping Tables (RCMT) relative to the nationally-defined reporting logic, and described the high level business processes and knowledge required to support laboratory-based public health reporting. We focused on logic for viral hepatitis. We found that CSTE tabular logic was unnecessarily complex (sufficient conditions superseded necessary and optional conditions) and was sometimes true for more than one reportable event: we uncovered major overlap in the logic between acute and chronic hepatitis B (52%), acute and Past and Present hepatitis C (90%). We found that the RCMT includes codes for all hepatitis criteria, but includes addition codes for tests not included in the criteria. The proportion of hepatitis variant-related codes included in RCMT that correspond to a criterion in the hepatitis-related position statements varied between hepatitis A (36%), acute hepatitis B (16%), chronic hepatitis B (64%), acute hepatitis C (96%), and past and present hepatitis C (96%). Public health epidemiologists have the need to communicate parameters other than just the name of a disease or organism that should be reported, such as the status and specimen sources. Existing knowledge resources should be integrated, harmonized and made computable. Our findings identified functionality that should be provided by future knowledge management systems to support epidemiologists as they communicate reporting rules for their jurisdiction. PMID:23569619

SHIELDING CONSIDERATIONS FOR THE SMALL ANIMAL RADIATION RESEARCH PLATFORM (SARRP)

PubMed Central

Sayler, Elaine; Dolney, Derek; Avery, Stephen; Koch, Cameron

2014-01-01

The Small Animal Radiation Research Platform (SARRP) is a commercially available platform designed to deliver conformal, image-guided radiation to small animals using a dual-anode kV x-ray source. At the University of Pennsylvania, a free-standing 2 m3 enclosure was designed to shield the SARRP according to federal code regulating cabinet x-ray systems. The initial design consisted of 4.0-mm-thick lead for all secondary barriers and proved wholly inadequate. Radiation levels outside the enclosure were 15 times higher than expected. Additionally, the leakage appeared to be distributed broadly within the enclosure, so concern arose that a subject might receive significant doses outside the intended treatment field. Thus, a detailed analysis was undertaken to identify and block all sources of leakage. Leakage sources were identified by Kodak X-OmatV (XV) film placed throughout the enclosure. Radiation inside the enclosure was quantified using Gafchromic film. Outside the enclosure, radiation was measured using a survey meter. Sources of leakage included (1) an unnecessarily broad beam exiting the tube, (2) failure of the secondary collimator to confine the primary beam entirely, (3) scatter from the secondary collimator, (4) lack of beam-stop below the treatment volume, and (5) incomplete shielding of the x-ray tube. The exit window was restricted, and a new collimator was designed to address problems (1–3). A beam-stop and additional tube shielding were installed. These modifications reduced internal scatter by more than 100-fold. Radiation outside the enclosure was reduced to levels compliant with federal regulations, provided the SARRP is operated using tube potentials of 175 kV or less. In addition, these simple and relatively inexpensive modifications eliminate the possibility of exposing a larger animal (such as a rat) to significant doses outside the treatment field. PMID:23532076

Development and validation of the Overlap Muon Track Finder for the CMS experiment

NASA Astrophysics Data System (ADS)

Dobosz, J.; Mietki, P.; Zawistowski, K.; Żarnecki, G.

2016-09-01

Present article is a description of the authors contribution in upgrade and analysis of performance of the Level-1 Muon Trigger of the CMS experiment. The authors are students of University of Warsaw and Gdansk University of Technology. They are collaborating with the CMS Warsaw Group. This article summarises students' work presented during the Students session during the Workshop XXXVIII-th IEEE-SPIE Joint Symposium Wilga 2016. In the first section the CMS experiment is briefly described and the importance of the trigger system is explained. There is also shown basic difference between old muon trigger strategy and the upgraded one. The second section is devoted to Overlap Muon Track Finder (OMTF). This is one of the crucial components of the Level-1 Muon Trigger. The algorithm of OMTF is described. In the third section there is discussed one of the event selection aspects - cut on the muon transverse momentum pT . Sometimes physical muon with pT bigger than a certain threshold is unnecessarily cut and physical muon with lower pT survives. To improve pT selection modified algorithm was proposed and its performance was studied. One of the features of the OMTF is that one physical muon often results in several muon candidates. The Ghost-Buster algorithm is designed to eliminate surplus candidates. In the fourth section this algorithm and its performance on different data samples are discussed. In the fifth section Local Data Acquisition System (Local DAQ) is briefly described. It supports initial system commissioning. The test done with OMTF Local DAQ are described. In the sixth section there is described development of web application used for the control and monitoring of CMS electronics. The application provides access to graphical user interface for manual control and the connection to the CMS hierarchical Run Control.

Foundations of planetary quarantine.

NASA Technical Reports Server (NTRS)

Hall, L. B.; Lyle, R. G.

1971-01-01

Discussion of some of the problems in microbiology and engineering involved in the implementation of planetary quarantine. It is shown that the solutions require new knowledge in both disciplines for success at low cost in terms of both monetary outlay and man's further exploration of the planets. A related problem exists in that engineers are not accustomed to the wide variation of biological data and microbiologists must learn to work and think in more exact terms. Those responsible for formulating or influencing national and international policies must walk a tightrope with delicate balance between unnecessarily stringent requirements for planetary quarantine on the one hand and prevention of contamination on the other. The success of planetary quarantine measures can be assured only by rigorous measures, each checked, rechecked, and triple-checked to make sure that no errors have been made and that no factor has been overlooked.

New method to design stellarator coils without the winding surface

DOE PAGES

Zhu, Caoxiang; Hudson, Stuart R.; Song, Yuntao; ...

2017-11-06

Finding an easy-to-build coils set has been a critical issue for stellarator design for decades. Conventional approaches assume a toroidal 'winding' surface, but a poorly chosen winding surface can unnecessarily constrain the coil optimization algorithm, This article presents a new method to design coils for stellarators. Each discrete coil is represented as an arbitrary, closed, one-dimensional curve embedded in three-dimensional space. A target function to be minimized that includes both physical requirements and engineering constraints is constructed. The derivatives of the target function with respect to the parameters describing the coil geometries and currents are calculated analytically. A numerical code,more » named flexible optimized coils using space curves (FOCUS), has been developed. Furthermore, applications to a simple stellarator configuration, W7-X and LHD vacuum fields are presented.« less

A mother with green breastmilk due to multivitamin and mineral intake: a case report.

PubMed

Yazgan, Hamza; Demirdöven, Mehmet; Yazgan, Zerrin; Toraman, Ahmet Ruhi; Gürel, Ahmet

2012-08-01

It is a globally accepted fact that breastfeeding reduces infant mortality and morbidity, optimizes infant growth, is superior to other forms of nutrition for infants, and has economic advantages for the family and the country. This case study reports a new mother who stopped breastfeeding her baby because her breastmilk was green. When her second child was born, her milk came in green, and a consultation was requested from pediatrics and infectious diseases. A physical examination and laboratory tests revealed that the abnormal color of her breastmilk was related to multivitamin intake. The patient was advised to continue breastfeeding despite the odd color. Although clinical specialists know that the color of breastmilk can change with the ingestion of certain medications and foods, mothers are usually unaware and may unnecessarily terminate breastfeeding.

The Need for Information on Standards on eAccessibility&eInclusion - Based on the Experience of the EU-Project IN LIFE.

PubMed

Galinski, Christian; Giraldo Perez, Blanca Stella

2017-01-01

Recent investigations in several EU-projects, incl. IN LIFE revealed that experts in the field of eAccessibility & eInclusion (eAcc&eIncl) - but also general ICT developers, decision makers in industry and administration - are quite unaware of the importance of standards for interoperability and sustainability of ICT solutions. Especially, if persons with disabilities (PwD) are concerned, system development and the design of services can become unnecessarily costly. For accessibility in general and eAcc&eIncl in particular, knowing about pertinent standards is becoming an asset of personal competencies of experts and decision makers, and particularly benefit small enterprises. Given the complex world of standardization and the multitude of standards developing organizations (SDOs) easy access to information on standards is critical.

New method to design stellarator coils without the winding surface

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

Zhu, Caoxiang; Hudson, Stuart R.; Song, Yuntao

Finding an easy-to-build coils set has been a critical issue for stellarator design for decades. Conventional approaches assume a toroidal 'winding' surface, but a poorly chosen winding surface can unnecessarily constrain the coil optimization algorithm, This article presents a new method to design coils for stellarators. Each discrete coil is represented as an arbitrary, closed, one-dimensional curve embedded in three-dimensional space. A target function to be minimized that includes both physical requirements and engineering constraints is constructed. The derivatives of the target function with respect to the parameters describing the coil geometries and currents are calculated analytically. A numerical code,more » named flexible optimized coils using space curves (FOCUS), has been developed. Furthermore, applications to a simple stellarator configuration, W7-X and LHD vacuum fields are presented.« less

A comparison of campfire impacts and policies in seven protected areas

USGS Publications Warehouse

Reid, S.E.; Marion, J.L.

2005-01-01

Using resource-monitoring data from seven protected areas, the effectiveness of three campfire policies-campfire ban, designated campfires, and unregulated campfires-were assessed based on the number of fire sites and the amount of tree damage. Results indicate that unregulated campfire policies permitted substantial numbers of fire sites and tree damage in campsites, although fire bans did not eliminate or even substantially decrease these problems. A designated campfire policy was effective in decreasing number of fire sites, but little difference was found among policies regarding tree damage. Given the importance of campfires to visitor experiences, campfire prohibitions could be viewed as unnecessarily restrictive based on their limited success in preventing resource damage. Conclusions encourage protected-area managers to consider designated campfire policies and prohibitions on axes, hatchets, and saws to better meet resource protection and visitor experience mandates.

Riddles of masculinity: gender, bisexuality, and thirdness.

PubMed

Fogel, Gerald I

2006-01-01

Clinical examples are used to illuminate several riddles of masculinity-ambiguities, enigmas, and paradoxes in relation to gender, bisexuality, and thirdness-frequently seen in male patients. Basic psychoanalytic assumptions about male psychology are examined in the light of advances in female psychology, using ideas from feminist and gender studies as well as important and now widely accepted trends in contemporary psychoanalytic theory. By reexamining basic assumptions about heterosexual men, as has been done with ideas concerning women and homosexual men, complexity and nuance come to the fore to aid the clinician in treating the complex characterological pictures seen in men today. In a context of rapid historical and theoretical change, the use of persistent gender stereotypes and unnecessarily limiting theoretical formulations, though often unintended, may mask subtle countertransference and theoretical blind spots, and limit optimal clinical effectiveness.

Food from cloned animals is part of our brave old world.

PubMed

Miller, Henry I

2007-05-01

When confronted by pressure from activists and Congress, the US Food and Drug Administration (FDA) has not always adopted policies and made decisions about individual products that accord with the scientific evidence. An example was the unnecessarily and markedly prolonged review of the veterinary drug bovine somatotropin (bST), or bovine growth hormone, during the 1980s. The FDA now faces a similar situation surrounding the question of whether meat and milk from cloned animals and their offspring are safe for human consumption. Having made a preliminary decision in the affirmative - based on an exhaustive analysis of scientific articles, health records, blood samples and studies of the composition of meat and milk - the agency has been beleaguered by criticisms. It remains to be seen whether, ultimately, science will trump anti-technology, anti-consumer activism.

[A simplified occupational health and safety management system designed for small enterprises. Initial validation results].

PubMed

Bacchi, Romana; Veneri, L; Ghini, P; Caso, Maria Alessandra; Baldassarri, Giovanna; Renzetti, F; Santarelli, R

2009-01-01

Occupational Health and Safety Management Systems (OHSMS) are known to be effective in improving safety at work. Unfortunately they are often too resource-heavy for small businesses. The aim of this project was to develop and test a simplified model of OHSMS suitable for small enterprises. The model consists of 7 procedures and various operating forms and check lists, that guide the enterprise in managing safety at work. The model was tested in 15 volunteer enterprises. In most of the enterprises two audits showed increased awareness and participation of workers; better definition and formalisation of respon sibilities in 8 firms; election of Union Safety Representatives in over one quarter of the enterprises; improvement of safety equipment. The study also helped identify areas where the model could be improved by simplification of unnecessarily complex and redundant procedures.

Emerging zoonoses: responsible communication with the media--lessons learned and future perspectives.

PubMed

Tabbaa, D

2010-11-01

Emerging zoonotic disease outbreaks are inevitable and often unpredictable events. The environment surrounding an outbreak is unique in public health, and outbreaks are frequently marked by uncertainty, confusion and a sense of urgency. Good communication at this time, generally through the media, is essential, but examples unfortunately abound of communication failures that have delayed outbreak control, undermined public trust and compliance, and unnecessarily prolonged economic, social and political turmoil. With this paper we hope to disseminate the idea that communication expertise has become as essential to outbreak control as epidemiological training and laboratory analysis. The paper presents the best practices for communicating with the public and discusses future aspects of communicating through the mass media during an outbreak. Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Occupational exposure to intermediate frequency and extremely low frequency magnetic fields among personnel working near electronic article surveillance systems.

PubMed

Roivainen, Päivi; Eskelinen, Tuomo; Jokela, Kari; Juutilainen, Jukka

2014-05-01

Cashiers are potentially exposed to intermediate frequency (IF) magnetic fields at their workplaces because of the electronic article surveillance (EAS) systems used in stores to protect merchandise against theft. This study aimed at investigating occupational exposure of cashiers to IF magnetic fields in Finnish stores. Exposure to extremely low frequency (ELF) magnetic fields was also evaluated because cashiers work near various devices operating with 50 Hz electric power. The peak magnetic flux density was measured for IF magnetic fields, and was found to vary from 0.2 to 4 µT at the cashier's seat. ELF magnetic fields from 0.03 to 4.5 µT were found at the cashier's seat. These values are much lower than exposure limits. However, according to the International Commission on Non-Ionizing Radiation Protection (ICNIRP) occupational reference levels for IF magnetic fields (141 µT for the peak field) were exceeded in some cases (maximum 189 µT) for short periods of time when cashiers walked through the EAS gates. As the ICNIRP reference levels do not define any minimum time for exposure, additional investigations are recommended to determine compliance with basic restrictions. Even if the basic restrictions are not exceeded, persons working near EAS devices represent an exceptional group of workers with respect to exposure to electromagnetic fields. This group could serve as a basis for epidemiological studies addressing possible health effects of IF magnetic fields. Compliance with the reference levels for IF fields was evaluated using both broadband measurement of peak fields and the ICNIRP summation rule for multiple frequencies. The latter was generally more conservative, and the difference between the two methods was large (>10-fold) for EAS systems using a 58 kHz signal with complex waveform. This indicates that the ICNIRP multiple frequency rule can be unnecessarily conservative when measuring complex waveforms. © 2014 Wiley Periodicals, Inc.

Ethical implications of excessive cluster sizes in cluster randomised trials.

PubMed

Hemming, Karla; Taljaard, Monica; Forbes, Gordon; Eldridge, Sandra M; Weijer, Charles

2018-02-20

The cluster randomised trial (CRT) is commonly used in healthcare research. It is the gold-standard study design for evaluating healthcare policy interventions. A key characteristic of this design is that as more participants are included, in a fixed number of clusters, the increase in achievable power will level off. CRTs with cluster sizes that exceed the point of levelling-off will have excessive numbers of participants, even if they do not achieve nominal levels of power. Excessively large cluster sizes may have ethical implications due to exposing trial participants unnecessarily to the burdens of both participating in the trial and the potential risks of harm associated with the intervention. We explore these issues through the use of two case studies. Where data are routinely collected, available at minimum cost and the intervention poses low risk, the ethical implications of excessively large cluster sizes are likely to be low (case study 1). However, to maximise the social benefit of the study, identification of excessive cluster sizes can allow for prespecified and fully powered secondary analyses. In the second case study, while there is no burden through trial participation (because the outcome data are routinely collected and non-identifiable), the intervention might be considered to pose some indirect risk to patients and risks to the healthcare workers. In this case study it is therefore important that the inclusion of excessively large cluster sizes is justifiable on other grounds (perhaps to show sustainability). In any randomised controlled trial, including evaluations of health policy interventions, it is important to minimise the burdens and risks to participants. Funders, researchers and research ethics committees should be aware of the ethical issues of excessively large cluster sizes in cluster trials. © 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.

Specialist Physicians' Attitudes and Practice Patterns Regarding Disclosure of Pre-referral Medical Errors.

PubMed

Dossett, Lesly A; Kauffmann, Rondi M; Lee, Jay S; Singh, Harkamal; Lee, M Catherine; Morris, Arden M; Jagsi, Reshma; Quinn, Gwendolyn P; Dimick, Justin B

2018-06-01

Our objective was to determine specialist physicians' attitudes and practices regarding disclosure of pre-referral errors. Physicians are encouraged to disclose their own errors to patients. However, no clear professional norms exist regarding disclosure when physicians discover errors in diagnosis or treatment that occurred at other institutions before referral. We conducted semistructured interviews of cancer specialists from 2 National Cancer Institute-designated Cancer Centers. We purposively sampled specialists by discipline, sex, and experience-level who self-described a >50% reliance on external referrals (n = 30). Thematic analysis of verbatim interview transcripts was performed to determine physician attitudes regarding disclosure of pre-referral medical errors; whether and how physicians disclose these errors; and barriers to providing full disclosure. Participants described their experiences identifying different types of pre-referral errors including errors of diagnosis, staging and treatment resulting in adverse events ranging from decreased quality of life to premature death. The majority of specialists expressed the belief that disclosure provided no benefit to patients, and might unnecessarily add to their anxiety about their diagnoses or prognoses. Specialists had varying practices of disclosure including none, non-verbal, partial, event-dependent, and full disclosure. They identified a number of barriers to disclosure, including medicolegal implications and damage to referral relationships, the profession's reputation, and to patient-physician relationships. Specialist physicians identify pre-referral errors but struggle with whether and how to provide disclosure, even when clinical circumstances force disclosure. Education- or communication-based interventions that overcome barriers to disclosing pre-referral errors warrant development.

Emergency management and homeland security: Exploring the relationship.

PubMed

Kahan, Jerome H

2015-01-01

In the years after the 9/11 tragedy, the United States continues to face risks from all forms of major disasters, from potentially dangerous terrorist attacks to catastrophic acts of nature. Professionals in the fields of emergency management and homeland security have responsibilities for ensuring that all levels of government, urban areas and communities, nongovernmental organizations, businesses, and individual citizens are prepared to deal with such hazards though actions that reduce risks to lives and property. Regrettably, the overall efficiency and effectiveness of the nation's ability to deal with disasters is unnecessarily challenged by the absence of a common understanding on how these fields are related in the workforce and educational arenas. Complicating matters further is the fact that neither of these fields has developed agreed definitions. In many ways, homeland security and emergency management have come to represent two different worlds and cultures. These conditions can have a deleterious effect on preparedness planning for public and private stakeholders across the nation when coordinated responses among federal, state, and local activities are essential for dealing with consequential hazards. This article demonstrates that the fields of emergency management and homeland security share many responsibilities but are not identical in scope or skills. It argues that emergency management should be considered a critical subset of the far broader and more strategic field of homeland security. From analytically based conclusions, it recommends five steps that be taken to bring these fields closer together to benefit more from their synergist relationship as well as from their individual contributions.

Ergonomic Redesign of an Industrial Control Panel.

PubMed

Raeisi, S; Osqueizadeh, R; Maghsoudipour, M; Jafarpisheh, A S

2016-07-01

Operator's role in industrial control centers takes place in time, which is one of the most important determinants of whether an expected action is going to be successful or not. In certain situations, due to the complex nature of the work, the existing interfaces and already prepared procedures do not meet the dynamic requirements of operator's cognitive demands, making the control tasks unnecessarily difficult. This study was conducted to identify ergonomic issues with a specific industrial control panel, and redesign its layout and elements to enhance its usability. Task and link analysis methodologies were implemented. All essential functions and supporting operations were identified at the required trivial levels. Next, the weight of any possible link between the elements of the panel was computed as a composite index of frequency and importance. Finally, all components were rearranged within a new layout, and a computerized mockup was generated. A total of 8 primary tasks was identified, including 4 system failure handling tasks, switching between manual and automated modes, and 3 types of routine vigilance and control tasks. These tasks were broken down into 28 functions and 145 supporting operations, accordingly. Higher link values were observed between hand rest position and 2 elements. Also, 6 other components showed robust linkages. In conclusion, computer modeling can reduce the likelihood of accidents and near misses in industrial control rooms by considering the operators' misperception or mental burden and correcting poor design of the panels and inappropriate task allocation.

Australian Football League concussion guidelines: what do community players think?

PubMed

White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua; Finch, Caroline F

2016-01-01

Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players' views on following the Australian Football League's (AFL) concussion guidelines. 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players' rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players' desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport.

[Systematic screening of deafness at a maternity ward using evoked otoacoustic emissions: practical aspects and parental attitudes].

PubMed

Moulin, A; Ferber-Viart, C; Berland, M; Dubreuil, C; Duclaux, R

2001-09-01

Evaluation of the feasibility and parental attitudes towards a hearing screening programme using evoked otoacoustic emissions, implemented in a maternity ward in France. A hearing screening test using transiently evoked otoacoustic emissions (TEOAE) was proposed to each baby, and an anonymous questionnaire was given to parents to assess their attitudes towards the screening procedure. Although the refusal of the test reached 16% (mainly during the first two weeks of the program), more than 92% of parents judged the test as being useful, and 65% wished it to be systematically done. However, nearly 35% of parents admitted to have a low level anxiety about being unnecessarily worried by the test results. One hundred and twenty-four babies were screened. Fifty three per cent of the tests have been performed in less than ten minutes, with an average of 12.2 minutes. This duration does not include delays due to programme and babies management. False positive rate (uni or bilateral fail) was 10.5% at the first stage. Repeating the test before discharge decreased the false positive rate to 6.5%. Although limited in time, this study shows that a systematic hearing screening programme using TEOAE is possible and should be done in France. False positive rate was below 7%, and the test was considered as useful by more than 90% of parents, although knowledge about deafness in childhood and its consequences were clearly insufficient.

Geophysical weight loss diet

NASA Astrophysics Data System (ADS)

Schatten, Kenneth

1984-04-01

Having for numerous reasons acquired a three digit kilogram mass, the author is experienced at the painful struggles that the gourmand must suffer to reduce weight, particularly if he/she enjoys reasonably large amounts of good food. To the avant-garde geophysicist, utilizing the following approach could be pleasurable, rewarding, and may even enable the accomplishment of what Ghengis Khan, Alexander the Great, Napolean, and Hitler could not!The basic approach is the full utilization of Newton's formula for the attraction of two massive bodies: F=GM1M2/r2, where G, is the gravitational constant; r, the distance between the two bodies; and M1 and M2, the masses of the two bodies. Although one usually chooses M1 to be the earth's mass ME and M2 to be the mass of a small object, this unnecessarily restricts the realm of phenomena. The less restrictive assumption is M1 + M2 = ME.

Catching flies with vinegar: a critique of the Centers for Medicare and Medicaid self-disclosure program.

PubMed

Veilleux, Jean Wright

2012-01-01

This Article argues that the current approach of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to enforcement of the Ethics in Patient Referrals Act (the "Stark Law") is unnecessarily punitive and discourages health-care providers from self-disclosing even very minor violations of the Stark Law. This Article suggests a number of specific changes to encourage provider self-disclosure and proposes that CMS create a demonstration project under the authority of the Patient Protection and Affordable Care Act to test the reforms. A demonstration project provides the perfect vehicle to prove that increased self-disclosure protocols for the Stark Law can decrease the government's costs of enforcement, improve program integrity, and encourage providers to deal responsibly with the inevitable minor lapses in compliance that arise in such an enormous government program as Medicare.

Diffusion processes of fragmentary information on scale-free networks

NASA Astrophysics Data System (ADS)

Li, Xun; Cao, Lang

2016-05-01

Compartmental models of diffusion over contact networks have proven representative of real-life propagation phenomena among interacting individuals. However, there is a broad class of collective spreading mechanisms departing from compartmental representations, including those for diffusive objects capable of fragmentation and transmission unnecessarily as a whole. Here, we consider a continuous-state susceptible-infected-susceptible (SIS) model as an ideal limit-case of diffusion processes of fragmentary information on networks, where individuals possess fractions of the information content and update them by selectively exchanging messages with partners in the vicinity. Specifically, we incorporate local information, such as neighbors' node degrees and carried contents, into the individual partner choice, and examine the roles of a variety of such strategies in the information diffusion process, both qualitatively and quantitatively. Our method provides an effective and flexible route of modulating continuous-state diffusion dynamics on networks and has potential in a wide array of practical applications.

Physiology is rocking the foundations of evolutionary biology.

PubMed

Noble, Denis

2013-08-01

The 'Modern Synthesis' (Neo-Darwinism) is a mid-20th century gene-centric view of evolution, based on random mutations accumulating to produce gradual change through natural selection. Any role of physiological function in influencing genetic inheritance was excluded. The organism became a mere carrier of the real objects of selection, its genes. We now know that genetic change is far from random and often not gradual. Molecular genetics and genome sequencing have deconstructed this unnecessarily restrictive view of evolution in a way that reintroduces physiological function and interactions with the environment as factors influencing the speed and nature of inherited change. Acquired characteristics can be inherited, and in a few but growing number of cases that inheritance has now been shown to be robust for many generations. The 21st century can look forward to a new synthesis that will reintegrate physiology with evolutionary biology.

The brain imaging data structure, a format for organizing and describing outputs of neuroimaging experiments.

PubMed

Gorgolewski, Krzysztof J; Auer, Tibor; Calhoun, Vince D; Craddock, R Cameron; Das, Samir; Duff, Eugene P; Flandin, Guillaume; Ghosh, Satrajit S; Glatard, Tristan; Halchenko, Yaroslav O; Handwerker, Daniel A; Hanke, Michael; Keator, David; Li, Xiangrui; Michael, Zachary; Maumet, Camille; Nichols, B Nolan; Nichols, Thomas E; Pellman, John; Poline, Jean-Baptiste; Rokem, Ariel; Schaefer, Gunnar; Sochat, Vanessa; Triplett, William; Turner, Jessica A; Varoquaux, Gaël; Poldrack, Russell A

2016-06-21

The development of magnetic resonance imaging (MRI) techniques has defined modern neuroimaging. Since its inception, tens of thousands of studies using techniques such as functional MRI and diffusion weighted imaging have allowed for the non-invasive study of the brain. Despite the fact that MRI is routinely used to obtain data for neuroscience research, there has been no widely adopted standard for organizing and describing the data collected in an imaging experiment. This renders sharing and reusing data (within or between labs) difficult if not impossible and unnecessarily complicates the application of automatic pipelines and quality assurance protocols. To solve this problem, we have developed the Brain Imaging Data Structure (BIDS), a standard for organizing and describing MRI datasets. The BIDS standard uses file formats compatible with existing software, unifies the majority of practices already common in the field, and captures the metadata necessary for most common data processing operations.

Preliminary report on aerotoxic syndrome (AS) and the need for diagnostic neurophysiological tests.

PubMed

Hale, Margaret A; Al-Seffar, Judith A

2009-09-01

Researchers have found, in studies carried out over several years, that many passengers and crew, following their recent flights in commercial jet aeroplanes, have become unwell, with a range of symptoms in common. This condition, which has not yet been officially recognised, is called Aerotoxic Syndrome (AS). It seems to be caused, primarily, by neurotoxic organophosphates contaminating the air circulating in jet cabins. Patients with such symptoms may visit their GPs, who then arrange diagnostic tests. Some of their symptoms fall within the jurisdiction of diagnostic neurophysiological investigations, but neurophysiology practitioners may be unaware of this syndrome. Until AS is officially recognised as an illness, and guidelines for diagnostic procedures established, patients requiring specific investigations may not be appropriately referred, or tests may be performed unnecessarily. This report seeks to stimulate debate within the field, and facilitate studies, if needed, to help define the diagnostic criteria.

The brain imaging data structure, a format for organizing and describing outputs of neuroimaging experiments

PubMed Central

Gorgolewski, Krzysztof J.; Auer, Tibor; Calhoun, Vince D.; Craddock, R. Cameron; Das, Samir; Duff, Eugene P.; Flandin, Guillaume; Ghosh, Satrajit S.; Glatard, Tristan; Halchenko, Yaroslav O.; Handwerker, Daniel A.; Hanke, Michael; Keator, David; Li, Xiangrui; Michael, Zachary; Maumet, Camille; Nichols, B. Nolan; Nichols, Thomas E.; Pellman, John; Poline, Jean-Baptiste; Rokem, Ariel; Schaefer, Gunnar; Sochat, Vanessa; Triplett, William; Turner, Jessica A.; Varoquaux, Gaël; Poldrack, Russell A.

2016-01-01

The development of magnetic resonance imaging (MRI) techniques has defined modern neuroimaging. Since its inception, tens of thousands of studies using techniques such as functional MRI and diffusion weighted imaging have allowed for the non-invasive study of the brain. Despite the fact that MRI is routinely used to obtain data for neuroscience research, there has been no widely adopted standard for organizing and describing the data collected in an imaging experiment. This renders sharing and reusing data (within or between labs) difficult if not impossible and unnecessarily complicates the application of automatic pipelines and quality assurance protocols. To solve this problem, we have developed the Brain Imaging Data Structure (BIDS), a standard for organizing and describing MRI datasets. The BIDS standard uses file formats compatible with existing software, unifies the majority of practices already common in the field, and captures the metadata necessary for most common data processing operations. PMID:27326542

Practical Capillary Electrophoresis, 2nd Edition by Robert Weinberger

NASA Astrophysics Data System (ADS)

Tilstra, Luanne

2001-01-01

Parts of the text are unnecessarily confusing. The confusion arises because the author assumes the reader knows some aspect of CE in detail, although the detail is not presented until a later chapter. The "Master Symbol List" in the early pages is complete for individuals who are fluent in the language of CE, but not necessarily for folks new to the field. When faced with a new abbreviation, I found it necessary to check for its presence in the master list; if the abbreviation wasn't there, I added it. For example, every CE practitioner knows that BGE stands for "background electrolyte". Although the abbreviation was clearly defined in Chapter 1, I had forgotten it by the time I got to Chapter 3. Nevertheless, the wealth of detailed information, the abundance of useful references, and the well-organized tables outweigh the few editorial problems I found.

Can Pearlite form Outside of the Hultgren Extrapolation of the Ae3 and Acm Phase Boundaries?

NASA Astrophysics Data System (ADS)

Aranda, M. M.; Rementeria, R.; Capdevila, C.; Hackenberg, R. E.

2016-02-01

It is usually assumed that ferrous pearlite can form only when the average austenite carbon concentration C 0 lies between the extrapolated Ae3 ( γ/ α) and Acm ( γ/ θ) phase boundaries (the "Hultgren extrapolation"). This "mutual supersaturation" criterion for cooperative lamellar nucleation and growth is critically examined from a historical perspective and in light of recent experiments on coarse-grained hypoeutectoid steels which show pearlite formation outside the Hultgren extrapolation. This criterion, at least as interpreted in terms of the average austenite composition, is shown to be unnecessarily restrictive. The carbon fluxes evaluated from Brandt's solution are sufficient to allow pearlite growth both inside and outside the Hultgren Extrapolation. As for the feasibility of the nucleation events leading to pearlite, the only criterion is that there are some local regions of austenite inside the Hultgren Extrapolation, even if the average austenite composition is outside.

Management of maxillectomy defect with a hybrid hollow bulb obturator

PubMed Central

Singh, Kamleshwar; Singh, Saumyendra V; Mishra, Niraj; Agrawal, Kaushal Kishor

2013-01-01

A woman having already undergone maxillectomy came to the department complaining of difficulty in eating and speech. During the construction of an obturator, the bulb area should be hollowed to reduce weight so that the teeth and supporting tissues are not stressed unnecessarily. The conventional open design drains fluid from the adjacent mucosa, possibly increasing the weight of the prosthesis, and is difficult to clean. The closed bulb design does not drain secretions and may cause obstruction and susceptibility to infection in the paranasal and pharyngeal regions, though it is easier to maintain. An alternative to the two designs, combining their advantages, is presented in this report. As the open hollow part of the obturator was shallow, it was easy to clean. Making the inferior part of the bulb hollow and closed led to a reduction in the overall weight of the prosthesis while increasing its resonance. PMID:23436886

IOTF thresholds for overweight and obesity and their relation to metabolic risk in children (EarlyBird 20).

PubMed

Voss, L D; Metcalf, B S; Jeffery, A N; Wilkin, T J

2006-04-01

The International Obesity TaskForce has published paediatric cutoffs from the age of 2 years for overweight and obesity, based on adult thresholds. We question their rationale. The adult cutoffs were based on known health risk; the children's were not. Data from the EarlyBird Study show that BMI category for overweight and obesity in young children are poor markers of insulin resistance and, by implication, of metabolic risk and diabetes. Moreover, BMI is known to track poorly from early childhood to adulthood. We know even less about the tracking of insulin resistance and other indices of metabolic risk from the earliest years. Until we understand more about which children acquire such risk factors, any such thresholds for overweight and obesity should be used with caution in the very young, as they may unnecessarily stigmatise the heavier child.

Is a separate monotherapy indication warranted for antiepileptic drugs?

PubMed

Mintzer, Scott; French, Jacqueline A; Perucca, Emilio; Cramer, Joyce A; Messenheimer, John A; Blum, David E; Rogawski, Michael A; Baulac, Michel

2015-12-01

Antiepileptic drugs (AEDs) are the only neurotherapeutics for which regulatory approval is consistently separated into monotherapy or adjunctive-therapy indications. Because head-to-head comparisons of AEDs (used in the European Union to approve drugs for monotherapy) have not shown substantial differences in efficacy between drugs, FDA approval for use of an AED as monotherapy has typically been based on trials with novel designs that have been criticised for reasons of ethics and clinical relevance. Many new-generation AEDs have not been approved for monotherapy, causing drug labelling and real-world use to be increasingly inconsistent, with negative consequences for patients. The regulatory requirement for separate monotherapy and adjunctive-therapy indications in epilepsy is unnecessarily restrictive. We recommend that regulatory agencies approve AEDs for the treatment of specific seizure types or epilepsy syndromes, irrespective of concomitant drug use. Copyright © 2015 Elsevier Ltd. All rights reserved.

Stigma by Any Other Name.

PubMed

Sheehan, Lindsay; Fominaya, Adam W; Bink, Andrea B; Kraus, Dana J; Schmidt, Anne; Corrigan, Patrick W

2016-12-01

Some advocates argue that the word "stigma" is itself stigmatizing and contributes to further denigration of people with mental illness. This brief report presents results of a nationwide survey comparing terminology related to stigma in regard to mental illness. A total of 340 Amazon Mechanical Turk survey takers read variations of a vignette depicting an individual with schizophrenia and then completed a brief stigma measure. The vignette varied in a single sentence in which three different words-"stigma," "prejudice," and "reactions"-were used to describe coworkers' possible attitudes toward the depicted individual. Stigma ratings did not differ by vignette group. "Reactions" was viewed as significantly less disrespectful than both "stigma" and "prejudice" (p<.001). Further research is needed to support replacing the word "stigma" in public arenas. Current efforts to remove the word may unnecessarily distract advocates and policy makers from the primary mission of erasing stigma.

The overconstraint of response time models: rethinking the scaling problem.

PubMed

Donkin, Chris; Brown, Scott D; Heathcote, Andrew

2009-12-01

Theories of choice response time (RT) provide insight into the psychological underpinnings of simple decisions. Evidence accumulation (or sequential sampling) models are the most successful theories of choice RT. These models all have the same "scaling" property--that a subset of their parameters can be multiplied by the same amount without changing their predictions. This property means that a single parameter must be fixed to allow the estimation of the remaining parameters. In the present article, we show that the traditional solution to this problem has overconstrained these models, unnecessarily restricting their ability to account for data and making implicit--and therefore unexamined--psychological assumptions. We show that versions of these models that address the scaling problem in a minimal way can provide a better description of data than can their overconstrained counterparts, even when increased model complexity is taken into account.

Environmental risk assessments for transgenic crops producing output trait enzymes

PubMed Central

Tuttle, Ann; Shore, Scott; Stone, Terry

2009-01-01

The environmental risks from cultivating crops producing output trait enzymes can be rigorously assessed by testing conservative risk hypotheses of no harm to endpoints such as the abundance of wildlife, crop yield and the rate of degradation of crop residues in soil. These hypotheses can be tested with data from many sources, including evaluations of the agronomic performance and nutritional quality of the crop made during product development, and information from the scientific literature on the mode-of-action, taxonomic distribution and environmental fate of the enzyme. Few, if any, specific ecotoxicology or environmental fate studies are needed. The effective use of existing data means that regulatory decision-making, to which an environmental risk assessment provides essential information, is not unnecessarily complicated by evaluation of large amounts of new data that provide negligible improvement in the characterization of risk, and that may delay environmental benefits offered by transgenic crops containing output trait enzymes. PMID:19924556

Avoiding potential problems when selling accounts receivable.

PubMed

Ayers, D H; Kincaid, T J

1996-05-01

Accounts receivable financing is a potential tool for managing a provider organization's working capital needs. But before entering into a financing agreement, organizations need to consider and take steps to avoid serious problems that can arise from participation in an accounts receivable financing program. For example, the purchaser may cease purchasing the receivables, leaving the organization without funding needed for operations. Or, the financing program may be inordinately complex and unnecessarily costly to the organization. Sometimes the organization itself may fail to comply with the terms of the agreement under which the accounts receivable were sold, thus necessitating that restitution be made to the purchaser or provoking charges of fraud. These potential problems should be addressed as early as possible--before an organization enters into an accounts receivable financing program--in order to minimize time, effort, and expanse and maximize the benefits of the financing agreement.

[Treatment and follow up protocol in differentiated thyroid carcinomas of follicular origin].

PubMed

Rodrigues, Fernando; Limbert, Edward; Marques, Ana Paula; Santos, Ana Paula; Lopes, Carlos; Rodrigues, Elizabete; Borges, Fátima; Carrilho, Francisco; Castro, João Jácome de; Neto, João; Salgado, Lucília; Oliveira, Maria João

2005-01-01

Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.

Shuttle Rocket Motor Program: NASA should delay awarding some construction contracts. Report to the Chair, Subcommittee on Government Activities and Transportation, Committee on Government Operations, House of Representatives

NASA Technical Reports Server (NTRS)

1992-01-01

Even though the executive branch has proposed terminating the Advanced Solid Rocket Motor (ASRM) program, NASA is proceeding with all construction activity planned for FY 1992 to avoid schedule slippage if the program is reinstated by Congress. However, NASA could delay some construction activities for at least a few months without affecting the current launch data schedule. For example, NASA could delay Yellow Creek's motor storage and dock projects, Stennis' dock project, and Kennedy's rotation processing and surge facility and dock projects. Starting all construction activities as originally planned could result in unnecessarily incurring additional costs and termination liability if the funding for FY 1993 is not provided. If Congress decides to continue the program, construction could still be completed in time to avoid schedule slippage.

The health professional's role in preventing nosocomial infections

PubMed Central

Saloojee, H; Steenhoff, A

2001-01-01

Despite their best intentions, health professionals sometimes act as vectors of disease, disseminating new infections among their unsuspecting clients. Attention to simple preventive strategies may significantly reduce disease transmission rates. Frequent hand washing remains the single most important intervention in infection control. However, identifying mechanisms to ensure compliance by health professionals remains a perplexing problem. Gloves, gowns, and masks have a role in preventing infections, but are often used inappropriately, increasing service costs unnecessarily. While virulent microorganisms can be cultured from stethoscopes and white coats, their role in disease transmission remains undefined. There is greater consensus about sterile insertion techniques for intravascular catheters—a common source of infections—and their care. By following a few simple rules identified in this review, health professionals may prevent much unnecessary medical and financial distress to their patients.


Keywords: infection control; cross infection; hand washing; catheterisation PMID:11123387

In modern linacs monitor units should be defined in water at 10 cm depth rather than at dmax.

PubMed

Van den Heuvel, Frank; Wu, Qiuwen; Cai, Jing

2018-05-28

Thanks to the widely adopted guidelines such as AAPM TG-51 1 and IAEA TRS-398 2 , linac calibration has become more consistent and accurate around the globe than previously. Modern linac photon beams are often calibrated in water at 10 cm depth, and configured such that 1 monitor unit (MU) corresponds to 1 cGy at the depth of maximum dose, (d max) . However, such configuration is not without limitations. Some think it is unnecessarily complex and prone to errors, and believe that defining MU at 10 cm is more appropriate. Others think that change of MU definition can cause confusion and possibly serious consequences without any real benefit. This is the premise debated in this month's Point/Counterpoint. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Food allergies are rarely a concern when considering vaccines for adolescents.

PubMed

Buyantseva, Larisa V; Horwitz, Alexandra

2014-03-01

Routine immunization provides protection from numerous infectious diseases and substantially reduces morbidity mortality from these diseases. In the United States, vaccination programs focused on infants and children have successfully decreased the incidence of many childhood vaccine-preventable diseases. However, vaccination coverage among adolescents has remained stagnant. Contributing to this lack of coverage is that patients with food allergies might be advised unnecessarily to avoid certain vaccinations, thus potentially causing adverse personal and community health. Studies have shown that food allergies are rarely contraindications to vaccine administration. Most adolescents who avoid vaccination because of food allergy concerns are actually able to receive their appropriate vaccinations. However, there are situations when evaluation by an allergist is recommended. In the present article, the authors provide guidance for physicians when administering vaccines to patients with food allergies to prevent adverse events and improve disease protection.

Further comment to "Reply to Comment on impact structures in Africa: A review (Short Note)" by Reimold and Koeberl [J. Afr. Earth Sci. 100 (2014) 757-758

NASA Astrophysics Data System (ADS)

Acevedo, R. D.; Rabassa, J.; Rocca, M.; González-Guillot, M.; Martínez, O.; Subías, I.; Corbella, H.; Prezzi, C.; Orgeira, M. J.; Ponce, J. F.

2016-06-01

In a Comment on Reimold and Koeberl (2014a) to JAES, Acevedo et al. (2014) claimed an impact origin for Bajada del Diablo crater-strewn field (BdD), a remote locality in Central Patagonia. Such genesis had been denied by Reimold and Koeberl (2014a), who rejected its relationship to any impact-cratering process since, in their opinion, Acevedo et al. (2009, 2012, among other papers) had not found direct evidence of impact. Neither Professor Wolf Uwe Reimold nor Professor Christian Koeberl had visited the site nor contacted us before about the nature of our investigations. It would have been nice to exchange information with these researchers, before they so strongly criticized our work, particularly when they have used, unnecessarily, quite offensive and bellicose words, which we believe we do not truly deserve.

Hawaii's public mental health system.

PubMed

VanderVoort, Debra J

2005-03-01

The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

Update on treatment modalities for optic nerve sheath meningiomas.

PubMed

Liu, James K; Forman, Scott; Moorthy, Chitti R; Benzil, Deborah L

2003-05-15

Optic nerve sheath meningiomas (ONSMs) represent 1 to 2% of all meningiomas and one third of all optic nerve tumors. The management of ONSMs is controversial. Traditional surgical removal often results in postoperative blindness in the affected eye and thus has been abandoned as a treatment option in most patients. Surgery may be unnecessarily aggressive, especially if the patient has useful vision. When these tumors are left untreated, however, ensuing progressive visual impairment may lead to complete blindness. More recently, radiotherapy has gained wider acceptance as a treatment for these lesions. The authors of some reports have suggested that fractionated stereotactic radiosurgery (SRS) may be the best option for treating primary ONSMs. In patients with documented progressive visual deterioration, fractionated SRS may be effective in improving or stabilizing remaining functional vision. The authors review the clinical presentation, radiographic characteristics, and management of ONSMs, emphasizing the use of fractionated SRS.

ontologyX: a suite of R packages for working with ontological data.

PubMed

Greene, Daniel; Richardson, Sylvia; Turro, Ernest

2017-04-01

Ontologies are widely used constructs for encoding and analyzing biomedical data, but the absence of simple and consistent tools has made exploratory and systematic analysis of such data unnecessarily difficult. Here we present three packages which aim to simplify such procedures. The ontologyIndex package enables arbitrary ontologies to be read into R, supports representation of ontological objects by native R types, and provides a parsimonius set of performant functions for querying ontologies. ontologySimilarity and ontologyPlot extend ontologyIndex with functionality for straightforward visualization and semantic similarity calculations, including statistical routines. ontologyIndex , ontologyPlot and ontologySimilarity are all available on the Comprehensive R Archive Network website under https://cran.r-project.org/web/packages/ . Daniel Greene dg333@cam.ac.uk. Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press.

Application of Nanoparticle Technologies in the Combat against Anti-Microbial Resistance.

PubMed

Kumar, Mayur; Curtis, Anthony; Hoskins, Clare

2018-01-14

Anti-microbial resistance is a growing problem that has impacted the world and brought about the beginning of the end for the old generation of antibiotics. Increasingly, more antibiotics are being prescribed unnecessarily and this reckless practice has resulted in increased resistance towards these drugs, rendering them useless against infection. Nanotechnology presents a potential answer to anti-microbial resistance, which could stimulate innovation and create a new generation of antibiotic treatments for future medicines. Preserving existing antibiotic activity through novel formulation into or onto nanotechnologies can increase clinical longevity of action against infection. Additionally, the unique physiochemical properties of nanoparticles can provide new anti-bacterial modes of action which can also be explored. Simply concentrating on antibiotic prescribing habits will not resolve the issue but rather mitigate it. Thus, new scientific approaches through the development of novel antibiotics and formulations is required in order to employ a new generation of therapies to combat anti-microbial resistance.

On vertical seismic profile processing

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

Tariel, P.; Michon, D.

1984-10-01

From the wealth of information which can be deduced from VSP, the information most directly comparable to well logs is considered: P-wave and S-wave interval velocity, acoustic impedance, and the velocity ratio ..gamma.. = V /SUB s/ /V /SUB p/ . This information not only allows better interpretation of surface seismic sections but also improves processing. For these results to be usable a number of precautions must be taken during acquisition and processing; the sampling in depth should be chosen in such a way that aliasing phenomena do not unnecessarily limit the spectra during the separation of upwards and downwardsmore » travelling waves. True amplitudes should be respected and checked by recording of signatures, and the interference of upwards and downwards travelling waves should be taken into account for the picking of first arrivals. The different steps in processing and the combination of results in the interpretation of surface seismic results are described with actual records.« less

Promise and Peril: Dissemination of Findings from Studies of Drugs Used in Pregnancy and Their Association with Birth Defects

PubMed Central

Patrick, Stephen W.; Cooper, William O.

2015-01-01

When and how to publish birth defects research can be complex, especially in the context of drugs used in pregnancy. Such research frequently involves multiple stakeholders, including regulatory agencies. Researchers must balance the potential peril of an unnecessarily panicked populace versus the benefit of protecting the public's health. We use a case presentation and contemporary literature to highlight the potential tradeoffs that researchers must consider. We highlight important considerations including the public health impact, examining the likelihood of causality, understanding common considerations when using large data sources, the role of peer review and working in partnership with regulatory agencies. We suggest that plans for analyses, dissemination and risk communication are done best a priori and not post hoc. Rigorous research evaluating the impact of drugs used in pregnancy, coupled with effective dissemination strategies, has the potential improve outcomes for mothers and their infants for generations. PMID:26153150

How the Timing of Climate Change Policy Affects Infrastructure Turnover in the Electricity Sector: Engineering, Economic and Policy Considerations

NASA Astrophysics Data System (ADS)

Izard, Catherine Finlay

The electricity sector is responsible for producing 35% of US greenhouse gas (GHG) emissions. Estimates suggest that ideally, the electricity sector would be responsible for approximately 85% of emissions abatement associated with climate polices such as America's Clean Energy and Security Act (ACES). This is equivalent to ˜50% cumulative emissions reductions below projected cumulative business-as-usual (BAU) emissions. Achieving these levels of emissions reductions will require dramatic changes in the US electricity generating infrastructure: almost all of the fossil-generation fleet will need to be replaced with low-carbon sources and society is likely to have to maintain a high build rate of new capacity for decades. Unfortunately, the inertia in the electricity sector means that there may be physical constraints to the rate at which new electricity generating capacity can be built. Because the build rate of new electricity generating capacity may be limited, the timing of regulation is critical---the longer the U.S. waits to start reducing GHG emissions, the faster the turnover in the electricity sector must occur in order to meet the same target. There is a real, and thus far unexplored, possibility that the U.S. could delay climate change policy implementation for long enough that it becomes infeasible to attain the necessary rate of turnover in the electricity sector. This dissertation investigates the relationship between climate policy timing and infrastructure turnover in the electricity sector. The goal of the dissertation is to answer the question: How long can we wait before constraints on infrastructure turnover in the electricity sector make achieving our climate goals impossible? Using the Infrastructure Flow Assessment Model, which was developed in this work, this dissertation shows that delaying climate change policy increases average retirements rates by 200-400%, increases average construction rates by 25-85% and increases maximum construction rates by 50-300%. It also shows that delaying climate policy has little effect on the age of retired plants or the stranded costs associated with premature retirement. In order for the electricity sector to reduce emissions to a level required by ACES while limiting construction rates to within achievable levels, it is necessary to start immediately. Delaying the process of decarbonization means that more abatement will be necessary from other sectors or geoengineering. By not starting emissions abatement early, therefore, the US forfeits its most accessible abatement potential and increases the challenge of climate change mitigation unnecessarily.

Vaccine Hesitancy Among Caregivers and Association with Childhood Vaccination Timeliness in Addis Ababa, Ethiopia.

PubMed

Masters, Nina B; Tefera, Yemesrach A; Wagner, Abram L; Boulton, Matthew L

2018-05-24

Vaccines are vital to reducing childhood mortality, and prevent an estimated 2 to 3 million deaths annually which disproportionately occur in the developing world. Overall vaccine coverage is typically used as a metric to evaluate the adequacy of vaccine program performance, though it does not account for untimely administration, which may unnecessarily prolong children's susceptibility to disease. This study explored a hypothesized positive association between increasing vaccine hesitancy and untimeliness of immunizations administered under the Expanded Program on Immunization (EPI) in Addis Ababa, Ethiopia. This cross-sectional survey employed a multistage sampling design, randomly selecting one health center within five sub-cities of Addis Ababa. Caregivers of 3 to 12-month-old infants completed a questionnaire on vaccine hesitancy, and their infants' vaccination cards were examined to assess timeliness of received vaccinations. The sample comprised 350 caregivers. Overall, 82.3% of the surveyed children received all recommended vaccines, although only 55.9% of these vaccinations were timely. Few caregivers (3.4%) reported ever hesitating and 3.7% reported ever refusing a vaccine for their child. Vaccine hesitancy significantly increased the odds of untimely vaccination (AOR 1.94, 95% CI: 1.02, 3.71) in the adjusted analysis. This study found high vaccine coverage among a sample of 350 young children in Addis Ababa, though only half received all recommended vaccines on time. High vaccine hesitancy was strongly associated with infants' untimely vaccination, indicating that increased efforts to educate community members and providers about vaccines may have a beneficial impact on vaccine timeliness in Addis Ababa.

Probability scores and diagnostic algorithms in pulmonary embolism: are they followed in clinical practice?

PubMed

Sanjuán, Pilar; Rodríguez-Núñez, Nuria; Rábade, Carlos; Lama, Adriana; Ferreiro, Lucía; González-Barcala, Francisco Javier; Alvarez-Dobaño, José Manuel; Toubes, María Elena; Golpe, Antonio; Valdés, Luis

2014-05-01

Clinical probability scores (CPS) determine the pre-test probability of pulmonary embolism (PE) and assess the need for the tests required in these patients. Our objective is to investigate if PE is diagnosed according to clinical practice guidelines. Retrospective study of clinically suspected PE in the emergency department between January 2010 and December 2012. A D-dimer value ≥ 500 ng/ml was considered positive. PE was diagnosed on the basis of the multislice computed tomography angiography and, to a lesser extent, with other imaging techniques. The CPS used was the revised Geneva scoring system. There was 3,924 cases of suspected PE (56% female). Diagnosis was determined in 360 patients (9.2%) and the incidence was 30.6 cases per 100,000 inhabitants/year. Sensitivity and the negative predictive value of the D-dimer test were 98.7% and 99.2% respectively. CPS was calculated in only 24 cases (0.6%) and diagnostic algorithms were not followed in 2,125 patients (54.2%): in 682 (17.4%) because clinical probability could not be estimated and in 482 (37.6%), 852 (46.4%) and 109 (87.9%) with low, intermediate and high clinical probability, respectively, because the diagnostic algorithms for these probabilities were not applied. CPS are rarely calculated in the diagnosis of PE and the diagnostic algorithm is rarely used in clinical practice. This may result in procedures with potential significant side effects being unnecessarily performed or to a high risk of underdiagnosis. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

[Anticoagulant therapy in patients with permanent atrial fibrillation - evidence based medicine and clinical practice].

PubMed

Bozić, Ivona; Capkun, Vesna; Bozić, Dorotea; Karabuva, Svjetlana; Caljkusić, Kresimir; Trgo, Gorana; Carević, Vedran; Fabijanić, Damir

2013-01-01

Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 S59%C male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs.38%/o; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age > or =75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2-2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29-0.76; P-0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment.

Knowledge, attitudes, and practices toward malaria risk and prevention among frequent business travelers of a major oil and gas company.

PubMed

Berg, Johannes; Breederveld, Daan; Roukens, Anna H; Hennink, Yvonne; Schouten, Marjolijn; Wendt, Judy K; Visser, Leo G

2011-01-01

Despite significant morbidity and mortality among business travelers due to malaria, very little has been published on knowledge, attitudes, and practices (KAP) toward malaria risk. The aim of this study was to assess KAP among frequent international business travelers (FBT) and to identify recommendations for improving malaria prevention that could be applied to the wider FBT community in occupational health. A retrospective web-based survey was conducted in 2005 among self-registered FBT of an oil and gas company based in the Netherlands. The survey was completed by 328 of the 608 self-registered FBT (54%). Fifty-four percent of respondents had visited a high-risk area for malaria. Most respondents (96%) were experienced travelers; the majority (71%) sought health advice before their trip and made use of a company health resource. Fever was recognized as a malaria symptom by all FBT; travel to high-risk malaria areas was correctly identified by 96%, and 99% of these travelers adhered to use of adequate personal protective measures. The proportion of travelers carrying appropriate anti-malaria drug regimen was positively associated with receiving company advice among FBT traveling to high-risk destinations (RR = 2.10, 95% CI: 1.21-3.67), but not for those traveling to low- or no-risk destinations. Only 8% (14) of those going to a high-risk area were not carrying malaria prophylaxis. One in five of FBT traveling to no-risk areas were unnecessarily carrying malaria prophylaxis. The majority of KAP results were excellent. We postulate that a company culture with a strong focus on health, safety, security, and environment can positively contribute to high KAP scores. Notwithstanding the excellent findings, this study also provides a cautionary tale for company health functions against overprescribing of malaria prophylaxis. It demonstrates the need for constant review and audit of adherence to quality criteria. © 2011 International Society of Travel Medicine.

Spatio-structural granularity of biological material entities

PubMed Central

2010-01-01

Background With the continuously increasing demands on knowledge- and data-management that databases have to meet, ontologies and the theories of granularity they use become more and more important. Unfortunately, currently used theories and schemes of granularity unnecessarily limit the performance of ontologies due to two shortcomings: (i) they do not allow the integration of multiple granularity perspectives into one granularity framework; (ii) they are not applicable to cumulative-constitutively organized material entities, which cover most of the biomedical material entities. Results The above mentioned shortcomings are responsible for the major inconsistencies in currently used spatio-structural granularity schemes. By using the Basic Formal Ontology (BFO) as a top-level ontology and Keet's general theory of granularity, a granularity framework is presented that is applicable to cumulative-constitutively organized material entities. It provides a scheme for granulating complex material entities into their constitutive and regional parts by integrating various compositional and spatial granularity perspectives. Within a scale dependent resolution perspective, it even allows distinguishing different types of representations of the same material entity. Within other scale dependent perspectives, which are based on specific types of measurements (e.g. weight, volume, etc.), the possibility of organizing instances of material entities independent of their parthood relations and only according to increasing measures is provided as well. All granularity perspectives are connected to one another through overcrossing granularity levels, together forming an integrated whole that uses the compositional object perspective as an integrating backbone. This granularity framework allows to consistently assign structural granularity values to all different types of material entities. Conclusions The here presented framework provides a spatio-structural granularity framework for all domain reference ontologies that model cumulative-constitutively organized material entities. With its multi-perspectives approach it allows querying an ontology stored in a database at one's own desired different levels of detail: The contents of a database can be organized according to diverse granularity perspectives, which in their turn provide different views on its content (i.e. data, knowledge), each organized into different levels of detail. PMID:20509878

The Cambridge Guide to the Solar System

NASA Astrophysics Data System (ADS)

Lang, Kenneth R.

2003-10-01

The Cambridge Guide to the Solar System provides a comprehensive, funamental, and up-to-date description of the solar system. It is written in a concise, light and uniform style, without being unnecessarily weighted down with specialized materials or the variable writing of multiple authors. It is filled with vital facts and information for astronomers of all types and for anyone with a scientific interest in the Earth, our Moon, all the other planets and their satellites, and related topics such as asteroids, comets, meteorites and meteors. The language, style, ideas and profuse illustrations will attract the general reader as well as professionals. A thorough report for general readers, it includes much compact reference data. Metaphors, similes and analogies will be of immense help to the lay person or non-science student, and they add to the enjoyment of the material. Vignettes containing historical, literary and even artistic material make this book unusual and interesting, and enhance its scientific content. Kenneth Lang is professor of astronomy in the Physics and Astronomy Department at Tufts University. He is the author of several astrophysics books, including The Sun from Space (Springer Verlag, 2000), Astrophysical Formulae: Radiation, Gas Processes, and High Energy Physics (Springer Verlag, 1999), Sun, Earth and Sky (Copernicus Books, 1997), Astrophysical Data: Planets and Stars (Springer Verlag, 1993), and Wanderers in Space: Exploration and Discovery in the Solar System (Cambridge, 1991),

Managing Radiation Degradation of CCDs on the Chandra X-ray Observatory

NASA Technical Reports Server (NTRS)

ODell, Stephen L.; Blackwell, William C.; Minow, Joseph I.; Cameron, Robert A.; Morris, David C.; Virani, Shanil N.; Six, N. Frank (Technical Monitor)

2002-01-01

The CCDs on the Chandra X ray Observatory are sensitive to radiation damage particularly from low-energy protons scattering off the telescope's mirrors onto the focal plane. In its highly elliptical orbit, Chandra passes through a spatially and temporally varying radiation environment, ranging from the radiation belts to the solar wind. Translating thc Advanced CCD Imaging Spectrometer (ACIS) out of the focal position during radiation-belt passages has prevented loss of scientific utility and eventually functionality. However, carefully managing the radiation damage during the remainder of the orbit, without unnecessarily sacrificing observing time, is essential to optimizing the scientific value of this exceptional observatory throughout its planned 10-year mission. In working toward this optimization, the Chandra team developed aid applied radiation-management strategies. These strategies include autonomous instrument safing triggered by the on-board radiation monitor, as well as monitoring, alerts, and intervention based upon real-time space-environment data from NOAA and NASA spacecraft. Furthermore, because Chandra often spends much of its orbit out of the solar wind (in the Earth's outer magnetosphere and magnetosheath), the team developed the Chandra Radiation Model to describe the complete low-energy-proton environment. Management of the radiation damage has thus far succeeded in limiting degradation of the charge-transfer inefficiency (CTI) to less than 4.4*10^-6 and 1.4*10^-6 per year for the front-illuminated and back-illuminated CCDs, respectively.

Intelligent Life-Extending Controls for Aircraft Engines Studied

NASA Technical Reports Server (NTRS)

Guo, Ten-Huei

2005-01-01

Current aircraft engine controllers are designed and operated to provide desired performance and stability margins. Except for the hard limits for extreme conditions, engine controllers do not usually take engine component life into consideration during the controller design and operation. The end result is that aircraft pilots regularly operate engines under unnecessarily harsh conditions to strive for optimum performance. The NASA Glenn Research Center and its industrial and academic partners have been working together toward an intelligent control concept that will include engine life as part of the controller design criteria. This research includes the study of the relationship between control action and engine component life as well as the design of an intelligent control algorithm to provide proper tradeoffs between performance and engine life. This approach is expected to maintain operating safety while minimizing overall operating costs. In this study, the thermomechanical fatigue (TMF) of a critical component was selected to demonstrate how an intelligent engine control algorithm can significantly extend engine life with only a very small sacrifice in performance. An intelligent engine control scheme based on modifying the high-pressure spool speed (NH) was proposed to reduce TMF damage from ground idle to takeoff. The NH acceleration schedule was optimized to minimize the TMF damage for a given rise-time constraint, which represents the performance requirement. The intelligent engine control scheme was used to simulate a commercial short-haul aircraft engine.

Getting maintenance of certification to work: a grounded theory study of physicians' perceptions.

PubMed

Cook, David A; Holmboe, Eric S; Sorensen, Kristi J; Berger, Richard A; Wilkinson, John M

2015-01-01

Despite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value. To identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes. Grounded theory focus group study of 50 board-certified primary care and subspecialist internal medicine and family medicine physicians in an academic medical center and outlying community sites. Eleven focus groups. Constant comparative method to analyze transcripts and identify themes related to MOC perceptions and purposes and to construct a model to guide improvement. Participants identified misalignments between the espoused purposes of MOC (eg, to promote high-quality care, commitment to the profession, lifelong learning, and the science of quality improvement) and MOC as currently implemented. At present, MOC is perceived by physicians as an inefficient and logistically difficult activity for learning or assessment, often irrelevant to practice, and of little benefit to physicians, patients, or society. To resolve these misalignments, we propose a model that invites increased support from organizations, effectiveness and relevance of learning activities, value to physicians, integration with clinical practice, and coherence across MOC tasks. Physicians view MOC as an unnecessarily complex process that is misaligned with its purposes. Acknowledging and correcting these misalignments will help MOC meet physicians' needs and improve patient care.

Two-point T1 measurement: wide-coverage optimizations by stochastic simulations.

PubMed

Lin, M S; Fletcher, J W; Donati, R M

1986-08-01

Stochastic reliability of T1 measurement from image signal ratios is examined in the ideal case by stochastic simulations in the context of wide-coverage optimizations. Precise measurements prove to be accurate, and accurate ones precise. Sign-preserved inversion-recovery (IR)/non-IR techniques are the best ratio method, reciprocal non-IR/IR ones being equivalent, but inconvenient. Wide-coverage optima are relatively unsharp. Suggested guidelines for covering the 150- to 1500-ms T1 band are minimal relevant TE; TI about 400 ms; effective repetition times about in the ratio, TR2(IR)/TR1 (non-IR) = 2.5-3.0, and in a sum as long as possible up to about TR1 + TR2 = 3.5-4.0 s; signal-averaging after and only after TR1 + TR2 has been lengthened to the said region. Also suggested are different guidelines for covering T1 bands, 120-1200 and 200-1800 ms. Typically, precisions and accuracies improve linearly or faster with increasing S/N and (S/N)2, respectively. Unnecessarily high pixel resolutions or thin slicings exact great penalties in accuracies. Progressively shortening TR1 eventually transforms a wide coverage into a sharp targeting with small potential gains in a narrow T1 locality and large compromises almost everywhere else. The simulations yield an insight into applicabilities of standard error propagation analyses in two-point T1 measurement.

Lumbar spine radiography — poor collimation practices after implementation of digital technology

PubMed Central

Zetterberg, L G; Espeland, A

2011-01-01

Objectives The transition from analogue to digital radiography may have reduced the motivation to perform proper collimation, as digital techniques have made it possible to mask areas irradiated outside the area of diagnostic interest (ADI). We examined the hypothesis that collimation practices have deteriorated since digitalisation. Methods After defining the ADI, we compared the proportion of the irradiated field outside the ADI in 86 digital and 86 analogue frontal lumbar spine radiographs using the Mann–Whitney test. 50 digital images and 50 analogue images were from a Norwegian hospital and the remainder from a Danish hospital. Consecutive digital images were compared with analogue images (from the hospitals' archives) produced in the 4 years prior to digitalisation. Both hospitals' standard radiographic procedures remained unchanged during the study. For digital images, the irradiated field was assessed using non-masked raw-data images. Results The proportion of the irradiated field outside the ADI was larger in digital than in analogue images (mean 61.7% vs 42.4%, p<0.001), and also in a subsample of 39 image pairs that could be matched for patient age (p<0.001). The mean total field size was 46% larger in digital than in analogue images (791 cm2 vs 541 cm2). Conclusion Following the implementation of digital radiography, considerably larger areas were irradiated. This causes unnecessarily high radiation doses to patients. PMID:21606070

Clinical management and patient persistence with antibiotic course in suspected group A streptococcal pharyngitis for primary prevention of rheumatic fever: the perspective from a New Zealand emergency department.

PubMed

Mathan, Jeremy J; Ekart, Jozsef; Houlding, Anthony; Payinda, Gary; Mills, Clair

2017-06-16

Rates of acute rheumatic fever in the Northland region are historically among the highest in New Zealand, impacting disproportionately on Māori children and youth. The primary aim of this study was to determine patient persistence to antibiotic treatment for group A streptococcus (GAS) pharyngitis in patients presenting with sore throat to the Whangarei Hospital Emergency Department. Secondarily, this study sought to determine prescriber adherence to the national antibiotic guideline for sore throat management. A retrospective audit of patients presenting to ED with presumed GAS pharyngitis between 1 May 2016 and 31 August 2016 was carried out. Data on patient demographics, clinical examination findings, investigations and antibiotic prescription were extracted from electronic medical records. Patients were contacted and after obtaining consent, were asked about their antibiotic treatment using a standardised telephone interview script. The patient population audited reflects those at high risk for acute rheumatic fever. All patients were discharged on the recommended medication, but only 82.7% (62/75) received the correct length (10 days) of oral antibiotics. Of the total of 75 patients audited, 61 (81%) had a swab taken and 41% (25/61) of these were confirmed positive for GAS. Patients were either advised to commence medication without waiting for a swab result (96%, 72/75) or delay treatment and commence only if no improvement in symptoms (4%, 3/75). Of those advised to commence medication immediately, 94% (67/72) obtained their medication from a community pharmacy. Three patients were advised to stop treatment after confirmation of a negative result. Of those patients assessable for medication persistence (n=65), 73.8% (48/65) of patients were compliant in completing the full course of antibiotic therapy. This is the first study to assess patient persistence to an antibiotic course for GAS after presentation at an emergency department in Northland and possibly New Zealand. The results indicate a relatively high persistence rate with oral antibiotic treatment by patients treated for suspected GAS pharyngitis. An important finding is that community pharmacy dispensing does not appear to be a major barrier to patients acquiring medications. Additionally, the study shows low levels of follow up of patients with negative throat swab results, resulting in these patients completing the course of antibiotics unnecessarily.

Vegan proteins may reduce risk of cancer, obesity, and cardiovascular disease by promoting increased glucagon activity.

PubMed

McCarty, M F

1999-12-01

Amino acids modulate the secretion of both insulin and glucagon; the composition of dietary protein therefore has the potential to influence the balance of glucagon and insulin activity. Soy protein, as well as many other vegan proteins, are higher in non-essential amino acids than most animal-derived food proteins, and as a result should preferentially favor glucagon production. Acting on hepatocytes, glucagon promotes (and insulin inhibits) cAMP-dependent mechanisms that down-regulate lipogenic enzymes and cholesterol synthesis, while up-regulating hepatic LDL receptors and production of the IGF-I antagonist IGFBP-1. The insulin-sensitizing properties of many vegan diets--high in fiber, low in saturated fat--should amplify these effects by down-regulating insulin secretion. Additionally, the relatively low essential amino acid content of some vegan diets may decrease hepatic IGF-I synthesis. Thus, diets featuring vegan proteins can be expected to lower elevated serum lipid levels, promote weight loss, and decrease circulating IGF-I activity. The latter effect should impede cancer induction (as is seen in animal studies with soy protein), lessen neutrophil-mediated inflammatory damage, and slow growth and maturation in children. In fact, vegans tend to have low serum lipids, lean physiques, shorter stature, later puberty, and decreased risk for certain prominent 'Western' cancers; a vegan diet has documented clinical efficacy in rheumatoid arthritis. Low-fat vegan diets may be especially protective in regard to cancers linked to insulin resistance--namely, breast and colon cancer--as well as prostate cancer; conversely, the high IGF-I activity associated with heavy ingestion of animal products may be largely responsible for the epidemic of 'Western' cancers in wealthy societies. Increased phytochemical intake is also likely to contribute to the reduction of cancer risk in vegans. Regression of coronary stenoses has been documented during low-fat vegan diets coupled with exercise training; such regimens also tend to markedly improve diabetic control and lower elevated blood pressure. Risk of many other degenerative disorders may be decreased in vegans, although reduced growth factor activity may be responsible for an increased risk of hemorrhagic stroke. By altering the glucagon/insulin balance, it is conceivable that supplemental intakes of key non-essential amino acids could enable omnivores to enjoy some of the health advantages of a vegan diet. An unnecessarily high intake of essential amino acids--either in the absolute sense or relative to total dietary protein--may prove to be as grave a risk factor for 'Western' degenerative diseases as is excessive fat intake.

The Pilot Lunar Geologic Mapping Project: Summary Results and Recommendations from the Copernicus Quadrangle

NASA Technical Reports Server (NTRS)

Skinner, J. A., Jr.; Gaddis, L. R.; Hagerty, J. J.

2010-01-01

The first systematic lunar geologic maps were completed at 1:1M scale for the lunar near side during the 1960s using telescopic and Lunar Orbiter (LO) photographs [1-3]. The program under which these maps were completed established precedents for map base, scale, projection, and boundaries in order to avoid widely discrepant products. A variety of geologic maps were subsequently produced for various purposes, including 1:5M scale global maps [4-9] and large scale maps of high scientific interest (including the Apollo landing sites) [10]. Since that time, lunar science has benefitted from an abundance of surface information, including high resolution images and diverse compositional data sets, which have yielded a host of topical planetary investigations. The existing suite of lunar geologic maps and topical studies provide exceptional context in which to unravel the geologic history of the Moon. However, there has been no systematic approach to lunar geologic mapping since the flight of post-Apollo scientific orbiters. Geologic maps provide a spatial and temporal framework wherein observations can be reliably benchmarked and compared. As such, a lack of a systematic mapping program means that modern (post- Apollo) data sets, their scientific ramifications, and the lunar scientists who investigate these data, are all marginalized in regard to geologic mapping. Marginalization weakens the overall understanding of the geologic evolution of the Moon and unnecessarily partitions lunar research. To bridge these deficiencies, we began a pilot geologic mapping project in 2005 as a means to assess the interest, relevance, and technical methods required for a renewed lunar geologic mapping program [11]. Herein, we provide a summary of the pilot geologic mapping project, which focused on the geologic materials and stratigraphic relationships within the Copernicus quadrangle (0-30degN, 0-45degW).

Review of Research on Low-Profile Vortex Generators to Control Boundary-Layer Separation

NASA Technical Reports Server (NTRS)

Lin, John C.

2002-01-01

An in-depth review of boundary-layer flow-separation control by a passive method using low-profile vortex generators is presented. The generators are defined as those with a device height between 10% and 50% of the boundary layer thickness. Key results are presented for several research efforts, all of which were performed within the past decade and a half where the majority of these works emphasize experimentation with some recent efforts on numerical simulations. Topics of discussion consist of both basic fluid dynamics and applied aerodynamics research. The fluid dynamics research includes comparative studies on separation control effectiveness as well as device-induced vortex characterization and correlation. The comparative studies cover the controlling of low-speed separated flows in adverse pressure gradient and supersonic shock-induced separation. The aerodynamics research includes several applications for aircraft performance enhancement and covers a wide range of speeds. Significant performance improvements are achieved through increased lift and/or reduced drag for various airfoils-low-Reynolds number, high-lift, and transonic-as well as highly swept wings. Performance enhancements for non-airfoil applications include aircraft interior noise reduction, inlet flow distortion alleviation inside compact ducts, and a more efficient overwing fairing. The low-profile vortex generators are best for being applied to applications where flow-separation locations are relatively fixed and the generators can be placed reasonably close upstream of the separation. Using the approach of minimal near-wall proturbances through substantially reduced device height, these devices can produce streamwise vortices just strong enough to overcome the separation without unnecessarily persisting within the boundary layer once the flow-control objective is achieved. Practical advantages of low-profile vortex generators, such as their inherent simplicity and low device drag, are demonstrated to be critically important for many applications as well.

Has NICE got it right? An international perspective considering the case of Technology Appraisal No. 98 by the National Institute for Health and Clinical Excellence (NICE).

PubMed

Schlander, Michael

2008-04-01

The National Institute for Health and Clinical Excellence (NICE) has been widely recognised as setting an international standard for high-quality health technology assessments (HTAs) including economic evaluation. A previous critical analysis of NICE Technology Appraisal No. 98 (TA98), evaluating methylphenidate, dexamphetamine and atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, revealed a number of issues, which must cast doubt on the robustness of the NICE approach when addressing a complex clinical decision problem. The exploration of potential underlying problems will be followed by a discussion of lessons for international healthcare policy-makers, and is intended to be an invitation to further debate and inquiry, not a presentation of definitive conclusions. Pertaining to the technology assessment report, potential problems were identified relating to an unnecessarily narrow scope, data search and selection strategy, the distinction between efficacy and effectiveness, data synthesis across studies and clinical effect measures, and limitations of the economic model. The appraisal process moderated the asserted 'clear conclusions' of the assessment but could not compensate for some of its gaps. It is suggested that key issues contributing to these problems may have included a separation of clinical and economic perspectives, a highly standardised reference case analysis that was followed schematically, the absence of an effective system for quality assurance of technology assessments, and transparency deficits of the economic evaluation. Further considerations for international policy-makers looking at NICE as a potential role model for HTAs are discussed, such as institutional context, the objectives of collectively financed healthcare and related value judgments, the reliance on QALYs as a universal and comprehensive measure of health benefits, the appropriate perspective for analysis, and process-related implications.

Robust control with structured perturbations

NASA Technical Reports Server (NTRS)

Keel, Leehyun

1988-01-01

Two important problems in the area of control systems design and analysis are discussed. The first is the robust stability using characteristic polynomial, which is treated first in characteristic polynomial coefficient space with respect to perturbations in the coefficients of the characteristic polynomial, and then for a control system containing perturbed parameters in the transfer function description of the plant. In coefficient space, a simple expression is first given for the l(sup 2) stability margin for both monic and non-monic cases. Following this, a method is extended to reveal much larger stability region. This result has been extended to the parameter space so that one can determine the stability margin, in terms of ranges of parameter variations, of the closed loop system when the nominal stabilizing controller is given. The stability margin can be enlarged by a choice of better stabilizing controller. The second problem describes the lower order stabilization problem, the motivation of the problem is as follows. Even though the wide range of stabilizing controller design methodologies is available in both the state space and transfer function domains, all of these methods produce unnecessarily high order controllers. In practice, the stabilization is only one of many requirements to be satisfied. Therefore, if the order of a stabilizing controller is excessively high, one can normally expect to have a even higher order controller on the completion of design such as inclusion of dynamic response requirements, etc. Therefore, it is reasonable to have a lowest possible order stabilizing controller first and then adjust the controller to meet additional requirements. The algorithm for designing a lower order stabilizing controller is given. The algorithm does not necessarily produce the minimum order controller; however, the algorithm is theoretically logical and some simulation results show that the algorithm works in general.

Vaccination Timeliness in Children Under India's Universal Immunization Program.

PubMed

Shrivastwa, Nijika; Gillespie, Brenda W; Lepkowski, James M; Boulton, Matthew L

2016-09-01

India has the highest number of deaths among children younger than 5 years of age globally; the majority are from vaccine preventable diseases. Untimely vaccination unnecessarily prolongs susceptibility to disease and contributes to the burden of childhood morbidity and mortality, yet there is scarce literature on vaccination delays. The aim of this study is to characterize the timeliness of childhood vaccinations administered under India's routine immunization program using a novel application of an existing statistical methodology. This study utilized the district level household and facility survey data, 2008 from India using vaccination data from children with and without immunization cards. Turnbull estimator of the cumulative distribution function was used to estimate the probability of vaccination at each age. Timeliness of Bacille Calmette-Guerin (BCG), all 3 doses of diphtheria, pertussis and tetanus vaccine (DPT) and measles-containing vaccine (MCV) were considered for this analysis. Vaccination data on 268,553 children who were 0-60 months of age were analyzed; timely administration of BCG, DPT3 and MCV occurred in 31%, 19% and 34% of children, respectively. The estimated vaccination probability plateaued for DPT and BCG around the age of 24 months, whereas MCV uptake increased another 5% after 24 months of age. The 5-year coverage of BCG, DPT3 and MCV in Indian children was 87%, 63% and 76%, respectively. Lack of timely administration of key childhood vaccines, especially DPT3 and MCV, remains a major challenge in India and likely contributes to the significant burden of vaccine preventable disease-related morbidity and mortality in children.

The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma.

PubMed

Markel, Troy A; Kumar, Rajiv; Koontz, Nicholas A; Scherer, L R; Applegate, Kimberly E

2009-07-01

There is a growing concern that computed tomography (CT) is being unnecessarily overused for the evaluation of pediatric patients. The purpose of this study was to analyze the trends and utility of chest CT use compared with chest X-ray (CXR) for the evaluation of children with blunt chest trauma. A 4-year retrospective review was performed for pediatric patients who underwent chest CT within 24 hours of sustaining blunt trauma at a Level-I trauma center. Trends in the use of CT and CXR were documented, and results of radiology reports were analyzed and compared with clinical outcomes. Three hundred thirty-three children, mean age 11 years, had chest CTs, increasing from 5.5% in 2001-2002 to 10.5% in 2004-2005 (p < 0.001). Conversely, in those children who underwent chest CT, the rate of initial CXR use decreased from 84% to 56% during the same period (p < 0.001). Twenty percent of chest CTs had significant positive findings. Six patients underwent emergency surgery for cardiac or arterial injuries, and all demonstrated abnormal findings on CXR or CT scout imaging. When compared with the CT, only 5% of initial CXRs falsely reported normal findings that may have altered management. CT use in children has increased rapidly for the initial evaluation of chest trauma, whereas CXR use has decreased. Despite this trend, CXR remains an acceptable screening tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.

Australian Football League concussion guidelines: what do community players think?

PubMed Central

White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua

2016-01-01

Background Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players’ views on following the Australian Football League's (AFL) concussion guidelines. Methods 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Results Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players’ rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players’ desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Conclusions Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport. PMID:28890801

Adequacy of published screening criteria for retinopathy of prematurity.

PubMed

Taranath, Deepa A; Oh, Dickson D-S; Keane, Miriam C; Fabel, Helen; Marshall, Peter

2016-03-01

Criteria for screening preterm infants for retinopathy of prematurity vary around the world. We aimed to analyse the efficacy of alternative screening criteria. We collected retrospective data at a tertiary level neonatal nursery. Our participants were 1007 babies, born between 1997 and 2011, at <32 weeks gestational age or <1500 g birth weight (as recommended by the National Health and Medical Research Council in 1996), who had completed follow-up to full retinal vascularization, with defined presence or absence of retinopathy of prematurity. We determined whether disease would be detected using an alternative Australian screening model (gestational age <30 weeks or birth weight <1250 g) or screening criteria utilized in developed countries with similar standards of neonatal care. Detection of retinopathy of prematurity is our main outcome. Using several of the alternative criteria, two neonates with clinically significant retinopathy of prematurity, one of whom required laser treatment to preserve sight, would not have been screened, and their disease may have gone undetected. Use of <30 weeks gestational age or <1500 g birth weight as the criteria would still have screened these infants but would have reduced the number of infants screened by 24.9%. Some commonly utilized international screening criteria for retinopathy of prematurity may risk clinically significant cases being missed and others may screen babies unnecessarily. Alternative criteria should be considered and '<30 weeks gestational age and/or <1500 g birth weight' appears a viable option. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Student supports: developmental education and other academic programs.

PubMed

Bettinger, Eric P; Boatman, Angela; Long, Bridget Terry

2013-01-01

Low rates of college completion are a major problem in the United States. Less than 60 percent of students at four-year colleges graduate within six years, and at some colleges, the graduation rate is less than 10 percent. Additionally, many students enter higher education ill-prepared to comprehend college-level course material. Some estimates suggest that only one-third of high school graduates finish ready for college work; the proportion is even lower among older students. Colleges have responded to the poor preparation of incoming students by placing approximately 35 to 40 percent of entering freshmen into remedial or developmental courses, along with providing academic supports such as summer bridge programs, learning communities, academic counseling, and tutoring, as well as student supports such as financial aid and child care. Eric Bettinger, Angela Boatman, and Bridget Terry Long describe the role, costs, and impact of these college remediation and academic support programs. According to a growing body of research, the effects of remedial courses are considerably nuanced. The courses appear to help or hinder students differently by state, institution, background, and academic preparedness. The mixed findings from earlier research have raised questions ranging from whether remedial programs, on average, improve student academic outcomes to which types of programs are most effective. Administrators, practitioners, and policy makers are responding by redesigning developmental courses and searching for ways to implement effective remediation programs more broadly. In addition, recent research suggests that colleges may be placing too many students into remedial courses unnecessarily, suggesting the need for further examining the placement processes used to assign students to remedial courses. The authors expand the scope of remediation research by discussing other promising areas of academic support commonly offered by colleges, including advising, tutoring, and mentoring programs, as well as supports that target the competing responsibilities of students, namely caring for dependents and balancing employment with schoolwork. They conclude that the limited resources of institutions and equally limited funds of students make it imperative for postsecondary institutions to improve student academic supports and other services.

Promotion of research on in vitro immunotoxicology.

PubMed

Balls, M; Sabbioni, E

2001-04-10

ECVAM was established to play a leading role at the European level in the independent evaluation of the reliability and relevance of test methods and testing strategies for specific purposes through research on advanced methods and new test development and validation, so that chemicals and products of various kinds, including medicines, vaccines, medical devices, cosmetics, household products and agricultural products, can be manufactured, transported and used more economically and more safely, whilst the current relevance on animal test procedures is progressively reduced. Nowhere is this activity more necessary than in the field of immunotoxicology, where we know that chemicals and products of many kinds have the potential to stimulate, modulate or suppress the induction or expression of various types of immune responses. The problem is to effectively evaluate the potency of these effectors, and, since the available information is currently based on rather qualitative animal tests, to evaluate the true relevance of this knowledge and apply it intelligently in risk assessment processes which will protect human beings without unnecessarily limiting the development and use of materials which otherwise have economic, health and social benefits. The way forward must depend on the following: (a) a better understanding of immunotoxicological processes, based on a sounder understanding of the immune system itself (and of its network of control systems and interrelationships with other body systems); (b) The use of in vitro (not in vivo) systems based on human (not animal) cells and tissues; (c) integrated and tiered testing strategies, incorporating QSAR, as well as in vitro approaches; (d) taking advantage of the use of cells or factors from humans who have been exposed to potential immunotoxins, be this voluntarily, occupationally, environmentally or by accident; and (e) the recognition that virtually everything will effect one or more aspects of the immune system at some dose level and, in some circumstances, deciding when such effects are relevant, is the key to immunotoxicity testing. Some current ECVAM-sponsored work and activities at ECVAM are described.

[Prevalence of hyperimmunization against tetanus and systematic adverse reactions to tetanus toxoid in children].

PubMed

Szenborn, Leszek; Saraczyńska, Elzbieta; Ilnicki, Lucjan

2008-01-01

during the last 30 years we have observed only two children (aged 6 and 3 years) with systemic reactions after tetanus vaccine, given unnecessarily 5 and 10 months after appropriate primary immunization. The adverse reactions after tetanic toxoid appear to be directly related to excessive titre of protecting antibodies. The aim of this paper is to investigate the concentration of tetanus antibodies, which may help to define the risk of adverse reactions. tests were carried out in 190 children (86 male, 104 female) aged 7 (n=95) and 14 (n=95) years. Antibodies to tetanus toxoid were determined using a commercial EIA. all examined children had protective concentration of tetanus antibodies (above 0.01 IU/ml; range from 0.1 to 6.0 IU/mL). There were significant differences between antibodies concentrations (GMC) in children aged 7 and 14 years (0.93 vs. 1,76 IU/ml; p=0.048). The antibodies concentrations above 1 IU/ml which indicate long term protection were more frequently observed in children aged 14 than those aged 7 years (73 vs. 59%; not statistically significant). Only 6.84% of all examined children (n=190) had high antibodies concentration above 5 IU/ml, which could increase the risk of side effects if the next booster would be given during the next 5 years. children in Poland are only slightly exposed to risk of severe side effects after vaccination against tetanus. The tetanus immunity in examined children can be assessed as very good.

Safe Handover : Safe Patients - The Electronic Handover System.

PubMed

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS.

Safe Handover : Safe Patients – The Electronic Handover System

PubMed Central

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS. PMID:26734244

Minimizing rubidium-82 tracer activity for relative PET myocardial perfusion imaging.

PubMed

Huizing, Eline D; van Dijk, Joris D; van Dalen, Jorn A; Timmer, Jorik R; Arkies, Hester; Slump, Cees H; Jager, Pieter L

2017-08-01

Recommended rubidium-82 activities for relative myocardial perfusion imaging (MPI) using present-generation PET scanners may be unnecessarily high. Our aim was to derive the minimum activity for a reliable relative PET MPI assessment. We analyzed 140 scans from 28 consecutive patients who underwent rest-stress MPI-PET (Ingenuity TF). Scans of 852, 682, 511, and 341 MBq were simulated from list-mode data and compared with a reference scan using 1023 MBq. Differences in the summed rest score, total perfusion deficit, and image quality were obtained between the reference and each of the simulated rest scans. Combined stress-rest scans obtained at a selected activity of 682 MBq were diagnostically interpreted by experts and outcome was compared with the reference scan interpretation. Differences in summed rest score more than or equal to 3 were found using 682, 511, and 341 MBq in two (7%), four (14%), and five (18%) patients, respectively. Differences in total perfusion deficit more than 7% were only found at 341 MBq in one patient. Image quality deteriorated significantly only for the 341 MBq scans (P<0.001). Interpretation of stress-rest scans did not differ between 682 and 1023 MBq scans. A significant reduction in administered Rb-82 activity is feasible in relative MPI. An activity of 682 MBq resulted in reliable diagnostic outcomes and image quality, and can therefore be considered for clinical adoption.

Expanding Access to Large-Scale Genomic Data While Promoting Privacy: A Game Theoretic Approach.

PubMed

Wan, Zhiyu; Vorobeychik, Yevgeniy; Xia, Weiyi; Clayton, Ellen Wright; Kantarcioglu, Murat; Malin, Bradley

2017-02-02

Emerging scientific endeavors are creating big data repositories of data from millions of individuals. Sharing data in a privacy-respecting manner could lead to important discoveries, but high-profile demonstrations show that links between de-identified genomic data and named persons can sometimes be reestablished. Such re-identification attacks have focused on worst-case scenarios and spurred the adoption of data-sharing practices that unnecessarily impede research. To mitigate concerns, organizations have traditionally relied upon legal deterrents, like data use agreements, and are considering suppressing or adding noise to genomic variants. In this report, we use a game theoretic lens to develop more effective, quantifiable protections for genomic data sharing. This is a fundamentally different approach because it accounts for adversarial behavior and capabilities and tailors protections to anticipated recipients with reasonable resources, not adversaries with unlimited means. We demonstrate this approach via a new public resource with genomic summary data from over 8,000 individuals-the Sequence and Phenotype Integration Exchange (SPHINX)-and show that risks can be balanced against utility more effectively than with traditional approaches. We further show the generalizability of this framework by applying it to other genomic data collection and sharing endeavors. Recognizing that such models are dependent on a variety of parameters, we perform extensive sensitivity analyses to show that our findings are robust to their fluctuations. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies

PubMed Central

Lindsay, David M.; Vandervoort, Anthony A.

2014-01-01

Golf is a popular sport with both perceived and real health benefits. However, certain injury risks are also prevalent, particularly to the lower back. Epidemiological studies have shown that lower back pain (LBP) from golf account for between 18% and 54% of all documented ailments, leading many researchers to regard the condition as the most common golf injury. The purpose of this review was to examine the scientific literature to ascertain the risk factors associated with the development of LBP from playing golf and suggest methods to modify or limit these factors. Results of the review indicate that the high frequency of LBP appears multi-factorial although the asymmetrical and forceful nature of the swing along with excessive play and practice, particularly amongst elite players, appear to be common factors. Other factors include swing flaws leading to excessive side-bend and over-rotation of the spine, abnormal muscle recruitment, poor trunk endurance, restricted lead hip internal rotation and the use of unnecessarily stressful club transportation methods. Methods to help control or eliminate excessive stress on the lower back would include reducing the amount spent playing or practicing, seeking professional assistance to assess and adjust swing mechanics, improve trunk and hip flexibility, increase the strength and endurance of the trunk musculature, consider different footwear options and avoid carrying the golf bag. Adopting some or all of these recommendations should allow players to continue to enjoy the sport of golf well into their senior years. PMID:25741420

Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis.

PubMed

Akalin, Serife; Kutlu, Selda Sayin; Cirak, Bayram; Eskiçorapcı, Saadettin Yilmaz; Bagdatli, Dilek; Akkaya, Semih

2012-02-01

To evaluate quality of perioperative antibiotic prophylaxis (PAP) and to calculate the cost per procedure in a Turkish university hospital. A 352-bed teaching hospital in Denizli, Turkey. An prospective audit was performed between July and October 2010. All clean, clean-contaminated and contaminated elective surgical procedures in ten surgical wards were recorded. Antimicrobial use was calculated per procedure using the ATC-DDD system. The appropriateness of antibiotic use for each procedure was evaluated according to international guidelines on PAP. In addition, the cost per procedure was calculated. Overall, in 577 of the 625 (92.3%) of the studied procedures, PAP was used. PAP was indicated in 12.5% of the group where it was not used, and not indicated in 7.1% of the group where it was used. Unnecessarily prolonged antimicrobial prophylaxis was observed in 56.9% of the procedures, mean duration was 2.6 ± 2.7 days. The most frequently used antimicrobials were cefazolin (117.9 DDD/100-operation) and sulbactam/ampicillin (102.2 DDD/100-operation). The timing of the starting dose was appropriate in 545 procedures (94.5%). In the group that received PAP, only 80 (13.7%) of the procedures were found to be fully appropriate and correct. The density of antimicrobial use per operation was 2.8 DDD. The mean cost of the use of prophylactic antimicrobials 18.6 per procedure. The density of antimicrobial use in PAP was found to be very high in our hospital. Antibiotic overuse extended into the postoperative period.

Effective quality improvement of thromboprophylaxis in acute medicine.

PubMed

Clark, Barbara M; d'Ancona, Grainne; Kinirons, Mark; Hunt, Beverley J; Hopper, Adrian

2011-05-01

The Health Select Committee Report on the prevalence of venous thromboembolism (VTE) in 2005 suggested that poor awareness of the risks of VTE contributed significantly to mortality and morbidity in hospitalised patients. It recommended that all hospitalised patients should undergo a VTE risk assessment. In 2006, an audit in medical patients at Guy's and St Thomas' NHS Foundation Trust (GSTFT) revealed a lack of documentation of VTE risk assessment and poor use of thromboprophylaxis in 'at risk' patients. In 2007, the GSTFT 'Venous Thromboembolism in Adult Medical Inpatients' guideline was approved. The aim was to achieve a thromboprophylaxis culture within Acute Medicine and, in doing so, achieve a high adherence rate. The guideline was launched and implemented using a multidisciplinary and multiple intervention approach involving education and feedback, IT intervention, verbal and written reminders, regular audit and process redesign. An audit in 2008 showed that the rate of adherence had increased from 56% preguideline to 96%. However, a repeat audit in 2009 suggested that even though the majority of patients were receiving appropriate thromboprophylaxis, risk assessment documentation was poor. This resulted in treatment being provided to some low-risk patients when it was not required. In conclusion, the most effective means of achieving VTE guideline adherence is to establish a thromboprophylaxis culture. This can be accomplished through a multiple intervention and continuous feedback approach. However, it is essential to ensure that a comprehensive VTE risk assessment is carried out to ensure that those not requiring treatment do not receive it unnecessarily.

Naval Undersea Warfare Center Division Newport utilities metering, Phase 1

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

Carroll, D.M.

Pacific Northwest Laboratory developed this report for the US Navy`s Naval Undersea Warfare Center Division Newport, Rhode Island (NUWC). The purpose of the report was to review options for metering electricity and steam used in the NUWC compound, and to make recommendations to NUWC for implementation under a follow-on project. An additional NUWC concern is a proposed rate change by the servicing utility, Newport Electric, which would make a significant shift from consumption to demand billing, and what effect that rate change would have on the NUWC utility budget. Automated, remote reading meters are available which would allow NUWC tomore » monitor its actual utility consumption and demand for both the entire NUWC compound and by end-use in individual buildings. Technology is available to perform the meter reads and manipulate the data using a personal computer with minimal staff requirement. This is not meant to mislead the reader into assuming that there is no requirement for routine preventive maintenance. All equipment requires routine maintenance to maintain its accuracy. While PNL reviewed the data collected during the site visit, however, it became obvious that significant opportunities exist for reducing the utility costs other than accounting for actual consumption and demand. Unit costs for both steam and electricity are unnecessarily high, and options are presented in this report for reducing them. Additionally, NUWC has an opportunity to undertake a comprehensive energy resource management program to significantly reduce its energy demand, consumption, and costs.« less

Naval Undersea Warfare Center Division Newport utilities metering, Phase 1

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

Carroll, D.M.

Pacific Northwest Laboratory developed this report for the US Navy's Naval Undersea Warfare Center Division Newport, Rhode Island (NUWC). The purpose of the report was to review options for metering electricity and steam used in the NUWC compound, and to make recommendations to NUWC for implementation under a follow-on project. An additional NUWC concern is a proposed rate change by the servicing utility, Newport Electric, which would make a significant shift from consumption to demand billing, and what effect that rate change would have on the NUWC utility budget. Automated, remote reading meters are available which would allow NUWC tomore » monitor its actual utility consumption and demand for both the entire NUWC compound and by end-use in individual buildings. Technology is available to perform the meter reads and manipulate the data using a personal computer with minimal staff requirement. This is not meant to mislead the reader into assuming that there is no requirement for routine preventive maintenance. All equipment requires routine maintenance to maintain its accuracy. While PNL reviewed the data collected during the site visit, however, it became obvious that significant opportunities exist for reducing the utility costs other than accounting for actual consumption and demand. Unit costs for both steam and electricity are unnecessarily high, and options are presented in this report for reducing them. Additionally, NUWC has an opportunity to undertake a comprehensive energy resource management program to significantly reduce its energy demand, consumption, and costs.« less

How MFN clauses used in the health care industry unreasonably restrain trade under the Sherman Act.

PubMed

Wright, Beth Ann

When used in the health care industry, an MFN clause is a contractual agreement that guarantees a health insurer the same best price as their market competitors. MFN clauses have the effect of unnecessarily raising consumer costs, reducing choice among providers, constraining access to care and preventing the development of alternative health care delivery models. The purpose of this paper is four-fold. First, to design a four-quadrant matrix to evaluate the pro-competitive and anticompetitive purposes and effects of MFN clauses under Section 1 of the Sherman Act. Second, to defeat the jurisprudential presumption that MFN clauses are pro-competitive in the health care industry and to recommend that this presumption be abolished. Third, to examine the U.S. Department of Justice's paradigmatic shift over the last decade toward prosecuting large insurers who employ MFN clauses resulting in U.S. Consent Decrees. Fourth, to outline the indicia of a meritorious claim against an insurer who employs an MFN clause.

Mandatory reporting for child protection in health settings and the rights of parents with disabilities.

PubMed

Mudrick, Nancy R; Smith, Carrie Jefferson

2017-04-01

This commentary considers the intersection of mandatory reporting in health settings and the public child protection system's treatment of parents with disabilities. Its impetus is the August 2015 technical assistance document issued jointly by the U.S. departments of Justice (DOJ) and Health and Human Services (HHS) that affirms the applicability of the ADA and Section 504 to child protection system (CPS) processes. The DOJ/HHS document speaks to actions of state child protection agencies and courts, without addressing the first step, mandatory reporting. Nonetheless, there are implications for how mandated reporters understand child risk in the presence of disability, and health settings are one venue where mandated reports initiate. This commentary seeks to provide medical professionals with greater understanding of the CPS process and its intersection with disability rights. It concludes that mandatory reporter training must include ADA principles for addressing disability so parents are not unnecessarily reported for investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

Emerging Resistance, New Antimicrobial Agents  …  but No Tests! The Challenge of Antimicrobial Susceptibility Testing in the Current US Regulatory Landscape.

PubMed

Humphries, R M; Hindler, J A

2016-07-01

Accurate and timely performance of antimicrobial susceptibility testing (AST) by the clinical laboratory is paramount to combating antimicrobial resistance. The ability of laboratories in the United States to effectively perform ASTs is challenged by several factors. Some, such as new resistance mechanisms and the associated evolution of testing recommendations and breakpoints, are inevitable. Others are entirely man-made. These include unnecessarily strict US Food and Drug Administration (FDA) limitations on how commercial AST systems can be used for diagnostic testing, the absence of up-to-date performance data on these systems, and the lack of commercially available FDA-cleared tests for newer antimicrobial agents or for older agents with updated breakpoints. This viewpoint will highlight contemporary AST challenges faced by the clinical laboratory, and propose some solutions. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Muslim patients in Ramadan: A review for primary care physicians

PubMed Central

Abolaban, Heba; Al-Moujahed, Ahmad

2017-01-01

Fasting Ramadan, in which Muslims abstain from specific habits and behaviors from dawn to sunset, is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslim patients with acute or chronic medical conditions still choose to fast, which may adversely affect their health if not addressed properly. Some patients may not be well educated about the effects of some medical treatments and procedures on the validity of their fast, which can unnecessarily lead to suboptimal management of their conditions or treatment nonadherence. Since spirituality, religiosity, and personal beliefs affect patients' health behaviors and adherence to treatments, health-care providers need to learn how fasting Ramadan can affect the health of their Muslim patients, especially those with chronic medical conditions, and how to help them achieve safe fasting. This article aims to provide an overview of the main topics that primary care physicians may need to know in order to improve their cultural competence when caring for their fasting Muslim patients. PMID:28791239

[Pursuit of economic efficiency in the hospital laboratory--full automatic re-test system of clinical chemistry, hematology, immunology and cost control system].

PubMed

Chiba, M

2000-10-01

Further business improvement is requested due to finance-based fluctuation and the influence of the revision in the medical treatment law. Therefore, new laboratories are needed. To achieving this in our hospital, economic efficiency is being pursued. The first issue is the use of space, the second issue is labor-saving. The third issue is the simplification of business procedures. There is individual quality control by the zonal verification method that we developed, as well as the quality control of the batch method using controlled substances. The four issue is cost control. By controlling the delivery and use of reagents and materials including the term of validity control, we made an effort to abolition defective stock. The fifth issue is correspondence to circulation style society. The disposal of laboratory garbage is a major issue. We controlled garbage that occurs unnecessarily. Furthermore, we are improving the demand for reagents that exceeds the specification and use reagent containers.

Imitation and local enhancement: detrimental effects of consensus definitions on analyses of social learning in animals.

PubMed

Galef, Bennett G

2013-11-01

Development of a widely accepted vocabulary referring to various types of social learning has made important contributions to decades of progress in analyzing the role of socially acquired information in the development of behavioral repertoires. It is argued here that emergence of a consensus vocabulary, while facilitating both communication and research, has also unnecessarily restricted research on social learning. The article has two parts. In the first, I propose that Thorndike's (1898, 1911) definition of imitation as "learning to do an act from seeing it done" has unduly restricted studies of the behavioral processes involved in the propagation of behavior. In part 2, I consider the possibility that success in labeling social learning processes believed to be less cognitively demanding than imitation (e.g. local and stimulus enhancement, social facilitation, etc.) has been mistaken for understanding of those processes, although essentially nothing is known of their stimulus control, development, phylogeny or substrate either behavioral or physiological. Copyright © 2013 Elsevier B.V. All rights reserved.

Introduction: evidence-based action in humanitarian crises.

PubMed

Dijkzeul, Dennis; Hilhorst, Dorothea; Walker, Peter

2013-07-01

This introductory paper sets the stage for this special issue of Disasters on evidence-based action in humanitarian crises. It reviews definition(s) of evidence and it examines the different disciplinary and methodological approaches to collecting and analysing evidence. In humanitarian action, the need for evidence-based approaches sometimes is viewed in tension with a principled approach, often unnecessarily. Choosing appropriate research methods depends on the objectives of the researcher, in particular whether the research focuses on the intervention and/or the context and the length and complexity of the causal chains involved. The paper concludes by defining some trends in evidence-based approaches in crises: the move away from inputs and outputs of humanitarian action towards outcomes and impacts; the shift towards a higher degree of partnerships in research, and the participation of users and target groups; and the acceptance of a broad array of approaches to establish evidence. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

A review of state legislation on DNA forensic data banking.

PubMed Central

McEwen, J. E.; Reilly, P. R.

1994-01-01

Recent advances in DNA identification technology are making their way into the criminal law. States across the country are enacting legislation to create repositories for the storage both of DNA samples collected from convicted offenders and of the DNA profiles derived from them. These data banks will be used to assist in the resolution of future crimes. This study surveys existing state statues, pending legislation, and administrative regulations that govern these DNA forensic data banks. We critically analyzed these laws with respect to their treatment of the collection, storage, analysis, retrieval, and use of DNA and DNA data. We found much variation among data-banking laws and conclude that, while DNA forensic data banking carries tremendous potential for law enforcement, many states, in their rush to create data banks, have paid little attention to issues of quality control, quality assurance, and privacy. In addition, the sweep of some laws is unnecessarily broad. Legislative modifications are needed in many states to better safeguard civil liberties and individual privacy. PMID:8198138

Application of Nanoparticle Technologies in the Combat against Anti-Microbial Resistance

PubMed Central

Kumar, Mayur; Curtis, Anthony

2018-01-01

Anti-microbial resistance is a growing problem that has impacted the world and brought about the beginning of the end for the old generation of antibiotics. Increasingly, more antibiotics are being prescribed unnecessarily and this reckless practice has resulted in increased resistance towards these drugs, rendering them useless against infection. Nanotechnology presents a potential answer to anti-microbial resistance, which could stimulate innovation and create a new generation of antibiotic treatments for future medicines. Preserving existing antibiotic activity through novel formulation into or onto nanotechnologies can increase clinical longevity of action against infection. Additionally, the unique physiochemical properties of nanoparticles can provide new anti-bacterial modes of action which can also be explored. Simply concentrating on antibiotic prescribing habits will not resolve the issue but rather mitigate it. Thus, new scientific approaches through the development of novel antibiotics and formulations is required in order to employ a new generation of therapies to combat anti-microbial resistance. PMID:29342903

The influence of weight-of-evidence strategies on audience perceptions of (un)certainty when media cover contested science.

PubMed

Kohl, Patrice Ann; Kim, Soo Yun; Peng, Yilang; Akin, Heather; Koh, Eun Jeong; Howell, Allison; Dunwoody, Sharon

2016-11-01

Controversy in science news accounts attracts audiences and draws attention to important science issues. But sometimes covering multiple sides of a science issue does the audience a disservice. Counterbalancing a truth claim backed by strong scientific support with a poorly backed argument can unnecessarily heighten audience perceptions of uncertainty. At the same time, journalistic norms often constrain reporters to "get both sides of the story" even when there is little debate in the scientific community about which truth claim is most valid. In this study, we look at whether highlighting the way in which experts are arrayed across truth claims-a strategy we label "weight-of-evidence reporting"-can attenuate heightened perceptions of uncertainty that can result from coverage of conflicting claims. The results of our study suggest weight-of-evidence strategies can indeed play a role in reducing some of the uncertainty audiences may perceive when encountering lop-sided truth claims. © The Author(s) 2015.

Use of health services in Hill villages in central Nepal.

PubMed

Niraula, B B

1994-10-01

This paper reports the use and non-use of health care facilities in the Hill villages in central Nepal. The health behaviour model (HBM) is applied to test the significance of socioeconomic variables on the use of the modern health care system. The study finds that all three characteristics of the HBM model, predisposing, enabling and need, are significantly related to use and non-use of the modern health care system. The analysis shows that number of living children, respondent's education, nearness to the road and service centre, value of land, knowledge about health workers and experience of child loss are some of the variables that are positively and significantly related to the use of modern health care. Age of the respondents and household size were found to be negatively associated with health-care use. Contrary to expectation, caste is unimportant. Making use of the qualitative data, this paper argues that the health care system is unnecessarily bureaucratic and patriarchal, which favours the socio-economically well-off.

Using Docker Compose for the Simple Deployment of an Integrated Drug Target Screening Platform.

PubMed

List, Markus

2017-06-10

Docker virtualization allows for software tools to be executed in an isolated and controlled environment referred to as a container. In Docker containers, dependencies are provided exactly as intended by the developer and, consequently, they simplify the distribution of scientific software and foster reproducible research. The Docker paradigm is that each container encapsulates one particular software tool. However, to analyze complex biomedical data sets, it is often necessary to combine several software tools into elaborate workflows. To address this challenge, several Docker containers need to be instantiated and properly integrated, which complicates the software deployment process unnecessarily. Here, we demonstrate how an extension to Docker, Docker compose, can be used to mitigate these problems by providing a unified setup routine that deploys several tools in an integrated fashion. We demonstrate the power of this approach by example of a Docker compose setup for a drug target screening platform consisting of five integrated web applications and shared infrastructure, deployable in just two lines of codes.

Patterns and Processes of Microbial Community Assembly

PubMed Central

Schmidt, Steven K.; Fukami, Tadashi; O'Neill, Sean P.; Bilinski, Teresa M.; Stanish, Lee F.; Knelman, Joseph E.; Darcy, John L.; Lynch, Ryan C.; Wickey, Phillip; Ferrenberg, Scott

2013-01-01

SUMMARY Recent research has expanded our understanding of microbial community assembly. However, the field of community ecology is inaccessible to many microbial ecologists because of inconsistent and often confusing terminology as well as unnecessarily polarizing debates. Thus, we review recent literature on microbial community assembly, using the framework of Vellend (Q. Rev. Biol. 85:183–206, 2010) in an effort to synthesize and unify these contributions. We begin by discussing patterns in microbial biogeography and then describe four basic processes (diversification, dispersal, selection, and drift) that contribute to community assembly. We also discuss different combinations of these processes and where and when they may be most important for shaping microbial communities. The spatial and temporal scales of microbial community assembly are also discussed in relation to assembly processes. Throughout this review paper, we highlight differences between microbes and macroorganisms and generate hypotheses describing how these differences may be important for community assembly. We end by discussing the implications of microbial assembly processes for ecosystem function and biodiversity. PMID:24006468

Dynamic Computation of Change Operations in Version Management of Business Process Models

NASA Astrophysics Data System (ADS)

Küster, Jochen Malte; Gerth, Christian; Engels, Gregor

Version management of business process models requires that changes can be resolved by applying change operations. In order to give a user maximal freedom concerning the application order of change operations, position parameters of change operations must be computed dynamically during change resolution. In such an approach, change operations with computed position parameters must be applicable on the model and dependencies and conflicts of change operations must be taken into account because otherwise invalid models can be constructed. In this paper, we study the concept of partially specified change operations where parameters are computed dynamically. We provide a formalization for partially specified change operations using graph transformation and provide a concept for their applicability. Based on this, we study potential dependencies and conflicts of change operations and show how these can be taken into account within change resolution. Using our approach, a user can resolve changes of business process models without being unnecessarily restricted to a certain order.

Improving publication rates in a collaborative clinical trials research network.

PubMed

Archer, Stephanie Wilson; Carlo, Waldemar A; Truog, William E; Stevenson, David K; Van Meurs, Krisa P; Sánchez, Pablo J; Das, Abhik; Devaskar, Uday; Nelin, Leif D; Petrie Huitema, Carolyn M; Crawford, Margaret M; Higgins, Rosemary D

2016-10-01

Unpublished results can bias biomedical literature, favoring positive over negative findings, primary over secondary analyses, and can lead to duplicate studies that unnecessarily endanger subjects and waste resources. The Neonatal Research Network's (NRN) publication policies for approving, reviewing, and tracking abstracts and papers work to combat these problems. In 2003, the NRN restricted investigators with unfinished manuscripts from proposing new ones and in 2010, urged authors to complete long-outstanding manuscripts. Data from 1991 to 2015 were analyzed to determine effectiveness of these policy changes. The NRN has achieved an overall publication rate of 78% for abstracts. For 1990-2002, of 137 abstracts presented, 43 (31%) were published within 2 years; for 2003-2009, after the manuscript completion policy was instituted, of 140 abstracts presented, 68 (49%) were published within 2 years. Following the effort in 2010, the rate increased to 64%. The NRN surpassed reported rates by developing a comprehensive process, holding investigators accountable and tracking abstracts from presentation to publication. Copyright © 2016. Published by Elsevier Inc.

Improving publication rates in a collaborative clinical trials research network

PubMed Central

Archer, Stephanie Wilson; Carlo, Waldemar A.; Truog, William E.; Stevenson, David K.; Van Meurs, Krisa P.; Sánchez, Pablo J.; Das, Abhik; Devaskar, Uday; Nelin, Leif D.; Petrie Huitema, Carolyn M.; Crawford, Margaret M.; Higgins, Rosemary D.

2016-01-01

Unpublished results can bias biomedical literature, favoring positive over negative findings, primary over secondary analyses, and can lead to duplicate studies that unnecessarily endanger subjects and waste resources. The Neonatal Research Network’s (NRN) publication policies for approving, reviewing, and tracking abstracts and papers work to combat these problems. In 2003, the NRN restricted investigators with unfinished manuscripts from proposing new ones and in 2010, urged authors to complete long-outstanding manuscripts. Data from 1991 to 2015 were analyzed to determine effectiveness of these policy changes. The NRN has achieved an overall publication rate of 78% for abstracts. For 1990–2002, of 137 abstracts presented, 43 (31%) were published within 2 years; for 2003–2009, after the manuscript completion policy was instituted, of 140 abstracts presented, 68 (49%) were published within 2 years. Following the effort in 2010, the rate increased to 64%. The NRN surpassed reported rates by developing a comprehensive process, holding investigators accountable and tracking abstracts from presentation to publication. PMID:27423510

Knowledge, Informationa and Literacy

NASA Astrophysics Data System (ADS)

Roberts, Peter

2000-09-01

This paper problematises the notion of the "knowledge society" found in two recent initiatives: the OECD's International Adult Literacy Survey, and the New Zealand Foresight Project. The author supports a broadening of the concept of literacy, as suggested by the OECD reports, but points to some of the limits of "information" as the focus for such a re-definition. The principle of theorising social and economic futures is also endorsed, but the form this takes in the Foresight Project is seen as unnecessarily restrictive. To date, the Foresight Project can be seen as a synthesis of elements of market liberalism and scientific rationalism. Both projects ignore crucial political and ethical questions in their accounts of the "knowledge society" and the process of globalisation, and both are wedded to a technocratic mode of policy development and planning. The author calls for further critical work on changing patterns of literate activity in the information age, and stresses the importance of contemplating futures other than those driven by the imperatives of global capitalism.

Test of Von Baer's law of the conservation of early development.

PubMed

Poe, Steven

2006-11-01

One of the oldest and most pervasive ideas in comparative embryology is the perceived evolutionary conservation of early ontogeny relative to late ontogeny. Karl Von Baer first noted the similarity of early ontogeny across taxa, and Ernst Haeckel and Charles Darwin gave evolutionary interpretation to this phenomenon. In spite of a resurgence of interest in comparative embryology and the development of mechanistic explanations for Von Baer's law, the pattern itself has been largely untested. Here, I use statistical phylogenetic approaches to show that Von Baer's law is an unnecessarily complex explanation of the patterns of ontogenetic timing in several clades of vertebrates. Von Baer's law suggests a positive correlation between ontogenetic time and amount of evolutionary change. I compare ranked position in ontogeny to frequency of evolutionary change in rank for developmental events and find that these measures are not correlated, thus failing to support Von Baer's model. An alternative model that postulates that small changes in ontogenetic rank are evolutionarily easier than large changes is tentatively supported.

[Techniques and strategy of pathological sampling in the diagnostic and therapeutic management of lung cancer].

PubMed

Remmelink, M; Sokolow, Y; Leduc, D

2015-04-01

Histopathology is key to the diagnosis and staging of lung cancer. This analysis requires tissue sampling from primary and/or metastatic lesions. The choice of sampling technique is intended to optimize diagnostic yield while avoiding unnecessarily invasive procedures. Recent developments in targeted therapy require increasingly precise histological and molecular characterization of the tumor. Therefore, pathologists must be economical with tissue samples to ensure that they have the opportunity to perform all the analyses required. More than ever, good communication between clinician, endoscopist or surgeon, and pathologist is essential. This is necessary to ensure that all participants in the process of lung cancer diagnosis collaborate to ensure that the appropriate number and type of biopsies are performed with the appropriate tissue sampling treatment. This will allow performance of all the necessary analyses leading to a more precise characterization of the tumor, and thus the optimal treatment for patients with lung cancer. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Composite Resection of Tumors of the Rostral Maxilla and Dorsolateral Muzzle Utilizing an Upper Lip-Sparing, Combined Approach in Dogs.

PubMed

Thomson, Amy E; Soukup, Jason W

2018-01-01

Tumors of the rostral maxilla that involve both the oral mucosa and the dermis or subdermis of the dorsolateral muzzle provide unique challenges for the oromaxillofacial surgeon. Traditionally described approaches to such lesions may involve an intraoral incision that extends and involves the upper lip to envelope the involved dermis of the dorsolateral muzzle. However, such an approach unnecessarily resects upper lip tissue resulting in a large defect that likely requires advanced skin flaps or grafts for reconstruction. Such flaps are technically challenging and introduce potential for significance postoperative complications. In this article, we provide a detailed description a combined intra- and extraoral approach that allows for composite resection of tumors of the rostral maxilla that also involve the dorsolateral muzzle. The described technique allows for excellent intraoperative visualization and provides a superior cosmetic outcome that minimizes postoperative complications. In addition, we describe our experience utilizing the technique in three clinical cases.

Composite Resection of Tumors of the Rostral Maxilla and Dorsolateral Muzzle Utilizing an Upper Lip-Sparing, Combined Approach in Dogs

PubMed Central

Thomson, Amy E.; Soukup, Jason W.

2018-01-01

Tumors of the rostral maxilla that involve both the oral mucosa and the dermis or subdermis of the dorsolateral muzzle provide unique challenges for the oromaxillofacial surgeon. Traditionally described approaches to such lesions may involve an intraoral incision that extends and involves the upper lip to envelope the involved dermis of the dorsolateral muzzle. However, such an approach unnecessarily resects upper lip tissue resulting in a large defect that likely requires advanced skin flaps or grafts for reconstruction. Such flaps are technically challenging and introduce potential for significance postoperative complications. In this article, we provide a detailed description a combined intra- and extraoral approach that allows for composite resection of tumors of the rostral maxilla that also involve the dorsolateral muzzle. The described technique allows for excellent intraoperative visualization and provides a superior cosmetic outcome that minimizes postoperative complications. In addition, we describe our experience utilizing the technique in three clinical cases. PMID:29616231

Promise and peril: Dissemination of findings from studies of drugs used in pregnancy and their association with birth defects.

PubMed

Patrick, Stephen W; Cooper, William O

2015-08-01

When and how to publish birth defects research can be complex, especially in the context of drugs used in pregnancy. Such research frequently involves multiple stakeholders, including regulatory agencies. Researchers must balance the potential peril of an unnecessarily panicked populace versus the benefit of protecting the public's health. We use a case presentation and contemporary literature to highlight the potential tradeoffs that researchers must consider. We highlight important considerations including the public health impact, examining the likelihood of causality, understanding common considerations when using large data sources, the role of peer review and working in partnership with regulatory agencies. We suggest that plans for analyses, dissemination and risk communication are done best a priori and not post hoc. Rigorous research evaluating the impact of drugs used in pregnancy, coupled with effective dissemination strategies, has the potential improve outcomes for mothers and their infants for generations. © 2015 Wiley Periodicals, Inc.

Design principles of nuclear receptor signaling: how complex networking improves signal transduction

PubMed Central

Kolodkin, Alexey N; Bruggeman, Frank J; Plant, Nick; Moné, Martijn J; Bakker, Barbara M; Campbell, Moray J; van Leeuwen, Johannes P T M; Carlberg, Carsten; Snoep, Jacky L; Westerhoff, Hans V

2010-01-01

The topology of nuclear receptor (NR) signaling is captured in a systems biological graphical notation. This enables us to identify a number of ‘design' aspects of the topology of these networks that might appear unnecessarily complex or even functionally paradoxical. In realistic kinetic models of increasing complexity, calculations show how these features correspond to potentially important design principles, e.g.: (i) cytosolic ‘nuclear' receptor may shuttle signal molecules to the nucleus, (ii) the active export of NRs may ensure that there is sufficient receptor protein to capture ligand at the cytoplasmic membrane, (iii) a three conveyor belts design dissipating GTP-free energy, greatly aids response, (iv) the active export of importins may prevent sequestration of NRs by importins in the nucleus and (v) the unspecific nature of the nuclear pore may ensure signal-flux robustness. In addition, the models developed are suitable for implementation in specific cases of NR-mediated signaling, to predict individual receptor functions and differential sensitivity toward physiological and pharmacological ligands. PMID:21179018

Management demands on information and communication technology in process-oriented health-care organizations: the importance of understanding managers' expectations during early phases of systems design.

PubMed

Andersson, Anna; Vimarlund, Vivian; Timpka, Toomas

2002-01-01

There are numerous challenges to overcome before information and communication technology (ICT) can achieve its full potential in process-oriented health-care organizations. One of these challenges is designing systems that meet users' needs, while reflecting a continuously changing organizational environment. Another challenge is to develop ICT that supports both the internal and the external stakeholders' demands. In this study a qualitative research strategy was used to explore the demands on ICT expressed by managers from functional and process units at a community hospitaL The results reveal a multitude of partially competing goals that can make the ICT development process confusing, poor in quality, inefficient and unnecessarily costly. Therefore, from the perspective of ICT development, the main task appears to be to coordinate the different visions and in particular clarify them, as well as to establish the impact that these visions would have on the forthcoming ICT application.

Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection: A Multi-Center Study of Clinical Decision Support for Children with Head Trauma.

PubMed

Deakyne, S J; Bajaj, L; Hoffman, J; Alessandrini, E; Ballard, D W; Norris, R; Tzimenatos, L; Swietlik, M; Tham, E; Grundmeier, R W; Kuppermann, N; Dayan, P S

2015-01-01

Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts. To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR. As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity. Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75-89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites. CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition, including prevalence and morbidity, in addition to the goals of the intervention being considered.

Using Transport Diagnostics to Understand Chemistry Climate Model Ozone Simulations

NASA Technical Reports Server (NTRS)

Strahan, S. E.; Douglass, A. R.; Stolarski, R. S.; Akiyoshi, H.; Bekki, S.; Braesicke, P.; Butchart, N.; Chipperfield, M. P.; Cugnet, D.; Dhomse, S.;

Antenna modeling considerations for accurate SAR calculations in human phantoms in close proximity to GSM cellular base station antennas.

PubMed

van Wyk, Marnus J; Bingle, Marianne; Meyer, Frans J C

2005-09-01

International bodies such as International Commission on Non-Ionizing Radiation Protection (ICNIRP) and the Institute for Electrical and Electronic Engineering (IEEE) make provision for human exposure assessment based on SAR calculations (or measurements) and basic restrictions. In the case of base station exposure this is mostly applicable to occupational exposure scenarios in the very near field of these antennas where the conservative reference level criteria could be unnecessarily restrictive. This study presents a variety of critical aspects that need to be considered when calculating SAR in a human body close to a mobile phone base station antenna. A hybrid FEM/MoM technique is proposed as a suitable numerical method to obtain accurate results. The verification of the FEM/MoM implementation has been presented in a previous publication; the focus of this study is an investigation into the detail that must be included in a numerical model of the antenna, to accurately represent the real-world scenario. This is accomplished by comparing numerical results to measurements for a generic GSM base station antenna and appropriate, representative canonical and human phantoms. The results show that it is critical to take the disturbance effect of the human phantom (a large conductive body) on the base station antenna into account when the antenna-phantom spacing is less than 300 mm. For these small spacings, the antenna structure must be modeled in detail. The conclusion is that it is feasible to calculate, using the proposed techniques and methodology, accurate occupational compliance zones around base station antennas based on a SAR profile and basic restriction guidelines. (c) 2005 Wiley-Liss, Inc.

Development of a 13 kW Hall Thruster Propulsion System Performance Model for AEPS

NASA Technical Reports Server (NTRS)

Stanley, Steven; Allen, May; Goodfellow, Keith; Chew, Gilbert; Rapetti, Ryan; Tofil, Todd; Herman, Dan; Jackson, Jerry; Myers, Roger

2017-01-01

The Advanced Electric Propulsion System (AEPS) program will develop a flight 13kW Hall thruster propulsion system based on NASA's HERMeS thruster. The AEPS system includes the Hall Thruster, the Power Processing Unit (PPU) and the Xenon Flow Controller (XFC). These three primary components must operate together to ensure that the system generates the required combinations of thrust and specific impulse at the required system efficiencies for the desired system lifetime. At the highest level, the AEPS system will be integrated into the spacecraft and will receive power, propellant, and commands from the spacecraft. Power and propellant flow rates will be determined by the throttle set points commanded by the spacecraft. Within the system, the major control loop is between the mass flow rate and thruster current, with time-dependencies required to handle all expected transients, and additional, much slower interactions between the thruster and cathode temperatures, flow controller and PPU. The internal system interactions generally occur on shorter timescales than the spacecraft interactions, though certain failure modes may require rapid responses from the spacecraft. The AEPS system performance model is designed to account for all these interactions in a way that allows evaluation of the sensitivity of the system to expected changes over the planned mission as well as to assess the impacts of normal component and assembly variability during the production phase of the program. This effort describes the plan for the system performance model development, correlation to NASA test data, and how the model will be used to evaluate the critical internal and external interactions. The results will ensure the component requirements do not unnecessarily drive the system cost or overly constrain the development program. Finally, the model will be available to quickly troubleshoot any future unforeseen development challenges.

Smart Extraction and Analysis System for Clinical Research.

PubMed

Afzal, Muhammad; Hussain, Maqbool; Khan, Wajahat Ali; Ali, Taqdir; Jamshed, Arif; Lee, Sungyoung

2017-05-01

With the increasing use of electronic health records (EHRs), there is a growing need to expand the utilization of EHR data to support clinical research. The key challenge in achieving this goal is the unavailability of smart systems and methods to overcome the issue of data preparation, structuring, and sharing for smooth clinical research. We developed a robust analysis system called the smart extraction and analysis system (SEAS) that consists of two subsystems: (1) the information extraction system (IES), for extracting information from clinical documents, and (2) the survival analysis system (SAS), for a descriptive and predictive analysis to compile the survival statistics and predict the future chance of survivability. The IES subsystem is based on a novel permutation-based pattern recognition method that extracts information from unstructured clinical documents. Similarly, the SAS subsystem is based on a classification and regression tree (CART)-based prediction model for survival analysis. SEAS is evaluated and validated on a real-world case study of head and neck cancer. The overall information extraction accuracy of the system for semistructured text is recorded at 99%, while that for unstructured text is 97%. Furthermore, the automated, unstructured information extraction has reduced the average time spent on manual data entry by 75%, without compromising the accuracy of the system. Moreover, around 88% of patients are found in a terminal or dead state for the highest clinical stage of disease (level IV). Similarly, there is an ∼36% probability of a patient being alive if at least one of the lifestyle risk factors was positive. We presented our work on the development of SEAS to replace costly and time-consuming manual methods with smart automatic extraction of information and survival prediction methods. SEAS has reduced the time and energy of human resources spent unnecessarily on manual tasks.

Learning from the public: citizens describe the need to improve end-of-life care access, provision and recognition across Europe

PubMed Central

Daveson, Barbara A.; Alonso, Juan P.; Calanzani, Natalia; Ramsenthaler, Christina; Gysels, Marjolein; Antunes, Barbara; Moens, Katrien; Groeneveld, Esther I.; Albers, Gwenda; Finetti, Silvia; Pettenati, Francesca; Bausewein, Claudia; Higginson, Irene J.; Harding, Richard; Deliens, Luc; Toscani, Franco; Ferreira, Pedro L.; Ceulemans, Lucas; Gomes, Barbara

2014-01-01

Background: Despite ageing populations and increasing cancer deaths, many European countries lack national policies regarding palliative and end-of-life care. The aim of our research was to determine public views regarding end-of-life care in the face of serious illness. Methods: Implementation of a pan-European population-based survey with adults in England, Belgium (Flanders), Germany, Italy, the Netherlands, Portugal and Spain. Three stages of analysis were completed on open-ended question data: (i) inductive analysis to determine a category-code framework; (ii) country-level manifest deductive content analysis; and (iii) thematic analysis to identify cross-country prominent themes. Results: Of the 9344 respondents, 1543 (17%) answered the open-ended question. Two prominent themes were revealed: (i) a need for improved quality of end-of-life and palliative care, and access to this care for patients and families and (ii) the recognition of the importance of death and dying, the cessation of treatments to extend life unnecessarily and the need for holistic care to include comfort and support. Conclusions: Within Europe, the public recognizes the importance of death and dying; they are concerned about the prioritization of quantity of life over quality of life; and they call for improved quality of end-of-life and palliative care for patients, especially for elderly patients, and families. To fulfil the urgent need for a policy response and to advance research and care, we suggest four solutions for European palliative and end-of-life care: institute government-led national strategies; protect regional research funding; consider within- and between-country variance; establish standards for training, education and service delivery. PMID:23487548

Clinical practice in secondary prophylaxis and management of febrile neutropenia in Poland: results of the febrile neutropenia awareness project

PubMed Central

Chmielowska, Ewa; Filipczyk-Cisarż, Emilia; Krzemieniecki, Krzysztof; Leśniewski-Kmak, Krzysztof; Litwiniuk, Maria M.; Wieruszewska-Kowalczyk, Karolina; Kosno-Kruszewska, Elżbieta

2014-01-01

Aim of the study This paper presents the second part of the GoPractice project involving oncologists from seven Polish provinces. The aim of this part of the project was to assess the knowledge of oncologists on indications for granulocyte colony-stimulating factor (G-CSF) secondary prophylaxis (SP) of febrile neutropenia (FN) and FN management based on current therapeutic guidelines (Polish Society of Clinical Oncology [PTOK] and European Organisation for Research and Treatment of Cancer [EORTC]). Material and methods The project involved 169 oncologists from 7 regions working in large specialist oncological centers, university hospitals, regional and city hospitals, specialist outpatient clinics and oncological wards in small, local hospitals. The participants completed a questionnaire based on 7 prepared clinical cases of patients with different tumor types and patient characteristics, receiving chemotherapy (CT) with different levels of FN risk. Participants answered questions related to FN risk assessment and G-CSF use as secondary prophylaxis (SP) and for the management of FN. After completing the questionnaire, the participants proceeded to an educational module in which they were provided with an analysis of correct diagnostic and therapeutic procedures according to the PTOK and EORTC guidelines. Results and Conclusions Indications for G-CSF SP were generally well recognized: in nearly 90% of responses, oncologists assessed correctly indications/lack of indications for secondary prophylaxis, in accordance with guideline recommendations and Experts’ opinion. However, the use of daily G-CSFs was often recommended by the study participants for the management of FN. This clinical practice is contradictory to PTOK and EORTC recommendations and may unnecessarily increase treatment costs. Changing this clinical approach may be achieved through regular training to improve guideline adherence. PMID:25784842

Using the failure mode and effects analysis model to improve parathyroid hormone and adrenocorticotropic hormone testing

PubMed Central

Magnezi, Racheli; Hemi, Asaf; Hemi, Rina

2016-01-01

Background Risk management in health care systems applies to all hospital employees and directors as they deal with human life and emergency routines. There is a constant need to decrease risk and increase patient safety in the hospital environment. The purpose of this article is to review the laboratory testing procedures for parathyroid hormone and adrenocorticotropic hormone (which are characterized by short half-lives) and to track failure modes and risks, and offer solutions to prevent them. During a routine quality improvement review at the Endocrine Laboratory in Tel Hashomer Hospital, we discovered these tests are frequently repeated unnecessarily due to multiple failures. The repetition of the tests inconveniences patients and leads to extra work for the laboratory and logistics personnel as well as the nurses and doctors who have to perform many tasks with limited resources. Methods A team of eight staff members accompanied by the Head of the Endocrine Laboratory formed the team for analysis. The failure mode and effects analysis model (FMEA) was used to analyze the laboratory testing procedure and was designed to simplify the process steps and indicate and rank possible failures. Results A total of 23 failure modes were found within the process, 19 of which were ranked by level of severity. The FMEA model prioritizes failures by their risk priority number (RPN). For example, the most serious failure was the delay after the samples were collected from the department (RPN =226.1). Conclusion This model helped us to visualize the process in a simple way. After analyzing the information, solutions were proposed to prevent failures, and a method to completely avoid the top four problems was also developed. PMID:27980440

Beliefs and perceptions of women with newly diagnosed breast cancer who refused conventional treatment in favor of alternative therapies.

PubMed

Citrin, Dennis L; Bloom, Diane L; Grutsch, James F; Mortensen, Sara J; Lis, Christopher G

2012-01-01

Although breast cancer is a highly treatable disease, some women reject conventional treatment opting for unproven "alternative therapy" that may contribute to poor health outcomes. This study sought to understand why some women make this decision and to identify messages that might lead to greater acceptance of evidence-based treatment. This study explored treatment decision making through in-depth interviews with 60 breast cancer patients identified by their treating oncologists. Thirty refused some or all conventional treatment, opting for alternative therapies, whereas 30 accepted both conventional and alternative treatments. All completed the Beck Anxiety Inventory and the Rotter Locus of Control scale. Negative first experiences with "uncaring, insensitive, and unnecessarily harsh" oncologists, fear of side effects, and belief in the efficacy of alternative therapies were key factors in the decision to reject potentially life-prolonging conventional therapy. Refusers differed from controls in their perceptions of the value of conventional treatment, believing that chemotherapy and radiotherapy were riskier (p < .0073) and less beneficial (p < .0001) than did controls. Controls perceived alternative medicine alone as riskier than did refusers because its value for treating cancer is unproven (p < .0001). Refusers believed they could heal themselves naturally from cancer with simple holistic methods like raw fruits, vegetables, and supplements. According to interviewees, a compassionate approach to cancer care plus physicians who acknowledge their fears, communicate hope, educate them about their options, and allow them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.

[Evaluation of rabies post-exposure prophylaxis in humans injured by dogs and cats in the municipality of Jaboticabal, SP, from 2000 through 2006].

PubMed

Frias, Danila Fernanda Rodrigues; Lages, Sonia Luisa Silva; Carvalho, Adolorata Aparecida Bianco

2011-12-01

The present study aimed to evaluate rabies post-exposure prophylaxis (PEP) in humans in the municipality of Jaboticabal, São Paulo from 2000 through 2006. A descriptive and retrospective study was conducted by collecting data available in patient records. Vaccination costs were also calculated; 2,493 patients injured by animals received PEP, totaling R$ 179,105.14 and 7,108 doses; 2,184 (71.5%) out of the total reports were caused by dogs and cats clinically healthy at the moment of the attack. These animals remained sound throughout the 10-day observation period. The observation was conducted by the victim or by the owner. Considering animal observation and the epidemiological status of rabies in the municipality, all of these patients could have been dismissed from PEP treatment. Instead, only 464 were dismissed, meaning that 1,720 patients were unnecessarily vaccinated. An estimated 4,590 doses and R$114,420.81 could have been saved. In comparison with rates of other municipalities of the State of São Paulo and with the national mean, the number of PEP in Jaboticabal is very high and it became evident that management evaluated neither the health status of the animal nor the epidemiological status of the area for rabies. Permanent awareness and education of public health professionals with respect to rabies epidemiology and the need to perform correct observation of the aggressors are recommended. It is essential that medical and veterinary services be integrated to provide better assessment of cases and safer decisions on the institution of PEP.

Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management.

PubMed

Rapisarda, Agnese Maria Chiara; Cianci, Antonio; Caruso, Salvatore; Vitale, Salvatore Giovanni; Valenti, Gaetano; Piombino, Eliana; Cianci, Stefano

2018-06-01

Peritoneal mesothelial cysts (PMC) are a clinical dilemma because of their true pathogenic nature. Many definitions have been associated with PMC, including "benign multicystic mesothelioma", "cystic mesothelioma", "multilocular peritoneal inclusion cysts", ''inflammatory cysts of the peritoneum" or "postoperative peritoneal cyst". We herein performed a systematic review of the literature focusing on clinical and histopathological aspects of PMC, diagnosis, and therapies. Moreover, we described our experience with a case of PMC in a young female. Since there is often a history of prior surgery or inflammatory disease, most authors consider PMC of reactive origin. However, in some cases they occur without any documentable signs of disease or injury. A variety of clinical findings can complicate the preoperative assessment and a multitude of histological pictures may potentially lead to a misdiagnosis. The absence of a uniform treatment strategy and lack of long-term follow-up often hinder the accurate definition leading to unnecessary or unnecessarily aggressive therapy. PMC are more common than had previously been thought. Most authors consider them non-neoplastic; thus the designation of "peritoneal inclusion cyst" is preferable. The term "mesothelioma" should be used only in cases of histological evidences of atypia. The high rates of recurrence suggest that the goal of treatment should not be necessarily complete eradication, but symptomatic relief through individualized treatment. This is a topic of particular importance, especially in young female where recurrence rates could be lower than those reported in adults and where an improperly aggressive treatment could have repercussions on fertility.

[Neumonía acquired in the community. Practical guide elaborated by a committee intersocieties].

PubMed

Luna, Carlos M; Calmaggi, Aníbal; Caberloto, Oscar; Gentile, Jorge; Valentini, Ricardo; Ciruzzi, Julian; Clara, Liliana; Rizzo, Oscar; Lasdica, Sergio; Blumenfeld, Marcelo; Benchetrit, Guillermo; Famiglietti, Angela; Apezteguia, Carlos; Monteverde, Alfredo

2003-01-01

Clinical practice guidelines for community-acquired pneumonia (CAP) contribute to improve patient's management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1% of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25% of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP). Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures.

Cerebral palsy: causes, pathways, and the role of genetic variants.

PubMed

MacLennan, Alastair H; Thompson, Suzanna C; Gecz, Jozef

2015-12-01

Cerebral palsy (CP) is heterogeneous with different clinical types, comorbidities, brain imaging patterns, causes, and now also heterogeneous underlying genetic variants. Few are solely due to severe hypoxia or ischemia at birth. This common myth has held back research in causation. The cost of litigation has devastating effects on maternity services with unnecessarily high cesarean delivery rates and subsequent maternal morbidity and mortality. CP rates have remained the same for 50 years despite a 6-fold increase in cesarean birth. Epidemiological studies have shown that the origins of most CP are prior to labor. Increased risk is associated with preterm delivery, congenital malformations, intrauterine infection, fetal growth restriction, multiple pregnancy, and placental abnormalities. Hypoxia at birth may be primary or secondary to preexisting pathology and international criteria help to separate the few cases of CP due to acute intrapartum hypoxia. Until recently, 1-2% of CP (mostly familial) had been linked to causative mutations. Recent genetic studies of sporadic CP cases using new-generation exome sequencing show that 14% of cases have likely causative single-gene mutations and up to 31% have clinically relevant copy number variations. The genetic variants are heterogeneous and require function investigations to prove causation. Whole genome sequencing, fine scale copy number variant investigations, and gene expression studies may extend the percentage of cases with a genetic pathway. Clinical risk factors could act as triggers for CP where there is genetic susceptibility. These new findings should refocus research about the causes of these complex and varied neurodevelopmental disorders. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Geneticizing Ethnicity and Diet: Anti-doping Science and Its Social Impact in the Age of Post-genomics.

PubMed

Hyun, Jaehwan

2017-01-01

While gene doping and other technological means of sport enhancement have become a topic of ethical debate, a major outcome from genomic research in sports is often linked to the regulation of doping. In particular, researchers within the field of anti-doping science, a regulatory science that aims to develop scientific solutions for regulating doped athletes, have conducted genomic research on anabolic-androgenic steroids. Genomic knowledge on anabolic-androgenic steroids, a knowledge base that has been produced to improve doping regulation, has caused the 'geneticization' of cultural objects such as ethnic identities and dietary habits. Through examining how anti-doping genomic knowledge and its media representation unnecessarily reify cultural objects in terms of genomics, I argue that Ethical, Legal, and Social Implications (ELSI) research programs in human enhancement should include the social impacts of anti-doping science in their discussions. Furthermore, this article will propose that ELSI scholars begin their academic analysis on anti-doping science by engaging with the recent ELSI scholarship on genomics and race and consider the regulatory and political natures of anti-doping research.

Aging commuter aeroplanes: Fatigue evaluation and control methods

NASA Technical Reports Server (NTRS)

Emmerson, A. J.

1992-01-01

The loss of reliability in aircraft is caused by two broad classes of problems. There are those problems which are self evident and hazardous rather than catastrophic. These are the problem areas where characteristically there have been multiple overhauls, repairs, and replacements, and where aging really means the results of repair ineffectiveness that accumulates. The other class of the problem is the insidious and potentially catastrophic class. It includes the progressive deterioration of items that are not maintained, and often cannot be maintained because the deterioration cannot be seen. It includes the loss of physical properties in adhesives and other organic compounds, corrosion, and the response of repeated loads. Dealt with here is a currently unnecessarily troublesome aspect of that response. Although we must remain concerned about those types of aircraft which have been certified under a design standard or operational rule which embodies the elementary fail-safe concept and which have not been subjected to a subsequent structural audit, the focus here is on types of aircraft for which fatigue and damage tolerance evaluation was not required as a condition of certification.

Classifying 50 years of Bell inequalities

NASA Astrophysics Data System (ADS)

Rosset, Denis; Bancal, Jean-Daniel; Gisin, Nicolas

2014-10-01

Since John S Bell demonstrated the interest of studying linear combinations of probabilities in relation with the EPR paradox in 1964, Bell inequalities have lead to numerous developments. Unfortunately, the description of Bell inequalities is subject to several degeneracies, which make any exchange of information about them unnecessarily hard. Here, we analyze these degeneracies and propose a decomposition for Bell-like inequalities based on a set of reference expressions which is not affected by them. These reference expressions set a common ground for comparing Bell inequalities. We provide algorithms based on finite group theory to compute this decomposition. Implementing these algorithms allows us to set up a compendium of reference Bell-like inequalities, available online at www.faacets.com. This website constitutes a platform where registered Bell-like inequalities can be explored, new inequalities can be compared to previously-known ones and relevant information on Bell inequalities can be added in a collaborative manner. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical devoted to ‘50 years of Bell’s theorem’.

Oral intake during labor: a review of the evidence.

PubMed

Sharts-Hopko, Nancy C

2010-01-01

The purpose of this article is to review evidence and practices within and beyond the United States related to the practice of maternal fasting during labor. Fasting in labor became standard policy in the United States after findings of a 1946 study suggested that pulmonary aspiration during general anesthesia was an avoidable risk. Today general anesthesia is rarely used in childbirth and its associated maternal mortality usually results from difficulty in intubation. Healthcare professionals have debated the risks and benefits of restricting oral intake during labor for decades, and practice varies internationally. Research from the United States, Australia, and Europe suggests that oral intake may be beneficial, and adverse events associated with oral intake such as vomiting and prolongation of labor do not seem to be associated with alterations in maternal or infant outcomes. The World Health Organization recommends that healthcare providers should not interfere in women's eating and drinking during labor when no risk factors are evident. Nurses in intrapartum settings are encouraged to work in multidisciplinary teams to revise policies that are unnecessarily restrictive regarding oral intake during labor among low-risk women.

Balancing ESA and iron therapy in a prospective payment environment.

PubMed

Aronoff, George R; Gaweda, Adam E

2014-02-01

Ever since the introduction of EPO, ESAs and iron dosing have been driven by financial incentives. When ESAs were a profit center for providers, large doses were used. With ESAs becoming a cost center, a new trend has appeared, gradually replacing their use with iron to achieve the same therapeutic effect at lower cost. This financially driven approach, treating ESAs and iron as alternatives, is not consistent with human physiology where these agents act in a complementary manner. It is likely that we are still giving unnecessarily large doses of ESAs and iron, relative to what our patients' true needs are. Although we have highlighted the economic drivers of this outcome, many other factors play a role. These include our lack of understanding of the complex interplay of the anemia of chronic disease, inflammation, poor nutrition, blood loss through dialysis, ESAs and iron deficiency. We propose that physiology-driven modeling may provide some insight into the interactions between erythropoiesis and ferrokinetics. This insight can then be used to derive new, physiologically compatible dosing guidelines for ESAs and iron.

The impact of comorbidity on cancer and its treatment.

PubMed

Sarfati, Diana; Koczwara, Bogda; Jackson, Christopher

2016-07-01

Answer questions and earn CME/CNE Comorbidity is common among cancer patients and, with an aging population, is becoming more so. Comorbidity potentially affects the development, stage at diagnosis, treatment, and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer, there is limited consensus on how to record, interpret, or manage comorbidity in the context of cancer, with the result that patients who have comorbidity are less likely to receive treatment with curative intent. Evidence in this area is lacking because of the frequent exclusion of patients with comorbidity from randomized controlled trials. There is evidence that some patients with comorbidity have potentially curative treatment unnecessarily modified, compromising optimal care. Patients with comorbidity have poorer survival, poorer quality of life, and higher health care costs. Strategies to address these issues include improving the evidence base for patients with comorbidity, further development of clinical tools to assist decision making, improved integration and coordination of care, and skill development for clinicians. CA Cancer J Clin 2016;66:337-350. © 2016 American Cancer Society. © 2016 American Cancer Society, Inc.

Current laboratory requirements for adrenocorticotropic hormone and renin/aldosterone sample handling are unnecessarily restrictive.

PubMed

Chakera, Ali J; McDonald, Timothy J; Knight, Bridget A; Vaidya, Bijay; Jones, Angus G

2017-02-01

Samples for adrenocorticotropic hormone (ACTH) and aldosterone/renin analysis usually require rapid transport to the receiving laboratory for immediate separation and freezing. In practice, this means assessment is limited to hospital settings and many samples are rejected. We examined whether these requirements are necessary by assessing the stability of ACTH, aldosterone and renin over 48 hours in whole blood collected in serum gel and EDTA plasma from 31 participants. Our results show that ACTH collected into EDTA plasma is stable at room temperature for at least 6 hours, mean change at 6 hours -2.6% (95% CI -9.7 to 4.5). Both aldosterone and renin were stable collected on serum gel at room temperature for at least 6 hours: mean change aldosterone +0.2% (95% CI -3.6 to 4.0), renin -1.9% (95% CI -7.0 to3.2). Therefore, by using appropriate preservatives, ACTH and aldosterone/renin can be measured on samples collected at room temperature and processed within 6 hours. This would facilitate outpatient and emergency room assessment of these analytes. © Royal College of Physicians 2017. All rights reserved.

Geneticizing Ethnicity and Diet: Anti-doping Science and Its Social Impact in the Age of Post-genomics

PubMed Central

Hyun, Jaehwan

2017-01-01

While gene doping and other technological means of sport enhancement have become a topic of ethical debate, a major outcome from genomic research in sports is often linked to the regulation of doping. In particular, researchers within the field of anti-doping science, a regulatory science that aims to develop scientific solutions for regulating doped athletes, have conducted genomic research on anabolic-androgenic steroids. Genomic knowledge on anabolic-androgenic steroids, a knowledge base that has been produced to improve doping regulation, has caused the ‘geneticization’ of cultural objects such as ethnic identities and dietary habits. Through examining how anti-doping genomic knowledge and its media representation unnecessarily reify cultural objects in terms of genomics, I argue that Ethical, Legal, and Social Implications (ELSI) research programs in human enhancement should include the social impacts of anti-doping science in their discussions. Furthermore, this article will propose that ELSI scholars begin their academic analysis on anti-doping science by engaging with the recent ELSI scholarship on genomics and race and consider the regulatory and political natures of anti-doping research. PMID:28536601

Integrating spheres for improved skin photodynamic therapy

NASA Astrophysics Data System (ADS)

Glennie, Diana L.; Farrell, Thomas J.; Hayward, Joseph E.; Patterson, Michael S.

2010-09-01

The prescribed radiant exposures for photodynamic therapy (PDT) of superficial skin cancers are chosen empirically to maximize the success of the treatment while minimizing adverse reactions for the majority of patients. They do not take into account the wide range of tissue optical properties for human skin, contributing to relatively low treatment success rates. Additionally, treatment times can be unnecessarily long for large treatment areas if the laser power is not sufficient. Both of these concerns can be addressed by the incorporation of an integrating sphere into the irradiation apparatus. The light fluence rate can be increased by as much as 100%, depending on the tissue optical properties. This improvement can be determined in advance of treatment by measuring the reflectance from the tissue through a side port on the integrating sphere, allowing for patient-specific treatment times. The sphere is also effective at improving beam flatness, and reducing the penumbra, creating a more uniform light field. The side port reflectance measurements are also related to the tissue transport albedo, enabling an approximation of the penetration depth, which is useful for real-time light dosimetry.

Rewards and incentives for the provision of human tissue for research.

PubMed

Devaney, Sarah

2014-01-01

The Nuffield Council on Bioethics' 2011 report, Human Bodies: Donation for Medicine and Research, proposes a system for examining the ethical implications of different types of incentives for the provision of human tissue for use in medicine and research. The cornerstone of this system is the principle of altruism which, the Council recommends, should, where possible, remain the starting point for any such tissue provision. Using the Council's example of ova provision for research as an area in which altruism-based rewards might be departed from, this article argues that such a system has the potential to become inconsistent and unnecessarily complex. It suggests that the outcomes-focussed and motivations-focussed justifications the Council provides do not sit easily within the fast-paced and unpredictable area of biotechnology research. Further, it may undermine the focus on autonomy that is enshrined in the relevant legislation. This article suggests that a fair system for incentivising and rewarding the provision of human tissue in research should be developed, which focuses on elements of this role that are common to all tissue providers.

Engaging in vocabulary learning in science: the promise of multimodal instruction

NASA Astrophysics Data System (ADS)

Townsend, Dianna; Brock, Cynthia; Morrison, Jennifer D.

2018-02-01

To a science 'outsider', science language often appears unnecessarily technical and dense. However, scientific language is typically used with the goal of being concise and precise, which allows those who regularly participate in scientific discourse communities to learn from each other and build upon existing scientific knowledge. One essential component of science language is the academic vocabulary that characterises it. This mixed-methods study investigates middle school students' (N = 59) growth in academic vocabulary as it relates to their teacher's instructional practices that supported academic language development. Students made significant gains in their production of general academic words, t(57) = 2.32, p = .024 and of discipline-specific science words, t(57) = 3.01, p = .004 in science writing. Results from the qualitative strand of this inquiry contextualised the students' learning of academic vocabulary as it relates to their teacher's instructional practices and intentions as well as the students' perceptions of their learning environment. These qualitative findings reveal that both the students and their teacher articulated that the teacher's intentional use of resources supported students' academic vocabulary growth. Implications for research and instruction with science language are shared.

Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates.

PubMed

Cosgrove, J F; Gaughan, M; Snowden, C P; Lees, T

2008-06-01

National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases in waiting times for urgent surgery and an increased seniority of medical care associated with overnight pre-operative assessment of patients by anaesthetic trainees. Nevertheless, urgent cases continued to be delayed unnecessarily. A classification of delays was developed from existing guidelines and their incidence was audited. The results were disseminated to involved directorates. A repeat of the audit demonstrated a significant decrease in delays (p = 0.001), a significant increase in the availability of surgeons (p = 0.001) and a significant decrease in the median waiting time for urgent surgery compared to the first audit cycle and a previous standard (p < 0.01). We conclude that auditing delays and disseminating the results of the audit significantly decreases delays and median waiting times for urgent surgery because of improved surgical availability.

A Global Analysis of Light and Charge Yields in Liquid Xenon

DOE PAGES

Lenardo, Brian; Kazkaz, Kareem; Manalaysay, Aaron; ...

2015-11-04

Here, we present an updated model of light and charge yields from nuclear recoils in liquid xenon with a simultaneously constrained parameter set. A global analysis is performed using measurements of electron and photon yields compiled from all available historical data, as well as measurements of the ratio of the two. These data sweep over energies from keV and external applied electric fields from V/cm. The model is constrained by constructing global cost functions and using a simulated annealing algorithm and a Markov Chain Monte Carlo approach to optimize and find confidence intervals on all free parameters in the model.more » This analysis contrasts with previous work in that we do not unnecessarily exclude datasets nor impose artificially conservative assumptions, do not use spline functions, and reduce the number of parameters used in NEST v 0.98. Here, we report our results and the calculated best-fit charge and light yields. These quantities are crucial to understanding the response of liquid xenon detectors in the energy regime important for rare event searches such as the direct detection of dark matter particles.« less

Assessing the Benefits of NASA Category 3, Low Cost Class C/D Missions

NASA Technical Reports Server (NTRS)

Bitten, Robert E.; Shinn, Steven A.; Mahr, Eric M.

2013-01-01

Category 3, Class C/D missions have the benefit of delivering worthwhile science at minimal cost which is increasingly important in NASA's constrained budget environment. Although higher cost Category 1 and 2 missions are necessary to achieve NASA's science objectives, Category 3 missions are shown to be an effective way to provide significant science return at a low cost. Category 3 missions, however, are often reviewed the same as the more risk averse Category 1 and 2 missions. Acknowledging that reviews are not the only aspect of a total engineering effort, reviews are still a significant concern for NASA programs. This can unnecessarily increase the cost and schedule of Category 3 missions. This paper quantifies the benefit and performance of Category 3 missions by looking at the cost vs. capability relative to Category 1 and 2 missions. Lessons learned from successful organizations that develop low cost Category 3, Class C/D missions are also investigated to help provide the basis for suggestions to streamline the review of NASA Category 3 missions.

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

PubMed Central

Trautner, Barbara W.; Grigoryan, Larissa

2013-01-01

Asymptomatic bacteriuria (ASB) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ASB must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. ABU is a very common condition that is often treated unnecessarily with antibiotics. Pregnant women and persons undergoing urologic procedures expected to cause mucosal bleeding are the only two groups with convincing evidence that screening for and treating ASB is beneficial. Randomized, controlled trials of ASB screening and/or treatment have established the lack of efficacy in premenopausal adult women, diabetic women, patients with spinal cord injury, catheterized patients, older adults living in the community, and elderly institutionalized adults. The overall purpose of this review is to promote an awareness of ASB as a distinct condition from UTI and to empower clinicians to withhold antibiotics in situations in which antimicrobial treatment of bacteriuria is not indicated. PMID:24484572

Calculating LOAEL/NOAEL uncertainty factors for wildlife species in ecological risk assessments

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

Suedel, B.C.; Clifford, P.A.; Ludwig, D.F.

1995-12-31

Terrestrial ecological risk assessments frequently require derivation of NOAELs or toxicity reference values (TRVS) against which to compare exposure estimates. However, much of the available information from the literature is LOAELS, not NOAELS. Lacking specific guidance, arbitrary factors of ten are sometimes employed for extrapolating NOAELs from LOAELs. In this study, the scientific literature was searched to obtain chronic and subchronic studies reporting NOAEL and LOAEL data for wildlife and laboratory species. Results to date indicate a mean conversion factor of 4.0 ({+-} 2.61 S.D.), with a minimum of 1. 6 and a maximum of 10 for 106 studies acrossmore » several classes of compounds (I.e., metals, pesticides, volatiles, etc.). These data suggest that an arbitrary factor of 10 conversion factor is unnecessarily restrictive for extrapolating NOAELs from LOAELs and that a factor of 4--5 would be more realistic for deriving toxicity reference values for wildlife species. Applying less arbitrary and more realistic conversion factors in ecological risk assessments will allow for a more accurate estimate of NOAEL values for assessing risk to wildlife populations.« less

Prophylactic antibiotics and anticonvulsants in neurosurgery.

PubMed

Ratilal, B; Sampaio, C

2011-01-01

The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

Throat swabs have no influence on the management of patients with sore throats.

PubMed

Cheung, L; Pattni, V; Peacock, P; Sood, S; Gupta, D

2017-11-01

Throat swabs are neither specific nor sensitive for micro-bacteria causing sore throat symptoms; however, current guidelines suggest they are still useful in some cases. Retrospective and prospective analyses were conducted of throat swabs requested within the months of January 2016 and August 2016, respectively. The study comprised 247 patients. Fifty-nine (24 per cent) had a positive culture. Forty-six grew group A beta-haemolytic streptococci, with the remainder growing candida (n = 10), coliform (n = 1) and klebsiella (n = 2). There was no significant difference in culture rates between primary or secondary care sources (χ2 = 0.56, p = 0.45). None of the swabs influenced a variation in patient management from local antimicrobial policies. Current practice has an estimated annual financial impact of £3 434 340 on the National Health Service. Throat swabs do not influence the antimicrobial treatment for patients with sore throats, even under current guidelines, and incur unnecessary cost. Current clinical guidelines could be reviewed to reduce the number of throat swabs being conducted unnecessarily.

Effectiveness of Rack Sanitation Procedures for Elimination of Bacteria from Automatic Watering Manifolds.

PubMed

Costello, Terry; Watkins, Linda; Straign, Mike; Bean, William; Toth, Linda; Rehg, Jerold

1998-03-01

An important responsibility of animal care programs is to protect research animals from exposure to potentially pathogenic microorganisms. To validate the need for steam sterilization of rodent automatic watering racks, we evaluate the post-sanitation microbial contamination of experimentally inoculated racks and of racks that had been used to house conventional mice. We tested three sanitation protocols: rack-washer sanitation without manifold flush, sanitation that included manifold flush, and sanitation that included manifold flush followed by autoclaving. Rack sanitation, with or without manifold flush, did not reliably eliminate microbial flora from the lixits or manifold drainage water. A total of 43% of all non-autoclaved racks were positive for bacterial contamination after sanitation, and racks that had been used for conventional animal housing were more frequently positive than were experimentally inoculated racks (79% vs 18%). These data indicate that steam sterilization is necessary for eliminating bacteria from automatic watering systems. These observations are particularly important in light of increasing numbers of immune-impaired rodents that may be inadvertently and unnecessarily exposed to microbial pathogens via the automatic watering system.

Sporotrichosis outbreak and mouldy 
hay in NSW.

PubMed

Dhingra, Deeksha; Durrheim, David; Porigneaux, Philippe

2015-04-01

Sporotrichosis is a subacute/chronic fungal infection caused by Sporothrix schenckii. The fungus thrives on organic matter including hay, wood, moss, soil and plants. Zoonotic transmission has also been reported. Lesions present as superficial skin nodules that become purulent and ulcerate. Lymphocutaneous spread is common. Haematogenous spread is uncommon and case fatality is rare. The aim of this article is to describe an outbreak of sporotrichosis in New South Wales. A cluster of six cases was identified in the NSW mid-north coast area in the first half of 2013. Telephone interviews were conducted in an attempt to identify possible exposures. General practitioners were contacted to report on patients with chronic non-healing skin lesions. A batch of mouldy hay supplied by a local farmer was identified as the potential source of exposure. Despite effective treatment with oral antifungals, diagnosis of sporotrichosis is often delayed and prolonged courses of antibiotics are unnecessarily prescribed. Timely detection and management (including referral to a dermatologist or infectious diseases specialist) significantly reduces morbidity. Personal protection is the key to prevention.

On a problematic procedure to manipulate response biases in recognition experiments: the case of "implied" base rates.

PubMed

Bröder, Arndt; Malejka, Simone

2017-07-01

The experimental manipulation of response biases in recognition-memory tests is an important means for testing recognition models and for estimating their parameters. The textbook manipulations for binary-response formats either vary the payoff scheme or the base rate of targets in the recognition test, with the latter being the more frequently applied procedure. However, some published studies reverted to implying different base rates by instruction rather than actually changing them. Aside from unnecessarily deceiving participants, this procedure may lead to cognitive conflicts that prompt response strategies unknown to the experimenter. To test our objection, implied base rates were compared to actual base rates in a recognition experiment followed by a post-experimental interview to assess participants' response strategies. The behavioural data show that recognition-memory performance was estimated to be lower in the implied base-rate condition. The interview data demonstrate that participants used various second-order response strategies that jeopardise the interpretability of the recognition data. We thus advice researchers against substituting actual base rates with implied base rates.

Myths in peritoneal dialysis.

PubMed

Lee, Martin B; Bargman, Joanne M

2016-11-01

To clarify misconceptions about the feasibility and risks of peritoneal dialysis that unnecessarily limit peritoneal dialysis uptake or continuation in patients for whom peritoneal dialysis is the preferred dialysis modality. The inappropriate choice of haemodialysis as a result of these misconceptions contributes to low peritoneal dialysis penetrance, increases transfer from peritoneal dialysis to haemodialysis, increases expenditure on haemodialysis and compromises quality of life for these patients. Peritoneal dialysis is an excellent renal replacement modality that is simple, cost-effective and provides comparable clinical outcomes to conventional in-centre haemodialysis. Unfortunately, many patients are deemed unsuitable to start or continue peritoneal dialysis because of false or inaccurate beliefs about peritoneal dialysis. Here, we examine some of these 'myths' and critically review the evidence for and against each of them. We review the feasibility and risk of peritoneal dialysis in patients with prior surgery, ostomies, obesity and mesh hernia repairs. We examine the fear of mediastinitis with peritoneal dialysis after coronary artery bypass graft surgery and the belief that the use of hypertonic glucose dialysate causes peritoneal membrane failure. By clarifying common myths about peritoneal dialysis, we hope to reduce overly cautious practices surrounding this therapy.

How complete and accurate is meningococcal disease notification?

PubMed

Breen, E; Ghebrehewet, S; Regan, M; Thomson, A P J

2004-12-01

Effective public health control of meningococcal disease (meningococcal meningitis and septicaemia) is dependent on complete, accurate and speedy notification. Using capture-recapture techniques this study assesses the completeness, accuracy and timeliness of meningococcal notification in a health authority. The completeness of meningococcal disease notification was 94.8% (95% confidence interval 93.2% to 96.2%); 91.2% of cases in 2001 were notified within 24 hours of diagnosis, but 28.0% of notifications in 2001 were false positives. Clinical staff need to be aware of the public health implications of a notification of meningococcal disease, and of failure of, or delay in notification. Incomplete or delayed notification not only leads to inaccurate data collection but also means that important public health measures may not be taken. A clinical diagnosis of meningococcal disease should be carefully considered between the clinician and the consultant in communicable disease control (CCDC). Otherwise, prophylaxis may be given unnecessarily, disease incidence inflated, and the benefits of control measures underestimated. Consultants in communicable disease control (CCDCs), in conjunction with clinical staff, should de-notify meningococcal disease if the diagnosis changes.

Effects of the use of multi-layer filter on radiation exposure and the quality of upper airway radiographs compared to the traditional copper filter.

PubMed

Klandima, Somphan; Kruatrachue, Anchalee; Wongtapradit, Lawan; Nithipanya, Narong; Ratanaprakarn, Warangkana

2014-06-01

The problem of image quality in a large number of upper airway obstructed patients is the superimposition of the airway over the bone of the spine on the AP view. This problem was resolved by increasing KVp to high KVp technique and adding extra radiographic filters (copper filter) to reduce the sharpness of the bone and increase the clarity of the airway. However, this raises a concern that patients might be receiving an unnecessarily higher dose of radiation, as well as the effectiveness of the invented filter compared to the traditional filter. To evaluate the level of radiation dose that patients receive with the use of multi-layer filter compared to non-filter and to evaluate the image quality of the upper airways between using the radiographic filter (multi-layer filter) and the traditional filter (copperfilter). The attenuation curve of both filter materials was first identified. Then, both the filters were tested with Alderson Rando phantom to determine the appropriate exposure. Using the method described, a new type of filter called the multi-layer filter for imaging patients was developed. A randomized control trial was then performed to compare the effectiveness of the newly developed multi-layer filter to the copper filter. The research was conducted in patients with upper airway obstruction treated at Queen Sirikit National Institute of Child Health from October 2006 to September 2007. A total of 132 patients were divided into two groups. The experimental group used high kVp technique with multi-layer filter, while the control group used copper filter. A comparison of film interpretation between the multi-layer filter and the copper filter was made by a number of radiologists who were blinded to both to the technique and type of filter used. Patients had less radiation from undergoing the kVp technique with copper filter and multi-layer filter compared to the conventional technique, where no filter is used. Patients received approximately 65.5% less radiation dose using high kVp technique with multi-layer filter compared to the conventional technique, and 25.9% less than using the traditional copper filter 45% of the radiologists who participated in this study reported that the high kVp technique with multi-layer filter was better for diagnosing stenosis, or narrowing of the upper airways. 33% reported that, both techniques were equal, while 22% reported that the traditional copper filter allowed for better details of airway obstruction. These findings showed that the multi-layered filter was comparable to the copper filter in terms of film interpretation. Using the multi-layer filter resulted in patients receiving a lower dose of radiation, as well as similar film interpretation when compared to the traditional copper filter.

A Prospective Cohort Study of Absconsion Incidents in Forensic Psychiatric Settings: Can We Identify Those at High-Risk?

PubMed Central

Cullen, Alexis E.; Jewell, Amelia; Tully, John; Coghlan, Suzanne; Dean, Kimberlie; Fahy, Tom

2015-01-01

Background Incidents of absconsion in forensic psychiatric units can have potentially serious consequences, yet surprisingly little is known about the characteristics of patients who abscond from these settings. The few previous studies conducted to date have employed retrospective designs, and no attempt has been made to develop an empirically-derived risk assessment scale. In this prospective study, we aimed to identify predictors of absconsion over a two-year period and investigate the feasibility of developing a brief risk assessment scale. Methods The study examined a representative sample of 135 patients treated in forensic medium- and low-secure wards. At baseline, demographic, clinical, treatment-related, and offending/behavioural factors were ascertained from electronic medical records and the treating teams. Incidents of absconsion (i.e., failure to return from leave, incidents of escape, and absconding whilst on escorted leave) were assessed at a two-year follow-up. Logistic regression analyses were used to determine the strongest predictors of absconsion which were then weighted according to their ability to discriminate absconders and non-absconders. The predictive utility of a brief risk assessment scale based on these weighted items was evaluated using receiver operator characteristics (ROC). Results During the two-year follow-up period, 27 patients (20%) absconded, accounting for 56 separate incidents. In multivariate analyses, four factors relating to offending and behaviour emerged as the strongest predictors of absconsion: history of sexual offending, previous absconsion, recent inpatient verbal aggression, and recent inpatient substance use. The weighted risk scale derived from these factors had moderate-to-good predictive accuracy (ROC area under the curve: 0.80; sensitivity: 067; specificity: 0.71), a high negative predictive value (0.91), but a low positive predictive value (0.34). Conclusion Potentially-targetable recent behaviours, such as inpatient verbal aggression and substance use, are strong predictors of absconsion in forensic settings; the absence of these factors may enable clinical teams to identify unnecessarily restricted low-risk individuals. PMID:26401653

Physicochemical and microbiological stability of azathioprine in InOrpha suspending agent studied under various conditions.

PubMed

Amin, Alexandre; Bourget, Philippe; Vidal, Fabrice; Cartier, François; Beauvais, Raphaëlle; Afonso, Veronica Do Nascimento

2015-01-01

Azathioprine is an antineoplastic antimetabolite drug currently used as an immunosuppressive agent after organ transplantation and for several dysimmunitary diseases. The usual daily dose ranges from 1 to 5 mg/kg orally. Azathioprine is marketed in France under the trade name Imurel in tablet form for oral administration that contains either 25 mg or 50 mg of the active ingredient. This Galenic formulation is not suitable for pediatric use and often requires a grinding operation or a dose fractionation to facilitate administration. In addition to a potential risk of imprecision in the administered dose, tablet grinding might unnecessarily expose nurses and families to a toxic compound. To overcome this problem, the objective of this study was to develop and evaluate the physicochemical and microbiological stabilities of azathioprine in a sugar-free, alcohol-free, and paraben-free InOrpha suspending agent. The studied samples were formulated into a 10-mg/mL suspension and stored in 24 plastic bottles of 60 mL at two different temperature conditions (between 2 degrees C to 8 degrees C and room temperature). Two series of 12 samples were tested for physicochemical stability using high-performance liquid chromatography as well as for a microbiological status for 35 days (daily opening of the bottles from day 0 of compounding) and for 56 days, upon daily flask opening (first opening at day 28 from compounding and daily opening for 28 consecutive days). The high-performance liquid chromatography method developed is linear, accurate, precise, and robust. In addition, a forced degradation study validated the selectivity and the specificity requirements of the method validated as stability indicating. At room temperature storage, high-performance liquid chromatography analysis showed that tested samples had concentrations ranging from 90% to 110% of the initial concentration throughout the course of the study. Microbiological status remained stable during the 56 days of investigation. Based on the data collected, the study led to the development of a new Galenic formulation of azathioprine that is suitable for pediatric use and can be safely stored at room temperature for 28 days (before and after opening for a maximum of 56 consecutive days).

A fixed-dose approach to conducting emamectin benzoate tolerance assessments on field-collected sea lice, Lepeophtheirus salmonis.

PubMed

Whyte, S K; Westcott, J D; Elmoslemany, A; Hammell, K L; Revie, C W

2013-03-01

In New Brunswick, Canada, the sea louse, Lepeophtheirus salmonis, poses an on-going management challenge to the health and productivity of commercially cultured Atlantic salmon, Salmo salar. While the in-feed medication, emamectin benzoate (SLICE® ; Merck), has been highly effective for many years, evidence of increased tolerance has been observed in the field since late 2008. Although bioassays on motile stages are a common tool to monitor sea lice sensitivity to emamectin benzoate in field-collected sea lice, they require the collection of large numbers of sea lice due to inherent natural variability in the gender and stage response to chemotherapeutants. In addition, sensitive instruments such as EC(50) analysis may be unnecessarily complex to characterize susceptibility subsequent to a significant observed decline in efficacy. This study proposes an adaptation of the traditional, dose-response format bioassay to a fixed-dose method. Analysis of 657 bioassays on preadult and adult stages of sea lice over the period 2008-2011 indicated a population of sea lice in New Brunswick with varying degrees of susceptibility to emamectin benzoate. A seasonal and spatial effect was observed in the robustness of genders and stages of sea lice, which suggest that mixing different genders and stages of lice within a single bioassay may result in pertinent information being overlooked. Poor survival of adult female lice in bioassays, particularly during May/June, indicates it may be prudent to consider excluding this stage from bioassays conducted at certain times of the year. This work demonstrates that fixed-dose bioassays can be a valuable technique in detecting reduced sensitivity in sea lice populations with varying degrees of susceptibility to emamectin benzoate treatments. © 2013 Blackwell Publishing Ltd.

Value-added Data Services at the Goddard Earth Sciences Data and Information Services Center

NASA Technical Reports Server (NTRS)

Leptoukh, Gregory G.; Alcott, Gary T.; Kempler, Steven J.; Lynnes, Christopher S.; Vollmer, Bruce E.

2004-01-01

The NASA Goddard Earth Sciences Data and Information Services Center (GES DISC), in addition to serving the Earth Science community as one of the major Distributed Active Archives Centers (DAACs), provides much more than just data. Among the value-added services available to general users are subsetting data spatially and/or by parameter, online analysis (to avoid downloading unnecessarily all the data), and assistance in obtaining data from other centers. Services available to data producers and high-volume users include consulting on building new products with standard formats and metadata and construction of data management systems. A particularly useful service is data processing at the DISC (i.e., close to the input data) with the users algorithm. This can take a number of different forms: as a configuration-managed algorithm within the main processing stream; as a stand-alone program next to the on-line data storage; as build-it-yourself code within the Near-Archive Data Mining (NADM) system; or as an on-the-fly analysis with simple algorithms embedded into the web-based tools. Partnerships between the GES DISC and scientists, both producers and users, allow the scientists to concentrate on science, while the GES DISC handles the data management, e.g., formats, integration, and data processing. The existing data management infrastructure at the GES DISC supports a wide spectrum of options: from simple data support to sophisticated on-line analysis tools, producing economies of scale and rapid time-to-deploy. At the same time, such partnerships allow the GES DISC to serve the user community more efficiently and to better prioritize on-line holdings. Several examples of successful partnerships are described in the presentation.

Place of laparoscopy in pelvic inflammatory disease.

PubMed

Krishna, U R; Sheth, S S; Motashaw, N D

1979-06-01

577 laparoscopic examinations were performed in women presenting with sterility, chronic abdominal pain, primary or secondary amenorrhea, and irregular menstrual periods. 125 cases of chronic pelvic inflammatory disease (PID) of both the tuberculous and nonspecific varieties were detected through this procedure. 59 of the 125 cases were diagnosed as tuberculous. Investigations prior to laparoscopy had yielded significant results in only 12 cases. 87 of the 125 cases had no abnormal clinical findings, and only 18 of the 37 tubo-ovarian masses were diagnosed by bimanual examination. These results indicate that laparoscopy is an invaluable tool for the diagnosis of PID. It can reveal peritubal adhesions, tubercles on the tubes, small tubo-ovarian masses, and hydrosalpinx cases that cannot be detected clinically. It is considered a more suitable tool than culdoscopy, which less frequently notes adhesions to the fallopian tubes and pathological conditions in the upper pelvis. Laparoscopy can play an especially valuable role in India as a prelude to tuboplasty, given the high incidence of pelvic tuberculosis. Of the 316 cases of primary sterility examined in this study, 51 had genital tuberculosis and 39 had nonspecific PID. Laparoscopy can also be useful in disproving cases wrongly labelled as chronic pelvic disease. 15 women in this study who reported chronic lower abdominal pain had normal findings, and only 13 cases of PID were confirmed among the 33 cases preoperatively diagnosed as PID. A significant number of PID cases are attributed to operative procedures such as hysterosalpingography and ventrisuspension that are repeated unnecessarily and without proper sepsis. Thus, the possibility of a flare-up of infection during laparoscopy, especially due to hydroperturbation, should be considered. Women in this study who were found to have PID were given postoperative antibiotics. No significant postoperative complications were observed.

A 1,000 GtC Coal Question for Future Energy Scenarios: How Much Coal Will Renewables Need to Displace?

NASA Astrophysics Data System (ADS)

Ritchie, W. J.; Dowlatabadi, H.

2016-12-01

Twenty years ago, global coal assessments indicated reserve-to-production (R-P) ratios of more than 300 years. Consequently, most studies of energy futures established coal as a virtually unlimited backstop to meet the world's projected energy needs. Coal was modeled to offset oil and gas production declines and provide a source of energy which renewables and lower carbon supply strategies needed to outcompete. Over the past two decades, increasingly consistent methodologies have been applied globally to assess recoverable coal. Coal production has also witnessed significant mechanization to meet higher demand. Each of these has led to a significant reduction in estimates of economically recoverable coal reserves despite a doubling of market prices over this period. The current reserve to production ratio for coal is now around 100 years. It is time to reconsider coal as the inexhaustible energy backstop The energy models which develop long-term estimates of renewable energy needs and projections of greenhouse gas (GHG) emissions still adopt the characteristics of vintage coal assessments. By convention, baseline GHG emissions used by the IPCC and others, project combustion of most known coal reserves before the year 2100. When vintage assessments are used, this involves extraction of all currently known coal reserves plus twice again from resources invalidated as recoverable for geologic, environmental, social, legal, technical or economic reasons. We provide evidence for rejecting these projections of unbounded growth in coal consumption. Legacy pathways of implausibly high coal use upwardly bias long-term scenarios for total cumulative GHG emissions and subsequent research on climate change. This bias has precluded consideration of much more ambitious climate mitigation targets without significant socio-economic dislocation and unnecessarily diminishes possible future contributions from renewables.

A plea for rational mitigation of poor outcomes in the 'off-label use' of medications for the management of pain.

PubMed

Khursheed, Faraz; Ioffe, Julia; Gould, Harry J

2015-02-15

Neuropathic pain is a common and difficult to manage public health problem characterized by frequent treatment failure and high management costs. The variable presentation and response to treatment among patients make it difficult for physicians to apply a single, standardized approach for management. The physician's role in treating neuropathic pain is complex. Clinical decisions must be drawn from personal and shared experience, case reports, and evidence-based, controlled trials performed on selected populations of patients with common, narrowly-defined conditions. Recent advances in our understanding of the mechanisms that underlie the processing of nociceptive stimuli and the perception of pain have led to the increased 'off-label use' of adjuvant medications in an attempt to provide relief for many patients who heretofore have suffered unnecessarily with intractable neuropathic pain. Unfortunately, as with any treatment, sound clinical decisions can occasionally result in an untoward adverse response. It is therefore imperative that potential adverse effects inherent to all medications be considered and weighed against the untoward consequences of withholding treatment prior to incorporating their use in any course of management. This commentary presents a case report that illustrates a particularly devastating consequence that was encountered when a medication was selected for 'off-label use' in the treatment of intractable pain and presents an opinion for consideration in developing guidelines for determining acceptable risk and standard of care based upon rational adherence or deviation from the approved indications offered for the use of a medication at the time of its introduction into practice is granted. Copyright © 2014 Elsevier B.V. All rights reserved.

How "accountable" are accountable care organizations?

PubMed

Addicott, Rachael; Shortell, Stephen M

2014-01-01

The establishment of accountable care organizations (ACOs) in the Affordable Care Act (ACA) was intended to support both cost savings and high-quality care. However, a key challenge will be to ensure that governance and accountability mechanisms are sufficient to support those twin ambitions. This exploratory study considers how recently developed ACOs have established governance structures and accountability mechanisms, particularly focusing on attempts at collaborative accountability and shared governance arrangements. Four case studies of ACOs across the United States were undertaken, with data collected throughout 2012. These involved 34 semistructured interviews with ACO administrative and clinical leaders, observation of nine meetings, and a review of documentary materials from each ACO. We identified very few examples of physicians being held to account as a collective and therefore only limited evidence of collaborative accountability impacting on behavior change. However, ACO leaders do have many mechanisms available to stimulate change across physicians. The challenge is to determine governance structure(s) and accountability mechanisms that facilitate the most effective combination of approaches, measures, incentives, and sanctions to achieve the goals of more accountable care. Accountability structures and processes will need to be tailored to local membership composition, historical evolution, and current stage of development. There are also some common lessons to be drawn. Shared goals and incentives should be reflected through performance criteria. It is important to align measures and thresholds across payers to ensure ACOs are not unnecessarily burdened or compromised by reporting on different and potentially disjointed measures. Finally, emphasis needs to be placed on the importance of credible, transparent data. This exploratory study provides early evidence regarding how ACOs are establishing their governance and accountability arrangements and provides a foundation for future research and theory-building in this area.

Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

PubMed

Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

2017-01-01

Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

A dirty little secret: stigma, shame and hepatitis C in the health setting.

PubMed

Northrop, Jane Megan

2017-12-01

While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman's model of actual and virtual social identities, along with Douglas' notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV. 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/.

Summoning compassion to address the challenges of conservation.

PubMed

Wallach, Arian D; Bekoff, Marc; Batavia, Chelsea; Nelson, Michael P; Ramp, Daniel

2018-04-27

Conservation practice is informed by science, but also reflects ethical beliefs about how we ought to value and interact with the Earth's biota. As human activities continue to drive extinctions and diminish critical life-sustaining ecosystem processes, achieving conservation goals becomes increasingly urgent. In our determination to react decisively, conservation challenges can be handled without due deliberation, particularly when wildlife individuals are sacrificed "for the greater good" of wildlife collectives (populations, species, ecosystems). With growing recognition of the widespread sentience and sapience of many nonhuman animals, standard conservation practices that categorically prioritize collectives without due consideration for the wellbeing of individuals are ethically untenable. Here we highlight three overarching ethical orientations characterizing current and historical practices in conservation that suppress compassion: instrumentalism, collectivism, and nativism. We illustrate how establishing a commitment to compassion could re-orient conservation in more ethically expansive directions, which incorporate recognition of the intrinsic value of wildlife, the sentience of nonhuman animals, and the values of novel ecosystems, introduced species and their members. A compassionate conservation approach allays practices that intentionally and unnecessarily harm wildlife individuals, while aligning with critical conservation goals. Although the urgency of achieving effective outcomes for solving major conservation problems may enhance the appeal of quick and harsh measures, the costs are too high. Continuing to justify moral indifference when causing the suffering of wildlife individuals, particularly those who possess sophisticated capacities for emotion, consciousness, and sociality, risks estranging conservation practice from prevailing, and appropriate, social values. As conservationists and compassionate beings, we must demonstrate concern for both the long-term persistence of collectives and the wellbeing of individuals, prioritizing strategies that do both. This article is protected by copyright. All rights reserved.

Numerical Estimation of the Spent Fuel Ratio

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

Lindgren, Eric R.; Durbin, Samuel; Wilke, Jason

Sabotage of spent nuclear fuel casks remains a concern nearly forty years after attacks against shipment casks were first analyzed and has a renewed relevance in the post-9/11 environment. A limited number of full-scale tests and supporting efforts using surrogate materials, typically depleted uranium dioxide (DUO 2 ), have been conducted in the interim to more definitively determine the source term from these postulated events. However, the validity of these large- scale results remain in question due to the lack of a defensible spent fuel ratio (SFR), defined as the amount of respirable aerosol generated by an attack on amore » mass of spent fuel compared to that of an otherwise identical surrogate. Previous attempts to define the SFR in the 1980's have resulted in estimates ranging from 0.42 to 12 and include suboptimal experimental techniques and data comparisons. Because of the large uncertainty surrounding the SFR, estimates of releases from security-related events may be unnecessarily conservative. Credible arguments exist that the SFR does not exceed a value of unity. A defensible determination of the SFR in this lower range would greatly reduce the calculated risk associated with the transport and storage of spent nuclear fuel in dry cask systems. In the present work, the shock physics codes CTH and ALE3D were used to simulate spent nuclear fuel (SNF) and DUO 2 targets impacted by a high-velocity jet at an ambient temperature condition. These preliminary results are used to illustrate an approach to estimate the respirable release fraction for each type of material and ultimately, an estimate of the SFR. This page intentionally blank« less

Evaluation of methods for characterizing the melting curves of a high temperature cobalt-carbon fixed point to define and determine its melting temperature

NASA Astrophysics Data System (ADS)

Lowe, David; Machin, Graham

2012-06-01

The future mise en pratique for the realization of the kelvin will be founded on the melting temperatures of particular metal-carbon eutectic alloys as thermodynamic temperature references. However, at the moment there is no consensus on what should be taken as the melting temperature. An ideal melting or freezing curve should be a completely flat plateau at a specific temperature. Any departure from the ideal is due to shortcomings in the realization and should be accommodated within the uncertainty budget. However, for the proposed alloy-based fixed points, melting takes place over typically some hundreds of millikelvins. Including the entire melting range within the uncertainties would lead to an unnecessarily pessimistic view of the utility of these as reference standards. Therefore, detailed analysis of the shape of the melting curve is needed to give a value associated with some identifiable aspect of the phase transition. A range of approaches are or could be used; some purely practical, determining the point of inflection (POI) of the melting curve, some attempting to extrapolate to the liquidus temperature just at the end of melting, and a method that claims to give the liquidus temperature and an impurity correction based on the analytical Scheil model of solidification that has not previously been applied to eutectic melting. The different methods have been applied to cobalt-carbon melting curves that were obtained under conditions for which the Scheil model might be valid. In the light of the findings of this study it is recommended that the POI continue to be used as a pragmatic measure of temperature but where required a specified limits approach should be used to define and determine the melting temperature.

Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list.

PubMed

Pohl-Dernick, Katharina; Meier, Florian; Maas, Renke; Schöffski, Oliver; Emmert, Martin

2016-04-01

Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.

Examining the effect of publishing of bill sizes to reduce information asymmetry on healthcare costs.

PubMed

Wong, C Y; Wu, E; Wong, T Y

2007-01-01

Information asymmetry has been offered as a reason for unnecessarily high costs in certain industries where significant information asymmetry traditionally exists between providers and consumers, such as healthcare. The purpose of this paper is to examine the impact of the introduction of publishing of bill size as a means to reduce healthcare costs. Specifically, we aim to examine if this initiative to decrease information asymmetry on healthcare prices between healthcare providers and patients, and between healthcare providers themselves, will lead to lower prices for patients. Bill size data of 29 commonly occurring diagnosis-related groups (DRGs) for two ward classes (B2 and C) over a 16- month period were studied. Each ward class was studied separately, i.e. involving 58 DRG data sets. The mean bill size data as well as that of 50th and 90th percentile bill sizes were examined. The study involved some 46,000 inpatient episodes which occurred in the five public sector acute general hospitals of Singapore. Mean prices dropped by 4.14 percent and 9.64 percent for B2 and C classes, respectively. 50 out of 58 DRG data sets showed a drop in prices. Bill sizes at the 50th percentile dropped by 7.95 percent and 10.12 percent for B2 and C classes, respectively; while at the 90th percentile, the corresponding figures were decreases of 8.01 percent and 11.4 percent for the two ward classes. The act of publishing bill sizes has led to less information asymmetry among providers, thereby facilitating more competitive behaviour among hospitals and lower bill sizes.

Effects of expiring reimbursability of pentaerythrityl tetranitrate (PETN, pentalong®) on anti-anginal therapy: an observational study.

PubMed

Grimmsmann, Thomas; Chenot, Jean-François; Angelow, Aniela

2015-08-01

Pentaerythrityl tetranitrate (PETN) was the most commonly prescribed long-acting nitrate in Germany. We aimed to assess whether the discontinuation of PETN reimbursability in 2011 resulted in alternative prescriptions of anti-anginal medications or in a discontinuation of anti-anginal therapy. This is an observational study using health claims data from one German federal state analysing all patients discontinuing a PETN treatment. Patients starting a new alternative anti-anginal treatment (long-acting nitrates, molsidome, ivabradine and ranolazine) were compared with patients without a new anti-anginal treatment with respect to use of short-acting nitrates, beta blockers (BBs) and calcium channel blockers (CCBs). Out of 12,909 patients, 12,763 (99%) discontinued PETN until 12/2012. Of these, 52% started an alternative anti-anginal treatment, 43% did not receive any alternative treatment and 5% were excluded from analysis. Before termination of PETN reimbursability, 65% of patients received BBs, 29% CCBs and 10% short-acting nitrates. In patients started on alternative anti-anginal treatment, prescription rates for short-acting nitrates, BBs and CCBs remained constant after discontinuing PETN. In patients without any alternative anti-anginal treatment, prescription rates for BBs and CCBs did not change meaningfully (<3%), and prescription rates for short-acting nitrates decreased from 9% to 6%. Half of the patients discontinued PETN without alternative. This did not lead to increased prescription rates of standard IHD medications or total medication number indicating that there might still be a high percentage of ischaemic heart disease patients treated unnecessarily with long-acting nitrates. The undertreatment with prognostically relevant first-line medications indicates a need for better guideline implementation activities. Copyright © 2015 John Wiley & Sons, Ltd.

Updating the debate on model complexity

USGS Publications Warehouse

Simmons, Craig T.; Hunt, Randall J.

2012-01-01

As scientists who are trying to understand a complex natural world that cannot be fully characterized in the field, how can we best inform the society in which we live? This founding context was addressed in a special session, “Complexity in Modeling: How Much is Too Much?” convened at the 2011 Geological Society of America Annual Meeting. The session had a variety of thought-provoking presentations—ranging from philosophy to cost-benefit analyses—and provided some areas of broad agreement that were not evident in discussions of the topic in 1998 (Hunt and Zheng, 1999). The session began with a short introduction during which model complexity was framed borrowing from an economic concept, the Law of Diminishing Returns, and an example of enjoyment derived by eating ice cream. Initially, there is increasing satisfaction gained from eating more ice cream, to a point where the gain in satisfaction starts to decrease, ending at a point when the eater sees no value in eating more ice cream. A traditional view of model complexity is similar—understanding gained from modeling can actually decrease if models become unnecessarily complex. However, oversimplified models—those that omit important aspects of the problem needed to make a good prediction—can also limit and confound our understanding. Thus, the goal of all modeling is to find the “sweet spot” of model sophistication—regardless of whether complexity was added sequentially to an overly simple model or collapsed from an initial highly parameterized framework that uses mathematics and statistics to attain an optimum (e.g., Hunt et al., 2007). Thus, holistic parsimony is attained, incorporating “as simple as possible,” as well as the equally important corollary “but no simpler.”

Gaps, inexperience, inconsistencies, and overlaps: crisis in the regulation of genetically modified plants and animals.

PubMed

Mandal, Gregory N

2004-04-01

The regulation of genetically modified products pursuant to statutes enacted decades prior to the advent of biotechnology has created a regulatory system that is passive rather than proactive about risks, has difficulty adapting to biotechnology advances, and is highly fractured and inefficient--transgenic plants and animals are governed by at least twelve different statutes and five different agencies or services. The deficiencies resulting from this piecemeal approach to regulation unnecessarily expose society and the environment to adverse risks of biotechnology and introduce numerous inefficiencies into the regulatory system. These risks and inefficiencies include gaps in regulation, duplicative and inconsistent regulation, unnecessary increases in the cost of and delay in the development and commercialization of new biotechnology products. These deficiencies also increase the risk of further unnecessary biotechnology scares, which may cause public overreaction against biotechnology products, preventing the maximization of social welfare. With science and society poised to soar from first-generation biotechnology (focused on crops modified for agricultural benefit), to next-generation developments (including transgenic fish, insects, and livestock, and pharmaceutical-producing and industrial compound-producing plants and animals), it is necessary to establish a comprehensive, efficient, and scientifically rigorous regulatory system. This Article details how to achieve such a result through fixing the deficiencies in, and risks created by, the current regulatory structure. Ignoring many details, the solutions can be summarized in two categories. First, statutory and regulatory gaps that are identified must be closed with new legislation and regulation. Second, regulation of genetically modified products must be shifted from a haphazard model based on statutes not intended to cover biotechnology to a system based upon agency expertise in handling particular types of risks.

Conserving energy: issues, opportunities, prospects

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

Darmstadter, J.

Energy conservation can be approached by a variety of means grouped under those associated with varying reliance on market forces and those with reliance on public interventionist policies. The latter would not be as disruptive of lifestyle, but would impose standards and government policies for efficiency in construction materials, transportation, and other areas--and would emphasize prudent resource management rather than lower prices. Information and demonstration projects can do more to foster public acceptance of conservation than economic pressures of higher taxes and prices. The feasibility of energy savings through reduced growth rates and energy demand needs to be measured andmore » presented to the public in a way that will modify the public values of consumerism nurtured in the past. The public, for example, could decide to spend a larger proportion of income on energy demand and give up some other spending if conservation is presented solely in economic terms. Energy demand can be put in economic terms for environmental damage to air, water, and land, but restraints to override market terms are needed for subjective valuations such as self-indulgence. Energy accounting to emphasize the concept of net energy is helpful, but could lead to an unnecessarily heavy burden of impact statements. (DCK)« less

Ethical approval for research involving geographically dispersed subjects: unsuitability of the UK MREC/LREC system and relevance to uncommon genetic disorders.

PubMed

Lewis, J C; Tomkins, S; Sampson, J R

2001-10-01

To assess the process involved in obtaining ethical approval for a single-centre study involving geographically dispersed subjects with an uncommon genetic disorder. Observational data of the application process to 53 local research ethics committees (LRECs) throughout Wales, England and Scotland. The Multicentre Research Ethics Committee (MREC) for Wales had already granted approval. Application to the 53 LRECs required 24,552 sheets of paper and took two months of the researcher's time. The median time taken for approval was 39 days with only seven (13%) of committees responding within the recommended 21 days. In at least nineteen cases (36%) a subcommittee considered the application. Thirty-three committees (62%) accepted the proposal without amendments but, of the remainder, four (8%) requested changes outside of the remit of LRECs. Difficulties still exist with the system for obtaining ethical approval for studies involving a single centre but with patients at multiple sites, as is often required for genetic observational research. As such studies differ from true multicentre studies, it may be advantageous to develop a separate and specific process of application to ensure that resources are not unnecessarily expended in the quest for ethical approval.

Classification of Depressive Disorders in DSM-V: Proposal for a Two-Dimension System

PubMed Central

Klein, Daniel N.

2011-01-01

The number of categories and specifiers for mood disorders has increased with each successive edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Many of these categories and specifiers can be viewed as an effort to map the various permutations of severity and chronicity that characterize the depressive disorders. However, this has resulted in a system that is unnecessarily complex and unwieldy, and created problems with artificial distinctions between categories and artifactual comorbidity, and at the same time obscures what may be more fundamental distinctions. A potentially useful and more parsimonious approach to capturing much of the heterogeneity of depressive disorders is to classify the depressive disorders along two dimensions, one reflecting severity and the other chronicity. Considerations in the development of these dimensions are discussed, and a set of examples is presented. Although further research and discussion are needed to determine the optimal form of these dimensions, the next edition of the DSM should consider replacing many of the existing categories and specifiers for depressive disorders with the simpler approach of classifying depressive disorders using the two dimensions of severity and chronicity. PMID:18729608

[To kill, let die and euthanasia in the bill of rights of patients and in the Chilean doctrine].

PubMed

Figueroa G, Rodolfo

2011-05-01

The Bill of Rights for Patients provides the patient with autonomy for disposing of his life, enabling him to reject those treatments that unnecessarily prolong his life. However, the bill does not allow an artificial acceleration of death. Therefore, the bill does not permit euthanasia (at least, certain form of it) nor assisted-suicide. However, according to the practice of medicine and also Chilean doctrine, it is permitted to inject morphine to a patient to relieve his pain, even though that could hasten his death. In consequence, it is allowed for the patient to dispose of his life and also to inject in him morphine for pain relief, endangering his life, but neither euthanasia nor assisted-suicide is allowed. Is this coherent? According to Chilean doctrine, it could be coherent under the condition of accepting the distinction between killing and letting die and also the double effect doctrine. The problem is that there is abundant English literature in the realm of moral philosophy to disregard both conditions. Therefore, it is possible to claim that the Bill is not coherent and that the Chilean doctrine is based upon a distinction and a doctrine that are not acceptable.

A proposal for amending administrative law to facilitate adaptive management

NASA Astrophysics Data System (ADS)

Craig, Robin K.; Ruhl, J. B.; Brown, Eleanor D.; Williams, Byron K.

2017-07-01

In this article we examine how federal agencies use adaptive management. In order for federal agencies to implement adaptive management more successfully, administrative law must adapt to adaptive management, and we propose changes in administrative law that will help to steer the current process out of a dead end. Adaptive management is a form of structured decision making that is widely used in natural resources management. It involves specific steps integrated in an iterative process for adjusting management actions as new information becomes available. Theoretical requirements for adaptive management notwithstanding, federal agency decision making is subject to the requirements of the federal Administrative Procedure Act, and state agencies are subject to the states’ parallel statutes. We argue that conventional administrative law has unnecessarily shackled effective use of adaptive management. We show that through a specialized ‘adaptive management track’ of administrative procedures, the core values of administrative law—especially public participation, judicial review, and finality— can be implemented in ways that allow for more effective adaptive management. We present and explain draft model legislation (the Model Adaptive Management Procedure Act) that would create such a track for the specific types of agency decision making that could benefit from adaptive management.

Innate immunity and genetic determinants of urinary tract infection susceptibility

PubMed Central

Godaly, Gabriela; Ambite, Ines; Svanborg, Catharina

2015-01-01

Purpose of review Urinary tract infections (UTIs) are common, dangerous and interesting. Susceptible individuals experience multiple, often clustered episodes, and in a subset of patients, infections progress to acute pyelonephritis (APN), sometimes accompanied by uro-sepsis. Others develop asymptomatic bacteriuria (ABU). Here, we review the molecular basis for these differences, with the intention to distinguish exaggerated host responses that drive disease from attenuated responses that favour protection and to highlight the genetic basis for these extremes, based on knock-out mice and clinical studies. Recent findings The susceptibility to UTI is controlled by specific innate immune signalling and by promoter polymorphisms and transcription factors that modulate the expression of genes controlling these pathways. Gene deletions that disturb innate immune activation either favour asymptomatic bacteriuria or create acute morbidity and disease. Promoter polymorphisms and transcription factor variants affecting those genes are associated with susceptibility in UTI-prone patients. Summary It is time to start using genetics in UTI-prone patients, to improve diagnosis and to assess the risk for chronic sequels such as renal malfunction, hypertension, spontaneous abortions, dialysis and transplantation. Furthermore, the majority of UTI patients do not need follow-up, but for lack of molecular markers, they are unnecessarily investigated. PMID:25539411

A framework for analyzing the cognitive complexity of computer-assisted clinical ordering.

PubMed

Horsky, Jan; Kaufman, David R; Oppenheim, Michael I; Patel, Vimla L

2003-01-01

Computer-assisted provider order entry is a technology that is designed to expedite medical ordering and to reduce the frequency of preventable errors. This paper presents a multifaceted cognitive methodology for the characterization of cognitive demands of a medical information system. Our investigation was informed by the distributed resources (DR) model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This method evaluates the relative distribution of external (system) and internal (user) representations embodied in system interaction. We conducted an expert walkthrough evaluation of a commercial order entry system, followed by a simulated clinical ordering task performed by seven clinicians. The DR model was employed to explain variation in user performance and to characterize the relationship of resource distribution and ordering errors. The analysis revealed that the configuration of resources in this ordering application placed unnecessarily heavy cognitive demands on the user, especially on those who lacked a robust conceptual model of the system. The resources model also provided some insight into clinicians' interactive strategies and patterns of associated errors. Implications for user training and interface design based on the principles of human-computer interaction in the medical domain are discussed.

How 3D immersive visualization is changing medical diagnostics

NASA Astrophysics Data System (ADS)

Koning, Anton H. J.

2011-03-01

Originally the only way to look inside the human body without opening it up was by means of two dimensional (2D) images obtained using X-ray equipment. The fact that human anatomy is inherently three dimensional leads to ambiguities in interpretation and problems of occlusion. Three dimensional (3D) imaging modalities such as CT, MRI and 3D ultrasound remove these drawbacks and are now part of routine medical care. While most hospitals 'have gone digital', meaning that the images are no longer printed on film, they are still being viewed on 2D screens. However, this way valuable depth information is lost, and some interactions become unnecessarily complex or even unfeasible. Using a virtual reality (VR) system to present volumetric data means that depth information is presented to the viewer and 3D interaction is made possible. At the Erasmus MC we have developed V-Scope, an immersive volume visualization system for visualizing a variety of (bio-)medical volumetric datasets, ranging from 3D ultrasound, via CT and MRI, to confocal microscopy, OPT and 3D electron-microscopy data. In this talk we will address the advantages of such a system for both medical diagnostics as well as for (bio)medical research.

Novel approaches are needed to develop tomorrow's antibacterial therapies.

PubMed

Spellberg, Brad; Bartlett, John; Wunderink, Rich; Gilbert, David N

2015-01-15

Society faces a crisis of rising antibiotic resistance even as the pipeline of new antibiotics has been drying up. Antibiotics are a public trust; every individual's use of antibiotics affects their efficacy for everyone else. As such, responses to the antibiotic crisis must take a societal perspective. The market failure of antibiotics is due to a combination of scientific challenges to discovering and developing new antibiotics, unfavorable economics, and a hostile regulatory environment. Scientific solutions include changing the way we screen for new antibiotics. More transformationally, developing new treatments that seek to disarm pathogens without killing them, or that modulate the host inflammatory response to infection, will reduce selective pressure and hence minimize resistance emergence. Economic transformation will require new business models to support antibiotic development. Finally, regulatory reform is needed so that clinical development programs are feasible, rigorous, and clinically relevant. Pulmonary and critical care specialists can have tremendous impact on the continued availability of effective antibiotics. Encouraging use of molecular diagnostic tests to allow pathogen-targeted, narrow-spectrum antibiotic therapy, using short rather than unnecessarily long course therapy, reducing inappropriate antibiotic use for probable viral infections, and reducing infection rates will help preserve the antibiotics we have for future generations.

A proposal for amending administrative law to facilitate adaptive management

USGS Publications Warehouse

Craig, Robin K.; Ruhl, J.B.; Brown, Eleanor D.; Williams, Byron K.

2017-01-01

In this article we examine how federal agencies use adaptive management. In order for federal agencies to implement adaptive management more successfully, administrative law must adapt to adaptive management, and we propose changes in administrative law that will help to steer the current process out of a dead end. Adaptive management is a form of structured decision making that is widely used in natural resources management. It involves specific steps integrated in an iterative process for adjusting management actions as new information becomes available. Theoretical requirements for adaptive management notwithstanding, federal agency decision making is subject to the requirements of the federal Administrative Procedure Act, and state agencies are subject to the states' parallel statutes. We argue that conventional administrative law has unnecessarily shackled effective use of adaptive management. We show that through a specialized 'adaptive management track' of administrative procedures, the core values of administrative law—especially public participation, judicial review, and finality— can be implemented in ways that allow for more effective adaptive management. We present and explain draft model legislation (the Model Adaptive Management Procedure Act) that would create such a track for the specific types of agency decision making that could benefit from adaptive management.

The search for mechanisms of change in behavioral treatments for alcohol use disorders: a commentary.

PubMed

Longabaugh, Richard

2007-10-01

Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple. This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested. It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders. Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.

Avoiding legal pitfalls in surrogacy arrangements.

PubMed

James, Summer; Chilvers, Rebecca; Havemann, Dara; Phelps, John Y

2010-12-01

The goal of this article is to discuss the legal pitfalls that reproductive endocrinologists face when participating in gestational surrogacy contracts. This paper was composed using Westlaw and LexisNexis commercial legal search engines to perform a review of statutes and cases pertaining to gestational surrogacy. The search results demonstrated that in the absence of suitable preparation, there is significant potential for litigation while participating in gestational agreements. Providers caring for gestational carriers have been named as parties in lawsuits for failure to provide psychological screening, failure to screen for infectious disease and participation in gestational contracts that are not compliant with state law. There is great disparity in state laws and court rulings pertaining to gestational agreements. When legal disputes arise, individual state laws and court rulings are controlling over the Uniform Parentage Act. Likewise, recommendations by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine do not supersede state laws. The failure to abide by individual state laws unnecessarily exposes reproductive endocrinologists and their IVF facilities to potential litigation. In order to lessen exposure to litigation, an understanding of individual state legislation or historical court rulings is advised. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Pneumonic tularaemia: experience of 58 cases from 2000 to 2012 in Northern Finland.

PubMed

Väyrynen, Sara A; Saarela, Elina; Henry, Janne; Lahti, Sini; Harju, Terttu; Kauma, Heikki

2017-10-01

Pneumonic tularaemia is less common clinical form of tularaemia compared with the ulceroglandular form, with only a limited number of case reports and case series in Europe. In Finland, Northern Ostrobothnia is an endemic area of tularaemia with occasional seasonal outbreaks. In our study, a consecutive series of 58 pneumonic tularaemia cases diagnosed and treated in Oulu University Hospital in 2000-2012 were retrospectively analysed in terms of epidemiology, clinical course, and prognosis. The incidence of pneumonic tularaemia showed peaks in cycles of a few years and most cases were diagnosed in late summer or early autumn. Respiratory symptoms were absent in 47% of patients, and 7% had normal chest X-ray. The chest computed tomography (CT) was performed in 81% of patients, demonstrating variable findings associated with pneumonic tularaemia. Bronchoscopy was performed for 22 (38%) patients and four (18%) of these also proceeded into mediastinoscopy. Moreover, thoracoscopy was performed for one (2%) patient. Two (3%) patients were treated shortly in the intensive care unit (ICU) during their stay in hospital. No mortality was observed. Most cases of pneumonic tularaemia are diagnosed during the seasonal outbreaks. The lack of specific symptoms often complicates the diagnosis and leads to unnecessarily invasive examinations.

A Reconciliation for the Future of Psychiatry: Both Folk Psychology and Cognitive Science.

PubMed

Hutto, Daniel D

2016-01-01

Philosophy of psychiatry faces a tough choice between two competing ways of understanding mental disorders. The folk psychology (FP) view puts our everyday normative conceptual scheme in the driver's seat - on the assumption that it, and it only, tells us what mental disorders are (1). Opposing this, the scientific image (SI) view (2, 3) holds that our understanding of mental disorders must come, wholly and solely, from the sciences of the mind, unfettered by FP. This paper argues that the FP view is problematic because it is too limited: there is more to the mind than FP allows; hence, we must look beyond FP for properly deep and illuminating explanations of mental disorders. SI promises just this. But when cast in its standard cognitivist formulations, SI is unnecessarily and unjustifiably neurocentric. After rejecting both the FP view, in its pure form, and SI view, in its popular cognitivist renderings, this paper concludes that a more liberal version of SI can accommodate what is best in both views - once SI is so formulated and the FP view properly edited and significantly revised, the two views can be reconciled and combined to provide a sound philosophical basis for a future psychiatry.

Data identification for improving gene network inference using computational algebra.

PubMed

Dimitrova, Elena; Stigler, Brandilyn

2014-11-01

Identification of models of gene regulatory networks is sensitive to the amount of data used as input. Considering the substantial costs in conducting experiments, it is of value to have an estimate of the amount of data required to infer the network structure. To minimize wasted resources, it is also beneficial to know which data are necessary to identify the network. Knowledge of the data and knowledge of the terms in polynomial models are often required a priori in model identification. In applications, it is unlikely that the structure of a polynomial model will be known, which may force data sets to be unnecessarily large in order to identify a model. Furthermore, none of the known results provides any strategy for constructing data sets to uniquely identify a model. We provide a specialization of an existing criterion for deciding when a set of data points identifies a minimal polynomial model when its monomial terms have been specified. Then, we relax the requirement of the knowledge of the monomials and present results for model identification given only the data. Finally, we present a method for constructing data sets that identify minimal polynomial models.

Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened?

PubMed

Kaspar, T; Schweiger, A; Droz, S; Marschall, J

2015-01-01

While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk. This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA). A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p < 0.001), surgical procedure in a hospital abroad (p = 0.007), and - on admission to our hospital - active infection (p = 0.002), antibiotic treatment (p = 0.014) and presence of skin lesions (p = 0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization. Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.

Impact of diastolic and systolic blood pressure on mortality: implications for the definition of "normal".

PubMed

Taylor, Brent C; Wilt, Timothy J; Welch, H Gilbert

2011-07-01

The National Heart, Lung and Blood Institute currently defines a blood pressure under 120/80 as "normal." To examine the independent effects of diastolic (DBP) and systolic blood pressure (SBP) on mortality and to estimate the number of Americans affected by accounting for these effects in the definition of "normal." DESIGN, PARTICIPANTS AND MEASURES: Data on adults (age 25-75) collected in the early 1970s in the first National Health and Nutrition Examination Survey were linked to vital status data through 1992 (N = 13,792) to model the relationship between blood pressure and mortality rate adjusting for age, sex, race, smoking status, BMI, cholesterol, education and income. To estimate the number of Americans in each blood pressure category, nationally representative data collected in the early 1960s (as a proxy for the underlying distribution of untreated blood pressure) were combined with 2008 population estimates from the US Census. The mortality rate for individuals over age 50 began to increase in a stepwise fashion with increasing DBP levels of over 90. However, adjusting for SBP made the relationship disappear. For individuals over 50, the mortality rate began to significantly increase at a SBP ≥ 140 independent of DBP. In individuals ≤ 50 years of age, the situation was reversed; DBP was the more important predictor of mortality. Using these data to redefine a normal blood pressure as one that does not confer an increased mortality risk would reduce the number of American adults currently labeled as abnormal by about 100 million. DBP provides relatively little independent mortality risk information in adults over 50, but is an important predictor of mortality in younger adults. Conversely, SBP is more important in older adults than in younger adults. Accounting for these relationships in the definition of normal would avoid unnecessarily labeling millions of Americans as abnormal.

Mountain biking injuries in children and adolescents.

PubMed

Aleman, Kylee B; Meyers, Michael C

2010-01-01

Over the last decade, the sport of mountain biking has experienced extensive growth in youth participation. Due to the unpredictable nature of outdoor sport, a lack of rider awareness and increased participation, the number of injuries has unnecessarily increased. Many believe that the actual incidence of trauma in this sport is underestimated and is just the 'tip of the iceberg'. The most common mechanism of injury is usually attributed to downhill riding and forward falling. Although rare, this type of fall can result in serious cranial and thoraco-abdominal trauma. Head and neck trauma continue to be documented, often resulting in concussions and the possibility of permanent neurological sequelae. Upper limb injuries range from minor dermal abrasions, contusions and muscular strains to complex particular fracture dislocations. These are caused by attempting to arrest the face with an outstretched hand, leading to additional direct injury. Common overuse injuries include repeated compression from the handlebars and vibration leading to neurovascular complications in the hands. Along with reports of blunt abdominal trauma and lumbar muscle strains, lower extremity injuries may include various hip/pelvic/groin contusions, patellofemoral inflammation, and various muscle strains. The primary causes of mountain biking injuries in children and adolescents include overuse, excessive fatigue, age, level of experience, and inappropriate or improperly adjusted equipment. Additional factors contributing to trauma among this age group involve musculoskeletal immaturity, collisions and falls, excessive speed, environmental conditions, conditioning and fitness status of the rider, nonconservative behavioural patterns, and inadequate medical care. The limited available data restrict the identification and understanding of specific paediatric mountain biking injuries and injury mechanisms. Education about unnecessary risk of injury, use of protective equipment, suitable bikes and proper riding technique, coupled with attentive and proper behaviour, are encouraged to reduce unnecessary injury. This article provides information on the causation and risk factors associated with injury among young mountain bikers, and recommendations to minimize trauma and enhance optimal performance and long-term enjoyment in this outdoor sport.

The role of digital data entry in participatory environmental monitoring.

PubMed

Brammer, Jeremy R; Brunet, Nicolas D; Burton, A Cole; Cuerrier, Alain; Danielsen, Finn; Dewan, Kanwaljeet; Herrmann, Thora Martina; Jackson, Micha V; Kennett, Rod; Larocque, Guillaume; Mulrennan, Monica; Pratihast, Arun Kumar; Saint-Arnaud, Marie; Scott, Colin; Humphries, Murray M

2016-12-01

Many argue that monitoring conducted exclusively by scientists is insufficient to address ongoing environmental challenges. One solution entails the use of mobile digital devices in participatory monitoring (PM) programs. But how digital data entry affects programs with varying levels of stakeholder participation, from nonscientists collecting field data to nonscientists administering every step of a monitoring program, remains unclear. We reviewed the successes, in terms of management interventions and sustainability, of 107 monitoring programs described in the literature (hereafter programs) and compared these with case studies from our PM experiences in Australia, Canada, Ethiopia, Ghana, Greenland, and Vietnam (hereafter cases). Our literature review showed that participatory programs were less likely to use digital devices, and 2 of our 3 more participatory cases were also slow to adopt digital data entry. Programs that were participatory and used digital devices were more likely to report management actions, which was consistent with cases in Ethiopia, Greenland, and Australia. Programs engaging volunteers were more frequently reported as ongoing, but those involving digital data entry were less often sustained when data collectors were volunteers. For the Vietnamese and Canadian cases, sustainability was undermined by a mismatch in stakeholder objectives. In the Ghanaian case, complex field protocols diminished monitoring sustainability. Innovative technologies attract interest, but the foundation of effective participatory adaptive monitoring depends more on collaboratively defined questions, objectives, conceptual models, and monitoring approaches. When this foundation is built through effective partnerships, digital data entry can enable the collection of more data of higher quality. Without this foundation, or when implemented ineffectively or unnecessarily, digital data entry can be an additional expense that distracts from core monitoring objectives and undermines project sustainability. The appropriate role of digital data entry in PM likely depends more on the context in which it is used and less on the technology itself. © 2016 Society for Conservation Biology.

Cancer registration, public health and the reform of the European data protection framework: Abandoning or improving European public health research?

PubMed

Andersen, Mette Rye; Storm, Hans H

2015-06-01

The importance of cancer- and other disease registries for planning, management and evaluation of healthcare systems has been shown repeatedly during the last 50 years. Complete and unbiased population-level analyses on routinely collected, individual data concerning health and personal characteristics can address significant concerns about risk factors for cancer and provide sound evidence about public health and the effectiveness of healthcare systems. The existence of quality controlled and comprehensive data in registries, allowed to be used for quality control, research and public health purposes are taken as granted by most health professionals and researchers. However, the current revision of the European Union (EU) data protection framework suggests a harmonisation of requirements for confidentiality and individual consent to data processing, likely at the expense of proper use of registry data in the health sector. Consequences of excessive confidentiality rules that may lead to missed data linkages have been simulated. The simulations provide one possible explanation for observed heterogeneity among some cancer incidence data. Further, public health, quality control and epidemiological research on large populations can no longer provide evidence for health interventions, if requirements for consent renders research impossible or where attempts to obtain consent from each data subject generates biased results. Health professionals should engage in the on-going debate on the Commission's proposal for a General Data Protection Regulation. The nature and use of registry data in public health research must be explained and known to policy-makers and the public. Use of cancer registry data and other epidemiological activity will terminate abruptly if an unnecessarily strict EU data protection regulation is adopted. Research based interventions, as well as the international recognised standing of cancer registries and register-based research institutions in Europe are at stake. Copyright © 2013 Elsevier Ltd. All rights reserved.

Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: a review of the National Cancer Database.

PubMed

Vlacich, Gregory; Samson, Pamela P; Perkins, Stephanie M; Roach, Michael C; Parikh, Parag J; Bradley, Jeffrey D; Lockhart, A Craig; Puri, Varun; Meyers, Bryan F; Kozower, Benjamin; Robinson, Cliff G

2017-12-01

For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson-Deyo comorbidity score ≥2 (OR 0.82), and high-volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non-Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high-volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

A case of low success of blind vaccination campaigns against myxomatosis and rabbit haemorrhagic disease on survival of adult European wild rabbits.

PubMed

Rouco, Carlos; Moreno, Sacramento; Santoro, Simone

2016-10-01

Vaccination campaigns against myxomatosis and rabbit haemorrhagic disease (RHD) are commonly used in translocation programs conducted for the purpose of recovering wild European rabbit populations in Iberian Mediterranean ecosystems. In most cases rabbits are vaccinated 'blind' (i.e. without assessing their prior immunological status) for economic and logistic reasons. However, there is conflicting evidence on the effectiveness of such an approach. We tested whether blind vaccination against myxomatosis and rabbit haemorrhagic disease improved rabbit survival in a rabbit translocation program where wild rabbits were kept in semi-natural conditions in three enclosures. We conducted nine capture sessions over two years (2008-2010) and used the information collected to compare the survival of vaccinated (n=511) versus unvaccinated (n=161) adult wild rabbits using capture-mark-recapture analysis. Average monthly survival was no different for vaccinated versus unvaccinated individuals, both in the period between release and first capture (short-term) and after the first capture onward (long-term). Rabbit survival was lower in the short term than in the long term regardless of whether rabbits were vaccinated or not. Lower survival in the short-term could be due to the stress induced by the translocation process itself (e.g. handling stress). However, we did not find any overall effect of vaccination on survival which could be explained by two non-exclusive reasons. First, interference of the vaccine with the natural antibodies in the donor population. Due to donor populations have high density of rabbits with, likely, high prevalence of antibodies as a result of previous natural exposure to these diseases. Second, the lack of severe outbreaks during the study period. Based on our findings we argue that blind vaccination of adult rabbits in translocation programs may be often mostly ineffective and unnecessarily costly. In particular, since outbreaks are hard to predict and vaccination of rabbits with natural antibodies is ineffective, it is crucial to assess the immunological status of the donor population before translocating adult rabbits. Copyright © 2016 Elsevier B.V. All rights reserved.

German battle casualties: the treatment of functional somatic disorders during World War I.

PubMed

Linden, Stefanie Caroline; Jones, Edgar

2013-10-01

World War I witnessed the admission of large numbers of German soldiers with neurological symptoms for which there was no obvious organic cause. This posed a considerable challenge for the military and medical authorities and resulted in an active discussion on the etiology and treatment of these disorders. Current historiography is reliant on published physician accounts, and this represents the first study of treatment approaches based on original case notes. We analyzed patient records from two leading departments of academic psychiatry in Germany, those at Berlin and Jena, in conjunction with the contemporaneous medical literature. Treatment, which can be broadly classified into reward and punishment, suggestion, affective shock, cognitive learning, and physiological methods, was developed in the context of the emerging fields of animal learning and neurophysiology. A further innovative feature was the use of quantitative methods to assess outcomes. These measures showed good response rates, though most cured patients were not sent back to battle because of their presumed psychopathic constitution. While some treatments appear unnecessarily harsh from today's perspective and were also criticized by leading psychiatrists of the time, the concentration of effort and involvement of so many senior doctors led to the development of psychotherapeutic methods that were to influence the field of psychiatric therapy for decades to come.

Access to pain treatment as a human right.

PubMed

Lohman, Diederik; Schleifer, Rebecca; Amon, Joseph J

2010-01-20

Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment. Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses. According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.

Animal use in pharmacology education and research: The changing scenario

PubMed Central

Badyal, Dinesh K.; Desai, Chetna

2014-01-01

The use of animals in research and education dates back to the period when humans started to look for ways to prevent and cure ailments. Most of present day's drug discoveries were possible because of the use of animals in research. The dilemma to continue animal experiments in education and research continues with varied and confusing guidelines. However, the animal use and their handling vary in each laboratory and educational institution. It has been reported that the animals are being subjected to painful procedures in education and training unnecessarily. The extensive use of animals in toxicity studies and testing dermatological preparations has raised concerns about the ways animals are sacrificed for these “irrelevant experiments”. On the other side of the coin are scientists who advocate the relevant and judicious use of animals in research so that new discoveries can continue. In this review, we discuss the evolution of the use of animals in education and research and how these have been affected in recent times owing to concerns from animal lovers and government regulations. A number of computer simulation and other models have been recommended for use as alternatives to use of animals for pharmacology education. In this review we also discuss some of these alternatives. PMID:24987170

Multilayer article having stabilized zirconia outer layer and chemical barrier layer

NASA Technical Reports Server (NTRS)

Bansal, Narottam P. (Inventor); Lee, Kang N. (Inventor)

2004-01-01

A multilayer article includes a substrate that includes at least one of a ceramic compound and a Si-containing metal alloy. An outer layer includes stabilized zirconia. Intermediate layers are located between the outer layer and the substrate and include a mullite-containing layer and a chemical barrier layer. The mullite-containing layer includes 1) mullite or 2) mullite and an alkaline earth metal aluminosilicate. The chemical barrier layer is located between the mullite-containing layer and the outer layer. The chemical barrier layer includes at least one of mullite, hafnia, hafnium silicate and rare earth silicate (e.g., at least one of RE.sub.2 SiO.sub.5 and RE.sub.2 Si.sub.2 O.sub.7 where RE is Sc or Yb). The multilayer article is characterized by the combination of the chemical barrier layer and by its lack of a layer consisting essentially of barium strontium aluminosilicate between the mullite-containing layer and the chemical barrier layer. Such a barium strontium aluminosilicate layer may undesirably lead to the formation of a low melting glass or unnecessarily increase the layer thickness with concomitant reduced durability of the multilayer article. In particular, the chemical barrier layer may include at least one of hafnia, hafnium silicate and rare earth silicate.

Animal use in pharmacology education and research: the changing scenario.

PubMed

Badyal, Dinesh K; Desai, Chetna

2014-01-01

The use of animals in research and education dates back to the period when humans started to look for ways to prevent and cure ailments. Most of present day's drug discoveries were possible because of the use of animals in research. The dilemma to continue animal experiments in education and research continues with varied and confusing guidelines. However, the animal use and their handling vary in each laboratory and educational institution. It has been reported that the animals are being subjected to painful procedures in education and training unnecessarily. The extensive use of animals in toxicity studies and testing dermatological preparations has raised concerns about the ways animals are sacrificed for these "irrelevant experiments". On the other side of the coin are scientists who advocate the relevant and judicious use of animals in research so that new discoveries can continue. In this review, we discuss the evolution of the use of animals in education and research and how these have been affected in recent times owing to concerns from animal lovers and government regulations. A number of computer simulation and other models have been recommended for use as alternatives to use of animals for pharmacology education. In this review we also discuss some of these alternatives.

Immediate newborn care practices delay thermoregulation and breastfeeding initiation

PubMed Central

Sobel, Howard L; Silvestre, Maria Asuncion A; Mantaring, Jacinto Blas V; Oliveros, Yolanda E; Nyunt-U, Soe

2011-01-01

Aim A deadly nosocomial outbreak in a Philippine hospital drew nationwide attention to neonatal sepsis. Together with specific infection control measures, interventions that protect newborns against infection-related mortality include drying, skin-to-skin contact, delayed cord clamping, breastfeeding initiation and delayed bathing. This evaluation characterized hospital care in the first hours of life with the intent to drive policy change, strategic planning and hospital reform. Methods Trained physicians observed 481 consecutive deliveries in 51 hospitals using a standardized tool to record practices and timing of immediate newborn care procedures. Results Drying, weighing, eye care and vitamin K injections were performed in more than 90% of newborns. Only 9.6% were allowed skin-to-skin contact. Interventions were inappropriately sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%) and early bathing (90.0%). While 68.2% were put to the breast, they were separated two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained in neonatal resuscitation were 2.5 (1.1–5.7) times more likely to unnecessarily suction vigorous newborns. Two per cent died and 5.7% developed sepsis/pneumonia. Conclusions This minute-by-minute observational assessment revealed that performance and timing of immediate newborn care interventions are below WHO standards and deprive newborns of basic protections against infection and death. PMID:21375583

Articulation Management for Intelligent Integration of Information

NASA Technical Reports Server (NTRS)

Maluf, David A.; Tran, Peter B.; Clancy, Daniel (Technical Monitor)

2001-01-01

When combining data from distinct sources, there is a need to share meta-data and other knowledge about various source domains. Due to semantic inconsistencies and heterogeneity of representations, problems arise in combining multiple domains when the domains are merged. The knowledge that is irrelevant to the task of interoperation will be included, making the result unnecessarily complex. This heterogeneity problem can be eliminated by mediating the conflicts and managing the intersections of the domains. For interoperation and intelligent access to heterogeneous information, the focus is on the intersection of the knowledge, since intersection will define the required articulation rules. An algebra over domain has been proposed to use articulation rules to support disciplined manipulation of domain knowledge resources. The objective of a domain algebra is to provide the capability for interrogating many domain knowledge resources, which are largely semantically disjoint. The algebra supports formally the tasks of selecting, combining, extending, specializing, and modifying Components from a diverse set of domains. This paper presents a domain algebra and demonstrates the use of articulation rules to link declarative interfaces for Internet and enterprise applications. In particular, it discusses the articulation implementation as part of a production system capable of operating over the domain described by the IDL (interface description language) of objects registered in multiple CORBA servers.

Tile prediction schemes for wide area motion imagery maps in GIS

NASA Astrophysics Data System (ADS)

Michael, Chris J.; Lin, Bruce Y.

2017-11-01

Wide-area surveillance, traffic monitoring, and emergency management are just several of many applications benefiting from the incorporation of Wide-Area Motion Imagery (WAMI) maps into geographic information systems. Though the use of motion imagery as a GIS base map via the Web Map Service (WMS) standard is not a new concept, effectively streaming imagery is particularly challenging due to its large scale and the multidimensionally interactive nature of clients that use WMS. Ineffective streaming from a server to one or more clients can unnecessarily overwhelm network bandwidth and cause frustratingly large amounts of latency in visualization to the user. Seamlessly streaming WAMI through GIS requires good prediction to accurately guess the tiles of the video that will be traversed in the near future. In this study, we present an experimental framework for such prediction schemes by presenting a stochastic interaction model that represents a human user's interaction with a GIS video map. We then propose several algorithms by which the tiles of the stream may be predicted. Results collected both within the experimental framework and using human analyst trajectories show that, though each algorithm thrives under certain constraints, the novel Markovian algorithm yields the best results overall. Furthermore, we make the argument that the proposed experimental framework is sufficient for the study of these prediction schemes.

Lupin sensitization and clinical allergy in food allergic children in Norway.

PubMed

Lindvik, Helene; Holden, Lise; Løvik, Martinus; Cvancarova, Milada; Halvorsen, Ragnhild

2008-01-01

The aim of the present pilot study was to investigate to what extent children in Norway sensitized to lupin had clinical lupin allergy, and to compare sensitization to lupin with sensitization to other legumes. Thirty-five children with food allergy referred to a national referral hospital were evaluated with skin prick test (SPT) and analysis of serum-specific IgE to lupin, peanut, pea and soy. The children with positive SPTs to lupin were offered oral food challenges with lupin flour. Fifteen children (43%) had positive SPT and 17 children (49%) had serum-specific IgE to lupin. Ten SPT-positive children underwent oral food challenges and one experienced an allergic reaction to lupin flour. This child was one of six challenged children with IgE antibodies to peanut >15 kU(A)/L. There was a strong relationship between positive SPT to lupin flour and positive SPT to soy and between positive SPT to lupin and specific IgE to soy, pea and peanut. Children with sensitization to lupin are not likely to have a clinical lupin allergy. Avoidance of lupin on the basis of lupin sensitization or peanut allergy would lead to unnecessarily strict diets. Food challenge is currently necessary to diagnose lupin allergy.

Contribution of case-mix classification to profiling hospital characteristics and productivity.

PubMed

Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Hayashida, Kenshi; Fujimori, Kenji

2011-01-01

Case-mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case-mix groups at 469 hospitals (1,721,274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case-mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency. Copyright © 2010 John Wiley & Sons, Ltd.

Australian Food Safety Policy Changes from a "Command and Control" to an "Outcomes-Based" Approach: Reflection on the Effectiveness of Its Implementation.

PubMed

Smith, James; Ross, Kirstin; Whiley, Harriet

2016-12-08

Foodborne illness is a global public health burden. Over the past decade in Australia, despite advances in microbiological detection and control methods, there has been an increase in the incidence of foodborne illness. Therefore improvements in the regulation and implementation of food safety policy are crucial for protecting public health. In 2000, Australia established a national food safety regulatory system, which included the adoption of a mandatory set of food safety standards. These were in line with international standards and moved away from a "command and control" regulatory approach to an "outcomes-based" approach using risk assessment. The aim was to achieve national consistency and reduce foodborne illness without unnecessarily burdening businesses. Evidence demonstrates that a risk based approach provides better protection for consumers; however, sixteen years after the adoption of the new approach, the rates of food borne illness are still increasing. Currently, food businesses are responsible for producing safe food and regulatory bodies are responsible for ensuring legislative controls are met. Therefore there is co-regulatory responsibility and liability and implementation strategies need to reflect this. This analysis explores the challenges facing food regulation in Australia and explores the rationale and evidence in support of this new regulatory approach.

[How much does the backlog on drug patents cost for health in Brazil?

PubMed

Jannuzzi, Anna Haydée Lanzillotti; Vasconcellos, Alexandre Guimarães

2017-08-21

The backlog in processing patent applications in Brazil has persisted since the enactment of Law 9,279/1996, when the country resumed granting patents on drugs. The agencies responsible for granting such patents, namely the Brazilian National Patent and Trademark Office (INPI) and the Brazilian National Health Surveillance Agency (Anvisa) cite technical and administrative reasons for the backlog. However, little research has focused on the economic impacts for health due to the inefficiency of the Brazilian patent system. The current study thus proposes a methodology to estimate the extent to which government procurement of medicines is burdened by the backlog in drug patent applications. According to the results, a total of more than BRL 14 million (USD 4.5 million) is spent unnecessarily per year by the Federal Government on just one antiretroviral drug due to the extension of the respective patent's life. Measures to resolve this situation are urgently needed in the three branches of government. These include hiring more staff for the INPI, analysis of bills of law under review in the two houses of the Brazilian Congress to amend the Industrial Property Law, and ruling on direct class action claims of unconstitutionality to suppress the legal mechanisms that allow extending the life of patents.

Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny.

PubMed

Morris, Brian J; Hankins, Catherine A; Tobian, Aaron A R; Krieger, John N; Klausner, Jeffrey D

2014-01-01

We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for "sampling bias," (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention.

Gaps, tensions, and conflicts in the FDA approval process: implications for clinical practice.

PubMed

Deyo, Richard A

2004-01-01

Despite many successes, drug approval at the Food and Drug Administration (FDA) is subject to gaps, internal tensions, and conflicts of interest. Recalls of drugs and devices and studies demonstrating advantages of older drugs over newer ones highlight the importance of these limitations. The FDA does not compare competing drugs and rarely requires tests of clinical efficacy for new devices. It does not review advertisements before use, assess cost-effectiveness, or regulate surgery (except for devices). Many believe postmarketing surveillance of drugs and devices is inadequate. A source of tension within the agency is pressure for speedy approvals. This may have resulted in "burn-out" among medical officers and has prompted criticism that safety is ignored. Others argue, however, that the agency is unnecessarily slow and bureaucratic. Recent reports identify conflicts of interest (stock ownership, consulting fees, research grants) among some members of the FDA's advisory committees. FDA review serves a critical function, but physicians should be aware that new drugs may not be as effective as old ones; that new drugs are likely to have undiscovered side effects at the time of marketing; that direct-to-consumer ads are sometimes misleading; that new devices generally have less rigorous evidence of efficacy than new drugs; and that value for money is not considered in approval.

The Search for Hydrologic Signatures: The Effect of Data Transformations on Bayesian Model Calibration

NASA Astrophysics Data System (ADS)

Sadegh, M.; Vrugt, J. A.

2011-12-01

In the past few years, several contributions have begun to appear in the hydrologic literature that introduced and analyzed the benefits of using a signature based approach to watershed analysis. This signature-based approach abandons the standard single criteria model-data fitting paradigm in favor of a diagnostic approach that better extracts the available information from the available data. Despite the prospects of this new viewpoint, rather ad-hoc criteria have hitherto been proposed to improve watershed modeling. Here, we aim to provide a proper mathematical foundation to signature based analysis. We analyze the information content of different data transformation by analyzing their convergence speed with Markov Chain Monte Carlo (MCMC) simulation using the Generalized Likelihood function of Schousp and Vrugt (2010). We compare the information content of the original discharge data against a simple square root and Box-Cox transformation of the streamflow data. We benchmark these results against wavelet and flow duration curve transformations that temporally disaggregate the discharge data. Our results conclusive demonstrate that wavelet transformations and flow duration curves significantly reduce the information content of the streamflow data and consequently unnecessarily increase the uncertainty of the HYMOD model parameters. Hydrologic signatures thus need to be found in the original data, without temporal disaggregation.

Communicating space weather to policymakers and the wider public

NASA Astrophysics Data System (ADS)

Ferreira, Bárbara

2014-05-01

As a natural hazard, space weather has the potential to affect space- and ground-based technological systems and cause harm to human health. As such, it is important to properly communicate this topic to policymakers and the general public alike, informing them (without being unnecessarily alarmist) about the potential impact of space-weather phenomena and how these can be monitored and mitigated. On the other hand, space weather is related to interesting phenomena on the Sun such as coronal-mass ejections, and incorporates one of the most beautiful displays in the Earth and its nearby space environment: aurora. These exciting and fascinating aspects of space weather should be cultivated when communicating this topic to the wider public, particularly to younger audiences. Researchers have a key role to play in communicating space weather to both policymakers and the wider public. Space scientists should have an active role in informing policy decisions on space-weather monitoring and forecasting, for example. And they can exercise their communication skills by talking about space weather to school children and the public in general. This presentation will focus on ways to communicate space weather to wider audiences, particularly policymakers. It will also address the role researchers can play in this activity to help bridge the gap between the space science community and the public.

Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny

PubMed Central

Morris, Brian J.; Hankins, Catherine A.; Tobian, Aaron A. R.; Krieger, John N.; Klausner, Jeffrey D.

2014-01-01

We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for “sampling bias,” (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention. PMID:24944836

Signal treatments to reduce heavy vehicle crash-risk at metropolitan highway intersections.

PubMed

Archer, Jeffery; Young, William

2009-05-01

Heavy vehicle red-light running at intersections is a common safety problem that has severe consequences. This paper investigates alternative signal treatments that address this issue. A micro-simulation analysis approach was adopted as a precursor to a field trial. The simulation model emulated traffic conditions at a known problem intersection and provided a baseline measure to compare the effects of: an extension of amber time; an extension of green for heavy vehicles detected in the dilemma zone at the onset of amber; an extension of the all-red safety-clearance time based on the detection of vehicles considered likely to run the red light at two detector locations during amber; an extension of the all-red safety-clearance time based on the detection of potential red-light runners during amber or red; and a combination of the second and fourth alternatives. Results suggested safety improvements for all treatments. An extension of amber provided the best safety effect but is known to be prone to behavioural adaptation effects and wastes traffic movement time unnecessarily. A green extension for heavy vehicles detected in the dilemma zone and an all-red extension for potential red-light runners were deemed to provide a sustainable safety improvement and operational efficiency.

German Battle Casualties: The Treatment of Functional Somatic Disorders during World War I

PubMed Central

Linden, Stefanie Caroline; Jones, Edgar

2013-01-01

World War I witnessed the admission of large numbers of German soldiers with neurological symptoms for which there was no obvious organic cause. This posed a considerable challenge for the military and medical authorities and resulted in an active discussion on the etiology and treatment of these disorders. Current historiography is reliant on published physician accounts, and this represents the first study of treatment approaches based on original case notes. We analyzed patient records from two leading departments of academic psychiatry in Germany, those at Berlin and Jena, in conjunction with the contemporaneous medical literature. Treatment, which can be broadly classified into reward and punishment, suggestion, affective shock, cognitive learning, and physiological methods, was developed in the context of the emerging fields of animal learning and neurophysiology. A further innovative feature was the use of quantitative methods to assess outcomes. These measures showed good response rates, though most cured patients were not sent back to battle because of their presumed psychopathic constitution. While some treatments appear unnecessarily harsh from today's perspective and were also criticized by leading psychiatrists of the time, the concentration of effort and involvement of so many senior doctors led to the development of psychotherapeutic methods that were to influence the field of psychiatric therapy for decades to come. PMID:22492735

Design Data Collection with Skylab Microwave Radiometer-Scatterometer S-193, Volume 1

NASA Technical Reports Server (NTRS)

Moore, R. K.; Ulaby, F. T. (Principal Investigator)

1975-01-01

The author has identified the following significant results. Observations with S-193 have provided radar design information for systems to be flown on spacecraft, but only at 13.9 GHz and for land areas over the United States and Brazil plus a few other areas of the world for which this kind of analysis was not made. Observations only extended out to about 50 deg angle of incidence. The value of a sensor with such a gross resolution for most overland resource and status monitoring systems seems marginal, with the possible exception of monitoring soil moisture and major vegetation variations. The complementary nature of the scatterometer and radiometer systems was demonstrated by the correlation analysis. Although radiometers must have spatial resolutions dictated by antenna size, radars can use synthetic aperture techniques to achieve much finer resolutions. Multiplicity of modes in the S-193 sensors complicated both the system development and its employment. An attempt was made in the design of the S-193 to arrange optimum integration times for each angle and type of measurement. This unnecessarily complicated the design of the instrument, since the gains in precision achieved in this way were marginal. Either a software-controllable integration time or a set of only two or three integration times would have been better.

Geographically isolated wetlands: Rethinking a misnomer

USGS Publications Warehouse

Mushet, David M.; Calhoun, Aram J.K.; Alexander, Laurie C.; Cohen, Matthew J.; DeKeyser, Edward S.; Fowler, Laurie G.; Lane, Charles R.; Lang, Megan W.; Rains, Mark C.; Walls, Susan

2015-01-01

We explore the category “geographically isolated wetlands” (GIWs; i.e., wetlands completely surrounded by uplands at the local scale) as used in the wetland sciences. As currently used, the GIW category (1) hampers scientific efforts by obscuring important hydrological and ecological differences among multiple wetland functional types, (2) aggregates wetlands in a manner not reflective of regulatory and management information needs, (3) implies wetlands so described are in some way “isolated,” an often incorrect implication, (4) is inconsistent with more broadly used and accepted concepts of “geographic isolation,” and (5) has injected unnecessary confusion into scientific investigations and discussions. Instead, we suggest other wetland classification systems offer more informative alternatives. For example, hydrogeomorphic (HGM) classes based on well-established scientific definitions account for wetland functional diversity thereby facilitating explorations into questions of connectivity without an a priori designation of “isolation.” Additionally, an HGM-type approach could be used in combination with terms reflective of current regulatory or policymaking needs. For those rare cases in which the condition of being surrounded by uplands is the relevant distinguishing characteristic, use of terminology that does not unnecessarily imply isolation (e.g., “upland embedded wetlands”) would help alleviate much confusion caused by the “geographically isolated wetlands” misnomer.

Inhalation Anthrax: Dose Response and Risk Analysis

PubMed Central

Thran, Brandolyn; Morse, Stephen S.; Hugh-Jones, Martin; Massulik, Stacey

2008-01-01

The notion that inhalation of a single Bacillus anthracis spore is fatal has become entrenched nearly to the point of urban legend, in part because of incomplete articulation of the scientific basis for microbial risk assessment, particularly dose-response assessment. Risk analysis (ie, risk assessment, risk communication, risk management) necessitates transparency: distinguishing scientific facts, hypotheses, judgments, biases in interpretations, and potential misinformation. The difficulty in achieving transparency for biothreat risk is magnified by misinformation and poor characterization of both dose-response relationships and the driving mechanisms that cause susceptibility or resistance to disease progression. Regrettably, this entrenchment unnecessarily restricts preparedness planning to a single response scenario: decontaminate until no spores are detectable in air, water, or on surfaces—essentially forcing a zero-tolerance policy inconsistent with the biology of anthrax. We present evidence about inhalation anthrax dose-response relationships, including reports from multiple studies documenting exposures insufficient to cause inhalation anthrax in laboratory animals and humans. The emphasis of the article is clarification about what is known from objective scientific evidence for doses of anthrax spores associated with survival and mortality. From this knowledge base, we discuss the need for future applications of more formal risk analysis processes to guide development of alternative non-zero criteria or standards based on science to inform preparedness planning and other risk management activities. PMID:18582166

Psychosocial aspects of diabetes management: dilemma of diabetes distress

PubMed Central

Tareen, Kinza

2017-01-01

Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well. At times these patients are mislabeled as “difficult patients”. In other cases they are considered to have and unnecessarily treated for psychiatric illness like depression, other mood or anxiety spectrum disorders which they may not need. In recent years clinical researcher are making strides in understanding the emotional distress a DM patient may feel and the factors contributing or perpetuating diabetes distress. This article focuses on understanding the diabetes distress and how it impacts our patients, how to screen, assess, treat and eventually prevent it from happening. The paper also attempt to bring out the major differences between diabetes distress and common psychiatric comorbidities of DM including but not limiting to major depressive disorder and other depression spectrum disorders. PMID:29184819

Australian Food Safety Policy Changes from a “Command and Control” to an “Outcomes-Based” Approach: Reflection on the Effectiveness of Its Implementation

PubMed Central

Smith, James; Ross, Kirstin; Whiley, Harriet

2016-01-01

Foodborne illness is a global public health burden. Over the past decade in Australia, despite advances in microbiological detection and control methods, there has been an increase in the incidence of foodborne illness. Therefore improvements in the regulation and implementation of food safety policy are crucial for protecting public health. In 2000, Australia established a national food safety regulatory system, which included the adoption of a mandatory set of food safety standards. These were in line with international standards and moved away from a “command and control” regulatory approach to an “outcomes-based” approach using risk assessment. The aim was to achieve national consistency and reduce foodborne illness without unnecessarily burdening businesses. Evidence demonstrates that a risk based approach provides better protection for consumers; however, sixteen years after the adoption of the new approach, the rates of food borne illness are still increasing. Currently, food businesses are responsible for producing safe food and regulatory bodies are responsible for ensuring legislative controls are met. Therefore there is co-regulatory responsibility and liability and implementation strategies need to reflect this. This analysis explores the challenges facing food regulation in Australia and explores the rationale and evidence in support of this new regulatory approach. PMID:27941657

Probabilistic pipe fracture evaluations for leak-rate-detection applications

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

Rahman, S.; Ghadiali, N.; Paul, D.

1995-04-01

Regulatory Guide 1.45, {open_quotes}Reactor Coolant Pressure Boundary Leakage Detection Systems,{close_quotes} was published by the U.S. Nuclear Regulatory Commission (NRC) in May 1973, and provides guidance on leak detection methods and system requirements for Light Water Reactors. Additionally, leak detection limits are specified in plant Technical Specifications and are different for Boiling Water Reactors (BWRs) and Pressurized Water Reactors (PWRs). These leak detection limits are also used in leak-before-break evaluations performed in accordance with Draft Standard Review Plan, Section 3.6.3, {open_quotes}Leak Before Break Evaluation Procedures{close_quotes} where a margin of 10 on the leak detection limit is used in determining the crackmore » size considered in subsequent fracture analyses. This study was requested by the NRC to: (1) evaluate the conditional failure probability for BWR and PWR piping for pipes that were leaking at the allowable leak detection limit, and (2) evaluate the margin of 10 to determine if it was unnecessarily large. A probabilistic approach was undertaken to conduct fracture evaluations of circumferentially cracked pipes for leak-rate-detection applications. Sixteen nuclear piping systems in BWR and PWR plants were analyzed to evaluate conditional failure probability and effects of crack-morphology variability on the current margins used in leak rate detection for leak-before-break.« less

Interpreting “statistical hypothesis testing” results in clinical research

PubMed Central

Sarmukaddam, Sanjeev B.

2012-01-01

Difference between “Clinical Significance and Statistical Significance” should be kept in mind while interpreting “statistical hypothesis testing” results in clinical research. This fact is already known to many but again pointed out here as philosophy of “statistical hypothesis testing” is sometimes unnecessarily criticized mainly due to failure in considering such distinction. Randomized controlled trials are also wrongly criticized similarly. Some scientific method may not be applicable in some peculiar/particular situation does not mean that the method is useless. Also remember that “statistical hypothesis testing” is not for decision making and the field of “decision analysis” is very much an integral part of science of statistics. It is not correct to say that “confidence intervals have nothing to do with confidence” unless one understands meaning of the word “confidence” as used in context of confidence interval. Interpretation of the results of every study should always consider all possible alternative explanations like chance, bias, and confounding. Statistical tests in inferential statistics are, in general, designed to answer the question “How likely is the difference found in random sample(s) is due to chance” and therefore limitation of relying only on statistical significance in making clinical decisions should be avoided. PMID:22707861

A Framework for Measuring Low-Value Care.

PubMed

Miller, George; Rhyan, Corwin; Beaudin-Seiler, Beth; Hughes-Cromwick, Paul

2018-04-01

It has been estimated that more than 30% of health care spending in the United States is wasteful, and that low-value care, which drives up costs unnecessarily while increasing patient risk, is a significant component of wasteful spending. To address the need for an ability to measure the magnitude of low-value care nationwide, identify the clinical services that are the greatest contributors to waste, and track progress toward eliminating low-value use of these services. Such an ability could provide valuable input to the efforts of policymakers and health systems to improve efficiency. We reviewed existing methods that could contribute to measuring low-value care and developed an integrated framework that combines multiple methods to comprehensively estimate and track the magnitude and principal sources of clinical waste. We also identified a process and needed research for implementing the framework. A comprehensive methodology for measuring and tracking low-value care in the United States would provide an important contribution toward reducing waste. Implementation of the framework described in this article appears feasible, and the proposed research program will allow moving incrementally toward full implementation while providing a near-term capability for measuring low-value care that can be enhanced over time. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Monte Carlo assessment of the finger shallow dose from direct contact with a microcentrifuge tube containing common biotechnology isotopes in solution.

PubMed

Cutright, Dan; Medich, David; Ring, Joseph

2012-04-01

Eppendorf tubes often are used in biomedical research labs and contain radioactive tracers. Although the associated direct contact finger doses are typically small, it is suggested (and in line with the principle of ALARA) to handle these tubes from the cap of the tube. When containing radioactive material, handling a tube near the bottom conical section would unnecessarily increase the skin dose to the fingers. This investigation modeled a 2.0-mL Eppendorf tube containing various individual beta emitting isotopes commonly used in a biomedical research environment (i.e., (14)C, (3)H, (131)I, (32)P, and (35)S) to determine the skin dose when directly handling the tube at the cap end and when handling it at the bottom conical section. The primary goal of this paper is to assess how significantly this dose is altered by handling geometry. The skin dose to a single finger was calculated with Monte Carlo simulations using MCNP5 and determined at a depth of 0.007 cm(2) in water averaged over 10 cm as described in 10CFR20. Results show that the dose rate may vary by as much as a factor of 700 depending on handling geometry.

Reversion of left ventricular systolic dysfunction and abnormal stress test: by catheter ablation, in a patient with Wolff-Parkinson-White syndrome from Para-Hisian Kent bundle.

PubMed

Tu, Chung-Ming; Chu, Kai-Ming; Cheng, Cheng-Chung; Cheng, Shu-Mung; Lin, Wei-Shiang

2010-01-01

The diagnosis of Wolff-Parkinson-White syndrome is typically reserved for patients who experience ventricular pre-excitation and symptoms that are related to paroxysmal supraventricular tachycardia, such as chest pain, dyspnea, dizziness, palpitations, or syncope. Herein, we report the case of a 38-year-old woman who presented at our outpatient department because of exercise intolerance. Cardiac auscultation revealed a grade 2/6 pansystolic murmur over the left lower sternal border. Twelve-lead electrocardiography showed sinus rhythm at a rate of 76 beats/min, with a significant delta wave. Transthoracic echocardiography revealed abnormal left ventricular systolic function. The results of a thallium stress test were also abnormal. Coronary artery disease was suspected; however, coronary angiography yielded normal results. Electrophysiologic study revealed a para-Hisian Kent bundle and a dual atrioventricular nodal pathway. After radiofrequency catheter ablation was performed, the patient's left ventricular function improved and her symptoms disappeared. In Wolff-Parkinson-White syndrome, left ventricular systolic dyssynchrony can yield abnormal findings on echocardiography and thallium scanning--even in persons who have no cardiovascular risk factors. Physicians who are armed with this knowledge can avoid performing coronary angiography unnecessarily. Catheter ablation can reverse the dyssynchrony of the ventricle and improve the patient's symptoms.

Case study: apparel industry waste management: a focus on recycling in South Africa.

PubMed

Larney, M; van Aardt, A M

2010-01-01

The need for effective apparel waste management is motivated by the increasing cost and decreasing availability of landfill space and the dwindling of natural resources. The aim of this study was to identify the current solid waste disposal and recycling practices of the apparel industry in South Africa and to determine their attitude and willingness towards recycling, their perception of the feasibility thereof, barriers to recycling and marketing strategies that would be appropriate for products made from recycled materials. A structured questionnaire was mailed to apparel manufacturers in South Africa. The results indicated that most apparel manufacturers use landfills to dispose of their waste, while approximately half recycle some of the waste. They are fairly positive towards recycling, with consideration of economical feasibility. Phi-coefficients show no practically significant relationship between company size and the use of recycled materials. The most important barriers to recycling are lack of equipment and technology, lack of material to recycle and lack of consumer awareness. Marketing strategies for recycled products are recommended. It is concluded that consumer awareness and knowledge regarding recycled apparel products should be developed in order to ensure a market and that apparel manufacturers should be encouraged to recycle more extensively, in order to ensure that resources will not be exhausted unnecessarily and the environment will be preserved optimally.

Ethical approval for research involving geographically dispersed subjects: unsuitability of the UK MREC/LREC system and relevance to uncommon genetic disorders

PubMed Central

Lewis, J C; Tomkins, S; Sampson, J R

2001-01-01

Objectives—To assess the process involved in obtaining ethical approval for a single-centre study involving geographically dispersed subjects with an uncommon genetic disorder. Design—Observational data of the application process to 53 local research ethics committees (LRECs) throughout Wales, England and Scotland. The Multicentre Research Ethics Committee (MREC) for Wales had already granted approval. Results—Application to the 53 LRECs required 24,552 sheets of paper and took two months of the researcher's time. The median time taken for approval was 39 days with only seven (13%) of committees responding within the recommended 21 days. In at least nineteen cases (36%) a subcommittee considered the application. Thirty-three committees (62%) accepted the proposal without amendments but, of the remainder, four (8%) requested changes outside of the remit of LRECs. Discussion—Difficulties still exist with the system for obtaining ethical approval for studies involving a single centre but with patients at multiple sites, as is often required for genetic observational research. As such studies differ from true multicentre studies, it may be advantageous to develop a separate and specific process of application to ensure that resources are not unnecessarily expended in the quest for ethical approval. Key Words: Research ethics • MREC • LREC PMID:11579194

Comparing and improving chronic illness primary care in Sweden and the USA.

PubMed

Øvretveit, John; Ramsay, Patricia; Shortell, Stephen M; Brommels, Mats

2016-06-13

Purpose - The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach - A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings - There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden's established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications - There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value - The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.

Fabrication of Fine Electrodes on the Tip of Hypodermic Needle Using Photoresist Spray Coating and Flexible Photomask for Biomedical Applications.

PubMed

Yun, Joho; Kim, Jinhwan; Lee, Jong-Hyun

2017-11-28

We have introduced a fabrication method for electrical impedance spectroscopy (EIS)-on-a-needle (EoN: EIS-on-a-needle) to locate target tissues in the body by measuring and analyzing differences in the electrical impedance between dissimilar biotissues. This paper describes the fabrication method of fine interdigitated electrodes (IDEs) at the tip of a hypodermic needle using a photoresist spray coating and flexible film photomask in the photolithography process. A polyethylene terephthalate (PET) heat shrink tube (HST) with a wall thickness of 25 µm is employed as the insulation and passivation layer. The PET HST shows a higher mechanical durability compared with poly(p-xylylene) polymers, which have been widely used as a dielectric coating material. Furthermore, the HST shows good chemical resistance to most acids and bases, which is advantageous for limiting chemical damage to the EoN. The use of the EoN is especially preferred for the characterization of chemicals/biomaterials or fabrication using acidic/basic chemicals. The fabricated gap and width of the IDEs are as small as 20 µm, and the overall width and length of the IDEs are 400 µm and 860 µm, respectively. The fabrication margin from the tip (distance between the tip of hypodermic needle and starting point of the IDEs) of the hypodermic needle is as small as 680 µm, which indicates that unnecessarily excessive invasion into biotissues can be avoided during the electrical impedance measurement. The EoN has a high potential for clinical use, such as for thyroid biopsies and anesthesia drug delivery in a spinal space. Further, even in surgery that involves the partial resection of tumors, the EoN can be employed to preserve as much normal tissue as possible by detecting the surgical margin (normal tissue that is removed with the surgical excision of a tumor) between the normal and lesion tissues.

Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2-59 months: a multicenter, double-blind, randomized, placebo-controlled trial in pakistan.

PubMed

Hazir, Tabish; Nisar, Yasir Bin; Abbasi, Saleem; Ashraf, Yusra Pervaiz; Khurshid, Joza; Tariq, Perveen; Asghar, Rai; Murtaza, Asifa; Masood, Tahir; Maqbool, Sajid

2011-02-01

world Health Organization (WHO) acute respiratory illness case management guidelines classify children with fast breathing as having pneumonia and recommend treatment with an antibiotic. There is concern that many of these children may not have pneumonia and are receiving antibiotics unnecessarily. This could increase antibiotic resistance in the community. The aim was to compare the clinical outcome at 72 h in children with WHO-defined nonsevere pneumonia when treated with amoxicillin, compared with placebo. we performed a double-blind, randomized, equivalence trial in 4 tertiary hospitals in Pakistan. Nine hundred children aged 2-59 months with WHO defined nonsevere pneumonia were randomized to receive either 3 days of oral amoxicillin (45mg/kg/day) or placebo; 873 children completed the study. All children were followed up on days 3, 5, and 14. The primary outcome was therapy failure defined a priori at 72 h. in per-protocol analysis at day 3, 31 (7.2%) of the 431 children in the amoxicillin arm and 37 (8.3%) of the 442 in placebo group had therapy failure. This difference was not statistically significant (odds ratio [OR], .85; 95%CI, .50-1.43; P = .60). The multivariate analysis identified history of difficult breathing (OR, 2.86; 95% CI, 1.29-7.23; P = .027) and temperature >37.5°C 100°F at presentation (OR, 1.99; 95% CI, 1.37-2.90; P = .0001) as risk factors for treatment failure by day 5. clinical outcome in children aged 2-59 months with WHO-defined nonsevere pneumonia is not different when treated with an antibiotic or placebo. Similar trials are needed in countries with a high burden of pneumonia to rationalize the use of antibiotics in these communities.

Diagnosis of invasive fungal infections using real-time PCR assay in paediatric acute leukaemia induction.

PubMed

Mandhaniya, Sushil; Iqbal, Sobuhi; Sharawat, Surender Kumar; Xess, Immaculata; Bakhshi, Sameer

2012-07-01

Invasive fungal infections (IFI) lead to morbidity and mortality in neutropenic patients and in allogenic stem cell transplantation. Serum-based fungal detection assays have limitation of specificity or sensitivity. Studies on fungal DNA detection using real-time PCR in childhood leukaemia are lacking. The aim of this study was to develop sensitive and specific diagnostic tools for IFI in paediatric acute leukaemia patients using real-time PCR. Of 100 randomised paediatric acute leukaemia patients receiving antifungal prophylaxis with voriconazole/amphotericin B, single peripheral whole blood sample in EDTA was used for Pan-AC real-time PCR assay (detects nine Candida and six Aspergillus species) in patients who failed prophylaxis due to proven, probable, possible or suspected fungal infections. PCR results were retrospectively correlated with clinical profile. Real-time PCR test was positive in 18/29 (62%) patients who failed prophylaxis. The only patient with proven IFI (mucormycosis), real-time PCR assay was negative. Real-time PCR was positive in 2/4 (50%) patients with possible and 16/24 (66.6%) suspected IFI and 5/10 (50%) patients with pneumonia. By applying method A/B, sensitivity and positive predictive value could not be commented due to unproven Aspergillus or Candida infections; specificity and negative predictive values (NPV) were 41% and 100% respectively; by method C (included episodes of possible IFI as true positive), sensitivity, specificity, PPV and NPV were 50%, 36%, 11% and 81% respectively. In those with suspected IFI, 8/24 (33.3%) were PCR negative and unnecessarily received empirical antifungal therapy (EAFT). Real-time PCR is a practical, rapid, non-invasive screening test for excluding IFI in paediatric leukaemia. The high NPV makes real-time PCR a promising tool to use this prior to initiating EAFT in antibiotic-resistant febrile neutropenic patients; this would avoid toxicity, cost and hospitalisation for EAFT (ClinicalTrials.gov identifier:NCT00624143). © 2011 Blackwell Verlag GmbH.

Practice-based evidence: profiling the safety of cilostazol by text-mining of clinical notes.

PubMed

Leeper, Nicholas J; Bauer-Mehren, Anna; Iyer, Srinivasan V; Lependu, Paea; Olson, Cliff; Shah, Nigam H

2013-01-01

Peripheral arterial disease (PAD) is a growing problem with few available therapies. Cilostazol is the only FDA-approved medication with a class I indication for intermittent claudication, but carries a black box warning due to concerns for increased cardiovascular mortality. To assess the validity of this black box warning, we employed a novel text-analytics pipeline to quantify the adverse events associated with Cilostazol use in a clinical setting, including patients with congestive heart failure (CHF). We analyzed the electronic medical records of 1.8 million subjects from the Stanford clinical data warehouse spanning 18 years using a novel text-mining/statistical analytics pipeline. We identified 232 PAD patients taking Cilostazol and created a control group of 1,160 PAD patients not taking this drug using 1:5 propensity-score matching. Over a mean follow up of 4.2 years, we observed no association between Cilostazol use and any major adverse cardiovascular event including stroke (OR = 1.13, CI [0.82, 1.55]), myocardial infarction (OR = 1.00, CI [0.71, 1.39]), or death (OR = 0.86, CI [0.63, 1.18]). Cilostazol was not associated with an increase in any arrhythmic complication. We also identified a subset of CHF patients who were prescribed Cilostazol despite its black box warning, and found that it did not increase mortality in this high-risk group of patients. This proof of principle study shows the potential of text-analytics to mine clinical data warehouses to uncover 'natural experiments' such as the use of Cilostazol in CHF patients. We envision this method will have broad applications for examining difficult to test clinical hypotheses and to aid in post-marketing drug safety surveillance. Moreover, our observations argue for a prospective study to examine the validity of a drug safety warning that may be unnecessarily limiting the use of an efficacious therapy.

[Exploration of microcosmic Chinese medicine used by western medicine].

PubMed

Zheng, Zhi-jing

2015-02-01

"Microcosmic syndrome", "treatment based on syndrome differentiation", and "combination of disease identification and syndrome differentiation" generally refer to a mode: following the syndrome if with no disease identified, following the disease if with no syndrome type differentiated. For example, Chinese medical treatment of hypertension, high blood lipids, increased transaminase, and so on candirectly use Chinese recipes, but no longer with syndrome differentiation. Clinical application of Chinese patent medicine can also obtain favorable clinical. Western doctors need not follow syndrome differentiation. The invention of artemisinin was screened from more than 40 000 kinds of compounds and herbs, but with no reference of any traditional Chinese medical theory. A lot of folk remedy and empirical recipes have obtained effective efficacy but unnecessarily with profound Chinese medical theories. Various evidences showed that disease can also be cured without syndrome differentiation. I held that it might be associated with the same mechanism of Chinese medicine and Western medicine. Any disease can be cured or alleviated by Chinese medicine is a result from its modern pharmacological effect, which is achieved by improving etiologies, and pathogeneses. I was inspired by whether we can directly use traditional Chinese medicine with modern pharmacological effects to treat symptomatic disease. So I raised an idea of microcosmic Chinese medicine used by Western medicine, i.e., we find and use Chinese herbs with relatively effective modern pharmacological effect to treat diseases targeting at patients' clinical symptoms and signs, as well as various positive laboratory results (collectively called as microscopic dialectical indicators). More Western doctors would use it to treat disease due to omission of complicated and mysterious syndrome differentiation. This will promote extensive application and expansion of Chi- nese medicine and pharmacy, enlarge the team of integrative medicine, improve Western doctors' interest in Chinese medicine and pharmacy, thus pushing the career of integrative medicine in a brand new development era.

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

PubMed Central

Steinert, Tilman; Noorthoorn, Eric O.; Mulder, Cornelis L.

2014-01-01

In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million € was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients. PMID:25309893

Acute exacerbations of chronic bronchitis: a pharmacoeconomic review of antibacterial use.

PubMed

Morris, Stephen; Anderson, Pippa; Irwin, Debra E

2002-01-01

Chronic bronchitis is a common problem affecting a large proportion of the adult population. People with chronic bronchitis are subject to recurrent attacks of bronchial inflammation called acute exacerbations of chronic bronchitis (AECBs). In patients with AECBs, symptoms may worsen due to a bacterial infection; the exacerbation is then known as an acute bacterial exacerbation of chronic bronchitis (ABECB). ABECBs are thought to be controllable through the use of antibacterial agents. In this paper we review current evidence on the cost of chronic bronchitis and AECBs, the cost effectiveness of antibacterials in the management of ABECB, and the factors that may affect the cost-effectiveness of antibacterials in the management of ABECB. We find that the number of economic evaluations conducted in this area is small. Of the few economic evaluations that have been conducted there has been only one prospective economic evaluation based on a clinical trial. The remainder are simple decision analysis-based modelling studies or retrospective database studies. Our principle findings are as follows: a key factor affecting the cost-effective use of antibacterials in the management of ABECB is the definitive diagnosis of the condition. Unfortunately, diagnosing a bacterial cause of an AECB is difficult, which presents problems in ensuring that antibacterials are not prescribed unnecessarily;current evidence suggests but does not prove that use of more effective but more costly first-line antibacterials may be relatively cost effective and may minimise overall expenditure by reducing the high costs associated with treatment failure;chronic bronchitis and AECB have a significant and negative physical and psychological effect on health-related quality of life. In conclusion, the small number of economic evaluations conducted in this area, coupled with the nature of the design of these studies, precludes a definitive statement recommending which specific antibacterial should be preferred on cost-effectiveness grounds for the management of ABECB. On the basis of our findings we suggest some topics for further research.

GRBs as standard candles: There is no “circularity problem” (and there never was)

NASA Astrophysics Data System (ADS)

Graziani, Carlo

2011-02-01

Beginning with the 2002 discovery of the "Amati Relation" of GRB spectra, there has been much interest in the possibility that this and other correlations of GRB phenomenology might be used to make GRBs into standard candles. One recurring apparent difficulty with this program has been that some of the primary observational quantities to be fit as "data" - to wit, the isotropic-equivalent prompt energy Eiso and the collimation-corrected "total" prompt energy Eγ - depend for their construction on the very cosmological models that they are supposed to help constrain. This is the so-called "circularity problem" of standard candle GRBs. This paper is intended to point out that the circularity problem is not in fact a problem at all, except to the extent that it amounts to a self-inflicted wound. It arises essentially because of an unfortunate choice of data variables - "source-frame" variables such as Eiso, which are unnecessarily encumbered by cosmological considerations. If, instead, the empirical correlations of GRB phenomenology which are formulated in source-variables are mapped to the primitive observational variables (such as fluence) and compared to the observations in that space, then all taint of circularity disappears. I also indicate here a set of procedures for encoding high-dimensional empirical correlations (such as between Eiso, Epk(src),tjet(src), and T45(src)) in a "Gaussian Tube" smeared model that includes both the correlation and its intrinsic scatter, and how that source-variable model may easily be mapped to the space of primitive observables, to be convolved with the measurement errors and fashioned into a likelihood. I discuss the projections of such Gaussian tubes into sub-spaces, which may be used to incorporate data from GRB events that may lack some element of the data (for example, GRBs without ascertained jet-break times). In this way, a large set of inhomogeneously observed GRBs may be assimilated into a single analysis, so long as each possesses at least two correlated data attributes.

The paradox of vaginal examination practice during normal childbirth: Palestinian women's feelings, opinions, knowledge and experiences.

PubMed

Hassan, Sahar J; Sundby, Johanne; Husseini, Abdullatif; Bjertness, Espen

2012-08-28

Vaginal examination (VE), is a frequent procedure during childbirth. It is the most accepted ways to assess progress during childbirth, but its repetition at short intervals has no value. Over years, VE continued to be plagued by a nature that implies negative feelings and experiences of women. The aim of this exploratory qualitative study was to explore women's feelings, opinions, knowledge and experiences of vaginal examinations (VE) during normal childbirth. We interviewed 176 postpartum women using semi-structured questionnaire in a Palestinian public hospital in the oPt. Descriptive statistics were conducted; frequency counts and percentages for the quantitative questions. The association between the frequency of VE and age, parity, years of education, locale and the time of delivery was tested by Chi-squared and Fisher's Exact test. The open-ended qualitative questions were read line-by-line for the content and coded. The assigned codes for all responses were entered to the SPSS statistical software version 18. As compared with WHO recommendations, VE was conducted too frequently, and by too many providers during childbirth. The proportion of women who received a 'too high' frequency of VEs during childbirth was significantly larger in primipara as compared to multipara women (P = .037). 82% of women reported pain or severe pain and 68% reported discomfort during VE. Some women reported insensitive approaches of providers, insufficient means of privacy and no respect of dignity or humanity during the exam. Palestinian women are undergoing unnecessary and frequent VEs during childbirth, conducted by several different providers and suffer pain and discomfort un-necessarily. Adhering to best evidence, VE during childbirth should be conducted only when necessary, and if possible, by the same provider. This will decrease the laboring women's unnecessary suffering from pain and discomfort. Providers should advocate for women's right to information, respect, dignity and privacy.

Practice-Based Evidence: Profiling the Safety of Cilostazol by Text-Mining of Clinical Notes

PubMed Central

Iyer, Srinivasan V.; LePendu, Paea; Olson, Cliff; Shah, Nigam H.

2013-01-01

Background Peripheral arterial disease (PAD) is a growing problem with few available therapies. Cilostazol is the only FDA-approved medication with a class I indication for intermittent claudication, but carries a black box warning due to concerns for increased cardiovascular mortality. To assess the validity of this black box warning, we employed a novel text-analytics pipeline to quantify the adverse events associated with Cilostazol use in a clinical setting, including patients with congestive heart failure (CHF). Methods and Results We analyzed the electronic medical records of 1.8 million subjects from the Stanford clinical data warehouse spanning 18 years using a novel text-mining/statistical analytics pipeline. We identified 232 PAD patients taking Cilostazol and created a control group of 1,160 PAD patients not taking this drug using 1∶5 propensity-score matching. Over a mean follow up of 4.2 years, we observed no association between Cilostazol use and any major adverse cardiovascular event including stroke (OR = 1.13, CI [0.82, 1.55]), myocardial infarction (OR = 1.00, CI [0.71, 1.39]), or death (OR = 0.86, CI [0.63, 1.18]). Cilostazol was not associated with an increase in any arrhythmic complication. We also identified a subset of CHF patients who were prescribed Cilostazol despite its black box warning, and found that it did not increase mortality in this high-risk group of patients. Conclusions This proof of principle study shows the potential of text-analytics to mine clinical data warehouses to uncover ‘natural experiments’ such as the use of Cilostazol in CHF patients. We envision this method will have broad applications for examining difficult to test clinical hypotheses and to aid in post-marketing drug safety surveillance. Moreover, our observations argue for a prospective study to examine the validity of a drug safety warning that may be unnecessarily limiting the use of an efficacious therapy. PMID:23717437

Overlay Tolerances For VLSI Using Wafer Steppers

NASA Astrophysics Data System (ADS)

Levinson, Harry J.; Rice, Rory

1988-01-01

In order for VLSI circuits to function properly, the masking layers used in the fabrication of those devices must overlay each other to within the manufacturing tolerance incorporated in the circuit design. The capabilities of the alignment tools used in the masking process determine the overlay tolerances to which circuits can be designed. It is therefore of considerable importance that these capabilities be well characterized. Underestimation of the overlay accuracy results in unnecessarily large devices, resulting in poor utilization of wafer area and possible degradation of device performance. Overestimation will result in significant yield loss because of the failure to conform to the tolerances of the design rules. The proper methodology for determining the overlay capabilities of wafer steppers, the most commonly used alignment tool for the production of VLSI circuits, is the subject of this paper. Because cost-effective manufacturing process technology has been the driving force of VLSI, the impact on productivity is a primary consideration in all discussions. Manufacturers of alignment tools advertise the capabilities of their equipment. It is notable that no manufacturer currently characterizes his aligners in a manner consistent with the requirements of producing very large integrated circuits, as will be discussed. This has resulted in the situation in which the evaluation and comparison of the capabilities of alignment tools require the attention of a lithography specialist. Unfortunately, lithographic capabilities must be known by many other people, particularly the circuit designers and the managers responsible for the financial consequences of the high prices of modern alignment tools. All too frequently, the designer or manager is confronted with contradictory data, one set coming from his lithography specialist, and the other coming from a sales representative of an equipment manufacturer. Since the latter generally attempts to make his merchandise appear as attractive as possible, the lithographer is frequently placed in the position of having to explain subtle issues in order to justify his decisions. It is the purpose of this paper to provide that explanation.

Simplified programming and control of automated radiosynthesizers through unit operations.

PubMed

Claggett, Shane B; Quinn, Kevin M; Lazari, Mark; Moore, Melissa D; van Dam, R Michael

2013-07-15

Many automated radiosynthesizers for producing positron emission tomography (PET) probes provide a means for the operator to create custom synthesis programs. The programming interfaces are typically designed with the engineer rather than the radiochemist in mind, requiring lengthy programs to be created from sequences of low-level, non-intuitive hardware operations. In some cases, the user is even responsible for adding steps to update the graphical representation of the system. In light of these unnecessarily complex approaches, we have created software to perform radiochemistry on the ELIXYS radiosynthesizer with the goal of being intuitive and easy to use. Radiochemists were consulted, and a wide range of radiosyntheses were analyzed to determine a comprehensive set of basic chemistry unit operations. Based around these operations, we created a software control system with a client-server architecture. In an attempt to maximize flexibility, the client software was designed to run on a variety of portable multi-touch devices. The software was used to create programs for the synthesis of several 18F-labeled probes on the ELIXYS radiosynthesizer, with [18F]FDG detailed here. To gauge the user-friendliness of the software, program lengths were compared to those from other systems. A small sample group with no prior radiosynthesizer experience was tasked with creating and running a simple protocol. The software was successfully used to synthesize several 18F-labeled PET probes, including [18F]FDG, with synthesis times and yields comparable to literature reports. The resulting programs were significantly shorter and easier to debug than programs from other systems. The sample group of naive users created and ran a simple protocol within a couple of hours, revealing a very short learning curve. The client-server architecture provided reliability, enabling continuity of the synthesis run even if the computer running the client software failed. The architecture enabled a single user to control the hardware while others observed the run in progress or created programs for other probes. We developed a novel unit operation-based software interface to control automated radiosynthesizers that reduced the program length and complexity and also exhibited a short learning curve. The client-server architecture provided robustness and flexibility.

Simplified programming and control of automated radiosynthesizers through unit operations

PubMed Central

2013-01-01

Background Many automated radiosynthesizers for producing positron emission tomography (PET) probes provide a means for the operator to create custom synthesis programs. The programming interfaces are typically designed with the engineer rather than the radiochemist in mind, requiring lengthy programs to be created from sequences of low-level, non-intuitive hardware operations. In some cases, the user is even responsible for adding steps to update the graphical representation of the system. In light of these unnecessarily complex approaches, we have created software to perform radiochemistry on the ELIXYS radiosynthesizer with the goal of being intuitive and easy to use. Methods Radiochemists were consulted, and a wide range of radiosyntheses were analyzed to determine a comprehensive set of basic chemistry unit operations. Based around these operations, we created a software control system with a client–server architecture. In an attempt to maximize flexibility, the client software was designed to run on a variety of portable multi-touch devices. The software was used to create programs for the synthesis of several 18F-labeled probes on the ELIXYS radiosynthesizer, with [18F]FDG detailed here. To gauge the user-friendliness of the software, program lengths were compared to those from other systems. A small sample group with no prior radiosynthesizer experience was tasked with creating and running a simple protocol. Results The software was successfully used to synthesize several 18F-labeled PET probes, including [18F]FDG, with synthesis times and yields comparable to literature reports. The resulting programs were significantly shorter and easier to debug than programs from other systems. The sample group of naive users created and ran a simple protocol within a couple of hours, revealing a very short learning curve. The client–server architecture provided reliability, enabling continuity of the synthesis run even if the computer running the client software failed. The architecture enabled a single user to control the hardware while others observed the run in progress or created programs for other probes. Conclusions We developed a novel unit operation-based software interface to control automated radiosynthesizers that reduced the program length and complexity and also exhibited a short learning curve. The client–server architecture provided robustness and flexibility. PMID:23855995

The compliance with and knowledge about radiation protection in operating room personnel: a cross-sectional study with a questionnaire.

PubMed

Jentzsch, Thorsten; Pietsch, Christiane M; Stigler, Brigitte; Ramseier, Leonhard E; Seifert, Burkhardt; Werner, Clément M L

2015-09-01

Radiation protection is becoming more important with an ongoing increase in radiation exposure due to the use of X-rays in minimally invasive procedures in orthopaedic and trauma surgeries. However, sufficient education in medical physics and radiation protection can often be improved. A questionnaire consisting of four questions about personal data and ten questions about radiation protection was distributed to lead consultants, consultants, residents, medical students, and medical technical assistants at two institutions, a level 1 trauma center and a children's hospital. This study consisted of 83 participants. The compliance with radiation protection, i.e., usage of a dosimetry, an apron, and a thyroid shield on a regular basis was only seen in 54 %. Participants from the trauma center wore a dosimeter and thyroid shield significantly more often. The regular use of a thyroid shield differed significantly between job positions. It was observed in 80 % of students, but only 15 % of technical assistants. Only 65 % of all knowledge questions were answered correctly. There was a discrepancy between incorrectly answered knowledge questions (35 %) and those marked as uncertain (20 %). Different job positions did not have an impact on the answers to the questions in most instances. The compliance with and the knowledge about radiation protection seems to be unnecessarily low in trauma physicians and technical assistants. The discrepancy in falsely answered questions and those marked as uncertain may suggest that participants may overestimate their knowledge about radiation protection, which is potentially harmful due to the increased radiation exposure. Therefore, we advocate a quick and valuable training of trauma surgeons and medical staff addressing the important preventive measures, some of which are illustrated in the present study. These consist of wearing dosimetry and protection devices, reduction in X-ray duration, preferably antero-posterior C-arm positioning with the image intensifier close to the patient and the surgeon, maximal distance, collimation, and increased voltage. Furthermore, the use of visual feedback on complex and potentially hazardous radiation facts may be useful for training purposes. Cross-sectional study with a questionnaire.

Companies' opinions and acceptance of global food safety initiative benchmarks after implementation.

PubMed

Crandall, Phil; Van Loo, Ellen J; O'Bryan, Corliss A; Mauromoustakos, Andy; Yiannas, Frank; Dyenson, Natalie; Berdnik, Irina

2012-09-01

International attention has been focused on minimizing costs that may unnecessarily raise food prices. One important aspect to consider is the redundant and overlapping costs of food safety audits. The Global Food Safety Initiative (GFSI) has devised benchmarked schemes based on existing international food safety standards for use as a unifying standard accepted by many retailers. The present study was conducted to evaluate the impact of the decision made by Walmart Stores (Bentonville, AR) to require their suppliers to become GFSI compliant. An online survey of 174 retail suppliers was conducted to assess food suppliers' opinions of this requirement and the benefits suppliers realized when they transitioned from their previous food safety systems. The most common reason for becoming GFSI compliant was to meet customers' requirements; thus, supplier implementation of the GFSI standards was not entirely voluntary. Other reasons given for compliance were enhancing food safety and remaining competitive. About 54 % of food processing plants using GFSI benchmarked schemes followed the guidelines of Safe Quality Food 2000 and 37 % followed those of the British Retail Consortium. At the supplier level, 58 % followed Safe Quality Food 2000 and 31 % followed the British Retail Consortium. Respondents reported that the certification process took about 10 months. The most common reason for selecting a certain GFSI benchmarked scheme was because it was widely accepted by customers (retailers). Four other common reasons were (i) the standard has a good reputation in the industry, (ii) the standard was recommended by others, (iii) the standard is most often used in the industry, and (iv) the standard was required by one of their customers. Most suppliers agreed that increased safety of their products was required to comply with GFSI benchmarked schemes. They also agreed that the GFSI required a more carefully documented food safety management system, which often required improved company food safety practices and increased employee training. Adoption of a GFSI benchmarked scheme resulted in fewer audits, i.e., one less per year. An educational opportunity exists to acquaint retailers and suppliers worldwide with the benefits of having an internationally recognized certification program such as that recognized by the GFSI.

Superconducting electromechanical rotating device having a liquid-cooled, potted, one layer stator winding

DOEpatents

Dombrovski, Viatcheslav V.; Driscoll, David I.; Shovkhet, Boris A.

2001-01-01

A superconducting electromechanical rotating (SER) device, such as a synchronous AC motor, includes a superconducting field winding and a one-layer stator winding that may be water-cooled. The stator winding is potted to a support such as the inner radial surface of a support structure and, accordingly, lacks hangers or other mechanical fasteners that otherwise would complicate stator assembly and require the provision of an unnecessarily large gap between adjacent stator coil sections. The one-layer winding topology, resulting in the number of coils being equal to half the number of slots or other mounting locations on the support structure, allows one to minimize or eliminate the gap between the inner radial ends of adjacent straight sections of the stator coilswhile maintaining the gap between the coil knuckles equal to at least the coil width, providing sufficient room for electrical and cooling element configurations and connections. The stator winding may be potted to the support structure or other support, for example, by a one-step VPI process relying on saturation of an absorbent material to fill large gaps in the stator winding or by a two-step process in which small gaps are first filled via a VPI or similar operation and larger gaps are then filled via an operation that utilizes the stator as a portion of an on-site mold.

Acoustical and Intelligibility Test of the Vocera(Copyright) B3000 Communication Badge

NASA Technical Reports Server (NTRS)

Archer, Ronald; Litaker, Harry; Chu, Shao-Sheng R.; Simon, Cory; Romero, Andy; Moses, Haifa

2012-01-01

To communicate with each other or ground support, crew members on board the International Space Station (ISS) currently use the Audio Terminal Units (ATU), which are located in each ISS module. However, to use the ATU, crew members must stop their current activity, travel to a panel, and speak into a wall-mounted microphone, or use either a handheld microphone or a Crew Communication Headset that is connected to a panel. These actions unnecessarily may increase task times, lower productivity, create cable management issues, and thus increase crew frustration. Therefore, the Habitability and Human Factors and Human Interface Branches at the NASA Johnson Space Center (JSC) are currently investigating a commercial-off-the-shelf (COTS) wireless communication system, Vocera(C), as a near-term solution for ISS communication. The objectives of the acoustics and intelligibility testing of this system were to answer the following questions: 1. How intelligibly can a human hear the transmitted message from a Vocera(c) badge in three different noise environments (Baseline = 20 dB, US Lab Module = 58 dB, Russian Module = 70.6 dB)? 2. How accurate is the Vocera(C) badge at recognizing voice commands in three different noise environments? 3. What body location (chest, upper arm, or shoulder) is optimal for speech intelligibility and voice recognition accuracy of the Vocera(C) badge on a human in three different noise environments?

Access to pain treatment as a human right

PubMed Central

2010-01-01

Background Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment. Discussion Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses. Summary According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment. PMID:20089155

Performance of the "CCS Algorithm" in real world patients.

PubMed

LaHaye, Stephen A; Olesen, Jonas B; Lacombe, Shawn P

2015-06-01

With the publication of the 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation, the Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee has introduced a new triage and management algorithm; the so-called "CCS Algorithm". The CCS Algorithm is based upon expert opinion of the best available evidence; however, the CCS Algorithm has not yet been validated. Accordingly, the purpose of this study is to evaluate the performance of the CCS Algorithm in a cohort of real world patients. We compared the CCS Algorithm with the European Society of Cardiology (ESC) Algorithm in 172 hospital inpatients who are at risk of stroke due to non-valvular atrial fibrillation in whom anticoagulant therapy was being considered. The CCS Algorithm and the ESC Algorithm were concordant in 170/172 patients (99% of the time). There were two patients (1%) with vascular disease, but no other thromboembolic risk factors, which were classified as requiring oral anticoagulant therapy using the ESC Algorithm, but for whom ASA was recommended by the CCS Algorithm. The CCS Algorithm appears to be unnecessarily complicated in so far as it does not appear to provide any additional discriminatory value above and beyond the use of the ESC Algorithm, and its use could result in under treatment of patients, specifically female patients with vascular disease, whose real risk of stroke has been understated by the Guidelines.

Maladaptive behavioral consequences of conditioned fear-generalization: a pronounced, yet sparsely studied, feature of anxiety pathology.

PubMed

van Meurs, Brian; Wiggert, Nicole; Wicker, Isaac; Lissek, Shmuel

2014-06-01

Fear-conditioning experiments in the anxiety disorders focus almost exclusively on passive-emotional, Pavlovian conditioning, rather than active-behavioral, instrumental conditioning. Paradigms eliciting both types of conditioning are needed to study maladaptive, instrumental behaviors resulting from Pavlovian abnormalities found in clinical anxiety. One such Pavlovian abnormality is generalization of fear from a conditioned danger-cue (CS+) to resembling stimuli. Though lab-based findings repeatedly link overgeneralized Pavlovian-fear to clinical anxiety, no study assesses the degree to which Pavlovian overgeneralization corresponds with maladaptive, overgeneralized instrumental-avoidance. The current effort fills this gap by validating a novel fear-potentiated startle paradigm including Pavlovian and instrumental components. The paradigm is embedded in a computer game during which shapes appear on the screen. One shape paired with electric-shock serves as CS+, and other resembling shapes, presented in the absence of shock, serve as generalization stimuli (GSs). During the game, participants choose whether to behaviorally avoid shock at the cost of poorer performance. Avoidance during CS+ is considered adaptive because shock is a real possibility. By contrast, avoidance during GSs is considered maladaptive because shock is not a realistic prospect and thus unnecessarily compromises performance. Results indicate significant Pavlovian-instrumental relations, with greater generalization of Pavlovian fear associated with overgeneralization of maladaptive instrumental-avoidance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Vulnerable populations in healthcare.

PubMed

Waisel, David B

2013-04-01

This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease. Recent studies have more closely examined the effects of being part of a vulnerable population. Greater societal income inequality impacts those at the lower end of the income curve by increasing mortality and heightening the importance of individual personal situations. Recommendations from an extensive WHO report on the social determinants of health may affect social policy and use of public resources in Europe. Clinicians are undereducated about the lives and concerns of vulnerable populations, including LGBTQI persons, immigrants, physicians, prisoners, and families of patients with diseases considered 'incompatible with life'. Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.

Why does the need for medication become a barrier to breastfeeding? A narrative review.

PubMed

McClatchey, Alyson K; Shield, Alison; Cheong, Lynn H; Ferguson, Sally L; Cooper, Gabrielle M; Kyle, Gregory J

2017-12-16

The need for medication during lactation can contribute to the early cessation of breastfeeding. Breastfeeding women may require medication for acute or chronic health conditions. For some women this need for medication can become a barrier to breastfeeding; this is despite the fact that the majority of medications are considered to be compatible with lactation. This narrative review aims to investigate factors relating to medicines safety that could contribute to medication unnecessarily becoming a barrier to breastfeeding. A selective literature search using PubMed, Scopus and Google Scholar was conducted over a 6-month period using the search terms "breastfeeding", "lactation", "medication" and "information". Articles were assessed to identify whether they addressed the impact of medication use on the decision to breastfeed. Fifty six articles were identified as having appropriate discussion about decision making for the safe use of medication during lactation. Themes identified included variable and conflicting safety advice for medicines; difficulty interpreting risks associated with medicine use; societal pressures faced by the breastfeeding woman; and the varied knowledge and training of health professionals involved in the care of breastfeeding women. Poor quality of information about medicine safety during lactation can contribute to confusion in giving recommendations. This confusion can result in early cessation of breastfeeding or insufficient health care for the breastfeeding woman. Copyright © 2017. Published by Elsevier Ltd.

Worrying about one's children after breast cancer diagnosis: desired timing of psychosocial intervention.

PubMed

Stinesen Kollberg, Karin; Wilderäng, Ulrica; Möller, Anders; Steineck, Gunnar

2014-11-01

The purposes of this observational study were to analyze at what time point mothers desired psychosocial support regarding the worry about their children during the year after breast cancer diagnosis and to identify any psychosocial factors associated with this worry. In a population-based study, we analyzed data from 280 mothers diagnosed with breast cancer at Sahlgrenska University Hospital in Gothenburg, Sweden. Of those who did not receive chemotherapy treatment, 70 out of 112 women (63 %) reported a desire to receive support about the worry about their children, and of those who received chemotherapy treatment, 20 out of 49 (41 %) reported a need for support immediately following diagnosis and before surgery. We identified having children at home (P < 0.0001), worry about sex life (P = 0.0009), fear of dying from breast cancer (P = 0.0055), and worried about one's personal financial situation (P = 0.0413) as the variables most closely related to worry about the children. Our population-based study shows that mothers with breast cancer had an immediate desire to receive psychosocial support regarding the worry about their own children. If we wish to shorten the pain associated with this worry among women diagnosed with breast cancer, it may be helpful to offer support as early in the disease trajectory as possible as it may reduce the risk of a later, more complicated, unnecessarily prolonged psychosocial rehabilitation process.

Learn ++.NC: combining ensemble of classifiers with dynamically weighted consult-and-vote for efficient incremental learning of new classes.

PubMed

Muhlbaier, Michael D; Topalis, Apostolos; Polikar, Robi

2009-01-01

We have previously introduced an incremental learning algorithm Learn(++), which learns novel information from consecutive data sets by generating an ensemble of classifiers with each data set, and combining them by weighted majority voting. However, Learn(++) suffers from an inherent "outvoting" problem when asked to learn a new class omega(new) introduced by a subsequent data set, as earlier classifiers not trained on this class are guaranteed to misclassify omega(new) instances. The collective votes of earlier classifiers, for an inevitably incorrect decision, then outweigh the votes of the new classifiers' correct decision on omega(new) instances--until there are enough new classifiers to counteract the unfair outvoting. This forces Learn(++) to generate an unnecessarily large number of classifiers. This paper describes Learn(++).NC, specifically designed for efficient incremental learning of multiple new classes using significantly fewer classifiers. To do so, Learn (++).NC introduces dynamically weighted consult and vote (DW-CAV), a novel voting mechanism for combining classifiers: individual classifiers consult with each other to determine which ones are most qualified to classify a given instance, and decide how much weight, if any, each classifier's decision should carry. Experiments on real-world problems indicate that the new algorithm performs remarkably well with substantially fewer classifiers, not only as compared to its predecessor Learn(++), but also as compared to several other algorithms recently proposed for similar problems.

Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study

PubMed Central

Gaß, Paul; Fasching, Peter A.; Fehm, Tanja; de Waal, Johann; Rezai, Mahdi; Baier, Bernd; Baake, Gerold; Kolberg, Hans-Christian; Guggenberger, Martin; Warm, Mathias; Harbeck, Nadia; Wuerstlein, Rachel; Deuker, Jörg-Uwe; Dall, Peter; Richter, Barbara; Wachsmann, Grischa; Brucker, Cosima; Siebers, Jan W.; Fersis, Nikos; Kuhn, Thomas; Wolf, Christopher; Vollert, Hans-Walter; Breitbach, Georg-Peter; Janni, Wolfgang; Landthaler, Robert; Kohls, Andreas; Rezek, Daniela; Noesselt, Thomas; Fischer, Gunnar; Henschen, Stephan; Praetz, Thomas; Heyl, Volker; Kühn, Thorsten; Krauss, Thomas; Thomssen, Christoph; Hohn, Andre; Tesch, Hans; Mundhenke, Christoph; Hein, Alexander; Rauh, Claudia; Bayer, Christian M.; Jacob, Adib; Schmidt, Katja; Belleville, Erik; Hadji, Peyman; Brucker, Sara Y.; Beckmann, Matthias W.; Wallwiener, Diethelm; Kümmel, Sherko; Löhberg, Christian R.

2016-01-01

Background Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. Methods Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. Results In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. Conclusion There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues. PMID:27920623

Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study.

PubMed

Gaß, Paul; Fasching, Peter A; Fehm, Tanja; de Waal, Johann; Rezai, Mahdi; Baier, Bernd; Baake, Gerold; Kolberg, Hans-Christian; Guggenberger, Martin; Warm, Mathias; Harbeck, Nadia; Wuerstlein, Rachel; Deuker, Jörg-Uwe; Dall, Peter; Richter, Barbara; Wachsmann, Grischa; Brucker, Cosima; Siebers, Jan W; Fersis, Nikos; Kuhn, Thomas; Wolf, Christopher; Vollert, Hans-Walter; Breitbach, Georg-Peter; Janni, Wolfgang; Landthaler, Robert; Kohls, Andreas; Rezek, Daniela; Noesselt, Thomas; Fischer, Gunnar; Henschen, Stephan; Praetz, Thomas; Heyl, Volker; Kühn, Thorsten; Krauss, Thomas; Thomssen, Christoph; Hohn, Andre; Tesch, Hans; Mundhenke, Christoph; Hein, Alexander; Rauh, Claudia; Bayer, Christian M; Jacob, Adib; Schmidt, Katja; Belleville, Erik; Hadji, Peyman; Brucker, Sara Y; Beckmann, Matthias W; Wallwiener, Diethelm; Kümmel, Sherko; Löhberg, Christian R

2016-10-01

Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.

Gastrointestinal and nutritional problems in neurologically impaired children.

PubMed

Quitadamo, Paolo; Thapar, Nikhil; Staiano, Annamaria; Borrelli, Osvaldo

2016-11-01

The current increasing survival of children with severe central nervous system damage has created a major challenge for medical care. Gastrointestinal and nutritional problems in neurologically impaired children have been recently recognized as an integral part of their disease, often leading to growth failure and worsened quality of life for both children and caregivers. Nutritional support is essential for the optimal care of these children. Undernourished handicapped children might not respond properly to intercurrent diseases and suffer unnecessarily. On the other hand, restoring a normal nutritional status results in a better quality of life in many. The easiest and least invasive method to increase energy intake is to improve oral intake. However, oral intake can be maintained as long as there is no risk of aspiration, the child is growing well and the time required to feed the child remains within acceptable limits. When oral intake is unsafe, insufficient or too time consuming, enteral nutrition should be initiated. Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux (GER), with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children, carrying further challenging long-term management issues. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Framework for risk analysis in Multimedia Environmental Systems (FRAMES)

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

Whelan, G.; Buck, J.W.; Castleton, K.J.

The objectives of this workshop are to (1) provide the NRC staff and the public with an overview of currently available Federally-Sponsored dose models appropriate for decommissioning assessments and (2) discuss NRC staff-developed questions related to model selection criteria with the final rule on ``Radiological Criteria for License Termination`` (62 FR 39058). For over 40 years, medium specific models have been and will continue to be developed in an effort to understand and predict environmental phenomena, including fluid-flow patterns, contaminant migration and fate, human or wildlife exposures, impacts from specific toxicants to specific species and their organs, cost-benefit analyses, impactsmore » from remediation alternatives, etc. For nearly 40 years, medium-specific models have been combined for either sequential or concurrent assessments. The evolution of multiple-media assessment tools has followed a logic progression. To allow a suite of users the flexibility and versatility to construct, combine, and couple attributes that meet their specific needs without unnecessarily burdening the user with extraneous capabilities, the development of a computer-based methodology to implement a Risk Analysis in Multimedia Environmental Systems (FRAMES) was begun in 1994. FRAMES represents a platform which links elements together and yet does not represent the models that are linked to or within it; therefore, changes to elements that are linked to or within FRAMES do not change the framework.« less

Waggle Dance Distances as Integrative Indicators of Seasonal Foraging Challenges

PubMed Central

Couvillon, Margaret J.; Schürch, Roger; Ratnieks, Francis L. W.

2014-01-01

Even as demand for their services increases, honey bees (Apis mellifera) and other pollinating insects continue to decline in Europe and North America. Honey bees face many challenges, including an issue generally affecting wildlife: landscape changes have reduced flower-rich areas. One way to help is therefore to supplement with flowers, but when would this be most beneficial? We use the waggle dance, a unique behaviour in which a successful forager communicates to nestmates the location of visited flowers, to make a 2-year survey of food availability. We “eavesdropped” on 5097 dances to track seasonal changes in foraging, as indicated by the distance to which the bees as economic foragers will recruit, over a representative rural-urban landscape. In year 3, we determined nectar sugar concentration. We found that mean foraging distance/area significantly increase from springs (493 m, 0.8 km2) to summers (2156 m, 15.2 km2), even though nectar is not better quality, before decreasing in autumns (1275 m, 5.1 km2). As bees will not forage at long distances unnecessarily, this suggests summer is the most challenging season, with bees utilizing an area 22 and 6 times greater than spring or autumn. Our study demonstrates that dancing bees as indicators can provide information relevant to helping them, and, in particular, can show the months when additional forage would be most valuable. PMID:24695678

The special case of the 2 × 2 table: asymptotic unconditional McNemar test can be used to estimate sample size even for analysis based on GEE.

PubMed

Borkhoff, Cornelia M; Johnston, Patrick R; Stephens, Derek; Atenafu, Eshetu

2015-07-01

Aligning the method used to estimate sample size with the planned analytic method ensures the sample size needed to achieve the planned power. When using generalized estimating equations (GEE) to analyze a paired binary primary outcome with no covariates, many use an exact McNemar test to calculate sample size. We reviewed the approaches to sample size estimation for paired binary data and compared the sample size estimates on the same numerical examples. We used the hypothesized sample proportions for the 2 × 2 table to calculate the correlation between the marginal proportions to estimate sample size based on GEE. We solved the inside proportions based on the correlation and the marginal proportions to estimate sample size based on exact McNemar, asymptotic unconditional McNemar, and asymptotic conditional McNemar. The asymptotic unconditional McNemar test is a good approximation of GEE method by Pan. The exact McNemar is too conservative and yields unnecessarily large sample size estimates than all other methods. In the special case of a 2 × 2 table, even when a GEE approach to binary logistic regression is the planned analytic method, the asymptotic unconditional McNemar test can be used to estimate sample size. We do not recommend using an exact McNemar test. Copyright © 2015 Elsevier Inc. All rights reserved.

Personalized Treatment of Mothers With ADHD and Their Young At-Risk Children: A SMART Pilot.

PubMed

Chronis-Tuscano, Andrea; Wang, Christine H; Strickland, Jennifer; Almirall, Daniel; Stein, Mark A

2016-01-01

Young children of mothers with adult attention-deficit/hyperactivity disorder (ADHD) are at risk for ADHD by virtue of genetics and environmental factors. Moreover, parent ADHD is associated with maladaptive parenting and poor child behavioral treatment response. Thus, a combined approach consisting of behavioral parent training (BPT) and maternal stimulant medication (MSM) may be needed to effectively treat ADHD within families. However, providing combined BPT+MSM initially to all families may be unnecessarily burdensome because not all families likely need combined treatment. The purpose of this study is to examine how to combine, sequence, and personalize treatment for these multiplex families in order to yield benefits to both the parent and child, thereby impacting the course of child ADHD and disruptive behavior symptoms. This article presents our rationale for, design of, and preliminary experiences (based on 26 participants) with an ongoing pilot Sequential Multiple Assessment Randomized Trial (SMART) designed to answer questions regarding the feasibility and acceptability of study protocols and interventions. This article also describes how the subsequent full-scale SMART might change based on what is learned in the SMART pilot and illustrates how the full-scale SMART could be used to inform clinical decision making about how to combine, sequence, and personalize treatment for complex children and families in which a parent has ADHD.

[Nerve-sparing radical prostatectomy--effect and risks].

PubMed

Borre, Michael

2008-08-18

The purpose of nerve-sparing technique performing radical prostatectomy (NSRP) is to attempt to preserve the neurovascular bundle which is located posterolaterally on both sides of the prostate. The nerve-sparing technique presupposes the pre- and per operative tumour stage as well as preoperative erectile function--so as not to unnecessarily risk compromising the radicalism of the surgery. In the period 2003-2006 242 patients were radical prostatectomized (RP) at the Dept. of Urology, Aarhus University Hospital, Skejby. A total of 84 of these were offered NSRP. Data concerning erectile function preoperatively and 12 months postoperatively were compared. Likewise the postoperative tumour control following NSRP was investigated. There was a statistically significant association between NSRP and preserved potency 12 months postoperatively compared to the non-NSRP patient group. Moreover, no association between risks of positive surgical margins in patients treated with or without NSRP technique was observed. During follow up (median 39 months) the rate of biochemical recurrence was 40. Among these 8, 13 and 20% of the patients were respectively treated with bilateral-, unilateral- and non-NSRP. NSRP seems to be both a safe and effective procedure in carefully selected patients. Furthermore, the results suggest that if preoperatively potent, low- to middle-risk group patients (cT1-2a/b, Gleason score < 7 and PSA < 10 ng/mL) are potential candidates for at least unilateral NSRP.

Instructional Efficiency of Tutoring in an Outreach Gene Technology Laboratory

NASA Astrophysics Data System (ADS)

Scharfenberg, Franz-Josef; Bogner, Franz X.

2013-06-01

Our research objective focused on examining the instructional efficiency of tutoring as a form of instructional change as opposed to a non-tutoring approach in an outreach laboratory. We designed our laboratory based on cognitive load (CL) theory. Altogether, 269 twelfth-graders participated in our day-long module Genetic Fingerprinting. In a quasi-experimental design, the control group ( n = 121) followed the non-tutoring approach previously used, while the treatment group ( n = 148) followed the newly developed tutoring approach. Each tutor was in charge of two student work groups and recorded the tutoring activities requested by the tutees throughout the day. We measured the students' invested mental effort (as an index of CL), cognitive achievement (in a pre-post-follow-up design), and the students' cooperation in their work groups as well as calculated the student instructional involvement (as a motivational variable). Additionally, we examined which aspects of the hands-on phases were of particular relevance to the students' invested mental effort. Unexpectedly, the combined mental effort and cognitive achievement data indicated that our implemented tutoring approach resulted in a lower instructional efficiency despite the relevance of tutoring for students' mental effort invested during the experimental phases. Most of the tutor assistance was unnecessarily requested for performing the procedural steps and using the equipment. Our results indicate an assistance dilemma and consequently underscore the necessity for effective tutor preparation in outreach laboratories.

Imaging utilization commentary: a radiology perspective.

PubMed

Reed, Martin H

2008-11-01

To adhere to the ALARA concept, imaging should be limited to studies that actually contribute to the management of the patient. For example, by applying the Ottawa Ankle Rule and the Ottawa Knee Rule, fewer radiographs are required to evaluate ankle and knee trauma in children. Chest radiographs usually do not contribute to the management of children presenting with typical acute bronchiolitis or asthma, and they can be detrimental because consolidation resulting from retained secretions is interpreted as pneumonia and the child is started on antibiotics unnecessarily. Moreover, a radiograph of the abdomen has poor validity and reproducibility for the diagnosis of constipation. The Pediatric Emergency Care Applied Research Network (PECARN) and the Pediatric Emergency Research in Canada (PERC) are currently developing decision rules for the use of CT in the assessment of minor head injuries in children, which should reduce its utilization in this condition. PECARN is also developing a decision rule for the use of CT in the assessment of abdominal trauma in children. CT is frequently used for the diagnosis of appendicitis in children, but appendicitis can be diagnosed clinically. If imaging is required, appendicitis can often be diagnosed with US, and CT need only be used in the minority of cases where the diagnosis is still in doubt. Utilization guidelines for pediatric imaging studies obtained in children in the emergency setting can improve yield and help in the more efficient management of often scarce health care resources.

Physicians' approaches to the use of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users.

PubMed

Murthy, S K; Kauldher, S; Targownik, L E

2006-05-01

Many doctors unnecessarily prescribe gastroprotective strategies to non-steroidal anti-inflammatory drugs users at low risk of non-steroidal anti-inflammatory drug-related gastrointestinal complications. To identify factors that predict the overuse of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users. We distributed a questionnaire to family doctors and general internists consisting of a clinical vignette describing a low-risk hypothetical patient with osteoarthritis who was a candidate for non-steroidal anti-inflammatory drug therapy. Respondents were asked whether they would prescribe this patient a gastroprotective strategy and to estimate the annual risk of that patient developing a gastrointestinal complication with non-steroidal anti-inflammatory drug use. Respondents inappropriately recommending a gastroprotective strategy were compared with respondents who opted not to use gastroprotection. We received 340 responses (response rate of 28.3%), of which 278 supplied analysable data. Thirty-five percent of respondents inappropriately recommended a gastroprotective strategy for the low-risk subject. Inappropriate prescribers were significantly more likely to overestimate the risk of gastrointestinal complications with traditional non-steroidal anti-inflammatory drugs and this was strongly predictive of gastroprotective strategy recommendation in logistic regression. Many doctors inappropriately recommend gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users. Improving doctors' awareness of non-steroidal anti-inflammatory drug-associated gastrointestinal risks may lead to a decrease in inappropriate utilization of gastroprotective strategies in low-risk patients.

Evidence of a broken healthcare delivery system in korea: unnecessary hospital outpatient utilization among patients with a single chronic disease without complications.

PubMed

Lee, Jin Yong; Jo, Min-Woo; Yoo, Weon-Seob; Kim, Hyun Joo; Eun, Sang Jun

2014-12-01

This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.

An unintended consequence of the IGY: Eisenhower, Sputnik, the Founding of NASA

NASA Astrophysics Data System (ADS)

Launius, Roger D.

2010-07-01

On October 4, 1957, the Soviet Union launched the first Earth-circling artificial satellite and the United States responded by taking numerous actions aimed at "remediating" a Cold War crisis. This included the establishment of a separate civilian space agency charged with the conduct of an official program of scientific and technological space exploration, consolidation of Department of Defense space activities, the passage of the National Defense Education Act, the creation of a Presidential Science Advisor, and a host of lesser actions. The politics of these changes is fascinating, and has been interpreted as an appropriate political response to a unique crisis situation. Interest groups, all for differing reasons, prodded national leaders to undertake large-scale efforts, something the president thought unnecessarily expensive and once set in place impossible to dismantle. But was the Sputnik crisis truly a crisis in any real sense? Was it made into one by interest groups who used it for their own ends? This paper will trace briefly some of the major themes associated with the IGY and Sputnik and describe the political construction of the crisis as it emerged in 1957-1958. It will also discuss something about the transformation of federal science and technology that took place in response to this "crisis" and how it set in train a series of processes and policies that did not unravel until the end of the Cold War.

Training of Attentional Filtering, but Not of Memory Storage, Enhances Working Memory Efficiency by Strengthening the Neuronal Gatekeeper Network.

PubMed

Schmicker, Marlen; Schwefel, Melanie; Vellage, Anne-Katrin; Müller, Notger G

2016-04-01

Memory training (MT) in older adults with memory deficits often leads to frustration and, therefore, is usually not recommended. Here, we pursued an alternative approach and looked for transfer effects of 1-week attentional filter training (FT) on working memory performance and its neuronal correlates in young healthy humans. The FT effects were compared with pure MT, which lacked the necessity to filter out irrelevant information. Before and after training, all participants performed an fMRI experiment that included a combined task in which stimuli had to be both filtered based on color and stored in memory. We found that training induced processing changes by biasing either filtering or storage. FT induced larger transfer effects on the untrained cognitive function than MT. FT increased neuronal activity in frontal parts of the neuronal gatekeeper network, which is proposed to hinder irrelevant information from being unnecessarily stored in memory. MT decreased neuronal activity in the BG part of the gatekeeper network but enhanced activity in the parietal storage node. We take these findings as evidence that FT renders working memory more efficient by strengthening the BG-prefrontal gatekeeper network. MT, on the other hand, simply stimulates storage of any kind of information. These findings illustrate a tight connection between working memory and attention, and they may open up new avenues for ameliorating memory deficits in patients with cognitive impairments.

Estimation of test characteristics of real-time PCR and bacterial culture for diagnosis of subclinical intramammary infections with Streptococcus agalactiae in Danish dairy cattle in 2012 using latent class analysis.

PubMed

Mahmmod, Yasser S; Toft, Nils; Katholm, Jørgen; Grønbæk, Carsten; Klaas, Ilka C

2013-05-01

The misdiagnosis of intramammary infections (IMI) with Streptococcus agalactiae (S. agalactiae) could lead farmers to treat or cull animals unnecessarily. The objective of this field study was to estimate the sensitivity (Se) and specificity (Sp) of real-time PCR at different cut-offs for cycle threshold (Ct) values against bacterial culture (BC) for diagnosis of S. agalactiae IMI using latent class analysis to avoid the assumption of a perfect reference test. A total of 614 dairy cows were randomly selected from 6 herds with bulk tank PCR Ct value ≤ 39 for S. agalactiae and S. aureus. At milk recording, 2456 quarter milk samples were taken aseptically for BC and the routinely taken cow level milk samples were analyzed by PCR. Results showed that 53 cows (8.6%) were positive for S. agalactiae IMI by BC. Sensitivity of PCR at cut-offs; ≤ 39, ≤ 37, ≤ 34, and ≤ 32, was 96.2%, 91.9%, 87.2% and 73.9%, while Se of BC was 25.7%, 29.9%, 59.9% and 72.1%. Specificity of PCR at cut-offs; ≤ 39, ≤ 37, ≤ 34, and ≤ 32, was 96.8%, 96.9%, 96.7%, and 97.22%, while Sp of BC was 99.7%, 99.5%, 99.2%, and 98.9%. The estimated prevalence of S. agalactiae IMI by PCR was higher than the apparent prevalence at the tested cut-offs, indicating under estimation of S. agalactiae IMI in the examined dairy cows. In conclusion, Se of PCR is always higher than Se of BC at all tested cut-offs. The lower cut-off, the more comparable becomes Se of PCR and Se of BC. The changes in Se in both PCR and BC at different Ct-value cut-offs may indicate a change in the definition of the latent infection. The similar Se of both tests at cut-off ≤ 32 may indicate high concentrations of S. agalactiae viable cells, representing a cow truly/heavily infected with S. agalactiae and thus easier to detect with BC. At cut-off ≤ 39 the latent definition of infection may reflect a more general condition of cows being positive for S. agalactiae. Our findings indicate that PCR Ct-value cut-offs should be chosen according to the underlying latent infection definition of interest. Latent class analysis proposes a useful alternative to classic test evaluation of diagnostic tests used for detection of S. agalactiae IMI in milk. Copyright © 2012 Elsevier B.V. All rights reserved.

Reevaluation of health risk benchmark for sustainable water practice through risk analysis of rooftop-harvested rainwater.

PubMed

Lim, Keah-Ying; Jiang, Sunny C

2013-12-15

Health risk concerns associated with household use of rooftop-harvested rainwater (HRW) constitute one of the main impediments to exploit the benefits of rainwater harvesting in the United States. However, the benchmark based on the U.S. EPA acceptable annual infection risk level of ≤1 case per 10,000 persons per year (≤10(-4) pppy) developed to aid drinking water regulations may be unnecessarily stringent for sustainable water practice. In this study, we challenge the current risk benchmark by quantifying the potential microbial risk associated with consumption of HRW-irrigated home produce and comparing it against the current risk benchmark. Microbial pathogen data for HRW and exposure rates reported in literature are applied to assess the potential microbial risk posed to household consumers of their homegrown produce. A Quantitative Microbial Risk Assessment (QMRA) model based on worst-case scenario (e.g. overhead irrigation, no pathogen inactivation) is applied to three crops that are most popular among home gardeners (lettuce, cucumbers, and tomatoes) and commonly consumed raw. The infection risks of household consumers attributed to consumption of these home produce vary with the type of produce. The lettuce presents the highest risk, which is followed by tomato and cucumber, respectively. Results show that the 95th percentile values of infection risk per intake event of home produce are one to three orders of magnitude (10(-7) to 10(-5)) lower than U.S. EPA risk benchmark (≤10(-4) pppy). However, annual infection risks under the same scenario (multiple intake events in a year) are very likely to exceed the risk benchmark by one order of magnitude in some cases. Estimated 95th percentile values of the annual risk are in the 10(-4) to 10(-3) pppy range, which are still lower than the 10(-3) to 10(-1) pppy risk range of reclaimed water irrigated produce estimated in comparable studies. We further discuss the desirability of HRW for irrigating home produce based on the relative risk of HRW to reclaimed wastewater for irrigation of food crops. The appropriateness of the ≤10(-4) pppy risk benchmark for assessing safety level of HRW-irrigated fresh produce is questioned by considering the assumptions made for the QMRA model. Consequently, the need of an updated approach to assess appropriateness of sustainable water practice for making guidelines and policies is proposed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Development and validation of InnoQuant™, a sensitive human DNA quantitation and degradation assessment method for forensic samples using high copy number mobile elements Alu and SVA.

PubMed

Pineda, Gina M; Montgomery, Anne H; Thompson, Robyn; Indest, Brooke; Carroll, Marion; Sinha, Sudhir K

2014-11-01

There is a constant need in forensic casework laboratories for an improved way to increase the first-pass success rate of forensic samples. The recent advances in mini STR analysis, SNP, and Alu marker systems have now made it possible to analyze highly compromised samples, yet few tools are available that can simultaneously provide an assessment of quantity, inhibition, and degradation in a sample prior to genotyping. Currently there are several different approaches used for fluorescence-based quantification assays which provide a measure of quantity and inhibition. However, a system which can also assess the extent of degradation in a forensic sample will be a useful tool for DNA analysts. Possessing this information prior to genotyping will allow an analyst to more informatively make downstream decisions for the successful typing of a forensic sample without unnecessarily consuming DNA extract. Real-time PCR provides a reliable method for determining the amount and quality of amplifiable DNA in a biological sample. Alu are Short Interspersed Elements (SINE), approximately 300bp insertions which are distributed throughout the human genome in large copy number. The use of an internal primer to amplify a segment of an Alu element allows for human specificity as well as high sensitivity when compared to a single copy target. The advantage of an Alu system is the presence of a large number (>1000) of fixed insertions in every human genome, which minimizes the individual specific variation possible when using a multi-copy target quantification system. This study utilizes two independent retrotransposon genomic targets to obtain quantification of an 80bp "short" DNA fragment and a 207bp "long" DNA fragment in a degraded DNA sample in the multiplex system InnoQuant™. The ratio of the two quantitation values provides a "Degradation Index", or a qualitative measure of a sample's extent of degradation. The Degradation Index was found to be predictive of the observed loss of STR markers and alleles as degradation increases. Use of a synthetic target as an internal positive control (IPC) provides an additional assessment for the presence of PCR inhibitors in the test sample. In conclusion, a DNA based qualitative/quantitative/inhibition assessment system that accurately predicts the status of a biological sample, will be a valuable tool for deciding which DNA test kit to utilize and how much target DNA to use, when processing compromised forensic samples for DNA testing. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Fox Den Disease: An Interesting Case Following Delayed Diagnosis.

PubMed

Stehr, Ryan C; Kim, Nicholas; LoGiudice, John A; Ludwig, Kirk

2015-06-01

Pyoderma fistulans sinifica, also known as fox den disease, is a rare and poorly understood inflammatory disorder of the skin and subcutaneous tissues. This disorder is often mistaken for other inflammatory skin disorders and treated inappropriately. The authors describe the case of a 53-year-old male who presented to the colorectal surgery service with a longstanding diagnosis of perirectal Crohn's disease. Despite aggressive immunosuppression and numerous surgical procedures, the patient continued to have unrelenting purulent drainage from the skin of his buttocks. Following wide excision of the affected skin and subcutaneous tissues by the colorectal surgeon, the plastic surgery team reconstructed the 30 cm x 55 cm wound using a combination of local flaps and skin grafts. The initial pathology report of the excised specimen confirmed the presence of nonspecific abscesses and inflammation. Upon special request by the plastic surgery team, the sample was resectioned with the specific intent of establishing a diagnosis of fox den disease. The additional slides met the criteria for an unequivocal diagnosis of fox den disease. Immunosuppression was discontinued and the patient healed his wounds without complication. Fox den disease is often overlooked because of the obscurity of the disease and the special histological sectioning needed to establish a diagnosis. In this case, the patient was unnecessarily treated with immunosuppressive drugs for more than 3 decades because of a misdiagnosis. With increased awareness of fox den disease, perhaps its pathophysiology can be better elucidated as more patients are appropriately diagnosed and treated.

The IGY and the Satellite Race: A Reconsideration of a Cold War Crisis that Never Should Have Been

NASA Astrophysics Data System (ADS)

Launius, R. D.

2006-05-01

In October 1957 the Soviet Union launched the first Earth-circling artificial satellite and the crisis that resulted led to numerous actions in the United States aimed at "remediating" a Cold War crisis. This included the establishment of a separate civilian space agency charged with the conduct of an official program of scientific and technological space exploration, consolidation of Department of Defense space activities, the passage of the National Defense Education Act, the creation of a Presidential Science Advisor, and a host of lesser actions. The politics of these changes is fascinating, and has been interpreted as an appropriate political response to a unique crisis situation. Interest groups, all for differing reasons, prodded national leaders to undertake large-scale efforts, something the president thought unnecessarily expensive and once set in place impossible to dismantle. But was the Sputnik crisis truly a crisis in any real sense? Was it made into one by interest groups who used it for their own ends? This paper will trace briefly some of the major themes associated with the IGY and Sputnik and describe the political construction of the crisis as it emerged in 1957- 1958. It will also discuss something about the transformation of federal science and technology that took place in the aftermath of the "crisis" and how it set in train a series of processes and policies that did not unravel until the end of the Cold War.

Review of methods for handling confounding by cluster and informative cluster size in clustered data

PubMed Central

Seaman, Shaun; Pavlou, Menelaos; Copas, Andrew

2014-01-01

Clustered data are common in medical research. Typically, one is interested in a regression model for the association between an outcome and covariates. Two complications that can arise when analysing clustered data are informative cluster size (ICS) and confounding by cluster (CBC). ICS and CBC mean that the outcome of a member given its covariates is associated with, respectively, the number of members in the cluster and the covariate values of other members in the cluster. Standard generalised linear mixed models for cluster-specific inference and standard generalised estimating equations for population-average inference assume, in general, the absence of ICS and CBC. Modifications of these approaches have been proposed to account for CBC or ICS. This article is a review of these methods. We express their assumptions in a common format, thus providing greater clarity about the assumptions that methods proposed for handling CBC make about ICS and vice versa, and about when different methods can be used in practice. We report relative efficiencies of methods where available, describe how methods are related, identify a previously unreported equivalence between two key methods, and propose some simple additional methods. Unnecessarily using a method that allows for ICS/CBC has an efficiency cost when ICS and CBC are absent. We review tools for identifying ICS/CBC. A strategy for analysis when CBC and ICS are suspected is demonstrated by examining the association between socio-economic deprivation and preterm neonatal death in Scotland. PMID:25087978

Detection of perimacular red dots and blots when screening for diabetic retinopathy: Refer or not refer?

PubMed

Baltatescu, Anatolie; Striglia, Elio; Trento, Marina; Mazzeo, Aurora; Cavallo, Franco; Charrier, Lorena; Porta, Massimo

2018-05-01

Detection of microaneurysms and/or microhaemorrhages near the fovea when screening for diabetic retinopathy poses a problem because referral to retinal specialists may alarm patients and unnecessarily burden ophthalmologists. Six-month prospective study of patients found to have minimal red lesions within one disc diameter of the fovea when screened for diabetic retinopathy. Two 45° digital photographs, one centred on the macula and the other nasal including the optic disc, were taken for each eye. All patients received a 6-month re-screening appointment. Out of 70 patients, 41 returned for re-screening. Diabetic retinopathy had worsened in 3 who required referral but no treatment, was unchanged in 19 and was undetectable in the other 19. Haemoglobin A1c decreased from 7.76% ± 1.50% (61.3 ± 16.2 mmol/mol) to 6.93% ± 1.7% (52.3 ± 18.9 mmol/mol) in the patients in whom diabetic retinopathy worsened but did not change in the other groups. Baseline haemoglobin A1c ( p = 0.048) and systolic blood pressure ( p = 0.007) were lower in the patients in whom diabetic retinopathy improved, but a multivariate model including haemoglobin A1c, blood pressure and known disease duration could not identify any independent risk factor. Minimal red lesions near the fovea, though commanding early re-screening, do not require immediate referral to retinal specialists.

Glad you brought it up: a patient-centred programme to reduce proton-pump inhibitor prescribing in general medical practice.

PubMed

Murie, Jill; Allen, Jane; Simmonds, Ray; de Wet, Carl

2012-01-01

Many patients unnecessarily receive proton-pump inhibitor (PPI) drugs long term with significant financial and safety implications. Educating, empowering and supporting patients to self-manage their symptoms can lead to significant and sustained reductions in PPI prescribing. We aimed to implement a programme to reduce inappropriate PPI prescribing. Eligible patients in one general medical practice in rural Scotland were invited for participation between November 2008 and February 2010. Patients attended special nurse advisor clinics, completed dyspepsia questionnaires, received information, formulated self-management plans and were offered flexible support. Of the study population, 437/2883 (15%) were prescribed PPIs. Of these, 166 (38%) were judged eligible for participation. After 12 months, 138/157 (83%) had reduced or stopped their PPIs, while 19/157 (11%) had reverted. The estimated annual net saving in the prescribing budget was ?3180.67. Self-reported understanding of symptom self-management increased from 6/20 (30%) to 18/20 (90%) patients after participation in the programme. A patient-centred programme delivered by a specialist nurse significantly reduced PPI prescribing with financial and potential therapeutic benefits. The vast majority of eligible patients were able to 'step down and off' or 'step off' PPI use after 12 months without any complications or deteriorating symptom control. Further research with larger cohorts of practices and patients is needed to develop a feasible, acceptable and effective programme if similar benefits are to be achieved for primary care in general.

Call Admission Control on Single Node Networks under Output Rate-Controlled Generalized Processor Sharing (ORC-GPS) Scheduler

NASA Astrophysics Data System (ADS)

Hanada, Masaki; Nakazato, Hidenori; Watanabe, Hitoshi

Multimedia applications such as music or video streaming, video teleconferencing and IP telephony are flourishing in packet-switched networks. Applications that generate such real-time data can have very diverse quality-of-service (QoS) requirements. In order to guarantee diverse QoS requirements, the combined use of a packet scheduling algorithm based on Generalized Processor Sharing (GPS) and leaky bucket traffic regulator is the most successful QoS mechanism. GPS can provide a minimum guaranteed service rate for each session and tight delay bounds for leaky bucket constrained sessions. However, the delay bounds for leaky bucket constrained sessions under GPS are unnecessarily large because each session is served according to its associated constant weight until the session buffer is empty. In order to solve this problem, a scheduling policy called Output Rate-Controlled Generalized Processor Sharing (ORC-GPS) was proposed in [17]. ORC-GPS is a rate-based scheduling like GPS, and controls the service rate in order to lower the delay bounds for leaky bucket constrained sessions. In this paper, we propose a call admission control (CAC) algorithm for ORC-GPS, for leaky-bucket constrained sessions with deterministic delay requirements. This CAC algorithm for ORC-GPS determines the optimal values of parameters of ORC-GPS from the deterministic delay requirements of the sessions. In numerical experiments, we compare the CAC algorithm for ORC-GPS with one for GPS in terms of schedulable region and computational complexity.

Ethical issues involved with in vitro fertilization.

PubMed

Shannon, T A

1990-09-01

There are three elements to consider with in vitro fertilization. First, the paramount concern needs to be the well-being and best interests of the child, even though he or she may be an embryo at the time. Second, some people think a child will solve their marital problems. Although couples seeking in vitro fertilization should not be subjected to more scrutiny than couples conceiving in the traditional way, the stresses and uncertainties of in vitro fertilization can further strain a marriage. Clinic staff members should be sensitive to this issue as a way of helping to avoid complications later. Third, how we resolve the status and fate of the frozen embryo and who has disposition over it surely will reflect how we consider abortion rights. For example, if the standards of Roe vs Wade were applied, one could argue that the woman should have total disposition over the frozen embryo. On the other hand, if the father receives a say in the matter, what impact would this have? Given the nature of our society and the tenuous state of marriage, the problem of disposing frozen embryos is a critical one that has no satisfactory solution. Finally, there is the stress factor. Although this is not an issue of direct ethical concern, it is related to the necessity of the couple receiving accurate information. If the couple receives an incorrect impression of a clinic's success rates, they may be exposed unnecessarily to further stress and frustration.(ABSTRACT TRUNCATED AT 250 WORDS)

Developmental effects of antiepileptic drugs and the need for improved regulations

PubMed Central

Loring, David W.

2016-01-01

Antiepileptic drugs (AEDs) are among the most common teratogenic drugs prescribed to women of childbearing age. AEDs can induce both anatomical (malformations) and behavioral (cognitive/behavioral deficits) teratogenicity. Only in the last decade have we begun to truly discriminate differential AED developmental effects. Fetal valproate exposure carries a special risk for both anatomical and behavioral teratogenic abnormalities, but the mechanisms and reasons for individual variability are unknown. Intermediate anatomical risks exist for phenobarbital and topiramate. Several AEDs (e.g., lamotrigine and levetiracetam) appear to possess low risks for both anatomical and behavioral teratogenesis. Despite advances in the past decade, our knowledge of the teratogenic risks for most AEDs and the underlying mechanisms remain inadequate. Further, the long-term effects of AEDs in neonates and older children remain uncertain. The pace of progress is slow given the lifelong consequences of diminished developmental outcomes, exposing children unnecessarily to potential adverse effects. It is imperative that new approaches be employed to determine risks more expediently. Our recommendations include a national reporting system for congenital malformations, federal funding of the North American AED Pregnancy Registry, routine meta-analyses of cohort studies to detect teratogenic signals, monitoring of AED prescription practices for women, routine preclinical testing of all new AEDs for neurodevelopmental effects, more specific Food and Drug Administration requirements to establish differential AED cognitive effects in children, and improved funding of basic and clinical research to fully delineate risks and underlying mechanisms for AED-induced anatomical and behavioral teratogenesis. PMID:26519545

The smart-talk trap.

PubMed

Pfeffer, J; Sutton, R I

1999-01-01

In today's business world, there's no shortage of know-how. When companies get into trouble, their executives have vast resources at their disposal: their own experiences, colleagues' ideas, reams of computer-generated data, thousands of publications, and consultants armed with the latest managerial concepts and tools. But all too often, even with all that knowledge floating around, companies are plagued with an inertia that comes from knowing too much and doing too little--a phenomenon the authors call the knowing-doing gap. The gap often can be traced to a basic human propensity: the willingness to let talk substitute for action. When confronted with a problem, people act as though discussing it, formulating decisions, and hashing out plans for action are the same as actually fixing it. And after researching organizations of all shapes and sizes, the authors concluded that a particular kind of talk is an especially insidious inhibitor of action: "smart talk." People who can engage in such talk generally sound confident and articulate; they can spout facts and may even have interesting ideas. But such people often exhibit the less benign aspects of smart talk as well: They focus on the negative, and they favor unnecessarily complex or abstract language. The former lapses into criticism for criticism's sake; the latter confuses people. Both tendencies can stop action in its tracks. How can you shut the smart-talk trap and close the knowing-doing gap? The authors lay out five methods that successful companies employ in order to translate the right kind of talk into intelligent action.

New results on the realizability of Reynolds stress turbulence closures

NASA Technical Reports Server (NTRS)

Speziale, Charles G.; Abid, Ridha; Durbin, Paul A.

1993-01-01

The realizability of Reynolds stress models in homogeneous turbulence is critically assessed from a theoretical standpoint. It is proven that a well known second-order closure formulated by Shih and Lumley using the strong realizability constraints of Schumann is, in fact, not a realizable model. The problem arises from the failure to properly satisfy the necessary positive second time derivative constraint when a principal Reynolds stress vanishes - a fatal flaw that becomes apparent when the non-analytic terms in their model are made single-valued as required on physical grounds. It is furthermore shown that the centrifugal acceleration generated by rotations of the principal axes of the Reynolds stress tensor can make the second derivative singular at the most extreme limits of realizable turbulence. This previously overlooked effect appears to make it impossible to identically satisfy the strong form of realizability in any version of the present generation of second-order closures. On the other hand, models properly formulated to satisfy the weak form of realizability - wherein states of one or two component turbulence are not accessible in finite time are found to be realizable. However, unlike the simpler and more commonly used second order closures, these models can be ill-behaved near the extreme limits of realizable turbulence due to the way that higher-degree nonlinearities are often unnecessarily introduced to satisfy realizability. Illustrative computations of homogeneous shear flows are presented to demonstrate these points which can have important implications for turbulence modeling.

Dissecting malpractice in pancreaticoduodenectomy cases.

PubMed

Anandalwar, Seema P; Scholer, Anthony J; Ninan, Gigio; Oliver, Joseph B; Christian, Derick; Eloy, Jean Anderson; Chokshi, Ravi J

2017-05-15

Medical malpractice is a growing concern for physicians in all fields. Surgical fields have some of the highest malpractice premiums and litigation rates. Pancreaticoduodenectomy (PD) has become a popular procedure; however, it is still associated with significant morbidity and mortality. This study is the first to analyze factors involved in litigation regarding PD cases. The Westlaw database was searched for jury verdicts and settlements using the terms "medical malpractice" and "pancreaticoduodenectomy". Twenty-nine cases from 1991 to 2012 were initially collected. Seven entries not involving PD and three duplicate cases were excluded. Nineteen cases were included for analysis. Of the 19 cases included in the analysis, three (15.8%) reached a settlement, three (15.8%) were ruled in favor of the plaintiff, and 13 (68.4%) were ruled in favor of the physician. The average settlement award was $398,333 (range, $195,000-500,000), and the average plaintiff award was $4,288,869 (range, $1,066,608-10,300,000). The most common factors raised in litigation included PD being allegedly unnecessary (47.4%), followed by postoperative negligence and misdiagnosis (36.8% each). The most common factors present in litigation included the allegation that PD was unnecessarily performed. The cases that are awarded large monetary sums are those that involve continued medical care. Ways to improve patient safety and limit litigation include increasing transparency and communication with a thorough discussion between surgeon and patient of the most common topics of litigation discussed. Published by Elsevier Inc.

Communicating Disclosure Risk in Informed Consent Statements

PubMed Central

Singer, Eleanor; Couper, Mick P.

2011-01-01

For several years, we have experimented with various ways of communicating disclosure risk and harm to respondents in order to determine how these affect their willingness to participate in surveys. These experiments, which used vignettes administered to an online panel as well as a mail survey sent to a national probability sample, have demonstrated that (a) the probability of disclosure alone has no apparent effect on people's willingness to participate in the survey described, (b) the sensitivity of the survey topic has such an effect, and (c) making explicit the possible harms that might result from disclosure also reduces willingness to participate, in both the vignette and the mail experiments. As a last study in this series, we experimented with different ways of describing disclosure risk in informed consent statements that might more plausibly be used in real surveys, again using vignettes administered to an online panel. As suggested by our earlier work, we found that the precise wording of the confidentiality assurance had little effect on respondents' stated willingness to participate in the hypothetical survey described. However, the experimental manipulations did have some effect on perceptions of the risks and benefits of participation, suggesting that they are processed by respondents. And, as we have found in our previous studies, the topic of the survey has a consistent and statistically significant effect on stated willingness to participate. We explore some implications of these findings for researchers seeking to provide adequate information to potential survey respondents without alarming them unnecessarily. PMID:20831416

Manifold regularized discriminative nonnegative matrix factorization with fast gradient descent.

PubMed

Guan, Naiyang; Tao, Dacheng; Luo, Zhigang; Yuan, Bo

2011-07-01

Nonnegative matrix factorization (NMF) has become a popular data-representation method and has been widely used in image processing and pattern-recognition problems. This is because the learned bases can be interpreted as a natural parts-based representation of data and this interpretation is consistent with the psychological intuition of combining parts to form a whole. For practical classification tasks, however, NMF ignores both the local geometry of data and the discriminative information of different classes. In addition, existing research results show that the learned basis is unnecessarily parts-based because there is neither explicit nor implicit constraint to ensure the representation parts-based. In this paper, we introduce the manifold regularization and the margin maximization to NMF and obtain the manifold regularized discriminative NMF (MD-NMF) to overcome the aforementioned problems. The multiplicative update rule (MUR) can be applied to optimizing MD-NMF, but it converges slowly. In this paper, we propose a fast gradient descent (FGD) to optimize MD-NMF. FGD contains a Newton method that searches the optimal step length, and thus, FGD converges much faster than MUR. In addition, FGD includes MUR as a special case and can be applied to optimizing NMF and its variants. For a problem with 165 samples in R(1600), FGD converges in 28 s, while MUR requires 282 s. We also apply FGD in a variant of MD-NMF and experimental results confirm its efficiency. Experimental results on several face image datasets suggest the effectiveness of MD-NMF.