In Defense of a Social Value Requirement for Clinical Research.

Science.gov (United States)

Wendler, David; Rid, Annette

2017-02-01

Many guidelines and commentators endorse the view that clinical research is ethically acceptable only when it has social value, in the sense of collecting data which might be used to improve health. A version of this social value requirement is included in the Declaration of Helsinki and the Nuremberg Code, and is codified in many national research regulations. At the same time, there have been no systematic analyses of why social value is an ethical requirement for clinical research. Recognizing this gap in the literature, recent articles by Alan Wertheimer and David Resnik argue that the extant justifications for the social value requirement are unpersuasive. Both authors conclude, contrary to almost all current guidelines and regulations, that it can be acceptable across a broad range of cases to conduct clinical research which is known prospectively to have no social value. The present article assesses this conclusion by critically evaluating the ethical and policy considerations relevant to the claim that clinical research must have social value. This analysis supports the standard view that social value is an ethical requirement for the vast majority of clinical research studies and should be mandated by applicable guidelines and policies. © 2017 John Wiley & Sons Ltd.

value-sensitive clinical accompaniment in community nursing science

African Journals Online (AJOL)

2010-11-05

Nov 5, 2010 ... negative effects on clinical learning in community nursing science. The goal of this ..... such positive effect of value-sensitive communication during clinical .... computer games the whole morning; it was unpleasant);. 'Ons [die ...

Chemicals to enhance microalgal growth and accumulation of high-value bioproducts

Directory of Open Access Journals (Sweden)

Xinheng eYu

2015-02-01

Full Text Available Photosynthetic microalgae have attracted significant attention as they can serve as important sources for cosmetic, food and pharmaceutical products, industrial materials and even biofuel biodiesels. However, current productivity of microalga-based processes is still very low, which has restricted their scale-up application. In addition to various efforts in strain improvement and cultivation optimization, it was proposed that the productivity of microalga-based processes can also be increased using various chemicals to trigger or enhance cell growth and accumulation of bioproducts. Herein, we summarized recent progresses in applying chemical triggers or enhancers to improve cell growth and accumulation of bioproducts in algal cultures. Based on their enhancing mechanisms, these chemicals can be classified into four categories：chemicals regulating biosynthetic pathways, chemicals inducing oxidative stress responses, phytohormones and analogues regulating multiple aspects of microalgal metabolism, and chemicals directly as metabolic precursors. Taken together, the early researches demonstrated that the use of chemical stimulants could be a very effective and economical way to improve cell growth and accumulation of high-value bioproducts in large-scale cultivation of microalgae.

Chemical composition, nutritional value and antioxidant properties of Mediterranean okra genotypes in relation to harvest stage.

Science.gov (United States)

Petropoulos, Spyridon; Fernandes, Ângela; Barros, Lillian; Ferreira, Isabel C F R

2018-03-01

The aim of the present study was to determine the effect of fruit size on nutritional value, chemical composition and antioxidant properties of Mediterranean okra genotypes. For this purpose, pods from four okra cultivars and local landraces commonly cultivated in Greece, as well as pods from four commercial cultivars from North America were collected at two sizes (3-5 and>7cm). Significant differences were observed between the studied genotypes for both nutritional value and chemical composition parameters. Small fruit had a higher nutritional value, whereas chemical composition differed in a genotype dependent manner with most of the studied cultivars showing better results when harvested in small size. In conclusion, fruit size has a genotype dependent impact on chemical composition and nutritional value of okra pods and the common practice of harvesting okra fruit while they still have a small size helps to increase nutritional value for most of the studied genotypes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Optimizing value utilizing Toyota Kata methodology in a multidisciplinary clinic.

Science.gov (United States)

Merguerian, Paul A; Grady, Richard; Waldhausen, John; Libby, Arlene; Murphy, Whitney; Melzer, Lilah; Avansino, Jeffrey

2015-08-01

Value in healthcare is measured in terms of patient outcomes achieved per dollar expended. Outcomes and cost must be measured at the patient level to optimize value. Multidisciplinary clinics have been shown to be effective in providing coordinated and comprehensive care with improved outcomes, yet tend to have higher cost than typical clinics. We sought to lower individual patient cost and optimize value in a pediatric multidisciplinary reconstructive pelvic medicine (RPM) clinic. The RPM clinic is a multidisciplinary clinic that takes care of patients with anomalies of the pelvic organs. The specialties involved include Urology, General Surgery, Gynecology, and Gastroenterology/Motility. From May 2012 to November 2014 we performed time-driven activity-based costing (TDABC) analysis by measuring provider time for each step in the patient flow. Using observed time and the estimated hourly cost of each of the providers we calculated the final cost at the individual patient level, targeting clinic preparation. We utilized Toyota Kata methodology to enhance operational efficiency in an effort to optimize value. Variables measured included cost, time to perform a task, number of patients seen in clinic, percent value-added time (VAT) to patients (face to face time) and family experience scores (FES). At the beginning of the study period, clinic costs were $619 per patient. We reduced conference time from 6 min/patient to 1 min per patient, physician preparation time from 8 min to 6 min and increased Medical Assistant (MA) preparation time from 9.5 min to 20 min, achieving a cost reduction of 41% to $366 per patient. Continued improvements further reduced the MA preparation time to 14 min and the MD preparation time to 5 min with a further cost reduction to $194 (69%) (Figure). During this study period, we increased the number of appointments per clinic. We demonstrated sustained improvement in FES with regards to the families overall experience with their providers

Screening values for Non-Carcinogenic Hanford Waste Tank Vapor Chemicals that Lack Established Occupational Exposure Limits

Energy Technology Data Exchange (ETDEWEB)

Poet, Torka S.; Mast, Terryl J.; Huckaby, James L.

2006-02-06

Over 1,500 different volatile chemicals have been reported in the headspaces of tanks used to store high-level radioactive waste at the U.S. Department of Energy's Hanford Site. Concern about potential exposure of tank farm workers to these chemicals has prompted efforts to evaluate their toxicity, identify chemicals that pose the greatest risk, and incorporate that information into the tank farms industrial hygiene worker protection program. Established occupation exposure limits for individual chemicals and petroleum hydrocarbon mixtures have been used elsewhere to evaluate about 900 of the chemicals. In this report headspace concentration screening values were established for the remaining 600 chemicals using available industrial hygiene and toxicological data. Screening values were intended to be more than an order of magnitude below concentrations that may cause adverse health effects in workers, assuming a 40-hour/week occupational exposure. Screening values were compared to the maximum reported headspace concentrations.

Analysis of determination modalities concerning the exposure and emission limits values of chemical and radioactive substances

International Nuclear Information System (INIS)

Schieber, C.; Schneider, T.

2002-08-01

This document presents the generic approach adopted by various organizations for the determination of the public exposure limits values to chemical and radioactive substances and for the determination of limits values of chemical products emissions by some installations. (A.L.B.)

Value-sensitive clinical accompaniment in community nursing science

Directory of Open Access Journals (Sweden)

Sonya Beukes

2010-11-01

The goal of this study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in the community nursing environment. An exploratory, descriptive and contextual design was used. Interactions between community nurses and students during clinical accompaniment were explored for value sensitivity by means of video recordings,participant observation and focus group interviews. Data were collected by means of video recordings, participant observation and focus group interviews. The data were analysed and coded by the researcher and the external coder, using an inductive descriptive method to identify important segments of the regularity of behaviour. The focus group interviews were transcribed, analysed and coded by the researcher and the external coder, using Tesch’s steps of analysis (Creswell 1994:155–156.Lincoln and Guba’s criteria (1985:290 for trustworthiness were applied to the study. The general findings indicate that clinical accompaniment in community nursing is not value sensitive and, as a result, guidelines for value-sensitive clinical accompaniment need to be developed for undergraduate students in the community nursing environment. The following values (values for which guidelines need to be developed were identified: respect during clinical accompaniment,value-sensitive communication and sensitivity to the quality of clinical accompaniment. Opsomming Kliniese gemeenskapsgesondheidsfasiliteite waar voorgraadse studente geplaas word vir gemeenskapsverpleegkundepraktika is dinamies en het groot veranderinge oor die laaste paar jare ondergaan. In die kliniese veld verteenwoordig gemeenskapsverpleegkundiges en voorgraadse studente verskillende rasse en taal- en etniese groepe in die Suid-Afrikaanse bevolking, elkeen met verskillende waardes. Albei partye – studente en gemeenskapsverpleegkundiges – het gerapporteer dat waardekonflik weens verskillende kulture en waardes tydens kliniese begeleiding

Methods for conversion of carbohydrates in ionic liquids to value-added chemicals

Science.gov (United States)

Zhao, Haibo [The Woodlands, TX; Holladay, Johnathan E [Kennewick, WA; Zhang, Zongchao C [Norwood, NJ

2011-05-10

Methods are described for converting carbohydrates including, e.g., monosaccharides, disaccharides, and polysaccharides in ionic liquids to value-added chemicals including furans, useful as chemical intermediates and/or feedstocks. Fructose is converted to 5-hydroxylmethylfurfural (HMF) in the presence of metal halide and acid catalysts. Glucose is effectively converted to HMF in the presence of chromium chloride catalysts. Yields of up to about 70% are achieved with low levels of impurities such as levulinic acid.

Improving healthcare value through clinical community and supply chain collaboration.

Science.gov (United States)

Ishii, Lisa; Demski, Renee; Ken Lee, K H; Mustafa, Zishan; Frank, Steve; Wolisnky, Jean Paul; Cohen, David; Khanna, Jay; Ammerman, Joshua; Khanuja, Harpal S; Unger, Anthony S; Gould, Lois; Wachter, Patricia Ann; Stearns, Lauren; Werthman, Ronald; Pronovost, Peter

2017-03-01

We hypothesized that integrating supply chain with clinical communities would allow for clinician-led supply cost reduction and improved value in an academic health system. Three clinical communities (spine, joint, blood management) and one clinical community-like physician led team of surgeon stakeholders partnered with the supply chain team on specific supply cost initiatives. The teams reviewed their specific utilization and cost data, and the physicians led consensus-building conversations over a series of team meetings to agree to standard supply utilization. The spine and joint clinical communities each agreed upon a vendor capping model that led to cost savings of $3 million dollars and $1.5 million dollars respectively. The blood management decreased blood product utilization and achieved $1.2 million dollars savings. $5.6 million dollars in savings was achieved by a clinical community-like group of surgeon stakeholders through standardization of sutures and endomechanicals. Physician led clinical teams empowered to lead change achieved substantial supply chain cost savings in an academic health system. The model of combining clinical communities with supply chain offers hope for an effective, practical, and scalable approach to improving value and engaging physicians in other academic health systems. This clinician led model could benefit both private and academic health systems engaging in value optimization efforts. N/A. Copyright © 2016 Elsevier Inc. All rights reserved.

Distribution of haematological and chemical pathology values among infants in Malawi and Uganda

Science.gov (United States)

Kumwenda, Newton I.; Khonje, Tiwonge; Mipando, Linda; Nkanaunena, Kondwani; Katundu, Pauline; Lubega, Irene; Elbireer, Ali; Bolton, Steve; Bagenda, Danstan; Mubiru, Michael; Fowler, Mary Glenn; Taha, Taha E.

2013-01-01

Background Data on paediatric reference laboratory values are limited for sub-Saharan Africa. Objective To describe the distribution of haematological and chemical pathology values among healthy infants from Malawi and Uganda. Methods A cross-sectional study was conducted among healthy infants, 0–6 months old, born to HIV-uninfected mothers recruited from two settings in Blantyre, Malawi and Kampala, Uganda. Chemical pathology and haematology parameters were determined using standard methods on blood samples. Descriptive analyses by age-group were performed based on 2004 Division of AIDS Toxicity Table age categories. Mean values and interquartile ranges were compared by site and age-group. Results A total of 541 infants were included altogether, 294 from Malawi and 247 from Uganda. Overall, the mean laboratory values were comparable between the two sites. Mean alkaline phosphatase levels were lower among infants aged ≤21 days while aspartate aminotransferase, creatinine, total bilirubin and gamma-glutamyl transferase were higher in those aged 0–7 days than in older infants. Mean haematocrit, haemoglobin and neutrophil counts were higher in the younger age-groups (<35 days) and overall were lower than US norms. Red and white blood cell counts tended to decrease after birth but increased after ~2 months of age. Mean basophil counts were higher in Malawi than in Uganda in infants aged 0–1 and 2–7 days; mean counts for eosinophils (for age groups 8–21 or older) and platelets (for all age groups) were higher in Ugandan than in Malawian infants. Absolute lymphocyte counts increased with infant age. Conclusion The chemical pathology and haematological values in healthy infants born to HIV-uninfected mothers were comparable in Malawi and Uganda and can serve as useful reference values in these settings. PMID:23164296

Correlations between the 1H NMR chemical shieldings and the pKa values of organic acids and amines.

Science.gov (United States)

Lu, Juanfeng; Lu, Tingting; Zhao, Xinyun; Chen, Xi; Zhan, Chang-Guo

2018-06-01

The acid dissociation constants and 1 H NMR chemical shieldings of organic compounds are important properties that have attracted much research interest. However, few studies have explored the relationship between these two properties. In this work, we theoretically studied the NMR chemical shifts of a series of carboxylic acids and amines in the gas phase and in aqueous solution. It was found that the negative logarithms of the experimental acid dissociation constants (i.e., the pK a values) of the organic acids and amines in aqueous solution correlate almost linearly with the corresponding calculated NMR chemical shieldings. Key factors that affect the theoretically predicted pK a values are discussed in this paper. The present work provides a new way to predict the pK a values of organic/biochemical compounds. Graphical abstract The chemical shielding values of organic acids and amines correlate near linearly with their corresponding pK a values.

Digestibility and energetic value of agricultural wastes as affected by gamma irradiation and chemical treatments

International Nuclear Information System (INIS)

Al-Masri, M.R.

2002-01-01

Experiments were carried out to study the changes in the values of in-vitro apparent organic matter digestibility (IVOMD), metabolizable energy (ME) and net energy lactation (NEL) of wheat straw, sunflower seed shell, olive cake wood, date palm seeds and peanut shell after spraying with different concentrations of hydrobromic acid (HBr) and sodium hydroxide (NaOH) (0,3,6 ml HBr and 3,6 g NaOH/25 ml water/100 g Dm) or after exposure to various doses of gamma radiation (0, 20, 40, 60 kGy). Results indicated that, except for the date palm seeds, the chemical treatments with either HBr or NaOH significantly (P<0.05) increased IVOMD, Me and NEL values for all treated samples. The experimental agricultural wastes did not respond equally to the chemical treatments investigated, i.e. they differ in the induced increases pertaining to their IVOMD, ME and NEL. The highest changes in the studied parameters due to chemical treatments were obtained when applying the 6% concentration. There was no significant effect (P<0.05) of irradiation on IVOMD, ME and NEL values for all treated samples. Moreover, the combined treatments of irradiation and hydrobromic acid or sodium hydroxide were found to have no significant affects on the IVOMD, ME and NEL values compared to the individual chemical treatments. (author)

Personal values and self-esteem in general and clinical population

Directory of Open Access Journals (Sweden)

Vanesa C. Góngora

2015-09-01

Full Text Available The aim of this study is to investigate the association between personal values and self-esteem in general population and clinical population. The sample was composed of a group of patients with a diagnosis of anxiety disorders and/or depression (n = 60 and a comparison group, paired by sex and age, of general population (n = 60. The Portrait Values Questionnaire of Schwartz (PVQ and the Autoe Self-esteem Scale were used. T-tests were performed to compare the scores of both instruments between the two groups. The clinical sample scored significantly lower in Self-esteem, Self- direction, Hedonism, and Openness to Change. For this reason, Pearson correlations were calculated in differential groups (clinical and general between the PVQ and the Self-esteem Scale. In the general population group self-esteem was associated to one value: Self-direction. In the clinical group, self-esteem was associated mainly to Self- direction, but also to Hedonism, Power and Security; and to the axis Self-promotion and Openness to Change. Both in the clinical and general population samples it was found a significant association between the interest in having independent thought, freedom of action and exploring with higher levels of self-esteem. 

Determination of reference values for intraocular pressure and Schirmer tear test results in clinically normal domestic donkeys (Equus asinus).

Science.gov (United States)

Selk Ghaffari, Masoud; Sabzevari, Amin; Ghamsari, SeyedMehdi; Shad, Hussein

2017-11-25

This study was conducted to establish normal reference range for the Schirmer tear test (STT) and intraocular pressure (IOP) in clinically normal donkeys for use in clinical practice. Sixteen adult Ethiopian domestic donkeys were used in this study. Complete ophthalmic examinations were performed without chemical restraint. STT values were evaluated in both eyes of all donkeys using a commercial STT strip. IOP was measured in both eyes with a Tono-Pen Vet (Reichert. USA) without using regional nerve blocks. STT values for all eyes (n=32) were 22.1±6.9 mm/minute with a range of 13-35 mm/minute. Comparison of mean STT values between right (n=16) and left eyes (n=16) showed no differences (P=0.6). Mean ±sd IOP values by applanation tonometry were 17.8±3.7 mmHg (range 13.5-24.5 mmHg). Comparison of mean IOP values between right (n=16) and left eyes (n=16) showed no differences (P=0.7). This initial survey provides means and ranges for IOP and STT values in donkeys. These data will assist veterinary ophthalmologists in more accurate diagnosis and management of ophthalmic diseases in donkeys, including keratoconjunctivitis sicca and glaucoma. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Clinical value of component-resolved diagnostics in peanut-allergic patients

DEFF Research Database (Denmark)

Eller, E; Bindslev-Jensen, C

2013-01-01

As replacement for the oral food challenge, decision-points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported to be of v......As replacement for the oral food challenge, decision-points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported...... to be of value, but data on correlation with clinical data are sparse. Our aim was to correlate IgE values with the outcome of peanut challenges....

Method for conversion of carbohydrate polymers to value-added chemical products

Science.gov (United States)

Zhang, Zongchao C [Norwood, NJ; Brown, Heather M [Kennewick, WA; Su, Yu [Richland, WA

2012-02-07

Methods are described for conversion of carbohydrate polymers in ionic liquids, including cellulose, that yield value-added chemicals including, e.g., glucose and 5-hydroxylmethylfurfural (HMF) at temperatures below 120.degree. C. Catalyst compositions that include various mixed metal halides are described that are selective for specified products with yields, e.g., of up to about 56% in a single step process.

Effect of mentoring on professional values in model C clinical nurse leader graduates.

Science.gov (United States)

Gazaway, Shena B; Anderson, Lori; Schumacher, Autumn; Alichnie, Chris

2018-04-19

Nursing graduates acquire their nursing values by professional socialization. Mentoring is a crucial support mechanism for these novice nurses, yet little is known about the model C clinical nurse leader graduate and the effects of mentoring. This investigation examined how mentoring affected the development of professional nursing values in the model C clinical nurse leader graduate. A longitudinal design was used to survey model C clinical nurse leader graduates before and after graduation to determine how different types of mentoring relationships influenced professional values. Demographic surveys documented participant characteristics and the Nurses Professional Values Scale - Revised (NPVS-R) assessed professional nursing values. Mean NPVS-R scores increased after graduation for the formally mentored participants, while the NPVS-R scores decreased or remained unchanged for the other mentoring groups. However, no significant difference was found in NPVS-R scores over time (p = .092) or an interaction between the NPVS-R scores and type of mentoring relationships (p = .09). These results suggest that model C clinical nurse leader graduate participants experiencing formal mentoring may develop professional nursing values more than their colleagues. Formal mentoring relationships are powerful and should be used to promote professional values for model C clinical nurse leader graduates. © 2018 John Wiley & Sons Ltd.

Medicine, methodology, and values: trade-offs in clinical science and practice.

Science.gov (United States)

Ho, Vincent K Y

2011-01-01

The current guidelines of evidence-based medicine (EBM) presuppose that clinical research and clinical practice should advance from rigorous scientific tests as they generate reliable, value-free knowledge. Under this presupposition, hypotheses postulated by doctors and patients in the process of their decision making are preferably tested in randomized clinical trials (RCTs), and in systematic reviews and meta-analyses summarizing outcomes from multiple RCTs. Since testing under this scheme is predominantly focused on the criteria of generality and precision achieved through methodological rigor, at the cost of the criterion of realism, translating test results to clinical practice is often problematic. Choices concerning which methodological criteria should have priority are inevitable, however, as clinical trials, and scientific research in general, cannot meet all relevant criteria at the same time. Since these choices may be informed by considerations external to science, we must acknowledge that science cannot be value-free in a strict sense, and this invites a more prominent role for value-laden considerations in evaluating clinical research. The urgency for this becomes even more apparent when we consider the important yet implicit role of scientific theories in EBM, which may also be subjected to methodological evaluation and for which selectiveness in methodological focus is likewise inevitable.

The Emerging Business Models and Value Proposition of Mobile Health Clinics.

Science.gov (United States)

Aung, Khin-Kyemon; Hill, Caterina; Bennet, Jennifer; Song, Zirui; Oriol, Nancy E

2015-12-01

Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health outcomes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them-adoption by accountable care organizations, payers, and employers.

Digestibility and energetic value of some agricultural wastes as affected by gamma irradiation and chemical treatments

International Nuclear Information System (INIS)

Al-Masri, M.R.

2001-08-01

Experiments were carried out to study the changes in the values of in-vitro apparent organic matter digestibility (IVOMD), metabolizable energy (ME) and net energy lactation (NEL) of wheat straw, sunflower seed shell, olive cake wood, date palm seeds and peanut shell after spraying with different concentrations of hydrobromic acid (HBr) and sodium hydroxide (NaOH) (0,3,6 ml HBr and 3,6 g NaOH/25 ml water/100 g DM) or after exposure to various doses of gamma radiation (0, 20, 40, 60 kGy). Results indicated that, except for the date palm seeds, the chemical treatments with either HBr or NaOH significantly (P<0.05) increased IVOMD, Me and NEL values for all treated samples. The experimental agricultural wastes did not respond equally to the chemical treatments investigated, i.e. they differ in the induced increases pertaining to their IVOMD, ME and NEL. The highest changes in the studied parameters due to chemical treatments were obtained when applying the 6% concentration. There was no significant effect (P<0.05) of irradiation on IVOMD, ME and NEL values for all treated samples. Moreover, the combined treatments of irradiation and hydrobromic acid or sodium hydroxide were found to have no significant affects on the IVOMD, ME and NEL values compared to the individual chemical treatments. (author)

DWI of Prostate Cancer: Optimal b-Value in Clinical Practice

Directory of Open Access Journals (Sweden)

Guglielmo Manenti

2014-01-01

Full Text Available Aim. To compare the diagnostic performance of diffusion weighted imaging (DWI using b-values of 1000 s/mm2 and 2000 s/mm2 at 3 Tesla (T for the evaluation of clinically significant prostate cancer. Matherials and Methods. Seventy-eight prostate cancer patients underwent a 3T MRI scan followed by radical prostatectomy. DWI was performed using b-values of 0, 1000, and 2000 s/mm2 and qualitatively analysed by two radiologists. ADC maps were obtained at b-values of 1000 and 2000 s/mm2 and quantitatively analyzed in consensus. Results. For diagnosis of 78 prostate cancers the accuracy of DWI for the young reader was significantly greater at b = 2000 s/mm2 for the peripheral zone (PZ but not for the transitional zone (TZ. For the experienced reader, DWI did not show significant differences in accuracy between b-values of 1000 and 2000 s/mm2. The quantitative analysis in the PZ and TZ was substantially superimposable between the two b-values, albeit with a higher accuracy with a b-value of 2000 s/mm2. Conclusions. With a b-value of 2000 s/mm2 at 3T both readers differentiated clinical significant cancer from benign tissue; higher b-values can be helpful for the less experienced readers.

From Value Assessment to Value Cocreation: Informing Clinical Decision-Making with Medical Claims Data.

Science.gov (United States)

Thompson, Steven; Varvel, Stephen; Sasinowski, Maciek; Burke, James P

2016-09-01

Big data and advances in analytical processes represent an opportunity for the healthcare industry to make better evidence-based decisions on the value generated by various tests, procedures, and interventions. Value-based reimbursement is the process of identifying and compensating healthcare providers based on whether their services improve quality of care without increasing cost of care or maintain quality of care while decreasing costs. In this article, we motivate and illustrate the potential opportunities for payers and providers to collaborate and evaluate the clinical and economic efficacy of different healthcare services. We conduct a case study of a firm that offers advanced biomarker and disease state management services for cardiovascular and cardiometabolic conditions. A value-based analysis that comprised a retrospective case/control cohort design was conducted, and claims data for over 7000 subjects who received these services were compared to a matched control cohort. Study subjects were commercial and Medicare Advantage enrollees with evidence of CHD, diabetes, or a related condition. Analysis of medical claims data showed a lower proportion of patients who received biomarker testing and disease state management services experienced a MI (p companies have in terms of identifying value-creating healthcare interventions. However, payers and providers also need to pursue system integration efforts to further automate the identification and dissemination of clinically and economically efficacious treatment plans to ensure at-risk patients receive the treatments and interventions that will benefit them the most.

Beyond clinical utility: The multiple values of DTC genetics

Directory of Open Access Journals (Sweden)

Mauro Turrini

2016-03-01

Full Text Available One point of consensus in the otherwise very controversial discussion about the benefits and dangers of DTC genetics in the health domain is the lack of substantial clinical utility. At the same time, both the empirical and conceptual literature indicate that health-related DTC tests can have value and utility outside of the clinic. We argue that a broader and multi-faceted conceptualization of utility and value would enrich the ethical and social discussion of DTC testing in several ways: First, looking at ways in which DTC testing can have personal and social value for users – in the form of entertainment, learning, or a way to relate to others – can help to explain why people still take DTC tests, and will, further down the line, foster a more nuanced understanding of secondary and tertiary uses of DTC test results (which could very well unearth new ethical and regulatory challenges. Second, considering the economic value and broader utility of DTC testing foregrounds wider social and political aspects than have been dominant in the ethical and regulatory debates surrounding DTC genetics so far. These wider political aspects include the profound power asymmetries that characterize the collection and use of personal genetic data in many contexts.

Top value platform chemicals: bio-based production of organic acids.

Science.gov (United States)

Becker, Judith; Lange, Anna; Fabarius, Jonathan; Wittmann, Christoph

2015-12-01

Driven by the quest for sustainability, recent years have seen a tremendous progress in bio-based production routes from renewable raw materials to commercial goods. Particularly, the production of organic acids has crystallized as a competitive and fast-evolving field, related to the broad applicability of organic acids for direct use, as polymer building blocks, and as commodity chemicals. Here, we review recent advances in metabolic engineering and industrial market scenarios with focus on organic acids as top value products from biomass, accessible through fermentation and biotransformation. Copyright © 2015 Elsevier Ltd. All rights reserved.

A national survey on pediatric critical values used in clinical laboratories across Canada.

Science.gov (United States)

Gong, Yanping; Adeli, Khosrow

2009-11-01

Notification of critical values to clinical staff is an important post-analytical process in all acute care clinical laboratories. No data are available however on how laboratories obtain or establish critical values, particularly in pediatric settings. This study was designed to examine and compare critical values used for pediatric patients in biochemistry laboratories in Canada and assess potential interlaboratory variability. Fourteen clinical laboratories, including two in pediatric hospitals and twelve in hospitals caring for both children and adults, participated in a survey that included 14 pre-selected STAT chemistry tests and 19 pre-selected therapeutic drug monitoring (TDM) tests. Among fourteen chemistry tests, good agreement was observed for critical values used for sodium and pH at both low and high levels within 14 participant laboratories. Significant interlaboratory variability existed for glucose critical values at the high end, magnesium at high end, and PO2 at the low end. For 19 TDM tests, the majority of laboratories did not have alert values to report values over the therapeutic level but not toxic. For critical values greater than the toxic range, significant variability existed at both trough and peak levels among laboratories surveyed. When asked to provide the source for critical values established at each site, only a limited number of laboratories identified their sources as either internal decision or published references. Although all laboratories have established and routinely use critical values to alert clinical staff, considerable variability exists in both the critical limits reported as well as the source of such values. There is a clear need for new national efforts to standardize pediatric critical value reporting and establish evidence-based critical limits for all medical laboratories across Canada.

Collaborative partnership and the social value of clinical research: a qualitative secondary analysis.

Science.gov (United States)

Nurmi, Sanna-Maria; Halkoaho, Arja; Kangasniemi, Mari; Pietilä, Anna-Maija

2017-10-25

Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders' perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for

Clinical Pathways and the Patient Perspective in the Pursuit of Value-Based Oncology Care.

Science.gov (United States)

Ersek, Jennifer L; Nadler, Eric; Freeman-Daily, Janet; Mazharuddin, Samir; Kim, Edward S

2017-01-01

The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.

Critical value reporting: a survey of 36 clinical laboratories in South Africa.

Science.gov (United States)

Schapkaitz, Elise; Mafika, Zipho

2013-10-11

Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. Despite their widespread use, critical value policies have not been published locally. A survey was designed to determine critical value policies for haematology tests in South Africa. A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were affiliated to academic institutions and 55.6% (n=20) were peripheral or regional National Health Laboratory Service laboratories. All the laboratories confirmed that they had a critical value policy, and 83.3% of such policies were derived from local clinical opinion. Mean low and high critical limits for the most frequently listed tests were as follows: haemoglobin 20 g/dl, platelet count 1 000 ×10(9)/l, white cell count 46 ×10(9)/l, activated partial thromboplastin time >101 seconds, and international normalised ratio >6. In almost all cases critical value reporting was performed by the technologist on duty (97.2%). The majority of laboratories required that the person notified of the critical value be the doctor who ordered the test or the caregiver directly involved in the patient's care (83.3%); 73.3% of laboratories indicated that they followed an algorithm if the doctor/caregiver could not be reached. Each laboratory is responsible for establishing clinically relevant critical limits. Clinicians should be involved in developing the laboratory's critical value policy. The findings of this survey may be of value to local laboratories that are in the process of establishing or reviewing critical value policies.

Opportunity for high value-added chemicals from food supply chain wastes.

Science.gov (United States)

Matharu, Avtar S; de Melo, Eduardo M; Houghton, Joseph A

2016-09-01

With approximately 1.3 billion tonnes of food wasted per annum, food supply chain wastes (FSCWs) may be viewed as the contemporary Periodic Table of biobased feedstock chemicals (platform molecules) and functional materials. Herein, the global drivers and case for food waste valorisation within the context of global sustainability, sustainable development goals and the bioeconomy are discussed. The emerging potential of high value added chemicals from certain tropical FSCW is considered as these are grown in three major geographical areas: Brazil, India and China, and likely to increase in volume. FSCW in the context of biorefineries is discussed and two case studies are reported, namely: waste potato, and; orange peel waste. Interestingly, both waste feedstocks, like many others, produce proteins and with the global demand for vegetable proteins on the rise then proteins from FSCW may become a dominant area. Copyright © 2016 Elsevier Ltd. All rights reserved.

The value of pathogen information in treating clinical mastitis

NARCIS (Netherlands)

Cha, Elva; Smith, Rebecca L.; Kristensen, Anders R.; Hertl, Julia A.; Schukken, Ynte H.; Tauer, Loren W.; Welcome, Frank L.; Gröhn, Yrjö T.

2016-01-01

The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the

The value of pathogen information in treating clinical mastitis

NARCIS (Netherlands)

Cha, Elva; Smith, Rebecca L.; Kristensen, Anders R.; Hertl, Julia A.; Schukken, Ynte H.; Tauer, Loren W.; Welcome, Frank L.; Gröhn, Yrjö T.

2016-01-01

The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen

Chemical compound-based direct reprogramming for future clinical applications

Science.gov (United States)

Takeda, Yukimasa; Harada, Yoshinori; Yoshikawa, Toshikazu; Dai, Ping

2018-01-01

Recent studies have revealed that a combination of chemical compounds enables direct reprogramming from one somatic cell type into another without the use of transgenes by regulating cellular signaling pathways and epigenetic modifications. The generation of induced pluripotent stem (iPS) cells generally requires virus vector-mediated expression of multiple transcription factors, which might disrupt genomic integrity and proper cell functions. The direct reprogramming is a promising alternative to rapidly prepare different cell types by bypassing the pluripotent state. Because the strategy also depends on forced expression of exogenous lineage-specific transcription factors, the direct reprogramming in a chemical compound-based manner is an ideal approach to further reduce the risk for tumorigenesis. So far, a number of reported research efforts have revealed that combinations of chemical compounds and cell-type specific medium transdifferentiate somatic cells into desired cell types including neuronal cells, glial cells, neural stem cells, brown adipocytes, cardiomyocytes, somatic progenitor cells, and pluripotent stem cells. These desired cells rapidly converted from patient-derived autologous fibroblasts can be applied for their own transplantation therapy to avoid immune rejection. However, complete chemical compound-induced conversions remain challenging particularly in adult human-derived fibroblasts compared with mouse embryonic fibroblasts (MEFs). This review summarizes up-to-date progress in each specific cell type and discusses prospects for future clinical application toward cell transplantation therapy. PMID:29739872

Threshold of toxicological concern values for non-genotoxic effects in industrial chemicals: re-evaluation of the Cramer classification.

Science.gov (United States)

Kalkhof, H; Herzler, M; Stahlmann, R; Gundert-Remy, U

2012-01-01

The TTC concept employs available data from animal testing to derive a distribution of NOAELs. Taking a probabilistic view, the 5th percentile of the distribution is taken as a threshold value for toxicity. In this paper, we use 824 NOAELs from repeated dose toxicity studies of industrial chemicals to re-evaluate the currently employed TTC values, which have been derived for substances grouped according to the Cramer scheme (Cramer et al. in Food Cosm Toxicol 16:255-276, 1978) by Munro et al. (Food Chem Toxicol 34:829-867, 1996) and refined by Kroes and Kozianowski (Toxicol Lett 127:43-46, 2002), Kroes et al. 2000. In our data set, consisting of 756 NOAELs from 28-day repeated dose testing and 57 NOAELs from 90-days repeated dose testing, the experimental NOAEL had to be extrapolated to chronic TTC using regulatory accepted extrapolation factors. The TTC values derived from our data set were higher than the currently used TTC values confirming the safety of the latter. We analysed the prediction of the Cramer classification by comparing the classification by this tool with the guidance values for classification according to the Globally Harmonised System of classification and labelling of the United Nations (GHS). Nearly 90% of the chemicals were in Cramer class 3 and assumed as highly toxic compared to 22% according to the GHS. The Cramer classification does underestimate the toxicity of chemicals only in 4.6% of the cases. Hence, from a regulatory perspective, the Cramer classification scheme might be applied as it overestimates hazard of a chemical.

Biological and chemical weapons of mass destruction: updated clinical therapeutic countermeasures since 2003.

Science.gov (United States)

Pettineo, Christopher; Aitchison, Robert; Leikin, Scott M; Vogel, Stephen N; Leikin, Jerrold B

2009-01-01

The objective of this article is to provide updated treatment options for bioterrorism agents. This updated synopsis includes recent clinical cases and treatment recommendations that have arisen in the last 5 years. The decontamination, treatment, and disposition of these biologic and chemical agents are presented alphabetically by agent type: biologic, chemical, and radiologic/nuclear. The information provided outlines only new treatment options since 2003.

Clinical value of natriuretic peptides in chronic kidney disease.

Science.gov (United States)

Santos-Araújo, Carla; Leite-Moreira, Adelino; Pestana, Manuel

2015-01-01

According to several lines of evidence, natriuretic peptides (NP) are the main components of a cardiac-renal axis that operate in clinical conditions of decreased cardiac hemodynamic tolerance to regulate sodium homeostasis, blood pressure and vascular function. Even though it is reasonable to assume that NP may exert a relevant role in the adaptive response to renal mass ablation, evidence gathered so far suggest that this contribution is probably complex and dependent on the type and degree of the functional mass loss. In the last years NP have been increasingly used to diagnose, monitor treatment and define the prognosis of several cardiovascular (CV) diseases. However, in many clinical settings, like chronic kidney disease (CKD), the predictive value of these biomarkers has been questioned. In fact, it is now well established that renal function significantly affects the plasmatic levels of NP and that renal failure is the clinical condition associated with the highest plasmatic levels of these peptides. The complexity of the relation between NP plasmatic levels and CV and renal functions has obvious consequences, as it may limit the predictive value of NP in CV assessment of CKD patients and be a demanding exercise for clinicians involved in the daily management of these patients. This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure. Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.

Radiation protection in clinical chemical laboratories

International Nuclear Information System (INIS)

Jacob, K.

1980-01-01

In the clinical-chemical laboratory, the problems of the personal radiation protection can be handled relatively simply. Important conditions are certain requirements as far as the building is concerned and the keeping to protection measures to invoid ingestion, inhalation, and resorption of open radioactive substances. Very intensive attention must be paid to a clean working technique in order to be able to exclude the danger of contamination which is very disturbing during the extremely sensitive measurements. The higgest problem in the handling of open radioactive substances, however, is in our opinion the waste management because it requires which space and personnel this causing high costs. Furthermore, since 1 January 1979, the permission for the final storage of radioactive waste in the shut down mine ASSE was taken back from the county collection places and it cannot be said yet if and when this permission will be given again. (orig./HP) [de

The Value of Clinical Jazz: Teaching Critical Reflection on, in, and Toward Action.

Science.gov (United States)

Casapulla, Sharon; Longenecker, Randall; Beverly, Elizabeth A

2016-05-01

Clinical Jazz is a small-group strategy in medical education designed to develop interpersonal skills and improve doctor-patient and interprofessional relationships. The purpose of this study was to explore medical students' and faculty facilitators' perceived value of Clinical Jazz. We conducted a modified Nominal Group Process with participating medical students (n=21), faculty facilitators (n=5), and research team members (n=3). Students and faculty facilitators independently answered the question, "What do you value about Clinical Jazz?" We then conducted content and thematic analyses on the resulting data. Three themes emerged during analysis: (1) students and faculty appreciated the opportunity to learn and practice a thoughtful and structured process for problem solving, (2) students and faculty valued the safety of the group process in sharing a diversity of perspectives on topics in medicine, and (3) students and faculty acknowledged the importance of addressing real and challenging problems that are rarely addressed in formal lectures and other planned small-group settings. Clinical Jazz provides students and faculty with the opportunity to address the hidden and/or informal curriculum in medical education, while providing a safe space and time to solve important clinical and interprofessional problems.

Are exposure index values consistent in clinical practice? A multi-manufacturer investigation

International Nuclear Information System (INIS)

Butler, M. L.; Rainford, L.; Last, J.; Brennan, P. C.

2010-01-01

The advent of digital radiography poses the risk of unnoticed increases in patient dose. Manufacturers have responded to this by offering an exposure index (EI) value to the clinician. Whilst the EI value is a measure of the air kerma at the detector surface, it has been recommended by international agencies as a method of monitoring radiation dose to the patient. Recent studies by the group have shown that EI values are being used in clinical practice to monitor radiation dose and assess image quality. This study aims to compare the clinical consistency of the EI value in computed radiography (CR) and direct digital radiography (DR) systems. An anthropomorphic phantom was used to simulate four common radiographic examinations: skull, pelvis, chest and hand. These examinations were chosen as they provide contrasting exposure parameters, image detail and radiation dose measurements. Four manufacturers were used for comparison: Agfa Gaevert CR, Carestream CR, Philips Digital Diagnost DR and Siemens DR. For each examination, the phantom was placed in the optimal position and exposure parameters were chosen in accordance with European guidelines and clinical practice. Multiple exposures were taken and the EI recorded. All exposure parameters and clinical conditions remained constant throughout. For both DR systems, the EI values remained consistent throughout. No significant change was noted in any examination. In both CR systems, there were noteworthy fluctuations in the EI values for all examinations. The largest for the Agfa system was a variation of 1.88-2.21 for the skull examination. This represents to the clinician a doubling of detector dose, despite all exposure parameters remaining constant. In the Kodak system, the largest fluctuation was seen for the chest examination where the EI ranged from 2560 to 2660, representing approximately an increase of 30% in radiation dose, despite consistent parameters. The fluctuations seen with the CR systems are most likely

Most oxidative stress response in water samples comes from unknown chemicals: the need for effect-based water quality trigger values.

Science.gov (United States)

Escher, Beate I; van Daele, Charlotte; Dutt, Mriga; Tang, Janet Y M; Altenburger, Rolf

2013-07-02

The induction of adaptive stress response pathways is an early and sensitive indicator of the presence of chemical and non-chemical stressors in cells. An important stress response is the Nrf-2 mediated oxidative stress response pathway where electrophilic chemicals or chemicals that cause the formation of reactive oxygen species initiate the production of antioxidants and metabolic detoxification enzymes. The AREc32 cell line is sensitive to chemicals inducing oxidative stress and has been previously applied for water quality monitoring of organic micropollutants and disinfection byproducts. Here we propose an algorithm for the derivation of effect-based water quality trigger values for this end point that is based on the combined effects of mixtures of regulated chemicals. Mixture experiments agreed with predictions by the mixture toxicity concept of concentration addition. The responses in the AREc32 and the concentrations of 269 individual chemicals were quantified in nine environmental samples, ranging from treated effluent, recycled water, stormwater to drinking water. The effects of the detected chemicals could explain less than 0.1% of the observed induction of the oxidative stress response in the sample, affirming the need to use effect-based trigger values that account for all chemicals present.

Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

NARCIS (Netherlands)

Heymans, R.; van der Helm, J. J.; de Vries, H. J. C.; Fennema, H. S. A.; Coutinho, R. A.; Bruisten, S. M.

2010-01-01

The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary

Chemical composition, nutritional value and in vitro starch digestibility of roasted chickpeas.

Science.gov (United States)

Simsek, Senay; Herken, Emine Nur; Ovando-Martinez, Maribel

2016-06-01

Chickpea is considered a wholesome and nutritious food due to its nutritional properties and glycemic response. Such properties can be influenced by the thermal treatment used to cook this legume and produce a snack named leblebi. From the consumers' point of view, it is desirable to improve texture and palatability of the chickpea by the processing steps used to make leblebi. However, consumers are increasingly concerned with the nutritional value of snack foods. Nutritional components and digestibility properties of single and double heat-treated chickpea, single and double roasted leblebi and white leblebi were studied. High sodium, starch damage and soluble dietary fiber content were observed in white leblebi; while the other samples showed significantly (P good nutritional quality and low glycemic response. White leblebi had relatively high sodium content and glycemic response. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Nutritional value and chemical composition of Cichorium spinosum L. under saline conditions

OpenAIRE

Petropoulos, Spyridon Α.; Vasilios, Antoniadis; Efi, Levizou; Fernandes, Ângela; Barros, Lillian; Ferreira, Isabel C.F.R.

2016-01-01

Soil salinity is an ever‐growing problem that hinders vegetable cultivation in many areas within the Mediterranean basin. Cichorium spinosum is native to the Mediterranean basin and is usually found in coastal areas and plateaus. In the present study, C. spinosum plants were grown under saline conditions (1.8, 4 and 8 dS/m), in order to evaluate the effect of salinity on their nutritional value and chemical composition. From the results it was observed that high salinity levels...

Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

Directory of Open Access Journals (Sweden)

Nicole Bijlsma

2016-02-01

Full Text Available A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, innovative breakthroughs in biomedical research encompassing the “-omics” fields, and advances in mobile sensing, peer-to-peer networks and big data, provide tools that future clinicians can use to assess environmental chemical exposures in their patients. There is also a need for concerted action at all levels, including actions by individual patients, clinicians, medical educators, regulators, government and non-government organisations, corporations and the wider civil society, to understand the “exposome” and minimise the extent of toxic exposures on current and future generations. Clinical environmental chemical risk assessment may provide a bridge between multiple disciplines that uses new technologies to herald in a new era in personalised medicine that unites clinicians, patients and civil society in the quest to understand and master the links between the environment and human health.

Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

International Nuclear Information System (INIS)

Liu Xiao; Wang Guiqi; He Shun

2014-01-01

Objective: To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer (EC). Methods: A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound (EUS), esophagoscopy, thoracic CT scans,and contrast esophagography and had detailed information on postoperative pathological stages. The predictive value of preoperative clinical T/N stage based on EUS + CT for postoperative pathological stage was analyzed. The disease free survival (DFS) and overall survival (OS) were analyzed according to the UICC TNM classification (2002/ 2009) and the clinical stage based on imaging findings. Results: The median follow-up was 47 months.A total of 305 (85.2%) of all patients were analyzed by clinical stage based on EUS + CT.Among them, the predictive value of clinical T stage for pathological T stage was 0-88.6%, highest (88.6%) for T1 stage and lowest for T4 stage. The predictive value of clinical N stage (N 0 /N1) was 62.5-100%. The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted (P=0.000 and 0.000). There were significant differences in OS between stage groups, except the comparison between two stage Ⅳ patients and other groups, according to 2002 UICC TNM classification. There were usually insignificant differences in OS between stage groups, according to 2009 UICC TNM classification. For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification, significant differences in OS and DFS rates were noted (P=0.000 and 0.000). Conclusions: Imaging modalities show good predictive value for N stage (N0/N1),even though they cannot accurately provide the number of metastatic lymph nodes. The clinical stage based on EUS + CT can effectively predict the prognosis of non-surgical EC patients

Groundwater chemical baseline values to assess the Recovery Plan in the Matanza-Riachuelo River basin, Argentina.

Science.gov (United States)

Zabala, M E; Martínez, S; Manzano, M; Vives, L

2016-01-15

The two most exploited aquifers in the Matanza-Riachuelo River basin are being monitored in the framework of the Integrated Environmental Sanitation Plan that implements the Basin Authority, Autoridad de Cuenca Matanza Riachuelo. In this context, this work identifies the groundwater chemical types and the natural processes behind them; determines spatial and temporal changes; establishes ranges of variation for chemical components, and proposes concentration values for the upper limit of the natural chemical background. A total of 1007 samples from three aquifer-layers (Upper Aquifer, top and bottom of Puelche Aquifer) have been studied. As concrete guidelines for practical determination of baseline values are not available in the region, the methodology used follows the proposals of European projects which assessed European water directives. The groundwater composition is very stable in terms of both chemical facies and mineralization degree, and the changes observed in the dry and wet periods analysed are subtle in general. Most of the groundwater is Na-HCO3 type, except a few samples that are Ca-HCO3, Na-ClSO4 and Na-Cl types. The Ca-HCO3 waters are the result of calcium carbonate dissolution, Na-HCO3 waters result from cation exchange and carbonate dissolution, while in the Na-ClSO4 and Na-Cl waters, mixing with connate and with encroached old marine water from the underlying and overlying sediments are the most relevant processes. The proposed values for the upper limit of the natural background consider the influence of geology and Holocene marine ingressions in the baseline of coastal groundwater. This study allowed to know the initial chemical conditions of the groundwater system of the Matanza-Riachuelo River basin and to establish the reference from which Basin Authority can start to evaluate trends and monitor the recovery plan. At the same time, it sets a precedent for future studies in the region. Copyright © 2015 Elsevier B.V. All rights reserved.

Clinical impact and value of workstation single sign-on.

Science.gov (United States)

Gellert, George A; Crouch, John F; Gibson, Lynn A; Conklin, George S; Webster, S Luke; Gillean, John A

2017-05-01

CHRISTUS Health began implementation of computer workstation single sign-on (SSO) in 2015. SSO technology utilizes a badge reader placed at each workstation where clinicians swipe or "tap" their identification badges. To assess the impact of SSO implementation in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations. Following implementation of SSO, a total of 65,202 logins were sampled systematically during a 7day period among 2256 active clinical end users for time saved in 6 facilities when compared to pre-implementation. Dollar values were assigned to the time saved by 3 groups of clinical end users: physicians, nurses and ancillary service providers. The reduction of total clinician login time over the 7day period showed a net gain of 168.3h per week of clinician time - 28.1h (2.3 shifts) per facility per week. Annualized, 1461.2h of mixed physician and nursing time is liberated per facility per annum (121.8 shifts of 12h per year). The annual dollar cost savings of this reduction of time expended logging in is $92,146 per hospital per annum and $1,658,745 per annum in the first phase implementation of 18 hospitals. Computer hardware equipment savings due to desktop virtualization increases annual savings to $2,333,745. Qualitative value contributions to clinician satisfaction, reduction in staff turnover, facilitation of adoption of EHR applications, and other benefits of SSO are discussed. SSO had a positive impact on clinician efficiency and productivity in the 6 hospitals evaluated, and is an effective and cost-effective method to liberate clinician time from repetitive and time consuming logins to clinical software applications. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Clinical value of ambulatory blood pressure: evidence and limits.

Science.gov (United States)

Mancia, Giuseppe; Verdecchia, Paolo

2015-03-13

This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ

CLINICAL VALUE OF CHROMOGRANIN A IN GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS

Directory of Open Access Journals (Sweden)

N. V. Lyubimova

2015-01-01

Full Text Available Background: Neuroendocrine tumors (NET is a heterogeneous group of neoplasms characterized by hypersecretion of biologically active sub- stances that manifests by specific syndromes and determines the clinical course of the disease. The most common NET types are those of gastrointestinal tract. The obligatory biochemical marker used in the examination of NET patients is chromogranin A (CgA.Aim: Evaluation of the CgA value for diagnostics and monitoring of gastrointestinal NETs.Materials and methods: A comparative study of plasma CgA levels was performed in 146 patients with gastroenteropancreatic neuroendocrine tu- mors and 66 healthy individuals using the enzyme immunoassay “Chromogranin A ELISA kit” (Dako A/S, Denmark.Results: CgA levels were significantly higher in patients with NETs of all localizations, such as pancreas, stomach, gut, small and large bowel, than in the healthy subjects (р < 0.000001. In NET patients, CgA secretion was highly variable, with the highest value in the group of patients with gastric NETs (102000 U/l. The highest CgA medians were detected in patients with small intestinal (183.9 U/l, colon (148.4 U/l and pancreatic (135.9 U/l NETs. There was an association between CgA secretion and extension or activity of NETs, with the highest median values in patients with hepatic metastases (395 U/l and those with carcinoid syndrome (352 U/l. The clinical significance of CgA as a NET marker was assessed using the cut-off value of 33 U/l, calculated according to the results in the control group. Overall diagnostic sensitivity of CgA in NET patients was high (85.8% with a specificity of 98.5%. Conclusion: The results obtained confirm a high sensitivity of CgA as a NET marker whose determination helps to improve accuracy of diagnostics and to assess NET prevalence.

Clinical value of Tei index in pediatric patients with repaired tetralogy of Fallot.

Science.gov (United States)

Song, Bing; Qi, Quan; Liu, Ruisheng; Xing, Wang; Tang, Hanbo; Li, Yuanmin

2015-01-01

Tetralogy of Fallot is a congenital heart disease characterized by underdevelopment of the right ventricular infundibulum. Present study aimed to explore the clinic value of Tei index in assessing right ventricular function of pediatric patients with repaired Tetralogy of Fallot. A total of 45 pediatric patients with repaired Tetralogy of Fallot were recruited and classified into: group A (Tei index 0.7; n=13, aging 4-14 years). The right ventricular Tei index value was related to the clinical characteristics of Tetralogy of Fallot repair patients. Right ventricular Tei index was positively correlated with ventilation time, drainage volumes, and negatively with drug assistance and Intensive Care Unit (ICU) stay, although time for drug assistance and ICU stay were not statically different between group B and group C. There was no significant difference in left ventricular ejection fraction. Tei index is a sensitive indicator of right ventricular dysfunction, and has important clinical value to better our understanding of right ventricular function after tetralogy of Fallot repair.

Driving out waste: a framework to enhance value in clinical care.

Science.gov (United States)

Burton, David A

2013-06-01

Many healthcare providers today are seeking to improve the value of the care they deliver by implementing standardized clinical practice guidelines aimed at reducing variations in care, avoiding complications, and lowering costs. To succeed, such an initiative requires the full support and participation of the clinicians who will use the guidelines. Providers also should have a fully developed infrastructure consisting of a clinical content system, an analytics system, and a deployment system.

Analysis of the Chemical, Pharmacological and Clinical Applications of Polygonum Cuspidatum

Science.gov (United States)

Guo, Chenyang; Bai, Ming; Miao, Mingsan; Miao, Yanyan

2018-01-01

Traditional Chinese medicine Polygonum cuspidatum widely used, the larger production, and in the clinical application of more, but the role played by the role of different roles are also different. By reviewing the relevant literatures in recent years, the chemical constituents and pharmacological effects of Polygonum cuspidatum were sorted and summarized, and the role of Polygonum cuspidatum was analyzed, and the function of Polygonum cuspidatum was explored to find out the role of Polygonum cuspidatum in compatibility. Application law. Which can not only study the medicinal mechanism of Polygonum cuspidatum, but also provide the theoretical basis for the medicinal development, clinical treatment and comprehensive utilization of Polygonum cuspidatum.

Significance and clinical value of the transitional zone volume (TZV ...

African Journals Online (AJOL)

M. El Ghoneimy

2017-01-12

Jan 12, 2017 ... Objective: The aim of this work was to evaluate the significance and clinical value of the TZI, which has been a point of ... Conclusion: Estimating the transition zone volume during TRUS is a reasonable way to obtain the required ... Besides the IPSS score, a complete medical and surgical history was also.

The major differences in chemical composition and antibacterial activity of two closely related Leonotis species (Lamiaceae may have taxonomic value

Directory of Open Access Journals (Sweden)

J.N. Eloff

2010-01-01

Full Text Available Several Leonotis species are used widely for medicinal purposes in Africa. There have been drastic changes in the taxonomic treatment of Leonotis species during the past decade. Two species, L. dysophylla and L. microphylla occurring in Pretoria have been considered as varieties of the same species and as different species by different authors. Because Leonotis species are used widely as medicinal plants inter alia against bacterial infections, we decided to compare the chemical composition and antibacterial activity of four plants from each of two populations of the species. The chemical composition of acetone extracts of finely ground leaves was determined by thin layer chromatography followed by spraying with vanillin-sulphuric acid. There were hardly any differences between plants from the same population. There were major differences between the two species in the composition of pigments separated by thin layer chromatography and for compounds visualized with the vanillin-sulphuric acid spray reagent. This supported the viewpoint that the two species should not be considered as varieties. The major differences found in chemical composition indicate that chemical parameters may play an important role in resolving taxonomic differences. Because such a small quantity of material is needed, it may be feasible to analyze one or two leaves obtained from herbarium sheets as an additional taxonomic parameter. The antibacterial activity of the acetone extracts was determined using a two-fold serial dilution microplate method with tetrazolium violet as indicator of growth. The specific strains of the four most important nosocomial bacterial pathogens suggested by the United States National Committee for Clinical Laboratory Standards were used: Staphylococcus aureus (American Type Culture Collection 29213, Pseudomonas aeruginosa (ATCC 27853, Escherichia coli (ATCC 25922 and Enterococcus faecalis (ATCC 21212. The minimum inhibitory activity of the

Value-based HR practices, i-deals and clinical error control with CSR as a moderator.

Science.gov (United States)

Luu, Tuan; Rowley, Chris; Siengthai, Sununta; Thanh Thao, Vo

2017-05-08

Purpose Notwithstanding the rising magnitude of system factors in patient safety improvement, "human factors" such as idiosyncratic deals (i-deals) which also contribute to the adjustment of system deficiencies should not be neglected. The purpose of this paper is to investigate the role of value-based HR practices in catalyzing i-deals, which then influence clinical error control. The research further examines the moderating role of corporate social responsibility (CSR) on the effect of value-based HR practices on i-deals. Design/methodology/approach The data were collected from middle-level clinicians from hospitals in the Vietnam context. Findings The research results confirmed the effect chain from value-based HR practices through i-deals to clinical error control with CSR as a moderator. Originality/value The HRM literature is expanded through enlisting i-deals and clinical error control as the outcomes of HR practices.

Top Value Added Chemicals From Biomass: I. Results of Screening for Potential Candidates from Sugars and Synthesis Gas

Energy Technology Data Exchange (ETDEWEB)

Werpy, Todd A.; Holladay, John E.; White, James F.

2004-11-01

This report identifies twelve building block chemicals that can be produced from sugars via biological or chemical conversions. The twelve building blocks can be subsequently converted to a number of high-value bio-based chemicals or materials. Building block chemicals, as considered for this analysis, are molecules with multiple functional groups that possess the potential to be transformed into new families of useful molecules. The twelve sugar-based building blocks are 1,4-diacids (succinic, fumaric and malic), 2,5-furan dicarboxylic acid, 3-hydroxy propionic acid, aspartic acid, glucaric acid, glutamic acid, itaconic acid, levulinic acid, 3-hydroxybutyrolactone, glycerol, sorbitol, and xylitol/arabinitol. In addition to building blocks, the report outlines the central technical barriers that are preventing the widespread use of biomass for products and chemicals.

Reference values of clinical chemistry and hematology parameters in rhesus monkeys (Macaca mulatta).

Science.gov (United States)

Chen, Younan; Qin, Shengfang; Ding, Yang; Wei, Lingling; Zhang, Jie; Li, Hongxia; Bu, Hong; Lu, Yanrong; Cheng, Jingqiu

2009-01-01

Rhesus monkey models are valuable to the studies of human biology. Reference values for clinical chemistry and hematology parameters of rhesus monkeys are required for proper data interpretation. Whole blood was collected from 36 healthy Chinese rhesus monkeys (Macaca mulatta) of either sex, 3 to 5 yr old. Routine chemistry and hematology parameters, and some special coagulation parameters including thromboelastograph and activities of coagulation factors were tested. We presented here the baseline values of clinical chemistry and hematology parameters in normal Chinese rhesus monkeys. These data may provide valuable information for veterinarians and investigators using rhesus monkeys in experimental studies.

Economic Evaluations for the Carbon Dioxide-involved Production of High-value Chemicals

Energy Technology Data Exchange (ETDEWEB)

Lee, Ji Hyun; Lee, Dong Woog; Jang, Se Gyu; Kwak, No-Sang; Lee, In Young; Jang, Kyung Ryoung; Shim, Jae-Goo [KEPCO Research Institute, Daejon (Korea, Republic of); Choi, Jong Shin [Korea East-West Power Co. LTD, Seoul (Korea, Republic of)

2014-06-15

Economic evaluation of the manufacturing technology of high-value chemicals through the carbonation reaction of carbon dioxide contained in the flue gas was performed, and analysis of the IRR (Internal Rate of Return) and whole profit along the production plan of the final product was conducted. Through a carbonation reaction with sodium hydroxide that is generated from electrolysis and by using carbon dioxide in the combustion gas that is generated in the power plant, it is possible to get a high value products such as sodium bicarbonate compound and also to reduce the carbon dioxide emission simultaneously. The IRR (Internal Rate of Return) and NPV (Net Present Value) methods were used for the economic evaluation of the process which could handle carbon dioxide of 100 tons per day in the period of the 20 years of plant operation. The results of economic evaluation showed that the IRR of baseline case of technology was 67.2% and the profit that obtained during the whole operation period (20 years) was 346,922 million won based on NPV value. When considering ETS due to the emissions trading enforcement that will be activated in 2015, the NPV was improved to a 6,000 million won. Based on this results, it could be concluded that this CO2 carbonation technology is an cost-effective technology option for the reduction of greenhouse gas.

Economic Evaluations for the Carbon Dioxide-involved Production of High-value Chemicals

International Nuclear Information System (INIS)

Lee, Ji Hyun; Lee, Dong Woog; Jang, Se Gyu; Kwak, No-Sang; Lee, In Young; Jang, Kyung Ryoung; Shim, Jae-Goo; Choi, Jong Shin

2014-01-01

Economic evaluation of the manufacturing technology of high-value chemicals through the carbonation reaction of carbon dioxide contained in the flue gas was performed, and analysis of the IRR (Internal Rate of Return) and whole profit along the production plan of the final product was conducted. Through a carbonation reaction with sodium hydroxide that is generated from electrolysis and by using carbon dioxide in the combustion gas that is generated in the power plant, it is possible to get a high value products such as sodium bicarbonate compound and also to reduce the carbon dioxide emission simultaneously. The IRR (Internal Rate of Return) and NPV (Net Present Value) methods were used for the economic evaluation of the process which could handle carbon dioxide of 100 tons per day in the period of the 20 years of plant operation. The results of economic evaluation showed that the IRR of baseline case of technology was 67.2% and the profit that obtained during the whole operation period (20 years) was 346,922 million won based on NPV value. When considering ETS due to the emissions trading enforcement that will be activated in 2015, the NPV was improved to a 6,000 million won. Based on this results, it could be concluded that this CO2 carbonation technology is an cost-effective technology option for the reduction of greenhouse gas

Recent progress in the development of solid catalysts for biomass conversion into high value-added chemicals

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Hara, Michikazu; Nakajima, Kiyotaka; Kamata, Keigo

2015-06-01

In recent decades, the substitution of non-renewable fossil resources by renewable biomass as a sustainable feedstock has been extensively investigated for the manufacture of high value-added products such as biofuels, commodity chemicals, and new bio-based materials such as bioplastics. Numerous solid catalyst systems for the effective conversion of biomass feedstocks into value-added chemicals and fuels have been developed. Solid catalysts are classified into four main groups with respect to their structures and substrate activation properties: (a) micro- and mesoporous materials, (b) metal oxides, (c) supported metal catalysts, and (d) sulfonated polymers. This review article focuses on the activation of substrates and/or reagents on the basis of groups (a)-(d), and the corresponding reaction mechanisms. In addition, recent progress in chemocatalytic processes for the production of five industrially important products (5-hydroxymethylfurfural, lactic acid, glyceraldehyde, 1,3-dihydroxyacetone, and furan-2,5-dicarboxylic acid) as bio-based plastic monomers and their intermediates is comprehensively summarized.

Recent progress in the development of solid catalysts for biomass conversion into high value-added chemicals

International Nuclear Information System (INIS)

Hara, Michikazu; Nakajima, Kiyotaka; Kamata, Keigo

2015-01-01

In recent decades, the substitution of non-renewable fossil resources by renewable biomass as a sustainable feedstock has been extensively investigated for the manufacture of high value-added products such as biofuels, commodity chemicals, and new bio-based materials such as bioplastics. Numerous solid catalyst systems for the effective conversion of biomass feedstocks into value-added chemicals and fuels have been developed. Solid catalysts are classified into four main groups with respect to their structures and substrate activation properties: (a) micro- and mesoporous materials, (b) metal oxides, (c) supported metal catalysts, and (d) sulfonated polymers. This review article focuses on the activation of substrates and/or reagents on the basis of groups (a)–(d), and the corresponding reaction mechanisms. In addition, recent progress in chemocatalytic processes for the production of five industrially important products (5-hydroxymethylfurfural, lactic acid, glyceraldehyde, 1,3-dihydroxyacetone, and furan-2,5-dicarboxylic acid) as bio-based plastic monomers and their intermediates is comprehensively summarized. (focus issue review)

Recent progress in the development of solid catalysts for biomass conversion into high value-added chemicals

Science.gov (United States)

Hara, Michikazu; Nakajima, Kiyotaka; Kamata, Keigo

2015-01-01

In recent decades, the substitution of non-renewable fossil resources by renewable biomass as a sustainable feedstock has been extensively investigated for the manufacture of high value-added products such as biofuels, commodity chemicals, and new bio-based materials such as bioplastics. Numerous solid catalyst systems for the effective conversion of biomass feedstocks into value-added chemicals and fuels have been developed. Solid catalysts are classified into four main groups with respect to their structures and substrate activation properties: (a) micro- and mesoporous materials, (b) metal oxides, (c) supported metal catalysts, and (d) sulfonated polymers. This review article focuses on the activation of substrates and/or reagents on the basis of groups (a)–(d), and the corresponding reaction mechanisms. In addition, recent progress in chemocatalytic processes for the production of five industrially important products (5-hydroxymethylfurfural, lactic acid, glyceraldehyde, 1,3-dihydroxyacetone, and furan-2,5-dicarboxylic acid) as bio-based plastic monomers and their intermediates is comprehensively summarized. PMID:27877800

Clinical ethics and values: how do norms evolve from practice?

Science.gov (United States)

Spranzi, Marta

2013-02-01

Bioethics laws in France have just undergone a revision process. The bioethics debate is often cast in terms of ethical principles and norms resisting emerging social and technological practices. This leads to the expression of confrontational attitudes based on widely differing interpretations of the same principles and values, and ultimately results in a deadlock. In this paper I would like to argue that focusing on values, as opposed to norms and principles, provides an interesting perspective on the evolution of norms. As Joseph Raz has convincingly argued, "life-building" values and practices are closely intertwined. Precisely because values have a more indeterminate meaning than norms, they can be cited as reasons for action by concerned stakeholders, and thus can help us understand how controversial practices, e.g. surrogate motherhood, can be justified. Finally, norms evolve when the interpretations of the relevant values shift and cause a change in the presumptions implicit in the norms. Thus, norms are not a prerequisite of the ethical solution of practical dilemmas, but rather the outcome of the decision-making process itself. Struggling to reach the right decision in controversial clinical ethics situations indirectly causes social and moral values to change and principles to be understood differently.

Clinical effect of vitamin A palmitate eye gel on early ocular surface reconstruction after thermal or chemical injuries

Directory of Open Access Journals (Sweden)

Fen-Dui Zhang

2015-11-01

Full Text Available AIM: To evaluate the clinical effect of vitamin A palmitate eye gel on early ocular surface reconstruction after thermal or chemical injuries. METHODS: Seventy-eight cases with thermal or chemical injuries to eyes were selected and divided into two groups by randomized, double-blind, positive drug parallel controlled method: group A(40 cases were treated with vitamin A palmitate eye geland group B \\〖38 cases were treated with basic fibroblast growth factor(bFGF\\〗. The bFGF and vitamin A palmitate eye gel were used 4 times a day. The treatment course was 14d. Restoration of epithelial defect, Schirmer's test values, tear break-up time(BUT, and subjective assessment of symptoms and signs were observed on D1, D3, D5, D7, D10 and D14.RESULTS: In group A, 31 cases were cured, 5 cases were effective, with the cure rate of 76% and efficiency 90%. In group B, 32 cases were cured, 3 cases were effective, with the cure rate of 84% and efficiency 92%. There were no significant differences between the two groups(P>0.05. However, there were significant differences on the results of Schirmer's test and BUT(PPCONCLUSION: Vitamin A palmitate eye gel is valuable and safe on early ocular surface reconstruction of the eyes suffered from thermal or chemical injuries.

Top Value Added Chemicals from Biomass: Volume I -- Results of Screening for Potential Candidates from Sugars and Synthesis Gas

Energy Technology Data Exchange (ETDEWEB)

Werpy, T.; Petersen, G.

2004-08-01

This report identifies twelve building block chemicals that can be produced from sugars via biological or chemical conversions. The twelve building blocks can be subsequently converted to a number of high-value bio-based chemicals or materials. Building block chemicals, as considered for this analysis, are molecules with multiple functional groups that possess the potential to be transformed into new families of useful molecules. The twelve sugar-based building blocks are 1,4-diacids (succinic, fumaric and malic), 2,5-furan dicarboxylic acid, 3-hydroxy propionic acid, aspartic acid, glucaric acid, glutamic acid, itaconic acid, levulinic acid, 3-hydroxybutyrolactone, glycerol, sorbitol, and xylitol/arabinitol.

Top Value Added Chemicals from Biomass - Volume I, Results of Screening for Potential Candidates from Sugars and Synthesis Gas

Energy Technology Data Exchange (ETDEWEB)

None

2004-08-01

This report identifies twelve building block chemicals that can be produced from sugars via biological or chemical conversions. The twelve building blocks can be subsequently converted to a number of high-value bio-based chemicals or materials. Building block chemicals, as considered for this analysis, are molecules with multiple functional groups that possess the potential to be transformed into new families of useful molecules. The twelve sugar-based building blocks are 1,4-diacids (succinic, fumaric and malic), 2,5-furan dicarboxylic acid, 3-hydroxy propionic acid, aspartic acid, glucaric acid, glutamic acid, itaconic acid, levulinic acid, 3-hydroxybutyrolactone, glycerol, sorbitol, and xylitol/arabinitol.

Reference values for 27 clinical chemistry tests in 70-year-old males and females.

Science.gov (United States)

Carlsson, Lena; Lind, Lars; Larsson, Anders

2010-01-01

Reference values are usually defined based on blood samples from healthy men or nonpregnant women in the age range of 20-50 years. These values are not optimal for elderly patients, as many biological markers change over time and adequate reference values are important for correct clinical decisions. To validate NORIP (Nordic Reference Interval Project) reference values in a 70-year-old population. We studied 27 frequently used laboratory tests. The 2.5th and 97.5th percentiles for these markers were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values. Reference values are reported for plasma alanine aminotransferase, albumin, alkaline phosphatase, pancreas amylase, apolipoprotein A1, apolipoprotein B, aspartate aminotransferase, bilirubin, calcium, chloride, cholesterol, creatinine, creatine kinase, C-reactive protein, glucose, gamma-glutamyltransferase, HDL-cholesterol, iron, lactate dehydrogenase, LDL-cholesterol, magnesium, phosphate, potassium, sodium, transferrin, triglycerides, urate and urea. Reference values calculated from the whole population and a subpopulation without cardiovascular disease showed strong concordance. Several of the reference interval limits were outside the 90% CI of a Scandinavian population (NORIP). 2009 S. Karger AG, Basel.

Evaluation of clinical value of serum CA19-9

International Nuclear Information System (INIS)

Lv Haifeng; Lin Zhiyu; Lu Xiaozhuo; Chen Yini

2003-01-01

The article is to study the clinical significance of serum CA19-9 in diagnosing malignant tumor occurred in digestive system and to select cut off values for differentiating diagnosis of a pancreatic neoplasms and pancreatitis. Using chemiluminescence immunoassay, serum CA19-9 level of below subjects were analyzed: control group (n=21); digestive system neoplasm group (n=125, with 7 cases conformed as pancreatic cancer); non-neoplastic disease group (n=387, with 15 cases conformed as pancreatitis secondary to destructive cholangitis). Receiver operating characteristic (ROC) curve was used for analyzing results and selecting cut off values. When cut off value was 18.4 kU/L, sensibility for conforming a digestive system neoplasm was 60.8%, while its related specificity against control group and non-neoplastic disease group was 95. 2% and 68.2%, respectively. Sensibility for diagnosing pancreatic neoplasm was 85.7%, while its related specificity against control group and non-pancreatic origin tumor group was 95.0% and 63.1%, respectively. When 37 kU/L was chosen as cut off value, specificity for differentiating diagnosis of pancreatic neoplasm and pancreatitis secondary to destructive cholangitis rose from 13.3% to 46.7%. Serum CA19-9 could be used as an aid in detecting digestive system neoplastic disease; it is a reliable marker for pancreatic neoplasm. Raising cut off value may help to differentiate pancreatic neoplasm and pancreatitis secondary to destructive cholangitis

The clinical value of serum PSA and PAP determinations in prostate cancer patients

International Nuclear Information System (INIS)

Zeng Lei; Yu Renbo; Du Guowei; Pang Baozhong

2001-01-01

Objective: To investigate the clinical value of serum PSA and PAP determinations in diagnosis of prostate cancer patients. Methods: The serum PSA and PAP levels of 98 prostate cancer patients, 45 prostate benign disease patients and 40 normal subjects were tested by IRMA. Results: The serum PSA and PAP levels of prostate cancer patients were significantly higher than those in prostate benign disease patients and normal controls (P < 0.01). The diagnostic sensitivity and specificity of serum PSA for prostate cancer were 93.9% and 93.3% respectively. The diagnostic sensitivity and specificity of serum PAP for prostate cancer were 71.4% and 91.1% respectively. Conclusion: The determination of serum PSA and PAP was of high clinical value for diagnosis of early prostate cancer. It could be used as an important reference parameter for the clinical staging, follow-up of treatment result and prediction of prognosis

The clinical value of planar thallium-201 myocardial perfusion scintigraphy

International Nuclear Information System (INIS)

Niemeyer, M.G.

1989-01-01

The clinical value of planar thalium-201 myocardial perfusion scintigraphy was examined, using visual and quantitative analysis, for the detection of presence, localization and extent of coronary disease, using coronary arteriography as gold standard. The indremental diagnostic yield of different noninvasive tests for the diagnosis and the severity of coronary artery disease was quantified by using multivariate discriminant analysis. (author). 284 refs.; 14 figs.; 37 tabs

Determining utility values in patients with anterior cruciate ligament tears using clinical scoring systems

Directory of Open Access Journals (Sweden)

Szucs Thomas

2011-08-01

Full Text Available Abstract Background Several instruments and clinical scoring systems have been established to evaluate patients with ligamentous knee injuries. A comparison of individual articles in the literature is challenging, not only because of heterogeneity in methodology, but also due to the variety of the scoring systems used to document clinical outcomes. There is limited information about the correlation between used scores and quality of life with no information being available on the impact of each score on the utility values. The aim of this study was to compare the most commonly used scores for evaluating patients with anterior cruciate ligament (ACL injuries, and to establish corresponding utility values. These values will be used for the interpretation and comparison of outcome results in the currently available literature for different treatment options. Methods Four hypothetical vignettes were defined, based on different levels of activities after rupture of the ACL to simulate typical situations seen in daily practice. A questionnaire, including the Health Utility Index (HUI for utility values, the IKDC subjective score, the Lysholm and the Tegner score, was created and 25 orthopedic surgeons were asked to fill the questionnaire for each hypothetical patient as proxies for all patients they had treated and who would fit in that hypothetical vignette. Results The utility value as an indicator for quality of life increased with the level of activity. Having discomforts already during normal activities of daily living was rated with a mean utility value of 0.37 ± 0.19, half of that of a situation where mild sport activity was possible without discomfort (0.78 ± 0.11. All investigated scores were able to distinguish clearly (p Conclusions Here we report the correlation between the most commonly used scores for the assessment of patients with a ruptured ACL and utility values as an indicator of quality of life. Assumptions were based on expert

CHEMICAL COMPOSITION AND NUTRITIVE VALUE OF MAIZE STEMS DEPENDING ON THE CUTTING HEIGHT OF PLANTS AT HARVEST

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Ireneus KOWALIK

2013-12-01

Full Text Available Studies were carried out in the two years in Trzcianka near Nowy Tomyśl, on brown soil, IIIa – IVa with pH 7.1 – 7.2. Plants of five maize cultivars were cut at the height of 15 cm and 55 cm. The lower parts of stems with leaves which remain on the field in case of high cutting, were characterized by a smaller content of protein and by a greater content of fibre, in comparison with the higher parts of plants. The energetic value of 1 kg of dry matter of the lower 40 cm part with leaves expressed in MJ NEL, in spite of significant differences in the chemical composition, was only insignificantly lower than the upper part. The content of dry matter, the chemical composition and the energetic value of both parts differed, depending on the cultivar.

Chemical restraint in routine clinical practice: a report from a general hospital psychiatric ward in Greece

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Papamichael Georgios

2011-02-01

Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

[Research progress on the clinical value of Ki-67 in breast cancer and its cut-off definition].

Science.gov (United States)

Chen, Qing; Wu, Kejin

2015-08-01

Ki-67 has an important application value in clinical practice. However, it is still a little tough in clinical application because of the debate on the cut-off definition of Ki-67 index. This review summarizes most studies on the prognostic and predictive value of Ki-67, analyzes the reasons for the discrepancies among the studies cited, and presents the necessity and clinical significance of scientifically defining the cut-off of Ki-67 index, providing a theoretical basis for Ki-67 in clinical application.

Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

Science.gov (United States)

Whitley, Heather P.

2011-01-01

Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

Evaluating Business Value of IT in Healthcare: Three Clinical Practices from Australia and the US.

Science.gov (United States)

Haddad, Peter; Schaffer, Jonathan L; Wickramasinghe, Nilmini

2015-01-01

Exponentially increasing costs in healthcare coupled with poor quality and limited access have motivated the healthcare industry to turn to IS/IT solutions to overcome these issues and facilitate superior healthcare delivery. In an environment of rapid development of new clinical informatics solutions claiming to provide better healthcare delivery, there is a paucity of systematic frameworks to robustly measure the actual value of these systems. The promised business value of these solutions has been elusive; hence, this study offers an approach for the evaluation of the business value of health IS/IT solutions based on a conceptual model, which has been validated using three clinical case studies.

Chemical Composition, Physicochemical Characteristics, and Nutritional Value of Lannea kerstingii Seeds and Seed Oil

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Judicaël Thomas Ouilly

2017-01-01

Full Text Available The chemical composition, main physicochemical properties, and nutritional value of seed flour and seed oil of Lannea kerstingii were studied. The results indicated that seeds contained 3.61% moisture, 57.85% fat, 26.39% protein, 10.07% carbohydrates, and 2.08% ash. Potassium was the predominant mineral, followed by magnesium and calcium. The essential amino acids were at higher levels than the estimated amino acid requirements of FAO/WHO/UNU except for lysine. Fatty acid composition showed that oleic acid was the major fatty acid, followed by palmitic, linoleic, and stearic acids. Physicochemical properties of the seed oil were melting point, 19.67°C; refractive index (25°C, 1.47; iodine value, 60.72/100 g of oil; peroxide value, 0.99 meq. O2/kg of oil; p-anisidine value, 0.08; total oxidation (TOTOX value, 2.06; oxidative stability index (120°C, 52.53 h; free fatty acids, 0.39%; acid value, 0.64 mg of KOH/g of oil; saponification value, 189.73. Total amount of tocopherols, carotenoids, and sterols was 578.60, 4.60, and 929.50 mg/kg of oil, respectively. γ-Tocopherol (82%, lutein (80%, and β-sitosterol (93% were the most abundant forms of tocopherols, carotenoids, and sterols, respectively. Seeds of L. kerstingii constitute an alternative source of stable vegetable oil and protein for nutritional and industrial applications.

The cultural shaping of alexithymia: values and externally oriented thinking in a Chinese clinical sample.

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Dere, Jessica; Tang, Qiuping; Zhu, Xiongzhao; Cai, Lin; Yao, Shuqiao; Ryder, Andrew G

2013-05-01

Alexithymia is a multi-faceted personality construct characterized by difficulties in identifying and describing emotional states. Originally based on observations of American psychosomatic patients, the construct is now studied in a variety of cultural contexts. However, few studies have critically examined alexithymia from a cultural perspective. Dere et al. [1] recently found support for the hypothesis that one alexithymia component - externally oriented thinking (EOT) - is linked to cultural values, among Euro-Canadian and Chinese-Canadian students. The current study examines this association in a Chinese clinical sample. Outpatients presenting at three hospital-based psychology clinics in Hunan province, China (N=268) completed a structured clinical interview and self-report measures of alexithymia and cultural values. All participants endorsed clinically significant levels of depressed mood, anhedonia, and/or fatigue. As expected, EOT was negatively predicted by Modernization and Euro-American values. Two other alexithymia components, difficulty identifying feelings and difficulty describing feelings, were unrelated to cultural values. These findings suggest that cultural variations in the importance placed on emotional experience must be taken into account in cross-cultural alexithymia research. Such studies should also consider separately the specific components of alexithymia; failure to do so can lead to overestimation of alexithymia in groups where scores are driven by culturally-promoted EOT. Copyright © 2013 Elsevier Inc. All rights reserved.

The importance of handling high-value biologicals: Physico-chemical instability and immunogenicity of monoclonal antibodies.

Science.gov (United States)

Laptoš, Tomislav; Omersel, Jasna

2018-04-01

The present review specifies the various chemical and physical factors that can influence drug stability and immunogenicity, and the treatment outcomes of antibody biologicals. Although monoclonal antibodies (mAbs) are known to be more resistant to environmental changes compared with other proteins, the molecules themselves can be subjected to chemical and physical processes that promote their degradation and transformation into their specific amino-acid moieties. With increasing use of medicinal products that contain mAbs, and their self-administration by the patients, the issue of the correct manipulation of these drugs is of increasing importance. This review summarises the correct handling of mAb biologicals from the point of view of the pharmacist, clinical biochemist and patient, as is supported by relevant cases from the literature and our own data and experience. In particular, if there is a break in the cold chain, both healthcare professionals and patients need to be aware of the potential pharmacokinetics and pharmacodynamics alterations to these biologicals. Furthermore, any alterations in the protein structure can induce harmful immune reactions, including anaphylaxis and cytokine storms, or result in the production of neutralising or blocking Abs. Overall, considering also that treatment costs usually remain high, drug stability can have a tremendous effect on the clinical, humanistic and economic outcomes of such treatments.

Aligning clinical compensation with clinical productivity: design and implementation of the financial value unit (FVU) system in an academic department of internal medicine.

Science.gov (United States)

Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan

2013-07-01

A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.

Optimising the clinical strategy for autoimmune liver diseases: Principles of value-based medicine.

Science.gov (United States)

Carbone, Marco; Cristoferi, Laura; Cortesi, Paolo Angelo; Rota, Matteo; Ciaccio, Antonio; Okolicsanyi, Stefano; Gemma, Marta; Scalone, Luciana; Cesana, Giancarlo; Fabris, Luca; Colledan, Michele; Fagiuoli, Stefano; Ideo, Gaetano; Belli, Luca Saverio; Munari, Luca Maria; Mantovani, Lorenzo; Strazzabosco, Mario

2018-04-01

Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis represent the three major autoimmune liver diseases (AILDs). Their management is highly specialized, requires a multidisciplinary approach and often relies on expensive, orphan drugs. Unfortunately, their treatment is often unsatisfactory, and the care pathway heterogeneous across different centers. Disease-specific clinical outcome indicators (COIs) able to evaluate the whole cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. Aim of our study was to generate a set of COIs for the three AILDs. We then prospectively validated these indicators based on a series of consecutive patients recruited at three tertiary clinical centers in Lombardy, Italy. In phase I using a Delphi method and a RAND 9-point appropriateness scale a set of COIs was generated. In phase II the indicators were applied in a real-life dataset. Two-hundred fourteen patients were enrolled and followed-up for a median time of 54months and the above COIs were recorded using a web-based electronic medical record program. The COIs were easy to collect in the clinical practice environment and their values compared well with the available natural history studies. We have generated a comprehensive set of COIs which sequentially capture different clinical outcome of the three AILDs explored. These indicators represent a critical tool to implement a value-based approach to patients with these conditions, to monitor, compare and improve quality through benchmarking of clinical performance and to assess the significance of novel drugs and technologies. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen. Copyright © 2017. Published by Elsevier B.V.

Recent advances in engineering propionyl-CoA metabolism for microbial production of value-added chemicals and biofuels.

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Srirangan, Kajan; Bruder, Mark; Akawi, Lamees; Miscevic, Dragan; Kilpatrick, Shane; Moo-Young, Murray; Chou, C Perry

2017-09-01

Diminishing fossil fuel reserves and mounting environmental concerns associated with petrochemical manufacturing practices have generated significant interests in developing whole-cell biocatalytic systems for the production of value-added chemicals and biofuels. Although acetyl-CoA is a common natural biogenic precursor for the biosynthesis of numerous metabolites, propionyl-CoA is unpopular and non-native to most organisms. Nevertheless, with its C3-acyl moiety as a discrete building block, propionyl-CoA can serve as another key biogenic precursor to several biological products of industrial importance. As a result, engineering propionyl-CoA metabolism, particularly in genetically tractable hosts with the use of inexpensive feedstocks, has paved an avenue for novel biomanufacturing. Herein, we present a systematic review on manipulation of propionyl-CoA metabolism as well as relevant genetic and metabolic engineering strategies for microbial production of value-added chemicals and biofuels, including odd-chain alcohols and organic acids, bio(co)polymers and polyketides. [Formula: see text].

The use of reference change values in clinical laboratories.

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Bugdayci, Guler; Oguzman, Hamdi; Arattan, Havva Yasemin; Sasmaz, Guler

2015-01-01

The use of Reference Change Values (RCV) has been advocated as very useful for monitoring individuals. Most of these are performed for monitoring individuals in acute situations and for following up the improvement or deterioration of chronic diseases. In our study, we aimed at evaluating the RCV calculation for 24 clinical chemistry analytes widely used in clinical laboratories and the utilization of this data. Twenty-four serum samples were analyzed with Abbott kits (Abbott Laboratories, Abbott Park, IL, USA), manufactured for use with the Architect c8000 (Abbott Laboratories, Abbott Park, IL, USA) auto-analyzer. We calculated RCV using the following formula: RCV = Z x 2 1/2x (CVA2 + CVw2)1/2. Four reference change values (RCV) were calculated for each analyte using four statistical probabilities (0.95, and 0.99, unidirectional and bidirectional). Moreover, by providing an interval after identifying upper and lower limits with the Reference Change Factor (RCF), serially measured tests were calculated by using two formulas: exp (Z x 2 1/2 x (CV(A)2 + CVw2)½/100) for RCF(UP) and (1/RCF(UP)) for RCF(DOWN). RCVs of these analytes were calculated as 14.63% for glucose, 29.88% for urea, 17.75% for ALP, 53.39% for CK, 46.98% for CK-MB, 21.00% amylase, 8.00% for total protein, 8.70% for albumin, 51.08% for total bilirubin, 86.34% for direct bilirubin, 6.40% for calcium, 15.03% for creatinine, 21.47% for urate, 14.19% for total cholesterol, 46.62% for triglyceride, 20.51% for HDL-cholesterol, 29.59% for AST, 46.31% for ALT, 31.54% for GGT, 20.92% for LDH, 19.75% for inorganic phosphate, 3.05% for sodium, 11.75% for potassium, 4.44% for chloride (RCV, p laboratories. RCV could be available as a tool for making clinical decision, especially when monitoring individuals.

Calorific Value and Chemical Composition of Five Semi-Arid Mexican Tree Species

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Maginot Ngangyo-Heya

2016-03-01

Full Text Available The current global energy crisis has generated growing interest in looking for alternatives to traditional fossil fuels, presenting lignocellulosic materials as a promising resource for sustainable energy production. In this paper, the calorific values and chemical composition of the trunks, branches, twigs and leaves of five timber species of the semi-arid land of Mexico (Helietta parvifolia (Gray Benth., Ebenopsis ebano (Berl. Barneby, Acacia berlandieri (Benth., Havardia pallens (Benth. Britton & Rose and Acacia wrightii (Benth. were determined according to international standards. The results highlighted the calorific value ranges of 17.56 to 18.61 MJ kg−1 in trunks, 17.15 to 18.45 MJ kg−1 in branches, 17.29 to 17.92 MJ kg−1 in twigs, and 17.35to 19.36 MJ kg−1 in leaves. The pH presented an acidic trend (3.95–5.64. The content of mineral elements varied in trunks (1.09%–2.29%, branches (0.86%–2.75%, twigs (4.26%–6.76% and leaves (5.77%–11.79%, showing the higher proportion in Ca (57.03%–95.53%, followed by K (0.95%–19.21% and Mg (0.88%–13.47%. The highest amount of extractives was obtained in the methanolic solvent (3.96%–17.03%. The lignin recorded values of 28.78%–35.84% for trunks, 17.14%–31.39% for branches and 20.61%–29.92% for twigs. Lignin showed a moderately strong correlation (r = 0.66 with calorific value, but the best mathematical model was registered with the calorific value depending on the pH and lignin (R2 = 58.86%.

Impact of environmental chemicals, sociodemographic variables, depression, and clinical indicators of health and nutrition on self-reported health status

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Public health researchers ideally integrate social, environmental, and clinical measures to identify predictors of poor health. Chemicals measured in human tissues are often evaluated in relation to intangible or rare health outcomes, or are studied one chemical at a time. Using ...

Economic Value Approach to Industrial Water Demand Management, A Case Study of Chemical Plants

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morteza tahami pour zarandi

2017-03-01

Full Text Available Limitations in water supply to meet the increasing demand have encouraged both planners and researchers to focus attention on water demand management, in which such economic tools as the water pricing system play a major role. A fundamental component of the pricing system is the estimation of the economic value of water, which reflects a firm’s maximum affordable water price or the ultimate elasticity of industrial water. The present study was conducted to estimate the economic value of water for basic chemical plants, excluding fertilizers and nitrogen compounds (code 2411, representing the four-digit ISIC industrial codes which account for about 14% of the total industrial water consumption. The econometric method of production function within the framework of panel data and the residual method were used. Data were collected from the Census of medium-sized businesses carried out by the Statistical Center of Iran over the period 1997–2013.  Results showed that one cubic meter of water allocated to the plants surveyed creates a value of 3,7071 Rials, which shows a large gap with the current purchase price of 5685 Rials. Moreover, it was found that the present water prices account for only about 1.3 percent of the total production cost of basic chemicals, excluding fertilizers and nitrogen compounds. It may, thus, be concluded that it is reasonable to increase the present water tariffs and discriminate among the various manufacturing codes by differences in tariffs in order to achieve water demand management goals. Finally, the information emerging from the study may be exploited to improve the revenues earned by water authorities or to carry out feasibility studies of industrial water development projects.

Faithful but Different: Clinical Social Workers Speak Out about Career Motivation and Professional Values

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Bradley, Carolyn; Maschi, Tina; O'Brien, Helen; Morgen, Keith; Ward, Kelly

2012-01-01

The purpose of this study was to describe licensed clinical social workers' (LCSWs) professional motivation to pursue a social work career and the decision to enter clinical practice. It used a probability sample of 245 New Jersey LCSWs and the Social Work Values Survey as part of an anonymous self-administered mail survey. Descriptive analyses…

Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability

NARCIS (Netherlands)

van Kampen, D.A.; van den Berg, T.; van der Woude, H.J.; Castelein, R.M.; Terwee, C.B.; Willems, W.J.

2013-01-01

Background: It is unknown which combination of patient information and clinical tests might beoptimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determinethe diagnostic value of individual clinical tests and to develop a prediction model that combined patient

Clinical chemistry reference values for 75-year-old apparently healthy persons.

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Huber, Klaus Roland; Mostafaie, Nazanin; Stangl, Gerhard; Worofka, Brigitte; Kittl, Eva; Hofmann, Jörg; Hejtman, Milos; Michael, Rainer; Weissgram, Silvia; Leitha, Thomas; Jungwirth, Susanne; Fischer, Peter; Tragl, Karl-Heinz; Bauer, Kurt

2006-01-01

Clinical chemistry reference values for elderly persons are sparse and mostly intermixed with those for younger subjects. To understand the links between metabolism and aging, it is paramount to differentiate between "normal" physiological processes in apparently healthy elderly subjects and metabolic changes due to long-lasting diseases. The Vienna Transdanube Aging (VITA) study, which began in 2000 and is continuing, will allow us to do just that, because more than 600 male and female volunteers aged exactly 75 years (to exclude any influence of the "aging" factor in this cohort) are participating in this study. Extensive clinical, neurological, biochemical, psychological, genetic, and radiological analyses, with a special emphasis on consumption of medication and abuse of drugs, were performed on each of the probands. The multitude of data and questionnaires obtained made possible an a posteriori approach to select individuals fulfilling criteria for a reference sample group of apparently healthy 75-year-old subjects for our study. Specific analytes were quantified on automated clinical analyzers, while manual methods were used for hormonal analytes. All clinical chemistry analytes were evaluated using in-depth statistical analyses with SPSS for Windows. In all, reference intervals for 45 analytes could be established. These include routine parameters for the assessment of organ functions, as well as hormone concentrations and hematological appraisals. Because all patients were reevaluated after exactly 30 months in the course of this study, we had the opportunity to reassess their health status at the age of 77.5 years. This was very useful for validation of the first round data set. Data of the second round evaluation corroborate the reference limits of the baseline analysis and further confirm our inclusion and exclusion criteria. In summary, we have established a reliable set of reference data for hormonal, hematological, and clinical chemistry analytes for

Challenges in the Clinical Application of the American Society of Clinical Oncology Value Framework: A Medicare Cost-Benefit Analysis in Chronic Lymphocytic Leukemia.

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Seymour, Erlene K; Schiffer, Charles A; de Souza, Jonas A

2017-12-01

The ASCO Value Framework calculates the value of cancer therapies. Given costly novel therapeutics for chronic lymphocytic leukemia, we used the framework to compare net health benefit (NHB) and cost within Medicare of all regimens listed in the National Comprehensive Cancer Network (NCCN) guidelines. The current NCCN guidelines for chronic lymphocytic leukemia were reviewed. All referenced studies were screened, and only randomized controlled prospective trials were included. The revised ASCO Value Framework was used to calculate NHB. Medicare drug pricing was used to calculate the cost of therapies. Forty-nine studies were screened. The following observations were made: only 10 studies (20%) could be evaluated; when comparing regimens studied against the same control arm, ranking NHB scores were comparable to their preference in guidelines; NHB scores varied depending on which variables were used, and there were no clinically validated thresholds for low or high values; treatment-related deaths were not weighted in the toxicity scores; and six of the 10 studies used less potent control arms, ranked as the least-preferred NCCN-recommended regimens. The ASCO Value Framework is an important initial step to quantify value of therapies. Essential limitations include the lack of clinically relevant validated thresholds for NHB scores and lack of incorporation of grade 5 toxicities/treatment-related mortality into its methodology. To optimize its application for clinical practice, we urge investigators/sponsors to incorporate and report the required variables to calculate the NHB of regimens and encourage trials with stronger comparator arms to properly quantify the relative value of therapies.

Changes in the classification of carcinogenic chemicals in the work area. Section III of the German List of MAK and BAT Values.

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Neumann, H G; Vamvakas, S; Thielmann, H W; Gelbke, H P; Filser, J G; Reuter, U; Greim, H; Kappus, H; Norpoth, K H; Wardenbach, P; Wichmann, H E

1998-11-01

Carcinogenic chemicals in the work area are currently classified into three categories in section III of the German List of MAK and BAT Values (list of values on maximum workplace concentrations and biological tolerance for occupational exposures). This classification is based on qualitative criteria and reflects essentially the weight of evidence available for judging the carcinogenic potential of the chemicals. It is proposed that these categories - IIIA1, IIIA2, IIIB - be retained as Categories 1, 2, and 3, to correspond with European Union regulations. On the basis of our advancing knowledge of reaction mechanisms and the potency of carcinogens, these three categories are supplemented with two additional categories. The essential feature of substances classified in the new categories is that exposure to these chemicals does not contribute significantly to risk of cancer to man, provided that an appropriate exposure limit (MAK value) is observed. Chemicals known to act typically by nongenotoxic mechanisms and for which information is available that allows evaluation of the effects of low-dose exposures, are classified in Category 4. Genotoxic chemicals for which low carcinogenic potency can be expected on the basis of dose-response relationships and toxicokinetics, and for which risk at low doses can be assessed are classified in Category 5. The basis for a better differentiation of carcinogens is discussed, the new categories are defined, and possible criteria for classification are described. Examples for Category 4 (1,4-dioxane) and Category 5 (styrene) are presented.

Exploring the Educational Value of Clinical Vignettes from the Society of General Internal Medicine National Meeting in the Internal Medicine Clerkship

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Wofford, James L; Singh, Sonal

2006-01-01

INTRODUCTION Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE To explore the relevance and learning value of clinical vignettes from the SGIM national meeting in the Internal Medicine clerkship. SETTING Third year Ambulatory Internal Medicine clerkship at one academic medical center (academic year 2005 to 2006). METHODS Students were introduced to the clinical vignette and oriented to the database of clinical vignettes available through the SGIM annual meeting website. Students then reviewed 5 to 10 clinical vignettes using a worksheet, and rated the learning value of each vignette using a 5-point Likert scale (1 = least, 5 = greatest). A single investigator evaluated congruence of the vignette with the Clerkship Directors of Internal Medicine (CDIM)-SGIM curriculum to assess relevance. MAIN RESULTS A total of 42 students evaluated 371 clinical vignettes from the 2004 and 2005 meetings. The clinical vignettes were curriculum-congruent in 42.6% (n = 175), and clearly incongruent in 40.4% (n = 164). The mean rating for learning value was 3.8 (±1.0) (5 signifying greatest learning value). Curriculum-congruent vignettes had a higher mean learning value compared with curriculum-incongruent vignettes (4.0 vs 3.6, Student's t-test, P =.017). CONCLUSION The clinical vignettes presented at the national SGIM meeting offer clinical content that is relevant and of some educational value for third year clerkship students. Based on this pilot study, the educational value and strategies for their use in the clinical clerkships deserve further study. PMID:17026730

Assessment of the nutritive value of cereal and legume straws based on chemical composition and in vitro digestibility

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Lopez, S.; Davies, D.; Dhanoa, M.S.; Dijkstra, J.; France, J.

2005-01-01

The nutritive value of 17 straws was determined on the basis of their chemical composition, in vitro dry matter (DM) digestibility and rumen fermentation kinetics (from gas production curves measured in vitro). Five roughages were from the cereal species Avena sativa (oat), Hordeum vulgare (barley),

Reference values for rotational thromboelastometry (ROTEM) in clinically healthy cats.

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Marly-Voquer, Charlotte; Riond, Barbara; Jud Schefer, Rahel; Kutter, Annette P N

2017-03-01

To establish reference intervals for rotational thromboelastometry (ROTEM) using feline blood. Prospective study. University teaching hospital. Twenty-three clinically healthy cats between 1 and 15 years. For each cat, whole blood was collected via jugular or medial saphenous venipuncture, and blood was placed into a serum tube, a tube containing potassium-EDTA, and tubes containing 3.2% sodium citrate. The tubes were maintained at 37°C for a maximum of 30 minutes before coagulation testing. ROTEM tests included the EXTEM, INTEM, FIBTEM, and APTEM assays. In addition, prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen concentration (Clauss method) were analyzed for each cat. Reference intervals for ROTEM were calculated using the 2.5-97.5 th percentile for each parameter, and correlation with the standard coagulation profile was performed. Compared to people, clinically healthy cats had similar values for the EXTEM and INTEM assays, but had lower plasma fibrinogen concentrations (0.9-2.2 g/L), resulting in weaker maximum clot firmness (MCF, 3-10 mm) in the FIBTEM test. In 18 cats, maximum lysis (ML) values in the APTEM test were higher than in the EXTEM test, which seems unlikely to have occurred in the presence of aprotinin. It is possible that the observed high maximum lysis values were due to clot retraction rather than true clot lysis. Further studies will be required to test this hypothesis. Cats have a weaker clot in the FIBTEM test, but have a similar clot strength to human blood in the other ROTEM assays, which may be due to a stronger contribution of platelets compared to that found in people. In cats, careful interpretation of the results to diagnose hyperfibrinolysis is advised, especially with the APTEM test, until further data are available. © Veterinary Emergency and Critical Care Society 2017.

The value of case-based teaching vignettes in clinical microbiology rounds.

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Spicer, Jennifer O; Kraft, Colleen S; Burd, Eileen M; Armstrong, Wendy S; Guarner, Jeannette

2014-03-01

To describe the implementation and evaluation of a case-based microbiology curriculum during daily microbiology rounds. Vignettes consist of short cases with images and questions that facilitate discussion among microbiologists, pathologists, infectious disease physicians, and trainees (residents and fellows). We performed a survey to assess the value of these vignettes to trainees. Motivation to come to rounds on time increased from 60% to 100%. Trainees attending rounds after implementation of the vignettes perceived the value of microbiology rounds to be significantly higher compared with those who attended rounds before implementation (P = .04). Pathology residents found that vignettes were helpful for retaining knowledge (8.3 of 10 points). The vignettes have enhanced the value of microbiology rounds by serving as a formalized curriculum exposing trainees from multiple specialties to various microbiology topics. Emphasis on interdisciplinary interactions between clinical and laboratory personnel was highlighted with this case-based curriculum.

The clinical value of angiography in diseases of the epigastric organs

International Nuclear Information System (INIS)

Mertens, A.W.

1981-01-01

76 cases in which in the time between 1969 and 1974 coeliacographies were carried out and the diagnoses are clinically manifested were retrospectively analysed. The angiographic symptoms and the diagnostic results are compared to the literature. Following this, the diagnostic and therapeutic value in liver processes, paucreas processes, stomach tumours, gastrointestinal bleedings, traumas of the epigastric organs, catheter embolisation and stopping of acute, severe gastrointestinal bleedings are discussed. The value of angiography in comparison to laparoscopy, ERCP, sonography, and computerized tomography is discussed. At the end, the indication of angiography in diseases of the epigastric organs is summarized in two tables, distinguishing between absolute, relative, strongly restricted indications and no indication at all. (orig./MG) [de

The clinical value of detection of serum TGAb and TPOAb level in autoimmune thyroid diseases

International Nuclear Information System (INIS)

Min Xiaoxia; Huang Xingming

2008-01-01

To study the clinical value of serum TGAb and TPOAb levels in the diagnosis of patients with autoimmune thyroid diseases (AITD), the serum levels of TGAb and TPOAb in 175 patients with AITD and 64 non-AITD patients and 57 health controls were measured by RIA. The results showed that the serum levels of TGAb and TPOAb in AITD patients with GD and HT were significantly higher than that of control group (P 0.05). The detection of serum TGAb and TPOAb levels may have clinical value in the diagnosis, treatment and prognosis of autoimmune thyroid diseases. (authors)

The clinical value of Huangqi injection in the treatment of leucopenia: a meta-analysis of clinical controlled trials.

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Changsong Zhang

Full Text Available BACKGROUND: Huangqi injection is derived from Astragalus membranaceus root. In China, recent reports of Huangqi injection for the treatment of leucopenia have emerged. However, a systematic review of these reports has not been performed. Thus, we conducted a meta-analysis of clinical controlled trials to assess the clinical value of Huangqi injection in the treatment of leucopenia. METHODS: We searched the Chinese Biomedical Literature Database (CBM, Wanfang Database, China National Knowledge Infrastructure (CNKI, Chinese Scientific Journals Full-text Database (VIP, as well as PubMed and EMBASE to collect the data about trials of Huangqi injection for treating leucopenia. A meta-analysis was performed using RevMan 5.2 software. RESULTS: A total of 13 studies involving 841 patients were included in this study. The overall study quality was lower according to the Jadad scale. The meta-analysis showed that experimentally treated patients experienced greater therapeutic efficacy and lower white blood cell counts than control groups treated with Western medicine (P < 0.05. No publication bias was evident, according to Egger's test. CONCLUSIONS: The validity of this meta-analysis was limited by the overall poor quality of the included studies. Huangqi injection may have potential clinical value in the treatment of leucopenia, but confirmation with rigorously well-designed multi-center trials is needed.

Utility of repeat testing of critical values: a Q-probes analysis of 86 clinical laboratories.

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Lehman, Christopher M; Howanitz, Peter J; Souers, Rhona; Karcher, Donald S

2014-06-01

A common laboratory practice is to repeat critical values before reporting the test results to the clinical care provider. This may be an unnecessary step that delays the reporting of critical test results without adding value to the accuracy of the test result. To determine the proportions of repeated chemistry and hematology critical values that differ significantly from the original value as defined by the participating laboratory, to determine the threshold differences defined by the laboratory as clinically significant, and to determine the additional time required to analyze the repeat test. Participants prospectively reviewed critical test results for 4 laboratory tests: glucose, potassium, white blood cell count, and platelet count. Participants reported the following information: initial and repeated test result; time initial and repeat results were first known to laboratory staff; critical result notification time; if the repeat result was still a critical result; if the repeat result was significantly different from the initial result, as judged by the laboratory professional or policy; significant difference threshold, as defined by the laboratory; the make and model of the instrument used for primary and repeat testing. Routine, repeat analysis of critical values is a common practice. Most laboratories did not formally define a significant difference between repeat results. Repeated results were rarely considered significantly different. Median repeated times were at least 17 to 21 minutes for 10% of laboratories. Twenty percent of laboratories reported at least 1 incident in the last calendar year of delayed result reporting that clinicians indicated had adversely affected patient care. Routine repeat analysis of automated chemistry and hematology critical values is unlikely to be clinically useful and may adversely affect patient care.

Drugs and having babies: an exploration of how a specialist clinic meets the needs of chemically dependent pregnant women.

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Morris, Michelle; Seibold, Carmel; Webber, Ruth

2012-04-01

to explore the extent to which a specialist clinic meets the needs of chemically dependent women. a critical ethnography informed by theorists such as Habermas and feminists' interpretation of Foucault. a specialist antenatal clinic for chemically dependent pregnant women at a major metropolitan women's hospital in Melbourne, Australia. a purposive sample of twenty (20) chemically dependent pregnant women who attended the clinic. Data collection and analysis included three taped interviews (two preceding the birth and one post birth), observation of the interactions between the women and the clinic staff over a 25-month period and chart audits. similar to other studies there were multiple factors influencing development and maintenance of chemical dependency in this group of women, including family instability, family history of drug and alcohol abuse, childhood sexual abuse, having a chemically dependent partner and having a dual diagnosis of both drug addiction and mental illness. Initially there was considerable variation between the women and the clinic staff's expectations with regard to attending for antenatal care and conforming to a set regime as the women struggled with the contradictions inherent in their lifestyle and that of the 'normal' expectant mother. Aspects of that struggle included their belief that their opinions and knowledge of their lives was largely ignored, leading to episodes of resistance. Several women alleged the clinics staff's relationship with them was influenced by a belief that the women were 'hopeless addicts in need of expert medical and midwifery care' and that the clinic staff exercised control in an authoritarian manner. However, as they explored possibilities for collaboration, they realised they could exercise power and work towards a more equal relationship with staff. The quality of relationships in most instances improved over time, and if not always strictly collaborative, was situated at various points along a continuum

Changes in the classification of carcinogenic chemicals in the work area. (Section III of the German List of MAK and BAT values).

Science.gov (United States)

Neumann, H G; Thielmann, H W; Filser, J G; Gelbke, H P; Greim, H; Kappus, H; Norpoth, K H; Reuter, U; Vamvakas, S; Wardenbach, P; Wichmann, H E

1998-01-01

Carcinogenic chemicals in the work area were previously classified into three categories in section III of the German List of MAK and BAT values (the list of values on maximum workplace concentrations and biological tolerance for occupational exposures). This classification was based on qualitative criteria and reflected essentially the weight of evidence available for judging the carcinogenic potential of the chemicals. In the new classification scheme the former sections IIIA1, IIIA2, and IIIB are retained as categories 1, 2, and 3, to correspond with European Union regulations. On the basis of our advancing knowledge of reaction mechanisms and the potency of carcinogens, these three categories are supplemented with two additional categories. The essential feature of substances classified in the new categories is that exposure to these chemicals does not contribute significantly to the risk of cancer to man, provided that an appropriate exposure limit (MAK value) is observed. Chemicals known to act typically by non-genotoxic mechanisms, and for which information is available that allows evaluation of the effects of low-dose exposures, are classified in category 4. Genotoxic chemicals for which low carcinogenic potency can be expected on the basis of dose/response relationships and toxicokinetics and for which risk at low doses can be assessed are classified in category 5. The basis for a better differentiation of carcinogens is discussed, the new categories are defined, and possible criteria for classification are described. Examples for category 4 (1,4-dioxane) and category 5 (styrene) are presented.

The value of iodide as a parameter in the chemical characterisation of groundwaters

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Lloyd, J. W.; Howard, K. W. F.; Pacey, N. R.; Tellam, J. H.

1982-06-01

Brackish and saline groundwaters can severely constrain the use of fresh groundwaters. Their chemical characterisation is important in understanding the hydraulic conditions controlling their presence in an aquifer. Major ions are frequently of limited value but minor ions can be used. Iodide in groundwater is particularly significant in many environments due to the presence of soluble iodine in aquifer matrix materials. Iodide is found in groundwaters in parts of the English Chalk aquifer in concentrations higher than are present in modern seawater. Its presence is considered as a indication of groundwater residence and is of use in the characterisation of fresh as well as saline waters. Under certain circumstances modern seawater intrusion into aquifers along English estuaries produces groundwaters which are easily identified due to iodide enrichment from estuarine muds. In other environments iodide concentrations are of value in distinguishing between groundwaters in limestones and shaly gypsiferous rocks as shown by a study in Qatar, while in an alluvial aquifer study in Peru iodide has been used to identify groundwaters entering the aquifer from adjacent granodiorites.

The Clinical Test of Nano gold Cosmetic for Recovering Skin Damage Due to Chemicals: Special Case

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Taufikurohmah, T.; Wardana, A. P.; Tjahjani, S.; Sanjaya, I. G. M.; Baktir, A.; Syahrani, A.

2018-01-01

Manufacturing of Nano gold cosmetics was done at PT. Gizi Indonesia. Clinical trials to cosmetics data supported that cosmetics are able to treat skin health which has been reported partially. For special cases, the recovery process of facial skin damage should also receive attention including cases of facial skin damage caused by chemicals such as phenol, HCl, aqua regia or other harsh chemicals. The problem determined whether the Nano gold is able to recover skin damage due to the harsh chemicals. This clinical trial data on the forms of early skin damage caused by phenol was delivered in the forms of facial photos patients. The recovery progress of facial skin condition was obtained every week for two months. The data included the forms of widespread wounds during the recovery process. This statement supported by anova statistical analysis of the widespread wound changing every week for 8 times. The conclusion is skin damage due to Phenol impregnation can be recovered with the use of Nano gold cosmetics for 8 weeks. This results support the manufacturing of Nano gold cosmetics for the needs of society. It also suggest that Nano gold material can be used for medicine manufacturing in the future.

Dental Students' Perceived Value of Peer-Mentoring Clinical Leadership Experiences.

Science.gov (United States)

Sheridan, Rachel A; Hammaker, Daniel J; de Peralta, Tracy L; Fitzgerald, Mark

2016-03-01

This pilot study compared second- and fourth-year dental students' perceived values of newly implemented clinical leadership experiences (CLEs) at one U.S. dental school during the 2012-13 academic year. In the CLEs, fourth-year (D4) students mentored second-year (D2) dental students during faculty-supervised patient treatment. The two cohorts' perceived value of the experiences was measured with questionnaires consisting of five-point Likert scale questions and open text responses. Out of a total of 114 D2 and 109 D4 students, 46 D2 students and 35 D4 students participated (response rates of 40.4% and 32.1%, respectively). While responses from both cohorts showed they highly valued the CLEs, the D2s perceived greater value: 4.07 (0.53) v. 3.51 (0.95), pmentor D2s, that the CLEs had educational benefits, and that the CLEs increased their comfort with peer communication. Theme analysis of open text questions revealed that the respondents perceived the D4s were more accessible than faculty and provided guidance and individual attention; the CLEs increased student comfort; the CLEs reinforced D4 skills, knowledge, and confidence; and the CLEs provided management, leadership, and collaborative work experience. Theme analysis also highlighted student concerns about a lack of program structure. Overall, the majority of both groups valued CLEs in their dental education. Particular advantages they perceived were increased comfort, guidance, and attention. Further program development should address student concerns. These results suggest that similar programs should be considered and/or expanded in other dental schools' curricula.

Clinical Correlates and Prognostic Value of Proenkephalin in Acute and Chronic Heart Failure

NARCIS (Netherlands)

Matsue, Yuya; ter Maaten, Jozine M.; Struck, Joachim; Metra, Marco; O'Connor, Christopher M.; Ponikowski, Piotr; Teerlink, John R.; Cotter, Gad; Davison, Beth; Cleland, John G.; Givertz, Michael M.; Bloomfield, Daniel M.; Dittrich, Howard C.; van Veldhuisen, Dirk J.; van der Meer, Peter; Damman, Kevin; Voors, Adriaan A.

Background: Proenkephalin (pro-ENK) has emerged as a novel biomarker associated with both renal function and cardiac function. However, its clinical and prognostic value have not been well evaluated in symptomatic patients with heart failure. Methods and Results: The association between pro-ENK and

Prediction of pKa Values for Druglike Molecules Using Semiempirical Quantum Chemical Methods.

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Jensen, Jan H; Swain, Christopher J; Olsen, Lars

2017-01-26

Rapid yet accurate pK a prediction for druglike molecules is a key challenge in computational chemistry. This study uses PM6-DH+/COSMO, PM6/COSMO, PM7/COSMO, PM3/COSMO, AM1/COSMO, PM3/SMD, AM1/SMD, and DFTB3/SMD to predict the pK a values of 53 amine groups in 48 druglike compounds. The approach uses an isodesmic reaction where the pK a value is computed relative to a chemically related reference compound for which the pK a value has been measured experimentally or estimated using a standard empirical approach. The AM1- and PM3-based methods perform best with RMSE values of 1.4-1.6 pH units that have uncertainties of ±0.2-0.3 pH units, which make them statistically equivalent. However, for all but PM3/SMD and AM1/SMD the RMSEs are dominated by a single outlier, cefadroxil, caused by proton transfer in the zwitterionic protonation state. If this outlier is removed, the RMSE values for PM3/COSMO and AM1/COSMO drop to 1.0 ± 0.2 and 1.1 ± 0.3, whereas PM3/SMD and AM1/SMD remain at 1.5 ± 0.3 and 1.6 ± 0.3/0.4 pH units, making the COSMO-based predictions statistically better than the SMD-based predictions. For pK a calculations where a zwitterionic state is not involved or proton transfer in a zwitterionic state is not observed, PM3/COSMO or AM1/COSMO is the best pK a prediction method; otherwise PM3/SMD or AM1/SMD should be used. Thus, fast and relatively accurate pK a prediction for 100-1000s of druglike amines is feasible with the current setup and relatively modest computational resources.

Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.

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Johnson, Nils P; Tóth, Gábor G; Lai, Dejian; Zhu, Hongjian; Açar, Göksel; Agostoni, Pierfrancesco; Appelman, Yolande; Arslan, Fatih; Barbato, Emanuele; Chen, Shao-Liang; Di Serafino, Luigi; Domínguez-Franco, Antonio J; Dupouy, Patrick; Esen, Ali M; Esen, Ozlem B; Hamilos, Michalis; Iwasaki, Kohichiro; Jensen, Lisette O; Jiménez-Navarro, Manuel F; Katritsis, Demosthenes G; Kocaman, Sinan A; Koo, Bon-Kwon; López-Palop, Ramón; Lorin, Jeffrey D; Miller, Louis H; Muller, Olivier; Nam, Chang-Wook; Oud, Niels; Puymirat, Etienne; Rieber, Johannes; Rioufol, Gilles; Rodés-Cabau, Josep; Sedlis, Steven P; Takeishi, Yasuchika; Tonino, Pim A L; Van Belle, Eric; Verna, Edoardo; Werner, Gerald S; Fearon, William F; Pijls, Nico H J; De Bruyne, Bernard; Gould, K Lance

2014-10-21

Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear. The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization. Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold. A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief. FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy. Copyright © 2014. Published by Elsevier Inc.

Searching for neurodegeneration in multiple sclerosis at clinical onset: Diagnostic value of biomarkers.

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Novakova, Lenka; Axelsson, Markus; Malmeström, Clas; Imberg, Henrik; Elias, Olle; Zetterberg, Henrik; Nerman, Olle; Lycke, Jan

2018-01-01

Neurodegeneration occurs during the early stages of multiple sclerosis. It is an essential, devastating part of the pathophysiology. Tools for measuring the degree of neurodegeneration could improve diagnostics and patient characterization. This study aimed to determine the diagnostic value of biomarkers of degeneration in patients with recent clinical onset of suspected multiple sclerosis, and to evaluate these biomarkers for characterizing disease course. This cross-sectional study included 271 patients with clinical features of suspected multiple sclerosis onset and was the baseline of a prospective study. After diagnostic investigations, the patients were classified into the following disease groups: patients with clinically isolated syndrome (n = 4) or early relapsing remitting multiple sclerosis (early RRMS; n = 93); patients with relapsing remitting multiple sclerosis with disease durations ≥2 years (established RRMS; n = 39); patients without multiple sclerosis, but showing symptoms (symptomatic controls; n = 89); and patients diagnosed with other diseases (n = 46). In addition, we included healthy controls (n = 51) and patients with progressive multiple sclerosis (n = 23). We analyzed six biomarkers of neurodegeneration: cerebrospinal fluid neurofilament light chain levels; cerebral spinal fluid glial fibrillary acidic protein; cerebral spinal fluid tau; retinal nerve fiber layer thickness; macula volume; and the brain parenchymal fraction. Except for increased cerebral spinal fluid neurofilament light chain levels, median 670 ng/L (IQR 400-2110), we could not find signs of early degeneration in the early disease group with recent clinical onset. However, the intrathecal immunoglobin G production and cerebral spinal fluid neurofilament light chain levels showed diagnostic value. Moreover, elevated levels of cerebral spinal fluid glial fibrillary acidic protein, thin retinal nerve fiber layers, and low brain parenchymal fractions were associated with

The Value of Laboratory Tests in Diagnosing Secondary Osteoporosis at a Fracture and Osteoporosis Outpatient Clinic

NARCIS (Netherlands)

de Klerk, Gijs; Hegeman, J. Han; van der Velde, Detlef; van der Palen, Jacobus Adrianus Maria; ten Duis, Henk J.

2013-01-01

Background: As more and more patients meeting the criteria for osteoporosis are referred to a fracture and osteoporosis outpatient clinic (FO clinic), the laboratory costs to screen for secondary osteoporosis also increases. This study was conducted to determine the value of screening on underlying

Anorectal physiology measurements are of no value in clinical practice. True or false?

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Carty, N. J.; Moran, B.; Johnson, C. D.

1994-01-01

This article examines whether there is any clinical value in anorectal physiology measurements. The function of the human rectum is poorly understood and the factors which affect function of the anal sphincters are complex. Several laboratories have reported results of anorectal physiology measurements, but there is extensive variation between normal values in different laboratories. It is argued that anorectal physiology measurements fail to meet the criteria of a useful clinical test: 1. It is not widely available to clinicians; 2. It is not possible to establish a reproducible normal range; 3. Abnormal measurements do not correlate with disease entities or explain symptoms; 4. The results are often unhelpful in diagnosis and management; 5. Clinical outcome after intervention does not correlate with alteration in the measurements obtained. On the other hand it can be argued that anorectal physiology measurements do provide information that assists in the management of conditions such as constipation, anismus, Hirschsprung's disease, faecal incontinence and tenesmus. Management based on biofeedback modification of physiological responses requires these techniques as part of the biofeedback system. There is evidence that this may be appropriate in anismus and solitary rectal ulcer syndrome. However, the assessment of these difficult conditions and the interpretation of the results are probably at present best confined to specialist units. PMID:8074392

Predicting Calcium Values for Gastrointestinal Bleeding Patients in Intensive Care Unit Using Clinical Variables and Fuzzy Modeling

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G Khalili-Zadeh-Mahani

2016-07-01

Full Text Available Introduction: Reducing unnecessary laboratory tests is an essential issue in the Intensive Care Unit. One solution for this issue is to predict the value of a laboratory test to specify the necessity of ordering the tests. The aim of this paper was to propose a clinical decision support system for predicting laboratory tests values. Calcium laboratory tests of three categories of patients, including upper and lower gastrointestinal bleeding, and unspecified hemorrhage of gastrointestinal tract, have been selected as the case studies for this research. Method: In this research, the data have been collected from MIMIC-II database. For predicting calcium laboratory values, a Fuzzy Takagi-Sugeno model is used and the input variables of the model are heart rate and previous value of calcium laboratory test. Results: The results showed that the values of calcium laboratory test for the understudy patients were predictable with an acceptable accuracy. In average, the mean absolute errors of the system for the three categories of the patients are 0.27, 0.29, and 0.28, respectively. Conclusion: In this research, using fuzzy modeling and two variables of heart rate and previous calcium laboratory values, a clinical decision support system was proposed for predicting laboratory values of three categories of patients with gastrointestinal bleeding. Using these two clinical values as input variables, the obtained results were acceptable and showed the capability of the proposed system in predicting calcium laboratory values. For achieving better results, the impact of more input variables should be studied. Since, the proposed system predicts the laboratory values instead of just predicting the necessity of the laboratory tests; it was more generalized than previous studies. So, the proposed method let the specialists make the decision depending on the condition of each patient.

The cost and value of pre-registration clinical placements for Project 2000 students.

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Jones, M L; Akehurst, R

1999-07-01

The research outlined in this article was commissioned by the Sheffield and North Trent College of Nursing and Midwifery to explore the cost implications of pre-registration clinical placements in the context of Project 2000. The authors outline the methodology and findings of an exercise designed to collect relevant cost information which was not readily available. On the basis of these findings, they suggest that: at 1995/1996 pay and prices, clinical placements cost the education provider approximately pound 890 per student per annum; in terms of real resources, the value to service providers of the service contribution made by second- and third-year nursing and midwifery students on ward-based placements outweighs the value of the time spent by qualified staff on their supervision and education. Once the funding assumptions underlying the introduction of Project 2000 have been taken into account, second- and third-year nursing and midwifery students benefit the service provider by on average pound 3.46 for every hour they spend in an unrostered ward-based placement. The service contribution made by students in community-based clinical placements cannot free staff time in the same way as on the wards and, because qualified staff in these areas are generally more highly graded, the value of the time they spend on the supervision and education of students on placement is higher than in ward-based placements. Second- and third-year students therefore appear to cost the service provider on average pound 0.48 for each hour they spend in a community-based placement. It was not possible to determine whether this cost translates into a reduction in patient contacts.

External Beam Radiotherapy for Clinically Localized Hormone-Refractory Prostate Cancer: Clinical Significance of Nadir Prostate-Specific Antigen Value Within 12 Months

International Nuclear Information System (INIS)

Ogawa, Kazuhiko; Nakamura, Katsumasa; Sasaki, Tomonari; Onishi, Hiroshi; Koizumi, Masahiko; Shioyama, Yoshiyuki; Araya, Masayuki; Mukumoto, Nobutaka M.S.; Mitsumori, Michihide; Teshima, Teruki

2009-01-01

Purpose: To analyze retrospectively the results of external beam radiotherapy for clinically localized hormone-refractory prostate cancer and investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcomes after radiotherapy. Methods and Materials: Eighty-four patients with localized hormone-refractory prostate cancer treated with external beam radiotherapy were retrospectively reviewed. The total radiation doses ranged from 30 to 76 Gy (median, 66 Gy), and the median follow-up period for all 84 patients was 26.9 months (range, 2.7-77.3 months). Results: The 3-year actuarial overall survival, progression-free survival (PFS), and local control rates in all 84 patients after radiotherapy were 67%, 61%, and 93%, respectively. Although distant metastases and/or regional lymph node metastases developed in 34 patients (40%) after radiotherapy, local progression was observed in only 5 patients (6%). Of all 84 patients, the median nPSA12 in patients with clinical failure and in patients without clinical failure was 3.1 ng/mL and 0.5 ng/mL, respectively. When dividing patients according to low (<0.5 ng/mL) and high (≥0.5 ng/mL) nPSA12 levels, the 3-year PFS rate in patients with low nPSA12 and in those with high nPSA12 was 96% and 44%, respectively (p < 0.0001). In univariate analysis, nPSA12 and pretreatment PSA value had a significant impact on PFS, and in multivariate analysis nPSA12 alone was an independent prognostic factor for PFS after radiotherapy. Conclusions: External beam radiotherapy had an excellent local control rate for clinically localized hormone-refractory prostate cancer, and nPSA12 was predictive of clinical outcomes after radiotherapy.

Clinical reference value of retinal microvascular changes in patients with cerebral microbleeds

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Ji-Yuan Guo

2014-12-01

Full Text Available AIM: To study clinical reference value of retinal microvascular changes in patients with cerebral microbleeds(CMBsand discuss its clinical significance. METHODS:From January 2012 to December 2013, 125 hospitalized patients were collected, including 81 cases were male, 44 cases were female, mean age 76.3±11.2 years old. For all patients, functions of liver and kidney, blood-lipoids, blood sugar and blood biochemical examination were tested, and fundus photography and cerebral MR was done. According to the fundus camera eyes, retinal arteriolar equivalent(RAE, retinal venular equivalent(RVE, retinal vein diameter ratio(AVRand arteriovenous crossing sign(AVNwere identified, CMBs were classified with cerebral MRI. All the data were processed by SPSS statistical software. RESULTS: The central retinal arteriolar equivalent(CRAE, central retinal venular equivalent(CRVEand AVR values in the eyes were found no statistical difference(PPCOCLUSION: The results show that retinal microvascular changes, especially small retinal vein arteriovenous cross width, and arteriovenous crossing phenomenon, in which CMBs will happen more likely. After sex, age, hypertension and hyperglycemia in patients with traditional cardiovascular risk factors being ruled out, the retinal microvascular changes are still relatively factors of CMB's occurrence.

Chemically modified tetracyclines an emerging host modulator in chronic periodontitis patients: A randomized, double-blind, placebo-controlled, clinical trial.

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Alyousef, Abdullah A; Divakar, Darshan Devang; Muzaheed

2017-09-01

Although periodontal diseases are caused by some of the specific pathogens, most of the tissue damage is caused by the host reaction to disease and not actually by the infections. Therefore, host modulatory therapy (HMT) has advanced benefit for the treatment of periodontitis, which works basically by reducing tissue destruction and regeneration in periodontium by altering the critical aspects of host response regulation and up regulating defensive regenerative responses. The present study was conducted with the goal to test an innovative therapeutic option using chemically modified tetracycline in patients affected with generalized, moderate and severe chronic periodontitis. We assumed that CMT might have the potential to provoke an assessable clinical result and pharmacologically impede the level inflammatory flow. CMT (incyclinide) treated group had significantly higher CAL (clinical attachment) values than Placebo Control suggesting an improved CAL in CMT treatment. Host modulation therapy width incyclinide can be as an adjunct to conventional nonsurgical therapies without antimicrobial resistance. Progress was noticed in the clinical parameters but not the serum CRP level in our study establishing the role of CMTs in controlling chronic periodontitis. Also CMT treatment indicates its role in anti-inflammatory process as it inhibited IL-12 and TNF alpha but IL-10 level was not affected. However, more randomized placebo-controlled clinical trials with large sample size are required in order to authenticate the usage of CMTs in chronic periodontitis treatment. Based on this understanding, exploration of the novel, low-cost synthetic inhibitors that can be used as potential therapeutic agents, has been tested. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nutritive value of some agricultural wastes as affected by relatively low gamma irradiation levels and chemical treatments

International Nuclear Information System (INIS)

Al-Masri, M. R.

2006-01-01

An experiment was carried out to study the changes in the values of in-vitro organic matter digestibility (IVOMD) and metabolizable energy (ME) of wheat straw, sunflower seed shell, olive cake wood, date palm seeds and peanut shell after irradiation by various levels of gamma radiation (0, 20, 40, 60 kGy) or after spraying with different amounts of hydrobromic acid (HBr; 47%) and sodium hydroxide (NaOH): 0, 3, 6 ml HBr and 3, 6 g NaOH in 25 ml water/100 g DM. The results indicated that chemical treatments increased the IVOMD and ME values significantly for all samples treated except the date palm seeds. There was no significant effect of irradiation on IVOMD and ME. Combined treatments of irradiation and HBr or NaOH were also found to be ineffective in increasing the IVOMD and ME values. (Author)

Biomass valorisation by staged degasification A new pyrolysis-based thermochemical conversion option to produce value-added chemicals from lignocellulosic biomass

NARCIS (Netherlands)

de Wild, P. J.; den Uil, H.; Reith, J. H.; Kiel, J. H. A.; Heeres, H. J.

Pyrolysis of lignocellulosic biomass leads to an array Of useful solid, liquid and gaseous products. Staged degasification is a pyrolysis-based conversion route to generate value-added chemicals from biomass. Because of different thermal stabilities of the main biomass constituents hemicellulose.

The 5 Clinical Pillars of Value for Total Joint Arthroplasty in a Bundled Payment Paradigm.

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Kim, Kelvin; Iorio, Richard

2017-06-01

Our large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms. We summarize a number of experiences and lessons learned since the implementation of Bundled Payments for Care Improvement at our institution. Our experience has led to the development of more refined clinical pathways and coordination of care through evidence-based approaches. We have established that the success of the bundled payment program rests on the following 5 main clinical pillars: (1) optimizing patient selection and comorbidities; (2) optimizing care coordination, patient education, shared decision making, and patient expectations; (3) using a multimodal pain management protocol and minimizing narcotic use to facilitate rapid rehabilitation; (4) optimizing blood management, and standardizing venous thromboembolic disease prophylaxis treatment by risk standardizing patients and minimizing the use of aggressive anticoagulation; and (5) minimizing post-acute facility and resource utilization, and maximizing home resources for patient recovery. From our extensive experience with bundled payment models, we have established 5 clinical pillars of value for bundled payments. Our hope is that these principles will help ease the transition to value-based care for less-experienced healthcare systems. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical application value of impulse oscillometry in geriatric patients with COPD

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Liu Z

2017-03-01

Full Text Available Zhonghui Liu,* Lianjun Lin,* Xinmin Liu Geriatrics Department, Peking University First Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Background: The diagnosis and assessment of COPD rely mainly on the use of spirometry, which is an effort-dependent test and requires good patient cooperation. Impulse oscillometry (IOS is a non-volitional method that requires less effort and cooperation and presents advantages for geriatric patients. However, the clinical application value of IOS in geriatric patients with COPD remains unclear. Aim: The aim of this study was to investigate the clinical application value of IOS in geriatric patients with COPD. Subjects and methods: A total of 234 subjects were retrospectively enrolled in this study, including 133 patients with COPD and 101 healthy volunteers. All the participants underwent IOS and spirometry examination. The data were collected and analyzed in the overall group, the geriatric group (aged ≥65 years, and the advanced elderly group (aged ≥80 years. Results: 1 In COPD patients, a significant increase in respiratory impedance (Z5, resonant frequency (Fres, and respiratory resistance (R5, R20, R5–R20 and a decrease in respiratory reactance (X5 were observed in the overall group, the geriatric group, and the advanced elderly group compared with the healthy control subjects. 2 The IOS parameters correlated well with spirometry in COPD. In particular, R5–R20 showed the best correlation with forced expiratory volume in 1 second (FEV1 in the different age groups. 3 Fres and R5–R20 had the best diagnostic efficiency for COPD. The area under the curve (AUC values for Fres, expressed by the receiver operating characteristic (ROC curve, were 0.905, 0.909, and 0.914, for the different age groups, respectively. 4 The optimal cutoff values for Fres to diagnose airflow obstruction from ROC curves was 17.715 in the COPD patients. Its sensitivity and

Evaluation of Physico-chemical Parameters of Manchar Lake Water and Their Comparison with Other Global Published Values

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Muhammad Balal Arain

2008-12-01

Full Text Available The aim of current study was to evaluate the status of the Manchar lake water with respect to different physico-chemical parameters (electric conductivity, pH, chloride, phosphate, sulfate, total alkalinity, potassium, calcium, magnesium, manganese, iron, cadmium, copper, arsenic, nickel, zinc, chromium lead and selenium in 2005-2007. Among the elemental investigation of Manchar Lake water except Co, Cr, Cu and Mn, other elements (Al, As, Ca, Cd, Fe, Mg, Na, K, Ni, Pb and Se have higher values as compared to the permissible level of these elements in drinking water. The results were compared with WHO water quality guidelines as well as with literature values reported for global lake water.

Clinical value of homodynamic numerical simulation applied in the treatment of cerebral aneurysm.

Science.gov (United States)

Zhang, Hailin; Li, Li; Cheng, Chongjie; Sun, Xiaochuan

2017-12-01

Our objective was to evaluate the clinical value of numerical simulation in diagnosing cerebral aneurysm based on the analysis of numerical simulation of hemodynamic model. The experimental method used was the numerical model of cerebral aneurysm hemodynamic, and the numerical value of blood flow at each point was analyzed. The results showed that, the wall shear stress (WSS) value on the top of CA1 was significantly lower than that of the top (Pvalue of each point on the CA2 tumor was significantly lower than that of tumor neck (Pvalue on the tumor top and tumor neck between CA1 and CA2 had no significant difference (P>0.05); the unsteady index of shear (UIS) value at the points of 20 had distinctly changed, the wave range was 0.6-1.5; the unsteady index of pressure value of every point was significantly lower than UIS value, the wave range was 0.25-0.40. In conclusion, the application of cerebral aneurysm hemodynamic research can help doctors to diagnose cerebral aneurysm more precisely and to grasp the opportunity of treatment during the formulating of the treatment strategies.

Understanding patient values and the manifestations in clinical research with traditional chinese medicine-with practical suggestions for trial design and implementation.

Science.gov (United States)

Mu, Wei; Shang, Hongcai

2013-01-01

Objective. To define patient values, identify their manifestations in a randomized clinical trial, and investigate the possible implications for clinical research of traditional Chinese medicine. Methods. We categorized patient values manifestations into patient choice, preference, compliance, and patient-reported outcomes and summarized the underlying personal values through purposeful electronic searches for relevant reports. By hypothesizing a set of positive versus negative circumstances occurring in the enrollment, intervention allocation, treatment, and the follow-up stage of a trial, it is possible to discuss the potential implications of patient values manifestation on a trial with traditional Chinese medicine. Results. Patient values and its manifestations are ubiquitous in the process of clinical research with traditional Chinese medicine. These values may provide motivation for participation or engender the internal and external validity of the study. Conclusions. Trialists should attach sufficient importance to the needs and concerns of individual participant. To incorporate patient values into the design and conduct of a clinical study with traditional Chinese medicine, researchers are recommended to adopt participant-friendly design and use patient-reported outcomes, take convenience-for-patients measures, and help foster rational beliefs and behaviors of trial participants.

Understanding Patient Values and the Manifestations in Clinical Research with Traditional Chinese Medicine—With Practical Suggestions for Trial Design and Implementation

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Wei Mu

2013-01-01

Full Text Available Objective. To define patient values, identify their manifestations in a randomized clinical trial, and investigate the possible implications for clinical research of traditional Chinese medicine. Methods. We categorized patient values manifestations into patient choice, preference, compliance, and patient-reported outcomes and summarized the underlying personal values through purposeful electronic searches for relevant reports. By hypothesizing a set of positive versus negative circumstances occurring in the enrollment, intervention allocation, treatment, and the follow-up stage of a trial, it is possible to discuss the potential implications of patient values manifestation on a trial with traditional Chinese medicine. Results. Patient values and its manifestations are ubiquitous in the process of clinical research with traditional Chinese medicine. These values may provide motivation for participation or engender the internal and external validity of the study. Conclusions. Trialists should attach sufficient importance to the needs and concerns of individual participant. To incorporate patient values into the design and conduct of a clinical study with traditional Chinese medicine, researchers are recommended to adopt participant-friendly design and use patient-reported outcomes, take convenience-for-patients measures, and help foster rational beliefs and behaviors of trial participants.

Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers.

Science.gov (United States)

Agha, Syed A; Kalogeropoulos, Andreas P; Shih, Jeffrey; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Anarado, Perry; Mangalat, Deepa; Hussain, Imad; Book, Wendy; Laskar, Sonjoy; Smith, Andrew L; Martin, Randolph; Butler, Javed

2009-09-01

Incremental value of echocardiography over clinical parameters for outcome prediction in advanced heart failure (HF) is not well established. We evaluated 223 patients with advanced HF receiving optimal therapy (91.9% angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 92.8% beta-blockers, 71.8% biventricular pacemaker, and/or defibrillator use). The Seattle Heart Failure Model (SHFM) was used as the reference clinical risk prediction scheme. The incremental value of echocardiographic parameters for event prediction (death or urgent heart transplantation) was measured by the improvement in fit and discrimination achieved by addition of standard echocardiographic parameters to the SHFM. After a median follow-up of 2.4 years, there were 38 (17.0%) events (35 deaths; 3 urgent transplants). The SHFM had likelihood ratio (LR) chi(2) 32.0 and C statistic 0.756 for event prediction. Left ventricular end-systolic volume, stroke volume, and severe tricuspid regurgitation were independent echocardiographic predictors of events. The addition of these parameters to SHFM improved LR chi(2) to 72.0 and C statistic to 0.866 (P advanced HF.

Chemical sensitizers for hypoxic cells: a decade of experience in clinical radiotherapy

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Dische, S [Mount Vernon Hospital, Northwood (UK)

1985-02-01

The clinical work with chemical agents to restore the radiosensitivity of hypoxic cells began in 1973 with metronidazole, misonidazole was first given in 1974. The results so far recorded of the clinical trials with misonidazole have been generally disappointing. Hypoxic cells must exist in all human tumours presenting for treatment and it is, however, probable that the oxygen effect is an important one at all dose fractionation regimes employed in radiotherapy but, after conventional fractionated radiotherapy, hypoxia may be a reason for failure in only a proportion of cases. The most important factor underlying the failure of misonidazole to acheive useful advantage is undoubtedly the low radiosensitizing concentrations achievable with the permitted dose of this neurotoxic drug. New drugs are under development and some have different dose-limiting toxicity. Those showing promise at this time are the Stanford compound, SR-2508 and the Roche compounds, Ro 03-8799. It is possible that the greatest sensitization with the greatest tolerance will be achieved by a combination of drugs.

Clinical value of CD133 and nestin in patients with glioma

DEFF Research Database (Denmark)

Dahlrot, Rikke H; Hansen, Steinbjørn; Jensen, Stine S

2014-01-01

Cancer stem cell-related (CSC) markers have been suggested to have promising potentials as novel types of prognostic and predictive markers in gliomas. However no single CSC-related marker is currently used in clinical decisions. The aim of this study was to investigate the prognostic value of CD......133 and nestin separately and in combination using a novel quantitative approach in a well-characterized population-based cohort of glioma patients. The expression of CD133 and nestin was measured by systematic random sampling in stained paraffin sections from 239 glioma patients diagnosed between...

Clinical value of positron emission tomography (PET) in oncology: Results of an interdisciplinary consensus conference

International Nuclear Information System (INIS)

Reske, S.N.; Bares, R.; Buell, U.; Guhlmann, A.; Moser, E.; Wannenmacher, M.F.

1996-01-01

Clinical value of PET in oncology was evaluated by a panel of recognized experts in the framework of an interdisciplinary consensus conference. On the basis of PET studies, well documented in the international literature, the value of PET for solving clinical questions was classified according to the following categories 'appropriate' (1a), 'mostly acceptable' (1b), 'helpful' (2a), 'value as yet unknown' (2b), 'useless' (3). 2-fluorodeoxyglucose (FDG) acts as the radiopharmaceutical of choice for PET in clinical oncology. PET is indicated (1a) for diagnosing relapse in high grade glioma (FDG) or low grade glioma (C-11 methionine or F-18 fluorotyrosine), differential diagnosis of solitary peripheral pulponary nodules in high risk patients and for diagnosis of pancreatic carcinoma. PET may be clinically used (1b): In 'low-grade' glioma, search for unknown primary in head and neck tumors, suspicion of relapse in nonsmall cell bronchial carcinoma (NSCBC) and colorectal carcinoma, lymphnode staging in NSCBC, pancreatic carcinoma, muscle invasive bladder carcinoma and testicular cancer. Staging of Hodgkin's disease (HD, stage I/II vs III), early therapy control in patients with a residual mass or suspicion of relapse in HD and in high grade NHL, lymph node staging and search for distant metastases in malignant melanoma (Breslow>1,5 mm), search for lymph node or distant metastases in differentiated thyroid cancer with elevated hTG and a negative radioiodide whole body scan. Many further indications are emerging, but are not yet sufficiently well documented in the literature. For most indications beside scientific studies, an individual cost benefit utility evaluation by the responsible physician is recommended. (orig./MG) [de

Clinical value of CT in neuropediatrics

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Reisner, Th. (Vienna Univ. (Austria). Neurologische Klinik)

1981-11-27

Cranial computed-tomography (CT) has opened new dimensions in neuropediatric diagnosis. The relationship between clinical symptoms and CT results is presented. 1930 patients were investigated, one group is made up of 334 newborns and infants, the other group contains children in the age between 13 months and 15 years. Newborns and infants confront the neurologist with stereotyped deficiency symptoms which nevertheless can arise from many causes. CT can make an etiological classification. In childhood illnesses of neurophyschiatric nature sometimes predominate whose clinical symptoms are often minimal (e.g. cerebral seizures, hydrocephalus, perinatal brain damage, various types of headache etc.). Here again CT can give the clinical valuable indications concerning diagnosis and therapeutic procedure.

[A study of work values, professional commitment, turnover intention and related factors among clinical nurses].

Science.gov (United States)

Wang, Kuei-Ying; Chou, Chuan-Chiang; Huang, Jui-Lan

2010-02-01

The high rate of turnover in nursing positions is a global problem. There have been few studies done addressing the relationship between work values and nurse turnover intention. The purpose of this study was to explore the relationship between work values, professional commitment and turnover intention among clinical nurses. A cross-sectional survey was conducted between February 1st to March 10th, 2008 on a convenience sample of nurses, all of whom had at least a half year of work experience at one of four teaching hospitals in Taiwan. A total of 289 valid responses were received, with a response rate of 96.3%. Major findings included: (1) Nurses who were older, had more years of school, had worked more years, held specific job duties, earned a higher salary, held Buddhist beliefs, or were married with two or more children presented higher work values and professional commitment and lower turnover intention; (2) As a group, total work values and professional commitment scores corresponded negatively with turnover intention scores; (3) Significant factors affecting turnover intent in clinical nurses included professional commitment, institution characteristics, Buddhist beliefs and salary. These four variables accounted for 52.2% of the variation in turnover intention. This study indicated that nurses with higher work values and professional commitment tend to exhibit less turnover intention. It is highly recommended to develop strategies to bolster the teaching of altruistic values and professional commitment in nursing education in order to reduce turnover intent. Also, further studies on the influence of religious beliefs and organizational attributes on nurse turnover intentions are also suggested.

The value of clinical tests in acute full-thickness tears of the supraspinatus tendon

DEFF Research Database (Denmark)

Bak, Klaus; Sørensen, Anne Kathrine Belling; Jørgensen, Uffe Viegh

2010-01-01

Early repair of rotator cuff tears leads to superior results. To detect symptomatic full-thickness tears of the supraspinatus tendon at an early stage, we conducted a prospective study to evaluate the value of clinical examination with and without subacromial lidocaine within the first weeks after...

[Multiple chemical sensitivity: Clinical evaluation of the severity and psychopathological profile].

Science.gov (United States)

Lago Blanco, Eva; Puiguriguer Ferrando, Jordi; Rodríguez Enríquez, Mónica; Agüero Gento, Laura; Salvà Coll, Joan; Pizà Portell, Maria Rosa

2016-02-05

Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

[The relevance of ADC value, T₁intensive rate and the clinical activities in ankylosing spondylitis sacroiliitis].

Science.gov (United States)

Zhao, Yinghua; Han, Xinai; Hu, Shaoyong; Shi, Xingliang; Zhao, Jing; Sun, Erwei; Li, Shaolin

2014-09-23

To evaluate the value of judging for the activity in AS by diffusion-weighted sequences (DWI) and enhance sequences MRI(DCE-MRI), to explore the correlation of Apparent diffusion coefficient(ADC) values, intensive rate and the clinical activity index in sacroiliitis (SIJ) of ankylosing spondylitis (AS). 56 patients prospectively choiced and diagnosed were divided into two groupsas, active group (n = 32) and chronic group (n = 24) by rheumatologist according to BASDAI and laboratory parameters. Twenty healthy adults were as control group. The values of ADC and intensive rate of all sacroiliac joints (SIJs) were measured on MRI. BASDAI score were got by Bath ankylosing spondylitis disease activity index. ESR, CPR and were got by laboratory. Statisticaly to analysis whether the parameters were significantly different amang AS active, chronic, and the control group. To assess the correlation of the values of ADC, intensive rate and BASDAI score, ESR, CPR and in SIJ. the values of ADC and intensive rate were significantly different among AS active, chronic and the control group. There were the significant correlation between the values of ADC, intensive rate and BASDAI score. Diffusion-weighted sequences and Contrast-enhanced sequences is superior to other methods in judging the activity in AS.combined with clinical activity index, the accuracy can significantly be improved to explore whether the activities of AS are.

Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy

DEFF Research Database (Denmark)

Toftmann Hansen, Charlotte; Pedersen, Per T.; Jensen, Bo Amdi

Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy.......Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy....

A Miniaturized Chemical Proteomic Approach for Target Profiling of Clinical Kinase Inhibitors in Tumor Biopsies

Science.gov (United States)

Chamrád, Ivo; Rix, Uwe; Stukalov, Alexey; Gridling, Manuela; Parapatics, Katja; Müller, André C.; Altiok, Soner; Colinge, Jacques; Superti-Furga, Giulio; Haura, Eric B.; Bennett, Keiryn L.

2014-01-01

While targeted therapy based on the idea of attenuating the activity of a preselected, therapeutically relevant protein has become one of the major trends in modern cancer therapy, no truly specific targeted drug has been developed and most clinical agents have displayed a degree of polypharmacology. Therefore, the specificity of anticancer therapeutics has emerged as a highly important but severely underestimated issue. Chemical proteomics is a powerful technique combining postgenomic drug-affinity chromatography with high-end mass spectrometry analysis and bioinformatic data processing to assemble a target profile of a desired therapeutic molecule. Due to high demands on the starting material, however, chemical proteomic studies have been mostly limited to cancer cell lines. Herein, we report a down-scaling of the technique to enable the analysis of very low abundance samples, as those obtained from needle biopsies. By a systematic investigation of several important parameters in pull-downs with the multikinase inhibitor bosutinib, the standard experimental protocol was optimized to 100 µg protein input. At this level, more than 30 well-known targets were detected per single pull-down replicate with high reproducibility. Moreover, as presented by the comprehensive target profile obtained from miniaturized pull-downs with another clinical drug, dasatinib, the optimized protocol seems to be extendable to other drugs of interest. Sixty distinct human and murine targets were finally identified for bosutinib and dasatinib in chemical proteomic experiments utilizing core needle biopsy samples from xenotransplants derived from patient tumor tissue. Altogether, the developed methodology proves robust and generic and holds many promises for the field of personalized health care. PMID:23901793

4D co-registration of X-ray and MR-mammograms: initial clinical results and potential incremental diagnostic value.

Science.gov (United States)

Dietzel, Matthias; Hopp, Torsten; Ruiter, Nicole V; Kaiser, Clemens G; Kaiser, Werner A; Baltzer, Pascal A

2015-01-01

4D co-registration of X-ray- and MR-mammograms (XM and MM) is a new method of image fusion. The present study aims to evaluate its clinical feasibility, radiological accuracy, and potential clinical value. XM and MM of 25 patients were co-registered. Results were evaluated by a blinded reader. Precision of the 4D co-registration was "very good" (mean-score [ms]=7), and lesions were "easier to delineate" (ms=5). In 88.8%, "relevant additional diagnostic information" was present, accounting for a more "confident diagnosis" in 76% (ms=5). 4D co-registration is feasible, accurate, and of potential clinical value. Copyright © 2015 Elsevier Inc. All rights reserved.

Physico-chemical, mineralogical and chemical considerations in ...

African Journals Online (AJOL)

... pH (5.17 – 6.90) and EC (16.53 – 149.20ìS/cm). Values from physico-chemical analyses, secondary minerals abundance index (SMAI) and chemical index of alteration (CIA) of the soils were reflective of particles with high potential for sliding. With major contributions from favourable slope, seismic and hydrologic forces, ...

Finding Chemical Structures Corresponding to a Set of Coordinates in Chemical Descriptor Space.

Science.gov (United States)

Miyao, Tomoyuki; Funatsu, Kimito

2017-08-01

When chemical structures are searched based on descriptor values, or descriptors are interpreted based on values, it is important that corresponding chemical structures actually exist. In order to consider the existence of chemical structures located in a specific region in the chemical space, we propose to search them inside training data domains (TDDs), which are dense areas of a training dataset in the chemical space. We investigated TDDs' features using diverse and local datasets, assuming that GDB11 is the chemical universe. These two analyses showed that considering TDDs gives higher chance of finding chemical structures than a random search-based method, and that novel chemical structures actually exist inside TDDs. In addition to those findings, we tested the hypothesis that chemical structures were distributed on the limited areas of chemical space. This hypothesis was confirmed by the fact that distances among chemical structures in several descriptor spaces were much shorter than those among randomly generated coordinates in the training data range. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula

International Nuclear Information System (INIS)

Yin, Hao-Qiang; Wang, Chen; Peng, Xin; Xu, Fang; Ren, Ya-Juan; Chao, Yong-Qing; Lu, Jin-Gen; Wang, Song; Xiao, Hu-Sheng

2016-01-01

Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). Thirty inpatients and outpatients with suspected RVF from January 2006 to June 2013 were included in the study, among whom 28 underwent surgical repair. All 28 patients underwent preoperative endoluminal ultrasonography, and the obtained diagnostic results were compared with the corresponding surgical results. All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. Regarding the 30 internal openings located in the vagina during surgery, the positive predictive value of preoperative endosonography was 93 %. The six cases of simple fistulas confirmed during surgery were revealed by endosonography; for the 22 cases of complex fistula confirmed during surgery, the positive predictive value of endosonography was 90 %. Surgery confirmed 14 cases of anal fistula and 14 cases of RVF, whereas preoperative endoluminal ultrasonography suggested 16 cases of anal fistula and 12 cases of RVF, resulting in positive predictive values of 92.3 and 93 %, respectively. The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. Thus, it is a good imaging tool for examining internal and external anal sphincter injuries and provides useful information for preoperative preparation and postoperative evaluation

Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition.

Science.gov (United States)

Sampalli, Tara; Shepherd, Michael; Duffy, Jack

2011-04-14

Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED(®) CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge.

Production of bioelectricity, bio-hydrogen, high value chemicals and bioinspired nanomaterials by electrochemically active biofilms.

Science.gov (United States)

Kalathil, Shafeer; Khan, Mohammad Mansoob; Lee, Jintae; Cho, Moo Hwan

2013-11-01

Microorganisms naturally form biofilms on solid surfaces for their mutual benefits including protection from environmental stresses caused by contaminants, nutritional depletion or imbalances. The biofilms are normally dangerous to human health due to their inherited robustness. On the other hand, a recent study suggested that electrochemically active biofilms (EABs) generated by electrically active microorganisms have properties that can be used to catalyze or control the electrochemical reactions in a range of fields, such as bioenergy production, bioremediation, chemical/biological synthesis, bio-corrosion mitigation and biosensor development. EABs have attracted considerable attraction in bioelectrochemical systems (BESs), such as microbial fuel cells and microbial electrolysis cells, where they act as living bioanode or biocathode catalysts. Recently, it was reported that EABs can be used to synthesize metal nanoparticles and metal nanocomposites. The EAB-mediated synthesis of metal and metal-semiconductor nanocomposites is expected to provide a new avenue for the greener synthesis of nanomaterials with high efficiency and speed than other synthetic methods. This review covers the general introduction of EABs, as well as the applications of EABs in BESs, and the production of bio-hydrogen, high value chemicals and bio-inspired nanomaterials. Copyright © 2013 Elsevier Inc. All rights reserved.

Clinical Laboratory Values as Early Indicators of Ebola Virus Infection in Nonhuman Primates.

Science.gov (United States)

Reisler, Ronald B; Yu, Chenggang; Donofrio, Michael J; Warren, Travis K; Wells, Jay B; Stuthman, Kelly S; Garza, Nicole L; Vantongeren, Sean A; Donnelly, Ginger C; Kane, Christopher D; Kortepeter, Mark G; Bavari, Sina; Cardile, Anthony P

2017-08-01

The Ebola virus (EBOV) outbreak in West Africa during 2013-2016 demonstrated the need to improve Ebola virus disease (EVD) diagnostics and standards of care. This retrospective study compared laboratory values and clinical features of 3 nonhuman primate models of lethal EVD to assess associations with improved survival time. In addition, the study identified laboratory values useful as predictors of survival, surrogates for EBOV viral loads, and triggers for initiation of therapeutic interventions in these nonhuman primate models. Furthermore, the data support that, in nonhuman primates, the Makona strain of EBOV may be less virulent than the Kikwit strain of EBOV. The applicability of these findings as potential diagnostic and management tools for EVD in humans warrants further investigation.

Top Value Added Chemicals From Biomass. Volume 1 - Results of Screening for Potential Candidates From Sugars and Synthesis Gas

Science.gov (United States)

2004-08-01

UsesIntermediatesBiomass Feedstocks Sugars Glucose Fructose Xylose Arabinose Lactose Sucrose Starch Starch Cellulose Lignin Oil Protein Hemicellulose...these goals, the Program supports the integrated biorefinery, a processing facility that extracts carbohydrates, oils, lignin , and other materials from...biomass, converts them into multiple products including fuels and high value chemicals and materials. Already today, corn wet and dry mills, and

Advancing medicine one research note at a time: the educational value in clinical case reports.

Science.gov (United States)

Cabán-Martinez, Alberto J; Beltrán, Wilfredo F García

2012-07-06

A case report--a brief written note that describes unique aspects of a clinical case--provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new "case reports" section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science--one research note at a time.

Validation of archived chemical shifts through atomic coordinates

Science.gov (United States)

Rieping, Wolfgang; Vranken, Wim F

2010-01-01

The public archives containing protein information in the form of NMR chemical shift data at the BioMagResBank (BMRB) and of 3D structure coordinates at the Protein Data Bank are continuously expanding. The quality of the data contained in these archives, however, varies. The main issue for chemical shift values is that they are determined relative to a reference frequency. When this reference frequency is set incorrectly, all related chemical shift values are systematically offset. Such wrongly referenced chemical shift values, as well as other problems such as chemical shift values that are assigned to the wrong atom, are not easily distinguished from correct values and effectively reduce the usefulness of the archive. We describe a new method to correct and validate protein chemical shift values in relation to their 3D structure coordinates. This method classifies atoms using two parameters: the per-atom solvent accessible surface area (as calculated from the coordinates) and the secondary structure of the parent amino acid. Through the use of Gaussian statistics based on a large database of 3220 BMRB entries, we obtain per-entry chemical shift corrections as well as Z scores for the individual chemical shift values. In addition, information on the error of the correction value itself is available, and the method can retain only dependable correction values. We provide an online resource with chemical shift, atom exposure, and secondary structure information for all relevant BMRB entries (http://www.ebi.ac.uk/pdbe/nmr/vasco) and hope this data will aid the development of new chemical shift-based methods in NMR. Proteins 2010. © 2010 Wiley-Liss, Inc. PMID:20602353

Demonstration of Parallel Algal Processing: Production of Renewable Diesel Blendstock and a High-Value Chemical Intermediate

Energy Technology Data Exchange (ETDEWEB)

Knoshaug, Eric P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mohagheghi, Ali [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Nagle, Nicholas J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Stickel, Jonathan J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Dong, Tao [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Karp, Eric M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kruger, Jacob S [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Brandner, David [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Manker, Lorenz [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Rorrer, Nicholas [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Hyman, Deborah A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Christensen, Earl D [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Pienkos, Philip T [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2017-12-19

Co-production of high-value chemicals such as succinic acid from algal sugars is a promising route to enabling conversion of algal lipids to a renewable diesel blendstock. Biomass from the green alga Scenedesmus acutus was acid pretreated and the resulting slurry separated into its solid and liquor components using charged polyamide induced flocculation and vacuum filtration. Over the course of a subsequent 756 hours continuous fermentation of the algal liquor with Actinobacillus succinogenes 130Z, we achieved maximum productivity, process conversion yield, and titer of 1.1 g L-1 h-1, 0.7 g g-1 total sugars, and 30.5 g L-1 respectively. Succinic acid was recovered from fermentation media with a yield of 60% at 98.4% purity while lipids were recovered from the flocculated cake at 83% yield with subsequent conversion through deoxygenation and hydroisomerization to a renewable diesel blendstock. This work is a first-of-its-kind demonstration of a novel integrated conversion process for algal biomass to produce fuel and chemical products of sufficient quality to be blend-ready feedstocks for further processing.

Does Fat Suppression via Chemically Selective Saturation (CHESS) Affect R2*-MRI for Transfusional Iron Overload Assessment? A Clinical Evaluation at 1.5 and 3 Tesla

Science.gov (United States)

Krafft, Axel J.; Loeffler, Ralf B.; Song, Ruitian; Bian, Xiao; McCarville, M. Beth; Hankins, Jane S.; Hillenbrand, Claudia M.

2015-01-01

Purpose Fat suppression (FS) via chemically selective saturation (CHESS) eliminates fat-water oscillations in multi-echo gradient echo (mGRE) R2*-MRI. However, for increasing R2* values as seen with increasing liver iron content (LIC), the water signal spectrally overlaps with the CHESS band, which may alter R2*. Here, we investigate the effect of CHESS on R2* and describe a heuristic correction for the observed CHESS-induced R2* changes. Methods Eighty patients (49/31 female/male, mean age: 18.3±11.7 years) with iron overload were scanned with a non-FS and a CHESS-FS mGRE sequence at 1.5T and 3T. Mean liver R2* values were evaluated using 3 published fitting approaches. Measured and model-corrected R2* values were compared and statistically analyzed. Results At 1.5T, CHESS led to a systematic R2* reduction (PCHESS-induced R2* bias after correction (linear regression slopes: 1.032/0.927/0.981). No CHESS-induced R2* reductions were found at 3T. Conclusion The CHESS-induced R2* bias at 1.5T needs to be considered when applying R2*-LIC biopsy calibrations for clinical LIC assessment which were established without FS at 1.5T. The proposed model corrects the R2* bias and could therefore improve clinical iron overload assessment based on linear R2*-LIC calibrations. PMID:26308155

Chemical Thermodynamics Vol. 12 - Chemical Thermodynamics of tin

International Nuclear Information System (INIS)

Gamsjaeger, Heinz; GAJDA, Tamas; Sangster, James; Saxena, Surendra K.; Voigt, Wolfgang; Perrone, Jane

2012-01-01

This is the 12th volume of a series of expert reviews of the chemical thermodynamics of key chemical elements in nuclear technology and waste management. This volume is devoted to the inorganic species and compounds of tin. The tables contained in Chapters III and IV list the currently selected thermodynamic values within the NEA TDB Project. The database system developed at the NEA Data Bank, see Section II.6, assures consistency among all the selected and auxiliary data sets. The recommended thermodynamic data are the result of a critical assessment of published information. The values in the auxiliary data set, see Tables IV-1 and IV-2, have been adopted from CODATA key values or have been critically reviewed in this or earlier volumes of the series

Early pleural fluid dynamics following video-assisted thoracoscopic lobectomy has limited clinical value

DEFF Research Database (Denmark)

Holbek, Bo Laksáfoss; Petersen, René Horsleben; Kehlet, Henrik

2017-01-01

The objective of this study was to evaluate the potential of predicting the pleural fluid output in patients after video-assisted thoracoscopic lobectomy of the lung. Detailed measurements of continuous fluid output were obtained prospectively using an electronic thoracic drainage device (Thopaz...... and 48 hours. Assessment of initial fluid production may predict high 24-hour fluid output (≥500 mL) but seems to lack clinical value in drain removal criteria....

Three-Year Analysis of Value and Utilization After Development of an Ultrasound-Based Orthopedic Injection Clinic.

Science.gov (United States)

Dukes, Chase; Melton, Thomas; Turner, Eric; Jackson, Andrew; Grassbaugh, Jason; Slevin, John; Arrington, Edward D; Eichinger, Josef K

2017-09-01

Sonography is an effective method of diagnosing and treating musculoskeletal conditions, and the use of ultrasound has been shown to improve the accuracy, safety, and efficacy of both therapeutic and diagnostic injections. In 2012, we established an injection clinic at our institution to address our growing need for diagnostic and therapeutic injections. We performed an analysis of value and utilization following the development of an orthopedic injection clinic. This included an evaluation of the cost of materials, equipment, and training required to develop and run the clinic, and an analysis of the services rendered and relative value units (RVUs) generated over 3 fiscal years (FYs). The cost to develop the clinic was $42,498.30. The cost to run the clinic thereafter was $16.90 to $21.60 per injection. By the end of FY 2012, 60% of providers performed at least 1 injection under ultrasound guidance. Every successive year thereafter, 100% of providers were using ultrasound guidance. In FY 2012, we performed 738 injections, 5.4% used ultrasound guidance and generated a total of 1,786.36 RVUs. In FY 2013, we performed 1,814 injections, 17.6% used ultrasound guidance, and generated a total of 7,224.5 RVUs. In FY 2014, we performed 2,821 injections, 25.2% used ultrasound guidance, and generated 13,786.82 RVUs. RVUs generated solely from ultrasound guided injections were 463.2 (2012), 3,694 (2013), 8,221.8 (2014). Injection accuracy was at least 98%. Average time until injection was 0 days. The cost to start an injection clinic is modest, with the potential for large annual growth and early return on investment, and can generate significant revenue by recapturing RVUs that would otherwise be lost to outside referrals. Furthermore, it helps to increase clinic throughput, maximize services rendered during a single patient visit improving the overall quality of their encounter, expands the clinical practice of our midlevel providers, offloads clinical time for surgical

Advancing medicine one research note at a time: the educational value in clinical case reports

Directory of Open Access Journals (Sweden)

Cabán-Martinez Alberto J

2012-07-01

Full Text Available Abstract A case report—a brief written note that describes unique aspects of a clinical case—provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new “case reports” section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science — one research note at a time.

Don't just do something, stand there! The value and art of deliberate clinical inertia.

Science.gov (United States)

Keijzers, Gerben; Cullen, Louise; Egerton-Warburton, Diana; Fatovich, Daniel M

2018-04-01

It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted. Several strategies to promote deliberate clinical inertia are outlined, with an emphasis on shared decision-making. Preventing medical harm must become one of the pillars of modern health care and the art of not intervening, that is, deliberate clinical inertia, can be a novel patient-centred quality indicator to promote harm reduction. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

System visualization of integrated biofuels and high value chemicals developed within the MacroAlgaeBiorefinery (MAB3) project

DEFF Research Database (Denmark)

Seghetta, Michele; Hasler, Berit; Bastianoni, Simone

MacroAlgaeBiorefinery (MAB3) may functions as production platform and raw material supplier for future sustainable production chains of biofuels and high value chemicals. Biofuels are interesting energy source but challenges in terms of the composition of the biomass and resulting energy...... efficiencies has to be compensated for to make the biofuel prices competitive in replacing fossil fuel. Since it is difficult to increase the yield of the single biorefinery, the overall system productivity can be improved integrating different sub-systems. In this study, macroalgae cultivation in Denmark...... is integrated with a biogas biorefinery, a bioethanol biorefinery and a fish feed industry. The modeled system is able to adapt itself to different amount and quality of feedstock and to maximize valuable outputs (e.g. bio-fuels and chemical). Macroalgae are harvested and utilized as feedstock in bioethanol...

Clinical Correlates and Prognostic Value of Proenkephalin in Acute and Chronic Heart Failure.

Science.gov (United States)

Matsue, Yuya; Ter Maaten, Jozine M; Struck, Joachim; Metra, Marco; O'Connor, Christopher M; Ponikowski, Piotr; Teerlink, John R; Cotter, Gad; Davison, Beth; Cleland, John G; Givertz, Michael M; Bloomfield, Daniel M; Dittrich, Howard C; van Veldhuisen, Dirk J; van der Meer, Peter; Damman, Kevin; Voors, Adriaan A

2017-03-01

Proenkephalin (pro-ENK) has emerged as a novel biomarker associated with both renal function and cardiac function. However, its clinical and prognostic value have not been well evaluated in symptomatic patients with heart failure. The association between pro-ENK and markers of renal function was evaluated in 95 patients with chronic heart failure who underwent renal hemodynamic measurements, including renal blood flow (RBF) and glomerular filtration rate (GFR) with the use of 131 I-Hippuran and 125 I-iothalamate clearances, respectively. The association between pro-ENK and clinical outcome in acute heart failure was assessed in another 1589 patients. Pro-ENK was strongly correlated with both RBF (P renal tubular markers. In the acute heart failure cohort, pro-ENK was a predictor of death through 180 days, heart failure rehospitalization through 60 days, and death or cardiovascular or renal rehospitalization through day 60 in univariable analyses, but its predictive value was lost in a multivariable model when other renal markers were entered in the model. In patients with chronic and acute heart failure, pro-ENK is strongly associated with glomerular function, but not with tubular damage. Pro-ENK provides limited prognostic information in patients with acute heart failure on top of established renal markers. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect-based trigger values for in vitro bioassays: Reading across from existing water quality guideline values.

Science.gov (United States)

Escher, Beate I; Neale, Peta A; Leusch, Frederic D L

2015-09-15

Cell-based bioassays are becoming increasingly popular in water quality assessment. The new generations of reporter-gene assays are very sensitive and effects are often detected in very clean water types such as drinking water and recycled water. For monitoring applications it is therefore imperative to derive trigger values that differentiate between acceptable and unacceptable effect levels. In this proof-of-concept paper, we propose a statistical method to read directly across from chemical guideline values to trigger values without the need to perform in vitro to in vivo extrapolations. The derivation is based on matching effect concentrations with existing chemical guideline values and filtering out appropriate chemicals that are responsive in the given bioassays at concentrations in the range of the guideline values. To account for the mixture effects of many chemicals acting together in a complex water sample, we propose bioanalytical equivalents that integrate the effects of groups of chemicals with the same mode of action that act in a concentration-additive manner. Statistical distribution methods are proposed to derive a specific effect-based trigger bioanalytical equivalent concentration (EBT-BEQ) for each bioassay of environmental interest that targets receptor-mediated toxicity. Even bioassays that are indicative of the same mode of action have slightly different numeric trigger values due to differences in their inherent sensitivity. The algorithm was applied to 18 cell-based bioassays and 11 provisional effect-based trigger bioanalytical equivalents were derived as an illustrative example using the 349 chemical guideline values protective for human health of the Australian Guidelines for Water Recycling. We illustrate the applicability using the example of a diverse set of water samples including recycled water. Most recycled water samples were compliant with the proposed triggers while wastewater effluent would not have been compliant with a few

Clinical workplace learning: perceived learning value of individual and group feedback in a collectivistic culture.

Science.gov (United States)

Suhoyo, Yoyo; Schönrock-Adema, Johanna; Emilia, Ova; Kuks, Jan B M; Cohen-Schotanus, Janke

2018-04-19

Feedback is essential for workplace learning. Most papers in this field concern individual feedback. In collectivistic cultures, however, group feedback is common educational practice. This study was conducted to investigate the perceived learning value and characteristics of individual and group feedback in a collectivistic culture. During two weeks, on a daily basis, clerkship students (n = 215) from 12 clinical departments at Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, recorded individual and group feedback moments by using a structured form: the providers, focus and perceived learning value of feedback. Data were analysed with logistic regression and multilevel techniques. Students reported 2687 group and 1535 individual feedback moments. Group feedback more often focused on history taking, clinical judgment, patient management, patient counselling, and professional behaviour (OR ranging from 1.232, p cultures, group feedback may add to the array of educational measures that optimize student learning. Congruence between culture and type of feedback may be important for the effectiveness of feedback.

Osteoporosis in water buffalo, in relation to age, clinical condition of the animal and physical-chemical bone and hepatic copper status

Directory of Open Access Journals (Sweden)

Washington Luiz Assunção Pereira

2010-04-01

Full Text Available This paper is part of a research program of metabolic nutritional diseases in water buffalo in the Humid Tropical Amazon. In that context, the objective was to study osteoporotic processes in buffalo raised in a grazing system on Marajó Island and the relation of the disease with the age as well as physical-chemical bone and hepatic copper status. One hundred and ten animals were evaluated: 39 young or juvenile and 71 adults that presented Body Condition Index from 1 to 2. One group was composed by young buffalo and another by adult animals. Based on anatomical-clinical and bone quality analyses, the animals were subdivided in two sub-groups, according to presence or absence of clinical signs of apparent osteopathic. Analysis of calcium, phosphorus, ash and bone density was performed on the middle third of the 11th right rib, and the copper concentration was determined from liver tissue. Pathological anatomical findings showed that 98.44% of juvenile animals and 96.16% of adult animals, respectively, presented some degree of osteoporosis (+, ++, +++. Low average percentages were demonstrated for phosphorus (10.69%, in ashes (60.24% and in density (1.46 g/ml. Hepatic copper presented similar low values (19.51 mg/kg. The results showed that juvenile animals presented more severe clinical sign of osteoporosis, and the pathogenesis may be related to low reserves of phosphorus in bony tissue and copper in liver tissue.

Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.

Science.gov (United States)

Salimi, Fereshteh; Shahabi, Shahab; Talebzadeh, Hamid; Keshavarzian, Amir; Pourfakharan, Mohammad; Safaei, Mansour

2017-01-01

Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM. This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated. Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis ( P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively). Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.

Upgrading of lignocellulosic biorefinery to value-added chemicals: Sustainability and economics of bioethanol-derivatives

DEFF Research Database (Denmark)

Cheali, Peam; Posada, John A.; Gernaey, Krist

2015-01-01

with a sustainability assessment method is used as evaluation tool. First, an existing superstructure representing the lignocellulosic biorefinery design network is extended to include the options for catalytic conversion of bioethanol to value-added derivatives. Second, the optimization problem for process upgrade...... of operating profit for biorefineries producing bioethanol-derived chemicals (247 MM$/a and 241 MM$/a for diethyl ether and 1,3-butadiene, respectively). Second, the optimal designs for upgrading bioethanol (i.e. production of 1,3-butadiene and diethyl ether) performed also better with respect...... to sustainability compared with the petroleum-based processes. In both cases, the effects of the market price uncertainties were also analyzed by performing quantitative economic risk analysis and presented a significant risk of investment for a lignocellulosic biorefinery (12 MM$/a and 92 MM$/a for diethyl ether...

Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism.

Science.gov (United States)

Swearingen, Andrew J; Kahramangil, Bora; Monteiro, Rosebel; Krishnamurthy, Vikram; Jin, Judy; Shin, Joyce; Siperstein, Allan; Berber, Eren

2018-04-01

Primary aldosteronism causes hypertension and hypokalemia and is often surgically treatable. Diagnosis includes elevated plasma aldosterone, suppressed plasma renin activity, and elevated aldosterone renin ratio. Adrenalectomy improves hypertension and hypokalemia. Postoperative plasma aldosterone and plasma renin activity may be useful in documenting cure or failure. A retrospective analysis of patients who underwent adrenalectomy for primary aldosteronism from 2010 to 2016 was performed, analyzing preoperative and postoperative plasma aldosterone, plasma renin activity, hypertension, and hypokalemia. The utility of postoperative testing was assessed. Clinical cure was defined as improved hypertension control and resolution of potassium loss. Biochemical cure was defined as aldosterone renin ratio reduction to <23.6. Forty-four patients were included; 20 had plasma aldosterone and plasma renin activity checked on postoperative day 1. In the study, 40/44 (91%) were clinically cured. All clinical failures had of biochemical failure at follow-up. Postoperative day 1aldosterone renin ratio <23.6 had PPV of 95% for clinical cure. Cured patients had mean plasma aldosterone drop of 33.1 ng/dL on postoperative day 1; noncured patient experienced 3.9 ng/dL increase. A cutoff of plasma aldosterone decrease of 10 ng/dL had high positive predictive value for clinical cure. Changes in plasma aldosterone and plasma renin activity after adrenalectomy correlate with improved hypertension and hypokalemia. The biochemical impact of adrenalectomy manifests as early as postoperative day 1. We propose a plasma aldosterone decrease of 10 ng/dL as a criterion to predict clinical cure. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical value of detection of serum β-Crosslaps, PINP and N-MID in postmenopausal women with osteoporosis

International Nuclear Information System (INIS)

Ou Mengmeng; Huang Jianrong

2011-01-01

To evaluate the clinical value of detection of concentration of β-Crosslaps, PINP and N-MID in postmenopausal women with osteoporosis, 116 postmenopausal women were detected by dual X-ray absorptionmetry and divided into NOP group (51 cases) and OP group (65 cases). The serum levels of three bone markers (β-Crosslaps, PINP and N-MID) were measured. The results showed that serum levels of β-Crosslaps, PINP and N-MID in OP group were significantly higher than that in NOP group (P<0.01). It was suggested that three bone markers level might be closely related with osteoporosis in postmenopausal women. The combined detection of bone markers and bone mineral density has important clinical value in the diagnosis of osteoporosis in postmenopausal women. (authors)

Developing a framework to guide the de-adoption of low-value clinical practices in acute care medicine: a study protocol.

Science.gov (United States)

Parsons Leigh, Jeanna; Niven, Daniel J; Boyd, Jamie M; Stelfox, Henry T

2017-01-19

Healthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value (e.g. ineffective or harmful to patients). While a number of lists outlining low-value practices in acute care medicine currently exist, less is known about how best to initiate and sustain the removal of low-value clinical practices (i.e. de-adoption). This study will develop a comprehensive list of barriers and facilitators to the de-adoption of low-value clinical practices in acute care facilities to inform the development of a framework to guide the de-adoption process. The proposed project is a multi-stage mixed methods study to develop a framework to guide the de-adoption of low-value clinical practices in acute care medicine that will be tested in a representative sample of acute care settings in Alberta, Canada. Specifically, we will: 1) conduct a systematic review of the de-adoption literature to identify published barriers and facilitators to the de-adoption of low-value clinical practices in acute care medicine and any associated interventions proposed (Phase one); 2) conduct focus groups with acute care stakeholders to identify important themes not published in the literature and obtain a comprehensive appreciation of stakeholder perspectives (Phase two); 3) extend the generalizability of focus group findings by conducting individual stakeholder surveys with a representative sample of acute care providers throughout the province to determine which barriers and facilitators identified in Phases one and two are most relevant in their clinical setting (Phase three). Identified barriers and facilitators will be catalogued and integrated with targeted interventions in a framework to guide the process of de-adoption in each of four targeted areas of acute care medicine (Emergency Medicine, Cardiovascular Health and Stroke, Surgery and Critical Care Medicine). Analyses will be

Clinical value of arteriography in postpartum hemorrhage by transcatheter arterial embolization

International Nuclear Information System (INIS)

Wang Kai; Jiang Guomin; Zhao Jinwei; Huang Wenhua; Liu Yizhi; Jin Yonghai

2010-01-01

Objective: To analyze the arterial supply in postpartum hemorrhage and to evaluate the clinical value of arteriography in transcatheter arterial embolization (TAE) for treating postpartum hemorrhage. Methods: The arteriography of 37 patients with postpartum hemorrhage was analyzed. TAE were performed after the bleeding artery was identified. Post TAE angiography was performed to confirm the success of embolization. Results: The bleeding artery in atonic uterus and abnormal placenta was the uterine artery. The bleeding artery in birth canal laceration is mainly non-uterine artery. Postpartum hemorrhage was successfully controlled in all 37 patients without sever complication of TAE. Conclusion: Arteriography in postpartum hemorrhage can demonstrate the bleeding artery and is potential collaterals allowing adequate embolization without complication. (authors)

Chemically-functionalized microcantilevers for detection of chemical, biological and explosive material

Science.gov (United States)

Pinnaduwage, Lal A [Knoxville, TN; Thundat, Thomas G [Knoxville, TN; Brown, Gilbert M [Knoxville, TN; Hawk, John Eric [Olive Branch, MS; Boiadjiev, Vassil I [Knoxville, TN

2007-04-24

A chemically functionalized cantilever system has a cantilever coated on one side thereof with a reagent or biological species which binds to an analyte. The system is of particular value when the analyte is a toxic chemical biological warfare agent or an explosive.

A counterfactual p-value approach for benefit-risk assessment in clinical trials.

Science.gov (United States)

Zeng, Donglin; Chen, Ming-Hui; Ibrahim, Joseph G; Wei, Rachel; Ding, Beiying; Ke, Chunlei; Jiang, Qi

2015-01-01

Clinical trials generally allow various efficacy and safety outcomes to be collected for health interventions. Benefit-risk assessment is an important issue when evaluating a new drug. Currently, there is a lack of standardized and validated benefit-risk assessment approaches in drug development due to various challenges. To quantify benefits and risks, we propose a counterfactual p-value (CP) approach. Our approach considers a spectrum of weights for weighting benefit-risk values and computes the extreme probabilities of observing the weighted benefit-risk value in one treatment group as if patients were treated in the other treatment group. The proposed approach is applicable to single benefit and single risk outcome as well as multiple benefit and risk outcomes assessment. In addition, the prior information in the weight schemes relevant to the importance of outcomes can be incorporated in the approach. The proposed CPs plot is intuitive with a visualized weight pattern. The average area under CP and preferred probability over time are used for overall treatment comparison and a bootstrap approach is applied for statistical inference. We assess the proposed approach using simulated data with multiple efficacy and safety endpoints and compare its performance with a stochastic multi-criteria acceptability analysis approach.

Interexaminer reliability in clinical measurement of L*C*h* values of anterior teeth using a spectrophotometer.

Science.gov (United States)

Hassel, Alexander J; Grossmann, Anne-christiane; Schmitter, Marc; Balke, Zibandeh; Buzello, Anja M

2007-01-01

The objective of this study was to investigate interexaminer reliability in the clinical measurement of the L*C*h* (lightness/value, chroma, hue) values of anterior teeth using a spectrophotometer (Vita Easyshade). The basic color of the maxillary right central incisors and canines of 23 subjects was spectrophotometrically determined by 4 clinicians and an experienced user (development manager) of the spectrophotometer. Also, to analyze the effect of different training with the instrument on interexaminer reliability, 2 of the clinicians were instructed in the use of the spectrophotometer by the experienced examiner, whereas the others instructed themselves by studying the operating manual. Agreement between all examiners was acceptable to excellent (intraclass coefficient > 0.4). The mean value of the measured differences for the central incisors of all subjects for L* values was 5 (for C* = 3.8, h* = 2.7 degrees) and for canines, the mean L* was 4.5 (C* = 3, h* = 1.6 degrees). Results from comparison of the 2 different training methods were inconsistent. Agreement with the experienced examiner ranged from not acceptable (C* values for incisors of self-instructed examiners) to excellent. The distribution of the measurements of 1 subject could lead to deviations in color, probably with clinical impact. For canines, the measurements were at least equally reproducible (in some cases significantly more reproducible) compared to central incisors. Because of the small number of examiners and the inconsistent results, it was not possible to reach a definite conclusion about the effect of different training methods on interexaminer reliability.

The clinical value of CT in neuropediatrics

International Nuclear Information System (INIS)

Reisner, Th.

1981-01-01

Cranial computed-tomography (CT) has opened new dimensions in neuropediatric diagnosis. The relationship between clinical symptoms and CT results is presented. 1930 patients were investigated, one group is made up of 334 newborns and infants, the other group contains children in the age between 13 months and 15 years. Newborns and infants confront the neurologist with stereotyped deficiency symptoms which nevertheless can arise from many causes. CT can make an etiological classification. In childhood illnesses of neurophsychiatric nature sometimes predominate whose clinical symptoms are often minimal (e.g. cerebral seizures, hydrocephalus, perinatal brain damage, various types of headache etc.). Here again CT can give the clinical valuable indications concerning diagnosis and therapeutic procedure. (M.J.)

Nutritive value and chemical composition of prickly pear seeds (Opuntia ficus indica L.) growing in Turkey.

Science.gov (United States)

Özcan, Mehmet Musa; Al Juhaimi, Fahad Y

2011-08-01

The proximate composition and physico-chemical properties (moisture, crude lipid, crude protein, ash, and crude fiber, peroxide value, saponification value, acidity, relative density and refractive index) of prickly pear seed and corresponding oil were determined. The mineral contents (Ca, Cu, Fe, K, Mg, Na, P, Mn and Zn) of samples were analyzed by inductively coupled plasma atomic emission spectrometry. Minerals determined were: calcium 471.2 mg/kg, potassium 532.7 mg/kg, magnesium 117.3 mg/kg, phosphorus 1,627.5 mg/kg and natrium 71.3 mg/kg. The fatty acid profiles of seed oil from the Opuntia ficus indica were analyzed by gas chromatography. Linoleic acid was established as the major fatty acid (61.01%), followed by oleic (25.52%) and palmitic (12.23%) acids. Both myristic, stearic and arachidonic acids were detected in O. ficus indica seed oil in low amounts. As a result, O. ficus indica seeds are an important source of natural fiber and, given its high linoleic acid content, its oil can be used as a nutraceutic agent.

Clinical application of 1H-chemical-shift imaging (CSI) to brain diseases

International Nuclear Information System (INIS)

Naruse, Shoji; Furuya, Seiichi; Ide, Mariko

1992-01-01

An H-1 chemical shift imaging (CSI) was developed as part of the clinical MRI system, by which magnetic resonance spectra (MRS) can be obtained from multiple small voxels and metabolite distribution in the brain can be visualized. The present study was to determine the feasibility and clinical potential of using an H-1 CSI. The device used was a Magnetom H 15 apparatus. The study population was comprised of 25 healthy subjects, 20 patients with brain tumor, 4 with ischemic disease, and 6 with miscellaneous degenerative disease. The H-1 CSI was obtained by the 3-dimensional Fourier transformation. After suppressing the lipid signal by the inversion-recovery method and the water signal by the chemical-shift selective pulse with a following dephasing gradient, 2-directional 16 x 16 phase encodings were applied to the 16 x 16∼18 x 18 cm field of view, in which a 8 x 8 x 2∼10 x 10 x 2 cm area was selected by the stimulated echo or spin-echo method. The metabolite mapping and its contour mapping were created by using the curve-fitted area, with interpolation to the 256 x 256 matrix. In the healthy group, high resolution spectra for N-acetyl aspartate (NAA), creatine, choline (Cho), and glutamine/glutamate were obtained from each voxel; and metabolite mapping and contour mapping also clearly showed metabolite distribution in the brain. In the group of brain tumor, an increased Cho and lactate and loss of NAA were observed, along with heterogeneity within the tumor and changes in the surrounding tissue; and there was a good correlation between lactate peak and tumor malignancy. The group of ischemic and degenerative disease had a decreased NAA and increased lactate on both spectra and metabolite mapping, depending on disease stage. These findings indicated that H-1 CSI is helpful for detecting spectra over the whole brain, as well as for determining metabolite distribution. (N.K.)

CHEMICAL COMPOSITION AND ENERGY VALUE IN THE MEAT OF THE MACEDONIAN AND OHRID TROUT

Directory of Open Access Journals (Sweden)

Aleksandar SAVESKI

2017-03-01

Full Text Available The aim of this research is to conduct a comparative analysis and to verify the quality properties of meat of the Macedonian trout (Salmo macedonicus and the Ohrid trout (Salmo letnica, from aquaculture production, bred on a fish farm under controlled conditions. In order to determine the quality of meat of the Macedonian and Ohrid trout, analyses of the chemical composition have been conducted: the amount of proteins, fat, water, minerals, as well as a determination of the energy value of the meat. The analyses have been made on samples from Macedonian and Ohrid trout, with size of consumption between 200g and 300g. By these analyses, it has been confirmed that in the meat of the Macedonian trout, the amount of water is 77.122%, 17.800% proteins, 3.333% fat and 1.667% minerals, whereas in the meat of the Ohrid trout 75.923% water, 16.783% proteins, 5.403% fat and 1.080% minerals. Though the established difference in the amount of water and fat is not significant, the differences determined in the contents of proteins and minerals are significant on a level p>0,05. The energy value of Macedonian trout meat is 435.29 KJ/100gm, i.e. and 498.49 KJ/100gm in the Ohrid trout meat.

The role and clinical value of thallium-201 myocardial scintigraphy in ischemic heart disease

International Nuclear Information System (INIS)

Shimada, Tomoyoshi; Nakamori, Hisato; Kurimoto, Toru; Karakawa, Masahiro; Matsuura, Takashi; Iwasaka, Toshiji; Inada, Mitsuo; Nishiyama, Yutaka

1990-01-01

To define the role and clinical value of thallium-201 myocardial scintigraphy in ischemic heart disease, 967 consecutive patients refered to our laboratory since 1985 were studied. The purpose of scintigraphy have changed from diagnosing of myocardial ischemia to assessing myocardial viability with the progress of coronary angioplasty. At present, thallium-201 myocardial scintigraphy have become indispensable noninvasive method for the management of patients with ischemic heart disease. (author)

The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

Science.gov (United States)

Morer, Carla; Roques, Christian-François; Françon, Alain; Forestier, Romain; Maraver, Francisco

2017-12-01

The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: "spa therapy" "balneotherapy" "mud" "peloid" "mud pack Therapy" in combination with "randomized controlled trial" "double blind trial." We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group ("non-mineral"). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or "non-mineral" mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain

The Nigerian Zanthoxylum : chemical and biological values ...

African Journals Online (AJOL)

The Nigerian Zanthoxylum is a common component of the rain forest vegetation of Southern Nigeria, and is represented by eleven species. ... The focus has been on the local uses and commercial importance of the species, the values of the various metabolites in medicine and their general potential in drug development.

Therapeutic values, chemical constituents and toxicity of Taiwanese Dysosma pleiantha--a review.

Science.gov (United States)

Karuppaiya, Palaniyandi; Tsay, Hsin Sheng

2015-07-16

Dysosma pleiantha (Hance) Woodson also called as Bajiaolian belongs to the family Berberidaceae, is widely used in Taiwan as traditional Chinese herbal medicine for more than thousands of years. It is usually recommended by various traditional Chinese medical doctors and herbal pharmacies for general remedies including postpartum recovery, treatment of weakness, neck mass, acne, hepatoma, lumbago, snakebite, tumor growth and dysmenorrhea. In the textbooks of traditional Chinese medicine, there is limited information about the toxicity of Bajiaolian. Podophyllotoxin, a lignan is the main toxic ingredient of Bajiaolian rhizome. Therefore, Bajiaolian is documented as the fifth highest cause of poisoning among the herbal medicine in Taiwan. Since the therapeutic and toxic doses are very close, Bajiaolian poisoning cases are frequently reported in Taiwan. Moreover, Dysosma poisoning cases are difficult to diagnosis because physicians are unfamiliar with this medicine's multiple clinical presentations in different stages of intoxication. Therefore, the objective of this review is to represent the collective information available in literatures regarding D. pleiantha, a cytotoxic lignan containing medicinal plant. Specifically, the literatures have been reviewed for articles pertaining to chemical constituents, properties, therapeutical benefits, toxicity, poisoning symptoms, toxic as well as therapeutic dose and medical management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The clinical value of routine whole-body magnetic resonance imaging (MRI) in palliative care

Energy Technology Data Exchange (ETDEWEB)

Geitung, Jonn Terje (Department of Radiology, Haraldspass Deaconess (University) Hospital (Norway); Department of Surgical Sciences, University of Bergen (Norway)), Email: jtgeit@online.no; Eikeland, Joakim (Department of Public Health and Primary Health Care, University of Bergen (Norway)); Rosland, Jan Henrik (Department of Public Health and Primary Health Care, University of Bergen (Norway); Sunniva Clinic for Palliative Care, Haraldsplass Deaconess (University) Hospital (Norway))

2012-03-15

Background. Whole-body MRI (WBMRI) has become an accessible method for detecting different types of pathologies both in the skeleton and the viscera, which may explain painful conditions, for example tumors and inflammation. Purpose. To assess a possible value of using WBMRI in order to improve palliative care. Material and Methods. Twenty patients (all eligible patients) admitted to the Department for Palliative Care were consecutively included in this study. They underwent a modified WBMRI, with fewer and shorter pulse sequences than in a standard WBMRI, to reduce patient stress. However, the patients' physicians were to exclude patients where little might be obtained and discomfort, distress, and pain could be induced. The treating physicians registered clinical utility directly after receiving the MRI report in a questionnaire. The registration was repeated after ended treatment. Results. Eighty percent had new findings detected, and 40% of the patients had a change in treatment due to the MRI result, mainly changes in analgesics and/or radiation therapy. Conclusion. The WBMRI helped the clinicians to improve treatment and a majority of the patients benefited from this. In eight patients the treatment was changed due to the results. The clinical value (utility) was indicated to be high

Prediction of cereal feed value using spectroscopy and chemometrics

DEFF Research Database (Denmark)

Jørgensen, Johannes Ravn; Gislum, René

2009-01-01

of EDOM, EDOMi, FEso and FEsv. The outcome of a successful NIRS calibration will be a relatively cheap tool to monitor, diversify and evaluate the quality of cereals for animal feed, a possible tool to assess the feed value of new varieties in the variety testing and a useful, cheap and rapid tool...... for cereal breeders. A collection of 1213 grain samples of wheat, triticale, barley and rye, and related chemical reference analyses to describe the feed value have been established. The samples originate from available field trials over a three-year period. The chemical reference analyses are dry matter...... value, the prediction error has to be compared with the error in the chemical analysis. Prediction error by NIRS prediction of feed value is above the error of the chemical measurement. The conclusion is that it is possible to predict the feed value in cereals with NIRS quickly and cheaply...

Public control of environmental health hazards (clinical and experimental studies of distal axonopathy--a frequent form of brain and nerve damage produced by environmental chemical hazards)

Energy Technology Data Exchange (ETDEWEB)

Schaumburg, H.H.; Spencer, P.S.

1979-01-01

Clinical and pathological studies of the peripheral and central nervous system degeneration (distal dying-back axonopathy) in humans and experimental animals produced by acrylamide monomer and certain hydrocarbon compounds are summarized. The human distal axonopathies include: many of the naturally occurring, genetically determined system disorders/ certain nutritional disorders/ uremic neuropathy/ the neuropathies associated with some malignancies/ and the toxic neuropathies induced by industrial chemicals. The irreversible, subclinical, and clinical effects of distal axonopathies on the human central nervous system are examined. A morphological rationale for previously enigmatic clinical phenomena in the human toxic neuropathies is presented. Neuropathology is potentially useful in the screening of chemicals for neurotoxicity. (7 photos, 24 references)

Clinical value of prognosis gene expression signatures in colorectal cancer: a systematic review.

Directory of Open Access Journals (Sweden)

Rebeca Sanz-Pamplona

Full Text Available INTRODUCTION: The traditional staging system is inadequate to identify those patients with stage II colorectal cancer (CRC at high risk of recurrence or with stage III CRC at low risk. A number of gene expression signatures to predict CRC prognosis have been proposed, but none is routinely used in the clinic. The aim of this work was to assess the prediction ability and potential clinical usefulness of these signatures in a series of independent datasets. METHODS: A literature review identified 31 gene expression signatures that used gene expression data to predict prognosis in CRC tissue. The search was based on the PubMed database and was restricted to papers published from January 2004 to December 2011. Eleven CRC gene expression datasets with outcome information were identified and downloaded from public repositories. Random Forest classifier was used to build predictors from the gene lists. Matthews correlation coefficient was chosen as a measure of classification accuracy and its associated p-value was used to assess association with prognosis. For clinical usefulness evaluation, positive and negative post-tests probabilities were computed in stage II and III samples. RESULTS: Five gene signatures showed significant association with prognosis and provided reasonable prediction accuracy in their own training datasets. Nevertheless, all signatures showed low reproducibility in independent data. Stratified analyses by stage or microsatellite instability status showed significant association but limited discrimination ability, especially in stage II tumors. From a clinical perspective, the most predictive signatures showed a minor but significant improvement over the classical staging system. CONCLUSIONS: The published signatures show low prediction accuracy but moderate clinical usefulness. Although gene expression data may inform prognosis, better strategies for signature validation are needed to encourage their widespread use in the clinic.

ERP in chronic pancreatitis - ductal morphology, relation to exocrine function and pain - clinical value

International Nuclear Information System (INIS)

Norup Lauridsen, K.; Raahede, J.; Kruse, A.; Thommesen, P.; Aarhus Univ.

1985-01-01

ERP was analyzed in 87 patients with chronic pancreatitis with special reference to its clinical value in management of pain, the dominating symptom in uncomplicated chronic pancreatitis. A significant correlation was found between ductal changes due to pancreatitis and decrease in pancreatic function. However, no association was found between severe pancreatic pain and pancreatic function or pancreatic morphology. The significance of ERP in management of patients with persistent severe pancreatic pain is discussed. (orig.) [de

Clinical value of serum vitamin B12 and folate in cerebrovascular disease

International Nuclear Information System (INIS)

Zhan Hao; Zhang Yongxue

2002-01-01

To study the clinical value of serum vitamin B 12 and folate in cerebrovascular disease, the concentration of serum vitamin B 12 and folate in 32 patients with cerebrovascular disease was measured by radioimmunoassay. The results showed that the changes in folate in all groups were not significant. The content of vitamin B 12 in multi-infarct dementia was markedly lower than that in cerebral infarction and cerebral hemorrhage. Moreover, the level of vitamin B 12 was lower in paralytic patients with muscular strength of grade 0-III. It can be concluded that serum vitamin B 12 level had association with intelligent disorder and paralytic degree

Value of FFR in clinical practice

Directory of Open Access Journals (Sweden)

Anil Mehra

2015-01-01

Full Text Available Fractional flow reserve is an important tool in the cardiac catheterization lab to assess the physiological significance of coronary lesions. This article discusses the basic concepts about FFR and its utility in clinical decision making.

Novel catalysts for valorization of biomass to value-added chemicals ...

Indian Academy of Sciences (India)

charides have attracted greater attention as a promis- ing carbon-based ... extensively studied due to importance of HMF as a plat- form chemical.4 Potential applications of HMF includes its selective oxidation to FDCA,5,6 hydrogenolysis to.

Health-related physical fitness measures: reference values and reference equations for use in clinical practice.

Science.gov (United States)

Tveter, Anne Therese; Dagfinrud, Hanne; Moseng, Tuva; Holm, Inger

2014-07-01

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice. Cross-sectional design. General community. Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway. Not applicable. The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test). The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants clinical practice. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

[Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia].

Science.gov (United States)

Guo, Xiao-Hui; Sun, Yan-Feng; Wang, Jiang-Bo; Han, Shu-Zhen; Miao, Jing; Cui, Min

2017-03-01

To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes. According to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded. Compared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (Prisk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.

The value of pathogen information in treating clinical mastitis.

Science.gov (United States)

Cha, Elva; Smith, Rebecca L; Kristensen, Anders R; Hertl, Julia A; Schukken, Ynte H; Tauer, Loren W; Welcome, Frank L; Gröhn, Yrjö T

2016-11-01

The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen causing CM is Gram-positive, Gram-negative or other (including no growth) can be determined by using on-farm culture methods. The most detailed level of information for mastitis diagnostics is obtainable by sending milk samples for culture to an external laboratory. Knowing the exact pathogen permits the treatment method to be specifically targeted to the causation pathogen, resulting in less discarded milk. The disadvantages are the additional waiting time to receive test results, which delays treating cows, and the cost of the culture test. Net returns per year (NR) for various levels of information were estimated using a dynamic programming model. The Value of Information (VOI) was then calculated as the difference in NR using a specific level of information as compared to more detailed information on the CM causative agent. The highest VOI was observed where the farmer assumed the pathogen causing CM was the one with the highest incidence in the herd and no pathogen specific CM information was obtained. The VOI of pathogen specific information, compared with non-optimal treatment of Staphylococcus aureus where recurrence and spread occurred due to lack of treatment efficacy, was $20.43 when the same incorrect treatment was applied to recurrent cases, and $30.52 when recurrent cases were assumed to be the next highest incidence pathogen and treated accordingly. This indicates that negative consequences associated with choosing the wrong CM treatment can make additional information cost-effective if pathogen identification is assessed at the generic information level and if the pathogen can spread to other cows if not treated appropriately.

Value 101: the basics of clinical transformation.

Science.gov (United States)

Hancock, Melinda S

2013-06-01

Health systems should take strong steps to ensure that their current and aspiring finance leaders are fully prepared to engage with clinicians in meeting the requirements of healthcare reform. In 2012, Bon Secours held a clinical transformation finance intensive to teach finance staff how to accelerate clinical transformation within their markets. The education and skills that Bon Secours' finance professionals gained from the intensive have strengthened the health system's ability to respond to the challenges of reform.

Novel catalysts for valorization of biomass to value-added chemicals ...

Indian Academy of Sciences (India)

The catalysts used for each transformation were subjected to detailed characterization using XRD, BET surface area, temperature-programmed desorption and transmission electron microscopy. The effect of various reaction parameters was also investigated for obtaining high yields of desired chemical intermediates.

Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries.

Directory of Open Access Journals (Sweden)

Xin Wang

Full Text Available BACKGROUND: The Ottawa ankle rules (OAR are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OAR have been proven that their application reduces unnecessary radiography. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. OBJECTIVES: The purpose of this study was to assess the applicability of the OAR in China, to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains, and to assess their clinical utility for the detection of occult fractures. METHODS: In this prospective study, patients with acute ankle injuries were enrolled during a 6-month period. The eligible patients were examined by emergency orthopedic specialists using the OAR, and then underwent ankle radiography. The results of examination using the OAR were compared with the radiographic results to assess the accuracy of the OAR for ankle fractures. Patients with OAR results highly suggestive of fracture, but no evidence of a fracture on radiographs, were advised to undergo 3-dimensional computed tomography (3D-CT. RESULTS: 183 patients with ankle injuries were enrolled in the study and 63 of these injuries involved fractures. The pooled sensitivity, specificity, positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%, 45.8%, 48.4% and 96.5%, respectively. Our results suggest that clinical application of the OAR could decrease unnecessary radiographs by 31.1%. Of the 21 patients with positive OAR results and negative radiographic findings who underwent 3D-CT examination, five had occult fractures of the lateral malleolus. CONCLUSIONS: The OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury. They may detect some occult fractures of the malleoli that are not visible on

Default values for assessment of potential dermal exposure of the hands to industrial chemicals in the scope of regulatory risk assessments.

Science.gov (United States)

Marquart, Hans; Warren, Nicholas D; Laitinen, Juha; van Hemmen, Joop J

2006-07-01

Dermal exposure needs to be addressed in regulatory risk assessment of chemicals. The models used so far are based on very limited data. The EU project RISKOFDERM has gathered a large number of new measurements on dermal exposure to industrial chemicals in various work situations, together with information on possible determinants of exposure. These data and information, together with some non-RISKOFDERM data were used to derive default values for potential dermal exposure of the hands for so-called 'TGD exposure scenarios'. TGD exposure scenarios have similar values for some very important determinant(s) of dermal exposure, such as amount of substance used. They form narrower bands within the so-called 'RISKOFDERM scenarios', which cluster exposure situations according to the same purpose of use of the products. The RISKOFDERM scenarios in turn are narrower bands within the so-called Dermal Exposure Operation units (DEO units) that were defined in the RISKOFDERM project to cluster situations with similar exposure processes and exposure routes. Default values for both reasonable worst case situations and typical situations were derived, both for single datasets and, where possible, for combined datasets that fit the same TGD exposure scenario. The following reasonable worst case potential hand exposures were derived from combined datasets: (i) loading and filling of large containers (or mixers) with large amounts (many litres) of liquids: 11,500 mg per scenario (14 mg cm(-2) per scenario with surface of the hands assumed to be 820 cm(2)); (ii) careful mixing of small quantities (tens of grams in default values are considered useful for estimating exposure for similar substances in similar situations with low uncertainty. Several other default values based on single datasets can also be used, but lead to estimates with a higher uncertainty, due to their more limited basis. Sufficient analogy in all described parameters of the scenario, including duration, is needed

Service quality and perceived value of technology-based service encounters: evaluation of clinical staff satisfaction in Taiwan.

Science.gov (United States)

Hung, Chung-Jye; Chang, Hsin Hsin; Eng, Cheng Joo; Wong, Kit Hong

Previous research has evaluated technology-based service encounters (TBSEs) in the delivery of health care by assessing patient satisfaction. This study examined service quality and perceived value of TBSEs used in health organisations from the perspective of clinical staff, with staff technology readiness as a moderator. A quantitative survey was conducted in Taiwan, across private and public healthcare organisations. Results showed that TBSEs had a direct effect on service quality and perceived value, which in turn had a direct effect on staff satisfaction in using TBSEs. However, service quality had no effect on perceived value when moderated by technology readiness. Theoretical and managerial implications of these findings are discussed.

Effect of white striping on chemical composition and nutritional value of chicken breast meat

Directory of Open Access Journals (Sweden)

Massimiliano Petracci

2014-03-01

Full Text Available White striping defect (appearance of white striations parallel to muscle fiber on surface of breast is considered an emerging issue in chicken breast meat which is related to increasing growth rate of modern hybrid birds. This study was aimed at evaluating the effect of white striping on chemical composition and nutritional value of chicken breast meat. During three replications, a total of 108 Pectoralis major muscles representing three degrees of white striping (absence=normal; presence classified in 2 levels as moderate or severe were selected to determine proximate composition (moisture, protein, lipid and collagen as well as sarcoplasmic and myofibrillar protein profile by sodium dodecyl sulphatepolyacrylamide gel electrophoresis analysis. The results showed that both severe and moderate white-striped fillets had higher fat content (2.53 vs 1.46 vs 0.78%; P<0.001, lower protein level (20.9 vs 22.2 vs 22.9%; P<0.001, decreased quality of protein as proven by higher collagen content (1.30 vs 1.37 vs 1.43%; P<0.001, and different pattern on myofibrillar and sarcoplasmic fractions when compared to normal fillets. Moreover, severe white-striped fillets exhibited higher energy content (450.7 vs 421.1 kJ/100g; P<0.01 with respect to normal meat. In conclusion, there was a large worsening of nutritional value of chicken breast meat following occurrence of white striping and this might impair consumer attitude towards poultry meat.

ProvenCare: Geisinger's Model for Care Transformation through Innovative Clinical Initiatives and Value Creation.

Science.gov (United States)

2009-04-01

Geisinger's system of care can be seen as a microcosm of the national delivery of healthcare, with implications for decision makers in other health plans. In this interview, Dr Ronald A. Paulus focuses on Geisinger's unique approach to patient care. In its core, this approach represents a system of quality and value initiatives based on 3 major programs-Proven Health Navigation (medical home); the ProvenCare model; and transitions of care. The goal of such an approach is to optimize disease management by using a rational reimbursement paradigm for appropriate interventions, providing innovative incentives, and engaging patients in their own care as part of any intervention. Dr Paulus explains the reasons why, unlike Geisinger, other stakeholders, including payers, providers, patients, and employers, have no intrinsic reasons to be concerned with quality and value initiatives. In addition, he says, an electronic infrastructure that could be modified as management paradigms evolve is a necessary tool to ensure the healthcare delivery system's ability to adapt to new clinical realities quickly to ensure the continuation of delivering best value for all stakeholders.

Analyzing patients' values by applying cluster analysis and LRFM model in a pediatric dental clinic in Taiwan.

Science.gov (United States)

Wu, Hsin-Hung; Lin, Shih-Yen; Liu, Chih-Wei

2014-01-01

This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs.

Analyzing Patients' Values by Applying Cluster Analysis and LRFM Model in a Pediatric Dental Clinic in Taiwan

Science.gov (United States)

Lin, Shih-Yen; Liu, Chih-Wei

2014-01-01

This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs. PMID:25045741

Analyzing Patients’ Values by Applying Cluster Analysis and LRFM Model in a Pediatric Dental Clinic in Taiwan

Directory of Open Access Journals (Sweden)

Hsin-Hung Wu

2014-01-01

Full Text Available This study combines cluster analysis and LRFM (length, recency, frequency, and monetary model in a pediatric dental clinic in Taiwan to analyze patients’ values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients’ needs.

Analysis of determination modalities concerning the exposure and emission limits values of chemical and radioactive substances; Analyse des modalites de fixation des valeurs limites d'exposition et d'emission pour les substances chimiques et radioactives

Energy Technology Data Exchange (ETDEWEB)

Schieber, C.; Schneider, T

2002-08-01

This document presents the generic approach adopted by various organizations for the determination of the public exposure limits values to chemical and radioactive substances and for the determination of limits values of chemical products emissions by some installations. (A.L.B.)

Measuring the nose in septorhinoplasty patients: ultrasonographic standard values and clinical correlations.

Science.gov (United States)

Stenner, Markus; Koopmann, Mario; Rudack, Claudia

2017-02-01

Although septorhinoplasty is the most commonly performed operation in plastic surgery, and the surgical plan as well as its outcome is directly related to the configuration of the anatomical structures in the nose, these are not routinely assessed preoperatively. The aim of our study was to evaluate the nasal soft tissue and cartilaginous structures by means of high-resolution ultrasonography to set up clinical correlations and standard values. We examined 44 patients before septorhinoplasty by high-resolution ultrasonography in noncontact mode. All pictures were quantitatively evaluated by measuring 13 lengths and 4 ratios. All patients underwent a rhinomanometry measuring the nasal air flow. Besides others, men as well as older patients have a significantly thicker alar cartilage. Patients with thinner alar cartilages have a significantly smaller interdomal distance as well as significantly thinner upper lateral cartilages. The soft tissue above the bony dorsum was significantly thicker in older patients. Younger patients have significantly thicker soft tissue in relation to their cartilage. Patients with thicker soft tissue and thinner cartilage have a smaller tip. The interdomal distance and the thickness of the cartilaginous septum significantly correlated with the nasal air flow. We set up standard values of nasal structures in septorhinoplasty patients which can be used as reference values. By judging cartilage and soft tissue characteristics preoperatively, relevant factors for distinct procedures could be analyzed and the surgical steps can be better planned. Visualization by ultrasonography enables the surgeon to achieve treatment goals in a more predictable fashion.

Thresholds in chemical respiratory sensitisation.

Science.gov (United States)

Cochrane, Stella A; Arts, Josje H E; Ehnes, Colin; Hindle, Stuart; Hollnagel, Heli M; Poole, Alan; Suto, Hidenori; Kimber, Ian

2015-07-03

There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges. In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation. Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens. The main conclusion drawn is that although there is evidence that the

Clinical value of diffusion-weighted MR imaging in acute contusion of spinal cord

International Nuclear Information System (INIS)

Zhang Jinsong; Huan Yi; Sun Lijun; Zhao Haitao; Ge Yali; Chang Yingjuan; Yang Chunmin

2005-01-01

Objective: To study the clinical value of diffusion-weighted MR imaging (DWI) in acute contusion of spinal cord. Methods: Eighteen cases with acute contusion of spinal cord were examined with routine MRI and DWI, including single-shot DWI (ssh-DWI) in 2 cases and multi-shot DWI (msh-DWI) in 16 cases, on a 1.5-tesla MR system within 72 h post-trauma. Results: Two cases examined by ssh-DWI showed local lesions with significant high signals, but ssh-DWI images could not be used to measure apparent diffusion coefficient (ADC) value due to its weak resolution. Other 16 cases examined by msh-DWI showed better images and were classified into three categories depending on different degrees of tissue injury and characteristics of DWI: (1) Edema-type: ten cases presented DWI high signals with different degree in local lesions. There were significant difference of ADC values between lesions and normal parts (t=7.515, P 2 WI heterogeneous high signals and T 1 WI low signals due to prominent hemorrhage. Conclusion: DWI of the spinal cord provided satisfactory images and was a useful method for visualizing the injury cord in the super-early stage, helping determine integrity and compression degree of spinal cord and detecting hemorrhage. (authors)

Chemical composition and nutritive value of the feed used in dairy cow feeding in the Republic of Moldova

Directory of Open Access Journals (Sweden)

Larisa CAISIN

2016-12-01

Full Text Available Information on nutritive value of locally available feed ingredients is scarce, therefore the study conducted in the laboratory of the Department “General Animal Husbandry” of the State Agrarian University of Moldova, was aimed at determining the chemical composition and nutrient content of various feeds and fodder species commonly used in the diets of dairy cow sraised in the University farm. Fodder samples, proceeding from different agricultural and ecological zones of the Republic of Moldova, were analyzed for their content of total moisture, dry matter, crude protein, fat, fiber, ash and NFE quantity and the data were compared with those available in the specialized literature. The comparative analysis showed differences in the content of a number of nutrients and large fluctuations were observed in terms of the level of oat nutrition units, energetic nutrition units and metabolizable energy contentin comparison with the data contained in normative references and used in the calculation of the nutritional value of feed and diets.

Comparison of clinical semi-quantitative assessment of muscle fat infiltration with quantitative assessment using chemical shift-based water/fat separation in MR studies of the calf of post-menopausal women

Energy Technology Data Exchange (ETDEWEB)

Alizai, Hamza; Nardo, Lorenzo; Karampinos, Dimitrios C.; Joseph, Gabby B.; Yap, Samuel P.; Baum, Thomas; Krug, Roland; Majumdar, Sharmila; Link, Thomas M. [University of California, San Francisco, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

2012-07-15

The goal of this study was to compare the semi-quantitative Goutallier classification for fat infiltration with quantitative fat-fraction derived from a magnetic resonance imaging (MRI) chemical shift-based water/fat separation technique. Sixty-two women (age 61 {+-} 6 years), 27 of whom had diabetes, underwent MRI of the calf using a T1-weighted fast spin-echo sequence and a six-echo spoiled gradient-echo sequence at 3 T. Water/fat images and fat fraction maps were reconstructed using the IDEAL algorithm with T2* correction and a multi-peak model for the fat spectrum. Two radiologists scored fat infiltration on the T1-weighted images using the Goutallier classification in six muscle compartments. Spearman correlations between the Goutallier grades and the fat fraction were calculated; in addition, intra-observer and inter-observer agreement were calculated. A significant correlation between the clinical grading and the fat fraction values was found for all muscle compartments (P < 0.0001, R values ranging from 0.79 to 0.88). Goutallier grades 0-4 had a fat fraction ranging from 3.5 to 19%. Intra-observer and inter-observer agreement values of 0.83 and 0.81 were calculated for the semi-quantitative grading. Semi-quantitative grading of intramuscular fat and quantitative fat fraction were significantly correlated and both techniques had excellent reproducibility. However, the clinical grading was found to overestimate muscle fat. (orig.)

Clinical relevance and prognostic value of radiographic findings in Zenker's diverticulum.

Science.gov (United States)

Mantsopoulos, Konstantinos; Psychogios, Georgios; Karatzanis, Alexander; Künzel, Julian; Lell, Michael; Zenk, Johannes; Koch, Michael

2014-03-01

The aim of this study was to evaluate the clinical relevance and prognostic value of preoperative and postoperative oesophagography in patients with Zenker's diverticulum. The medical records of 155 patients who underwent surgical treatment (with an endoscopic or transcervical approach) for Zenker's diverticulum between 1992 and 2010 in a tertiary referral centre were retrospectively evaluated. The size of the diverticula on oesophagography, recognizable muscular septum, and protection of the diverticulum were assessed relative to the surgical procedures performed. The incidence of diverticular remnants on postoperative oesophagography was also assessed relative to the surgical procedure. It was investigated whether the detection of a residual pharyngeal pouch and filling of it with contrast medium were related to the patients' immediate postoperative symptoms and the development of symptomatic recurrence. Larger diverticula (Brombart III-IV) were manageable significantly more often with endoscopic procedures (P = 0.007). Residual diverticulum and filling with contrast medium were strongly associated with prolonged dysphagia immediately postoperatively (P = 0.005 and P = 0.009, respectively). However, these parameters failed to correlate significantly with a symptomatic recurrence. Preoperative oesophagography proved to be extremely important for surgical planning, with the surgeon's personal preference seeming to be the driving indicator in many cases. Postoperative oesophagography is only useful for excluding postoperative complications in the immediate postoperative phase and did not have a prognostic value as to a recurrence of the disease.

Biological implications and clinical value of mir-210 in gastrointestinal cancer.

Science.gov (United States)

Yang, Wanli; Ma, Jiaojiao; Zhou, Wei; Zhou, Xin; Cao, Bo; Fan, Daiming; Hong, Liu

2017-06-01

Hypoxia, a common feature of tumor microenvironment, is known to accelerate tumor development and growth by promoting the formation of a neoplastic environment. Recent studies have provided a wealth of evidence that miRNAs are significant members of the adaptive response to low oxygen in tumors. miR-210 is one of the hypoxia-induced miRNAs, which has been reported extensively in cancer researches. However, there is no systematic discussion about the role of miR-210 in gastrointestinal cancer. We conducted a literature research in database including PubMed, Elsevier Science Direct and Medline before 16 September 2016, in order to collect articles of miR-210 in gastrointestinal cancer. Areas covered: In the present review, we mainly discuss the following aspects: hypoxia-induced dysregulation of miR-210, the expression of miR-210 and tumorigenesis, the resultant changes of miR-210 targets and its roles in different types of gastrointestinal cancer progression, the diagnostic, therapeutic and prognostic value of miR-210 in gastrointestinal cancer. Expert commentary: Numerous researches have demonstrated the values of miR-210 in cancer diagnosis, prognosis and targeted therapies, especially in gastrointestinal cancers. However, there are also some existing problems and challenges in translating the new research findings into clinical utility. Further investigations and studies are still urgently required.

Sensitivity, specificity and predictive value of blood cultures from cattle clinically suspected of bacterial endocarditis

DEFF Research Database (Denmark)

Houe, Hans; Eriksen, L.; Jungersen, Gregers

1993-01-01

This study investigated the number of blood culture-positive cattle among 215 animals clinically suspected of having bacterial endocarditis. For animals that were necropsied, the sensitivity, specificity and predictive value of the diagnosis of endocarditis were calculated on the basis...... of the isolation of the causative bacteria from blood. Furthermore, it was investigated whether the glutaraldehyde coagulation time, total leucocyte count, per cent neutrophil granulocytes, pulse rate and duration of disease could help to discriminate endocarditis from other diseases. Among 138 animals necropsied...... the sensitivity, specificity and predictive value of blood cultivation were 70.7 per cent, 93.8 per cent and 89.1 per cent, respectively. None of the other measurements could be used to discriminate between endocarditis and non-endocarditis cases....

Natural background levels and threshold values of chemical species in three large-scale groundwater bodies in Northern Italy

International Nuclear Information System (INIS)

Molinari, Antonio; Guadagnini, Laura; Marcaccio, Marco; Guadagnini, Alberto

2012-01-01

We analyze natural background levels (NBLs) and threshold values (TVs) of spatially distributed chemical species (NH 4 , B and As) which may be a potential pressure and concern in three large scale alluvial and fluvio-deltaic aquifers at different depths of the Apennines and Po river plains in Emilia–Romagna, Northern Italy. Our results are based on statistical methodologies designed to separate the natural and anthropogenic contributions in monitored concentrations by modeling the empirical distribution of the detected concentration with a mixture of probability density functions. Available chemical observations are taken over a 20 years period and are associated with different depths and cover planar investigation scales of the order of hundreds of kilometers. High concentration values detected for NH 4 and B appear to be related to high natural background levels. Due to interaction with the host rock in different geochemical environments we observed that concentration vary in time and space (including in depth) consistently with the hydrogeochemical features and the occurrence of natural attenuation mechanisms in the analyzed reservoirs. Conversely, estimated As NBLs are not consistent with the conceptual model of the hydrogeochemical behavior of the systems analyzed and experimental evidences of As content in aquifer cores. This is due to the inability of these techniques to incorporate the complex dynamics of the processes associated with the specific hydrogeochemical setting. Statistical analyses performed upon aggregating the concentration data according to different time observation windows allow identifying temporal dynamics of NBLs and TVs of target compounds within the observation time frame. Our results highlight the benefit of a dynamic monitoring process and analysis of well demarcated groundwater bodies to update the associated NBLs as a function of the temporal dependence of natural processes occurring in the subsurface. Monitoring protocols could

Chemical Information Literacy: pK[subscript a] Values--Where Do Students Go Wrong?

Science.gov (United States)

Flynn, Alison B.; Amellal, Delphine G.

2016-01-01

Chemical information literacy is an essential skillset for navigating, evaluating, and using the wealth of print and online information. Accordingly, efforts are underway to improve students' acquisition and mastery of this skillset. However, less is known about students' abilities related to finding and using chemical information to solve…

Clinical relevance of the apparent diffusion coefficient value of metastatic bone tumours on diffusion-weighted MRI images: differences according to the types of primary tumour, the affected bones, and clinical factors.

Science.gov (United States)

Cha, M J; Yoon, Y C

2015-10-01

To evaluate whether the apparent diffusion coefficient (ADC) of metastatic bone tumours on diffusion-weighted magnetic resonance imaging (MRI) images differs according to the type of primary cancer, the affected bone, and clinical factors. For this retrospective study, two radiologists reviewed MRI images, including ADC maps, of 67 patients (M:F=38:29; median age, 48 years) who were diagnosed with bone metastasis by means of histological or clinical confirmation. The primary tumours included 29 lung adenocarcinomas, 15 invasive ductal adenocarcinomas of the breast, 13 hepatocellular carcinomas, six prostatic carcinomas, and four renal cell carcinomas. ADC values of the metastatic tumour were compared according to the type of primary malignancy, the affected bone, and the age and sex of the patient using Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction. In addition, pre-contrast CT images were available in 38 of 67 patients; a subanalysis of the CT radiodensity and ADC values were performed with Spearman correlation. The mean, standard deviation, and minimum and maximum values of the ADC of metastatic bone tumours did not differ significantly according to type of primary malignancy, the affected bone, or clinical variables (p>0.1). The ADC value was not significantly correlated with CT radiodensity (p=0.24). Intra- and interobserver agreements for the mean ADC values were excellent (intra-observer: p=0.98; interobserver: p=0.98). Assessment of the ADC value of metastatic bone tumours is not reliable for differentiation of the type of primary cancer. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity.

Science.gov (United States)

Lee, Linda K; Gan, Victor C; Lee, Vernon J; Tan, Adriana S; Leo, Yee Sin; Lye, David C

2012-01-01

Elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT ≥ 1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical relevance and discriminatory value of AST or ALT for dengue hemorrhagic fever (DHF) and severe dengue. We retrospectively studied and classified polymerase chain reaction positive dengue patients from 2006 to 2008 treated at Tan Tock Seng Hospital, Singapore according to WHO 1997 and 2009 criteria for dengue severity. Of 690 dengue patients, 31% had DHF and 24% severe dengue. Elevated AST and ALT occurred in 86% and 46%, respectively. Seven had AST or ALT ≥ 1000 U/L. None had acute liver failure but one patient died. Median AST and ALT values were significantly higher with increasing dengue severity by both WHO 1997 and 2009 criteria. However, they were poorly discriminatory between non-severe and severe dengue (e.g., AST area under the receiver operating characteristic [ROC] curve=0.62; 95% confidence interval [CI]: 0.57-0.67) and between dengue fever (DF) and DHF (AST area under the ROC curve=0.56; 95% CI: 0.52-0.61). There was significant overlap in AST and ALT values among patients with dengue with or without warning signs and severe dengue, and between those with DF and DHF. Although aminotransferase levels increased in conjunction with dengue severity, AST or ALT values did not discriminate between DF and DHF or non-severe and severe dengue.

Recent advances in the production of value added chemicals and lipids utilizing biodiesel industry generated crude glycerol as a substrate - Metabolic aspects, challenges and possibilities: An overview.

Science.gov (United States)

Vivek, Narisetty; Sindhu, Raveendran; Madhavan, Aravind; Anju, Alphonsa Jose; Castro, Eulogio; Faraco, Vincenza; Pandey, Ashok; Binod, Parameswaran

2017-09-01

One of the major ecological concerns associated with biodiesel production is the generation of waste/crude glycerol during the trans-esterification process. Purification of this crude glycerol is not economically viable. In this context, the development of an efficient and economically viable strategy would be biotransformation reactions converting the biodiesel derived crude glycerol into value added chemicals. Hence the process ensures the sustainability and waste management in biodiesel industry, paving a path to integrated biorefineries. This review addresses a waste to wealth approach for utilization of crude glycerol in the production of value added chemicals, current trends, challenges, future perspectives, metabolic approaches and the genetic tools developed for the improved synthesis over wild type microorganisms were described. Copyright © 2017 Elsevier Ltd. All rights reserved.

CLINICAL-PHARMACOLOGICAL VALUE OF TREATMENT EFFICIENCY OF BHP-PATIENTS BY ANTITHROMBOTIC THERAPY

Directory of Open Access Journals (Sweden)

A.A. Svistunov

2007-09-01

Full Text Available Patients with BHP need in pharmacological treatment of thrombosis the most often in the first 3 cases because has dysfunctions of platelets and coagulation. According to results of analysis of efficiency antithrombotic therapy in BHP-patients confirmed clinical and biochemical influence antithrombotic therapy by Ticlid 250 mg twice on the day in comparison with Aspirin 100 mg and Dipiridomol 25 mg on the basic therapy of the BHP by Permixon 160 mg. The received results have had statistically meant differences. Manifestation of BHP and value QOL and others urodynamic complications most often appear on the basic specific monotherapy of BHP and lost after antithrombotic therapy for 1-3 months. The important complications of antithrombotic therapy of BHP-patients did not observe.

The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear

NARCIS (Netherlands)

van Kampen, D.A.; van den Berg, T.; van der Woude, H.J.; Castelein, R.M.; Scholtes, V.A.B.; Terwee, C.B.; Willems, W.J.

2014-01-01

Background: It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for

Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: proven clinical value?

International Nuclear Information System (INIS)

Pinna, Gian Domenico; Maestri, Roberto; La Rovere, Maria Teresa

2015-01-01

The baroreceptor-heart rate reflex (baroreflex sensitivity, BRS) is a key mechanism contributing to the neural regulation of the cardiovascular system. Several methods have been proposed so far to assess BRS by analyzing the spontaneous beat-to-beat fluctuations of arterial blood pressure and heart rate. These methods are inherently simple, non-invasive and low-cost. This study is an attempt to address the question of whether spontaneous baroreflex methods have proven to be of value in the clinical setting. In the first part of this article, we critically review most representative clinical studies using spontaneous BRS techniques either for risk stratification or treatment evaluation, these being major issues in the clinical management of the patients. In the second part, we address two important aspects of spontaneous BRS measurements: measurability and reliability. Estimation of BRS in the studies selected for the review was performed according to the sequence, transfer function, alpha-index and phase-rectified signal averaging method. Arterial blood pressure was recorded non-invasively during supine, short-term (<30 min) laboratory recordings. The conclusion from this review is that spontaneous BRS techniques have been shown to be of great value in clinical practice but further work is needed to confirm the validity of previous findings and to widen the field of clinical applications. Measurability and reliability can be a major issue in the measurement of spontaneous BRS, particularly in some patient populations like post-myocardial infarction and heart failure patents. Main causes of poor measurability are: non-sinus rhythm, a high rate of ectopic beats and the need for recorded time series of RR interval and arterial blood pressure to satisfy the constraints of the different BRS estimation algorithms. As for reliability, within-subject variability is rather high in the measurements of spontaneous BRS and, therefore, should be carefully taken into account

Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

Science.gov (United States)

van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

2014-01-01

Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

Value of Prophylactic Postoperative Antibiotic Therapy after Bimaxillary Orthognathic Surgery: A Clinical Trial

Directory of Open Access Journals (Sweden)

Majid Eshghpour

2014-10-01

Full Text Available Introduction: Antibiotic therapy before or after orthognathic surgery is commonly recommended by surgeons to minimize the risk of wound infection. This article evaluates the value of Prophylactic antibiotic therapy in order to diminish the incidence of postoperative wound infection after orthognathic surgery.   Materials and Methods: Fifty candidates for bimaxillary orthognathic surgery were divided into cases and controls. Cefazolin (1g was administered intravenously to all participants 30 mins prior to surgery followed by a similar dose 4 hours later. Case-group patients ingested amoxicillin (500 mg orally for 7 days after surgery. Postoperative wound infection was assessed using clinical features, and the P-value significance was set at P  Results: Both groups were similar according to gender, age, and operating time. During the follow-up period no infection was observed in either the case or control group.   Conclusion:  The results of this study suggest that long-term postoperative antibiotic therapy is not essential for the prevention of postoperative infection, and that application of aseptic surgical technique and hygiene instruction after surgery are sufficient.

Clinical value of 99Tcm-octreotide SPECT/CT in diagnostics of lung cancer

International Nuclear Information System (INIS)

Liu Xiaofang; Li Mei; Liu Yong; Li Ran; Xu Jie; Sun yongchang; Dai Haojie

2012-01-01

Objective: To evaluate the clinical value of 99 Tc m -Octreotide SPECT-CT in the diagnosis of lung cancer. Methods: Sixty-five consecutive patients with suspected lung cancer received intravenous injection of 740 MBq 99 Tc m -Octreotide and additional SPECT images of the chest were performed at 4h post injection. The SPECT/CT images were interpreted separately. The tumor uptake of 99 Tc m -Octreotide was visually determined and then measured and expressed as the activity ratio of tumor to normal tissues (T/N). The differences between lung cancer and benign lung lesion and between SCLC and NSCLC, and between adenocarcinoma and squamous carcinoma were studied by statistical analysis. Moreover, the receiver operating characteristic ROC curves were plotted and the predicted probabilities and areas under the curve were calculated. Results: Fifty-one patients and fourteen patients in 65 cases were diagnosed as lung cancer and benign lung lesion by histopathological analysis, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99 Tc m -Octreotide SPECT/CT in diagnosis of lung cancer were 92.2%, 85.7%, 95.9% and 75%, respectively. The area under ROC curve was 0.889 (P 99 Tc m -Octreotide SPECT/CT could play an important role in the diagnosis of lung cancer, and it may be useful for identifying SCLC and NSCLC. (authors)

Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment.

Science.gov (United States)

Seo, Yu-Mi; Kang, Hyun-Mi; Lee, Sung-Churl; Yu, Jae-Won; Kil, Hong-Ryang; Rhim, Jung-Woo; Han, Ji-Whan; Lee, Kyung-Yil

2018-05-01

This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). The mean fever duration was 6.6±2.3 days, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.

Hematologic reference values for clinically healthy captive golden conures (Guaruba guarouba).

Science.gov (United States)

Prioste, Fabíola Eloisa Setim; Zwarg, Ticiana; Teixeira, Rodrigo Hidalgo; Vanstreels, Ralph Eric Thijl; Rocha, Arnaldo; Matushima, Eliana Reiko

2012-12-01

Golden conures or ararajubas (Guaruba guarouba) are endangered parrots endemic to the Brazilian Amazon forest. Body mass, blood cell counts, and total plasma protein were determined for 70 clinically healthy golden conures captive at zoologic parks and private breeder facilities in Brazil. Hematologic results (mean +/- SD) were: Erythrocytes 3.6 +/- 0.5 x 10(6) cells/mm3, hemoglobin 12.8 +/- 1.4 g/dl, packed cell volume 46 +/- 3.8%, mean corpuscular volume 132 +/- 20 fl, mean corpuscular hemoglobin (MCH) 36 +/- 5.7 pg, mean corpuscular hemoglobin concentration (MCHC) 28 +/- 3.5%, thrombocytes 26.3 +/- 9.3 x 10(3) cells/mm3, leukocytes 11.9 +/- 4.5 x 10(3) cells/mm3, heterophils 6284 +/- 2715 cells/mm3, lymphocytes 5473 +/- 2408 cells/ mm3, monocytes 113 +/- 162 cells/mm3, eosinophils 10 +/- 42 cells/mm3, basophils 27 +/- 64 cells/mm3. Body mass was 254 +/- 24.9 g and total plasma protein (TPP) was 3.54 +/- 0.58 g/dl. No statistical differences were observed between genders within age groups. Differences between juveniles (J) and adults (A) were identified for TPP (J A), and MCHC (J > A). These results provide reliable reference values for the clinical interpretation of hematologic results for the species. Hematology may be an important tool for population health investigations on free-ranging golden conure populations and will also be essential to survey the health of release candidates in future reintroduction programs.

[Clinical value of angiogenin in predicting the prognosis of patients with idiopathic pulmonary fibrosis].

Science.gov (United States)

Bai, Yanling; Zhu, Haiyan; Sun, Qiyu; Gu, Guozhong; Zhang, Lingyu; Li, Ying; Yang, Baofeng

2017-09-01

To explore the relationship between angiogenin-1/2 (Ang-1/2) and clinical parameters of idiopathic pulmonary fibrosis (IPF), and to assess the value of Ang-1/2 in predicting the prognosis of patients with IPF. A retrospective analysis was conducted. Ninety-one patients diagnosed as IPF by high resolution CT (HRCT) and lung biopsy admitted to Daqing Oil Field General Hospital from March 2014 to January 2015 were enrolled. The general data, serum parameters and pulmonary function parameters of all patients were collected. After treatment, all of the 91 patients were followed-up to 2 years. The patients were divided into favorable prognosis group and unfavorable prognosis group according to follow-up results. The differences in all parameters between the two groups were compared. The relationship between Ang-1, Ang-2 and lung function parameters was analyzed by Pearson correlation analysis. Cox proportional hazard regression model was used to evaluate the effect of clinical parameters on the prognosis of patients with IPF. The effect of Ang-2 in predicting prognosis of patients with IPF was analyzed by receiver operating characteristic (ROC) curve. During the 2-year follow-up period, 30 of 91 patients showed a favorable prognosis, and 55 showed an unfavorable prognosis with a poor prognosis rate of 64.71%, and 6 patients withdrew from the study due to loss of follow-up and death. Compared with the favorable prognosis group, Ang-2 level in the unfavorable prognosis group was significantly increased (μg/L: 2.88±1.63 vs. 1.89±1.22, t = 2.909, P = 0.005), but Ang-1 only showed a slight increase (μg/L: 28.70±14.26 vs. 25.62±11.95, t = 1.005, P = 0.318). The results of Pearson correlation analysis showed that Ang-2 level was negatively correlated with forced expiratory volume in 1 second (FVC1) and the percentage of carbon monoxide diffusing capacity accounting for the expected value (DLCO%: r value was -0.227 and -0.206, and P value was 0.147 and 0.253, respectively

Elbow Room for Best Practice? Montgomery, Patients' values, and Balanced Decision-Making in Person-Centred Clinical Care.

Science.gov (United States)

Herring, Jonathan; Fulford, Kmw; Dunn, Michael; Handa, Ashoki

2017-11-01

The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In this article, we set risk disclosure in context with three further elements of the judgment: benefits, options, and dialogue. These elements, we argue, taken together with risk disclosure, reflect the origins of the Montgomery ruling in a model of consent based on autonomy of patient choice through shared decision-making with their doctor. This model reflects recent developments in both law and medicine and is widely regarded (by the General Medical Council and others) as representing best practice in contemporary person-centred medicine. So understood, we suggest, the shift marked by Montgomery in the basis of duty of care is a shift in underpinning values: it is a shift from the clinician's interpretation about what would be best for patients to the values of (to what is significant or matters from the perspective of) the particular patient concerned in the decision in question. But the values of the particular patient do not thereby become paramount. The Montgomery test of duty of care requires the values of the particular patient to be balanced alongside the values of a reasonable person in the patient's position. We illustrate some of the practical challenges arising from the balance of considerations required by Montgomery with examples from surgical care. These examples show the extent to which Montgomery, in mirroring the realities of clinical decision-making, provides elbowroom for best practice in person-centred clinical care. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia.

Science.gov (United States)

Chen, Po-Hao; Slanetz, Priscilla J

2014-01-01

To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography. Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy. A total of 353 mammograms were obtained from 327 unique patients (ages 18-95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses. Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia

Energy Technology Data Exchange (ETDEWEB)

Chen, Po-Hao, E-mail: howard_chen@post.harvard.edu [Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 (United States); Department of Radiology, Hospital of University of Pennsylvania, 3400 Spruce Street, Philadlephia, PA 19104 (United States); Slanetz, Priscilla J., E-mail: pslanetz@bidmc.harvard.edu [Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 (United States); Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215 (United States)

2014-01-15

Purpose: To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography. Materials and Methods: Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy. Results: A total of 353 mammograms were obtained from 327 unique patients (ages 18–95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses. Conclusion: Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management.

Coronary CT angiography: Diagnostic value and clinical challenges.

Science.gov (United States)

Sabarudin, Akmal; Sun, Zhonghua

2013-12-26

Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.

Comparative study of the chemical properties of palm oil extracted ...

African Journals Online (AJOL)

The chemical properties of oil samples determined were free fatty acid, acid value, saponification value, peroxide value, iodine value and moisture content. The experimental design adopted was 3 x 2 x 2 factorial randomized complete block design in three replicates. The data of chemical properties of extracted palm oil ...

Analysis of clinical value of CT in the diagnosis of pediatric pneumonia and mycoplasma pneumonia

OpenAIRE

GONG, LIANG; ZHANG, CHONG-LIN; ZHEN, QING

2016-01-01

Pneumonia is an infectious disease of the lung causing mortality. Mycoplasma pneumonia (MP) is an atypical bacterial pneumonia that damages several organs. Lung computed tomography (CT) has been utilized in its identification. The aim of the present study was to examine the value of computed tomography diagnosis for pediatric MP. The present study prospectively analyzed the clinical and imaging data of 1,280 cases of pediatric MP in the out- and inpatient departments from March, 2010 to March...

The clinical value of trans-vaginal ultrasound-guided puncture in the treatment of pelvic abscess

International Nuclear Information System (INIS)

Wang Ping; Gong Wei

2008-01-01

Objective: To investigate the clinical value of trans-vaginal ultrasound-guided (TVS) puncture in the treatment of pelvic abscess. Methods 30 cases with pelvic abscess were treated by transvaginal ultrasound-guided puncture. The long-dated effects were followed-up. Results: 29 cases were cured by TVS puncture. Operation was performed in 1 patient because of invalid effect. The cure rate was 97%. Conclusion: Ultrasound-guided puncture is a safe and convenient method in the treatment of pelvic abscess. (authors)

Chemical-induced Vitiligo

Science.gov (United States)

Harris, John E.

2016-01-01

Synopsis Chemical-induced depigmentation of the skin has been recognized for over 75 years, first as an occupational hazard but then extending to those using household commercial products as common as hair dyes. Since their discovery, these chemicals have been used therapeutically in patients with severe vitiligo to depigment their remaining skin and improve their appearance. The importance of recognizing this phenomenon was highlighted during an outbreak of vitiligo in Japan during the summer of 2013, when over 16,000 users of a new skin lightening cosmetic cream developed skin depigmentation at the site of contact with the cream and many in remote areas as well. Depigmenting chemicals appear to be analogs of the amino acid tyrosine that disrupt melanogenesis and result in autoimmunity and melanocyte destruction. Because chemical-induced depigmentation is clinically and histologically indistinguishable from non-chemically induced vitiligo, and because these chemicals appear to induce melanocyte autoimmunity, this phenomenon should be known as “chemical-induced vitiligo”, rather than less accurate terms that have been previously used. PMID:28317525

Interventional management of spine eosinophilic granuloma in children: preliminary investigation of its clinical value

International Nuclear Information System (INIS)

He Yu; Wu Chungen; Gu Yifeng; Cheng Yongde

2011-01-01

Objective: To assess the clinical value of interventional management in treating spine eosinophilic granuloma in children. Methods: Interventional therapies, including per cutaneous biopsy and percutaneous vertebroplasty (PVP), were carried out in three child patients with five pathologically-proved eosinophilic granuloma lesions, which were localized in the vertebrae. The clinical data were retrospectively analyzed. Visual analogue pain scale (VAS) and Oswesty disability index (ODI) were assessed before and after operation. Results: A total of four operations were successfully carried out in all of three patients. The mean VAS score reduced from 7 before treatment of 1 after treatment. The mean ODI decreased from preoperative 52.5% to postoperative 10.5%. During procedures no significant complications occurred except for cement leakage in some cases. Pain relief and daily activity were remarkably improved after treatment. All patients were followed up for 3 months to 5 years. Conclusion: For the treatment of spine eosinophilic granuloma in children, interventional techniques are mini-invasive, safe and effective therapeutic methods. (authors)

The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low

NARCIS (Netherlands)

Graat, Marleen E.; Choi, Goda; Wolthuis, Esther K.; Korevaar, Johanna C.; Spronk, Peter E.; Stoker, Jaap; Vroom, Margreeth B.; Schultz, Marcus J.

2006-01-01

INTRODUCTION: The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care

Physico-chemical analysis and calorific values of poultry manure.

Science.gov (United States)

Quiroga, G; Castrillón, L; Fernández-Nava, Y; Marañón, E

2010-05-01

Spain is one of the major producers of broilers and laying hens in the European Union, with an overall market share of around 12%. The poultry manure that is produced is usually employed as fertilizer on cropland, either directly or after a composting process. In some cases, however, this waste is transported over 120km to be used as fertilizer, with the resulting high transport costs. In other countries, poultry manure is used as an alternative natural fuel source for power generation. In this study, poultry manure from all the laying hen farms in Asturias was characterized with a view to its possible use as an energy source. The Higher Heating Values on a dry basis (experimental) varies between 12,052 and 13,882kJ/kg. Lower Heating Values (LHVs) on a wet basis range are much lower (mean values of 2664kJ/kg) due to the high moisture content of poultry manure. Accordingly, the co-combustion of this waste with other types of waste such as forest and wood waste (LHV on a wet basis of 8044 and 15,830kJ/kg, respectively) or municipal solid waste (LHV on a wet basis of 10,725kJ/kg) should be considered as an alternative energy source. Chlorine and sulphur contents in dry matter vary around mean values of 0.64% and 0.11%, respectively. The waste also presents high amounts of Ca (4.84%) and K (2.38%). Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Clinical value of plasma endothelin levels in children with cardiovascular diseases

International Nuclear Information System (INIS)

Chen Nianfa; Duan Yongqiang

2009-01-01

To explore the clinical value of plasma endothelin (ET-1) levels in children with cardiovascular diseases, 77 children with heart failure, obesity, hyperlipemia, fatty liver and hypertension were divided into 5 experimental groups and 21 health children with same age and gender as control group. The plasma levels of ET-1 in these children were tested by RIA. The results showed that plasma levels of ET-1 in 5 experimental groups were 112.8 ± 34.1ng/L, 57.8 ± 19.1ng/L,64.5 ± 25.3ng/L, 74.9 ± 28.4ng/L and 60.7 ± 21.6ng/L, respectively. The ET-1 levels in 5 groups were significantly higher than that in control group (P<0.01). The results indicate the higher plasma ET-1 levels in children are related with cardiovascular diseases, and it is useful in the diagnosis of children cardiovascular diseases. (authors)

On being supervised: getting value from a clinical supervisor and making the relationship work when it is not.

Science.gov (United States)

Parker, Stephen; Suetani, Shuichi; Motamarri, Balaji

2017-12-01

The importance of clinical supervision is emphasised in psychiatric training programs. Despite this, the purpose and processes of supervision are often poorly defined. There is limited guidance available for trainees about their role in making supervision work. This paper considers the nature of supervision in psychiatric training and provides practical advice to help supervisees take active steps to make supervision work. In obtaining value from supervision, the active role of the supervisee in seeking feedback, finding value in criticism and building autonomy is emphasised. Additionally, the importance of exploring what value a supervisor can offer and maintaining realistic expectations is considered. Trainees can benefit from taking an active role in planning and managing their supervision to maximise their learning.

Prediction of cereal feed value by near infrared spectroscopy

DEFF Research Database (Denmark)

Jørgensen, Johannes Ravn

. NIRS is therefore appropriate as a quick method for the determination of FEsv and FEso, since it is rapid (approximately 1 minute per measurement of a ground test) and cheap. The aim is to develop a rapid method to analyse grain feed value. This will contribute to highlight the opportunities...... feed, a possible tool to assess the feed value of new varieties in the variety testing and a useful, cheap and rapid tool for cereal breeders. A bank of 1213 grain samples of wheat, triticale, barley and rye, and related chemical reference analyses to describe the feed value have been established...... with the error in the chemical analysis. Prediction error by NIRS prediction of feed value has been shown to be above the error of the chemical measurement. The conclusion is that it has proved possible to predict the feed value in cereals with NIRS quickly and cheaply, but prediction error with this method...

A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework.

Science.gov (United States)

Gonzalo, Jed D; Graaf, Deanna; Ahluwalia, Amarpreet; Wolpaw, Dan R; Thompson, Britta M

2018-03-21

After emphasizing biomedical and clinical sciences for over a century, US medical schools are expanding experiential roles that allow students to learn about health care delivery while also adding value to patient care. After developing a program where all 1st-year medical students are integrated into interprofessional care teams to contribute to patient care, authors use a diffusion of innovations framework to explore and identify barriers, facilitators, and best practices for implementing value-added clinical systems learning roles. In 2016, authors conducted 32 clinical-site observations, 29 1:1 interviews with mentors, and four student focus-group interviews. Data were transcribed verbatim, and a thematic analysis was used to identify themes. Authors discussed drafts of the categorization scheme, and agreed upon results and quotations. Of 36 sites implementing the program, 17 (47%) remained, 8 (22%) significantly modified, and 11 (31%) withdrew from the program. Identified strategies for implementing value-added roles included: student education, patient characteristics, patient selection methods, activities performed, and resources. Six themes influencing program implementation and maintenance included: (1) educational benefit, (2) value added to patient care from student work, (3) mentor time and site capacity, (4) student engagement, (5) working relationship between school, site, and students, and, (6) students' continuity at the site. Health systems science is an emerging focus for medical schools, and educators are challenged to design practice-based roles that enhance education and add value to patient care. Health professions' schools implementing value-added roles will need to invest resources and strategize about best-practice strategies to guide efforts.

Establishment of virtual three-dimensional model for intravascular interventional devices and its clinical value

International Nuclear Information System (INIS)

Wei Xin; Zhong Liming; Xie Xiaodong; Wang Chaohua; You Jian; Hu Hong; Hu Kongqiong; Zhao Xiaowei

2012-01-01

Objective: To explore virtual three-dimensional (3D) model for intravascular interventional devices,the method of preoperative simulation and its value in clinical work. Methods: The virtual models including catheter, guide wire, stent and coil were established by using the 3D moulding software of 3D Studio MAX R3. The interventional preoperative simulation was performed on personal computer including 21 patients of cerebral aneurysm embolization (anterior communicating artery 5, posterior communicating artery 10,middle cerebral artery 3, internal carotid artery 2, and vertebral artery 1), during interventional procedures, the surgeon relied on the simulation results for plastic micro-guide wire, catheter and the release of micro-coils and stents. Results: (1) All the virtual instruments and real instruments had similar shape,the overall tine for constructing virtual model was about 20 hours. The preoperative simulation took 50 to 80 minutes. (2) The simulation result of catheter insertion in the 18 cases had relevant value to guide micro-catheter, molding micro-guide wire tip, and shortened the operating time. For embolization, the simulation results of filling coil and releasing stent were similar to surgical results in 76% of the patients (16/21). (3)For teaching and training, 93% (38/41) of doctors in training believed that preoperative simulation facilitated the understanding of surgery. Conclusions: The method of virtual model of intravascular interventional devices was reliable. The preoperative simulation results could be used to guide practical clinical operation with relatively high degree of similarity, and could play a role in promoting researches on interventional virtual operations. (authors)

A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application.

Science.gov (United States)

Garland, Megan; Yim, Joshua J; Bogyo, Matthew

2016-01-21

The Precision Medicine Initiative aims to use advances in basic and clinical research to develop therapeutics that selectively target and kill cancer cells. Under the same doctrine of precision medicine, there is an equally important need to visualize these diseased cells to enable diagnosis, facilitate surgical resection, and monitor therapeutic response. Therefore, there is a great opportunity for chemists to develop chemically tractable probes that can image cancer in vivo. This review focuses on recent advances in the development of optical probes, as well as their current and future applications in the clinical management of cancer. The progress in probe development described here suggests that optical imaging is an important and rapidly developing field of study that encourages continued collaboration among chemists, biologists, and clinicians to further refine these tools for interventional surgical imaging, as well as for diagnostic and therapeutic applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

The hidden values

DEFF Research Database (Denmark)

Rasmussen, Birgitte; Jensen, Karsten Klint

“The Hidden Values - Transparency in Decision-Making Processes Dealing with Hazardous Activities”. The report seeks to shed light on what is needed to create a transparent framework for political and administrative decisions on the use of GMOs and chemical products. It is our hope that the report...

The clinical value of three-dimensional contrast-enhanced MR angiography in abdominal aortic aneurysms

International Nuclear Information System (INIS)

Liu Qi; Lu Jianping; Tian Jianming; Wang Fei; Wang Li; Jin Aiguo; Zeng Hao; Gong Jianguo

2004-01-01

Objective: To evaluate the clinical value of three-dimensional contrast-enhanced MR angiography (3D CE-MRA) and its 3D reconstruction in the diagnosis of abdominal aortic aneurysms (AAA). Methods: Sixty-three patients with clinically diagnosed AAA underwent 3D CE-MRA combined with other sequences. 3D CE-MRA was performed with a 3D FISP sequence(TR, TE, FA=3.64 ms, 1.44 ms, 25 degrees, matrix=196 x 512, eff. slice=1.8 mm, FOV 30 cm x 40 cm, acquisition time=18-20 s) after injection of 0.2 mmol Gd-DTPA per kg b. w. A bolus-test was done before angiography to optimize imaging delay time. After 3D CE-MRA a T 1 -weighted sequence was acquired on the axial plane. The source images were subtracted from mask images and transferred to computer workstation, and subsequently post-processed using 3D reconstruction. All sequences were used to depict the type, location, extent, and thrombosis of the AAA, the morphology of its proximal neck, the distal aortoiliac inflow tract, and the relationship with the branches of aorta. The length, diameter, and angle of the aneurysm sac, and proximal and distal arteries were measured. The clinical role was evaluated for treatment planning. Results: High-quality 3D CE-MRA/MRI images were obtained in all patients. Among them, fifty-six had infrarenal AAA, five juxtarenal AAA, and two AAA with suprarenal extension. The mean diameter of aneurysms was 5.3 cm. The thrombosis was thicker than 2.0 cm in 26 patients. 3D CE-MRA clearly demonstrated the morphology and extent of AAA, and its proximal neck and distal aortoiliac inflow tract. The accurate parameters needed by endovascular treatment were gained simultaneously. Aneurysm and its neck depiction at 3D CE-MRA was better than that at DSA. The endovascular and surgical treatment were selected according the images (31 endovascular treatment, 4 surgical treatment, 28 conservative treatment only). The parameters at 3D CE-MRA coincided well with those at DSA in all cases (P>0.1). Conclusion: 3D CE

Chemical variability along the value chains of turmeric (Curcuma longa): a comparison of nuclear magnetic resonance spectroscopy and high performance thin layer chromatography.

Science.gov (United States)

Booker, Anthony; Frommenwiler, Debora; Johnston, Deborah; Umealajekwu, Chinenye; Reich, Eike; Heinrich, Michael

2014-03-14

Herbal medicine value chains have generally been overlooked compared with food commodities. Not surprisingly, revenue generation tends to be weighted towards the end of the chain and consequently the farmers and producers are the lowest paid beneficiaries. Value chains have an impact both on the livelihood of producers and on the composition and quality of products commonly sold locally and globally and consequently on the consumers. In order to understand the impact of value chains on the composition of products, we studied the production conditions for turmeric (Curcuma longa) and the metabolomic composition of products derived from it. We aimed at integrating these two components in order to gain a better understanding of the effect of different value chains on the livelihoods of some producers. This interdisciplinary project uses a mixed methods approach. Case studies were undertaken on two separate sites in India. Data was initially gathered on herbal medicine value chains by means of semi-structured interviews and non-participant observations. Samples were collected from locations in India, Europe and the USA and analysed using (1)H NMR spectroscopy coupled with multivariate analysis software and with high performance thin layer chromatography (HPTLC). We investigate medicinal plant value chains and interpret the impact different value chains have on some aspects of the livelihoods of producers in India and, for the first time, analytically assess the chemical variability and quality implications that different value chains may have on the products available to end users in Europe. There are benefits to farmers that belonged to an integrated chain and the resulting products were subject to a higher standard of processing and storage. By using analytical methods, including HPTLC and (1)H NMR spectroscopy, it has been possible to correlate some variations in product composition for selected producers and identify strengths and weaknesses of some types of value

DianaHealth.com, an On-Line Database Containing Appraisals of the Clinical Value and Appropriateness of Healthcare Interventions: Database Development and Retrospective Analysis.

Science.gov (United States)

Bonfill, Xavier; Osorio, Dimelza; Solà, Ivan; Pijoan, Jose Ignacio; Balasso, Valentina; Quintana, Maria Jesús; Puig, Teresa; Bolibar, Ignasi; Urrútia, Gerard; Zamora, Javier; Emparanza, José Ignacio; Gómez de la Cámara, Agustín; Ferreira-González, Ignacio

2016-01-01

To describe the development of a novel on-line database aimed to serve as a source of information concerning healthcare interventions appraised for their clinical value and appropriateness by several initiatives worldwide, and to present a retrospective analysis of the appraisals already included in the database. Database development and a retrospective analysis. The database DianaHealth.com is already on-line and it is regularly updated, independent, open access and available in English and Spanish. Initiatives are identified in medical news, in article references, and by contacting experts in the field. We include appraisals in the form of clinical recommendations, expert analyses, conclusions from systematic reviews, and original research that label any health care intervention as low-value or inappropriate. We obtain the information necessary to classify the appraisals according to type of intervention, specialties involved, publication year, authoring initiative, and key words. The database is accessible through a search engine which retrieves a list of appraisals and a link to the website where they were published. DianaHealth.com also provides a brief description of the initiatives and a section where users can report new appraisals or suggest new initiatives. From January 2014 to July 2015, the on-line database included 2940 appraisals from 22 initiatives: eleven campaigns gathering clinical recommendations from scientific societies, five sets of conclusions from literature review, three sets of recommendations from guidelines, two collections of articles on low clinical value in medical journals, and an initiative of our own. We have developed an open access on-line database of appraisals about healthcare interventions considered of low clinical value or inappropriate. DianaHealth.com could help physicians and other stakeholders make better decisions concerning patient care and healthcare systems sustainability. Future efforts should be focused on

DianaHealth.com, an On-Line Database Containing Appraisals of the Clinical Value and Appropriateness of Healthcare Interventions: Database Development and Retrospective Analysis.

Directory of Open Access Journals (Sweden)

Xavier Bonfill

Full Text Available To describe the development of a novel on-line database aimed to serve as a source of information concerning healthcare interventions appraised for their clinical value and appropriateness by several initiatives worldwide, and to present a retrospective analysis of the appraisals already included in the database.Database development and a retrospective analysis. The database DianaHealth.com is already on-line and it is regularly updated, independent, open access and available in English and Spanish. Initiatives are identified in medical news, in article references, and by contacting experts in the field. We include appraisals in the form of clinical recommendations, expert analyses, conclusions from systematic reviews, and original research that label any health care intervention as low-value or inappropriate. We obtain the information necessary to classify the appraisals according to type of intervention, specialties involved, publication year, authoring initiative, and key words. The database is accessible through a search engine which retrieves a list of appraisals and a link to the website where they were published. DianaHealth.com also provides a brief description of the initiatives and a section where users can report new appraisals or suggest new initiatives. From January 2014 to July 2015, the on-line database included 2940 appraisals from 22 initiatives: eleven campaigns gathering clinical recommendations from scientific societies, five sets of conclusions from literature review, three sets of recommendations from guidelines, two collections of articles on low clinical value in medical journals, and an initiative of our own.We have developed an open access on-line database of appraisals about healthcare interventions considered of low clinical value or inappropriate. DianaHealth.com could help physicians and other stakeholders make better decisions concerning patient care and healthcare systems sustainability. Future efforts should be

Predictive value of PSA velocity over early clinical and pathological parameters in patients with localized prostate cancer who undergo radical retropubic prostatectomy

Directory of Open Access Journals (Sweden)

Martinez Carlos A.L.

2004-01-01

Full Text Available OBJECTIVES: To analyze the behavior of the prostate specific antigen velocity (PSAV in localized prostate adenocarcinoma. MATERIALS AND METHODS: We conducted a retrospective study of 500 men who had localized prostate adenocarcinoma, who underwent radical retropubic prostatectomy between January 1986 and December 1999. The PSAV was calculated for each patient and subsequently, the values were correlated with 5 groups: age, initial PSA value, clinical stage, tumor volume and Gleason score. RESULTS: The behavior of PSAV presented statistic significance with an increment between 1.3 ng/mL and 9.6 ng/mL, ranging from 38.6% and 59.8% when compared with the initial PSA value (p < 0.0001, clinical stage (p = 0.0002, tumor volume (p < 0.0001 and Gleason score (p = 0.0009. CONCLUSION: PSAV up to 2.5 ng/mL/year is associated with factors of good prognosis, such as initial PSA below 10 mg/mL, clinical stage T1, tumor volume below 20% and Gleason score lower than 7.

Clinical value of measurement of pulmonary radioaerosol mucociliary clearance in the work up of primary ciliary dyskinesia

DEFF Research Database (Denmark)

Munkholm, Mathias; Nielsen, Kim Gjerum; Mortensen, Jann

2015-01-01

BACKGROUND: We aimed to evaluate and define the general clinical applicability and impact of pulmonary radioaerosol mucociliary clearance (PRMC) on the work up of patients suspected of having primary ciliary dyskinesia (PCD). In addition, we wanted to evaluate the accuracy of the reference values...... primarily to results from nasal ciliary function testing, to electron microscopic (EM) examination of the ultrastructure of the cilia, and to the final clinical diagnosis. RESULTS: Of the 239 patients, 27 ended up with a final clinical diagnosis of definitive PCD. No patients with a PRMC test...... of the entire lung. Its greatest strength is its ability to reject a suspected PCD diagnosis with great certainty. In our material, this accounted for 2/3 of referred patients. In addition, the test has a high rate of conclusive results. According to our analyses, reference equations on children would benefit...

Chemical composition and nutritional value of the freezing consolidated burgers (Kilka–Silver carp during cold storage

Directory of Open Access Journals (Sweden)

S Fathi

2014-05-01

Full Text Available Consolidated fish burger is a new product which is a combination of common Kilka (Clupeonellacultriventriscaspia and Silver carp (Hypophthalmichthys molitrix minced with flavors, fillers, vegetables and tofu dressing. Consolidated fish burger is produced in order to boost the nutritional value and to reduce the cost of end product. This study aimed to investigate the variations in the composition of consolidated burger during 4 months of storage at -18 °C. For this purpose, 4 types of burgers with a combination of a various percentages of Kilka and Silver carp were produced. The chemical composition by means of total protein, fat, moisture and ash contents were evaluated during preparation (zero phase and 4 months of storage. Results showed that at zero-phase protein% and moisture% in raw Silver carp was higher, whereas fat% and ash% in Kilka was found higher. Protein content in all groups was decreased during 4 months of storage. The decreasing rate was more rapid in control group as well as treatment 3. Fat percentage was dropped during the storage period and the decreasing trend in treatment 2 was found higher. In the case of moisture, the percentage was declined in all groups and in treatment 1, in particular. Considering the results, it was concluded that freezing could significantly decrease the nutritional value of the consolidated Burgers.

Natural background levels and threshold values of chemical species in three large-scale groundwater bodies in Northern Italy

Energy Technology Data Exchange (ETDEWEB)

Molinari, Antonio, E-mail: ant.molinari2002@libero.it [Politecnico di Milano, Dipartimento di Ingegneria Idraulica, Ambientale, Infrastrutture Viarie e Rilevamento, Piazza L. Da Vinci, 32-20133 Milano (Italy); Guadagnini, Laura [Politecnico di Milano, Dipartimento di Ingegneria Idraulica, Ambientale, Infrastrutture Viarie e Rilevamento, Piazza L. Da Vinci, 32-20133 Milano (Italy); Marcaccio, Marco [ARPA Emilia-Romagna, Direzione Tecnica, Largo Caduti del Lavoro, 6-40122 Bologna (Italy); Guadagnini, Alberto [Politecnico di Milano, Dipartimento di Ingegneria Idraulica, Ambientale, Infrastrutture Viarie e Rilevamento, Piazza L. Da Vinci, 32-20133 Milano (Italy)

2012-05-15

We analyze natural background levels (NBLs) and threshold values (TVs) of spatially distributed chemical species (NH{sub 4}, B and As) which may be a potential pressure and concern in three large scale alluvial and fluvio-deltaic aquifers at different depths of the Apennines and Po river plains in Emilia-Romagna, Northern Italy. Our results are based on statistical methodologies designed to separate the natural and anthropogenic contributions in monitored concentrations by modeling the empirical distribution of the detected concentration with a mixture of probability density functions. Available chemical observations are taken over a 20 years period and are associated with different depths and cover planar investigation scales of the order of hundreds of kilometers. High concentration values detected for NH{sub 4} and B appear to be related to high natural background levels. Due to interaction with the host rock in different geochemical environments we observed that concentration vary in time and space (including in depth) consistently with the hydrogeochemical features and the occurrence of natural attenuation mechanisms in the analyzed reservoirs. Conversely, estimated As NBLs are not consistent with the conceptual model of the hydrogeochemical behavior of the systems analyzed and experimental evidences of As content in aquifer cores. This is due to the inability of these techniques to incorporate the complex dynamics of the processes associated with the specific hydrogeochemical setting. Statistical analyses performed upon aggregating the concentration data according to different time observation windows allow identifying temporal dynamics of NBLs and TVs of target compounds within the observation time frame. Our results highlight the benefit of a dynamic monitoring process and analysis of well demarcated groundwater bodies to update the associated NBLs as a function of the temporal dependence of natural processes occurring in the subsurface. Monitoring

Chemicals manufacture via biotechnology - the prospects for western Europe

Energy Technology Data Exchange (ETDEWEB)

Lewis, C.; Kristiansen, B.

1985-09-02

The trend of European chemical and biotechnological companies to move away from low value, high volume bulk chemicals towards the manufacture of high value, low volume, fine and speciality chemicals will continue into the 21st century. The manufacture of fine chemicals (principally antibiotics, biopesticides, enzymes and organic acids) and commodity chemicals (principally butanol and industrial ethanol) necessitates 1.5Mt and 2-3 Mt of carbohydrate feedstocks for their production. Thus it is vital that the Common Agricultural Policy does not interfere with the progress of the biotechnology industry by maintaining carbohydrate feedstock prices at their present high levels.

Clinical value of SPECT/CT imaging in the diagnosis of bone metastasis

International Nuclear Information System (INIS)

Wang Xinhua; Zhao Yanping; Lu Haijian; Dong Zhanfei

2010-01-01

Objective: To evaluate the clinical value of 99 Tc m -methylene diphosphonic acid (MDP) SPECT/CT imaging for the diagnosis of bone metastasis. Methods: Patients suspected for bone metastasis and with bone pain of unknown origin were included in this study (n=237). All cases underwent SPECT and CT imaging at 180 min after 99 Tc m -MDP injection. Diagnosis was confirmed by pathology (n=21), more than 2 kinds of radiologieal imaging (MRI, CT, X-ray) (n=106), and clinical follow up in 2 years (n=110). χ 2 -test was used to compare the results of planar and SPECT/CT imaging using SAS 6.12 software. Results: In 237 patients, planar imaging of 142 cases matched the final diagnosis in which 72 had benign lesions and 70 had bone metastases. The definite coincidence rate was 95.30% (142/149). SPECT/CT imaging of 224 cases matched the final diagnosis in which 104 had benign lesions and 120 cases diagnosed as bone metastases. The coincidence and definite coincidence rates were 94.51% (224/237), and 99.48% (192/193). Difference in the definite coincidence rate between planar and SPECT/CT imaging was statistically significant (χ 2 = 5.37, P=0.024). Conclusion: SPECT/CT imaging is valuable for accurate localization of osseous pathology and for improvement of diagnosing bone metastasis. (authors)

Scientific value of systematic reviews: survey of editors of core clinical journals.

Directory of Open Access Journals (Sweden)

Joerg J Meerpohl

Full Text Available BACKGROUND: Synthesizing research evidence using systematic and rigorous methods has become a key feature of evidence-based medicine and knowledge translation. Systematic reviews (SRs may or may not include a meta-analysis depending on the suitability of available data. They are often being criticised as 'secondary research' and denied the status of original research. Scientific journals play an important role in the publication process. How they appraise a given type of research influences the status of that research in the scientific community. We investigated the attitudes of editors of core clinical journals towards SRs and their value for publication. METHODS: We identified the 118 journals labelled as "core clinical journals" by the National Library of Medicine, USA in April 2009. The journals' editors were surveyed by email in 2009 and asked whether they considered SRs as original research projects; whether they published SRs; and for which section of the journal they would consider a SR manuscript. RESULTS: The editors of 65 journals (55% responded. Most respondents considered SRs to be original research (71% and almost all journals (93% published SRs. Several editors regarded the use of Cochrane methodology or a meta-analysis as quality criteria; for some respondents these criteria were premises for the consideration of SRs as original research. Journals placed SRs in various sections such as "Review" or "Feature article". Characterization of non-responding journals showed that about two thirds do publish systematic reviews. DISCUSSION: Currently, the editors of most core clinical journals consider SRs original research. Our findings are limited by a non-responder rate of 45%. Individual comments suggest that this is a grey area and attitudes differ widely. A debate about the definition of 'original research' in the context of SRs is warranted.

Clinical value of pre-operative embolization of maxillary artery for nasopharyngeal angiofibroma

International Nuclear Information System (INIS)

Zhu Wenke; Shan Hong; Zhu Kangshun; Jiang Zabo; Guan Shouhai; Huang Mingsheng; Li Zhengran; Shen Xinying

2004-01-01

Objective: To assess the clinical value of pre-operative embolization for nasopharyngeal angiofibroma. Methods: 13 patients with nasopharyngeal angiofibroma confirmed by surgery and biopsy were retrospectively analysed. Bilateral carotid artery angiography was performed for demonstration of the arterial supply of tumor. According to the size and different caliber of arteries, embolization were separately undertaken by different types of coil via 4.1 or 5F Head-Hunter catheter. The embolization efficacy, embolization was evaluated by amount of blood loss. Results: After coil embolization, no complication happened ranging 1-4 days (mean 2 days) in all 13 patients and then all the tumor masses were totally resected with mean blood loss of (584.6 ± 379.4) ml (range 250-1500 ml). Conclusions: Preoperative coils embolization is safe, reliable with less complication especially for reducing intraoperative blood loss and promoting the prognosis. (authors)

Hepatic fat quantification using automated six-point Dixon: Comparison with conventional chemical shift based sequences and computed tomography.

Science.gov (United States)

Shimizu, Kie; Namimoto, Tomohiro; Nakagawa, Masataka; Morita, Kosuke; Oda, Seitaro; Nakaura, Takeshi; Utsunomiya, Daisuke; Yamashita, Yasuyuki

To compare automated six-point Dixon (6-p-Dixon) MRI comparing with dual-echo chemical-shift-imaging (CSI) and CT for hepatic fat fraction in phantoms and clinical study. Phantoms and fifty-nine patients were examined both MRI and CT for quantitative fat measurements. In phantom study, linear regression between fat concentration and 6-p-Dixon showed good agreement. In clinical study, linear regression between 6-p-Dixon and dual-echo CSI showed good agreement. CT attenuation value was strongly correlated with 6-p-Dixon (R 2 =0.852; PDixon and dual-echo CSI were accurate correlation with CT attenuation value of liver parenchyma. 6-p-Dixon has the potential for automated hepatic fat quantification. Copyright © 2017 Elsevier Inc. All rights reserved.

Histological evaluation of the human testis--approaches to optimizing the clinical value of the assessment

DEFF Research Database (Denmark)

McLachlan, R I; Rajpert-De Meyts, E; Hoei-Hansen, C E

2007-01-01

on genotype-phenotype relationships. The rising incidence of testis cancer and carcinoma in situ (CIS), especially in infertile populations, requires that every effort be made for its early detection. We provide a systematic approach to the histological classification of spermatogenic disorders and detection...... within the hypospermatogenesis classification, that helps account for reported success of TESE. We propose a new diagnosis code for testicular biopsies that addresses the needs of ART clinicians and allows data storage and retrieval of value in clinical practice and research....

The diagnostic value of the fibrinogen/fibrin fragment E antigen assay in clinically suspected deep vein thrombosis

International Nuclear Information System (INIS)

Zielinsky, A.; Hirsh, J.; Straumanis, G.; Carter, C.J.; Gent, M.; Sackett, D.L.; Hull, R.; Kelton, J.G.; Powers, P.; Turpie, A.G.

1982-01-01

We have evaluated the fibrinogen/fibrin fragment E antigen assay as a diagnostic test in patients with clinically suspected venous thrombosis by comparing the results of this assay with venography in 272 patients. The result of the fragment E antigen assay was elevated in 79 of 80 patients with positive venograms for recent venous thrombosis (sensitivity 99%) and within the normal range in 161 of 192 patients with normal venograms (specificity 84%). The fragment E assay was also evaluated in 130 medical and surgical controls without evidence of venous thrombosis by leg scanning and the test was found to be relatively nonspecific. However, in the patient group under study, a correct clinical diagnosis of no thrombosis, based on a normal fragment E result, was made in 161 of 162 cases (negative predictive value of 99%). Therefore, a normal test result effectively excludes a diagnosis of venous thrombosis in clinically symptomatic patients. The assay, as currently performed, is technically demanding and takes 24 hr to complete. Therefore, it will have to be simplified before it can be applied to clinical practice

The diagnostic value of the fibrinogen/fibrin fragment E antigen assay in clinically suspected deep vein thrombosis

International Nuclear Information System (INIS)

Zielinsky, A.; Hirsh, J.; Straumanis, G.; Carter, C.J.; Gent, M.; Sackett, D.L.; Hull, R.; Kelton, J.G.; Powers, P.

1982-01-01

We have evaluated the fibrinogen/fibrin fragment E antigen assay as a diagnostic test in patients with clinically suspected venous thrombosis by comparing the results of this assay with venography in 272 patients. The result of the fragment E antigen assay was elevated in 79 of 80 patients with positive venograms for recent venous thrombosis (sensitivity 99%) and within the normal range in 161 of 192 patients with normal venograms (specificity 84%). The fragment E assay was also evaluated in 130 medical and surgical controls without evidence of venous thrombosis by leg scanning and the test was found to be relatively nonspecific. However, in the patient group under study, a correct clinical diagnosis of no thrombosis, based on a normal fragment E result, was made in 161 of 162 cases (negative predictive value 99%). Therefore, a normal test result effectively excludes a diagnosis of venous thrombosis in clinically symptomatic patients. The assay, as currently performed, is technically demanding and takes 24 hr to complete. Therefore, it will have to be simplified before it can be applied to clinical practice

Experimental determination of the bulk temperature values in a nonisothermal flow of the chemically reacting nitrogen tetroxide

International Nuclear Information System (INIS)

Devojno, A.N.; Kolykhan, L.I.; Stepanenko, V.N.; Tverkovkin, B.E.; Uyutov, G.I.

1975-01-01

The technique and results of an experimental determination of mean mass temperatures of a cooled chemically active nitrogen tetroxide flowing in a circular tube under turbulent flow conditions are considered. The parameters range as follows: pressure-from 8.10 5 to 16.10 5 H/m 2 , flow temperature-from 140 deg to 550 deg C, Reynolds number-from 3,1.1g 5 , flow velocity-from 3.5 to 45 m/s. The gas temperature along the length of the test tube is measured with movable probe with a mixer and thermocouple in a stainless steel capillary 2mm in dia and the wall 0,2 mm thick. The mean-square deviations of measured temperature values from the predicted ones are about -0.9 and +1.8%. The obtained data show the predicted temperature values to be somewhat lower than the measured ones, the difference increasing with the distance to the test tube outlet. It may be explained by both unaccounted systematic experimental errors and errors in calculating the mean mass flow temperatures. The investigation described confirms the possibility of an experimental determination of the mean gas temperature along the cooled channel length by mean mass of a movable mixer with a single thermocouple

Survival and cardiovascular events after coarctation-repair in long-term follow-up (COAFU): Predictive value of clinical variables.

Science.gov (United States)

Bambul Heck, P; Pabst von Ohain, J; Kaemmerer, H; Ewert, P; Hager, A

2017-02-01

Long-term sequelae and events after coarctation repair are well described. However, the predictive value of variables from clinical follow-up investigation for late events and survival has rarely been investigated. All patients who participated in the prospective cross-sectional COALA Study in 2000 with a structural clinical investigation including blood pressure measurement and symptom-limited exercise test were contacted for reevaluation of survival, current clinical status and major cardiovascular events. Of 273 eligible patients, 209 were available for follow-up. Nine patients had died at a median age of 46years (range 30-64years), five of them due to cardiovascular complications. Late mortality after surgical intervention was 5.7% with a median age of 41years (range 16-64years). Twenty-five patients had a major cardiovascular event: 12 had procedures at the aortic valve or aortic arch, 8 had procedures for restenosis, 2 had endocarditis, 2 had a cerebrovascular insult and 1 an aortic dissection. The presence of bicuspid aortic valve (p=0.009), brachial-ankle blood pressure gradient >20mmHg (p<0.001) and reduced left ventricular function (p=0.002) correlated with major cardiovascular events. Surgical correction of coarctation of the aorta shows fairly low mortality in the long-term follow-up. Late morbidities include recoarctation, but also the consequences of the hemodynamics produced by a congenital bicuspid aortic valve, presence of which is predictive for aortic valve procedures: however the predictive value of clinical variables is limited. Copyright © 2016. Published by Elsevier Ireland Ltd.

Diagnostic and prognostic value of asphyxia, Sarnat's clinical classification, and CT-scan in perinatal brain damage

Energy Technology Data Exchange (ETDEWEB)

Kubo, Toshihide; Wakita, Yoshiharu; Kubonishi, Sakae; Yoshikawa, Seishi (Kochi Prefectural Central Hospital (Japan)); Ito, Toshiyuki; Okada, Yasusuke

1990-11-01

A retrospective review was made of 145 babies, excluding those with congenital heart disease or chromosome aberration, admitted for CT scanning. The study was done to determine the diagnostic and prognostic value of CT findings, as well as the presence of asphyxia and the clinical stage based on the Sarnat's classification, in perinatal brain damage. The patients had a minimum follow up of 2 years for the evaluation of neurologic manifestations, such as cerebral palsy, epilepsy and mental retardation. Among babies weighing 2,000 g or more at birth, neonatal asphyxia was significantly correlated with neurologic prognosis. In addition, both clinical stages and CT findings were significantly correlated with neurologic prognosis, irrespective of birth weight. The correlation between clinical stages and CT findings was significant, irrespective of body weight, however, a significant correlation between clinical stages and neonatal asphyxia was restricted to those weighing 2,000 g or more. These findings suggest that the presence of asphyxia, clinical stages and CT findings are complementary in the diagnosis and prognosis evaluation of perinatal brain damage. (N.K.).

A case of chemical pneumonia

Energy Technology Data Exchange (ETDEWEB)

Lee, Sung Woo; Eun, Choung Ki; Choi, Byung Soo; Park, Soo Sung [Chungang University School of Medicine, Seoul (Korea, Republic of)

1974-10-15

A case of chemical pneumonia due to the fumes of nitric acid and chemical compounds was encountered, and it is reported with a review of the literatures. A 19 year old Korean male working in an electric materials manufacturing factory of poor facilities dealing with chemical compounds showed initial symptoms closely similar to those of pulmonary tuberculosis of hematogenous disseminating type, and a roentgenogram was hardly helpful for differentiating chemical pneumonia from pulmonary tuberculous of hematogenous disseminating type. The clinical course in this case was very favourable as compared with those of pulmonary tuberculosis and bacterial pneumonia.

A case of chemical pneumonia

International Nuclear Information System (INIS)

Lee, Sung Woo; Eun, Choung Ki; Choi, Byung Soo; Park, Soo Sung

1974-01-01

A case of chemical pneumonia due to the fumes of nitric acid and chemical compounds was encountered, and it is reported with a review of the literatures. A 19 year old Korean male working in an electric materials manufacturing factory of poor facilities dealing with chemical compounds showed initial symptoms closely similar to those of pulmonary tuberculosis of hematogenous disseminating type, and a roentgenogram was hardly helpful for differentiating chemical pneumonia from pulmonary tuberculous of hematogenous disseminating type. The clinical course in this case was very favourable as compared with those of pulmonary tuberculosis and bacterial pneumonia

Value Set Authority Center

Data.gov (United States)

U.S. Department of Health & Human Services — The VSAC provides downloadable access to all official versions of vocabulary value sets contained in the 2014 Clinical Quality Measures (CQMs). Each value set...

Urine storage under refrigeration preserves the sample in chemical, cellularity and bacteriuria analysis of ACS

OpenAIRE

Karen Cristina Barcellos Ribeiro; Bruno Rotondo Levenhagem Serabion; Eduardo Lima Nolasco; Chislene Pereira Vanelli; Harleson Lopes de Mesquita; José Otávio do Amaral Corrêa

2013-01-01

INTRODUCTION: The analysis of urine abnormal constituents and sediment (ACS) comprises tests of great diagnostic and prognostic value in clinical practice. When the analysis of ACS cannot be performed within two hours after collection, the sample must be preserved in order to avoid pre-analytical interferences. Refrigeration is the most applied technique due to its cost effectiveness. Moreover, it presents fewer inconveniences when compared to chemical preservation. However, changes in ACS ma...

Clinical value of Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

Energy Technology Data Exchange (ETDEWEB)

Urbain, D.; Reding, P.; Georges, B.; Thys, O.; Ham, H.R.

1986-09-01

The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death.

The perceived value of clinical pharmacy service provision by pharmacists and physicians: an initial assessment of family medicine and internal medicine providers.

Science.gov (United States)

Wietholter, Jon P; Ponte, Charles D; Long, Dustin M

2017-10-01

Few publications have addressed the perceptions of pharmacists and physicians regarding the value of clinical pharmacist services. A survey-based study was conducted to determine whether Internal Medicine (IM) and Family Medicine (FM) pharmacists and physicians differed in their attitudes regarding the benefits of collaboration in an acute care setting. The primary objective was to evaluate perceived differences regarding self-assessment of value between IM and FM pharmacists. The secondary objective was to evaluate perceived differences of clinical pharmacist benefit between IM and FM physicians. An eight-item questionnaire assessed the attitudes and beliefs of pharmacists and physicians regarding the value of clinical pharmacy services. Surveys were emailed and participants marked their responses using a 7-point Likert scale for each item. Demographic data and overall comments were collected from each participant. Overall, 167 surveys were completed. When comparing cumulative physician and pharmacist responses, none of the eight questions showed significant differences. Statistically significant differences were noted when comparing IM and FM clinical pharmacists on five of the eight survey items; for each of these items, FM pharmacists had more favourable perceptions than their IM counterparts. No statistically significant differences were noted when comparing responses of IM and FM physicians. This study found that FM pharmacists perceived a greater benefit regarding participation in inpatient acute care rounds when compared to their IM pharmacist counterparts. Future studies are necessary to determine if other medical specialties' perceptions of clinical pharmacy provision differ from our findings and to evaluate the rationale behind specific attitudes and behaviours. © 2016 Royal Pharmaceutical Society.

Economics evaluation for on-site pyrolysis of kraft lignin to value-added chemicals.

Science.gov (United States)

Farag, Sherif; Chaouki, Jamal

2015-01-01

This work is part of a series of investigations on pyrolysis of lignin. After obtaining the necessary information regarding the quantity and quality of the obtained products, a first step economics evaluation for converting lignin into chemicals was essential. To accomplish this aim, a pyrolysis plant with a 50t/d capacity was designed, and the total capital investment and operating costs were estimated. Next, the minimal selling price of the obtained dry oil was calculated and the effect of crucial variables on the estimated price was examined. The key result indicates the estimated selling price would not compete with the price of the chemicals that are fossil fuel based, which is primarily due to the high cost of the feedstock. To overcome this challenge, different scenarios for reducing the selling price of the obtained oil, which consequently is helping by taking a place among the fossil fuel based chemicals, were discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinical utility of high b-value diffusion-weighted magnetic resonance imaging in post-resuscitative encephalopathy

International Nuclear Information System (INIS)

Kano, Hitoshi; Danjou, Wataru; Yamazaki, Kei

2002-01-01

It is very important to estimate brain functional capacity immediately after successful cardiopulmonary resuscitation (CPR) to determine subsequent treatment strategy and to elucidate the pathophysiology of patients with post-resuscitative encephalopathy. However, computed tomography scanning, electric encephalography and conventional magnetic resonance imaging do not contribute significantly to the assessment of brain functions immediately after CPR. Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) has been applied to the patients with post-resuscitative encephalopathy. However, no papers have described serial clinical and repeated DW-MRI studies of patients during the acute phase of post-resuscitative encephalopathy. Moreover, in some cases, high signal intensity in the cortex after CPR is indistinguishable from normal cortex. Thus, we tried to apply high b-value DW-MRI to estimate the brain function of patients with post-resuscitative encephalopathy. This study was performed on 11 patients with post-resuscitative encephalopathy and 5 healthy volunteers as controls. DW-MRI was performed using GYROSCAN 1.5 Tesla MR imager (Philips) with single-shot echo-planner imaging sequences performed 3 times, first within 24 hours after CPR, second between day 3 to 6, and third more than 7 days after CPR. And we tested the usefulness of DW-MRI at 800, 1000, 1500, 2000 and 3000 in b value. Five patients survived, one fully recovered and four remained in a vegetative state. The other six died with clinical brain death. The first DW-MRI revealed in high signal intensity in the frontal and the parietal lobes in all patients who eventually progressed to a vegetative state or brain death. This result was much more wide-spread in the latter patients, while it was never seen in the patients who recovered fully. The high signal intensity areas increased in follow-up DW-MRI studies. The signal intensity remained high in some parts, while it decreased in other parts with

Clinical utility of high b-value diffusion-weighted magnetic resonance imaging in post-resuscitative encephalopathy

Energy Technology Data Exchange (ETDEWEB)

Kano, Hitoshi; Danjou, Wataru; Yamazaki, Kei [Sapporo City General Hospital (Japan)] (and others)

2002-03-01

It is very important to estimate brain functional capacity immediately after successful cardiopulmonary resuscitation (CPR) to determine subsequent treatment strategy and to elucidate the pathophysiology of patients with post-resuscitative encephalopathy. However, computed tomography scanning, electric encephalography and conventional magnetic resonance imaging do not contribute significantly to the assessment of brain functions immediately after CPR. Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) has been applied to the patients with post-resuscitative encephalopathy. However, no papers have described serial clinical and repeated DW-MRI studies of patients during the acute phase of post-resuscitative encephalopathy. Moreover, in some cases, high signal intensity in the cortex after CPR is indistinguishable from normal cortex. Thus, we tried to apply high b-value DW-MRI to estimate the brain function of patients with post-resuscitative encephalopathy. This study was performed on 11 patients with post-resuscitative encephalopathy and 5 healthy volunteers as controls. DW-MRI was performed using GYROSCAN 1.5 Tesla MR imager (Philips) with single-shot echo-planner imaging sequences performed 3 times, first within 24 hours after CPR, second between day 3 to 6, and third more than 7 days after CPR. And we tested the usefulness of DW-MRI at 800, 1000, 1500, 2000 and 3000 in b value. Five patients survived, one fully recovered and four remained in a vegetative state. The other six died with clinical brain death. The first DW-MRI revealed in high signal intensity in the frontal and the parietal lobes in all patients who eventually progressed to a vegetative state or brain death. This result was much more wide-spread in the latter patients, while it was never seen in the patients who recovered fully. The high signal intensity areas increased in follow-up DW-MRI studies. The signal intensity remained high in some parts, while it decreased in other parts with

Clinical value of FDG hybrid-PET in staging and restaging of malignant lymphoma. Compared with conventional diagnostic methods

International Nuclear Information System (INIS)

Pichler, R.; Maschek, W.; Hatzl-Griesenhofer, M.; Huber, H.; Wimmer, G.; Wahl, G.; Fridrik, M.

2000-01-01

Aim of the present retrospective study was to validate the clinical value of F-18-FDG PET imaging in lymphoma patients with a dual head camera modified for coincidence detection. Staging before and after oncological treatment was compared with a conservative diagnostic approach. Methods: 48 patients (28 non-Hodgkin lymphoma, 20 Hodgkin's disease) received FDG-Hybrid-PET scans. Pretherapeutic staging was realized in 28 patients, 9 of them had control studies after they had completed therapy. Totally 29 persons were examined for posttherapeutic restaging. Computed tomography imaging and lymph node sonography was performed in all cases. Results were validated by clinical follow-up, in three cases a recidive was proven by biopsy. Results: CT and ultrasound detected 77 lesions in 28 patients compared with 100 visualized by PET, but this difference in pretherapeutic staging did not reach significance at p>0.05 by Fisher's t-test. Hybrid-PET obtained a sensitivity of 93%, a specifity of 79%, a positive of 82% and a negative predictive value of 92% for detection of residual disease. The values for CT+US were 87%, 64%, 72% and 88% respectively. Conclusion: FDG Hybrid-PET is as or even more accurate than standard morphologic diagnostic methods for prestaging in malignant lymphoma. Additionally, there is a substancial benefit for therapy monitoring of residual disease using coincidence detection PET with a 3/4-inch crystal gamma camera. (orig.) [de

Value-driven ERM: making ERM an engine for simultaneous value creation and value protection.

Science.gov (United States)

Celona, John; Driver, Jeffrey; Hall, Edward

2011-01-01

Enterprise risk management (ERM) began as an effort to integrate the historically disparate silos of risk management in organizations. More recently, as recognition has grown of the need to cover the upside risks in value creation (financial and otherwise), organizations and practitioners have been searching for the means to do this. Existing tools such as heat maps and risk registers are not adequate for this task. Instead, a conceptually new value-driven framework is needed to realize the promise of enterprise-wide coverage of all risks, for both value protection and value creation. The methodology of decision analysis provides the means of capturing systemic, correlated, and value-creation risks on the same basis as value protection risks and has been integrated into the value-driven approach to ERM described in this article. Stanford Hospital and Clinics Risk Consulting and Strategic Decisions Group have been working to apply this value-driven ERM at Stanford University Medical Center. © 2011 American Society for Healthcare Risk Management of the American Hospital Association.

[The clinical value of urinary antigen detection of Legionella pneumonia].

Science.gov (United States)

Jiang, Luxi; Chen, Yu; Xia, Shuyue; Ma, Jiangwei; Zhao, Hongwen; Lu, Ye; Tao, Sixu; Zhao, Li

2015-01-01

To investigate the clinical value of urinary antigen detection of Legionella, and to describe the clinical characteristics of Legionella pneumonia. Patients with suspected Legionella pneumonia were enrolled from the Respiratory departments of 3 tertiary hospitals in Shenyang during May 2011 to November 2013. Urinary Legionella antigen was detected for all the enrolled patients. Bacterial culture, polymerase chain reaction (PCR) for Legionella, and double Legionella antibody detection in sera were performed for each patient whose urinary antigen was positive. Patients confirmed to have Legionella pneumonia were pooled and analyzed. Totally 13 cases presenting with pneumonia were positive for Legionella by the urinary antigen method, and in one of them Legionella strain was isolated from the secretion of lower respiratory tract. PCR detection was performed in 8 patients, and 4 of them were positive. Legionella antibody detection was performed in 12 patients, and 7 of them were positive. Nine patients had a history of exposure to Legionella high-risk environments. The characteristics of the cases with Legionella pneumonia were as follows: characteristic orange sputum in 4 patients, digestive symptoms in 6, neurologic disorders in 8, hyponatremia in 10, hypoxia with oxygenation index 130) in 8 patients . Chest CT scan showed bilateral involvement in 6, ground-glass opacity combined with consolidation in 11, and moderate pleural effusion in 11 patients. Cavity and reversed halo sign were found in one case, respectively. All of the patients received fluoroquinolone treatment, and 11 patients recovered completely while 2 died of multiple organ dysfunction syndrome, one of them was complicated with secondary infection. Detection of urinary antigen of Legionella is very useful in the diagnosis of Legionella pneumonia. Attention should be paid to exposure history to the high-risk environments and multiple organ impairment when Legionella infection is suspected. Orange sputum

Chemical sensitivity: pathophysiology or pathopsychology?

Science.gov (United States)

Genuis, Stephen J

2013-05-01

Escalating numbers of people throughout the world are presenting to primary care physicians, allergists, and immunologists with myriad clinical symptoms after low-level exposure to assorted everyday chemicals such as smoke, perfumes, air fresheners, paints, glues, and other products. This clinical state is referred to by various diagnostic labels, including multiple chemical sensitivity disorder, environmental intolerance, chemical sensitivity (CS), and sensitivity-related illness, and has been the subject of much controversy within the health care community. The goal of this study was to provide a brief overview of the etiology, pathogenesis, clinical presentation, and management of CS. An evaluation of the medical community's response to this emerging diagnosis was also explored. This review was prepared by assessing available medical and scientific literature from MEDLINE, as well as by reviewing numerous books, toxicology journals, conference proceedings, government publications, and environmental health periodicals. A primary observation, however, is that there is limited scientific literature available on the issue of CS. The format of a traditional integrated review was chosen because such reviews play a pivotal role in scientific research and professional practice in medical issues with limited primary study and uncharted clinical territory. The sensitization state of CS seems to be initiated by a significant toxic exposure, occurring as a 1-time event, or on surpassing a threshold of toxicity after toxicant accrual from repeated lower-level exposures. Once sensitized through a toxicant-induced loss of tolerance, individuals exposed to inciting triggers such as minute amounts of diverse everyday chemicals may experience various clinical and immune sequelae, sometimes involving lymphocyte, antibody, or cytokine responses. Precautionary avoidance of inciting triggers will prevent symptoms, and desensitization immunotherapy or immune suppression may improve

Added Diagnostic Value of 11C-PiB-PET in Memory Clinic Patients with Uncertain Diagnosis

Directory of Open Access Journals (Sweden)

K.S. Frederiksen

2012-12-01

Full Text Available Introduction: The added diagnostic value of 11C-PiB-PET for the assessment of the accumulation of cortical beta-amyloid in memory clinic patients with uncertain diagnosis remains undetermined. Methods: All patients who underwent PiB-PET at the Copenhagen Memory Clinic between March 2008 and November 2011 were included in this uncontrolled, retrospective study. The standard diagnostic evaluation program included physical and neurological examination, cognitive and functional assessment, a cranial CT or MRI, functional imaging and cerebrospinal fluid sampling. Based on anonymized case reports, three experienced clinicians reached a consensus diagnosis and rated their confidence in the diagnosis before and after disclosure of PiB-PET ratings. PiB-PET scans were rated as either positive or negative. Results: A total of 57 patients (17 females, 30 males; age 65.7 years, range 44.2–82.6 were included in the study. Twenty-seven had a positive PiB-PET scan. At the first diagnostic evaluation, 16 patients were given a clinical Alheimer’s disease diagnosis (14 PiB positive. Of the 57 patients, 13 (23% were diagnostically reclassified after PiB-PET ratings were disclosed. The clinicians’ overall confidence in their diagnosis increased in 28 (49% patients. Conclusion: PiB-PET adds to the specialist clinical evaluation and other supplemental diagnostic investigations in the diagnostic classification of patients with uncertain diagnosis in a specialized memory clinic.

Chemical Industry Waste water Treatment

International Nuclear Information System (INIS)

Nasr, F.A.; Doma, H.S.; El-Shafai, S.A.; Abdel-HaJim, H.S.

2004-01-01

Treatment of chemical industrial wastewater from building and construction chemicals factory and plastic shoes manufacturing factory was investigated. The two factories discharge their wastewater into the public sewerage network. The results showed the wastewater discharged from the building and construction chemicals factory was highly contaminated with organic compounds. The average values of COD and BOD were 2912 and 150 mg O 2 /l. Phenol concentration up to 0.3 mg/l was detected. Chemical treatment using lime aided with ferric chloride proved to be effective and produced an effluent characteristics in compliance with Egyptian permissible limits. With respect to the other factory, industrial wastewater was mixed with domestic wastewater in order to lower the organic load. The COD, BOD values after mixing reached 5239 and 2615 mg O 2 /l. The average concentration of phenol was 0.5 mg/l. Biological treatment using activated sludge or rotating biological contactor (RBe) proved to be an effective treatment system in terms of producing an effluent characteristic within the permissible limits set by the law

Study on clinical value of determination of plasma brain natriuretic peptide levels in patients with chronic congestive heart failure

International Nuclear Information System (INIS)

Chen Jianxiong; Li Zhuocheng; Tu Hong

2010-01-01

Objective: To evaluate the clinical value of determination of plasma brain natriuretic peptide (BNP) levels in patients with chronic congestive heart failure(CHF). Methods: The levels of plasma BNP were measured with fluorescence immunoassay in 341 patients with chronic CHF and 55 controls. Left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) were determined with color doppler ultrasonography in CHF patients. Results: Plasma levels of BNP were significantly increased in patients with CHF as compared with those in controls (P<0.01). There were also significant differences in plasma levels of CHF patients of different clinical stages (P<0.01). There was obvious correlation between plasma levels of BNP and the values of LVEF, LVESD and LVEDD (r was-0.62, +0.54 and +0.60 respectively, P<0.01). Conclusion: Plasma level of BNP is a sensitive indicator for assessment of ventricle function in CHF patients. (authors)

Clinically healthy overweight and obese dogs differ from lean controls in select CBC and serum biochemistry values.

Science.gov (United States)

Radakovich, Lauren B; Truelove, Matthew P; Pannone, Stephen C; Olver, Christine S; Santangelo, Kelly S

2017-06-01

Obesity is a global disease, affecting nearly half a billion people. Unfortunately, this trend is mirrored in our canine population. As obesity is a complex inflammatory disease, there is a need to determine whether routine medical screening tests may indicate, or be influenced by, its presence. The objective of the current study was to determine if significant differences exist between CBC and biochemical profile values from control vs overweight/obese, client-owned dogs considered clinically healthy. Dogs presented for routine health examinations, including minor dental or elective surgical procedures, were retrospectively identified from a hospital population. Animals were allocated to 2 categories based on body condition score (BCS), and data were analyzed by Mann-Whitney nonparametric analysis with statistical significance at a P ≤ .05. After exclusions, 116 dogs were assigned to the overweight/obese group (BCS ≥ 7) and 240 dogs to the control group (BCS = 4-6). Overweight/obese dogs had higher total leukocyte counts and higher plasma protein and globulin concentrations. Other differences were attributed to decreased serum water fraction (increased sodium, albumin, calcium, and anion gap) in the overweight/obese group. Interestingly, chloride concentration was decreased (in the face of increased sodium) in the obese group. There is CBC and biochemical evidence to support the concern that obesity influences laboratory values, even in dogs considered clinically healthy. Prospective studies aimed at characterizing these changes are needed to provide insight into the connection between obesity and its comorbidities. © 2017 American Society for Veterinary Clinical Pathology.

Chemical analysis of high purity graphite

International Nuclear Information System (INIS)

1993-03-01

The Sub-Committee on Chemical Analysis of Graphite was organized in April 1989, under the Committee on Chemical Analysis of Nuclear Fuels and Reactor Materials, JAERI. The Sub-Committee carried out collaborative analyses among eleven participating laboratories for the certification of the Certified Reference Materials (CRMs), JAERI-G5 and G6, after developing and evaluating analytical methods during the period of September 1989 to March 1992. The certified values were given for ash, boron and silicon in the CRM based on the collaborative analysis. The values for ten elements (Al, Ca, Cr, Fe, Mg, Mo, Ni, Sr, Ti, V) were not certified, but given for information. Preparation, homogeneity testing and chemical analyses for certification of reference materials were described in this paper. (author) 52 refs

Clinical value of patient-specific three-dimensional printing of congenital heart disease: Quantitative and qualitative assessments

Science.gov (United States)

Lau, Ivan Wen Wen; Liu, Dongting; Xu, Lei; Fan, Zhanming

2018-01-01

Objective Current diagnostic assessment tools remain suboptimal in demonstrating complex morphology of congenital heart disease (CHD). This limitation has posed several challenges in preoperative planning, communication in medical practice, and medical education. This study aims to investigate the dimensional accuracy and the clinical value of 3D printed model of CHD in the above three areas. Methods Using cardiac computed tomography angiography (CCTA) data, a patient-specific 3D model of a 20-month-old boy with double outlet right ventricle was printed in Tango Plus material. Pearson correlation coefficient was used to evaluate correlation of the quantitative measurements taken at analogous anatomical locations between the CCTA images pre- and post-3D printing. Qualitative analysis was conducted by distributing surveys to six health professionals (two radiologists, two cardiologists and two cardiac surgeons) and three medical academics to assess the clinical value of the 3D printed model in these three areas. Results Excellent correlation (r = 0.99) was noted in the measurements between CCTA and 3D printed model, with a mean difference of 0.23 mm. Four out of six health professionals found the model to be useful in facilitating preoperative planning, while all of them thought that the model would be invaluable in enhancing patient-doctor communication. All three medical academics found the model to be helpful in teaching, and thought that the students will be able to learn the pathology quicker with better understanding. Conclusion The complex cardiac anatomy can be accurately replicated in flexible material using 3D printing technology. 3D printed heart models could serve as an excellent tool in facilitating preoperative planning, communication in medical practice, and medical education, although further studies with inclusion of more clinical cases are needed. PMID:29561912

The clinical value of pulmonary perfusion imaging complicated with pulmonary embolism in children of nephrotic syndrome

International Nuclear Information System (INIS)

Lin Jun; Chen Ning; Miao Weibing; Peng Jiequan; Jiang Zhihong; Wu Jing

2001-01-01

To investigate the clinical features of complicated with pulmonary embolism nephrotic syndrome in children. 99m Tc-MAA pulmonary perfusion imaging was performed on 30 nephrotic syndrome in children with elevated plasma D-dimer. Results shown that 14 of 30 patients were found to have pulmonary embolism (46.7%). Pulmonary perfusion imaging showed an involvement of 1 pulmonary segment in 3 cases, 2 segments in 2 cases and over 3 segments in other 9 cases. Among them, there were 7 segments involved in one case. After two weeks of heparin anti-coagulative therapy, most cases showed a recovery. The result of this study suggested that pulmonary embolism is a common complication of nephrotic syndrome. Pulmonary perfusion imaging is simple, effective and accurate method for the diagnosis of pulmonary embolism, and it also can help to assess the value of clinical therapy

Medical device innovation and the value analysis process.

Science.gov (United States)

Krantz, Heidi; Strain, Barbara; Torzewski, Jane

2017-09-01

Heidi A. Krantz, RN, BSN is the Director of Value Analysis at Johns Hopkins Bayview Medical Center in the Johns Hopkins Health System. Barbara Strain, MA, CVAHP is the Director of Value Management at the University of Virginia Health System. Jane Torzewski RN, MAN, MBA is a Senior Category Manager for the Mayo Clinic Physician Preference Contracting team. She previously was a Senior Clinical Value Analyst on the Mayo Clinic Value Analysis team. Copyright © 2018. Published by Elsevier Inc.

Is a comparative clinical trial for breast cancer tumor markers to monitor disease recurrence warranted? A value of information analysis.

Science.gov (United States)

Thariani, Rahber; Henry, Norah Lynn; Ramsey, Scott D; Blough, David K; Barlow, Bill; Gralow, Julie R; Veenstra, David L

2013-05-01

Breast cancer tumor markers are used by some clinicians to screen for disease recurrence risk. Since there is limited evidence of benefit, additional research may be warranted. To assess the potential value of a randomized clinical trial of breast tumor marker testing in routine follow-up of high-risk, stage II-III breast cancer survivors. We developed a decision-analytic model of tumor marker testing plus standard surveillance every 3-6 months for 5 years. The expected value of sample information was calculated using probabilistic simulations and was a function of: the probability of selecting the optimal monitoring strategy with current versus future information; the impact of choosing the nonoptimal strategy; and the size of the population affected. The value of information for a randomized clinical trial involving 9000 women was US$214 million compared with a cost of US$30-60 million to conduct such a trial. The probability of making an alternate, nonoptimal decision and choosing testing versus no testing was 32% with current versus future information from the trial. The impact of a nonoptimal decision was US$2150 and size of population impacted over 10 years was 308,000. The value of improved information on overall survival was US$105 million, quality of life US$37 million and test performance US$71 million. Conducting a randomized clinical trial of breast cancer tumor markers appears to offer a good societal return on investment. Retrospective analyses to assess test performance and evaluation of patient quality of life using tumor markers may also offer valuable areas of research. However, alternative investments may offer even better returns in investments and, as such, the trial concept deserves further study as part of an overall research-portfolio evaluation.

Feasibility of using 'lung density' values estimated from EIT images for clinical diagnosis of lung abnormalities in mechanically ventilated ICU patients.

Science.gov (United States)

Nebuya, Satoru; Koike, Tomotaka; Imai, Hiroshi; Iwashita, Yoshiaki; Brown, Brian H; Soma, Kazui

2015-06-01

This paper reports on the results of a study which compares lung density values obtained from electrical impedance tomography (EIT), clinical diagnosis and CT values (HU) within a region of interest in the lung. The purpose was to assess the clinical use of lung density estimation using EIT data. In 11 patients supported by a mechanical ventilator, the consistency of regional lung density measurements as estimated by EIT was validated to assess the feasibility of its use in intensive care medicine. There were significant differences in regional lung densities recorded in the supine position between normal lungs and diseased lungs associated with pneumonia, atelectasis and pleural effusion (normal; 240 ± 71.7 kg m(-3), pneumonia; 306 ± 38.6 kg m(-3), atelectasis; 497 ± 130 kg m(-3), pleural effusion; 467 ± 113 kg m(-3): Steel-Dwass test, p EIT images. The results of CT and EIT images from five patients in an intensive care unit showed a correlation coefficient of 0.66 ± 0.13 between the CT values (HU) and the lung density values (kg m(-3)) obtained from EIT. These results indicate that it may be possible to obtain a quantitative value for regional lung density using EIT.

Pipelines for New Chemicals: a strategy to create new value chains and stimulate innovation-based economic revival in Southern European countries.

Science.gov (United States)

Timmis, Kenneth; de Lorenzo, Victor; Verstraete, Willy; Garcia, Jose Luis; Ramos, Juan Luis; Santos, Helena; Economidis, Ioannis; Nogales, Balbina; Timmis, James Kenneth; Fonseca, César; Pruzzo, Carla; Karagouni, Amalia; Panopoulos, Nickolas; Dixon, Bernard

2014-01-01

Countries of Southern Europe are currently suffering from severe socio-economic pain resulting from high debt levels and austerity measures which constrain investment in innovation-based recovery strategies that are essential for entry into a long-term sustainable period of increasing employment and wealth creation. Young university-educated people are particularly innovative, and hence vital to the development of such strategies, but employment opportunities are poor and many are forced to seek employment that neither profits from their training nor satisfies their justified career expectations, or to emigrate. They are the 'lost generation'. A strategy is proposed here for the creation of Pipelines for New Chemicals, national centre-network partnerships for the discovery-synthesis of new chemicals obtained though harvesting new biological diversity, and their exploitation to develop new medicines, agrochemicals, materials, and other products and applications. The goal is to create new regional motors of economic growth and development, by harnessing the knowledge, motivation and innovation potential of the excellently educated young people of Europe to catalyse the development of new small, medium and large enterprises centred around novel chemicals, and the value chains that will evolve with them, and thereby develop a powerful sector of sustainable growth in employment and social and economic prosperity in Southern Europe. © 2014 Society for Applied Microbiology and John Wiley & Sons Ltd.

The η/s of hadrons out of chemical equilibrium

International Nuclear Information System (INIS)

Wiranata, A; Wang, X N; Prakash, M; Huovinen, P; Koch, V

2014-01-01

We study how the shear viscosity, η, entropy density, s, and η/s depend on growing hadron chemical potentials resulting from the loss of chemical equilibrium during the evolution of a relativistic heavy-ion collision. Our calculations here are for an interacting pion gas in a system of net baryon number zero. Time evolution of the temperature and pion chemical potential are taken from ideal fluid hydrodynamic calculations of RHIC and LHC collisions. We find that the shear viscosity decreases whereas the entropy density increases with increasing pion chemical potential resulting in values of η/s that are slightly reduced from the case of chemical potentials being zero when chemical equilibrium prevails. Our results indicate that the inclusion of additional mesons and baryons will likely lead to further reduction in the value of η/s.

Congruent leadership: values in action.

Science.gov (United States)

Stanley, David

2008-07-01

To discuss the significance of an appropriate leadership theory in order to develop an understanding of clinical leadership. Leadership theories developed from management and related paradigms, particularly transformational leadership, may be ineffective in supporting nurses to gain insights into clinical leadership or to develop and implement clinical leadership skills. Instead, congruent leadership theory, based on a match between the clinical leaders' actions and their values and beliefs about care and nursing, may offer a more firm theoretical foundation on which clinical nurses can build an understanding of and capacity to implement clinical leadership or become clinical leaders. Evaluation The information used is drawn from the contemporary literature and a study conducted by the author. Leadership can be better understood when an appropriate theoretical foundation is employed. With regard to clinical leadership, congruent leadership is proposed as the most appropriate theory. It is important to recognize that leadership theories based on a management paradigm may not be appropriate for all clinical applications. Education should be aimed specifically at clinical leaders, recognizing that clinical leaders are followed not for their vision or creativity (even if they demonstrate these), but because they translate their values and beliefs about care into action.

Assessment of impacts at the advanced test reactor as a result of chemical releases at the Idaho Chemical Processing Plant

International Nuclear Information System (INIS)

Rood, A.S.

1991-02-01

This report provides an assessment of potential impacts at the Advanced Test Reactor Facility (ATR) resulting from accidental chemical spill at the Idaho Chemical Processing Plant (ICPP). Spills postulated to occur at the Lincoln Blvd turnoff to ICPP were also evaluated. Peak and time weighted average concentrations were calculated for receptors at the ATR facility and the Test Reactor Area guard station at a height above ground level of 1.0 m. Calculated concentrations were then compared to the 15 minute averaged Threshold Limit Value - Short Term Exposure Limit (TLV-STEL) and the 30 minute averaged Immediately Dangerous to Life and Health (IDLH) limit. Several different methodologies were used to estimate source strength and dispersion. Fifteen minute time weighted averaged concentrations of hydrofluoric acid and anhydrous ammonia exceeded TLV-STEL values for the cases considered. The IDLH value for these chemicals was not exceeded. Calculated concentrations of ammonium hydroxide, hexone, nitric acid, propane, gasoline, chlorine and liquid nitrogen were all below the TLV-STEL value

Clinical value of serum bilirubin subfractionation by high-performance liquid chromatography and conventional methods in patients with primary biliary cirrhosis

NARCIS (Netherlands)

Jansen, P. L.; Peters, W. H.; Janssens, A. R.

1986-01-01

The clinical value of serum bilirubin subfractionation, using high-performance liquid chromatography (HPLC), was studied in 26 patients with primary biliary cirrhosis (PBC) from whom 59 serum samples were obtained. Total bilirubin (TB) levels were determined by alkaline methanolysis and HPLC

The clinical value of membranes in bone augmentation procedures in oral implantology: 
A systematic review of randomised controlled trials

NARCIS (Netherlands)

Jonker, Brend P.; Roeloffs, Maarten W. K.; Wolvius, Eppo B.; Pijpe, Justin

2016-01-01

To determine the clinical value of membranes in bone augmentation procedures such as ridge augmentation with simultaneous (one-stage) and delayed (two-stage) implant placement, sinus augmentation surgery, ridge preservation and immediate implant placement. In April 2016, Embase, Medline (Ovid-SP),

Clinical chemistry since 1800: growth and development.

Science.gov (United States)

Rosenfeld, Louis

2002-01-01

The 19th and 20th centuries witnessed the growth and development of clinical chemistry. Many of the individuals and the significance of their contributions are not very well known, especially to new members of the profession. This survey should help familiarize them with the names and significance of the contributions of physicians and chemists such as Fourcroy, Berzelius, Liebig, Prout, Bright, and Rees. Folin and Van Slyke are better known, and it was their work near the end of the second decade of the 20th century that brought the clinical chemist out of the annex of the mortuary and into close relationship with the patient at the bedside. However, the impact on clinical chemistry and the practice of medicine by the 1910 exposé written by Abraham Flexner is not as well known as it deserves to be, nor is the impetus that World War I gave to the spread of laboratory medicine generally known. In the closing decades of the 20th century, automated devices produced an overabundance, and an overuse and misuse, of testing to the detriment of careful history taking and bedside examination of the patient. This is attributable in part to a fascination with machine-produced data. There was also an increased awareness of the value of chemical methods of diagnosis and the need to bring clinician and clinical chemist into a closer partnership. Clinical chemists were urged to develop services into dynamic descriptions of the diagnostic values of laboratory results and to identify medical relevance in interpreting significance for the clinician.

One-Step Reforming of CO2 and CH4 into High-Value Liquid Chemicals and Fuels at Room Temperature by Plasma-Driven Catalysis.

Science.gov (United States)

Wang, Li; Yi, Yanhui; Wu, Chunfei; Guo, Hongchen; Tu, Xin

2017-10-23

The conversion of CO 2 with CH 4 into liquid fuels and chemicals in a single-step catalytic process that bypasses the production of syngas remains a challenge. In this study, liquid fuels and chemicals (e.g., acetic acid, methanol, ethanol, and formaldehyde) were synthesized in a one-step process from CO 2 and CH 4 at room temperature (30 °C) and atmospheric pressure for the first time by using a novel plasma reactor with a water electrode. The total selectivity to oxygenates was approximately 50-60 %, with acetic acid being the major component at 40.2 % selectivity, the highest value reported for acetic acid thus far. Interestingly, the direct plasma synthesis of acetic acid from CH 4 and CO 2 is an ideal reaction with 100 % atom economy, but it is almost impossible by thermal catalysis owing to the significant thermodynamic barrier. The combination of plasma and catalyst in this process shows great potential for manipulating the distribution of liquid chemical products in a given process. © 2017 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA.

[A Retrospective Study of Mean Computed Tomography Value to Predict 
the Tumor Invasiveness in AAH and Clinical Stage Ia Lung Cancer].

Science.gov (United States)

Wu, Hanran; Liu, Changqing; Xu, Meiqing; Xiong, Ran; Xu, Guangwen; Li, Caiwei; Xie, Mingran

2018-03-20

Recently, the detectable rate of ground-glass opacity (GGO ) was significantly increased, a appropriate diagnosis before clinic treatment tends to be important for patients with GGO lesions. The aim of this study is to validate the ability of the mean computed tomography (m-CT) value to predict tumor invasiveness, and compared with other measurements such as Max CT value, GGO size, solid size of GGO and C/T ratio (consolid/tumor ratio, C/T) to find out the best measurement to predict tumor invasiveness. A retrospective study was conducted of 129 patients who recieved lobectomy and were pathological confirmed as atypical adenomatous pyperplasia (AAH) or clinical stage Ia lung cance in our center between January 2012 and December 2013. Of those 129 patients, the number of patients of AAH, AIS, AIS and invasive adenocarcinoma were 43, 26, 17 and 43, respectively. We defined AAH and AIS as noninvasive cancer (NC), MIA and invasive adenocarcinoma were categorized as invasive cancer(IC). We used receiver operating characteristic (ROC) curve analysis to compare the ability to predict tumor invasiveness between m-CT value, consolidation/tumor ratio, tumor size and solid size of tumor. Multiple logistic regression analyses were performed to determine the independent variables for prediction of pathologic more invasive lung cancer. 129 patients were enrolled in our study (59 male and 70 female), the patients were a median age of (62.0±8.6) years (range, 44 to 82 years). The two groups were similar in terms of age, sex, differentiation (P>0.05). ROC curve analysis was performed to determine the appropriate cutoff value and area under the cure (AUC). The cutoff value of solid tumor size, tumor size, C/T ratio, m-CT value and Max CT value were 9.4 mm, 15.3 mm, 47.5%, -469.0 HU and -35.0 HU, respectively. The AUC of those variate were 0.89, 0.79, 0.82, 0.90, 0.85, respectively. When compared the clinical and radiologic data between two groups, we found the IC group was strongly

Clinical Value of Thyrotropin Receptor Antibodies for the Differential Diagnosis of Interferon Induced Thyroiditis.

Science.gov (United States)

Benaiges, D; Garcia-Retortillo, M; Mas, A; Cañete, N; Broquetas, T; Puigvehi, M; Chillarón, J J; Flores-Le Roux, J A; Sagarra, E; Cabrero, B; Zaffalon, D; Solà, R; Pedro-Botet, J; Carrión, J A

2016-01-01

The clinical value of thyrotropin receptor antibodies for the differential diagnosis of thyrotoxicosis induced by pegylated interferon-alpha remains unknown. We analyzed the diagnostic accuracy of thyrotropin receptor antibodies in the differential diagnosis of thyrotoxicosis in patients with chronic hepatitis C (CHC) receiving pegylated interferon-alpha plus ribavirin. Retrospective analysis of 274 patients with CHC receiving pegylated interferon-alpha plus ribavirin. Interferon-induced thyrotoxicosis was classified according to clinical guidelines as Graves disease, autoimmune and non- autoimmune destructive thyroiditis. 48 (17.5%) patients developed hypothyroidism, 17 (6.2%) thyrotoxicosis (6 non- autoimmune destructive thyroiditis, 8 autoimmune destructive thyroiditis and 3 Graves disease) and 22 "de novo" thyrotropin receptor antibodies (all Graves disease, 2 of the 8 autoimmune destructive thyroiditis and 17 with normal thyroid function). The sensitivity and specificity of thyrotropin receptor antibodies for Graves disease diagnosis in patients with thyrotoxicosis were 100 and 85%, respectively. Patients with destructive thyroiditis developed hypothyroidism in 87.5% of autoimmune cases and in none of those with a non- autoimmune etiology (pthyroid scintigraphy for the differential diagnosis of thyrotoxicosis in CHC patients treated with pegylated interferon. © Georg Thieme Verlag KG Stuttgart · New York.

Chemical and biological evaluation of the nutritive value of Algerian green seaweed Ulva lactuca using in vitro gas production technique fior ruminant animals

OpenAIRE

Zitouni, Hind; Arhab, Rabah; Boudry, Christelle; Bousseboua, Hacène; Beckers, Yves

2014-01-01

This study aimed to determine the nutritive value of seaweed Ulva lactuca collected from the Algerian coast by estimation of its chemical composition and fermentation characteristics, comparatively to vetch-oat hay (control), using in vitro gas production technique. Seaweed and control were incubated with rumen liquor taken from fistulated and non lactating cows. Gas production was recorded at: 2, 4, 6, 8, 12, 24, 48 and 72h. The in vitro rumen fermentation parameters were measured after 24h ...

The feasibility, perceived satisfaction, and value of using synchronous webinars to educate clinical research professionals on reporting adverse events in clinical trials: a report from the Children's Oncology Group.

Science.gov (United States)

Borgerson, Dawn; Dino, Jennifer

2012-01-01

Clinical research professionals are faced with decreased funding and increased workloads; innovative methods of professional development programs are necessary to accommodate these factors. This study evaluated the feasibility, perceived satisfaction, and value of using webinars to educate clinical research professionals on reporting adverse events commonly experienced in pediatric oncology clinical trials. The setting incorporated synchronous web-based educational technology. Constructivist learning provides the theoretical framework for this study. Participants evaluated the professional development program at 2 time points: (a) at the conclusion and (b) 4 to 6 weeks afterward, using survey method. Synchronous webinars were both economical and effective in educating clinical research professionals across institutional sites. Participants reported exceptionally high levels of satisfaction with the accessibility, scope, quality, and interactivity of the professional development program. The vast majority of participants reported that the education would assist with reporting adverse events in pediatric oncology clinical trials and this perception persisted into clinical practice. Although the results of this study were intended to guide future educational efforts of the Children's Oncology Group, they may also apply to other cooperative groups.

Chemical composition and nutritional value of unripe banana flour (Musa acuminata, var. Nanicão).

Science.gov (United States)

Menezes, Elizabete Wenzel; Tadini, Carmen Cecília; Tribess, Tatiana Beatris; Zuleta, Angela; Binaghi, Julieta; Pak, Nelly; Vera, Gloria; Dan, Milana Cara Tanasov; Bertolini, Andréa C; Cordenunsi, Beatriz Rosana; Lajolo, Franco M

2011-09-01

Banana flour obtained from unripe banana (Musa acuminata, var. Nanicão) under specific drying conditions was evaluated regarding its chemical composition and nutritional value. Results are expressed in dry weight (dw). The unripe banana flour (UBF) presented a high amount of total dietary fiber (DF) (56.24 g/100 g), which consisted of resistant starch (RS) (48.99 g/100 g), fructans (0.05 g/100 g) and DF without RS or fructans (7.2 g/100 g). The contents of available starch (AS) (27.78 g/100 g) and soluble sugars (1.81 g/100 g) were low. The main phytosterols found were campesterol (4.1 mg/100 g), stigmasterol (2.5 mg/100 g) and β-sitosterol (6.2 mg/100 g). The total polyphenol content was 50.65 mg GAE/100 g. Antioxidant activity, by the FRAP and ORAC methods, was moderated, being 358.67 and 261.00 μmol of Trolox equivalent/100 g, respectively. The content of Zn, Ca and Fe and mineral dialyzability were low. The procedure used to obtain UBF resulted in the recovery of undamaged starch granules and in a low-energy product (597 kJ/100 g).

[Value of history and clinical and laboratory data for the diagnosis of dehydration due to acute diarrhea in children younger than 5 years].

Science.gov (United States)

Pruvost, Isabelle; Dubos, François; Aurel, Marie; Hue, Valérie; Martinot, Alain

2008-04-01

Acute diarrhea is frequent, costly because of the number of hospital admissions required, and sometimes serious, even fatal to children in France. The clinical diagnosis of dehydration is difficult, but essential to determine management. To summarize the published data on the value of clinical history, clinical signs and laboratory results for diagnosing dehydration during acute diarrhea in young (1 month-5 years) non-malnourished children. Four databases (Medline, INIST, Ovid, and Cochrane) were searched through November 2006, with the key words "dehydration" subcategories "diagnosis, or etiology, or history", "diarrhea" subcategory "diagnosis", and age limits "infant or preschool child". We selected the articles and reviews that included as an endpoint for dehydration "weight gain > 5% after recovery" (the gold standard). Thirteen studies were selected. No single clinical history item, clinical sign or laboratory value was sufficient to discriminate between children with and without dehydration. The reproducibility of clinical signs varied substantially between studies. Persistent skin folds and signs of vasoconstriction contributed the most information, with good specificity but sensitivity dehydration. No dehydration scale has been validated. None of the studies selected had a very high level of proof (level 1 and 2); neither signs nor scores have been validated internally or externally because of the low number of subjects. The diagnosis of dehydration due to acute diarrhea in young children depends on the number of signs present, since no individual element of clinical history, clinical picture or laboratory tests distinguished dehydration. Other studies are necessary.

Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis

Directory of Open Access Journals (Sweden)

CHEN Min

2018-01-01

Full Text Available Objective To investigate the clinical value of acoustic radiation force impulse (ARFI in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group (EV0, 16 patients, mild varices group (EV1, 39 patients, moderate varices group (EV2, 26 patients, and severe varices group (EV3, 35 patients. The receiver operating characteristic (ROC curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2.54±0.34 m/s for EV0 patients, 3.05±0.34 m/s for EV1 patients, 3.48±0.50 m/s for EV2 patients, and 3.69±0.33 m/s for EV3 patients (χ2=60.121,P＜0.001. The ARFI value of the spleen was positively correlated with the grade of esophageal varices (r=0.713, P＜0.001. The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0.93, 0.88, and 0.83, respectively. There was no significant difference in the ARFI value of the liver between groups (P=0.085, and the ARFI value of the liver was not correlated with the degree of

Reference line-pair values of panoramic radiographs using an arch-form phantom stand to assess clinical image quality

International Nuclear Information System (INIS)

Choi, Da Hye; Choi, Bo Ram; Huh, Kyung Hoe; Heo, Min Suk; Choi, Soon Chul; Choi, Jin Woo; Yi, Won Jin; Lee, Sam Sun

2013-01-01

This study was performed to suggest reference line-pair values of panoramic images with clinically desirable qualities using an arch-form phantom stand. The line-pair test phantom was chosen. A real skull model was selected for setting the arch-form model of the phantom stand. The phantom stand had slits in four regions (incisor, premolar, molar, TMJ). Four raw images of the test phantom in each region and one raw image of the real skull were converted into 50 test phantom images and 50 skull phantom images with various line-pair values. 50 post-processed real skull phantom images were divided into 4 groups and were randomly submitted to 14 evaluators. Image quality was graded on a 4 point scale (1. good, 2. normal, 3. poor but interpretable, and 4. not interpretable). The reference line pair was determined as the first line-pair value scored less than 2 points. The mean scores tended to decrease as the line-pair values increased. The reference line-pair values were 3.19 LP/mm in the incisor, 2.32 LP/mm in the premolar and TMJ, and 1.88 LP/mm in the molar region. Image quality evaluation methods and criteria should be able to assess various regions considering the characteristics of panoramic systems. This study suggested overall and regional reference line-pair values and established a set of standard values for them.

Reference line-pair values of panoramic radiographs using an arch-form phantom stand to assess clinical image quality

Energy Technology Data Exchange (ETDEWEB)

Choi, Da Hye; Choi, Bo Ram; Huh, Kyung Hoe; Heo, Min Suk; Choi, Soon Chul [Dept. of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Jin Woo [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Dankook University, Cheonan (Korea, Republic of); Yi, Won Jin; Lee, Sam Sun [Dept. of Oral and Maxillofacial Radiology, BK21 Craniomaxillofacial Life Science, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

2013-03-15

This study was performed to suggest reference line-pair values of panoramic images with clinically desirable qualities using an arch-form phantom stand. The line-pair test phantom was chosen. A real skull model was selected for setting the arch-form model of the phantom stand. The phantom stand had slits in four regions (incisor, premolar, molar, TMJ). Four raw images of the test phantom in each region and one raw image of the real skull were converted into 50 test phantom images and 50 skull phantom images with various line-pair values. 50 post-processed real skull phantom images were divided into 4 groups and were randomly submitted to 14 evaluators. Image quality was graded on a 4 point scale (1. good, 2. normal, 3. poor but interpretable, and 4. not interpretable). The reference line pair was determined as the first line-pair value scored less than 2 points. The mean scores tended to decrease as the line-pair values increased. The reference line-pair values were 3.19 LP/mm in the incisor, 2.32 LP/mm in the premolar and TMJ, and 1.88 LP/mm in the molar region. Image quality evaluation methods and criteria should be able to assess various regions considering the characteristics of panoramic systems. This study suggested overall and regional reference line-pair values and established a set of standard values for them.

Clinical value of 18F-FDG coincidence imaging for diagnosis of nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Ning Yanli; Lou Cen; Huang Zhongke; Shi Guohua; Chen Dongfang; Mu Da

2012-01-01

Objective: To investigate the value of 18 F-FDG coincidence imaging for diagnosis of nasopharyngeal carcinoma. Methods: A total of 45 patients with nasopharyngeal carcinoma (33 males and 12 females, average age (55.56 ± 13.50) years), who underwent 18 F-FDG coincidence imaging before treatment, were studied retrospectively. The images of 18 F-FDG coincidence imaging (GE Millennium VG SPECT) and MRI were analyzed. The radioactivity ratio of the accumulated regions to cerebellum (T/NT)was calculated by ROI technique. The volume of nasopharyngeal carcinoma was recorded by MRI. The positive rates of 18 F-FDG coincidence imaging and EB virus-related antibody measurements were compared by paired χ 2 test. The correlation between T/NT ratios and tumor volumes were tested by Pearson correlation, and then ROC curves were established. The T/NT ratios and tumor volumes of different groups (different first symptoms, clinical stages, T stages, pathological classification and outcomes, with or without lymph node enlargement) were compared by t-test and rank sum test. Results: The positive rate of 18 F-FDG coincidence imaging was 97.78% (44/45), and the positive rate of EB virus-related antibody measurement was 95.56% (43/45, χ 2 =1.33, P>0.05). The T/NT ratio (2.439 ±1.119) and tumor volume ((7.311 ± 8.280) cm 3 ) of primary lesions had a positive correlation (r=0.463, P<0.05). The cut-off values of T/NT ratio and the tumor volume were 2.396 and 7.348 cm 3 , respectively, by ROC curves. T/NT ratios in groups with or without first symptom of epistaxis (2.847 ± 1.254 vs 2.082 ± 0.863, t=-2.409) and groups with or without facial numbness (2.855 ± 1.261 vs 2.134 ± 0.913, t=-2.225) were both significantly different (both P<0.05). T/NT ratios of differentiated and undifferentiated cancer were 2.266 ± 0.997 and 2.971 ± 1.351, respectively (t=-2.018, P<0.05). There was a significant difference of tumor volumes between groups with or without facial numbness (t=-2.684, P<0

Chemical engineer in business; Kemikaru enjinia to bijinesu

Energy Technology Data Exchange (ETDEWEB)

Tsuchiya, Yasuaki

1999-05-05

It is Coca-Cola and General Electric Co. (GE) that the aggregate market value is drastically expanding in U.S.A. throughout over past of 15. Direct common point is not very much found to these 2 companies. During over of 15 years, the leadership was demonstrated as management top of both companies, 2 managers who drastically contributed to the enterprise value improvement are the chemical engineer graduate both. It does be not done either mere in which that both persons with the grounded ability of chemical engineering contributed to the enterprise value improvement of the dramatic was not accidental. It is the essence of the chemical engineering,'By discerning essence of the process, the appropriate countermeasure is passed' there was it for the basis of the management of both persons. (NEDO)

Clinical Value of High Mobility Group Box 1 and the Receptor for Advanced Glycation End-products in Head and Neck Cancer: A Systematic Review

Directory of Open Access Journals (Sweden)

Nguyen, Austin

2016-04-01

Full Text Available Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation end-products are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.

Journal of Chemical Sciences | Indian Academy of Sciences

Indian Academy of Sciences (India)

Home; Journals; Journal of Chemical Sciences. Ganesh Kokate. Articles written in Journal of Chemical Sciences. Volume 126 Issue 2 March 2014 pp 403-413. Novel catalysts for valorization of biomass to value-added chemicals and fuels · Nishita Lucas Narasimha Rao Kanna Atul S Nagpure Ganesh Kokate ...

Added clinical value of the inferior temporal EEG electrode chain.

Science.gov (United States)

Bach Justesen, Anders; Eskelund Johansen, Ann Berit; Martinussen, Noomi Ida; Wasserman, Danielle; Terney, Daniella; Meritam, Pirgit; Gardella, Elena; Beniczky, Sándor

2018-01-01

To investigate the diagnostic added value of supplementing the 10-20 EEG array with six electrodes in the inferior temporal chain. EEGs were recorded with 25 electrodes: 19 positions of the 10-20 system, and six additional electrodes in the inferior temporal chain (F9/10, T9/10, P9/10). Five-hundred consecutive standard and sleep EEG recordings were reviewed using the 10-20 array and the extended array. We identified the recordings with EEG abnormalities that had peak negativities at the inferior temporal electrodes, and those that only were visible at the inferior temporal electrodes. From the 286 abnormal recordings, the peak negativity was at the inferior temporal electrodes in 81 cases (28.3%) and only visible at the inferior temporal electrodes in eight cases (2.8%). In the sub-group of patients with temporal abnormalities (n = 134), these represented 59% (peak in the inferior chain) and 6% (only seen at the inferior chain). Adding six electrodes in the inferior temporal electrode chain to the 10-20 array improves the localization and identification of EEG abnormalities, especially those located in the temporal region. Our results suggest that inferior temporal electrodes should be added to the EEG array, to increase the diagnostic yield of the recordings. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

The Value of the SYNTAX Score II in Predicting Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.

Science.gov (United States)

Ryan, Nicola; Nombela-Franco, Luis; Jiménez-Quevedo, Pilar; Biagioni, Corina; Salinas, Pablo; Aldazábal, Andrés; Cerrato, Enrico; Gonzalo, Nieves; Del Trigo, María; Núñez-Gil, Iván; Fernández-Ortiz, Antonio; Macaya, Carlos; Escaned, Javier

2017-11-27

The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the SS-II in predicting outcomes in patients undergoing TAVI. A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all-cause death, cerebrovascular event, or myocardial infarction at 1 year. Increased SS-II was associated with higher 30-day mortality (P=.036) and major bleeding (P=.015). The 1-year risk of death and MACE was higher among patients in the 3rd SS-II tertile (HR, 2.60; P=.002 and HR, 2.66; P<.001) and was similar among patients in the 2nd tertile (HR, 1.27; P=.507 and HR, 1.05; P=.895) compared with patients in the 1st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P=.046) and MACE (P=.001). The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Chemicalization in water treatment in peat production areas

International Nuclear Information System (INIS)

Madekivi, O.; Marja-Aho, J.; Selin, P.; Jokinen, S.

1995-01-01

Chemicalization of runoff waters of peat production has been studied since 1989, first in laboratory and since 1990 in practice. The methods have been developed as cooperation between Vapo Oy and Kemira Chemicals Oy. In chemicalization the dissolved substances are coagulated and they settle after that into sedimentation basins. Good purification results require rapid and effective mixing, so the formed particles are combined to larger particles, and they form settleable flock. The coagulation efficiency depends on the properties of the water to be purified, such as alkalinity and pH, the quality and the quantity of humic substances, and the quality and the quantity of the flocking chemicals. Chemicalization is at present the most effective, but also the most expensive method for purification of drying waters of peat production areas. The chemicalized water is on the basis of most quality factors cleaner than water running off a virgin bog. The most visible change is the clarification of the water which is due to the coagulation of the colouring humic substances and iron. The colorimetric value is decreased by over 70 %, the best results being over 90 %. The colorimetric value of the purified water (30-100 mg Pt/l) is below the values of the runoff water of a virgin bog (100-200 mg Pt/l). The chemicalization process and the results of the researches are presented in the article. (3 refs., 6 figs., 2 tabs.)

Increasing fetal ovine number per gestation alters fetal plasma clinical chemistry values.

Science.gov (United States)

Zywicki, Micaela; Blohowiak, Sharon E; Magness, Ronald R; Segar, Jeffrey L; Kling, Pamela J

2016-08-01

Intrauterine growth restriction (IUGR) is interconnected with developmental programming of lifelong pathophysiology. IUGR is seen in human multifetal pregnancies, with stepwise rises in fetal numbers interfering with placental nutrient delivery. It remains unknown whether fetal blood analyses would reflect fetal nutrition, liver, and excretory function in the last trimester of human or ovine IUGR In an ovine model, we hypothesized that fetal plasma biochemical values would reflect progressive placental, fetal liver, and fetal kidney dysfunction as the number of fetuses per gestation rose. To determine fetal plasma biochemical values in singleton, twin, triplet, and quadruplet/quintuplet ovine gestation, we investigated morphometric measures and comprehensive metabolic panels with nutritional measures, liver enzymes, and placental and fetal kidney excretory measures at gestational day (GD) 130 (90% gestation). As anticipated, placental dysfunction was supported by a stepwise fall in fetal weight, fetal plasma glucose, and triglyceride levels as fetal number per ewe rose. Fetal glucose and triglycerides were directly related to fetal weight. Plasma creatinine, reflecting fetal renal excretory function, and plasma cholesterol, reflecting placental excretory function, were inversely correlated with fetal weight. Progressive biochemical disturbances and growth restriction accompanied the rise in fetal number. Understanding the compensatory and adaptive responses of growth-restricted fetuses at the biochemical level may help explain how metabolic pathways in growth restriction can be predetermined at birth. This physiological understanding is important for clinical care and generating interventional strategies to prevent altered developmental programming in multifetal gestation. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

An integrated biorefinery concept for conversion of sugar beet pulp into value-added chemicals and pharmaceutical intermediates.

Science.gov (United States)

Cárdenas-Fernández, Max; Bawn, Maria; Hamley-Bennett, Charlotte; Bharat, Penumathsa K V; Subrizi, Fabiana; Suhaili, Nurashikin; Ward, David P; Bourdin, Sarah; Dalby, Paul A; Hailes, Helen C; Hewitson, Peter; Ignatova, Svetlana; Kontoravdi, Cleo; Leak, David J; Shah, Nilay; Sheppard, Tom D; Ward, John M; Lye, Gary J

2017-09-21

Over 8 million tonnes of sugar beet are grown annually in the UK. Sugar beet pulp (SBP) is the main by-product of sugar beet processing which is currently dried and sold as a low value animal feed. SBP is a rich source of carbohydrates, mainly in the form of cellulose and pectin, including d-glucose (Glu), l-arabinose (Ara) and d-galacturonic acid (GalAc). This work describes the technical feasibility of an integrated biorefinery concept for the fractionation of SBP and conversion of these monosaccharides into value-added products. SBP fractionation is initially carried out by steam explosion under mild conditions to yield soluble pectin and insoluble cellulose fractions. The cellulose is readily hydrolysed by cellulases to release Glu that can then be fermented by a commercial yeast strain to produce bioethanol at a high yield. The pectin fraction can be either fully hydrolysed, using physico-chemical methods, or selectively hydrolysed, using cloned arabinases and galacturonases, to yield Ara-rich and GalAc-rich streams. These monomers can be separated using either Centrifugal Partition Chromatography (CPC) or ultrafiltration into streams suitable for subsequent enzymatic upgrading. Building on our previous experience with transketolase (TK) and transaminase (TAm) enzymes, the conversion of Ara and GalAc into higher value products was explored. In particular the conversion of Ara into l-gluco-heptulose (GluHep), that has potential therapeutic applications in hypoglycaemia and cancer, using a mutant TK is described. Preliminary studies with TAm also suggest GluHep can be selectively aminated to the corresponding chiral aminopolyol. The current work is addressing the upgrading of the remaining SBP monomer, GalAc, and the modelling of the biorefinery concept to enable economic and Life Cycle Analysis (LCA).

Chemical Profiling of Primary Mesothelioma Cultures Defines Subtypes with Different Expression Profiles and Clinical Responses.

Science.gov (United States)

Schunselaar, Laurel M; Quispel-Janssen, Josine M M F; Kim, Yongsoo; Alifrangis, Constantine; Zwart, Wilbert; Baas, Paul; Neefjes, Jacques

2018-04-01

Purpose: Finding new treatment options for patients with malignant pleural mesothelioma is challenging due to the rarity and heterogeneity of this cancer type. The absence of druggable targets further complicates the development of new therapies. Current treatment options are therefore limited, and prognosis remains poor. Experimental Design: We performed drug screening on primary mesothelioma cultures to guide treatment decisions of corresponding patients that were progressive after first- or second-line treatment. Results: We observed a high concordance between in vitro results and clinical outcomes. We defined three subgroups responding differently to the anticancer drugs tested. In addition, gene expression profiling yielded distinct signatures that segregated the differently responding subgroups. These genes signatures involved various pathways, most prominently the fibroblast growth factor pathway. Conclusions: Our primary mesothelioma culture system has proved to be suitable to test novel drugs. Chemical profiling of primary mesothelioma cultures allows personalizing treatment for a group of patients with a rare tumor type where clinical trials are notoriously difficult. This personalized treatment strategy is expected to improve the poor prospects of patients with mesothelioma. Clin Cancer Res; 24(7); 1761-70. ©2017 AACR See related commentary by John and Chia, p. 1513 . ©2017 American Association for Cancer Research.

The 1994 list of limiting values. Safety and hygiene at work

International Nuclear Information System (INIS)

Pflaumbaum, W.; Kleine, H.; Barig, A.; Nies, E.; Blome, H.; Deiniger, C.; Christ, E.; Siekmann, H.; Fischer, S.; Kupfer, J.; Kaulbars, U.; Pfeiffer, W.; Kreutzkampf, F.; Zilligen, H.; Zinken, E.; Boerner, F.; Kloss, G.; Pfeiffer, B.

1994-09-01

This book contains the most important limiting values for chemical, biological and physical effects on persons relevant to safety and hygiene at work. The section on chemical effects falls into two chapters: maximum working site concentrations of hazardous substances (MAK and TRK values), and limiting and recommended values for hazardous substances in indoor and external air. Regarding biological effects, limiting values for exposure at work do not exist. Therefore, this section looks mainly at the basic demands on work places. The section on physical effects contains limiting values and explanations regarding the following areas: noise, vibration, thermal stress, radiation and biomechanical stress (lifting and carrying of heavy weights). (orig./MG) [de

Clinical experiences with a chemical radioprotector in tumor radiotherapy: WR-2721

International Nuclear Information System (INIS)

Tanaka, Y.

1984-01-01

Since cysteine was found to protect lethally irradiated rats, sulfhydryl compounds that provide protection of laboratory animals against lethal doses of ionizing radiations have also been given much attention. The SH compounds have been the most extensively investigated, and β-aminoethylisothiouronium (AET) and cysteamine have been selected as being representative of those drugs that are highly protective. However, clinical application is limited, as the toxicity of these compounds is high. In a series of experiments to reevaluate radioprotective agents with low toxicity, the authors found that 2-mercaptopropionylglycine (MPG) and adrenochrome monoguangylhydrazone methanesulfonate (AMM) have a potent radioprotector effect in a dose far below their toxic doses in both mice and humans. Recently, the development of effective thiophosphate derivatives of cysteamine, namely WR-2721 [S-2-(3-amino-propylaminoethyl)phosphorothioate] by the U.S. Army Medical Research and Development Commands, led to a reevaluation of these compounds and their potential in radiotherapy. Initial investigations indicated that WR-2721 provided a considerable degree of radioprotection to normal tissues. This compound provided excellent protection for normal tissues (DMF = 2-2.5) but little protection for the transplanted tumor. Thus this drug may have a differential protection in vivo and may be useful for improving the therapeutic ratio in cancer radiotherapy. The results of animal and chemical experiments in Japan are summarized herein

Enhanced oil recovery chemicals from renewable wood resources

Energy Technology Data Exchange (ETDEWEB)

Grune, W.N.; Compere, A.L.; Griffith, W.L.; Crenshaw, J.M.

1979-04-01

Most of the wood pulp in the U.S. is produced by cooking, or digesting, wood chips in a chemical solution. These pulping processes have effluent streams which contain dissolved lignins, lignin breakdown products, and carbohydrates. There is a substantial economic incentive to use these materials as feedstocks for the production of high-valued micellar flood chemicals. The pulp and paper industries have practiced chemical recovery for almost a century. The largest chemical recycle processes are the internal recycle of inorganic salts for reuse in pulping. This is coupled with the use of waste organic compounds in the liquor as a fuel for directly-fired evaporation processes. Diversion of effluent and low valued streams for chemical recovery using fermentation, purification, or synthesis methods appears technically feasible in several cases. The use of new recovery processes could yield a variety of different wood-effluent based products. Some of the sugar acids in pulping liquors might be used as sequestering agents in reservoirs where there are large amounts of multivalent cations in flood brines. Fermentation production of high viscosity polymers, sequestering agents, and coagent alcohols appears worth further investigation. Tall oil acids and their derivatives can be used as surfactants in some reservoirs. Some waste constituents may adsorb preferentially on formations and thereby reduce loss of surfactants and other higher-valued chemicals.

Progress toward isolation of strains and genetically engineered strains of microalgae for production of biofuel and other value added chemicals: A review

International Nuclear Information System (INIS)

Ghosh, Ashmita; Khanra, Saumyakanti; Mondal, Madhumanti; Halder, Gopinath; Tiwari, O.N.; Saini, Supreet; Bhowmick, Tridib Kumar; Gayen, Kalyan

2016-01-01

Highlights: • Sample collection, isolation and identification to obtain a pure microalgal species. • Isolation of microalgal strains worldwide based on continent and habitat. • Genetic engineering tools for enhanced production of biodiesel and value added chemicals. • Cultivation systems for genetically modified strain. - Abstract: Microalgae and cyanobacteria are promising sources of biodiesel because of their high oil content (∼10 fold higher) and shorter cultivation time (∼4 fold lesser) than conventional oil producing territorial plants (e.g., soybean, corn and jatropha). These organisms also provide source of several valuable natural chemicals including pigments, food supplements like eicosapentanoic acid [EPA], decosahexaenoic acid [DHA] and vitamins. In addition, many cellular components of these organisms are associated with therapeutic properties like antioxidant, anti-inflammatory, immunostimulating, and antiviral. Isolation and identification of high-yielding strains with the faster growth rate is the key for successful implementation of algal biodiesel (or other products) at a commercial level. A number of research groups in Europe, America, and Australia are thus extensively involved in exploration of novel microalgal strain. Further, genetic engineering provides a tool to engineer the native strain resulting in transgenic strain with higher yields. Despite these efforts, no consensus has yet been reached so far in zeroing on the best microalgal strain for sustainable production of biofuel at reasonable cost. The search for novel microalgal strain and transgenesis of microalgae, are continuing side by side with the hope of commercial scale production of microalgae biofuel in near future. However, no consolidated review report exists which guides to isolate and identify a uncontaminated microalgal strain along with their transgenesis. The present review is focused on: (i) key factors for sample collection, isolation, and identification to

Classified study and clinical value of the phase imaging features

International Nuclear Information System (INIS)

Dang Yaping; Ma Aiqun; Zheng Xiaopu; Yang Aimin; Xiao Jiang; Gao Xinyao

2000-01-01

445 patients with various heart diseases were examined by the gated cardiac blood pool imaging, and the phase was classified. The relationship between the seven types with left ventricular function index, clinical heart function, different heart diseases as well as electrocardiograph was studied. The results showed that the phase image classification could match with the clinical heart function. It can visually, directly and accurately indicate clinical heart function and can be used to identify diagnosis of heart disease

Value-based genomics.

Science.gov (United States)

Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi

2018-03-20

Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics.

Unipolar Endocardial Voltage Mapping in the Right Ventricle: Optimal Cutoff Values Correcting for Computed Tomography-Derived Epicardial Fat Thickness and Their Clinical Value for Substrate Delineation.

Science.gov (United States)

Venlet, Jeroen; Piers, Sebastiaan R D; Kapel, Gijsbert F L; de Riva, Marta; Pauli, Philippe F G; van der Geest, Rob J; Zeppenfeld, Katja

2017-08-01

Low endocardial unipolar voltage (UV) at sites with normal bipolar voltage (BV) may indicate epicardial scar. Currently applied UV cutoff values are based on studies that lacked epicardial fat information. This study aimed to define endocardial UV cutoff values using computed tomography-derived fat information and to analyze their clinical value for right ventricular substrate delineation. Thirty-three patients (50±14 years; 79% men) underwent combined endocardial-epicardial right ventricular electroanatomical mapping and ablation of right ventricular scar-related ventricular tachycardia with computed tomographic image integration, including computed tomography-derived fat thickness. Of 6889 endocardial-epicardial mapping point pairs, 547 (8%) pairs with distance 1.50 mV, the optimal endocardial UV cutoff for identification of epicardial BV the curve, 0.75; sensitivity, 60%; specificity, 79%) and cutoff for identification of abnormal epicardial electrogram was 3.7 mV (area under the curve, 0.88; sensitivity, 100%; specificity, 67%). The majority of abnormal electrograms (130 of 151) were associated with transmural scar. Eighty-six percent of abnormal epicardial electrograms had corresponding endocardial sites with BV the remaining could be identified by corresponding low endocardial UV right ventricular scar, an endocardial UV cutoff value of 3.9 mV is more accurate than previously reported cutoff values. Although the majority of epicardial abnormal electrograms are associated with transmural scar with low endocardial BV, the additional use of endocardial UV at normal BV sites improves the diagnostic accuracy resulting in identification of all epicardial abnormal electrograms at sites with <1.0 mm fat. © 2017 American Heart Association, Inc.

Inflation Rates, Car Devaluation, and Chemical Kinetics.

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Pogliani, Lionello; Berberan-Santos, Mario N.

1996-01-01

Describes the inflation rate problem and offers an interesting analogy with chemical kinetics. Presents and solves the car devaluation problem as a normal chemical kinetic problem where the order of the rate law and the value of the rate constant are derived. (JRH)

Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes

Directory of Open Access Journals (Sweden)

Marzorati C

2017-03-01

Full Text Available Chiara Marzorati,1,2 Gabriella Pravettoni2,3 1Foundations of the Life Sciences, Bioethics and Cognitive Science, European School of Molecular Medicine (SEMM, 2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, 3Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy Abstract: In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of “value” is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on “value” and new paradigms such as patient-centered system (PCS, patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care. Keywords: health care system, value, value-based medicine, patient empowerment, clinical decision

'What the patient wants': an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice.

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Wieten, Sarah

2018-02-01

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.

Metabolic disruption in context: Clinical avenues for synergistic perturbations in energy homeostasis by endocrine disrupting chemicals.

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Sargis, Robert M

2015-01-01

The global epidemic of metabolic disease is a clear and present danger to both individual and societal health. Understanding the myriad factors contributing to obesity and diabetes is essential for curbing their decades-long expansion. Emerging data implicate environmental endocrine disrupting chemicals (EDCs) in the pathogenesis of metabolic diseases such as obesity and diabetes. The phenylsulfamide fungicide and anti-fouling agent tolylfluanid (TF) was recently added to the list of EDCs promoting metabolic dysfunction. Dietary exposure to this novel metabolic disruptor promoted weight gain, increased adiposity, and glucose intolerance as well as systemic and cellular insulin resistance. Interestingly, the increase in body weight and adipose mass was not a consequence of increased food consumption; rather, it may have resulted from disruptions in diurnal patterns of energy intake, raising the possibility that EDCs may promote metabolic dysfunction through alterations in circadian rhythms. While these studies provide further evidence that EDCs may promote the development of obesity and diabetes, many questions remain regarding the clinical factors that modulate patient-specific consequences of EDC exposure, including the impact of genetics, diet, lifestyle, underlying disease, pharmacological treatments, and clinical states of fat redistribution. Currently, little is known regarding the impact of these factors on an individual's susceptibility to environmentally-mediated metabolic disruption. Advances in these areas will be critical for translating EDC science into the clinic to enable physicians to stratify an individual's risk of developing EDC-induced metabolic disease and to provide direction for treating exposed patients.

A long-term variation of chemical composition in precipitation

International Nuclear Information System (INIS)

Yoshioka, Ryuma; Okimura, Takashi; Okumura, Takenobu

1991-01-01

Precipitation samples are collected at the six localities in the southwestern Japan weekly or monthly over a long period of time (1978-1989) in order to estimate chemical weathering rates and amount of weathered materials through chemical composition in natural waters. Major chemical composition is determined for the precipitation samples. Together with the data available in the literature, the following characteristics are recognized : 1) Most pH values fall in the narrow range of 4.4 to 5.4, 2) Systematic variations in pH values are observed among the precipitation samples of different geologic environments, 3) pH values become almost constant from 1984 to 1989, 4) NO 3 - concentrations gradually decrease to an almost constant value with time, and 5) ΔSO 4 2- concentrations gradually have a tendency to decrease from 1978 to 1985. The mechanism of phenomena described above is also presented. (author)

Comparative Evaluation of the Antimicrobial Efficacy of Three Immersion Chemical Disinfectants on Clinically Derived Poly(Vinyl Siloxane) Impressions.

Science.gov (United States)

Jeyapalan, Vidhya; Krishnan, Chitra Shankar; Ramasubramanian, Hariharan; Sampathkumar, Jayakrishnakumar; Azhagarasan, N S; Krishnan, Madhusudan

2016-07-06

To comparatively evaluate the antimicrobial efficacy of freshly prepared electrolyzed oxidizing water (EOW) with that of 2.4% glutaraldehyde (GA) and 1% sodium hypochlorite (SH) on clinically derived poly vinyl siloxane (PVS) impressions. Four clinically derived PVS impressions each were obtained from 10 subjects. One impression from each subject was randomly kept as control (group I), without disinfection. The remaining three impressions were randomly disinfected by immersion in either 2.4% GA (group II), 1% SH (group III), or freshly prepared EOW (group IV). The samples were subjected to microbial culture individually on brain heart infusion (BHI) agar medium. The organisms isolated were confirmed by visual examination and gram staining. Mean colony forming units (CFU) were counted, log 10 reduction obtained and compared. Data were statistically analyzed using one-way ANOVA, followed by multiple comparisons using Tukey-HSD post hoc tests (p < 0.05). Streptococci, Staphylococci, Pseudomonas, Candida, Proteus, Klebsiella, and E. coli were isolated from all impressions including the controls, except those disinfected by EOW. All three disinfectants showed significant reduction in CFU and log 10 reduction values as compared to the controls. EOW showed significantly higher reduction in log 10 values compared to GA and SH, whereas GA and SH showed similar reductions. EOW, GA, and SH showed kill rates of 100%, 99.60%, and 99.82%, respectively. EOW showed significant antimicrobial efficacy as evidenced by reduction in log 10 values when used as an immersion disinfectant for PVS impressions when compared with the results obtained using GA and SH. These results need further investigation. EOW shows high antimicrobial efficacy when used as an immersion disinfectant as compared to GA and SH for clinically derived PVS impressions. © 2016 by the American College of Prosthodontists.

Diagnostic value of brain chronic black holes on T1-weighted MR images in clinically isolated syndromes.

Science.gov (United States)

Mitjana, Raquel; Tintoré, Mar; Rocca, Maria A; Auger, Cristina; Barkhof, Frederik; Filippi, Massimo; Polman, Chris; Fazekas, Franz; Huerga, Elena; Montalban, Xavier; Rovira, Alex

2014-10-01

Non-enhancing black holes (neBHs) are more common in multiple sclerosis (MS) patients with longer disease durations and progressive disease subtypes. Our aim was to analyse the added value of neBHs in patients with clinically isolated syndromes (CISs) for predicting conversion to clinically definite MS (CDMS). Patients were classified based on the presence or absence of neBHs and on the number of Barkhof-Tintoré (B-T) criteria fulfilled. Dissemination in space (DIS) was defined as the presence of at least three of the four B-T criteria. Dissemination in time (DIT)1 was defined by simultaneous presence of enhancing and non-enhancing lesions. DIT2 was defined by simultaneous presence of neBHs and T2 lesions not apparent on T1-weighted images. Focal T2-hyperintense brain lesions were identified in 87.7% of the 520 CIS patients, and 41.4% of them presented at least one neBH. Patients meeting DIS, DIT1, and DIT2 had a significantly higher rate of conversion to CDMS. After adjusting for DIS, only patients who fulfilled DIT1 preserved a significant increase in CDMS conversion. Non-enhancing black holes in CIS patients are associated with a higher risk of conversion to CDMS. However, the predictive value of this finding is lost when added to the DIS criteria. © The Author(s) 2014.

Susceptibility based upon Chemical Interaction with Disease ...

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One of the challenges facing toxicology and risk assessment is that numerous host and environmental factors may modulate vulnerability and risk. An area of increasing interest is the potential for chemicals to interact with background aging and disease processes, an interaction that may yield cumulative damage, altered chemical potency, and increased disease incidence. This review outlines the interactions possible between chemicals and background disease and identifies the type of information needed to evaluate such interactions. Key among these is the existence of a clinically relevant and easy to measure biomarker of disease risk which allows the identification of vulnerable individuals based upon the level of risk biomarker. The impact of toxic chemicals on this biomarker can then be used to predict how the chemical modifies disease risk as long as related mechanistic and toxicological data are consistent with toxicant effect on the disease process. Several case studies are briefly presented which describe the toxic chemical, the clinical biomarker and the impacted disease including: fine particulate matter/decreased heart rate variability/increased cardiopulmonary events; cadmium/decreased glomerular filtration rate/increased chronic kidney disease; methyl mercury/decreased paraoxonase-1/increased cardiovascular risk; trichloroethylene/increased anti-nuclear antibody/autoimmunity; dioxin/increased CYP1A1/hypertension. These case studies point o

Clinical value of determination of TSH-binding inhibiting immunoglobulins (TBII) by a radioreceptor assay

International Nuclear Information System (INIS)

Heberling, H.J.; Bierwolf, B.; Lohmann, D.

1986-01-01

The clinical value of a commercial kit for determination of TBII was evaluated. 50 patients with untreated Graves' disease, 21 patients with Graves' disease before and during medical therapy, 18 patients after finishing medical therapy and 10 patients after surgical treatment were examined. Besides these, 41 patients with other thyroid diseases and 36 patients without any thyroid disorder were included. In 47 (94%) of 50 patients with untreated Graves' disease TBII were detectable in serum using a TSH standard curve. Binding activities exceeding 10 U/l TSH equivalents were regarded as positive. In other thyroid diseases TBII were negative with the exception of 3 of 22 patient with autonomously functioning thyroid nodules. After 12 months of antithyroid drug treatment of 19 patients the incidence of positive antibody findings was 26%. During follow-up after medical therapy (1-9 years) 7 of 18 patients had increased TBII in correlation with clinical and functional findings. The determination of TBII by TRAK assay proved to be a sensitive and specific method. The assay can be used to differentiate between hyperthyroidism of autoimmune or non-immunogenic origin. Thus the method seems to be helpful for the follow-up under medical treatment of patients with Graves' disease. (author)

Review of clinically accessible methods to determine lean body mass for normalization of standardized uptake values

International Nuclear Information System (INIS)

DEVRIESE, Joke; POTTEL, Hans; BEELS, Laurence; MAES, Alex; VAN DE WIELE, Christophe; GHEYSENS, Olivier

2016-01-01

With the routine use of 2-deoxy-2-[ 18 F]-fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scans, metabolic activity of tumors can be quantitatively assessed through calculation of SUVs. One possible normalization parameter for the standardized uptake value (SUV) is lean body mass (LBM), which is generally calculated through predictive equations based on height and body weight. (Semi-)direct measurements of LBM could provide more accurate results in cancer populations than predictive equations based on healthy populations. In this context, four methods to determine LBM are reviewed: bioelectrical impedance analysis, dual-energy X-ray absorptiometry. CT, and magnetic resonance imaging. These methods were selected based on clinical accessibility and are compared in terms of methodology, precision and accuracy. By assessing each method’s specific advantages and limitations, a well-considered choice of method can hopefully lead to more accurate SUVLBM values, hence more accurate quantitative assessment of 18F-FDG PET images.

The study on clinical value of the detection about serum and Unconjugated Bilirubin in diagnosis of neonatal jaundice.

Science.gov (United States)

Wang, Guangzhou; Wang, Jiefei; Huang, Nannan; Yu, Fengqin

2016-01-01

In this paper, the clinical value of the detection about serum and unconjugated bilirubin (UCB) in neonatal jaundice was studied to found an effective and rapid method for diagnose of neonatal jaundice. ALB (Serum Albumin), total serum bilirubin (TSB) and UCB were detected by ELISA method among the 100 cases with neonatal jaundice selected for the study. The values of ALB, UCB and TSB in moderate jaundice patients were (42.83±3.87) g/L, (287.35±44.38) μm/L, (304.16±43.40) μm/L, respectively; as for the severe jaundice patients, the values were (38.41±4.82) g/L, (354.38±48.75) μm/L, (375.20±47.51) μm/L. The results showed significant differences with the pjaundice patients. The level of ALB, UCB, TSB in hemolytic jaundice, obstructive jaundice and jaundice caused by other infections also had significant differences, and the difference was statistically significant (pjaundice.

The value of a core clinical rotation in urology for medical students.

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Patel, Premal; Nayak, Jasmir G; McGregor, Thomas B

2015-01-01

In 2013, our institution underwent a change to the undergraduate medical curriculum whereby a clinical urology rotation became mandatory. In this paper, we evaluated the perceived utility and value of this change in the core curriculum. Third year medical students, required to complete a mandatory 1-week clinical urology rotation, were asked to complete a survey before and after their rotation. Fourth year medical students, not required to complete this rotation, were also asked to complete a questionnaire. Chi-squared and Fisher's exact test were used for data analysis. In total, 108 third year students rotated through urology during the study period. Of these, 66 (61%) completed the pre-rotation survey and 54 (50%) completed the post-rotation survey. In total, there were 110 fourth year students. Of these, 44 (40%) completed the questionnaire. After completing their mandatory rotations, students felt more comfortable managing and investigating common urological problems, such as hematuria and renal colic. Students felt they had a better understanding of how to insert a Foley catheter and felt comfortable independently inserting a Foley catheter. Importantly, students felt they knew when to consult urology and were also more likely to consider a career in urology. Compared to fourth year students, third year students felt urology was an important component to a family medicine practice and felt they had a better understanding of when to consult urology. The introduction of a mandatory urology rotation for undergraduate medical students leads to a perceived improvement in fundamental urological knowledge and skill set of rotating students. This mandatory rotation provides a valuable experience that validates its inclusion.

A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care

Directory of Open Access Journals (Sweden)

Dipak Kalra

2013-05-01

Full Text Available Background The case has historically been presented that structured and/or coded electronic health records (EHRs benefit direct patient care, but the evidence base for this is not well documented.Methods We searched for evidence of direct patient care value from the use of structured and/or coded information within EHRs. We interrogated nine international databases from 1990 to 2011. Value was defined using the Institute of Medicine’s six areas for improvement for healthcare systems: effectiveness, safety, patient-centredness, timeliness, efficiency and equitability. We included studies satisfying the Cochrane Effective Practice and Organisation of Care (EPOC group criteria.Results Of 5016 potentially eligible papers, 13 studies satisfied our criteria: 10 focused on effectiveness, with eight demonstrating potential for improved proxy and actual clinical outcomes if a structured and/or coded EHR was combined with alerting or advisory systems in a focused clinical domain. Three studies demonstrated improvement in safety outcomes. No studies were found reporting value in relation to patient-centredness, timeliness, efficiency or equitability.Conclusions We conclude that, to date, there has been patchy effort to investigate empirically the value from structuring and coding EHRs for direct patient care. Future investments in structuring and coding of EHRs should be informed by robust evidence as to the clinical scenarios in which patient care benefits may be realised.

Clinical value of serum TRAb levels determination in diagnosis of Graves's disease

International Nuclear Information System (INIS)

Huang Zhaosui; Huang Chunhong; Liu Kaiyuan; Huang Shengli

2005-01-01

Objective: To investigate the clinical diagnostic value of serum TRAb levels determination in patients with Graves' disease. Methods: Serum TRAb (with RRA), FT 3 , FT 4 , TSH (with CLIA) levels were measured in 223 patients with Graves' disease both before and 6, 12, 36 months after treatment with antithyroid drugs (ATD) as well as in 50 controls. Results: Positive rate of serum TRAb was 93.3% in patients with Graves' disease before treatment. Six months after ATD therapy the positive rate dropped to 41.3%, being still significantly higher than that in controls (P<0.05). The TRAb positive rate dropped steadily with 12 (18.3% ), 24 (8.9% ) and 36 months (4.9%) of ATD treatment. In the 21 patients who had hyperthyroidism recurred after the course of treatment, TRAb remained positive in 18 of them (80.7%). Conclusion: Persistent positive TRAb despite euthyroid status in patients with Graves' disease after seemingly successful ATD treatment donates persistent immunodysfunction and possible recurrence. It is mandatory to continue ATD treatment until TRAb negative. (authors)

The clinical value of detecting INS and C - P in essential hypertension

International Nuclear Information System (INIS)

Huang Jianmin; Sun Shuqiang; Liu Xiaomei

2001-01-01

In order to explore the clinical value of insulin (INS) and C - peptide (C-P) in essential hypertension patients (EH), concentrations of blood glucose, serum INS and serum C - P both during fasting and 2 - hour postprandial time were measured in 32 non-diabetic patients with EH and 40 healthy persons, and the ISI of each group was calculated and compared. The results showed that with the exception of fasting blood glucose level being of no difference between two groups, all the other parameters observed, including concentrations of 2 hour postprandial glucose, both fasting and 2 hour postprandial INS and C - P were significantly higher than those of healthy control group (P < 0.01). The proportions of patients with insulin resistance and hyperinsulinemia in EH group were both significantly higher than those of control group (P < 0.01). These results suggest that EH patients may coexist with some metabolic disorders at the same time, thus INS and C - P detection may have other wider applications in non-diabetic diseases

The target landscape of clinical kinase drugs.

Science.gov (United States)

Klaeger, Susan; Heinzlmeir, Stephanie; Wilhelm, Mathias; Polzer, Harald; Vick, Binje; Koenig, Paul-Albert; Reinecke, Maria; Ruprecht, Benjamin; Petzoldt, Svenja; Meng, Chen; Zecha, Jana; Reiter, Katrin; Qiao, Huichao; Helm, Dominic; Koch, Heiner; Schoof, Melanie; Canevari, Giulia; Casale, Elena; Depaolini, Stefania Re; Feuchtinger, Annette; Wu, Zhixiang; Schmidt, Tobias; Rueckert, Lars; Becker, Wilhelm; Huenges, Jan; Garz, Anne-Kathrin; Gohlke, Bjoern-Oliver; Zolg, Daniel Paul; Kayser, Gian; Vooder, Tonu; Preissner, Robert; Hahne, Hannes; Tõnisson, Neeme; Kramer, Karl; Götze, Katharina; Bassermann, Florian; Schlegl, Judith; Ehrlich, Hans-Christian; Aiche, Stephan; Walch, Axel; Greif, Philipp A; Schneider, Sabine; Felder, Eduard Rudolf; Ruland, Juergen; Médard, Guillaume; Jeremias, Irmela; Spiekermann, Karsten; Kuster, Bernhard

2017-12-01

Kinase inhibitors are important cancer therapeutics. Polypharmacology is commonly observed, requiring thorough target deconvolution to understand drug mechanism of action. Using chemical proteomics, we analyzed the target spectrum of 243 clinically evaluated kinase drugs. The data revealed previously unknown targets for established drugs, offered a perspective on the "druggable" kinome, highlighted (non)kinase off-targets, and suggested potential therapeutic applications. Integration of phosphoproteomic data refined drug-affected pathways, identified response markers, and strengthened rationale for combination treatments. We exemplify translational value by discovering SIK2 (salt-inducible kinase 2) inhibitors that modulate cytokine production in primary cells, by identifying drugs against the lung cancer survival marker MELK (maternal embryonic leucine zipper kinase), and by repurposing cabozantinib to treat FLT3-ITD-positive acute myeloid leukemia. This resource, available via the ProteomicsDB database, should facilitate basic, clinical, and drug discovery research and aid clinical decision-making. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

Value and Payment in Sleep Medicine.

Science.gov (United States)

Wickwire, Emerson M; Verma, Tilak

2018-05-15

Value, like beauty, exists in the eye of the beholder. This article places the value of clinical sleep medicine services in historical context and presents a vision for the value-based sleep of the future. First, the history of value and payment in sleep medicine is reviewed from the early days of the field, to innovative disruption, to the widespread adoption of home sleep apnea testing. Next, the importance of economic perspective is discussed, with emphasis on cost containment and cost-shifting between payers, employers, providers, and patients. Specific recommendations are made for sleep medicine providers and the field at large to maximize the perceived value of sleep. Finally, alternate payment models and value-based care are presented, with an eye toward the future for clinical service providers as well as integrated health delivery networks. © 2018 American Academy of Sleep Medicine.

Accounting of costs in a service of physical health. Relative units of value in dosimetry clinic in teletherapy

International Nuclear Information System (INIS)

Font Gomez, J. A.; Gandia Martinez, A.; Jimenez Albericio, F. J.; Andres Redondon, M. M.; Mengual Gil, M. A.

2013-01-01

A single - although laborious - start in the economic and clinical management of our units can be come to the knowledge of the time invested in the tasks functional, having to differentiate them, name them and even encrypt them. The time spent in performing the tasks multiplied by the annual number of these will indicate the resources necessary to achieve our objectives. In addition, pooling the values of times that members of the Unit provide analysed inter-workers dispersal, their causes and possible solutions. The establishment of relative units of value in any process benefits all workers involved in the process since it allows to know the dispersion of the times that each person employed in the development of the tasks. (Author)

Investigation of the added value of high-energy electrons in intensity-modulated radiotherapy: four clinical cases

International Nuclear Information System (INIS)

Korevaar, Erik W.; Huizenga, Henk; Loef, Johan; Stroom, Joep C.; Leer, Jan Willem H.; Brahme, Anders

2002-01-01

Purpose: Intensity-modulated radiotherapy (IMRT) with photon beams is currently pursued in many clinics. Theoretically, inclusion of intensity- and energy-modulated high-energy electron beams (15-50 MeV) offers additional possibilities to improve radiotherapy treatments of deep-seated tumors. In this study the added value of high-energy electron beams in IMRT treatments was investigated. Methods and Materials: In a comparative treatment planning study, conventional treatment plans and various types of IMRT plans were constructed for four clinical cases (cancer of the bladder, pancreas, chordoma of the sacrum, and breast). The conventional plans were used for the actual treatment of the patients. The IMRT plans were optimized using the Orbit optimization code (Loef et al., 2000) with a radiobiologic objective function. The IMRT plans were either photon or combined electron and photon beam plans, with or without dose homogeneity constraints assuming standard or increased radiosensitivities of organs at risk. Results: Large improvements in expected treatment outcome are found using IMRT plans compared to conventional plans, but differences in tumor control probability (TCP) and normal tissue complication probabilities (NTCP) values between IMRT plans with and without electrons are small. However, the use of electrons improves the dose-volume histograms for organs at risk, especially at lower dose levels (e.g., 0-40 Gy). Conclusions: This preliminary study indicates that addition of higher energy electrons to IMRT can only marginally improve treatment outcome for the selected cases. The dose-volume histograms of organs at risk show improvements for IMRT with higher energy electrons, which may reduce tumor induction but does not substantially reduce NTCP

The adenoid-nasopharynx ratio. Its clinical value in children

International Nuclear Information System (INIS)

Zou Mingshun

1997-01-01

To evaluate the clinical usefulness of adenoid-nasopharynx ratio (A/N ratio) measured on nasopharyngeal lateral plain film, 106 clinical cases of secretory otitis media were selected to measure the A/N ratio before treatment. For patients with A/N ratio of 0.50-0.70, the symptoms improved distinctly after conservative treatment, but one half of patients with A/N ratio ≥ 0.71 required adenoidectomy. A/N ratio is a practical and convenient method for evaluation of the adenoid. A/N ratio ≥ 0.71 indicates pathological enlarged adenoid

Validation of predicted exponential concentration profiles of chemicals in soils

International Nuclear Information System (INIS)

Hollander, Anne; Baijens, Iris; Ragas, Ad; Huijbregts, Mark; Meent, Dik van de

2007-01-01

Multimedia mass balance models assume well-mixed homogeneous compartments. Particularly for soils, this does not correspond to reality, which results in potentially large uncertainties in estimates of transport fluxes from soils. A theoretically expected exponential decrease model of chemical concentrations with depth has been proposed, but hardly tested against empirical data. In this paper, we explored the correspondence between theoretically predicted soil concentration profiles and 84 field measured profiles. In most cases, chemical concentrations in soils appear to decline exponentially with depth, and values for the chemical specific soil penetration depth (d p ) are predicted within one order of magnitude. Over all, the reliability of multimedia models will improve when they account for depth-dependent soil concentrations, so we recommend to take into account the described theoretical exponential decrease model of chemical concentrations with depth in chemical fate studies. In this model the d p -values should estimated be either based on local conditions or on a fixed d p -value, which we recommend to be 10 cm for chemicals with a log K ow > 3. - Multimedia mass model predictions will improve when taking into account depth dependent soil concentrations

Chemical composition and the nutritive value of pistachio epicarp (in situ degradation and in vitro gas production techniques).

Science.gov (United States)

Bakhshizadeh, Somayeh; Taghizadeh, Akbar; Janmohammadi, Hossein; Alijani, Sadegh

2014-01-01

The nutritive value of pistachio epicarp (PE) was evaluated by in situ and in vitro techniques. Chemical analysis indicated that PE was high in crude protein (11.30%) and low in neutral detergent fiber (26.20%). Total phenols, total tannins, condensed tannins and hydrolysable tannins contents in PE were 8.29%, 4.48%, 0.49% and 3.79%, respectively. Ruminal dry matter and crude protein degradation after 48 hr incubation were 75.21% and 82.52%, respectively. The gas production volume at 48 hr for PE was 122.47 mL g(-1)DM. As a whole, adding polyethylene glycol (PEG) to PE increased (p gas production volumes, organic matter digestibility and the metabolizable energy that illustrated inhibitory effect of phenolics on rumen microbial fermentation and the positive influence of PEG on digestion PE. The results showed that PE possessed potentials to being used as feed supplements.

Chemical toxicity approach for emergency response

International Nuclear Information System (INIS)

Bauer, T.

2009-01-01

In the event of an airborne release of chemical agent or toxic industrial chemical by accidental or intentional means, emergency responders must have a reasonable estimate of the location and size of the resulting hazard area. Emergency responders are responsible for warning persons downwind of the hazard to evacuate or shelter-in-place and must know where to look for casualties after the hazard has passed or dissipated. Given the same source characterization, modern hazard assessment models provide comparable concentration versus location and time estimates. Even urban hazard assessment models often provide similar predictions. There is a major shortcoming, though, in applying model output to estimating human toxicity effects. There exist a variety of toxicity values for non-lethal effects ranging from short-term to occupational to lifetime exposures. For health and safety purposes, these estimates are all safe-sided in converting animal data to human effects and in addressing the most sensitive subset of the population. In addition, these values are usually based on an assumed 1 hour exposure duration at constant concentration and do not reflect either a passing clouds concentration profile or duration. Emergency responders need expected value toxicity parameters rather than the existing safe-sided ones. This presentation will specify the types of toxicity values needed to provide appropriate chemical hazard estimates to emergency responders and will demonstrate how dramatically their use changes the hazard area.(author)

Estimation of Radiative Efficiency of Chemicals with Potentially Significant Global Warming Potential.

Science.gov (United States)

Betowski, Don; Bevington, Charles; Allison, Thomas C

2016-01-19

Halogenated chemical substances are used in a broad array of applications, and new chemical substances are continually being developed and introduced into commerce. While recent research has considerably increased our understanding of the global warming potentials (GWPs) of multiple individual chemical substances, this research inevitably lags behind the development of new chemical substances. There are currently over 200 substances known to have high GWP. Evaluation of schemes to estimate radiative efficiency (RE) based on computational chemistry are useful where no measured IR spectrum is available. This study assesses the reliability of values of RE calculated using computational chemistry techniques for 235 chemical substances against the best available values. Computed vibrational frequency data is used to estimate RE values using several Pinnock-type models, and reasonable agreement with reported values is found. Significant improvement is obtained through scaling of both vibrational frequencies and intensities. The effect of varying the computational method and basis set used to calculate the frequency data is discussed. It is found that the vibrational intensities have a strong dependence on basis set and are largely responsible for differences in computed RE values.

Genetic variability of genital mycoplasmas and its clinical value

Directory of Open Access Journals (Sweden)

K. I. Plakhova

2015-01-01

Full Text Available The article presents data on genetic variability of genital mycoplasmas. The author presents the results of genetic variability studies for M. hominis, gene vaa, U. parvum, gene mba, and M. genitalium, gene mg192, sampled from women with different clinical manifestations of inflammatory diseases of the urogenital system. Based on the molecular typing results for 138 samples of genital mycoplasmas, the author revealed a relationship between clinical manifestations of inflammatory diseases of the urogenital system caused by U. parvum and different U. parvum serovars as well as different genetic variations of M. hominis.Infection with 6 U. parvum serovar results in the development of inflammatory diseases of the urogenital tract accompanied by subjective manifestations (р < 0.05. Genetic variant II of М. hominis was revealed more often in patients with clinical manifestations of inflammatory diseases while variant I was revealed more often in patients infected with М. hominis without any signs of inflammation (р < 0.05. Genetic variants of M. genitalium were determined; no significant differences in terms of their prevalence in the examined patients were revealed.

Chemical shift imaging: a review

International Nuclear Information System (INIS)

Brateman, L.

1986-01-01

Chemical shift is the phenomenon that is seen when an isotope possessing a nuclear magnetic dipole moment resonates at a spectrum of resonance frequencies in a given magnetic field. These resonance frequencies, or chemical shifts, depend on the chemical environments of particular nuclei. Mapping the spatial distribution of nuclei associated with a particular chemical shift (e.g., hydrogen nuclei associated with water molecules or with lipid groups) is called chemical shift imaging. Several techniques of proton chemical shift imaging that have been applied in vivo are presented, and their clinical findings are reported and summarized. Acquiring high-resolution spectra for large numbers of volume elements in two or three dimensions may be prohibitive because of time constraints, but other methods of imaging lipid of water distributions (i.e., selective excitation, selective saturation, or variations in conventional magnetic resonance imaging pulse sequences) can provide chemical shift information. These techniques require less time, but they lack spectral information. Since fat deposition seen by chemical shift imaging may not be demonstrated by conventional magnetic resonance imaging, certain applications of chemical shift imaging, such as in the determination of fatty liver disease, have greater diagnostic utility than conventional magnetic resonance imaging. Furthermore, edge artifacts caused by chemical shift effects can be eliminated by certain selective methods of data acquisition employed in chemical shift imaging

Chemical radioprotection

International Nuclear Information System (INIS)

Siegel, G.

1979-01-01

A reivew of the problems and progress in the field of chemical radioprotection is given. After defining the field of research, the practical significance of radioprotective substances and the requirements for a utilizable radioprotective preparation are presented. Trends of development of this field of research, the state of the art, and resulting conclusions for the future development of radioprotective substances of practical value are discussed. (author)

Terrestrial ecotoxicity of eight chemicals in a systematic approach

Energy Technology Data Exchange (ETDEWEB)

Hund-Rinke, K.; Simon, M. [Fraunhofer Inst. for Molecular Biology and Applied Ecology, Schmallenberg (Germany)

2005-07-01

Background and objective. Terrestrial ecotoxicity data are required for many research purposes. The data are derived either from the literature or elaborated by own investigations. As the terrestrial toxicity tests are usually time-consuming and labour intensive, the experiments are performed with a limited number of test organisms and soils. In the context of a project sponsored by CEFIC-LRI (European Chemical Industry Council - Long-Range Research Initiative), EC{sub 50}-values were systematically elaborated for eight chemicals with a wide range of logK{sub ow}-values (CdCl{sub 2}, Trinitrotoluene, 3,4-dichloroaniline, 2,4-dichlorophenol, Tributyltinchloride, Pentachlorophenol, Benzo(a)pyrene, p,p-dichloro-2,2-diphenyl-1,1,1-trichloroethane). The substances were selected covering a broad range of physico-chemical and ecotoxicological properties. As toxicity endpoints, microbial activities, plant germination and growth as well as reproduction of earthworms and collembola were determined. As such systematic investigations are rarely performed and for some substances no data existed, the data pool is made available to the scientific community. Methods. All toxicity tests were conducted on three different soil types (sandy soil, silty soil, loamy soil), according to ISO and OECD guidelines Results, discussion, conclusion and outlook. The different toxicities of the chemicals, the influence of soil properties on bioavailability as well as different sensitivities of test organisms and test parameters are reflected by the EC{sub 50}-values. The results showed that the EC{sub 50}-values calculated on the basis of nominal concentrations can significantly vary from EC{sub 50}-values derived from analytical concentrations for some substances. To avoid false conclusions, this has to be considered especially when concentrations determined in the field are compared with toxicity data obtained from the literature or calculated on the basis of nominal concentrations. Moreover

Further Relationships Between Blood Chemical Values and College Student Performance and Attitudes.

Science.gov (United States)

Lindeman, Richard H.; And Others

Blood serum uric acid and cholesterol levels in the blood were studied in relation to inner drive and external pressures of college students in the U.S.A. and in Sweden. Subjects for the study included 210 American and 78 Swedish male and female college students and 138 college football players. The blood chemicals were measured by Technicon…

The clinical value of 201Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

International Nuclear Information System (INIS)

Urbain, D.; Reding, P.; Georges, B.; Thys, O.; Ham, H.R.; Vrije Univ., Brussels

1986-01-01

The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death. (orig.)

Clinical value of sodium iodide symporter

International Nuclear Information System (INIS)

Li Qian

2003-01-01

The sodium iodide symptorter (NIS) is a membrane glycoprotein that mediates iodide uptake in the thyroid gland and several extrathyroidal tissues. In addition to thyroid tissues, the expression of NIS is found in stomach, prostate, placenta and so on. Radioiodine-concentrating activity in thyroid tissues has allowed the use of radioiodine as a diagnostic and therapeutic agent for patients with thyroid disorders. However, some extrathyroid tissues also take up radioiodine, contributing to unwanted side effects of radioiodine therapy. Now that the molecule of NIS has been cloned and characterized, it may be possible to develop novel strategies to differentially modulate NIS expression and activity, enhancing it in target tissues and impeding it in others. It is also important to explore the use of NIS as an imaging reporter gene to monitor the expression profile of the transgene in transgenic mouse animal models and in patients undergoing gene therapy clinical trials

Healthcare Practitioners' Personal and Professional Values

Science.gov (United States)

Moyo, Mpatisi; Goodyear-Smith, Felicity A.; Weller, Jennifer; Robb, Gillian; Shulruf, Boaz

2016-01-01

Personal and professional values of healthcare practitioners influence their clinical decisions. Understanding these values for individuals and across healthcare professions can help improve patient-centred decision-making by individual practitioners and interprofessional teams, respectively. We aimed to identify these values and integrate them…

Improving nutritive values of roughages by physical and chemical treatments

International Nuclear Information System (INIS)

Al-Masri, M.R.; Guenther, K.D.

1998-05-01

Experiments have been carried out to study the changes in the values of cell-wall constituents, total nitrogen (N), in vitro digestible crude protein (IVDCP), in vitro organic matter digestibility, and in vitro digestible energy of some agricultural residues after irradiation by various doses of gamma irradiation (0, 100, 150, 200 kilo gray, k Gy) or after spraying with different amounts of urea: 0, 20, 30, and 50 g urea/kg dry matter. The results indicated that treating with 3% - 5% urea or with 200 k Gy decreased the cell-wall constituents and increased the digestible energy values. Combined treatment resulted in a better increase in the digestible energy for all studied agricultural residues. Urea treatment increased total nitrogen and IVDCP. Gamma irradiation had no effect on N and IVDCP. (Author)

Improving nutritive values of roughages by physical and chemical treatments

International Nuclear Information System (INIS)

Al-Masri, M.R.; Guenther, K.D.

1998-01-01

Experiments have been carried out to study the changes in the values of cell-wall constituents, total nitrogen (N), in vitro digestible crude protein (IVDCP), in vitro organic matter digestibility, and in vitro digestible energy of some agricultural residues after irradiation by various doses of gamma irradiation (0, 100, 150, 200 kilo gray, k Gy) or after spraying with different amounts of urea: 0, 20, 30, and 50 g urea/kg dry matter. The results indicated that treating with 3% - 5% urea or with 200 k Gy decreased the cell-wall constituents and increased the digestible energy values. Combined treatment resulted in a better increase in the digestible energy for all studied agricultural residues. Urea treatment increased total nitrogen and iVDCP. Gamma irradiation had no effect on N and IVDCP. (Author)

Clinical values of CT and dynamic CT in brain infarction

International Nuclear Information System (INIS)

Lim, Soo Il; Jang, Do; Seo, Eun Joo; Sohn, Myung Hee; Choi, Ki Chul

1985-01-01

scan had a marked difference in CT (HU) on absolute scale graph of dynamic CT, so diagnosis of lacunar infarction could be made easily. 7. The clinical values of dynamic CT consist in not only diagnosis of lacunar infarction but also evaluation of effectiveness of medical or surgical treatment

Clinical value of colonic irrigation in patients with continence disturbances.

Science.gov (United States)

Briel, J W; Schouten, W R; Vlot, E A; Smits, S; van Kessel, I

1997-07-01

Continence disturbances, especially fecal soiling, are difficult to treat. Irrigation of the distal part of the large bowel might be considered as a nonsurgical alternative for patients with impaired continence. This study is aimed at evaluating the clinical value of colonic irrigation. Thirty-two patients (16 females; median age, 47 (range, 23-72) years) were offered colonic irrigation on an ambulatory basis. Sixteen patients suffered from fecal soiling (Group I), whereas the other 16 patients were treated for fecal incontinence (Group II). Patients were instructed by enterostomal therapists how to use a conventional colostomy irrigation set to obtain sufficient irrigation of the distal part of their large bowel. Patients with continence disturbances during the daytime were instructed to introduce 500 to 1,000 ml of warm (38 degrees C) water within 5 to 10 minutes after they passed their first stool. In addition, they were advised to wait until the urge to defecate was felt. Patients with soiling during overnight sleep were advised to irrigate during the evening. To determine clinical outcome, a detailed questionnaire was used. Median duration of follow-up was 18 months. Ten patients discontinued irrigation within the first month of treatment. Symptoms resolved completely in two patients. They believed that there was no need to continue treatment any longer. Irrigation had no effect in two patients. Despite the fact that symptoms resolved, six patients discontinued treatment because they experienced pain (n = 2) or they considered the irrigation to be too time-consuming (n = 4). Twenty-two patients are still performing irrigations. Most patients irrigated the colon in the morning after the first stool was passed. Time needed for washout varied between 10 and 90 minutes. Frequency of irrigations varied from two times per day to two times per week. In Group I, irrigation was found to be beneficial in 92 percent of patients, whereas 60 percent of patients in Group II

Clinical values of CT and dynamic CT in brain infarction

Energy Technology Data Exchange (ETDEWEB)

Lim, Soo Il; Jang, Do; Seo, Eun Joo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University College of Medicine, Jeonju (Korea, Republic of)

1985-04-15

-and postcontrast CT scan had a marked difference in CT (HU) on absolute scale graph of dynamic CT, so diagnosis of lacunar infarction could be made easily. 7. The clinical values of dynamic CT consist in not only diagnosis of lacunar infarction but also evaluation of effectiveness of medical or surgical treatment.

Plant cell tissue culture: A potential source of chemicals

Energy Technology Data Exchange (ETDEWEB)

Scott, C.D.; Dougall, D.K.

1987-08-01

Higher plants produce many industrially important products. Among these are drugs and medicinal chemicals, essential oils and flavors, vegetable oils and fats, fine and specialty chemicals, and even some commodity chemicals. Although, currently, whole-plant extraction is the primary means of harvesting these materials, the advent of plant cell tissue culture could be a much more effective method of producing many types of phytochemicals. The use of immobilized plant cells in an advanced bioreactor configuration with excretion of the product into the reactor medium may represent the most straightforward way of commercializing such techniques for lower-value chemicals. Important research and development opportunities in this area include screening for plant cultures for nonmedical, lower-value chemicals; understanding and controlling plant cell physiology and biochemistry; optimizing effective immobilization methods; developing more efficient bioreactor concepts; and perfecting product extraction and purification techniques. 62 refs., 2 figs.

Clinical value of serum anti-mullerian hormone and inhibin B in prediction of ovarian response in patients with polycystic ovary syndrome.

Science.gov (United States)

Zhang, Fan; Liu, Xiao-Ling; Rong, Nan; Huang, Xiao-Wen

2017-02-01

The present study aimed to investigate the clinical value of serum anti-mullerian hormone (AMH) and inhibin B (INHB) in predicting the ovarian response of patients with polycystic ovary syndrome (PCOS). A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response: a low-response group (n=36), a normal-response group (n=44), and a high-response group (n=40). The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay (ELISA). The follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels were determined by chemiluminescence microparticle immunoassay. The correlation of the serum AMH and INHB levels with other indicators was analyzed. A receiver operating characteristic (ROC) curve was established to analyze the prediction of ovarian response by AMH and INHB. The results showed that there were significant differences in age, body mass index (BMI), FSH, total gonadotropin-releasing hormone (GnRH), LH, E2, and antral follicle counts (AFCs) between the groups (Povarian response of PCOS patients increasing (Povarian response showed that the area under the ROC curve (AUC) value of the serum AMH level was 0.817, with a cut-off value of 1.29 ng/mL. The sensitivity and specificity were 71.2% and 79.6%, respectively. The AUC value of serum INHB was 0.674, with a cut-off value of 38.65 ng/mL, and the sensitivity and specificity were 50.7% and 74.5%, respectively. ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response, the AUC value of the serum AMH level was 0.742, with a cut-off value of 2.84 ng/mL, and the sensitivity and specificity were 72.7% and 65.9%, respectively; the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/mL, and the sensitivity and specificity were 76.3% and 40.2%, respectively. It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS

Encoding of Fundamental Chemical Entities of Organic Reactivity Interest using chemical ontology and XML.

Science.gov (United States)

Durairaj, Vijayasarathi; Punnaivanam, Sankar

2015-09-01

Fundamental chemical entities are identified in the context of organic reactivity and classified as appropriate concept classes namely ElectronEntity, AtomEntity, AtomGroupEntity, FunctionalGroupEntity and MolecularEntity. The entity classes and their subclasses are organized into a chemical ontology named "ChemEnt" for the purpose of assertion, restriction and modification of properties through entity relations. Individual instances of entity classes are defined and encoded as a library of chemical entities in XML. The instances of entity classes are distinguished with a unique notation and identification values in order to map them with the ontology definitions. A model GUI named Entity Table is created to view graphical representations of all the entity instances. The detection of chemical entities in chemical structures is achieved through suitable algorithms. The possibility of asserting properties to the entities at different levels and the mechanism of property flow within the hierarchical entity levels is outlined. Copyright © 2015 Elsevier Inc. All rights reserved.

Exploring the value of qualitative research films in clinical education.

Science.gov (United States)

Toye, Fran; Jenkins, Sue; Seers, Kate; Barker, Karen

2015-11-27

Many healthcare professionals use both quantitative and qualitative research to inform their practice. The usual way to access research findings is through peer-reviewed publications. This study aimed to understand the impact on healthcare professionals of watching and discussing a short research based film. The film, 'Struggling to be me' portrays findings from a qualitative synthesis exploring people's experiences of chronic pain, and was delivered as part of an inter-professional postgraduate e-learning module. The innovation of our study is to be the first to explore the impact of qualitative research portrayed through the medium of film in clinical education. All nineteen healthcare professionals enrolled on the course in December 2013 took part in on-line interviews or focus groups. We recorded and transcribed the interviews verbatim and used the methods of Grounded Theory to analyse the interview transcripts. Watching and discussing the film became a stimulus for learning : (a) A glimpse beneath the surface explored a pro-active way of seeing the person behind the pain (b) Pitfalls of the Medical Model recognised the challenge, for both patient and clinician, of 'sitting with' rather than 'fixing' an ill person; (c) Feeling bombarded by despair acknowledged the intense emotions that the clinicians brings to the clinical encounter; (d) Reconstructing the clinical encounter as a shared journey reconstructed the time-constrained clinical encounter as a single step on a shared journey towards healing, rather than fixing. Films portraying qualitative research findings can stimulate a pro-active and dialectic form of knowing. Research-based qualitative films can make qualitative findings accessible and can be a useful resource in clinical training. Our research presents, for the first time, specific learning themes for clinical education.

Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values.

Science.gov (United States)

Pasquarella, Cesira; Veronesi, Licia; Napoli, Christian; Castiglia, Paolo; Liguori, Giorgio; Rizzetto, Rolando; Torre, Ida; Righi, Elena; Farruggia, Patrizia; Tesauro, Marina; Torregrossa, Maria V; Montagna, Maria T; Colucci, Maria E; Gallè, Francesca; Masia, Maria D; Strohmenger, Laura; Bergomi, Margherita; Tinteri, Carola; Panico, Manuela; Pennino, Francesca; Cannova, Lucia; Tanzi, Marialuisa

2012-03-15

A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics. Copyright © 2012 Elsevier B.V. All rights reserved.

Valorisation of lignin – Achievements of the LignoValue project

NARCIS (Netherlands)

Gosselink, R.J.A.; Dam, van J.E.G.; Wild, de P.; Huijgen, W.; Bridgwater, T.; Heeres, H.J.; Kloekhorst, A.; Scott, E.L.; Sanders, J.P.M.

2011-01-01

Lignocellulosic biorefinery for production of biofuels, materials and chemicals requires valorization of all fractions including lignin. As a consequence of its poly-aromatic structure, lignin potentially serves as a source for aromatic chemicals. The developed biorefinery concept of the LignoValue

Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

Energy Technology Data Exchange (ETDEWEB)

Zaorsky, Nicholas G.; Malatesta, Theresa M.; Den, Robert B.; Wuthrick, Evan; Ahn, Peter H.; Werner-Wasik, Maria; Shi, Wenyin; Dicker, Adam P.; Anne, P. Rani; Bar-Ad, Voichita [Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org [Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)

2012-07-15

Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students' knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students' prerotation test scores had an average of 64% (95% confidence interval [CI], 61-66%). The postrotation test scores improved to an average of 82% (95% CI, 80-83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1-9; 95% CI, 7.3-9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5-9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6-9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

International Nuclear Information System (INIS)

Zaorsky, Nicholas G.; Malatesta, Theresa M.; Den, Robert B.; Wuthrick, Evan; Ahn, Peter H.; Werner-Wasik, Maria; Shi, Wenyin; Dicker, Adam P.; Anne, P. Rani; Bar-Ad, Voichita; Showalter, Timothy N.

2012-01-01

Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students’ knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students’ prerotation test scores had an average of 64% (95% confidence interval [CI], 61–66%). The postrotation test scores improved to an average of 82% (95% CI, 80–83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1–9; 95% CI, 7.3–9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5–9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6–9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

Clinical value of FDG-PET/CT in suspected paraneoplastic syndromes: a retrospective analysis of 137 patients

Energy Technology Data Exchange (ETDEWEB)

Bjoern Kristensen, Stine; Hess, Soeren; Petersen, Henrik; Hoeilund-Carlsen, Poul Flemming [Odense University Hospital, Department of Nuclear Medicine, Odense (Denmark)

2015-12-15

Paraneoplastic syndromes (PNS) are relatively infrequent manifestations appearing before or after a cancer declares itself. Autoimmune mechanisms may be involved, but their cause and pathogenesis are often unknown. Due to disparity of symptoms, PNS remain a major diagnostic challenge. We examined the value of FDG-PET/CT for ruling in or out malignancy in a heterogeneous group of patients with suspected PNS. We retrospectively extracted data from all patients referred 2009-2013 with suspected PNS. Data included age, sex, follow-up period, scan report, further diagnostic procedures, and final clinical diagnosis. Conclusions of the scan reports were compared to the final follow-up outcome as determined during an average follow-up of 31 months (range 6-51.5) in patients who were not diagnosed with cancer in immediate continuation of a positive PET/CT scan. A total of 137 patients were included. Main causes for referral were neurological (n = 67), rheumatological (n = 25), dermatological (n = 18), nephrological (n = 6), haematological (n = 2), abnormal biochemistry (n = 11), and others (n = 8). The cancer prevalence was 8.8 %. The FDG-PET/CT results were as follows: nine true positives, 22 false positives, 103 true negatives, and three false negatives. Corresponding diagnostic values were: sensitivity 75 %, specificity 82 %, accuracy 82 %, and positive and negative predictive values of 29 % and 97 %, respectively. FDG-PET/CT has in patients with suspected PNS an impressively high negative predictive value and may be of value in ruling out PNS, the more so, the more the number of false positives can be minimized or used in differential diagnosis. We believe that FDG-PET/CT may become an important adjunct to the work-up and triage of patients with suspected PNS. (orig.)

What Is the Value of Value-Based Purchasing?

Science.gov (United States)

Tanenbaum, Sandra J

2016-10-01

Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others). Process measures are usually based on clinical science that cannot determine the effects of a process on individual patients or patients with comorbidities, and do not necessarily measure effects that patients value; additionally, there is no provision for different patients valuing different things. Proximate outcome measures may or may not predict distal ones, and the more distal the outcome, the less reliably it can be attributed to health care. Outcome measures may be quite rudimentary, such as mortality rates, or highly contestable: survival or function after prostate surgery? When cost is an element of value-based purchasing, it is the cost to the value-based payer and not to other payers or patients' families. The greatest value of value-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press.

Clinical value of IS6110-based loop-mediated isothermal amplification for detection of Mycobacterium tuberculosis complex in respiratory specimens.

Science.gov (United States)

Aryan, Ehsan; Makvandi, Manoochehr; Farajzadeh, Ahmad; Huygen, Kris; Alvandi, Amir-Hooshang; Gouya, Mohammad-Mehdi; Sadrizadeh, Ali; Romano, Marta

2013-06-01

A fundamental to global tuberculosis (TB) control is timely and accurate diagnosis of infectious cases of the disease. Among various methods, techniques based on nucleic acid amplification are the ones with promising prospects. The present study evaluates the diagnostic value of the recently developed IS6110-based loop-mediated isothermal amplification (LAMP) for detection of Mycobacterium tuberculosis complex (MTBC) in sputum specimens. In this cross-sectional study (2008-2009), IS6110-LAMP was evaluated on 101 sputum specimens from 93 highly suspected TB patients and compared to Amplicor MTB test and in-house IS6110-PCR and -nested PCR assays. Culture results or clinical recovery following anti-TB therapy was considered as a reference to prove the TB cases. The overall sensitivity of IS6110-LAMP, Amplicor, nPCR, and PCR were respectively 89.6% (69/77 specimens; 95% confidence interval [CI], 80.5-95.4%), 76.6% (59/77 specimens; CI, 65.6-85.5%), 79.2% (61/77 specimens; CI, 68.5-87.6%) and 59.7% (46/77 specimens; CI, 47.9-70.8%). The specificity and positive predictive value (PPV) were 100% for all the tests, and the negative predictive value (NPV) of IS6110-LAMP, Amplicor, nPCR, and PCR were respectively 75%, 57.1%, 60%, and 43.6%. There was an excellent overall agreement between LAMP and nPCR (k 0.828), and between LAMP and Amplicor (k 0.746), in addition to a better tolerance of IS6110-LAMP to inhibitors present in clinical specimens. The better diagnostic performance of IS6110-LAMP compared to Amplicor (p = 0.009), nPCR (p = 0.013) and PCR (p < 0.0001) besides its rapidity, simplicity, and cost-effectiveness makes it a valuable method for the detection of MTBC in clinical samples, particularly in resource-limited settings. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

[Comparison of 2D and 3D sequences for MRCP. Clinical value of the different techniques].

Science.gov (United States)

Wallnoefer, A M; Herrmann, K A; Beuers, U; Zech, C J; Gourtsoyianni, S; Reiser, M F; Schoenberg, S O

2005-11-01

Magnetic resonance cholangio-pancreaticograpy (MRCP) is a non-invasive imaging modality of the pancreatico-biliary system which plays an increasingly important role in the clinical and diagnostic workup of patients with biliary or pancreatic diseases. The present review is designed to give an overview of the currently available and appropriate sequences, their technical background, as well as new developments and their relevance to the various clinical issues and challenges. The impact of the latest technical innovations, such as integrated parallel imaging techniques and navigator-based respiratory triggering, on the diagnostic capacities of MRCP is discussed. In this context, the individual value of RARE, T2w single shot turbo/fast spin echo (SSFSE) and the recently introduced 3D T2w turbo/fast spin echo sequences (T2w 3D-T/FSE) is reviewed. RARE imaging may be preferred in severely ill patients with limitations in cooperation, SSFSE is particularly effective in differentiating benign and malignant stenosis, and 3D-FSE offers additional advantages in the detection of small biliary concrements.

Chemical composition and the nutritive value of pistachio epicarp (in situ degradation and in vitro gas production techniques

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Somayeh Bakhshizadeh

2014-04-01

Full Text Available The nutritive value of pistachio epicarp (PE was evaluated by in situ and in vitro techniques. Chemical analysis indicated that PE was high in crude protein (11.30% and low in neutral detergent fiber (26.20%. Total phenols, total tannins, condensed tannins and hydrolysable tannins contents in PE were 8.29%, 4.48%, 0.49% and 3.79%, respectively. Ruminal dry matter and crude protein degradation after 48 hr incubation were 75.21% and 82.52%, respectively. The gas production volume at 48 hr for PE was 122.47 mL g-1DM. As a whole, adding polyethylene glycol (PEG to PE increased (p < 0.05 gas production volumes, organic matter digestibility and the metabolizable energy that illustrated inhibitory effect of phenolics on rumen microbial fermentation and the positive influence of PEG on digestion PE. The results showed that PE possessed potentials to being used as feed supplements.

Evaluation of clinical value of combined tumor markers detection in diagnosis of lung cancer

International Nuclear Information System (INIS)

Zhang Guangming; Deng Shouzhen; Wang Yun; Xu Lianqin; He Wanting; Gao Quan; Lin Xiangtong

2002-01-01

To evaluate clinical value of single or combined tumor marker detection CY21-1, CEA, CA15-3 and SCC in the diagnosis of lung cancer. There was retrospective analysis of 87 lung cancer inpatients, all of them was confirmed by pathology. Results showed: (1) Sensitivity of CY21-1, CEA, CA15-3 and SCC by single detection in diagnosing lung cancer was 59.8%, 39.1%, 44.8%, 18.4%, respectively. (2) Sensitivity of group I (CY21-1 + CEA) was 78.2%; sensitivity of group II (CY21-1 + CEA + CA15-3) was 88.5%; sensitivity of group III (CY21-1 + CEA + CA15-3 + SCC) was the same as group II. In the diagnosis of lung cancer, the combined detection with CY21-1, CEA, CA15-3 was an ideal selective combination

Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes

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Katerndahl, David A.; Bell, Iris R.; Palmer, Raymond F.; Miller, Claudia S.

2012-01-01

PURPOSE This study extends previous community-based studies on the prevalence and clinical characteristics of chemical intolerance in a sample of primary care clinic patients. We evaluated comorbid medical and psychiatric disorders, functional status, and rates of health care use. METHODS A total of 400 patients were recruited from 2 family medicine clinic waiting rooms in San Antonio, Texas. Patients completed the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to assess chemical intolerance; the Primary Care Evaluation of Mental Disorders (PRIME-MD) screen for possible psychiatric disorders; the Dartmouth–Northern New England Primary Care Cooperative Information Project (Dartmouth COOP) charts for functional status; and the Healthcare Utilization Questionnaire. RESULTS Overall, 20.3% of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. The total number of possible mental disorders was correlated with chemical intolerance scores (P intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non–chemically intolerant patients. After controlling for comorbid psychiatric conditions, the groups differed significantly only regarding limitations of social activities. CONCLUSIONS Chemical intolerance occurs in 1 of 5 primary care patients yet is rarely diagnosed by busy practitioners. Psychiatric comorbidities contribute to functional limitations and increased health care use. Chemical intolerance offers an etiologic explanation. Symptoms may resolve or improve with the avoidance of salient chemical, dietary (including caffeine and alcohol), and drug triggers. Given greater medication

The Chemical Potential of Plasma Membrane Cholesterol: Implications for Cell Biology.

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Ayuyan, Artem G; Cohen, Fredric S

2018-02-27

Cholesterol is abundant in plasma membranes and exhibits a variety of interactions throughout the membrane. Chemical potential accounts for thermodynamic consequences of molecular interactions, and quantifies the effective concentration (i.e., activity) of any substance participating in a process. We have developed, to our knowledge, the first method to measure cholesterol chemical potential in plasma membranes. This was accomplished by complexing methyl-β-cyclodextrin with cholesterol in an aqueous solution and equilibrating it with an organic solvent containing dissolved cholesterol. The chemical potential of cholesterol was thereby equalized in the two phases. Because cholesterol is dilute in the organic phase, here activity and concentration were equivalent. This equivalence allowed the amount of cholesterol bound to methyl-β-cyclodextrin to be converted to cholesterol chemical potential. Our method was used to determine the chemical potential of cholesterol in erythrocytes and in plasma membranes of nucleated cells in culture. For erythrocytes, the chemical potential did not vary when the concentration was below a critical value. Above this value, the chemical potential progressively increased with concentration. We used standard cancer lines to characterize cholesterol chemical potential in plasma membranes of nucleated cells. This chemical potential was significantly greater for highly metastatic breast cancer cells than for nonmetastatic breast cancer cells. Chemical potential depended on density of the cancer cells. A method to alter and fix the cholesterol chemical potential to any value (i.e., a cholesterol chemical potential clamp) was also developed. Cholesterol content did not change when cells were clamped for 24-48 h. It was found that the level of activation of the transcription factor STAT3 increased with increasing cholesterol chemical potential. The cholesterol chemical potential may regulate signaling pathways. Copyright © 2018. Published by

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.

Science.gov (United States)

El Alaoui, Samir; Lindefors, Nils

2016-01-01

A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT). Data was collected from 568 adult patients treated with ICBT for depression during 2013-2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Taking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 cost-effectiveness plane at both post-treatment and at follow-up, indicating that the ICBT treatment was less costly and equally effective after staff reallocation. Treating patients to the target

Prognostic value of Ki-67 index in adult medulloblastoma after accounting for molecular subgroup: a retrospective clinical and molecular analysis.

Science.gov (United States)

Zhao, Fu; Zhang, Jing; Li, Peng; Zhou, Qiangyi; Zhang, Shun; Zhao, Chi; Wang, Bo; Yang, Zhijun; Li, Chunde; Liu, Pinan

2018-04-23

Medulloblastoma (MB) is a rare primary brain tumor in adults. We previously evaluated that combining both clinical and molecular classification could improve current risk stratification for adult MB. In this study, we aimed to identify the prognostic value of Ki-67 index in adult MB. Ki-67 index of 51 primary adult MBs was reassessed using a computer-based image analysis (Image-Pro Plus). All patients were followed up ranging from 12 months up to 15 years. Gene expression profiling and immunochemistry were used to establish the molecular subgroups in adult MB. Combined risk stratification models were designed based on clinical characteristics, molecular classification and Ki-67 index, and identified by multivariable Cox proportional hazards analysis. In our cohort, the mean Ki-67 value was 30.0 ± 11.3% (range 6.56-63.55%). The average Ki-67 value was significantly higher in LC/AMB than in CMB and DNMB (P = .001). Among three molecular subgroups, Group 4-tumors had the highest average Ki-67 value compared with WNT- and SHH-tumors (P = .004). Patients with Ki-67 index large than 30% displayed poorer overall survival (OS) and progression free survival (PFS) than those with Ki-67 less than 30% (OS: P = .001; PFS: P = .006). Ki-67 index (i.e. > 30%, < 30%) was identified as an independent significant prognostic factor (OS: P = .017; PFS: P = .024) by using multivariate Cox proportional hazards model. In conclusion, Ki-67 index can be considered as a valuable independent prognostic biomarker for adult patients with MB.

Self-assessment of clinical nurse mentors as dimensions of professional development and the capability of developing ethical values at nursing students: A correlational research study.

Science.gov (United States)

Skela-Savič, Brigita; Kiger, Alice

2015-10-01

Providing adequate training for mentors, fostering a positive mentorship culture and establishing the necessary operational procedures for ensuring mentorship quality are the keys to effective clinical mentoring of nursing students. The purpose of the research was to explain different dimensions of clinical mentors' professional development and their capability of developing ethical values in nursing students. A non-experimental quantitative research design was employed. Data were collected by means of a questionnaire administered to the population of clinical mentors (N=143). The total number of questions was 36. Descriptive statistics were used, and bivariate analysis, factor analysis, correlation analysis and linear regression analysis were performed. The professional development of clinical nurse mentors was explained (R(2)=0.256) by career advancement (p=0.000), research and learning (p=0.024) and having a career development plan (p=0.043). Increased professional self-confidence (R(2)=0.188) was explained by career advancement (p=0.000) and the time engaged in record keeping (p=0.028). Responsibility for the development of ethical values in nursing students (R(2)=0.145) was explained by the respondents' level of education (p=0.020) and research and learning (p=0.024). Applying ethical principles and norms into practice (R(2)=0.212) was explained by self-assessed knowledge in ethics (p=0.037) and research and learning (p=0.044). Clinical nurse mentors tended to lack a career development plan, had low work time spent on research and insufficiently participated in education and training activities, which turned out to be significant explanatory factors of their professional development and their capability of developing ethical values in nursing students. The research showed that nursing and higher education managers often failed to assume responsibility for the professional development of clinical nurse mentors. Copyright © 2015 Elsevier Ltd. All rights

Organoleptic and physico-chemical evaluation of capretto baladi goats: a value-added meat alternative in an extensive rearing system

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S. Abi Saab

2017-06-01

Full Text Available Abi Saab, S. Esseily, F. Saliba, M. and Aad P. 2017. Organoleptic and physico-chemical evaluation of capretto baladi goats: a value-added meat alternative in an extensive rearing system. Lebanese Science Journal. 18(1: 73-80. The local Baladi breed is considered a common source of fresh meat in Lebanon. Due to the extensive rearing system and the scarcity of pasture, kids resulting from multiple births are not reared, though cultural preference for young meat may valorize these twin kids as an expensive delicacy. Few studies observed growth parameters, physical-chemical and sensory properties of meat in Baladi kids. Therefore, 24 male Baladi kids were fed milk ad libitum post-natally for 24 days, after which 9 were randomly selected and fed pasture grass ad libitum and goat milk (Control, and 15 were fed only milk (Capretto twice per day. Animals were slaughtered at 4, 6 and 8 weeks of age and body organs compared. Feed intake was measured by weighing kids pre- and post- feeding, and body weight measured twice per week. Meat chemical properties were total ether-extracted fat, kjeldhal protein, and minerals. Meat organoleptic properties were evaluated by consumers for color, taste, odor, richness, juiciness, tenderness and overall appreciation, as cooked by housewives or professionals. Data were analyzed as a CRD using SPSS 10.0 and presented as LSMeans ± SEM. Results showed that Capretto consumed increasing levels of milk from 4 to 8 weeks, with ADG decreasing (P 0.05 between Capretto and control, although capretto showed lower (p<0.05 meat fat content than control kids. Meat organoleptic characteristics were desirable at weeks 4 and 6 for both Capretto and control kids, whereas only Capretto meat stayed desirable at week 8. To conclude, Capretto kids have similar properties to their traditional counterparts, with added desirable properties for a longer growing period, in addition to the increased health benefit of lower fat content.

Investigation of the chemical origin and evidential value of differences in the SERS spectra of blue gel inks.

Science.gov (United States)

Ho, Yen Cheng; Lee, Wendy W Y; Bell, Steven E J

2016-08-15

Highly swellable polymer films doped with Ag nanoparticle aggregates (poly-SERS films) have been used to record very high signal : noise ratio, reproducible surface-enhanced (resonance) Raman (SER(R)S) spectra of in situ dried ink lines and their constituent dyes using both 633 and 785 nm excitation. These allowed the chemical origins of differences in the SERRS spectra of different inks to be determined. Initial investigation of pure samples of the 10 most common blue dyes showed that the dyes which had very similar chemical structures such as Patent Blue V and Patent Blue VF (which differ only by a single OH group) gave SERRS spectra in which the only indications that the dye structure had been changed were small differences in peak positions or relative intensities of the bands. SERRS studies of 13 gel pen inks were consistent with this observation. In some cases inks from different types of pens could be distinguished even though they were dominated by a single dye such as Victoria Blue B (Zebra Surari) or Victoria Blue BO (Pilot Acroball) because their predominant dye did not appear in other inks. Conversely, identical spectra were also recorded from different types of pens (Pilot G7, Zebra Z-grip) because they all had the same dominant Brilliant Blue G dye. Finally, some of the inks contained mixtures of dyes which could be separated by TLC and removed from the plate before being analysed with the same poly-SERS films. For example, the Pentel EnerGel ink pen was found to give TLC spots corresponding to Erioglaucine and Brilliant Blue G. Overall, this study has shown that the spectral differences between different inks which are based on chemically similar, but nonetheless distinct dyes, are extremely small, so very close matches between SERRS spectra are required for confident identification. Poly-SERS substrates can routinely provide the very stringent reproducibility and sensitivity levels required. This, coupled with the awareness of the reasons

Chemical influences of the environment

Energy Technology Data Exchange (ETDEWEB)

Carr, D J

1961-01-01

It is possible to consider the chemical effects of the environment in various ways. A distinction can be made, for instance, between chemical and physicochemical effects. The latter would include such phenomena as osmotic pressure, pH, adsorption phenomena and redox potentials. Of these, pH is so universally involved in physiological experiments as to render any treatment of its effects almost superfluous. The measurement and interpretation of redox potentials is so fraught with difficulties that they are of real value only with systems which can be simplified to a few chemical components. In this study of the effects of chemicals on plant growth and development, only such chemicals as occur in natural environments where plants grow will be considered. The effects of synthetic hormones or of fertilizers will, therefore, be neglected, but some attention must be given to certain gases which, as pollutants, must be considered as part of the atmosphere of any industrialized country. They are O/sub 3/, CO, and ethylene.

Predicting degradability of organic chemicals

Energy Technology Data Exchange (ETDEWEB)

Finizio, A; Vighi, M [Milan Univ. (Italy). Ist. di Entomologia Agraria

1992-05-01

Degradability, particularly biodegradability, is one of the most important factors governing the persistence of pollutants in the environment and consequently influencing their behavior and toxicity in aquatic and terrestrial ecosystems. The need for reliable persistence data in order to assess the environmental fate and hazard of chemicals by means of predictive approaches, is evident. Biodegradability tests are requested by the EEC directive on new chemicals. Neverthless, degradation tests are not easy to carry out and data on existing chemicals are very scarce. Therefore, assessing the fate of chemicals in the environment from the simple study of their structure would be a useful tool. Rates of degradation are a function of the rates of a series of processes. Correlation between degradation rates and structural parameters are will be facilitated if one of the processes is rate determining. This review is a survey of studies dealing with relationships between structure and biodegradation of organic chemicals, to identify the value and limitations of this approach.

A comparison of chemical and ionization dosimetry for high-energy x-ray and electron beams

International Nuclear Information System (INIS)

Durocher, J.J.; Boese, H.; Cormack, D.V.; Holloway, A.F.

1981-01-01

A comparison was made of ferrous sulfate (Fricke) and ionometric methods for determining the absorbed dose in a phantom irradiated with 4-MV x-rays, 25-MV x-rays, or electron beams having various incident energies between 10 and 32 MeV. Both chemical and ionization instruments were calibrated in a 60 Co beam at a point in water where the absorbed dose had been previously determined. The chemical yield measurements were corrected for spatial variations in dose within the volume of the solution and used to obtain a value of the absorbed dose for each of the x-ray and electron beams. The ratios of G-values required for these determinations were taken from ICRU reports 14 and 21. Ionization instrument readings from three types of commercial ionization chambers were used to obtain alternate values of the absorbed dose for each radiation. C lambda and CE values used in determining these ionization values of dose were also taken from the above ICRU reports. For 4-MV x-rays the values of absorbed dose obtained from chemical measurements agreed to within 0.5% with values obtained from ionization measurements; for 25-MV x-rays the chemical values were about 1% higher than the ionization values; for the electron beams the chemical values were 1%-4% below the ionization values. These discrepancies suggest an inconsistency among the recommended G, C lambda, and CE values similar to that which has been noted by other workers

Critical value reporting: A survey of 36 clinical laboratories in South ...

African Journals Online (AJOL)

A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Results. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were ...

Clinical data management: Current status, challenges, and future directions from industry perspectives

Directory of Open Access Journals (Sweden)

Zhengwu Lu

2010-06-01

Full Text Available Zhengwu Lu1, Jing Su21Smith Hanley Consulting, Houston, Texas; 2Department of Chemical Engineering, University of Massachusetts, Amherst, MA, USAAbstract: To maintain a competitive position, the biopharmaceutical industry has been facing the challenge of increasing productivity both internally and externally. As the product of the clinical development process, clinical data are recognized to be the key corporate asset and provide critical evidence of a medicine’s efficacy and safety and of its potential economic value to the market. It is also well recognized that using effective technology-enabled methods to manage clinical data can enhance the speed with which the drug is developed and commercialized, hence enhancing the competitive advantage. The effective use of data-capture tools may ensure that high-quality data are available for early review and rapid decision-making. A well-designed, protocol-driven, standardized, site workflow-oriented and documented database, populated via efficient data feed mechanisms, will ensure regulatory and commercial questions receive rapid responses. When information from a sponsor’s clinical database or data warehouse develops into corporate knowledge, the value of the medicine can be realized. Moreover, regulators, payer groups, patients, activist groups, patient advocacy groups, and employers are becoming more educated consumers of medicine, requiring monetary value and quality, and seeking out up-todate medical information supplied by biopharmaceutical companies. All these developments in the current biopharmaceutical arena demand that clinical data management (CDM is at the forefront, leading change, influencing direction, and providing objective evidence. Sustaining an integrated database or data repository for initial product registration and subsequent postmarketing uses is a long-term process to maximize return on investment for organizations. CDM should be the owner of driving clinical data

Sensitivity and predictive value of 15 PubMed search strategies to answer clinical questions rated against full systematic reviews.

Science.gov (United States)

Agoritsas, Thomas; Merglen, Arnaud; Courvoisier, Delphine S; Combescure, Christophe; Garin, Nicolas; Perrier, Arnaud; Perneger, Thomas V

2012-06-12

Clinicians perform searches in PubMed daily, but retrieving relevant studies is challenging due to the rapid expansion of medical knowledge. Little is known about the performance of search strategies when they are applied to answer specific clinical questions. To compare the performance of 15 PubMed search strategies in retrieving relevant clinical trials on therapeutic interventions. We used Cochrane systematic reviews to identify relevant trials for 30 clinical questions. Search terms were extracted from the abstract using a predefined procedure based on the population, interventions, comparison, outcomes (PICO) framework and combined into queries. We tested 15 search strategies that varied in their query (PIC or PICO), use of PubMed's Clinical Queries therapeutic filters (broad or narrow), search limits, and PubMed links to related articles. We assessed sensitivity (recall) and positive predictive value (precision) of each strategy on the first 2 PubMed pages (40 articles) and on the complete search output. The performance of the search strategies varied widely according to the clinical question. Unfiltered searches and those using the broad filter of Clinical Queries produced large outputs and retrieved few relevant articles within the first 2 pages, resulting in a median sensitivity of only 10%-25%. In contrast, all searches using the narrow filter performed significantly better, with a median sensitivity of about 50% (all P PubMed pages. These results can help clinicians apply effective strategies to answer their questions at the point of care.

Chemical analysis and full value of albumens of meat of pork

OpenAIRE

BIRTA G.O.

2011-01-01

Quality of meat has a genetic conditionality and changes depending on external factors. The pedigree differences of quality of pork are based on quantitative correlation the degree of forming of muscular and fatty fabric. Meat of pigs of greasy and meat breeds already on a 5-6 monthly age has a complex of chemical and фізико-біологічних properties which determine his maturity, and meat and bacon to 6-7 monthly, that is why the animals of different directions of the productivity in a the same ...

Chemical analysis of reactor and commercial columbium

International Nuclear Information System (INIS)

Anon.

1981-01-01

The methods cover the chemical analysis of reactor and commercial columbium having chemical compositions within specified limits. The following analytical procedures are discussed along with apparatus, reagents, photometric practice, safety precautions, sampling, and rounding calculated values: nitrogen, by distillation (photometric) method; molybdenum and tungsten by the dithiol (photometric) method; iron by the 1,10-phenanthroline (photometric) method

Correlation between Expression of MVP, Index of p53 and AgNOR Value with Chemoradiotherapy Clinical Response of Cervical Cancer

Directory of Open Access Journals (Sweden)

I. Kurnia

2014-12-01

Full Text Available Cervical cancer is the most frequent cancer found in Indonesia. The primary treatment of cervical cancer at the locally advanced stage is usually performed by using radiotherapy and chemotherapy. The combination of the two techniques is often called chemoradioherapy. The response to chemoradiotherapy is influenced by biological and physical factors. Major vault protein (MVP is a ribonucleoprotein which contributes to drug resistance in some cancers. The purposes of this research were: (1 to determine the correlation between the expression of MVP and the index of p53, including AgNOR values and index of MIB-1; and (2 between MVP and chemoradiotherapy clinical response of cervical cancer. Twenty-one microscopic slides taken from biopsy tissues of cervical cancer patients before undergoing treatment were stained to identify MVP, p53, and MIB-1 by means of immunohistochemistry techniques and AgNORs staining. After undergoing chemoradiotherapy treatment, the patients’ clinical responses were observed by pelvic control method. Experimental results showed that there was a correlation between MVP and AgNOR value (P=0.05, but no correlation between MVP and index of p53 (P=0.729, including MIB-1 LI (P=0.63, in untreated cervical cancer. In addition, there was no association between MVP and chemoradioterapy response. In conclusion, MVP expression correlates with the process of cell proliferation before the G2 phase of cell cycle in untreated cancer cells. Those have no association with clinical responses after the completion of treatment.

Correlation between expression of MVP, index of p53 and AgNOR value with chemoradiotherapy clinical response of cervical cancer

International Nuclear Information System (INIS)

Kurnia, I.; Tetriana, D.; Siregar, B.; Ramli, I.; Andrijono, A.; Soetopo, S.; Kurjana, T.; Hernowo, B.S.; Tobing, M.D.M.

2014-01-01

Cervical cancer is the most frequent cancer found in Indonesia. The primary treatment of cervical cancer at the locally advanced stage is usually performed by using radiotherapy and chemotherapy. The combination of the two techniques is often called chemoradiotherapy. The response to chemoradiotherapy is influenced by biological and physical factors. Major vault protein (MVP) is a ribonucleoprotein which contributes to drug resistance in some cancers. The purposes of this research were: (1) to determine the correlation between the expression of MVP and the index of p53, including AgNOR values and index of MIB-1; and (2) between MVP and chemoradiotherapy clinical response of cervical cancer. Twenty-one microscopic slides taken from biopsy tissues of cervical cancer patients before undergoing treatment were stained to identify MVP, p53, and MIB-1 by means of immunohistochemistry techniques and AgNORs staining. After undergoing chemoradiotherapy treatment, the patients’ clinical responses were observed by pelvic control method. Experimental results showed that there was a correlation between MVP and AgNOR value (P=0.05), but no correlation between MVP and index of p53 (P=0.729), including MIB-1 LI (P=0.63), in untreated cervical cancer. In addition, there was no association between MVP and chemoradiotherapy response. In conclusion, MVP expression correlates with the process of cell proliferation before the G2 phase of cell cycle in untreated cancer cells. Those have no association with clinical responses after the completion of treatment. (author)

Quality of life after surgical treatment of coarctation in long-term follow-up (CoAFU): Predictive value of clinical variables.

Science.gov (United States)

Bambul Heck, Pinar; Pabst von Ohain, Jelena; Kaemmerer, Harald; Ewert, Peter; Hager, Alfred

2018-01-01

We sought to analyze the quality of life and the predictive value of clinical variables from previous follow-up study in patients late after surgical treatment of aortic coarctation on the quality of life. All patients, who have participated in the prospective cross-sectional COALA Study in 2000 with a structural clinical investigation including blood pressure measurement and symptom-limited exercise test were contacted for the health-related quality of life questionnaire SF-36 from January 2013 through December 2014. From 273 eligible patients, we received data from 135 patients, 9 of them died during the follow-up time at the median age of 46years (range 30-64years). Seventy-four patients did not participate in the study, other 64 patients moved to remote or unknown areas and could not be contacted. Quality of life was good in the fields of physical role and pain. However, patients reported a significant impairment in general health and in health transition, depending on the age. Arterial hypertension and variables from echocardiography or exercise testing from the COALA study were not predictive on functional health status. Quality of life in patients late after aortic coarctation repair is fairly good compared with healthy controls. Impairments in general health and health transition depend mainly on age, can be explained due to numerous comorbidities and reinterventions in long-term. The predictive value of the commonly assessed clinical variables on quality of life is limited. Copyright © 2017. Published by Elsevier B.V.

Do Simulation-Based Skill Exercises and Post-Encounter Notes Add Additional Value to a Standardized Patient-Based Clinical Skills Examination?

Directory of Open Access Journals (Sweden)

Michael D. Prislin

2011-01-01

Full Text Available Background. Standardized patient (SP clinical assessments have limited utility in assessing higher-level clinical competencies. This study explores the value of including simulation exercises and postencounter notes in an SP clinical skills examination. Methods. Two exercises involving cardiac auscultation and ophthalmic funduscopy simulations along with written post encounter notes were added to an SP-based performance examination. Descriptive analyses of students' performance and correlations with SP-based performance measures were obtained. Results. Students' abilities to detect abnormalities on physical exam were highly variable. There were no correlations between SP-based and simulation-derived measures of physical examination competency. Limited correlations were found between students' abilities to perform and document physical examinations and their formulation of appropriate differential diagnoses. Conclusions. Clinical simulation exercises add depth to SP-based assessments of performance. Evaluating the content of post encounter notes offers some insight into students' integrative abilities, and this appears to be improved by the addition of simulation-based post encounter skill exercises. However, further refinement of this methodology is needed.

The Enduring Value of the Physical Examination.

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Zaman, Junaid A B

2018-05-01

This article focuses exclusively on physical examination (PE) in the context of clinical medicine, that is, the interaction between a health care provider and patient. In essence, there is not only benefit (value) to PE but also that it will last (endure) for some time. Both "enduring" and "value" are explored in more depth with respect to the future integration of PE into the clinical assessment of a patient and how its value extends well beyond current diagnostic/cost-based metrics. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Prognostic value of site SYNTAX score and rationale for combining anatomic and clinical factors in decision making: Insights from the SYNTAX trial

NARCIS (Netherlands)

Y.-J. Zhang (Yao-Jun); A. Iqbal (Anwarul); C.A.M. Campos (Carlos); D. van Klaveren (David); C.V. Bourantas (Christos); K.D. Dawkins (Keith); A. Banning (Adrian); J. Escaned (Javier); T. de Vries (Ton); M-A.M. Morel (Marie-Angèle); V. Farooq (Vasim); Y. Onuma (Yoshinobu); H.M. Garcia-Garcia (Hector); G.W. Stone (Gregg); E.W. Steyerberg (Ewout); F.W. Mohr (Friedrich); P.W.J.C. Serruys (Patrick)

2014-01-01

textabstractBackground The results of SYNTAX trial have been reported based on "corelab" calculated SS (cSS). It has been shown that reproducibility of SS is better among the core laboratory technicians than interventional cardiologists. Thus, the prognostic value and clinical implication of the

Evaluation of the nutritional value of locally produced forage in Korea using chemical analysis and in vitro ruminal fermentation.

Science.gov (United States)

Ki, Kwang Seok; Park, Su Bum; Lim, Dong Hyun; Seo, Seongwon

2017-03-01

The use of locally produced forage (LPF) in cattle production has economic and environmental advantages over imported forage. The objective of this study was to characterize the nutritional value of LPF commonly used in Korea. Differences in ruminal fermentation characteristics were also examined for the LPF species commonly produced from two major production regions: Chungcheong and Jeolla. Ten LPF (five from each of the two regions) and six of the most widely used imported forages originating from North America were obtained at least three times throughout a year. Each forage species was pooled and analyzed for nutrient content using detailed chemical analysis. Ruminal fermentation characteristics were also determined by in vitro anaerobic incubations using strained rumen fluid for 0, 3, 6, 12, 24, and 48 h. At each incubation time, total gas, pH, ammonia, volatile fatty acid (VFA) concentrations, and neutral detergent fiber digestibility were measured. By fitting an exponential model, gas production kinetics were obtained. Significant differences were found in the non-fiber carbohydrate (NFC) content among the forage species and the regions (pruminal fermentation of LPF between the two regions and interactions between regions and forage species were also significant (pruminal fermentation was lower in the forages from Chungcheong than from Jeolla (p<0.01), and total VFA concentration was higher in Chungcheong than in Jeolla (p = 0.05). This implies that fermentation was more active with the forages from Chungcheong than from Jeolla. Analysis of gas production profiles showed the rate of fermentation differed among forage species (p<0.05). The results of the present study showed that the nutritional values of some LPF (i.e., corn silage and Italian ryegrass) are comparable to those of imported forages widely used in Korea. This study also indicated that the nutritional value of LPF differs by origin, as well as by forage species. Detailed analyses of nutrient

12C. Environmental Chemical Exposure: Endocrine System Effects and Clinical Health Implications

OpenAIRE

Cohen, Aly

2013-01-01

Focus Area: Pediatrics Every day, the United States alone uses or imports about 42 million pounds of synthetic chemicals. There are more than 84 000 compounds approved for commercial use in the United States, most of which have never been tested for toxicity. A 2011 policy statement issued by the American Academy of Pediatrics acknowledges that the large quantities of chemicals that enter commerce could be harmful to children's health and development. The contribution of many of these chemica...

Clinical Value of CT-Guided Needle Biopsy for Retroperitoneal Lesions

International Nuclear Information System (INIS)

Tomozawa, Yuki; Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kato, Mina; Kanamoto, Takaaki; Sakane, Makoto

2011-01-01

The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma.

Plasma biochemical reference values in clinically healthy captive bearded dragons (Pogona vitticeps) and the effects of sex and season.

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Tamukai, Kenichi; Takami, Yoshinori; Akabane, Yoshihito; Kanazawa, Yuko; Une, Yumi

2011-09-01

Bearded dragons are one of the most popular pet lizard species, and biochemical reference values are useful for health management of these reptiles. The objectives of this study were to measure plasma biochemical values in healthy captive bearded dragons, determine reference values, and evaluate the effects of sex and season on the results. Blood samples were collected from 100 captive healthy bearded dragons in Tokyo during the summer and winter. Plasma biochemical measurements were performed using a dry-slide automated biochemical analyzer. The data were then compared based on sex and season using 2-way ANOVA. Globulin, cholesterol, and calcium concentrations of females were higher in both summer and winter compared with the values obtained for males. Both males and females had higher uric acid concentrations in winter than in summer. When compared with males, females had a higher chloride concentration in summer and a higher total protein concentration and aspartate aminotransferase activity in winter. Potassium concentration in males was lower in winter than in summer, whereas in females cholesterol concentration was lower in winter than in summer. Biochemical values that differed based on sex and season in bearded dragons were similar to those in other lizards. These differences reflect physiologic differences in reproductive status in females and seasonal changes in temperature and hydration status. Plasma biochemical values established for bearded dragons in this study will be useful in the diagnostic assessment of captive animals. ©2011 American Society for Veterinary Clinical Pathology.

International Trade of Croatian Chemical Industry Summary

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Goran Buturac

2009-07-01

Full Text Available In this paper Croatian chemical industry in international trade is analyzed by applying k-means cluster method. The work is oriented toward the role and contribution of individual product groups in total trade patterns of chemical industry. The RCA indicator, GL index, RUV indicator and the share of individual chemical products in the total export of chemical industry are used as variables. The products at the fourdigit level of the SITC are used as objects. The cluster of chemical products in which Croatia has comparative advantages contributes significantly in export structure. At the same time this cluster consists of a few product types thus indicating strong export concentration of Croatian chemical industry. Regarding of the value of RUV indicator, Croatian chemical industry benefits most in the international trade with antibiotics and medicines that contain antibiotics. Beside fertilizers, these two products have the greatest share in the export structure. The great majority of the chemical products have the low level of intra-industry trade specialization.

Diagnosis of early sacroiliitis in seronegative spondyloarthropathies by DWI and correlation of clinical and laboratory findings with ADC values

Energy Technology Data Exchange (ETDEWEB)

Gezmis, Esin; Donmez, Fuldem Y., E-mail: fuldemyildirim@yahoo.com; Agildere, Muhtesem

2013-12-01

Purpose: Sacroiliitis is one of the diagnostic criteria of seronegative SpA. The purpose of our study is to show the signal characteristics of the sacral and iliac surfaces by DWI which may contribute in early diagnosis of sacroiliitis and investigate the correlation between ADC values and clinical and laboratory parameters. Materials and methods: 62 patients with inflammatory low back pain, with a history or suspect of seronegative SpA are enrolled into the study. 40 age and sex-matched subjects without SpA constituted the control group. After obtaining routine T1 and T2 weighted sequences, echo planar imaging at b values of 0, 400 and 800 was performed. ADC values on both surfaces of the both sacroiliac joints were measured in all subjects. The CRP and sedimentation results and the presence of arthritis and enthesitis were also correlated with the ADC values. Results: ADC values on both surfaces of the both sacroiliac joints were found 0.23 × 10{sup −3} mm{sup 2}/sn in the control group. In the patient group, mean ADC value of 0.48 × 10{sup −3} mm{sup 2}/sn was obtained (p < 0.001), which was statistically significant, compatible with the increased diffusion due to medullary edema in early sacroiliitis. There was a slight correlation between CRP and ADC values; presumed to be showing the relation between the activity of the disease and the active inflammation on DWI. There was no correlation between arthritis and enthesitis and the ADC values (p > 0.001). Conclusion: DWI, by measuring ADC values, adds significant information in the early diagnosis of sacroiliitis and may help to evaluate the efficiency of the treatment.

Management of chemical disposal in BARC

International Nuclear Information System (INIS)

Shenoy, K.T.; Deolekar, Shailesh

2017-01-01

Most of the activities in BARC are of radiological in nature and are regulated as per Atomic Energy Act 1962. The radioactive waste generated is managed safely as per Atomic Energy (Safe Disposal of Radioactive Waste) Rules, 1987. However, many developmental activities related to nuclear fuel cycle and laboratories, which support the quality control aspects, generate inactive chemical waste. In addition, being multidisciplinary in nature, BARC carries out research in frontiers of chemical science for societal benefit and academic interest. All these scientific activities over the decades have resulted in accumulation of many partially used/surplus laboratory chemicals. These chemicals are in large varieties though small in terms of quantity. Although these chemicals do not have any further utility and commercial value, can add to potential hazards and hence require safe disposal. Considering this, BARC Safety Council(BSC) has re-constituted the 'Advisory Committee for Chemical Disposal (ACCD)' on March 18, 2016

The clinical value of MR diffusion-weighted imaging in the follow-up observation of hepatocellular carcinoma after transcatheter arterial chemoembolization

International Nuclear Information System (INIS)

Li Zhenwu; Zhang Wei; Sun Lijun; Qi Shun

2010-01-01

Objective: To discuss the clinical value of MR diffusion-weighted imaging (DWI) in the follow-up of hepatocellular carcinoma after transcatheter arterial chemo embolization (TACE). Methods: MR DWI was performed in 16 patients with hepatocellular carcinoma after receiving TACE. The DWI findings were compared with DSA and/or CT signs. The mean apparent diffusion coefficient (ADC) value of each lesion was determined separately, and the mean ADC value of intra-hepatic metastatic lesion was compared with that of the primary lesion. Results: A total of 18 lesions were revealed in DSA, of which satisfactory iodinated oil deposit was seen in 11 (satisfactory group) and poor deposit in 7 (poor group). After TACE, the mean ADC value of normal hepatic parenchyma showed no obvious changes when compared to its preoperative value (t = 0.54, P > 0.05). The mean ADC value obtained in poor group was significantly lower than that obtained in satisfactory group (t = 4.81, P < 0.01). In satisfactory group the preoperative ADC values were higher than the postoperative ones (t = 6.81, P < 0.01), while in poor group no significant difference was found between preoperative and postoperative ADC values. In addition, twelve intra-hepatic metastases were detected on DWI. Statistically significant difference in the mean ADC value existed between the metastatic lesions and the primary lesions (t = 4.61, P < 0.01). Conclusion: DWI is very sensitive in detecting hepatic metastatic lesions and, therefore, can be used to evaluate the therapeutic effect of TACE. (authors)

Predictive value of antinuclear antibodies in autoimmune diseases classified by clinical criteria: Analytical study in a specialized health institute, one year follow-up

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María Elena Soto

2015-01-01

Full Text Available Introduction: Determination of antinuclear antibodies (ANA by indirect immunofluorescence (IIF is usually the initial test for the diagnosis of systemic rheumatic diseases (SRD. Assigning predictive values to positive and negative results of the test is vital because lack of knowledge about ANAs and their usefulness in classification criteria of SRD leads to inappropriate use. Methods: Retrospective study, ANA tests requested by different specialties, correlation to patients' final diagnosis. Results: The prevalence of autoimmune disease was relatively low in our population yielding a low PPV and a high NPV for the ANA test. 40% of the patients had no clinical criteria applied prior to test. Coexistence of two or more autoimmune disorders affects prevalence and predictive values. Conclusion: Application of the test after careful evaluation for clinical criteria remarkably improves the positive likelihood ratio for the diagnosis.

Dietary antioxidant synergy in chemical and biological systems.

Science.gov (United States)

Wang, Sunan; Zhu, Fan

2017-07-24

Antioxidant (AOX) synergies have been much reported in chemical ("test-tube" based assays focusing on pure chemicals), biological (tissue culture, animal and clinical models), and food systems during the past decade. Tentative synergies differ from each other due to the composition of AOX and the quantification methods. Regeneration mechanism responsible for synergy in chemical systems has been discussed. Solvent effects could contribute to the artifacts of synergy observed in the chemical models. Synergy in chemical models may hardly be relevant to biological systems that have been much less studied. Apparent discrepancies exist in understanding the molecular mechanisms in both chemical and biological systems. This review discusses diverse variables associated with AOX synergy and molecular scenarios for explanation. Future research to better utilize the synergy is suggested.

Clinical value of natriuretic peptides in chronic kidney disease

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Carla Santos-Araújo

2015-05-01

This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure.

Image-Rich Radiology Reports: A Value-Based Model to Improve Clinical Workflow.

Science.gov (United States)

Patel, Bhavik N; Lopez, Jose M; Jiang, Brian G; Roth, Christopher J; Nelson, Rendon C

2017-01-01

To determine the value of image-rich radiology reports (IRRR) by evaluating the interest and preferences of referring physicians, potential impact on clinical workflow, and the willingness of radiologists to create them. Referring physicians and radiologists were interviewed in this prospective, HIPAA-compliant study. Subject willingness to participate in the study was determined by an e-mail. A single investigator conducted all interviews using a standard questionnaire. All subjects reviewed a video mockup demonstration of IRRR and three methods for viewing embedded images, as follows: (1) clickable hyperlinks to access a scrollable stack of images, (2) scrollable and enlargeable small-image thumbnails, and (3) scrollable but not enlargeable medium-sized images. Questionnaire responses, free comments, and general impressions were captured and analyzed. Seventy-two physicians (36 clinicians, 36 radiologists) were interviewed. Thirty-one clinicians (86%) expressed interest in using IRRR. Seventy-seven percent of subjects believed IRRR would improve communication. Ten clinicians (28%) preferred method 1, 18 (50%) preferred method 2, and 8 (22%) preferred method 3 for embedding images. Thirty clinicians (83%) stated that IRRR would improve efficiency. Twenty-two radiologists (61%) preferred selecting a tool button with a mouse and right-clicking images to embed them, 13 (36%) preferred pressing a function key, and 11 (31%) preferred dictating series and image numbers. The average time radiologists were willing to expend for embedding images was 66.7 seconds. Referring physicians and radiologist both believe IRRR would add value by improving communication with the potential to improve the workflow efficiency of referring physicians. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Feasibility of using ‘lung density’ values estimated from EIT images for clinical diagnosis of lung abnormalities in mechanically ventilated ICU patients

International Nuclear Information System (INIS)

Nebuya, Satoru; Koike, Tomotaka; Imai, Hiroshi; Iwashita, Yoshiaki; Brown, Brian H; Soma, Kazui

2015-01-01

This paper reports on the results of a study which compares lung density values obtained from electrical impedance tomography (EIT), clinical diagnosis and CT values (HU) within a region of interest in the lung. The purpose was to assess the clinical use of lung density estimation using EIT data. In 11 patients supported by a mechanical ventilator, the consistency of regional lung density measurements as estimated by EIT was validated to assess the feasibility of its use in intensive care medicine. There were significant differences in regional lung densities recorded in the supine position between normal lungs and diseased lungs associated with pneumonia, atelectasis and pleural effusion (normal; 240 ± 71.7 kg m"−"3, pneumonia; 306 ± 38.6 kg m"−"3, atelectasis; 497 ± 130 kg m"−"3, pleural effusion; 467 ± 113 kg m"−"3: Steel–Dwass test, p < 0.05). In addition, in order to compare lung density with CT image pixels, the image resolution of CT images, which was originally 512 × 512 pixels, was changed to 16 × 16 pixels to match that of the EIT images. The results of CT and EIT images from five patients in an intensive care unit showed a correlation coefficient of 0.66 ± 0.13 between the CT values (HU) and the lung density values (kg m"−"3) obtained from EIT. These results indicate that it may be possible to obtain a quantitative value for regional lung density using EIT. (paper)

Development of Screening Tools for the Interpretation of Chemical Biomonitoring Data

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Richard A. Becker

2012-01-01

Full Text Available Evaluation of a larger number of chemicals in commerce from the perspective of potential human health risk has become a focus of attention in North America and Europe. Screening-level chemical risk assessment evaluations consider both exposure and hazard. Exposures are increasingly being evaluated through biomonitoring studies in humans. Interpreting human biomonitoring results requires comparison to toxicity guidance values. However, conventional chemical-specific risk assessments result in identification of toxicity-based exposure guidance values such as tolerable daily intakes (TDIs as applied doses that cannot directly be used to evaluate exposure information provided by biomonitoring data in a health risk context. This paper describes a variety of approaches for development of screening-level exposure guidance values with translation from an external dose to a biomarker concentration framework for interpreting biomonitoring data in a risk context. Applications of tools and concepts including biomonitoring equivalents (BEs, the threshold of toxicologic concern (TTC, and generic toxicokinetic and physiologically based toxicokinetic models are described. These approaches employ varying levels of existing chemical-specific data, chemical class-specific assessments, and generic modeling tools in response to varying levels of available data in order to allow assessment and prioritization of chemical exposures for refined assessment in a risk management context.

A retrospective analysis of heterophoria values in a clinical population aged 18 to 30 years

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N.T. Makgaba

2006-12-01

Full Text Available Information on heterophoria values in South Africans  is  scanty. The  purpose  of  this  paper therefore, is to present information on the distribution of heterophoria in a clinical popula-tion aged 18 to 30 years, which hitherto is not available. The data presented here was obtained from  the  record  cards  of  475  black  South African  patients  examined  at  the  Optometry clinic, University of Limpopo (Turfloop cam-pus between 2000 and 2005. The patients were examined by final year students under the supervision  of  qualified  optometrists.  Heterophoria was  measured  for  each  patient  using  the  von Graefe  method.  The  horizontal  heterophoria for distance vision (6 m ranged from 16 prism diopters (pd esophoria to 12 pd exophoria with a mean of 0.74 pd exophoria (SD = ± 2.84 pd. For  distance  vision,  esophoria  ranged  from 0.5 to 16 pd with a mean of 3.08 pd (SD = ± 3.09, while exophoria ranged from 0.5 pd to 12 pd with a mean of 2.21 pd (SD = 1.82 pd. For near vision (0.4 m, the horizontal phorias ranged from 17 pd esophoria to 15 pd exopho-ria with a mean of 3.84 pd exophoria (SD = ± 4.80 pd. The near esophorias ranged from 0.5 to 17 pd with a mean 4.88 pd (SD = ± 3.41, while the exophorias ranged from 1.0 to 15 pd with a mean of 6.30 pd (SD = ± 2.58. Vertical heterophoria for distance vision ranged from 5 to 3 pd right hyperphoria with a mean of 0.05 pd right hyperphoria (SD = ± 0.76 whereas at near it ranged from 4 to 6 pd right hyperphoria with a mean of 0.08 pd right hypophoria (SD =  ±  0.96.  The  distributions  of  heterophoria at distance and near were non-normal.  There was  no  significant  gender  variation  in  the horizontal  values  for  distance  vision  and  the vertical  (distance  and  near  ones.  However, there was a statistically significant gender varia-tion  in  the  near  horizontal  values  (p �

Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education.

Science.gov (United States)

de Paula, Jonas Jardim; Bertola, Laiss; Ávila, Rafaela Teixeira; Moreira, Lafaiete; Coutinho, Gabriel; de Moraes, Edgar Nunes; Bicalho, Maria Aparecida Camargos; Nicolato, Rodrigo; Diniz, Breno Satler; Malloy-Diniz, Leandro Fernandes

2013-01-01

The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.

Valorization of Renewable Carbon Resources for Chemicals.

Science.gov (United States)

Chen, Xi; Zhang, Bin; Wang, Yunzhu; Yan, Ning

2015-01-01

The overuse of fossil fuels has caused an energy crisis and associated environment issues. It is desirable to utilize renewable resources for the production of chemicals. This review mainly introduces our recent work on the transformation of renewable carbon resources including the conversion of cellulose, lignin, and chitin into sustainable chemicals. Various transformation routes have been established to form value-added chemicals, and accordingly a variety of effective catalytic systems have been developed, either based on metal catalysis and/or acid-base catalysis, to enable the desired transformation.

Chemical composition of groundwater/drinking water and oncological disease mortality in Slovak Republic.

Science.gov (United States)

Rapant, S; Cvečková, V; Fajčíková, K; Dietzová, Z; Stehlíková, B

2017-02-01

This study deals with the analysis of relationship between chemical composition of the groundwater/drinking water and the data on mortality from oncological diseases (MOD) in the Slovak Republic. Primary data consist of the Slovak national database of groundwater analyses (20,339 chemical analyses, 34 chemical elements/compounds) and data on MOD (17 health indicators) collected for the 10-year period (1994-2003). The chemical and health data were unified in the same form and expressed as the mean values for each of 2883 municipalities within the Slovak Republic. Pearson and Spearman correlation as well as artificial neural network (ANN) methods were used for analysis of the relationship between chemical composition of groundwater/drinking water and MOD. The most significant chemical elements having influence on MOD were identified together with their limit values (limit and optimal contents). Based on the results of calculations, made through the neural networks, the following eight chemical elements/parameters in the groundwater were defined as the most significant for MOD: Ca + Mg (mmol l -1 ), Ca, Mg, TDS, Cl, HCO 3 , SO 4 and NO 3 . The results document the highest relationship between MOD and groundwater contents of Ca + Mg (mmol l -1 ), Ca and Mg. We observe increased MOD with low (deficit) contents of these three parameters of groundwater/drinking water. The following limit values were set for the most significant groundwater chemicals/parameters: Ca + Mg 1.73-5.85 mmol l -1 , Ca 60.5-196.8 mg l -1 and Mg 25.6-35.8 mg l -1 . At these concentration ranges, the mortality for oncological diseases in the Slovak Republic is at the lowest levels. These limit values are about twice higher in comparison with the current Slovak valid guideline values for the drinking water.

Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes.

Science.gov (United States)

Marzorati, Chiara; Pravettoni, Gabriella

2017-01-01

In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of "value" is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on "value" and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care.

Estimating clinical chemistry reference values based on an existing data set of unselected animals.

Science.gov (United States)

Dimauro, Corrado; Bonelli, Piero; Nicolussi, Paola; Rassu, Salvatore P G; Cappio-Borlino, Aldo; Pulina, Giuseppe

2008-11-01

In an attempt to standardise the determination of biological reference values, the International Federation of Clinical Chemistry (IFCC) has published a series of recommendations on developing reference intervals. The IFCC recommends the use of an a priori sampling of at least 120 healthy individuals. However, such a high number of samples and laboratory analysis is expensive, time-consuming and not always feasible, especially in veterinary medicine. In this paper, an alternative (a posteriori) method is described and is used to determine reference intervals for biochemical parameters of farm animals using an existing laboratory data set. The method used was based on the detection and removal of outliers to obtain a large sample of animals likely to be healthy from the existing data set. This allowed the estimation of reliable reference intervals for biochemical parameters in Sarda dairy sheep. This method may also be useful for the determination of reference intervals for different species, ages and gender.

The clinical value of serum thyrotrophin receptor antibody level in patients with Graves ophthalmopathy

International Nuclear Information System (INIS)

Wang Chaodian; Shi Yuhong; Yan Bing

2013-01-01

Objective: To explore the value of serum thyrotrophin receptor antibody (TRAb) on the pathological mechanism of Graves ophthalmopathy. Methods: Two hundred and nineteen newly diagnosed Graves disease patients who were divided into Graves ophthalmopathy group (n=121) and without Graves ophthalmopathy group (n=98) were tested serum concentration with thyroid function, thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and TRAb. According to the consensus statement of the European Group on Graves ophthalmopathy, clinical activity score (CAS) and severity evaluation were carried out on Graves ophthalmopathy patients. Results: There was no significant difference in serum concentration of free thyroxine (FT 4 ), free triiodothyronine (FT 3 ), TPOAb and TRAb between the Graves ophthalmopathy group and the without Graves ophthalmopathy group. Serum concentration of TRAb was not correlated with the severity and CAS of Graves ophthalmopathy. Conclusions: The CAS and the severity of Graves ophthalmopathy were irrelevant to the serum concentration of TRAb. Therefore, the correlation between TRAb and Graves ophthalmopathy still needs further study. (authors)

Prediction of chemical composition of South African Medicago sativa ...

African Journals Online (AJOL)

The near infrared reflectance spectroscopy (NIRS) to predict chemical and digestibility parameters was investigated. Samples (n = 168) representing the spectral characteristics of the South African. Medicago sativa L. hay population were chemically analysed for the development of calibration equations. Values for r² and ...

Electrochemical Sensors for Clinic Analysis

Directory of Open Access Journals (Sweden)

Guang Li

2008-03-01

Full Text Available Demanded by modern medical diagnosis, advances in microfabrication technology have led to the development of fast, sensitive and selective electrochemical sensors for clinic analysis. This review addresses the principles behind electrochemical sensor design and fabrication, and introduces recent progress in the application of electrochemical sensors to analysis of clinical chemicals such as blood gases, electrolytes, metabolites, DNA and antibodies, including basic and applied research. Miniaturized commercial electrochemical biosensors will form the basis of inexpensive and easy to use devices for acquiring chemical information to bring sophisticated analytical capabilities to the non-specialist and general public alike in the future.

Value-Based Medicine and Integration of Tumor Biology.

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Brooks, Gabriel A; Bosserman, Linda D; Mambetsariev, Isa; Salgia, Ravi

2017-01-01

Clinical oncology is in the midst of a genomic revolution, as molecular insights redefine our understanding of cancer biology. Greater awareness of the distinct aberrations that drive carcinogenesis is also contributing to a growing armamentarium of genomically targeted therapies. Although much work remains to better understand how to combine and sequence these therapies, improved outcomes for patients are becoming manifest. As we welcome this genomic revolution in cancer care, oncologists also must grapple with a number of practical problems. Costs of cancer care continue to grow, with targeted therapies responsible for an increasing proportion of spending. Rising costs are bringing the concept of value into sharper focus and challenging the oncology community with implementation of value-based cancer care. This article explores the ways that the genomic revolution is transforming cancer care, describes various frameworks for considering the value of genomically targeted therapies, and outlines key challenges for delivering on the promise of personalized cancer care. It highlights practical solutions for the implementation of value-based care, including investment in biomarker development and clinical trials to improve the efficacy of targeted therapy, the use of evidence-based clinical pathways, team-based care, computerized clinical decision support, and value-based payment approaches.

Homogenization of the lipid profile values.

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Pedro-Botet, Juan; Rodríguez-Padial, Luis; Brotons, Carlos; Esteban-Salán, Margarita; García-Lerín, Aurora; Pintó, Xavier; Lekuona, Iñaki; Ordóñez-Llanos, Jordi

Analytical reports from the clinical laboratory are essential to guide clinicians about what lipid profile values should be considered altered and, therefore, require intervention. Unfortunately, there is a great heterogeneity in the lipid values reported as "normal, desirable, recommended or referenced" by clinical laboratories. This can difficult clinical decisions and be a barrier to achieve the therapeutic goals for cardiovascular prevention. A recent international recommendation has added a new heterogeneity factor for the interpretation of lipid profile, such as the possibility of measuring it without previous fasting. All this justifies the need to develop a document that adapts the existing knowledge to the clinical practice of our health system. In this regard, professionals from different scientific societies involved in the measurement and use of lipid profile data have developed this document to establish recommendations that facilitate their homogenization. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Effect of Chemical Refining on Citrullus Colocynthis and Pongamia ...

African Journals Online (AJOL)

Oil from the both plant seeds was evaluated (both before and after refining) for different physico-chemical parameters like free fatty acids, iodine value, peroxide value, saponification value, unsaponifiable matter and fatty acid composition. Oil yield (30-35 %) in both plants was found average. After refining, per cent reduction ...

Personal and professional values grading among midwifery students.

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Özcan, Müesser; Akpinar, Aslihan; Ergin, Ayla B

2012-05-01

The purpose of this study was to determine the professional and personal values among midwifery students in Turkey and to identify whether the years of study affected these values. A total of 192 participants were asked to prioritize 16 professional and 36 personal values. The relationship between the year of study and value ranking was analyzed by Kruskal-Wallis test. The first three of the professional values were justice, equality, and human dignity. Equality ranked sixth among the personal terminal values, and it increased with the years of study. Of personal instrumental values, responsibility and cleanliness ranked second and fifth, which are of central importance for the profession of midwifery. However, the other two important values, privacy and preventing unnecessary suffering, ranked lower when the years of study increased, in other words when the students confront clinics. Since these values are important for midwifery, ethics courses should be given throughout the midwifery education to prepare students for the challenges they face in the clinical environment.

Human volunteer studies with non-pharmaceutical chemicals: metabolism and pharmacokinetic studies.

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Wilks, M F; Woollen, B H

1994-06-01

1. Human volunteer studies are an essential part of drug development but their use in the area of non-pharmaceutical chemicals has so far been very limited. Such studies can have considerable value in the assessment and improvement of the safe use of chemicals. 2. Once metabolic pathways and target metabolites have been identified in volunteers this information can be used in studies in the workplace or in the general population. Studies should be performed selectively only if there is both a toxic hazard and a significant exposure potential. In addition, they should only be carried out if the required information cannot be obtained in any other way. 3. Volunteer studies with non-pharmaceuticals have become increasingly acceptable in the light of established international guidelines, no-fault compensation, improvements in study design and technical developments which allow the use of very low dose levels. The final decision on whether to carry out a study must always rest with an independent ethical committee. 4. The practical aspects of the study should be specified in a detailed protocol conforming with the principles of good clinical practice. The safety of volunteers must be of paramount concern throughout. Depending on the nature of the chemical and the study, it may be advisable to carry out studies in a clinical facility where equipment is available for the treatment of any emergencies that might occur. 5. Numerous investigators have now shown that human volunteer studies are ethically acceptable, practicable and yield important information. The risk to volunteers is minimal and this approach can lead to an improved foundation for occupational hygiene standards, more accurate risk assessment and thus better protection of the workforce and the general population.

Revisiting the definition of the electronic chemical potential, chemical hardness, and softness at finite temperatures

International Nuclear Information System (INIS)

Franco-Pérez, Marco; Gázquez, José L.; Ayers, Paul W.; Vela, Alberto

2015-01-01

We extend the definition of the electronic chemical potential (μ e ) and chemical hardness (η e ) to finite temperatures by considering a reactive chemical species as a true open system to the exchange of electrons, working exclusively within the framework of the grand canonical ensemble. As in the zero temperature derivation of these descriptors, the response of a chemical reagent to electron-transfer is determined by the response of the (average) electronic energy of the system, and not by intrinsic thermodynamic properties like the chemical potential of the electron-reservoir which is, in general, different from the electronic chemical potential, μ e . Although the dependence of the electronic energy on electron number qualitatively resembles the piecewise-continuous straight-line profile for low electronic temperatures (up to ca. 5000 K), the introduction of the temperature as a free variable smoothens this profile, so that derivatives (of all orders) of the average electronic energy with respect to the average electron number exist and can be evaluated analytically. Assuming a three-state ensemble, well-known results for the electronic chemical potential at negative (−I), positive (−A), and zero values of the fractional charge (−(I + A)/2) are recovered. Similarly, in the zero temperature limit, the chemical hardness is formally expressed as a Dirac delta function in the particle number and satisfies the well-known reciprocity relation with the global softness

Rhizomes of Eremostachys laciniata: Isolation and Structure Elucidation of Chemical Constituents and a Clinical Trial on Inflammatory Diseases

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Abbas Delazar

2013-08-01

Full Text Available Purpose: The purpose of this study was the isolation and structure elucidation of chemical compounds from the rhizomes of Eremostachys laciniata (L Bunge (EL, an Iranian traditional medicinal herb with a thick root and pale purple or white flowers as well as the clinical studies on the therapeutic efficacy and safety of topical application of the EL extract in the management of some inflammatory conditions, e.g., arthritis, rheumatoid arthritis and septic arthritis (Riter’s syndrome. Methods: The structures of the isolated compounds were elucidated unequivocally on the basis of one and two dimensional NMR, UV and HR-FABMS spectroscopic data analyses. A single-blinded randomized clinical trial was carried out with the extract of the rhizomes of E. laciniata (EL to determine the efficacy and safety of the traditional uses of EL compared to that of piroxicam in treatment of inflammatory diseases, e.g., osteoarthritis, rheumatoid arthritis and Reiter’s syndrome. Results: Eleven iridoid glycosides, two phenylethanoids and two phytosterols were isolated and identified for the first time from the rhizomes of EL. After 14 days of treatment with the EL and piroxicam ointments, all groups showed significant improvements compared to the control groups. EL (5% ointment induced better initial therapeutic response than piroxicam (5% onitment. Conclusion: This clinical trial established that EL was suitable for topical applications as a safe and effective complementary therapy for inflammatory diseases.

MR chemical shift imaging of human atheroma

International Nuclear Information System (INIS)

Mohiaddin, R.H.; Underwood, R.; Firmin, D.; Abdulla, A.K.; Rees, S.; Longmore, D.

1988-01-01

The lipid content of atheromatous plaques has been measured with chemical shift MR imaging by taking advantage of the different resonance frequencies of protons in lipid and water. Fifteen postmortem aortic specimens of the human descending aorta and the aortae of seven patients with documented peripheral vascular disease were studied at 0.5 T. Spin-echo images were used to localize the lesions before acquisition of the chemical shift images. The specimens were examined histologically, and the lipid distribution in the plaque showed good correlation with the chemical shift data. Validation in vivo and clinical applications remain to be established

Predictive performance of the human Cell Line Activation Test (h-CLAT) for lipophilic chemicals with high octanol-water partition coefficients.

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